Chapter: Abdomen; Topic: Spleen and Its Ligaments; Subtopic: Peritoneal Attachments of Spleen
Keyword Definitions:
Spleen: A lymphoid organ situated in the left upper quadrant of the abdomen, important for blood filtration and immune response.
Phrenicolic Ligament: A peritoneal fold between the left colic flexure and diaphragm that supports the spleen and prevents it from descending into the iliac fossa.
Splenic Ligaments: Peritoneal folds such as gastrosplenic and lienorenal ligaments connecting the spleen to stomach and kidney, respectively.
Lead Question – 2015
Ligament which prevents spleen to fall in left iliac fossa -
a) Leinorenal ligament
b) Phrenicolic ligament
c) Upper pole of right kidney
d) Sigmoid colon
Explanation: The phrenicolic ligament acts as a shelf supporting the spleen, extending between the left colic flexure and diaphragm. It prevents downward displacement of the spleen toward the left iliac fossa, especially in conditions like splenomegaly. The lienorenal ligament connects spleen to the left kidney. Hence, the correct answer is b) Phrenicolic ligament.
1. The spleen is located in which region of the abdomen?
a) Left hypochondrium
b) Left lumbar
c) Umbilical
d) Epigastric
Explanation: The spleen lies in the left hypochondrium, between the 9th and 11th ribs, following the axis of the 10th rib. It is intraperitoneal and surrounded by peritoneum except at its hilum. Its location provides protection under the rib cage. Thus, the correct answer is a) Left hypochondrium.
2. Clinical case: A patient with splenomegaly has the lower pole of the spleen palpable below the costal margin. Which ligament prevents further descent?
a) Phrenicolic ligament
b) Lienorenal ligament
c) Gastrosplenic ligament
d) Splenocolic ligament
Explanation: The phrenicolic ligament supports the spleen from below, forming a peritoneal shelf over the left colic flexure. Even in splenomegaly, this ligament prevents excessive descent into the left iliac fossa. It stabilizes the organ’s position within the left upper quadrant. Correct answer: a) Phrenicolic ligament.
3. Which ligament connects the spleen to the posterior abdominal wall?
a) Lienorenal ligament
b) Gastrosplenic ligament
c) Phrenicocolic ligament
d) Splenocolic ligament
Explanation: The lienorenal ligament (splenorenal) connects the spleen to the left kidney and contains splenic vessels and tail of pancreas. It secures the spleen posteriorly and provides a route for vascular supply. Correct answer: a) Lienorenal ligament.
4. Clinical case: A patient suffers trauma to the left lower ribs causing internal bleeding. Which organ is most likely injured?
a) Spleen
b) Left kidney
c) Stomach
d) Pancreas
Explanation: The spleen lies beneath the 9th to 11th ribs and is most commonly injured in blunt trauma to the left lower thorax. Its capsule is thin, making it prone to rupture with internal hemorrhage. Prompt splenectomy may be needed. Correct answer: a) Spleen.
5. Which peritoneal ligament contains the splenic artery?
a) Lienorenal ligament
b) Gastrosplenic ligament
c) Phrenicolic ligament
d) Hepatogastric ligament
Explanation: The lienorenal ligament contains the splenic vessels and tail of the pancreas as it connects spleen to the posterior abdominal wall. The gastrosplenic ligament, however, contains short gastric and left gastroepiploic vessels. Correct answer: a) Lienorenal ligament.
6. The spleen is derived embryologically from:
a) Endoderm
b) Mesoderm
c) Ectoderm
d) Neural crest
Explanation: The spleen develops from mesoderm within the dorsal mesogastrium. It appears as a lobulated structure that later fuses to form the adult organ. Its mesodermal origin explains its reticular tissue framework rather than epithelial lining. Correct answer: b) Mesoderm.
7. Clinical case: Following a splenectomy, which organ compensates for its phagocytic function?
a) Liver
b) Kidney
c) Pancreas
d) Adrenal gland
Explanation: After splenectomy, the liver and bone marrow compensate for phagocytosis and removal of damaged RBCs. Kupffer cells of the liver take over filtering functions of the spleen, though immune efficiency may decline. Correct answer: a) Liver.
8. The diaphragmatic surface of the spleen is related to:
a) Stomach
b) Left kidney
c) 9th–11th ribs and diaphragm
d) Pancreas tail
Explanation: The diaphragmatic surface of the spleen is smooth and convex, related to the diaphragm and 9th–11th ribs. This provides protection and respiratory mobility. In trauma, rib fractures may cause splenic rupture. Correct answer: c) 9th–11th ribs and diaphragm.
9. Clinical case: A patient undergoing splenectomy has the tail of pancreas injured. Which ligament transmits both structures?
a) Lienorenal ligament
b) Gastrosplenic ligament
c) Phrenicocolic ligament
d) Splenocolic ligament
Explanation: The lienorenal ligament carries the splenic vessels and tail of pancreas to the hilum of spleen. During splenectomy, accidental damage to pancreatic tail may cause pancreatitis or leakage of enzymes. Correct answer: a) Lienorenal ligament.
10. The spleen’s function in fetal life is mainly:
a) Bile secretion
b) Hematopoiesis
c) Lipid metabolism
d) Urine formation
Explanation: In fetal life, the spleen acts as a hematopoietic organ, producing red and white blood cells until bone marrow becomes functional. This role diminishes after birth, but splenic red pulp retains phagocytic activity. Correct answer: b) Hematopoiesis.
Chapter: Abdomen; Topic: Posterior Abdominal Wall; Subtopic: Lumbar Triangles
Keyword Definitions:
Petit Triangle: It is the inferior lumbar triangle located on the posterolateral abdominal wall.
Internal Oblique: Muscle forming part of the abdominal wall, important in trunk rotation and support.
Fascia Transversalis: Thin aponeurotic membrane between the inner surface of the transversus abdominis and the peritoneum.
Sacrospinalis (Erector Spinae): Group of muscles running longitudinally along the vertebral column, aiding in extension of the spine.
Rectus Abdominis: Vertical muscle of the anterior abdominal wall responsible for trunk flexion.
Lead Question (2015):
Floor of Petit triangle is formed by?
a) Sacrospinalis
b) Internal oblique
c) Rectus abdominis
d) Fascia Transversalis
Explanation: The correct answer is Internal oblique. The Petit triangle or inferior lumbar triangle is bounded by the latissimus dorsi posteriorly, external oblique anteriorly, and iliac crest inferiorly. Its floor is formed by the internal oblique muscle. This region is clinically important as a potential site for lumbar hernia formation.
1) Superior lumbar triangle (Grynfeltt-Lesshaft) is bounded by?
a) Internal oblique, Quadratus lumborum, and 12th rib
b) Latissimus dorsi, Iliac crest, and External oblique
c) Psoas major, Iliacus, and Transversus abdominis
d) Quadratus lumborum, External oblique, and Iliacus
Explanation: The answer is a) Internal oblique, Quadratus lumborum, and 12th rib. The superior lumbar triangle is located above the inferior triangle and is bordered by the internal oblique anteriorly, quadratus lumborum posteriorly, and the 12th rib superiorly. Its floor is formed by the transversalis fascia and is also a site for lumbar hernia.
2) Which structure passes through the lumbar triangle during a lumbar hernia?
a) Small intestine
b) Appendix
c) Kidney
d) Urinary bladder
Explanation: The correct answer is a) Small intestine. Lumbar hernias are rare and usually occur through weak points such as the inferior or superior lumbar triangles. The hernial sac may contain small intestine, colon, or omentum. The weakness in the internal oblique and transversalis fascia predisposes this area to herniation.
3) Clinical importance of Petit triangle is mainly related to?
a) Appendicitis
b) Lumbar hernia
c) Inguinal hernia
d) Femoral hernia
Explanation: The answer is b) Lumbar hernia. The inferior lumbar triangle (Petit triangle) is a weak area of the posterior abdominal wall where lumbar hernias may occur, especially following trauma or surgery. Recognition of this triangle helps surgeons during retroperitoneal access and hernia repair procedures.
4) Which muscle forms the roof of the inferior lumbar triangle?
a) Latissimus dorsi
b) External oblique
c) Internal oblique
d) Gluteus maximus
Explanation: The correct answer is a) Latissimus dorsi. The inferior lumbar triangle or Petit triangle has the latissimus dorsi muscle forming its posterior border and partially the roof. It is an important anatomical landmark for surgical approaches to the kidney and posterior abdominal wall structures.
5) In a patient with a lumbar hernia, which layer must be sutured to reinforce the floor of Petit triangle?
a) Transversalis fascia
b) Internal oblique
c) External oblique
d) Skin
Explanation: The answer is b) Internal oblique. Since the internal oblique muscle forms the floor of the Petit triangle, it is crucial in repairing lumbar hernias. Suturing or reinforcing this layer helps strengthen the posterior abdominal wall and prevent recurrence of the hernia.
6) A 45-year-old man presents with a soft swelling in the posterolateral abdominal wall below the 12th rib. The hernia likely occurs through?
a) Inferior lumbar triangle
b) Superior lumbar triangle
c) Inguinal canal
d) Femoral canal
Explanation: The answer is a) Inferior lumbar triangle. Clinical presentation of a posterolateral swelling below the 12th rib indicates a lumbar hernia through the Petit triangle. The inferior lumbar triangle is more commonly affected than the superior one due to its weaker muscular support.
7) Which of the following muscles does not form part of any lumbar triangle?
a) Quadratus lumborum
b) Latissimus dorsi
c) Internal oblique
d) Psoas major
Explanation: The correct answer is d) Psoas major. Psoas major lies deep within the posterior abdominal wall and does not contribute to the formation of either the superior or inferior lumbar triangles. Instead, it serves as a landmark for retroperitoneal structures like the ureter and gonadal vessels.
8) Lumbar hernia is more common in which group?
a) Elderly males
b) Young females
c) Children
d) Newborns
Explanation: The answer is a) Elderly males. Lumbar hernias are uncommon but more frequent in older men due to muscle weakness and degenerative changes. They can be spontaneous, traumatic, or postoperative. Knowledge of lumbar anatomy helps in correct diagnosis and surgical planning.
9) The Petit triangle is located in relation to which anatomical landmark?
a) Iliac crest
b) 10th rib
c) Umbilicus
d) Pubic symphysis
Explanation: The correct answer is a) Iliac crest. The inferior lumbar triangle is bounded inferiorly by the iliac crest, posteriorly by the latissimus dorsi, and anteriorly by the external oblique. It is a surface landmark useful in retroperitoneal surgeries and diagnosing posterior abdominal wall hernias.
10) A surgical incision placed along the Petit triangle is used to approach?
a) Kidney
b) Liver
c) Appendix
d) Spleen
Explanation: The answer is a) Kidney. Surgeons sometimes use the inferior lumbar triangle as an access point for retroperitoneal approaches to the kidney, as it provides a relatively avascular and safe pathway. However, care must be taken to avoid herniation postoperatively through this area.
Chapter: Abdomen; Topic: Peritoneum and Mesenteries; Subtopic: Transverse Mesocolon
Keyword Definitions:
Transverse Mesocolon: A double layer of peritoneum that suspends the transverse colon from the posterior abdominal wall.
Middle Colic Artery: A branch of the superior mesenteric artery supplying the transverse colon through the transverse mesocolon.
Right Colic Artery: Supplies the ascending colon and arises from the superior mesenteric artery.
Left Colic Artery: Branch of the inferior mesenteric artery supplying the descending colon.
Iliocolic Artery: Supplies the terminal ileum, cecum, and appendix; arises from the superior mesenteric artery.
Lead Question (2015):
In which of the following vessels transverse mesocolon is seen?
a) Right colic artery
b) Left colic artery
c) Middle colic artery
d) Iliocolic artery
Explanation: The correct answer is Middle colic artery. The transverse mesocolon is a peritoneal fold attaching the transverse colon to the posterior abdominal wall. It encloses the middle colic vessels, branches of the superior mesenteric artery. These vessels supply most of the transverse colon, making this region crucial in colonic surgeries and vascular anastomoses.
1) The middle colic artery is a branch of which major artery?
a) Inferior mesenteric artery
b) Superior mesenteric artery
c) Celiac trunk
d) Common iliac artery
Explanation: The answer is b) Superior mesenteric artery. The middle colic artery arises from the superior mesenteric artery just below the pancreas and supplies the transverse colon. It divides into right and left branches, forming anastomoses with right and left colic arteries, maintaining collateral circulation in the colon.
2) The transverse mesocolon divides the abdominal cavity into which compartments?
a) Supra- and infracolic compartments
b) Right and left paracolic gutters
c) Anterior and posterior peritoneal cavities
d) Greater and lesser sacs
Explanation: The correct answer is a) Supra- and infracolic compartments. The transverse mesocolon forms an important peritoneal partition dividing the peritoneal cavity into supracolic and infracolic compartments. The supracolic compartment contains the liver, stomach, and spleen, while the infracolic compartment contains the intestines and mesentery.
3) During a colectomy, which vessel must be ligated within the transverse mesocolon?
a) Middle colic artery
b) Left gastric artery
c) Splenic artery
d) Gastroduodenal artery
Explanation: The answer is a) Middle colic artery. In transverse colectomy, the middle colic artery is carefully identified and ligated within the transverse mesocolon to prevent bleeding and ensure proper resection margins. Preservation of collateral circulation between right and left colic arteries is essential for postoperative healing.
4) A 60-year-old man undergoing pancreatic surgery may have injury to which vessel within the transverse mesocolon?
a) Middle colic artery
b) Left gastric artery
c) Inferior mesenteric artery
d) Splenic vein
Explanation: The correct answer is a) Middle colic artery. The transverse mesocolon crosses the anterior surface of the pancreas, making the middle colic vessels vulnerable during pancreatic surgeries. Injury can cause colonic ischemia or necrosis; hence, surgical awareness of mesocolic vascular anatomy is crucial for safe dissection.
5) The root of the transverse mesocolon crosses which structures posteriorly?
a) Second part of duodenum and pancreas
b) Spleen and left kidney
c) Liver and gallbladder
d) Inferior vena cava and right ureter
Explanation: The answer is a) Second part of duodenum and pancreas. The root of the transverse mesocolon passes across the head and anterior border of the pancreas and the second part of the duodenum. This anatomical relation is vital during surgical mobilization of the transverse colon and in understanding spread of infections or malignancies.
6) The lymphatic drainage of the transverse mesocolon primarily follows which vessel?
a) Middle colic artery
b) Inferior mesenteric artery
c) Left gastric artery
d) Splenic artery
Explanation: The correct answer is a) Middle colic artery. Lymph nodes along the middle colic artery drain lymph from the transverse colon. These nodes eventually drain into the superior mesenteric lymph nodes. Proper identification of these nodes is essential during oncologic resections for accurate staging and clearance of colon carcinoma.
7) In a CT scan, the transverse mesocolon appears as a fold connecting which two organs?
a) Transverse colon and posterior abdominal wall
b) Ascending colon and liver
c) Descending colon and spleen
d) Cecum and appendix
Explanation: The answer is a) Transverse colon and posterior abdominal wall. On imaging, the transverse mesocolon appears as a double peritoneal fold extending from the posterior abdominal wall to the transverse colon. It contains middle colic vessels, lymphatics, and nerves, playing a key role in supporting the transverse colon anatomically and functionally.
8) A surgeon retracting the transverse colon upward exposes which peritoneal compartment?
a) Infracolic compartment
b) Supracolic compartment
c) Pelvic cavity
d) Subphrenic space
Explanation: The correct answer is b) Supracolic compartment. When the transverse colon is lifted upwards, the transverse mesocolon moves with it, exposing the supracolic compartment. This compartment contains major organs like the stomach, liver, and spleen, and is of great surgical importance during upper abdominal operations.
9) During embryological development, the transverse mesocolon originates from which mesentery?
a) Dorsal mesentery
b) Ventral mesentery
c) Mesoduodenum
d) Mesogastrium
Explanation: The answer is a) Dorsal mesentery. The transverse mesocolon develops from the dorsal mesentery of the midgut. It becomes attached to the posterior abdominal wall and fuses partially with the greater omentum, reflecting the complex peritoneal rearrangements during embryogenesis of the gastrointestinal tract.
10) A 50-year-old woman with carcinoma of the transverse colon shows lymphatic spread through nodes located in?
a) Transverse mesocolon
b) Mesentery of small intestine
c) Lesser omentum
d) Sigmoid mesocolon
Explanation: The correct answer is a) Transverse mesocolon. Lymphatic drainage of the transverse colon primarily occurs via the transverse mesocolon, where lymph nodes accompany the middle colic vessels. In colon cancer, metastasis through these nodes is common, emphasizing the need for complete mesocolic excision during colectomy to ensure oncologic safety.
Chapter: Pelvis and Perineum; Topic: Nerve Supply of Pelvic Organs; Subtopic: Innervation of Uterus
Keyword Definitions:
Labour pain: Intense uterine contractions during childbirth transmitted through visceral afferent fibers.
Sympathetic nerves: Fibers arising from thoracolumbar segments that carry pain from the uterine body during labour.
Parasympathetic nerves: Fibers from sacral outflow (S2–S4) mainly supplying cervix and vagina.
Pudendal nerve: Somatic nerve supplying perineum and external genitalia, involved in somatic pain.
Splanchnic nerves: Visceral nerves carrying sympathetic and sensory fibers from abdominal and pelvic organs.
Lead Question (2015):
Labour pain in uterus is carried by
a) Parasympathetic nerves
b) Sympathetic nerves
c) Pudendal nerve
d) Splanchnic nerve
Explanation: The correct answer is b) Sympathetic nerves. Labour pain originates from uterine contractions and cervical dilation. Pain from the uterine body is transmitted via sympathetic fibers through the hypogastric plexus and enters the spinal cord at T10–L1 levels. Pain from the cervix and perineum, however, is carried by parasympathetic and pudendal nerves respectively.
1) Pain from uterine contractions during first stage of labour is transmitted via:
a) T10–L1 sympathetic fibers
b) S2–S4 parasympathetic fibers
c) Pudendal nerve
d) Femoral nerve
Explanation: The answer is a) T10–L1 sympathetic fibers. During the first stage of labour, pain arises from stretching of the uterine wall and is transmitted through sympathetic afferents accompanying the hypogastric nerves to T10–L1 spinal segments. This explains why epidural blocks at these levels effectively relieve early labour pain.
2) Pain during the second stage of labour is mainly transmitted by:
a) Pudendal nerve
b) Sympathetic nerves
c) Pelvic splanchnic nerves
d) Ilioinguinal nerve
Explanation: The correct answer is a) Pudendal nerve. In the second stage of labour, pain is somatic due to stretching of perineal tissues and vaginal walls. This pain is transmitted by the pudendal nerve (S2–S4). Pudendal block provides effective anesthesia for perineal delivery procedures and episiotomy.
3) Which nerve fibers carry pain from the cervix during labour?
a) Parasympathetic fibers from S2–S4
b) Sympathetic fibers from T12–L1
c) Pudendal nerve
d) Iliohypogastric nerve
Explanation: The answer is a) Parasympathetic fibers from S2–S4. Cervical dilation pain is transmitted by parasympathetic afferents through pelvic splanchnic nerves (S2–S4). This explains why a caudal block that anesthetizes these sacral roots helps relieve cervical pain in later stages of labour.
4) In epidural anesthesia for labour, which spinal segments are targeted to block uterine contraction pain?
a) T10–L1
b) L4–S1
c) S2–S4
d) T4–T6
Explanation: The correct answer is a) T10–L1. Blocking these segments relieves pain from uterine contractions during the first stage of labour. For complete perineal analgesia during the second stage, the block is extended to include S2–S4 roots that carry pudendal nerve fibers.
5) A woman in early labour complains of pain in the lower abdomen radiating to the back. The nerve pathway involved is:
a) Sympathetic afferents via hypogastric plexus
b) Pudendal nerve
c) Pelvic splanchnic nerves
d) Somatic fibers from iliohypogastric nerve
Explanation: The answer is a) Sympathetic afferents via hypogastric plexus. Visceral pain from uterine contractions is referred to the lower abdomen and back due to shared T10–L1 dermatomes. These sympathetic afferents travel through the hypogastric and aortic plexuses to the spinal cord.
6) Which of the following statements about pudendal nerve is TRUE?
a) It carries somatic pain from perineum
b) It supplies the uterine body
c) It originates from T10–L1
d) It is purely parasympathetic
Explanation: The correct answer is a) It carries somatic pain from perineum. The pudendal nerve is derived from sacral spinal nerves (S2–S4) and supplies motor and sensory innervation to the perineum, external anal sphincter, and genitalia. It is crucial in transmitting somatic pain during the second stage of labour.
7) Pain from the uterine fundus is referred to which dermatome level?
a) T10–L1
b) L4–L5
c) S1–S3
d) T4–T6
Explanation: The correct answer is a) T10–L1. The uterine fundus is supplied by sympathetic afferents that enter the spinal cord at T10–L1. Therefore, pain from uterine contractions is referred to the lower abdomen and back corresponding to these dermatomes, a typical presentation during early labour.
8) Which type of nerve fibers transmit visceral pain from the uterus?
a) Unmyelinated C fibers
b) Myelinated A-beta fibers
c) Myelinated A-delta fibers
d) Somatic motor fibers
Explanation: The correct answer is a) Unmyelinated C fibers. Labour pain is transmitted via unmyelinated visceral C fibers associated with sympathetic afferents. These fibers conduct slow, dull, and diffuse pain sensations that are poorly localized, typical of visceral pain from uterine contractions.
9) During caudal anesthesia, which nerve fibers are blocked to relieve perineal pain?
a) Pudendal and pelvic splanchnic nerves
b) Femoral and obturator nerves
c) Iliohypogastric nerve
d) Sympathetic chain fibers
Explanation: The answer is a) Pudendal and pelvic splanchnic nerves. Caudal anesthesia blocks sacral nerve roots (S2–S4), providing effective analgesia for perineal pain during childbirth. It targets both pudendal (somatic) and pelvic splanchnic (visceral parasympathetic) nerves, useful in second-stage labour pain relief.
10) A multiparous woman in labour experiences pain not relieved by epidural block at T10–L1. The cause is likely unblocked:
a) Pudendal nerve
b) Iliohypogastric nerve
c) Femoral nerve
d) Genitofemoral nerve
Explanation: The correct answer is a) Pudendal nerve. An epidural block covering T10–L1 levels relieves visceral pain from uterine contractions but not somatic pain from perineal distension. The pudendal nerve (S2–S4) carries perineal pain; thus, a supplementary pudendal block is required for complete analgesia during delivery.
Chapter: Pelvis and Perineum; Topic: Nerve Supply of Pelvic Organs; Subtopic: Innervation of Uterus
Keyword Definitions:
Labour pain: Intense uterine contractions during childbirth transmitted through visceral afferent fibers.
Sympathetic nerves: Fibers arising from thoracolumbar segments that carry pain from the uterine body during labour.
Parasympathetic nerves: Fibers from sacral outflow (S2–S4) mainly supplying cervix and vagina.
Pudendal nerve: Somatic nerve supplying perineum and external genitalia, involved in somatic pain.
Splanchnic nerves: Visceral nerves carrying sympathetic and sensory fibers from abdominal and pelvic organs.
Lead Question (2015):
Labour pain in uterus is carried by
a) Parasympathetic nerves
b) Sympathetic nerves
c) Pudendal nerve
d) Splanchnic nerve
Explanation: The correct answer is b) Sympathetic nerves. Labour pain originates from uterine contractions and cervical dilation. Pain from the uterine body is transmitted via sympathetic fibers through the hypogastric plexus and enters the spinal cord at T10–L1 levels. Pain from the cervix and perineum, however, is carried by parasympathetic and pudendal nerves respectively.
1) Pain from uterine contractions during first stage of labour is transmitted via:
a) T10–L1 sympathetic fibers
b) S2–S4 parasympathetic fibers
c) Pudendal nerve
d) Femoral nerve
Explanation: The answer is a) T10–L1 sympathetic fibers. During the first stage of labour, pain arises from stretching of the uterine wall and is transmitted through sympathetic afferents accompanying the hypogastric nerves to T10–L1 spinal segments. This explains why epidural blocks at these levels effectively relieve early labour pain.
2) Pain during the second stage of labour is mainly transmitted by:
a) Pudendal nerve
b) Sympathetic nerves
c) Pelvic splanchnic nerves
d) Ilioinguinal nerve
Explanation: The correct answer is a) Pudendal nerve. In the second stage of labour, pain is somatic due to stretching of perineal tissues and vaginal walls. This pain is transmitted by the pudendal nerve (S2–S4). Pudendal block provides effective anesthesia for perineal delivery procedures and episiotomy.
3) Which nerve fibers carry pain from the cervix during labour?
a) Parasympathetic fibers from S2–S4
b) Sympathetic fibers from T12–L1
c) Pudendal nerve
d) Iliohypogastric nerve
Explanation: The answer is a) Parasympathetic fibers from S2–S4. Cervical dilation pain is transmitted by parasympathetic afferents through pelvic splanchnic nerves (S2–S4). This explains why a caudal block that anesthetizes these sacral roots helps relieve cervical pain in later stages of labour.
4) In epidural anesthesia for labour, which spinal segments are targeted to block uterine contraction pain?
a) T10–L1
b) L4–S1
c) S2–S4
d) T4–T6
Explanation: The correct answer is a) T10–L1. Blocking these segments relieves pain from uterine contractions during the first stage of labour. For complete perineal analgesia during the second stage, the block is extended to include S2–S4 roots that carry pudendal nerve fibers.
5) A woman in early labour complains of pain in the lower abdomen radiating to the back. The nerve pathway involved is:
a) Sympathetic afferents via hypogastric plexus
b) Pudendal nerve
c) Pelvic splanchnic nerves
d) Somatic fibers from iliohypogastric nerve
Explanation: The answer is a) Sympathetic afferents via hypogastric plexus. Visceral pain from uterine contractions is referred to the lower abdomen and back due to shared T10–L1 dermatomes. These sympathetic afferents travel through the hypogastric and aortic plexuses to the spinal cord.
6) Which of the following statements about pudendal nerve is TRUE?
a) It carries somatic pain from perineum
b) It supplies the uterine body
c) It originates from T10–L1
d) It is purely parasympathetic
Explanation: The correct answer is a) It carries somatic pain from perineum. The pudendal nerve is derived from sacral spinal nerves (S2–S4) and supplies motor and sensory innervation to the perineum, external anal sphincter, and genitalia. It is crucial in transmitting somatic pain during the second stage of labour.
7) Pain from the uterine fundus is referred to which dermatome level?
a) T10–L1
b) L4–L5
c) S1–S3
d) T4–T6
Explanation: The correct answer is a) T10–L1. The uterine fundus is supplied by sympathetic afferents that enter the spinal cord at T10–L1. Therefore, pain from uterine contractions is referred to the lower abdomen and back corresponding to these dermatomes, a typical presentation during early labour.
8) Which type of nerve fibers transmit visceral pain from the uterus?
a) Unmyelinated C fibers
b) Myelinated A-beta fibers
c) Myelinated A-delta fibers
d) Somatic motor fibers
Explanation: The correct answer is a) Unmyelinated C fibers. Labour pain is transmitted via unmyelinated visceral C fibers associated with sympathetic afferents. These fibers conduct slow, dull, and diffuse pain sensations that are poorly localized, typical of visceral pain from uterine contractions.
9) During caudal anesthesia, which nerve fibers are blocked to relieve perineal pain?
a) Pudendal and pelvic splanchnic nerves
b) Femoral and obturator nerves
c) Iliohypogastric nerve
d) Sympathetic chain fibers
Explanation: The answer is a) Pudendal and pelvic splanchnic nerves. Caudal anesthesia blocks sacral nerve roots (S2–S4), providing effective analgesia for perineal pain during childbirth. It targets both pudendal (somatic) and pelvic splanchnic (visceral parasympathetic) nerves, useful in second-stage labour pain relief.
10) A multiparous woman in labour experiences pain not relieved by epidural block at T10–L1. The cause is likely unblocked:
a) Pudendal nerve
b) Iliohypogastric nerve
c) Femoral nerve
d) Genitofemoral nerve
Explanation: The correct answer is a) Pudendal nerve. An epidural block covering T10–L1 levels relieves visceral pain from uterine contractions but not somatic pain from perineal distension. The pudendal nerve (S2–S4) carries perineal pain; thus, a supplementary pudendal block is required for complete analgesia during delivery.
Chapter: Abdomen; Topic: Inguinal Region; Subtopic: Cremasteric Muscle and its Nerve Supply
Keyword Definitions:
Cremasteric muscle: A thin layer of skeletal muscle covering the spermatic cord and testis, derived from the internal oblique muscle.
Genitofemoral nerve: A mixed nerve from the lumbar plexus (L1-L2) that divides into genital and femoral branches.
Pudendal nerve: Main somatic nerve of the perineum originating from S2-S4 roots.
Ilioinguinal nerve: Arises from L1 and supplies skin over the superomedial thigh and genital area.
Lead Question - 2015
Nerve supply of cremasteric muscle?
a) Pudendal nerve
b) Femoral branch of genitofemoral
c) Genital branch of genitofemoral nerve
d) Ilioinguinal nerve
Explanation: The genital branch of the genitofemoral nerve supplies the cremasteric muscle. This branch passes through the inguinal canal and innervates the muscle derived from the internal oblique. The cremasteric reflex involves this nerve for the motor limb and the ilioinguinal nerve for the sensory limb, crucial in testicular elevation and diagnosis of spinal lesions.
1. Cremasteric reflex is mediated by which spinal segment?
a) L1-L2
b) S2-S4
c) T12-L1
d) L3-L4
Explanation: The L1-L2 spinal segments mediate the cremasteric reflex. The sensory input is via the ilioinguinal nerve and the motor output via the genital branch of the genitofemoral nerve. This reflex is an indicator of integrity of the L1-L2 spinal cord segment and is often tested in neurological examination.
2. Absence of cremasteric reflex may indicate lesion in:
a) Femoral nerve
b) L1 spinal segment
c) Pudendal nerve
d) Obturator nerve
Explanation: Absence of the reflex may suggest a lesion in the L1 spinal segment or damage to the genitofemoral or ilioinguinal nerve. It may also be absent in upper and lower motor neuron lesions, testicular torsion, or during anesthesia affecting the related dermatomes.
3. Which nerve is responsible for the sensory limb of the cremasteric reflex?
a) Genitofemoral nerve
b) Pudendal nerve
c) Ilioinguinal nerve
d) Femoral nerve
Explanation: The ilioinguinal nerve provides the sensory limb of the cremasteric reflex by sensing touch from the upper medial thigh, while the genital branch of genitofemoral nerve provides the motor response, lifting the testis. Both nerves originate from the lumbar plexus and coordinate the reflex response.
4. Clinical absence of cremasteric reflex is most commonly tested for:
a) Appendicitis
b) Testicular torsion
c) Inguinal hernia
d) Hydrocele
Explanation: The cremasteric reflex is absent in testicular torsion, a urological emergency. Its absence helps distinguish torsion from epididymitis, where the reflex remains intact. Loss of reflex indicates disruption of the genitofemoral or ilioinguinal nerve pathway, often due to torsion or upper motor neuron lesion.
5. In which type of hernia is the cremasteric reflex usually absent?
a) Direct inguinal hernia
b) Indirect inguinal hernia
c) Femoral hernia
d) Obturator hernia
Explanation: The indirect inguinal hernia may involve compression or stretching of the genital branch of the genitofemoral nerve, leading to an absent cremasteric reflex. Since this nerve passes through the inguinal canal, it can be affected during the herniation process or following surgical repair procedures.
6. Which of the following nerves arises from the lumbar plexus and enters the inguinal canal through the deep ring?
a) Ilioinguinal nerve
b) Genitofemoral nerve
c) Pudendal nerve
d) Obturator nerve
Explanation: The genitofemoral nerve (L1-L2) enters the inguinal canal via the deep inguinal ring. Its genital branch accompanies the spermatic cord to supply the cremasteric muscle and scrotal skin. This pathway is crucial for maintaining reflex function and sensation in the inguinal region.
7. Cremasteric muscle is derived from which abdominal muscle?
a) External oblique
b) Internal oblique
c) Transversus abdominis
d) Rectus abdominis
Explanation: The internal oblique muscle gives rise to the cremasteric muscle fibers, which form a loop around the spermatic cord and testis. These fibers help elevate the testis in response to temperature and touch stimuli, an essential function in thermoregulation and protection of the testis.
8. Which of the following best describes the function of the cremasteric muscle?
a) Elevation of penis
b) Elevation of testis
c) Retraction of scrotum
d) Constriction of urethra
Explanation: The cremasteric muscle is responsible for elevation of the testis toward the body. This action regulates testicular temperature for optimal spermatogenesis and protects from external trauma. It acts reflexively to cold and touch stimuli, mediated via genitofemoral and ilioinguinal nerves.
9. Cremasteric reflex is absent in which spinal cord injury level?
a) Above T6
b) At L1-L2
c) Below S2
d) C5-C6
Explanation: The reflex is lost in L1-L2 spinal cord injury, as these segments mediate both afferent and efferent limbs of the reflex. The ilioinguinal and genitofemoral nerves are derived from these levels, and any lesion interrupts the sensory-motor arc, eliminating the testicular elevation response.
10. Which of the following reflexes shares a similar spinal level as cremasteric reflex?
a) Anal reflex
b) Abdominal reflex
c) Plantar reflex
d) Biceps reflex
Explanation: The abdominal reflex shares a similar spinal level (T7–L2) with the cremasteric reflex (L1–L2). Both are superficial reflexes involving cutaneous stimulation and muscle contraction, commonly assessed in neurological exams to localize lesions in the thoracolumbar spinal cord.
Chapter: Lower Limb; Topic: Venous System of Lower Limb; Subtopic: Great Saphenous Vein
Keyword Definitions:
Great Saphenous Vein: The longest vein in the body, originating from the medial end of the dorsal venous arch of the foot and draining into the femoral vein.
Femoral Vein: A deep vein in the thigh that receives blood from the great saphenous vein just below the inguinal ligament.
Inguinal Ligament: A fibrous band extending from the anterior superior iliac spine to the pubic tubercle, marking the lower border of the abdomen.
Venous Valves: Structures that prevent backflow of blood, ensuring one-way flow toward the heart, especially in lower limb veins.
Lead Question - 2015
True about the anatomy of great saphenous vein:
a) Starts as a continuation of medial marginal vein
b) Ends of femoral vein 2.5 cm below the inguinal ligament
c) There are 2 - 5 valves below the knee
d) Ascends 2.5 - 3 cm behind tibial malleolus
Explanation: The great saphenous vein begins as a continuation of the medial marginal vein of the foot. It passes anterior to the medial malleolus, ascends along the medial side of the leg and thigh, and drains into the femoral vein approximately 3.5 cm below the inguinal ligament. It has 10–20 valves preventing venous reflux.
1. The great saphenous vein terminates in which structure?
a) Popliteal vein
b) Femoral vein
c) External iliac vein
d) Deep femoral vein
Explanation: The femoral vein receives the great saphenous vein at the saphenofemoral junction, located approximately 3.5 cm below and lateral to the pubic tubercle. This site is clinically important in varicose vein surgery, where the vein is often ligated to prevent venous reflux and recurrence.
2. The great saphenous vein passes in front of which bony landmark?
a) Lateral malleolus
b) Medial malleolus
c) Tibial tuberosity
d) Fibular head
Explanation: The great saphenous vein passes anterior to the medial malleolus before ascending along the medial aspect of the leg. This relationship helps in identifying the vein for venipuncture or bypass graft harvesting, as it remains superficial and consistent in location.
3. Which of the following veins is commonly used in coronary artery bypass grafting (CABG)?
a) Small saphenous vein
b) Great saphenous vein
c) Femoral vein
d) Popliteal vein
Explanation: The great saphenous vein is most commonly used in CABG because of its suitable length, diameter, and accessibility. It can be easily harvested without causing major circulatory compromise in the limb due to collateral venous drainage via perforators and deep veins.
4. The saphenous opening is located in which fascia?
a) Cribriform fascia
b) Deep fascia of thigh
c) Superficial fascia
d) Fascia lata
Explanation: The cribriform fascia, a part of the fascia lata, covers the saphenous opening through which the great saphenous vein pierces to join the femoral vein. This opening allows communication between superficial and deep venous systems and is a key landmark during varicose vein surgery.
5. Which of the following clinical conditions is associated with incompetence of great saphenous vein valves?
a) Varicose veins
b) Deep vein thrombosis
c) Phlebitis
d) Lymphedema
Explanation: Varicose veins occur due to valve incompetence in the great saphenous vein or perforator veins. This leads to venous hypertension, dilation, and tortuosity. Common symptoms include heaviness, pain, and swelling in the legs, and treatment includes compression, sclerotherapy, or surgical stripping of the vein.
6. Which perforator connects the great saphenous vein with deep veins in the lower leg?
a) Cockett’s perforator
b) Boyd’s perforator
c) Dodd’s perforator
d) Sherman’s perforator
Explanation: The Cockett’s perforators connect the great saphenous vein with the posterior tibial veins in the lower leg. These perforators play a key role in maintaining unidirectional venous flow; their incompetence results in venous stasis ulcers and varicosities of the lower limb.
7. Which structure accompanies the great saphenous vein throughout its course?
a) Saphenous nerve
b) Femoral nerve
c) Obturator nerve
d) Tibial nerve
Explanation: The saphenous nerve, a branch of the femoral nerve, accompanies the great saphenous vein in the leg. It provides sensory innervation to the medial aspect of the leg and foot, and care must be taken during vein harvesting to avoid nerve injury that can cause numbness.
8. During coronary artery bypass surgery, the great saphenous vein is reversed before grafting because:
a) It improves arterial flow
b) To prevent valve obstruction
c) To match lumen diameter
d) To reduce thrombosis
Explanation: The great saphenous vein is reversed before grafting to ensure that the valves do not obstruct the flow of blood when used as an arterial conduit. In its normal orientation, the valves allow only upward venous flow, hence reversal prevents blockage during coronary artery bypass grafting.
9. Which of the following statements about saphenous vein harvesting is true?
a) It can cause lymphedema
b) It leads to deep vein obstruction
c) It rarely affects limb circulation
d) It is contraindicated in elderly patients
Explanation: Removal of the great saphenous vein rarely affects limb circulation because deep veins carry the majority of venous return. The presence of numerous perforating veins ensures collateral drainage, making it a safe choice for bypass grafting or vascular surgeries without significant circulatory compromise.
10. The great saphenous vein is located in which compartment of the leg?
a) Deep posterior compartment
b) Superficial fascia
c) Anterior compartment
d) Deep fascia
Explanation: The great saphenous vein runs in the superficial fascia of the leg and thigh. It lies between the two layers of superficial fascia, making it easily visible and accessible for venous cannulation, bypass surgery, and varicose vein management.
Chapter: Abdomen; Topic: Posterior Relations of Kidneys; Subtopic: Surface Anatomy and Relations
Keyword Definitions:
Kidney: A retroperitoneal organ responsible for urine formation and excretion of metabolic wastes.
Posterior relation: Structures located behind an organ, important in surgical and anatomical understanding.
Subcostal nerve: The nerve running below the 12th rib, providing motor and sensory supply to the abdominal wall.
Ilioinguinal nerve: A branch of the lumbar plexus supplying the skin over the groin and scrotum/labia.
Diaphragm: The muscular sheet separating the thoracic and abdominal cavities, aiding in respiration.
Lead Question (2015)
Posterior relation of right kidney are all except -
a) Diaphragm
b) Subcostal nerve
c) 11th rib
d) Ilioinguinal nerve
Explanation: The posterior relations of the right kidney include the diaphragm, 12th rib, and muscles like psoas major, quadratus lumborum, and transversus abdominis, along with nerves like subcostal, iliohypogastric, and ilioinguinal. The 11th rib does not relate posteriorly to the right kidney. Hence, the answer is (c) 11th rib.
1. Posterior relations of left kidney include all except -
a) 11th rib
b) 12th rib
c) Psoas major
d) Descending colon
Explanation: The left kidney is related posteriorly to both 11th and 12th ribs, psoas major, quadratus lumborum, and transversus abdominis. The descending colon lies anterior to the kidney, not posteriorly. Hence, the answer is (d) Descending colon.
2. The right kidney lies opposite which vertebral levels?
a) T10–L1
b) T11–L2
c) T12–L3
d) L1–L4
Explanation: The right kidney typically lies lower due to the presence of the liver, extending from T12 to L3 vertebral levels, while the left kidney lies slightly higher (T11–L2). Hence, the answer is (c) T12–L3.
3. Which muscle forms the medial relation of the kidney posteriorly?
a) Transversus abdominis
b) Quadratus lumborum
c) Psoas major
d) Latissimus dorsi
Explanation: The psoas major muscle forms the medial posterior relation of the kidney and plays a role in flexing the thigh at the hip joint. Hence, the answer is (c) Psoas major.
4. The nerve located posterior to both kidneys is -
a) Obturator nerve
b) Iliohypogastric nerve
c) Phrenic nerve
d) Femoral nerve
Explanation: The iliohypogastric nerve runs posterior to both kidneys along with subcostal and ilioinguinal nerves. It arises from L1 and supplies the abdominal wall. Hence, the answer is (b) Iliohypogastric nerve.
5. The structure anterior to the right kidney is -
a) Liver
b) Spleen
c) Stomach
d) Pancreas
Explanation: The anterior relation of the right kidney includes the liver, duodenum, and right colic flexure, while the spleen and stomach relate to the left kidney. Hence, the answer is (a) Liver.
6. A stab injury at the right costovertebral angle injures which structure first?
a) Diaphragm
b) 12th rib
c) Kidney
d) Liver capsule
Explanation: The costovertebral angle corresponds to the posterior relation of the kidney. A stab wound here usually affects the lower part of the kidney first, making it vulnerable to injury. Hence, the answer is (c) Kidney.
7. The upper pole of the right kidney is related to -
a) Liver
b) Spleen
c) Diaphragm
d) Stomach
Explanation: The upper pole of the right kidney lies beneath the diaphragm and is in contact with the right suprarenal gland and the liver. Hence, the answer is (a) Liver.
8. In renal surgeries, posterior approach is preferred because -
a) Avoids peritoneal cavity
b) Provides better exposure of renal hilum
c) Easy access to renal vein
d) Prevents injury to adrenal gland
Explanation: Posterior approach avoids opening the peritoneal cavity, thus minimizing risk of contamination and complications. It also allows direct access to the kidney's posterior surface. Hence, the answer is (a) Avoids peritoneal cavity.
9. During nephrectomy, which nerve may be damaged posteriorly?
a) Obturator
b) Iliohypogastric
c) Phrenic
d) Sciatic
Explanation: The iliohypogastric nerve lies close to the posterior surface of the kidney and can be damaged during posterior incisions or retraction in nephrectomy. Hence, the answer is (b) Iliohypogastric.
10. In a CT scan, the posterior relation of left kidney at the level of 12th rib includes -
a) Diaphragm
b) Liver
c) Duodenum
d) Stomach
Explanation: At the level of the 12th rib, the posterior surface of the left kidney is covered by the diaphragm, quadratus lumborum, and psoas major. Hence, the answer is (a) Diaphragm.
Chapter: Abdomen; Topic: Blood Supply of Kidney; Subtopic: Renal Arteries and Veins
Keyword Definitions:
Renal artery: A branch of the abdominal aorta supplying blood to each kidney.
Renal vein: The vein that drains deoxygenated blood from the kidney into the inferior vena cava.
Inferior vena cava (IVC): The large vein that carries blood from the lower body to the heart.
End arteries: Arteries that do not anastomose with others; blockage leads to tissue necrosis.
Common iliac artery: A terminal branch of the aorta that divides into external and internal iliac arteries, not supplying the kidney.
Lead Question (2015)
Not True about blood supply of kidney -
a) Renal vein drains into IVC
b) Renal artery is a branch of common iliac artery
c) Right renal artery passes behind IVC
d) Branches of renal artery are end arteries
Explanation: The renal artery arises directly from the abdominal aorta, not from the common iliac artery. The right renal artery passes posterior to the IVC, and both renal arteries divide into end arteries without anastomosis. The renal vein drains into the IVC. Hence, the incorrect statement is (b) Renal artery is a branch of common iliac artery.
1. Which of the following arteries supplies the upper pole of the kidney?
a) Superior suprarenal artery
b) Inferior phrenic artery
c) Renal artery
d) Gonadal artery
Explanation: The superior pole of the kidney receives blood mainly from the renal artery, with minor contributions from the inferior phrenic and superior suprarenal arteries. The gonadal artery does not supply the kidney. Hence, the correct answer is (c) Renal artery.
2. The left renal vein is longer than the right because -
a) It receives more tributaries
b) It crosses anterior to aorta
c) It passes behind IVC
d) It lies higher than right vein
Explanation: The left renal vein is longer because it crosses anterior to the abdominal aorta to reach the IVC and receives tributaries from the left gonadal and suprarenal veins. The right renal vein directly enters the IVC and is shorter. Hence, the answer is (b) It crosses anterior to aorta.
3. Accessory renal arteries arise from -
a) Common iliac artery
b) Abdominal aorta
c) Lumbar arteries
d) Gonadal artery
Explanation: Accessory renal arteries are additional branches that arise directly from the abdominal aorta. They may enter the kidney at poles and are also end arteries, meaning damage may cause ischemia. Hence, the correct answer is (b) Abdominal aorta.
4. During renal transplantation, the donor renal artery is anastomosed to -
a) Common iliac artery
b) External iliac artery
c) Internal iliac artery
d) Inferior epigastric artery
Explanation: In renal transplantation, the donor renal artery is commonly anastomosed to the recipient’s external iliac artery due to easy accessibility and adequate blood flow. Hence, the answer is (b) External iliac artery.
5. The venous drainage of the right suprarenal gland is into -
a) Left renal vein
b) Right renal vein
c) IVC directly
d) Inferior phrenic vein
Explanation: The right suprarenal vein drains directly into the inferior vena cava, while the left suprarenal vein drains into the left renal vein. Hence, the answer is (c) IVC directly.
6. A patient undergoing nephrectomy has bleeding due to injury of a posterior structure to right renal artery. Which is it?
a) IVC
b) Psoas major
c) Right renal vein
d) Diaphragm
Explanation: The right renal artery passes posterior to the IVC before entering the kidney. During surgical dissection, injury to the IVC can cause massive bleeding. Hence, the answer is (a) IVC.
7. Which of the following is an end artery in the kidney?
a) Interlobar artery
b) Arcuate artery
c) Interlobular artery
d) All of the above
Explanation: The segmental, interlobar, arcuate, and interlobular arteries of the kidney are all end arteries without significant anastomoses. Occlusion leads to infarction of supplied areas. Hence, the answer is (d) All of the above.
8. In renal vein thrombosis, which symptom is most likely?
a) Hematuria
b) Hypotension
c) Polyuria
d) Bradycardia
Explanation: Renal vein thrombosis leads to impaired venous drainage causing congestion and rupture of small vessels resulting in hematuria and flank pain. It may also cause renal enlargement and proteinuria. Hence, the answer is (a) Hematuria.
9. The renal artery divides into segmental branches before entering which structure?
a) Hilum
b) Cortex
c) Medulla
d) Capsule
Explanation: The renal artery divides into five segmental branches before entering the hilum of the kidney. Each supplies a specific renal segment without anastomosis, maintaining functional independence. Hence, the answer is (a) Hilum.
10. In CT angiography, a prehilar branch of renal artery is seen compressing the renal pelvis. What condition can result?
a) Hydronephrosis
b) Renal infarction
c) Pyelonephritis
d) Nephrocalcinosis
Explanation: An aberrant prehilar renal artery crossing anterior to the renal pelvis may compress it, causing obstruction of urine flow leading to hydronephrosis, especially in younger patients. Hence, the answer is (a) Hydronephrosis.
Chapter: Abdomen and Pelvis; Topic: Inguinal Canal' Subtopic: Deep Inguinal Ring and its Contents
Keyword Definitions:
Deep Inguinal Ring: An opening in the transversalis fascia, located above the midpoint of the inguinal ligament, through which the spermatic cord or round ligament passes.
Spermatic Cord: A collection of structures including vas deferens, testicular vessels, and nerves that pass through the inguinal canal to the testis.
Ilioinguinal Nerve: A branch of the first lumbar nerve (L1) that enters the inguinal canal through the superficial ring, not the deep ring.
Round Ligament: A fibromuscular band in females passing through the inguinal canal to support the uterus.
Internal Spermatic Fascia: The innermost covering of the spermatic cord derived from the transversalis fascia at the deep inguinal ring.
Lead Question (2015)
All pass through deep inguinal ring, EXCEPT?
a) Spermatic cord
b) Internal spermatic fascia
c) Round ligament
d) Ilioinguinal nerve
Explanation: The deep inguinal ring transmits the spermatic cord in males and the round ligament in females. The internal spermatic fascia is derived from the transversalis fascia at this ring. However, the ilioinguinal nerve does not pass through the deep inguinal ring but enters the canal midway and exits via the superficial ring. Hence, the correct answer is (d) Ilioinguinal nerve.
1. Which structure forms the anterior wall of the inguinal canal?
a) Transversalis fascia
b) External oblique aponeurosis
c) Internal oblique muscle
d) Fascia transversalis and peritoneum
Explanation: The anterior wall of the inguinal canal is mainly formed by the external oblique aponeurosis and is reinforced laterally by fibers of the internal oblique muscle. This wall provides support and prevents herniation. Hence, the answer is (b) External oblique aponeurosis.
2. The posterior wall of the inguinal canal is formed by -
a) Transversalis fascia
b) Conjoint tendon
c) Both a and b
d) Internal oblique muscle
Explanation: The posterior wall is mainly formed by the transversalis fascia and reinforced medially by the conjoint tendon (fusion of internal oblique and transversus abdominis aponeuroses). Hence, the answer is (c) Both a and b.
3. A 30-year-old male presents with an indirect inguinal hernia. The hernial sac enters through which structure?
a) Deep inguinal ring
b) Superficial inguinal ring
c) Hesselbach’s triangle
d) Femoral canal
Explanation: An indirect inguinal hernia occurs when abdominal contents herniate through the deep inguinal ring, traveling along the spermatic cord, and may reach the scrotum. It is lateral to the inferior epigastric vessels. Hence, the answer is (a) Deep inguinal ring.
4. Direct inguinal hernia occurs through -
a) Deep inguinal ring
b) Superficial inguinal ring
c) Posterior wall of inguinal canal
d) Femoral canal
Explanation: Direct inguinal hernia occurs through a weakness in the posterior wall of the inguinal canal within Hesselbach’s triangle, medial to the inferior epigastric vessels. It usually does not reach the scrotum. Hence, the answer is (c) Posterior wall of inguinal canal.
5. Which layer gives rise to the cremasteric muscle and fascia?
a) External oblique aponeurosis
b) Internal oblique muscle
c) Transversus abdominis
d) Transversalis fascia
Explanation: The cremasteric muscle and fascia are derived from the internal oblique muscle layer as the spermatic cord passes through the inguinal canal. The cremaster muscle elevates the testis during temperature changes. Hence, the answer is (b) Internal oblique muscle.
6. Which nerve supplies the cremasteric muscle?
a) Ilioinguinal nerve
b) Genital branch of genitofemoral nerve
c) Femoral nerve
d) Pudendal nerve
Explanation: The genital branch of the genitofemoral nerve supplies the cremasteric muscle. This nerve also carries afferent fibers for the cremasteric reflex. Hence, the answer is (b) Genital branch of genitofemoral nerve.
7. A patient presents with absence of the cremasteric reflex. The lesion is likely in -
a) L1 spinal segment
b) L2 spinal segment
c) L3 spinal segment
d) S2 spinal segment
Explanation: The cremasteric reflex involves the sensory input from the ilioinguinal nerve (L1) and motor output through the genital branch of the genitofemoral nerve (L1–L2). Loss of reflex indicates damage to L1–L2 segments. Hence, the answer is (b) L2 spinal segment.
8. Which structure forms the roof of the inguinal canal?
a) Transversus abdominis and internal oblique muscles
b) External oblique aponeurosis
c) Conjoint tendon
d) Transversalis fascia
Explanation: The roof of the inguinal canal is formed by arching fibers of the transversus abdominis and internal oblique muscles. These fibers provide dynamic support during increased intra-abdominal pressure. Hence, the answer is (a) Transversus abdominis and internal oblique muscles.
9. The superficial inguinal ring is an opening in the -
a) Transversalis fascia
b) Internal oblique muscle
c) External oblique aponeurosis
d) Conjoint tendon
Explanation: The superficial inguinal ring is a triangular gap in the external oblique aponeurosis located just above the pubic crest. It allows exit of the spermatic cord or round ligament. Hence, the answer is (c) External oblique aponeurosis.
10. In a male child with a patent processus vaginalis, which hernia type is most likely?
a) Direct inguinal hernia
b) Indirect inguinal hernia
c) Umbilical hernia
d) Femoral hernia
Explanation: A patent processus vaginalis creates a congenital communication between the peritoneal cavity and scrotum, predisposing to an indirect inguinal hernia. The hernia follows the same path as the spermatic cord. Hence, the answer is (b) Indirect inguinal hernia.