This is the first in a series of comprehenisve clinical anatomy and imaging questions for the abdomen.  Good luck!

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Abdominal Anatomy Part One

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Question 1
A patient presents to her GP in the second trimester of her fourth pregnancy with a “weird black line” running from her xiphoid to her pubic symphysis.  The doctor reassures the patient that this is perfectly normal for pregnancy.  What is the term for this appearance?
A
Linea albicans
B
Linea nigra
C
Linea alba
D
Linea corpus
Question 2
Which of the following abdominal access techniques would most likely take the longest to heal?
A
Paramedian
B
Subcostal
C
Median longitudinal
D
Suprapubic
Question 2 Explanation: 
The linea alba is relatively avascular and thus will take a longer time to heal.
Question 3
The patient has a duodenal bulb ulcer and asks you to point to where this is on his body. Which of the following is the best way to quickly ascertain the vertebral level of this anatomical point?
A
Midway between the xiphisternum and umbilicus
B
Midway between the xiphisternum and pubis
C
Midway between the ASIS and pubic tubercle
D
McBurney’s point
Question 4
A patient with recurrent seizures requires a lumbar puncture to rule out meningitis and other causes.  With the patient in the fetal position, lying laterally the needle is inserted. What surface anatomy landmark can be used to ascertain this site?
A
L1 transverse processes
B
Midway between T12 spinous process and dimples of venus (PSIS)
C
Vertebrae prominens
D
Midway between Iliac crests
Question 5
Which structure lies immediately deep to the endothoracic fascia?
A
Internal intercostal muscle
B
Visceral pleura
C
Parietal pleura
D
Subcutaneous fascia
Question 6
A patient suffers a fall and fractures her eighth rib, left side by the angle of the rib.  Use your knowledge of neurovascular planes to discuss into which space the lesioned bundle would haemorrhage
A
Between the external and internal intercostal muscles
B
Between the endothoracic fascia and parietal pleura
C
Between the external and innermost intercostal muscles
D
Between the internal and innermost intercostal muscles
Question 7
A patient has suffered an infection to their anterior abdominal wall that has become necrotic. Examination is notable for bumpy prominence that can be palpated immediately deep to the skin layers.  A biopsy is taken and soapy infiltrates are present in the cells. Based on the necrosis type explained above, which layer of the wall is most likely affected?
A
External intercostal fascia
B
Camper
C
Scarpa
D
Endothoracic fascia
Question 7 Explanation: 
The correct answer is Camper's fascia, due to its relatively high prevalence of lipid deposit. The pattern of necrosis described above is fat. In fatty tissues undergoing necrosis, lipase frees triglycerides from fatty acids to complex with calcium and form "soaps". These can be seen diagnostically with light microscopy.
Question 8
As Scarpa's fascia is continuous inferiorly, it merges with a layer about the scrotum.  This layer is called the ...
A
suprapubic fascia
B
subscrotal fascia
C
dartos fascia
D
colles fascia
Question 9
A patient has an infection of the scrotum that is tracking superoinferiorly from the T4 dermatome down to the L1 dermatome.  In which plane is this travelling superior to the umbilicus?
A
Between Camper and Scarpa fascia
B
Between Camper and the hypodermis
C
Immediately deep to rectus abdominis within the rectus sheath
D
Between the external and internal intercostal muscles
Question 10
What forms the inguinal ligament?
A
The superficial anterior abdominal wall muscle that tracks inferomedially
B
The superficial anterior abdominal wall muscle that tracks superolaterally
C
The superficial anterior abdominal wall muscle that tracks transversely
D
The superficial anterior abdominal wall muscle that tracks longitudinally
Question 10 Explanation: 
It is formed of the free aponeurotic border of external oblique muscle, the fibres of which run inferiorly and medially.
Question 11
A patient presents with a palpable mass from their RLQ (right lumbar region) that is reducible and does not transilluminate.  On auscultation, normal bowel sounds are heard and no ischaemia is noted on initial inspection. What surface anatomy marker is used to test reducibility of the mass?
A
Superomedial to the pubic tubercle
B
Midway between the midinguinal point and midpoint of the inguinal ligament
C
Superolateral to the pubic tubercle
D
McBurney's point
Question 11 Explanation: 
The question is describing an indirect inguinal hernia with ileum present. To test whether it is direct/indirect, the surgeon would attempt to reduce the mass by pushing through the superficial inguinal ring - which can be found superlateral to the pubic tubercle.
Question 12
A patient is diagnosed with a reducible inguinal hernia.  What is the surface anatomy of the unique region of the anterior abdominal wall through which the herniation has occurred?
A
Superolateral to the pubic tubercle
B
Midway between the midpoint of the inguinal ligament and the midinguinal point
C
Superomedial to the pubic tubercle
D
McBurney's point
Question 13
A 32 year-old female presents with a left-sided femoral hernia.  During the differential, a registrar mentions that they are ruling out an abscess.  What is the function of the muscle for which this abscess type is named?
A
Powerful knee flexion
B
Powerful hip flexion
C
Powerful hip extension
D
Assisting psoas major
Question 14
A neonate is born with viscus protrusion through the anterior abdominal wall.  What form of hernia is most likely in this demography?
A
Inferior lumbar
B
Inguinal
C
Femoral
D
Umbilical
Question 15
A patient's medial thigh is stroked to elicit a reflex which has an efferent limb powered by the genital branch of the genitofemoral nerve.  From where does the muscle of this reflex derive?
A
Transversus abdominis muscle
B
External oblique muscle
C
Rectus abdominis muscle
D
Internal oblique muscle
Question 16
A patient with 5 year history of weightlifting presents to his GP with a palpable mass midway between the umbilicus and mons pubis.  Which regions are most prone to this type of ventral herniation of viscus?
A
Regions superior to the region where the inferior epigastric artery penetrates the rectus abdominis muscle
B
Region within the lumbar triangle of Petit
C
Region lateral to the umbilicus
D
Region inferior to the arcuate line of Douglas
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