446.Episiotomies are performed to control tearing that can occur during
a vaginal delivery. When performing a mediolateral episiotomy, an OB-
GYN will likely cut through several structures of the perineum. What per-
ineal structures must be sutured back together following a typical
mediolateral episiotomy?
a. Vaginal wall, pubococcygeus, and piriformis muscles
b. Vaginal wall, pubococcygeus, and iliococcygeus muscles
c. Vaginal wall, bulbospongiosus, and superficial transverse perineal muscles
d. Vaginal wall, prepuce, and rectus abdominis muscle
e. Vaginal wall, sacrospinous and sacrotuberous ligaments
447.A man comes to your office because he thinks he has bilateral hernias
and bilateral pain in the inguinal area. Upon physical examination he does
nothave a direct norindirect inguinal hernia, but does have bilateral pal-
pable superficial inguinal lymph nodes, which are tender. You formulate a
differential diagnosis of locations from which lymph drains into the super-
ficial inguinal lymph nodes. Which anatomical region or structure does not
drain into the superficial inguinal lymph nodes and thus should be
EXCLUDED from your differential diagnosis list?
a. Penis
b. Scrotum
c. Testicles
d. Anus
e. Epididymides
448.A 35-year-old married woman comes to the emergency room due to
sudden onset of nausea, vomiting, positional hypotension, and tachycar-
dia. She also complains of sudden abdominal fullness and generalized
pelvic pain. Her period is “late,” with the last menses 55 days ago. A preg-
nancy test is positive. Pelvic sonogram suggests extravasated fluid in the
peritoneal cavity and pooling in the rectouterine pouch (of Douglas) and a
mass in the left fallopian tube. A culdocentesis yields fresh blood. You cor-
rectly suggest that she be admitted for which of the following?
a. D and C (dilation and curettage)
b. Endoscopic exploration to rule out ectopic pregnancy
c. Ovariectomy for ovarian cancer
d. Hysterectomy for fibroids
e. Cystocele repair
544 Anatomy, Histology, and Cell Biology