Questions in Human Anatomy on the Reproductive System

Module REP 301

By
Prof. M. Fawzi Gaballah
Head of the Anatomy Department, College of Medicine, MUST

These are objective questions especially prepared as a guide to study anatomy

in a better and critical way. These are also meant to be examples for single best
questions, and true or false questions that may be encountered in the
assessment, midterm and final anatomy exams. True statements and various
types of questions are presented here as possible material for multiple choice
questions.
Students should answer these objective questions as student activity, and
present their written answers to the staff of the department to be evaluated.

Contents
Unit ( 1 ): Bony pelvis & pelvic walls

Unit ( 2 ): Male genital organs

Unit ( 3 ): Female genital organs

Unit ( 4 ): Ischorectal fossa, pudendal nerve and internal

pudendal artery

Unit: ( 5 ): Perineal pouches

Unit ( 6 ): Embryology

Problem solving questions

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 Unit ( 1 ):

Bony Pelvis & Pelvic Walls

Complete:
- The 2 ligaments in the bony pelvic wall that are attached to the side of the
sacrum are the -------------------------------------------- &
-------------------------------------------------
- The muscle in the lateral wall of the true pelvis is the ------------------muscle.
- The piriformis muscle arises from the ------------------------------ vertebrae.
- The tendon of the obturator internus leaves the pelvis through
--------------------------------- foramen.
- The obturator fascia covers the ----------------------------------- muscle.
- The obturator fascia splits in the ischiorectal fossa to form the
----------------------------------------------------- canal.

Levator Ani Muscle

# True statements:
1. The levator ani muscle arises from 2 bones and a tendinous arch in between.
2. Its anterior fibers are inserted partly into the perineal body.
3. It surrounds the vagina to form the sphincter vaginae.
4. The puborectalis part of the muscle curves behind the rectum at the anorectal
junction.
5. The levator ani is also inserted into the anococcygeal raphe (ligament).
6. Each surface of the levator ani receives a separate nerve supply.
7. It the main support to the floor of the pelvis and the uterus.

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8. The perineal body is a fibromuscular mass situated between the vagina and
the anal canal and gives insertion to most fibers of the lavator ani. If this
perineal body is ruptured prolapse of the uterus may occur.

Complete:
- The levator ani forms together with the coccygeus muscle the -------------------
diaphragm.
- Its upper surface is supplied by ---------------------------------- nerve, while its
inferior surface is supplied by -------------------------------------- nerve.
- It forms the medial wall of the ------------------------------------- fossa.
- Its upper surface is covered by -------------------------------- fascia.
- The anterior free borders of both muscles bound a gap that surrounds the
----------------------------------------- in the male & the
---------------------------------------------- in the female.

Pelvic Peritoneum
# True statements:
1. The peritoneum covers the upper surface only of the urinary bladder.
2. It is reflected from the bladder on to the rectum to form the rectovesical pouch
in the male.
3. In the female the peritoneum is reflected from the rectum on to the upper 1/4
of the back of the vagina forming the recto-uterine pouch of Douglas.
4. The lower 1/3 of the rectum is not covered by peritoneum.
5. The peritoneal folds on each side of the uterus form the broad ligaments.

Matching:
A) Peritoneal coverings:

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 1. covered by peritoneum 2. not covered by peritoneum
B) Pelvic organs:
- base of bladder ( )
- fundus of uterus ( )
- anterior aspect of cervix ( )
- lower 1/3 of anterior surface of rectum ( )
- upper 1/4 of posterior vaginal wall ( )

Nerves of the Pelvis

# True statements:
1. The sacral plexus lies in front of the piriformis. It is formed of L.4,5 & S.1,2,3.
2. The sacral plexus receives the lumbosacral trunk from the lumbar plexus.
3. The branches to the perineum are the pudendal nerve and perineal branch of
the 4th sacral nerve.
4. The sympathetic trunk enters the pelvis deep to the common iliac vessels.
5. The sympathetic trunks unite together in the ganglion impar.

Complete:
- The lumbosacral trunk descends in front of the ------------------------- joint.
- The largest branch of the sacral plexus is the ------------------- nerve.
- The pelvic splanchnic nerve arises from----------------& carries
------------------autonomic fibers.
- The sympathetic trunk descends vertically medial to the
---------------------------------------- foramina of the sacrum.

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 Internal Iliac Artery
# True statements:
1. It arises opposite the disc between the 5th lumbar vertebra and the base of the
sacrum.
2. It descends just behind and parallel to the ureter.
3. It gives off many branches to the pelvic organs, perineum and lower limbs.
4. It is shorter than the external iliac artery.

Complete:
- The nerve trunk that descends behind the internal iliac artery is the
--------------------------
- Its highest branch reaches the umbilicus in the form of a ligament
called-------------------------------------- artery.
- The terminal branches of its anterior division are ------------------------ &
-------------------
- Its branches to the sacrum are
------------------------------------------------------------- arteries.
- Its branch to the rectum is called
----------------------------------------------------------- artery.
- Its inferior vesical branch in the male is replaced by the
--------------------------------------- in the female.
- Its branch to the uterus is called-------which has a long course on the floor
of-------------and along the side of---------------and below--------------

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 Unit (2)

Male Genital Organs

Prostate
# True statements:
1. It has a firm capsule that is surrounded by a prostatic fascial sheath. This
fascial sheath contains a plexus of veins.
2. It can be felt by P/R examination.
3. It lies behind the lower border of the symphysis pubis.
4. Its part that lies in front of the prostatic urethra contains few glandular tissue.
5. It has a large right and left lateral lobes, in addition to a median lobe.

Complete:
- The median lobe is the part lying between the 2
------------------------------------------- ducts & behind
-------------------------------------------------.
- The duct within the prostate that transmits urine is the
-----------------------------------------------whereas the ducts that transmit
semen are the ---------------------------------------------------
- The median lobe projects upward behind the internal urethral orifice forming
the ------------------------------------------------------ of the bladder.
- The part of the levator ani muscle that surrounds the prostate is called
-----------------------------------------------------------
Ductus (Vas) Deferens
Complete:

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- It begins in the scrotum as the continuation of -----------------------the
epidydimis.
- In the spermatic cord, it is surrounded by the ---------------------------------
plexus of veins.
- It enters the pelvic cavity through the
-------------------------------------------------------- ring where it lies lateral to the
------------------------------------------------------- artery.
- At the lateral angle of the bladder, it runs in front of ------------------------------
- On the base of the bladder it is dilated to form
-------------------------------------Its termination joins the duct of the seminal
vesicle to form ----------------------------- duct.
- Its artery is a branch from --------------------------------------- artery.

Scrotum, Testis & Epididymis

# True statements:
1. The scrotum has no superficial fascia, but instead there is the dartos muscle
which is a non-striated muscle.
2. The scrotal cavity is divided by a septum into 2 compartments, each of which
contains a tests, epididymis and lower part of the spermatic cord.
3. The testis has 2 borders, 2 surfaces and 3 ends. The posterior border carries
the epididymis and the beginning of the vas deferens.
4. The testis is surrounded by the tunica vaginalis and the 3 coats of the
spermatic cord. The tunical vaginalis is the terminal part of the processus
vaginalis, and if becomes filled with fluid the condition is called hydrocele.
5. The artery of the testis is the testicular artery which arises from the aorta. The
vein of the right testis ends in the inferior vena cava while that of the left testis
ends in the left renal vein.

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6. The lymphatic drainage of the testis is into the lumbar (para-aortic) lymph
nodes, while lymph drainage of the scrotum is into inguinal lymph nodes.
7. The epididymis is a highly coiled duct that forms its body, head and tail. The
head of the epididymis is an expanded part that lies on the upper end of the
testis, while its tail is very narrow and is continuous with the vas deferens.

Unit (3)

Female Genital Organs

Ovary
Complete:
- The ovarian fossa is bounded posteriorly by ---------------------------------
- The upper end of the ovary gives attachment to the
--------------------------------ligament, while its lower end gives attachment to
the --------------- ligament.
- It is attached by a fold of peritoneum called
----------------------------------------------------- which is a part of the broad
ligament.
- The ovarian artery arises from -------------- at the level of -------------------------
vertebra.
- Its lymphatic drainage goes to -------------------------------- nodes.
- On the left side the ovarian vein drains into
------------------------------------------------------- while on the right side the
ovarian vein drains into --------------------------------------

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 Uterine Tube
Complete:
- It lies in the free border of the --------------------------ligament.
- It opens laterally into the --------------------------------------- cavity.
- Its part which traverses the wall of the uterus is called ---------------------
- Its narrow part that lies just lateral to the uterus is called -------------------------
- Its wide part in which fertilization of the ovum takes place is called ------------
- Its funnel-shaped expansion is called ---------------gives processes called
---------------------------------------
- It gets blood supply from the --------------- & --------------arteries.

Uterus
# True statements:
1. It is 3 inches long and 2 inches from side to side.
2. The part of the uterus above the level of the uterine tubes is the fundus.
3. The normal position of the uterus is anteflexed and anteverted.
4. It is covered completely by peritoneum except the anterior surface of the
cervix which is bare.
5. Its lateral margins give attachment to the broad ligament.
6. The cavity of the uterus is triangular in coronal section but that of the cervix is
fusiform.

Complete:
- The angle of anteversion lies between the long axis of the uterus and that of
----------------
- The opening of the cervix into the vagina is called ------------------------------
- The cervix is normally directed downward & ------------------------

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- The ligament of the uterus that passes through the inguinal canal to reach the
labium majus is called the ---------------------------------
- The strong ligament attached to the side of the cervix and lateral fornix of
vagina is called the ----------------------------------------------------
- The dense connective tissue between the 2 layers of the broad ligament is
called the -----------------------------------------------------
- The supravaginal part of the cervix is related laterally to an artery called
------------------------------------------ & a tube called ----------------------------

Broad Ligament of Uterus

# True statements:
1. The uterus is kept in position by the support of pelvic floor, strong ligaments
and perineal body. However, the broad ligaments are not important in fixation
of the uterus.
2. The uterine artery has a course on the floor of pelvis where it lies in the root of
the broad ligament.
3. In the broad ligament there are some embryological remnants.
4. The ureter is one of the contents of the broad ligament.
5. The part of the broad ligament which is attached to the uterine tube is called
mesosalpinx, while the part attached to the side of the uterus is called
mesometrium.
6. The 2 ligaments in the broad ligament are the ligament of the ovary and round
ligament of uterus.

Complete:

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- The part of the broad ligament attached to the ovary is called
----------------------------------------------- while its part attached to the uterine
tube is called -------------------------------------------------------
- The 2 tubes in the broad ligament are --------------- & ----------------------------
- The 2 ligaments in the broad ligament are ------------ & ---------------------------
- The embryological remnants in the broad ligament are called
-------------------------------------- & ---------------------------------
- The artery which runs in the root of the ligament is ------------------- artery.

Matching:
A) Parts of uterus:
1. fundus & upper part of body of uterus
2. lower part of body of uterus
3. an area at lateral angle of uterus

B) Draining to lymph nodes:

- superficial inguinal nodes ( )
- aortic nodes ( )
- external iliac nodes ( )

Vulva or Pudendum

- The vulva is external female genital organs which comprise the mons pubis,
labia minora, clitoris, labia majora, bulb of the vestibule and greater vestibular
glands.

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 - The cleft between the 2 labia majora is called pudendal cleft
(pudendum=external genital organs).
- The interval between the 2 labia minora is called vestibule of the vagina.
- The clitoris has a glans and 2 crura but no urethra. Its bulb is called bulb of
the vestibule and is divided into right and left masses of erectile tissue.

Unit (4)

Ischiorectal fossa, pudendal nerve & internal pudendal artery

Complete:
- Its base is formed by ----------------------------------------------------
- The muscle in its lateral wall is the ----------------------------------
- The muscle in its medial wall is the -----------------------------------
- The canal in the fascia covering its lateral wall is called
---------------------------------------- & contains --------------------------------
nerve & ------------------------------------------ artery.
- The artery and nerve that cross the fossa from lateral to medial are the
---------------------------artery.

Pudendal Nerve
Complete:
- Its root value is ---------------------------------------------------------------
- It leaves the pelvic cavity through the ----------------------- foramen.
- In the ischiorectal fossa it runs in the --------------------------- canal.

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- Its terminal branches are ----------------- & --------------------------------------
- The accompanying artery in the perineum is called
---------------------------------------------- which arises from
--------------------------------- artery.

Internal Pudendal Artery

Complete:
- It is a branch from ----------------------------------------- artery.
- Its terminal divisions are --------------------- & ----------------- arteries.
- Its branch that crosses the ischiorectal fossa is from lateral to medial is called
----------------------------------- artery.
- It is called pudendal because it supplies ---------------------------------
- Its branches to the penis are ---------------- & -----------------&-------
- It leaves the pelvis through the ----------------------------- foramen but it leaves
the gluteal region through the --------------------------------------------- foramen.

Unit ( 5 )

Perineal Pouches (spaces)

Superficial Perineal Pouch

Complete:
- Its roof is formed by --------------------------------------------------------
- Its floor is formed by ----------------------------------------------------

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- It contains the root of the penis which consists of a
-------------------------------------- on each side & a --------------------------------
in the median plane.
- The muscle covering the crus of penis is called
-------------------------------------------------- while that covering the bulb of
penis is called ---------------------------------------------------
- The bulb of the penis is traversed by the ------------------------- urethra.
- The artery in the crus of the penis is called----------
- The artery on the dorsum of the penis is called--------------------

Deep Perineal Pouch

True statements:
1. It is a closed space situated in the urogenital triangle.
2. The perineal membrane separates the deep pouch from the superficial pouch.
3. It contains the sphincter urethrae and the membranous urethra.
4. On each side the membranous urethra there is a bulbo-urethral gland.

Unit: ( 6 )

Embryology

:True statements

The testis develops from 3 sources: celomic epithelium, primordial germ .1

cells and intermediate cell mass of mesoderm. The germ cells and the
Sertoli cells which arise from the celomic epithelium mix together and form
.testis cords that become canalized to form the seminiferous tubules

The testis descends by shortening of the gubernaculum which traverses .2

.the inguinal canal to get attached to the floor of the scrotum

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The main congenital anomalies of the testis are: undescended testis .3
(cryptorchism), ectopic testis, anomalies of the processus vaginalis and
.hermaphroditism (intersex)

In the female, the gubernaculum gets attached to the side of the uterus .4
close to the uterine tube, and thus becomes divided into 2 parts: the cranial
part will form the ligament of the ovary, while the caudal part will form the
.round ligament of the uterus

The paramesonephric (Mullerian) duct is one on each side and will give .5
rise to the uterine tube and uterus, but it degenerates in the male almost
.completely

The fundus and upper part of the body of the uterus develop from the .6
transverse intermediate part of the paramesonephric duct. However, the
cervix and lower part of the body of uterus arise from the caudal fused parts
.of the mesonephric ducts

The common anomalies of the uterus are: double uterus (uterus .7

.didelphys), uterus bicornis bicollis, bipartite uterus and bicornuate uterus

The common anomalies of the vagina are failure of canalization and .8

.imperforate hymen

**********

CLINICAL PROBLEM SOLVING QUESTIONS

# A 45-year-old woman complained of vaginal discharge

having bad odour. Vaginal examination reveals an ulcer
on the cervix of the uterus.

Answer the following true or false statements:

a) The opening of the cervical canal into the vagina is called
internal os.
b) The space of the vagina around the cervix is called fornix.

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c) The supravaginal part of the cervix is related to the right and
left ureters, one on each side.
d) The sphincter vaginae is formed by the levator ani muscle.
e) The female urethra is embedded into the posterior wall of the
vagina.
***

# A patient was admitted to hospital complaining of a

swelling in the scrotum diagnosed as a hydrocele.

Answer the following true or false statements:

a) A hydrocele means collection of serous fluid the cavity of the
tunica vaginalis.
b) The epididymis lies on the back of the testis.
c) The testis is supplied by an artery arising from the abdominal
aorta.
d) The testicular vein on the right side ends in the inferior vena
cava.
e) The sinus of the epididymis is directed laterally.

# A woman complaining of low back pain was examined

per vagina by her obstetrician and gynecologist who
diagnosed the cause of the pain due to be uterine
prolapse.
Answer the following true or false statements:
.a) Intact levator ani muscles are essential to support the uterus
b) The round ligament of uterus is the principal ligament in
.support of the uterus
c) The transverse cervical ligament is also called Mackenrodt’s
.ligament

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d) Normally, the vaginal part of the cervix is directed downward
.and forward
.e) The cervix opens into the uterus by the external os

A middle aged-man was admitted to hospital #

complaining of a mass in the inguinal region close to the
midline. The mass was diagnosed oblique inguinal
hernia and was reduced surgically, but the vas deferens
.was injured during the operation

Answer the following true or false statements:

a) The vas deferens begins as the continuation of the body of the
epididymis.
b) The artery of the vas deferens arises directly from the internal
iliac artery.
c) The vas deferens curves lateral to the inferior epigastric artery
at the deep inguinal ring.
d) At the back of the bladder the vas deferens lies in front of the
end of the ureter.
e) In the spermatic cord the vas deferens is surrounded directly by
the external spermatic fascia.

**********

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