Abdomen - Mich blue link

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

linea alba

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

inferior epigastric

which portion of the small intestine is most distal and transitions into the large intestine

ileum

what is the term for a reflection of parietal peritoneum on the abdominal wall that is visibly due to an underlying structure

peritoneal fold

a man is moving into a new house and during the process lifts a large chest of drawers. as he lifts he feels a severe pain in the lower right quadrant of his abdomen. he finds that he can no longer lift without pain and the next day goes to see his physician. surgery is indicated and during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels. the hernia was diagnosed as

indirect inguinal hernia

semilunar folds are notable structures unique to which part of the gastrointestinal tract

colon

what is the artery of the midgut

superior mesenteric

what is the artery of the foregut?

celiac trunk

the inferior mesenteric artery is often occluded by atherosclerosis without symptoms; its normal area of distribution therefore must be mainly supplied by collateral blood flow between which arteries

left and middle colic

the anastomotic artery running alone the border of the large intestine is called the

marginal

the spleen normally does not descend below the costal margin. however, it pushes downward and medially when pathologically enlarged. what structure limits the straight vertical downward movement?

left colic flexure

occlusion of the inferior mesenteric artery is seldom symptomatic because its territory may be supplied by branches of the

middle colic

which of the following structures does not lie at least partially in the retroperitoneum?

spleen

the kidneys have what type of positional relationship to the peritoneum of the abdominopelvic cavity

primarily retroperitoneal

the superficial inguinal ring is an opening in which structure

external abdominal oblique aponeurosis

which structure passes through the deep inguinal ring?

round ligament of the uterus

the sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?

right ventricle

a patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of th 4th or 5th costal cartilage. if the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged

right ventricle

blockage of which of the following arteries would lead to ischemia of the apex of the heart?

anterior interventricular descending

which valves would be open during ventricular systole

aortic and pulmonary

what happens to the right atrioventricular valve during ventricular diastole?

it is open

during fetal life and sometimes persisting into the adult there is an opening between the right and left atria; this opening is called the

foramen ovale

which heart valve has leaflets described as anterior, left and right?

pulmonary

the sound associated with tricupsid stenosis (narrowing) in a 40 year old male would be best hear at which location on the anterior chest wall

left 4th or 5th intercostal space near the sternum

blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retrograde flow into this artery develops via an important anastomosis with which other artery?

posterior interventricular

what structure does not lie in the coronary sulcus

right marginal artery

elevated systolic blood pressure in the right ventricle suggest stenosis of which valve?

pulmonary

while attempting to suture the distal end of a coronary bypass onto the anterior interventricular artery, the surgeon accidentally passed the needle through the adjacent vein. which vein was damaged?

great cardiac vein

you are called to perform thoracentesis (remove fluid from pleural cavity). if you are to avoid injuring lungs or neuromuscular elements, where would you insert the aspiration needle?

the bottom of interspace 9 in the midaxillary line

the pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the

costomediastinal recess

what feature is found only in the left left?

cardiac notch

the oblique fissure of the right lung separates which structures?

inferior lobe from both the middle and superior lobe

a 4 year old girl is brought in with coughing, and you are told by her mother that she had been playing with some beads and had aspirated one. where would you expect it to most likely be?

right main bronchus

a sick person, lying supine in bed aspirates some fluid into her lungs while swallowing. it would most likely end up in which of the following bronchopulmonary segments?

superior segmental bronchus of right inferior lobe

you are observing a doctor perform a bronchoscopy. as he passe sthe bronchoscope down the trachea, a cartilaginous structure is observed separating the right and left main stem bronchi. he asks what it is called and you reply that it really does look like a ships keel adn that it is called the

carina

the horizontal fissure separates the

middle and upper lobes of the right lung

because of its angle with the trachea and size of the main bronchus, a bronchoscope would pass more readily into which lung?

right

a 78 year old female presented with edema of the left upper limb due to poor venous return. examination revelaed an aneurysms of the ascending aorta that was impinging on a large vein lying immediately anterosuperior to it, most likely the

left brachiocephalic vein

in the midregion of the thorax the thoracic duct lies immediately posterior to the

esophagus

which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac?

esophagus

most of the drainage of the throacic body wall reaches the superior vena cava via the azygous vein. a notable exception is the left superior intercostal vein which normally drains into the

left brachiocephalic vein

while viewing an exploratory surgery on a patient injured in an automobile accident, you see the surgeon elevate the esophagus off the vertebral bodies and look in the area between the azygous vein and descending aorta. what structure was she most likely looking for?

thoracic duct

in obstruction of the superior or inferior vena cava, venous blood is returned to the heart by an alternate route via the azygous vein, which becomes dilated int he process. which of the following structure might it compress as a result

thoracic duct

the second costal cartilage can be located by palpating the

sternal angle

the thoracic wall is innervated by

intercostal nerves

when inserting a chest tube, the main intercostal vessels and nerves are avoided by placing the tube immediately

above the margin of a rib

you are attending an operation to remove a thymic tumor from the superior mediastinum. the surgeon asks, what important nerve lying on and partly curving posteriorly around the arch of the aorta should we be careful of as we remove this mass?

left recurrent laryngeal

the tubercle of the 7th rib articulates with which structure?

transverse process of vertebra t7

a third year medical student was doing their first physical exam. in order to properly place the stethoscope to listen to the heart sounds, the student palpated bony landmarks. they began at the jugular notch then slid their fingers down to the sternal angle. at which rib level were their fingers?

2

if the ductus arteriosus does not close off soon after birth to become ligamentum arteriosusm, it may have to be surgically ligated. when clamping it, what important structure immediately behind it must be identified and saved?

left recurrent laryngeal nerve

which vessel course across the mediastinum in an almost horizontal fashion?

left brachiocephalic vein

a 78 year old female presented with edema of the left upper limb due to poor venous return. examination revealed an aneurysm of the ascending aorta that was impinging on a large vein lying immediately anterosuperior to it, most likely the

left brachiocephalic vein

an 8 year old boy is found to have a mid-line tumor of the htymus gland that is impinging posteriorly on a blood vessel. the affected vessel is most likely the

left brachiocephalic vein

during a surgical procedure, a patients right sympathetic trunk was accidentally severed just cranial to the level of spinal nerve T1. which function would be left intact in the affected region

voluntary muscle activity

a muscular patient who regularly lifts weights presents with pain and weakness in his right upper limb that has been slowly developing over time. his limb is cool and there is an obvious vascular insufficiency in his upper extremity. subsequent tests how that a large vessel passing between the anterior and middle scalene muscles i being occluded by hypertrophy of the muscles due to the exercise. the artery involved is the

subclavian

a stab wound just above the left clavicle, laterally to the sternocleidomastoid muscle may be life threatening because of the possibility of injury to the

subclavian artery

what nervous structure lying immediately deep to the subclavian vein as it crosses the anterior scalene muscle may be injured during central venous catheter into the heart?

phrenic nerve

thoracic plane divides what regions of thorax?

superior mediastinum from all other parts of the mediastinum

which of the following is not a structure of the superior mediastinum?

left subclavian vein

the heart sound associated with the mitral valve is best heard at

the 5th left intercostal space

the sound associated with tricuspid stenosis in a 40 year old male would be best heard at which location on the anterior chest wall?

left 4th-5th intercostal space near sternum

which autonomic nerve plexus is responsible for providing innovation to the stomach

celiac plexus

the fundus of the stomach reaches its arterial supply from the

splenic

a patient was diagnosed with the bleeding ulcer do the lesser curvature of the stomach. which artery is most likely involved

left gastric

a 60 year old male executive who had a history of chronic duodenal ulcer was admitted to the RR exhibiting signs of a severe internal hemorrhage. he was quickly diagnosed with perforation of the posterior wall of the first part of the duodenum and erosion of an artery behind it by the gastric excellent. the arthritis most likely the

gastroduodenal

through which surface of the liver does the porta hepatis transmit structure such as the hepatic portal vein

inferior surface

the inferior mesenteric vein usually joins which vein

splenic

through which vessels is the blood from the hepatic sinusoidal cells delivered into the inferior vena cava

hepatic vein

which structure joins the common hepatic duct to form the common bile duct?

cystic duct

which artery typically passes through the hepatobiliary triangle

cystic artery

a large sweeping was felt protruding downward and medically below the left costal margin. x-rays revealed that her 9th and 10th ribs were fractured near their angle on the left side. the abdominal organ most likely to be injured by the fracture is

spleen

The spleen contacts all of the following organs EXCEPT:

A. Jejunum

B. Kidney

C. Left colic flexure

D. Tail of the pancreas

E. Stomach

jejunum