Perineum quiz answers
1.
Each hypogastric nerve (that connects the superior and inferior hypogastric plexuses) crosses the
__________. At the point of crossing, the nerve and vessel(s) are separated by ___________.
A) internal iliac artery or its branches --- peritoneum
B) internal iliac artery or its branches --- extraperitoneal connective tissue
C) external iliac artery --- peritoneum
D) external iliac artery --- extraperitoneal connective tissue
Feedback: The hypogastric nerves form from the superior hypogastric plexus at approximately the sacral
promontory, after which the nerves descend into the pelvis. Therefore, the hypogastric nerves will cross
the internal iliac artery or its branches, since the external iliac artery never enters the pelvis. When the
nerves and vessels cross, they are separated by extraperitoneal connective tissue. In order to be
separated by peritoneum, either the nerves or vessels would have to be within the peritoneal cavity;
nothing but a small amount of fluid is in the peritoneal cavity. Answer = B
Correct Answer(s):
B
2.
An episiotomy is often performed during childbirth to enlarge the vaginal orifice. The ________ nerve is
responsible for the pain felt during the episiotomy. In order to anaesthetize this nerve, the obstetrician
uses the _________ as a landmark for injection of local anaesthetic.
A) genitofemoral --- ischial spine
B) genitofemoral --- pubic tubercle
C) pudendal --- ischial spine
D) pudendal --- pubic tubercle
Feedback: The central region of the perineum, including the lower part of the vagina and perineal body,
is innervated by the pudendal nerve; a spinal nerve formed by the ventral rami of S2, 3 and 4. The
genital branch of the genitofemoral nerve supplies the anterior portion of the labia majora. The
pudendal nerve enters the perineum from the gluteal region by passing laterally to the sacrospinous
ligament. Therefore, the ischial spine is used as a landmark for injection of local anesthetic. Answer = C
Correct Answer(s):
C
3.
A hysterectomy was performed because of a cancerous lesion on the wall of a patient's uterus. The
fundus, body and cervix of the uterus were removed, but the uterine tubes were transected at their
junction with the uterus and left in place with the ovaries. In order to perform this procedure, it was
necessary to cut the
A) suspensory ligament of the ovary and (round) ligament of the ovary.
B) (round) ligament of the ovary and transverse cervical (lateral, cardinal) ligament.
C) transverse cervical (lateral, cardinal) ligament and mesovarium.
D) mesovarium and suspensory ligament of the ovary.
Feedback: Any ligaments or mesenteries attached to the uterus would have to be cut during the surgical
procedure described. This would include the (round) ligament of the ovary and transverse cervical
(lateral, cardinal) ligament. The suspensory ligament of the ovary extends laterally from the ovary and
the mesovarium is a portion of the broad ligament connecting the ovary to the mesometrium (the
largest part of the broad ligament); neither of these attach to the uterus. Answer = B
Correct Answer(s):
B
4.
Following the removal of his prostate gland, a patient may be unable to have an erection. The reason is
that the part of the inferior hypogastric plexus that surrounds the prostate gland contains __________
axons that cause __________ of the penile branches of the internal pudendal artery.
A) parasympathetic --- constriction
B) parasympathetic --- dilation
C) sympathetic --- constriction
D) sympathetic --- dilation
Feedback: Dilation of the penile branches of the internal pudendal artery allows blood to flow into the
corpora cavernosa and corpus spongiosum of the penis thereby causing these erectile bodies to become
turgid resulting in an erection. This process occurs as a result of parasympathetic innervation; the
presynaptic neuronal cell bodies are located in the spinal cord from S2 to S4, the axons run in the pelvic
splanchnic nerves (also known as nervi erigentes or erogenous nerves) and travel through the part of
the inferior hypogastric plexus that surrounds the prostate gland. Answer = B
Correct Answer(s):
B
5.
Malignant cells from a tumor of the testis would first metastasize to __________ lymph nodes by
lymphogenous dissemination.
A) deep inguinal
B) internal iliac
C) lumbar (lateral aortic)
D) sacral
E) superficial inguinal
Feedback: Lymphatic vessels from the testes follow the testicular artery and vein to the posterior
abdominal wall, thereby reaching the lumbar (caval/lateral aortic) lymph nodes. Answer = C
Correct Answer(s):
6.
C
The __________ muscle contributes to the lateral wall of the ischioanal (ischiorectal) fossa.
A) piriformis
B) obturator internus
C) external anal sphincter
D) coccygeus
E) levator ani
Feedback: The ischioanal (ischiorectal) fossae are present in both the anal and urogenital triangles. In
both triangles, they are bounded by the obturator internus laterally and the levator ani medially. The
external anal sphincter and coccygeus are medial to the ischioanal (ischiorectal) fossa, while the
piriformis is not part of any boundary of the fossa. Answer = B
Correct Answer(s):
B
7.
The parietal pelvic fascia that lines the floor and walls of the pelvic cavity is continuous with the
__________ of the abdomen.
A) transversalis fascia
B) Colles' fascia
C) Scarpa's fascia
D) peritoneum
E) Camper's fascia
Feedback: The parietal pelvic fascia is a membranous layer that lines the inner (deep, pelvic) aspect of
the muscles forming the walls and floor of the pelvis. It covers the pelvic surfaces of muscles such as the
obturator internus, piriformis, coccygeus, levator ani, and part of the urethral sphincter muscles. It is
continuous superiorly with the transversalis fascia of the abdomen. Colles’ fascia is the deep
membranous layer of fascia in the perineum that is attached to the fascia lata and is continuous with the
dartos fascia of the penis and scrotum as well as Scarpa’s fascia of the anterior abdominal wall.
Camper’s fascia is the fatty layer of subcutaneous tissue of the abdomen; this is continuous with the
superficial perineal fascia. The peritoneum is not continuous with the parietal pelvic fascia; it is
surrounded by transversalis fascia. Answer = A
Correct Answer(s):
A
8.
The __________ is in the superficial perineal pouch (compartment).
A) ischiocavernosus muscle
B) external urethral sphincter
C) coccygeus muscle
D) puborectalis muscle
Feedback: The superficial perineal pouch (space) of the urogenital triangle is a potential space between
the membranous layer of subcutaneous tissue (Colles’ fascia) and the perineal membrane. In males this
pouch contains the bulb and crura of the penis and associated muscles (ischiocavernosus,
bulbospongiosus), the proximal part of the spongy urethra, the superficial transverse perineal muscles
and the deep perineal branches of the internal pudendal vessels and pudendal nerves. In females it
contains the clitoris and crura and its associated muscle (ischiocavernosus), the bulbs of the vestibule
and surrounding muscle (bulbospongiosus), the greater vestibular glands, the superficial transverse
perineal muscles and the deep perineal branches of the internal pudendal vessels and pudendal nerves.
Answer = A
Correct Answer(s):
A
9.
The __________ of the uterus is superior to the openings of the uterine tubes.
A) cervix
B) isthmus
C) fundus
D) broad ligament
Feedback: The fundus of the uterus is the rounded part of the body of the uterus that lies superior to
the openings of the uterine tubes. The isthmus is the narrow portion of the uterus superior to the cervix.
The broad ligament of the uterus is a double layer of peritoneum that extends from the uterus to the
floor of the pelvis; its two layers are continuous as they surround the uterine tube. Answer = C
Correct Answer(s):
C
10.
The seminal glands (vesicles) lie directly ________ to the __________.
A) posterior --- base of the bladder (trigone)
B) superior --- apex of the bladder
C) inferior --- prostate gland
D) anterior --- anal canal
Feedback: The seminal glands (vesicles) lie between the base of the urinary bladder and the rectum.
Therefore, the seminal glands are posterior to the base of the bladder and anterior to the rectum; the
seminal glands are superior to the anal canal. The base of the bladder is equivalent to the trigone
formed by the ureteric and internal urethral orifices, and is located on the posterior and inferior walls of
the bladder. The apex of the bladder is its superior limit at the pubic symphysis when the bladder is
empty; the seminal glands are posterior and inferior to the apex of the bladder. The prostate gland is
inferior to the neck of the bladder (the site of the internal urethral orifice); the seminal glands are
superior to the prostate gland. Answer = A
Correct Answer(s):
11.
A
The ___________ can be used to mark the junction of the rectum and anal canal.
A) inferior end of the sigmoid mesentery
B) puborectalis
C) lower transverse rectal fold
D) anal valves
Feedback: The anorectal junction occurs as the gut perforates the levator ani. The most medial portion
of the levator ani is a thick, narrow muscle known as the puborectalis that makes a U shaped sling right
at the anorectal junction. The sigmoid mesentery ends at the junction of the sigmoid colon and the
rectum. The lower transverse rectal fold is one of three internal infoldings of the rectum; they are within
the rectum and superior to the anal canal. The anal valves are the inferior ends of the anal columns and
form what is known as the pectinate line. This marks the border between the superior portion of the
anal canal (visceral; derived from embryonic hindgut) and the inferior portion of the anal canal (somatic;
derived from the embryonic proctodeum). Answer = B
Correct Answer(s):
B
12.
__________ axons cause contraction of a muscle that elevates the testis and __________ axons cause
contraction of a muscle that decreases the surface area of the skin of the scrotum.
A) Somatic --- somatic
B) Somatic --- sympathetic
C) Sympathetic --- somatic
D) Sympathetic --- sympathetic
Feedback: The cremaster muscle elevates the testis, while the dartos muscle assists by decreasing the
surface area of the skin of the scrotum. The cremaster is a skeletal muscle innervated by general somatic
efferent (GSE) neurons, while the dartos is subcutaneous smooth muscle in the scrotum innervated by
postsynaptic sympathetic axons of the autonomic nervous system. Answer = B
Correct Answer(s):
B
13.
When performing a normal intravenous urogram (IVU), in which sterile, water-soluble, iodine-containing
contrast is administered via a peripheral vein, the part of the urinary collecting system that will be
visualized before any other is
A) the bladder.
B) the major calyx.
C) the renal artery.
D) the minor calyx.
Feedback: The contrast will pass through the venous system and the heart before reaching the kidney.
Although contrast reaches the renal artery first, it is too dilute to be visualized. It will be visible in the
urine since it will have been concentrated in the kidney. Therefore, it will be seen first in the minor
calyces as the urine is released from the collecting tubules. The contrast would next be seen in the major
calyces, renal pelvis, ureter and then bladder and urethra. Answer = D
Correct Answer(s):
D
14.
Imagine that you are a scuba diver within the uterine lumen. If you exit through the uterine tubes you
would be able to reach the _________ without breaking any barriers (assume normal anatomy).
A) bare area of the liver
B) inguinal canal
C) retropubic space
D) superior recess of omental bursa (lesser sac)
E) deep perineal pouch (space)
Feedback: If you exit the uterine tubes, you will be scuba diving within the peritoneal cavity. Therefore
you will have access to the omental bursa (lesser sac) via the omental (epiploic) foramen and can reach
its upper recess. The coronary ligaments would prevent you from reaching the bare area of the liver; the
bare area is devoid of peritoneum. The inguinal canal is not accessible from the peritoneal cavity since it
is formed from an evagination of the transversalis fascia. You would be able to swim into a patent
processus vaginalis, if present. Both the retropubic space and deep perineal pouch (space) are
extraperitoneal. Answer = D
Correct Answer(s):
D
15.
The median umbilical ligament (remnant of the urachus) is continuous with the ________ of the
bladder.
A) apex
B) body
C) fundus
D) neck
Feedback: The median umbilical ligament is the remnant of the fibrous cord, the urachus, which was
originally the allantois. In the embryo, the allantois is a diverticulum from the yolk sac that projects into
the connecting stalk. As folding occurs, this part of the yolk sac (along with the allantois) becomes
incorporated into the embryo as the hindgut while the connecting stalk becomes incorporated into the
umbilical cord. Once the hindgut subdivides into the urogenital sinus and rectum, the allantois extends
from the umbilical cord to the superior part of the urogenital sinus that becomes the bladder. In the
adult, the remnant of the allantois is the median umbilical ligament and this ligament extends from the
umbilicus to the superior part of the bladder, the apex. The body of the bladder is the portion between
the apex and the fundus. The fundus of the bladder is opposite the apex and includes the base of the
bladder (trigone) on the posterior wall. The neck of the bladder is the site of the internal urethral orifice
on its inferior surface. Answer = A
Correct Answer(s):
A
16.
Most of the course of the middle rectal arteries is on the _________ surface of the levator ani muscle
and are usually branches of the _________ artery (or one of its branches).
A) superior (deep) --- inferior mesenteric
B) superior (deep) ---internal iliac
C) inferior (superficial) --- inferior mesenteric
D) inferior (superficial) --- internal iliac
Feedback: The middle rectal artery is part of the systemic circulation and is usually a branch of the
internal iliac artery. The inferior mesenteric artery is part of the portal system and gives rise to the
superior rectal artery. Since the internal iliac artery is in the pelvis, the middle rectal artery is superior
(deep) to the levator ani. This is in contrast to the inferior rectal artery, a branch of the internal
pudendal artery, which runs through the ischioanal fossa inferior (superficial) to the levator ani. Answer
=B
Correct Answer(s):
B
17.
The _________ has an attachment to the ischial spine.
A) coccygeus
B) obturator internus
C) piriformis
D) puborectalis
Feedback: Of the muscles listed, only the coccygeus had an attachment to the ischial spine. The
coccygeus is deep to the sacrospinous ligament and also runs from the sacrum to the ischial spine. The
obturator internus is attached to the ilium, ischium and obturator membrane, and the greater
trochanter of the femur; as it passes through the lesser sciatic foramen the obturator internus passes in
close proximity to the ischial spine. The piriformis is attached to the sacrum, sacrotuberous ligament and
the greater trochanter of the femur. The puborectalis part of the levator ani is attached to the pubic
bone and makes a U-shaped sling posterior to the anorectal junction. Answer = A
Correct Answer(s):
A
18.
The pectinate line can be seen on proctoscopic examination at the _____________ limit of the anal
columns. Internal hemorrhoids originate above this line and are relatively __________.
A) superior --- painful
B) superior --- painless
C) inferior --- painful
D) inferior --- painless
Feedback: The pectinate line is formed by the anal valves that are at the inferior ends of the anal
columns. The pectinate line marks the border between the superior portion of the anal canal (visceral;
derived from embryonic hindgut) and the inferior portion of the anal canal (somatic; derived from the
embryonic proctodeum). Hemorrhoids that originate superior to the pectinate line will be relatively
painless because the general afferent neurons return with the parasympathetic pelvic splanchnic nerves
to the dorsal root ganglia from S2 to S4. This pain will be diffuse and poorly localized. In contrast,
hemorrhoids that originate inferior to the pectinate line will be relatively painful because this portion of
the anal canal is innervated by branches of spinal nerves resulting in a sharp and well-localized pain.
Answer = D
Correct Answer(s):
D
19.
Among the muscles that attach to the perineal body in the male are the
A) ischiocavernosus, dartos and bulbospongiosus.
B) dartos, bulbospongiosus and levator ani.
C) bulbospongiosus, levator ani and external anal sphincter.
D) levator ani, external anal sphincter and ischiocavernosus.
Feedback: Of the muscles listed, only the bulbospongiosus, levator ani and external anal sphincter
attach to the perineal body. The ischiocavernosus is attached to the ischiopubic ramus, ischial tuberosity
and perineal membrane, while dartos muscle is subcutaneous smooth muscle in the skin of the scrotum.
Answer = C
Correct Answer(s):
C
20.
The principal artery to the perineum is the _________ artery.
A) superior gluteal
B) lateral sacral
C) internal pudendal
D) iliolumbar
Feedback: The internal pudendal artery and its branches are the primary blood supply of the perineum.
The superior gluteal artery supplies part of the gluteal region, the lateral sacral artery supplies structures
on the anterior part of the sacrum, and the iliolumbar artery supplies structures in the iliac fossa.
Answer = C
Correct Answer(s):
C
21.
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 --- lesser sciatic
B) pudendal --- greater sciatic
C) pudendal --- obturator
D) obturator --- lesser sciatic
E) obturator --- greater sciatic
F) obturator --- obturator
Feedback: The pudendal canal is a space within the obturator internus fascia lining the lateral wall of the
ischioanal fossa. The neurovascular bundle within the canal reaches the perineum by passing through
the lesser sciatic foramen, while it travels from the pelvis to the gluteal region via the greater sciatic
foramen. The obturator canal is an opening in the obturator membrane through which the obturator
nerve and vessels pass from the pelvis to the medial thigh. Answer = A
Correct Answer(s):
A
22.
The detrusor muscle of the bladder contracts in response to parasympathetic innervation, resulting in
_________ of the bladder. These presynaptic (preganglionic) parasympathetic cell bodies are located in
the __________.
A) emptying --- vagal nucleus in the brainstem
B) emptying --- lumbar spinal cord
C) emptying --- sacral spinal cord
D) filling --- vagal nucleus in the brainstem
E) filling --- lumbar spinal cord
F) filling --- sacral spinal cord
Feedback: The walls of the bladder body are composed of detrusor smooth muscle. This muscle
contracts during emptying of the bladder in response to parasympathetic stimulation and relaxes during
filling of the bladder as a result of sympathetic stimulation. The bladder receives parasympathetic
innervation from the pelvic splanchnic nerves and the presynaptic parasympathetic neuronal cell bodies
of axons in the pelvic splanchnic nerves are located in the sacral spinal cord from S2 to S4. The vagus
nerve (X) does not provide parasympathetic innervation to any pelvic viscera. The upper lumbar spinal
cord contains presynaptic sympathetic neuronal cell bodies. Answer = C
Correct Answer(s):
C
23.
The ejaculatory duct enters the part of the urethra that is __________ the external urethral sphincter in
the deep perineal pouch (space). It carries fluids from the testis and the __________.
A) superior (deep) to --- seminal glands (vesicles)
B) superior (deep) to --- bulbourethral glands
C) within --- seminal glands (vesicles)
D) within --- bulbourethral glands
E) inferior (superficial) to --- seminal glands (vesicles)
F) inferior (superficial) to --- bulbourethral glands
Feedback: The ejaculatory ducts enter the prostatic urethra. Since the prostate gland is located between
the internal and external urethral sphincters, the ejaculatory ducts enter the urethra superior (deep) to
the external urethral sphincter in the deep perineal pouch (space). The ejaculatory ducts form by union
of the ductus (vas) deferens and ducts of the seminal glands (vesicles), combining the fluids from the
testis and seminal glands. Although the bulbourethral glands are located in the deep perineal pouch
(space), the ducts of the bulbourethral glands pass through the perineal membrane and empty into the
spongy urethra. Answer = A
Correct Answer(s):
A
24.
Lymphatics along the _________ accompany the ________ vessels and lead to _________ nodes.
A) round ligament of the uterus --- ovarian --- superficial inguinal
B) round ligament of the uterus --- ovarian --- lumbar (lateral aortic)
C) round ligament of the uterus --- uterine --- superficial inguinal
D) round ligament of the uterus --- uterine --- lumbar (lateral aortic)
E) suspensory ligament of the ovary --- ovarian --- superficial inguinal
F) suspensory ligament of the ovary --- ovarian --- lumbar (lateral aortic)
G) suspensory ligament of the ovary --- uterine --- superficial inguinal
H) suspensory ligament of the ovary --- uterine --- lumbar (lateral aortic)
Feedback: Lymphatic drainage from the uterus can go to a variety of lymph nodes including the lumbar
(caval/aortic), superficial inguinal, external & internal iliac, and sacral lymph nodes. The route varies
depending upon the part of the uterus involved. Lymphatic vessels accompany both the vessels
accompanying the suspensory ligament of the ovary and the round ligament of the uterus, however
while the ovarian artery runs through the suspensory ligament of the ovary, unnamed vessels
accompany the round ligament of the uterus. The uterine artery runs through the transverse cervical
(cardinal) ligament. The lymphatic vessels accompanying the ovarian artery go to the lumbar
(caval/aortic) lymph nodes. Those accompanying the round ligament of the uterus go to the superficial
inguinal nodes, while those accompanying the uterine artery go to the internal iliac nodes. Answer = F
Correct Answer(s):
F
25.
In the developing fetus, the _________ pass(es) through the opening in the transversalis fascia that
becomes the deep inguinal ring.
A) ovarian artery and vein
B) ilioinguinal nerve
C) processus vaginalis
D) scrotal lymph vessels
Feedback: The processus vaginalis and testis push through the transversalis fascia to create the deep
inguinal ring and the sac of internal spermatic fascia that covers the spermatic cord. The ovarian vessels,
scrotal lymphatics and vessels, and the ilioinguinal nerve do not pass through the deep inguinal ring. The
ovarian and scrotal vessels never enter the inguinal canal. The ilioinguinal nerve enters the inguinal
canal distal to the deep inguinal ring. Answer = C
Correct Answer(s):
C
26.
A strangulated indirect inguinal hernia lies in the inguinal canal. A surgeon will gain access to the lateral
one third of the canal using an anterior approach to reduce the hernia and prevent its reoccurrence. The
_________ is most endangered in this procedure because of its location in the anterior wall of the
lateral one third of the inguinal canal.
A) genital branch of the genitofemoral nerve
B) inferior epigastric vessels
C) ductus (vas) deferens
D) ilioinguinal nerve
E) aberrant obturator artery
Feedback: The lateral one third of the anterior wall of the inguinal canal is formed by the internal
oblique and the aponeurosis of the external oblique muscle. The ilioinguinal nerve passes into the
inguinal canal between these two layers and is therefore endangered during the surgical procedure
described. The genital branch of the genitofemoral nerve and the ductus (vas) deferens are within the
spermatic cord. The inferior epigastric vessels and the aberrant obturator artery are not part of the walls
of the inguinal canal. Answer = D
Correct Answer(s):
D
27.
The surgeon must also be careful not to damage the __________ at the point at which it enters the
inguinal canal through the deep inguinal ring.
A) testicular vessels
B) femoral branch of the genitofemoral nerve
C) deep circumflex iliac vein
D) ilioinguinal nerve
Feedback: The testicular vessels go through the direct inguinal ring. The ilioinguinal nerve enters the
inguinal canal distal to the deep inguinal ring. The femoral branch of the genitofemoral nerve and deep
circumflex iliac vein are not within the inguinal region. Answer = A
Correct Answer(s):
A
28.
________ hernia enters the inguinal canal by penetrating the posterior wall of the inguinal
(Hesselbach's) triangle ______ to the inguinal ligament.
A) A direct inguinal --- superior
B) A direct inguinal --- inferior
C) An indirect inguinal --- superior
D) An indirect inguinal --- inferior
E) A femoral --- superior
F) A femoral --- inferior
Feedback: Direct inguinal hernias occur through the posterior wall of the inguinal triangle that is
bounded by the inguinal ligament (iliopubic tract internally), the lateral border of the rectus abdominis
and the lateral umbilical fold (or ligament) overlying the inferior epigastric vessels. Indirect inguinal
hernias occur lateral to the inguinal triangle and pass through a persistent processus vaginalis. Both
direct and indirect inguinal hernias occur superior to the inguinal ligament. Femoral hernias usually
occur through the femoral ring into the femoral canal, inferior to the inguinal ligament. Answer = A
Correct Answer(s):
A
29.
During laparoscopic repair of a hernia, the inferior border of a piece of synthetic fabric could be stapled
to the
A) lateral umbilical ligament.
B) arcuate line.
C) iliopubic tract.
D) cremasteric fascia.
Feedback: The iliopubic tract is the inferior border of the inguinal triangle on the posterior surface of the
anterior abdominal wall. It is tough and fibrous and can be used to staple the fabric. The lateral umbilical
fold (or ligament) overlies the inferior epigastric vessels and stapling would endanger these vessels. The
arcuate line is a bony landmark forming part of the pelvic brim and is unsuitable for stapling. Stapling
the cremasteric fascia would endanger structures within the spermatic cord. Answer = C
Correct Answer(s):
C
30.
The flow of urine in a ureter is likely to be obstructed by a kidney stone at a point of normal constriction
or narrowing, such as where the ureter _____________________. Afferent axons conveying the pain
associated with such an obstruction and the resulting distension are carried back to the spinal cord by
way of the _______________.
A) passes over the sacral spinal nerves --- thoracoabdominal (intercostoabdominal) nerves of T7- T10
levels
B) passes over the sacral spinal nerves --- splanchnic postsynaptic (postganglionic) sympathetic axons at
T11-L2 levels
C) joins the renal pelvis --- thoracoabdominal (intercostoabdominal) nerves of T7-T10 levels
D) joins the renal pelvis --- splanchnic postsynaptic (postganglionic) sympathetic axons at T11-L2 levels
Feedback: There are three parts of the ureter that are somewhat constricted; the junction of the renal
pelvis and ureter, where the ureter crosses the pelvic brim and external iliac artery, and within the wall
of the bladder. Pain from the superior part of the ureter, such as the junction with the renal pelvis, is
relayed by GA axons accompanying the sympathetic splanchnic branches supplying this region (lower
thoracic and upper lumbar) and would refer to dermatomes T11 to L2. Pain from the inferior part of the
ureter would be more likely to refer to the upper lumbar (L1 & 2) dermatomes by traveling with
sympathetic lumbar splanchnic nerves or sacral (S2, 3 & 4) dermatomes by traveling with the
parasympathetic pelvic splanchnic nerves. Answer = D
Correct Answer(s):
D
31.
The lateral wall of the greater (false) pelvis is lined by the _________ muscle whereas the lateral wall of
the lesser (true) pelvis is lined with the __________ muscle.
A) transverse abdominal (transversus abdominis) --- piriformis
B) transverse abdominal (transversus abdominis) --- transverse abdominal (transversus abdominis)
C) transverse abdominal (transversus abdominis) --- obturator internus
D) iliacus --- piriformis
E) iliacus --- transverse abdominal (transversus abdominis)
F) iliacus --- obturator internus
Feedback: The pelvis is the space within the pelvic girdle; the greater (false) pelvis and lesser (true)
pelvis are divided by the pelvic inlet (brim; superior aperture). The greater pelvis is bounded by the ala
of the ilium posterolaterally and the anterosuperior aspect of the S1 vertebra posteriorly, while the
lesser (true) pelvis is between the pelvic inlet and outlet, and is bounded by the pelvic surfaces of the
hip bones, sacrum and coccyx. The iliacus muscle lines the lateral wall of the greater pelvis and the
obturator internus lines the lateral wall of the lesser pelvis. The transverse abdominal (transversus
abdominis) muscle has an attachment to the iliac crest, but does not extend into the greater pelvis. The
piriformis lines the posterolateral wall of the lesser pelvis. Answer = F
Correct Answer(s):
F
32.
If the inferior ramus of the pubis is resected (removed) due to bone cancer, the ________ will be
affected.
A) greater sciatic foramen
B) lesser sciatic foramen
C) obturator foramen
D) pelvic inlet (brim, superior aperture)
E) 1st ventral sacral foramen
Feedback: The inferior ramus of the pubis extends from the body of the pubis superiorly to the ischial
ramus inferiorly. The inferior ramus of the pubis is part of the bony border of the obturator foramen and
contributes to the pubic arch; therefore, the obturator foramen would be affected by resection of the
inferior ramus of the pubis. The greater and lesser sciatic notches, which are the bony contributions to
the greater and lesser sciatic foramina, are part of the ischium as well as the ilium in the case of the
lesser sciatic notch. The pelvic inlet (brim, superior aperture) is made up of the tubercle, crest,
symphysis and pectineal line of the pubis, and the arcuate line of the ilium and sacral promontory. The
first ventral sacral foramen is entirely within the sacrum. Answer = C
Correct Answer(s):
C
33.
The _______________ are either boundaries or contents of the deep perineal pouch (space).
A) levator ani and sacrotuberous ligament
B) sacrotuberous ligament and perineal membrane
C) perineal membrane and bulb of the vestibule
D) bulb of the vestibule and external urethral sphincter muscle
E) external urethral sphincter muscle and levator ani
Feedback: The deep perineal pouch (space) of the urogenital triangle contains the external urethral
sphincter, part of the urethra, the deep transverse perineal muscle, the anterior recess of the ischioanal
fossa and the bulbourethral glands in the male. The borders of the deep perineal pouch include the
levator ani, obturator internus and the perineal membrane. The sacrotuberous ligament is a boundary
of the anal triangle. The bulb of the vestibule is within the superficial perineal pouch (space) of the
female. Answer = F
Correct Answer(s):
E
34.
Exudate in the superficial perineal pouch (space) can enter the ____________ without crossing a
membranous barrier.
A) space between Camper’s and Scarpa’s fascia
B) space between the superficial and deep (Buck’s) fascia of the penis
C) ischioanal fossa
D) space between the superficial fascia of the thigh and the fascia lata
Feedback: The superficial perineal pouch (space) of the urogenital triangle is a potential space between
the membranous layer of subcutaneous tissue (Colles’ fascia) and the perineal membrane. The perineal
membrane is continuous with the deep fascia of the penis (Buck’s fascia) and Colles’ fascia is continuous
with Dartos fascia of the penis. Therefore exudate within the superficial perineal pouch could enter the
space between the superficial (Dartos) and deep (Buck’s) fascia of the penis. Camper’s fascia is
continuous with the fatty tissue between Colles’ fascia and the skin. Scarpa’s fascia is continuous with
Colles’ fascia. The anterior recess of the ischioanal fossa is part of the deep perineal pouch. The perineal
membrane is continuous with the fascia lata of the thigh. Answer = B
Correct Answer(s):
B
35.
A tumor confined to the true (lesser) pelvis can impinge on the
A) obturator nerve and lumbosacral trunk.
B) lumbosacral trunk and femoral nerve.
C) femoral and lateral femoral cutaneous nerves.
D) lateral femoral cutaneous and genitofemoral nerves.
E) genitofemoral and obturator nerves.
Feedback: Both the obturator nerve and lumbosacral trunk enter the lesser (true) pelvis. The femoral,
lateral femoral cutaneous and genitofemoral nerves travel through the greater (false) pelvis only.
Answer = A
Correct Answer(s):
A
36.
To anesthetize the anterior part of the scrotum, spinal anesthetic is injected at vertebral level(s) ______
in order to affect the _______ nerve.
A) S2 to S4 --- pudendal
B) S2 to S4 --- ilioinguinal
C) L1 to L2 --- pudendal
D) L1 to L2 --- ilioinguinal
Feedback: The anterior surface of the scrotum is innervated by the anterior scrotal branches of the
ilioinguinal nerve (L1), as well as by the genital branch of the genitofemoral nerve (L1&2). The posterior
scrotal branches of the pudendal nerve innervate the posterior surface of the scrotum. Answer = D
Correct Answer(s):
D
37.
Because the perineal body is susceptible to tearing during childbirth, it may be cut intentionally
(episiotomy) where it lies between the
A) external urethral orifice and ischial tuberosity.
B) ischial tuberosity and coccyx.
C) coccyx and anus.
D) anus and vestibule of vagina.
E) vestibule of vagina and external urethral orifice.
Feedback: The perineal body is the site where the urorectal septum fused with the cloacal membrane to
subdivide the urogenital and GI regions from one another. Therefore the perineal body is located
between the urogenital and anal triangles, and is midway between the ischial tuberosities between the
anus and the vestibule of the vagina. The other answers are pairs of structures entirely within either the
urogenital or anal triangles. Answer = D
Correct Answer(s):
D
38.
The _________ in the male penis is unpaired.
A) deep artery
B) dorsal artery
C) deep dorsal vein
D) corpora cavernosa
E) dorsal nerve
Feedback: The deep dorsal vein of the penis is unpaired; the superficial dorsal vein may be paired or
unpaired. The deep artery, dorsal artery, dorsal nerve and corpora cavernosa of the penis are all paired.
Answer = C
Correct Answer(s):
C
39.
The intermediate (membranous) part of the urethra passes through the
A) perineal body.
B) external urethral sphincter.
C) prostate gland.
D) bulb of the penis.
Feedback: The intermediate (membranous) part of the urethra is between the prostatic and spongy
parts. The intermediate part begins at the apex of the prostate gland, goes through the deep perineal
pouch (space) surrounded by the external urethral sphincter, and ends as the urethra pierces the
perineal membrane and enters the bulb of the penis. Answer = B
Correct Answer(s):
B
40.
The __________ is in direct contact with peritoneum.
A) fundus of the uterus
B) base (fundus, trigone) of the bladder
C) anal canal
D) cervix
Feedback: Of the structures listed, only the fundus of the uterus is covered with peritoneum. The base
of the bladder, anal canal and cervix are subperitoneal. Answer = A
Correct Answer(s):
41.
A
The __________ artery provides blood to the prostate gland.
A) inferior gluteal
B) inferior vesical
C) obturator
D) umbilical
Feedback: The prostate gland is supplied with blood by the inferior vesical, internal pudendal and
middle rectal branches of the internal iliac artery. The inferior gluteal, obturator and umbilical arteries
are superior to the prostate gland and too far removed to supply it. Answer = B
Correct Answer(s):
B
42.
The ductus (vas) deferens crosses the ureter just ________ to the entry of the ureter into the bladder
wall. At this point the ductus deferens expands to form an ampulla that is ________ to the seminal
vesicle.
A) inferior --- medial
B) inferior --- lateral
C) superior --- medial
D) superior --- lateral
Feedback: The ductus (vas) deferens crosses the ureter just superior to the entry of the ureter into the
bladder wall. At this point the ductus deferens expands to form an ampulla that is medial to the seminal
vesicle. Answer = C
Correct Answer(s):
43.
C
The relationship of the testis to the head of epididymis is comparable to the relationship of the ovary to
the
A) infundibulum of uterine (fallopian) tube.
B) cervix.
C) isthmus of uterine (fallopian) tube.
D) posterior fornix.
Feedback: The duct within the head of the epididymis is in direct continuity with the testis. Similarly, the
infundibulum of the uterine tube is closest to the ovary. The isthmus of the uterine tube is the thickwalled part before it enters the uterus. The cervix and posterior fornix are too far removed from the
ovary. Answer = A
Correct Answer(s):
A
44.
This is a CT study of the female pelvis. Prior to the study the patient received both oral contrast to
opacify the GI tract and intravenous contrast to opacify the urinary tract. Her bladder is not distended
because a (Foley) catheter was draining the urine via the urethra. The asterisk is placed over the
A) rectum.
B) sigmoid colon.
C) urinary bladder.
D) uterus.
Feedback: In this CT, the radio-opaque structures that received contrast are the sigmoid colon or loops
of small intestine and the ureters. The most posterior medium density structure is the rectum and the
structure with the asterisk is the uterus. The bladder is not visualized since it is empty and close to the
anterior body wall. Answer = D
Correct Answer(s):
D