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Abdomen
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Abdomen
1. A 63-year-old man comes to the emergency
department with back pain, weakness, and shortness Description
of breath. On examination, he has an aneurysm of the Gross Anatomy - Abdomen
abdominal aorta at the aortic hiatus of the diaphragm.
Updated
Which of the following pairs of structures would most 12/27/2010, 11:31:22 AM
likely be compressed?
Show Answers
A. Vagus nerve and azygos vein
B. Esophagus and vagus nerve
C. Azygos vein and thoracic duct
D. Thoracic duct and vagus nerve
E. Inferior vena cava and phrenic nerve
C. Azygos vein and thoracic duct

2. A 36-year-old woman with yellow pigmentation of the

skin and sclerae presents at the outpatient clinic.
Which of the following conditions most likely is the
cause of her obstructive jaundice?

A. Aneurysm of the splenic artery

B. Perforated ulcer of the stomach
C. Obstruction of the main pancreatic duct
D. Cancer in the head of the pancreas
E. Cancer in the body of the pancreas
D. Cancer in the head of the pancreas

3. A 2-year-old presents with pain in his groin which has

been increasing in nature over the past few weeks. He
is found to have a degenerative malformation of the
transversalis fascia during development. Which of the
following structures on the anterior abdominal wall is
likely defective?

A. Superficial inguinal ring

B. Deep inguinal ring
C. Inguinal ligament
D. Sac of a direct inguinal hernia
E. Anterior wall of the inguinal canal
B. Deep inguinal ring

4. A 29-year-old man comes to a local hospital with

duodenal peptic ulcer and complains of cramping
epigastric pain. Which of the following structures
harbors the cell bodies of the abdominal pain fibers?

A. Lateral horn of the spinal cord

B. Anterior horn of the spinal cord
C. Dorsal root ganglion
D. Sympathetic chain ganglion
E. Celiac ganglion
C. Dorsal root ganglion

5. A 42-year-old obese woman with seven children is

brought to a local hospital by her daughter. Physical
examination and her radiograph reveal that large
 gallstones have ulcerated through the posterior wall of
the fundus of the gallbladder into the intestine. Which
of the following parts of the intestine is most likely to
initially contain gallstones?

A. Cecum
B. Ascending colon
C. Transverse colon
D. Descending colon
E. Sigmoid colon
C. Transverse colon

6. A 35-year-old woman comes to a local hospital with

abdominal tenderness and acute pain. On
examination, her physician observes that an
abdominal infection has spread retroperitoneally.
Which of the following structures is most likely
affected?

A. Stomach
B. Transverse colon
C. Jejunum
D. Descending colon
E. Spleen
D. Descending colon

7. During an annual health examination of a 46-year-old

woman, a physician finds hypersecretion of
norepinephrine from her suprarenal medulla. Which of
the following types of nerve fibers are most likely
overstimulated?

A. Preganglinonic sympathetic fibers

B. Postganglionic sympathetic fibers
C. Somatic motor fibers
D. Postganglionic parasympathetic fibers
E. Preganglionic parasympathetic fibers
A. Preganglinonic sympathetic fibers

8. A 6-year-old girl comes to her pediatrician with

constipation, abdominal distention, and vomiting. After
thorough examination, she is diagnosed as having
Hirschsprung's disease (aganglionic megacolon),
which is a congenital disease and leads to dilation of
the colon. This condition is caused by an absence of
which of the following kinds of neural cell bodies?

A. Sympathetic preganglionic neuron cell bodies

B. Sympathetic postganglionic neuron cell bodies
C. Parasympathetic preganglionic neuron cell bodies
D. Parasympathetic postganglionic neuron cell bodies
E. Sensory neuron cell bodies
D. Parasympathetic postganglionic neuron cell bodies

9. A pediatric surgeon is resecting a possible malignant

mass from the liver of a neonate with cerebral palsy.
The surgeon divides the round ligament of the liver
during surgery. A fibrous remnant of which of the
following fetal vessels is severed?

A. Ductus venosus
B. Ductus arteriosus
 C. Left umbilical vein
D. Right umbilical vein
E. Umbilical artery
C. Left umbilical vein

10. A 27-year-old woman has suffered a gunshot wound

to her midabdomen. After examining the patient's
angiogram, a trauma surgeon locates the source of
the bleeding from pairs of veins that typically terminate
in the same vein. Which of the following veins are
damaged?

A. Left and right ovarian veins

B. Left and right gastroepiploic veins
C. Left and right colic veins
D. Left and right suprarenal veins
E. Left and right hepatic veins
E. Left and right hepatic veins

11. A 43-year-old man complains of abdominal pain just

above his umbilicus. On examination, a tumor is found
anterior to the inferior vena cava. Which of the
following structures would most likely be compressed
by this tumor?

A. Right sympathetic trunk

B. Left third lumbar artery
C. Third part of the duodenum
D. Left renal artery
E. Cisterna chyli
C. Third part of the duodenum

12. A 33-year-old man with a perforated gastric ulcer

complains of excruciating pain in his stomach. It is
observed that the pain comes from peritoneal irritation
by gastric contents in the lesser sac. Which of the
following nerves contain sensory nerve fibers that
convey this sharp, stabbing pain?

A. Vagus nerves
B. Great splanchnic nerves
C. Lower intercoastal nerves
D. White rami communicantes
E. Gray rami communicantes
C. Lower intercoastal nerves

13. A young boy is brought to the hospital after a bicycle

accident and possible pelvic fracture. While awaiting a
computed tomography (CT) scan of his pelvis, a
physician proceeds with a focal neurologic
examination. In testing the child's reflexes, which of
the following nerves would carry afferent impulses of
the cremasteric reflex?

A. Subcoastal nerve
B. Lateral femoral cutaneous nerve
C. Genitofemoral nerve
D. Iliohypogastric nerve
E. Femoral nerve
C. Genitofemoral nerve
14. A 21-year-old man receives a penetrating knife wound
in the abdomen and is injured in both the superior
mesenteric artery and the vagus nerve. Which portion
of the colon would most likely be impaired by this
injury?

A. Ascending and descending colons

B. Transverse and sigmoid colons
C. Descending and sigmoid colons
D. Ascending and transverse colons
E. Transverse and descending colons
D. Ascending and transverse colons

15. A 42-year-old man with portal hypertension secondary

to cirrhosis of the liver and subsequent massive
ascites presents to the emergency department. He
refuses to have a transjugular intrahepatic
portosystemic shunt (TIPS) procedure and prefers
surgery. Which of the following surgical connections is
involved in the most practical method of shuntingportal
blood around the liver?

A. Superior mesenteric vein to the inferior mesenteric

vein
B. Portal vein to the superior vena cava
C. Portal vein to the left renal vein
D. Splenic vein to the left renal vein
E. Superior rectal vein to the left colic vein
D. Splenic vein to the left renal vein

16. A 78-year-old man is suffering from ischemia of the

suprarenal glands. This condition results from rapid
occlusion of direct branches of which of the following
arteries?

A. Aorta, splenic, and inferior phrenic arteries

B. Renal, splenic, and inferior mesenteric arteries
C. Aorta, inferior phrenic, and renal arteries
D. Superior mesenteric, inferior mesenteric, and renal
arteries
E. Aorta and hepatic and renal arteries
C. Aorta, inferior phrenic, and renal arteries

17. A radiograph of a 32-year-old woman reveals a

perforation in the posterior wall of the stomach in
which the gastric contents have spilled into the lesser
sac. The general surgeon has opened the lienogastric
(gastrosplenic) ligament to reach the lesser sac and
notes erosion of the ulcer into an artery. Which of the
following vessels is most likely involved?

A. Splenic artery
B. Gastroduodenal artery
C. Left gastric artery
D. Right gastric artery
E. Left gastroepiploic artery
E. Left gastroepiploic artery

18. A 35-year-old woman with with a history of

cholecystectomy arrives int eh emergency room with
intractable hiccups most likely causd by an abdominal
 abcess secondary to surgical infection. Which of the
following nerves carries pain sensation caused by
irritation of the peritoneum on the central portion of the
inferior surface of he diaphragm?

A. Vagus nerve
B. Lower intercoasal nerve
C. Phrenic nerve
D. Greater splanchnic nerve
E. Subcoastal nerve
C. Phrenic nerve

19. A 16-year-old boy with a ruptured spleen comes to an

emergency department for a splenectomy. Soon after
the ligation of the splenic artery just distal to its origin,
a surgical resident observes that the patient is healing
normally. Normal blood flow would occur in which of
the following arteries?

A. Short gastric arteries

B. Dorsal pancreatic artery
C. Inferior pancreaticoduodenal artery
D. Left gastroepiploic artery
E. Artery in the lienorenal ligament
C. Inferior pancreaticoduodenal artery

20. A 9-year-old boy was admitted to the emergency

department complaining of nausea, vomiting, fever,
and loss of appetite. On examination, he was found to
have tenderness and pain on the right lower quadrant.
Based on signs and symptoms, the diagnosis of acute
appendicitis was made. During an appendectomy
performed at McBurney's point, which of the following
structures is most likely to be injured?

A. Deep circumflex femoral artery

B. Inferior epigastric artery
C. Iliohypogastric nerve
D. Genitofemoral nerve
E. Spermatic cord
C. Iliohypogastric nerve

21. A 54-year-old man with a long history of alcohol abuse

presents to the emergency department with rapidly
increasing abdominal distention most likely resulting
from an alteration in portal systemic blood flow. Which
of the following characteristics is associated with the
portal vein of the portal venous system?

A. Lower blood pressure that in the inferior vena cava

B. Lest risk of venous varices because of portal
hypertension
C. Distension of the portal vein resulting from its
numerous valves.
D. Caput medusae and hemorrhoids caused by portal
hypertension
E. Less blood flow than in the hepatic artery
D. Caput medusae and hemorrhoids caused by portal
hypertension

22. While examining radiographs and angiograms of a 52-

year-old patient, a physician is trying to distinguish the
 jejunum from the ileum. He has observed that the
jejunum has:

A. Fewer plicae circulares

B. Fewer mesenteric arterial arcades
C. Less digestion and absorption of nutrients
D. Shorter vasa recta
E. More fat in its mesentery
B. Fewer mesenteric arterial arcades

23. A 67-year-old woman with a long history of liver

cirrhosis was seen in th emergency department. In
this patient with portal hypertension, which of the
following veins is most likely o be dilated?

A. Right colic vein

B. Inferior epigastric vein
C. Inferior phrenic vein
D. Suprarenal vein
E. Ovarian vein
A. Right colic vein

24. A 26-year-old patient is admitted to a local hospital

with a retroperitoneal infection. Which of the following
arteries is most likely to be infected?

A. Left gastric
B. Proper hepatic artery
C. Middle colic artery
D. Sigmoid arteries
E. Dorsal pancreatic artery
E. Dorsal pancreatic artery

25. A pediatric surgeon has reseced a structure that is a

fibrous remnant of an embryonic or fetal artery in a
5-year-old child. Which of the following structures is
most likely to be divided?

A. Lateral umbilical fold

B. Medial umbilical fold
C. Median umbilical fold
D. Ligamentum teres hepatitis
E. Ligamentum venosum
B. Medial umbilical fold

26. A 57-year-old patient has a tumor in the body of the

pancreas that obstructs the inferior mesenteric vein
just before joining he splenic vein. Which of the veins
is most likely to be enlarged?

A. Middle colic vein

B. Left gastroepiploic vein
C. Inferior pancreaticoduodenal vein
D. Ileocolic vein
E. Left colic vein
D. Ileocolic vein

27. An elderly man with prostatic hypertrophy returns to

his urologist with another case of epididiymitis. An
acute infection involving the dartos muscle layer of the
scrotum most likely leads to an enlargement of which
 of the following lymph nodes?

A. Preaortic nodes
B. Lumbar nodes
C. External iliac nodes
D. Superficial inguinal nodes
E. Common iliac nodes
D. Superficial inguinal nodes

28. A patient with cirrhosis is scheduled for liver transplant

surgery. During the operation rounds, the transplant
surgeon explains to his residents that one of the
reasons a surgeon must pay close attention to the
anatomic location of the liver is that this organ:

A. Receives blood only from the hepatic arteries

B. Manufactures red blood cells in an adult
C. Drains bile from the quadrate lobe into the right
hepatic duct
D. Drains venous blood into the hepatic veins
E. Functions to concentrate and sore bile
D. Drains venous blood into the hepatic veins

29. A 41-year-old woman is brought to the emergency

room by her family because of acute onset of right
upper quadrant pain, nausea, and vomiting. For this
case, it is important to remember that the bile duct:

A. Drains bile into the second part of the duodenum

B. Can be blocked by cancer in the body of the
pancreas
C. Joins the main pancreatic duct, which carries
hormones
D. Is formed by union of the right and left hepatic duct
E. Lies posterior to the portal vein in the right free
edge of the leseer omentum
A. Drains bile into the second part of the duodenum

30. A patient with diverticulosis of the colon presents for a

follow-up to his primary care physician with ongoing
complaints of left lower quadrant pain and
occasionally bloody stools. His physician begins
workup with appropriating test recalling that the
sigmoid colon:

A. Is drained by systemic veins

B. Is a retroperitoneal organ
C. Receives parasympathetic fibers from the vagus
nerve
D. Receives its blood from the superior mesenteric
artery
E. Has teniae coli and epiploic appendages
E. Has teniae coli and epiploic appendages

31. A 19-year-old man with a ruptured appendix is sent to

the emergency department for surgery. To cut of the
blood supply to the appendix (if collateral circulation is
discounted), a surgeon should ligate which of the
following arteries?

A. Middle colic artery

B. Right colic artery
 C. Ileocolic colic artery
D. Inferior mesenteric artery
E. Common iliac artery
C. Ileocolic colic artery

32. Because of an inflammatory bowel disease (Crohn's

disease) and a small bowel obstruction leading to
bowel ischemia, an elderly woman requires bypass of
her ileum and jejunum and is scheduled for a
gastrocolostomy. The surgeon will ligate all arteries
that send branches to the stomach. Which of the
following arteries will be spared?

A. Splenic artery
B. Gastroduodenal artery
C. Inferior pancreaticduodenal artery
D. Left gastroepiploic artery
E. Proper hepatic artery
C. Inferior pancreaticduodenal artery

33. A 38-year-old woman with peptic ulcer disease of the

stomach experiences severe abdominal pain. Which
of the following nervous structures is most likely
involved?

A. Greater splanchnic nerve

B. Ventral roots of the spinal nerve
C. Lower intercoastal nerve
D. Vagus nerve
E. Gray ramus communicans
A. Greater splanchnic nerve

34. Before beginning a cesarean section (C-section) in a

pregnant woman with genital herpes infection, the
obstetrician noted that the woman had a normal
aponeurosis of the transverse abdominal muscle. This
aponeurosis most likely contributes to the formation of
which of the following?

A. Anterior layer of the rectus sheath below the

arcuate line
B. Anterior layer of the rectus sheath above the
umbilicus
C. Posterior layer of the rectus sheath below the
arcuate line
D. Deep inguinal ring
E. Lacunar liament
A. Anterior layer of the rectus sheath below the arcuate line

35. Examination of a 54-year-old man reveals an isolated

tumor located at the porta hepatis. This tumor most
likely compresses which of the following structures?

A. Cystic duct
B. Hepatic Veins
C. Common hepatic artery
D. Left gastric artery
E. Branches of the portal vein
E. Branches of the portal vein
36. A patient is rushed to the operating room for an
emergent cholecystectomy (resection of a gallbladder)
because of cholecystitis. While locating landmarks
before surgical resection of an infected gallbladder,
the surgeon recalls a portal-caval anastomosis. Which
of the following pairs of veins form a portal-caval
anastomosis?

A. Hepatic veins and inferior vena cava

B. Superior and middle rectal vein
C. Left and right gastric vein
D. Inferior and superficial epigastric veins
E. Suprarenal and renal veins
B. Superior and middle rectal vein

37. Mrs. Jones is undergoing a routine colonoscopy for

colon cancer prevention. The gas-troenterologist finds
a Meckel's diverticulum. Which of the following
statements is true about the diverticulum?

A. It is found 2 feet distal to the ileocecal junction

B. It is located on the mesenteric side of the ileum
C. It occurs in about 20% of the population
D. It is a persistent remnant of the embryonic yolk
stalk
E. It may contain renal and suprarenal tissues
D. It is a persistent remnant of the embryonic yolk stalk

38. A 54-year-old man comes to a hospital with abdominal

pain, jaundice, loss of appetite, and weight loss. On
examination of his radiograms and computed
tomography (CT) scans, a physician finds a slowly
growing tumor in the uncinate process of the
pancreas. Which of the following structures is most
likely compressed by this tumor?

A. Main pancreatic duct

B. Splenic artery
C. Portal vein
D. Superior mesenteric artery
E. Superior pancreaticoduodenal artery
D. Superior mesenteric artery

39. A 6-year-old boy comes to his pediatrician with a lump

in the groin near the thigh and pain in the groin. On
examination, the physician makes a diagnosis of a
direct inguinal hernia because the herniated tissue:

A. Enters the deep inguinal ring

B. Lies lateral to the inferior epigastric artery
C. Is covered by spermatic fasciae
D. Descends into the scrotum
E. Develops after birth
E. Develops after birth

40. A 21-year-old man developed a hernia after lifting

heavy boxes while moving into his new house. During
the repair of his resulting hernia, the urologist recalls
that the genitofemoral nerve:

A. Runs in front of the quadratus lumborum

 B. Is a branch of the femoral nerve
C. Supplies the testis
D. Passes through the deep inguinal ring
E. Gives rise to an anterior scrotal branch
D. Passes through the deep inguinal ring

41. An oncologist is reviewing a computed tomography

(CT) scan of a 74-year-old man with newly diagnosed
hepatocellular carcinoma. He locates the affected
quadrate lobe of the liver that:

A. Lies between the inferior vena cava and

ligamentum
venosum
B. Receives blood from the right hepatic artery
C. Drains bile into the left hepatic duct
D. Is a medial superior segment
E. Is functionally a part of the right lobe
C. Drains bile into the left hepatic duct

42. A 58-year-old man is presented with edema of the

lower limb and enlarged superficial veins of the
abdominal wall. Examination of radiographs and
angiograms reveals obstruction of the inferior vena
cava just proximal to the entrance of the renal vein.
This venous blockage may result in dilation of which
of the following veins?

A. Left suprarenal vein

B. Right inferior phrenic vein
C. Right hepatic vein
D. Left gastric vein
E. Portal vein
A. Left suprarenal vein

43. A physical fitness trainer for a young Hollywood movie

star explains the reasons for 100 stomach crunches a
day. The young star, a medical student before “hitting
it big,” reaffirms to his trainer that the lateral margin of
the rectus abdominis, the muscle responsible for a
washboard stomach, defines which of the following
structures?

A. Linea alba
B. Linea semilunaris
C. Linea semicircularis
D. Transversalis fascia
E. Falx inguinalis
B. Linea semilunaris

44. During surgical treatment of portal hypertension in a

59-year-old man with liver cirrhosis, a surgeon
inadvertently lacerates the dilated paraumbilical veins.
The veins must be repaired to allow collateral flow.
Which of the following ligaments is most likely
severed?

A. Lienorenal ligament
B. Lienogastric ligament
C. Gastrophrenic ligament
D. Ligamentum teres hepatis
E. Ligamentum venosum
 D. Ligamentum teres hepatis

45. A 43-year-old woman is admitted to a hospital

because of deep abdominal pain in her epigastric
region. On examination, it is observed that a
retroperitoneal infection erodes an artery that runs
along the superior border of the pancreas.
Which of the following arteries is likely injured?

A. Right gastric artery

B. Left gastroepiploic artery
C. Splenic artery
D. Gastroduodenal artery
E. Dorsal pancreatic artery
C. Splenic artery

46. A 19-year-old young woman with a long history of

irritable bowel syndrome presents for the possibility of
surgical resection of the gastrointestinal (GI) tract
where the vagal parasympathetic innervation
terminates. Which of the following sites is most
appropriate for surgical resection?

A. Duodenojejunal junction
B. Ileocecal junction
C. Right colic flexure
D. Left colic flexure
E. Anorectal junction
D. Left colic flexure

47. A 58-year-old man is admitted to a hospital with

severe abdominal pain, nausea, and vomiting
resulting in dehydration. Emergency computed
tomography (CT) scan reveals a tumor located
between the celiac trunk and the superior mesenteric
artery. Which of the following structures is likely
compressed by this
tumor?

A. Fundus of the stomach

B. Neck of the pancreas
C. Transverse colon
D. Hepatopancreatic ampulla
E. Duodenojejunal junction
B. Neck of the pancreas

48. An emergent hernia repair is scheduled. As the

attending physician is driving to the hospital, the
medical student assisting on the case quickly reviews
his anatomy atlas and is trying to commit to memory
that the internal oblique abdominis muscle contributes
to the formation of which of the following structures?

A. Inguinal ligament
B. Deep inguinal ring
C. Falx inguinalis (conjoint tendon)
D. Internal spermatic fascia
E. Reflected inguinal ligament
C. Falx inguinalis (conjoint tendon)
49. A 9-year-old girl has crashed into her neighbor's brick
fence while riding her bike and is brought to the
emergency department with a great deal of abdominal
pain. Her radiogram and angiogram show laceration of
the superior mesenteric artery immediately distal to
the origin of the middle colic artery. If collateral
circulation is discounted, which of the following organs
may become ischemic?

A. Descending colon
B. Duodenum
C. Pancreas
D. Ascending colon
E. Transverse colon
D. Ascending colon

50. A 53-year-old woman with known kidney disease

presents to a hospital because her pain has become
increasingly more severe. A physician performing
kidney surgery must remember that:

A. The left kidney lies a bit lower than the right one
B. The perirenal fat lies external to the renal fascia
C. The renal fascia does not surround the suprarenal
gland
D. The left renal vein runs anterior to both the aorta
and the left renal artery
E. The right renal artery is shorter than the left renal
artery
D. The left renal vein runs anterior to both the aorta and the
left renal artery

51. A neonatal baby was born with diabetes mellitus due

to an inadequate production of insulin. Cells in the
endocrine portion of the pancreas that secrete insulin,
glucagon, and somatostatin are derived from which of
the following?

A. Ectoderm
B. Mesoderm
C. Endoderm
D. Proctodeum
E. Neural crest cells
C. Endoderm

52. During development, the midgut artery appears to be

markedly narrowed at its origin. Which of the following
structures is derived from the midgut and may receive
inadequate blood supply?

A. Gallbladder
B. Stomach
C. Descending colon
D. Ascending colon
E. Rectum
D. Ascending colon
53.

Which structure is hematopoietic in early life and later

destroys worn out red blood cells?
The answer is E

54.

Which structure runs along the superior border of the

pancreas and enters the lienore-nal ligament?
The answer is D.

55.

Which structure is divided into the proper hepatic and

gastroduodenal arteries?
The answer is A.

56.

Which structure provides an attachment of the

suspensory muscle of the duodenum (ligament of
Treitz)?
The answer is B.

57.

Which structure is retroperitoneal in position and

receives blood from the splenic artery?
 The answer is C.

58.

Which structure is a direct branch of the aorta and

supplies blood to the ascending and transverse
colons?
The answer is D.

59.

Which structure receives blood from the liver and

kidney and enters the thorax by piercing the central
tendon of the diaphragm?
The answer is B.

60.

Which structure receives bile, concentrates it by

absorbing water and salt, and stores it?
The answer is A.

61.

Which structure receives blood from the left gonad

and suprarenal gland?
The answer is E.
62.

Which structure runs behind the inferior vena cava?

The answer is C.

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