Topic: Large Intestine
Subtopic: Peritoneal Relations of Colon
Keyword Definitions:
• Colon: The longest part of the large intestine, responsible for water absorption and feces formation.
• Mesentery: A double layer of peritoneum that attaches intestines to the posterior abdominal wall.
• Retroperitoneal: Organs located behind the peritoneum and not completely covered by it.
• Peritoneum: Serous membrane lining the abdominal cavity and covering abdominal organs.
Lead Question - 2014
Part of colon with no mesentery?
a) Transverse colon
b) Sigmoid colon
c) Ascending colon
d) Rectum
Explanation: The ascending and descending colon are retroperitoneal parts of the colon and do not have a mesentery. They are fixed to the posterior abdominal wall, unlike the transverse and sigmoid colon which are intraperitoneal. Answer: c) Ascending colon.
1) Which part of the colon is intraperitoneal?
a) Ascending colon
b) Transverse colon
c) Descending colon
d) Cecum
Explanation: The transverse colon is an intraperitoneal structure having its own mesentery (transverse mesocolon). It is highly mobile due to this attachment, unlike the ascending and descending colon which are retroperitoneal. Answer: b) Transverse colon.
2) Which peritoneal fold attaches the transverse colon to the posterior abdominal wall?
a) Mesoappendix
b) Transverse mesocolon
c) Sigmoid mesocolon
d) Greater omentum
Explanation: The transverse mesocolon is the double layer of peritoneum attaching the transverse colon to the posterior abdominal wall. It provides pathways for blood vessels and lymphatics to the colon. Answer: b) Transverse mesocolon.
3) The sigmoid colon derives its name because:
a) It has no mesentery
b) It forms an S-shaped loop
c) It is retroperitoneal
d) It connects directly to the ileum
Explanation: The sigmoid colon forms an S-shaped loop in the lower abdomen and is attached to the posterior wall by the sigmoid mesocolon. It is intraperitoneal and highly mobile. Answer: b) It forms an S-shaped loop.
4) Which portion of the colon is secondarily retroperitoneal?
a) Ascending colon
b) Cecum
c) Transverse colon
d) Sigmoid colon
Explanation: The ascending colon is a secondarily retroperitoneal organ, meaning it initially develops intraperitoneally but later fuses with the posterior abdominal wall during development. Answer: a) Ascending colon.
5) In a patient undergoing surgery for colon cancer, which segment is fixed and difficult to mobilize?
a) Ascending colon
b) Transverse colon
c) Sigmoid colon
d) Cecum
Explanation: The ascending colon is fixed because it is retroperitoneal, making surgical mobilization more challenging than intraperitoneal parts like the transverse colon. Answer: a) Ascending colon.
6) A tumor in which colon segment is most likely to invade the posterior abdominal wall directly?
a) Sigmoid colon
b) Ascending colon
c) Transverse colon
d) Cecum
Explanation: The ascending colon lies retroperitoneally, allowing a tumor to extend posteriorly into adjacent retroperitoneal structures, unlike intraperitoneal parts. Answer: b) Ascending colon.
7) During colonoscopy, the scope passes from rectum to which part next?
a) Sigmoid colon
b) Cecum
c) Ascending colon
d) Ileum
Explanation: The colonoscope enters the sigmoid colon immediately after the rectum. It is intraperitoneal and curved, requiring careful navigation during the procedure. Answer: a) Sigmoid colon.
8) In a CT scan, gas collection behind the peritoneum near the right flank suggests perforation of?
a) Sigmoid colon
b) Ascending colon
c) Transverse colon
d) Cecum
Explanation: Gas behind the peritoneum in the right flank indicates retroperitoneal perforation, most likely from the ascending colon, which lies in that region. Answer: b) Ascending colon.
9) Which artery supplies the ascending colon?
a) Left colic artery
b) Right colic artery
c) Middle colic artery
d) Inferior mesenteric artery
Explanation: The right colic artery, a branch of the superior mesenteric artery, supplies the ascending colon. It provides vital blood supply along with the ileocolic branch. Answer: b) Right colic artery.
10) Which part of the large intestine has teniae coli, haustra, and appendices epiploicae?
a) Rectum
b) Ascending colon
c) Anal canal
d) Cecum
Explanation: The ascending colon shows the three features characteristic of the large intestine: teniae coli, haustra, and appendices epiploicae. These features are absent in the rectum and anal canal. Answer: b) Ascending colon.
11) During abdominal surgery, which peritoneal reflection indicates the start of the retroperitoneal part of colon?
a) Line of Toldt
b) Linea alba
c) White line of Hilton
d) Arcuate line
Explanation: The line of Toldt marks the lateral peritoneal reflection where the colon becomes retroperitoneal. It’s important in mobilization during colon surgeries. Answer: a) Line of Toldt.
Topic: Urinary Bladder
Subtopic: Trigone of Bladder
Keyword Definitions:
• Trigone of bladder: A smooth triangular area on the internal surface of the bladder base bounded by two ureteric orifices and the internal urethral orifice.
• Transitional epithelium: Specialized epithelium that lines most of the urinary tract and allows stretching.
• Mesonephric duct: Embryonic duct giving rise to male genital structures and part of the bladder trigone.
• Internal urethral orifice: Opening at the lower end of trigone leading into urethra.
Lead Question - 2014
False regarding trigone of bladder?
a) Lined by transitional epithelium
b) Mucosa smooth and firmly adherent
c) Internal urethral orifice lies at lateral angle of base
d) Developed from mesonephric duct
Explanation: The trigone of the bladder is a smooth triangular area between the ureteric and internal urethral orifices. It is lined by transitional epithelium, its mucosa is firmly adherent to the muscular layer, and it develops from the mesonephric ducts. The internal urethral orifice lies at the inferior angle, not lateral. Answer: c) Internal urethral orifice lies at lateral angle of base.
1) The apex of the urinary bladder is connected to the umbilicus by?
a) Median umbilical ligament
b) Medial umbilical ligament
c) Urachus
d) Both a and c
Explanation: The apex of the bladder is connected to the umbilicus by the median umbilical ligament, a fibrous remnant of the urachus. This structure represents the obliterated allantoic duct from fetal development and extends from the bladder’s apex to the umbilicus. Answer: a) Median umbilical ligament.
2) Which part of the urinary bladder is least distensible?
a) Apex
b) Trigone
c) Body
d) Fundus
Explanation: The trigone is the least distensible part of the bladder due to its mucosa being tightly adherent to the underlying muscle. Unlike other regions, it remains smooth even when the bladder is empty, facilitating consistent function of the ureteric and urethral openings. Answer: b) Trigone.
3) During catheterization, urine first enters which part of the bladder?
a) Apex
b) Fundus
c) Trigone
d) Neck
Explanation: During catheterization, urine enters through the neck of the bladder, which continues into the internal urethral orifice. This area corresponds to the inferior angle of the trigone and is the most dependent part of the bladder when in the upright position. Answer: d) Neck.
4) Which muscle forms the internal urethral sphincter?
a) Pubococcygeus
b) Detrusor muscle (circular fibers)
c) External sphincter muscle
d) Compressor urethrae
Explanation: The internal urethral sphincter is formed by the circular fibers of the detrusor muscle near the neck of the bladder. It plays a key role in preventing retrograde ejaculation in males by closing during ejaculation. Answer: b) Detrusor muscle (circular fibers).
5) In males, the trigone of the bladder is related posteriorly to which structure?
a) Seminal vesicles
b) Rectum
c) Prostate gland
d) Vas deferens
Explanation: The posterior surface of the male bladder, including the region near the trigone, is related to the seminal vesicles and vas deferens. These structures form the ejaculatory ducts which open into the prostatic urethra below the bladder. Answer: a) Seminal vesicles.
6) A patient presents with backflow of urine from the bladder into ureters. Which structure is defective?
a) Trigone muscle
b) Ureteric orifices
c) Vesicoureteral junction
d) Internal sphincter
Explanation: Vesicoureteral reflux occurs when the oblique intramural passage of ureters through the bladder wall is defective. Normally, contraction of the bladder compresses these tunnels to prevent reflux. A defect in this junction leads to recurrent infection. Answer: c) Vesicoureteral junction.
7) Which part of the bladder is derived from the endoderm of the urogenital sinus?
a) Trigone
b) Body of bladder
c) Ureteric orifices
d) Both a and b
Explanation: The body of the bladder develops from the endoderm of the urogenital sinus, while the trigone develops from the mesonephric ducts (mesodermal origin). This dual embryological origin explains the distinct developmental patterns of the bladder regions. Answer: b) Body of bladder.
8) In cystoscopy, the trigone appears smooth and triangular because?
a) It has thick muscle layer
b) Mucosa firmly adherent
c) Covered by non-keratinized epithelium
d) It lacks blood vessels
Explanation: The smooth appearance of the trigone in cystoscopy is due to its firmly adherent mucosa, which does not form folds like other bladder regions. This helps maintain the orientation of ureteric orifices for proper urine flow. Answer: b) Mucosa firmly adherent.
9) In a newborn male, the internal urethral sphincter fails to close during voiding. This may cause?
a) Urinary retention
b) Retrograde ejaculation
c) Bladder prolapse
d) Hydronephrosis
Explanation: Failure of closure of the internal urethral sphincter can cause retrograde ejaculation in males, where semen enters the bladder during ejaculation instead of exiting through the urethra. This occurs due to weakness of circular detrusor fibers. Answer: b) Retrograde ejaculation.
10) A patient with recurrent cystitis shows mucosal inflammation limited to the trigone. This is termed?
a) Interstitial cystitis
b) Trigonitis
c) Vesiculitis
d) Pyelonephritis
Explanation: Trigonitis is localized inflammation of the bladder trigone, commonly seen in women due to recurrent urinary tract infections. The mucosa becomes edematous and hyperemic but the rest of the bladder remains unaffected. Answer: b) Trigonitis.
11) During bladder filling, stretch receptors are most concentrated in?
a) Dome
b) Trigone
c) Apex
d) Neck
Explanation: Stretch receptors in the trigone and neck of the bladder detect bladder distension and send signals via the pelvic splanchnic nerves to initiate micturition reflex. Their high concentration helps regulate controlled urination. Answer: b) Trigone.
Topic: Urinary Bladder
Subtopic: Development of Trigone of Bladder
Keyword Definitions:
• Trigone of bladder: Smooth triangular area on the bladder’s posterior wall, bounded by ureteric orifices and the internal urethral orifice.
• Mesoderm: The middle embryonic germ layer forming muscles, bones, and urogenital structures.
• Endoderm: The innermost germ layer giving rise to the epithelial lining of the urinary bladder except trigone.
• Mesonephric duct: Embryonic duct that contributes to formation of trigone and male genital organs.
Lead Question - 2014
Trigone of urinary bladder develops from:
a) Mesoderm
b) Ectoderm
c) Endoderm of urachus
d) None of the above
Explanation: The trigone of the urinary bladder develops from the mesonephric ducts (mesodermal origin). As the ducts are absorbed into the posterior wall of the bladder, their tissue forms the trigone region. The remaining bladder, including the dome and body, arises from the endoderm of the urogenital sinus. Answer: a) Mesoderm.
1) Which part of the urinary bladder develops from endoderm?
a) Trigone
b) Body of bladder
c) Neck of bladder
d) Apex of bladder
Explanation: Except for the trigone, all other parts of the urinary bladder — the body, neck, and apex — develop from the endoderm of the urogenital sinus. This distinction explains the different epithelial origins of the trigone and rest of the bladder wall. Answer: b) Body of bladder.
2) In males, the mesonephric duct contributes to the development of?
a) Ureter
b) Seminal vesicles
c) Trigone of bladder
d) Both b and c
Explanation: The mesonephric ducts play a dual role — forming the trigone of the bladder and also giving rise to the seminal vesicles and ejaculatory ducts in males. This shared embryologic origin explains their close anatomical relationship near the bladder base. Answer: d) Both b and c.
3) A defect in mesonephric duct absorption can result in which anomaly?
a) Double ureter
b) Urachal fistula
c) Exstrophy of bladder
d) Vesicoureteral reflux
Explanation: Improper absorption of the mesonephric ducts into the posterior bladder wall can lead to vesicoureteral reflux (VUR). In this condition, urine flows back from the bladder to the ureters and kidneys, predisposing the patient to recurrent infections. Answer: d) Vesicoureteral reflux.
4) Which germ layer forms the muscular wall of the urinary bladder?
a) Mesoderm
b) Ectoderm
c) Endoderm
d) Neuroectoderm
Explanation: The muscular wall of the urinary bladder, including the detrusor muscle, originates from the mesoderm. The endoderm forms only the epithelial lining, while mesoderm contributes to the connective tissue and smooth muscle. Answer: a) Mesoderm.
5) In a newborn, an anomaly involving incomplete closure of the urachus may result in?
a) Patent urachus
b) Ureteric stenosis
c) Trigonitis
d) Hydronephrosis
Explanation: If the urachus (a fetal connection between bladder and umbilicus) fails to close, it results in a patent urachus. This causes urine leakage through the umbilicus. The urachus normally becomes the median umbilical ligament after birth. Answer: a) Patent urachus.
6) A 35-year-old male presents with reflux nephropathy. The defect likely involves?
a) Endodermal bladder lining
b) Mesonephric duct remnant
c) Trigone development
d) Urachal cyst
Explanation: Reflux nephropathy is caused by a developmental defect in the trigone and the oblique entry of the ureters into the bladder. Faulty mesonephric duct incorporation leads to poor valvular closure, allowing urine reflux. Answer: c) Trigone development.
7) Which of the following statements about bladder trigone is true?
a) Derived from urogenital sinus endoderm
b) Smooth mucosa and immovable
c) Highly distensible
d) Lies on bladder dome
Explanation: The trigone has smooth, firmly adherent mucosa that does not form folds, unlike other parts of the bladder. It is mesodermal in origin and located at the base of the bladder, forming a functional unit with the ureteric and urethral openings. Answer: b) Smooth mucosa and immovable.
8) During cystoscopy, the trigone is identified by?
a) Rough mucosa
b) Folded appearance
c) Smooth triangular area
d) Raised ridges
Explanation: On cystoscopy, the trigone appears as a smooth triangular area between the ureteric orifices and the internal urethral orifice. Its mucosa is tightly adherent to the muscle beneath, distinguishing it from the folded dome mucosa. Answer: c) Smooth triangular area.
9) A defect in which embryologic process causes duplicated ureteric orifices within the trigone?
a) Double budding of ureteric bud
b) Failure of mesonephric fusion
c) Abnormal urachus closure
d) Cloacal septation defect
Explanation: Double ureteric buds from the mesonephric duct during early development may lead to two ureters draining separately into the bladder trigone. This duplication is a congenital anomaly often seen on imaging studies. Answer: a) Double budding of ureteric bud.
10) The nerve supply to the trigone of bladder is primarily from?
a) Hypogastric plexus
b) Pelvic splanchnic nerves
c) Pudendal nerve
d) Genitofemoral nerve
Explanation: The trigone and neck of the bladder receive sympathetic innervation from the hypogastric plexus (T11–L2), which maintains sphincter control. Parasympathetic supply from pelvic splanchnic nerves mediates detrusor contraction during micturition. Answer: a) Hypogastric plexus.
11) In males, the trigone lies superior to which structure?
a) Seminal vesicles
b) Prostate gland
c) Rectum
d) Vas deferens
Explanation: The trigone forms the base of the bladder and lies directly above the prostate gland in males. This anatomical relationship explains how prostatic enlargement can cause urinary symptoms due to pressure on the bladder neck. Answer: b) Prostate gland.
Topic: Large Intestine Blood Supply
Subtopic: Watershed Areas and Ischemic Zones
Keyword Definitions:
• Watershed zone: Region of intestine between two arterial supplies prone to ischemia.
• Rectosigmoid junction: Area between inferior mesenteric and internal iliac artery supplies.
• Marginal artery of Drummond: Continuous arterial circle along colon’s inner border.
• Ischemic colitis: Inflammation caused by reduced blood flow in watershed areas.
Lead Question - 2014
Watershed zone of large intestine?
a) Cecum
b) Ascending colon
c) Rectosigmoid
d) Transverse colon
Explanation:
The correct answer is c) Rectosigmoid. The rectosigmoid junction represents a classic watershed area between the territories of the inferior mesenteric and internal iliac arteries. Due to dual supply borders, it is highly susceptible to ischemic colitis during low perfusion states, hypotension, or shock conditions, making it clinically significant.
1. The artery forming marginal artery of the colon is:
a) Superior mesenteric artery
b) Inferior mesenteric artery
c) Both a and b
d) Internal iliac artery
Explanation:
The correct answer is c) Both a and b. The marginal artery of Drummond is formed by anastomosis between branches of the superior and inferior mesenteric arteries. This continuous arterial arcade supplies the colon and provides collateral circulation, reducing the risk of ischemia except at the watershed areas like splenic flexure.
2. The splenic flexure is supplied by:
a) Superior mesenteric artery only
b) Inferior mesenteric artery only
c) Both SMA and IMA
d) Celiac artery
Explanation:
The correct answer is c) Both SMA and IMA. The splenic flexure represents another watershed zone, located between the terminal branches of the superior and inferior mesenteric arteries. Because of this dual supply, it becomes vulnerable during systemic hypotension and is a common site for ischemic colitis or mucosal necrosis.
3. The blood supply to the rectum is mainly from:
a) Superior rectal artery
b) Middle rectal artery
c) Inferior rectal artery
d) All of the above
Explanation:
The correct answer is d) All of the above. The rectum has a rich blood supply from three sources: the superior rectal artery (from IMA), middle rectal artery (from internal iliac), and inferior rectal artery (from internal pudendal). This overlapping supply helps maintain perfusion except in rectosigmoid ischemia zones.
4. Clinical case: A 65-year-old with hypotension develops abdominal pain and bloody stool. The most likely site of ischemia is:
a) Sigmoid colon
b) Rectosigmoid junction
c) Cecum
d) Descending colon
Explanation:
The correct answer is b) Rectosigmoid junction. In elderly or hypotensive patients, ischemia often occurs at watershed regions where dual arterial supplies meet, such as the rectosigmoid junction. The lack of sufficient collateral flow during low perfusion states leads to mucosal necrosis and abdominal pain with bloody diarrhea.
5. Which of the following arteries is a branch of the inferior mesenteric artery?
a) Ileocolic artery
b) Right colic artery
c) Left colic artery
d) Middle colic artery
Explanation:
The correct answer is c) Left colic artery. The inferior mesenteric artery gives off three main branches: left colic, sigmoid, and superior rectal arteries. The left colic artery supplies the descending colon and forms an anastomosis with the middle colic artery, contributing to the marginal artery of Drummond’s loop.
6. Clinical case: A patient post-surgery develops ischemia at the splenic flexure. Which vessel is involved?
a) Left colic artery
b) Middle colic artery
c) Both a and b
d) Right colic artery
Explanation:
The correct answer is c) Both a and b. The splenic flexure is supplied by terminal branches of the middle colic (SMA) and left colic (IMA) arteries. Any compromise in either vessel or systemic hypoperfusion can lead to ischemia, making this flexure another classical watershed region of the colon.
7. Which vessel directly continues as the superior rectal artery?
a) Internal iliac artery
b) Inferior mesenteric artery
c) External iliac artery
d) Common iliac artery
Explanation:
The correct answer is b) Inferior mesenteric artery. The superior rectal artery is the terminal continuation of the inferior mesenteric artery. It descends into the pelvis to supply the upper rectum. Its anastomoses with the middle and inferior rectal arteries maintain blood flow to the rectal region during reduced perfusion.
8. Clinical case: A patient presents with segmental ischemic colitis after shock. Which part of colon is most affected?
a) Transverse colon
b) Sigmoid colon
c) Splenic flexure
d) Ascending colon
Explanation:
The correct answer is c) Splenic flexure. The splenic flexure is a typical site for ischemic colitis because it lies between the blood supplies of SMA and IMA. Reduced perfusion during shock or atherosclerosis leads to necrosis in this zone, presenting clinically with abdominal pain and bloody stool.
9. The inferior mesenteric artery arises from:
a) Abdominal aorta at L1
b) Abdominal aorta at L3
c) Common iliac artery
d) Internal iliac artery
Explanation:
The correct answer is b) Abdominal aorta at L3. The inferior mesenteric artery originates from the anterior surface of the abdominal aorta at the level of L3 vertebra. It supplies the hindgut structures including the descending colon, sigmoid colon, and upper rectum through its terminal branches.
10. Clinical case: In a CT angiogram showing reduced flow through the inferior mesenteric artery, which area is least affected due to collaterals?
a) Splenic flexure
b) Rectosigmoid junction
c) Ascending colon
d) Descending colon
Explanation:
The correct answer is d) Descending colon. The descending colon receives rich collateral blood flow from both the left colic and middle colic arteries through the marginal artery of Drummond. Hence, it is relatively protected from ischemia compared to the splenic flexure and rectosigmoid regions in arterial compromise.
Topic: Uterine Supports
Subtopic: Ligaments of the Uterus
Keyword Definitions:
• Uterine ligaments: Fibromuscular structures supporting uterus in pelvic cavity.
• Transverse cervical ligament (Cardinal ligament): Extends from cervix and lateral vagina to lateral pelvic wall.
• Pubocervical ligament: Connects cervix to pubic bone anteriorly.
• Round ligament: Maintains anteversion of uterus, runs from uterus to labia majora.
Lead Question - 2014
Ligament extending from cervix and vagina to lateral pelvic wall?
a) Broad ligament
b) Pubocervical ligament
c) Round ligament
d) Transverse cervical ligament
Explanation:
The correct answer is d) Transverse cervical ligament. Also known as the cardinal ligament, it provides major support to the uterus and cervix, extending laterally from the cervix and vagina to the pelvic wall. It carries uterine vessels and resists uterine descent. Weakening causes uterine prolapse or cervical descent clinically.
1. Which ligament maintains the anteverted position of the uterus?
a) Broad ligament
b) Round ligament
c) Uterosacral ligament
d) Pubocervical ligament
Explanation:
The correct answer is b) Round ligament. The round ligament extends from the uterine fundus to the labia majora through the inguinal canal. It maintains the anteverted and anteflexed position of the uterus, preventing its backward tilt. During pregnancy, it stretches considerably and may cause “round ligament pain.”
2. The broad ligament of the uterus is a fold of:
a) Peritoneum
b) Endopelvic fascia
c) Connective tissue
d) Muscular tissue
Explanation:
The correct answer is a) Peritoneum. The broad ligament is a double layer of peritoneum extending from the sides of the uterus to the lateral pelvic walls. It acts as a mesentery for the uterus and contains the uterine tube, round ligament, ovarian ligament, and uterine vessels within its layers.
3. Clinical case: A 45-year-old woman with uterine prolapse likely has weakening of which ligament?
a) Broad ligament
b) Cardinal ligament
c) Round ligament
d) Pubococcygeus muscle
Explanation:
The correct answer is b) Cardinal ligament. The cardinal or transverse cervical ligament provides strong lateral support to the cervix and uterus. Its weakening leads to descent of the cervix and uterus through the vaginal canal, resulting in uterine prolapse. Pelvic floor muscle laxity may worsen this condition.
4. Uterosacral ligament connects:
a) Cervix to sacrum
b) Fundus to sacrum
c) Cervix to pubic bone
d) Vagina to ischial spine
Explanation:
The correct answer is a) Cervix to sacrum. The uterosacral ligaments are paired fibromuscular structures extending from the posterior cervix to the sacrum. They maintain the uterus in an anteverted position and prevent its posterior displacement. They are palpable during pelvic examination and important in surgical repairs of prolapse.
5. Clinical case: During a hysterectomy, which ligament must be carefully ligated to avoid ureteric injury?
a) Round ligament
b) Cardinal ligament
c) Uterosacral ligament
d) Broad ligament
Explanation:
The correct answer is b) Cardinal ligament. The uterine artery runs through the cardinal ligament, crossing the ureter about 2 cm lateral to the cervix. During ligation of the uterine artery in hysterectomy, surgeons must carefully identify and preserve the ureter to prevent accidental injury or ureteric obstruction.
6. Pubocervical ligaments extend between:
a) Cervix and pubic bone
b) Cervix and sacrum
c) Cervix and lateral pelvic wall
d) Cervix and ischial spine
Explanation:
The correct answer is a) Cervix and pubic bone. The pubocervical ligaments support the bladder neck and anterior vaginal wall by connecting the cervix and upper vagina to the posterior surface of the pubic bone. Their weakening leads to anterior vaginal wall prolapse (cystocele) and urinary incontinence in women.
7. Clinical case: A woman with pelvic pain and uterine retroversion likely has laxity of which structure?
a) Round ligament
b) Broad ligament
c) Uterosacral ligament
d) Pubocervical ligament
Explanation:
The correct answer is c) Uterosacral ligament. The uterosacral ligament maintains the anteverted position of the uterus. Its laxity allows the uterus to tilt posteriorly (retroversion), resulting in pelvic discomfort, backache, and dyspareunia. Strengthening these ligaments surgically may restore the normal position of the uterus.
8. The ligament containing the uterine artery is:
a) Round ligament
b) Broad ligament
c) Cardinal ligament
d) Uterosacral ligament
Explanation:
The correct answer is c) Cardinal ligament. The uterine artery runs within the cardinal ligament, supplying blood to the uterus. This ligament extends from the cervix and upper vagina to the lateral pelvic wall. It provides major support and stability to the uterus in the pelvic cavity.
9. Clinical case: Following childbirth, a patient develops cystocele. Which ligament is likely damaged?
a) Pubocervical ligament
b) Uterosacral ligament
c) Round ligament
d) Cardinal ligament
Explanation:
The correct answer is a) Pubocervical ligament. The pubocervical ligament supports the bladder neck and anterior vaginal wall. During childbirth, excessive stretching or tearing weakens this ligament, leading to herniation of the bladder into the vagina (cystocele). Surgical repair aims to restore pelvic support and bladder function.
10. Which structure forms the main mechanical support for the uterus?
a) Broad ligament
b) Pelvic diaphragm
c) Uterosacral and cardinal ligaments
d) Round ligament
Explanation:
The correct answer is c) Uterosacral and cardinal ligaments. Together, these ligaments form the main mechanical support for the uterus, maintaining its central position and preventing descent. They attach the cervix to the sacrum and pelvic walls, respectively, forming a supportive sling around the cervix and upper vagina.
Topic: Anterior Abdominal Wall
Subtopic: Superficial Fascia and Its Extensions
Keyword Definitions:
• Scarpa’s fascia: Deep membranous layer of superficial fascia in the lower anterior abdominal wall.
• Camper’s fascia: Fatty layer superficial to Scarpa’s fascia.
• Buck’s fascia: Deep fascia of penis continuous with Scarpa’s fascia.
• Suspensory ligament of penis: Fibrous structure supporting penis, formed partly by Scarpa’s fascia.
Lead Question - 2014
True about Scarpa’s fascia?
a) Deep fascia of anterior abdominal wall
b) Also called Buck’s fascia
c) Attached to Iliotibial tract
d) Forms suspensory ligament of penis
Explanation:
The correct answer is d) Forms suspensory ligament of penis. Scarpa’s fascia is the deep membranous layer of superficial fascia in the lower anterior abdominal wall. It continues into the perineum as Colles’ fascia and contributes to the formation of the suspensory ligament of penis or clitoris. It limits fluid extravasation below the inguinal ligament.
1. The membranous layer of the superficial fascia of the anterior abdominal wall is known as:
a) Camper’s fascia
b) Scarpa’s fascia
c) Colles’ fascia
d) Dartos fascia
Explanation:
The correct answer is b) Scarpa’s fascia. It lies deep to Camper’s fascia and is most prominent below the umbilicus. It is a tough fibrous layer that is clinically important in preventing urine extravasation from penetrating into the thigh due to its attachment to the fascia lata just below the inguinal ligament.
2. Scarpa’s fascia is continuous with which fascia in the perineum?
a) Buck’s fascia
b) Colles’ fascia
c) Gallaudet’s fascia
d) Dartos fascia
Explanation:
The correct answer is b) Colles’ fascia. Scarpa’s fascia extends into the perineum and becomes continuous with Colles’ fascia (the superficial perineal fascia). This continuity allows fluid or urine from a ruptured urethra to track from the perineum to the anterior abdominal wall but not into the thigh due to fascial attachments.
3. Clinical case: A male patient with rupture of spongy urethra shows swelling over the lower abdomen and scrotum but not the thigh. This is due to attachment of which fascia?
a) Camper’s fascia
b) Dartos fascia
c) Scarpa’s fascia
d) Deep fascia of thigh
Explanation:
The correct answer is c) Scarpa’s fascia. It is attached to the fascia lata (deep fascia of thigh) just below the inguinal ligament, preventing urine from spreading into the thigh. Instead, urine collects in the scrotum, penis, and lower abdominal wall, forming a characteristic clinical pattern of extravasation.
4. Which structure lies deep to Scarpa’s fascia?
a) External oblique muscle
b) Deep fascia
c) Camper’s fascia
d) Skin
Explanation:
The correct answer is a) External oblique muscle. Scarpa’s fascia lies superficial to the external oblique aponeurosis in the lower abdominal wall. It serves as a plane separating the superficial fat (Camper’s fascia) from the muscular layer, important during surgical dissections and in the spread of fluid in trauma or infections.
5. Clinical case: A man sustains a pelvic fracture causing rupture of the membranous urethra. Urine is seen collecting deep to Colles’ fascia. Which layer of anterior abdominal wall fascia is continuous with this space?
a) Camper’s fascia
b) Scarpa’s fascia
c) Deep fascia
d) Dartos fascia
Explanation:
The correct answer is b) Scarpa’s fascia. This fascia forms a continuous plane with Colles’ fascia in the perineum. Urine from urethral injury may spread along this plane to involve the scrotum, penis, and lower anterior abdominal wall, highlighting its clinical importance in pelvic trauma.
6. Camper’s fascia is:
a) Fatty layer
b) Fibrous layer
c) Deep fascial layer
d) Muscular layer
Explanation:
The correct answer is a) Fatty layer. Camper’s fascia forms the superficial fatty layer of the anterior abdominal wall fascia. It is well developed in the lower abdomen and continues into the thigh and perineum. It acts as insulation and a site of fat storage, especially prominent in obese individuals.
7. Scarpa’s fascia is attached to:
a) Iliotibial tract
b) Fascia lata
c) Rectus sheath
d) Linea alba
Explanation:
The correct answer is b) Fascia lata. Scarpa’s fascia is attached to the fascia lata below the inguinal ligament, preventing downward spread of infections or fluid collections from the anterior abdominal wall to the thigh. This attachment has great clinical importance in localizing urinary extravasation in pelvic injuries.
8. Clinical case: Following catheterization injury, a patient develops swelling confined to the scrotum and lower abdomen. The urine is limited by which structure?
a) Deep perineal fascia
b) Camper’s fascia
c) Scarpa’s fascia
d) Dartos fascia
Explanation:
The correct answer is c) Scarpa’s fascia. It restricts the spread of urine beyond the lower abdominal wall due to its firm attachment to the fascia lata. Understanding this fascial continuity helps surgeons predict the spread of fluid collections in perineal and urethral injuries effectively.
9. The fascia forming the superficial perineal pouch roof is derived from:
a) Dartos fascia
b) Camper’s fascia
c) Scarpa’s fascia
d) Deep fascia
Explanation:
The correct answer is c) Scarpa’s fascia. The membranous layer of the superficial fascia continues as Colles’ fascia, which forms the roof of the superficial perineal pouch. This anatomical continuity allows infections or urine to spread along these fascial planes from the perineum to the lower abdomen.
10. Scarpa’s fascia contributes to the formation of:
a) Dartos muscle
b) Suspensory ligament of penis
c) Deep perineal fascia
d) Buck’s fascia
Explanation:
The correct answer is b) Suspensory ligament of penis. The membranous Scarpa’s fascia contributes to the formation of the suspensory ligament of penis or clitoris. This ligament helps anchor the root of the penis to the pubic symphysis, maintaining its position and stability during erection and movement.
Topic: Pelvic Spaces and Fascia
Subtopic: Cave of Retzius
Keyword Definitions:
Cave of Retzius: Also known as the retropubic space, it lies between the pubic symphysis and urinary bladder.
Pelvic Fascia: Connective tissue covering pelvic organs, providing support and passage for vessels.
Urinary Bladder: A hollow muscular organ for urine storage, located in the lesser pelvis.
Rectovesical Space: The peritoneal space between bladder and rectum in males.
Pubic Symphysis: Midline cartilaginous joint uniting the left and right pubic bones.
Lead Question – 2014
Where is the Cave of Retzius present?
a) Between urinary bladder and rectum
b) Between urinary bladder and cervix
c) In front of the bladder
d) Between the cervix and the rectum
Explanation: The Cave of Retzius, or retropubic space, is located anterior to the urinary bladder and posterior to the pubic symphysis, not in contact with the peritoneum. It contains loose connective tissue and the venous plexus, aiding in surgical access to the bladder. Hence, the correct answer is c) In front of the bladder.
1. The retropubic space of Retzius is bounded anteriorly by:
a) Rectum
b) Pubic symphysis
c) Urethra
d) Peritoneum
Explanation: The retropubic space (Cave of Retzius) lies between the pubic symphysis anteriorly and the urinary bladder posteriorly. This space is clinically important in bladder surgery and pelvic trauma. It contains the retropubic venous plexus. The correct answer is b) Pubic symphysis.
2. The space of Retzius is filled with:
a) Loose areolar tissue
b) Fat
c) Fibrous tissue
d) Muscular tissue
Explanation: The space of Retzius is a potential space filled with loose areolar connective tissue, allowing bladder distension and movement. It acts as a cushion and supports surrounding structures. Therefore, the correct answer is a) Loose areolar tissue.
3. The clinical importance of the space of Retzius is:
a) Site for hernia repair
b) Approach for retropubic prostatectomy
c) Passage of fallopian tubes
d) Site for peritoneal dialysis
Explanation: The space of Retzius provides a surgical approach to the prostate and bladder without breaching the peritoneum. Retropubic prostatectomy and bladder neck procedures utilize this route safely. Hence, the correct answer is b) Approach for retropubic prostatectomy.
4. Which structure is located posterior to the Cave of Retzius?
a) Pubic symphysis
b) Rectum
c) Urinary bladder
d) Peritoneum
Explanation: Posterior to the Cave of Retzius lies the urinary bladder, separated by fascia and connective tissue. The space serves as a buffer during bladder filling and emptying. Thus, the correct answer is c) Urinary bladder.
5. In females, the space of Retzius lies between:
a) Pubic symphysis and uterus
b) Pubic symphysis and urinary bladder
c) Urinary bladder and cervix
d) Rectum and vagina
Explanation: In females, the space of Retzius occupies the area between the pubic symphysis and the urinary bladder, similar to males. It helps in gynecological surgeries like Burch colposuspension. Therefore, the answer is b) Pubic symphysis and urinary bladder.
6. (Clinical) A 60-year-old male undergoing prostatectomy develops venous bleeding from the retropubic area. The source is likely from:
a) External iliac vein
b) Retropubic venous plexus
c) Superior vesical artery
d) Inferior epigastric vein
Explanation: During retropubic surgeries, injury to the retropubic venous plexus within the Cave of Retzius can cause severe bleeding. This plexus drains the prostate and bladder. Therefore, the correct answer is b) Retropubic venous plexus.
7. (Clinical) During bladder surgery, why is the retropubic space entered carefully?
a) It contains the ureters
b) It contains a venous plexus prone to bleeding
c) It contains peritoneum
d) It contains nerves to bladder wall
Explanation: The retropubic space holds a dense venous plexus (Santorini’s plexus), which, if injured, can lead to major bleeding. This makes careful dissection essential during urological procedures. Hence, the correct answer is b) It contains a venous plexus prone to bleeding.
8. (Clinical) A cystocele repair often involves dissection through which space?
a) Rectovaginal space
b) Space of Retzius
c) Ischiorectal fossa
d) Vesicouterine pouch
Explanation: During cystocele repair, the surgeon enters the space of Retzius to reposition the bladder and reinforce pelvic fascia. It provides access to the anterior vaginal wall without entering the peritoneal cavity. Hence, the answer is b) Space of Retzius.
9. (Clinical) A patient with pelvic trauma has urine extravasation in front of the bladder but not into the peritoneum. The space involved is:
a) Retropubic space (Cave of Retzius)
b) Rectovesical pouch
c) Ischiorectal fossa
d) Paravesical space
Explanation: Extraperitoneal urine extravasation occurs in the retropubic space (Cave of Retzius) after bladder rupture anteriorly. This distinguishes it from intraperitoneal rupture involving peritoneal spaces. Hence, the correct answer is a) Retropubic space (Cave of Retzius).
10. (Clinical) During laparoscopic surgery, which landmark helps identify the space of Retzius?
a) Cooper’s ligament
b) Ischial spine
c) Arcus tendineus fascia pelvis
d) Round ligament
Explanation: Cooper’s ligament (pectineal ligament) marks the lateral boundary of the space of Retzius during laparoscopic or open pelvic surgeries. It guides dissection in hernia repairs and bladder surgeries. Hence, the correct answer is a) Cooper’s ligament.
Topic: Inguinal Canal and Its Contents
Subtopic: Nerves Associated with the Inguinal Canal
Keyword Definitions:
Inguinal Canal: An oblique passage in the lower anterior abdominal wall transmitting the spermatic cord in males and round ligament in females.
Deep Inguinal Ring: The internal opening of the inguinal canal located above the midpoint of the inguinal ligament.
Genitofemoral Nerve: A branch of the lumbar plexus (L1-L2) dividing into genital and femoral branches.
Ilioinguinal Nerve: A branch of L1 nerve that traverses part of the canal but not through the deep ring.
Pudendal Nerve: Supplies perineum, not related to the inguinal canal.
Lead Question – 2014
Nerve entering the inguinal canal through deep inguinal ring?
a) Ilioinguinal nerve
b) Pudendal nerve
c) Genital branch of genitofemoral nerve
d) Superior rectal nerve
Explanation: The genital branch of the genitofemoral nerve enters the inguinal canal through the deep inguinal ring and runs within the spermatic cord in males, supplying the cremaster muscle and scrotal skin. In females, it travels with the round ligament. The ilioinguinal nerve, however, enters the canal through the superficial ring only. Hence, the correct answer is c) Genital branch of genitofemoral nerve.
1. The genital branch of the genitofemoral nerve arises from:
a) L1-L2
b) T12-L1
c) L2-L3
d) L3-L4
Explanation: The genitofemoral nerve originates from the lumbar plexus with roots L1-L2. It divides into the genital and femoral branches. The genital branch enters the inguinal canal, while the femoral branch supplies skin over the femoral triangle. Thus, the correct answer is a) L1-L2.
2. The ilioinguinal nerve enters the inguinal canal through:
a) Deep inguinal ring
b) Superficial inguinal ring
c) Posterior wall
d) Femoral ring
Explanation: The ilioinguinal nerve passes through part of the inguinal canal but enters it by piercing the internal oblique muscle, not through the deep inguinal ring. It exits via the superficial ring to supply skin of the upper medial thigh and external genitalia. Hence, the answer is b) Superficial inguinal ring.
3. The nerve responsible for the cremasteric reflex is:
a) Femoral branch of genitofemoral nerve
b) Genital branch of genitofemoral nerve
c) Iliohypogastric nerve
d) Pudendal nerve
Explanation: The cremasteric reflex involves contraction of the cremaster muscle when the inner thigh is stroked. The afferent limb is supplied by the femoral branch of genitofemoral and ilioinguinal nerves, and the efferent limb by the genital branch of the genitofemoral nerve. Therefore, the correct answer is b) Genital branch of genitofemoral nerve.
4. Which nerve does not pass through the inguinal canal?
a) Ilioinguinal nerve
b) Genital branch of genitofemoral nerve
c) Pudendal nerve
d) None
Explanation: The pudendal nerve does not traverse the inguinal canal; it passes through the greater sciatic foramen, Alcock’s canal, and supplies the perineum. The genital branch of genitofemoral and ilioinguinal nerves, however, are associated with the inguinal canal. Hence, the correct answer is c) Pudendal nerve.
5. The contents of the spermatic cord include all except:
a) Vas deferens
b) Pampiniform plexus
c) Genital branch of genitofemoral nerve
d) Iliohypogastric nerve
Explanation: The iliohypogastric nerve does not enter the inguinal canal or spermatic cord. The spermatic cord carries vas deferens, testicular vessels, cremasteric artery, pampiniform plexus, and genital branch of the genitofemoral nerve. Therefore, the correct answer is d) Iliohypogastric nerve.
6. (Clinical) Injury to the genital branch of the genitofemoral nerve during hernia repair may cause:
a) Loss of cremasteric reflex
b) Loss of sensation in the scrotum
c) Weakness of abdominal muscles
d) Urinary retention
Explanation: The genital branch supplies the cremaster muscle and scrotal skin. Injury during hernia repair may abolish the cremasteric reflex and cause localized numbness. Other functions remain intact. Thus, the correct answer is a) Loss of cremasteric reflex.
7. (Clinical) During laparoscopic hernia repair, identifying which nerve helps avoid postoperative neuralgia?
a) Genital branch of genitofemoral nerve
b) Pudendal nerve
c) Obturator nerve
d) Lateral cutaneous nerve of thigh
Explanation: The genital branch of the genitofemoral nerve runs close to the internal spermatic vessels. During laparoscopic hernia repair, avoiding its injury prevents chronic groin pain or sensory loss. Hence, the correct answer is a) Genital branch of genitofemoral nerve.
8. (Clinical) A 35-year-old male presents with pain and loss of sensation in the anterior scrotum after hernia surgery. The most likely injured nerve is:
a) Iliohypogastric
b) Ilioinguinal
c) Genital branch of genitofemoral
d) Pudendal
Explanation: The genital branch of the genitofemoral nerve supplies the cremaster and skin of the anterior scrotum. Its injury leads to scrotal numbness and absent cremasteric reflex. The ilioinguinal nerve supplies root of penis and upper medial thigh. Thus, the answer is c) Genital branch of genitofemoral.
9. (Clinical) In females, the genital branch of the genitofemoral nerve supplies:
a) Round ligament of uterus
b) Labia majora
c) Uterus
d) Perineum
Explanation: In females, the genital branch accompanies the round ligament within the inguinal canal to the labia majora, providing sensory innervation. It corresponds to the scrotal supply in males. Hence, the correct answer is b) Labia majora.
10. (Clinical) During varicocele surgery, which nerve is most at risk due to its proximity to spermatic vessels?
a) Femoral branch of genitofemoral nerve
b) Genital branch of genitofemoral nerve
c) Iliohypogastric nerve
d) Obturator nerve
Explanation: The genital branch of the genitofemoral nerve runs with the spermatic cord structures and is close to the testicular vessels. It can be damaged during varicocele or hernia surgeries, leading to scrotal anesthesia. Thus, the answer is b) Genital branch of genitofemoral nerve.
Topic: Development of Kidneys and Their Blood Supply
Subtopic: Embryological Origin of Renal Arteries
Keyword Definitions:
Renal Arteries: Paired arteries arising from the abdominal aorta to supply the kidneys.
Common Iliac Artery: One of the terminal branches of the abdominal aorta dividing into internal and external iliac arteries.
Mesonephros: The embryonic kidney that functions temporarily before the metanephros develops.
Metanephros: The definitive kidney, developing in the pelvis and ascending during fetal life.
Aorta: The main arterial trunk supplying oxygenated blood to the systemic circulation.
Lead Question – 2014
Initially, renal arteries are branches of?
a) Internal pudendal artery
b) External iliac artery
c) Common iliac artery
d) Aorta
Explanation: In early embryonic life, kidneys develop in the pelvic region and receive their blood supply from branches of the common iliac arteries. As kidneys ascend, their arterial supply shifts sequentially to higher levels, finally deriving from the abdominal aorta. The transient arteries regress as the kidney ascends. Hence, the correct answer is c) Common iliac artery.
1. During kidney ascent, which artery becomes the final source of its blood supply?
a) Common iliac artery
b) Abdominal aorta
c) Internal iliac artery
d) Median sacral artery
Explanation: Initially supplied by branches from the common iliac artery, the kidney ascends to the lumbar region where it ultimately receives blood from the abdominal aorta. Lower vessels regress, and the renal arteries from the aorta become the definitive arterial supply. Therefore, the correct answer is b) Abdominal aorta.
2. Accessory renal arteries arise due to:
a) Failure of regression of primitive renal arteries
b) Abnormal division of the aorta
c) Persistent mesonephric arteries
d) Recanalization defects
Explanation: Accessory renal arteries result from the persistence of embryonic renal arteries that normally regress as the kidney ascends. They may arise from the aorta or iliac arteries and are common anatomical variations. These vessels are functionally important and supply specific kidney segments. Thus, the correct answer is a) Failure of regression of primitive renal arteries.
3. The kidney ascends from the pelvis to the lumbar region during which week of development?
a) 3rd week
b) 4th–5th week
c) 6th–9th week
d) 10th–12th week
Explanation: The metanephric kidneys initially lie in the pelvic region and ascend to their lumbar position between the 6th and 9th weeks of gestation. The ascent is due to body growth and decreased curvature of the embryo. Hence, the correct answer is c) 6th–9th week.
4. A patient with a pelvic kidney has its arterial supply most likely from:
a) Abdominal aorta
b) Common iliac artery
c) Superior mesenteric artery
d) Inferior mesenteric artery
Explanation: A pelvic kidney results when the kidney fails to ascend during development. It retains its early blood supply from the common iliac artery. The renal vessels are shorter, and this anomaly is often incidental but may cause ureteral obstruction. The correct answer is b) Common iliac artery.
5. During embryonic development, which structure gives rise to the definitive kidney?
a) Pronephros
b) Mesonephros
c) Metanephros
d) Wolffian duct
Explanation: The metanephros forms the permanent kidney. It appears in the 5th week, derived from the ureteric bud (collecting system) and metanephric blastema (nephrons). The pronephros and mesonephros regress. Thus, the answer is c) Metanephros.
6. (Clinical) An aberrant renal artery crossing the ureter anteriorly may cause:
a) Hydronephrosis
b) Renal vein thrombosis
c) Pyelonephritis
d) Renal failure
Explanation: An aberrant renal artery may cross the ureter anteriorly, compressing it and obstructing urine flow, leading to hydronephrosis. This condition causes flank pain and renal pelvis dilation visible on imaging. Thus, the correct answer is a) Hydronephrosis.
7. (Clinical) A 30-year-old male with pelvic kidney presents with hematuria. Imaging shows accessory arteries from the common iliac. The cause is:
a) Ectopic kidney with persistent early blood supply
b) Renal artery stenosis
c) Inferior mesenteric artery aneurysm
d) Abnormal ureteral insertion
Explanation: A pelvic kidney receives its blood supply from the arteries at its developmental level, usually the common iliac. Persistence of embryonic vessels leads to multiple accessory arteries. Hence, the correct answer is a) Ectopic kidney with persistent early blood supply.
8. (Clinical) A patient undergoing renal transplantation has the donor renal artery anastomosed with:
a) Internal iliac artery
b) Common iliac artery
c) External iliac artery
d) Inferior epigastric artery
Explanation: In renal transplantation, the donor renal artery is usually anastomosed to the external iliac artery because of its accessibility and size match. The renal vein is connected to the external iliac vein. This provides optimal graft perfusion. Therefore, the correct answer is c) External iliac artery.
9. (Clinical) During aortic aneurysm repair, which artery must be preserved to maintain kidney perfusion?
a) Mesenteric artery
b) Renal artery
c) Lumbar artery
d) Celiac trunk
Explanation: The kidneys are supplied by the renal arteries directly from the abdominal aorta. During aneurysm repair near the renal hilum, preserving these arteries is crucial to prevent renal ischemia or infarction. Hence, the correct answer is b) Renal artery.
10. (Clinical) A 40-year-old patient with renovascular hypertension is found to have stenosis of the renal artery. The cause of hypertension is due to:
a) Increased renin release
b) Decreased angiotensin II
c) Low aldosterone
d) Increased GFR
Explanation: Renal artery stenosis reduces renal perfusion pressure, stimulating the juxtaglomerular cells to release renin. This activates the renin-angiotensin-aldosterone system, increasing blood pressure. Hence, renovascular hypertension develops. The correct answer is a) Increased renin release.
Topic: Renal Circulation
Subtopic: Blood Supply of Kidney in Fetal and Neonatal Life
Keyword Definitions:
• Renal Artery: Major artery supplying blood to the kidney, usually arising from the abdominal aorta.
• Common Iliac Artery: Terminal branch of the aorta that divides into internal and external iliac arteries.
• Fetal Circulation: The circulatory system in the fetus, which includes temporary vessels like the umbilical arteries.
• Neonate: A newborn child, especially within the first 28 days after birth.
Lead Question – 2014
In a neonate, kidney is supplied by?
a) Internal pudendal artery
b) External iliac artery
c) Common iliac artery
d) Aorta
Explanation:
In the neonate, the kidney receives its blood supply from the common iliac artery. During embryonic development, the kidneys ascend from the pelvic region to the lumbar region, and their arterial supply changes from the common iliac to the aorta. However, in neonates, remnants of this early pattern persist temporarily before stabilization occurs. Thus, the answer is common iliac artery.
1. During fetal development, the kidneys receive blood supply from which arteries initially?
a) Umbilical arteries
b) Common iliac arteries
c) Internal iliac arteries
d) Median sacral artery
2. Which of the following statements about the development of renal arteries is true?
a) They arise from the thoracic aorta initially
b) They remain constant in position during development
c) They change position as kidneys ascend
d) They arise from internal iliac arteries permanently
3. A 1-month-old infant presents with an accessory renal artery. This is due to:
a) Persistence of embryonic vessels
b) Renal agenesis
c) Congenital adrenal hyperplasia
d) Malrotation of kidney
4. The final arterial supply of adult kidneys originates from:
a) Common iliac artery
b) Abdominal aorta
c) External iliac artery
d) Median sacral artery
5. Which artery directly gives rise to segmental arteries in the kidney?
a) Interlobar artery
b) Renal artery
c) Afferent arteriole
d) Arcuate artery
6. In fetal life, the kidneys are located in which region?
a) Pelvic region
b) Lumbar region
c) Thoracic region
d) Sacral region
7. A neonate’s renal artery originates lower than normal. What does this indicate?
a) Incomplete renal ascent
b) Polycystic kidney disease
c) Nephroptosis
d) Ectopic kidney
8. Which of the following arteries supplies the suprarenal gland?
a) Renal artery
b) Superior mesenteric artery
c) Median sacral artery
d) Common iliac artery
9. A 3-day-old newborn is found to have reduced renal perfusion. Which vessel’s constriction could cause this?
a) Common iliac artery
b) Umbilical artery
c) Renal artery
d) Internal pudendal artery
10. Which of the following changes occur in renal blood supply after birth?
a) Blood supply shifts from common iliac to aortic origin
b) Blood supply remains same
c) Blood supply shifts to external iliac artery
d) Blood supply decreases due to closure of umbilical arteries
11. A clinical case of ectopic kidney shows its blood supply derived from which artery?
a) Common iliac artery
b) Abdominal aorta
c) Superior mesenteric artery
d) Renal artery
Explanation:
The common iliac artery supplies the kidney in early fetal life. As the kidney ascends during development, its arterial source changes sequentially—from common iliac to abdominal aorta. Clinical remnants may persist as accessory renal arteries. Understanding these variations is crucial for renal surgery, transplantation, and diagnosing congenital anomalies.