This document provides information about a book titled "MCQs in Anatomy - An aid to revision and self assessment". The book contains multiple choice questions (MCQs) about anatomy of the thorax, abdomen, pelvis and perineum. It is aimed at medical and dental undergraduates and postgraduates for self-assessment. The document outlines the contents of the book, including preface and chapters on thorax, abdomen and pelvis/perineum regions. It introduces the authors and their credentials, as well as acknowledgements.
Human Anatomy is fundamental to every medical and healthcare professional. However, the science of anatomy and effects of stroke are also extremely useful to anyone interested in understanding more about the human body. In this course, you’ll gain an understanding of the basic concepts of anatomy and learn to ‘dissect’ the human body with a logical approach through
Human Anatomy is fundamental to every medical and healthcare professional. However, the science of anatomy and effects of stroke are also extremely useful to anyone interested in understanding more about the human body. In this course, you’ll gain an understanding of the basic concepts of anatomy and learn to ‘dissect’ the human body with a logical approach through
Abdomen MCQs with Answers Key (below)
(Anterior Abdominal Wall)
NOTE: For each of the following multiple choice questions select the one most appropriate answer:
1. Rectus Abdominus Muscle is divided in bellies by tendinous intersections. What is by far the most common configuration of the muscle bellies of the rectus Abdominus.
(A) 2 Bellies and symmetric
(B) 2 Bellies and asymmetric
(C) 4 Bellies and asymmetric
(D) 6 Bellies and symmetric
(E) 8 Bellies and symmetric
2. A person was stung by a bee in the left lumbar region. The nerves supplying the region accompany the branches of
(A) Musculophrenic Artery
(B) Anterior Intercostal Arteries
(C) Posterior Intercostal Arteries
(D) Superior Epigastric Artery
(E) Inferior Epigastric Artery
3. A patient comes to your clinic whom you operated for obstructed irreducible indirect Left Inguinal hernia one month ago. He says “It has been over four weeks from the surgery and I still have much discomfort. Inside of my thigh is numb, burns or simply hurts when touched. When I move in certain ways I get a stabbing pain in that area accompanied with a sensation of being bit by a bunch of wasps (Bees).” Which nerve is most likely damaged?
(A) Genital branch of Genitofemoral nerve
(B) Illioinguinal Nerve
(C) Cremasteric Nerve
(D) Illiohypogastric Nerve
(E) Subcoastal Nerve
4. This patient has more chances of developing which type of hernia in future
(A) Right Direct Inguinal Hernia
(B) Left Direct Inguinal Hernia
(C) Right Indirect Inguinal Hernia
(D) Left Indirect Inguinal Hernia
(E) Umbilical Hernia
5. During Laproscopic repair of Direct inguinal Hernia, the site of hernia will be located in
(A) Median Umbilical fold
(B) Medial Umbilical fold
(C) Medial Inguinal Fossa
(D) Lateral Inguinal Fossa
(E) Lateral umbilical Fold
6. Median Umbilical Fold
(A) Is a remnant of Urachus
(B) Is a remnant of Umbilical Artery
(C) Contains Inferior Epigastric Artery
(D) Is a remnant Umbilical Vein
(E) Contains Ductus Venosus
7. While operating for Indirect Inguinal Hernia there started an unusual rapid oozing of blood, which filled the site with blood. The Surgeon had to stop to control the bleed. Which artery is most likely injured?
(A) Inferior Epigastric
(B) Cremasteric
(C) Testicular
(D) External Illiac
(E) Internal iliac
8. You are examining a patient for Hernia during exam. The examiner asks you to differentiate between inguinal and Femoral Hernia. Your best response will be
(A) Femoral Hernia is above and medial to Pubic tubercle
(B) Femoral Hernia is below and medial to Pubic tubercle
(C) Femoral Hernia is above and Lateral to Pubic tubercle
(D) Femoral Hernia is below and Lateral to Pubic tubercle
(E) None of Above
9. A patient was diagnosed with Testicular Carcinoma (Seminoma). He comes to you and asks what stage is his cancer i
Slideshow is from the University of Michigan Medical School's M1 Cardiovascular / Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Cardio
Abdomen MCQs with Answers Key (below)
(Anterior Abdominal Wall)
NOTE: For each of the following multiple choice questions select the one most appropriate answer:
1. Rectus Abdominus Muscle is divided in bellies by tendinous intersections. What is by far the most common configuration of the muscle bellies of the rectus Abdominus.
(A) 2 Bellies and symmetric
(B) 2 Bellies and asymmetric
(C) 4 Bellies and asymmetric
(D) 6 Bellies and symmetric
(E) 8 Bellies and symmetric
2. A person was stung by a bee in the left lumbar region. The nerves supplying the region accompany the branches of
(A) Musculophrenic Artery
(B) Anterior Intercostal Arteries
(C) Posterior Intercostal Arteries
(D) Superior Epigastric Artery
(E) Inferior Epigastric Artery
3. A patient comes to your clinic whom you operated for obstructed irreducible indirect Left Inguinal hernia one month ago. He says “It has been over four weeks from the surgery and I still have much discomfort. Inside of my thigh is numb, burns or simply hurts when touched. When I move in certain ways I get a stabbing pain in that area accompanied with a sensation of being bit by a bunch of wasps (Bees).” Which nerve is most likely damaged?
(A) Genital branch of Genitofemoral nerve
(B) Illioinguinal Nerve
(C) Cremasteric Nerve
(D) Illiohypogastric Nerve
(E) Subcoastal Nerve
4. This patient has more chances of developing which type of hernia in future
(A) Right Direct Inguinal Hernia
(B) Left Direct Inguinal Hernia
(C) Right Indirect Inguinal Hernia
(D) Left Indirect Inguinal Hernia
(E) Umbilical Hernia
5. During Laproscopic repair of Direct inguinal Hernia, the site of hernia will be located in
(A) Median Umbilical fold
(B) Medial Umbilical fold
(C) Medial Inguinal Fossa
(D) Lateral Inguinal Fossa
(E) Lateral umbilical Fold
6. Median Umbilical Fold
(A) Is a remnant of Urachus
(B) Is a remnant of Umbilical Artery
(C) Contains Inferior Epigastric Artery
(D) Is a remnant Umbilical Vein
(E) Contains Ductus Venosus
7. While operating for Indirect Inguinal Hernia there started an unusual rapid oozing of blood, which filled the site with blood. The Surgeon had to stop to control the bleed. Which artery is most likely injured?
(A) Inferior Epigastric
(B) Cremasteric
(C) Testicular
(D) External Illiac
(E) Internal iliac
8. You are examining a patient for Hernia during exam. The examiner asks you to differentiate between inguinal and Femoral Hernia. Your best response will be
(A) Femoral Hernia is above and medial to Pubic tubercle
(B) Femoral Hernia is below and medial to Pubic tubercle
(C) Femoral Hernia is above and Lateral to Pubic tubercle
(D) Femoral Hernia is below and Lateral to Pubic tubercle
(E) None of Above
9. A patient was diagnosed with Testicular Carcinoma (Seminoma). He comes to you and asks what stage is his cancer i
Slideshow is from the University of Michigan Medical School's M1 Cardiovascular / Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Cardio
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Assalamualaikum everyone,
Here is the full curriculum of Anatomy of Spinal Cord Injury. This presentation was made by me at my student life where I have done a lot of researchs, findings and notes.
Please correct me if you find anything wrong by a responsive comment !
I wish you all the very best!
USMLE RESP 05 thoracic wall anatomy medical chest .pdfAHMED ASHOUR
The thoracic wall refers to the skeletal and muscular structures that form the outer boundary of the thoracic cavity, providing protection to the organs within the chest in addition to running vessels and nerves.
The thoracic wall plays a crucial role in protecting the vital organs of the chest, including the heart and lungs. The coordinated action of the ribs, sternum, muscles, and diaphragm allows for the expansion and contraction of the thoracic cavity during respiration. The bony and muscular structures also contribute to the overall stability and integrity of the chest region.
describes the muscles, nerves and vessels of arm region. it gives an overview to understand to basic anatomical aspect of arm region including cubital fossa.
This book is the compilation of Solved Questions with Explanation of AIAPGET2020 (Unani). This is the rule that
previously asked questions guide the aspirants in preparation of an examination. We hope this effort will be helpful for students preparing for PG (Unani) entrance
test. Compilation of this book was very tedious work, our near and dear one help us, we express our gratitude to all of them. We are extremely grateful to our family
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Dr. Shabistan Fatma Taiyabi
Dr. Sana Kauser Ateeque Ahmed
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
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Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
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Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
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Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
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Mcq abd thorax
1. MCQs in
Anatomy
An aid to revision and self assessment
Thorax
Abdomen
Pelvis and Perineum
First Edition
2. 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
5. 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.
6. 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
7. 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
8. 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
9. ________________________________________________________
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 4th 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
1
10. 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
11. 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
12. 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. The aortic opening in the diaphragm
A. lies anterior to the body of tenth thoracic vertebra
13. B. lies between the crura of the diaphragm
C. transmits the sympathetic trunk
D. transmits the vagus nerve
E. 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. The diaphragm is developed from the
A. ventral mesentery of oesophagus
B. dorsal mesentery of oesophagus
C. pleuroperitoneal membrane
D. pleuropericardial membrane
E. septum transversum
15. Derivatives of the septum transversum include
A. lesser omentum
14. B. Kupffer cells
C. ligamentum teres
D. falciform ligament
E. central tendon of the diaphragm
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 5th rib
C. The central tendon lies at the level of the xiphisternal joint
D. The hemiazygos vein passes through the right crus
15. 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 3rd costal cartilage
D. receives the hemi azygos vein
E. lies in the superior mediastinum
16. 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. Regarding the arch of the aorta
A. It commences at the level of the sternal angle
B. It is developed from the third left aortic arch
C. Left vagus nerve lies anterior to it
D. It forms the cervical constriction of the oesophagus
17. E. A cardinal sign in the coarctation of aorta is diminished femoral
pulse
23. The ascending aorta
A. is an elastic artery
B. is developed from the fourth left aortic arch
C. lies posterior to the root of the pulmonary trunk
D. is covered by the fibrous pericardium at its commencement
E. is stenosed in tetralogy of Fallot
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
18. B. superior vena cava
C. left atrium
D. left vagus nerve
E. right atrium
26. The trachea
A. is about 10 cm in length
B. lies in the midline through out its course
C. is supplied by the inferior thyroid arteries
D. has an epithelium derived from the endoderm of the foregut
E. is supplied by the recurrent laryngeal nerves
27. The pulmonary trunk
A. lies within the pericardial sac
B. divides at the fourth thoracic vertebral level
C. lies posterior to the transverse sinus
D. is stenosed in Fallot’s tetralogy
E. is developed from the truncus arteriosus
19. 28. 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. At the sternal angle
A. the first rib articulates with sternum
B. the aortic arch ends
C. the trachea bifurcates
D. the azygos vein enters the superior vena cava
E. 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
20. E. Common iliac vein is developed from the sacrocardinal
anastomosis
31. Veins draining into the right brachiocephalic vein include
A. vertebral
B. inferior thyroid
C. middle thyroid
D. external jugular
E. internal thoracic
32. Structures found in both superior and posterior mediastina are
A. oesophagus
B. trachea
C. thoracic aorta
D. phrenic nerves
E. vagi
Anterior mediastinum
21. 33. The thymus
A. lies in the anterior mediastinum
B. is developed from the 3rd branchial pouch
C. has lymphoid follicles
D. involutes after puberty
E. is supplied by the inferior thyroid artery
34. The thymus
A. is the only structure lying in the anterior mediastinum
B. has a blood supply from the internal thoracic artery
C. regresses soon after birth
D. contains Hassall’s corpuscles
E. lies in front of the left brachiocephalic vein
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
22. 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
23. 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. The right coronary artery
A. arises from the anterior aortic sinus
B. supplies blood to the sinu-atrial node
C. is accompanied by the great cardiac vein
D. causes an infarction at the apex of the heart if occluded
E. gives off the circumflex branch
41. The left atrium
A. forms the major part of the left border of the heart
24. B. lies behind the right atrium
C. has the oblique sinus posterior to it
D. lies anterior to the oesophagus
E. receives the four pulmonary veins
42. Regarding the development of the heart
A. The secondary septum completely divides the atrium
B. The septum spurium contributes to the formation of the
interatrial septum
C. The pulmonary arteries develop from the right horn of sinus
venosus
D. The right valve of sinus venosus gives rise to the valve of the
inferior vena cava
E. 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
25. 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 descending thoracic aorta are
A. third right posterior intercostal artery
B. musculophrenic artery
C. superior phrenic artery
D. superior intercostal artery
E. bronchial arteries
46. Regarding the thoracic part of the oesophagus
A. It lies posterior to the left bronchus
B. It lies anterior to the thoracic duct
26. 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. The oesophagus
A. is lined by the stratified squamous non keratininsed epithelium
B. is constricted by the right bronchus
C. lies posterior to the pericardium and the left atrium
D. passes through both superior and posterior mediastina
E. has an arterial supply from the left gastric artery
48. The right phrenic nerve
A. lies in the superior mediastinum
B. has the superior vena cava on its medial side
C. is posterior to the thoracic duct
D. passes through the caval opening in the diaphragm
E. supplies the fibrous pericardium
Lungs and Pleurae
49. The right lung
27. 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. The parietal pleura
A. extends superiorly up to the neck of the first rib
B. is attached to the mediastinal surface of the fibous pericardium
C. is developed from the splanchnic mesoderm
D. forms the pulmonary ligament
E. 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
28. 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.
29. 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 7th 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 2nd 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
30. 3.
A. False – The 3rd -11th arteries arise from the descending aorta. The 1st
and 2nd 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 vein-artery-
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.
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
31. abdominal wall as the subcostal nerve
B. True – Although the ribs develop from sclerotome the intercostal
muscles develop from the somatic mesoderm (body wall
muscles)
C. True – The muscle extends as far forwards as the costochondral
junction and continues as the anterior intercostal membrane
D. False – It is attached to the tubercle of the rib
E. 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 6th intercostal space by dividing
into superior epigastric and musculophrenic artery
E. False
32. 6.
A. True - The fibres of the external intercostal muscle are directed
downwards and forwards. The fibres of the internal intercostal
muscle are directed downwards and backwards
B. False - The intercostal nerves and vessels (neurovascular bundle) run
between the intermediate and innermost layers of muscles
C. 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)
D. False –They arise from the superior intercostal artery. Others arise
from the descending aorta
E. 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
33. tubercle lodges the subclavian artery
E. False – It articulates with the manubrium sterni. The 2nd 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)
34. 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
35. 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
36. 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
37. 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. True
C. True
D. False
E. True
15.
A. True – Derivatives of the septum transversum include the central
tendon of the diaphragm, falciform ligament, lesser omentum,
38. 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
39. 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
40. 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)
41. 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
42. 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
43. 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
44. 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.
45. 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
border of T4 vertebral level include the arch of the aorta, left
and right lungs and pleura, superior vena cava, trachea,
46. oesophagus, azygos vein, left superior intercostal vein, vagi
and right and left phrenic nerves
B. True
C. False
D. True
E. 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
47. 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.
48. 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
and the right principal bronchus into three lobar bronchi
E. 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
49. 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 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
B. False – The left brachiocephalic vein develops from the left
anterior
cardinal vein and anterior cardinal anastomosis
50. C. 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
D. False – The right renal vein has no embryonic vein of origin. The
subcardinal anastomosis gives rise to the left renal vein.
E. 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
51. 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
52. 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
53. 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
54. 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
55. 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)
56. E. False – The gastrosplenic ligament is a derivative of the dorsal
mesentery of the stomach and hence is not a foetal vessel
38.
57. A. True - The right border of the heart is formed by the right
atrium, the
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
B. 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
C. True – Both the sinuatrial and atrioventricular nodes are located
in
the wall of the right atrium
D. 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
E. True – The right atrium receives the superior vena cava, inferior
vena
cava and the coronary sinus
58. 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
59. 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
60. 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
61. 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
of the aorta. The arch ends at the fourth thoracic vertebral
level and the descending aorta begins at this level
B. True
C. False –The pericardiacophrenic artery arises from the internal
thoracic artery
D. False – It passes through the diaphragm at T12 vertebral level
E. 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
62. 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 4th 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
63. intercostal arteries (for 3rd -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
64. 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
65. 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
66. 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
67. 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
68. 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
69. 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 1-
1.5 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
70. 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
71. 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 10th 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
72. 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
73. 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
74. 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
75. 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. Components of the spermatic cord include
A. ilioinguinal nerve
B. vas deferens
C. genitofemoral nerve
D. appendix testis
E. 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
76. 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. The coeliac trunk
A. is the artery of the foregut
B. arises at the 10th thoracic vertebral level
C. gives off the splenic artery
D. supplies the entire oesophagus
E. 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 the superior mesenteric artery include
77. A. ileocolic
B. left colic
C. right gastric
D. gastroduodenal
E. inferior pancreaticoduodenal
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. The portal vein
A. is formed behind the neck of the pancreas
B. lies in front of the inferior vena cava
C. receives right and left gastric veins
D. ascends in the greater omentum
E. lies anterior to the bile duct
78. 72. Porto-systemic anastomoses occur at the
A. upper end of oesophagus
B. area around the umbilicus
C. anal canal
D. hilum of the spleen
E. transverse colon
73. The splenic vein
A. lies below the splenic artery
B. is derived from the left umbilical vein
C. ends behind the neck of the pancreas
D. receives short gastric veins
E. 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
79. E. Left colic artery supplies the proximal 1/3 of the transverse colon
75. Derivatives of the vitelline veins include
A. portal vein
B. inferior mesenteric vein
C. splenic vein
D. superior mesenteric vein
E. 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
80. 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 following is/are retroperitoneal
A. Ureter
B. Head of the pancreas
C. Ascending colon
D. Appendix
E. Spleen
79. Derivatives of the dorsal mesentery (dorsal mesogastrium) include
A. lienorenal ligament
81. 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
A. extends between the stomach and the liver
B. is attached to the greater curvature of the stomach
C. extends into the fissure for the ligamentum teres
D. forms the anterior boundary of the epiploic foramen
E. is developed from the ventral mesentery
82. Regarding the sigmoid mesocolon
82. 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
83. B. The duodenum rotates 90° clockwise
C. Mid gut loop rotates 90° anticlockwise at 6th 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 cells is/are mesodermal
A. Kupffer cells
B. APUD cells
C. Paneth cells
D. cells of the zona glomerulosa
E. hepatocytes
86. Abnormalities associated with a malrotation of the gut include
A. biliary atresia
B. Hirschprungs disease
C. annular pancreas
D. imperforate anus
E. vitelline fistula
84. 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 non keratinizing epithelium
E. The lesser sac lies posterior to the stomach
89. Structures forming the stomach bed include
A. Left kidney
B. Splenic artery
C. Body of the pancreas
D. Superior mesenteric artery
E. Lesser sac
85. 90. First part of the duodenum
A. lies on the transpyloric plane
B. is supplied by the celiac trunk
C. is anterior to the bile duct
D. is posterior to the gastroduodenal artery
E. is developed from the midgut
91. The jejunum differs from the ileum in having
A. a thicker wall
B. longer vasa recta
C. Peyer’s patches
D. more arterial arcades
E. broader windows
92. The caecum
A. is completely covered by the peritoneum
B. lies over the iliacus and psoas muscles
C. has taeniae coli
D. is supplied by the inferior mesenteric artery
E. has the lateral cutaneous nerve of the thigh anterior to it
86. 93. The second part of the duodenum
A. is covered in front with the peritoneum
B. runs in front of the hilum of the right kidney
C. is supplied by superior pancreaticoduodenal artery
D. is developed entirely from the foregut
E. has the bile duct opening in to its anterior wall
94. Meckel’s diverticulum
A. is found 2 feet distal to the ileocaecal junction
B. arises from the mesenteric surface of the ileum
C. is a persistent remnant of the vitellointestinal duct
D. contains renal and suprarenal tissue
E. occurs in about 20% of the population
95. Posterior relations of the 1st 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
87. 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 9th 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
88. 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
89. 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
90. 105. The spleen
A. Is developed from the dorsal mesogastrium
B. Has a notch in its anterior border
C. Lies beneath the 7th and 9th ribs
D. Has a lower pole extending upto the midaxillary line
E. 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
91. 108. The inferior vena cava
A. is formed at the fourth lumbar vertebral level
B. grooves the bare area of the liver
C. passes through the tendinous part of the diaphragm
D. receives the right suprarenal vein
E. 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. Tributaries of the inferior vena cava include
A. left fourth lumbar vein
B. left gonadal vein
C. right renal vein
D. left suprarenal vein
92. E. 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
93. 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
94. 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. Regarding the right ureter
A. It is retroperitoneal
B. It is crossed by the right ileocolic vessels
95. C. It receives an arterial supply from the renal arteries
D. The projection of the ureter on a radiograph is opposite the tips
of the transverse processes of upper lumbar vertebrae
E. It lies behind the fourth part of the duodenum
119. Regarding the suprarenal glands
A. They are symmetrical in shape
B. They are enclosed in renal fascia
C. Each gland is drained by three veins
D. 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
96. 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
97. 124. The adrenal cortex
A. has cells secreting androgens
B. is developed from the intermediate mesoderm
C. is supplied by the preganglionic sympathetic fibres
D. has cells having an abundance of smooth endoplasmic reticulum
E. has a rich reticulin fibre network
98. 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
99. 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
100. 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
101. 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
102. 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
103. 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
104. 60.
A. True – It arises by two heads: a medial from in front of the pubic
symphysis and a lateral from the pubic crest
B. False – The muscle is inserted on to the front of the 5th to 7th
costal
cartilages
C. 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
D. True – Typically three tendinous intersections are found in the
muscle, one at the umbilicus, one at the xiphisternum, and
one between these two
E. False – The rectus muscle and external obique muscle are both
supplied by the lower intercostal and subcostal nerves (T7-
T12). 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.
105. 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
106. 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
107. C. True
D. True
E. True
64.
A. False – Rectus abdominis and external oblique muscles are
supplied
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.
B. True
C. True
D. True
E. False
108. 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
at the first lumbar vertebral level
B. False – Bifurcation of the descending aorta is at the fourth
lumbar
vertebral level
109. C. 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
D. False – Bifurcation of the trachea is at the fourth thoracic
vertebral
level which is at the level of the manubriosternal joint (angle
of Louis)
E. 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
110. 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
111. 68.
A. True – It arises from the abdominal aorta a centimeter below the
origin of the celiac trunk at the L1 vertebral level
B. True - After airsing from the aorta the superior mesenteric artery
is
directed downwards behind the body of the pancreas and
splenic vein
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
112. 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.
113. 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.
114. 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 1st 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 porto-systemic
anastomoses:
(i) At the lower end of the oesophagus (oesophageal or
gastric varices) the oesophageal branches of the left gastric
115. vein (portal tributary) anastomoses with oesophageal veins
that drain into azygos and accessory azygos veins
(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
B. True
C. True
D. False
E. False
73.
A. True – The vein leaves the hilum of the spleen and passes in the
116. 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
117. 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 – 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
B. False
C. False
D. True
118. E. 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
119. 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
D. True – 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
120. 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 5th lumbar vertebra and the
sacrum) in front of the sacroiliac joint
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
121. 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
122. 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 L-shaped.
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
123. 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.
124. 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
125. 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. True- The midgut rotates 90° anticlockwise at the 6th week
intrauterine life and completes its rotation at the 10th week
intrauterine life by rotating another 180° anticlockwise
D. True
E. False – Physiological umbilical herniation occurs between 6th to
10th 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
126. 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 of the bile
duct.
B. Fasle - Hirschprungs disease is due to the absence of nerve plexus
(parasympathetic nerve cells) which develops from neural
crests.
C. 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
D. False – An imperforate anus occurs due to the non rupture of the