374.Many cesarean sections are performed by making a horizontal skin
incision that is slightly curved (about 15 cm) on the anterior abdominal
wall just superior to the pubic hairline (bikini or Pfannerenstiel incision).
However, this incision is often only made through the skin down to the
perimysium of the rectus abdominis muscle. Which of the following cuta-
neous nerves are at greatest risk with this type of incision?
a. Thoracoabdominal (intercostal) nerve (T 10)
b. Thoracoabdominal (intercostal) nerve (T 11)
c. Iliohypogastric nerve (L1)
d. Ilioinguinal nerve (L1)
e. Lateral (femoral) cutaneous nerve of the thigh (L2–3)
375.A 13-year-old boy was vacationing with his parents in Mexico on spring
break. He developed nausea, vomiting 4 days into the trip despite caution
about what he ate and drank. He switched to a clear liquid diet. None of the
others on the trip were sick. On his flight back to the United States the next
day he developed a fever and increased abdominal pain, especially in the
paraumbilical region. His parents took him to their pediatrician the next day
as he was feeling worse and could barely move. During the physical exam the
pediatrician noted tenderness around the umbilicus and rebound tenderness
over McBurney’s point and was sent for an abdominal CT at a local pediatric
hospital. Where is McBurney’s point and what is the likely diagnosis?
a. At the right costal margin at the mid-clavicular line; ruptured gallbladder
b. On a line drawn between the anterior superior iliac spine and umbilicus on the
right; appendicitis
c. On a line drawn between the anterior superior iliac spine and umbilicus on the
left; appendicitis
d. On a line drawn between the anterior superior iliac spine and the pubic tuber-
cle on the right; kidney stone
e. On a line drawn between the anterior superior iliac spine and the pubic tuber-
cle on the left; kidney stone
Abdomen 495