Snell Abdomen Questions Answers
Snell Abdomen Questions Answers
Snell Abdomen Questions Answers
REVIEW
Matching Questions
6.
7.
8.
9.
10.
Structure
Structure
Structure
Structure
Structure
1
2
3
4
5
A.
B.
C.
D.
E.
F.
Jejunum
Pylorus
Lesser curvature of the stomach
First part of the duodenum
Antrum of the stomach
None of the above
1.
2.
3.
4.
5.
Structure
Structure
Structure
Structure
Structure
1
2
3
4
5
A. Sacroiliac joint
B. Pedicle of the fourth lumbar
vertebra
C. Iliopectineal line
D. Transverse process of the fifth
lumbar vertebra
E. Psoas muscle
F. None of the above
11.
12.
13.
14.
15.
Structure
Structure
Structure
Structure
Structure
1
2
3
4
5
A.
B.
C.
D.
E.
F.
G.
Aorta
Vertebral body
Gallbladder
Pancreas
Left ureter
Inferior vena cava
None of the above
CHAPTER 2 Abdomen 69
26.
27.
28.
29.
30.
Structure
Structure
Structure
Structure
Structure
1
2
3
4
5
A.
B.
C.
D.
E.
F.
G.
16.
17.
18.
19.
20.
Structure
Structure
Structure
Structure
Structure
1
2
3
4
5
A.
B.
C.
D.
E.
F.
Sigmoid colon
Ascending colon
Rectum
Descending colon
Transverse colon
None of the above
Match the numbered areas shown on the previous radiograph of the abdomen with the appropriate lettered arterial
supply.
21.
22.
23.
24.
25.
Area
Area
Area
Area
Area
1
2
3
4
5
70 CHAPTER 2 Abdomen
34. Pain caused by the passage of a stone down the lower
end of the left ureter may be referred to the
A. umbilical region.
B. right iliac region.
C. epigastric region.
D. penis or clitoris.
E. None of the above.
35. The short gastric arteries originate from the
A. superior mesenteric artery.
B. hepatic artery.
C. splenic artery.
D. inferior phrenic artery.
E. left renal artery.
36. The right gastric artery originates from the
A. inferior mesenteric artery.
B. superior mesenteric artery.
C. hepatic artery.
D. gastroduodenal artery.
E. None of the above.
37. The left gastric artery originates from the
A. superior mesenteric artery.
B. left renal artery.
C. splenic artery.
D. celiac artery.
E. hepatic artery.
38. The gastroduodenal artery originates from the
A. splenic artery.
B. hepatic artery.
C. superior mesenteric artery.
D. right renal artery.
E. celiac artery.
CHAPTER 2 Abdomen 71
C. anterior surface.
D. posterior surface.
E. lower border.
51. The ilioinguinal nerve, a branch of the lumbar plexus,
emerges from the psoas muscle on its
A. medial side.
B. inferior border.
C. lateral side.
D. anterior surface.
E. posterior surface.
52. Lymphatic spread of carcinoma of the fundus of the
stomach is likely to metastasize to the
A. internal iliac nodes.
B. superior mesenteric nodes.
C. inferior mesenteric nodes.
D. celiac nodes.
E. right gastroepiploic nodes.
53. Infection from an inflamed appendix is likely to spread
via the lymphatics to the
A. superior mesenteric nodes.
B. celiac nodes.
C. splenic nodes.
D. inferior mesenteric nodes.
E. right internal iliac nodes.
54. Lymphatic spread of carcinoma of the right side of the
greater curvature of the stomach is likely to metastasize
to the
A. left renal nodes.
B. celiac nodes.
C. superior mesenteric nodes.
D. right gastroepiploic nodes.
E. splenic nodes.
55. Lymphatic spread of carcinoma of the sigmoid colon is
likely to metastasize to the
A. left common iliac nodes.
B. inferior mesenteric nodes.
C. superior mesenteric nodes.
D. celiac nodes.
E. para-aortic nodes.
56. Bacteria from diverticulitis of the proximal two thirds
of the transverse colon are likely to spread via lymph
vessels to the
A. inferior mesenteric nodes.
B. celiac nodes.
C. para-aortic nodes.
D. superior mesenteric nodes.
E. left renal nodes.
57. The skin of the umbilicus receives its sensory innervation from
A. T7.
B. T10.
C. L1.
D. T12.
E. L2.
72 CHAPTER 2 Abdomen
D. The renal vein emerges from the hilum of the kidney in front of the renal artery and drains into the
inferior vena cava.
E. The inferior vena cava pierces the central tendon
of the diaphragm at the level of the tenth thoracic
vertebra.
64. The following statements concerning the lymphatics of
the abdomen are correct except which?
A. The intestinal, right, and left lumbar trunks drain
into the cisterna chyli.
B. The lymphatic drainage of the kidney is directly to
the superior mesenteric nodes.
C. The thoracic duct begins in the abdomen at the cisterna chyli.
D. The cisterna chyli lies in front of the first two lumbar vertebrae.
E. The lymph vessels from the testes drain into the
para-aortic nodes at the level of the first lumbar
vertebra.
65. The following statements concerning the abdominal
peritoneal omenta and ligaments are correct except
which?
A. The gastrosplenic omentum contains the short gastric arteries and the left gastroepiploic artery.
B. The splenicorenal ligament contains the tail of the
pancreas.
C. The lesser omentum is attached superiorly to the
porta hepatis of the liver.
D. The greater omentum is attached to the upper border of the transverse colon.
E. The coronary ligament of the liver is the main support for this organ.
66. The following information concerning the sensory innervation of the abdominal peritoneum is correct except which?
A. The peritoneum on the central part of the inferior
surface of the diaphragm is supplied by the phrenic
nerves.
B. The peritoneum forming the mesentery of the small
intestine is innervated by autonomic nerves.
C. The peritoneum on the peripheral part of the inferior surface of the diaphragm is supplied by the
phrenic nerves.
D. The peritoneum lining the anterior abdominal wall
in the right lower quadrant is supplied by T12 and
L1 spinal nerves.
E. The peritoneum lining the lateral wall of the pelvis
is supplied by the obturator nerve.
67. The following statements concerning the right kidney
are correct except which?
A. The renal papillae open directly into the major
calyces.
B. The kidney lies slightly lower than the left kidney.
C. The right suprarenal gland covers its upper pole.
D. The medulla is composed of approximately twelve
renal pyramids.
E. At the junction of the renal pelvis with the ureter,
the lumen of the ureter is narrowed.
CHAPTER 2 Abdomen 73
74 CHAPTER 2 Abdomen
84. The following structures are connected to the liver except which?
A. The falciform ligament
B. The coronary ligament
C. The greater omentum
D. The ligamentum teres
E. The ligamentum venosum
85. The following statements concerning the superficial inguinal ring are correct except which?
A. It is a perforation in the aponeurosis of the external
oblique muscle.
B. Its greatest width lies above and medial to the pubic tubercle.
C. It is strengthened posteriorly by the conjoint tendon.
D. The internal spermatic fascia is attached to its
margins.
E. In males, it allows passage of the spermatic cord
and ilioinguinal nerve.
CHAPTER 2 Abdomen 75
96. The following statements are correct regarding an inguinal hernia except which?
A. The inferior epigastric artery lies medial to the neck
of an indirect inguinal hernia.
B. An inguinal hernia is more common than a femoral
hernia in females.
C. A direct inguinal hernia is more common in elderly
men than in boys.
D. The opening of the sac of a direct inguinal hernia is
wide.
E. The contents of an indirect inguinal hernia may be
strangulated against the lacunar ligament.
97. The following statements regarding the portal vein are
correct except which?
A. It courses through a portion of the lesser omentum.
B. It enters the liver at the porta hepatis.
C. It receives venous blood from both the large and
the small intestines.
D. It originates at the junction of the superior mesenteric and the splenic veins.
E. It passes in front of the neck of the neck of the pancreas.
98. If the common hepatic artery is unavoidably ligated
during surgery, the arterial supply to the liver is maintained by the following anastomotic connections except which?
A. The superior pancreaticoduodenal artery anastomosing with the inferior pancreaticoduodenal artery
B. The right gastric artery anastomosing with the left
gastric artery
C. The gastroduodenal artery anastomosing with the
splenic artery
D. The esophageal arteries anastomosing with the inferior phrenic arteries
E. The right gastroepiploic artery anastomosing with
the left gastroepiploic artery
99. The following general statements are correct except
which?
A. The superior and inferior epigastric vessels anastomose on the posterior surface of the rectus abdominis muscle.
B. The inguinal ligament is attached laterally to the
anterior inferior iliac spine.
C. The abdominal aorta bifurcates below into the two
common iliac arteries.
D. The foregut ends in the second segment of the duodenum.
E. The umbilicus is inconstant in position but is usually located at the level of L4.
100. The following veins drain directly into the inferior vena
cava except which?
A. The hepatic veins
B. The renal veins
C. The lumbar veins
D. The inferior mesenteric vein
E. The right testicular (ovarian) vein
101. When tapping a hydrocele (collection of fluid in the tunica vaginalis), the cannula must pierce the following
structures except which?
A. The skin
B. The fatty subcutaneous tissue
C. Dartos muscle
D. The cremasteric fascia
E. The external and internal spermatic fasciae
102. The following structures are present in the porta hepatis except which?
A. Lymph nodes
B. The right and left branches of the portal vein
C. The right and left hepatic ducts
D. The right and left hepatic veins
E. The right and left branches of the hepatic artery
103. The following statements regarding the celiac plexus
are correct except which?
A. The celiac plexus is not a purely sympathetic plexus.
B. The celiac plexus does not surround the celiac
artery.
C. The celiac ganglia are made of nerve cell bodies
and nerve fibers.
D. Parasympathetic preganglionic fibers pass through
the plexus, generally synapsing with postganglionic neurons within the walls of the organs they
innervate.
E. Sympathetic preganglionic fibers to the celiac
plexus originate from thoracic spinal segments and
travel in thoracic splanchnic nerves.
104. The right kidney has the following important relationships except which?
A. It is related to the neck of the pancreas.
B. It is anterior to the right costodiaphragmatic recess.
C. It is related to the second part of the duodenum.
D. It is related to the right colic flexure.
E. It is anterior to the right twelfth rib.
Read the case histories and select the best answer to the
questions following them.
A 45-ye a r-o ld o b e s e w o m a n co m p la in in g o f in d ig e s tio n w a s a d m itte d to h o s p ita l fo r in ve s tig a tio n . Sh e h a d a p a s t h is to ry o f g a lls to n e s a n d tra n sie n t a tta cks o f ja u n dice . La rg e g a lls to n e s h a ve
b e e n kn o w n to e ro d e th ro u g h th e p o s terior w a ll
o f th e g a llb la d d e r an d e n te r th e in tes tin a l tract.
105. Which part of the intestinal tract is likely to initially
contain the stone?
A. The sigmoid colon
B. The descending colon
C. The transverse colon
D. The ascending colon
E. The jejunum
A 53-ye a r-o ld m a n w a s a d m itte d to h o s p ita l
co m p la in in g o f a ch ro n ic g a s tric u lce r th a t w a s
n o t re s p o n d in g to m e d ica l tre a tm e n t. Th e s u r-
76 CHAPTER 2 Abdomen
g e o n d e cid e d to p e rfo rm a va g o to m y. Th e a n te rio r va g a l tru n k w a s d ivid e d b e tw e e n s u tu re s a s
it lie s o n th e a n te rio r s u rfa ce o f th e a b d o m in a l
p a rt o f th e e s o p h a g u s .
106. Which of the following is likely to result from this procedure?
A. A loss of secretomotor nerve supply to the mucosal
glands of the stomach.
B. Hoarse voice because of paralysis of the intrinsic
muscles of the larynx on the left side.
C. Increased heart rate because of decreased
parasympathetic input to the cardiac plexus.
D. Incontinence because of an absence of parasympathetic input to the bladder.
D. Compromised input into the greater splanchnic
nerves.
A 54-ye a r-o ld m a n w ith a lo n g h is to ry o f d u o d e n a l u lce r w a s s e e n in th e e m e rg e n cy d e p a rtm e n t
a fte r vo m itin g b lo o d -s ta in e d flu id a n d e xh ib itin g
a ll th e s ig n s a n d s ym p to m s o f s e ve re h yp o vo le m ic (lo s s o f b lo o d ) s h o ck.
107. Assuming the ulcer had perforated the posterior wall of
the first part of the duodenum, name the artery that is
most likely to have been eroded.
A. The splenic artery
B. The right gastric artery
C. The gastroduodenal artery
D. The right gastroepiploic artery
E. The right renal artery
108. If the duodenal ulcer had perforated the anterior wall
of the duodenum, where in the peritoneal cavity
would the duodenal contents have entered?
A. The lesser sac
B. The right anterior subphrenic space
C. The left lateral paracolic gutter
D. The right posterior subphrenic space
E. The pouch of Douglas
A 10-ye a r-o ld g irl w a s s e e n in th e e m e rg e n cy d e p a rtm e n t w ith a te m p e ra tu re o f 101F, a fu rre d
to n g u e , a n d p a in in th e rig h t ilia c re g io n . On
p h ys ica l e xa m in a tio n , th e s kin in th e rig h t lo w e r
q u a d ra n t w a s h yp e re s th e tic a n d te n d e r to to u ch ,
a n d th e a b d o m in a l m u s cle s s h o w e d rig id ity a n d
g u a rd in g . A d ia g n o s is o f a cu te a p p e n d icitis w a s
m ade.
109. The skin in the right lower quadrant was tender to
touch b ecause which of the following nerves was
(were) stimulated by the inflamed appendix?
A. The eighth right intercostal nerve
B. The tenth right intercostal nerve
C. The subcostal and first lumbar nerves
D. The sympathetic autonomic afferent nerves from
the appendix
E. The seventh right thoracic nerve
35.
36.
37.
38.
39.
40.
41.
61.
62.
63.
64.
65.
66.
67.
68.
D
9. B
17. E
25. C
B
10. A
18. A
26. D
E
11. C
19. D
27. F
A
12. F
20. C
28. E
C
13. E
21. E
29. A
C
14. A
22. B
30. C
E
15. D
23. A
31. C
D
16. B
24. D
32. B
D
D. Pain from the upper end of the ureter is referred
to the back behind the kidney. Pain from the
middle region of the ureter is referred to the inguinal region, and pain from the lower end is referred to the penis or clitoris. This is because the
afferent nerves enter the spinal cord at different
levels, so the pain is referred along the spinal
nerves originating from those spinal cord levels.
C
42. E
49. D
56. D
C
43. A
50. A
57. B
D
44. A
51. C
58. C
B
45. C
52. D
59. D
C
46. D
53. A
60. A
A
47. C
54. D
D
48. C
55. B
C. The aorta bifurcates into the two common iliac
arteries at the level of the fourth lumbar vertebra.
B. The superior mesenteric artery descends anterior
to the third part of the duodenum.
E. The inferior vena cava pierces the central tendon
of the diaphragm at the level of the eighth thoracic vertebra.
B. The lymphatic drainage of the kidneys is into the
lateral (para-aortic) group of lymph nodes.
E. The attachment of the hepatic veins to the inferior vena cava provides the main support for the
liver; the various peritoneal ligaments are weak
and stretch.
C. The peritoneum on the peripheral part of the inferior surface of the diaphragm is supplied by the
lower six intercostal nerves.
A. The renal papillae open directly into the minor
calyces of the kidney.
E. The internal spermatic fascia is derived from the
fascia transversalis lining the anterior abdominal
wall.
CHAPTER 2 Abdomen 77