Pelvis

Question 1

Contents of the greater sciatic foramen

Answer 1

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

Question 2

Contents of the lesser sciatic foramen

Answer 2

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

Question 3

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

Answer 3

Transverse ridge

Question 4

At which vertebral level does the dural sac terminate?

Answer 4

S2

Question 5

How many vertebrae normally comprise the coccyx?

Answer 5

4

Question 6

What is the function of the anococcygeal raphe?

Answer 6

To support the Anus

Question 7

What is Coccydynia

Answer 7

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.

Question 8

What is the most common presenting tumour of the newborn

Answer 8

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.

Question 9

Where are the testes originally located during embryonic development?

Answer 9

Posterior abdominal wall

Question 10

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

Answer 10

Spongy and simple columnar

Question 11

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

Answer 11

Genital tubercle

Question 12

What is the lining of the urethra

Answer 12

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

Question 13

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

Answer 13

Uterovaginal

Question 14

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

Answer 14

Transverse ridge

Question 15

Where are the testes originally located during embryonic development?

Answer 15

Posterior abdominal wall

Question 16

Describe the apex of the bladder

Answer 16

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).

Question 17

What are the ligaments of the penis

Answer 17

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.

Question 18

What is the epithelial lining of the bulbourethral glands?

Answer 18

Simple columnar

Question 19

What is the navicular fossa

Answer 19

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

Question 20

During its course, the pudendal nerve crosses which ligament?

Answer 20

Sacrospinous ligament

Question 21

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?

Answer 21

Superficial perineal pouch

Question 22

Posterior border of the perineum

Answer 22

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

Question 23

What is the afferent supply of the penis

Answer 23

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.

Question 24

What structure are the seminal glands derived from?

Answer 24

Mesonephric duct

Question 25

At which vertebral level does the dural sac terminate?

Answer 25

s2

Question 26

How is a patient’s ‘true’ leg length measured?

Answer 26

ASIS to medial malleolus

Question 27

Which vulval structure is embryologically derived from the urethral folds?

Answer 27

Labia minora

Question 28

On which vertebra are the coccygeal cornua found?

Answer 28

Co1

Question 29

How many vertebrae normally comprise the coccyx?

Answer 29

4

Question 30

Which part of the male urethra receives secretions from the seminal vesicle glands?

Answer 30

Prostatic

Question 31

The cremaster muscle is derived from which abdominal wall muscle?

Answer 31

Internal oblique

Question 32

What relationship does the rectum have with the peritoneum?

Answer 32

Covers the anterior and lateral parts of the upper third and only the anterior in the middle third

Question 33

What part of the ischium is palpable PV

Answer 33

Ischial spine

Question 34

Most common lymph nodes mets for the cervix

Answer 34

Obtruator nodes

Question 35

What is the greater and the lesser sciatic foramen separated by

Answer 35

Sacrospinous ligament

Question 36

Which of the sacroiliac ligaments are strongest and weakest

Answer 36

The interosseous ones are the strongest and the. anterior ones are the weakest

Question 37

What are the sensory fibres of the ureter

Answer 37

T11 - L2

Question 38

Urethra cheat sheet

Answer 38

Prostatic: Receives ejaculatory ducts and is the widest Membranous: Narrowest and is surrounded by the external sphincter Bulbous or penile: Bulbourethral glands

Question 39

Where does the cremasteric artery arise from

Answer 39

The inferior epigastric

Question 40

Where does the artery to the vas deferens arise from

Answer 40

The inferior vesicle

Question 41

What is the arrangement of the muscles of the vas deferens

Answer 41

Long - circ - long

Question 42

What is the bulbourethral gland function

Answer 42

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).

Question 43

What is the functions of the seminal vesicles

Answer 43

* 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.

Question 44

Where is the labia majora derived from

Answer 44

o Embryologically derived from urethral folds

Question 45

Where is the labia minora derived from

Answer 45

o Embryologically derived from labioscrotal swellings

Question 46

Where is the clitoris derived from

Answer 46

o Embryologically derived from the genital tubercle

Question 47

Where are the ovarian vessels contained

Answer 47

Suspensory ligament of the ovaries

Question 48

Where are the Uterine vessels contained

Answer 48

Cardinal ligament or the transverse cervical ligament

Question 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?

Answer 49

Pelvic nerve (Parasympathetic)

Question 50

Neuropathy of the pudendal nerve can result in faecal incontinence. Which branch of the pudendal nerve innervates the external anal sphincter?

Answer 50

Inferior rectal

Question 51

Which of the following statements correctly describes the apex of the bladder?

Answer 51

Connected to umbilicus by the median umbilical ligament

Question 52

What is the epithelial lining of the urethra?

Answer 52

Stratified columnar

Question 53

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

Answer 53

Uterovaginal

Question 54

Which part of the urethra do the bulbourethral ducts empty into?

Answer 54

Spongy

Question 55

Which of the following vessels is not a direct tributary of the internal iliac vein?

Answer 55

The superior rectal vein becomes the inferior mesenteric vein. It does not empty into the internal iliac vein.

Question 56

Which part of the male urethra receives secretions from the seminal vesicle glands?

Answer 56

Prostatic

Question 57

Epithelium of the vagina

Answer 57

The stratified squamous epithelium provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).

Question 58

What relationship does the rectum have with the peritoneum

Answer 58

Ant and lat in the upper third and ant in the middle third

Question 59

Which muscle is involved in piriformis syndrome

Answer 59

Sciatic nerve

Question 60

How would you treat a hydrocele in adults vs children

Answer 60

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.

Question 61

What are the fascial layers surrounding the rectum

Answer 61

Fascial layers surrounding the rectum: Anteriorly lies the fascia of Denonvilliers Posteriorly lies Waldeyers fascia

Question 62

Origin and positioning of the pudendal canal

Answer 62

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.