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Chapter 4: Pelvis

During a pelvic examination, an Ob/Gyn resident distinguishes a pulse adjacent to the lateral vaginal fornix. This is the pulse in the:

A. Internal iliac artery

B. Internal pudendal artery

C. Ovarian artery

D. Uterine artery

E. Vaginal artery

Answer D. The uterine artery courses within the transverse cervical (cardinal) ligament along the inferior portion of the mesometrium of the broad ligament. The artery reaches the uterus near the junction of the body with the cervix. This position places the artery near the lateral part of the vaginal fornix.

During digital rectal examination of a male, an urologist evaluates structures on the postero-inferior surface of the urinary bladder. Which paired structures are closest to the midline?

A. Ampullae of the ducta deferens (vasa deferentia)

B. Superior vesicle arteries

C. Seminal glands

D. Superior rectal (anal) arteries

E. Ureters

Answer A. From the deep inguinal ring, the vas deferens from either side descends across the pelvic brim, crosses superior to the ureter, and lies on the posterior surface of the urinary bladder. The ampullae of the vasa deferentia, the dilated, terminal portions of these ducts, lie near the midline.

Imaging reveals a collection of fluid in the pelvic portion of the peritoneal cavity of a 39-year-old female. To sample the fluid, a sterile needle is introduced into the peritoneal cavity by piercing the wall of the posterior vaginal fornix. Properly placed, the tip of the needle should be in which part of the peritoneal cavity?

A. Left paracolic gutter

B. Lesser sac (omental bursa)

C. Rectouterine pouch (cul-de-sac)

D. Rectovesical pouch

E. Vesico-uterine pouch

Answer C. The most inferior portion of the greater sac of the peritoneal cavity is the rectouterine pouch (Douglas), also known as the cul-de-sac. It is formed as peritoneum reflects from the uterus onto the middle portion of the rectum. This pouch lies adjacent to the posterior vaginal fornix.

During a follow-up appointment 30 days after transurethral resection of his prostate, a 63-year-old male relates that he is now impotent. The perivascular nerve plexus that lies just outside the ...

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