Chapter: Abdomen; Topic: Duodenum; Subtopic: First Part of Duodenum
Keyword Definitions:
• Duodenum: The first part of the small intestine, connecting the stomach to the jejunum; it has four parts — superior, descending, horizontal, and ascending.
• Foregut: Embryonic region giving rise to the stomach, liver, pancreas, and the upper part of the duodenum.
• Superior Mesenteric Artery (SMA): Artery supplying midgut structures; the first part of the duodenum is mainly supplied by branches of the celiac trunk.
• Celiac Trunk: The first major branch of the abdominal aorta, supplying the foregut organs.
• Duodenal Cap (Bulb): The proximal smooth portion of the duodenum seen on X-rays.
Lead Question - 2015
All are true about 1st part of duodenum, except ?
a) 5 cm long
b) Is superior part
c) Develops from foregut
d) Supplied by superior mesenteric artery
Explanation: The first part of the duodenum is about 5 cm long and lies at the level of L1 vertebra, forming the duodenal cap. It is the superior part and develops from the foregut. Its arterial supply is from the gastroduodenal artery (a branch of the celiac trunk), not the superior mesenteric artery. Answer: d) Supplied by superior mesenteric artery.
1. The first part of the duodenum is related posteriorly to:
a) Portal vein
b) Common bile duct
c) Gastroduodenal artery
d) All of the above
Explanation: Posterior to the first part of the duodenum lie the portal vein, common bile duct, and gastroduodenal artery. These relations are crucial surgically because posterior ulcers in this region may erode the gastroduodenal artery causing severe bleeding. Answer: d) All of the above.
2. Which of the following structures is found anterior to the first part of the duodenum?
a) Gallbladder
b) Lesser omentum
c) Quadrate lobe of liver
d) All of the above
Explanation: The anterior surface of the first part of the duodenum is related to the quadrate lobe of the liver, gallbladder, and lesser omentum. These relations explain referred pain and bile reflux in duodenal disease. Answer: d) All of the above.
3. The duodenal bulb is commonly affected in:
a) Peptic ulcer disease
b) Crohn’s disease
c) Ulcerative colitis
d) Celiac disease
Explanation: The duodenal bulb (first part) is the most common site for peptic ulcers due to acid exposure and proximity to the pylorus. Ulceration here can perforate posteriorly into the gastroduodenal artery. Answer: a) Peptic ulcer disease.
4. A posterior duodenal ulcer eroding the gastroduodenal artery causes:
a) Massive hematemesis
b) Steatorrhea
c) Peritonitis
d) Jaundice
Explanation: Posterior duodenal ulcers can erode the gastroduodenal artery, leading to massive upper gastrointestinal bleeding (hematemesis). Prompt surgical or endoscopic control is required. Answer: a) Massive hematemesis.
5. Which ligament connects the duodenum to the liver?
a) Hepatogastric ligament
b) Hepatoduodenal ligament
c) Gastroduodenal ligament
d) Duodenocolic ligament
Explanation: The hepatoduodenal ligament, part of the lesser omentum, connects the liver to the duodenum and encloses the portal triad—portal vein, hepatic artery, and bile duct. Answer: b) Hepatoduodenal ligament.
6. Which artery supplies the first part of the duodenum?
a) Gastroduodenal artery
b) Superior mesenteric artery
c) Inferior pancreaticoduodenal artery
d) Right gastric artery
Explanation: The gastroduodenal artery, a branch of the common hepatic artery, supplies the first part of the duodenum and the head of the pancreas. It forms a vital anastomosis with the inferior pancreaticoduodenal artery. Answer: a) Gastroduodenal artery.
7. The first part of the duodenum lies at which vertebral level?
a) T12
b) L1
c) L2
d) L3
Explanation: The first part of the duodenum lies horizontally at the L1 vertebral level (also known as the transpyloric plane). This is an important surgical landmark for identifying nearby structures such as the gallbladder and pancreas. Answer: b) L1.
8. During endoscopy, the smooth mucosal area before the duodenal folds is termed:
a) Duodenal cap
b) Ampulla of Vater
c) Plica circularis
d) Sphincter of Oddi
Explanation: The duodenal cap is a smooth, thin-walled portion of the first part of the duodenum before the circular folds begin. It appears radiologically as a rounded shadow and is commonly involved in peptic ulcers. Answer: a) Duodenal cap.
9. Which nerve supplies the first part of the duodenum?
a) Vagus nerve
b) Phrenic nerve
c) Splanchnic nerve
d) Hypogastric nerve
Explanation: The vagus nerve provides parasympathetic innervation to the duodenum, promoting motility and secretion. The sympathetic fibers arise from the greater splanchnic nerve. Together they regulate duodenal activity. Answer: a) Vagus nerve.
10. A patient presents with duodenal ulcer perforation; which area is most affected?
a) First part
b) Second part
c) Third part
d) Fourth part
Explanation: The first part of the duodenum is the most frequent site of perforation in peptic ulcer disease. Perforation leads to peritonitis with sudden severe epigastric pain and free air under the diaphragm on X-ray. Answer: a) First part.
11. A posterior perforation of the duodenal ulcer can erode which vessel leading to hemorrhage?
a) Gastroduodenal artery
b) Hepatic artery
c) Superior mesenteric artery
d) Portal vein
Explanation: A posterior duodenal ulcer may erode the gastroduodenal artery leading to life-threatening upper GI bleeding. This clinical correlation highlights the importance of posterior anatomical relations of the duodenum. Answer: a) Gastroduodenal artery.
Topic: Development of Pancreas; Subtopic: Ventral and Dorsal Pancreatic Buds
Keyword Definitions:
Pancreas: A gland with both exocrine and endocrine functions that develops from foregut endoderm.
Ventral Pancreatic Bud: Arises from the ventral aspect of the duodenum and forms part of the pancreas.
Dorsal Pancreatic Bud: Develops first from the dorsal side and gives rise to the major portion of the pancreas.
Uncinate Process: A projection from the head of the pancreas, derived from the ventral bud.
Pancreatic Ducts: Ducts that drain pancreatic secretions into the duodenum.
Lead Question (2015):
Ventral pancreatic duct give rise to?
a) Body
b) Tail
c) Neck
d) Uncinate process
Explanation:
The ventral pancreatic bud develops near the bile duct and rotates dorsally to fuse with the dorsal bud. It gives rise to the **inferior part of the head and the uncinate process of the pancreas**. The dorsal bud forms the superior part of the head, body, and tail. Answer: d) Uncinate process.
1)
Which part of the pancreas develops from the dorsal pancreatic bud?
a) Head
b) Body
c) Uncinate process
d) Inferior part of head
Explanation:
The dorsal pancreatic bud arises first from the duodenum and forms the **superior part of the head, body, and tail of the pancreas**. The ventral bud contributes only to the inferior head and uncinate process. Answer: b) Body.
2)
The main pancreatic duct is derived from which structure?
a) Dorsal bud only
b) Ventral bud only
c) Both dorsal and ventral buds
d) Common bile duct
Explanation:
After rotation and fusion of the pancreatic buds, the ducts from both buds join to form the main pancreatic duct (duct of Wirsung), which opens into the major duodenal papilla. Thus, it is derived from **both the dorsal and ventral pancreatic buds**. Answer: c) Both dorsal and ventral buds.
3)
In annular pancreas, which embryological error occurs?
a) Failure of dorsal bud to form
b) Non-fusion of pancreatic ducts
c) Ventral bud encircles duodenum
d) Overgrowth of dorsal bud
Explanation:
Annular pancreas occurs when the **ventral pancreatic bud splits and encircles the duodenum**, causing constriction. It results from abnormal migration during rotation. The condition may lead to duodenal obstruction or vomiting in newborns. Answer: c) Ventral bud encircles duodenum.
4)
Which artery mainly supplies the head of the pancreas?
a) Splenic artery
b) Superior mesenteric artery
c) Gastroduodenal artery
d) Inferior pancreaticoduodenal artery
Explanation:
The pancreatic head, derived from both buds, is mainly supplied by the **superior and inferior pancreaticoduodenal arteries**. The superior pancreaticoduodenal branch arises from the gastroduodenal artery, making it the principal source. Answer: c) Gastroduodenal artery.
5)
Which part of the pancreas contains the uncinate process?
a) Tail
b) Head
c) Body
d) Neck
Explanation:
The **uncinate process** is a small hook-like projection extending from the **inferior portion of the head** of the pancreas. It lies behind the superior mesenteric vessels and arises from the ventral pancreatic bud. Answer: b) Head.
6) (Clinical)
A newborn presents with bilious vomiting and duodenal obstruction. Imaging shows pancreatic tissue surrounding the duodenum. What is the most likely diagnosis?
a) Annular pancreas
b) Pancreas divisum
c) Pseudocyst
d) Agenesis of dorsal pancreas
Explanation:
This is a classic presentation of **annular pancreas**, where the ventral pancreatic bud abnormally splits and encircles the duodenum, leading to obstruction. It’s often associated with Down syndrome. Surgical bypass is usually required. Answer: a) Annular pancreas.
7) (Clinical)
A patient with recurrent pancreatitis is found to have two separate pancreatic ducts draining into the duodenum. What embryological anomaly is responsible?
a) Annular pancreas
b) Pancreas divisum
c) Duplication of dorsal bud
d) Agenesis of ventral bud
Explanation:
**Pancreas divisum** results from failure of fusion between the dorsal and ventral pancreatic ducts, leading to two ducts draining separately. This causes impaired drainage and recurrent pancreatitis. It’s the most common congenital anomaly of the pancreas. Answer: b) Pancreas divisum.
8) (Clinical)
A 40-year-old man develops a tumor in the uncinate process compressing nearby vessels. Which vessel is most likely affected?
a) Inferior vena cava
b) Splenic vein
c) Superior mesenteric vessels
d) Portal vein
Explanation:
The **uncinate process** lies posterior to the **superior mesenteric vessels**, so a tumor here compresses them first, possibly affecting venous return or intestinal blood supply. The relation helps in radiological localization of lesions. Answer: c) Superior mesenteric vessels.
9) (Clinical)
During pancreatic surgery, the surgeon notes that the ventral bud-derived part lies posterior to major vessels. Which part is this?
a) Tail
b) Neck
c) Uncinate process
d) Body
Explanation:
The **uncinate process**, derived from the ventral bud, lies posterior to the superior mesenteric vessels. Recognizing this relationship is crucial during pancreatic and duodenal surgeries to avoid vascular injury. Answer: c) Uncinate process.
10) (Clinical)
A patient presents with diabetes due to agenesis of dorsal pancreas. Which parts of the pancreas are missing?
a) Head and uncinate process
b) Body and tail
c) Inferior head only
d) Entire pancreas
Explanation:
**Agenesis of dorsal pancreas** leads to absence of the **body and tail**, which are derived from the dorsal bud. These parts contain most islets of Langerhans, leading to diabetes. The head and uncinate process remain intact. Answer: b) Body and tail.
Chapter: Embryology; Topic: Development of Pancreas; Subtopic: Dorsal and Ventral Pancreatic Buds
Keyword Definitions:
Pancreas: A mixed gland derived from the endoderm of the foregut that performs both endocrine and exocrine functions.
Dorsal Pancreatic Bud: The first outgrowth from the duodenum forming the body, tail, and upper part of the head of the pancreas.
Ventral Pancreatic Bud: Develops later and contributes to the inferior head and uncinate process.
Pancreatic Ducts: Channels that drain secretions from the pancreas into the duodenum.
Hepatic Diverticulum: An endodermal outpouching forming the liver, gallbladder, and part of the bile ducts.
Lead Question (2015):
Tail of pancreas develops from –
a) Hepatic diverticulum
b) Dorsal pancreatic duct
c) Ventral pancreatic duct
d) All of the above
Explanation:
The **tail of the pancreas** develops from the **dorsal pancreatic bud**, which originates as an outgrowth from the dorsal wall of the duodenum. It forms the body and tail of the pancreas, while the ventral bud gives rise to the uncinate process and inferior head. The hepatic diverticulum is unrelated. Answer: b) Dorsal pancreatic duct.
1)
Which embryological structure gives rise to the major part of the pancreas?
a) Ventral pancreatic bud
b) Dorsal pancreatic bud
c) Hepatic diverticulum
d) Common bile duct
Explanation:
The **dorsal pancreatic bud** forms the majority of the pancreas, including the upper part of the head, body, and tail. The ventral bud contributes only to the lower part of the head and uncinate process. The dorsal bud appears first and fuses later during rotation. Answer: b) Dorsal pancreatic bud.
2)
Which of the following parts of the pancreas is derived from the ventral pancreatic bud?
a) Tail
b) Body
c) Uncinate process
d) Neck
Explanation:
The **ventral pancreatic bud** gives rise to the inferior portion of the head and the **uncinate process**. During development, it rotates posteriorly to fuse with the dorsal bud. The dorsal bud contributes to the remainder of the pancreas, including the body and tail. Answer: c) Uncinate process.
3)
Which duct mainly drains the body and tail of the pancreas?
a) Duct of Wirsung
b) Duct of Santorini
c) Bile duct
d) Accessory hepatic duct
Explanation:
The **duct of Santorini** (accessory pancreatic duct) usually drains the dorsal part of the pancreas, including the body and tail, into the minor duodenal papilla. The main duct (Wirsung) drains the ventral part. Variations exist among individuals. Answer: b) Duct of Santorini.
4)
During development, the ventral pancreatic bud rotates around which structure to fuse with the dorsal bud?
a) Common bile duct
b) Portal vein
c) Duodenum
d) Hepatic artery
Explanation:
The **ventral pancreatic bud** rotates dorsally and to the left **around the duodenum**, bringing it into contact with the dorsal bud. This fusion forms the definitive pancreas, with the ducts joining to create the main pancreatic duct. Answer: c) Duodenum.
5)
In normal development, fusion of pancreatic buds results in formation of –
a) Accessory pancreatic duct
b) Main pancreatic duct
c) Hepatic duct
d) Cystic duct
Explanation:
When the **ventral and dorsal buds** fuse, their ducts also join to form the **main pancreatic duct (duct of Wirsung)**. This duct drains the major portion of the pancreas into the major duodenal papilla. Answer: b) Main pancreatic duct.
6) (Clinical)
A newborn presents with bilious vomiting. Imaging shows pancreatic tissue encircling the duodenum. Which developmental abnormality is this?
a) Pancreas divisum
b) Annular pancreas
c) Agenesis of pancreas
d) Pancreatic cyst
Explanation:
**Annular pancreas** occurs when the ventral pancreatic bud splits and encircles the duodenum, constricting it. This can cause duodenal obstruction and bilious vomiting in newborns. It’s often associated with Down syndrome. Surgical correction may be required. Answer: b) Annular pancreas.
7) (Clinical)
A 45-year-old patient with recurrent pancreatitis shows two separate ducts draining into the duodenum. What is the diagnosis?
a) Annular pancreas
b) Pancreas divisum
c) Agenesis of dorsal pancreas
d) Pancreatic carcinoma
Explanation:
**Pancreas divisum** results from failure of fusion between dorsal and ventral pancreatic ducts, leaving two separate drainage channels. The dorsal duct empties into the minor papilla and may cause recurrent pancreatitis due to inadequate drainage. Answer: b) Pancreas divisum.
8) (Clinical)
A patient with dorsal pancreatic agenesis is most likely to have deficiency of which pancreatic part?
a) Head
b) Body and tail
c) Uncinate process
d) Inferior head only
Explanation:
In **agenesis of the dorsal pancreas**, the body and tail are absent because they originate from the dorsal bud. The head and uncinate process derived from the ventral bud remain intact. It may lead to diabetes due to loss of islet cells. Answer: b) Body and tail.
9) (Clinical)
A mass in the tail of the pancreas is most likely to compress which structure?
a) Superior mesenteric artery
b) Portal vein
c) Spleen
d) Inferior vena cava
Explanation:
The **tail of the pancreas** lies in close proximity to the **hilum of the spleen** and runs within the splenorenal ligament. Therefore, a tumor in this region can compress or invade the spleen or splenic vessels. Answer: c) Spleen.
10) (Clinical)
During pancreatic surgery, which vessels are related to the tail of the pancreas?
a) Superior mesenteric vessels
b) Splenic vessels
c) Portal vein
d) Hepatic veins
Explanation:
The **tail of the pancreas** lies in close relation to the **splenic artery and vein**, running along the superior border of the gland. These vessels are at risk during splenectomy or distal pancreatectomy, requiring careful dissection. Answer: b) Splenic vessels.
Chapter: Gastrointestinal Tract; Topic: Large Intestine; Subtopic: Haustrations
Keyword Definitions:
Haustrations: Small pouch-like sacculations seen in the colon due to the arrangement of longitudinal muscle bands called taeniae coli.
Taeniae Coli: Three distinct longitudinal bands of smooth muscle present on the colon wall, responsible for haustral formation.
Large Intestine: The distal part of the alimentary canal, responsible for water absorption and fecal formation.
Colonic Movements: Segmental contractions aiding in the mixing and absorption of contents.
Lead Question – 2015
Haustrations are present in –
a) Duodenum
b) Ileum
c) Jejunum
d) Colon
Explanation:
Haustrations are sacculations found only in the colon, formed by tonic contractions of taeniae coli. They increase the surface area for absorption and aid in segmentation movements of feces. The small intestine lacks taeniae coli and therefore has no haustra. The correct answer is d) Colon. Haustrations disappear when taeniae are damaged. (100 words)
1. Segmental contractions in the colon that produce sacculations are termed –
a) Peristalsis
b) Pendular movements
c) Haustral churning
d) Mass movement
2. The three longitudinal muscle bands of the colon are known as –
a) Rugae
b) Haustra
c) Taeniae coli
d) Plicae circulares
3. Loss of haustrations in radiological images is characteristic of –
a) Ulcerative colitis
b) Appendicitis
c) Crohn’s disease
d) Diverticulosis
4. Which segment of large intestine shows most prominent haustrations?
a) Cecum
b) Ascending colon
c) Transverse colon
d) Rectum
5. Which muscle layer forms taeniae coli?
a) Circular muscle
b) Longitudinal muscle
c) Muscularis mucosa
d) Submucosa
6. (Clinical) A 45-year-old patient presents with chronic constipation. Barium enema reveals loss of haustrations. What is the likely diagnosis?
a) Hirschsprung’s disease
b) Ulcerative colitis
c) Crohn’s disease
d) Irritable bowel syndrome
7. (Clinical) During colonoscopy, multiple haustrations are observed. Their absence would indicate –
a) Normal colon
b) Spastic colitis
c) Smooth atonic colon
d) Hyperactive bowel
8. (Clinical) A patient with sigmoid volvulus shows distended haustrated colon loops. This suggests obstruction in –
a) Small intestine
b) Large intestine
c) Duodenum
d) Jejunum
9. (Clinical) Bowel sounds accompanied by visible haustral contractions indicate –
a) Normal colonic motility
b) Paralytic ileus
c) Intestinal perforation
d) Peritonitis
10. (Clinical) Colon losing its haustrations and showing “lead-pipe” appearance on barium enema is typical of –
a) Ulcerative colitis
b) Crohn’s disease
c) Amebic colitis
d) Tubercular colitis
Explanation:
Haustrations, caused by taeniae coli, are unique to the colon and are absent in the rectum and small intestine. Their loss (lead-pipe appearance) signifies chronic mucosal damage, as seen in ulcerative colitis. Functionally, they segment fecal matter to optimize water absorption. The correct answer is a) Ulcerative colitis. (100 words)
Chapter: Pelvis and Perineum; Topic: Perineum; Subtopic: Perineal Body and Its Muscles
Keyword Definitions:
Perineal Body: A fibromuscular node situated between the anal canal and urogenital structures; it provides support to the pelvic floor.
Perineum: The region between the thighs, divided into urogenital and anal triangles.
Superficial Transverse Perineal Muscle: A paired muscle that helps stabilize the perineal body.
Bulbospongiosus Muscle: Surrounds the bulb of the penis or vestibule; compresses the bulb and assists in erection and ejaculation.
Ischiocavernosus Muscle: Covers the crus of the penis or clitoris; aids in erection by compressing venous drainage.
Deep Transverse Perineal Muscle: Lies deep to the superficial perineal pouch; reinforces the perineal body and supports pelvic viscera.
Lead Question – 2015
The muscles attached to perineal body are A/E –
a) Ischiocavernosum
b) Bulbospongiosus
c) Superficial transverse perinea
d) Deep transverse perinea
Explanation:
The perineal body serves as a central attachment for several muscles including bulbospongiosus, superficial and deep transverse perineal, external anal sphincter, and fibers of levator ani. Ischiocavernosus is not attached to the perineal body but to the ischiopubic ramus. The correct answer is a) Ischiocavernosum. Damage to the perineal body can cause pelvic organ prolapse. (100 words)
1. Which muscle contributes most to the integrity of the perineal body?
a) Bulbospongiosus
b) Ischiocavernosus
c) External anal sphincter
d) Superficial transverse perineal
2. The perineal body is located between –
a) Vagina and rectum
b) Urethra and clitoris
c) Anus and coccyx
d) Ischial tuberosities
3. During episiotomy, incision passes through which structure?
a) Perineal body
b) Anal canal
c) Ischiorectal fossa
d) Urogenital diaphragm
4. Damage to perineal body during childbirth may cause –
a) Cystocele
b) Rectocele
c) Both a and b
d) None
5. The perineal body is derived embryologically from –
a) Cloacal membrane
b) Urogenital sinus
c) Cloacal septum
d) Mesonephric duct
6. (Clinical) A postpartum woman develops uterine prolapse. The most likely cause is –
a) Damage to perineal body
b) Uterine artery injury
c) Pubic fracture
d) Vaginal cyst
7. (Clinical) A patient with perineal tear has difficulty in controlling defecation. Which muscle is likely involved?
a) External anal sphincter
b) Ischiocavernosus
c) Bulbospongiosus
d) Coccygeus
8. (Clinical) Which muscle of the perineum is not attached to perineal body?
a) Ischiocavernosus
b) Bulbospongiosus
c) Deep transverse perineal
d) External anal sphincter
9. (Clinical) A 35-year-old woman presents with weakened pelvic floor after multiple deliveries. Which structure provides major central support?
a) Perineal body
b) Perineal membrane
c) Pubic symphysis
d) Ischial tuberosities
10. (Clinical) A midline perineal incision that preserves the anal sphincter but relieves childbirth stress is called –
a) Median episiotomy
b) Mediolateral episiotomy
c) Perianal incision
d) Transverse perineotomy
Explanation:
The perineal body is the central point of the perineum where major muscles converge, providing essential pelvic support. It is attached to bulbospongiosus, superficial and deep transverse perineal, and external anal sphincter. Ischiocavernosus is not attached. Median episiotomy passes through the perineal body. Correct answer: a) Median episiotomy. (100 words)
Chapter: Urogenital System; Topic: Urinary Bladder; Subtopic: Development of Trigone
Keyword Definitions:
Trigone of Urinary Bladder: A smooth triangular area located at the base of the urinary bladder between the openings of the ureters and urethra.
Urinary Bladder: A hollow muscular organ that stores urine temporarily before expulsion.
Mesoderm: The middle germ layer of the embryo giving rise to muscles, bones, and connective tissues.
Endoderm: The innermost germ layer forming the epithelial lining of most internal organs.
Urachus: A fibrous remnant of the allantois connecting the bladder to the umbilicus during fetal life.
Lead Question – 2015
Trigone of urinary bladder develops from:
a) Mesoderm
b) Ectoderm
c) Endoderm of urachus
d) None of the above
Explanation:
The trigone of the urinary bladder develops from the mesoderm of the absorbed caudal ends of the mesonephric ducts, whereas the rest of the bladder wall is derived from the endoderm of the urogenital sinus. This embryological dual origin explains its different mucosal appearance. The correct answer is a) Mesoderm. Trigone smoothness contrasts with the folded mucosa elsewhere. (100 words)
1. The rest of the urinary bladder (excluding trigone) develops from –
a) Endoderm of urogenital sinus
b) Mesoderm of mesonephric ducts
c) Ectoderm of cloaca
d) Neural crest cells
2. The epithelial lining of urinary bladder is derived from –
a) Endoderm
b) Mesoderm
c) Ectoderm
d) Neuroectoderm
3. The trigone is related embryologically to which ducts?
a) Mesonephric ducts
b) Paramesonephric ducts
c) Wolffian and Müllerian ducts
d) Ureteric bud only
4. Which of the following muscles forms the wall of urinary bladder?
a) Detrusor muscle
b) Trigonal sphincter
c) Levator ani
d) Internal oblique
5. Which epithelium lines the urinary bladder?
a) Transitional epithelium
b) Stratified squamous
c) Pseudostratified columnar
d) Cuboidal
6. (Clinical) A newborn presents with patent urachus and urine leakage from umbilicus. The embryological defect involves –
a) Incomplete closure of allantoic duct
b) Failure of ureteric bud formation
c) Malformation of cloacal septum
d) Agenesis of mesonephric duct
7. (Clinical) A child with recurrent urinary infection has smooth mucosa over trigone but folds elsewhere. This indicates –
a) Normal development
b) Trigonal agenesis
c) Vesicoureteral reflux
d) Urachal cyst
8. (Clinical) A patient with duplication of ureter likely had abnormal development of –
a) Mesonephric duct
b) Metanephric blastema
c) Allantois
d) Cloacal membrane
9. (Clinical) In females, part of mesonephric duct contributing to trigone later forms –
a) Gartner’s duct
b) Bartholin’s gland
c) Skene’s gland
d) Urethral crest
10. (Clinical) A 50-year-old man has bladder neck carcinoma involving the trigone. The tumor likely arises from cells of –
a) Mesodermal origin
b) Endodermal origin
c) Ectodermal origin
d) Neural crest origin
Explanation:
The trigone is mesodermal, derived from incorporated portions of the mesonephric ducts. The rest of the bladder is endodermal from the urogenital sinus. In males, mesonephric duct remnants may form the ejaculatory ducts; in females, they persist as Gartner’s ducts. The correct answer is a) Mesodermal origin. This dual embryonic origin explains its unique structure. (100 words)
Chapter: Pelvis and Perineum; Topic: Rectum; Subtopic: Relations of the Rectum
Keyword Definitions:
• Rectum: The terminal part of the large intestine that stores feces before defecation.
• Rectovesical pouch: A peritoneal reflection between the rectum and the urinary bladder in males.
• Seminal Vesicle: Paired glands posterior to the bladder producing seminal fluid.
• Ductus Deferens: A muscular tube conveying sperm from epididymis to ejaculatory duct.
• Sacrum: Large triangular bone forming posterior wall of pelvis.
Lead Question – 2015
Anterior relation to upper part of rectum in male is –
a) Rectovesical pouch
b) Sacrum
c) Seminal vesicle
d) Ductus deferens
Explanation:
The upper one-third of the rectum in males is covered anteriorly by peritoneum reflected onto the bladder, forming the rectovesical pouch. This pouch may contain loops of the small intestine or sigmoid colon. It is the most dependent part of the peritoneal cavity in males when supine. The correct answer is a) Rectovesical pouch. (100 words)
1. The posterior relation of the upper part of the rectum is –
a) Sacrum and coccyx
b) Bladder
c) Prostate
d) Ureter
Explanation:
The posterior aspect of the rectum throughout its length is related to the concavity of the sacrum and coccyx. It lies over the median sacral vessels and sympathetic trunks. The presacral fascia separates the rectum from these structures. This relation helps surgeons identify the presacral venous plexus during pelvic operations. The correct answer is a) Sacrum and coccyx. (100 words)
2. Which structure lies anterior to the lower third of rectum in males?
a) Prostate gland
b) Seminal vesicle
c) Rectovesical pouch
d) Urinary bladder
Explanation:
The anterior relation of the lower third of the rectum in males is the prostate gland and the posterior surface of the urethra. This part of the rectum is devoid of peritoneal covering and is separated from the prostate by the rectovesical fascia (Denonvilliers’ fascia). Digital rectal examination often assesses prostate health. The correct answer is a) Prostate gland. (100 words)
3. In females, the peritoneal reflection between rectum and uterus is called –
a) Rectouterine pouch (Pouch of Douglas)
b) Vesicouterine pouch
c) Rectovesical pouch
d) Pararectal fossa
Explanation:
In females, the peritoneal reflection between the rectum and uterus forms the rectouterine pouch, also known as the Pouch of Douglas. It is the lowest point of the peritoneal cavity in standing position and a common site for fluid collection, such as pus or blood. The correct answer is a) Rectouterine pouch (Pouch of Douglas). (100 words)
4. The lowest part of the peritoneal cavity in males when standing is –
a) Rectovesical pouch
b) Paracolic gutter
c) Hepatorenal pouch
d) Vesicouterine pouch
Explanation:
In males, the rectovesical pouch lies between the rectum and urinary bladder and forms the lowest part of the peritoneal cavity when standing upright. Any intraperitoneal fluid or pus tends to accumulate here, which can be clinically drained through the anterior rectal wall. The correct answer is a) Rectovesical pouch. (100 words)
5. The middle third of the rectum in males is related anteriorly to –
a) Seminal vesicles and ductus deferens
b) Rectovesical pouch
c) Prostate gland
d) Urinary bladder
Explanation:
The anterior relation of the middle third of the rectum in males is the seminal vesicles and the terminal parts of the ductus deferens. This portion is not covered by peritoneum. These structures lie within the rectovesical fascia. Understanding this anatomy helps prevent damage to reproductive organs during rectal or pelvic surgeries. The correct answer is a) Seminal vesicles and ductus deferens. (100 words)
6. (Clinical) During rectal examination, a firm swelling felt anteriorly through rectal wall in a male most likely involves –
a) Prostate gland
b) Coccyx
c) Seminal vesicle
d) Rectal wall only
Explanation:
A firm swelling palpable through the anterior rectal wall in a male is most commonly the prostate gland. It is examined digitally via the rectum to assess its size, consistency, and surface. Enlargement or nodularity may indicate benign prostatic hypertrophy or carcinoma. The correct answer is a) Prostate gland. (100 words)
7. (Clinical) A patient with pelvic peritonitis in males would accumulate fluid in –
a) Rectovesical pouch
b) Rectouterine pouch
c) Pararectal fossa
d) Ischiorectal fossa
Explanation:
In males, the most dependent peritoneal recess is the rectovesical pouch, lying between the rectum and urinary bladder. Any intraperitoneal infection or rupture of an abdominal viscus may lead to pus or fluid collecting here. It can be drained via the rectum without opening the abdominal cavity. The correct answer is a) Rectovesical pouch. (100 words)
8. (Clinical) Rectal carcinoma involving the upper part of rectum may spread to which peritoneal space first?
a) Rectovesical pouch
b) Paracolic gutter
c) Vesicouterine pouch
d) Hepatorenal pouch
Explanation:
Carcinoma of the upper part of the rectum can infiltrate through the peritoneum into the rectovesical pouch in males or rectouterine pouch in females. These spaces are the most dependent areas of the peritoneal cavity where malignant cells or ascitic fluid may collect. The correct answer is a) Rectovesical pouch. (100 words)
9. (Clinical) During surgery, the rectovesical pouch is approached by –
a) Incision through the peritoneum between bladder and rectum
b) Posterior incision near sacrum
c) Cutting prostate capsule
d) Opening anal canal
Explanation:
To access the rectovesical pouch surgically, an incision is made through the peritoneum located between the posterior surface of the bladder and the anterior surface of the rectum. This approach allows drainage of abscesses or fluids without disturbing other pelvic viscera. The correct answer is a) Incision through peritoneum between bladder and rectum. (100 words)
10. (Clinical) A man with peritoneal fluid collection in the pelvis is positioned head down (Trendelenburg). The fluid will move away from –
a) Rectovesical pouch
b) Subphrenic space
c) Hepatorenal pouch
d) Pelvic cavity
Explanation:
In the Trendelenburg position, the head is lower than the pelvis, causing peritoneal fluid to flow from the pelvic cavity toward the upper abdomen. This maneuver moves fluid away from the rectovesical pouch and aids in pelvic surgeries by displacing intestines upward. The correct answer is a) Rectovesical pouch. (100 words)
Chapter: Male Reproductive System; Topic: Seminal Vesicles; Subtopic: Anatomy and Physiology
Keyword Definitions:
Seminal Vesicles: Paired glands posterior to bladder producing about 60% of seminal fluid rich in fructose and prostaglandins.
Fructose: A sugar that provides energy for sperm motility.
Prostate: A gland surrounding the urethra contributing secretions to semen.
Seminal Fluid: The liquid medium in which sperm are transported during ejaculation.
Lead Question - 2015 & 2012
FALSE for seminal vesicles:
a) Contains large amount of fructose
b) Stores sperms
c) Situated on either side near prostate
d) Secretion of seminal vesicle gives mucoid consistency to semen
Explanation:
Answer: b) Stores sperms
Seminal vesicles do not store sperms; they secrete a fructose-rich, alkaline fluid that nourishes sperm and forms a major portion of semen. The sperm are stored mainly in the epididymis and vas deferens. The secretion from seminal vesicles adds volume, viscosity, and nutrients to semen, ensuring sperm viability and motility during ejaculation.
1. Seminal vesicles open into which structure?
a) Ejaculatory duct
b) Prostatic urethra
c) Membranous urethra
d) Bulbourethral gland
Explanation:
Answer: a) Ejaculatory duct
The duct of each seminal vesicle joins the ductus deferens to form the ejaculatory duct, which passes through the prostate to open into the prostatic urethra. This junction allows seminal vesicle secretions to mix with sperm from the vas deferens before ejaculation, contributing to semen composition and pH regulation.
2. The secretion of seminal vesicle is rich in:
a) Protein
b) Fructose
c) Glucose
d) Urea
Explanation:
Answer: b) Fructose
Seminal vesicle secretion is rich in fructose, which provides an energy source for spermatozoa. It also contains prostaglandins and clotting proteins. Fructose is essential for sperm motility, enabling the sperm to survive and move through the female reproductive tract. Deficiency of fructose may result in reduced fertility.
3. Which of the following is NOT secreted by seminal vesicles?
a) Prostaglandins
b) Fructose
c) Fibrinogen
d) Spermine
Explanation:
Answer: d) Spermine
Spermine is secreted by the prostate gland, not by seminal vesicles. Seminal vesicles mainly secrete fructose, prostaglandins, and fibrinogen-like proteins, contributing to semen coagulation and nourishment of sperm. These secretions enhance sperm survival and facilitate fertilization by supporting sperm motility in the female tract.
4. Clinical: A 35-year-old male with ejaculatory duct obstruction shows low semen volume but normal sperm count. Which gland is likely affected?
a) Prostate
b) Seminal vesicle
c) Bulbourethral gland
d) Epididymis
Explanation:
Answer: b) Seminal vesicle
Seminal vesicle obstruction leads to decreased semen volume as it produces nearly 60% of seminal fluid. Sperm count remains normal because sperm production occurs in the testes. Obstruction can result in infertility due to reduced seminal plasma volume and decreased fructose concentration affecting sperm motility and energy supply.
5. The ejaculatory duct is formed by the union of:
a) Vas deferens and urethra
b) Vas deferens and duct of seminal vesicle
c) Epididymis and vas deferens
d) Urethra and prostate
Explanation:
Answer: b) Vas deferens and duct of seminal vesicle
Each ejaculatory duct is formed by the union of the ampulla of vas deferens and the duct of seminal vesicle. This duct passes through the prostate and opens into the prostatic urethra. Its main function is to transport semen during ejaculation by combining sperm with seminal vesicle fluid.
6. Clinical: A patient with congenital absence of seminal vesicles will have which of the following abnormalities?
a) Azoospermia
b) Low semen fructose
c) High semen volume
d) Increased sperm motility
Explanation:
Answer: b) Low semen fructose
Seminal vesicles are the major source of fructose in semen. Absence of seminal vesicles results in low fructose concentration, leading to reduced sperm motility and fertility issues. Sperm production remains unaffected because spermatogenesis occurs in testes, but sperm lose the nutrient-rich environment necessary for effective fertilization.
7. Seminal vesicle lies posterior to:
a) Urinary bladder
b) Prostate
c) Rectum
d) Pubic symphysis
Explanation:
Answer: a) Urinary bladder
Seminal vesicles are paired sac-like glands located posterior to the urinary bladder and anterior to the rectum. Their ducts join the vas deferens to form ejaculatory ducts. Their location is clinically important in rectal examinations, as enlargement or tenderness may indicate inflammation or obstruction of seminal vesicles.
8. Clinical: During prostatectomy, damage to seminal vesicles may result in:
a) Impotence
b) Reduced semen volume
c) Testicular atrophy
d) Urinary retention
Explanation:
Answer: b) Reduced semen volume
Seminal vesicles contribute significantly to semen volume. Surgical injury or removal can drastically reduce seminal fluid secretion, leading to low semen volume and infertility. However, it does not directly cause impotence since erection is mediated by neural mechanisms and vascular function, not seminal secretion.
9. Which of the following statements about seminal vesicles is FALSE?
a) They are paired glands
b) They lie anterior to rectum
c) Their secretion contains sperm
d) They open into ejaculatory duct
Explanation:
Answer: c) Their secretion contains sperm
Seminal vesicles do not contain sperm; sperm come from testes via vas deferens. Seminal vesicles contribute secretions that nourish and activate sperm. These secretions mix with sperm only after reaching ejaculatory ducts, forming semen just before ejaculation. Thus, the glands themselves contain no spermatozoa.
10. Seminal vesicle secretion contributes to semen alkalinity due to presence of:
a) Citric acid
b) Phosphates and bicarbonates
c) Lactic acid
d) Cholesterol
Explanation:
Answer: b) Phosphates and bicarbonates
Seminal vesicle secretion contains alkaline substances like bicarbonates and phosphates, which neutralize the acidic environment of the female vagina. This ensures sperm viability and enhances motility. The alkaline nature of seminal fluid is crucial for maintaining optimal pH for fertilization and preventing sperm damage.
11. Clinical: Infection of seminal vesicles is known as:
a) Vesiculitis
b) Epididymitis
c) Orchitis
d) Prostatitis
Explanation:
Answer: a) Vesiculitis
Vesiculitis refers to inflammation of the seminal vesicles, commonly due to bacterial infections spreading from the prostate or urethra. Symptoms include painful ejaculation, fever, and hematospermia (blood in semen). Chronic vesiculitis can affect semen composition and fertility due to impaired secretion and altered pH balance.
Chapter: Hepatobiliary System; Topic: Gall Bladder; Subtopic: Nerve Supply and Clinical Anatomy
Keyword Definitions:
Gall Bladder: A pear-shaped organ beneath the liver that stores and concentrates bile.
Cystic Duct: Connects the gall bladder to the common bile duct, allowing bile flow.
Vagus Nerve: The tenth cranial nerve that supplies parasympathetic fibers to thoracic and abdominal organs.
Phrenic Nerve: A mixed nerve that carries sensory fibers to the diaphragm and peritoneum.
Lead Question - 2015
Sensory nerve supply of gall bladder is through -
a) Vagus nerve
b) Trigeminal nerve
c) Parasympathetic nerve
d) Facial nerve
Explanation:
Answer: a) Vagus nerve
The gall bladder receives sensory innervation primarily via the right phrenic nerve and vagus nerve. The vagus nerve mediates visceral sensations such as distension or inflammation. Pain from gall bladder disease is often referred to the right shoulder due to shared sensory pathways with the diaphragm via the phrenic nerve. Both autonomic and sensory components interact to coordinate gall bladder function.
1. Which of the following nerves carries referred pain from the inflamed gall bladder to the right shoulder?
a) Vagus nerve
b) Phrenic nerve
c) Hypoglossal nerve
d) Glossopharyngeal nerve
Explanation:
Answer: b) Phrenic nerve
Referred pain from gall bladder inflammation (cholecystitis) is transmitted via the phrenic nerve, whose sensory fibers supply the diaphragm. The brain interprets pain from the diaphragm as originating in the shoulder region, a phenomenon known as referred pain. This link explains right shoulder discomfort in gall bladder disease.
2. Parasympathetic stimulation of gall bladder causes -
a) Relaxation
b) Contraction
c) No effect
d) Pain
Explanation:
Answer: b) Contraction
Parasympathetic fibers from the vagus nerve stimulate gall bladder contraction, particularly during digestion. The release of cholecystokinin from the duodenum enhances this action, leading to bile ejection into the duodenum. Coordinated contraction and relaxation of the sphincter of Oddi ensure efficient bile flow and fat digestion.
3. Clinical: A 40-year-old woman with gallstones presents with right shoulder pain. Which nerve carries this referred pain?
a) Vagus nerve
b) Phrenic nerve
c) Intercostal nerve
d) Thoracodorsal nerve
Explanation:
Answer: b) Phrenic nerve
Gallstones cause irritation of the gall bladder and diaphragm, which share sensory input via the phrenic nerve. This results in referred pain to the right shoulder. The vagus nerve mediates visceral sensations but not the somatic referral pathway. This pattern helps distinguish biliary pain from other abdominal causes.
4. Which artery supplies the gall bladder?
a) Hepatic artery proper
b) Cystic artery
c) Gastroduodenal artery
d) Inferior mesenteric artery
Explanation:
Answer: b) Cystic artery
The cystic artery, usually a branch of the right hepatic artery, supplies the gall bladder. It divides into superficial and deep branches, nourishing both surfaces. Knowledge of its anatomical variation is essential during cholecystectomy to prevent hemorrhage or ischemia. Proper ligation of the cystic artery is a crucial surgical step.
5. Clinical: In cholecystitis, which nerve is responsible for localized pain in the right upper quadrant?
a) Phrenic nerve
b) Intercostal nerves (T7–T9)
c) Vagus nerve
d) Sympathetic chain
Explanation:
Answer: b) Intercostal nerves (T7–T9)
Localized right upper quadrant pain in cholecystitis arises due to somatic afferents carried by intercostal nerves T7–T9 supplying the parietal peritoneum. When the inflamed gall bladder irritates the overlying peritoneum, pain becomes sharp and localized. Deeper visceral pain remains dull and referred to the epigastrium.
6. The motor supply to the gall bladder comes from -
a) Sympathetic nerves
b) Parasympathetic nerves via vagus
c) Phrenic nerve
d) Somatic nerves
Explanation:
Answer: b) Parasympathetic nerves via vagus
Motor innervation to the gall bladder is provided by parasympathetic fibers from the vagus nerve. These fibers cause contraction of the gall bladder and relaxation of the sphincter of Oddi during digestion. This mechanism is essential for bile release in response to fatty meal intake.
7. Clinical: During laparoscopic cholecystectomy, which nerve may cause referred shoulder pain due to CO₂ insufflation?
a) Vagus nerve
b) Phrenic nerve
c) Intercostal nerve
d) Sciatic nerve
Explanation:
Answer: b) Phrenic nerve
CO₂ insufflation irritates the diaphragm, stimulating the phrenic nerve, which refers pain to the shoulder. This transient shoulder pain is common after laparoscopic procedures involving the upper abdomen. Awareness of this mechanism helps reassure patients postoperatively and differentiate it from surgical complications.
8. Sympathetic fibers to gall bladder arise from -
a) T5–T9 via greater splanchnic nerves
b) T10–T12 via lesser splanchnic nerves
c) L1–L2 via hypogastric plexus
d) None
Explanation:
Answer: a) T5–T9 via greater splanchnic nerves
Sympathetic fibers to the gall bladder originate from T5–T9 spinal segments through greater splanchnic nerves. These fibers reach the celiac plexus and regulate vasoconstriction, reducing bile flow during stress. Sympathetic activation inhibits gall bladder contraction and modulates pain perception from visceral organs.
9. Clinical: A patient undergoing vagotomy may experience -
a) Increased gall bladder contraction
b) Decreased gall bladder contraction
c) Increased bile secretion
d) Pain relief
Explanation:
Answer: b) Decreased gall bladder contraction
Vagotomy disrupts parasympathetic supply to the gall bladder, reducing its contractile response to cholecystokinin. Consequently, bile ejection into the duodenum decreases, impairing fat digestion. This effect is rarely significant clinically but demonstrates the vagus nerve’s role in biliary motility control.
10. Pain in the epigastric region from gall bladder disease is mediated by -
a) Vagus and sympathetic nerves
b) Phrenic nerve only
c) Glossopharyngeal nerve
d) Somatic nerves
Explanation:
Answer: a) Vagus and sympathetic nerves
Visceral pain from gall bladder distension or inflammation is transmitted via sympathetic and vagal afferent fibers. These converge in the spinal cord at thoracic levels, resulting in poorly localized epigastric pain. The combined action of these nerves explains the diffuse character of early gall bladder pain before peritoneal irritation develops.
11. Clinical: A patient has pain radiating from right hypochondrium to shoulder during deep inspiration. The affected nerve is -
a) Phrenic nerve
b) Vagus nerve
c) T12 intercostal nerve
d) Lumbar nerve
Explanation:
Answer: a) Phrenic nerve
Inflammation of the gall bladder during inspiration causes stretching of the diaphragm, stimulating the phrenic nerve. This nerve carries sensory fibers to the shoulder via cervical spinal nerves C3–C5. The characteristic radiation of pain to the right shoulder is an important diagnostic feature of acute cholecystitis.
Chapter: Urinary System; Topic: Urinary Bladder; Subtopic: Uvula Vesicae
Keyword Definitions:
Uvula Vesicae: A small elevation in the posterior part of the bladder, near the internal urethral orifice.
Prostate Gland: A male accessory gland located below the urinary bladder, surrounding the prostatic urethra.
Median Lobe: The portion of the prostate between the ejaculatory ducts and urethra, projecting upward beneath the bladder neck.
Lead Question – 2015
Uvula vesicae seen in bladder is formed from the following structure?
a) Median lobe of prostate
b) Lateral lobe of prostate
c) Anterior lobe of prostate
d) Posterior lobe of prostate
Explanation: The uvula vesicae is formed by the submucosal projection produced by the enlargement of the median lobe of the prostate beneath the internal urethral orifice. It plays a role in controlling urinary flow by closing the urethral opening during ejaculation. Hypertrophy of this lobe may obstruct urine flow in elderly males. Hence, the correct answer is a) Median lobe of prostate.
1. The trigone of urinary bladder is derived from:
a) Mesonephric ducts
b) Metanephros
c) Ureteric bud
d) Cloaca
Explanation: The trigone of the bladder develops from the mesonephric ducts, while the rest of the bladder is endodermal in origin from the urogenital sinus. Initially, it is mesodermal but becomes endodermal due to mucosal overgrowth. The trigone region is smooth and non-contractile. Thus, the correct answer is a) Mesonephric ducts.
2. Which artery supplies the superior surface of the urinary bladder?
a) Superior vesical artery
b) Inferior vesical artery
c) Middle rectal artery
d) Internal pudendal artery
Explanation: The superior vesical artery, a branch of the umbilical artery, supplies the upper surface of the bladder. The inferior vesical artery (in males) and vaginal artery (in females) supply the base. These arteries provide vital oxygen and nutrients for bladder wall contraction. Correct answer: a) Superior vesical artery.
3. Clinical case: A 70-year-old male presents with urinary obstruction. The likely cause is hypertrophy of which lobe of the prostate?
a) Median lobe
b) Lateral lobe
c) Anterior lobe
d) Posterior lobe
Explanation: In elderly men, benign prostatic hyperplasia primarily affects the median lobe located beneath the bladder neck. Its enlargement compresses the urethra and causes urinary retention, frequency, and dribbling. Surgical removal of the hypertrophied lobe relieves obstruction. Thus, the correct answer is a) Median lobe.
4. Nerve supply to the urinary bladder includes all EXCEPT:
a) Pelvic splanchnic nerves
b) Hypogastric plexus
c) Pudendal nerve
d) Femoral nerve
Explanation: The bladder receives parasympathetic fibers from pelvic splanchnic nerves (S2-S4), sympathetic fibers from the hypogastric plexus, and somatic fibers from the pudendal nerve. The femoral nerve has no role in bladder control. Thus, the correct answer is d) Femoral nerve.
5. Clinical case: A male with prostate cancer shows invasion into the bladder base. Which area is most affected?
a) Trigone
b) Dome
c) Uvula vesicae
d) Neck
Explanation: In prostate carcinoma, the uvula vesicae and adjacent trigone are often invaded due to close anatomical proximity. This results in urinary obstruction and hematuria. The bladder base lies directly above the prostate, making it prone to infiltration. Thus, the correct answer is c) Uvula vesicae.
6. Which muscle helps to expel the last drops of urine during micturition?
a) Detrusor muscle
b) Compressor urethrae
c) Bulbospongiosus
d) External urethral sphincter
Explanation: The bulbospongiosus muscle aids in expelling the last drops of urine and semen by rhythmic contraction. It surrounds the bulb of the penis and contributes to urethral emptying after bladder contraction. The detrusor muscle empties the main volume, while bulbospongiosus clears the residue. Correct answer: c) Bulbospongiosus.
7. The epithelial lining of urinary bladder is:
a) Simple columnar
b) Stratified squamous
c) Transitional epithelium
d) Pseudostratified columnar
Explanation: The bladder is lined by transitional epithelium (urothelium) that stretches to accommodate varying urine volumes. It appears cuboidal when relaxed and squamous when distended. This flexibility prevents leakage and maintains barrier integrity. Correct answer: c) Transitional epithelium.
8. Clinical case: Pain from bladder distension is referred to which region?
a) Suprapubic
b) Umbilical
c) Epigastric
d) Perineal
Explanation: Bladder distension pain is referred to the suprapubic region due to afferent fibers traveling with pelvic splanchnic nerves (S2-S4). These fibers project to the same dermatomes, producing suprapubic discomfort. Correct answer: a) Suprapubic.
9. The internal urethral sphincter is made up of:
a) Skeletal muscle
b) Smooth muscle
c) Elastic tissue
d) Fibrous tissue
Explanation: The internal urethral sphincter consists of smooth muscle located at the neck of the bladder. It prevents retrograde ejaculation by closing during semen emission. Being involuntary, it is under sympathetic control. Correct answer: b) Smooth muscle.
10. Clinical case: A patient complains of continuous dribbling of urine after prostate surgery. The structure likely damaged is:
a) Internal urethral sphincter
b) External urethral sphincter
c) Detrusor muscle
d) Uvula vesicae
Explanation: The external urethral sphincter provides voluntary control of urination. Injury during prostatectomy leads to urinary incontinence manifested as dribbling. The internal sphincter maintains continence at rest, but voluntary control is lost when the external one is damaged. Correct answer: b) External urethral sphincter.