🥵 HARD

These anatomy MCQs focus on the abdominal viscera and include some clincal vignettes.

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Abdominal Anatomy Part Three MCQ

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Question 1

Stem 1 of 4

Joseph, a 55 year-old male, presents to his GP with diffuse T10 dermatome pain, a history of bleeding from his rectum and vomitus for the past two days.  After a thorough history and examination, the doctor concludes the patient may have a volvulus.
Based on the referred pain location above, which of the following is NOT likely to be the site of the volvulus?
A
Proximal duodenum
B
Jejunum
C
Ileum
D
Caecum
Question 1 Explanation: 
The T10 dermatome includes the umbilicus. Pain in the region of the T10 dermatome indicates a midgut problem. All of the examples above are midgut structures apart from the proximal duodenum.
Question 2

Stem 2 of 4

The patient is blue-lighted to ED for emergency laparoscopy. The surgeon insists on a median-line incision into the anterior abdominal wall, in order to preserve neurovasculature.  What is the risk of this operative procedure?
A
Damage to the transversus abdominis muscle fibres
B
Damage of the inguinal ligamenet
C
Damage to the superior epigastric vessels
D
Slow healing time of the linea alba
Question 2 Explanation: 
The linea alba is the site of median-line insertion during emergent exploratory abdominal surgery when laparoscope is not advised - eg time, etc. The concern is the relative avascularity of the structure and therefore its slow healing time.
Question 3

Stem 3 of 4

The doctor's differential included Crohn's disease.  Which of the below symptoms are most suggestive of this diagnosis?
A
Haematochezia
B
Haemoptysis
C
Diffuse abdominal pain
D
Decreased level of consciousness
Question 3 Explanation: 
Haematochezia is the passage of fresh blood per rectum.
Question 4

Stem 4 of 4

A plain radiograph of the abdomen is ordered confirming volvulus to the distal ileum.  As the surgeon later explores, he notes ischaemic change of the ileum.  What is the origin of the blood supply to these impinged structures?
A
Coeliac axis
B
Coeliac trunk
C
Superior mesenteric artery
D
Inferior mesenteric artery
Question 5
A patient has had iatrogenic-destruction of the iliohypogastric nerve, resulting in a direct inguinal hernia.  Which of the following best describe the cause of this herniation?
A
Atrophied external oblique muscles
B
Inferior epigastric aneurysm
C
Linea alba resection
D
Conjoint tendon weakness
Question 5 Explanation: 
The conjoint tendon is formed from the aponeurosis of the internal obliques and transversus abdominis.
Question 6
A patient has suffered major abdominal trauma with viscus extra-corpus.  You look at the loop of intestine that has herniated from a laceration and see that the mesentery is full of fat.  Which of the following is this most likely to be?
A
Duodenum
B
Proximal jejunum
C
Proximal ileum
D
Distal jejunum
Question 7
A longitudinal line of smooth muscle lies external to the adventitia of the large bowel.  What is the function of this?
A
Peristalsis
B
Mass movement coordination
C
Passive structural support
D
Haustration formation
Question 7 Explanation: 
The muscle being described is the teniae coli.
Question 8
A patient with previous diagnosis of endometriosis has uncontrolled cystic inflammation to her cervix and presents to her OBGYN for review.  Suggest where the pain will most likely refer.
A
L1
B
L4
C
S3
D
S5
Question 8 Explanation: 
The cervix lies below the pelvic pain line, but is not ectoderm-derived as the distal vagina. Thus the localisation must be related to the S2-4 dermatome.
Question 9
Which of the following is true of the dentate line?
A
It is formed of mesoderm
B
it is the boundary between anus and rectum
C
It is the division of hindgut-ectoderm marking
D
It is a common site of colonic cancer
Question 9 Explanation: 
The dentate (or pectinate) line is found two thirds of the way along the anus. The proximal two third are formed from the hindgut while the distal third is formed from the ectoderm.
Question 10
A patient with notable general examination of scleral jaundice and asterixis states a 24 year history of "heavy drinking" of alcohol.   He reports to the GP with pain on defecation and some spotty bleeding in the stool.  Which of the following is best representative of the diagnosis?
A
Anorectal varices
B
Internal haemorrhoids
C
External haemorrhoids
D
Visceral haemorrhoids
Question 11
A patient with notable general examination of scleral jaundice and asterixis states a 24 year history of "heavy drinking" of alcohol.   He reports to the GP with pain on defecation and some spotty bleeding in the stool.  Of this patient, which of the following is correct?
A
Patient has decreased risk of oesophageal varices
B
Patient may have increased risk of cerebral oedema
C
Patient may have increased clearance of ammonia
D
Patient is in CO2 retention
Question 11 Explanation: 
Liver cirrhosis, or dysfunction, will lead to hypoalbuminaemia, and thus cause a decrease of serum oncotic potential. This risks extravasation, such as from the cerebral capillaries. Although asterixis is a sign of CO2 retention, this patient's jaundice and excess alcohol consumption makes liver damage the more likely cause of this sign.
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