,Chapter 1 – Genital Anatomy (Test Bank)
Question 1
A 32-year-old woman presents with vulvar discomfort after shaving. On
exam, the clinician notes that the labia majora are covered with coarse hair
follicles, while the vestibular area appears smooth and glistening. Which
distinction best explains this anatomical difference?
A. The labia majora are lined by columnar epithelium, while the vestibule is
lined by keratinized epithelium
B. The labia majora are hair-bearing skin, while the vestibule is non–hair-
bearing mucosa
C. The vestibule is vascularized by the femoral artery, while the labia majora
lack significant blood supply
D. The labia majora drain into the pelvic lymph nodes, while the vestibule
drains into inguinal nodes
✅ Correct Answer: B
Rationale: The vulva contains distinct zones: the labia majora are hair-
bearing keratinized skin, while the vestibule is a non–hair-bearing mucosal
surface. This distinction is clinically important because inflammatory and
infectious processes present differently depending on tissue type.
Keywords: vulva, labia majora, vestibule, hair-bearing vs. non–hair-bearing
skin
Question 2
A 45-year-old man presents with concern about “extra tissue” on his penis.
On exam, the clinician identifies normal foreskin folds that the patient
mistakes for warts. Why is knowledge of genital anatomy essential in this
case?
A. It allows accurate recognition of mucocutaneous junctions
,B. It prevents unnecessary biopsy or destructive treatment of normal variants
C. It ensures vascular mapping for surgical procedures
D. It allows classification of lesions into inflammatory vs. neoplastic
✅ Correct Answer: B
Rationale: Misinterpretation of normal anatomic structures (e.g., foreskin
folds, vestibular glands) is a frequent cause of misdiagnosis in genital
dermatology. Recognizing normal variants prevents unnecessary
interventions such as biopsy, cryotherapy, or excision.
Keywords: foreskin folds, normal variant, misdiagnosis, biopsy
Question 3
A 29-year-old woman presents with a tender vulvar lesion. On exam, the
lesion is located at the 4 o’clock position near the vestibule. Which glandular
structure is most likely involved?
A. Skene’s glands
B. Bartholin’s gland
C. Sebaceous glands of the labia majora
D. Cowper’s gland
✅ Correct Answer: B
Rationale: Bartholin’s glands are located at the 4 and 8 o’clock positions of
the vestibule. Blockage can lead to cyst or abscess formation, a common
cause of painful vulvar swelling in reproductive-age women.
Keywords: Bartholin’s gland, vestibule, abscess, anatomy
Question 4
A 40-year-old HIV-positive male presents with a painless perianal papule. On
inspection, the lesion is located in a hair-bearing region. Which anatomical
clue helps distinguish perianal skin lesions from anal canal lesions?
A. Hair-bearing skin is distal to the mucocutaneous junction
B. Hair follicles are only found proximal to the dentate line
,C. The anal canal is keratinized, while perianal skin is nonkeratinized
D. Perianal skin lacks sebaceous glands
✅ Correct Answer: A
Rationale: The mucocutaneous junction at the anus divides hair-bearing
perianal skin from the non–hair-bearing mucosa of the anal canal. This
distinction helps differentiate dermatologic lesions (e.g., warts, molluscum)
from anorectal pathology.
Keywords: perianal, mucocutaneous junction, anal canal, HIV
Question 5
A 23-year-old male presents with a lump at the base of his scrotum. On
exam, it is a small sebaceous cyst arising from the hair-bearing scrotal skin.
Why is this not concerning for a malignant lesion?
A. Scrotal lesions are never malignant
B. Sebaceous glands are normal structures in hair-bearing genital skin
C. Malignancies never occur in young patients
D. Malignant lesions only arise from mucocutaneous junctions
✅ Correct Answer: B
Rationale: The scrotum is covered by hair-bearing skin containing sebaceous
and sweat glands. Benign cysts are common and distinguished from
concerning masses by their superficial, mobile nature. Knowledge of normal
anatomy avoids unnecessary alarm.
Keywords: scrotum, sebaceous cyst, hair-bearing skin, benign
Question 6
A gynecologist performs a biopsy of the vulvar vestibule. The patient
experiences more post-procedural discomfort than expected. Which anatomic
feature explains the sensitivity of this area?
A. Dense concentration of sweat glands
B. Thin mucosa with rich innervation
,C. Poor vascularization limiting healing
D. Proximity to lymphatic drainage channels
✅ Correct Answer: B
Rationale: The vestibule is lined with thin, non–hair-bearing mucosa that is
richly innervated, making it more sensitive to pain and trauma.
Understanding innervation is important for counseling patients about
procedures.
Keywords: vestibule, innervation, mucosa, biopsy
Question 7
A 37-year-old woman presents with vulvar erythema. The clinician
distinguishes the affected area as vestibular mucosa rather than labial skin.
Which histologic feature most clearly differentiates these two sites?
A. Presence of columnar epithelium in vestibule
B. Lack of hair follicles in vestibular mucosa
C. Dense keratinization of vestibular mucosa
D. Absence of sebaceous glands in labia majora
✅ Correct Answer: B
Rationale: The vestibular mucosa lacks hair follicles, sebaceous, and sweat
glands, while the labia majora contain hair-bearing keratinized epithelium.
Recognizing these differences assists in correlating pathology with site-
specific anatomy.
Keywords: vestibule, labia majora, hair follicles, histology
Question 8
A 56-year-old man undergoes excision of a penile carcinoma. During the
procedure, the surgeon must consider lymphatic drainage patterns. Which
lymph nodes primarily receive drainage from the penile shaft and scrotum?
A. Pelvic nodes
B. Inguinal nodes
, C. Para-aortic nodes
D. Mesenteric nodes
✅ Correct Answer: B
Rationale: The penile shaft, foreskin, and scrotum drain primarily to the
superficial inguinal lymph nodes. Penile cancer staging requires careful
assessment of these nodes.
Keywords: penile cancer, lymphatics, inguinal nodes, drainage
Question 9
A 34-year-old woman is evaluated for suspected lichen sclerosus. Why is
understanding the vascular supply of the vulva important when planning a
biopsy?
A. The vulvar vestibule is poorly vascularized, reducing risk of bleeding
B. Vulvar tissues have rich vascular supply, increasing bleeding risk during
biopsy
C. Vulvar tissues lack lymphatic drainage, reducing risk of metastasis
D. Vulvar vessels anastomose only with pelvic arteries
✅ Correct Answer: B
Rationale: The vulva is highly vascularized, primarily via branches of the
internal pudendal artery. Biopsies can bleed significantly, so careful
technique and hemostasis are required.
Keywords: vulva, vascular supply, biopsy, bleeding risk
Question 10
A 60-year-old man with diabetes presents with chronic balanitis. The
urologist notes the lesion involves the glans penis. Which feature best
distinguishes the glans from penile shaft skin?
A. The glans is keratinized with thick epidermis
B. The glans is hairless and lined by thin mucosal epithelium
Question 1
A 32-year-old woman presents with vulvar discomfort after shaving. On
exam, the clinician notes that the labia majora are covered with coarse hair
follicles, while the vestibular area appears smooth and glistening. Which
distinction best explains this anatomical difference?
A. The labia majora are lined by columnar epithelium, while the vestibule is
lined by keratinized epithelium
B. The labia majora are hair-bearing skin, while the vestibule is non–hair-
bearing mucosa
C. The vestibule is vascularized by the femoral artery, while the labia majora
lack significant blood supply
D. The labia majora drain into the pelvic lymph nodes, while the vestibule
drains into inguinal nodes
✅ Correct Answer: B
Rationale: The vulva contains distinct zones: the labia majora are hair-
bearing keratinized skin, while the vestibule is a non–hair-bearing mucosal
surface. This distinction is clinically important because inflammatory and
infectious processes present differently depending on tissue type.
Keywords: vulva, labia majora, vestibule, hair-bearing vs. non–hair-bearing
skin
Question 2
A 45-year-old man presents with concern about “extra tissue” on his penis.
On exam, the clinician identifies normal foreskin folds that the patient
mistakes for warts. Why is knowledge of genital anatomy essential in this
case?
A. It allows accurate recognition of mucocutaneous junctions
,B. It prevents unnecessary biopsy or destructive treatment of normal variants
C. It ensures vascular mapping for surgical procedures
D. It allows classification of lesions into inflammatory vs. neoplastic
✅ Correct Answer: B
Rationale: Misinterpretation of normal anatomic structures (e.g., foreskin
folds, vestibular glands) is a frequent cause of misdiagnosis in genital
dermatology. Recognizing normal variants prevents unnecessary
interventions such as biopsy, cryotherapy, or excision.
Keywords: foreskin folds, normal variant, misdiagnosis, biopsy
Question 3
A 29-year-old woman presents with a tender vulvar lesion. On exam, the
lesion is located at the 4 o’clock position near the vestibule. Which glandular
structure is most likely involved?
A. Skene’s glands
B. Bartholin’s gland
C. Sebaceous glands of the labia majora
D. Cowper’s gland
✅ Correct Answer: B
Rationale: Bartholin’s glands are located at the 4 and 8 o’clock positions of
the vestibule. Blockage can lead to cyst or abscess formation, a common
cause of painful vulvar swelling in reproductive-age women.
Keywords: Bartholin’s gland, vestibule, abscess, anatomy
Question 4
A 40-year-old HIV-positive male presents with a painless perianal papule. On
inspection, the lesion is located in a hair-bearing region. Which anatomical
clue helps distinguish perianal skin lesions from anal canal lesions?
A. Hair-bearing skin is distal to the mucocutaneous junction
B. Hair follicles are only found proximal to the dentate line
,C. The anal canal is keratinized, while perianal skin is nonkeratinized
D. Perianal skin lacks sebaceous glands
✅ Correct Answer: A
Rationale: The mucocutaneous junction at the anus divides hair-bearing
perianal skin from the non–hair-bearing mucosa of the anal canal. This
distinction helps differentiate dermatologic lesions (e.g., warts, molluscum)
from anorectal pathology.
Keywords: perianal, mucocutaneous junction, anal canal, HIV
Question 5
A 23-year-old male presents with a lump at the base of his scrotum. On
exam, it is a small sebaceous cyst arising from the hair-bearing scrotal skin.
Why is this not concerning for a malignant lesion?
A. Scrotal lesions are never malignant
B. Sebaceous glands are normal structures in hair-bearing genital skin
C. Malignancies never occur in young patients
D. Malignant lesions only arise from mucocutaneous junctions
✅ Correct Answer: B
Rationale: The scrotum is covered by hair-bearing skin containing sebaceous
and sweat glands. Benign cysts are common and distinguished from
concerning masses by their superficial, mobile nature. Knowledge of normal
anatomy avoids unnecessary alarm.
Keywords: scrotum, sebaceous cyst, hair-bearing skin, benign
Question 6
A gynecologist performs a biopsy of the vulvar vestibule. The patient
experiences more post-procedural discomfort than expected. Which anatomic
feature explains the sensitivity of this area?
A. Dense concentration of sweat glands
B. Thin mucosa with rich innervation
,C. Poor vascularization limiting healing
D. Proximity to lymphatic drainage channels
✅ Correct Answer: B
Rationale: The vestibule is lined with thin, non–hair-bearing mucosa that is
richly innervated, making it more sensitive to pain and trauma.
Understanding innervation is important for counseling patients about
procedures.
Keywords: vestibule, innervation, mucosa, biopsy
Question 7
A 37-year-old woman presents with vulvar erythema. The clinician
distinguishes the affected area as vestibular mucosa rather than labial skin.
Which histologic feature most clearly differentiates these two sites?
A. Presence of columnar epithelium in vestibule
B. Lack of hair follicles in vestibular mucosa
C. Dense keratinization of vestibular mucosa
D. Absence of sebaceous glands in labia majora
✅ Correct Answer: B
Rationale: The vestibular mucosa lacks hair follicles, sebaceous, and sweat
glands, while the labia majora contain hair-bearing keratinized epithelium.
Recognizing these differences assists in correlating pathology with site-
specific anatomy.
Keywords: vestibule, labia majora, hair follicles, histology
Question 8
A 56-year-old man undergoes excision of a penile carcinoma. During the
procedure, the surgeon must consider lymphatic drainage patterns. Which
lymph nodes primarily receive drainage from the penile shaft and scrotum?
A. Pelvic nodes
B. Inguinal nodes
, C. Para-aortic nodes
D. Mesenteric nodes
✅ Correct Answer: B
Rationale: The penile shaft, foreskin, and scrotum drain primarily to the
superficial inguinal lymph nodes. Penile cancer staging requires careful
assessment of these nodes.
Keywords: penile cancer, lymphatics, inguinal nodes, drainage
Question 9
A 34-year-old woman is evaluated for suspected lichen sclerosus. Why is
understanding the vascular supply of the vulva important when planning a
biopsy?
A. The vulvar vestibule is poorly vascularized, reducing risk of bleeding
B. Vulvar tissues have rich vascular supply, increasing bleeding risk during
biopsy
C. Vulvar tissues lack lymphatic drainage, reducing risk of metastasis
D. Vulvar vessels anastomose only with pelvic arteries
✅ Correct Answer: B
Rationale: The vulva is highly vascularized, primarily via branches of the
internal pudendal artery. Biopsies can bleed significantly, so careful
technique and hemostasis are required.
Keywords: vulva, vascular supply, biopsy, bleeding risk
Question 10
A 60-year-old man with diabetes presents with chronic balanitis. The
urologist notes the lesion involves the glans penis. Which feature best
distinguishes the glans from penile shaft skin?
A. The glans is keratinized with thick epidermis
B. The glans is hairless and lined by thin mucosal epithelium
