Abdomen

A 63-year-old man comes to the emergency department with back pain, weakness, and shortness of breath. On examination, he has an aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed?

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

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

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 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

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

Which structure is hematopoietic in early life and later destroys worn out red blood cells?

Which structure runs along the superior border of the pancreas and enters the lienore-nal ligament?

Which structure is divided into the proper hepatic and gastroduodenal arteries?

Which structure provides an attachment of the suspensory muscle of the duodenum (ligament of Treitz)?

Which structure is retroperitoneal in position and receives blood from the splenic artery?

Which structure is a direct branch of the aorta and supplies blood to the ascending and transverse colons?

Which structure receives blood from the liver and kidney and enters the thorax by piercing the central tendon of the diaphragm?

Which structure receives bile, concentrates it by absorbing water and salt, and stores it?

Which structure receives blood from the left gonad and suprarenal gland?

Which structure runs behind the inferior vena cava?