Week 9- Anatomy Self Study

Front 1

What is the demarcation between the false and true pelvis?

Back 1

The pelvic brim, following along the superior margin of the pubic symphysis, pectin of the pubis, arcuate line of the ilium, ala of the sacrum and sacral promontory.

Front 2

What are the three bones that make up the hip bone?

Back 2

Ilium, ischium, and pubis.

Front 3

What is the structure where the two hip bones unite anteriorly?

Back 3

Pubic symphysis.

Front 4

What part of the sacrum unites with the hip bones posteriorly?

Back 4

The ala of the sacrum articulates with the ilium and are held in place by strong sacroiliac ligaments. There is actually a joint which is reasonably nonmotile, the sacroiliac joint.

Front 5

What ligaments and bony prominences are involved in the formation of the greater and lesser sciatic foramina?

Back 5

The sacrotuberous and sacrospinous ligaments that connect the ischial tuberosity and ischial spine to the sacrum. The space between the sacrotuberous and sacrospinous ligaments is the lesser sciatic foramen.

Front 6

In the anatomic position what two bony features of the pelvis lie on the same vertical plane?

Back 6

The anterior part of the pubic symphysis and anterior superior iliac spine.

Front 7

Concerning differences in male and female bony pelvises:
Which has the widest subpubic angle?
Which has the smallest pelvic inlet and outlet?
Which has the shallowest true pelvis?

Back 7

Female.

Male.

Female.

Front 8

What is the pouch of Douglas and what is its clinical significance?

Back 8

The rectouterine space or peritoneal space between the uterus and anterior rectum. Clinically, it is an important area adjacent to the posterior fornix of the vagina. The thin vaginal wall is all that separates the peritoneal cavity from the outer environment. It can easily be punctured, thus transmitting infection to the peritoneal cavity.

Front 9

What is the sacral plexus?

Back 9

The sacral plexus is composed of ventral primary rami of segments S1 to S5 and the lumbosacral trunk from L4-5. These nerves combine to form the major nerves that leave the pelvis to supply the lower limb.

Front 10

What are the major nerves derived from the sacral plexus? (6)

Back 10

Sciatic, superior and inferior gluteal, pudendal, posterior femoral cutaneous, and pelvic splanchnics. (Don't worry about which segments supply each nerve.)

Front 11

What are the two sources for sympathetic nerves in the pelvis?

Back 11

Sacral sympathetic trunk (or chain) and the hypogastric plexus.

Front 12

What is the origin of the parasympathetic innervation to the pelvic viscera?

Back 12

Pelvis splanchnics from S2-S4.

Front 13

What are the chief arteries off the internal iliac artery? (7)

Back 13

Superior and inferior gluteal arteries, umbilical supplying superior vesicular branches, obturator, middle rectals, internal pudendals, uterine and vaginal branches.

Front 14

What arteries in the pelvis are unique to females? (3) and where do they originate from?

Back 14

Uterine and vaginal branches off the internal iliac and ovarian from the lumbar aorta.

Front 15

What is the origin for the common variation of the obturator artery?

Back 15

It may arise off the inferior epigastric branch from the external iliac and pass over the pelvic brim to the obturator canal (20% occurrence).

Front 16

On a rectal exam, what can be palpated anteriorly in the female?

Back 16

Cervix of uterus.

Front 17

What is the muscular sheet found at the pelvic outlet?

What are its components?

Back 17

Pelvic diaphragm.

Levator ani and coccygeus muscles.

Front 18

What is the name of the medial part of the levator ani that keeps the "kink" in the anus?

Back 18

Puborectal sling.

Front 19

What is the path for the ureters?

What are the three constrictions or narrowed areas in the ureters?

Back 19

The pass down the posterior abdominal wall, over the pelvic brim, along the posterior wall of the pelvis and then anterior to the posterior wall of the bladder.

Three constrictions are
1) At the renal pelvis
2) Where they cross the external iliac artery and pass over the pelvic brim
3) As they pass through the bladder wall.
These areas are where large calculi, "kidney stones", often are stopped and then cause increased pain. Small stones may pass with little or no pain.

Front 20

As the ureters approach the uterus, what structure crosses immediately over them?

Back 20

Uterine artery.

Front 21

What is the smooth area in the bladder where the ureters pierce the bladder wall?

Back 21

Trigone, outlined by the inlets of the ureters and inferiorly by the outlet of the bladder.

Front 22

What is the name of the smooth muscle found in the urinary bladder wall?

Back 22

Detrusor muscle.

Front 23

What is the ring of smooth muscle called at the neck of the urinary bladder?

Back 23

Internal sphincter.

Front 24

What is the innervation to the internal sphincter?

Back 24

It is closed tonically by the sympathetics and stimulated to open by the parasympathetics (by inhibition of sympathetics).

Front 25

On rectal exam what can be palpated anteriorly in the male.

Back 25

Prostate and seminal vesicles.

Front 26

Where is the membranous urethra located in both sexes?

Back 26

Within the urogenital diaphragm.

Front 27

What is the pathway for sperm after passing through the superficial inguinal ring?

Back 27

In the vas deferens the sperm pass through the inguinal canal, then through the deep inguinal ring, over the pelvic brim, along the lateral aspect of the bladder, join the duct of the seminal vesicle to form the ejaculatory duct, passes through the prostate gland, and enter the prostatic urethra on the posterior aspect along the colliculus seminalis.

Front 28

Into what do the ejaculatory ducts empty?

Back 28

Prostatic urethra, along the side of the colliculus seminalis.

Front 29

What nerve group functions during ejaculation?

Back 29

Parasympathetics, cause contraction of urethral muscles. Sympathetics, cause movement of sperm down the vas and secretion of glands (emission).
"Parasympathetics=Point and sympathetics=Shoot"

Front 30

How does the prostate empty into the urethra compared to the ejaculatory ducts?

Back 30

Numerous small ducts open into the prostatic urethra.

Front 31

What is the name for the longest part of the urethra in males?

Back 31

Spongy urethra (since it enclosed by the corpus spongiosum).

Front 32

The female urethra opens into what space?

Back 32

Vestibule.

Front 33

What arteries supply the rectum? (3)

Back 33

-Superior rectal from inferior mesenteric
-middle rectal from internal iliac
- inferior rectal from internal pudendal artery.

Front 34

What are the boundaries of the perineum?

Back 34

It is a diamond formed by the pubic symphysis, pubic rami, ischial rami, ischial tuberosities, sacrotuberous ligaments, and coccyx.

Front 35

What are its two subdivisions, and in general what is found in each?

Back 35

Anal triangle; anal canal, external anal sphincter, and ischiorectal fossa. Urogenital triangle; UG diaphragm, scrotum/labia, penis/clitoris, vestibule.

Front 36

What are the boundaries of the ischiorectal fossae?

With what is it normally filled?

Back 36

Perineal body anteriorly, laterally obturator internus muscle, levator ani.

They are filled with fat.

Front 37

What is the UG diaphragm and how does it differ from the pelvic diaphragm?

Back 37

It stretches between the inferior pubic rami. It lies superficial to the pelvic diaphragm and contains the external sphincter of the urethra.

Front 38

What pierces the UG diaphragm in the female?

The male?

Back 38

Female - urethra and vagina.

Male - urethra.

Front 39

What is found in the deep perineal space?

Back 39

The urogenital diaphragm.

Front 40

What is the superficial perineal space?

And what is found there?

Back 40

It is the area superficial to the UG diaphragm. It contains the structures associated with the penis and scrotum, or structures of the vestibule, clitoris, and labia, plus all the associated nerves and vessels.

Front 41

What is the difference between the external and internal urethral sphincter?

Back 41

The external sphincter is under voluntary control while the internal sphincter is controlled by autonomic nerves.

Front 42

What is the chief nerve supply to the perineum?

Back 42

Pudendal nerve and its branches.

Front 43

What is the origin of the inferior rectal nerves and vessels?

Back 43

Pudendal nerve and internal pudendal artery and veins.

Front 44

What are the names of the nerves and arteries on the dorsum of the body of the penis? What is the function of the nerves found here?

Back 44

Deep dorsal vein, dorsal arteries, and dorsal nerves.

Sensory to the surface.

Front 45

The crura and bulb of the penis make up what basic part of the penis?

Back 45

Root of the penis.

Front 46

What is the muscle layer that lies over the bulb of the penis?

What is its function?

Back 46

Bulbospongiosus, compresses the bulb and assists erection.

Front 47

How does the path of the urethra differ between the sexes?

Back 47

The male urethra consists of prostatic and spongy components that are not found in the female. The membranous component is common in both.

Front 48

The bulb of the penis is continuous with what structure in the shaft of the penis?

Back 48

Corpora spongiosum.

Front 49

What is the mechanism of erection?

Back 49

Upon stimulation the smooth muscle in the trabeculae and arteries of the corpora relax because of parasympathetic stimulation (via pelvic splanchnics). The arteries straighten and enlarge, allowing increased blood flow into the cavernous spaces. The bulbospongiosus and ischiocavernosus muscles compress the venous drainage at the periphery of the corpora and impede outflow of blood. As a result, the corpora becomes enlarged and rigid and erection occurs.

Front 50

How do the drainage patterns for the superficial veins of the perineum differ from that of the deep dorsal vein?

Back 50

The perineum is drained via the internal pudendal veins back toward the lesser sciatic foramen while the deep dorsal vein drains through a defect in the UG diaphragm directly into a plexus of veins surrounding the prostate gland.

Front 51

What is the name of the end of the uterine tube that drapes over the ovary?

Back 51

Fimbrae, which sweep over the surface of the ovary and pick up ovulated oocytes.
-"think Kung-fu hands"= fimbre

Front 52

What is the origin of the ovarian arteries?

Back 52

They pass into the pelvis over the pelvic brim. They originate as paired arteries off the aorta.

Front 53

What is the peritoneal sheet that attaches the uterus to the lateral pelvic wall?

Back 53

Broad ligament of the uterus.

Front 54

What is the ligamentous structure within broad ligament that contains the ovarian vessels?

Back 54

Suspensory ligament of the ovary.

Front 55

What ligament supports the cervix/uterus within the broad ligament?

Back 55

Transverse cervical or "cardinal" ligament.

Front 56

What is the usual orientation of the uterus in relationship to the bladder?

Back 56

Anteflexed anteriorly over the bladder.

Front 57

At what uterine anatomic landmark does the uterine artery approach the uterus?

Back 57

It approaches at the uterine cervix from both sides and then its branches go superiorly and inferiorly to supply the uterus.

Front 58

What are the vaginal spaces around the end of the cervix?

Back 58

Anterior, lateral, and posterior fornices (fornix is singular).

Front 59

The crura of the clitoris makes up structure in the body?

Back 59

Corpora cavernosa.

Front 60

What is the skeletal muscle that lays over the crura of the clitoris?

What is its function?

Back 60

Ischiocavernosus muscle.

Its function is to help maintain erection in the clitoris.

Front 61

What is the nerve supply to the female perineum?

Back 61

Perineal branches of the pudendal nerve.

Front 62

What is the surgical procedure called that prevents the UG diaphragm from ripping during childbirth?

Back 62

Episiotomy. It is done to enlarge the vaginal orifice and prevent a jagged tear in the perineum. This heals more quickly and can prevent damage to important structures such as the perineal body that have consequences later in life in support of pelvic viscera.

Front 63

In the pudendal nerve block, what bony feature does the clinician use as a guide to anesthetize the pudendal nerve?

Back 63

Ischial spine.

Front 64

To where do the lymphatics for the cervix drain?

Back 64

They pass along the uterine vessels to the internal iliac nodes and then superior along the aorta.

Front 65

To where do the lymphatics for the scrotum/labia drain initially?

Back 65

They drain to the superficial inguinal nodes.

Front 66

To where do the lymphatics of the ovary/testes drain?

Back 66

The lymphatics follow the ovarian and testicular blood vessels and ascend to the lumbar lymph nodes (para-aortic lymph nodes)