Lec7/8/9Pelvis&Perineum

Question 1

The pelvic cavity is divided into what to pelvis’s?

Answer 1

False (greater) pelvis-superior portion
True (lesser) pelvis= inferior portion

Question 2

What is the bony support for the pelvic cavity of the pelvis?

Answer 2

1. ilium, ischium, pubis
2. sacrum
   —-Promontory=connects sacrum to lumbar spine
   —–Ant + Post sacral foramen=house sacral nerves
3. coccyx

Question 3

What are the pelvic ligaments within the pelvic cavity?

Answer 3

(names tell you where they go)

1. Anterior SI ligament:
   sacrum to ilum
2. Lumbosacral ligament: lumar spine to sacrum
3. Iliolumbar ligament: ilium to lumbar spine

Question 4

What does the pelvic inlet separate?

Answer 4

The false pelvis from the true pelvis

Question 5

What is the pelvic inlet comprised of?

Answer 5

“People Always Love Pumpkin Season” or PALPS

Promontory (connects sacrum to lumbar spine)
Ala
Linea terminalis (arcuate line)
Pecten pubis (pectineal line)
Symphysis Pubis

Question 6

What are three key characteristics of the male pelvis?

Answer 6

-heart shaped pelvis inlet
-decreased angle of pubis: 50-60 (smaller)
-more prominent promontory + ischial spine

Question 7

What are three key characteristics of the female pelvis?

Answer 7

-circular pelivc inlet
-increased angle of pubis: 80-85 (bigger)
-less prominent promontory+ ischial spine

Question 8

While performing a pelvic exenteration, the surgical oncologist notices a fracture in the boundary of the pelvic inlet. Which of the following structures is most likely damaged?
A. sacrotuberous ligament
B. sacropspinous ligament
C. greater sciatic foramen
D. promontory

Answer 8

D

Question 9

What bones make up the pelvic wall?

Answer 9

ischium, pubis, sacrum, coccyx

Question 10

What are the ligaments contained in the pelvic wall?

Answer 10

Sacrospinous: sacrum to ischial spine
Sacrotuberous: sacrum to ischial tuberosity

Question 11

If you had a patient that damaged a nerve that exited superiorly to the piriformis muscle which nerve would be affected?

Answer 11

sup. gluteal nerve

Question 12

What the muscles contained in the pelvic wall?

Answer 12

piriformis-goes through GSF
Obturator internus- goes through LSF

Question 13

What are the apertures of the pelvic wall?

Answer 13

1. GSF
   -above piriformis: sup, gluteal art. and nerve
   -below piriformis: inf. gluteal art and nerve
2. LSF: pudendal + internal pudendal vessels
3. Obturar canal: obturator artery + nerve

Question 14

What does the pelvis floor support?

Answer 14

Pelvic viscera (ex. uterus)

Question 15

What three structures make up the pelvic floor?

Answer 15

Pelvic diaphragm: muscle
Deep perineal pouch: muscle
Perineal membrane: fascia (CT)

Question 16

What does the pelvic diaphragm include?

Answer 16

Coccygenous m
Levator Ani
-iliococcygeus m: ilium to coccys
-pubococcygeus m: pubis to coccyx
-puborectalis m: pubis to rectum

Question 17

What does the deep perineal pouch include?

Answer 17

External urethral sphincter
Sphincter urethrovaginalis (female)
Compressor urethrae (female)
Deep transverse perineal muscle

1st three listed wraps around urethra

Question 18

What does the perineal membrane include?

Answer 18

opening for urethra
attaches to external genitalia (ex: root of the penis)

Question 19

Exam question last year: If you had a patient and she tore her pelvic diaphragm during childbirth and had paralysis of one of her pelvic diaphragm muscles, which of the following muscles would be affected?
A. Sphincter urethrovaginalis
B. Levator Ani
C. Piriformis
D. Obturator internus

Answer 19

B

Question 20

The main blood supply to the pelvic region comes from the

Answer 20

internal iliac artery

Question 21

What arteries come off the anterior trunk of the internal iliac artery?

Answer 21

Internal pudendal a
Umbilical a
Middle rectal a
Obturator a
Vaginal a
Uterine a (crosses OVER (superior to) the ureters
Inferior gluteal a

Question 22

What arteries come off the posterior trunk of the internal iliac artery?

Answer 22

PILS
Iliolumbar a
Lateral sacral a
Superior gluteal a

Question 23

What are the minor arteries that branch off the abdominal aorta?( not impt for exam but you can still know)

Answer 23

Gonadal a: ovarian or testicular
Superior rectal a
Median sacra a

Question 24

As the uterine arteries pass from the internal iliac arteries to the uterus it crosses superiorly to which of the following structures that sometimes is mistakingly ligated during surgery?

Answer 24

ureters

Question 25

What is the innervation for the pelvis?

Answer 25

(S 2/3/4 keeps shit off the floor) sacral plexus ----pudendal nerve

Question 26

What does the pudendal nerve supply and what structure does it travel through?

Answer 26

Supplies external genitalia, external urethral sphincter (deep perineal pouch), external anal sphincter Travels though LSF

Question 27

The sympathetic innervation of the pelvis comes from where

Answer 27

PARAvertebral sympathetic chain (sympathetic trunk)----sacral splanchnic nerves with preganglionic fibers

Question 28

What is the sympathetic innervation response for the pelvis

Answer 28

"Point and Shoot" "fight or flight" response-- contraction and ejaculation "Shoot penis, ejaculation, sympathetic"

Question 29

The parasympathtic innervation to the pelvis comes from where?

Answer 29

PREvertebral plexus (aka sacral plexus)----pelvic splanchnic nerves with preganglionic fibers

Question 30

What is the parasympathetic innervation response for the pelvis

Answer 30

"Point and Shoot" "rest and digest" response---dilation and erection "Point penis, erection, Parasympathetic"

Question 31

Sympathetic and Parasympathetic innervation contributes to which plexuses?

Answer 31

superior and inferior hypogastric plexus

Question 32

The rectum is the most anterior or posterior pelvic organ

Answer 32

posterior

Question 33

What pulls the anorectal junction forward to prevent flow of stool

Answer 33

puborectalis of levator ani

Question 34

The rectum contains 3 lateral curvatures, what are they?

Answer 34

upper curves to right middle curves to left lower curves to right

Question 35

What is the blood supply for the rectum?

Answer 35

anterior trunk of internal iliac artery superior rectal artery middle rectal artery inferior rectal artery

Question 36

What is the innervation of the rectum?

Answer 36

sacral plexus

Question 37

The bladder receives urine from ____ via the _____

Answer 37

kidneys, ureters

Question 38

How is the bladder organized?

Answer 38

APEX= directed towards the top of the pubic symphysis BASE: trigone (ureters + urethral sphincter are @ the corners of trigone) NECK: most fixed part (anchored by pubovesical (F)/puboprostatic (M) ligaments

Question 39

What muscle is contained within the bladder and what is its fxn?

Answer 39

detrusor muscle and its a smooth muscle that contracts to push urine into the urethra

Question 40

What is the blood supply to the bladder?

Answer 40

anterior trunk of internal iliac artery umbilical artery--superior vesical artery inferior vesical artery

Question 41

What is the innervation of the bladder?

Answer 41

inferior hypogastric plexus parasymp: contracts detrusor muslcle- empties bladder symp: relaxes detrusor muscle---stops bladder from emptying

Question 42

The bladder is the most anterior or posterior pelvic organ?

Answer 42

anterior

Question 43

What are the muscles wrapped around the female urethra?

Answer 43

external urethral sphincter sphincter urethrovaginalis compressor urethrae

Question 44

What are the muscles wrapped around the male urethra?

Answer 44

external urethral sphincter

Question 45

What are the 4 segments of the male urethra?

Answer 45

preprostatic=before the prostate prostatic=in the prostate membranous=after the prostate---perineal membrane spongy= in external genitalia --surrounded by corpus spongiosum (penile tissue) -- forms navicular fossa @ tip of penis

Question 46

You have a patient with prostate cancer, you need to remove the tumor, but you don't want to harm the neighboring structures within the prostate. You are worried about damaging the prostatic duct which drains into which of the following? A. navicular fossa B. midline of male prostatic urethra C. prostatic sinus D. remnant of mullerian duct (in colliculus)

Answer 46

c

Question 47

What structures are the prostate relations?

Answer 47

1. urethral crest=midline of male prostatic urethra 2. prostatic ducts--drain into prostatic sinus 3. prostatic utricle= remnant of Mullerian duct (in colliculus)

Question 48

The root of the penis is A. middle (free) part B. proximal (fixed) part C. distal part

Answer 48

proximal (fixed) part

Question 49

The root of the penis is composed of erectile tissue. What is this tissue comprised of?

Answer 49

Right and Left Crura---give rise to corpora cavernosum (surround the bulb of the penis) Bulb of penis--gives rise to corpus spongiosum

Question 50

What muscles are within the root of the penis?

Answer 50

Ischiocavernosus (x2 right and left)---covers the crura Bulbospongiosus (x2 right and left) -----covers the bulb

Question 51

The body of the penis is A. middle (free) part B. proximal (fixed) part C. distal part

Answer 51

middle (free) part

Question 52

The body of the penis is composed of erectile tissue. What is this tissue comprised of?

Answer 52

Copora Cavernosa: formed by the crura Corpus Spongiosum: gives rise to the glans (formed by the bulb and surrounds the male spongy urethra

Question 53

The glans of the penis is A. middle (free) part B. proximal (fixed) part C. distal part

Answer 53

distal part

Question 54

What does the glans of the penis formed by and what does it contain?

Answer 54

Formed by corpus spongiosum (of penile body) Contains male spongy urethra--- navicular fossa

Question 55

What are the structures (in order) contained within the testes?

Answer 55

Seminiferous tubules, rete testis, efferent duct, epididymis, vas deferens, seminal vesicle, ejaculatory duct, urethra

Question 56

Spermatozoa (premature sperm) are produced in the

Answer 56

seminiferous tubules

Question 57

What two structures join to form the ejaculatory duct?

Answer 57

vas deferens and seminal vesicle

Question 58

Does the vas deferens travel over or under the ureter?

Answer 58

over

Question 59

What is the blood supply to the testis?

Answer 59

testicular arteries (off abdominal aorta)

Question 60

What is the venous drainage of the testes?

Answer 60

pampiniform plexus---drains into testicular veins left testicular vein --drains into left renal vein---IVC right testicular vein---IVC

Question 61

What are three zones of the prostate?

Answer 61

peripheral zone, central zone, transitional zone

Question 62

You had a patient come in and you perfomed a digital rectal exam. Which of the zones of the prostate will be felt during this exam?

Answer 62

peripheral zone

Question 63

The prostate peripheral zone

Answer 63

major part most posterior zone area felt on DRE

Question 64

The central zone

Answer 64

minor part middle zone surrounds the ejaculatory ducts

Question 65

Transitional zone

Answer 65

minor part most anterior zone surrounds the urethra indicated in BPH

Question 66

What is the blood supply and innervation of the prostate?

Answer 66

blood supply: prostatic arteries innervation: inferior hypogastric plexus

Question 67

The uterus is comprised of what three segments?

Answer 67

Fundus: top---connects to uterine (fallopian) tubes Body: middle---site of implantation Cervix: bottom--connects to the vagina

Question 68

The uterine (fallopian) tubes consist of

Answer 68

fimbraie, infundibulum, ampulla, isthmus

Question 69

What are the ligaments of the uterus?

Answer 69

broad, suspensory, ovarian

Question 70

What are the parts of the broad ligament of the uterus?

Answer 70

mesometrium--covers myometrium mesosalpinx---covers uterine (fallopian) tubes mesovarium---covers ovaries

Question 71

What does the suspensory ligament connect and what does it contain?

Answer 71

connects the ovary to pelvis contains the uterine vasculature

Question 72

What does the ovarian ligament connect?

Answer 72

Ovary to uterus

Question 73

What is the blood supply and venous drainage of the uterus?

Answer 73

blood supply: uterine arteries (off internal iliac artery) venous drainage: uterine plexus

Question 74

What is the normal position of the uterus 100% on exam?

Answer 74

anteverted and anteflexed

Question 75

Which structure would play the most important role in supporting the uterus?

Answer 75

Levator ani or coccygeus

Question 76

What is the uterine support for the uterus (very high yield)?

Answer 76

pelvic diaphragm=levator ani + coccygeus Uterine ligaments= (a) pubocervical attaches pubis to cervix (b) transverse cervical (cardinal) attaches cervix to the lateral walls (c)Uterosacral attaches uterus to sacrum

Question 77

What are the cervical structures of the uterus?

Answer 77

endocervix: endocervical canal (contains Internal os (opening) that leads into uterus Ectocervix: connects to vagina (contains External os (opening) that leads into endocervix

Question 78

What is the fxn of the cervix?

Answer 78

facilitate sperm passage + stop bacteria

Question 79

What is the ovary covered by and attached to?

Answer 79

Covered by mesothelium=mesovarium (broad ligament) attached to the uterus via ovarian ligament

Question 80

What is the endocrine fxn of the ovary

Answer 80

produces hormones and oocytes

Question 81

What is the blood supply and he venous drainage of the ovary?

Answer 81

Blood supply: ovarian arteries (off abdominal aorta) travel in the suspensory ligament of the uterus

Question 82

What is the venous drainage of the ovary?

Answer 82

Venous drainage: ovarian (gonadal) veins right ovarian vein---IVC left ovarian vein---Left renal vein--IVC

Question 83

What is the vulva?

Answer 83

external female genitalia

Question 84

What is the vulva composed of and its function?

Answer 84

mons pubis, labia, vestibule, clitoris. fxn: sensory tissue, urination, prevent infection

Question 85

What is the mons pubis?

Answer 85

fat pad (fupa)

Question 86

What is the labia majora and minora?

Answer 86

Majora: 2 external folds w/ hair Minor: 2 internal folds w/o hair fuse anteriorly to form the prepuce (hood) of the clitoris

Question 87

What is the vestibule?

Answer 87

Contains urethra + external vaginal orifice surrounded by bulbospongiosus m

Question 88

What is bartholin's glands?

Answer 88

secretes lubricating mucus

Question 89

What the clitoris?

Answer 89

erectile tissue=corpora cavernosa crura (ischiocavernosus m.) on either side

Question 90

What are the fxn's of the vagina?

Answer 90

sex, childbirth, menstruation

Question 91

What are the borders off the vagina?

Answer 91

anterior= bladder + urethra posterior= rectum lateral= ureters +uterine arteries

Question 92

What are fornices of the vagina?

Answer 92

recesses in the vaginal canal anterior, posterior(longest), lateral

Question 93

What is the blood supply of the vagina?

Answer 93

uterine + vaginal arteries (off ant, trunk of internal iliac a)

Question 94

What two structures project into the vagina?

Answer 94

ectocervix (and external os)

Question 95

What is the normal position of the uterus? a. Anteflexed and retroverted b. Retroflexed and retroverted c. Anteflexed and anteverted d. Retroflexed and anteverted

Answer 95

c

Question 96

What important prostatic structure do the prostatic ducts empty or drain into? a. Prostatic utricle b. Prostatic sinus c. Seminal colliculus d. Urethral crest

Answer 96

b

Question 97

Which of the following structures provides the primary support for the cervix? a. Uterosacral ligament b. Broad ligament c. Transverse cervical (cardinal) ligament d. Round ligament

Answer 97

c

Question 98

Identify this penile structure: a. Bulbospongiosum b. Right crura of the penis c. Ischiocavernosus d. The bulb of the penis

Answer 98

a

Question 99

What major blood vessel crosses superior to the ureters? a. Ovarian artery b. Umbilical artery c. Vaginal artery d. Uterine artery

Answer 99

d

Question 100

What structure passes through the indicated foramen? a. Piriformis b. Inferior gluteal nerve c. Obturator internus d. Sciatic nerve

Answer 100

c

Question 101

A young patient with pain and swelling of the left testicle is likely experiencing thrombosis due to a blockage in a major vessel. Which of the following veins is most likely affected? a. Left renal vein b. Inferior vena cava c. Left inferior epigastric vein d. Internal pudendal vein

Answer 101

a

Question 102

Which of the following structures plays the most important role in the support of the uterus? a. Uterosacral ligament b. Broad ligament c. Levator ani d. Arcuate pubic ligament

Answer 102

c

Question 103

A patient who received a gunshot wound to the pelvic region suffers from damage to the sacral splanchnic nerves. Which of the following nerve fibers would primarily be damaged? a. Postganglionic sympathetic fibers b. Preganglionic sympathetic fibers c. Postganglionic parasympathetic fibers d. Preganglionic parasympathetic fibers

Answer 103

b

Question 104

An older patient is unable to produce a penile erection after having undergone a prostatectomy. The surgeon most likely damaged which of the following nerves? a. Sacral splanchnic nerve b. Pelvic splanchnic nerve c. Dorsal nerve of the penis d. Pudendal nerve

Answer 104

b

Question 105

A fracture to the pelvic inlet is most likely in which of the following structures? a. Iliac crest b. Anterior inferior iliac spine c. Ischiopubic ramus d. Promontory

Answer 105

d

Question 106

Which of the following structures contribute to the pelvic diaphragm? a. Piriformis b. Obturator internus c. Levator ani d. External urethral sphincter

Answer 106

c