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Chapter 5: Perineum

As part of a preschool physical evaluation of a 5-year-old male, a normal cremasteric reflex is elicited. Which is not associated with the cremasteric reflex?

A. Genitofemoral nerve

B. Middle layer of spermatic fascia

C. Obturator nerve

D. Skin of the proximal, medial thigh

E. Spinal cord segment L1

Answer C. The obturator nerve does not innervate skin of the thigh involved in this reflex and does not provide motor innervation to the cremaster muscle (located in the middle layer of cremasteric fascia).

A 38-year-old male presents with complaints of peri-anal pain. Radiologic imaging reveals a large abscess in contact with the lateral wall of the left ischio-anal fossa. Which of the following contributes to the lateral wall of the ischio-anal fossa?

A. Fascia of obturator internus muscle

B. Levator ani muscle

C. Perineal membrane

D. Piriformis muscle

E. Skin

Answer A. The lateral wall of the ischioanal fossa is formed by the muscular fascia covering obturator internus muscle.

A 13-year-old boy is brought to the pediatric clinic with concerns about the progressive enlargement of his scrotum. Transillumination of the scrotum reveals a testicular hydrocele. Which structure would not be penetrated by a needle used to drain the hydrocele?

A. Cremasteric fascia

B. Dartos fascia

C. External spermatic fascia

D. Parietal layer of tunica vaginalis

E. Tunica albuginea

Answer B. The fluid of the hydrocele lies external to the testicle. In this patient, the fluid within the hydrocele "communicates" with the peritoneal cavity via the patent processus vaginalis. The tunica albuginea is the capsule of the testicle and lies internal to the processus vaginalis.

A female patient presents with complaints of severe anal pain during defecation. Physical examination reveals enlarged superficial inguinal lymph nodes, which drain the inferior part of the anal canal. Which structure would not have lymph drainage into these nodes?

A. Camper fascia of right lower abdominal quadrant

B. Clitoris

C. Inferior one-third of rectum


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