Pelvis and Perineum Quiz 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 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 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. 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 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 6. 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 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 8. The __________ is in the superficial perineal pouch (compartment). A) ischiocavernosus muscle B) external urethral sphincter C) coccygeus muscle D) puborectalis muscle 9. The __________ of the uterus is superior to the openings of the uterine tubes. A) cervix B) isthmus C) fundus D) broad ligament 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 11. 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 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 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. 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) 15. The median umbilical ligament (remnant of the urachus) is continuous with the ________ of the bladder. A) apex B) body C) fundus D) neck 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 17. The _________ has an attachment to the ischial spine. A) coccygeus B) obturator internus C) piriformis D) puborectalis 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 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. 20. The principal artery to the perineum is the _________ artery. A) superior gluteal B) lateral sacral C) internal pudendal D) iliolumbar 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 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 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 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) 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 Questions 26 and 27 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 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 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 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. 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 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 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 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 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 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. 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 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. 38. The _________ in the male penis is unpaired. A) deep artery B) dorsal artery C) deep dorsal vein D) corpora cavernosa E) dorsal nerve 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. 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 41. The __________ artery provides blood to the prostate gland. A) inferior gluteal B) inferior vesical C) obturator D) umbilical 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 43. 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. 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.