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MRCS A > ANATOMY - PELVIS > Flashcards

ANATOMY - PELVIS Flashcards

1
Q

Prior to pubity, what separates the 3 parts of the hip bone?

A

Triradiate cartilage

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2
Q

At what age do the hip bones fuse?

A

15-17 y/o

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3
Q

Which bone of the hip bone is the largest?

A

ilium

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4
Q

wing/ala of ilium - what attaches on the inner surface

A

iliacus muscle (iliac fossa)

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5
Q

wing/ala of ilium - what attaches on the outer surface

A

gluteal muscles

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6
Q

Mid-inguinal point + significance

A

half way between ASIS and PS
Palpate femoral artery here

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7
Q

Mid point inguinan ligament

A

half way between ASIS + PT

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8
Q

‘True leg length’

A

ASIS to medial malleolus

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9
Q

Which hip bone is the most anterior?

A

Pubis

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10
Q

what are the 3 parts of the pubis

A

pubic body (sup pubic crest –> PT)
superior pubic ramus
inferior pubic ramus

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11
Q

What foramen do the pubic rami enclose and what travels through it

A

obturator foramen
obturator aa, vv, nn

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12
Q

position of ischium in hip bone

A

posteroinferior

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13
Q

inf ischial ramus + inf pubic ramus –>

A

ischiopubic ramus

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14
Q

What are the 2 important ligaments related to the ischium?

A

Sacrospinous ligament (sacrum to IS) - GSF
Sacrotuberous ligament (sacrum to IT) - LSF

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15
Q

Pelvic girdle - what are the 4 articulations

A

2 x sacroiliac joints
sacrococcygeal symphysis
pubic symphysis

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16
Q

role of greater pelvis (false pelvis)

A

provides support for lower abdominal viscera

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17
Q

role of lesser pelvis (true pelvis)

A

pelvic cavity and pelvic viscera

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18
Q

pelvic inlet - anterior border

A

Pubic symphysis

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19
Q

pelvic inlet - posterior border

A

Sacral promontry + sacral wings

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20
Q

pelvic inlet - lateral border

A

arcuate line ilium, pectineal line, sup pubic ramus AKA iliopectineal line

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21
Q

pelvic outlet - anterior border

A

pubic arch

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22
Q

pelvic outlet - posterior border

A

tip of coccyx

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23
Q

pelvic outlet - lateral border

A

ischial tuberosity + sacrotuberous ligament

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24
Q

How many sacral vertebra

A

5

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25
Q

what does base of sacrum articulate with?

A

L5 Intervertebral disc

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26
Q

What does apex of sacrum articulate with?

A

coccyx

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27
Q

what does lateral sacrum articulate with

A

ilium

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28
Q

what are the 2 surfaces of the sacrum and the fundamental difference between them

A

posterosuperior dorsal surface = coarse
anteroinferior pelvic surface = smooth

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29
Q

what surface of sacrum is median sacral crest on

A

dorsal surface

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30
Q

what attaches to median sacral crest?

A

Supraspinatous ligament

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31
Q

what attaches to intermediate sacral crest?

A

posterior sacroiliac ligament

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32
Q

what attaches to lateral sacral crest?

A

posterior sacroiliac ligaments
sacrotuberous ligaments

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33
Q

which sacral articular processes arent fused>

A

S1 + S5

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34
Q

how many transverse lines on pelvic sacral surface?

A

4

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35
Q

what are the sacral transverse lines remenants of and when does this process begin?

A

fused sacral intervertebral discs
from age 20

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36
Q

3 muscles attaching to anterior sacral surface

A

piriformis (–> GT)
coccygeus (–>coccyx)
iliacus (–>LT)

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37
Q

2 muscles attaches to posterior sacral surface

A

multifidus lumbrorum
erector spinae

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38
Q

what is carried in the central canal of the sacrum

A

sacral fibres, cauda equinal

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39
Q

at what level does the dural sac terminate in the sacrum

A

S2

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40
Q

how many ganglia of the sympathetic trunks in the sacrum

A

4

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41
Q

what is the medial sacral artery a branch of

A

abdominal aorta posteriorly

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42
Q

what does medial sacral aa supply (before anastomoses w/ lateral sacral aa) (2)

A

posterior rectum
coccygeal gland

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43
Q

what is the lateral sacral artery a branch of?

A

internal iliac aa

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44
Q

what does the anastomoses of the sacral arteries supply

A

meninges
sacrum

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45
Q

how many vertebra fuse to form coccyx

A

4

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46
Q

embryological origin coccyx

A

caudate eminence
4-8w gestation

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47
Q

what do the coccygeal cornua articulate with?

A

sacral cornua via intraarticular ligaments

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48
Q

action of sacrococcygeal symphysis

A

minor passive flexion and extension

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49
Q

what are the 5 ligaments associated with the coccyx?

A

anterior sacrococcygeal ligament
deep posterior sacrococcygeal ligament
superficial posterior sacrococcygeal ligament
lateral sacrococcygeal ligament
intraarticular ligaments

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50
Q

anterior sacrococcygeal ligament

A

connects anterior aspects vertebral bodies

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51
Q

deep posterior sacrococcygeal ligament

A

post 5th VB sacrum –> dorsal coccyx

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52
Q

superficial posterior sacrococcygeal ligament

A

med sacral crest –> dorsal coccyx

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53
Q

lateral sacrococcygeal ligament

A

lateral sacrum –> TP Co1

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54
Q

what 3 mm attach to coccyx

A

gluteus maximus
levator ani
anococcygeal raphe

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55
Q

role anococcygeal raphe

A

help support position of anus

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56
Q

what is coccydynia

A

discomfort around coccyx

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57
Q

what is the most common presenting tumour in newborns?

A

sacrococcygeal teratoma

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58
Q

embryological origin sacrococcygeal teratoma

A

primitive streak

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59
Q

which structure separates the greater and lesser sicatic foramen?

A

sacrospinous ligament

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60
Q

GSF - superior border

A

anterior sacroiliac ligament

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61
Q

GSF - anterolateral border

A

greater sciatic notch (ilium)(

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62
Q

GSF - posteromedial border

A

sacrotuberous ligament

63
Q

GSF - inferior border

A

sacrospinous ligament + ischial spine

64
Q

which muscle divides the greater sciatic foramen into 2 sections?

A

piriformis muscle

65
Q

suprapiriform GSF - contents (3)

A

superior gluteal aa, v, nn

66
Q

infrapiriform GSF - contents (8)

A

inferior gluteal aa, vv, nn
nn obturator internus
nn to quadratus femoris
sciatic nn
pudendal nn
post femoral cutaneous nn

67
Q

superior border LSF

A

sacrospinous ligament + ischial spine

68
Q

anterior border LSF

A

ischial spine, lesser sciatic notch

69
Q

posterior border LSF

A

sacrotuberous ligament

70
Q

contents lesser sciatic foramen (5)

A

internal pudendal aa + vv
pudendal nn
nn to obturator internus
obturator internus tendon

71
Q

significance of sciatic foramina + pudendal nn

A

pudendal nn leaves pelvis via GSF and then re-enters pelvis via LSF

72
Q

what 2 muscle groups make up the pelvic floor>

A

levator ani
coccygeus

73
Q

shape of pelvic floor

A

funnel shaped

74
Q

what does pelvic floor separate?

A

pelvic cavity from perineum

75
Q

2 holes in pelvic floor of significance

A

urogenital hiatus
rectal hiatus

76
Q

what fibrous structure is between the urogenital and rectal hiatus?

A

perineal body

77
Q

functions of pelvic floor (3)

A

support abdominopelvic viscera
resist increases in intra abdominal pressure
urinary and faecal continence with mm fibres –> sphincter action around urethra and rectum

78
Q

inn levator ani mm

A

ant ramus S4
Pudendal nn S2-4

79
Q

what 3 muscles constitute the levator ani

A

pubococcygeus
puborectalis
iliococcygeus

80
Q

anterior attachment levator ani

A

pubic bodies

81
Q

lateral attachment levator ani

A

tendinous arch obturator internus

82
Q

posterior attachment levator ani

A

ischial spines

83
Q

pre-rectal fibres

A

u shaped sling around urethra + vagina important in urinary continence

84
Q

role puborectalis

A

bends anal canal anteriorly, maintaining faecal continence

85
Q

role iliococcygeus

A

elevates pelvic floor + anorectal canal

86
Q

which muscle is the main constituent of the levator ani?

A

pubococcygeus

87
Q

coccygeus origin/insertion

A

ischial spines –> lateral sacrum + coccyx

88
Q

innervation coccygeus

A

anterior rami S4/5

89
Q

what is the most inferior part of the pelvic outlet

A

perineum

90
Q

shape of perineum

A

diamond shaped

91
Q

anterior anatomical border perineum

A

Pubic symphysis

92
Q

posterior anatomical border perineum

A

tip of coccyx

93
Q

lateral anatomical border perineum

A

inferior pubic rami
inferior ischial rami
sacrotuberous ligament

94
Q

anatomical base of perineum

A

skin/fascia

95
Q

anterior surface border perineum

A

mon pubs (f)
base of penis (m)

96
Q

lateral surface border perineum

A

medial surface thigh

97
Q

posterior surface border perineum

A

superior gluteal cleft

98
Q

what structure divides the perineum into the anterior and posterior triangles?

A

ischial tuberosities

99
Q

contents of anal triangle of the perineum (4)

A

anal aperture
ext anal sphincter
ischioanal fossa
pudendal nn

100
Q

role of ischioanal fossa

A

allows for expansion of the anal canal during defacation

101
Q

layers of the urogenital triangle of perineum (deep –> superficial) (5)

A

deep perineal pouch
perineal membrane
superficial perineal pouch
deep perineal fascia
superficial perineal fascia

102
Q

contents deep perineal pouch (5)

A

urethra
external urethral sphincter
vagina
bulbourethral glands
deep transverse perineal muscles

103
Q

what 2 structures perforate the perineal membrane?

A

vagina
urethra

104
Q

role perineal membrane

A

provide attachment for muscles in the external genetalia

105
Q

contents superficial perineal pouch (4)

A

ischiocavernosus
bulbospongiosus
transverse perineal muscles
Bartholins glands

106
Q

what are the 2 layers of the superficial perineal fascia and what are they continuous with respectively

A

superficial layer - continuous with Campers fascia
Deep layer - continuous with Scarpas = Colles

107
Q

what material is the perineal body

A

fibromuscular - SKM, SM, collagen + elastic fibres

108
Q

which mm attach to perineal body? (5)

A

levator ani
bulbospongiosus
sup + deep transverse perineal mm
ext anal sphincter mm
ext urethral sphincter mm

109
Q

nn supply to perineum

A

pudendal nn S2-4

110
Q

aa supply to perineum

A

internal pudendal aa

111
Q

sensory supply by pudendal nn

A

external genitalia
skin around anus
anal canal
perineum

112
Q

motor supply by pudendal nn (5)

A

bulbospongiosus
ischiocavernosus
levator ani
ext urethral sphincter
ext anal sphincter

113
Q

pathway pudendal nn

A

sacral plexus ant ramus S2-4
descends between piriformis + ischiococcygeus mm
through greater sciatic foramen
crosses sacrospinous ligament
re-enters via lesser sciatic foramen
accompanies int pudendal aa/vv anterosuperiorly to Alcocks canal where it divides

114
Q

3 main divisions of pudendal nn

A

1 - inf rectal nn
2- perineal nn
3 - dorsal nn penis/clitoris

115
Q

action inferior rectal nn

A

inn perianal skin
lower 1/3 anal canal

116
Q

action perineal nn

A

skin perineum, labia + post scrotum

117
Q

action dorsal nn penis/clitoris

A

skin penis or clitoris
afferent aspect of erection

118
Q

which muscle is the sacral plexus anterior to?

A

piriformis

119
Q

which nn roots/ant rami make up sacral plexus

A

ant rami S1-4
L4 + L5 lumbar roots

120
Q

what are the 5 major nn that are formed by sacral plexus

A

Sometimes Izzy Shits Poo Persistently
Sup gluteal L4-S1
Inf gluteal L5-S2
Sciatic L4-S3
Post femoral S1-3
Pudendal S2-4

121
Q

route superior gluteal nn

A

leaves pelvis via GSF –> gluteal region superior to piriformis via sup gluteal aa + vv

122
Q

motor function superior gluteal nn (3)

A

gluteus minimus
gluteus medius
TFL

123
Q

route inferior gluteal nn

A

leaves pelvis via LSF –> gluteal region inferior to piriformis w/ inf gluteal aa + vv

124
Q

motor fct inferior gluteal nn

A

gluteus maximus

125
Q

tibial portion sciatic nn - motor fct

A

mm post compartment APART FROM BICEPS FEMORIDS
Hamstring adductor magnus
all mm posterior leg + sole foot

126
Q

tibial portion sciatic nn - sensory fct

A

skin post lateral leg
lateral foot
sole of foot

127
Q

common fibular portion sciatic nn - motor fct

A

short head biceps femoris
ant + lat leg
EDB

128
Q

common fibular portion sciatic nn - sensory fct

A

skin lateral leg
skin dorsum foot

129
Q

route posterior femoral cutaneous nn

A

leaves pelvis via GSF –> gluteal region inferior to piriformis –> descends deep to gluteus maxmus –> down back of thigh to knee

130
Q

posterior femoral cutaneous nn - sensory fct

A

skin post thigh + leg + perineum

131
Q

other nn from sacral plexus not mentioned (3)

A

nn to piriformis
nn to obturator internus
nn to quadratus femoris

132
Q

which artery is the major artery to the pelvis?

A

internal iliac aa

133
Q

anterior trunk branches internal iliac aa (7)

A

obturator aa
umbilical aa –> sup vesical aa
inf vesical aa
vaginal aa (F)
uterine aa (F)
Middle rectal aa
Inf gluteal aa

134
Q

posterior trunk branches int iliac aa (3)

A

iliolumba raa
lateral sacral aa
sup gluteal aa (terminal branch)

135
Q

obturator aa supplies

A

adductor thigh region via adductor canal

136
Q

sup vesical aa supplies

A

sup bladder

137
Q

inf vesical aa suppplies

A

lower bladder
prostate
seminal vesicles

138
Q

vaginal aa supplies (3)

A

vagina
inf bladder
rectum

139
Q

inf gluteal aa supples

A

gluteus max + hip joint

140
Q

what does iliolumbar aa branch off into + what do the branches supply

A

iliac branches - mm + bone around iliac fossa
lumbar branches - psoas major, quadratus lumbrorum + post abdo wall

141
Q

lateral sacral aa supplies

A

structures in sacral canal
skin + mm post to sacrum

142
Q

superior gluteal aa supplies

A

skin + mm gluteus medius + minimus

143
Q

level that median sacral aa posterior branches off from abdo aorta

A

L2

144
Q

where does ext iliac vv receive blood from (3)

A

inf epigastric vv
deep circumflex iliac vv
femoral vv

145
Q

where vv is responsible for the majority of pelvic drainage

A

int iliac vv

146
Q

sup/inf gluteal vv - drain where

A

buttock + upper thigh

147
Q

int pudendal vv drains where

A

reprodcutive organs + inf rectum via inf rectal vv

148
Q

lateral sacral vv drains

A

part of sacrum

149
Q

middle rectal vv drains where

A

bladder, prostate, mid rectum

150
Q

vesical vv drains where

A

bladder via vesical venous plexus

151
Q

uterine + vaginal vv drain where

A

female reproductive organs
via vaginal/uterine venous plexus

152
Q

where does common iliac vv form

A

at pubic symphysis

153
Q

what drains into common iliac vv

A

ext + iliac vv
ilioluumbar vv
middle sacral vv

154
Q

what level does Common iliac become ivc

A

L5

MRCS A (36 decks)

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