Transcript Lane`s Turning Pt Abdomen first 15 questions

Rotation of the stomach during development results in movement of the left
vagus nerve from its original position. Through approximately how many
degrees of rotation does the nerve move, and what is its final position?
1.
2.
3.
4.
5.
90° to become the anterior vagal trunk
90° to become the posterior vagal trunk
270° to become the anterior vagal trunk
270° to become the posterior vagal trunk
180° to become the posterior vagal trunk
100%
0%
1
0%
2
3
0%
4
0%
5
A 32 year old male is admitted to the emergency department with groin pain.
Examination reveals that the patient has an indirect inguinal hernia. Which of the
following nerves is compressed by the herniating structure in the inguinal canal to give
the patient pain?
1.
2.
3.
4.
5.
Iliohypogastirc
Lateral femoral cutaneous
Ilioinguinal
Subcostal
Pudendal
90%
10%
0%
1
0%
2
0%
3
4
5
During a scheduled laparoscopic cholecystectomy in a 47 year old female patient, the
resident accidentally clamped the hepatoduodenal ligament instead of they cystic artery.
Which of the following vessels would most likely be occluded in this iatrogenic injury?
1.
2.
3.
4.
5.
Superior mesenteric artery
Proper hepatic artery
Splenic artery
Common hepatic artery
Inferior vena cava
44%
44%
11%
0%
1
2
3
0%
4
5
A 45 year old male was admitted to the hospital with groin pain and a palpable mass just
superior to the inguinal ligament. The patient was diagnosed with an inguinal hernia and
a surgical repair was performed. During the operation the surgeon found a loop of
intestine passing through the deep inguinal ring. Which of the following types of hernia
was this?
1.
2.
3.
4.
5.
Direct inguinal
Umbilical
Femoral
Lumbar
Indirect inguinal
70%
30%
0%
1
2
0%
0%
3
4
5
A 55 year old man was admitted to the hospital with severe abdominal pain. Gastroscopy
and CT scan examinations revealed a perforating ulcer in the posterior wall of the
stomach. Where would peritonitis most likely develop initially?
1.
2.
3.
4.
5.
Right subhepatic space
Hepatorenal space (of Morison)
Omental bursa (lesser sac)
Right subphrenic space
Greater sac
90%
10%
0%
1
0%
2
3
4
0%
5
A 58 year old male alcoholic is admitted to the hospital after vomiting dark red blood
(hematemesis). Endoscopy reveals ruptured esophageal varices, resulting from portal
hypertension. Which of the following venous tributaries to the portal system
anastomoses with caval veins to cause the varices?
1.
2.
3.
4.
5.
Splenic
Left gastroomental
Left gastric
Left hepatic
Right Gastric
56%
22%
11%
11%
0%
1
2
3
4
5
A 45 year old male entered the emergency department with a complaint of severe
abdominal pain. During physical examination it is observed that his cremasteric reflex is
absent. Which of the following nerves is responsible for the efferent limb of the
cremasteric reflex?
1.
2.
3.
4.
5.
Ilioinguinal
Iliohypogastric
Genitofemoral
Pudendal
Ventral ramus of T12
50%
40%
10%
0%
1
2
3
4
0%
5
The decision is made by emergency department surgeons to perform an exploratory
laparotomy on a 32 year female with severe abdominal pain. Where would the incision
most likely be made to separate the left and right rectus sheaths?
1.
2.
3.
4.
5.
Midaxillary line
Arcuate line
Semilunar line
Tendinous intersection
Linea alba
100%
0%
1
0%
2
0%
0%
3
4
5
A 44 year old man is admitted to the emergency department with excessive vomiting and
dehydration. Radiographic images demonstrate that part of the bowel is being
compressed between the abdominal aorta and the superior mesenteric artery. Which of
the following intestinal structures is most likely being compressed?
1.
2.
3.
4.
5.
Second part of duodenum
Transverse colon
Third part of duodenum
First part of duodenum
Jejunum
67%
22%
11%
0%
1
0%
2
3
4
5
During the surgical repair of a perforated duodenal ulcer in a 47 year old male patient the
gastroduodenal artery is ligated. A branch of which of the following arteries will continue
to supply blood to the pancreas in this patient?
1.
2.
3.
4.
5.
Inferior mesenteric
Left gastric
Right gastric
Proper hepatic
Superior mesenteric
50%
25%
25%
0%
1
0%
2
3
4
5
A 70 year old man is admitted to the emergency department with severe diarrhea. An
arteriogram reveals 90% blockage at the origin of the inferior mesenteric artery from the
aorta. Which of the following arteries would most likely provide collateral supply to the
descending colon?
1.
2.
3.
4.
5.
Left gastroepiploic artery
Middle colic artery
Sigmoid artery
Splenic artery
Superior rectal artery
33%
22%
22%
3
4
22%
0%
1
2
5
In a routine visit to the outpatient clinic for his annual checkup, a 42 year old male is
informed that radiographic examination has given strong evidence that he has a
malignancy of his scrotum. Which of the following nodes are the first lymph nodes that
drain the affected area?
1.
2.
3.
4.
5.
Superficial inguinal
Internal iliac
Lumbar
Presacral
Axilliary
75%
13%
1
2
13%
0%
0%
3
4
5
A 34 year old man is undergoing an emergency appendectomy. After the appendectomy
has been performed successfully, the patient undergoes an exploratory laparoscopy.
Which of the following anatomic features are the most useful to distinguish the jejunum
from the ileum?
1.
2.
3.
4.
5.
Jejunum has thinner walls compared with the ileum.
Jejunum has less encroaching mesenteric fat compared with the ileum.
Jejunum has more numerous vascular arcades compared with the ileum.
Jejunum has more numerous lymphatic follicles beneath the mucosa
compared with the ileum.
Jejunum has fewer villi compared with the ileum.
67%
33%
0%
1
0%
2
3
4
0%
5
A 61 year old woman had been scheduled for a cholecystectomy. During the operation
the scissors of the surgical resident accidentally entered the tissues immediately
posterior to the epiploic (omental) foramen (its posterior boundary). The surgical field
was filled immediately by profuse bleeding. Which of the following vessels was the most
likely source of bleeding?
1.
2.
3.
4.
5.
Aorta
Inferior vena cava
Portal vein
Right renal artery
Superior mesenteric vein
63%
38%
0%
1
0%
2
3
4
0%
5
A 32 year old woman was admitted to the hospital with a complaint of pain over her
umbilicus. Radiographic examination revealed acute appendicitis. The appendix was
removed successfully in an emergency appendectomy. One week postoperatively the
patient complained of parathesia of the skin over the pubic region and the anterior portion
of her perineum. Which of the following nerves was most likely injured during the
appendectomy.
63%
1.
2.
3.
4.
5.
Genitofemoral
Ilioinguinal
Subcostal
Iliohypogastric
Spinal nerve T9
25%
13%
0%
1
2
3
0%
4
5