Abdomen and Pelvis I Flashcards
(35 cards)
Lies anterior to the left common iliac vein.
Left common iliac artery
Is superior to the splenic vein in the midline.
Coeliac trunk
Runs a tortuous course along the superior border of the pancreas.
Splenic artery
Passes anterior to the third part of the duodenum.
Superior mesenteric artery
To which of the listed group of lymph nodes do the following structures first drain?
Testis
Para-aortic
Lymphatics run back with the testicular artery to the para-aortic nodes lying alongside the aorta at the level of origin of the testicular arteries (L2).
To which of the listed group of lymph nodes do the following structures first drain?
Scrotum
Superficial inguinal
Unlike the testis the lymphatic drainage of the scrotum is to the superficial inguinal nodes.
To which of the listed group of lymph nodes do the following structures first drain?
Cervix
Iliac
The cervix drains to external and internal iliac nodes by lymphatic channels that run respectively in front of or behind the ureter, and also to the sacral nodes via the uterosacral ligaments.
To which of the listed group of lymph nodes do the following structures first drain?
Cervix
Lower rectum
Iliac
The lower 1/3 rectum and upper anal canal drain to the internal and common iliac nodes along the middle rectal and inferior rectal vessels. There is also drainage to the sacral nodes and along the superior rectal (from IMA) arteries to the pre-aortic nodes.
Cancer of the rectum commonly spreads via the lymphatic vessels, thus surgical attempts at cure must include removal of all these lymphatics.
n the following which artery and the region that it primarily supplies are incorrectly paired?
(Please select 1 option)
Left gastric:cardiac part of stomach IncorrectIncorrect answer selected
Middle colic: descending colon This is the correct answerThis is the correct answer
Right colic: ascending colon
Right gastric : pylorus of stomach
Right gastroepiploic : greater curvature
The middle colic supplies the transverse colon.
Afferent fibres from the carotid sinus travel via which of the following?
(Please select 1 option)
Accessory nerve. IncorrectIncorrect answer selected
Cervical sympathetics
Glossopharyngeal nerve. This is the correct answerThis is the correct answer
Recurrent laryngeal nerve.
Vagus nerve
The sinu-carotid nerve (a branch of the glossopharyngeal nerve) supplies the carotid sinus and carotid body.
The fibres pass centrally to the vasomotor centre.
A 24-year-old actress has generalised lymphadenopathy and splenomegaly. She is diagnosed to be suffering from acute myeloid leukaemia.
Myelocyte precursors
Acute myeloid leukaemia is characterised by a clonal proliferation of myeloid precursors with reduced capacity to differentiate into more mature cellular elements.
A 8-year-old girl with a paravaginal mass. Biopsy confirms a diagnosis of rhabdomyosarcoma.
Skeletal muscle cell
The classification of a tumour as rhabdomyosarcoma requires the identification of features of skeletal muscle lineage.
A 40-year-old teacher presents with a well circumscribed non-tender lump on her back. A diagnosis of lipoma is made.
Adipocyte
Lipoma is a benign tumour of predominantly adipocytes.
The position of the ‘transpyloric plane of Addison’ is located at a point half way between the suprasternal notch of the manubrium and the symphysis pubis.
Which of the following is found at this level?
(Please select 1 option)
Bifurcation of the aorta
Entry of the ureters into the bladder
Origin of the superior mesenteric artery
Passage of the inferior vena cava through the diaphragm
Termination of the inferior mesenteric vein
Origin of the superior mesenteric artery
The transpyloric plane of Addison is important as it is a constant landmark even in the obese patient.
It corresponds to the body of the first lumbar vertebra.
A number of important structures are found at this level:
Spinal cord ends
Origin of superior mesenteric artery
Hilum of the kidneys
Origin of the portal vein (from the superior mesenteric and splenic veins)
Gall bladder.
The aorta terminates at the level of the fourth and fifth vertebra into the iliac arteries. The distal ureter passes over these vessels.
On reviewing the CT films of a 65-year-old male with chronic pancreatitis the radiologist notes a structure lying posterior to the head of the pancreas. Which of the following structures lies posterior to the head of the pancreas? (Please select 1 option) Abdominal aortic area Cystic artery Duodenum Inferior vena cava Right kidney
IVC
The pancreas can be divided into a head, neck, body and tail.
The head of the pancreas lies at the L2 vertebra level.
It overlies the inferior vena cava, as well as the right and left renal veins, the common bile duct and the superior mesenteric vein and artery.
When looking at a CT scan of the pelvis, which of the following would be seen as the superior relation of the male bladder? (Please select 1 option) Levator ani Obturator internus Pubic symphysis Rectum Sigmoid colon
Sigmoid colon This is the correct answerThis is the correct answer
The relations of the bladder are:
Superior - Sigmoid colon, small intestine (uterus in females)
Anterior - Pubic symphysis
Posterior - Rectum, seminal vessels (vagina and cervix in females)
Lateral - Levator ani and obturator internus.
You are assisting in a laparoscopic cholecystectomy.
During the operation the arterial supply to the gallbladder, the cystic artery, is ligated.
Of which of the following is the cystic artery a direct branch?
(Please select 1 option)
Abdominal aorta
Gastroduodenal artery
Left hepatic artery
Right hepatic artery
Splenic artery
Right hepatic artery
The gallbladder is normally supplied by the cystic artery which is a branch of the right hepatic artery.
The cystic artery is formed within the hepatoduodenal ligament.
The right hepatic artery is a branch of the hepatic artery.
The gastroduodenal artery also arises from the hepatic artery.
The hepatic artery is a branch of the celiac trunk, as are the splenic and left gastric arteries.
The cystic artery can be identified during surgery as it lies in the triangle formed by the liver, cystic duct and common hepatic duct.
A 44-year-old lady with a history of alcohol abuse is brought to the emergency department after a large haematemesis.
Fluid resuscitation is started but it appears that bleeding is ongoing.
An emergency endoscopy is arranged. The gastroenterologist notes that she is bleeding from varices in the lower part of her oesophagus.
Which vein drains this area into the portal system?
(Please select 1 option)
Azygous vein
Inferior mesenteric vein
Left gastric vein
Lower oesophageal vein
Thoracic vein
Left gastric vein
Varicosities are formed at areas of connection between the systemic venous and portal venous systems. The most important area clinically is in the lower osesophagus, haemorrhage in this area can be fatal. The left gastric vein drains this area into the portal vein. The azygous vein is part of the systemic venous system.
Other important sites of anastamosis are the peri-umbilical region, the bare area of the liver, the retroperitoneum and the anal canal.
A 23-year-old male attends casualty with a nose bleed following a blow to his face during a rugby match.
On examination the blood appears to be coming from the anterior inferior part of the left nostril.
What artery is likely to be the source of the bleeding?
(Please select 1 option)
The anterior ethmoidal artery
The greater palatine artery
The posterior ethmoidal artery
The sphenopalatine artery
The superior labial artery
The superior labial artery This is the correct answerThis is the correct answer
The superior labial artery is a branch of the facial artery and supplies the anterior inferior part of the nasal cavity.
The rest of the inferior nasal cavity is supplied by branches derived from the maxillary artery, namely the sphenopalatine and greater palatine arteries.
The superior part of the nasal cavity is supplied by the anterior and posterior ethmoidal arteries which are branches of the ophthalmic artery.
During a road traffic accident a 76-year-old patient sustains a sternal injury and is tender over the manubriosternal joint. Of which type of joint is the manubriosternal joint an example? (Please select 1 option) A double synovial joint A fibrous joint A primary cartilaginous joint A single synovial joint A symphysis
A symphysis This is the correct answerThis is the correct answer
The manubriosternal joint is a symphysis or secondary cartilaginous joint. Both articular surfaces are covered with hyaline cartilage and united by fibrocartilage.
The greater splanchnic nerves usually synapse in which of the following?
(Please select 1 option)
Coeliac ganglion
Ganglia of the lower thoracic sympathetic trunk
Hypogastric plexus
Inferior mesenteric ganglion
Superior mesenteric ganglion
Coeliac ganglion
The greater splachnic nerves arise from T5-T9 and pass forwards and downwards on the sides of the vertebral bodies.
They pierce the crus of the diaphragm and then join the coeliac ganglion.
A 67-year-old gentleman is brought to the emergency department vomiting large volumes of fresh blood. He is in a state of hypovolaemic shock.
Following resuscitation, an upper GI endoscopy is performed and a bleeding vessel is injected in the posterior aspect of the first part of the duodenum.
Which vessel is the cause of the bleeding?
(Please select 1 option)
Gastroduodenal artery
Inferior pancreaticoduodenal artery
Left hepatic artery
Right gastric artery
Right gastroepiploic artery
The gastroduodenal artery is a posterior relation of the first part of the duodenum. Erosion of an ulcer through the arterial wall results in severe haemorrhage.
The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery (SMA).
The gastroduodenal artery is a branch of the hepatic artery.
A 73-year-old gentleman presents to the outpatient clinic with a swelling in the scrotum. Further examination demonstrates that the spermatic cord cannot be palpated separately from the swelling and the lump does not transilluminate. What is the most likely diagnosis? (Please select 1 option) Direct inguinal hernia Epidydimal cyst Hydrocele Indirect inguinal hernia Testicular tumour
Indirect inguinal hernia
The fact the cord cannot be palpated separately suggests that the swelling is arising from above the testicle and cord. This makes an inguinal hernia the most likely diagnosis.
Almost all direct inguinal hernias are limited to the inguinal canal and do not enter the scrotum.
A hydrocele would transilluminate.
Epidydimal cysts and testicular tumours cause scrotal swelling but the cord would be able to be palpated.
A 46-year-old homosexual man presents to clinic complaining of a lump that has appeared from his anus.
Per rectal examination and proctoscopy reveal a hard irreducible mass arising from the lower half of the anal canal.
Which additional finding would suggest a diagnosis of squamous cell carcinoma rather than adenocarcinoma?
(Please select 1 option)
Inguinal lymphadenopathy
Liver metastases
Previous haemorrhoids
Pruritus ani
Rectal bleeding
inguinal lymphadenopathy
The upper half of the anal canal is lined by columnar epithelium and the lower half of the anal canal is lined by squamous epithelium.
The lymphatic drainage between the two areas is different; the upper half drains along the superior rectal vessels to the abdominal nodes whereas the lymph drains from the lower anus to the inguinal nodes.
