Revision Questions

Question 1

Meiosis
a. Does not involve replication of DNA
b. Starts at the onset of puberty in the female ovaries
c. Occurs only in the gonads
d. Is responsible for multiplication of granulosa cells in the follicular phase of the ovarian phase
e. Is only completed in spermatozoa following fertilization of an ovum

Answer 1

C

Question 2

Expl meiosis during oogenesis

Answer 2

Question 3

Ovarian cycle
a. Consists of proliferation and secretory phases
b. Is controlled by FSH and LH from posterior pituitary
c. Involves development of only 1 primordial follicle in each cycle
d. Leads to release of secondary oocyte
e. Produces estrogens that exhibit negative feedback on hypothalamus throughout each cycle

Answer 3

D. Ovarian phases: follicular, ovulation, luteal; Uterine phases: menses, proliferative, secretory. FSH and LH from ant. Pituitary cause development of multiple follicles, non-dominant follicles regress and undergo atresia. Estrogen exerts negative feedback on hypothalamus at low levels, but has a positive effect when present in high levels

Question 4

Menopause is
a. Followed by rise in FSH concentration
b. Caused by decline in hypothalamic function
c. Due to the fact that uterus has become less responsive to estrogens in a female after midlife
d. Seen in both males and females
e. Followed by rise in progesterone concentration

Answer 4

A. Can think of menopause as a depletion of follicles within the ovary. Once no more follicles are available, estrogen production by granulosa cells cannot take place, resulting in the removal of –ve feedback on the pituitary. FSH production rises as a result.

Question 5

. In a normal, healthy 25-year old woman
a. Plasma LH is lowest concentration during 2 days prior to ovulation
b. Plasma FSH is lowest concentration during 2 days prior to ovulation
c. Plasma estrogen concentration is at its lowest during 2 days prior to ovulation
d. Ovulation is followed by a decline in plasma estrogen
e. Ovulation is followed by decline in plasma progesterone

Answer 5

E. Menstrual cycle is ~28 days long. Corpus luteum degeneration to corpus albicans is followed by menstruation approx. 1-2 days later

Question 6

All of the following are correct except, progesterone
a. Concentration in luteal phase is greater than in the follicular phase of menstrual cycle
b. Inhibits hypothalamus GnRH secretion
c. Stimulates respiration
d. Increases excitability of uterine tissue to contractile stimuli
e. Is found in adrenal glands

Answer 6

D. Recall that in late stages of pregnancy, high levels of estrogen and progesterone inhibit uterine contractility and prevent onset of labour

Question 7

. Which of the following is not produced by placenta?
a. Oxytocin
b. hCG
c. somatomammotrophin
d. estrogen
e. progesterone

Answer 7

A

Question 8

Wrt male reproductive function, which is incorrect?
a. Hypothalamus regulates spermatogenesis
b. Hypothalamus controls testerone secretion
c. Testosterone has paracrine effects
d. Oestrogens can be found in male
e. Inhibin is secreted by Leydig cells

Answer 8

E. Inhibin is produced by Sertoli cells in the male and Granulosa cells in the female

Question 9

Which would be effective in initiating labour?
a. Administer progesterone to mother
b. Administer oestrogen to mother
c. Administer LH to mother
d. Antagonist of prostaglandin F2a to mother
e. Mechanically dilating and stimulating the cervix

Answer 9

14. E. Massaging and dilating the cervix causes release of oxytocin from post. Pituitary, resulting in labour onset. Prostaglandins stimulate contractions (therefore, D, which mentions antagonists, is the wrong option) while progesterone inhibits them

Question 10

In order to restore fertility in a hypophysectomized adult male, it is necessary to administer:
A. gonadotrophin-releasing hormone
B. gonadotrophins
C. prolactin
D. inhibin
E. steroid hormones

Answer 10

15. B. Hypophysis (pituitary gland) usually produces FSH and LH to act on testes, replacing them will restore fertility. While administering GnRH can stimulate the pituitary to release LH and FSH, in a hypophysectomized male, the pituitary is not present to respond to GnRH. Therefore, simply administering GnRH would not lead to the release of these hormones.

Question 11

In a normal adult male, the administration of a specific luteinizing hormone (LH) receptor inhibitor will lead to which one of the following sets of changes in plasma hormone concentration? With regard to Plasma LH, Plasma FSH, Plasma testosterone respectively?
A Increase, No change, Decrease
B No change Increase No change
C Decrease No change Decrease
D Increase Decrease Increase
E Increase Increase Decrease

Answer 11

E. LH normally induces release of testosterone from Leydig cells. Blocking the receptor will reduce testosterone levels. This removes the negative inhibition effect it has on FSH and LH, resulting in a rise in both

Question 12

After a blastocyst implantation has occurred, the first missed menstrual period in a healthy female is the result of:
A. degeneration of the corpus luteum
B. formation of a trophoblast that secretes gonadotrophins
C. formation of a trophoblast that secretes osteogen and progesterone
D. decreased ovarian synthesis of osteogen and progesterone
E. increased placenta secretion of osteogen and progesterone

Answer 12

B. After implantation, syncitiotrophoblasts produce hCG, maintaining the corpus luteum to produce estrogen and progesterone, which suppress the ovarian cycle and maintain the endometrium respectively

Question 13

. Which one of the following statements is FALSE? Testosterone:
A. is produced by foetal testes
B. inhibits luteinizing hormone secretion from the pituitary gland
C. is a prooestrogen
D. is inactivated when converted to dihydrotestosterone (DHT)
E. is produced in the female

Answer 13

D. DHT is more active than testosterone

Question 14

A 32-year old woman is diagnosed with secondary amenorrhea and is suspected of intrauterine adhesions. Which of the following supports this diagnosis?
A. Presence of hot flushes
B. Low follicle-stimulating hormone levels
C. Normal oestrogen levels
D. Monophasic basal body temperature chart
E. Enlargement of her uterus

Answer 14

19. C. Intrauterine adhesions (Asherman’s syndrome) refer to scarring of the endometrium, possibly caused by surgery. Scarring prevents the endometrium from being shed normally. Therefore, even if sex hormones function normally (normal oestrogen levels), menstruation cannot take place.
    * Hot flush indicates a fall in FSH and estrogen, occurs commonly in menopause
    * Monophasic body temperature indicates disruption of cycle, as temperature usually rises during secretory phase
    * Enlargement of uterus potentially indicates pregnancy, which could also cause amenorrhea

Question 15

Common investigations of a breast lump include all of the following, EXCEPT:
A) Ultrasound examination
B) CT scan
C) Fine needle aspiration biopsy
D) Mammogram
E) Core biopsy

Answer 15

B

Question 16

Lymphatic vessels from the anal canal, below the pectinate line, drain into which lymph nodes?
a. para-aortic
b. superior mesenteric
c. internal iliac
d. superficial inguinal
e. inferior mesenteric

Answer 16

D. Above PECTINATE LINE: Lymph drains into the internal iliac lymph nodes
Below PECTINATE LINE: Lymph drains into superficial inguinal lymph nodes

Question 17

The ischiocavernosus muscle is found in the:
a. true pelvis
b. superficial perineal space
c. deep perineal space
d. ischiorectal fossa
e. around the bulb of the penis

Answer 17

B. The superficial perineal space/ pouch is a fully enclosed compartment. Its superior border is the perineal membrane while its inferior border is the fascia of perineum. Yes, it contains the ischiocavernosus muscle!

Question 18

In the male, during a rectal examination, each of the structures below can be palpated
(felt) EXCEPT for the:
a. prostate
b. sacrum
c. ductus deferens
d. coccyx
e. ischial tuberosity

Answer 18

C

Question 19

What are the walls of the ischorectal fossa?
Lateral wall:
Medial wall:
Inferior wall:
Superiomedial wall:
Superiolateral wall:

Answer 19

Lateral wall: Ischium, obturator internus muscle (D), sacrotuberous ligament Medial wall: Levator ani muscle (A)
Inferior wall: Deep perineal pouch
Superiomedial wall: Levator ani muscle (A)
Superiolateral wall: Obturator internus muscle (D)

Question 20

In the male, the pelvic diaphragm separates the:
a. true pelvis from the false pelvis
b. lesser and greater sciatic notches
c. perineum from the ischiorectal fossa
d. deep perineal pouch from the superficial perineal pouch
e. pelvis from the ischiorectal fossa

Answer 20

E

Question 21

EachofthefollowingcrossesthepelvicbrimEXCEPTthe:
a. vas deferens
b. uterine artery
c. ureters
d. middle sacral artery
e. internal iliac artery

Answer 21

B.
(A) Refer to Gray’s Anatomy Page 424 (Fig 5.2B, In Men). It is evident that the vas deferens/ ductus deferens crosses the pelvic brim.
(B) The uterine artery arises from the interior division of the internal iliac artery. It supplies the uterus. It does not pass the pelvic brim because it originates and terminates inside the pelvis.
(C) The ureters arise from the kidneys at the posterior abdominal wall (upper parts) and have to travel to the bladder that sits on the pelvic floor. It definitely has to pass through the pelvic brim.
(D): The middle sacral artery/ median sacral artery is a small vessel that arises posterior to abdominal aorta and superior to its bifurcation. It descends in the middle line in front of the 4th and 5th lumbar vertebrae, the sacrum and coccyx, ending in the glomus coccygeum. From the description of its path, it definitely passes through the pelvic brim.
(E): From the diagrams, the internal iliac artery crosses the pelvic brim.

Question 22

A needle in the vagina can be used to determine fluid-dependent spaces within the
peritoneal cavity. Which of the following peritoneal spaces would most likely
accumulate fluid?
a. Vesicouterine pouch
b. Pararectal space
c. Rectouterine pouch (of Douglas)
d. Paravesical space
e. Retropubic space

Answer 22

C. As the lowest part of the peritoneal cavity, fluids tend to gravitate and collect in the rectouterine pouch

Question 23

While doing a suprapubic puncture to empty a fully distended urinary bladder, all
the following structures may be encountered EXCEPT
A. Scarpa’s (membranous) fascia.
B. rectus abdominis.
C. transversalis fascia.
D. rectus sheath.
E. peritoneum.

Answer 23

E. The peritoneum is located superior to the bladder and would not be encountered during a suprapubic puncture, as the needle is inserted into the bladder below the peritoneal reflection. Entering the peritoneal cavity during this procedure could lead to serious complications such as bowel perforation.

Question 24

The functions of the Sertoli cells of the testis include all the following EXCEPT
A. supporting spermatogenesis.
B. forming the blood-testis barrier.
C. secreting testosterone.
D. facilitating maturation of spermatozoa.
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E. providing physical support to the seminiferous tubule.

Answer 24

C

Question 25

In an ovarian mid-cycle, ovulation is triggered by a surge of
A. progesterone
B. estrogen
C. follicle stimulating hormone (FSH)
D. oxytocin
E. luteinizing hormone (LH)

Answer 25

E

Question 26

All the following functions may be affected in a 44-year-old man following an
injury to the pudendal nerve EXCEPT
A. touch sensation from the scrotal skin.
B. sensation of distended urinary bladder.
C. urinary continence.
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D. bowel continence.
E. pain sensation from the anal canal.

Answer 26

B. The pudendal nerve primarily provides sensory and motor innervation to the perineum, external genitalia, and anal region.

Question 27

Mesoderm gives rise to all the following structures in the testis EXCEPT the
A. connective tissue.
B. tunica vaginalis.
C. Sertoli cells.
D. Leydig cells.
E. spermatogonia

Answer 27

E. Spermatogonia are the germ cells responsible for sperm production. They originate from primordial germ cells, which arise from the epiblast and migrate into the developing gonads during embryogenesis.

Question 28

During embryonic development of the ovary, follicular cells are derived from the
A. cortical cords.
B. hindgut.
C. paramesonephric ducts.
D. primordial germ cells.
E. yolk sac.

Answer 28

A. Cortical cords: The epithelium of the genital ridge proliferates to form cortical cords, which surround the oogonia.

Question 29

Differentiation of the Wolffian duct in the male results in the formation of the
A. testis.
B. penis.
C. scrotum.
D. vas deferens.
E. penile urethra.

Answer 29

D

Question 30

At the time of fertilization, the secondary oocyte is arrested at
A. prophase of the last mitosis
B. prophase of meiosis-I
C. metaphase of meiosis-I
D. prophase of meiosis-II
E. metaphase of meiosis-II

Answer 30

E

Question 31

During pregnancy, which one of the following hormones controls the conversion
of the epithelial cells to secretory cells for milk production?
A. Progesterone
B. Estrogen
C. Oxytocin
D. Prolactin
E. Human placental lactogen (hPL)

Answer 31

A

Question 32

The pudendal nerve supplies the following EXCEPT
A. anal canal.
B. perineal muscles.
C. scrotum.
D. penile (spongy) urethra.
E. detrusor muscle.

Answer 32

D

Question 33

Special histological types of breast carcinomas are generally associated with a
better prognosis than ductal and lobular carcinomas. A special type of breast
carcinoma with pleomorphic neoplastic cells, many mitoses and prominent
lymphoid infiltrate is called:
A. Tubular carcinoma
B. Papillary carcinoma
C. Mucinous carcinoma
D. Metaplastic carcinoma
E. Medullary carcinoma

Answer 33

E. Pleomorphic nuclei that are high-grade.
A prominent lymphocytic infiltrate surrounding the tumor, which may help contain its spread.

Question 34

Which test should be included as part of routine antenatal follow-up?
A. Hepatitis A antibody
B. Hepatitis C antibody
C. Hepatitis B DNA
D. Toxoplasma antibody
E. HIV antibody

Answer 34

E

Question 35

Genital infection with which of the following pathogens is associated with an
increased risk of ectopic pregnancy?
A. Candida albicans
B. Treponema pallidum
C. Gardnerella vaginalis
D. Chlamydia trachomatis
E. Haemophilus ducreyi

Answer 35

D

Question 36

A 35-year-old man developed urethral discharge a few days after having sex
with a new partner. His doctor took a urethral smear and found Gram-negative
diplococci. Select the BEST answer?
A. Serology for syphilis is routinely performed in patients with gonorrhoea
B. As the urethral smear was positive, further tests are unnecessary
C. Empirical therapy for gonorrhoea is oral azithromycin
D. Neisseria gonorrhoeae has a polysaccharide capsule
E. Vaccinate contacts of patients with gonorrhoea

Answer 36

A. Serology for syphilis is routinely performed in patients with gonorrhoea.
Explanation of Each Option
A. Serology for syphilis is routinely performed in patients with gonorrhoea.
This statement is correct. It is common practice to perform serological testing for syphilis in patients diagnosed with gonorrhea due to the high rate of co-infection with sexually transmitted infections (STIs). This helps in early detection and treatment of syphilis.
B. As the urethral smear was positive, further tests are unnecessary.
This statement is incorrect. While a positive urethral smear for Gram-negative diplococci suggests gonorrhea, further testing (such as for chlamydia and other STIs) is often warranted for comprehensive management.
C. Empirical therapy for gonorrhoea is oral azithromycin.
This statement is misleading. Current guidelines recommend dual therapy for gonorrhea, typically involving an injectable cephalosporin (like ceftriaxone) combined with azithromycin, rather than azithromycin alone due to concerns about resistance.
D. Neisseria gonorrhoeae has a polysaccharide capsule.
This statement is incorrect. Neisseria gonorrhoeae does not have a polysaccharide capsule; it has a complex outer membrane structure but lacks a classic capsule like some other bacteria.
E. Vaccinate contacts of patients with gonorrhoea.
This statement is incorrect. There is currently no vaccine available for gonorrhea, and vaccination of contacts is not part of standard practice.

Question 37

A neonate aged two weeks was admitted with meningitis. Select the BEST
answer?
A. The absence of a rash excludes Neisseria meningitidis
B. A cephalosporin such as ceftriaxone is sufficient monotherapy
C. Late-onset disease is associated with Escherichia coli
D. Bordetella pertussis causes meningitis in this age group
E. The CSF-to-blood glucose ratio is reduced in bacterial meningitis

Answer 37

E. In cases of bacterial meningitis, the glucose levels in cerebrospinal fluid (CSF) are typically lower than those in the blood due to the consumption of glucose by bacteria and inflammatory cells. A reduced CSF-to-blood glucose ratio is a classic finding in bacterial meningitis and is critical for diagnosis.

Question 38

A 24-year-old woman was in a car that was involved in a road traffic accident.
She was seen by her family physician, and was prescribed some oral
analgesics. A month later, she noticed a painless swelling in her breast. The
biopsy revealed fat surrounded by epithelioid histiocytes, multinucleated giant
cells and chronic inflammation. What is the LIKELY diagnosis?
A. Fat necrosis
B. Tuberculous mastitis
C. Foreign body implantation
D. Sarcoidosis
Fungal mastitis

Answer 38

A. Fat necrosis
Explanation
Clinical Context:
The patient experienced trauma from a car accident, which is a common precipitating factor for fat necrosis in the breast.
Histopathological Findings:
The biopsy revealed fat surrounded by epithelioid histiocytes, multinucleated giant cells, and chronic inflammation. These findings are characteristic of fat necrosis, which occurs when fat tissue is damaged (often due to trauma or surgery), leading to necrosis of adipocytes and subsequent inflammatory response.
Differential Diagnosis:
Fat Necrosis: Typically presents with a history of trauma and shows necrotic fat with inflammatory cells, including giant cells.
Tuberculous Mastitis: Would show caseating granulomas and is less likely in this context without other systemic symptoms.
Foreign Body Implantation: Would typically show foreign body giant cells but would not be associated with the history of trauma unless there was an implant.
Sarcoidosis: Would present with non-caseating granulomas and systemic symptoms, which are not indicated here.
Fungal Mastitis: Uncommon and would usually present with a different set of clinical features.

Question 39

Which types of human papillomavirus is associated with condyloma
accuminatum of the penis?
i. Type 6
ii. Type 11
iii. Type 16
iv. Type 18
A. i and ii
B. ii and iii
C. iii and iv
D. ii and iv
E. i and iii

Answer 39

A

Question 40

Phyllodes tumour (PT) of the breast is a stromal neoplasm. Which of the
following statements regarding the characteristics of PT is CORRECT?
A. Typically displays low mitotic rate (<1 per high-power field)
B. Arises from extra-lobular stroma
C. Displays very low cellularity
D. Lymphatic spread is common
E. Most are low-grade tumours

Answer 40

E.

Question 41

A 25-year-old woman presented with a 1-cm lump in her left breast. The lump
was firm and mobile. Biopsy of the lump showed proliferation of benign glands
and stromal components. What is the MOST likely diagnosis?
A. Fibroadenoma
B. Invasive ductal carcinoma
C. Ductal carcinoma in situ
D. Fibrocystic change
E. Fat necrosis

Answer 41

A. Fibroadenoma
Explanation
Clinical Presentation:
The lump is described as firm and mobile, which is characteristic of fibroadenomas. They are common benign breast tumors that typically present in younger women, particularly in their late teens to early 30s.
Biopsy Findings:
The biopsy showed proliferation of benign glands and stromal components, which is typical for fibroadenomas. These tumors consist of both glandular (epithelial) and stromal (connective tissue) components, leading to their characteristic appearance.
Differential Diagnosis:
Invasive Ductal Carcinoma (B): This would typically show malignant features on biopsy, such as atypical cells and invasion into surrounding tissues.
Ductal Carcinoma In Situ (C): This condition would show abnormal cells confined to the ducts without invasion, but it does not present as a palpable mass in the same way as a fibroadenoma.
Fibrocystic Change (D): This condition usually involves cysts and fibrous tissue changes, often associated with pain or tenderness, and does not typically present as a discrete firm lump.
Fat Necrosis (E): This usually occurs after trauma or surgery and presents as a firm, round mass but is associated with a history of injury to the breast tissue.

Question 42

Concerning the diagnosis of genital herpes simplex virus (HSV) infection,
which of the following statement is FALSE?
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A. Assays demonstrating the presence of HSV DNA in a vesicle swab are the
most sensitive
B. The clinical features of recurrent genital herpes are so distinctive that
laboratory confirmation is not required
C. The presence of antibodies specific for HSV-2 in a blood sample is not
diagnostic
D. The diagnosis can be aided by immunofluorescent antigen detection using
cells scraped from the base of a genital ulcer
E. The virus can be isolated in cell culture from a sample of vesicle fluid

Answer 42

B

To determine which statement regarding the diagnosis of genital herpes simplex virus (HSV) infection is FALSE, let’s evaluate each option:
A. Assays demonstrating the presence of HSV DNA in a vesicle swab are the most sensitive
True: Nucleic acid amplification tests (NAATs), such as PCR, are highly sensitive and specific for detecting HSV DNA from vesicle swabs. This method is considered the gold standard for diagnosing active HSV infections.
B. The clinical features of recurrent genital herpes are so distinctive that laboratory confirmation is not required
False: While recurrent genital herpes can have characteristic clinical features, laboratory confirmation is often recommended to ensure accurate diagnosis, especially in atypical cases or to differentiate from other conditions.
C. The presence of antibodies specific for HSV-2 in a blood sample is not diagnostic
True: The presence of antibodies indicates exposure to the virus but does not confirm an active infection. Serological tests can show past infections but cannot determine whether a current outbreak is occurring.
D. The diagnosis can be aided by immunofluorescent antigen detection using cells scraped from the base of a genital ulcer
True: Immunofluorescent assays can be used to detect HSV antigens from samples taken from lesions, aiding in diagnosis.
E. The virus can be isolated in cell culture from a sample of vesicle fluid
True: HSV can be cultured from vesicular fluid, although this method is less sensitive than NAATs and may yield false negatives if the lesion is healing or if the sample is not collected properly.

Question 43

A 27-year-old woman, who was 12-weeks pregnant, presented with a diffuse
morbilliform rash and small joint polyarthropathy. The following are her
serology results:
* anti-rubella IgG positive, anti-rubella IgM negative
* anti-parvovirus IgG positive, anti-parvovirus IgM positive
Which of the following is the MOST likely outcome of her pregnancy?
A. A normal healthy baby
B. A baby with multiple congenital abnormalities
C. A baby with congenital deafness
D. A baby with congenital microcephaly
E. A baby with congenital bilateral cataracts

Answer 43

A
In the case of the 27-year-old woman who is 12 weeks pregnant and has serology results indicating positive anti-parvovirus IgG and IgM, along with positive anti-rubella IgG and negative IgM, we need to analyze the implications of these findings for her pregnancy outcome.
Serology Interpretation
Anti-Rubella IgG Positive, Anti-Rubella IgM Negative:
This indicates that she has immunity to rubella, likely from a past infection or vaccination. There is no active rubella infection at this time, which means there is no risk of congenital rubella syndrome.
Anti-Parvovirus IgG Positive, Anti-Parvovirus IgM Positive:
The presence of both IgG and IgM antibodies to parvovirus B19 suggests a recent or current infection. Parvovirus B19 can cause complications in pregnancy, particularly during the first and second trimesters.
Potential Outcomes
Congenital Anomalies from Parvovirus B19: Infection with parvovirus B19 during pregnancy can lead to fetal complications such as:
Hydrops fetalis: A serious condition where excess fluid accumulates in the fetus.
Anemia: Due to the virus’s effect on red blood cell production.
Congenital Abnormalities: While parvovirus B19 is primarily associated with anemia and hydrops fetalis, it does not have a well-established link to specific congenital abnormalities like those seen with other infections (e.g., rubella).
Analysis of Options
A. A normal healthy baby:
Unlikely due to the recent parvovirus infection.
B. A baby with multiple congenital abnormalities:
Not typically associated with parvovirus B19.
C. A baby with congenital deafness:
Congenital deafness is more commonly associated with rubella, not parvovirus B19.
D. A baby with congenital microcephaly:
Microcephaly is also associated with infections like Zika or rubella but not specifically with parvovirus B19.
E. A baby with congenital bilateral cataracts:
Congenital cataracts are primarily linked to maternal infections like rubella but not parvovirus B19.
Conclusion
Given the serology results indicating a recent parvovirus infection and the absence of active rubella infection, the most likely outcome of her pregnancy would be complications related to parvovirus B19 rather than specific congenital abnormalities typically associated with other infections.
Therefore, while none of the options perfectly fit the scenario, the best interpretation based on the information given would be:
A. A normal healthy baby

Question 44

Pregnant lady presents with ?faintness and a thready pulse. She was detected to have a normally implanted placenta with a retroplacental hematoma. Which best describes the patient’s condition?
A. Placenta accreta
B. Placentaincreta
C. Placentapercreta
D. Placentaabruptio
E. Placenta praevia

Answer 44

D. This conclusion is based on the presentation of faintness and a thready pulse, which are indicative of potential hemorrhagic shock, often associated with placental abruption. The presence of a retroplacental hematoma further supports this diagnosis, as it is a common finding in cases of abruptio placentae. In contrast, conditions like placenta accreta, increta, and percreta involve abnormal implantation of the placenta but do not typically present with acute symptoms like faintness and a thready pulse due to hemorrhage

Question 45

Lady with lump in outer upper breast. Imaging-guided biopsy was done. Histology shows fibrocystic change with apocrine metaplasia and epithelial hyperplasia and some calcifications. Which of the following courses of action would be most appropriate? (This was a pyp question)
A. Do a breast MRI to further investigate
B. RepeattheBiopsy
C. Reassurancecanbegivenasthisisabenignfinding
D. Mastectomyasthisisamalignantfinding
E. Do an excisional biopsy so that you can examine more tissue

Answer 45

C

Question 46

28yo guy presents with enlargement of testicle. Markedly raised AFP and hCG. Cut surface is variegated in colour. Which is the most likely cause of the enlargement?
A. Seminoma
B. Mixedgermcelltumour
C. Filariasis
D. Lymphoma E. Tuberculosis

Answer 46

B. Elevated Tumor Markers:
AFP is typically elevated in non-seminomatous germ cell tumors, particularly in yolk sac tumors and embryonal carcinoma.
hCG can be elevated in both seminomas and non-seminomatous germ cell tumors, especially those with choriocarcinoma components.
Variegated Cut Surface:
The description of a “variegated” cut surface is indicative of mixed germ cell tumors, which often contain different types of germ cell components (e.g., seminoma, embryonal carcinoma, teratoma).

Question 47

40 year old woman with microcalcifications detected on mammography. Advised to undergo wide excision of the affected area, but no adjuvant radiotherapy or chemotherapy was required.
A. Usual type ductal hyperplasia
B. Fibroadenoma
C. Ductal carcinoma in situ
D. Phyllodes tumour
E. Mucinous carcinoma

Answer 47

C. This is a slightly tricky question if you are not familiar with the microscopic appearance of DCIS, but the question drops a few hints. Firstly, “microcalcifications” is a nod towards the typical radiological findings of high-grade DCIS, although we should be wary that microcalcifications are often a benign finding and do not mean there is cancer. Secondly, wide excision was required but no adjuvant radiotherapy or chemotherapy was needed. The wide excision rules out the possibility of A and B, and the lack of any precautionary radio/chemotherapy suggests that E is unlikely (since it is cancer).

Microcalcifications are more associated with DCIS than phyllodes tumour, and were specifically mentioned by Prof Putti in his breast patho lecture, so it is most likely to be the answer.

Question 48

Which of the following molecular categories is the most common in invasive breast carcinoma?

A) ER+, HER2 equivocal
B) ER+, HER2+
C) ER-, HER2-
D) ER+, HER2-
E) ER-, HER2+

Answer 48

D. Based on the molecular subtypes of invasive breast cancer, the ‘Luminal A’ subtype is the most common (~ 50%) and corresponds to ER/PR positive and HER2 negative.

Question 49

An elderly man has developed poor urinary stream. He has a prostatic condition that is pathologically depicted in the attached figure. Picture of BPH
A. Metastases occur most often to the bones and lungs
B. Androgenic stimulation plays a key role in the pathogenesis
C. Per-rectal examination causes exquisite pain
D. The condition preferentially affects younger men
E. Prostatic specific antigen is invariably within the normal range

Answer 49

B

Question 50

An elderly man developed a left-sided testicular tumour. Which of the following is MOST LIKELY the tumour?
A. Seminoma
B. Yolk sac tumour
C. Sertoli-Leydig cell tumour
D. Lymphoma
E. Embryonal carcinoma

Answer 50

D. Elderly man + testicular tumor = lymphoma
This is to distinguish top performing students.
A is common for all age groups, but since it is an elderly man, more likely to be a lymphoma.

Question 51

Which of the following matches the breast cancer with the appropriate presentation?
A. Intraductal carcinoma in situ- Malignant cells in ducts, causing ductal expansion
B. Mucinous carcinoma - Intracellular mucin
C. Phyllodes tumour - Well circumscribed
D. Invasive ductal carcinoma - Leaf like extensions

Answer 51

A. Intraductal carcinoma in situ (DCIS) involves malignant cells in the ducts limited by the basement membrane i.e. these cells are contained by the basement membrane. DCIS tends to fill and distort ductal spaces.
Mucinous carcinoma - tumor cells are arranged in clusters and small islands of cells within large lakes of extracellular mucin
Phyllodes tumour - not fully circumscribed, with tongues of tumour going into adjacent tissue
Invasive ductal carcinoma - several molecular subtypes fall under ductal NOS, but leaf-like extensions are more characteristic of phyllodes tumour (hence the name phyllodes)

Question 52

Young Patient with mobile breast lump excised. The gross and histology are shown below. What is the most likely diagnosis?

1. Medullary carcinoma
2. Phyllodes Tumour
3. Invasive ductal carcinoma
4. Fibroadenoma
5. Intraductal Papilloma

Answer 52

D. The history of a young patient with mobile breast lump should already point us towards the most likely diagnosis. The gross shows us a well-circumscribed, pale, firm mass with a homogeneous cut surface. In the histology, we see a loose fibroblastic stroma containing ductlike, epithelium-lined spaces lined by luminal and myoepithelial cells with a well-defined, intact basement membrane.
The most likely diagnosis is therefore a fibroadenoma, which is very common in young women.

Question 53

Which of Paget’s disease of the breast is the MOST CORRECT?
1. it is a pattern of spread of invasive ductal carcinoma
2. it is a pattern of eczematous dermatitis
3. it is a pattern of spread of intraductal carcinoma
4. it is a pattern of spread of phyllodes tumour
5. it is a pattern of nipple change due to fibrocystic changes

Answer 53

C. As mentioned by Prof Putti during his lecture, Paget’s disease follows a pattern of spread of intraductal carcinoma - which is in fact ductal carcinoma in-situ or DCIS. Just to be clear, an intraductal carcinoma is therefore actually a pre-cancerous lesion of the breast, in spite of its name!

The pattern of spread of Paget’s disease of the breast is proliferation of malignant cells in the lining of a breast duct without evidence of spreading outside the duct to other tissues in the breast or outside the breast - aka intraductal carcinoma pattern of spread. The tumour cells proliferate and spread along the inside of the ducts towards the nipple and eventually the surrounding areola.

Question 54

A 52 year old woman presents with a 6 cm breast lump. It is a well-circumscribed tumor with high spindle cell stroma, epithelial (structure?) and leaf like configuration. The surgeon excised it. What is most TRUE about it?
1. It causes Paraneoplastic syndrome
2. Clinical observation rather than surgical resection is recommended
3. Tumor Grade is based on nuclear features
4. It commonly metastasizes to axillary lymph node
5. Common recurrence after surgical resection

Answer 54

E. This is likely to be a Phyllodes tumour, based on the description given (stromal + epithelial structures, leaf like configurations). Phyllodes tumours are non-cancerous tumours, and do not commonly metastasise to axillary lymph nodes. They are not known for causing paraneoplastic syndrome. However, they are known for having a higher chance of turning malignant as compared to fibroadenomas and tend to grow quite large compared to normal fibroadenomas - therefore, they are routinely recommended for resection. Therefore, A, B and D are incorrect.

C is incorrect because the grading of a Phyllodes tumour (which can be predictive of how likely it is to turn malignant) is based on not just nuclear features, but also degree of stromal atypia, infiltrative tumour margins, presence of stromal overgrowth. From there, they are classified as being benign, borderline or malignant.

E is the answer, and it is indeed true that Phyllodes tumours are known for commonly recurring after surgical resection.

P.S. according to UpToDate, Phyllodes tumours have a high rate of recurrence due to the wide margin of excision required - which means that if not enough of the normal breast tissue surrounding the tumour is removed, there is a high chance of recurrence. This is also due to Phyllodes tumours being mistaken for fibroadenomas, which only require local excision.

Question 55

18 year old girl presents with primary amenorrhea and has normal secondary sex characteristics and no significant family history. The doctor should order the following tests EXCEPT
a. Testosterone
b. Oxytocin
c. hCG
d. FSH
e. LH

Answer 55

B. Testosterone, FSH and LH; all on the hypo-pituitary axis for estrogen (our suspect)
hCG - Pregnancy. Contentious option because its very unlikely that the girl could get pregnant when she had amenorrhea, but there are some high level clinical reasoning shit where essentially some conditions can have a small proportion of women conceive despite having premature ovarian failure (i.e. both pregnancy and premature ovarian failure can cause primary amenorrhea), so some drs opt to check hCG as well…
At the very least, oxytocin is the worst option here.

Question 56

A girl presents with primary amenorrhea. The doctor should proceed to test all the following hormones except:
a. Aldosterone
b. Oestradiol
c. Prolactin
d. Follicle Stimulating Hormone
e. Human chorionic gonadotropin (HCG)

Answer 56

A

Question 57

59. Which of the following statements about the ovaries is false?
    a. The ovaries descend into pelvis before birth.
    b. The left ovarian vein drains into the left renal vein
    c. Folliculogenesis takes place in the ovarian medulla
    d. The ovary attaches to the uterus by the ovarian ligament

Answer 57

C. No it is in the ovarian cortex

Question 58

Which of these observations is NOT CONSISTENT with a male diagnosed with 5-α reductase deficiency?
A. Patient is infertile
B. Patient has no male internal genitalia
C. Patient is likely to have female external genitalia
D. Patient has levels of testosterone as in a normal male
E. Patient has normal androgen receptor function

Answer 58

D

Question 59

Oxytocin is produced in ____, and secreted by _____.
A. hypothalamus; posterior pituitary
B. hypothalamus; anterior pituitary
C. hypothalamus; corpus luteum
D. anterior pituitary; corpus luteum
E. posterior pituitary; corpus luteum

Answer 59

A

Question 60

The ulnar nerve innervates the following structures EXCEPT:
A. Opponens Pollicis
B. 4th lumbrical
C. Palmar interossei
D. Dorsal interossei
E. Adductor pollicis

Answer 60

A. Innervate everything except thenar muscles and first 2 lumbrical

Question 61

In a normal, healthy 25-year old woman
a. Plasma LH is lowest concentration during 2 days prior to ovulation
b. Plasma FSH is lowest concentration during 2 days prior to ovulation
c. Plasma estrogen concentration is at its lowest during 2 days prior to ovulation
d. Ovulation is followed by a decline in plasma estrogen
e. Ovulation is followed by decline in plasma progesterone

Answer 61

D. Fall in FSH leads to reduced secretion of estrogen

Question 62

What is the cause of involution of corpus luteum?
a. Low levels of LH
b. Low estrogen and progesterone in blood
c. High levels of FSH secreted from anterior pituitary
d. High levels of hCG in blood
e. Onset of menstruation

Answer 62

A. Fall in the level of LH is what causes degeneration of corpus luteum

Question 63

Prolactin is regulated in a non-pregnant woman by:
A. oestrogen
B. progesterone
C. dopamine
D. LH
E. FSH

Answer 63

C. Dopamine (aka Prolactin inhibiting hormone/PIH) suppresses prolactin release from ant. Pituitary

Question 64

Sertoli cells produce:
a. mucus
b. androgen-binding protein (ABP)
c. testosterone
d. FSH and LH

Answer 64

B. Androgen binging protein (aka androgen receptor) is necessary for Sertoli cells to respond to testosterone, which modulates spermatogenesis. Testosterone is produced by Leydig cells while the anterior pituitary produces FSH and LH

Question 65

During ovulation all of the following occur EXCEPT:
a. rupture of the Graafian follicle
b. estrogen production is very low
c. FSH and LH production is high
d. formation of the corpus luteum

Answer 65

B. During ovulation, estrogen levels are high; this triggers the release of large amounts of FSH and LH from the Pituitary to cause ovulation

Question 66

The placenta is fully developed by the _____ month if gestation:
a. 1st
b. 3rd
c. 5th
d. 7th

Answer 66

B. The placenta grows during the 1st trimester

Question 67

The lateral wall of the ischiorectal fossa is the:
a. levator ani muscle
b. external anal sphincter
c. internal anal sphincter
d. obturator internus muscle
e. obturator externus muscle

Answer 67

D. Lateral wall: Ischium, obturator internus muscle (D), sacrotuberous ligament Medial wall: Levator ani muscle (A)
Inferior wall: Deep perineal pouch
Superiomedial wall: Levator ani muscle (A)
Superiolateral wall: Obturator internus muscle (D)

Question 68

Which of the following leaves the pelvis by passing through the lesser sciatic foramen?
a. piriformis muscle
b. pubococcygeus muscle
c. obturator internus muscle
d. inferior gluteal nerve
e. iliacus muscle

Answer 68

C. The obturator internus muscle passes through the LESSER SCIATIC FORAMEN to enter the gluteal region!

Question 69

Each of the following crosses the pelvic brim EXCEPT the:
a. vas deferens
b. uterine artery
c. ureters
d. middle sacral artery
e. internal iliac artery

Answer 69

B. The uterine artery arises from the interior division of the internal iliac artery. It supplies the uterus. It does not pass the pelvic brim because it originates and terminates inside the pelvis.

Question 70

Which of the following cannot be observed in the light microscopy slides of the testis?
a. Spermatids
b. Spermatocytes in various stages of development
c. Seminiferous tubules
d. Leydig cells
e. Sertoli cells in the interstitial spaces of seminiferous tubules

Answer 70

E. SERTOLI CELLS ARE FOUND IN THE SEMINIFEROUS TUBULES, NOT THE INTERSTITIAL SPACES!!! (LEYDIG)

Question 71

19. Benign enlargement of the prostate gland often involves the median lobe, which:
    a. is 1 of 4 lobes
    b. is immediately posterior to the internal urethral orifice
    c. has ejaculatory ducts opening into it
    d. contains serous acini

Answer 71

B.
A: Wrong since we are using the traditional “lobes” as opposed to zones. Using the old method of “lobes”, the prostate is divided anatomically into 5 lobes- anterior lobe (isthmus), posterior lobe, 2 lateral lobes and median/middle lobe.
B: Correct. The internal urethral orifice is the opening of the urinary bladder into the urethra. The mucous membrane immediately behind it presents a slight elevation in males, the uvula vesicae, caused by the middle lobe of the prostate. (Original answer)
C: False. The ejaculatory ducts open into the urethra.
D: False. Serous acini/ serous glands not present in prostate.

Question 72

A 65-year-old man with a history of prostatic enlargement complained that he could
not micturate. The last time that he passed urine had been 6 hours previously. He was
found lying on his bed in great distress, clutching his anterior abdominal wall with
both hands and pleading for something to be done quickly. Q. On examination, a large
ovoid swelling could be palpated through the abdominal wall above the symphysis
pubis. In this patient the following statements are correct except which?
a. In the adult, the urinary bladder is a pelvic structure.
b. When the bladder fills the superior wall of the bladder rises out of the pelvis.
c. When the bladder becomes filled it never reaches a level above the umbilicus.
d. The swelling is dull on percussion.
e. Pressure on the swelling exacerbates the symptoms

Answer 72

C.
A: Obviously true. It is the most anterior of the pelvic viscera.
B: True, a filled bladder expands superiorly out of the pelvis into the abdominal cavity.
D: True, a bladder that is full (which is true in this case) is dull on percussion. Dullness indicates presence of a solid mass under the surface, a resonant sound indicates hollow/ air-containing structures.
E: Pressure on the swelling further increases pressure within the bladder. Evidently, it will contribute to pain!

Question 73

A 28-year-old pregnant woman was very frightened by the thought of going through
the pain of childbirth. She asked her obstetrician if it was possible to relieve the pain
without having a general anesthetic. She was told that she could have a relatively
simple procedure called caudal anesthesia. Q. When performing caudal anesthesia,
the syringe needle is inserted into the sacral canal by piercing the following anatomic
structures except which?”
a. Skin
b. Fascia
c. Ligaments
d. Sacral hiatus
e. Dura mater

Answer 73

E. The epidural space is the space inside t

Question 74

Besides the vas deferens, the following structures pass through the spermatic cord EXCEPT:
a. testicular artery
b. pampiniform venous plexus
c. artery to vas deferens
d. testicular lymph vessels
e. iliohypogastric nerve

Answer 74

E. The spermatic cord contains:
* The ductus deferens and its associated vessels
* Pampiniform venous plexus which drains the testis
* Testicular artery
* Testicular lymph vessels (which drain towards the para-aortic lymph nodes)
The ilioinguinal nerve accompanies the spermatic cord through the inguinal canal, and exits through the superficial inguinal ring, medial to the inferior epigastric artery.

Question 75

Lowest (Most dependent) space in the female peritoneal cavity is
a. Lesser sac
b. pararectal space
c. ischiorectal fossa
d. Pouch of douglas
e. paravesical space

Answer 75

D. The rectouterine pouch (of Douglas) is the lowest and gravity-dependent space in the female peritoneal cavity. Extravasation of urine or blood may cause an accumulation of fluid in the pouch of Douglas and the accumulation may be palpated via a digital vaginal examination via the posterior fornix of the vagina.
Other gravity-dependent recesses in the body include the hepatorenal recess (also known as Morrison’s pouch). Accumulation of fluid in the Morrison’s pouch can be visualized via an ultrasound scan

Question 76

Vas Deferens:
a. inactive during ejaculation
b. May be palpated up of scrotum
c. long lumen thin muscular wall
d. open directly to prostatic urethra
e. pass medially to inferior epigastric artery at deep inguinal ring

Answer 76

B
(a) The vas deferens is active during ejaculation, more accurately during emission. During emission,
* The smooth muscles of the prostate gland contracts, secreting prostatic fluid into the prostatic urethra
* Peristalsis of the ductus deferens and seminal glands delivers the semen and other glandular secretions to the ejaculatory duct, which empties into the urethra via tiny apertures on the seminal colliculus.
(b) The vas deferens may be palpated through the thin wall of the scrotum.
(c) The vas deferens is indeed a long duct which carries sperm from the epididymis (the cauda part being the reservoir where the sperms are stored) to the ejaculatory duct. It has a minute lumen and relatively thick muscular wall.
(d) The vas deferens DOES NOT open directly to the prostatic urethra. It first fuses with the duct of the seminal vesicle to form the ejaculatory duct, which then opens into the prostatic urethra via tiny apertures on the seminal colliculi.
(e) It passes laterally to the inferior epigastric artery at the deep inguinal ring. Recall the extents of the inguinal canal. The superficial inguinal ring is located medial to the inferior epigastric artery while the deep inguinal ring is located lateral to the artery.

Question 77

The structure at greatest risk when ligating(tying) the uterine artery near the broad ligament during the surgical removal of uterus (Hysterectomy) is the
a. Obturator nerve
b. middle rectal artery
c. ureter
d. Fallopian tube
e. round ligament

Answer 77

C. This is because the ureter crosses under the uterine artery near the broad ligament and there’s a good chance that the surgeon mistakenly ligates the ureter instead of the uterine artery during a hysterectomy procedure. One way of recalling the relations between the two is “water under the bridge”.
The ureters travel UNDER the uterine arteries.
In males, the ureters travel inferior to the ductus deferens.

Question 78

The glandular epithelium of the prostate is most commonly
a. Transitional
b. Stratified squamous
c. Simple columnar
d. Simple squamous
e. Simple cuboidal

Answer 78

C. * Simple columnar epithelium: Characterized by a single layer of elongated epithelial cells neatly arranged adjacent to one another. Observed in abundance in the glands of the gastrointestinal tract.
* Simple cuboidal epithelium: Characterized by a single layer of cuboidal epithelial cells, which are most commonly arranged in a circular fashion to form a lumen; observed in the renal tubules (thick limbs of the loop of Henle and the distal convoluted tubule)

Question 79

Which one of the following statements regarding the vagina is FALSE?
a. It usually lies at an angle of 90
b. It is related on its lateral side to the ureter
c. It has lymphatic drainage to both iliac and superficial inguinal nodes
d. It is lined by squamous epithelium
e. It develops from the mesonephric duct with the uterus

Answer 79

E. The vagina has two embryonic origins: (a) the upper third of the vagina (as well as the uterine tubes, the uterus and cervix) is derived from the paramesonephric (or Müllerian) ducts; (b) the lower two-thirds of the vagina is derived from the sinovaginal bulbs, outpouchings of the urogenital sinus.
It is lined by non-keratinizing stratified squamous epithelium (more commonly known as wear-and-tear epithelium) in order to resist the abrasion during sexual intercourse and parturition. It is supplied by the vaginal arteries and the vaginal branches of the uterine arteries. Venous blood is drained from the vagina via the vaginal venous plexus, continuous with the uterine venous plexus. Lymph from the vagina is drained towards quite a number of lymph nodes: the upper third primarily towards the internal iliac nodes (the anterior fornix towards the external iliac nodes), the body towards the sacral nodes and the inferior part of the vagina closer to the vaginal orifice towards the superficial inguinal nodes.
Laterally, it is related to the ureters, visceral pelvic fascia and the levator ani muscle; anteriorly, it is related to the fundus of the urinary bladder and the urethra; and posteriorly, it is related to the rectum and the recto-uterine pouch.

Question 80

Impaired erectile function following surgery in pelvis is most likely from damage to:
a. Pudendal Nerve
b. Pelvic Plexus
c. Lumbosacral Plexus
d. Sympathetic Chain
e. Sacral Splanchnic Nerve

Answer 80

B. Recall that erection of the penis is mediated by parasympathetic nerve fibres. For instance, relaxation of the smooth muscles of the fibrous trabeculae and the helicine arteries (and subsequent dilation of the helicine arteries) is mediated by the cavernous nerves of the prostatic nerve plexus, a continuation of the inferior hypogastric plexus (also known as the pelvic plexus). So if the pelvic plexus is severed, erectile function would certainly be impaired.

Question 81

The following statements concerning the ischiorectal fossa are correct except which?
a. The pudendal nerve lies in its lateral wall.
b. The floor is formed by the superficial fascia and skin.
c. The lateral wall is formed by the obturator internus muscle and its fascia.
d. The medial wall is formed in part by the levator ani muscles.
e. The roof is formed by the urogenital diaphragm.

Answer 81

E.

Question 82

If urine from a rupture of the bulbous urethra were to leak out, where can’t it be possibly found?
a. anterior abdominal wall
b. glans penis
c. shaft of penis
d. scrotum
e. superficial perineal pouch

Answer 82

B. If the bulbous part of the spongy urethra were to be ruptured, urine would extravasate primarily into the superficial perineal pouch, bounded inferiorly by the superficial fascia (Colle’s fascia) and superiorly by the perineal membrane. The urine may pass into the loose connective tissue in the scrotum, around the penis and superiorly, deep to the membranous layer of subcutaneous connective tissue of the inferior anterior abdominal wall. Accumulation of fluid within the scrotum and the penis would cause swelling.
Recall that the glans penis is an expansion of the corpus spongiosum, one of the three cylindrical bodies running inside the penis. It is unlikely that urine extravasates into the corpus spongiosum and the glans penis.

Question 83

The following structures can be palpated by a vaginal examination except which?
a. Sigmoid colon
b. Ureters
c. Perineal body
d. Ischial spines
e. Iliopectineal line

Answer 83

E. The iliopectineal line forms the lateral boundary of the pelvic brim and lies far beyond the reach of a vaginal examination.

Question 84

The following statements concerning the female urethra are correct except which?
a. It lies immediately anterior to the vagina.
b. Its external orifice lies about 2 in. (5 cm) from the clitoris.
c. It is about 1.5 in. (3.75 cm) long.
d. It pierces the urogenital diaphragm.
e. It is straight, and only minor resistance is felt as a catheter is passed through the urethral sphincter.

Answer 84

B. The female urethra, unlike the male urethra, is straight and catheterization is usually much simpler. The sites where the tips of the catheter may face resistance are the external urethral sphincter (which is voluntarily controlled) and the internal urethral sphincter, a muscular band encircling the neck of the bladder (autonomically controlled). It is about 3.75cm in length but for convenience, clinicians usually remember it as approximately 4cm.
The urethral orifice lies immediately anterior to the vagina. This complete separation of the urinary system and the reproductive tract is unlike that in males, whereby the urethra conducts both semen and urine. Anterior to the urethral orifice is the glans clitoris, which lies about 2.5cm away.

Question 85

A 34-year-old man was suffering from postoperative retention of urine after an appendectomy. The patient’s urinary tract was otherwise normal. Because the patient was in considerable discomfort, the resident decided to pass a catheter. Q. The following statements concerning the catheterization of a male patient are correct except which?”
a. Because the external urethral orifice is the narrowest part of the urethra, once the tip of the catheter has passed this point, the further passage should be easy.
b. Near the posterior end of the fossa terminalis, a fold of mucous membrane projects from the roof and may catch the end of the catheter.
c. The membranous part of the urethra is narrow and fixed and may produce some resistance to the passage of the catheter.
d. The prostatic part of the urethra is the widest and most easily dilated part of the urethra and should cause no difficulty to the passage of the catheter.
e. The bladder neck is surrounded by the sphincter vesicae and always strongly resists the passage of the tip of the catheter.

Answer 85

E

Question 86

A 16-year-old boy was taking part in a bicycle race when, on approaching a steep hill, he stood up on the pedals to increase the speed. His right foot slipped off the pedal and he fell violently, his perineum hitting the bar of the bicycle. Several hours later he was admitted to the hospital unable to micturate. On examination, he was found to have extensive swelling of the penis and scrotum. A diagnosis of ruptured urethra was made. Q. The following statements concerning this case are correct except which?”
a. Rupture of the bulbous part of the urethra had taken place.
b. The urine had escaped from the urethra and extravasated into the superficial perineal pouch.
c. The urine had passed forward over the scrotum and penis to enter the anterior abdominal wall.
d. The urine had extended posteriorly into the ischiorectal fossae.
e. The urine was located beneath the membranous layer of superficial fascia.

Answer 86

D. The ischiorectal fossa does not communicate with the superficial perineal space because it is bounded anteriorly by the perineal membrane, which bounds the superficial perineal pouch superiorly. Hence urine does not collect in the ischiorectal fossae.