Block 6 Anatomy wk 9 from TA's w xpl

1. A patient goes into surgery and the surgeon says oh this patient has an ileocolic intussusception, where is the most likely location for this type of pathology?

Jejunoileal junction

Second part of the duodenum

Transverse colon

Ileocecal valve

Rectum

the most common site of intussusception is when the distal ileum telescopes into the cecum (ileocolic)

Explanation

the most common site of intussusception is when the distal ileum telescopes into the cecum (ileocolic)

2. The anastomotic artery running along the border of the large intestine is called?

Arcade

Middle colic

Splenic

Marginal

Vasa recta

Marginal Artery of Drummond provides anastomoses colic arteries

Explanation

Marginal Artery of Drummond provides anastomoses colic arteries

3. An indirect inguinal herniation does which of the following?

Passes through the deep inguinal ring medial to the inferior epigastric vein

Passes through Hasselbach’s triangle medial to the inferior epigastric vein

Passes through Hasselbach’s triangle lateral to the inferior epigastric vein

Passes through the deep inguinal ring lateral to the inferior epigastric vein

Leaps over small buildings in a single bound

Simply remember the mnemonic (MD's LI) for these herniations. Medial - Direct; Lateral - Indirect; (both in relation to the inferior epigastric BVs). In case you were wondering, E would be if Superman was having an inguinal hernia. Sorry, you don't get points for fictional characters.

Explanation

Simply remember the mnemonic (MD's LI) for these herniations. Medial - Direct; Lateral - Indirect; (both in relation to the inferior epigastric BVs). In case you were wondering, E would be if Superman was having an inguinal hernia. Sorry, you don't get points for fictional characters.

4. A pediatric surgeon is resecting a possible malignant mass from the liver of a neonate with cerebral palsy. The surgeon divides the round ligament of the liver during surgery. A fibrous remnant of which of the following fetal vessels is severed?

Ductus venosus

Ductus arteriosus

Left umbilical vein

Right umbilical vein

Umbilical artery

Remember the right umbilical vein degenerates very early in the fetus, leaving the left umbilical vein to bypass the liver in fetal circulation.

Explanation

Remember the right umbilical vein degenerates very early in the fetus, leaving the left umbilical vein to bypass the liver in fetal circulation.

5. During a surgery, you identify a loop of bowel as jejunum. You noticed which of the following features in making your identification.

Tenia coli, many small arcades, greater blood supply

Greater blood supply, semilunar folds, few arcades

Few long arcades, highly vascular, plicae circulares

Plicae circulares, less vascular, few long arcades

Less vascular, epiploic appendages, plicae circulares

Tenia coli, semilunar folds, and epiploic appendages are features of large intestine. The jejunum is more vascularized than the ileum.

Explanation

Tenia coli, semilunar folds, and epiploic appendages are features of large intestine. The jejunum is more vascularized than the ileum.

6. So 15 year old Johnny is dropped off by his mother at the emergency room because he is being a hassle and complaining of a stomach ache. He says it is around his "belly button real bad". The triage nurse asks him to jump and he tries and falls to the floor due to the pain. The visceral pain sensation from the acute appendicitis is carried by which nerves.

Para sympathetic fibers running to T8-L3

Sympathetic fibers running to T9-T11

Para sympathetic fibers running to S2-S4

Sympathetic fibers running T5-T9

MDA page 304 has a great picture of spinal cord levels for abdominal viscera. This question is easy as you really only need to know the dermatome for the umbilicus T10. Parasympathetics are not found in thoracic levels

Explanation

MDA page 304 has a great picture of spinal cord levels for abdominal viscera. This question is easy as you really only need to know the dermatome for the umbilicus T10. Parasympathetics are not found in thoracic levels

7. A 42-year-old obese woman with seven children is brought to a local hospital by her daughter. Physical examination and her radiograph reveal that large gallstones have eroded through the anterior wall of the fundus of the gallbladder into the intestine. Which of the following parts of the intestine is most likely to initially contain gallstones?

Cecum

Ascending colon

Descending colon

Transverse colon

Sigmoid colon

The gallbladder is in close relation to the liver, duodenum and transverse colon.

Explanation

The gallbladder is in close relation to the liver, duodenum and transverse colon.

8. There is hepatocellular carcinoma (HCC) directly medial to the gallbladder and bounded laterally by the falciform ligament in anatomical position. You have just completed your general surgery residency and your attending gives you the task of removing the carcinoma in hopes that it will improve the patient's chance to live. Which anatomical lobe will you remove?

Left

Right

Caudate

Quadrate

http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngthe quadrate lobe is bounded by the gallbladder and the falciform ligament.

Explanation

http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngthe quadrate lobe is bounded by the gallbladder and the falciform ligament.

9. Meckel's Diverticulum:

Is located 2 feet distal to the ileocecal junction

May contain ectopic gastric tissue

Is found in ~2% of the population

A & C

B & C

All of the above

It’s usually located 2 feet proximal to ileocecal junction. The 2 tissue types are pancreatic or gastric.

Explanation

It’s usually located 2 feet proximal to ileocecal junction. The 2 tissue types are pancreatic or gastric.

10. A 58-year old man comes to your clinic complaining of an enlarged scrotum. He denies recent trauma. His medical history is positive for high blood pressure and high cholesterol. What is the likely cause for his predicament?

Atherosclerotic changes of superior mesenteric artery

Portal hypertension backing up renal vein

Renal carcinoma of the right kidney invading renal vein

Twisting of spermatic cord blocking testicular veins

Indirect inguinal hernia into scrotum

Atherosclerotic hardening of the superior mesenteric artery classically compresses the left renal vein preventing the left testicular vein from draining. Thus, the patient has a varicocele of the left testicle. B. portal hypertension backs up the portal venous system, not the somatic venous system. C. A renal carcinoma can invade the renal vein, but the right testicular vein drains directly into the inferior vena cava. D. No trauma so torsion isn't likely. E. Indirect inguinal hernia is most likely in a young patient with a patent processus vaginosis.

Explanation

Atherosclerotic hardening of the superior mesenteric artery classically compresses the left renal vein preventing the left testicular vein from draining. Thus, the patient has a varicocele of the left testicle. B. portal hypertension backs up the portal venous system, not the somatic venous system. C. A renal carcinoma can invade the renal vein, but the right testicular vein drains directly into the inferior vena cava. D. No trauma so torsion isn't likely. E. Indirect inguinal hernia is most likely in a young patient with a patent processus vaginosis.

Block 6 Anatomy Wk 9 From Ta's W Xpl