-
Question 1
Incorrect
-
If the presenting part of the foetus is the large fontanel, this presentation is known as?
Your Answer: Vertex
Correct Answer: Sinciput
Explanation:Sinciput means the head is neither flexed nor extended. It is the area between forehead and crown and in this case the anterior fontanel is the presenting part.
-
This question is part of the following fields:
- Anatomy
-
-
Question 2
Incorrect
-
All of the following are features of the female bony pelvis, except?
Your Answer: Has an obtuse greater sciatic notch
Correct Answer: It is funnel shaped
Explanation:The female bony pelvis is larger, broader and more of a funnel shape. The inlet is larger and oval in shape and the sides of the female pelvis are wider apart.
-
This question is part of the following fields:
- Anatomy
-
-
Question 3
Incorrect
-
Which one of the following measurements is usually taken during clinical exam of the pelvis?
Your Answer: Bi-ischial diameter
Correct Answer: Shape of the pubic arch
Explanation:During pelvimetry, the shape of the pubic arch is usually examined. It helps in determining the outcome of the type of fetal delivery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 4
Correct
-
Which of the following leaves the pelvis via the greater sciatic foramen?
Your Answer: Pudendal Nerve
Explanation:The pudendal nerve arises from the S2-S4 nerve roots and it lies medial to the internal pudendal artery while exiting the pelvis via the greater sciatic foramen. It curves around the sacrospinous ligament and re-enters the pelvis via the lesser sciatic foramen and from there it runs medial to the ischial tuberosity over the obturator internus in the pudendal canal to the deep perineal pouch.
-
This question is part of the following fields:
- Anatomy
-
-
Question 5
Correct
-
The arterial blood supply to the bladder is via branches of which artery?
Your Answer: Internal Iliac
Explanation:The bladder is supplied by branches of the internal iliac artery, including the superior vesical artery, branches of the gluteal and obturator arteries and the inferior vesical artery in males and the vaginal and the uterine arteries in females.
-
This question is part of the following fields:
- Anatomy
-
-
Question 6
Correct
-
The superficial inguinal ring is an aperture in which structure?
Your Answer: Aponeurosis external oblique
Explanation:The superficial ring is the exit to the inguinal canal. It is a triangular aperture in the aponeurosis of external oblique. The conjoint tendon reinforces the ring posteriorly
-
This question is part of the following fields:
- Anatomy
-
-
Question 7
Incorrect
-
Which spinal segment is the lumbar plexus derived from?
Your Answer: T10-L5
Correct Answer: T12-L4
Explanation:The lumbar plexus is formed via contributions from the T12-L4 spinal cord segment. The plexus is responsible for the motor and sensory innervation of portions of the lower extremities and some parts of the lower abdomen and pelvis. Nerves arising from the plexus include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral nerve, obturator, and nerve to the lumbosacral trunk.
-
This question is part of the following fields:
- Anatomy
-
-
Question 8
Correct
-
The rectus sheath is formed by which of the following?
Your Answer: aponeuroses of transversus abdominis, external and internal oblique
Explanation:The rectus sheath is formed by the decussation and interweaving of the aponeuroses of the fl at abdominal muscles. The external oblique aponeurosis contributes to the anterior wall of the sheath throughout its length. The superior two thirds of the internal oblique aponeurosis splits into two layers (laminae) at the lateral border of the rectus abdominis; one lamina passing anterior to the muscle and the other passing posterior to it. The anterior lamina joins the aponeurosis of the external oblique to form the anterior layer of the rectus sheath. The posterior lamina joins the aponeurosis of the transversus abdominis to form the posterior layer of the rectus sheath.
-
This question is part of the following fields:
- Anatomy
-
-
Question 9
Correct
-
Question 10
Incorrect
-
The ureters receive autonomic supply from which spinal segments?
Your Answer: T10-12
Correct Answer: T11-L2
Explanation:The ureters receive innervation by a number of nerve plexuses. The nerves supplying the ureters originate from spinal segments T11 to L2. When you think about ureteric colic giving classic ‘loin to groin’ pain it is because the pain is referred to these dermatomes.
-
This question is part of the following fields:
- Anatomy
-
-
Question 11
Correct
-
A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness of the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Ilioinguinal
Explanation:The anterior aspect of the vulva (mons pubis, anterior labia) is supplied by derivatives of the lumbar plexus: the anterior labial nerves, derived from the
ilio-inguinal nerve, and the genital branch of the genitofemoral nerve.
The posterior aspect of the vulva is supplied by derivatives of the sacral plexus: the perineal branch of the posterior cutaneous nerve of the thigh laterally, and the pudendal nerve centrally. -
This question is part of the following fields:
- Anatomy
-
-
Question 12
Correct
-
In which one of the following positions does hyperextension of the fetal head occur?
Your Answer: Face presentation
Explanation:Face presentation is the abnormal position of the fetal head in labour. In this position the neck is hyperextended.
Vertex position is the normal presentation of the foetus for delivery, in which the head is flexed and the position of the chin is towards the chest. -
This question is part of the following fields:
- Anatomy
-
-
Question 13
Correct
-
What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spine is the anatomical landmark for assessing the station of the fetal head and also placing pudendal nerve blocks. (the pudendal nerve runs posterior to the ischial spine). The ischial spine can be palpated approximately 8cm into the vagina, at 4 and 8 o’clock.
-
This question is part of the following fields:
- Anatomy
-
-
Question 14
Correct
-
Question 15
Correct
-
Pelvic ligaments can change at term resulting in?
Your Answer: Enlargement of the pelvic cavity
Explanation:The pelvis is supported by a variety of ligaments. At term, these ligaments allow for variation in its structure such that the overall size of the pelvic cavity is increased in order to accommodate the upcoming foetus into the cavity.
-
This question is part of the following fields:
- Anatomy
-
-
Question 16
Correct
-
Regarding the pelvic outlet, what structure marks the posterior boundary?
Your Answer: Tip of the coccyx
Explanation:The bony pelvis is made up of a girdle with a central canal. The rim that surrounds the upper opening of the canal is called the pelvic inlet, while the lower rim is the called the pelvic outlet. The pelvic outlet is diamond-shaped and is bounded posteriorly by the tip of the sacrum, and anteriorly by the pubic symphysis, with its lateral boundaries being the ischial tuberosities and the sacrotuberous ligament.
-
This question is part of the following fields:
- Anatomy
-
-
Question 17
Incorrect
-
The inguinal canal is reinforced anterolaterally by which structure?
Your Answer: Aponeurosis external oblique
Correct Answer: Internal oblique
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal ligament is part of the floor.
The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part -
This question is part of the following fields:
- Anatomy
-
-
Question 18
Correct
-
The joint between the two pubic bones is called the:
Your Answer: Pubis symphysis
Explanation:The pubic symphysis or symphysis pubis is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to it.
-
This question is part of the following fields:
- Anatomy
-
-
Question 19
Correct
-
A patient attends clinic with a vaginal prolapse. On examination the vaginal prolapse is visible 1.5cm above the plane of the hymen. According to the POPQ classification what grade is this prolapse?
Your Answer: Grade 1
Explanation:This is a grade 1 prolapse
-
This question is part of the following fields:
- Anatomy
-
-
Question 20
Correct
-
The typical female breast contains how many lobes?
Your Answer: 15-20
Explanation:The female breast is made of about 15 to 20 individual lobes. The lobules each consists of alveoli which drain into a single lactiferous duct. The ductal system leads to lactiferous sinuses and collecting ducts which expel milk from openings in the nipple.
-
This question is part of the following fields:
- Anatomy
-
-
Question 21
Correct
-
The femoral triangle is bounded medially by which of the following structures?
Your Answer: Adductor longus
Explanation:The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.
-
This question is part of the following fields:
- Anatomy
-
-
Question 22
Correct
-
Regarding the foetus, which one of the following statements is true?
Your Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother
Explanation:Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure. -
This question is part of the following fields:
- Anatomy
-
-
Question 23
Correct
-
Regarding the structure of the detrusor muscle. Which of the following is true?
Your Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer
Explanation:The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.
-
This question is part of the following fields:
- Anatomy
-
-
Question 24
Correct
-
You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends through the vaginal mucosa into the perineal muscle and fascia. The external anal sphincter appears to be in tact. How would you classify this tear?
Your Answer: 2nd
Explanation:If the external anal sphincter is in tact then this is a 1st or 2nd degree tear. As the perineal muscles are involved this is 2nd degree tear.
-
This question is part of the following fields:
- Anatomy
-
-
Question 25
Correct
-
Regarding the rectus sheath which of the following statements are true?
Your Answer: Above the arcuate line the internal oblique divides into two lamellae
Explanation:The rectus sheath is formed by the aponeurosis of the internal and external oblique muscles and the transversus abdominus muscle. The internal oblique divides into two lamellae and encloses the rectus muscle. Anteriorly it fuses with the aponeurosis of the external oblique and posteriorly with that of the transverus abdominus. Below the arcuate line the aponeurosis of all the flat muscles lies anteriorly and posteriorly it is only enclosed by the transveralis fascia.
-
This question is part of the following fields:
- Anatomy
-
-
Question 26
Correct
-
During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer: 150ml
Explanation:Micturition is defined as a process of expelling urine from the body. It is caused by the reflex contraction of detrusor muscle. Urinary bladder is a hollow muscular organ which can store 400-600ml of urine until it is expelled from the body. The first urge to urinate is felt when the bladder is filled with around 150ml of urine. The reflex action is initiated when the stretch receptors located in the bladder wall are stimulated. The afferent fibres pass to the pelvic splanchnic nerves to the 2nd, 3rd, and 4th sacral segments and some pass through the hypogastric plexus to the first and second lumbar segments of the spinal cord. Efferent pathways from the 2nd, 3rd, and 4th sacral segments leave the cords and through the splanchnic nerves and inferior hypogastric plexus supplies the smooth muscle of the bladder i.e. detrusor muscle. Detrusor muscle contracts and the sphincters are relaxed.
-
This question is part of the following fields:
- Anatomy
-
-
Question 27
Correct
-
The inguinal canal is reinforced posteriorly by which structure?
Your Answer: Conjoint tendon
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal and lacunar ligaments are part of the floor The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part
-
This question is part of the following fields:
- Anatomy
-
-
Question 28
Incorrect
-
Which of the following is contained within the deep perineal pouch?
Your Answer: Ischiocavernosus muscle
Correct Answer: Proximal portion of urethra
Explanation:The deep perineal pouch contains the external urethral sphincter, proximal urethra in females and membranous urethra in males, deep transverse perineal muscles and the glands of cowper.
-
This question is part of the following fields:
- Anatomy
-
-
Question 29
Correct
-
Regarding the round ligament, it leaves the pelvis via which structure?
Your Answer: Deep inguinal ring
Explanation:The round ligament is a band of fibromuscular connective tissue attached to the cornua of the uterus, near the attachment of the ovaries. On each side of the body, the ligament exits the pelvis through the deep inguinal ring, travels through the inguinal canal and enters the labia majora where its fibres terminate at the mons pubis. It is also important to know the embryological origins of the round ligament from the gubernaculum.
-
This question is part of the following fields:
- Anatomy
-
-
Question 30
Correct
-
After a vaginal delivery, a patient suffers a perineal tear. On examination the laceration involves the external anal sphincter and has partially torn the internal anal sphincter. Which of the following classifies this tear?
Your Answer: 3c
Explanation:During childbearing the vagina and perineum are prone to lacerations that may involve the skin or can extend into the anal sphincter complex. It is important to be able to identify obstetric and anal sphincter injuries to provide adequate care and prevent complications. In the classification of obstetric tears according to RCOG guidelines:
First degree tear: injury to the perineal skin and/or the vaginal mucosa
Second degree tears: Injury to perineum involving perineal muscles but not the anal sphincter.
Third-degree tear: Injury to perineum involving the anal sphincter complex:
Grade 3a tear: Less than 50% of external anal sphincter (EAS) thickness torn.
Grade 3b tear: More than 50% of EAS thickness torn.
Grade 3c tear: Both EAS and internal anal sphincter (IAS) torn.
Fourth-degree tear: Injury to perineum involving the anal sphincter complex (EAS and IAS)
and anorectal mucosa. -
This question is part of the following fields:
- Anatomy
-
-
Question 31
Incorrect
-
Sertoli cells contain receptors to which hormone?
Your Answer: LH
Correct Answer: FSH
Explanation:Sertoli cells contain receptors for FSH. In response to this Sertoli cells synthesize inhibin, androgen binding proteins and anti Mullerian hormone all which are connected to the reproduction cycle.
-
This question is part of the following fields:
- Anatomy
-
-
Question 32
Correct
-
What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spines and palpable through the vagina and are used as landmarks to assess the decent of the fetal head from the cervix. It also serves as a landmark for giving the pudendal block.
-
This question is part of the following fields:
- Anatomy
-
-
Question 33
Incorrect
-
A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness and groin pain. You assess her and find the numb area is the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Perineal
Correct Answer: Ilioinguinal
Explanation:This describes the sensory area supplied by the ilioinguinal nerve. This is a potential complication with pelvic surgery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 34
Incorrect
-
The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer: Ischium
Correct Answer: Ilium
Explanation:The arcuate line is a smooth rounded border on the internal surface of the ilium just inferior to the iliac fossa. It forms the boundary of the pelvic inlet.
-
This question is part of the following fields:
- Anatomy
-
-
Question 35
Correct
-
Regarding molding of the fetal head, which one is true?
Your Answer: Does NOT have time to occur in breech delivery
Explanation:Molding allows the skull bones of the fetal head some mobility during the normal delivery of foetus as the skull changes its shape to accommodate passage through the mothers pelvis. However this does not occur in breach delivery where the skull is in circular shape. Babies born breech typically have craniofacial and limb deformations resulting from their in utero position. These babies characteristically have a long, narrow head, (“dolichocephaly” or “type 1”), with a prominent occipital shelf, redundant skin over the neck, overlapping lambdoidal sutures, and an indentation below their ears (from shoulder compression).
-
This question is part of the following fields:
- Anatomy
-
-
Question 36
Correct
-
A patient undergoes oophorectomy and the ovarian veins are ligated. Which vein does the left ovary drain into?
Your Answer: Left renal
Explanation:The right ovarian vein ascends and enters the inferior vena cava and the left ovarian vein drains into the longer left renal vein.
-
This question is part of the following fields:
- Anatomy
-
-
Question 37
Incorrect
-
You have been asked to perform a pudendal nerve block on a patient by your consultant. The pudendal nerve is formed from which spinal segments?
Your Answer: S3,S4 and S5
Correct Answer: S2,S3 and S4
Explanation:The pudendal nerve has its origins form S2, S3 and S4 spinal segments. It provides sensation to the clitoris and labia along with the ilioinguinal nerve.
-
This question is part of the following fields:
- Anatomy
-
-
Question 38
Correct
-
The ovarian artery is a branch of the:
Your Answer: Aorta
Explanation:The ovarian artery is an artery that supplies oxygenated blood to the ovary in females. It arises from the abdominal aorta below the renal artery. It can be found in the suspensory ligament of the ovary, anterior to the ovarian vein and ureter.
-
This question is part of the following fields:
- Anatomy
-
-
Question 39
Correct
-
From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
-
This question is part of the following fields:
- Anatomy
-
-
Question 40
Incorrect
-
Which cell type of the testis secrete inhibin?
Your Answer: Leydig cells
Correct Answer: Sertoli cells
Explanation:Summary points of the two key testicular cell types:
1. Sertoli Cells = Secrete Inhibin. Forms blood-testis barrier. Have FSH receptors
2. Leydig Cells = Secrete testosterone. Have LH receptors -
This question is part of the following fields:
- Anatomy
-
-
Question 41
Correct
-
The roof of the femoral triangle is formed by which structure?
Your Answer: Fascia lata
Explanation:Boundaries of the Femoral Triangle: Superior: Inguinal ligament Medial: Medial border of the adductor longus Lateral: Medial border of the sartorius Floor: Pectineus, Adductor longus and Iliopsoas muscles Roof: Fascia Lata (cribriform fascia at the saphenous opening) Trasversalis fascia forms part of the roof of the inguinal canal
-
This question is part of the following fields:
- Anatomy
-
-
Question 42
Correct
-
If your patient is 8 weeks pregnant which one of the following USS measurements is most useful?
Your Answer: Crown rump length
Explanation:Fetal crown-rump length (CRL) is recommended over last menstrual period for estimating GA when measured in early pregnancy i.e. before 9 to 13+6 weeks.
-
This question is part of the following fields:
- Anatomy
-
-
Question 43
Incorrect
-
Which of the following takes part in the arterial supply of the ovary?
Your Answer: None of the above
Correct Answer: Uterine arteries
Explanation:The ovarian arteries, arising from the abdominal aorta and the ascending uterine arteries which are branches of the internal iliac artery all supply the ovaries. They terminate by bifurcating into the ovarian and tubal branches and anastomose with the contralateral branches providing a collateral circulation.
-
This question is part of the following fields:
- Anatomy
-
-
Question 44
Incorrect
-
The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer: Ischium
Correct Answer: Ilium
Explanation:Arcuate means ‘bow shaped’ and there are different arcuate lines in anatomical terms. Regarding the pelvic brim this is composed of the arcuate line of the ilium, pectineal line and prominences of sacrum and pubic symphysis (as demonstrated in the images below). As can be seen the arcuate line is a smooth rounded border on the internal surface of the ilium inferior to the iliac fossa and Iliacus. Image sourced from Wikipedia Note: The pelvic outlet is also called the inferior aperture. The pelvic brim is the superior aperture
-
This question is part of the following fields:
- Anatomy
-
-
Question 45
Correct
-
Which of the following arteries branches directly from the aorta?
Your Answer: Ovarian
Explanation:The ovarian artery takes its origin directly from the aorta. While the uterine and the vaginal arteries are all branches of the internal iliac artery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 46
Correct
-
What is the inferior border of the deep perineal pouch?
Your Answer: Perineal membrane
Explanation:The perineal membrane (also known as the inferior fascia of the urogenital diaphragm) separates the deep and superficial perineal pouches i.e. it is the inferior border of the deep pouch and superior border of the superficial pouch. The deep perineal pouch is the space therefore between superior and inferior layers of the urogenital diaphragm The superior fascia of the urogenital diaphragm is the superior border
-
This question is part of the following fields:
- Anatomy
-
-
Question 47
Correct
-
Regarding the uterine artery which of the following statements are FALSE?
Your Answer: It crosses the Ureter posteriorly
Explanation:The Uterine artery typically arises from the anterior branch of the internal iliac artery. It crosses the ureter ANTERIORLY. It is the primary source of arterial supply to the uterus and its branches anastomose with branches of the ovarian and vaginal arteries.
-
This question is part of the following fields:
- Anatomy
-
-
Question 48
Correct
-
Which two nerves provide the primary cutaneous sensory innervation to the labia majora?
Your Answer: Ilioinguinal and pudendal
Explanation:The Pudendal provides cutaneous innervation to the posterior external genitalia via one of its terminal branches called the perineal nerve (this further branches into the posterior labial nerves or posterior scrotal nerve in men). The ilioinguinal nerve provides anterior sensation via the anterior labial nerves (anterior scrotal nerve in men). The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora in females. The posterior cutaneous nerve of thigh sometimes overlaps sensory areas.
-
This question is part of the following fields:
- Anatomy
-
-
Question 49
Correct
-
Which nerves innervate the internal anal sphincter?
Your Answer: Pelvic Splanchnic
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle or involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
-
This question is part of the following fields:
- Anatomy
-
-
Question 50
Correct
SESSION STATS - PERFORMANCE PER SPECIALTY
