,Chapter 1: Genital Anatomy
Question 1
A 28-year-old woman presents with concern about “abnormal bumps” on the
vulva. On examination, you identify small, symmetrical vestibular papillae
arranged in linear rows on the inner labia minora. What is the best
explanation for these findings?
A. Human papillomavirus (HPV) warts
B. Vestibular gland variants
C. Molluscum contagiosum
D. Lichen planus papules
✅ Correct Answer: B
Rationale: Vestibular papillae are a normal anatomic variant, often
misdiagnosed as HPV warts. They are soft, symmetric, and located along the
vestibule. Recognizing these variants prevents unnecessary treatment.
Keywords: Vestibular papillae, normal variant, HPV misdiagnosis
Question 2
A 42-year-old man presents for evaluation of penile irritation. On exam, you
note a normal foreskin with prominent ridges and folds. He is worried about
cancer. How should the clinician interpret this finding?
A. Suspicious for penile intraepithelial neoplasia
B. Physiologic foreskin anatomy
C. Evidence of chronic balanitis
D. Consistent with genital psoriasis
✅ Correct Answer: B
,Rationale: Foreskin folds and ridges are normal anatomy. Misinterpretation
can lead to unnecessary biopsy or anxiety. Differentiating physiologic
structures from true pathology is a key clinical skill.
Keywords: Foreskin folds, normal anatomy, misdiagnosis
Question 3
During a gynecologic exam, a 55-year-old woman expresses concern about
“white patches” on her vulva. Closer inspection reveals the mucocutaneous
junction between the labia minora and perineal skin. What is the clinical
relevance of this finding?
A. Indicates early lichen sclerosus
B. Represents normal transition zone
C. Suggests fungal infection
D. Possible leukoplakia requiring biopsy
✅ Correct Answer: B
Rationale: The mucocutaneous junction is a normal site of color variation.
Misinterpretation as pathology can lead to unnecessary treatment. Correct
identification avoids overdiagnosis.
Keywords: Mucocutaneous junction, color variation, normal anatomy
Question 4
A 30-year-old male undergoes scrotal exam. The scrotal skin is thin, hair-
bearing, and contains visible sebaceous glands. Which anatomical feature
distinguishes scrotal skin from penile shaft skin?
A. Absence of lymphatic drainage
B. Presence of hair follicles and sebaceous glands
C. Increased vascular resistance
D. Lack of sensory innervation
,✅ Correct Answer: B
Rationale: Scrotal skin is hair-bearing with sebaceous glands, unlike penile
shaft mucosa, which is non–hair-bearing. Recognizing this distinction helps
interpret dermatologic findings correctly.
Keywords: Scrotum, hair-bearing skin, sebaceous glands
Question 5
A 26-year-old woman presents with vulvar itching. Examination reveals a
normal perineal body and intact perianal folds. The clinician explains that
irritation is likely external rather than structural. Which anatomical
knowledge supports this reasoning?
A. The perineum is poorly innervated
B. The perineal body is a fibromuscular support structure
C. The perianal folds are exclusively glandular
D. The perineal region has no lymphatic drainage
✅ Correct Answer: B
Rationale: The perineal body provides structural support and is not typically
a primary site of dermatologic disease. Understanding normal anatomy helps
clinicians avoid overpathologizing.
Keywords: Perineum, perineal body, structural support
Question 6
A 33-year-old man has a small palpable node in the inguinal region after a
groin rash. Which lymphatic pathway explains this finding?
A. Genital mucosa drains into pelvic nodes only
B. Penile shaft drains into inguinal lymph nodes
C. Scrotal skin drains exclusively into iliac nodes
D. Testes drain into inguinal lymph nodes
,✅ Correct Answer: B
Rationale: Penile shaft and scrotal skin drain into inguinal lymph nodes.
Testicular lymphatics, however, drain to para-aortic nodes. Recognizing these
patterns aids diagnosis of infection versus malignancy spread.
Keywords: Lymphatic drainage, inguinal nodes, penile shaft
Question 7
A patient is undergoing biopsy of a vulvar lesion. Why must the clinician
consider vascular supply when selecting biopsy site?
A. Genital tissue is avascular
B. Increased vascularity increases bleeding risk
C. Genital mucosa resists trauma
D. Vulvar vessels drain only to deep venous plexus
✅ Correct Answer: B
Rationale: Genital mucosa is highly vascular, increasing the risk of bleeding
with biopsy. Careful planning reduces complications and enhances specimen
quality.
Keywords: Vulva, vascular supply, biopsy risk
Question 8
A 22-year-old woman presents with concern about “bumps” near the perianal
area. On exam, you see normal perianal papillae. What feature supports these
as benign anatomic structures?
A. Irregular and asymmetric growth
B. Located symmetrically at mucocutaneous junction
C. Friable tissue with bleeding
D. Association with pruritus
, ✅ Correct Answer: B
Rationale: Perianal papillae are symmetrical and benign normal variants.
Unlike warts or neoplasia, they are non-friable and asymptomatic.
Keywords: Perianal papillae, normal anatomy, benign
Question 9
A 45-year-old woman has chronic vulvar irritation. Examination shows hair-
bearing labia majora but non–hair-bearing labia minora. Why is this
distinction clinically important?
A. Hair follicles reduce risk of infection
B. Inflammatory conditions often differ in distribution
C. Cancer risk is higher in hair-bearing areas
D. Non–hair-bearing skin has no lymphatic drainage
✅ Correct Answer: B
Rationale: Many dermatologic conditions differ by site (hair-bearing vs.
non–hair-bearing). For example, folliculitis affects hair-bearing areas, while
mucosal diseases affect non–hair-bearing regions.
Keywords: Hair-bearing skin, labia majora, clinical distinction
Question 10
A biopsy of a penile lesion shows squamous mucosa with thin keratinization.
The pathology report notes it is from non–hair-bearing skin. Which anatomic
location is most consistent with this sample?
A. Penile shaft
B. Scrotal skin
C. Glans penis
D. Perineal skin
Question 1
A 28-year-old woman presents with concern about “abnormal bumps” on the
vulva. On examination, you identify small, symmetrical vestibular papillae
arranged in linear rows on the inner labia minora. What is the best
explanation for these findings?
A. Human papillomavirus (HPV) warts
B. Vestibular gland variants
C. Molluscum contagiosum
D. Lichen planus papules
✅ Correct Answer: B
Rationale: Vestibular papillae are a normal anatomic variant, often
misdiagnosed as HPV warts. They are soft, symmetric, and located along the
vestibule. Recognizing these variants prevents unnecessary treatment.
Keywords: Vestibular papillae, normal variant, HPV misdiagnosis
Question 2
A 42-year-old man presents for evaluation of penile irritation. On exam, you
note a normal foreskin with prominent ridges and folds. He is worried about
cancer. How should the clinician interpret this finding?
A. Suspicious for penile intraepithelial neoplasia
B. Physiologic foreskin anatomy
C. Evidence of chronic balanitis
D. Consistent with genital psoriasis
✅ Correct Answer: B
,Rationale: Foreskin folds and ridges are normal anatomy. Misinterpretation
can lead to unnecessary biopsy or anxiety. Differentiating physiologic
structures from true pathology is a key clinical skill.
Keywords: Foreskin folds, normal anatomy, misdiagnosis
Question 3
During a gynecologic exam, a 55-year-old woman expresses concern about
“white patches” on her vulva. Closer inspection reveals the mucocutaneous
junction between the labia minora and perineal skin. What is the clinical
relevance of this finding?
A. Indicates early lichen sclerosus
B. Represents normal transition zone
C. Suggests fungal infection
D. Possible leukoplakia requiring biopsy
✅ Correct Answer: B
Rationale: The mucocutaneous junction is a normal site of color variation.
Misinterpretation as pathology can lead to unnecessary treatment. Correct
identification avoids overdiagnosis.
Keywords: Mucocutaneous junction, color variation, normal anatomy
Question 4
A 30-year-old male undergoes scrotal exam. The scrotal skin is thin, hair-
bearing, and contains visible sebaceous glands. Which anatomical feature
distinguishes scrotal skin from penile shaft skin?
A. Absence of lymphatic drainage
B. Presence of hair follicles and sebaceous glands
C. Increased vascular resistance
D. Lack of sensory innervation
,✅ Correct Answer: B
Rationale: Scrotal skin is hair-bearing with sebaceous glands, unlike penile
shaft mucosa, which is non–hair-bearing. Recognizing this distinction helps
interpret dermatologic findings correctly.
Keywords: Scrotum, hair-bearing skin, sebaceous glands
Question 5
A 26-year-old woman presents with vulvar itching. Examination reveals a
normal perineal body and intact perianal folds. The clinician explains that
irritation is likely external rather than structural. Which anatomical
knowledge supports this reasoning?
A. The perineum is poorly innervated
B. The perineal body is a fibromuscular support structure
C. The perianal folds are exclusively glandular
D. The perineal region has no lymphatic drainage
✅ Correct Answer: B
Rationale: The perineal body provides structural support and is not typically
a primary site of dermatologic disease. Understanding normal anatomy helps
clinicians avoid overpathologizing.
Keywords: Perineum, perineal body, structural support
Question 6
A 33-year-old man has a small palpable node in the inguinal region after a
groin rash. Which lymphatic pathway explains this finding?
A. Genital mucosa drains into pelvic nodes only
B. Penile shaft drains into inguinal lymph nodes
C. Scrotal skin drains exclusively into iliac nodes
D. Testes drain into inguinal lymph nodes
,✅ Correct Answer: B
Rationale: Penile shaft and scrotal skin drain into inguinal lymph nodes.
Testicular lymphatics, however, drain to para-aortic nodes. Recognizing these
patterns aids diagnosis of infection versus malignancy spread.
Keywords: Lymphatic drainage, inguinal nodes, penile shaft
Question 7
A patient is undergoing biopsy of a vulvar lesion. Why must the clinician
consider vascular supply when selecting biopsy site?
A. Genital tissue is avascular
B. Increased vascularity increases bleeding risk
C. Genital mucosa resists trauma
D. Vulvar vessels drain only to deep venous plexus
✅ Correct Answer: B
Rationale: Genital mucosa is highly vascular, increasing the risk of bleeding
with biopsy. Careful planning reduces complications and enhances specimen
quality.
Keywords: Vulva, vascular supply, biopsy risk
Question 8
A 22-year-old woman presents with concern about “bumps” near the perianal
area. On exam, you see normal perianal papillae. What feature supports these
as benign anatomic structures?
A. Irregular and asymmetric growth
B. Located symmetrically at mucocutaneous junction
C. Friable tissue with bleeding
D. Association with pruritus
, ✅ Correct Answer: B
Rationale: Perianal papillae are symmetrical and benign normal variants.
Unlike warts or neoplasia, they are non-friable and asymptomatic.
Keywords: Perianal papillae, normal anatomy, benign
Question 9
A 45-year-old woman has chronic vulvar irritation. Examination shows hair-
bearing labia majora but non–hair-bearing labia minora. Why is this
distinction clinically important?
A. Hair follicles reduce risk of infection
B. Inflammatory conditions often differ in distribution
C. Cancer risk is higher in hair-bearing areas
D. Non–hair-bearing skin has no lymphatic drainage
✅ Correct Answer: B
Rationale: Many dermatologic conditions differ by site (hair-bearing vs.
non–hair-bearing). For example, folliculitis affects hair-bearing areas, while
mucosal diseases affect non–hair-bearing regions.
Keywords: Hair-bearing skin, labia majora, clinical distinction
Question 10
A biopsy of a penile lesion shows squamous mucosa with thin keratinization.
The pathology report notes it is from non–hair-bearing skin. Which anatomic
location is most consistent with this sample?
A. Penile shaft
B. Scrotal skin
C. Glans penis
D. Perineal skin
