Pelvis

Question 1

Name the branches of the internal iliac artery

Answer 1

Anterior division - into PELVIS

1) Superior vesical artery
2) Obturator Artery
3) Vaginal (F) / Inferior vesical artery (M)
4) Uterine (F) / A to Ductus Deferens (M)
5) Middle rectal artery
6) Internal pudendal artery
7) Inferior gluteal artery

Posterior division - mainly MUSCULAR

1) Superior gluteal artery
2) Lateral sacral artery
3) Iliolumbar artery

Question 2

Where does the ureter enter the bladder?

Answer 2

Posterolateral angles of trigone of bladder

Question 3

How long is the ureter?

Answer 3

25-30cm long

Question 4

What are the different parts of the ureter?

Answer 4

1) Abdominal - renal pelvis to pelvic brim
2) Pelvic - pelvic brim to bladder
3) Intravesical/intramural - within bladder wall

Question 5

Name the 3 constrictions of the ureter

Answer 5

1) Pelviureter junction
2) Pelvic brim / crossing over common or internal iliac artery
3) Uretovesicular junction

Question 6

What is the MAIN arterial blood supply of the ureter?

Answer 6

Superior 1/3: Renal artery

Middle 1/3: Gonadal artery

Lower 1/3: Superior vesical artery (will also be supplied by other contributing arteries from the internal iliac artery)

Question 7

What is the lymphatic drainage of the ureter?

Answer 7

Abdominal ureter: aorto-caval and common iliac nodes

Pelvic ureter: Internal and external iliac nodes

Question 8

How does the ureters descend inferiorly in relation to the psoas muscle?

Answer 8

Lateral to medial anterior to psoas muscle running along the transverse processes of the lumbar vertebrae

Question 9

What are the different parts of the urethra in men and their associated membranous linings?

Answer 9

1) Prostatic urethra - transitional cell
2) Membranous urethra - transitional cell
3) Bulbous - psuedostratified columnar cell
4) Pendulous - psuedostratified columnar cell
5) Fossa Navicularis - squamous cell

Question 10

Which zone of the prostate is affected in BPH?

Answer 10

Transitional zone - medial and lateral lobes of prostate

Question 11

Which zone of the prostate is commonly affected in Prostate Ca?

Answer 11

`Peripheral zone - posterior lobe

Question 12

What is the arterial supply of the prostate?

Answer 12

1) Inferior vesical artery
2) Middle rectal artery
3) Internal pudendal artery

Question 13

What is the venous drainage of the prostate?

Answer 13

Prostate venous plexus:

1) Santorini’s plexus - drain into internal iliac vein connecting with the vertebral lumbar veins
2) Batson’s plexus - valveless veins draining the deep pelvic veins into internal venous plexus

Question 14

What is the nerve supply to the prostate?

Answer 14

Inferior hypogastric plexus (autonomic)

Question 15

What is the lymphatic drainage of the prostate?

Answer 15

Anterior lobe:

1) External iliac LN
2) Inferior gluteal LN (part of internal iliac LN)

Posterior lobe:

1) External iliac LN (lateral pathway)
2) Internal iliac LN (latarodorsal pathway)
3) Sacral & common iliac LN (dorsal pathway)

Question 16

Which lymph nodes do the testes drain into?

Answer 16

Para-aortic LN

Question 17

Which lymph nodes do the gluteal and lateral lumbar regions drain into?

Answer 17

Superolateral superficial inguinal LN

Question 18

Which lymph nodes do the outside of anal canal, external genitalia, skin of penis and scrotum drain into?

Answer 18

Superomedial superficial inguinal LN

Question 19

Which lymph nodes do the glans penis and spongey urethra drain into?

Answer 19

Deep inguinal LN

Question 20

Which lymph nodes does the lower limb drain into?

Answer 20

Inferior superficial inguinal LN

Question 21

What are the components of the pelvic floor?

Answer 21

• *LEVATOR ANI**
  1) Puborectalis
  2) Pubococcygeus
  3) Iliococcygeus
• *COCCYGEUS**
• *FASCIA COVERING THESE MUSCLES**

Question 22

Through which foramen does the pudendal nerve pass through?

Answer 22

Greater sciatic foramen

Question 23

Below which muscle does the pudendal nerve travel passed?

Answer 23

Piriformis muscle

Question 24

Which nerve provides innervation to the perineum, pelvic floor and pelvic diaphragm?

Answer 24

Pudendal nerve

Question 25

Through which foramen does the pudendal nerve pass into after passing below piriformis muscle?

Answer 25

Lesser sciatic foramen

Question 26

Through which canal does the pudendal nerve pass through after passing through the lesser sciatic foramen?

Answer 26

Alcock's / pudendal canal

Question 27

Which nerves are anaesthetised for an episiotomy?

Answer 27

Deep and superficial perineal nerves (branches of pudendal nerve)

Question 28

What is Denonvillier's fascia?

Answer 28

Rectogenital fascia

Question 29

What is Waldeyer's fascia?

Answer 29

Rectosacral fascia - keeps inferior hypogastric plexus from rectum

Question 30

Within which fascia is the superficial dorsal penile vein immediately deep to?

Answer 30

Superficial / Dartos fascia

Question 31

Within which fascia is the deep dorsal penile vein immediately deep to?

Answer 31

Deep / Buck's fascia

Question 32

Dartos fascia of the penis & scrotum are continuous to which other fascial layers in the body?

Answer 32

1) Colles fascia of the perineum | 2) Scarpa's fascia of anterior abdominal wall

Question 33

Buck's fascia of the penis is continuous to which other fascial layers in the body?

Answer 33

1) External spermatic fascia of the penis | 2) Aponeurosis of external oblique

Question 34

Between which fascial layers is the deep perineal space situated?

Answer 34

Superior & inferior fascia of the urogenital diaphragm

Question 35

Between which fascial layers is the superficial perineal space situated?

Answer 35

Inferior fascia of the urogenital diaphragm & superficial fascia of perineum / Colles fascia

Question 36

What is the lymphatic drainage of the superior aspect of the vagina?

Answer 36

External iliac LN

Question 37

What is the lymphatic drainage of the middle aspect of the vagina?

Answer 37

Internal iliac LN

Question 38

What is the lymphatic drainage of the inferior aspect of the vagina?

Answer 38

Superficial inguinal LN

Question 39

What is the innervation of the vagina?

Answer 39

Uterovaginal nerve plexus (both parasympathetic & sympathetic)

Question 40

What are the nerves that pass through the greater sciatic foramen?

Answer 40

1) Sciatic Nerve 2) Superior and Inferior Gluteal Nerves 3) Pudendal Nerve 4) Posterior Femoral Cutaneous Nerve 5) Nerve to Quadratus Femoris 6) Nerve to Obturator internus

Question 41

What are the vessels that pass through the greater sciatic foramen?

Answer 41

1) Superior Gluteal Artery and vein 2) Inferior Gluteal Artery and vein 3) Internal Pudendal Artery and vein

Question 42

What are the boundaries of the greater sciatic foramen?

Answer 42

Anterolateral - Greater sciatic notch of the ilium Posteromedial - Sacrotuberous ligament Inferior - Sacrospinous ligament and the ischial spine Superior - Anterior sacroiliac ligament

Question 43

What are the contents of the lesser sciatic foramen?

Answer 43

1) Tendon of the obturator internus 2) Pudendal nerve 3) Internal pudendal artery and vein 4) Nerve to the obturator internus

Question 44

What structures pass through the obturator foramen?

Answer 44

1) Obturator nerve 2) Obturator artery 3) Obturator vein

Question 45

What are the layers of the scrotum?

Answer 45

SUPERFICIAL 1) Skin 2) Dartos fascia and muscle 3) External spermatic fascia 4) Cremasteric muscle and fascia 5) Internal spermatic fascia 6) Parietal layer of the tunica vaginalis DEEP

Question 46

What is the main structure to provide structural support for the uterus?

Answer 46

Central perineal tendon

Question 47

What is the dermatome of the groin?

Answer 47

L1

Question 48

What are the 3 fascial layers of the spermatic cord?

Answer 48

1) External spermatic 2) Cremasteric 3) Internal spermatic

Question 49

What are the 3 arteries of the spermatic cord?

Answer 49

1) Testicular - from aorta 2) Cremasteric - from inf. epigastric 3) Artery of Vas - Inferior vesical

Question 50

What are the 3 veins of the spermatic cord?

Answer 50

1) Pampiniform plexus of veins - R side drains to IVC, L side drains to L renal vein 2) Cremasteric vein 3) Vein of Vas

Question 51

What are the 3 nerves of the spermatic cord?

Answer 51

1) Ilioinguinal nerve (superficial to spermatic cord) 2) Nerve to cremaster (from genitofemoral nerve) 3) T10/T11 Sympathetic nerves

Question 52

What are the 3 common places for ureteric stones?

Answer 52

1) Pelvi-ureteric junction 2) Ureter crosses the bifurcation of common iliac blood vessels 3) Vesico-ureteric junction

Question 53

What parts of the rectum is covered by peritoneum?

Answer 53

Upper third - anterior & lateral surfaces Middle third - anterior surfaces Lower third - NO PERITONEUM

Question 54

Which nerve roots do the pelvic splanchnic nerve arise from?

Answer 54

S2 - S4 (parasympathetic efferent fibres)

Question 55

What structures converge into the perineal body?

Answer 55

1) Bulbospongiosus 2) Transverse perineal (DEEP) 3) Transverse perineal (SUPERFICIAL) 4) Ant fibres of levator ani 5) Fibres from urethral sphincter 6) External anal sphincter

Question 56

What structures are in the superficial perineal pouch?

Answer 56

1) Transverse perineal pouch (superficial) 2) Bulbospongiosus 3) Ischiocavernosus