(A) Vagus Nerve and Azygos Vein

Abdomen

1.  An aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm is most likely to result in compression of which of the following pairs of structures?

(A)  Vagus nerve and azygos vein

(B)  Esophagus and vagus nerve

(C)  Azygos vein and thoracic duct

(D)  Thoracic duct and vagus nerve

(E)  Inferior vena cava and phrenic nerve

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 causes obstructive jaundice?

(A)  Aneurysm of the splenic artery

(B)  Perforated ulcer of the stomach

(C)  Damage to the pancreas during splenectomy

(D)  Cancer in the head of the pancreas

(E)  Cancer in the body of the pancreas

3.If the transversalis fascia has been damaged during development, which of the following structures on the anterior abdominal wall is defective?

(A)  Superficial inguinal ring

(B)  Deep inguinal ring

(C)  Inguinal ligament

(D)  Sac of a direct inguinal hernia

(E)  Anterior wall of the inguinal canal

4.Lack of preganglionic parasympathetic fibers in the liver may result from a lesion in which of the following nerves?

(A)  Phrenic nerve

(B)  Lumbar splanchnic nerve

(C)  Intercostal nerve

(D)  Vagus nerve

(E)  Greater splanchnic nerve

5.Destruction of cell bodies of efferent and afferent nerve fibers in visceral branches(splanchnic nerve )of the sympathetic trunk affects which of the following locations?

(A)  Ventral horn of the spinal cord,collateral ganglia

(B)  Lateral horn of the spinal cord ,dorsal root ganglia

(C)  Ventral horn of the spinal cord, dorsal root ganglia

(D)  Dorsal horn of the spinal cord,sympathetic chain ganglia

(E)  Lateral horn of the spinal cord , sympathetic chain ganglia

6.If an abdominal infection spreads retroperitoneally, which of the following structures is most likely affected?

(A)  Stomach

(B)  Transverse colon

(C)  Jejunum

(D)  Descending colon

(E)  Spleen

7.Which of the following types of nerve fibers stimulates the supraarenal medulla to secrete nor-epinephrine?

(A)  Preganglionic sympathetic fibers

(B)  Postganglionic sympathetic fibers

(C)  Somatic motor fibers

(D)  Postganglionic parasympathetic fibers

(E)  Preganglionic parasympathetic fibers

8.Hirschsprung’s disease (aganglionic megacolon) is a congenital disease characterized by a dysfunctional distal portion of the colon ,which results in an inability to evacuate the bowels .this condition is caused by an absence of which of the following kinds of neural cell bodies ?

(A)  Sympathetic preganglionic neuron cell bodies

(B)  Sympathetic postganglionic neuron cell bodies

(C)  Parasympathetic preganglionic neuron cell bodies

(D)  Parasympathetic postganglionic neuron cell bodies

(E)  Sensory neuron cell bodies

9.Which of the following fetal vessels becomes the round ligament of the liver after birth?

(A)  Ductus venosus

(B)  Paraumbilical vein

(C)  Umbilical artery

(D)  Ductus arteriosus

(E)  Umbilical vein (left)

10. Which of the following pairs of veins typically terminates in the same vein ?

(A)  Left and right ovarian veins

(B)  Left and right gastroepiploic veins

(C)  Left and right colic veins

(D)  Left and right suprarenal veins

(E)  Left and right hepatic veins

11.A small tumor located to the inferior vena cava would most likely damage which of the following structures ?

(A)  Right sympathetic trunk

(B)  Left third lumbar artery

(C)  Third part of the duodenum

(D)  Left renal artery

(E)  Cisterna chyli

12.A male patient with a perforated gastriculcer complains of excruciating pain in his epigastrium.If the pain comes from peritoneal irritation by gastric contents in the lesser sac , which of the following nerves contains the fibers that convey this sharp,stabbing pain ?

(A)  Vagus nerve

(B)  Greater splanchnic nerve

(C)  Lower intercostal nerve

(D)  White rami communicantes

(E)  Gray rami communicantes

13.Which of the following nerves would carry afferent impulses of the cremasteric reflex?

(A)  Subcostal nerve

(B)  Lateral femoral cutaneous nerve

(C)  Genitofemoral nerve

(D)  Iliohypogastric nerve

(E)  Femoral nerve

14.Injury to both the superior mesenteric artery and the vagus nerve affects which portion of the colon?

(A)  Ascending and descending segments

(B)  Transverse and sigmoid segments

(C)  Descending and sigmoid segments

(D)  Ascending and transverse segments

(E)  Transverse and descending segment

15.A 42-year-old man with portal hypertension resulting from cirrhosis of the liver presents to the emergency department .The most practical method of shunting portal blood around the liver in volves .which of the following surgical connections?

(A)  Superior mesenteric vein to the inferior mesenteric vein

(B)  Portal vein to the superior vena cava

(C)  Portal vein to the left renal vein

(D)  Splenic vein to the left renal vein

(E)  Superior rectal vein to the left colic vein

16.Rapid occlusion of direct branches of which of the following arteries results in ischemia of the suprarenal glands?

(A)  Aorta ,splenic and inferior phrenic arteries

(B)  Renal, splenic and inferior mesenteric arteries

(C)  Aorta, inferior phrenic and renal arteries

(D)  Superior mesenteric , inferior mesenteric and renal arteries

(E)  Aorta ,hepatic and renal arteries

17.A radiograph of a 32-year-old women reveals a perforation in the posterior wall of the stomach in which the gastric contents have spilled into the lesser sac.The abdominal surgeon who opened the lienogastric (gastrosplenic) ligament to reach the lesser sac cut an artery accidentally.Which of the following vessels is most likely to be injured?

(A)  Splenic artery

(B)  Gastroduodenal artery

(C)  Left gastric artery

(D)  Right gastric artery

(E)  Left gastroepiploic artery

18.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?

(A)  Vagus nerve

(B)  Lower intercostal nerve

(C)  Phrenic nerve

(D)  Greater splanchnic nerve

(E)  Subcostal nerve

19.Soon after ligation of the splenic artery just distal to its origin,a surgical resident observes normal blood flow in which of the following arteries?

(A)  Short gastric arteries

(B)  Dorsal pancreatic artery

(C)  Inferior pancreaticoduodenal artery

(D)  Left gastroduodenal artery

(E)  Artery in the lienorenal ligament

20.During an appendectomy at McBurney;s point , which of the following structures is most likely to be injured?

(A)  Deep circumflex femoral artery

(B)  Inferior epigastric artery

(C)  Iliohypogastric nerve

(D)  Genitofemoral nerve Spermatic cord

21. Which of the following characteristics is associated with the portal vein or the portal venous system?

(A)  Lower blood pressure than in the inferior vena cava

(B)  Least risk of venous varices at the lower end of the esophagus as a result of portal hypertension

(C)  Distention of the portal vein due to its numerous valves

(D)  Caput medusae and hemorrhoids caused by portal hypertension

(E)  Less blood flow than in the hepatic artery

22.A physician who is trying to distinguish the jejunum from the ileum has observed that the jejunum has

(A)  fewer plicae

(B)  fewer mesenteric arterial arcades

(C)  less digestion and absorption of nutrients

(D)  shorter vasa recta

(E)  more fat in its mesentery

23.In a patient with portal hypertension , which of the following veins is is most likely to be dilated ?

(A)  Right colic vein

(B)  Inferior epigastric vein

(C)  Inferior phrenic vein

(D)  Ovarian vein

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

(A)  Left gastric artery

(B)  Proper hepatic artery

(C)  Middle colic artery

(D)  Sigmoid artery

(E)  Dorsal pancreatic artery

25.A pediatric surgeon has cut a structure that is not related to embryonic or fetal blood vessels in a 5-year-old child . Which of the following structures is most likely to be divided?

(A)  Lateral umbilical fold

(B)  Medial umbilical fold

(C)  Ligamentum venosum

(D)  Ligamentum teres hepatis

(E)  Ligamentum arteriosum

26.An obstruction of the inferior mesenteric vein just before joining the splenic vein is most likely to enlarge which of the following veins?

(A)  Middle colic vein

(B)  Right colic vein

(C)  Inferior pancreaticoduodenal vein

(D)  Ileocolic vein

(E)  Left colic vein

27.An acute infection involving the dartos muscle most likely leads to an enlargement of which of the following lymph nodes ?

(A)  Preaortic nodes

(B)  Lumbar nodes

(C)  External iliac nodes

(D)  Superficial inguinal nodes

(E)  Common iliac nodes

28.The liver

(A)  receives blood only from the hepatic arteries

(B)  manufactures red blood cells in an adult

(C)  drains bile from the quadrate lobe into the right hepatic duct

(D)  drains venous blood into the hepatic veins

(E)  functions to concentrate and store bile

29.The common bile duct

(A)  drains bile into the second part of the duodenum

(B)  can be blocked by cancer in the body of the pancreas

(C)  joins the main pancreatic duct ,which carries hormones

(D)  is formed by union of the right and left hepatic duct

(E)  lies posterior to the portal vein in the right free edge of the lesser omentum

30.The sigmoid colon

(A)  is drained by systemic veins

(B)  is a retroperitoneal organ

(C)  receives parasympathetic preganglionic fibers from the vagus nerve

(D)  receives its blood from the superior mesenteric artery

(E)  has teniae coli and epiploic appendages

31.To cut off the blood supply to the appendix (if collateral circulation is discounted),a surgeon ligates which of the following arteries ?

(A)  Middle colic artery

(B)  Right colic artery

(C)  Ileocolic colic artery

(D)  Inferior mesenteric artery

(E)  Common iliac artery

32.During gastrocolostomy ,a surgeon is ligating all arteries that send branches to the stomach.Which of the following arteries may be spared ?

(A)  Splenic artery

(B)  Gastroduodenal artery

(C)  Inferior pancreaticoduodenal artery

(D)  Left gastroepiploic artery

(E)  Proper hepatic artery

33.Loss of pain sensation from the abdominal viscera may result from a lesion of which of the following structures ?

(A)  Greater splanchnic nerve

(B)  Ventral roots of the spinal nerve

(C)  Lower intercostal nerve

(D)  Vagus nerve

(E)  Gray ramus communicans

34.The aponeurosis of the transverse abdominal muscle most likely contributes to the formation of which of the following ?

(A)  Linea alba

(B)  Anterior layer of rectus sheath above the umbilicus

(C)  Posterior layer of rectus sheath below the arcuate line

(D)  Lacunar ligament

(E)  Internal spermatic fascia

35.A tumor located at the porta hepatis most likely compresses which of the following structures ?

(A)  Cystic duct

(B)  Hepatic veins

(C)  Common hepatic artery

(D)  Left gastric artery

(E)  Branches of the portal vein

36.Which of the following pairs of veins is considered a portal-caval anastomosis?

(A)  Hepatic veins and inferior vena cava

(B)  Superior and middle rectal vein

(C)  Left and right gastric veins

(D)  Inferior and superficial epigastric veins

(E)  Suprarenal and renal veins

37.The Meckel’s diverticulum

(A)  is found 2 feet distal to the ileocecal junction

(B)  is located on the mesenteric side of the ileum

(C)  occurs in about 10% of the population

(D)  is a persistent remnant of the embryonic yolk sac

(E)  may contain renal and suprarenal tissues

38. A slowly growing tumor in the uncinate process of the pancreas most likely compresses which of the following structures ?

(A)  Main pancreatic duct

(B)  Splenic artery

(C)  Portal vein

(D)  Superior mesenteric artery

(E)  Superior pancreaticoduodenal artery

39.Dignosis of a direct inguinal hernia requires that the herniated tissue ?

(A)  enters the deep inguinal ring

(B)  lies lateral to the inferior epigastric artery

(C)  is coverd by spermatic fasciae

(D)  descends into the scrotum

(E)  develops after birth

40.The genitofemoral nerve

(A)  runs in front of the quadratus lumborum

(B)  is a branch of the femoral nerve

(C)  supplies the testis

(D)  passes through the deep inguinal ring

(E)  gives rise to an anterior scrotal branch

41.The quadrate lobe of the liver

(A)  lies between the inferior vena cava and ligamentum venosum

(B)  receives blood from the right and left hepatic arteries

(C)  drains bile into the left hepatic duct

(D)  is a medial superior segment

(E)  is functionally a part of the right lobe

42.Obstruction of the inferior vena cava may result in dilation of the which of the following veins ?

(A)  Left suprarenal vein

(B)  Left ascending lumbar vein

(C)  Left hepatic vein

(D)  Left gastric vein

(E)  Portal vein

43.Which of the following structures defines the lateral margin of the rectus abdominis?

(A)  Linea alba

(B)  Linea semilunaris

(C)  Linea semicircularis

(D)  Transversalis fascia

(E)  Falx inguinalis

44.Severance of which of the following ligaments may damage the paraumbilical vein ?

(A)  Lienorenal ligament

(B)  Lienogastric ligament

(C)  Gastrophrenic ligament

(D)  Falciform ligament

(E)  Hepatoduodenal ligament

45.A knief wound has cut an artery that runs along the superior border of the pancreas . Which of the following arteries is injured?

(A)  Right gastric artery

(B)  Left gastroepiploic artery

(C)  Splenic artery

(D)  Gastroduodenal artery

(E)  Dorsal pancreatic artery

46.The vagal parasympathetic innervation of the gastrointestinal(GI) tract terminates approximately at which of the following structures ?

(A)  Duodenojejunal junction

(B)  Ileocecal junction

(C)  Right colic flexure

(D)  Left colic flexure

(E)  Anorectal junction

47.Which of the following structures is located between the celiac trunk and the superior mesenteric artery?

(A)  Spleen and body of the stomach

(B)  Pyloric canal and neck of the pancreas

(C)  Transverse colon and ileum

(D)  Kidney and head of the pancrea

(E)  Duodenal cap and cecum

48.The internal oblique abdominis muscle contributes to the formation of which of the following structures ?

(A)  Inguinal ligament

(B)  Deep inguinal ring

(C)  Falx inguinalis

(D)  Internal spermatic fascia

(E)  Reflected inguinal ligament

49.Laceration of the superior mesenteric artery immediately inferior to the origin of the middle colic artery may reduce blood supply to the

(A)  descending colon