Anatomy, Radiology & Embryology - Block E Final Review

1.

1 point

Lecture: Dr. Davis - Anterior abdominal wall & inguinal region - Jan 28
Author: Marcus Oosenbrug

All of the following statements regarding the anterior abdominal wall are incorrect, EXCEPT (choose the TRUE statement):

Above the arcuate line, the inferior epigastric vessels travel anterior to the rectus abdominis, but posterior to the transversus abdominis.

It is innervated in part by nerves T8-T12, which are termed thoracoabdominal nerves.

The cremaster muscle is a component of the deep inguinal ring.

The conjoint tendon is derived from fusion of the aponeuroses of the external and internal oblique muscles.

The ilioinguinal nerve originates from L1 and innervates the groin.

2.

1 point

Lecture: Dr. Davis - Anterior abdominal wall & inguinal region - Jan 28
Author: Marcus Oosenbrug

All of the following statements regarding the inguinal canal are incorrect, EXCEPT (choose the TRUE statement):

The deep inguinal ring is formed from an invagination of the transversalis fascia and is located lateral to the inferior epigastric vessels.

The aponeurosis of the transversus abdominis muscle is continuous with the internal spermatic fascia.

The superficial inguinal ring is located approximately halfway between the ASIS and the pubic tubercle.

The inguinal canal is a common site of direct inguinal hernias and these often result from a patent processus vaginalis.

The iliohypogastric nerve emerges from the superficial inguinal ring and passes on the surface of the spermatic cord (or round ligament).

3.

1 point

Lecture: Dr. Davis - Peritoneal cavity, omentum - Jan 29
Author: Marcus Oosenbrug

Which of the following relations of the epiploic foramen is INCORRECT:

Inferior: Duodenum

Posterior: IVC.

Anterior: Hepatoduodenal ligament (contains the portal triad).

Superior: Quadrate lobe of the liver

4.

1 point

Lecture: Dr. Davis - Peritoneal cavity, omentum - Jan 29
Author: Marcus Oosenbrug

All of the following statements regarding the abdominal cavity are incorrect, EXCEPT (choose the TRUE statement):

The borders of the lesser sac include the parietal peritoneum, the lesser omentum, the gastrocolic ligament and the mesentary proper.

The first and fourth portions of the duodenum are considered to be secondarily retroperitoneal (but not the second or third).

The transverse mesocolon supports the transverse colon and extends from pancreas to the transverse colon.

Both the short gastric vessels and the left gastroepiploic vessels travel through the lienorenal ligament.

The diaphragmatic surface of the liver is covered with parietal peritoneum.

5.

1 point

Lecture: Dr. Davis - Abdominal organs – Hollow viscera - Jan 30
Author: Marcus Oosenbrug

All of the following statements regarding the vasculature of the abdomen are incorrect, EXCEPT (choose the TRUE statement):

The cystic artery is a branch of the left hepatic artery.

The dorsal pancreatic artery is a direct branch of the splenic artery.

The right inferior mesenteric vein feeds directly into the IVC, while the left inferior mesenteric vein feeds into the left renal vein.

The jejunal arteries are direct branches of the inferior mesenteric artery.

The superficial epigastric artery is a direct branch of the external iliac artery.

6.

1 point

Lecture: Dr. Davis - Abdominal organs – Hollow viscera - Jan 30
Author: Marcus Oosenbrug

Which of the following structures is NOT located directly posterior to the third part of the duodenum?

Right ureter

Right quadratus lumborum

Right gonadal artery

Right psoas major

IVC

7.

1 point

Lecture: Dr. Davis - Abdominal organs – Solid organs - Feb 2
Author: Marcus Oosenbrug

All of the following statements regarding the pancreas are incorrect, EXCEPT (choose the TRUE statement):

The accessory pancreatic duct joins the common bile duct before opening into the duodenum at the minor duodenal papilla.

Its blood supply includes the inferior pancreaticoduodenal arteries, which are direct branches of the splenic artery.

The pylorus of the stomach lies inferior to the body of the pancreas.

The tail of the pancreas extends to the hilum of the spleen in the lienorenal ligament.

The head and neck of the pancreas are considered primary retroperitoneal structures.

8.

1 point

Lecture: Dr. Davis - Abdominal organs – Solid organs - Feb 2
Author: Marcus Oosenbrug

All of the following statements regarding the liver are correct, EXCEPT (choose the FALSE statement):

The porta hepatis contains the hepatic duct and branches of the portal vein and hepatic artery.

The spiral folds function to keep the common hepatic duct open, ensuring that a continuous flow of bile is delivered to the duodenum through the ampulla of Vater.

The ligamentum venosum is continuous with the ligamentum teres.

The ligamentum venosum represents the division between the left and right anatomical lobes of the liver.

The hepatic veins are found at the periphery of each functional liver segment, whereas the center has branches of the portal veins, hepatic arteries and bile ducts.

9.

1 point

Lecture: Dr. Davis - Abdominal organs – Solid organs - Feb 2
Author: Marcus Oosenbrug

All of the following statements regarding the innervation of the gut are correct, EXCEPT (choose the FALSE statement):

The vagus nerve innervates the gut from the esophagus to the end of the proximal 2/3 of the transverse colon.

The lesser splanchnic nerve originates from the ganglia of spinal nerves T10 and T11.

The pelvic splanchnic nerves provide parasympathetic innervation to the gut.

Pre-ganglionic parasympathetic fibers travel along the vessels in the abdomen and synapse in the walls of the organs they innervate.

The left vagus nerve enters the abdomen through the esophageal hiatus of the diaphragm as the posterior vagal trunk.

10.

1 point

Lecture: Dr. Daniels - Midgut Embryology (Feb 12)
Author: Iline Guan

Which of the following is FALSE?

The foramen of Winslow connects the greater sac with the lesser sac.

The liver bud grows in the septum tranversum.

The dorsal mesentery is attached to the lesser curvature of the stomach.

The ventral mesentery will form the falciform ligament.

The inferior retention band becomes the phrenico-colic ligament.

11.

1 point

Lecture: Dr. Stein - Abdominal Imaging (Feb 3)
Author: Ben Mappin-Kasirer

Which of the following statements about abdominal plain film (X-rays) is FALSE? (Choose the INCORRECT statement).

The two front teeth of the upper row are numbered 11 and 21.

An apple core lesion in the esophagus suggests esophageal cancer.

Plain film is used in the diagnosis of gallstones.

GI obstruction and perforation can be identified on plain film.

Plain film is not the best modality for abdominal imaging and should not be systematically used as a first line imaging test as it lacks sensitivity.

12.

1 point

Lecture: Dr. Stein - Abdominal Imaging (Feb 3)
Author: Ben Mappin-Kasirer

A sigmoid volvulus is:

Associated with a bird’s beak sign on fluoroscopy.

Often asymptomatic.

A subtype of cecum volvulus.

A twisting of the proximal portion of the large intestine.

Often associated with cancer.

13.

1 point

Lecture: Dr. Stein - Abdominal Imaging (Feb 3)
Author: Ben Mappin-Kasirer

Ultrasound is a useful diagnostic tool in the evaluation of (check all that apply):

Sigmoid volvulus.

GERD.

Gallstones.

Stomach cancer.

Kidney cancer.

14.

1 point

Lecture: Dr. Daniels - Abdo wall, scrotal descent, inguinal area - Jan 30
Author: Amar Bhindi

You are on your peds general surgery rotation, and a 3 year old boy is on the operating table with an indirect inguinal hernia. The attending points out that a small portion of the boys intestinal loop has pushed into his spermatic chord, and asks you "how come?"
You say:

"A congenitally patent Tunica vaginalis left room for the SI loop to push through the deep inguinal ring into the spermatic chord"

"There's a hydrocoele with an obliterated processus vaginalis on either side, leaving room for the SI loop to push through the deep inguinal ring into the spermatic chord"

"A congenitally weakened wall, medial to the inferior epigastric artery makes it is easy for the SI loop to push through the deep inguinal ring"

"The failure of the processus vaginalis to close properly allowed the SI loop to push through the deep inguinal ring into the spermatic chord"

"I am a first year med student, and have no idea what you're talking about"

15.

1 point

Lecture: Dr. Davis - Posterior abdominal wall 2 - Feb 9
Author: Marcus Oosenbrug

All of the following statements regarding the posterior abdominal wall are incorrect, EXCEPT (choose the TRUE statement):

The psoas minor is an accessory muscle involved in medial movement of the leg.

The psoas major muscle is pierced by the genitofemoral nerve.

The central tendon of the diaphragm is the site in which its COSTAL, LUMBAR, and EPIGASTRIC muscle fibers insert.

A portion of the left crus of the diaphragm is located to the right of the abdominal aorta.

The lateral arcuate ligament lies directly superior to the transversus abdominis as it reaches the posterior abdominal wall.

16.

1 point

Lecture: Dr. Davis - Posterior abdominal wall 2 - Feb 9
Author: Marcus Oosenbrug

All of the following statements regarding the diaphragmatic apertures are incorrect, EXCEPT (choose the TRUE statement):

The vagus nerves enter the abdomen at the level of T12.

The sympathetic trunk enters the abdomen through the aortic hiatus, running underneath the median arcuate ligament.

The thoracic duct exits the abdomen through the caval foramen, and functions in the return of lymph to the systemic circulation.

The esophageal hiatus is formed by both the right and left crura of the diaphragm.

The subcostal nerve enter the diaphragm posterior to the lateral arcuate ligament, and its branches provide sensory innervation to the skin of the lower back.

17.

1 point

Lecture: Dr. Davis - Posterior abdominal wall 2 - Feb 9
Author: Marcus Oosenbrug

All of the following statements regarding the abdominal vasculature are incorrect, EXCEPT (choose the TRUE statement):

The left ovarian vein drains directly into the inferior vena cava.

The inferior mesenteric vein drains directly into the left renal vein.

The left renal vein is crossed anteriorly by the superior mesenteric artery.

The right testicular artery is direct branch of the ilioinguinal artery.

I cannot deal with these blood vessels right now.

18.

1 point

Lecture: Dr. Davis - Posterior abdominal wall 2 - Feb 9
Author: Marcus Oosenbrug

All of the following statements regarding the abdominal innervation are incorrect, EXCEPT (choose the TRUE statement):

A reflex arc is a neural circuit that creates a link between a sensory input and a specific motor output, and is relayed to and from the brain through fast axons.

The obturator nerve originates from the ganglia of spinal nerves L2, L3 and L4.

The greater, lesser and least splanchnic nerves synapse in the sympathetic trunk, and travel along the vessels in the abdomen to reach the organs they innervate.

General visceral afferent fibers enter the spinal cord through ventral root ganglia, while preganglionic sympathetic fibers exit through dorsal root ganglia.

For any given spinal nerve, the dorsal ramus is connected to the ventral ramus via rami communicantes.

19.

1 point

Lecture: Dr. Daniels - Foregut Embryology (Feb 10)
Author: Marcus Oosenbrug

All of the following statements are correct, EXCEPT (choose the FALSE statement):

Paracolic gutters are formed due to the incomplete fusion of the ascending and descending colon with the posterior wall in the developing embryo.

The peritoneal cavity is continuous with the space in the umbilical cord.

An abnormally long superior retention band may affect affect the rotation of the gut and predispose it to herniation.

“Watershed areas of overlap” in the developing gut refer to the fact that they are supplied by more than one artery originating from the vitelline vessels.

The presence of the developing gut in the extra-embryonic coelum of the umbilicus is a congenital cause of herniation and may be a medical emergency.

20.

1 point

Lecture: Dr. Davis - Solid organs - Feb 2
Author: Kapil

Where is it unlikely that a bile stone can get stuck?

Common hepatic duct.

Cystic duct.

Duct of santorini.

Ampulla of vater.

21.

1 point

Lecture: Dr. Davis - Posterior Abdominal Wall - Feb 9
Author: Kapil

An esophageal perforation is most likely to affect which nerve’s functions?

Vagus.

Left phrenic.

Right phrenic.

Sympathetic chain.

22.

1 point

Lecture: Dr. Davis - Posterior Abdominal Wall - Feb 9
Author: Kapil

You are a surgeon who has to operate directly on the psoas major. What nerve will you have to be most cautious of not to cut when operating?

Illoinguinal.

Femoral.

Genitofemoral.

Lateral cutaneous nerve of the thigh.

23.

1 point

Lecture: Dr. Daniels - Midgut Embryology (Feb 12)
Author: Marcus Oosenbrug

All of the following statements regarding the posterior abdominal wall are correct, EXCEPT (choose the FALSE statement):

The mesogastrium is continuous with the mesoduodenum.

Pitx2 expression in the dorsal mesentery induces clockwise rotation of the gut.

The ventral layer of the mesogastrium gives rise to the greater curvature of the stomach.

The omental bursa opens into the right peritoneal cavity.

The ventral mesentery extends from the lesser curvature of the stomach to the midline of the anterior abdominal wall and contributes to the developing liver.

24.

1 point

Daniels Pancreas lecture, by Amar

Ellen Degeneres and Portia (Degeneres?) adopt a newborn baby, but much to their dismay, they got a lemon. They bring Marcelo Degeneres to you complaining that he has feeding intolerance and is vomiting up greenish fluid. You run a CT and notice a circumferential narrowing at D2 of the duodenum. Your supervisor suspects the pancreas may be involved and asks you what embryological abnormality involving the pancreas could lead to this clinical presentation. You say:

"The ventral pancreatic bud and dorsal pancreatic bud fail to fuse, leading to 2 pancreases that encircle the duodenum and obstruct it "

"the ventral pancreatic bud rotates counter clockwise, leaving it and the common bile duct ventral to the duodenum. The 2 structures are pressing and impede flow through the duodenum"

"a bifid ventral pancreatic bud has one portion that anchors at it's original side and the other that rotates normally. This results in a pancreas that encircles the duodenum and impedes flow through it"

"Intestinal atresia at the distal portion of the D2 leads to a narrowed lumen that cannot pass intestinal contents. Bile and ingested food are vomited up"

"Ellen and Portia make a cute couple. Good on them for adopting a baby."

25.

1 point

Lecture: Dr. Daniels - Hindgut Embryology (Feb 26)
Author: Marcus Oosenbrug

All of the following pairs of congenital anomalies and underlying causes are incorrect, EXCEPT (choose the TRUE pair):

Meckel’s diverticulum: incomplete yolk sac regression.

Left-sided colon: failure of neural crest cell migration and normal motor innervation.

Sub-hepatic cecum and appendix: failure of 180 degree counter-clockwise rotation of the gut.

Ileo-colic intussusception: absence of downward growth and attachment of the ascending colon.

Megacolon (Hirschsprung’s disease): unfixed (mobile) cecum.

26.

1 point

Lecture: Dr. Daniels - Hindgut Embryology (Feb 26)
Author: Marcus Oosenbrug

All of the following statements regarding the embryology of the hindgut are correct, EXCEPT (choose the FALSE statement):

A clockwise rotation of the midgut may result in abnormal positioning of the superior mesenteric artery (posterior to the third stage of the duodenum).

Fixation of the cecum to the posterior abdominal wall will invariably prevent volvulus formation at this site.

A Meckel’s diverticulum may become ischemic due to obstruction of the superior mesenteric artery.

An abnormally long ligament of Treitz may result in a midgut volvulus.

All of the above statements are correct.

27.

1 point

Lecture: Dr. Daniels - Hindgut Embryology (Feb 26)
Author: Marcus Oosenbrug

Which of the following statements regarding the embryology of the hindgut is/are correct?

A. Absence of downward growth and attachment of the ascending colon may result in the cecum being located in the sub-splenic region.
B. Incomplete fixation of the ascending and descending mesocolon may result in the formation of paracolic gutters.
C. Absence of 180 degree counter-clockwise rotation of the gut around the superior mesenteric artery may result in the cecum being located in the sub-hepatic region.
D. An omphalocele is a congenital anomaly resulting in a segment of gut protruding into an amnion-lined sac.

A and C are correct.

A, B and C are correct.

B and D are correct.

D is correct.

All OR none of the above are correct.

28.

1 point

Dr Emil By Amar

It is 11:30 PM the night before the GI final, and Doulia reminds Amar that he has failed to upload his question. Amar quickly asks himself, what would Bing do? He turns to a random slide and quickly formulates a question about the Pancreas Divisum. What would lead to recurrent pancreatitis if a kid presents has pancreas divisum?

The duct of Santorini is the main pancreatic duct that drains alone through the minor papilla. That papilla becomes stenosed

The duct of Wirsung is the main pancreatic duct that drains alone through the minor papilla. That papilla becomes stenosed

The duct of Santorini is the main pancreatic duct that drains alone through the major papilla. That papilla becomes stenosed

The duct of Wirsung is the main pancreatic duct that drains alone through the major papilla. That papilla becomes stenosed

Bing wouldn't have forgotten to do his question