1: Anatomy - Pelvic side wall

Question 1

What is the relationship between the ureters and the uterine arteries?

Answer 1

WATER UNDER THE BRIDGE

Ureters run deep to the uterine arteries (in women)

Question 2

Which vasculature is closely associated with the ureters?

Answer 2

Uterine arteries

Question 3

Which structures are the uterine arteries closely associated with?

Answer 3

Ureters

Question 4

During surgery, how would you be able to differentiate the ureters from the uterine arteries?

Answer 4

Ureters are deep to the uterine arteries

And the ureter vermiates when you touch it

Question 5

Which bony features are also known as the sit bones?

Answer 5

Ischial tuberosities

Not the spines

Question 6

Which bony feature is the distal attachment for coccygeus, a landmark on vaginal examination and can also be identified on pelvic X-rays?

Answer 6

Ischial spines

Question 7

Which two pelvic ligaments must you remember?

What are their proximal and distal attacments?

Answer 7

Sacrospinous ligament - closely related to pudendal nerve; sacrum to ischial spine

Sacrotuberous ligament - sacrum to ischial tuberosity

Question 8

Which three holes on each side of the pelvis must you remember?

Answer 8

Greater sciatic foramen

Lesser sciatic foramen

Obturator foramen

Question 9

What is the covering of the obturator foramen?

Answer 9

Obturator membrane

:)

Question 10

What structures run through the obturator foramen?

Answer 10

Obturator artery, vein and nerve

Question 11

Which muscle is found superficial to the obturator membrane?

What is its function?

Answer 11

Obturator internus

LATERAL ROTATION of hip

Question 12

Obturator ___ is a lateral rotator of the hip joint.

Answer 12

Obturator internus

Question 13

The tendinous arch of which muscle runs from the pubic bone to the ischial spine?

Answer 13

Levator ani

Question 14

The ___ ___ of levator ani runs from the pubic bone to the ischial spine.

Answer 14

tendinous arch of levator ani

Question 15

Which fat-filled space contains the pudendal canal and is found deep to the tendinous arch of levator ani?

Answer 15

Ischioanal fossa

Question 16

What is the clinical relevance of the ischioanal fossa?

Answer 16

Site of development of perineal abscesses and fistulae

Question 17

Apart from obturator internus, which other lower limb muscle is found in the pelvis?

Answer 17

Piriformis

Question 18

Which blood vessels are closely related to piriformis?

Answer 18

Superior and inferior gluteal arteries

Branches of the posterior division of internal iliac

Question 19

At which vertebral level does the common iliac artery bifurcate?

Answer 19

L4

Question 20

From which artery do all pelvic and perineal arteries arise?

Answer 20

Internal iliac artery

Question 21

Which areas of the body are supplied by the

a) internal iliac artery
b) external iliac artery?

Answer 21

a) Pelvis and perineum
b) Lower limb

Question 22

All pelvic and perineal arteries are supplied by the internal iliac artery.

What are the two exceptions, and from which vertebral levels do these arteries arise?

Answer 22

Gonadal artery @ L2 (think about developmental origin of the gonads)

Superior rectal artery from IMA @ L3

Question 23

Name the vertebral levels at which

a) the common iliac artery bifurcates

b) the gonadal arteries come off the abdominal aorta

c) the IMA comes off the abdominal aorta.

Answer 23

a) L4

b) L2

c) L3

Question 24

In the pelvis, the internal iliac artery splits into two ___.

Answer 24

two divisions

Question 25

What are the **two divisions** of the **internal iliac artery?**

Answer 25

**Anterior division** **Posterior division**

Question 26

The **posterior division** of the **internal iliac artery** is **(the same / different)** in males and females.

Answer 26

**the same**

Question 27

The **anterior division** of the **internal iliac artery** is **(the same / different)** in males and females.

Answer 27

**different**

Question 28

What are the branches of the **anterior division** in **men?**

Answer 28

**Inferior gluteal artery** **Internal pudendal artery** **Inferior vesical artery** **Middle rectal artery** **Obturator artery**

Question 29

In **men**, what does the **inferior vesical artery** supply?

Answer 29

**Prostate gland** **Seminal vesicles**

Question 30

What are the branches of the **anterior division** in females?

Answer 30

**Inferior gluteal artery** **Internal pudendal artery** **Vaginal** **artery** **Middle rectal artery** **Obturatory artery** **Uterine artery**

Question 31

Do women have an **inferior vesical artery**?

Answer 31

**No** Instead they have a **uterine artery** which gives off the **vaginal artery**

Question 32

Where is the **inguinal triangle**?

Answer 32

Between **ASIS** and **pubic symphysis**

Question 33

What are the borders of the **inguinal triangle**?

Answer 33

**Rectus abdominis** medially **Inferior epigastric artery** superiorly **Inguinal ligament** inferiorly

Question 34

Which **remnants** of the **foetal** **umbilical arteries** are found paired on the posterior abdominal wall?

Answer 34

**Medial umbilical folds**

Question 35

Which **structure** is found in the **posterior midline** of the abdominal wall and is a **remnant of the tube draining urine from the foetal bladder?**

Answer 35

**MediaN umbilical fold** or **Urachus** Remnant of the **allantois**

Question 36

Which **paired** **umbilical folds** are actually functional?

Answer 36

**Lateral umbilical folds** Contain the **inferior epigastric artery and vein**

Question 37

Name the **folds** of the posterior abdominal wall and the **structures** they are formed from.

Answer 37

**Median umbilical fold** or **Urachus** - remnant of the allantois **Medial umbilical folds** - remnants of the umbilical arteries **Lateral umbilical folds** - ***functioning*** inferior epigastric artery and vein

Question 38

What is the **median umbilical fold** also known as?

Answer 38

**Urachus**

Question 39

Which artery supplies most of the **perineum** in **males**?

Answer 39

**Internal pudendal artery**

Question 40

Which **artery**, supplying part of the male perineum, does **not** derive from the **internal pudendal artery**?

Answer 40

**Anterior scrotal artery** Derived from **external pudendal artery**

Question 41

The **perineum** is supplied by the **internal pudendal artery**, which is a branch of what?

Answer 41

**Posterior division of the internal iliac artery**

Question 42

The **male perineum** is supplied by the **internal pudendal artery**. What is the one exception?

Answer 42

**External pudendal artery** gives off the **Anterior scrotal artery** only

Question 43

Which part of the **male perineum** is supplied by the **external pudendal artery**?

Answer 43

**Anterior scrotum** via anterior scrotal artery the rest is **internal pudendal artery**

Question 44

From which **vertebral levels** are the **testicular and ovarian arteries** derived?

Answer 44

**L2** They're both gonadal arteries

Question 45

In **females**, which three arteries anastomose to supply the ovaries, uterus and vagina?

Answer 45

**Ovarian artery** (L2) **Uterine artery** **Vaginal artery** (both derived from posterior division of internal iliac artery)

Question 46

Which ligament does the **ovary** hang off?

Answer 46

**Suspensory ligament**

Question 47

Which vein is **mostly** responsible for draining the **pelvis**?

Answer 47

**Internal iliac vein**

Question 48

Which veins are responsible for draining the pelvis apart from the **internal iliac vein**? What is the **clinical significance** of this?

Answer 48

**Internal vertebral plexus** Infection / cancer can track up the valveless veins, through the spinal cord to the brain

Question 49

What is the **main venous drainage** of the **pelvis**?

Answer 49

**Internal iliac veins**

Question 50

Which artery is usually found superior to the **S1 ramus** of the **lumbosacral plexus**?

Answer 50

**Superior gluteal artery**

Question 51

What is the **lymphatic drainage** of the **superior pelvic viscera**?

Answer 51

**External iliac nodes**

Question 52

What is the lymphatic drainage of the **inferior pelvic viscera**?

Answer 52

**Internal iliac nodes**

Question 53

What is the **lymphatic drainage** of the **superficial** **perineum**?

Answer 53

**Superficial inguinal nodes**

Question 54

What is the **lymphatic drainage** of the a) **superior pelvic viscera** b) **inferior pelvic viscera**?

Answer 54

**a) External iliac nodes** **b) Internal iliac nodes**

Question 55

What is the **lymphatic drainage** of the a) **perineum** b) **superior pelvic viscera** c) **inferior pelvic viscera**?

Answer 55

**a) Superficial inguinal nodes** **b) External iliac nodes** **c) Internal iliac nodes**

Question 56

Which nerves (and roots) supply the a) **inferior** **aspect** b) **superior aspect** of **levator ani?**

Answer 56

**a) Pudendal nerve (S2,3,4)** **b) Nerve to levator ani (S3,4,5)**

Question 57

From the **external iliac nodes**, describe the lymphatic drainage of the **superior pelvic viscera**.

Answer 57

**External iliac nodes** **Common iliac ""** **Para-aortic ""** **Thoracic duct** **=\> Left venous angle**

Question 58

From the **internal iliac** nodes, describe the lymphatic drainage of the **inferior pelvic viscera**​.

Answer 58

**Internal iliac** **Common iliac** **Para-aortic** **Thoracic duct** **Right venous angle**

Question 59

Which **muscle** are the **gluteal arteries** closely related to?

Answer 59

**Piriformis**

Question 60

Which blood vessels are closely related to **piriformis**?

Answer 60

**Superior and inferior gluteal arteries**