Block 7 Anat Pelv & Perineum Prt 2

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Block 7 Anat Pelv & Perineum Prt 2 - Quiz

The perineum plays an important role in functions as such maturation, defecation, sexual intercourse and childbirth. The block 7 on anatomy of pelvis and perineum quiz below is the second in a series of tests aimed at increasing your understanding on the chapter give it a try and keep an eye out for chapter 3.


Questions and Answers
  • 1. 

    You examine a young boy in the emergency room who is bleeding from his penis after an accident.  This blood is derived primarily from a branch of which of the following arteries?

    • A.

      Superior gluteal

    • B.

      Internal pudendal

    • C.

      External pudendal

    • D.

      Femoral

    • E.

      Inferior epigastric

    Correct Answer
    B. Internal pudendal
    Explanation
    The internal pudendal artery is the correct answer because it is responsible for supplying blood to the external genitalia, including the penis. In cases of trauma or injury to the penis, bleeding can occur from this artery. The other arteries listed do not primarily supply blood to the penis, making them incorrect choices.

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  • 2. 

    Which of the following is incorrect pertaining to the ovarian artery?

    • A.

      It traverses the suspensory ligament of the ovary.

    • B.

      It crosses anterior to the ureter.

    • C.

      It has reduced blood flow following ligature of the internal iliac artery.

    • D.

      It helps supply the uterine tube.

    • E.

      It is accompanied by lymph vessels draining the ovary.

    Correct Answer
    C. It has reduced blood flow following ligature of the internal iliac artery.
    Explanation
    The correct answer is "It has reduced blood flow following ligature of the internal iliac artery." This statement is incorrect because the ovarian artery receives its blood supply from the aorta, not the internal iliac artery. Ligature of the internal iliac artery would not directly affect the blood flow to the ovarian artery.

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  • 3. 

    Which of the following is not typically a tributary of the internal iliac vein?

    • A.

      Superior rectal vein

    • B.

      Veins from the vesical pelvic plexus

    • C.

      Internal pudendal vein

    • D.

      Uterine vein

    • E.

      Superior gluteal vein

    Correct Answer
    A. Superior rectal vein
    Explanation
    The superior rectal vein is not typically a tributary of the internal iliac vein. The internal iliac vein receives blood from various veins in the pelvis, including the veins from the vesical pelvic plexus, internal pudendal vein, uterine vein, and superior gluteal vein. However, the superior rectal vein drains into the inferior mesenteric vein, which then joins the splenic vein to form the portal vein. Therefore, it is not a direct tributary of the internal iliac vein.

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  • 4. 

    Pelvic lymph drainage:

    • A.

      Is associated with six primary groups of well-defined lymph nodes.

    • B.

      Is defined by well-developed flow patterns that permit prediction of the spread of metastatic cancer from one organ to another.

    • C.

      Includes vessels that drain the testis.

    • D.

      Is characterized by terminal efferent vessels that pass the lymph to lumbar (caval/aortic) nodes.

    • E.

      Rigidly follows venous drainage patterns.

    Correct Answer
    D. Is characterized by terminal efferent vessels that pass the lymph to lumbar (caval/aortic) nodes.
    Explanation
    The correct answer is that pelvic lymph drainage is characterized by terminal efferent vessels that pass the lymph to lumbar (caval/aortic) nodes. This means that the lymph from the pelvic area is carried by specific vessels to the lumbar nodes located near the aorta or inferior vena cava. This pattern of drainage is well-defined and helps predict the spread of metastatic cancer from one organ to another. It does not rigidly follow venous drainage patterns and also includes vessels that drain the testis.

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  • 5. 

    The ureters:

    • A.

      Pass straight through the bladder wall (in a horizontal plane).

    • B.

      Are accompanied throughout their length by arteries and veins derived from the renal vessels.

    • C.

      Have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region.

    • D.

      Cross anterior to the ductus deferens.

    • E.

      Are intraperitoneal.

    Correct Answer
    C. Have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region.
    Explanation
    The correct answer is that the ureters have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region. This means that when there is inflammation or obstruction in the ureters, the pain is often felt in the lower abdomen and inguinal region. This is because the nerves that transmit pain signals from the ureters to the brain follow a pathway that refers the pain to these specific areas.

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  • 6. 

    Detrusor muscle contraction is stimulated by:

    • A.

      The superior hypogastric nerve.

    • B.

      Lumbar splanchnic nerves.

    • C.

      Pelvic splanchnic nerves

    • D.

      Internal pudendal nerve.

    • E.

      Contractions of the levator ani.

    Correct Answer
    C. Pelvic splanchnic nerves
    Explanation
    The pelvic splanchnic nerves are responsible for stimulating detrusor muscle contraction. These nerves are part of the autonomic nervous system and play a crucial role in controlling the bladder function. When the pelvic splanchnic nerves are activated, they cause the detrusor muscle to contract, leading to the emptying of the bladder. This process is essential for normal urination and maintaining bladder control.

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  • 7. 

    Which of the following is incorrect pertaining to the bladder?

    • A.

      A cystocele may result from injuries associated with parturition.

    • B.

      Withdrawal of urine from the bladder requires the needle to enter the peritoneal cavity.

    • C.

      Rupture of the superior part of the bladder is usually associated with extravasation (passage) of urine into the peritoneal cavity.

    • D.

      The interior of the bladder may be viewed with a cystoscope.

    • E.

      A complete spinal cord transaction superior to the second sacral segment would eliminate voluntary control of micturition.

    Correct Answer
    B. Withdrawal of urine from the bladder requires the needle to enter the peritoneal cavity.
    Explanation
    The statement "Withdrawal of urine from the bladder requires the needle to enter the peritoneal cavity" is incorrect. The peritoneal cavity is not involved in the process of withdrawing urine from the bladder. Urine is typically withdrawn from the bladder using a catheter, which is inserted into the bladder through the urethra, not the peritoneal cavity.

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  • 8. 

    In the following MRI of a woman with an anteverted and anteflexed uterus, the arrow indicates the:

    • A.

      Body of the uterus.

    • B.

      Opening of the vagina

    • C.

      External os (opening of the cervix).

    • D.

      Bladder

    • E.

      Rectum

    Correct Answer
    C. External os (opening of the cervix).
    Explanation
    The arrow in the MRI image is indicating the external os, which is the opening of the cervix. This is the correct answer because the external os is located at the lower end of the uterus and is the pathway between the uterus and the vagina. It is important to note that the question mentions the woman has an anteverted and anteflexed uterus, which means the uterus is tilted forward and bent forward. This information helps to confirm that the arrow is indeed pointing to the external os, as it is in the correct position relative to the uterus.

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  • 9. 

    The female urethra:

    • A.

      Is more difficult to catheterize than the male urethra.

    • B.

      Opens into the vestibule of the vagina.

    • C.

      Has cilia that very effectively prevent bacteria from entering the bladder.

    • D.

      Begins with a distinct sphincter in the bladder, the internal urethral sphincter.

    • E.

      Has a distinct posterior ridge termed the urethral crest.

    Correct Answer
    B. Opens into the vestibule of the vagina.
    Explanation
    The female urethra opens into the vestibule of the vagina.

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  • 10. 

    The trigone of the bladder:

    • A.

      Forms the boundaries of the internal urethral orifice.

    • B.

      Is a slight elevation of the internal posterior wall produced by the prostate.

    • C.

      Is the internal area demarcated by the internal urethral and ureteric orifices.

    • D.

      Is the extraperitoneal part of the external surface.

    • E.

      Is synonymous with the apex.

    Correct Answer
    C. Is the internal area demarcated by the internal urethral and ureteric orifices.
    Explanation
    The trigone of the bladder refers to the internal area that is demarcated by the internal urethral and ureteric orifices. This area is triangular in shape and is important for the normal functioning of the bladder. It is a smooth region that helps in the efficient flow of urine and prevents the backflow of urine into the ureters. The trigone is clinically significant as it is the most common site for bladder cancer.

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  • 11. 

    The ductus deferens:

    • A.

      Is typically ligated during a vasectomy as it exits the superficial inguinal ring.

    • B.

      Terminates by uniting with the duct of the seminal glands to form the ejaculatory duct.

    • C.

      Begins at the head of the testis.

    • D.

      Is intraperitoneal.

    • E.

      Is drained by lymph vessels destined for the deep inguinal nodes.

    Correct Answer
    B. Terminates by uniting with the duct of the seminal glands to form the ejaculatory duct.
    Explanation
    The ductus deferens is a tube that carries sperm from the epididymis to the urethra. It terminates by joining with the duct of the seminal glands to form the ejaculatory duct. This is an important step in the process of ejaculation, as the ejaculatory duct then carries sperm and seminal fluid into the urethra for ejaculation.

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  • 12. 

    A middle-aged male patient complains of a weak "stream" and nocturia. You believe the most likely cause to be:

    • A.

      A bladder infection.

    • B.

      A spinal cord lesion affecting his pelvic splanchnic nerves.

    • C.

      A ureteric calculi.

    • D.

      An obstruction of his intramural (preprostatic) urethra.

    • E.

      Benign prostatic hypertrophy.

    Correct Answer
    E. Benign prostatic hypertrophy.
    Explanation
    The most likely cause of the patient's weak "stream" and nocturia is benign prostatic hypertrophy. This condition commonly occurs in middle-aged and older males and is characterized by the enlargement of the prostate gland. The enlarged prostate can obstruct the flow of urine through the urethra, leading to a weak stream and increased frequency of urination. Bladder infection, spinal cord lesion, ureteric calculi, and obstruction of the intramural urethra are less likely causes in this case.

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  • 13. 

    Prostate cancer:

    • A.

      Is characterized by a softening of the prostate that can be felt during a digital rectal exam.

    • B.

      Is best identified rectally when the patient has a full bladder.

    • C.

      Often metastasizes to the testes.

    • D.

      Is conclusively identified by a positive test of the external iliac lymph nodes.

    • E.

      Is associated with bladder cancer.

    Correct Answer
    B. Is best identified rectally when the patient has a full bladder.
    Explanation
    Prostate cancer is best identified rectally when the patient has a full bladder. This is because when the bladder is full, it pushes the prostate against the rectal wall, making it easier to feel any abnormalities or softening of the prostate during a digital rectal exam. This technique is commonly used by healthcare professionals to screen for prostate cancer and assess the condition of the prostate gland.

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  • 14. 

    Which of the following associations is incorrect?

    • A.

      Digital examination of the vagina—ovarian cysts

    • B.

      Urethrovaginal fistula—continuous dribbling of urine from the vagina

    • C.

      Digital examination of the vagina—pulsations of uterine artery

    • D.

      Culdocentesis—drainage of a pelvic abscess via posterior vaginal fornix

    • E.

      Rectovaginal fistula—discharge of fecal matter from the vagina

    Correct Answer
    B. Urethrovaginal fistula—continuous dribbling of urine from the vagina
    Explanation
    The incorrect association is between urethrovaginal fistula and continuous dribbling of urine from the vagina. Urethrovaginal fistula is an abnormal connection between the urethra and the vagina, which can result in urinary incontinence, but not specifically continuous dribbling of urine from the vagina. Continuous dribbling of urine from the vagina is more commonly associated with a vesicovaginal fistula, which is an abnormal connection between the bladder and the vagina.

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  • 15. 

    The vaginal fornix:

    • A.

      Surrounds the vaginal part of the cervix.

    • B.

      Contains the ovaries.

    • C.

      Is part of the broad ligament.

    • D.

      Is the inferior part of the rectouterine pouch.

    • E.

      Is the recess between the external urethral and vagina orifices.

    Correct Answer
    A. Surrounds the vaginal part of the cervix.
    Explanation
    The vaginal fornix refers to the recess or space surrounding the vaginal part of the cervix. It is a deep recess in the vagina that forms a ring around the cervix. This structure helps to provide support and protection to the cervix and is important in sexual intercourse and childbirth. The other options mentioned in the question are incorrect as they do not accurately describe the vaginal fornix.

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  • 16. 

    Which of the following structures is least important for supporting the uterus and/or  maintaining its position?

    • A.

      Broad ligament

    • B.

      Transverse cervical (cardinal) ligaments

    • C.

      Uterosacral ligament

    • D.

      Pelvic diaphragm

    • E.

      Round ligament of the uterus

    Correct Answer
    E. Round ligament of the uterus
    Explanation
    The round ligament of the uterus is the least important structure for supporting the uterus and maintaining its position. While the other structures listed, such as the broad ligament, transverse cervical (cardinal) ligaments, uterosacral ligament, and pelvic diaphragm, play important roles in providing support and maintaining the position of the uterus, the round ligament has a lesser role in comparison. The round ligament primarily helps to anchor the uterus to the anterior abdominal wall, but its function in supporting the uterus is not as significant as the other structures mentioned.

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  • 17. 

    Softening of the isthmus of the uterus (Hegar sign) is associated with:

    • A.

      Pregnancy

    • B.

      Uterine cancer.

    • C.

      A prolapsed uterus.

    • D.

      Menopause

    • E.

      Menstruation.

    Correct Answer
    A. Pregnancy
    Explanation
    The softening of the isthmus of the uterus, known as Hegar sign, is a characteristic finding in pregnancy. This softening occurs due to hormonal changes and increased blood flow to the uterus during pregnancy. It is a common physical sign used by healthcare providers to confirm the presence of pregnancy. Therefore, the correct answer is pregnancy.

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