Practice Questions Flashcards
A 4-month-old male infant is admitted to the pediatric clinic because he was passing urine near the anus rather than from the tip of the penis. Physical examination reveals that the patient has perineal hypospadias. Which of the following embryologic structures failed to fuse?
A. Labioscrotal Folds B. Cloacal Membrane C. Urogenital Folds D. Genital Tubercle E. Urogenital Membrane
A. Perineal hypospadias is due to a failure of fusion of labioscrotal folds so that the external urethral orifice is between the unfused halves of the scrotum.
A 2-month-old infant has epispadias and the bladder mucosa is exposed to the outside. Which of the following is the most likely cause of this condition?
A. Failure of the Primitive Streak Mesoderm to migrate around the cloacal membrane B. Failure of the urethral folds to fuse C. Insufficient Androgen Stimulation D. Klinefelters Syndrome E. Persistent Allantois
A. When the urinary bladder mucosa is open to the outside in the fetus or newborn, the condition is referred to as extrophy of the bladder. The extrophy results from failure of the primitive streak mesoderm to migrate around the cloacal membrane, and it occurs often in combination with epispadias.
A bifid ureter or paired unilateral ureters result from partial or complete division of which of the following embryologic structures?
A. Ureteric Bud / Metenephric Diverticulum B. Mesonephric Duct C. Paramesonephric Duct D. Metanephric Mesoderm E. Pronephros
A. The ureteric bud, or metanephric diverticulum, is an outgrowth from the mesonephric duct. It is the primordium of the ureter, renal pelvis, the calyces, and the collecting tubules. Incomplete division results in a divided kidney with a bifid ureter. Complete division results in a double kidney with a bifid ureter, or separate ureters.
A 6-year-old boy has a large intraabominal mass in the midline just above the pubic symphysis. During surgery a cystic mass is found attached to the umbilicus and to the apex of the bladder. Which of the following is the most likely diagnosis?
A. Hydrocele B. Meckel Cyst C. Meckel Diverticulum D. Omphalocele E. Urachal Cyst
E. The persistence of the epithelial lining of the urachus can give rise to a urachal cyst. This swelling is found in the midline in the umbilical region.
A 4-month-old infant is admitted to the pediatric clinic because urine can be observed passing through an opening on the dorsum of the penis. Which of the following embryologic structures failed to fuse?
A. Spongy Urethra B. Labioscrotal Folds C. Cloacal Membrane D. Urogenital Folds E. Genital Tubercle
A. Epispadias is a developmental defect in the Spongy Urethra resulting in urine being expelled from the dorsal aspect of the penis.
A 16-year-old female is brought to the Emergency Department with severe abdominal pain and fever. Laboratory examination is remarkable for an elevated white blood cell count and a positive test for pregnancy. Colpocentesis is performed to ascertain the presence of blood in the pelvis from the ruptured ectopic pregnancy. Through which of the following structures does the needle need to be inserted?
A. Through the perineal body into the vesicouterine space
B. Through the posterior fornix into the rectouterine pouch
C. Through the anterior fornix into the endocervical canal
D. Through the introitus into the vestibular gland
E. Through the perineal membrane into the urogenital diaphragm
B. This is going to open up into the pouch of Douglass. Blood is NOT likely to enter the vesicouterine space from an ectopic pregnancy. Going through the Membrane by the posterior fornix to enter the Rectouterine pouch is the MOST DIRECT route to test for Pelvic Bleeding.
A 68-year-old male is admitted to the hospital with painful urination and nocturia (urination during the night). MRI examination reveals enlargement and irregularity of the uvula or the urethra. This enlargement resulted in difficulty with urinary voiding and inadequate emptying of the bladder. Which of the following lobes of the prostate gland will most likely be hypertrophied?
A. Anterior B. Median C. Lateral D. Posterior E. Lateral and Posterior
B. When the internal urethra orifice is obstructed, it is most likely due to an enlargement of the median lobe of the prostate gland. This glandular tissue is most frequently involved in benign hypertrophy.
A 22-year-old male complained to the urologist of pain that he experiences from bladder fullness after drinking large quantities of fluid. What is the location of the neural cell bodies responsible for pain sensation from the urinary bladder?
A. Dorsal root ganglia of spinal cord levels S2, S3, and S4
B. The intermediolateral cell column of spinal cord levels S2, S3, and S4
C. The sensory ganglia of spinal nerves T5-T9
D. The preaortic ganglia at the site of origin of the testicular arteries
E. Dorsal root ganglia of spinal levels T10-L2
A. Conscious pain due to bladder fullness results from the excitation of stretch receptors in the bladder wall. These pain fibers are carried through the pelvic nerve plexuses and into the pelvic splanchnic nerves. The sensory fibers enter the dorsal root ganglia of spinal nerves S2, S3, and S4.
On digital examination of the vagina, the portion of the uterus that one anticipates palating with the examining finger is the cervix and its external os. Which of the following is the most common position of the uterus?
A. Anteflexed and retroverted
B. Retroflexed and anteverted
C. Anteflexed and anteverted
D. Retroflexed and retroverted
C. Normally the uterus is ANTEFLEXED at the junction of the cervix and the body and ANTERVERTED at the junction of the vagina and the cervical canal.
A 42-year-old woman is admitted to the emergency department because of pelvic discomfort. During physical examination the gynecologist discovers that the patient has suffered complete uterine prolapse. Which of the following ligaments provides direct support to the uterus?
A. Mesosalpinx and mesometrium B. Infundibulopelvis Ligament C. Round Ligament of the uterus D. Lateral cervical (cardinal) ligament E. Broad ligament of the uterus
D. The cardinal ligament is composed of condensations of fibromuscular tissues that accompany the uterine vessels. These bands of pelvic fascia provide DIRECT support to the uterus
A 34-year-old woman is admitted to the hospital due to severe lower abdominal pain. Radiographic examination reveals tumors in both of her ovaries. A biopsy is ordered and confirms the initial diagnosis of ovarian cancer. Which of the following lymph nodes are the first to receive lymph from the dieseased ovaries?
A. Superficial and deep inguinal lymph nodes
B. External iliac nodes
C. Paraaortic nodes at the level of the renal vessels
D. Node of Cloquet
E. Internal iliac nodes accompanying the uterine artery and vein
C. Ovarian lymph first drains into the paraaortic nodes at the level of the renal vessels.
After having given birth to five children, a 41-year-old woman seeks correction of chronic urinary incontinence. While relating her history the patient reveals that she have leakage of urine with increased intrabdominal pressure. An MRI examination reveals injury to the pelvic floor that has altered the position of the neck of the bladder and the urethra. Which of the following structures has most probably been injured during the multiple deliveries?
A. Tendinous arch of levator ani B. Coccygeus C. Tendinous arch of pelvic fascia D. Obturator internus E. Rectovaginal septum
C. The tenidnous arch of pelvic fascia is a dense band of connective tissue that joins the fasci of the levator ani to the felt like pubocervical fascia that covers the anterior wall of the vagina. If this fascial band is torn, the ipsilateral side of the vagina falls, carrying with it the bladder and urethra, often leading to urinary incontinence.
A 58-year-old postmenopausal woman is diagnosed with carcinoma of the distal gastrointestinal tract. During surgery lymph nodes from the sacra, internal iliac, and inguinal lymph node groups were removed and sent for histopathologic examination. The pathology report revealed positive cancerous cells only at the inguinal lymph nodes. Which of the following parts of the gastrointestinal tract were most likely affected?
A. Cutaneous portion of anal canal B. Distal Rectum C. Mucosal zone of anal canal D. Pectinate line of anal canal E. Proximal rectum at the inferior valve (of Houston)
A. Lymph from the cutaneous portion of the anal canal (below the pectinate line) drains into the inguinal nodes.
A 13-year-old female is brought to the emergency department with a complaint of severe, deep pelvic discomfort. Physical examination reveals that the patient has an intact hymen. Incision of the hymen reveals hematocolpos. Which of the following conditions is associated with heatocolpos?
A. Cyst of Bartholin Gland
B. Bleeding from an ectopic pregnancy
C. Imperforate hymen
D. Indirect inguinal hernia with cremasteric arterial bleeding
E. Iatrogenic bleeding from the uterine veins
C. Hematocolpos is characterized by filling of the vagina with menstrual blood. This commonly occurs due to the presence of an imporforate hymen. Blood from an ectopic pregnancy is going to drain into the rectouterine pouch. Bleeding from the uterine veins would not flow into the vagina.
A 36-year-old male rodeo rider is admitted to the hospital after being thrown violently from a Brahma bull. An MRI scan reveals rupture of the penile urethra and deep (Bucks) fascia. Where is the most likely place that extravasated urine will flow?
A. Inschioanal Fossa B. Rectovesical pouch C. Deep perineal pouch D. Retropubic space E. Superficial perineal cleft
E. Because the penile urethra and deep (Bucks) fascia are both located in the superficial perineal pouch, rupture will occur here, with extravasation of fluids into the superficial perineal cleft.
A 32-year-old woman is admitted to the hospital with a complaint of painful spasms of her vagina. Physical examination reveals several involuntary contractions of the vaginal musculature. The patient also complains of painful intercourse. Which of the following conditions will most likely describe the signs of this patient?
A. Vaginismus B. Pudendal nerve compression in the pudendal canal C. Disruption of the perineal body D. Endometriosis E. Fibroma of the uterus
A. Vaginismus is a painful, psychosomatic gynecologic disorder; it is describe as involving distension of the cavernous tissues and the bulbospongiosus and transverse perineal muscles, the stimulation of which triggers the involuntary spasms of the perivaginal and levator ani muscles. This can in turn lead to painful intercourse and dyspareunia.
A 46-year-old male is admitted to the emergency department after a car crash. An MRI examination reveals a hematoma of the perineum spreading to his adbomen wall beneath the superficial fascia. Where should the initial extravasation be located?
A. Between the superior aspect of the urogenital diaphragm and the pelvic diaphragm
B. Between the perineal membrane and the fascia of Galaudet
C. Between Camper’s fascia and Scarpa’s fascia
D. Between Colles’ fascia and Gallaudet’s fascia
E. Between Buck’s fascia and the tunica albuginea
B. This is a classic example of extravasation of blood and urine from the superificial perineal pouch. This usually is a reuly of rupture of hte spongy urethra. The extravasation of fluid will begin between Buck’s fascia and the dartos layer.
