1. DR. Ibtisam Musallam Aljohani. KAMC .
Anatomy Qs ( abdomen )
DR. Ibtisam Musallam Aljohani.
KAMC .

2. 2 appendix questions

3. The incidence of retro-cecal appendix is:
b)40%
c)75%
d)95%

4. The appendix size by the Us is: a)1.5cm b)2.5cm c)3mm d)6mm
Ultrasonography of normal and abnormal appendix in children
The appendix size by the Us is:
a)1.5cm
b)2.5cm
c)3mm
d)6mm

5. SR 169
Its position is variable and according to most authors the retrocaecal position is commonest The possible positions are: retrocaecal, pelvic, pre-ileal (anterior to ileum), post-ileal (behind ileum), sub- caecal (inferior to caecum)

6. Applied 198
Very mobile - retrocaecal in 75% and lying along the right pelvic sidewall in 20%.

7. Ultrasonography of normal and abnormal appendix in children http://www
Normal appendix is a compressible tubular structure with a blind end. It is generally accepted that normal appendix does not exceed 6 mm in maximal outer diameter (MOD), which is the most important diagnostic criterion to exclude acute appendicitis.

8. 4 questions about the relation of ureter

9. In the course of the right ureter it passes:
A) Posterior to the iliac vessels.
B) posterior to the testicular vessels.
C) superior to the vas deference.
D) anterior to the ileocecal artery.
E) Superior to the broad ligament.

10. which passes anterior to the right ureter:
A) right ileocolic artery.
B) IVC

11. One of the following is a posterior relation to the right ureter:
a) Iliocecal art
b) Iliac vessels
c) Vas deferanse
d) Broad ligament
e) Bowel loops

12. The right ureter is:
A) medal to the 3rd part of duodenum,
B) lateral to the 3rd part of duodenum
C) posterior to the 3rd part of duodenum
D) above the 2nd part of duodenum

13. Applied page 224 Relations (see Figs. 12.7 and 12.8):
Posterior : psoas muscle, genitofemoral nerve, sacroiliac joint and common iliac vessels, tips of the transverse processes of L2-L5 lumbar vertebrae
Anterior:
right - duodenum, gonadal and colic artery
left - gonadal and colic artery, sigmoid mesentery.

14. SR page 202
On the right side it is related to the second part of the duodenum and is crossed by the gonadal, the right colic and the ileocolic vessels and lies lateral to the IVC.
On the left side it is crossed by the gonadal and left colic vessels and has jejunal loops anterior to it, and is crossed at the pelvic brim on the left side by the mesentery of the sigmoid colon and is posterior to this part of the colon.

15. Based on radiopedia
Abdominal ureter

16. PELVIC URETER

17. HERE ARE SOME IMAGES

21. statdx Which one is a significant congenital anomaly:
a)complete duplicated ureter.
b)febella.
c)ischio-pubic synchondrosis.
d)bipartate patella.
e)retro aortic left renal vein.

22. statdx Clinical Issues · Often asymptomatic in males
· Incontinence only in females due to insertion of upper pole ureteral orifice below bladder sphincter
· Intermittent or persistent urinary tract infections ± acute pyelonephritis, frequently in females
· Female predominance (M:F = 1:10)

23. febella
it is a sesamoid bone typically found in the lateral head of the gastrocnemius. It occurs in 10-30% of the population.

24. Synchondroses
Synchondroses are temporary joints that only exist during skeletal maturation. Bilateral widening of the ischiopubic synchondrosis (IPS) is a normal growth phenomenon, but when it is unilateral and painful it can become a diagnostic challenge.
The ischiopubic synchrondrosis syndrome or van Neck-Odelberg disease

25. bipartite patella
A bipartite patella, represents the presence of an accessory ossification center at the superolateral pole. Partite means divided into parts.
usually discovered incidentally in asymptomatic individuals. Occurs bilaterally in about 43% of the cases. Only 2% of patients with bipartite patella experience symptoms.

26. 4 questions about adrenal gland

27. the diaphragm is directly related to:
A) left adrenal gland ( antromedialy)

28. adrenal gland:
A) inside gerotus fascia and inside internal capsule
B) outside gerotus fascia and inside internal capsule
C) in perirenal space and outside capsule.

29. SR page 203 All true about adrenal glands except :
A) Lie within renal facia

30. Regarding the adrenal gland, one is true:
a) Supplied by 2 art for each side.
b) Located superolateral to the kidney.
c) Located within the renal capsule.
d) The diameter of each limb can reach up to 10mm.

31. right lobe (bare area) of the liver
Based on rediopedia
Right adrenal
Left adrnal
latral
right lobe (bare area) of the liver
medial
right crus of the diaphragm, right inferior phrenic nerve
left crus of the diaphragm, left inferior phrenic nerve
Anteriour
IVC
less sac, stomach, splenic artery, pancreas
posterior
The right kidny
The left kidney

32. SR 203
The adrenal glands lie retroperitoneally above each kidney They are each enclosed within the perirenal fascia but in a separate compartment from the kidney Each gland is composed of a body and medial and lateral limbs

33. SR page 104
The right adrenal gland is seen posterior to the IVC More laterally it lies between the liver and the crura of the dia- phragm.
The left adrenal is higher and extends more laterally anterior to the kidney, from which it is separated by perirenal fat

34. SR page 203 and appliaid ana page 228
The adrenal glands lie retroperitoneally above each kidney They are each enclosed within the perirenal fascia but in a separate compartment from the kidney.
Paired retroperitoneal glands, supero-medial to the kidneys within the perinephric space, but outside the renal capsule.

35. SR 203, statdx
Three arteries supply these glands on each side, namely:
the superior adrenal artery from the inferior phrenic artery
the middle adrenal artery from the aorta
the inferior adrenal artery from the renal artery .
Superior adrenal arteries: (6-8) from inferior phrenic arteries
Middle adrenal artery: (1) from abdominal aorta
Inferior adrenal artery: (1) from renal arteries.

36. radiopedia
The adrenal gland weighs on average 4-6g and measures 4-6cm long and 2-3cm wide 6. Each limb normally measures <5mm in width and the body should measure <10mm in width 1-4. Proportionately, the adrenal size is larger in neonates and infants, being almost one-third of the size of the kidney

37. 3 Questions about the kidneys

38. Posterior relation of the left kidney:
A) Tail of pancrease
B) Lesser sac
C) Subcostal artery
D) IVC

39. Which of the following is correct:
a) jujenal loops ant. To the left kidney.

40. horse shoe kidney associated with all except:
A) PUJ obstruction
B) Renal stone
C) Wilms tumor
D) Uretrocele >>> with douple ureter mostly.
E) Vascular injury

41. ULTRASOUND: THE REQUISITES PAGE 142
in Doppler US, which of the following is most indicating renal artery stenosis:
a.       Increased resistive index
b.      Peak systolic velocity
Pulsed Doppler analysis of abnormal areas identified on color Doppler imaging will reveal a peak systolic velocity exceeding 200 cm/sec (see Fig. 5-62) and a peak renal artery velocity-to-peak aortic velocity ratio of greater than 3.5.

42. SR page 197
Left kid
Right kid
Stomach
pancreas and its vessels
Spleen
splenic flexure of the colon
jejunal loops
Liver
second part of the duodenum
ascending colon
small intestinal loops
Anterior
the adrenal gland – more medial on the right kidney.
Superiorly
The same in both kidneys but divided to upper and lower
Posteriorly
diaphragm and twelfth rib and the costodiaphragmatic recess of the pleura
upper third
medial to lateral: psoas, quadratus lumborum and transversus abdominis muscles
lower third

43. APPLIED ANA 222

44. SR page 197 These are as follows: • Posteriorly:
upper third, diaphragm and twelfth rib and the costodiaphragmatic recess of the pleura
lower third, medial to lateral: psoas, quadratus lumborum and transversus abdominis muscles

45. statdx
hydronephrosis, secondary to pelviureteric junction obstruction infection and pyeloureteritis cystica renal calculi increased incidence of malignancy
· ··Wilms tumour
· ··transitional cell carcinoma (TCC)
increased susceptibility to trauma

46. Radiopedia
Conginetal dialatation distal most portion of the uerter , herniated into the bladder.
Ectopic ureterocoele: ~75 % almost always associated with a duplicated collecting system and the result of abnormal embryogenesis. There is abnormality in the early development of the intravesicular ureter, the ipsilateral kidney and its collecting system 1. It is significantly more common than the simple type. 

47. 8 Liver questions

48. The venous drainage of the caudate lobe of the liver:
A) IVC
B) the portal vein
C) the right and middle hepatic veins.
D) the middle hepatic vein.
E) The middle and left hepatic veins.

49. APPLIED RADIOLOGYCAL ANTOMY PAGE 166
Venus drainage of caudate lobe :
A) SMV
B) IVC
C) PV
D) IMV
caudate lobe drains directly into the IVC and may therefore be spared in cases of hepatic vein thrombosis.
SR page 179

50. Which of the following statements are correct:
A) The falciform ligament connects the liver to the diaphragm.
B) the quadrate lobe is bordered on its left side by the fissure of ligamentum venosum. No relation
C) the quadrate lobe is bordered on its right side by the fissure of ligamentum teres. Left side

51. APPLIED ANATOMY 148 Falciform ligament (Figs. 9.11,9.14b)
extends from the anterosuperior surface of the liver to the diaphragm and anterior abdominal wall, carrying the ligamentum teres (obliterated left umbilical vein) in its free edge
in continuity with the fissure for the ligamentum venosum and coronary ligaments.

55. A liver mass is seen by CT scan
A liver mass is seen by CT scan. It is located medial to the middle hepatic vein, lateral to ligamentum teres and inferior to portal vein. Which segment of the liver does this mass lie within:
a) III
b) IVa
c) IVb
d) V
e) VIII

56. patient CT scan show a hepatic lesion anterior to the right hepatic vein and superior to the PV level, the segment is :
A) 8
B) 6
C) 5
D) 4
E) 7

57. A liver lesion located medial to the middle hepatic vein and anterior and above the portal vein, which segment:
a.  8
b. 7
c. 6
d. 5
Non of the above
Its segment 1

58. SR 177 Anterior superior liver segment of the right lobe: a)I b)III
c)V
d)VII
e)VIII

60. Which separate between medial & lateral left hepatic lobe :
A) Ligamentum teres
B) Ligamentum venosum
C) Left portal vein
D) Gall bladder bed
None of them ! It the left hepatic vein.

61. SR177
The right hepatic vein divides the right lobe into anterior and posterior segments
The left hepatic vein divides the left lobe into medial and lateral parts
The portal vein divides the liver into upper and lower seg- ments
The left and right portal veins branch superiorly and inferiorly to run in the centre of each segment

62. US THE REQUESTITS PAGE 72
patient with small liver, large spleen and tubular structures in the area of the ligamentum teres with flow in color Doppler, most likely they are:
A) recanalised umbilical vein
B) left portal vein
C) right hepatic artery
D) left hepatic vein
The easiest collateral to detect with ultrasound is the umbilical vein (Fig. 3-30).

65. Applied ana page 151
nine segments (segments I—III, IVa and IVb, V-VIII)
- caudate lobe = segment I
- portal and hepatic veins used as landmarks to divide the remainder of the liver into eight segments
- the three (left, middle and right) hepatic veins divide the liver into four sections
- the portal veins divide each of these into superior and inferior segments, a total of eight.

66. 3 primitive GIT questions

67. which of the following is derived from midgut :
a.    dudenum
b.   jejuneum
c.    ileum
d.   ascending, descending and transverse colon

68. All arise from midgut except :
A) Doudenum
B) inferior mesenteric
C) Colon

69. Which of the following is not derived from the midgut:
a) duodenum. Only 3rd and 4th part.
b) jejunum.
c) ileum.
d) colon. 2/3 of the transever colon.
e) caecum.

70. Applied ana 181
Foregut • The forgut consists of the pharynx, oesophagus, stomach and the first and second parts of the duodenum. The blood supply of these structures is predominantly derived from the coeliac artery,
Midgut • The midgut consists of the third and fourth part of the duodenum, jejunum, ileum, caecum, appendix, ascending colon and proximal two-thirds of the transverse colon. The blood supply is predominantly from the superior mesenteric artery and its branches.
Hindgut • The hindgut forms the distal transverse colon, descending colon, sigmoid colon, rectum and anus. The vascular supply is predominantly from the inferior mesenteric artery,

71. Peritoneal questions

72. Pancrease located in:
a) Anterior pararenal
b) Posterior pararenal
c) Perirenal
pancreas is retroperitoneal with the exception of the tail, which lies in the splenorenal ligament SR187
Applied ana 222
The anterior pararenal space contains the duodenum and pancreas.
The posterior pararenal space contains fat alone.

74. One of the following is seen in the ant pararenal space except:
a) duodenum
b) IVC
c) Aorta
d) Adrenal
e) pancreas

75. Regarding peritoneal spaces all true except :
A) ascending & descending colon seen in the posterior para renal space

76. Applied 139 Which of the following statement is NOT correct:
A) the left kidney is a posterior relation to the spleen.
B) The tail of the pancrease is contained within the splenorenal ligament.
C) The pararenal spaces open medially.
D) the descending colon is in the posterior pararenal spaces.
E) The Gerot's fascia is outside the perirenal space.

77. SR 198
The anterior pararenal space lies anterior to the anterior renal fascia and behind the posterior peritoneum It is continu- ous across the midline and contains the pancreas, duodenum and ascending and descending colon It fuses with the lateral conal fascia and peritoneum laterally Superiorly, the space is limited where the anterior renal fascia blends with the posterior peritoneum, but inferiorly the space is open to the pelvic extraperitoneal spaces Some writers describe the anterior pararenal space as multilaminar rather than a single space.
The posterior pararenal space lies posterior to the posterior renal fascia and anterior to the muscles of the posterior abdom- inal wall This is limited medially by the attachment of the renal fascia to the psoas muscle, but is continuous laterally with the extraperitoneal fatty tissue (properitoneal fat plane) deep to the transversalis fascia It extends inferiorly to the fat anterior to the iliacus muscle and the pelvic extraperitoneal spaces It contains only fat

78. Regarding peritoneal spaces which is false :
a) Mesocolon of the transverse colon forms the inferior border of the lesser sac.
b) Right subphrenic region called hepatorenal reces
c) Gastrohepatic ligament contains coronary vein and right gastric artery
d) Right and left subphrenic regions separated by falciform ligament
Subhepatic
hepoatorenal

79. posterior right subhepatic space (hepatorenal fossa or Morisons pouch) extends posteriorly to the peritoneum overlying the right kidney. Applied 139
Right subphrenic space extends over the diaphragmatic surface of the right lobe of the liver to the right coronary ligament posteroinferiorly and the falciform ligament medially (which separates it from the left subphrenic space).

80. Transverse mesocolon : connects the transverse colon to the posterior abdominal wall formed by two layers passing from the anterior surface of the head and the anterior border of the body of the pancreas to the posterior surface of the transverse colon, where they separate to surround the bowel the upper layer is adherent to, but separable from, the greater omentum carries the middle colic vessels, autonomic nerves, and lymphatics which supply the transverse colon becomes confluent with the root of the small bowel mesentery near the uncinate process of the pancreas

81. Lesser omentum (gastrohepatic ligament) extends from the lesser curvature of the stomach and proximal 2 cm of the duodenum to the liver
contains adipose tissue, the gastric artery, the coronary vein, and the left gastric nodal chain

82. which of the following has a direct relation to lesser sac:
A. Caudate lobe
B. Right hepatic lobe
C. GB
D. Descending colon
E. Caecum

83. All of the following is a boundary of the lesser sac except:
a.       The stomach anteriorly b.      Pancreas post and portal
c.       Spleen latral
d.      GB
e.      The caudate lobe encolse it

84. Which of the following viscera is not related to the lesser sac:
a) Pancreas
b) Stomach
c) Left kidney
d) GB fundus
e) spleen

85. All are boundaries of the lesser sac except :
A) Stomach
B) Pancreas
C) Doudenum
D) Spleen

86. SR 209
The posterior wall of the lesser sac is formed by the peritoneum over the pancreas and the left adrenal and upper pole of the left kidney, whereas its anterior wall is formed by the peritoneum over the posterior wall of the stomach and the lesser omentum It is limited laterally by the spleen and its attached gastrosplenic and splenorenal ligaments.
The lesser sac is partially divided by the fold of peritoneum over the left gastric artery, the pancreatogastric fold
Medially the lesser sac communicates with the general cavity of the peritoneum via the epiploic foramen (of Winslow)

87. Applied 139, 192
The lesser sac communicates with the rest of the peritoneal cavity through the epiploic foramen (of Winslow), which lies between the inferior vena cava and the free margin of the hepatoduodenal ligament
Relations
• Anteriorly - gallbladder and liver
• Posteriorly - common bile duct, portal vein, gastroduodenal artery, which separate it from the inferior vena cava
• Superiorly - epiploic foramen
• Inferiorly - pancreatic head

88. Applied ana 139
divided into two recesses by the pancreatogastric fold (peritoneal fold over the left gastric artery):
- smaller superior recess completely encloses the caudate lobe of the liver and lies posterior to the portal vein at the porta hepatis;
superiorly, it extends deep into the fissure for the ligamentum venosum and posteriorly lies adjacent to the right diaphragmatic crus - larger inferior recess lies between the stomach and the pancreas; it is bounded inferiorly by the transverse colon and its mesentery, but can extend for a variable distance within the greater omentum; to the left it is bounded by the gastrosplenic and splenorenal ligaments.

89. Morrison’s pouch opens into a. Lesser sac
b. Paracolic gutter
c. Antrerior pararenal space
posterior right subhepatic space (hepatorenal fossa or Morisons pouch) extends posteriorly to the peritoneum overlying the right kidney
bounded superiorly by the inferior surface of the right lobe of the liver communicates freely with the right subphrenic space and the right paracolic gutter.
Applied 139

90. Applied 142 Paracolic gutters
peritoneal recesses on the posterior abdominal wall lateral to the ascending and descending colon right paracolic gutter: continuous superiorly with the right subhepatic and subphrenic spaces; larger than the left.

92. the gastrosplenic ligament contains:
A. Gastrodudenal artery
B. Short gastric vessels
C. Inferior pancreaticodudenal artery
D. Splenic vessels
E. Right hepatic artery

93. Applied 148
Gastrosplenic ligament extends from the greater curve of the stomach to the spleen continuous with the greater omentum contains the left gastroepiploic and short gastric vessel.

94. which of the following structure has a direct relation to foramen of winslow:
A. 1st part of duodenum
B. Spleen
C. Right hepatic lobe
D. GB
E. Right adrenal gland

95. Applied 139,142 Regarding the peritoneal sac and peritoneal spaces:
A) The epiploic foramen is the opening to lesser sac.
B) Is similar (closed) in males & females.
C) Left para-colic gutter communicates with left sub-phrenic space.
D) Fluid accumulates in the lesser sac.

96. Pouch of morrison’s opens directly into:
A) infra mesentric space
B) infra colic space
C) lesser sac
D) left paracolic gutter.

97. Apllaied 139,142 Regarding peritoneal spaces :
A) Epiploic foramin is opening of the lesser sac
B) Is closed in both sides
C) Right paracolic gutter communicating with right subphrenic space

98. SR page 183 68) The free edge of the omentum contains: A) CBD B) SMA
C) Left renal vein
The CBD has a supraduodenal third where it lies in the free edge of the lesser omentum, with the hepatic artery on its left and the portal vein posteriorly

100. Regarding the IVC, which is true:
A) Forms the posterior boundary of the epiploic opening
B) Forms the anterior boundary of the epiploic opening
C) Forms the inferior boundary of the epiploic opening
D) Forms the superior boundary of the epiploic opening

101. ( omental foramen / Foramen of Winslow) Boundaries of the epiploic foramen SR page 209
• Posteriorly: the IVC •
Anteriorly: the free edge of the lesser omentum containing the portal vein, hepatic artery and common bile duct
• Superiorly: the caudate process of the liver
• Inferiorly: the fi rst part of the duodenum

104. Esophegus

105. Gastroesophageal junction all true except :
A) 2 cm above hiatus in the normal adult <<< hitus hernia
B) 2 cm below hiatus in the normal adult
C) cardiac is another name
D) A ring can be identified in barium swallow
E) B ring can be identified in barium swallow

107. SR page 146
The lower end of the oesophagus has a fusiform dilatation just above the oesophagogastric junction This is called the oesophageal vestibule On barium examination, the upper part of the vestibule is defi ned by a transiently contractile ring known as the ‘ A ring ’ The lower limit of the vestibule is defi ned by another transiently contractile ring known as the ‘ Bring ’ , ‘ Schatzki ring ’ or ‘ transverse mucosal fold ’ The vestibule corresponds to the manometrically measurable zone of increased pressure that is felt to represent the lower oesopha- geal sphincter

108. Anterior relation to the esophagus
A) Right ventricle
B) Right main bronchus
C) Left atrium
D) Aorta

109. .SR page 144 Anterior relation of the esophagus :
It descends behind the trachea and thyroid, lying in front of the lower cervical vertebrae It then inclines slightly to the left in the neck and upper mediastinum before returning to the midline at the level of T 5 , from where it passes to the left again before sweeping forward to pass through the diaphragm In the chest it passes behind the trachea, left main bronchus, left atrium and upper part of the left ventricle from above downward; it then passes behind the posterior sloping part of the diaphragm before traversing this at the level of T 10 The oesophageal hiatus in the diaphragm is surrounded by a sling of fi bres from the right crus of the diaphragm

110. the esophagus is posterior to:
A. Right atrium
B. Right bronchus
C. Left atrium
D. Thoracic duct
E. Ascending aorta

112. Which of the following is an anterior relation to the esophagus:
A) Right main bronchus
B) Hemiazygos vein
C) Descending aorta
D) Left main bronchus

113. pancreas

114. The pancreatic ducts and their development ( Figs 5 38 – 5 40 )
The pancreas arises from the junction of the primitive foregut and midgut as a larger dorsal division and two smaller ventral buds which arise in common with the biliary duct The left ventral bud atrophies and the right ventral bud swings poste- riorly to unite with the inferior aspect of the dorsal division, trapping the superior mesenteric vessels between divisions .

115. the normal endoscopic diameter of pancreatic duct is:
A. 2mm
B. 3mm?
C. 4mm (since its endoscopic diameter )
D. 5mm
E. 6mm

116. The pancreatic duct is seen within the gland closer to its anterior surface It is seen in over 80% of cases It is best seen in the central portion of the body where it is perpendicular to the plane of imaging It measures approximately mm in the tail, 2 mm in the body and 3 mm in the head On high- resolution images in slim subjects it can be identifi ed running inferiorly from the neck in the head to the duodenum SR189.
The duct is 16 cm long and measures up to 4 mm in diameter in the head The accessory duct may be fi lled via its communication with the main duct and is seen to pass anteriorly and superiorly to the main duct SR 191
Pancreatic duct measurements are higher on ERCP than on MRCP and ultrasound because they distend as they are fi lled with contrast on ERCP

117. All are true regarding the pancreas EXCEPT:
a) It is developed from 2 ventral buds and 1 dorsal bud.
b) The SMV and SMA lie anterior to the uncinate process posterior t the neck
c) Is hypo echoic in old age
d) The gastrodudenal art lies ant to the neck
e) The accessory duct opens proximal to the main duct in 2nd part of duodenum.

118. SR 189
The echotexture of the pancreas is normally homogeneous and iso- or slightly hyperechoic with respect to liver.
With ageing and in obesity it may be hyperechoic due to the pres- ence of fat
When hyperechoic, it can be diffi cult to distinguish from surrounding fat

119. The diameter of duct can increase with inspiration.
RADIOPEDIA
In ERCP, pancreatic duct measures:
a. 4mm in diameter
b. 3mm
c. 5mm
d. 6mm
The diameter of the pancreatic duct (main pancreatic duct) is commonly assessed parameter in imaging. Its normal reported value ranges between 1-3mm 5.
The duct diameter is greatest at the head and neck region and is slightly narrower towards the body and tail.
The diameter of duct can increase with inspiration.

120. SR PAGE 191
Pancreatic duct measurements are higher on ERCP than on MRCP and ultrasound because they distend as they are filled with contrast on ERCP

121. pancreaticosplenic nodes from Coeliac nodes drian the spleen and panc
One of the following drain into superior mesenteric LN: A) Tail of pancrease B) Spleen C) Ascending colon D) 1st part of the deudenum.
pancreaticosplenic nodes from  Coeliac nodes  drian the spleen and panc
Pyloric group from left gastric LN from celic drian the 1st and th 2nd dudonaum

122. SR page 207 Superior and inferior mesenteric nodes:
  The superior and inferior mesenteric nodes drain the bowel from the duodenojejunal fl exure to the anal canal Lymph drainage from the small bowel is to mesenteric nodes, from the terminal ileum and colon to ileocolic nodes, and from the rectum to pararectal nodes From here, lymph drains along the arterial supply to more proximally located nodes along the arterial supply and to nodes at the origins of the superior and inferior mesenteric arteries All nodes lie on the mesenteric side of the bowel, and lymphatic channels run in the mesen- tery

124. SR page 117 One of the following passes through the caval opening:
a) Left phrenic nerve
b) Vagal trunk
c) Right phrenic nerve
d) Inferior phrenic art
e) Thoracic duct

125. Applaid radiological antomy page 95
There are three main openings: • aortic - (T12) - transmitting the aorta, thoracic duct and azygous vein
• oesophageal (T10) - oesophagus, left gastric artery and vein and vagus
• vena cava (T8) - inferior vena cava and right phrenic.

127. which structure is anterior to the left real vein:
A) 3rd part of duodenum
B) SMA
C) renal artery
SR page 161

128. Regarding the cecum, all are true except:
A) Can be located in the RUQ
B) Anterior to the psoase muscle
C) The terminal ileum is attached to the most inferior part of its medial side
D) Supplied by the ilio-colic artery

129. SR page 169 applied page 198
The distal ileum opens into the medial and posterior aspect of the large intestine at the junction of the caecum and the ascending colon.
Posteriorly - psoas, iliacus, lateral cutaneous nerve of the thigh, femoral nerve and often appendix.
• Anteriorly - anterior abdominal wall and ileal loops.
• Medial - terminal ileum.
Colic artery (branch of the ileocolic artery) - anterior and posterior caecal branches, appendiceal branch, and ascending colic branch which supplies the proximal ascending colon. Applied 207
• The ileocolic artery (the lowest right-sided branch of the main trunk of the superior mesenteric artery) supplies the caecum, appendix and the beginning of the ascending colon SR 173

130. Lt. renal vein is posterior to :
a.       iliac vein
b.      iliac artery
c.       Rt. renal artery
d.      3rd part of deudenum
SR 161

131. Sporadic pathological 3 questions

132. Radiopeadea Mercedes-Benz=Gas in Gallstones
The Mercedes-Benz sign describes a star-shaped pattern of gas-fissuring within gallstones initially described on an abdominal radiograph 2.
Fissures, usually fluid-filled, are present in close to 50% of gallstones. Less than half of these fissured gallstones contain some amount of gas 1. The radiolucency caused by the gas usually appears in a triradiate pattern, mimicking the Mercedes-Benz logo.

133. An old pt came with abd pain and signs of obstruction
An old pt came with abd pain and signs of obstruction. Abd xray shows free air in the biliary tree and an opaque structure in distal small bowel. The most likely diagnosis is:
a) Appendicitis
b) Gallstone ileus
c) Intussusseption
d) Colon ca
e) polyp

134. GI IMAGING THE REQUSITES PAGE 222
A contraindication to ERCP:
a) Sclerosing cholangitis
b) Previous gastric surgery
c) Ca of ampulla of vatar
d) Post-cholecystectomy syndrome
Other causes of failure, such as papillary stenosis, peripapillary duodenal fibrosis and deformity, previous gastric surgery, severe duodenal inflammatory disease, and duodenal diverticula in the area of the papilla, also may result in unsuccessful cannulation.

135. radiopaedia
In abdominal ultrasound you saw anechoic stracture with positive flow retroaortic, possible kidney donor:
a)left renal vein.
b)retro-aortic left renal vein.

136.
A retro-aortic left renal vein (RLRV) is an anatomical variant there the left renal vein is located between the aorta and the vertebra and drains into the inferior vena cava.
Its estimated prevalence is at ~ 2.1 % 3. Urological symptoms can be caused by increased pressure in the renal vein.

137. statdx
A retro-aortic left renal vein (RLRV) is an anatomical variant there the left renal vein is located between the aorta and the vertebra and drains into the inferior vena cava.
Its estimated prevalence is at ~ 2.1 % 3. Urological symptoms can be caused by increased pressure in the renal vein.
It's recognition is important in order to avoid complications during retroperitoneal surgery or interventional procedures 2

139. This presentation is based on personal effort.
I tried as much as possible to choose the right answer however ,I am not sure 100% about all the answer.
Thank you.