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anatomy exam questions | revision 5

rectum and anal canal - description, divisions, syntopy (draw frontal and sagittal sections), vascular supply, sphincters and their innervation. peritoneum - parietal and visceral, greater and lesser omentum, mesentery ...

Congenital Anomalies of the Anorectum - Diseases of the Rectum and ...

By 6 weeks of gestation, the urorectal septum begins to move in a caudal direction to divide the cloaca into the anterior urogenital sinus and posterior anorectal canal. Failure of the urorectal septum to form results in a fistula ... Magnetic resonance imaging accurately delineates the anatomy of the pouch relative to the levator ani musculature and sphincters; it is particularly useful during postoperative evaluation of the child with continence problems after repair. ...

The Syllabus for Anatomy in MBBS Course

Level 2Axilla: Collaterals Lymph nodes (breast) Axillary sheath cervico-axillary canal, Abscess drainage, Palm: comparative Anatomy (thumb, palmaris brevis), position of rest and of function, collaterals, Fascial spaces: Surgical ...

Anorectal Disease

55 ANORECTAL DISEASE
Eric L. Sarin M.D., John B. Moore M.D.

1. What aspect of the initial patient encounter is most important in the diagnosis of anorectal disease?

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Clinical history, including duration of complaints, exacerbating or alleviating issues, precipitating events, dietary and bowel habits, and current or previous treatments. This may not sound glamorous, but you will never encounter a more grateful patient than one whose rectal problem you have solved.
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Anorectal Disease. Anorectal Abscess & Fistula In Ano

ANORECTAL ABSCESS AND FISTULA IN ANO

5. What is the most common cause of anorectal abscess?

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Ninety percent result from cryptoglandular infection.

6. What are the four potential anorectal spaces used to classify anorectal abscesses?

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1. Perianal (area of the anal verge)
2. Ischiorectal (area lateral to the external sphincter muscles, extending from the levator ani muscles to the perineum)
3. Intersphincteric (area between the internal and external sphincter muscles, continuous inferiorly with the perianal space and superiorly with the rectal wall)
4. Supralevator (area superior to the levator ani muscles, inferior to the peritoneum, and lateral to the rectal wall)
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, anorectal disease, purpose of a seton for a fistula in ano,

Anorectal Disease. Anal Fissure

ANAL FISSURE

14. What is the most common location for idiopathic anal fissure?

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90% are posterior, and 10% are anterior.

15. What are the most common symptoms of anal fissure?

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Tearing anal pain and bleeding with bowel movements.
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Hepatic & Biliary Trauma. Surgical Anatomy Of The Liver

SURGICAL ANATOMY OF THE LIVER

7. How many anatomic lobes are present in the liver? What is their topographic boundary?

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The liver is divided into two anatomic lobes, the right and the left. Their boundary lies in an oblique plane extending from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. The three hepatic veins define the division between the lobar segments and the planes of surgical resection. Lobar segments are numbered I-VIII, according to Couinaud’s nomenclature. (See Figure 25-1.)
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Anorectal Disease. Pilonidal Sinus Disease

PILONIDAL SINUS DISEASE

29. What is the most common clinical presentation of a pilonidal sinus?

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Pain and swelling in the sacrococcygeal region, which typically are associated with a (sometimes several) chronic draining sinus tract.
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pilonidal sinus and anorectal pain,

Inguinal Hernia

56 INGUINAL HERNIA
Gregory P. Victorino M.D., Jyoti Arya M.D., James Bascom M.D.

1. “Groin” hernia refers to which three hernias?

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Direct and indirect inguinal hernias and femoral hernias.
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poupart 1616-1708,

Inguinal Hernia. Controversies

CONTROVERSIES

36. What are some of the anatomic issues related to inguinal hernias?

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At issue is the iliopubic tract, which is central to the Anson/McVay anatomic description of the inguinal area and featured in the McVay Cooper’s ligament repair. Although the McVay repair is used in England, the iliopubic tract is not referred to or described in English anatomic texts.
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Anorectal Disease. Hemorrhoids

HEMORRHOIDS

21. What are hemorrhoidal tissues, and what are their normal functions?

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Hemorrhoids are cushions of vascular tissue that contribute to anal continence and protect the sphincter mechanism during defecation. Hemorrhoids are not veins, but sinusoids. Bleeding originates from presinusoidal arterioles, thus explaining the bright red arterial color.
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Intestinal Obstruction Of Neonates & Infants

83 INTESTINAL OBSTRUCTION OF NEONATES AND INFANTS
Richard J. Hendrickson M.D., Denis D. Bensard M.D.

1. What signs or symptoms suggest intestinal obstruction in the neonate?

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Signs and symptoms vary according to the level of obstruction. Proximal intestinal obstruction leads to the early onset of bilious emesis, generally with minimal abdominal distention. In contrast, neonates with distal intestinal obstruction present after the first day of life with bilious vomiting and pronounced abdominal distention. Bilious emesis should always be interrogated further in infants and children.
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j pediatr surg 37:909-911,

Properties In Evaluation Of The Acute Abdomen

14 PRIORITIES IN EVALUATION OF THE ACUTE ABDOMEN
Alden H. Harken M.D.

1. What is the surgeon’s responsibility when confronted by a patient with an acute abdomen?

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1. To identify how sick the patient is
2. To determine whether the patient (a) needs to go directly to the operating room, (b) should be admitted for resuscitation or observation, or (c) can be sent safely home

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Surgical Infectious Disease. Prophylaxis

PROPHYLAXIS

17. Should systemic antibiotic prophylaxis be used in elective colon resection?

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Yes, beyond any statistical shadow of a doubt. At least two dozen clinical trials have been carried out using placebo controls against a variety of antibiotics, principally those active against at least the anaerobic-predominant flora, and nearly all have shown a reduction in infectious complications in the antibiotic group. Never again should this point need repeating, and no patient should be placed at risk when systemic antibiotic prophylaxis has been established as the standard of care. No new clinical trials against placebo in this group of patients with known risk can be performed ethically given the confirmed risk reduction.
Other risk groups (e.g., cesarean section after membrane rupture) besides patients undergoing colon resection have been standardized by trials in large patient populations and have shown similar risk reduction. The benefit of prophylaxis has been demonstrated. In other groups of patients that cannot be standardized because of unusual contamination factors or unique factors of host resistance impairment, guidelines for rational prophylaxis should follow similar principles.
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Lower Gastrointestinal Bleeding

52 LOWER GASTROINTESTINAL BLEEDING
Kathleen Liscum M.D.

1. Describe the treatment of a patient who presents with lower gastrointestinal (GI) bleeding.

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Treatment begins with the ABCs (airway, breathing, circulation). Place two large-bore intravenous (IV) catheters in the upper extremities. Obtain hemoglobin and hematocrit levels, blood type, and cross-match. A Foley catheter should be placed to help monitor volume status.

2. What is the next step in evaluating the patient?

Show answer
A nasogastric tube should be placed to rule out an upper GI source. If the aspirate is bilious, the examiner can be fairly certain that the source is distal to the ligament of Treitz. However, if the aspirate reveals no bile, the patient may still be bleeding in the duodenum with a competent pylorus.
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Hepatic & Biliary Trauma. Biliary Tract Injury

BILIARY TRACT INJURY

22. Why are complications associated with bile duct leaks?

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Bilomas (i.e., collections of bile) frequently become infected and may result in lethal peritonitis. Biliopleural fistula, a communication between the biliary system and pleural cavity, persists because of the relative negative pressure in the thorax and may result in a bile empyema.

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Properties In Evaluation Of The Acute Abdomen. Lab Stadies

LABORATORY STUDIES

15. How is a complete blood count helpful?

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1. Hematocrit. If the hematocrit is high (> 45%), the patient is most likely dry or may have chronic obstructive pulmonary disease. If it is low (< 30%), the patient probably has a more chronic disease (associated with blood loss-always do a rectal and test the stool for blood).
2. White blood cell count. It takes hours for inflammation to release cytokines and elevate the white blood cell count. A normal white blood cell count is entirely consistent with significant abdominal trouble. Read more

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Congenital Cysts & Sinuses Of The Neck

July 13, 2009 · Posted in PEDIATRIC SURGERY · Comment 

88 CONGENITAL CYSTS AND SINUSES OF THE NECK
Frederick M. Karrer M.D., Denis D. Bensard M.D.

1. What are branchial cleft anomalies?

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Cysts, sinuses, and fistulas that result from incomplete obliteration of the first, second, or third branchial clefts, and are present in early fetal development.

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