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03 Anatomy Aabdomen Pelvis & Perineum (290Qs)

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03 Anatomy Aabdomen Pelvis & Perineum (290Qs) MyPasTest: MRCS A Online - Jan Exam 2015 03. Anatomy; Aabdomen, Pelvis & Perineum (290Qs) ---------------------------------------------------------------------------------------------------------------------- 01. You are assisting in fitting an inferior vena cava (IVC) filter. The consultant asks you about the anatomy of the IVC. Which one of the following is true? Select one answer only. It commences at the level of L3« YOUR ANSWER It enters the thoracic cavity at the level of T8« CORRECT ANSWER It lies anterior to the aorta Page | It lies anterior to the caudate lobe of the liver 124 It lies to the left of the aorta. The IVC commences opposite the L5 vertebra, formed by the confluence of the right and left common iliac veins. It runs on the right of the aorta upwards towards the diaphragm and extends to the central tendinous diaphragm at the level of the body of the T8 vertebra. The IVC lies posterior to the bare area and caudate lobe of the liver. Due to its compound embryological origin, the tributaries are not identical to the branches of the abdominal aorta. On the right side, the testicular vein drains into the inferior vena cava; but on the left, the testicular vein drains into the left renal vein. 02. A 72-year-old male is undergoing a coronary artery bypass grafting procedure. To allow access to the thorax, a median sternotomy is performed by the operating surgeon, disrupting the manubriosternal joint. What type of joint is this? Single best answer - select one answer only. Condylar« YOUR ANSWER Fibrous Primary cartilagenous Secondary cartilagenous« CORRECT ANSWER Synovial. All joints in the body can be broadly divided into three types: fibrous, cartilaginous (primary and secondary) and synovial (typical and atypical). Fibrous joints unite the bones of the vault of the skull at the sutures; the bone ends are joined by fibrous tissue. Movement is negligible in fibrous joints. All midline joints – symphysis pubis, manubriosternum, xiphisternum and intervertebral discs – are examples of secondary cartilaginous joints. Primary cartilaginous joints are formed when a bone unites with a cartilage. They are immobile and strong. All epiphyses and the attachments of ribs to their costal cartilages are examples of primary cartilaginous joints. 03. You are treating a patient with portal hypertension and request a scan to look for a portal vein thrombosis. Which of the following would help you locate the portal vein on the scan images? Single best answer question – choose ONE true option only. It arises at the union of the splenic and inferior mesenteric veins« YOUR ANSWER It lies directly anterior to the aorta It lies in the free edge of the lesser omentum« CORRECT ANSWER --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, E-mail: [email protected] MyPasTest: MRCS A Online - Jan Exam 2015 03. Anatomy; Aabdomen, Pelvis & Perineum (290Qs) ---------------------------------------------------------------------------------------------------------------------- It lies in front of the hepatic artery at the porta hepatis It receives the ligamentum teres at its right branch. The portal vein is the continuation of the superior mesenteric vein after it has received the splenic vein behind the neck of the pancreas. It lies behind the bile duct and the hepatic artery. It lies anterior to the inferior vena cava. The ligamentum teres and the paraumbilical veins join Page | the left branch. 125 04. In locating the ureter on a plain abdominal x-ray, which landmark would you use to find it? It crosses the pelvic brim overlying the sacral foramina« YOUR ANSWER It extends inferiorly from the 12th thoracic vertebra It lies slightly medial to the tips of the transverse processes of the lumbar vertebrae « CORRECT ANSWER It passes towards the contralateral ischial spine It extends beyond the pubic tubercle. The hila of the kidney lie at around the level of the first lumbar vertebra. The ureters extend inferiorly from here and are projected slightly medial to the tips of the transverse processes of the lumbar vertebrae. The ureters cross the pelvic brim at the sacroiliac joints, pass over the aforementioned joints and then towards the ischial spine and then passes towards (and not beyond, on radiographs) the pubic tubercle. 05. A 47-year-old female undergoes low anterior resection to treat a rectal adenocarcinoma. During the surgery, great care is taken to preserve the pelvic splanchnic nerves. From which nerve roots do these arise? Single best answer - select one answer only. L2-4« YOUR ANSWER L3-5 L4,5-S1 S1-3 S2-4« CORRECT ANSWER. The pelvic plexuses supply the viscera of the pelvic cavity. They are situated at the sides of the rectum in men and at the sides of the rectum and vagina in women. The pelvic plexuses are formed on either side by a continuation of the hypogastric plexus, by the sacral parasympathetic efferent fibers from the second, third and fourth sacral nerves and by a few filaments from the first two sacral ganglia. In general, the muscles of the bladder (detrusor muscle) and rectum are innervated by the pelvic splanchnic nerves, the smooth muscle of the internal sphincter of the bladder through the superior hypogastric plexus and the smooth muscles of the internal sphincter of the anal canal by the branches from the sacral ganglia (which pass through the sacral plexuses). The pelvic splanchnic nerves supply the colon distal to the splenic flexure. Normal sensations of distension of bladder and rectum pass through the pelvic splanchnic nerves. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, E-mail: [email protected] MyPasTest: MRCS A Online - Jan Exam 2015 03. Anatomy; Aabdomen, Pelvis & Perineum (290Qs) ---------------------------------------------------------------------------------------------------------------------- 06. A 25-year-old is involved in a high speed road traffic accident and complains of left upper quadrant pain. After a normal primary survey and fluid resuscitation, he is deemed haemodynamically stable but complains of persistent left upper quadrant pain. Examination reveals a soft abdomen with moderate left upper quadrant tenderness, and no evidence of peritonism.What would be the most appropriate next step in his management? Continue the trauma management sequence« YOUR ANSWER Page | Diagnostic peritoneal lavage 126 Abdominal ultrasonography CT Scan of the abdomen with continued resuscitation« CORRECT ANSWER Emergency laparotomy. The spleen should never normally be palpable even on deep inspiration. Mobilisation of the splenic flexure can cause troublesome fractures to the splenic capsule resulting in significant blood loss that can be difficult to stop. Occasionally, splenectomy may be required to stop this. The splenic artery is a direct branch of the coeliac plexus. The tail of pancreas abuts the splenic hilum and although classified as a „disaster‟ it is possible to cause irreparable damage to this area which contains the islet (B) cells that produce insulin. Appreciation of this anatomy is therefore essential. The gastro-splenic and spleno-renal (Lieno renal) ligaments: the former carries the short gastric vessels that require ligation during splenectomy and gastrectomy. The scenario suggests splenic trauma. The mainstay of treatment for splenic trauma is conservation wherever possible. It would be important to confirm splenic injury and severity. The latter is described by the American Association for the Surgery of Trauma and is graded from 1 to 5. Each grade is subdivided into haematoma and laceration with grade 5 including vascular injury to the hilum. Grades 1 to 4 can be treated non-operatively and approximately 65% of blunt splenic injuries can be treated non-operatively with a 98% success rate. Haematomas are usually subcapsular and lacerations involve the capsule and parenchyma. Grade 4 injuries involve segmental or hilar vessel lacerations with major devascularisation to > 25% of the spleen. Of the options offered in the question, the above-mentioned injuries are best delineated by CT scanning of the abdomen. 07. In a 25-year-old football player undergoing an inguinal hernia repair, what would the surgeon note in order to identify the superficial inguinal ring? Single best answer - select one answer only. A V-shaped defect in the external oblique« YOUR ANSWER Intercrural fibres« CORRECT ANSWER The conjoint tendon and the transversalis fascia That the ilioinguinal nerve is within the spermatic cord That the inferior epigastric vessels are lateral to the deep inguinal ring The inguinal canal is a short oblique passage through the anterior abdominal wall. The relatively weak transversalis fascia and the conjoint tendon form the posterior wall. The deep ring is a --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dr Mohammed
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