Pelvis and Perineum

Question 1

What are the three divisions of the puedendal nerve?

Answer 1

Inferior Rectal nerve
Perineal nerve
Dorsal nerve of penis/ clitoris

Question 2

What are the two terminal branches of the puedendal nerve?

Answer 2

perineal nerve, and the dorsal nerve of the penis or the dorsal nerve of the clitoris

Question 3

Which structures pass through the greater and lesser sciatic foramina?

Answer 3

Structures passing through the lesser and greater sciatic foramina (medial to lateral): PIN
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus

Question 4

From which embryological structure is the ureter derived?

Answer 4

mesonephric duct

Question 5

What is the nerve root value of the external urethral sphincter?

Answer 5

The external urethral sphincter is innervated by branches of the pudendal nerve- S2, S3, S4.

Question 5

What is the difference between the male and female urethra?

Answer 5

The female urethra is shorter and more acutely angulated than the male urethra.

Question 6

what are the four parts of the male urethra?

Answer 6

1. pre-prostatic urethra
2. prostatic urethra
3. membranous urethra
4. penile urethra

Question 7

what is the widest part of the male urethra?

Answer 7

Prostatic urethra (contains several openings for semen)

Question 8

what is the narrowest part of the male urethra?

Answer 8

Membranous urethra (surrounded by external sphincter)

Question 9

which lymph nodes does the ureter drain to?

Answer 9

upper ureter - para-aortic lymph nodes
lower ureter - common iliac nodes

Question 10

What are the origin nerve roots of puedendal nerve?

Answer 10

Anterior rami of S2-4

Question 11

what is the path of the puedendal nerve?

Answer 11

posterior to the sacrospinous ligament

Question 12

What is the motor function of the puedendal nerve?

Answer 12

Levator Ani (IRN)
External anal sphincter (IRN)
Superficial pouch muscles (perineal nerve)

Question 13

What is the sensory function of the puedendal nerve?

Answer 13

Skin over anal triangle (IRN)
Glans clitoris (dorsal nerve)
General sensation (perineal nerve)

Question 14

Where does the internal puedendal artery originate and what does it supply?

Answer 14

Originates from the anterior branch of the internal iliac artery

supply erectile tissues/muscles and parts of the rectum and anal canal)

Question 15

Where do the external pudendal arteries originate and what do they supply

Answer 15

Originate from the femoral artery
Superficial and deep
Supply the clitoris and labia majora

Question 16

What is the venous drainage of the perineum?

Answer 16

veins in perineum
internal puedendal vein
internal iliac vein

Question 17

What is deep lymphatic drainage of the female perineum?

Answer 17

internal iliac nodes

Question 18

what drains to superficial inguinal nodes?

Answer 18

superficial tissues of the genitalia (body and crura of clitoris/labia majora)

Question 19

what drains to deep inguinal and external iliac nodes?

Answer 19

Glans clitoris, labia minora and terminal end of vagina

Question 20

which blood vessels are responsible for supplying the rectal stump directly?

Answer 20

superior rectal artery
Middle rectal artery (from the internal iliac)
Inferior rectal artery (from the pudendal vessels)

Question 21

Venous drainage of the rectum?

Answer 21

Superior rectal vein
Inferior rectal vein
Note the venous drainage is a site of portosystemic anastomosis.

Question 22

Lymphatic drainage of the rectum?

Answer 22

Mesorectal lymph nodes (superior to dentate line)
Inguinal nodes (inferior to dentate line)

Question 23

Where does the puedendal canal extend from?

Answer 23

lesser sciatic foramen to the posterior margin of the urogenital diaphragm

(lateral wall of the ischioanal fossa at the inferior margin of the obturator internus muscle.)

Question 24

What forms the urogenital triangle?

Answer 24

Ischiopubic inferior rami Ischial tuberosities A fascial sheet is attached to the sides, forming the inferior fascia of the urogenital diaphragm.

Question 25

In males what does the superficial perineal pouch contain?

Answer 25

Bulb of penis Crura of the penis Superficial transverse perineal muscle Posterior scrotal arteries Posterior scrotal nerves

Question 26

In surgical exploration of the testes what are the layers that will be encountered? (and in what order)

Answer 26

The layers that will be encountered are (in order): 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 Some Damned Examiner Called It The Testes (skin dartos external fascia cremaster internal fascia tunica Testes)

Question 27

What runs through greater sciatic foramen (above piriformis)?

Answer 27

superior gluteal nerve, artery and vein

Question 28

What runs through greater sciatic foramen (below piriformis)?

Answer 28

sciatic nerve inferior gluteal nerve, artery, vein pudendal nerve internal pudendal artery and vein posterior femoral cutaneous nerve nerve to obturator interns and gemellus superior nerve to quadrates femoris and gemellus inferior

Question 29

What transmits between gap between inguinal ligament and pelvic bone?

Answer 29

psoas major, iliacus, pectineous femoral artery, fem vein lymphatics femoral branch of genitofemoral nerve lateral cutaneous nerve of thigh femoral nerve

Question 30

Mucles în deep gluteal compartment?

Answer 30

Piriformis Obturator internis Superior gamellus Inferior gamellus Quadratus femoris

Question 31

which structure is most important in supporting the uterus?

Answer 31

central perineal tendon

Question 32

What is the lymphatic drainage the spongy urethra and the glans penis?

Answer 32

deep inguinal

Question 33

What is the lymphatic drainage of the prostatic and membranous urethra?

Answer 33

internal iliac nodes

Question 34

which nerve is the primary source of innervation to the anterior scrotal skin?

Answer 34

ilioinguinal

Question 35

what are the boundaries of the superficial perineal pouch?

Answer 35

superficially: superficial perineal fascia deep: perineal membrane (inferior fascia of the urogenital diaphragm) laterally: ischiopubic ramus

Question 36

Contents of the superficial perineal pouch in males?

Answer 36

Bulb of penis Crura of the penis Superficial transverse perineal muscle Posterior scrotal arteries Posterior scrotal nerves

Question 37

Boundaries of the deep perineal pouch?

Answer 37

inferiorly: perineal membrane, also known as the inferior fascia of the urogenital diaphragm superiorly: superior fascia of the urogenital diaphragm

Question 38

Contents of superficial perineal pouch in females?

Answer 38

- greater vestibular glands (Bartholin glands) - bulbospongiosus muscle: separated by the urethra and vagina in the midline and covers the bulb of the vestibule -paired ischiocavernosus muscles: tenses the vagina during orgasm -perineal body -paired superficial transverse perineal muscles -crura of the clitoris

Question 39

Contents of the deep perineal pouch in females?

Answer 39

1. proximal urethra 2. deep transverse perineal muscles 3. compressor urethrae muscle 4. urethrovaginalis muscle 5. sphincter urethrae 6. internal pudendal vessels 7. dorsal nerve of clitoris

Question 40

Contents of deep perineal pouch in males?

Answer 40

1. membranous urethra 2. deep transverse perineal muscles 3. sphincter urethrae 4. paired bulbourethral glands (Cowper's glands). 5. internal pudendal vessels 6. dorsal nerve of the penis

Question 41

Which lymph nodes drain the area below the dentate line?

Answer 41

inguinal

Question 42

which lymph nodes drain the area above the dentate line?

Answer 42

Mesorectal lymph nodes

Question 43

Which parts of the rectum are extra-peritoneal?

Answer 43

Posterior upper third Posterior and lateral middle third Whole lower third

Question 44

which fascial layers surround the rectum?

Answer 44

Anterior: fascia of Denonvilliers Posterior: Waldeyers fascia