Pelvis and Perineum — MCQs

Which of the following are correct regarding pelvic cellular tissue? 1. It supports the pelvic organs. 2. It forms protective sheath for blood vessels and terminal part of ureter. 3. It prevents infection to be spread out of pelvis. 4. Marked hypertrophy of pelvic cellular tissue occurs in pregnancy. Select the answer using the code given below.

Q516

Uterus is supported by which of the following ligaments? 1. Pubocervical ligament 2. Cardinal ligament 3. Uterosacral ligament 4. Ovarian ligament.

Q517

The following are the branches of the anterior division of internal iliac artery except

Q518

The true conjugate of the pelvic brim measures

Q519

Which one of the following is not a branch of internal iliac artery?

Q520

Which of the following regarding blood supply of rectum is NOT true?

Pelvis and Perineum Indian Medical PG Practice Questions and MCQs

Question 511: Opening of Bartholin's duct is in the :

A. periurethral region in anterior 1/3rd of labia minora
B. superficial perineal pouch at the junction of anterior 1/3rd and posterior 1/3rd
C. groove between labia majora and labia minora
D. vestibule outside the hymen at the junction of the anterior 2/3rd and posterior 1/3rd in the groove between the hymen and labium minus (Correct Answer)

Explanation: ***vestibule outside the hymen at the junction of the anterior 2/3rd and posterior 1/3rd in the groove between the hymen and labium minus*** - The **Bartholin's glands** (also known as greater vestibular glands) are located on each side of the vaginal opening, and their ducts open into the **vestibule** [1]. - Specifically, the openings are found in the groove between the **hymen** and the **labium minus**, in the posterior region of the vestibule [1]. *periurethral region in anterior 1/3rd of labia minora* - This description corresponds to the location of the **Skene's glands** (also known as lesser vestibular glands or paraurethral glands), which secrete into the urethra, not the Bartholin's glands [1]. - The Bartholin's glands are located more posteriorly and laterally to the vaginal opening, distinct from the urethral area. *superficial perineal pouch at the junction of anterior 1/3rd and post 1/3rd* - The **superficial perineal pouch** contains structures like the bulbospongiosus and ischiocavernosus muscles, and the crura of the clitoris, but not the external opening of Bartholin's ducts. - The duct openings are externally visible in the **vestibule**, not within a deeper anatomical space like the superficial perineal pouch [1]. *groove between labia majora and labia minora* - This describes the **interlabial sulcus**, which is the general space between the labia majora and minora. - While the vestibule is within this general area, the precise opening of Bartholin's duct is specifically at the junction of the anterior 2/3rd and posterior 1/3rd of the vaginal introitus, in the groove between the hymen and labium minus [1].

Question 512: Blood supply to the uterus comes from which of the following arteries ? 1. Ovarian artery 2. Vaginal artery 3. Uterine artery 4. Inferior vesical artery Select the correct answer using the code given below :

A. 2, 3 and 4
B. 1, 2 and 3 (Correct Answer)
C. 1, 3 and 4
D. 1, 2 and 4

Explanation: ***1, 2 and 3*** - The **uterine artery** is the primary blood supply to the uterus, originating from the internal iliac artery, and is crucial for uterine nutrition [1]. - The **ovarian artery** (a branch of the aorta) also contributes to the blood supply, forming anastomoses with the uterine artery, especially at the cornua [1]. - The **vaginal artery**, a branch of the internal iliac artery, forms anastomoses with the cervical branches of the uterine artery, providing additional blood supply to the lower uterus and cervix [1]. *2, 3 and 4* - This option incorrectly includes the **inferior vesical artery** as a direct supply to the uterus while omitting the ovarian artery, which is a significant contributor. - While the **inferior vesical artery** supplies the bladder and lower ureter, its direct anastomoses sufficient for uterine perfusion are limited. *1, 3 and 4* - This choice incorrectly includes the **inferior vesical artery** as a direct significant uterine supply and omits the **vaginal artery**, which provides relevant anastomoses to the lower uterus. - The **inferior vesical artery** primarily supplies the bladder and does not have a major, direct contribution to the main body of the uterus [2]. *1, 2 and 4* - This option incorrectly includes the **inferior vesical artery** as a primary or significant contributor while omitting the **uterine artery**, which is the main arterial supply to the uterus. - The **uterine artery** is essential for uterine function, and its absence from this selection makes the option incorrect from a physiological standpoint.

Question 513: Which of the following set of muscles collectively form the muscle 'Levator Ani' that forms the pelvic floor ? 1. Puborectalis 2. Pubococcygeus 3. Sacrococcygeus 4. Iliococcygeus Select the correct answer using the code given below :

A. 2, 3 and 4
B. 1, 3 and 4
C. 1, 2 and 3
D. 1, 2 and 4 (Correct Answer)

Explanation: ***1, 2 and 4*** - The **levator ani** muscle group is comprised of three distinct muscles: **puborectalis**, **pubococcygeus**, and **iliococcygeus** [1]. - These muscles collectively form the main component of the **pelvic floor**, supporting pelvic organs and controlling continence [1]. - The levator ani, together with the coccygeus muscle, forms the **pelvic diaphragm**. *2, 3 and 4* - This option incorrectly includes the **sacrococcygeus** muscle, which is not part of the **levator ani** group. - The **sacrococcygeus** is a small, vestigial muscle found anterior to the sacrum and coccyx, and is separate from the pelvic diaphragm. - It excludes the **puborectalis**, which is an essential component of the levator ani [1]. *1, 3 and 4* - This option incorrectly includes the **sacrococcygeus** muscle, which is not a component of the **levator ani**. - It excludes the **pubococcygeus**, a major and essential component of the **levator ani** complex, critical for maintaining pelvic floor integrity and function [1]. *1, 2 and 3* - This option incorrectly includes the **sacrococcygeus** muscle and excludes the **iliococcygeus**. - The **iliococcygeus** muscle is a distinct and recognized part of the **levator ani** alongside the puborectalis and pubococcygeus [1].

Question 514: The inferior rectal artery is a branch of :

A. Internal pudendal artery (Correct Answer)
B. Inferior mesenteric artery
C. Internal iliac artery
D. Median sacral artery

Explanation: ***Internal pudendal artery*** - The **inferior rectal artery** is a key branch of the **internal pudendal artery**, supplying blood to the anal canal below the pectinate line. - This artery typically arises in the **ischioanal fossa** (also known as the ischiorectal fossa), providing vascularization to the external anal sphincter and perineal skin. *Inferior mesenteric artery* - The **inferior mesenteric artery** is responsible for supplying large intestine structures from the distal transverse colon to the superior part of the rectum [1]. - Its main branches are the **left colic artery**, **sigmoid arteries**, and **superior rectal artery**, none of which directly give rise to the inferior rectal artery [1]. *Internal iliac artery* - The **internal iliac artery** is a large artery that supplies many pelvic organs and the perineum; it gives off the **internal pudendal artery** as one of its terminal branches. - While it is the source of the internal pudendal artery, it does not directly branch into the inferior rectal artery. *Median sacral artery* - The **median sacral artery** is a small, unpaired artery that arises from the posterior aspect of the abdominal aorta just above its bifurcation. - It supplies structures in the posterior pelvic wall, such as the sacrum, coccyx, and adjacent posterior muscles but has no direct connection to the inferior rectal artery.

Question 515: Which of the following are correct regarding pelvic cellular tissue? 1. It supports the pelvic organs. 2. It forms protective sheath for blood vessels and terminal part of ureter. 3. It prevents infection to be spread out of pelvis. 4. Marked hypertrophy of pelvic cellular tissue occurs in pregnancy. Select the answer using the code given below.

A. 1, 2 and 3
B. 1, 3 and 4
C. 1, 2 and 4 (Correct Answer)
D. 2, 3 and 4

Explanation: ***1, 2 and 4*** - Pelvic cellular tissue (parametrium/paracervix) provides crucial **structural support** to the uterus, cervix, and bladder, preventing **pelvic organ prolapse** (Statement 1 is correct) [1]. - It forms a **protective sheath** around important structures including the **uterine vessels** and **terminal portions of the ureters**, safeguarding them from injury (Statement 2 is correct) [1]. - During **pregnancy**, the parametrium undergoes **marked hypertrophy and hyperplasia** with increased vascularity to accommodate and support the enlarging uterus and increased blood flow (Statement 4 is correct) [2]. - Statement 3 is **incorrect** because pelvic cellular tissue does NOT prevent infection spread; rather, it is a **loose connective tissue space** that can serve as a **pathway for infection dissemination** within the pelvis (parametritis, pelvic cellulitis) [1]. *1, 2 and 3* - This combination incorrectly includes Statement 3. The pelvic cellular tissue actually facilitates infection spread rather than preventing it from spreading out of the pelvis [1]. *1, 3 and 4* - Statement 3 is incorrect as explained above. The loose areolar tissue of the parametrium is a potential space for infection spread, not a barrier [1]. *2, 3 and 4* - While statements 2 and 4 are correct [1], [2], Statement 3 is incorrect, and this option omits Statement 1, which is clearly correct regarding structural support.

Question 516: Uterus is supported by which of the following ligaments? 1. Pubocervical ligament 2. Cardinal ligament 3. Uterosacral ligament 4. Ovarian ligament.

A. 2, 3 and 4
B. 1, 2 and 3 (Correct Answer)
C. 1, 2 and 4
D. 1, 3 and 4

Explanation: ***1, 2 and 3*** - The **Pubocervical**, **Cardinal**, and **Uterosacral ligaments** are collectively known as the **endopelvic fascia** or **true ligaments** of the uterus, providing primary support [1]. - These ligaments attach the cervix and uterus to the pelvic walls, preventing uterine prolapse [1]. *2, 3 and 4* - This option incorrectly includes the **ovarian ligament** as a primary uterine support, while excluding the critical **pubocervical ligament**. - The ovarian ligament mainly connects the ovary to the uterus and does not offer significant structural support for the uterus itself. *1, 2 and 4* - This choice incorrectly excludes the **uterosacral ligament**, which is a key component of the primary uterine support system [1]. - The uterosacral ligaments contribute to posterior uterine support and help maintain its anteverted position [1]. *1, 3 and 4* - This option omits the **cardinal ligament** (also known as Mackenrodt's ligament), which is one of the most crucial supports for the uterus, stabilizing the cervix laterally [1]. - The cardinal ligaments are rich in connective tissue and provide significant lateral structural support [1].

Question 517: The following are the branches of the anterior division of internal iliac artery except

A. Inferior vesical artery
B. Uterine artery
C. Superior rectal artery (Correct Answer)
D. Middle rectal artery

Explanation: ***Superior rectal artery*** - This artery is a direct continuation of the **inferior mesenteric artery**, which is a branch of the **abdominal aorta**, not the internal iliac artery. - It supplies the **superior part of the rectum** and is not associated with the internal iliac artery's divisions. *Inferior vesical artery* - This artery typically arises from the **anterior division of the internal iliac artery** and supplies the **bladder** and male reproductive organs. - It is a correct branch of the anterior division, making it an incorrect answer to the "except" question. *Uterine artery* - The **uterine artery** is a significant branch of the **anterior division of the internal iliac artery** in females. - It supplies the **uterus**, vagina, and surrounding structures, confirming its origin from the anterior division. *Middle rectal artery* - This artery originates from the **anterior division of the internal iliac artery** and supplies the **middle portion of the rectum**. [1] - It is a recognized branch of the anterior division, so it is not the exception.

Question 518: The true conjugate of the pelvic brim measures

A. 11.5 cm (Correct Answer)
B. 12.5 cm
C. 13.5 cm
D. 10.5 cm

Explanation: ***11.5 cm*** - The **true conjugate (conjugata vera)** is the anteroposterior diameter of the pelvic inlet, measured from the **posterior superior margin** of the pubic symphysis to the sacral promontory. [1] - It typically measures **11 cm** (range 10.5-11.5 cm), making 11.5 cm the most accurate answer among the given options. [1] - The true conjugate **cannot be measured clinically** but can be estimated by subtracting 1.5 cm from the diagonal conjugate. [1] - It is **distinct from** the obstetric conjugate, which is slightly shorter at 10.5 cm. *10.5 cm* - This measurement corresponds to the **obstetric conjugate**, not the true conjugate. - The obstetric conjugate is measured from the **most prominent point** on the posterior surface of the pubic symphysis (not the superior margin) to the sacral promontory. - While clinically important as the shortest fixed AP diameter through which the fetal head must pass, it is a **different measurement** from the true conjugate. *12.5 cm* - This value corresponds to the **diagonal conjugate**, which is the only conjugate diameter that can be measured clinically. - It is measured from the **lower border** of the symphysis pubis to the sacral promontory during pelvic examination. - The true conjugate is estimated by subtracting 1.5-2 cm from the diagonal conjugate (12.5 - 1.5 = 11 cm). *13.5 cm* - This measurement is considerably **larger** than any standard pelvic conjugate diameter. - It does not correspond to any clinically relevant pelvic measurement and would represent an unusually spacious pelvic inlet.

Question 519: Which one of the following is not a branch of internal iliac artery?

A. Superior gluteal artery
B. Ovarian artery (Correct Answer)
C. Inferior gluteal artery
D. Uterine artery

Explanation: Ovarian artery - The ovarian artery typically originates directly from the abdominal aorta, usually below the renal arteries. - It does not branch off the internal iliac artery, making it the correct answer. *Superior gluteal* - The superior gluteal artery is a parietal branch of the internal iliac artery, supplying muscles in the gluteal region. - It exits the pelvis through the greater sciatic foramen, superior to the piriformis muscle. *Inferior gluteal* - The inferior gluteal artery is also a parietal branch of the internal iliac artery, supplying the buttocks and posterior thigh. - It usually accompanies the sciatic nerve and exits through the greater sciatic foramen, inferior to the piriformis muscle. *Uterine artery* - The uterine artery is a visceral branch of the internal iliac artery, primarily supplying the uterus. - It is critical for female reproductive health and forms important anastomoses with the ovarian and vaginal arteries.

Question 520: Which of the following regarding blood supply of rectum is NOT true?

A. Superior rectal artery is a direct continuation of Inferior mesenteric artery
B. Inferior rectal artery arises from internal pudendal artery
C. Middle rectal artery arises from external iliac artery and passes through the lateral ligaments into rectum (Correct Answer)
D. Inferior rectal artery traverses the Alcock’s canal into rectum

Explanation: ***Middle rectal artery arises from external iliac artery and passes through the lateral ligaments into rectum*** - This statement is **FALSE** (making it the correct answer for this "NOT true" question) - The middle rectal artery actually arises from the **internal iliac artery**, not the external iliac artery [1] - It does correctly pass through the lateral ligaments of the rectum to supply the middle and lower parts of the rectum *Superior rectal artery is a direct continuation of Inferior mesenteric artery* - This statement is TRUE - The superior rectal artery is indeed the direct continuation of the inferior mesenteric artery [1] - It supplies the superior part of the rectum *Inferior rectal artery arises from internal pudendal artery* - This statement is TRUE - The inferior rectal artery is a branch of the internal pudendal artery [1] - It supplies the anal canal and perianal skin *Inferior rectal artery traverses the Alcock's canal into rectum* - This statement is TRUE - The inferior rectal artery traverses Alcock's canal (pudendal canal) along with the internal pudendal vessels and pudendal nerve [1] - Upon exiting Alcock's canal, it branches to supply the anal region

Practice by Chapter

Pelvic Walls and Floor

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Pelvic Viscera

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Urogenital Organs

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Pelvic Vasculature

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Pelvic Innervation

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Male Perineum

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Female Perineum

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Pelvic Lymphatics

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Applied Anatomy and Clinical Correlations

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Gender Differences in Pelvic Anatomy

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