Unit 3 Quiz, part 2

During your peer presentation of the inguinal region dissection, you would indicate the position of the deep inguinal ring to be: Above the anterior superior iliac spine Above the midpoint of the inguinal ligament Above the pubic tubercle In the supravesical fossa Medial to the inferior epigastric artery

Above the midpoint of the inguinal ligament The deep inguinal ring is found near the midpoint of the inguinal ligament, below the anterior superior iliac spine. This ring is lateral to the inferior epigastric artery. The superficial inguinal ring is found above the pubic tubercle. Remember--the supravesical fossa is the space between the median and medial umbilical folds.

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

Ampulla of the Uterine Tube

A man is moving into a new house and during the process lifts a large chest of drawers. As he lifts he feels a severe pain in the lower right quadrant of his abdomen. He finds that he can no longer lift without pain and the next day goes to see his physician. Surgery is indicated and during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and lateral to the inferior epigastric vessels. The hernia was diagnosed as: A congenital inguinal hernia A direct inguinal hernia A femoral hernia An incisional hernia An indirect inguinal hernia

An indirect inguinal hernia An indirect inguinal hernia leaves the abdominal cavity lateral to the inferior epigastric vessels and enters the inguinal canal through the deep inguinal ring. Commonly, these hernias traverse the entire inguinal canal, leave the canal through the superficial inguinal ring, and enter the scrotum. The indirect inguinal hernias are the most common type of hernia, and are often caused by heavy lifting. Direct inguinal hernias leave the abdominal cavity medial to the inferior epigastric vessels, through the weak fascia. These usually do not traverse the entire inguinal canal, and they rarely enter the scrotum. Direct inguinal hernias may be caused by a weakness of abdominal musculature.

The skin of the mons pubis is supplied by which nerve? Anterior scrotal Anterior labial Femoral branch of the genitofemoral Iliohypogastric nerve Subcostal nerve

Anterior labial The anterior labial nerve (anterior scrotal in males) is the terminal branch of the ilioinguinal nerve. It innervates the skin of the mons pubis in females and the skin of the anterior scrotum in males. The femoral branch of the genitofemoral nerve provides sensory innervation to the upper medial thigh. The iliohypogastric nerve innervates muscles of the abdominal wall. The subcostal nerve is the ventral primary ramus of the twelfth thoracic nerve. It innervates muscles of the abdominal wall and skin of the lower abdominal wall.

The cisterna chyli accompanies which structure as it passes through the diaphragm? Inferior vena cava Esophagus Aorta Greater thoracic splanchnic nerve

Aorta

The boundaries of the inguinal triangle include all except: Arcuate line Inferior epigastric vessels Inguinal ligament Lateral border of rectus abdominus muscle

Arcuate line The inguinal triangle is the site for direct inguinal hernias. It is defined medially by the lateral border of rectus abdominus, inferiorly by the inguinal ligament, and superiorly by the inferior epigastric artery.

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

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.

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

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.

Which statement regarding the suprarenal glands is correct? Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater thoracic splanchnic nerve. x The glands are localized in the pararenal space. Its entire arterial supply is directly from the abdominal aorta. Veins from both glands drain directly into the inferior vena cava

Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater thoracic splanchnic nerve.

Regarding the diaphragm, which, is paired INCORRECTLY? Central tendon - aortic hiatus Medial arcuate ligament - psoas muscle Vertebrocostal trigone - lateral arcuate ligament Esophageal hiatus - right crus Vena caval foramen - right phrenic nerv

Central tendon--aortic hiatus The aortic hiatus is not in the central tendon of the diaphragm--the caval opening, for the inferior vena cava, is found in the central tendon of the diaphragm. The aortic hiatus is formed by the median arcuate ligament, which unites the two crura of the diaphragm. The vertebrocostal trigone is an area of the diaphragm superior to the lateral arcuate ligament. Here, the diaphragmatic muscle is deficient and the trigone is closed primarily by the inferior and superior fascia of the diaphragm. It is a significant area for hernias. The esophageal hiatus is formed entirely by the fibers of the right crus. The psoas major muscle passes behind the medial arcuate ligament. Finally, the right phrenic nerve passes through the central tendon of the diaphragm, near the vena caval foramen.

During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels. These boundaries defined the hernia as a(n): Congenital inguinal hernia Direct inguinal hernia Femoral hernia Indirect inguinal hernia Umbilical hernia

Direct inguinal hernia The boundaries listed in this question are the boundaries of the inguinal triangle, which is the site for direct inguinal hernias. Remember--direct inguinal hernias protrude through the weak fascia of the abdominal wall, medial to the inferior epigastric vessels. Indirect inguinal hernias (which can also be called congenital inguinal hernias) occur lateral to the inferior epigastric vessels--they protrude through the deep inguinal ring. Femoral hernias protrude through the femoral ring, into the femoral canal. They can be felt in the femoral triangle, inferior to the pubic tubercle. Finally, an umbilical hernia is an abnormal protrusion of abdominal contents into a defect in the umbilical area. These are common in the newborn, but they usually resolve by age two.

The vagus nerve passes into the abdomen by passing through the Lateral arcuate ligament Caval foramen Esophageal hiatus Aortic hiatus Medial arcuate ligament

Esophageal hiatus

The superficial inguinal ring is an opening in which structure? External abdominal oblique aponeurosis Falx inguinalis Internal abdominal oblique muscle Scarpa's fascia Transversalis fascia

External abdominal oblique aponeurosis The superficial inguinal ring is a slit-like opening between the diagonal fibers of the external abdominal oblique. It is bounded by the medial and lateral crus, and it forms the exit of the inguinal canal. The falx inguinalis is composed of arching fibers of the internal abdominal oblique and the transversus abdominis. It forms the roof of the inguial canal, and the posterior wall medially where it inserts as the conjoint tendon (onto the pubic crest and medial part of the pectineal ligament. Scarpa's fascia is the membranous layer of subcutaneous fascia. Finally, transversalis fascia is found laterally on the posterior wall of the inguinal canal, forming the area of weak fascia in that wall.

During a vaginal delivery, a surgeon performed median episiotomy in which he cut too far (i.e., through the perineal body into the structure immediately posterior). Which perineal structure did he cut? Bulbospongiosis muscle External anal sphincter muscle Ischiocavernosis muscle Sacrospinous ligament Sphincter urethrae

External anal sphincter muscle An episiotomy is an incision made in the perineum to enlarge the distal end of the birth canal and to prevent serious damage to the perineal structures. This procedure is often performed when there is a risk of tearing the birth canal due to a breech or forceps delivery. When performing a median episiotomy, a cut is made immediately posterior to the vagina, through the perineal body. If this cut went too far, the physician might cut through the external anal sphincter or the rectum. So, external anal sphincter is the correct answer. It's important to remember that episiotomies are often made in the posterolateral direction, not on the midline. If the incision tears further during the delivery, a median incision is more likely than a posterolateral incision to extend posteriorly through the external anal sphincter, and the rectum. Consequently, a posterolateral incision is considered safer by some. The bulbospongiosus muscle, ischiocavernosus muscle, and sphincter urethrae are anterior to the area that is cut during an episiotomy. The sacrospinous ligament extends from the sacrum to the ischial spine--it is deep to the perineum and should not be involved with this procedure.

The pararenal fat in the kidney bed is an elaboration of: Fusion fascia Transversalis fascia Peritoneum Extraperitoneal connective tissue

Extraperitoneal connective tissue

The nerve that innervates the cells of the suprarenal medulla consists of fibers of the: Anterior vagal trunk Posterior vagal trunk Lesser thoracic splanchnic nerve Greater thoracic splanchnic nerve Least thoracic splanchnic nerve

Greater thoracic splanchnic nerve

A 45-year-old man had developed a direct inguinal hernia several months after having an emergency appendectomy. The examining doctor linked the cause of hernia to accidental nerve injury that happened during appendectomy and weakened the falx inguinalis. Which nerve had been injured? Femoral branch of the genitofemoral Genital branch of the genitofemoral Ilioinguinal Subcostal Ventral primary ramus of T10

Ilioinguinal A direct inguinal hernia is caused by a weakness in the abdominal muscles which prevents a patient from contracting these muscles strongly. If this patient can't contract his muscles, he can't pull the falx inguinalis down to cover the thin area of weak fascia on the posterior wall of the inguinal canal. The ilioinguinal nerve is important for innervating the muscles of the lower abdominal wall. So, if this nerve was damaged during the appendectomy, the man might not be able to contract his abdominal muscles and pull the falx inguinalis over the weak fascia. This could have led him to develop the direct inguinal hernia.

Which nerve passes through the superficial inguinal ring and may therefore be endangered during inguinal hernia repair? Femoral branch of the genitofemoral Ilioinguinal Iliohypogastric Obturator Subcostal

Ilioinguinal The ilioinguinal nerve enters the inguinal canal from the side (instead of passing through the deep inguinal ring). It leaves the inguinal canal by passing through the superficial inguinal ring to exit the canal, so it might be injured during inguinal hernia repair. The femoral branch of the genitofemoral nerve travels lateral to the superficial inguinal ring. The iliohypogastric nerve and the subcostal nerve travel superior to the inguinal canal and superficial inguinal ring. Finally, the obturator nerve is a branch of the lumbar plexus which innervates muscles in the thigh. To reach the thigh, this nerve travels deep to the inguinal canal, and it is not involved with this region. See Netter Plate 249 for an illustration of these nerves.

An elderly patient with a large indirect inguinal hernia came to your clinic complaining of pain in the scrotum. You conclude that the hernial sac is compressing the following nerve: Femoral branch of the genitofemoral Femoral Iliohypogastric Ilioinguinal Subcostal

Ilioinguinal nerve The ilioinguinal nerve runs in the inguinal canal, so this nerve could easily be compressed by an inguinal hernia. The ilioinguinal nerve also gives off the anterior scrotal nerve, which is the nerve responsible for sensory innervation to the anterior scrotum. The location of this hernia and the scrotal pain both fit with an injury to the ilioinguinal nerve.

If a hernia enters into the scrotum, it is most likely a(n): Direct inguinal hernia Indirect inguinal hernia Femoral hernia Obturator hernia

Indirect inguinal hernia Indirect inguinal hernias cross through the deep inguinal ring, passing deep to the internal spermatic fascia. This means that they can enter the scrotum fairly easily, and indirect inguinal hernias are often found in the scrotum. Direct inguinal hernias are not covered by the internal spermatic fascia; they enter the inguinal canal next to the spermatic cord, and rarely enter the scrotum. (However, direct inguinal hernias can enter the scrotum on rare occasion, so don't assume that you are dealing with an indirect inguinal hernia just because it has entered the scrotum.) A femoral hernia is protrusion of abdominal viscera through the femoral ring into the femoral canal. It appears as a mass in the femoral triangle, inferolateral to the pubic tubercle. An obturator hernia is a protrusion of a loop of bowel through the obturator canal.

If the venous drainage of the anal canal above the pectinate line is impaired in a patient with portal hypertension, there may be an increase in blood flow downward to the systemic venous system via anastomoses with the inferior rectal vein, which is a tributary of the: External iliac Inferior gluteal Inferior mesenteric Internal iliac Internal pudendal

Internal pudendal The rectal venous plexus is one of the four portal/systemic anastomoses. Blood from the portal system can flow into the venous system at this junction. This means that portal blood, from the superior rectal vein, could flow through the rectal venous plexus, into the inferior rectal vein and into the systemic venous drainage. Now, you just need to figure out what the inferior rectal vein drains into. And it drains into the internal pudendal vein, so that's the answer. See Netter plate 370 for a picture illustrating this concept of the portal/systemic anastomosis in the rectum. The external iliac vein is one of the two branches of the common iliac vein (along with the internal iliac vein). However, the internal iliac vein and its tributaries (including the pudendal vein) are much more important in draining the pelvic structures. The inferior gluteal vein is a branch of the anterior division of the internal iliac vein--it drains gluteus maximus. The inferior mesenteric vein is part of the portal venous system--it gives rise to the superior rectal veins, but not the inferior rectal veins!

A 45-year-old porter develops a direct inguinal hernia. If the hernia extended through the superficial inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the: External spermatic fascia Internal spermatic fascia Peritoneum and extraperitoneal connective tissue Weak fascia of the transversus abdominis muscle lateral to the falx

Internal spermatic fascia The internal spermatic fascia is derived from the transversalis fascia. As the testes descend through the deep inguinal ring, the transversalis fascia is pulled along, forming the innermost covering of the spermatic cord. So, in an adult, the spermatic cord is lying in the inguinal canal, covered by the internal spermatic fascia. Now, think about what happens in the direct inguinal hernia--a piece of bowel begins to protrude through the weak fascia on the posterior wall of the inguinal canal. But at that location, the spermatic cord is already lying in the inguinal canal, covered by the internal spermatic fascia. This means that the direct inguinal hernia will lie next to the spermatic cord, but it cannot enter the spermatic cord. In contrast, an indirect inguinal hernia passes through the deep inguinal ring, and it will be covered by the internal spermatic fascia of the spermatic cord.

What bony landmark on the lateral pelvic wall may be used as a reference for localizing female pelvic anatomy or pain phenomena? Coccyx Ischial spine Ischial tuberosity Obturator canal Pectineal line

Ischial spine The ischial spine is the only answer choice on the lateral pelvic wall. It arises just superior to the lesser sciatic notch and serves as the site of attachment of the sacrospinous ligament. The coccyx is the most inferior part of the vertebral column, resulting from the fusion of the four coccygeal vertebrae. It articulates with the sacrum, which means that it is associated with the posterior wall of the pelvis. The ischial tuberosity protrudes posteroinferiorly, not laterally, from the body of the ischium. This is where weight rests when the body is in the sitting postion. The ischial tuberosity also serves as the site of attachment for the sacrotuberous ligament. The obturator canal is the space in the obturator foramen that is not covered with obturator membrane. It transmits the obturator nerve and vessels, and it is on the anterior, not lateral, side of the pelvis. Finally, the pectineal line is the ridge on the pubis that creates the anterior border of the pelvic inlet and is an important landmark of the inguinal region.

In order to perform an episiotomy prior to childbirth, the perineum must be anesthetized. By inserting a finger in the vagina and pressing laterally, what palpable bony landmark can be used as the posterior limit of the pudendal canal? Coccyx Ischial tuberosity Ischiopubic ramus Obturator groove Ischial spine

Ischial spine The pudendal canal travels from the lesser sciatic foramen to the deep transverse perineus muscle. The ischial spine marks the posterior limit of the pudendal canal, so that's the correct answer. If you weren't sure about that, you might also notice that the physician here is trying to perform a transvaginal pudendal nerve block. This means that the physician will be using the ischial spine as a landmark and inserting the needle near this prominence, coating the pudendal nerve with anesthesia before it gives off its branches. The ischial tuberosity (not to be confused with the ischial spine!) protrudes posteroinferiorly from the body of the ischium. It is the attachment for the sacrotuberous ligament. The ischiopubic ramus is the articulation between the ischial ramus and the inferior pubic ramus in the anterior pubis. The obturator groove is a groove on the inferior surface of the superior pubic ramus. It marks the area of passage of the obturator vessels and nerve in the obturator canal.

During childbirth a bilateral pudendal nerve block may be performed to provide anesthesia to the majority of the perineum and the lower one fourth of the vagina. To do this an anesthetic agent is injected near the pudendal nerve as it passes from the pelvic cavity to the perineum. The physician inserts a finger into the vagina and presses laterally to palpate what landmark? Arcus tendineus levator ani Coccyx Ischial spine Lateral fornix Obturator foramen

Ischial spine When performing a transvaginal pudendal nerve block, the ischial spine is palpated through the wall of the vagina and the needle is then passed through the vaginal mucous membrane toward the ischial spine. Eventually, the needle pierces the sacrospinous ligament, at which point the pudendal nerve is bathed with anesthetic. Remember--the pudendal nerve is within the pudendal canal, and it wraps around the ischial spine before it delivers its branches. So, administering the nerve block at the ischial spine allows a physician to anesthetize all the branches of the pudendal nerve. This is a very important landmark that you want to remember! Also remember--the pudendal nerve block does not need to be administered transvaginally. In a perineal pudendal nerve block, the ischial tuberosity is palpated through the buttock and the needle is inserted into the pudendal canal about one inch deep medial to the ischial tuberosity. The anesthetic can then be injected to bathe pudendal nerve. In this case, a different anatomical landmark, the ischial tuberosity, is used to deliver the nerve block

Which statement about the pelvic floor is NOT correct? Along with the pelvic brim, it defines the true pelvic cavity It is a funnel-shaped skeletal muscle It is referred to as the pelvic diaphragm It is tensed during defecation It projects into the anal triangle

It is tensed during defecation.

After giving birth, a patient complains of urinary stress incontinence characterized by dribbling of urine with an increase in intra-abdominal pressure. Her physician suspects injury to the pelvic floor during delivery which may have altered the position of the neck of bladder and the urethra. Which muscle was most likely damaged during the vaginal delivery? Bulbospongiosus Coccygeus Levator ani Obturator internus Piriformis

Levator ani

In a patient with rectal cancer located in the wall of the ampulla, you find that the cancer has spread to the muscle immediately lateral to the ampulla. This muscle is the: Piriformus Obturator internus Levator ani Sphincter urethrae Bulbospongeosis

Levator ani The levator ani is the muscle immediately lateral to the ampulla of the rectum, so this is where the cancer would have spread. This muscle is important for elevating the pelvic floor. The obturator internus and piriformis muscles are lateral and posterior to the rectum--they would not be affected by the cancer. The sphincter urethrae encircles and compresses the urethra. Bulbospongeosus is a muscle in the perineum which compresses the bulb of the penis and the spongy urethra in men and compresses the vestibular bulb and constricts the vaginal orifice in women.

After giving birth, a patient complains of dribbling of urine while coughing, sneezing, or laughing. Which muscle was most likely damaged during the vaginal delivery? Coccygeus Levator ani Obturator internus Piriformis Transverse perineal

Levator ani Urinary stress incontinence happens when the bladder can't handle increased compression during exercise, coughing, or sneezing. This form of incontinence is the result of relaxation of the pelvic muscles and displacement of the urethrovesiculal junction. Remember--levator ani is the major pelvic muscle which elevates the pelvic floor. So, if this muscle became injured during a vaginal birth, a woman might experience urinary incontinence.

The part of the broad ligament giving attachment and support to the uterine tube is the: mesometrium mesovarium mesosalpinx round ligament

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.

The nerves of the lumbar plexus are arranged around specific muscles of the posterior abdominal wall. Which of these nerves lies immediately medial to the psoas major muscle? Obturator Femoral Ilioinguinal Genitofemoral

Obturator

The arcus tendineus levator ani is a thickening of fascia of the: Coccygeus Obturator externus Obturator internus Piriformis

Obturator internus The fascia of obturator internus has two specializations. First, there is a strong band on the medial edge of obturator internus that stretches between the spine of the ischium and the superior pubic ramus. This is the arcus tendineus levator ani, which gives origin to the levator ani muscles. The other specialization is the obturator membrane, which nearly covers the entire obturator foramen, only leaving space for the obturator nerves and vessels to exit. Coccygeus is a muscle that elevates the pelvic diaphragm--it is found posterior to levator ani. Obturator externus is not found it the pelvis--it takes origin from the external surface of the obturator membrane and inserts on the femur. It is an important muscle for laterally rotating the thigh. The piriformis muscle takes origin from the anterior surfaces of S2 to S4, both between and lateral to the sacral foramina. It exits the pelvis via the greater sciatic foramen, inserting on the greater trochanter of the femur in order to rotate the thigh laterally.

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

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.

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

Pectinate line

The sacral outflow of the parasympathetic (craniosacral) system enters the pelvic plexus via: Hypogastric nerves Pelvic splanchnic nerves Pudendal nerves Sacral splanchnic nerves

Pelvic splanchnic nerves Pelvic splanchnic nerves come from the anterior branches of S2 through S4. These are parasympathetic nerves, which send parasympathetic neurons to the hypogastric plexus, and therefore the pelvic viscera and distal colon. Hypogastric nerves are from the superior hypogastric plexus. These nerves transmit sympathetic neurons to the hypogastric plexus, and therefore the pelvic viscera. The pudendal nerve is a branch of the sacral plexus. It provides motor innervation to the muscles of the perineum, and it is the primary sensory innervation to the genitalia. Sacral splanchnic nerves are from the second and/or third ganglia of the sacral sympathetic trunk. These provide a secondary way for sympathetic neurons to reach the hypogastric plexus, and therefore the pelvic viscera.

During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate? Deep perineal Dorsal nerve of the penis Genitofemoral Pelvic splanchnics Pudendal

Pelvic splanchnics Erection is mediated by parasympathetic nerves, and the pelvic splanchnic nerves are the parasympathetic nerves that innervate the smooth muscle and glands of all pelvic viscera. So, the pelvic splanchnic nerves are the nerves contributing the fibers to the prostatic plexus which innervate penile/clitoral erectile tissue to cause erection. None of the other listed nerves carry parasympathetic fibers which could innervate the penis and cause erection. Additionally, none of these other nerves contribute to the prostatic plexus, which is an extension of the inferior hypogastric plexus. The deep perineal nerve is the a branch of the perineal nerve that innervates all the muscles of the urogenital triangle. The dorsal nerve of the penis/clitoris is a branch of the pudendal nerve that provides sensory innervation to the skin of the shaft of the penis/clitoris. The genitofemoral nerve provides motor innervation to the cremaster muscle and sensory innervation to the skin of the anterior scrotum/labium majus and the upper medial thigh. Finally, the pudendal nerve is the major nerve of the perineal region. Its branches include the inferior rectal nerve, perineal nerve, and the dorsal nerve of the penis/clitoris.

A pediatrician has diagnosed a newborn baby of having right-sided cryptorchidism (undescended testis). The testis may have been trapped in any site EXCEPT: At the deep inguinal ring Just outside the superficial inguinal ring Pelvic brim Perineum Somewhere in the inguinal canal

Perineum To understand this question, you need to understand the descent of the testes. The testes begin as retroperitoneal structures in the posterior abdominal wall. They are attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum "pulls" the testes through the deep inguinal ring, inguinal canal, superficial inguinal ring, and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis, which is derived from the peritoneum anterior to the testes. The processus vaginalis "pushes" the muscle and fascia layers, which will eventually make up the canal and spermatic cord, into the scrotum. After the testes are in position in the scrotum, the gubernaculum persists as the scrotal ligament, while part of the processus vaginalis remains as a bursa-like sac called the tunica vaginalis testis. So, the testes could get caught in the deep inguinal ring, inguinal canal, at the superficial inguinal ring, or at the pelvic brim. The testes are never in the perineum, and they wouldn't get stuck there.

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

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.

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

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.

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

Posterior to the bladder and anterior to the rectum 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.

The nerves that end on the secretory cells of the medulla of the suprarenal glands are principally: Postganglionic fibers from the aorticorenal ganglia Postganglionic fibers from the celiac plexus Preganglionic fibers from the lesser thoracic splanchnic nerve Preganglionic fibers from the greater thoracic splanchnic nerve Postganglionic fibers from the renal plexus

Preganglionic fibers from the greater thoracic splanchnic nerve

In the lumbar region, tuberculosis may spread from the vertebrae into an adjacent muscle to produce an abscess. Pus from the abscess may travel within the fascial sheath surrounding the affected muscle. A patient presents with pus surfacing in the superomedial part of the thigh. To which muscle did the tuberculosis most likely spread? Internal oblique Psoas major Rectus abdominis Obturator internus Quadratus lumborum

Psoas major

In a female with an indirect inguinal hernia, the herniated mass lies along side of which structure as it traverses the inguinal canal? Iliohypogastric nerve Inferior epigastric artery Ovarian artery and vein Pectineal ligament Round ligament of the uterus

Round ligament of the uterus In females, the round ligament of the uterus is the main structure traversing the inguinal canal. In males, the most important structure in the inguinal canal is the spermatic cord. The iliohypogastric nerve innervates the abdominal wall. It runs between the transversus abdominis and internal oblique muscles, then pierces the internal oblique at the anterior superior iliac spine to run between the internal and external obliques. The inferior epigastric artery lies between the peritoneum and the transversus abdominis, creating the lateral umbilical fold. The ovarian artery and vein are branches from the descending aorta and inferior vena cava which supply the ovary in the pelvis. The pectineal ligament is a thick layer of fascia over the pectineal line of the pubis. Although the pectineal ligament helps define the boundaries of the inguinal canal, you can't really say that the pectineal ligament traverses the canal. That's why the round ligament is the best answer.

A patient presents complaining of blood-stained stools and the inability to completely empty his rectum. He also has pain along the back of his thigh and weakness of the posterior thigh muscles. Digital examination reveals a tumor in the posterolateral wall of the rectum. Pressure on what nerve plexus could cause the pain in his lower limb? Inferior hypogastric Inferior mesenteric Lumbar Sacral Superior hypogastric

Sacral plexus The sacral plexus includes contributions from L4 through part of S4. It supplies motor innervation to muscles of the pelvic diaphragm, muscles of the urogenital diaphragm, and muscles of the posterior hip, posterior thigh, leg and foot. It supplies sensory innervation to the skin of the perineum, posterior thigh, leg and foot. So, this patient's pain and weakness in the thigh, as well as his inability to empty his rectum, point to damage in the sacral plexus.

A caudal epidural block is a form of regional anesthetic used in childbirth. Within the sacral canal, the anesthetic agent bathes the sacral spinal nerve roots which would anesthetize all of the following nerves except: Pelvic splanchnics Pudendal S2 dorsal root Sacral splanchnics S2 ventral primary ramus

Sacral splanchnics The sacral splanchnic nerves do not come out of the sacral nerve roots--instead, these nerves come from the sacral sympathetic ganglia. So, anesthesia bathing the sacral nerve roots would not affect the sacral splanchnic nerves, which are coming from the sympathetic trunk. The sacral splanchnic nerves contribute to the inferior hypogastric plexus and provide sympathetic innervation to the vascular smooth muscle of the pelvic viscera. The pelvic splanchnic nerves are comprised of fibers from S2, 3, and 4, and pudendal nerve is made of the ventral primary rami of S2-4. These nerves would be numbed if the sacral nerve roots were anesthetized. Finally, the S2 dorsal root and S2 ventral primary ramus would also be anesthetized by the caudal epidural block.

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

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.

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

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!

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

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.

A patient complains of a boil located on her labia majora. Lymphatic spread of the infection would most likely enlarge which nodes? Lumbar nodes Sacral nodes External iliac nodes Superficial inguinal nodes Internal iliac nodes

Superficial inguinal lymph nodes The perineum and the external genitalia, including the labia majora and scrotum, drain to the superficial inguinal lymph nodes. However, in the male, remember that the testes do not drain to the superficial inguinal lymph nodes! The lymphatic vessels for testes travel in the spermatic cord and drain the testes into the lumbar nodes (ovaries also drain to lumbar nodes). The lumbar nodes drain the internal pelvic organs; the sacral nodes drain the prostate gland, uterus, vagina, rectum, and posterior pelvic wall; the external iliac nodes drain the lower limb; the internal iliac nodes drain the pelvis and gluteal region.

Which statement is true regarding pelvic veins? The external iliac vein lies medial to the external iliac artery The external iliac veins join to form the inferior vena cava The inferior vena cava cannot be imaged Pelvic veins are usually imaged using an arteriogram

The external iliac veins lie medial to the external iliac artery

A patient presents with a hernia that is palpable at the superficial inguinal ring. Is this an indirect inguinal hernia? Yes No There is insufficient evidence to tell

There is insufficient evidence to tell. You can't tell if a hernia is direct or indirect just by palpating it! Although it is more common for indirect hernias to pass through the superficial inguinal ring while direct hernias usually stay in the inguinal canal, it is possible that a direct hernia could protrude through the superficial ring and even enter the scrotum.

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

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.

Blood supply to the superior portions of the bladder typically arises from the ____________ arteries. Umbilical Middle rectal Obturator Inferior gluteal Uterine

Umbilical The umbilical artery supplies the superior part of the bladder by giving off the superior vesical arteries. In males, this artery supplies the ductus deferens via the artery of the ductus deferens. Distal to those branches, the umbilical artery is not patent, and it becomes the medial umbilical ligament. The middle rectal artery supplies blood to the middle of the rectum, while the obturator artery supplies blood to the medial thigh and hip. The inferior gluteal artery supplies blood to gluteus maximus, and the uterine artery supplies blood to the uterus.

While performing a hysterectomy, the resident must ligate the uterine artery. To avoid iatrogenic injury to the ureters, she must be aware that the ureter passes ___________ the artery at the level of the ______________. Over; cervix Over; fundus of uterus Over; pelvic brim Under; cervix Under; pelvic brim

Under; cervix Remember--the ureter passes under the uterine artery, in the inferior portion of the mesometrium, near the cervix! This is a very important relationship

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

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 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 vagina

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.

The expanded region of the lower rectum, where fecal matter is retained, is known as the: Anal columns Anal sinuses Ampulla Transverse folds

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.

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

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.

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

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.

The artery which supplies blood to the major erectile body in both the male and female is the: Artery of the bulb Dorsal artery of the penis/clitoris Deep artery of the penis/clitoris Posterior labial/scrotal artery Superficial external pudendal artery

deep artery of the penis/clitoris The deep artery supplies the corpus cavernosum of the penis/clitoris, which is the major erectile body. It is one of the two terminal branches of the internal pudendal artery, with the other one being the dorsal artery of the penis/clitoris. This artery supplies superficial structures. The artery of the bulb supplies blood to the bulb of the penis and the bulb of the vestibule. Although the bulbs are erectile tissue, the corpus cavernosum is the main erectile body. The posterior labial/scrotal artery supplies exactly what you would guess--the posterior labia or scrotum. It is a branch of the perineal artery. Finally, the superficial external pudendal artery supplies the skin and superficial fascia of the upper medial thigh, as well as the skin of the pubic region. It is a superficial branch of the femoral artery.

Which of the following does not conduct spermatozoa? Ampulla of the ductus deferens Duct of the seminal vesicle Epididymis Prostatic Urethra

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.

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

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.

The most inferior extent of the peritoneal cavity in the female is the: Pararectal fossa Paravesical fossa Rectouterine pouch Rectovesical pouch Vesicouterine pouch

ectouterine 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.)

The part of the male reproductive tract which carries only semen within the prostate gland is the: Prostatic urethra Membranous urethra Seminal vesicle Ductus deferens Ejaculatory duct

ejaculatory duct The ejaculatory duct is a duct which courses through the prostate gland and contains only semen. Remember, semen is the combination of sperm from the ductus deferens, seminal fluid from the seminal vesicle, and secretions of the prostate gland. The ejaculatory duct is formed by the union of the duct of the seminal vesicle and the ampulla of the ductus deferens, and it is the site where sperm and seminal fluid mix. The prostatic urethra is also contained in the prostate gland, and it carries semen, but it also carries urine out of the bladder. The membranous urethra is the continuation of the prostatic urethra outside of the prostate gland, and it carries both semen and urine as well. The seminal vesicle is a structure on the posterior surface of the bladder that produces seminal fluid. The ductus deferens is a passageway that carries sperm from the epididymis to the ejaculatory duct.

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

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.

Which of the following developmental processes is least likely to be involved in the differentiation of male external genitalia from the indifferent state? Descent of the gonads into the labio-scrotal folds Fusion of the urogenital folds Elongation of the phallus Formation of new erectile bodies

formation of new erectile bodies Males and females have analogous erectile bodies. The three main erectile bodies in males are 2 corpus cavernosa and a corpus spongiosum. Females have 2 corpus cavernosa plus 2 vestibular bulbs which are analogs to the corpus spongiosum. So, females actually have more erectile bodies than males. Development differs, however, in many other ways. Remember: the gubernaculum pulls the testes to descend into the scrotum, but the ovaries stop their descent and remain in the pelvis. The urogenital folds fuse in males to create the raphe of the penis. However, they stay open in females to create the labial minora and perineal raphe. Finally, the phallus elongates in males but not in females.

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

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.

After successfully performing two adrenalectomies (removal of the adrenal gland), the surgical resident was disappointed to learn that he would be merely assisting at the next one. The chief of surgery told him: "I'm doing this one, since the one on the right side may be a little too difficult for you." The difficulty he envisioned stems from the fact that the right suprarenal gland is partly overlain anteriorly by the: inferior vena cava right crus of the diaphragm right renal artery aorta left hepatic vein

inferior vena cava

Blood from an injured kidney will seep through the perirenal fat until it contacts the internal surface of the renal (Gerota's) fascia. Without perforating this fascia the blood could then continue to pass in what direction? superiorly into contact with the fascia of the diaphragm medially across the midline to the other kidney laterally into the body wall inferiorly toward the pelvis

inferiorly toward the pelvis

A structure which is homologous to the male scrotum: Labia minora Labia majora Glans Shaft of corpus cavernosum

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.

The celiac plexus of nerves may contain fibers derived from all of the following sources except: posterior vagal trunk lumbar splanchnic nerves greater thoracic splanchnic nerve lesser thoracic splanchnic nerve

lesser thoracic splanchnic nerve

A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region? Deep inguinal ring Lateral inguinal fossa Medial inguinal fossa Superficial inguinal ring Supravesical fossa

medial inguinal fossa A direct inguinal hernia passes through the weak fascia in the medial inguinal fossa. This is the area between the medial and lateral umbilical folds (made of the obliterated umbilical artery and inferior epigastric vessels, respectively). A direct inguinal hernia does not pass through the deep inguinal ring or the lateral inguinal fossa--that's what an indirect hernia does.

During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a lighted scope on a thin tube inserted through the wall), the attending physician noted something of interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor would have to look at the area between the: - inferior epigastric artery and urachus - medial umbilical ligament and urachus - inferior epigastric artery and lateral umbilical fold - medial umbilical ligament and inferior epigastric artery - median umbilical ligament and medial umbilical ligament

medial umbilical ligament and inferior epigastric artery Remember, the medial umbilical fold is made by the medial umbilical ligament (the obliterated portion of the umbilical artery), while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umibilical fold is a midline structure made by the median umbilical ligament (obliterated urachus). The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. This is the place in the abdominal wall where there is an area of weak fascia called the inguinal triangle--direct inguinal hernias can break through this space. The lateral inguinal fossa is a space lateral to the lateral umbilical fold--indirect inguinal hernias push through the deep inguinal ring in this space.

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 Uterosacral ligament

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.

An intrahepatic blockage of the portal venous outflow may cause intestinal blood to drain via portal-systemic anastomoses into the: Superior gluteal vein Middle rectal vein Splenic vein Renal vein Inferior phrenic vein

middle rectal vein There are four portal-caval anastomoses in the body. First, between the superior rectal veins in the portal system and the middle and inferior rectal veins in the caval system. Second, between the esophageal veins that go to the left gastric vein (portal) and the esophageal veins that go to the azygos system (caval). Third, between the paraumbilical veins of the portal system and the veins of the anterior abdominal wall that drain into the inferior vena cava. Fourth, between the colic veins of the portal system and the retroperitoneal veins of the caval system. So middle rectal is the right answer. The superior gluteal vein, renal vein, and inferior phrenic vein are all part of the caval system; the splenic vein is part of the portal system.

The part of the uterine wall which is not shed during menstruation is the: Endometrium Myometrium Mesometrium Cervical mucosa Rugae

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).

A 19-year-old male suffers a tear to the psoas major muscle during the course of a football game. A scar, which formed on the medial part of the belly of the muscle, involved an adjacent nerve, immediately medial to the muscle. The nerve is called the: genitofemoral iliohypogastric femoral ilioguinal obturator

obturator The obturator nerve runs along the medial border of the psoas major muscle, eventually passing through the obturator canal to innervate muscles of the medial thigh. So, it might be damaged by an injury to the medial portion of psoas major. The femoral nerve runs along the lateral border of psoas major, where psoas major contacts iliacus. The genitofemoral nerve pierces through psoas major at the level of L3 or L4. The iliohypogastric and ilioinguinal nerves run under psoas major, emerging at the lateral border of psoas major to run over quadratus lumborum. The way to distinguish between these two nerves is to remember that the iliohypogastric is superior to the ilioinguinal nerve.

During preparations to remove the left kidney from a 28-year-old female patient, the surgeon asked an observing medical student where best to ligate the renal vein. Upon hearing the reply: "as close to the inferior vena cava as possible, leaving just enough stump to ensure tight closure," the surgeon's eyebrow shot up. "Do you mean to say you're willing to compromise the venous drainage of the other structures that drain into the renal vein?" By this he meant all of the following except: ovary diaphragm pancreas suprarenal gland

pancreas

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

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.

Preganglionic parasympathetic nerve fibers within the pelvic (inferior hypogastric) plexus arise from S2, 3, 4 and enter the plexus via: gray rami communicantes hypogastric nerves pelvic splanchnic nerves sacral splanchnic nerves white rami communicantes

pelvic splanchnic nerves

A condensation of fibrous tissue in the female located at the center of the posterior border of the perineal membrane is the: Frenulum Posterior labial commissure Perineal body Anococcygeal ligament Pubovesical ligament

perineal body The perineal body is an irregular fibromuscular mass located at the center of the posterior border of the perineal membrane. It is the site where many muscles converge, including bulbospongiosus, external anal sphincter, and the superficial and deep transverse perineal muscles. This is found only in females; the male homolog for this structure is the central tendinous point.

The vestibular bulbs/bulb of the corpus spongiosum are firmly attached to the: Perineal membrane Superior pubic rami Ischiopubic rami Pubic symphysis Ischial tuberosities

perineal membrane The bulbs of the vestibule/bulb of the corpus spongiosum are pieces of erectile tissue that attach to the perineal membrane. They are covered by the bulbospongiosis muscle. The ischiopubic rami, pubic symphysis, and ischial tuberosities are bony structures important for defining the boundaries of the perineum. The crura of the corpora cavernosa attach to the ischiopubic rami and the perineal membrane.

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

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.

What part of the ischioanal (ischiorectal) fossa extends deep to the sacrotuberal ligament? Anterior recess Genital hiatus Posterior recess Pudendal canal

posterior recess The ischioanal fossa is a space found on both sides of the anal canal. It is bounded laterally by the obturator internus, superiorly by the pelvic diaphragm, and medially by the pelvic diaphragm and anus. It is the area that is lateral to the anal canal and inferior to the pelvic diaphragm. The anterior recesses are the parts of the ischioanal fossa that extend above the perineal membrane, and the posterior recesses extend deep to the sacrotuberal membrane and superior to the gluteus maximus. The genital hiatus is the place where the pelvic diaphragm splits to allow the urethra/vagina and anus to pass through. The pudendal canal travels from the lesser sciatic foramen, where its contents enter the perineum. It contains the internal pudendal artery, internal pudendal vein, and pudendal nerve.

The pelvic splanchnic nerves primarily carry ____________ to the _____________ plexus. Preganglionic parasympathetics--superior hypogastric Preganglionic parasympathetics--inferior hypogastric Postganglionic parasympathetics--superior hypogastric Postganglionic sympathetics--superior hypogastric Postganglionic sympathetics--superior hypogastric

preganglionic parasympathetics--inferior hypogastric Although all the other splanchnic nerves carry sympathetic fibers, the pelvic splanchnic nerves transmit preganglionic parasympathetic fibers from S2, 3, and 4. These fibers are carried to the inferior hypogastric plexus. The parasympathetic fibers from the inferior hypogastric plexus supply the smooth muscle of the pelvic viscera, while the sympathetic fibers from the inferior hypogastric plexus supply vascular smooth muscle of vessels supplying the pelvic viscera. The superior hypogastric plexus is a continuation of the intermesenteric plexus--it contributes sympathetic fibers to the inferior hypogastric plexus through hypogastric nerves.

A structure which takes the form of a hood anterosuperior to the clitoris: Frenulum of the clitoris Labia majora Labia minora Prepuce

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.

Following pregnancy and delivery, a 32-year-old woman continued to have problems with urinary incontinence which developed during pregnancy. Her obstetrician counseled her to strengthen the muscle bordering the vagina and urethra, increasing its tone and exerting pressure on the urethra. This physical therapy was soon adequate to restore urinary continence. What muscle was strengthened? Coccygeus Ischiocavernosus Obturator Internus Piriformis Puborectalis

puborectalis Puborectalis is the part of levator ani that is closest to the vagina and urethra. This muscle may be injured during a difficult childbirth. By doing Kegel exercises, where women contract and relax the pelvic floor, these injured muscles may be strengthened and urinary continence may be improved. Besides levator ani, coccygeus is the second muscle that makes the pelvic floor. However, it extends between the ischial spine and the side of the coccyx/lower sacrum, so it is not next to the vagina and urethra and is not important for maintaining urinary continence. Ischiocavernosus compresses the corpus cavernosum. It is closely applied to the crus penis/clitoris in the perineum. Obturator internus and piriformis laterally rotate and abduct the thigh. Although these muscles originate in the pelvis, they are functionally more important to the lower limb.

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

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.

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

rectouterine pouch

A 57-year-old male complains of intense chest pain, but tests rule out any cardiac pathology. It was determined that the patient suffers from an esophageal (hiatal) hernia in which the stomach herniates through an enlarged esophageal hiatus. Muscle fibers from which of the following parts of the diaphragm would border directly on this hernia? sternal fibers right crus costal fibers left crus central tendon

right crus The right crus is the part of the diaphragm that takes origin from L1-L3. It splits to enclose the esophagus. So, in the case of an esophageal hernia, the herniating stomach would be entirely surrounded by the fibers of the right crus. The left crus is the part of diaphragm that takes origin from L1 and L2. It is smaller and shorter than the right crus, and it intermingles with the right crus around the aortic hiatus. It does not contribute to the esophageal hiatus. The central tendon is the tendon in the middle of the diaphragm where all the fibers of the diaphragm attach. It provides an opening for the inferior vena cava. Finally, sternal and costal fibers refer to muscle fibers in the diaphragm that take origin from the xyphoid process or the ribcage.

The boundaries of the perineum include all the following except: Ischiopubic rami Ischial tuberosity Tip of the coccyx Sacrotuberal ligament Sacrospinal ligament

sacrospinal ligament The bounderies of the perineum are as follows. Anterior: pubic symphysis; Anterolateral: ischiopubic rami; Lateral: ischial tuberosities; Posterolateral: sacrotuberous ligament; Posterior: tip of the coccyx. These boundaries create two triangles in the perineum: the urogenital triangle and the anal triangle. The urogenital triangle is the anterior subdivision, bounded by the pubic symphysis, ischiopubic rami, and the posterior margin of the perineal membrane, which corresponds to an imaginary line between the two ischial tuberosities. The anal triangle is the posterior division of the perineum. It starts off where the urogenital triangle ends: at the posterior margin of the perineal membrane. Then, it is bounded by the sacrotuberous ligament and the tip of the coccyx.

A 6 mo. old male was brought to the pediatric clinic by his parents because of leakage of urine from the ventral surface of his penis. This congenital condition, hypospadias, is due to incomplete ventral closure of a component of the penis. Which of the below structures would be partially open for urine to take such a course? Shaft of corpus cavernosum Membranous urethra Glans Shaft of corpus spongiosum

shaft of the corpus spongiosum Since the urine is leaking through the ventral side of the penis, it must be leaking through a defect in the spongy urethra. The spongy urethra is contained in the corpus spongiosum, so it follows that the corpus spongiosum must be open. The membranous urethra is a brief portion of the urethra extending from the bottom of the prostate to the top of the corpus spongiosum. A defect here would not cause leakage on the ventral surface of the penis. The corpora cavernosa are erectile bodies that lie beside the corpus spongiosum. They are not involved with the flow of urine or the urethra. The glans of the penis is at the tip - if this structure failed to close, there would be abnormal leakage from the tip of the penis, not the ventral surface.

A 15-year-old boy was admitted to the emergency room for having large bowel obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal segment involved in this obstruction is the: ascending colon cecum descending colon rectum sigmoid colon

sigmoid colon The sigmoid colon is the most likely intestinal segment to be involved in a left-sided indirect inguinal hernia.

Sympathetic fibers in the greater splanchnic nerve arise from neuron cell bodies found in the: celiac ganglion superior mesenteric ganglion brainstem spinal cord chain ganglion

spinal cord

The perineum is bounded by all of the following skeletal elements except: coccyx ischiopubic ramus spine of ischium symphysis pubis

spine of the ischium The bounderies of the perineum are as follows. Anterior: pubic symphysis; Anterolateral: ischiopubic rami; Lateral: ischial tuberosities; Posterolateral: sacrotuberous ligament; Posterior: tip of the coccyx. The spine of the ischium, which projects into the pelvis toward the lateral pelvic wall, does not make up a boundary of the perineum

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

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.

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

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.

Structures within the lower gastrointestinal tract specialized for physical support of fecal material are the: Transverse rectal folds Circular folds Anal valves Anal columns

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.

If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall? Camper's and Scarpa's fascias External abdominal oblique and internal abdominal oblique muscles Internal abdominal oblique and transversus abdominis muscles Skin and deep fascia of the abdominal wall Tranversus abdominis muscle and peritoneum

transversus abdominis and peritoneum The inferior epigastric vessels lay on the inner surface of the transversus abdominis and are covered by parietal peritoneum. Remember, the peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper's fascia and Scarpa's fascia are two layers of the superficial fascia - Camper's is the fatty layer and Scarpa's is the membranous layer.

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

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.