blood supply for the testicles comes directly off the abdominal aorta, where
the testicles first develop, prior to their inferior migration into the scrotum.
All the other pelvic structures: penis (answer a),scrotum (answer b),
anus(answer d),and epididymides (answer e)can drain lymphatics to
the superficial inguinal nodes. The anus and rectum have drainage to three
sites: superficial inguinal nodes, internal iliac nodes, and inferior mesen-
teric preaortic nodes.
448.The answer is b.(Moore and Dalley, pp 413, 426–427.)Endoscopic
exploration to rule out ectopic pregnancy. The positive pregnancy test, the
blood in the cul-de-sac of Douglas and the mass in the uterine tube all sug-
gest ectopic pregnancy. All the other possible answers (answers a, c, d,
and e)donotfit with a positive pregnancy test and are much lower fre-
quency events.
449.The answer is b.(Moore and Dalley, p 400.)Cystocele. Bulges in the
anterior wall of the vagina are most likely due to the bladder falling poste-
riorly into the anterior vaginal wall. A bulge on the posterior wall of the
vagina would most likely be a rectocele (answer b).Cervical cancer
(answer c)generally would notpresent as described. A didelphic uterus
(answer d)is a duplication of the uterus as result of failure of the right and
left paramesonephric ducts to fuse in the midline. An indirect inguinal her-
nia(answer e)would generally present as a mass within the labia major.
450.The answer is b.(Moore and Dalley, pp 422–423, 465–466.)The
pudendal nerve serves the skin around the posterior/ lateral entrance of the
vagina; the nerve wraps around the ischial spine, which is used as a land-
mark; transvaginal administration is less painful since the upper portion of
the vagina has fewer pain receptors. The pudendal nerve serves the skin
around the posterior/lateral entrance of the vagina; the nerve wraps around
the ischial spine, which is used as a landmark; transvaginal administration
is less painful since the upper portion of the vagina has fewer pain recep-
tors [thus none of the other (answers a, c, and d)are correct].
558 Anatomy, Histology, and Cell Biology