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Question 1
Correct
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A patient undergoes oophorectomy and the ovarian veins are ligated. Which vein does the left ovary drain into?
Your Answer: Left renal
Explanation:The right ovarian vein ascends and enters the inferior vena cava and the left ovarian vein drains into the longer left renal vein.
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This question is part of the following fields:
- Anatomy
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Question 2
Correct
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After a vaginal delivery, a patient suffers a perineal tear. On examination the laceration involves the external anal sphincter and has partially torn the internal anal sphincter. Which of the following classifies this tear?
Your Answer: 3c
Explanation:During childbearing the vagina and perineum are prone to lacerations that may involve the skin or can extend into the anal sphincter complex. It is important to be able to identify obstetric and anal sphincter injuries to provide adequate care and prevent complications. In the classification of obstetric tears according to RCOG guidelines:
First degree tear: injury to the perineal skin and/or the vaginal mucosa
Second degree tears: Injury to perineum involving perineal muscles but not the anal sphincter.
Third-degree tear: Injury to perineum involving the anal sphincter complex:
Grade 3a tear: Less than 50% of external anal sphincter (EAS) thickness torn.
Grade 3b tear: More than 50% of EAS thickness torn.
Grade 3c tear: Both EAS and internal anal sphincter (IAS) torn.
Fourth-degree tear: Injury to perineum involving the anal sphincter complex (EAS and IAS)
and anorectal mucosa. -
This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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Regarding molding of the fetal head, which one is true?
Your Answer: Becomes progressively easier as gestational age increase
Correct Answer: Does NOT have time to occur in breech delivery
Explanation:Molding allows the skull bones of the fetal head some mobility during the normal delivery of foetus as the skull changes its shape to accommodate passage through the mothers pelvis. However this does not occur in breach delivery where the skull is in circular shape. Babies born breech typically have craniofacial and limb deformations resulting from their in utero position. These babies characteristically have a long, narrow head, (“dolichocephaly” or “type 1”), with a prominent occipital shelf, redundant skin over the neck, overlapping lambdoidal sutures, and an indentation below their ears (from shoulder compression).
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This question is part of the following fields:
- Anatomy
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Question 4
Correct
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All of the following are features of the female bony pelvis, except?
Your Answer: It is funnel shaped
Explanation:The female bony pelvis is larger, broader and more of a funnel shape. The inlet is larger and oval in shape and the sides of the female pelvis are wider apart.
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This question is part of the following fields:
- Anatomy
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Question 5
Incorrect
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Which of the following terms best describes the pelvic type of small posterior sagittal diameter, convergent sidewalls, prominent ischial spines, and narrow pubic arch?
Your Answer: Gynecoid
Correct Answer: Android
Explanation:There are four types pelvic shapes:
1) Android pelvis: it has a larger inlet and smaller outlet along with small posterior sagittal diameter, prominent ischial spines and has a two finger arch.
2) Gynecoid pelvis: it has a transverse or nearly a circular ellipse and it is the most favourable for delivery.
3) Anthropoid pelvis: the brim is an anteroposterior ellipse.
4) Platypelloid pelvis: in this type the pelvic brim is kidney shape -
This question is part of the following fields:
- Anatomy
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Question 6
Incorrect
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The main support of the uterus is provided by:
Your Answer: The round ligament
Correct Answer: The cardinal ligament
Explanation:The cardinal ligament (or Mackenrodt’s ligament, lateral or transverse cervical ligament) is a major ligament of the uterus. It is located at the base of the broad ligament of the uterus. It attaches the cervix to the lateral pelvic wall by its attachment to the Obturator fascia of the Obturator internus muscle, and is continuous externally with the fibrous tissue that surrounds the pelvic blood vessels. It thus provides support to the uterus.
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer: S5
Correct Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 8
Correct
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Regarding lymph drainage of the breast where does the majority of lymph drain to?
Your Answer: Axillary nodes
Explanation:Lymphatic drainage of the breast.
The lateral two thirds of the breast drains into the axillary lymph nodes. This constitute about 75% of the lymphatic drainage of the breast. The medial third of the breast drains into the parasternal lymph nodes and these communicate with the ipsilateral lymph nodes from the opposite breast. The superior part of the breast drains into the infraclavicular lymph nodes and inferior part drains into the diaphragmatic lymph nodes. -
This question is part of the following fields:
- Anatomy
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Question 9
Incorrect
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A patient is about to undergo a pudendal nerve block after vaginal delivery to repair an episiotomy. Which spinal segments form the pudendal nerve?
Your Answer: L3, L4, L5 and S1
Correct Answer: S2, S3 and S4
Explanation:The pudendal nerve provides sensory innervation to regions of the anus, the perineum, the labia and the clitoris in women. The nerve is formed from the ventral rami of the S2-S4 sacral spinal nerves. The nerve is paired, each innervating the left and the right side of the body. Pudendal nerve blocks are indicated for analgesia of the second stage of labour, repair of an episiotomy or perineal laceration, and for minor surgeries of the lower vagina and perineum.
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This question is part of the following fields:
- Anatomy
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Question 10
Incorrect
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The testicular arteries are branches of what?
Your Answer: Perineal artery
Correct Answer: Aorta
Explanation:The testicular artery arises from the aorta and supplies the testis and the epididymis. The testis is supplied by 3 arteries.: Testicular artery, cremasteric artery that arises from the inferior hypogastric artery and the artery to the vas deferens from the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 11
Incorrect
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Sensory supply to the clitoris is via branches of which nerve?
Your Answer: Superior rectal
Correct Answer: Pudendal nerve
Explanation:The pudenal nerves has three branches, namely the inferior rectal, perineal and the dorsal nerve of the clitoris. The perineal nerve has two branches: The superficial perineal nerve gives rise to posterior scrotal or labial (cutaneous) branches, and the deep perineal nerve supplies the muscles of the deep and superficial perineal pouches, the skin of the vestibule, and the mucosa of the inferior most part of the vagina. The inferior rectal nerve communicates with the posterior scrotal or labial and perineal nerves. The dorsal nerve of the penis or clitoris is the primary sensory nerve serving the male or female organ, especially the sensitive glans at the distal end.
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This question is part of the following fields:
- Anatomy
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Question 12
Incorrect
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At what angle is the plane of the pelvic inlet to the anatomical horizontal plane?
Your Answer: 45
Correct Answer: 60
Explanation:The female pelvic inlet tilts at an inclination that is about 60 degrees from the anatomical horizontal plane. This tilt is maintained by muscles and fascia. The pelvic outlet slopes at an angle of 15 degrees.
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This question is part of the following fields:
- Anatomy
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Question 13
Correct
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The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer: Ilium
Explanation:Arcuate means ‘bow shaped’ and there are different arcuate lines in anatomical terms. Regarding the pelvic brim this is composed of the arcuate line of the ilium, pectineal line and prominences of sacrum and pubic symphysis (as demonstrated in the images below). As can be seen the arcuate line is a smooth rounded border on the internal surface of the ilium inferior to the iliac fossa and Iliacus. Image sourced from Wikipedia Note: The pelvic outlet is also called the inferior aperture. The pelvic brim is the superior aperture
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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Question 15
Incorrect
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Regarding the pelvic outlet, what structure marks the posterior boundary?
Your Answer: anterior border piriformis
Correct Answer: Tip of the coccyx
Explanation:The bony pelvis is made up of a girdle with a central canal. The rim that surrounds the upper opening of the canal is called the pelvic inlet, while the lower rim is the called the pelvic outlet. The pelvic outlet is diamond-shaped and is bounded posteriorly by the tip of the sacrum, and anteriorly by the pubic symphysis, with its lateral boundaries being the ischial tuberosities and the sacrotuberous ligament.
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This question is part of the following fields:
- Anatomy
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Question 16
Incorrect
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Which of the following arteries branches directly from the aorta?
Your Answer: Femoral
Correct Answer: Ovarian
Explanation:The uterine and vaginal arteries branch from the internal iliac artery. The ovarian artery branches direct from the aorta.
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This question is part of the following fields:
- Anatomy
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Question 17
Incorrect
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Which of the following structures does the broad ligament contain?
Your Answer: Vaginal artery
Correct Answer: Uterine artery
Explanation:The broad ligament is one of the secondary supporting structures of the uterus which attaches the lateral portion of the uterus to the pelvic sidewall. The broad ligament primarily serves a protective layer for important structures including the fallopian tubes, the ovaries, the ovarian arteries, and the uterine arteries, the round and ovarian ligaments, and the infundibulopelvic ligaments.
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This question is part of the following fields:
- Anatomy
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Question 18
Incorrect
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Which of the following muscles does NOT receive innervation from the pudendal nerve?
Your Answer: Levator ani
Correct Answer: Internal anal sphincter
Explanation:The internal anal sphincter is innervated by the splanchnic nerves. Sympathetic nerve supply from the inferior hypogastric plexus (for contraction) and parasympathetic supply from nervi erigentes (for relaxation).
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This question is part of the following fields:
- Anatomy
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Question 19
Incorrect
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Bladder neck closure and relaxation of the bladder is mediated by?
Your Answer: Parasympathetic Fibres T11,L1,L2
Correct Answer: Sympathetic Fibres L1,L2
Explanation:The neck of the bladder is surrounded by the internal sphincter. It is supplied by the sympathetic and parasympathetic nerves of the splanchnic nerve. Parasympathetic stimulation causes the detrusor muscle to contract and the internal urethral sphincter to relax. It Is predominantly by the parasympathetic nerves S2-S4. Relaxation of the bladder is caused by inhibiting the sacral parasympathetic preganglionic neurons and exciting the lumbar sympathetic preganglionic neurons. Remember SYMPATHETIC is for STORAGE and PARASYMPATHETIC is for PEEING.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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The femoral triangle is bounded superiorly by which of the following structures?
Your Answer: Inguinal canal
Correct Answer: Inguinal ligament
Explanation:Boundaries of the Femoral Triangle:
Superior: Inguinal ligament
Medial: Medial border of the adductor longus
Lateral: Medial border of the sartorius
Floor: Pectineus, Adductor longus and Iliopsoas muscles
Roof: Fascia Lata -
This question is part of the following fields:
- Anatomy
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Question 21
Incorrect
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Regarding the uterine artery which of the following statements are TRUE?
Your Answer: It arises from the vaginal artery
Correct Answer: It arises from the internal iliac artery
Explanation:The uterine artery arises from the internal iliac artery, in particular the anterior division of the internal iliac artery. Some older texts refer to the internal iliac as the hypogastric artery. The vaginal artery typically arises as its own branch of the internal iliac artery. The ovarian arteries are branches of the aorta
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This question is part of the following fields:
- Anatomy
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Question 22
Correct
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Which nerves innervate the internal anal sphincter?
Your Answer: Pelvic Splanchnic
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle or involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 23
Incorrect
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You are reviewing a patient who is complaining of pain and numbness to the right anterior aspect of her labia following abdominal hysterectomy. You suspect ilioinguinal nerve injury. What spinal segment is the ilioinguinal nerve derived from?
Your Answer: T12-L4
Correct Answer: L1
Explanation:Ilioinguinal nerve injury is one of the most common nerve injuries associated with pelvic surgery.
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This question is part of the following fields:
- Anatomy
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Question 24
Incorrect
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A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness of the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Genitofemoral
Correct Answer: Ilioinguinal
Explanation:The anterior aspect of the vulva (mons pubis, anterior labia) is supplied by derivatives of the lumbar plexus: the anterior labial nerves, derived from the
ilio-inguinal nerve, and the genital branch of the genitofemoral nerve.
The posterior aspect of the vulva is supplied by derivatives of the sacral plexus: the perineal branch of the posterior cutaneous nerve of the thigh laterally, and the pudendal nerve centrally. -
This question is part of the following fields:
- Anatomy
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Question 25
Correct
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Which structure reinforces the inguinal canal anterolaterally?
Your Answer: Internal oblique
Explanation:The anatomy of the inguinal canal is of surgical importance. In the male, the inguinal canal carries the spermatic cord, ilioinguinal nerve and important blood vessels, while in females the inguinal canal holds the round ligament, ilioinguinal nerve and blood vessels. The floor of the inguinal canal is made of the inguinal ligament (a thickened portion of the inguinal ligament), while the posterior wall is made of the transversalis muscle. The anterior wall is made of the external oblique aponeurosis, and the roof is made up of fibres of the internal oblique, transversus abdominis and its aponeurosis, and the conjoint tendon. This means that the anterolateral support structure of the inguinal canal would be the fibres of the internal oblique.
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This question is part of the following fields:
- Anatomy
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Question 26
Incorrect
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Regarding lymph drainage of the ovary where does the majority of lymph drain to?
Your Answer: External iliac lymph nodes
Correct Answer: para-aortic nodes
Explanation:The Ovaries lymph drains primarily to the lateral para-aortic lymph nodes
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This question is part of the following fields:
- Anatomy
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Question 27
Incorrect
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Iliac Spine
Correct Answer: Ischial Spine
Explanation:The ischial spines and palpable through the vagina and are used as landmarks to assess the decent of the fetal head from the cervix. It also serves as a landmark for giving the pudendal block.
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This question is part of the following fields:
- Anatomy
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Question 28
Incorrect
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The juxtaglomerular apparatus (JGA) lies within which part of the kidney?
Your Answer: Renal Pelvis
Correct Answer: Renal Cortex
Explanation:The juxtaglomerular apparatus is the main site for the production of renin. It plays an important role in the regulation of the blood pressure. These structures are mainly located in the cortex of the kidneys.
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This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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The typical female breast contains how many lobes?
Your Answer: 1
Correct Answer: 15-20
Explanation:The female breast is made of about 15 to 20 individual lobes. The lobules each consists of alveoli which drain into a single lactiferous duct. The ductal system leads to lactiferous sinuses and collecting ducts which expel milk from openings in the nipple.
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This question is part of the following fields:
- Anatomy
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Question 30
Correct
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The inguinal canal is reinforced posteriorly by which structure?
Your Answer: Conjoint tendon
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal and lacunar ligaments are part of the floor The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part
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This question is part of the following fields:
- Anatomy
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Question 31
Incorrect
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Regarding lymph drainage of the lower vagina where does the majority of lymph drain to?
Your Answer: External iliac node
Correct Answer: Inguinal nodes
Explanation:The lower vagina drains to the inguinal nodes where as the upper vagina drains to the internal and external iliacs
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This question is part of the following fields:
- Anatomy
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Question 32
Incorrect
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Which of the following is contained within the deep perineal pouch?
Your Answer: Superficial transverse perineal muscle
Correct Answer: Proximal portion of urethra
Explanation:The deep perineal pouch contains the external urethral sphincter, proximal urethra in females and membranous urethra in males, deep transverse perineal muscles and the glands of cowper.
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This question is part of the following fields:
- Anatomy
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Question 33
Incorrect
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If your patient is 8 weeks pregnant which one of the following USS measurements is most useful?
Your Answer: Abdominal circumference
Correct Answer: Crown rump length
Explanation:Fetal crown-rump length (CRL) is recommended over last menstrual period for estimating GA when measured in early pregnancy i.e. before 9 to 13+6 weeks.
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This question is part of the following fields:
- Anatomy
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Question 34
Incorrect
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The inferior 1/3 of the rectum is principally supplied by which artery?
Your Answer:
Correct Answer: Middle rectal artery
Explanation:Remember the inferior rectal artery supplies the anus. The middle rectal artery is the principle supply to the lower 1/3 rectum. The rectal arteries do form an anastomosis.
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This question is part of the following fields:
- Anatomy
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Question 35
Incorrect
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What is the anterior boundary of the pelvic outlet?
Your Answer:
Correct Answer: pubic arch
Explanation:The pelvic outlet is bounded anteriorly by the inferior border of the pubic arch, posteriorly by the sacrotuberous ligament and the tip of the coccyx and laterally by the ischial tuberosities.
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This question is part of the following fields:
- Anatomy
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Question 36
Incorrect
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Regarding lymph drainage of the lower vagina where does the majority of lymph drain to?
Your Answer:
Correct Answer: Inguinal nodes
Explanation:Lymphatic vessels from the vagina drain from the parts of the vagina as follows:
• Superior part: to the internal and external iliac lymph nodes.
• Middle part: to the internal iliac lymph nodes.
• Inferior part: to the sacral and common iliac nodes. -
This question is part of the following fields:
- Anatomy
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Question 37
Incorrect
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Question 38
Incorrect
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The juxtaglomerular apparatus (JGA) lies within which part of the kidney?
Your Answer:
Correct Answer: Renal Cortex
Explanation:The substructures of the nephrons are mainly located within the cortex. The JGA sits next to the glomerulus in the cortex (click on the magnifying glass of the image to see the arrangement). They play an important role in blood pressure homeostasis as the juxtaglomerular cells produce renin. The descending and ascending limbs of the loop of Henle and collecting ducts have sections within both the cortex and medulla
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This question is part of the following fields:
- Anatomy
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Question 39
Incorrect
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Question 40
Incorrect
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?
Your Answer:
Correct Answer: 3a
Explanation:1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
2. Second-degree tears involve perineal muscles and therefore include episiotomies.
3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
i Less than 50 per cent of the external anal
sphincter is torn.
ii More than 50 per cent of the external anal
sphincter is torn.
iii Tear involves the internal anal sphincter
(usually there is complete disruption of the
external sphincter).
4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa. -
This question is part of the following fields:
- Anatomy
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