Extra: Pelvis and Perineum Flashcards
- Regarding the pelvis:
A. The sacro-iliac joint is a synovial joint
B. The sacrotuberous ligament lies anterior to the sacrospinous ligament
C. The sub public angle is wider in male than in female
D. The piriformis muscle leaves the pelvis through the greater sciatic foramen
E. The inferior pubic rami are everted in males
125.
A. True – The articular surfaces of this joint are jagged and very little
movement is present at this joint. With ageing fibrous adhesions occur and gradual obliteration of the joint cavity takes place; earlier in males and after the menopause in females
B. False – The sacrotuberous ligament is found posterior to the sacrospinous ligament. The sacrotuberous ligament is a flat
fibrous band of great strength having a wide attachment. It is attached to the posterior border of the ilium and posterior superior and posterior inferior iliac spines, to the transverse tubercles of the sacrum and to the upper part of the coccyx and is inserted to the medial surface of the ischial tuberosity
C. False – The subpubic angle is larger in females forming an obtuse angle wich is considered as a sex difference
D. True - The piriformis muscle arises from the front of the middle three pieces of the sacrum within the pelvis and leaves the pelvis through the greater sciatic foramen to be attached to the greater trochanter of the femur
E. True – The crus of the penis is attached to this everted inferior pubic ramus
- The pelvic outlet is formed by the:
A. ischial tuberosities
B. sacrotuberous ligaments
C. alar of the sacrum
D. ischiopubic rami
E. sacroiliac ligaments
A. True – The pelvic outlet is bounded anteriorly by the pubic symphysis, arcuate or inferior pubic ligament, posteriorly by the coccyx and on each side by the ischiopubic rami, ischial tuberosities and sacrotuberous ligaments.
B. True
C. False – The alar of the sacrum forms a part of the pelvic inlet.
D. True
E. False – Sacroiliac ligaments are ligamentous bands that surround the
capsule of the sacroiliac joint.
- The levator ani muscle:
A. has superior and inferior surfaces covered with fascia
B. is supplied by a branch from the 1st sacral nerve
C. is inserted into the perineal body
D. has fibres forming a sling around the anorectal junction
E. forms the medial boundary of the ischioanal fossa
127.
A. True – The pelvic surface of the levator ani and coccygeus is covered
by the superior fascia of the pelvic diaphragm. The inferior surface is covered by the inferior fascia of the pelvic diaphragm which blends with the obturator fascia laterally
B. False – It is mainly supplied from the sacral plexus by branches of S3 and S4 spinal segments. Puborectalis may be supplied from below by the perineal branch of S4 and inferior rectal branch of the pudendal nerve, in common with the external anal sphincter
C. True - The muscles attached to the perineal body include the external anal sphincter, pubovaginalis (levator prostate), a part of levator ani, bulbospongiosus and the superficial and deep transverse perinei muscles
D. True – Fibres arising more anteriorly from the inner aspect of the body of the pubis form a sling around the anorectal junction and this part of the muscle is called the puborectalis.
Contraction of this muscle sling helps in defaecation
E. True – The ischioanal fossa is wedge shaped. The external sphincter of the anal canal and the leavator ani muscles form the medial wall of each fossa and the lateral wall is formed by the ischial tuberosity with the obturator internus muscle
- Pelvic peritoneum in the female covers the:
A. Superior surface of the bladder
B. Anterior surface of the lower third of the rectum
C. Lateral surface of the urinary bladder
D. Fundus of the uterus
E. Anterior surface of the vagina
- A. True – The pelvic peritoneum covers the superior surface of the
bladder and is reflected from a little in front of the posterior margin of this surface on to the undersurface of the uterus
B. False – The upper one-third of the rectum is covered by the peritoneum in front and on the sides; the middle one-third is covered only in front and the lower one-third which is dilated to form the ampulla is devoid of peritoneum. It is reflected forwards on to the upper part of the vagina to form the rectouterine pouch (of Douglas)
C. False
D. True - The fundus, the anterior or vesical surface and the posterior
or the intestinal surface of the uterus are covered by the peritoneum
E. False – The only part of the vagina to have a peritoneal covering is
the posterior fornix. This peritoneal covering is the part that forms the front of the rectouterine pouch (of Douglas)
- The rectum in the male:
A. rests in front of the 3rd,4th and 5th sacral vertebrae
B. is covered by the peritoneum in its upper 1/3 in front and sides
C. is derived from the lower part of the urogenital sinus
D. is lined by the stratified squamous non keratinizing epithelium
E. drains its upper part to the pre aortic lymph nodes
129.
A. True – The rectum lies in front of the sacrum from the mid of 3rd sacral segment and descends up to the tip of the coccyx
B. True – The rectum in the male is covered by the peritoneum in its upper 1/3 in front and on the sides and in its middle 1/3 only in front
C. False – The rectum is developed from the distal part of the hindgut.
The urogenital sinus gives rise to the urinary bladder and urethra
D. False – The rectum is lined by the simple columnar epithelium with goblet cells. Only the lower 1/3 of the anal canal is lined by the stratified squamous non keratinizing epitelium
E. True – Lymphatics of the upper rectum drains along the inferior mesenteric artery to pre aortic nodes. The lymphatics from the lower rectum reach the internal iliac nodes along the middle and inferior rectal vessels
- Regarding the anal canal:
A. It has internal sphincter composed of striated muscle
B. Its upper part is developed from the hindgut
C. Its lower part is derived from the urogenital sinus
D. Superficial inguinal nodes drain lymph from its upper third
E. Pecten is lined by a simple columnar epithelium
130.
A. False – The anal canal consists of internal and external sphincters. The internal anal sphincter is continuous with the inner circular and outer longitudinal muscle layers of the anal canal. Hence it is developed from the splanchnic mesoderm and consists of smooth muscle. The external anal sphincter consists of three parts, namely, deep, superficial and subcutaneous parts derived from the somatic mesoderm (striated muscle)
B. True – The upper part of the anal canal above the pectinate line is developed from the hindgut and the lower part below the pectinate line is developed from the proctodeum (ectodermal origin)
C. False – refer B above
D. False – The upper part of the anal canal above the pectinate line drains into the internal iliac nodes. The lower part of the anal canal below the pectinate line drains into the superficial inguinal nodes
E. True – The pecten is the area below the pectinate line and is lined by a stratified squamous non keratinized epithelium. The area above the pectinate line (anal column area) is lined by a simple columnar epithelium
- Regarding the anal canal:
A. The pectinate line separates the ectodermal and endodermal parts
B. The middle rectal artery supplies it
C. The pecten is lined by stratified squamous keratinized epithelium
D. It drains into the superior rectal veins
E. Pectinate line is a site of portosystemic anastomosis
131.
A. True – The anal canal above the pectinate line is lined by a simple columnar epithelium and below the pectinate line is lined by
a stratified squamous non keratinized epithelium
B. False – The superior rectal branches and the inferior rectal artery supply the mucosa above and below the pectinate line
respectively. The middle rectal artery supplies the rectum
C. False– The pecten area is lined by the stratified squamous non keratinized epithelium (ectodermal)
D. True – The area above the pectinate line drains into the superior rectal vein (a tributary of portal vein) and the area below the pecten drains into the inferior rectal vein (systemic veins)
E. True – In portal hypertension this anastomosis dilates to form the internal haemorrhoids (internal piles) as it is a portosystemic anastomosis
- Regarding the rectum:
A. It is covered by the peritoneum throughout
B. It is developed from the lower part of the urogenital sinus
C. It is lined by a simple columnar epithelium
D. It is supplied by the inferior rectal artery
E. In the male the prostate can be palpated on its anterior wall by per rectal examination
132.
A. False - Only the front and sides of the upper third and the front of the middle third of the rectum are covered by the peritoneum. The lower third is devoid of a peritoneal covering
B. False – The rectum is developed from the distal part of the hindgut
and the mucosa is endodermal in origin. The urogenital sinus gives rise to the urinary bladder and urethra
C. True – It is lined by the gut epithelium which is the simple columnar epithelium
D. False – It is supplied by the superior rectal artery (a branch of the Inferior mesenteric artery), middle rectal artery (a branch of the internal iliac artery) and median sacral artery (a branch of the abdominal aorta). The inferior rectal artery supplies the anal canal
E. True – By per rectal examination in the male, the prostate, seminal vesicle, base of the urinary bladder and the rectovesical pouch (if fluid is filled) could be palpated on the anterior rectal wall. In the female all internal reproductive organs could be felt. In both sexes some bony parts namely the lower sacrum and coccyx, the ischial spine and the ischial tuberosity could be palpated on the posterior rectal wall
- The female urethra is:
A. lined by the stratified squamous keratinizing epithelium
B. ten centimeters long
C. supplied by the internal pudendal artery
D. derived from the mesonephric duct
E. drained into the internal iliac nodes
133.
A. False - The uppermost part of the female urethra is lined by the transitional epithelium followed by the stratified squamous non keratinizing epithelium at the external urethral meatus.
B. False - The urethra in the female is 4 cm long. During later stages of pregnancy it can get stretched and could increase its length up to 10 cm.
C. True - Upper part of the female urethra is supplied by the inferior
vescical and vaginal arteries with the lower end being
supplied by internal pudendal artery
D. False - It is developed from the lower part of the urogenital sinus. The remnants of the mesonephric duct in the female is seen as epoophoron and paroophoron.
E. True - Lymph from the female urethra mainly drains into internal iliac nodes but some may reach the external iliac nodes.
- Regarding the urinary bladder:
A. Its epithelium is derived from endoderm
B. The extrophy of the bladder is due to persistence of the urachus
C. Has no peritoneal covering
D. Is lined by a stratified squamous non keratinizing peithelium
E. Its apex is connected to the umbilicus by the median umbilical ligament
134.
A. True – The urogenital sinus becomes the bladder and therefore the epithelium of the bladder is endodermal and the surrounding mesoderm which is developed from the splanchnic mesoderm forms the muscle and connective tissue. The incorporation of the lower ends of mesonephric the ducts into the posterior part of the bladder forms the trigone which is intermediate mesoderm in origin
B. False – The fusion of the anterior abdominal wall below the umbilicus
is facilitated by the migrating primitive streak mesoderm. If this migration fails, the anterior abdominal wall will not fuse leading to exposure of the bladder wall. This is called the extrophy of the bladder. Persistence of the urachus leads to urine discharge from the umbilical region
C. False – The superior surface and the upper part of the posterior surface are covered by the peritoneum in both sexes
D. False – It is lined by the transitional epithelium
E. True – The apex of the bladder points anteriorly and lies behind symphysis pubis. It is connected to the umbilicus by the median umbilical ligament – which is the fibrosed (obliterated) urachus
- The testis:
A. develops in the paraxial mesoderm
B. drains its lymph to the para aortic nodes
C. has the appendix testis which is a derivative of the mesonephric duct
D. is supplied by sympathetic nerve firbres originating from the T10
segment
E. contains diploid cells in the wall of seminiferous tubule
135.
A. False – Both gonads (testis and ovary) develop in the gonadal ridge in
the pelvic region of the intermediate mesoderm. The paraxial mesoderm forms the dermatomes, myotomes and sclerotomes of each spinal segment
B. True – The testis drains into para aortic nodes lying alongside the aorta at second lumbar vertebral level and do not drain into inguinal nodes although the overlying scrotal skin does
C. False – The derivatives of the mesonephric duct include efferent ducts, epidydimis and vas deferens in the male and epoophoron and paroophoron in the ffemale. Appendix testis
and utriculus prostaticus are the remnants of the paramesonephric duct attached to the testis in the male
D. True – The sympathetic preganglionic fibres originate from the tenth thoracic segment of the spinal cord and pass in the greater or lesser splanchnic nerves to the celiac ganglia and synapse there. The postganglionic sympathetic fibres reach the testis via the testicular artery
E. True – The primary spermatogonia in the walls of the seminiferous tubules are diploid cells. Secondary spermatogonia, spermatids and sperms are haploid cells.
- The testis:
A. The tunica vaginalis completely encloses the testis
B. Has the epididymis located along its anterior border
C. Is supplied by sympathetic nerves arising from T10 spinal segment
D. Has cells of Leydig that secrete testosterone
E. The veins drain into the inferior vena cava on both sides
- A. False – It covers the whole testis except the posterior border
B. False – The epididymis is attached to its posterolateral surface
C. True
D. True – Cells of Leydig or interstitial cells are found as clusters scattered among the cells of connective tissue in between the seminiferous tubules. They constitute the endocrine portion of the testis and secrete testosterone
E. False – The veins emerging from the testis form the pampiniform plexus. In the inguinal canal the plexus separates out into
about four veins which join to form two that leave the deep inguinal ring. The left vein drains into the left renal vein where the right drains directly into the inferior vena cava.
- The ductus deferens:
A. is lined by a cuboidal epithelium
B. develops from the mesonephric duct
C. passes through the inguinal canal
D. crosses the ureter in the region of the ischial spine
E. joins with that of the opposite side to form the ejaculatory duct
137.
A. False – It is lined by a pseudostratified columnar epithelium with stereocilia
B. True - The mesonephric duct gives rise to the efferent ducts, epididymis and vas deferens in the male
C. True - It passes through the inguinal canal and enters the abdomen by emerging through the deep inguinal ring
D. True – It passes downward and backwards on the lateral wall of the pelvis and crosses the ureter in the region of the ischial spine
E. False - It joins with the duct of the seminal vesicle to form the ejaculatory duct. The ejaculatory ducts pierce the posterior wall of the prostate and open into the prostatic urethra
- Regarding ductus deferens:
A. It begins as a continuation from the upper pole of epididymis
B. It is palpable in spermatic cord
C. It is supplied by a branch of the testicular artery
D. It leaves the spermatic cord at the deep inguinal ring
E. The ampulla of the vas lies behind the base of the bladder
138.
A. False – It begins as a continuation from the tail of the epididymis
B. True
C. False – The artery to the ductus deferens arises from the superior vesical (or sometimes from the inferior vesical) artery. The epididymis is supplied by a branch of the testicular artery
D. True
E. True – The part of the ductus lying behind the base of the bladder is dilated and tortuous, and is known as the ampulla
- Pelvic part of the urogenital sinus in the male gives rise to the:
A. penile urethra
B. ejaculatory duct
C. seminal vesicle
D. prostatic urethra
E. membranous urethra
A. False - The urogenital sinus has a definitive part, pelvic part and a phallic part. The definitive part gives rise to the urinary bladder, the pelvic part gives rise to the ejaculatory duct, seminal vesicle, prostate, prostatic urethra and membranous urethra in the male. The phallic part gives rise to the penile urethra.
B. True
C. True
D. True
E. True
