Abdominal surface landmarks — MCQs

During a surgical procedure to repair an abdominal aortic aneurysm, the surgeon must be careful to avoid injury to which of the following arterial structures that originates near the level of the renal vessels?

A 24-year-old woman comes to the emergency department because of abdominal pain, fever, nausea, and vomiting for 12 hours. Her abdominal pain was initially dull and diffuse but has progressed to a sharp pain on the lower right side. Two years ago she had to undergo right salpingo-oophorectomy after an ectopic pregnancy. Her temperature is 38.7°C (101.7°F). Physical examination shows severe right lower quadrant tenderness with rebound tenderness; bowel sounds are decreased. Laboratory studies show leukocytosis with left shift. An abdominal CT scan shows a distended, edematous appendix. The patient is taken to the operating room for an appendectomy. During the surgery, the adhesions from the patient's previous surgery make it difficult for the resident physician to identify the appendix. Her attending mentions that she should use a certain structure for guidance to locate the appendix. The attending is most likely referring to which of the following structures?

A 48-year-old woman presents to the emergency department because of increasingly severe right upper abdominal pain, fever, and non-bloody vomiting for the last 5 hours. The pain is dull, intermittent, and radiates to her right shoulder. During the past 3 months, she has had recurring abdominal discomfort after meals. The patient underwent an appendectomy more than 30 years ago. She has hypertension, diabetes mellitus type 2, and chronic back pain. She takes bisoprolol, metformin, and ibuprofen daily. She is 171 cm (5 ft 6 in) tall and weighs 99 kg (218 lb). Her BMI is 35.2 kg/m2. She appears uncomfortable and is clutching her abdomen. Her temperature is 38.5°C (101.3°F), pulse is 108/min, and blood pressure is 150/82 mm Hg. Abdominal examination shows right upper quadrant abdominal tenderness and guarding. Upon deep palpation of the right upper quadrant, the patient pauses during inspiration. Laboratory studies show the following: Blood Hemoglobin 13.1 g/dL Leukocyte count 10,900/mm3 Platelet count 236,000/mm3 Mean corpuscular volume 89/µm3 Serum Urea nitrogen 28 mg/dL Glucose 89 mg/dL Creatinine 0.7 mg/dL Bilirubin Total 1.6 mg/dL Direct 1.1 mg/dL Alkaline phosphatase 79 U/L Alanine aminotransferase (ALT, GPT) 28 U/L Aspartate aminotransferase (AST, GOT) 32 U/L An X-ray of the abdomen shows no abnormalities. Further evaluation of the patient is most likely to reveal which of the following?

A 42-year-old woman presents to the emergency department complaining of abdominal pain, nausea, and vomiting for the last 4 hours. She says that symptoms onset right after she had 2 generous portions of pizza. She notes that she had prior similar episodes which resolved spontaneously within an hour. However, the pain today has persisted for 5 hours and is much more severe. She says the pain is located in the right upper quadrant of her abdomen and radiates to her upper back. She describes the pain as dull and cramping. She has had hypertension for the past 10 years, managed medically. Her vital signs are a blood pressure of 148/96 mm Hg, a pulse of 108/min, a respiratory rate of 18/min, and a temperature of 37.7°C (99.9°F). Her BMI is 28 kg/m2. On physical examination, the patient appears uncomfortable and is clutching her abdomen in pain. Abdominal exam reveals severe tenderness to palpation in the right upper quadrant with guarding. A positive Murphy’s sign is present. Her serum chemistry levels, including amylase, lipase, bilirubin, and liver function tests and urinalysis are normal. Urine hCG level is < 0.5 IU/L. Abdominal ultrasound reveals a large stone lodged in the neck of the gallbladder. Which of the following is the most likely pathway for referred pain in this patient?

An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A 31-year-old woman presents to the emergency room with high-grade fever and abdominal pain for the past 2 days. She also complains of malaise and has vomited several times since last night. The past medical history is benign. The vital signs include: temperature 40.0°C (104.0°F), pulse 120/min, respiratory rate 28/min, and blood pressure 120/89 mm Hg. On physical examination, severe costovertebral angle tenderness is noted. She is admitted to the medical floor and blood is drawn. The laboratory testing reveals leukocytosis with predominant neutrophilia and increased C-reactive protein and ferritin levels. She is suspected to have a retroperitoneal organ infection. Which of the following best describes the involved organ?

A 45-year-old male is brought to the emergency department by emergency medical services after sustaining a gunshot wound to the abdomen. He is unresponsive. His temperature is 99.0°F (37.2°C), blood pressure is 95/58 mmHg, pulse is 115/min, and respirations are 20/min. Physical examination reveals an entry wound in the left abdominal quadrant just inferior to the left lateral costal border. Abdominal CT shows the bullet trajectory through the left abdominal cavity. Which of the following structures has the bullet most likely penetrated?

A researcher is investigating the blood supply of the adrenal gland. While performing an autopsy on a patient who died from unrelated causes, he identifies a vessel that supplies oxygenated blood to the inferior aspect of the right adrenal gland. Which of the following vessels most likely gave rise to the vessel in question?

A 72-year-old male presents to a cardiac surgeon for evaluation of severe aortic stenosis. He has experienced worsening dyspnea with exertion over the past year. The patient also has a history of poorly controlled hypertension, diabetes mellitus, and hyperlipidemia. An echocardiogram revealed a thickened calcified aortic valve. The surgeon is worried that the patient will be a poor candidate for open heart surgery and decides to perform a less invasive transcatheter aortic valve replacement. In order to perform this procedure, the surgeon must first identify the femoral pulse just inferior to the inguinal ligament and insert a catheter into the vessel in order to gain access to the arterial system. Which of the following structures is immediately lateral to this structure?