Download 1. The part of the uterine wall which is not shed during menstruation

1. The part of the uterine wall which is not shed during menstruation
is the:
Endometrium
Myometrium
Mesometrium
Cervical mucosa
Rugae
2. The extension of the vaginal lumen around the intravaginal part of
the uterine cervix is the:
Cervical canal
Uterine lumen
Fornix
Rectouterine Pouch
Uterovesical Pouch
3. Which of the following would be most likely to be damaged by a
stab wound into the ischiorectal (ischioanal) fossa 2 cm lateral to
the anal canal?
Crus of the Penis
Perineal Body
Pudendal Nerve
Inferior Rectal Artery
Vesicular Bulb
4. Lymphatic drainage of the terminal portion of the gastrointestinal
tract may flow initially into either the superficial inguinal nodes or
the pararectal nodes, depending upon whether the lymph is
formed above or below the:
Anorectal Junction
Muscular Sling of the Puborectalis Muscle
Pectinate Line
White Line
Cutaneous Zone
5. Under normal conditions, fertilization occurs in which part of the
female reproductive tract?
Infundibulum of the Uterine Tube
Ampulla of the Uterine Tube
Isthmus of the Uterine Tube
Uterine Lumen
Cervical Canal
6. Benign hyperplasia (excessive growth of cells) of which part of the
male reproductive system would be most likely to interfere with the
passage of urine?
Periurethral Zone of the Prostate
Central Zone of the Prostate
Peripheral Zone of the Prostate
Ejaculatory Duct
Seminal Vesicle
7. After agreeing to have no more children, a man and his wife
decided he should have a vasectomy. What structure would then
be surgically ligated?
Ductus deferens
Ejaculatory duct
Epididymis
Fossa navicularis
Seminal vesicle
8. Which pair of structures does NOT differentiate from comparable
embryonic structures in the male and female?
Bulb of corpus spongeosum and vestibular bulb
Shaft of penis and labia majora
Glans of penis and glans of clitoris
Crus of corpus cavernosum penis and crus of corpus
cavernosum clitoris
9. Which structure does NOT form part of the boundary defining the
trigone of the bladder?
Interuteric crest
Left Ureteric Orifice
Right Ureteric Orifice
Urachus
10.
Urethral Orifice
Which structure is found only in males?
Anterior recess of ischoianal fossa
Genital Hiatus
Ischiocavernosus muscle
Rectovesical pouch
Sphincter urethrae muscle
11.
Which structure is outlined with contrast on a CT using
intraperitoneal contrast material?
Ovary
Prostate
Rectum
Seminal Vesicles
Vagina
12.
The prostate is often imaged using an ultrasound transducer
placed in which location?
Penis
Perineum
Rectum
Urethra
Urinary Bladder
13.
Which of the following is considered a part of the broad
ligament?
Mesovarium
Ovarian ligament
Round ligament of the uterus
Suspensory Ligament of the ovary
14.
Uterosacral ligament
Which of the following does not conduct spermatozoa?
Ampulla of the ductus deferens
Duct of the seminal vesicle
Epididymis
Prostatic Urethra
15.
During the course of surgery for benign prostatic hypertrophy
(benign enlargement of the prostate tissue which occludes the
prostatic urethra) an electrical cutting device is inserted into the
penile, then prostatic urethra, to remove the hypertrophic tissue.
The posterior wall of the prostatic urethra is by necessity removed
as well. Which part of the male seminal tract may also be partially
removed?
duct of seminal vesicle
ductus deferens
ejaculatory duct
fossa navicularis
seminiferous tubule
16.
A 27-year-old woman is examined by her gynecologist. Upon
rectal examination, a firm structure, directly in front of the rectum in
the midline, is palpated through the anterior wall of the rectum.
This structure is the:
bladder
body of uterus
cervix of uterus
pubic symphysis
vagina
17.
The most inferior extent of the peritoneal cavity in the female
is the:
Pararectal fossa
Paravesical fossa
Rectouterine pouch
Rectovesical pouch
18.
Vesicouterine pouch
The prostate gland:
Contains upper, middle and lower lobes
Encircles the urethra
Is well imaged radiologically using an intravenous urogram
Is extraperitoneal
B and D
19.
A 64-year-old woman was diagnosed as having carcinoma of
the distal gastrointestinal tract. At surgery, lymph nodes from the
sacral, internal iliac and inguinal lymph node groups were removed
and sent to pathology for study. Only the superificial inguinal
nodes contained cancerous cells. In which part of the GI tract was
the tumor localized?
cutaneous portion of anal canal
distal rectum
mucosal zone of anal canal
pectinate line of anal canal
proximal rectum
20.
Structures within the lower gastrointestinal tract specialized
for physical support of fecal material are the:
Transverse rectal folds
Circular folds
Anal valves
Anal columns
21.
A malignant tumor in the cutaneous zone of the anal canal
would most likely metastasize (spread) to which group of lymph
nodes?
Inferior mesenteric
Pararectal
Sacral
Superficial inguinal
22.
Which of these features of the anal canal serves to indicate
the point where the mucosal covering of the gastrointestinal tract
ends and a skin-like covering begins?
Mucosal zone
White line
Transitional zone
Pectinate line
23.
The expanded region of the lower rectum, where fecal matter
is retained, is known as the:
Anal columns
Anal sinuses
Ampulla
Transverse folds
24.
During a vasectomy, the ductus deferens is ligated in the
superior part of the scrotum. Two months following this sterilization
procedure, the subsequent ejaculate contains:
Prostatic fluid only
Seminal fluid and prostatic fluid
Sperm only
Sperm and seminal fluid
Sperm, seminal fluid, and prostatic fluid
25.
During a hysterectomy, the uterine vessels are ligated.
However, the patient's uterus continues to bleed. The most likely
source of blood still supplying the uterus is from which artery?
Inferior vesical
Internal pudendal
Middle rectal
Ovarian
Superior vesical
26.
A female patient is found to have an ectopic (tubal)
pregnancy (embryo develops in the uterine tube). In order to gain
access to the peritoneal cavity endoscopically to remove the
embryo, the instrument can be passed into the vagina and through
the:
anterior fornix
cervix
posterior fornix
retropubic space
vesicouterine pouch
27.
An elderly male patient presents with dysuria and urgency.
You suspect benign prostatic hypertrophy which has caused an
enlargement of the:
interureteric crest
prostatic utricle
seminal colliculus
sphincter urethrae
uvula
28.
During a hysterectomy and an oophorectomy, the uterine
and ovarian vessels must be ligated. These vessels can be found
in which ligaments?
Broad and ovarian
Broad and suspensory
Round and ovarian
Round and suspensory
Suspensory and ovarian
29.
A female patient comes to your office with lower abdominal
pain. She missed her last menses and her pregnancy test is
positive. Ultrasound imaging reveals a cyst-like structure in the
right uterine tube which you feel may be a tubal pregnancy. In
order to confirm your diagnosis and to remove the tubal embryo,
you can gain access to the patient's lower pelvic cavity by passing
a culdoscope through the vagina and the:
vesicouterine pouch
posterior fornix
cervix
isthmus
ampulla
30.
An elderly patient notices red blood in his stool. As part of his
examination, you insert a proctoscope (sigmoidoscope) through
his anal canal. As you pass the scope superiorly through the
rectum, the most prominent features to be seen are:
longitudinal muscle bands
tenia coli
transverse rectal folds
rectovesical pouches
haustra
31.
An elderly patient is having difficulty in voiding (urinating). He
complains that after voiding, he still feels as though he needs "to
go" again. You suspect that this patient suffers from benign
prostatic hypertrophy, which has caused enlargement of the
__________ of the bladder.
seminal colliculus
interureteric crest
ampulla
trigone
uvula
32.
During a hysterectomy, care must be taken in ligation of the
uterine vessels because they cross the _________ superiorly.
ureter
round ligament of the uterus
ovarian artery
lumbosacral trunk
inferior hypogastric plexus
33.
The prostate gland:
encircles the urethra
is well imaged using an intravenous urogram
is partially intraperitoneal
contains upper, middle and lower lobes
34.
The part of the broad ligament giving attachment and support
to the uterine tube is the:
mesometrium
mesovarium
mesosalpinx
35.
round ligament
Which structure is NOT found within the true pelvis?
Femoral nerve
Hypogastric nerve
Internal pudendal artery
Obturator artery
Pelvic splanchnic nerves
36.
A structure which takes the form of a hood anterosuperior to
the clitoris:
Frenulum of the clitoris
Labia majora
Labia minora
37.
Prepuce
A structure which is homologous to the male scrotum:
Labia minora
Labia majora
Glans
Shaft of corpus cavernosum
38.
Which skeletal feature would you consider to be most
characteristic of the female pelvis?
Subpubic angle of 90 degrees or greater
Marked anterior curvature of the sacrum
Tendency to vertical orientation of the iliac bones
Prominent medial projection of the ischial spines
39.
You are observing a doctor perform an abdominal
hysterectomy. He notes that it is vital to protect the ureter which is
found in the base of the:
mesometrium
mesovarium
mesosalpinx
round ligament of the uterus
suspensory ligament of the ovary
40.
A female patient is found to have an ectopic (tubal)
pregnancy. In order to gain access to the peritoneal cavity
endoscopically to remove the tubal embryo, the instrument can be
passed through the posterior fornix of the vagina piercing into the:
external os
internal os
rectouterine pouch
rectovesical pouch
vesicouterine pouch
41.
The male pelvis tends to differ from the female pelvis in that
the male pelvis often has a:
larger pelvic inlet
smaller subpubic angle
straighter sacral curvature
larger pelvic outlet
rounder pelvic inlet
42.
The rectouterine pouch is the lowest extent of the female
peritoneal cavity. At its lowest, it provides a coat of peritoneum to a
portion of the:
urinary bladder
urethra
uterine cervix
43.
vagina
In a CT scan of the pelvis, the uterus is located:
posterior to the bladder and rectum
posterior to the bladder and anterior to the rectum
anterior to the bladder and rectum
anterior to the bladder and posterior to the rectum
1. The correct answer is:
myometrium
This question is phrased in a slightly tricky way, so it's important to break
it down before looking at the answers. There are two things to think
about here. First, you need to decide if a structure is part of the uterus. If
it is part of the uterus, then you need to decide if it is shed during
menstruation. The correct answer will be a structure that is part of the
uterus but is not shed during menstruation. Answers about structures
that are not shed during menstruation because they are not part of the
uterine wall are incorrect. The myometrium is our correct answer. It is
the middle muscular component of the uterine wall and it is not shed
during menstruation. The endometrium is the inner mucosal coat of the
uterus. It exhibits many characteristic changes during the menstrual
cycle and all but its stratum basalis is shed during menstruation. The
mesometrium is the mesentary of the uterus which forms the major part
of the broad ligament of the uterus. It is not even part of the uterine wall,
so it's not the answer to look for. Cervical mucosa lines the cervix, which
is the inferior portion of the uterus. This mucosa is shed during
menstruation. Finally, the uterus does not have rugae - rugae are the
folds found in the lining of the vagina (and stomach).
2. The correct answer is:
fornix
The cervix is the inferior end of the uterus that projects into the vagina.
This means that the vagina comes up and wraps around the cervix,
creating the vaginal fornix. There are multiple fornices at the top of the
vagina: anterior, posterior, and lateral. The cervical canal is the
passageway through the cervix to the vagina. The uterine lumen is the
hollow center of the uterus. The rectouterine and uterovesicular pouches
are two peritoneal folds found in the pelvic cavity. The rectouterine
pouch is a peritoneal fold extending across the floor of the pelvic cavity
from the sacrum (beside the rectum) to the uterus. The uterovesicular
pouch is a peritoneal fold extending from the uterus to the bladder.
3. The correct answer is:
pudendal nerve
The pudendal nerve is found about 2 cm lateral to the anal canal.
Therefore, it is the structure most likely to be damaged by the stab
wound. The crus of the penis is the lateral part of the corpus
cavernosum found at the base of the penis. It is anterior, not lateral, to
the anal canal. The perineal body is a structure found in the female only-it is a fibromuscular mass found in the plane between the anal canal
and the perineal membrane that serves at the convergence of several
muscles. It is anterior to the anal canal. The inferior rectal artery is a
branch of the internal pudendal artery that delivers blood to the inferior
part of the rectum. It would not be injured by the stabbing because it is
located on the surface of the rectum, not 2 cm lateral to the anal canal.
Finally, the vesicular bulb is a structure of erectile tissue located on
either side of the vestibule of the vagina, attached to the perineal
membrane. So, it would be anterior to the site of the stabbing.
4. The correct answer is:
pectinate line
The pectinate line is the place where the lining of the anal canal changes
from skin to mucosa. It is also a landmark that divides the lymphatic
drainage, vascular supply, and innervation of the anal canal. Lymph
coming from structures above the pectinate line drains to the inferior
mesenteric lymph nodes or the internal iliac nodes. Lymph from
structures below the pectinate line travels to the superficial inguinal
lymph nodes.
As far as vasculature and nerves go... Superior to the pectinate line,
arterial blood comes from the superior rectal artery and drains to the
portal system through the superior rectal veins. This area is innervated
by the inferior hypogastric plexus (autonomic innervation). Inferior to the
pectinate line, blood comes from the inferior rectal arteries and is
drained into the caval system. Innervation here comes from the inferior
rectal nerves (somatic innervation).
The anorectal junction is the point where the rectal ampulla narrows due
to a U-shaped sling created by the puborectalis muscle. This area is
superior to the pectinate line. The white line is a transitional area inferior
to the pectinate line that represents some subtle changes as the
mucosal lining becomes "regular" skin. Finally, the cutaneous zone is the
area of skin at the very end of the rectum.
5. The correct answer is:
ampulla of the uterine tube
Fertilization normally takes place in the ampulla of the uterine tube. This
is the middle segment of the uterine tube, and it is the longest and
widest segment. The infundibulum is the funnel-shaped distal end of the
uterine tube, and the isthmus is the narrowest part of the uterine tube
which connects directly to the uterus. The uterine lumen is the site of
implantation, not fertilization. Finally, the cervical canal is the pathway
out of the uterus at its inferior end-- it would not be an appropriate site
for fertilization or implantation.
6. The correct answer is:
periurethral zone of the prostate
Remember that the prostatic urethra travels through the prostate gland.
So, if the periurethral zone of the prostate hypertrophied, the nearby
prostatic urethra would be occluded. The central and peripheral zones of
the prostate are not as close to the urethra. If they enlarged, they would
not restrict the flow of urine quite as much. The ejaculatory duct is the
duct formed once the ductus deferens joins with the duct of the seminal
vesicle. It passes through the prostate gland, but its enlargement would
have no effect on the prostate or the urethra. Finally, the seminal vesicle
is a sac on the posterior surface of the bladder which is superior to the
prostate gland. It produces seminal fluid, and changes in the seminal
vesicle should not alter the flow of urine.
7. The correct answer is:
ductus deferens
In a vasectomy, the ductus deferens is ligated or excised. This means
that the fluid that is then ejaculated from the seminal vesicles, prostate,
and bulbourethral glands has no sperm. The sperm simply degenerate in
the epididymis and the proximal ductus deferens. It would not be a good
idea to ligate the ejaculatory duct or the seminal vesicle because that
might compromise the patient's ability to ejaculate. Just remember,
another name for the ductus deferens is the vas deferens, so it make
sense that the procedure to ligate this structure is called a vasectomy.
8. The correct answer is:
Shaft of penis and labia majora
The shaft of the penis is an analog of the shaft of the clitoris, while the
labia majora is derived from the same embryonic structures as the
scrotum. The other three answer choices list structures that come from
comparable embryonic structures in the male and female. See Netter
Plate 389 for a picture of the homologous structures in males and
females!
9. The correct answer is:
urachus
The trigone of the bladder is bounded by the openings of the left and
right ureteric orifices superolaterally, the interureteric crest between the
openings of the ureters and the internal urethral orifice inferiorly. The
urachus is the structure that joins the apex of the fetal bladder to the
umbilicus. After birth, it becomes the median umbilical ligament.
10. The correct answer is:
rectovesicular pouch
The rectovesicular pouch is a reflection of the peritoneum between the
rectum and the bladder. It can only be found in males because females
have the uterus sitting between the rectum and the bladder. This means
that females have two pouches created by reflections of peritoneum
draped over the pelvic viscera: the rectouterine and vesicouterine
pouches. The ischioanal fossa is the fat filled space located lateral to the
anal canal and inferior to the pelvic diaphragm. It has an anterior recess
that extends superior to the perineal membrane and sphincter urethrae
muscle, and it is found in both males and females. The genital hiatus is
also found in both sexes--it is the place where the urethra/vagina and
anus exit the pelvic diaphragm. The ischiocavernosis muscle
compresses the corpus cavernosum of the penis or clitoris. Finally, the
sphincter urethrae encircles and compresses the urethra in both sexes.
11. The correct answer is:
ovary
The ovary is entirely covered by a layer of peritoneum called the
mesovarium. The mesovarium, along with the mesometrium and the
mesosalpinx, creates the broad ligament. Because the ovary is
completly encased in peritoneum, it would be outlined on a CT with
intraperitoneal contrast material. The prostate, seminal vesicles and
vagina are located below the rectovesicular pouch or
rectouterine/vesicouterine pouches. So, they are not associated with the
peritoneal cavity and would not be seen on the CT scan. Although
peritoneum drapes over the rectum, forming the rectovesicular fold in
males and the rectouterine fold in females, the rectum would not be
clearly outlined by the intraperitoneal contrast since it is not covered by
peritoneum on all sides.
12. The correct answer is:
rectum
The prostate is located on the posterior side of the bladder. Since the
rectum is behind the bladder and prostate, you can image the prostate
by placing an ultrasound transducer in the rectum and pressing it against
the anterior wall. Then, the ultrasound transducer will be against the
prostate gland.
13. The correct answer is:
mesovarium
The mesovarium, mesometrium, and mesosalpinx are the three
peritoneal sections that create the broad ligament. The mesosalpinx
covers the uterine tube and hangs below it to meet with the mesovarium.
The mesovarium covers the ovary and ovarian ligament. It extends
posteriorly from the mesosalpinx like a shelf. The mesometrium makes
up the rest of the broad ligament.
The ovarian ligament is located in the broad ligament but is not part of
the broad ligament. It is a round cord that attaches the ovary to the
uterus just below the point where the uterine tube enters the uterus. The
round ligament of the uterus reaches the lateral surface of the uterus
below the uterine tube. It is continuous with the ovarian ligament and it
holds the fundus of the uterus forward. The suspensory ligaments of the
ovary are peritoneal folds that cover the ovarian neurovascular supply as
these vessels pass over the pelvic brim to reach the ovary. Finally, the
uterosacral ligament connects the isthmus of the uterus to the sacrum. It
is important for the support of the uterus, and it is found in the
rectouterine fold.
14. The correct answer is:
duct of the seminal vesicle
The duct of the seminal vesicle carries seminal fluid, a basic fluid
containing fructose. The contents of the seminal fluid buffers the acid in
the vagina and provides nutrients for sperm. The duct of the seminal
vesicle joins with the ampulla of the ductus deferens (which is carying
sperm) to form the ejaculatory duct. This is the first place where seminal
fluid mixes with sperm. Sperm is first formed in the seminiferous tubules.
They then travel from the head to the tail of the epididymis, through the
ductus deferens, into the ejaculatory duct where they mix with seminal
fluid, into the prostatic urethra, through the rest of the urethra, and then
out the penis. So, all of the other answer choices are places that are
important for the passage of sperm.
15. The correct answer is:
ejaculatory duct
The ejaculatory duct travels through the prostate and opens into the
prostatic urethra. So, it is likely that this duct might get removed or
damaged during the surgery. The duct of the seminal vesicle and the
ductus deferens are the two ducts that join to make the ejaculatory duct.
They both lie on the posterior surface of the bladder and would not be
interrupted by the surgery. The fossa navicularis is a dilation in the
penile urethra. It would not be harmed by surgery in the prostatic
urethra. Finally, the seminferous tubules are the tubules in the testes
where sperm are formed.
16. The correct answer is:
cervix of the uterus
The cervix of the uterus is anterior to the rectum. Since the cervix is the
inferior part of the uterus that is protruding into the vagina, it should feel
like a firm structure upon palpation. The bladder is the most anterior
organ in the pelvis, in front of the uterus and rectum. So, the bladder
would not be directly in front of the anterior wall of the rectum. The body
of the uterus lies upon the bladder, so it is too far in front of the anterior
rectal wall to be palpated. The pubic symphysis is the joint connecting
the two pubic bones. It forms the anterior boundary of the pelvis, and
would be too far forward to palpate through the rectum. Although the
vagina is directly anterior to the rectum, it would not feel like a distinct
and firm structure upon palpation.
17. The correct answer is:
rectouterine pouch
Remember: The rectouterine and vesicouterine pouches are the two
pouches created by draping the peritoneum over the pelvic organs.
These pouches are the two lowest extents of the peritoneal cavity, so to
answer this question, you just need to decide which one goes lower.
Since the uterus is folded over the bladder, the rectouterine pouch can
extend to a slightly lower level than the vesicouterine pouch, which
makes C the correct answer. The pararectal fossa is formed by lateral
reflections of perineum over the superior one third of the rectum; this
space gives the rectum room to fill with feces. The paravesicular fossa is
a space near the bladder that allows the bladder to expand. Why is the
rectovesicular pouch incorrect? It's only found in males, not females!
(But, if the question had asked about males, the rectovesicular pouch
would have been the correct answer.)
18. The correct answer is:
B and D
There are two true statements here. First, the prostate gland encircles
the urethra. It circles around the first part of the urethra, the prostatic
urethra. This is why urinary retention is one symptom of prostatic
hypertrophy--if the prostate is enlarged, it may close around the urethra,
occluding this passage and preventing urine from exiting the bladder.
The prostate gland is also extraperitoneal. Remember: the
rectovesicular pouch, a fold of peritoneum that hangs between the
bladder and rectum, is the lowest extent of the peritoneal cavity in males
. But, the prostate is found on the posterior side of the bladder, below
the point where the peritoneal membrane created this fold. So, it is an
extraperitoneal organ.
The lobes of the prostate are: anterior, posterior, lateral, and middle.
Finally, the prostate would not be imaged using an intravenous urogram.
In an intravenous urogram, a patient is given IV contrast, and
radiographic images are taken as the contrast is excreted, passing
through the kidneys, ureters, and bladder. Since the prostate is not part
of this excretory pathway, it would not be viewed through this method.
19. The correct answer is:
cutaneous portion of the anal canal
The pectinate line is more than the line where the mucosal lining of the
anal canal changes to skin. It is also a key dividing point for the flow of
lymph in the anal canal. Above the pectinate line, lymph flows to the
inferior mesenteric and internal iliac lymph nodes. Below the pectinate
line, lymph flows to the superficial inguinal lymph nodes. So, the
pathology report tells you that the tumor must be somewhere below the
pectinate line since the superficial inguinal lymph nodes are the only
nodes involved. The only answer representing a tumor below the
pectinate line is A, the cutaneous portion of the anal canal. The proximal
and distal rectum represents a space far above the pectinate line, and
the mucosal zone of the anal canal is, by definition, above the pectinate
line. At the pectinate line itself, lymph should be flowing to all the sets of
nodes, and it would be unlikely that a tumor at the pectinate line would
involve only the superficial inguinal lymph nodes.
20. The correct answer is:
transverse rectal folds
There are usually three transverse rectal folds in the lower rectum.
These are specializations of the circular layer of musculature that are
designed to support fecal mass. Although circular folds is somewhat
descriptive of the transverse rectal folds, this is not the best answer.
Anal columns are longitudinal folds of mucosa over rectal vessels. They
are found on the inner wall of the anal canal. Anal valves are the folds of
mucosa that join the anal columns at their inferior ends.
21. The correct answer is:
superficial inguinal lymph nodes
Remember, the pectinate line (the line in the anus where mucosa
changes to skin) is the dividing line for lymphatic drainage. Structures
above the pectinate line drain into the inferior mesenteric and internal
iliac nodes. Structures below the pectinate line drain into the superficial
inguinal nodes. Since the tumor is in the cutaneous (skin) region of the
anal canal, it is going to be drained by the superficial inguinal nodes.
This means that these nodes would be the first site of metastases.
22. The correct answer is:
pectinate line
The pectinate line is the line of transition between the mucosal lining of
the anal canal and the skin lining of the anal canal. So, this is the point
where the mucosal zone ends and the skin begins. The white line is a
transitional zone between the pectinate line and "regular" skin where
there are some more subtle changes in the epithelial lining of the anal
canal. But the pectinate line is the line that demarcates the major
transition from mucosal lining to skin.
23. The correct answer is:
ampulla
The ampulla is an expanded part of the lower rectum that stores feces.
The transverse rectal folds are three folds in the ampulla which help to
support fecal mass, but they are not the same as the actual region that
stores the feces. Anal columns are longitudinal folds of mucosa over
rectal vessels. They are found on the inner wall of the anal canal. Anal
valves are folds of mucosa that join the anal columns at their inferior
ends and create spaces between the wall and the valves known as anal
sinuses.
24. The correct answer is:
Seminal fluid and prostatic fluid
The ductus deferens carries sperm from the tail of the epididymis to the
ejaculatory duct. When this cord is ligated, sperm cannot enter the
ejaculatory duct, so there will be no sperm in the subsequent ejaculate.
The seminal vesicles and prostate also contribute fluid to the ejaculate.
However, ligating the ductus deferens will not interrupt the path of
seminal fluid or prostatic fluid. So, the ejaculate will still contain both of
these fluids.
25. The correct answer is:
Ovarian
The ovarian artery has branches which supply the uterus. In fact, this
artery anastomoses with the uterine artery. So, if the uterus is still
bleeding after ligating the uterine artery, the ovarian artery is probably
supplying the uterus. The inferior vesical artery supplies the inferior part
of the bladder--it anastomoses with the middle rectal artery. The internal
pudendal artery supplies blood to the perineum. The middle rectal artery
supplies blood to the rectum. The superior vesical artery supplies blood
to the superior bladder.
26. The correct answer is:
Posterior fornix
In females, the rectouterine pouch is a peritoneal fold reflecting from the
rectum to the posterior fornix of the vagina. This means that an incision
made through the posterior fornix of the vagina will allow a surgeon to
enter the rectouterine pouch of the peritoneal cavity and remove the
embryo. Take a look at Netter Plate 337 for a picture of this relationship.
Entering the anterior fornix of the vagina would not allow a surgeon to
enter the peritoneal cavity. The cervix is the inferior portion of the uterus
which connects the uterus to the vagina--passing through the cervix
would allow the surgeon to enter the uterus, but not the peritoneal cavity.
The vesicouterine pouch is a fold of peritoneum reflected from the uterus
onto the posterior margin of the superior surface of the bladder--it helps
to separate the uterus from the bladder.
27. The correct answer is:
uvula
The uvula of the bladder is an elevation on the posterior wall of the
bladder. The uvula is caused by the middle lobe of the prostate gland. If
the prostate becomes enlarged (either by benign hypertrophy or
malignancy), the uvula can constrict the internal urethral orifice and
cause difficulty in voiding the bladder. The interureteric crest is an
elevation on the posterior wall of the bladder, between the two ureteric
orifices. The seminal collicus is an elevation on the posterior wall of the
prostatic urethra. At the summit of the seminal collicus, you can find the
prostatic utricle, which is a small blind diverticulum in the posterior wall
of the prostatic urethra. Finally, the sphincter urethrae is a muscle which
encircles the urethra and compresses the urethra. None of these other
structures would be enlarged in a case of benign prostatic hypertrophy.
28. The correct answer is:
Broad and suspensory
The uterine vessels are found in the inferior portion of the broad
ligament, while the ovarian vessels are found in the suspensory
ligaments of the ovaries. The suspensory ligaments of the ovaries are
peritoneal folds covering ovarian arteries, veins, nerves, and lymphatics
as the structures pass over the pelvic brim to reach the ovary.
The ovarian ligament proper is a round cord which attaches the ovary to
the uterus, just below the entrance of the uterine tube into the uterus.
The round ligament of the uterus is a connective tissue band that
attaches to the inner aspect of the labium majus and the uterus--it
traverses the inguinal canal and it is found in the broad ligament.
29. The correct answer is:
Posterior fornix
In females, the rectouterine pouch is a peritoneal fold reflecting from the
rectum to the posterior fornix of the vagina. This means that an incision
made through the posterior fornix of the vagina will allow a surgeon to
enter the rectouterine pouch of the peritoneal cavity and remove the
embryo. The vesicouterine pouch is a fold of peritoneum reflected from
the uterus onto the posterior margin of the superior surface of the
bladder--it helps to separate the uterus from the bladder. The cervix is
the inferior end of the uterus which connects the uterus to the vagina.
The isthmus and ampulla are parts of the uterine tube--the isthmus is the
constricted part of the uterine tube nearest the uterus, and the ampulla is
the dilated region that connects the infundibulum with the isthmus.
30. The correct answer is:
Transverse rectal folds
The rectum features three transverse rectal folds--these folds would be
the most prominent features that you would see in the interior of the
rectum if you were using a proctoscope. The tenia coli are the three
bands of longitudinal muscle seen on the surface of the colon--the
pattern of the teniae coli changes as the transition from sigmoid colon to
rectum occurs. The sigmoid colon, like the rest of the colon, has three
longitudinal muscular bands. These coalesce into two bands, anterior
and posterior, on the rectum. However, none of these longitudinal
muscle layers would be visible from the interior of the rectum. The
rectovesical pouch is a peritoneal fold reflecting from the rectum to the
posterior wall of the bladder in the male. Remember--females do not
have the rectovesicular pouch. Instead, they have the vesicouterine and
rectouterine pouches. Finally, the haustra are multiple pouches in the
wall of the large intestine--they are not found in the rectum.
31. The correct answer is:
Uvula
The uvula of the bladder is an elevation on the posterior wall of the
bladder. The uvula is produced by the middle lobe of the prostate gland.
If the prostate becomes enlarged (either by benign hypertrophy or
malignancy) the uvula can constrict the internal urethral orifice and
cause difficulty in voiding the bladder. The seminal collicus is an
elevation on the posterior wall of the prostatic urethra. The interureteric
crest is an elevation on the posterior wall of the bladder, between the
two ureteric orifices. The ampulla of the ductus deferens is the dilated
part of the ductus deferens located posterior to the bladder. It joins with
the duct of the seminal vesical to form the ejaculatory duct. The trigone
is a triangular area on the posterior wall of the bladder. It is delineated
by the two ureteric orifices and the internal urethral orifice, which form an
equilateral triangle known as the trigone.
32. The correct answer is:
Ureter
The uterine vessels cross over the ureter as the ureters pass through
the base of the mesometrium. Remember--the ureters must travel
through the mesometrium to reach the base of the bladder. The
relationship between the ureter and the uterine vessels is very
important--you should remember this!
The round ligament of the uterus is a connective tissue band that
attaches to the inner aspect of the labium majora and the uterus. It is
found in the broad ligament, but it is superior to the ureter and the
uterine vessels. The ovarian vessels are contained in the suspensory
ligament of the ovary. The lumbosacral trunk is part of the ventral
primary ramus of L4 united with the ventral primary ramus of L5--it
contributes to the formation of the sacral plexus. The inferior hypogastric
plexus lies between the pelvic viscera and the pelvic wall--it supplies
sympathetic innervation to the vascular smooth muscle of pelvic vessels
and parasympathetic innervation to the smooth muscles of the pelvis.
33. The correct answer is:
Encircles the urethra
The prostate gland encircles the urethra. It circles around the first part of
the urethra, the prostatic urethra. This is why urinary retention is one
symptom of prostatic hypertrophy--if the prostate is enlarged, it may
close around the urethra, occluding this passage and preventing urine
from exiting the bladder.
The prostate would not be imaged using an intravenous urogram. In an
intravenous urogram, a patient is given IV contrast, and radiographic
images are taken as the contrast is excreted, passing through the
kidneys, ureters, and bladder. Since the prostate is not part of this
excretory pathway, it would not be viewed through this method. The
prostate gland is completely extraperitoneal. Remember: the
rectovesicular pouch, a fold of peritoneum that hangs between the
bladder and rectum, is the lowest extent of the peritoneal cavity in males
. But, the prostate is found on the posterior side of the bladder, below
the point where the peritoneal membrane created this fold. So, it is an
extraperitoneal organ. Finally, the lobes of the prostate are: anterior,
posterior, lateral, and middle.
34. The correct answer is:
Mesosalpinx
The mesosalpinx is the part of broad ligament that supports the uterine
tube. The mesosalpinx extends inferiorly to meet the root of the
mesovarium; it attaches the uterine tube to the mesometrium. The
mesometrium is the part of the broad ligament below the junction of the
mesosalpinx and the mesovarium; it attaches the body of the uterus to
the pelvic wall. The mesovarium is the part of broad ligament that forms
a shelf-like fold supporting the ovary--it attaches the ovary to the
mesometrium and mesosalpinx. The round ligament of the uterus is a
connective tissue band that attaches to the inner aspect of the labium
majus and the uterus. It is found in the broad ligament, and it traverses
the inguinal canal.
35. The correct answer is:
femoral nerve
To answer this question, you need to understand what the true pelvis is.
The true pelvis is the area beneath the pelvic brim (pelvic inlet), where
the pelvic viscera are located. The false pelvis is the area above the
pelvic brim, bounded by the iliac blades. Now, you just need to think
about the structures listed and determine which ones are in which
location. The femoral nerve is the structure that is not in the true pelvis.
After coming off the lumbar plexus with contributions from L2, 3, and 4,
the femoral nerve runs along the border between the psoas major
muscle and the iliacus to travel into the lower limb. It never descends
below the pelvic brim, so it is not in the true pelvis. Hypogastric nerves
connect the superior and inferior hypogastric plexuses. Since the inferior
hypogastric plexus is lying between the pelvic viscera and the pelvis
wall, in the true pelvis, the hypogastric nerves should also be in the true
pelvis. The internal pudendal artery is a branch of the anterior division of
the internal iliac artery. It lies in the true pelvis and supplies blood to the
perineum. The obturator artery is a branch of the anterior internal iliac
artery or, if it is the aberrant obturator, the inferior epigastric artery. It is
in the true pelvis, and exits the pelvis through the obturator foramen. The
pelvic splanchnic nerves represent the sacral portion of the craniosacral
outflow (parasympathetic) of the autonomic nervous system. They come
from the ventral rami of the second, third, and fourth sacral nerves. So,
that puts them in the true pelvis, too.
36. The correct answer is:
prepuce
The prepuce is a fold of smooth skin that extends over the glans clitoris.
It is formed by the joining of the anterior divisions of the labia minora.
The frenulum of the clitoris is a small fold found posterior to the clitoris. It
is formed by the joining of deeper, posterior, divisions of the labia
minora. The labia majora are fat-filled elevations of skin lying on each
side of the vestibule of the vagina. The labia minora are smaller folds of
skin lying medial to the labia majora. They extend posteriorly and
inferiorly from the clitoris.
37. The correct answer is:
labia majora
The labia majora and scrotum are homologous structures. The labia
minora is the female counterpart of the pentscrotal raphe. The glans of
the clitoris and glans of the penis are homologous structures. Finally, the
shaft of the corpus cavernosum in the female is the shaft of the clitoris,
which is homologous to the shaft of the penis.
38. The correct answer is:
subpubic angle of 90 degrees or greater
There are four major differences between the male and female pelvis.
First, the subpubic angle and pubic arch are greater in the female pelvis
than in the male pelvis. This is why A is correct-- females often have a
subpubic angle of 90 degrees or greater. A second difference between
the female and male pelvis is that the pelvis inlet for females is rounded,
while for males it is heart shaped. Third, the pelvic outlet for females is
larger than in males. Finally, the female pelvis has iliac wings that are
more flared than in males.
39. The correct answer is:
Mesometrium
The mesometrium is the part of the broad ligament of the uterus that
attaches the body of the uterus to the pelvic wall. The ureters pass
through the base of the mesometrium as they travel to reach the
bladder. See Netter Plate 346 for a picture of this relationship. The
mesovarium is the part of broad ligament that forms a shelf-like fold
supporting the ovary. The suspensory ligament of the ovary, which
conveys the ovarian vessels, lymphatics, and nerves to and from the
ovary, constitutes the lateral part of the mesovarium of the broad
ligament. The mesosalpinx is the part of broad ligament that supports
the uterine tube. Finally, the round ligament of the uterus is a connective
tissue band that attaches to the inner aspect of the labium majus and the
uterus. It lies in the mesometrium, and it is continuous with the ovarian
ligament.
40. The correct answer is:
Rectouterine pouch
In females, the rectouterine pouch is a peritoneal fold reflecting from the
rectum to the posterior fornix of the vagina. This means that an incision
made through the posterior fornix of the vagina will allow a surgeon to
enter the rectouterine pouch of the peritoneal cavity to remove the
embryo. Take a look at Netter Plate 337 for a picture of this relationship.
The vesicouterine pouch is a fold of peritoneum reflected from the uterus
onto the posterior margin of the superior surface of the bladder--it helps
to separate the uterus from the bladder. The rectovesicular pouch is only
found in males--it is a peritoneal fold reflecting from the rectum to the
posterior wall of the bladder.
The external os of the cervix is the part of the cervix between the vagina
and the cervical canal; the internal os of the cervix is the part of the
cervix between the uterus and the cervical canal. See Netter Plate 346
for a picture of these osses.
41. The correct answer is:
Smaller subpubic angle
There are four major differences between the male and female pelvis.
First, the subpubic angle and pubic arch are greater in the female pelvis
than in the male pelvis. This is why B is correct-- the male pelvis has a
smaller subpubic angle than the female pelvis. A second difference
between the female and male pelvis is that the pelvic inlet for females is
rounded, while for males it is heart shaped. Third, the pelvic outlet for
females is larger than in males. Finally, the female pelvis has iliac wings
that are more flared than in males.
42. The correct answer is:
Vagina
In females, the rectouterine pouch is a peritoneal fold reflecting from the
rectum to the posterior fornix of the vagina. At its lowest extent, the
rectouterine fold is draped over the posterior fornix of the vagina. This
means that surgeons can make an incision in the posterior fornix of the
vagina and enter the rectouterine pouch to harvest eggs from the
ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337
for a picture of this relationship.
43. The correct answer is:
rectum
Posterior to the bladder and anterior to the
In the female pelvis, the bladder is the most anterior organ; the uterus is
posterior to the bladder, and the rectum is posterior to the bladder and
uterus. See Netter Plate 337 for a picture.