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Oh yeah Anatomy! > Abdomen > Flashcards

Abdomen Flashcards

1
Q

The dermatomal level of the umbilicus:

a. L1
b. L3
c. T10
d. T12

A

c

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2
Q

Two muscles that make up the conjoint tendon

A

Internal oblique+transversus abdominis

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3
Q

The SVC drains into the right atrium at what level?

A

3rd right costochondral junction

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4
Q

At the level below the ASIS the posterior wall of the rectus sheath is formed by?

A

The transversalis fascia alone. Above the ASIS (corresponds to level of the arcuate line, three layers in both anteriorly and posterior
y: aponeurosis of the rectus abdominis, transversus abdominis, internal oblique

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5
Q

The inferior epigastric comes from

A

Internal thoracic. The other two blood vessels, the inferior epigastric and deep circumflex iliac comes from the external iliac.

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6
Q

Poupart ligament aka?

A

Inguinal ligament

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7
Q

Derivative of the Internal oblique in the testis?

A

Cremasteric muscle

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8
Q

Derivative of the transversalis fascia in the scrotum?

A

Internal spermatic fascia

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9
Q

Which abdominal muscle has NO derivative in the scrotum?

A

Transversus abdominis

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10
Q

The cremasteric reflex sensory fibers is supplied by the _____ and the motor fibers are supplied by the genital branch of the genitofemoral nerve.

A

L1 spinal nerve

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11
Q

Which part of the rectum is extraperitoneal?

A

Inferior rectum. Superior is intra, middle is retro.

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12
Q

Ligation of the common hepatic artery will eliminate the blood supply of the stomach by which of the following arteries?

a. left gastric, short gastric
b. right gastroepiploic, short gastric
c. right gastroepiploic and right gastric
d. right and left gastric

A

C. Common hepatic artery branches into the RIGHT gastric and gastroduodenal which further branches into the right gastroepiploic and the superior pancreaticoduodenal.

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13
Q

The lower respiratory tract, biliary tree and pancreas comes from which embryonic gut layer?

A

Foregut

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14
Q

The appendix comes from which embryonic gut layer?

A

Midgut

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15
Q

Distal third of the transverse colon, superior part of the anal canal and the appendix are all part of the hindgut. T/F?

A

False. Only the appendix in those mentioned is not part of the hindgut. it comes from the midgut.

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16
Q

Vertebral Levels of celiac artery, SMA and IMA?

a. T12, L1, L2
b. T12, L1, L3
c. L1, L2, L3
d. none of the above

A

B.

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17
Q

MC site of AA aneurysm?

A

At bifurcation, level L4 vertebra

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18
Q

A patient comes to the ER unconscious. The relatives told you that the patient has been complaining of severe abdominal pain since yesterday and has been taking Maalox for such episodes in the past. A few days before, the patient passed foul-smelling black stools and an hour before being brought to the ER, she vomited fresh blood. Her BP was 60/70, HR 140 and afebrile. NGT inserted revealed fresh bloody aspirate admixed with food materials. Urgent endoscopy was done revealing a perforated ulcer in the posterior wall of the first portion of the duodenum with a spurting blood vessel. Which blood vessel is the one seen in endoscopy?

a. Right gastroepiploic
b. Gastroduodenal
c. Splenic
d. Left gastric

A

B.
The splenic artery can also be eroded, but by a perforated ulcer in the posterior gastric wall, while the left gastric can be eroded by perforating ulcers in the lesser curvature of the stomach. The right gastroepiploic, though a branch of the gastroduodenal, is too far off from the described site to be the bleeding vessel.

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19
Q

A man comes into your clinic for scrotal swelling on his left scrotum. Physical examination suggests that the said mass is a varicocoele. Further investigation and examinations reveal that the man has an SMA aneurysm. What other findings could result from such an aneurysm?

a. Right renal and adrenal hypotension due to vascular steal
b. Left renal and adrenal hypertension
c. Left renal and adrenal hypotension due to vascular steal
d. none of the above

A

B. An SMA aneurysm can compress the left renal vein as it crosses in front of the aorta. Remember that the left gonadal vein would join with the left renal vein before the left renal vein drains into the IVC (right renal: direct drainage.). This translates to damming up of blood in the structures that are drained by the left renal vein (i.e., left renal and adrenal hpn and left scrotal varicocoele).

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20
Q

A 65 y/o male with known liver cirrhosis comes into the ER for hematemesis. Stat endoscopy reveals a a bleeding esophageal varix. Which of the following vessels should be ligated to stop the bleeding?

a. Superior mesenteric vein
b. Inferior mesenteric vein
c. Paraumbilical vein
d. Left gastric vein

A

D. The left gastric vein, along with those mentioned in the choices are tributaries of the portal venous system. The left gastric vein further branches to drain the esophagus as the esophageal branch, which also communicates with the esophageal vein of the azygous. Collateral formation and eventual swelling of these collaterals happen due high pressure from the cirrhotic liver, and this causes the varices. Other tributaries that swell include the paraumbilical (caput medusae) amd superior, middle and inferior rectal veins (hemorrhoids).

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21
Q

A patient suffered from a gun shot to the abdomen. The patient was brought to the OR for stat exlap. The surgeon discovers that the slug hit the ASIS and it ricocheted around until it terminated its path at the level of the diaphragm, hitting the inferior vena cava as it emerged from the diaphragmatic hiatus. What other structure could have been potentially injured from the findings said above?

a. Vagus nerve
b. Thoracic duct
c. Azygous vein
d. Phrenic nerve

A

D. The bullet hit the CAVAL opening of the diaphragm at level T8. The phrenic nerve emerges alongside the SVC through this opening. The ESOPHAGEAL hiatus at level T10 has the esophagus and the vagus. The AORTIC hiatus at level T12 has the aorta, thoracic duct and azygous vein.

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22
Q

Which muscle causes the first or the pharyngoesophageal constriction?

A

Cricopharyngeus

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23
Q

A child swallowed a piece of lego by accident and was brought to the ER. Chest film confirm that the lego was not in the respiratory system, and it was, in fact, lodged in the esophagus. Which part of the esophagus do swallowed foreign bodies usually lodge?

a. Proximal third
b. Middle third
c. Distal third
d. Mali yung chest film, nasa bronchus yun I’m sure

A

C. The distal third is the site of the esophagus is where the diaphragmatic constriction is, and it is the MC site where strictures and carcinoma developand foreign bodies lodge. Etchosera yung D. tinabla yung xray.

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24
Q

Blood supply of the esophagus?

A

Upper third: inferior thyroid a from the subclavian
Middle third: descending aortal branches
Lower third: Left gastic artery from the celiac artery

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25
Q

If you are a surgeon contemplating on a new technique on vagotomy that utilizes an esophageal approach, a potential hurdle might be:

a. It will be difficult to perform a left vagotomy at the level of the esophagus because the left vagus is posteriorly located.
b. It will be difficult to perform a right vagotomy at the level of the esophagus because the right vagus is posteriorly located.
c. No hurdles will be encountered because the left and right vagus both descend anterior to the esophagus.
d. why do you even think of such an approach? The vagus isn’t related to the esophagus anyway

A

B. Remember, LARP. Left vagus anterior, right vagus posterior

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26
Q

As the surgeon performing a esophagectomy on a patient with cancer confined in the lower esophagus, you think it might be prudent to also excise lymph nodes for sampling and staging. Which nodes should you harvest?

a. Deep cervical
b. superior mediastinal
c. inferior mediastinal
d. Celiac

A

D.
A-upper esophagus
B and C - middle esophagus

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27
Q

The anatomic level of the umbilicus:

a. L1
b. L3
c. T10
d. T12

A

B.

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28
Q 
Upon investigating a failed vagotomy, the Chairman of the Department of Surgery found that the attending surgeon of the patient failed to identify and ligate the Criminal Nerve of Grassi. From which vagal trunk does the said nerve emerge from?
a. Right vagus
b. Left vagus
C. both
d. none of the above
A

A. Recall: Right vagus: POSTERIORLY: Celiac division, Criminal nerve. Left vagus: ANTERIORLY: Nerve of Laterjet, Crow’s feet

29
Q

Ligating the hepatic branch of the celiac trunk could compromise the circulation of which portion of the duodenum?

a. Upper part
b. Lower part
c. Both
d. None of the above, the hepatic branch of the celiac does not give branches to supply the duodenum

A

A. Recall that the hepatic branch of the celiac trunk gives rise to the right gastric and the gastroduodenal, which further branches to the superior pancreaticoduodenal and right gastroepiploic. the sup pancreaticoduodenal artery supplies the upper part. lower part, inferior pancraticoduodenal from SMA.

30
Q

A 50 y/o hypertensive male was brought in the ER for repeated bouts of epigastric pain coupled with nausea and vomiting. The vomitus, according to the patient and his wife was greenish to yellowish. Plain film of the abdomen have findings suggestive of upper GI obstruction. Abdominal CT scan done revealed that the obstruction may be at the level of the duodenum, and that there are several blood vessels surrounding the horizontal part of the duodenum that look atherosclerotic and thickened, and have beginning thrombus formation. The radiologist reads this as duodenal compression of the said blood vessels. Which of the following blood vessels could be the one located in the description above?

a. Celiac trunk
b. Superior mesenteric vessels
c. Inferior mesenteric vessels
d. Abdominal aorta

A

B. The superior mesenteric vessels cross the horizontal part of the duodenum and it may cause compression if it is thrombosed or thickened.

31
Q

A patient presented with painless jaundice. Further work-up revealed a tumor in the pancreas. Where is the tumor most likely located?

a. Uncinate process
b. Head
c. Body
d. Tail

A

B. the head is situated near the C-shaped curve of the duodenum. This make it easy for the tumor to compress the bile duct, causing obstructive jaundice.

Tumors in the uncinate process would compress the SMA, while tumors of the neck and body cause obstruction of the portal vein and the IVC.

32
Q

You are assisting a surgeon in a pancreatectomy. The surgeon mentions to you that he has already ligated the inferior pancreaticoduodenal and the pancreatic branches of the splenic artery. The surgeon then asks you if there are blood vessels that he missed to ligate. You answer:

a. None. Goods na po tayo, doc. Game na!!!
b. Yes, we have to ligate the left gastric as well.
c. Yes, we have to ligate the Gastroduodenal artery from the hepatic Artery as well.
d. Yes. We have to just clamp the whole abdominal aorta then release it after the pancreas has been removed.

A

B. Remember that the gastroduodenal (from hepatic artery of the celiac trunk) gives off the superior pancreaticoduodenal artery. The left gastric does not contribute to the blood supply of the panc.
Recall: Inferior pancreaticoduodenal from SMA, pancreatic branches of the splenic from the celiac trunk.

33
Q

The fibrous tissue that coats the liver

A

Glisson capsule

34
Q

The medial umbilical ligament is the remnant of the?

A

Urachus.

Recall: Gubernaculum: round lig
ductus venosum: ligamentum venosum
umbilical vein: ligamentum teres hepatis (round lig of the liver)
umbilical artery: MEDIAL umbilical ligament

35
Q

The surgical maneuver, consisting of compressing the hepatoduodenal ligament, done to control liver hemorrhage.

A

Pringle maneuver

36
Q

Capacity of the gallbladder?

A

30-50 ml

37
Q

Main GI hormone that mediates bile release from the GB?

A

CCK

38
Q

While performing a laparoscopic cholecystectomy, the surgeon noted that the patient’s cystic artery does not come from its usual source in most individuals. From where does the cystic artery branch from?

A

Right hepatic artery

39
Q

boundaries of the triangle of Calot?

A

Liver, superior. Cystic duct, inferior. Common hepatic duct, medial

40
Q

MC site of an impacted gallstone?

A

Hepaticopancreatic ampulla

41
Q

The base of the appendix is located one third of the way up the line connecting the right ASIS and the umbilicus. This area is called the?

A

Mc Burney’s point

42
Q

Blood supply of the rectum?

A

Superior: rectal artery from IMA
Middle: internal iliac
Inferior: internal pudendal

43
Q

The anal canal starts at the level of which muscle in the perineum?

A

Puborectalis

44
Q

Which structure separates the anal canal into 2 segments which have different blood supplies, innervations and embryonic origin?

A

Dentate line

45
Q

The internal anal sphincter is derived from which muscular layer of the colon?

A

inner circular

46
Q

The lower anal canal is derived from which embryonic layer?

A

Ectoderm

47
Q

The upper anal canal has the ____ while the lower anal canal has none.

A

Columns of Morgagni

48
Q

The Valves of Houston are found where?

A

Rectum

49
Q

The Valves of Heister are found where?

A

Gallbladder

50
Q

Failure of neural crest cell migration during the 5th-7th week AOG, leading to absence of the myenteric (Auerbach) plexus

A

Hirshsprung disease

51
Q

Rule of 2s in Meckel

A

2 feet from ileocecal junction
2% of population
2 inches long
2 sources of ectopic tissue- gastric or pancreatic

52
Q

A woman receives a penetrating knife wound in the abdomen and both her SMAs and vagus nerves were severed. Which portions of the colon will be affected?

a. ascending and descending colon
b. transverse and sigmoid
c. ascending and transverse
d. transverse and descending

A

C. Remember: Ascending and transverse: SMA and vagus (para), t5-t9(symp)
descending and sigmoid: IMA and pelvic splanchnic (para) t11-12 (sym)

53
Q

A patient was operated on for gastric cancer. The surgeon harvests lymph nodes. Which of the following groups of lymph nodes were taken out?

a. Preaortic
b. Paraaortic
c. superficial inguinal
d. internal iliac

A

a. Preaortic: includes the celiac, superior mesenteric and inferior mesenteric

Recall: Paraaortic: lumbar, posterior abdominal wall nodes
superficial inguinal: drains the perineum, genitalia and anal canal ABOVE the dentate line
internal iliac: Anal canal BELOW the dentate line, bladder, uterus, vaguna, prostate

54
Q

Muscle of the loin that flexes the vertebra, supplied by L2-4 and very closely related to the kidneys?

A

Psoas major

55
Q

Muscle where the lumbar plexus forms?

A

Psoas major. Lumbar plexus: L1-4.

Recall: Sacral plexus L4-5, S1-4

56
Q

Kidneys are at the level of?

A

T12-L3

57
Q

Order by which structures leave the renal hilum?

A

From anterior to posterior: VAP. Vein, artery, pelvis

58
Q

Upon examining the CT stonogram of a patient, you note that one of the kidneys has their hilum at the level of L2, while the other has its hilum at L1. Which kidney has its hilum at L2?

A

Right! the right is lower than the left kidney, and its vessels are shorter than the left’s.

59
Q

As a urologist performing a nephrectomy, you wanted to make sure that the hilum of the right kidney has no infiltration of the tumor. Which of the following structures would you need to elevate and reflect to do so?

a. Duodenum
b. Stomach
c. Ascending colon
d. Adrenal gland

A

A.

Recall:
Anterior to right kidney: duodenum, liver
Anterior to left kidney: Pancreas, spleen, stomach

60
Q

In a renal transplantation, which of the following pairs of blood vessel anastomoses that is performed is correct?

a. Renal artery - abdominal aorta
b. Renal vein - IVC
c. Renal artery - external iliac artery
d. Renal vein - external iliac vein

A

D!

Recall: Renal artery - internal iliac artery
Renal vein - external iliac vein

61
Q

A 4 y/o male was brought in for an incidental finding of increased BP on routine check-up. On abdominal PE, you palpate a mass that crosses the midline. Further work-up revealed that he had elevated urine VMA and metanephrines. Abdominal MRI performed revealed a tumor in his adrenal gland. From which embryologic structure did this tumor come from?

a. Splanchnic mesoderm
b. Somatic mesoderm
c. Endoderm
d. Ectoderm

A

D. The tumor exhibits characteristics of a neuroblastoma, the most common abdominal tumor of childhood, that crosses the midline (Eilms does NOT cross the midline). The tumor comes from the adrenal medulla, which comes from the ectoderm, specifically the neural crest cells. Recall that the cortex comes from the splanchnic mesoderm.

62
Q

A patient with pheochromocytoma will have the tumor excised. Which of the following blood vessels should be ligated during surgery?

a. Inferior suprarenal from the Inferior phrenic
b. Middle suprarenal from the abdominal aorta
c. Inferior suprarenal from the abdominal aorta
d. Superior suprarenal from the renal artery

A

B.

Recall:
SUPERIOR suprarenal from the Inferior phrenic
MIDDLE suprarenal from the abdominal aorta
INFERIOR suprarenal from the renal artery

63
Q

Addison vs Cushing?

A

Addison : adrenal INSUFFICIENCY

Cushing : adrenal HYPERPLASIA

64
Q

A urologist was called in by the OB GYN surgical team for intra-operative referral for ureteral intubation during a hysterectomy for multiple large myoma uteri. Why does ureteral intubation help safeguard the ureter in this procedure?

a. In a hysterectomy, the vessels that need to be ligated, the uterine arteries, are found crossing SUPERIOR to the ureters as the ureters turn to go beneath the broad ligament.
b. In a hysterectomy, the vessels that need to be ligated, the gonadal arteries, are found crossing INFERIOR to the ureters as the ureters turn to go beneath the broad ligament.
c. both
d. None of the above

A

A! Recall that in OB GYN surgeries, the ureter is in danger of being ligated or damaged accidentally at 3 points:

  1. ovarian vessels: ureters found medial to them
  2. Uterine vessels: ureters found inferior to them (bridge over troubled water)
  3. Cervix: ureters found lateral to both sides of cervix

Recall:
For males, the ureter is crossed by the VAS DEFERENS

65
Q

A 55 y/o male patient comes in the ER complaining of flank pain that radiates from then flank down to his scrotum. The patient also has reddish discoloration of his urine a few hours before he went to the ER. A CT stonogram performed revealed a ureteric stone lodged along the ureter. Which dermatome supplies the pain of renal colic?

a. T11 to L4
b. T11 to L2
c. L1 to L3
d. L1 to L2

A

B.

66
Q

A 55 y/o male patient comes in the ER complaining of flank pain that radiates from then flank down to his scrotum. The patient also has reddish discoloration of his urine a few hours before he went to the ER. A CT stonogram performed revealed a ureteric stone lodged along the ureter. Which of the following ureteral constrictions did the stone most likely lodge in?

a. Ureteropelvic
b. Ureterovesical
c. Crossing of the external iliacs in the pelvic brim
d. None of the above

A

B. Narrowest and MC site of ureteral stone impaction

67
Q

A 55 y/o male patient comes in the ER complaining of flank pain that radiates from then flank down to his scrotum. The patient also has reddish discoloration of his urine a few hours before he went to the ER. A CT stonogram performed revealed a ureteric stone lodged along the ureter. You also note a muscle behind the ureter. Which muscle is this?

a. quadratus lumborum
b. transversus abdominis
c. internal oblique
d. psoas major

A

D. Recall that the psoas major muscles and the bifurcation of the common iliacs lie posterior to the ureters. Anteriorly, you find the gonadal vessels.

68
Q

The collecting tubules are derived from which derivative of the metanephros?

A

Metanephric diverticulum/ureteric bud

69
Q

The nephrons are derived from which derivative of the metanephros?

A

metanephric tubules/metanephric blastema

Oh yeah Anatomy! (3 decks)

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