Surface Landmarks of the Abdomen — MCQs
Which of the following does not form a visceral relation with the spleen?
Which structure lies midway between the anterior superior iliac spine and pubic symphysis?
What anatomical regions does the transpyloric plane separate?
Which of the following structures does NOT pass through Calot's triangle?
Most common position of the appendix is?
All the following are true about acute cholecystitis, except
The four points of probe placement in focused abdominal sonogram for trauma (FAST) in thoracoabdominal trauma are
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Hypertrophic scar is characterized by the following, except
What is the SI unit of illuminance (brightness of light on a surface)?
Surface Landmarks of the Abdomen Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following does not form a visceral relation with the spleen?
- A. Stomach
- B. Splenic flexure of colon
- C. Left kidney
- D. Adrenal glands (Correct Answer)
Explanation: The adrenal glands, specifically the **left adrenal gland**, are located superior to the **left kidney** but are generally not in direct visceral relation with the spleen itself [2]. The spleen's concavities accommodate other organs. The spleen is typically located in the **left hypochondrium**, nestled against the diaphragm, superior to the left kidney, but the adrenal gland is usually separated by the kidney or surrounding fascia. *Stomach* - The **gastric impression** on the spleen's anterior surface is formed by the fundus of the **stomach**, indicating a direct visceral relation [3]. - The stomach is one of the primary organs that directly abuts the spleen's visceral surface. *Splenic flexure of colon* - The **colic impression** on the inferior aspect of the spleen is formed by the **splenic flexure of the colon**, confirming a direct visceral relation [1]. - This anatomical arrangement explains why an enlarged spleen can sometimes be palpated near the colon. *Left kidney* - The **renal impression** on the posterior aspect of the spleen is formed by the anterior superior surface of the **left kidney**, establishing a clear visceral relation [1]. - The spleen lies directly superior and lateral to the left kidney.
Question 2: Which structure lies midway between the anterior superior iliac spine and pubic symphysis?
- A. Femoral artery (Correct Answer)
- B. Deep inguinal ring
- C. Superior epigastric artery
- D. Inguinal ligament
Explanation: ***Femoral artery*** - The **femoral artery** is a direct continuation of the external iliac artery and is the most reliable palpable pulse in the groin area. [1] - Its surface marking is clinically important as it's found midway between the **anterior superior iliac spine (ASIS)** and the **pubic symphysis**, specifically at the **mid-inguinal point**. [1] *Deep inguinal ring* - The **deep inguinal ring** is located at the **midpoint of the inguinal ligament** (midway between ASIS and pubic tubercle), which is approximately 1.5 cm above and lateral to the mid-inguinal point. - It marks the beginning of the **inguinal canal** and is the site where the vas deferens and gonadal vessels exit the abdominal cavity. *Superior epigastric artery* - The **superior epigastric artery** is a terminal branch of the internal thoracic artery and primarily supplies the upper abdominal wall. [2] - It is located in the anterior abdominal wall, far from the inguinal region and the midpoint between the ASIS and pubic symphysis. [2] *Inguinal ligament* - The **inguinal ligament** extends between the anterior superior iliac spine and the pubic tubercle, forming the inferior border of the anterior abdominal wall. - While relevant to the region, the ligament itself is a fibrous band, not a structure found *midway between* the ASIS and pubic symphysis in the same way the femoral artery is.
Question 3: What anatomical regions does the transpyloric plane separate?
- A. Hypogastrium from hypochondrium
- B. Hypochondrium from lumbar region (Correct Answer)
- C. Iliac fossa from lumbar region
- D. Umbilical region from lumbar region
Explanation: ***Hypochondrium from lumbar region*** - The **transpyloric plane** is an imaginary horizontal line that passes through the **pylorus of the stomach** and the tips of the ninth costal cartilages. - This plane separates the **upper lateral abdominal regions** (hypochondria) from the **middle lateral abdominal regions** (lumbar regions) on each side. *Hypogastrium from hypochondrium* - The **hypogastrium** is inferior to the umbilical region, while the **hypochondria** are located in the upper lateral parts of the abdomen. - These regions are separated by the **subcostal plane**, not the transpyloric plane. *Iliac fossa from lumbar region* - The **iliac fossa** is located in the lower lateral part of the abdomen, while the **lumbar region** is in the middle lateral part. - These specific regions are primarily divided by the **intertubercular plane**, which is inferior to the transpyloric plane. *Umbilical region from lumbar region* - The **umbilical region** is the central area of the abdomen around the umbilicus, and the **lumbar regions** are lateral to it. - The transpyloric plane transverses the upper part of the umbilical region but does not primarily serve to separate the umbilical from the lumbar regions.
Question 4: Which of the following structures does NOT pass through Calot's triangle?
- A. Right hepatic artery
- B. Lymph node of Lund
- C. Portal vein (Correct Answer)
- D. Cystic artery
Explanation: ***Portal vein*** - The **portal vein** is a major vessel that carries venous blood from the gastrointestinal tract and spleen to the liver; it is located within the **porta hepatis** and does not pass through Calot's triangle. - Its position is medial and posterior to the structures within Calot's triangle, making it an unlikely structure to be inadvertently ligated during cholecystectomy. *Cystic artery* - The **cystic artery** is a consistent structure found within Calot's triangle, typically arising from the **right hepatic artery**. - Its presence in the triangle makes it a primary target for ligation during **cholecystectomy**. *Right hepatic artery* - The **right hepatic artery** typically runs **superior to Calot's triangle** and gives off the cystic artery which enters the triangle. - While the right hepatic artery itself does not routinely pass through the triangle, anatomical variations may bring it into close proximity, and it can be at risk of injury during dissection if the critical view of safety is not established. *Lymph node of Lund* - The **lymph node of Lund**, also known as the cystic lymph node, is a key landmark located within Calot's triangle. - Its presence is important for identifying the boundaries of the triangle and assessing for inflammation or malignancy related to the gallbladder.
Question 5: Most common position of the appendix is?
- A. Pelvic
- B. Retrocaecal (Correct Answer)
- C. Preileal
- D. Postileal
Explanation: ***Retrocaecal*** - The **retrocaecal position** is the most common anatomical location for the appendix, found in approximately **65-70%** of individuals [1]. - In this position, the appendix lies behind the **caecum**, often curving upwards [1]. *Preileal* - In the **preileal position**, the appendix is located in front of the **terminal ileum**. - This position is relatively rare, occurring in about 1% of cases. *Postileal* - The **postileal position** describes the appendix located behind the **terminal ileum**. - This is also a less common variant, occurring in about 2% of individuals. *Pelvic* - The **pelvic position** means the appendix descends into the **pelvis**, often in contact with the bladder or reproductive organs [1]. - This position is the second most common, found in about **30%** of individuals.
Question 6: All the following are true about acute cholecystitis, except
- A. Gall bladder thickness >3 mm on USG
- B. Murphy's sign positive
- C. Preferential visualization of gall bladder in HIDA scan (Correct Answer)
- D. Leukocytosis
Explanation: ***Preferential visualization of gall bladder in HIDA scan*** - In acute cholecystitis, the **cystic duct** becomes obstructed, preventing bile flow into the gallbladder. - A **HIDA scan** (hepatobiliary iminodiacetic acid scan) would show **non-visualization of the gallbladder** due to this obstruction, not preferential visualization. *Gall bladder thickness >3 mm on USG* - An **ultrasound (USG)** finding of gallbladder wall thickening **greater than 3 mm** is a common indicator of inflammation in acute cholecystitis. - This thickening is due to **edema** and inflammation of the gallbladder wall. *Murphy's sign positive* - A **positive Murphy's sign** involves tenderness and an inspiratory arrest upon palpation of the right upper quadrant, specifically over the gallbladder. - This clinical sign is a **classic indicator** of acute cholecystitis. *Leukocytosis* - **Leukocytosis**, an elevated white blood cell count, is a common systemic inflammatory response seen in acute cholecystitis. - It reflects the body's reaction to the **inflammation and possible infection** within the gallbladder.
Question 7: The four points of probe placement in focused abdominal sonogram for trauma (FAST) in thoracoabdominal trauma are
- A. Hypogastrium, (R) and (L) lumbar region, (R) lower chest
- B. Epigastrium, (R) and (L) lumbar region, (R) lower chest
- C. Subxiphoid, (R) upper quadrant, (L) upper quadrant, suprapubic (Correct Answer)
- D. Epigastrium, (R) and (L) hypochondria, (R) iliac fossa
Explanation: ***Subxiphoid, (R) upper quadrant, (L) upper quadrant, suprapubic*** - These four areas represent the standard views for a **FAST exam**, designed to detect **free fluid** in the most gravity-dependent and common spaces for accumulation within the abdomen and pericardium. - The **subxiphoid view** assesses the pericardial sac, the **right upper quadrant** evaluates Morrison's pouch, the **left upper quadrant** examines the splenorenal recess, and the **suprapubic view** checks the rectovesical or uterovesical pouch. *Hypogastrium, (R) and (L) lumbar region, (R) lower chest* - The **lumbar regions** are not primary or standard FAST windows due to anatomical complexity and lower fluid accumulation likelihood. - While the lower chest can be part of an extended FAST, the specified regions (right and left lumbar) are not the typical, most critical points for initial trauma assessment. *Epigastrium, (R) and (L) lumbar region, (R) lower chest* - The **epigastrium** is not a standard primary FAST window for free fluid; the subxiphoid view specifically targets the pericardium. - Again, the **lumbar regions** are not part of the core four FAST views for rapid detection of intraperitoneal hemorrhage. *Epigastrium, (R) and (L) hypochondria, (R) iliac fossa* - The terms **hypochondria** and **iliac fossa** are less precise than the specific anatomical spaces targeted by FAST (Morrison's pouch, splenorenal recess, pelvic cul-de-sac). - The **epigastrium** is not one of the four established primary FAST windows for free fluid in trauma.
Question 8: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 9: Hypertrophic scar is characterized by the following, except
- A. it involves the flexor surface
- B. it outgrows the wound area (Correct Answer)
- C. it is non-familial
- D. it is not related to the race
Explanation: ***it outgrows the wound area*** - This statement is characteristic of a **keloid scar**, not a hypertrophic scar. Keloids are distinguished by their growth beyond the original wound margins [1]. - **Hypertrophic scars**, on the other hand, remain confined within the boundaries of the original injury, though they may be raised and erythematous [1]. *it involves the flexor surface* - While hypertrophic scars can occur on any body surface, they are commonly found on areas of **high tension**, such as the **flexor surfaces** of joints (e.g., knee, elbow) or the chest and shoulders. - This involvement is due to constant movement stretching the healing skin, which can stimulate excessive collagen production. *it is non-familial* - Hypertrophic scars are generally **not associated with a strong genetic predisposition** or familial inheritance patterns. - Their development is primarily linked to factors like wound tension, infection, and individual healing responses rather than inherited tendencies. *it is not related to the race* - The incidence of hypertrophic scars does **not show a significant racial predilection**, unlike keloid scars, which are more common in individuals with darker skin types. - Hypertrophic scars can affect individuals from all racial backgrounds. **References:** [1] Kumar v, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 119-121.
Question 10: What is the SI unit of illuminance (brightness of light on a surface)?
- A. Luminance
- B. Lux (Correct Answer)
- C. Candela
- D. Lumen
Explanation: ***Lux*** - **Lux** is the SI unit specifically designated for **illuminance**, which measures the **luminous flux** incident on a surface per unit area. - It quantifies the perceived **brightness** of light on a surface, taking into account the human eye's sensitivity to different wavelengths. *Luminance* - **Luminance** is a measure of the **intensity of light emitted or reflected from a surface** in a given direction, expressed in candelas per square meter (cd/m²). - It describes the brightness of a surface as perceived by the eye, but unlike illuminance, it is **independent of the incident light**. *Candela* - The **candela** is the SI base unit of **luminous intensity**, measuring the **power emitted by a light source in a particular direction**. - It doesn't describe the **brightness on a surface** but rather the output of the light source itself. *Lumen* - The **lumen** is the SI unit of **luminous flux**, representing the total amount of **visible light emitted by a source per unit time**. - While related to brightness, it describes the **total light output** of a source, not the illuminance on a specific surface.
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