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Question 1

1. During a practice match, a heavyweight prizefighter endured an illegal hit to the left flank. Following
   the match, a focused assessment with sonography for trauma (FAST) exam revealed that blood from a
   renal laceration had tracked inferiorly and accumulated in the groove between the psoas major and
   iliacus muscles. What nerve would you expect to be irritated by blood in this location?
   A. Sciatic
   B. Femoral
   C. Obturator
   D. Superior gluteal
   E. Lateral femoral cutaneous

Answer 1

B. Femoral

Question 2

Which one of the following statements best describes the muscles of the pelvis?
A. The obturator internus muscle leaves the pelvis through the greater sciatic foramen.
B. The levator ani muscle is composed of the pubococcygeus, puborectalis, and iliococcygeus.
C. The pelvic diaphragm is a sling of muscle that separates the true pelvis from the false pelvis.
D. The piriformis muscle forms the lateral wall of the pelvis.
E. The coccygeus muscle attaches to the sacrotuberous ligament.

Answer 2

B. The levator ani muscle is composed of the pubococcygeus, puborectalis, and iliococcygeus.

Question 3

3. Typically, the posterior division of the internal iliac artery supplies
A. structures of the perineum
B. muscles of the medial thigh
C. meninges of the sacral spinal roots
D. uterus and uterine tubes
E. prostate

Answer 3

C. meninges of the sacral spinal roots

Question 4

4. The components of the pelvic splanchnic nerves are most similar to the components of the
A. lumbar splanchnic nerves
B. sacral splanchnic nerves
C. pudendal nerve
D. vagus nerve
E. hypogastric nerves

Answer 4

D. vagus nerve

Question 5

Carcinoma of the prostate can metastasize to bone and the brain through its connections with the
vertebral venous plexus. Which other structures communicate with this venous plexus?
A. Breast
B. Spinal cord
C. Intercostal muscles
D. Esophagus
E. All of the above

Answer 5

E. All of the above

Question 6

6. Although branches of the uterine artery anastomose extensively throughout the pelvis, the main stem of
the vessel travels within the
A. proper ovarian ligament
B. cardinal ligament
C. uterosacral ligament
D. ovarian suspensory ligament
E. round ligament

Answer 6

B. cardinal ligament

Question 7

7. Which of the following statements accurately describes the relations of the ureter?
   A. It is crossed anteriorly by the gonadal vessels on the posterior abdominal wall.
   B. It crosses the brim of the pelvis at the bifurcation of the common iliac artery.
   C. In females it passes under the uterine artery ~2 cm lateral to the cervix.
   D. It enters the bladder at the posterolateral aspect of the trigone.
   E. All of the above

Answer 7

E. all the above

Question 8

. During a routine physical exam on a male patient, you test the integrity of the external anal sphincter.
What spinal cord segments are involved in this?
A. T12–L1
B. L2–L4
C. L4–L5
D. S1–S2
E. S2–S4

Answer 8

E. S2–S4

Question 9

9. The superficial perineal fascia is continuous with the
A. perineal membrane
B. dartos fascia
C. deep penile fascia
D. tunica albuginea of the penis
E. endopelvic fascia

Answer 9

B. dartos fascia

Question 10

10. The boundary of the pelvic inlet
    A. provides the attachment site for the pelvic diaphragm
    B. includes the iliac crests
    C. includes the ramus of the ischium
    D. is crossed by the ovarian and testicular arteries
    E. separates the cavity of the true pelvis from the abdominal cavity

Answer 10

E. separates the cavity of the true pelvis from the abdominal cavity

Question 11

11. Several years after delivering her twin boys, Laura experienced mild uterine prolapse and urinary
    incontinence. Her gynecologist was able to confirm that the angle of her anococcygeal ligament had
    changed, suggesting a laxity in her pelvic floor muscles. Which muscles insert on the anococcygeal
    ligament?
    A. Coccygeus
    B. Iliococcygeus
    C. Piriformis
    D. Deep transverse perineal
    E. Obturator internus

Answer 11

B. Iliococcygeus

Question 12

12. Tumors that metastasize via the bloodstream often form metastases in the first capillary bed that the
    cells reach after they enter the bloodstream. Based on their venous drainage, tumors in which of the
    following locations are likely to reach the lung before they reach the liver?
    A. Ascending colon
    B. Sigmoid colon
    C. Pancreas
    D. Superior (proximal) rectum
    E. Inferior (distal) rectum

Answer 12

E. Inferior (distal) rectum

Question 13

13. Which one of the following structures passes through the genital hiatus?
A. Ductus deferens
B. Cavernous nerves
C. Round ligament
D. Obturator nerve
E. External iliac artery

Answer 13

B. Cavernous nerves

Question 14

14. A 44-year-old woman undergoes a total hysterectomy for painful fibroids. The ovaries will not be
    removed during the procedure. Which of the following ligaments must be preserved?
    A. Suspensory ligament
    B. Ovarian ligament
    C. Uterosacral ligament
    D. Transverse cervical ligament
    E. Round ligament

Answer 14

A. Suspensory ligament

Question 15

15. Which of the following statements best describes the uterine cervix?
    A. In a normally anteflexed uterus, the cervix is tilted posteriorly.
    B. Vaginal fornices surround its supravaginal part.
    C. It is the attachment site for the round ligament.
    D. It makes up the inferior third of the uterus.
    E. It communicates with the uterine cavity through the external os.

Answer 15

D. It makes up the inferior third of the uterus.

Question 16

16. A 53-year-old man had an aortic aneurysm that extended through his aortic bifurcation into his
    common iliac arteries. During the open repair, the surgeon opened the vessels longitudinally and fixed
    a synthetic graft to the walls of the vessels above and below the aneurysm. Following surgery, the
    man experienced retrograde ejaculation because of damage to nerves that innervated his internal
    urethral sphincter. Which nerves were damaged?
    A. Sympathetic nerves of the superior hypogastric plexus
    B. Parasympathetic nerves of the superior hypogastric plexus
    C. Somatic nerves of the sacral plexus
    D. Pelvic splanchnic nerves
    E. Sympathetic trunk

Answer 16

A. Sympathetic nerves of the superior hypogastric plexus

Question 17

17. You are treating a 34-year-old woman for hemorrhoids. Although she does not complain of pain, the
    hemorrhoids protrude into her anal canal and are becoming ulcerated. There is no evidence of portal
    hypertension, but blood from the ulcers is bright red. Based on her brief history, what can you surmise
    about her condition?
    A. The prolapsed tissue contains the dilated veins of the external rectal plexus.
    B. The hemorrhoids originate from below the dentate line.
    C. The dilated veins in the hemorrhoids drain to the inferior rectal veins.
    D. The dilated veins communicate with the rectal arteries to form an arteriovenous hemorrhoidal
    plexus.
    E. All of the above

Answer 17

D. The dilated veins communicate with the rectal arteries to form an arteriovenous hemorrhoidal
plexus.

Question 18

18. During a robotic prostatectomy on a 41-year-old man, the cavernous nerves were inadvertently
    damaged. What symptoms would you expect in this patient?
    A. Loss of tone in his external anal sphincter
    B. Urinary incontinence
    C. Inability to ejaculate
    D. Inability to form an erection
    E. Loss of sensation at the tip of the penis

Answer 18

D. Inability to form an erection

Question 19

19. Structures that pass through the greater sciatic foramen include the
A. obturator internus
B. coccygeus
C. iliopsoas
D. piriformis
E. obturator nerve

Answer 19

D. piriformis

Question 20

20. The tendinous arch of the pelvic fascia
    A. is a condensation of endopelvic fascia
    B. includes the lateral rectal ligament
    C. supports the pelvic viscera
    D. provides an attachment site for the pelvic diaphragm
    E. All of the above

Answer 20

C. supports the pelvic viscera

Question 21

21. Structures that drain (directly or indirectly) into the deep inguinal lymph nodes include the
    A. glans of the penis
    B. perianal skin
    C. supralateral part of the uterus via the round ligament
    D. scrotum
    E. all of the above

Answer 21

E. all of the above

Question 22

22. During the national championships an Olympic gymnast fell backward off the balance beam, fracturing
    the tip of her coccyx and subluxing (dislocating) her sacroiliac joint. The team physician was
    concerned about damage to her sacral plexus and its branches that exit the pelvis. Nerves of the sacral
    plexus pass through the
    A. posterior sacral foramina
    B. obturator canal
    C. lesser sciatic foramen
    D. superficial inguinal ring
    E. deep inguinal ring

Answer 22

C. lesser sciatic foramen

Question 23

23. A young, pregnant woman in her third trimester was alarmed when she experienced a sharp pain in the
    anterior part of her labia majora when she stood up. Her obstetrician assured her that this was a
    common problem in late pregnancy and was most likely caused by
    A. stretching of the round ligament
    B. tightening of the inguinal ligament
    C. pressure on the obturator nerve
    D. irritation of the perineal branch of the pudendal nerve
    E. stretching of the iliohypogastric nerve

Answer 23

A. stretching of the round ligament

Question 24

24. A vascular surgeon is repairing an aneurysm of the aortic bifurcation that extends along the right
    common iliac artery to its division into internal iliac and external iliac branches. What structure does
    the surgeon encounter that is at risk as it crosses over the pelvic brim at this distal end of the
    aneurysm?
    A. Ureter
    B. Testicular artery
    C. Lumbosacral trunk
    D. Sciatic nerve
    E. Ductus deferens

Answer 24

A. Ureter

Question 25

Similar to other sections of the large intestine, the rectum is characterized by
A. teniae coli
B. haustra
C. a mesentery
D. epiploic appendices
E. None of the above

Answer 25

E. None of the above

Question 26

Which of the following are found within the superficial perineal space?
A. Bulbourethral glands
B. External urethral sphincter
C. Bulbospongiosus muscle
D. Anterior extension of ischioanal fat pad
E. Inferior rectal nerve

Answer 26

C. Bulbospongiosus muscle