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USMLE STEP 1 > Anatomy practical > Flashcards

Anatomy practical Flashcards

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USMLE® Step 1 flashcards
1
Q

Path of pudendal neurovascular bundle

A
  • Exits greater sciatic foramen below piriformis muscle
  • Travels through lesser sciatic foramen to enter the ischioanal fossa
  • Travels in the pudendal canal (within the obturator internus fascia)
  • Enters the urogenital triangle
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2
Q

Borders of the ischioanal fossa

A

Lateral: obturator internus muscle
Medial/superior: pelvic diaphragm (mostly levator ani)
Inferior: membranous layer of the superficial layer of the gluteal region

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3
Q

Levator ani muscles

A

Puborectalis
Pubococcygeus
Iliococcygeus

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4
Q

Puborectalis attachments

A

Origin: superior pubic rami
Insertion: anococcygeal ligament

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5
Q

Pubococcygeus attachments

A

Origin: pubis (lateral to puborectalis)
Insertion: anococcygeal ligament, coccyx

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6
Q

Iliococcygeus attachments

A

Origin: tendinous arch of the levator ani
Insertion: anococcygeal ligament, coccyx

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7
Q

Iliococcygeus innervation

A

Sacral plexus (S4), pudendal nerve (S2-S4) via inferior rectal nerve

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8
Q

External anal sphincter innervation

A

Pudendal nerve (S2-S4) via inferior rectal nerve

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9
Q

Inferior rectal nerve functions

A
  • sensory innervation to anal canal inferior to pectinate line
  • motor innervation to external anal sphincter
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10
Q

Bulbospongiosus muscle attachments

A

perineal body and clitoris/penile raphe

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11
Q

Bulbospongiosus muscle innervation

A

Pudendal nerve (S2-S4)

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12
Q

Bulbospongiosus muscle actions

A

Females: compresses vestibular glands
Males: assists in erection of penis

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13
Q

Ischiocavernosus muscle attachments

A

Origin: Ischial ramus
Insertion: crus of clitoris/penis

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14
Q

Ischiocavernosus muscle innervation

A

Pudendal nerve (S2-S4)

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15
Q

Ischiocavernosus muscle actions

A

Maintain erection by squeezing blood into penis or clitoris

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16
Q

Colles’ fascia other name

A

superficial perineal fascia

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17
Q

Where is the perineal membrane found, and what does it look like?

A

White inferior fascia covering the deep transverse perineal muscle

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18
Q

Deep transverse perineal muscle attachments

A

Origin: Inferior pubic ramus and ischial ramus
Insertion: perineal body (central tendon), prostate/wall of vagina

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19
Q

External urethral sphincter location

A

Circular fibers within the deep transverse perineal muscle

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20
Q

External urethral sphincter innervation

A

Pudendal nerve (S2-S4)

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21
Q

Deep transverse perineal muscle innervation

A

Pudendal nerve (S2-S4)

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22
Q

Superficial transverse perineal muscle attachments

A

Origin: ischial ramus (posterior inferior part)
Insertion: perineal body (central tendon)

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23
Q

Superficial transverse perineal muscle innervation

A

Pudendal nerve (S2-S4)

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24
Q

Neurovascular strucutres on the dorsum of the penis

A

Deep dorsal penile vein at the midline, with dorsal penile arteries and nerves on either side

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25
Q

Dartos fascia other name

A

Superficial penile fascia

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26
Q

Buck’s fascia other name

A

Deep penile fascia

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27
Q

Tunica albuginea location

A

Surrounding corpora cavernosa; surrounding testicle (below tunica vaginalis); surrounding ovary

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28
Q

Deep penile artery location

A

Within the corpora cavernosa

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29
Q

Spongy urethra location

A

Within the corpus spongiosum

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30
Q

The external spermatic fascia is continuous with what muscle?

A

External oblique muscle

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31
Q

Cremaster muscle is continuous with what muscle?

A

Internal oblique muscle

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32
Q

Internal spermatic fascia is continuous with what muscle?

A

Transversalis fascia

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33
Q

Where do scrotum lymphatics drain

A

Superficial inguinal nodes

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34
Q

Where do lymphatics from testes drain?

A

Lumbar (para-aortic) nodes

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35
Q

Parts of the broad ligament

A

Mesometrium- covers the uterus
Mesosalpinx- covers the uterine tube
Mesovarium- connects to the ovary

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36
Q

Between which nervous structures does the superior gluteal artery pass?

A

Lumbosacral trunk and S1

37
Q

Visceral motor innervation above the pectinate line

A

Inferior hypogastric plexus

38
Q

Good anchor point for sutures during hernia repair and anti-incontinence surgeries

A

Pectineal (Cooper’s) ligament

39
Q

Location of pectineal (Cooper’s) ligament

A

Within the pectineal line, a ridge on the superior pubic ramus

40
Q

Pelvic floor muscle that attaches to ischial spine

A

Coccygeus muscle

41
Q

Coccygeus muscle innervation

A

Pudendal nerve (S2-S4), sacral nerves (S3-S5, varies)

42
Q

Lowest part of peritoneal cavity in female; where fluid may accumulate

A

Pouch of Douglas (rectourterine pouch)

43
Q

Where would a needle be inserted to drain the pouch of Douglas?

A

Posterior fornix

44
Q

Main sympathetic supply to pelvis; continuation of aortic plexus

A

Superior hypogastric plexus

45
Q

Indications and location for presacral neurectomy

A

Women with pelvic pain (e.g. dysmenorrhea). Resection of superior hypogastric plexus.

46
Q

Connect superior and inferior hypogastric plexuses

A

Right and left hypogastric nerves

47
Q

Connect sacral sympathetic trunks to inferior hypogastric plexues

A

Sacral splanchnic nerves

48
Q

Pure parasympathetic innervation in the pelvis

A

Pelvic splanchnic nerves

49
Q

Main supply to pelvis; mixed sympathetic and parasympathetic fibers

A

Inferior hypogastric plexus

50
Q

Structures above the “pelvic pain line.” What is their innervation?

A

Those in contact with peritoneal covering.
o Male: top of bladder
o Female: top part of bladder, top part of uterus
Follow sympathetics retrograde to T11-L2 spinal levels/dermatomes.

51
Q

Sensory/pain innervation below “pelvic pain line”

A

Follows parasympathetics retrograde via pelvic splanchnic nerves to S2-S4 spinal levels/dermatomes.

52
Q

Exception to “pelvic pain line” rule; where is its pain line?

A

Colon; pain line is at midpoint of sigmoid colon

53
Q

Lymphatic drainage of the vagina

A
  • Superior 1/3- external and internal iliac nodes
  • Middle 1/3- internal iliac nodes
  • Inferior 1/3- superficial inguinal nodes
54
Q

Lymphatic drainage of the uterus and cervix

A
  • Fundus/upper body- lumbar (para-aortic) and/or superficial inguinal nodes
  • Lower body/cervix- external and internal iliac nodes
55
Q

Lymphatic drainage of the ovaries and uterine tubes

A

Lumbar (para-aortic) nodes

56
Q

Lymphatic drainage of the skin of the penis (shaft)

A

Superficial inguinal nodes

57
Q

Lymphatic drainage of the glans (penis)

A

Deep inguinal and external iliac nodes

58
Q

Lymphatic drainage superior to pectinate line

A

Internal iliac nodes

59
Q

Embryonic origin superior to pectinate line

A

Endoderm

60
Q

Blood supply and venous drainage superior to pectinate line

A

Superior rectal artery; superior rectal veins (portal venous system)

61
Q

Epithelium superior to pectinate line

A

Cuboidal epithelium

62
Q

Epithelium inferior to pectinate line

A

Stratified squamous epithelium (non-keratinized until Hilton’s white line)

63
Q

Lymphatic drainage inferior to pectinate line

A

Superficial inguinal nodes

64
Q

Blood supply and venous drainage inferior to pectinate line

A

Internal iliac and inferior rectal arteries; inferior rectal veins (caval venous system)

65
Q

When does the gubernaculum arise?

A

Week 7 of embryonic development

66
Q

What pulls down the testis?

A

Differential growth of the fetus and shortening of the gubernaculum

67
Q

What causes hydrocyle?

A

Remnant of tunica vaginalis (NOT patent), made from peritoneum. Serous, peritoneal-like fluid accumulates. Can be idiopathic or caused by infection.

68
Q

How do you distinguish hydrocele from a tumor?

A

Transillumination by flashlight (hydrocele lights up)

69
Q

Pathophysiology and treatment of testicular torsion

A

The scrotal ligament (a remnant of the gubernaculum) normally holds the testis in place, but becomes loose. This causes the testis to get twisted on itself and ischemic. Should be treated surgically within five hours (both sides sutured for prevention).

70
Q

What cryptorchidism and what causes it?

A

Undescended testis. Commonly occurs in premies.
Causes:
-prematurity
-hormonal disorders
-retractile testes (cremaster m.)
-acquired failure of spermatic cord to grow at pace of body

71
Q

Name of surgery and normal timing for treatment of cryptorchidism

A

Orchiopexy/Orchidopexy; usually at 9-15 months

72
Q

5 ways that testes are thermoregulated

A

1) Hypothalamic control of specialized sweating and panting
2) Countercurrent cooling of blood in testicular artery by the pampiniform plexus
3) Testicular artery is coiled over surface of testis to dissipate heat before entering
4) Dartos muscle can contract or relax
5) Cremaster muscle can pull up testis

73
Q

Describe the cremaster reflex

A

Stroking the inner thigh sends sensory info through the femoral branch of the genitofemoral nerve (L1-L2) and the ilioinguinal nerve (L1). Motor fibers of the genital branch of the genitofemoral nerve are activated, causing contraction of the cremaster muscle.

74
Q

Type of epithelium within seminiferous tubules

A

Germinal epithelium

75
Q

When do primordial germ cells migrate to the gonadal ridge? Where do they come from?

A

Week 5 of embryonic development; from the yolk sac

76
Q

How many spermatozoa come from one spermatogonoium?

A

256 spermatazoa

77
Q

How long does it take for spermatozoa to mature?

A

72-74 days

78
Q

Describe homonymous division in the context of sperm development

A

Spermatogonium (stem cells) divide. One cell goes on to mature into spermatozoa; the other one stays behind to keep dividing

79
Q

DNA in primary spermatocyte

A

4N, diploid

80
Q

DNA in secondary spermatocyte

A

2N, haploid

81
Q

DNA in spermatids/spermatozoa

A

1N, haploid

82
Q

Organelles that remain in spermatozoa

A

Mitochondria are packed into the midpiece of the spermatozoan to power the flagellum

83
Q

Cells with gap junctions to “nurse” the sperm cells

A

Sertoli cells (epithelial)

84
Q

What forms the blood-testis barrier? What happens inside/outside? Why is it there?

A

Formed by occluding junctions of Sertoli cells.

85
Q

Hormones produced by Sertoli cells

A
  • anti-mullerian hormone

- inhibin (to regulate FSH, which is needed for sperm development)

86
Q

Where is androgen binding protein produced, and what is it’s function?

A

Produced by Sertoli cells; maintains high levels of testosterone in the testes for sperm development

87
Q

Where is luminal fluid produced, and why is it there?

A

Produced by Sertoli cells; sperm develop motility in the epididymis, so a current in the luminal fluid is required to carry them there

88
Q

Cause of Sertoli cell only syndrome

A

There is evidence that Sertoli cell-only syndrome can be caused by interstitial deletions in the ‘azoospermia factor’ (AZF) region on the long arm of the Y chromosome.

USMLE STEP 1 (24 decks)

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