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Question 1
Incorrect
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In which part of the gastrointestinal tract is Meckel's diverticulum commonly located?
Your Answer: Caecum
Correct Answer: Ileum
Explanation:Meckel’s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the general population. Meckel’s diverticulum are designated true diverticula because their walls contain all the layers found in normal small intestine. Their location varies among individual patients, but they are usually found in the ileum within 100 cm of the ileocecal valve.Approximately 60% of Meckel’s diverticulum contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Pancreatic acini are the next most common; others include Brunner’s glands, pancreatic islets, colonic mucosa, endometriosis, and hepatobiliary tissues.A useful, although crude, mnemonic describing Meckel’s diverticulum is the “rule of twos”: 2% prevalence, 2:1 male predominance, location 2 feet proximal to the ileocecal valve in adults, and half of those who are symptomatic are under 2 years of age.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 2
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the deepest structure injured in the case above?
Your Answer: Aponeurosis of internal oblique
Correct Answer: Transversalis fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 3
Correct
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Which lobe of the prostate gland is most commonly affected in benign prostatic hypertrophy?
Your Answer: Median
Explanation:Benign enlargement of the prostate is common in men older than 50 years. The cause is possibly an imbalance in the hormonal control of the gland. The median lobe of the gland enlarges upward and encroaches within the sphincter vesicae, located at the neck of the bladder. The leakage of urine into the prostatic urethra causes an intense reflex desire to micturate. The enlargement of the median and lateral lobes of the gland produces elongation and lateral compression and distortion of the urethra so that the patient experiences difficulty in passing urine and the stream is weak. Back-pressure effects on the ureters and both kidneys are a common complication. The enlargement of the uvula vesicae (owing to the enlarged median lobe) results in the formation of a pouch of stagnant urine behind the urethral orifice within the bladder. The stagnant urine frequently becomes infected, and the inflamed bladder (cystitis) adds to the patient’s symptoms.In all operations on the prostate, the surgeon regards the prostatic venous plexus with respect. The veins have thin walls, are valveless, and are drained by several large trunks directly into the internal iliac veins. Damage to these veins can result in a severe haemorrhage.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 4
Incorrect
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Through which of the following anatomical structures does an indirect inguinal hernia pass?
Your Answer: Internal oblique
Correct Answer: External oblique
Explanation:Inguinal hernias are subdivided into direct and indirect.An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 5
Correct
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Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?
Your Answer: Posterior
Explanation:The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 6
Incorrect
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Which segment of the colon is most likely to be affected in diverticulitis?
Your Answer: Transverse colon
Correct Answer: Sigmoid colon
Explanation:Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left sided abdominal pain, with or without fever, and leucocytosis. The most common location for diverticulitis is the sigmoid colon.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 7
Incorrect
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A 69-year-old man presents with a painful groin swelling on the right side. The suspected diagnosis is an inguinal hernia.Which of the following examination features make it more likely to be an indirect inguinal hernia?
Your Answer: The hernia appears ‘round’ in shape
Correct Answer: It can be controlled by pressure over the deep inguinal ring
Explanation:The reduced indirect inguinal hernia can be controlled by pressure over the internal ring; a direct inguinal hernia cannot.An indirect inguinal hernia can be reduced superiorly then superolaterally, while a direct inguinal hernia can be reduced superiorly then posteriorly.An indirect inguinal hernia takes time to reach full size, but a direct inguinal hernia appears immediately upon standing.Indirect inguinal hernias are seen as elliptical swelling, while direct inguinal hernias appear as symmetric, circular swelling.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 8
Correct
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 9
Correct
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.Which of the following most likely describes the location of the ulcer?
Your Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 10
Incorrect
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A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?
Your Answer: 1 cm below the right xiphocostal angle
Correct Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 11
Incorrect
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A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.Which of the following is the surface anatomy of the McBurney's point?
Your Answer:
Correct Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus
Explanation:Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 12
Incorrect
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The most common site of ectopic pregnancy is?
Your Answer:
Correct Answer: Ampulla of Fallopian tube
Explanation:Nearly 95% of ectopic pregnancies are implanted in the various segments of the fallopian tube and give rise to fimbrial, ampullary, isthmic, or interstitial tubal pregnancies. The ampulla is the most frequent site, followed by the isthmus. The remaining 5% of non tubal ectopic pregnancies implant in the ovary, peritoneal cavity, cervix, or prior caesarean scar.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 13
Incorrect
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A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes. The lymph from the testes will drain to which of the following nodes?
Your Answer:
Correct Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.The scrotum is the one which drains into the nearby superficial inguinal nodes.The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 14
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the most superficial structure injured in the case above?
Your Answer:
Correct Answer: Camper’s fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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