Block 7 Anatomy Perineum Pelvis BRS W Exp Prt 2
- 1.
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 antevertedExplanation
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).Rate this question:
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- 2.
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 above 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 plexusExplanation
http://upload.wikimedia.org/wikipedia/commons/7/7b/Gray588.pngThe 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.Rate this question:
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- 3.
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 nerveExplanation
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.Rate this question:
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- 4.
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. OvaryExplanation
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.Rate this question:
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- 5.
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 nerveExplanation
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.Rate this question:
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- 6.
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 penisExplanation
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.Rate this question:
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- 7.
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 aniExplanation
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.Rate this question:
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- 8.
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. ScrotumExplanation
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.Rate this question:
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- 9.
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 cervixExplanation
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.Rate this question:
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- 10.
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 tubeExplanation
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 wallRate this question:
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- 11.
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 glandExplanation
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.Rate this question:
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- 12.
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 nerveExplanation
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.Rate this question:
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- 13.
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 sacrumExplanation
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.Rate this question:
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- 14.
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 nerveExplanation
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.Rate this question:
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- 15.
A general surgeon is giving a lecture to a team of surgery residents. She describes characteristics of structures above the pectinate line of the anal canal, which include
- A.
Stratified squamous epithelium
- B.
Venous drainage into the caval system
- C.
Lymphatic drainage into the superficial inguinal nodes
- D.
Visceral sensory innervation
- E.
External hemorrhoids
Correct Answer
D. Visceral sensory innervationExplanation
The pectinate line is a point of demarcation between visceral and somatic
portions of the anal canal. Characteristics above the pectinate line include columnar epithelium,
venous drainage into the portal system, lymphatic drainage into the internal iliac nodes, visceral
sensory innervation, and internal hemorrhoids.Rate this question:
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- 16.
An elderly man with prostatitis is seen at an internal medicine clinic. The seminal colliculus of his prostate gland is infected, and its fine openings are closed. Which of the following structures is most likely to be disturbed?
- A.
Ducts of the prostate gland
- B.
Prostatic utricle
- C.
Ducts of the bulbourethral glands
- D.
Ejaculatory ducts
- E.
Duct of the seminal vesicles
Correct Answer
D. Ejaculatory ductsExplanation
The ejaculatory ducts, which open onto the seminal colliculus, may be
injured. The prostate ducts open into the urethral sinus, the bulbourethral ducts open into the
bulbous part of the penile urethra, and the ducts of the seminal vesicle join the ampulla of the
ductus deferens to form the ejaculatory duct. The prostatic utricle is a minute pouch on the summit
of the seminal colliculus.Rate this question:
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- 17.
A trauma surgeon in the emergency room at a local center examines a 14-year-old boy with extensive pelvic injuries after a hit and run accident. The surgeon inspects the ischiorectal fossa because it:
- A.
Accumulates urine leaking from rupture of the bulb of the penis
- B.
Contains the inferior rectal vessels
- C.
Has a pudendal canal along its medial wall
- D.
Is bounded anteriorly by the sacrotuberous ligament
- E.
Contains a perineal branch of the fifth lumbar nerve
Correct Answer
B. Contains the inferior rectal vesselsExplanation
The ischiorectal fossa is bounded posteriorly by the gluteus maximus and
the sacrotuberous ligament. It contains fat, the inferior rectal nerve and vessels, and perineal
branches of the posterior femoral cutaneous nerve. The pudendal canal runs along its lateral wall.
Urine leaking from a ruptured bulb of the penis does not spread into the ischiorectal fossa because
Scarpa's fascia ends by firm attachment to the fascia lata of the thigh.Rate this question:
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- 18.
A 26-year-old man comes to a hospital with fever, nausea, pain, and itching in the perineal region. On examination by an urologist, he is diagnosed as having infected bulbourethral (Cowper's) glands. Which of the following structures is affected by this infection?
- A.
Superficial perineal space.
- B.
Sphincter urethrae.
- C.
Production of sperm.
- D.
Testis
- E.
Seminal vesicles
Correct Answer
B. SpHincter urethrae.Explanation
The bulbourethral glands lie on either side of the membranous urethra, embedded
in the sphincter urethrae. Their ducts open into the bulbous part of the penile urethra.
Semen—a thick, yellowish white, viscous, spermatozoa-containing fluid—is a mixture of the secretions
of the testes, seminal vesicles, prostate, and bulbourethral glands. Sperm, or spermatozoa,
are produced in the seminiferous tubules of the testis and matured in the head of the epididymis.
The seminal vesicles are lobulated glandular structures, produce the alkaline constituent
of the seminal fluid that contains fructose and choline, and lie inferior and lateral to the ampullae
of the ductus deferens against the fundus (base) of the bladder.Rate this question:
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- 19.
A 21-year-old man is involved in a highspeed motor vehicle accident. As a result, he has extensive damage to his sphincter urethrae. Which of the following statements best explains the injured sphincter urethrae?
- A.
Smooth muscle
- B.
Innervated by the perineal nerve
- C.
Lying between the perinea] membrane and CoIles' fascia
- D.
Enclosed in the pelvic fascia
- E.
Part of the pelvic diaphragm
Correct Answer
B. Innervated by the perineal nerveExplanation
The sphincter urethrae is striated muscle that lies in the deep perineal space
and forms a part of the urogenital diaphragm but not the pelvic diaphragm. It is not enclosed in
the pelvic fascia. It is innervated by a deep (muscular) branch of the perineal nerve.Rate this question:
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- 20.
An obstetrician is about to perform a pudendal block so a woman can experience less pain when she delivers her child. He recalls what he learned in medical school about this nerve:
- A.
It passes superficial to the sacrotuberous ligament
- B.
It innervates the testis and epididymis in a male
- C.
It provides motor fibers to the coccygeus
- D.
It can be blocked by injecting an anesthetic near the inferior margin of the ischial spine
- E.
It arises from the lumbar plexus
Correct Answer
D. It can be blocked by injecting an anesthetic near the inferior margin of the ischial spineExplanation
The pudendal nerve, which arises from the sacral plexus, provides sensory
innervation to the labium majus (or scrotum in a male). It leaves the pelvis through the greater
sciatic foramen and enters the perineum through the lesser sciatic foramen near the inferior margin
of the ischial spine. Therefore, it can be blocked by injection of an anesthetic near the inferior
margin of the ischial spine.Rate this question:
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Mar 20, 2023Quiz Edited by
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Mar 19, 2012Quiz Created by
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