MCQs in
Anatomy
An aid to revision and self assessment Thorax Abdomen Pelvis and Perineum First Edition
MCQs in
Anatomy
An aid to revision and self assessment Volume 2
Thorax Abdomen Pelvis and Perineum First Edition Professor Deepthi Nanayakkara Senior Professor in Anatomy Department of Basic Sciences Faculty of Dental Sciences University of Peradeniya Sri Lanka
Professor Malkanthi Chandrasekera Senior Professor of Anatomy Department of Anatomy Faculty of Medicine University of Peradeniya Sri Lanka
Dr Deepthika Chandrasekera Registrar in Surgery
MCQs in Anatomy An aid to revision and self assessment Volume 2 Thorax Abdomen Pelvis and Perineum © Deepthi Nanayakkara and Malkanthi Chandrasekera
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission in writing of the copyright owner.
First published in 2013 ISBN 978-
Medical knowledge is constantly changing. The authors have, as far as it is possible, taken care to ensure that the information given in this publication is accurate and up to date.
Dedicated to our parents and teachers
Preface
_____________________________________________________________________
Students preparing for examinations are burdened with many difficulties. A significant difficulty encountered by all students is the non availability of practice questions especially MCQs. Students are always curious to know as to how and from where they are supposed to prepare for MCQs. This inspired us to write a book on MCQs with explanatory answers. The MCQs contained in this text have been prepared by the authors under careful scrutiny. Eventhough the commonly used MCQ type in many parts of the world is the single best response type this book contains ‘true/false type MCQs’ as they are the frequently used type in most examinations in Anatomy in Sri Lanka. To fulfill the demands of the readers explanatory answers have been given. These explanatory answers will help the students to understand the section dealt in the MCQ. This text is primarily aimed at fulfilling the requirements of medical/dental undergraduates as well as postgraduates. It is our sincere hope, that this text will provide students an opportunity to assess themselves the depth of their knowledge. This book, ‘MCQs in Anatomy – An aid to revision and self assessment’ has been intentionally split in several parts for the convenience of handling. Different parts of the series will be covering different regions of the body. Within each part the questions have been grouped into topics.
Even though every effort has been taken, to ensure accuracy and clarity, and to avoid ambiguity in phrasing the questions, it is quite possible that there are errors that have been unnoticed. The authors would be grateful to the readers for their suggestions for improvement of the text from all angles. We wish to thank Mr Dhammika Ihalagedera, Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya for his help in numerous ways, Miss Himali Disanayake for typing part of the text, and the students who prompted us to undertake the task of writing this book.
Deepthi Nanayakkara Malkanthi Chandrasekera Deepthika Chandrasekera
Contents
_____________________________________________________________________
Preface
Chapter I : Thorax Questions Thoracic Wall and Diaphragm The Thoracic Cavity Superior Mediastinum Anterior Mediastinum Middle Mediastinum Posterior Mediastinum Lungs and Pleurae Answers and Explanations Chapter 2 : Abdomen Questions Anterior Abdominal Wall Vessels and Nerves of the Gut Abdominal cavity and the peritoneum Development of the Gut Gastrointestinal Tract Liver and Biliary System, Pancreas and Spleen Posterior Abdominal Wall Kidneys, Ureters and Suprarenal glands Answers and Explanations
Chapter 3 : Pelvis and Perineum Questions Pelvic Cavity and joints Rectum and anal canal Urinary bladder, urethra and ureters in the pelvis Male Reproductive Organs Female Reproductive Organs Pelvic vessels and nerves Perineum Answers and Explanations
1
________________________________________________________
Thorax Thoracic Wall and Diaphragm 1. Intercostal nerves A. are the ventral rami of thoracic spinal nerves B. lie deep to the internal intercostal muscles C. supply the parietal pleura D. lie above the intercostal vessels in the costal groove E. cross in front of the internal thoracic artery near the sternum 2.
Regarding intercostal nerves A. The anterior primary ramus of the twelfth thoracic nerve is the subcostal nerve B. The 7th intercostal nerve is a typical spinal nerve C. They lie in the subcostal groove D. The 4 th intercostal nerve supplies only the thoracic wall E. The 2nd has a supply to the skin of the axilla
3. Regarding intercostal arteries A. All posterior intercostal arteries arise from the descending aorta B. They lie superior to the vein and nerve in the costal groove C. All anterior intercostal arteries arise from the internal thoracic artery D. Posterior intercostal arteries supply the spinal cord E. The right third posterior intercostal artery gives off the right bronchial artery
4. External intercostal muscle A. is innervated by the posterior ramus of the thoracic spinal nerve
B. is derived from the paraxial mesoderm C. extends as far forwards as the costochondral junction D. has an attachment to the neck of the respective rib E. has fibres directed downwards and backwards 5. Internal thoracic artery A. arises from the first part of the subclavian artery B. supplies the upper six intercostal spaces C. supplies the thymus D. gives off the superior epigastric artery E. terminates in the 5th intercostal space 6. Regarding intercostal spaces A. External intercostal muscle has fibres directed downwards and forwards B. Neurovascular bundle runs between the internal and innermost intercostal muscle layers C. Each intercostal space is supplied by two anterior intercostal arteries D. Posterior intercostal arteries supplying the first two spaces arise from the descending aorta E. All anterior intercostal veins drain into the internal thoracic vein 7. The first rib A. Its head articulates with the body of first thoracic vertebra B. Its neck is related to the sympathetic trunk C. The inner border gives attachment to the suprapleural membrane D. Has a groove for the subclavian vein on its inferior surface E. Articulates with the manubriosternal angle
8. Branches of the internal thoracic artery are A. pericardiacophrenic artery B. posterior intercostal artery C. superior epigastric artery D. musculophrenic artery E. superior intercostal artery 9. Primary cartilaginous joints are A. manubriosternal joint B. sternoclavicular joint C. costochondral joint D. first sternocostal joint E. costotransverse joint 10. Regarding thoracic vertebrae A. The first thoracic vertebra has a complete facet for the 1st rib B. They have thick bifid spines C. Transverse process articulates with the neck of the corresponding rib D. The articulation between two vertebral bodies is synovial E. An inferior costal facet is absent on T9 vertebra 11. Regarding the inlet of the thorax A. The lateral boundary is formed by the inner surface of the first rib and its costal cartilage B. Manubrium sterni forms the anterior boundary C. Posterior boundary is formed by the lower border of T4 vertebra D. Brachiocephalic artery passes through it E. Vertebral artery passes through it 12. A. B. C. D. E.
The aortic opening in the diaphragm lies anterior to the body of tenth thoracic vertebra lies between the crura of the diaphragm transmits the sympathetic trunk transmits the vagus nerve transmits the azygos vein
13. The thoracic sympathetic trunk A. is present in the posterior mediastinum B. has ganglia most of which lie anterior to the heads of ribs C. passes into the abdomen behind the lateral arcuate ligament D. sends postganglionic fibres to the cardiac plexus E. sends preganglionic fibres to the greater splanchnic nerve 14. A. B. C. D. E.
The diaphragm is developed from the ventral mesentery of oesophagus dorsal mesentery of oesophagus pleuroperitoneal membrane pleuropericardial membrane septum transversum
15. Derivatives of the septum include A. lesser omentum B. Kupffer cells C. ligamentum teres D. falciform ligament E. central tendon of the diaphragm
transversum
16. The oesophageal opening in the diaphragm A. is at the tenth thoracic vertebral level B. is surrounded by a sling of fibres from right crus C. lies in the central tendon of the diaphragm D. transmits branches of the right gastric artery E. transmits the right phrenic nerve
17. Regarding the diaphragm A. The level of the diaphragm is higher in the supine position than in the standing position B. The right dome reaches the upper border of the 5 th rib C. The central tendon lies at the level of the xiphisternal joint D. The hemiazygos vein passes through the right crus E. The sympathetic trunk passes behind the medial arcuate ligament 18. Regarding the arcuate ligaments of the diaphragm A. The medial arcuate ligament is a thickening of lumbar fascia B. The medial arcuate ligament has an attachment to the body of first lumbar vertebra C. The lateral arcuate ligament is the thickening of the fascia of quadratus lumborum muscle D. The lateral arcuate ligament extends from transverse process of L1 vertebra to the 12th rib E. Crura develops from the dorsal mesentery of the oesophagus
The Thoracic Cavity Superior Mediastinum 19. The superior vena cava A. is formed by the right anterior cardinal and right common cardinal veins B. is formed behind the manubrium sterni C. opens into the right atrium behind the 3 rd costal cartilage D. receives the hemi azygos vein E. lies in the superior mediastinum
20. Regarding the superior mediastinum A. Its anterior boundary is formed by the body of the sternum B. The arch of the aorta lies within it C. The prevertebral fascial layer is present within it D. It is separated from the inferior mediastinum by a plane passing through the third costal cartilage E. It contains the thymus 21. The thoracic duct A. commences at twelfth thoracic vertebral level B. passes through the aortic opening of the diaphragm C. lies along the left margin of the oesophagus in the superior mediastinum D. crosses from right to left side at the fourth thoracic vertebral level E. drains lymph from the right upper limb 22. A. B. C. D. E.
Regarding the arch of the aorta It commences at the level of the sternal angle It is developed from the third left aortic arch Left vagus nerve lies anterior to it It forms the cervical constriction of the oesophagus A cardinal sign in the coarctation of aorta is diminished femoral pulse
23.
The ascending aorta is an elastic artery is developed from the fourth left aortic arch lies posterior to the root of the pulmonary trunk is covered by the fibrous pericardium at commencement is stenosed in tetralogy of Fallot
A. B. C. D. E.
its
24. The trachea A. commences at the inferior border of the cricoid cartilage B. contains incomplete rings of hyaline cartilage C. is lined by a simple columnar epithelium D. bifurcates at the level of sternal angle E. lies in the posterior mediastinum 25. Structures present in a cross section of the thorax at the upper border of the fourth thoracic vertebra include A. arch of aorta B. superior vena cava C. left atrium D. left vagus nerve E. right atrium 26. A. B. C. D.
The trachea is about 10 cm in length lies in the midline through out its course is supplied by the inferior thyroid arteries has an epithelium derived from the endoderm of the foregut E. is supplied by the recurrent laryngeal nerves
27.
A. B. C. D. E.
28.
The pulmonary trunk lies within the pericardial sac divides at the fourth thoracic vertebral level lies posterior to the transverse sinus is stenosed in Fallot’s tetralogy is developed from the truncus arteriosus
The left principal (main) bronchus
A. is wider than the right principal bronchus B. is longer than the right principal bronchus C. is developed from the tracheo-bronchial diverticulum
D. divides into two lobar bronchi E. has the root of the pulmonary trunk anterior to it 29. A. B. C. D. E.
At the sternal angle the first rib articulates with sternum the aortic arch ends the trachea bifurcates the azygos vein enters the superior vena cava the inferior boundary of the superior medisatinum is demarcated
30. Regarding the development of the venous system A. Azygos vein is developed from the right supracardinal vein B. Left brachiocephalic vein is developed from the left supracardinal vein C. The inferior vena cava has a part developed from the right subcardinal vein D. Right renal vein is developed from the subcardinal anastomosis E. Common iliac vein is developed from the sacrocardinal anastomosis 31. Veins draining into brachiocephalic vein include A. vertebral B. inferior thyroid C. middle thyroid D. external jugular E. internal thoracic
the
right
32. Structures found in posterior mediastina are A. oesophagus B. trachea C. thoracic aorta D. phrenic nerves E. vagi
both
superior
and
Anterior mediastinum 33.
A. B. C. D. E. 34.
The thymus lies in the anterior mediastinum is developed from the 3rd branchial pouch has lymphoid follicles involutes after puberty is supplied by the inferior thyroid artery The thymus the only structure lying in the anterior mediastinum has a blood supply from the internal thoracic artery regresses soon after birth contains Hassall’s corpuscles lies in front of the left brachiocephalic vein
A. is B. C. D. E.
Middle mediastinum 35. In the foetal circulation mixing of oxygenated and deoxygenated blood occurs in the A. left atrium B. left ventricle C. right atrium D. right ventricle E. liver
36. Embryonic structures that contribute to the inter-atrial septum include A. septum primum B. septum spurium C. septum secondum D. left valve of sinus venosus E. right valve of sinus venosus 37. Ligaments that have foetal vessels of origin include A. median umbilical ligament B. ligamentum teres C. ligamentum venosum D. medial umbilical ligaments E. gastrosplenic ligament 38.
The right atrium
A. forms the right border of the heart B. has a smooth part derived from the right horn of sinus venosus C. has the sinuatrial node in its wall D. has the crista terminalis separating the smooth and rough parts E. receives the coronary sinus 39. The ductus arteriosus A. represents the distal portion of the left sixth aortic arch B. is functionally closed shortly after birth C. connects the pulmonary vein to the aortic arch D. is present as the ligamentum arteriosum at birth E. shunts blood from the pulmonary trunk to the aorta before birth
40. A. B. C. D.
The right coronary artery arises from the anterior aortic sinus supplies blood to the sinu-atrial node is accompanied by the great cardiac vein causes an infarction at the apex of the heart if occluded E. gives off the circumflex branch
41.
A. B. C. D. E. 42. A. B. C.
D. E.
The left atrium forms the major part of the left border of the heart lies behind the right atrium has the oblique sinus posterior to it lies anterior to the oesophagus receives the four pulmonary veins Regarding the development of the heart The secondary septum completely divides the atrium The septum spurium contributes to the formation of the interatrial septum The pulmonary arteries develop from the right horn of sinus venosus The right valve of sinus venosus gives rise to the valve of the inferior vena cava The smooth part of the right atrium is developed from the left horn of sinus venosus
Posterior Mediastinum 43. The descending thoracic aorta A. begins at the level of the lower border of the fourth thoracic vertebra B. lies in the posterior mediastinum C. gives off the pericardiacophrenic artery D. passes through the diaphragm at the tenth thoracic vertebral level E. gives off branches to supply the middle third of the oesophagus 44. The azygos vein A. is formed by the union of right subcostal and right ascending lumbar veins B. passes through the oesophageal opening C. arches over the root of the right lung D. receives the superior intercostal vein E. drains directly into the right atrium 45. Branches arising from the thoracic aorta are A. third right posterior intercostal artery B. musculophrenic artery C. superior phrenic artery D. superior intercostal artery E. bronchial arteries
descending
46. Regarding the thoracic part of the oesophagus A. It lies posterior to the left bronchus B. It lies anterior to the thoracic duct C. Its wall is composed of smooth muscle along its entire length D. Venous blood from the thoracic part drains into azygos vein E. The right pulmonary artery is anterior to it
47.
A. B. C. D. E. 48.
A. B. C. D. E.
The oesophagus is lined by the stratified squamous non keratininsed epithelium is constricted by the right bronchus lies posterior to the pericardium and the left atrium passes through both superior and posterior mediastina has an arterial supply from the left gastric artery The right phrenic nerve lies in the superior mediastinum has the superior vena cava on its medial side is posterior to the thoracic duct passes through the caval opening in the diaphragm supplies the fibrous pericardium
Lungs and Pleurae 49. The right lung A. has its inferior lobe below and behind the oblique fissure B. has four structures in the hilum C. has five bronchopulmonary segments in its lower lobe D. has the arch of the aorta related to its mediastinal surface E. is supplied by two bronchial arteries 50.
A. B. C. D. E.
The parietal pleura extends superiorly up to the neck of the first rib is attached to the mediastinal surface of the fibous pericardium is developed from the splanchnic mesoderm forms the pulmonary ligament forms the costo diaphragmatic recess
51. Regarding the bronchopulmonary segments A. There are eight bronchopulmonary segments in each lung B. Each segment is pyramidal in shape with the base towards the hilum C. Each segment is supplied by a lobar bronchus D. It is the smallest part of the lung that could be removed surgically E. They are supplied by end arteries 52. Regarding the pleura A. The cervical pleura extends above the clavicle B. The parietal layer is separated from the thoracic wall by the endothoracic fascia C. The parietal and visceral pleurae are continuous around the root of the lung D. The visceral pleura extends into the depths of the interlobar fissures of the lung E. The visceral pleura is sensitive to pain
Thorax : Answers and Explanations Thoracic wall and diaphragm 1. A. True – The intercostal nerves are the ventral rami of T1 – T11 spinal nerves B. True In the intercostal space the nerve lies in the subcostal groove between the internal intercostal muscle and innermost intercostal muscles C. True – The collateral branch arising near the angle of the rib supplies the muscles of that space. It also supplies the parietal pleura and the parietal peritoneum in the case of the lower nerves D. False – In the costal groove the nerve lies below the intercostal vessels. The order from above downwards is vein, artery and nerve E. True 2. A. True B. False – The 3rd to 6th intercostal nerves supply only the thoracic wall and are called typical nerves. The 7 th to 11th nerves supply the abdominal wall in addition to the intercostal spaces C. True D. True – It is a typical intercostal nerve E. True – The lateral cutaneous branch of the 2 nd intercostal nerve
crosses the axilla to the medial side of the arm as the intercostobrachial nerve and supplies the skin of the axilla . Not infrequently the lateral cutaneous nerve of the 3rd intercostal nerve also supplies the skin of the axilla
3. A. False – The 3rd -11th arteries arise from the descending aorta. The 1st and 2 nd arise from the superior intercostal artery which is a branch of the costocervical trunk B. False – In the costal groove the artery is accompanied by the vein and nerve. The relationship from above downwards being veinartery-nerve C. False - The upper six arise from the internal thoracic artery and the 7th to 9th arise from the musculophrenic artery D. True – The dorsal branch which supplies the muscles and skin at the back gives off a spinal branch which supplies the spinal cord and vertebrae. E. True 4. A. False – The intercostal muscles are innervated by the corresponding intercostal nerve.
B.
C.
D. E.
The intercostal nerves are the anterior rami of first 11 thoracic spinal nerves. The anterior ramus of the twelfth thoracic nerve lies in the abdomen and runs forward in the abdominal wall as the subcostal nerve True – Although the ribs develop from sclerotome the intercostal muscles develop from the somatic mesoderm (body wall muscles) True – The muscle extends as far forwards as the costochondral junction and continues as the anterior intercostal membrane False – It is attached to the tubercle of the rib False – The fibres of the external intercostal muscle are directed downwards and forwards. The fibres of the internal intercostal muscle are directed downwards and backwards
5. A. True – It is the second branch that arises from the inferior aspect of the first part of the subclavian artery B. True - It gives off two anterior intercostals to each of the upper six intercostal spaces C. True - It supplies the thymus via mediastinal branches
D. True – The artery terminates in the 6 th intercostal space by dividing into superior epigastric and musculophrenic artery E. False 6.
A. True - The fibres of the external intercostal muscle are
B.
C.
D. E.
directed downwards and forwards. The fibres of the internal intercostal muscle are directed downwards and backwards False The intercostal nerves and vessels (neurovascular bundle) run between the intermediate and innermost layers of muscles True - Each intercostal space contains a large single posterior intercostal artery (branches of the descending thoracic aorta) and two small anterior intercostal arteries (branches of the internal thoracic artery) False –They arise from the superior intercostal artery. Others arise from the descending aorta False - The upper six drain into the internal thoracic vein and the 7th 9th spaces drain into the musculophrenic vein
7. A. True B. True – Anteriorly the neck is related from medial to lateral to the sympathetic chain, the first posterior intercostal vein, the superior intercostal artery and the first thoracic nerve C. True
D. False –The groove for the subclavian vein is on its superior surface anterior to the scalene tubercle. The groove behind the tubercle lodges the subclavian artery E. False – It articulates with the manubrium sterni. The 2 nd rib articulates at the manubriosternal angle 8. A. True – Branches of the internal thoracic artery include : two anterior intercostal arteries to each space, pericardiacophrenic artery, mediastinal branches, perforating branches, superior epigastric artery, musculophrenic artery B. False – Posterior intercostal arteries are 11 in number. 1-2 arise from the superior intercostal artery and 3-11 arise from the descending aorta. C. True D. True E. False - The superior intercostal artery is a branch of the costocervical trunk which comes off from the second part of the subclavian artery. The first and second posterior intercostal arteries arise from it 9. A. False – The manubriosternal joint is a symphyseal joint. The joint between the body of the sternum and the xiphoid process (xiphisternal joint) is another symphysis. B. False – It is a synovial joint C. True – The anterior end of each rib makes a a primary cartilaginous joint with its costal cartilage (costochondral joint) D. True – The first costal cartilage articulates with the sternum at a primary cartilaginous joint. The other six costal cartilages (2nd
to 7th ) articulate with the sternum at synovial joints E. False – It is a synovial joint
10. A. True – Except the first, tenth, eleventh and twelfth vertebrae all others have demi facets to articulate with the respective ribs B. False – This is not a feature of thoracic vertebrae. Bifid spines are found in some of the cervical vertebrae (2nd to 6th) C. True D. False – The articulation between two vertebral bodies (the intervertebral disc), is a symphyseal or secondary cartilaginous E. True – The tenth, eleventh and twelfth vertebrae have only single facets on each side of their bodies for articulation with the numerically corresponding ribs. The tenth rib has only a single facet on the head for articulation with the body of the tenth thoracic vertebra. It has no articulation with the vertebra
above. Hence T9 vertebra has no inferior costal facet. 11. A. True B. True C. False – The posterior boundary is formed by the superior surface of the body of the first thoracic vertebra D. True E. False – The vertebral artery (right and left) arise from the first part of the subclavian artery. The vertebral artery enters the foramen transversarium of the sixth cervical vertebra. It does not pass through the inlet of the thorax 12. A. False – The aortic opening lies anterior to the body of the twelfth thoracic vertebra B. True - It lies between the left and right crura which form the median arcuate ligamnet C. True – The sympathetic trunk passes behind the medial arcuate ligament D. False - It transmits the aorta with azygos vein to the right and the thoracic duct between them E. True 13. A. False – The thoracic sympathetic trunk lies posterior to the costovertebral pleura. Hence it is not a content of the posterior mediastinum
B. True – It has about 12 ganglia, most of which lie anterior to the heads of ribs. The stellate ganglion (the fused first thoracic ganglion and the inferior cervical ganglion) lies anterior to the neck of the first rib while the lowest three ganglia lie lateral to the corresponding vertebral bodies C. False – It passes into the abdomen behind the medial arcuate ligament which is the thickening of the psoas fascia. The subcostal nerve and vessels pass behind the lateral arcuate ligament which is the thickening of the quadratus lumborum fascia D. True – Postganglionic sympathetic fibres pass to the cardiac and pulmonary plexuses, trachea, oesophagus, thoracic aorta and its branches, and to each thoracic spinal nerves E. True – Preganglionic sympathetic fibres are present in the greater spanchnic nerve which receives branches from the fifth to ninth thoracic sympathetic ganglia 14. A. False – The diaphragm is developed from four embryonic structures namely, the septum transversum, left and right pleuroperitoneal membranes, dorsal mesentery of the oesophagus and left and right lateral body wall muscles originating from the lower six intercostal region
B. C. D. E.
True True False True
15. A. True – Derivatives of the septum transversum include the central tendon of the diaphragm, falciform ligament, lesser omentum, coronary ligaments of the liver, connective tissue and Kupffer cells of the liver and connective tissue of the gall bladder B. True C. False D. True E. True 16. A. True B. True – lies within a sling of muscle fibres originating from the right crus C. False – It lies in the muscular part of the diaphragm. The inferior vena cava passes through the central tendon D. False – It transmits the oesophageal branches of the left gastric artery E. False – It transmits the oesophagus, right and left vagus nerves, oesophageal branches of left gastric artery and lymphatics from the lower part of the oesophagus 17.
A. True B. True – The right dome reaches as high as the upper border of the fifth rib whereas the left reaches the lower border of the fifth rib C. True D. False – The hemiazygos vein passes through the left crus E. True – The sympathetic trunk passes behind the medial arcuate ligament which is the thickening of the psoas fascia. The subcostal nerve and vessels pass through the lateral arcuate ligament which is the thickening of the fascia of the quadratus lumborum muscle 18. A. False – The medial arcuate ligament is the thickened upper margin of the fascia covering the anterior surface of the psoas muscle The lateral arcuate ligament is the thickened upper margin of the fascia covering the anterior surface of the quadratus lumborum muscle B. False – The medial arcuate ligament extends from the body of the second lumbar vertebra to the transverse process of first lumbar vertebra C. True D. True E. True
The Thoracic Cavity
Superior Mediastinum 19. A. True B. False – It is formed behind the right first costal cartilage by the union of right and left brachiocephalic veins C. True D. False - Its tributaries are azygos vein, mediastinal and pericardial veins E. True – Its upper part lies in the superior mediastinum. The lower part lies in the anterior mediastinum
20. A. False – The anterior boundary is formed by the manubrium as the lower boundary of the superior mediastinum is at T4 level (manubriosternal joint) B. True – The commencement and the termination of the arch of the aorta is at the T4 level (manubriosternal junction). Therefore the arch of the aorta is above this level lying in the superior mediastinum
C. True - The prevertebral fascial layer passes in front of the vertebral bodies into the superior mediastinum and is attached to the body of the fourth thoracic vertebra D. False – It is separated from the inferior mediastinum by an imaginary plane passing through the sternal angle anteriorly and the lower border of the body of the fourth thoracic vertebra posteriorly E. True – Contents of the superior mediastinum include the thymus, large veins, large arteries, trachea, oesophagus, thoracic duct and sympathetic trunks 21. A. True – The thoracic duct commences as a continuation of cisterna chili at the lower border of the twelfth thoracic vertebra B. True – It passes through the aortic opening of the diaphragm between the right crus of diaphragm and abdominal aorta C. True – In the posterior mediastinum the thoracic duct passes upwards in front of T12 to T5 vertebrae and lies between the azygos vein and descending aorta. It crosses from right to left side behind the oesophagus at T5 vertebral level. Next it passes in the superior mediastinum along the left margin of the oesophagus to the neck
D. False – It crosses from right to left side at the fifth thoracic vertebral level E. False – It drains right and left lower limbs, viscera and walls of the abdomen and pelvis, left half of the thorax, left half of the head and neck and left upper limb. The right lymphatic duct drains the right upper limb 22. A. True – The arch of the aorta commences at the level of the sternal angle (T4 level). It passes upwards and backwards forming an arch in the superior mediastinum. It then passes downwards to the left of the midline to reach the level of the fourth thoracic vertebra and continues as the descending aorta B. False - The third left aortic arch gives rise to the left internal carotid artery. The arch of the aorta is developed from the fourth left aortic arch C. True – Both the left vagus and left phrenic nerves lie anterior to the arch of the aorta D. False - There are four constrictions in the oesophagus. The first is at the cricopharyngeal sphincter (ie. 6 inches (15cm) away from incisor teeth). This is called the cervical constriction. The second is at the crossing of the arch of the aorta (ie 9 inches
(22.5 cm) from the incisor teeth). The third is at where it is crossed by the left bronchus (ie. 11 inches (27.5 cm) from the incisor teeth). The fourth is at where is passes through the diaphragm ( 16 inches (40 cm) from the incisor teeth) E. True – The pulsation in the femoral arteries of both lower limbs can be absent or diminished in coarctation of aorta. A collateral circulation helps to compensate the diminished blood flow
23. A. True – Arteries close to the heart are elastic arteries B. False – The ascending aorta is developed from the truncus arteriosus. A spiral septum forms within the truncus arteriosus which separates the truncus into the pulmonary trunk and ascending aorta. The fourth left aortic arch gives rise to the arch of the aorta C. True D. True – The fibrous pericardium invests the commencement of great
vessels E. False – The abnormalities present in tetralogy of Fallot are , high ventricular septal defect, an overriding aorta, pulmonary stenosis and right ventricular hypertrophy 24. A. True – The trachea is the continuation of the larynx and it commences in the neck below the cricoid cartilage at the level of the sixth cervical vertebra B. True – Its wall contains 16-20 incomplete rings of hyaline cartilage C. False – It is lined by a pseudostratified columnar ciliated epithelium with goblet cells which is the respiratory epithelium D. True – It bifurcates into the two main bronchi at the level of the sternal angle (T4-T5 vertebral level) E. False – It lies in the superior mediastinum and bifurcates at the level of the lower border of the fourth thoracic vertebra which is the lower boundary of the superior mediastinum
25.
A. True – Structures present in a cross section of the thorax at the upper
B. C. D. E.
border of T4 vertebral level include the arch of the aorta, left and right lungs and pleura, superior vena cava, trachea, oesophagus, azygos vein, left superior intercostal vein, vagi and right and left phrenic nerves True False True False
26. A. True B. False – It lies in the midline over most of its length but near the lower end it deviates slightly to the right C. True – Branches from the inferior thyroid and bronchial arteries form an anastomotic network in the tracheal wall D. True – Apart from the epithelium, the other structures (cartilage, muscle etc) are derived from the splanchnic mesoderm E. True – It receives a parasympathetic supply through vagi and recurrent laryngeal nerves, and sympathetic fibres from the upper ganglia of the sympathetic trunk to smooth muscles and blood vessels
27. A. True – The fibrous pericardium blends with the wall of the pulmonary trunk up to its division and thus it lies in the pericardial sac B. False – The pulmonary trunk divides at the fifth thoracic vertebral level C. False – The pulmonary trunk lies anterior to the transverse sinus D. True – The abnormalities present in the tetralogy of Fallot are high ventricular septal defect, an overriding aorta, pulmonary stenosis and right ventricular hypertrophy E. True – The truncus arteriosus is divided into the pulmonary artery and ascending aorta by the formation of a spiral septum within it. 28. A. False – The left principal bronchus is narrower, longer and more horizontal than the right principal bronchus B. True C. True – The lung develops as an outgrowth (diverticulum) from the ventral aspect of the foregut which gives rise to all parts of the bronchial tree ie. the trachea, principal bronchi, tertiary bronchi, bronchioles and alveoli. This diverticulum is called the tracheo-bronchial diverticulum
D. True – The left principal bronchus divides into two lobar bronchi
E.
and the right principal bronchus into three lobar bronchi True – The immediate relation of the left principal bronchus is the pulmonary trunk. The arch of the aorta lies superior to the left principal bronchus.
29. A. False – The sternal angle is the junction of the manubrium and the body of the sternum. It is located at the level where the second costal cartilage articulates with the sternum. At this level lies the bifurcation of the trachea, origin and termination of the aortic arch and the opening of the azygos vein into the superior vena cava. It marks the end of the arch of the aorta and the beginning of the descending aorta. It demarcates the inferior boundary of the superior mediastinum B. True C. True D. True E. True 30.
A. True - The azygos system of veins develop from the left
B.
C.
D.
E.
and right supra cardinal veins and supra cardinal anastomosis. Left supra cardinal vein and supra cardinal anastomosis give rise to the hemiazygos vein and the right supracardinal vein gives rise to the azygos vein False – The left brachiocephalic vein develops from the left anterior cardinal vein and anterior cardinal anastomosis True – The inferior vana cava develops from several embryonic veins. From above downwards it develops from the right vitelline vein (later becomes the right hapatocardiac channel), right subcardinal vein, right sacrocardinal vein and sacrocardinal anastomosis False – The right renal vein has no embryonic vein of origin. The subcardinal anastomosis gives rise to the left renal vein. True
31.
A. True – Both right and left brachiocephalic veins receive vertebral, inferior thyroid and internal thoracic veins (tributaries corresponding to the branches of the first part of the subclavian artery). In addition the left brachiocephalic vein
receives the superior intercostal vein B. True C. False – The middle thyroid vein drains into the internal jugular vein D. False – The external jugular vein drains into the subclavian vein E. True 32. A. True – The superior mediastinum contains the thymic remnants, internal thoracic arteries and veins, brachiocephalic veins, upper half of the superior vena cava, the aortic arch, the braciocephalic artery, left common carotid artery, subclavian arteries, the left superior intercostal vein, the vagus, cardiac, phrenic, and left recurrent laryngeal nerves, the trachea, oesophagus, the superficial part of the cardiac plexus and thoracic duct. The posterior mediastinum contains the oesophagus, thoracic aorta, azygos, hemiazygos and accessory azygos veins, the vagus and splanchnic nerves, thoracic duct and the posterior mediastinal lymph nodes. Hence the structures contained in both mediastina are the oesophagus, vagi and thoracic duct B. False – The trachea ends and bifurcates into left and right bronchi at the sternal angle – the lower limit of the superior
mediastinum C. False – The thoracic aorta which is the continuation of the arch of the aorta begins at the level of the sternal angle and is located in the posterior mediastinum D. False – The phrenic nerves pass through the superior mediastinum and the middle mediastinum only E. True Anterior mediastinum 33. A. True – The thymus lies in both the superior and anterior mediastina. B. True – It develops from the ventral wing of the third branchial pouch C. False – The thymus consists of lymphoid cells arranged in lobes and lobules D. True– It is large and active during infancy and childhood and remains active up to puberty after which it involutes E. True – The inferior thyroid artery and branches of the internal thoracic artery supply the thymus 34.
A. False – The anterior mediastinum contains the thymus (or its remnants), a few lymph nodes and branches of the internal thoracic vessels B. True - The inferior thyroid artery and branches of the internal thoracic artery supply the thymus C. False – It is largest in the early part of life up to adolescence,
although its activity continues into old age D. True – Some of the epithelial cells become thymic (Hassall’s) corpuscles and the others form an epithelial network E. False – The thymus lies in front of the upper pericardium and great vessels
Middle mediastinum 35. A. True – Mixing of oxygenated blood from the inferior vena cava via the foramen ovale and deoxygenated blood from the pulmonary veins occur in the left atrium B. False – Left ventricle receives oxygenated blood from the left atrium and no deoxygenated blood enters into it C. True – Mixing of oxygenated blood from the inferior vena cava and deoxygenated blood from the superior vena cava occurs in the right atrium D. False - The right ventricle receives deoxygenated blood from the superior vena cava (via the right atrium) and no oxygenated blood enters into it
E. True – Oxygenated blood entering the liver via the left umbilical vein (from the placenta) mixes with the deoxygenated blood from the portal vein 36. A. True – The interatrial septum is developed from the septum primum, septum secundum, septum spurium and the left valve of sinus venosus. The right valve of sinus venosus gives rise to the crista terminalis and valves of the coronary sinus and inferior vena cava B. True C. True D. True E. False
37.
A. False – The median umbilical ligament is the urachus (a derivative of distal urogenital sinus) which is not a foetal vessel B. True – The ligamentum teres is the obliterated left umbilical vein which carries oxygenated blood from the placenta to the foetus during foetal life C. True – The ligamentum venosum is the obliterated ductus venosus
which shunts oxygenated blood from the left umbilical vein to the right hepatocardiac channel which will be the post hepatic part of the inferior vena cava D. True – The left and right umbilical arteries which carry deoxygenated blood from the foetus to the placenta form the medial umbilical ligaments (distal part) and the superior vescical arteries (proximal part) E. False – The gastrosplenic ligament is a derivative of the dorsal mesentery of the stomach and hence is not a foetal vessel
38. A. True - The right border of the heart is formed by the right atrium, the
B.
C.
D.
E.
left border by the left atrium and left ventricle. The lower border or base is formed by the left and right ventricles. The upper border is related to the ascending aorta, pulmonary trunk and superior vena cava True - The right atrium has a smooth part and a rough part separated by the crista. The smooth part is derivedfrom the absorbed right horn of the sinus venosus and sinus venosus. The rough part is the right side of the primitive common atrium from the right horn of the sinus venosus True – Both the sinuatrial and atrioventricular nodes are located in the wall of the right atrium False – The crista terminalis is developed from the upper part of the right valve of sinus venosus and separates the smooth and rough parts of the right atrium True – The right atrium receives the superior vena cava, inferior vena cava and the coronary sinus
39. A. True – It represents the distal portion of the of the left sixth aortic arch and connects the left pulmonary artery to the aortic arch closer to the commencement of the descending aorta B. True – It is functionally closed shortly after birth; however, its
structural closure takes place after several months C. False – It connects the pulmonary artery to the aortic arch D. True – At birth, with the pulmonary circulation, the release of Bradykinin leads to the contraction of ductus arteriosus. It gradually becomes a ligament E. True – It shunts blood from the pulmonary trunk to the aortic arch before birth, by passing the pulmonary circulation
40. A. True – Arising from the anterior aortic sinus on the right side of the pulmonary trunk the artery passes between the right auricle and the pulmonary trunk and descends in the anterior atrioventricular groove B. True – The artery to the SA node supplies the SA node and right and left atrioventricular bundles C. False – It accompanies the small cardiac vein in the anterior interventricular groove and accompanies the coronary sinus in the right posterior coronary sulcus. The great cardiac vein passes in the anterior interventricular groove along with the anterior interventricular artery, a branch of the left coronary artery
D. False – The apex of the heart receives blood from the anterior interventricular branch of the left coronary artery and not by a branch of the right coronary artery E. False – The branches arising from the right coronary artery are conus artery, SA nodal artery, marginal artery, AV nodal artery and posterior interventricular branch. The circumflex artery is a branch of the left coronary artery
41. A. False – The left border of the heart is formed mostly (4/5ths) by the left ventricle, with the auricle of the left atrium forming the uppermost part (1/5th ). B. True - The left atrium forms the posterior surface (base) of the heart and lies behind the right atrium C. True – The oblique sinus lies posterior to the left atrium and the transverse sinus lies anterior to the left atrium D. True – Its posterior relations are the oesophagus and descending
thoracic aorta E. True – The four pulmonary veins, two on each side on its posterior wall open in to the left atrium. These veins do not have valves 42. A. False The common atrium is separated by the interatrial septum which in developed from four embryonic parts. They are the septum primum, septum secondum, septum spurium and the left value of sinus venosus. B. True C. False The pulmonary arteries develop from the proximal part of the sixth aortic arches on left and right sides. The right horn of sinus venosus along with the sinus venosus gets absorbed into the right side of the common atrium giving rise to the smooth part of the right atrium. D. True Upper half of the right valve of sinus venosus gives rise to the crista terminals and from the lower half develops the valves of the coronary sinus and inferior vena cava. E. False- Smooth part of the right atrium is developed from the sinus venosus and its right horn. The coronary sinus develops from the left horn of sinus venosus.
Posterior Mediastinum 43. A. True – The descending thoracic aorta is the continuation of the arch
B. C.
D. E.
of the aorta. The arch ends at the fourth thoracic vertebral level and the descending aorta begins at this level True False –The pericardiacophrenic artery arises from the internal thoracic artery False – It passes through the diaphragm at T12 vertebral level True – The upper part of the oesophagus (the cervical part) is supplied by branches of the inferior thyroid arteries. The middle part (the thoracic part) is supplied by oesophageal branches of the descending thoracic aorta and bronchial arteries. The lower part is supplied by the oesophageal branches of the left gastric artery
44. A. True B. False – It enters the thorax by passing through the aortic opening of the diaphragm C. True - It ascends upto the 4 th thoracic vertebral level and arches forwards over the root of the right lung and ends by opening into the superior vena cava D. True – Its tributaries are superior intercostal vein formed by 2nd, 3rd, 4th posterior intercostal veins, 5th 11th posterior intercostal veins, hemiazygos and accessory hemiazygos, oesophageal,
pericardial and mediastinal veins, and the right bronchial vein. E. False – The azygos vein drains into the superior vena cava. The right atrium receives the superior vena cava, inferior vena cava and the coronary sinus.
45. A. True – The descending aorta gives off nine pairs of posterior intercostal arteries (for 3 rd -11th spaces), a pair of subcostal arteries, bronchial arteries, oesophageal vessels, pericardial branches and superior phrenic arteries B. False – The musculophrenic artery is a terminal branch of the internal thoracic artery C. True D. False – The superior intercostal artery is a descending branch of the costocervical trunk which comes off from the second part of the subclavian artery E. True 46. A. True – The anterior relations of the thoracic part of the oesophagus from above downwards are: the trachea and the left recurrent laryngeal nerve; the left principal bronchus and the
right pulmonary artery; and the pericardium which separates it from the left atrium B. True – The thoracic part of the oesophagus lies anterior to the bodies of the thoracic vertebrae, thoracic duct, azygos vein, right posterior intercostal arteries and at the lower end the descending thoracic aorta C. False – The muscularis externa of the oesophagus in the upper third is composed of skeletal muscle; the middle third is composed of both skeletal and smooth muscle; and the lower third is composed of smooth muscle D. True – The veins from the upper third drain into the inferior thyroid veins, from the middle third into the azygos veins and from the lower third into the left gastric vein, a tributary of the portal vein E. True – Just below the bifurcation of the trachea in the posterior mediastinum the oesophagus is crossed anteriorly by the left main bronchus and the right pulmonary artery 47. A. True B. False – The oesophagus has three anatomic constrictions. The first is pharyngo-oesophageal junction, the second is where aortic arch and left bronchus cross its anterior surface, and third
occurs where the oesophagus passes through the diaphragm C. True – It lies posterior to the trachea and the left recurrent laryngeal nerve; the left principal bronchus and the right pulmonary artery; and the pericardium which separates it from the left atrium D. True E. True – The upper third of the oesophagus is supplied by the inferior thyroid artery, the middle third by branches from the descending thoracic aorta, and the lower third by branches from the left gastric artery 48. A. True – Nerves lying in the superior mediastinum are : phrenic, vagus and cardiac nerves, and left recurrent laryngeal nerve B. True – The right brachiocephalic vein, superior vena cava, the pericardium over the right atrium and the inferior cava lie on its medial side C. False – The right phrenic is not related to the thoracic duct D. True – Its terminal branches pass through the caval opening in the central tendon to supply the undersurface of the diaphragm E. True – The phrenic nerve supplies the mediastinal pleura, fibrous pericardium, parietal layer of the serous pericardium
Lungs and Pleurae 49. A. True – The right lung has three lobes. The inferior lobe is below and behind the oblique fissure. The part of right lung in front and above the oblique fissure is subdivided in to the superior lobe and middle lobe by the horizontal fissure. The left lung has two lobes, superior and inferior, sparated by the oblique fissure B. False – The right lung has five structure in the hilum, namely the two pulmonary veins, one pulmonary artery, upper lobar bronchus and right principal bronchus. The left has four structures in the hilum, namely the two pulmonary veins, one pulmonary artery and the left principal bronchus C. True – It has three, two and five bronchopulmonary segements in the upper, middle and lower lobes respectively D. False – The arch of the aorta is related to the mediastinal surface of the left lung. The azygos vein is related to the mediastinal surface of the right lung E. False – It is supplied by a single bronchial artery
50. A. True – The parietal pleura is attached to the inferior surface of the suprapeural membrane and extends up to the neck of the first rib B. True C. False – The parietal pleura is developed from the somatic mesoderm and the visceral pleura from the visceral (splanchnic) mesoderm D. True – From the mediastinal layer of the parietal a cuff of membrane surrounds the hilum of the lung (the root of lung) which forms the pulmonary ligament inferiorly and continues with the visceral pleura. E. True – The parietal pleura lines the inner surface of the thoracic wall (rib cage, vertebrae and diaphragm). The recess formed by the parietal pleura inferiorly between the ribs and the diaphragm
is the costo diaphragmatic recess. 51. A. False – There are ten bronchpulmonary segments in each lung and each of the ten bronchopulmonary segments have ten segmental bronchi B. False – Each bronchopulmonary segment is pyramidal in shape with the base towards the lung surface and apex towards the hilum C. False – Each segment is supplied by a segmental brochuus. Lobar bronchi supply the lobes of the lung (two lobar bronchi in the left lung and three lobar bronchi in the right lung) D. True – It is the smallest part of the lung that could be surgically removed with minimal bleeding and damage E. True – This is important because if this artery gets blocked that part will become an infarct
52. A. True – The cervical pleura extends up into the neck above the clavicle up to the level of the neck of the first rib, lining the undersurface of suprapleural membrane. It reaches a level 11.5 inches (2.5 – 4 cm) above the medial third of the clavicle
B. True – The parietal layer of pleura lines the thoracic wall. Loose areolar tissue separates it from the endothoracic fascia which is an extrapleural sheet of fascia that lines the thoracic wall C. True – The two layers are continuous with one another by means of a cuff of pleura that surrounds the structures entering and leaving the lung at the hilum of each lung. This pleura extends for a distance below the hilum froming a double layered fold called the pulmonary ligament D. True E. False – It is sensitive to stretch, but is insensitive to common sensations such as pain and touch. The parietal pleura is sensitive to pain, temperature and pressure
2
________________________________________________________
Abdomen Anterior Abdominal Wall 53. The transpyloric plane A. Transects the body through L1 vertebra B. Is midway between the xiphisternum and the pubic symphysis C. Crosses through the neck of the pancreas D. Marks the level of termination of the spinal cord E. Cuts through the neck of the gall bladder 54. Regarding the anterior abdominal wall A. Skin around the umbilicus is supplied by the 10 th thoracic spinal nerve B. The transpyloric plane marks the level of the hila of the kidneys C. The intertubercular plane lies at the level of the pubic tubercles D. The subcostal plane is at the L3 vertebral level E. Nerves of the anterior abdominal wall lie between the internal oblique and external oblique muscles 55. At the transpyloric plane A. the common iliac artery commences B. the superior mesenteric artery arises from the aorta C. the splenic vein joins the superior mesenteric vein to form the portal vein D. the neck of the pancreas is located E. the inferior vena cava commenses
56.
The inguinal canal
A. commences at the superficial inguinal ring B. has an anterior wall formed by the external oblique aponeurosis assisted laterally by the internal oblique muscle C. has the floor formed by the inguinal ligament D. has the posterior wall reinforced in its medial third by the conjoint tendon E. transmits the round ligament in the female 57. The superficial inguinal ring A. is oval shaped B. is a defect in the superficial fascia C. lies immediately above and lateral to the pubic tubercle D. has crura giving attachment to external spermatic fascia E. transmits the ilioinguinal nerve 58. Regarding the inguinal canal A. It lies above the lateral part of the inguinal ligament B. Its deep ring lies half an inch above the mid inguinal point C. The lacunar ligament forms the floor medially D. It transmits the genitofemoral nerve E. Its roof is formed by the fibres of internal oblique and transversus abdominis muscles 59. The inguinal canal A. is 1.5 cm long B. has the ilioinguinal nerve entering through the deep ring C. has part of its floor formed by the lacunar ligament D. has fascia transversalis along the whole length of the posterior wall E. has the inferior epigastric artery medial to its deep ring
60. The rectus abdominis muscle A. arises from the pubic symphysis and pubic crest B. inserts on to the 9th rib C. is enclosed in the aponeurosis of the internal oblique muscle between the umbilicus and costal margin D. has a tendinous intersection at the level of the umbilicus E. is supplied by the iliohypogastric nerve 61. The external oblique muscle A. has fibres interdigitating with fibres of latissimus dorsi B. has an attachment to the anterior half of the iliac crest C. has the superficial inguinal ring in its aponeurosis D. contributes to the formation of the conjoint tendon E. has its lower border forming the roof of the inguinal canal 62. Regarding the rectus sheath A. The anterior layer above the level of the costal margin is formed by the external oblique aponeurosis B. The posterior layer above the level of the costal margin formed by the internal oblique aponeurosis C. The subcostal nerve supplies it D. The anterior layer above the pubic symphysis is formed by the fusion of aponeuroses of external and internal oblique and transversus abdominis muscles E. The posterior layer above the pubic symphysis is formed by the aponeurosis of the transversus abdominis muscle 63. The anterior abdominal wall is supplied by the A. eighth posterior intercostal artery B. superior epigastric artery C. inferior epigastric artery
D. tenth posterior intercostal artery E. musculophrenic artery 64. Nerves that supply the muscles of the anterior abdominal wall include A. sixth intercostal nerve B. subcostal nerve C. ilioinguinal nerve D. iliohypogastric nerve E. lateral femoral cutaneous nerve 65. A. B. C. D. E.
Components of the spermatic cord include ilioinguinal nerve vas deferens genitofemoral nerve appendix testis testicular artery
66. Regarding vertebral levels A. The portal vein commences at theL1 vertebral level B. Bifurcation of the descending aorta is at the S1 level C. Oesophageal opening in the diaphragm is at the T12 vertebral level D. Bifurcation of the trachea is at the T6 vertebral level E. The lower limit of the prevertebral fascia is at the T4 vertebral level
Vessels and Nerves of the Gut 67. A. B. C. D. E.
The coeliac trunk is the artery of the foregut arises at the 10th thoracic vertebral level gives off the splenic artery supplies the entire oesophagus lies behind the peritoneum of the lesser sac
68. The superior mesenteric artery A. arises at the level of the transpyloric plane B. lies behind the body of the pancreas C. supplies the pancreas
D. lies anterior to the left renal vein E. supplies the caecum 69. Branches arising from mesenteric artery include A. ileocolic B. left colic C. right gastric D. gastroduodenal E. inferior pancreaticoduodenal
the
superior
70. The inferior mesenteric artery A. arises at the L3 vertebral level B. crosses the pelvic brim at the bifurcation of the left common iliac artery C. supplies the descending colon D. descends into the pelvis as the superior rectal artery E. gives off the right colic artery 71.
A. B. C. D. E.
72. A. B. C. D. E.
The portal vein is formed behind the neck of the pancreas lies in front of the inferior vena cava receives right and left gastric veins ascends in the greater omentum lies anterior to the bile duct
Porto-systemic anastomoses occur at the upper end of oesophagus area around the umbilicus anal canal hilum of the spleen transverse colon
73. The splenic vein A. lies below the splenic artery
B. C. D. E.
is derived from the left umbilical vein ends behind the neck of the pancreas receives short gastric veins receives the right gastric vein
74. Regarding the blood supply of the gut A. Left gastric artery supplies the lesser curvature of the stomach B. Short gastric arteries supply the pyloric region of the stomach C. Right colic artery supplies the ascending colon D. Right gastric artery supplies the first part of the duodenum E. Left colic artery supplies the proximal 1/3 of the transverse colon 75.
A. B. C. D. E.
Derivatives of the vitelline veins include portal vein inferior mesenteric vein splenic vein superior mesenteric vein inferior vena cava
76. Regarding the coeliac plexus A. It lies around the origin of the coeliac trunk B. The greater splanchnic nerve carries postganglionic sympathetic fibres to the plexus C. Both vagi contribute fibres to the plexus D. The coeliac plexus contributes fibres to the renal plexus E. The adrenal medulla receives preganglionic sympathetic fibres from the splanchnic nerves via the plexus
77. Regarding vertebral levels A. Coeliac trunk arises at the tenth thoracic vertebral level B. Superior mesenteric artery arises at the twelfth thoracic vertebral level C. Inferior mesenteric artery arises at the third lumbar vertebral level D. The abdominal aorta divides into right and left common iliac arteries at the fourth lumbar vertebral level E. The common iliac artery divides at the level of the second sacral vertebral level
Abdominal cavity and the peritoneum 78. Which of the retroperitoneal A. Ureter B. Head of the pancreas C. Ascending colon D. Appendix E. Spleen
following
is/are
79. Derivatives of the dorsal mesentery (dorsal mesogastrium) include A. lienorenal ligament B. spleen C. falciform ligament D. lesser omentum E. greater omentum 80. Regarding the epiploic foramen A. Its lower boundary is the second part of the duodenum
B. Its upper boundary is the caudate process of the liver C. Its posterior boundary is the superior mesenteric vein D. Its anterior boundary is the free margin of the lesser omentum E. The right subhepatic space communicates with the lesser sac via the epiploic foramen 81.
The lesser omentum extends between the stomach and the liver is attached to the greater curvature of the stomach extends into the fissure for the ligamentum teres forms the anterior boundary of the epiploic foramen E. is developed from the ventral mesentery
A. B. C. D.
82. Regarding the sigmoid mesocolon A. It has two limbs diverging from each other at the common iliac bifurcation B. Its lateral limb passes forwards along the pelvic brim C. Its medial limb reaches the midline in front of the first sacral vertebra D. It is derived from the dorsal mesentery E. It is formed by the parietal layer of the peritoneum
83. Which of the following ligaments originate from foetal vessels A. Ligamentum teres B. Gastrosplenic ligament C. Ligamentum venosum D. Median umbilical ligament E. Medial umbilical ligament
Development of the Gut 84.
Regarding the rotation of the gut
A. The stomach rotates in an anticlockwise direction B. The duodenum rotates 90° clockwise C. Mid gut loop rotates 90° anticlockwise at 6 th week intra uterine life D. Mid gut rotation is complete at 10th week intra uterine life E. Physiological umbilical herniation occurs after completion of mid gut rotation 85. Which of the following mesodermal A. Kupffer cells B. APUD cells C. Paneth cells D. cells of the zona glomerulosa E. hepatocytes 86. of A. B. C. D. E.
cells
is/are
Abnormalities associated with a malrotation the gut include biliary atresia Hirschprungs disease annular pancreas imperforate anus vitelline fistula
Gastrointestinal Tract 87. The greater curvature of the stomach is supplied by the A. left gastric artery B. right gastric artery C. short gastric arteries D. left gastroepiploic artery E. right gastroepiploic artery 88. Regarding the stomach A. It receives all its arterial supply from the coeliac trunk
B. It is completely invested by the peritoneum C. The lymph is drained to the celiac lymph nodes D. It is lined by the stratified squamous keratinizing epithelium E. The lesser sac lies posterior to the stomach
non
89. A. B. C. D. E.
Structures forming the stomach bed include Left kidney Splenic artery Body of the pancreas Superior mesenteric artery Lesser sac
90.
First part of the duodenum lies on the transpyloric plane is supplied by the celiac trunk is anterior to the bile duct is posterior to the gastroduodenal artery is developed from the midgut
A. B. C. D. E.
91. The jejunum differs having A. a thicker wall B. longer vasa recta C. Peyer’s patches D. more arterial arcades E. broader windows 92. A. B. C. D. E.
93.
from
the
ileum
in
The caecum is completely covered by the peritoneum lies over the iliacus and psoas muscles has taeniae coli is supplied by the inferior mesenteric artery has the lateral cutaneous nerve of the thigh anterior to it The second part of the duodenum
A. B. C. D. E.
is covered in front with the peritoneum runs in front of the hilum of the right kidney is supplied by superior pancreaticoduodenal artery is developed entirely from the foregut has the bile duct opening in to its anterior wall
94. A. B. C. D. E.
Meckel’s diverticulum is found 2 feet distal to the ileocaecal junction arises from the mesenteric surface of the ileum is a persistent remnant of the vitellointestinal duct contains renal and suprarenal tissue occurs in about 20% of the population
95. Posterior relations of the 1 st part of the duodenum include A. bile duct B. gall bladder C. gastroduodenal artery D. portal vein E. neck of the pancreas 96. The ascending colon A. is retroperitoneal B. is a derivative of the hindgut C. extends upwards to the splenic flexure D. lies on the iliac fascia E. is related to the anterior surface of the right kidney 97. Regarding the appendix A. It is a derivative of the midgut B. The position of its base is constant in relation to the caecum C. It has its own mesentery D. It is supplied by the inferior mesenteric artery E. It has taenia coli 98. Regarding the appendix A. It develops at the 4th week IUL B. It is lined by a simple cuboidal epithelium C. It is supplied by an end artery
D. Its surface projection is the tip of the right 9 th costal cartilage E. Its commonest position is retrocaecal
Liver and Biliary System, Pancreas and Spleen 99. The caudate lobe of the liver A. lies between the fissure for the ligamentum teres and gall bladder B. is connected to the right lobe by the caudate process C. forms the upper boundary of the foramen of Winslow D. belongs to the left and right morphological lobes of the liver E. is enclosed by the peritoneum
100. Regarding the bile duct A. It is formed by the union of left and right hepatic ducts B. Its lining is endodermal in origin C. Its upper third lies in the free edge of the lesser omentum D. It passes between the second part of the duodenum and head of pancreas E. It lies behind the right renal vein 101. The pancreas A. has its neck in front of the commencement of the portal vein B. has its tail related to the hilum of the kidney C. consists of cells derived from neuroectoderm D. is retroperitoneal E. has its tail lying within the gastrosplenic ligament
102. Organs related to the visceral surface of the spleen include A. Left kidney B. left colic flexure C. Stomach D. Tail of the pancreas E. Greater omentum 103. Organs related to the visceral surface of the liver include A. Stomach B. Duodenum C. Hepatic flexure of the colon D. Right kidney E. Pancreas
104. Regarding the pancreas A. Its head lies anterior to the commencement of the portal vein B. The uncinate process extends behind the superior mesenteric vessels C. Annular pancreas causes duodenal obstruction D. It is supplied by branches of the superior mesenteric artery E. The tail passes in the lienorenal ligament 105. A. B. C. D. E.
The spleen Is developed from the dorsal mesogastrium Has a notch in its anterior border Lies beneath the 7th and 9th ribs Has a lower pole extending upto the midaxillary line Is supplied by vessels passing in the gastrosplenic ligament
Posterior Abdominal Wall 106. The abdominal aorta A. passes through the diaphragm tenth thoracic vertebral level B. terminates at the fifth lumbar vertebral level C. gives off branches supplying the gut from its anterior aspect D. has a longer course than the inferior vena cava in the abdomen E. is accompanied by thoracic duct at the aortic opening 107. Paired branches of the abdominal aorta include A. gonadal arteries B. hepatic arteries C. subcostal arteries D. lumbar ateries E. inferior phrenic arteries
108. A. B. C. D. E.
The inferior vena cava is formed at the fourth lumbar vertebral level grooves the bare area of the liver passes through the tendinous part of the diaphragm receives the right suprarenal vein has its post hepatic part derived from the left vitelline vein
109. Regarding the inferior vena cava A. It passes through the diaphragm at the tenth thoracic vertebral level B. It has a valve at its termination C. Its post hepatic part is derived from the right supracardinal vein D. It receives the hepatic vein
E. Both gonadal veins drain into it 110. A. B. C. D. E.
Tributaries of the inferior vena cava include left fourth lumbar vein left gonadal vein right renal vein left suprarenal vein right inferior phrenic vein
111. The right renal artery A. arises from the aorta at the second lumbar vertebral level B. lies anterior to the right crus of the diaphragm C. passes anterior to the inferior vena cava D. supplies the ureter E. gives off the right gonadal artery
112.
The left renal vein
A. lies posterior to the left renal artery B. is longer than the right renal vein C. is developed from the subcardinal anastomosis D. enters the inferior vena cava at second lumbar vertebral level E. receives the left gonadal vein 113. Regarding the lumbar plexus A. It lies within the psoas major muscle B. It is formed by the dorsal rami of upper four lumbar nerves C. It has branches supplying the skin D. The femoral nerve emerges from the medial border of the psoas muscle E. It gives off the pudendal nerve
114. The genitofemoral nerve A. descends on the quadratus lumborum muscle B. is a branch of the femoral nerve C. has its genital branch passing though the inguinal canal D. supplies the cremaster muscle E. has motor and sensory components 115. The ilioinguinal nerve A. contains fibres arising from first and second lumbar segments B. emerges from the lateral border of the psoas muscle C. lies within the inguinal canal D. supplies the skin of the scrotum E. is entirely sensory
116. The ovarian artery A. arises from the abdominal aorta just above the origin of renal artery B. lies on the psoas major muscle C. crosses in front of the ureter D. on the right side crosses in front of the inferior vena cava E. supplies the ureter
Kidneys, Ureters and Suprarenal glands 117. The ureter A. passes down on the psoas major muscle B. has a narrowing at the pelviureteric junction C. lies anterior to the gonadal vessels
D. crosses the bifurcation of the common iliac artery anteriorly E. is developed from the paramesonephric duct 118.
A. B. C. D. E.
Regarding the right ureter It is retroperitoneal It is crossed by the right ileocolic vessels It receives an arterial supply from the renal arteries The projection of the ureter on a radiograph is opposite the tips of the transverse processes of upper lumbar vertebrae It lies behind the fourth part of the duodenum
119. A. B. C. D.
Regarding the suprarenal glands They are symmetrical in shape They are enclosed in renal fascia Each gland is drained by three veins The inferior vena cava is an anterior relation of the right suprarenal gland E. The medulla is developed from endoderm
120. Regarding the suprarenal glands A. The anterior surface of the left gland is in contact with the bare area of the liver B. The left gland lies on the left crus of the diaphragm C. Suprarenal arteries arise from the renal arteries D. Cells of the zona glomerulosa develop from the neural crest cells E. They receive preganglionic sympathetic fibres via the splanchnic nerves 121. Regarding the relations of the kidneys A. The costodiaphragmatic recess of the pleura is at risk in the lumbar approach to the kidney B. The right kidney rests on the twelfth rib C. Iliohpogastric and ilioinguinal nerves are related posteriorly D. The hilum of the left kidney is related to the pancreas
E. The hila of both kidneys lie at the subcostal plane 122. The anterior relations of the right kidney include A. liver B. second part of the duodenum C. head of pancreas D. hepatic flexure of colon E. subcostal vessels 123. Derivatives of the metanephric blastema include A. ureter B. minor calyces C. Bowmans capsule D. distal convoluted tubule E. collecting ducts
124.
A. B. C. D. E.
The adrenal cortex has cells secreting androgens is developed from the intermediate mesoderm is supplied by the preganglionic sympathetic fibres has cells having an abundance of smooth endoplasmic reticulum has a rich reticulin fibre network
Abdomen : Answers and Explanations 53. A. True – The plane passes through the lower border of the L1 vertebra B. False – The plane lies midway between the jugular notch (upper border of the manubrium) and symphysis pubis C. False – The plane passes through the head, neck and body of the pancreas D. True – The spinal cord ends at L1 vertebral level E. True – It cuts each costal margin at the tip of the ninth costal cartilage, which is at the lateral border of the rectus abdominis; deep to this point on the right side lies the fundus of the gall bladder 54. A. True– Dermatomes over the xiphoid process is T7, over the umbilicus is T10 and over the pubis – L1
B. True - The hila of the kidneys lie at this plane, the right just below and the left just above it C. False – Intertubercular plane passes through the tubercles of iliac crests and body of L5 vertebra D. True – The subcostal plane passes through the lower border of the 10th costal cartilage and body of L3 vertebra E. False – Nerves of the anterior abdominal wall lie between internal oblique and transversus abdominis muscle
55. A. False – The abdominal aorta divides into the two common iliac arteries at the level of the body of L4 vertebra B. True - Thesuperior mesenteric artery arises from the aorta at the level of the lower border of the body of L1 vertebra C. True - The commencement of the portal vein is just behind the neck of the pancreas D. True E. False – The inferior vena cava begins opposite the L5 vertebral level by the confluence of the two common iliac veins behind the right common iliac artery
56. A. False - The inguinal canal is an oblique passage through the lower part of the anterior abdominal wall which commences at the deep inguinal ring and ends at the superficial inguinal ring B. True – The anterior wall along its entire length of the canal is formed by the aponeurosis of the external oblique muscle. It is reinforced in its lateral third by the internal oblique C. True – The floor or the inferior wall is formed by the inrolled inferior edge of the inguinal ligament (the aponeurosis of the external oblique) reinforced medially by the lacunar ligament D. True – The posterior wall is formed along its entire length by the fascia transversalis. It is reinforced in its medial third by the conjoint tendon E. True– It transmits the round ligament of the uterus and the ilioinguinal nerve in the female and the spermatic cord and ilioinguinal nerve in the male
57.
A. False – It is a triangular defect or aperture in the aponeurosis of the external oblique muscle B. False C. True D. True - Margins of the ring are called the crura (lateral and medial) and give attachment to external spermatic fascia E. True - It transmits the round ligament of the uterus and the ilioinguinal nerve in the female and the spermatic cord and ilioinguinal nerve in the male 58.
A. False - The inguinal canal is an oblique intermuscular slit about 4 cm long lying above the medial part of the inguinal ligament B. True – The deep ring lies about 1.25 cm (1 inch) above the midpoint of the inguinal ligament which is an opening in the transversalis fascia C. True - The floor is the inrolled lower edge of the inguinal ligament reinforced medially by the lacunar ligament D. False – The inguinal canal transmits the spermatic cord and ilioinguinal nerve in the male and the round ligament of uterus and ilioinguinal nerve in the female. The genitofemoral nerve is formed in the psoas major muscle and emerges on its anterior surface and runs down along the muscle,
pierces the psoas fascia and divides into the genital and femoral branches. The genital branch passes through the deep ring, enters the inguinal canal and supplies the cremaster muscle, spermatic fascia, tunica vaginalis and scrotal skin E. True – The roof is formed by the lower edges of the internal oblique and transversus abdominis muscles 59. A. False – It is 1.5 inches (4 cm) long B. False – The ilioinguinal nerve enters the canal by piercing the lower border of the internal oblique muscle and emerges through the superficial inguinal ring C. True – The floor is formed by the inrolled lower border of the inguinal ligament and reinforced medially by the lacunar ligament D. True – The posterior wall is formed along its entire length by fascia transversalis. It is reinforced on its medial third by the conjoint tendon E. True – Related to it medially are the inferior epigastric vessels, which pass upward from the external iliac vessels 60.
A. True – It arises by two heads: a medial from in front of B. C.
D.
E.
the pubic symphysis and a lateral from the pubic crest False – The muscle is inserted on to the front of the 5 th to 7th costal cartilages True – Between the umbilicus and costal margin, the aponeurosis of the internal oblique splits into anterior and posterior layers to enclose the rectus abdominis muscle True – Typically three tendinous intersections are found in the muscle, one at the umbilicus, one at the xiphisternum, and one between these two False – The rectus muscle and external obique muscle are both supplied by the lower intercostal and subcostal nerves (T7T12). The internal oblique and transversus abdominis are also supplied by the same nerves but with the addition of the iliohypogastric and ilioinguinal nerves (L1)
61. A. True – The muscle arises by eight digitations, one from each of the lower eight ribs. The lower four slips interdigitate with the costal fibres of latissimus dorsi and the upper four with the digitations of the sarratus anterior B. True – The muscle has a free posterior border which extends
from the twelfth rib to its insertion into the anterior half of the outer lip of the iliac crest C. True - Above and lateral to the pubic tubercle is the superficial inguinal ring in the aponeurosis of the external oblique muscle D. False – Muscles contributing to the formation of the conjoint tendon are the internal oblique and the transversus abdominis E. False – Its lower border forms the inguinal ligament. The inguinal ligament forms the floor of the inguinal canal. The roof of the canal is formed by arching fibres of internal oblique and transversus abdominis 62. A. True B. False – The posterior layer above the level of the costal margin has no rectus sheath. The rectus muscle rests directly on the fifth, sixth and seventh costal cartilages C. True – Seventh to eleventh intercostal nerves and subcostal nerve (12th thoracic nerve) supply it D. True E. False – The posterior layer above the pubic symphysis is deficient and the rectus muscle rests directly on the fascia transversalis
63. A. False – The anterior abdominal wall is supplied by the superior epigastric and musculophrenic arteries (branches of internal throracic artery), tenth and eleventh posterior intercostal arteries (branches of thoracic aorta), subcostal artery, inferior epigastric artery and deep circumflex iliac artery (branches of the external iliac artery) and lumbar arteries (dorsal branches of abdominal aorta) B. True C. True D. True E. True 64.
A. False – Rectus abdominis and external oblique muscles are supplied
B. C. D. E.
by the lower intercostals (T7-T12) and subcostal (T12) nerves; the internal oblique and transversus abdominis by the lower intercostals, subcostal, iliohypogastric and ilioinguinal nerves and the lowest fibres of the internal oblique and transversus abdominis by the first lumbar fibres. True True True False
65. A. False – The spermatic cord has three coverings and six constituents. They are the internal spermatic fascia, cremasteric fascia and muscle, external spermatic fascia, ductus deferns, testicular artery with the artery to the ducts and cremasteric artery, pampiniform plexus of veins, lymphatics, genital branch of the genitofemoral nerve and processus vaginalis. The ilioinguinal nerve passes down deep to the external oblique muscle and emerges on the front of the spermatic cord through the superficial inguinal ring. B. True C. True D. False - The appendix testis is a small cystic part attached to the upper pole of testis which is a remnant of the paramesonephric duct E. True 66.
A. True - The portal vein commences behind the neck of pancreas by the union of the splenic vein and superior mesenteric vein
B. C.
D.
E.
at the first lumbar vertebral level False – Bifurcation of the descending aorta is at the fourth lumbar vertebral level False – Oesophageal opening in the diaphragm is at the tenth thoracic vertebral level. The inferior vena caval opening is at the eighth thoracic vertebral level and the aortic opening is at the twelfth thoracic vertebral level False – Bifurcation of the trachea is at the fourth thoracic vertebral level which is at the level of the manubriosternal joint (angle of Louis) True – The prevertebral fascia extends from the base of the skull to the fourth thoracic vertebral level
Vessels and Nerves of the Gut 67. A. True – It is the artery of the distal part of the foregut and supplies the gastrointestinal tract from the lower one third of the oesophagus down to the duodenum as far as the opening of the bile duct. It supplies the liver, spleen and pancreas which are foregut derivatives B. False – It arises at the 12th thoracic vertebral level C. True – Its three branches are the left gastric, splenic and common hepatic arteries D. False – The derivatives of the distal part of the foregut including the
liver, pancreas and spleen are supplied by the coeliac trunk. The upper part of the oesophagus is supplied by the inferior thyroid arteries; middle part by the oesophageal branches of the aorta and bronchial arteries; and the lower part by the oesophageal branches of the left gastric artery E. True – The three branches from the coeliac trunk are given off at the upper border of the pancreas behind the peritoneum of the posterior wall of the upper sac
68. A. True – It arises from the abdominal aorta below the origin of the celiac trunk at the level B. True - After airsing from the aorta mesenteric artery is directed downwards behind the pancreas and splenic vein
a centimeter L1 vertebral the superior body of the
C. False – It is the artery of the mid gut and supplies the gut from the duodenal papilla up to the junction between the proximal two-thirds and distal one-third of the transverse colon. The pancreas is supplied mainly by the splenic artery, a branch of the coeliac trunk (neck, body and tail). Superior and inferior pancreaticoduodenal arteries supply the head of pancreas D. True – It lies anterior to the left renal vein, uncinate process of the pancreas and the third part of the duodenum, in that order from above downwards E. True – The ileocolic artery is a branch of the superior mesenteric artery. The inferior branch of the ileocolic artery gives off the anterior and posterior caecal arteries to supply the caecum. 69. A. True – Branches arising from the superior mesenteric artery are inferior pancreaticoduodenal, ileocolic, right colic, middle colic, jejunal and ileal arteries B. False – The left colic is a branch of the inferior mesenteric artery C. False – The right gastric artery is a branch of the common hepatic artery which arises from the coeliac trunk D. False – The gastroduodenal artery is a branch of the common hepatic artery which arises from the coeliac trunk
E. True
70. A. True – It arises from the aorta behind the inferior border of the third part of the duodenum at the third lumbar vertebral level (3-4 cm above the bifurcation of the aorta) B. True – It crosses the pelvic brim at the bifurcation of the left common iliac vessels over the sacroiliac joint and converges towards the ureter and lie at the apex of the attachment of the sigmoid mesocolon C. True – It supplies the distal third of the transverse colon, left colic Flexure (splenic flexure), the descending colon, the sigmoid colon, the rectum, and the anal canal above the pectinate line D. True – The terminal branch of the inferior mesenteric artery is the superior rectal artery which anastomoses with the last branch of the sigmoid arteries E. False – Its branches are the left colic, sigmoid and superior rectal arteries. The right colic artery is a branch of the superior mesenteric artery 71.
A. True - The portal vein is formed by the union of splenic vein (which also receives the inferior mesenteric vein) with the superior mesenteric vein, behind the neck of the pancreas at the 1 st lumbar vertebral level B. True – It lies in front of the inferior vena cava behind the neck of the pancreas and the first part of the duodenum. By entering between the two layers of the lesser omentum it loses contact with the inferior vena cava C. True – Tributaries of the portal vein are the right and left gastric veins, superior pancreaticoduodenal veins, cystic veins and paraumbilical veins D. False – it ascends in the free edge of the lesser omentum E. False – The portal vein runs upwards in the free edge of the lesser omentum which forms the anterior boundary of the epiploic foramen lying behind the bile duct and the hepatic artery 72. A. False – The following are the four common sites of portosystemic anastomoses: (i) At the lower end of the oesophagus (oesophageal or gastric varices) the oesophageal branches of the left gastric vein (portal tributary) anastomoses with oesophageal veins that drain into azygos and accessory azygos veins
B. C. D. E.
(ii) Anorectal region – superior rectal veins (portal tributary) anastomose with the middle and inferior rectal veins (systemic tributaries) that drain into internal iliac and pudendal veins (iii) Around the umbilicus – the left branch of the portal vein anastomoses with the superficial veins (superior and inferior epigastric) of the anterior abdominal wall (systemic tributaries) through paraumbilical veins that accompany the ligamentum teres In portal obstruction the veins around the umbilicus distend. The distended veins radiate from the umbilicus giving rise to caput medusae (iv) In the bare area of liver – the right branch of the portal vein in the bare area anastomoses with the retroperitoneal veins that drain into lumbar, azygos and hemiazygos veins True True False False
73. A. True – The vein leaves the hilum of the spleen and passes in the lienorenal ligament lying below the splenic artery B. False – The splenic vein has no foetal vessel of origin. The left umbilical vein which is the main source of oxygenated blood to the foetus becomes the ligamentum teres after birth C. True – It unites with the superior mesenteric vein behind the neck of the pancreas (at the first lumbar vertebral level) to form the portal vein D. True – It receives short gastric, left gastroepiploic, inferior mesenteric and pancreatic veins E. False - The right gastric vein passes along the lesser curvature to the pylorus of the stomach and empties into the portal vein 74.
A. True – The lesser curvature of the stomach is supplied by the left and right gastric arteries B. False – Short gastric arteries (about six branches) are branches from the splenic artery that supply the fundus and upper part of the greater curvature of the stomach. The pyloric region of the stomach is supplied by the gastroduodenal artery, right gastroepiploic artery and supraduodenal artery
C. True – The ascending colon is supplied by the ileocolic, right colic and middle colic arteries, which are branches of the superior mesenteric artery D. True – The first 2 cm of the duodenum receives blood from the hepatic, gastroduodenal, supraduodenal, right gastric and right gastroepiploic arteries E. False - The middle colic artery, a branch of the superior mesenteric artery supplies the proximal 1/3 of the transverse colon. The left colic artery supplies the descending colon
75.
A. True –
B. C. D. E.
Left and right vitelline veins and vitelline anastomosis give rise to superior mesenteric vein, portal vein and post hepatic inferior vena cava. The inferior mesenteric and splenic veins do not have a foetal vessel of origin False False True True
76. A. True – It lies around the origin of the coeliac trunk above the upper border of the pancreas B. False – The greater and lesser splanchnic nerves carry preganglionic
sympathetic fibres. They pierce the crura of the diaphragm and enter the two large coeliac ganglia C. True D. True – Fibres from the plexus supply all abdominal viscera, renal ganglion and plexus, testes and ovaries E. True – Preganglionic fibres from the greater splanchnic nerve pass without relay to the cells of the suprarenal medulla
77.
A. False – The coeliac trunk arises from the abdominal aorta between the crura of the diaphragm a little below the median arcuate ligament at the twelfth thoracic vertebral level B. False – The superior mesenteric artery arises from the aorta a centimeter below the coeliac trunk at the first lumbar vertebral level C. True – The inferior mesenteric artery arises from the aorta
behind the inferior border of the third part of the duodenum at the third lumbar vertebral level The abdominal aorta passes behind the median arcuate ligament at the twelfth thoracic vertebral level and passes downwards behind the peritoneum on the bodies of lumbar vertebrae with the left sympathetic trunk at its left margin. At the fourth lumbar vertebral level it divides into the two common iliac arteries E. False – The common iliac arteries divide into internal and external iliac arteries at the fifth lumbar vertebral level (at the disc between the 5 th lumbar vertebra and the sacrum) in front of the sacroiliac joint
D. True –
78. A. False – Although the kidney is retroperitoneal, the ureter lies on the posterior abdominal wall in front of the muscles B. True – The pancreas after development fuses with the posterior abdominal wall and becomes secondarily retroperitoneal C. True – During development the descending colon has a dorsal mesentery which will fuse with the posterior abdominal wall and becomes retroperitoneal D. False – The appendix has a mesentery called the mesoappendix
and is not retroperitoneal E. False– The spleen develops in the dorsal mesentery and is attached to the posterior abdominal wall by the lienorenal ligament 79. A. True – Derivatives of the dorsal mesentery include the greater omentum, gastrosplenic ligament, spleen and the lienorenal ligament. The lesser omentum and falciform ligament develops from the ventral mesentery (ventral mesogastrium) B. True C. False D. False E. True 80. A. False – Its lower boundary is the first part of the duodenum B. True C. False – The posterior boundary is the inferior vena cava covered by the parietal peritoneum of the posterior abdominal wall D. True – The free margin of the lesser omentum contains between its two peritoneal layers the portal vein and anterior to it the hepatic artery and bile duct E. True – Left (lesser sac) and righr subhepatic spaces communicate with each other via the epiploic foramen
81. A. True – The two layers of peritoneum that extend between the liver and the lesser curvature of the stomach constitute the lesser omentum. This is part of the ventral mesogastrium B. False – It is attached to the lesser curvature of the stomach. The greater omentum is attached to the greater curvature of the stomach. C. False – The attachment of the lesser omentum to the liver is Lshaped. It is attached to the fissure for the ligamentum venosum and the porta hapatis D. True – Anteriorly the foramen is bounded by the right free margin of the lesser omentum containing between its two peritoneal layers the portal vein, hepatic artery and bile duct. E. True - The ventral mesentery (or septum transversum) gives rise to the lesser omentum, falciform ligament, central tendon of
diaphragm, connective tissue of the liver, Kupffer cells and coronary ligaments 82. A. True – The sigmoid mesocolon has an inverted ‘V’ shape with two limbs diverging from each other at the bifurcation of the common iliac vessels, on the pelvic brim over the left sacroiliac joint B. True – The lateral limb passes forward along the pelvic brim C. False – The medial limb slopes down to the hollow of the sacrum, reaches the midline in front of the third sacral vertebra (at the commencement of the rectum) D. True – There is no ventral mesentery in relation to the sigmoid colon E. False – The sigmoid mesocolon is a double fold of visceral layer of peritoneum suspended from the sigmoid colon.
83.
A. True - The left umbilical vein that carries oxygenated blood from the placenta to the foetus becomes the ligamentum teres after birth B. False – The gastrosplenic ligament is derived from the dorsal mesogastrium and extends from the stomach to the
spleen C. True - Ligamentum venosum carries oxygenated blood coming from the left umbilical vein to the right hepatocardiac vein during foetal life. It becomes ligamentous after birth with the cessation of blood entering via the left umbilical vein D. False – The median umbilical ligament is the distal part of the urogenital sinus (earlier the allantoic diverticulum) which forms the urachus. It becomes ligamentous at birth. It is attached to the anterior wall of the urinary bladder E. True – The medial umbilical ligaments are the obliterated distal parts of the left and right umbilical arteries. The umbilical arteries carry deoxygenated blood from the foetus to the placenta during foetal life. The proximal part of the umbilical arteries become the superior vesical arteries 84. A. False – The stomach rotates 90° in a clockwise direction B. False – The duodenum does not rotate during development C. TrueThe midgut rotates 90° anticlockwise at the 6 th week intrauterine life and completes its rotation at th the 10 week intrauterine life by rotating another 180° anticlockwise
D. True E. False – Physiological umbilical herniation occurs between 6th to 10 th week intrauterine life and the rotation occurs during this period
85. A. True – Kupffer cells are the macrophage cells in the liver. These cells are derived from the septum transversum which is the ventral mesogastrium. Hence they develop from mesoderm B. False – APUD cells are neuroendocrine cells of the gut wall. These cells are developed from the neural crest cells C. False – Paneth cells are present in the intestinal mucosa and hence derived from the endoderm D. True – Zona glomerulosa cells are present in the adrenal cortex.The adrenal cortex is developed from the intermediate mesoderm and therefore the cells of the zona glomerulosa are mesodermal in origin. The adrenal medullary cells are neural crest in origin E. False – The liver develops from the hepatic diverticulum from the foregut endoderm. Therefore the hepatocytes (liver parenchymal cells) are derived from the endoderm
86.
A. False – Biliary atresia occurs due to the non canalization B.
C.
D. E.
of the bile duct. Fasle - Hirschprungs disease is due to the absence of nerve plexus (parasympathetic nerve cells) which develops from neural crests. True – During the rotation of the mid gut, the two pancreatic buds (dorsal and ventral) fuse together in an abnormal way giving rise to a ring of pancreatic tissue around the duodenum, called the annular pancreas False – An imperforate anus occurs due to the non rupture of the anal membrane False – A vitelline fistula occurs due to the persistence of the vitello-intestinal duct which connects the ileum with the umbilicus
87. A. False – The greater curvature of the stomach is supplied by the short gastric, left and right gastroepiploic arteries The lesser curvature is supplied by the left and right gastric arteries B. False C. True D. True E. True
88. A. True – The stomach is a derivative of the foregut and its artery of supply is the coeliac trunk and therefore it is supplied by branches of the coeliac trunk. B. True– The stomach has a dorsal and a ventral mesentery (mesogastrium). Hence it is completely covered by the peritoneum C. True D. False – The epithelium lining the stomach is simple columnar epithelium. This epithelium forms gastric glandsof the gut. The stratified squamous epithelium is present in the oral cavity, oesophagus and the lower third of the anal canal E. True – The peritoneum of the anterior wall of the lesser sac covers the posterior wall of the stomach and the stomach bed is covered by the posterior wall of the lesser sac
89.
A. True – Behind the stomach are a group of structures comprising
B. C. D. E.
the stomach bed. Structures forming the stomach bed include the lesser sac, left crus and the dome of the diaphragm, splenic artery, body of the pancreas, transverse mesocolon, upper part of left kidney, left suprarenal gland, spleen and left colic flexure True True False True
90.
A. True – The duodenum makes a C-shaped loop round the head of the pancreas, which is opposite the body of L2 vertebra. The first part lies at the level of L1 vertebra (at the transpyloric plane), the second on the right side of L2 vertebra, the third crosses in front of L3 vertebra, and the fourth is on the left of L2 vertebra B. True – The foregut is supplied by the coeliac trunk. The first part and the second part of the duodenum upto the duodenal papilla is derived from the foregut and hence supplied by branches of the coeliac trunk C. True – It lies in front of the gastroduodenal artery, bile duct and portal vein D. False – The lesser sac, bile duct, gastroduodenal artery, portal
vein and inferior vena cava are posterior relations of the first part of the duodenum E. False – It is a derivative of the foregut
91. A. True – The jejunum has a larger diameter and a thicker wall than the ileum. B. True – It has longer vasa recta or straight arteries C. False –Peyer’s patches or aggregations of lymphoid follicles are present in the ileum D. False – The jejunum has less prominent arterial arcades or anastomotic loops in its mesentery compared to the ileum E. False – The jejunum has high narrow windows between the straight arteries running to its wall whereas the ileum has low broad windows 92.
A. True – It is situated in the right iliac fossa and is completely covered by the peritoneum B. True – It lies on the right iliac fosaa on the fascia over the iliacus and psoas muscle and femoral and lateral femoral cutaneous nerves C. True – As in the rest of the colon the longitudinal muscle layer is
concentrated into three flat bands called taeniae coli which converge on to the base of the appendix D. False – It is supplied by branches of the ileocolic artery (anterior and posterior caecal arteries) which is a branch of the superior mesenteric artery. The inferior mesenteric artery supplies the derivatives of the hindgut (from distal 1/3 of the colon to upper part of anal canal) E. False - The femoral and lateral cutaneous nerve of the thigh lie posterior to the caecum
93. A. True – Also it is crossed by the attachment of the transverse mesocolon B. True C. True – It is supplied by the superior pancreaticoduodenal artery which is a branch of the gastroduodenal artery. Also it receives branches from the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery D. False – The foregut gives rise to the duodenum proximal to the entrance of bile duct (duodenal papilla) and the midgut gives
rise to the duodenum distal to the entrance of the bile duct. Hence the second part of the duodenum is developed from both the foregut and the midgut E. Fasle – Its posteromedial wall receives the common opening of the bile duct and the pancreatic duct at the hepatopancreatic ampulla that opens on the summit of the major duodenal papilla 94. A. False – Meckel’s diverticulum, a finger-like pouch of the ileum is located 2 feet proximal to the ileoceacal junction B. False – It arises from the antimesenteric border of the ileum C. True - It is a persistent remnant of the yolk sac (vitelline duct) and may be connected to the umbilicus via a fibrous cord or fistula D. False – It may contain gastric, liver or pancreatic mucosal tissue E. False – It occurs in about 2% of the population
95.
A. True – Posterior to the 1st part of the duodenum, the gastroduodenal artery, bile duct and portal vein are found
B. C. D.
E.
and behind these structures lies the inferior vena cava False - The gall bladder lies anterior to the first part of the duodenum (duodenal cap) True True False – The pancreas is not a posterior relation of any of the parts of the duodenum. The head of the pancreas is moulded into the ‘C’ shaped concavity of the duodenum and completely fills it
96. A. True – Of the four parts of the colon, transverse and sigmoid parts are suspended by mesenteries but the ascending and descending colon are plastered on to the posterior abdominal wall and covered by the peritoneum only on the anterior surface thus making it retroperitoneal B. False – The ascending colon and the proximal two-thirds of the transverse colon are derivatives of the midgut. The distal onethird of the transverse colon, descending colon, sigmoid colon and proximal part of the rectum are derivatives of the hindgut. C. False – The ascending colon extends upwards from the ileocaecal junction to the right colic flexure (hepatic flexure)
D. True – It lies on both the iliac fascia and the anterior layer of lumbar fascia E. True – The right colic (hepatic) flexure is related to the inferolateral part of the anterior surface of the right kidney
97. A. True – The derivatives of the midgut include the duodenum (distal duodenal papilla), jejunum, ileum, caecum, appendix , ascending colon and the proximal 2/3 of the transverse colon B. True – In relation to the abdominal wall its base is situated onethird of the way up the line joining the right anterior ileac spine to the umbilicus (McBurney’s point) and the position of the base is constant in relation to the caecum although it may lie in a variety of positions C. True – It has its own short mesentery named the mesoappendix D. False – It is supplied by the appendicular artery which is a branch of the inferior division of the ileocaecal artery. This is an end artery E. False – The three taenia coli of the caecum merge to a point at the base of the appendix. Therfore taenia coli are not present in the appendix
98.
A. False – Although organogenesis of most of the organs commences at the 4 th week intrauterine life, the appendix is an exception. It develops at the 10 th week intrauterine life B. False – The appendix is a part of the large intestine. Therefore the epithelium that lines it is the simple columnar epithelium C. True – The appendix is supplied by the appendicular artery which is a branch of the inferior division of the ileocaecal artery. The appendicular artery may be thrombosed in appendicitis which may lead to ischaemic necrosis of the appendix as there is no collateral circulation
D. False – As the position of the appendix is variable there is no definitive surface projection. The surface projection of the fundus of the gall bladder is the tip of the right ninth costal cartilage E. True – Althought the commonest position of the appendix is retrocaecal, it can be in other positions such as pelvic, retroileal and retrocolic
Liver and Biliary System, Pancreas and Spleen 99. A. False – The caudate lobe lies between the fissure for the ligamentum venosum and the inferior vena cava. The quadrate lobe lies between the fissure for the ligamentum teres and gall bladder B. True C. False – It is the caudate lobe that forms the upper boundary of the foramen of Winslow
D. True – The anatomical division of lobes is different from the morphological division of lobes.The morphological division lies to the right of the gross anatomical plane and therefore the quadrate lobe is part of the left morphological lobe of the liver while the caudate lobe belongs partly to the left and partly to the right morphological lobes of the liver E. True – The liver is enclosed by the peritoneum except the bare area which is demarcated by the peritoneal reflections as the coronary ligaments
100. A. False – The bile duct is formed by the union of the common hepatic duct and cystic duct. Left and right hepatic ducts unite to form the common hepatic duct
B. True – The proximal part of the hepatic diverticulum that grows from the ventral aspect of the foregut gives rise to the bile duct and gallbladder. Hence its lining is similar to the gut lining which is developing from endoderm C. True – The bile duct has three parts. The upper third lies in the free edge of the lesser omentum. The middle third is behind the first part of the duodenum and the lower third lies in a groove between the back of the head of the pancreas and the second part of the duodenum D. True – The lower third of the bile duct passes between the second part of the duodenum and head of the pancreas E. False – The bile duct lies in front of the right renal vein 101. A. True – The portal vein commences at the first lumbar vertebral level (ie. behind the neck of the pancreas) by the union of the splenic vein and superior mesenteric vein B. False – The tail of the pancreas is related to the hilum of the spleen. The body of the pancreas is related to the hilum of the left kidney C. True – The islets of Langerhans (the endocrine part) are developed from the neural crest cells (neuroectoderm) D. True E. False – The tail of the pancreas lies within the lienorenal ligament
which is the part of the dorsal mesentery extending between the greater curvature of the stomach and spleen
102. A. True – Organs related to the visceral surface include the left kidney, stomach, tail of the pancreas and left colic flexure B. True C. True D. True E. False – The greater omentum is attached to the greater curvature of the stomach and is connected to the gastrosplenic ligament which extends from the stomach to the spleen 103. A. True - The visceral surface is related, with peritoneum intervening, to the stomach, duodenum, hepatic flexure of the colon and the right kidney, and these organs may leave impressions on the liver surface B. True C. True D. True E. False
104. A. False – The head of pancreas is moulded to the Cshaped concavity of the duodenum. It lies over the inferior vena cava and the right and left renal veins at the second lumbar vertebral level. The neck of the pancreas lies in front of the commencement of the portal vein B. True – The uncinate process arises from the lower part of the posterior surface of the pancreas as a hook shaped extension which passes upwards and to the left behind the superior mesenteric vessels C. True – An annular pancreas forms due to a defective fusion of the dorsal and ventral pancreatic buds. Pancreatic tissue is formed around the duodenum giving rise to an annular pancreas leading to obstruction of the duodenum D. True – It is supplied by branches of the superior mesenteric and coeliac arteries
E. True – The tail of the pancreas extends forwards and to the left from the anterior surface of the left kidney along with the splenic vessels and lymphatics and lie within the lienorenal ligament to reach the hilum of the spleen 105. A. True – It develops at the 6 th week intra uterine life as a condensation in the dorsal mesogastrium. Other structures derived from the dorsal mesogastrium include the greater omentum, lienorenal ligament and gastrosplenic ligament B. True – When enlarged the spleen may extend beyond the left costal margin and the palpable spleen is identified by the notch on its anterior border C. False – It lies just beneath the left half of the diaphragm between the 9th and 11th ribs. D. True - Its long axis lies along the shaft of the tenth rib and its lower pole extends forwards as far as the mid axillary line E. False – It is supplied by the splenic artery which passes in the lienorenal ligament extending from the spleen to the kidney 106. A. False – It passes through the diaphragm at the twelfth thoracic vertebral level. The oesophagus passes through the diaphragm at the tenth thoracic vertebral level
B. False – It ends by dividing into the two common iliac arteries at the fourth lumbar vertebral level C. True – The main branches of the abdominal aorta fall into three types: single ventral arteries to the gut and its derivatives (coeliac, superior and inferior mesenteric), paired branches to other viscera (suprarenal, renal and gonadal arteries) and paired branches to the abdominal wall (inferior phrenic and lumbar arteries). In addition, a small posterior branch, the median sacral artery leaves the aorta a little above its bifurcation. D. False – The inferior vena cava has a longer course in the abdomen than the abdominal aorta. The abdominal aorta extends from the twelfth thoracic vertebral level to the fifth lumbar vertebral level while the inferior vena cava extends from the fifth lumbar vertebral level to the eighth thoracic vertebral level E. True – The thoracic duct passes through the aortic opening of the diaphragm at the twelfth thoracic vertebral level while lying between the aorta and the azygos vein
107. A. True - Paired branch of the abdominal aorta include suprarenal, renal and gonadal arteries to visceral structures; inferior phrenic and lumbar arteries to the abdominal wall. There are four paired lumbar arteries arising from the abdominal aorta opposite the bodies of upper four lumbar vertebrae. Inferior phrenic arteries are the first branches of the abdominal aorta. Hepatic arteries arise from the coeliac trunk. Subcostal arteries although paired, arise from the lowest part of the thoracic aorta and enter the abdomen behind the lateral arcuate ligaments. B. False C. False D. True E. True 108. A. False – It is formed at the fifth lumbar vertebral level by the confluence of the two common iliac veins behind the right common iliac artery B. True
C. True – It passes upwards on to the right of the aorta, grooves the bare area of the liver and pierces the tendinous part of the diaphragm at the eighth thoracic vertebral level D. True – The left suprarenal vein enters the left renal vein while the right suprarenal vein enters the posterior aspect of the inferior vena cava behind the bare area of the liver E. False – Its post hepatic part is derived from the proximal part of the right vitelline vein. The left vitelline vein disappears after contributing to a small part of the portal vein
109. A. False - The inferior vena cava passes through the diaphragm at the eighth thoracic vertebral level. At the 10 th and 12th thoracic vertebral levels the oesophagus and aorta pass through the diaphragm B. True – There is a valve at the termination of the inferior vena cava which is nonfunctional. It is developed from the right valve of the sinus venosus C. False – The post hepatic part of the inferior vena cava (IVC) is developed from the right hepatocardiac channel (ie. the proximal part of the right vitelline vein). The renal part of the
IVC is developed from the right subcardinal vein and the pelvic part from the right sacrocardinal vein D. True – From above downwards the IVC receives hepatic veins, inferior phrenic veins, right suprarenal vein, right and left renal veins, right and left 3 rd and 4th lumbar veins and right testicular or ovarian vein (gonadal vein). E. False 110. A. True – The tributaries of the inferior vena cava include left and right third and fourth lumbar veins, right gonadal vein, left and right renal veins, right suprarenal vein, left and right inferior phrenic veins and hepatic veins. The left gonadal vein and the left suprarenal vein drain into the left renal vein B. False C. True D. False E. True
111. A. True – The right and left renal arteries arise from the aorta at the second lumbar vertebral level just below the origin of the superior mesenteric artery B. True - The right renal artery crosses the right crus of diaphragm
and psoas muscle behind the inferior vena cava and the right renal vein C. False D. True – It gives off the ureteric and suprarenal branches E. False- Both gonadal arteries (testicular and ovarian) arise from the front of the aorta below the renal arteries but well above origin of the inferior mesenteric artery 112. A. False – The left renal vein lies in front of the left renal artery B. True - The left renal vein is about 3 times as long as the right renal vein C. True – The left renal vein has a foetal veinl of origin which is the subcardinal anastomosis. The right renal vein has no foetal vessel of origin D. True – The left renal vein joins the inferior vena cava at a right angle at the second lumbar vertebral level E. True – It receives the left suprarenal vein and left gonadal vein and sometimes the left inferior phrenic vein. The right renal vein usually drains only the right kidney
113. A. True – The anterior primary rami of the upper four lumbar nerves contribute to form the lumbar plexus in the substance of psoas major muscle B. False – It is formed by the anterior rami of the upper four lumbar nerves C. True – The plexus supplies the lower abdominal wall and mainly supply the skin and muscles of the lower limb D. False – The femoral nerve emerges from the lateral border of the psoas muscle and crosses the iliac fossa between the psoas and iliacus muscle E. False – The pudendal nerve is branch given off from the sacral plexus and contains fibres of first, second and third sacral segments 114. A. False – The genitofemoral nerve is formed in the substance of psoas major muscle by the union of branches from L1 and L2, and emerges from the anterior surface of the psoas major and runs down on the muscle deep to psoas fascia B. False C. True – Just above the inguinal ligament it perforates the psoas fascia and divides into genital (L2) and femoral (L1) branches. The genital branch passes through the deep ring and enters the
inguinal canal. D. True – The genital branch supplies motor fibres to the cremaster muscle and sensory fibres to the spermatic fascia, tunica vaginalis of the testis and scrotal skin E. True
115. A. False – It contains only the first lumbar segment B. True - The iliohypogastric nerve, ilioinguinal nerve, lateral cutaneous nerve of the thigh and the femoral nerve emerge from the lateral border of the psoas muscle, in that order from above downwards C. True – The nerve pierces the lower border of internal oblique and enters the inguinal canal and emerges through the superficial inguinal ring D. True – The structures supplied by the ilioinguinal nerve include external oblique, internal oblique, transversus abdominis muscles of the anterior abdominal wall, skin of the upper medial aspect of the thigh, root of the penis, anterior onethird of the scrotal skin, mons pubis and labium majora E. False – It is both sensory and motor
116. A. False – It is given off just below the origin of the renal artery and well above the inferior mesenteric artery B. True – They pass steeply downwards over psoas and genitofemoral nerve C. True – The artery on the left side crosses in front of the ureter and genitofemoral nerve D. True – The artery on the right side crosses in front of the inferior vena cava, ureter and genitofemoral nerve E. True – It supplies the middle portion of the ureter
117. A. True – It passes down on the psoas major muscle under cover of the peritoneum. B. True – Both ureters have three anatomic sites that show narrowings. They are located at the pelviureteric junction, where it crosses the pelvic brim and as it enters the bladder wall C. False – It lies posterior to the gonadal vessels D. True – The ureter enters the pelvis by crossing the bifurcation of the common iliac artery anteriorly over the sacroiliac joint E. False – The ureter is developed from the proximal part of the ureteric
bud which arises as an outgrowth of the mesonephric duct. The paramesonephric duct gives rise to the duct system in the female genital tract (Fallopian tube, uterus, cervix and upper vagina) 118. A. True - Both ureters lie on the posterior abdominal wall covered by the peritoneum B. True – Lower down it is crossed anteriorly by the right colic and ileocolic vessels and by the root of the mesentery. C. True – The upper end is supplied by the ureteric branch of the renal artery. The middle region of the ureter is supplied by the abdominal aorta, gonadal, common iliac and internal iliac arteries. The lower end is supplied by branches from inferior and superior vesical and uterine arteries. D. True – On a radiograph the ureter lies medial to the tips of the transverse processes of lumbar vertebrae E. True – The upper part of the right ureter lies behind the third part of the duodenum
119.
A. False - The suprarenal glands lie at the upper pole of each kidney and are asymmetrical. The right gland is pyramidal and the left is crescentic in shape. B. True – They lie within their own compartment of renal fascia C. False - The glands have a rich arterial supply and each receives blood from three sources which are the renal artery, inferior phrenic artery, and a branch directly from the aorta. In contrast there is usually a single vein draining it. D. True – The inferior vena cava overlaps the anteromedial surface of the right suprarenal gland E. False – The medulla develops from neural crest cells. The cortex is developed from the intermediate mesoderm
120. A. False – The anterior surface of the right suprarenal gland is overlapped medially by the inferior vena cava and the rest of the anterior surface is in contact with the bare area of the liver. The anterior surface of the upper part of the left suprarenal gland is covered by the peritoneum of the lesser sac and the lower part is in contact with the body of the pancreas and splenic vessels B. True – The left gland lies on the left crus of the diaphragm and overlaps the front of the kidney C. True – The suprarenal gland receives arterial supply from three sources. Inferior suprarenal artery from the renal artery, middle suprarenal artery from the abdominal aorta and the superior suprarenal artery from the inferior phrenic artery D. False – The zona glomerulosa is in the adrenal cortex. The adrenal cortex is developed from the intermediate mesoderm and the adrenal medulla is developed from the neural crest cells E. True – Preganglionic sympathetic fibres arising from the spinal cord pass via the sympathetic chain without relay as the greater,
lesser and least splanchnic nerves. The greater splanchnic nerve ends in the cells of the adrenal medulla
121. A. True - A small triangular part of the costodiaphragmatic recess of the pleura lies behind the diaphragm and is an important posterior relation of the kidney, which is at risk in the lumbar approach to the kidney. B. True - The upper pole of the right kidney overlies the twelfth rib, that of the left kidney the eleventh rib C. True – The subcostal vein, artery and nerve, on emerging beneath The lateral arcuate ligament, lie behind the kidney, as do the iliohypogastric and ilioinguinal nerves as they emerge from the lateral border of psoas. D. True - The hilum of the left kidney is related to the pancreas and on the right to the second part of the duodenum.
E. False - The hilum of the left kidney lies just above and that of the right just below the transpyloric plane 122. A. True – The anterior relations of the right kidney are right suprarenal gland,liver, hepatic flexure of colon, small intestine and second part of the duodenum. The anterior relations of the left kidney are left suprarenal gland, stomach, spleen, pancreas, colon and small intestine B. True C. False D. True E. False – Subcostal vessels are a posterior relation of both kidneys.
123. A. False - The kidney develops from two embryonic parts namely the ureteric bud and metanephric blastema. The metanephric blastema gives rise to the Bowmans capsule, proximal convoluted tubule, loop of Henle and distal convoluted tubule. The ureteric bud gives rise to the collecting ducts, minor
B. C. D. E.
calyces, major calyces, pelvis of the kidney and ureter False True True True
124. A. True – Androgens are secreted by the zona reticulosa cells of the adrenal cortex B. True – The adrenal cortex develops from the intermediate mesoderm close to the area of the kidney. The adrenal medulla develops from the neural crest cells. C. False – The adrenal cortex in supplied from the ………….. It is the adrenal medulla that is supplied by the myelinated preganglionic sympathetic fibers which synapse with the medullary cells. D. True – The adrenal cortex secretes steroid hormones. The cells that secrete steroids have an abundance of smooth endoplasmic reticulum. The rough endoplasmic reticulum is found in abundance in protein secreting cells E. True - All endocrine glands have a rich reticulin fibre network.
3
________________________________________________________
Pelvis and Perineum Pelvic Cavity and joints 125. Regarding the pelvis A. The sacro-iliac joint is a synovial joint B. The sacrotuberous ligament lies anterior to the sacrospinous ligament C. The sub public angle is wider in male than in female D. The piriformis muscle leaves the pelvis through the greater sciatic foramen E. The inferior pubic rami are everted in males 126. A. B. C. D. E.
The pelvic outlet is formed by the ischial tuberosities sacrotuberous ligaments alar of the sacrum ischiopubic rami sacroiliac ligaments
127. The levator ani muscle A. has superior and inferior surfaces covered with fascia B. is supplied by a branch from the 1st sacral nerve C. is inserted into the perineal body D. has fibres forming a sling around the anorectal junction E. forms the medial boundary of the ischioanal fossa 128. A. B. C. D. E.
Pelvic peritoneum in the female covers the Superior surface of the bladder Anterior surface of the lower third of the rectum Lateral surface of the urinary bladder Fundus of the uterus Anterior surface of the vagina
Rectum and anal canal 129. The rectum in the male A. rests in front of the 3rd,4th and 5th sacral vertebrae B. is covered by the peritoneum in its upper 1/3 in front and sides C. is derived from the lower part of the urogenital sinus D. is lined by the stratified squamous non keratinizing epithelium E. drains its upper part to the pre aortic lymph nodes 130. Regarding the anal canal A. It has internal sphincter composed of striated muscle B. Its upper part is developed from the hindgut C. Its lower part is derived from the urogenital sinus D. Superficial inguinal nodes drain lymph from its upper third E. Pecten is lined by a simple columnar epithelium 131. Regarding the anal canal A. The pectinate line separates the ectodermal and endodermal parts B. The middle rectal artery supplies it C. The pecten is lined by stratified squamous keratinized epithelium D. It drains into the superior rectal veins E. Pectinate line is a site of portosystemic anastomosis 132. Regarding the rectum A. It is covered by the peritoneum throughout B. It is developed from the lower part of the urogenital sinus C. It is lined by a simple columnar epithelium D. It is supplied by the inferior rectal artery E. In the male the prostate can be palpated on its anterior wall by per rectal examination
Urinary bladder, urethra and ureters in the pelvis 133. The female urethra is A. lined by the stratified squamous keratinizing epithelium B. ten centimeters long C. supplied by the internal pudendal artery D. derived from the mesonephric duct E. drained into the internal iliac nodes 134. Regarding the urinary bladder A. Its epithelium is derived from endoderm B. The extrophy of the bladder is due to persistence of the urachus C. Has no peritoneal covering D. Is lined by a stratified squamous non keratinizing peithelium E. Its apex is connected to the umbilicus by the median umbilical ligament Male Reproductive Organs 135. The testis A. develops in the paraxial mesoderm B. drains its lymph to the para aortic nodes C. has the appendix testis which is a derivative of the mesonephric duct D. is supplied by sympathetic nerve firbres originating from the T10 segment E. contains diploid cells in the wall of seminiferous tubule 136. The testis A. The tunica vaginalis completely encloses the testis B. Has the epididymis located along its anterior border C. Is supplied by sympathetic nerves arising from T10 spinal segment D. Has cells of Leydig that secrete testosterone
E. The veins drain into the inferior vena cava on both sides 137. The ductus deferens A. is lined by a cuboidal epithelium B. develops from the mesonephric duct C. passes through the inguinal canal D. crosses the ureter in the region of the ischial spine E. joins with that of the opposite side to form the ejaculatory duct 138. Regarding ductus deferens A. It begins as a continuation from the upper pole of epididymis B. It is palpable in spermatic cord C. It is supplied by a branch of the testicular artery D. It leaves the spermatic cord at the deep inguinal ring E. The ampulla of the vas lies behind the base of the bladder 139. Pelvic part of the urogenital sinus in the male gives rise to the A. penile urethra B. ejaculatory duct C. seminal vesicle D. prostatic urethra E. membranous urethra 140. Regarding the prostate gland A. Its base lies against the neck of the bladder B. It has a skeletal muscle covering C. Its posterior lobe is devoid of glandular tissue D. The normal gland can be palpated by per rectal examination E. Carcinoma of the prostate can directly spread to the pelvic bones 141.
Regarding the seminal vesicles
A. They lie on the posterior surface of the bladder B. The medial surface is related to the vas deferens C. Develop from the paramesonephric ducts D. Store spermstozoa E. Are palpable by per rectal examination
142. A. B. C. D. E.
The penis consists of two masses of erectile tissue is developed from the genital swellings drains into superficial inguinal lymph nodes is supplied by a branch of the pudendal artery has the bulbospongiosis muscle attached to the side of the pubic arch
Female reproductive organs 143. A. B. C. D.
Regarding the vagina The upper part develops from the urogenital sinus The lower half lies within the perineum It receives an arterial supply from the uterine artery Its posterior wall is completely covered by the peritoneum E. Its posterior wall is longer than the anterior wall
144. The ovary A. Is developed from the paraxial mesoderm B. when diseased will cause pain on the inner side of the thigh on the same side C. is supplied by the uterine artery D. has its own mesentery E. is attached to the uterus by the ligament of the ovary 145. Regarding the uterus A. Lymph from the upper part of the body drains in to the para aortic nodes B. It is normally anterverted and retroflexed C. Its body is enclosed by the peritoneum
D. The anterior surface of the cervix is attached to the bladder above the trigone E. It is developed from the paramesonephric ducts
146. A. B. C. D. E.
The broad ligament has the ovary on its anterior margin has the fallopian tube at its upper border has an attachment to the labium majus contains remnants of the mesonephric tubules extend from the uterus to the lateral wall of the pelvis
147. A. B. C. D. E.
Major supports of the uterus include levator ani muscle round ligament pubo-cervical ligament utero-sacral ligament perineal body
148. A. B. C. D. E.
Dizygotic twins always have a common chorionic cavity are always of the oppsosite sex have separate amniotic cavities have two placentae aAre commoner than monozygotic twins
149. A. B. C. D. E.
The uterine tube is the site of fertilization of the ovum is narrowest at the ampulla develops from the paramesonephric ducts is lined by a simplecolumnar ciliated epithelium has an arterial supply from the ovarian artery
150.
Which of the following are homologous Penis and clitoris Scrotum and labia minora Testis and ovary Vas deferens and fallopian tube
A. B. C. D.
E. Penile urethra and vaginal fornices Pelvic vessels and nerves 151. Following are branches of internal iliac artery A. Iliolumbar artery B. Uterine artery C. Median sacral artery D. Inferior epigastric artery E. Superior gluteal artery 152. The pudendal nerve A. Consists of second, third and fourth sacral spinal segments B. Leaves the pelvis through the obturator foramen C. Lies in the medial wall of the ischiorectal fossa D. Gives off the dorsal nerve of the penis E. Supplies the deep transverse perinei muscle 153. The uterine artery A. is a branch of the posterior division of the internal iliac artery B. lies within the broad ligament C. passes above the ureter D. anastomoses with obturator artery E. supplies the ovaries 154. A. B. C. D.
The sacral plexus Lies on the obturator internus muscle Receives a contribution from the lumbosacral trunk Supplies the quadratus femoris muscle Gives branches to supply the perianal skin and skin of buttock E. Supplies the gluteal muscles
155.
The internal iliac artery
A. begins in front of the sacroiliac joint B. ends near the upper margin of the lesser sciatic foramen C. is crossed anteriorly by the ureter at the pelvic brim D. gives off the the median sacral artery from its posterior division E. supplies the vas deferens Perineum 156. Contents of the deep perineal pouch in the male include A. membranous urethra B. perineal membrane C. internal pudendal vessels D. dorsal nerve of the penis E. bulb of the penis 157. Structures that drain superficial inguinal lymph nodes include A. scrotum B. testis C. glans penis D. labia minora E. clitoris
directly
158. Muscles attached body include A. levator ani B. superficial transverse perinei C. external anal sphincter D. deep transverse perinei E. ischiocavernosus
to
159. Muscles found within perineal pouch include A. bulbospongiosus muscle B. ischiocavernosus mucle C. sphincter urethrae
the
the
to
the
perineal
superficial
D. deep transverse perineal muscle E. superficial transverse perineal muscle
Pelvis and Perineum : Answers and Explanations Pelvic Cavity and joints 125. A. True – The articular surfaces of this joint are jagged and very little movement is present at this joint. With ageing fibrous adhesions occur and gradual obliteration of the joint cavity takes place; earlier in males and after the menopause in females B. False – The sacrotuberous ligament is found posterior to the sacrospinous ligament. The sacrotuberous ligament is a flat fibrous band of great strength having a wide attachment. It is attached to the posterior border of the ilium and posterior superior and posterior inferior iliac spines, to the transverse tubercles of the sacrum and to the upper part of the coccyx and is inserted to the medial surface of the ischial tuberosity C. False – The subpubic angle is larger in females forming an obtuse angle wich is considered as a sex difference D. True - The piriformis muscle arises from the front of the middle
three pieces of the sacrum within the pelvis and leaves the pelvis through the greater sciatic foramen to be attached to the greater trochanter of the femur E. True – The crus of the penis is attached to this everted inferior pubic ramus 126. A. True – The pelvic outlet is bounded anteriorly by the pubic symphysis, arcuate or inferior pubic ligament, posteriorly by the coccyx and on each side by the ischiopubic rami, ischial tuberosities and sacrotuberous ligaments. B. True C. False – The alar of the sacrum forms a part of the pelvic inlet. D. True E. False – Sacroiliac ligaments are ligamentous bands that surround the capsule of the sacroiliac joint. 127. A. True – The pelvic surface of the levator ani and coccygeus is covered by the superior fascia of the pelvic diaphragm. The inferior surface is covered by the inferior fascia of the pelvic diaphragm which blends with the obturator fascia laterally B. False – It is mainly supplied from the sacral plexus by branches of S3 and S4 spinal segments. Puborectalis may be supplied from
below by the perineal branch of S4 and inferior rectal branch of the pudendal nerve, in common with the external anal sphincter C. True The muscles attached to the perineal body include the external anal sphincter, pubovaginalis (levator prostate), a part of levator ani, bulbospongiosus and the superficial and deep transverse perinei muscles D. True – Fibres arising more anteriorly from the inner aspect of the body of the pubis form a sling around the anorectal junction and this part of the muscle is called the puborectalis. Contraction of this muscle sling helps in defaecation E. True – The ischioanal fossa is wedge shaped. The external sphincter of the anal canal and the leavator ani muscles form the medial wall of each fossa and the lateral wall is formed by the ischial tuberosity with the obturator internus muscle
128. A. True – The pelvic peritoneum covers the superior surface of the bladder and is reflected from a little in front of the posterior margin of this surface on to the undersurface of the uterus B. False – The upper one-third of the rectum is covered by the peritoneum in front and on the sides; the middle one-third is covered only in front and the lower one-third which is dilated to form the ampulla is devoid of peritoneum. It is reflected forwards on to the upper part of the vagina to form the rectouterine pouch (of Douglas) C. False D. True - The fundus, the anterior or vesical surface and the posterior or the intestinal surface of the uterus are covered by the peritoneum E. False – The only part of the vagina to have a peritoneal covering is the posterior fornix. This peritoneal covering is the part that forms the front of the rectouterine pouch (of Douglas) Rectum and anal canal 129. A. True – The rectum lies in front of the sacrum from the mid of 3rd
sacral segment and descends up to the tip of the coccyx B. True – The rectum in the male is covered by the peritoneum in its upper 1/3 in front and on the sides and in its middle 1/3 only in front C. False – The rectum is developed from the distal part of the hindgut. The urogenital sinus gives rise to the urinary bladder and urethra D. False – The rectum is lined by the simple columnar epithelium with goblet cells. Only the lower 1/3 of the anal canal is lined by the stratified squamous non keratinizing epitelium E. True – Lymphatics of the upper rectum drains along the inferior mesenteric artery to pre aortic nodes. The lymphatics from the lower rectum reach the internal iliac nodes along the middle and inferior rectal vessels 130. A. False – The anal canal consists of internal and external sphincters. The internal anal sphincter is continuous with the inner circular and outer longitudinal muscle layers of the anal canal. Hence it is developed from the splanchnic mesoderm and consists of smooth muscle. The external anal sphincter consists of three parts, namely, deep, superficial and
B.
C. D.
E.
subcutaneous parts derived from the somatic mesoderm (striated muscle) True – The upper part of the anal canal above the pectinate line is developed from the hindgut and the lower part below the pectinate line is developed from the proctodeum (ectodermal origin) False – refer B above False – The upper part of the anal canal above the pectinate line drains into the internal iliac nodes. The lower part of the anal canal below the pectinate line drains into the superficial inguinal nodes True – The pecten is the area below the pectinate line and is lined by a stratified squamous non keratinized epithelium. The area above the pectinate line (anal column area) is lined by a simple columnar epithelium
131.
A. True – The anal canal above the pectinate line is lined
B.
C. D.
E.
by a simple columnar epithelium and below the pectinate line is lined by a stratified squamous non keratinized epithelium False – The superior rectal branches and the inferior rectal artery supply the mucosa above and below the pectinate line respectively. The middle rectal artery supplies the rectum False– The pecten area is lined by the stratified squamous non keratinized epithelium (ectodermal) True – The area above the pectinate line drains into the superior rectal vein (a tributary of portal vein) and the area below the pecten drains into the inferior rectal vein (systemic veins) True – In portal hypertension this anastomosis dilates to form the internal haemorrhoids (internal piles) as it is a portosystemic anastomosis
132. A. False - Only the front and sides of the upper third and the front of the middle third of the rectum are covered by the peritoneum. The lower third is devoid of a peritoneal covering B. False – The rectum is developed from the distal part of the hindgut and the mucosa is endodermal in origin. The urogenital sinus gives rise to the urinary bladder and urethra C. True – It is lined by the gut epithelium which is the simple columnar epithelium D. False – It is supplied by the superior rectal artery (a branch of the Inferior mesenteric artery), middle rectal artery (a branch of the internal iliac artery) and median sacral artery (a branch of the abdominal aorta). The inferior rectal artery supplies the anal canal E. True – By per rectal examination in the male, the prostate, seminal vesicle, base of the urinary bladder and the rectovesical pouch (if fluid is filled) could be palpated on the anterior rectal wall. In the female all internal reproductive organs
could be felt. In both sexes some bony parts namely the lower sacrum and coccyx, the ischial spine and the ischial tuberosity could be palpated on the posterior rectal wall
Urinary bladder, urethra and ureters in the pelvis 133. A. False - The uppermost part of the female urethra is lined by the transitional epithelium followed by the stratified squamous non keratinizing epithelium at the external urethral meatus. B. False - The urethra in the female is 4 cm long. During later stages of pregnancy it can get stretched and could increase its length up to 10 cm. C. True - Upper part of the female urethra is supplied by the inferior vescical and vaginal arteries with the lower end being supplied by internal pudendal artery
D. False - It is developed from the lower part of the urogenital sinus. The remnants of the mesonephric duct in the female is seen as epoophoron and paroophoron. E. True - Lymph from the female urethra mainly drains into internal iliac nodes but some may reach the external iliac nodes.
134. A. True – The urogenital sinus becomes the bladder and therefore the epithelium of the bladder is endodermal and the surrounding mesoderm which is developed from the splanchnic mesoderm forms the muscle and connective tissue. The incorporation of the lower ends of mesonephric the ducts into the posterior part of the bladder forms the
B.
C.
D. E.
trigone which is intermediate mesoderm in origin False – The fusion of the anterior abdominal wall below the umbilicus is facilitated by the migrating primitive streak mesoderm. If this migration fails, the anterior abdominal wall will not fuse leading to exposure of the bladder wall. This is called the extrophy of the bladder. Persistence of the urachus leads to urine discharge from the umbilical region False – The superior surface and the upper part of the posterior surface are covered by the peritoneum in both sexes False – It is lined by the transitional epithelium True – The apex of the bladder points anteriorly and lies behind symphysis pubis. It is connected to the umbilicus by the median umbilical ligament – which is the fibrosed (obliterated) urachus
Male Reproductive Organs 135. A. False – Both gonads (testis and ovary) develop in the gonadal ridge in the pelvic region of the intermediate mesoderm. The paraxial mesoderm forms the dermatomes, myotomes and sclerotomes of each spinal segment B. True – The testis drains into para aortic nodes lying alongside the aorta at second lumbar vertebral level and do not drain into inguinal nodes although the overlying scrotal skin does C. False – The derivatives of the mesonephric duct include efferent ducts, epidydimis and vas deferens in the male and epoophoron and paroophoron in the ffemale. Appendix testis and utriculus prostaticus are the remnants of the paramesonephric duct attached to the testis in the male D. True – The sympathetic preganglionic fibres originate from the tenth thoracic segment of the spinal cord and pass in the greater or lesser splanchnic nerves to the celiac ganglia and synapse there. The postganglionic sympathetic fibres reach the testis via the testicular artery E. True – The primary spermatogonia in the walls of the seminiferous tubules are diploid cells.
Secondary spermatogonia, spermatids and sperms are haploid cells. 136. A. False – It covers the whole testis except the posterior border B. False – The epididymis is attached to its posterolateral surface C. True D. True – Cells of Leydig or interstitial cells are found as clusters scattered among the cells of connective tissue in between the seminiferous tubules. They constitute the endocrine portion of the testis and secrete testosterone E. False – The veins emerging from the testis form the pampiniform plexus. In the inguinal canal the plexus separates out into about four veins which join to form two that leave the deep inguinal ring. The left vein drains into the left renal vein where the right drains directly into the inferior vena cava. 137. A. False – It is lined by a pseudostratified columnar epithelium with stereocilia B. True - The mesonephric duct gives rise to the efferent ducts, epididymis and vas deferens in the male C. True - It passes through the inguinal canal and enters the abdomen by emerging through the deep inguinal ring D. True – It passes downward and backwards on the lateral wall of the
pelvis and crosses the ureter in the region of the ischial spine E. False - It joins with the duct of the seminal vesicle to form the ejaculatory duct. The ejaculatory ducts pierce the posterior wall of the prostate and open into the prostatic urethra 138. A. False – It begins as a continuation from the tail of the epididymis B. True C. False – The artery to the ductus deferens arises from the superior vesical (or sometimes from the inferior vesical) artery. The epididymis is supplied by a branch of the testicular artery D. True E. True – The part of the ductus lying behind the base of the bladder is dilated and tortuous, and is known as the ampulla 139. A. False - The urogenital sinus has a definitive part, pelvic part and a phallic part. The definitive part gives rise to the urinary bladder, the pelvic part gives rise to the ejaculatory duct, seminal vesicle, prostate, prostatic urethra and membranous urethra in the male. The phallic part gives rise to the penile urethra. B. True C. True D. True E. True
140. A. True - Prostate gland is conical in shape with its base lying against the neck of the bladder and the apex lying inferiorly against the urogenital diaphragm B. False – The smooth muscle of the bladder wall pass without interruption to the prostate as the prostate is continuous with the neck of the bladder C. False – The prostate has five lobes namely the anterior lobe, median or middle lobe, posterior lobe and left and right lateral lobes. The anterior lobe lies in front of the urethra and is devoid of glandular tissue. All other lobed consist of glandular tissue D. True – The following can be felt by the index finger inserted into the anal canal and rectum in the male Opposite the terminal phalanx- contents of rectovesical pouch, posterior surface of the bladder, seminal vesicles and vas deferens Opposite the middle phalanx – the prostate Opposite the proximal phalanx – perineal body, urogenital diaphragm and bulb of the penis E. True – The prostatic venous plexus is directly connected to the vertebral veins. During abdominal straining or coughing the prostatic venous blood could flow in a reverse direction and
enter vertebral veins. The frequent occurrence of metstases of carcinoma of prostate in the lower part of the vertebral column and pelvic bones could be explained due to the above.
141. A. True - They lie on the base of the bladder above the prostate on the posterior aspect. The left and right vas deferens lie side by side on the posterior surface and separates the seminal vesicles from each other B. True – The terminal part of the vas deferens lies on the medial surface of each seminal vesicle C. False – It develops from the mesonephric duct. The paramesonephic ducts in the male regress and its remnants are the utriculus prostaticus and appendix testis D. False – They do not store spermatozoa but produce about 60% of the seminal fluid which contains substances which are essential for the nourishment of spermatozoa
E. True - By per rectal examination in the male, the prostate, seminal vesicle, base of the urinary bladder and the rectovesical pouch (if fluid is filled) could be palpated on the anterior rectal wall. In the female all internal reproductive organs could be felt. In both sexes some bony parts namely the lower sacrum and coccyx, the ischial spine and the ischial tuberosity could be palpated on the posterior rectal wall
142. A. False – The root of the penis consists of three masses of erectile tissue namely the bulb of the penis, and right and left crura of the penis. The bulb continues forward in to the body of the penis as the corpus spongiosum. The two crura converge
B.
C.
D.
E.
forwards and lie side by side in the dorsal part of the body of the penis forming corpora cavernosa False – The penis is developed from the genital tubercle present in the indifferent stage of external genitalia. In the female it gives rise to the clitoris. The genital swellings give rise to the scrotum in the male and the labia majora in the female True - The skin of the penis drains into the superficisl inguinal nodes and the deep structures of the penis drains into internal iliac nodes True – The deep arteries of the penis supply the corpora cavernosa, the artery of the bulb supplies the corpora cavernosa, the artery of the bulb supplies the corpus spongiosum and the dorsal artery of the penis also supplies it. All three arteries are branches of the internal pudendal artery False - The bulbospongiosus muscle covers the bulb of the penis. The ischiocavernosus muscle covers the crus of the penis which is attached to the side of the pubic arch
Female Reproductive Organs 143. A. False –The upper part develops from the paramesonephric ducts and the lower part is developed from the urogenital sinus B. True – The upper half of the vagina lies above the pelvic floor and
lower half lies within the perineum C. True – The vaginal branch of the internal iliac artery is supplemented by the uterine, inferior vesical and middle rectal vessels. The branches of these vessels make good anastomotic connections on the vaginal wall D. False – The posterior fornix is covered by the peritoneum of the front of the rectouterine pouch (of Douglas). It is the only part of the vagina to have a peritoneal covering E. True – Also the posterior fornix is deeper than the other fornices 144. A. False - The ovary develops from the gonadal ridge formed by the intermediate mesoderm. The germ cells develop in the wall of the yolk sac and migrate to the developing gonads at sixth week intrauterine life. Paraxial mesoderm gives rise to segmental muscles of the vertebral column, ribs, vertebrae and annulus fibrosus of intervertebral discs. B. True - The ovary is closely related to the obturator nerve from which it is separated from the parietal peritoneum. Therefore a diseased ovary can cause referred pain along the cutaneous distribution of the obturator nerve which is the inner side of the thigh. C. False - The ovary is supplied by the ovarian artery, a branch of the
abdominal aorta. The uterine artery supplies the uterus and the fallopian tubes. D. True - The anterior border of the ovary is attached to the broad ligament (posterior leaf) by a fold of peritoneum called mesovarium. E. True - The lower pole of the ovary is attached to the uterus by the ligament of ovary.
145. A. True - Lymph from the upper part of body, fundUs and fallopian tube drains into para aortic nodes. (some may drain into external iliac nodes). Lower part of the uterine body drains into external iliac nodes, and the cervix drains into both external and internal iliac nodes and to sacral nodes. B. False - The normal position of the uterus is anteverted and anteflexed. Other abnormal positions are
C. True -
The body of the uterus is enclosed by the peritoneum which becomes the broad ligament laterally. The posterior surface of the cervix is also covered by the peritoneum but the anterior surface of the cervix has no peritoneal covering. D. True - Due to this relationship and being deep to the vescicouterine pouch, the anterior surface of the cervix has no peritoneal covering. E. True - The uterus develops from the lower third of the fused paranesonephric ducts while the fallopian tube develops from the upper 2/3 of the paramesonephric ducts.
146. A. False - The anterior layer of the round ligament is bulged forwards by the round ligament of the uterus just below the uterine tube.
B. C.
D.
E.
The ovary is related to the posterior layer of the ligament from which it is suspended (mesovarium). True - The upper border of the broad ligament is free forming the mesosalpinx containing the fallopian tube False - The broad ligament extends from the side wall of uterus to the pelvic wall. It is the round ligament of the uterus that extends from the junction of the uterus and the fallopian tube and passing through the inguinal canal gets attached distally to the fibro fatty tissue of the labium majus. True - Between the two layers of the broad ligament lie the fallopian tubes, lymphatics, round ligament, ligament of the ovary and remnants of the mesonephric tubules namely paroophoron and epoophoron. True
147. A. True – The uterus is supported by the tone of the levator ani muscles and condensations of pelvic fascia, which form three important ligaments, namely, transverse cervical (cardinal) ligaments, pubocervical ligaments and uterosacral ligaments. B. False - The round ligament of the uterus is the counterpart of the gubernaculums testis in the male C. True D. True E. True
148. A. False - Dizygotic twins are produced by the fertilization of two ova by two separate sperms giving rise to two separate zygotes. They will not resemble each other can have the same or opposite sex, have a different genetic constitution, always have two placentae, two amniotic cavities and two chorionic cavities. Of all twins 70% are dizygotic and 30% are monozygotic B. False C. True D. True E. True 149. A. True – the uterine tube receives the ovum from the ovary and provides a site where the fertilization of the ovum can takes place B. False - The narrowest part of the tube is the region called the isthmus. The ampulla is widest part of the tube C. True D. True – It is lined by the simple columnar ciliated epithelium E. True – It is supplied by the uterine artery of the internal iliac artery and the ovarian artery of the abdominal aorta 150. A. True
B. False - The homologous structure of the scrotum is the labia majora. The homologous structure of the labia minora is the penile urethra. C. True D. False - Vas deferens develops from the mesonephric duct. The remnants of the vas deferens in the female is the paroophoron and epoophoron which are its homologous structures. The Fallopian tube develops from the upper 2/3 of paramesonephric ducts is the utriculus prostaticus and appendix testis which is its homologous structure. E. False - Homologous structure of the penile urethra is the labia minora and the vestibule. Pelvic vessels and nerves 151. A.
B.
C.
True – The internal iliac artery divides into anterior and posterior divisions. Branches arising from the posterior division are iliolumbar, lateral sacral and superior gluteal. The anterior division gives off nine branches, three associated with the bladder (superior vesical, obliterated umbilical and inferior vesical), three other visceral branches (middle rectal, uterine and vaginal), and three parietal branches (obturator, internal pudendal and inferior gluteal) True False – The median sacral artery arises from the back of the
D.
E.
abdominal aorta above its bifurcation and ends in front of the coccyx. False – The inferior epigastric artery arises from the external iliac artery near its lower end just above the inguinal ligament True
152. A. True – The pudendal nerve is a branch of the sacral plexus consisting of second, third and fourth sacral segments. B. False – The pudendal nerve enters the pudendal canal on the lateral wall of the ischiorectal fossa C. False D. True – The dorsal nerve of the penis (clitoris) is one of the terminal branches (the other terminal branch is the perineal nerve) which runs forward deep to perineal membrane and piercing it supplies the skin of the penis (clitoris). E. True – The motor part of the perineal nerve (branch of pudendal nerve) supplies the ischiocavernosus, bulbospongiosus, superficial and deep transversus perinei and sphincter urethrae muscles
153. A. False – It arises from the anterior division of the internal iliac artery B. True It runs medially in the base of the broad ligament passing
above the ureter to reach the junction of the cervix and the body of the uterus C. True D. False – Near the entrance of the uterine tube it turns laterally to supply the tube and anastomoses with the tubal branches of the ovarian artery E. False – The ovary is supplied by the ovarian artery, a branch of the abdominal aorta given off just below the renal artery The uterine artery supplies the body, fundus and cervix of the uterus, and gives off branches to supply the uterine tubes and the vagina 154. A. False – It rests upon piriformis muscle and is covered anteriorly by the parietal pelvic fasicia B. True – It is formed by the lumbosacral trunk and the anterior rami of the upper four sacral nerves C. True – It is supplied by the nerve to quadratus femoris (anterior divisions of L4,L5,S1). This nerve also supplies the inferior gamellus and the hip joint D. True – The perineal branch of S4 which passes between the coccygeus and levator ani enters the ischioanal fossa and supplies the perianal skin. The perforating cutaneous nerve arising from S2 and S3 supplies the skin of the buttock
E. True – The superior gluteal (L4, L5, S1) and inferior gluteal (L5, S1, S2) nerves supply the gluteal muscles
155. A. True – The common iliac artery bifurcates at the pelvic brim oppostite the sacroiliac joint to form the external and internal iliac arteries B. False – It passes downwards from its origin and divides into an anterior and a posterior division at the upper margin of the greater sciatic foramen C. True D. False – The branches of the posterior division of the internal iliac artery iliolumbar, lateral sacral and superior gluteal arteries. The median sacral artery arises from the posterior aspect of the aorta a little above the point where it bifurcates into the two common iliac arteries E. True – The inferior vesical artery given off from its anterior division supplies the trigone and lower part of the bladder, the ureter, vas deferens, seminal vesicle and prostate. Perineum 156.
A. True - The contents of the deep perineal pouch are the membranous urethra, bulbo urethral glands, sphincter urethrae and deep transverse perinei muscle, dorsal nerve of penis, internal pudendal artery, artery to the bulb and dorsal artery of penis. The perineal membrane forms the inferior boundary of the deep perineal pouch and therefore not a content. Bulb of the penis is present in the superficial perineal pouch. B. False C. True D. True E. False
157. A. True –There are two groups of superficial inguinal lymph nodes namely the proximal and distal groups. The proximal group receives lymph from the buttock, back of the body below the waist, umbilicus and anterior abdominal wall below umbilicus, external genitalia in both sexes excluding the testis, lower vagina, lower part of anal canal and perineum and from uterus via lymphatics accompanying the round ligament. The distal
B. C. D. E.
group receives all superficial lymphatics from the lower limb except the posterolateral part of the calf. The superficial inguinal lymph nodes drain mainly into the external iliac nodes. Testis drains into para aortic nodes. The glans penis drains into deep inguinal nodes. False False True True
158. A. True – The perineal body (central tendon of the perineum) is fibomuscular mass located between the anal canal and the vagina (or the bulb of the penis). Muscles attaching to it are the superficial and deep transverse perinei, bulbospongiosis, levator ani and external sphincter. B. True C. True D. True E. False – Ischiocavernosus arises from the posterior part of the perineal membrane and ischiopubic rami and inserts into the corpus cavernosum
159.
A. True – The muscles found within the superficial perineal pouch are the superficial transverse perineal, ischiocavernosus and bulbospongiosus muscles. It also contains branches of the internal pudendal vessels, branches of the perineal nerve and greater vestibular glands in the female (Bartholin glands) B. True C. False –Sphincter urethrae and deep transverse perineal muscles are in the depth perineal space D. False E. True
