Chapter: Abdomen; Topic: Inguinal Canal; Subtopic: Superficial Inguinal Ring
Keyword Definitions:
Inguinal Canal: A short oblique passage in the lower anterior abdominal wall, transmitting the spermatic cord in males and the round ligament in females.
Superficial Inguinal Ring: A triangular defect in the external oblique aponeurosis, forming the exit of the inguinal canal.
Aponeurosis: A flat, broad tendon that serves as a connective tissue attachment for muscles.
External Oblique Muscle: The largest and outermost muscle of the abdominal wall, contributing to trunk rotation and compression of abdominal contents.
Lead Question (2015): Superficial inguinal ring is a defect in the:
a) Internal oblique aponeurosis
b) External oblique aponeurosis
c) Transverse abdominis aponeurosis
d) Internal oblique muscle
Explanation: The superficial inguinal ring is an opening in the external oblique aponeurosis, forming the exit of the inguinal canal. It transmits the spermatic cord in males and the round ligament in females. The ring is bounded by medial and lateral crura of the external oblique aponeurosis. Answer: (b)
1. The deep inguinal ring is an opening in which structure?
a) External oblique aponeurosis
b) Transversalis fascia
c) Internal oblique aponeurosis
d) Linea alba
The deep inguinal ring is an opening in the transversalis fascia. It serves as the entrance to the inguinal canal and allows passage of the spermatic cord or round ligament. Its position is above the midpoint of the inguinal ligament. Answer: (b)
2. Which of the following forms the posterior wall of the inguinal canal?
a) External oblique aponeurosis
b) Transversalis fascia
c) Internal oblique muscle
d) Inguinal ligament
The posterior wall of the inguinal canal is mainly formed by the transversalis fascia, with reinforcement from the conjoint tendon medially. This wall provides strength and prevents herniation. Answer: (b)
3. The conjoint tendon is formed by the fusion of aponeuroses of:
a) External and internal oblique
b) Internal oblique and transversus abdominis
c) Transversus abdominis and rectus abdominis
d) Rectus abdominis and external oblique
The conjoint tendon is formed by the lower fibers of the internal oblique and transversus abdominis aponeuroses. It strengthens the posterior wall of the inguinal canal and supports the superficial ring area. Answer: (b)
4. In a male patient, an indirect inguinal hernia passes through which structures?
a) Only superficial ring
b) Both deep and superficial rings
c) Only deep ring
d) Femoral canal
An indirect inguinal hernia enters through the deep inguinal ring, traverses the canal, and emerges from the superficial inguinal ring. It often extends into the scrotum and is congenital due to a patent processus vaginalis. Answer: (b)
5. Inguinal canal in females transmits:
a) Round ligament of uterus
b) Ureter
c) Ovarian artery
d) Inferior epigastric vessels
In females, the inguinal canal transmits the round ligament of the uterus, a remnant of the gubernaculum. It helps maintain uterine anteversion and exits through the superficial ring, ending in the labia majora. Answer: (a)
6. A 45-year-old man presents with a swelling that increases on coughing and reduces on lying down. The hernia passes through both deep and superficial rings. Identify the type.
a) Direct inguinal hernia
b) Indirect inguinal hernia
c) Femoral hernia
d) Umbilical hernia
The described hernia passes through both deep and superficial rings, typical of an indirect inguinal hernia. It follows the embryological path of the testis and may reach the scrotum. The swelling reduces when supine. Answer: (b)
7. A patient with a direct inguinal hernia typically has a defect in:
a) Hesselbach’s triangle
b) Femoral canal
c) Deep ring
d) Pectineal ligament
A direct inguinal hernia occurs through Hesselbach’s triangle, an area bounded by the lateral edge of rectus abdominis, inferior epigastric vessels, and inguinal ligament. It protrudes directly through the posterior wall and does not pass through the deep ring. Answer: (a)
8. A surgeon repairing an inguinal hernia must take care not to injure which nerve lying near the superficial ring?
a) Genitofemoral nerve
b) Ilioinguinal nerve
c) Femoral nerve
d) Obturator nerve
The ilioinguinal nerve runs along the inguinal canal and exits through the superficial ring. During hernia repair, this nerve must be preserved to prevent sensory loss over the upper medial thigh and anterior scrotum or labia majora. Answer: (b)
9. A newborn male has a swelling in the scrotum due to a patent processus vaginalis. The condition is called:
a) Hydrocele
b) Indirect inguinal hernia
c) Cryptorchidism
d) Varicocele
A patent processus vaginalis in newborns can cause an indirect inguinal hernia or a communicating hydrocele. In this case, intestinal loops may herniate through the canal into the scrotum. Answer: (b)
10. A 60-year-old male develops a bulge above the medial part of the inguinal ligament. The hernia does not enter the scrotum. Identify the likely type.
a) Direct inguinal hernia
b) Indirect inguinal hernia
c) Femoral hernia
d) Umbilical hernia
This hernia protrudes directly through the posterior wall of the inguinal canal within Hesselbach’s triangle, not passing through the deep ring. It typically occurs in older males due to abdominal wall weakness. Answer: (a)
Chapter: Male Reproductive System; Topic: Spermatic Cord; Subtopic: Components and Clinical Anatomy
Keyword Definitions:
Spermatic Cord: A bundle of structures passing from the abdomen to the testes through the inguinal canal, enclosed in fascial coverings.
Vas Deferens: A muscular tube that transports sperm from the epididymis to the ejaculatory duct.
Pampiniform Plexus: A network of veins surrounding the testicular artery, aiding in temperature regulation of the testes.
Genitofemoral Nerve: A mixed nerve supplying the cremaster muscle and skin of the upper thigh and scrotum.
Poupart’s Ligament: Another name for the inguinal ligament, forming the lower border of the abdominal wall.
Lead Question (2015): All are components of Spermatic cord except:
a) Poupart's ligament
b) Genito-femoral nerve
c) Vas deferens
d) Pampiniform plexus
Explanation: The spermatic cord contains the vas deferens, pampiniform plexus, testicular artery, cremasteric artery, and genital branch of the genitofemoral nerve. It extends from the deep inguinal ring to the testis. The Poupart’s ligament (inguinal ligament) forms a boundary of the inguinal canal but is not a part of the spermatic cord. Answer: (a)
1. Which artery does not contribute to the spermatic cord?
a) Testicular artery
b) Cremasteric artery
c) Artery to vas deferens
d) Inferior epigastric artery
The inferior epigastric artery is not a component of the spermatic cord. It gives origin to the cremasteric artery, but it lies outside the cord itself. The spermatic cord contains the testicular artery, cremasteric artery, and artery to the vas deferens. Answer: (d)
2. The pampiniform plexus drains into which vein?
a) Internal iliac vein
b) Inferior vena cava
c) Testicular vein
d) Femoral vein
The pampiniform plexus converges to form the testicular vein. On the right, it drains into the inferior vena cava; on the left, into the left renal vein. This venous arrangement helps maintain testicular temperature essential for spermatogenesis. Answer: (c)
3. Which fascial covering of the spermatic cord is derived from the transversalis fascia?
a) Cremasteric fascia
b) Internal spermatic fascia
c) External spermatic fascia
d) Dartos fascia
The internal spermatic fascia arises from the transversalis fascia at the deep inguinal ring and surrounds the cord and testes. It forms the innermost covering, followed by the cremasteric and external spermatic fasciae. Answer: (b)
4. During varicocele surgery, which structure must be preserved to prevent testicular atrophy?
a) Vas deferens
b) Pampiniform plexus
c) Testicular artery
d) Cremasteric muscle
The testicular artery provides the main blood supply to the testis. Injury during varicocele ligation can cause ischemia and testicular atrophy. The pampiniform plexus veins are ligated while preserving the artery and lymphatics. Answer: (c)
5. The genital branch of the genitofemoral nerve supplies:
a) Dartos muscle
b) Cremaster muscle
c) External oblique muscle
d) Internal oblique muscle
The genital branch of the genitofemoral nerve innervates the cremaster muscle and provides sensory fibers to the scrotal skin. It passes within the spermatic cord and is responsible for the cremasteric reflex. Answer: (b)
6. A 22-year-old male presents with a soft scrotal swelling that increases on standing and disappears when lying down. The likely cause is:
a) Hydrocele
b) Varicocele
c) Epididymitis
d) Inguinal hernia
A swelling that increases on standing and reduces when supine indicates a varicocele, which is dilation of the pampiniform plexus veins. It is more common on the left due to venous drainage into the left renal vein. Answer: (b)
7. A 30-year-old man has infertility and left scrotal heaviness. Doppler ultrasound shows dilated veins above the testis. What is the pathophysiological basis?
a) Obstruction of vas deferens
b) Incompetent testicular venous valves
c) Herniation of bowel loops
d) Arterial occlusion
A varicocele occurs due to incompetent valves in the testicular vein, leading to venous reflux and stasis. This raises scrotal temperature, impairing spermatogenesis, and may cause infertility if untreated. Answer: (b)
8. A surgeon performing hernia repair must be cautious of which structure in the spermatic cord to avoid infertility?
a) Cremasteric artery
b) Vas deferens
c) Ilioinguinal nerve
d) Dartos muscle
Inadvertent injury to the vas deferens during hernia repair can lead to obstructive infertility. It is a thick-walled muscular duct that transports sperm from the epididymis to the ejaculatory duct. Preservation is essential for reproductive function. Answer: (b)
9. A 40-year-old man undergoes varicocelectomy. Postoperatively, he develops testicular swelling due to lymphatic obstruction. Which structure’s damage caused it?
a) Vas deferens
b) Pampiniform plexus
c) Lymphatic vessels
d) Genitofemoral nerve
Postoperative testicular swelling results from injury to lymphatic vessels of the spermatic cord. They accompany the testicular artery and veins, and damage leads to lymph accumulation around the testis, forming secondary hydrocele. Answer: (c)
10. A 25-year-old male with trauma to the groin loses the cremasteric reflex. Which nerve is likely injured?
a) Iliohypogastric nerve
b) Genitofemoral nerve
c) Pudendal nerve
d) Femoral nerve
Loss of the cremasteric reflex indicates damage to the genitofemoral nerve. The genital branch stimulates contraction of the cremaster muscle, elevating the testis in response to thigh stimulation. This reflex tests integrity of L1-L2 spinal segments. Answer: (b)
Chapter: Pelvis and Perineum; Topic: Perineum; Subtopic: Superficial Perineal Pouch
Keyword Definitions:
Perineum: The diamond-shaped area between the thighs, below the pelvic diaphragm, containing urogenital and anal triangles.
Superficial Perineal Space: A compartment of the urogenital triangle located between the perineal membrane and Colles’ fascia.
Ischiocavernosus Muscle: A muscle that helps maintain erection by compressing the crus of the penis or clitoris.
Deep Transverse Perinei Muscle: A muscle present in the deep perineal pouch that helps support the pelvic floor.
Bulbourethral Glands: Small glands in the deep perineal pouch secreting pre-ejaculate fluid for lubrication.
Lead Question (2015): Superficial perineal space contains?
a) Sphincter urethrae muscle
b) Ischiocavernosus muscle
c) Deep transverse perinei muscle
d) Bulbourethral gland
Explanation: The superficial perineal space lies between Colles’ fascia and the perineal membrane. It contains the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscles, as well as the roots of the penis or clitoris and branches of the pudendal vessels and nerves. The deep transverse perinei and bulbourethral glands are in the deep pouch. Answer: (b)
1. Which structure forms the superior boundary of the superficial perineal pouch?
a) Colles’ fascia
b) Perineal membrane
c) Deep fascia of thigh
d) Scarpa’s fascia
The perineal membrane (inferior fascia of the urogenital diaphragm) forms the superior boundary of the superficial perineal pouch. The inferior boundary is Colles’ fascia. This anatomical arrangement encloses muscles and erectile tissues of the urogenital triangle. Answer: (b)
2. The superficial transverse perinei muscle assists in:
a) Ejaculation
b) Supporting perineal body
c) Sphincter control of urethra
d) Defecation
The superficial transverse perinei muscle helps stabilize the perineal body, a fibromuscular node providing attachment to perineal muscles. It plays a supportive role in maintaining pelvic organ integrity during contraction and childbirth. Answer: (b)
3. Which structure lies in the deep perineal pouch?
a) Bulbospongiosus muscle
b) Bulbourethral glands
c) Ischiocavernosus muscle
d) Perineal branches of pudendal nerve
The bulbourethral glands (Cowper’s glands) are located in the deep perineal pouch. They secrete mucus to lubricate the urethra before ejaculation. Their ducts open into the spongy urethra, distinguishing them from structures in the superficial pouch. Answer: (b)
4. Which of the following structures passes through both superficial and deep perineal spaces?
a) Vas deferens
b) Urethra
c) Testicular artery
d) Internal pudendal vein
The urethra passes through both deep and superficial perineal spaces. The membranous part lies in the deep pouch and the spongy part in the superficial pouch. It is supported by the sphincter urethrae and bulbospongiosus muscles. Answer: (b)
5. A tear in the spongy urethra can cause urine to extravasate into:
a) Pelvic cavity
b) Deep perineal pouch
c) Superficial perineal pouch
d) Ischiorectal fossa
Injury to the spongy urethra allows urine and blood to collect in the superficial perineal pouch. From here, it may spread into the scrotum, penis, and lower anterior abdominal wall beneath Scarpa’s fascia, but not into the thigh due to fascia attachments. Answer: (c)
6. A 35-year-old male presents with swelling of the scrotum and penis after straddle injury. Urine collection indicates rupture of which structure?
a) Membranous urethra
b) Spongy urethra
c) Prostatic urethra
d) Bladder neck
A straddle injury often causes rupture of the spongy urethra within the bulb of the penis. Urine leaks into the superficial perineal pouch, spreading into the scrotum and lower abdominal wall due to continuity of fasciae. Answer: (b)
7. A surgeon performing perineal repair must locate the perineal body. It serves as attachment for all except:
a) Superficial transverse perinei
b) Bulbospongiosus
c) Ischiocavernosus
d) External anal sphincter
The ischiocavernosus muscle does not attach to the perineal body. It originates from the ischial tuberosity and helps maintain erection by compressing venous outflow. The other muscles contribute directly to perineal body support. Answer: (c)
8. A postpartum woman develops perineal tear extending into the superficial pouch. Which muscles are affected?
a) Ischiocavernosus and bulbospongiosus
b) Deep transverse perinei and sphincter urethrae
c) Coccygeus and levator ani
d) Obturator internus and piriformis
A tear in the superficial perineal pouch affects the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscles. These structures help maintain integrity of the perineal body, and damage can cause pelvic floor weakness and prolapse. Answer: (a)
9. A 40-year-old man has a perineal abscess below the perineal membrane. The infection lies in:
a) Deep perineal pouch
b) Superficial perineal pouch
c) Ischiorectal fossa
d) Retropubic space
An abscess below the perineal membrane lies in the superficial perineal pouch. It may spread across the midline and cause scrotal or penile swelling due to continuity of fascial layers in the perineum. Answer: (b)
10. A 25-year-old male with pelvic fracture presents with urinary retention. Rupture of membranous urethra would lead urine to collect in:
a) Superficial perineal pouch
b) Deep perineal pouch
c) Scrotum
d) Subcutaneous tissue of thigh
Rupture of the membranous urethra results in extravasation of urine into the deep perineal pouch and potentially into the retropubic space of Retzius. The perineal membrane prevents its spread into the superficial pouch. Answer: (b)
Chapter: Abdomen; Topic: Duodenum; Subtopic: Third Part of Duodenum – Relations
Keyword Definitions:
Duodenum: The first part of the small intestine, about 25 cm long, divided into four parts.
Superior mesenteric vessels: These are the artery and vein that supply and drain the midgut.
Head of pancreas: The broad part of the pancreas encircled by the C-shaped curve of the duodenum.
Quadrate lobe of liver: A small lobe located on the visceral surface of the liver between the gallbladder and ligamentum teres.
Ureter: A muscular tube that carries urine from the kidney to the urinary bladder.
Lead Question – 2015
3rd part of duodenum is not related –
a) Superior mesenteric vessels
b) Right ureter
c) Head of pancreas
d) Quadrate lobe of liver
Explanation: The third part of the duodenum (horizontal part) crosses the midline at the level of L3 and lies anterior to the inferior vena cava and aorta, but posterior to the superior mesenteric vessels. It is related to the head of the pancreas superiorly. The quadrate lobe of liver is not related. Answer: d) Quadrate lobe of liver.
1) The second part of duodenum receives the openings of:
a) Hepatic ducts
b) Pancreatic duct and bile duct
c) Cystic duct
d) Main pancreatic duct only
Explanation: The second part of the duodenum, also called the descending part, receives the common bile duct and the main pancreatic duct at the major duodenal papilla. Occasionally, the accessory pancreatic duct opens at the minor papilla above it. These ducts help deliver bile and pancreatic enzymes. Answer: b) Pancreatic duct and bile duct.
2) Blood supply to the first part of duodenum is mainly from:
a) Superior mesenteric artery
b) Gastroduodenal artery
c) Celiac trunk directly
d) Left gastric artery
Explanation: The first part of the duodenum (ampulla) is supplied mainly by the gastroduodenal artery, a branch of the common hepatic artery from the celiac trunk. It anastomoses with branches from the superior mesenteric artery, forming a crucial connection between foregut and midgut circulation. Answer: b) Gastroduodenal artery.
3) The third part of duodenum lies at which vertebral level?
a) L1
b) L2
c) L3
d) L4
Explanation: The third part of the duodenum crosses horizontally from right to left at the level of the third lumbar vertebra (L3). This anatomical location makes it posteriorly related to the inferior vena cava and aorta and anteriorly related to the superior mesenteric vessels. Answer: c) L3.
4) Which structure crosses anterior to the third part of the duodenum?
a) Inferior vena cava
b) Superior mesenteric artery
c) Left ureter
d) Portal vein
Explanation: The superior mesenteric artery and vein cross anteriorly over the third part of the duodenum. This relation is clinically significant because compression of the duodenum between the SMA and aorta can cause superior mesenteric artery syndrome. Answer: b) Superior mesenteric artery.
5) The ligament of Treitz is attached to which part of the duodenum?
a) First part
b) Second part
c) Third part
d) Fourth part
Explanation: The ligament of Treitz, or suspensory muscle of the duodenum, attaches to the junction between the duodenum and jejunum, primarily at the fourth part. It helps maintain the duodenojejunal flexure and supports intestinal positioning. Answer: d) Fourth part.
6) A patient with SMA syndrome presents due to compression of which part of duodenum?
a) First part
b) Second part
c) Third part
d) Fourth part
Explanation: Superior mesenteric artery syndrome occurs when the third part of the duodenum is compressed between the SMA and aorta, causing obstruction. This condition is seen in individuals with severe weight loss or thin body habitus due to loss of mesenteric fat. Answer: c) Third part.
7) Which of the following structures passes posterior to the first part of duodenum?
a) Common bile duct
b) Portal vein
c) Gastroduodenal artery
d) All of the above
Explanation: The posterior relations of the first part of the duodenum include the common bile duct, portal vein, and gastroduodenal artery, making this area prone to bleeding in posterior duodenal ulcers. Answer: d) All of the above.
8) Clinical: A duodenal ulcer perforating posteriorly most likely damages which artery?
a) Right gastric artery
b) Gastroduodenal artery
c) Right gastroepiploic artery
d) Superior mesenteric artery
Explanation: A posterior perforation of a duodenal ulcer typically erodes into the gastroduodenal artery, which lies directly posterior to the first part of the duodenum. This can cause life-threatening upper gastrointestinal hemorrhage. Answer: b) Gastroduodenal artery.
9) Clinical: A tumor in the head of the pancreas can compress which part of the duodenum?
a) First
b) Second
c) Third
d) Fourth
Explanation: The head of the pancreas lies within the C-shaped curve of the duodenum, particularly around the second part. Tumors in this region can cause obstruction and jaundice by compressing the duodenal lumen or bile duct. Answer: b) Second part.
10) Clinical: During abdominal surgery, a surgeon identifies a horizontal duodenal segment passing anterior to aorta. It is most likely:
a) First part
b) Second part
c) Third part
d) Fourth part
Explanation: The third part of the duodenum runs horizontally across the midline at the level of L3, crossing anterior to the aorta and inferior vena cava and posterior to the superior mesenteric vessels. Recognition of this anatomy helps avoid iatrogenic injury. Answer: c) Third part.
CHAPTER: Abdomen; TOPIC: Peritoneum and its Folds; SUBTOPIC: Gastrosplenic Ligament
Keyword Definitions:
Gastrosplenic Ligament: A peritoneal fold connecting the greater curvature of the stomach to the spleen.
Short Gastric Arteries: Small branches from the splenic artery that supply the fundus of the stomach.
Splenic Vessels: Blood vessels that supply and drain the spleen.
Portal Vein: Major vein that carries blood from the gastrointestinal tract to the liver.
Pancreatic Tail: The left end of the pancreas, near the spleen, within the splenorenal ligament.
Lead Question (2015):
Gastrosplenic ligament contains?
a) Splenic vessels
b) Tail of pancreas
c) Short gastric artery
d) Portal vein
Explanation:
The gastrosplenic ligament connects the stomach to the spleen and transmits the short gastric arteries and the left gastroepiploic artery. It does not contain the splenic vessels or tail of pancreas, as these are present in the splenorenal ligament. The correct answer is short gastric artery (c). These arteries arise from the splenic artery and supply the fundus of the stomach, traversing the gastrosplenic ligament. This ligament forms part of the greater omentum and helps anchor the spleen and stomach within the peritoneal cavity.
1. The splenorenal ligament connects the spleen to which structure?
a) Stomach
b) Left kidney
c) Diaphragm
d) Colon
Explanation:
The splenorenal ligament connects the spleen to the left kidney and contains the splenic vessels and tail of the pancreas. It plays a role in supporting the spleen and transmitting vital vascular structures between the spleen and the retroperitoneal organs. The correct answer is b) Left kidney.
2. Which peritoneal fold connects the liver to the lesser curvature of the stomach?
a) Falciform ligament
b) Gastrosplenic ligament
c) Hepatogastric ligament
d) Gastrocolic ligament
Explanation:
The hepatogastric ligament connects the liver to the lesser curvature of the stomach and forms part of the lesser omentum. It contains branches of the left gastric artery and veins. The correct answer is c) Hepatogastric ligament. This fold helps stabilize the stomach’s lesser curvature and facilitates blood supply.
3. A surgeon notes that during splenectomy, bleeding occurs from short vessels attached to the stomach’s fundus. These vessels most likely lie within which ligament?
a) Gastrosplenic
b) Splenorenal
c) Gastrohepatic
d) Gastrocolic
Explanation:
During splenectomy, bleeding from short gastric vessels indicates involvement of the gastrosplenic ligament. This ligament contains the short gastric arteries which arise from the splenic artery and supply the stomach’s fundus. Hence, the correct answer is a) Gastrosplenic. Proper identification of this ligament is crucial to avoid injury during surgery.
4. The ligament containing the tail of the pancreas is:
a) Splenorenal ligament
b) Gastrosplenic ligament
c) Gastrocolic ligament
d) Hepatoduodenal ligament
Explanation:
The splenorenal ligament encloses the tail of the pancreas and splenic vessels. It attaches the spleen to the posterior abdominal wall over the left kidney. The correct answer is a) Splenorenal ligament. Recognizing this relationship helps prevent pancreatic injury during splenectomy or renal surgery.
5. (Clinical) A 45-year-old man undergoing splenectomy experiences accidental injury to a vessel within the gastrosplenic ligament. Which organ’s blood supply is affected?
a) Fundus of stomach
b) Duodenum
c) Pancreas
d) Jejunum
Explanation:
Injury to vessels within the gastrosplenic ligament affects the fundus of the stomach, supplied by the short gastric arteries. These vessels run from the splenic artery through the gastrosplenic ligament. The correct answer is a) Fundus of stomach. Damage can cause ischemia or necrosis of the gastric fundus post-surgery.
6. (Clinical) During trauma surgery, a laceration near the spleen leads to bleeding from vessels within the splenorenal ligament. Which vessel is most likely injured?
a) Left gastric artery
b) Splenic artery
c) Short gastric artery
d) Left gastroepiploic artery
Explanation:
The splenic artery lies within the splenorenal ligament along with the tail of the pancreas. Injury to this ligament often causes severe bleeding from the splenic artery. The correct answer is b) Splenic artery. This highlights the need for careful dissection in upper abdominal surgeries involving the spleen or pancreas.
7. The greater omentum consists of all the following ligaments except:
a) Gastrosplenic
b) Gastrocolic
c) Gastrophrenic
d) Hepatogastric
Explanation:
The hepatogastric ligament is part of the lesser omentum, not the greater omentum. The greater omentum includes the gastrosplenic, gastrocolic, and gastrophrenic ligaments. Hence, the correct answer is d) Hepatogastric. The greater omentum hangs from the greater curvature of the stomach and drapes over the intestines.
8. (Clinical) A patient develops infarction of the fundus of the stomach after splenectomy. Which vessel was most likely ligated inadvertently?
a) Left gastric artery
b) Short gastric arteries
c) Right gastroepiploic artery
d) Left gastroepiploic artery
Explanation:
Infarction of the gastric fundus post-splenectomy suggests accidental ligation of the short gastric arteries, which supply this region and traverse the gastrosplenic ligament. The correct answer is b) Short gastric arteries. Their poor collateral circulation makes the fundus vulnerable during splenic surgery if these vessels are damaged.
9. The ligament forming part of the posterior wall of the lesser sac and containing the portal triad is:
a) Gastrosplenic ligament
b) Hepatoduodenal ligament
c) Splenorenal ligament
d) Gastrocolic ligament
Explanation:
The hepatoduodenal ligament connects the liver to the duodenum and encloses the portal triad—portal vein, hepatic artery, and bile duct. The correct answer is b) Hepatoduodenal ligament. It forms part of the lesser omentum and the anterior boundary of the epiploic foramen (of Winslow).
10. (Clinical) A CT scan reveals a pancreatic pseudocyst extending into the splenorenal ligament. Which part of the pancreas is involved?
a) Head
b) Neck
c) Body
d) Tail
Explanation:
A pseudocyst extending into the splenorenal ligament indicates involvement of the tail of the pancreas, which lies within this ligament near the splenic hilum. The correct answer is d) Tail. Such extensions can cause splenic complications or bleeding, requiring careful radiologic and surgical management during treatment.
CHAPTER: Abdomen; TOPIC: Peritoneum and Mesenteries; SUBTOPIC: Derivatives of Ventral and Dorsal Mesogastrium
Keyword Definitions:
Ventral Mesogastrium: A double layer of peritoneum that connects the foregut to the anterior abdominal wall and gives rise to structures like the lesser omentum and falciform ligament.
Dorsal Mesogastrium: The posterior peritoneal fold that gives rise to the greater omentum, gastrosplenic, and splenorenal ligaments.
Lesser Omentum: A peritoneal fold connecting the liver to the lesser curvature of the stomach and the first part of the duodenum.
Greater Omentum: A large apron-like fold hanging from the greater curvature of the stomach, derived from dorsal mesogastrium.
Ligamentum Teres Hepatis: The fibrous remnant of the umbilical vein, running in the free margin of the falciform ligament.
Lead Question (2015):
Which of the following is a derivative of ventral mesogastrium?
a) Greater omentum
b) Gastrosplenic ligament
c) Linorenal ligament
d) Lesser omentum
Explanation:
The ventral mesogastrium gives rise to the lesser omentum and the falciform ligament. The lesser omentum connects the liver to the stomach and duodenum and encloses the portal triad. The greater omentum, gastrosplenic, and splenorenal ligaments arise from the dorsal mesogastrium. Hence, the correct answer is d) Lesser omentum. Understanding mesenteric derivatives is essential for identifying peritoneal reflections, surgical planes, and the arrangement of abdominal organs during dissection or laparoscopic procedures.
1. Which of the following structures develops from the dorsal mesogastrium?
a) Falciform ligament
b) Lesser omentum
c) Greater omentum
d) Ligamentum teres hepatis
Explanation:
The dorsal mesogastrium gives rise to the greater omentum, gastrosplenic ligament, and splenorenal ligament. The correct answer is c) Greater omentum. These structures are posterior peritoneal folds supporting the stomach and spleen. In contrast, the falciform ligament and lesser omentum originate from the ventral mesogastrium.
2. The falciform ligament connects which two structures?
a) Stomach and liver
b) Liver and anterior abdominal wall
c) Spleen and kidney
d) Stomach and spleen
Explanation:
The falciform ligament connects the liver to the anterior abdominal wall and the diaphragm. It is derived from the ventral mesogastrium and contains the ligamentum teres hepatis within its free edge. The correct answer is b) Liver and anterior abdominal wall. It helps anchor the liver and marks the division between the right and left lobes.
3. (Clinical) During laparoscopic cholecystectomy, the surgeon identifies the hepatoduodenal ligament. Which embryologic structure gives rise to this ligament?
a) Dorsal mesogastrium
b) Ventral mesogastrium
c) Dorsal mesentery
d) Septum transversum
Explanation:
The hepatoduodenal ligament is derived from the ventral mesogastrium and connects the liver to the duodenum. It contains the portal triad—portal vein, hepatic artery, and bile duct. Hence, the correct answer is b) Ventral mesogastrium. Knowledge of its origin helps during hepatic and biliary surgeries to avoid major vessel injury.
4. The ligament that contains the ligamentum teres hepatis is:
a) Lesser omentum
b) Falciform ligament
c) Hepatoduodenal ligament
d) Gastrosplenic ligament
Explanation:
The ligamentum teres hepatis is located in the free margin of the falciform ligament, a remnant of the ventral mesogastrium. The correct answer is b) Falciform ligament. This fibrous cord represents the obliterated left umbilical vein that carried oxygenated blood from the placenta to the fetus before birth.
5. (Clinical) A surgeon identifies the portal triad within a peritoneal fold connecting the liver to the duodenum. This structure is derived from:
a) Ventral mesogastrium
b) Dorsal mesogastrium
c) Dorsal mesentery
d) Mesocolon
Explanation:
The portal triad lies within the hepatoduodenal ligament, a derivative of the ventral mesogastrium. The correct answer is a) Ventral mesogastrium. This ligament forms the right free edge of the lesser omentum and is clinically significant as it can be compressed during Pringle’s maneuver to control hepatic bleeding.
6. Which ligament is a part of the lesser omentum?
a) Gastrosplenic ligament
b) Hepatoduodenal ligament
c) Splenorenal ligament
d) Gastrocolic ligament
Explanation:
The lesser omentum consists of two parts—hepatogastric and hepatoduodenal ligaments. Both are derivatives of the ventral mesogastrium. The correct answer is b) Hepatoduodenal ligament. It connects the liver to the duodenum and encloses the portal triad, making it vital in liver and biliary tract surgeries.
7. (Clinical) After trauma, a patient shows injury to a ligament between the liver and the stomach containing the left gastric artery. This ligament is derived from:
a) Dorsal mesogastrium
b) Ventral mesogastrium
c) Dorsal mesentery
d) Mesocolon
Explanation:
The hepatogastric ligament connects the liver to the lesser curvature of the stomach and contains the left gastric artery. It is derived from the ventral mesogastrium. Hence, the correct answer is b) Ventral mesogastrium. Damage to this ligament can cause upper GI bleeding due to injury to the left gastric artery.
8. The spleen develops within which embryological mesentery?
a) Ventral mesogastrium
b) Dorsal mesogastrium
c) Mesocolon
d) Dorsal mesentery
Explanation:
The spleen develops within the dorsal mesogastrium, specifically in the region between the stomach and the posterior abdominal wall. The correct answer is b) Dorsal mesogastrium. As it grows, it forms the splenorenal and gastrosplenic ligaments, which help attach it to surrounding structures and transmit important vessels.
9. (Clinical) A CT scan shows fluid collection between the stomach and the liver. This space is known as:
a) Greater sac
b) Lesser sac
c) Subphrenic recess
d) Paracolic gutter
Explanation:
The space between the stomach and liver is the lesser sac (omental bursa), which lies posterior to the lesser omentum and stomach. The correct answer is b) Lesser sac. It allows free movement of the stomach and communicates with the greater sac through the epiploic foramen. Fluid here indicates pancreatic or gastric pathology.
10. (Clinical) A surgeon performing hepatic resection identifies the falciform ligament and its content. What embryologic structure is this a remnant of?
a) Left umbilical vein
b) Vitelline duct
c) Right umbilical vein
d) Ductus venosus
Explanation:
The ligamentum teres hepatis, contained in the falciform ligament, is the remnant of the left umbilical vein. Thus, the correct answer is a) Left umbilical vein. It carried oxygenated blood from the placenta to the fetus. After birth, it becomes fibrosed, leaving a useful surgical landmark separating hepatic lobes.
Chapter: Anatomy of Female Genital Tract; Topic: Uterine Blood Supply; Subtopic: Sequence of Arterial Branches in the Uterus
Keyword Definitions:
• Uterine artery: Main arterial supply to the uterus, a branch of the internal iliac artery.
• Arcuate artery: Vessels running circumferentially within the myometrium.
• Radial artery: Branches from arcuate arteries that penetrate deep into the myometrium.
• Spiral artery: Terminal branches supplying the endometrium, especially functional layer.
1. Lead Question (NEET PG 2023):
Correct sequence of uterine blood flow -
A) Uterine A → Arcuate A → Radial A → Spiral A
B) Uterine A → Radial A → Arcuate A → Spiral A
C) Uterine A → Spiral A → Radial A → Arcuate A
D) Uterine A → Arcuate A → Spiral A → Radial A
Explanation:
The correct sequence of blood flow in the uterus is from the uterine artery, which gives rise to arcuate arteries within the myometrium. From the arcuate arteries, radial arteries branch inward toward the endometrium and further divide into straight and spiral arteries. Spiral arteries supply the functional layer of the endometrium and undergo cyclical changes during menstruation. Therefore, the correct answer is Option A (Uterine A → Arcuate A → Radial A → Spiral A).
Guessed Questions:
2. The uterine artery is a direct branch of which major artery?
A) External iliac artery
B) Internal iliac artery
C) Common iliac artery
D) Inferior mesenteric artery
Explanation: The uterine artery arises from the anterior division of the internal iliac artery. It supplies the uterus, cervix, and upper vagina and anastomoses with the ovarian artery. Hence, the correct answer is B) Internal iliac artery.
3. Which arteries of the uterus are primarily responsible for cyclic changes during the menstrual cycle?
A) Arcuate arteries
B) Radial arteries
C) Spiral arteries
D) Straight arteries
Explanation: Spiral arteries supply the functional layer of the endometrium and undergo significant changes during the menstrual cycle, including constriction during menstruation leading to endometrial shedding. Thus, the correct answer is C) Spiral arteries.
4. Which layer of the uterus contains arcuate arteries?
A) Endometrium
B) Myometrium
C) Perimetrium
D) Cervical canal
Explanation: The arcuate arteries run circumferentially within the middle layer of the uterus, the myometrium, and give rise to radial arteries that penetrate deeper layers. The correct answer is B) Myometrium.
5. During hysterectomy, uterine artery is closely related to which structure?
A) Ureter
B) Ovary
C) Fallopian tube
D) Round ligament
Explanation: The uterine artery crosses the ureter superiorly near the lateral fornix of the vagina — often remembered as “water under the bridge.” Therefore, care must be taken to avoid ureteric injury. Correct answer is A) Ureter.
6. Which artery forms an anastomosis with the ovarian artery at the uterine cornua?
A) Vaginal artery
B) Internal pudendal artery
C) Uterine artery
D) Inferior vesical artery
Explanation: The uterine artery anastomoses with the ovarian artery at the uterine cornua, ensuring collateral circulation. Hence, the correct answer is C) Uterine artery.
7. (Clinical) A 35-year-old woman with postpartum hemorrhage is undergoing uterine artery ligation. Which of the following best explains the purpose of this procedure?
A) To increase uterine perfusion
B) To reduce blood loss by decreasing uterine arterial flow
C) To improve ovarian blood flow
D) To block venous drainage
Explanation: Uterine artery ligation helps in controlling postpartum hemorrhage by decreasing arterial inflow to the uterus, reducing bleeding while preserving fertility via collateral circulation from ovarian arteries. Thus, correct answer is B) To reduce blood loss by decreasing uterine arterial flow.
8. (Clinical) A patient with Asherman’s syndrome has damage to which vascular structure supplying the endometrium?
A) Arcuate arteries
B) Radial arteries
C) Spiral arteries
D) Straight arteries
Explanation: Asherman’s syndrome involves scarring of the endometrium, primarily affecting spiral arteries that supply the functional layer. The resultant hypoperfusion leads to amenorrhea or infertility. Correct answer: C) Spiral arteries.
9. (Clinical) A 42-year-old woman with fibroids undergoes uterine artery embolization. Which of the following mechanisms is responsible for fibroid shrinkage?
A) Increased perfusion
B) Ischemic necrosis due to reduced arterial supply
C) Venous congestion
D) Hormonal inhibition
Explanation: Uterine artery embolization induces ischemic necrosis by blocking arterial blood flow to fibroids, leading to reduction in size and symptoms. Hence, the correct answer is B) Ischemic necrosis due to reduced arterial supply.
10. (Clinical) A 28-year-old woman with severe dysmenorrhea shows excessive constriction of which arteries leading to ischemic pain?
A) Arcuate arteries
B) Spiral arteries
C) Radial arteries
D) Straight arteries
Explanation: Dysmenorrhea is associated with prostaglandin-mediated constriction of spiral arteries, leading to uterine ischemia and pain. The correct answer is B) Spiral arteries.
11. (Clinical) In placenta accreta, abnormal trophoblastic invasion is primarily due to the absence of which endometrial layer affecting uterine vasculature?
A) Decidua basalis
B) Myometrium
C) Endometrium functional layer
D) Decidua capsularis
Explanation: Placenta accreta occurs when the decidua basalis is absent, allowing chorionic villi to invade the myometrium and its vascular layers. This leads to hemorrhage during delivery. Correct answer: A) Decidua basalis.
Chapter: Ear Anatomy; Topic: Middle Ear Muscles; Subtopic: Nerve Supply of Stapedius
Keyword Definitions:
• Stapedius: Smallest skeletal muscle in the human body; controls the movement of the stapes bone in the middle ear.
• Facial nerve (VII): Cranial nerve responsible for facial expression, taste from anterior tongue, and supplies stapedius muscle.
• Tensor tympani: Middle ear muscle supplied by mandibular division of trigeminal nerve (V3).
Lead Question (NEET PG 2023):
Nerve supply of stapedius is:
A) 2nd nerve
B) 3rd nerve
C) 5th nerve
D) 7th nerve
Answer: D) 7th nerve
Explanation:
The stapedius muscle is supplied by the facial nerve (cranial nerve VII) via its branch, the nerve to stapedius. It stabilizes the stapes bone and dampens vibrations of the ossicles to protect the inner ear from loud sounds. Paralysis of the stapedius due to facial nerve lesions leads to hyperacusis (increased sensitivity to sound). The tensor tympani, in contrast, is supplied by the mandibular division of the trigeminal nerve (V3).
Guessed Questions:
2) The smallest skeletal muscle in the human body is:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Tensor veli palatini
The muscle responsible for damping excessive movement of the stapes is:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Tensor veli palatini
Hyperacusis occurs due to paralysis of which muscle?
A) Stapedius
B) Tensor tympani
C) Salpingopharyngeus
D) Levator veli palatini
The stapedius muscle is located in which cavity?
A) Outer ear
B) Middle ear
C) Inner ear
D) Nasopharynx
The tensor tympani is supplied by which nerve?
A) Glossopharyngeal nerve
B) Facial nerve
C) Mandibular nerve (V3)
D) Vagus nerve
Which branch of facial nerve supplies the stapedius?
A) Chorda tympani
B) Greater petrosal nerve
C) Nerve to stapedius
D) Posterior auricular nerve
A patient with facial nerve palsy complains of increased sound sensitivity. The affected muscle is:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Tensor veli palatini
Function of stapedius muscle includes:
A) Opening auditory tube
B) Protecting cochlea from loud sounds
C) Equalizing air pressure
D) Tensing tympanic membrane
Damage to the nerve to stapedius results in:
A) Conductive hearing loss
B) Sensorineural hearing loss
C) Hyperacusis
D) Tinnitus
The muscle that attaches to the neck of the stapes is:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Salpingopharyngeus
Chapter: Ear Anatomy; Topic: Middle Ear Muscles; Subtopic: Action of Stapedius
Keyword Definitions:
• Stapedius: Smallest skeletal muscle of the body, located in the posterior wall of the middle ear cavity.
• Stapes: One of the three auditory ossicles; transmits sound vibrations from the incus to the oval window.
• Nerve to stapedius: Branch of the facial nerve (VII cranial nerve) that supplies the stapedius muscle.
Lead Question (NEET PG 2022):
1) Stapedius pulls stapes in which direction –
A) Anterior
B) Superior
C) Inferior
D) Posterior
Answer: D) Posterior
Explanation:
The stapedius muscle arises from the posterior wall of the middle ear and inserts into the neck of the stapes. Its contraction pulls the stapes posteriorly, tilting its base in the oval window. This action decreases the amplitude of stapes movement and protects the inner ear from loud sounds. The muscle is supplied by the facial nerve (VII cranial nerve) through the nerve to stapedius. Paralysis of this muscle leads to hyperacusis due to excessive vibration of the stapes.
Guessed Questions:
2) The stapedius muscle is supplied by which nerve?
A) Trigeminal nerve
B) Glossopharyngeal nerve
C) Facial nerve
D) Vagus nerve
3) The action of stapedius muscle helps in:
A) Increasing sound transmission
B) Decreasing sound transmission
C) Equalizing ear pressure
D) Opening auditory tube
4) The smallest skeletal muscle in the body is:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Salpingopharyngeus
5) Hyperacusis occurs when there is paralysis of:
A) Tensor tympani
B) Stapedius
C) Levator veli palatini
D) Salpingopharyngeus
6) The stapedius muscle inserts on the:
A) Handle of malleus
B) Body of incus
C) Neck of stapes
D) Footplate of stapes
7) The direction of pull of stapedius is opposite to that of:
A) Tensor tympani
B) Levator veli palatini
C) Salpingopharyngeus
D) Tensor veli palatini
8) Which muscle protects the cochlea from loud sounds?
A) Tensor tympani
B) Stapedius
C) Salpingopharyngeus
D) Levator veli palatini
9) The stapedius originates from which part of the temporal bone?
A) Mastoid cavity
B) Posterior wall of middle ear
C) Tegmen tympani
D) Auditory tube
10) Contraction of stapedius causes:
A) Increased ossicular movement
B) Reduced stapes vibration
C) Increased cochlear stimulation
D) None of the above
11) The stapedius reflex is a protective mechanism that acts in response to:
A) Low-frequency sound
B) Loud noise
C) Whispering
D) Absence of sound
Chapter: Head and Neck Anatomy; Topic: Muscles of the Neck; Subtopic: Sternocleidomastoid – Examination and Action
Keyword Definitions:
• Sternocleidomastoid (SCM): Prominent neck muscle arising from the manubrium sterni and medial clavicle, inserting on the mastoid process.
• Accessory nerve (XI): Cranial nerve supplying sternocleidomastoid and trapezius muscles.
• Contralateral rotation: Movement where the face turns to the side opposite to the contracting SCM.
Lead Question (NEET PG 2021):
1) Sternocleidomastoid muscle is examined by:
A) Turning the head towards the same side
B) Turning the head towards opposite side
C) Shrugging of shoulder
D) Overhead abduction
Answer: B) Turning the head towards opposite side
Explanation:
The sternocleidomastoid muscle (SCM) is tested by asking the patient to turn the head to the opposite side against resistance. This action makes the SCM of the tested side stand out prominently. The SCM rotates the head to the opposite side and flexes the neck to the same side. It is supplied by the spinal accessory nerve (cranial nerve XI). Weakness of SCM results in difficulty turning the head to the opposite side.
Guessed Questions:
2) Sternocleidomastoid is supplied by which nerve?
A) Facial nerve
B) Accessory nerve
C) Hypoglossal nerve
D) Glossopharyngeal nerve
3) The action of sternocleidomastoid includes:
A) Extension of neck
B) Lateral flexion to same side and rotation to opposite side
C) Lateral flexion to opposite side
D) Rotation to same side
4) Contraction of both SCM muscles together causes:
A) Flexion of neck
B) Extension of neck
C) Rotation of head
D) Lateral bending
5) Paralysis of the sternocleidomastoid is due to lesion of:
A) Trigeminal nerve
B) Facial nerve
C) Accessory nerve
D) Vagus nerve
6) The mastoid process gives insertion to:
A) Trapezius
B) Sternocleidomastoid
C) Splenius capitis
D) Longus colli
7) Sternocleidomastoid arises from:
A) Manubrium and medial clavicle
B) Xiphoid process and clavicle
C) Sternum and scapula
D) Clavicle and occipital bone
8) The action of SCM on unilateral contraction is:
A) Rotation to same side
B) Rotation to opposite side
C) Extension of head
D) Elevation of shoulder
9) The nerve tested during head rotation against resistance is:
A) Hypoglossal nerve
B) Accessory nerve
C) Facial nerve
D) Vagus nerve
10) Injury to spinal accessory nerve causes:
A) Inability to flex neck
B) Inability to turn head to opposite side
C) Inability to close eyelid
D) Inability to chew
11) Both sternocleidomastoid and trapezius are derived from:
A) 1st branchial arch
B) 2nd branchial arch
C) 3rd branchial arch
D) Occipital myotomes