Chapter: Anatomy
Inferior vena cava (IVC): The large vein that carries deoxygenated blood from the lower body to the right atrium of the heart.
Collateral circulation: Alternate venous pathways that develop when the normal venous route is obstructed.
Paraumbilical veins: Veins connecting portal venous system to systemic veins around the umbilicus.
Thoracoepigastric veins: Superficial veins connecting axillary vein with femoral vein, serving as collaterals.
Esophageal varices: Dilated veins in the esophagus, usually due to portal hypertension.
Hemorrhoids: Dilated veins in the rectum or anus, linked with portal hypertension or increased abdominal pressure.
'Obstruction of Inferior vena cava' presents:
Paraumbilical dilatation
Thoraco-epigastric dilatation
Oesophagus varies
Haemorrhoides
Explanation: The correct answer is b) Thoraco-epigastric dilatation. Inferior vena cava obstruction leads to the development of collateral circulation through superficial abdominal veins, particularly thoraco-epigastric veins. These connect superficial epigastric veins with lateral thoracic veins, bypassing the obstruction. Paraumbilical veins, esophageal varices, and hemorrhoids are associated with portal hypertension, not IVC obstruction.
Which of the following is the most common cause of inferior vena cava obstruction?
Renal cell carcinoma
Portal hypertension
Cirrhosis of the liver
Esophageal carcinoma
Explanation: The answer is a) Renal cell carcinoma. Renal cell carcinoma often invades the renal vein and extends into the IVC. This intraluminal tumor thrombus obstructs venous return. Portal hypertension and cirrhosis are unrelated to IVC obstruction. Esophageal carcinoma leads to dysphagia but not IVC block. Thus, malignancy is a key cause clinically.
Which clinical sign is most characteristic of inferior vena cava obstruction?
Caput medusae
Scrotal varicocele
Ascites
Distended superficial abdominal veins
Explanation: The correct answer is d) Distended superficial abdominal veins. In IVC obstruction, collateral veins in the abdominal wall become prominent, particularly thoracoepigastric veins. Caput medusae occurs due to portal hypertension through the paraumbilical veins. Ascites is also more linked with portal disease. Scrotal varicocele is a localized venous dilation.
Direction of blood flow in superficial abdominal veins in IVC obstruction is:
Upward toward thorax
Downward toward legs
Both upward and downward
Unchanged
Explanation: The correct answer is a) Upward toward thorax. When the IVC is obstructed, blood from lower limbs is redirected via thoracoepigastric veins toward the axillary vein in the thorax. This reversal provides collateral drainage. Downward or unchanged flow would not bypass the block. Both directions are not characteristic.
A patient with IVC obstruction presents with bilateral lower limb edema. What is the underlying mechanism?
Increased lymphatic drainage
Venous stasis due to blocked return
Portal hypertension
Cardiac failure
Explanation: The answer is b) Venous stasis due to blocked return. Obstruction of IVC prevents venous blood from lower limbs returning to the heart, causing venous congestion, edema, and dilated collaterals. Lymphatic changes are secondary. Portal hypertension affects splanchnic circulation, not primarily lower limbs. Cardiac failure causes systemic edema, not isolated leg swelling.
Which investigation best demonstrates IVC obstruction?
Ultrasound with Doppler
X-ray abdomen
Barium swallow
Electrocardiogram
Explanation: The correct answer is a) Ultrasound with Doppler. Doppler ultrasound is the first-line, non-invasive imaging to detect IVC thrombus or obstruction by showing blood flow changes. CT and MRI can also help, but plain X-ray and barium swallow are irrelevant. ECG is for heart rhythm, not IVC pathology.
Collateral pathway in IVC obstruction involves:
Superior mesenteric vein
Thoracoepigastric vein
Paraumbilical vein
Splenic vein
Explanation: The answer is b) Thoracoepigastric vein. This vein connects superficial epigastric veins (femoral territory) to lateral thoracic veins (axillary territory). It becomes a major collateral in IVC obstruction. Paraumbilical and mesenteric veins are linked with portal system. Splenic vein also belongs to portal venous circulation.
In chronic IVC obstruction, which symptom is least likely?
Leg swelling
Abdominal wall venous distension
Hematemesis
Liver enlargement
Explanation: The correct answer is c) Hematemesis. Hematemesis occurs in portal hypertension due to esophageal varices. In IVC obstruction, main symptoms are leg edema, superficial abdominal venous prominence, and sometimes hepatomegaly due to hepatic venous congestion. Bleeding from upper GI tract is not a direct feature of IVC block.
Which clinical maneuver helps differentiate IVC obstruction from portal hypertension?
Direction of flow in superficial veins
Liver palpation
Rectal examination
Spleen percussion
Explanation: The correct answer is a) Direction of flow in superficial veins. In IVC obstruction, superficial abdominal veins show upward flow to thorax, while in portal hypertension, paraumbilical veins flow radially outward. This clinical test differentiates both entities effectively. Liver palpation, rectal exam, and spleen percussion are less specific.
Which surgical approach is preferred for removal of IVC thrombus extending from renal vein?
Midline laparotomy
Posterior approach
Thoracoabdominal approach
Inguinal incision
Explanation: The answer is a) Midline laparotomy. This provides excellent exposure to renal veins, IVC, and surrounding structures. In cases of renal cell carcinoma with thrombus, vascular control is essential. Posterior and inguinal approaches do not provide adequate access. Thoracoabdominal is reserved for extensive suprahepatic extension.
In IVC obstruction below renal veins, which collateral venous pathway is most significant?
Azygos-hemiazygos system
Thoracoepigastric vein
Ovarian/testicular veins
Inferior phrenic veins
Explanation: The correct answer is b) Thoracoepigastric vein. When obstruction is infra-renal, thoracoepigastric veins form the most important superficial collateral pathway, draining into axillary vein. Azygos sys
Ovarian artery: A paired branch of the abdominal aorta that supplies the ovary, uterine tube, and part of the uterus.
Abdominal aorta: The largest artery in the abdomen, giving rise to visceral and parietal branches.
Internal iliac artery: Supplies pelvic organs, gluteal region, and perineum.
Common iliac artery: Terminal branch of abdominal aorta dividing into external and internal iliac arteries.
External iliac artery: Continues as femoral artery supplying lower limb.
Gonadal arteries: Paired arteries (ovarian in females, testicular in males) from abdominal aorta below renal arteries.
Right ovarian artery is a branch of ?
Abdominal aorta
Right internal iliac
Common iliac
External iliac
Explanation: The correct answer is a) Abdominal aorta. The ovarian arteries arise directly from the abdominal aorta just below the renal arteries. They descend into the pelvis through the suspensory ligament of ovary to supply ovaries and fallopian tubes. They are not branches of iliac arteries, which mainly supply pelvic and lower limb regions.
At what vertebral level do the ovarian arteries usually arise?
L1
L2
L3
T12
Explanation: The answer is b) L2. Ovarian arteries typically arise from the abdominal aorta at the level of L2, just below the renal arteries. This anatomical relationship is important for surgical approaches to retroperitoneal space. Variations can exist, but L2 origin is the most consistent for both ovarian and testicular arteries.
Which ligament of the ovary carries the ovarian artery?
Ovarian ligament
Suspensory ligament
Round ligament
Broad ligament
Explanation: The correct answer is b) Suspensory ligament. The ovarian artery passes through the suspensory ligament of the ovary (infundibulopelvic ligament), carrying vessels and nerves to the ovary. The ovarian ligament connects ovary to uterus, while round ligament extends to labia majora. Broad ligament is a peritoneal fold, not a vessel carrier.
Which structure does the ovarian artery anastomose with?
Uterine artery
Internal pudendal artery
Inferior mesenteric artery
Renal artery
Explanation: The answer is a) Uterine artery. The ovarian artery forms an important anastomosis with the uterine artery within the mesovarium and broad ligament, ensuring dual blood supply to uterus and ovary. This collateral circulation is essential for maintaining perfusion, especially during pregnancy. Pudendal and mesenteric arteries are unrelated branches.
A 28-year-old woman undergoing oophorectomy is at risk of bleeding from which artery if not ligated properly?
Ovarian artery
Uterine artery
Internal iliac artery
Superior vesical artery
Explanation: The correct answer is a) Ovarian artery. During oophorectomy, the suspensory ligament of ovary must be ligated to control bleeding from the ovarian artery. Uterine artery ligation is important during hysterectomy. Internal iliac branches may be ligated in pelvic hemorrhage, but primary risk in ovary removal is ovarian artery.
Which embryonic structure gives rise to the ovarian artery?
Vitelline arteries
Umbilical arteries
Lateral mesonephric arteries
Arch arteries
Explanation: The answer is c) Lateral mesonephric arteries. The gonadal arteries, including ovarian arteries, develop from the lateral mesonephric arteries in the embryo. These paired vessels supply the mesonephros and later persist as gonadal arteries. Vitelline arteries form celiac and mesenteric vessels, while umbilical arteries contribute to internal iliac branches.
In angiography, an ovarian artery arising from the renal artery is considered:
Normal variant
Pathological finding
Developmental defect
Trauma-induced change
Explanation: The correct answer is a) Normal variant. Though typically from abdominal aorta, the ovarian artery may arise from renal, suprarenal, or common iliac arteries. Such variations are developmental and considered normal variants. They are important to recognize during radiology and surgery to avoid misdiagnosis or accidental vessel injury.
A 32-year-old woman with postpartum hemorrhage undergoes uterine artery ligation. Which collateral maintains uterine blood supply?
Ovarian artery
Superior rectal artery
Middle sacral artery
Inferior epigastric artery
Explanation: The answer is a) Ovarian artery. In cases of uterine artery ligation, the ovarian artery via its anastomosis continues to perfuse the uterus. This collateral circulation helps maintain fertility and uterine viability. Other listed arteries do not have significant uterine anastomoses, making ovarian artery vital clinically in hemorrhage management.
Which vein accompanies the ovarian artery?
Uterine vein
Ovarian vein
Renal vein
Hypogastric vein
Explanation: The correct answer is b) Ovarian vein. The ovarian vein runs with the ovarian artery in the suspensory ligament. The right ovarian vein drains into the inferior vena cava, while the left ovarian vein drains into the left renal vein. Uterine veins accompany uterine arteries, not ovarian arteries.
Which imaging technique best demonstrates ovarian artery during interventional procedures?
Ultrasound
CT angiography
MRI pelvis
X-ray KUB
Explanation: The answer is b) CT angiography. CT angiography allows detailed visualization of ovarian artery origin, course, and anastomoses. It is especially useful in embolization procedures for uterine fibroids or ovarian tumors. Ultrasound and MRI can provide supportive information but not direct arterial mapping. X-ray KUB has no role.
During aortic surgery, ligation of which artery may compromise ovarian function?
Ovarian artery
Inferior mesenteric artery
Middle sacral artery
Superior mesenteric artery
Explanation: The correct answer is a) Ovarian artery. If the ovarian artery is inadvertently ligated during aortic or retroperitoneal surgery, blood supply to the ovary is significantly reduced. This can impair ovarian function and fertility. Mesenteric arteries supply intestines, not gonads. Middle sacral has minor role in pelvic supply.
Pancreas: A retroperitoneal organ of both endocrine and exocrine function located across the posterior abdominal wall.
Pancreatic head: The widened part of the pancreas that lies in the C-shaped curve of the duodenum.
Inferior vena cava (IVC): Large vein returning blood from the lower body, lies posterior to pancreatic head.
Right renal vein: Vessel draining the right kidney into the IVC, related to the posterior aspect of pancreatic head.
Splenic artery: A tortuous branch of celiac trunk, runs along the superior border of pancreas but not posterior to head.
Inferior mesenteric vein: Drains into splenic vein or SMV, not directly behind pancreatic head.
Celiac trunk: Major abdominal artery arising at T12, located superior to pancreas, not directly posterior to head.
Structure immediately posterior to pancreatic head?
Right renal vein
Splenic artery
Inferior mesenteric vein
Coeliac trunk
Explanation: The correct answer is a) Right renal vein. The structures lying posterior to the head of the pancreas include the inferior vena cava, right renal vessels, and left renal vein (more to the left side). The splenic artery lies superior along the body, the inferior mesenteric vein drains elsewhere, and the celiac trunk lies higher above the pancreas.
The uncinate process of pancreas is related posteriorly to which vessel?
Superior mesenteric vein
Splenic artery
Inferior mesenteric vein
Left renal artery
Explanation: The correct answer is a) Superior mesenteric vein. The uncinate process extends behind the superior mesenteric vessels. This relation is clinically important in pancreatic surgery, as tumors of uncinate process may compress these vessels. Splenic artery runs on superior border, while IMV drains separately, and left renal artery is more lateral.
Which structure lies anterior to the head of pancreas?
Stomach
Second part of duodenum
IVC
Right kidney
Explanation: The answer is b) Second part of duodenum. The head of the pancreas is encircled by the C-shaped duodenum, especially its second part. This is the anterior relation. Stomach lies anterior to the body and tail, not head. IVC and kidney are posterior relations, not anterior.
Which duct joins the common bile duct at the ampulla of Vater in relation to the pancreatic head?
Accessory pancreatic duct
Main pancreatic duct
Cystic duct
Right hepatic duct
Explanation: The answer is b) Main pancreatic duct. The main pancreatic duct joins the common bile duct at the hepatopancreatic ampulla (ampulla of Vater) located within the head of pancreas. This relation is critical in obstructive jaundice due to pancreatic head carcinoma. Accessory duct drains separately into duodenum.
A 55-year-old male with carcinoma head of pancreas presents with jaundice. Which structure is compressed?
Inferior vena cava
Portal vein
Common bile duct
Splenic vein
Explanation: The correct answer is c) Common bile duct. The common bile duct passes through a groove in the posterior surface of pancreatic head. Tumors in this region compress the duct, leading to obstructive jaundice. IVC and portal vein may also be involved but classical clinical sign is jaundice from bile duct obstruction.
Which artery lies superior to the body of the pancreas?
Splenic artery
Superior mesenteric artery
Inferior mesenteric artery
Middle colic artery
Explanation: The answer is a) Splenic artery. The splenic artery runs tortuously along the superior border of pancreas before reaching spleen. It gives off pancreatic branches to body and tail. Superior mesenteric artery lies anterior to uncinate process, not body. Inferior mesenteric artery originates lower, unrelated to pancreas.
Which venous structure runs behind the neck of the pancreas?
Portal vein
Splenic vein
Left renal vein
Superior mesenteric vein
Explanation: The correct answer is a) Portal vein. The portal vein is formed by the union of superior mesenteric vein and splenic vein behind the neck of the pancreas. This anatomical landmark is key in portal hypertension surgeries. Left renal vein runs more posterior and lateral, not behind pancreatic neck.
Which structure is closely related to the posterior surface of pancreatic tail?
Left kidney
Spleen
Left colic flexure
Adrenal gland
Explanation: The answer is b) Spleen. The tail of pancreas extends to the hilum of the spleen within the splenorenal ligament. This relation explains why splenectomy can damage pancreatic tail. Left kidney and adrenal are related but more posterior and medial. Colic flexure is inferior, not posterior.
Which artery runs posterior to the superior part of duodenum near pancreatic head?
Right gastroepiploic artery
Gastroduodenal artery
Inferior pancreaticoduodenal artery
Middle colic artery
Explanation: The answer is b) Gastroduodenal artery. The gastroduodenal artery descends posterior to the first part of duodenum near pancreatic head. Peptic ulcer perforation in this region may erode it, causing massive hemorrhage. Inferior pancreaticoduodenal artery arises from SMA but lies lower, supplying duodenum and pancreas.
A 60-year-old patient with pancreatic head carcinoma develops portal hypertension. Which vessel is compressed?
Splenic vein
Portal vein
Superior mesenteric vein
Hepatic vein
Explanation: The correct answer is b) Portal vein. The portal vein passes behind the neck of the pancreas and is closely related to the pancreatic head. Carcinoma in this region can compress the vein, leading to portal hypertension and its consequences such as varices and splenomegaly. Hepatic vein obstruction is unrelated here.
During Whipple’s procedure, which structure must be carefully preserved near pancreatic head?
Inferior vena cava
Superior mesenteric vessels
Splenic artery
Left renal vein
Explanation: The correct answer is b) Superior mesenteric vessels. In pancreaticoduodenectomy (Whipple’s procedure), the superior mesenteric artery and vein run close to the uncinate process and must be carefully preserved to maintain gut perfusion. IVC and renal vein are nearby but not directly endangered. Splenic artery lies more superiorly on body.
Renal angle: The angle formed between the 12th rib and the lateral border of erector spinae muscle, used clinically for renal palpation and percussion.
12th rib: The last rib, often short and floating, forms a landmark for kidney location.
Erector spinae: Group of back muscles running longitudinally, providing support and posture, forming medial boundary of renal angle.
Latissimus dorsi: A large back muscle but not forming renal angle.
Iliac crest: The superior border of ilium, landmark for lumbar puncture, not part of renal angle.
Rectus abdominis: Vertical abdominal muscle in anterior abdominal wall, unrelated to renal angle.
Renal percussion: Clinical method where tenderness on tapping at renal angle indicates kidney pathology like pyelonephritis.
Which of these best describes the renal angle?
The angle between the lattissimus dorsi and the 12th rib
The angle between the erector spinae and the iliac crest
The angle between the 12th rib and the erector spinae
The angle between the 12th rib and the rectus abdominis
Explanation: The correct answer is c) The angle between the 12th rib and the erector spinae. This is the classical renal angle, a posterior landmark for examining kidneys. Clinically, tenderness on percussion here suggests renal pathology. Other options describe unrelated muscular and skeletal landmarks that do not define the renal angle.
Which clinical sign is elicited at the renal angle?
Murphy’s sign
Renal punch tenderness
McBurney’s tenderness
Psoas sign
Explanation: The correct answer is b) Renal punch tenderness. Percussion at the renal angle produces pain in renal infections like pyelonephritis. Murphy’s sign relates to gallbladder, McBurney’s point tenderness to appendicitis, and Psoas sign to retrocecal appendix irritation. Thus, renal punch is specific for kidneys.
The renal angle is located posteriorly at the level of which vertebra?
T10
T12
L1
L3
Explanation: The correct answer is b) T12. The renal angle is formed at the 12th rib, corresponding to the T12 vertebra level. This anatomical landmark helps clinicians localize kidneys, which lie between T12–L3 vertebrae. Higher thoracic and lower lumbar levels are not consistent with renal angle localization.
Pain elicited at the renal angle on percussion is commonly seen in:
Cholecystitis
Renal stones
Appendicitis
Inguinal hernia
Explanation: The answer is b) Renal stones. Both renal stones and infections like pyelonephritis produce renal angle tenderness. Cholecystitis produces Murphy’s sign, appendicitis produces right iliac fossa tenderness, and hernias produce groin swellings. Renal angle percussion is a direct test for kidney pathology.
Which structure lies deep to the renal angle?
Kidney
Liver
Spleen
Pancreas
Explanation: The correct answer is a) Kidney. The kidneys are retroperitoneal organs lying deep to the renal angle. The liver lies higher and anterior, the spleen is left-sided and lateral, while pancreas is anterior to vertebral column, not directly related to renal angle posteriorly.
In renal colic, tenderness is best elicited at:
Epigastric region
Renal angle
McBurney’s point
Inguinal ligament
Explanation: The correct answer is b) Renal angle. Patients with renal colic or stones exhibit tenderness at renal angle due to obstruction of urinary tract. Epigastrium is related to stomach, McBurney’s point to appendix, and inguinal ligament to hernia or lymph nodes. Renal angle percussion is diagnostic.
Which muscle forms the medial boundary of renal angle?
Latissimus dorsi
Erector spinae
Quadratus lumborum
Psoas major
Explanation: The answer is b) Erector spinae. The erector spinae group forms the medial border of the renal angle, while the 12th rib forms its superior boundary. Latissimus dorsi lies more lateral and superior, quadratus lumborum is deeper, and psoas major is anterior to kidney, not forming angle boundary.
A patient with acute pyelonephritis presents with fever, flank pain, and renal angle tenderness. Which test is positive?
Renal punch test
Murphy’s sign
Obturator test
Carnett’s sign
Explanation: The correct answer is a) Renal punch test. This test is positive when percussion at renal angle elicits pain due to renal inflammation. Murphy’s sign relates to gallbladder, Obturator test to appendix, and Carnett’s sign to abdominal wall pain. Thus, renal punch confirms kidney pathology.
Renal angle tenderness is absent in which of the following?
Pyelonephritis
Perinephric abscess
Hydronephrosis
Cholecystitis
Explanation: The correct answer is d) Cholecystitis. Renal angle tenderness occurs in renal and perinephric conditions like pyelonephritis, abscess, and hydronephrosis. In gallbladder inflammation (cholecystitis), Murphy’s sign is elicited in right hypochondrium, not at renal angle. This distinction is clinically important in diagnosis.
Which rib forms the superior boundary of renal angle?
11th rib
12th rib
10th rib
9th rib
Explanation: The correct answer is b) 12th rib. The renal angle is bounded superiorly by the 12th rib. This floating rib is a landmark for kidney palpation. The 11th rib may be related to kidney but does not form the renal angle. 9th and 10th ribs are too high.
During clinical examination, renal angle percussion is used primarily to assess:
Liver disease
Gallbladder inflammation
Kidney pathology
Spleen enlargement
Explanation: The correct answer is c) Kidney pathology. Renal angle percussion detects tenderness in kidney disorders such as stones, hydronephrosis, and infections. Liver and gallbladder are anterior abdominal structures, spleen enlargement is felt in left hypochondrium. Thus, renal angle percussion is specific for kidneys.
Chapter: Anatomy & Clinical Correlations
Topic: Venous System
Subtopic: Obstruction of Inferior Vena Cava (IVC)
Keywords and Definitions:
• Inferior vena cava – Large vein carrying deoxygenated blood from lower body to right atrium.
• Paraumbilical veins – Small veins around umbilicus connecting to portal circulation.
• Thoraco-epigastric vein – Vein on thoracoabdominal wall linking superficial epigastric and lateral thoracic veins.
• Esophageal varices – Dilated veins in lower esophagus due to portal hypertension.
• Hemorrhoids – Swollen rectal venous plexus, commonly linked to straining or portal hypertension.
Lead Question – 2012
Obstruction of Inferior vena cava presents:
a) Paraumblical dilatation
b) Thoraco-epigastric dilatation
c) Oesophagus varices
d) Haemorrhoids
Explanation:
The correct answer is (b) Thoraco-epigastric dilatation. Obstruction of IVC causes venous return to bypass through collateral circulation, especially via thoraco-epigastric veins on the abdominal wall, leading to visibly dilated superficial veins. Paraumbilical dilatation is more typical of portal hypertension (caput medusae), while varices and hemorrhoids are linked to portal systemic anastomosis.
Guessed Question 1:
A 45-year-old male presents with distended superficial veins on the anterior abdominal wall. On examination, blood flow is directed from below upward. This finding suggests:
a) Superior vena cava obstruction
b) Inferior vena cava obstruction
c) Portal vein thrombosis
d) Hepatic vein obstruction
Explanation:
Answer: (b) Inferior vena cava obstruction. Direction of venous flow helps differentiate cause. In IVC obstruction, venous blood bypasses blockage via thoraco-epigastric veins, flowing upward toward SVC. In contrast, SVC obstruction would show downward collateral flow. Portal vein thrombosis and hepatic vein obstruction produce other signs like ascites or varices.
Guessed Question 2:
Caput medusae in portal hypertension is due to dilatation of:
a) Thoraco-epigastric veins
b) Paraumbilical veins
c) Inferior epigastric veins
d) Azygos vein
Explanation:
Answer: (b) Paraumbilical veins. Portal hypertension causes reopening and dilation of paraumbilical veins, leading to the classic "caput medusae" around the umbilicus. This differentiates it from IVC obstruction, where thoraco-epigastric veins are predominantly involved. Clinical examination of venous flow direction helps distinguish between the two.
Guessed Question 3:
Which collateral pathway is most important in IVC obstruction?
a) Azygos and hemiazygos veins
b) Superior rectal veins
c) Paraumbilical veins
d) Inferior thyroid veins
Explanation:
Answer: (a) Azygos and hemiazygos veins. In IVC obstruction, azygos-hemiazygos system provides a major collateral route to drain venous blood into SVC. Thoraco-epigastric veins also provide superficial drainage, but the azygos system is the key deep collateral. Superior rectal and thyroid veins are not involved here.
Guessed Question 4:
A patient with chronic Budd-Chiari syndrome develops prominent abdominal wall veins. The mechanism is:
a) Portal vein obstruction
b) IVC obstruction
c) Hepatic arterial thrombosis
d) Splenic vein thrombosis
Explanation:
Answer: (b) IVC obstruction. Budd-Chiari syndrome leads to hepatic vein outflow obstruction. Over time, it may cause IVC compression, resulting in dilated collateral veins on abdominal wall. Portal vein obstruction more commonly produces varices and ascites rather than thoraco-epigastric dilatation.
Guessed Question 5:
Direction of blood flow in dilated abdominal wall veins helps in differential diagnosis. In IVC obstruction, blood flow is:
a) Above downward
b) Below upward
c) Centripedal
d) Random
Explanation:
Answer: (b) Below upward. In IVC obstruction, venous return from lower limbs cannot pass through the IVC, so blood finds alternative pathways to reach the SVC via upward flow in thoraco-epigastric veins. In SVC obstruction, the flow is downward from above.
Guessed Question 6:
A patient presents with esophageal varices and splenomegaly. Which is the most likely underlying cause?
a) IVC obstruction
b) SVC obstruction
c) Portal hypertension
d) Iliac vein thrombosis
Explanation:
Answer: (c) Portal hypertension. Esophageal varices result from increased portal venous pressure causing dilation of left gastric (coronary) veins. Splenomegaly further supports portal hypertension. IVC or SVC obstruction causes abdominal wall vein dilatation instead, not varices.
Guessed Question 7:
In IVC obstruction, the superficial collateral veins seen are:
a) Thoraco-epigastric veins
b) Esophageal veins
c) Paraumbilical veins
d) Hemorrhoidal veins
Explanation:
Answer: (a) Thoraco-epigastric veins. These veins form important collaterals between femoral and axillary venous systems. Their dilation is a hallmark of IVC obstruction. The other options are typical for portal hypertension and not primarily for IVC block.
Guessed Question 8:
Which investigation best confirms IVC obstruction?
a) Abdominal ultrasound with Doppler
b) Chest X-ray
c) Barium swallow
d) ECG
Explanation:
Answer: (a) Abdominal ultrasound with Doppler. Doppler imaging helps visualize venous flow and detect IVC obstruction. CT/MRI venography may also be used. Chest X-ray, barium swallow, and ECG are not definitive for IVC pathology.
Guessed Question 9:
Which of the following is not a cause of IVC obstruction?
a) Retroperitoneal tumor
b) Thrombosis
c) Pregnancy
d) Cirrhosis with portal hypertension
Explanation:
Answer: (d) Cirrhosis with portal hypertension. Cirrhosis causes portal vein obstruction, not IVC obstruction. Retroperitoneal tumors, thrombosis, and gravid uterus may compress or block IVC. Clinical examination and imaging differentiate these conditions.
Guessed Question 10:
Which of the following syndromes is most directly associated with IVC obstruction?
a) Budd-Chiari syndrome
b) Mallory-Weiss syndrome
c) Zollinger-Ellison syndrome
d) Conn’s syndrome
Explanation:
Answer: (a) Budd-Chiari syndrome. It involves hepatic vein outflow obstruction, often extending to IVC. Clinical features include hepatomegaly, ascites, abdominal pain, and dilated abdominal veins. The other syndromes are unrelated to venous obstruction.
Chapter: Anatomy
Topic: Genitourinary System
Subtopic: Penile Injury & Fascia
Keyword Definitions:
Colle's fascia: A membranous layer of superficial perineal fascia that limits the spread of urine after urethral rupture.
Extravasation: Leakage of fluid, particularly urine or blood, from its normal pathway into surrounding tissues.
Ischiorectal fossa: A fat-filled space on either side of the anal canal.
Perineum: Region between the pubic symphysis and coccyx, including urogenital and anal triangles.
Superficial perineal pouch: Space between Colle’s fascia and perineal membrane.
Lead Question – 2012
In patients with penile injury, Colle's fascia prevents extravasation of urine in?
a) Ischiorectal fossa
b) Perineum
c) Abdomen
d) None
Explanation: The correct answer is a) Ischiorectal fossa. Colle’s fascia attaches laterally to ischiopubic rami and posteriorly to the perineal membrane, preventing urine from entering the ischiorectal fossa. Instead, urine collects in the superficial perineal pouch and may spread into the scrotum, penis, and lower abdominal wall.
Guessed Questions
1) Rupture of the spongy urethra leads to urine collection in?
a) Superficial perineal pouch
b) Deep perineal pouch
c) Ischiorectal fossa
d) Bladder
Explanation: Answer: a) Superficial perineal pouch. Injury to spongy urethra leads to urine leakage limited by Colle’s fascia, spreading into superficial perineal pouch, scrotum, penis, and anterior abdominal wall.
2) Which fascia is continuous with Scarpa’s fascia of the abdomen?
a) Buck’s fascia
b) Colle’s fascia
c) Dartos fascia
d) Camper’s fascia
Explanation: Answer: b) Colle’s fascia. Scarpa’s fascia continues into the perineum as Colle’s fascia, creating a confined space where urine can spread but is prevented from reaching thighs and ischiorectal fossa.
3) A patient has scrotal swelling with perineal bruising after straddle injury. Which urethra is most likely injured?
a) Prostatic urethra
b) Membranous urethra
c) Spongy urethra
d) Bladder neck
Explanation: Answer: c) Spongy urethra. Straddle injuries usually rupture the bulbous part of the spongy urethra, causing extravasation into superficial perineal spaces.
4) Buck’s fascia of the penis limits urine extravasation to?
a) Shaft of penis
b) Perineum
c) Scrotum
d) Ischiorectal fossa
Explanation: Answer: a) Shaft of penis. When Buck’s fascia is intact, extravasated urine is confined to the shaft of the penis; once torn, urine spreads to perineum and scrotum.
5) In urethral catheterization, resistance at membranous urethra occurs due to?
a) External urethral sphincter
b) Colle’s fascia
c) Dartos fascia
d) Prostate
Explanation: Answer: a) External urethral sphincter. The membranous urethra is surrounded by the external sphincter, creating resistance to catheter passage.
6) Which space communicates between scrotum and anterior abdominal wall in urethral rupture?
a) Superficial perineal pouch
b) Deep perineal pouch
c) Retrovesical pouch
d) Ischiorectal fossa
Explanation: Answer: a) Superficial perineal pouch. Colle’s fascia allows urine to track into scrotum and anterior abdominal wall but prevents spread into thighs and ischiorectal fossa.
7) A 25-year-old male presents with perineal pain and inability to urinate after pelvic fracture. Which urethra is injured?
a) Membranous urethra
b) Penile urethra
c) Prostatic urethra
d) Bladder neck
Explanation: Answer: a) Membranous urethra. Pelvic fractures commonly disrupt membranous urethra, leading to urinary retention and perineal hematoma.
8) Which fascia forms the roof of the superficial perineal pouch?
a) Colle’s fascia
b) Perineal membrane
c) Camper’s fascia
d) Buck’s fascia
Explanation: Answer: b) Perineal membrane. The superficial perineal pouch is bounded below by Colle’s fascia and above by perineal membrane, containing muscles and part of the urethra.
9) Dartos fascia is a continuation of?
a) Colle’s fascia
b) Scarpa’s fascia
c) Camper’s fascia
d) Buck’s fascia
Explanation: Answer: b) Scarpa’s fascia. Dartos fascia is derived from Scarpa’s fascia and forms a thin layer in scrotum without fat, helping in thermoregulation of testes.
10) A child presents with extravasated urine confined to the shaft of the penis. Which structure is intact?
a) Buck’s fascia
b) Colle’s fascia
c) Perineal membrane
d) Dartos fascia
Explanation: Answer: a) Buck’s fascia. When intact, Buck’s fascia confines urine to the penile shaft; rupture allows spread into perineum and scrotum.
Chapter: Anatomy
Topic: Nerves of Perineum
Subtopic: Ischiorectal Abscess and Nerve Supply
Keyword Definitions:
Ischiorectal Abscess: A pus collection in ischiorectal fossa, usually due to anal gland infection.
Inferior Rectal Nerve: Branch of pudendal nerve, supplies external anal sphincter and perianal skin.
Superior Rectal Nerve: Branch of inferior mesenteric plexus, supplies rectal mucosa.
Inferior Gluteal Nerve: Supplies gluteus maximus muscle.
Superior Gluteal Nerve: Supplies gluteus medius, minimus, tensor fascia lata.
Pudendal Nerve: Main nerve of perineum, gives inferior rectal branches.
Clinical Correlation: Abscess drainage can damage inferior rectal nerve causing anal incontinence.
Lead Question – 2012
During incision & drainage of ischiorectal abscess, which nerve is/are affected/injured:
a) Superior rectal nerve
b) Inferior rectal nerve
c) Superior gluteal nerve
d) Inferior gluteal nerve
Explanation: The ischiorectal fossa contains branches of pudendal nerve, mainly inferior rectal nerves. Incision and drainage can damage these nerves, leading to sensory loss in perianal skin and possible sphincter dysfunction. Correct answer: Inferior rectal nerve.
Guessed Questions for NEET PG
Q1. Which structure forms the medial boundary of the ischiorectal fossa?
a) Levator ani
b) Obturator internus
c) Gluteus maximus
d) Piriformis
Explanation: The ischiorectal fossa lies between levator ani medially and obturator internus laterally. Medial boundary is levator ani muscle, covered by anal fascia. Correct answer: Levator ani.
Q2. A patient with ischiorectal abscess drainage later develops perianal sensory loss. The most likely injured nerve is:
a) Superior hypogastric plexus
b) Inferior rectal nerve
c) Sciatic nerve
d) Coccygeal plexus
Explanation: Perianal sensory loss after ischiorectal abscess surgery indicates inferior rectal nerve injury, which supplies perianal skin and external sphincter. Correct answer: Inferior rectal nerve.
Q3. Inferior rectal nerve is a branch of:
a) Pudendal nerve
b) Obturator nerve
c) Sacral plexus directly
d) Coccygeal nerve
Explanation: The inferior rectal nerve arises from the pudendal nerve, providing motor supply to external anal sphincter and sensory supply to perianal skin. Correct answer: Pudendal nerve.
Q4. Which vessel accompanies the inferior rectal nerve in the ischiorectal fossa?
a) Superior rectal artery
b) Middle rectal artery
c) Inferior rectal artery
d) Internal pudendal artery
Explanation: The inferior rectal nerve is accompanied by inferior rectal vessels, branches of internal pudendal vessels, within the ischiorectal fossa. Correct answer: Inferior rectal artery.
Q5. A 40-year-old with ischiorectal abscess presents with fecal incontinence post-surgery. Which muscle is most likely affected?
a) Internal anal sphincter
b) External anal sphincter
c) Puborectalis
d) Levator ani
Explanation: The inferior rectal nerve supplies external anal sphincter. Injury causes sphincter weakness leading to incontinence. Correct answer: External anal sphincter.
Q6. The pudendal nerve exits the pelvis through:
a) Greater sciatic foramen
b) Lesser sciatic foramen
c) Obturator canal
d) Sacral hiatus
Explanation: Pudendal nerve exits pelvis via greater sciatic foramen, curves around sacrospinous ligament, and enters perineum through lesser sciatic foramen. Correct answer: Greater sciatic foramen.
Q7. Which nerve is spared in ischiorectal abscess incision?
a) Inferior rectal nerve
b) Superior gluteal nerve
c) Perineal branch of posterior femoral cutaneous
d) Pudendal nerve
Explanation: Superior gluteal nerve is high in gluteal region, away from perianal surgery. Hence, spared in ischiorectal abscess drainage. Correct answer: Superior gluteal nerve.
Q8. Clinical sign of inferior rectal nerve damage is:
a) Loss of rectal mucosal sensation
b) Weakness of internal sphincter
c) Fecal incontinence
d) Urinary incontinence
Explanation: Inferior rectal nerve supplies external sphincter; injury leads to fecal incontinence, not urinary. Correct answer: Fecal incontinence.
Q9. Which of the following is NOT located in the ischiorectal fossa?
a) Fat
b) Inferior rectal vessels
c) Inferior rectal nerve
d) Superior rectal nerve
Explanation: Superior rectal nerve is from inferior mesenteric plexus and lies higher, not in ischiorectal fossa. Correct answer: Superior rectal nerve.
Q10. During perianal surgery, surgeon avoids deep lateral dissection to prevent injury to:
a) Pudendal canal structures
b) Sciatic nerve
c) Inferior gluteal nerve
d) Coccygeal plexus
Explanation: Pudendal canal contains pudendal nerve and internal pudendal vessels; deep lateral dissection risks injury. Correct answer: Pudendal canal structures.
Chapter: Anatomy
Topic: Liver Anatomy
Subtopic: Hepatic Veins
Keyword Definitions:
Liver segments: The liver is divided into 8 segments according to Couinaud classification, each with its own vascular inflow and biliary drainage.
Hepatic veins: Major veins draining blood from liver segments into the inferior vena cava (IVC). Right, middle, and left hepatic veins are primary.
Right hepatic vein: Drains liver segments V, VI, VII, and VIII, especially segment VII and VI.
Couinaud classification: Anatomical system dividing liver into functionally independent segments based on portal triads and hepatic veins.
Segment I: Caudate lobe, drains directly into IVC, not via main hepatic veins.
Segment IV: Left medial section of the liver, mainly drained by the middle hepatic vein.
Clinical relevance: Knowledge of hepatic vein drainage is essential in liver surgery and transplantation.
Lead Question – 2012
Right hepatic vein drains which segment of the liver?
a) I
b) II
c) IV
d) VII
Explanation: The right hepatic vein drains segments V, VI, VII, and VIII of the liver. Segment VII is specifically drained by the right hepatic vein into the IVC. Segment I drains directly into IVC, segment II into left hepatic vein, and segment IV into middle hepatic vein. Answer: d) VII
Guessed Questions:
1. Which hepatic vein drains segment IV of the liver?
a) Right hepatic vein
b) Left hepatic vein
c) Middle hepatic vein
d) Inferior vena cava
Explanation: Segment IV is drained by the middle hepatic vein. It separates the right and left lobes functionally. This is vital for surgical resections of left medial segments. Answer: c) Middle hepatic vein
2. The caudate lobe (segment I) drains blood directly into?
a) Right hepatic vein
b) Left hepatic vein
c) Middle hepatic vein
d) Inferior vena cava
Explanation: The caudate lobe (segment I) has independent venous drainage directly into the IVC without using the major hepatic veins. This is important during liver transplantation. Answer: d) Inferior vena cava
3. Which liver segment is supplied by both right and left portal veins?
a) Segment I
b) Segment II
c) Segment IV
d) Segment VII
Explanation: The caudate lobe (segment I) is unique as it receives dual blood supply from both right and left branches of the portal vein. Answer: a) Segment I
4. In Couinaud classification, how many functional segments does the liver have?
a) 4
b) 6
c) 8
d) 10
Explanation: The Couinaud classification divides the liver into 8 functionally independent segments, each with its own portal triad and venous drainage. Answer: c) 8
5. A patient undergoes right hepatectomy. Which hepatic vein is preserved?
a) Right hepatic vein
b) Middle hepatic vein
c) Left hepatic vein
d) None
Explanation: In right hepatectomy, the right hepatic vein is sacrificed. The middle and left hepatic veins are preserved to maintain venous drainage of remaining liver. Answer: c) Left hepatic vein
6. Which imaging modality best demonstrates hepatic venous anatomy before surgery?
a) X-ray
b) Ultrasound
c) CT angiography
d) Plain MRI
Explanation: CT angiography provides detailed visualization of hepatic veins, arteries, and portal circulation, essential in preoperative planning for liver resection or transplant. Answer: c) CT angiography
7. Which vein forms the boundary between right and left functional lobes of the liver?
a) Right hepatic vein
b) Middle hepatic vein
c) Left hepatic vein
d) Portal vein
Explanation: The middle hepatic vein forms the plane of division between right and left functional lobes of the liver, important in hepatic surgeries. Answer: b) Middle hepatic vein
8. A trauma patient has bleeding from right superior liver segments. Which vein is likely injured?
a) Left hepatic vein
b) Middle hepatic vein
c) Right hepatic vein
d) Portal vein
Explanation: Segments VII and VIII are drained by the right hepatic vein. Trauma to superior right lobe often injures this vein, leading to major bleeding. Answer: c) Right hepatic vein
9. Which segment is located posteriorly and drained mainly by right hepatic vein?
a) Segment II
b) Segment IV
c) Segment VI
d) Segment I
Explanation: Segment VI lies posteriorly in the right lobe and drains via the right hepatic vein into IVC. Answer: c) Segment VI
10. During liver transplant, which segment is most critical due to its independent venous drainage?
a) Segment VII
b) Segment VIII
c) Segment I
d) Segment IV
Explanation: The caudate lobe (segment I) is surgically critical because of its independent venous drainage directly into the IVC. Injury can cause uncontrollable bleeding. Answer: c) Segment I
Chapter: Head and Neck Anatomy
Topic: Pterygopalatine Fossa
Subtopic: Contents and Relations
Keyword Definitions
Pterygopalatine fossa: A small inverted pyramidal space deep in the face, between maxilla and sphenoid bone, transmitting nerves and vessels.
Pterygopalatine ganglion: A parasympathetic ganglion in the fossa associated with lacrimal and nasal secretions.
Maxillary artery: One of the terminal branches of the external carotid artery, supplying deep facial structures.
Maxillary nerve: Second division of the trigeminal nerve (CN V2), carrying sensory fibers from midface.
Greater petrosal nerve: Branch of facial nerve carrying parasympathetic fibers to the pterygopalatine ganglion.
Lead Question – 2012
All of the following are structures associated with pterygopalatine fossa, EXCEPT:
a) Pterygopalatine ganglion
b) Mid third of maxillary artery
c) Maxillary nerve
d) Greater petrosal nerve
Explanation: The pterygopalatine fossa contains the pterygopalatine ganglion, terminal part of maxillary artery, and maxillary nerve. The mid-third of the maxillary artery is not directly associated, as only its terminal part enters the fossa. Correct answer: b) Mid third of maxillary artery.
Guessed Questions for NEET PG
Q1. Which foramen communicates the pterygopalatine fossa with the orbit?
a) Foramen rotundum
b) Inferior orbital fissure
c) Sphenopalatine foramen
d) Pterygoid canal
Explanation: The inferior orbital fissure communicates the pterygopalatine fossa with the orbit, allowing passage of infraorbital vessels and nerves. This is clinically relevant in orbital infections. Correct answer: b) Inferior orbital fissure.
Q2. Through which foramen does the maxillary nerve enter the pterygopalatine fossa?
a) Foramen ovale
b) Foramen rotundum
c) Pterygoid canal
d) Greater palatine foramen
Explanation: The maxillary nerve enters the pterygopalatine fossa via the foramen rotundum. This pathway is important in maxillary nerve block anesthesia. Correct answer: b) Foramen rotundum.
Q3. Which artery passes through the sphenopalatine foramen into the nasal cavity?
a) Facial artery
b) Sphenopalatine artery
c) Infraorbital artery
d) Middle meningeal artery
Explanation: The sphenopalatine artery, a terminal branch of the maxillary artery, passes through the sphenopalatine foramen to supply the nasal cavity. Correct answer: b) Sphenopalatine artery.
Q4. The greater palatine nerve arises from which structure?
a) Pterygopalatine ganglion
b) Otic ganglion
c) Geniculate ganglion
d) Trigeminal ganglion
Explanation: The greater palatine nerve arises from the pterygopalatine ganglion and supplies the hard palate mucosa. Correct answer: a) Pterygopalatine ganglion.
Q5. Which clinical block involves deposition of anesthetic into the pterygopalatine fossa?
a) Inferior alveolar nerve block
b) Maxillary nerve block
c) Lingual nerve block
d) Mandibular nerve block
Explanation: The maxillary nerve block is performed by injecting anesthetic into the pterygopalatine fossa, providing anesthesia to the midface. Correct answer: b) Maxillary nerve block.
Q6. The Vidian nerve is formed by union of greater petrosal nerve and which other nerve?
a) Chorda tympani
b) Deep petrosal nerve
c) Lesser petrosal nerve
d) Auriculotemporal nerve
Explanation: The Vidian nerve (nerve of pterygoid canal) is formed by the union of greater petrosal and deep petrosal nerves. Correct answer: b) Deep petrosal nerve.
Q7. The pterygopalatine ganglion is functionally associated with which cranial nerve?
a) Trigeminal nerve
b) Facial nerve
c) Glossopharyngeal nerve
d) Vagus nerve
Explanation: Though anatomically linked to the maxillary nerve, the pterygopalatine ganglion is functionally associated with the facial nerve via parasympathetic fibers. Correct answer: b) Facial nerve.
Q8. Which structure passes through the pterygoid canal to reach the pterygopalatine fossa?
a) Greater palatine nerve
b) Nerve of pterygoid canal
c) Chorda tympani
d) Auriculotemporal nerve
Explanation: The nerve of pterygoid canal (Vidian nerve) passes through the pterygoid canal to enter the pterygopalatine fossa. Correct answer: b) Nerve of pterygoid canal.
Q9. A tumor in the pterygopalatine fossa would most likely compress which of the following, leading to facial pain?
a) Optic nerve
b) Maxillary nerve
c) Hypoglossal nerve
d) Vestibulocochlear nerve
Explanation: A lesion in the pterygopalatine fossa can compress the maxillary nerve, resulting in trigeminal neuralgia affecting the midface. Correct answer: b) Maxillary nerve.
Q10. Which venous connection makes the pterygopalatine fossa a potential route for spread of infection to the cavernous sinus?
a) Retromandibular vein
b) Pterygoid venous plexus
c) Facial vein
d) Superior ophthalmic vein
Explanation: The pterygoid venous plexus communicates with the cavernous sinus and connects to the pterygopalatine fossa, serving as a dangerous route for infection spread. Correct answer: b) Pterygoid venous plexus.
Chapter: Abdomen
Topic: Portal Vein
Subtopic: Formation and Tributaries
Keyword Definitions
Portal vein: Large vein that carries nutrient-rich blood from the gastrointestinal tract and spleen to the liver.
Superior mesenteric vein (SMV): Vein draining small intestine, ascending and transverse colon.
Splenic vein: Vein draining spleen, pancreas, and part of stomach.
Inferior mesenteric vein (IMV): Vein draining descending colon, sigmoid colon, and rectum.
Hepatic veins: Veins draining processed blood from the liver into the inferior vena cava.
Lead Question – 2012
Portal vein is formed by union of which of the following veins?
a) Superior mesenteric vein & Splenic vein
b) Superior mesenteric vein & Inferior mesenteric vein
c) Inferior mesenteric vein & Splenic vein
d) Inferior mesenteric vein & Hepatic vein
Explanation: The portal vein is formed behind the neck of the pancreas by union of the superior mesenteric vein and the splenic vein. The inferior mesenteric vein usually drains into the splenic vein, not directly forming the portal vein. Correct answer: a) Superior mesenteric vein & Splenic vein.
Guessed Questions for NEET PG
Q1. The inferior mesenteric vein most commonly drains into which vein?
a) Superior mesenteric vein
b) Splenic vein
c) Left renal vein
d) Hepatic vein
Explanation: The inferior mesenteric vein most commonly drains into the splenic vein before joining the superior mesenteric vein to form the portal vein. Variations may occur but splenic vein drainage is the rule. Correct answer: b) Splenic vein.
Q2. At what anatomical location is the portal vein formed?
a) Behind the head of pancreas
b) Behind the neck of pancreas
c) In front of the duodenum
d) Within the liver hilum
Explanation: The portal vein is formed posterior to the neck of the pancreas by union of the SMV and splenic vein. This location is important during pancreatic surgeries. Correct answer: b) Behind the neck of pancreas.
Q3. Which of the following veins is not a direct tributary of the portal vein?
a) Left gastric vein
b) Right gastric vein
c) Superior mesenteric vein
d) Inferior vena cava
Explanation: The inferior vena cava drains systemic circulation and does not contribute to the portal system. Gastric veins and SMV are portal tributaries. Correct answer: d) Inferior vena cava.
Q4. Which of the following conditions is most commonly associated with portal hypertension?
a) Cirrhosis of liver
b) Acute appendicitis
c) Cholecystitis
d) Pancreatitis
Explanation: Cirrhosis of the liver is the most common cause of portal hypertension due to architectural distortion and resistance to portal blood flow. Correct answer: a) Cirrhosis of liver.
Q5. Caput medusae in portal hypertension is due to dilatation of which veins?
a) Superior rectal veins
b) Periumbilical veins
c) Esophageal veins
d) Inferior mesenteric veins
Explanation: Caput medusae is caused by dilatation of paraumbilical veins, which are portosystemic anastomoses around the umbilicus. Correct answer: b) Periumbilical veins.
Q6. A patient with chronic alcoholism develops hematemesis. Which venous anastomosis is responsible?
a) Rectal
b) Esophageal
c) Paraumbilical
d) Retroperitoneal
Explanation: Hematemesis in portal hypertension is commonly due to rupture of dilated esophageal varices, a site of portosystemic anastomosis. Correct answer: b) Esophageal.
Q7. Which structure lies anterior to the portal vein in the hepatoduodenal ligament?
a) Common bile duct
b) Hepatic artery proper
c) Inferior vena cava
d) Gallbladder
Explanation: In the hepatoduodenal ligament, the portal vein lies posteriorly, the hepatic artery proper lies to the left, and the common bile duct lies anteriorly to the right. Correct answer: a) Common bile duct.
Q8. Which vein connects the left gastric vein to the azygos vein system in portal hypertension?
a) Short gastric vein
b) Esophageal vein
c) Inferior phrenic vein
d) Left renal vein
Explanation: The left gastric vein communicates with esophageal veins that drain into the azygos system, creating a portosystemic shunt in portal hypertension. Correct answer: b) Esophageal vein.
Q9. In Budd–Chiari syndrome, obstruction occurs in which vein?
a) Portal vein
b) Inferior vena cava
c) Hepatic veins
d) Splenic vein
Explanation: Budd–Chiari syndrome involves obstruction of hepatic veins, preventing outflow of blood from the liver into the IVC, distinct from portal vein obstruction. Correct answer: c) Hepatic veins.
Q10. A 50-year-old patient presents with bleeding per rectum due to portal hypertension. Which venous communication is involved?
a) Superior rectal vein with middle and inferior rectal veins
b) Splenic vein with gastric vein
c) Left renal vein with gonadal vein
d) Inferior mesenteric vein with renal vein
Explanation: In portal hypertension, rectal varices occur due to anastomosis between superior rectal vein (portal system) and middle/inferior rectal veins (systemic). Correct answer: a) Superior rectal vein with middle and inferior rectal veins.