B5 Death to Anatomy PQs

BRS Anat, BRS Embryo, 27', 28'

TruLearn: A researcher identified a group of modified neuroendocrine cells within the adrenal gland that are derived from neural crest cells. These cells most likely produce…?

• Aldosterone

• Androstenedione 

• Cortisol 

• Epinephrine 

• Estrogen

• Epinephrine 

TruLearn: A researcher identified a group of modified neuroendocrine cells within the adrenal gland that are derived from neural crest cells. These cells most likely produce…?

• Epinephrine 

Regarding the previous question, from which of the following does the chromaffin cells receive input from?

• Pelvic splanchnic n. 

• L vagal trunk

• Greater splanchnic n. and Lesser splanchnic n.

• Post-synaptic sympathetic fibers 

• Phrenic n. 

• Greater splanchnic n. and Lesser splanchnic n.

A surgeon is performing an adrenalectomy and is looking to clamp the origin to the superior suprarenal a. Which artery was clamped?

• Abdominal aorta 

• Inferior phrenic a. 

• Renal a. 

• L renal v. 

• Inferior esophageal a.

• Inferior phrenic a. 

TruLearn: A 32 y/o male presents w/ flank pain. Urinalysis reveals RBCs. PE reveals tenderness to the R lumbar paraspinal musculature and flexion posturing of the R hip. Which of the following muscles is most useful for localizing the source of the current symptoms?

• Iliacus 

• Psoas major 

• Psoas minor 

• Quadratus lumborum 

• Rectus abdominis 

• Psoas major 

A 42 y/o female presents w/ flank pain, blood in urine, nausea, and vomiting. She claims she recently started a strict diet and lost 50 lbs in the past 3 months. Abdominal CT revealed a descended L kidney by 2 spinal levels with coiling of the ureter at the renal hilum. Which of the following is a contributing factor to this patients presentation?

• Renal fascia rupture

• Inferior opening of the perirenal space 

• Inferior opening of the pararenal space 

• Paranephric fat swelling/edema 

• Interstitial fluid accumulation within the renal sinus

• Inferior opening of the perirenal space 

TruLearn: A 16 y/o female presents to the ED w/ 1-week hx of burning w/ urination and increased urinary frequency and urgency. PE reveals tender costovertebral angles. Abdominal CT reveals a horseshoe kidney. Which of the following structure limited the embryologic migration of the kidney in this patient?

• Common iliac a. 

• Inferior mesenteric a. 

• Splenic v. 

• Superior mesenteric a. 

• L renal v.

• Inferior mesenteric a. 

A 12 year old male presents to the ED w/ acute onset abdominal pain w/ associated blood in urine, nausea, and vomiting. He also complains of testicular pain. CTA revealed a varicocele. Given the most probable diagnosis, which of the following is true?

• Abdominal aortic stenosis results in hypoperfusion of the L testicular a. 

• Entrapment of the R renal v. results in kidney ischemia 

• Traction of the SMA induces torsional forces on the kidneys 

• L renal v compression by SMA reduces drainage of the kidney

• Varicocele is caused by emboli, most likely from undiagnosed Afib

• L renal v compression by SMA reduces drainage of the kidney

A 47 y/o male presents to the ED w/ flank pain for 2 days w/ blood in his urine and new onset nausea and vomiting. PE revealed positive CVA tenderness with no abdominal guarding. An abdominal xray was taken as shown. Where is this man’s kidney stone located?

• Ureteropelvic junction 

• Crossing of the iliac vessels

• Uterovesical junction 

• Renal pelvis 

• Ureterosplanchnic line

• Ureteropelvic junction 

A 58 year old women w/ PMHx of ovarian cancer w/ subsequent bilateral oophorectomy 4 days ago presents to the ED w/ symptoms of abdominal pain, fever, and hematuria. Differential diagnosis includes iatrogenic injury of the ureter during her operation. Which structure was most likely being operated on when her injury occurred? 

• Ovarian a. 

• Uterine a. 

• Ductus deferens 

• Round ligament of the uterus 

• Fallopian tubes

• Ovarian a. 

A 34 year old male presents after an MVC where he received a full workup. Incidentally, it was noted on abdominal CT that he has a duplicated ureter. Which of the following is a potential complication of the inferior ureter? 

• Obstruction

• Infection 

• Cystic dilation 

• Rupture 

• Reflux

• Reflux

A developing fetus w/ reduced levels of retinoic acid may have agenesis of which of the following structures?

• Urogenital ridge 

• Nephrogenic cord 

• Pronephros 

• Mesonephros 

• Metanephros

• Metanephros

TruLearn: 41 y/o females undergoes a uncomplicated hysterectomy and bilateral salpingo-oophorectomy. The sx was complicated by adhesions from prior appendectomy. She complains of post operative flank pain and, lateral, abdominal distention. Abdominal US reveals free fluid in the pelvis. The structure most likely injured during sx directly originates from which of the following systems?

• First brachial arch 

• Mesonephros 

• Metanephros 

• Pronephros 

• Third brachial pound

• Metanephros 

Which of the following is the origin of the nephrogenic vesicles?

• Ureteric bud 

• Mesonephros

• Aorta 

• Metanephric blastema 

• Collecting ducts

• Metanephric blastema 

TruLearn: A researcher find that early exposure of mice embryos to Compound A results in bilateral renal agenesis, and that those w/ agenesis show normal structures that develop from the ureteric bud but lack the other renal structures. These embryos most likely have absent…?

• Collecting ducts 

• Distal convoluted tubules 

• Minor calyces 

• Renal pelvis 

• Ureters

• Distal convoluted tubules 

Embryologic origin of Distal convoluted tubules?

Metanephric blastema

Which of the following structures of the bladder is continuous w/ with the allantois 

• Prostatic urethra 

• Vesical part 

• Phallic part 

• Vestibule 

• Pelvic part

• Vesical part 

In females, this structure will develop into labia minora while in males, it fuses together.

• What is, pelvic portion of the bladder 

• What is, urachus 

• What is, allantois 

• What is, genital tubercle

• What is, urethral folds

• What is, urethral folds

In the development of male vs female genitourinary tract, which of the following is true?

• The phallic portion of the bladder become the vestibule in both males and females 

• In males, the urachus obliterates while in females it becomes the tunica vaginalis 

• The pelvic portion of the bladder become only the prostatic urethra in males but the entire urethra in females 

• Males and females have a spongy component of the urethra, but are histologically unique between males and females

• The pelvic portion of the bladder become only the prostatic urethra in males but the entire urethra in females 

Around what time does androgen production begin?

• Week 8 

• Week 30

• Month 2

• Month 12 

• Year 3

• Year 3

A 22 year old male was found dead in his home. Autopsy reports drug overdose with incidental discovery of multiple fluid filled sacs within both kidneys, resulting in a granular surface that is not architecturally abnormal. Which of the following statements is true?

• His disease was inherited in an autosomal dominant fashion 

• His diseases is not progressive 

• His condition is a result of nephrogenic developmental failure 

• His disease is a result of PKHD1 mutation 

• Abnormal protein folding of polycystin-1 resulted in his pathology

• His disease is a result of PKHD1 mutation 

A 26 year old male presents to UC w/ complaints of lower back pain. He states it started after lifting weights at the gym but now the pain is keeping him awake at night. PE showed diffuse tenderness along the paraspinal muscles. He states inhaling deeply exacerbates the pain, as well as worsens along his right flank when he hikes up his right hip. Given the most probable muscle strained, which of the follow structures lies directly anterior?

• Endoabdominal fascia 

• Anterior layer of thoracolumbar fascia 

• Psoas Fascia 

• Erector spinae m. 

• Medial arcuate ligament

• Anterior layer of thoracolumbar fascia 

A 46 year old female w/ PMHx of GERD is following up with her PCP regarding a hiatal hernia. Which of the following structures contains this patients hernia?  

• Left crus of the diaphragm 

• Central tendon of the diaphragm 

• Inguinal canal 

• Right crus of the diaphragm 

• Median arcuate ligament of the diaphragm

• Right crus of the diaphragm 

What is housed in Right crus of the diaphragm?

esophageal hiatus

A 49 year old male w/ PMHx of Crohn’s presents to UC w/ complaints of flank pain for the past 4 days. He was noted to have a limp when walking towards the patient room. PE was positive for pain during passive R high flexion and he prefers to sit with his knees pulled towards his chest. Abdomen was benign, no g/r/t. He was noted to have a low grade fever. Abdominal CT is as shown. Given the most probable diagnosis, which of the following is true?

• Ipsilateral flexion would relax the affected structure 

• Phrenic n. carries afferent fibers to the structure 

• L1 to L3 ventral rami are carrying pain stimulus from the affected structure 

• The affected structure is superiorly attached to rib 12 

• The affected structure is inferiorly attached to the greater trochanter

• L1 to L3 ventral rami are carrying pain stimulus from the affected structure 

During anatomy lab, a structure is observed exiting the lateral border of psoas major before providing innervation to the medial upper thigh and some parts of the genital region. Which of the following is the root level of this structure?

• T12 

• L1 

• L2-L3 

• L2-L4

• L4-L5

• L1 

L1 contributes to _____ and ________

iliohypogastric and ilioinguinal

A 27 year old female 30 weeks gravida presents to her OBGYN w/ complaints to new onset numbness to the anterolateral aspect of her upper right thigh. He OB suspect meralgia paresthetica. Which of the following is true regarding this patient?

• The affected nerve emerges from the belly of psoas major m. 

• The affected nerve carries GSA, GSE, and post-symp fiber types 

• The suspected diagnosis only occurs in pregnant women 

• The affected nerve runs deep to the inguinal ligament 

• The affected nerves runs lateral to the ASIS

• The affected nerve runs deep to the inguinal ligament 

What fiber types goes genitofemoral n. carry in males? (more than 1 answer)

GSA, GSE, & Post-ganglionic sympathetic

A runner presents after a muscle strain in her left pelvic area. She states the pain worsens w/ she rotates her thigh externally. The muscle is question runs deep to the sacrotuberous ligament. Which of the following provides innervation to this muscle?

• Ventral rami S1-S2 

• Sciatic n. 

• N. to obturator internus 

• Superior gluteal n. 

• Pudendal n.

• N. to obturator internus 

A female presents to the ED after an MVA and US confirmed intraperitoneal hemorrhage in the space superior to subperitonal organs. Within which of the following spaces is the blood most likely pooling? 

• Rectouterine pouch 

• Rectovesical pouch 

• Lesser pelvis 

• Pelvic inlet 

• Pelvic diaphragm

• Rectouterine pouch 

During a hysterectomy, the surgeon notes the cardinal ligament and recalls ‘24 VCOM anatomy lecture and knows it is a condensation of which structure?

• Membranous pelvic fascia 

• Transversalis fascia 

• Parietal pelvic fascia 

• Endopelvic fascia 

• Visceral pelvic fascia

• Endopelvic fascia 

A female presents after an MVA with fracture of the R sacral ala. Which of the following structures is disrupted?

• Pelvic diaphragm 

• Pelvic outlet 

• Pelvic inlet 

• Perineum 

• Pelvic midplane

• Pelvic inlet 

Dr. Dittmar walks into lab and realizes 2 pelvises were not labeled. Luckily, she remembers that one belongs to a male and the other a female. Which of the following traits would typically identify the pelvis as female?

• Heart shaped inlet 

• Narrow pubic arch 

• Rounded obturator foramen 

• Small pelvic outlet  

• Wider sciatic notch

• Wider sciatic notch

Which of the following structure is seen in both superior and inferior view of the pelvic floor?

• Puborectalis m.

• Sacrococcygeal ligament 

• Deep transverse perineal m. 

• Perineum 

• External anal sphincter

• Puborectalis m.

Which of the following describes the action of the 3 muscles that make up much of the pelvic diaphragm?

• Coccyx flexion 

• Contraction during micturition 

• Contraction during sneezing 

• Relaxation at baseline 

• Flexion of the pelvic

• Contraction during sneezing 

A patient w/ PMHx of Crohn disease presents w/ pain and fullness around the anal region w/ associated fever. Pertinent hx include anal fissures. He is scheduled for an I&D the next morning. Which of the following structures may be compressed by the patient’s abscess?

• Superior rectal n. 

• N. to obturator internus

• Lateral cutaneous femoral n. 

• Perineal n. 

• Sciatic n.

• Perineal n. 

Which of the following structures is formed by labia minora folds and is highly susceptible to injury during delivery?

• Labia majora 

• Prepuce of clitoris 

• Frenulum of the clitoris 

• Copra cavernosa 

• Fourchette

• Fourchette

A 31 year old female presents to her PCP w/ complaints of vaginal swelling and painful sexual intercourse for the past week. PE reveals a tender swelling lateral to the right labia majora. The structure affected is within which of the following spaces?

• Deep perineal pouch 

• Superficial perineal pouch 

• False pelvis 

• Ischioanal recess 

• Pelvic diaphragm

• Superficial perineal pouch 

A 48 year old male presents to the ED after an MVA. FAST exam was positive for fluid surrounding the prostate deep to the pelvic peritoneum. Damage in which of the following structures is the probable etiology of this fluid?

• ASIS

• Membranous urethra 

• Spongy urethra 

• Pelviuretic junction of the ureter 

• Bulb of the penis

• Membranous urethra 

A 67 year old female presents to her PCP w/ genital itching for 3 month. Exam reveals a dark lesion lateral of the labia majora. Biopsy under local anesthetic is planned. Which of the following is the origin of the nerve providing sensory input to this area?

• Posterior femoral cutaneous n. 

• Perineal n. 

• Pudendal n. 

• Ilioinguinal n. 

• Genitofemoral n.

• Posterior femoral cutaneous n. 

Which of the following is the origin of the blood supply to the mons pubis? 

• Internal pudendal a. 

• Dorsal a. of the clitoris 

• External pudendal a. 

• Perineal a. 

• External iliac a.

• Internal pudendal a. 

A 36 year old male presents to his PCP w/ increasing breast size. Which of the following is the most probable etiology?

• Puberty 

• Age 

• Mastitis 

• Weight gain

• Breast cancer

• Weight gain

A 45 year old female presents with complaints of swelling and pain of her left breast for the past week. Exam reveals mastitis on the lower inner quadrant of the left breast. Which of the following structures are likely involved?

• Subclavian nodes 

• Axillary nodes 

• Supraclavicular nerves 

• Terminal branches of internal thoracic aa. 

• Lateral mammary n. branches

• Terminal branches of internal thoracic aa. 

Of the 5 perineal muscles in the male perineum, which one is innervated by the dorsal nerve of the penis and is matched with the correct symptom when it is dysfunctional?

• External urethral sphincter, urinary incontinence

• Superficial transverse perineal m., fecal incontinence

• Bulbospongious m., impotence

• Ischiocavernosus m., impotence

• Deep transverse perineal m., hernia

• External urethral sphincter, urinary incontinence

A 37 year old man is having his testicle removed due to testicular cancer. Once removed, the surgeon remarks that the testice has two distinct coverings. You being a knowledgeable medical student point out that those coverings are in order from superficial to deep:

• External and Internal Spermatic Fascia 

• Tunica Vaginalis and Tunica Albuginea

• Cremasteric Fascia and Internal Spermatic Fascia 

• Dartos Fascia and Cremasteric Fascia 

• Dartos Fascia and Tunica Albuginea

• Tunica Vaginalis and Tunica Albuginea

A high school boy needs to urinate for a drug test to play football. You are assisting the doctor in collecting the sample. You, being a well educated OMS II Block 5 competent medical student, know that the correct flow of urine from the bladder to the glans via the urethra is:

• Prostatic urethra, membranous urethra, intramural urethra, spongy urethra

• Intramural urethra, membranous urethra, prostatic urethra, spongy urethra

• Intramural urethra, spongy urethra, prostatic urethra, membranous urethra

• Membranous urethra, prostatic urethra, spongy urethra, intramural urethra

• Intramural urethra, prostatic urethra, membranous urethra, spongy urethra

• Intramural urethra, prostatic urethra, membranous urethra, spongy urethra

An unfortunate man presents to your office with a right testicular torsion. His twisting of the spermatic cord has compromised his right testicle. What specific structure within the cord will be responsible for the necrosis of the testicle that will ensue if the torsion is not fixed?

• Testicular a.

• Cremaster m.

• Ductus Deferens

• Cremasteric a.

• Genital branch of Genitofemoral n.

• Testicular a.

A 65 year old man arrives in the ER having just been in a car wreck. Emergent surgery is performed in order to fix the pelvic fracture he suffered. During surgery it is noted that damage has been sustained to the pudendal canal. Which of the following structures is not at risk due to damage to the canal?

• Inferior rectal a,

• Dorsal nerve of the penis

• Pudenal n.

• External pudendal a.

• Perineal n.

• External pudendal a.

A 35 year old man presents post catheterization with a complaint of lower abdominal pain and a fullness in his pelvic region. Imaging shows fluid around the bladder and the rectum filling the retropubic space. Paracentesis reveals the fluid to be blood. Which part of the urethra was damaged during the catheterization resulting in the patient presentation?

• Spongy urethra 

• Intramural urethra

• Membranous urethra

• Prostatic urethra

• Left and Right ureter

• Membranous urethra

A 27 year old woman is diagnosed with an ectopic pregnancy. Due to the advanced nature of the embryo, extensive damage has been done to the fallopian tubes. The recommendation is to take out the tube entirely. What part of the broad ligament of the uterus must be taken out along with the tube?

• Mesometrium

• Round ligament of the uterus 

• Mesovarium

• Ovarian ligament 

• Mesosalpinx

• Mesosalpinx

A 27 year old woman is diagnosed with an ectopic pregnancy. Due to the advanced nature of the embryo, extensive damage has been done to the fallopian tubes. The recommendation is to take out the tube entirely. What part of the broad ligament of the uterus must be taken out along with the tube? = Mesosalpinx

Referring to the woman in the previous question, where are ectopic pregnancies most likely to lodge themselves?

• Infundibulum

• Isthmus 

• Uterine 

• Ampulla

• Uterine Ostia

• Ampulla

While performing an oophorectomy (removal of ovary), the surgeon accidentally cuts on of the ligaments of the ovary. Unfortunately, massive bleeding ensues. The surgeon scrambles to control the bleed. Which ligament did the surgeon cut and what vessel in most likely contributing to the profuse bleeding? 

• Ovarian ligament containing the Uterine a.

• Ovarian suspensory ligament containing the Uterine a.

• Mesovarium containing the Ovarian a.

• Ovarian ligament containing the Ovarian a.

• Ovarian suspensory ligament containing the Ovarian a.

• Ovarian suspensory ligament containing the Ovarian a.

A 75 year old woman with cirrhosis and hypoalbuminemia presents with ascites. Her abdomen is distended, and she has gained a considerable amount of water weight. In which part of the woman’s abdominal cavity did fluid first collect?

• Vesicouterine pouch

• Rectovesical pouch

• Rectouterine pouch

• Anterior fornix

• Posterior fornix

• Rectouterine pouch

During a speculum exam, what part of the cervix is made visible using the speculum?

• Vaginal Cervix

• Anterior Fornix

• Supravaginal Cervix

• Posterior Fornix

• Internal Os

• Vaginal Cervix

A 50 year old woman sustain damage to her paracolpium resulting a vaginal wall prolapse. Physical exam reveals the prolapse to be in the anterior wall. What is the correct name and contents of the prolapse?

• Enterocele containing bladder

• Cystocele containing bladder

• Rectocele containing rectum

• Cystocele containing small bowel

• Enterocele containing small bowel

• Cystocele containing bladder

A 29 year old man presents to your clinic with fertility issues. After a battery of tests, it is determined that his infertility is due to a lack of seminal fluid production. The drastic reduction in his seminal fluid is most likely due to dysfunction of what structure(s)?

• Seminal Vesicles

• Prostate Gland

• Bulbourethral Glands

• Seminiferous Tubules 

• Vas Deferens

• Seminal Vesicles

A 65 year old man with known atherosclerotic disease presents lower abdominal pain and issues urinating. CT scan shows marked ischemia and necrosis of the bladder. Thrombosis of which vessel most likely let to this outcome?

• Renal a.

• Aorta

• Common Iliac a.

• Internal Iliac a.

• External Iliac a.

• Internal Iliac a.

What structure of the prostate does the ejaculatgory duct use to deposit semen into the prostatic urethra?

• Urethral Crest

• Vas Deferens

• Seminal Colliculus

• Prostatic Sinus

• Seminal Vesicle

• Seminal Colliculus

A 45 year old man was in a minor car wreck but suffered no major injuries. He presents several weeks later with a copulatory issue. After diagnostic tests and a physical exam, you determine the patient has suffered damage to the part of the pelvic splanchnic nerves that supply the cavernous nerves. What was the man's presenting symptom?

• Trouble ejaculating

• Trouble with erection 

• Trouble producing semen

• Urinating while copulating

• Numbness of the penis

• Trouble with erection 

A man with benign prostatic hypertrophy is undergoing TURP (transurethral resection of the prostate). Which clinical zone of the prostate is most likely responsible for the enlargement and will most likely be resected?

• Peripheral Zone

• Central Zone

• Transitional Zone

• Anterior Zone

• Transitional Zone

Which of the following correctly shows the path of sperm from the testes to the urethra?

• Ductus Deferens, Ampulla of the Ductus Deferens, Epididymis, Ejactulatory Duct, Prostatic Urethra

• Epididymis, Ampulla of the Ductus Deferens, Ductus Deferens, Prostatic Urethra, Ejactulatory Duct

• Ejactulatory Duct, Prostatic Urethra, Ductus Deferens, Ampulla of the Ductus Deferens, Epididymis

• Epididymis, Ductus Deferens, Ampulla of the Ductus Deferens, Ejaculatory Duct, Prostatic Urethra

• Epididymis, Ampulla of the Ductus Deferens, Ductus Deferens, Ejaculatory Duct, Prostatic Urethra

• Epididymis, Ductus Deferens, Ampulla of the Ductus Deferens, Ejaculatory Duct, Prostatic Urethra

A 27 year old women who is at 6 weeks gestation comes in for an ultrasound. The doctor claims that after inspecting the fetus, it is a girl. How can the doctor make this conclusion?

• The lack of elongation of the genital tubercle 

• The failure of the appearance of a scrotum

• The development of embryological breast tissue

• The doctor cannot as the embryo is sexually indifferent

• The orientation of the developing pelvis

• The doctor cannot as the embryo is sexually indifferent

At week 7, the XX embryo begins to feminize with the development of the would be ovaries. How would such an embryo change if it was androgen resistant?

• The embryo would masculinize and develop testes 

• The embryo would become hermaphroditic possessing both male and female genitals

• The embryo would develop internal male genitalia and external female genitalia

• The embryo would develop internal female genitalia and external male genitalia 

• The embryo would still develop ovaries as such development is genetically controlled by the X chromosome

• The embryo would still develop ovaries as such development is genetically controlled by the X chromosome

In the presence of estrogen, the paramesonephric develops in the female embryo. Which of the following structures is not a derivative of this duct?

• Fallopian Tubes

• Epoophoron 

• Uterus

• Cervix

• Superior ⅓ of the vagina

• Epoophoron 

A new born girl is discovered to have an ectopic ovary that is stuck in her abdomen. A failure of what embryological structure would allow the ovary to wander out of its anatomically normal position?

• Cortical Cords

• Germ Cells

• Gubernaculum 

• Mesonephric Duct

• Paramesonephric Duct

• Gubernaculum 

In the development of an embryo, folding will migrate germ cells to the gonadal ridge. If an error in folding prevents this migration, what happens in the development of the embryo?

• The total agenesis of the urogenital tract

• The agenesis of the gonads

• A urogenital fistula

• A persistent cloaca containing urethra, anus, and/or vagina

• An imperforate anus

• The agenesis of the gonads

A newborn screening of a neonatal girl reveals she posses a uterine abnormality characterized by the persistence of the uterine septum. The diagnosis of the child is:

• Unicornuate uterus

• Didelphys 

• Bicornuate uterus 

• Septate uterus 

• Atretic uterus

• Septate uterus 

Which of the following triplets correctly matches the cell type with its product and the product’s function?

• Sertoli cells produce testosterone which promotes degeneration of the paramesonephric ducts

• Leydig cells produce testosterone which promotes the degeneration of the paramesonephric ducts

• Sertoli cells produce anti-mullerian hormone which is required for genital duct development

• Leydig cells produce anti-mullerian hormone which promotes the degeneration of the paramesonephric ducts

• Sertoli cells produce anti-mullerian hormone which promotes the degeneration of the paramesonephric ducts

• Sertoli cells produce anti-mullerian hormone which promotes the degeneration of the paramesonephric ducts

A Male infant is born without a scrotum, possessing only exposed testicles. What precursor to the scrotal swellings failed to develop?

• Urethral Folds

• Anal Folds

• Cloacal Folds

• Genital Swellings

• Urethral Groove

• Genital Swellings

During development, a male fetus experiences a disruption to the mesonephric ducts. Which of the following structures will not be affects by this aberration?

• Epididymis

• Ductus Deferens

• Bulbourethral Glands

• Ampulla of the Ductus Deferens

• Seminal Vesicle

• Bulbourethral Glands

A one year old boy presents with cryptorchidism. The parents are hesitant to resolve the issue for fear of having surgery on their young child. If the parents forgo surgery what is a major complication the baby boy may face?

• Inguinal Hernia

• Dysuria

• Nephritis 

• Urinary Incontinence 

• Testicular Cancer

• Testicular Cancer

Under the hormonal influence of TDF, the gonads begin to differentiate into testes. Which one of these processes is not directed by the influence of TDF?

• Degeneration of the Mesonephric Duct

• Degeneration of the Paramesonephric Duct

• The Development of Leydig Cells

• The Development of Sertoli Cells

• The Development of Spermatogonia

• Degeneration of the Mesonephric Duct

A neonate is born to a 30 year old mother. The delivery doctor is having trouble identifying the sex of the child. Testing reveals masculinized external genitalia and female appearing internal genitalia. The mother admits to being treated with androgens while pregnant. What is the diagnosis of the child?

• 46,XY Gonadal Dysgenesis 

• 45,XO Gonadal Dysgenesis

• 46,XY Disorder of Sexual Development

• 46,XX Disorder of Sexual Development 

• 46,XY Androgen Insensitivity Syndrome

• 46,XX Disorder of Sexual Development 

1. A 63-year-old man comes to the emergency

department with back pain, weakness, and short-

ness of breath. On examination, he has an aneu-

rysm of the abdominal aorta at the aortic hiatus

of the diaphragm. Which of the following pairs of

structures would most likely be compressed?

(A) Vagus nerve and azygos vein

(B) Esophagus and vagus nerve

(C) Azygos vein and thoracic duct

(D) Thoracic duct and vagus nerve

(E) Inferior vena cava (IVC) and phrenic nerve

(C) Azygos vein and thoracic duct

3. A 2-year-old boy presents with pain in

his groin that has been increasing in nature

over the past few weeks. He is found to have a

degenerative malformation of the transversalis

fascia during development. Which of the fol-

lowing structures on the anterior abdominal

wall is likely defective?

(A) Superficial inguinal ring

(B) Deep inguinal ring

(C) Inguinal ligament

(D) Sac of a direct inguinal hernia

(E) Anterior wall of the inguinal canal

(B) Deep inguinal ring

7. During an annual health examination of a

46-year-old woman, a physician finds hyperse-

cretion of norepinephrine from her suprarenal

medulla. Which of the following types of nerve

fibers are most likely overstimulated?

(A) Preganglionic sympathetic fibers

(B) Postganglionic sympathetic fibers

(C) Somatic motor fibers

(D) Postganglionic parasympathetic fibers

(E) Preganglionic parasympathetic fibers

(A) Preganglionic sympathetic fibers

11. A 43-year-old man complains of abdominal

pain just above his umbilicus. On examination,

a tumor is found anterior to the IVC. Which of

the following structures would most likely be

compressed by this tumor?

(A) Right sympathetic trunk

(B) Left third lumbar artery

(C) Third part of the duodenum

(D) Left renal artery

(E) Cisterna chyli

(C) Third part of the duodenum

13. A young boy is brought to the hospital after

a bicycle accident and possible pelvic fracture.

While awaiting a computed tomography (CT)

scan of his pelvis, a physician proceeds with

a focal neurologic examination. In testing the

child’s reflexes, which of the following nerves

would carry afferent impulses of the cremas-

teric reflex?

(A) Subcostal nerve

(B) Lateral femoral cutaneous nerve

(C) Genitofemoral nerve

(D) Iliohypogastric nerve

(E) Femoral nerve

(C) Genitofemoral nerve

16. A 78-year-old man is suffering from

ischemia of the suprarenal glands. This

condition results from rapid occlusion of direct

branches of which of the following arteries?

(A) (B) Aorta, splenic, and inferior phrenic arteries

Renal, splenic, and inferior mesenteric

arteries

(C) Aorta, inferior phrenic, and renal arteries

(D) Superior mesenteric, inferior mesenteric,

and renal arteries

(E) Aorta and hepatic and renal arteries

(C) Aorta, inferior phrenic, and renal arteries

25. A pediatric surgeon has resected a structure

that is a fibrous remnant of an embryonic or

fetal artery in a 5-year-old child. Which of the

following structures is most likely to be divided?

(A) Lateral umbilical fold

(B) Medial umbilical fold

(C) Median umbilical fold

(D) Ligamentum teres hepatis

(E) Ligamentum venosum

(B) Medial umbilical fold

27. An elderly man with prostatic hypertrophy

returns to his urologist with another case of

epididymitis. An acute infection involving the

dartos muscle layer of the scrotum most likely

leads to an enlargement of which of the follow-

ing lymph nodes?

(A) Preaortic nodes

(B) Lumbar nodes

(C) External iliac nodes

(D) Superficial inguinal nodes

(E) Common iliac nodes

(E) Common iliac nodes

42. A 58-year-old man is presented with

edema of the lower limb and enlarged

superficial veins of the abdominal wall.

Examination of radiographs and angiograms

reveals obstruction of the IVC just proximal

to the entrance of the renal vein. This venous

blockage may result in dilation of which of the

following veins?

(A) Left suprarenal vein

(B) Right inferior phrenic vein

(C) Right hepatic vein

(D) Left gastric vein

(E) Portal vein

(A) Left suprarenal vein

50. A 53-year-old woman with known kidney

disease presents to a hospital because her pain

has become increasingly more severe. A physi-

cian performing kidney surgery must remem-

ber that:

(A) The left kidney lies a bit lower than the

right one

(B) The perirenal fat lies external to the renal

fascia

(C) The renal fascia does not surround the su-

prarenal gland

(D) The left renal vein runs anterior to both the

aorta and the left renal artery

(E) The right renal artery is shorter than the

left renal artery

(D) The left renal vein runs anterior to both the

aorta and the left renal artery

53. A 3-year-old boy is admitted to the

children’s hospital with complaints of rest-

lessness, abdominal pain, and fever. An MRI

examination reveals that he has a double ureter.

Which of the following embryonic structures is

most likely failed to develop normally?

(A) Mesonephric (Wolffian) duct

(B) Paramesonephric (Müllerian) duct

(C) Ureteric bud

(D) Metanephros

(E) Pronephros

(C) Ureteric bud

63. Which structure receives blood from the left

gonad and suprarenal gland?

E = left renal vein = runs anterior to the aorta but posterior to the superior mesenteric artery and receives blood from the gonad and suprarenal gland.

1. A 68-year-old woman with uterine carci-

noma undergoes surgical resection. This can-

cer can spread directly to the labia majora in

lymphatics that follow which of the following

structures?

(A) Pubic arcuate ligament

(B) Suspensory ligament of the ovary

(C) Cardinal (transverse cervical) ligament

(D) Suspensory ligament of the clitoris

(E) Round ligament of the uterus

(E) Round ligament of the uterus

2. A 17-year-old boy suffers a traumatic groin

injury during a soccer match. The urologist

notices tenderness and swelling of the boy’s left

testicle that may be produced by thrombosis in

which of the following veins?

(A) Left internal pudendal vein

(B) Left renal vein

(C) Inferior vena cava

(D) Left inferior epigastric vein

(E) Left external pudendal vein

(B) Left renal vein

3. On a busy Saturday night in Chicago, a

16-year-old boy presents to the emergency de-

partment with a stab wound from a knife that

entered the pelvis above the piriformis muscle.

Which of the following structures is most likely

to be damaged?

(A) Sciatic nerve

(B) Internal pudendal artery

(C) Superior gluteal nerve

(D) Inferior gluteal artery

(E) Posterior femoral cutaneous nerve

(C) Superior gluteal nerve

4. A 22-year-old woman receives a deep cut

in the inguinal canal 1 in. lateral to the pubic

tubercle. Which of the following ligaments is

lacerated within the inguinal canal?

(A) Suspensory ligament of the ovary

(B) Ovarian ligament

(C) Mesosalpinx

(D) Round ligament of the uterus

(E) Rectouterine ligament

(D) Round ligament of the uterus

5. A 29-year-old carpenter sustains severe

injuries of the pelvic splanchnic nerve by a deep

puncture wound, which has become contami-

nated. The injured parasympathetic pregangli-

onic fibers in the splanchnic nerve are most likely

to synapse in which of the following ganglia?

(A) Ganglia in or near the viscera or pelvic

plexus

(B) Sympathetic chain ganglia

(C) Collateral ganglia

(D) Dorsal root ganglia

(E) Ganglion impar

(A) Ganglia in or near the viscera or pelvic

plexus

6. A 59-year-old woman comes to a local hos-

pital for uterine cancer surgery. As the uterine

artery passes from the internal iliac artery to the

uterus, it crosses superior to which of the fol-

lowing structures that is sometimes mistakenly

ligated during such surgery?

(A) Ovarian artery

(B) Ovarian ligament

(C) Uterine tube

(D) Ureter

(E) Round ligament of the uterus

(D) Ureter

7. A 29-year-old woman is admitted to a hospi-

tal because the birth of her child is several days

overdue. Tearing of the pelvic diaphragm dur-

ing childbirth leads to paralysis of which of the

following muscles?

(A) Piriformis

(B) Sphincter urethrae

(C) Obturator internus

(D) Levator ani

(E) Sphincter ani externus

(D) Levator ani

8. A 37-year-old small business manager re-

ceives a gunshot wound in the pelvic cavity,

resulting in a lesion of the sacral splanchnic

nerves. Which of the following nerve fibers

would primarily be damaged?

(A) Postganglionic parasympathetic fibers

(B) Postganglionic sympathetic fibers

(C) Preganglionic sympathetic fibers

(D) Preganglionic parasympathetic fibers

(E) Postganglionic sympathetic and parasympathetic fibers

(C) Preganglionic sympathetic fibers

9. A young couple is having difficulty

conceiving a child. Their physician at a

reproduction and fertility clinic explains to

them that

(A) The ovary lies within the broad ligament

(B) The glans clitoris is formed from the cor-

pus spongiosum

(C) Erection of the penis is a sympathetic

response

(D) Ejaculation follows parasympathetic

stimulation

(E) Fertilization occurs in the infundibulum or

ampulla of the uterine tube

(E) Fertilization occurs in the infundibulum or

ampulla of the uterine tube

10. A 46-year-old woman has a history of

infection in her perineal region. A comprehen-

sive examination reveals a tear of the superior

boundary of the superficial perineal space.

Which of the following structures would most

likely be injured?

(A) Pelvic diaphragm

(B) Colles fascia

(C) Superficial perineal fascia

(D) Deep perineal fascia

(E) Perineal membrane

(E) Perineal membrane

11. A 58-year-old man is diagnosed as having

a slowly growing tumor in the deep perineal

space. Which of the following structures would

most likely be injured?

(A) Bulbourethral glands

(B) Crus of penis

(C) Bulb of vestibule

(D) Spongy urethra

(E) Great vestibular gland

(A) Bulbourethral glands

12. An elderly man with a benign enlarge-

ment of his prostate experiences difficulty in

urination, urinary frequency, and urgency.

Which of the following lobes of the prostate

gland is commonly involved in benign hyper-

trophy that obstructs the prostatic urethra?

(A) Anterior lobe

(B) Middle lobe

(C) Right lateral lobe

(D) Left lateral lobe

(E) Posterior lobe

(B) Middle lobe

13. A 59-year-old man is diagnosed with pros-

tate cancer following a digital rectal examina-

tion. For the resection of prostate cancer, it is

important to know that the prostatic ducts open

into or on which of the following structures:

(A) Membranous part of the urethra

(B) Seminal colliculus

(C) Spongy urethra

(D) Prostatic sinus

(E) Prostatic utricle

(D) Prostatic sinus

14. A 29-year-old woman with a ruptured ec-

topic pregnancy is admitted to a hospital for

culdocentesis. A long needle on the syringe is

most efficiently inserted through which of the

following structures?

(A) Anterior fornix of the vagina

(B) Posterior fornix of the vagina

(C) Anterior wall of the rectum

(D) Posterior wall of the uterine body

(E) Posterior wall of the bladder

(B) Posterior fornix of the vagina