Block 7 Repro Perineum & Pelvis MCQ's
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There is much that we have covered concerning the Perineum and pelvis and it will most likely be the main topic in the midterm exam. Just how much did you understand when it came to the chapter? Take the Block 7 on Repro Perineum and pelvic MCQ`s and adequately prepare for the exam.
- 1.
The rectum and anal canal have a system of anastomoses that will facilitate blood flow in the case of a blockage. Which of the following vessels drains into the portal system of veins?
- A.
Median sacral vein
- B.
Middle rectal vein
- C.
Inferior rectal vein
- D.
Superior rectal vein
- E.
Iliolumbar vein
Correct Answer
D. Superior rectal veinExplanation
The superior rectal vein drains into the portal system of veins. The portal system carries blood from the digestive organs to the liver for processing before it is returned to the heart. Since the rectum and anal canal are part of the digestive system, the blood from these areas is also drained into the portal system. The other veins listed in the options do not drain into the portal system.Rate this question:
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- 2.
The fascia in the pelvis and perineum consists of three layers that are continuous with abdominal fascial layers. Which of the following types of fascia can all be found in the deep layer of fascia?
- A.
External spermatic fascia & buck's fascia
- B.
Fascia lata & colle's fascia
- C.
Scarpa's fascia & dartos fascia
- D.
Camper's fascia & buck's fascia
- E.
External spermatic fascia & dartos fascia
Correct Answer
A. External spermatic fascia & buck's fasciaExplanation
The correct answer is External spermatic fascia & buck's fascia. These two types of fascia can be found in the deep layer of fascia in the pelvis and perineum. The external spermatic fascia is a continuation of the external oblique fascia, while buck's fascia is a continuation of the deep fascia of the abdomen. Both fascia play a role in supporting and protecting structures in the pelvis and perineum.Rate this question:
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- 3.
An obstetrician injects local anesthetic to block sensation from the perineum during the third stage of labor. After verifying a bony landmark transvaginally (through the vagina), she blocks the pudendal nerve. Which of the following bony landmarks should she use to locate the pudendal nerve?
- A.
Ischial spine
- B.
External as of cervix
- C.
Sacral promontory
- D.
Pubic symphysis
- E.
Tip of the coccyx
Correct Answer
A. Ischial spineExplanation
The obstetrician should use the ischial spine as the bony landmark to locate the pudendal nerve. This is because the pudendal nerve passes posterior to the ischial spine and can be blocked effectively at this location to provide local anesthesia to the perineum during the third stage of labor.Rate this question:
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- 4.
Which one of the following nerves can be used to check for reflex and integrity of the spinal cord at L2?
- A.
Genitofemoral
- B.
Ilioinguinal
- C.
Lateral femoral cutaneous
- D.
Obturator
- E.
Iliohypogastric
Correct Answer
A. GenitofemoralExplanation
The genitofemoral nerve can be used to check for reflex and integrity of the spinal cord at L2. This nerve arises from the lumbar plexus and provides sensory innervation to the upper anterior thigh and motor innervation to the cremaster muscle in males. By testing the reflex and integrity of the genitofemoral nerve, healthcare professionals can assess the functioning of the L2 spinal cord segment.Rate this question:
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- 5.
A 29-year-old man injures his perineum jumping over seats in the grandstand following a baseball game. Urine leaking from the ruptured spongy urethra is most likely to collect in which of the following spaces?
- A.
Inguinal canal
- B.
Between Camper's and CoIle's fascia
- C.
Femoral triangle
- D.
Ischioanal fossa
- E.
Rectovesical pouch
Correct Answer
B. Between Camper's and CoIle's fasciaExplanation
The perineum is the area between the scrotum and anus in males. The spongy urethra is located within the penis and can be injured in cases of trauma. When the spongy urethra is ruptured, urine can leak into the surrounding tissues. Camper's fascia is a superficial layer of fatty tissue, while Colle's fascia is a deeper layer of connective tissue in the perineum. Therefore, urine leaking from the ruptured spongy urethra is most likely to collect between Camper's and Colle's fascia.Rate this question:
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- 6.
A 59-year-old woman presents in the emergency department with severe abdominal pain in the lower quadrants, positive rebound tenderness, fever, and elevated WBC. She also reported that she recently had a painful colonoscopy with some post-procedural bleeding. Exploratory laparoscopy found peritonitis with a perforated rectum. Where would the abscess from the peritonitis MOST LIKELY accumulate?
- A.
Infraperitoneal space
- B.
Rectouterine pouch
- C.
Rectovesical pouch
- D.
Vesiculo-uterine space
- E.
Retrorectal pouch
Correct Answer
B. Rectouterine pouchExplanation
The rectouterine pouch, also known as the pouch of Douglas, is the deepest part of the peritoneal cavity in females. It is located between the rectum and the uterus. In this case, the patient has peritonitis with a perforated rectum, which means that bacteria and inflammatory fluid from the perforation can accumulate in the rectouterine pouch, leading to an abscess. This is the most likely location for the abscess to accumulate based on the given information.Rate this question:
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- 7.
During a radical hysterectomy procedure, the surgeon must expose the broad ligament to ligate the uterine arteries that travel within the transverse cervical ligament. Which of the following structures can MOST LIKELY be injured during this procedure?
- A.
Uterosacral ligament
- B.
Suspensory ligament of the ovary
- C.
Ureters
- D.
Sigmoid colon
- E.
Bladder
Correct Answer
C. UretersExplanation
During a radical hysterectomy procedure, the surgeon must expose the broad ligament to ligate the uterine arteries. The uterine arteries travel within the transverse cervical ligament. The uterers, which are tubes that carry urine from the kidneys to the bladder, are located in close proximity to the broad ligament and transverse cervical ligament. Therefore, they are most likely to be injured during this procedure if proper care is not taken.Rate this question:
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- 8.
A 55-year-old woman presents in your clinic with procidontia, or appearance of her cervix at the vulva. Based on your knowledge of the structures that provide significant support for the uterus and cervix, which one of these must be weakened or compromised in this case?
- A.
Round ligament of the uterus (ligamentum teres uteri)
- B.
Mesosalpinx
- C.
Mesometrium
- D.
Proper ovarian ligament
- E.
Cardinal ligament
Correct Answer
E. Cardinal ligamentExplanation
The cardinal ligament must be weakened or compromised in this case. The cardinal ligament provides significant support for the uterus and cervix, so if it is weakened or compromised, it can lead to the appearance of the cervix at the vulva, also known as procidontia.Rate this question:
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- 9.
A 20-year old woman, 7 weeks after giving vaginal birth to a healthy, 4.25 kg girl, complains that she still has brownish vaginal flow and it has a bad odor. She has pain during defecation. What is your suspicion?
- A.
Due to the big size of the baby, the tissues of the vagina heal slower and there is still occasional bleeding a few weeks after childbirth. The color and odor of the fluid is that of partially disintegrated blood.
- B.
She developed hemorroids during pregnancy, and they bleed and cause pain during defecation.
- C.
There is a fistula between vagina and anal canal due to a tear in the perineum during childbirth.
- D.
She has developed fungal infection during childbirth, and that causes the bad odor
- E.
She has developed a vaginal adenocarcinoma secondary to the trauma
Correct Answer
C. There is a fistula between vagina and anal canal due to a tear in the perineum during childbirth.Explanation
The suspicion is that there is a fistula between the vagina and anal canal due to a tear in the perineum during childbirth. This is supported by the fact that the woman has brownish vaginal flow with a bad odor, which could indicate the presence of fecal matter in the vaginal discharge. Additionally, the woman also experiences pain during defecation, which further suggests a connection between the vagina and anal canal.Rate this question:
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- 10.
A 25 year old full term pregnant woman was admitted to the hospital for delivery of the child. She wanted to have a normal vaginal delivery and wanted to witness it too. After all routine clinical investigations, she was found to be a suitable candidate for vaginal delivery. The type of anesthesia / nerve block that would completely anesthetize the external genitalia and will satisfy the needs of this patient would be
- A.
General anesthesia
- B.
Epidural block
- C.
Pudendal nerve block
- D.
Ilioinguinal nerve block
- E.
Pudendal + Ilioinguinal nerve block
Correct Answer
E. Pudendal + Ilioinguinal nerve blockExplanation
The combination of pudendal and ilioinguinal nerve blocks would be the most suitable type of anesthesia for this patient. These nerve blocks would completely anesthetize the external genitalia, providing pain relief during the delivery process. This would allow the patient to have a normal vaginal delivery and witness the birth of her child, as she desires. General anesthesia would not be necessary in this case, as the patient is suitable for vaginal delivery. Epidural block may provide pain relief, but it may not completely anesthetize the external genitalia. Pudendal nerve block alone may not be sufficient to fully anesthetize the area, but when combined with ilioinguinal nerve block, it would provide the desired effect.Rate this question:
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- 11.
A 32 year old woman was brought to the clinic, by her husband, with complaints of severe stabbing pain in right lower abdomen and vaginal bleeding. She also had intermittent pain in her right shoulder, particularly while lying down. On questioning it is learnt that she had missed her period last month. She had also fainted once before being brought to the hospital and felt dizzy. Her blood pressure was found to be lower than the normal limits. Based on the clinical scenario mentioned above the MOST LIKELY diagnosis you would arrive at would be
- A.
Appendicitis
- B.
Ovarian tumour
- C.
Normal menstruation
- D.
Rupture of the fallopian tube
- E.
Ovarian pregnancy
Correct Answer
D. Rupture of the fallopian tubeExplanation
Based on the symptoms described, including severe stabbing pain in the right lower abdomen, vaginal bleeding, intermittent pain in the right shoulder, missed period, fainting, dizziness, and low blood pressure, the most likely diagnosis would be rupture of the fallopian tube. This is a medical emergency known as ectopic pregnancy, where a fertilized egg implants outside of the uterus, usually in the fallopian tube. The symptoms are indicative of internal bleeding and the need for immediate medical attention.Rate this question:
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- 12.
A 65 year old man reported to the clinic with complaints of low back pain and difficulty in urination. He also complained of increase in number of visits to the washroom, painful urination and blood in urine. A digital rectal examination revealed an enlarged prostate. Further laboratory investigations revealed abnormally high levels of PSA in his blood. The surgeon arrived at a diagnosis of Stage IV prostate cancer and decided to resect the prostate, other closely relates structures and lymph nodes and follow it up with chemotherapy. The first lymph node that will be infiltrated with cancer cells in case of prostate cancer would be
- A.
External iliac nodes
- B.
Internal iliac nodes
- C.
Superficial inguinal nodes
- D.
Deep inguinal nodes
- E.
Para aortic nodes
Correct Answer
B. Internal iliac nodesExplanation
The internal iliac nodes would be the first lymph nodes to be infiltrated with cancer cells in case of prostate cancer. This is because the prostate gland drains into the internal iliac nodes, which are located in the pelvis. These nodes are responsible for filtering and draining lymphatic fluid from the pelvic organs, including the prostate gland. Therefore, if cancer cells are present in the prostate, they are likely to spread to the internal iliac nodes first.Rate this question:
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- 13.
The space within the fascia lining the lateral wall of the ischioanal fossa is called the ___________ canal. The canal contains a neurovascular bundle that passes from the gluteal region to the perineum through the______________ foramen.
- A.
Pudendal -- greater sciatic
- B.
Pudendal --- lesser sciatic
- C.
Pudendal obturator
- D.
Obturator --- lesser sciatic
- E.
Obturator --- greater sciatic
Correct Answer
B. Pudendal --- lesser sciaticExplanation
the "PIN" go out through the greater and re-enter through lesser
P-udendal nerve
I-nternal pudendal vessels
N-erves to obturator internus
(slide 4 pelvis perine-Barrenk)
(also mentioned at 8:45 in media site jan 2012)Rate this question:
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- 14.
Because the perineal body is susceptible to tearing during childbirth, it may be cut intentionally (episiotomy) where it lies between which of the following structures?
- A.
Anus and vestibule of vagina
- B.
External urethral orifice and ischial tuberosity
- C.
Ischial tuberosity and coccyx
- D.
Coccyx and anus
- E.
Vestibule of vagina and external urethral orifice
Correct Answer
A. Anus and vestibule of vaginaExplanation
During childbirth, the perineal body, which is the area between the anus and the vestibule of the vagina, is at risk of tearing. To prevent uncontrolled tearing, an episiotomy may be performed intentionally in this area. An episiotomy is a surgical cut made to enlarge the vaginal opening and prevent severe tearing during delivery. Therefore, the correct answer is "Anus and vestibule of vagina."Rate this question:
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- 15.
A 58-year-old woman with a right ovarian tumor undergoes an ovariectomy, which removes the ovary and a portion of the suspensory ligament. What important artery follows the path of the suspensory ligament?
- A.
Ovarian artery
- B.
Uterine artery
- C.
Cervical artery
- D.
Vesical artery
- E.
Umbilical artery
Correct Answer
C. Cervical artery -
- 16.
On your ob/gyn rotation you have seen several women who have endonnetriosis. Because of your knowledge of anatomy, you know that any excess fluid that may result because of the endometriosis may accumulate in which of the following areas when you have the patient in a supine position?
- A.
Hepatorenal pouch
- B.
Rectovesical pouch
- C.
Rectouterine pouch
- D.
Vesicouterine pouch
- E.
Pubovesical pouch
Correct Answer
C. Rectouterine pouchExplanation
When the patient is in a supine position, any excess fluid resulting from endometriosis is likely to accumulate in the rectouterine pouch. The rectouterine pouch, also known as the pouch of Douglas, is the deepest point in the peritoneal cavity in females. It is located between the rectum and the uterus, making it a potential space for fluid accumulation. This anatomical knowledge helps in understanding the potential complications and symptoms associated with endometriosis.Rate this question:
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- 17.
Which of the following is the correct path of the pudendal nerve as it courses from the pelvic cavity to the ischioanal fossa?
- A.
Enters the lesser sciatic foramen, courses around the ischial spine and through the obturator foramen
- B.
Enters the gluteal foramen, courses around the ischial spine and enters the pudendal canal
- C.
Enters the greater sciatic foramen, courses around the ischial spine, enters the lesser sciatic foramen and then courses in the pudendal canal
- D.
Enters the lesser sciatic foramen, courses through the greater sciatic foramen and wraps around the ischial spine before entering the pudendal canal
Correct Answer
C. Enters the greater sciatic foramen, courses around the ischial spine, enters the lesser sciatic foramen and then courses in the pudendal canal -
- 18.
Which of the following positions of the uterus & vagina is the "usual" position in a female?
- A.
Anteverted
- B.
Anteverted & anteflexed
- C.
Retroverted & retroflexed
- D.
Retroverted
Correct Answer
B. Anteverted & anteflexedExplanation
The "usual" position of the uterus and vagina in a female is anteverted and anteflexed. Anteverted means that the uterus is tilted forward towards the bladder, while anteflexed means that the uterus is bent forward at the cervix. This position is considered normal and common in most females.Rate this question:
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- 19.
Erection is primarily controlled by_____________________ nervous innervations while ejaculation and remission are primarily controlled by_____________ nervous innervation.
- A.
Sympathetic - Parasympathetic
- B.
Parasympathetic - Sympathetic
- C.
Somatic - Parasympathetic
- D.
Somatic - Sympathetic
Correct Answer
B. Parasympathetic - SympatheticExplanation
Erection, which refers to the process of achieving and maintaining a firm penis, is primarily controlled by parasympathetic nervous innervation. The parasympathetic nervous system is responsible for promoting relaxation and increased blood flow to the penis, leading to an erection. On the other hand, ejaculation and remission, which involve the release of semen and the return of the penis to its flaccid state, are primarily controlled by sympathetic nervous innervation. The sympathetic nervous system triggers the contraction of muscles involved in ejaculation and the constriction of blood vessels, causing the penis to become flaccid again.Rate this question:
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- 20.
The anterior recess of the ischioanal fossa is continuous with what perinea' space (pouch)?
- A.
Superficial perinea' space
- B.
Skin and fascial space
- C.
Space above the pelvic diaphragm
- D.
Deep perineal space
Correct Answer
D. Deep perineal spaceExplanation
The anterior recess of the ischioanal fossa is continuous with the deep perineal space. This space is located above the pelvic diaphragm and contains various structures such as the urethra, vagina, and deep transverse perineal muscles. It is important for understanding the anatomy and function of the perineal region.Rate this question:
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- 21.
Which of the following is a branch of the pudendal nerve?
- A.
Vaginal nerve
- B.
Ilioinguinal nerve
- C.
Genitofemoral nerve
- D.
Perineal nerve
- E.
Nerve to ductus deferens
Correct Answer
D. Perineal nerveExplanation
The perineal nerve is a branch of the pudendal nerve. It innervates the perineum, which is the area between the anus and the external genitalia. It provides sensory innervation to the skin and mucous membranes in this region, as well as motor innervation to the muscles involved in urination and sexual function.Rate this question:
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- 22.
Which of the following muscles is most important in creating the pelvic diaphragm?
- A.
Piriformis
- B.
Obturator internus
- C.
External anal sphincter
- D.
Levator ani
- E.
Tendinous arch
Correct Answer
D. Levator aniExplanation
The levator ani muscle is the most important muscle in creating the pelvic diaphragm. It is a broad, thin muscle that forms the majority of the pelvic floor. It supports the pelvic organs and plays a crucial role in maintaining continence and providing stability to the pelvis. The levator ani muscle helps to control the opening and closing of the urethra, vagina, and anus. It also assists in the process of childbirth by aiding in the relaxation and stretching of the pelvic floor muscles.Rate this question:
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- 23.
Your cousin was rollerblading and took a pretty bad fall in the park. He is now in the ER and has swelling in his scrotum, anterior abdominal wall and around his penis. He is freaking out to you, of course. Which of the following was most likely injured?
- A.
Prostatic urethra
- B.
Penile (spongy) urethra
- C.
Intermediate (membranous) urethra
- D.
Pre-prostatic urethra
Correct Answer
B. Penile (spongy) urethraExplanation
Based on the symptoms described, the most likely injured structure is the penile (spongy) urethra. The swelling around the penis and scrotum suggests trauma to the area, which could result in damage to the penile urethra. The other options, such as the prostatic, intermediate, and pre-prostatic urethra, are not typically associated with swelling in this context.Rate this question:
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- 24.
A 23-year old male is hit by a car while crossing a busy street. Among his many injuries is a torn sacrospinous ligament. Name (i) the muscle that will most likely also be affected and (ii) the nerve that may also be compromised.
- A.
Obturator internus muscle - pudendal nerve
- B.
Levator ani muscle - pudendal nerve
- C.
Coccygeus muscle - pudendal nerve
- D.
Levator ani muscle - perineal nerve
- E.
Coccygeus muscle - perineal nerve
Correct Answer
C. Coccygeus muscle - pudendal nerveExplanation
The torn sacrospinous ligament is located in the pelvic region. The coccygeus muscle is also located in the pelvic region and is in close proximity to the sacrospinous ligament. Therefore, it is likely that if the sacrospinous ligament is torn, the coccygeus muscle may also be affected. Additionally, the pudendal nerve passes through the pelvic region and is in close proximity to both the sacrospinous ligament and the coccygeus muscle. Therefore, there is a possibility that the pudendal nerve may also be compromised in this injury.Rate this question:
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- 25.
In your obstetrics rotation, the resident physician asks you to measure the diagonal conjugate of a 23-year old female patient who is hoping to get pregnant. You know that this measurement is between which of the following structures?
- A.
Sacral promontory and coccyx
- B.
Sacral promontory and superior edge of pubic symphysis
- C.
Sacral promontory and inferior edge of pubic symphysis
- D.
Coccyx and ischial spine
- E.
Coccyx and inferior edge of pubic symphysis
Correct Answer
C. Sacral promontory and inferior edge of pubic symphysisExplanation
The diagonal conjugate is a measurement used in obstetrics to estimate the size of the pelvic inlet. It is measured between the sacral promontory, which is a bony prominence at the base of the spine, and the inferior edge of the pubic symphysis, which is the joint where the two halves of the pelvis meet in the front. This measurement helps determine if the pelvis is large enough for a baby to pass through during childbirth.Rate this question:
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Mar 22, 2023Quiz Edited by
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Mar 25, 2012Quiz Created by
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