Pelvic Vasculature — MCQs
Which structure lies midway between the anterior superior iliac spine and pubic symphysis?
All of the following arteries are branches of ECA that supply nasal septum except:
All of the following are branches of the external carotid artery except?
Which of the following statements about the femoral triangle is NOT true?
Which arteries contribute to the vascular supply of the vulva?
Through which route does prostate cancer primarily spread to the vertebral column?
All are true regarding course of ureter in pelvis except
Which of the following is not felt with a digital rectal examination?
Among the following the plane of least pelvic dimension is:
Which lymph nodes drain the skin and fascia of the great toe?
Pelvic Vasculature Indian Medical PG Practice Questions and MCQs
Question 1: Which structure lies midway between the anterior superior iliac spine and pubic symphysis?
- A. Femoral artery (Correct Answer)
- B. Deep inguinal ring
- C. Superior epigastric artery
- D. Inguinal ligament
Explanation: ***Femoral artery*** - The **femoral artery** is a direct continuation of the external iliac artery and is the most reliable palpable pulse in the groin area. [1] - Its surface marking is clinically important as it's found midway between the **anterior superior iliac spine (ASIS)** and the **pubic symphysis**, specifically at the **mid-inguinal point**. [1] *Deep inguinal ring* - The **deep inguinal ring** is located at the **midpoint of the inguinal ligament** (midway between ASIS and pubic tubercle), which is approximately 1.5 cm above and lateral to the mid-inguinal point. - It marks the beginning of the **inguinal canal** and is the site where the vas deferens and gonadal vessels exit the abdominal cavity. *Superior epigastric artery* - The **superior epigastric artery** is a terminal branch of the internal thoracic artery and primarily supplies the upper abdominal wall. [2] - It is located in the anterior abdominal wall, far from the inguinal region and the midpoint between the ASIS and pubic symphysis. [2] *Inguinal ligament* - The **inguinal ligament** extends between the anterior superior iliac spine and the pubic tubercle, forming the inferior border of the anterior abdominal wall. - While relevant to the region, the ligament itself is a fibrous band, not a structure found *midway between* the ASIS and pubic symphysis in the same way the femoral artery is.
Question 2: All of the following arteries are branches of ECA that supply nasal septum except:
- A. Facial artery
- B. Superior labial artery
- C. Anterior ethmoidal artery (Correct Answer)
- D. Sphenopalatine artery
Explanation: ***Anterior ethmoidal artery*** - The **anterior ethmoidal artery** is a branch of the **ophthalmic artery**, which itself is a branch of the **internal carotid artery (ICA)**, not the external carotid artery (ECA). - It supplies the **upper anterior nasal septum** and lateral wall of the nasal cavity. *Facial artery* - The **facial artery** is a direct branch of the **external carotid artery (ECA)**. - It contributes to the blood supply of the nasal septum through its septal branches. *Superior labial artery* - The **superior labial artery** is a branch of the **facial artery**, meaning it indirectly originates from the **external carotid artery (ECA)**. - It sends a septal branch to supply the **anterior inferior part of the nasal septum**. *Sphenopalatine artery* - The **sphenopalatine artery** is a direct terminal branch of the **maxillary artery**, which is one of the terminal branches of the **external carotid artery (ECA)**. - It is the major blood supply to the **posterior nasal septum** and lateral wall, forming part of Kesselbach's plexus.
Question 3: All of the following are branches of the external carotid artery except?
- A. Superior thyroid artery
- B. Transverse cervical artery (Correct Answer)
- C. Ascending pharyngeal artery
- D. Superficial temporal artery
Explanation: ***Transverse cervical artery*** - The **transverse cervical artery** is a branch of the **thyrocervical trunk**, which itself originates from the **subclavian artery**, not the external carotid artery. - It supplies muscles in the neck and shoulder region. *Superior thyroid artery* - The **superior thyroid artery** is typically the first branch of the **external carotid artery**. - It supplies the **thyroid gland** and adjacent structures in the neck. *Ascending pharyngeal artery* - The **ascending pharyngeal artery** is the only **medial branch** of the **external carotid artery**. - It supplies the **pharynx**, prevertebral muscles, and middle ear. *Superficial temporal artery* - The **superficial temporal artery** is one of the **two terminal branches** of the **external carotid artery**, forming in the parotid gland. - It supplies the scalp in the temporal region and is palpable anterior to the ear.
Question 4: Which of the following statements about the femoral triangle is NOT true?
- A. Contains the femoral vessels
- B. Floor is formed by adductor longus (Correct Answer)
- C. Lateral margin is formed by sartorius
- D. Medial margin is formed by adductor longus
Explanation: ***Floor is formed by adductor longus*** - The floor of the femoral triangle is actually formed by the **iliopsoas** laterally and the **pectineus** medially. - The **adductor longus** forms part of the medial boundary of the femoral triangle, not its floor. - This is the INCORRECT statement (correct answer for a "NOT true" question). *Contains the femoral vessels* - The femoral triangle is a crucial anatomical space containing the **femoral artery**, **femoral vein**, and **femoral nerve**. - These structures are organized from lateral to medial as nerve, artery, vein (NAVY). *Lateral margin is formed by sartorius* - The **sartorius muscle** forms the lateral boundary of the femoral triangle. - Its medial border defines one of the triangle's sides. *Medial margin is formed by adductor longus* - The **adductor longus** does form the medial boundary of the femoral triangle. - This is anatomically correct along with the inguinal ligament (superior boundary) and sartorius (lateral boundary).
Question 5: Which arteries contribute to the vascular supply of the vulva?
- A. Inferior vesicle artery
- B. Vaginal artery
- C. Internal pudendal artery
- D. All of the options (Correct Answer)
Explanation: ***All of the options (All three arteries listed contribute)*** - The **inferior vesical artery**, **vaginal artery**, and **internal pudendal artery** all contribute to the vascular supply of the vulva. - Together, these vessels form part of the rich vascular network supplying the external female genitalia. - **Note:** The external pudendal artery (from the femoral artery) also contributes significantly via anterior labial branches. *Inferior vesical artery* - Branch of the **internal iliac artery** that primarily supplies the bladder - Provides minor contributions to the **lower vagina and vulva** in females - Part of the internal iliac arterial supply to the region *Vaginal artery* - Branch of the **internal iliac artery** - Major blood supply to the **vagina** with branches extending to the **posterior vulva** - Works in anastomotic network with other pelvic vessels *Internal pudendal artery* - **Primary arterial supply** to the perineum and external genitalia - Gives rise to the **posterior labial arteries**, **deep and dorsal arteries of the clitoris**, and **artery of the vestibular bulb** - Most clinically significant vessel for vulvar blood supply
Question 6: Through which route does prostate cancer primarily spread to the vertebral column?
- A. None of the options
- B. Batson plexus (Correct Answer)
- C. Inferior hypogastric plexus
- D. Superior hypogastric plexus
Explanation: Batson plexus - The Batson plexus is a valveless network of veins that connects the deep pelvic veins (including those draining the prostate) to the internal vertebral venous plexuses. - The absence of valves in this plexus allows for the retrograde flow of tumor cells, facilitating the direct spread of prostate cancer to the vertebral column and other bones without passing through the pulmonary circulation. Inferior hypogastric plexus - The inferior hypogastric plexus is a nerve plexus containing sympathetic and parasympathetic fibers, primarily involved in innervating pelvic organs. - It is a neural structure, not a vascular pathway, and therefore does not play a direct role in the hematogenous spread of cancer cells. Superior hypogastric plexus - The superior hypogastric plexus is also a nerve plexus, located anterior to the sacral promontory, involved in autonomic innervation of pelvic organs. - Like the inferior hypogastric plexus, it is a neural structure and not a venous pathway for metastatic spread of cancer. None of the options - This option is incorrect because the Batson plexus is a well-established and critically important route for the metastatic spread of prostate cancer to the vertebral column. - The involvement of this valveless venous system is a hallmark in understanding the predilection of prostate cancer for bone metastases.
Question 7: 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 8: Which of the following is not felt with a digital rectal examination?
- A. Seminal vesicles
- B. Prostate
- C. Rectovesical pouch
- D. Ureter (Correct Answer)
Explanation: ***Ureter*** - The **ureters** are too deep and medially located to be reliably palpated during a **digital rectal examination** (DRE). - They are typically not accessible through the rectal wall due to their anatomical position posterior to the urinary bladder and prostate (in males). *Seminal vesicles* - The **seminal vesicles** are located superior to the prostate and can sometimes be palpated, especially if enlarged or inflamed. - They are adjacent to the posterior surface of the bladder and anterior to the rectum. *Prostate* - The **prostate gland** is directly anterior to the rectum and is the primary structure evaluated during a **DRE**. - Its size, consistency, and any nodules or tenderness can be assessed. *Rectovesical pouch* - The **rectovesical pouch** is the peritoneal reflection between the rectum and the bladder in males. - While not a distinct organ to "feel," pathology within this space (e.g., fluid collections, masses) can sometimes be appreciated as a fullness or mass effect above the prostate via the DRE.
Question 9: Among the following the plane of least pelvic dimension is:
- A. Inlet
- B. False pelvis
- C. Mid-cavity (Correct Answer)
- D. Outlet
Explanation: ***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].
Question 10: Which lymph nodes drain the skin and fascia of the great toe?
- A. Superficial inguinal lymph nodes (Correct Answer)
- B. External iliac lymph nodes
- C. Internal iliac lymph nodes
- D. Deep inguinal lymph nodes
Explanation: ***Superficial inguinal lymph nodes*** - The **superficial inguinal lymph nodes** are responsible for draining lymph from the skin and fascia of the lower limb, including the **great toe**. [1] - They are located in the superficial fascia below the inguinal ligament and receive lymphatic vessels associated with the **great saphenous vein**. *External iliac lymph nodes* - The external iliac lymph nodes drain structures within the **pelvis** and receive lymph from the **deep inguinal lymph nodes**, not directly from the skin of the great toe. - They are located along the external iliac artery and vein. *Internal iliac lymph nodes* - The internal iliac lymph nodes primarily drain lymph from the **pelvic organs** and the **perineum**. - They do not directly receive lymphatic drainage from the great toe or the superficial lower limb. *Deep inguinal lymph nodes* - The deep inguinal lymph nodes are located deeper, medial to the **femoral vein**, and receive lymph mainly from the deep structures of the lower limb. - While they eventually drain into the external iliac nodes, they do not directly drain the superficial skin and fascia of the great toe.
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