Page 1 of 1: LET US STUDY ANATOMY FOR AIIMS

dragonlives4ever · Credits: 17755 My Scrapbook

Which of the following statements concerning the duodenum is NOT correct?

1. The first (upper) part is freely mobile in the peritoneal cavity.
2. The bile duct terminates in the second (descending) part of the duodenum.
3. The greater duodenal papilla is the site for the opening for the pancreatic and bile ducts.
4. Venous drainage is into the inferior vena cava.
5. Arterial blood is supplied by branches from the superior mesenteric artery

dragonlives4ever · Credits: 17755 My Scrapbook

dragonlives4ever · Credits: 17755 My Scrapbook

A PATIENT PRESENT WITH TORN MEDIAL COLLATERAL LIGAMENT OF LEFT KNEE.WHICH OF THE FOLLOWING SIGNS MAY BE ILLICITED BY PHYSICAL EXAMINATION?
a)posterior dispacement of tibia
b)abnormal lateral rotation during extension
c)abnormal passive abduction of extended leg
d)inability to lock knee on full extension

ans?

dragonlives4ever · Credits: 17755 My Scrapbook

You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region:
Epigastric
Left inguinal
Left lumbar
Right hypochondrial
Hypogastric

The correct answer is: Epigastric
The epigastric region is one of the nine regions of the abdomen. It contains the duodenum, part of the stomach, part of the liver, and the pancreas. This is the region that the surgeon would need to enter to reach the ulcer in the first part of the duodenum. The left inguinal region contains the sigmoid colon. The left lumbar region contains the descending colon and kidney. The right hypochondrial region contains part of the liver and the gall bladder. Finally, the hypogastric region contains the bladder and rectum.

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An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision is chosen for that purpose. All of the following abdominal wall layers will be encountered during the incision EXCEPT the:
Anterior rectus sheath
Posterior rectus sheath
Rectus abdominis muscle
Skin and subcutaneous tissue
Transversalis fascia, extraperitoneal fat, and peritoneum

The correct answer is: Posterior rectus sheath

Remember - the transverse suprapubic incision (also called the Pfannenstiel incision) is made below the arcuate line. So, there is no longer a posterior layer of the rectus sheath, and the inner surface of the rectus abdominis is lined only with transversalis fascia. When making this incision, the abdominal wall layers are incised as follows: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue, and peritoneum.

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In order to reduce a hernia (return it to the abdominal cavity), a surgeon finds it necessary to ligate an artery in the extraperitoneal connective tissue (preperitoneal fat) running vertically just medial to the bowel as the bowel passes through the abdominal wall. This artery is the:
Deep circumflex iliac
Inferior epigastric
Superficial circumflex iliac
Superficial epigastric
Superficial external pudendal

The correct answer is: Inferior epigastric
The inferior epigastric vessels are found in the preperitoneal fat of the abdomen. They lie just superficial to the peritoneum and form the lateral umbilical fold. Hernias may pass lateral or medial to these vessels. If the hernia is lateral to the vessels (which is what happened in this case), it is an indirect inguinal hernia. If the hernia is medial to these vessels, it is a direct inguinal hernia.

The deep circumflex artery courses along the iliac crest on the inner surface of the abdominal wall. This artery is very lateral on the abdominal wall, and hernias would pass medial to this vessel. The superficial circumflex iliac, superficial epigastric, and superficial external pudendal arteries are all superficial arteries that arise from the femoral artery. They are all found in the superficial fascia--not in the preperitoneal fat.

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Surgical approaches to the abdomen sometimes necessitate a midline incision between the two rectus sheaths, i.e., through the

Surgical approaches to the abdomen sometimes necessitate a midline incision between the two rectus sheaths, i.e., through the:
Linea aspera
Arcuate line
Semilunar line
Iliopectineal line
Linea alba

The correct answer is: Linea alba
The linea alba is an aponeurotic band on the midline of the anterior abdominal wall, which extends from the xiphoid process to the pubic symphysis. It is formed by the combined abdominal muscle aponeuroses. Because there are no major arteries or nerves running in the linea alba, it provides a useful site for a midline incision in the abdomen.

The linea aspera is a vertical ridge on posterior surface of the femur. The arcuate line is the point at which the posterior lamina of the rectus sheath ends, and transversalis fascia lines the inner surface of rectus abdominis. The semilunar line is the lateral margin of the rectus abdominus, formed by the fused aponeuroses of the abdominal wall muscles. The iliopectineal line is a line on the pelvic bones, formed by the arcuate line of the ilium and the pectineal line of the pubis. (Note--the arcuate line of the ilium is totally different than the arcuate line of the rectus sheath!) This line is important because it marks the boundary between the abdominal cavity and the pelvic cavity.

dragonlives4ever · Credits: 17755 My Scrapbook

The internal thoracic artery is sometimes surgically cut near the caudal end of the sternum and used to supply blood to a region of the heart. In these cases, maintenance of adequate blood flow to the rectus abdominis may be dependent on increased flow through which artery?
Superficial epigastric
Inferior epigastric
Umbilical
Superficial circumflex iliac
Deep circumflex iliac

The correct answer is: Inferior epigastric
If the internal thoracic artery was ligated, blood would no longer flow to the superior epigastric artery, which is the branch of the internal thoracic that supplies blood to rectus abdominis. However, the superior epigastric artery communicates with the inferior epigastric artery, a branch of the external iliac artery. This means that blood could flow from the external iliac, to the inferior epigastric, to the superior epigastric and the rectus abdominis. The superficial epigastric and superficial circumflex iliac arteries are two superficial branches of the femoral artery. They do not supply deep structures in the abdomen. The distal portions of the umbilical arteries are obliterated in adults--they are the medial umbilical ligaments that form the medial umbilical folds. The deep circumflex iliac artery courses along the iliac crest on the inner surface of the abdominal wall. It is too lateral to supply blood to rectus abdominis.

dragonlives4ever · Credits: 17755 My Scrapbook

During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a lighted scope on a thin tube inserted through the wall), the attending physician noted something of interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor would have to look at the area between the:
inferior epigastric artery and urachus
medial umbilical ligament and urachus
inferior epigastric artery and lateral umbilical fold
medial umbilical ligament and inferior epigastric artery
median umbilical ligament and medial umbilical ligament

The correct answer is: medial umbilical ligament and inferior epigastric artery
Remember, the medial umbilical fold is made by the medial umbilical ligament (the obliterated portion of the umbilical artery), while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umibilical fold is a midline structure made by the median umbilical ligament (obliterated urachus). The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. This is the place in the abdominal wall where there is an area of weak fascia called the inguinal triangle--direct inguinal hernias can break through this space. The lateral inguinal fossa is a space lateral to the lateral umbilical fold--indirect inguinal hernias push through the deep inguinal ring in this space.

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