Block 6 Anatomy Pelvis Pelv Viscera Umich W Exp Prt 2
Questions and Answers
- 1.
The expanded region of the lower rectum, where fecal matter is retained, is known as the:
- A.
Anal columns
- B.
Anal sinuses
- C.
Ampulla
- D.
Transverse folds
Correct Answer
C. AmpullaExplanation
The ampulla is an expanded part of the lower rectum that stores feces. The transverse rectal folds are three folds in the ampulla which help to support fecal mass, but they are not the same as the actual region that stores the feces. Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the inner wall of the anal canal. Anal valves are folds of mucosa that join the anal columns at their inferior ends and create spaces between the wall and the valves known as anal sinuses.Rate this question:
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- 2.
During a vasectomy, the ductus deferens is ligated in the superior part of the scrotum. Two months following this sterilization procedure, the subsequent ejaculate contains:
- A.
Prostatic fluid only
- B.
Seminal fluid and prostatic fluid
- C.
Sperm only
- D.
Sperm and seminal fluid
- E.
Sperm, seminal fluid, and prostatic fluid
Correct Answer
B. Seminal fluid and prostatic fluidExplanation
The ductus deferens carries sperm from the tail of the epididymis to the ejaculatory duct. When this cord is ligated, sperm cannot enter the ejaculatory duct, so there will be no sperm in the subsequent ejaculate. The seminal vesicles and prostate also contribute fluid to the ejaculate. However, ligating the ductus deferens will not interrupt the path of seminal fluid or prostatic fluid. So, the ejaculate will still contain both of these fluids.Rate this question:
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- 3.
During a hysterectomy, the uterine vessels are ligated. However, the patient's uterus continues to bleed. The most likely source of blood still supplying the uterus is from which artery?
- A.
Inferior vesical
- B.
Internal pudendal
- C.
Middle rectal
- D.
Ovarian
- E.
Superior vesical
Correct Answer
D. OvarianExplanation
The ovarian artery has branches which supply the uterus. In fact, this artery anastomoses with the uterine artery. So, if the uterus is still bleeding after ligating the uterine artery, the ovarian artery is probably supplying the uterus. The inferior vesical artery supplies the inferior part of the bladder--it anastomoses with the middle rectal artery. The internal pudendal artery supplies blood to the perineum. The middle rectal artery supplies blood to the rectum. The superior vesical artery supplies blood to the superior bladder.Rate this question:
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- 4.
A female patient is found to have an ectopic (tubal) pregnancy (embryo develops in the uterine tube). In order to gain access to the peritoneal cavity endoscopically to remove the embryo, the instrument can be passed into the vagina and through the:
- A.
Anterior fornix
- B.
Cervix
- C.
Posterior fornix
- D.
Retropubic space
- E.
Vesicouterine pouch
Correct Answer
C. Posterior fornixExplanation
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity and remove the embryo. Take a look at Netter Plate 337 for a picture of this relationship. Entering the anterior fornix of the vagina would not allow a surgeon to enter the peritoneal cavity. The cervix is the inferior portion of the uterus which connects the uterus to the vagina--passing through the cervix would allow the surgeon to enter the uterus, but not the peritoneal cavity. The vesicouterine pouch is a fold of peritoneum reflected from the uterus onto the posterior margin of the superior surface of the bladder--it helps to separate the uterus from the bladder.Rate this question:
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- 5.
An elderly male patient presents with dysuria and urgency. You suspect benign prostatic hypertrophy which has caused an enlargement of the:
- A.
Interureteric crest
- B.
Prostatic utricle
- C.
Seminal colliculus
- D.
Sphincter urethrae
- E.
Uvula
Correct Answer
E. UvulaExplanation
The uvula of the bladder is an elevation on the posterior wall of the bladder. The uvula is caused by the middle lobe of the prostate gland. If the prostate becomes enlarged (either by benign hypertrophy or malignancy), the uvula can constrict the internal urethral orifice and cause difficulty in voiding the bladder. The interureteric crest is an elevation on the posterior wall of the bladder, between the two ureteric orifices. The seminal collicus is an elevation on the posterior wall of the prostatic urethra. At the summit of the seminal collicus, you can find the prostatic utricle, which is a small blind diverticulum in the posterior wall of the prostatic urethra. Finally, the sphincter urethrae is a muscle which encircles the urethra and compresses the urethra. None of these other structures would be enlarged in a case of benign prostatic hypertrophy.Rate this question:
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- 6.
During a hysterectomy and an oophorectomy, the uterine and ovarian vessels must be ligated. These vessels can be found in which ligaments?
- A.
Broad and ovarian
- B.
Broad and suspensory
- C.
Round and ovarian
- D.
Round and suspensory
- E.
Suspensory and ovarian
Correct Answer
B. Broad and suspensoryExplanation
The uterine vessels are found in the inferior portion of the broad ligament, while the ovarian vessels are found in the suspensory ligaments of the ovaries. The suspensory ligaments of the ovaries are peritoneal folds covering ovarian arteries, veins, nerves, and lymphatics as the structures pass over the pelvic brim to reach the ovary.
The ovarian ligament proper is a round cord which attaches the ovary to the uterus, just below the entrance of the uterine tube into the uterus. The round ligament of the uterus is a connective tissue band that attaches to the inner aspect of the labium majus and the uterus--it traverses the inguinal canal and it is found in the broad ligament.Rate this question:
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- 7.
A female patient comes to your office with lower abdominal pain. She missed her last menses and her pregnancy test is positive. Ultrasound imaging reveals a cyst-like structure in the right uterine tube which you feel may be a tubal pregnancy. In order to confirm your diagnosis and to remove the tubal embryo, you can gain access to the patient's lower pelvic cavity by passing a culdoscope through the vagina and the:
- A.
Vesicouterine pouch
- B.
Posterior fornix
- C.
Cervix
- D.
Isthmus
- E.
Ampulla
Correct Answer
B. Posterior fornixExplanation
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity and remove the embryo. The vesicouterine pouch is a fold of peritoneum reflected from the uterus onto the posterior margin of the superior surface of the bladder--it helps to separate the uterus from the bladder. The cervix is the inferior end of the uterus which connects the uterus to the vagina. The isthmus and ampulla are parts of the uterine tube--the isthmus is the constricted part of the uterine tube nearest the uterus, and the ampulla is the dilated region that connects the infundibulum with the isthmus.Rate this question:
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- 8.
An elderly patient notices red blood in his stool. As part of his examination, you insert a proctoscope (sigmoidoscope) through his anal canal. As you pass the scope superiorly through the rectum, the most prominent features to be seen are:
- A.
Longitudinal muscle bands
- B.
Tenia coli
- C.
Transverse rectal folds
- D.
Rectovesical pouches
- E.
Haustra
Correct Answer
C. Transverse rectal foldsExplanation
The rectum features three transverse rectal folds--these folds would be the most prominent features that you would see in the interior of the rectum if you were using a proctoscope. The tenia coli are the three bands of longitudinal muscle seen on the surface of the colon--the pattern of the teniae coli changes as the transition from sigmoid colon to rectum occurs. The sigmoid colon, like the rest of the colon, has three longitudinal muscular bands. These coalesce into two bands, anterior and posterior, on the rectum. However, none of these longitudinal muscle layers would be visible from the interior of the rectum. The rectovesical pouch is a peritoneal fold reflecting from the rectum to the posterior wall of the bladder in the male. Remember--females do not have the rectovesicular pouch. Instead, they have the vesicouterine and rectouterine pouches. Finally, the haustra are multiple pouches in the wall of the large intestine--they are not found in the rectum.Rate this question:
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- 9.
An elderly patient is having difficulty in voiding (urinating). He complains that after voiding, he still feels as though he needs "to go" again. You suspect that this patient suffers from benign prostatic hypertrophy, which has caused enlargement of the __________ of the bladder.
- A.
Seminal colliculus
- B.
Interureteric crest
- C.
Ampulla
- D.
Trigone
- E.
Uvula
Correct Answer
E. UvulaExplanation
The uvula of the bladder is an elevation on the posterior wall of the bladder. The uvula is produced by the middle lobe of the prostate gland. If the prostate becomes enlarged (either by benign hypertrophy or malignancy) the uvula can constrict the internal urethral orifice and cause difficulty in voiding the bladder. The seminal collicus is an elevation on the posterior wall of the prostatic urethra. The interureteric crest is an elevation on the posterior wall of the bladder, between the two ureteric orifices. The ampulla of the ductus deferens is the dilated part of the ductus deferens located posterior to the bladder. It joins with the duct of the seminal vesical to form the ejaculatory duct. The trigone is a triangular area on the posterior wall of the bladder. It is delineated by the two ureteric orifices and the internal urethral orifice, which form an equilateral triangle known as the trigone.Rate this question:
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- 10.
During a hysterectomy, care must be taken in ligation of the uterine vessels because they cross the _________ superiorly.
- A.
Ureter
- B.
Round ligament of the uterus
- C.
Ovarian artery
- D.
Lumbosacral trunk
- E.
Inferior hypogastric plexus
Correct Answer
A. UreterExplanation
The uterine vessels cross over the ureter as the ureters pass through the base of the mesometrium. Remember--the ureters must travel through the mesometrium to reach the base of the bladder. The relationship between the ureter and the uterine vessels is very important--you should remember this!
The round ligament of the uterus is a connective tissue band that attaches to the inner aspect of the labium majora and the uterus. It is found in the broad ligament, but it is superior to the ureter and the uterine vessels. The ovarian vessels are contained in the suspensory ligament of the ovary. The lumbosacral trunk is part of the ventral primary ramus of L4 united with the ventral primary ramus of L5--it contributes to the formation of the sacral plexus. The inferior hypogastric plexus lies between the pelvic viscera and the pelvic wall--it supplies sympathetic innervation to the vascular smooth muscle of pelvic vessels and parasympathetic innervation to the smooth muscles of the pelvis.Rate this question:
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- 11.
The prostate gland:
- A.
Encircles the urethra
- B.
Is well imaged using an intravenous urogram
- C.
Is partially intraperitoneal
- D.
Contains upper, middle and lower lobes
Correct Answer
A. Encircles the urethraExplanation
The prostate gland encircles the urethra. It circles around the first part of the urethra, the prostatic urethra. This is why urinary retention is one symptom of prostatic hypertrophy--if the prostate is enlarged, it may close around the urethra, occluding this passage and preventing urine from exiting the bladder.
The prostate would not be imaged using an intravenous urogram. In an intravenous urogram, a patient is given IV contrast, and radiographic images are taken as the contrast is excreted, passing through the kidneys, ureters, and bladder. Since the prostate is not part of this excretory pathway, it would not be viewed through this method. The prostate gland is completely extraperitoneal. Remember: the rectovesicular pouch, a fold of peritoneum that hangs between the bladder and rectum, is the lowest extent of the peritoneal cavity in males . But, the prostate is found on the posterior side of the bladder, below the point where the peritoneal membrane created this fold. So, it is an extraperitoneal organ. Finally, the lobes of the prostate are: anterior, posterior, lateral, and middle.Rate this question:
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- 12.
The part of the broad ligament giving attachment and support to the uterine tube is the:
- A.
Mesometrium
- B.
Mesovarium
- C.
Mesosalpinx
- D.
Round ligament
Correct Answer
C. MesosalpinxExplanation
The mesosalpinx is the part of broad ligament that supports the uterine tube. The mesosalpinx extends inferiorly to meet the root of the mesovarium; it attaches the uterine tube to the mesometrium. The mesometrium is the part of the broad ligament below the junction of the mesosalpinx and the mesovarium; it attaches the body of the uterus to the pelvic wall. The mesovarium is the part of broad ligament that forms a shelf-like fold supporting the ovary--it attaches the ovary to the mesometrium and mesosalpinx. The round ligament of the uterus is a connective tissue band that attaches to the inner aspect of the labium majus and the uterus. It is found in the broad ligament, and it traverses the inguinal canal.Rate this question:
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- 13.
Which structure is NOT found within the true pelvis?
- A.
Femoral nerve
- B.
Hypogastric nerve
- C.
Internal pudendal artery
- D.
Obturator artery
- E.
Pelvic splanchnic nerves
Correct Answer
A. Femoral nerveExplanation
To answer this question, you need to understand what the true pelvis is. The true pelvis is the area beneath the pelvic brim (pelvic inlet), where the pelvic viscera are located. The false pelvis is the area above the pelvic brim, bounded by the iliac blades. Now, you just need to think about the structures listed and determine which ones are in which location. The femoral nerve is the structure that is not in the true pelvis. After coming off the lumbar plexus with contributions from L2, 3, and 4, the femoral nerve runs along the border between the psoas major muscle and the iliacus to travel into the lower limb. It never descends below the pelvic brim, so it is not in the true pelvis. Hypogastric nerves connect the superior and inferior hypogastric plexuses. Since the inferior hypogastric plexus is lying between the pelvic viscera and the pelvis wall, in the true pelvis, the hypogastric nerves should also be in the true pelvis. The internal pudendal artery is a branch of the anterior division of the internal iliac artery. It lies in the true pelvis and supplies blood to the perineum. The obturator artery is a branch of the anterior internal iliac artery or, if it is the aberrant obturator, the inferior epigastric artery. It is in the true pelvis, and exits the pelvis through the obturator foramen. The pelvic splanchnic nerves represent the sacral portion of the craniosacral outflow (parasympathetic) of the autonomic nervous system. They come from the ventral rami of the second, third, and fourth sacral nerves. So, that puts them in the true pelvis, too.Rate this question:
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- 14.
A structure which takes the form of a hood anterosuperior to the clitoris:
- A.
Frenulum of the clitoris
- B.
Labia majora
- C.
Labia minora
- D.
Prepuce
Correct Answer
D. PrepuceExplanation
The prepuce is a fold of smooth skin that extends over the glans clitoris. It is formed by the joining of the anterior divisions of the labia minora. The frenulum of the clitoris is a small fold found posterior to the clitoris. It is formed by the joining of deeper, posterior, divisions of the labia minora. The labia majora are fat-filled elevations of skin lying on each side of the vestibule of the vagina. The labia minora are smaller folds of skin lying medial to the labia majora. They extend posteriorly and inferiorly from the clitoris.Rate this question:
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- 15.
A structure which is homologous to the male scrotum:
- A.
Labia minora
- B.
Labia majora
- C.
Glans
- D.
Shaft of corpus cavernosum
Correct Answer
B. Labia majoraExplanation
The labia majora and scrotum are homologous structures. The labia minora is the female counterpart of the pentscrotal raphe. The glans of the clitoris and glans of the penis are homologous structures. Finally, the shaft of the corpus cavernosum in the female is the shaft of the clitoris, which is homologous to the shaft of the penis.Rate this question:
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- 16.
Which skeletal feature would you consider to be most characteristic of the female pelvis?
- A.
Subpubic angle of 90 degrees or greater
- B.
Marked anterior curvature of the sacrum
- C.
Tendency to vertical orientation of the iliac bones
- D.
Prominent medial projection of the ischial spines
Correct Answer
A. Subpubic angle of 90 degrees or greaterExplanation
There are four major differences between the male and female pelvis. First, the subpubic angle and pubic arch are greater in the female pelvis than in the male pelvis. This is why A is correct-- females often have a subpubic angle of 90 degrees or greater. A second difference between the female and male pelvis is that the pelvis inlet for females is rounded, while for males it is heart shaped. Third, the pelvic outlet for females is larger than in males. Finally, the female pelvis has iliac wings that are more flared than in males.Rate this question:
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- 17.
You are observing a doctor perform an abdominal hysterectomy. He notes that it is vital to protect the ureter which is found in the base of the:
- A.
Mesometrium
- B.
Mesovarium
- C.
Mesosalpinx
- D.
Round ligament of the uterus
- E.
Suspensory ligament of the ovary
Correct Answer
A. MesometriumExplanation
The mesometrium is the part of the broad ligament of the uterus that attaches the body of the uterus to the pelvic wall. The ureters pass through the base of the mesometrium as they travel to reach the bladder. See Netter Plate 346 for a picture of this relationship. The mesovarium is the part of broad ligament that forms a shelf-like fold supporting the ovary. The suspensory ligament of the ovary, which conveys the ovarian vessels, lymphatics, and nerves to and from the ovary, constitutes the lateral part of the mesovarium of the broad ligament. The mesosalpinx is the part of broad ligament that supports the uterine tube. Finally, the round ligament of the uterus is a connective tissue band that attaches to the inner aspect of the labium majus and the uterus. It lies in the mesometrium, and it is continuous with the ovarian ligament.Rate this question:
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- 18.
A female patient is found to have an ectopic (tubal) pregnancy. In order to gain access to the peritoneal cavity endoscopically to remove the tubal embryo, the instrument can be passed through the posterior fornix of the vagina piercing into the:
- A.
External os
- B.
Internal os
- C.
Rectouterine pouch
- D.
Rectovesical pouch
- E.
Vesicouterine pouch
Correct Answer
C. Rectouterine pouchExplanation
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity to remove the embryo. Take a look at Netter Plate 337 for a picture of this relationship. The vesicouterine pouch is a fold of peritoneum reflected from the uterus onto the posterior margin of the superior surface of the bladder--it helps to separate the uterus from the bladder. The rectovesicular pouch is only found in males--it is a peritoneal fold reflecting from the rectum to the posterior wall of the bladder.
The external os of the cervix is the part of the cervix between the vagina and the cervical canal; the internal os of the cervix is the part of the cervix between the uterus and the cervical canal. See Netter Plate 346 for a picture of these osses.Rate this question:
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- 19.
The male pelvis tends to differ from the female pelvis in that the male pelvis often has a:
- A.
Larger pelvic inlet
- B.
Smaller subpubic angle
- C.
Straighter sacral curvature
- D.
Larger pelvic outlet
- E.
Rounder pelvic inlet
Correct Answer
B. Smaller subpubic angleExplanation
There are four major differences between the male and female pelvis. First, the subpubic angle and pubic arch are greater in the female pelvis than in the male pelvis. This is why B is correct-- the male pelvis has a smaller subpubic angle than the female pelvis. A second difference between the female and male pelvis is that the pelvic inlet for females is rounded, while for males it is heart shaped. Third, the pelvic outlet for females is larger than in males. Finally, the female pelvis has iliac wings that are more flared than in males.Rate this question:
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- 20.
The rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the:
- A.
Urinary bladder
- B.
Urethra
- C.
Uterine cervix
- D.
Vagina
Correct Answer
D. VaginaExplanation
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the posterior fornix of the vagina. This means that surgeons can make an incision in the posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337 for a picture of this relationship.Rate this question:
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- 21.
In a CT scan of the pelvis, the uterus is located:
- A.
Posterior to the bladder and rectum
- B.
Posterior to the bladder and anterior to the rectum
- C.
Anterior to the bladder and rectum
- D.
Anterior to the bladder and posterior to the rectum
Correct Answer
B. Posterior to the bladder and anterior to the rectumExplanation
In the female pelvis, the bladder is the most anterior organ; the uterus is posterior to the bladder, and the rectum is posterior to the bladder and uterus. See Netter Plate 337 for a picture.Rate this question:
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Mar 20, 2023Quiz Edited by
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Feb 21, 2012Quiz Created by
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