Anatomy — Thorax and Abdomen: Surface Anatomy, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
Why is a needle inserted just above a rib rather than just below one when entering the pleural space?
Answer: Because the intercostal vein, artery and nerve run in a groove along the lower border of each rib. The upper border is bone and therefore safe; approaching under a rib risks the neurovascular bundle directly.
A woman of 26 presents with severe left shoulder-tip pain. The shoulder has a full range of movement and is not tender. What must be considered?
Answer: Irritation beneath the diaphragm, referred to the shoulder because the diaphragm takes its nerve supply from cervical segments that also supply that skin. In a woman of reproductive age a ruptured ectopic pregnancy must be excluded — examine the abdomen and check a pregnancy test.
A 62-year-old man describes epigastric pain and sweating. Why should an ECG precede treatment for dyspepsia?
Answer: Because an inferior myocardial infarction is commonly felt in the epigastrium. Treating it as indigestion delays reperfusion in a condition where time determines the amount of muscle lost.
A 17-year-old reports pain that began vaguely around the umbilicus and is now sharp and localised in the right iliac fossa. Explain the sequence anatomically.
Answer: Early inflammation produces visceral pain, carried by nerves that localise poorly, so it is felt centrally. As inflammation reaches the parietal peritoneum, which is precisely localised, the pain becomes sharp and focal over the appendix. The migration itself is the diagnostic feature.
Why is a stab wound below the nipple treated as a potential abdominal injury?
Answer: Because the diaphragm domes upward, so the upper abdominal organs — including the spleen and much of the liver — lie beneath the lower ribs. A wound that appears to be in the chest can readily involve abdominal structures.
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