Pelvis and Perineum Practice Questions

Q: The blood supply of uterus is from: 1. Uterine artery 2. Ovarian artery 3. Pudendal artery 4. Superior vesical artery Select the correct answer using the code given below:

1 and 2. Option A: 1 and 2 - The uterine artery, a branch of the internal iliac artery, is the primary blood supply to the uterus [1]. - The ovarian artery, a direct branch from the abdominal aorta, also contributes to uterine blood supply by anastomosing with the uterine artery [1]. Option B: 1 and 3 - While the uterine artery is a primary source, the pudendal artery supplies the external genitalia and perineum, not the uterus directly. - The pudendal artery's territory is distinct from the uterine circulation. Option C: 2 and 4 - The ovarian artery does supply the uterus [1], but the superior vesical artery primarily supplies the superior portion of the urinary bladder. - The superior vesical artery does not significantly contribute to uterine vascularization. Option D: 3 and 4 - Neither the pudendal artery nor the superior vesical artery are direct or significant suppliers of blood to the uterus. - Their primary supply territories are the perineum/external genitalia and the bladder, respectively.

Q: The following are the contents of broad ligament EXCEPT:

Internal iliac artery. ***Internal iliac artery*** - The **internal iliac artery** is a large pelvic artery supplying various pelvic organs and **does NOT traverse within the broad ligament itself**. [2] - While its branches (like the uterine artery) enter the broad ligament, the main trunk of the internal iliac artery is located more posteriorly and laterally on the **pelvic sidewall**, outside the broad ligament. [1] - This is the correct answer to this EXCEPT question. *Uterine and ovarian arteries with their branches* - These **ARE contents of the broad ligament**, making this option incorrect. [1] - The **uterine artery** travels within the base of the broad ligament (cardinal ligament region), providing blood supply to the uterus. [2] - The **ovarian artery** travels within the suspensory ligament of the ovary, which is a lateral fold of the broad ligament, to supply the ovary. [1] *Fallopian tube* - This **IS a content of the broad ligament**, making this option incorrect. [3] - The **fallopian tube** (uterine tube) is enclosed within the superior free margin of the broad ligament, specifically within the **mesosalpinx** (the portion of broad ligament between fallopian tube and ovary). [1] - It extends laterally from the uterus, providing a pathway for ova. *Ovarian ligament* - This **IS a content of the broad ligament**, making this option incorrect. - The **ovarian ligament** is a fibrous cord that connects the medial pole of the ovary to the lateral aspect of the uterus, running within the posterior layer of the broad ligament. [3] - It helps to anchor the ovary to the uterus.

Q: Which one of the following is NOT a support of uterus, preventing its descent?

Inguinal ligament. ***Inguinal ligament*** - The **inguinal ligament** is a fibrous band extending from the **anterior superior iliac spine** to the **pubic tubercle**, forming the inferior border of the anterior abdominal wall [2]. - It plays no direct role in supporting the uterus; its primary function is to serve as an attachment site for muscles and define the **inguinal canal** [2]. *Endopelvic fascia* - The **endopelvic fascia** is a connective tissue layer that surrounds pelvic organs and contributes significantly to their support [1]. - It forms condensations such as the **uterosacral** and **cardinal (Mackenrodt's) ligaments**, which directly stabilize the uterus [1]. *Mackenrodt's ligament* - Also known as the **cardinal ligament** or **transverse cervical ligament**, it extends from the cervix and lateral vaginal fornix to the lateral pelvic walls [1]. - This ligament is a primary support of the uterus, preventing its descent and maintaining its position [1]. *Pubocervical ligament* - The **pubocervical ligament** extends from the anterior aspect of the cervix to the posterior surface of the pubic symphysis. - It is a condensation of the **endopelvic fascia** and provides anterior support to the uterus and bladder [1].

Q: What is the volume of the prostate in normal adult males?

20cc. ***20cc*** - The normal prostate volume in adult males is typically **20 cubic centimeters (cc)** or grams, which is approximately the size of a walnut. - This volume is generally used as a baseline when assessing for conditions like **benign prostatic hyperplasia (BPH)** or prostate cancer, where an enlarged prostate is a key indicator [1]. *50cc* - A prostate volume of 50cc is considered **enlarged** and is often indicative of **benign prostatic hyperplasia (BPH)**, especially in older men [1]. - This volume would lead to symptoms of **lower urinary tract symptoms (LUTS)**, such as frequent urination or difficulty voiding, which are not characteristic of a normal prostate [1]. *75cc* - A prostate volume of 75cc represents a **significantly enlarged prostate**, well beyond the normal range. - Such a size would almost certainly be associated with **moderate to severe LUTS** and likely require medical intervention for BPH. *100cc* - A 100cc prostate is considered a **markedly enlarged prostate**, typically resulting in severe **urinary obstruction** and significant impact on quality of life. - This volume is far from normal and would usually necessitate treatment for **benign prostatic hyperplasia (BPH)**.

Q: What can cause the absence of fructose in seminal fluid?

Both of the above. ***Both of the above*** - **Fructose** in seminal fluid is primarily produced by the **seminal vesicles**, providing energy for sperm motility. - Therefore, either a **congenital absence of seminal vesicles** or an **ejaculatory duct obstruction** (preventing seminal vesicle secretions from reaching the ejaculate) would lead to the absence of fructose. *Congenital absence of seminal vesicle* - The **seminal vesicles** are the primary source of fructose in seminal fluid. - If a person is born without these glands, **fructose will be absent** from their seminal fluid. *Ejaculatory duct obstruction* - An obstruction in the **ejaculatory ducts** would block the passage of secretions from the **seminal vesicles** and vasoepididymis into the urethra. - This prevents **fructose** (from the seminal vesicles) and sperm (from the testes/epididymis) from being present in the ejaculate. *None of the above* - This option is incorrect because both **congenital absence of seminal vesicles** and **ejaculatory duct obstruction** are valid causes for the absence of fructose in seminal fluid.

Q: Identify the pelvic diaphragm in the picture given below:

1. ***1*** - Label 1 points to the **levator ani muscle**, which is the primary component of the **pelvic diaphragm**. - The pelvic diaphragm consists of the levator ani and coccygeus muscles, forming the floor of the pelvic cavity. *2* - Label 2 points to the **external anal sphincter**, a voluntary muscle that surrounds the anal canal. - This muscle is superficial to the pelvic diaphragm and is responsible for maintaining fecal continence. *3* - Label 3 points to the **internal anal sphincter**, an involuntary smooth muscle layer intrinsic to the anal canal. - It maintains resting anal tone and is deep to the external anal sphincter. *4* - Label 4 points to the **ischiorectal fossa**, a fat-filled space located on either side of the anal canal. - This space contains vessels and nerves, but it is not part of the muscular pelvic diaphragm.

Q: Bleeding vessel in hemorrhoids is

Superior rectal artery. Superior rectal artery - Hemorrhoidal bleeding primarily originates from the **terminal branches of the superior rectal artery** within the hemorrhoidal plexus. - The hemorrhoidal cushions contain **arteriovenous anastomoses**, and bleeding occurs from rupture or erosion of the **arterial component**. - This explains why hemorrhoidal bleeding is typically **bright red** (oxygenated arterial blood) and can be brisk. - Modern surgical treatments like **hemorrhoidal artery ligation (HAL)** specifically target these arterial branches, confirming the arterial source of bleeding. Superior rectal vein - While the superior rectal vein drains the hemorrhoidal plexus and is dilated in hemorrhoids, it is **not the primary source of bleeding**. - The venous component contributes to the cushion engorgement but the **actual bleeding is arterial** in nature. - This is an older, outdated concept that has been revised with modern understanding of hemorrhoidal pathophysiology. Middle rectal vein - The middle rectal vein drains the **muscular wall of the rectum** and has minimal involvement in the hemorrhoidal venous plexus. - It is not a significant contributor to hemorrhoidal bleeding. Middle rectal artery - The middle rectal artery provides collateral blood supply to the rectum but plays a **minor role** compared to the superior rectal artery. - The **superior rectal artery** is the dominant arterial supply to the internal hemorrhoidal plexus and is the primary bleeding source.

Q: Among the following the plane of least pelvic dimension is:

Mid-cavity. ***Mid-cavity*** - The **mid-cavity** or **mid-pelvis** is the plane of smallest dimensions during labor, defined by the ischial spines laterally [1]. - This plane is crucial for determining if a fetus can successfully navigate the birth canal, as it represents the narrowest point [1]. *Inlet* - The **pelvic inlet** is the widest part of the pelvis and usually poses less of a restriction during the descent of the fetal head [1]. - It is bounded by the sacral promontory, arcuate line, pectineal line, and pubic crest [2]. *False pelvis* - The **false pelvis** is the upper, broader part of the pelvis and does not play a direct role in guiding the fetal head through the birth canal [1]. - Its boundaries are largely abdominal and do not define crucial dimensions for passage [2]. *Outlet* - The **pelvic outlet** is the final opening that the fetal head must pass through, and while its dimensions are important, the mid-cavity is generally the narrowest point. - Its dimensions are measured from the pubic arch to the tip of the coccyx [3].

Q: Injury to which of the following muscles that forms the deep support of the perineal body causes cystocele, enterocele and urethral descent?

Pubococcygeus. ***Pubococcygeus*** - The **pubococcygeus muscle** is a major component of the **levator ani muscle** group, forming the primary support structure of the pelvic floor [1]. Damage to this muscle impairs the support for the bladder, rectum, and uterus, leading to prolapse conditions like **cystocele**, **enterocele**, and **urethral descent**. - Its integrity is crucial for maintaining the position of pelvic organs and proper function of the urinary and defecatory systems, as it directly supports the vagina, rectum, and bladder neck [3]. *Sphincter of urethra and anus* - The **external urethral sphincter** primarily controls voluntary urination, and its injury mainly leads to **stress urinary incontinence**, not necessarily prolapse [2]. - The **external anal sphincter** controls defecation, and its injury would primarily lead to **fecal incontinence**, not cystocele, enterocele, or urethral descent [2]. *Bulbospongiosus* - The **bulbospongiosus muscle** is superficial, supporting the clitoris and compressing erectile tissue in females, and expelling semen/urine in males. - Its injury would primarily affect sexual function and perineal body integrity but is **not a primary cause of pelvic organ prolapse** like cystocele or enterocele [3]. *Ischiocavernosus* - The **ischiocavernosus muscle** is also superficial, maintaining erection of the clitoris/penis by compressing the crura. - Injury to this muscle would mainly disrupt **erectile function** and contribute minimally to pelvic organ support or prolapse.

Q: Vaginal sphincter is formed by all except

Internal urethral sphincter. ***Internal urethral sphincter*** - The **internal urethral sphincter** is an involuntary smooth muscle sphincter located at the **bladder neck** [2] - It is responsible for maintaining urinary continence and is NOT involved in forming the vaginal sphincter [2] - This structure is entirely separate from the vaginal musculature *Deep transverse perinei* - The **deep transverse perinei** is a muscle of the urogenital diaphragm that provides structural support to the perineum [1] - It contributes to the muscular framework surrounding and supporting the vagina - Works in conjunction with other perineal muscles to provide vaginal support *Bulbospongiosus* - The **bulbospongiosus muscle** is a superficial perineal muscle that directly surrounds the vaginal orifice - It functions to constrict the vaginal opening and is a primary component of the vaginal sphincter mechanism - Also aids in clitoral erection during sexual arousal *Pubovaginalis* - The **pubovaginalis muscle** is part of the levator ani complex (specifically the pubococcygeus portion) - It loops around and directly supports the vagina, functioning as a key component of the vaginal sphincter - Helps maintain vaginal position and provides voluntary constriction

Question 1

The blood supply of uterus is from:

1. Uterine artery
2. Ovarian artery
3. Pudendal artery
4. Superior vesical artery

Select the correct answer using the code given below:

Accepted Answer

1 and 2

Answer

1 and 3

Answer

2 and 4

Answer

3 and 4

Question 2

The following are the contents of broad ligament EXCEPT:

Accepted Answer

Internal iliac artery

Answer

Uterine and ovarian arteries with their branches

Answer

Fallopian tube

Answer

Ovarian ligament

Question 3

Which one of the following is NOT a support of uterus, preventing its descent?

Accepted Answer

Inguinal ligament

Answer

Endopelvic fascia

Answer

Mackenrodt's ligament

Answer

Pubocervical ligament

Question 4

What is the volume of the prostate in normal adult males?

Accepted Answer

20cc

Answer

50cc

Answer

75cc

Answer

100cc

Question 5

What can cause the absence of fructose in seminal fluid?

Accepted Answer

Both of the above

Answer

None of the above

Answer

Congenital absence of seminal vesicle

Answer

Ejaculatory duct obstruction

Question 6

Identify the pelvic diaphragm in the picture given below:

Accepted Answer

1

Answer

2

Answer

3

Answer

4

Question 7

Bleeding vessel in hemorrhoids is

Accepted Answer

Superior rectal artery

Answer

Superior rectal vein

Answer

Middle rectal vein

Answer

Middle rectal artery

Question 8

Among the following the plane of least pelvic dimension is:

Accepted Answer

Mid-cavity

Answer

Inlet

Answer

False pelvis

Answer

Outlet

Question 9

Injury to which of the following muscles that forms the deep support of the perineal body causes cystocele, enterocele and urethral descent?

Accepted Answer

Pubococcygeus

Answer

Sphincter of urethra and anus

Answer

Bulbospongiosus

Answer

Ischiocavernosus

Question 10

Vaginal sphincter is formed by all except

Accepted Answer

Internal urethral sphincter

Answer

Deep transverse perinei

Answer

Bulbospongiosus

Answer

Pubovaginalis

Pelvis and Perineum — MCQs

Pelvis and Perineum — MCQs

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