Questions Flashcards Preview

SHB - Exam 2 > Questions > Flashcards

Flashcards in Questions Deck (56):
1

If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper's and Scarpa's fascias
External abdominal oblique and internal abdominal oblique muscles
Internal abdominal oblique and transversus abdominis muscles
Skin and deep fascia of the abdominal wall
Tranversus abdominis muscle and peritoneum

Transversus Abdominus & peritoneum

2

loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region?
Deep inguinal ring
Lateral inguinal fossa
Medial inguinal fossa
Superficial inguinal ring
Supravesical fossa

Medial Inguinal Fossa

3

While performing a routine digital examination of the inguinal region in a healthy teen-aged male, the physician felt a walnut-sized lump protruding from the superficial inguinal ring. She correctly concluded that it was :
definitely an indirect inguinal hernia
possibly an unusual femoral hernia
definitely a direct inguinal hernia
possibly an enlarged superficial inguinal lymph node
either a direct or an indirect inguinal hernia

Either a direct or indirect hernia

4

Where is the deep inguinal ring found?

The deep inguinal ring is found near the midpoint of the inguinal ligament, below the anterior superior iliac spine. This ring is lateral to the inferior epigastric artery. The superficial inguinal ring is found above the pubic tubercle. Remember--the supravesical fossa is the space between the median and medial umbilical folds.

5

An elderly patient with a large indirect inguinal hernia came to your clinic complaining of pain in the scrotum. You conclude that the hernial sac is compressing the following nerve:
Femoral branch of the genitofemoral
Femoral
Iliohypogastric
Ilioinguinal
Subcostal

Ilioinguinal

6

A 45-year-old porter develops a direct inguinal hernia. If the hernia extended through the superficial inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the:
External spermatic fascia
Internal spermatic fascia
Peritoneum and extraperitoneal connective tissue
Weak fascia of the transversus abdominis muscle lateral to the falx

Internal Spermatic Fascia

7

Which organ becomes retroperitoneal during rotation of the gut tube?
Duodenum
Kidney
Spleen
Stomach
Transverse Colon

Duodenum

8

During a cholecystectomy (removal of the gall bladder), the surgical resident accidentally jabbed a sharp instrument into the area immediately posterior to the epiploic foramen (its posterior boundary). He was horrified to see the surgical field immediately fill with blood, the source which he knew was the:
aorta
inferior vena cava
portal vein
right renal artery
superior mesenteric vein

IVC

(Portal Vein is anterior to epiploic foramen)

9

The division between the true right and left lobes (internal lobes) of the liver may be visualized on the outside of the liver as a plane passing through the:
gallbladder fossa and round ligament of liver
falciform ligament and ligamentum venosum
gallbladder fossa and inferior vena cava
falciform ligament and right hepatic vein
gallbladder fossa and right triangular ligament

Gall bladder Fossa & IVC

10

A 50-year-old female patient with severe jaundice was diagnosed with pancreatic cancer. You suspect that the tumor is located in which portion of the pancreas?
Head
Neck
Body
Tail
Uncinate process

HEAD
- obstructing the COMMON BILE DUCT

11

A medical student was asked to identify a small specimen taken for pathological examination from a surgically removed duodenum. The student noted that the specimen revealed a thin wall and no circular folds. The specimen is from which segment?
Superior
Descending
Horizontal
Ascending

Superior Part

12

Upon endoscopic examination of a 65-year-old man who had a history of a chronic duodenal ulcer, it was found that the ulcer had been eroding the posterior wall of the first part of the duodenum. If erosion perforates the wall, the gastric expellant of high acidity would endanger the structures in its vicinity. Which is least likely to be endangered?
Common bile duct
Gastroduodenal artery
Main pancreatic duct
Portal vein

Main Pancreatic DUct

13

A 58-year-old patient was diagnosed with a severe case of portal hypertension due to alcoholic cirrhosis of the liver. It was determined that a bypass between the vessels of the portal and caval systems was necessary. The plan most likely to be successful is:
Coronary vein to right gastro-omental vein
Left colic vein to sigmoidal vein
Inferior mesenteric vein to splenic vein
Splenic vein to left renal vein
Superior rectal vein to inferior rectal vein

Splenic Vein to Left Renal Vein

The splenic vein is a major vein of the portal system, while the left renal vein is a major vein of the caval system.

14

An ulcer near the pyloroduodenal junction perforated and eroded a large artery immediately posterior to the duodenum. The ligation of the eroded vessel at its origin would LEAST affect the arterial supply to the:
First part of the duodenum
Second part of the duodenum
Greater curvature of the stomach
Head of the pancreas
Tail of the pancreas

Tail of the pancreas

15

A surgeon needs to construct a bypass between the veins of the portal and caval systems to circumvent insufficient drainage through the natural portacaval anastomoses. Which plan is likely to be successful?
Coronary vein to right gastroepiploic vein
Inferior mesenteric vein to splenic vein
Left colic vein to middle colic vein
Splenic vein to left renal vein
Superior mesenteric vein to splenic vein

SPlenic Vein & Left Renal Vein

16

A patient with jaundice was diagnosed with cancer of the head of the pancreas. Which structure was compressed by the tumor?
Common bile duct
Common hepatic duct
Cystic duct
Left hepatic duct
Right hepatic duct

Common Bile Duct

17

In order to do a vagotomy (section of vagal nerve trunks) to reduce the secretion of acid by cells of the stomach mucosa in patients with peptic ulcers, one needs to cut the gastric branches and retain vagal innervation to other abdominal organs. Where would a surgeon look for these branches in relation to the stomach?
along the gastroepiploic vessels
along the greater curvature
along the lesser curvature
in the base of the omental apron
in the gastrocolic ligament

Lesser Curvature

18

Which of the following structures does not lie at least partially in the retroperitoneum?
adrenal gland
duodenum
kidney
pancreas
spleen

Spleen

19

Which ligament is a derivative of the dorsal mesogastrium?
Coronary
Falciform
Hepatoduodenal
Hepatogastric
Gastrocolic

Gastrocolic

20

A 60-year-old male executive who had a history of a chronic duodenal ulcer was admitted to the ER exhibiting signs of a severe internal hemorrhage. He was quickly diagnosed with perforation of the posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric expellent. The artery is most likely the:
Common hepatic
Gastroduodenal
Left gastric
Proper hepatic
Superior mesenteric

Gastoduodenal

21

During emergency surgery, it was found that a chronic gastric ulcer had perforated the posterior wall of the stomach and eroded a large artery running immediately posterior to the stomach. The artery is the:
Gastroduodenal
Common hepatic
Left gastroepiploic
Splenic
Superior mesenteric

SPLENIC

22

The fundus of the stomach receives its arterial supply from the:
Common hepatic
Inferior phrenic
Left gastroepiploic
Right gastric
Splenic

Splenic

23

A 57-year-old male complains of intense chest pain, but tests rule out any cardiac pathology. It was determined that the patient suffers from an esophageal (hiatal) hernia in which the stomach herniates through an enlarged esophageal hiatus. Muscle fibers from which of the following parts of the diaphragm would border directly on this hernia?
left crus
right crus
central tendon
costal fibers
sternal fibers

Right Crus

24

The boundaries of the perineum include all the following except:
Ischiopubic rami
Ischial tuberosity
Tip of the coccyx
Sacrotuberal ligament
Sacrospinal ligament

Sacrotuberal Ligament

25

The part of the male reproductive tract which carries only semen within the prostate gland is the:
Prostatic urethra
Membranous urethra
Seminal vesicle
Ductus deferens
Ejaculatory duct

Ejaculatory DUct

26

The perineum is bounded by all of the following skeletal elements except:
coccyx
ischiopubic ramus
spine of ischium
symphysis pubis

Ischiopubic Ramus

27

During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate?
Deep perineal
Dorsal nerve of the penis
Genitofemoral
Pelvic splanchnics
Pudendal

Pelvic Splanchnics

28

In order to perform an episiotomy prior to childbirth, the perineum must be anesthetized. By inserting a finger in the vagina and pressing laterally, what palpable bony landmark can be used as the posterior limit of the pudendal canal?
Coccyx
Ischial tuberosity
Ischiopubic ramus
Obturator groove
Ischial spine

Ischial Spine

-The pudendal canal travels from the lesser sciatic foramen to the deep transverse perineus muscle. The ischial spine marks the posterior limit of the pudendal canal, so that's the correct answer. If you weren't sure about that, you might also notice that the physician here is trying to perform a transvaginal pudendal nerve block. This means that the physician will be using the ischial spine as a landmark and inserting the needle near this prominence, coating the pudendal nerve with anesthesia before it gives off its branches.

29

The prostate gland:
Contains upper, middle and lower lobes
Encircles the urethra
Is well imaged radiologically using an intravenous urogram
Is extraperitoneal
B and D

B & D

30

Which skeletal feature would you consider to be most characteristic of the female pelvis?
Subpubic angle of 90 degrees or greater
Marked anterior curvature of the sacrum
Tendency to vertical orientation of the iliac bones
Prominent medial projection of the ischial spines

Subpubic angle of 90 degrees or greater

31

The rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the:
urinary bladder
urethra
uterine cervix
vagina

VAGINA

In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the posterior fornix of the vagina. This means that surgeons can make an incision in the posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337 for a picture of this relationship

32

A patient has sustained a fracture to the base of the skull. Thorough examination concluded that the right greater petrosal nerve, among other structures, has been injured. This conclusion was based on which of the patient's signs:
Partial dryness of the mouth due to lack of salivary secretions from the submandibular and sublingual glands
Partial dryness of the mouth due to lack of salivary secretions from the parotid gland
Dryness of the right cornea due to lack of lacrimal secretion
Loss of taste sensation from the right anterior 2/3rd of the tongue
Loss of general sensation from the right anterior 2/3rd of the tongue

Dryness of the right cornea due to lack of lacrimal secretion

33

he soft palate is active in all of the following except:
Breathing
Chewing
Coughing
Swallowing
Yawning

BREATHING

34

Thoracic duct
A 16-year-old male suffered a stab wound in which a knife blade entered immediately superior to the upper edge of the right clavicle near its head. He was in extreme pain, which was interpreted by the ER physician as a likely indicator of a collapsed lung following disruption of the pleura. If that was true, what portion of the pleura was most likely cut or torn?
costal pleura
cupola
hilar reflection
mediastinal pleura
pulmonary ligament

CUPOLA

35

During a lung transplant procedure, an observing 4th year attempted to pass his index finger posteriorly inferior to the root of the left lung, but he found passage of the finger blocked. Which structure would most likely be responsible for this?
Costodiaphragmatic recess
Cupola
Inferior vena cava
Left pulmonary vein
Pulmonary ligament

Pulmonary ligament

36

What 3 muscles attach to the posterior border of the Thyroid Cartilage?

1. Salpingopharyngeus
2. Palatopharyngeus
3. Stylopharyngeus

37

What three muscles attach to the Ischial Tuberosity?

1. Semitendinosus
2. Semimebranosus
3. Long head of Biceps Femoris

38

Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac?
aorta
azygos vein
esophagus
thoracic duct
trachea

Esophogus

39

What are the contents of the posterior mediastinum?

This area contains the descending thoracic aorta, the azygos system, the esophagus, the thoracic duct, and lymph nodes

40

What is the order of the thoracic duct, esophagus, and azygos vein in the posterior mediastinum?

A, T, E (left to right)

Azygos
Thoracid Duct
Esophogus

41

Most of the drainage of the thoracic body wall reaches the superior vena cava via the azygos vein. A notable exception is the left superior intercostal vein, which normally drains into the:
Left brachiocephalic vein
Left bronchial vein
Left pulmonary vein
Left subclavian vein
Superior vena cava

Left Brachiocephalic Vein

42

You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region:
Epigastric
Left inguinal
Left lumbar
Right hypochondrial
Hypogastric

EPIGASTRIC

43

Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is:
Genitofemoral
Iliohypogastric
Subcostal
Spinal nerve T10
Spinal nerve T9

ILIOHYPOGASTRIC

44

If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper's and Scarpa's fascias
External abdominal oblique and internal abdominal oblique muscles
Internal abdominal oblique and transversus abdominis muscles
Skin and deep fascia of the abdominal wall
Tranversus abdominis muscle and peritoneum

Transversus Abdominus & Peritoneum

45

The spleen:
Develops in the dorsal mesogastrium
Develops in the ventral mesogastrium
Develops in both the dorsal and ventral mesogastria
Is always retroperitoneal
Becomes retroperitoneal during its development

Develops in the dorsal mesogastrium

46

Which of the following structures does not lie at least partially in the retroperitoneum?
adrenal gland
duodenum
kidney
pancreas
spleen

SPLEEN

- covered entirely by VISCERAL peritoneum

47

In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser omentum. Before incising the mesentery she was careful to find and preserve a nerve lying in the upper portion of the hepatogastric ligament, i.e., the
Celiac branch of the anterior vagal trunk
Celiac branch of the posterior vagal trunk
Greater splanchnic branch to the right suprarenal gland
Hepatic branch of the anterior vagal trunk
Hepatic branch of the posterior vagal trunk

Hepatic Branch of Anterior Vagal Trunk

48

The fundus of the stomach receives its arterial supply from the:
Common hepatic
Inferior phrenic
Left gastroepiploic
Right gastric
Splenic

SPLENIC

49

During an emergency splenectomy, the surgeon accidentally tore the gastrosplenic ligament and its contents. The artery (ies) likely to be damaged in this event is (are) the:
Left gastric
Splenic
Short gastric
Middle colic
Caudal pancreatic

Short Gastric

50

While performing emergency surgery to control hemorrhage brought on by arterial erosion caused by a duodenal ulcer, surgeons ligated the badly damaged gastroduodenal artery near its origin, which affected all of its branches as well. Assuming "average anatomy", in which of the following arteries would blood now flow in retrograde fashion (backwards) from collateral sources?
Left hepatic
Right gastroepiploic
Short gastric
Left gastric
Omental branches

Right Gastropepiploic

51

Meckel's diverticulum:
is an abnormal persistance of the urachus
is a site of ectopic pancreatic tissue
is caused by a failure of the midgut loop to return to the abdominal cavity
is an abnormal connection of the midgut to the duodenum
is associated with polyhydramnios

Site of ectopic pancreatic tissue

52

A patient was admitted with symptoms of bowel obstruction. Further examination revealed that the obstruction was caused by the nutcracker-like compression of the bowel between the superior mesenteric artery and the aorta. The compressed bowel is most likely the:
Duodenum
Jejunum
Ileum
Ascending colon
Transverse colon

Duodenum

53

suprarenal gland
The celiac plexus of nerves may contain fibers derived from all of the following sources except:
posterior vagal trunk
greater thoracic splanchnic nerve
lesser thoracic splanchnic nerve
lumbar splanchnic nerves

Lesser Thoracic

54

The nerves that end on the secretory cells of the medulla of the suprarenal glands are principally:
Preganglionic fibers from the greater thoracic splanchnic nerve
Postganglionic fibers from the celiac plexus
Postganglionic fibers from the aorticorenal ganglia
Preganglionic fibers from the lesser thoracic splanchnic nerve
Postganglionic fibers from the renal plexus

Pre-ganglionic fibers from the greater thoracic splanchnic nerves

55

The cisterna chyli accompanies which structure as it passes through the diaphragm?
Inferior vena cava
Esophagus
Greater thoracic splanchnic nerve
Aorta

AORTA

56

During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate?
Deep perineal
Dorsal nerve of the penis
Genitofemoral
Pelvic splanchnics
Pudendal

Pelvic Splanchnics