Advanced Pudendal Nerve Quiz

Q1. Which sequence most accurately describes the course of the pudendal nerve from the sacral plexus to the perineum?

• Obturator canal, ischial tuberosity, greater sciatic foramen, inguinal canal
• Inguinal canal, obturator canal, ischial spine, sacral hiatus
• Lesser sciatic foramen, sacral canal, greater sciatic foramen, femoral canal
• Greater sciatic foramen, ischial spine, lesser sciatic foramen, pudendal canal

Q2. A lesion of the pudendal nerve proximal to its major branches would most directly impair which combination of functions?

• Detrusor contraction and ureteric peristalsis
• Perineal sensation and voluntary sphincter control
• Rectal smooth muscle contraction and colonic peristalsis
• Hip flexion and knee extension

Q3. Pudendal nerve entrapment can occur where the nerve passes between or near which two ligaments?

• Sacrospinous and sacrotuberous ligaments
• Anterior and posterior longitudinal ligaments
• Inguinal and lacunar ligaments
• Iliolumbar and inguinal ligaments

Q4. Another recognized site of pudendal nerve entrapment is within which anatomical structure?

• Femoral sheath
• Carpal tunnel
• Pudendal canal
• Adductor canal

Q5. Why can pudendal nerve injury contribute to fecal incontinence?

• It can weaken the external anal sphincter
• It permanently relaxes the internal anal sphincter through parasympathetic denervation
• It eliminates rectal smooth muscle
• It blocks blood supply to the rectum

Q6. Why can pudendal nerve injury affect urinary continence without directly paralyzing the detrusor muscle?

• It supplies only the ureters
• It provides the entire sympathetic supply to the bladder
• It supplies only the detrusor and not the urethral sphincter
• It supplies the external urethral sphincter but not the primary parasympathetic motor supply to detrusor

Q7. A patient retains erectile autonomic function but loses much of the somatic sensation from the glans after a nerve injury. Which nerve is most likely affected?

• Pelvic splanchnic nerve
• Sacral splanchnic nerve
• Dorsal nerve of the penis or clitoris
• Hypogastric nerve

Q8. A pudendal nerve block placed near the ischial spine is intended to interrupt nerve conduction before which event?

• Exit from the spinal cord through a thoracic intervertebral foramen
• Passage through the obturator canal
• Entry into the femoral triangle
• Entry into the perineum through the lesser sciatic foramen

Q9. Which finding would best distinguish pudendal nerve dysfunction from injury to the pelvic splanchnic nerves?

• Reduced parasympathetic activity in pelvic viscera
• Loss of perineal somatic sensation with weakness of voluntary sphincters
• Loss of parasympathetic vasodilation of erectile tissue
• Impaired parasympathetic stimulation of the detrusor

Q10. Which statement best integrates the anatomy and function of the pudendal nerve?

• It is the principal parasympathetic nerve controlling pelvic smooth muscle
• It is the major somatic nerve of the perineum, supplying sensory territories and voluntary perineal muscles
• It is a motor nerve supplying only the muscles of the lower limb
• It is a sympathetic nerve arising from the sacral sympathetic trunk