Unit 19 Question Bank
Sourcing: items tagged TMU 2021–22 come from the real final paper. Items tagged
Slide come from the TMU lecture. Items tagged Gray's are built from the textbook to cover
examinable content. Nothing here is invented; answers are verifiable against the cited page — check against
the official marking scheme where one exists.
0 / 20 answered
1The covering closest to the surface of the kidney is the ( ).
Answer: D
From inner to outer: fibrous capsule → adipose capsule → renal fascia. The fibrous capsule is directly on the kidney surface.TMU 2021–22 final, Section II Q9 · TMU Lecture 22 Slide 5
2Within the renal pedicle, the order from FRONT backwards is ( ).
Answer: A
Vein in front, artery behind it, pelvis most posterior. From above downwards the order differs: artery, vein, pelvis. The pelvis is always last in both directions.TMU Lecture 22 Slide 7 (★★★)
3The left testicular vein empties into the ( ).
Answer: B
Into the left renal vein, at a right angle. The right testicular vein drains obliquely into the IVC — which is why varicoceles are commoner on the left.TMU 2021–22 final, Section II Q5
4The middle suprarenal artery arises from the ( ).
Answer: C
Directly from the abdominal aorta. The superior comes from the inferior phrenic artery and the inferior from the renal artery — three arteries from three sources.TMU Lecture 22 Slide 8
5The RIGHT suprarenal vein drains into the ( ).
Answer: D
Directly into the inferior vena cava, because the IVC lies on the right. The left suprarenal vein drains into the left renal vein.TMU 2021–22 Section III Q2
6Which branch of the lumbar plexus emerges from the MEDIAL border of psoas major?
Answer: A
The obturator nerve, together with the lumbosacral trunk. The femoral nerve emerges from the lateral border.TMU 2021–22 final, Section II Q4
7The lumbosacral trunk is formed by part of ( ) joining ( ).
Answer: B
Part of the anterior ramus of L4 emerging from the medial border of psoas major joins the anterior ramus of L5, then descends into the pelvis to join the sacral plexus.TMU 2021–22 definition 2 · Snell's 10e Ch.8
8The unpaired visceral branches of the abdominal aorta are the ( ).
Answer: C
The three unpaired visceral branches: celiac trunk (T12), superior mesenteric (L1) and inferior mesenteric (L3). Renal, middle suprarenal and gonadal are the paired visceral branches.TMU 2021–22 Section III Q3 · TMU Lecture 22 Slide 8
9The greater splanchnic nerve belongs to the ( ).
Answer: D
It is a sympathetic nerve, arising from the T6–T9 ganglia of the sympathetic trunk and passing to the coeliac ganglion.TMU 2021–22 final, Section II Q10
10Nephroptosis (dropping of the kidney) results from loss of ( ).
Answer: A
The kidney is held in place mainly by perirenal fat and the renal fascia. Rapid weight loss removes that packing and the kidney descends, sometimes kinking the ureter.Snell's 10e Ch.7 (clinical)
11Why is the left renal vein longer than the right?
Answer: B
The IVC lies to the right of the midline, so the left renal vein crosses in front of the aorta and behind the superior mesenteric artery to reach it.Gray's 4e Ch.4
12The abdominal aorta bifurcates at the level of ( ).
Answer: C
At L4, into the two common iliac arteries. It begins at the aortic hiatus at T12.TMU Lecture 22 · Gray's 4e Ch.4
13A new left-sided varicocele in an older man should prompt investigation for ( ).
Answer: D
Because the left testicular vein drains into the left renal vein, a tumour obstructing that vein can present as a new varicocele. It is imaged rather than dismissed.Snell's 10e Ch.7 (clinical)
14The testicular (ovarian) arteries arise from the ( ).
Answer: A
From the anterior wall of the abdominal aorta, below the renal arteries, running down across the ureter. Their long course reflects the gonad's descent from high on the posterior abdominal wall.TMU Lecture 22 Slides 8–9
15Which structure is NOT retroperitoneal?
Answer: B
The spleen is intraperitoneal, suspended by the gastrosplenic and splenorenal ligaments. The other three are retroperitoneal.TMU Lecture 22 Slide 3
16Within the renal pedicle, the order from ABOVE downwards is ( ).
Answer: C
From above down: artery, vein, pelvis. From front to back: vein, artery, pelvis. Only the artery and vein swap; the pelvis is always last.TMU Lecture 22 Slide 7
17The superior suprarenal artery is a branch of the ( ).
Answer: D
From the inferior phrenic artery. Middle from the aorta, inferior from the renal artery — three sources for one small gland.TMU Lecture 22 Slide 8
18Which nerve emerges from the LATERAL border of psoas major?
Answer: A
The femoral nerve, with the iliohypogastric, ilioinguinal and lateral cutaneous nerve of the thigh. The genitofemoral emerges on the anterior surface.Snell's 10e Ch.7
19A perinephric abscess is confined by the ( ).
Answer: B
The renal fascia encloses the kidney, suprarenal gland and perirenal fat, so pus is contained within it and tracks downward rather than spreading freely.Snell's 10e Ch.7 (clinical)
20Injury to which vessel is most feared during right adrenalectomy?
Answer: C
The right suprarenal vein is short and wide and enters the IVC directly behind the liver. It can tear flush with the cava, causing sudden major haemorrhage that is hard to control.Snell's 10e Ch.7 (clinical)
1 Coverings of the kidney — past paper · 3′+
From inner to outer:
1. Fibrous capsule — directly on the kidney surface, strippable from a healthy organ
2. Adipose capsule (perirenal fat) — the cushioning fatty layer
3. Renal fascia — the outermost fibrous sheath with anterior and posterior layers, enclosing both kidney and suprarenal gland; outside it lies pararenal fat
Clinical: perirenal fat holds the kidney in position — its loss causes nephroptosis; the renal fascia confines a perinephric abscess.TMU Lecture 22 Slides 5–6
1. Fibrous capsule — directly on the kidney surface, strippable from a healthy organ
2. Adipose capsule (perirenal fat) — the cushioning fatty layer
3. Renal fascia — the outermost fibrous sheath with anterior and posterior layers, enclosing both kidney and suprarenal gland; outside it lies pararenal fat
Clinical: perirenal fat holds the kidney in position — its loss causes nephroptosis; the renal fascia confines a perinephric abscess.TMU Lecture 22 Slides 5–6
2 Renal pedicle — ★★★ · 3′+
The bundle of structures entering and leaving the hilum of the kidney: the renal artery, renal vein and renal pelvis.
From FRONT backwards: renal vein → renal artery → renal pelvis.
From ABOVE downwards: renal artery → renal vein → renal pelvis.
The renal pelvis is always the most posterior and most inferior structure.TMU Lecture 22 Slide 7
From FRONT backwards: renal vein → renal artery → renal pelvis.
From ABOVE downwards: renal artery → renal vein → renal pelvis.
The renal pelvis is always the most posterior and most inferior structure.TMU Lecture 22 Slide 7
3 Blood supply of the suprarenal gland — TMU 2021–22 · 10′+
THREE arteries, from three sources:
• Superior suprarenal artery — from the inferior phrenic artery
• Middle suprarenal artery — from the abdominal aorta
• Inferior suprarenal artery — from the renal artery
ONE vein each side, draining asymmetrically:
• Right suprarenal vein → inferior vena cava
• Left suprarenal vein → left renal vein
The asymmetry reflects the position of the IVC to the right of the midline.TMU 2021–22 Section III Q2
• Superior suprarenal artery — from the inferior phrenic artery
• Middle suprarenal artery — from the abdominal aorta
• Inferior suprarenal artery — from the renal artery
ONE vein each side, draining asymmetrically:
• Right suprarenal vein → inferior vena cava
• Left suprarenal vein → left renal vein
The asymmetry reflects the position of the IVC to the right of the midline.TMU 2021–22 Section III Q2
4 Lumbosacral trunk — TMU 2021–22 · 3′+
A nerve trunk formed by part of the anterior ramus of the fourth lumbar nerve, emerging from the medial border of psoas major, joining the anterior ramus of the fifth lumbar nerve.
It descends into the pelvis in front of the sacroiliac joint and joins the sacral plexus, forming the anatomical bridge by which L4 and L5 fibres reach the sciatic nerve.TMU 2021–22 definition 2 · Snell's 10e Ch.8
It descends into the pelvis in front of the sacroiliac joint and joins the sacral plexus, forming the anatomical bridge by which L4 and L5 fibres reach the sciatic nerve.TMU 2021–22 definition 2 · Snell's 10e Ch.8
5 Branches of the abdominal aorta — 3′+
Unpaired visceral: celiac trunk (T12) · superior mesenteric (L1) · inferior mesenteric (L3)
Paired visceral: middle suprarenal · renal · testicular or ovarian
Paired parietal: inferior phrenic · four lumbar arteries
Terminal: two common iliac arteries at L4TMU Lecture 22 Slide 8
Paired visceral: middle suprarenal · renal · testicular or ovarian
Paired parietal: inferior phrenic · four lumbar arteries
Terminal: two common iliac arteries at L4TMU Lecture 22 Slide 8
6 Retroperitoneal space — 2′+
The space lying between the parietal peritoneum in front and the fascia of the posterior abdominal wall muscles behind, filled with fat.
Contents: kidneys, suprarenal glands, ureters, the descending and inferior parts of the duodenum, pancreas, abdominal aorta and inferior vena cava with their branches, lymph nodes, the lumbar plexus and the sympathetic trunks.TMU Lecture 22 Slides 2–3
Contents: kidneys, suprarenal glands, ureters, the descending and inferior parts of the duodenum, pancreas, abdominal aorta and inferior vena cava with their branches, lymph nodes, the lumbar plexus and the sympathetic trunks.TMU Lecture 22 Slides 2–3
1
Write down the coverings of the kidney (from inner to outer). What structures are included in the renal pedicle? Describe their positional relations.
6′
Real question — TMU past paper.
Coverings, inner → outer
- Fibrous capsule — a thin tough membrane directly on the kidney surface, easily stripped from a healthy organ
- Adipose capsule (perirenal fat) — cushions the kidney and holds it in position
- Renal fascia — anterior and posterior layers enclosing both the kidney and the suprarenal gland; outside it lies pararenal fat
The renal pedicle
Contains the renal artery, renal vein and renal pelvis.
Positional relations
- From front backwards: renal vein → renal artery → renal pelvis
- From above downwards: renal artery → renal vein → renal pelvis
In both directions the renal pelvis is last — most posterior and most inferior. Only the artery and vein exchange places.
Clinical points worth adding
- Loss of perirenal fat after rapid weight loss causes nephroptosis
- The renal fascia confines a perinephric abscess, which tracks downward rather than spreading
- The left renal vein is longer because it must cross in front of the aorta to reach the right-sided IVC
Marking guide: three coverings in correct order 2 · three pedicle structures 1 · front-to-back order 1.5 · above-to-below order 1.5.
2
Write down the blood supply and venous drainage of the suprarenal gland, and explain the origins of the vessels.
10′
Real question — TMU 2021–22 final, Section III Q2.
Position
The suprarenal (adrenal) glands cap the upper poles of the kidneys, enclosed within the renal fascia but separated from the kidney by a septum of fascia.
Arterial supply — three arteries from three sources
| Artery | Arises from |
|---|---|
| Superior suprarenal artery | Inferior phrenic artery |
| Middle suprarenal artery | Abdominal aorta, directly |
| Inferior suprarenal artery | Renal artery |
The triple supply reflects the gland's endocrine importance — it is fed from above, from the middle and from below, so no single occlusion can devascularise it.
Venous drainage — one vein each side, asymmetric
- Right suprarenal vein — short and wide, draining directly into the inferior vena cava
- Left suprarenal vein — longer, draining into the left renal vein
Why the asymmetry
The inferior vena cava lies to the right of the midline. The right gland is therefore adjacent to it and drains straight in; the left gland is far from it and must route through the left renal vein — exactly as the left testicular/ovarian vein does.
Clinical
The short right suprarenal vein may tear flush with the IVC during right adrenalectomy, causing sudden major haemorrhage behind the liver — the most feared moment of that operation.
Marking guide: three arteries named 3 · three origins 3 · right venous drainage 1.5 · left venous drainage 1.5 · explanation of asymmetry 1.
3
Describe the branches of the abdominal aorta.
7′
Extent
From the aortic hiatus of the diaphragm at T12 to its bifurcation into the two common iliac arteries at L4.
Unpaired visceral branches — the three gut arteries
- Celiac trunk (T12) — foregut, to the descending duodenum
- Superior mesenteric artery (L1) — midgut, to the distal third of the transverse colon
- Inferior mesenteric artery (L3) — hindgut, to the upper rectum
Paired visceral branches
- Middle suprarenal arteries
- Renal arteries (about L1–L2), each giving the inferior suprarenal artery
- Testicular or ovarian arteries — from the anterior wall of the aorta, running down across the ureter
Paired parietal branches
- Inferior phrenic arteries — each giving the superior suprarenal artery
- Four pairs of lumbar arteries to the posterior abdominal wall
Terminal branches
The two common iliac arteries at L4, with a small median sacral artery arising from the bifurcation.
Point worth adding
The gonadal arteries have a very long course because the gonads develop high on the posterior abdominal wall and descend, dragging their arteries with them — the vessel is a record of the migration.
Marking guide: extent and levels 1 · three unpaired visceral with levels 2 · paired visceral 2 · paired parietal 1 · terminal 1.
4
Describe the lumbar plexus and the relations of its branches to psoas major.
6′
Formation
Formed from the anterior rami of L1–L4 within the substance of psoas major on the posterior abdominal wall.
Branches by the border they emerge from
| Emerges from | Nerves | Main destination |
|---|---|---|
| Lateral border | Iliohypogastric · ilioinguinal · lateral cutaneous nerve of the thigh · femoral nerve | Abdominal wall; anterior thigh |
| Medial border | Obturator nerve · lumbosacral trunk | Medial thigh; sacral plexus |
| Anterior surface | Genitofemoral nerve | Cremaster; upper thigh skin |
The lumbosacral trunk
Part of the anterior ramus of L4, emerging from the medial border of psoas major, joins the anterior ramus of L5. It descends into the pelvis in front of the sacroiliac joint to join the sacral plexus — the bridge by which L4 and L5 fibres reach the sciatic nerve.
Clinical relevance
- A psoas abscess or retroperitoneal haematoma can compress the plexus, most often the femoral nerve, causing weak knee extension and anterior thigh numbness
- The relationship to psoas is directly examinable: femoral lateral, obturator medial
Marking guide: formation and root value 1.5 · lateral border branches 1.5 · medial border branches 1.5 · lumbosacral trunk 1 · one clinical point 0.5.
5
Explain why varicoceles are commoner on the left, and why a new left varicocele warrants investigation.
5′
The venous anatomy
- The right testicular vein drains obliquely and directly into the inferior vena cava
- The left testicular vein drains into the left renal vein, and does so at a right angle
Why the left side is at a disadvantage
- The left vein is longer, giving a taller column of blood and therefore higher hydrostatic pressure at the testis
- Entry at a right angle is haemodynamically less efficient than the oblique right-sided entry
- The left renal vein itself may be compressed between the aorta and the superior mesenteric artery — the nutcracker phenomenon
The result is that around 90% of varicoceles are left-sided.
Why a new left varicocele matters
Because the left testicular vein drains into the left renal vein, anything obstructing that vein raises pressure in the testicular vein. A renal cell carcinoma invading or compressing the left renal vein can therefore present as a new varicocele in an older man.
A varicocele that is new, right-sided, or does not decompress on lying down is investigated with imaging of the kidneys rather than dismissed.
Marking guide: right drainage 1 · left drainage 1 · two reasons for left predominance 1.5 · renal carcinoma link 1.5.