Included Content
- Anterolateral Abdominal Wall
- Peritoneum and Peritoneal Cavity
- Esophagus, Stomach, and Spleen
- Liver and Gall Bladder
- Small and Large Intestine
- Pancreas, Kidneys, Ureters, and Suprarenal Glands
- Posterior Abdominal Wall and Diaphragm
- Pelvis Girdle, Joints and Ligaments
- Nerve Tissue
- Urogenital Triangle and Anal Triangle
- Male and Female Perineum
- Pelvic Peritoneum and Urinary Organs
- Internal Genital Organs
- Pelvic Walls, Floor, Fascia, and Rectum
- Pelvic Nerves and Vessels
- Muscle Tissue
A patient who came in with severe pain, nausea and vomiting was found to have gallstones. In which region do you think this patient would feel the most pain?
Right hypochondrial
Epigastric
Left hypochondrial
Right umbilical
Left umbilical
2. A man comes into the clinic with weakness of his anterior abdominal wall in the inguinal triangle area. You find that he actually has a direct hernia near his lateral fold. What blood vessel is immediately lateral to the hernia?
superior epigastric artery
superficial epigastric artery
inferior epigastric artery
Deep circumflex iliac artery
Gonadal artery
3. What organ would you find inferior to the subcostal plane left of the belly button?
Stomach
Liver
Gallbladder
Ascending colon
Sigmoid arteries
4. Which of the following is a predisposition for torsion of the spermatic cord?
Inguinal hernia
Lack of scrotal ligament
Positive cremasteric reflex
Cut ductus deferens
Pampiniform venous plexus rupture
5. A patient who underwent routine liposuction had _____ fascia surgically removed. During the procedure, the membranous fascia layer deep to the superficial layer was incidentally cut. Because the _____ fascia continues inferiorly as the ______ fascia in the perineal region yet does continue into the thigh, a T2 weighted MRI revealed fluid accumulation inferior to the transtubercular plane extending into the inguinal region yet did not involve the proximal portion of the lower limbs.
Scarpas, Campers, Peroneal
Campers, Scarpas, Colles
Campers, Colles, Scarpas
Campers, Scarpas, Peroneal
Scarpas, Peroneal, Campers
6. In which abdominal region are you most likely to find the spleen?
Right Hypochondriac
Left Upper Quadrant
Left Hypochondriac
Umbilical
Left Inguinal
7. The aponeurosis of which muscles make up the anterior rectus sheath on the lower ⅓ of the rectus abdominis?
External oblique, internal oblique, transverse abdominis
External oblique, internal oblique
Internal oblique, transverse abdominis
External oblique, transverse abdominis
None of the muscles do, it just rests on the transversalis fascia
8. A patient presents with an inability to perform the cremaster reflex. Knowing where this muscle originates from, what other muscle may be dysfunctional?
External Oblique
Internal Oblique
Transverse Abdominis
Rectus Abdominis
Pyramidalis
9. The inferior margin of the external oblique aponeurosis directly forms what structure?
Cremaster muscle
Conjoint tendon
Lacunar Ligament
Inguinal Ligament
Posterior aspect of the rectus sheath
10. The umbilicus is found in which dermatome?
T9
T10
T11
T12
L1
11. Which of the following contain the remnants of the umbilical arteries?
Median umbilical fold
Medial umbilical folds
Lateral umbilical folds
Falciform ligament
Round ligament of the liver
12. Being born without a lesser omentum would cause many issues related to chronic infections because of white spots on the omentum known as milky patches. Which of the following does NOT originate from or reside inside the lesser omentum?
Hepatogastric ligament
Hepatic artery
Bile duct
Gastrosplenic ligament
Hepatic duct
13. Lewis comes into the ER complaining of pain in his belly button region. There is no obvious bruising or any signs of trauma and you assume this could be potentially viscerally related referred pain from which of the following organs?
Heart
Liver
Appendix
Kidney
Sigmoid colon
14. Kate had to have an appendectomy to remove her infected appendix. If left untreated, the appendix could burst spewing its contents throughout the body. Which of the following would be the first to allow the infection to spread?
A paracolic gutter between the right superior and inferior compartments
A paracolic gutter between the left superior and inferior compartments
A paracolic gutter between the right and left superior compartments
A paracolic gutter between the right and left inferior compartments
A paracolic gutter between the right inferior compartment and the pelvic girdle
15. Which of the following organs would be considered subperitoneal?
Stomach
Spleen
Liver
Kidneys
Bladder
16. The visceral peritoneum is sensitive to which of the following stimuli?
Touch
Heat
Laceration
Pressure/stretching
Cold
17. While dissecting your cadaver you accidentally rip out the entire lesser omentum. Which of the following ligaments did you damage?
Gastrophrenic
Gastrocolic
Hepatogastric
Gastroduodenal
Gastrosplenic
18. During a GI surgery you see the surgeon start freaking out and mentioning how he damaged the anterior boundary of the epiploic foramen. Which of the following structures may have been damaged in the surgery?
Inferior Vena Cava
Duodenum
Right Lobe of the Liver
Hepatic Artery Proper
Abdominal Aorta
19. Due to colorectal cancer a patients sigmoid colon has ruptured and begun to leak feces and fluid into the peritoneal cavity. In which of the following spaces will the leakage be unable to go to?
Left subphrenic space
Right subphrenic space
Subhepatic space
Left paracolic gutter
Right paracolic gutter
20. A tall, thin adolescent male comes into your clinic complaining of chest pain sensation that almost feels like burning. You notice his voice is hoarse and he has tooth decay. You find that he does indeed have bulimia nervosa as if he has been making himself vomit for months now. You explain to him the reason he is having this pain is because his stomach contents have repeatedly splashed up to his esophagus by going through what structure?
Ileocecal Valve
Pyloric sphincter
Inferior esophageal sphincter
Superior esophageal sphincter
Hepatoduodenal ampulla
21. GERD is a condition where stomach acid gets into the esophagus causing severe heartburn when patients eat. Which of the following does the acid travel through to cause these symptoms?
Inferior esophageal sphincter
Pyloric sphincter
Superior esophageal sphincter
Hepatogastric ligament
Gastrosplenic ligament
22. Brandon is a worried first time dad who is concerned because his newborn keeps vomiting after every feeding. They have tried breast milk and formula to no avail. What is the most likely differential diagnosis?
There is nothing to worry about, this is a reflex that will stop soon
His baby has GERD and there are some medications that can help with the symptoms
His baby has pyloric stenosis where the food cannot pass and he will require surgery
His baby is colic and this is a clinical symptom
His baby has a lactose allergy and should be switched from formula to lactose free milk
23. Which of the following, if cut would lead to ischemia of the fundus of the stomach?
Short gastric arteries
Left gastro omental artery
Hepatic artery
Left gastric artery
Right gastric artery
24. Esophageal varices are abnormally enlarged veins within the lower esophagus. They are a common complication of liver cirrhosis, where obstruction of the portal vein leads to portal venous hypertension. This places strain on the portacaval anastamoses of the lower esophagus, which often rupture and lead to fatal, torrential hemorrhage.
A 50 year old alcoholic is brought to your emergency department C/O hematemesis. EMS reports the patient lost approximately a liter of blood on scene and an additional liter en route to the hospital. The patient’s vitals are as follows:
HR: 130
RR: 12 (ventilated)
BP: 58/30, left arm, supine
SpO2: 100% on 100% oxygen
Surgery arrives, yells at the ED team for some reason, and takes the patient for emergent sternotomy/laparotomy. They also never bring you your monitor or stretcher back. What vessel should they ligate with their gifted hands?
Esophageal branches of azygos vein
Esophageal arteries from the thoracic aorta
Portal vein
Esophageal branches of left gastric artery
Esophageal branches of left gastric vein
25. A 45-year-old male is diagnosed with an inguinal hernia. During the operation the surgeon found a loop of intestine passing through the deep inguinal ring. Which type of hernia is this?
Direct inguinal
Indirect inguinal
Umbilical
Pelvic
Upper abdominal
26. A 45-year-old male is admitted to the hospital with a massive hernia that passes through the inguinal triangle (of Hesselbach). Which structure will help to diagnose the injury?
Inferior epigastric vessels
Inguinal ligament
Femoral canal
Pectineal ligament
Rectus abdominis muscle (lateral border)
27. A patient receives a shallow stab wound in the abdomen below the arcuate line. The knife pierces through the structures superficial to the rectus abdominal muscle. Which structures are affected?
external abdominal oblique only
external and internal abdominal oblique
external abdominal oblique, internal abdominal oblique, and transversus abdominus
external abdominal oblique, internal abdominal oblique, transversus abdominus, and the transversalis fascia
28. The rugae of the stomach are formed from which muscle layer?
Circular
Longitudinal
Oblique
Transverse
Spiral
29. If there is an occlusion of the splenic artery, which section of the stomach is unable to get blood, oxygen, and nutrients through anastomosis?
Cardia
Fundus
Body
Pyloric Antrum
Pyloric Canal
30. In which of the following ligaments are the splenic vessels (artery and vein) found?
Gastrosplenic
Splenorenal
Phrenicosplenic
Pancreaticosplenic
Splenocolic
31. Which organ of the foregut is NOT supplied from T6-T9 sympathetics?
Stomach
Liver
Pancreas
Spleen
Duodenum
32. A patient presents with pain on their upper left shoulder but denies any chest pain. Your attending tells you this is a classic example of Kehr’s sign and asks you to tell him what is probably wrong. What would you respond with?
The patient has cholecystitis or cholelithasis
The spleen is irritating the diaphragm
The patient has gastroesophageal reflux disease
The liver is irritating the diaphragm
The patient has pancreatitis
33. During a gastric bypass surgery, your preceptor accidently ligates the short gastric arteries, which of the following would be most likely to occur?
Ischemia of the lesser curvature of the stomach
Ischemia of the greater curvature of the stomach
Ischemia of the fundus of the stomach
Ischemia of the cardia of the stomach
Ischemia of the pyloric antrum
34. Johnny has cirrhosis caused by his years of heavy drinking that has lead to impeded blood flow to his liver. Which of the following allows for him to still drain his deoxygenated blood from his GI tract into the heart?
Hepatic artery
hepatic vein
Anastomoses of Portal Venous system
Renal veins
renal artery
35. Greg’s MRI recently showed that he has fluid built up in his abdominal cavity. He feels pressure on his back when he lays down. In which of the following structures would you expect to see the fluid accumulation?
Subphrenic recess
Subhepatic recess
Hepatorenal recess
Hepatic portal vein
Portal venous system
36. A clinical condition where there is dilation of veins in the abdominal cavity is known as Caput Medusae. It appears as a spider web of veins that looks like the snake-like hair of Medusa. The accumulation of blood occurs in which of the following structures?
Perisinusoidal spaces of Disse
Submucosa of inferior esophagus
Submucosa of anal canal
Paraumbilical region
Posterior aspect of secondarily retroperitoneal viscera
37. What is the major artery that supplies the gallbladder (in most people)?
Anterior superior pancreaticoduodenal
Common hepatic
Proper hepatic
Right hepatic
Left Hepatic
38. A varicocele (enlarged veins within the scrotum) on the left side is suggestive of an occlusion to which vein?
Left phrenic
Left renal
Left suprarenal
Splenic
Superior Mesenteric
39. You receive a phone call that your patient has been rushed to the E/R due to recent exacerbation of DIC (Disseminated intravascular coagulation). As excessive clots develop in her blood, she becomes depleted of clotting and coagulation factors making her an extreme risk for hemorrhage without resolve should she acquire some type of cut or incision. To make matters worse, your patient has a long history of alcoholism and has been suffering from xerosis of the liver. As you fly down the highway towards the hospital, you receive a phone call that medical imaging studies revealed that her Hepatic Portal Vein proximal to the L&R hepatic divisions, Inferior Mesenteric Vein, and Para-Umbilical Veins are completely blocked by the developing embolisms. What portal-system anastomoses remains that would offer your patient an alternate route of venous blood supply to systemic circulation?
Superior Rectal veins :: Inferior Rectal veins
Epigastric veins :: Para-umbilical veins
Splenic vein :: Retroperitoneal veins
Left Gastric vein :: Esophageal vein
Superior Rectal veins :: Common Rectal veins
40. During your clinical rotation in radiology, you observe your attending physician examine a T2 weighted MRI of patient’s liver. A dark pit indicative of a necrotic core is surrounded by a bright network of newly formed vasculature within the liver. The radiologist is certain this lesion is cancer, and because of its location has decided to surgically excise the entire lobe immediately. As he gloves up for surgery, he abruptly tosses the MRI in front of you – demanding to know what lobe he is about to excise! You study the inferior image, and notice that the cancerous lobe is bound by the Gallbladder on the Right, the Round ligament on the Left, and the Porta Hepatis posteriorly. What lobe is to be surgically removed?
Quadrate lobe
Left lobe
Caudate lobe
Caudate process
Right lobe
McWhorter Lecture: Anatomical lobes of liver.
41. The infamous Portal Triad encased in the Hepatoduodenal ligament is not the only portal triad that exists in our viscera. Liver lobules in the human liver contain many interlobular portal triads where hepatocytes work tirelessly to both produce bile and detoxify our blood. Regarding hepatocytic bile production, what is the correct flow of bile from hepatocyte to bile duct?
Hepatocyte → Interlobular biliary ducts → Bile canaliculi → Bile duct
Hepatocyte → Bile canaliculi → Interlobular biliary ducts → Bile duct
Interlobular biliary ducts → Hepatocyte → Bile canaliculi → Bile duct
Bile canaliculi → Hepatocyte → Interlobular biliary ducts → Bile duct
McWhorter Lecture: dual blood supply of liver.
42. 6 weeks after giving birth to a healthy baby girl, your patient storms into the E/R with a clearly jaundiced and malnourished infant. She reports failure to thrive and that the yellow color has spread to the whites of her eyes. Biliary atresia is an uncommon disease where bile is unable to flow into the intestines. Blocking the flow results in a build-up of bile in the liver leading to malnutrition, jaundice, and liver damage. Blocking of which duct(s) or would result in Biliary atresia?
Left Hepatic duct
Cystic duct
Common hepatic duct
Right Hepatic duct
Right Hepatic duct and Cystic duct
43. Which of the lobes is between the gallbladder and the round ligament of the liver?
Right
Left
Caudate
Quadrate
Round
44. What lobe may be referred to as a “third liver” since its vascularization is independent of the bifurcation of the portal triad and it can drain directly into the inferior vena cava?
Right
Left
Caudate
Qudrate
Round
45. Which of the following nutrients is NOT carried by the portal venous system?
Proteins
Carbohydrates
Nucleic Acids
Lipids
Vitamins
46. If a gallstone is lodged into and blocking the common bile duct, where is the first place the bile will back up into?
Right hepatic duct
Bile canaliculi
Left hepatic duct
Interlobular ducts
Cystic duct
47. Which of the following hormones will cause the gallbladder to contract and release bile into the duodenum?
Secretin
Cholecystokinin (CCK)
Gastrin
Adrenocorticotropic hormone (ACTH)
Somatostatin
48. Bile will flow through which of the following in order to go from the gallbladder to the bile duct?
Sphincter of the bile duct
Sphincter of the pancreatic duct
Major duodenal papilla
Spiral valve
Hepatic valve
49. A patient presents with hepatic portal venous stenosis making it difficult for the blood from the hepatic portal vein to the inferior vena cava. Blood from which of the following locations would be least likely to reach the IVC via an alternative route?
Esophagus
Duodenum
Umbilicus
Descending Colon
Rectum
50. Connor has peritonitis caused by a buildup of fluid in the peritoneal cavity. Which of the following allows this fluid to travel from the anterior to posterior aspects of the abdominal cavity?
Greater sac
Lesser sac
Greater omentum
Foramen ovale
Epiploic foramen
51. Invasion of the greater sac with a ruptured abscess is going to transmit to the lesser sac through which structure?
Greater sac
Lesser sac
Greater omentum
Foramen ovale
Epiploic foramen
52. During a gastric bypass surgery, the splenic artery was nicked near the body of the pancreas. Which of the following allows for blood supply to still reach the spleen?
Left Gastro omental artery
Superior pancreaticoduodenal
Short gastric arteries
Left gastric artery
Right gastric artery
53. Yolanda presents to the office with pain that radiates from her umbilicus to her lower right quadrant, fever, nausea and vomiting and a loss of appetite that began about six hours ago. Which of the following are you expecting to see?
Gall stone
Kidney Stone
Appendicitis
Hemorrhoids
GERD
54. Mononucleosis, or “mono” is an illness that makes you feel tired and weak for an extended period of time. It can cause a high fever, sore throat, swollen lymph nodes, weakness and fatigue. It can also cause the spleen to swell and in severe causes can cause the spleen to burst. Since the spleen does not have many free nerve endings, in which of the following areas would you be most likely to feel the pain from a ruptured spleen?
Ascending colon
Descending colon
Transverse colon
Right colic flexure
Left colic flexure
55. Jim is a 67 year old male who presents with decreased bowel sounds, interruption of the ability to move contents through the bowel, and pain. A CT reveals avascular necrosis of the bowel. If the iliocolic artery was affected, in which area of the large intestine would you expect to see the ischemia?
Ilium
Ascending colon
Descending colon
Transverse colon
Sigmoid colon
56. In which of the following regions of the intestines would the above image have been obtained from an endoscopy?
Sigmoid
Transverse
Duodenum
Ilium
Cecum
Which of the following would have been obtained from an endoscopy of the jejunum?
57. A blood sample from which of the following veins will have the highest concentration of chylomicrons?
Cystic vein
Superior mesenteric vein
Inferior mesenteric vein
Hepatic portal vein
Superior vena cava
58. A blood sample from which of the following veins will have the highest concentration of ingested amino acids?
A. Cystic vein
B. Superior mesenteric vein
C. Inferior mesenteric vein
D. Hepatic portal vein
E. Superior vena cava
59. Your patient’s Inferior Pancreaticoduodenal artery has completely collapsed proximal to the Superior Mesenteric artery during an intra-abdominal surgery. Through which artery will blood still be supplied to the head of the Pancreas?
Left gastro-omental artery
Supraduodenal artery
Gastroduodenal artery
Splenic artery
The Gastroduodenal artery gives rise to the Superior Anterior/Posterior Pancreaticoduodenal arteries that will additionally supply the head of the Pancreas as they anastomose with their inferior counterparts that arise from the SMA.
60. During a parasitic helminth infection of the small intestine, what physiological changes would result in the viscera from our body’s innate immune system to combat the infection?
A constriction of the Left Colic Flexure inferior to the Spleen
An extension of the Taeniae Coli along the entire length of the Colon
An increase in size and activity of Peyer’s Patches in the small intestine
A tapering off of the Appendix resulting in Cecum necrosis
Peyer’s patches are major concentrations of lymph tissue in the small intestine and appendix that will become more pronounced with the infiltration of leukocytes (lymphocytes and granulocytes) in response to a localized infection.
61. During an impromptu bike exploration of the local trails in Fort Smith, a medical student “bit off more than he could chew” and wiped out hard on a rocky trail that he attempted. If the student’s fall was severe enough to obliterate the sacral nerves S1-S3, what visceral organs would be compromised in their function?
Ascending duodenum, jejunum, and proximal ileum
Descending colon, Sigmoid colon, and Rectum
Cecum, Ascending colon, and first ½ Transverse colon
Terminal ileum, Cecum, and Ascending colon
62. Which of the following would be considered secondary retroperitoneal?
Head of the pancreas
Inferior duodenum
Tail of the pancreas
Right kidney
Spleen
63. In which section of the GI system are a majority of the nutrients absorbed?
Duodenum
Jejunum
Ilium
Ascending Colon
Descending Colon
64. Which section of the large intestine is most likely to be subject to ischemic bowel disease (IBD)?
Ascending Colon
Hepatic Flexure
Transverse Colon
Splenic Flexure
Descending Colon
65. Lymph from the Jejunum will initially go into which of the following lymph nodes?
Celiac
Superior Mesenteric
Inferior Mesenteric
Mesocolic
Cisterna Chyli
66. Activation of which of the following will cause increased peristalsis to move a food bolus through the GI tract?
Sympathetic nervous system
Somatic nervous system
Myenteric plexus
Submucosal plexus
T8-T10
67. In which type of stool would you recommend a patient add dietary fiber?
Type 1
Type 2
Type 3
Type 4
Type 5
68. A patient presents to the ED with a chief complaint of abdominal pain. Upon doing your physical exam you notice hypoactive bowel sounds. Which of the following could be a cause of the decreased sounds and the patient’s pain?
Recent meal
Bowel Obstruction
Cholelithiasis (gallstones)
Diarrhea
Cirrhosis of the liver
69. Judy comes into your clinic complaining of severe pain in her stomach anytime she eats anything. It began about a month ago and has caused her to dread eating so much that she has lost 20 pounds. Examination reveals that she has ischemia in the splenic flexure of her large intestine. Damage to which of the following arteries is likely the cause of the ischemia?
Ileocolic
Left colic
Right colic
Superior mesenteric
Inferior mesenteric
70. Your patient, who has atrial fibrillation, suffers acute ischemic colitis due to a blood clot residing in the marginal artery of the colon. An interventional radiologist plans to remove the clot by catheterizing the femoral artery. Which of the following arteries will the physician pass through en route to the marginal artery from the femoral artery?
Gastro-omental artery
Celiac artery
Ileocolic artery
Internal iliac artery
Inferior mesenteric artery
71. Brian shows up at the ER with extreme left flank pain, nausea, and painful urination. A urine sample shows cloudy urine that shows signs of hematuria. You believe he has a kidney stone. In which of the following locations would the blockage be most likely to occur.
Renal cortex
Renal papilla
Major calyx
Apex of renal pelvis
Minor calyx
72. Which of the following is the correct pairing of the embryological origin of the adrenal gland?
Cortex: mesoderm; Medulla: Neural Crest Cells
Cortex: Neural crest cells; medulla: mesoderm
Cortex: exoderm; Medulla: endoderm
Cortex and medulla: Mesoderm
Cortex and medulla: endoderm
73. After a severe kidney infection leading to septic shock that almost cost Tara her life, her kidneys had started shutting down and she now has necrotic tissue in her right superior portion of her kidneys. Which of the following would you perform to remedy this problem?
Complete removal of both kidneys as this necrosis would spread not only to the rest of the kidney, but throughout the body.
A kidney transplant as this problem will be stable until one becomes available but because of the damage, she cannot survive with only one kidney
Resect the apical segment as it has its own complete blood supply
Resect the apical and anterosuperior segments as they share a blood supply
Put her on antibiotics and high flow oxygen via a non-rebreather mask to reverse the necrosis
74. The apical segmental artery of the kidney anastomose with what other segmental artery?
Anterosuperior
Anterio-inferior
Posterior
Inferior
None of the above
75. The head of the pancreas is primarily in contact with which of the following?
Liver
Duodenum
Abdominal Aorta
Left Kidney
Spleen
76. If the hepatopancreatic ampulla becomes blocked with a gallstone, how will a patient be able to continue digestion?
The main pancreatic duct will still be able to drain into the duodenum since it does not participate in the hepatopancreatic ampulla
The accessory pancreatic duct will still be able to drain into the duodenum since it does not participate in the hepatopancreatic ampulla
Pancreatic juices are not necessary for digestion so digestion will continue as normal
The bile duct will still be able to drain into the duodenum since it does not participate in the hepatopancreatic ampulla
The stomach will begin producing the necessary enzymes for digestion and it will compensate
77. A patient is found to have a blockage of the celiac trunk and is worried about the entire pancreas being ischemic and necrossing. You reassure the patient that which of the following arteries to the patient will still have blood flow and be able to compensate for a portion of the pancreas?
Dorsal pancreatic
Greater pancreatic
Anterior superior pancreaticoduodenal
Anterior inferior pancreaticoduodenal
Posterior superior pancreaticoduodenal
78. Lymph from the pancreas primarily drains to which of the following lymph nodes?
Pancreaticosplenic
Superior mesenteric
Celic
Inferior mesenteric
Hepatic
79. Which of the following will have the greatest effect on activating the pancreas’ exocrine activity?
Sympathetic nervous system
Parasympathetic nervous system
Cholecystokinin
Gastrin
Increase in glucose levels
80. When performing a pancreatectomy, which section of the pancreas is impossible to remove completely?
Head
Neck
Body
Tail
Fundus
81. A patient presents to the ED with a stab wound on their posterior left flank that appear to have pierced into the kidney. Which nerves are you also worried about being severed due to their locations in the area?
Phrenic
Vagus
Iliohypogastric
Greater splanchnic
Internal pudendal
82. Which of the following is the correct order for urine flow in a kidney?
Ureter
Major calyx
Renal pyramid
Renal pelvis
Minor calyx
Urinary bladder
Renal papilla
3, 7, 5, 2, 4, 1, 6
6, 1, 4, 2, 5, 7, 3
7, 3, 5, 2, 4, 1, 6
3, 7, 2, 5, 1, 4, 6
5, 2, 4, 1, 6, 3, 2
83. The Kidney, Adrenal glands, and superior portion of the ureters initially drain into which lymph nodes?
Inferior mesenteric
Superior mesenteric
Lumbar
Common Iliac
External Iliac
84. Kidney stones that move into the ureters (ureteric calculi) often cause individuals severe amounts of pain that will follow the sympathetic fibers. In which dermatome levels will the pain be felt?
T6-8
T6-9
T10-12
T11-L2
S2-4
85. In which of the following congenital anomalies is it likely that if a cancer would happen to one of the kidneys, both would have to be removed?
Bifid renal pelvis
Retrocaval ureter
Horseshoe kidney
Ectopic pelvic kidney
Unilateral duplicated ureter
86. Following inguinal hernia repair, George, a 47 year old male, sustained an injury to his ilioinguinal nerve. Which of the following would he experience?
Numbness on the anterior surface of his scrotum
Numbness on his mons pubis
Numbness on his inner thigh
Numbness on his outter thigh
Paralysis of his cremasteric muscle
87. A patient presents to the ED with an inability to walk and extreme pain on the superior posterior portion of their thigh. After an XRay it is notice the lesser trochanter has been fractured. Which muscle functions are now going to be compromised?
Psoas Minor
Iliacus
Rectus Femoris
Adductor Magnus (hamstring portion)
Gluteus Maximus
88. Which posterior abdominal wall muscle has an important action in respiration?
Psoas Major
Psoas Minor
Iliacus
Quadratus Lumborum
Transversus Abdominis
89. The Median arcuate ligament passes over which structure?
Quadratus Lumborum
Psoas Major
Iliacus
Esophagus
Abdominal Aorta
90. An aortic aneurysm is found at the junction of the thoracic and abdominal aorta. At which vertebral level would the diaphragm have trouble moving around the aneurysm?
T8
T9
T10
T11
T12
91. Which of the following paired veins differ in where they drain into?
Renal
Suprarenal
External Iliac
Internal Iliac
4th lumbar
92. While on a general surgery rotation, your preceptor is about to perform a surgery to relieve nutcracker syndrome and is quizzing you on the cause of this condition What would you respond to him with?
The right renal vein is being compressed by the superior mesenteric artery
The superior mesenteric artery is being compressed by the left renal artery
The left renal vein is being compressed by the inferior mesenteric artery
The left renal artery is being compressed by the superior mesenteric artery
The left renal vein is being compressed by the superior mesenteric artery
93. Which nerve would be unaffected by an injury to the ventral rami of L2?
Obturator
Femoral
Lateral femoral cutaneous
Genitofemoral
Ilioinguinal
94. While taking your 3rd anatomy practical you notice a tagged nerve on the anterior of the psoas major that also appears to be piercing the same muscle. You being quite the smartie immediately write down which nerve?
Genitofemoral
Obturator
Iliohypogastric
Lateral cutaneous nerve of the thigh
Femoral
95. Tom’s tiny testicles are trapped and unable to ascend closer to the abdominal cavity in cold weather. What nerve must be damaged?
Ilioinguinal
Iliohypogastric
Genitofemoral
Obturator
Femoral
96. Which of the following is a border of the pelvic inlet?
Inferior border of the pubic symphysis
Pecten pubis
Coccyx
Inferior rami of the pubis
Sacrotuberous ligaments
97. Which type of joint lies between the tuberosities of the ilium and sacrum?
Sutures
Synovial plane
Syndesmosis
Synovial hinge
Gomphosis
98. Which ligament is primarily responsible for transferring the weight of the upper body to the ilium to the femurs?
Interosseous sacro-iliac
Inferior pubic
Iliolumbar
Anterior sacrococcygeal
Anterior sacro-iliac
99. What is the gender of the person whos XRay is shown above?
Male
Female
Hermaphrodite
Non-binary
This is 2019, how dare you assume someone’s gender!
100. Which of the following would you expect to find in or be characteristic of a female pelvic girdle?
Generally thick and heavy
Circular obturator foramen
Rounded pelvic inlet
Narrow pubic arch and subpubic angle
Large acetabulum
101. Which of the following pelvic types is uncommon in both sexes?
Android
Iphone
Gynecoid
Anthropoid
Platypelloid
102. While on your OBGYN rotation you are concerned about a pregnant patient’s ability to vaginally deliver her future child. You perform a manual digital conjugate to estimate her true (obstetric) conjugate and find it measures 11 cm. Will she be able to have a vaginal delivery?
Yes 11 cm on a diagonal is within the normal range
No 11 cm on a diagonal is too small to be able to deliver safely
It is irrelevant because only the interspinous distance matters
Depends on if her vagina is able to permit three fingers side by side
Through god, anything is possible
103. In persons with Down syndrome, the spines of dendrites can exhibit structural changes resulting in shorter or non functioning processes. Which of the following would be affected?
Sending signals
Integrating information
Receiving signals
Differentiating stimulus size
Moving signals to the axon hilux
104. Viral encephalitis can occur and be fatal when viruses cross the blood-brain barrier. Which of the following help to maintain the integrity of the blood brain barrier?
Gap Junctions
Desmosomes
Oligodendrocytes
Astrocytes
Ependymal cells
105. Your friend gets pissed off at you while studying in the anatomy lab and stabs you in the hand with a scalpel. The pain is carried in which of the following nerve fibers?
Somatic sensory
Visceral sensory
Somatic motor
Parasympathetic autonomic motor
Sympathetic autonomic motor
106. When waking up for FOPC you notice a beautiful Arkansas sunrise. Which type of neuron is found in your retina that carries this information?
Multipolar
Bipolar
Pseudounipolar
Anaxonic
Tripolar
107. When creating peptide neurotransmitters such as Somatostatin they are created in the soma and have to be transported to the axon. Which motor protein and direction are you going to use to accomplish this?
Kinesin for anterograde transport
Kinesin for retrograde transport
Dynein for anterograde transport
Dynein for retrograde transport
Dynein for terminal transport
108. Which of the following glial cells would you expect to find in a sympathetic chain ganglia?
Astrocyte
Microglia
Oligodendrocyte
Satellite cell
Schwann cell
109. Which glial cells is responsible for preventing carbidopa access to the CNS while L-DOPA can pass through with no problem when giving a patient with Parkinson’s Sinemet?
Oligodendrocytes
Astrocytes
Ependymal Cells
Microglia
Satellite Cells
110. Rupture of which structure would result in a “penile fracture”
Cavernous tissue
Corpus cavernosum
Corpus spongiosum
Tunica albuginea
Penile urethra
111. Which part of the external anal spincter attaches to the perineal body and the anococcygeal ligament?
External part
Deep part
Superficial part
Subcutaneous part
Cutaneous part
112. Which of the following arteries is a branch off what passes through Alcock’s canal?
Superior gluteal
Inferior gluteal
Middle rectal
Inferior rectal
Umbilical
113. Which of the following composes the ventral surface of the penis?
Ischiocavernosus
Corpora Cavernosa
Bulbospongiosus
Corpus Spongiosum
Prepuce
114. Phimosis is a condition associated with what aspect of the penis?
Scrotal raphe
Prepuce
Crura
Tunica albuginea
Buck’s fascia
115. Which of the following are NOT homologous structures between the external genitalia?
Penis and clitoris
Bulbourethral glands and greater vestibular glands
Scrotum and labia minora
Round ligament of the uterus and vas deferens
Prepuce of the penis and hood of the clitoris
116. Activation of which nerves will cause erection of the penis?
Dorsal penile nerve
Ilioinguinal
Cavernous nerves
Deep branch of perineal nerve
Genitofemoral
117. An unlucky 55 year old male patient has developed cancer in the tissue of the glans of his penis. Which group of lymph nodes would you most certainly need to remove?
deep inguinal,
superficial inguinal,
sacral,
internal iliac,
external iliac.
118. A third year medical student performs an unsupervised surgery to remove a mass in the anal triangle of a patient. The patient presents to the emergency department a few days later complaining of fecal incontinence (inability to stop defecation). You, as the attending physician, deduce that the student severed the nerve that controls the external anal sphincter. Which nerve has been severed?
inferior rectal,
internal pudendal, nerve to levator ani,
deep branch of perineal nerve,
superficial branch of perineal nerve.
119. You have determined via angiogram that a patient has blockage in their inferior rectal arteries. Which of these arteries provide branches that anastomose with this artery to compensate for the lack of circulation?
internal iliac/inferior mesenteric,
internal iliac/internal pudendal,
internal pudendal/inferior mesenteric,
internal pudendal/external iliac,
inferior mesenteric/external iliac.
120. During Mary’s last ultrasound, her baby’s head was measuring at 11 inches. The OB/GYN told her that she will require either a C-section or an episiotomy to deliver her baby. If she decides to deliver naturally, what must occur to ensure the least amount of severe vaginal laceration?
Nothing, the pubic symphysis will expand enough to pass the baby through
She will tear her perineum so she must deliver via C-section
She will be cut between her vagina and anus through the perineal body
She will be cut between her vagina and anus around the perineal body
She will be cut between her vagina and pubic symphysis through the perineal body
121. Jack racked himself trying to impress Tina by doing a wheelie on his motorcycle. He ended up rupturing his urethra and is now in the hospital with a painful, swollen scrotum and an unimpressed Tina. In which of the following areas would urine from his ruptured urethra be least likely to accumulate?
Between Dartos and Buck fascia
In front of the bladder
Between the superficial and deep layer of perineal fascia
Between the Dartos and colles fascia
In the scrotum
122. Which of the following is NOT a osseofibrous structure marking the boundary of the perineum?
Pubic symphysis
Ischiopubic rami
Ischial spines
Sacrotuberous ligaments
Sacrum
123. Which of the following would be found in the deep perineal pouch?
Clitoris
Membranous urethra
Superficial transverse perineal muscles
Deep perineal branch of the internal pudendal artery
Bulbospongiosus
124. Mad Matt’s ultimate finishing move is the “Perineum punch” which has been known to rupture the spongy urethra. After the recipient of said move is taken to the hospital, urine will pass to all of the following EXCEPT which?
Around the right testicle
Around the penis
Inferior abdominal wall
Anal triangle
Around the left testicle
125. Which aspect of the male urethra is most likely to be ruptured during urethral catheterization?
Preprostatic
Prostatic
Membranous
Spongy
Penile
126. While a woman is experiencing perineal pain during childbirth, your attending wants you to administer a pudendal nerve block. Which bony structure would you use as a landmark to administer the anesthetic?
Pubic Tuberosity
Ischial tuberosity
Ischial spine
Sacrum
Anterior Superior Iliac Spine
127. A congenital birth defect resulting in ureters that go into the bladder anteriorly would result in frequent bladder and kidney infections, why is this?
It would cause the buildup of bacteria in the angle it is entering the kidney from
It would allow for the buildup of calcium in the kidney resulting in stones and subsequent infections
It would create a longer distance for the urine to travel thus giving it more time to acquire an infection
It would result in a shorter urethra as well which would thus allow for more bacteria to enter the system
It would cause issues with backflow as there would be no flap valve to prevent it.
128. After the removal of a kidney stone, stents are often put into the ureter to keep it open as it heals and prevent further blockages. Because of the arterial supply to the ureters insertion of these stents can be difficult. Which of the following ways of inserting it would have the least chance of rupturing vessels?
Pulling the ureter laterally the whole time once inserted
Pulling the ureter laterally then medially once inserted
Pushing the ureter medally the whole time once inserted
Pushing the ureter medially then laterally once inserted
There are no vessels directly on the ureter so this is not a consideration that needs to be made
129. Harold is suffering from a kidney stone passing from his right kidney. As it passes through the ureter the sharp edges can pierce the inside or the large size can cause it to get stuck–especially at areas of natural constriction. Where would this pain be felt?
On the right midsagital anterior side of the stomach
On the left midsagital anterior side of the stomach
In the left flank
In the right flank
In the kidney and bladder since the ureter has no afferent nerve fibers
130. You’re coming into your ER shift when the person you are taking over for sleepily hands you this x-ray image saying it is a ruptured bladder in room 4. Before you can ask him any further questions he is gone. You cannot find the chart and have no idea who the patient is. You walk into the exam room and there is a tired mom with her four kids, three of which are sleeping and one who is quietly playing video games on her phone. None of who appear to be distressed. Not wanting to seem incompetent you guess who the x-ray belongs to. Would you guess that it belongs to her, her 2 year old, her 6 year old, her 10 year old, or her 15 year old?
Her
2 year old
6 year old
10 year old
15 year old
131. Carrie sat down to go to the bathroom when a group of girls walked into the bathroom and now despite her urge, she cannot pee. This is due, in part, to which types of nerves in her bladder?
Sympathetic
Parasympathetic
Motor
Afferent
Efferent
132. Jeff was just diagnosed with prostate cancer. Where is the first place that you should check to see if the cancer has metastasized?
External iliac lymph nodes
Internal iliac lymph nodes
Femoral lymph nodes
Inguinal lymph nodes
Thoracic duct
133. During a vasectomy, the vas deferens is cut. Usually, this structure drains directly into:
Prostate Gland
Ejaculatory Duct
Seminiferous tubules
Seminal vesicles
Spongy urethra
134. Linda was recently diagnosed with ovarian cancer. Where should you check for metastases?
Lumbar lymph nodes
External iliac lymph nodes
Internal iliac lymph nodes
Sacral lymph nodes
Inguinal lymph nodes
135. Which of the following innervations is responsible for ejaculation in males?
Presynaptic sympathetic fibers of S2-S4
Presynaptic sympathetic fibers of T12-L2
Presynaptic parasympathetic fibers of S2-S4
Presynaptic parasympathetic fibers of T12-L2
Motor neurons of L2-S4
136. While going through the haunted forest with your friends for Halloween, a man with a chainsaw chases you all the way back to the beginning. Which of the following nerves keeps you from shitting your pants?
Parasympathetic fibers of S2-S4
Sympathetic fibers of S2-S4
Superior rectal nerve
Inferior rectal nerve
Middle rectal nerve
137. After birthing four beautiful babies, Mandy’s Levator ani muscle is weaker and she sometimes over contracts it doing things like sneezing. Which of the following is a consequence of that?
Constipation
Diarrhea
Pooping her pants
Hemorrhoids
Muscle spasms of her pelvic floor
138. Persons who have had Human papilloma virus are much more suseptable to developing anal cancer. Symptoms of anal cancer include bleeding upon defication and a palpable mass in the anus. In which of the following would you expect to see metastasies first if the anal tumor was found below the pectinate line in the anus?
External iliac lymph nodes
Internal iliac lymph nodes
Sacral lymph nodes
Lumbar lymph nodes
Deep Inguinal lymph nodes
139. During childbirth, the fetal head may compress the nerves of the mother’s sacral plexus and producing pain in the lower limbs, particularly in the posterior thigh and the leg. Which nerve is likely affected?
Femoral
Obturator
Lateral femoral cutaneous
Sciatic
Puedendal
140. When cancer has spread to the external iliac pelvic lymph nodes they are needed to be removed surgically. Which nerve is often damaged in this procedure?
Femoral
Obturator
Sciatic
Puedendal
Nerve to the levator ani
141. When performing a hysterectomy you must be especially careful due to which artery that passes under the ureter?
Umbilical
Superior vesicular
Internal pudendal
Uterine
Vaginal
142. Which nerve innervates the external urethral sphincter?
Puedendal
Inferior rectal
Dorsal nerve of the penis
Pelvic splanchnic
Sacral splanchnic
143. Henry was recently diagnosed with renal cancer. Which of the following slides could have been created from the biopsy of his kidney.
144. Grant recently ruptured strands of his hamstring while squatting his new personal best. He shows up at your clinic with a large bruise running longitudinally on the backside of his leg. If you were to send a piece of his tissue to the lab and get the above image, which connective tissue structure was disrupted?
Endomysium
Perimysium
Epimysium
Tendon
Ligament
145. Betty comes in complaining of muscle weakness that comes and goes “for no apparent reason” but what she is most concerned about is that her eyes seem to freeze and get locked to where she cannot look around without moving her head. Betty is exhibiting signs of what disorder?
Multiple sclerosis
Von gierke
Myasthenia gravis
Rigor mortis
Parkinsons
146. 146. Becky, a 48 year old female, had been experiencing a heavy period for almost two weeks when she went to the doctor. She thought it was menopause. But upon examination, her stomach was distended and tender to the touch. CT revealed a 27 pound hematoma that had prolapsed her uterus and decided that they needed to do an emergency hysterectomy to remove it. Which of the following structures seen in the ultrasound above would be removed?
A
B
C
D
E