Pelvis and Perineum — MCQs

Pelvis and Perineum Indian Medical PG Practice Questions and MCQs

Question 531: Which of the following is present in males but not in females?

A. Bulbospongiosus muscle
B. Membranous urethra
C. Corpus cavernosum
D. Bulbourethral gland (Correct Answer)

Explanation: ***Bulbourethral gland*** - Also known as **Cowper's glands**, these are exocrine glands found **exclusively in males**, with no homologous structure in females. - They are located inferior to the prostate gland within the deep perineal pouch, secreting pre-ejaculate fluid into the spongy urethra. - Females have Bartholin's glands (greater vestibular glands), which are functionally analogous but anatomically distinct structures. *Bulbospongiosus muscle* - This muscle is present in **both males and females**, though it has different functions. - In males, it covers the bulb of the penis and aids in penile erection and ejaculation. - In females, it covers the vestibular bulbs and supports the clitoris and vagina. *Membranous urethra* - While the male urethra is anatomically divided into prostatic, membranous, and spongy segments, the female urethra also passes through the urogenital diaphragm (perineal membrane), which some anatomists refer to as a "membranous" portion. - The key distinction is that the bulbourethral glands are **exclusively male structures** with no female equivalent, making them the most definitive answer. *Corpus cavernosum* - **Both males and females** possess homologous erectile tissue. - In males, paired corpora cavernosa form the bulk of the penile shaft. - In females, homologous erectile tissue forms the body of the clitoris.

Question 532: Uterosacral ligament contains

A. Mainly smooth muscle
B. Contain uterine vessels
C. Sympathetic and parasympathetic nerves (Correct Answer)
D. Ureters

Explanation: ***Sympathetic and parasympathetic nerves*** - The **uterosacral ligaments** are a component of the pelvic connective tissue that extends from the cervix to the sacrum, richly innervated [1]. - These ligaments are crucial for providing **nervous input** to the uterus and surrounding organs, including both **sympathetic** and **parasympathetic fibers**. *Mainly smooth muscle* - While ligaments are connective tissue, the **uterosacral ligaments** are primarily composed of **collagen** and **elastic fibers**, with some smooth muscle components, but not "mainly" smooth muscle [1]. - Their primary function is support, not contraction, distinguishing them from structures predominantly composed of smooth muscle. *Contain uterine vessels* - The **uterine vessels** (arteries and veins) are primarily located within the **broad ligament** (specifically, in the mesometrium) as they approach the uterus from the lateral pelvic wall. - While there might be small anastomosing vessels, the main uterine supply does not run within the uterosacral ligaments. *Ureters* - The **ureters** course through the pelvic cavity to reach the bladder, but they are not contained within the uterosacral ligaments. - They pass more laterally, close to the lateral fornix of the vagina, superior to the uterine artery, often remembered by the phrase "**water under the bridge**."

Question 533: Most important support of the uterus for preventing prolapse is:

A. Round ligament of ovary
B. Pelvic floor
C. Transverse cervical ligament (Correct Answer)
D. Round ligament of uterus

Explanation: ***Transverse cervical ligament*** - The **transverse cervical ligaments (Cardinal ligaments)** are the primary static support for the uterus, anchoring the cervix and upper vagina to the lateral pelvic walls [1]. - They contain the **uterine artery and veins** and prevent the uterus from prolapsing downwards. *Round ligament of ovary* - This ligament connects the **medial pole of the ovary to the uterus**, specifically the lateral aspect of the uterus, just below the fallopian tubes. - Its primary role is to tether the ovary to the uterus and is not a significant support against uterine prolapse. *Pelvic floor* - The **pelvic floor muscles** provide dynamic support to the pelvic organs, including the uterus [2]. - While crucial for general organ support and continence, the pelvic floor is considered a secondary, rather than the most important primary, support for preventing immediate uterine prolapse compared to the strong static ligaments. *Round ligament of uterus* - The **round ligament of the uterus** extends from the uterus, through the inguinal canal, to the labia majora. - Its function is to help maintain the **anteversion of the uterus** and is a weak support for preventing uterine prolapse.

Question 534: All are true regarding course of ureter in pelvis except

A. It is crossed by ovarian vessels where it enters true pelvis
B. Ureter pierces lateral ligament where ureteric canal is developed.
C. Ureter passes over bifurcation of common iliac artery
D. Obturator vessels and nerve lie medially in relation to ureter at pelvic brim (Correct Answer)

Explanation: ***Obturator vessels and nerve lie medially in relation to ureter at pelvic brim*** - This statement is **FALSE** and is the correct answer to this "except" question. - The obturator nerve and vessels actually lie **laterally** (not medially) in relation to the ureter at the pelvic brim. - As the ureter descends into the pelvis, it crosses **anterior and medial** to the obturator nerve and vessels. - The obturator structures run along the **lateral pelvic wall** toward the obturator foramen. *It is crossed by ovarian vessels where it enters true pelvis* - This is **TRUE**. - The ovarian vessels cross anterior to the ureter at the pelvic brim as it enters the true pelvis [1]. - This is an important surgical landmark, particularly during **oophorectomy** and pelvic surgery to avoid ureteral injury [1]. - The relationship is remembered as "water (ureter) under the bridge (ovarian vessels)." *Ureter pierces lateral ligament where ureteric canal is developed* - This statement is **questionable** but may refer to the ureter's passage through the **parametrium** (base of broad ligament). - The ureter runs in the lateral parametrial tissue before passing beneath the uterine artery. - While not standard terminology, "ureteric canal" may refer to this passage through parametrial tissue. *Ureter passes over bifurcation of common iliac artery* - This is **TRUE**. - The ureter crosses **anterior** to the bifurcation of the common iliac artery at the pelvic brim. - This occurs at approximately the level of the **sacroiliac joint**. - This is a consistent and important anatomical landmark during pelvic and retroperitoneal surgery.

Question 535: Which of the following anatomic boundary separates the true pelvis from the false pelvis?

A. Linea terminalis (Correct Answer)
B. Ischial spine
C. Arcuate line
D. Pectineal line

Explanation: ***Linea terminalis*** - The **linea terminalis** is the imaginary line forming the boundary between the **true (lesser) pelvis** and the **false (greater) pelvis** [1]. - It delineates the **pelvic inlet** and defines the space where the pelvic organs are located [1]. *Ischial spine* - The **ischial spine** is a bony prominence within the **true pelvis** that serves as an important landmark for assessing fetal station during labor. - It does not separate the true from the false pelvis but is entirely contained within the true pelvis [1]. *Arcuate line* - The **arcuate line** is a part of the **linea terminalis**, specifically located on the ilium. - It forms only a segment of the complete boundary that separates the true and false pelvis. *Pectineal line* - The **pectineal line** (pecten pubis) is another component of the **linea terminalis**, located on the superior ramus of the pubic bone. - Like the arcuate line, it is a part of the overall boundary and not the entire separating structure itself.

Question 536: The anatomical space in the external female genitalia that contains the urethral and vaginal openings is the:

A. Vestibule (Correct Answer)
B. Fossa navicularis
C. Labia minora
D. Fourchette

Explanation: ***Vestibule*** - The **vestibule** is the anatomical space bordered by the labia minora, where the urethral and vaginal openings are located [1]. - It also contains the **the two Skene's ducts which open in the vestibule on either side of the external urethral meatus as well as the ducts of the greater vestibular (Bartholin's) glands** [1]. *Fossa navicularis* - The **fossa navicularis** is a small depression or boat-shaped area located between the fourchette and the vaginal opening. - It is a specific part of the **vestibule**, not the entire space containing multiple openings. *Labia minora* - The **labia minora** are two folds of skin that enclose the vestibule. - They form the **boundaries** of the vestibule, rather than being the space itself [1]. *Fourchette* - The **fourchette** is the posterior fold of tissue formed by the fusion of the labia minora. - It marks the **posterior boundary** of the vestibule, but is not the vestibule itself.

Question 537: Bartholin gland opening is at:

A. Inner side of labia minora external to hymen (Correct Answer)
B. Outer side of labia minora internal to hymen
C. Outer side of labia minora external to hymen
D. Inner side of labia minora internal to hymen

Explanation: ***Inner side of labia minora external to hymen*** - The **Bartholin glands** (also known as greater vestibular glands) are located on either side of the **vaginal opening**. [1] - Their ducts open into the **vestibule** just outside the **hymen**, specifically between the **labia minora**. [1] *Outer side of labia minora internal to hymen* - The opening is **not on the outer side** of the labia minora but rather on the inner face defining the vestibule. [1] - The opening is **external to the hymen**, not internal. [1] *Outer side of labia minora external to hymen* - The opening is located on the **inner, medial aspect of the labia minora**, not its outer surface. [1] - While correct that it is external to the hymen, the location relative to the labia minora is inaccurate. *Inner side of labia minora internal to hymen* - The opening is indeed on the **inner side of the labia minora**, forming part of the vestibule. [1] - However, the opening is consistently positioned **external to the hymen**, not internal. [1]

Question 538: The fouchette is formed where

A. Both labia minora meet anteriorly
B. Labia minora and majora meet
C. Both labia minora meet posteriorly (Correct Answer)
D. Distance between vulva and labia minora

Explanation: ***Both labia minora meet posteriorly*** - The **fourchette** is a fold of skin that represents the commissure (point of union) of the posterior ends of the **labia minora** [1]. - It forms the posterior border of the **vulvar vestibule** [1]. *Both labia minora meet anteriorly* - The labia minora meet anteriorly to form the **prepuce** (hood) and **frenulum** of the clitoris, not the fourchette [1]. - This anterior union is distinct from the posterior area of the fourchette. *Labia minora and majora meet* - The **labia majora** are the outer, larger folds, and they do not directly meet the labia minora in a single, defined commissure posteriorly to form the fourchette. - The folds delineate the **vulva**, but their meeting points are not termed fourchette. *Distance between vulva and labia minora* - The fourchette is an anatomical structure, specifically a **posterior commissure**, not a measure of distance between anatomical parts. - The term "distance" does not describe the specific anatomical landmark of the fourchette.

Question 539: Contents of broad ligament are all except

A. Uterine vessels
B. Internal pudendal artery (Correct Answer)
C. Round ligament
D. Infundibulopelvic Ligament

Explanation: ***Internal pudendal artery*** - The **internal pudendal artery** is not a content of the broad ligament; it supplies structures in the perineum and external genitalia. [2] - Its course is typically outside the peritoneal folds that constitute the broad ligament. *Uterine vessels* - The **uterine artery and veins** are major contents of the broad ligament, specifically within its base (cardinal ligament), providing blood supply to the uterus. [1] - They run medially towards the uterus, crossing over the ureters. [2] *Round ligament* - The **round ligament of the uterus** is embryological remnant running within the anterior fold of the broad ligament. [3] - It extends from the uterus, through the inguinal canal, to the labia majora. *Infundibulopelvic Ligament* - The **infundibulopelvic ligament** (also known as the suspensory ligament of the ovary) is the most superior portion of the broad ligament, connecting the ovary to the lateral pelvic wall. [1] - It contains the **ovarian artery and vein**, along with nerves and lymphatic vessels. [1]

Question 540: Gartner's duct cyst lies in the

A. Lateral aspect of uterine wall
B. Anterolateral wall of vagina (Correct Answer)
C. Posterior to ovarian ligament
D. Upper edge of broad ligament

Explanation: ***Anterolateral wall of vagina*** - Gartner's duct cysts are remnants of the **mesonephric (Wolffian) duct** in females, which typically regress. - When segments of this duct persist and become distended, they form cysts usually located along the **anterolateral wall of the vagina**. *Lateral aspect of uterine wall* - While other **Müllerian anomalies** or **paramesonephric remnants** might be found near the lateral uterine wall, Gartner's duct cysts are specifically associated with the vaginal wall [1]. - Cysts in this location are less commonly attributed to Gartner's duct. *Posterior to ovarian ligament* - Structures posterior to the ovarian ligament often include **paratubal cysts** or **paraoophoron cysts**, which originate from different embryological remnants [2]. - This location is not characteristic for Gartner's duct cysts, which are typically found lower in the reproductive tract. *Upper edge of broad ligament* - Cysts found at the upper edge of the broad ligament are often **hydatid cysts of Morgagni** (remnants of the Müllerian duct) or **paraovarian cysts** [2]. - Gartner's duct remnants can rarely extend higher, but their classic cystic presentation is in the vagina.

Practice by Chapter

Pelvic Walls and Floor

Practice Questions

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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