2 Flashcards
(39 cards)
23 year old woman is admitted with severe abdominal pain, nausea, and vomitting. History taking shows that the pain is acute and has been constant for 4 days. The pain began in the epigastric region and radiated bilaterally around the chest to just below the scapulae. Currently the pain is localized in the right hypochondrium. A CT scan examination reveals calcified stones in the gallbladder. Which of the following nerves is carrying the aff. fibers of the referred pain?
Greater thoracic splanchnic nerves
In a routine visit to the outpatient clinic for his annual checkup, a 42 year old male is informed that radiographic exam has given strong evidence that he has a malignancy of his scrotum. Which of the ofllowing nodes are the lymph nodes that drain the affected area?
Superficial inguinal
An obese 45 year old female patient with an elevated temperature comes to the physician’s office complaining of nausea and intermittent, acute pain in the right upper quad of the abdomen during the past 2 days. She has a 24 hour history of jaundice. She has a history of gallstones. Which of the following structures has most likely been obstructed by a gallstone?
Common bile duct
45 year old male is admitted to the hospital with a massive hernia that passes through the inguinal triangle of Hesselbach. Which of the following structures is used to distinguish a direct inguinal hernia from an indirect inguinal hernia?
Inferior epigastric vessels
48 year old man is admitted to the hospital with severe abdominal pain. Radiographic exam reveals a tumor in the tail of the pancreas. A diagnostic arteriogram shows that the tumor has compromised the blood supply to another organ. Which of the following organs is most likely to have its blood supply compromised by this tumor?
Spleen
57 year old man is admitted to the emergency department with left flank pain. Blood tests indicate hematuria and anemia. A magnetic resonance scan reveals that blood flow in the left renal vein is being occluded by an arterial aneurysm where the vein crosses the aorta. The aneurysm is most likely located in which of the following arteries?
Superior mesenteric
A 51 year old woman is admitted to the hospital with an acutely painful abdomen. Radiographic exam reveals penetration of the fundic region of the stomach by an ulcer resulting in intra-abdominal bleeding. Which of the following arteries is the most likely source of the bleeding?
Short gastric artery
68 year old woman is admitted to the hospital with severe pain radiating from her lower back toward her pubic symphysis. Ultrasound exam reveals that a renal calculus is partially obstructing her right ureter. At which of the following locations is the calculus most likely to lodge?
Pelvic brim
25 year old female is admitted to the hospital with sharp pain the left lower quadrant. Patient history reveals that her last menstrual period was 10 days ago. Transvaginal ultrasound reveals a ruptured cyst on the left ovary. The sonogram also reveals approximately 100 ml of fluid in the pelvis, which is presumed to represent cyst contents and bleeding from the rupture site. Which the patient in the supine position, where is this fluid most likely located?
Rectouterine pouch of Douglas
53 year old quality control engineer is admitted to the hospital with severe abdominal pain. The patient’s history and physical examination indicate chronic colonic diverticulitis, with tachycardia nad hypotension at the present time. An ultrasonographic examination reveals bleeding from the descending colon. Which of the following arteries is most likely to be the source of the hemorrhage?
A branch of the inferior mesenteric
53 year old man is admitted to the hospital with rectal bleeding. Physical exam including a rectal exam reveals an abdnormal mass of tissue protruding from an area sup. to the external anal sphincter, sup to the pectinate line. Biopsy reveals the presence of an adenocarcinoma. Which of the following groups of lymph nodes would first receive lymph from the cancerous area?
Internal Iliac
46 year old man is admitted to the hospital with a rather large but painless mass on his right groin. During physical examination, it is noted that the inguinal lymph nodes are hard an palpable. A lymph node biopsy reveals the presence of malignant cells. Which of the following locations would be the most likely primary source of carcinoma?
Anal canal
48 year old woman is admitted to the emergency department with a complaint of severe abdominal pain. Radiographic exam reveals advanced carcinoma of the head of the pancreas. A celiac plexus block is performed to relieve her pain. Which of the following best describes the nerve structures that are most likely to be present in the celiac ganglion?
Pre- and postganglionic sympathetic, preganglionic parasympathetic, and visceral afferent fibers
64 year old man is admitted to the hospital with intense abdominal pain from a pancreatic tumor. A neurectomy is performed to interrupt the neural fibers supplying the pancreas. Which of the following neural fibers would be the most likely objective of the neurectomy?
Visceral afferent
65 year old man is admitted with complaints of nonspecific ab pain. Physical and radiographic exam reveals mild intestinal ischemia due to atherosclerotic occlusion of the midproximal part of the superior mesenteric artery, but collateral blood supply has delayed the onset of necrosis. What vessels provide collateral channels between the celiac trunk and the sup mes artery?
Superior and inferior pancreaticoduodenal
A 3 year old male is admitted to the pediatric clinic with a a palpable mass in the right side of his scrotum, and a preliminary diagnosis is made of a congenital, indirect inguinal hernia. Which of the following is the most likely cause of an indirect inguinal hernia in this patient?
The deep ring opens into an intact processus vaginalis
68 year old owman had been suffeering longterm effects of diverticulosis and inflammation of the transverse colon. To permit operating on a patient with severe diverticulosis of the transverse colon, it would be necessary to first ligate or clamp the sourceo f arterial supply. Which of the following arteries will most likely be ligated?
Middle colic
A hard mass (fecolith) in the ostium of the 37 year old patient’s appendix had led to a local infection in with a slightly elevated temperature and a moderate increase in WBC count. The initial pain from the infection was dull and difficult to localize, but the patient placed his hand in the periumbilical area to indicate the general area of discomfort. The region of the umbilicus receives its sensory supply, classically, from which of the following spinal nerves?
T10
While preforming a voiding cystourethrogram on a 45 year old male, the urologist was too forceful when he inserted the catheter and accidentally damaged the wall of the membranous portion of the urethra in the deep perineal compartment (urogenital diaphragm). Which of the following structures would most likely be traumatized at this location?
External urethral sphincter
On digital examination of the vagina, the portion of the uterus that one anticipates palpating with the examining finger is the cervis and its external os. Which of the following is the most common position of the uterus?
Anteflexed and anteverted
Several days after a 34 year old woman was admitted after her automobile collided with a lamppost, her urinary bladder gives evidence of paralysis. A CT scan reveals multiple fractures of her pelvis with a significant pelvic hematoma, either of which could have interrupted or injured the nerve supply of the organ. Which of the following nerves was most likely traumatized?
Pelvic splanchnic
A 68 year old man complains of pain upon urination. A CT scan and a biopsy provide evidence of an enlarged, cancerous prostate gland. Subsequently, he undergoes a radical prostatectomy. Postoperatively, he suffers from urinary incontinence because of paralysis of the external urethral sphincter. Which of the following nerves was injured during the operation?
Pudendal
A 34 year old pregnant woman is prepared in the hospital for delivery. The gynecologist decides to perform a pudendal nerve block using a transvaginal approach. Which bony structure would be the most reliable as a landmark to block the pudendal nerve?
Ischial Spine
A 22 year old male is admitted with groin pain and blood in the semen. An MRI exam and biopsy reveal testicular cancer. Which of the following lymph nodes will be first involved in case of metastasis?
Paraaortic and lumbar
