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Question 1
Incorrect
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A patient present to the clinic with a 1 day history of vaginal prolapse. Upon examination, the vagina is 1.5 cm below the vaginal plane. What grade is the prolapse according to the POP-Q classification?
Your Answer: Grade 2
Correct Answer: Grade 3
Explanation:Pelvic organ prolapse is a common condition amongst ageing women where a weakness in the pelvic support structures of the pelvic floor allows pelvic viscera to descend.
The Pelvic Organ Prolapse Quantification system (POP-Q) is useful for describing and staging the severity of the pelvic organ prolapse.
Grade 1: the most distal portion of the prolapse is more than 1 cm above the level of the hymen
Grade 2: the most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane
Grade 3: the most distal portion of the prolapse protrudes more than 1 cm below the hymen but protrudes no farther than 2 cm less than the total vaginal length (for example, not all of the vagina has prolapsed)
Grade 4: vaginal eversion complete -
This question is part of the following fields:
- Anatomy
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Question 2
Incorrect
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Uterine Cervix:
Your Answer: Laterally is attached to the round ligament
Correct Answer: Is the portion of the uterus below the isthmus
Explanation:The uterus is divisible into two portions. The portion above the isthmus is termed the body, and that below, the cervix. The uterine cervix is the narrow inferior segment of the uterus, which projects into the vaginal cavity. It is a fibromuscular organ lined by a mucous membrane and measures approximately 3cm in length and 2.5cm in diameter. The cervix is continuous at its superior margins with the body of the uterus and at its inferior margins with the vagina.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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The roof of the femoral triangle is formed by which structure?
Your Answer: Sartorius
Correct Answer: Fascia lata
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 (cribriform fascia at the saphenous opening) Trasversalis fascia forms part of the roof of the inguinal canal
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This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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The posterior scrotal artery is a branch of which artery?
Your Answer: Inferior Rectal
Correct Answer: Internal Pudendal
Explanation:The posterior scrotal artery is a terminal branch of the perineal artery which is a branch of the internal pudendal artery.
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This question is part of the following fields:
- Anatomy
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Question 5
Correct
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Question 6
Correct
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If the presenting part of the foetus is the large fontanel, this presentation is known as?
Your Answer: Sinciput
Explanation:Sinciput means the head is neither flexed nor extended. It is the area between forehead and crown and in this case the anterior fontanel is the presenting part.
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This question is part of the following fields:
- Anatomy
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Question 7
Correct
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Regarding lymph drainage of the fallopian tubes where does the majority of lymph drain to?
Your Answer: Para-aortic nodes
Explanation:Lymphatic vessels from the ovaries, joined by vessels from the uterine tubes and most from the fundus of the uterus, follow the ovarian veins as they ascend to the right and left lumbar (caval/aortic) lymph nodes.
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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 the rectus sheath which of the following statements are true?
Your Answer: Above the arcuate line the internal oblique divides into two lamellae
Explanation:The rectus sheath is formed by the aponeurosis of the internal and external oblique muscles and the transversus abdominus muscle. The internal oblique divides into two lamellae and encloses the rectus muscle. Anteriorly it fuses with the aponeurosis of the external oblique and posteriorly with that of the transverus abdominus. Below the arcuate line the aponeurosis of all the flat muscles lies anteriorly and posteriorly it is only enclosed by the transveralis fascia.
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This question is part of the following fields:
- Anatomy
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Question 9
Incorrect
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Pubic arch
Correct Answer: Ischial Spine
Explanation:The ischial spine is the anatomical landmark for assessing the station of the fetal head and also placing pudendal nerve blocks. (the pudendal nerve runs posterior to the ischial spine). The ischial spine can be palpated approximately 8cm into the vagina, at 4 and 8 o’clock.
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This question is part of the following fields:
- Anatomy
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Question 10
Correct
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Regarding the structure of the detrusor muscle. Which of the following is true?
Your Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer
Explanation:The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.
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This question is part of the following fields:
- Anatomy
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Question 11
Correct
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Which of the following statements regarding the Vaginal artery is typically TRUE?
Your Answer: It arises from the Internal iliac artery
Explanation:The Vaginal artery, like the Uterine artery is typically a branch of the Internal Iliac artery. It can sometimes arise as a branch of the Uterine artery so it is important to read the question (if the stem stated it CAN arise from the Uterine artery then that would be true)
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This question is part of the following fields:
- Anatomy
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Question 12
Incorrect
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Which of the following arteries branches directly from the aorta?
Your Answer: Uterine
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 13
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: S1 and S2
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 14
Correct
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In which one of the following positions does hyperextension of the fetal head occur?
Your Answer: Face presentation
Explanation:Face presentation is the abnormal position of the fetal head in labour. In this position the neck is hyperextended.
Vertex position is the normal presentation of the foetus for delivery, in which the head is flexed and the position of the chin is towards the chest. -
This question is part of the following fields:
- Anatomy
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Question 15
Correct
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer: 150ml
Explanation:The normal functional bladder capacity is around 400-600ml. First urge to void is typically felt when the bladder is approximately 150ml full.
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This question is part of the following fields:
- Anatomy
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Question 16
Correct
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Regarding the pubic symphysis, what type of joint is it
Your Answer: Secondary Cartilaginous
Explanation:The pubic symphysis is a cartilaginous joint. The cartilaginous joints are divided further into primary and secondary joints. The primary joint is called the synchondrosis. It articulates with the pubis of the other side.
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This question is part of the following fields:
- Anatomy
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Question 17
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 through the vaginal mucosa into the perineal muscle and fascia. The external anal sphincter appears to be in tact. How would you classify this tear?
Your Answer: 3rd type A
Correct Answer: 2nd
Explanation:If the external anal sphincter is in tact then this is a 1st or 2nd degree tear. As the perineal muscles are involved this is 2nd degree tear.
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This question is part of the following fields:
- Anatomy
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Question 18
Correct
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Which of the following arteries branches directly from the aorta?
Your Answer: Ovarian
Explanation:The ovarian artery takes its origin directly from the aorta. While the uterine and the vaginal arteries are all branches of the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 19
Correct
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Bladder contraction during voiding (micturating) is mediated via innervation of which of the following pathways?
Your Answer: Parasympathetic fibres from S2,S3,S4 nerve roots
Explanation:Detrusor contraction is via Parasympathetic innervation of pelvic splanchnic nerves (S2-4). This also causes relaxation of the internal urethral sphincter Note contraction and relaxation of the external urethral sphincter is under somatic control.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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A patient who is 36 weeks pregnant comes to see you as she has developed tingling to the right lateral thigh over the past 3 weeks. On examination there are no skin changes and no muscle weakness. What is the likely diagnosis?
Your Answer: Pudendal nerve entrapment
Correct Answer: Meralgia Paraesthetica
Explanation:Raised pressure with the pelvis can cause a number of nerve entrapment syndromes. This is entrapment of the lateral cutaneous nerve of the thigh (or lateral femoral cutaneous nerve) also known as Meralgia Paraesthetica. Pregnancy is a risk factor. Shingles can effect this nerve but the rash would usually present itself within 14days.
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This question is part of the following fields:
- Anatomy
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Question 21
Correct
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At the time of delivery, if there is a laceration of perineal body but not the anal sphincter, this type of laceration is classified as?
Your Answer: Second degree
Explanation:Perineal tears are common at the time of child birth. First degree perineal laceration means that the wound is so small that it doesn’t require any stitches and usually heals on its own. 2nd degree means that skin and smooth muscles are both torn. 3rd degree tear means that the tear is beyond the perineal muscles and the muscles surrounding the anal canal, while in 4th degree, the perineal tear goes through the anal sphincter up to the rectum.
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This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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Which one of the following statements regarding the fetal head is true?
Your Answer: Can be delivered vaginally in persistent occipito-mental presentation
Correct Answer: Considered to be engaged when the biparietal diameter passes the level of the pelvic inlet
Explanation:The fetal head is engaged when the head of the foetus or the presenting part enters the pelvic inlet or pelvic brim. It usually occurs at 38 weeks of gestation.
The Spalding sign refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain. It appears usually a week or more after fetal death in utero.
In brow presentation the scalp is deflexed as the foetus is looking upward. Normally the head is inflexed such that the chin is touching the chest. -
This question is part of the following fields:
- Anatomy
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Question 23
Correct
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The roof of the femoral triangle is formed by which structure?
Your Answer: Fascia lata
Explanation:The femoral triangle is bounded:
– Superiorly by the inguinal ligament that forms the base of the femoral triangle.
– Medially by the lateral border of the adductor longus.
– Laterally by the sartorius; the apex of the femoral triangle is formed where the borders of the sartorius and the adductor muscles meet.
– The floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus muscle medially.
– The roof of the femoral triangle is formed by the fascia lata and cribriform
fascia, subcutaneous tissue, and skin. -
This question is part of the following fields:
- Anatomy
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Question 24
Incorrect
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Which of the following leaves the pelvis via the greater sciatic foramen?
Your Answer: Obturator Nerve
Correct Answer: Pudendal Nerve
Explanation:The pudendal nerve is formed by sacral nerve roots S2, S3 and S4 almost immediately as they exit the spinal foramina. The pudendal nerve exits the pelvis via the greater sciatic foramen, travels behind the sacrospinous ligament before re-entering the pelvis via the lesser sciatic foramen. It is an important nerve to be aware of as it supplies sensation to the genitalia and can also be damaged/compressed at a number of places along its course. Image sourced from Wikipedia
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This question is part of the following fields:
- Anatomy
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Question 25
Correct
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The main function of the cilia of the fallopian tube is?
Your Answer: Transport the ovum towards the uterus
Explanation:Cilia are small hair line projections in the fallopian tube. Their main function is to transport the egg through he fallopian tube towards the uterus. It is present in many other tubular organs and its function varies accordingly to the organ.
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This question is part of the following fields:
- Anatomy
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Question 26
Correct
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The juxtaglomerular apparatus (JGA) lies within which part of the kidney?
Your 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 27
Incorrect
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Which structure reinforces the inguinal canal anterolaterally?
Your Answer: Aponeurosis external oblique
Correct 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 28
Correct
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Which cell type of the testis secrete inhibin?
Your Answer: Sertoli cells
Explanation:Summary points of the two key testicular cell types:
1. Sertoli Cells = Secrete Inhibin. Forms blood-testis barrier. Have FSH receptors
2. Leydig Cells = Secrete testosterone. Have LH receptors -
This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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Regarding the round ligament, it leaves the pelvis via which structure?
Your Answer: Greater sciatic notch
Correct Answer: Deep inguinal ring
Explanation:The round ligament is a band of fibromuscular connective tissue attached to the cornua of the uterus, near the attachment of the ovaries. On each side of the body, the ligament exits the pelvis through the deep inguinal ring, travels through the inguinal canal and enters the labia majora where its fibres terminate at the mons pubis. It is also important to know the embryological origins of the round ligament from the gubernaculum.
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This question is part of the following fields:
- Anatomy
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Question 30
Incorrect
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer:
Correct Answer: 150ml
Explanation:Micturition is defined as a process of expelling urine from the body. It is caused by the reflex contraction of detrusor muscle. Urinary bladder is a hollow muscular organ which can store 400-600ml of urine until it is expelled from the body. The first urge to urinate is felt when the bladder is filled with around 150ml of urine. The reflex action is initiated when the stretch receptors located in the bladder wall are stimulated. The afferent fibres pass to the pelvic splanchnic nerves to the 2nd, 3rd, and 4th sacral segments and some pass through the hypogastric plexus to the first and second lumbar segments of the spinal cord. Efferent pathways from the 2nd, 3rd, and 4th sacral segments leave the cords and through the splanchnic nerves and inferior hypogastric plexus supplies the smooth muscle of the bladder i.e. detrusor muscle. Detrusor muscle contracts and the sphincters are relaxed.
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This question is part of the following fields:
- Anatomy
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Question 31
Incorrect
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You see a patient who is 32 weeks pregnant. She complains of tingling to the right buttock and shooting pain down the leg. You suspect Piriformis syndrome. Regarding Piriformis which of the following statements are true?
Your Answer:
Correct Answer: Insertion is onto the greater trochanter
Explanation:Nerve Supply: L5 to S2 via Nerve to Piriformis
Origin: Sacrum
Insertion: Greater trochanter
Action: External rotation of hip
Blood Supply: Superior and Inferior gluteal arteries and lateral sacral arteries -
This question is part of the following fields:
- Anatomy
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Question 32
Incorrect
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Presence of which one of the following features at term makes spontaneous delivery incompatible?
Your Answer:
Correct Answer: Mentum posterior
Explanation:When face presentation is diagnosed, around 60% of cases are in the mentum anterior position, 25% are mentum posterior and 15% are mentum transverse; most malpositions rotate spontaneously into mentum anterior. A vaginal birth at term is possible only if the foetus is in the mentum anterior position.
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This question is part of the following fields:
- Anatomy
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Question 33
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 34
Incorrect
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Regarding lymph drainage of the breast where does the majority of lymph drain to?
Your Answer:
Correct 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 35
Incorrect
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Sensory supply to the clitoris is via branches of which nerve?
Your Answer:
Correct Answer: Pudendal nerve
Explanation:The Pudendal nerve divides into inferior rectal, perineal and dorsal nerve of the clitoris (or penis in males). The dorsal nerve of clitoris supplies sensory innervation to the clitoris. The perineal branch supplies sensory innervation to the skin of the labia majora and minora and the vestibule.
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This question is part of the following fields:
- Anatomy
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Question 36
Incorrect
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A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness and groin pain. You assess her and find the numb area is the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer:
Correct Answer: Ilioinguinal
Explanation:This describes the sensory area supplied by the ilioinguinal nerve. This is a potential complication with pelvic surgery.
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This question is part of the following fields:
- Anatomy
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Question 37
Incorrect
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer:
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 38
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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Question 39
Incorrect
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During vertex presentation, the position is determined by relationship of which part of the fetal vertex to the mother's pelvis?
Your Answer:
Correct Answer: Occiput
Explanation:A cephalic presentation is the one where head of the foetus enters the pelvic cavity at the time of delivery. The commonest form of cephalic presentation is the vertex presentation in which the occiput of the foetus enters the birth canal.
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This question is part of the following fields:
- Anatomy
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Question 40
Incorrect
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Under which one of the following conditions is the pelvic inlet felt to be contracted?
Your Answer:
Correct Answer:
Explanation:Contracted pelvis occurs when one or more of its diameters is reduced so that it interferes with the normal mechanism of labour. A transverse diameter below 11 cm will result in difficult delivery of the foetus and C-section will be the better option in that case
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This question is part of the following fields:
- Anatomy
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Question 41
Incorrect
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What is the average anteroposterior distance of the female pelvic outlet?
Your Answer:
Correct Answer: 13 cm
Explanation:The pelvic outlet is bounded in front by the lower margin of the symphysis pubis, on each side by the descending ramus of the pubic bone, the ischial tuberosity and the sacrotuberous ligament, and posteriorly by the last piece of the sacrum. The AP diameter of the pelvic outlet is 13.5 cm and the transverse diameter is 11 cm.
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This question is part of the following fields:
- Anatomy
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Question 42
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 43
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:
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 44
Incorrect
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Which of the following is true about the origin of the ovarian artery?
Your Answer:
Correct Answer: It arises from the Abdominal Aorta
Explanation:The ovarian arteries are considered the main blood supply for the ovaries. The ovarian arteries usually arise from the lateral aspect of the abdominal artery, though in some instances they may arise from the renal or iliac arteries.
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This question is part of the following fields:
- Anatomy
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Question 45
Incorrect
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You see a patient who is 32 weeks pregnant. She complains of tingling to the right buttock and shooting pain down the leg. You suspect Piriformis syndrome. Regarding Piriformis which of the following statements are true?
Your Answer:
Correct Answer: Insertion is onto the greater trochanter
Explanation:The proximal attachment of the piriformis muscles is from the anterior surface of sacrum and it attaches distally to the superior border of the greater trochanter of the femur. It is innervated by the anterior rami of S1 and S2.
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This question is part of the following fields:
- Anatomy
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Question 46
Incorrect
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Regarding the uterine artery which of the following statements are TRUE?
Your Answer:
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 47
Incorrect
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Which spinal segment is the lumbar plexus derived from?
Your Answer:
Correct Answer: T12-L4
Explanation:The lumbar plexus is formed via contributions from the T12-L4 spinal cord segment. The plexus is responsible for the motor and sensory innervation of portions of the lower extremities and some parts of the lower abdomen and pelvis. Nerves arising from the plexus include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral nerve, obturator, and nerve to the lumbosacral trunk.
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This question is part of the following fields:
- Anatomy
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Question 48
Incorrect
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The joint between the two pubic bones is called the:
Your Answer:
Correct Answer: Pubis symphysis
Explanation:The pubic symphysis or symphysis pubis is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to it.
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This question is part of the following fields:
- Anatomy
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Question 49
Incorrect
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Question 50
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
