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Gross Anatomy - Snell's > Pelvis and Perineum > Flashcards

Pelvis and Perineum Flashcards

1
Q
  1. The lymphatic drainage of the labia majora is into the
    A. internal iliac nodes.
    B. superficial inguinal nodes.
    C. inferior mesenteric nodes.
    D. internal and external iliac nodes.
    E. para-aortic nodes at the level of the first lumbar
    vertebra.
A

B

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2
Q
  1. A carcinoma of the skin of the glans penis is likely to spread via the lymphatics into the
    A. external iliac nodes.
    B. internal iliac nodes.
    C. internal and external iliac nodes.
    D. superficial inguinal nodes.
    E. para-aortic nodes at the level of the first lumbar
    vertebra.
A

D

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3
Q 
24. A carcinoma of the cervix of the uterus is likely to spread via the lymphatics into the
A. external iliac nodes.
B. internal iliac nodes.
C. superficial inguinal nodes.
D. internal and external iliac nodes.
E. presacral lymph nodes.
A

D

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4
Q 
25. A carcinoma of the prostate is likely to spread via the lymphatics into the
A. internal and external iliac nodes.
B. internal iliac nodes.
C. para-aortic nodes.
D. superficial inguinal nodes.
E. inferior mesenteric nodes.
A

B

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5
Q
  1. A carcinoma of the vaginal orifice is likely to spread via the lymphatics into the
    A. medial group of horizontal superficial inguinal
    nodes.
    B. internal iliac nodes.
    C. internal and external iliac nodes.
    D. vertical group of superficial inguinal nodes.
    E. none of the above.
A

A

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6
Q 
27. The superior rectal artery originates from the
A. internal pudendal artery.
B. external iliac artery.
C. internal iliac artery.
D. inferior mesenteric artery.
E. none of the above.
A

D

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7
Q 
28. The left ovarian artery originates from the
A. external iliac artery.
B. internal iliac artery.
C. left renal artery.
D. left common iliac artery.
E. abdominal part of the aorta.
A

E

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8
Q 
29. The inferior rectal artery originates from the
A. superior mesenteric artery.
B. internal iliac artery.
C. internal pudendal artery.
D. external iliac artery.
E. presacral artery.
A

C

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9
Q 
30. The middle rectal artery originates from the
A. presacral artery.
B. common iliac artery.
C. internal iliac artery.
D. external iliac artery.
E. inferior mesenteric artery.
A

C

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10
Q
  1. The obturator internus muscle receives its nerve supply from the
    A. obturator nerve.
    B. pudendal nerve.
    C. pudendal nerve and the perineal branch of S4.
    D. hypogastric plexus.
    E. none of the above.
A

E. The obturator internus muscle receives its nerve supply from the sacral plexus.

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11
Q
  1. The internal anal sphincter receives its nerve supply from the
    A. hypogastric plexuses.
    B. vagus nerve.
    C. obturator nerve.
    D. pudendal nerve.
    E. pudendal nerve and the perineal branch of S4.
A

A

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12
Q 
33. The sphincter urethrae receives its innervation from the
A. vagus nerve.
B. obturator nerve.
C. pudendal nerve.
D. inferior rectal nerve.
E. hypogastric plexuses.
A

C

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13
Q
  1. The levator ani muscle receives its innervation from the
    A. pudendal nerve.
    B. hypogastric plexuses.
    C. pudendal nerve and the perineal branch of S4.
    D. obturator nerve.
    E. inferior rectal nerve.
A

C

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14
Q 
35. The superior rectal vein drains into the
A. inferior vena cava.
B. internal iliac vein.
C. external iliac vein.
D. inferior mesenteric vein.
E. none of the above.
A

D

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15
Q 
36. The right ovarian vein drains into the
A. right internal iliac vein.
B. inferior vena cava.
C. inferior mesenteric vein.
D. right external iliac vein.
E. right renal vein.
A

B

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16
Q 
37. A patient was examined with a left-sided varicocele; the left testicular vein drains into the
A. left renal vein.
B. left internal iliac vein.
C. left external iliac vein.
D. inferior vena cava.
E. left inferior suprarenal vein.
A

A

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17
Q 
38. The prostatic venous plexus drains into the
A. inferior vena cava.
B. internal iliac veins.
C. external iliac veins.
D. internal and external iliac veins.
E. testicular veins.
A

B

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18
Q 
39. In most women, the anatomic position of the uterus when the bladder is empty is
A. retroverted.
B. anteverted.
C. anteflexed.
D. anteverted and anteflexed.
E. retroflexed.
A

D

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19
Q 
40. The uterus receives its blood supply from the
A. superior vesical artery.
B. middle rectal artery.
C. ovarian artery.
D. uterine artery.
E. uterine and ovarian arteries.
A

E

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20
Q
  1. In a woman with ovarian cancer, it is judicious to examine the
    A. peritoneal cavity for evidence of excessive fluid (ascites).
    B. superficial inguinal lymph nodes.
    C. para-aortic nodes at the level of the first lumbar
    vertebra.
    D. external iliac lymph nodes.
    E. para-aortic lymph nodes and evidence of excessive peritoneal fluid (ascites).
A

E

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21
Q 
42. The narrowest part of the male urethra is the
A. membranous part.
B. prostatic part.
C. penile part.
D. external meatus on the glans penis.
E. none of the above.
A

D

22
Q
  1. Erection of the penis is a response to the activity of the
    A. sympathetic nerves.
    B. parasympathetic nerve.
    C. sympathetic and parasympathetic nerves.
    D. ilioinguinal nerves.
    E. none of the above.
A

B

23
Q
  1. Ejaculation is the response to the activity of the
    A. obturator nerves.
    B. perineal branch of S4.
    C. sympathetic nerves.
    D. parasympathetic nerves.
    E. sympathetic and parasympathetic nerves.
A

C

24
Q 
45. The posterior wall of the lower third of the vagina is sup- ported by the
A. coccyx.
B. perineal body.
C. anal canal.
D. anococcygeal body.
E. none of the above.
A

B

25
Q
  1. The rectouterine pouch (pouch of Douglas) can be most efficiently entered by a surgical incision through the
    A. posterior fornix of the vagina.
    B. anterior fornix of the vagina.
    C. anterior rectal wall.
    D. lateral fornix of the vagina.
    E. posterior wall of the cavity of the uterine body.
A

A

26
Q 
47. Cancer of the prostate can metastasize to the skull via the
A. pampiniform plexus.
B. external iliac veins.
C. vertebral venous plexus.
D. portal vein.
E. inferior vena cava.
A

C

27
Q
  1. The middle (median) lobe of the prostate lies
    A. inferior to the ejaculatory ducts.
    B. superior to the ejaculatory ducts.
    C. anterior to the prostatic urethra.
    D. lateral to the lower part of the prostatic urethra.
    E. superior to the ejaculatory ducts and posterior to the upper part of the prostatic urethra.
A

E

28
Q
  1. The promontory of the sacrum is formed by the
    A. lower border of the anterior surface of the fifth
    sacral vertebra.
    B. anterior surface of the second sacral vertebra.
    C. lateral masses of the sacrum.
    D. anterior and upper border of the first sacral verte-
    bra.
    E. lateral edge of the sacrum.
A

D

29
Q 
50. The pelvic outlet is bounded posteriorly by the coccyx, laterally by the sacrotuberous ligaments and the \_\_\_\_\_\_\_\_, and anteriorly by the pubic arch.
A. ischial spines
B. piriformis muscle
C. ischial tuberosities
D. perineal membrane
E. obturator foramen
A

C

30
Q 
51. The pelvic diaphragm is formed by the \_\_\_\_\_\_\_\_ and coccygeus muscles and their covering fasciae.
A. p irifo rm is
B. levator ani
C. deep transverse perineal muscles
D. perineal membrane
E. sphincter urethrae
A

B

31
Q
  1. The urogenital diaphragm is attached laterally to the
    A. tip of the coccyx.
    B. ischial spine.
    C. inferior ramus of the pubis and the ischial ramus.
    D. ischial tuberosities.
    E. obturator internus fascia.
A

C

32
Q
  1. During defecation, the levator ani muscles
    A. are completely inactive.
    B. do not support the uterus and vagina.
    C. relax (puborectalis portion) with the anal
    sphincters.
    D. do not support the sigmoid colon.
    E. do not support the bladder.
A

C

33
Q
  1. During the second stage of labor, the gutter shape of the pelvic floor tends to
    A. become flat.
    B. cause the baby’s head to rotate so that its frontooccipital diameter assumes the transverse
    position.
    C. cause the baby’s head to rotate so that its frontooccipital diameter assumes the anteroposterior position with the occipital bone lying posterior.
    D. cause the baby’s head to rotate so that its frontooccipital diameter assumes the anteroposterior position with the frontal bone lying posterior.
    E. interfere with the normal process of labor.
A

D

34
Q
  1. The mucous membrane lining the upper half of the anal canal is
    A. lined with stratified squamous epithelium.
    B. drained by the inferior rectal vein.
    C. drained into the superficial inguinal lymph nodes.
    D. sensitive to touch and to pain.
    E. sensitive to stretch
A

E

35
Q
  1. The anal columns
    A. contain tributaries of the superior rectal vein.
    B. are connected at their ends by spiral valves.
    C. are located in the lower half of the anal canal.
    D. are transverse folds of mucous membrane.
    E. contain branches of the pudendal nerve.
A

A

36
Q
  1. The female urethra
    A. is approximately 3 in. (7.62 cm) in length.
    B. is difficult to dilate.
    C. is insensitive to stretching.
    D. opens into the vestibule above the clitoris.
    E. is readily accessible to infection.
A

E

37
Q
  1. The process of orgasm in the female depends in part on the
    A. smooth muscle in the vaginal walls contracting in response to the activity of the parasympathetic innervation.
    B. bulbospongiosus muscles contracting in response to the sympathetic nerve fibers.
    C. ischiocavernosus muscles contracting in response to the activity of the pudendal nerve.
    D. stimulation of the clitoris, which is innervated by the obturator nerve.
    E. stimulation of the labia minora, which are inner- vated by the obturator nerve.
A

C

38
Q
  1. The rectouterine pouch (pouch of Douglas)
    A. is formed by parietal pelvic fascia.
    B. commonly contains coils of jejunum.
    C. lies anterior to the vagina.
    D. lies behind the posterior fornix of the vagina and the body of the uterus.
    E. is not the most dependent part of the female peritoneal cavity when the woman is in the standing position.
A

D

39
Q
  1. The rectouterine pouch (pouch of Douglas) except which? A. Anteriorly is situated the posterior surface of the following structures are closely related to the
    upper part of the vagina.
    B. Posteriorly is situated the upper part of the rectum.
    C. The trigone of the bladder is directly related to its anterior wall.
    D. Anteriorly is situated the posterior surface of the body of the uterus.
    E. Laterally is situated the sacrocervical ligaments passing forward to the cervix.
A

C. The pouch of Douglas is separated from the trigone of the bladder by the uterus and the vagina.

40
Q
  1. Support for the uterus, either directly or indirectly, is provided by the following structures except which?
    A. The perineal body
    B. The mesosalpinx
    C. The transverse cervical (cardinal) ligaments
    D. The levator ani muscles
    E. The pubocervical ligaments
A

B. The mesosalpinx is an area of the broad ligament between the uterine tube and the attachment of the mesovarium. It provides no support for the uterus.

41
Q
  1. The following statements regarding the ovary are correct except which?
    A. It is attached to the posterior layer of the broad ligament.
    B. It ovulates an ovum into the peritoneal cavity.
    C. It is attached to the lateral pelvic wall by the round ligament of the ovary.
    D. It normally is not related to the posterior fornix of the vagina.
    E. The right ovarian vein drains into the inferior vena cava.
A

C. The ovary is attached (suspended) from the lateral wall of the pelvis by the suspensory ligament. It contains the blood and the lymphatic vessels as well as the nerves supplying the ovary. The round ligament of the ovary is the remains of the upper part of the gubernaculum, and it extends from the medial border of the ovary to the lateral wall of the body of the uterus.

42
Q
  1. The following statements regarding the urinary bladder are true except which?
    A. It lies in the visceral layer of pelvic fascia beneath the peritoneum.
    B. When the bladder is empty, the internal surface is wrinkled except at the trigone, which is smooth.
    C. Parasympathetic nerve fibers innervate the detrusor muscle.
    D. The trigone is the area between the openings of the urethra and the two ureters.
    E. In children, the bladder is located entirely within
    the pelvis.
A

E. Because the pelvis is small in young children, there is insufficient room for the urinary bladder. Even the empty bladder projects upward into the abdomen. Later, when the pelvis enlarges, the bladder sinks to become a pelvic organ.

43
Q 
64. The broad ligament contains all of the following except which?
A. The round ligament of the ovary
B. The uterine artery
C. The round ligament of the uterus
D. The uterine tubes
E. The ureters
A

E. The ureters pass forward inferior to the broad ligaments.

44
Q 
65. Malignant tumors of the trigone of the bladder spread (metastasize) to which of the following lymph nodes?
A. Lumbar
B. Sacral
C. External iliac only
D. External and internal iliac
E. Superficial inguinal
A

D

45
Q 
66. In males, traumatic injury to the perineum may rupture the bulb of the penis or the penile urethra. The resulting leakage of blood or urine may be found in all of the following areas except which?
A. The anterior abdominal wall
B. The ischiorectal fossa
C. The scrotum
D. The penis
E. The superficial perineal pouch
A

B. The arrangement of the membranous layer of superficial fascia (Colles’ fascia) in the perineum prevents fluid from traveling backward into the ischiorectal fossae. The fascia is attached to the posterior border of the urogenital diaphragm.

46
Q

A 21-year-old woman complaining of severe pain in the right iliac region was seen in the emergency department. Just before admission, she had fainted. On physical examination, her abdominal wall was extremely tender on palpation in the right iliac region, and some rigidity and guarding of the lower abdominal muscles were noticed. A vaginal examination revealed that a tender, “doughlike” mass could be felt through the posterior fornix. The patient had missed her last period. The diagnosis of a ruptured ectopic pregnancy was made. In this ectopic pregnancy, the embryo was implanted in the right uterine tube. Rupture of the tube produced the symptoms and the signs that were noted.
67. Using your knowledge of anatomy, explain the relationship of the uterine tube to the peritoneal cavity.
A. The tube is retroperitoneal.
B. The tube lies within the peritoneal cavity.
C. The tube lies within the broad ligament near its base.
D. The tube lies in the free margin of the broad
ligament.
E. The tube lies within the parametrium.

A

D

47
Q 
68. The tender, doughlike mass felt through the posterior wall of the vagina resulted from what?
A. A retroverted uterus
B. Blood in the pouch of Douglas
C. A fullbladder
D. Blood in the uterovesical pouch 
E. A prolapsed ovary
A

B. Tubal pregnancies commonly occur where the infundibulum narrows to join the isthmus. Rupture of the tube almost invariably occurs with severe intraperitoneal hemorrhage. The blood gravitates downward into the lowest part of the peritoneal cavity (pouch of Douglas), where it clots and forms a dough like mass that can usually be felt through the posterior vaginal wall.

48
Q
  1. What was responsible for the guarding (partial contraction) of the lower abdominal muscles?
    A. Blood in the peritoneal cavity causing irritation of
    the parietal peritoneum and reflex contraction of the lower abdominal muscles
    B. Apprehension of the patient
    C. Reflex contraction of the abdominal muscles
    because of damage to the wall of the uterine tube
    D. Stretching of the peritoneum of the broad ligament
    E. The high level of blood estrogen causing irritability of the abdominal muscles
A

A. Blood is an irritant to the peritoneum. The parietal peritoneum of the lower part of the abdomen and pelvis receives its sensory nerve supply from the lumbar spinal nerves (iliohypogastric, ilioin- guinal, and obturator nerves). The muscles of the lower part of the anterior abdominal wall are innervated by the iliohypogastric and ilioinguinal nerves, and there is a reflex spasm of these abdominal muscles. This spasm is essentially a protective mechanism and an attempt to keep that area of the abdomen at rest so that the irritant will remain localized.

49
Q

A 56-year-old man was seen by his physician because the patient had noticed that his “bowel” was protruding from his anus after defecation. On questioning, the patient stated that for the past 2 years he had frequently passed blood- stained stools. Digital rectal examination revealed nothing abnormal. Proctoscopic examination showed that the mucous membrane above the level of the anal valves tended to bulge downward in three areas when the patient strained. The swollen mucous membrane contained large, congested veins beneath the surface.

  1. Based on your knowledge of anatomy, make a reasoned diagnosis.
    A. External hemorrhoids
    B. Perianal abscess
    C. Complete rectal prolapse D. Internal hemorrhoids
    E. Chronic anal fissures
A

D. Internal hemorrhoids are dilatations of the tributaries of the superior rectal vein. They are covered by mucous membrane in the upper half of the anal canal, and they lie within the vertical anal columns. One large tributary occurs on the left of the canal; two large tributaries occur on the right. As these dilatations enlarge, they are pushed down the anal canal during defecation and may be extruded through the anus. At first, they return to the canal at the end of defecation, but with further enlargement and elongation, they remain outside the anus.

50
Q 
71. What is the venous drainage of the mucous membrane of the anal canal?
A. Middle rectal veins only
B. Inferior rectal veins only
C. Superior and inferior rectal veins 
D. Middle and inferior rectal veins 
E. Internal pudendal veins
A

C. Venous drainage of the mucous membrane of the upper half of the anal canal is from the superior rectal vein and that from the lower half is from the inferior rectal veins. The middle rectal veins are mainly concerned with draining blood from the muscle and connective tissue of the canal. Because the superior rectal vein is a tributary of the portal vein and the inferior and the middle rectal veins are tributaries of the systemic veins, the anal canal is an important site for portal– systemic anastomoses in patients with a blocked portal vein.

Gross Anatomy - Snell's (35 decks)

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