Chapter 1 Osteo1ogy.............................1 Chapter 2



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11. Two tissue layers, or tunics, cover the testes. The outer is tunica vaginalis and inner is tunica albuginea. The later partitions the testis into 100 to 200 wedge-shaped testicular lobules. Each lobule of the testis contains 2 to 4 tightly convoluted seminiferous tubules which produce sperms. Between the contorted seminiferous tubules are specialized endocrine cells called interstitial cells. Once the sperms are produced in the contorted seminiferous tubules, they move through the contorted seminiferous tubules and enter a series of very short ducts called straight seminiferous tubules. The straight tubules lead to the rete testis. The sperms are transported out of the testis and into the epididymis through a series of efferent ductules.

12. The process by which a testis descends is not well understood, but it seems to be associated with the shortening and differential growth of the gubernaculum, which is attached to the testis and extends through the inguinal canal to the wall of the scrotum. As the testis descends about week 28, it passes to the side of the urinary bladder and anterior to the pubic symphysis. It carries with it the ductus deferens, the testicular vessels and nerve, a portion of the internal abdominal oblique muscle, and lymph vessels. All of these structures remain attached to the testis and form what is known as the spermatic cord. By the time the testis has taken its position in the scrotal sac, the gubernaculum is no more than a remnant of scar-like tissue.

(Yang Xiangqun)

Multiple Choice Questions

A1

1. The suspensory ligament of the ovary .



A. connects the ovary to the uterus

B. is continuous with the round ligament

C. passes inferiorly to the ureter

D. contains the ovarian artery and vein

E. is firmly attached to the bifurcation of the aorta

2. The ovary .

A. lies against the anterior pelvic wall

B. lies within the ovarian fossa, which is bounded superiorly by the internal iliac vessels

C.receives its blood supply from the ovarian artery,which courses through the ovarian ligament to reach the ovary

D. has lymphatic drainage which goes to lumbar lymph nodes

E. releases ova directly into the isthmus of the uterine tube

3. The duct of the greater vestibular gland opens .

A. at the posterior-lateral edge of the introitus of the vagina

B. just superior to the hymen

C. at the posterior labial commissure

D. between the labium minus and labium majus

E. between the introitus and the urethra

4. Anterior extensions of the labia minima meet in the midline to form the .

A. mons pubis

B. introitus

C. body of the clitoris

D. frenulum of clitoris

E. opening of the urethra

5. The extension of the vaginal lumen around the intravaginal part of the uterine cervix is the .

A. cervical canal

B. uterine lumen

C. fornix

D. rectouterine pouch

E. uterovesical pouch

6. Under normal conditions, fertilization occurs in which part of the female reproductive tract.'?

A. infundibulum of the uterine tube

B. ampulla of the uterine tube

C. isthmus of the uterine tube

D. uterine lumen

E. cervical canal

7. Which of the following is considered a part of the broad ligament?

A. mesovarium

B. ovarian ligament

C. round ligament of the uterus

D. suspensory ligament of the ovary

E. uterosacral ligament

8. The most inferior extent of the peritoneal cavity in the female is the .

A. pararectal fossa

B. paravesical fossa

C. rectouterine pouch

D. parauterine fossa

E. vesicouterine pouch

9. The vestibular bulbs/bulb of the corpus spongiosum are firmly attached to the .

A. perineal membrane

B. sacrotuberous ligament

C. ischiopubic rami

D. pubic symphysis

E. ischial tuberosities

10. A structure which takes the form of a hood anterosuperior to the clitoris?

A. frenulum of the clitoris

B. labia majora

C. labia minora

D. prepuce

E. all of the above

11. A structure which is homologous to the male scrotum?

A. labia minora

B. labia majora

C. glans

D. shaft of corpus cavernosum

E. all of the above

12. The part of the internal lining of the uterus which is NOT shed during menstruation is the .

A. endometrium

B. myometrium

C. mesometrium

D. cervical mucosa

E. rugae

13. During ovulation, a(n) is released from the ovary.

A. ovum

B. secondary oocyte



C. primary oocyte

D. oogonium

E. follicle

14. Which layer of the uterus is shed once monthly during menstruation?

A. the myometrium

B. the perimetrium

C. the endometrium

D. the cervix of uterus

E. the middle layer

15. What is the term for the primary human sex organs?

A. gonads

B. genitals

C. ova

D. gametes



E. uterus

16. How many mature, functional follicles will a female produce in a lifetime?

A. about 1 million

B. 400


C. 4,000

D. 350,000

E. 1,000

17. What is the source of female sex steroids?

A. pituitary

B. ovary


C. uterus

D. hypothalamus

E. brain

18. What does an ovulated oocyte first come into contact with?

A. uterine tube

B. fimbriae

C. uterus

D. oviduct

E. vagina

19. The largest ovarian ligament is the ligament.

A. ovarian

B. broad


C. suspensory

D. sacral

E. proper

20. Which cell has been fertilized by a sperm cell?

A. primary oocyte

B. secondary oocyte

C. ovum

D. oogonia



E. follicle

21. During ovulation, the oocyte passes into the .

A. uterine tube

B. uterus

C. pelvic cavity

D. ovary


E. vagina

22. What is the first structure to receive the oocyte?

A. fimbriae

B. uterine tube

C. infundibulum

D. uterus

E. vagina

23. The largest component of the uterus by weight is the .

A. broad ligament

B. myometrium

C. round ligament

D. endometrium

E. perimetrium

24. The superior portion of the uterus is the .

A. body

B. cervix



C. fundus

D. infundibulum

E. isthmus of uterus

25. The outer serosal layer of the uterus is the .

A. perimetrium

B. cervix

C. endometrium

D. myometrium

E. isthmus of uterus

26. The superior region of the vagina is the .

A. vaginal orifice

B. cervix

C. hymen

D. vaginal rugae

E. isthmus of uterus

27. Which of these includes the other terms?

A. labia

B. clitoris

C. vulva

D. vestibular glands

E. mons pubis

28. What structure corresponds to the scrotum in the male?

A. labia major

B. labia minor

C. pudendal cleft

D. mons pubis

E. clitoris

29. The is the space between the labia minor.

A. vulva

B. vestibule

C. vaginal orifice

D. pudendal deft

E. mons pubis

30. The female greater vestibular glands correspond to the male .

A. prostate

B. Cowper' s

C. seminal vesicle

D. glans


E. bulbourethral glands

31. The notable structure of uterine tube or recognition is .

A. mesosalpinx

B. infundibulum of uterine tube

C. fimbriae of uterine tube

D. suspensory ligament of ovary

E. broad ligament of uterus

32. What area experiences the greatest changes in a menstrual cycle?

A. vagina

B. perimetrium

C. cervix

D. endometrium

E. myometrium

33. Where does fertilization normally occur?

A. uterus

B. uterine tube

C. ovary

D. pelvic cavity

E. vagina

34. Where does implantation of the blastocyst occur?

A. uterine tubes

B. endometrium

C. cervix

D. ovary


E. pelvic cavity

35. Which structure will actually become the fetus?

A. morula

B. blastocyst

C. inner cell mass

D. zygote

E. ova

36. The uterine vessels cross the superiorly.



A. ureter

B. round ligament of the uterus

C. ovarian artery

D. lumbosacral trunk

E. inferior hypogastric plexus

37. The uterine and ovarian vessels can be found in which ligaments?

A. broad and ovarian

B. broad and suspensory

C. round and ovarian

D. round and suspensory

E. suspensory and ovarian

38. Which one is formed by peritoneal plica?

A. round ligament of uterus

B. cardinal ligament of uterus

C. broad ligament of uterus

D. sacrouterine ligament of uterus

E. suspensory ligament of ovary

39. About uterus, which statement is right?

A. It lies between urinary bladder and rectum.

B. It belongs to the intraperitoneal organ.

C. It contains fundus, body, neck and isthmus.

D. Neck of uterus lies superiorly to vagina.

E. The lower third of the cervix has been termed the isthmus of uterus.

40. Uterus appendix refers to .

A. urinary bladder and rectum

B. urinary bladder and ovary

C. ovary and uterine tube

D. uterine tube and rectum

E. uterine tube and urinary bladder

41. Which one is the main structure to keep anteversion of uterus?

A. broad ligament of uterus

B. round ligament of uterus

C. cardinal ligament of uterus

D. uterosacral ligament of uterus

E. proper ligament of ovary

42. Which one is the main structure to avoid metroptosis?

A. broad ligament of uterus

B. round ligament of uterus

C. cardinal ligament of uterus

D. uterosacral ligament of uterus

E. proper ligament of ovary

43. The accessory gland of the female internal genital organs is .

A. ovary

B. uterine tube

C. uterus

D. vagina

E. greater vestibular gland

44. The common site for tubal ligation is .

A. uterine part

B. isthmus

C. ampulla

D. infundibulum

E. fimbriae

45. Which organ produces ovum?

A. ovary

B. uterine tube

C. uterus

D. vagina

E. greater vestibular gland

46. Which organ secretes female sex hormone?

A. ovary

B. uterine tube

C. uterus

D. vagina

E. greater vestibular gland

47. Which one belongs to the intraperitoneal organ?

A. vermiform appendix

B. sigmoid colon

C. uterus

D. adrenal gland

E. superior part of duodenum

48. The tumor predilection site of uterus is .

A. fundus of uterus

B. body of uterus

C. cervix of uterus

D. isthmus of uterus

E. horn of uterus

A2

1. Which structure is outlined with contact on a CT using intraperitoneal contact material?



A. ovary

B. prostate

C. rectum

D. seminal vesicles

E. vagina

2. During a hysterectomy, the uterine vessels are ligated.However, the patient's uterus continues to bleed. The most likely source of blood still supplying the uterus is from which artery?

A. inferior vesical

B. internal pudendal

C. middle rectal

D. ovarian

E. superior vesical

3. While recovering from an open abdominal hysterectomy (i.e., using a midline abdominal incision to gain entry to the pelvis), a patient realizes that she has lost sensation to the skin of her anterior thigh and cannot extend her knee. Retractors holding the incision open and pressing against the posterior abdominal wall most likely caused injury to which nerve?

A. femoral

B. genitofemoral

C. iliohypogastric

D. lateral femoral cutaneous

E. obturator

4. You are observing a doctor perform an abdominal hysterectomy. He notes that it is vitals protect the ureter which is found in the base of the .

A. mesometrium

B. mesovarium

C. mesosalpinx

D. round ligament of the uterus

E. suspensory ligament of the ovary

5. Following pregnancy and delivery, a 32-year-old woman continued to have problems with urinary incontinence, which developed during pregnancy. Her obstetrician counseled her to strengthen the muscle bordering the vagina and urethra, increasing its tone and exerting pressure on the urethra. This physical therapy was soon adequate to restore urinary continence. What muscle was strengthened?

A. coccygeus

B. ischiocavernosus

C. obturator internus

D. piriformis

E. puborectalis

6. After giving birth, a patient complains of urinary stress incontinence characterized by dribbling of urine with an increase in intraabdominal pressure. Her physician suspects injury to the pelvic floor during delivery, which may have altered the position of the neck of bladder and the urethra. Which muscle was most likely damaged during the vaginal delivery?

A. bulbospongiosus

B. coccygeus

C. levator ani

D. obturator internus

E. piriformis

7. A gynecologist examines a 27-year-old woman. Upon rectal examination, a firm structure, directly in front of the rectum in the midline, is palpated through the anterior wall of the rectum. This structure is the .

A. bladder

B. body of uterus

C. cervix of uterus

D. pubic symphysis

E. vagina

8. During a vaginal delivery, a surgeon performed medial episiotomy in which he cut too far (i. e. , through the perineal body into the structure immediately posterior). Which perineal structure did he cut?

A. bulbocavernosus

B. external anal sphincter muscle

C. ischiocavernosus

D. sacrospinous ligament

E. sphincter urethrae

9. A patient complains of a boil located on her labia majora. Lymphatic spread of the infection would most likely enlarge which nodes?

A. lumbar nodes

B. sacral nodes

C. external iliac nodes

D. superficial inguinal nodes

E. internal iliac nodes

10. A female patient is found to have an ectopic (tubal) pregnancy (embryo develops in the uterine tube). In order to gain access to the peritoneal cavity endoscopically to remove the embryo, the instrument can be passed into the vagina and through the .

A. anterior fornix

B. cervix

C. posterior fornix

D. retropubic space

E. vesicouterine pouch

BI

A. uterine part of uterine tube



B. isthmus of uterine tube

C. ampulla of uterine tube

D. infundibulum of uterine tube

E. fimbriae of uterine tube

1. The tubal ligation site is .

2. The fertilization site is .

3. The terminal structure of uterine tube is .

A. fundus of uterus

B. body of uterus

C. cervix of uterus

D. horn of uterus

E. isthmus of uterus

4. The part superior to the uterine orifice of uterine tube is .

5. The tumor predilection site is .

6. The lower uterine segment can be formed by .

A. ovary


B. uterine tube

C. cervix of uterus

D. round ligament of uterus

E. proper ligament of ovary

7. Digital rectal examination can touch .

8. Structure maintains anteversion and anteflexion of uterus.

9. Duct transports ovum or spermatovum.

10. In vitro fertilization, to obtain ovum from .

True or False Questions

1. Ovarian follicles are located in the ovarian cortex. ( )

2. The ovarian medulla contains cells that will differentiate into the oocytes. ( )

3. Females produce hundreds of oocytes each month in comparison to the millions of sperm cells produced in the same age male. ( )

4. The vagina is anterior to the bladder and posterior to the rectum. ( )

5. Although prolactin levels are high during pregnancy, milk production does not occur until after delivery. ( )

6. Like the testes, the female gonads-ovaries are endocrine glands that produce gametes. ( )

7. The primary reproductive organ of the female is the uterus. ( )

8. Puberty in females starts with changes in the hypothalamus that causes the release of FSH and LH from the pituitary gland. ( )

9. The mixture of blood and the cells that make up the lining of the vagina is called menstrual fluid. ( )

10. The lower entrance to the uterus is called the cervix. Leading from the cervix to the outside of the body is a muscular tube called the vagina or birth canal. ( )

11. The female genital gland is the vestibular glands. ( )

12. Ovary can produce ova and secrete sex hormones. ( )

13. The inferior extremity of the ovary, also called tubal extremity, is positioned near the open end of the uterine tube. ( )

14. The principal supporting membrane of the female reproductive tract is the ovarian ligament. ( )

15. The uterine tube consists of 4 parts and 2 orifice. The 4 parts are the uterine part, the isthmus, the ampulla and the infundibulum. The 2 orifice are the uterine orifice and the abdominal orifice. ( )

16. The uterus receives the follicle and provides a site for implantation. ( )

17. The uterus contains 3 parts, the fundus of uterus, the body of uterus and the isthmus of uterus. ( )

18. The canal of cervix of uterus is a part of the cavity of uterus. ( )

19. The whole perimetrium is continuous with the broad ligament. ( )

20. The vesicouterine pouch is the lowest point in the pelvic cavity and provides a site for puncture entry into the peritoneal cavity via vagina. ( )

21. Anteversion is formed between the body of uterus and the cervix. ( )

22. Anteflexion is formed between the uterus and vagina. ( )

23. The broad ligament of uterus is divided into three portions, the mesovarium, mesosalpinx, and the mesometrium, which support their corresponding organs. ( )

24. The round ligament of uterus lies in the broad ligament of uterus. ( )

25. The vagina is situated at the center of the pelvis between the urinary bladder and the rectum, and is continuous with uterine tube. ( )

26. The fornix of vagina is the deep recess surrounding the protrusion of the cervix into the vagina. ( )

27. The pudendal cleft lies between the labia minora. ( )

28. The clitoris is an erectile structure, homologous with the penis in male. ( )

29. The greater vestibular glands are the homologues of prostate in male. ( )

30. Suspensory ligaments extend from the skin to the deep fascia overlying the pectoralis major muscle and support the breasts. ( )

Explanation of Terms

1. mesovarium

2. fimbriae of uterine tube

3. isthmus of uterus

4. vesicouterine pouch

5. rectouterine pouch

6. cardinal ligaments

7. anteversion

8. anteflexion

9. fornix of vagina

10. suspensory ligament of mammary glands

Answer the Following Questions

1. Describe the relationship between the cervix, the vagina, and the uterus.

2. Describe the division of uterine tube.

3. Which structures in females are homologous to the testes, the glans penis, the prostate gland, and the bulbourethral gland in male?

4. Describe the composition of vulva.

5. How does the fornix of vagina form?

6. Describe the composition and functions of female reproductive system.

7. Describe the position and support of ovaries.

8. Describe the position, division, cavity, and support of uterus.

9. Describe the pathway of ovum or fertilized ovum discharge and normal fetal disengagement.

10. Describe the structure of mammary glands.

ANSWERS


Multiple Choice Questions

A1

1. D 2. D 3. A 4. D 5. C 6. B 7. A 8. C 9. B 10. D 11. B 12. B 13. B 14. C 15. A 16. B 17. B 18. B 19. C 20. B 21. C 22. A 23. B 24. C 25. A 26. B 27. C 28. D 29. B 30. E 31. C 32. D 33. B 34. B 35. B 36. A 37. B 38. C 39. A 40. C 41. B 42. C 43. E 44. B 45. A 46. A 47. C 48. C



A2

1. A 2. D 3. A 4. A 5. E 6. C 7. C 8. A 9. B 10. C

BI

1. B 2. C 3. E 4. A 5. C 6. E 7. C 8. D 9. B 10. A



True or False Questions

1. T 2. F 3. F 4. F 5. T 6. T 7. F 8. T 9. F 10. T 11. F 12. T 13. F 14. F 15. T 16. F 17. F 18. F 19. F 20. F 21. F 22. F 23. T 24. T 25. F 26. T 27. F 28. T 29. F 30. T

Explanation of Terms

1. The mesovarium is a specialized posterior extension of the broad ligament that attaches to an ovary.

2. Many slender digitationes formed around the terminal end of uterine tube near its abdominal orifice.

3. Approximately the upper third of the cervix has been termed the isthmus of uterus.

4. The vesicouterine pouch is a shallow pouch and formed as the peritoneum is reflected over the urinary bladder. It lies between urinary bladder and uterus.

5. The rectouterine pouch formed as the peritoneum is reflected onto the rectum. It lies between rectum and uterus. The rectouterine pouch is the lowest point in the pelvic cavity and provides a site for puncture entry into the peritoneal cavity via vagina.

6. The cardinal ligaments are fibrous bands located at the base of the broad ligaments that extend laterally from the cervix and vagina across the pelvic floor, where they attach to the wall of the pelvis.

7. About 90~ angle formed between the uterus and vagina.

8. About 170~ angle formed between the body of uterus and the cervix.

9. The deep recess surrounding the protrusion of the cervix into the vagina is called the fornix of vagina.

10. Suspensory ligaments lie between the lobules, extend from the skin to the deep fascia overlying the pectoralis major muscle and support the breasts.

Answer the Following Questions

1. The anatomical regions of the uterus include fundus of uterus, body of uterus and neck or cervix of uterus. The narrow canal of cervix of uterus extends through the cervix and opens into the lumen of the vagina.

2. The uterine tubes are described as consisting of four portions. (1) The uterine part, which lies in the wall of the uterus; (2) the isthmus, where is the place of tubosterilization; (3) the ampulla, a dilated portion for fertilization normally, which curves over the ovary; and (4) the infundibulum with its abdominal orifice, surrounded by fimbriae, one of which, the ovarian fimbria is attached to the ovary.

3. The ovaries are homologous to the testes; the clitoris is homologous to the glans penis; the paraurethral glands are homologous to the prostate; and the greater vestibular glands are homologous to the bulbourethral gland.

4. The vulva includes the mons pubis, labia majora, labia minora, clitoris, vaginal vestibule, vestibular bulbs of vestibule, and vestibular glands. The structures of the vulva surround the vaginal vestibule.

5. The cervix projects posteriorly and inferiorly, joining the anterior wall of the vagina at nearly a right angle, which divides it into upper, supravaginal part and lower, vaginal part.

The deep recess surrounding the protrusion of the cervix into the vagina is called the fornix of vagina. To the recess behind the cervix the term posterior fornix (part) is applied, while the anterior and lateral parts are smaller called the anterior and lateral fornices as well.

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