ABDOMEN

1) All but which are transected / at the level of the transpylonic plane?
a) superior mesenteric artery leaves aorta
b) splenic vein joins superior mesenteric vein to become the portal vein
c) hila of kidneys *
d) lower border L1 vertebra
e) gall bladder

2) The anterolateral abdominal muscles:

a) external oblique muscle arises by eight digitations from back of lower eight ribs and
interdigitates with serratus anterior and pectoralis major
b) external oblique fibres run obliquely upwards and forwards
c) the lower border ext-oblique forms the inguinal ligaments*
d) internal oblique insects into the line alba from a single aponeurosis
e) transversus abdominus runs anterior to rectus abdominus until the cruciate line

3) The anterior abdominal wall:

a) the deep surface above the umbilicus has lymphatic drainage to mediastinal nodes*
b) the deep surface below the umbilicus has lymphatic drainage to the internal iliac and
paraaortic
nodes
c) rectus abdominus is supplied by lower intercostal and subcostal nn (T8-T10)
d) internal oblique and transversus abdominus are supplied solely by the iliohypo??? and
ilioinguinal nerves
e) the superior and inferior epigastric vessels (arteries) anastomose within the body of the rectus
muscle

4) Contents of the deep inguinal ring include all but:

a) ilioinguinal nerve*
b) vas deferens
c) cremasturic artery
d) genital branch of the genitofemoral ligament
e) obliterated remains of the processes vaginalis

5) Referred pain from which organ may be felt in the cutaneous distribution of the obturator
nerve?
a) bladder
b) prostate
c) ovary*
d) uterus
e) sigmoid colon

6) Within the anal canal are anal cushions (dilated venous spaces and avanestomoses)
a) 3, 7 and 11 o’clock*
b) 2, 6, and 10 o’clock
c) 3, 6 and 11 o’clock
d) 1, 7 and 12 o’clock
e) 1, 7 and 9 o’clock

1 Regarding the inguinal canal

A The deep inguinal ring is an opening in internal oblique
B The superior epigastric artery is located deep to the posterior wall medial to the deep ring
C An indirect hernia passes through the deep inguinal ring*
D A direct hernia passes lateral to the deep inguinal ring
E The floor of the inguinal canal is reinforced laterally by the lacunar ligament

2 Contents of the spermatic cord include all of the following EXCEPT

A Ductus deferens
B Testicular artery
C Pampiniform plexus
D Ilioinguinal nerve*
E Genital branch of the genitofemoral nerve

3 Regarding the testis

A Leydig cells secrete testosterone*
B The epididymis is located posteromedially
C Lymphatic drainage is to the inguinal lymph nodes
D Arterial supply is from the aorta just above the renal arteries
E The right testicular vein drains to the right renal vein

4 The following structures are related to the transpyloric plane EXCEPT

A Coeliac trunk*
B Tip of the 9th costal cartilage
C Hilum of the kidney
D Origin of the portal vein
E Body of the pancreas

5 All of the following are retroperitoneal structures EXCEPT

A Cisterna chyli
B Sympathetic trunk
C Duodenum*
D Pancreas
E Ureter

6 The celiac trunk

A supplies the gut from the entrance of the bile duct to the splenic flexure of the colon
B gives rise to the inferior pancreaticoduodenal artery
C is the 1st branch of the abdominal aorta
D arises from the aorta at the level of L2
E supplies the lower part of the oesophagus*

7 The superior mesenteric artery

A arises from the aorta at the level of T11
B passes anterior to the body of the pancreas
C passes anterior to the 3rd part of the duodenum
D gives the superior pancreaticoduodenal branch
E supplies the jejunum*

8 The inferior mesenteric artery

A supplies the hindgut as far as the dentate line*
B arises at the level of L1
C passes posterior to the 3rd part of the duodenum
D crosses the ureter at the pelvic brim
E gives rise to the right colic artery

9 Regarding the duodenum

A All of the duodenum is retroperitoneal
B The 3rd part receives the bile duct
C The 2nd part passes over the hilum of the right kidney
D The 3rd part is crossed by the superior mesenteric artery*
E The 4th part is 5 cm long

10 Regarding the liver

A The caudate lobe is bounded by the ligamentum venosum and the inferior vena cava*
B The left lobe extends approximately 12cm to the left of the midline
C The gall bladder is at the tip of the 11th costal cartilage
D The bare area lies against the duodenum
E Porta hepatis contains the hepatic and portal veins

11 Regarding the spleen

A It lies between the 7th and 9th ribs
B The tail is contained in the lienorenal ligament*
C The head is immediately anterior to the aorta
D The tail lies in the transpyloric plane
E The main blood supply is from the left gastric artery

12 Regarding the abdominal aorta

A It commences at T10 as it passes through the aortic opening of the diaphragm
B The first branch is the celiac trunk
C It terminates at the level of L2
D The gonadal arteries arise above the origin of the superior mesenteric artery
E The median sacral artery is a small posterior branch just before bifurcation*
1. Regarding the urinary tract
a. The narrowest points of the ureter are at the pelviureteric junction, where it crosses the pelvic
brim, and at the vesicoureteric junction*
b. Kidney innervation is derived from segments L2-L5
c. The hilum of the right kidney lies just above the transpyloric plane 5 cm from the midline
d. The hilum of the right kidney lies lateral to the psoas
e. The left kidney lies over the tenth, eleventh and twelfth ribs

2. With regard to the blood supply of the rectum and anus

a. It is principally the inferior rectal artery
b. The anal canal is a site of porto-systemic anastomosis*
c. The veins do not correspond to the arteries
d. The inferior mesenteric artery changes to the superior rectal artery at L3
e. The vessels do not supply the full thickness of the anal wall

3. Lymph drainage of the testes are to

a. The deep inguinal nodes
b. The mediastinal nodes
c. The para-aortic nodes*
d. The pectoral group of axillary nodes
e. The external iliac nodes

4. Lymph drainage of the scrotum is to

a. The superficial inguinal nodes*
b. The internal iliac nodes
c. The deep inguinal does
d. The external iliac nodes
e. None of the above

5. Regarding radiological imaging of the gastrointestinal tract

a. The terminal ileum can be identified by haustrations
b. Haustrations represent the taeniae coli*
c. Air fluid levels on an erect abdominal X-ray are diagnostic of large bowel obstruction
d. Gas should always be visible in the rectum
e. Small bowel is always visible on a normal abdominal X-ray

6. Regarding the kidneys

a. Each weighs about 340 grams
b. The left kidney lies below the transpyloric plane
c. The iliohypogastric and ilioinguinal nerves lie behind the posterior surface of the kidney*
d. Each kidney has six segments
e. The hilum is separated from the peritoneum on the right side by the 3rd part of the duodenum

7. Regarding the ureters

a. They exit the hilum behind the renal artery*
b. They are a continuation of the renal pelvis which is formed by the union of 10 major calyces
c. They are each 40cm long
d. On a radiograph they run lust lateral to the transverse processes of the lumber vertebrae
e. The lower ends are supplied by the ureteric branch of the renal artery

8. All of the following are relations of the body of the pancreas EXCEPT:
a. Left crus of diaphragm
b. Left psoas muscle
c. Left kidney hilum
d. Bile duct*
e. Lesser sac

9. Which of the following is INCORRECT?

a. The inguinal canal of the female contains the round ligament of the uterus
b. The deep inguinal ring is an opening in transverses muscle*
c. The spermatic cord in the male emerges from the deep inguinal ring
d. The inguinal canal lies above the medial half of the inguinal ligament
e. The roof of the inguinal canal is formed by lower edges of internal oblique and transverses
muscles

10. The duodenum

a. Is a retroperitoneal structure
b. Is 25cm in length*
c. Lies between the levels of L2-L4
d. In its fourth part lies to the right of the aorta
e. All of the above

11. The highest branch of the abdominal aorta is

a. Right suprarenal artery
b. Celiac trunk*
c. Left renal artery
d. Left gonadal artery
e. Superior mesenteric artery

12. The main vessel supplying the body of the pancreas is the
a. Superior pancreaticoduodenal artery
b. Splenic artery*
c. Left gastric artery
d. Left gastroepiploic artery
e. Inferior pancreaticoduodenal artery

13. All of the following about the abdominal aorta are correct EXCEPT:
a. It passes between crura of the diaphragm at the level of T12 vertebra and terminates at body of
L4
b. It is crossed by the splenic vein below the celiac trunk and above the superior mesenteric
artery
c. It has the uncinate process of the pancreas lying anteriorly
d. It gives off 5 paired lumbar arteries*
e. It continues as the median sacral artery

14. The ureter

a. Passes anterior to genitofemoral nerve*
b. Develops from the metanephric cap
c. Is represented by dermatome L2
d. In the male, is crossed anteriorly by the ductus deferens
e. Passes anterior to the uterine artery in the female

15. The abdominal aorta is crossed anteriorly by

a. Left renal artery
b. Inferior mesenteric artery
c. Left renal vein*
d. Right gonadal artery
e. Right renal vein

16. Which is true of the superior mesenteric artery and its branches?
a. Right colic artery is the main supply of the caecum
b. Superior mesenteric artery runs anterior to the 1st part of the duodenum
c. Right colic artery passes behind the right ureter
d. Superior mesenteric arises from aorta at level of L2
e. Main trunk of the superior mesenteric artery ends at the level of Meckel’s diverticulum*

17. Which is true of the inferior mesenteric artery and its branches?
a. Inferior mesenteric ends as the superior rectal artery*
b. The main trunk crosses the left ureter, but its branches pass behind it
c. It arises from the aorta at the level of L2
d. The descending branch of the left colic supplies the sigmoid colon only
e. There is very little anastomosis between the branches

18. Direct tributaries of the portal vein include all but

a. Right gastric vein
b. Short gastric vein*
c. Splenic vein
d. Superior pancreaticoduodenal vein
e. Left gastric vein

19. Which is the correct portosystemic anastomosis?

a. Portal = tributary of inferior mesenteric vein, systemic = tributary of internal iliac vein*
b. Portal = periumbilical vein, systemic = phrenic veins
c. Portal = intrahepatic portal branches, systemic= azygos vein
d. Portal = left gastric vein, systemic = IVC via oesophageal veins
e. Portal = middle rectal vein, systemic = inferior rectal vein

20. Which is not true of the surface markings of the liver?

a. Lies below ribs 7-11 in the right midaxillary line
b. Highest point on right is 5th rib
c. Superior surface crosses the xiphisternal joint
d. Inferior margin lies level with right costal margin in most cases
e. Highest point on left is 6th intercostal space*

21. Which is the correct order of structures in the porta hepatis (anterior-posterior)
a. hepatic arteries, portal veins, hepatic ducts
b. portal veins, hepatic ducts, hepatic arteries
c. hepatic ducts, cystic duct, hepatic arteries, portal veins
d. hepatic ducts, hepatic arteries, cystic duct, portal veins
e. hepatic ducts, hepatic arteries, portal veins*

22. Which is not a tructure of the retroperitoneum?

a. Kidney
b. Adrenal gland
c. Cisterna chili
d. Spleen*
e. Pancreas

23. Which is not a tructure in the transpyloric plane?

a. Pancreas
b. Superior mesenteric artery origin
c. Fundus of gallbladder
d. Tip of 9th costal cartilage
e. Lower pole of right kidney*

24. Regarding the relations of the ureter, which is INCORRECT?

a. Cross the vas deferens in males*
b. Medial to the transverse process of lumbar spine
c. Cross the genitofemoral nerve
d. Cross the SI joint
e. ?

25. Which is true of colon?

a. Ascending is longer than descending
b. Only part suspended on mesentery is transverse colon
c. Marginal artery is weakest at hepatic flexure
d. Lymphatic drainage is via superior and inferior mesenteric lymph nodes*
e. ?

26. where does the appendix lie in health?

a. Retroileal*
b. ?
c. ?
d. ?
e. ?

27. Regarding the kidneys:

a. The hilum of the left kidney is just below that of the right
b. The hilum faces medially and somewhat posteriorly
c. The long axis is parallel with the lateral border of psoas*
d. The perinephric fat is surrounded by the renal fascia
e. The renal artery lies in front of the renal vein

28. Concerning the colon:

a. Appendices epiploicae are most frequent on the ascending colon
b. The transverse colon is normally shorter than the descending colon
c. The blood supply includes the superior mesenteric artery*
d. Parasympathetic supply does not include the vagi
e. None of the above

29. Regarding the left kidney

a. Anterior relations include the spleen
b. Posteriorly lies the costodiaphragmatic recess*
c. The suprarenal gland lies within the renal fascia
d. The lateral femoral cutaenous nerve lies posteriorly
e. The median arcuate ligament lies posteriorly

30. The pelvic floor

a. Consists of ischiococcygeus, iliococcygeus and pubococcygeus*
b. Muscles have significant insertion into the sacrum
c. Creates a gutter that slopes downwards and backwards
d. Has the anococcygeal raphe a superficial part
e. None of the above

31. Regarding the inguinal canal

a. It has a roof formed by lower edges of internal oblique and transverses muscles*
b. The ilioinguinal nerve enters the canal through the deep ring
c. Its posterior wall is formed by the external oblique aponeurosis
d. The conjoint tendon lies anterior to the superficial inguinal ring
e. The superior epigastric artery crosses the posterior wall medial to the deep inguinal ring

32. The liver

a. Is divided into superior and inferior lobes by the falciform ligament
b. Has a bare area inferiorly
c. Receives blood from portal and hepatic veins
d. Has a caudate lobe that lies within the lesser sac*
e. Takes sympathetic nerve supply from paravertebral ganglia
33. The abdominal aorta
a. Bifurcates into the common iliac vessels on the body of L4*
b. Gives rise to the testicular/ovarian artery above the renal artery
c. Arises from the thoracic aorta on passing anterior to the median arcuate ligament
d. Gives rise to the renal arteries at the level of T12
e. Lies to the right side of the inferior vena cava

34. The branches of the lumbar plexus includes:

a. The iliohypogastric and ilioinguinal which provide motor innervation to the internal and
external
oblique muscles
b. The genitofemoral nerve which is derived from L3 and L4
c. The femoral nerve which supplies the ileus*
d. The obturator nerve which is derived from L2,3 and 4 posterior divisions
e. The lateral femoral cutaneous nerve which supplies sensory and motor innervation to the
lateral thigh

35. Regarding the ureter the right is

a. Narrowed at pelviureteric junction*
b. Is 10cm long
c. Lower end of ureter is supplied by the ureteric branch of the renal artery
d. It is endodermal in origin
e. It is related to the second part of the duodenum on the right

36. The pancreas

a. Lies at the level of the L1 vertebra
b. Body slopes downwards across the aorta
c. Receives its blood supply form the splenic artery*
d. Is about 20cm long
e. Develops from three separate buds

37. Regarding the vessels of the pelvis

a. The inferior and superior gluteal arteries are branches of the posterior division of the internal
iliac
artery
b. The iliolumbar artery passes in front of the obturator nerve
c. The uterine artery passes above the ureter*
d. The inferior vesical artery always supplies the lower end of the ureter
e. The obturator artery lies above the obturator nerve on the side wall of the pelvis

38. The pelvic floor

a. Muscles include obturator internus
b. Slopes down and forwards*
c. Is supplied by S2, S3 and S4
d. Is relaxed during quiet respiration
e. Muscle iliococcygeus arises from the ilium

39. Regarding the stomach

a. The cardia is at the level of T8
b. The stomach is supplied by branches from the celiac trunk*
c. The fundus is supplied by gastroepiploic vessels
d. The pyloric opening lies to the right of midline at T12
e. It has an outer longitudinal muscle layer and an inner oblique layer

40. Which lymph nodes drain the lower anal canal?

a. Superficial inguinal*
b. External iliac
c. Deep inguinal
d. Para-aortic
e. Internal iliac

41. Superior pancreaticoduodenal vein drains into

a. Left gastric vein
b. Portal vein*
c. Splenic vein
d. Superior mesenteric vein
e. IVC

42. All the following are veins which drain the stomach EXCEPT:
a. Gastroepiploic
b. Gastroduodenal*
c. Right gastric
d. Left gastric
e. Short gastric

43. Which is not true of the stomach?

a. Completely invested by peritoneum
b. Cardia situated at T12*
c. Pyloric opening at L1
d. Aorta to the left of lesser curve
e. Supplied by branches of the celiac trunk

44. Which does not pass through the transpyloric plane?

a. Splenic vein
b. Tips of the 9th costal cartilages
c. Lower border of L1
d. Spleen*
e. Superior mesenteric artery

45. Appendix
a. Usually lies retrocaecal in health
b. Drains to inguinal nodes
c. Has no mesentery
d. Has a tip constant in relation to the caecum*
e. Opens into the caecum 2cm below the ileocaecal valve

46. Regarding the abdominal aorta

a. Renal arteries originate at T12
b. Splenic vein crosses the aorta just below superior mesenteric artery origin
c. Surface marking from a point just above the transpyloric plane to a point just to the left of the
umbilicus*
d. ?
e. ?

47. Regarding the testicular blood supply

a. Division of the testicular artery results in testicular infarction
b. Testicular artery has numerous anastomoses with the cremasteric artery
c. Pampiniform plexus is a superficial plexus surrounding the testicular artery*
d. ?
e. ?

48. Which of the following regarding the apprendix is FALSE?

a. It has a base constant in relation to the caecum
b. It has its own mesentery
c. It is formed by teneae coli convergence
d. Varies in length between 2 and 25 cm
e. It always lies retro-ilieal in presence of disease*

49. The ureters

a. Widest in diameter at the PUJ
b. Innervated by sympathetic nerves T12-L1
c. Lie lateral to the tips of the lumbar transverse processes
d. Depend on innervation from the pelvis for peristalsis
e. None of the above are true*

50. The ureters

a. Cross the gonadal vessels
b. Cross over the vas deferens
c. Are crossed by the genitofemoral nerve
d. Pass under the cover of the psoas muscle
e. Lie lateral to the lumbar transverse processes