1. The terminal ends of the ilioinguinal nerves in the female are
referred to as:
Anterior cutaneous branches
Anterior labial
Cremasterics
Iliohypogastrics
2. The usual location for an appendectomy incision is the:
left lower quadrant
left upper quadrant
right lower quadrant
right upper quadrant
3. The inferior border of the rectus sheath posteriorly is called the:
Falx inguinalis
Inguinal ligament
Internal inguinal ring
Arcuate line
Linea alba
4. A medical student was asked by her preceptor to palpate the
margin of the superficial inguinal ring of a healthy male patient.
After passing her finger down the edge of the medial crus of the
superficial inguinal ring, she felt a bony protuberance deep to the
lateral edge of the spermatic cord, which she correctly identified as
the :
pecten pubis
pubic symphysis
pubic tubercle
iliopubic eminence
iliopectineal line
5. You were asked to assist in a surgical operation on a young
patient to treat an ulcer in the first part of the duodenum. You
would expect that the surgeon will approach the ulcer by doing an
anterior abdominal wall incision in the following region:
Epigastric
Left inguinal
Left lumbar
Right hypochondrial
Hypogastric
6. Following an emergency appendectomy your patient complained
of having paresthesia (numbness) of the skin at the pubic region.
The most likely nerve that has been injured during the operation is:
Genitofemoral
Iliohypogastric
Subcostal
Spinal nerve T10
Spinal nerve T9
7. An obstetrician decides to do a Caesarean section on a 25-yearold pregnant woman. A transverse suprapubic incision is chosen
for that purpose. All of the following abdominal wall layers will be
encountered during the incision EXCEPT the:
Anterior rectus sheath
Posterior rectus sheath
Rectus abdominis muscle
Skin and subcutaneous tissue
Transversalis fascia, extraperitoneal fat, and peritoneum
8. In order to reduce a hernia (return it to the abdominal cavity), a
surgeon finds it necessary to ligate an artery in the extraperitoneal
connective tissue (preperitoneal fat) running vertically just medial
to the bowel as the bowel passes through the abdominal wall. This
artery is the:
Deep circumflex iliac
Inferior epigastric
Superficial circumflex iliac
Superficial epigastric
Superficial external pudendal
9. The posterior layer of the rectus sheath ends inferiorly at the
Arcuate line
Intercrestal line
Linea alba
Pectineal line
Semilunar line
10.
Surgical approaches to the abdomen sometimes necessitate
a midline incision between the two rectus sheaths, i.e., through
the:
Linea aspera
Arcuate line
Semilunar line
Iliopectineal line
Linea alba
11.
The internal thoracic artery is sometimes surgically cut near
the caudal end of the sternum and used to supply blood to a region
of the heart. In these cases, maintenance of adequate blood flow
to the rectus abdominis may be dependent on increased flow
through which artery?
Superficial epigastric
Inferior epigastric
Umbilical
Superficial circumflex iliac
Deep circumflex iliac
12.
The normal pattern of venous and lymphatic drainage of the
superficial tissues of the anterior abdominal wall is arranged
around a horizontal plane. Above that plane, drainage is in a
cranial direction; below the plane drainage is in a caudal direction.
This reference plane corresponds to:
Transpyloric plane
Level of anterior superior iliac spines
Transtubercular line
Level of arcuate line
Level of umbilicus
1. The correct answer is:
anterior labial
The ilioinguinal nerves supply motor and sensory fibers to the abdominal
wall inferior to the umbilicus. What differentiates these nerves from the
iliohypogastric nerves is that the ilioinguinal nerves also innervate the
scrotum or labia by passing through the inguinal canal. These branches
are called the anterior scrotal or labial nerves. Anterior cutaneous
branches pretty much describes what these branches are, but there's an
answer here that is a little more specific. The genital branch of the
genitofemoral nerve innervates the cremaster muscle.
2. The correct answer is:
right lower quadrant
Since the appendix is located in the right lower quadrant, you would
probably want to make your incision there to remove it! The appendix is
the terminal portion of the cecum which has a small, dead-end lumen. It
is located just behind the cecum in the right internal iliac fossa.
Where are incisions made for other procedures? For a cholecystectomy
(gall bladder removal), there is an incision in the right upper quadrant.
(Or, this surgery can be performed laproscopically.) For a caesarian, a
transverse suprapubic incision (also called a Pfannenstiel incision) is
used. A midline incision, through the linea alba, may be used to repair
an aortic aneurysm.
3. The correct answer is:
arcuate line
The rectus sheath is a tough, tendinous sheath over the rectus
abdominis muscle. It covers the entire anterior surface of the rectus
abdominis. However, on the posterior side of the muscle, the sheath is
incomplete-- it ends inferiorly at the arcuate line. Below the arcuate line,
the rectus abdominis is covered by transversalis fascia, not the rectus
sheath! The linea alba is also related to the rectus abdominis--it is a
ligament that runs down the middle of the abdomen, bisecting the rectus
abdominis. It is made by the intermingling of the aponeuroses of the
external oblique, internal oblique, and transversus abdominis. It's a good
place to make a vertical incision.
All of the other answer choices are related to the inguinal canal. The falx
inguinalis (sometimes called the inguinal falx or conjoint tendon), is the
inferomedial attachment of transversus abdominis with some fibers of
internal abdominal oblique--it contributes to the posterior wall of the
inguinal canal. The inguinal ligament is the ligament that connects the
anterior superior iliac spine with the pubic tubercle--it makes the floor of
the inguinal canal. The internal (deep) inguinal ring is the entrance to the
inguinal canal, where the transversalis fascia pouches out and creates
an opening through which structures can leave the abdominal cavity.
4. The correct answer is:
pubic tubercle
The pubic tubercle is a bony process that would be felt lateral to the
edge of the spermatic cord at the superficial inguinal ring. (This is really
the only answer choice that could feel like a bony prominence when
palpated.)The pubic tubercle serves as the point of attachment for the
inguinal ligament, which makes up the floor of the inguinal canal. The
pubic pecten is the ridge on the superior surface of the superior pubic
ramus. This is the place where you find the pectineal ligament, a
thickening of fascia on the pecten of the pubis. The pectineal ligament is
a good place to put sutures when doing surgery. The pubic symphysis is
the joint between the two pubic bones. The iliopubic eminence is a bony
process on the pubis found near its articulation with the ilium. The
iliopectineal line is a line formed by the arcuate line of the ilium and the
pectineal line of the pubis. This line forms a plane that marks the
transition between the abdominal and pelvic cavity.
5. The correct answer is:
Epigastric
The epigastric region is one of the nine regions of the abdomen. It
contains the duodenum, part of the stomach, part of the liver, and the
pancreas. This is the region that the surgeon would need to enter to
reach the ulcer in the first part of the duodenum. The left inguinal region
contains the sigmoid colon. The left lumbar region contains the
descending colon and kidney. The right hypochondrial region contains
part of the liver and the gall bladder. Finally, the hypogastric region
contains the bladder and rectum. For a good picture of this, see the
dissector answer 1 for this lab.
6. The correct answer is:
Iliohypogastric
The iliohypogastric nerve is a branch of the lumbar plexus. It provides
sensory innervation to the skin of the lower abdominal wall, upper hip
and upper thigh. This is the region where the patient is experiencing
paresthesia, so this nerve must be injured. The genitofemoral nerve is
another nerve from the lumbar plexus. It provides sensory innervation to
the skin of the anterior scrotum or labia majora and upper medial thigh.
The subcostal nerve is the ventral primary ramus of T12--it is the
equivalent of an intercostal nerve at a higher thoracic level. It provides
sensory innervation to the anterolateral abdominal wall, but in an area
superior to the pubic region. A spinal nerve would not have been injured
in the operation. Remember--the spinal nerve is just that small segment
of nerve that exists once the dorsal and ventral rootlets come together,
before the dorsal and ventral primary rami branch off. In any case, the
T9 and T10 dermatomes are superior to the area where the patient is
experiencing paresthesia.
7.
The correct answer is:
Posterior rectus sheath
Remember - the transverse suprapubic incision (also called the
Pfannenstiel incision) is made below the arcuate line. So, there is no
longer a posterior layer of the rectus sheath, and the inner surface of the
rectus abdominis is lined only with transversalis fascia. When making
this incision, the abdominal wall layers are incised as follows: skin,
superficial fascia (fatty and membranous), deep fascia, anterior rectus
sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal
connective tissue, and peritoneum.
8. The correct answer is:
Inferior epigastric
The inferior epigastric vessels are found in the preperitoneal fat of the
abdomen. They lie just superficial to the peritoneum and form the lateral
umbilical fold. Hernias may pass lateral or medial to these vessels. If the
hernia is lateral to the vessels (which is what happened in this case), it is
an indirect inguinal hernia. If the hernia is medial to these vessels, it is a
direct inguinal hernia.
The deep circumflex artery courses along the iliac crest on the inner
surface of the abdominal wall. This artery is very lateral on the
abdominal wall, and hernias would pass medial to this vessel. The
superficial circumflex iliac, superficial epigastric, and superficial external
pudendal arteries are all superficial arteries that arise from the femoral
artery. They are all found in the superficial fascia--not in the
preperitoneal fat.
9. The correct answer is:
Arcuate line
The arcuate line is an anatomical feature on the inner surface of the
abdominal wall. It is the point at which the posterior lamina of the rectus
sheath ends and transversalis fascia lines the inner surface of rectus
abdominis. The intercrestal line is an imaginary line drawn in the
horizontal plane at the upper margin of the iliac crests. It is a landmark
used to find the L4 vertebra, which is useful when performing a spinal
tap. Linea alba is an aponeurotic band on the midline of the anterior
abdominal wall, which extends from the xiphoid process to the pubic
symphysis. It is formed by the combined abdominal muscle
aponeuroses, and it provides a useful site for a midline incision in the
abdomen. The pectineal line is a structural feature of the pubic bone. It
is an oblique ridge on the lateral part of the superior ramus. Finally, the
semilunar line is the lateral margin of the rectus abdominis, formed by
the fused aponeuroses of the abdominal wall muscles at the lateral
margin of the rectus sheath.
10. The correct answer is:
Linea alba
The linea alba is an aponeurotic band on the midline of the anterior
abdominal wall, which extends from the xiphoid process to the pubic
symphysis. It is formed by the combined abdominal muscle
aponeuroses. Because there are no major arteries or nerves running in
the linea alba, it provides a useful site for a midline incision in the
abdomen.
The linea aspera is a vertical ridge on posterior surface of the femur.
The arcuate line is the point at which the posterior lamina of the rectus
sheath ends, and transversalis fascia lines the inner surface of rectus
abdominis. The semilunar line is the lateral margin of the rectus
abdominus, formed by the fused aponeuroses of the abdominal wall
muscles. The iliopectineal line is a line on the pelvic bones, formed by
the arcuate line of the ilium and the pectineal line of the pubis. (Note--the
arcuate line of the ilium is totally different than the arcuate line of the
rectus sheath!) This line is important because it marks the boundary
between the abdominal cavity and the pelvic cavity.
11. The correct answer is:
Inferior epigastric
If the internal thoracic artery was ligated, blood would no longer flow to
the superior epigastric artery, which is the branch of the internal thoracic
that supplies blood to rectus abdominis. However, the superior epigastric
artery communicates with the inferior epigastric artery, a branch of the
external iliac artery. This means that blood could flow from the external
iliac, to the inferior epigastric, to the superior epigastric and the rectus
abdominis. The superficial epigastric and superficial circumflex iliac
arteries are two superficial branches of the femoral artery. They do not
supply deep structures in the abdomen. The distal portions of the
umbilical arteries are obliterated in adults--they are the medial umbilical
ligaments that form the medial umbilical folds. The deep circumflex iliac
artery courses along the iliac crest on the inner surface of the abdominal
wall. It is too lateral to supply blood to rectus abdominis.
12. The correct answer is:
Level of umbilicus
The umbilicus is an important landmark for venous and lymphatic
drainage of the abdominal wall. Above the umbilicus, lymphatics drain
into the axillary lymph nodes and the venous blood drains into the
superior epigastric vein, which drains to the internal thoracic vein. Below
the umbilicus, lymphatics drain into the superficial inguinal lymph nodes,
while venous blood drains into the inferior epigastric vein and the
external iliac vein.