Chapter: Gastrointestinal Tract
Topic: Appendix Tumors
Subtopic: Appendicular Carcinoid
Keyword Definitions:
Carcinoid tumor: Neuroendocrine tumor commonly arising in appendix, small intestine, or bronchus.
Appendicular carcinoid: Carcinoid tumor of the appendix, often incidental finding during appendectomy.
Right hemicolectomy: Surgical removal of the right colon with ileocolic anastomosis.
Appendicectomy: Surgical removal of the appendix.
Neuroendocrine tumor (NET): Tumor arising from neuroendocrine cells secreting peptides or amines.
Lead Question – September 2002
Treatment of an incidentally detected Appendicular carcinoid measuring 2.5 cm is:
a) Right hemicolectomy
b) Limited resection of the right colon
c) Total colectomy
d) Appendicectomy
Explanation: Carcinoid tumors of appendix less than 2 cm are treated by appendicectomy. Tumors greater than 2 cm require right hemicolectomy due to high risk of nodal metastasis. In this case (2.5 cm), the correct treatment is Right hemicolectomy (Answer: a). This ensures adequate margins and lymph node clearance.
Question 2
A 60-year-old man underwent appendectomy. Histology showed a carcinoid tumor of 1.2 cm at the tip of appendix. Best management is:
a) Appendicectomy alone
b) Right hemicolectomy
c) Chemotherapy
d) Radiotherapy
Explanation: Carcinoids of appendix Appendicectomy alone (Answer: a)
is sufficient. Larger tumors or those at base require hemicolectomy.
Question 3
A 30-year-old woman with an incidental appendicular carcinoid tumor measuring 3 cm at the base of appendix should undergo:
a) Appendicectomy
b) Right hemicolectomy
c) Chemotherapy
d) Observation only
Explanation: Tumors >2 cm or at the base of appendix have increased metastatic potential. Standard treatment is Right hemicolectomy (Answer: b). Chemotherapy has no role unless disseminated disease is present.
Question 4
Which site is most common for appendiceal carcinoid?
a) Tip
b) Base
c) Middle third
d) Diffuse involvement
Explanation: Most appendiceal carcinoids are located at the tip (Answer: a). This explains why many are found incidentally during appendectomy. Base involvement carries worse prognosis due to proximity to cecum.
Question 5
Which marker is most useful in follow-up of appendiceal carcinoid?
a) CEA
b) Chromogranin A
c) AFP
d) CA 125
Explanation: Neuroendocrine tumors, including carcinoid, secrete chromogranin A, a reliable tumor marker. Chromogranin A (Answer: b) levels correlate with tumor burden and recurrence, making it most useful in follow-up.
Question 6
A patient with appendiceal carcinoid presents with flushing, diarrhea, and bronchospasm. The syndrome is due to:
a) Serotonin secretion
b) Histamine release
c) Dopamine release
d) Catecholamine excess
Explanation: Carcinoid syndrome occurs due to secretion of serotonin into systemic circulation, usually after liver metastasis. Classic symptoms are flushing, diarrhea, and bronchospasm. Correct answer is Serotonin secretion (Answer: a).
Question 7
Carcinoid syndrome develops only after liver metastasis because:
a) Liver inactivates serotonin
b) Lung inactivates serotonin
c) Kidney filters serotonin
d) Serotonin is not produced in primary tumors
Explanation: Serotonin produced in GI tract is normally metabolized in liver. Only after hepatic metastasis does serotonin bypass metabolism and enter systemic circulation, leading to carcinoid syndrome. Correct answer: Liver inactivates serotonin (Answer: a).
Question 8
Which stain is most helpful in diagnosing carcinoid tumor?
a) H&E
b) Silver stain
c) Chromogranin immunostain
d) PAS stain
Explanation: Neuroendocrine tumors are positive for chromogranin and synaptophysin immunostains. Chromogranin (Answer: c) is a specific marker for diagnosis, confirming neuroendocrine origin.
Question 9
What is the prognosis of appendicular carcinoid
a) Poor
b) Fair
c) Excellent
d) Guarded
Explanation: Appendicular carcinoids Excellent (Answer: c).
Question 10
A patient with 4 cm appendiceal carcinoid with nodal metastasis should receive:
a) Appendicectomy
b) Right hemicolectomy
c) Total colectomy
d) Chemotherapy only
Explanation: Large tumors with nodal involvement are treated with Right hemicolectomy (Answer: b). Chemotherapy is considered only for disseminated or unresectable disease. Total colectomy is unnecessary.
Question 11
Which drug is useful in symptomatic control of carcinoid syndrome?
a) Octreotide
b) Cisplatin
c) Cyclophosphamide
d) Vincristine
Explanation: Octreotide, a somatostatin analogue, inhibits serotonin release and controls flushing and diarrhea in carcinoid syndrome. Thus, the correct answer is Octreotide (Answer: a).
Keyword Definitions
Anterior abdominal wall: multilayered structure formed by skin, fascia, muscles, vessels, and nerves protecting abdominal viscera.
External oblique: outermost flat abdominal muscle with fibers directed inferomedially.
Internal oblique: middle layer muscle with fibers running superomedially.
Transversus abdominis: innermost flat muscle, fibers run horizontally.
Rectus abdominis: paired vertical strap muscle enclosed in rectus sheath.
Neurovascular plane: potential space where segmental nerves and vessels run between muscle layers.
Segmental nerves: lower intercostal, subcostal, iliohypogastric, and ilioinguinal nerves supplying wall and skin.
Arcuate line: point below umbilicus where posterior rectus sheath ends; important in surgical incisions.
Linea alba: midline fibrous raphe formed by fusion of aponeuroses.
Transversalis fascia: fascia deep to transversus abdominis, continuous with extraperitoneal fat and peritoneum.
Chapter: Anatomy
Topic: Abdominal Wall
Subtopic: Neurovascular Plane
Lead Question – 2012
Neurovascular plane in anterior abdominal wall -
a) Between ext oblique and internal oblique
b) Between int. oblique and transversus abdominis
c) Below transversus abdominis
d) Above ext. oblique
Explanation: The neurovascular plane of the anterior abdominal wall lies between the internal oblique and transversus abdominis. Intercostal, subcostal, iliohypogastric, and ilioinguinal nerves course here with vessels, making this the safe plane for surgical splitting incisions. Correct answer: (b).
A surgeon makes a gridiron incision for appendectomy. Which muscular plane is split to access the appendix safely?
a) Between external oblique and internal oblique
b) Between internal oblique and transversus abdominis
c) Between rectus and transversalis fascia
d) Below peritoneum
Explanation: The gridiron incision exploits the neurovascular plane between internal oblique and transversus abdominis. This minimizes vascular injury, preserves nerves, and provides safe access. Correct answer: (b).
During laparotomy, injury to iliohypogastric nerve leads to which deficit?
a) Sensory loss over umbilicus
b) Weakness of external oblique
c) Numbness over suprapubic skin
d) Loss of cremaster reflex
Explanation: The iliohypogastric nerve (L1) runs in the neurovascular plane, supplying suprapubic skin. Injury causes sensory loss over suprapubic region. Correct answer: (c).
A patient undergoing lower abdominal surgery develops numbness in scrotum and medial thigh. Which nerve likely injured in the neurovascular plane?
a) Ilioinguinal nerve
b) Genitofemoral nerve
c) Obturator nerve
d) Lateral femoral cutaneous nerve
Explanation: The ilioinguinal nerve travels in the neurovascular plane and enters inguinal canal. Injury produces scrotal/labial and medial thigh numbness. Correct answer: (a).
Which muscle’s aponeurosis contributes to both anterior and posterior layers of rectus sheath above arcuate line?
a) External oblique
b) Internal oblique
c) Transversus abdominis
d) Pyramidalis
Explanation: Internal oblique aponeurosis splits to enclose rectus above arcuate line, forming both anterior and posterior sheath layers. Correct answer: (b).
Below arcuate line, which layer lies posterior to rectus abdominis?
a) External oblique aponeurosis
b) Internal oblique aponeurosis
c) Transversalis fascia
d) Posterior rectus sheath
Explanation: Below arcuate line, all aponeuroses pass anteriorly; only transversalis fascia remains posterior to rectus. Correct answer: (c).
During open hernia repair, which nerve is at risk near superficial inguinal ring?
a) Ilioinguinal nerve
b) Iliohypogastric nerve
c) Genitofemoral nerve
d) Femoral branch of genitofemoral
Explanation: The ilioinguinal nerve emerges from neurovascular plane and runs in inguinal canal, exiting superficial ring. Injury during hernia surgery causes scrotal/labial numbness. Correct answer: (a).
During Pfannenstiel incision, which vessel is at risk in neurovascular plane near lateral rectus?
a) Superior epigastric artery
b) Inferior epigastric artery
c) Deep circumflex iliac artery
d) External iliac vein
Explanation: The inferior epigastric artery runs in rectus sheath lateral border and is vulnerable in lower transverse incisions. Correct answer: (b).
A patient with penetrating trauma to abdominal wall has paralysis of lower rectus abdominis. Which nerve injured?
a) Intercostal T6
b) Intercostal T10
c) Subcostal T12
d) Iliohypogastric L1
Explanation: Rectus abdominis receives segmental innervation from T7–T12 nerves traveling in neurovascular plane. Paralysis of lower rectus implies injury to subcostal T12. Correct answer: (c).
Which landmark guides safe splitting of abdominal wall muscles during laparotomy?
a) Linea alba
b) Neurovascular plane between internal oblique and transversus abdominis
c) Transversalis fascia
d) Median umbilical ligament
Explanation: Muscle splitting incisions like McBurney’s rely on neurovascular plane between internal oblique and transversus abdominis to reduce bleeding and nerve injury. Correct answer: (b).
A 40-year-old male develops flank bulge after nephrectomy incision. Cause?
a) Damage to iliohypogastric/ilioinguinal nerves in neurovascular plane
b) Weakness of transversalis fascia
c) Injury to femoral nerve
d) Loss of rectus sheath integrity
Explanation: Flank bulge results from denervation of internal oblique and transversus due to iliohypogastric/ilioinguinal nerve injury in neurovascular plane during flank incision. Correct answer: (a).
Chapter: Abdomen
Topic: Autonomic Nervous System of Abdomen
Subtopic: Celiac Plexus Block
Keyword Definitions:
Celiac Plexus: A network of nerves around the abdominal aorta supplying abdominal viscera.
Retrocrural Approach: Classic posterior approach to reach the celiac plexus.
Visceral Pain: Pain arising from internal organs, often dull and poorly localized.
Hypotension: Decrease in blood pressure, common after sympathetic block.
Anesthesia vs Analgesia: Anesthesia blocks sensation including touch and pain, while analgesia only blocks pain.
Lead Question – 2012
Celiac plexus block all the following is true except?
a) Relieved pain from gastric malignancy
b) Cause hypotention
c) Can be used to provide anesthesia for intra abdominal surgery
d) Can be given only by retrocrural (classic) approach
Explanation: The celiac plexus block is useful for pain relief in gastric and pancreatic malignancy and may cause hypotension due to sympathetic block. It is not used to provide complete anesthesia for intra-abdominal surgery. Multiple approaches (retrocrural, anterior, endoscopic) exist, so option c is correct.
Guessed Questions for NEET PG:
1) Celiac plexus block is most commonly used for pain relief in:
a) Chronic appendicitis
b) Pancreatic cancer
c) Gallbladder stones
d) Peptic ulcer disease
Explanation: Pancreatic cancer produces severe intractable pain, which is effectively relieved by celiac plexus block. It reduces narcotic use and improves quality of life. Hence option b is correct.
2) Complication of celiac plexus block includes:
a) Hypertension
b) Hypotension
c) Tachycardia
d) None of the above
Explanation: The sympathetic fibers in the celiac plexus regulate vascular tone. Their block causes vasodilation and hypotension, not hypertension. Tachycardia may be compensatory, but main complication is hypotension. Answer: b.
3) Approach not used for celiac plexus block:
a) Retrocrural
b) Anterior transabdominal
c) Endoscopic ultrasound-guided
d) Transoral
Explanation: The block can be done by retrocrural (classic posterior), anterior percutaneous, or endoscopic methods. Transoral is not a described route. Hence option d is correct.
4) Which type of nerve fibers are blocked by celiac plexus block?
a) Parasympathetic
b) Sympathetic
c) Somatic sensory
d) Motor
Explanation: The celiac plexus contains sympathetic fibers supplying abdominal viscera. Blocking these fibers reduces visceral pain. Parasympathetic and somatic motor fibers remain unaffected. Hence option b is correct.
5) A patient with unresectable pancreatic carcinoma complains of severe epigastric pain. Best palliative option is:
a) Celiac plexus block
b) Cholecystectomy
c) Gastrectomy
d) Splenectomy
Explanation: Celiac plexus block provides long-term relief of upper abdominal visceral pain, especially in pancreatic carcinoma. Surgical options are not indicated. Answer: a.
6) Hypotension after celiac plexus block occurs due to:
a) Increased vagal tone
b) Sympathetic blockade and vasodilation
c) Blood loss
d) Reflex bradycardia
Explanation: Sympathetic blockade leads to vasodilation of splanchnic vessels, reducing systemic vascular resistance and causing hypotension. Hence option b is correct.
7) Duration of analgesia after celiac plexus block using alcohol is:
a) Few hours
b) Days
c) Weeks to months
d) Lifetime
Explanation: Neurolytic agents like alcohol or phenol produce long-lasting destruction of sympathetic fibers, giving pain relief for weeks to months. Answer: c.
8) Clinical sign of successful celiac plexus block:
a) Increased heart rate
b) Warmth and vasodilation in lower limbs
c) Warmth and vasodilation in upper abdomen
d) Sweating in face
Explanation: Blocking sympathetic fibers causes vasodilation in splanchnic circulation, presenting as warmth in the upper abdomen. Thus option c is correct.
9) Contraindication for celiac plexus block:
a) Coagulopathy
b) Chronic pain of pancreas
c) Severe malignancy pain
d) Endoscopic procedure planned
Explanation: Coagulopathy increases the risk of retroperitoneal hemorrhage, hence is a contraindication. Chronic pain and malignancy are indications. Answer: a.
10) A patient undergoing celiac plexus block develops sudden severe back pain with leg weakness. Most likely cause is:
a) Alcohol neurotoxicity to somatic nerves
b) Hypotension
c) Pneumothorax
d) Allergy
Explanation: Neurolytic agents may spread to somatic nerves like lumbar plexus, leading to back pain and transient leg weakness. Hence option a is correct.
Chapter: Pelvis and Perineum
Topic: Nerves and Vessels
Subtopic: Relations of Ischial Spine
Keywords:
Ischial spine: A bony projection on the ischium important as a landmark in pelvic anatomy.
Pudendal nerve: Main nerve of perineum, crosses posterior to ischial spine.
Internal pudendal vessels: Artery and vein accompanying pudendal nerve.
Nerve to obturator internus: Motor nerve crossing ischial spine with pudendal bundle.
Obturator nerve: Runs along lateral pelvic wall, does not cross ischial spine.
Lead Question - 2012
Structure crossing dorsal surface of ischial spine are A/E:
a) Internal pudendal vessel
b) Pudendal nerve
c) Obturator nerve
d) Nerve to obturator internus
Explanation: The pudendal nerve, internal pudendal vessels, and nerve to obturator internus cross the ischial spine. The obturator nerve runs along the pelvic sidewall and exits via obturator canal, not over the ischial spine. Answer: c) Obturator nerve
1) A 35-year-old female during childbirth suffered injury to the structure crossing the ischial spine. Which function is most likely affected?
a) Sensation of perineum
b) Hip adduction
c) Quadriceps contraction
d) Knee extension
Explanation: The pudendal nerve crosses ischial spine and provides sensory supply to perineum. Injury causes perineal sensory loss. Hip adduction involves obturator nerve which does not cross spine. Answer: a) Sensation of perineum
2) Which vessel accompanies pudendal nerve while crossing ischial spine?
a) Inferior gluteal artery
b) Internal pudendal artery
c) Superior gluteal artery
d) Obturator artery
Explanation: Pudendal nerve crosses ischial spine along with internal pudendal vessels. Inferior and superior gluteal arteries do not directly cross spine. Answer: b) Internal pudendal artery
3) A surgeon performing pudendal block locates which landmark near ischial spine?
a) Sacral promontory
b) Coccyx tip
c) Ischial spine via vaginal exam
d) Iliac crest
Explanation: Pudendal block is given by palpating ischial spine transvaginally where pudendal nerve passes. Coccyx and iliac crest are not related landmarks. Answer: c) Ischial spine via vaginal exam
4) Which nerve does not cross ischial spine?
a) Pudendal nerve
b) Nerve to obturator internus
c) Internal pudendal vessels
d) Obturator nerve
Explanation: Obturator nerve runs through obturator canal and does not cross ischial spine. Others cross spine dorsally. Answer: d) Obturator nerve
5) Pudendal nerve block provides anesthesia for which procedure?
a) Episiotomy
b) Appendectomy
c) Inguinal hernia repair
d) Cholecystectomy
Explanation: Pudendal block is mainly used in obstetrics for episiotomy and perineal repair by anesthetizing pudendal nerve at ischial spine. Answer: a) Episiotomy
6) Nerve to obturator internus after crossing ischial spine enters which region?
a) Perineum
b) Gluteal region
c) Obturator canal
d) Femoral canal
Explanation: The nerve to obturator internus crosses the ischial spine dorsally and enters the gluteal region before supplying obturator internus muscle. Answer: b) Gluteal region
7) Which muscle acts as close relation of structures crossing ischial spine?
a) Piriformis
b) Coccygeus
c) Obturator externus
d) Psoas major
Explanation: Coccygeus muscle lies in relation to ischial spine, providing support to crossing pudendal bundle. Piriformis is higher, obturator externus and psoas are not related. Answer: b) Coccygeus
8) Clinical feature of pudendal nerve entrapment near ischial spine is:
a) Loss of knee reflex
b) Perineal pain and numbness
c) Foot drop
d) Loss of Achilles reflex
Explanation: Pudendal entrapment near ischial spine causes perineal pain, numbness, and sphincter dysfunction. Reflexes and foot drop are unrelated. Answer: b) Perineal pain and numbness
9) In pelvic fracture involving ischial spine, which function is spared?
a) Perineal sensation
b) Anal sphincter tone
c) Hip adduction
d) External urethral sphincter
Explanation: Hip adduction is mediated by obturator nerve, which does not cross ischial spine, hence spared. Pudendal functions are compromised. Answer: c) Hip adduction
10) The pudendal nerve is derived from which spinal segments?
a) L2-L4
b) L4-S1
c) S2-S4
d) S1-S3
Explanation: Pudendal nerve originates from sacral plexus segments S2, S3, S4. These supply perineum and external sphincters. Answer: c) S2-S4
Chapter: Abdomen
Topic: Urinary Bladder
Subtopic: Bladder Injury & Referred Pain
Keyword Definitions:
Referred pain – Pain perceived at a site distant from its origin due to shared nerve pathways.
Bladder injury – Trauma or rupture of the urinary bladder, leading to extravasation of urine.
Dermatomes – Areas of skin innervated by sensory fibers of a spinal nerve.
Pelvic pain referral – Pain from pelvic viscera often referred to abdomen, thighs, or perineum.
Lead Question – 2012
In bladder injury, pain is referred to all except?
a) Upper part of thigh
b) Lower abdominal wall
c) Flank
d) Penis
Explanation: Referred pain from the bladder is mediated via pelvic splanchnic and sympathetic nerves (T10–L2). It is commonly felt in the suprapubic region, thigh, and penis. Flank pain is not typical of bladder injury, but rather of ureteric or renal origin. Answer: c) Flank.
Guessed Question 1
A patient with pelvic fracture develops urine extravasation confined to the pelvis. Which part is most likely injured?
a) Extraperitoneal bladder
b) Intraperitoneal bladder
c) Renal pelvis
d) Posterior urethra
Explanation: Extraperitoneal bladder rupture is common with pelvic fractures, leading to urine extravasation localized in the pelvis. Intraperitoneal rupture causes urine in peritoneal cavity. Answer: a) Extraperitoneal bladder.
Guessed Question 2
Which of the following imaging techniques is best for diagnosing bladder rupture?
a) Intravenous urography
b) Cystography
c) Ultrasound
d) MRI
Explanation: Retrograde cystography with contrast is the investigation of choice for bladder rupture. It accurately distinguishes extraperitoneal and intraperitoneal leaks. Answer: b) Cystography.
Guessed Question 3
A trauma patient has gross hematuria with suprapubic tenderness. What should be suspected?
a) Bladder injury
b) Renal carcinoma
c) Ureteric stone
d) Prostate enlargement
Explanation: In trauma, gross hematuria with suprapubic tenderness strongly indicates bladder injury. Associated pelvic fractures increase suspicion. Answer: a) Bladder injury.
Guessed Question 4
Which type of bladder rupture is commonly associated with inability to void and peritonitis?
a) Extraperitoneal
b) Intraperitoneal
c) Both equally
d) None
Explanation: Intraperitoneal bladder rupture leads to urine leakage into peritoneal cavity causing peritonitis and inability to void. Extraperitoneal ruptures usually cause localized pelvic pain. Answer: b) Intraperitoneal.
Guessed Question 5
Referred pain to the tip of the penis in bladder pathology is due to involvement of which nerve?
a) Pudendal
b) Ilioinguinal
c) Dorsal nerve of penis
d) Genitofemoral
Explanation: Pain from bladder can be referred to penis via pelvic splanchnics and pudendal innervation, especially involving the dorsal nerve of penis. Answer: c) Dorsal nerve of penis.
Guessed Question 6
In extraperitoneal bladder rupture, urine commonly collects in which region?
a) Suprapubic space
b) Flank
c) Subhepatic space
d) Rectouterine pouch
Explanation: Extraperitoneal rupture causes urine extravasation in perivesical tissues including suprapubic space, confined by pelvic fascia. Answer: a) Suprapubic space.
Guessed Question 7
Which of the following is NOT a common cause of bladder rupture?
a) Road traffic accident
b) Pelvic fracture
c) Direct stab injury
d) Ureteric calculus
Explanation: Ureteric calculi cause hydronephrosis/ureteric colic but not bladder rupture. Pelvic fractures and trauma are common causes. Answer: d) Ureteric calculus.
Guessed Question 8
During catheterization, a patient with suspected bladder rupture shows blood at meatus. What should be done?
a) Forceful catheterization
b) Gentle catheterization
c) Retrograde urethrogram first
d) Immediate laparotomy
Explanation: Blood at urethral meatus suggests urethral injury; catheterization should be avoided. Retrograde urethrogram is the first investigation. Answer: c) Retrograde urethrogram first.
Guessed Question 9
Which bladder region is most vulnerable in blunt trauma?
a) Dome
b) Trigone
c) Neck
d) Base
Explanation: The dome of bladder is weakest and prone to rupture during blunt trauma, especially when bladder is full. Answer: a) Dome.
Guessed Question 10
A patient presents with abdominal distension, inability to void, and signs of peritonitis after trauma. What is the most likely diagnosis?
a) Intraperitoneal bladder rupture
b) Extraperitoneal bladder rupture
c) Renal laceration
d) Urethral stricture
Explanation: Classic features of intraperitoneal bladder rupture include abdominal distension, urine ascites, and peritonitis after trauma. Answer: a) Intraperitoneal bladder rupture.
Chapter: Abdomen
Topic: Abdominal Aorta and Related Structures
Subtopic: Vertebral Level Anatomy
Keyword Definitions:
Aorta: Main arterial trunk of the body running along the vertebral column.
IVC (Inferior Vena Cava): Largest vein of the body draining blood into the right atrium.
Coeliac trunk: First major branch of abdominal aorta at T12 supplying foregut.
Iliac vessels: Branches of aorta and IVC located at L4–L5.
Lead Question – 2012
Structure not seen at L3 level ?
a) Iliac vessels
b) Aorta
c) Coeliac trunk
d) IVC
Explanation: At L3 level, the aorta and IVC are present. Iliac vessels occur at L4–L5 after bifurcation. The coeliac trunk arises at T12. Thus, coeliac trunk is not seen at L3. Answer: c) Coeliac trunk.
1) Structure present at the level of L1 vertebra is?
a) Coeliac trunk
b) Superior mesenteric artery
c) Inferior mesenteric artery
d) Renal arteries
Explanation: The SMA arises at the level of L1. Coeliac trunk is at T12, renal arteries at L2, and IMA at L3. Hence correct answer is b) Superior mesenteric artery.
2) Inferior mesenteric artery originates at?
a) L1
b) L2
c) L3
d) L4
Explanation: Inferior mesenteric artery arises from the abdominal aorta at L3 vertebral level, supplying hindgut structures. Correct answer is c) L3.
3) At which vertebral level does the aorta bifurcate?
a) L2
b) L3
c) L4
d) L5
Explanation: The abdominal aorta bifurcates into the common iliac arteries at the level of L4. Correct answer is c) L4.
4) The inferior vena cava pierces the diaphragm at?
a) T8
b) T10
c) T12
d) L1
Explanation: The IVC passes through the central tendon of the diaphragm at the T8 vertebral level. Correct answer is a) T8.
5) A patient with bleeding from the foregut most likely has involvement of?
a) Inferior mesenteric artery
b) Superior mesenteric artery
c) Coeliac trunk
d) Renal artery
Explanation: Foregut structures are supplied by branches of the coeliac trunk (T12). Hence the vessel involved is c) Coeliac trunk.
6) Renal arteries arise at which vertebral level?
a) T12
b) L1
c) L2
d) L3
Explanation: Renal arteries arise from the aorta at the level of L2, just below SMA origin. Correct answer is c) L2.
7) Testicular arteries originate from?
a) Common iliac artery
b) Abdominal aorta at L2
c) Inferior mesenteric artery
d) External iliac artery
Explanation: Testicular arteries arise from the abdominal aorta at the L2 vertebral level. Correct answer is b) Abdominal aorta at L2.
8) The cisterna chyli is located at?
a) L1
b) L2
c) L3
d) L4
Explanation: The cisterna chyli, lymphatic dilatation, is located anterior to bodies of L1–L2 vertebrae. Correct answer is b) L2.
9) Which of the following passes through the diaphragm at T10?
a) Esophagus
b) Aorta
c) IVC
d) Thoracic duct
Explanation: The esophagus passes through the esophageal hiatus at T10. IVC at T8 and aorta at T12. Correct answer is a) Esophagus.
10) A patient with ischemia of the midgut is most likely to have occlusion of?
a) Coeliac trunk
b) Inferior mesenteric artery
c) Superior mesenteric artery
d) Median sacral artery
Explanation: Midgut structures are supplied by branches of SMA (arising at L1). Occlusion causes midgut ischemia. Correct answer is c) Superior mesenteric artery.
Chapter: Abdomen
Topic: Spleen
Subtopic: Surface Anatomy
Keyword Definitions:
Spleen: Largest lymphoid organ, located in the left hypochondrium.
Surface Anatomy: Study of external landmarks that indicate internal structures.
Ribs: Bony framework of thorax, important landmarks for organ projection.
Lead Question - 2012
Spleen extends from ?
a) 5th to 9th rib
b) 9th to 11th rib
c) 2nd to 5th rib
d) 11th to 12th rib
Explanation: The spleen lies in the left hypochondrium, deep to ribs 9–11 along the midaxillary line. Its long axis is parallel to the 10th rib. Correct Answer: b) 9th to 11th rib.
Guessed Question 1
The hilum of the spleen is located on which surface?
a) Diaphragmatic surface
b) Visceral surface
c) Inferior border
d) Superior border
Explanation: The hilum is present on the visceral surface where splenic vessels and lymphatics enter and leave. It is an important landmark for surgical procedures. Correct Answer: b) Visceral surface.
Guessed Question 2
Splenic artery is a branch of?
a) Celiac trunk
b) Superior mesenteric artery
c) Inferior mesenteric artery
d) Renal artery
Explanation: The splenic artery is a tortuous branch of the celiac trunk. It supplies the spleen, pancreas, and part of the stomach. Correct Answer: a) Celiac trunk.
Guessed Question 3
Which ligament connects the spleen to the stomach?
a) Gastrosplenic ligament
b) Splenorenal ligament
c) Phrenicocolic ligament
d) Hepatogastric ligament
Explanation: The gastrosplenic ligament connects the spleen to the greater curvature of the stomach and contains short gastric vessels. Correct Answer: a) Gastrosplenic ligament.
Guessed Question 4
Accessory spleens are most commonly found in?
a) Splenorenal ligament
b) Mesentery
c) Greater omentum
d) Pancreatic tail
Explanation: Accessory spleens are usually found near the splenic hilum or in the splenorenal ligament. They may mimic pathology in imaging. Correct Answer: a) Splenorenal ligament.
Guessed Question 5
In splenomegaly, spleen enlarges along the axis of?
a) 8th rib
b) 9th rib
c) 10th rib
d) 11th rib
Explanation: Splenomegaly causes the spleen to enlarge obliquely downward and medially along the 10th rib. This helps differentiate from renal enlargement. Correct Answer: c) 10th rib.
Guessed Question 6
Splenic vein joins with which vessel to form the portal vein?
a) Superior mesenteric vein
b) Inferior mesenteric vein
c) Left gastric vein
d) Right gastric vein
Explanation: The splenic vein unites with the superior mesenteric vein to form the portal vein behind the neck of the pancreas. Correct Answer: a) Superior mesenteric vein.
Guessed Question 7
Which of the following is NOT a relation of the spleen?
a) Left kidney
b) Stomach
c) Left colic flexure
d) Right adrenal gland
Explanation: The spleen is related to the stomach, left kidney, pancreas, and left colic flexure. The right adrenal gland lies on the opposite side. Correct Answer: d) Right adrenal gland.
Guessed Question 8
During trauma, spleen rupture leads to bleeding into?
a) Peritoneal cavity
b) Pleural cavity
c) Retroperitoneal space
d) Mediastinum
Explanation: Rupture of the spleen results in intraperitoneal hemorrhage, often massive, requiring immediate intervention. Correct Answer: a) Peritoneal cavity.
Guessed Question 9
Splenectomy most commonly predisposes a patient to infections by?
a) Gram-negative bacilli
b) Encapsulated organisms
c) Anaerobic bacteria
d) Mycobacteria
Explanation: Post-splenectomy, patients are more prone to infections with encapsulated bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Correct Answer: b) Encapsulated organisms.
Guessed Question 10
Which hematological condition is splenectomy most useful in?
a) Thalassemia major
b) Sickle cell anemia
c) Hereditary spherocytosis
d) Iron deficiency anemia
Explanation: Splenectomy is indicated in hereditary spherocytosis as the spleen destroys the abnormal red cells. Correct Answer: c) Hereditary spherocytosis.
Chapter: Autonomic Nervous System
Topic: Coeliac Plexus Block
Subtopic: Clinical Applications
Keywords:
Coeliac Plexus: A nerve plexus located in the upper abdomen around the origin of the celiac trunk, supplying abdominal viscera.
Pain Block: An injection that interrupts pain signals in a specific nerve plexus or pathway.
Retroperitoneal: Anatomical space behind the peritoneum where structures like kidneys and major vessels lie.
Hypotension: Abnormally low blood pressure due to vasodilation or decreased cardiac output.
Diarrhea: Increased frequency of loose stools caused by autonomic imbalance in intestines after nerve block.
Lead Question – 2012
Which of the following is true about coeliac plexus block?
a) Located retroperitoneally at the level of L3
b) Usually done unilaterally
c) Useful for the painful conditions of lower abdomen
d) Most common side effect is diarrhea and hypotension
Explanation: The coeliac plexus lies retroperitoneally at the level of T12–L1, not L3. It is performed bilaterally, not unilaterally. It is mainly useful for pain relief in upper abdominal malignancies such as pancreatic cancer. The most common side effects are diarrhea and hypotension. Answer: d)
Q2. Coeliac plexus block is most commonly indicated in:
a) Renal colic
b) Pancreatic cancer pain
c) Chronic appendicitis
d) Hernia pain
Explanation: Coeliac plexus block is primarily indicated for intractable upper abdominal pain, especially due to pancreatic cancer. It is not used for lower abdominal or somatic pain. Answer: b)
Q3. Which vertebral level corresponds to the coeliac plexus?
a) T6–T7
b) T10–T11
c) T12–L1
d) L3–L4
Explanation: The coeliac plexus is located around the origin of the celiac trunk, corresponding to the vertebral level T12–L1. This location allows innervation to abdominal viscera. Answer: c)
Q4. Which imaging technique is commonly used for coeliac plexus block guidance?
a) MRI
b) Ultrasound
c) CT Scan
d) X-ray
Explanation: CT scan guidance is often used for precise needle placement during coeliac plexus block, ensuring accurate delivery and minimizing complications. Answer: c)
Q5. Which artery is closely related to the coeliac plexus?
a) Superior mesenteric artery
b) Inferior mesenteric artery
c) Celiac trunk
d) Renal artery
Explanation: The coeliac plexus surrounds the origin of the celiac trunk, which arises from the abdominal aorta at T12. This anatomical relation is crucial for block procedure. Answer: c)
Q6. A 50-year-old male with pancreatic cancer undergoes coeliac plexus block. What is the likely immediate effect?
a) Relief of upper abdominal pain
b) Increased heart rate
c) Paralysis of lower limb
d) Relief of pelvic pain
Explanation: Coeliac plexus block specifically reduces visceral pain from upper abdominal organs such as the pancreas, liver, stomach. Answer: a)
Q7. Which is the most serious complication of coeliac plexus block?
a) Diarrhea
b) Hypotension
c) Vascular injury
d) Nausea
Explanation: Though diarrhea and hypotension are common, the most serious complication is vascular injury, which may cause bleeding or ischemia. Answer: c)
Q8. Which sympathetic fibers are mainly targeted in coeliac plexus block?
a) Thoracic splanchnic nerves
b) Lumbar splanchnic nerves
c) Sacral splanchnic nerves
d) Cervical sympathetic trunk
Explanation: The thoracic splanchnic nerves (greater, lesser, least) converge on the coeliac plexus, carrying visceral pain signals. Answer: a)
Q9. A patient develops severe hypotension after a coeliac plexus block. What is the immediate management?
a) IV atropine
b) IV fluids and vasopressors
c) Oral rehydration solution
d) Wait for spontaneous recovery
Explanation: Sudden hypotension results from sympathetic blockade. Management involves IV fluid resuscitation and vasopressors to restore hemodynamic stability. Answer: b)
Q10. Which of the following conditions is least likely to benefit from a coeliac plexus block?
a) Gastric cancer pain
b) Pancreatic cancer pain
c) Chronic pancreatitis pain
d) Acute appendicitis pain
Explanation: Coeliac plexus block is beneficial for chronic visceral pain of upper abdominal organs, but not for somatic pain like acute appendicitis. Answer: d)
Q11. After coeliac plexus block, a patient complains of persistent diarrhea. What is the cause?
a) Parasympathetic overactivity
b) Vagus nerve block
c) Somatic nerve injury
d) Loss of sympathetic inhibition
Explanation: Sympathetic blockade removes inhibitory control over the intestines, leading to unopposed parasympathetic activity and diarrhea. Answer: d)
Chapter: Abdomen & Pelvis
Topic: Female Reproductive System
Subtopic: Ovarian Fossa
Keyword Definitions:
Ovarian fossa – Depression on lateral pelvic wall where the ovary rests.
Internal iliac artery – Major pelvic artery forming the posterior boundary of ovarian fossa.
Ureter – Muscular tube carrying urine, forming part of the floor of the fossa.
Obliterated umbilical artery – Remnant of fetal circulation, forms anterior boundary of fossa.
Round ligament of ovary – Incorrect term; true ligament is ovarian ligament.
Lead Question – 2012
Ovarian fossa is formed by all except?
a) Obliterated umbilical artery
b) Internal iliac artery
c) Ureter
d) Round ligament of ovary
Explanation: The ovarian fossa is bounded anteriorly by the obliterated umbilical artery, posteriorly by the internal iliac artery and ureter. The round ligament of ovary does not exist (confusion with ovarian ligament). Hence, the correct answer is d) Round ligament of ovary.
Guessed Questions for NEET PG
1. Ovary is supplied mainly by?
a) Uterine artery
b) Ovarian artery
c) Vaginal artery
d) Inferior epigastric artery
Explanation: The ovary receives its main blood supply from the ovarian artery, a direct branch of the abdominal aorta. The uterine artery provides anastomotic supply. Correct answer is b) Ovarian artery.
2. Venous drainage of ovary is?
a) Directly into IVC (right), renal vein (left)
b) Both into renal veins
c) Both into IVC
d) Into iliac veins
Explanation: The right ovarian vein drains directly into the IVC, while the left drains into the left renal vein. This asymmetry has clinical significance in varicocele. Correct answer is a).
3. Lymphatic drainage of ovary is?
a) Superficial inguinal nodes
b) External iliac nodes
c) Para-aortic nodes
d) Internal iliac nodes
Explanation: The ovary develops in the lumbar region and descends into pelvis. Its lymph drains into para-aortic (lumbar) nodes, important for staging ovarian cancer. Correct answer is c).
4. Which nerve is closely related to ovarian fossa?
a) Genitofemoral
b) Obturator
c) Femoral
d) Pudendal
Explanation: The obturator nerve runs along the lateral pelvic wall beneath the ovarian fossa, making it vulnerable during pelvic surgery. Correct answer is b).
5. A patient with ovarian carcinoma presents with enlarged para-aortic nodes. This is because of?
a) Direct spread
b) Lymphatic drainage
c) Venous spread
d) Peritoneal spread
Explanation: The ovary’s lymphatics drain to para-aortic nodes, explaining enlargement in malignancy. Correct answer is b) Lymphatic drainage.
6. Which structure does NOT pass through the broad ligament?
a) Round ligament of uterus
b) Ovarian ligament
c) Ureter
d) Ovarian vessels
Explanation: The ureter runs under the broad ligament but does not pass through it. Other structures are enclosed within folds of the broad ligament. Correct answer is c) Ureter.
7. During oophorectomy, which structure is most at risk of injury at infundibulopelvic ligament?
a) Ureter
b) Internal iliac artery
c) External iliac vein
d) Femoral nerve
Explanation: The ureter lies close to the infundibulopelvic ligament (suspensory ligament of ovary). Surgical clamping risks ureteral injury. Correct answer is a) Ureter.
8. Pain of ovarian torsion is referred to?
a) Umbilical region
b) Suprapubic region
c) Shoulder tip
d) Left hypochondrium
Explanation: Ovarian pain is referred to the umbilical region via T10 spinal segments, same as appendix. Correct answer is a).
9. Which ligament contains ovarian vessels?
a) Broad ligament
b) Ovarian ligament
c) Infundibulopelvic ligament
d) Round ligament
Explanation: The infundibulopelvic ligament (suspensory ligament of ovary) carries ovarian vessels from aorta to ovary. Correct answer is c).
10. Ovary develops from which embryological structure?
a) Mesonephric duct
b) Paramesonephric duct
c) Genital ridge
d) Cloaca
Explanation: The ovary develops from the genital ridge, formed by coelomic epithelium and underlying mesenchyme. Correct answer is c).
Chapter: Abdomen
Topic: Arterial Supply of the Colon and Rectum
Subtopic: Inferior Mesenteric Artery
Keyword Definitions:
Inferior Mesenteric Artery (IMA): Third unpaired branch of the abdominal aorta supplying the hindgut.
Left Colic Artery: Branch of IMA supplying descending colon.
Sigmoid Arteries: Branches of IMA supplying sigmoid colon.
Superior Rectal Artery: Terminal branch of IMA supplying upper rectum.
Middle Rectal Artery: Branch of internal iliac artery supplying middle rectum.
Lead Question – 2012
All are branches of the inferior mesenteric artery except ?
a) Left colic
b) Sigmoidal artery
c) Middle rectal
d) Superior rectal
Explanation: The middle rectal artery is not a branch of the inferior mesenteric artery. It arises from the internal iliac artery. The inferior mesenteric artery gives left colic, sigmoid, and superior rectal arteries. Clinical relevance: knowledge of arterial supply is vital in colorectal surgeries and controlling hemorrhage. Answer: c) Middle rectal
Guessed Question 1
Which artery supplies the upper part of the rectum?
a) Superior rectal artery
b) Middle rectal artery
c) Inferior rectal artery
d) Median sacral artery
Explanation: The superior rectal artery, terminal branch of the IMA, supplies the upper rectum. It forms an important anastomosis with middle and inferior rectal arteries, relevant in portal hypertension. Answer: a) Superior rectal artery
Guessed Question 2
The middle rectal artery is a branch of?
a) Inferior mesenteric artery
b) Internal iliac artery
c) External iliac artery
d) Median sacral artery
Explanation: The middle rectal artery arises from the internal iliac artery. It supplies the muscular wall of the rectum and the prostate in males. Not from IMA, differentiating pelvic and abdominal arterial supply. Answer: b) Internal iliac artery
Guessed Question 3
Which artery is most important during sigmoid colectomy?
a) Left colic
b) Middle colic
c) Sigmoid arteries
d) Superior mesenteric artery
Explanation: The sigmoid arteries (branches of IMA) are crucial during sigmoid colectomy. Ligation must be done with care to maintain marginal artery circulation. Answer: c) Sigmoid arteries
Guessed Question 4
Marginal artery of Drummond is formed by?
a) Branches of SMA and IMA
b) Branches of celiac and SMA
c) Branches of IMA only
d) Internal iliac and IMA
Explanation: The marginal artery of Drummond is formed by anastomosis between SMA and IMA branches along the colon, important in maintaining collateral circulation during arterial ligation. Answer: a) Branches of SMA and IMA
Guessed Question 5
During rectal cancer surgery, which artery is ligated to control bleeding from the superior rectum?
a) Inferior rectal
b) Middle rectal
c) Superior rectal
d) Median sacral
Explanation: The superior rectal artery is ligated during upper rectal surgeries to control bleeding. It is the terminal continuation of the IMA and the main blood supply to the upper rectum. Answer: c) Superior rectal
Guessed Question 6
Arc of Riolan connects?
a) Left colic and middle colic
b) Superior rectal and inferior rectal
c) Middle rectal and sigmoid
d) Right colic and ileocolic
Explanation: The arc of Riolan is an arterial connection between the left colic artery (IMA) and the middle colic artery (SMA), ensuring collateral circulation of the colon. Answer: a) Left colic and middle colic
Guessed Question 7
Which artery forms the main collateral between SMA and IMA?
a) Middle colic
b) Left colic
c) Marginal artery of Drummond
d) Median sacral
Explanation: The marginal artery of Drummond forms the main collateral between SMA and IMA along the colon, preventing ischemia in case of arterial occlusion. Answer: c) Marginal artery of Drummond
Guessed Question 8
Which rectal artery is involved in hemorrhoids due to portal hypertension?
a) Middle rectal
b) Inferior rectal
c) Superior rectal
d) Median sacral
Explanation: The superior rectal veinAnswer: c) Superior rectal
Guessed Question 9
During abdominal aortic aneurysm surgery, which artery must be preserved for left colon viability?
a) Right colic
b) Middle colic
c) Left colic
d) Ileocolic
Explanation: The left colic artery, a branch of IMA, must be preserved during aortic surgery to maintain blood supply to the descending colon. Answer: c) Left colic
Guessed Question 10
Which of the following is not directly related to IMA branches?
a) Sigmoid arteries
b) Left colic artery
c) Superior rectal artery
d) Inferior rectal artery
Explanation: The inferior rectal artery is not a branch of IMA. It arises from the internal pudendal artery, a branch of the internal iliac, supplying anal canal and perianal region. Answer: d) Inferior rectal artery