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OSPE MSK > Pelvis and Male Reproductive Structures > Flashcards

Pelvis and Male Reproductive Structures Flashcards

1
Q

Name 5 structures that form the boundary of inferior pelvic aperture/pelvic outlet

A

superior: inferior rami of pubis
lateral boundary: ischial tuberosities
sacrotuberous ligament
posterior: tip of coccyx

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2
Q

True/lesser pelvis defined by…

A

enclosed by pelvic girdle
below the pelvic brim
between pelvic inlet and the pelvic floor

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3
Q

False/greater pelvis defined by…

A

above and in front of the pelvic brim

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4
Q

Female subpubic angle is obtuse/acute

A

obtuse

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5
Q

Male subpubic angle is obtuse/acute

A

acute

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6
Q

What type of joint is the SI joint

A

synovial plane joint

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7
Q

What type of joint is the pubic symphysis

A

secondary cartilaginous joint

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8
Q

Which muscle/structures occupy the lateral pelvic wall
Which muscle is present in the posterior wall of the pelvis
What are their origins and insertions

A

Obturator internus
Origin - obturator membrane
Piriformis
Origin - sacrum

Both insert into the greater trochanter of the femur

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9
Q

Where is the perineal body

Where is the anococcygeal body

A

Perineal body is the junction between the urogenital and anal triangle
Anococcygeal body is between coccyx and anus

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10
Q

Which nerve network lies on the muscle forming the posterior wall of the pelvis

A

Sacral plexus

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11
Q

/What are the 2 major parts of the pelvic diaphragm/floor

A

Coccygeus and levator ani

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12
Q

What are the 2 functions of the pelvic floor?

A

Maintains mostly fecal continence

Maintains intra-abdominal pressure supporting pelvic viscera > prevents prolapse of organs

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13
Q

What is the innervation of the pelvic diaphragm/floor?

A

Nerve to levator ani

2 muscles of the levator ani are also innervated by inferior rectal nerve

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14
Q

What is a cystocoele?

A

Anterior prolapse - wall between bladder and vagina weakens and allows bladder to droop into vagina

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15
Q

What is a rectocele?

A

Bulging of front wall of rectum in back wall of vagina

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16
Q

Why is injury to pelvic floor during childbirth common and potentially damaging?

A

Leads to urinary incontinence, sexual dysfunction, potential prolapse
When the pubococcygeus and puborectalis are torn, decrease in support for vagina, bladder. uterus and rectum > urinary stress incontinence also develops

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17
Q

Why may an episiotomy minimise long term damage

A

Heals faster, lessens damage to perineal body, lessens perineal trauma

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18
Q

Why is a mediolateral episiotomy preferable to a midline episiotomy?

A

Avoids trauma to the perineal body which is essential to the integrity of the pelvic floor only cuts through vagina epithelium, skin and transversalis and bulbospongiosus

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19
Q

What are the main pelvic viscera in the female pelvis

A

Bladder and urethra
Uterus, vagina, cervix, fallopian tubes, ovaries
Rectum and anus

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20
Q

What are the main pelvic viscera in the male pelvis

A

Bladder and urethra
VD, SV, prostate, bulbourethral gland
Rectum and anus

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21
Q

Supply of bladder

A

superior vesical artery > internal iliac artery (anterior division)

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22
Q

Supply of seminal gland and prostate

A

inferior vesicle artery > internal iliac artery (anterior division)

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23
Q

Supply of uterus, ovary, vagina, cervix

A

Uterine artery > internal iliac artery

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24
Q

Supply of testis, ovaries

A

Gonadal arteries

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25
Q

What is the origin of the gonadal arteries

A

Abdominal aorta

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26
Q

What supplies the upper third of the rectum?

A

superior rectal artery

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27
Q

What supplies the lower 2/3 of the rectum

A

middle and inferior rectal artery > internal iliac artery

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28
Q

What is the origin of the superior rectal artery

A

inferior mesenteric artery

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29
Q

What 3 structures does the vaginal artery supply

A

vagina
cervix
bladder

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30
Q

What is the origin of the vaginal artery

A

uterine artery

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31
Q

What does the internal pudendal artery supply?

A

Main artery to perineum

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32
Q

What does the obturator artery supply?

A

obturator externes
medial compartment of the thigh
femur

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33
Q

Which part of the rectum drains into portal circulation?

A

upper third of rectum drains into portal vein

superior rectal vein > inferior mesenteric vein > splenic vein > portal vein

34
Q

Where does the lower 2/3 of the rectum drain into

A

internal iliac vein > IVC

35
Q

Why might haemorrhoids be associated with cirrhosis of the liver

A

Anorectal varices in portal HTN - shunting of blood from portal system to portosystemic anastomoses

36
Q

Which venous plexus does the prostatic/Santorini’s venous plexus communicate with on posterior side of prostate

A

internal vertebral venous plexus

37
Q

Which venous plexus does the prostatic/Santorini’s venous plexus communicate with on anterior side of prostate

A

vesical venous plexus

38
Q

Where does the internal vertebral venous plexus and vesicle venous plexus drain into

A

Internal iliac veins

39
Q

Which is thought to be the route of bone mets of prostate cancer?

A

Posterior side - internal vertebral venous plexus

40
Q

Ilioinguinal nerve origin and where does it enter

A

L1 - enters inguinal canal at the superficial inguinal ring

41
Q

Genitofemoral nerve origin and where does it enter

A

L1-2 and deep inguinal ring

42
Q

What does the ilioinguinal nerve supply

A

skin at root of penis in male

labia in female

43
Q

What does the genitofemoral nerve supply

A

Cremaster muscle

44
Q

Pudendal nerve: state its origin (which segmental level), course and innervation

A

originates from the sacral plexus at S2, S3, S4
follows the course of the pudendal artery
innervates skin and muscle of perineum

45
Q

What bony landmarks do you think are used when performing a pudendal nerve block during labour?

A

ischial spine

46
Q

What are the 3 nerves of reproductive organs

A

ilioinguinal nerve
genitofemoral nerve
pudendal nerve

47
Q

Which autonomic component of the nerve supply of male reproductive organs is responsible for ejaculation

A

sympathetic fibres originating from L1-2

48
Q

Which autonomic component of the nerve supply of male reproductive organs is responsible for erection

A

parasympathetic fibres originating from S2-4

49
Q

What LN groups drain the prostate

A

internal iliac

sacral

50
Q

What LN groups drain the seminal vesicles

A

internal iliac

external iliac

51
Q

What LN groups drain the scrotum

A

superficial inguinal

52
Q

What LN groups drain the penis

A

skin: superficial inguinal

glans - superficial inguinal, deep inguinal, external iliac

53
Q

What LN groups drain the rectum

A

upper, lower para-rectal LN

Internal iliac LN

54
Q

What are the 3 components of the spermatic cord

A

Vas deferens
Nerves: cremaster nerve, testicular nerve, genital branch of genitofemoral nerve
Vessels: lymphatic vessels, arteries, pampiniform plexus

55
Q

What are the arterial vessels in the spermatic cord

A

testicular artery, deferential artery, cremaster artery,

56
Q

What is the tough outer fibrous layer of the testis

A

Tunica albuginea

57
Q

What are the two layers of the tunica vaginalis

A

Parietal and visceral lamina

58
Q

What material is present between the 2 layers of the tunica vaginalis

A

Serous fluid

59
Q

What is a hydrocele

A

Accumulation of fluid within vaginalis cavity

60
Q

What is a hematocele

A

accumulation of blood within vaginalis cavity

61
Q

What is the blood supply of the testis

A

Testicular arteries

62
Q

At what vertebral level do the testicular arteries arise from the abdominal aorta

A

L1-2

Just below the level of the renal arteries

63
Q

What structures do the testicular arteries cross in their anatomical course near the pelvic brim before they go through the inguinal canal?

A

Ureter and genitofemoral nerve

64
Q

What is the term used for the 8-12 anastomosing veins associated with the testis

A

pampiniform plexus

65
Q

What is the function of the pampiniform plexus

A

To cool arterial blood before it reaches the testis

66
Q

Into which vein does the right testicular vein drain?

A

IVC

67
Q

Into which vein does the left testicular vein drain

A

Left renal vein

68
Q

What is a varicocele

A

an abnormal enlargement of the pampiniform plexus in the scrotum

69
Q

What LN group drains the testes

A

Lateral aortic group of para-aortic LN at L2

Lumbar lymph nodes

70
Q

What secretions are produced by the seminal vesicles

A

seminal fluid

71
Q

What secretions are produced by the prostate gland

A

prostatic fluid - PSA, zinc, enzymes, citric acid

72
Q

What secretions are produced by the bulbourethral glands

A

alkaline mucus-like fluid

73
Q

Muscles of the perineum (6)

A 
external anal sphincter
external urethral sphincter
superficial transverse perineal muscle
deep transverse perineal muscle
bulbospongiosus
ischiocavernosus
74
Q

What are the 3 parts of male urethra

A

Prostatic, membranous, spongy/penile

75
Q

Narrowest portion of male urethra

A

membranous

76
Q

Most dilatable portion of male urethra

A

prostatic

77
Q

What is the major content of the ischia-anal fossa

A

Fat

78
Q

Alcock’s canal contents (3)

A

internal pudendal artery
internal pudendal vein
pudendal nerve

79
Q

Where does the neuromuscular bundle that enters the sischioanal fossa enter through

A

lesser sciatic foramen

80
Q

What structures do the contents of the alcock’s canal supply?

A

external genitalia
perineal muscles
parts of the levator ani

81
Q

Where are the bulbourethral glands

Where do they empty into?

A

Located in the urogenital diaphragm

Empty into the spongy urethra

82
Q

Function of testes, epididymis, ductus deferens

A

Testes - production of sperm
Epididymis - storage of sperm
Ductus deferens- transport of sperm

OSPE MSK (8 decks)

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