1
Q
31. Pain due to a gastric ulcer may be referred to the A. umbilical region. B. right iliac region. C. epigastric region. D. penis or clitoris. E. None of the above.
A
C
2
Q
32. Pain caused by appendicitis may first be referred to the A. right iliac region. B. umbilical region. C. point of the shoulder. D. epigastric region. E. below the right shoulder blade.
A
B
3
Q
33. Intermittent pain (colic) in the small intestine may be referred to A. the epigastric region. B. the left iliac region. C. just above the symphysis pubis. D. the umbilical region. E. None of the above.
A
D
4
Q
34. Pain caused by the passage of a stone down the lower end of the left ureter may be referred to the A. umbilical region. B. right iliac region. C. epigastric region. D. penis or clitoris. E. None of the above.
A
D. Pain from to the back behind the kidney. Pain from the middle region of the ureter is referred to the inguinal region, and pain from the lower end is referred to the penis or clitoris. This is because the afferent nerves enter the spinal cord at different levels, so the pain is referred along the spinal the upper end of the ureter is referred nerves originating from those spinal cord levels.
5
Q
35. The short gastric arteries originate from the A. superior mesenteric artery. B. hepatic artery. C. splenic artery. D. inferior phrenic artery. E. left renal artery.
A
C
6
Q
36. The right gastric artery originates from the A. inferior mesenteric artery. B. superior mesenteric artery. C. hepatic artery. D. gastroduodenal artery. E. None of the above.
A
C
7
Q
37. The left gastric artery originates from the A. superior mesenteric artery. B. left renal artery. C. splenic artery. D. celiac artery. E. hepatic artery.
A
D
8
Q
38. The gastroduodenal artery originates from the A. splenic artery. B. hepatic artery. C. superior mesenteric artery. D. right renal artery. E. celiac artery.
A
B
9
Q
39. The left gastroepiploic artery originates from the A. inferior mesenteric artery. B. superior mesenteric artery. C. splenic artery. D. celiac artery. E. left renal artery.
A
C
10
Q
40. The descending colon receives parasympathetic nerves from the A. pelvic splanchnic nerves. B. spinal cord segments L1 and 2. C. greater splanchnic nerve. D. lesser splanchnic nerve. E. vagus nerve.
A
A
11
Q
- The jejunum receives sympathetic nerves from the
A. vagus nerves.
B. pelvic splanchnic nerves.
C. spinal cord segments L1 and 2.
D. greater splanchnic nerves and lesser splanchnic nerves.
E. spinal cord segments S2, 3, and 4.
A
D
12
Q
42. The sigmoid colon receives sympathetic nerves from the A. lesser splanchnic nerves. B. vagus nerves. C. greater splanchnic nerves. D. spinal cord segments T5 to 9. E. spinal cord segments L1 and 2.
A
E
13
Q
43. The ileum receives parasympathetic nerves from the A. vagus nerves. B. pelvic splanchnic nerves. C. lesser splanchnic nerves. D. spinal cord segments T10 and 11. E. inferior mesenteric plexus.
A
A
14
Q
- The azygos vein passes __________ in the diaphragm.
A. through the aortic hiatus
B. through the esophageal hiatus
C. through the vena caval hiatus
D. through perforations in the crura
E. between the slips of origin of the diaphragm from
the ribs
A
A
15
Q
45. The thoracic duct passes through \_\_\_\_\_\_\_\_\_\_ in the diaphragm. A. the esophageal hiatus B. the vena caval hiatus C. the aortic hiatus D. perforations in the crura E. None of the above.
A
C
16
Q
- The vagus nerves pass––––- in the diaphragm?
A. through the vena caval hiatus
B. through the aortic hiatus
C. between the slips of origin of the diaphragm from
the ribs
D. through the esophageal hiatus
E. through the perforation is the crura
A
D
17
Q
- The iliohypogastric nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its
A. medial side.
B. anterior surface.
C. lateral side.
D. posterior surface. E. None of the above.
A
C
18
Q
48. The obturator nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its A. anterior surface. B. posterior surface. C. medial side. D. upper border. E. lateral side.
A
C
19
Q
49. The genitofemoral nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its A. lateral side. B. posterior surface. C. medial side. D. anterior surface. E. None of the above.
A
D
20
Q
50. The femoral nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its A. lateral side. B. medial side. C. anterior surface. D. posterior surface. E. lower border.
A
A
21
Q
51. The ilioinguinal nerve, a branch of the lumbar plexus, emerges from the psoas muscle on its A. medial side. B. inferior border. C. lateral side. D. anterior surface. E. posterior surface.
A
C
22
Q
52. Lymphatic spread of carcinoma of the fundus of the stomach is likely to metastasize to the A. internal iliac nodes. B. superior mesenteric nodes. C. inferior mesenteric nodes. D. celiac nodes. E. right gastroepiploic nodes.
A
D
23
Q
53. Infection from an inflamed appendix is likely to spread via the lymphatics to the A. superior mesenteric nodes. B. celiac nodes. C. splenic nodes. D. inferior mesenteric nodes. E. right internal iliac nodes.
A
A
24
Q
54. Lymphatic spread of carcinoma of the right side of the greater curvature of the stomach is likely to metastasize to the A. left renal nodes. B. celiac nodes. C. superior mesenteric nodes. D. right gastroepiploic nodes. E. splenic nodes.
A
D
25
```
55. Lymphatic spread of carcinoma of the sigmoid colon is likely to metastasize to the
A. left common iliac nodes.
B. inferior mesenteric nodes.
C. superior mesenteric nodes.
D. celiac nodes.
E. para-aortic nodes.
```
B
26
```
56. Bacteria from diverticulitis of the proximal two thirds of the transverse colon are likely to spread via lymph vessels to the
A. inferior mesenteric nodes.
B. celiac nodes.
C. para-aortic nodes.
D. superior mesenteric nodes.
E. left renal nodes.
```
D
27
```
57. The skin of the umbilicus receives its sensory innerva- tion from
A. T7.
B. T10.
C. L1.
D. T12.
E. L2.
```
B
28
58. In both sexes, the inguinal canal is formed by the
A. descent of the gonad.
B. contraction of the gubernaculum.
C. processus vaginalis.
D. growth and descent of the ilioinguinal nerve.
E. contraction of the cremaster muscle.
C
29
59. The lacunar ligament is
A. formed from the conjoint tendon.
B. part of the posterior wall of the rectus sheath.
C. not continuous with the inguinal ligament.
D. an important medial relation to the femoral ring of
the femoral sheath.
E. attached to the inferior ramus of the pubis.
D
30
60. The suprarenal gland receives its arterial supply from the
A. aorta, inferior phrenic, and renal arteries.
B. lumbar arteries.
C. superior phrenic artery.
D. testicular (ovarian) artery.
E. subcostal artery.
A
31
61. The following statements concerning the abdominal aorta are correct except which?
A. The aorta lies in the midline of the abdomen.
B. The aorta bifurcates into the right and left common
iliac arteries.
C. The level of bifurcation of the aorta is the fifth lum-
bar vertebra.
D. The aorta lies on the left side of the inferior vena
cava.
E. The aorta is related to the anterior surface of the
bodies of the lumbar vertebrae.
C. The aorta bifurcates into the two common iliac arteries at the level of the fourth lumbar vertebra.
32
62. The statements concerning the following arteries are correct except which?
A. The superior epigastric artery descends in the rectus
sheath posterior to the rectus abdominis muscle.
B. The superior mesenteric artery descends posterior
to the third part of the duodenum.
C. The gonadal arteries cross in front of the ureters on
both sides.
D. The gastroduodenal artery is directly related to the
posterior surface of the first part of the duodenum.
E. The appendicular artery is a branch of the posterior
cecal artery.
B. The superior mesenteric artery descends anterior to the third part of the duodenum.
33
63. The statements concerning the following veins are correct except which?
A. The inferior mesenteric vein is usually a direct tributary of the splenic vein.
B. The portal vein is formed by the union of the splenic vein and superior mesenteric vein.
C.The hepatic veins emerge from the posterior surface of the liver and drain into the inferior vena cava.
D. The renal vein emerges from the hilum of the kidney in front of the renal artery and drains into the inferior vena cava.
E. The inferior vena cava pierces the central tendon of the diaphragm at the level of the tenth thoracic vertebra.
E. The inferior vena cava pierces the central tendon of the diaphragm at the level of the eighth thoracic vertebra.
34
64. The following statements concerning the lymphatics of the abdomen are correct except which?
A. The intestinal, right, and left lumbar trunks drain into the cisterna chyli.
B. The lymphatic drainage of the kidney is directly to the superior mesenteric nodes.
C. The thoracic duct begins in the abdomen at the cisterna chyli.
D. The cisterna chyli lies in front of the first two lumbar vertebrae.
E. The lymph vessels from the testes drain into the para-aortic nodes at the level of the first lumbar vertebra.
B. The lymphatic drainage of the kidneys is into the lateral (para-aortic) group of lymph nodes.
35
65. The following statements concerning the abdominal peritoneal omenta and ligaments are correct except which?
A. The gastrosplenic omentum contains the short gastric arteries and the left gastroepiploic artery.
B. The splenicorenal ligament contains the tail of the pancreas.
C. The lesser omentum is attached superiorly to the porta hepatis of the liver.
D. The greater omentum is attached to the upper border of the transverse colon.
E. The coronary ligament of the liver is the main support for this organ.
E. The attachment of the hepatic veins to the inferior vena cava provides the main support for the liver; the various peritoneal ligaments are weak and stretch.
36
66. The following information concerning the sensory innervation of the abdominal peritoneum is correct except which?
A. The peritoneum on the central part of the inferior surface of the diaphragm is supplied by the phrenic nerves.
B. The peritoneum forming the mesentery of the small intestine is innervated by autonomic nerves.
C. The peritoneum on the peripheral part of the inferior surface of the diaphragm is supplied by the phrenic nerves.
D. The peritoneum lining the anterior abdominal wall in the right lower quadrant is supplied by T12 and L1 spinal nerves.
E. The peritoneum lining the lateral wall of the pelvis is supplied by the obturator nerve.
C. The peritoneum on the peripheral part of the in- ferior surface of the diaphragm is supplied by the lower six intercostal nerves
37
67. The following statements concerning the right kidney are correct except which?
A. The renal papillae open directly into the major calyces.
B. The kidney lies slightly lower than the left kidney.
C. The right suprarenal gland covers its upper pole.
D. The medulla is composed of approximately twelve
renal pyramids.
E. At the junction of the renal pelvis with the ureter, the lumen of the ureter is narrowed.
A. The renal papillae open directly into the minor calyces of the kidney.
38
68. The following statements concerning the wall of the scrotum are correct except which?
A. It is covered by skin.
B. It possesses superficial fascia that contains smooth muscle called the dartos muscle.
C. It has the external spermatic fascia derived from the external oblique aponeurosis.
D. It has cremasteric fascia derived from the internal oblique muscle.
E. It has the internal spermatic fascia derived from the fatty layer of the superficial fascia.
E. The internal spermatic fascia is derived from the fascia transversalis lining the anterior abdominal wall.
39
69. The following statements concerning the epididymides are correct except which?
A. Each has a head, a body, and a tail.
B. Each lies anterior to the testis.
C. Each is made up of a coiled tube.
D. The vas deferens emerges from the tail.
E. They provide storage space for the spermatozoa prior to ejaculation.
B. The epididymis lies on the posterior surface of the testis.
40
70. The following statements concerning the spermatic cord are correct except which?
A. It is covered with three layers of fascia derived from the anterior abdominal wall.
B. It contains the vas deferens.
C. The testicular artery and vein lie within it.
D. The inferior epigastric artery passes through it.
E. It contains the genital branch of the genitofemoral
nerve.
D. The inferior epigastric artery is a branch of the external iliac artery just above the inguinal ligament. It ascends in the anterior abdominal wall just medial to the deep inguinal ring and eventually reaches the rectus sheath.
41
71. The following statements concerning the sigmoid colon are correct except which?
A. It is a continuation of the descending colon.
B. It begins above in front of the left quadratus lumborum muscle.
C. It receives its arterial supply from the inferior
mesenteric artery.
D. It becomes continuous with the rectum in front of
the third sacral vertebra.
E. It is attached to the posterior pelvic wall by the sigmoid mesocolon.
B. The sigmoid colon begins above the level of the pelvic brim.
42
72. The following statements concerning the liver are correct except which?
A. Its lymph drainage is to the celiac nodes.
B. The quadrate and the caudate loves are functionally part of the left lobe.
C. Its parasympathetic innervation is from the vagus nerve.
D. It receives highly oxygenated blood from the portal vein.
E. The triangular ligaments connect the liver to the diaphragm.
D. The liver receives highly oxygenated blood via the hepatic artery.
43
73. The following differences exist between the ileum and the ascending colon except which?
A. The ascending colon has appendices epiploicae, whereas the ileum does not.
B. The arterial supply to the wall of the ileum is arranged so that it produces areas of weakness through which mucosal herniations may occur.
C. The ascending colon may have a well developed marginal artery, whereas the ileum does not.
D. The ileum has longitudinal muscle that forms a continuous layer around the wall, whereas the ascending colon has teniae coli.
E. The ascending colon is retroperitoneal, whereas the ileum is intraperitoneal.
B. It is the colon that often develops mucosal herniations along its arterial supply.
44
74. The following statements concerning the duodenum are correct except which?
A. The lower half of the duodenum receives its arterial supply from the superior mesenteric artery via the inferior pancreaticoduodenal artery.
B. The first part of the duodenum is completely
retroperitoneal.
C. The bile duct enters the second (vertical) portion
of the duodenum.
D. Lymph from the fourth part of the duodenum
drains into the superior mesenteric nodes.
E. The third part of the duodenum passes horizontally to the left in front of the vertebral column and be hind the root of the mesentery.
B. The first inch of the first part of the duodenum is covered by peritoneum on its anterior and posterior surfaces.
45
75. The following statements concerning the appendix are correct except which?
A. The appendix is situated in the right iliac region.
B. At the base of the appendix, the teniae coli of the cecum fuse to from a complete longitudinal muscle layer in the wall of the appendix.
C. Afferent pain nerve fibers accompany the sympathetic nerves and enter the spinal cord at the level of the tenth thoracic segment.
D. The appendix receives its blood supply from a branch of the posterior cecal artery.
E. The tip of the appendix cannot reach down into the pelvic cavity
E. The appendix generally varies in length from 3 to 5 in. (8 to 13 cm), but it can be even longer. (It tends to be longer during childhood and later at- rophies.) When long, the tip is often found hanging down into the pelvic cavity.
46
```
76. The lesser omentum contains the following important structures except which?
A. The left gastric artery
B. The portal vein
C. The inferior vena cava
D. The bile duct
E. The common hepatic artery
```
C. The inferior vena cava is retroperitoneal behind the opening into the lesser sac.
47
77. The following statements concerning the pyloric sphincter are correct except which?
A. It receives its motor innervation from the sympathetic autonomic nerves.
B. It lies on the level of the third lumbar vertebra.
C. It is inhibited by the impulses passing down the vagus nerves.
D. It is formed by a thickening of the circular layer of smooth muscle in the stomach wall.
E. The cavity of the pylorus is called the pyloric canal.
B. The pylorus lies on the transpyloric plane at the level of the first lumbar vertebra.
48
```
78. The following structures form the boundaries of the en- trance into the lesser sac (epiploic foramen) except which?
A. The inferior vena cava
B. The bile duct
C. The portal vein
D. The quadrate lobe of liver
E. The first part of the duodenum
```
D. The superior boundary of the entrance into the lesser sac is formed by the caudate process of the caudate lobe of the liver, not by the quadrate lobe.
49
79. After complete occlusion of the origin of the inferior mesenteric artery with a blood clot, the blood supply of the left portion of the colon is maintained by the fol- lowing arteries except which?
A. The marginal artery
B. The middle colic artery
C. The left lumbar arteries
D. Anastomoses between the superior, middle, and inferior hemorrhoidal arteries
E. The sigmoid arteries
C. The middle colic artery from the superior mesenteric artery, the sigmoid arteries, and the marginal artery as well as the anastomoses of all these arteries with the superior, middle, and inferior hemorrhoidal arteries will maintain the blood supply to the left portion of the colon.
50
80. The following statements concerning the gallbladder are correct except which?
A. The arterial supply is from the cystic artery, which is a branch of the right hepatic artery.
B. The fundus of the gallbladder is located just beneath the tip of the right ninth costal cartilage.
C. The peritoneum completely surrounds the fundus, the body, and the neck.
D. The nerves of the gallbladder are derived from the celiac plexus.
E. Pain sensation from gallbladder disease may be referred along the phrenic and the supraclavicular nerves to the skin over the shoulder.
C. The fundus is the only part of the gallbladder completely surrounded by peritoneum.
51
81. In patients with an obstruction of the superior vena
cava, blood may return to the right atrium through the following anastomotic channels except which?
A. The lateral thoracic, lumbar, and superficial epigastric veins
B. The superior and inferior epigastric veins
C. The lateral thoracic, paraumbilical, and portal veins
D. The posterior intercostal and lumbar veins
E. The lateral thoracic veins
E. The lateral thoracic and the superior epigastric
| veins are directly or indirectly connected with the superior vena cava only.
52
```
82. The following structures could be eroded as the result of perforation of an ulcer in the posterior wall of the stomach except which?
A. The splenic artery
B. The right kidney
C. The pancreas
D. The left kidney
E. The spleen
```
B
53
83. The following statements concerning the left ureter are correct except which?
A. It lumen is constricted at the point where it crosses the brim of the pelvis.
B. Its arterial supply is derived from the renal artery above, the gonadal artery halfway down, and the
superior vesical artery below.
C. The inferior mesenteric vein lies on its medial side.
D. It lies in direct contact with the tips of the transverse processes of the lumbar vertebrae.
E. It is situated on the posterior abdominal wall behind the peritoneum
D. The ureter is separated from the transverse processes of the lumbar vertebrae by the psoas muscle and fascia.
54
```
84. The following structures are connected to the liver except which?
A. The falciform ligament
B. The coronary ligament
C. The greater omentum
D. The ligamentum teres
E. The ligamentum venosum
```
C. The greater omentum is attached above to the greater curvature of the stomach and below to the lower border of the transverse colon.
55
85. The following statements concerning the superficial inguinal ring are correct except which?
A. It is a perforation in the aponeurosis of the external oblique muscle.
B. Its greatest width lies above and medial to the pubic tubercle.
C. It is strengthened posteriorly by the conjoint tendon.
D. The internal spermatic fascia is attached to its
margins.
E. In males, it allows passage of the spermatic cord and ilioinguinal nerve.
D. The external spermatic fascia is attached to the margins of the superficial inguinal ring.
56
86. The following statements concerning the superficial fascia of the anterior abdominal wall are correct except which?
A. It has a superficial fatty layer and a deep membranous layer.
B. Scarpa’s fascia fuses with the fascia lata just below
the inguinal ligament.
C. Camper’s fascia is continuous with the Colles’ fascia in the perineum.
D. It is continuous with the dartos muscle in the wall of the scrotum.
E. It does not contribute to the femoral sheath.
C
57
```
87. The rectus sheath contains the following structures except which?
A. The pyramidalis muscle (when present)
B. The ligamentum teres
C. The inferior epigastric artery
D. The T7 to 12 anterior nerve rami
E. The rectus abdominis muscle
```
B
58
88. The following statements concerning the epididymis are correct except which?
A. It lies within the scrotum.
B. It is partially covered by the tunica vaginalis.
C. It is easily palpated through the scrotal wall.
D. It is supplied by the testicular artery.
E. Its lymph drains into the superficial inguinal nodes.
E. The lymphatic drainage of the epididymis is into the lateral aortic (para-aortic) nodes at the level of the first lumbar vertebra.
59
89. The jejunum and ileum can be differentiated on the basis of the following anatomic features except which?
A. Numerous (four to five) arterial arcades are associated with the jejunum.
B. The plicae circulares are much more prominent in the jejunum than in the ileum.
C. Fat depositions are generally present throughout the mesentery associated with the ileum.
D. The jejunum is generally located in the upper left region of the abdominal cavity.
E. Peyer’s patches are characteristic of the lower ileum and may be visible on the surface.
A. The jejunum usually has only one or two arterial
| arcades with long branches passing to the intestinal wall.
60
```
90. The spermatic cord contains the following structures except which?
A. The scrotal arteries and veins
B. The vas deferens
C. The pampiniform plexus
D. The testicular artery
E. Autonomic nerves
```
A
61
```
91. The following structures pass through the esophageal hiatus in the diaphragm except which?
A. The left vagus nerve
B. Branches of the left gastric artery
C. The left phrenic nerve
D. The right vagus nerve
E. A tributary of the portal vein
```
C. The terminal branches of the left phrenic nerve pierce the diaphragm but do not pass through the esophageal hiatus.
62
92. The following statements regarding the peritoneum are correct except which?
A. The parietal peritoneum is sensitive to pain, temperature, touch, and pressure.
B. The parietal peritoneum lining the anterior abdominal wall is innervated by the lower six thoracic and the first lumbar spinal nerves.
C. The visceral peritoneum is innervated by the posterior primary rami of the twelfth thoracic and the lumbar spinal nerves.
D. The visceral peritoneum is only sensitive to stretch.
E. The peritoneum lining the lesser sac has a sensory nerve supply.
C. The visceral peritoneum is sensitive to stretch and is innervated by autonomic afferent nerves.
63
93. If the portal vein becomes blocked, the following venous anastomoses are important in uniting the portal with the systemic venous systems except which?
A. Esophageal branches of the left gastric and azygos veins
B. Veins of the ligamentum teres and paraumbilical veins
C. The superior and inferior rectal veins
D. The right colic veins and lumbar veins
E. The middle and inferior rectal veins
E. The middle and inferior rectal veins are tributaries of the systemic circulation only.
64
94. In a patient with cancer of the stomach who requires a total gastrectomy, the following arteries must be ligated except which?
A. The common hepatic artery
B. The short gastric arteries
C. The left and the right gastroepiploic arteries
D. The right gastric artery
E. The left gastric artery
A
65
95. When performing a midline abdominal paracentesis (tapping the abdominal cavity) below the umbilicus, the cannula will pass through the following anatomic structures except which?
A. The skin and the fascia
B. The linea alba
C. The transversalis fascia and extraperitoneal fat
D. The rectus abdominis muscle
E. The parietal peritoneum
D. The rectus abdominis muscles lie on either side
| of the midline and are separated by the linea alba.
66
96. The following statements are correct regarding an inguinal hernia except which?
A. The inferior epigastric artery lies medial to the neck of an indirect inguinal hernia.
B. An inguinal hernia is more common than a femoral hernia in females.
C. A direct inguinal hernia is more common in elderly men than in boys.
D. The opening of the sac of a direct inguinal hernia is wide.
E. The contents of an indirect inguinal hernia may be strangulated against the lacunar ligament.
E. The lacunar ligament is related to the sac of a femoral hernia, not an inguinal hernia.
67
97. The following statements regarding the portal vein are correct except which?
A. It courses through a portion of the lesser omentum.
B. It enters the liver at the porta hepatis.
C. It receives venous blood from both the large and the small intestines.
D. It originates at the junction of the superior mesenteric and the splenic veins.
E. It passes in front of the neck of the neck of the pancreas.
E. The portal vein is formed behind the neck of the pancreas by the union of the superior mesenteric vein with the splenic vein.
68
98. If the common hepatic artery is unavoidably ligated during surgery, the arterial supply to the liver is maintained by the following anastomotic connections except which?
A. The superior pancreaticoduodenal artery anastomosing with the inferior pancreaticoduodenal artery
B. The right gastric artery anastomosing with the left
gastric artery
C. The gastroduodenal artery anastomosing with the splenic artery
D. The esophageal arteries anastomosing with the in-
ferior phrenic arteries
E. The right gastroepiploic artery anastomosing with
the left gastroepiploic artery
C. The gastroduodenal artery does not directly anastomose with the splenic artery.
69
99. The following general statements are correct except which?
A. The superior and inferior epigastric vessels anastomose on the posterior surface of the rectus abdominis muscle.
B. The inguinal ligament is attached laterally to the anterior inferior iliac spine.
C. The abdominal aorta bifurcates below into the two common iliac arteries.
D. The foregut ends in the second segment of the duodenum.
E. The umbilicus is inconstant in position but is usually located at the level of L4.
B. The inguinal ligament is attached laterally to the anterior superior iliac spine.
70
```
100. The following veins drain directly into the inferior vena cava except which?
A. The hepatic veins
B. The renal veins
C. The lumbar veins
D. The inferior mesenteric vein
E. The right testicular(ovarian) vein
```
D. The inferior mesenteric vein is a tributary of the splenic vein.
71
101. When tapping a hydrocele (collection of fluid in the tunica vaginalis), the cannula must pierce the following structures except which?
A. The skin
B. The fatty subcutaneous tissue
C. Dartos muscle
D. The cremasteric fascia
E. The external and internal spermatic fasciae
B. The dartos muscle takes the place of the fatty subcutaneous tissue in the wall of the scrotum.
72
102. The following structures are present in the porta hepatis except which?
A. Lymph nodes
B. The right and left branches of the portal vein
C. The right and left hepatic ducts
D. The right and left hepatic veins
E. The right and left branches of the hepatic artery
D. The hepatic veins (three or more in number) leave the posterior surface of the liver and drain directly into the inferior vena cava.
73
103. The following statements regarding the celiac plexus are correct except which?
A. The celiac plexus is not a purely sympathetic plexus.
B. The celiac plexus does not surround the celiac
a rte ry.
C. The celiac ganglia are made of nerve cell bodies
and nerve fibers.
D. Parasympathetic preganglionic fibers pass through
the plexus, generally synapsing with postganglionic neurons within the walls of the organs they innervate.
E. Sympathetic preganglionic fibers to the celiac plexus originate from thoracic spinal segments and travel in thoracic splanchnic nerves.
B. The celiac plexus completely surrounds the origin of the celiac artery.
74
104. The right kidney has the following important relation- ships except which?
A. It is related to the neck of the pancreas.
B. It is anterior to the right costodiaphragmatic recess.
C. It is related to the second part of the duodenum.
D. It is related to the right colic flexure.
E. It is anterior to the right twelfth rib.
A. The pancreas is not related to the right kidney.
75
A 45-year-old obese woman complaining of indigestion was admitted to hospital for investigation. She had a past history of gallstones and transient attacks of jaundice. Large gallstones have been known to erode through the posterior wall of the gallbladder and enter the intestinal tract.
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105. Which part of the intestinal tract is likely to initially contain the stone?
A. The sigmoid colon
B. The descending colon
C. The transverse colon
D. The ascending colon
E. The jejunum
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C. The transverse colon is in close posterior relation to the gallbladder.
76
A 53-year-old man was admitted to hospital complaining of a chronic gastric ulcer that was not responding to medical treatment. The surgeon decided to perform a vagotomy. The anterior vagal trunk was divided between sutures as it lies on the anterior surface of the abdominal part of the esophagus.
106. Which of the following is likely to result from this procedure?
A. A loss of secretomotor nerve supply to the mucosal glands of the stomach.
B. Hoarse voice because of paralysis of the intrinsic muscles of the larynx on the left side.
C. Increased heart rate because of decreased parasympathetic input to the cardiac plexus.
D. Incontinence because of an absence of parasympathetic input to the bladder.
D. Compromised input into the greater splanchnic nerves.
A
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A 54-year-old man with a long history of duodenal ulcer was seen in the emergency department after vomiting blood-stained fluid and exhibiting all the signs and symptoms of severe hypovolemic (loss of blood) shock.
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107. Assuming the ulcer had perforated the posterior wall of the first part of the duodenum, name the artery that is most likely to have been eroded.
A. The splenic artery
B. The right gastric artery
C. The gastroduodenal artery
D. The right gastroepiploic artery
E. The right renal artery
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C. The gastroduodenal artery is a large branch of the hepatic artery. It descends behind the first part of the duodenum and then divides into the superior pancreaticoduodenal artery and the right gastroepiploic artery.
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108. If the duodenal ulcer had perforated the anterior wall of the duodenum, where in the peritoneal cavity would the duodenal contents have entered?
A. The lesser sac
B. The right anterior subphrenic space
C. The left lateral paracolic gutter
D. The right posterior subphrenic space
E. The pouch of Douglas
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D. If the patient is in the erect position when the perforation occurs, the duodenal contents tend to gravitate downward along the right paracolic gutters.
79
A 10-year-old girl was seen in the emergency department with a temperature of 101°F, a furred tongue, and pain in the right iliac region. On physical examination, the skin in the right lower quadrant was hyperesthetic and tender to touch, and the abdominal muscles showed rigidity and guarding. A diagnosis of acute appendicitis was made.
109. The skin in the right lower quadrant was tender to touch because which of the following nerves was (were) stimulated by the inflamed appendix?
A. The eighth right intercostal nerve
B. The tenth right intercostal nerve
C. The subcostal and first lumbar nerves
D. The sympathetic autonomic afferent nerves from the appendix
E. The seventh right thoracic nerve
C. Once the inflamed appendix comes into contact with the parietal peritoneum in the right iliac region, it stimulates the lower thoracic spinal nerves and first lumbar spinal nerve, which sup- ply the peritoneum. Because these nerves also supply the anterior abdominal wall muscles in this region, they are thus stimulated to contract. This mechanism tends to immobilize this region and assists in localizing the inflammatory process should the appendix rupture.
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110. Which oft he following muscles was(were) contracted in the right lower quadrant to produce the increased tone and guarding?
A. The right rectus abdominis muscle
B. The right pyramidalis muscle
C. The right psoas muscle
D. The right external oblique, internal oblique, and transversus abdominis muscles
E. The right quadratus lumborum muscle
D
ANATOMY
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