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Um-Hani's QBank Um-Hani's QBank

Abdominal Wall

The terminal ends of the ilioinguinalnerves in the female are referred toas:A.Anterior cutaneous branchesB.Anterior labialC.CremastericsD.Iliohypogatrics

The usual location for anappendectomy incision is the:A.left lower quadrantB.left upper quadrantC.right lower quadrantD.right upper quadrant

The inferior border of the rectussheath posteriorly is called the:A.Falx inguinalisB.Inguinal ligamentC.Internal inguinal ringD.Arcuate lineE.Linea alba

A medical student was asked by her preceptor to palpate the margin of the superficial inguinal ring of ahealthy male patient. After passingher finger down the edge of themedial crus of the superficial inguinalring, she felt a bony protuberancedeep to the medial edge of thespermatic cord, which she correctlyidentified as the :A.pecten pubisB.pubic symphysisC.pubic tubercleD.iliopubic eminenceE.iliopectineal line

You were asked to assist in asurgical operation on a young patientto treat an ulcer in the first part of theduodenum. You would expect thatthe surgeon will approach the ulcer by doing an anterior abdominal wallincision in the following region:A.EpigastricB.Left inguinalC.Left lumbar D.Right hypochondrialE.Hypogastric

Following an emergencyappendectomy your patientcomplained of having paraesthesia(numbness) of the skin at the pubicregion. The most likely nerve thathas been injured during theoperation is:A.GenitofemoralB.IliohypogastricC.SubcostalD.Spinal nerve T10E.Spinal nerve T9

An obstetrician decides to do aCaesarean section on a 25-year-oldpregnant woman. A transversesuprapubic incision is chosen for thatpurpose. All of the followingabdominal wall layers will beencountered during the incisionEXCEPT the:A.Anterior rectus sheathB.Posterior rectus sheathC.Rectus abdominus muscleD.Skin and subcutaneous tissueE.Transversalis fascia,extraperitoneal fat, and peritoneum

In order to reduce a hernia (return itto the abdominal cavity), a surgeonfinds it necessary to ligate an arteryin the extraperitoneal connectivetissue (preperitoneal fat) runningvertically just medial to the bowel asthe bowel passes through theabdominal wall. This artery is the:A.Deep circumflex iliacB.Inferior epigastricC.Superficial circumflex iliacD.Superficial epigastricE.Superficial external pudendal

The posterior layer of the rectussheath ends inferiorly at theA.Arcuate lineB.Intercrestal lineC.Linea albaD.Pectineal lineE.Semilunar line

Dr: Ahmed Nawaz Jamali

Um-Hani's QBank Um-Hani's QBank

10.

Surgical approaches to the abdomensometimes necessitate a midlineincision between the two rectussheaths, i.e., through the:A.Linea asperaB.Arcuate lineC.Semilunar lineD.Iliopectineal lineE.Linea alba

11.

The internal thoracic artery issometimes surgically cut near thecaudal end of the sternum and usedto supply blood to a region of theheart. In these cases, maintenanceof adequate blood flow to the rectusabdominis may be dependent onincreased flow through which artery?A.Superficial epigastricB.Inferior epigastricC.UmbilicalD.Superficial circumflex iliacE.Deep circumflex iliac

12.

The normal pattern of venous andlymphatic drainage of the superficialtissues of the anterior abdominalwall is arranged around a horizontalplane. Above that plane, drainage isin a cranial direction; below theplane drainage is in a caudaldirection. This reference planecorresponds to:A.Transpyloric planeB.Level of anterior superior iliacspinesC.Transtubercular lineD.Level of arcuate lineE.Level of umbilicus

Answers

B. The ilioinguinal nerves supplymotor and sensory fibers to theabdominal wall inferior to theumbilicus. What differentiates thesenerves from the iliohypogastricnerves is that the ilioinguinal nervesalso innervate the scrotum or labiaby passing through the inguinalcanal. These branches are called theanterior scrotal or labial nerves.Anterior cutaneous branches prettymuch describes what thesebranches are, but there's an answer here that is a little more specific. Thegenital branch of the genitofemoralnerve innervates the cremaster muscle.

C. Since the appendix is located inthe right lower quadrant, you wouldprobably want to make your incisionthere to remove it! The appendix isthe terminal portion of the cecumwhich has a small, dead-end lumen.It is located just behind the cecum inthe right internal iliac fossa. Whereare incisions made for other procedures? For a cholecystectomy(gall bladder removal), there is anincision in the right upper quadrant.(Or, this surgery can be performedlaproscopically.) For a caesarian, atransverse suprapubic incision (alsocalled a Pfannenstiel incision) isused. A midline incision, through thelinea alba, may be used to repair anaortic aneurysm.

D. rectus sheath is a tough,tendinous sheath over the rectusabdominis muscle. It covers theentire anterior surface of the rectusabdominis. However, on theposterior side of the muscle, thesheath is incomplete-- it endsinferiorly at the arcuate line. Belowthe arcuate line, the rectusabdominis is covered bytransversalis fascia, not the rectussheath! The linea alba is also relatedto the rectus abdominis--it is aligament that runs down the middleof the abdomen, bisecting the rectusabdominis. It is made by theintermingling of the aponeuroses of the external oblique, internal oblique,and transversus abdominis. It's agood place to make a verticalincision. All of the other answer choices are related to the inguinal

Dr: Ahmed Nawaz Jamali

Um-Hani's QBank Um-Hani's QBank

canal. The falx inguinalis (sometimescalled the inguinal falx or conjointtendon), is the inferomedialattachment of transversus abdominiswith some fibers of internalabdominal oblique--it contributes tothe posterior wall of the inguinalcanal. The inguinal ligament is theligament that connects the anterior superior iliac spine with the pubictubercle--it makes the floor of theinguinal canal. The internal (deep)inguinal ring is the entrance to theinguinal canal, where thetransversalis fascia pouches out andcreates an opening through whichstructures can leave the abdominalcavity.

C. The pubic tubercle is a bonyprocess that would be felt lateral tothe edge of the spermatic cord at thesuperficial inguinal ring. (This isreally the only answer choice thatcould feel like a bony prominencewhen palpated.)The pubic tubercleserves as the point of attachment for the inguinal ligament, which makesup the floor of the inguinal canal.The pectin pubis is the ridge on thesuperior surface of the superior pubic ramus. This is the place whereyou find the pectineal ligament, athickining of fascia on the pecten of the pubis. The pectineal ligament isa good place to put sutures whendoing surgery. The pubic symphysisis the joint between the two pubicbones. The iliopubic eminence is abony process on the pubis foundnear its articulation with the ilium.The iliopectineal line is a line formedby the arcuate line of the ilium andthe pectinate line of the pubis. Thisline forms a plane that marks thetransition between the abdominaland pelvic cavity.

A. The epigastric region is one of thenine regions of the abdomen. Itcontains the duodenum, part of thestomach, part of the liver, and thepancreas. This is the region that thesurgeon would need to enter toreach the ulcer in the first part of theduodenum. The left inguinal regioncontains the sigmoid colon. The leftlumbar region contains thedescending colon and kidney. Theright hypochondrial region containspart of the liver and the gall bladder.Finally, the hypogastric regioncontains the bladder and rectum. For a good picture of this, see thedissector answer 1 for this lab.

B. The iliohypogastric nerve is abranch of the lumbar plexus. Itprovides sensory innervation to theskin of the lower abdominal wall,upper hip and upper thigh. This isthe region where the patient isexperiencing parasthesia, so thisnerve must be injured . Thegenitofemoral nerve is another nervefrom the lumbar plexus. It providessensory innervation to the skin of theanterior scrotum or labia majora andupper medial thigh. The subcostalnerve is the ventral primary ramus of T12--it is the equivalent of anintercostal nerve at a higher thoraciclevel. It provides sensory innervationto the anterolateral abdominal wall,but in an area superior to the pubicregion. A spinal nerve would nothave been injured in the operation.Remember--the spinal nerve is justthat small segment of nerve thatexists once the dorsal and ventralrootlets come together, before thedorsal and ventral primary ramibranch off. In any case, the T9 andT10 dermatomes are superior to thearea where the patient isexperiencing parasthesia.

B. Remember--the transversesuprapubic incision (also called thePfannenstiel incision) is made belowthe arcuate line. So, there is nolonger a posterior layer of the rectussheath, and the inner surface of therectus abdominus is lined only withtransversalis fascia. When makingthis incision, the abdominal walllayers are incised as follows: skin,superficial fascia (fatty and

Dr: Ahmed Nawaz Jamali