MCQs in

AnatomyAn aid to revision and self assessment

ThoraxAbdomen

Pelvis and Perineum

First Edition

MCQs in

AnatomyAn aid to revision and self assessment

Volume 2

ThoraxAbdomen

Pelvis and Perineum

First Edition

Professor Deepthi NanayakkaraSenior Professor in AnatomyDepartment of Basic Sciences

Faculty of Dental SciencesUniversity of Peradeniya

Sri Lanka

Professor Malkanthi ChandrasekeraSenior Professor of Anatomy

Department of AnatomyFaculty of Medicine

University of PeradeniyaSri Lanka

Dr Deepthika ChandrasekeraRegistrar in Surgery

MCQs in Anatomy An aid to revision and self assessment

Volume 2 Thorax AbdomenPelvis and Perineum© Deepthi Nanayakkara and Malkanthi Chandrasekera

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission in writing of the copyright owner.

First published in 2013

ISBN 978-

Medical knowledge is constantly changing. The authors have, as far as it is possible, taken care to ensure that the information given in this publication is accurate and up to date.

Dedicatedto

our parents and teachers

Preface_____________________________________________________________________

Students preparing for examinations are burdened with many difficulties. A significant difficulty encountered by all students is the non availability of practice questions especially MCQs. Students are always curious to know as to how and from where they are supposed to prepare for MCQs. This inspired us to write a book on MCQs with explanatory answers.

The MCQs contained in this text have been prepared by the authors under careful scrutiny. Eventhough the commonly used MCQ type in many parts of the world is the single best response type this book contains ‘true/false type MCQs’ as they are the frequently used type in most examinations in Anatomy in Sri Lanka. To fulfill the demands of the readers explanatory answers have been given. These explanatory answers will help the students to understand the section dealt in the MCQ. This text is primarily aimed at fulfilling the requirements of medical/dental undergraduates as well as postgraduates. It is our sincere hope, that this text will provide students an opportunity to assess themselves the depth of their knowledge.

This book, ‘MCQs in Anatomy – An aid to revision and self assessment’ has been intentionally split in several parts for the convenience of handling. Different parts of the series will be covering different regions of the body. Within each part the questions have been grouped into topics.

Even though every effort has been taken, to ensure accuracy and clarity, and to avoid ambiguity in phrasing the questions, it is quite possible that there are errors that have been unnoticed. The authors would be grateful to the readers for their suggestions for improvement of the text from all angles.

We wish to thank Mr Dhammika Ihalagedera, Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya for his help in numerous ways, Miss Himali Disanayake for typing part of the text, and the students who prompted us to undertake the task of writing this book.

Deepthi Nanayakkara Malkanthi ChandrasekeraDeepthika Chandrasekera

Contents_____________________________________________________________________

Preface

Chapter I : ThoraxQuestionsThoracic Wall and DiaphragmThe Thoracic Cavity Superior Mediastinum

Anterior Mediastinum Middle MediastinumPosterior Mediastinum

Lungs and PleuraeAnswers and Explanations

Chapter 2 : AbdomenQuestionsAnterior Abdominal WallVessels and Nerves of the GutAbdominal cavity and the peritoneumDevelopment of the GutGastrointestinal TractLiver and Biliary System, Pancreas and SpleenPosterior Abdominal WallKidneys, Ureters and Suprarenal glandsAnswers and Explanations

Chapter 3 : Pelvis and PerineumQuestionsPelvic Cavity and jointsRectum and anal canalUrinary bladder, urethra and ureters in the pelvisMale Reproductive OrgansFemale Reproductive OrgansPelvic vessels and nervesPerineumAnswers and Explanations

________________________________________________________

Thorax

Thoracic Wall and Diaphragm

1. Intercostal nerves

A. are the ventral rami of thoracic spinal nerves

B. lie deep to the internal intercostal muscles

C. supply the parietal pleura

D. lie above the intercostal vessels in the costal groove

E. cross in front of the internal thoracic artery near the sternum

2. Regarding intercostal nerves A. The anterior primary ramus of the twelfth thoracic nerve is the

subcostal nerve B. The 7th intercostal nerve is a typical spinal nerve C. They lie in the subcostal groove D. The 4th intercostal nerve supplies only the thoracic wall E. The 2nd has a supply to the skin of the axilla

3. Regarding intercostal arteries

A. All posterior intercostal arteries arise from the descending aorta

B. They lie superior to the vein and nerve in the costal groove

C. All anterior intercostal arteries arise from the internal thoracic artery

D. Posterior intercostal arteries supply the spinal cord

1

E. The right third posterior intercostal artery gives off the right bronchial artery

4. External intercostal muscle

A. is innervated by the posterior ramus of the thoracic spinal nerve

B. is derived from the paraxial mesoderm

C. extends as far forwards as the costochondral junction

D. has an attachment to the neck of the respective rib

E. has fibres directed downwards and backwards

5. Internal thoracic artery

A. arises from the first part of the subclavian artery

B. supplies the upper six intercostal spaces

C. supplies the thymus

D. gives off the superior epigastric artery

E. terminates in the 5th intercostal space

6. Regarding intercostal spaces

A. External intercostal muscle has fibres directed downwards and forwards

B. Neurovascular bundle runs between the internal and innermost intercostal muscle layers

C. Each intercostal space is supplied by two anterior intercostal arteries

D. Posterior intercostal arteries supplying the first two spaces arise from the descending aorta

E. All anterior intercostal veins drain into the internal thoracic vein

7. The first rib

A. Its head articulates with the body of first thoracic vertebra

B. Its neck is related to the sympathetic trunk

C. The inner border gives attachment to the suprapleural membrane

D. Has a groove for the subclavian vein on its inferior surface

E. Articulates with the manubriosternal angle

8. Branches of the internal thoracic artery are

A. pericardiacophrenic artery

B. posterior intercostal artery

C. superior epigastric artery

D. musculophrenic artery

E. superior intercostal artery

9. Primary cartilaginous joints are

A. manubriosternal joint

B. sternoclavicular joint

C. costochondral joint

D. first sternocostal joint

E. costotransverse joint

10. Regarding thoracic vertebrae

A. The first thoracic vertebra has a complete facet for the 1st rib

B. They have thick bifid spines

C. Transverse process articulates with the neck of the corresponding rib

D. The articulation between two vertebral bodies is synovial

E. An inferior costal facet is absent on T9 vertebra

11. Regarding the inlet of the thorax

A. The lateral boundary is formed by the inner surface of the first rib and its costal cartilage

B. Manubrium sterni forms the anterior boundary

C. Posterior boundary is formed by the lower border of T4 vertebra

D. Brachiocephalic artery passes through it

E. Vertebral artery passes through it

12. The aortic opening in the diaphragm

A. lies anterior to the body of tenth thoracic vertebra

B. lies between the crura of the diaphragm

C. transmits the sympathetic trunk

D. transmits the vagus nerve

E. transmits the azygos vein

13. The thoracic sympathetic trunk

A. is present in the posterior mediastinum

B. has ganglia most of which lie anterior to the heads of ribs

C. passes into the abdomen behind the lateral arcuate ligament

D. sends postganglionic fibres to the cardiac plexus

E. sends preganglionic fibres to the greater splanchnic nerve

14. The diaphragm is developed from the

A. ventral mesentery of oesophagus

B. dorsal mesentery of oesophagus

C. pleuroperitoneal membrane

D. pleuropericardial membrane

E. septum transversum

15. Derivatives of the septum transversum include

A. lesser omentum

B. Kupffer cells

C. ligamentum teres

D. falciform ligament

E. central tendon of the diaphragm

16. The oesophageal opening in the diaphragm

A. is at the tenth thoracic vertebral level

B. is surrounded by a sling of fibres from right crus

C. lies in the central tendon of the diaphragm

D. transmits branches of the right gastric artery

E. transmits the right phrenic nerve

17. Regarding the diaphragm

A. The level of the diaphragm is higher in the supine position than in the standing position

B. The right dome reaches the upper border of the 5th rib

C. The central tendon lies at the level of the xiphisternal joint

D. The hemiazygos vein passes through the right crus

E. The sympathetic trunk passes behind the medial arcuate ligament

18. Regarding the arcuate ligaments of the diaphragm

A. The medial arcuate ligament is a thickening of lumbar fascia

B. The medial arcuate ligament has an attachment to the body of first lumbar vertebra

C. The lateral arcuate ligament is the thickening of the fascia of quadratus lumborum muscle

D. The lateral arcuate ligament extends from transverse process of L1 vertebra to the 12th rib

E. Crura develops from the dorsal mesentery of the oesophagus

The Thoracic Cavity

Superior Mediastinum

19. The superior vena cava

A. is formed by the right anterior cardinal and right common cardinal veins

B. is formed behind the manubrium sterni

C. opens into the right atrium behind the 3rd costal cartilage

D. receives the hemi azygos vein

E. lies in the superior mediastinum

20. Regarding the superior mediastinum

A. Its anterior boundary is formed by the body of the sternum

B. The arch of the aorta lies within it

C. The prevertebral fascial layer is present within it

D. It is separated from the inferior mediastinum by a plane passing through the third costal cartilage

E. It contains the thymus

21. The thoracic duct

A. commences at twelfth thoracic vertebral level

B. passes through the aortic opening of the diaphragm

C. lies along the left margin of the oesophagus in the superior mediastinum

D. crosses from right to left side at the fourth thoracic vertebral level

E. drains lymph from the right upper limb

22. Regarding the arch of the aorta

A. It commences at the level of the sternal angle

B. It is developed from the third left aortic arch

C. Left vagus nerve lies anterior to it

D. It forms the cervical constriction of the oesophagus

E. A cardinal sign in the coarctation of aorta is diminished femoral pulse

23. The ascending aorta

A. is an elastic artery

B. is developed from the fourth left aortic arch

C. lies posterior to the root of the pulmonary trunk

D. is covered by the fibrous pericardium at its commencement

E. is stenosed in tetralogy of Fallot

24. The trachea

A. commences at the inferior border of the cricoid cartilage

B. contains incomplete rings of hyaline cartilage

C. is lined by a simple columnar epithelium

D. bifurcates at the level of sternal angle

E. lies in the posterior mediastinum

25. Structures present in a cross section of the thorax at the upper border of the fourth thoracic vertebra include

A. arch of aorta

B. superior vena cava

C. left atrium

D. left vagus nerve

E. right atrium

26. The trachea

A. is about 10 cm in length

B. lies in the midline through out its course

C. is supplied by the inferior thyroid arteries

D. has an epithelium derived from the endoderm of the foregut

E. is supplied by the recurrent laryngeal nerves

27. The pulmonary trunk

A. lies within the pericardial sac

B. divides at the fourth thoracic vertebral level

C. lies posterior to the transverse sinus

D. is stenosed in Fallot’s tetralogy

E. is developed from the truncus arteriosus

28. The left principal (main) bronchus

A. is wider than the right principal bronchus

B. is longer than the right principal bronchus

C. is developed from the tracheo-bronchial diverticulum

D. divides into two lobar bronchi

E. has the root of the pulmonary trunk anterior to it

29. At the sternal angle

A. the first rib articulates with sternum

B. the aortic arch ends

C. the trachea bifurcates

D. the azygos vein enters the superior vena cava

E. the inferior boundary of the superior medisatinum is demarcated

30. Regarding the development of the venous system

A. Azygos vein is developed from the right supracardinal vein

B. Left brachiocephalic vein is developed from the left supracardinal vein

C. The inferior vena cava has a part developed from the right subcardinal vein

D. Right renal vein is developed from the subcardinal anastomosis

E. Common iliac vein is developed from the sacrocardinal anastomosis

31. Veins draining into the right brachiocephalic vein include

A. vertebral

B. inferior thyroid

C. middle thyroid

D. external jugular

E. internal thoracic

32. Structures found in both superior and posterior mediastina are

A. oesophagus

B. trachea

C. thoracic aorta

D. phrenic nerves

E. vagi

Anterior mediastinum

33. The thymus

A. lies in the anterior mediastinum

B. is developed from the 3rd branchial pouch

C. has lymphoid follicles

D. involutes after puberty

E. is supplied by the inferior thyroid artery

34. The thymus

A. is the only structure lying in the anterior mediastinum

B. has a blood supply from the internal thoracic artery

C. regresses soon after birth

D. contains Hassall’s corpuscles

E. lies in front of the left brachiocephalic vein

Middle mediastinum

35. In the foetal circulation mixing of oxygenated and deoxygenated blood occurs in the

A. left atrium

B. left ventricle

C. right atrium

D. right ventricle

E. liver

36. Embryonic structures that contribute to the inter-atrial septum include

A. septum primum

B. septum spurium

C. septum secondum

D. left valve of sinus venosus

E. right valve of sinus venosus

37. Ligaments that have foetal vessels of origin include

A. median umbilical ligament

B. ligamentum teres

C. ligamentum venosum

D. medial umbilical ligaments

E. gastrosplenic ligament

38. The right atrium

A. forms the right border of the heart

B. has a smooth part derived from the right horn of sinus venosus

C. has the sinuatrial node in its wall

D. has the crista terminalis separating the smooth and rough parts

E. receives the coronary sinus

39. The ductus arteriosus

A. represents the distal portion of the left sixth aortic arch

B. is functionally closed shortly after birth

C. connects the pulmonary vein to the aortic arch

D. is present as the ligamentum arteriosum at birth

E. shunts blood from the pulmonary trunk to the aorta before birth

40. The right coronary artery

A. arises from the anterior aortic sinus

B. supplies blood to the sinu-atrial node

C. is accompanied by the great cardiac vein

D. causes an infarction at the apex of the heart if occluded

E. gives off the circumflex branch

41. The left atrium

A. forms the major part of the left border of the heart

B. lies behind the right atrium

C. has the oblique sinus posterior to it

D. lies anterior to the oesophagus

E. receives the four pulmonary veins

42. Regarding the development of the heart A. The secondary septum completely divides the atrium B. The septum spurium contributes to the formation of the

interatrial septum C. The pulmonary arteries develop from the right horn of sinus venosus D. The right valve of sinus venosus gives rise to the valve of the

inferior vena cava E. The smooth part of the right atrium is developed from the left

horn of sinus venosus

Posterior Mediastinum

43. The descending thoracic aorta

A. begins at the level of the lower border of the fourth thoracic vertebra

B. lies in the posterior mediastinum

C. gives off the pericardiacophrenic artery

D. passes through the diaphragm at the tenth thoracic vertebral level

E. gives off branches to supply the middle third of the oesophagus

44. The azygos vein

A. is formed by the union of right subcostal and right ascending lumbar veins

B. passes through the oesophageal opening

C. arches over the root of the right lung

D. receives the superior intercostal vein

E. drains directly into the right atrium

45. Branches arising from the descending thoracic aorta are

A. third right posterior intercostal artery

B. musculophrenic artery

C. superior phrenic artery

D. superior intercostal artery

E. bronchial arteries

46. Regarding the thoracic part of the oesophagus

A. It lies posterior to the left bronchus

B. It lies anterior to the thoracic duct

C. Its wall is composed of smooth muscle along its entire length

D. Venous blood from the thoracic part drains into azygos vein

E. The right pulmonary artery is anterior to it

47. The oesophagus

A. is lined by the stratified squamous non keratininsed epithelium

B. is constricted by the right bronchus

C. lies posterior to the pericardium and the left atrium

D. passes through both superior and posterior mediastina

E. has an arterial supply from the left gastric artery

48. The right phrenic nerve

A. lies in the superior mediastinum

B. has the superior vena cava on its medial side

C. is posterior to the thoracic duct

D. passes through the caval opening in the diaphragm

E. supplies the fibrous pericardium

Lungs and Pleurae

49. The right lung

A. has its inferior lobe below and behind the oblique fissure

B. has four structures in the hilum

C. has five bronchopulmonary segments in its lower lobe

D. has the arch of the aorta related to its mediastinal surface

E. is supplied by two bronchial arteries

50. The parietal pleura

A. extends superiorly up to the neck of the first rib

B. is attached to the mediastinal surface of the fibous pericardium

C. is developed from the splanchnic mesoderm

D. forms the pulmonary ligament

E. forms the costo diaphragmatic recess

51. Regarding the bronchopulmonary segments

A. There are eight bronchopulmonary segments in each lung

B. Each segment is pyramidal in shape with the base towards the hilum

C. Each segment is supplied by a lobar bronchus

D. It is the smallest part of the lung that could be removed surgically

E. They are supplied by end arteries

52. Regarding the pleura

A. The cervical pleura extends above the clavicle

B. The parietal layer is separated from the thoracic wall by the endothoracic fascia

C. The parietal and visceral pleurae are continuous around the root of the lung

D. The visceral pleura extends into the depths of the interlobar fissures of the lung

E. The visceral pleura is sensitive to pain

Thorax : Answers and Explanations

Thoracic wall and diaphragm1.

A. True – The intercostal nerves are the ventral rami of T1 – T11 spinal nerves B. True - In the intercostal space the nerve lies in the subcostal groove between the internal intercostal muscle and innermost intercostal musclesC. True – The collateral branch arising near the angle of the rib supplies the muscles of that space. It also supplies the parietal pleura and the parietal peritoneum in the case of the lower nervesD. False – In the costal groove the nerve lies below the intercostal vessels. The order from above downwards is vein, artery and nerveE. True

2. A. True

B. False – The 3rd to 6th intercostal nerves supply only the thoracic wall

and are called typical nerves. The 7th to 11th nerves supply the

abdominal wall in addition to the intercostal spaces

C. True

D. True – It is a typical intercostal nerve

E. True – The lateral cutaneous branch of the 2nd intercostal nerve

crosses the axilla to the medial side of the arm as the

intercostobrachial nerve and supplies the skin of the

axilla . Not infrequently the lateral cutaneous nerve of

the 3rd intercostal nerve also supplies the skin of the axilla

3.A. False – The 3rd -11th arteries arise from the descending aorta. The 1st

and 2nd arise from the superior intercostal artery which is a

branch of the costocervical trunk

B. False – In the costal groove the artery is accompanied by the vein and

nerve. The relationship from above downwards being vein-

artery-nerve

C. False - The upper six arise from the internal thoracic artery and the

7th to 9th arise from the musculophrenic artery

D. True – The dorsal branch which supplies the muscles and skin at the

back gives off a spinal branch which supplies the spinal cord

and vertebrae.

E. True

4.A. False – The intercostal muscles are innervated by the corresponding

intercostal nerve.

The intercostal nerves are the anterior rami of first 11 thoracic spinal nerves. The anterior ramus of the twelfth thoracic nerve lies in the abdomen and runs forward in the

abdominal wall as the subcostal nerveB. True – Although the ribs develop from sclerotome the intercostal

muscles develop from the somatic mesoderm (body wall

muscles)

C. True – The muscle extends as far forwards as the costochondral

junction and continues as the anterior intercostal membrane

D. False – It is attached to the tubercle of the rib

E. False – The fibres of the external intercostal muscle are directed

downwards and forwards. The fibres of the internal

intercostal muscle are directed downwards and backwards

5.A. True – It is the second branch that arises from the inferior aspect of

the first part of the subclavian artery

B. True - It gives off two anterior intercostals to each of the upper six

intercostal spaces

C. True - It supplies the thymus via mediastinal branches

D. True – The artery terminates in the 6th intercostal space by dividing

into superior epigastric and musculophrenic artery

E. False

6.A. True - The fibres of the external intercostal muscle are directed

downwards and forwards. The fibres of the internal intercostal

muscle are directed downwards and backwards

B. False - The intercostal nerves and vessels (neurovascular bundle) run

between the intermediate and innermost layers of muscles

C. True - Each intercostal space contains a large single posterior

intercostal artery (branches of the descending thoracic aorta)

and two small anterior intercostal arteries (branches of the

internal thoracic artery)

D. False –They arise from the superior intercostal artery. Others arise

from the descending aorta

E. False - The upper six drain into the internal thoracic vein and the 7th -

9th spaces drain into the musculophrenic vein

7.A. True

B. True – Anteriorly the neck is related from medial to lateral to the

sympathetic chain, the first posterior intercostal vein, the

superior intercostal artery and the first thoracic nerve

C. True

D. False –The groove for the subclavian vein is on its superior surface

anterior to the scalene tubercle. The groove behind the

tubercle lodges the subclavian artery

E. False – It articulates with the manubrium sterni. The 2nd rib

articulates at the manubriosternal angle

8.A. True – Branches of the internal thoracic artery include : two anterior

intercostal arteries to each space, pericardiacophrenic artery, mediastinal branches, perforating branches, superior epigastric artery, musculophrenic artery

B. False – Posterior intercostal arteries are 11 in number. 1-2 arise from the superior intercostal artery and 3-11 arise from the descending aorta.

C. True

D. True

E. False - The superior intercostal artery is a branch of the costocervical trunk which comes off from the second part of the subclavian artery. The first and second posterior intercostal arteries arise from it

9.A. False – The manubriosternal joint is a symphyseal joint. The joint

between the body of the sternum and the xiphoid process

(xiphisternal joint) is another symphysis.

B. False – It is a synovial joint

C. True – The anterior end of each rib makes a a primary cartilaginous

joint with its costal cartilage (costochondral joint)

D. True – The first costal cartilage articulates with the sternum at a

primary cartilaginous joint. The other six costal cartilages (2nd

to 7th ) articulate with the sternum at synovial joints

E. False – It is a synovial joint

10.A. True – Except the first, tenth, eleventh and twelfth vertebrae all

others have demi facets to articulate with the respective ribs

B. False – This is not a feature of thoracic vertebrae. Bifid spines are

found in some of the cervical vertebrae (2nd to 6th)

C. True

D. False – The articulation between two vertebral bodies (the

intervertebral disc), is a symphyseal or secondary

cartilaginous

E. True – The tenth, eleventh and twelfth vertebrae have only single

facets on each side of their bodies for articulation with the

numerically corresponding ribs. The tenth rib has only a single

facet on the head for articulation with the body of the tenth

thoracic vertebra. It has no articulation with the vertebra

above. Hence T9 vertebra has no inferior costal facet.

11.A. True

B. True

C. False – The posterior boundary is formed by the superior surface of

the body of the first thoracic vertebra

D. True

E. False – The vertebral artery (right and left) arise from the first

part of the subclavian artery. The vertebral artery enters the

foramen transversarium of the sixth cervical vertebra. It does

not pass through the inlet of the thorax

12.A. False – The aortic opening lies anterior to the body of the twelfth

thoracic vertebra

B. True - It lies between the left and right crura which form the

median arcuate ligamnet

C. True – The sympathetic trunk passes behind the medial arcuate

ligament

D. False - It transmits the aorta with azygos vein to the right and the

thoracic duct between them

E. True

13.A. False – The thoracic sympathetic trunk lies posterior to the

costovertebral pleura. Hence it is not a content of the

posterior mediastinum

B. True – It has about 12 ganglia, most of which lie anterior to the

heads of ribs. The stellate ganglion (the fused first thoracic

ganglion and the inferior cervical ganglion) lies anterior to the

neck of the first rib while the lowest three ganglia lie lateral

to the corresponding vertebral bodies

C. False – It passes into the abdomen behind the medial arcuate

ligament which is the thickening of the psoas fascia. The

subcostal nerve and vessels pass behind the lateral arcuate

ligament which is the thickening of the quadratus lumborum

fascia

D. True – Postganglionic sympathetic fibres pass to the cardiac and

pulmonary plexuses, trachea, oesophagus, thoracic aorta and

its branches, and to each thoracic spinal nerves

E. True – Preganglionic sympathetic fibres are present in the greater

spanchnic nerve which receives branches from the fifth to

ninth thoracic sympathetic ganglia

14.A. False – The diaphragm is developed from four embryonic

structures

namely, the septum transversum, left and right

pleuroperitoneal membranes, dorsal mesentery of the

oesophagus and left and right lateral body wall muscles

originating from the lower six intercostal region

B. True

C. True

D. False

E. True

15.A. True – Derivatives of the septum transversum include the central

tendon of the diaphragm, falciform ligament, lesser omentum,

coronary ligaments of the liver, connective tissue and Kupffer

cells of the liver and connective tissue of the gall bladder

B. True

C. False

D. True

E. True

16.A. True

B. True – lies within a sling of muscle fibres originating from the right

crus

C. False – It lies in the muscular part of the diaphragm. The inferior vena

cava passes through the central tendon

D. False – It transmits the oesophageal branches of the left gastric

artery

E. False – It transmits the oesophagus, right and left vagus nerves,

oesophageal branches of left gastric artery and lymphatics

from the lower part of the oesophagus

17.A. True

B. True – The right dome reaches as high as the upper border of the

fifth rib whereas the left reaches the lower border of the fifth

rib

C. True

D. False – The hemiazygos vein passes through the left crus

E. True – The sympathetic trunk passes behind the medial arcuate

ligament which is the thickening of the psoas fascia. The

subcostal nerve and vessels pass through the lateral arcuate

ligament which is the thickening of the fascia of the quadratus

lumborum muscle

18.A. False – The medial arcuate ligament is the thickened upper

margin of

the fascia covering the anterior surface of the psoas muscle

The lateral arcuate ligament is the thickened upper margin of the fascia covering the anterior surface of the quadratus lumborum muscleB. False – The medial arcuate ligament extends from the body of

the

second lumbar vertebra to the transverse process of first

lumbar vertebra

C. True

D. True

E. True

The Thoracic Cavity

Superior Mediastinum

19.A. True

B. False – It is formed behind the right first costal cartilage by the union

of right and left brachiocephalic veins

C. True

D. False - Its tributaries are azygos vein, mediastinal and pericardial

veins

E. True – Its upper part lies in the superior mediastinum. The lower part

lies in the anterior mediastinum

20.A. False – The anterior boundary is formed by the manubrium as the

lower boundary of the superior mediastinum is at T4 level

(manubriosternal joint)

B. True – The commencement and the termination of the arch of the

aorta is at the T4 level (manubriosternal junction). Therefore

the arch of the aorta is above this level lying in the superior

mediastinum

C. True - The prevertebral fascial layer passes in front of the vertebral

bodies into the superior mediastinum and is attached to the

body of the fourth thoracic vertebra

D. False – It is separated from the inferior mediastinum by an imaginary

plane passing through the sternal angle anteriorly and the

lower border of the body of the fourth thoracic vertebra

posteriorly

E. True – Contents of the superior mediastinum include the thymus,

large veins, large arteries, trachea, oesophagus, thoracic duct

and sympathetic trunks

21.A. True – The thoracic duct commences as a continuation of cisterna

chili at the lower border of the twelfth thoracic vertebra

B. True – It passes through the aortic opening of the diaphragm

between the right crus of diaphragm and abdominal aorta

C. True – In the posterior mediastinum the thoracic duct passes

upwards in front of T12 to T5 vertebrae and lies between the

azygos vein and descending aorta. It crosses from right to left

side behind the oesophagus at T5 vertebral level. Next it

passes in the superior mediastinum along the left margin of

the oesophagus to the neck

D. False – It crosses from right to left side at the fifth thoracic vertebral

level

E. False – It drains right and left lower limbs, viscera and walls of the

abdomen and pelvis, left half of the thorax, left half of the

head and neck and left upper limb. The right lymphatic duct

drains the right upper limb

22.A. True – The arch of the aorta commences at the level of the

sternal

angle (T4 level). It passes upwards and backwards forming

an arch in the superior mediastinum. It then passes

downwards to the left of the midline to reach the level of the

fourth thoracic vertebra and continues as the descending

aorta

B. False - The third left aortic arch gives rise to the left internal carotid

artery. The arch of the aorta is developed from the fourth left

aortic arch

C. True – Both the left vagus and left phrenic nerves lie anterior to the

arch of the aorta

D. False - There are four constrictions in the oesophagus. The first is at

the cricopharyngeal sphincter (ie. 6 inches (15cm) away from

incisor teeth). This is called the cervical constriction. The

second is at the crossing of the arch of the aorta (ie 9 inches

(22.5 cm) from the incisor teeth). The third is at where it is

crossed by the left bronchus (ie. 11 inches (27.5 cm) from the

incisor teeth). The fourth is at where is passes through

the diaphragm ( 16 inches (40 cm) from the incisor teeth)

E. True – The pulsation in the femoral arteries of both lower limbs can

be absent or diminished in coarctation of aorta. A collateral

circulation helps to compensate the diminished blood flow

23.A. True – Arteries close to the heart are elastic arteries

B. False – The ascending aorta is developed from the truncus arteriosus.

A spiral septum forms within the truncus arteriosus which

separates the truncus into the pulmonary trunk and

ascending aorta.

The fourth left aortic arch gives rise to the arch of the aorta

C. True

D. True – The fibrous pericardium invests the commencement of great

vessels

E. False – The abnormalities present in tetralogy of Fallot are , high

ventricular septal defect, an overriding aorta, pulmonary

stenosis and right ventricular hypertrophy

24.

A. True – The trachea is the continuation of the larynx and it

commences in the neck below the cricoid cartilage at the level

of the sixth cervical vertebra

B. True – Its wall contains 16-20 incomplete rings of hyaline cartilage

C. False – It is lined by a pseudostratified columnar ciliated epithelium

with goblet cells which is the respiratory epithelium

D. True – It bifurcates into the two main bronchi at the level of the

sternal angle (T4-T5 vertebral level)

E. False – It lies in the superior mediastinum and bifurcates at the level

of the lower border of the fourth thoracic vertebra which is

the lower boundary of the superior mediastinum

25.A. True – Structures present in a cross section of the thorax at the

upper

border of T4 vertebral level include the arch of the aorta, left

and right lungs and pleura, superior vena cava, trachea,

oesophagus, azygos vein, left superior intercostal vein, vagi

and right and left phrenic nerves

B. True

C. False

D. True

E. False

26.A. True

B. False – It lies in the midline over most of its length but near the lower

end it deviates slightly to the right

C. True – Branches from the inferior thyroid and bronchial arteries form

an anastomotic network in the tracheal wall

D. True – Apart from the epithelium, the other structures (cartilage,

muscle etc) are derived from the splanchnic mesoderm

E. True – It receives a parasympathetic supply through vagi and

recurrent laryngeal nerves, and sympathetic fibres from the

upper ganglia of the sympathetic trunk to smooth muscles and

blood vessels

27.A. True – The fibrous pericardium blends with the wall of the pulmonary

trunk up to its division and thus it lies in the pericardial sac

B. False – The pulmonary trunk divides at the fifth thoracic vertebral

level

C. False – The pulmonary trunk lies anterior to the transverse sinus

D. True – The abnormalities present in the tetralogy of Fallot are high

ventricular septal defect, an overriding aorta, pulmonary

stenosis and right ventricular hypertrophy

E. True – The truncus arteriosus is divided into the pulmonary artery

and ascending aorta by the formation of a spiral septum

within it.

28.A. False – The left principal bronchus is narrower, longer and more

horizontal than the right principal bronchus

B. True

C. True – The lung develops as an outgrowth (diverticulum) from the

ventral aspect of the foregut which gives rise to all parts of

the bronchial tree ie. the trachea, principal bronchi, tertiary

bronchi, bronchioles and alveoli. This diverticulum is called

the tracheo-bronchial diverticulum

D. True – The left principal bronchus divides into two lobar bronchi

and the right principal bronchus into three lobar bronchi

E. True – The immediate relation of the left principal bronchus is the

pulmonary trunk. The arch of the aorta lies superior to the

left principal bronchus.

29.A. False – The sternal angle is the junction of the manubrium and

the

body of the sternum. It is located at the level where the

second costal cartilage articulates with the sternum. At this

level lies the bifurcation of the trachea, origin and

termination of the aortic arch and the opening of the azygos

vein into the superior vena cava. It marks the end of the arch

of the aorta and the beginning of the descending aorta. It

demarcates the inferior boundary of the superior

mediastinum

B. True

C. True

D. True

E. True

30. A. True - The azygos system of veins develop from the left and right

supra cardinal veins and supra cardinal anastomosis. Left

supra cardinal vein and supra cardinal anastomosis give rise

to the hemiazygos vein and the right supracardinal vein gives

rise to the azygos vein

B. False – The left brachiocephalic vein develops from the left anterior

cardinal vein and anterior cardinal anastomosis

C. True – The inferior vana cava develops from several embryonic

veins. From above downwards it develops from the right

vitelline vein (later becomes the right hapatocardiac channel),

right subcardinal vein, right sacrocardinal vein and

sacrocardinal anastomosis

D. False – The right renal vein has no embryonic vein of origin. The

subcardinal anastomosis gives rise to the left renal vein.

E. True

31.A. True – Both right and left brachiocephalic veins receive

vertebral,

inferior thyroid and internal thoracic veins (tributaries

corresponding to the branches of the first part of the

subclavian artery). In addition the left brachiocephalic vein

receives the superior intercostal vein

B. True

C. False – The middle thyroid vein drains into the internal jugular vein

D. False – The external jugular vein drains into the subclavian vein

E. True

32.A. True – The superior mediastinum contains the thymic remnants,

internal thoracic arteries and veins, brachiocephalic veins,

upper half of the superior vena cava, the aortic arch, the

braciocephalic artery, left common carotid artery, subclavian

arteries, the left superior intercostal vein, the vagus, cardiac,

phrenic, and left recurrent laryngeal nerves, the trachea,

oesophagus, the superficial part of the cardiac plexus and

thoracic duct.

The posterior mediastinum contains the oesophagus, thoracic aorta, azygos, hemiazygos and accessory azygos veins, the vagus and splanchnic nerves, thoracic duct and the posterior mediastinal lymph nodes. Hence the structures contained in both mediastina are the oesophagus, vagi and thoracic ductB. False – The trachea ends and bifurcates into left and right bronchi at

the sternal angle – the lower limit of the superior

mediastinum

C. False – The thoracic aorta which is the continuation of the arch of the

aorta begins at the level of the sternal angle and is located in

the posterior mediastinum

D. False – The phrenic nerves pass through the superior mediastinum

and the middle mediastinum only

E. True

Anterior mediastinum

33.A. True – The thymus lies in both the superior and anterior

mediastina.

B. True – It develops from the ventral wing of the third branchial pouch

C. False – The thymus consists of lymphoid cells arranged in lobes and

lobules

D. True– It is large and active during infancy and childhood and remains

active up to puberty after which it involutes

E. True – The inferior thyroid artery and branches of the internal

thoracic artery supply the thymus

34.A. False – The anterior mediastinum contains the thymus (or its

remnants), a few lymph nodes and branches of the internal

thoracic vessels

B. True - The inferior thyroid artery and branches of the internal

thoracic artery supply the thymus

C. False – It is largest in the early part of life up to adolescence,

although its activity continues into old age

D. True – Some of the epithelial cells become thymic (Hassall’s)

corpuscles and the others form an epithelial network

E. False – The thymus lies in front of the upper pericardium and great

vessels

Middle mediastinum

35.A. True – Mixing of oxygenated blood from the inferior vena cava

via

the foramen ovale and deoxygenated blood from the

pulmonary veins occur in the left atrium

B. False – Left ventricle receives oxygenated blood from the left atrium

and no deoxygenated blood enters into it

C. True – Mixing of oxygenated blood from the inferior vena cava and

deoxygenated blood from the superior vena cava occurs in

the right atrium

D. False - The right ventricle receives deoxygenated blood from the

superior vena cava (via the right atrium) and no oxygenated

blood enters into it

E. True – Oxygenated blood entering the liver via the left umbilical vein

(from the placenta) mixes with the deoxygenated blood from

the portal vein

36.A. True – The interatrial septum is developed from the septum

primum,

septum secundum, septum spurium and the left valve of sinus

venosus. The right valve of sinus venosus gives rise to the

crista terminalis and valves of the coronary sinus and inferior

vena cava

B. True

C. True

D. True

E. False

37.A. False – The median umbilical ligament is the urachus (a derivative

of

distal urogenital sinus) which is not a foetal vessel

B. True – The ligamentum teres is the obliterated left umbilical vein

which carries oxygenated blood from the placenta to the

foetus during foetal life

C. True – The ligamentum venosum is the obliterated ductus venosus

which shunts oxygenated blood from the left umbilical vein to

the right hepatocardiac channel which will be the post hepatic

part of the inferior vena cava

D. True – The left and right umbilical arteries which carry deoxygenated

blood from the foetus to the placenta form the medial

umbilical ligaments (distal part) and the superior vescical

arteries (proximal part)

E. False – The gastrosplenic ligament is a derivative of the dorsal

mesentery of the stomach and hence is not a foetal vessel

38.

A. True - The right border of the heart is formed by the right atrium, the

left border by the left atrium and left ventricle. The lower

border or base is formed by the left and right ventricles. The

upper border is related to the ascending aorta, pulmonary

trunk and superior vena cava

B. True - The right atrium has a smooth part and a rough part

separated by the crista. The smooth part is derivedfrom the

absorbed right horn of the sinus venosus and sinus venosus.

The rough part is the right side of the primitive common

atrium from the right horn of the sinus venosus

C. True – Both the sinuatrial and atrioventricular nodes are located in

the wall of the right atrium

D. False – The crista terminalis is developed from the upper part of the

right valve of sinus venosus and separates the smooth and

rough parts of the right atrium

E. True – The right atrium receives the superior vena cava, inferior vena

cava and the coronary sinus

39.A. True – It represents the distal portion of the of the left sixth

aortic

arch and connects the left pulmonary artery to the aortic arch

closer to the commencement of the descending aorta

B. True – It is functionally closed shortly after birth; however, its

structural closure takes place after several months

C. False – It connects the pulmonary artery to the aortic arch

D. True – At birth, with the pulmonary circulation, the release of

Bradykinin leads to the contraction of ductus arteriosus. It

gradually becomes a ligament

E. True – It shunts blood from the pulmonary trunk to the aortic arch

before birth, by passing the pulmonary circulation

40.

A. True – Arising from the anterior aortic sinus on the right side of the

pulmonary trunk the artery passes between the right auricle

and the pulmonary trunk and descends in the anterior

atrioventricular groove

B. True – The artery to the SA node supplies the SA node and right and

left atrioventricular bundles

C. False – It accompanies the small cardiac vein in the anterior

interventricular groove and accompanies the coronary sinus

in the right posterior coronary sulcus.

The great cardiac vein passes in the anterior interventricular

groove along with the anterior interventricular artery, a

branch of the left coronary artery

D. False – The apex of the heart receives blood from the anterior

interventricular branch of the left coronary artery and not by

a branch of the right coronary artery

E. False – The branches arising from the right coronary artery are conus

artery, SA nodal artery, marginal artery, AV nodal artery and

posterior interventricular branch.

The circumflex artery is a branch of the left coronary artery

41.A. False – The left border of the heart is formed mostly (4/5 ths) by

the

left ventricle, with the auricle of the left atrium forming the

uppermost part (1/5th ).

B. True - The left atrium forms the posterior surface (base) of the heart

and lies behind the right atriumC. True – The oblique sinus lies posterior to the left atrium and the

transverse sinus lies anterior to the left atrium

D. True – Its posterior relations are the oesophagus and descending

thoracic aorta

E. True – The four pulmonary veins, two on each side on its posterior wall open in to the left atrium. These veins do not have valves

42.A. False - The common atrium is separated by the interatrial septum

which in developed from four embryonic parts. They are the septum primum, septum secondum, septum spurium and the left value of sinus venosus.

B. True C. False - The pulmonary arteries develop from the proximal part of

the sixth aortic arches on left and right sides. The right horn

of sinus venosus along with the sinus venosus gets absorbed into the right side of the common atrium giving rise to the smooth part of the right atrium.

D. True - Upper half of the right valve of sinus venosus gives rise to the crista terminals and from the lower half develops the valves of the coronary sinus and inferior vena cava.

E. False- Smooth part of the right atrium is developed from the sinus venosus and its right horn. The coronary sinus develops from the left horn of sinus venosus.

Posterior Mediastinum

43.A. True – The descending thoracic aorta is the continuation of the

arch

of the aorta. The arch ends at the fourth thoracic vertebral

level and the descending aorta begins at this level

B. True

C. False –The pericardiacophrenic artery arises from the internal

thoracic artery

D. False – It passes through the diaphragm at T12 vertebral level

E. True – The upper part of the oesophagus (the cervical part) is

supplied by branches of the inferior thyroid arteries. The

middle part (the thoracic part) is supplied by oesophageal

branches of the descending thoracic aorta and bronchial

arteries. The lower part is supplied by the oesophageal

branches of the left gastric artery

44.A. True

B. False – It enters the thorax by passing through the aortic opening of

the diaphragm

C. True - It ascends upto the 4th thoracic vertebral level and arches

forwards over the root of the right lung and ends by opening

into the superior vena cava

D. True – Its tributaries are superior intercostal vein formed by 2nd, 3rd,

4th posterior intercostal veins, 5th 11th posterior intercostal

veins, hemiazygos and accessory hemiazygos, oesophageal,

pericardial and mediastinal veins, and the right bronchial vein.

E. False – The azygos vein drains into the superior vena cava. The right

atrium receives the superior vena cava, inferior vena cava and

the coronary sinus.

45.A. True – The descending aorta gives off nine pairs of posterior

intercostal arteries (for 3rd -11th spaces), a pair of subcostal

arteries, bronchial arteries, oesophageal vessels, pericardial

branches and superior phrenic arteries

B. False – The musculophrenic artery is a terminal branch of the internal

thoracic artery

C. True

D. False – The superior intercostal artery is a descending branch of the

costocervical trunk which comes off from the second part of

the subclavian artery

E. True

46.A. True – The anterior relations of the thoracic part of the

oesophagus

from above downwards are: the trachea and the left

recurrent laryngeal nerve; the left principal bronchus and the

right pulmonary artery; and the pericardium which separates

it from the left atrium

B. True – The thoracic part of the oesophagus lies anterior to the bodies

of the thoracic vertebrae, thoracic duct, azygos vein, right

posterior intercostal arteries and at the lower end the

descending thoracic aorta

C. False – The muscularis externa of the oesophagus in the upper third

is composed of skeletal muscle; the middle third is composed

of both skeletal and smooth muscle; and the lower third is

composed of smooth muscle

D. True – The veins from the upper third drain into the inferior thyroid

veins, from the middle third into the azygos veins and from

the lower third into the left gastric vein, a tributary of the

portal vein

E. True – Just below the bifurcation of the trachea in the posterior

mediastinum the oesophagus is crossed anteriorly by the left

main bronchus and the right pulmonary artery

47.A. True

B. False – The oesophagus has three anatomic constrictions. The first is

pharyngo-oesophageal junction, the second is where aortic

arch and left bronchus cross its anterior surface, and third

occurs where the oesophagus passes through the diaphragm

C. True – It lies posterior to the trachea and the left recurrent laryngeal

nerve; the left principal bronchus and the right pulmonary

artery; and the pericardium which separates it from the left

atrium

D. True

E. True – The upper third of the oesophagus is supplied by the inferior

thyroid artery, the middle third by branches from the

descending thoracic aorta, and the lower third by branches

from the left gastric artery

48.A. True – Nerves lying in the superior mediastinum are : phrenic,

vagus

and cardiac nerves, and left recurrent laryngeal nerve

B. True – The right brachiocephalic vein, superior vena cava, the

pericardium over the right atrium and the inferior cava lie on

its medial side

C. False – The right phrenic is not related to the thoracic duct

D. True – Its terminal branches pass through the caval opening in the

central tendon to supply the undersurface of the diaphragm

E. True – The phrenic nerve supplies the mediastinal pleura, fibrous

pericardium, parietal layer of the serous pericardium

Lungs and Pleurae

49.A. True – The right lung has three lobes. The inferior lobe is below

and

behind the oblique fissure. The part of right lung in front and

above the oblique fissure is subdivided in to the superior lobe

and middle lobe by the horizontal fissure. The left lung has

two lobes, superior and inferior, sparated by the oblique

fissure

B. False – The right lung has five structure in the hilum, namely the two

pulmonary veins, one pulmonary artery, upper lobar

bronchus and right principal bronchus. The left has four

structures in the hilum, namely the two pulmonary veins, one

pulmonary artery and the left principal bronchus

C. True – It has three, two and five bronchopulmonary segements in

the upper, middle and lower lobes respectively

D. False – The arch of the aorta is related to the mediastinal surface of

the left lung. The azygos vein is related to the mediastinal

surface of the right lung

E. False – It is supplied by a single bronchial artery

50.A. True – The parietal pleura is attached to the inferior surface of

the

suprapeural membrane and extends up to the neck of the first

rib

B. True

C. False – The parietal pleura is developed from the somatic mesoderm

and the visceral pleura from the visceral (splanchnic)

mesoderm

D. True – From the mediastinal layer of the parietal a cuff of membrane

surrounds the hilum of the lung (the root of lung) which forms

the pulmonary ligament inferiorly and continues with the

visceral pleura.

E. True – The parietal pleura lines the inner surface of the thoracic wall

(rib cage, vertebrae and diaphragm). The recess formed by the

parietal pleura inferiorly between the ribs and the diaphragm

is the costo diaphragmatic recess.

51.A. False – There are ten bronchpulmonary segments in each lung

and

each of the ten bronchopulmonary segments have ten

segmental bronchi

B. False – Each bronchopulmonary segment is pyramidal in shape with

the base towards the lung surface and apex towards the

hilum

C. False – Each segment is supplied by a segmental brochuus. Lobar

bronchi supply the lobes of the lung (two lobar bronchi in the

left lung and three lobar bronchi in the right lung)

D. True – It is the smallest part of the lung that could be surgically

removed with minimal bleeding and damage

E. True – This is important because if this artery gets blocked that part

will become an infarct

52.A. True – The cervical pleura extends up into the neck above the

clavicle

up to the level of the neck of the first rib, lining the

undersurface of suprapleural membrane. It reaches a level 1-

1.5 inches (2.5 – 4 cm) above the medial third of the clavicle

B. True – The parietal layer of pleura lines the thoracic wall. Loose

areolar tissue separates it from the endothoracic fascia which

is an extrapleural sheet of fascia that lines the thoracic wall

C. True – The two layers are continuous with one another by means of

a cuff of pleura that surrounds the structures entering and

leaving the lung at the hilum of each lung. This pleura extends

for a distance below the hilum froming a double layered fold

called the pulmonary ligament

D. True

E. False – It is sensitive to stretch, but is insensitive to common

sensations such as pain and touch. The parietal pleura is

sensitive to pain, temperature and pressure

________________________________________________________

Abdomen

2

Anterior Abdominal Wall

53. The transpyloric planeA. Transects the body through L1 vertebra

B. Is midway between the xiphisternum and the pubic symphysis

C. Crosses through the neck of the pancreas

D. Marks the level of termination of the spinal cord

E. Cuts through the neck of the gall bladder

54. Regarding the anterior abdominal wall

A. Skin around the umbilicus is supplied by the 10 th thoracic spinal nerve

B. The transpyloric plane marks the level of the hila of the kidneys

C. The intertubercular plane lies at the level of the pubic tubercles

D. The subcostal plane is at the L3 vertebral level

E. Nerves of the anterior abdominal wall lie between the internal oblique and external oblique muscles

55. At the transpyloric plane

A. the common iliac artery commences

B. the superior mesenteric artery arises from the aorta

C. the splenic vein joins the superior mesenteric vein to form the portal vein

D. the neck of the pancreas is located

E. the inferior vena cava commenses

56. The inguinal canal

A. commences at the superficial inguinal ring

B. has an anterior wall formed by the external oblique aponeurosis assisted laterally by the internal oblique muscle

C. has the floor formed by the inguinal ligament

D. has the posterior wall reinforced in its medial third by the conjoint tendon

E. transmits the round ligament in the female

57. The superficial inguinal ring

A. is oval shaped

B. is a defect in the superficial fascia

C. lies immediately above and lateral to the pubic tubercle

D. has crura giving attachment to external spermatic fascia

E. transmits the ilioinguinal nerve

58. Regarding the inguinal canal

A. It lies above the lateral part of the inguinal ligament

B. Its deep ring lies half an inch above the mid inguinal point

C. The lacunar ligament forms the floor medially

D. It transmits the genitofemoral nerve

E. Its roof is formed by the fibres of internal oblique and transversus abdominis muscles

59. The inguinal canal

A. is 1.5 cm long

B. has the ilioinguinal nerve entering through the deep ring

C. has part of its floor formed by the lacunar ligament

D. has fascia transversalis along the whole length of the posterior wall

E. has the inferior epigastric artery medial to its deep ring

60. The rectus abdominis muscle

A. arises from the pubic symphysis and pubic crest

B. inserts on to the 9th rib

C. is enclosed in the aponeurosis of the internal oblique muscle between the umbilicus and costal margin

D. has a tendinous intersection at the level of the umbilicus

E. is supplied by the iliohypogastric nerve

61. The external oblique muscle

A. has fibres interdigitating with fibres of latissimus dorsi

B. has an attachment to the anterior half of the iliac crest

C. has the superficial inguinal ring in its aponeurosis

D. contributes to the formation of the conjoint tendon

E. has its lower border forming the roof of the inguinal canal

62. Regarding the rectus sheath

A. The anterior layer above the level of the costal margin is formed by the external oblique aponeurosis

B. The posterior layer above the level of the costal margin formed by the internal oblique aponeurosis

C. The subcostal nerve supplies it

D. The anterior layer above the pubic symphysis is formed by the fusion of aponeuroses of external and internal oblique and transversus abdominis muscles

E. The posterior layer above the pubic symphysis is formed by the aponeurosis of the transversus abdominis muscle

63. The anterior abdominal wall is supplied by the

A. eighth posterior intercostal artery

B. superior epigastric artery

C. inferior epigastric artery

D. tenth posterior intercostal artery

E. musculophrenic artery

64. Nerves that supply the muscles of the anterior abdominal wall include

A. sixth intercostal nerve

B. subcostal nerve

C. ilioinguinal nerve

D. iliohypogastric nerve

E. lateral femoral cutaneous nerve

65. Components of the spermatic cord include

A. ilioinguinal nerve

B. vas deferens

C. genitofemoral nerve

D. appendix testis

E. testicular artery

66. Regarding vertebral levels

A. The portal vein commences at theL1 vertebral level

B. Bifurcation of the descending aorta is at the S1 level

C. Oesophageal opening in the diaphragm is at the T12 vertebral level

D. Bifurcation of the trachea is at the T6 vertebral level

E. The lower limit of the prevertebral fascia is at the T4 vertebral level

Vessels and Nerves of the Gut

67. The coeliac trunk

A. is the artery of the foregut

B. arises at the 10th thoracic vertebral level

C. gives off the splenic artery

D. supplies the entire oesophagus

E. lies behind the peritoneum of the lesser sac

68. The superior mesenteric artery

A. arises at the level of the transpyloric plane

B. lies behind the body of the pancreas

C. supplies the pancreas

D. lies anterior to the left renal vein

E. supplies the caecum

69. Branches arising from the superior mesenteric artery include

A. ileocolic

B. left colic

C. right gastric

D. gastroduodenal

E. inferior pancreaticoduodenal

70. The inferior mesenteric artery

A. arises at the L3 vertebral level

B. crosses the pelvic brim at the bifurcation of the left common iliac artery

C. supplies the descending colon

D. descends into the pelvis as the superior rectal artery

E. gives off the right colic artery

71. The portal vein

A. is formed behind the neck of the pancreas

B. lies in front of the inferior vena cava

C. receives right and left gastric veins

D. ascends in the greater omentum

E. lies anterior to the bile duct

72. Porto-systemic anastomoses occur at the

A. upper end of oesophagus

B. area around the umbilicus

C. anal canal

D. hilum of the spleen

E. transverse colon

73. The splenic vein

A. lies below the splenic artery

B. is derived from the left umbilical vein

C. ends behind the neck of the pancreas

D. receives short gastric veins

E. receives the right gastric vein

74. Regarding the blood supply of the gut

A. Left gastric artery supplies the lesser curvature of the stomach

B. Short gastric arteries supply the pyloric region of the stomach

C. Right colic artery supplies the ascending colon

D. Right gastric artery supplies the first part of the duodenum

E. Left colic artery supplies the proximal 1/3 of the transverse colon

75. Derivatives of the vitelline veins include

A. portal vein

B. inferior mesenteric vein

C. splenic vein

D. superior mesenteric vein

E. inferior vena cava

76. Regarding the coeliac plexus

A. It lies around the origin of the coeliac trunk

B. The greater splanchnic nerve carries postganglionic sympathetic fibres to the plexus

C. Both vagi contribute fibres to the plexus

D. The coeliac plexus contributes fibres to the renal plexus

E. The adrenal medulla receives preganglionic sympathetic fibres from the splanchnic nerves via the plexus

77. Regarding vertebral levels

A. Coeliac trunk arises at the tenth thoracic vertebral level

B. Superior mesenteric artery arises at the twelfth thoracic vertebral level

C. Inferior mesenteric artery arises at the third lumbar vertebral level

D. The abdominal aorta divides into right and left common iliac arteries at the fourth lumbar vertebral level

E. The common iliac artery divides at the level of the second sacral vertebral level

Abdominal cavity and the peritoneum

78. Which of the following is/are retroperitoneal

A. Ureter

B. Head of the pancreas

C. Ascending colon

D. Appendix

E. Spleen

79. Derivatives of the dorsal mesentery (dorsal mesogastrium) include

A. lienorenal ligament

B. spleen

C. falciform ligament

D. lesser omentum

E. greater omentum

80. Regarding the epiploic foramen

A. Its lower boundary is the second part of the duodenum

B. Its upper boundary is the caudate process of the liver

C. Its posterior boundary is the superior mesenteric vein

D. Its anterior boundary is the free margin of the lesser omentum

E. The right subhepatic space communicates with the lesser sac via the epiploic foramen

81. The lesser omentum

A. extends between the stomach and the liver

B. is attached to the greater curvature of the stomach

C. extends into the fissure for the ligamentum teres

D. forms the anterior boundary of the epiploic foramen

E. is developed from the ventral mesentery

82. Regarding the sigmoid mesocolon

A. It has two limbs diverging from each other at the common iliac bifurcation

B. Its lateral limb passes forwards along the pelvic brim

C. Its medial limb reaches the midline in front of the first sacral vertebra

D. It is derived from the dorsal mesentery

E. It is formed by the parietal layer of the peritoneum

83. Which of the following ligaments originate from foetal vessels

A. Ligamentum teres

B. Gastrosplenic ligament

C. Ligamentum venosum

D. Median umbilical ligament

E. Medial umbilical ligament

Development of the Gut

84. Regarding the rotation of the gut

A. The stomach rotates in an anticlockwise direction

B. The duodenum rotates 90° clockwise

C. Mid gut loop rotates 90° anticlockwise at 6th week intra uterine life

D. Mid gut rotation is complete at 10th week intra uterine life

E. Physiological umbilical herniation occurs after completion of mid gut rotation

85. Which of the following cells is/are mesodermal

A. Kupffer cells

B. APUD cells

C. Paneth cells

D. cells of the zona glomerulosa

E. hepatocytes

86. Abnormalities associated with a malrotation of the gut include

A. biliary atresia

B. Hirschprungs disease

C. annular pancreas

D. imperforate anus

E. vitelline fistula

Gastrointestinal Tract

87. The greater curvature of the stomach is supplied by the

A. left gastric artery

B. right gastric artery

C. short gastric arteries

D. left gastroepiploic artery

E. right gastroepiploic artery

88. Regarding the stomach

A. It receives all its arterial supply from the coeliac trunk

B. It is completely invested by the peritoneum

C. The lymph is drained to the celiac lymph nodes

D. It is lined by the stratified squamous non keratinizing epithelium

E. The lesser sac lies posterior to the stomach

89. Structures forming the stomach bed include

A. Left kidneyB. Splenic arteryC. Body of the pancreasD. Superior mesenteric arteryE. Lesser sac

90. First part of the duodenum

A. lies on the transpyloric planeB. is supplied by the celiac trunkC. is anterior to the bile ductD. is posterior to the gastroduodenal arteryE. is developed from the midgut

91. The jejunum differs from the ileum in having

A. a thicker wallB. longer vasa rectaC. Peyer’s patches D. more arterial arcadesE. broader windows

92. The caecum

A. is completely covered by the peritoneumB. lies over the iliacus and psoas musclesC. has taeniae coliD. is supplied by the inferior mesenteric arteryE. has the lateral cutaneous nerve of the thigh anterior to it

93. The second part of the duodenum

A. is covered in front with the peritoneumB. runs in front of the hilum of the right kidneyC. is supplied by superior pancreaticoduodenal arteryD. is developed entirely from the foregutE. has the bile duct opening in to its anterior wall

94. Meckel’s diverticulum

A. is found 2 feet distal to the ileocaecal junctionB. arises from the mesenteric surface of the ileumC. is a persistent remnant of the vitellointestinal ductD. contains renal and suprarenal tissueE. occurs in about 20% of the population

95. Posterior relations of the 1st part of the duodenum include

A. bile duct B. gall bladderC. gastroduodenal arteryD. portal veinE. neck of the pancreas

96. The ascending colon

A. is retroperitonealB. is a derivative of the hindgutC. extends upwards to the splenic flexureD. lies on the iliac fascia

E. is related to the anterior surface of the right kidney

97. Regarding the appendix

A. It is a derivative of the midgutB. The position of its base is constant in relation to the caecumC. It has its own mesenteryD. It is supplied by the inferior mesenteric arteryE. It has taenia coli

98. Regarding the appendix

A. It develops at the 4th week IULB. It is lined by a simple cuboidal epitheliumC. It is supplied by an end arteryD. Its surface projection is the tip of the right 9th costal cartilageE. Its commonest position is retrocaecal

Liver and Biliary System, Pancreas and Spleen

99. The caudate lobe of the liver

A. lies between the fissure for the ligamentum teres and gall bladder

B. is connected to the right lobe by the caudate process

C. forms the upper boundary of the foramen of Winslow

D. belongs to the left and right morphological lobes of the liver

E. is enclosed by the peritoneum

100. Regarding the bile duct

A. It is formed by the union of left and right hepatic ducts

B. Its lining is endodermal in origin

C. Its upper third lies in the free edge of the lesser omentum

D. It passes between the second part of the duodenum and head

of pancreas

E. It lies behind the right renal vein

101. The pancreas

A. has its neck in front of the commencement of the portal vein

B. has its tail related to the hilum of the kidney

C. consists of cells derived from neuroectoderm

D. is retroperitoneal

E. has its tail lying within the gastrosplenic ligament

102. Organs related to the visceral surface of the spleen include

A. Left kidney B. left colic flexureC. StomachD. Tail of the pancreas

E. Greater omentum

103. Organs related to the visceral surface of the liver include

A. StomachB. DuodenumC. Hepatic flexure of the colonD. Right kidneyE. Pancreas

104. Regarding the pancreas

A. Its head lies anterior to the commencement of the portal veinB. The uncinate process extends behind the superior mesenteric

vessels

C. Annular pancreas causes duodenal obstructionD. It is supplied by branches of the superior mesenteric arteryE. The tail passes in the lienorenal ligament

105. The spleen

A. Is developed from the dorsal mesogastriumB. Has a notch in its anterior borderC. Lies beneath the 7th and 9th ribsD. Has a lower pole extending upto the midaxillary lineE. Is supplied by vessels passing in the gastrosplenic ligament

Posterior Abdominal Wall

106. The abdominal aorta

A. passes through the diaphragm tenth thoracic vertebral level

B. terminates at the fifth lumbar vertebral level

C. gives off branches supplying the gut from its anterior aspect

D. has a longer course than the inferior vena cava in the abdomen

E. is accompanied by thoracic duct at the aortic opening

107. Paired branches of the abdominal aorta include

A. gonadal arteries

B. hepatic arteries

C. subcostal arteries

D. lumbar ateries

E. inferior phrenic arteries

108. The inferior vena cava

A. is formed at the fourth lumbar vertebral level

B. grooves the bare area of the liver

C. passes through the tendinous part of the diaphragm

D. receives the right suprarenal vein

E. has its post hepatic part derived from the left vitelline vein

109. Regarding the inferior vena cava

A. It passes through the diaphragm at the tenth thoracic vertebral level

B. It has a valve at its termination

C. Its post hepatic part is derived from the right supracardinal vein

D. It receives the hepatic vein

E. Both gonadal veins drain into it

110. Tributaries of the inferior vena cava include

A. left fourth lumbar vein

B. left gonadal vein

C. right renal vein

D. left suprarenal vein

E. right inferior phrenic vein

111. The right renal artery

A. arises from the aorta at the second lumbar vertebral level

B. lies anterior to the right crus of the diaphragm

C. passes anterior to the inferior vena cava

D. supplies the ureter

E. gives off the right gonadal artery

112. The left renal vein

A. lies posterior to the left renal artery

B. is longer than the right renal vein

C. is developed from the subcardinal anastomosis

D. enters the inferior vena cava at second lumbar vertebral level

E. receives the left gonadal vein

113. Regarding the lumbar plexus

A. It lies within the psoas major muscle

B. It is formed by the dorsal rami of upper four lumbar nerves

C. It has branches supplying the skin

D. The femoral nerve emerges from the medial border of the psoas muscle

E. It gives off the pudendal nerve

114. The genitofemoral nerve

A. descends on the quadratus lumborum muscle

B. is a branch of the femoral nerve

C. has its genital branch passing though the inguinal canal

D. supplies the cremaster muscle

E. has motor and sensory components

115. The ilioinguinal nerve

A. contains fibres arising from first and second lumbar segments

B. emerges from the lateral border of the psoas muscle

C. lies within the inguinal canal

D. supplies the skin of the scrotum

E. is entirely sensory

116. The ovarian artery

A. arises from the abdominal aorta just above the origin of renal

artery

B. lies on the psoas major muscle

C. crosses in front of the ureter

D. on the right side crosses in front of the inferior vena cava

E. supplies the ureter

Kidneys, Ureters and Suprarenal glands

117. The ureter

A. passes down on the psoas major muscle

B. has a narrowing at the pelviureteric junction

C. lies anterior to the gonadal vessels

D. crosses the bifurcation of the common iliac artery anteriorly

E. is developed from the paramesonephric duct

118. Regarding the right ureter

A. It is retroperitoneal

B. It is crossed by the right ileocolic vessels

C. It receives an arterial supply from the renal arteries

D. The projection of the ureter on a radiograph is opposite the tips of the transverse processes of upper lumbar vertebrae

E. It lies behind the fourth part of the duodenum

119. Regarding the suprarenal glands

A. They are symmetrical in shape

B. They are enclosed in renal fascia

C. Each gland is drained by three veins

D. The inferior vena cava is an anterior relation of the right suprarenal gland

E. The medulla is developed from endoderm

120. Regarding the suprarenal glands

A. The anterior surface of the left gland is in contact with the bare area of the liver

B. The left gland lies on the left crus of the diaphragm

C. Suprarenal arteries arise from the renal arteries

D. Cells of the zona glomerulosa develop from the neural crest cells

E. They receive preganglionic sympathetic fibres via the splanchnic nerves

121. Regarding the relations of the kidneys

A. The costodiaphragmatic recess of the pleura is at risk in the lumbar approach to the kidney

B. The right kidney rests on the twelfth rib

C. Iliohpogastric and ilioinguinal nerves are related posteriorly

D. The hilum of the left kidney is related to the pancreas

E. The hila of both kidneys lie at the subcostal plane

122. The anterior relations of the right kidney include

A. liver

B. second part of the duodenum

C. head of pancreas

D. hepatic flexure of colon

E. subcostal vessels

123. Derivatives of the metanephric blastema include

A. ureter

B. minor calyces

C. Bowmans capsule

D. distal convoluted tubule

E. collecting ducts

124. The adrenal cortex

A. has cells secreting androgens

B. is developed from the intermediate mesoderm

C. is supplied by the preganglionic sympathetic fibres

D. has cells having an abundance of smooth endoplasmic reticulum

E. has a rich reticulin fibre network

Abdomen : Answers and Explanations

53.A. True – The plane passes through the lower border of the L1

vertebra

B. False – The plane lies midway between the jugular notch (upper

border of the manubrium) and symphysis pubis

C. False – The plane passes through the head, neck and body of the

pancreas

D. True – The spinal cord ends at L1 vertebral level

E. True – It cuts each costal margin at the tip of the ninth costal

cartilage, which is at the lateral border of the rectus

abdominis; deep to this point on the right side lies the fundus

of the gall bladder

54.A. True– Dermatomes over the xiphoid process is T7, over the umbilicus

is T10 and over the pubis – L1

B. True - The hila of the kidneys lie at this plane, the right just

below and the left just above it

C. False – Intertubercular plane passes through the tubercles of iliac

crests and body of L5 vertebra

D. True – The subcostal plane passes through the lower border of the

10th costal cartilage and body of L3 vertebra

E. False – Nerves of the anterior abdominal wall lie between internal

oblique and transversus abdominis muscle

55. A. False – The abdominal aorta divides into the two common iliac

arteries at the level of the body of L4 vertebra

B. True - Thesuperior mesenteric artery arises from the aorta at the

level of the lower border of the body of L1 vertebra

C. True - The commencement of the portal vein is just behind the neck

of the pancreas

D. True

E. False – The inferior vena cava begins opposite the L5 vertebral level

by the confluence of the two common iliac veins behind the

right common iliac artery

56.A. False - The inguinal canal is an oblique passage through the lower

part of the anterior abdominal wall which commences at the

deep inguinal ring and ends at the superficial inguinal ring

B. True – The anterior wall along its entire length of the canal is formed

by the aponeurosis of the external oblique muscle. It is

reinforced in its lateral third by the internal oblique

C. True – The floor or the inferior wall is formed by the inrolled

inferior edge of the inguinal ligament (the aponeurosis of the

external oblique) reinforced medially by the lacunar ligament

D. True – The posterior wall is formed along its entire length by the

fascia transversalis. It is reinforced in its medial third by the

conjoint tendon

E. True– It transmits the round ligament of the uterus and the

ilioinguinal nerve in the female and the spermatic cord and

ilioinguinal nerve in the male

57.A. False – It is a triangular defect or aperture in the aponeurosis of

the

external oblique muscle

B. False

C. True

D. True - Margins of the ring are called the crura (lateral and medial)

and give attachment to external spermatic fascia

E. True - It transmits the round ligament of the uterus and the

ilioinguinal nerve in the female and the spermatic cord and

ilioinguinal nerve in the male

58. A. False - The inguinal canal is an oblique intermuscular slit about 4

cm

long lying above the medial part of the inguinal ligament

B. True – The deep ring lies about 1.25 cm (1 inch) above the midpoint

of the inguinal ligament which is an opening in the

transversalis fascia

C. True - The floor is the inrolled lower edge of the inguinal ligament

reinforced medially by the lacunar ligament

D. False – The inguinal canal transmits the spermatic cord and

ilioinguinal nerve in the male and the round ligament of

uterus and ilioinguinal nerve in the female. The genitofemoral

nerve is formed in the psoas major muscle and emerges

on its anterior surface and runs down along the muscle,

pierces the psoas fascia and divides into the genital and

femoral branches. The genital branch passes through the

deep ring, enters the inguinal canal and supplies the

cremaster muscle, spermatic fascia, tunica vaginalis and

scrotal skin

E. True – The roof is formed by the lower edges of the internal

oblique and transversus abdominis muscles

59.A. False – It is 1.5 inches (4 cm) long

B. False – The ilioinguinal nerve enters the canal by piercing the lower

border of the internal oblique muscle and emerges through

the superficial inguinal ring

C. True – The floor is formed by the inrolled lower border of the

inguinal ligament and reinforced medially by the lacunar

ligament

D. True – The posterior wall is formed along its entire length by fascia

transversalis. It is reinforced on its medial third by the

conjoint tendon

E. True – Related to it medially are the inferior epigastric vessels,

which pass upward from the external iliac vessels

60.A. True – It arises by two heads: a medial from in front of the pubic

symphysis and a lateral from the pubic crest

B. False – The muscle is inserted on to the front of the 5 th to 7th

costal

cartilages

C. True – Between the umbilicus and costal margin, the aponeurosis of

the internal oblique splits into anterior and posterior layers to

enclose the rectus abdominis muscle

D. True – Typically three tendinous intersections are found in the

muscle, one at the umbilicus, one at the xiphisternum, and

one between these two

E. False – The rectus muscle and external obique muscle are both

supplied by the lower intercostal and subcostal nerves (T7-

T12). The internal oblique and transversus abdominis are also

supplied by the same nerves but with the addition of the

iliohypogastric and ilioinguinal nerves (L1)

61.

A. True – The muscle arises by eight digitations, one from each of

the lower eight ribs. The lower four slips interdigitate with

the costal fibres of latissimus dorsi and the upper four

with the digitations of the sarratus anterior

B. True – The muscle has a free posterior border which extends

from the twelfth rib to its insertion into the anterior half

of the outer lip of the iliac crest

C. True - Above and lateral to the pubic tubercle is the superficial

inguinal ring in the aponeurosis of the external oblique

muscle

D. False – Muscles contributing to the formation of the conjoint

tendon are the internal oblique and the transversus

abdominis

E. False – Its lower border forms the inguinal ligament. The inguinal

ligament forms the floor of the inguinal canal. The roof of

the canal is formed by arching fibres of internal oblique

and transversus abdominis

62.A. True

B. False – The posterior layer above the level of the costal margin

has no rectus sheath. The rectus muscle rests directly on

the fifth, sixth and seventh costal cartilages

C. True – Seventh to eleventh intercostal nerves and subcostal

nerve (12th thoracic nerve) supply it

D. True

E. False – The posterior layer above the pubic symphysis is deficient

and the rectus muscle rests directly on the fascia

transversalis

63.A. False – The anterior abdominal wall is supplied by the superior

epigastric and musculophrenic arteries (branches of internal

throracic artery), tenth and eleventh posterior intercostal

arteries (branches of thoracic aorta), subcostal artery,

inferior epigastric artery and deep circumflex iliac artery

(branches of the external iliac artery) and lumbar arteries

(dorsal branches of abdominal aorta)

B. True

C. True

D. True

E. True

64.A. False – Rectus abdominis and external oblique muscles are

supplied

by the lower intercostals (T7-T12) and subcostal (T12) nerves;

the internal oblique and transversus abdominis by the lower

intercostals, subcostal, iliohypogastric and ilioinguinal nerves

and the lowest fibres of the internal oblique and transversus

abdominis by the first lumbar fibres.

B. True

C. True

D. True

E. False

65.A. False – The spermatic cord has three coverings and six constituents. They are the internal spermatic fascia, cremasteric fascia and muscle, external spermatic fascia, ductus deferns, testicular artery with the artery to the ducts and cremasteric artery, pampiniform plexus of veins, lymphatics, genital branch of the genitofemoral nerve and processus vaginalis. The ilioinguinal nerve passes down deep to the external oblique muscle and emerges on the front of the spermatic cord through the superficial inguinal ring. B. TrueC. TrueD. False - The appendix testis is a small cystic part attached to the upper pole of testis which is a remnant of the paramesonephric ductE. True

66.A. True - The portal vein commences behind the neck of pancreas

by the union of the splenic vein and superior mesenteric vein

at the first lumbar vertebral level

B. False – Bifurcation of the descending aorta is at the fourth lumbar

vertebral level

C. False – Oesophageal opening in the diaphragm is at the tenth

thoracic vertebral level. The inferior vena caval opening is

at the eighth thoracic vertebral level and the aortic opening

is at the twelfth thoracic vertebral level

D. False – Bifurcation of the trachea is at the fourth thoracic vertebral

level which is at the level of the manubriosternal joint (angle

of Louis)

E. True – The prevertebral fascia extends from the base of the skull

to the fourth thoracic vertebral level

Vessels and Nerves of the Gut67.A. True – It is the artery of the distal part of the foregut and

supplies

the gastrointestinal tract from the lower one third of the

oesophagus down to the duodenum as far as the opening of

the bile duct. It supplies the liver, spleen and pancreas

which are foregut derivatives

B. False – It arises at the 12th thoracic vertebral level

C. True – Its three branches are the left gastric, splenic and

common hepatic arteries

D. False – The derivatives of the distal part of the foregut including the

liver, pancreas and spleen are supplied by the coeliac trunk.

The upper part of the oesophagus is supplied by the inferior

thyroid arteries; middle part by the oesophageal branches of

the aorta and bronchial arteries; and the lower part by the

oesophageal branches of the left gastric artery

E. True – The three branches from the coeliac trunk are given off at the

upper border of the pancreas behind the peritoneum of the

posterior wall of the upper sac

68.A. True – It arises from the abdominal aorta a centimeter below the

origin of the celiac trunk at the L1 vertebral level

B. True - After airsing from the aorta the superior mesenteric artery is

directed downwards behind the body of the pancreas and

splenic vein

C. False – It is the artery of the mid gut and supplies the gut from

the duodenal papilla up to the junction between the proximal

two-thirds and distal one-third of the transverse colon.

The pancreas is supplied mainly by the splenic artery, a branch

of the coeliac trunk (neck, body and tail). Superior and inferior

pancreaticoduodenal arteries supply the head of pancreas

D. True – It lies anterior to the left renal vein, uncinate process of

the pancreas and the third part of the duodenum, in that

order from above downwards

E. True – The ileocolic artery is a branch of the superior mesenteric

artery. The inferior branch of the ileocolic artery gives off the

anterior and posterior caecal arteries to supply the caecum.

69.A. True – Branches arising from the superior mesenteric artery are

inferior pancreaticoduodenal, ileocolic, right colic, middle

colic, jejunal and ileal arteries

B. False – The left colic is a branch of the inferior mesenteric artery

C. False – The right gastric artery is a branch of the common hepatic

artery which arises from the coeliac trunk

D. False – The gastroduodenal artery is a branch of the common hepatic

artery which arises from the coeliac trunk

E. True

70.

A. True – It arises from the aorta behind the inferior border of the third

part of the duodenum at the third lumbar vertebral level (3-4

cm above the bifurcation of the aorta)

B. True – It crosses the pelvic brim at the bifurcation of the left

common iliac vessels over the sacroiliac joint and converges

towards the ureter and lie at the apex of the attachment of

the sigmoid mesocolon

C. True – It supplies the distal third of the transverse colon, left colic

Flexure (splenic flexure), the descending colon, the sigmoid

colon, the rectum, and the anal canal above the pectinate line

D. True – The terminal branch of the inferior mesenteric artery is the

superior rectal artery which anastomoses with the last

branch of the sigmoid arteries

E. False – Its branches are the left colic, sigmoid and superior rectal

arteries. The right colic artery is a branch of the superior

mesenteric artery

71.

A. True - The portal vein is formed by the union of splenic vein (which

also receives the inferior mesenteric vein) with

the superior mesenteric vein, behind the neck of the

pancreas at the 1st lumbar vertebral level

B. True – It lies in front of the inferior vena cava behind the neck of

the pancreas and the first part of the duodenum. By

entering between the two layers of the lesser omentum it

loses contact with the inferior vena cava

C. True – Tributaries of the portal vein are the right and left gastric

veins, superior pancreaticoduodenal veins, cystic veins

and paraumbilical veins

D. False – it ascends in the free edge of the lesser omentum

E. False – The portal vein runs upwards in the free edge of the lesser

omentum which forms the anterior boundary of the epiploic

foramen lying behind the bile duct and the hepatic artery

72.A. False – The following are the four common sites of porto-

systemic anastomoses:

(i) At the lower end of the oesophagus (oesophageal or gastric varices) the oesophageal branches of the left gastric

vein (portal tributary) anastomoses with oesophageal veins that drain into azygos and accessory azygos veins (ii) Anorectal region – superior rectal veins (portal tributary) anastomose with the middle and inferior rectal veins (systemic tributaries) that drain into internal iliac and pudendal veins (iii) Around the umbilicus – the left branch of the portal vein anastomoses with the superficial veins (superior and inferior epigastric) of the anterior abdominal wall (systemic tributaries) through paraumbilical veins that accompany the ligamentum teres In portal obstruction the veins around the umbilicus distend. The distended veins radiate from the umbilicus giving rise to caput medusae (iv) In the bare area of liver – the right branch of the portal vein in the bare area anastomoses with the retroperitoneal veins that drain into lumbar, azygos and hemiazygos veinsB. True

C. True

D. False

E. False

73.A. True – The vein leaves the hilum of the spleen and passes in the

lienorenal ligament lying below the splenic artery

B. False – The splenic vein has no foetal vessel of origin. The left

umbilical vein which is the main source of oxygenated blood

to the foetus becomes the ligamentum teres after birth

C. True – It unites with the superior mesenteric vein behind the

neck of the pancreas (at the first lumbar vertebral level) to

form the portal vein

D. True – It receives short gastric, left gastroepiploic, inferior

mesenteric and pancreatic veins

E. False - The right gastric vein passes along the lesser curvature to the

pylorus of the stomach and empties into the portal vein

74.A. True – The lesser curvature of the stomach is supplied by the left

and right gastric arteries

B. False – Short gastric arteries (about six branches) are branches

from the splenic artery that supply the fundus and upper

part of the greater curvature of the stomach. The pyloric

region of the stomach is supplied by the gastroduodenal

artery, right gastroepiploic artery and supraduodenal artery

C. True – The ascending colon is supplied by the ileocolic, right

colic and middle colic arteries, which are branches of the

superior mesenteric artery

D. True – The first 2 cm of the duodenum receives blood from the

hepatic, gastroduodenal, supraduodenal, right gastric and

right gastroepiploic arteries

E. False - The middle colic artery, a branch of the superior mesenteric

artery supplies the proximal 1/3 of the transverse colon.

The left colic artery supplies the descending colon

75.A. True – Left and right vitelline veins and vitelline anastomosis give

rise to superior mesenteric vein, portal vein and post hepatic

inferior vena cava. The inferior mesenteric and splenic veins

do not have a foetal vessel of origin

B. False

C. False

D. True

E. True

76.A. True – It lies around the origin of the coeliac trunk above the

upper border of the pancreas

B. False – The greater and lesser splanchnic nerves carry preganglionic

sympathetic fibres. They pierce the crura of the diaphragm

and enter the two large coeliac ganglia

C. True

D. True – Fibres from the plexus supply all abdominal viscera, renal

ganglion and plexus, testes and ovaries

E. True – Preganglionic fibres from the greater splanchnic nerve

pass without relay to the cells of the suprarenal medulla

77.A. False – The coeliac trunk arises from the abdominal aorta

between

the crura of the diaphragm a little below the median

arcuate ligament at the twelfth thoracic vertebral level

B. False – The superior mesenteric artery arises from the aorta a

centimeter below the coeliac trunk at the first lumbar

vertebral level

C. True – The inferior mesenteric artery arises from the aorta

behind the inferior border of the third part of the

duodenum at the third lumbar vertebral level

D. True – The abdominal aorta passes behind the median arcuate

ligament at the twelfth thoracic vertebral level and

passes downwards behind the peritoneum on the bodies

of lumbar vertebrae with the left sympathetic trunk at its

left margin. At the fourth lumbar vertebral level it divides

into the two common iliac arteries

E. False – The common iliac arteries divide into internal and

external iliac arteries at the fifth lumbar vertebral level

(at the disc between the 5th lumbar vertebra and the

sacrum) in front of the sacroiliac joint

78.A. False – Although the kidney is retroperitoneal, the ureter lies on

the posterior abdominal wall in front of the muscles

B. True – The pancreas after development fuses with the posterior

abdominal wall and becomes secondarily retroperitoneal

C. True – During development the descending colon has a dorsal

mesentery which will fuse with the posterior abdominal

wall and becomes retroperitoneal

D. False – The appendix has a mesentery called the mesoappendix

and is not retroperitoneal

E. False– The spleen develops in the dorsal mesentery and is

attached to the posterior abdominal wall by the

lienorenal ligament

79.A. True – Derivatives of the dorsal mesentery include the greater

omentum, gastrosplenic ligament, spleen and the

lienorenal ligament. The lesser omentum and falciform

ligament develops from the ventral mesentery (ventral

mesogastrium)

B. True

C. False

D. False

E. True

80.A. False – Its lower boundary is the first part of the duodenum

B. True

C. False – The posterior boundary is the inferior vena cava covered

by the parietal peritoneum of the posterior abdominal

wall

D. True – The free margin of the lesser omentum contains between

its two peritoneal layers the portal vein and anterior to it

the hepatic artery and bile duct

E. True – Left (lesser sac) and righr subhepatic spaces communicate

with each other via the epiploic foramen

81.A. True – The two layers of peritoneum that extend between the

liver and the lesser curvature of the stomach constitute

the lesser omentum. This is part of the ventral mesogastrium

B. False – It is attached to the lesser curvature of the stomach. The

greater omentum is attached to the greater curvature of the

stomach.

C. False – The attachment of the lesser omentum to the liver is L-

shaped. It is attached to the fissure for the ligamentum

venosum and the porta hapatis

D. True – Anteriorly the foramen is bounded by the right free

margin of the lesser omentum containing between its two

peritoneal layers the portal vein, hepatic artery and bile duct.

E. True - The ventral mesentery (or septum transversum) gives rise to

the lesser omentum, falciform ligament, central tendon of

diaphragm, connective tissue of the liver, Kupffer cells and

coronary ligaments

82.A. True – The sigmoid mesocolon has an inverted ‘V’ shape with

two limbs diverging from each other at the bifurcation of

the common iliac vessels, on the pelvic brim over the left

sacroiliac joint

B. True – The lateral limb passes forward along the pelvic brim

C. False – The medial limb slopes down to the hollow of the sacrum,

reaches the midline in front of the third sacral vertebra

(at the commencement of the rectum)

D. True – There is no ventral mesentery in relation to the sigmoid

colon

E. False – The sigmoid mesocolon is a double fold of visceral layer of

peritoneum suspended from the sigmoid colon.

83.A. True - The left umbilical vein that carries oxygenated blood from

the placenta to the foetus becomes the ligamentum teres

after birth

B. False – The gastrosplenic ligament is derived from the dorsal

mesogastrium and extends from the stomach to the

spleen

C. True - Ligamentum venosum carries oxygenated blood coming

from the left umbilical vein to the right hepatocardiac vein

during foetal life. It becomes ligamentous after birth with

the cessation of blood entering via the left umbilical vein

D. False – The median umbilical ligament is the distal part of the

urogenital sinus (earlier the allantoic diverticulum) which

forms the urachus. It becomes ligamentous at birth. It

is attached to the anterior wall of the urinary bladder

E. True – The medial umbilical ligaments are the obliterated distal

parts of the left and right umbilical arteries. The umbilical

arteries carry deoxygenated blood from the foetus to the

placenta during foetal life. The proximal part of the

umbilical arteries become the superior vesical arteries

84.A. False – The stomach rotates 90° in a clockwise direction

B. False – The duodenum does not rotate during development

C. True- The midgut rotates 90° anticlockwise at the 6th week

intrauterine life and completes its rotation at the 10 th week

intrauterine life by rotating another 180° anticlockwise

D. True

E. False – Physiological umbilical herniation occurs between 6th to

10th week intrauterine life and the rotation occurs during

this period

85.A. True – Kupffer cells are the macrophage cells in the liver. These

cells are derived from the septum transversum which is

the ventral mesogastrium. Hence they develop from

mesoderm

B. False – APUD cells are neuroendocrine cells of the gut wall. These

cells are developed from the neural crest cells

C. False – Paneth cells are present in the intestinal mucosa and

hence derived from the endoderm

D. True – Zona glomerulosa cells are present in the adrenal

cortex.The adrenal cortex is developed from the

intermediate mesoderm and therefore the cells of the zona

glomerulosa are mesodermal in origin. The adrenal medullary

cells are neural crest in origin

E. False – The liver develops from the hepatic diverticulum from the

foregut endoderm. Therefore the hepatocytes (liver

parenchymal cells) are derived from the endoderm

86.A. False – Biliary atresia occurs due to the non canalization of the bile

duct.

B. Fasle - Hirschprungs disease is due to the absence of nerve plexus

(parasympathetic nerve cells) which develops from neural

crests.

C. True – During the rotation of the mid gut, the two pancreatic

buds (dorsal and ventral) fuse together in an abnormal

way giving rise to a ring of pancreatic tissue around the

duodenum, called the annular pancreas

D. False – An imperforate anus occurs due to the non rupture of the

anal membrane

E. False – A vitelline fistula occurs due to the persistence of the

vitello-intestinal duct which connects the ileum with the

umbilicus

87.A. False – The greater curvature of the stomach is supplied by the

short gastric, left and right gastroepiploic arteries

The lesser curvature is supplied by the left and right gastric arteriesB. False

C. True

D. True

E. True

88.A. True – The stomach is a derivative of the foregut and its artery of

supply is the coeliac trunk and therefore it is supplied

by branches of the coeliac trunk.

B. True– The stomach has a dorsal and a ventral mesentery

(mesogastrium). Hence it is completely covered by the

peritoneum

C. True

D. False – The epithelium lining the stomach is simple columnar

epithelium. This epithelium forms gastric glandsof the gut.

The stratified squamous epithelium is present in the oral

cavity, oesophagus and the lower third of the anal canal

E. True – The peritoneum of the anterior wall of the lesser sac covers

the posterior wall of the stomach and the stomach bed is

covered by the posterior wall of the lesser sac

89.A. True – Behind the stomach are a group of structures comprising

the stomach bed. Structures forming the stomach bed

include the lesser sac, left crus and the dome of the

diaphragm, splenic artery, body of the pancreas, transverse

mesocolon, upper part of left kidney, left suprarenal gland,

spleen and left colic flexure

B. TrueC. TrueD. FalseE. True

90.

A. True – The duodenum makes a C-shaped loop round the head of

the pancreas, which is opposite the body of L2 vertebra.

The first part lies at the level of L1 vertebra (at the

transpyloric plane), the second on the right side of L2

vertebra, the third crosses in front of L3 vertebra, and the

fourth is on the left of L2 vertebra

B. True – The foregut is supplied by the coeliac trunk. The first part and

the second part of the duodenum upto the duodenal papilla is

derived from the foregut and hence supplied by branches of

the coeliac trunk

C. True – It lies in front of the gastroduodenal artery, bile duct and

portal vein

D. False – The lesser sac, bile duct, gastroduodenal artery, portal

vein and inferior vena cava are posterior relations of the

first part of the duodenum

E. False – It is a derivative of the foregut

91.

A. True – The jejunum has a larger diameter and a thicker wall than the

ileum.

B. True – It has longer vasa recta or straight arteriesC. False –Peyer’s patches or aggregations of lymphoid follicles are

present in the ileum

D. False – The jejunum has less prominent arterial arcades or

anastomotic loops in its mesentery compared to the

ileum

E. False – The jejunum has high narrow windows between the

straight arteries running to its wall whereas the ileum has

low broad windows

92.A. True – It is situated in the right iliac fossa and is completely

covered by the peritoneum

B. True – It lies on the right iliac fosaa on the fascia over the iliacus and

psoas muscle and femoral and lateral femoral cutaneous

nerves

C. True – As in the rest of the colon the longitudinal muscle layer is

concentrated into three flat bands called taeniae coli which

converge on to the base of the appendix

D. False – It is supplied by branches of the ileocolic artery (anterior

and posterior caecal arteries) which is a branch of the

superior mesenteric artery. The inferior mesenteric artery

supplies the derivatives of the hindgut (from distal 1/3 of the

colon to upper part of anal canal)

E. False - The femoral and lateral cutaneous nerve of the thigh lie

posterior to the caecum

93.A. True – Also it is crossed by the attachment of the transverse

mesocolon

B. TrueC. True – It is supplied by the superior pancreaticoduodenal artery

which is a branch of the gastroduodenal artery. Also it receives

branches from the inferior pancreaticoduodenal artery, a

branch of the superior mesenteric artery

D. False – The foregut gives rise to the duodenum proximal to the

entrance of bile duct (duodenal papilla) and the midgut gives

rise to the duodenum distal to the entrance of the bile duct.

Hence the second part of the duodenum is developed from

both the foregut and the midgut

E. Fasle – Its posteromedial wall receives the common opening of

the bile duct and the pancreatic duct at the

hepatopancreatic ampulla that opens on the summit of

the major duodenal papilla

94.A. False – Meckel’s diverticulum, a finger-like pouch of the ileum is

located 2 feet proximal to the ileoceacal junction

B. False – It arises from the antimesenteric border of the ileumC. True - It is a persistent remnant of the yolk sac (vitelline duct)

and may be connected to the umbilicus via a fibrous cord

or fistula

D. False – It may contain gastric, liver or pancreatic mucosal tissueE. False – It occurs in about 2% of the population

95.A. True – Posterior to the 1st part of the duodenum, the

gastroduodenal artery, bile duct and portal vein are found

and behind these structures lies the inferior vena cava

B. False - The gall bladder lies anterior to the first part of the duodenum

(duodenal cap)

C. TrueD. TrueE. False – The pancreas is not a posterior relation of any of the parts

of

the duodenum. The head of the pancreas is moulded into the

‘C’ shaped concavity of the duodenum and completely fills it

96.A. True – Of the four parts of the colon, transverse and sigmoid

parts are suspended by mesenteries but the ascending and

descending colon are plastered on to the posterior

abdominal wall and covered by the peritoneum only on the

anterior surface thus making it retroperitoneal

B. False – The ascending colon and the proximal two-thirds of the

transverse colon are derivatives of the midgut. The distal one-

third of the transverse colon, descending colon, sigmoid colon

and proximal part of the rectum are derivatives of the

hindgut.

C. False – The ascending colon extends upwards from the ileocaecal

junction to the right colic flexure (hepatic flexure)

D. True – It lies on both the iliac fascia and the anterior layer of lumbar

fascia

E. True – The right colic (hepatic) flexure is related to the inferolateral

part of the anterior surface of the right kidney

97.

A. True – The derivatives of the midgut include the duodenum (distal

duodenal papilla), jejunum, ileum, caecum, appendix ,

ascending colon and the proximal 2/3 of the transverse colon

B. True – In relation to the abdominal wall its base is situated one-

third of the way up the line joining the right anterior ileac

spine to the umbilicus (McBurney’s point) and the position of

the base is constant in relation to the caecum although it may

lie in a variety of positions

C. True – It has its own short mesentery named the mesoappendixD. False – It is supplied by the appendicular artery which is a branch

of the inferior division of the ileocaecal artery. This is an end

artery

E. False – The three taenia coli of the caecum merge to a point at the

base of the appendix. Therfore taenia coli are not present in

the appendix

98.

A. False – Although organogenesis of most of the organs commences

at the 4th week intrauterine life, the appendix is an exception.

It develops at the 10th week intrauterine life

B. False – The appendix is a part of the large intestine. Therefore

the epithelium that lines it is the simple columnar

epithelium

C. True – The appendix is supplied by the appendicular artery

which is a branch of the inferior division of the ileocaecal

artery. The appendicular artery may be thrombosed in

appendicitis which may lead to ischaemic necrosis of the

appendix as there is no collateral circulation

D. False – As the position of the appendix is variable there is no

definitive surface projection. The surface projection of the

fundus of the gall bladder is the tip of the right ninth

costal cartilage

E. True – Althought the commonest position of the appendix is

retrocaecal, it can be in other positions such as pelvic,

retroileal and retrocolic

Liver and Biliary System, Pancreas and Spleen99.A. False – The caudate lobe lies between the fissure for the

ligamentum

venosum and the inferior vena cava. The quadrate lobe lies

between the fissure for the ligamentum teres and gall

bladder

B. True

C. False – It is the caudate lobe that forms the upper boundary of the

foramen of Winslow

D. True – The anatomical division of lobes is different from the

morphological division of lobes.The morphological division

lies to the right of the gross anatomical plane and therefore

the quadrate lobe is part of the left morphological lobe of the

liver while the caudate lobe belongs partly to the left and

partly to the right morphological lobes of the liver

E. True – The liver is enclosed by the peritoneum except the bare area

which is demarcated by the peritoneal reflections as the

coronary ligaments

100.A. False – The bile duct is formed by the union of the common

hepatic

duct and cystic duct. Left and right hepatic ducts unite to

form the common hepatic duct

B. True – The proximal part of the hepatic diverticulum that grows from

the ventral aspect of the foregut gives rise to the bile duct

and gallbladder. Hence its lining is similar to the gut lining

which is developing from endoderm

C. True – The bile duct has three parts. The upper third lies in the free

edge of the lesser omentum. The middle third is behind the

first part of the duodenum and the lower third lies in a

groove between the back of the head of the pancreas and

the second part of the duodenum

D. True – The lower third of the bile duct passes between the second

part of the duodenum and head of the pancreas

E. False – The bile duct lies in front of the right renal vein

101. A. True – The portal vein commences at the first lumbar vertebral

level

(ie. behind the neck of the pancreas) by the union of the

splenic vein and superior mesenteric vein

B. False – The tail of the pancreas is related to the hilum of the spleen.

The body of the pancreas is related to the hilum of the left

kidney

C. True – The islets of Langerhans (the endocrine part) are developed

from the neural crest cells (neuroectoderm)

D. True

E. False – The tail of the pancreas lies within the lienorenal ligament

which is the part of the dorsal mesentery extending between

the greater curvature of the stomach and spleen

102.A. True – Organs related to the visceral surface include the left

kidney,

stomach, tail of the pancreas and left colic flexure

B. TrueC. TrueD. TrueE. False – The greater omentum is attached to the greater curvature

of

the stomach and is connected to the gastrosplenic ligament

which extends from the stomach to the spleen

103.A. True - The visceral surface is related, with peritoneum

intervening, to

the stomach, duodenum, hepatic flexure of the colon and the

right kidney, and these organs may leave impressions on the

liver surface

B. TrueC. TrueD. TrueE. False

104.A. False – The head of pancreas is moulded to the C-shaped

concavity of

the duodenum. It lies over the inferior vena cava and the right

and left renal veins at the second lumbar vertebral level.

The neck of the pancreas lies in front of the commencement

of the portal vein

B. True – The uncinate process arises from the lower part of

the posterior surface of the pancreas as a hook shaped

extension which passes upwards and to the left behind the

superior mesenteric vessels

C. True – An annular pancreas forms due to a defective fusion of the

dorsal and ventral pancreatic buds. Pancreatic tissue is

formed around the duodenum giving rise to an annular

pancreas leading to obstruction of the duodenum

D. True – It is supplied by branches of the superior mesenteric and

coeliac arteries

E. True – The tail of the pancreas extends forwards and to the left from

the anterior surface of the left kidney along with the splenic

vessels and lymphatics and lie within the lienorenal ligament

to reach the hilum of the spleen

105.A. True – It develops at the 6th week intra uterine life as a

condensation

in the dorsal mesogastrium. Other structures derived from

the dorsal mesogastrium include the greater omentum,

lienorenal ligament and gastrosplenic ligament

B. True – When enlarged the spleen may extend beyond the left costal

margin and the palpable spleen is identified by the notch on

its anterior border

C. False – It lies just beneath the left half of the diaphragm between the

9th and 11th ribs.

D. True - Its long axis lies along the shaft of the tenth rib and its lower

pole extends forwards as far as the mid axillary line

E. False – It is supplied by the splenic artery which passes in the

lienorenal ligament extending from the spleen to the kidney

106.A. False – It passes through the diaphragm at the twelfth thoracic

vertebral level. The oesophagus passes through the

diaphragm at the tenth thoracic vertebral level

B. False – It ends by dividing into the two common iliac arteries at the

fourth lumbar vertebral level

C. True – The main branches of the abdominal aorta fall into three

types: single ventral arteries to the gut and its derivatives

(coeliac, superior and inferior mesenteric), paired branches to

other viscera (suprarenal, renal and gonadal arteries) and

paired branches to the abdominal wall (inferior phrenic and

lumbar arteries).

In addition, a small posterior branch, the median sacral artery

leaves the aorta a little above its bifurcation.

D. False – The inferior vena cava has a longer course in the abdomen

than the abdominal aorta. The abdominal aorta extends from

the twelfth thoracic vertebral level to the fifth lumbar

vertebral level while the inferior vena cava extends from the

fifth lumbar vertebral level to the eighth thoracic vertebral

level

E. True – The thoracic duct passes through the aortic opening of the

diaphragm at the twelfth thoracic vertebral level while lying

between the aorta and the azygos vein

107.A. True - Paired branch of the abdominal aorta include suprarenal,

renal and gonadal arteries to visceral structures; inferior phrenic and lumbar arteries to the abdominal wall.

There are four paired lumbar arteries arising from the abdominal aorta opposite the bodies of upper four lumbar

vertebrae. Inferior phrenic arteries are the first branches of the abdominal aorta. Hepatic arteries arise from the coeliac trunk. Subcostal arteries although paired, arise from the lowest part of the thoracic aorta and enter the abdomen behind the lateral arcuate ligaments. B. False

C. False

D. True

E. True

108.A. False – It is formed at the fifth lumbar vertebral level by the

confluence of the two common iliac veins behind the right

common iliac artery

B. True

C. True – It passes upwards on to the right of the aorta, grooves the

bare area of the liver and pierces the tendinous part of the

diaphragm at the eighth thoracic vertebral level

D. True – The left suprarenal vein enters the left renal vein while the

right suprarenal vein enters the posterior aspect of the

inferior vena cava behind the bare area of the liver

E. False – Its post hepatic part is derived from the proximal part of the

right vitelline vein. The left vitelline vein disappears after

contributing to a small part of the portal vein

109.A. False - The inferior vena cava passes through the diaphragm at

the

eighth thoracic vertebral level. At the 10th and 12th thoracic

vertebral levels the oesophagus and aorta pass through the

diaphragm

B. True – There is a valve at the termination of the inferior vena cava

which is nonfunctional. It is developed from the right valve of

the sinus venosus

C. False – The post hepatic part of the inferior vena cava (IVC) is

developed from the right hepatocardiac channel (ie. the

proximal part of the right vitelline vein). The renal part of the

IVC is developed from the right subcardinal vein and the

pelvic part from the right sacrocardinal vein

D. True – From above downwards the IVC receives hepatic veins,

inferior phrenic veins, right suprarenal vein, right and left

renal veins, right and left 3rd and 4th lumbar veins and

right testicular or ovarian vein (gonadal vein).

E. False

110.A. True – The tributaries of the inferior vena cava include left and

right

third and fourth lumbar veins, right gonadal vein, left and right

renal veins, right suprarenal vein, left and right inferior

phrenic veins and hepatic veins. The left gonadal vein and the

left suprarenal vein drain into the left renal vein

B. False

C. True

D. False

E. True

111.A. True – The right and left renal arteries arise from the aorta at the

second lumbar vertebral level just below the origin of the

superior mesenteric artery

B. True - The right renal artery crosses the right crus of diaphragm

and psoas muscle behind the inferior vena cava and the

right renal vein

C. False

D. True – It gives off the ureteric and suprarenal branches

E. False- Both gonadal arteries (testicular and ovarian) arise from

the front of the aorta below the renal arteries but well

above origin of the inferior mesenteric artery

112.A. False – The left renal vein lies in front of the left renal artery

B. True - The left renal vein is about 3 times as long as the right

renal vein

C. True – The left renal vein has a foetal veinl of origin which is the

subcardinal anastomosis. The right renal vein has no

foetal vessel of origin

D. True – The left renal vein joins the inferior vena cava at a right

angle at the second lumbar vertebral level

E. True – It receives the left suprarenal vein and left gonadal vein

and sometimes the left inferior phrenic vein. The right

renal vein usually drains only the right kidney

113.A. True – The anterior primary rami of the upper four lumbar nerves

contribute to form the lumbar plexus in the substance of

psoas major muscle

B. False – It is formed by the anterior rami of the upper four lumbar

nerves

C. True – The plexus supplies the lower abdominal wall and mainly

supply the skin and muscles of the lower limb

D. False – The femoral nerve emerges from the lateral border of the

psoas muscle and crosses the iliac fossa between the psoas

and iliacus muscle

E. False – The pudendal nerve is branch given off from the sacral plexus

and contains fibres of first, second and third sacral segments

114.A. False – The genitofemoral nerve is formed in the substance of

psoas major muscle by the union of branches from L1 and L2,

and emerges from the anterior surface of the psoas major

and runs down on the muscle deep to psoas fascia

B. False

C. True – Just above the inguinal ligament it perforates the psoas fascia

and divides into genital (L2) and femoral (L1) branches. The

genital branch passes through the deep ring and enters the

inguinal canal.

D. True – The genital branch supplies motor fibres to the cremaster

muscle and sensory fibres to the spermatic fascia, tunica

vaginalis of the testis and scrotal skin

E. True

115.A. False – It contains only the first lumbar segment

B. True - The iliohypogastric nerve, ilioinguinal nerve, lateral cutaneous

nerve of the thigh and the femoral nerve emerge from the

lateral border of the psoas muscle, in that order from above

downwards

C. True – The nerve pierces the lower border of internal oblique and

enters the inguinal canal and emerges through the superficial

inguinal ring

D. True – The structures supplied by the ilioinguinal nerve include

external oblique, internal oblique, transversus abdominis

muscles of the anterior abdominal wall, skin of the upper

medial aspect of the thigh, root of the penis, anterior one-

third of the scrotal skin, mons pubis and labium majora

E. False – It is both sensory and motor

116.A. False – It is given off just below the origin of the renal artery and

well above the inferior mesenteric artery

B. True – They pass steeply downwards over psoas and genitofemoral

nerve

C. True – The artery on the left side crosses in front of the ureter and

genitofemoral nerve

D. True – The artery on the right side crosses in front of the inferior

vena cava, ureter and genitofemoral nerve

E. True – It supplies the middle portion of the ureter

117. A. True – It passes down on the psoas major muscle under cover of

the peritoneum.

B. True – Both ureters have three anatomic sites that show narrowings.

They are located at the pelviureteric junction, where it crosses

the pelvic brim and as it enters the bladder wall

C. False – It lies posterior to the gonadal vessels

D. True – The ureter enters the pelvis by crossing the bifurcation of the

common iliac artery anteriorly over the sacroiliac joint

E. False – The ureter is developed from the proximal part of the ureteric

bud which arises as an outgrowth of the mesonephric duct.

The paramesonephric duct gives rise to the duct system in the

female genital tract (Fallopian tube, uterus, cervix and upper

vagina)

118.A. True - Both ureters lie on the posterior abdominal wall covered

by the peritoneum

B. True – Lower down it is crossed anteriorly by the right colic and

ileocolic vessels and by the root of the mesentery.

C. True – The upper end is supplied by the ureteric branch of the renal

artery. The middle region of the ureter is supplied by the

abdominal aorta, gonadal, common iliac and internal iliac

arteries. The lower end is supplied by branches from inferior

and superior vesical and uterine arteries.

D. True – On a radiograph the ureter lies medial to the tips of the

transverse processes of lumbar vertebrae

E. True – The upper part of the right ureter lies behind the third

part of the duodenum

119.A. False - The suprarenal glands lie at the upper pole of each kidney

and are asymmetrical. The right gland is pyramidal and

the left is crescentic in shape.

B. True – They lie within their own compartment of renal fascia

C. False - The glands have a rich arterial supply and each receives

blood from three sources which are the renal artery, inferior

phrenic artery, and a branch directly from the aorta. In

contrast there is usually a single vein draining it.

D. True – The inferior vena cava overlaps the anteromedial surface

of the right suprarenal gland

E. False – The medulla develops from neural crest cells. The cortex

is developed from the intermediate mesoderm

120.A. False – The anterior surface of the right suprarenal gland is

overlapped medially by the inferior vena cava and the rest of

the anterior surface is in contact with the bare area of the

liver. The anterior surface of the upper part of the left

suprarenal gland is covered by the peritoneum of the lesser

sac and the lower part is in contact with the body of the

pancreas and splenic vessels

B. True – The left gland lies on the left crus of the diaphragm and

overlaps the front of the kidney

C. True – The suprarenal gland receives arterial supply from three

sources. Inferior suprarenal artery from the renal artery,

middle suprarenal artery from the abdominal aorta and the

superior suprarenal artery from the inferior phrenic artery

D. False – The zona glomerulosa is in the adrenal cortex. The adrenal

cortex is developed from the intermediate mesoderm and

the adrenal medulla is developed from the neural crest cells

E. True – Preganglionic sympathetic fibres arising from the spinal cord

pass via the sympathetic chain without relay as the greater,

lesser and least splanchnic nerves. The greater splanchnic

nerve ends in the cells of the adrenal medulla

121.A. True - A small triangular part of the costodiaphragmatic recess of

the pleura lies behind the diaphragm and is an important

posterior relation of the kidney, which is at risk in the lumbar

approach to the kidney.

B. True - The upper pole of the right kidney overlies the twelfth rib,

that of the left kidney the eleventh rib

C. True – The subcostal vein, artery and nerve, on emerging beneath

The lateral arcuate ligament, lie behind the kidney, as do the

iliohypogastric and ilioinguinal nerves as they emerge from the

lateral border of psoas.

D. True - The hilum of the left kidney is related to the pancreas and

on the right to the second part of the duodenum.

E. False - The hilum of the left kidney lies just above and that of the

right just below the transpyloric plane

122.A. True – The anterior relations of the right kidney are right

suprarenal

gland,liver, hepatic flexure of colon, small intestine and second

part of the duodenum.

The anterior relations of the left kidney are left suprarenal gland, stomach, spleen, pancreas, colon and small intestine B. True

C. False

D. True

E. False – Subcostal vessels are a posterior relation of both kidneys.

123.A. False - The kidney develops from two embryonic parts namely

the

ureteric bud and metanephric blastema. The metanephric

blastema gives rise to the Bowmans capsule, proximal

convoluted tubule, loop of Henle and distal convoluted tubule.

The ureteric bud gives rise to the collecting ducts, minor

calyces, major calyces, pelvis of the kidney and ureter

B. False

C. True

D. True

E. True

124.A. True – Androgens are secreted by the zona reticulosa cells of the

adrenal cortex

B. True – The adrenal cortex develops from the intermediate mesoderm close to the area of the kidney. The adrenal medulla develops from the neural crest cells.

C. False – The adrenal cortex in supplied from the …………..It is

the adrenal medulla that is supplied by the myelinated preganglionic sympathetic fibers which synapse with the

medullary cells.D. True – The adrenal cortex secretes steroid hormones. The cells

that

secrete steroids have an abundance of smooth endoplasmic

reticulum. The rough endoplasmic reticulum is found in

abundance in protein secreting cells

E. True - All endocrine glands have a rich reticulin fibre network.

________________________________________________________

Pelvis and Perineum

Pelvic Cavity and joints

125. Regarding the pelvisA. The sacro-iliac joint is a synovial jointB. The sacrotuberous ligament lies anterior to the sacrospinous

ligamentC. The sub public angle is wider in male than in femaleD. The piriformis muscle leaves the pelvis through the greater

sciatic foramenE. The inferior pubic rami are everted in males

126. The pelvic outlet is formed by theA. ischial tuberositiesB. sacrotuberous ligamentsC. alar of the sacrum

3

D. ischiopubic ramiE. sacroiliac ligaments

127. The levator ani muscleA. has superior and inferior surfaces covered with fasciaB. is supplied by a branch from the 1st sacral nerveC. is inserted into the perineal bodyD. has fibres forming a sling around the anorectal junctionE. forms the medial boundary of the ischioanal fossa

128. Pelvic peritoneum in the female covers the A. Superior surface of the bladderB. Anterior surface of the lower third of the rectumC. Lateral surface of the urinary bladderD. Fundus of the uterusE. Anterior surface of the vagina

Rectum and anal canal

129. The rectum in the male

A. rests in front of the 3rd,4th and 5th sacral vertebrae

B. is covered by the peritoneum in its upper 1/3 in front and sides

C. is derived from the lower part of the urogenital sinus

D. is lined by the stratified squamous non keratinizing epithelium

E. drains its upper part to the pre aortic lymph nodes

130. Regarding the anal canal

A. It has internal sphincter composed of striated muscle

B. Its upper part is developed from the hindgut

C. Its lower part is derived from the urogenital sinus

D. Superficial inguinal nodes drain lymph from its upper third

E. Pecten is lined by a simple columnar epithelium

131. Regarding the anal canal

A. The pectinate line separates the ectodermal and endodermal parts

B. The middle rectal artery supplies it

C. The pecten is lined by stratified squamous keratinized epithelium

D. It drains into the superior rectal veins

E. Pectinate line is a site of portosystemic anastomosis

132. Regarding the rectum

A. It is covered by the peritoneum throughout

B. It is developed from the lower part of the urogenital sinus

C. It is lined by a simple columnar epithelium

D. It is supplied by the inferior rectal artery

E. In the male the prostate can be palpated on its anterior wall by per rectal examination

Urinary bladder, urethra and ureters in the pelvis

133. The female urethra is A. lined by the stratified squamous keratinizing epitheliumB. ten centimeters longC. supplied by the internal pudendal artery D. derived from the mesonephric ductE. drained into the internal iliac nodes

134. Regarding the urinary bladder

A. Its epithelium is derived from endodermB. The extrophy of the bladder is due to persistence of the urachusC. Has no peritoneal coveringD. Is lined by a stratified squamous non keratinizing peitheliumE. Its apex is connected to the umbilicus by the median umbilical

ligament

Male Reproductive Organs

135. The testisA. develops in the paraxial mesodermB. drains its lymph to the para aortic nodesC. has the appendix testis which is a derivative of the mesonephric

ductD. is supplied by sympathetic nerve firbres originating from the T10

segmentE. contains diploid cells in the wall of seminiferous tubule

136. The testis

A. The tunica vaginalis completely encloses the testis B. Has the epididymis located along its anterior borderC. Is supplied by sympathetic nerves arising from T10 spinal

segmentD. Has cells of Leydig that secrete testosteroneE. The veins drain into the inferior vena cava on both sides

137. The ductus deferensA. is lined by a cuboidal epitheliumB. develops from the mesonephric ductC. passes through the inguinal canalD. crosses the ureter in the region of the ischial spineE. joins with that of the opposite side to form the ejaculatory duct

138. Regarding ductus deferensA. It begins as a continuation from the upper pole of epididymis B. It is palpable in spermatic cordC. It is supplied by a branch of the testicular arteryD. It leaves the spermatic cord at the deep inguinal ringE. The ampulla of the vas lies behind the base of the bladder

139. Pelvic part of the urogenital sinus in the male gives rise to theA. penile urethraB. ejaculatory ductC. seminal vesicleD. prostatic urethraE. membranous urethra

140. Regarding the prostate glandA. Its base lies against the neck of the bladderB. It has a skeletal muscle coveringC. Its posterior lobe is devoid of glandular tissueD. The normal gland can be palpated by per rectal examinationE. Carcinoma of the prostate can directly spread to the pelvic

bones

141. Regarding the seminal vesiclesA. They lie on the posterior surface of the bladderB. The medial surface is related to the vas deferensC. Develop from the paramesonephric ductsD. Store spermstozoaE. Are palpable by per rectal examination

142. The penisA. consists of two masses of erectile tissueB. is developed from the genital swellingsC. drains into superficial inguinal lymph nodesD. is supplied by a branch of the pudendal arteryE. has the bulbospongiosis muscle attached to the side of the

pubic arch

Female reproductive organs

143. Regarding the vaginaA. The upper part develops from the urogenital sinusB. The lower half lies within the perineumC. It receives an arterial supply from the uterine arteryD. Its posterior wall is completely covered by the peritoneumE. Its posterior wall is longer than the anterior wall

144. The ovaryA. Is developed from the paraxial mesodermB. when diseased will cause pain on the inner side of the thigh on

the same sideC. is supplied by the uterine arteryD. has its own mesenteryE. is attached to the uterus by the ligament of the ovary

145. Regarding the uterusA. Lymph from the upper part of the body drains in to the para

aortic nodesB. It is normally anterverted and retroflexedC. Its body is enclosed by the peritoneumD. The anterior surface of the cervix is attached to the bladder

above the trigoneE. It is developed from the paramesonephric ducts

146. The broad ligament A. has the ovary on its anterior margin B. has the fallopian tube at its upper borderC. has an attachment to the labium majus D. contains remnants of the mesonephric tubulesE. extend from the uterus to the lateral wall of the pelvis

147. Major supports of the uterus include

A. levator ani muscleB. round ligamentC. pubo-cervical ligamentD. utero-sacral ligamentE. perineal body

148. Dizygotic twinsA. always have a common chorionic cavityB. are always of the oppsosite sexC. have separate amniotic cavitiesD. have two placentaeE. aAre commoner than monozygotic twins

149. The uterine tube

A. is the site of fertilization of the ovum

B. is narrowest at the ampulla

C. develops from the paramesonephric ducts

D. is lined by a simplecolumnar ciliated epithelium

E. has an arterial supply from the ovarian artery

150. Which of the following are homologous

A. Penis and clitorisB. Scrotum and labia minoraC. Testis and ovaryD. Vas deferens and fallopian tubeE. Penile urethra and vaginal fornices

Pelvic vessels and nerves

151. Following are branches of internal iliac arteryA. Iliolumbar arteryB. Uterine arteryC. Median sacral arteryD. Inferior epigastric arteryE. Superior gluteal artery

152. The pudendal nerveA. Consists of second, third and fourth sacral spinal segmentsB. Leaves the pelvis through the obturator foramenC. Lies in the medial wall of the ischiorectal fossaD. Gives off the dorsal nerve of the penisE. Supplies the deep transverse perinei muscle

153. The uterine arteryA. is a branch of the posterior division of the internal iliac arteryB. lies within the broad ligamentC. passes above the ureterD. anastomoses with obturator arteryE. supplies the ovaries

154. The sacral plexusA. Lies on the obturator internus muscleB. Receives a contribution from the lumbosacral trunk C. Supplies the quadratus femoris muscleD. Gives branches to supply the perianal skin and skin of buttockE. Supplies the gluteal muscles

155. The internal iliac arteryA. begins in front of the sacroiliac jointB. ends near the upper margin of the lesser sciatic foramenC. is crossed anteriorly by the ureter at the pelvic brimD. gives off the the median sacral artery from its posterior divisionE. supplies the vas deferens

Perineum

156. Contents of the deep perineal pouch in the male include A. membranous urethraB. perineal membraneC. internal pudendal vesselsD. dorsal nerve of the penisE. bulb of the penis

157. Structures that drain directly to the superficial inguinal lymph nodes includeA. scrotumB. testisC. glans penisD. labia minoraE. clitoris

158. Muscles attached to the perineal body includeA. levator aniB. superficial transverse perineiC. external anal sphincterD. deep transverse perineiE. ischiocavernosus

159. Muscles found within the superficial perineal pouch includeA. bulbospongiosus muscleB. ischiocavernosus mucleC. sphincter urethrae

D. deep transverse perineal muscleE. superficial transverse perineal muscle

Pelvis and Perineum : Answers and Explanations

Pelvic Cavity and joints

125.A. True – The articular surfaces of this joint are jagged and very little

movement is present at this joint. With ageing fibrous adhesions occur and gradual obliteration of the joint cavity takes place; earlier in males and after the menopause in females

B. False – The sacrotuberous ligament is found posterior to the sacrospinous ligament. The sacrotuberous ligament is a flat fibrous band of great strength having a wide attachment. It is attached to the posterior border of the ilium and posterior superior and posterior inferior iliac spines, to the transverse tubercles of the sacrum and to the upper part of the coccyx and is inserted to the medial surface of the ischial tuberosity

C. False – The subpubic angle is larger in females forming an obtuse angle wich is considered as a sex difference

D. True - The piriformis muscle arises from the front of the middle three pieces of the sacrum within the pelvis and leaves the pelvis through the greater sciatic foramen to be attached to the greater trochanter of the femur

E. True – The crus of the penis is attached to this everted inferior pubic ramus

126.A. True – The pelvic outlet is bounded anteriorly by the pubic

symphysis, arcuate or inferior pubic ligament, posteriorly by the coccyx and on each side by the ischiopubic rami, ischial tuberosities and sacrotuberous ligaments.

B. TrueC. False – The alar of the sacrum forms a part of the pelvic inlet.D. TrueE. False – Sacroiliac ligaments are ligamentous bands that surround the

capsule of the sacroiliac joint.

127.A. True – The pelvic surface of the levator ani and coccygeus is covered

by the superior fascia of the pelvic diaphragm. The inferior surface is covered by the inferior fascia of the pelvic diaphragm which blends with the obturator fascia laterally

B. False – It is mainly supplied from the sacral plexus by branches of S3 and S4 spinal segments. Puborectalis may be supplied from below by the perineal branch of S4 and inferior rectal branch of the pudendal nerve, in common with the external anal sphincter

C. True - The muscles attached to the perineal body include the external anal sphincter, pubovaginalis (levator prostate), a part of levator ani, bulbospongiosus and the superficial and deep transverse perinei muscles

D. True – Fibres arising more anteriorly from the inner aspect of the body of the pubis form a sling around the anorectal junction and this part of the muscle is called the puborectalis. Contraction of this muscle sling helps in defaecation

E. True – The ischioanal fossa is wedge shaped. The external sphincter of the anal canal and the leavator ani muscles form the medial wall of each fossa and the lateral wall is formed by the ischial tuberosity with the obturator internus muscle

128.A. True – The pelvic peritoneum covers the superior surface of the

bladder and is reflected from a little in front of the posterior margin of this surface on to the undersurface of the uterus

B. False – The upper one-third of the rectum is covered by the peritoneum in front and on the sides; the middle one-third is covered only in front and the lower one-third which is dilated to form the ampulla is devoid of peritoneum. It is reflected forwards on to the upper part of the vagina to form the rectouterine pouch (of Douglas)

C. FalseD. True - The fundus, the anterior or vesical surface and the posterior

or the intestinal surface of the uterus are covered by the peritoneum

E. False – The only part of the vagina to have a peritoneal covering is the posterior fornix. This peritoneal covering is the part that forms the front of the rectouterine pouch (of Douglas)

Rectum and anal canal

129.A. True – The rectum lies in front of the sacrum from the mid of 3rd

sacral segment and descends up to the tip of the coccyx

B. True – The rectum in the male is covered by the peritoneum in its

upper 1/3 in front and on the sides and in its middle 1/3

only in front

C. False – The rectum is developed from the distal part of the hindgut.

The urogenital sinus gives rise to the urinary bladder and

urethra

D. False – The rectum is lined by the simple columnar epithelium with

goblet cells. Only the lower 1/3 of the anal canal is lined by

the stratified squamous non keratinizing epitelium

E. True – Lymphatics of the upper rectum drains along the inferior mesenteric artery to pre aortic nodes. The lymphatics from the lower rectum reach the internal iliac nodes along the middle and inferior rectal vessels

130.A. False – The anal canal consists of internal and external

sphincters.

The internal anal sphincter is continuous with the inner

circular and outer longitudinal muscle layers of the anal

canal. Hence it is developed from the splanchnic mesoderm

and consists of smooth muscle. The external anal sphincter

consists of three parts, namely, deep, superficial and

subcutaneous parts derived from the somatic mesoderm

(striated muscle)

B. True – The upper part of the anal canal above the pectinate line is

developed from the hindgut and the lower part below the

pectinate line is developed from the proctodeum (ectodermal

origin)

C. False – refer B above

D. False – The upper part of the anal canal above the pectinate line

drains into the internal iliac nodes. The lower part of the anal

canal below the pectinate line drains into the superficial

inguinal nodes

E. True – The pecten is the area below the pectinate line and is lined by

a stratified squamous non keratinized epithelium. The area

above the pectinate line (anal column area) is lined by a

simple columnar epithelium

131.

A. True – The anal canal above the pectinate line is lined by a simple

columnar epithelium and below the pectinate line is lined by

a stratified squamous non keratinized epithelium

B. False – The superior rectal branches and the inferior rectal artery

supply the mucosa above and below the pectinate line

respectively. The middle rectal artery supplies the rectum

C. False– The pecten area is lined by the stratified squamous non

keratinized epithelium (ectodermal)

D. True – The area above the pectinate line drains into the superior

rectal vein (a tributary of portal vein) and the area below the

pecten drains into the inferior rectal vein (systemic veins)

E. True – In portal hypertension this anastomosis dilates to form the

internal haemorrhoids (internal piles) as it is a portosystemic

anastomosis

132.A. False - Only the front and sides of the upper third and the front

of the

middle third of the rectum are covered by the peritoneum.

The lower third is devoid of a peritoneal covering

B. False – The rectum is developed from the distal part of the hindgut

and the mucosa is endodermal in origin. The urogenital sinus

gives rise to the urinary bladder and urethra

C. True – It is lined by the gut epithelium which is the simple columnar

epithelium

D. False – It is supplied by the superior rectal artery (a branch of the

Inferior mesenteric artery), middle rectal artery (a branch of

the internal iliac artery) and median sacral artery (a branch of

the abdominal aorta). The inferior rectal artery supplies the

anal canal

E. True – By per rectal examination in the male, the prostate, seminal

vesicle, base of the urinary bladder and the rectovesical

pouch (if fluid is filled) could be palpated on the anterior

rectal wall. In the female all internal reproductive organs

could be felt. In both sexes some bony parts namely the lower

sacrum and coccyx, the ischial spine and the ischial tuberosity

could be palpated on the posterior rectal wall

Urinary bladder, urethra and ureters in the pelvis

133.A. False - The uppermost part of the female urethra is lined by the

transitional epithelium followed by the stratified squamous non keratinizing epithelium at the external urethral meatus.

B. False - The urethra in the female is 4 cm long. During later stages of

pregnancy it can get stretched and could increase its length

up to 10 cm.

C. True - Upper part of the female urethra is supplied by the inferior vescical and vaginal arteries with the lower end being supplied by internal pudendal artery

D. False - It is developed from the lower part of the urogenital sinus. The

remnants of the mesonephric duct in the female is seen as

epoophoron and paroophoron.

E. True - Lymph from the female urethra mainly drains into internal

iliac nodes but some may reach the external iliac nodes.

134.A. True – The urogenital sinus becomes the bladder and therefore the epithelium of the bladder is endodermal and the surrounding mesoderm which is developed from the splanchnic mesoderm forms the muscle and connective tissue. The incorporation of the lower ends of mesonephric the ducts into the posterior part of the bladder forms the trigone which is intermediate mesoderm in origin B. False – The fusion of the anterior abdominal wall below the

umbilicus is facilitated by the migrating primitive streak mesoderm. If this migration fails, the anterior abdominal wall will not fuse leading to exposure of the bladder wall. This is called the extrophy of the bladder. Persistence of the urachus leads to urine discharge from the umbilical region

C. False – The superior surface and the upper part of the posterior surface are covered by the peritoneum in both sexes

D. False – It is lined by the transitional epitheliumE. True – The apex of the bladder points anteriorly and lies behind

symphysis pubis. It is connected to the umbilicus by the median umbilical ligament – which is the fibrosed (obliterated) urachus

Male Reproductive Organs135.A. False – Both gonads (testis and ovary) develop in the gonadal ridge in

the pelvic region of the intermediate mesoderm. The paraxial mesoderm forms the dermatomes, myotomes and sclerotomes of each spinal segment

B. True – The testis drains into para aortic nodes lying alongside the aorta at second lumbar vertebral level and do not drain into inguinal nodes although the overlying scrotal skin does

C. False – The derivatives of the mesonephric duct include efferent ducts, epidydimis and vas deferens in the male and epoophoron and paroophoron in the ffemale. Appendix testis and utriculus prostaticus are the remnants of the paramesonephric duct attached to the testis in the male

D. True – The sympathetic preganglionic fibres originate from the tenth thoracic segment of the spinal cord and pass in the greater or lesser splanchnic nerves to the celiac ganglia and synapse there. The postganglionic sympathetic fibres reach the testis via the testicular artery

E. True – The primary spermatogonia in the walls of the seminiferous tubules are diploid cells. Secondary spermatogonia, spermatids and sperms are haploid

cells.

136.A. False – It covers the whole testis except the posterior borderB. False – The epididymis is attached to its posterolateral surfaceC. TrueD. True – Cells of Leydig or interstitial cells are found as clusters scattered among the cells of connective tissue in between the seminiferous tubules. They constitute the endocrine portion of the testis and secrete testosteroneE. False – The veins emerging from the testis form the pampiniform plexus. In the inguinal canal the plexus separates out into about four veins which join to form two that leave the deep

inguinal ring. The left vein drains into the left renal vein where the right drains directly into the inferior vena cava.

137.A. False – It is lined by a pseudostratified columnar epithelium with stereociliaB. True - The mesonephric duct gives rise to the efferent ducts, epididymis and vas deferens in the maleC. True - It passes through the inguinal canal and enters the abdomen by emerging through the deep inguinal ringD. True – It passes downward and backwards on the lateral wall of the pelvis and crosses the ureter in the region of the ischial spineE. False - It joins with the duct of the seminal vesicle to form the ejaculatory duct. The ejaculatory ducts pierce the posterior wall of the prostate and open into the prostatic urethra

138.A. False – It begins as a continuation from the tail of the epididymisB. TrueC. False – The artery to the ductus deferens arises from the superior

vesical (or sometimes from the inferior vesical) artery. The epididymis is supplied by a branch of the testicular artery

D. TrueE. True – The part of the ductus lying behind the base of the bladder is

dilated and tortuous, and is known as the ampulla

139.A. False - The urogenital sinus has a definitive part, pelvic part and a

phallic part. The definitive part gives rise to the urinary

bladder, the pelvic part gives rise to the ejaculatory duct,

seminal vesicle, prostate, prostatic urethra and membranous

urethra in the male. The phallic part gives rise to the penile

urethra.

B. True

C. True

D. True

E. True

140.A. True - Prostate gland is conical in shape with its base lying against

the neck of the bladder and the apex lying inferiorly against the urogenital diaphragm

B. False – The smooth muscle of the bladder wall pass without interruption to the prostate as the prostate is continuous with the neck of the bladder

C. False – The prostate has five lobes namely the anterior lobe, median or middle lobe, posterior lobe and left and right lateral lobes. The anterior lobe lies in front of the urethra and is devoid of glandular tissue. All other lobed consist of glandular tissue

D. True – The following can be felt by the index finger inserted into the anal canal and rectum in the male

Opposite the terminal phalanx- contents of rectovesical pouch, posterior surface of the bladder, seminal vesicles and vas deferens Opposite the middle phalanx – the prostate Opposite the proximal phalanx – perineal body, urogenital diaphragm and bulb of the penisE. True – The prostatic venous plexus is directly connected to the

vertebral veins. During abdominal straining or coughing the prostatic venous blood could flow in a reverse direction and enter vertebral veins. The frequent occurrence of metstases of carcinoma of prostate in the lower part of the vertebral column and pelvic bones could be explained due to the above.

141.A. True - They lie on the base of the bladder above the prostate on the

posterior aspect. The left and right vas deferens lie side by side on the posterior surface and separates the seminal vesicles from each other

B. True – The terminal part of the vas deferens lies on the medial surface of each seminal vesicle

C. False – It develops from the mesonephric duct. The paramesonephic ducts in the male regress and its remnants are the utriculus prostaticus and appendix testis

D. False – They do not store spermatozoa but produce about 60% of the seminal fluid which contains substances which are essential for the nourishment of spermatozoa

E. True - By per rectal examination in the male, the prostate, seminal

vesicle, base of the urinary bladder and the rectovesical

pouch (if fluid is filled) could be palpated on the anterior

rectal wall. In the female all internal reproductive organs

could be felt. In both sexes some bony parts namely the lower

sacrum and coccyx, the ischial spine and the ischial tuberosity

could be palpated on the posterior rectal wall

142.A. False – The root of the penis consists of three masses of erectile

tissue namely the bulb of the penis, and right and left crura of the penis. The bulb continues forward in to the body of the penis as the corpus spongiosum. The two crura converge forwards and lie side by side in the dorsal part of the body of the penis forming corpora cavernosa

B. False – The penis is developed from the genital tubercle present in the indifferent stage of external genitalia. In the female it gives rise to the clitoris. The genital swellings give rise to the scrotum in the male and the labia majora in the female

C. True - The skin of the penis drains into the superficisl inguinal nodes and the deep structures of the penis drains into internal iliac nodes

D. True – The deep arteries of the penis supply the corpora cavernosa, the artery of the bulb supplies the corpora cavernosa, the artery of the bulb supplies the corpus spongiosum and the dorsal artery of the penis also supplies it. All three arteries are branches of the internal pudendal artery

E. False - The bulbospongiosus muscle covers the bulb of the penis. The ischiocavernosus muscle covers the crus of the penis which is attached to the side of the pubic arch

Female Reproductive Organs

143.A. False –The upper part develops from the paramesonephric ducts

and the lower part is developed from the urogenital sinus

B. True – The upper half of the vagina lies above the pelvic floor and lower half lies within the perineum

C. True – The vaginal branch of the internal iliac artery is supplemented by the uterine, inferior vesical and middle rectal vessels. The branches of these vessels make good anastomotic connections on the vaginal wall

D. False – The posterior fornix is covered by the peritoneum of the front of the rectouterine pouch (of Douglas). It is the only part of the vagina to have a peritoneal covering

E. True – Also the posterior fornix is deeper than the other fornices

144. A. False - The ovary develops from the gonadal ridge formed by the

intermediate mesoderm. The germ cells develop in the wall of the yolk sac and migrate to the developing gonads at sixth week intrauterine life. Paraxial mesoderm gives rise to segmental muscles of the vertebral column, ribs, vertebrae and annulus fibrosus of intervertebral discs.

B. True - The ovary is closely related to the obturator nerve from which it is separated from the parietal peritoneum. Therefore a diseased ovary can cause referred pain along the cutaneous distribution of the obturator nerve which is the inner side of the thigh.

C. False - The ovary is supplied by the ovarian artery, a branch of the abdominal aorta. The uterine artery supplies the uterus and the fallopian tubes.

D. True - The anterior border of the ovary is attached to the broad ligament (posterior leaf) by a fold of peritoneum called mesovarium.

E. True - The lower pole of the ovary is attached to the uterus by the ligament of ovary.

145. A. True - Lymph from the upper part of body, fundUs and fallopian

tube drains into para aortic nodes. (some may drain into external iliac nodes). Lower part of the uterine body drains into external iliac nodes, and the cervix drains into both external and internal iliac nodes and to sacral nodes.

B. False - The normal position of the uterus is anteverted and anteflexed. Other abnormal positions are

C. True - The body of the uterus is enclosed by the peritoneum which becomes the broad ligament laterally. The posterior surface of the cervix is also covered by the peritoneum but the anterior surface of the cervix has no peritoneal covering.

D. True - Due to this relationship and being deep to the vescicouterine pouch, the anterior surface of the cervix has no peritoneal covering.

E. True - The uterus develops from the lower third of the fused paranesonephric ducts while the fallopian tube develops from the upper 2/3 of the paramesonephric ducts.

146.A. False - The anterior layer of the round ligament is bulged

forwards by the round ligament of the uterus just below the uterine tube. The ovary is related to the posterior layer of the ligament from which it is suspended (mesovarium).

B. True - The upper border of the broad ligament is free forming the mesosalpinx containing the fallopian tube

C. False - The broad ligament extends from the side wall of uterus to the pelvic wall. It is the round ligament of the uterus that extends from the junction of the uterus and the fallopian tube and passing through the inguinal canal gets attached distally to the fibro fatty tissue of the labium majus.

D. True - Between the two layers of the broad ligament lie the fallopian tubes, lymphatics, round ligament, ligament of the ovary and remnants of the mesonephric tubules namely paroophoron and epoophoron.

E. True

147.A. True – The uterus is supported by the tone of the levator ani

muscles and condensations of pelvic fascia, which form three important ligaments, namely, transverse cervical (cardinal) ligaments, pubocervical ligaments and uterosacral ligaments.

B. False - The round ligament of the uterus is the counterpart of the gubernaculums testis in the male

C. TrueD. TrueE. True

148.A. False - Dizygotic twins are produced by the fertilization of two

ova by two separate sperms giving rise to two separate zygotes. They will not resemble each other can have the same or opposite sex, have a different genetic constitution, always have two placentae, two amniotic cavities and two chorionic cavities. Of all twins 70% are dizygotic and 30% are monozygotic

B. FalseC. TrueD. TrueE. True

149.A. True – the uterine tube receives the ovum from the ovary and

provides a site where the fertilization of the ovum can takes

place

B. False - The narrowest part of the tube is the region called the

isthmus. The ampulla is widest part of the tube

C. True

D. True – It is lined by the simple columnar ciliated epithelium

E. True – It is supplied by the uterine artery of the internal iliac artery

and the ovarian artery of the abdominal aorta

150.A. TrueB. False - The homologous structure of the scrotum is the labia

majora. The homologous structure of the labia minora is the penile urethra.

C. TrueD. False - Vas deferens develops from the mesonephric duct. The

remnants of the vas deferens in the female is the paroophoron and epoophoron which are its homologous structures. The Fallopian tube develops from the upper 2/3 of paramesonephric ducts is the utriculus prostaticus and appendix testis which is its homologous structure.

E. False - Homologous structure of the penile urethra is the labia minora and the vestibule.

Pelvic vessels and nerves

151.A. True – The internal iliac artery divides into anterior and posterior

divisions. Branches arising from the posterior division are iliolumbar, lateral sacral and superior gluteal. The anterior division gives off nine branches, three associated with the bladder (superior vesical, obliterated umbilical and inferior vesical), three other visceral branches (middle rectal, uterine and vaginal), and three parietal branches (obturator, internal pudendal and inferior gluteal)

B. TrueC. False – The median sacral artery arises from the back of the

abdominal aorta above its bifurcation and ends in front of the coccyx.

D. False – The inferior epigastric artery arises from the external iliac artery near its lower end just above the inguinal ligament

E. True

152.

A. True – The pudendal nerve is a branch of the sacral plexus consisting of second, third and fourth sacral segments.

B. False – The pudendal nerve enters the pudendal canal on the lateral wall of the ischiorectal fossa

C. False D. True – The dorsal nerve of the penis (clitoris) is one of the

terminal branches (the other terminal branch is the perineal nerve) which runs forward deep to perineal membrane and piercing it supplies the skin of the penis (clitoris).

E. True – The motor part of the perineal nerve (branch of pudendal nerve) supplies the ischiocavernosus, bulbospongiosus, superficial and deep transversus perinei and sphincter urethrae muscles

153.A. False – It arises from the anterior division of the internal iliac

arteryB. True - It runs medially in the base of the broad ligament passing

above the ureter to reach the junction of the cervix and the body of the uterus

C. True D. False – Near the entrance of the uterine tube it turns laterally to

supply the tube and anastomoses with the tubal branches of the ovarian artery

E. False – The ovary is supplied by the ovarian artery, a branch of the abdominal aorta given off just below the renal artery The uterine artery supplies the body, fundus and cervix of the uterus, and gives off branches to supply the uterine tubes and the vagina

154.A. False – It rests upon piriformis muscle and is covered anteriorly

by the parietal pelvic fasicia

B. True – It is formed by the lumbosacral trunk and the anterior rami of the upper four sacral nerves

C. True – It is supplied by the nerve to quadratus femoris (anterior divisions of L4,L5,S1). This nerve also supplies the inferior gamellus and the hip joint

D. True – The perineal branch of S4 which passes between the coccygeus and levator ani enters the ischioanal fossa and supplies the perianal skin. The perforating cutaneous nerve arising from S2 and S3 supplies the skin of the buttock

E. True – The superior gluteal (L4, L5, S1) and inferior gluteal (L5, S1, S2) nerves supply the gluteal muscles

155.A. True – The common iliac artery bifurcates at the pelvic brim

oppostite the sacroiliac joint to form the external and internal iliac arteries

B. False – It passes downwards from its origin and divides into an anterior and a posterior division at the upper margin of the greater sciatic foramen

C. TrueD. False – The branches of the posterior division of the internal iliac

artery iliolumbar, lateral sacral and superior gluteal arteries. The median sacral artery arises from the posterior aspect of the aorta a little above the point where it bifurcates into the

two common iliac arteriesE. True – The inferior vesical artery given off from its anterior division

supplies the trigone and lower part of the bladder, the ureter, vas deferens, seminal vesicle and prostate.

Perineum

156.A. True - The contents of the deep perineal pouch are the

membranous urethra, bulbo urethral glands, sphincter urethrae and deep transverse perinei muscle, dorsal nerve of penis, internal pudendal artery, artery to the bulb and dorsal artery of penis.

The perineal membrane forms the inferior boundary of the deep perineal pouch and therefore not a content. Bulb of the penis is present in the superficial perineal pouch. B. FalseC. TrueD. TrueE. False

157.A. True –There are two groups of superficial inguinal lymph nodes

namely the proximal and distal groups. The proximal group receives lymph from the buttock, back of the body below the waist, umbilicus and anterior abdominal wall below umbilicus, external genitalia in both sexes excluding the testis, lower vagina, lower part of anal canal and perineum and from uterus via lymphatics accompanying the round ligament. The distal group receives all superficial lymphatics from the lower limb except the posterolateral part of the calf. The

superficial inguinal lymph nodes drain mainly into the external

iliac nodes. Testis drains into para aortic nodes. The glans penis drains into deep inguinal nodes. B. False C. FalseD. TrueE. True

158.A. True – The perineal body (central tendon of the perineum) is

fibomuscular mass located between the anal canal and the vagina (or the bulb of the penis). Muscles attaching to it are the superficial and deep transverse perinei, bulbospongiosis, levator ani and external sphincter.

B. True C. TrueD. TrueE. False – Ischiocavernosus arises from the posterior part of the

perineal membrane and ischiopubic rami and inserts into the corpus cavernosum

159.A. True – The muscles found within the superficial perineal pouch are

the superficial transverse perineal, ischiocavernosus and bulbospongiosus muscles. It also contains branches of the internal pudendal vessels, branches of the perineal nerve and greater vestibular glands in the female (Bartholin glands)

B. TrueC. False –Sphincter urethrae and deep transverse perineal muscles are

in the depth perineal space

D. FalseE. True