Sample Chapter

Clinically Oriented Anatomy 7Th Ed By Agur Dalley – Test Bank
1. Which of the following is most likely pertaining to the two pelves depicted above?
A) The one on the left is male and the one on the right is female.
B) The one on the right is male and the one on the left is female.
C) The one on the left is from a younger person than the one on the right.
D) The one on the right is from a younger person than the one on the left.
E) The one on the right shows arthritic degeneration at the sacroiliac joint.
Ans: A



2. Which of the following is incorrect pertaining to the bony pelvis?
A) The pelvic girdle is composed of the right and left hip bones and the sacrum.
B) In infants and children the hip bone is composed of three separate bones—the ilium, ischium, and pubis.
C) The ala of the ilium helps to form the acetabulum.
D) The ischial spine separates the greater and lesser sciatic foramina.
E) The pelvic brim separates the greater (false) and lesser (true) pelves.
Ans: C



3. The sacrotuberous ligament:
A) passes through the greater sciatic notch.
B) attaches to the ala of the sacrum.
C) resists posterosuperior rotation of the sacrum (inferior aspect moving posteriorly and superiorly).
D) passes through the obturator foramen.
E) prevents posterior dislocation of the femoral head.
Ans: C



4. In examining a newly pregnant woman, you notice that the spinous process of the L5 vertebra is abnormally prominent compared to the spinous processes of the superior lumbar vertebrae.  You suspect:
A) a fracture of the body of L5.
B) spondylolisthesis.
C) a vertebral canal tumor.
D) spina bifida.
E) kyphosis.
Ans: B



5. Which of the following is incorrect pertaining to the pelvis during pregnancy?
A) The true (conjugate) distance between the sacral promontory and the posterosuperior aspect of the pubic symphysis increases.
B) The hormone, relaxin, relaxes the pelvic ligaments.
C) The transverse diameter of the pelvis is increased.
D) The amount of pelvic rotation permitted around the sacrum is increased.
E) The coccyx is permitted to move more posteriorly.
Ans: A



6. Which of the following is incorrect pertaining to the pelvic diaphragm?
A) It separates the pelvic cavity from the perineum.
B) It is pierced by the vagina in females.
C) It helps maintain urinary continence.
D) It helps maintain fecal continence.
E) It is synonymous with the levator ani.
Ans: E



7. In the following AP pelvic radiograph, the arrow indicates:
A) the sacrotuberous ligament.
B) the ischial spine.
C) the ischial tuberosity.
D) the iliac tubercle.
E) a posteriorly dislocated femoral head.
Ans: B



8. The levator ani:
A) is innervated by pelvic splanchnic nerves.
B) actively contracts during coughing.
C) causes increased urination when spastic.
D) is part of the urogenital diaphragm.
E) actively contracts during inspiration.
Ans: B



9. The rectouterine pouch:
A) may be entered from the anterior vaginal fornix.
B) is a peritoneal recess.
C) is within the broad ligament.
D) contains the ovaries.
E) provides support to the bladder.
Ans: B



10. Which of the following is incorrect pertaining to the transverse cervical (cardinal) ligament?
A) It is composed of subperitoneal endopelvic fascia.
B) It provides support to the uterus.
C) It attaches to the lateral wall of the pelvic cavity.
D) It provides an attachment for the levator ani.
E) It may be used to hold sutures during pelvic surgery.
Ans: D



11. Which of the following is incorrect pertaining to the sacral plexus?
A) It is located on the posterolateral wall of the lesser pelvis.
B) It is related to the anterior surface of the piriformis muscle.
C) It is joined by the lumbosacral trunk.
D) It may be compressed during parturition, resulting in lower limb pain.
E) Most of its branches exit the pelvis through the lesser sciatic foramen.
Ans: E



12. The hypogastric plexuses:
A) convey vagal fibers to the pelvic viscera.
B) convey pelvic splanchnic fibers to pelvic viscera.
C) convey sympathetic fibers to pelvic viscera.
D) receive white communicating rami from the sacral spinal nerves.
E) comprise the pelvic part of the sympathetic trunk.
Ans: C



13. Which of the following is incorrect pertaining to pelvic parasympathetic innervation?
A) It derives from spinal segments S2-4.
B) It stimulates rectal contraction for defecation.
C) It stimulates bladder contraction for urination.
D) It stimulates ejaculation.
E) The fibers are accompanied by visceral afferent fibers from pelvic viscera.
Ans: D



14. The pelvic pain line:
A) characterizes pelvic pain referral areas based on the inferior limit of peritoneum.
B) is at the level of the first sacral segment.
C) refers to the vertebral level at which the pain associated with parturition is most severe.
D) is only relevant during childbirth.
E) relates to the referred pain felt in the midsagittal plane after hysterectomy.
Ans: A



15. Which of the following is incorrect pertaining to the umbilical artery?
A) It gives rise to the obturator artery.
B) It is a branch of the internal iliac artery.
C) It gives rise to superior vesical arteries.
D) It forms the medial umbilical ligament.
E) Postnatally, has both patent and occluded parts.
Ans: A



16. The uterine artery:
A) passes superior to the ureter at the lateral fornix of the vagina.
B) is a branch of the external iliac artery.
C) is intraperitoneal.
D) supplies the bladder.
E) connects to the uterus at its junction with the uterine tubes.
Ans: A



17. You examine a young boy in the emergency room who is bleeding from his penis after an accident.  This blood is derived primarily from a branch of which of the following arteries?
A) superior gluteal
B) internal pudendal
C) external pudendal
D) femoral
E) inferior epigastric
Ans: B



18. Which of the following is incorrect pertaining to the ovarian artery?
A) It traverses the suspensory ligament of the ovary.
B) It crosses anterior to the ureter.
C) It has reduced blood flow following ligature of the internal iliac artery.
D) It helps supply the uterine tube.
E) It is accompanied by lymph vessels draining the ovary.
Ans: C



19. Which of the following is not typically a tributary of the internal iliac vein?
A) superior rectal vein
B) veins from the vesical pelvic plexus
C) internal pudendal vein
D) uterine vein
E) superior gluteal vein
Ans: A



20. Pelvic lymph drainage:
A) is associated with six primary groups of well-defined lymph nodes.
B) is defined by well-developed flow patterns that permit prediction of the spread of metastatic cancer from one organ to another.
C) includes vessels that drain the testis.
D) is characterized by terminal efferent vessels that pass the lymph to lumbar (caval/aortic) nodes.
E) rigidly follows venous drainage patterns.
Ans: D



21. The ureters:
A) pass straight through the bladder wall (in a horizontal plane).
B) are accompanied throughout their length by arteries and veins derived from the renal vessels.
C) have afferent fibers that typically refer pain to the lower abdomen, especially the inguinal region.
D) cross anterior to the ductus deferens.
E) are intraperitoneal.
Ans: C



22. Detrusor muscle contraction is stimulated by:
A) the superior hypogastric nerve.
B) lumbar splanchnic nerves.
C) pelvic splanchnic nerves.
D) internal pudendal nerve.
E) contractions of the levator ani.
Ans: C



23. Which of the following is incorrect pertaining to the bladder?
A) A cystocele may result from injuries associated with parturition.
B) Withdrawal of urine from the bladder requires the needle to enter the peritoneal cavity.
C) Rupture of the superior part of the bladder is usually associated with extravasation (passage) of urine into the peritoneal cavity.
D) The interior of the bladder may be viewed with a cystoscope.
E) A complete spinal cord transaction superior to the second sacral segment would eliminate voluntary control of micturition.
Ans: B



24. In the following MRI of a woman with an anteverted and anteflexed uterus, the arrow indicates the:
A) body of the uterus.
B) opening of the vagina.
C) external os (opening of the cervix).
D) bladder.
E) rectum.
Ans: C



25. The female urethra:
A) is more difficult to catheterize than the male urethra.
B) opens into the vestibule of the vagina.
C) has cilia that very effectively prevent bacteria from entering the bladder.
D) begins with a distinct sphincter in the bladder, the internal urethral sphincter.
E) has a distinct posterior ridge termed the urethral crest.
Ans: B



26. The trigone of the bladder:
A) forms the boundaries of the internal urethral orifice.
B) is a slight elevation of the internal posterior wall produced by the prostate.
C) is the internal area demarcated by the internal urethral and ureteric orifices.
D) is the extraperitoneal part of the external surface.
E) is synonymous with the apex.
Ans: C



27. The ductus deferens:
A) is typically ligated during a vasectomy as it exits the superficial inguinal ring.
B) terminates by uniting with the duct of the seminal glands to form the ejaculatory duct.
C) begins at the head of the testis.
D) is intraperitoneal.
E) is drained by lymph vessels destined for the deep inguinal nodes.
Ans: B



28. A middle-aged male patient complains of a weak “stream” and nocturia. You believe the most likely cause to be:
A) a bladder infection.
B) a spinal cord lesion affecting his pelvic splanchnic nerves.
C) benign prostatic hypertrophy.
D) a ureteric calculi.
E) an obstruction of his intramural (preprostatic) urethra.
Ans: C



29. Prostate cancer:
A) is characterized by a softening of the prostate that can be felt during a digital rectal exam.
B) is best identified rectally when the patient has a full bladder.
C) often metastasizes to the testes.
D) is conclusively identified by a positive test of the external iliac lymph nodes.
E) is associated with bladder cancer.
Ans: B



30. Which of the following associations is incorrect?
A) digital examination of the vagina—ovarian cysts
B) digital examination of the vagina—pulsations of uterine artery
C) urethrovaginal fistula—continuous dribbling of urine from the vagina
D) culdocentesis—drainage of a pelvic abscess via posterior vaginal fornix
E) rectovaginal fistula—discharge of fecal matter from the vagina
Ans: C



31. The vaginal fornix:
A) surrounds the vaginal part of the cervix.
B) contains the ovaries.
C) is part of the broad ligament.
D) is the inferior part of the rectouterine pouch.
E) is the recess between the external urethral and vagina orifices.
Ans: A



32. Which of the following structures is least important for supporting the uterus and/or  maintaining its position?
A) broad ligament
B) transverse cervical (cardinal) ligaments
C) uterosacral ligament
D) pelvic diaphragm
E) round ligament of the uterus
Ans: E



33. Softening of the isthmus of the uterus (Hegar sign) is associated with:
A) pregnancy.
B) uterine cancer.
C) a prolapsed uterus.
D) menopause.
E) menstruation.
Ans: A



34. A pregnant patient seeks your counsel pertaining to anesthesia during delivery.  She is particularly interested in a caudal epidural block.  You explain that this procedure:
A) eliminates all pain associated with labor and delivery.
B) just minimizes the pain sensations that arise from the lower part of the birth canal (cervix and vagina) and the perineum.
C) just minimizes the pain sensations that arise from the body and fundus of the uterus.
D) just minimizes the pain associated with fibers traveling in the pudendal nerve.
E) is typically not used for delivery, but rather for an episiotomy.
Ans: B



35. Which of the following is incorrect pertaining to the uterine tubes?
A) They lie in the mesosalpinx part of the broad ligament.
B) They allow the development of peritonitis from genitourinary tract infections.
C) They may be ligated to prevent pregnancy.
D) They may become the site of an ectopic pregnancy.
E) Their distal part, the ampulla, surrounds the ovary.
Ans: E



36. In the following hysterosalpingogram, the arrows indicate the:
A) uterine arteries.
B) uterine tubes.
C) mesovarium.
D) round ligaments.
E) ureters.
Ans: B



37. The anorectal flexure of the anal canal:
A) occurs at the level of S3.
B) is maintained by the transverse rectal folds.
C) is where the alimentary tract penetrates the pelvic diaphragm.
D) is within the rectovesical pouch.
E) is where the omental appendices cease.
Ans: C



38. Which of the following is incorrect pertaining to the perineal body?
A) Stretching or tearing during parturition is associated with prolapse of pelvic viscera.
B) It is an attachment site for the external anal sphincter.
C) It is an attachment site for both the superficial and deep transverse perineal muscles.
D) It lies anterior to the vestibule in females.
E) It blends anteriorly with the perineal membrane.
Ans: D



39. In the emergency room you examine a young boy whose was injured while trying to climb a fence. He says he hit his “bottom” hard while straddling the horizontal bar at the top of the fence. Your examination reveals that his penis and scrotum are edematous as is the lower part of his anterior abdominal wall. Only the most superior aspects of his thighs are also edematous. You suspect the boy:
A) ruptured his corpus cavernosa and the swelling is due to blood.
B) bruised his penis and scrotum and the swelling is due to lymph.
C) ruptured his spongy urethra and the swelling is due to urine.
D) ruptured his internal pudendal vein and the swelling is due to blood.
E) ruptured his deep perineal pouch and the swelling is due to an inflammatory reaction resulting from the release of fluid from the bulbourethral glands.
Ans: C



40. In the following image of a coronal section through the rectum and anal canal, the arrow indicates:
A) the pudendal canal.
B) the superficial perineal space.
C) the deep perineal space.
D) the ischioanal fossa.
E) an ischioanal fistula.
Ans: D



41. The superficial and deep perineal pouches are separated superiorly by the:
A) deep transverse perineal muscles.
B) superficial transverse perineal muscles.
C) perineal membrane.
D) deep perineal fascia (investing or Gallaudet fascia).
E) membranous layer of the subcutaneous tissue of the perineum.
Ans: C



42. According to current concepts, the external urethral sphincter:
A) is similar in males and females.
B) only exists in females.
C) only exists in males.
D) is innervated by pelvic splanchnic nerves.
E) has an inferior part in males that acts as a true sphincter of the intermediate (membranous) urethra.
Ans: E



43. Which of the following is incorrect pertaining to the ischioanal fossa?
A) The anococcygeal ligament prevents the spread of infection from one fossa to the other.
B) Each fossa is bounded medially by the external anal sphincter.
C) Each fossa is traversed by the inferior anal vessels and nerves.
D) Tenderness between the anus and ischial tuberosity is a diagnostic sign associated with an ischioanal abscess.
E) Loss of the fat within each fossa (occurs with extreme starvation) is associated with rectal prolapse.
Ans: A



44. The pectinate line of the anal canal:
A) denotes the separation of the external and internal sphincter ani muscles.
B) denotes the separation between the rectal and anal mucosa.
C) separates the part of the anal canal that is sensitive to laceration from the part that is not.
D) separates the part of the anal canal that is innervated by sympathetic fibers from that innervated by parasympathetic fibers.
E) indicates the anorectal junction.
Ans: C



45. Hemorrhoids are:
A) enlarged anal lymph nodes.
B) infected anal sinuses.
C) varicosities in rectal/anal veins.
D) infected and enlarged anal mucus glands.
E) arteriovenous malformations in the anal mucosa.
Ans: C



46. In the following coronal MRI of the penis and scrotum from a normal male, the arrow indicates the:
A) corpus spongiosum.
B) corpus cavernosum.
C) pampiniform venous plexus.
D) vas deferens.
E) testis.
Ans: B



47. In male urethral catheterization:
A) the diameter of the urethra at the external urethral orifice is narrower than at any other point.
B) the urethra is least protected (most likely to rupture) at the bulb.
C) the intermediate (membranous) segment is the most distensible part of the urethra.
D) the location of the ducts of the bulbourethral glands must be identified in order to avoid injuring the glands.
E) the patient is likely to feel the most discomfort (sharpest pain) when the catheter penetrates the prostatic urethra.
Ans: A



48. The blood that results in penile erection is primarily derived from the:
A) posterior scrotal arteries.
B) deep arteries of the penis.
C) deep branches of the external pudendal arteries.
D) deep dorsal vein.
E) superficial dorsal veins.
Ans: B



49. Circumcision involves:
A) removal of the glans of the penis.
B) removal of the prepuce of the penis.
C) removal of the corona of the glans of the penis.
D) enlarging the external urethral orifice.
E) surgically constructing a new external urethral orifice.
Ans: B



50. Which of the following is not associated with male erection or ejaculation?
A) closure of the vesical (internal urethral) sphincter.
B) contraction of urethral smooth musculature.
C) contraction of bulbospongiosus.
D) parasympathetic impulses reaching the penis from the prostatic nervous plexus.
E) contraction of the smooth muscle of the helical arteries.
Ans: E



51. Which of the following is incorrect pertaining to the female perineum?
A) The greater vestibular glands are typically palpable.
B) The bulbs of the vestibule are composed of erectile tissue.
C) Located immediately within the vaginal orifice, the hymen is a thin fold of mucous membrane that ruptures in young women with physical activity or sexual intercourse.
D) The vestibule is the space enclosed by the labia minora.
E) The mons pubis is composed of skin covering fatty tissue.
Ans: A