Chapter: Abdomen & Gastrointestinal Tract; Topic: Pancreas and Duodenum; Subtopic: Arterial Supply of Pancreas and Duodenum
Keyword Definitions:
Pancreas: A mixed gland with both exocrine (digestive enzymes) and endocrine (hormone secretion) functions located in the retroperitoneal space.
Duodenum: The first and shortest part of the small intestine that receives bile and pancreatic secretions.
Pancreaticoduodenal arteries: Arteries forming an arcade around the head of the pancreas, connecting the celiac and SMA territories.
Gastroduodenal artery (GDA): A branch of the common hepatic artery that supplies the stomach, duodenum, and pancreas.
Superior mesenteric artery (SMA): A major vessel from the abdominal aorta that supplies the midgut, including the lower duodenum.
Lead Question - 2015
Superior pancreaticoduodenal artery is a branch of?
a) Hepatic artery
b) Splenic artery
c) Gastroduodenal artery
d) Inferior mesenteric artery
Answer: c) Gastroduodenal artery
Explanation: The superior pancreaticoduodenal artery arises from the gastroduodenal artery, a branch of the common hepatic artery. It divides into anterior and posterior branches that anastomose with the inferior pancreaticoduodenal artery from the SMA. This arterial arcade supplies the head of the pancreas and upper duodenum, forming an essential connection between foregut and midgut circulations.
1. The inferior pancreaticoduodenal artery arises from which artery?
a) Celiac trunk
b) Superior mesenteric artery
c) Splenic artery
d) Hepatic artery
Answer: b) Superior mesenteric artery
Explanation: The inferior pancreaticoduodenal artery originates from the SMA and ascends to anastomose with the superior pancreaticoduodenal artery. This anastomosis ensures a continuous blood supply to the duodenum and pancreatic head, even if one arterial source is obstructed, maintaining vital collateral circulation between foregut and midgut regions.
2. The superior pancreaticoduodenal artery supplies which part of the duodenum?
a) Upper part
b) Lower part
c) Third part
d) Fourth part
Answer: a) Upper part
Explanation: The superior pancreaticoduodenal artery supplies the upper half of the duodenum and the superior portion of the pancreatic head. It originates from the gastroduodenal artery and ensures arterial supply from the celiac trunk, linking foregut circulation with the superior mesenteric supply through arterial arcades.
3. The superior pancreaticoduodenal artery divides into how many branches?
a) One
b) Two
c) Three
d) Four
Answer: b) Two
Explanation: The superior pancreaticoduodenal artery divides into anterior and posterior branches. These form arterial arcades with corresponding branches of the inferior pancreaticoduodenal artery. This dual branching ensures adequate perfusion to the pancreatic head and duodenal loop, which are functionally significant in gastrointestinal anastomoses.
4. The superior pancreaticoduodenal artery forms an anastomosis with:
a) Left gastric artery
b) Inferior pancreaticoduodenal artery
c) Splenic artery
d) Left gastroepiploic artery
Answer: b) Inferior pancreaticoduodenal artery
Explanation: The superior and inferior pancreaticoduodenal arteries form an anastomotic loop around the pancreatic head. This anastomosis provides continuity between the celiac trunk and SMA territories, ensuring constant duodenal and pancreatic blood flow, even in vascular compromise, thus playing an important role in maintaining splanchnic circulation.
5. Which artery gives rise to the gastroduodenal artery?
a) Splenic artery
b) Common hepatic artery
c) Left gastric artery
d) SMA
Answer: b) Common hepatic artery
Explanation: The common hepatic artery, a branch of the celiac trunk, gives rise to the gastroduodenal artery. The GDA further divides into the superior pancreaticoduodenal artery and right gastroepiploic artery, supplying upper duodenal and pancreatic regions essential for foregut circulation.
6. A pancreatic head carcinoma can compress which arterial arcade?
a) Splenic artery arcade
b) Pancreaticoduodenal arcade
c) Left gastric arcade
d) Middle colic arcade
Answer: b) Pancreaticoduodenal arcade
Explanation: The pancreaticoduodenal arcade is formed by superior and inferior pancreaticoduodenal arteries encircling the pancreatic head. Tumors in this region can compromise blood flow, causing ischemia of the duodenal wall and complicating surgical management during pancreaticoduodenectomy or Whipple’s procedure.
7. A patient undergoing celiac artery ligation may maintain blood supply to the duodenum through:
a) Inferior pancreaticoduodenal artery
b) Left gastric artery
c) Splenic artery
d) Cystic artery
Answer: a) Inferior pancreaticoduodenal artery
Explanation: Collateral blood supply through the inferior pancreaticoduodenal artery from SMA maintains perfusion to the pancreas and duodenum when the celiac trunk or its branches are ligated. This highlights the clinical significance of pancreaticoduodenal arterial anastomoses in maintaining gastrointestinal circulation.
8. Which artery provides the main blood supply to the head of pancreas?
a) Splenic artery
b) Gastroduodenal artery
c) Pancreaticoduodenal arteries
d) Left gastric artery
Answer: c) Pancreaticoduodenal arteries
Explanation: The head of the pancreas receives its major blood supply from both superior and inferior pancreaticoduodenal arteries, which form an arterial ring. This dual supply ensures constant perfusion and explains why the pancreatic head is rarely ischemic even after partial vascular obstruction.
9. The superior pancreaticoduodenal artery represents blood supply from which vascular territory?
a) Celiac trunk
b) SMA
c) IMA
d) Portal vein
Answer: a) Celiac trunk
Explanation: The superior pancreaticoduodenal artery, via the gastroduodenal and common hepatic arteries, arises from the celiac trunk, supplying the foregut-derived upper duodenum and pancreas. It bridges circulation with the SMA through its anastomotic arcade with the inferior pancreaticoduodenal artery.
10. During Whipple’s surgery, the ligation of which artery can endanger duodenal viability?
a) Superior pancreaticoduodenal artery
b) Splenic artery
c) Right gastroepiploic artery
d) Left gastric artery
Answer: a) Superior pancreaticoduodenal artery
Explanation: The superior pancreaticoduodenal artery provides essential perfusion to the upper duodenum and pancreatic head. Ligation during pancreaticoduodenectomy may cause duodenal ischemia if the inferior pancreaticoduodenal artery cannot compensate. Hence, surgical preservation or reconstruction of this artery is critical for postoperative viability.
Chapter: Abdomen & Gastrointestinal Tract; Topic: Celiac Trunk and Its Branches; Subtopic: Splenic Artery and Its Distribution
Keyword Definitions:
Splenic artery: A tortuous branch of the celiac trunk that supplies the spleen, pancreas, and stomach.
Short gastric arteries: Small branches from the splenic artery supplying the fundus of the stomach.
Left gastroepiploic artery: Branch of splenic artery supplying the greater curvature of the stomach.
Pancreatic branches: Vessels supplying the body and tail of the pancreas, including arteria pancreatica magna.
Right gastroepiploic artery: A branch of the gastroduodenal artery (not of splenic artery), supplying the greater curvature of the stomach.
Lead Question - 2015
All of the following are branches of splenic artery, except?
a) Hilar branches
b) Short Gastric Artery
c) Arteria Pancreatica Magna
d) Right Gastroepiploic Artery
Answer: d) Right Gastroepiploic Artery
Explanation: The splenic artery gives pancreatic, short gastric, and left gastroepiploic branches, but not the right gastroepiploic artery. The right gastroepiploic artery arises from the gastroduodenal artery, a branch of the common hepatic artery. Together, the right and left gastroepiploic arteries form an anastomosis along the greater curvature of the stomach, ensuring gastric collateral circulation.
1. Which artery gives rise to the splenic artery?
a) Superior mesenteric artery
b) Celiac trunk
c) Common hepatic artery
d) Inferior mesenteric artery
Answer: b) Celiac trunk
Explanation: The splenic artery is one of the three main branches of the celiac trunk, along with the common hepatic and left gastric arteries. It runs tortuously along the superior border of the pancreas toward the spleen, supplying the spleen, pancreas, and stomach through several important branches, maintaining upper abdominal blood flow.
2. The left gastroepiploic artery is a branch of:
a) Splenic artery
b) Right gastric artery
c) Gastroduodenal artery
d) Left gastric artery
Answer: a) Splenic artery
Explanation: The left gastroepiploic artery arises from the splenic artery near the hilum of the spleen. It runs along the greater curvature of the stomach and anastomoses with the right gastroepiploic artery, ensuring collateral circulation between the celiac and hepatic arterial systems along the stomach’s outer curvature.
3. The arteria pancreatica magna supplies which organ?
a) Liver
b) Pancreas
c) Spleen
d) Duodenum
Answer: b) Pancreas
Explanation: The arteria pancreatica magna, a large branch of the splenic artery, supplies the body and tail of the pancreas. It forms an important arterial connection with the superior and inferior pancreaticoduodenal arteries, ensuring continuous perfusion of pancreatic tissue, especially during surgical or pathological disruptions of major vessels.
4. Short gastric arteries are branches of:
a) Left gastric artery
b) Splenic artery
c) Common hepatic artery
d) SMA
Answer: b) Splenic artery
Explanation: The short gastric arteries (usually five to seven) arise from the terminal branches of the splenic artery near the spleen. They pass through the gastrosplenic ligament to supply the fundus of the stomach. Their occlusion may lead to fundic ischemia, particularly after splenectomy or gastric surgeries affecting splenic circulation.
5. During splenectomy, which artery must be ligated to prevent gastric ischemia?
a) Short gastric arteries
b) Left gastric artery
c) Left gastroepiploic artery
d) Hepatic artery
Answer: a) Short gastric arteries
Explanation: During splenectomy, the short gastric arteries must be carefully ligated to prevent hemorrhage and avoid ischemia of the stomach fundus. These vessels connect the spleen and stomach via the gastrosplenic ligament and may tear easily during mobilization of the spleen due to their fragile walls and close proximity.
6. A patient presents with a splenic artery aneurysm. Which structure is most at risk of compression?
a) Left kidney
b) Pancreas
c) Left adrenal gland
d) Duodenum
Answer: b) Pancreas
Explanation: The splenic artery runs along the superior border of the pancreas. An aneurysm in this artery can compress the pancreatic tissue, leading to abdominal pain, pancreatitis, or erosion into adjacent structures like the stomach. It is one of the most common visceral arterial aneurysms encountered clinically.
7. The left gastroepiploic artery anastomoses with which artery along the greater curvature of stomach?
a) Right gastric artery
b) Right gastroepiploic artery
c) Left gastric artery
d) Gastroduodenal artery
Answer: b) Right gastroepiploic artery
Explanation: The left gastroepiploic artery (from splenic artery) and the right gastroepiploic artery (from gastroduodenal artery) anastomose along the greater curvature of the stomach. This arterial arcade is vital for gastric perfusion and becomes an important collateral channel during obstruction of celiac or hepatic arteries.
8. Which of the following is not a direct branch of the splenic artery?
a) Short gastric arteries
b) Left gastroepiploic artery
c) Pancreatic branches
d) Right gastric artery
Answer: d) Right gastric artery
Explanation: The right gastric artery arises from the hepatic artery, not from the splenic artery. The splenic artery gives pancreatic, short gastric, and left gastroepiploic branches. The right gastric artery supplies the lesser curvature and anastomoses with the left gastric artery to maintain stomach wall perfusion.
9. In case of splenic artery thrombosis, which stomach region may suffer ischemia?
a) Pylorus
b) Fundus
c) Lesser curvature
d) Cardiac region
Answer: b) Fundus
Explanation: The fundus of the stomach is supplied by short gastric arteries arising from the splenic artery. Thrombosis or ligation of the splenic artery during splenectomy may lead to ischemia of the fundus, since these short gastric arteries have limited collateral supply, especially in patients with celiac artery disease.
10. During partial gastrectomy, which splenic artery branch must be preserved for fundic perfusion?
a) Left gastroepiploic artery
b) Short gastric arteries
c) Left gastric artery
d) Pancreatic branches
Answer: b) Short gastric arteries
Explanation: Preservation of short gastric arteries is critical during upper stomach resections, as they ensure perfusion to the gastric fundus and adjacent greater curvature. Their accidental division may cause necrosis in the residual fundic tissue, emphasizing the surgical importance of splenic artery branches in gastric procedures.
Chapter: Abdomen & Gastrointestinal Tract; Topic: Celiac Trunk and Its Branches; Subtopic: Common Hepatic Artery and Its Distribution
Keyword Definitions:
Celiac trunk: A short arterial trunk arising from the abdominal aorta that gives rise to three main branches—left gastric, splenic, and common hepatic arteries.
Common hepatic artery: A branch of the celiac trunk that supplies the liver, gallbladder, stomach, and duodenum through its subdivisions.
Gastroduodenal artery: A branch of the common hepatic artery supplying the duodenum, head of the pancreas, and stomach.
Proper hepatic artery: Terminal branch of the common hepatic artery that divides into right and left hepatic arteries supplying the liver.
Left gastric artery: A branch of the celiac trunk supplying the stomach and lower esophagus.
Lead Question - 2015
Common hepatic artery is a branch of -
a) Splenic artery
b) Superior mesenteric artery
c) Inferior mesenteric artery
d) Coeliac trunk
Answer: d) Coeliac trunk
Explanation: The common hepatic artery arises from the celiac trunk, along with the splenic and left gastric arteries. It gives off branches including the right gastric, gastroduodenal, and proper hepatic arteries. It provides arterial supply to the liver, gallbladder, stomach, and upper duodenum. Understanding its anatomy is crucial in hepatic and biliary surgeries to prevent vascular injuries.
1. Which of the following arteries is not a branch of the celiac trunk?
a) Left gastric artery
b) Common hepatic artery
c) Splenic artery
d) Superior mesenteric artery
Answer: d) Superior mesenteric artery
Explanation: The superior mesenteric artery arises directly from the abdominal aorta below the celiac trunk and supplies midgut derivatives. In contrast, the celiac trunk supplies foregut structures through its three branches—left gastric, splenic, and common hepatic arteries. Differentiating these origins is vital in abdominal angiographic procedures and upper GI surgeries.
2. The proper hepatic artery is a branch of:
a) Gastroduodenal artery
b) Common hepatic artery
c) Right gastric artery
d) Left gastric artery
Answer: b) Common hepatic artery
Explanation: The common hepatic artery divides into the proper hepatic artery and the gastroduodenal artery. The proper hepatic artery further bifurcates into right and left hepatic arteries supplying the respective lobes of the liver. It runs within the hepatoduodenal ligament alongside the portal vein and common bile duct forming the portal triad.
3. Right gastric artery is a branch of:
a) Left gastric artery
b) Common hepatic artery
c) Gastroduodenal artery
d) Splenic artery
Answer: b) Common hepatic artery
Explanation: The right gastric artery typically arises from the common hepatic artery or its branch, the proper hepatic artery. It supplies the lesser curvature of the stomach and anastomoses with the left gastric artery, forming part of the vascular arcades ensuring adequate gastric mucosal perfusion along the lesser curvature.
4. Gastroduodenal artery arises from:
a) Common hepatic artery
b) Left gastric artery
c) Right hepatic artery
d) Splenic artery
Answer: a) Common hepatic artery
Explanation: The gastroduodenal artery branches from the common hepatic artery near the duodenum. It descends behind the first part of the duodenum, supplying the duodenum and head of the pancreas. It divides into right gastroepiploic and superior pancreaticoduodenal arteries. It is vulnerable during posterior duodenal ulcer perforations causing severe bleeding.
5. A posterior duodenal ulcer erodes an artery leading to massive bleeding. Which artery is most likely involved?
a) Left gastric artery
b) Gastroduodenal artery
c) Right hepatic artery
d) Splenic artery
Answer: b) Gastroduodenal artery
Explanation: The gastroduodenal artery runs posterior to the first part of the duodenum and is prone to erosion by posterior duodenal ulcers. Its rupture causes upper gastrointestinal bleeding. Prompt diagnosis and surgical ligation of the artery are life-saving measures in peptic ulcer disease complications.
6. Which of the following structures lies in the free margin of the lesser omentum?
a) Portal vein
b) Left gastric artery
c) Splenic vein
d) Inferior mesenteric vein
Answer: a) Portal vein
Explanation: The free margin of the lesser omentum encloses the portal triad, consisting of the portal vein posteriorly, the proper hepatic artery on the left, and the common bile duct on the right. The lesser omentum connects the liver to the lesser curvature of the stomach and first part of the duodenum.
7. The hepatic artery proper divides into:
a) Right and left hepatic arteries
b) Right gastric and gastroduodenal arteries
c) Cystic and splenic arteries
d) Left gastric and superior mesenteric arteries
Answer: a) Right and left hepatic arteries
Explanation: The proper hepatic artery divides into right and left hepatic arteries to supply respective lobes of the liver. The right hepatic artery gives off the cystic artery to the gallbladder. This division is significant in hepatic resections and cholecystectomy to avoid accidental hepatic ischemia or bile duct injury.
8. During laparoscopic cholecystectomy, the cystic artery is identified as a branch of:
a) Left hepatic artery
b) Right hepatic artery
c) Gastroduodenal artery
d) Proper hepatic artery
Answer: b) Right hepatic artery
Explanation: The cystic artery usually arises from the right hepatic artery within Calot’s triangle. It supplies the gallbladder and cystic duct. Accurate identification and ligation of the cystic artery during cholecystectomy are crucial to prevent hemorrhage and ensure safe gallbladder removal, especially in cases with variant hepatic arterial anatomy.
9. In a liver transplant, which artery is crucial to maintain hepatic arterial inflow?
a) Gastroduodenal artery
b) Proper hepatic artery
c) Right gastric artery
d) Splenic artery
Answer: b) Proper hepatic artery
Explanation: The proper hepatic artery provides oxygenated blood to the liver and is vital during liver transplantation. Its patency ensures adequate hepatic perfusion and graft viability. Injury or thrombosis of this artery can lead to hepatic necrosis, emphasizing its importance in hepatic surgery and interventional radiology procedures.
10. In angiography, the common hepatic artery is visualized branching into:
a) Gastroduodenal and proper hepatic arteries
b) Left gastric and splenic arteries
c) Inferior pancreaticoduodenal and middle colic arteries
d) Right gastric and splenic arteries
Answer: a) Gastroduodenal and proper hepatic arteries
Explanation: On angiographic imaging, the common hepatic artery divides into the gastroduodenal artery (descending) and the proper hepatic artery (ascending). The gastroduodenal supplies the duodenum and pancreas, while the proper hepatic supplies the liver. This branching pattern is essential in identifying arterial territories during hepatic embolization and surgical planning.
Chapter: Gastrointestinal Tract; Topic: Portal Venous System; Subtopic: Esophageal Varices
Keyword Definitions:
Esophageal Varices: Dilated veins in the lower esophagus due to portal hypertension.
Portal Hypertension: Increased pressure in the portal venous system often caused by liver cirrhosis.
Portosystemic Anastomosis: Connection between portal and systemic venous systems allowing collateral blood flow.
Lower Esophagus: The distal third of the esophagus near the gastroesophageal junction.
Left Gastric Vein: A vein that drains into the portal vein and connects with esophageal veins forming varices.
Lead Question - 2015
Esophageal varices occur in which portion of esophagus?
a) Upper
b) Middle
c) Lower
d) All sites
Explanation: The correct answer is c) Lower. Esophageal varices occur in the lower third of the esophagus where the portal and systemic circulations communicate via the left gastric and esophageal veins. In portal hypertension, these veins become dilated and tortuous, posing a risk of rupture and massive upper gastrointestinal bleeding. (100 words)
1. The venous drainage of lower esophagus is through?
a) Azygos vein
b) Hemiazygos vein
c) Left gastric vein
d) Inferior vena cava
Explanation: The correct answer is c) Left gastric vein. The lower esophagus drains into the left gastric vein, which in turn drains into the portal vein. This forms a vital portosystemic anastomosis with the systemic esophageal veins, a site of variceal formation during portal hypertension leading to potential bleeding. (100 words)
2. Which of the following veins forms portosystemic anastomosis at the lower esophagus?
a) Inferior phrenic vein
b) Left gastric vein and azygos vein
c) Inferior vena cava
d) Splenic vein
Explanation: The correct answer is b) Left gastric vein and azygos vein. The left gastric vein belongs to the portal system, while the azygos vein drains into the superior vena cava, representing the systemic system. Their anastomosis at the lower esophagus allows blood diversion in portal hypertension, forming varices. (100 words)
3. Clinical presentation of bleeding esophageal varices includes:
a) Hematemesis
b) Melena
c) Pallor and hypotension
d) All of the above
Explanation: The correct answer is d) All of the above. Bleeding from esophageal varices causes hematemesis, melena, and hypovolemic shock due to massive blood loss. It is a life-threatening emergency commonly associated with portal hypertension secondary to cirrhosis of the liver or chronic viral hepatitis. (100 words)
4. Which vein is most likely dilated in portal hypertension leading to esophageal varices?
a) Right gastric vein
b) Left gastric vein
c) Superior mesenteric vein
d) Inferior mesenteric vein
Explanation: The correct answer is b) Left gastric vein. The left gastric vein becomes engorged in portal hypertension and forms collaterals with esophageal veins. This venous dilation leads to varices, which may rupture and cause upper gastrointestinal bleeding, often seen in cirrhotic patients. (100 words)
5. In patients with liver cirrhosis, varices commonly occur at:
a) Lower esophagus
b) Rectum
c) Umbilicus
d) All of the above
Explanation: The correct answer is d) All of the above. Portal hypertension due to liver cirrhosis leads to collateral formation at three main sites: lower esophagus (esophageal varices), rectum (hemorrhoids), and umbilicus (caput medusae). These portosystemic shunts help decompress the portal system but may cause serious bleeding. (100 words)
6. A 45-year-old alcoholic male presents with hematemesis. Endoscopy reveals varices in the lower esophagus. The underlying condition is most likely:
a) Peptic ulcer
b) Portal hypertension
c) Mallory-Weiss tear
d) Esophagitis
Explanation: The correct answer is b) Portal hypertension. Chronic alcoholism causes cirrhosis, leading to portal hypertension. This increases pressure in the left gastric vein, producing esophageal varices in the lower esophagus. Variceal rupture results in massive hematemesis, requiring urgent intervention. (100 words)
7. The best investigation to confirm esophageal varices is:
a) Endoscopy
b) Barium swallow
c) CT scan
d) Ultrasound
Explanation: The correct answer is a) Endoscopy. Upper GI endoscopy directly visualizes esophageal varices, assessing their size, risk of rupture, and presence of bleeding. It is the gold standard diagnostic tool, essential for both diagnosis and therapeutic band ligation in variceal management. (100 words)
8. Which of the following best describes portosystemic shunting in portal hypertension?
a) Blood bypasses the liver
b) Blood flow to the liver increases
c) Decreased systemic venous return
d) None of these
Explanation: The correct answer is a) Blood bypasses the liver. In portal hypertension, elevated portal pressure causes blood to reroute through collateral vessels connecting portal and systemic circulations, bypassing the liver. This helps decompress the portal system but leads to varices and complications. (100 words)
9. The left gastric vein drains directly into:
a) Superior mesenteric vein
b) Splenic vein
c) Portal vein
d) Inferior mesenteric vein
Explanation: The correct answer is c) Portal vein. The left gastric vein drains blood from the lower esophagus and upper stomach directly into the portal vein. During portal hypertension, this connection with esophageal veins becomes distended, forming portosystemic anastomoses, resulting in esophageal varices. (100 words)
10. A patient with cirrhosis develops hematemesis. Which treatment is used to control bleeding from esophageal varices?
a) Vasopressin
b) Beta-blockers
c) Band ligation
d) All of the above
Explanation: The correct answer is d) All of the above. Esophageal variceal bleeding is treated with vasoconstrictors like vasopressin, beta-blockers for prevention, and endoscopic band ligation for active bleeding. Together, they reduce portal pressure, control hemorrhage, and lower the risk of rebleeding in cirrhotic patients. (100 words)
Chapter: Abdominal Wall; Topic: Muscles of the Anterior Abdominal Wall; Subtopic: External Oblique Muscle and Its Aponeurosis
Keyword Definitions:
External Oblique Muscle: The largest and most superficial of the three flat abdominal muscles, running downward and medially.
Aponeurosis: A flattened tendon-like sheet that contributes to formation of the anterior abdominal wall and inguinal canal.
Inguinal Ligament: A fibrous band formed by the rolled lower border of the external oblique aponeurosis.
Lacunar Ligament: A crescent-shaped extension of the inguinal ligament to the pectineal line of the pubis.
Conjoint Tendon: A tendon formed by the lower fibers of internal oblique and transversus abdominis muscles, not by external oblique.
Lead Question - 2015
External oblique forms all except?
a) Lacunar ligament
b) Pectineal ligament
c) Conjoint tendon
d) Inguinal ligament
Explanation: The correct answer is c) Conjoint tendon. The external oblique forms the inguinal and lacunar ligaments, but the conjoint tendon is derived from internal oblique and transversus abdominis. The external oblique aponeurosis also forms part of the anterior wall of the inguinal canal, supporting abdominal structures and maintaining wall integrity. (100 words)
1. Which of the following is derived from the lower border of external oblique aponeurosis?
a) Inguinal ligament
b) Conjoint tendon
c) Cremaster muscle
d) Pectineal ligament
Explanation: The correct answer is a) Inguinal ligament. The lower margin of the external oblique aponeurosis folds backward to form the inguinal ligament extending from the anterior superior iliac spine to the pubic tubercle. It marks the inferior boundary of the abdominal wall. (100 words)
2. Which ligament is formed from the reflection of inguinal ligament onto the pectineal line?
a) Lacunar ligament
b) Pectineal ligament
c) Conjoint tendon
d) Round ligament
Explanation: The correct answer is b) Pectineal ligament. The pectineal ligament, also called the ligament of Cooper, is a strong fibrous extension of the lacunar ligament along the pectineal line of the pubis. It provides attachment for fascia and serves as a surgical landmark in hernia repairs. (100 words)
3. The external oblique muscle helps form which of the following structures?
a) Anterior wall of the inguinal canal
b) Posterior wall of the inguinal canal
c) Deep inguinal ring
d) Conjoint tendon
Explanation: The correct answer is a) Anterior wall of the inguinal canal. The aponeurosis of the external oblique forms the anterior wall of the inguinal canal, providing structural support and protection to the spermatic cord in males and the round ligament in females. (100 words)
4. A 40-year-old male presents with an indirect inguinal hernia. Which structure forms the anterior wall of the inguinal canal that may be weakened?
a) Internal oblique
b) Transversus abdominis
c) External oblique aponeurosis
d) Transversalis fascia
Explanation: The correct answer is c) External oblique aponeurosis. The anterior wall of the inguinal canal is formed mainly by the external oblique aponeurosis. Weakness or defects in this aponeurosis may allow abdominal contents to protrude, leading to hernia formation through the inguinal canal. (100 words)
5. Which of the following ligaments does not develop from the external oblique aponeurosis?
a) Inguinal ligament
b) Lacunar ligament
c) Pectineal ligament
d) Reflected part of inguinal ligament
Explanation: The correct answer is c) Pectineal ligament. The pectineal ligament (Cooper’s ligament) develops from the periosteum along the pectineal line and not from the external oblique. The other listed ligaments are formed by special modifications of the external oblique aponeurosis. (100 words)
6. A 32-year-old male complains of a bulge in the groin region aggravated by coughing. The hernial sac passes through the superficial inguinal ring. Which muscle’s aponeurosis forms this ring?
a) Internal oblique
b) External oblique
c) Transversus abdominis
d) Rectus abdominis
Explanation: The correct answer is b) External oblique. The superficial inguinal ring is an opening in the aponeurosis of the external oblique muscle. It transmits the spermatic cord in males and round ligament in females, and forms a potential site of indirect inguinal hernia. (100 words)
7. The external oblique muscle originates from which of the following structures?
a) Iliac crest
b) Lower eight ribs
c) Lumbar fascia
d) Xiphoid process
Explanation: The correct answer is b) Lower eight ribs. The external oblique muscle arises from the outer surfaces of the lower eight ribs (ribs 5–12). Its fibers run downward and medially to insert into the iliac crest and linea alba, assisting in trunk rotation and compression of abdominal contents. (100 words)
8. Which of the following structures reinforces the anterior wall of the inguinal canal medially?
a) Conjoint tendon
b) Transversalis fascia
c) Lacunar ligament
d) Deep inguinal ring
Explanation: The correct answer is a) Conjoint tendon. Although formed by internal oblique and transversus abdominis, the conjoint tendon lies behind the superficial inguinal ring, strengthening the anterior wall medially and preventing direct hernia protrusion through Hesselbach’s triangle. (100 words)
9. A surgeon repairing an inguinal hernia identifies a structure extending from the ASIS to the pubic tubercle. This is:
a) Inguinal ligament
b) Lacunar ligament
c) Pectineal ligament
d) Conjoint tendon
Explanation: The correct answer is a) Inguinal ligament. The inguinal ligament is a strong fibrous band formed by the rolled lower margin of the external oblique aponeurosis. It extends from the anterior superior iliac spine to the pubic tubercle, forming the base of the inguinal canal. (100 words)
10. A 45-year-old woman undergoing hernia surgery is found to have a strong fibrous band extending from the lacunar ligament along the pectineal line. Identify this structure.
a) Pectineal ligament
b) Inguinal ligament
c) Conjoint tendon
d) Rectus sheath
Explanation: The correct answer is a) Pectineal ligament. The pectineal ligament (Cooper’s ligament) is a continuation of the lacunar ligament running along the pectineal line of the pubis. It provides a strong base for suturing in hernia repair and supports the anterior abdominal wall. (100 words)
Chapter: Abdomen; Topic: Inguinal Region; Subtopic: Inferior Epigastric Artery and Hesselbach’s Triangle
Keyword Definitions:
Inferior Epigastric Artery: A branch of the external iliac artery that ascends within the rectus sheath to supply the lower anterior abdominal wall.
Hesselbach’s Triangle: A weak area in the lower abdominal wall bounded by the inferior epigastric artery, rectus abdominis, and inguinal ligament.
Direct Inguinal Hernia: Hernia passing through Hesselbach’s triangle medial to the inferior epigastric artery.
Indirect Inguinal Hernia: Hernia passing lateral to the inferior epigastric artery through the deep inguinal ring.
Inguinal Ligament: A fibrous band extending from the ASIS to the pubic tubercle forming the base of the inguinal canal.
Lead Question - 2015
Inferior epigastric artery forms the boundary of?
a) Femoral triangle
b) Hesselbach's triangle
c) Adductor canal
d) Popliteal triangle
Explanation: The correct answer is b) Hesselbach's triangle. The inferior epigastric artery forms the superolateral boundary of Hesselbach’s triangle. The other boundaries are the lateral border of rectus abdominis (medially) and the inguinal ligament (inferiorly). This area is clinically important as direct inguinal hernias pass through it, medial to the inferior epigastric vessels. (100 words)
1. The inferior epigastric artery arises from which of the following arteries?
a) External iliac artery
b) Femoral artery
c) Internal iliac artery
d) Aorta
Explanation: The correct answer is a) External iliac artery. The inferior epigastric artery is a direct branch of the external iliac artery just above the inguinal ligament. It ascends obliquely in the transversalis fascia to enter the rectus sheath and anastomoses with the superior epigastric artery. (100 words)
2. Which of the following statements about Hesselbach’s triangle is true?
a) It is bounded laterally by the inferior epigastric artery
b) It is bounded inferiorly by the pectineal ligament
c) It is bounded medially by the transversus abdominis
d) It contains the deep inguinal ring
Explanation: The correct answer is a) It is bounded laterally by the inferior epigastric artery. The triangle’s boundaries are the rectus abdominis medially, inferior epigastric artery laterally, and the inguinal ligament inferiorly. It is a site of direct inguinal hernia due to weakness in the transversalis fascia. (100 words)
3. A direct inguinal hernia lies in relation to inferior epigastric artery:
a) Medial
b) Lateral
c) Posterior
d) Inferior
Explanation: The correct answer is a) Medial. A direct inguinal hernia protrudes through the posterior wall of the inguinal canal within Hesselbach’s triangle, which lies medial to the inferior epigastric artery. Indirect hernias, in contrast, pass lateral to this vessel through the deep inguinal ring. (100 words)
4. A 55-year-old man presents with a bulge in the groin. On surgery, the hernia sac is seen medial to the inferior epigastric artery. What type of hernia is this?
a) Direct inguinal hernia
b) Indirect inguinal hernia
c) Femoral hernia
d) Obturator hernia
Explanation: The correct answer is a) Direct inguinal hernia. Direct hernias pass through Hesselbach’s triangle medial to the inferior epigastric artery due to weakness of the posterior wall of the inguinal canal, usually acquired from chronic straining or increased intra-abdominal pressure. (100 words)
5. The inferior epigastric artery enters the rectus sheath at which level?
a) Midway between umbilicus and pubic symphysis
b) At the level of arcuate line
c) Just below xiphoid process
d) At the umbilicus
Explanation: The correct answer is b) At the level of arcuate line. The inferior epigastric artery enters the rectus sheath by piercing the transversalis fascia at the arcuate line, where the posterior layer of the rectus sheath is absent. It ascends to anastomose with the superior epigastric artery. (100 words)
6. In laparoscopic surgery, inferior epigastric vessels are identified to prevent injury. They lie:
a) Between peritoneum and transversalis fascia
b) Between internal oblique and transversus abdominis
c) Within the rectus abdominis
d) Between rectus abdominis and its posterior sheath
Explanation: The correct answer is d) Between rectus abdominis and its posterior sheath. The inferior epigastric vessels ascend behind the rectus abdominis between it and the posterior layer of its sheath, making their identification crucial during laparoscopic port placement. (100 words)
7. During inguinal hernia repair, the surgeon identifies the inferior epigastric artery. This artery helps to differentiate:
a) Direct and indirect inguinal hernias
b) Inguinal and femoral hernias
c) Obturator and femoral hernias
d) Internal and external hernias
Explanation: The correct answer is a) Direct and indirect inguinal hernias. The position of the hernial sac in relation to the inferior epigastric artery distinguishes direct (medial) from indirect (lateral) inguinal hernias, an essential surgical landmark in herniorrhaphy. (100 words)
8. A 35-year-old man has an indirect inguinal hernia. The hernial sac lies:
a) Lateral to inferior epigastric artery
b) Medial to inferior epigastric artery
c) Posterior to it
d) Inferior to it
Explanation: The correct answer is a) Lateral to inferior epigastric artery. Indirect inguinal hernias enter the deep inguinal ring lateral to the inferior epigastric artery and traverse the inguinal canal, often extending into the scrotum. It is commonly congenital due to a patent processus vaginalis. (100 words)
9. Injury to the inferior epigastric artery during trocar placement in laparoscopy can cause bleeding from which space?
a) Preperitoneal space
b) Retropubic space
c) Retrorectus space
d) Subcutaneous space
Explanation: The correct answer is c) Retrorectus space. The inferior epigastric vessels lie in the retrorectus space, between rectus abdominis and its posterior sheath. Damage to these vessels during trocar insertion leads to hematoma formation in this potential space. (100 words)
10. The inferior epigastric artery anastomoses with which of the following arteries?
a) Superior epigastric artery
b) Deep circumflex iliac artery
c) Superficial epigastric artery
d) Inferior mesenteric artery
Explanation: The correct answer is a) Superior epigastric artery. The inferior and superior epigastric arteries form a vital anastomosis between the external iliac and internal thoracic arterial systems, providing collateral circulation between the subclavian and external iliac arteries. (100 words)
Chapter: Abdomen; Topic: Peritoneum and Omental Bursa; Subtopic: Epiploic (Winslow’s) Foramen
Keyword Definitions:
• Peritoneum: A thin serous membrane lining the abdominal cavity and covering abdominal organs.
• Lesser sac: A cavity behind the stomach, also called omental bursa.
• Foramen of Winslow: Opening connecting greater and lesser sacs.
• Lesser omentum: Double layer of peritoneum between liver and stomach.
• Caudate lobe: Part of the liver adjacent to the IVC.
Lead Question - 2015
The boundaries of the interconnection between greater sac and lesser sac of peritoneum known as 'Foramen of Winslow' are all, EXCEPT:
a) Caudate lobe of liver
b) Inferior vena cava
c) Free border of lesser omentum
d) 4th part of Duodenum
Explanation: The Foramen of Winslow (epiploic foramen) connects the greater and lesser sacs. Its boundaries are: anteriorly the free border of lesser omentum containing the portal triad, posteriorly the IVC, superiorly the caudate lobe of liver, and inferiorly the first part of the duodenum. Thus, option (d) is incorrect. Answer: 4th part of duodenum.
1. The lesser sac is situated:
a) Behind the stomach
b) In front of the liver
c) Below the diaphragm
d) Behind the spleen
Explanation: The lesser sac (omental bursa) is a peritoneal recess behind the stomach and lesser omentum, providing space for stomach movements. It is part of the peritoneal cavity and communicates with the greater sac via the Foramen of Winslow. Answer: Behind the stomach.
2. Which structure forms the anterior boundary of Foramen of Winslow?
a) Inferior vena cava
b) Free border of lesser omentum
c) Caudate lobe
d) First part of duodenum
Explanation: The anterior boundary of the epiploic foramen is formed by the free border of lesser omentum, which encloses the portal vein, hepatic artery, and bile duct. This forms an important surgical landmark during Pringle’s maneuver. Answer: Free border of lesser omentum.
3. Posterior relation of Foramen of Winslow is:
a) Inferior vena cava
b) Aorta
c) Portal vein
d) Hepatic vein
Explanation: The posterior boundary of the foramen is the inferior vena cava covered by peritoneum. It separates the foramen from the right suprarenal gland and kidney. This relation is clinically relevant during hepatic and retroperitoneal surgeries. Answer: Inferior vena cava.
4. Superior boundary of Foramen of Winslow is formed by:
a) Quadrate lobe
b) Caudate lobe
c) Right lobe of liver
d) Hepatic vein
Explanation: The caudate lobe of the liver forms the superior boundary of the epiploic foramen. It separates the foramen from the posterior aspect of the liver. This area is also called the caudate process region. Answer: Caudate lobe.
5. Inferior boundary of the Foramen of Winslow:
a) 1st part of duodenum
b) 2nd part of duodenum
c) 3rd part of duodenum
d) 4th part of duodenum
Explanation: The first part of the duodenum and the hepatic artery lie inferior to the foramen of Winslow, forming its lower limit. This anatomical feature is significant for surgical access to the posterior stomach wall. Answer: 1st part of duodenum.
6. A surgeon compresses the hepatoduodenal ligament to control liver bleeding. This maneuver is called:
a) Kocher maneuver
b) Pringle maneuver
c) Cattell-Braasch maneuver
d) Mattox maneuver
Explanation: The Pringle maneuver involves compressing the hepatoduodenal ligament (anterior wall of Foramen of Winslow) to temporarily occlude hepatic inflow and control bleeding from the liver during surgery. Answer: Pringle maneuver.
7. A fluid collection in the lesser sac after gastric perforation most likely occurs:
a) Behind the stomach
b) Between the right kidney and colon
c) In front of liver
d) Between spleen and diaphragm
Explanation: The lesser sac lies posterior to the stomach and lesser omentum. Hence, posterior gastric perforations cause fluid to collect within it, detectable on imaging as fluid behind the stomach. Answer: Behind the stomach.
8. The portal triad runs through which ligament?
a) Gastrocolic ligament
b) Hepatogastric ligament
c) Hepatoduodenal ligament
d) Gastrosplenic ligament
Explanation: The hepatoduodenal ligament contains the portal triad — bile duct (right), hepatic artery (left), and portal vein (posterior). It forms the anterior boundary of the Foramen of Winslow. Answer: Hepatoduodenal ligament.
9. In portal hypertension, blood can pass from the portal vein to systemic veins via:
a) Umbilical veins
b) Esophageal varices
c) Inferior vena cava
d) Aortic branches
Explanation: In portal hypertension, blood diverts through portosystemic anastomoses such as esophageal varices and paraumbilical veins. The Foramen of Winslow remains an anatomic rather than functional channel. Answer: Esophageal varices.
10. During laparoscopic cholecystectomy, which structure lies immediately posterior to the foramen of Winslow?
a) Inferior vena cava
b) Hepatic artery
c) Portal vein
d) Duodenum
Explanation: The inferior vena cava lies posterior to the epiploic foramen, covered by peritoneum. Awareness of this relation prevents accidental injury during hepatobiliary surgery. Answer: Inferior vena cava.
11. A patient with retroperitoneal abscess involving the right kidney may have pus tracking into:
a) Lesser sac
b) Greater sac
c) Subphrenic space
d) Pelvic cavity
Explanation: The lesser sac can become secondarily involved through communication near the Foramen of Winslow if infection spreads anteriorly. This is clinically important for abscess drainage. Answer: Lesser sac.
Chapter: Pelvis; Topic: Pelvic Floor and Anal Canal; Subtopic: Anorectal Angle and Puborectalis Muscle
Keyword Definitions:
• Anorectal Angle: The angle formed between the rectum and anal canal that helps maintain fecal continence.
• Puborectalis Muscle: A U-shaped sling from pubic bones that loops around the anorectal junction, maintaining the anorectal angle.
• Pelvic Diaphragm: Muscular floor of pelvis formed by levator ani and coccygeus.
• Internal Anal Sphincter: Smooth muscle maintaining involuntary control of the anal canal.
• Levator Ani: Group of muscles including pubococcygeus, puborectalis, and iliococcygeus.
Lead Question - 2015
Anorectal angle is formed due to action of -
a) Internal anal sphincter
b) Circular muscle layer of smooth muscles
c) Longitudinal muscle layer of smooth muscle
d) Puborectalis
Explanation: The puborectalis muscle, part of the levator ani, forms a sling around the anorectal junction, pulling it forward to create the anorectal angle (about 80°). This angle is crucial for continence and straightens during defecation as the puborectalis relaxes. Its dysfunction leads to fecal incontinence. Answer: Puborectalis.
1. The levator ani muscle is composed of all, EXCEPT:
a) Pubococcygeus
b) Iliococcygeus
c) Coccygeus
d) Puborectalis
Explanation: The levator ani comprises the pubococcygeus, puborectalis, and iliococcygeus. The coccygeus is a separate pelvic diaphragm muscle located posteriorly. These muscles support pelvic viscera and maintain continence. Answer: Coccygeus.
2. The nerve supply of levator ani is:
a) Pudendal nerve
b) Sacral plexus (S3-S4)
c) Inferior rectal nerve
d) Pelvic splanchnic nerve
Explanation: The levator ani receives innervation from the nerve to levator ani (S3-S4) and branches of the pudendal nerve. Proper function of these nerves maintains pelvic floor tone and continence mechanisms. Answer: Sacral plexus (S3-S4).
3. Which muscle relaxes during defecation?
a) Puborectalis
b) Internal anal sphincter
c) External anal sphincter
d) Coccygeus
Explanation: During defecation, the puborectalis relaxes to straighten the anorectal angle, allowing stool passage. This coordinated action with relaxation of both anal sphincters ensures controlled evacuation. Answer: Puborectalis.
4. The anorectal angle normally measures approximately:
a) 30°
b) 60°
c) 80°
d) 110°
Explanation: The anorectal angle averages around 80° in resting condition due to puborectalis tone. During straining or defecation, this angle becomes more obtuse (~110°), facilitating stool passage. Answer: 80°.
5. Incontinence after vaginal delivery is usually due to injury of:
a) Internal anal sphincter
b) Puborectalis muscle
c) Iliococcygeus
d) Obturator internus
Explanation: Childbirth may damage the puborectalis muscle or its nerve supply, resulting in weakened pelvic support and fecal incontinence due to loss of the anorectal angle. Answer: Puborectalis muscle.
6. The puborectalis muscle originates from:
a) Coccyx
b) Ischial spine
c) Pubic bone
d) Perineal body
Explanation: The puborectalis arises from the posterior surface of pubic bones and loops posteriorly around the anorectal junction. It functions as a muscular sling maintaining the anorectal angle. Answer: Pubic bone.
7. The pelvic floor is mainly formed by:
a) Obturator internus
b) Levator ani and coccygeus
c) Piriformis
d) Gluteus maximus
Explanation: The pelvic diaphragm forming the pelvic floor consists of the levator ani (puborectalis, pubococcygeus, iliococcygeus) and the coccygeus muscle. They support the pelvic organs and maintain continence. Answer: Levator ani and coccygeus.
8. A patient with chronic constipation has a sharp anorectal angle on defecography. Which muscle is likely overactive?
a) Puborectalis
b) External sphincter
c) Internal sphincter
d) Coccygeus
Explanation: Excessive contraction of puborectalis causes persistent acute anorectal angle, obstructing stool passage—a condition called anismus. It requires biofeedback or muscle retraining therapy. Answer: Puborectalis.
9. The internal anal sphincter is derived from:
a) Circular smooth muscle layer
b) Longitudinal muscle layer
c) External oblique
d) Transversus abdominis
Explanation: The internal anal sphincter is formed by thickened circular smooth muscle of the rectum. It maintains involuntary control and contributes 70% of resting anal tone. Answer: Circular smooth muscle layer.
10. In rectal examination, contraction of puborectalis produces:
a) Straight anal canal
b) Forward pull of anal canal
c) Posterior displacement of rectum
d) Loss of anal tone
Explanation: On contraction, the puborectalis muscle pulls the anal canal forward toward the pubic symphysis, increasing the anorectal angle and preventing defecation. This mechanism is key in continence. Answer: Forward pull of anal canal.
11. Injury to pudendal nerve causes all, EXCEPT:
a) Loss of anal sphincter control
b) Loss of external urethral sphincter tone
c) Loss of internal sphincter tone
d) Fecal incontinence
Explanation: The pudendal nerve supplies the external anal and urethral sphincters. The internal sphincter is autonomically innervated, so its function remains intact after pudendal injury. Answer: Loss of internal sphincter tone.
Chapter: Pelvis; Topic: Urogenital System; Subtopic: Female Homologues of Male Reproductive Organs
Keyword Definitions:
• Prostate Gland: A male accessory gland producing seminal fluid that nourishes sperm.
• Skene’s Glands: Also known as paraurethral glands; small glands located near the female urethra, homologous to the male prostate.
• Homologous Structures: Organs that develop from the same embryonic tissues in both sexes but differ functionally.
• Bartholin’s Gland: Large paired glands in the vestibule providing lubrication during intercourse.
• Bulbourethral Gland: Male gland secreting mucus-like fluid for urethral lubrication before ejaculation.
Lead Question - 2015
Prostate analogue in female is -
a) Skene gland
b) Bulbourethral gland
c) Great vestibular gland
d) Bartholin's gland
Explanation: The Skene’s glands (paraurethral glands) in females are homologous to the prostate gland in males. They secrete a fluid similar in composition to prostatic fluid and open near the urethral meatus. Their development originates from the urogenital sinus, the same as the prostate. Answer: Skene gland.
1. The male homolog of Bartholin’s gland is:
a) Bulbourethral gland
b) Prostate
c) Seminal vesicle
d) Cowper’s duct
Explanation: The Bartholin’s gland in females is homologous to the bulbourethral (Cowper’s) gland in males. Both develop from the urogenital sinus and secrete mucus to lubricate the genital tract during sexual activity. Answer: Bulbourethral gland.
2. The embryological origin of the prostate is:
a) Mesonephric duct
b) Paramesonephric duct
c) Urogenital sinus
d) Cloaca
Explanation: The prostate gland arises as an outgrowth from the urogenital sinus epithelium around the 10th week of fetal life. The surrounding mesenchyme forms its stroma. Similarly, female Skene’s glands share the same embryonic source. Answer: Urogenital sinus.
3. In females, Skene’s glands open into:
a) Vagina
b) Urethra near external meatus
c) Vestibule
d) Cervical canal
Explanation: The Skene’s glands open into the urethra near the external meatus. These glands secrete an antimicrobial fluid and help maintain urethral health. Their infection can mimic urinary tract infection symptoms. Answer: Urethra near external meatus.
4. The female structure homologous to the scrotum is:
a) Labia minora
b) Labia majora
c) Vestibule
d) Mons pubis
Explanation: The labia majora in females develop from the same embryological folds that form the scrotum in males. Both are derived from the labioscrotal swellings. Answer: Labia majora.
5. The female homolog of penis is:
a) Labia minora
b) Vestibule
c) Clitoris
d) Mons pubis
Explanation: The clitoris in females is homologous to the penis in males. Both develop from the genital tubercle and contain erectile tissue. Answer: Clitoris.
6. A woman presents with a paraurethral mass discharging pus. The likely infected gland is:
a) Bartholin’s gland
b) Skene’s gland
c) Vestibular gland
d) Bulbourethral gland
Explanation: Infection of the Skene’s gland (paraurethral abscess) causes periurethral swelling and pus discharge near the urethral meatus. Common pathogens include E. coli and Gonococcus. Answer: Skene’s gland.
7. Bartholin’s cyst is located at:
a) Upper vaginal wall
b) Vestibule at 5 and 7 o’clock positions
c) Around urethral meatus
d) Posterior fornix
Explanation: Bartholin’s glands lie at the posterolateral part of the vaginal opening (5 and 7 o’clock positions). Blockage of its duct leads to cyst formation. Answer: Vestibule at 5 and 7 o’clock positions.
8. Which of the following female structures develops from the mesonephric duct?
a) Uterine tube
b) Uterus
c) Gartner’s duct
d) Ovary
Explanation: The Gartner’s duct (remnant of mesonephric duct) may persist along the vaginal wall. In males, this duct forms the vas deferens and seminal vesicle. Answer: Gartner’s duct.
9. Which hormone influences prostate development in males?
a) Estrogen
b) Testosterone
c) Dihydrotestosterone (DHT)
d) Progesterone
Explanation: The development of the prostate gland requires dihydrotestosterone (DHT), a potent androgen derived from testosterone by 5α-reductase. In its absence, prostate and external genitalia fail to differentiate. Answer: Dihydrotestosterone (DHT).
10. Skene’s glands in females are located:
a) Posterior to vagina
b) Lateral to urethra
c) Deep to clitoris
d) Within vestibule
Explanation: The Skene’s glands are situated lateral to the urethra, embedded in the anterior vaginal wall. They secrete fluid during sexual arousal and drain into the urethral orifice. Answer: Lateral to urethra.
11. A tumor in female paraurethral glands is analogous to which male cancer?
a) Penile carcinoma
b) Prostate carcinoma
c) Testicular tumor
d) Epididymal cyst
Explanation: Malignancy arising from Skene’s glands is rare but histologically resembles prostate carcinoma, confirming their homology. Such cases may show PSA and PAP positivity on immunostaining. Answer: Prostate carcinoma.
Chapter: Pelvis; Topic: Arterial Supply of Pelvic Organs; Subtopic: Uterine Artery and Its Relations
Keyword Definitions:
• Uterine Artery: Main artery supplying the uterus, cervix, and upper vagina, derived from the internal iliac artery.
• Internal Iliac Artery: Major pelvic artery supplying reproductive organs, bladder, rectum, and muscles.
• Ovarian Artery: A branch from the abdominal aorta supplying the ovaries and anastomosing with the uterine artery.
• Ureter: A muscular tube that conveys urine from the kidney to the bladder, crossing under the uterine artery (“water under the bridge”).
• Parametrium: Connective tissue surrounding the uterus, containing uterine vessels and lymphatics.
Lead Question - 2015
The uterine artery is a branch of which of the following?
a) Left common iliac artery
b) Internal iliac artery
c) Internal pudendal artery
d) Ovarian artery
Explanation: The uterine artery arises from the anterior division of the internal iliac artery. It ascends along the lateral wall of the pelvis, crosses the ureter (posteriorly), and reaches the uterus at the level of the cervix. It supplies the uterus, upper vagina, and anastomoses with the ovarian artery. Answer: Internal iliac artery.
1. The uterine artery crosses which structure near the lateral fornix?
a) Round ligament
b) Ureter
c) Ovarian ligament
d) Broad ligament
Explanation: The uterine artery crosses the ureter approximately 2 cm lateral to the cervix. The relation is remembered as “water (ureter) under the bridge (uterine artery).” This is a key surgical landmark during hysterectomy to prevent ureteric injury. Answer: Ureter.
2. The uterine artery enters the uterus at the level of:
a) Fundus
b) Body
c) Cervix
d) Isthmus
Explanation: The uterine artery enters the uterus at the level of the cervix, within the broad ligament. From there, it ascends tortuously along the uterine margin to reach the fundus and supplies the myometrium and endometrium. Answer: Cervix.
3. A 35-year-old woman undergoes hysterectomy. During surgery, the uterine artery must be ligated carefully to avoid injury to:
a) Ureter
b) Internal pudendal artery
c) Vaginal artery
d) Ovarian vein
Explanation: During hysterectomy, the uterine artery is tied close to the uterus to avoid accidental ligation of the ureter, which passes inferior to the artery. Ureteric injury can cause urinary leakage and flank pain postoperatively. Answer: Ureter.
4. The uterine artery gives rise to which branch that supplies the upper vagina?
a) Cervical branch
b) Vaginal branch
c) Vesical branch
d) Ovarian branch
Explanation: The vaginal branch of the uterine artery descends to supply the upper part of the vagina. It anastomoses with the vaginal artery from the internal iliac. This dual blood supply is vital during childbirth and uterine surgeries. Answer: Vaginal branch.
5. In angiography, the uterine artery can be identified by its:
a) Straight course to uterus
b) Tortuous path along uterus
c) Branch from posterior division of internal iliac
d) Branching to ovary only
Explanation: The uterine artery follows a tortuous course along the lateral surface of the uterus to accommodate uterine enlargement during pregnancy. On angiography, this spiral pattern distinguishes it from other pelvic arteries. Answer: Tortuous path along uterus.
6. A postpartum woman has heavy bleeding. Embolization of which artery is most effective?
a) Ovarian artery
b) Internal iliac artery
c) Uterine artery
d) Vaginal artery
Explanation: Uterine artery embolization effectively controls postpartum hemorrhage or fibroid-related bleeding. Blocking its flow reduces uterine perfusion, leading to clot formation without compromising fertility if collateral circulation remains intact. Answer: Uterine artery.
7. The uterine artery anastomoses with which artery near the uterine tube?
a) Vaginal artery
b) Ovarian artery
c) Pudendal artery
d) Inferior vesical artery
Explanation: Near the uterine tube, the uterine artery forms an anastomosis with the ovarian artery. This connection ensures continuous uterine blood flow, especially during pregnancy, even if one artery is compromised. Answer: Ovarian artery.
8. The uterine artery is derived from which embryonic artery?
a) Umbilical artery
b) Fourth lumbar artery
c) Common iliac artery
d) Median sacral artery
Explanation: Embryologically, the uterine artery originates from the umbilical artery as a secondary branch of the internal iliac system. This relation explains its origin from the anterior division of the internal iliac artery in adults. Answer: Umbilical artery.
9. A fibroid in the uterus may cause increased flow through which vessel?
a) Uterine artery
b) Vaginal artery
c) Ovarian artery
d) Pudendal artery
Explanation: Fibroids (leiomyomas) are vascular tumors drawing excessive blood through the uterine artery. Doppler imaging shows increased uterine flow, which can contribute to menorrhagia. Answer: Uterine artery.
10. During cesarean section, ligation of the uterine artery is done where?
a) Below the level of the cervix
b) Above the level of the cervix
c) At the fundus
d) Near the ovarian ligament
Explanation: During cesarean section, the uterine artery is ligated just above the cervix to control bleeding while preserving ovarian circulation. This prevents postpartum hemorrhage without damaging vital pelvic structures. Answer: Above the level of the cervix.
11. A 40-year-old woman with fibroids undergoes uterine artery embolization. Which artery’s catheterization is performed?
a) Internal iliac artery
b) External iliac artery
c) Ovarian artery
d) Common femoral artery
Explanation: In uterine artery embolization, access is gained via the common femoral artery, advancing the catheter into the internal iliac artery and then into the uterine artery. Tiny embolic particles block the blood flow to fibroids, causing their shrinkage. Answer: Internal iliac artery.