Section A: Select any 60 consecutive Multiple choice questions.

For each question circle one

best alternative.

1. A surgeon entering the abdominal cavity through the abdominal wall

will take care to avoid injury to the vessels and nerves within the wall.
The main portion of these vessels and nerves will be found immediately
deep to which of the following?
A. Skin
B. Superficial fascia
C. External abdominal oblique muscle
D. Internal abdominal oblique muscle
2. As a surgeon performing an appendectomy, you encounter an artery
and vein in the superficial fascia of the lower abdominal wall. These
vessels are most likely which of the following?
A. Superficial epigastric artery and vein
B. Superficial circumflex iliac artery and vein
C. Intercostal artery and vein
D. Inferior epigastric artery and vein
3. During surgery, you must incise the anterior rectus sheath between the
xiphoid process and the umbilicus. In this region, the sheath is derived from the
aponeurosis of which of the following?
A. External abdominal oblique only
B. Internal abdominal oblique only
C. External and internal abdominal oblique
D. Internal oblique and transversus abdominis
4. During a laparoscopic procedure, you observe the inferior epigastric vessels ascending
on the posterior surface of the rectus abdominis muscle. They suddenly disappear from
view by passing superior to which of the following?
A. Falx inguinalis
B. Linea semilunaris
C. Falciform ligament
D. Arcuate line
5. As a physician examining the inguinal region of a patient, the inguinal ligament will be a
key landmark. This structure is a feature derived from which of the following?
A. Superficial fascia
B. Fascia lata of the thigh
C. Aponeurosis of the external abdominal oblique

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 D. Aponeurosis of the internal abdominal oblique
6. As you continue your examination to check for the presence of an inguinal hernia, you
insert the tip of your finger into the superficial inguinal ring. This is an opening in which
of the following?
A. Superficial fascia
B. Fascia lata of the thigh
C. Aponeurosis of the external abdominal oblique
D. Aponeurosis of the internal abdominal oblique
7. You are in the process of repairing a direct inguinal hernia. Which of the following
anatomical relations will you find during surgery?
A. The hernia will enter the deep inguinal ring
B. The hernia will enter the femoral ring
C. The hernia will lie lateral to the inferior epigastric vessels
D. The hernia will lie medial to the inferior epigastric vessels
8. Which of the following is the correct landmark for locating the normal position of the
gallbladder during a physical examination?
A. The lowest point of the left subcostal margin
B. The junction of the left linea semilunaris with the subcostal margin
C. The lowest point of the right subcostal margin
D. The junction of the right linea semilunaris with the subcostal margin
9. During a surgical procedure in which you will remove the gallbladder, you will expect its
blood supply, the cystic artery, to arise from which of the following arteries?
A. Right hepatic artery
B. Left hepatic artery
C. Proper hepatic artery
D. Common hepatic artery
10. During the surgical procedure in the above question, your index finger is placed into the
epiploic foramen. Which of the following structures would be inferior to your finger?
A. Caudate lobe of the liver
B. First part of the duodenum
C. Inferior vena cava
D. Portal vein
11. During a surgical procedure, you have elevated the transverse colon and note an artery
in the transverse mesocolon. What is this vessel?
A. Right gastro-omental artery
B. Middle colic artery
C. Inferior pancreaticoduodenal artery
D. Right colic artery

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12. During surgery you note a retroperitoneal artery crossing the right side of the posterior
abdominal wall and supplying the ascending colon. Which vessel is this?
A. Middle colic artery
B. Left colic artery
C. Ileocolic artery
D. Right colic artery
13. A 44-year-old accountant develops a bleeding ulcer around tax time. The
gastroenterologist visualizes the ulcer in the proximal duodenum. A radiologist has been
called to cannulate and embolize the artery supplying the ulcer. Which of the following
arteries does the radiologist need to cannulate?
A. Celiac artery
B. Superior Mesenteric Artery (SMA)
C. Inferior Mesenteric Artery (IMA)
D. Superior epigastric artery
14. You are at surgery for the removal of a suspected appendicitis, but the appendix is not
visible. The appendix is likely to be which of the following?
A. Anticecal
B. Paracecal
C. Paracolic
D. Retrocecal
15. Which of the following techniques could you use to precisely locate the appendix?
A. Locate a region devoid of haustra
B. Trace the right collect artery
C. Trace the ileocolic artery
D. Trace the teniae coli on the cecum
16. A patient experiencing infraumbilical pain is likely to have a disorder of which organ?
A. Appendix
B. Ascending colon
C. Ileum
D. Stomach
E. Sigmoid colon
17. You are at surgery and are about to mobilize the second portion of the duodenum and
the head of the pancreas. You note an artery and vein passing anteriorly to the uncinate
process of the pancreas and the third portion of the duodenum. Which vessels are
these?
A. Superior mesenteric artery (SMA) and Superior mesenteric vein (SMV)
B. Inferior mesenteric artery and vein
C. Gastroduodenal artery and vein

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 D. Superior pancreaticoduodenal artery and vein
18. As you proceed to elevate the duodenum and pancreas, you note two veins posterior to
the neck of the pancreas uniting to form a large vein that passes superiorly. Which large
vein has been formed?
A. Splenic vein
B. Inferior venacava (IVC)
C. Portal vein
D. Right gastric vein
19. As you continue, you also note a large, tortuous artery passing to the left along the
superior border of the pancreas. This is likely to be which of the following?
A. Left renal artery
B. Inferior mesenteric artery (IMA)
C. Splenic artery
D. Left gastro-omental artery
20. You are examining the liver during a surgical procedure. The gallbladder will be found in
its fossa between which two anatomical lobes?
A. Quadrate and left lobes
B. Quadrate and caudate lobes
C. Right and quadrate lobes
D. Caudate and right lobes
21. If you ligated the right hepatic artery, the arterial supply to which of the following
portions of the liver would remain intact?
A. Right lobe only
B. Right and quadrate lobes
C. Left lobe only
D. Left and quadrate lobes only
E. Left, quadrate, and a portion of the caudate lobe
22. Your patient who had cirrhosis has symptoms of esophageal varices. This is due to
dilatation of the anastomosis between which of the following pairs of veins?
A. Left gastric and the azygous veins
B. Right gastric and the azygous veins
C. Right gastric and the hemiazygos
D. Left gastric and the hemiazygos
23. Gastric contents exiting a posterior perforation of the stomach wall will accumulate in
which of the following?
A. The left paracolic gutter
B. The left paravertebral gutter
C. The right paravertebral gutter

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 D. The omental bursa
24. Ligation of the common hepatic artery will eliminate the gastric blood supply through
which of the following arteries?
A. Left gastric and short gastric arteries
B. Short gastric and right gastro-omental arteries
C. Right gastro-omental and right gastric arteries
D. Right gastric and left gastric arteries
25. A surgical incision through the fundus of the stomach would require you to clamp which
of the following?
A. Right gastric artery
B. Left gastric artery
C. Right gastro-omental artery
D. Left gastro-omental artery
E. Short gastric arteries
26. During the removal of a patient’s kidney, you would observe which of the following as
being most anterior within the renal sinus?
A. Renal arteries
B. Renal vein
C. Major calyx
D. Minor calyx
27. You wish to examine the hilum of the right kidney during surgery. Which of the
following structures must be elevated and reflected to do so?
A. Stomach
B. Suprarenal gland
C. Ascending colon
D. Duodenum
28. To elevate the kidney within the renal fascia and the peri-renal fat, the renal fascia must
be reflected or incised from the fascia of which of the following muscles?
A. Diaphragm
B. Psoas muscle
C. Quadratus lumborum muscle
D. Transverses abdominis muscle
29. As a surgeon about to remove the right adrenal gland, you examine the blood supply of
the right adrenal gland and observe which of the following?
A. It receives its arterial blood supply from the aorta only
B. Its central vein drains into the IVC
C. Its central vein drains into the left renal vein
D. It is in contact with the head of the pancreas

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30. After removal of a large portion of the stomach in a patient who has cancer, you are
now examining the lymph nodes that receive lymph from the stomach. Which of the
following structures receives lymph directly from the stomach?
A. Cisterna chili
B. Aortico-renal nodes
C. Celiac nodes
D. Superior mesenteric nodes
31. In a patient who has testicular cancer that has metastasized (spread) to the lymph
nodes, which of the following would you expect to be involved first?
A. Lumbar (aortic) nodes
B. Aortico-renal nodes
C. Inferior mesenteric nodes
D. Common iliac nodes
32. A 34-year-old woman who has diabetes develops a “boil” on the right labia majora.
Which of the following lymph nodes is most likely to be enlarged in response to the
infection?
A. Internal iliac
B. External iliac
C. Superficial inguinal
D. Obturator
33. Which of the following structures divides the perineum into the genitourinary and anal
triangles?
A. Levator ani muscles
B. Superficial transverse perineal muscle
C. Line from the ischial tuberosities
D. Anal verge
34. A 24-year-old woman is undergoing a vaginal delivery. A midline episiotomy is
performed that incises into the perineal body. Which of the following muscles is most
likely to be cut during this process?
A. Superficial transverse perineal muscle
B. Levator ani muscle
C. Puborectalis muscle
D. Pubococcygeus muscle
35. Which of the following is the male homologue of the female clitoris?
A. Epididymis
B. Vas deferens
C. Penis
D. Scrotum

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36. The scrotum appears to have a slightly pigmented and wrinkled appearance. What is the
explanation for this appearance?
A. Hyperkeratinized squamous epithelium
B. The tunica albuginea
C. The dartos fascia
D. The pampiniform plexus
37. An 18-year-old man is noted to have probable testicular cancer. He undergoes surgery.
After incising the scrotum, the surgeon contemplates the approach to the parenchyma
of the testes. Through which layer must the surgeon incise to reach the testicular
parenchyma?
A. Buck fascia
B. Tunica albuginea
C. Dartos fascia
D. Scarpa fascia
38. A 31-year-old woman is in her physician’s office for a fitting for an intrauterine
contraceptive device. The physician performs a pelvic examination to ensure that the
device is placed in the correct direction. The physical examination shows that the
uterine body is tipped toward the rectum and that the uterine fundus is tipped
anteriorly. Which of the following describes the position of the uterus?
A. Anteverted, anteflexed
B. Anteverted, retroflexed
C. Retroverted, anteflexed
D. Retroverted, retroflexed
39. A 45-year-old woman is having significant uterine bleeding from uterine fibroids. The
radiologist performs an embolization procedure of the uterine arteries. Through which
of the following structures do the uterine arteries traverse?
A. Transverse cervical (cardinal) ligaments
B. Uterosacral ligaments
C. Vesicouterine fold
D. Anterior vaginal fornix
40. A 20-gauge spinal needle is placed through the vagina to assess whether there is blood
in the peritoneal cavity. Which of the following describes the most dependent part of
the peritoneum or pelvis?
A. Vesicouterine fold
B. Pararectal space
C. Paravesical space
D. Rectouterine pouch (of Douglas)

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41. A 22-year-old woman is noted during surgery to have a 3-cm ectopic pregnancy
involving the ampulla of the fallopian tube. Which of the following best describes this
location of the tube?
A. Portion within the muscle of the uterus
B. Portion that is narrowest and mobile
C. Portion that begins to widen distally and is the longest portion of the tube
D. Portion with finger-like projections
42. Bilateral oophorectomy is performed in a woman who had ovarian cancer. To
accomplish this procedure, the ovarian arteries were ligated. Which of the following
describes the anatomy of the ovarian vessels?
A. Right ovarian artery arises from the right renal artery
B. Right ovarian vein drains into the vena cava
C. Left ovarian artery arises from the left internal iliac artery
D. Left ovarian vein drains into the vena cava
43. A 3-cm ectopic pregnancy of the isthmus of the left tube is noted to have ruptured,
leading to hemorrhage. The blood noted arises principally from which of the following?
A. Uterine artery
B. Ovarian artery
C. Uterine and ovarian arteries
D. Neither the uterine nor the ovarian arteries
44. A 66-year-old man complains of difficulty voiding and is noted to have probable BPH.
Which of the following prostatic lobes is likely to be responsible for these symptoms?
A. Anterior lobe
B. Posterior lobe
C. Lateral lobe
D. Middle lobe
45. A 48-year-old man is undergoing cystoscopic examination. As the cystoscope is placed
into the urethra through the penile portion, which of the following tissues surrounds the
urethra?
A. Prostate
B. Corpus spongiosum
C. Seminal colliculus
D. Sphincter urethrae muscles
46. A police detective takes a scraping of some stains to be examined for alkaline
phosphatase to assess whether these might be ejaculate. What is the source of alkaline
phosphatase in the semen?
A. Prostatic gland
B. Bulbourethral glands

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 C. Seminal vesicles
D. Seminal colliculus apparatus
47. A 39-year-old woman complains of hematuria and significant flank tenderness. She has
a history of kidney stones. A CT scan depicts the abdominal portion of the ureter lying
anterior to a muscle. Which of the following is most likely to be the name of this
muscle?
A. Psoas
B. Serratus anterior muscle
C. Obturator muscle
D. Rectus muscle
48. A dissection of the ureter is accomplished to excavate a large retroperitoneal mass. In
isolating the ureter, the surgeon is attempting to ensure that the blood supply to the
ureter is not disrupted. Which of the following best describes the arterial supply to the
ureter?
A. Ureteral artery arising from the abdominal aorta
B. Ureteral artery arising from the external iliac artery
C. Ureteral artery arising from the internal iliac artery
D. No specific artery, but rather small branches from the nearby arteries
49. A 30-year-old woman is noted to have an absent kidney. Which of the following findings
is she also likely to have?
A. Absent unilateral ovary
B. Unicornuate uterus
C. Imperforate hymen
D. Inguinal hernia
50. A 50-year-old man who has diabetes is having difficulty voiding urine. On examination,
he has decreased sensation of the perineal region. Which of the following reflexes is the
most likely to be affected?
A. Patellar tendon
B. Achilles tendon
C. Cremaster
D. Anal wink
51. A midline abdominal incision below the umbilicus passes through all the following
EXCEPT:
A. pyramidalis
B. linea alba
C. extra peritoneal fat
D. transversalis fascia
52. The spleen:

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 A. has a lower pole which normally projects forward to the anterior axillary line
B. lies between the 8th and 10th ribs
C. has a long axis lying in the line of the 9th rib
D. as it enlarges, glides in contact with the anterior abdominal wall in front of the
splenic flexure of the colon
53. Which is the most common site for the appendix found at appendicectomy?
A. retro-ilieal
B. retrocaecal
C. pelvic
D. anterior to terminal ileum
54. The abdominal aorta:
A. passes into the abdomen behind the diaphragm at the level of the 10th thoracic
vertebra
B. bifurcates at the level of the body of the 2nd lumbar vertebra
C. has a surface marking for its bifurcation as 2cm below and to the right of the
umbilicus
D. gives rise to the coeliac artery at the level of the body of the 10th thoracic
vertebra
55. With regard to the spleen, which is NOT true?
A. in splenomegaly, the splenic flexure of the colon lies superficial to its anterior
border
B. its anterior border is notched
C. its medial relations include left kidney, lienorenal ligament, pancreas and lesser
sac
D. it lies between the 9th and 11th ribs
56. With regard to the duodenum, which is NOT true?
A. the duodenal cap has plicae circulares which are often evident on x-ray
B. the third part may be compressed by the superior mesenteric artery
C. the second part lies at level of 2nd lumbar vertebra in cadavers
D. the duodenal cap lies upon bile duct, hepatic artery and portal vein
57. The ejaculatory ducts:
A. are formed by the union of the prostatic ducts and the ducts of the seminal
vesicle
B. lie on the superior surface of the bladder
C. open into the membranous urethra
D. contract with parasympathetic stimulation
E. have none of the above properties
58. The ureter passes deep to the:

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 A. femoral nerve
B. gonadal artery
C. psoas muscle
D. genitofemoral nerve
59. With respect to the testicle:
A. the tunica albuginea overlies tunica vaginalis
B. the head of the epididymis is attached to the lower pole of the testis
C. the appendix testis (if present) is attached to the upper pole of the testicle
D. testicular and scrotal lymph drainage is the superficial inguinal nodes
60. With regard to the spleen, which is NOT true?
A. it is in direct contact with the lesser sac
B. it projects into the greater sac
C. its anterior border is notched
D. it receives both sympathetic and parasympathetic supply
61. Regarding abdominal vascular anatomy, all of the following are true EXCEPT:
A. the left renal vein lies under the superior mesenteric artery
B. the appendix is supplied by the ileo-colic branch of the superior mesenteric
artery
C. the left gastro epiploic artery is a branch of the splenic artery
D. the portal vein lies posterior to the pylorus
E. the duodenum receives no supply from the superior mesenteric artery
62. With regard to the ureter, which is NOT true?
A. it is narrowed at its halfway mark
B. it crosses the genitofemoral nerve under cover of peritoneum
C. the upper part of the right ureter lies behind the duodenum
D. it lies just lateral to the tips of the transverse processes of L3-5
63. With regard to the female pelvis, which is NOT true?
A. the cervix is separated from the rectum by the Pouch of Douglas
B. the cervix is separated from the bladder by the vesico-uterine pouch
C. the ureter passes 1-2cm lateral to the cervix
D. the ureter passes under both the broad ligament and the uterine artery
64. With regard to the duodenum:
A. it is wholly retro-peritoneal
B. it lies wholly inferior to gallbladder
C. the third part overlies the superior mesenteric vessels
D. the second part projects slightly behind the right renal hilum
E. the head of pancreas is wholly contained within its c-shaped loop

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65. The transversalis fascia contributes to which of the following structures on the anterior
abdominal wall?
A. superficial inguinal ring
B. deep inguinal ring
C. inguinal ligament
D. sac of an indirect inguinal hernia
66. The transpyloric plane of the abdomen (passing through the lower border of L1 vertebra)
passes through:
A. the spleen
B. the third part of the duodenum
C. the tail of the pancreas
D. the origin of the superior mesenteric artery
67. Afferent pain fibres for the biliary tract:
A. as far as known do not exist; pain sensation relates to inflamed overlying parietal
peritoneum
B. run with the vagus nerve to the Nucleus of the Solitary Tract
C. may run with the right phrenic nerve
D. run with spinal nerves to T2-5
68. With regard to the usual vasculature of the abdomen, which is NOT true?
A. the splenic vein mainly drains into the inferior vena cava
B. the portal vein drains nearly all of the gastrointestinal tract and unpaired
abdominal glands except liver
C. the left gastroepiploic artery and the short gastric arteries are branches of the
splenic artery
D. the right gastric artery is a branch of the hepatic artery
69. Which is NOT related to the kidneys as indicated:
A. the pleura posteriorly
B. the second part of the duodenum, anterior to the right kidney
C. the tail of the pancreas, anterior to the left kidney
D. the peritoneum of the lesser sac, anterior to the left kidney
E. the splenic artery, anterior to the lower pole of the left kidney
70. With regard to the kidneys, which is NOT true?
A. the renal nerves are from spinal segment T12-L1
B. at the hilum, the vein is anterior to the artery which is anterior to the ureter
C. in horseshoe kidneys, ureters pass behind the isthmus of the kidney substance
D. percutaneous renal biopsy is via a point 2.5cm below the 12th rib
71. With regard to the urethra in the young adult male, which is NOT true?
A. the prostatic urethra is narrower than the membranous urethra

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 B. it is approximately 20cm long
C. has a short dilated region just proximal to the external urethral meatus
D. it is horizontal in cross-section when empty
72. The first part of the duodenum:
A. lies at the level of L2 in the supine body
B. is approximately 10cm long in the adult
C. partially overlies the right crus of the diaphragm and psoas muscle
D. is entirely retroperitoneal
73. Which of the following forms the posterior wall of the inguinal canal?
A. conjoint tendon
B. internal oblique muscle
C. transversus abdominus muscle
D. lacunar ligament
74. Fibres of transversus abdominus arise from which part of the inguinal ligament?
A. medial one third
B. lateral one third
C. lateral two thirds
D. lateral half
75. A patient was deeply stabbed high up in the costovertebral angle beneath the 12th rib on
the left side. The most likely internal injury is?
A. laceration of the infra-renal aorta
B. laceration of the right renal vascular pedicle
C. puncture of the 3rd part of the duodenum
D. pneumothorax of the left lung
76. Concerning the abdominal aorta and branches:
A. the inferior mesenteric artery arises below the L4 lumbar arteries
B. the superior mesenteric artery arises at the level of L2
C. the renal artery arises below the level of the superior mesenteric artery
D. the suprarenal arteries arise above the coeliac trunk
77. The relations of the THIRD part of the duodenum include:
A. the hilum of the right kidney
B. the attachment of the transverse mesocolon
C. the inferior pole of the right kidney
D. the superior mesenteric vein
78. All of the following are true regarding the pancreas EXCEPT:
A. the neck and body of the pancreas lie anterior to the first lumbar vertebrae
B. the neck of the pancreas lies over the right and left renal veins at the level of L2
vertebra

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 C. the splenic artery supplies all of the pancreas
D. parasympathetic vagal fibres stimulate the exocrine secretion from the gland
79. The spleen:
A. lymphatic drainage is to coeliac nodes
B. lies between the 8th and 11th ribs
C. has an identifiable notch on its posterior border
D. is supplied with parasympathetic fibres from coeliac plexus
80. Regarding the kidneys:
A. the right kidney lies at a lower level to the left kidney
B. they lie inferior to the pleura
C. the hilum of the left kidney is separated from the peritoneum by the duodenum
D. the renal fascia encloses the kidney and suprarenal gland within the same sheath

Section B: Select any four consecutive questions

1. A 55-year-old male is admitted to the hospital for a suspected kidney infection. He is

placed on intravenous antibiotic therapy but continues to have a temperature of 103°F
after 3 days of therapy. The urine culture grows Escherichia coli, which is sensitive to the
antibiotics being used. On examination, he appears ill and has marked left flank
tenderness. Ultrasound depicts an abnormal collection of fluid around the left kidney.
a. What is the most likely diagnosis?
b. What anatomical structure is involved?
c. Draw and label the urinary system
2. An 18-year-old female presents with increasing hair growth on her face and chest,
deepening of her voice, and acne over the past year. She has no history of other medical
problems. On examination, she has acne, abnormal male pattern balding, and
enlargement of her clitoris. The pelvic examination is normal including the ovaries.
Blood tests show that the serum testosterone levels are normal, but that the level of
dihydroepiandrostenedione sulfate, an adrenal androgen, is markedly elevated.
a. What is the most likely diagnosis?
b. Outline the layers of the supra-renal gland indicating at least one hormone that
each layer produces
c. What is the blood supply of the supra-renal gland?

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3. A 27-year-old female notes a tender lump in her groin area that appeared
approximately 3 weeks ago. She relates that she had a similar mass about one year ago
that required minor surgery. On physical examination, she is afebrile, and inspection of
the perineum shows a 3 2-cm fluctuant mass at the 5-o’clock position of the
vestibule. It is mildly tender, red, and slightly warm to the touch.
a. What is the most likely diagnosis?
b. What structures are causing the groin enlargement?
c. Outline the contents of the superficial perineal pouch in males and females
4. A 20-year-old male reports that he has had a non-tender, heavy sensation in his scrotal
area for two months. He jogs several miles every day but denies lifting heavy objects. He
does not recall trauma to the area, has no urinary complaints, does not smoke, and
otherwise appears healthy. His blood pressure is 110/70 mm Hg, heart rate is 80
beats/min, and he is without fever. Heart and lungs examinations are normal. His back
and abdomen are non-tender, and no abdominal masses are detected. External genitalia
examination reveals a 2-cm non-tender mass in the right testicle that shows no light
penetration with transillumination. The rectal examination is unremarkable.
a. What is the most likely diagnosis?
b. Outline the layers traversed to reach the testes
c. What is the venous drainage of the testes?
5. A 50-year-old female who has borne five children complains that she has noticed vaginal
spotting of blood after intercourse for approximately the past 6 months. More recently,
she has had a foul smelling vaginal discharge and indicates that her left leg seems larger
than her right one. She previously had syphilis. She has smoked one pack of cigarettes
per day for 20 years. Examination of her back shows left flank tenderness. The
circumferences of her left thigh and calf are larger than those of the right. Pelvic
examination shows normal female external genitalia and a 3-cm growth on the surface
on the left lip of the uterine cervix.
a. What is the most likely diagnosis?
b. What is the applied clinical anatomy for this condition?

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 c. Outline the lymphatic drainage of the uterus
6. A 19-year-old female with one healthy child presents at seven weeks’ gestation based
on her last menstrual period and her complaints of vaginal spotting and lower
abdominal pain. She denies the passage of any tissue through the vagina, trauma, or
recent intercourse. Her medical history is significant for a pelvic infection approximately
3 years previously. On examination, her blood pressure is 90/60 mm Hg, heart rate is
110 beats/min, and temperature is within normal limits. The abdomen is normal, and
bowel sounds are present and normal. On pelvic examination, the external genitalia and
uterus palpate as normal. There is moderate right adnexal tenderness with palpation.
Quantitative human β-corticotropin gonadotropin is 2300 mIU/mL, and transvaginal
sonogram displays an empty uterus and some free fluid in the cul-de sac.
a. What is the most likely diagnosis?
b. What is the cause of the hypotension?
c. Outline the sites of ectopic pregnancy
7. A 63-year-old male complains of a 6-month history of difficulty voiding and feeling as
though he cannot empty his bladder completely. After voiding, he often feels as though
he needs to urinate again. He denies urethral discharge or burning with urination. He
has had mild hypertension and takes a thiazide diuretic. His only other medication has
been ampicillin for two urinary tract infections during the previous year. On
examination, his blood pressure is 130/84 mm Hg, pulse rate is 80 beats/min, and he is
without fever (afebrile). The heart and lung examinations are normal, and the
abdominal examination shows no masses.
a. What is the most likely diagnosis?
b. What is the anatomical explanation for the patient’s symptoms?
c. Outline the parts of the male urethra
8. A 45-year-old female underwent surgical removal of the uterus (total hysterectomy) for
symptomatic endometriosis 2 days previously. She complains of right back and flank
tenderness. On examination, her temperature is 102°F, heart rate is 100 beats/min, and
blood pressure is 130/90 mm Hg. The heart and lung examinations are normal. Her

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abdomen is slightly tender diffusely, but bowel sounds are normal. The surgical incision
appears within normal limits. There is exquisite right costovertebral angle tenderness on
palpation. Ultrasound of the kidneys shows marked dilation of the right renal collecting
system and dilation of the right ureter.
a. What is the most likely diagnosis?
b. What is the anatomical explanation for this condition?
c. Outline the sites where the ureters are anatomically narrowed

SUCCESS!!

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