Gross prelims 2nd Sem.

1. Esophageal hiatus is the opening of the diaphragm found at the level of T10

Diaphragm has 3 openings:

a. Vena caval foramen : hole for the inferior vena cava, where it passes to the liver. Around T8.
b. Esophageal hiatus: opening that admits the esophagus guarded by two muscles left crus and right crus; left
gastric artery and left gastric vein also pass through the esophageal hiatus; around T10
c. Aortic hiatus: is actually posterior to the diaphragm—not really a hole in the diaphragm; thoracic duct goes
posterior through this opening as well as aorta; about level T12

2. Inguinal ligament is the aponeurosis of this abdominal muscle - external abdominal oblique muscle.
3.d. In\ women, the only structure passing through the inguinal canal: round ligament of the uterus
e.
In male: spermatic cord is composed: ductus deferens; testicular, cremasteric and deferential arties; pampiniform
plexus of testicular veins; genital branch of genitofemoral and cremasteric nerves and the testicular sympathetic
plexus and lymph vessels.

Fascia of spermatic cord

a. External spermatic fascia – derived from the aponeurosis of the external oblique muscle
b. Cremasteric fascia – internal oblique muscle
c. Internal spermatic fascia – transversalis fascia

4. This type of hernia enters the inguinal canal through the deep inguinal ring: indirect inguinal hernia

Hernia: is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
Types:
Indirect inguinal hernia: enters the inguinal canal through the deep inguinal ring. It passes through the inguinal
canal to exit through the superficial inguinal ring in the aponeurosis of the external oblique m.
Direct inguinal hernia: passes directly through the posterior wall of the inguinal canal. It does not pass down the
inguinal canal.
Femoral hernia: occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral
hernias are most common in women especially those who are pregnant or obese.
Epigastric hernia: occurs when fat or other tissues pushes through a weak part of the abdominal wall.
Umbilical hernia: occurs when tissue pushes through the part of the abdomen near to the navel. Most common in
infants.
Incisional hernia: occurs when tissue pushes through a surgical scar.

5. Below the arcuate line this make up the posterior boundary of the rectus abdominis muscle: transversalis fascia

Above the arcuate line:

Anterior layer: aponeurosis of the external and internal oblique muscles
Posterior layer: aponeurosis of internal oblique and transverse muscles.
Below the arcuate line:
Anterior layer: aponeurosis of external oblique, internal oblique and transverse muscles
Posterior layer: transversalis fascia

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 6. This superficial fascia is thin and membranous and continuous into the thigh: scarpa’s fascia

Superficial fascia is the same thing as the hypodermis

Camper’s fascia: fatty layer, first of the two layers found throughout the anterior abdominal wall.

Scarpa’s fascia: membranous layer, found in the lower 1/3 of the anterior abdominal wall. It is thin and membranous
and contains little or no fat. Inferiorly, it continues into the thigh, but just below the inguinal ligament, it fuses with
the deep fascia of the thigh ( the fascia lata)
7. One of this muscle form part of the anterolateral and posterior boundary of the abdomen: transversus
abdominis muscle

Anterior abdominal wall muscles:

External abdominal oblique, internal abdominal oblique, transversus abdominis, rectus abdominis
8. Divide the abdomen to region which runs from suprasternal notch : transpyloric

Abdominal regions: Horizontal lines of division

Subcostal plane: immediately inferior to the costal margins; at the lower border of the costal cartilage of rib X; and
passes posteriorly through the body of vertebra LIII
Transpyloric plane: a horizontal plane that transects the body through the lower aspect of vertebra LI; it is halfway
between the suprasternal notch and the pubic symphysis

9. The umbilicus is normally on a horizontal plane that passes through the disc between: B. L3-L4
10. 10. Pain from the foregut is referred to this region: A. Epigastric pain

Defining surface regions to which pain from the gut is referred:

a. Pain from the abdominal part of the foregut is referred to the epigastric region
b. Pain from the midgut is referred to the umbilical region
c. pain from the hindgut is referred to the pubic region

11. A patient at the E.R. presents with pain at the upper right quadrant with associated tenderness on palpation
and fever. The most probable organ that is inflamed is the:
A. liver C. Appendix
B. Transverse colon D. Gall Bladder
12. A direct inguinal hernia is where the herniating intestine pass through the: A. Posterior wall of the inguinal
canal
13. One of these bony landmarks is utilized as a guide for lumbar tap: B. Iliac crest

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 14. This artery origins from the aorta approximately at the level of L2: A. Renal artery

Celiac trunk: originates from the aorta at the upper border of the L1 vertebra
Superior mesenteric artery: originates at the lower border of the L1 vertebra
Renal arteries: originates at approximately the LII vertebra
Inferior mesenteric artery: originates at the LIII vertebra
Aorta bifurcates into the right and left common iliac arteries at the level of the LIV vertebra.
Left and right common iliac veins: join to form the inferior vena cava at the LV vertebra

15. The nerve supply of the anterior abdominal wall around the umbilicus from this spinal nerve level is:B. T10

a. From the xiphoid process to just above the umbilicus: T7- T9

b. Around the umbilicus: T10
c. From just below the umbilicus to and including the pubic region: T11, T12 and L1

16. . L1 and L2 level of the lumbosacral plexus give rise to this nerve: Genitofemoral

The nerves of the posterior abdominal wall are branches of the lumbosacral plexus : L1-L5
a. L1 gives rise to the iliohypogastric and ilioinguinal nerves
b. L1 + L2 gives rise to the genitofemoral nerves
c. L2 + L3 gives rise to the lateral femoral cutaneous nerve
d. L2 + L3 + L4 give rise to the femoral and obturator nerves
e. L4 + L5 give rise to the lumbosacral trunk which joins the sacral nerves to form the sacral plexus

17. This division of the peritoneal cavity rise behind the stomach and the liver: B. Omental Bursa

The peritoneal cavity is subdivided further into:

a. Greater sac – accounts for most of the space in the peritoneal cavity, beginning superiorly at the diaphragm
and continuing inferiorly into the pelvic cavity ; it is entered once the parietal peritoneum has been
penetrated
b. Omental bursa – a smaller subdivision of the peritoneal cavity posterior to the stomach and liver;
continuous with the greater sac through an opening the omental foramen

18. This border of the liver runs from the 5th rib to the 10th rib
A. Upper C. Left
B. Inferior D. Right
19. The fundus of the gall bladder lies deep to the intersection of_____ with the costal margin in the transpyloric
plane

B. Linea semilunaris

Fundus of the gall bladder:

- This lies deep to the intersection of the linea semilunaris with the costal margin in the transpyloric
plane.
- At this point the fundus of the gall bladder lies behind the 9 th costal cartilage

20. The left and right common iliac veins join infront of the inferior vena cava at this vertebral layer: D. L5

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21. Spillage of duodenal contents is spread from the epigastric area to right lower quadrant that may indicate acute
appendicitis. This is because the orientation of the mesenteric attachment of the small intestine is from

C. Left upper quadrant to right lower quadrant

22. Visceral pain from an inflamed appendix is usually felt at the periumbilical area. This is because the appendix is
derived from B. Midgut

23. The formation of the small intestine is due to the A. Lengthening of the midgut in the physiologic umbilical hernia

24. Congenital anomaly that results from the outpouching of the small intestine due to persistence of communication
between the midgut and yolk sac after birth C. Meckel diverticulum

Meckel's Diverticulum:
- congenital anomaly representing a persistent portion of the vitellointestinal duct
- if present, usually located on the antimesenteric border of the ileum, about 2 feet from the ileocecal
junction
- important clinically since bleeding may occur from an ulcer in its mucous membrane
- a portion of the bowel along the Ileum that may be left over from development.
Rule of Twos:
In 2% of population, 2 feet from the distal end of the Ileum, and 2 inches long., 2 complications
It creates a pouch which can collect unwanted waste and materials.

25. The main blood supply of the small intestine are branches of: B. Inferior mesenteric artery

26. The ultrasound result of a 34y/o female with complaints of jaundice and abdominal pain, with presence of 1.5cm
stone in the common bile duct. The stone can be confirmed intraoperatively if the surgeon will palpate what structure:

A. Hepatoduodenal ligament

27. The jejunal mesentery is attached to posterior abdominal wall and to the :D. Left of aorta

28. Lymphatic aggregates noted along the mesenteric border of ileum are called C. Peyer’s patches

29. The valves of kerckring are also known as B. Plicae circularis

Plicae Circulares: refers to the name of the fold on the distal three parts of duodenum

30. The junction of duodenum and jejunum is marked by A. Ligament of treitz

Ligament of Treitz: attaches the fourth part of the duodenum to the right crus of the diaphragm
- goes posterior to the pancreas
- essentially attaches duodenum to posterior wall
- suspensory muscle of the duodenum
o function to hold duodenum
o opened/ closed for passage of food into jejunum

31. A pyloric sphincter is caused by the thickening of the B. Middle circular muscle

32. A patient was noted to have duodenal mass that appears to originate from the ampulla vater. The mass can be best
visualized during endoscopy by directing the scope towards what part of the duodenum

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D. Posteromedial aspect of the 2nd portion of duodenum

33. The duodenum receives its blood supply from B. Superior pancreaticoduodenal artery which is a branch of
gastroduodenal artery

34. Which of the following statement about the duodenum is correct: D. all of the above

35. The foramen of winslow: C. is where the index finger is insinuated in order to perform the palpation of the
hepatoduodenal ligament

36. Mucus membranes tend to be smooth in the: C. Ileum

37. during upper gastro intestinal endoscopy one will be able to identify the duodenum bec. of
a. circular lumen
b. presence of
c. triangular lumen
d. thickened wall

38. this refers to the telescoping of the proximal intestine adjoining distal segment usually triggered by mesenteric
lymphadenopathies or tumors into the intestine: b. intussusception

39. this maneuver is perform in order to stabilized or to mobilized the duodenum from lateral to medial area in order to
exposed the posterior wall of the 2nd portion of the duodenum and evaluate the common bile duct and identify the
pancreatic head B. kocher maneuver

40. During bleeding from hepatic injury one can attempt to control the bleeding by pressing on the hepatoduodenal
ligament a. pringle maneuver

Pringle maneuver – is a temporary cross- clamping (intermittent soft vascular clamping) of the hepatoduodenal
ligament containing portal triads at the foramen of Winslow for control of hepatic bleeding during liver surgery
or donor hepatectomy for living liver transplantation.

41. to best locate the base of the appendix at the cecum, the student should look for? convergence of the taenia coli

42. thickened bands of longitudinal muscle: taenia coli

Large intestine : special features:

a. Taenia coli- thickening of longitudinal muscularis
b. Haustra- puckering created by taenia coli
c. Epiploic appendages – fat filled pouches of visceral peritoneum

43. the narrowest part of the colon is the: sigmoid colon

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44. which of the following statement is true about the blood supply of the colon? a. MIDDLE COLIC ARTERY IS THE
BRANCH OF THE SUPERIOR MESENTERIC ARTERY

45. THE BLOOD SUPPLY OF THE ENTIRE COLON can be maintained in one major vessel is ligated provided the patency of
length is reserved

B. marginal artery of Drummond

The marginal artery of the colon, or artery of Drummond, is an artery that runs along the inside border of the
large intestine, ending at the rectum. This blood vessel connects the inferior mesenteric artery to the superior
mesenteric artery and is formed from branches of the right colic, left colic, ileocolic, and middle colic
arteries.Together, Drummond's artery and the internal iliac arteries carry oxygen-rich blood to the large intestine.
In situations in which the internal iliac arteries are not capable of supplying blood to the intestine (such as after
repair of an abdominal aortic aneurysm), the marginal artery of the colon is large enough to perform this function
on its own.

46. Which of the ff statement above the cecum is correct? A. the ileocecal valve will pierce the large intestine at the
junction of cecum and ascending colon

47. Which of the following regarding the appendix is correct? b. the base of the appendix can be located using mc
burney’s point

48. In most anatomic specimens, which of the ff part of the - is 100% intraperitoneal? b. transverse colon

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49. the rectum develops from? c. posterior portion of the cloaca

50. Reflux of colonic contents back to the ileum is prevented by the? c. patent ileocecal valve

51. In order to visualized the posterior wall of the stomach and the area of pancreas one should: B. dissect the
gastrocolic omentum

52. the transverse colon? D. all of the above

TRANSVERSE COLON
- About 38cm (15in) long and passes across the abdomen, occupying the umbilical and hypogastric region
- Begins at the right colic flexure below the right lobe of the liver and hangs downward, suspended by the
transverse mesocolon from the pancreas
- ascends to the left colic (splenic) flexure below the spleen
- Left colic flexure is higher than the right and is held up by the phrenicocolic ligament
- Transverse mesocolon is attached to its superior border
- Posterior layers of the greater omentum area attached to its inferior border
( copied directly from the trans of Dr. Danac’s lecture)

53. it regards to anterior supply of the colon: D. all of the above

54. the superior rectal vein drains in to the: inferior mesenteric vein

55. the valves of houston seen during —oscopy is due to: c. transverse folds of the rectum

56. which of the ff characterized anal sphincter d. all

57. internal hemorrhoids are usually found: above the pectinate line

Hemorrhoids are dilated internal and external venous plexus around the rectum and anal canal.
a. Internal hemorrhoids - occur above the pectinate line and are covered by mucous membrane; their
pain fibers are carried by GVA fibers of the sympathetic nerves.
b. External hemorrhoids – are situated below the pectinate line, are covered by skin and are more painful
than internal hemorrhoids because their pain fibers are carried by GSA fibers of the inferior rectal
nerves.

58. Upon insertion of proctosigmoidoscope the endoscopy was able to insert up to 25cm the visualized structure on the
is? B. rectosigmoid area

59. presence of black stool in watery stool is most likely due to pathological condition in the area of? ascending colon

60. during colonic dilatation tension will be greatest at? cecum

61. the olfactory tract is formed by the axons of? mitral cells

62. the mitral cells send impulse to the following structure except? d. medulla

Mitral cells send impulse ( taken from dr. datu’s lecture)

a. The olfactory cortex
b. The hypothalamus, amygdala, and limbic system

63. true to internal nose Except c. the roof is adjacent to the posterior cranial fossa

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64. blood supply to the internal nose except? d. none of the choices

Blood supply ( taken from Dr. Datu’s lecture)

Anterior ethmoid
- to roof and anterior superior portion of septum
and lateral wall.
Sphenopalatine - to lateral wall of nose
Nasopalatine - supplies roof, septum, and floor
Lateral nasal - supplies lateral nasal wall anteriorly
Descending palatine
- supplies the lateral nasal wall posteriorly.
Pharyngeal - supplies roof posteriorly
Posterior ethmoid
- supplies septum and lateral nasal wall superiorly
Septal - supplies septum inferiorly and floor
65. bones that bound the external nose d. mandible

66. this will form the roof of the nasal cavity b. ethmoid

Nasal Cavity (taken from Dr. Datu’ lecture)

• Roof – formed by the cribriform plate of the ethmoid
• Lateral walls – formed by the superior and middle conchae of the ethmoid, the perpendicular plate of
the palatine, and the inferior nasal conchae
• Floor – formed by palatine process of the maxillae and palatine bone

67. posterior rhinoscopy will visualized the following structure d. all of the above

68. the frontal sinus drains in the? b. middle meatus

69. the posterior ethmoid sinus drains in the? c. superior meatus

70. the anterior ethmoid sinus drains in the? b. middle meatus

71. the narrowest normal constriction of the esophagus a. at the beginning

Esophageal constrictions:
the esophagus has three anatomic and physiologic constrictions. The first is where the pharynx joins the upper end,
the second is where the aortic arch and the left bronchus cross its anterior surface and the third occurs where the
esophagus passes through the diaphragm into the stomach,

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72. the blood supply of the gastrointestinal tract is derived from?

a. celiac trunk c. inferior mesenteric

b. superior mesenteric d. all of the above

73. the blood supply of the proximal 3rd of the esophagus is derived from?
a. aorta
b. celiac truck
c. subclavian artery

Blood supply of the esophagus: (snell)

Upper third of the esophagus – inferior thyroid artery (subclavian artery)
Middle third- descending thoracic aorta
Lower third -left gastric artery ( celiac trunk)

74. the esophageal hiatus in the diaphragm lies at the level of c. t10

75. the part of the stomach immediately that receives the esophagus is? b. cardiac

76. the inferior border of the stomach is form by the b. pylorus

77. A direct branch of the celiac trunk running along the lesser curvature of the stomach is the left gastric artery

78. Which of the ff accompanies the esophagus at the diaphragmatic hiatus? C. vagus nerve

79. the upper esophageal sphincter is marked by? B. cricopharyngeus muscle

80. Which of the following statement regarding the pylorus is correct?

a. the cavity of the pylorus is in the pyloric canal
b. the pyloric sphincters marked by the thickened middle circular muscle
c.
d. all of the above

81. The epiploic foramen of winslow:

a. bounded anteriorly by the inferior vena cava
b. serves as communication between the lesser omental sac and the greater omental sac
c. lies anterior to the pancreas
d. all of the above

82. Perforation of a gastric ulcer located in the posterior wall of the stomach may erode the
a. Inferior mesenteric artery
b. 2nd part of duodenum
c. phrenic artery
d. quadrate lobe of the liver

83. Each of the following statement about the lower esophageal sphincter is correct:
a. no anatomic sphincter exists
b. acts only as a physiologic sphincter

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c. noted during upper gastric intestinal endoscopy at the 40cm mark of the ___
d. all of the above

84. Blood supply of the esophagus is derived from the following except: b. Superior thyroid artery

85. Blood supply of the stomach except: d. long gastric artery

Blood supply of the stomach ( Snell)

The arteries are derived from the branches of the celiac artery.
Left gastric artery – arises from the celiac artery. It passes upward and to the left to reach the esophagus and then
descends along the lesser curvature of the stomach. It supplies the lower third of the esophagus and the upper right
part of the stomach.

Right gastric artery – arises from the hepatic artery at the upper border of the pylorus and runs to the left along the
lesser curvature. It supplies the lower right part of the stomach.

Short gastric arteries – arise from the splenic artery at the hilum of the spleen and pass forward in the gastrosplenic
omentum to supply the fundus.

Left gastroepiploic artery – arises from the splenic artery at the hilum of the spleen and passes forward in the
gastrosplenic omentum to supply the stomach along the upper part of the greater curvature.

Right gastroepiploic artery - arises from the gastroduodenal branch of the hepatic artery. It passes to the left and
supplies the stomach along the lower part of the greater curvature.

86. Nerve supply of the stomach comes from:

a. celiac ganglia
b. superior mesenteric ganglia
c. vagus nerve
d. only A and C are correct

87. Lymphatic drainage of the stomach:

a. celiac lymph node
b. superior mesenteric lymph node
c. inferior mesenteric lymph node
d. all of the above

88. This structure will form the roof of the stomach: a. fundus

89. Source of the superior pancreaticoduodenal artery of the celiac trunk:

a. left gastric artery
b. common hepatic artery
c. splenic artery
d. none of the above

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90. Which of the following statement about Barrett esophagus is correct: a. choice not stated

91. Normal rugal pattern of the esophagus is: c. Parallel

92. The following are normal points of narrowness in the esophagus except d. level of the right main bronchus

Normal sites/ anatomic narrowing of esophagus: ( taken from GI imaging from Dr. Limos)
Superiorly: level of cricoid cartilage, juncture with pharynx
Middle: crossed by aorta and left main bronchi
Inferiorly: diaphragmatic sphincter

93. The Schatzki’s ring refers to a. True mucosal junction between esophagus and stomach

94. The rugal pattern of the gastric mucosa on contrast radiograph is c. parallel

95. The following are true of duodenum except: a. it has mesentery and is free on the posterior abdominal wall

96. The head of the pancreas is anatomically continuous in what subdivision of the duodenum: b. descending
duodenum

97. The rugal pattern of the duodenum is ___ in the appearance except: a. superior

98. A predominant visceral organ readily seen in abdominal radiograph is: c. liver

99. The rugal pattern of the small intestine is c. Tethering

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100. The following distinguish the large from the small intestine except: d. Colon has plica circulares

101. Which of the following radiologic procedure provides a detailed view of colonic polyps, colorectal cancer or
inflammation b. Double contrast barium enema

102. Which of the following regional procedure does not utilize air as contrast medium: a. Single contrast barium
enema

103. Indication for doing barium enema are the following except: c. Colon rupture

104. Risks of barium enema are the following except: b. Diarrhea

105. The following are indication for doing upper gastrointestinal ___ except: c. Rectal Polyp

106. The following modality has a ____ upper GI as a choice in detecting esophageal gastric and duodenal pathology: b.
Upper GI endoscopy

107. Indications for doing small bowel ____ are the following except: d. Intussusception

108. Which of the following _____ of imaging modalities have no ionizing radiation b. MRI and ultrasound

109. The radiologic exam that examines only the pharynx and esophagus is called: b. Barium swallow

110. The best imaging modality for detecting pancreatic mass a. CT scan

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111. Blood supply of pancreas is/are derived from: d. a and b are correct

Blood supply: ( moore)

The arterial supply of the pancreas is derived mainly from the branches of the markedly tortuous plenic artery.
Multiple pancreatic arteries form several arcades with pancreatic branches of the gastroduodenal and superior
mesenteric arteries. As many as 10 branches may pass from the splenic artery to the body and tail of the pancreas.
The anterior and posterior superior pancreaticoduodenal arteries, branches of the gastroduodenal artery and
anterior and posterior inferior pancreaticoduodenal arteries, branches of the SMA, form anteriorly and posteriorly
placed arcades that supply the head of the pancreas.

112. The following are major salivary glands: d. all are correct

Salivary glands:
a. Submandibular gland
b. Sublingual gland
c. Parotid gland

113. blood supply of the liver c. Both portal vein and hepatic artery

Blood vessels of liver ( moore)

The liver, like lungs, has a dual blood supply: a dominant venous source and a lesser arterial one. The hepatic portal
vein brings 75-80% of blood to the liver. Portal blood, containing about 40% more oxygen than blood returning to
the heart from systemic circuit, sustains the liver parenchyma. Arterial blood from the hepatic artery accounting for
only 20-25% of blood received by the liver.
114. Which statement is not descriptive of the falciform ligament c. Functionally separates the left and right lobe

115. Ligaments that provide support to the liver

a. falciform ligament
b. coronary ligament
c. triangular ligament
d. all of the above

116. Which is not a classic liver lobe d. caudate

117. This ligament contains the ligamentum teres hepatis: falciform ligament

118. The lines of the liver is cover by single layer of mesothelial cells

119. Content of the porta hepatic? Except d. hepatic vein

Liver contains the portal triad which is a group of the branches of the portal vein, hepatic artery, and bile duct at
every corner of the lobule.
120. Which of the following statement concerning the liver is incorrect: a. the quadrate lobe drains into the right
hepatic trunk

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