Anatomy Perineum –pelvis BRS - Part 1

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Anatomy Perineum pelvis BRS - Part 1 - Quiz

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Questions and Answers
  • 1. 

    A 68-year-old woman with uterine carcinoma undergoes surgical resection. This cancer can spread directly to the labia majora in lymphatics that follow which of the following structures?

    • A.

      Pubic arcuate ligament

    • B.

      Suspensory ligament of the ovary

    • C.

      Cardinal (transverse cervical) ligament

    • D.

      Suspensory ligament of the clitoris

    • E.

      Round ligament of the uterus

    Correct Answer
    E. Round ligament of the uterus
    Explanation
    The round ligament of the uterus runs laterally from the uterus through the
    deep inguinal ring, inguinal canal, and superficial inguinal ring and becomes lost in the subcutaneous
    tissues of the labium majus. Thus, carcinoma of the uterus can spread directly to the
    labium majus by traveling in lymphatics that follow the ligament. The pubic arcuate ligament attaches
    across the inferior aspect of the pubic symphysis and attaches to the medial borders of the
    inferior pubic rami. The suspensory ligament of the ovary runs from the ovary to the pelvic wall
    and transmits the ovarian vessels. The cardinal (transverse cervical) ligament runs from the cervix
    and the vagina to the pelvic walls. The suspensory ligament of the clitoris runs from the pubic
    symphysis and the arcuate pubic ligament to the deep fascia of the body of the clitoris.

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  • 2. 

    A 17-year-old boy suffers a traumatic groin injury during a soccer match. The urologist notices tenderness and swelling of the boy's left testicle that may be produced by thrombosis in which of the following veins?

    • A.

      Left internal pudendal vein

    • B.

      Left renal vein

    • C.

      Inferior vena cava

    • D.

      Left inferior epigastric vein

    • E.

      Left external pudendal vein

    Correct Answer
    B. Left renal vein
    Explanation
    A tender swollen left testis may be produced by thrombosis in the left renal
    vein, because the left testicular vein drains into the left renal vein. The right testicular vein drains
    into the inferior vena cava. The left internal pudendal vein empties into the left internal iliac
    vein. The left inferior epigastric drains into the left external iliac vein and the left external pudendal
    vein empties into the femoral vein.

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  • 3. 

    On a busy Saturday night in Chicago, a 16- year-old boy presents to the emergency room with a stab wound from a knife that enters the pelvis above the piriformis muscle. Which of the following structures is most likely to be damaged?

    • A.

      Sciatic nerve

    • B.

      Internal pudendal artery

    • C.

      Superior gluteal nerve

    • D.

      Inferior gluteal artery

    • E.

      Posterior femoral cutaneous nerve

    Correct Answer
    C. Superior gluteal nerve
    Explanation
    The superior gluteal nerve leaves the pelvis through the greater sciatic foramen,
    above the piriformis. The sciatic nerve, internal pudendal vessels, inferior gluteal vessels and
    nerve, and posterior femoral cutaneous nerve leave the pelvis below the piriformis.

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  • 4. 

    A 22-year-old woman receives a deep cut in the inguinal canal 1 inch lateral to the pubic tubercle. Which of the following ligaments is lacerated within the inguinal canal?

    • A.

      Suspensory ligament of the ovary

    • B.

      Ovarian ligament

    • C.

      Mesosalpinx

    • D.

      Round ligament of the uterus

    • E.

      Rectouterine ligament

    Correct Answer
    D. Round ligament of the uterus
    Explanation
    The round ligament of the uterus is found in the inguinal canal along its
    course. Other ligaments are not passing through the inguinal canal.

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  • 5. 

    A 29-year-old carpenter sustains severe injuries of the pelvic splanchnic nerve by a deep puncture wound, which has become contaminated. The injured parasympathetic preganglionic fibers in the splanchnic nerve are most likely to synapse in which of the following ganglia?

    • A.

      Ganglia in or near the viscera or pelvic plexus

    • B.

      Sympathetic chain ganglia

    • C.

      Collateral ganglia

    • D.

      Dorsal root ganglia

    • E.

      Ganglion impar

    Correct Answer
    A. Ganglia in or near the viscera or pelvic plexus
    Explanation
    The pelvic splanchnic nerves carry preganglionic parasympathetic general
    visceral efferent (GVE) fibers that synapse in the ganglia of the inferior hypogastric plexus and in
    terminal ganglia in the muscular walls of the pelvic organs. The sympathetic preganglionic fibers
    synapse in the sympathetic chain (paravertebral) ganglia or in the collateral (prevertebral) ganglia.
    The dorsal root ganglia contains cell bodies of general somatic afferent (GSA) and general visceral
    afferent (GVA) fibers and have no synapsis. The two sympathetic trunks unite and terminate
    in the ganglion impar (coccygeal ganglion), which is the most inferior, unpaired ganglion located
    in front of the coccyx.

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  • 6. 

    A 59-year-old woman comes to a local hospital for uterine cancer surgery. As the uterine artery passes from the internal iliac artery to the uterus, it crosses superior to which of the following structures that is sometimes mistakenly ligated during such surgery?

    • A.

      Ovarian artery

    • B.

      Ovarian ligament

    • C.

      Uterine tube

    • D.

      Ureter

    • E.

      Round ligament of the uterus

    Correct Answer
    D. Ureter
    Explanation
    The ureter runs under the uterine artery near the cervix; thus, the ureter is
    sometimes mistakenly ligated during pelvic surgery. The other structures mentioned are not
    closely related to the uterine artery near the uterine cervix.

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  • 7. 

    A 29-year-old woman is admitted to a hospital because the birth of her child is several days overdue. Tearing of the pelvic diaphragm during childbirth leads to paralysis of which of the following muscles?

    • A.

      Piriformis

    • B.

      Sphincter urethrae

    • C.

      Obturator internus

    • D.

      Levator ani

    • E.

      Sphincter ani externus

    Correct Answer
    D. Levator ani
    Explanation
    The pelvic diaphragm is formed by the levator ani and coccygeus, whereas
    the urogenital diaphragm consists of the sphincter urethrae and deep transverse perinei muscles.
    The piriformis passes through the greater sciatic notch and inserts on the greater trochanter of
    the femur. The obturator internus forms the lateral wall of the ischiorectal fossa. The sphincter
    ani externus is composed of three layers, including the subcutaneous (corrugator cutis ani), superficial,
    and deep portions and maintains a voluntary tonic contracture.

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  • 8. 

    A 37-year-old small business manager receives a gunshot wound in the pelvic cavity, resulting in a lesion of the sacral splanchnic nerves. Which of the following nerve fibers would primarily be damaged?

    • A.

      Postganglionic parasympathetic fibers

    • B.

      Postganglionic sympathetic fibers

    • C.

      Preganglionic sympathetic fibers

    • D.

      Preganglionic parasympathetic fibers

    • E.

      Postganglionic sympathetic and parasympathetic fibers

    Correct Answer
    C. Preganglionic sympathetic fibers
    Explanation
    The sacral splanchnic nerves consist primarily of preganglionic sympathetic
    neurons and also contain general visceral afferent (GVA) fibers. None of the other fibers listed are
    contained in these nerves.

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  • 9. 

    A young couple is having difficulty conceiving a child. Their physician at a reproduction and fertility clinic explains to them that:

    • A.

      The ovary lies within the broad ligament

    • B.

      The glans clitoris is formed from the corpus spongiosum

    • C.

      Erection of the penis is a sympathetic response

    • D.

      Ejaculation follows parasympathetic stimulation

    • E.

      Fertilization occurs in the infundibulum or ampulla of the uterine tube.

    Correct Answer
    E. Fertilization occurs in the infundibulum or ampulla of the uterine tube.
    Explanation
    Fertilization takes place in the infundibulum or ampulla of the uterine tube. The
    glans clitoris is derived from the corpora cavernosa, whereas the glans penis is the expanded terminal
    part of the corpus spongiosum. Erection of the penis is caused by parasympathetic stimulation,
    whereas ejaculation is mediated via the sympathetic nerve. The ovaries are not enclosed in the broad
    ligament, but their anterior surface is attached to the posterior surface of the broad ligament.

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  • 10. 

    A 46-year-old woman has a history of infection in her perineal region. A comprehensive examination reveals a tear of the superior boundary of the superficial perineal space. Which of the following structures would most likely be injured?

    • A.

      Pelvic diaphragm

    • B.

      Colles' fascia

    • C.

      Superficial perineal fascia

    • D.

      Deep perineal fascia

    • E.

      Perineal membrane

    Correct Answer
    E. Perineal membrane
    Explanation
    The superior (deep) boundary of the superficial perineal space is the perineal
    membrane (inferior fascia of the urogenital diaphragm). Colles' fascia is the deep membranous
    layer of the superficial perineal fascia. The deep perineal fascia essentially divides the superficial
    perineal space into a superficial and deep compartment. The pelvic diaphragm consists
    of the levator ani and coccygeus muscles

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  • 11. 

    A 58-year-old man is diagnosed as having a slowly growing tumor in the deep perineal space. Which of the following structures would most likely be injured?

    • A.

      Bulbourethral glands

    • B.

      Crus of penis

    • C.

      Bulb of vestibule

    • D.

      Spongy urethra

    • E.

      Great vestibular gland

    Correct Answer
    A. Bulbourethral glands
    Explanation
    The deep perineal space contains the bulbourethral (Cowper's) glands. The
    crus of the penis, bulb of the vestibule, spongy urethra, and great vestibular gland are found in
    the superficial perineal space.

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  • 12. 

    An elderly man with benign enlargement of his prostate experiences difficulty in urination, urinary frequency, and urgency. Which of the following lobes of the prostate gland is commonly involved in benign hypertrophy that obstructs the prostatic urethra?

    • A.

      Anterior lobe

    • B.

      Middle lobe

    • C.

      Right lateral lobe

    • D.

      Left lateral lobe

    • E.

      Posterior lobe

    Correct Answer
    B. Middle lobe
    Explanation
    The middle lobe of the prostate gland is commonly involved in benign prostatic
    hypertrophy, resulting in obstruction of the prostatic urethra, whereas the posterior lobe is
    commonly involved in carcinomatous transformation. The anterior lobe contains little glandular
    tissue, and the two lateral lobes on either side of the urethra form the major part of the gland.

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  • 13. 

    A 59-year-old man is diagnosed with prostate cancer following a digital rectal examination. For the resection of prostate cancer, it is important to know that the prostatic ducts open into or on which of the following structures?

    • A.

      Membranous part of the urethra

    • B.

      Seminal colliculus

    • C.

      Spongy urethra

    • D.

      Prostatic sinus

    • E.

      Prostatic utricle

    Correct Answer
    D. Prostatic sinus
    Explanation
    Ducts from the prostate gland open into the prostatic sinus, which is a
    groove on either side of the urethral crest. The prostate gland receives the ejaculatory duct, which
    opens into the prostatic urethra on the seminal colliculus (a prominent elevation of the urethral
    crest) just lateral to the prostatic utricle, which is a small blind pouch. The bulbourethral gland
    lies on the lateral side of the membranous urethra within the deep perineal space, but its duct
    opens into the bulbous portion of the spongy (penile) urethra.

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  • 14. 

    A 29-year-old woman with a ruptured ectopic pregnancy is admitted to a hospital for culdocentesis. A long needle on the syringe is most efficiently inserted through which of the following structures?

    • A.

      Anterior fornix of the vagina

    • B.

      Posterior fornix of the vagina

    • C.

      Anterior wall of the rectum

    • D.

      Posterior wall of the uterine body

    • E.

      Posterior wall of the bladder

    Correct Answer
    B. Posterior fornix of the vagina
    Explanation
    A needle should be inserted through the posterior fornix, just below the
    posterior lip of the cervix while the patient is in supine position, to aspirate abnormal fluid in the
    cul-de-sac of Douglas (rectouterine pouch). Rectouterine excavation is not most efficiently aspirated
    by puncture of other structures

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  • 15. 

    A 37-year-old man is suffering from carcinoma of the skin of the glans penis. Cancer cells are likely to metastasize directly to which of the following lymph nodes?

    • A.

      External iliac nodes

    • B.

      Internal iliac nodes

    • C.

      Superficial inguinal nodes

    • D.

      Aortic (lumbar) nodes

    • E.

      Common iliac nodes

    Correct Answer
    C. Superficial inguinal nodes
    Explanation
    The superficial inguinal nodes receive lymph from the penis, scrotum, buttocks,
    labium majus, and the lower parts of the vagina and anal canal. These nodes have efferent
    vessels that drain primarily into the external iliac and common iliac nodes and ultimately to the
    lumbar (aortic) nodes. The internal iliac nodes receive lymph from the upper part of the rectum,
    vagina, uterus, and other pelvic organs, and they drain into the common iliac and then to the
    lumbar (aortic) nodes.

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  • 16. 

    A 42-year-old woman who has had six  children develops a weakness of the urogenital diaphragm. Paralysis of which of the following muscles would cause such a symptom?

    • A.

      Sphincter urethrae

    • B.

      Coccygeus

    • C.

      Superficial transversus perinei

    • D.

      Levator ani

    • E.

      Obturator internus

    Correct Answer
    A. Sphincter urethrae
    Explanation
    The urogenital diaphragm consists of the sphincter urethrae and deep
    transverse perineal muscles. Weakness of the muscles, ligaments, and fasciae of the pelvic floor
    such as the pelvic diaphragm, urogenital diaphragm, and cardinal (transverse cervical) ligaments
    occurs as result of multiple child delivery, advancing age, and menopause. The pelvic diaphragm
    is composed of the levator ani and coccygeus muscles. The superficial transverses perinei is one
    of the superficial perineal muscles and the obturator internus forms the lateral wall of the ischiorectal
    fossa.

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  • 17. 

    A 43-year-old man has a benign tumor located near a gap between the arcuate pubic ligament and the transverse perineal ligament. Which of the following structures is most likely compressed by this tumor?

    • A.

      Perineal nerve

    • B.

      Deep dorsal vein of the penis

    • C.

      Superficial dorsal vein

    • D.

      Posterior scrotal nerve

    • E.

      Deep artery of the penis

    Correct Answer
    B. Deep dorsal vein of the penis
    Explanation
    The deep dorsal vein, dorsal artery, and dorsal nerve of the penis pass
    through a gap between the arcuate pubic ligament and the transverse perineal ligament. The perineal
    nerve divides into a deep branch, which supplies all of the perineal muscles, and superficial
    branches as posterior scrotal nerves that supply the scrotum. The superficial dorsal vein of the penis
    empties into the greater saphenous vein. The deep artery of the penis runs in the corpus cavernosum
    penis.

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  • 18. 

    An obstetrician performs a median episiotomy  on a woman before parturition to prevent uncontrolled tearing. If the perineal body is damaged, the function of which of the following muscles might be impaired?

    • A.

      Ischiocavernosus and sphincter urethrae

    • B.

      Deep transverse perineal and obturator internus

    • C.

      Bulbospongiosus and superficial transverse perineal

    • D.

      External anal sphincter and sphincter urethrae

    • E.

      Bulbospongiosus and ischiocavernosus

    Correct Answer
    C. Bulbospongiosus and superficial transverse perineal
    Explanation
    The perineal body (central tendon of the perineum) is a fibromuscular node
    at the center of the perineum. It provides attachment for the bulbospongiosus, the superficial and
    deep transverse perineal muscles, and the sphincter ani externus muscles. Other muscles (ischiocavernosus,
    sphincter urethrae, and obturator internus) are not attached to the perineal body.

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  • 19. 

    A 22-year-old man has a gonorrheal infection that has infiltrated the space between the inferior fascia of the urogenital diaphragm and the superficial perineal fascia. Which of the following structures might be inflamed?

    • A.

      Greater vestibular gland

    • B.

      Bulbourethral gland

    • C.

      Membranous part of the male urethra

    • D.

      Deep transverse perineal muscle

    • E.

      Sphincter urethrae

    Correct Answer
    A. Greater vestibular gland
    Explanation
    The greater vestibular gland is located in the superficial perineal space between
    the inferior fascia of the urogenital diaphragm and the membranous layer of the superficial
    perineal fascia (Colles' fascia). All of the other structures are found in the deep perineal pouch.

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  • 20. 

    A 39-year-old man is unable to expel the last drops of urine from the urethra at the end of micturition because of paralysis of the external urethral sphincter and bulbospongiosus muscles. This condition may occur as a result of injury to which of the following nervous structures?

    • A.

      Pelvic plexus

    • B.

      Prostatic plexus

    • C.

      Pudendal nerve

    • D.

      Pelvic splanchnic nerve

    • E.

      Sacral splanchnic nerve

    Correct Answer
    C. Pudendal nerve
    Explanation
    The perineal branch of the pudendal nerve supplies the external urethral
    sphincter and bulbospongiosus muscles in the male. All other nervous structures do not supply
    skeletal muscles but supply smooth muscles in the perineal and pelvic organs. The pelvic and prostatic
    plexuses contain both sympathetic and parasympathetic nerve fibers. The pelvic splanchnic
    nerve carries preganglionic parasympathetic fibers, whereas the sacral splanchnic nerve transmits
    preganglionic sympathetic fibers.

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  • 21. 

    A 21-y/o marine biologist asks about her first bimanual examination and it is explained to her that the normal position of the uterus is:

    • A.

      Anteflexed and anteverted

    • B.

      Retroflexed and anteverted

    • C.

      Anteflexed and retroverted

    • D.

      Retroverted arid retroflexed

    • E.

      Anteverted and retroverted

    Correct Answer
    A. Anteflexed and anteverted
    Explanation
    The normal position of the uterus is anteverted (i.e., angle of 90 degrees at
    the junction of the vagina and cervical canal) and anteflexed (i.e., angle of 160 to 170 degrees at
    the junction of the cervix and body).

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  • 22. 

    After his bath, but before getting dressed, a 4-year-old boy was playing with his puppy. The boy's penis was bitten by the puppy and the deep dorsal vein was injured. The damaged vein:

    • A.

      Lies deep to Buck's fascia

    • B.

      Drains into the prostatic venous plexus

    • C.

      Lies lateral to the dorsal artery of the penis

    • D.

      Is found in the corpus spongiosum

    • E.

      Is dilated during erection

    Correct Answer
    B. Drains into the prostatic venous plexus
    Explanation
    The deep dorsal vein of the penis lies medial to the dorsal artery of the penis
    on the dorsum of the penis and superficial to Buck's fascia, drains into the prostatic plexus of
    veins, and is compressed against the underlying deep fascia of the penis during erection.

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  • 23. 

    A 62-year-old man is incapable of penile erection after rectal surgery with prostatectomy. The patient most likely has a lesion of which of the following nerves?

    • A.

      Dorsal nerve of the penis

    • B.

      Perineal nerve

    • C.

      Hypogastric nerve

    • D.

      Sacral splanchnic nerve

    • E.

      Pelvic splanchnic nerve

    Correct Answer
    E. Pelvic splanchnic nerve
    Explanation
    The pelvic splanchnic nerve contains preganglionic parasympathetic fibers,
    whereas the sacral splanchnic nerve contains preganglionic sympathetic fibers. Parasympathetic
    fibers are responsible for erection, whereas sympathetic fibers are involved with ejaculation. The
    right and left hypogastric nerves contain primarily sympathetic fibers and visceral sensory fibers.
    The dorsal nerve of the penis and the perineal nerve provide sensory nerve fibers.

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  • 24. 

    A 23-year-old massage therapist who specializes in women's health attends a lecture at an annual conference on techniques of massage. She asks which of the following structures is drained by the lumbar (aortic) lymph nodes?

    • A.

      Perineum

    • B.

      Lower part of the vagina

    • C.

      External genitalia

    • D.

      Ovary

    • E.

      Lower part of the anterior abdominal wall

    Correct Answer
    D. Ovary
    Explanation
    The lymphatic vessels from the ovary ascend with the ovarian vessels in
    the suspensory ligament and terminate in the lumbar (aortic) nodes. Lymphatic vessels from the
    perineum, external genitalia, and lower part of the anterior abdominal wall drain into the superficial
    inguinal nodes.

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  • 25. 

    A sexually active adolescent presents with an infection within the ischiorectal fossa. Which of the following structures is most likely injured?

    • A.

      Vestibular bulb

    • B.

      Seminal vesicle

    • C.

      Greater vestibular gland

    • D.

      Inferior rectal nerve

    • E.

      Internal pudendal artery

    Correct Answer
    D. Inferior rectal nerve
    Explanation
    The ischiorectal fossa contains the inferior rectal nerves and vessels arid
    adipose tissue. The bulb of the vestibule and the great vestibular gland are located in the superficial
    perineal space, whereas the bulbourethral gland is found in the deep perineal space. The internal
    pudendal artery runs in the pudendal canal, but its branches pass through the superficial
    and deep perineal spaces.

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  • 26. 

    A first-year resident in the urology department reviews pelvic anatomy before seeing patients. Which of the following statements is correct?

    • A.

      The dorsal artery of the penis supplies the glans penis

    • B.

      The seminal vesicles store spermatozoa

    • C.

      The duct of the hulbourethral gland opens into the membranous urethra

    • D.

      The duct of the greater vestibular gland opens into the vagina

    • E.

      The anterior lobe of the prostate gland is prone to carcinomatous transformation

    Correct Answer
    A. The dorsal artery of the penis supplies the glans penis
    Explanation
    The dorsal artery of the penis supplies the glans penis. The seminal vesicles
    store no spermatozoa. The duct of the bulbourethral gland opens into the bulbous portion of the
    spongy urethra, whereas the greater vestibular gland opens into the vestibule between the labium
    minora and the hymen. The anterior lobe of the prostate is devoid of glandular substance, the
    middle lobe is prone to benign hypertrophy, and the posterior lobe is prone to carcinomatous
    transformation.

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  • 27. 

    A 43-year-old woman presents with a prolapsed uterus. Repair of a prolapsed uterus requires knowledge of the supporting structures of the uterus. Which of the following structures plays the most important role in the support of the uterus?

    • A.

      Levator ani

    • B.

      Sphincter urethrae

    • C.

      Uterosacral ligament

    • D.

      Ovarian ligament

    • E.

      Arcuate pubic ligament

    Correct Answer
    A. Levator ani
    Explanation
    The pelvic diaphragm, particularly the levator ani, provides the most important
    support for the uterus, although the urogenital diaphragm and the uterosacral and ovarian
    ligaments support the uterus. The arcuate pubic ligament arches across the inferior aspect of
    the pubic symphysis.

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  • 28. 

    A 16-year-old boy presents to the emergency department with rupture of the penile urethra. Extravasated urine from this injury can spread into which of the following structures?

    • A.

      Scrotum

    • B.

      Ischiorectal fossa

    • C.

      Pelvic cavity

    • D.

      Testis

    • E.

      Thigh

    Correct Answer
    A. Scrotum
    Explanation
    Extravasated urine from the penile urethra below the perineal membrane
    spreads into the superficial perineal space, scrotum, penis, and anterior abdominal wall. However,
    it does not spread into the testis, ischiorectal fossa, pelvic cavity, and thigh because Scarpa's fascia
    ends by firm attachment to the fascia lata of the thigh.

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  • 29. 

    A 23-year-old woman visits her obstetrician for an annual checkup. During vaginal examination, which of the following structures may be palpated?

    • A.

      Apex of the urinary bladder

    • B.

      Fundus of the uterus

    • C.

      Terminal part of the round ligament of the uterus

    • D.

      Body of the clitoris

    • E.

      Uterine cervix

    Correct Answer
    E. Uterine cervix
    Explanation
    In addition to the uterine cervix, the uterus, uterine tubes, ovaries, and
    ureters can be palpated. The apex of the urinary bladder is the anterior end of the bladder; thus,
    it cannot be palpated. The fundus of the uterus is anterosuperior part of the uterus. The terminal
    part of the round ligament of the uterus emerges from the superficial inguinal ring and becomes
    lost in the subcutaneous tissue of the labium majus.

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  • 30. 

    A 53-year-old bank teller is admitted to a local hospital for surgical removal of a benign pelvic tumor confined within the broad ligament. There is a risk of injuring which of the following structures that lies in this ligament?

    • A.

      Ovary

    • B.

      Proximal part of the pelvic ureter

    • C.

      Terminal part of the round ligament of the uterus

    • D.

      Uterine tube

    • E.

      Suspensory ligament of the ovary

    Correct Answer
    D. Uterine tube
    Explanation
    The uterine tubes lie in the broad ligament. The anterior surface of the
    ovary is attached to the posterior surface of the broad ligament of the uterus. The ureter
    descends retroperitoneally on the lateral pelvic wall but is crossed by the uterine artery in the
    base (in the inferomedial part) of the broad ligament. The terminal part of the round ligament
    of the uterus becomes lost in the subcutaneous tissue of the labium majus. The suspensory ligament
    of the ovary is a band of peritoneum that extends superiorly from the ovary to the
    pelvic wall

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  • 31. 

    A 72-year-old man comes to his physician for an annual check-up. Which of the following structures is most readily palpated during rectal examination?

    • A.

      Prostate gland

    • B.

      Epididymis

    • C.

      Ejaculatory duct

    • D.

      Ureter

    • E.

      Testis

    Correct Answer
    A. Prostate gland
    Explanation
    The prostate gland may be palpated on rectal examination. The ejaculatory
    duct runs within the prostate gland and cannot be felt. In the male, the pelvic part of the ureter
    lies lateral to the ductus deferens and enters the posterosuperior angle of the bladder, where it is
    situated anterior to the upper end of the seminal vesicle, and thus cannot be palpated during rectal
    examination. However, in the female the ureter can be palpated during vaginal examination
    because it runs near the uterine cervix and the lateral fornix of the vagina to enter the posterosuperior
    angle of the bladder. The testis are examined during a routine annual check-up but obviously
    not during a rectal examination.

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  • 32. 

    A 48-year-old college football coach undergoes a radical prostatectomy for a malignant tumor in his prostate. Following surgery, he is incapable of achieving an erection. Which of  the following nerves is most likely damaged during the surgery?

    • A.

      Sacral splanchnic nerve

    • B.

      Pelvic splanchnic nerve

    • C.

      Pudendal nerve

    • D.

      Dorsal nerve of the penis

    • E.

      Posterior scrotal nerve

    Correct Answer
    B. Pelvic splanchnic nerve
    Explanation
    Parasympathetic preganglionic fibers in the pelvic splanchnic nerve are responsible
    for erection of the penis. Sympathetic preganglionic fibers in the sacral splanchnic
    nerve are responsible for ejaculation. The pudendal nerve supplies the external anal sphincter and
    perineal muscles and supplies general somatic afferent (GSA) fibers to the perineal region. The
    dorsal nerve of the penis is a terminal branch of the pudendal nerve and supplies sensation of the
    penis. The posterior scrotal nerves are superficial branches of the perineal nerve and supply sensory
    fibers to the scrotum.

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  • 33. 

    While performing a pelvic exenteration, the surgical oncologist notices a fractured or  ruptured boundary of the pelvic inlet. Which of the following structures is most likely damaged?

    • A.

      Promontory of the sacrum

    • B.

      Anterior-inferior iliac spine

    • C.

      Inguinal ligament

    • D.

      Iliac crest

    • E.

      Arcuate pubic ligament

    Correct Answer
    A. Promontory of the sacrum
    Explanation
    The pelvic inlet (pelvic brim) is bounded by the promontory and the anterior
    border of the ala of the sacrum, the arcuate line of the ilium, the pectineal line, the pubic
    crest, and the superior margin of the pubic symphysis.

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  • 34. 

    A 32-year-old patient with multiple fractures of the pelvis has no cutaneous sensation in the urogenital triangle. The function of which of the following nerves is most likely to be spared?

    • A.

      Ilioinguinal nerve

    • B.

      Iliohypogastric nerve

    • C.

      Posterior cutaneous nerve of the thigh

    • D.

      Pudendal nerve

    • E.

      Genitofemoral nerve

    Correct Answer
    B. Iliohypogastric nerve
    Explanation
    The iliohypogastric nerve innervates the skin above the pubis. The skin of
    the urogenital triangle is innervated by the pudendal nerve, perineal branches of the posterior
    femoral cutaneous nerve, anterior scrotal or labial branches of the ilioinguinal nerve, and the genital
    branch of the genitofemoral nerve.

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