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MFSRH part 1 > pelvic anatomy > Flashcards

pelvic anatomy Flashcards

1
Q

what are the muscles that make up the pelvic floor or pelvic diaphragm called

A

Levator Ani and coccyges

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2
Q

what are the names of the muscles that make up Levator Ani

A

-puborectalis
-pubococcygeus
- iliococygeal

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3
Q

what is the nerve supply to the pelvic diaphragm

A

pudendal nerve (s2-s4), perineal nerve of S4 and obturator nerve (L2-L4)

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4
Q

piriformis is a muscle that makes up the pelvic floor

True or false

A

False

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5
Q

what is the primary function of piriformis muscle

A

external rotation of the hip

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6
Q

what is the nerve origin of pudendal nerve

A

S2-S4

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7
Q

what are the branches of the pudendal nerve

A

PID

  • Perineal nerve
    -inferior rectal nerve
    -Dorsal nerve of the clitoris or penis(in men)
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8
Q

what type of epithelium lines the bladder

A

transitional epithelium

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9
Q

what is the name of the muscle found in the bladder and how many layers does it have

A

detrusor - 3 layers

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10
Q

what is the part of the bladder called that is referred to as a ‘triangle’ and encloses the ureter orrifeces and the urethra

A

trigone of the bladder

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11
Q

What is the embryological origin of the bladder (not the trigone of the bladder)

A

urogenital sinus - cranial portion

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12
Q

what is the average length of the uretha in

A - males
B - females

A

males - 22-29cm, average 25cm
Women- 2-4cm

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13
Q

What is the role of the parasympathetic NS to the bladder; what is the parasympathetic nerve that supplies the bladder

A

parasympathetic = peeing - detrusor contraction
pelvic splanchnic s2-s4

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14
Q

what is the role of the sympathetic nerve supply to the bladder?

A

sympathetic bladder nerve supply = storage, detrusor relaxation
T11-L2

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15
Q

what is the lymph drainage of the bladder

A

internal iliac nodes

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16
Q

what is the blood supply to the bladder

A

branches of the internal iliac artery (superior vesicle artery, vaginal artery, minor branches of gluteal and obturator arteries)

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17
Q

What is the orientation of the pudenal nerve in relation to the pudendal artery as it leaves the pelvis

A

pudendal nerve lies lateral to the pudendal artery as it leaves the pelvis

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18
Q

describe the course of the pudendal nerve as it leaves the pelvis

A

Pudenal nerve lies lateral to the pudendal artery and leaves the pelvis through the greater sciatic foramen, hooks around the ischial spine and passes under the sacrospinous and then re-enters the pelvis through the lesser sciatic foramen.

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19
Q

when performing a pudendal nerve block what bony landmark should you identify?

A

ischial spines (as the sacrospinous ligament lies inferior to this bony landmark)

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20
Q

a pudendal nerve block will block sensation to the anterior vagina/mons pubis?
True or false

A

false - this area is supplied by the genitofemoral and ilioinguinal nerves

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21
Q

is the internal anal sphincter under voluntary or involuntary control

A

involuntary control

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22
Q

what is the nerve supply to the internal anal sphincter

A

pelvic splanchic nerves

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23
Q

is the external anal sphincter under involuntary or voluntary control

A

voluntary control

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24
Q

what is the innervation to the external anal sphincter

A

inferior rectal branch of the pudendal nerve (S4)

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25
Q

what does version of the uterus refer to

A

version of the uterus is the angle between the vagina and the cervix

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26
Q

what does flexion of the uterus refer to

A

uterine flexion is the degree of flexion between the uterus and cervix

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27
Q

what is the degree of anterversion that is normally demonstrated

A

90 degrees (angle between the vagina and the cervix)

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28
Q

what is the degree of ante flexion of the uterus that is considered normal

A

120-170 degrees

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29
Q

what are the ovarian arteries branches of?

A - internal iliac arteries
B - external iliac arteries
C- abdominal aorta
D- vaginal arteries

A

C- Abdominal aorta

(ovarian arteries come directly off the abdominal aorta)

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30
Q

what does the right ovarian vein drain into?

A

IVC (inferior vena cava)

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31
Q

what does the left ovarian vein drain into?

A

left renal vein

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32
Q

what is the main blood supply to the uterus

A

uterine artery

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33
Q

the uterine artery branches off..

A - abdominal aorta
B- internal iliac artery
c- external iliac artery
D- ovarian artery

A

B- internal iliac artery

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34
Q

what is the venous drainage of the uterus

A

uterine veins - drain into internal iliac veins

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35
Q

what is the lymphatic drainage of the uterine fundus

A

para-aortic nodes

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36
Q

what are the two ligaments of the ovary called

A
  1. ovarian ligament (medial)
  2. suspensory ligament of the ovary (lateral)
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37
Q

Which ligament would you find the ovarian arteries and veins

A

Suspensory ligament of the ovary

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38
Q

what nerve is found in the ovarian fossa

A

obturator nerve (t10)

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39
Q

what important anatomical structures lie posterior to the ovary

A

internal iliac artery and ureter

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40
Q

what lymph nodes do the ovaries drain into

A

para-aortic nodes

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41
Q

what lymph nodes do the fallopian tubes drain into

A

para-aortic nodes

42
Q

Pain at the diaphragm can be referred to the shoulder what are the nerve roots that cause this

A

diaphragm is supplied by S2,3,4 and this is referred to the shoulder (hence why people can present with shoulder tip pain)

43
Q

A patient has a large amount of free fluid in the Pouch of Douglas secondary to presumed PID. Where might they experience the pain and why?

A

pain from the pouch of douglas can be referred/transmitted to umbilicus to the anterior thigh (T10-L2)

44
Q

a patient presents with severe genital HSV surrounding the clitoris, vulva and extends into the vaginal canal. She is experiencing a large amount of her pain down her thighs but can’t understand why. How would you explain this?

A

referred pain - pain from the cervix and vagina can be referred to the buttock and posterior thighs (s2-s4)

45
Q

what is the blood supply to the vagina

A

internal iliac artery branches producing vaginal arteries, uterine arteries, rectal arteries and pudendal arteries

46
Q

what is the venous drainage of the vagina

A

venous plexus drains into internal iliac vein

47
Q

what is the main blood supply to the vulva

A

pudendal artery (this is the terminal branch of the internal iliac artery)

48
Q

what nerve provides sensory innervation to the mons pubis and labia majora

A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve

A

B - ilioinguinal nerve

hence if you do a pudendal nerve block patient will still experience pain and sensation in the anterior vulva

49
Q

what nerve provides sensory innervation to the lower vagina, perineum and peri-anal area

A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve

A

A - pudendal nerve

50
Q

what nerve supplies sensory innervation to the cervix and upper vagina

A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve

A

C - pelvic splanchnic nerves (S2-s4)

51
Q

what is the sensory nerve supply to the uterus and adnexa

A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve

A

D - hypogastric nerve supply sympathetic fibres to the uterus and adnexa

52
Q

what is the motor innervation to the uterine fundus and body

A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve

A

A - sympathetic

53
Q

what is the motor innervation to the lower uterus and upper vagina

A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve

A

B - parasympathetic via uterovaginal nerve plexus (inferior hypogastric nerve)

54
Q

what is the motor supply to the lower vagina and perineum

A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve
D - pudendal nerve

A

pudendal nerve supplies somatic fibres (deep perineal nerve branch)

55
Q

which of the following uterine ligaments is made from a double layer of peritoneum

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

A - broad ligament

56
Q

which of the following ligaments is an embryological remnant of the gubernaculum

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

B - round ligament

57
Q

which of the following ligaments divides the pelvis into anterior and posterior compartments

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

broad ligament (attaches to the lateral pelvic wall)

58
Q

what are the three divisions of the broad ligament

A
  1. mesosalpinx - covers fallopian tubes
  2. mesovarium - covers the ovary
  3. mesometrium -covers the uterus, extenal iliac vessels and proximal part of the round ligament of the uterus
59
Q

which ligament connects the anterior horn of the uterus to the labia major

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

B - round ligament

60
Q

what canal does the round ligament travel through to reach the labia major

A

inguinal canal

61
Q

what nerve does the round ligament lie in close proximity too as it passes through the deep inguinal ring to travel to the labia majora

A - pudendal nerve
B- hypogastric nerve
C- ilioingunal nerve
D- pelvic splanchnic nerve

A

C - ilioininguinal nerve

62
Q

which uterine ligament contains the uterine arteries and veins?

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

C = cardinal ligament

(C= contains arteries )

63
Q

what is the course of the cardinal ligament

A

cervix to the lateral pelvic wall

64
Q

do the ureters run

A) anterior to the cardinal ligament
B) posterior to cardinal ligament
C) lateral to cardinal ligemant
D) medial to cardinal ligament

A

B - posterior to cardinal ligament

65
Q

which ligament needs to be ligated at oophorectomy and why?

A) broad ligament
B) round ligament
C) cardinal ligament
D) ligament of the ovary
E) suspensory ligament of the ovary

A

E - suspensory ligament of the ovary as it contains the ovarian artery and vein (+ lymphatics)

66
Q

which uterine ligament is the anatomical landmark of a pudendal nerve block

A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament

A

D - uterosacral ligament

67
Q

what is the course of the uterosacral ligament

A

cervix to sacrum

68
Q

a patient is undergoing diagnostic laprascopy for investigation of pelvic pain ? endometriosis. The trochar has been inserted and the anaesthetist starts becoming concerned as the patient is becoming increasing hypotensive and tachycardia. What vessel could have been damaged?

A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) external iliac artery
E) inferior epigastric artery

A

B - abdominal aorta

(is at risk from complications of trochar at laprascopy)

69
Q

a patient develops a rectal sheath haematoma following laparotomy. Which blood vessel is likely to have been damaged during the procedure

A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) external iliac artery
E) inferior epigastric artery

A

E - inferior epigastric artery

70
Q

which artery is most vulnerable during episiotomy

A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) pudendal artery
E) inferior epigastric artery

A

D- pudendal artery

71
Q

does the uterine artery run anterior or posterior to the ureters

A

anterior (remember water under the bridge)

72
Q

what is the lymphatic drainage of the uterine fundus

A

para-aortic lymph nodes

73
Q

what is the lymphatic drainage of the ovaries

A

para-aortic lymph nodes

74
Q

what is the lymphatic drainage of the fallopian tubes

A

para-aortic lymph nodes

75
Q

what is the lymphatic drainage of the upper uterus

A

superficial inguinal nodes (via the round ligament)

76
Q

where is the lymphatic drainage of the body of the uterus

A

external iliac nodes via the broad ligament

77
Q

where does the lymph drain to from the cervix

A

external iliac nodes - ultimately para-aortic nodes

78
Q

where does the lymph drain to from the upper vagina

A

internal and external iliac lymph nodes

79
Q

where does the lower vagina lymphatic drain to

A

superficial inguinal nodes

80
Q

where does the vulva lymphatic drain to ultimately

A

femoral nodes (first the superficial inguinal nodes)

81
Q

what embryological structure are the batholins glands derived from?

A

urogenital sinus

82
Q

what are the two erectile tissues called in the male penis (pick 2)

A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous

A

A)corpus spongiosum and C) corpus cavernosa

83
Q

what happens to blood flow during arousal in the erectile tissues

A

blood flows into the erectile tissues during arousal to help produce an errection

84
Q

what are the names of the two muscles that are found in the penis

A) corpus spongiosum
B) bulbospongiosum
C) corpus cavernosa
D) ischiocavernous

A

B - bulbospongiosum and
D) ischiocavernous

85
Q

which muscle is responsible for forcing blood into the corpus cavernosa to help maintain an errection

A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous

A

D - ischiocavernous

86
Q

which muscle is responsible for ensuring the spongy uretra is empty of any residual sperm and urine

A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous

A

B- bulbospongiosum

87
Q

where does the blood supply to the penis branch from

A

3 branches of the internal pudendal artery

88
Q

what are the names of the three arteries that supply the penis

A

branches of internal pudendal artery

  1. dorsal artery of the penis
  2. deep artery of the penis
  3. bulbourethral artery
89
Q

what is the venous drainage of the penis

A

deep and superficial dorsal veins

90
Q

which nerve is responsible for errection of the penis

A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)

A

D - parasympathetic nerve supply - pelvic splanchnic nerves (S2-S4)

remember point and shoot

91
Q

which nerve is responsible for ejaculation

A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)

A

A - pudendal nerve S2-s4 (somatic control)

92
Q

what nerve in males is involved in arousal

A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)

A

A - pudendal nerve under somatic control

93
Q

During development of an errection what neurotransmitter is responsible for causing vasodilation of the penile arteries

A) noradrenaline
B) adrenaline
C) Acteylcholine
D) nitrous oxide

A

D - nitrous oxide

causes vasodilation of the penile arteries and so blood flows into the ejaculatory tissues and causes compression of the penile veins

94
Q

what is the name of the phase that occurs following errection and is responsible for moving sperm from the epididymis to the seminal vesicles

A) stimulation
B) errection
C) emission
D) remission

A

C - emission

95
Q

during emission the sperm move from the epididymis to the seminal vesicles getting ready for ejaculation. What neurotransmitter is responsible for co-ordinating the peristaltic contractions

A) noradrenaline
B) adrenaline
C) Acteylcholine
D) nitrous oxide

A

A - noradrenaline

96
Q

what prevents retrograde flow of semen into the bladder during ejaculation?

A) noradrenaline causes external urethral sphincter to contract
B) noradrenaline causes internal urethral sphincter to contract
C) Acteylcholine causes internal urethral sphincter to contract
D) nitrous oxide causes internal urethral sphincter to contract

A

B - noradrenaline causes the smooth muscle of the internal urethral sphincter to contract

97
Q

A 42-year-old man with type 2 diabetes mellitus is assessed in the neurological clinic. He has recently found that he is incapable of sustaining a penile erection. He is in a long-term relationship with no problems.
Which of the following nerves is most likely to have suffered damage in the course of long standing disease?

A. Dorsal nerve of the penis
B. Hypogastricnerve
C. Pelvic splanchnic nerve
D. Perineal nerve
E. Sacralsplanchnicnerve

A

c. pelvic splanchnic nerve

98
Q

testicular arteries are

A) branch directly of the aorta
B) branch of internal iliac artery
C) branch of external iliac artery
D) branch of pudnendal nerve

A

A - branch directly of the aorta

99
Q

what hormone do serotoli cells secrete

A) testosterone
B) inhibin
C) oestrogen
D) progesterone

A

B - inhibin

100
Q

what hormone do leydig cells secrete

A) testosterone
B) inhibin
C) oestrogen
D) progesterone

A

A - testosterone

101
Q

what type of receptors do leydig cells have

A) FSH receptors
B) LH receptors

A

LH receptors

102
Q

what type of receptors do sertoli cells have

A) FSH receptors
B) LH receptors

A

FSH receptors

MFSRH part 1 (20 decks)

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