Clinical Correlations Interval 5

Question 1

What is the clinical significance of a weak pelvic diaphragm?

Answer 1

Could cause prolapse of part of the uterus into the vaginal or herniation of the bladder or rectum into the vagina

Question 2

What are kegal exercises?

Answer 2

They strengthen the pelvic diaphragm, particularly the pubococcygeus muscles to prevent prolapse or herniation of the pelvic viscera

Question 3

Internal vs external hemorrhoids

Answer 3

Internal:

• painless, protrusions of the anal canal covered by mucosa above the pectinate line
• Contain dilated veins of the internal rectal venous plexus

External:
-painful, enlargements covered by skin that contain dilated veins of external rectal venous plexus

Question 4

Name two masses that can occur in the prostate, describe them and say where they are located

Answer 4

1. Benign prostatic hyperplasia (BPH)
   - periurethral zone
   - can obstruct prostatic urethra
2. Adenocarcinoma of the prostate
   - peripheral zone, usually posterior part
   - blood in urine
   - elevated prostatic acid pho

Question 5

What are episiotomy sites?

Answer 5

These are sites of incision performed on a mother during delivery to allow the posterior wall of the vagina to heal more readily

-surgeon must be careful not to knick the external anal sphincter!

Question 6

Bicornuate Uterus

Answer 6

Results when there is a lack of complete fusion of the mullerian ducts. This is a common congenital defect in which the uterus has two horns that fuse near the cervix and open into the vagina

Question 7

Most common site of ectopic pregnancy?

Answer 7

Ampulla of the uterine tube

Question 8

Cervical neoplasms

Answer 8

95% develop at the transition zone of the ectocervix of the vagina and the endocervical canal

Question 9

What is a Cullen’s sign?

Answer 9

Edema and bruising around the umbilicus due to trauma, ruptured AAA, acute pancreatitis and ruptured ectopic pregnancy

Question 10

What is a culdotomy

Answer 10

A needle puncture or incision via the posterior wall of the vagina to access the retrouterine pouch and test for fluid

Question 11

Chronic endometriosis

Answer 11

Endometriosis is present in the vesicouterine pouch (which usually is eliminated when the bladder is distended)

Question 12

What is the autonomic explanation for pain in the medial upper thigh when an obturator hernia occurs?

Answer 12

The hernia sac impinges on the sensory branch of the obturator nerve, causing pain

Question 13

What is the Howship-Romberg sign?

Answer 13

When pain occurs in the medial upper thigh during thigh extension, medial rotation and abduction due to impingement of the obturator nerve

Question 14

What internal structures are commonly injured in pelvic fractures?

Answer 14

Multiple pelvic arteries and veins, urethra and urinary bladder

Question 15

What pelvic floor muscles are most at risk during difficult vaginal deliveries?

Answer 15

Pubococcygeus and puborectalis

Question 16

What structures can be palpated by digital rectal exam (DRE)?

Answer 16

Structures: Prostate, seminal vesicles, coccyx, anal sphincter

Question 17

What does it mean if you have pain with motion of cervix on a DRE?

Answer 17

Possible ischioanal abscess

Question 18

What are the effects of an enlarging gravid uterus on appendix location?

Answer 18

Starting at about the 5th month, as the uterus enlarges it pushes appendix up and lateral; by the 9th month it can be in right flank. Pain and tenderness in the 2nd and 3rd trimesters will be above and lateral to McBurney’s point. Important to make incision at point of maximum tenderness with patient rolled to the left to take uterine pressure off IVC

Question 19

What causes hypospadias

Answer 19

Failure of urogenital folds to fuse properly causing external urethral orifice to be on the ventral aspect of the penis

Question 20

What is the significance of the oblique entry of the distal ureter into the bladder through the detrusor muscle?

Answer 20

Oblique entry prevents reflux up the ureter when the bladder contracts

Question 21

What peri-vaginal gland, when infected, can cause painful labial swelling and erythema?

Answer 21

Greater vestibular (barthonlin) gland

Question 22

What is the anatomic rationale for median or medio-lateral episiotomies?

Answer 22

Long and difficult labor may cause pressure necrosis or tears in the vaginal wall causing urethrovaginal or rectovaginal fistulas which are difficult to repair surgically. Median or mediolateral episiotomies are done as prophylaxis against soft tissue trauma to prevent uncontrolled tears