This Copy is for Dr.

Mohamed ElHodiby
 STRATOG 2015 SBA

Anatomy
Question 1 of 36

What is the lymphatic drainage of the ovaries?

A Common iliac nodes

B External iliac and superficial iliac nodes via the round ligament
C External iliac nodes
D Internal iliac nodes
E Lateral aortic and preaortic nodes Correct

The answer is lateral aortic and preaortic nodes. It is useful to remember the following: the
bladder drains to the external iliac nodes; the urethra drains to the internal iliac nodes; the
fallopian tubes and fundus uteri drain to the external iliac and superficial iliac nodes via the
round ligament; and the cervix drains to the external and internal iliac, rectal and sacral nodes
andoccasionally obturator nodes.

Question 2 of 36

A 30yearold woman has developed haematuria, pain and reduced urine output on day 3
following a total abdominal hysterectomy. A urine dipstick showed red blood cells but no
nitrites. An Xray of the pelvis was unremarkable. What is the most likely diagnosis?

A Bladder injury
B Intraabdominal
C bleeding
D Ureteric stone
E Ureteric trauma Correct
F Urinary tract infection

The answer is ureteric trauma. While intraabdominal bleeding may be associated with these
signs, it is more likely to present at an earlier stage, as would significant bladder injury. The
unremarkable pelvic Xray makes ureteric stone unlikely, while the absence of nitrites makes
urinary tract infection unlikely.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 3 of 36

You have been asked to suture a deep episiotomy by a midwife. On examination you notice
that the external anal sphincter is mostly torn, with a few fibres left intact. The internal anal
sphincter is intact. How would this tear be described?

A Seconddegree tear
B Thirddegree tear, 3a
C Thirddegree tear, 3b Correct
D Thirddegree tear, 3c
E Fourthdegree tear

The correct answer is thirddegree tear, 3b. 3a: less than 50% external anal sphincter
involvement. 3b: more than 50% external anal sphincter involvement. 3c: both external and
internal sphincter involvement. It is essential that the appropriate diagnosis is made. A
thirddegree tear should be repaired in theatre under adequate light and by a trained surgeon.

Question 4 of 36

A 65yearold woman underwent vaginal surgery for which she was in the lithotomy position
for 2 ½ hours. Postoperatively you have noticed parasthesia of the lateral side of the leg, foot
and foot drop. The compression of which nerve is likely to be responsible?

A Common peroneal nerve Correct

B Femoral nerve
C Great saphenous nerve
D Obturator nerve
E Pudendal nerve

The answer is common peroneal nerve. The injury is thought to be secondary to compression of
the nerve between the lateral head of the fibula and the bar holding the legs. When the stirrups
are used, special attention must be paid in order to avoid compression. Injury to the femoral
nerve will cause hypoesthesia in the anterior and anteromedial area on the thigh below the
inguinal ligament.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

Question 5 of 36

Which artery is a direct branch of the aorta?

A Inferior vesical
B Internal iliac
C Ovarian Correct
D Uterian
E Vaginal

The answer is ovarian. The ovarian artery is a branch of the aorta. It arises anterolaterally just
below the renal artery, running retroperitoneally to leave the abdomen by crossing the
common or external iliac artery in the infundibulopelvic fold. It crosses corresponding ureters
and supplies twigs to it but does not supply to abdominal organs. The internal iliac artery arises
from the common iliac and its inferior branch further supplies to the pelvis.

Question 6 of 36

A 28yearold woman presents to the gynaecology clinic with a history of dysmenorrhoea,

dysparunia and menorrhagia. A vaginal examination reveals a thickened nodule in the
posterior fornix. Which anatomical structure is most likely to be affected?

A Constipated bowel
B Ovaries
C Pectineal ligaments
D Ureter
E Uterosacral ligaments Correct

The answer is the uterosacral ligament. The above trio of symptoms is characteristic of
endometriosis. It is possible to palpate the affected uterosacral ligament by vaginal
examination.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 7 of 36

What is the most serious risk associated with the insertion of a Veress needle through the
umbilicus in a thin patient, an outcome that is unlikely with the Hasan entry technique?

A Bowel perforation
B Damage to liver
C Damage to ureters
D Inferior epigastric artery injury
E Vascular injury Correct

The answer is vascular injury. The aorta, inferior vena cava and common iliac arteries are put at
risk with the insertion of the Veress needle. The open entry technique is considered to be safer
in this matter. The risk of bowel damage is not completely avoided using the open entry
technique. The common iliac artery arises from the aorta on the left side of the fourth lumbar
vertebra and divulges acutely. The inferior vena cava lies behind the right common iliac vessel.
In a thin patient, the major blood vessels are only a few centimetres away and are particularly
at risk with a Veress entry.

Question 8 of 36

Which structure is lined by nonkeratinised stratified squamous epithelium?

A Endocervix
B Fallopian tubes
C Skin
D Ureters
E Vagina Correct

The answer is the vagina. The endocervix is lined by columnar epithelium. Skin is lined by
keratinised squamous epithelium. The fallopian tubes are lined by ciliary, and ureters by
transitional epithelium.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 9 of 36

Ischemic injury to the pelvic ureter may be caused by which one of the following arteries?

A Aorta
B Common iliac artery
C Inferior vesical artery Correct
D Renal artery
E Uterine artery

The correct answer is the inferior vesical artery.

Question 10 of 36

A 20yearold
woman presents with a painful lump in the vagina. The examination confirms Bartholin’s
abscess. Which one of the following glands is involved?

A Bulbourethral glands (Cowper’s)

B Glands of skini
C Greater vestibular gland Correct
D Lesser vestibular gland
E Seminal vescicle

The answer is the greater vestibular (Bartholin’s) gland. These are small paired glands located in
the superficial perineal pouch. They are partially covered by posterior portions of the bulb of
the vestibule and the bulbospongiousus muscles. The duct opens into the vestibule between
the hymen and the labium minus. These glands provide lubrication at the introitus. Bartholin’s
abscess may occur due to infection and blockage of these glands.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 11 of 36

A baby delivered after shoulder dystocia was diagnosed to have Erb’s palsy. Which
component of the brachial plexus is most likely to be involved?

A C5
B C5, C6 Correct
C C7, C8
D C7, C8, T1
E C8, T1

The answer is C5, C6. Brachial plexus injury is a known complication of difficult delivery and
shoulder dystocia. It results from excessive stretch to the brachial plexus nerve roots. Generally
the type of the nerve injury is neuropraxia and leads to complete recovery. The classic picture is
the 'waiter's tip' posture of the hand. It involves adduction and internal rotation of the
shoulder, along with pronation and extension of forms.

Question 12 of 36

The lower third of the vagina has lymphatic drainage to which nodes?

A Common iliac nodes

B External iliac nodes
C Internal iliac nodes
D Paraaortic nodes
E Superficial inguinal nodes Correct

The answer is the superficial inguinal nodes. Remember the embryological difference between
the lower onethird of the vagina and the upper twothirds.The upper part is derived from the
fused mesonephric ducts, and the lower onethird from canalisation of the ectodermal
thickening.The upper twothirds of the vagina drain to the internal and external nodes.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 13 of 36

Sympathetic supply to the bladder is derived from which lumbar segments?

A L1 and L2 Correct
B L2 and L3
C L3 and L4
D L4 and L5
E S2 , S3 and S4

The answer is L1 and L2. Nerve root supply for pelvic organs is a common single best answer
examination question. It is worth drawing a table for each of the main pelvic organs and writing
down the artery, venous, lymphatic and nerve supply. Note that the parasympathetic supply for
the bladder comes from S2, S3 and S4 but the sympathetic is as above. Sensory nerves are
found in both supplies.

Question 14 of 36

Which three muscles form the superficial group of muscles of the perineum?

A Bulbospongiosus, superficial transverse perineal muscle, and ischiocavernous Correct

B Deep transverse perineal muscle, external anal sphincter, and bulbospongiosus
C External vaginal sphincter, deep transverse perineal muscle, and external anal sphincter
D Iliococceageus, ischiocavernosus, and bulbospongiosus
E Levator ani, ischiocavernous, and bulbospongiosus

The answer is bulbospongiosus, superficial transverse perineal muscle and ischiocavernous.

These three muscles make up the superficial group of perineal muscles. The bulbospongiosus is
superficial to the Bartholin's glands.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 15 of 36

The inferior hypogastric plexus is an important plexus supplying the hind gut. What are its
nerve root origins?

A T8–T12 and L1–L3

B T10–12 and L1–L2 Correct
C S2–S4
D L4–L5 and S1–S4
E L3–L5

The answer is T10–12 and L1–L2. The inferior hypogastric plexus is a continuation of both
hypogastric nerves. It is derived from the lower three thoracic and upper two lumbar segments.
The parasympathetic and sympathetic supply of this plexus effects uterine contractions and
vasoconstriction.

Question 16 of 36

Which group of nerves all constitute branches of the pudendal nerve?

A Perineal nerve, inferior clitoral nerve, mid rectal nerve

B Perineal nerve, dorsal clitoral nerve, inferior rectal nerve Correct
C Perineal nerve and posterior clitoral nerve
D Mid rectal nerve, dostal clitoral nerve, perineal nerve
E Internal pudendal nerve, perineal nerve, dorsal clitoral nerve

The answer is the perineal nerve, dorsal clitoral nerve and inferior rectal nerve. These are the
three important branches of the pudendal nerve.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 17 of 36

A urinary catheter is vigorously inflated in the urethra at the time of caesarean section. Urine
leaks from the rupture into which anatomical space?

A Laterally to the femoral triangles

B Into the vagina
C Into the peritoneal cavity
D Into the lesser pelvis
Into the anterior abdominal wall and mons pubis
E Correct

The answer is into the anterior abdominal wall and mons pubis. This is the only route possible
due to the anatomy of the urethra.

Question 18 of 36

The inguinal canal transmits the round ligament and which important nerve?

A Pudendal nerve
B Pelvic splanchnic nerve
C Obturator nerve
D Ilioinguinal nerve Correct
E Iliohypogastric nerve

The answer is the ilioinguinal nerve. It orginates from the anterior rami of L1 and supplies the
skin on the mons pubis and labia majora. It also has motor supply to the internal oblique and
transversus abdominis so it strengthens the conjoint tendon.

Question 19 of 36

The superficial inguinal ring is strengthened posteriorly by what structure?

A Transversus abdominus
B Superficial inguinal tendon
C Recti adbominus
D Puborectalis
E Falx inguinalis Correct

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

The answer is the falx inguinalis. The falx inguinalis is also called the conjoint tendon and
strengthens this anatomical area of weakness of the abdominal wall. Note that although the
superficial inguinal tendon sounds plausible, it actually does not exist.

Question 20 of 36

The median umbilical ligament is the embryological remnant of what fetal structure?

A Vitelline duct
B Urachus Correct
C Umbilical veins
D Umbilical arteries
E Gubenaculum

The answer is urachus. The urachus forms the median umbilical ligament. Be careful not to
confuse it with the medial umbilical ligament, which represents the remnants of fetal umbilical
arteries. Note there is an umbilical vein, not veins, and this forms the ligamentum teres hepatis.

Question 21 of 36

Which of the following is NOT a branch of the anterior division of the internal iliac artery?

A Ilieolumbar artery Correct

B Internal pudendal artery
C Obturator artery
D Uterine artery
E Vaginal artery

The correct answer is the ilieolumbar artery.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 22 of 36

From which embryological structure does the round ligament of the uterus originate?

A Cloaca
B Gubernaculum Correct
C Mullerian duct
D Urachus
E Wolffian duct

The correct answer is gubernaculums

Question 23 of 36

Lymphatic drainage of the uterus is primarily to:

A Common iliac nodes

B External iliac nodes
C Internal iliac nodes Correct
D Paraaortic nodes
E Superficial inguinal nodes

The correct answer is internal iliac nodes

Question 25 of 36

A direct inguinal hernia that develops from the weakness of the conjoint tendon can cause
damage to the:

A Genitofemoral nerve
B Iliohypogastric nerve
C Ilioinguinal nerve Correct
D Pudendal nerve
E Subcostal nerve

The correct answer is ilioinguinal nerve.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 26 of 36

The internal pudenda artery leaves the pelvis via:

A Greater sciatic foramen Correct

B Lesser sciatic foramen
C Obturator foramen
D Pudendal canal
E Sacral canal

The correct answer is the greater sciatic foramen. The internal pudendal artery is an artery that
branches off the internal iliac artery, providing blood to the external genitalia. The internal
pudendal artery is the terminal branch of the anterior trunk of the internal iliac artery. It is
smaller in the female than in the male. It exits the pelvic cavity through the greater sciatic
foramen, inferior to the piriformis muscle, to enter the gluteal region. It then curves around the
sacrospinous ligament to enter the perineum through the lesser sciatic foramen. It travels
through the pudendal canal with the internal pudendal veins and the pudendal nerve.

Question 27 of 36

Regarding the urinary bladder:

A A glycosaminoglycan layer coats the luminal surface of the bladder mucosa Correct
B At the trigone, the epithelium is loosely adherent to the underlying muscle
C The bladder wall consists of two layers of detrusor muscle
D The uterovesical fold creates the Pouch of Douglas
E The urinary bladder is covered entirely by peritoneum

The correct answer is a glycosaminoglycan layer coats the luminal surface of the bladder
mucosa. The bladder mucosa is transitional epithelium and is loosely connected to the muscular
bladder wall by the lamina propria that serves as a connectivetissue layer. The bladder
submucosa or lamina propria is rich in microvasculature and overlies the detrusor muscle. At
the trigone, the epithelium is more densely adherent to the underlying muscle. A layer of fatty
connective tissue covers most of the anterior and lateral bladder in the retropubic space and
can be viewed cystoscopically in the case of a bladder perforation. The peritoneum covers the
bladder posteriorly and separates it from the anterior culdesac or vesicouterine pouch and
abdominal cavity contents.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 28 of 36

What size is a follicle that is ready to ovulate?

A 2 mm
B 4 mm
C 10 mm
D 15 mm
E 20 mm Correct

The correct answer is 20 mm.

Question 29 of 36

What size is a resting follicle?

A 0.02 mm Correct
B 2 mm
C 10 mm
D 15 mm
E 20 mm

The correct answer is 0.02 mm

Question 30 of 36
.

With regard to ovulation, what is the fluid filled space in a follicle called?

A Antrum Correct
B Basal lamina
C Blastocyst
D Lacuna
E Uniblastocyst

The correct answer is antrum.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 31 of 36

What is the layer between the theca cells and the mural granulosa?

A Basal lamina Correct

B Basement membrane
C Podocysts
D VEGF unregulated capillary bed
E Zona pellucida

The correct answer is basal lamina.

Question 32 of 36

What type of cells are sertoli cells?

A Circular cells
B Cubodial cells
C Epithelia with gap junctions
D Flat columnar
E Tall columnar Correct

The correct answer is tall columnar.

Question 33 of 36

What testicular cells are located outside the blood/testis barrier?

A Leydig Correct
B Primary spermocytes
C Sertoli
D Spermatids
E Spermatogonia

The correct answer is leydig cells.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 34 of 36

What part of the spermatozoa has a high concentration of mitochondria?

A Acrosome
B Flagellate tail
C Middle piece Correct
D Principle piece
E True head

The correct answer is the middle piece.

Question 36 of 36

What is the nerve supply to the anterior onethird

of the labium majus?

A Dorsal branch of the pudendal nerve

B Inferior rectal nerve
C Ilio inguinal nerve Correct
D Obturator nerve
E Pudendal nerve

The correct answer is ilio inguinal nerve (l1). Posterior twothirds of the perineal branch of the
pudendal nerve.

Question 36 of 36

What artery supplies the distal third of the transverse colon?

A Celiac trunk artery

B Inferior mesenteric artery Correct
C Left renal artery
D Right renal artery
E Superior mesenteric artery

The correct answer is the inferior mesenteric artery.

This Copy is for Dr. Mohamed ElHodiby