Practice Quiz - Kidneys & Retroperitoneum
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  1. A 57-year-old male complains of intense chest pain, but tests rule out any cardiac pathology. It was determined that the patient suffers from an esophageal (hiatal) hernia in which the stomach herniates through an enlarged esophageal hiatus. Muscle fibers from which of the following parts of the diaphragm would border directly on this hernia?
    left crus
    right crus
    central tendon
    costal fibers
    sternal fibers
  2. Sympathetic fibers in the greater splanchnic nerve arise from neuron cell bodies found in the:
    brainstem
    celiac ganglion
    chain ganglion
    spinal cord
    superior mesenteric ganglion
  3. After successfully performing two adrenalectomies (removal of the adrenal gland), the surgical resident was disappointed to learn that he would be merely assisting at the next one. The chief of surgery told him: "I'm doing this one, since the one on the right side may be a little too difficult for you." The difficulty he envisioned stems from the fact that the right suprarenal gland is partly overlain anteriorly by the:
    aorta
    inferior vena cava
    left hepatic vein
    right crus of the diaphragm
    right renal artery
  4. During preparations to remove the left kidney from a 28-year-old female patient, the surgeon asked an observing medical student where best to ligate the renal vein. Upon hearing the reply: "as close to the inferior vena cava as possible, leaving just enough stump to ensure tight closure," the surgeon's eyebrow shot up. "Do you mean to say you're willing to compromise the venous drainage of the other structures that drain into the renal vein?" By this he meant all of the following except:
    diaphragm
    pancreas
    ovary
    suprarenal gland
  5. The celiac plexus of nerves may contain fibers derived from all of the following sources except:
    posterior vagal trunk
    greater thoracic splanchnic nerve
    lesser thoracic splanchnic nerve
    lumbar splanchnic nerves
  6. Which statement regarding the suprarenal glands is correct?
    Its entire arterial supply is directly from the abdominal aorta.
    Veins from both glands drain directly into the inferior vena cava.
    The glands are localized in the pararenal space.
    Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater thoracic splanchnic nerve.
  7. The nerve that innervates the cells of the suprarenal medulla consists of fibers of the:
    Greater thoracic splanchnic nerve
    Lesser thoracic splanchnic nerve
    Least thoracic splanchnic nerve
    Anterior vagal trunk
    Posterior vagal trunk
  8. Regarding the diaphragm, which, is paired INCORRECTLY?
    Vertebrocostal trigone - lateral arcuate ligament
    Esophageal hiatus - right crus
    Medial arcuate ligament - psoas muscle
    Central tendon - aortic hiatus
    Vena caval foramen - right phrenic nerve
  9. The nerves that end on the secretory cells of the medulla of the suprarenal glands are principally:
    Preganglionic fibers from the greater thoracic splanchnic nerve
    Postganglionic fibers from the celiac plexus
    Postganglionic fibers from the aorticorenal ganglia
    Preganglionic fibers from the lesser thoracic splanchnic nerve
    Postganglionic fibers from the renal plexus
  10. The vagus nerve passes into the abdomen by passing through the
    Aortic hiatus
    Esophageal hiatus
    Caval foramen
    Lateral arcuate ligament
    Medial arcuate ligament
  11. With one exception, preganglionic sympathetic axons synapse upon postganglionic sympathetic dendrites or cell bodies. The exception to this general rule occurs within the:
    Kidney cortex
    Kidney medulla
    Suprarenal medulla
    Suprarenal cortex
  12. The pararenal fat in the kidney bed is an elaboration of:
    Peritoneum
    Extraperitoneal connective tissue
    Transversalis fascia
    Fusion fascia
  13. The cisterna chyli accompanies which structure as it passes through the diaphragm?
    Inferior vena cava
    Esophagus
    Greater thoracic splanchnic nerve
    Aorta
  14. Blood from an injured kidney will seep through the perirenal fat until it contacts the internal surface of the renal (Gerota's) fascia. Without perforating this fascia the blood could then continue to pass in what direction?
    inferiorly toward the pelvis
    laterally into the body wall
    medially across the midline to the other kidney
    superiorly into contact with the fascia of the diaphragm
  15. A 19-year-old male suffers a tear to the psoas major muscle during the course of a football game. A scar, which formed on the medial part of the belly of the muscle, involved an adjacent nerve, immediately medial to the muscle. The nerve is called the:
    femoral
    genitofemoral
    iliohypogastric
    ilioguinal
    obturator
  16. While recovering from an open abdominal hysterectomy (i.e., using a midline abdominal incision to gain entry to the pelvis), a patient realizes that she has lost sensation to the skin of her anterior thigh and cannot extend her knee. Retractors holding the incision open and pressing against the posterior abdominal wall most likely caused injury to which nerve?
    Femoral
    Genitofemoral
    Iliohypogastric
    Lateral femoral cutaneous
    Obturator
  17. In the lumbar region, tuberculosis may spread from the vertebrae into an adjacent muscle to produce an abscess. Pus from the abscess may travel within the fascial sheath surrounding the affected muscle. A patient presents with pus surfacing in the superomedial part of the thigh. To which muscle did the tuberculosis most likely spread?
    Internal oblique
    Obturator internus
    Psoas major
    Quadratus lumborum
    Rectus abdominis
  18. The nerves of the lumbar plexus are arranged around specific muscles of the posterior abdominal wall. Which of these nerves lies immediately medial to the psoas major muscle?
    Femoral
    Genitofemoral
    Ilioinguinal
    Obturator