Abdomen: liver segments: 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: liver segments

Sample item

A 35-year-old woman with polycythaemia vera has painful hepatomegaly, ascites and absent hepatic vein flow on Doppler. CT shows an enlarged caudate lobe with preserved enhancement. Which feature explains the caudate lobe being spared?

AIt is supplied exclusively by the cystic arteryBIts small veins drain directly into the inferior vena cavaCIt drains through the left hepatic vein, which stays patentDIt receives arterial blood only with no portal blood

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

The answer and the reasoning

B. Its small veins drain directly into the inferior vena cava

The caudate lobe (segment 1) has its own short hepatic veins that open directly into the IVC, bypassing the three main hepatic veins. In Budd-Chiari syndrome it can therefore remain drained and hypertrophy while the rest of the liver is congested. Enlargement of the lobe can even compress the IVC.

Option by option

A. It is supplied exclusively by the cystic artery
The cystic artery supplies the gallbladder, not the caudate lobe.
B. Its small veins drain directly into the inferior vena cava (correct)
Correct. Direct drainage into the IVC bypasses the obstructed main hepatic veins.
C. It drains through the left hepatic vein, which stays patent
The left hepatic vein is also occluded in Budd-Chiari syndrome, so it cannot be the explanation.
D. It receives arterial blood only with no portal blood
The caudate lobe receives portal blood from both the right and left portal branches, as well as arterial blood.

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 B, Its small veins drain directly into the inferior vena cava. The caudate lobe (segment 1) has its own short hepatic veins that open directly into the IVC, bypassing the three main hepatic veins.

Why is "It is supplied exclusively by the cystic artery" not the answer?

The cystic artery supplies the gallbladder, not the caudate lobe.

Why is "It drains through the left hepatic vein, which stays patent" not the answer?

The left hepatic vein is also occluded in Budd-Chiari syndrome, so it cannot be the explanation.

Why is "It receives arterial blood only with no portal blood" not the answer?

The caudate lobe receives portal blood from both the right and left portal branches, as well as arterial blood.

What concept does this question test?

It tests Abdomen: liver segments in Anatomy. In Budd-Chiari syndrome it can therefore remain drained and hypertrophy while the rest of the liver is congested. Enlargement of the lobe can even compress the IVC.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: liver segments?

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.