Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 38
Anatomy

38–1. Because of dermal fiber orientation, termed Langer lines, all EXCEPT which type of anterior abdominal wall incision leads to superior cosmetic results?

a. Cherney

b. Maylard

c. Pfannenstiel

d. Midline vertical

38–2. Camper and Scarpa fasciae of the anterior abdominal wall are not discrete layers but represent a continuum of the subcutaneous tissue layer. Which of the following best describes Camper fascia?

a. Deeper, more membranous

b. Deeper, predominantly fatty

c. Superficial, more membranous

d. Superficial, predominantly fatty

38–3. Below the arcuate line, the anterior rectus sheath represents the conjoined aponeuroses of which of the following muscles?

a. External and internal oblique

b. Rectus abdominis and external oblique

c. Transversus abdominis and pyramidalis

d. External and internal oblique plus the transversus abdominis

38–4. The fascia best recognized as the layer bluntly or sharply dissected off the anterior surface of the bladder during entry into the abdominal cavity is which of the following?

a. Camper

b. Arcuate

c. Superficial

d. Transversalis

38–5. The peritoneum that lines the inner surface of the abdominal walls is termed which of the following?

a. Rectus

b. Parietal

c. Transversalis

d. None of the above

38–6. Laceration of abdominal wall vessels can increase blood loss and risk of postoperative hematoma formation. The superficial epigastric, superficial circumflex iliac, and superficial external pudendal arteries all arise from which of the following?

a. Femoral artery

b. External iliac artery

c. Deep circumflex artery

d. Internal thoracic artery

38–7. The superficial epigastric vessels course diagonally toward the umbilicus and can be identified between which of the following structures?

a. Rectus fascia and skin

b. Peritoneum and Scarpa fascia

c. Transversalis and rectus fasciae

d. Internal and external oblique muscles

38–8. Damage to the ilioinguinal nerve during abdominal entry may cause loss of sensory function to the skin over which of the following?

a. Lower abdominal wall

b. Medial portion of the thigh

c. Upper portion of the labia majora

d. All of the above

38–9. The bony pelvis is comprised of the coccyx, the sacrum, and the two hip bones termed innominate bones. The innominate bones consist of all EXCEPT which of the following?

a. Ilium

b. Pubis

c. Ischium

d. Sacrotuberous

38–10. The U-shaped opening in the pelvic floor muscles through which the urethra, vagina, and rectum pass is termed which of the following?

a. Levator plate

b. Obturator canal

c. Urogenital hiatus

d. Greater sciatic foramen

38–11. The muscles colored yellow, green, and blue in the following figure indicate components of which of the following?

Image

Image contributed by Ms. Marie Sena, CMI.

a. Perineal body

b. Levator ani muscle

c. Iliococcygeal raphe

d. None of the above

38–12. The levator ani muscle in the pelvic floor represents a critical component of pelvic organ support. The levator ani muscle is a complex unit that consists of all EXCEPT which of the following muscle components?

a. Puborectalis

b. Pubococcygeus

c. Iliococcygeus

d. Ischiocavernosus

38–13. The medial and inferior fibers of the levator ani muscle that arise on either side from the pubic bone and form a U-shaped muscle sling behind the anorectal junction may contribute to maintenance of fecal continence. This describes which of the following muscles?

a. Puboanalis

b. Puborectalis

c. Pubovaginalis

d. Puboperinealis

38–14. As shown by the red bracket in this figure, the clinical term used to describe the region between the anus and coccyx, formed primarily by the insertion of the iliococcygeus muscles, is which of the following?

Image

Reproduced, with permission, from Corton MM: Anatomy. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 38-7.

a. Levator ani

b. Levator plate

c. Levator raphe

d. Levator ligament

38–15. Which of the following approximate uterine measurements characterize the adult, nonpregnant woman?

a. 7 cm length, 5 cm width at fundus

b. 10 cm length, 5 cm width at fundus

c. 10 cm length, 10 cm width at fundus

d. 7 cm length, 10 cm width at fundus

38–16. The uterine cervix begins caudal to the uterine isthmus, consists primarily of fibrous tissue, and is approximately how many centimeters in length?

a. 1

b. 3

c. 5

d. 7

38–17. The lower border of the endocervical canal contains a transition from columnar epithelium of the cervical canal to squamous epithelium of the portio vaginalis and is termed which of the following?

a. Endocervical os

b. Squamoendocervix

c. Portio supravaginalis

d. Squamocolumnar junction

38–18. The main support of the uterus and cervix is provided by the interaction between the levator ani muscles and the connective tissue that attaches the walls of the cervix to the pelvic walls. The connective tissue that attaches lateral to the uterus is called the parametria and consists of what is known clinically as which of the following?

a. Cardinal ligament

b. Uterosacral ligament

c. Transverse cervical ligaments

d. All of the above

Image

Reproduced, with permission, from Cunningham FG, Leveno KL, Bloom SL et al (eds): Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 2-8.

38–19. The broad ligaments are double layers of peritoneum that extend from the lateral walls of the uterus to the pelvic walls. Within the upper portion of these two layers lie which of the following?

a. Fallopian tubes

b. Round ligaments

c. Utero-ovarian ligaments

d. All of the above

38–20. In the image below, superior to the broad ligament, the double layer of peritoneum that drapes over the round ligament is termed which of the following?

a. Mesoteres

b. Mesovarium

c. Mesosalpinx

d. Mesosuspensus

38–21. The blood supply to the uterine corpus generally arises from which of the following two arteries?

a. Renal and ovarian

b. Renal and uterine

c. Uterine and ovarian

d. External iliac and vaginal

38–22. The uterine artery approaches the uterus in the area of transition between the corpus and the cervix known as the uterine isthmus. In this area, the uterine artery courses over which of the following important structures?

a. Ureter

b. Round ligament

c. Fallopian tube

d. None of the above

38–23. Which of the following is true regarding the ovarian vessels?

a. Both arteries arise from the aorta.

b. Both veins drain into the vena cava.

c. Right and left ovarian arteries arise from the right renal artery and aorta, respectively.

d. Right and left ovarian veins drain into the right renal vein and vena cava, respectively.

38–24. The fallopian tube is a tubular structure that measures 7 to 12 cm in length and has four identifiable portions. In this figure, the arrow is pointing to which portion?

Image

Reproduced, with permission, from Cunningham FG, Leveno KL, Bloom SL et al (eds): Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 2-15.

a. Fimbria

b. Ampulla

c. Isthmus

d. Interstitium

38–25. The walls of the vagina consist of three layers. Adjacent to the lumen, the first layer consists of which of the following?

a. Smooth muscle

b. Collagen and elastin

c. Nonkeratinized squamous epithelium overlying a lamina propria

d. None of the above

38–26. During the procedure shown here, which of the following vessels may commonly be lacerated?

Image

Reproduced, with permission, from Schaffer JI, Hoffman BL: Surgeries for female pelvic reconstruction. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 42-2.2.

a. Obturator vessels

b. External iliac vessels

c. Santorini venous plexus

d. Deep circumflex iliac vein

38–27. The prepuce is the anterior fold that overlies the glans of the clitoris, and the frenulum is the fold that passes below the clitoris. These two folds comprise the apex of which of the following?

a. Mons pubis

b. Labia minora

c. Labia majora

d. Posterior fourchette

38–28. The pubic symphysis anteriorly, ischiopubic rami and ischial tuberosities anterolaterally, coccyx posteriorly, and sacrotuberous ligaments posterolaterally provide the boundaries for which of the following?

a. Perineum

b. Ischiorectal fossa

c. Posterior anal triangle

d. Anterior urogenital triangle

38–29. Measuring approximately 2 to 4 cm anterior-to-posterior as well as superior-to-inferior, this mass of fibromuscular tissue found between the distal part of the posterior vaginal wall and the anus is termed which of the following?

a. Perineal body

b. Posterior fourchette

c. Bulbocavernosus muscle

d. External anal sphincter

38–30. The vessels that drain vulvar and perineal structures, with the exception of the erectile tissue of the clitoris, drain into which of the following veins?

a. Middle sacral

b. Superior rectal

c. Internal pudendal

d. Superficial epigastric

Chapter 38 ANSWER KEY

Image