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Year 2 Mock MCQ Explanations Emma Ball 2440051B@student.gla.ac.uk1.Sam, a 28 year old man presented with an acute onset, left testicular pain. A diagnosis of testicular torsion is made. Unfortunately, the testicle is not re-perfusing in theatre and an orchiectomy must be carried out. The surgeon decides to perform an orchiectomy and divides the left testicular artery. From which vessel does the left testicular artery originate? A. External iliac artery B. Internal iliac artery C. Abdominal aorta D. Right renal artery E. Left renal artery1.Sam, a 28 year old man presented with an acute onset, left testicular pain. A diagnosis of testicular torsion is made. Unfortunately, the testicle is not re-perfusing in theatre and an orchiectomy must be carried out. The surgeon decides to perform an orchiectomy and divides the left testicular artery. From which vessel does the left testicular artery originate? A. External iliac artery B. Internal iliac artery C. Abdominal aorta D. Right renal artery E. Left renal artery2.Which of the following structures surrounding the testis is an extension of the peritoneum? A. External spermatic fascia B. Internal spermatic fascia C. Tunica vaginalis D. Tunica albuginea E. Cremasteric fascia2.Which of the following structures surrounding the testis is an extension of the peritoneum? A. External spermatic fascia B. Internal spermatic fascia C. Tunica vaginalis D. Tunica albuginea E. Cremasteric fasciaCoverings of the Testes Layers: ● Skin ● Dartos muscle ● External spermatic fascia ● Cremaster muscle ● Cremasteric fascia ● Internal spermatic fascia Spermatic Cord surrounded by: ● Internal spermatic fascia (from Transversalis fascia) ● Cremasteric fascia (from Internal oblique muscle) ● External spermatic fascia (from External oblique) NOT transversus abdominus (during descent, the testes passed under this muscle) NOTE: these layers were formed as the testes descended through the inguinal canal from posterior abdominal wall into scrotum, during development. The layers of the anterior abdominal wall were maintained as the testes passed through, to form the three layers above.3.Which of the following is a feature of leydig cells in the testes? A. Elongated in shape B. Produce testosterone C. Secrete androgen binding protein D. Decrease Pituitary production of FSH E. Form the blood testis barrier3.Which of the following is a feature of leydig cells in the testes? A. Elongated in shape (sertoli cells) B. Produce testosterone C. Secrete androgen binding protein (sertoli cells) D. Decrease Pituitary production of FSH (inhibin) E. Form the blood testis barrier (sertoli cells)Support cellular structure ● Sertoli cells - ovoid nucleus ■ Blood testis barrier: tight junctions between cells divides the tubule in basal and adluminal compartments (contains spermatids). This prevent autoimmune destruction of the maturing spermatocytes. This is needed because the spermatids are haploid and thus "non-self" to the immune system ■ Regulation of spermatogenesis and spermiogenesis ■ Regulate function of Leydig and peritubular cells ■ Secrete tubular fluid ■ Phagocytosis of residual body ■ Secretion of inhibin ● Leydig cells - punctate nucleus ○ Function ■ Secrete testosteroneSpermatogonia —-mitosis—-> primary spermatocyte —---meiosis I —-> secondary spermatocyte —- meiosis II —-> spermatid The round spermatid enters sertoli cell cytoplasm and undergoes spermiogenesis. In spermiogenesis the round spermatid becomes the motile mature spermatozoa. Changes: 1. Acrosomal head cap forms 2. Flagellum forms 3. Mid-pieces containing mitochondria forms 4. Nucleus compact 5. Cytoplasmic remodelling (flagellum elongates and excess cytoplasm phagocytosed)4. Robert, a 90 year old man is found collapsed in his home. He is brought to A&E, where he is found to be hypotensive and dehydrated. Renin from the juxtaglomerular cells is released in response to this. What is the mechanism of action of renin? A. Aldosterone agonist B. Aldosterone antagonist C. Hydrolyse angiotensin to angiotensinogen D. Hydrolyse angiotensin I to angiotensin II E. Hydrolyse angiotensinogen to angiotensin I4. Robert, a 90 year old man is found collapsed in his home. He is brought to A&E, where he is found to be hypotensive and dehydrated. Renin from the juxtaglomerular cells is released in response to this. What is the mechanism of action of renin? A. Aldosterone agonist B. Aldosterone antagonist C. Hydrolyse angiotensin to angiotensinogen D. Hydrolyse angiotensin I to angiotensin II E. Hydrolyse angiotensinogen to angiotensin I Renin Release RAAS 1. Renin released from juxtaglomerular apparatus in response to: a. Reduced Na+ to DCT (detected by macula densa) b. Reduced perfusion pressure (detected by baroreceptors in afferent arteriole) c. Sympathetic stimulation of JGA via Beta-1 adrenoreceptorsProduction of angiotensin II 1. Angiotensinogen produced by liver and cleaved by renin to produce angiotensin I 2. Angiotensin I converted to Angiotensin II by ACE (mainly in lungs but also renin endothelium)Angiotensin II (binds to various GPCR) 1. Vasoconstriction of arterioles - increase total peripheral resistance 2. Stimulate “thirst” in hypothalamus leading to ADH secretion from posterior pituitary. ADH increase aquaporins causing water reabsorption and concentrated urine 3. Sympathetic stimulation (increase cardiac output, vasoconstriction and renin release) 4. Renal Effects: a. Efferent>Afferent arteriole constriction b. Contraction of mesangial cells (decreases filtration area i.e. reduces GFR) c. Increases Na+/H+ antiporter and thus increase Na+ reabsorption 5. Stimulates release of aldosteroneAldosterone ● Released from adrenal cortex (zona glomerulosa, mineralocorticoid) in response to low blood pressure/RAAS activation and production of angiotensin II ● Acts on principal cells ● *Increase ENaC expression ● Increase Na+ reabsorption and thus osmotic water movement (increasing blood volume i.e. BP) ● *HYPERKALAEMIA and HYPONATRAEMIA Think… aldosterone antagonists i.e. spironolactone as a K+ sparing diuretic *HIGH YIELD5.Katie, an 8 year old girl is brought to A&E after losing consciousness at school. Her father said she vomited twice this morning but he thought she would be fine to go to school. He said in the last few weeks she has been running to the toilet lots. On examination her GCS is 9 and she is breathing very slow. ABG RESULT: pH 7.0 (normal 7.35-7.45) PaCO2 3.1kPa (normal 4.6-6.4 kPa) A. 31 B. 209 PaO2 11.9kPa(normal 11.0-14.4 kPa) C. 9 D. 19 U&E Results: E. 12 Na+ 126mmol/L(normal 133-146mmol/L) K+ 5.1mmol/L(normal 3.5-5.3mmol/L) HCO3- 12mmol/L(normal 22-29mmol/L) Cl- 95mmol/L(normal 95-108mmol/L) What is her anion gap?5.Katie, an 8 year old girl is brought to A&E after losing consciousness at school. Her father said she vomited twice this morning but he thought she would be fine to go to school. He said in the last few weeks she has been running to the toilet lots. On examination her GCS is 9 and she is breathing very slow. ABG RESULT: pH 7.0 (normal 7.35-7.45) PaCO2 3.1kPa (normal 4.6-6.4 kPa) PaO2 11.9kPa(normal 11.0-14.4 kPa) A 31 B 209 U&E Results: Na+ 126mmol/L(normal 133-146mmol/L) C 9 D 19 K+ 5.1mmol/L(normal 3.5-5.3mmol/L) E 12 HCO3- 12mmol/L(normal 22-29mmol/L) Cl- 95mmol/L(normal 95-108mmol/L) What is her anion gap?Anion Gap ● A diagnostic concept that accounts for the difference between unmeasured anions and unmeasured cations that is used in differentiating causes of metabolic acidosis ● [Na+] – {[Cl-] + [HCO3-]} ● High Anion Gap? - ACID BEING ADDED ○ Ketoacidosis, lactic acidosis, chronic renal failure, aspirin poisoning, starvation (amino acid metabolism) ● Low Anion Gap? - BICARBONATE BEING LOST ○ Diarrhoea, renal tubular acidosis6.The adrenal glands are supplied by three suprarenal arteries. The superior suprarenal arteries are most likely to branch directly from which vessel? A. Aorta B. Coeliac trunk C. Inferior Mesenteric artery D. Inferior phrenic artery E. Renal artery6.The adrenal glands are supplied by three suprarenal arteries. The superior suprarenal arteries are most likely to branch directly from which vessel? A. Aorta B. Coeliac trunk C. Inferior Mesenteric artery D. Inferior phrenic artery E. Renal artery7.In the kidney, aldosterone: A. Increase glucose reabsorption in the proximal tubule B. Enhances the countercurrent multiplier system C. Inhibits Na+/K+ ATPase in the distal tubule D. Increases transport of ENaCs from the cytoplasm to the cell membrane E. Leads to insertion of aquaporin channels into the cell membrane7.In the kidney, aldosterone: A. Increase glucose reabsorption in the proximal tubule B. Enhances the countercurrent multiplier system C. Inhibits Na+/K+ ATPase in the distal tubule D. Increases transport of ENaCs from the cytoplasm to the cell membrane E. Leads to insertion of aquaporin channels into the cell membrane8.A patient is found to have hypokalemia. Which of their drugs could have caused this? AAtorvastatin B Furosemide C Ramipril D Spironolactone E Co-codamol8.A patient is found to have hypokalemia. Which of their drugs could have caused this? AAtorvastatin - nonsense B Furosemide C Ramipril - causes HYPERkalaemia; blocks ACE therefore reduces angiotensin II production and thus aldosterone. Essentially has the same impact as aldosterone antagonists e.g. spironolactone D Spironolactone - causes HYPERkalaemia; an aldosterone antagonist E Co-codamol - nonsenseDiuretics 1. Loop Diuretics e.g. furosemide a. Inhibit NKCC2 in thick ascending limb b. Adverse effects: Hypokalaemia (may be coupled with K+ sparing diuretic) c. Uses: Heart failure, liver failure 2. Thiazide Diuretics e.g. bendroflumethiazide a. Inhibit NaCl in DCT 3. K+ Sparing e.g. a. ENaC inhibitors e.g. amiloride b. Aldosterone antagonists e.g. Spironolactone9.Which enzyme is most commonly impacted by congenital adrenal hyperplasia? A 11 beta hydroxylase B 21 alpha hydroxylase C Neprilysin D Aromatase E 17 alpha hydroxylase9.Which enzyme is most commonly impacted by congenital adrenal hyperplasia? A 11 beta hydroxylase B 21 alpha hydroxylase C Neprilysin D Aromatase E 17 alpha hydroxylase Really mean question…Congenital Adrenal Hyperplasia ● 21-hydroxylase deficiency - one of the converting enzymes in the steroidogenic pathway i.e. no cortisol or aldosterone production and OVERPRODUCTION of androgens ● Deficiency of 11B-hydroxylase less common ● Presentation? ○ Ambiguous genitalia ○ Precocious puberty ○ Anovulation ○ Hirsutism (excess body hair)10. Hormones during the menstrual cycle vary greatly. Which hormone rises and triggers ovulation? A Progesterone B Oestrogen C Cortisol D Luteinising hormone E Follicle stimulating hormone10. Hormones during the menstrual cycle vary greatly. Which hormone rises and triggers ovulation? A Progesterone B Oestrogen C Cortisol D Luteinising hormone E Follicle stimulating hormoneFollicular Phase (Proliferative) ~0-14 days 1. Primordial Follicle ○ Primary oocyte is surrounded by a single layer of follicular cells ○ Ovum is suspended in Meiosis I by oocyte maturation inhibiting factor until FSH and LH release (begins in puberty) ○ Form in utero 2. Primary Follicle ○ Oocyte has grown ○ 30-50 primary follicles will be selected each month ○ Follicular cell (now granulosa cells) growth and proliferation -> stratified cuboidal epithelium ○ Granulosa cells secrete the components of the zona pellucida 3. Secondary Follicle ○ FSH and LH secretion increases (LH lags by ~2 days) causing: ■ Proliferation of granulosa cells to form more layers thus releasing MORE oestrogen ■ Theca cell layers form ■ Theca interna: can secrete oestrogen and progesterone ■ Theca externa: highly vascularised capsule of the developing follicle ■ Fluid filled spaces between granulosa cells coalesce -> antrum ○ Meiosis I now complete and a secondary oocyte formed. 4. Graafian (tertiary follicle) ○ One follicle selected for dominance (due to number of sex steroid hormone receptors) ○ Remaining (19/20) follicles undergo Follicular AtresiaOvulation (~day 14) LH surge begins 2 days before ovulation. Initiation of Ovulation 1. Dominant follicle in the ovary produces more and more oestrogen as it grows larger 2. Oestrogen levels peak and switch to POSITIVE FEEDBACK, causing a sudden release of Luteinising Hormone(LH) 3. LH surge stimulates release of proteolytic enzymes that allow the egg to be released 4. The granulosa cells stay behindLuteal Phase (Secretory) ● Remaining granulosa and theca interna cells become lutein cells ● Become filled luteinized (filled with lipid) - this is the corpus luteum Corpus Luteum ● LH, secreted from the anterior pituitary causes granulosa cells to begin secreting progesterone (prepares endometrium for implantation) ● Theca cells form androgens ● Oestrogen levels rise for the next 10-14 days and become inhibitory of LH release - negative feedback ● Causes regression of the corpus luteum -> now the corpus albicans ● The drop in oestrogen/progesterone as the corpus luteum degrades causes menstruation11.Which of the following does not play a role in the diagnosis of PCOS? AAmenorrhoea B Ultrasound ovaries C Obesity D Raised serum androgen levels E Hirsutism11.Which of the following does not play a role in the diagnosis of PCOS? AAmenorrhoea B Ultrasound ovaries C Obesity D Raised serum androgen levels E HirsutismPCOS Rotterdam Criteria (HIGH YIELD) A diagnosis requires at least two of the three key features: 1. Oligoovulation or anovulation, presenting with irregular or absent menstrual periods 2. Hyperandrogenism, characterised by hirsutism and acne 3. Polycystic ovaries on ultrasound (or ovarian volume of more than 10cm3) Presentation : ● Oligomenorrhoea or amenorrhoea ● Infertility ● Obesity (in about 70% of patients with PCOS) ● Hirsutism ● Acne ● Hair loss in a male patternGeneral Management It is crucial to reduce the risks associated with obesity, type 2 diabetes, hypercholesterolaemia and cardiovascular disease. These risks can be reduced by: ● Weight loss ● Low glycaemic index, calorie-controlled diet ● Exercise ● Smoking cessation ● Antihypertensive medications where required ● Statins where indicated (QRISK >10%) Patients should be assessed and managed for the associated features and complications, such as: ● Endometrial cancer ● Infertility - weight loss, clomifene, laparoscopic ovarian drilling, IVF (METFORMIN and LETROZOLE may also help restore ovulation) ● Hirsutism - weight loss, combined oral contraceptive ● Acne - combined oral contraceptive + standard acne treatments12. Pre-eclampsia is a complication in pregnancy that is defined by new onset hypertension and is associated with oedema and proteinuria. Which is NOT a risk factor for pre-eclampsia? A Primigravidae B Multigravida C BMI >35 D Age >40 E Family history12. Pre-eclampsia is a complication in pregnancy that is defined by new onset hypertension and is associated with oedema and proteinuria. Which is NOT a risk factor for pre-eclampsia? A Primigravidae B Multigravida C BMI >35 D Age >40 E Family historyPre-eclampsia Normally… ● Blastocyst implants into endometrium ● Outermost layer (syncytiotrophoblast), grows into the endometrium and forms chorionic villi that contain foetal blood vessels ● Trophoblast invasion of endometrium signals remodelling of spiral arteries, reducing their vascular resistance ● Blood flow in the arteries increases and they eventually breakdown ● Pools of blood remain (lacunae) ● Blood flows from uterine arteries, into lacune and back out through the veins to the foetusIn pre-eclampsia… ● Remodelling of spiral arteries is incomplete ● High resistance arteries remain leading to poor perfusion of placenta ● This causes oxidative stress and release of inflammatory markers into circulation ● Systemic inflammation and endothelial dysfunction occursRisk factors: • Primigravidae (first pregnancy) • Age >40 years • Family history of preeclampsia • BMI>35 or weight>90kg • Multiple pregnancy • Existing HTN, diabetes, renal disease Presentation: ● Hypertension ● Proteinuria ● Oedema ● If severe: headaches, blurred vision, heartburn without relief from antacids, abdominal pain Treatment: Labetolol is first line13. The karyotype of Kleinfelter’s Syndrome is: A 45 XXY B 45 XY C 47 XX D 47XXY E 48YY13. The karyotype of Kelinfelter’s Syndrome is: A 45 XXY B 45 XY C 47 XX D 47XXY E 48YYKleinfelter’s Syndrome A sex chromosome disorder, that is a common cause of hypogonadism in med and occurs as a result of an additional inactive X chromosome causing the karyotyp 47 XXY Pathophysiology: nondisjunction i.e. failure of chromosome separation during gametogenesis result in a gamete with one less or one extra chromosome Presentation: infertility, gynaecomastia, reduced libido, mild learning disability Signs: tall stature, pear shaped, gynaecomastia, microchidism, cryptorchidism14. Which muscle raises the testicles? A Rectus abdominis B Dartos Muscle C Detrusor Muscle D Cremasteric Muscle E Gracilis14. Which muscle raises the testicles? A Rectus abdominus B Dartos Muscle - controls the temperature of the testicle causing wrinkling of the scrotum, creating optimal conditions for spermatogenesis/spermiogenesis C Detrusor Muscle - muscle of the bladder D Cremasteric Muscle E Gracilis15. On its descent through the abdomen, the ureter passes anterior to which structure? AAbdominal aorta B Psoas major C Pelvic brim D Lumbar vertebrae (L2-4) E Inferior vena cava15. On its descent through the abdomen, the ureter passes anterior to which structure? AAbdominal aorta B Psoas major C Pelvic brim D Lumbar vertebrae (L2-4) E Inferior vena cavaThe ureter ● 25cm long ● Proximal ⅔ = retroperitoneal ● Distal ⅓ = intraperitoneal ● Course 1. Arise from ureteropelvic junction 2. Anterior to psoas major (pass under gonadal vessels/genitofemoral nerves) 3. Enter pelvic cavity, crossing over the pelvic brim at the sacroiliac joints/bifurcation of common iliac artery 4. In the pelvis: travel along lateral pelvic walls 5. Turn anteromedially at ischial spines 6. Travel to bladder in transverse plane 7. Pierce lateral aspect of bladder in oblique manner16. Which transporter is responsible for glucose reabsorption in the proximal tubule? A GLUT1 B GLUT2 C GLUT3 D GLUT4 E GLUT516. Which transporter is responsible for glucose reabsorption in the proximal tubule? A GLUT1 B GLUT2 C GLUT3 D GLUT4 E GLUT5Glucose in the kidney… ● In the PCT 100% of glucose is reabsorbed ● Na+/K+ ATPase on basolateral surface pumps sodium into the extracellular compartment by active transport ● This creates an electrochemical gradient between tubular lumen and intracellular compartment ● Na+ is pulled into the cell (out of the lumen) via several transporters - in this case it is SGLT2 ● On the basal surface, Na+ continues to move through Na+/K+ ATPase to the peritubular capillaries BUT Glucose moves through GLUT217. Which of these drugs directly inhibits ENaC in the distal convoluted tubule? A Furosemide B Bendroflumethiazide C Spironolactone D Indapamide E Amiloride17. Which of these drugs directly inhibits ENaC in the distal convoluted tubule? A Furosemide B Bendroflumethiazide C Spironolactone - inhibits ENac but not directly; it inhibits aldosterone which normally increases the expression of ENaC in the DCT D Indapamide E Amiloride18. The macula densa is associated with which part of the kidney? A Proximal convoluted tubule B Loop of Henle C Segmental arteriole D Minor calyx E Distal Convoluted Tubule18. The macula densa is associated with which part of the kidney? A Proximal convoluted tubule B Loop of Henle C Segmental arteriole D Minor calyx E Distal Convoluted Tubule19 Which is correct about the male urethra? A. Female urethra is longer B. Prostatic part is 3-4 cm C. Male urethra has two parts, prostatic and spongiose D. Passes anterior to psoas major E. Forms upper boundary of trigone19 Which is correct about the male urethra? A. Female urethra is longer B. Prostatic part is 3-4 cm C. Male urethra has two parts, prostatic and spongiose D. Passes anterior to psoas major E. Forms upper boundary of trigoneMale Urethra ● Prostatic is 3-4cm ● Spongiose (penile) part is 15cm ● Membranous part is 1-2cm20. Which is the most abundant extracellular cation? A. Na+ B. K+ C. HCO3- D. Protein E. Glucose 20. Which is the most abundant extracellular cation? A. Na+ B. K+ C. HCO3- D. Protein E. Glucose What are the most abundant ions in the extracellular fluid? ● Sodium (140mmol/L) ● Chloride (114mmol/L) What are the most abundant ions in the intracellular fluid? ● Potassium (4mmol/L) ● Proteins (-ve charge)21.During embryological development of the genital system, what does the genital tubercle develop into in females? A. Clitoris B. Labia Majora C. Labia minora D. Urachus E. Endometrium21.During embryological development of the genital system, what does the genital tubercle develop into in females? A. Clitoris B. Labia Majora C. Labia minora D. Urachus E. Endometrium22. Which of the following targets the NKCC2 channels in the kidney? A. Furosemide B. Spironolactone C. Indapamide D. Amiloride E. Bendroflumethiazide22. Which of the following targets the NKCC2 channels in the kidney? A. Furosemide - this is the only loop diuretic, NKCC2 are present in the Loop of Henle B. Spironolactone C. Indapamide D. Amiloride E. Bendroflumethiazide23.The bladder is controlled by various neural pathways. Which of the following is correct about sympathetic stimulation of the bladder? A. Detrusor muscle relaxes B. External sphincter contracts C. Controlled By S2-4 D. Internal urethral sphincter relaxes E. Micturition contractions are at high frequency23.The bladder is controlled by various neural pathways. Which of the following is correct about sympathetic stimulation of the bladder? A. Detrusor muscle relaxes B. External sphincter contracts C. Controlled By S2-4 D. Internal urethral sphincter relaxes E. Micturition contractions are at high frequencyBladder Physiology There are two phases of micturition 1. Storage phase (urine stored in bladder) 2. Voiding phase (peeing)Storage phase ● Stimulus: urine slowly filling the urinary bladder ● Receptor: sensory stretch receptors in bladder wall ● Afferent: pelvic parasympathetic ● Centre: S2-4 ● Efferent: Hypogastric sympathetic (Lumbar) ● Effectors: ○ Detrusor muscle relaxation ○ Internal urethral sphincter contraction NOTE: towards the end of this phase there are micturition contractions starting to occur but not at the threshold frequency and intensity to cause detrusor muscle relaxation.Voiding Phase The micturition reflex (autonomic spinal cord reflex) ● Stimulus: bladder volume reaches 300-400mL ● Receptor: stretch receptor in bladder wall ● Afferent: Pelvic parasympathetic nerves ● Centre: S2-4 ● Efferent: Pelvic parasympathetic nerves ● Effector: ○ Detrusor muscle contraction ○ Internal urethral sphincter relaxation Voluntary voiding This stage is the final control of urination. The micturition reflex is an autonomic cord reflex but can be inhibited by the brain. ● Until a convenient time for micturition occurs, signals from the pons excite the pudendal nerve, keeping the external urethral sphincter contracted. Urination is voided. Process of urination ● Convenient time arises ● Voluntary contraction of abdominal muscles ● Bladder neck and posterior urethra increased pressure ● Stimulate sensory stretch receptors ● In the cortical centres: ○ Micturition reflex initiated once again (detrusor muscle contracts) ○ Inhibition of the external urethral sphincter ● Urination can occur24. A 45 year old woman has end stage renal failure, with an eGFR of 11. After 5 years of haemodialysis, her twin sister decides to donate her kidney to her sister? What is the name for the nature of this transplant? A. Autologous B. Xenogeneic C. Syngeneic D. Heterogenous E. Homogenous24.A 45 year old woman has end stage renal failure, with an eGFR of 11. After 5 years of haemodialysis, her twin sister decides to donate her kidney to her sister? What is the name for the nature of this transplant? A. Autologous B. Xenogeneic C. Syngeneic D. Autologous E. HomogenousDefinitions (high yield) Autologous: donor and recipient are the same individual Syngeneic: donor and recipient are genetically identical twins Allogenic: donor and recipient are not genetically identical but from the same species e.g. related or unrelated donors Xenogeneic: donor and recipient are from different species25.Which structure anchors the ovary to the lateral aspect of the uterus? A. Suspensory ligament of ovary B. Cardinal ligament C. Ligament of ovary D. Round ligament E. mesovarium25.Which structure anchors the ovary to the lateral aspect of the uterus? A. Suspensory ligament of ovary B. Cardinal ligament C. Ligament of ovary D. Round ligament E. mesovarium