Abdomen and pelvis: biliary tract: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Abdomen and pelvis: biliary tract

Sample item

A small gallstone becomes impacted at the major duodenal papilla, and the patient develops jaundice and acute pancreatitis. In which part of the duodenum does the hepatopancreatic ampulla open?

AFourth part, near the duodenojejunal flexureBFirst part, on the anterior wallCThird part, on the inferior wallDSecond part, on the posteromedial wall

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Second part, on the posteromedial wall

The bile duct and main pancreatic duct usually unite to form the hepatopancreatic ampulla of Vater, which opens at the major duodenal papilla on the posteromedial wall of the descending (second) part of the duodenum, controlled by the sphincter of Oddi. An obstructing stone blocks both bile and pancreatic secretions.

Option by option

A. Fourth part, near the duodenojejunal flexure
The fourth part ascends to the duodenojejunal flexure, which is not where the ducts open.
B. First part, on the anterior wall
The first part is the duodenal cap, which contains no papilla, and is a common site of ulcer.
C. Third part, on the inferior wall
The third part crosses the aorta and has no papilla.
D. Second part, on the posteromedial wall (correct)
Correct. The major papilla lies on the posteromedial wall of the second part.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Second part, on the posteromedial wall. The bile duct and main pancreatic duct usually unite to form the hepatopancreatic ampulla of Vater, which opens at the major duodenal papilla on the posteromedial wall of the descending (second) part of the duodenum, controlled by the sphincter of Oddi.

Why is "Fourth part, near the duodenojejunal flexure" not the answer?

The fourth part ascends to the duodenojejunal flexure, which is not where the ducts open.

Why is "First part, on the anterior wall" not the answer?

The first part is the duodenal cap, which contains no papilla, and is a common site of ulcer.

Why is "Third part, on the inferior wall" not the answer?

The third part crosses the aorta and has no papilla.

What concept does this question test?

It tests Abdomen and pelvis: biliary tract in Anatomy. An obstructing stone blocks both bile and pancreatic secretions.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdomen and pelvis: biliary tract?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.