This document contains a review of pelvis and perineum structures and functions including: 1. A multiple choice question regarding structures at risk of injury during adrenal gland removal. 2. The layer enclosing the adrenal gland when not removed with the kidney during nephrectomy. 3. Expected effects on a boy who develops without FSH release due to anterior pituitary injury. 4. The enzyme deficiency suspected in a newborn with ambiguous genitalia and enlarged adrenals. 5. The typical days of ovulation within a 28-30 day menstrual cycle.

1. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
1) A 43-year-old female is to undergo the removal of the left adrenal
gland. Which one of the following is least likely to be injured during
the procedure?
a. Stomach
b. Pancreas
c. Kidney
d. Inferior vena cava
e. Diaphragm
2) While doing nephrectomy, the adrenal gland will not get removed
with the kidney as it is enclosed in a separate compartment
composed of one of the following layers
a. Renal capsule
b. Renal fascia
c. Perinephric fat
d. Visceral peritoneum
e. Psoas fascia

2. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
3) A boy who has not passed through puberty sustains an injury to his
anterior pituitary such that FSH is no longer released, but LH is normal.
After he grows to maturity, one would expect that he would
a. develop secondary sex characters
b. be sterile
c. have improper functioning of the testicular
interstitial cells
d. have normal spermatogenesis
e. have normal sperm count
4) A newborn was delivered by normal vaginal delivery. Obstetriciaan
noticed that the genitalia were ambiguous with enlarged clitoris
and partially fused labia. The ultrasound abdomen revealed slightly
enlarged adrenals bilaterally. What enzyme deficiency do you
suspect in this patient?
a. 25- Hydroxylase deficiency
b. Peroxidase deficiency
c. 5 alpha reductase
d. 5’- Monodeiodinase deficiency
e. 21- α Hydroxylase deficiency
5) In a woman with regular menstrual cycle of 28 – 30 days, an
obstetrician wants to give the ideal time of ovulation to a lady to
increase her sexual activity at that time. Ovulation is most likely to
occur between cycle days
a. 6 to 8
b. 10 to12
c. 14 to l6
d. 18 to 20
e. 22 to 24
6) Process of ovulation is hormone dependent, a sudden increase in
which of the
following hormone will lead to ovulation?
a. Estrogen
b. Progesterone

3. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
c. LH*
d. FSH
e. Prolactin
7) 30 years old married women consulted a doctor because she has
not been able to conceive for the last five years. Her menstrual
cycle was 28 days with normal flow. Doctor suspects a problem with
ovulation, which one of the following tests would be most helpful for
the clinician during the menstrual cycle?
a. FSH and LH on day 3
b. Day 7 Estradiol
c. Testosterone
d. Day 21 progesterone
e. Prolactin on day 14
8) A 15 years old girl with absence of menstruation, on investigation is
diagnosed as a case of XY female. She is seen to have very low
estrogen levels. This hypoestrogenism will not effect the
development and maturation of
a. Vulva and vagina
b. Fallopian tubes and cervix
c. Breasts and axillary and pubic hair
d. Uterus and endometrium
e. Ovarian tissue
9) A 17-year old girl presented with a complaint of amenorrhea. She
has normal looking breasts and normal pubic hair. She has
rudimentary vagina. A mobile mass is found in each labium majus.
Uterus is not seen on USG. She has one of the following syndromes:
a. Klinefelter
b. Turner
c. Fragile-X
d. Androgen Insensitivity
e. Prader-Willi
10)A 23 years old married woman missed her periods for two
consecutive months and came to see her doctor. She was also

4. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
feeling nauseated especially early in the morning. Her urine test for
pregnancy was positive indicating increased levels of beta hCG
and USG of the pelvic region showed the presence of intrauterine
gestational sac. During early pregnancy, the main function of hCG
is to
a. Nourish the embryo.
b. Stimulate placental growth.
c. Maintains corpus luteum
d. Depress estrogen production.
e. Prevent passage of testosterone to the
developing embryo.
11)During pregnancy once hCG levels are decreased, estrogen and
progesterone are secreted mainly by which of the following organ?
a. Placenta
b. Embryo
c. Corpus leutum
d. Hypothalamus
e. Endometrium
12)The principal steroid secreted by the fetal adrenal cortex is
a. Cortisol
b. Corticosterone
c. Dehydroepiandrosterone
d. Progesterone
e. Pregnenolone
13)Which one of the following conditions experienced by the pregnant
woman may be due to the effects of pregnancy?
a. Increased incidence of heart burn
b. Decreased facial hair
c. Increased gastric emptying
d. Decreased afterload
e. decreased cardiac output

5. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
14)A woman who is 5 weeks pregnant requests the ultrasonologist for
the sex determination of her child. She is asked to come again
because differentiation of external genitalia is completed at one of
the following weeks of development
a. 6th
b. 7th
c. 8th
d. 10th
e. 12th
15)Testosterone deficiency will not affect the development of:
a. Prostate
b. seminal vesicles
c. ejaculatory ducts
d. ductus deferens
e. ductus epididymis
16)Which one of the following cells will not be seen in seminiferous
tubules?
a. Spermatogonium
b. Spermatocyte
c. Spermatid
d. Sertoli
e. Leydig
17)A 22-year-old male presented with solid testicular swelling which
was found to be a tumour. He also had an epigastric mass and a CT
scan showed it to be enlarged lymph nodes. They belong to one of
the following groups of lymph nodes:
a. Para aortic
b. Pre aortic
c. Lumbar
d. Celiac
e. Superior mesenteric
18)A 55-year old patient was undergoing hysterectomy, for a huge
fibroid (uterine tumor). The structure most likely to be damaged
during the procedure is:
a. Ovarian artery
b. Ureter

6. REVIEW OF PELVIS & PERINEUM
Prof. Saeed Shafi
SAHARA MEDICAL COLLEGE
c. Urethra
d. Sigmoid colon
e. Rectum
19)Superficial inguinal lymph nodes were found to be enlarged on a
routine examination of a female patient. One of following structures
is not the source of this lymphadenopathy:
a. Cervix
b. Vagina
c. Uterine fundus
d. Anus
e. Perianal skin
20)A 60-year old woman was diagnosed to have uterovaginal
prolapse (protrusion of uterus and vagina out of introitus). Which
one of the following ligaments is damaged?
a. Transverse cervical
b. Pubocervical
c. Uterosacral
d. Round
e. Broad
21)A 67 years old man is evaluated after being treated for a broken
arm. He sustained a small hairline fracture of the distal ulna after
hitting his arm on the railing. He says it was only a minor bump and
was surprised it caused a fracture. Serum chemistry is remarkable for
elevated calcium and low phosphate and slightly elevated alkaline
phosphatase. What is the most likely abnormality in this patient?
a. Hyperparathyroidism
b. Osteoporosis
c. Paget’s disease of bone
d. Renal insufficiency
e. Vitamin D deficiency