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Gross Anatomy Post Midterm > Gray's Review Pelvis and Perineum > Flashcards

Gray's Review Pelvis and Perineum Flashcards

1
Q

what results due to a failure of fusion of the labiosacral folds so that the external urethral orifice is between the unfused halves of the scrotum?

A

perineal hypospadias

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2
Q

what forms the cloacal membrane?

A

from ectoderm of the cloaca and ectoderm of the procotodeum

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3
Q

what does the cloacal membrane eventually form?

A

the anus

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4
Q

where do the urogenital folds typically fuse? what does it form?

A

along the ventral side of the penis to form the spongy urethra

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5
Q

what is the condition in which the urethra opens on the dorsal surface of the penis resulting from the genital tubercle developing more dorsally during development?

A

epispadias

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6
Q

what is the urogenital membrane bounded by?

A

urogenital folds

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7
Q

what does the urogenital membrane rupture to form?

A

urogenital orifice

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8
Q

what happens when there is abnormal development of the urorectal septum (most anorectal anomalies…)?

A

result in non division of the cloaca into urogenital and anorectal parts

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9
Q

what is specifically associated with a persistent cloaca?

A

common outlet of the intestinal, urinary and reproductive tracts

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10
Q

when does ectopic testes occur?

A

when a portion of the gubernaculum passes to an abnormal position or fails to descend or fixed to the skin of the scrotum

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11
Q

what does the genital tubercle form? what is it associated with?

A

primordial phallus

epispadias

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12
Q

what do the seminiferous cords form?

A

primordia of the seminiferous tubules

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13
Q

what is the condition where the urinary bladder mucosa is open to the outside in the fetus?

A

extrophy of the bladder

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14
Q

what developmental failure leads to extrophy of the bladder?

A

failure of the primitive streak mesoderm to migrate around the cloacal membrane

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15
Q

what does extrophy of the bladder occur in combination with?

A

epispadias

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16
Q

what are responsible for the development of the testes?

A

androgens

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17
Q

what is Klinefelter syndrome?

A

condition in which the male has 47 XXY chromosomes

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18
Q

what is a persistent allantois associated with?

A

patent urachus and an allantoic cyst

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19
Q

what is the ureteric bud (metannephric diverticulum)?

A

outgrowth from the mesonephric duct

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20
Q

what does the ureteric bud form?

A

ureter, renal pelvis, and calyces and collecting tubules

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21
Q

what does incomplete division of the ureteric bud result in?

A

divided kidney with a bifid ureter

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22
Q

what does a complete division of the ureteric bud result in?

A

double kidney with a bifid ureter or separate ureters

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23
Q

how does a double uterus form?

A

failure of fusion of the inferior parts of the paramesonephric ducts

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24
Q

how does a bicornuate uterus form?

A

failure of fusion of the superior parts of the paramesonephric ducts

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25
Q

what causes agenesis of the vagina?

A

failure of the sinovaginal bulbs to form

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26
Q

what are involved in the development of the male urogenital structures?

A

mesonephric ducts

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27
Q

what can give rise to a urachal cyst? how does it present?

A

persistence of the epithelial linign fo the urachus

swelling found in the midline in the umbilical region

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28
Q

what is an omphalocele?

A

persistence of the herniation ofhte abdominal contents into the umbilical cord

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29
Q

what does the pronephros form? When does it degenerate?

A

parts of the primordial urinary system

in the first 4 weeks of development

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30
Q

when the ureters cross at the pelvic brim, what structures are they crossing anterior to?

A

bifurcation of the common iliac artery bilaterally

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31
Q

what would failure of the urogenital folds to fuse lead to?

A

agenesis of the external urethral folds

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32
Q

If an ectopic pregnancy ruptures, where is the blood likely to accumulate?

A

rectouterine pouch of Douglas

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33
Q

what is the most direct route to the rectouterine pouch of Douglas?

A

posterior vaginal fornix

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34
Q

what would a break or tear in the rectovaginal septum (fascia of Denonvilliers) result in?

A

the small intestine (in an enterocele) or rectum (in a rectocele) to herniate into the posterior vaginal wall, even to the point of protrusion through the vaginal introitus

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35
Q

what is an internal urethral orifice obstruction usually due to?

A

enlargement of the median (middle) lobe of the prostate gland
has glandular tissue = benign hypertrophy

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36
Q

what happens is the membraneous portion of the urethra is injured?

A

urine and blood can leak upward into the retropubic space of Retzius limited inferiorly by the urogenital diaphragm and the musce within - which are the one that are injured

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37
Q

where are the cell bodies located for pain sensation in the urinary bladder?

A

DRG of S2-S4

remember - pain fibers travel through pelvic splanchnic nerve plexus (parasympathetic)

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38
Q

which muscle is responsible for rectal incontinence?

A

pubococcygeous muscle - the medial portion = puborectalis

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39
Q

what makes up the levator ani?

A

pubococcygeous

iliococcygeous

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40
Q

damage to what structure can contribute to urinary incontinence?

A

urogenital diaphragm

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41
Q

what nerve is constricted in “Calvin Klein” syndrome?

A

lateral femoral cutaneous n. - runs behind the inguinal ligament

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42
Q

what ligaments provide direct support to the uterus?

A

the cardinal ligament = Mackenrodt’s ligament = transverse cervical ligament - composed of fibromuscular tissues that accompany the uterine vessels

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43
Q

where do ovarian lymph nodes first drain?

A

into the paraaortic nodes at the level fo the renal vessels

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44
Q

where is the node of Cloquet located?

A

in the femoral ring adjacent to external iliac vein and beneath the inguinal ligament

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45
Q

where does the node of Cloquet drain into?

A

common iliac nodes

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46
Q

what travels with the internal iliac nodes? Where do they receive lymph from?

A

uterine artery and vein

recieve lymph from much of the uterus - not from ovaries

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47
Q

which sphincter is important for maintaining fecal incontinence?

A

external anal sphincter

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48
Q

what is the tendinous arch of fascia pelvis?

A

dense band of CT that joins the fascia of the levator any to the pubocervical fascia that covers the anterior wall of the vagina - incontinence!

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49
Q

what is the levator ani tendinous arch?

A

thicken portion of the obturator internus fascia - plays no role in incontinence!

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50
Q

what can happen if the rectovaginal septum is torn?

A

rectocele or enterocele prolapse

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51
Q

where does lymph from cutaneous portion of anal canal drain - below pectinate line?

A

inguinal nodes

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52
Q

where does lymph from most of the rectum and from the mucosal zone of anal canal - above the pectinate line - drain?

A

internal iliac nodes

lymph from some parts of rectum drain into sacral nodes as well.

53
Q

why does hematocolpos commonly occur?

A

imperforate hymen

54
Q

what artery must be kept in mind during a hysterectomy with division of the round ligament?

A

cremasteric a. provides small branch to round ligament of uterus = called Samson’s a.

55
Q

what are cystoceles or utrethroceles associated with defects in?

A

pubocervical fascia

56
Q

what is uterine prolapse especially due to?

A

weakening of the cardinal ligament

57
Q

where do ovarian vessels and nerves run?

A

infundibulopelvic ligament (suspensatory ligament of the ovary)

58
Q

what are cluneal nerves?

A

cutaneous nerves to parts of buttocks

59
Q

what does the broad ligament contain?

A

only the uterovaginal vessels and nerve plexus - not for ovary

60
Q

where does the superficial perineal space or cleft lie?

A

between the ecternal perineal fascia of Fallaudet and the membraneous layer of Colle’s fascia

61
Q

where is the perineal membrane located and what does it form?

A

inferior fascia of the urogential diaphragm that forms the inferior boundary of the deep perineal compartment

62
Q

what does the superior fascia of the urogential diaphragm bind?

A

inferior border of the anterior recess fo teh ischioanal fossa

63
Q

where is there no space between?

A

urogenital diaphragm and apex of prostate gland

64
Q

what is the innervation to the urinary bladder?

A

motor and sensory inneration from parasympathetic nerve fibers transmitted by the pelvic splanchnic nerves S2-S4

65
Q

what nerve innervates the external urethral sphincter?

A

the perineal branch of pudendal n.

66
Q

what is the main blood supply to the erectile tissue?

A

deep artery from itnernal pudendal a.

67
Q

what is cancer found in inguinal nodes indicative of?

A

cancer of the uterus at the level of the round ligaments by which cancer passes to the inguinal region

68
Q

where do the lymphatic vessels of the ovaries and the uterine tubes ascend to?

A

right and left lumbar (cavil/aortic) lymph nodes = first to receive cancerous cells from ovaries

69
Q

what structure is used as a guide for a pudendal nerve block?

A

ischial spine

70
Q

what nerve is responsible for pain associated with external hemorrhoids?

A

pudendal n.

71
Q

how is the uterus stabilizes and anchored to the bladder?

A

pubovesical and vesicocervical fasciae on anterior surface

72
Q

what structure can be torn during childbirth that allows the bladder to herniate into the anterior vaginal wall with prolapse possible through vaginal introits?

A

pubovesical and vesicocervical fasciae

73
Q

what does the median umbilical ligament contain?

A

urachus

74
Q

what is a embryologic remnant of the allantoid?

A

median umbilical ligament

75
Q

what is vagininismus?

A

painful, psychosomatic gyno disorder
distension of the cavernous tissues and the bulbospongiosus and transverse perineal muscles - the sitmulation which triggers the involuntary spasms of the perivaginal and levator ani muscles = painful intercourse or dysparenunia

76
Q

what does a hematoma of the peritoneum spreading to his abdominal wall beneath the superficial fascia an example of
?

A

extravasation of the blood and urine from the superficial perineal pouch

77
Q

what causes extravasation of the blood and urine from the superficial perineal pouch?

A

rupture of the spongy urethra

78
Q

Where will the fluid accumulate with extravasation of the blood and urine from the superficial perineal pouch

A

between Buck’s fascia and dartos muscle layer

79
Q

what are the two main ligaments that stabilize the uterus?

A

uretosacral ligaments and the transverse cervical (cardinal) ligaments

80
Q

what do uretosacral ligaments and the transverse cervical (cardinal) ligaments do?

A

inhibit the uterus from prolapsing into the vagina

81
Q

what is the round ligament and where is it found?

A

related to the descent of the ovaries in embryologic development and continues into the inguinal canal

82
Q

What does the broad ligament cover?

A

uterine tubes, uterus, and vessels

83
Q

what is the arcus tendineus fascia pelvis?

A

joins the fascia of the levator ani to the pubocervical fascia on the vagina

84
Q

which lymph nodes would be involved in a pelvic lymphadectomy which often would be desired in surgical resection for prostate cancer?

A

internal iliac lymph nodes

sacral nodes

85
Q

what lymph nodes can communicate with lymphatics within the vertebral canal and metastasize cranially?

A

sacral lymphatics

86
Q

which nodes would mostly likely be infiltrated by metastasis of testicular cancer and why?

A

paraaortic and lumbar nodes

because testicular lymphatics run in close association with the testicular vessels and drain the testicles and epididymis

87
Q

what does the deep inguinal nodes recieve and drain?

A

more superficial vessels and drain the glans penis

88
Q

what would rupture of the preprostatic urethra, prostatic urethra, or urinary bladder leads to fluid accumulation where?

A

within the pelvis because they are not located in the perineum

89
Q

what carried the afferents of the cremastric reflex?

A

ilioinguinal n.

90
Q

what carries the motor/efferent output of the cremasteric reflex?

A

genitofemoral n.

91
Q

where do S2-S4 dermatomes provide sensation?

A

perineum and posterior thigh

92
Q

what structure of the male produces fructose?

A

seminal vesicles = alkaline content = fructose + choline

93
Q

what does the prostate gland secrete?

A

prostaglandins
citric acid
acid phosphatase

94
Q

what do the testes produce?

A

spermatozoa

sex hormones

95
Q

what do the bulbourethral glands (Cowper’s glands) produce?

A

mucous secretions that enter the penile bulb

96
Q

where is site of implantation of placenta pre via?

A

internal cervical os

97
Q

where is the normal site of implantation?

A

uterine fundus

98
Q

what will implantation within the mesentaries of the abdomen result in?

A

abdominal pregnancy

99
Q

What nerves contain pain fibers for internal hemorrohoids?

A

there is no pain because this area is innervated by visceral afferent fibers

100
Q

What are the first lymph nodes to receive lymph from the cervix?

A

internal iliac nodes

101
Q

what nerve would have to be anesthetized in order to drain an abcess in the anterior recess ofhte ischioanal fossa?

A

perineal nerve

102
Q

what does the superficial perineal branch of the perineal nerve supple?

A

labia majora

103
Q

what does the inferior rectal nerve innervate?

A

skin around anus

external anal sphincter

104
Q

if an abscess in the posterior recess of the ichioanal fossa (horseshoe anal abscess) which nerve would have to be anesthetized to drain it?

A

inferior rectal n.

105
Q

after a repair of inguinal hernia, two days post op = hypovolemic shock. the vessel crossing the pectineal (Cooper’s) ligament as it descends into the pelvis was injured by a staple = confirming “arterial circle of death” - what vessel is this?

A

abberrant obturator artery

106
Q

where does the aberrant obturator a. arise from?

A

inferior epigastic a.

107
Q

what nerve is typically injured in vasectomy procedure leading to postvasectomy pain syndrome?

A

visceral afferent T10-L2 - thats why it hurts the belly when guys are kicked in the nuts

108
Q

which artery is the most likely source of blood from a hematoma following a tubal ligation?

A

ovarian a.

109
Q

which pelvic distances will not move even if the women is given “relaxin”?

A

true conjugate diameter

110
Q

which pelvic distance changes dramatically with childbirth due to relaxation of the joints?

A

interspinous distance

111
Q

what nerve innervations the major adductors of the thigh and the skin of the medial aspect of the distal thigh?

A

obturator n.

112
Q

what pelvic distance is most easily measured?

A

interspinous distance

113
Q

where does lymph from testes drain?

A

lumbar nodes

114
Q

where is a common site of rupture of the urethra?

A

bulb of the penis

115
Q

what is “butterfly” ecchymosis associated with?

A

superficial pouch extravasation
rupture of buck’s fascia
more common

116
Q

what is ruptured in a penile fracture?

A

tunica albuginia

117
Q

what happens with penile ecchymosis?

A

Buck’s fascia is intact - penis swells with urine

118
Q

what innervates the anterior scrotum?

A

ilioinguinal and genital branch of genitofemoral n.

119
Q

what innervates the posterior scrotum?

A

scrotal branches of perineal n. from pudendal n.

posterior cutaneous nerve of the thigh

120
Q

what structures can be palpated in men?

A

prostate
seminal visicle
bulbourethral gland
rectovesical pouch

121
Q

what structures can be palpated in a female?

A

posterior wall of vagina
cervix
rectourterine pouch of douglas

122
Q

what is an “anal wink”

A

cutaneous reflex mediated by pudendal n. S2-4

123
Q

if the puboprostatic l. is torn, what can happen?

A

can tear urethra - posterior urethral tear - urine will leak into perivesicle space

124
Q

what should i assume if I see a high riding prostate?

A

significant damage in pelvis

125
Q

what nerve should I be mindful of during vasectomy?

A

ilioinguinal n.

126
Q

what ligament is continuous with perineum?

A

broad ligament

127
Q

what level is epidural administers and what spinal levels are affected?

A

S2

S1, S2, S3, S4, C1

128
Q

where are spinal blocks inserted?

A

subarachnoid space

Gross Anatomy Post Midterm (4 decks)

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