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Abdomen MCQs1. Regarding the urinary tracta. The narrowest points of the ureter are at the pelviureteric junction, where it crosses the pelvic brim, and at the vesicoureteric junction <- correctb. Kidney innervation is derived from segments L2-L5 – T11-L2 (groin pain)c. The hilum of the right kidney lies just above the transpyloric plane 5 cm from the midline – just below on R, 2.5cm lowerd. The hilum of the right kidney lies lateral to the psoas - ante. The left kidney lies over the tenth, eleventh and twelfth ribs -11th and 12th2. With regard to the blood supply of the rectum and anusa. It is principally the inferior rectal arteryb. The anal canal is a site of porto-systemic anastomosis <- correctc. The veins do not correspond to the arteriesd. The inferior mesenteric artery changes to the superior rectal artery at L3e. The vessels do not supply the full thickness of the anal wall3. Lymph drainage of the testes are toa. The deep inguinal nodesb. The mediastinal nodesc. The para-aortic nodes <- (R) and (L) lumbar (caval/aortic) and preaorticd. The pectoral group of axillary nodes e. The external iliac nodes4. Lymph drainage of the scrotum is toa. The superficial inguinal nodes <- the skin of lower abdo/upper thigh and genitals drain here firstb. The internal iliac nodesc. The deep inguinal doesd. The external iliac nodese. None of the above5. Regarding radiological imaging of the gastrointestinal tracta. The terminal ileum can be identified by haustrationsb. Haustrations represent the taeniae coli <-c. Air fluid levels on an erect abdominal X-ray are diagnostic of large bowel obstructiond. Gas should always be visible in the rectume. Small bowel is always visible on a normal abdominal X-ray6. Regarding the kidneysa. Each weighs about 340 gramsb. The left kidney lies below the transpyloric planec. The iliohypogastric and ilioinguinal nerves lie behind the posterior surface of the kidney <- also the subcostal nerve and vesselsd. Each kidney has six segments - 5e. The hilum is separated from the peritoneum on the right side by the 3rd part of the duodenum7. Regarding the uretersa. They exit the hilum behind the renal artery <- correctb. They are a continuation of the renal pelvis which is formed by the union of 10 major calyces – 2 or 3 major each from 2 or 3 minorc. They are each 40cm long – 25-30cmd. On a radiograph they run lust lateral to the transverse processes of the lumber vertebrae - mediale. The lower ends are supplied by the ureteric branch of the renal artery – aorta and common iliac8. All of the following are relations of the body of the pancreas EXCEPT:a. Left crus of diaphragmb. Left psoas musclec. Left kidney hilumd. Bile duct <– this lies behind the heade. Lesser sac9. Which of the following is INCORRECT?a. The inguinal canal of the female contains the round ligament of the uterusb. The deep inguinal ring is an opening in transverses muscle <- transversalis fasciac. The spermatic cord in the male emerges from the deep inguinal ringd. The inguinal canal lies above the medial half of the inguinal ligamente. The roof of the inguinal canal is formed by the lower edges of internal oblique and transverses muscles10. The duodenuma. Is a retroperitoneal structure – it is?, secondarily so (SAD PUCKER)b. Is 25cm in length <-truec. Lies between the levels of L2-L4 - L1-3d. In its fourth part lies to the right of the aorta – lies to the lefte. All of the above11. The highest branch of the abdominal aorta isa. Right suprarenal artery – this comes off the inferior phrenicb. Celiac trunk <- T12 the inferior phrenic is higher, but not listedc. Left renal arteryd. Left gonadal arterye. Superior mesenteric artery – L112. The main vessel supplying the body of the pancreas is thea. Superior pancreaticoduodenal artery - headb. Splenic artery <-correctc. Left gastric artery - stomachd. Left gastroepiploic artery - stomache. Inferior pancreaticoduodenal artery - head13. All of the following about the abdominal aorta are correct EXCEPT:a. It passes between the crura of the diaphragm at the level of T12 vertebra and terminates at the body of L4 vertebra - trueb. It is crossed by the splenic vein below the celiac trunk and above the superior mesenteric arteryc. It has the uncinate process of the pancreas lying anteriorlyd. It gives off 5 paired lumbar arteries – usually 4, L1-L4e. It continues as the median sacral artery <- true14. The uretera. Passes anterior to genitofemoral nerve <-correctb. Develops from the metanephric capc. Is represented by dermatome L2 – T12-L2 (groin, via genitofemoral nerve)d. In the male, is crossed anteriorly by the ductus deferense. Passes anterior to the uterine artery in the female15. The abdominal aorta is crossed anteriorly bya. Left renal arteryb. Inferior mesenteric arteryc. Left renal vein <- correctd. Right gonadal arterye. Right renal vein16. Which is true of the superior mesenteric artery and its branches?a. Right colic artery is the main supply of the caecumb. Superior mesenteric artery runs anterior to the 1st part of the duodenum – 3rd partc. Right colic artery passes behind the right ureterd. Superior mesenteric arises from aorta at level of L2 – L1e. Main trunk of the superior mesenteric artery ends at the level of Meckel’s diverticulum17. Which is true of the inferior mesenteric artery and its branches?a. Inferior mesenteric ends as the superior rectal artery <- trueb. The main trunk crosses the left ureter, but its branches pass behind itc. It arises from the aorta at the level of L2 – L3d. The descending branch of the left colic supplies the sigmoid colon onlye. There is very little anastomosis between the branches18. Direct tributaries of the portal vein include all buta. Right gastric veinb. Short gastric veinc. Splenic veind. Superior pancreaticoduodenal veine. Left gastric vein19. Which is the correct portosystemic anastomosis?a. Portal = tributary of inferior mesenteric vein, systemic = tributary of internal iliac vein <- correct, on bare areasb. Portal = periumbilical vein, systemic = phrenic veins – systemic = epigastric veinsc. Portal = intrahepatic portal branches, systemic = azygos vein ?d. Portal = left gastric vein, systemic = IVC via oesophageal veins – systemic = azygose. Portal = middle rectal vein, systemic = inferior rectal vein – portal = superior rectal w/ mid and inf20. Which is not true of the surface markings of the liver?a. Lies below ribs 7-11 in the right midaxillary line - trueb. Highest point on right is 5th rib – in full expirationc. Superior surface crosses the xiphisternal joint - ?d. Inferior margin lies level with right costal margin in most cases - truee. Highest point on left is 6th intercostal space <– 7th?21. Which is the correct order of structures in the porta hepatis (anterior-posterior)a. hepatic arteries, portal veins, hepatic ductsb. portal veins, hepatic ducts, hepatic arteriesc. hepatic ducts, cystic duct, hepatic arteries, portal veinsd. hepatic ducts, hepatic arteries, cystic duct, portal veinse. hepatic ducts, hepatic arteries, portal veins – hepatic ducts (R), arteries (L) and veins posterior22. Which is not a structure of the retroperitoneum?a. Kidneyb. Adrenal glandc. Cisterna chilid. Spleen <- correct (SAD PUCKER = suprarenals, aorta, duodenum (2nd and 3rd), pancreas, ureter, colon (asc/desc only), kidney, eosophagus, rectum)e. Pancreas23. Which is not a structure in the transpyloric plane?a. Pancreasb. Superior mesenteric artery originc. Fundus of gallbladderd. Tip of 9th costal cartilagee. Lower pole of right kidney <- correct, should be hilum left, upper pole (R)24. Regarding the relations of the ureter, which is INCORRECT?a. Cross the vas deferens in males <- the vas deferens crosses over the ureter near the VUJb. Medial to the transverse process of lumbar spinec. Cross the genitofemoral nerved. Cross the SI jointe. ?25. Which is true of colon?a. Ascending is longer than descending – transverse is the longest > descending > ascendingb. Only part suspended on mesentery is transverse colon – is all isc. Marginal artery is weakest at hepatic flexure - ?d. Lymphatic drainage is via superior and inferior mesenteric lymph nodese. ?26. where does the appendix lie in health?a. Retroileal – it is usually retrocaecal (65%)b. ?c. ?d. ?e. ?27. Regarding the kidneys:a. The hilum of the left kidney is just below that of the right – right lowerb. The hilum faces medially and somewhat posteriorly - medialyc. The long axis is parallel with the lateral border of psoas <- trued. The perinephric fat is surrounded by the renal fascia - outsidee. The renal artery lies in front of the renal vein – veins in front28. Concerning the colon:a. Appendices epiploicae are most frequent on the ascending colon – usually transverse and sigmoidb. The transverse colon is normally shorter than the descending colon – transverse longestc. The blood supply includes the superior mesenteric artery <- trued. Parasympathetic supply does not include the vagi – guess it doese. None of the above29. Regarding the left kidneya. Anterior relations include the spleen – this is true, superiorly it does…b. Posteriorly lies the costodiaphragmatic recess <- this is also truec. The suprarenal gland lies within the renal fascia - outsided. The lateral femoral cutaenous nerve lies posteriorlye. The median arcuate ligament lies posteriorly – medial (w/ psoas under)30. The pelvic floora. Consists of ischiococcygeus, iliococcygeus and pubococcygeus <- trueb. Muscles have significant insertion into the sacrumc. Creates a gutter that slopes downwards and backwards – down and forwardd. Has the anococcygeal raphe a superficial parte. None of the above31. Regarding the inguinal canala. It has a roof formed by lower edges of internal oblique and transverses muscles <- trueb. The ilioinguinal nerve enters the canal through the deep ring – no, enters between transversus and internal obliquec. Its posterior wall is formed by the external oblique aponeurosis – transversalis fasciad. The conjoint tendon lies anterior to the superficial inguinal ring – inguinal falx, cojoint tendon of transversus and internal oblique – part of posterior walle. The superior epigastric artery crosses the posterior wall medial to the deep inguinal ring – the inferior epigastric artery is medial to the ring32. The livera. Is divided into superior and inferior lobes by the falciform ligament – left and right lobesb. Has a bare area inferiorly - posteriorlyc. Receives blood from portal and hepatic veins – porta vein and hepatic arteriesd. Has a caudate lobe that lies within the lesser sac <- unclear in Moore’se. Takes sympathetic nerve supply from paravertebral ganglia33. The abdominal aortaa. Bifurcates into the common iliac vessels on the body of L4 <- true, the transcristal plane at level of umbilicusb. Gives rise to the testicular/ovarian artery above the renal artery - belowc. Arises from the thoracic aorta on passing anterior to the median arcuate ligament – posterior tod. Gives rise to the renal arteries at the level of T12 – renal at L1e. Lies to the right side of the inferior vena cava - left34. The branches of the lumbar plexus includes:a. The iliohypogastric and ilioinguinal which provide motor innervation to the internal and external oblique muscles – they pass through these, supply the transversus and internal (but main supply from thoracoabdominal nerves from ant rami T7-11)b. The genitofemoral nerve which is derived from L3 and L4 – L1 and 2c. The femoral nerve which supplies the ileus <- trued. The obturator nerve which is derived from L2,3 and 4 posterior divisions – anterior divisionse. The lateral femoral cutaneous nerve which supplies sensory and motor innervation to the lateral thigh – skin only35. Regarding the ureter the right isa. Narrowed at pelviureteric junction <-trueb. Is 10cm long – 25-30cmc. Lower end of ureter is supplied by the ureteric branch of the renal artery – from aorta and common iliacd. It is endodermal in origine. It is related to the second part of the duodenum on the right - ?3rd36. The pancreasa. Lies at the level of the L1 vertebra – L1 and L2b. Body slopes downwards across the aorta - ?c. Receives its blood supply from the splenic arteryd. Is about 20cm long -?e. Develops from three separate buds -?37. Regarding the vessels of the pelvisa. The inferior and superior gluteal arteries are branches of the posterior division of the internal iliac artery – anterior division of the internal iliacb. The iliolumbar artery passes in front of the obturator nerve -?c. The uterine artery passes above the ureter <-true and may supply itd. The inferior vesical artery always supplies the lower end of the ureter – not in womene. The obturator artery lies above the obturator nerve on the side wall of the pelvis -?38. The pelvic floora. Muscles include obturator internus – lateral wallb. Slopes down and forwards <- correctc. Is supplied by S2, S3 and S4 – S4 and S5d. Is relaxed during quiet respiratione. Muscle iliococcygeus arises from the ilium – from tendinous arch39. Regarding the stomacha. The cardia is at the level of T8b. The stomach is supplied by branches from the celiac trunkc. The fundus is supplied by gastroepiploic vesselsd. The pyloric opening lies to the right of midline at T12e. It has an outer longitudinal muscle layer and an inner oblique layer40. Which lymph nodes drain the lower anal canal?a. Superficial inguinal <- below pectinate line (w/ artery from internal iliac, venous to IVC)b. External iliac c. Deep inguinald. Para-aortice. Internal iliac – above pectinate line (w/ arterial from IMA, and venous to portal)41. Superior pancreaticoduodenal vein drains intoa. Left gastric veinb. Portal vein <-c. Splenic veind. Superior mesenteric veine. IVC42. All the following are veins which drain the stomach EXCEPT:a. Gastroepiploicb. Gastroduodenal <-c. Right gastricd. Left gastrice. Short gastric43. Which is not true of the stomach?a. Completely invested by peritoneumb. Cardia situated at T12 <– T11, post to 6th CC, 2-4cm from midlinec. Pyloric opening at L1d. Aorta to the left of lesser curve <- this should be incorrect too, the aorta is to the righte. Supplied by branches of the celiac trunk44. Which does not pass through the transpyloric plane?a. Splenic veinb. Tips of the 9th costal cartilagesc. Lower border of L1- trued. Spleen <- just abovee. Superior mesenteric artery45. Appendixa. Usually lies retrocaecal in health <- true according to Moore’sb. Drains to inguinal nodes - to SMA nodesc. Has no mesentery – it does, the caecum doesntd. Has a tip constant in relation to the caecum - noe. Opens into the caecum 2cm below the ileocaecal valve - true46. Regarding the abdominal aortaa. Renal arteries originate at T12b. Splenic vein crosses the aorta just below superior mesenteric artery originc. Surface marking from a point just above the transpyloric plane to a point just to the left of the umbilicus <-?d. ?e. ?47. Regarding the testicular blood supplya. Division of the testicular artery results in testicular infarctionb. Testicular artery has numerous anastomoses with the cremasteric artery – artery of the ductus deferensc. Pampiniform plexus is a superficial plexus surrounding the testicular arteryd. ?e. ?48. Which of the following regarding the apprendix is FALSE?a. It has a base constant in relation to the caecum - ?b. It has its own mesentery – true, the mesoappendixc. It is formed by teneae coli convergence - ?d. Varies in length between 2 and 25 cm - 6-10 in Moore’se. It always lies retro-ilieal in presence of disease49. The uretersa. Widest in diameter at the PUJ - nob. Innervated by sympathetic nerves T12-L1c. Lie lateral to the tips of the lumbar transverse processesd. Depend on innervation from the pelvis for peristalsise. None of the above are true50. The uretersa. Cross the gonadal vessels – crossed byb. Cross over the vas deferens – cross overc. Are crossed by the genitofemoral nerve – cross overd. Pass under the cover of the psoas muscle - run one. Lie lateral to the lumbar transverse processes – medial to ................
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