Pelvis Flashcards

1
Q

Contents of the greater sciatic foramen

A

Suprapiriform foramen:

Superior gluteal artery and vein
Superior gluteal nerve

Infrapiriform foramen:

Sciatic nerve
Pudendal nerve
Inferior gluteal artery and vein
Inferior gluteal nerve
Posterior femoral cutaneous nerve
Nerve to obturator internus
Nerve to quadratus femoris

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2
Q

Contents of the lesser sciatic foramen

A

Internal pudendal artery and vein
Pudendal nerve (note the pudendal nerve first leaves the pelvis via the greater sciatic foramen, and then re-enters via the lesser sciatic foramen)
Obturator internus tendon
Nerve to obturator internus

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3
Q

Which of the following is the remnant of the fused sacral intervertebral discs?

A

Transverse ridge

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4
Q

At which vertebral level does the dural sac terminate?

A

S2

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5
Q

How many vertebrae normally comprise the coccyx?

A

4

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6
Q

What is the function of the anococcygeal raphe?

A

To support the Anus

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7
Q

What is Coccydynia

A

Coccydynia refers to a sensation of general discomfort around the coccyx, and has a wide range of causes. Childbirth may be a cause, as the stretching of pelvic floor muscles during labour puts pressure on their attachment to the coccyx, causing pain. Blunt trauma can contribute, as can poor posture when cycling or rowing, leading to irritation of the bone.

Normally coccydynia is an acute condition, although if the pain lasts for more than 3 months it is considered chronic, and requires more specialised treatment.

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8
Q

What is the most common presenting tumour of the newborn

A

A sacrococcygeal teratoma is a tumor of the coccyx that is thought to derive from the embryological primitive streak. Mostly they are benign, although 12% of the time they are malignant and life-threatening. They are present in 1/35,000 live births, and so are the most common presenting tumor in newborns.

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9
Q

Where are the testes originally located during embryonic development?

A

Posterior abdominal wall

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10
Q

Which part of the urethra do the bulbourethral ducts empty into? What is the epithelial lining of the bulbourethral glands?

A

Spongy and simple columnar

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11
Q

Which early developmental structure gives rise to the phallus in males and clitoris in females?

A

Genital tubercle

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12
Q

What is the lining of the urethra

A

The urethra is lined by stratified columnar epithelium, which is protected from the corrosive urine by mucus secreting glands.

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13
Q

The parasympathetic supply to the vulva is via the cavernous nerves. Which nerve plexus do they arise from?

A

Uterovaginal

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14
Q

Which of the following is the remnant of the fused sacral intervertebral discs?

A

Transverse ridge

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15
Q

Where are the testes originally located during embryonic development?

A

Posterior abdominal wall

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16
Q

Describe the apex of the bladder

A

The apex of the bladder is located superiorly, pointing towards the pubic symphysis. It is connected to the umbilicus by the median umbilical ligament (a remnant of the urachus).

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17
Q

What are the ligaments of the penis

A

Suspensory ligament – a condensation of deep fascia. It connects the erectile bodies of the penis to the pubic symphysis.
Fundiform ligament – a condensation of abdominal subcutaneous tissue. It runs down from the linea alba, surrounding the penis like a sling, and attaching to the pubic symphysis.

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18
Q

What is the epithelial lining of the bulbourethral glands?

A

Simple columnar

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19
Q

What is the navicular fossa

A

In the glans (head) of the penis, the penile urethra dilates to form the navicular fossa.

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20
Q

During its course, the pudendal nerve crosses which ligament?

A

Sacrospinous ligament

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21
Q

A 25 year old woman presents to her primary care physician with tenderness and swelling of the vulva. Infective Bartholinitis is suspected.

Where in the perineum are the Bartholin’s glands located?

A

Superficial perineal pouch

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22
Q

Posterior border of the perineum

A

In terms of surface anatomy, the posterior border of the perineum is the superior end of the intergluteal cleft. The anatomical posterior border is the tip of the coccyx

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23
Q

What is the afferent supply of the penis

A

Dorsal nerve of the penis or clitoris – innervates the skin of the penis or clitoris. Thus, responsible for the afferent component of penile and clitoral erection.

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24
Q

What structure are the seminal glands derived from?

A

Mesonephric duct

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25
At which vertebral level does the dural sac terminate?
s2
26
How is a patient’s ‘true’ leg length measured?
ASIS to medial malleolus
27
Which vulval structure is embryologically derived from the urethral folds?
Labia minora
28
On which vertebra are the coccygeal cornua found?
Co1
29
How many vertebrae normally comprise the coccyx?
4
30
Which part of the male urethra receives secretions from the seminal vesicle glands?
Prostatic
31
The cremaster muscle is derived from which abdominal wall muscle?
Internal oblique
32
What relationship does the rectum have with the peritoneum?
Covers the anterior and lateral parts of the upper third and only the anterior in the middle third
33
What part of the ischium is palpable PV
Ischial spine
34
Most common lymph nodes mets for the cervix
Obtruator nodes
35
What is the greater and the lesser sciatic foramen separated by
Sacrospinous ligament
36
Which of the sacroiliac ligaments are strongest and weakest
The interosseous ones are the strongest and the. anterior ones are the weakest
37
What are the sensory fibres of the ureter
T11 - L2
38
Urethra cheat sheet
Prostatic: Receives ejaculatory ducts and is the widest Membranous: Narrowest and is surrounded by the external sphincter Bulbous or penile: Bulbourethral glands
39
Where does the cremasteric artery arise from
The inferior epigastric
40
Where does the artery to the vas deferens arise from
The inferior vesicle
41
What is the arrangement of the muscles of the vas deferens
Long - circ - long
42
What is the bulbourethral gland function
Has glycoproteins * Serves as lubrication medium for the urethra and the tip of the penis. * Expels any residue of urine, dead cells or mucous through the urethral meatus, preparing a clean and lubricated pathway for ejaculation. * Helps to neutralise residual acidity in the male urethra (secretions are alkaline).
43
What is the functions of the seminal vesicles
* Alkaline fluid – neutralises the acidity of the male urethra and vagina in order to facilitate the survival of spermatozoa. * Fructose – provides an energy source for spermatozoa. * Prostaglandins – have a role in suppressing the female immune response to foreign semen. * Clotting factors – designed to keep semen in the female reproductive tract post-ejaculation.
44
Where is the labia majora derived from
o Embryologically derived from urethral folds
45
Where is the labia minora derived from
o Embryologically derived from labioscrotal swellings
46
Where is the clitoris derived from
o Embryologically derived from the genital tubercle
47
Where are the ovarian vessels contained
Suspensory ligament of the ovaries
48
Where are the Uterine vessels contained
Cardinal ligament or the transverse cervical ligament
49
A 78 year old man presents with metastatic spinal cord compression from prostate cancer at the vertebral level L3. The patient reports a 2 month history of bladder incontinence. Which part of the micturition reflex is likely to be affected?
Pelvic nerve (Parasympathetic)
50
Neuropathy of the pudendal nerve can result in faecal incontinence. Which branch of the pudendal nerve innervates the external anal sphincter?
Inferior rectal
51
Which of the following statements correctly describes the apex of the bladder?
Connected to umbilicus by the median umbilical ligament
52
What is the epithelial lining of the urethra?
Stratified columnar
53
The parasympathetic supply to the vulva is via the cavernous nerves. Which nerve plexus do they arise from?
Uterovaginal
54
Which part of the urethra do the bulbourethral ducts empty into?
Spongy
55
Which of the following vessels is not a direct tributary of the internal iliac vein?
The superior rectal vein becomes the inferior mesenteric vein. It does not empty into the internal iliac vein.
56
Which part of the male urethra receives secretions from the seminal vesicle glands?
Prostatic
57
Epithelium of the vagina
The stratified squamous epithelium provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).
58
What relationship does the rectum have with the peritoneum
Ant and lat in the upper third and ant in the middle third
59
Which muscle is involved in piriformis syndrome
Sciatic nerve
60
How would you treat a hydrocele in adults vs children
In children it may occur as a result of a patent processus vaginalis. Treatment in adults is with a Lords or Jabouley procedure. Treatment in children is with trans inguinal ligation of PPV.
61
What are the fascial layers surrounding the rectum
Fascial layers surrounding the rectum: Anteriorly lies the fascia of Denonvilliers Posteriorly lies Waldeyers fascia
62
Origin and positioning of the pudendal canal
The pudendal canal is located along the lateral wall of the ischioanal fossa at the inferior margin of the obturator internus muscle. It extends from the lesser sciatic foramen to the posterior margin of the urogenital diaphragm. It conveys the internal pudendal vessels and nerve.
63