Gray's Review Flashcards
A 1 year old female is admitted to the hospital with a palpable mass within one of her labia majora. Radiographic examination reveals that a loop of intestine has herniated into the visibly enlarged labium majus. This condition is due to failure of the processus vaginalis to close off. From which of the following tissue layers is the process derived?
A. Parietal peritoneum B. Extraperitoneal tissue C. Transversalis fascia D. Dartos fascia E. Internal abdominal oblique aponeurosis
A. Parietal peritoneum
Rotation of the stomach during development results in movement of the left vagus n. from its original position. Through approximately how many degrees of rotation does the nerve move, and what is its final position?
A. 90 degrees to become anterior vagal trunk
B. 90 degrees to become the posterior vagal trunk
C. 270 degrees to become the anterior vagal trunk
D. 270 degrees to become the posterior vagal trunk
E. 180 degrees to become the right vagal trunk
A. 90 degrees to become the anterior vagal trunk
A newborn was diagnosed with eventration of the diaphragm, wherein one half of the diaphragm ascends into the thorax during inspiration, but the other half contracts normally. What is the most likely cause of this condition?
A. Absence of pleuropericardial fold
B. Absence of musculature in one half of diaphragm
C. Failure of migration of the diagphragm
D. Failure of development of septum transversum
E. Absence of pleuroperitoneal fold
B. Absence of musculature in one half of diaphragm
A 3 day old infant has difficulty breathing; a CT of his chest and abdomen reveals absence of central tendon of the diaphragm. Which of the following structures failed to develop properly?
A. Pleuroperitoneal folds B. Pleuroepicardial folds C. Septum transversum D. Cervical myotomes E. Dorsal mesentery of the esophagus
C. Septum transversum
A 23 y/o woman is admitted with severe abdominal pain, nausea, and vomiting. History taking shows that 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 afferent fibers of the referred pain?
A. Greater thoracic splanchnic nerves B. Dorsal primary rami of intercostal nerves C. Phrenic nerves D. Vagus nerves E. Pelvic splanchnic nerves
A. Greater thoracic splanchnic nerves
A 45 year old male was admitted to the hospital with groin pain and a palpable mass just superior to the inguinal ligament. The patient was diagnosed with an inguinal hernia and a surgical repair was performed. During the operation the surgeon found a loop of intestine passing through the deep inguinal ring. Which of the following types of hernia was this?
A. Direct inguinal B. Umbilical C. Femoral D. Lumbar E. Indirect inguinal
E. Indirect inguinal
A 45 y/o male entered the ED with a complaint of severe abdominal pain. During PE it is observed that his cremasteric reflex is absent. Which of the following nerves is responsible for the efferent limb of the cremasteric reflex?
A. Ilioinguinal B. Iliohypogastric C. Genitofemoral D. Pudendal E. Ventral ramus of T12
C. Genitofemoral
A 49 y/o man presents with acute abdominal pain and jaundice. Radiographic studies reveal a tumor in a head of the pancreas. Which of the following structures is most likely being obstucted?
A. Common bile duct B. Common hepatic duct C. Cystic duct D. Accessory pancreatic duct E. Proper hepatic artery
A. Common bile duct
A 44 y/o man is admitted to the ED with excessive vomiting and dehydration. Radiographic images demonstrate that part of the bowel is being compressed between the abdominal aorta and the superior mesenteric artery. Which of the following intestinal structures is most likely being compressed?
A. Second part of duodenum B. Transverse colon C. Third part of duodenum D. First part of duodenum E. Jejunum
C. Third part of duodenum
A 35 y/o male is admitted to the hospital from the ED because of excruciating pain in the back and left shoulder. A CT scan reveals an abscess in the upper part of the left kidney, but no abnormality is detected in the shoulder region. The shoulder pain may be caused by the spread of inflammation to which of the following neighboring structures?
A. Descending colon B. Diaphragm C. Duodenum D. Liver E. Pancreas
B. Diaphragm
In a routine visit to the clinic for his checkup, a 42 y/o male is informed that radiographic examination has given strong evidence that he has a malignancy of his scrotum. which of the following nodes are the first lymph nodes that drain the affected area?
A. Superficial inguinal B. Internal iliac C. Lumbar D. Presacral E. Axillary
A. Superficial inguinal
A 63 y/o man with hx of alcoholism is brought to the ED with hematemesis. Endoscopic findings suggest bleeding from esophageal varices. The varices are most likely a result of the anastomoses between the left gastric vein and which other vessel or vessels?
A. Azygous system of veins B. Inferior vena cava C. Left umbilical vein D. Superior mesenteric vein E. Subcostal veins
A. Azygous system of veins
A 34 y/o man is undergoing an emergency appendectomy. After the appendectomy has been performed successfully, the patient undergoes exploratory laparoscopy. Which of the following anatomic features are the most useful to distinguish the jejunum from the ileum?
A. Jejunum has thinner walls than ileum
B. Jejunum has less mesenteric fat than ileum
C. Jejunum has more vascular arcades than ileum
D. Jejunum has more numerous lymphatic follicles beneath the mucosa than ileum
E. Jejunum has fewer villi compared with the ileum
B. Jejunum has less mesenteric fat than ileum
An anteroposterior radiograph is taken of the lumbar region in a 31 y/o female patient who had been treated for tuberculosis spondylitis at T12-L1. Pt has been asymptomatic for 10 years. Which of the following is most likely site of calcified Tb abscess?
A. Body of pancreas B. Cecum C. Fundus of stomach D. Psoas fascia E. Suspensory ligament of the duodenum
D. Psoas fascia
A 32 y/o woman was admitted to the hospital with a complaint of pain over her umbilicus. Radiographic examination revealed acute appendicitis. The appendix was removed successfully in an emergency appendectomy. One week postoperatively the patient complained of paresthesia of the skin over the pubic region and the anterior portion of her perineum. Which of the following nerves was most likely injured during the appendectomy?
A. Genitofemoral B. Ilioinguinal C. Subcostal D. Iliohypogastric E. Spinal nerve T9
B. Ilioinguinal
A 61 y/o woman had been scheduled for a cholecystectomy. During the operation the scissors of the surgical resident accidentally entered the tissues immediately posterior to the epiploic foramen. The surgical field was filled immediately with profuse bleeding. Which of the following vessels was the most likely source of bleeding?
A. Aorta B. Inferior vena cava C. Portal vein D. Right renal artery E. Superior mesenteric vein
B. Inferior vena cava
A 45 y/o male is admitted to the hospital with a massive hernia that passes through the inguinal triangle. Which of the following structures is used to distinguish a direct inguinal hernia from an indirect inguinal hernia?
A. Inferior epigastric vessels B. Femoral canal C. Inguinal ligament D. Rectus abdominis muscle (lateral border) E. Pectineal ligament
A. Inferior epigastric vessels
A 48 y/o man has had 3 episodes of upper GI bleeding from esophageal varices. He has a history of chronic alcoholism but has recently been rehabilitated. Further evaluation shows ascites and splenomegaly. Which of the following surgical venous anastomoses is most commonly used to relieve these symptoms and signs before a liver transplant is attempted?
A. Left gastric to splenic v. B. Right gastric to left gastric v. C. Right renal to right gonadal v. D. Splenic to left renal v. E. Superior mesenteric to inferior mesenteric v.
D. Splenic to left renal v.
A 55 y/o man is admitted to the hospital with nausea, vomiting, and hematuria. A CT scan examination reveals a neoplasm in the posterior surface of the inferior pole of his left kidney that has invaded through the renal pelvis, renal capsule, ureter, and fat. To which of the following regions will pain most likely be referred?
A. Skin of anterior and lateral thighs and femoral triangle
B. Skin over gluteal region, pubis, medial thigh, and scrotal area
C. Skin over medial, anterior, and lateral side of the thigh
D. Skin over the pubis and umbilicus
E. Skin over the pubis, umbilicus, and posterior abdominal wall muscles
B. Skin over gluteal region, pubis, medial thigh, and scrotal area
A 30 y/o female complains of weakness and fatigue over the past 6 months. She has a 3 month acute hx of severe HTN that has not responded to medication. Fasting BG is 140 mg/dl. A CT of the abdomen shows a 6 cm mass in the adrenal gland affecting the secretory cells of the adrenal medulla. Which of the following structures is most likely releasing products into the bloodstream to produce the HTN and other signs?
A. Preganglionic sympathetic axons in thoracic splanchnic nn
B. Cells of neural crest origin that migrated to the adrenal medulla
C. Preganglionic parasympathetic branches of the posterior vagal trunk
D. Postganglionic parasympathetic branches of the left or right vagus nn
E. Postganglionic fibers from pelvic splanchnic nn
B. Cells of neural crest origin that migrated to the adrenal medulla
A 51 y/o female 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 intraabdominal bleeding. Which of the following arteries is most likely source of bleeding?
A. Common hepatic a B. Inferior phrenic a C. Left gastroepiploic a D. Short gastric a E. Splenic a
D. Short gastric a
A 39 y/o woman is admitted to the hospital with pain radiating to her inguinal region. Radiographic and physical exam reveal a herniation. Which of the following is the most common type of hernia in a female patient?
A. Femoral hernia B. Umbilical hernia C. Direct inguinal hernia D. Indirect inguinal hernia E. Epigastric hernia
D. Indirect inguinal hernia
A 56 y/o male is admitted to the hospital with severe abdominal pain. The patient has a history of IBS affecting his rectum. Which of the following nerves will most likely be responsible for the transmission of pain in this case?
A. Lumbar sympathetic chains B. Pelvic splanchnic nerves C. Pudendal nerves D. Sacral sympathetic chains E. Vagus nerves
B. Pelvic splanchnic nerves
A 48 y/o female is admitted to the hospital with a distended abdomen. A CT scan exam provides evidence of ascites. In which of the following locations will an ultrasound machine most likely confirm the presence of the ascitic fluid with the patient in the supine position?
A. Subphrenic recess B. Hepatorenal recess (pouch of Morison) C. Rectouterine recess (pouch of Douglas) D. Vesicouterine recess E. Subhepatic recess
B. Hepatorenal recess (pouch of Morison)
A 58 y/o man was admitted to the hospital with complaints of pain in the RUQ and jaundice. Ultrasound examination reveals numerous large gallstones in his gallbladder. Which of the following nerves would transmit the pain of cholecystitis?
A. The right vagus nerve, with referral to the inferior angle of the scapula
B. Afferent fibers in spinal nerves T1 to T4
C. Visceral afferent fibers in the greater thoracic splanchnic nerve, with referral to the dermatomes from T6 to T8
D. Sympathetic T10 to T12 portions of greater thoracic splanchnic n. via celiac ganglion and celiac plexus
E. Afferent fibers of dorsal primary rami of spinal nerves T6 to T8, with referral to the epigastric region
C. Visceral afferent fibers in the greater thoracic splanchnic nerve, with referral to the dermatomes from T6 to T8
A 41 y/o woman is admitted to the hospital with upper abdominal pain. A gastroscopic examination reveals multiple small ulcerations in the body of the stomach. Which of the following nerves transmits the sensation of pain from this region?
A. Spinal nerves T5 to T12 B. Greater thoracic splanchnic nerves C. Lesser thoracic splanchnic nerves D. Lumbar splanchnic nerves E. Spinal nerves T12 to L2
B. Greater thoracic splanchnic nerves
