Pelvis and Perineum

Question 1

What are the boundaries of the superior pelvic aperture (pelvic inlet)?

Answer 1

anterior: superior margin of pubic symphysis
posterior: sacral promontory
lateral: ilium

Question 2

what are the boundaries of the inferior pelvic aperture (pelvic outlet)?

Answer 2

anterior: inferior margin of pubic symphysis
posterior: tip of the coccyx

Question 3

what is the true conjugate (obstetrical conjugate)

Answer 3

• distance between superior margin of pubic symphisis and the sacral promontory
• it is the narrowest fixed diameter through which a baby’s head must pass in a vaginal delivery

Question 4

What bounds the walls of the pelvic cavity?

Answer 4

Anterior:
-pubis bone and pubic symphisis
Lateral:
-obturator internus muscles
inferior:
-pelvic floor
posterior:
-piriformis muscles

Question 5

During a hysterectomy, what structure must one be careful not to harm while ligating the uterine artery?

Answer 5

-the ureter
-the ureter passes directly under the uterine artery
“water goes under the bridge”

Question 6

How does the vas deferens pass the pelvic bone

Answer 6

the vas deferens passes over the superior ramus of the pubis.

Question 7

what is the perineal body?

Answer 7

The integrity of the perineal body is critical to the strength of the entire perineum in women.

Question 8

Why perform a medio-lateral episiotomy rather than a median episiotomy?

Answer 8

A median episiotomy risks injury to the perineal body and thus a medio-lateral episiotomy is preferred

(doubt “episiotomy” and “preferred” are used in the same sentence much…)

Question 9

Other than the prostate what structures can be palpated in a male during a digital rectal exam?

Answer 9

• vas deferens

- seminal vesicles

Question 10

How to remember which nerves are responsible for all facets of an erection?

Answer 10

"Point" and "Shoot"
Point:
-erection by Parasympathetic
Shoot:
-ejaculation by Sympathetic

Question 11

What is the normal position of the uterus?

Answer 11

-Anteverted and Anteflexed

Question 12

Define flexion with respect to the uterus

Answer 12

Flexion is defined as the angle between the axes of the body of the uterus and the cervix.

Question 13

Define version wrt the uterus

Answer 13

Version is defined as the angle between the axis of the cervix and the axis of the vagina

Question 14

hyster-

-meaning?

Answer 14

-having to do with the uterus

Question 15

salphingo-

-meaning?

Answer 15

-having to do with the oviduct

Question 16

oophoro-

-meaning?

Answer 16

-having to do with the ovary

Question 17

mesosalpinx

Answer 17

The part of the broad ligament of the uterus that covers the uterine tubes

Question 18

mesovarium

Answer 18

The part of the broad ligament of the uterus that covers the ovary

Question 19

mesometrium

Answer 19

The part of the broad ligament of the uterus that covers the uterus itself

Question 20

How to anesthetize from the waist down?

-what specific areas lose sensation?

Answer 20

-anesthetic via lumbar puncture site
What's blocked:
-intraperitoneal viscera
-subperitoneal viscera 
-somatic structures

Question 21

Caudal epidural

• what’s blocked
• procedural landmark

Answer 21

what’s blocked:

• subperitoneal viscera
• somatic structures

Landmark:
-sacral hiatus

Question 22

pudendal nerve block

-what’s blocked?

Answer 22

-somatic structures

Question 23

hydrocele

Answer 23

• process vaginalis reopens/didnt close completely

- fluid leaks through inguinal canal from the peritoneal cavity and get edema of the testis

Question 24

varicocele

Answer 24

• pampiniform plexus becomes varicose
• the pampiniform plexus is just a lot of branching vessels that act to cool the blood before it gets to the testes, protecting sperm production.
• varicose pampiniform vessels can compromise the plexus’s ability to properly cool blood. So individual may have problems with sperm production.
• also can lead to thrombus formation