1.

The terminal ends of the ilioinguinal nerves in the female are referred to as:

 Anterior cutaneous branches

 Anterior labial

 Cremasterics

 Iliohypogastrics
2. The usual location for an appendectomy incision is the:

 left lower quadrant

 left upper quadrant

 right lower quadrant

 right upper quadrant

3. The inferior border of the rectus sheath posteriorly is called the:

 Falx inguinalis

 Inguinal ligament

 Internal inguinal ring

 Arcuate line

 Linea alba
4. A medical student was asked by her preceptor to palpate the margin of the superficial inguinal ring of a
healthy male patient. After passing her finger down the edge of the medial crus of the superficial
inguinal ring, she felt a bony protuberance deep to the lateral edge of the spermatic cord, which she
correctly identified as the :

 pecten pubis

 pubic symphysis

 pubic tubercle

 iliopubic eminence

 iliopectineal line
5. You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of
the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior
abdominal wall incision in the following region:

 Epigastric

 Left inguinal

 Left lumbar

 Right hypochondrial

 Hypogastric
6. Following an emergency appendectomy your patient complained of having paresthesia (numbness) of
the skin at the pubic region. The most likely nerve that has been injured during the operation is:
  Genitofemoral

 Iliohypogastric

 Subcostal

 Spinal nerve T10

 Spinal nerve T9
7. An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse
suprapubic incision is chosen for that purpose. All of the following abdominal wall layers will be
encountered during the incision EXCEPT the:

 Anterior rectus sheath

 Posterior rectus sheath

 Rectus abdominis muscle

 Skin and subcutaneous tissue

 Transversalis fascia, extraperitoneal fat, and peritoneum

8. In order to reduce a hernia (return it to the abdominal cavity), a surgeon finds it necessary to ligate an
artery in the extraperitoneal connective tissue (preperitoneal fat) running vertically just medial to the
bowel as the bowel passes through the abdominal wall. This artery is the:

 Deep circumflex iliac

 Inferior epigastric

 Superficial circumflex iliac

 Superficial epigastric

 Superficial external pudendal

9. The posterior layer of the rectus sheath ends inferiorly at the

 Arcuate line

 Intercrestal line

 Linea alba

 Pectineal line

 Semilunar line
10. Surgical approaches to the abdomen sometimes necessitate a midline incision between the two rectus
sheaths, i.e., through the:

 Linea aspera

 Arcuate line

 Semilunar line
  Iliopectineal line

 Linea alba
11. The internal thoracic artery is sometimes surgically cut near the caudal end of the sternum and used to
supply blood to a region of the heart. In these cases, maintenance of adequate blood flow to the rectus
abdominis may be dependent on increased flow through which artery?

 Superficial epigastric

 Inferior epigastric

 Umbilical

 Superficial circumflex iliac

 Deep circumflex iliac

12. The normal pattern of venous and lymphatic drainage of the superficial tissues of the anterior abdominal
wall is arranged around a horizontal plane. Above that plane, drainage is in a cranial direction; below the
plane drainage is in a caudal direction. This reference plane corresponds to:

 Transpyloric plane

 Level of anterior superior iliac spines

 Transtubercular line

 Level of arcuate line

 Level of umbilicus

1. During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a
lighted scope on a thin tube inserted through the wall), the attending physician noted something of
interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor
would have to look at the area between the:

 inferior epigastric artery and urachus

 medial umbilical ligament and urachus

 inferior epigastric artery and lateral umbilical fold

 medial umbilical ligament and inferior epigastric artery

 median umbilical ligament and medial umbilical ligament

2. If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the
inferior epigastric vessels between which layers of the abdominal wall?

 Camper's and Scarpa's fascias

 External abdominal oblique and internal abdominal oblique muscles

 Internal abdominal oblique and transversus abdominis muscles

  Skin and deep fascia of the abdominal wall

 Tranversus abdominis muscle and peritoneum

3. A man is moving into a new house and during the process lifts a large chest of drawers. As he lifts he
feels a severe pain in the lower right quadrant of his abdomen. He finds that he can no longer lift without
pain and the next day goes to see his physician. Surgery is indicated and during the surgery the
surgeon opens the inguinal region and finds a hernial sac with a small knuckle of intestine projecting
through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels.
The hernia was diagnosed as:

 A congenital inguinal hernia

 A direct inguinal hernia

 A femoral hernia

 An incisional hernia

 An indirect inguinal hernia

4. Which structure passes through the deep inguinal ring?

 Iliohypogastric nerve

 Ilioinguinal nerve

 Inferior epigastric artery

 Medial umbilical ligament

 Round ligament of the uterus

5. A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the
abdominal side, the hernial sac would be found in which region?

 Deep inguinal ring

 Lateral inguinal fossa

 Medial inguinal fossa

 Superficial inguinal ring

 Supravesical fossa
6. A patient presents with a hernia that is palpable at the superficial inguinal ring. Is this an indirect inguinal
hernia?

 Yes

 No

 There is insufficient evidence to tell

7. In a female with an indirect inguinal hernia, the herniated mass lies along side of which structure as it
traverses the inguinal canal?

 Iliohypogastric nerve

 Inferior epigastric artery

 Ovarian artery and vein

  Pectineal ligament

 Round ligament of the uterus

8. The skin of the mons pubis is supplied by which nerve?

 Anterior scrotal

 Anterior labial

 Femoral branch of the genitofemoral

 Iliohypogastric nerve

 Subcostal nerve
9. While performing a routine digital examination of the inguinal region in a healthy teen-aged male, the
physician felt a walnut-sized lump protruding from the superficial inguinal ring. She correctly concluded
that it was :

 definitely an indirect inguinal hernia

 possibly an unusual femoral hernia

 definitely a direct inguinal hernia

 possibly an enlarged superficial inguinal lymph node

 either a direct or an indirect inguinal hernia

10. During your peer presentation of the inguinal region dissection, you would indicate the position of the
deep inguinal ring to be:

 Above the anterior superior iliac spine

 Above the midpoint of the inguinal ligament

 Above the pubic tubercle

 In the supravesical fossa

 Medial to the inferior epigastric artery

11. An elderly patient with a large indirect inguinal hernia came to your clinic complaining of pain in the
scrotum. You conclude that the hernial sac is compressing the following nerve:

 Femoral branch of the genitofemoral

 Femoral

 Iliohypogastric

 Ilioinguinal

 Subcostal
12. A 45-year-old porter develops a direct inguinal hernia. If the hernia extended through the superficial
inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the:

 External spermatic fascia

 Internal spermatic fascia

  Peritoneum and extraperitoneal connective tissue

 Weak fascia of the transversus abdominis muscle lateral to the falx

13. A pediatrician has diagnosed a newborn baby of having right-sided cryptorchidism (undescended testis).
The testis may have been trapped in any site EXCEPT:

 At the deep inguinal ring

 Just outside the superficial inguinal ring

 Pelvic brim

 Perineum

 Somewhere in the inguinal canal

14. A 15-year-old boy was admitted to the emergency room for having large bowel obstruction resulting
from a left-sided indirect inguinal hernia. The most likely intestinal segment involved in this obstruction is
the:

 ascending colon

 cecum

 descending colon

 rectum

 sigmoid colon
15. A 45-year-old man had developed a direct inguinal hernia several months after having an emergency
appendectomy. The examining doctor linked the cause of hernia to accidental nerve injury that
happened during appendectomy and weakened the falx inguinalis. Which nerve had been injured?

 Femoral branch of the genitofemoral

 Genital branch of the genitofemoral

 Ilioinguinal

 Subcostal

 Ventral primary ramus of T10

16. The boundaries of the inguinal triangle include all except:

 Arcuate line

 Inferior epigastric vessels

 Inguinal ligament

 Lateral border of rectus abdominus muscle

17. The superficial inguinal ring is an opening in which structure?

 External abdominal oblique aponeurosis

 Falx inguinalis

 Internal abdominal oblique muscle

  Scarpa's fascia

 Transversalis fascia
18. If a hernia enters into the scrotum, it is most likely a(n):

 Direct inguinal hernia

 Indirect inguinal hernia

 Femoral hernia

 Obturator hernia
19. Which nerve passes through the superficial inguinal ring and may therefore be endangered during
inguinal hernia repair?

 Femoral branch of the genitofemoral

 Ilioinguinal

 Iliohypogastric

 Obturator

 Subcostal
20. During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the
lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels.
These boundaries defined the hernia as a(n):

 Congenital inguinal hernia

 Direct inguinal hernia

 Femoral hernia

 Indirect inguinal hernia

 Umbilical hernia

1. Which of the following veins does not run a course parallel to the artery of the same name?

 superior epigastric

 superficial circumflex iliac

 inferior mesenteric

 superior rectal

 ileocolic
2. The presence of which feature (also obvious on a radiograph with barium contrast) distinguishes small
from large bowel?

 Circular folds of the mucosa

 Circular smooth muscle layer in the wall

  Mucosal glands

 Longitudinal smooth muscle layer in the wall

 Serosa
3. Occlusion of the inferior mesenteric artery is seldom symptomatic because its territory may be supplied
by branches of the:

 Gastroduodenal

 Ileocolic

 Middle colic

 Right colic

 Splenic
4. During exploratory abdominal surgery on a 55-year-old male complaining of right lower quadrant pain,
the surgeon initially sees no appendix but knows that he can quickly locate it by

 looking at the confluence of the teniae coli

 palpating the ileocecal valve and looking just above it

 following the course of the right colic artery

 removing the right layer of the mesentery of the jejunoileum

 palpating and inspecting the pelvic brim

5. During development of the gut:

 the sigmoid colon is retroperitoneal

 the inferior mesenteric artery is the axis for rotation of the midgut loop

 the stomach rotates around its longitudinal axis causing the ventral border to become the greater
curvature

 the liver is non-functional

 none of the above

6. Meckel's diverticulum:

 is an abnormal persistance of the urachus

 is a site of ectopic pancreatic tissue

 is caused by a failure of the midgut loop to return to the abdominal cavity

 is an abnormal connection of the midgut to the duodenum

 is associated with polyhydramnios

7. Visceral pain is often referred to a site on the body wall (where the patient "feels" it) that is innervated by
the same spinal cord segment that innervates the visceral organ involved. Pain of appendicitis is often
first felt around the umbilicus, indicating that the appendix receives its sympathetic (and thus visceral
afferents) from which spinal cord segment?
  T 9

 T 10

 T 11

 T 12

 L 1
8. A surgical maneuver which takes advantage of the avascular plane of fusion fascia can be applied to
mobilize all of the organs below, except the:

 Ascending colon

 Descending colon

 Duodenum

 Kidney

 Pancreas
9. A surgeon performing an appendectomy was unable to identify the base of the appendix due to massive
adhesions in the peritoneal cavity. Eventually she identified the cecum and was able to localize the base
of the appendix. What anatomical structure(s) on the cecum would she have used to find the base of the
appendix?

 Omental appendages

 Haustra coli

 Ileal orifice

 Semilunar folds

 Teniae coli
10. The spleen normally does not descend below the costal margin. However, it pushes downward and
medially when pathologically enlarged. What structure limits the straight vertical downward movement?

 Left colic flexure

 Left suprarenal gland

 Ligament of Treitz

 Pancreas

 Stomach
11. During the surgical repair of a hiatal hernia, the celiac branch of the posterior vagal trunk was severed
accidentally. The damage to this nerve would affect the muscular movements, as well as some
secretory activities, of the gastrointestinal tract (GI). Which segment is least likely to be affected by the
nerve damage?

 Ascending colon

 Cecum

 Jejunum
  Ileum

 Sigmoid colon
12. A 70-year-old man with cancer of the ascending colon was admitted to the hospital for tumor removal.
The surgeon may perform any of these surgical procedures EXCEPT:

 an incision in the left lower quadrant to access the tumor.

 examination of the superior mesenteric lymph nodes for possible metastasis.

 ligation of the relevant branches of the superior mesenteric artery.

 mobilization of the concerned intestinal segment by freeing its fusion fascia.

 protect the peritoneum from possible fecal contamination.

13. A 60-year-old woman arrived at the emergency room complaining of acute abdominal pain. She was
diagnosed with ischemic bowel resulting from an obstruction of one or more branches of the inferior
mesenteric artery. Which of the following is most likely NOT to be seriously affected by the ischemia?

 Cecum

 Descending colon

 Rectum

 Sigmoid colon

 Splenic flexure
14. A surgeon has decided to perform a segmental resection of the descending colon on a 70-year-old man
with intestinal cancer. In principle, any of these surgical procedures might be necessary EXCEPT:

 An extended left lower quadrant incision to approach the descending colon.

 Examining the sacral lymph nodes for possible enlargement.

 Ligation of the relevant left colic artery branches.

 Mobilizing the concerned intestinal segment by freeing its fusion fascia.

 Protecting the peritoneum from possible fecal contamination.

15. As the bowel is exposed, the surgeon says in amazement, "This is a loop of large bowel!" Which
characteristic(s) would identify it specifically as large bowel?

 A serosa

 Circular folds

 Epiploic appendages

 Tenia

 C and D
16. The anastomotic artery running along the border of the large intestine is called the:

 Arcade

 Arteriae rectae
  Coronary

 Ileocolic

 Marginal
17. The inferior mesenteric artery is often occluded by atherosclerosis without symptoms; its normal area of
distribution therefore must be supplied by collateral blood flow between which arteries?

 Ileocolic and right colic

 Left and middle colic

 Left colic and sigmoidal

 Right and middle colic

 Sigmoidal and superior rectal

18. The artery of the midgut is the:

 Celiac trunk

 Inferior mesenteric

 Proper hepatic

 Splenic

 Superior mesenteric

1. A patient was diagnosed with bleeding ulcer of the lesser curvature of the stomach. Which artery is most
likely involved?

 Gastroduodenal

 Left gastric

 Left gastro-omental (epiploic)

 Right gastro-omental (epiploic)

 Short gastrics
2. Which is a derivative of the dorsal mesogastrium?

 Falciform ligament

 Hepatoduodenal ligament

 Hepatogastric ligament

 Greater omentum

 Lesser omentum
3. The spleen:

 Develops in the dorsal mesogastrium

  Develops in the ventral mesogastrium

 Develops in both the dorsal and ventral mesogastria

 Is always retroperitoneal

 Becomes retroperitoneal during its development

4. During a full workup on a 2-month-old infant with a history of intermittent gastrointestinal pain and
vomiting, physicians discovered that the cause was lack of emptying of the stomach. They immediately
suspected that the cause was a spasmodic contraction of which of the following parts of the stomach?

 cardiac notch

 fundus

 lesser curvature

 pylorus

 rugae
5. In order to do a vagotomy (section of vagal nerve trunks) to reduce the secretion of acid by cells of the
stomach mucosa in patients with peptic ulcers, one needs to cut the gastric branches and retain vagal
innervation to other abdominal organs. Where would a surgeon look for these branches in relation to the
stomach?

 along the gastroepiploic vessels

 along the greater curvature

 along the lesser curvature

 in the base of the omental apron

 in the gastrocolic ligament

6. While performing a splenectomy (removal of the spleen) following an automobile accident, the surgeons
were especially attentive to locate and preserve the tail of the pancreas which is closely associated with
the spleen. This they found in the:

 gastrocolic ligament

 gastrosplenic ligament

 phrenicocolic ligament

 splenorenal ligament

 transverse mesocolon
7. Which of the following structures does not lie at least partially in the retroperitoneum?

 adrenal gland

 duodenum

 kidney
  pancreas

 spleen
8. Which ligament is a derivative of the dorsal mesogastrium?

 Coronary

 Falciform

 Hepatoduodenal

 Hepatogastric

 Gastrocolic
9. A 60-year-old male executive who had a history of a chronic duodenal ulcer was admitted to the ER
exhibiting signs of a severe internal hemorrhage. He was quickly diagnosed with perforation of the
posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric expellent.
The artery is most likely the:

 Common hepatic

 Gastroduodenal

 Left gastric

 Proper hepatic

 Superior mesenteric
10. A twenty-year-old woman was broad-sided on the driver side by an SUV and was taken to the hospital
emergency room. Examination showed low blood pressure and tenderness on the left mid-axillary line.
Also, a large swelling was felt protruding downward and medially below the left costal margin. X-rays
revealed that her 9th and 10th ribs were fractured near their angles on the left side. The abdominal
organ most likely to be injured by the fracture is:

 Descending colon

 Left kidney

 Pancreas

 Spleen

 Stomach
11. You are observing an operation to remove the left suprarenal gland. To expose the gland the surgeon
mobilizes the descending colon by cutting along its lateral attachment to the body wall and dissecting
medialward in the fusion fascia behind it. Suddenly the operative field is filled with blood. The surgeon
realizes he has failed to cut a mesenteric attachment between the left colic flexure and another organ.
As a result of the traction, the surface of the organ tore. Which organ was injured?

 Duodenum

 Kidney

 Liver

 Spleen

 Suprarenal gland
12. A patient presented with a swollen spleen, which protruded medially toward the umbilicus in the
abdomen. A vertical and downward expansion of the spleen was resisted by the:

 Tail of the pancreas

 Left colic flexure

 Left kidney

 Left renal artery

 Stomach
13. During emergency surgery, it was found that a chronic gastric ulcer had perforated the posterior wall of
the stomach and eroded a large artery running immediately posterior to the stomach. The artery is the:

 Gastroduodenal

 Common hepatic

 Left gastroepiploic

 Splenic

 Superior mesenteric
14. The spleen contacts all of the following organs EXCEPT:

 Jejunum

 Kidney

 Left colic flexure

 Tail of the pancreas

 Stomach
15. Which is not a boundary of the epiploic (omental) foramen?

 Aorta

 Caudate lobe of the liver

 First part of the duodenum

 Hepatoduodenal ligament
16. In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser
omentum. Before incising the mesentery she was careful to find and preserve a nerve lying in the upper
portion of the hepatogastric ligament, i.e., the

 Celiac branch of the anterior vagal trunk

 Celiac branch of the posterior vagal trunk

 Greater splanchnic branch to the right suprarenal gland

 Hepatic branch of the anterior vagal trunk

 Hepatic branch of the posterior vagal trunk

17. Which of the following is NOT in contact with the spleen?

 Colon

 Diaphragm

 Duodenum

 Pancreas

 Stomach
18. The fundus of the stomach receives its arterial supply from the:

 Common hepatic

 Inferior phrenic

 Left gastroepiploic

 Right gastric

 Splenic
19. During an emergency splenectomy, the surgeon accidentally tore the gastrosplenic ligament and its
contents. The artery (ies) likely to be damaged in this event is (are) the:

 Left gastric

 Splenic

 Short gastric

 Middle colic

 Caudal pancreatic
20. While performing emergency surgery to control hemorrhage brought on by arterial erosion caused by a
duodenal ulcer, surgeons ligated the badly damaged gastroduodenal artery near its origin, which
affected all of its branches as well. Assuming "average anatomy", in which of the following arteries
would blood now flow in retrograde fashion (backwards) from collateral sources?

 Left hepatic

 Right gastroepiploic

 Short gastric

 Left gastric

 Omental branches

1. Which organ becomes retroperitoneal during rotation of the gut tube?

 Duodenum

 Kidney

 Spleen
  Stomach

 Transverse Colon
2. A 40 year-old male with a long history of duodenal ulcer problems was brought in for emergency surgery
to control severe hemorrhage into the peritoneal cavity. The surgeons found that erosion by the ulcer of
a vessel passing behind the first part of the duodenum was the source of the hemorrhage. Which of the
following vessels passes behind the first part of the duodenum and would need to be clamped off to
control the bleeding?

 coronary vein

 gastroduodenal artery

 inferior pancreatoduodenal arcade

 proper hepatic artery

 splenic vein
3. During a cholecystectomy (removal of the gall bladder), the surgical resident accidentally jabbed a sharp
instrument into the area immediately posterior to the epiploic foramen (its posterior boundary). He was
horrified to see the surgical field immediately fill with blood, the source which he knew was the:

 aorta

 inferior vena cava

 portal vein

 right renal artery

 superior mesenteric vein

4. The division between the true right and left lobes (internal lobes) of the liver may be visualized on the
outside of the liver as a plane passing through the:

 gallbladder fossa and round ligament of liver

 falciform ligament and ligamentum venosum

 gallbladder fossa and inferior vena cava

 falciform ligament and right hepatic vein

 gallbladder fossa and right triangular ligament

5. Orally ingested contrast medium opacifies all of the following structures except the:

 colon

 duodenum

 esophagus

 gall bladder

 stomach
6. To stop hemorrhaging from a ruptured spleen, it was necessary to temporarily ligate the splenic artery
near the celiac trunk. The blood supply to which structure is least likely to be affected by the ligation?

 Duodenum
  Greater omentum

 Body of pancreas

 Tail of pancreas

 Stomach
7. A 50-year-old female patient with severe jaundice was diagnosed with pancreatic cancer. You suspect
that the tumor is located in which portion of the pancreas?

 Head

 Neck

 Body

 Tail

 Uncinate process
8. A patient was admitted with symptoms of bowel obstruction. Further examination revealed that the
obstruction was caused by the nutcracker-like compression of the bowel between the superior
mesenteric artery and the aorta. The compressed bowel is most likely the:

 Duodenum

 Jejunum

 Ileum

 Ascending colon

 Transverse colon
9. A medical student was asked to identify a small specimen taken for pathological examination from a
surgically removed duodenum. The student noted that the specimen revealed a thin wall and no circular
folds. The specimen is from which segment?

 Superior

 Descending

 Horizontal

 Ascending
10. You are observing a laparoscopic cholecystectomy. The surgeon states that he is next going to expose
the cystic artery in order to staple across it. He asks you where he should look for it. You reply, "In the
triangle of Calot." What stuctures form this triangle and are the keys to finding the artery?

 Common hepatic duct, liver and cystic duct

 Cystic duct, right hepatic artery and right hepatic duct

 Gall bladder, liver and common bile duct

 Left hepatic duct, liver and cystic duct

 Right branch of portal vein, liver and common bile duct

11. Upon endoscopic examination of a 65-year-old man who had a history of a chronic duodenal ulcer, it
was found that the ulcer had been eroding the posterior wall of the first part of the duodenum. If erosion
 perforates the wall, the gastric expellant of high acidity would endanger the structures in its vicinity.
Which is least likely to be endangered?

 Common bile duct

 Gastroduodenal artery

 Main pancreatic duct

 Portal vein
12. A 58-year-old patient was diagnosed with a severe case of portal hypertension due to alcoholic cirrhosis
of the liver. It was determined that a bypass between the vessels of the portal and caval systems was
necessary. The plan most likely to be successful is:

 Coronary vein to right gastro-omental vein

 Left colic vein to sigmoidal vein

 Inferior mesenteric vein to splenic vein

 Splenic vein to left renal vein

 Superior rectal vein to inferior rectal vein

13. A radiological examination of a patient revealed a large tumor in the quadrate lobe of the liver. During
the surgical removal of the tumor, one of the vessels that needs to be clamped to effectively control
bleeding is the:

 Left hepatic artery

 Right hepatic artery

14. A patient was admitted with symptoms of an upper bowel obstruction. Upon CT examination, it was
found that the third (transverse) portion of the duodenum was compressed by a large vessel causing the
obstruction. The vessel involved is most likely to be the:

 inferior mesenteric artery

 superior mesenteric artery

 inferior mesenteric vein

 portal vein

 splenic vein
15. An ulcer near the pyloroduodenal junction perforated and eroded a large artery immediately posterior to
the duodenum. The ligation of the eroded vessel at its origin would LEAST affect the arterial supply to
the:

 First part of the duodenum

 Second part of the duodenum

 Greater curvature of the stomach

 Head of the pancreas

 Tail of the pancreas

16. A patient was diagnosed with pancreatitis due to a reflux of bile into the pancreatic duct caused by a
gallstone. The stone is likely to be lodged at the:
  Common bile duct

 Common hepatic duct

 Cystic duct

 Hepatopancreatic ampulla
17. The blockage of a main bile duct in the quadrate lobe will likely cause reduced flow of bile secretion in
the:

 Left hepatic duct

 Right hepatic duct

18. Regarding the 2nd portion of the duodenum, all are correct EXCEPT:

 It is crossed by the transverse colon.

 It is thin walled and circular folds are absent in its interior.

 It has the opening for the common bile duct and pancreatic duct on its posteromedial wall.

 It is secondarily retroperitoneal.

 It is supplied by both the gastroduodenal and superior mesenteric arteries.

19. A Kocher manuever dissects in the avascular plane behind which organ that becomes retroperitoneal
during rotation of the gut?

 Duodenum

 Kidney

 Spleen

 Suprarenal gland

 Transverse colon
20. The inferior mesenteric vein usually joins which vein?

 Inferior vena cava

 Left renal

 Portal

 Splenic

 Superior mesenteric
21. A surgeon needs to construct a bypass between the veins of the portal and caval systems to circumvent
insufficient drainage through the natural portacaval anastomoses. Which plan is likely to be successful?

 Coronary vein to right gastroepiploic vein

 Inferior mesenteric vein to splenic vein

 Left colic vein to middle colic vein

  Splenic vein to left renal vein

 Superior mesenteric vein to splenic vein

22. A patient with jaundice was diagnosed with cancer of the head of the pancreas. Which structure was
compressed by the tumor?

 Common bile duct

 Common hepatic duct

 Cystic duct

 Left hepatic duct

 Right hepatic duct

23. The structure that traverses the space between the aorta and first part of the superior mesenteric artery
and is vulnerable to the nutcracker-like compression by these two vessels is the:

 Duodenum

 Jejunum

 Pancreas

 Splenic vein

 Transverse colon
24. A 60-year-old patient who has had a chronic ulcer of the duodenum for many years was admitted to the
hospital with signs of a severe internal hemorrhage. The ulcer perforated the posterior wall of the first
portion of the duodenum and eroded an artery in that position. The damaged artery was:

 Cystic

 Gastroduodenal

 Hepatic

 Left gastric

1. A 57-year-old male complains of intense chest pain, but tests rule out any cardiac pathology. It was
determined that the patient suffers from an esophageal (hiatal) hernia in which the stomach herniates
through an enlarged esophageal hiatus. Muscle fibers from which of the following parts of the
diaphragm would border directly on this hernia?

 left crus

 right crus

 central tendon

 costal fibers

 sternal fibers
2. Sympathetic fibers in the greater splanchnic nerve arise from neuron cell bodies found in the:

 brainstem

 celiac ganglion

 chain ganglion

 spinal cord

 superior mesenteric ganglion

3. After successfully performing two adrenalectomies (removal of the adrenal gland), the surgical resident
was disappointed to learn that he would be merely assisting at the next one. The chief of surgery told
him: "I'm doing this one, since the one on the right side may be a little too difficult for you." The difficulty
he envisioned stems from the fact that the right suprarenal gland is partly overlain anteriorly by the:

 aorta

 inferior vena cava

 left hepatic vein

 right crus of the diaphragm

 right renal artery

4. During preparations to remove the left kidney from a 28-year-old female patient, the surgeon asked an
observing medical student where best to ligate the renal vein. Upon hearing the reply: "as close to the
inferior vena cava as possible, leaving just enough stump to ensure tight closure," the surgeon's
eyebrow shot up. "Do you mean to say you're willing to compromise the venous drainage of the other
structures that drain into the renal vein?" By this he meant all of the following except:

 diaphragm

 pancreas

 ovary

 suprarenal gland
5. The celiac plexus of nerves may contain fibers derived from all of the following sources except:

 posterior vagal trunk

 greater thoracic splanchnic nerve

 lesser thoracic splanchnic nerve

 lumbar splanchnic nerves

6. Which statement regarding the suprarenal glands is correct?

 Its entire arterial supply is directly from the abdominal aorta.

 Veins from both glands drain directly into the inferior vena cava.

 The glands are localized in the pararenal space.

 Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the
greater thoracic splanchnic nerve.
7. The nerve that innervates the cells of the suprarenal medulla consists of fibers of the:

 Greater thoracic splanchnic nerve

 Lesser thoracic splanchnic nerve

 Least thoracic splanchnic nerve

 Anterior vagal trunk

 Posterior vagal trunk

8. Regarding the diaphragm, which, is paired INCORRECTLY?

 Vertebrocostal trigone - lateral arcuate ligament

 Esophageal hiatus - right crus

 Medial arcuate ligament - psoas muscle

 Central tendon - aortic hiatus

 Vena caval foramen - right phrenic nerve

9. The nerves that end on the secretory cells of the medulla of the suprarenal glands are principally:

 Preganglionic fibers from the greater thoracic splanchnic nerve

 Postganglionic fibers from the celiac plexus

 Postganglionic fibers from the aorticorenal ganglia

 Preganglionic fibers from the lesser thoracic splanchnic nerve

 Postganglionic fibers from the renal plexus

10. The vagus nerve passes into the abdomen by passing through the

 Aortic hiatus

 Esophageal hiatus

 Caval foramen

 Lateral arcuate ligament

 Medial arcuate ligament

11. With one exception, preganglionic sympathetic axons synapse upon postganglionic sympathetic
dendrites or cell bodies. The exception to this general rule occurs within the:

 Kidney cortex

 Kidney medulla

 Suprarenal medulla

 Suprarenal cortex
12. The pararenal fat in the kidney bed is an elaboration of:

 Peritoneum
  Extraperitoneal connective tissue

 Transversalis fascia

 Fusion fascia
13. The cisterna chyli accompanies which structure as it passes through the diaphragm?

 Inferior vena cava

 Esophagus

 Greater thoracic splanchnic nerve

 Aorta
14. Blood from an injured kidney will seep through the perirenal fat until it contacts the internal surface of
the renal (Gerota's) fascia. Without perforating this fascia the blood could then continue to pass in what
direction?

 inferiorly toward the pelvis

 laterally into the body wall

 medially across the midline to the other kidney

 superiorly into contact with the fascia of the diaphragm

15. A 19-year-old male suffers a tear to the psoas major muscle during the course of a football game. A
scar, which formed on the medial part of the belly of the muscle, involved an adjacent nerve,
immediately medial to the muscle. The nerve is called the:

 femoral

 genitofemoral

 iliohypogastric

 ilioguinal

 obturator
16. While recovering from an open abdominal hysterectomy (i.e., using a midline abdominal incision to gain
entry to the pelvis), a patient realizes that she has lost sensation to the skin of her anterior thigh and
cannot extend her knee. Retractors holding the incision open and pressing against the posterior
abdominal wall most likely caused injury to which nerve?

 Femoral

 Genitofemoral

 Iliohypogastric

 Lateral femoral cutaneous

 Obturator
17. In the lumbar region, tuberculosis may spread from the vertebrae into an adjacent muscle to produce an
abscess. Pus from the abscess may travel within the fascial sheath surrounding the affected muscle. A
patient presents with pus surfacing in the superomedial part of the thigh. To which muscle did the
tuberculosis most likely spread?

 Internal oblique
  Obturator internus

 Psoas major

 Quadratus lumborum

 Rectus abdominis
18. The nerves of the lumbar plexus are arranged around specific muscles of the posterior abdominal wall.
Which of these nerves lies immediately medial to the psoas major muscle?

 Femoral

 Genitofemoral

 Ilioinguinal

 Obturator