A newborn girl is delivered vaginally at term to a healthy 25-year-old G1P1. The pregnancy was uncomplicated. On examination, she was found to have a slight anal invagination, but no opening. Further examination shows a vestibular fistula and normally developed external genitalia. Which of the following statements about this condition is correct?
ASuch abnormal anatomy is formed after week 12 of intrauterine development.
BThe presence of an associated perineal or vestibular fistula is more likely in females with trisomy 21.
CThere is a failure of the division of the embryonic cloaca into the urogenital sinus and rectoanal canal.
DOther congenital abnormalities are extremely rare in patients with this condition.
EThere is a failure of the rupture of the anal membrane (dorsal portion of the cloacal membrane).
A 28-year-old man is admitted to the hospital for the evaluation of symmetric, ascending weakness that started in his feet and has become progressively worse over the past 5 days. A lumbar puncture is performed to confirm the diagnosis. As the needle is advanced during the procedure, there is resistance just before entering the epidural space. This resistance is most likely due to which of the following structures?
ADura mater
BSupraspinous ligament
CInterspinous ligament
DLigamentum flavum
ESuperficial fascia
A 47-year-old woman comes to the physician because of involuntary leakage of urine for the past 4 months, which she has experienced when bicycling to work and when laughing. She has not had any dysuria or urinary urgency. She has 4 children that were all delivered vaginally. She is otherwise healthy and takes no medications. The muscles most likely affected by this patient's condition receive efferent innervation from which of the following structures?
AS3–S4 nerve roots
BObturator nerve
CSuperior hypogastric plexus
DSuperior gluteal nerve
ES1-S2 nerve roots
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