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CHAPTER 6: ABDOMEN

1. The femoral canal contains which of the following structures?

a. The femoral artery
b. The femoral vein
c. The femoral branch of the genitofemoral nerve.
* d. Connective tissue and lymph nodes.
e. The great saphenous vein

2. Indirect inguinal herniae, find the FALSE statement:

* a. Pass through the Hesselbach's triangle.
b. Are more common in males.
c. Are often congenital
d. Pass through the deep inguinal ring.
e. Lies inferior and lateral to the pubic tubercle.

3. The following structures constitute the posterior abdominal wall except:

a. Quadratus lumborum muscle
* b. Branches of internal mammary artery
c. Thoracolumbar fascia
d. Erector spinae muscle
e. Lumbar plexus of nerves.

4. Which of the following is retroperitoneal:

a. Transverse colon
b. Caecum
* c. Ascending colon
d. Sigmoid colon
e. Appendix.

5. Regarding the deep inguinal ring, find the TRUE statement.

a. An opening in transversus abdominis.
* b. Is oval shaped.
c. Is about 4 cm long.
d. Is the same as mid inguinal point.
e. Lies just above half way between anterior superior iliac spine and pubic
symphysis.

6. Between the level of the anterior superior iliac spine and symphsis pubis, which muscle
forms a sheath around rectus abdominis:
a. External oblique.
b. Internal oblique.
c. Transversus abdominis.
d. All the above
* e. None of the above
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7. Which of the following is not a content of the female inguinal canal:

a. Ilio inguinal nerve.
b. Genital branch of genitofemoral.
c. Remnants of processus vaginalis.
d. Round ligament of uterus.
* e. Pampiniform plexus.

8. Transpyloric plane lies at level of:

a. T12 - L1
* b. L1 - L12
c. L2 - L3
d. L3 - L4
e. L4 - L5

9. The dermatome of the region of the umbilicus is:

* a. T10
b. T11
c. T1
d. T9
e. T8

10. On herniae, find the FALSE statement:

a. Incisional herniae are more common in the lower abdomen than upper abdomen.
* b. Incisional and interstitial herniae are the same.
c. Congenital umbilical hernia started as omphalocoele in the foetus.
d. Epipheliazation made a difference between congenital umbilical herniae and
omphalocoele.
e. Oesophageal hiatus hernia can be both congenital and acquired diaphragmatic
hernia.

11. Nerve supply to the external oblique is:

a. From T7 - T11
b. From T6 - T12
c. From T5 - T11
d. From T7 - T12
* e. From T7 - T12 and L1

12. The lumbar triangle of Petit:

* a. Is behind the free posterior border of the external oblique.
b. Has its floor made by the internal oblique and transversus abdominis:
c. Anterior border is made by the anterior border of latissimus dorsi.
d. All the above apply.
e. None of the above.
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13. The inguinal ligament (Poupart's ligament):
a. Extends from the anterior superior iliac spine to the pubic tubercle.
b. Its lateral part gives the origin to part of internal oblique and transversus
abdominis.
c. Is attached to the fascia lata.
* d. All the above.
e. None of the above

14. Regarding the rectus sheath:

a. It has both anterior and posterior layers running same lengths.
*b. It is contributed to by the aponeuroses of the external oblique, internal oblique
and the transverse abdominis.
c. In the midline it forms the linea alba which runs with the same consistent strength
throughout its entire length.
d. All the above.
e. None of the above

15. Regarding the inguinal canal:

a. Its anterior wall is formed by the external oblique aponeurosis.
b. Its floor is formed by the inguinal ligament and lacunar ligament.
c. Conjoint tendon forms part of the posterior wall.
* d. All the above.
e. None of the above

16. The mid inguinal point:

a. Is a point half way the inguinal ligament.
b. Is a point half way between the pubic tubercle and the anterior inferior iliac spine.
* c. Is a point half way between the pubic symphysis and anterior superior iliac spine.
d. Is a point half way between the pubic tubercle and the anterior superior iliac
spine.
e. None of the above.

17. The lateral umbilical fold on each side is created by underlying:

a. Falx inguinalis.
* b. Inferior epigastric artery.
c. Lateral border of the rectus sheath.
d. Obliterated umbilical artery.
e. Urachus.

18. The median umbilical ligament is the remnant of.

a. The umbilical arteries
* b. The urachus
c. The umbilical vein
d. The ductus arterosus
e. The septum primum
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19. Which of the following structures enters the deep inguinal ring?
* a. The round ligament of the uterus
b. The uterine tubes.
c. The suspensory ligament of the ovary
d. The mesosalpinx
e. The mesovarium

20. Lumbar plexus of nerves supplies the following muscles except:

a. Psoas major
b. Quadratus Lumborum
c. Transversus abdominis
d. Iliacus
* e. (c) and (d)

21. The following structures are found in the right iliac fossa except:
a. Appendix
b. Right ovary
* c. Base of urinary bladder
d. Caecum
e. Ileo-caecal junction.

22. The following imaginary lines or planes are used to divide the anterior abdominal wall
into 9 regions or zones except:
a. Transpyloric plane
b. Intertubercular plane
c. Midclavicular lines
* d. All the above
e. None of the above.

23. Which of the following statements concerning the rectus sheath is FALSE:
a. The anterior wall of the rectus sheath above the umbilicus above the costal margin
is formed by aponeurosis of the external oblique.
*b. The posterior wall below the umbilicus between the level of anterior superior iliac
spine and the pubis is formed by the aponeurosis of all three muscles.
c. The inferior epigastric vessels enter the rectus sheath at the arcuate line.
d. The neurovascular bundle of the anterior abdominal wall are found in the plane
between the internal oblique and transversus muscles.
e. The nerve supply to the anterior abdominal wall is from T7 to L1.

24. Lymphatic drainage from the anterior abdominal wall can flow to the following except:
a. Pectoral group of lymph nodes
* b. Superficial and deep inguinal group
c. Porta hepatis
d. Posterior mediastinum
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e. Para-aortic nodes.

25. Laterally, the inguinal ligament attaches to the:

* a. Anterior superior iliac spine
b. Anterior inferior iliac spine
c. Crest of the ilium
d. Ischial spine
e. Tubercle of the iliac crest

26. The linea alba is:

a. The white line around the iris of the elderly people.
b. The light reflex of the tympanic membrane.
c. Formed by the fusion of the eighth, ninth and tenth costal cartilage.
d. A reflection of the inguinal ligament.
*e. Formed by the midline fusion of the aponeuroses of the anterolateral abdominal
wall muscles.

27. Which of the following statement about the peritoneum is FALSE?

a. It is a serous membrane
* b. It is a closed sac in both the male and female
c. It has parietal and visceral portions that are continuous.
d. It is present in both abdominal and pelvic cavities.
e. Peritoneum secretes some amount of serous fluid

28. Failure of the processus vaginalis to close can result into all the following except:
* a. Direct inguinal hernia
b. Vaginal hydrocele
c. congenital hydrocele
d. Indirect inguinal hernia
e. Infantile hydrocele

29. Which of the following statements is TRUE about the ilio-inguinal nerve:
a. Has lateral cutaneous branch
b. It accompanies the round ligament of ovary
c. It traverses both the deep and superficial inguinal lungs.
* d. Innervates the labia major
e. Its derived from the dorsal division of L1.

30. The medial umbilical ligament is a remnant of:

a. Covers the inferior epigastric vessel
b. Remains of urachus
* c. Obliterated umbilical arteries
d. Remains of the umblical veins
e. None of the above.
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31. Tendinous intersections lie in anterior part of rectus abdominis, at the following levels:
a. Xiphisternum
b. Umbilicus
c. Between umbilicus and xiphisternum
* d. All the above
e. None of the above

32. Concerning the anterior abdominal wall, which of these statements is FALSE:
a. Linea semilunaris meets the costal margin at tip of T9.
b. Linea alba is avascular
*c. Tendinous intersections fuse with aponeuroses on the posterior surface of the
muscles of anterior abdominal wall.
d. Transtubercular plane is synonymus with the level of L5.
e. Surface marking for the appendix is at junction of the lateral third and medial two
thirds on the line drawn from ASIS to umbilicus.

33. At the level of the transpyloric plane, the anterior wall of the sheath of the rectus
abdominis muscle receives contributions from the:
* a. Aponeuroses of the internal and external oblique muscles.
b. Aponeuroses of the transversus abdominis and internal oblique muscles.
c. Aponeuroses of the transversus abdominis, internal and external oblique muscles.
d. Transversalis fascia.
e. Transversalis fascia and aponeourosis of the transversus abdominis muscle.

34. Superior epigastic artery anastomoses with the following artery:

a. Deep circumflex iliac artery.
* b. Inferior epigastric artery.
c. Intercostal arteries
d. Internal thoracic artery.
e. Musculophrenic artery.

35. The boundaries of the femoral ring include all the following except:
* a. Femoral nerve.
b. Femoral vein
c. Inguinal ligament
d. Lacunar ligament
e. Pectineal ligament

36. McBurney's point:

a. Is half way the line from the umblicus to the anterior superior iliac spine.
b. Is half way the line from the anterior superior iliac spine to the pubic symphisis.
*c. Is a third way on an imaginary line from the anterior superior iliac spine and the
umbilicus.
d. Is found at the sternal angle of Louis.
e. None of the above.
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37. The lower six intercostal nerves supply:

a. Intercostal muscles.
b. Intercostal and abdominal muscles.
c. Intercostal and abdominal muscles and overlying skin.
* d. All of the above structures together with the underlying parietal peritoneum.
e. All the above structures, together with both the parietal and visceral layers of the
peritoneum.

38. The nerves to anterior abdominal wall T7-L1; run between:

a. Superficial and deep fascia.
b. Deep fascia and external oblique.
c. External oblique and internal oblique.
* d. Internal oblique and transversus abdominis.
e. Transversus abdominis and transversalis fascia.

39. The abdomen can be said to be beautifully designed to accomodate the organs it contains
and fulfil their various function because of:
* a. Arrangement of its muscle layers.
b. Presence of tough aponeurotic fibres that fuse in the midline.
c. Segmental nerve distribution which normally overlaps.
d. Presence of semi-rigid spine posteriorly.
e. Being an inexpansible.

40. Peritoneal fluid is produced by:

a. Blood vessels.
b. Lymph nodes
c. Lymphatic duct
d. Nerve fibres
* e. Peritoneum

41. The following are TRUE except:

a. Relaxation of the abdominal muscles allows accommodation of a full term with
5kg foetus.
b. Tight wall keeps organs in place.
c. Abdominal muscles participate in respiration.
d. Raised intra-abdominal pressure is necessary for normal micturation.
* e. All the above.

42. Regarding the scarpa's fascia, the following is TRUE except:

* a. Represents the deep fascia of the anterior abdominal wall.
b. Its upper limit is at T.5
c. Is tightly attached to the iliac crest and inguinal ligament.
d. Its lowest attachment to the perineal body.
e. It is the colles fascia in the scrotum.
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43. The conjoint tendon is formed by:

a. The aponeurosis part of the internal oblique.
b. Medial fibres of the external oblique
c. Aponeurosis of the transversus abdominis.
d. All of the above
* e. (a) and (c)

44. The following peritoneal folds are found in the upper abdominal cavity except:
a. Falciform
b. Ligament teres
c. The embryological remnant of ligamentum venosum
d. Left triangular ligament
* e. Median umbilical ligament.

45. The following lie within the mesentery:

a. Blood vessels
b. Lymph nodes
c. Lymphatic duct
d. Nerve fibres
* e. All of the above

46. The following refer to the abdomen except:

a. Lined by three major muscles anterolaterally.
b. Extend from rib case to pelvis.
* c. Laterally borded by quadratus lumborum muscles.
d. Has rectus abdominis muscles medially.
e. Segmentally innervated from T.7 - T.12 and L.1

47. In GIT surgery, one can avoid complication by:

a. Making sure that the bowel layers are precisely approximated.
b. Leaving no holes.
c. Avoiding too many sutures.
d. Avoiding tension at anastomotic site.
* e. All the above.

48. The following is TRUE of the rectus sheath except:

a. It is made up of an anterior and a posterior layer.
b. The posterior layer is shorter than the anterior layer.
c. The sheath is open at both ends.
d. There is no blood supply to the sheath.
* e. Some parts of the sheath are muscular.

49. Testicles drain their lymph to:

a. Superficial inguinal nodes.
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b. External iliac nodes.
* c. Lumbar nodes.

d. Deep inguinal nodes.

e. None of the above.

50. Drainage of a hydrocele, one goes through the following structures except:
a. Dartos muscle.
b. Cremasteric fascia.
c. Internal spermatic fascia.
* d. Tunica Albuginea.
e. Parietal layer of tunica vaginalis.

51. Tunica vaginalis covers the testes over all these areas except:
* a. Posterior to the testis.
b. Anterior to the testis.
c. Lateral to the testis.
d. Inferior to the testis.
e. Medial to the testis.

52. The cremaster muscle and its fascia are:

a. Smooth muscle
b. Derived from the external abdominal oblique muscle
* c. Derived from the internal abdominal oblique muscle.
d. Derived from the transversus abdominis muscle.
e. Derived from both external and internal oblique muscles.

53. All these wall structures contribute directly to the coverings of the spermatic cord except:
a. External oblique muscle.
b. Scarpa's fascia.
c. Internal oblique muscle
* d. Rectus sheath
e. Transversalis fascia.

54. In addition to the vas deferens, structures normally found within the spermatic cord
include all the following except
a. Vas deferens artery.
b. Sympathetic nerves
c. Pampiniform plexus
d. Testicular artery
* e. Round ligament.

55. The following are TRUE regarding the ventral mesentery except:
a. Exists only in the region of the terminal part of the oesophagus, the stomach and
the upper part of the duodenum.
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b. Is derived from the septum transversum.
c. Develops into lesser omentum.
d. Develops into falciform ligament.
* e. All of the above

56. The following statements about physiological herniation are TRUE except:
a. The cephalic limb of the primary intestinal loop elongates more than caudal end.
b. Expansion of liver in 5th week contributes more than the cephalic limb.
c. The intestinal loops enter the extra-embryonic coelom.
* d. In the 6th week intestinal loops return to the abdominal cavity.
e. None of the above.

57. All the following statements regarding gastroschisis are TRUE except:
a. Refers to herniation of abdominal contents into the chorionic cavity.
* b. Has herniated abdominal contents covered by amnion.
c. Occurs with a frequency of 1 in every 10,000 births.
d. Frequency of occurance increases with use of cocaine.
e. Occurs lateral to the umbilicus.

58. The following are TRUE regarding Apple peel atresia except:
a. Accounts for 10% of intestinal atresia.
b. Is located in the proximal part of jejunum.
c. The intestine is shorter than normal..
d. Babies with the defect have low birth weight.
* e. All the above.

59. In infantile pyloric stenosis the following is TRUE except:

a. Most victims are first born males.
b. There is projectile vomiting
c. No bile in the vomitus.
d. There is always a palpable mass on feeding.
* e. It is always due to hypertrophy of both circular and longitudinal muscles.

60. The following are anatomical developmental anomallies except:

a. Annular pancreas
b. Duodenal atresia
* c. Tubular gastric lumen
d. Oesophageal achalasia
e. Pyloric stenosis.

61. Regarding the histology of the stomach, the following are TRUE except:
a. The cardia consists of epithelial cells that predominantly secrete mucus.
b. The fundus contains mucus secreting and digestive juices.
* c. The body secretes mucus, hydrochloric acid and gastrin.
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d. The pyrolus produces mucus and gastrin.
e. Mucus is produced by the entire epithelium of the stomach.

62. The major blood supply to the stomach include the following except:
a. The short gastric arteries
b. The left gastric artery
c. The right gastric artery.
d. The left gastro-epiploic artery
* e. The gastro-duodenal artery.

63. The stomach bed is comprised of the following except:

a. Spleen
b. Upper pole of the left kidney
c. The left suprarenal
* d. Transverse colon
e. Upper part of pancreas with all its associated blood vessels.

64. The short gastrics branch from:

* a. Splenic artery.
b. Left gastric artery.
c. Left gastro duodenal artery.
d. Coeliac trunk.
e. Pancreatico duodenal.

65. The following is TRUE about oxyntic cells.

a. Secrete pepsin.
* b. Are most numerous in the middle portion of the gastric part.
c. Have an extensively Basophillic cytoplasm.
d. Are small rounded cells.
e. None of the above.

66. The following statements concerning gastric ulceration are TRUE except:
* a. Gastric ulcers on the greater curve are always benign.
b. Secretion of acid and pepsin are linked so that their outputs rise and fall in
parallel.
c. Gastric ulcers are associated with either normal or hyposecretion of acid.
d. Regarding duodenal ulcers, most patients, although by no means all, have gastric
hypersecretion of acid.
e. Gastric ulcers are more common on the lesser curve than on the greater curve.

67. The following statements regarding cancer of the stomach are TRUE except:
a. Malignancy is a complication of both duodenal and gastric ulcer.
b. Barium meal can differentiate the different types of gastric neoplasms.
c. The most common site for the neoplasm is in the prepyloric region.
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*d. Lymphatic spread of gastric cancer to the ovaries gives rise to Krukenberg's
tumours.
e. Weight loss after gastric operations is due to reduced intake of food and the
diminished absorption.

68. The proximal gastric unit comprises:

a. The lower third of the stomach.
b. 0.5 - 2.5 cm of abdominal oesophagus.
c. The abdominal oesophagus, fundus and body of stomach.

d. Body and antrum of stomach.

* e. Fundus and body of stomach.

69. The Magenstrasse, find the TRUE statement:

* a. Is produced by contraction of the oblique coat of the stomach.
b. Is a pathway along the greater curvature.
c. Does not facilitate water going directly to the duodenum.
d. Does not exist in anatomical history.
e. Opens up the body and the greater curvature during ingestion of fluids.

70. Find the TRUE statement on gastro-oesophageal junction.

a. Has a functional though not obvious anatomical sphincter
b. The left 7th costal cartilage is its external landmark.
c. Has the same epithelium on both sides.
d. Lies at the level of T10
* e. All the above.

71. During inspiration, the following take place:

a. Negative intrathoracic pressure
b. Widening of IVC opening
c. Narrowing of the oesophageal hiatus
d. Collapse of gastric wall
* e. (a), (b) and (c).

72. Generous anastomotic blood supply to the stomach is generally believed to be due to:
a. It is the largest viscus in the GIT so it requires a lot of blood supply to enhances
its functions.
b. Good blood supply is essential for pepsin secretion.
c. It protects the viscus from being over distended in case one over feeds.
d. In order for adequate acid production high oxygenation is mandatory.
* e. (a), (b) & (d).

73. The oesophageal opening into the stomach is at the level of:
a. L1
b. L2
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c. T12
d. T11
* e. None of the above.

74. On the vermiform appendix, which of the statements is FALSE:

a. Has a variable position but is most commonly retrocaecal.
b. Is closely related to the right psoas major muscle
* c. Has three taeniae coli
d. Is supplied by a branch of the ileocolic artery.
e. Contains lymphatic aggregations especially in infants.

75. The following are the derivatives of the midgut except:

a. Vermiform appendix
b. Jejunum
c. Duodenum
d. Hepatic flexure
* e. Splenic flexure of the colon

76. Appendicular artery is a branch of:

a. Middle colic
b. Right colic
* c. Posterior caecal artery
d. Anterior caecal artery
e. Superior mesenteric artery.

77. Which is not a feature of the jejunum as compared to ileum:

* a. Presence of Peyer's patches.
b. Fat far from gut.
c. Bigger diameter.
d. Numerous plica circularis.
e. Clear mesentery.

78. The commonest position of the appendix is:

a. Pelvic
b. Sub ceacal
c. Pre ileal
* d. Retroceacel
e. Post ileal

79. What is FALSE about first part of duodenum:

a. Has the duodenal cup.
b. Crossed by prepyloric vein of Mayo.
* c. Is retroperitoneal.
d. Common site for duodenal ulcers.
e. Gets blood from gastro duodenal artery.
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80. Regarding the coeliac artery, find the TRUE statement:

a. It supplies the foregut and midgut.
* b. All the blood that supplies the stomach comes from the artery.
c. Arises from the front of the aorta at the level of T10.
d. It is separated from the superior mesenteric artery by a length of 4 cm.
e. All the above apply.

81. Regarding Peyer's patches, find the FALSE statement:

a. They are located in the lower reaches of the ileum.
b. They lie on the antimesenteric border of the ileum.
c. They lie with their long axes lying longitudinally along.
d. A few are present in large intestine.
* e. (a), (b) and (c).

82. Regarding lymph drainage of the appendix:

a. The lymph passes through the muscle wall into nodes in the meso appendix.
b. The meso appendix nodes drain into the paracolic nodes.
c. All the lymph ultimately drains into the superior mesenteric group of nodes.
* d. All the above apply.
e. Only (a) and (c) apply.

83. The duodenum, find the TRUE statement:

* a. Has villi covered with columnar epithelium.
b. The whole of the muscularis mucosa is packed with the Brunner's glands.
c. Its whole length is retroperitoneal
d. Receives the opening of the bileduct and main pancreatic duct 20 cm from the
pylorus.
e. All the above.

84. Meckel's diverticulum, find the TRUE statement:

a. Is present in 2% of individuals.
b. Is located 60cm from the caecum.
c. Has a very variable length.
d. Is always a blind ending sac.
* e. All the above.

85. The vermiform appendix is best located by which of the following:

a. Anterior anal artery.
b. Descending branch of the right colic artery.
c. Ileum to the ileocolic juncture.
d. Posterior cecal artery.
* e. Teniae coli of the ascending colon.

86. Which of the following structures is associated with the small intestine?
 15
a. Taenia coli
* b. Mesentery
c. Sacculations
d. Epiploic appendages
e. Haustra coli

87. The following statements are TRUE except:

a. The ileocaecal valve prevents reflux of caecal contents into the terminal ileum.
* b. McBurney's point represents the surface Anatomy of the tip of the appendix.
c. Initial pain of appendicitis is felt at the umbilical area.
d. The somatic nerve supply of the parietal peritoneum around the base of appendix
is from T12.
e. Appendicular artery is a branch of posterior caecal artery.

88. The following statements on the root of the mesentery are TRUE except:
a. Begins at the pyloric end of the stomach.
* b. Crosses the horizontal part of the duodenum.
c. Contains a branch of the coeliac trunk.
d. Crosses the left ureter.
e. Ends at L1.

89. All the following are TRUE of the first part of the duodenum except:
* a. Terminates at the neck of the gall bladder.
b. Is the most mobile part.
c. Is derived from Foregut.
d. Is a common site for ulcers.
e. Commences in the transpyloric plane.

90. The duodenojejunal flexure:

a. Lies in the transpyloric plane
b. Is guarded by a sphincter
* c. Bounds a paraduodenal peritoneal recess
d. Is marked by a nerve
e. (b) and (c).

91. Find the TRUE statement on annular pancreas:

a. Oddi's sphincter surrounds the ampulla of Vater
b. Annular pancreas is due to failure of complete rotation of the dorsal segment of
the pancreas.
c. The majority of patients with symptoms of annular pancreas are infants.
d. The best treatment is excision of the annular pancreas.
* e. Sometimes duodeno-duodenostomy is the ideal treatment.

92. Meckel's diverticulum is a result of:

a. Improper retraction of herniated intestinal loops.
 16
b. Congenital umbilical hernia.
c. Abnormal rotation of the primitive intestinal loop.
* d. Persistence of a portion of the vitelline duct.
e. Remnants of the yolk sac.

93. Failure of the intestinal loops to return to the abdominal cavity forms:
a. A congenital umbilical hernia.
b. A vitelline cyst.
* c. An omphalocele
d. Eventration of the abdominal viscera.
e. Left sided colon.

94. In the embryo all of the gut tube is supported by a mesentery some of which is obliterated
in the adult. All of the following adult structures are supported by a peritoneal mesentery
except the:
a. Transverse colon
b. Stomach
c. Ileum
d. Jejunum
* e. Descending colon

95. The first part of the duodenum:

* a. Is in contact with the common bile duct.
b. Is entirely retroperitoneal in position.
c. Is suspended by the ligament of Treitz.
d. Receives only secretions produced by the liver.
e. Runs to the right and forward.

96. The myenteric plexus (of Auerbach) is located:

a. External to the longitudinal layers of the muscularis externa.
b. In the submucosa of the bowel.
* c. Between the circular and longitudinal layers of the tunica muscularis.
d. In the epithelial layer of the bowel.
e. In the mucosa layer of the bowel.

97. The inferior boundary to the foramen of Winslow is formed by:

a. Hepatic artery
b. Caudate process
c. Portal vein and bile duct
d. Inferior vena cava
* e. First part of duodenum

98. All are anterior relations of the descending part of the duodenum except:
a. Right lobe of the liver
b. Fundus of gall bladder
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* c. Superior mesenteric artery
d. Transverse colon
e. Coils of small intestine

99. Regarding the length of the duodenal parts, the following are TRUE except:
* a. The total length of the duodenum is 30 cm
b. The first part is 5cm long
c. The second part is 8cm long
d. The third part is 8cm long
e. The fourth part is 5cm long

100. The mesentery of the appendix has an attachment to the following except:
a. Caecum
* b. Ascending colon
c. Terminal ileum
d. Meso ileum
e. Appendix

101. The Vermiform Appendix is characterised by:

a. A large amount of villi
* b. A large amount of lymphoid tissue in the mucosa.
c. A prominent muscularis mucosae.
d. Taenia cali.
e. None of the above.

102. The duodeno-jejunal junction is marked by:

a. Emerging of the small bone from the retroperitoneal space.
b. Ligament of Treitz which is found there ascends to the left crus of the diaphragm
to hold the junction in place.
* c. This junction is fixed to the left psoas fascia by a fibrous band.
d. Superior mesenteric artery originates.
e. The head of the pancreas is above it.

103. Pre-pyloric vein of Mayo is important surgically because:

a. It is the major blood drainage from the gastric antrum.
b. It runs from the lesser curvature to the duodenum.
c. It must be spared at all costs.
d. It is absent in some people.
* e. None of the above.

104. The 4th part of the duodenum:

a. Extends between T12 and L3
* b. Is supplied by jejunal branches of the superior mesenteric artery.
c. Is pierced by the common duct formed by the pancreatic and bile duct.
d. Has duodenal papilla in the anterior luminal wall.
 18
e. Its anterior part is retroperitoneal.

105. The anatomical junction of foregut and midgut is indicated by:

a. The duodeno-jejunal flexure
b. The ileo-caecal junction
c. The left colic flexure
d. The right colic flexure
* e. The common opening of the common bile duct and the main pancreatic duct

106. Regarding the hindgut, find the FALSE statement:

a. Gives rise to the distal third of the transverse colon.
*b. Undergoes a 90o rotation to place the descending colon on the left side of the
abdominal cavity.
c. The endoderm also forms the internal lining of the bladder and urethra.
d. The terminal portion enters into the cloaca which is an endoderm-lined cavity.
e. Is partly vascularised by the inferior mesenteric artery.

107. On the large gut, find the TRUE statement:

a. Marginal artery of Drummond is a branch of superior mesenteric artery.
b. Hepatic portal vein is formed in most cases by union of superior mesenteric,
inferior mesenteric and splenic veins.
c. Vagus nerve supplies the gut down to the sigmoid colon.
*d. Twisting (Volvulus) of the large gut is only possible to those parts (of the gut)
which have a mesocolon.
e. The lymphatic drainage of the colon and rectum enter thoracic duct directly from
aortic nodes

108. Which of the following statements is TRUE:

a. The right and left paracolic gutters communicate.
b. Referred pain from acute appendicitis is first felt in the right iliac fossa.
c. Supra colic compartment communicates with the infracolic compartment through
the epiploic foramen.
* d. The fundus of the gall bladder lies opposite the tip of 9th costal cartilage.
e. The 4th part of duodenum extends into the gastrosplenic omentum.

109. Parasympathetic nerve supply to the sigmoid colon is derived from:

a. Coeliac plexus.
b. The vagus nerves.
* c. Superior hypogastric plexus.
d. Lumbo sacral plexus.
e. Inferior hypogastric plexus.

110. Regarding the sigmoid colon, find the FALSE statement:

a. Is about 25 - 38 cm long though great variations is common.
b. Begins at the pelvic brim.
 19
c. It has a mesocolon whose root resembles an inverted letter V.
d. The left ureter lies beneath the floor of the sigmoid colon.
* e. All the above.

111. Which part or parts of the rectum is/are covered by the peritoneum?
a. Anterior surface of the whole length.
b. Posterior surface of the whole length.
c. The anterior and lateral surfaces of the first third.
d. Anterior surface of the middle third.
* e. (c) and (d).

112. All the following have a mesentry except:

a. The fourth part of the duodenum.
b. The sigmoid colon.
c. The vermiform appendix.
* d. The caecum.
e. The transverse colon.

113. On the large intestines, find the TRUE statement:

a. The blood supply to the descending colon comes largely from the blood supply of
midgut.
b. The nerve supply to the descending colon is from the vagus nerve.
c. The mesocolon is restricted to the caecum, transverse and sigmoid colons.
d. Some essential vitamins are synthesized in the large colon.
* e. The lumen of the ascending colon is bigger than that of the descending colon.

114. The inferior mesenteric vein:

a. Ends by draining into the inferior vena cava.
b. Drains blood from right and left colic flexures.
* c. Begins as a continuation of the superior rectal vein.
d. Lies to the right of the inferior mesenteric artery.
e. Ends by draining into the left renal vein.

115. Teniae coli:

a. Are condensed bands of peritoneum
b. Plays an active part in peristalsis.
c. Are present in the rectum.
d. Bind the descending colon to the posterior abdominal wall.
* e. None of the above.

116. Rotation of the primitive intestinal loop:

a. Occurs about the coeliac axis.
* b. Occurs in a counterclockwise direction and amounts to approximately 270o.
c. Is completed prior to umbilical herniation of the intestinal loops.
d. Occurs prior to elongation of the intestinal loop.
 20
e. Involves only the jejunum and ileum.

117. Atresia and stenosis of the gut result from the following except:
a. Volvulus of the intestinal loops.
b. Improper recanalization of the gut tube.
* c. Constriction by the dorsal mesentery.
d. Improper gut rotation.
e. Abnormalities in the blood supply to the affected segement.

118. Appendices epiploicae is the name given to:

a. An outpouching from the small intestine.
b. Fat in greater omentum.
* c. Fat tags on the large bowel.
d. Posterior boundary of the epiploic foramen.
e. Secondary growth from the appendix.

119. The middle rectal artery is a:

a. Branch of the abdominal aorta.
b. Branch of the superior mesenteric artery.
* c. Branch of the internal iliac artery.
d. Continuation of the median sacral artery.
e. Continuation of inferior mesenteric artery.

120. The sigmoid colon:

a. Develops from distal part of midgut.
* b. Has a mesentery
c. Receives motor branches from the vagus nerve.
d. Veins drain into the left common iliac vein.
e. Is fairly constant in length

121. The following are TRUE about the anal mucous membrane above the level of the
pectinate line except:
a. Has a venous drainage to the portal system.
* b. Receives sensory supply from the pudendal nerve.
c. Is characterised by anal columns.
d. Has a lymphatic drainage to the inferior mesenteric nodes.
e. Has one of its arterial supply from the inferior mesenteric artery.

122. The following are TRUE about the rectum except:

a. Has no mesentery.
b. Has no sacculations.
c. Has muscle in its wall supplied by parasympathetic motor fibres.
* d. Is related to the bladder anteriorly in the females.
e. Is closely related to the inferior hypogastric plexus.
 21
123. The supra colic compartment connects to the infracolic compartment through:
a. Epiploic foramen
b. Greater omentum
c. Left paracolic gutter
d. Pouch of Douglas
* e. Right paracolic gutter.

124. Hirchsprung's disease, find the TRUE statement:

a. Is due to poor blood supply during development.
b. Is more common in the females.
* c. Is due to absence of parasympathetic ganglia in the pelvic colon.
d. Is due to volvulus of the sigmoid colon.
e. None of the above.

125. Regarding aganglionic megacolon, find the TRUE statement:

a. Is the same as congenital megacolon.
b. May be due to atresia or agenesis areas or, to an absence of parasympathetic
ganglia in the bowel wall.
c. The transverse colon may be involved.
d. The whole colon can also be involved.
* e. All the above.

126. The following statements about columns of Morgagni are TRUE except:
a. Are more prominent in adults than children.
* b. Each contains a terminal radicle of the superior rectal artery and vein.
c. Are folds of the mucosa.
d. Anal valves mark the lower terminal end of these columns.
e. These columns occur in the upper half of the anal canal.

127. Regarding the pecten (of anal canal):

a. Epithelium has both simple columnar and stratified non-keratinising.
b. Epithelium is slightly thicker than that of the upper part.
c. It is an intersphincteric line.
d. It is separated from the anal verge by Hilton's line.
* e. All the above.

128. Anal glands:

a. May penetrate deep into the internal sphincter.
b. Contain one to six spiral or straight tubules.
c. Ducts are lined by stratified columnar epithelium.
d. Are surrounded by lymphocytes.
* e. All the above.

129. The typical appearance of the colon on radiographs distinguishing it from the small
intestine is caused by the:
 22
a. Haustrae
b. Taeniae
c. Appendices epiploicae
d. Circular folds.
* e. (a) and (d)

130. Tumour cells from the sigmoid colon may reach the liver via blood stream. Which is the
first vessel to be involved?
a. IVC
b. External iliac vein
* c. Splenic vein
d. Ascending lumbar vein
e. Left renal vein

131. The transverse colon does not lie within the lesser sac because:
a. The great omentum is made up of four layers
b. The anterior layer fuses with the colon
* c. The common transverse mesocolon is a fusion of the anterior and posterior layers.
d. In children the omentum is partly developed.
e. The omental bursa is limited interiorly by the greater curvature of the stomach.

132. On the pancreas, find the FALSE statement.

a. During rotation of the duodenum, the ventral bud of the pancreas comes to lie
below and behind the dorsal bud.
b. The ventral bud forms uncinate process and inferior part of head of pancreas
whereas the dorsal bud forms the rest of the pancreas.
c. In 10%, the ventral and dorsal buds duct system fail to fuse and the double system
enters the duodenum.
* d. Annular pancreas is caused by two components of dorsal bud failing to rotate.
e. All the above
133. Paneth cells, find the FALSE statement
* a. Have both digestive and absorptive functions.
b. Are found scatered at the base of the crypts of Lieberkuhn.
c. Are strongly eosinophilic .
d. Have ultrastructural characteristics of exocrine, protein secreting cells.
e. Function is obscure.

134. Regarding enterocytes, find the TRUE statement:

a. May bear upto 3000 microvilli per cell.
b. Are loosely bound near their luminal surfaces to facilitate absorption and/or
secretion.
c. Have a relatively small number of mitochondria.
d. Lymphocytes and plasma cells are commonly found in the intercellular clefts
between them.
* e. (a) and (d) above
 23

135. About the pancreas, find the FALSE statement.

a. Crosses the vertebral column at the level of L2
b. Has the splenic artery on the superior aspect of the body.
c. Is entirely extraperitoneal.
d. Contains insulin secreting cells.
* e. Duct of the ventral bud forms the accessory pancreatic duct.

136. Porto-systemic anastomosis occur between the:

a. Azygos and left gastric veins.
* b. Para-umbilical veins and veins in falciform ligament
c. Portal vein and inferior vena cava
d. Portal vein and renal vein
e. Superior rectal vein and other rectal veins.

137. Regarding the liver, all are TRUE except:

* a. Is retroperitoneal in position.
b. Drains by hepatic veins into the inferior vena cava
c. Has a central vein in the centre of the hepatic triad
d. Is directly related to the right suprarenal gland
e. Is the largest gland in the body.

138. Which of the following structures is not found in a portal tract:

a. Lymphatics
b. Branches of portal vein.
* c. Central vein.
d. Biliary collecting duct.
e. Branch of hepatic artery.

139. Which lobe of the liver lies in the lesser sac:

a. Quadrate lobe.
b. Caudate lobe.
* c. Left lobe.
d. Bare area.
e. Right lobe.

140. Which of these statements about the liver is FALSE:

a. In the porta hepatis the bile duct is more accessible than the hepatic artery and
portal vein.
*b. The quadrate lobe derives its blood supply from the right branch of the hepatic
artery.
c. The caudate lobe is part of the left lobe of the liver.
d. The liver has an impression for the oesophagus on the diaphragmatic surface.
 24
e. The neck of the gall bladder is higher than its fundus.

141. The pancreatic duct opens into the duodenum:

a. Medially
b. Anteromedially
c. Posteriorly
d. Postero laterally
* e. Postero medially.

142. Regarding the foramen of Winslow, find the correct statement:

a. Lies behind the free edge of the gastro-hepatic omentum.
b. Can admit two fingers.
c. The duodenum lies inferior to the foramen.
d. Anteriorly it is related to the bile duct and portal vein.
* e. All the above.

143. The splenic artery, find the TRUE statement:

a. Is very tortuous.
b. Breaks up into four or five branches at the hilum of the spleen.
c. Gives off vasa brevia (short arteries) to the fundus of the stomach before giving
off terminal branches.
* d. All the above.
e. None of the above.

144. Regarding the inferior pancreatico-duodenal artery, find the FALSE statement.
a. It supplies the commencement of the midgut.
b. The right hepatic artery occasionally arises with it.
c. Contrary to what the name depicts, this artery does not supply the pancreas.
* d. (a) and (b).
e. All the of the above.

145. Regarding the arrangement of structures at the porta hepatis from superficial to deep:
a. Hepatic ducts, portal vein, hepatic artery.
b. Hepatic artery, portal vein, hepatic duct.
* c. Hepatic ducts, hepatic artery, portal vein.
d. Portal vein, hepatic artery, hepatic ducts.
e. None of the above.

146. Lying in the free margin of the falciform ligament is:

a. The remnant of the umbilical artery.
b. The remnant of the urachus.
* c. The remnant of the left umbilical vein.
d. The lateral umbilical ligament.
e. The remnant of ductus venosus.
 25

147. The following are located in the free margin of the lesser omentum:
a. Portal vein.
b. Inferior vena cava.
c. Duodenum.
d. Bile duct.
* e. (a) and (d).

148. The posterior boundary of the foramen of Winslow is:

a. Duodenum.
b. Caudate process.
c. Quadrate lobe.
d. Free edge of lesser omentum.
* e. Inferior vena cava.

149. Rutherford Morrison's space is also known as:

a. The superficial perineal pouch.
* b. The hepato renal recess.
c. The omental bursa.
d. The left subphrenic recess.
e. The right subphrenic recess.

150. The most important support of the liver is the:

a. Falciform ligament.
b. Anterior abdominal wall.
c. Coronary ligaments.
d. Ligamentum venosum.
* e. Hepatic veins.

151. The lesser sac (omental bursa) is directly continuous with which of the following recesses
or spaces?
a. Infracolic compartment.
b. Left colic gutter.
c. Left subphrenic recess.
d. Right subphrenic space.
* e. Hepato renal recess.

152. Which of the following statements regarding the common bile duct is most correct?
a. It lies to the left of the hepatic artery.
b. It descends anteriorly to the first part of the duodenum.
c. It crosses the uncinate process of the pancreas.
*d. It joins the main pancreatic duct and they together pass into the second part of the
duodenum.
e. It lies in front of the superior vena cava.
 26
153. Regarding the common hepatic artery the following are TRUE except:
* a. Is the largest branch of the coeliac trunk
b. Passes forward below the epiploic foramen
c. Gives off the right gastric artery
d. Gives arterial blood supply to the gall bladder via the right hepatic artery.
e. Lies on the left of the bile duct.

154. Regarding the pancreas, find the FALSE statement.

* a. Pacinian corpuscles are common in human pancreas.
b. The head of the pancreas is overlapped by the first part of the duodenum.
c. The uncinate process is located posterior to the superior mesenteric vessels.
d. The portal vein is formed behind the neck of the pancreas.
e. The splenic vein runs on the posterior part of the pancreas.

155. Regarding the main pancreatic duct:

a. May communicate with the accessory (of Santorini).
b. Lies left of the common bile duct at their exit into the duodenum.
c. May open separately on the major duodenal papilla.
d. Runs from the left to the right.
* e. All the above.

156. Blood supply to the pancreas comes from the following except:
a. Common hepatic artery.
b. Splenic artery
c. Superior mesenteric artery
d. Coelic trunk
* e. Inferior mesenteric artery.

157. The size of the spleen in adult is normally (length, width and thickness):
a. 12 cm x 5 cm x 3 cm.
* b. 12 cm x 6 cm x 2 cm.
c. 10 cm x 5 cm x 2 cm.
d. 10 cm x 6 cm x 3 cm.
e. 15 cm x 6 cm x 3 cm.

158. Accessory Spleens (spleniculi) may be found in the following except:

a. Transverse mesocolon
b. Mesentery of small intestine
c. Gastrosplenic ligament
d. Greater omentum
* e. Lesser omentum

159. The following cells are components of the endocrine portion of the pancreas except:
a. A (alpha) cells
b. B (beta) cells
 27
c. Non granulated C (clear) cells
d. D (delta) cells
* e. E (centroacinar) cells

160 The following visceral organs are in contact with the liver except:
a. Hepatic flexure of colon.
b. Oesophagus (abdominal).
c. Right kidney
* d. Left suprarenal gland.
e. Duodenal cap

161. The duct system of the pancreas, find the TRUE statement.
a. Contains a main duct that is normally formed by the distal part of the ventral
pancreatic bud.
b. Contains a main duct that enters at the minor papilla in the duodenum, while the
bile duct enters at the major papilla.
*c. May have an accessory system that persists in approximately 10% of all
individuals.
d. Forms as an outgrowth of the bile duct.
e. None of the above.

162. The liver, find the TRUE statement.

a. Forms as a diverticulum from the foregut region.
b. Contains hepatic sinusoids derived entirely from the vitelline veins.
c. Contains hematopoietic and connective tissue cells derived from mesoderm of the
septum transversum.
d. Is completely surrounded by peritoneum.
* e. Only (a) and (c) are correct.

163. The omental bursa communicates with the greater sac of the peritoneal cavity through an
opening called:
a. Pancreatic foramen
b. Gastric caecum
c. Foramen rotundum
d. Iliac sinus
* e. Epiploic foramen

164. The functional left lobe of the liver consists of the:

a. Part of the liver to the left of falciform ligament, ligamentum teres and venosum.
b. Quadrate lobe.
c. Caudate lobe
d. (a) and (b).
* e. (a), (b) & (c).

165. Which is a branch of the right hepatic artery:

 28
* a. Cystic
b. Left gastric
c. Splenic
d. Gastrohepatic
e. None of the above.

166. The common bile duct:

a. Lies in the free edge of the lesser omentum:
b. Is formed by the union of the right and left hepatic ducts.
c. Lies behind the portal vein.
d. All the above.
* e. (a) and (b) only.

167. About the liver, which is the FALSE statement:

a. It is a very vascular organ
b. It is the largest gland in the body
* c. It has three lobes
d. It has two surfaces
e. 5th rib is the level of superior aspect of the right lobe

168. Regarding the development of the liver all are TRUE except:
a. Liver primordium appears in the middle of the 3rd week intrauterine life.
b. Hepatic sinusoids develop from epithelial liver cords, intermingle with vitelline
and umbilical veins.
c. Hamatopoietic cells, Kupffer cells and connective tissue cells are derived from
septum transversum.
d. In the 10th week of development the weight of the liver is approximately 10% of
the total weight.
* e. The liver is a very active haemopoetic organ throughout intra-uterine life.

169. Regarding anomalies associated with the biliary system all are TRUE except.
a. Include accessory hepatic ducts which may fail to recanalize.
b. Extrahepatic biliary atresia (EHBA) occurs with a frequency of 1 in 15,000 live
births.
c. In EHBA some 15-20% of the patients may have their conditions corrected.
* d. Intrahepatic biliary duct atresia is more common than the extrahepatic one.
e. Intrahepatic biliary duct atresia may be due to fetal infections.

170. The islets of langarhans:

a. Start development in the fourth month intrauterine life from the parencymatous
pancreatic tissue.
* b. Start insulin secretion in the fifth month intrauterine life.
c. Have cells for secretion of glucagon somatostatin and insulin microscopically
easily distinguishable.
d. Are dominant in the body region.
 29
e. Are numerous along the accessory pancreatic duct (of santorini).

171. The following statements are TRUE except:

a. The common bile duct is about 7 to 8cm long
b. The common bile duct (CBD) may open separately into the 2nd part of the
duodenum.
c. The lower third of the common bile duct lies behind the head of the pancreas.
* d. Variations of the common bile duct are rare.
e. Common bile duct strictures may be congenital in origin.

172. Concerning the liver, which of the following statements is FALSE:

a. The bare area is triangular
b. The main support of the liver is by the hepatic veins.
* c. Hepatic veins are entirely extra-hepatic in their course.
d. Bile is manufactured by the liver cells.
e. Lymphatics of the liver drain into three or four nodes in the porta hepatis.

173. Regarding the liver, all the following are TRUE except:
a. The liver is divided into a larger right lobe and a small left lobe by the falciform
ligament.
b. The ligamentum teres is the obliterated remains of the left umbilical vein.
c. The ligamentus venosum is the fibrous remnant of the fetal ductus venosus.
* d. The liver is completely enclosed in the peritoneum.
e. At the hilum of the liver, the hepatic artery, portal vein an bile duct each divide
into right and left branches and there is little or no anastomosis between the
divisions on the two sides.

174. Concerning the gall bladder, which of the following is TRUE:

a. Cystic artery is usually a branch of left hepatic artery.
b. The gall bladder normally holds 1000 mls of bile.
c. The gall bladder is divided into the fundus, body, neck and antrum.
* d. A long cystic duct may join the hepatic duct low down behind the duodenum.
e. Variations in the course of the cystic duct are uncommon.

175. The uncinate process of the pancreas lies:

* a. Behind the superior mesenteric vessels.
b. In front of the portal vein
c. Within the lienorenal ligament
d. (a) and (b)
e. (a), (b) and (c)

176. Concerning the splenic artery which of the following is FALSE:

a. It is the major branch of the coeliac axis.
* b. It crosses anterior to the whole length of the left suprarenal and left kidney.
c. Runs between the lienorenal ligament layers before reaching the hilum.
 30
d. Its branch, the gastro epiploic artery, anastomoses with the gastro-lienal artery in
the gastro-colic ligament.
e. Arteria pancreatica magna artery is one of the branches.

177. The gall bladder, find the TRUE statement:

a. Develops from the dorsal pancreatic bud.
b. Is normally suspended from the liver by mesentery.
c. Has many mucous glands in its submucosa.
d. Receives its blood supply from the gastroduodenal artery.
* e. Has a neck which is at a higher level than the fundus.

178. Regarding the pancreas which is the most TRUE statement:

a. The veins from the pancreas drain into the inferior vena cava.
b. Develops from the mesoderm
c. Lies behind the spleen
* d. Has an omental tuberosity which is related to the lesser omentum
e. The islets of Langherms discharge partly through the pancreatic duct.

179. As regards to the spleen the following is TRUE:

* a. Lies along the 9, 10, 11th left ribs.
b. Found in the cupula of the left diaphragm.
c. It is friable.
d. It has no notch.
e. It weighs 10 ounces

180. The TRUE statements about the embryology of the spleen include which of the
following?
*a. It is attached to the kidneys by a mesenteric remnant called the lienorental
ligament
b. It contains endodermally derived cells.
c. Its sinusoidal cells are derived from mesenchymal cells in the dorsal
mesogastrium.
d. It serves no hematopoietic function during development.

181. Partial liver resection or transplant is possible in the following except:

a. Crush injury to a liver segment
b. Primary tumour involving a segment of the liver
* c. Total biliary atresia
d. Secondary deposit of tumour in a lobe of the liver

182. As regards to hepatic portal system, find the FALSE statement:

a. Normal pressure is 8 - 12 cm H20
b. Above 25 cm H20 can be regarded as hypertension
c. Splenomegaly is a feature
d. Frank blood passed per rectum may be the first symptom
 31
* e. Caput madusae is unknown.

183. The bile duct, find the TRUE statement:

a. Starts in the head of pancreas.
b. Lies behind the duodenum throughout its extent.
* c. Opens into the 2nd part of duodenum.
d. Carries venous blood.
e. All of the above.

184. The kidneys: Find the FALSE statement:

a. Each contains about one million nephrons
b. The right kidney is related inferiorly to the hepatic colic flexure
* c. Lie with their hila at the level of L4 vertebra
d. Lie in a fascial sheath with their related suprarenals gland
e. Develop from the metanephros

185. The suprarenal glands, find the TRUE answer:

a. Related posteriorly to the right and left lobes.
* b. Supplied by the superior, middle and inferior suprarenal arteries.
c. Right gland is crescentric in shape
d. Right suprarenal vein drains to right renal vein
e. Zona glomerulosa secretes glucocorticoids.

186. Which of the following statements about the ureters is FALSE:

a. Have three anatomical constrictions.
* b. Both pass anterior to testicular or ovarian vessels.
c. Both lie anterior to sacral iliac joint.
d. Both are separated from the transverse processes of the lumbar veterbrae by psoas
muscle.
e. Both derive blood from testicular or ovarian arteries.

187. Which of the following structures does not lie in front of the right kidney:
a. Right lobe of liver.
b. Second part of duodenum.
* c. Pancreatic head.
d. Hepatic flexure.
e. Jejunum.

188. Regarding the right suprarenal gland, which of the following statements is FALSE
a. Lies behind I.V.C.
b. The medulla is innervated by sympathetics from splanchnic plexus.
c. Is pyramidal shaped.
* d. Venous drainage goes to renal vein.
e. One of the arteries is the inferior phrenic.
 32
189. Ureteric constrictions exist at which of the following points?
a. Renal pelvis as it joins the ureter in the abdomen.
b. As it crosses the pelvic brim.
c. When it pierces the bladder wall.
d. (a) and (b).
* e. (a), (b) and (c).

190. Which of the following statements applies to the right kidney?

* a. The second portion of the duodenum lies anteriorly to its medial border.
b. Its superior extremity reaches the upper border of the 5th thoracic vertebra.
c. Its inferior extremity is closer to the median plane than its superior pole.
d. It is usually somewhat longer than the left kidney.
e. It is in contact laterally with the spleen.

191. The following belong to APUD (Amine precursor uptake and Decarboxylaton cells
except:
a. Adrenal medullary chromaffin cells.
* b. All pancreatic endocrine cells.
c. All gastro-intestinal hormone cells.
d. Mast cells
e. None of the above.

192. The abdominal aorta: Find the FALSE statement.

a. Ends anterior to the body of L4 vertebra
b. Cisterna chyli lies on its right side
* c. Supplies the hindgut via the inferior mesenteric artery only
d. Its pulsation is transmissible to anterior abdominal wall.
e. Renal arteries arise at the level of L2 vertebra.

193. Regarding nerve supply to the alimentary canal: Find the TRUE statement.
* a. Preganglionic parasympathetic fibres accompany arteries and are myelinated.
b. Parasympathetics are sensory to the gut.
c. Sympathetics are secreto-motor for glands and rely on cell bodies in the plexus of
Meisner.
d. Parasympathetics are vaso-motor to the gut.
e. All the above.

194. Immediately the vagal trunks enter the abdominal cavity,they

give off the following branches except:
a. Gastric
b. Hepatic
* c. Phrenic
d. Pyloric
e. Coeliac
 33
195. Which of the following statements is FALSE:
a. Vagus nerve is both motor and secretory to the stomach.
b. Left gastric veins and oesophageal tributaries of Azygos venous system constitute
porto-systemic circulation.
* c. The circular, longitudinal and oblique muscles of the stomach contribute to the
formation of pyloric sphincter.
d. Peptic ulcers commonly occur in the pylorus, antrum, body of stomach and
duodenum.
e. A full stomach lies in the epigastric, left hypochondriac and umbilical regions of
the abdomen.

196. The following organs are supplied by the coeliac trunk except the:
a. Duodenum
b. Liver
c. Pancreas
d. Spleen
* e. Suprarenal gland.

197. Diffuse pain referred to the epigastric region and radiating circumferentially around the
chest is the result of afferent fibres that travel via which of the following nerves?
a. Greater splanchnic.
* b. Intercostal.
c. Phrenic.
d. Vagus.
e. None of the above.

198. Pain associated with external haemorrhoids is mediated by:

a. The hypogastric nerves to the lumbar splanchnic nerves.
b. the pelvic splanchnic nerves.
* c. The pudendal nerve.
d. The sacral sympathetic chain.
e. None of the above.

199. All of the following functional components are associated with the vagus nerve except
the:
a. General somatic afferent
* b. General somatic efferent
c. General visceral efferent
d. General visceral afferent
e. Special visceral afferent

200 An incision made above and parallel to the inguinal ligament to the depth of the
aponeurosis of the internal oblique will incise the following except:
a. External oblique aponeurosis
b. Fatty (superficial) layer of superficial fascia.
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c. Membranous (deep) layer of superficial fascia.
* d. Transversalis fascia.
e. None of the above.

201. Pain referred to the umbilical region in a patient with obstructed indirect inguinal hernia
is probably due to:
a. Compression of the genito femoral.
b. Compression of the ilioinguinal nerve.
c. Dilatation of the inguinal canal
d. Presence of the appendix in the the sac.
* e. Ischaemic necrosis of the cremaster muscle.

202. Regarding abdominal portion of the oesophagus, find the TRUE statement:
a. Lies on the posterior surface of the right lobe of the liver.
b. Is wholly covered by peritoneum.
c. Measures about 3 cm in length
* d. Has four coats
e. Has three coats

203. The following statements on oesophageal atresia are TRUE except:

a. May result from spontaneous deviation of the oesophagotracheal septum in a
posterior direction.
b. Its commonest form is the proximal blind-end part of the oesophagus.
c. Is associated with polyhydramnios.
d. Usually associated with tracheoesophageal fistula (TEF).
* e. None of the above.

204. To describe the diaphram the following is TRUE except one:

a. It is composed of double cupula.
b. It is dome shaped.
c. It has a forward pointing trifoil shapes central tendon.
d. It is partially attached to the bodies of L1, 2, 3.
* e. It is never totally flat.

205. The following are attachments of the diaphragm except:

a. Lateral arcuate ligament.
b. Xiphoid sternum
c. The medial arcuate ligament.
d. The transverse process of L.1
* e. The median arcuate ligament.

206. The aortic opening in the diaphragm is at the level of:

a. T8
b. T10
* c. T12
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d. L1
e. L3

207. The following are TRUE concerning the oesophageal varices except:
a. The anastomosis is between the left gastric vein and lower oesophageal vessels.
b. Anastomosis between the branches of the short gastric vessels and the lower
oesophageal vessels.
c. If they bleed, the patient should be advised to report to hospital for investigations.
* d. Bleeding varices can be managed conservatively
e. All other causes of haematemesis should be excluded before definitive.

208. Swallowed foreign bodies tend to lodge at the following regions except:
a. At the fornices.
b. At 15cm from the incisors.
c. At 25cm from the incisors.
d. At 43cm from the incisors.
* e. Pyloric antrum.

209. At the crura of diaphragm, the following take place except:

a. There is one crus on either side.
b. The median arcuate ligament is formed in front of aorta.
c. The thoracic duct and the azygus vein pass between the crura.
d. The right crura pass to the left surrounding the oesophageal hiatus.
* e. The oesophagus hiatus is found at T.9.

210. During respiration the following structures move except one:

a. The kidneys
b. The spleen.
c. The liver.
d. The gall bladder.
* e. The stomach.