Gross Anatomy Chapter 5

Front 1

A 63 year old man comes to the emergency department with back pain, weakness, and shortness of breath. On examination, he has an aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed?

Back 1

Azygos vein and thoracic duct

Front 2

A 36 year old woman with yellow pigmentation of the skin and sclerae presents at the outpatient clinic. Which of the following conditions most likely is the cause of her obstructive jaundice?

Back 2

Cancer in the head of the pancreas

Front 3

A 2 year old boy presents with pain in his groin that has been increasing in nature over the past few weeks. he is found to have a degenerative malformation of the transversalis fascia during development. Which of the following structures on the anterior abdominal wall is likely defective?

Back 3

Deep inguinal ring

Front 4

A 29 year old man comes to a local hospital with duodenal peptic ulcer and complains of cramping epigastric pain. Which of the following structures harbors the cell bodies of abdominal pain fibers?

Back 4

Dorsal root ganglion

Front 5

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 ulcerated through the posterior 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?

Back 5

Transverse colon

Front 6

A 35 year old woman comes to a local hospital with abdominal tenderness and acute pain. on examination, her physician observes that an abdominal infection has spread retroperitoneally. Which of the following structures is most likely affected?

Back 6

Descending colon

Front 7

During an annual health examination of a 46 year old woman, a physician finds hypersecretion of norepinephrine from her suprarenal medulla. Which of the following types of nerve fibers are most likely overstimulated?

Back 7

Preganglionic sympathetic fibers

Front 8

A 6 year old girl comes to her pediatrician with constipation, abdominal distention, and vomiting. After thorough examination, she is diagnosed as having Hirschsprung's disease (aganglionic megacolon), which is a congenital disease and leads to dilation of the colon. This condition is caused by an absence of which of the following kinds of neural cell bodies?

Back 8

Paraympathetic postganglionic neuron cell bodies

Front 9

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?

Back 9

Left umbilical vein

Front 10

A 27 year old woman has suffered a gunshot wound to her midabdomen. After examining the patient's angiogram, a trauma surgeon locates the source of bleeding from pairs of veins that typically terminate in the same vein. Which of the following veins are damaged?

Back 10

Left and right hepatic veins

Front 11

A 43 year old man complains of abdominal pain just above his umbilicus. On examination, a tumor is found anterior to the inferior vena cava. Which of the following structures would most likely be compressed by this tumor?

Back 11

Third part of the duodenum

Front 12

A 33 year old man with a perforated gastric ulcer complains of excruciating pain in his stomach. It is observed that the pain comes from peritoneal irritation by gastric contents in the lesser sac. Which of the following nerves contain sensory nerve fibers that convey this sharp, stabbing pain?

Back 12

Lower intercostal nerves

Front 13

A young boy is brought to the hospital after a bicycle accident and possible pelvic fracture. While awaiting a computed tomography (CT) scan of his pelvis, a physician proceeds with a focal neurologic examination. In testing the child's reflexes, which of the following nerves would carry afferent impulses of the cremasteric reflex?

Back 13

Genitofemoral nerve

Front 14

A 21 year old man receives a penetrating knife wound in the abdomen and is injured in both the supeerior mesenteric artery and the vagus nerve. Which portion of the colon would most likely be impaired by this injury?

Back 14

Ascending and transverse colons

Front 15

A 42 year old man with portal hypertension secondary to cirrhosis of the liver and subsequent massive ascites presents to the emergency department. He refuses to have a transjugular intrahepatic portosystemic shunt (TIPS) procedure and prefers surgery. Which of the following surgical connections is involved in the most practical method of shunting portal blood around the liver?

Back 15

Splenic vein to the left renal vein

Front 16

A 78 year old man is suffering from ischemia of the suprarenal glands. This condition results from rapid occlusion of direct branches of which off the following arteries?

Back 16

Aorta, inferior phrenic, and renal arteries

Front 17

A radiograph of a 32 year old woman reveals a perforation in the posterior wall of the stomach in which the gastric contents have spilled into the lesser sac. The general surgeon has opened the lienogastric (gastrosplenic) ligament to reach the lesser sac and notes erosion of the ulcer into an artery. Which of the following vessels is most likely involved?

Back 17

Left gastroepiploic artery

Front 18

A 35 year old woman with a histroy of cholecystectomy arrives in the emergency room with intractable hiccups most likely caused by an abdominal abscess secondary to surgical infection. Which of the following nerves carries pain sensation caused by irritation of the peritoneum on the central portion of the inferior surface of the diaphragm?

Back 18

Phrenic nerve

Front 19

A 16 year old boy with a ruptured spleen comes to the emergency department for splenectomy. Soon after ligation of the splenic artery just distal to its origin, a surgical resident observes that the patient is healing normally. Normal blood flow would occur in which of the following arteries?

Back 19

Inferior pancreaticoduodenal artery

Front 20

A 9 year old boy was admitted to the emergency department complaining of nausea, vomiting, fever, and loss of appetite. On examination, he was found to have tenderness and pain on the right lower quadrant. Based on signs and symptoms, the diagnosis of acute appendicitis was made. During an appendectomy performed at McBurney's point, which of the following structures is most likely to be injured.

Back 20

Iliohypogastric nerve

Front 21

A 54 year old man with a long history of alcohol abuse presents to the emergency department with rapidly increasing abdominal distention most likely resulting from an alteration in portal systemic blood flow. Which of the following characteristics is associated with the portal vein or the portal venous system?

Back 21

Caput medusae and hemorrhoids caused by portal hypertension

Front 22

While examining radiographs and angiograms of a 52 year old patient, a physician is trying to distinguish the jejunum from the ileum. He has observed that the jejunum has:

Back 22

Fewer mesenteric arterial arcades

Front 23

A 67 year old woman with a long history of liver cirrhosis was seen in the emergency department. In this patient with portal hypertension, which of the following veins is most likely to be dilated?

Back 23

Right colic vein

Front 24

A 26 year old patient is admitted to a local hospital with a retroperitoneal infection. Which of the following arteries is most likely to be infected?

Back 24

Dorsal pancreatic artery

Front 25

A pediatric surgeon has resected a structure that is a fibrous remnant of an embryonic or fetal artery in a 5 year old child. Which of the following structures is most likely to be divided?

Back 25

Medial umbilical fold

Front 26

A 57 year old patient has a tumor in the body of the pancreas that obstructs the inferior mesenteric vein just before joining the splenic vein. Which of the following veins is most likely to be enlarged?

Back 26

Left colic vein

Front 27

An elderly man with prostatic hypertrophy returns to his urologist with another case of epididymitis. An acute infection involving the dartos muscle layer of the scrotum most likely leads to an enlargement of which of the following lymph nodes?

Back 27

Superficial inguinal nodes

Front 28

A patient with cirrhosis is scheduled for liver transplant surgery. During the operation rounds, the transplant physician explains to his residents that one of the reasons a surgeon must pay close attention to the anatomic location of the liver is that this organ:

Back 28

Drains venous blood into the hepatic veins

Front 29

A 41 year old woman is brought to the emergency room by her family because of acute onset of right upper quadrant pain, nausea, and vomiting. For this case, it is important to remember that the bile duct:

Back 29

Drains bile into the second part of the duodenum

Front 30

A patient with diverticulosis of the colon presents for follow-up to his primary care physician with ongoing complaints of left lower quadrant pain and occasionally bloody stools. His physician begins workup with appropriating test by recalling that the sigmoid colon:

Back 30

Has tenia coli and epiploic appendages

Front 31

A 19 year old man with a ruptured appendix is sent to the emergency department for surgery. To cut off the blood supply to the appendix (if collateral circulation is discounted), a surgeon should ligate which of the following arteries?

Back 31

Ileocolic colic artery

Front 32

Because of an inflammatory bowel disease (Crohn's disease) and a small bowel obstruction leading to bowel ischemia, an elderly woman requires bypass of her ileum and jejunum and is scheduled for a gastrocolostomy. The surgeon will ligate all arteries that send branches to the stomach Which of the following arteries may be spared?

Back 32

Inferior pancreaticoduodenal artery

Front 33

A 38 year old woman with peptic ulcer disease of the stomach experiences severe abdominal pain. Which of the following nervous structures is most likely involved?

Back 33

Greater splanchnic nerve

Front 34

Before beginning a cesarean section (C-section) in a pregnant woman with a genital herpes infection, the obstetrician noted that the woman had a normal aponeurosis of the transverse abdominal muscle. This aponeurosis most likely contributes to the formation of which of the following?

Back 34

Anterior layer of the rectus sheath below the arcuate line

Front 35

Examination of a 54 year old man reveals an isolated tumor located at the porta hepatis. This tumor most likely compresses which of the following structures?

Back 35

Branches of the portal vein

Front 36

A patient is rushed to the operating room for an emergent cholecystectomy (resection of a gallbladder) because of cholecystitis. While locating landmarks before surgical resection of an infected gallbladder, the surgeon recalls a portalcaval anastomosis. Which of the following pairs of veins form a portal-caval anastomosis?

Back 36

Superior and middle rectal vein

Front 37

Mrs. Jones is undergoing a routine colonoscopy for colon cancer prevention. The gastroenterologist finds a Meckel's diverticulum. Which of the following statements is true about the diverticulum?

Back 37

It is persistent remnant of the embryonic yolk stalk

Front 38

A 54 year old man comes to a hospital with abdominal pain, jaundice, loss of appetite, and weight loss. On examination of his radiograms and computed tomography (CT) scans, a physician finds a slowly growing tumor in the uncinate process of the pancreas. Which of the following structures is most likely compressed by this tumor?

Back 38

Superior mesenteric artery

Front 39

A 6 year old boy comes to his pediatrician with a lump in the groin near the thigh and pain in the groin. On examination, the physician makes a diagnosis of a direct inguinal hernia because the herniated tissue:

Back 39

Develops after birth

Front 40

A 21 year old man developed a hernia after lifting heavy boxes while moving into his new house. During the repair of his resulting hernia, the urologist recalls that the genitofemoral nerve:

Back 40

Passes through the deep inguinal ring

Front 41

An oncologist is reviewing a computed tomography (CT) scan of a 74 year old man with newly diagnosed hepato cellular carcinoma. He locates the affected quadrate lobe of the liver that:

Back 41

Drains bile into the left hepatic duct

Front 42

A 58 year old man is presented with edema of the lower limb and enlarged superficial veins of the abdominal wall. Examination of radiographs and angiograms reveals obstruction of the inferior vena cava just proximal to the entrance of the renal vein. This venous blockage may result in dilation of which of the following veins?

Back 42

Left suprarenal vein

Front 43

A physical fitness trainer for a young Hollywood movie star explains the reasons for 100 stomach crunches a day. The young star, a medical student before "hitting it big" reaffirms to his trainer that the lateral margin of the rectus abdominis, the muscle responsible for a washboard stomach, defines which of the following structures?

Back 43

Linea semilunaris

Front 44

During surgical treatment of portal hypertension in a 59 year old man with liver cirrhosis, a surgeon inadvertently lacerates the dilated paraumbilical veins. The veins must be repaired to allow collateral flow. Which of the following ligaments is most likely severed?

Back 44

Ligamentum teres hepatis

Front 45

A 43 year old woman is admitted to a hospital because of deep abdominal pain in her epigastric region. on examination, it is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured?

Back 45

Splenic artery

Front 46

A 19 year old young woman with a long history of irritable bowel syndrome presents for the possibility of surgical resection of the gastrointestinal (GI) tract where the vagal parasympathetic innervation terminates. Which of the following sites is most appropriate for surgical resection?

Back 46

Left colic flexure

Front 47

A 58 year old man is admitted to a hospital with severe abdominal pain, nausea, and vomiting resulting in dehydration. Emergency computed tomography (CT) scan reveals a tumor located between the celiac trunk and the superior mesenteric artery. Which of the following structures is likely compressed by this tumor?

Back 47

Neck of the pancreas

Front 48

An emergent hernia repair is scheduled. As the attending physician is driving to the hospital, the medical student assisting on the case quickly reviews his anatomy atlas and is trying to commit to memory that the internal oblique abdominis muscle contributes to the formation of which of the following strutures?

Back 48

Falx inguinalis (conjoint tendon)

Front 49

A 9 year old girl has crashed into her neighbor's brick fence while riding her bike and is brought to the emergency department with a great deal of abdominal pain. Her radiogram and angiogram show laceration of the superior mesenteric artery immediately distal to the origin of the middle colic artery. If collateral circulation is discounted, which of the following organs may become ischemic?

Back 49

Ascending colon

Front 50

A 53 year old woman with known kidney disease presents to a hospital because her pain has become increasingly more severe. A physician performing kidney surgery must remember that:

Back 50

The left renal vein runs anterior to both the aorta and the left renal artery

Front 51

A neonatal baby was born with diabetes mellitus due to an inadequate production of insulin. Cells in the endocrine portion of the pancreas that secrete insulin, glucagon, and somatostatin are derived from which of the following?

Back 51

Endoderm

Front 52

During development, the midgut artery appears to be markedly narrowed at its origin. Which of the following structures is derived from the midgut and may receive inadequate blood supply?

Back 52

Ascending colon