Applied Anatomy

Question 1

Label the bones of the anterior and posterior view of the pelvis using the labels below:

coccyx
hip bone
ilium 
pubis
ischium
ilium 
pubis
sacrum
ischium
pubic symphysis
sacrum

Answer 1

1 = sacrum
2 = ilium 
3 = pubis
4 = ischium
5 = pubic symphysis
6 = sacrum
7 = hip bone
8 = ilium 
9 = pubis
10 = ischium
11 = coccyx

Question 2

Pelvic fractures are common occurrences. What part of the pelvis are generally damaged?

1 - pubic and ischium rami
2 - ileum
3 - acetabulum
4 - sacroiliac joint

Answer 2

1 - pubic and ischium rami

Question 3

Pelvic fractures are common occurrences. What 2 joints in the pelvis are most likely to be dislocated due to trauma?

Answer 3

• sacroiliac joint

- pubic symphysis joint

Question 4

What time periods are women more susceptible to dislocation/damage to the sacroiliac and pubic symphysis joints?

Answer 4

• before & during menstruation (due to hormones)
• pregnancy & childbirth, menopause (preparation for birth and hormones)
• abnormal weight-bearing (carrying babies on hips, can also affect men)

Question 5

What is a hysterectomy?

Answer 5

• surgical removal of the uterus

- can also involve removal of the cervix, ovaries, fallopian tubes, and other surrounding structures

Question 6

A hysterectomy is a surgical removal of the uterus, that can also involve removal of the cervix, ovaries, fallopian tubes, and other surrounding structures. What is an important tube that runs closes to the uterine artery that must be kept in mind during a hysterectomy?

1 - inguinal canal
2 - alcocks canal
3 - ureter
4 - fallopian tube

Answer 6

• ureter
• runs over and then under (close to cervix) the uterine artery
• remember water under the bridge (ureter carries water)

Question 7

An episiotomy is where a cut (incision) is made through the area between your vaginal opening and your anus called the perineum. Which nerve is generally anaesthetised during this procedure?

1 - obturator nerve
2 - sciatic nerve
3 - femoral nerve
4 - pudendal nerve

Answer 7

4 - pudendal nerve (called pudendal nerve block)

- this nerve supplies pain sensation to perineum

Question 8

An episiotomy is where a cut (incision) is made through the area between your vaginal opening and your anus called the perineum. The pudendal nerve is generally anaesthetised during this procedure, called the pudendal nerve block, as this nerve supplies pain sensation to perineum. What anatomical landmark is used to identify where to inject the needle?

1 - ischial tuberostiy
2 - ischial spine
3 - ASIS
4 - PSIS

Answer 8

2 - ischial spine and sacrospinous ligament

Question 9

What are the 2 terms used to described the orientation of the vagina, cervix and fundus?

Answer 9

• anteflexed = fundus and body point forward relative to cervix
• anteverted = uterus is angled forward relative to vagina

Question 10

The 2 terms used to described the orientation of the vagina, cervix and fundus are:

• anteflexed = fundus and body point forward relative to cervix
• anteverted = uterus is angled forward relative to vagina

What term is used to describe what occurs in 20% of females where the uterus tilts backwards instead of forwards?

Answer 10

• retroverted

Question 11

If a catheter is not placed through the urethra, as it may be in for a prolonged period of time. Where would it be placed?

1 - through femoral triangle
2 - through inguinal canal
3 - suprapubic
4 - inferiorpubic

Answer 11

3 - suprapubic catheterisation (above pubic symphysis)

- below the peritoneum cavity

Question 12

Label the parts of the uterus

vaginal fornix
cervix
ovary
fundus
body of uterus
vagina
fallopian tube
endometrium
myometrium
cervical canal

Answer 12

1 = fundus
2 = body of uterus
3 = cervix
4 = vagina
5 = ovary
6 = fallopian tube
7 = endometrium
8 = myometrium
9 = cervical canal 
10 = vaginal fornix

Question 13

What are uterine fibroids, also called leiomyomas?

Answer 13

• leio = smooth
• myo = muscle
• mas = tumour
• benign muscle tumours that form in the uterus

Question 14

What are the most common form of tumours in females?

1 - uterine fibroids
2 - endometrial
3 - ovarian
4 - cervical

Answer 14

1 - uterine fibroids, also called leiomyomas

• leio = smooth
• myo = muscle
• mas = tumour
• benign muscle tumours that form in the uterus

Question 15

What is the external os?

Answer 15

• site where uterine cells (columnar) and vaginal cells (squamous) meet
• cellular proliferation occurs here and is at risk of hyperplasia

Question 16

What are the most common symptoms associated with uterine fibroids, also called leiomyomas?

1 - heavy menstrual bleeding, abdominal pain, frequent urination, glycosuria
2 - heavy menstrual bleeding, back pain, frequent urination, dyspareunia
3 - light menstrual bleeding, back pain, frequent urination, dyspareunia
4 - heavy menstrual bleeding, pelvic pain, unable to urinate, dyspareunia

Answer 16

2 - heavy menstrual bleeding, back pain, frequent urination, dyspareunia

• heavy menstrual bleeding (if located on submucosa)
• back pain = press on nerve
• frequent urination = compress urethra/ureter
• dyspareunia = pain during sexual intercourse

Question 17

What is a cervical smear?

Answer 17

• sample is taken from the external os site of the cervix

- external os is where cervical cancer most commonly occurs

Question 18

What is a hydrocele?

Answer 18

• fluid collection in the tunica vaginalis which wraps around the testicles
• can be present standing and lying down, but more obvious when standing

Question 19

A hydrocele is when fluid collects in the tunica vaginalis which wraps around the testicles. What is the most common cause for this to occur?

1 - testes descends into scrotum and take peritoneal with it
2 - trauma damages the peritoneal wall and fluid leaks down into scrotum
3 - infection in scrotum causes fluid to accumulate
4 - fluid leads from urethra back into the scrotum

Answer 19

1 - testes descends into scrotum and take peritoneal with it

• as testes move down into the scrotum they bring the lining of the abdominal cavity with it allowing some fluid to fill the scrotum
• at birth the sac surrounding the testicles (tunica vaginalis) seals
• if the sac does not seal it can allow fluid from abdomen into the scrotum

Question 20

What is a hematocele?

Answer 20

• haemorrhage into the tunica vaginalis space

- usually as a result of traumatic or surgical injury or testis tumour

Question 21

What is testicular torsion?

Answer 21

• spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted
• twisting cuts off the testicle’s blood supply and causes sudden pain and swelling
• medical emergency

Question 22

What is benign prostatic hyperplasia?

Answer 22

• cells of prostate undergo hyperplasia and increase the size of the prostate
• the increased size of the prostate compresses the urethra and reduces urine flow
• occurs in the transitional zone of the prostate

Question 23

What is cryptorchidism mean?

Answer 23

• crypto =greekfor hidden
• orchis = greek for testis
• refers to the absence of a testis from the scrotum, generally because it has not descended into the scrotum causing infertility

Question 24

What is cystitis?

Answer 24

• inflammation of the lining of the bladder

Question 25

What is varicocele?

Answer 25

- enlargement of the veins within the scrotum - can cause low sperm production and decreased sperm quality and infertility - more obvious when standing

Question 26

Varicocele is enlargement of the veins within the scrotum that can cause low sperm production and decreased sperm quality and infertility. is this more common in the left or right testes and why?

Answer 26

- left testicle | - has to drain into the left renal vein

Question 27

What is the name of the loose network of small veins found within the male spermatic cord, that ultimately will go on to form the testicular veins? 1 - hypophyseal portal system 2 - scrotal portal system 3 - pampiniform plexus 4 - testicular portal system

Answer 27

3 - pampiniform plexus

Question 28

The peritoneum is the tissue that lines the abdominal wall and covers most of the organs in your abdomen. This covers the superior surfaces of the pelvic organs. What are the 2 pouches that are formed in females?

Answer 28

1 - uterovesical pouch (between bladder and uterus) | 2 - rectouterine pouch (between uterus and rectum)

Question 29

The peritoneum is the tissue that lines the abdominal wall and covers most of the organs in your abdomen. This covers the superior surfaces of the pelvic organs. What is the name of the pouch that is formed in males?

Answer 29

- rectovesical pouch

Question 30

What is the lowest point of the abdominal cavity where fluid could collect causing infection in males and females?

Answer 30

- females = rectouterine pouch (pouch of douglas) | - males = rectovesicle pouch

Question 31

If there is fluid in the rectouterine pouch, how can this be drained without opening a patient up with surgery? 1 - via umbilicus 2 - via the vagina 3 - via rectum

Answer 31

2 - via the vagina

Question 32

The peritoneum is the tissue that lines your abdominal wall and covers most of the organs in your abdomen. This peritoneum lines the superior surface of the major pelvic organs, specifically the uterus, bladder and rectum. It also creates a 2 layered fold over the uterus creating a number of ligaments that are important for providing structure and support to the uterus. Label the 4 key ligaments of the uterus using the labels below: Broad ligament Uterine-Ovarian ligament Round ligament Uterosacral ligament

Answer 32

1 - Round ligament 2 - Uterine-Ovarian ligament 3 - Broad ligament 4 - Uterosacral ligament

Question 33

There is a fibrous median raphe in the floor of the pelvis, which extends between the coccyx and the margin of the anus that is composed of fibers of the levator ani muscle that unite with the muscle of the opposite side, muscle fibres from external anal sphincter, and fibrous connective tissue. What is this fibrous median called? 1 - Coccygeus 2 - Iliococcygeus 3 - Puborectalis 4 - Anococcygeal raphe

Answer 33

4 - anococcygeal raphe

Question 34

What are mesenteries?

Answer 34

- the mesentery is a double fold of peritoneal tissue - it suspends tissues to walls for stability - it provides a conduit for blood vessels, nerves and lymphatics

Question 35

The mesenteries are double folds of peritoneal tissue that suspends tissues to walls for stability and provide a conduit for blood vessels, nerves and lymphatics. The broad ligament that covers the uterus has 3 mesenteries, label them using the labels below and what each one supplies: mesovarium mesosalpinx mesometrium

Answer 35

``` 1 = mesosalpinx = associated with uterine tubes 2 = mesometrium = associated with the uterus 3 = mesovarium = associated with the ovaries ```

Question 36

The folds of the peritoneum encapsulate the majority of the uterus, ovaries and fallopian tubes providing support and holding the female reproductive organ in place. What ligament contributes to maintaining the anteverted position (pointing towards the vagina) of the uterus and where does it insert? 1 - broad ligament attaches to the uterus, through inguinal canal and to the labium majora 2 - round ligament attaches to the uterus, through inguinal canal and to the labium majora 3 - suspensory ligament attaches to the uterus, through inguinal canal and to the labium majora 4 - ovarian ligament attaches to the uterus, through inguinal canal and to the labium majora

Answer 36

2 - round ligament attaches to the uterus, through inguinal canal and to the labium majora - helps maintain the anteverted position of uterus

Question 37

The round ligament is a cordlike structures in the pelvis that help support the uterus by connecting the front of the uterus to the groin region. Where does the round ligament attach to?

Answer 37

- proximally = cornu (horn) of uterus | - distally = through inguinal canal and attaches to labia majora

Question 38

The round ligament is a cordlike structures in the pelvis that helps support the uterus by connecting the front of the uterus to the groin region and helps maintain the anteverted position of uterus. it attaches to the cornu of the uterus and the labia majora. The round ligament is a remnant of embryological development from what? 1 - gubernaculum 2 - allantoic duct 3 - gonadal ridge 4 - mesonphric duct

Answer 38

1 - gubernaculum

Question 39

The gubernaculum is a remnant of embryological development that goes on to form the round ligament, a cordlike structures in the pelvis that helps support the uterus by connecting the front of the uterus to the groin region and helps maintain the anteverted position of uterus. What is the early function of the gubernaculum?

Answer 39

- guide the gonads in males and females from the abdomen to the pelvis

Question 40

During pregnancy the round ligament can be stretched. What can this cause for the mother? 1 - heavy bleeding 2 - pain and cramping 3 - miscarriage 4 - back pain

Answer 40

2 - pain and cramping

Question 41

What is endometriosis? 1 - endometrium tissue of the uterus migrates to other area of the body 2 - endometrium tissue hypertrophies 3 - endometrium tissue atrophies 4 - endometrium develops adeomas

Answer 41

1 - endometrium tissue of the uterus migrates to other area of the body - tissue similar to the tissue that normally lines the inside of your uterus, called the endometrium grows outside your uterus - once this tissue migrates somewhere other that the endometrium, this is called endometriosis

Question 42

Endometriosis is where tissue similar to the tissue that normally lines the inside of your uterus, called the endometrium grows outside your uterus. The tissue migrates to other parts of the uterus. What are the 3 most common areas this tissue migrates to? 1 - ovaries, round ligament, fallopian tubes 2 - ovaries, round ligament, broad ligament 3 - round ligament, fallopian tubes, vagina 4 - large intestines, round ligament, fallopian tubes

Answer 42

1 - ovaries, round ligament, fallopian tubes

Question 43

Endometriosis is where tissue similar to the tissue that normally lines the inside of your uterus, called the endometrium grows outside your uterus. The tissue migrates to other parts of the uterus, most commonly the ovary, fallopian tubes or round ligament. As these are cells that are similar to those cells found in the endometrium, these cells posses receptors, such as estrogen receptors. What can this mean during the menstrual cycle?

Answer 43

- this tissue will go through proliferation and secretion - angiogenesis will occur causing bleeding, which will collect in this area - bleeding in this areas can cause severe pain

Question 44

The cardinal ligaments are situated along the inferior border of the broad ligament and house the uterine artery and uterine veins.These ligaments arise from the side of the cervix and the lateral fornix of the vagina. They provide an extensive attachment on the lateral pelvic wall at the level of the ischial spines. Label the 3 key ligaments using the labels below: transverse ligament pubocervical ligament uterosacral ligament

Answer 44

``` 1 = pubocervical ligament 2 = transverse ligament 3 = uterosacral ligament ```

Question 45

The cardinal ligaments are situated along the inferior border of the broad ligament and house the uterine artery and uterine veins. These ligaments arise from the side of the cervix and the lateral fornix of the vagina. They provide an extensive attachment on the lateral pelvic wall at the level of the ischial spines and the 3 key ligaments are: transverse ligament pubocervical ligament uterosacral ligament Which of these ligaments is the strongest?

Answer 45

- transverse ligament | - has to be as it sits in the middle supporting the weight of the uterus

Question 46

The cardinal ligaments are situated along the inferior border of the broad ligament and house the uterine artery and uterine veins. These ligaments arise from the side of the cervix and the lateral fornix of the vagina. They provide an extensive attachment on the lateral pelvic wall at the level of the ischial spines and the 3 key ligaments are: transverse ligament pubocervical ligament uterosacral ligament The transverse ligament is the strongest and provides substantial support to what structure, and what is the clinical importance of this?

Answer 46

- extensive support to the uterus | - if damaged during surgery can cause problems such as prolapse, can be repaired in surgery though

Question 47

The pelvic outlet also called the inferior pelvic aperture, defines the lower margin of the lesser (true) pelvis. This can be subdivided into 2 regions, what are these 2 regions called?

Answer 47

- anal triangle | - urogenital triangle

Question 48

The pelvic outlet also called the inferior pelvic aperture, defines the lower margin of the lesser (true) pelvis. This can be subdivided into 2 regions called - anal triangle - urogenital triangle What closes off these 2 triangles?

Answer 48

- pelvic diaphragm

Question 49

The pelvic diaphragm closes off the urogenital and anal triangles. What are the 2 groups of muscles that make up the pelvic diaphragm? 1 - obturators and coccygeus 2 - levator ani and coccygeus 3 - piriformis and coccygeus 4 - levator ani and obturators

Answer 49

2 - levator ani and coccygeus

Question 50

The pelvic diaphragm closes off the urogenital and anal triangles and is composed of 2 muscles groups, the levator ani (puborectalis, pubococcygeus, and iliococcygeus.) and coccygeaus. Labels the muscles of the levator ani and coccygeus on the image below: pubococcygeus coccygeus puborectalis iliococcygeus

Answer 50

``` 1 = puborectalis 2 = pubococcygeus 3 = iliococcygeus 4 = coccygeus ```

Question 51

The pelvic diaphragm closes off the urogenital and anal triangles and is composed of 2 muscles groups, the levator ani and coccygeaus. What are the main functions of pelvic diaphragm?

Answer 51

- supports pelvic organs and vagina - supports the orifices: rectum, urethra, / vagina - prevent incontinence (urinary & faecal)

Question 52

The pelvic diaphragm closes off the urogenital and anal triangles and is composed of 2 muscles groups, the levator ani and coccygeaus. Which somatic nerves innervate the pelvic diaphragm? 1 - L4-S4 2 - L5-S2 3 - S1-S4 4 - S2-S5

Answer 52

4 - S2-S5

Question 53

The perineum is the space between the anus and genitals, extending from either the vaginal opening to the anus or the scrotum to the anus. This can be damaged and torn during trauma, most commonly during pregnancy. What is the surgical procedure used to repair this?

Answer 53

- episiotomy

Question 54

What are the 4 most common causes of damage to the pelvic floor and perineum in women?

Answer 54

``` 1 = pregnancy or childbirth, during hysterectomy 2 = pelvic surgery (perineal approach) 3 = episiotomy (trauma to perineal body) 4 = tumours (fibroids) ```

Question 55

What are the 4 most common causes of damage to the pelvic floor and perineum in men?

Answer 55

- heavy lifting - obesity - chronic cough, constipation, vomiting - trauma

Question 56

What is the strongest ligament in the body? 1 - iliofemoral ligament 2 - sacrotuberous ligament 3 - ischiofemoral ligament 4 - pubofemoral ligament

Answer 56

2 - sacrotuberous ligament

Question 57

If the pelvic floor and diaphragm is damaged or weakened, what are some of the most common consequences?

Answer 57

- fullness or pressure inside vagina - prolapse of the vagina or uterus - inability to empty bladder or bowel with straining - incontinence (loss of bladder control) - dysparunia (pain during sex) or reduced sensation during intercourse - backache

Question 58

What is the important relationship between the ureter and the uterine artery that is important in surgery?

Answer 58

- ureters goes over the top of the uterine artery = water over bridge - ureters goes under the uterine artery = water under the bridge (at level of cervix)

Question 59

The gubernaculum is remnant of embryology development that helps guide the gonads into pelvic region. What will the gubernaculum then become in the scrotum? 1 - outer layer of the scrotum 2 - inner layer of the scrotum 3 - scrotal ligament attaching the testes to the scrotum 4 - part of spermatic cord

Answer 59

3 - scrotal ligament attaching the testes to the scrotum

Question 60

The gubernaculum is remnant of embryology development that helps guide the gonads into pelvic region. The gubernaculum then forms a scrotal ligament attaching the testes to the scrotum. If this does not develop correctly, what emergency situation can arise in males? 1 - hydrocele 2 - varicocele 3 - testicular torsion 4 - haematocele

Answer 60

3 - testicular torsion