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Flashcards in Lower urinary tract and male genitalia Deck (34)
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1

The greater and lesser sciatic foramina are separated by the:
 
a   
sacrotuberous ligament.
 
b   
Cooper (pectineal) ligament.
 
c   
arcuate line.
 
d   
sacrospinous ligament.
 
e   
piriformis muscle.

D sacrospinous lig

2

During inguinal incisions, the vessels invariably encountered in Camper fascia are the:
 
a   
superficial inferior epigastric artery and vein.
 
b   
superficial circumflex iliac artery and vein.
 
c   
external pudendal artery and vein.
 
d   
gonadal artery and veins.
 
e   
accessory obturator vein.

a

3

Rupture of the penile urethra at the junction of the penis and scrotum can result in urinary extravasation into all of the following structures EXCEPT the:
 
a   
anterior abdominal wall up to the clavicles.
 
b   
scrotum.
 
c   
penis, deep to the dartos fascia.
 
d   
perineum in a “butterfly” pattern.
 
e   
buttock

e- Blood and urine can accumulate in the scrotum and penis deep to the dartos fascia after an anterior urethral injury. In the perineum, their spread is limited bu the fusions of colles fascia to the ischiopubic rami laterally, and to the posterior edge of the perineal membrane, the resulting hematoma is therefore butterfly shaped. these processess will not extend down the leg or into the buttock, but they can freely travel up the anterior abdominal wall deep to Scarpa fascia to the clavicles and around the flank on the bank

4

During inguinal hernia repair in a male patient, injury of the ilioinguinal nerve in the canal will most likely produce:

 

a  

anesthesia over the dorsum of the penis.

 

b  

anesthesia over the pubis and scrotum and loss of cremasteric contraction.

 

c  

anesthesia over the pubis and anterior scrotum only.

 

d  

anesthesia over the anterior and medial thigh.

 

e  

anesthesia over the pubis only.

C

5

A child has dense scarring after failed extravesical reimplantation. The landmark that can assist in locating the ureter in the pelvis is the:

 

a  

obturator nerve; the ureter will be medial to it.

 

b  

obliterated umbilical artery; the ureter will be found lateral to it.

 

c  

obliterated umbilical artery; the ureter will be found medial to it.

 

d  

external iliac artery; the ureter crosses it to reach the pelvis.

 

e  

vas deferens; the ureter will pass anterior to it.

c. obliterated umibilical artery, the obliterated umbilical artery in the medial umbilical fold serves as an important landmark for the surgeon. It can be traced from the origin from the internal iliac artery to locate the ureter, which lies on its medial side

6

The levator ani attaches to all of the following EXCEPT the:

 

a  

perineal body.

 

b  

pubis.

 

c  

coccyx.

 

d  

vagina.

 

e  

arcus tendineus fascia pelvis.

E.

7

Accessory obturator veins (from the external iliac artery) and accessory obturator arteries (from the inferior epigastric artery) are encountered in:

 

a  

50% and 25% of patients, respectively.

 

b  

5% and 50% of patients, respectively.

 

c  

50% and 75% of patients, respectively.

 

d  

25% and 50% of patients, respectively.

 

e  

25% and 5% of patients, respectively.

A. 50 and 25

8

A retractor blade has rested on the psoas muscle during a prolonged procedure, resulting in a femoral nerve palsy. Postoperatively, the patient will experience:

 

a  

inability to flex the hip and numbness over the anterior thigh.

 

b  

inability to flex the knee and numbness over the thigh.

 

c  

numbness over the anterior thigh only.

 

d  

inability to extend the knee and numbness over the anterior thigh.

 

e  

inability to flex the knee only.

D.

9

Autonomic nerves contributing to the pelvic plexus include the:

 

a  

superior hypogastric nerves from the para-aortic plexuses.

 

b  

pelvic sympathetic trunks.

 

c  

pelvic parasympathetic neurons from the sacral spinal cord.

 

d  

a and c only.

 

e  

a, b, and c.

E. the presynaptic sympathetic cell bodies reach the pelvic plexus by two pathways. (1) the superior hypogastric plexus (2) pelvic continuation of the sympathetic trunks., presynaptic parasympathetic innervation arises from the intermediolateral cell column of the sacral cord

10

To preserve the vascular supply to the ureter, incisions in the peritoneum should be made:

 

a  

medially in the abdomen and laterally in the pelvis.

 

b  

laterally in the abdomen and medially in the pelvis.

 

c  

always medial to the ureter.

 

d   

always lateral to the ureter.

 

e  

directly over the ureter.

B. blood supply in the abdomen and medially in the pelvis

11

Relative to the ureter, the uterine vessels are found:

 

a  

laterally.

 

b  

posteriorly.

 

c  

anteriorly.

 

d  

medially.

 

e  

running together in a common sheath.

C. Anteriorly, the ureter first runs posterior to the ovary then turns medially to run deep to the base of the broad ligament before entering a loose connective tissue tunnel through the substance of the cardinal ligament

12

All of the following features of the ureterovesical junction cooperate to prevent vesicoureteral reflux EXCEPT:

 

a  

fixation of the ureter to the superficial trigone.

 

b  

sphincteric closure of the ureteral orifice.

 

c  

detrusor backing.

 

d  

telescoping of the bladder outward over the ureter.

 

e  

passive closure of the intramural ureter caused by bladder filling.

 

A. the intravesical portion of the ureter lies immediately beneath the bladder urothelium and is therefore quite pliant, it is backed by a strong plate of the detrusor muscle. With bladder filling, this arrangement is thought to result in passive occlusion of the ureter like a valve flap

13

n contrast to that of the male, the female bladder neck:

 

a  

has extensive adrenergic innervation.

 

b  

has a thickened middle smooth muscle layer.

 

c  

is largely responsible for urinary continence.

 

d  

is surrounded by type I (slow-twitch) fibers.

 

e  

has longitudinal smooth muscle fibers that extend to the external meatus.

E. At the female bladder neck, the inner longitudinal fibers converge radially to pass downward as the inner longitudinal circular of the urethra. The middle circular layer does not appear to be as robust as that of the male. The female bladder neck differs strikingly from the male in possessing little adrenergic innervation

14

Which of the following statements about the trigone is TRUE?

a  

Epithelium is thicker than the rest of the bladder and densely adherent.

b  

Superficial smooth muscle is a continuation of Waldeyer sheath.

c  

Smooth muscle enlarges to form thick fascicles.

d  

Smooth muscle of the ureter forms the interureteric ridge (Mercier bar).

e  

When the bladder empties, the trigone is thrown into thick folds.

D.Fibers from each of the ureter form a triangular sheet of muscle that extends from the two ureteral orifices at the internal urethra meatus. The edges of this muscular sheet are thickened between the ureteral orifices (the interureteric crest or mercier bar_ and between the ureters and the internal urethral meatus (BELL MUSCLE)

15

During a perineal prostatectomy, the muscle that must be divided to gain access to the apex of the prostate is the:

 

a  

rectourethralis.

 

b   

internal anal sphincter.

 

c  

perineal body.

 

d  

external anal sphincter.

 

e  

puboanalis.

a. The prostate may be accessed anterior to the sphincter, by dividing the central tendon and sphincteric attachments to the perineum (Young procedure) or by following the anterior rectal wall beneath the external anal sphincter (Belt procedure).

16

Arterial supply to the bladder includes:

 

a  

the superior vesical artery.

 

b  

the inferior vesical artery.

 

c  

the obturator artery

 

d  

the uterine artery.

 

e  

all of the above.

e.

17

The ducts of which of the following prostatic zones drain into the preprostatic urethra?

 

a  

Periurethral glands

 

b  

Central zone

 

c  

Transition zone

 

d  

Peripheral zone

 

e  

a and c

A. periurethral glands

18

Benign prostatic hyperplasia (BPH) may arise from the:

 

a  

periurethral glands.

 

b  

central zone.

 

c  

transition zone.

 

d  

peripheral zone.

 

e  

a and c.

E.

19

In BPH, blood supply to the adenoma arises from the:

 

a  

superior vesical artery.

 

b  

urethral arteries extending down the urethra from the bladder neck.

 

c  

capsular arteries that arise laterally.

 

d  

dorsal venous complex.

 

e  

neurovascular bundle.

b.

20

Which of the following statements concerning the striated urethral sphincter is TRUE?

 

a  

It is composed of type I (slow-twitch) and type II (fast-twitch) fibers.

 

b  

It is bounded above by the superior fascia.

 

c  

It receives motor blanches from the dorsal nerve of the penis.

 

d  

It is shaped like a signet ring and is 2 to 2.5 cm in length.

 

e  

It is densely supplied with proprioceptive muscle spindles.

d

21

The seminal vesicle:

 

a  

is normally palpable in a rectal examination.

 

b  

is a lateral outpouching of the prostate (central zone).

 

c  

contracts in response to excitatory efferents from the sacral parasympathetic nerves.

 

d  

is medial to the vas deferens.

 

e  

stores sperm.

c. innervation arises from the pelvic plexus, with major excitatory efferents contributed by the hypogastric nerves (sympathetic)

22

When the endopelvic fascia lateral to the prostate and puboprostatic ligaments is opened, vessels are commonly encountered that pierce the levator ani to join the periprostatic plexus laterally. These vessels are communicating branches from the:

 

a  

pampiniform plexus of veins.

 

b  

dorsal vein of the penis.

 

c  

internal pudendal veins.

 

d  

external pudendal veins.

 

e  

accessory obturator veins.

 

C.

23

Lymphatic drainage from the prostate flows to the:

 

a  

external iliac and common iliac nodes.

 

b  

internal iliac and obturator nodes.

 

c  

para-aortic nodes.

 

d  

internal iliac and inguinal nodes.

 

e  

perirectal and common iliac nodes.

B. Internal and obturator nodes

24

The first branch of the pudendal nerve in the perineum is the:

 

a  

dorsal nerve of the penis.

 

b  

inferior rectal nerve(s).

 

c  

perineal nerve.

 

d  

posterior femoral cutaneous branches.

 

e  

posterior scrotal branches.

a

25

After fracture of the penis (disruption of the tunica albuginea), if Buck fascia remains intact, the hematoma will be visible in the:

 

a  

perineum in a butterfly pattern.

 

b  

penis and scrotum only.

 

c  

penis, scrotum, and perineum and tracking up the anterior abdominal wall.

 

d  

shaft of the penis only.

 

e  

shaft and glans of the penis.

 

 

d

26

The skin of the penile shaft and foreskin can be elevated as a rotational flap supplied by the:

 

a  

dorsal artery of the penis.

 

b  

superficial inferior epigastric vessels.

 

c  

gonadal vessels.

 

d  

external pudendal vessels.

 

e  

several branches of the perineal vessels.

D. the blood supply of the skin of the penile shaft is independent of the erectily bodies and is derived from the external pudendal branches of the femoral vessels

27

The dartos layer of smooth muscle and fascia in the scrotum is continuous with:

 

a  

the dartos layer of the penis.

 

b  

Colles fascia.

 

c  

Scarpa fascia.

 

d  

Buck fascia.

 

e  

a, b, and c.

e

28

The cremaster muscle is supplied by the:

 

a  

ilioinguinal nerve.

 

b  

genital branch of the genitofemoral nerve.

 

c  

femoral branch of the genitofemoral nerve.

 

d  

terminal branches of the subcostal nerve (T12).

 

e   

iliohypogastric nerve.

b

29

Lymphatic drainage from the bulbar urethra travels:

 

a  

through perianal nodes to reach the pelvis.

 

b  

directly to the deep pelvic lymph nodes.

 

c  

through the superficial and deep inguinal lymph nodes.

 

d  

to prepubic nodes.

c

30

In their course from the seminiferous tubule to the epididymis, sperm pass through, in order:

 

a  

straight tubules, efferent ductules, rete testis.

 

b  

rete testis, straight tubules, efferent ductules.

 

c  

efferent ductules, rete testis, straight tubules.

 

d  

straight tubules, rete testis, efferent ductules.

 

e  

rete testis, efferent ductules, straight tubules.

d