Directions: For questions 1 through 22, choose the single best answer
1. An infant presents with an omphalocele at birth. Which of the following applies to this condition?
(A) It is also seen in patients with aganglionic megacolon.
(B) It results from a failure of resorption of the vitelline duct.
(C) It results from herniation at the site of regression of the right umbilical vein.
(D) It is caused by failure of recanalization of the midgut part of the duodenum.
(E) It is caused by a failure of the midgut to return to the abdominal cavity after herniation into the umbilical stalk
2. After surgical repair of a hernia, the patient experiences numbness in the skin on the anterior aspect of the scrotum. What nerve may have been lesioned during the herniorrhaphy?
3. Muscles in which of the following regions contract during the Valsalva maneuver to help increase intra-abdominal pressure?
(B) Posterior abdominal wall
(D) Urogenital diaphragm
(E) Superficial perineal pouch
4. CT cross-sectional imaging at the level of the L2vertebra reveals parts of the gut that are pressed against the posterior abdominal wall. Which part of the GI tract might be seen normally in this position?
(A) Transverse colon
(B) Descending colon
(C) Duodenum proximal to the entrance of the common bile duct
(E) Sigmoid colon
5. A 38-year-old banker with a history of heartburn suddenly experiences excruciating pain in the epigastric region of the abdomen. Surgery is performed immediately upon admission to the emergency room. There is evidence of a ruptured ulcer in the posterior wall of the stomach. Where will a surgeon first find the stomach contents?
(A) Greater peritoneal sac
(B) Cul-de-sac of Douglas
(C) Omental bursa
(D) Paracolic gutter
(E) Between the parietal peritoneum and the posterior body wall
6. Other than the spleen, occlusion of the splenic artery at its origin will most likely affect the blood supply to which structure?
(B) Head of the pancreas
(C) Lesser curvature of the stomach
(D) Duodenum distal to the entrance of the common bile duct
(E) Fundus of the stomach
7. A 23-year-old female secretary in good health suddenly doubles over with pain in the area of the umbilicus. She feels warm and uneasy and has no appetite. That night the pain seems to have moved to the lower right abdominal region, and she calls her family doctor who then arranges for an ambulance to pick her up and take her to the hospital. Which nerves, perceived in the area of the umbilicus, most likely carried the painful sensations into the CNS?
(A) Vagus nerves
(B) Lesser splanchnic nerves
(C) Pudendal nerves
(D) Iliohypogastric nerves
(E) Greater splanchnic nerves
8. A young individual with fully developed female external genitalia presents with bilateral inguinal masses. Karyotyping reveals that the individual is 46 XY. What is the cause of the pseudointersexuality?
(A) Adrenal hyperplasia
(B) Inadequate production of testosterone
(C) Inactive androgen receptors in the external genitalia
(D) Failure of Sertoli cells to produce mullerian inhibitory substance
(E) Absence of an SRY gene on the Y chromosome
9. A young female patient in the emergency room complains of intense pain in the lower right part of the abdominal wall. She appears to be in a state of shock and shows signs of an internal hemorrhage. A vaginal exam reveals that the patient’s cervix is soft, and the patient indicates that she missed her last period. Your diagnosis is that of an ectopic pregnancy. Which is the most likely site of the ruptured implantation?
(A) Cervix of the uterus
(B) Body of the uterus
(C) Ampulla of the uterine tube
(D) Posterior fornix of the vagina
(E) Isthmus of the uterine tube
10. Your diagnosis in the case above is made on the basis of the presence of a palpable fluidlike mass. The mass is located?
(A) in the posterior fornix of the vagina
(B) in the broad ligament
(C) in the lesser peritoneal sac
(D) in the rectouterine pouch
(E) in the vesicouterine pouch
11. The midclavicular plane passes through the midpoint of the clavicles to the midpoint of which of the following?
(A) anterior superior iliac spine
(B) symphysis pubis
(D) inguinal ligament
(E) xiphoid process
12. Inferiorly, the inferior margin of the external oblique aponeurosis thickens and folds back on itself to form which of the following structures?
(A) rectus sheath
(B) inguinal ligament
(C) arcuate line
(D) deep inguinal ring
(E) fundiform ligament
13. The superficial muscle fibers of the external abdominal oblique arising from the middle to lower ribs interdigitate with which of the following muscles?
(A) internal abdominal oblique
(B) serratus anterior
(C) rectus abdominis
(E) transversus abdominis
14. The cremaster muscle and fascia are derived from which of the following structures?
(A) external abdominal oblique muscle
(B) transverse abdominal muscle and fascia
(C) internal abdominal muscle
(D) transversalis fascia
(E) external abdominal aponeurosis
15. Which of the following structures forms the superior boundary of the omental foramen?
(A) inferior vena cava
(C) caudate lobe of the liver
(D) head of the pancreas
(E) hepatoduodenal ligament
16. The duodenojejunal junction is supported by the attachment of which of the following structures?
(A) suspensory muscle of the duodenum (ligament of Treitz)
(B) falciform ligament
(C) hepatoduodenal ligament
(D) greater omentum
(E) transverse mesocolon
17. The gubernaculum is represented postnatally by which of the following structures?
(A) tunica vaginalis testes
(B) processus vaginalis
(C) ductus deferens
(D) scrotal ligament
(E) internal spermatic fascia
18. An adult man with adult polycystic kidney disease (APKD) suddenly collapses and dies. The cause of death can be attributed to?
(A) occlusive stroke
(B) ruptured berry aneurysm
(C) pulmonary embolism
(D) obstructive hydrocephalus
(E) myocardial infarction
19. A stillborn infant succumbed as a result of oligohydramnios causedby bilateral renal agenesis. Which of the following would most likely be observed in an autopsy?
(B) Urachal cyst
(C) Berry aneurysms
(D) Situs inversus
20. A healthy 3-year-old male patient experiences a hernial sac protruding from the anterior abdominal wall about halfway between the anterior superior iliac spine and the pubic tubercle. Pulsations of an artery are palpated medial to the protrusion site through the abdominal wall. Which layer of the anterior abdominal wall will first be traversed by the hernia?
(A) Rectus sheath
(B) External oblique aponeurosis
(C) Inguinal ligament
(D) Transversalis fascia
(E) Cremasteric fascia
21. At birth, an infant presents with a stomach that has herniated into the diaphragm. Where is the defect that resulted in the herniation?
(A) Esophageal hiatus
(B) Hiatus for the inferior vena cava
(C) Pleuroperitoneal membrane
(D) Septum transversum
(E) Right crus
22. A CT reveals carcinoma in the body of the pancreas. Which blood vessel that courses immediately posterior to the body of the pancreas is the most likely to be compressed?
(A) Splenic artery
(B) Abdominal aorta
(C) Portal vein
(D) Splenic vein
(E) Renal vein