Urologic Anatomy

Question 1

List the nerves of the lumbar plexus, their nerve roots, and their sensory and motor function?

“I I get laid on friday”

Answer 1

1. Illiohypogastric (L1)
2. Illioinguinal (L1)
3. Genitofemoral (L1, L2)
4. Lateral cutaneous nerve of the thigh (L2, L3)
5. Obturator(L2-L4)
6. Femoral (L2-L4)

Question 2

List the nerve of the sacral plexus, its nerve root, and sensory and motor function?

Answer 2

1. Sciatic (L4-S3) (branches into common peroneal, tibial, and sural)

Question 3

List the nerve of the coccygeal plexus its nerve root, and sensory and motor function?

Answer 3

1. Pudendal nerve (S2-S4)

Question 4

Describe the path of a red blood cell from the renal artery to a glomerulus?

Answer 4

Renal artery -> segmental artery -> interlobar artery -> arcuate artery -> interlobular artery -> afferent artery -> glomerulus

Question 5

List 8 functions of the kidney?

Answer 5

1. Excretion of waste
2. pH homeostasis
3. Na+ homeostasis
4. BP regulation
5. Drug metabolism
6. Erythropoetin
7. Fluid balance
8. Vitamin D homeostasis

Question 6

List the paired and unpaired arteries that come off of the abdominal aorta from top to bottom?

Answer 6

1. Inferior phrenic (paired)
2. Celiac artery
3. Adrenal artery (paired)
4. SMA
5. Renal artery (paired)
6. Gonadal artery (paired)
7. IMA
8. Middle sacral
9. Lumbars (posterior, paired and multiple)

Question 7

What is the arterial supply to the testis?

Answer 7

1. Testicular (gonadal) artery (from aorta)
2. Cremasteric artery (from inferior epigastric)
3. Vas deferes artery (inferior vesical)

Question 8

What are the contents of the spermatic cord (9)

Answer 8

Arteries (3) - Testicular, cremasteric, Vas
Nerves (3) - testicular, genital branch of gen-fem, illioinguinal
Veins (1) - pam-uniform plexus
Lymphatics (1) (drain into para aortic nodes)
Vas deferens (1)

Question 9

What are the fascial layers of the spermatic cord and their analogous abdominal structures?

Answer 9

1. External spermatic fascia (external oblique aponeurosis)
2. Cremasteric muscle (internal oblique)
3. Cremasteric fascia (internal oblique fascia)
4. Internal spermatic fascia (transvalis fascia)
5. Tunica vaginalis (peritoneum)

Question 10

What are the layers of the scrotum and their analogous abdominal structures?

Answer 10

Skin - skin
Dartos - scarpas/colles fascia
External spermatic fascia - external oblique aponeurosis)
Cremaster muscle - internal oblique
Cremasteric fascia - int. oblique aponeurosis
Internal spermatic fascia - trasversali fascia
Tunica vaginalis - parietal peritoneum
Tunica albuginea - visceral peritoneum

Question 11

What are the branches of the external iliac artery (5) in order from proximal to distal?

Answer 11

1. Inferior epigastric
2. Deep circumflex
3. Pubic
4. Cremasteric
5. Femoral (end artery)

Question 12

What are the branches of the internal iliac anterior division (from proximal to distal)?

Answer 12

1. Obliterated umbilical artery
2. Superior vesical artery
3. Obturator artery
4. Vaginal artery
5. Inferior vesical artery
6. Uterine artery
7. Middle rectal artery
8. Inferior gluteal artery
9. Internal pudendal artery (terminal artery)

Question 13

What are the branches of the internal pudendal artery?

Answer 13

1. Inferior rectal artery
2. Perineal artery
3. Posterior scrotal
4. Artery to bulb of penis
5. Common penile (terminal artery)

Question 14

What are the branches of the common penile artery?

Answer 14

1. Dorsal artery
2. Cavernosal artery
3. Bulbourethral

Question 15

What are the branches of the posterior division of the internal iliac artery?

Answer 15

1. Ascending lumbar
2. Lateral sacral
3. Superior gluteal
4. Inferior gluteal (terminal)

Question 16

What are the borders of Petit’s triangle?

Answer 16

External oblique, latissimus dorsi, illiac crest, (floor is internal oblique)

Question 17

What are the borders of the femoral triangle?

Answer 17

Inguinal ligament, sartorial and adductor longus. (floor: pectineus, illiopsoas, and adductor longus, roof: fascia lata))

Question 18

What are the zones of the prostate?

Answer 18

Anterior, transitional, central, and peripheral.

Question 19

What are the borders of the inguinal canal?

Answer 19

Roof - conjoint tendon (transversals fascia, internal oblique, and transversus abdominus.
Floor - inguinal ligament, lacunal ligament
Anterior wall - aponeurosis of the external oblique reinforced by the internal oblique muscle laterally
Posterior wall - transversalis fascia

Openings - superficial (exit from inguinal canal) and deep ring (opening to inguinal canal)

Question 20

Main arterial supply to the bladder

Answer 20

Superior and inferior vesical pedicles from anterior trunk of internal iliac artery

Question 21

Sympathetic innervation of the bladder

Answer 21

Hypogastric nerve T10-L2, innervates trigone, bladder neck

Question 22

Parasympathetic innervation of the bladder

Answer 22

Pelvic nerve S2-4, innervates bladder

Question 23

Somatic innervation of the bladder

Answer 23

Pudendal & Pelvic nerve, mainly S2, external sphincter/bladder

Question 24

Embryologic structure that gives rise to the ureter, renal pelvis, collecting ducts

Answer 24

ureteral bud (also a derived from the mesonephric duct)

Question 25

Embryologic structure that gives rise to the trigone

Answer 25

mesonephric duct, mesodermal structure

Question 26

Embryologic structure that give rise to the bladder

Answer 26

urogenital sinus (an endodermal structure)

Question 27

Describe the supraspinal vesicovesical (vesico-bulbo-vesical) reflex

Answer 27

1. Bladder filling activates stretch receptors in the bladder wall that reach the spinal cord via pelvic nerve.
2. Fibers connect in the dorsal horn that project to periaqueductal gray matter (PAG).
3. PAG activates the pontine micturition center (PMC) that project directly to the bladder via preganglionic neurons in the Sacral PNS then back to pelvic nerves to activated PNS in the pelvic plexus releasing Ach stimulating M2 M3 receptors.

Question 28

Describe the Vesico-spinal-vesical reflex

Answer 28

Occurs when there is a lesion rostral to the to lumbosacral level that interrupts the vesico-bulbo-vesical reflex. An automatic vesico-spinal-vesical micturition relex develops.

Question 29

Describe the somatic storage reflex (pelvic to pudendal reflex)

Answer 29

Also called the guarding reflex
During normal storage, this reflex is initiated when there is a sudden increase in valsalva or intraabdominal pressure. Afferent signals travel to the spinal cord (also to the PAG then PMC) via pelvic nerve which activate efferent somatic urethral motor neurons in the Onufs nucleus. Motor neurons in this nucleus are activated which have axons that travel in pudendal nerve and release Ach which activates the rhabdosphincter.

Question 30

What is the Pronephros?

Answer 30

Initial phase of embryologic kidney development. develops first 4 weeks of gestation. Degenerates by the end of the 5th week.

Question 31

What is the Mesonephros?

Answer 31

2nd phase of embryologic kidney development. Develops as a persistence of the pronephros duct. Drains into the urogenital sinus and serves as primary excretory organ in weeks 4 -8. Mesonephric tubules develop by 16 weeks while mesonephros regresses.

Question 32

Which elements of the mesonephros persists at week 16 of gestation?

Answer 32

Efferent tubules of the testis in men, nonfunctional mesosalpingeal in women (Epoohoron, and paroophoron)

Question 33

What is the metanephros?

Answer 33

Final phase of embyrologic kidney development. Starts in sacral region as the ureteric bud originates from mesonephric duct. Metanephric mesenchyme condenses from intermediate mesoderm during 5th week which is induced by the ureteric bud to form the metanephric kidney.

Question 34

When is nephrogenesis completed?

Answer 34

32 - 34 weeks gestation.

Question 35

Which structures are derived from the metanephric mesenchyme?

Answer 35

glomerulus, proximal tubule, Loop of henle, and distal tubule

Question 36

Ultimate fate of the ureteric bud

Answer 36

After successive division will develop to form the collecting system consisting of the collecting duct, calyces, renal pelvis, and ureter.

Question 37

Length of right renal pelvis

Answer 37

2 - 4 cm

Question 38

Length of the left renal pelvis

Answer 38

6 - 10 cm

Question 39

Embryologic germ layer forming the adrenal cortex

Answer 39

Mesoderm

Question 40

What are the layers of the adrenal gland and their associated function

Answer 40

Zona glomerulosa: - produces mineralcorticoids (aldosterone).
Zone fasiculata: - produces glucocorticoids (cortisol)
Zona Reticularis: - Synthesizes sex hormones (androgens)

Question 41

Embryologic germ layer forming the adrenal medulla

Answer 41

ectoderm and develops from migrating cells of the neural crest.

Question 42

Function of the adrenal medulla

Answer 42

Secretes neuroactive catecholamines (under sympathetic control).

Question 43

Which nerves provide innervation to the adrenal gland

Answer 43

Sympathetic visceral nervous system

• preganglionic sympathetic fibers from lower T and L spinal cord via sympathetic chain innervates cortex
• Visceral afferent fibers from the celiac ganglia traverse cortex to the medulla.

Question 44

What are chromaffin cells

Answer 44

Found in the adrenal medulla, are post ganglionic sympathetic neurons that have lost their axons and dendrites

Question 45

General length of ureters

Answer 45

22 - 30 cm, 1.5 - 6 mm in diameter

Question 46

Blood supply to the ureter

Answer 46

Upper: arterial branches from renal artery, gonadal artery, abdominal artery, common iliac,
Lower: Internal iliac, including vesical, uterine, middle rectal, vaginal arteries.

Question 47

Does normal ureteral peristalsis require autonomic input?

Answer 47

No. Peristalsis is thought to originate and propagge from intrinsic from smooth muscle pacemaker sites in the minor calyces of the collecting system.

Question 48

3 segments of the ureter

Answer 48

Upper: renal pelvis to upper boarder of sacrum
Middle: Upper to lower boarder of the sacrum
Lower: Lower sacrum to bladder

Question 49

Innervation to the female urethra

Answer 49

Somatic and autonomic nerves that travel near urethra in vaginal walls.
Smooth muscle control under parasympathetic control
Pudendal and pelvic somatic nerves innervate striated urethral sphincter.

Question 50

Lymphatic drainage female urethra. Distal vs proximal.

Answer 50

Distal urethra and labia drain to the superficial and deep inguinal nodes

Proximal urethra drains to iliac, obturator, pre-sacral, para-aortic nodes

Question 51

Blood supply to the female urethra

Answer 51

Internal pudendal, vaginal , and inferior vesical arteries

Question 52

Blood supply to male urethra

Answer 52

Internal pudendal artery becomes common penile artery

1. two become dorsal artery and urethral artery to supply the male urethra
2. Prostatic branches off of the inferior vesical and middle rectal arteries to supply the prostatic urethra

Question 53

Lymphatic drainage of male urethra

Answer 53

Distal: superficial inguinal LN
Bulbar, membranous, prostatic urethra: iliac, obturator, presacral LN

Question 54

Innervation to the male urethra

Answer 54

Pudendal nerve supply motor and sensory innervation. Autonomic innervation arises from pelvic plexus.

Question 55

Penis blood supply:

Answer 55

Arises from femoral artery–> left/right superficial ext pudendal–> skin of penis

Internal pudendal

1. First branch–> bulbourethral artery supplies the perineal membrane, and enters sponsgiosum to supp;ly the urethra, spongiosum and glans.
2. Cavernosal arteries
3. Dorsal artery: travels b/t deep dorsal vein and dorsal nerve. Circumflex artery branches off and supplies spongiosum and urethra

Question 56

Penile lymphatic drainage

Answer 56

Skin and shaft drain to bilateral superficial inguinal nodes

Glans drain to deep inguinal lymph nodes.

Question 57

Blood supply to prostate and seminal vesicles

Answer 57

Inferior vesical artery. First prostatic branch of the artery is the urethral artery that enters the gland posteriorlaterally at 5 & 7 o clock

Question 58

Venous drainage of the Prostate and seminal vesicles

Answer 58

composed of inferior vesical veins that feed into the internal iliac vein.

Question 59

Batsons venous plexus

Answer 59

network of valveless veins that connect the internal iliac to the vertebral vein plexus. This is thought to provide a route for bony mets.

Question 60

Lymphatic drainage of the prostate

Answer 60

Obturator and internal iliac lymph node chains. Additional drainage through the external iliac and pre-sacral nodes.

Question 61

4 factors that alter GFR

Answer 61

1. Transglomerular hydrostatic pressure
2. Renal plasma flow
3. Glomerular permeability
4. Oncotic pressure

Question 62

Transglomerular hydrostatic pressure

Answer 62

Most significant determinant of GFR. regulated by afferent and efferent arterioles which are independent of systemic blood pressure.

Question 63

Directly related to GFR

Answer 63

renal plasma flow. When RPF increases GFR increases and vice cersa

Question 64

3 Phases of Unilateral ureteral obstruction

Answer 64

Phase 1: 1-2h, both RBF and Ureteral pressure increases + vasodilation of afferent arteriole increases RBF.

Phase 2: lasts 2-3h. Increased rise in ureteral pressure, RBF begins to decrease. ACE-I mitgates the decline in GFR and RBF,

Phase 3: 5 hours after obstruction. RBG and ureteral pressure decline. d/t increase in afferent arteriole resistance. RBF shifts from outer cortex to medullary regions resulting in lack of perfusion to the glomeruli –> reduced GFR. RBF gradually decreases over time.

Question 65

Physiologic changes of bilateral ureteral obstruction

Answer 65

Early: RBF increases only slightly for 90 minute via NO. Followed by extreme decrease in RBF (Thromboxane, endothelin, angiotensin II). Ureteral pressure is much higher in bilateral obstruction and remains elevated for 24h. Thought to be d/t ANP

Question 66

Proposed mechanisms or post obstructive diuresis

Answer 66

1. Impaired Na reabsorption d/t tubular damage
2. Impaired urinary concentration ability
3. Solute diuresis to excretion of retain urea
4. Presence of a circulating natriuretic factor (ANP)

Question 67

How is primary hyperaldosteronism diagnosed

Answer 67

An ARR≥20 along with a concomitant aldosterone concentration above 15 ng/mL suggest the diagnosis of primary hyperaldosteronism

A positive ARR screen should prompt 24 hour study with salt loading to assess for primary aldosteronism

Question 68

Screening Guidelines for hyperaldosternonism (8)

Answer 68

1. Any patient with sustained blood pressure above 150/100 on three separate measurements taken on different days
2. Hypertension resistant to 3 antihypertensives
3. Hypertension controlled with four or more medications
4. Hypertension and low potassium
5. Hypertension and a newly diagnosed adrenal incidentaloma
6. Hypertension and concomitant sleep apnea
7. Hypertension and a family history of early onset hypertension or stroke before age 40
8. All first-degree relatives of patients with a diagnosis of primary aldosteronism

Question 69

Blood supply to the Vas

Answer 69

Vesiculodeferential artery (branch from superior vesical artery)

Inferior vesical artery provides collateral supply

Question 70

Drainage pathway for sperm.

Answer 70

1. tubuli recti–> rete testis–> efferent ductules (head of epididymis)–>ductus epidiymis–> vas

Question 71

When should sex hormone testing be performed with adrenal masses?

Answer 71

not warranted unless the patient is suspected of having an adrenocortical carcinoma (mass > 4 cm) and/or obvious clinical stigmata of feminization or virilization.

Measure DHEA with 17-Ketosteroids

For women: Get serum testosterone

For men get 17B-estradiol

Question 72

Stages of sperm production

Answer 72

spermatogonium, primary spermatocyte, 2nd spermatocyte, spermatids, spermatozoa

Question 73

Testicular blood supply

Answer 73

1. Testicular artery (aka internal spermatic or gonadal artery),
2. cremasteric artery (from inferior epigastric)
3. vas deferens artery

Question 74

Testicular lymphatic drainage

Answer 74

Right side: interaortacaval nodes–> precaval, preaortic.

Left: para-aortic and pre-aortic lymph nodes followed by the interaortacaval nodes.

More common for lymphatic drainage of the right testis, and rare with left sided tumors to cross the midline and exhibit bilateral lymph node mets.

Question 75

layers of the scrotum and spermatic cord (superficial - deep)

Answer 75

Skin, dartos fascia, external spermatic fascia (from scarpas), cremasteric fascia (from internal oblique), cremasteric muscle, internal spermatic fascia (transversalis fascia), tunica vaginalis (parietal then visceral), tunica albuginea

Question 76

Vignette: A 45-year-old man presents with a recent injury to his abdomen. You suspect nerve damage affecting his abdominal wall muscles. Which nerve originating from T12 innervates muscles of the abdominal wall?

A) Ilioinguinal
B) Subcostal
C) Genitofemoral
D) Femoral

Answer 76

Correct Answer: B) Subcostal

Explanation:

A) Ilioinguinal: Innervates internal oblique and transversus abdominis, but originates from L1.
B) Subcostal: Correct. Innervates muscles of the abdominal wall and originates from T12.
C) Genitofemoral: Innervates genital branch: male cremasteric muscle, but originates from L1 and L2.
D) Femoral: Innervates iliacus, pectineus, and muscles in the anterior compartment of the thigh, originates from L2-L4.

Question 77

Vignette: A patient complains of numbness on her medial thigh. You suspect nerve damage. Which nerve could be compromised?

A) Subcostal
B) Ilioinguinal
C) Lateral cutaneous nerve of the thigh
D) Obturator

Answer 77

Correct Answer: D) Obturator

Explanation:

A) Subcostal: Provides sensory function to the skin over the hip.
B) Ilioinguinal: Sensory function in upper medial thigh, but also skin over either the root of the penis and anterior scrotum or the mons pubis and labium majus.
C) Lateral cutaneous nerve of the thigh: Sensory function to skin on anterior and lateral thigh to the knee.
D) Obturator: Correct. Provides sensory function to skin on the medial aspect of the thigh.
Memory Tool: “Obturator is the ‘Medial Mate’ for your thigh.”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: A grasp of sensory functions of the lumbosacral plexus branches is essential for identifying possible sites of nerve damage.

Question 78

Vignette: A 30-year-old man has difficulty in movements that would normally engage the pectineus muscle. Which nerves could be responsible for this?

A) Obturator
B) Femoral
C) Ilioinguinal
D) Both A and B

Answer 78

Explanation:

A) Obturator: Innervates pectineus and originates from L2-L4.
B) Femoral: Also innervates pectineus and originates from L2-L4.
C) Ilioinguinal: Innervates internal oblique and transversus abdominis and originates from L1.
D) Both A and B: Correct. Both the obturator and femoral nerves innervate the pectineus muscle.
Memory Tool: “OF Pectineus: Obturator and Femoral make it move.”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Knowing which nerves innervate specific muscles aids in the precise diagnosis of neuromuscular issues.

Question 79

Vignette: A 29-year-old female patient presents with a lesion affecting spinal nerves in the lumbar region. She shows no sensory symptoms in the anterior and lateral thigh down to the knee. Which nerve is likely unaffected?

A) Femoral
B) Ilioinguinal
C) Lateral cutaneous nerve of the thigh
D) Obturator

Answer 79

Correct Answer: C) Lateral cutaneous nerve of the thigh

Explanation:

A) Femoral: Provides sensory function to the skin on the anterior thigh and medial surface of the leg, originating from L2-L4.
B) Ilioinguinal: Provides sensory function to the skin in upper medial thigh, originating from L1.
C) Lateral cutaneous nerve of the thigh: Correct. Provides sensory function to the skin on the anterior and lateral thigh down to the knee, originating from L2 and L3.
D) Obturator: Provides sensory function to skin on the medial aspect of the thigh, originating from L2-L4.
Memory Tool: “If the lateral thigh feels fine, look to L2 and L3, darling!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Understanding the spinal segments responsible for each branch of the lumbosacral plexus is crucial for proper diagnosis when spinal injuries occur.

Question 80

Vignette: A patient shows weakness in the muscles of the internal oblique and transversus abdominis. Which nerve is most likely affected?

A) Ilioinguinal
B) Obturator
C) Femoral
D) Subcostal

Answer 80

Correct Answer: A) Ilioinguinal

Explanation:

A) Ilioinguinal: Correct. Innervates internal oblique and transversus abdominis, originating from L1.
B) Obturator: Innervates obturator externus, pectineus, and muscles in the medial compartment of the thigh, originating from L2-L4.
C) Femoral: Innervates iliacus, pectineus, and muscles in the anterior compartment of the thigh, originating from L2-L4.
D) Subcostal: Innervates muscles of the abdominal wall, originating from T12.
Memory Tool: “For Internal and Transversus, ILIO-inguinal is a must!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Identifying nerves responsible for specific muscle innervation is important for diagnosing and treating muscle weakness.

Question 81

Vignette: A 60-year-old male patient complains of numbness over his hip area. Which nerve is likely to be involved?

A) Subcostal
B) Genitofemoral
C) Iliohypogastric
D) Femoral

Answer 81

Correct Answer: A) Subcostal

Explanation:

A) Subcostal: Correct. Provides sensory function to the skin over the hip, originating from T12.
B) Genitofemoral: Provides sensory function to the skin of the anterior scrotum or skin of the mons pubis and labium majus, originating from L1 and L2.
C) Iliohypogastric: Provides sensory function to the posterolateral gluteal skin and skin in the pubic region, originating from L1.
D) Femoral: Provides sensory function to the skin on the anterior thigh and medial surface of the leg, originating from L2-L4.
Memory Tool: “Subcostal for the hip; think ‘hip sub’!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Sensory function in different areas can indicate the health of specific nerves, which is vital for diagnosis.

Question 82

Vignette: A 40-year-old female patient reports numbness in the skin over her mons pubis and labium majus. Which nerve should you consider as possibly compromised?

A) Iliohypogastric
B) Ilioinguinal
C) Genitofemoral
D) Subcostal

Answer 82

Correct Answer: C) Genitofemoral

Explanation:

A) Iliohypogastric: Provides sensory function to the posterolateral gluteal skin and skin in the pubic region, originating from L1.
B) Ilioinguinal: Provides sensory function to skin in upper medial thigh and the skin over either the root of the penis and anterior scrotum or the mons pubis and labium majus, but it’s not exclusive to these regions.
C) Genitofemoral: Correct. Provides sensory function to the skin of the mons pubis and labium majus, originating from L1 and L2.
D) Subcostal: Provides sensory function to the skin over the hip, originating from T12.
Memory Tool: “Genitofemoral: Genital regions get priority, darling!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Properly diagnosing which nerves are likely compromised based on sensory symptoms is key in effective treatment planning.

Question 83

Vignette: During a routine check-up, you observe that a patient does not have any loss of motor function but reports sensory loss on the anterior and lateral thigh to the knee. Which nerve is likely affected?

A) Iliohypogastric
B) Femoral
C) Obturator
D) Lateral cutaneous nerve of the thigh

Answer 83

Correct Answer: D) Lateral cutaneous nerve of the thigh

Explanation:

A) Iliohypogastric: Affects the internal oblique and transversus abdominis, originating from L1.
B) Femoral: Affects the iliacus, pectineus, and muscles in the anterior compartment of the thigh, originating from L2-L4.
C) Obturator: Affects the obturator externus, pectineus, and muscles in the medial compartment of the thigh, originating from L2-L4.
D) Lateral cutaneous nerve of the thigh: Correct. This nerve has no motor function but provides sensory function to the skin on the anterior and lateral thigh down to the knee, originating from L2 and L3.
Memory Tool: “Lateral cutaneous nerve keeps your thigh feeling alive, but doesn’t make it move!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: It’s essential to know which nerves serve exclusively sensory functions when diagnosing patients who exhibit specific types of sensory loss but no motor dysfunction.

Question 84

Vignette: A 35-year-old male athlete presents with isolated muscle weakness affecting his medial thigh compartment. Which nerve would you suspect to be compromised?

A) Femoral
B) Obturator
C) Genitofemoral
D) Iliohypogastric

Answer 84

orrect Answer: B) Obturator

Explanation:

A) Femoral: Innervates the iliacus, pectineus, and muscles in the anterior compartment of the thigh, originating from L2-L4.
B) Obturator: Correct. Innervates the obturator externus, pectineus, and muscles in the medial compartment of the thigh, originating from L2-L4.
C) Genitofemoral: Innervates the male cremasteric muscle, originating from L1 and L2.
D) Iliohypogastric: Innervates the internal oblique and transversus abdominis, originating from L1.
Memory Tool: “Medial thigh muscle mess? Obturator is your best guess!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: Knowing which nerve affects the muscles in the medial thigh compartment is essential for diagnosis, especially in athletes where precise muscle function is critical.

Question 85

Vignette: A patient with a spinal injury at the T12 level complains of sensory loss. Which area is most likely to be affected?

A) Skin over the hip
B) Skin on the anterior thigh
C) Posterolateral gluteal skin
D) Skin on medial aspect of the thigh

Answer 85

Correct Answer: A) Skin over the hip

Explanation:

A) Skin over the hip: Correct. The subcostal nerve originates from the anterior ramus of T12 and provides sensory function to the skin over the hip.
B) Skin on the anterior thigh: The femoral nerve provides this function and originates from L2-L4.
C) Posterolateral gluteal skin: The iliohypogastric nerve provides this function and originates from L1.
D) Skin on medial aspect of the thigh: The obturator nerve provides this function and originates from L2-L4.
Memory Tool: “T12 takes care of the hips, so don’t let it slip!”

Reference Citation: Modified from Drake RL, Vogl AW, Mitchell AWM: Gray’s Anatomy for Students, Philadelphia, 2005, Churchill Livingstone. (Table 75.4)

Rationale: For patients with spinal injuries, understanding which spinal segment affects which sensory region is crucial for accurate diagnosis and treatment planning.

Question 86

Clinical Vignette:
A 45-year-old male patient is undergoing an abdominal surgery. During the procedure, which nerve should be carefully preserved to maintain sensation to the anterior abdominal wall and pubis?

Multiple Choice Options:
A. Pudendal Nerve
B. Iliohypogastric Nerve
C. Genitofemoral Nerve
D. Nervi erigentes

Answer 86

Correct Answer:
B. Iliohypogastric Nerve

In-depth Explanation for All Answer Choices:
A. The pudendal nerve primarily supplies the perineum, scrotum, and controls the urinary and anal sphincters.
B. The iliohypogastric nerve originates from L1 and supplies the anterior abdominal wall and pubis.
C. The genitofemoral nerve supplies the cremaster muscle and anterior scrotum, and the anterior thigh.
D. The nervi erigentes supply parasympathetic fibers from the sacral cord to the pelvic viscera.

Memory Tool:
Remember Iliohypogastric as “Ilio-Hypo-Gastric” - Ilio for iliac, Hypo for below, and Gastric for stomach area - collectively covering the anterior abdominal wall and pubis.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Understanding nerve anatomy is crucial for surgeries to avoid nerve damage and preserve functions like sensation and motor control.

Question 87

Clinical Vignette:
A 28-year-old male comes to the clinic with numbness in his anterior thigh. Which nerve could be compromised?

Multiple Choice Options:
A. Ilioinguinal Nerve
B. Posterior Femoral Cutaneous Nerve
C. Genitofemoral Nerve
D. Lateral Cutaneous Femoral Nerve

Answer 87

Correct Answer:
C. Genitofemoral Nerve

In-depth Explanation for All Answer Choices:
A. The ilioinguinal nerve primarily supplies the anterior scrotum.
B. The posterior femoral cutaneous nerve supplies the perineum and posterior scrotum.
C. The femoral branch of the genitofemoral nerve supplies the anterior thigh.
D. The lateral cutaneous femoral nerve supplies the lateral thigh.

Memory Tool:
Genitofemoral nerve splits into two: “Genito” for genital and “Femoral” for thigh.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Assessing numbness requires precise understanding of nerve distribution to identify possible neuropathy.

Question 88

Clinical Vignette:
A 65-year-old male with a history of chronic constipation reports difficulty in controlling bowel movements. Which nerve is most likely implicated in maintaining anal sphincter tone?

Multiple Choice Options:
A. Pudendal Nerve
B. Pelvic Somatic Efferents
C. Nervi erigentes
D. Ilioinguinal Nerve

Answer 88

Correct Answer:
A. Pudendal Nerve

In-depth Explanation for All Answer Choices:
A. The pudendal nerve controls the urinary and anal sphincters, and also provides sensation to the perineum, scrotum, and penis.
B. Pelvic somatic efferents supply motor control to the levator ani and striated urethral sphincter, but not the anal sphincter.
C. The nervi erigentes primarily supply parasympathetic fibers to the pelvic viscera.
D. The ilioinguinal nerve supplies the anterior scrotum.

Memory Tool:
Pudendal sounds like “Poo-dendal.” Think of “poo” when you think of anal sphincter control.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Understanding the role of the pudendal nerve is essential in managing conditions like incontinence.

Question 89

Clinical Vignette:
A 42-year-old female cyclist reports pain and numbness along her lateral thigh. Which nerve is most likely involved?

Multiple Choice Options:
A. Genitofemoral Nerve
B. Lateral Cutaneous Femoral Nerve
C. Ilioinguinal Nerve
D. Posterior Femoral Cutaneous Nerve

Answer 89

Correct Answer:
B. Lateral Cutaneous Femoral Nerve

In-depth Explanation for All Answer Choices:
A. Genitofemoral nerve affects the anterior thigh, not lateral.
B. Lateral cutaneous femoral nerve supplies the lateral thigh.
C. Ilioinguinal nerve affects the anterior scrotum.
D. Posterior femoral cutaneous nerve affects the perineum and posterior scrotum.

Memory Tool:
Lateral Cutaneous Femoral (LCF) Nerve: LCF for “Laterally Causes Feelings” in the thigh.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Accurate diagnosis of lateral thigh pain in cyclists can guide management and prevent further nerve injury.

Question 90

Clinical Vignette:
A 55-year-old male patient with post-prostatectomy incontinence is being evaluated for treatment options. Which nerve is primarily responsible for controlling the striated urethral sphincter?

Multiple Choice Options:
A. Ilioinguinal Nerve
B. Pelvic Somatic Efferents
C. Pudendal Nerve
D. Nervi erigentes

Answer 90

Correct Answer:
B. Pelvic Somatic Efferents

In-depth Explanation for All Answer Choices:
A. The ilioinguinal nerve primarily supplies the anterior scrotum.
B. Pelvic somatic efferents supply the motor control to the levator ani and the striated urethral sphincter.
C. The pudendal nerve controls the urinary and anal sphincters but is not primarily responsible for the striated urethral sphincter.
D. The nervi erigentes supply parasympathetic fibers to the pelvic viscera but not the urethral sphincter.

Memory Tool:
Pelvic Somatic Efferents: “Somatic” for body (urethral sphincter) and “Efferents” for outgoing (motor control).

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
For management of post-prostatectomy incontinence, knowing which nerve controls the striated urethral sphincter is crucial for targeted treatment options.

Question 91

Clinical Vignette:
A 30-year-old male patient complains of urinary retention and constipation. Which nerve provides parasympathetic innervation to the bladder and rectum?

Multiple Choice Options:
A. Genitofemoral Nerve
B. Posterior Femoral Cutaneous Nerve
C. Pelvic Somatic Efferents
D. Nervi erigentes

Answer 91

Correct Answer:
D. Nervi erigentes

In-depth Explanation for All Answer Choices:
A. The genitofemoral nerve does not provide parasympathetic fibers to the bladder or rectum.
B. The posterior femoral cutaneous nerve supplies the perineum and posterior scrotum.
C. The pelvic somatic efferents are primarily motor nerves for the levator ani and striated urethral sphincter.
D. The nervi erigentes provide parasympathetic fibers from the sacral cord to the pelvic viscera, including the bladder and rectum.

Memory Tool:
Nervi erigentes: Think of “E-rigentes” as “E-rectum and bladd-Er” for parasympathetic supply.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Understanding the parasympathetic innervation is crucial for managing urinary and bowel dysfunction.

Question 92

Clinical Vignette:
A 35-year-old male patient presents with pain in the anterior scrotal region. No obvious lesions or swellings are visible. Which nerve is most likely involved?

Multiple Choice Options:
A. Ilioinguinal Nerve
B. Genitofemoral Nerve
C. Pudendal Nerve
D. Lateral Cutaneous Femoral Nerve

Answer 92

Correct Answer:
A. Ilioinguinal Nerve

In-depth Explanation for All Answer Choices:
A. The ilioinguinal nerve supplies the anterior scrotum.
B. The genitofemoral nerve does have a genital branch that supplies the anterior scrotum but it also affects the cremaster muscle and anterior thigh.
C. The pudendal nerve supplies the perineum and posterior scrotum.
D. The lateral cutaneous femoral nerve supplies the lateral thigh and would not be involved in scrotal pain.

Memory Tool:
Ilioinguinal: “Inguinal” like “In-Scrotal,” for anterior scrotum pain.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
For proper diagnosis and treatment of scrotal pain, knowing the nerve distribution is vital.

Question 93

Clinical Vignette:
A patient undergoing abdominal surgery experiences pain in the lower anterior abdominal wall and pubic region post-operatively. Which nerve may have been affected during surgery?

Multiple Choice Options:
A. Genitofemoral Nerve
B. Ilioinguinal Nerve
C. Iliohypogastric Nerve
D. Nervi erigentes

Answer 93

Correct Answer:
C. Iliohypogastric Nerve

In-depth Explanation for All Answer Choices:
A. Genitofemoral nerve supplies the anterior thigh, not the lower abdominal wall.
B. The ilioinguinal nerve primarily affects the anterior scrotum.
C. The iliohypogastric nerve supplies the anterior abdominal wall and pubis.
D. Nervi erigentes primarily affect the pelvic viscera, not the abdominal wall.

Memory Tool:
Iliohypogastric: “Hypo-“ like “below,” for below the navel, relating to the anterior abdominal wall and pubis.

Reference Citation:
Table 109.2, Somatic and Autonomic Nerves of the Pelvis

Rationale for Importance:
Identifying which nerve may have been impacted during abdominal surgery helps guide post-operative pain management.

Question 94

Clinical Vignette: A 45-year-old man comes to your office complaining of testicular pain. You suspect testicular torsion and are concerned about ischemia. What is the main blood supply to the testis?

Multiple Choice Options:
A. Deferential artery
B. Cremasteric (external spermatic) artery
C. Testicular (internal spermatic) artery
D. Inferior epididymal artery

Answer 94

Correct Answer: C. Testicular (internal spermatic) artery
In-depth Explanation:

A. Deferential artery: Although it does supply the testis, it is not the main blood supply. This artery mainly originates from the internal iliac (hypogastric) artery/superior vesicle artery.
B. Cremasteric (external spermatic) artery: Supplies the cremaster muscle and testis but is not the main source of blood supply. It originates from the inferior epigastric artery.
C. Testicular (internal spermatic) artery: Correct. This is the main blood supply to the testis and originates from the aorta.
D. Inferior epididymal artery: This artery mainly supplies the epididymis, not the testis. It is derived from the vassal (deferential) artery.
Memory Tool: “In-Test” to remember “Internal Testicular” as the main supply.
Reference Citation: Paragraph 1, Table 67.1
Rationale: Knowing the main blood supply to the testis is crucial for any urological emergency involving ischemia or torsion.

Question 95

Clinical Vignette: During a surgical procedure to address epididymitis in a 35-year-old man, you need to be cautious of the blood supply. Which artery primarily supplies the superior part of the epididymis?

Multiple Choice Options:
A. Superior epididymal artery
B. Inferior epididymal artery
C. Deferential artery
D. Testicular (internal spermatic) artery

Answer 95

Correct Answer: A. Superior epididymal artery
In-depth Explanation:

A. Superior epididymal artery: Correct. This artery is derived from the testicular artery and supplies the superior part of the epididymis.
B. Inferior epididymal artery: Supplies the inferior part of the epididymis, derived from the vassal (deferential) artery.
C. Deferential artery: Mainly supplies the vas deferens, not the epididymis.
D. Testicular (internal spermatic) artery: Main blood supply to the testis, not the epididymis.
Memory Tool: “Superior Epi gets the Top supply” to remember superior epididymis gets supply from the superior epididymal artery.
Reference Citation: Paragraph 2, Table 67.1
Rationale: Knowledge of blood supply is essential when performing surgical procedures involving the epididymis to prevent unintended vascular damage.

Question 96

Vignette: A patient has been diagnosed with damage to the sacral nerves due to aortic aneurysm surgery. Which artery originating from the aorta supplies the sacral nerves and sacrum?

Options:
A. Middle sacral
B. Ascending lumbar
C. Lateral sacral
D. Superior vesical

Answer 96

Correct Answer: A. Middle sacral

Explanation:

A: The middle sacral artery originates from the aorta and supplies the sacral nerves and sacrum.
B: The ascending lumbar artery does not originate from the aorta and supplies psoas and quadratus lumborum muscles.
C: The lateral sacral artery does not originate from the aorta and supplies sacral nerves and sacrum.
D: The superior vesical artery does not originate from the aorta and supplies the bladder, ureter, vas deferens, and seminal vesicle.
Memory Tool: “Middle Sacral is the Aorta’s Sacred Route” – The Middle sacral artery originates from the aorta and supplies the sacral nerves and sacrum.

Reference: Table 109.1, Paragraph 1

Rationale for Question: Awareness of the origin of arteries supplying the sacral nerves is key for diagnosing complications related to aortic procedures.

Question 97

Vignette: A patient undergoing elective hernia repair is at risk for compromising which artery supplying the inguinal ligament and surrounding structures laterally?

Options:
A. Deep circumflex iliac
B. Inferior vesical
C. Pubic
D. Obturator

Answer 97

Correct Answer: A. Deep circumflex iliac

Explanation:

A: The deep circumflex iliac artery supplies the inguinal ligament and surrounding structures laterally.
B: The inferior vesical artery supplies the bladder, seminal vesicle, prostate, and ureter, but not the inguinal ligament.
C: The pubic artery supplies the inguinal ligament and surrounding structures medially, not laterally.
D: The obturator artery supplies the adductor muscles of the leg and overlying skin, not the inguinal ligament.
Memory Tool: “Deep Circumflex for Lateral Ligament” – Deep circumflex iliac artery supplies the inguinal ligament laterally.

Reference: Table 109.1, Paragraph 1

Rationale for Question: Understanding the blood supply to the inguinal ligament is crucial in hernia repair procedures to minimize risks.

Question 98

Vignette: A patient has sustained a gluteal injury and is experiencing pain and swelling. Which artery supplying the gluteus muscles originates from the posterior trunk of the internal iliac?

Options:
A. Superior gluteal
B. Inferior gluteal
C. Superior vesical
D. Ascending lumbar

Answer 98

Correct Answer: A. Superior gluteal

Explanation:

A: The superior gluteal artery originates from the posterior trunk of the internal iliac and supplies the gluteus muscles.
B: The inferior gluteal artery originates from the anterior trunk of the internal iliac, not the posterior.
C: The superior vesical artery does not supply the gluteus muscles.
D: The ascending lumbar artery does not originate from the posterior trunk of the internal iliac and does not supply the gluteus muscles.
Memory Tool: “Superior Gluteal for Superior Glutes” – Superior gluteal artery comes from the posterior trunk of the internal iliac and is responsible for the gluteus muscles.

Reference: Table 109.1, Paragraph 1

Rationale for Question: Knowledge of the origin of ar

Question 99

The principal dietary source of ISO-flavones is:

A. Soybeans
B. Tomato
C. Fruits
D. Olive oil

Answer 99

A. Soybeans

Question 100

Proximal ureter is mainly vascularised by a ureteric artery arising from the:

A. Aorta
B. Renal artery
C. Gonadal artery
D. External iliac artery

Answer 100

B. Renal artery

Question 101

Which statement is correct with regarding to the location of Denonvilliers fascia?

A. Covers Santorini’s plexus
B. Envelopes the neurovascular pedicles
C. Contributes to the formation of the puboprostatic ligaments
D. Envelopes the posterior surfade of the seminal vesicles and prostate

Answer 101

D. Envelopes the posterior surfade of the seminal vesicles and prostate

Question 102

The main adrenal vein drains into the:

A. Inferior vena cava bilaterally
B. Renal vein on the left and phrenic vein on the right
C. Renal vein on the left and inferior vena cava on the right
D. Inferior vena cava on the right and phrenic vein on the left

Answer 102

C. Renal vein on the left and inferior vena cava on the right

Question 103

Which diversion has the highest incidence of megaloblastic anemia as a late complication?

A. Mainz I pouch
B. Ileal W-neobladder
C. Indiana pouch
D. Bricker conduit

Answer 103

B. Ileal W-neobladder

Question 104

What percentage of normal serum calcium is present in free ionic form?

A. 15%
B. 35%
C. 45%
D. 65%

Answer 104

C. 45%

Question 105

Which statement on crossing vessels is correct?

A. Less than 10% of the population have crossing vessels
B. The vast majority of crossing vessels causes obstruction
C. The work-up for crossing vessels is indicated prior to endopyelotomy
D. The presence of a crossing vessel does not contraindicate endopyelotomy

Answer 105

C. The work-up for crossing vessels is indicated prior to endopyelotomy

Question 106

The external diameter of an 18 Fr (Chartiere) catheter is approximately:

A. 1.8 mm
B. 3 mm
C. 4.8 mm
D. 6 mm

Answer 106

D. 6 mm

Question 107

The occurence of cancer at the situ of a ureterosigmoid anastomosis is well known. What is the characteristic appearance of this tumour at colonoscopy?

A. Ulcerated polyps in the rectum
B. Blood clot in the ureteric effluent
C. A polypoid lesion at the ureteric anastomosis
D. A cavitating ulcer replacing the ureteric orifice

Answer 107

C. A polypoid lesion at the ureteric anastomosis

Question 108

Geriatric 8 is:

A. Treatment outcome predicting tool
B. Tool to assess functional status of cancer patients
C. Health status screening tool for senior adults (>70 years old)
D. Performance status assessment tool for oncological patients

Answer 108

C. Health status screening tool for senior adults (>70 years old)

Question 109

The dorsal lumbotomy incision to expose the kidney

Answer 109

Splits the lumbodorsal fascia without incising muscle,. This approach allows entrance to the retroperitoneum without violation of musculature

Question 110

The lumbodorsal fascia originates from the

Answer 110

Lumbar vertebrae

Question 111

The lumbodorsal fascia consists of how many layers

Answer 111

3- Posterior, middle and anterior

Posterior: covering for the sacrospinalis, latissimus dorsi origin

Middle: separates the anterior of of sacrospinalis from the posteror aspect of the quadratus lumborum,

Anterior: lumodorsal fascia probides the anterior covering to the quadratus lumborum muscle and forms the posterior margin of the retroperitoneum

Question 112

All three layers of the lumbodorsal fascia join to form the a single thick aponeurosis lateral to the quadratus lumborum muscle before extending further anterolaterally, where they are contiguous with the aponeurosis of the ____________.

Answer 112

Transversus abdominis muscle

Question 113

The psoas major joins the iliacus muscle, which originates ____, to become the _____ and insert on the _____ and _____ the thigh at the hip

Answer 113

1. Inner aspect of the iliac wing of the pelvis
2. iliopsoas
3. lesser trochanter
4. flex

Question 114

What is the boundary of the retroperitoneum?

Answer 114

Posterior surface: lumbar vertebral bodies covered by shiny, longitudinal fibers of the anterior spinous ligament, these are flanked bilaterally by the psoas. Psoas is covered by the psoas sheath which are contiguous with the transversus abdominis muscle

LAterally: transversus abdominis

Superior: posterior insertion of the diaphragm along the lower ribs

Inferior: below the level of the iliac crest, iliopsoas forms the posterior confine

Question 115

in a subcostal flank approach to the kidney, which of the ff may be incised to increase upward mobility of the 12th rib

Answer 115

the costovertebral ligament

Question 116

What are the first abdominal branches of the aorta

Answer 116

the paired inferior phrenic arteries

Question 117

which of the following arteries branches from the celiac trunk?

a. the left gastric
b. the right gastric
c. the pancreaticoduodenal
d. SMA

E. IMA

Answer 117

A. left gastric

The short celiac arterial trunk trifurcates into common hepatic, left gastric, and splenic branches

Question 118

The renal arteries typically branch from the abdominal aorta at the level of the ____

Answer 118

2nd lumbar

Question 119

the testicular arteries commonly originate from the

Answer 119

Abdominal aorta below the renal arteries

Question 120

The inferior mesenteric artery can be sacrificed without complication

Answer 120

True, especially in individuals without atherosclerotic occlusive arterial disease

Question 121

Which of the following drains directly to the IVC?

REnal veins, IMV,SMV,splenic veins

Answer 121

only renal vein, the rest drains into to the portal vein

Question 122

the left gonadal vein usually enters the ____

Answer 122

inferior aspect of the left gonadal vein

Question 123

left renal vein receives the ff

Answer 123

left adrenal, left lumbar, left gonadal

Question 124

cysternal chyli is located

Answer 124

located at the 1st lumbar vertebra posterior to aorta

Question 125

the right testis lymphatics drains into

Answer 125

interaortocaval region

Question 126

the lumbar sympathetic chains

Answer 126

1. Run vertically in the retroperitoneum, ,medial to the psoas muscles
2. contain numerous sympathetic ganglia
3. Closely associated with the lumbar blood vessels

contain postganglionic sympathetic neurons supplying the lower ex

Question 127

Disruption of which sympathetic nervous plexus on this anterior abdominal aorta during retrpoperioneal dissection will likely cause loss of seminal emission?

A. Celiac plexus

B. Renal plexus

C. Superior mesenteric plexus

D. Superior hypogastric plexus

E AOTA

Answer 127

D. superior hypogastric plexus
From book: At the lower extent of the abdominal aorta, much of the autonomic input to the pelvic urinary organs and genital tract travels through the superior hypogastric plexus. This plexus lies on the aorta anterior to its bifurcation and extends inferiorly on the anterior surface of the fifth lumbar vertebra. This plexus is contiguous bilaterally with inferior hypogastric plexuses, which extend into the pelvis. Disruption of the sympathetic nerve fibers that travel through these plexuses during retroperitoneal dissection can cause loss of seminal vesicle emission and/ or failure of bladder neck closure, resulting in retrograde ejaculation.

Question 128

23
In the lateral abdominal wall, the iliohypogastric nerve will be found coursing in the plane:

a
deep to the transversalis fascia.

b
between the transversalis fascia and the transversus abdominis muscle.

c
between the transversus abdominis and internal oblique muscles.

d
between the internal oblique and external oblique muscles.

e
superficial to the external oblique muscle.

Answer 128

c. In between the transversus abdominis and internal oblique muscles.

Question 129

The cremaster muscle is innervated by the:

a
ilioinguinal nerve.

b
iliohypogastric nerve.

c
obturator nerve.

d
genital branch of the genitofemoral nerve.

Answer 129

D. genital branch

Question 130

In the retroperitoneum, where can the genitofemoral nerve be found?

a
Posterior to the psoas muscle

b
On the anterior surface of the psoas muscle

c
Lateral to the psoas muscle

d
Medial to the psoas muscle

Answer 130

B. the genitofemoral branch lies directly atop and parallels the psoas on most of its retroperitoneal course

Question 131

Autonomic system divided into sympathetic and parasympathetic fibers. The sympathetitic ganglion originates from ___ while the parasymphatetic originates from ____. The major autonomic plexuses are associated with the primary branches of the aorta namely: ___, ___, ___

Answer 131

sympathetic: thoracic and lumbar portions

PArasymphathetic: Cranial and sacral collumns

Major autonomic branches: Celiac, superior hypogastric, inferior hypogastric plexus

Question 132

26
The descending duodenum:

a
lies within the retroperitoneum.

b
receives the common bile duct.

c
lies lateral to the head of the pancreas.

d
lies anterior to the right renal hilum.

e
does all of the above.

Answer 132

e. The second part of the duodenum descends vertically, directly anterior to the right renal hilum, and this is intimately related on its posterior aspect to the medial margin of the right kidney, right renal vessels, renal pelvis, UPJ, upper right ureter, the CBD also lies posterior and drains into this part

Question 133

The posterior surface of the tail of the pancreas is closely associated with:

a
the splenic artery.

b
the splenic vein.

c
the upper pole of the left kidney.

d
the left adrenal gland.

e
all of the above.

Answer 133

e all of the above

Question 134

In cases of renal ectopia, the ipsilateral adrenal gland is typically:

a
absent.

b
found in its normal anatomic position in the upper retroperitoneum.

c
found in association with the contralateral adrenal gland.

d
found closely applied to the superior pole of the ectopic kidney.

e
found closely associated with the ipsilateral renal artery.

Answer 134

B. found in its normal position in the upper retroperitoneum

Question 135

30
Which of the following statements is NOT true?

a
The right renal vein is much shorter than the left renal vein.

b
The right adrenal vein is much shorter than the left adrenal vein.

c
The right kidney is typically located lower in the retroperitoneum than the left kidney.

d
The right adrenal gland is typically located lower in the retroperitoneum than the left adrenal gland.

e
Both c and d

Answer 135

d

Question 136

s one proceeds outward from the adrenal medulla, the three separate functional layers of the adrenal cortex are, in correct order:

a
zona reticularis, zona fasciculata, and zona glomerulosa.

b
zona fasciculata, zona reticularis, and zona glomerulosa.

c
zona glomerulosa, zona fasciculata, and zona reticularis.

d
zona glomerulosa, zona reticularis, and zona fasciculata.

e
zona reticularis, zona glomerulosa, and zona fasciculata.

Answer 136

a

Question 137

Which of the following statements is (are) NOT true?

a
The adrenal medulla produces catecholamines in response to stimulation from the sympathetic nervous system.

b
The zona glomerulosa produces aldosterone in response to angiotensin II.

c
The zona reticularis of the adrenal cortex produces androgens in response to luteinizing hormone (LH).

d
The zona fasciculate of the adrenal cortex produces glucocorticoids in response to adrenocorticotropic hormone (ACTH).

e
Both b and c

Answer 137

C. it is regulated by ACTH not LH

Question 138

The adrenal arteries are branches from:

a
the aorta.

b
the inferior phrenic arteries.

c
the renal arteries.

d
the celiac arterial trunk.

e
a, b, and c.

Answer 138

e

Question 139

The kidney produces:

a
renin.

b
angiotensin.

c
erythropoietin.

d
both a and c.

e
a, b, and c.

Answer 139

D. Kidneys play a central role in the fluid electrolyte, and acid base balance in humans, but they have important endocrine functions known to include vit D met and the production of both renin and erythropoietin

Question 140

The normal kidney in an avg sized adult man weighs

Answer 140

150 grams

Question 141

Persistent fetal lobation identified in the kidney of an adult patient:

a
indicates the presence of a congenital renal disorder.

b
indicates childhood renal injury due to infection.

c
is observed only with long-standing obstructive uropathy.

d
is normal.

e
is never seen.

Answer 141

d

Question 142

The upper pole of the kidney lies anterior to:

a
the 12th rib.

b
the diaphragm.

c
the pleura.

d
all of the above.

e
none of the above.

Answer 142

D

Question 143

Which of the following statements regarding the typical anatomic positioning of the kidney is TRUE?

a
The lower pole of the kidney lies more anterior than the upper pole.

b
The lower pole of the kidney lies more lateral than the upper pole.

c
The medial aspect of the kidney lies more anterior than its lateral aspect.

d
The anterior renal calyces lie lateral to the posterior renal calyces.

e
All of the above.

Answer 143

e

Question 144

During left radical nephrectomy performed via a transabdominal approach, excessive traction on which of the following structures might be expected to produce a significant injury to the spleen?

a
Left adrenal gland

b
Splenorenal ligament

c
Splenocolic ligament

d
Both b and c

e
a, b, and c

Answer 144

D

Question 145

Gerota fascia envelops and contains:

a
the adrenal gland.

b
the kidney.

c
the ureter.

d
the gonadal vessels.

e
all of the above.

Answer 145

E

Question 146

After blunt trauma to the right kidney, with a major laceration to the renal parenchyma and ongoing hemorrhage, the expanding hematoma contained within Gerota fascia will tend to extend:

a
across the midline into Gerota fascia surrounding the left (contralateral) kidney.

b
downward into the pelvis.

c
upward into the thorax.

d
anterolaterally, deep to the transversalis fascia.

e
anterolaterally, between the peritoneum and transversalis fascia.

Answer 146

b

Question 147

After blunt trauma to the right kidney, with a major laceration to the renal parenchyma and ongoing hemorrhage, the expanding hematoma contained within Gerota fascia will tend to extend:

a
across the midline into Gerota fascia surrounding the left (contralateral) kidney.

b
downward into the pelvis.

c
upward into the thorax.

d
anterolaterally, deep to the transversalis fascia.

e
anterolaterally, between the peritoneum and transversalis fascia.

Answer 147

B.

Question 148

The first branch segmental artery from the main renal artery is typically the:

a
apical anterior segmental artery.

b
lower anterior segmental artery.

c
posterior segmental artery.

d
upper anterior segmental artery.

e
middle anterior segmental artery.

Answer 148

C. posterior branch

Question 149

4
During pyeloplasty, the posterior segmental renal artery is inadvertently divided. This will produce:

a
no effect on the kidney.

b
ischemic loss of a large posterior segment of the renal parenchyma.

c
ischemic loss of a small posterior segment of the renal parenchyma.

d
ischemic loss of a segment of upper pole renal parenchyma.

e
ischemic loss of a segment of lower pole renal parenchyma.

Answer 149

b

Question 150

The sequential branches of the renal artery are, in order, the:

a
segmental, interlobar, arcuate, interlobular, and afferent arteriole.

b
segmental, interlobular, arcuate, interlobar, and afferent arteriole.

c
segmental, subsegmental, interlobar, interlobular, arcuate, and afferent arteriole.

d
segmental, arcuate, interlobar, interlobular, and afferent arteriole.

e
segmental, interlobar, interlobular, arcuate, and afferent arterio

Answer 150

a

Question 151

48
The most common renal vascular anomaly is a:

a
supernumerary left renal artery.

b
supernumerary right renal artery.

c
supernumerary left renal vein coursing anterior to the aorta.

d
supernumerary left renal vein coursing posterior to the aorta.

e
supernumerary right renal vein.

Answer 151

A

Question 152

After involvement of lymph nodes directly at the renal hilum, the primary lymph node drainage site for the left kidney is:

a
the left lateral para-aortic lymph nodes.

b
the interaortocaval lymph nodes.

c
the right paracaval lymph nodes.

d
the left retrocrural lymph nodes.

e
all of the above.

Answer 152

A-

Question 153

In a typical human kidney, there are approximately how many renal papillae and corresponding minor calyces?

a
3 to 5

b
7 to 9

c
11 to 12

d
14 to 15

e
17 to 18

Answer 153

B

Question 154

51
A compound renal papilla and calyx:

a
is protective against ascending infection.

b
is least common at the upper pole of the kidney.

c
is a rare finding.

d
is commonly associated with formation of kidney stones.

e
is none of the above.

Answer 154

E.

Question 155

The ureteral smooth muscle consists of:

a
a single layer of longitudinally oriented muscle bundles.

b
a single layer of circular and obliquely oriented muscle bundles.

c
a single layer of randomly oriented muscle bundles.

d
two layers—an inner layer of longitudinal muscle and an outer layer of circular and oblique muscle.

e
two layers—an inner layer of circular and oblique muscle and an outer layer of longitudinal muscle.

Answer 155

d

Question 156

The ureter receives its blood supply from the:

a
renal artery.

b
aorta.

c
common iliac artery.

d
gonadal artery.

e
all of the above.

Answer 156

e

Question 157

An invasive transitional cell carcinoma is diagnosed in the left proximal ureter, at the level of the third lumbar vertebral body. The primary site of potential nodal metastases from this lesion will be the:

a
left para-aortic lymph nodes.

b
interaortocaval lymph nodes.

c
left common iliac lymph nodes.

d
lymph nodes at the left renal hilum.

e
left external iliac lymph nodes.

Answer 157

a

Question 158

During surgical dissection, the ureter can be identified as it enters the pelvis:

a
at the aortic bifurcation.

b
crossing the superior border of the sacrum.

c
crossing the common iliac artery at the branching of the internal iliac artery.

d
crossing the uterine artery.

e
at the internal inguinal ring.

Answer 158

c

Question 159

A young man with right-sided abdominal pain is diagnosed with right hydroureteronephrosis by renal ultrasonography. Which of the following inflammatory processes might impinge on the right ureter and cause obstruction?

a
Acute appendicitis

b
Crohn ileitis

c
Perforated cecal carcinoma

d
All of the above

Answer 159

d

Question 160

Narrowing of the ureteral luminal caliber naturally occurs at:

a
the ureteropelvic junction.

b
the crossing of the iliac vessels.

c
the ureterovesical junction.

d
all of the above.

e
none of the above.

Answer 160

D

Question 161

Sympathetic nerve input to the kidney typically travels through:

a
the celiac plexus.

b
the superior mesenteric plexus.

c
the superior hypogastric plexus.

d
the inferior hypogastric plexus.

e
none of the above.

Answer 161

a- the kidneys receive preganglionic sympathetic input from the eight thoracic through the first lumbar segements. Postganglionic fibers arise from the celiac and aorticorenal ganglia

Question 162

Ureteral peristalsis requires:

a
intact sympathetic input.

b
intact parasympathetic input.

c
both sympathetic and parasympathetic input.

d
intact spinal cord.

e
intrinsic smooth muscle pacemakers in the renal collecting system.

Answer 162

e