The boundaries of the perineum include all the following except: Ischiopubic rami Ischial tuberosity Tip of the coccyx Sacrotuberal ligament Sacrospinal ligament
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
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
The vestibular bulbs/bulb of the corpus spongiosum are firmly attached to the: Perineal membrane Superior pubic rami Ischiopubic rami Pubic symphysis Ischial tuberosities
What part of the ischioanal (ischiorectal) fossa extends deep to the sacrotuberal ligament? Anterior recess Genital hiatus Posterior recess Pudendal canal
The perineum is bounded by all of the following skeletal elements except: coccyx ischiopubic ramus spine of ischium symphysis pubis
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
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
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
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
The part of the uterine wall which is not shed during menstruation is the: Endometrium Myometrium Mesometrium Cervical mucosa Rugae
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
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
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
Which pair of structures does NOT differentiate from comparable embryonic structures in the male and female? Bulb of corpus spongiosum 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
Which structure is outlined with contrast on a CT using intraperitoneal contrast
material? Ovary Prostate Rectum Seminal Vesicles Vagina
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
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
The most inferior extent of the peritoneal cavity in the female is the: Pararectal fossa Paravesical fossa Rectouterine pouch Rectovesical pouch Vesicouterine pouch
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
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
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
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
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
The part of the broad ligament giving attachment and support to the uterine tube is the: mesometrium mesovarium mesosalpinx round ligament
Which structure is NOT found within the true pelvis? Femoral nerve Hypogastric nerve Internal pudendal artery Obturator artery Pelvic splanchnic nerves
A structure which takes the form of a hood anterosuperior to the clitoris: Frenulum of the clitoris Labia majora Labia minora Prepuce
A structure which is homologous to the male scrotum: Labia minora Labia majora Glans Shaft of corpus cavernosum
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
You are observing a doctor perform an abdominal hysterectomy. She 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
The arcus tendineus levator ani is a thickening of fascia of the: Coccygeus Obturator externus Obturator internus Piriformis
The sacral outflow of the parasympathetic (craniosacral) system enters the pelvic plexus via: Hypogastric nerves Pelvic splanchnic nerves Pudendal nerves Sacral splanchnic nerves
A woman with breast cancer subsequently develops metastases in her vertebral column.
The most direct route for spread of the tumor to the vertebral column was via:
branches of the cephalic vein branches of the lateral thoracic vein branches of the thoracoacromial veins lymphatic vessels draining into the axilla branches of the intercostal veins
Mastitis is a condition which involves:
A type of leukemia Inflammation of the breast Infection of lymph nodes Mast cells Tumors of glandular tissue
In the process of doing an axillary lymph node dissection in a 50 year-old patient, the surgery resident cleans the space between the pectoralis major and minor muscles, in an attempt to remove all of the lateral pectoral lymph nodes. Upon recovery it is noted that the patient's lower pectoralis major is paralyzed. The nerve most likely injured is the:
axillary lateral pectoral medial pectoral suprascapular thoracodorsal
In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes?
Central axillary Deltopectoral Lateral axilllary Parasternal Subscapular
The prognosis in breast cancer is poorer as more proximal lymph nodes are found to have cancerous cells in them. Spread of cancer to which of the following axillary nodes would indicate the worst prognosis?
apical central lateral pectoral subscapular
During the planning of therapeutic intervention for a 54-year-old female patient with cancer of the right breast, a 3rd year medical student would need to first consider where most of the cancer cells would metastasize, which would be: Abdominal wall Anterior mediastinum Axillary lymph nodes Opposite breast Parasternal lymph nodes
Breast cancer cells can spread directly to the cranial cavity and brain via the vertebral venous plexus. Through which route can they reach this plexus? Axillary lymph nodes Internal thoracic vein Intercostal veins Parasternal lymph nodes Thoracoacromial artery
Upon finding a malignant tumor in the medial portion of the breast of a 40-year-old female, the surgeon began to search for the lymph nodes that would be the first ones reached by metastatic spread of cancer cells from this site. Which group(s) would have to be examined to determine whether metastasis had occurred? Central only Parasternal only Parasternal and apical Parasternal and lateral Parasternal and pectoral
While observing a mastectomy on a 60-year-old female patient, a medical student was asked by the surgeon to help tie off the arteries that supply the medial side of the breast. The artery that gives origin to these small branches is the: Internal thoracic Musculophrenic Posterior intercostal Superior epigastric Thoracoacromial