Pelvic and Reproductive Anatomy

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Questions and Answers

Which of the following best describes the anatomical boundary formed by the tip of the coccyx and the intergluteal cleft?

  • Lateral border of the perineum
  • Inferior border of the perineum (correct)
  • Superior border of the pelvic diaphragm
  • Anterior border of the perineum

A clinician is evaluating a patient with suspected pelvic floor dysfunction. Which muscle group is MOST directly involved in supporting the pelvic organs and resisting increases in intra-abdominal pressure?

  • Deep transverse perineal muscle
  • Levator ani muscle group (correct)
  • Internal obturator muscle
  • Superficial transverse perineal muscle

The bulbospongiosus muscle contributes to clitoral erection in females and ejaculation/penile erection in males.

True (A)

The ______ is a fibromuscular mass located in the midline of the perineum at the junction of the urogenital and anal triangles and serves as an attachment for perineal muscles.

<p>perineal body</p>
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Match the pelvic structure with its location:

<p>Sacral promontory = Anterior border of the pelvic inlet Ischial spines = Marks the narrowest part of the pelvic cavity Pubic symphysis = Anterior midline of the bony pelvis Sacroiliac joint = Connects the sacrum to the ilium</p>
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During a difficult vaginal delivery, an obstetrician performs an episiotomy. If the incision extends posterolaterally from the vaginal opening, which muscle is MOST likely to be directly injured?

<p>Bulbospongiosus (D)</p>
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Identify the MOST accurate sequence of structures through which sperm pass from the testes to the external urethral meatus.

<p>Testis, epididymis, ductus deferens, ejaculatory duct, urethra (A)</p>
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The rectouterine pouch (of Douglas) is the lowest point in the female peritoneal cavity and a common site for fluid accumulation.

<p>True (A)</p>
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Describe the clinical significance of the angle of inclination of the pelvis and how it is determined.

<p>The angle of inclination affects weight distribution and posture. It's measured between the sacral promontory and the upper margin of the pubic symphysis (normally 50-60 degrees).</p>
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The ______ muscle is unique because it is composed of puborectalis, pubococcygeus and iliococcygeus.

<p>levator ani</p>
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A male patient presents with a varicocele (enlargement of the veins within the spermatic cord). Which venous structure is MOST likely affected?

<p>Testicular vein (C)</p>
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The male and female embryos are morphologically distinct from the beginning of their development.

<p>False (B)</p>
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Describe the course of the round ligament of the uterus, and identify its homologue in the male anatomy.

<p>The round ligament of the uterus passes through the inguinal canal to the labia majora, and the homologue structure in males is the spermatic cord.</p>
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The ______ diameter of the pelvic inlet has a typical measurement of 13 cm .

<p>transverse</p>
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Match the following structures with the correct description.

<p>Bulbourethral Glands = Secrete a lubricating mucus that cleanses the urethra before ejaculation. Seminal Vesicles = Secrete a fluid that contributes to semen volume and contains nutrients for sperm. Prostate Gland = Secretes a milky fluid that contributes to semen volume and contains enzymes. Urethra = Carries both urine and semen to the outside environment.</p>
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During a pelvic examination, a physician palpates the ischial spines. What is the primary clinical significance of these bony landmarks?

<p>Estimating the bispinous diameter of the pelvic outlet (D)</p>
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In females, the ilioinguinal nerve passes through the inguinal canal along with the round ligament of the uterus

<p>True (A)</p>
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Describe the three layers of the uterine wall and their respective functions.

<p>The uterine wall consists of the perimetrium (outer serous layer), the myometrium (muscular layer responsible for contractions), and the endometrium (inner mucosal layer that undergoes cyclical changes).</p>
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The ______ is the suspensory structure that attaches the ovary to the lateral pelvic wall.

<p>suspensor ligament of ovary</p>
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Match the following structures found in the inguinal canal:

<p>Spermatic cord = Males Round ligament of the uterus = Females Genital branch of genitofemoral nerve = Both males and females Ilioinguinal nerve = Both males and females</p>
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Damage to the iliococcygeus portion of the levator ani muscle is MOST likely to result in

<p>Pelvic Organ Prolapse (D)</p>
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The Perineal Body is located at the border of the anterior surface of the anus.

<p>True (A)</p>
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What are the borders of the perineum as defined by anatomical landmarks?

<p>Anterior: Pubic Symphysis, Lateral: Ischiopubic rami and sacrotuberous ligaments, Inferior: Tip of Coccyx</p>
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The Transverse diameter that exists in the Pelvic Outlet has a measurement of ______ cms.

<p>11</p>
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Match the description to the anatomical location being described.

<p>Ala of Ilium = Part of the False/Greater Pelvis Obturator Internus = Part of the True/Lesser Pelvis Muscles of Abdominal Wall = Part of the False/Greater Pelvis Perineum = Part of the True/Lesser Pelvis</p>
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What is the relationship between the angle of inclination and the tip of the coccyx?

<p>Angle between the tip of the coccyx and the lower margin of the pubic symphysis is between 10 and 15 degrees (A)</p>
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The sacrum and the Coccyx are both considered to be part of the Coxal Bone.

<p>False (B)</p>
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What are two other terms for the Pelvic Inlet?

<p>Pelvic Brim, Superior Pelvic Aperture</p>
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The Levator Ani consists of three parts. Name two of these three parts (Puborectalis, Pubococcygeus, and ______ .

<p>iliococcygeus</p>
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Match the definition to the anatomical location.

<p>Uterus = The womb Cervix = The neck of the womb Vagina = Musclar tube leading to the Cervix Clitoris = A sensitive sexual organ</p>
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Which components are located in the male reproductive tract?

<p>Penis, Testis, Scrotum, Prostate, Seminal Vesicles, Ejaculatory Duct and Urethra (B)</p>
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Sperm travels through the urethra.

<p>True (A)</p>
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What are common female reproductive organs that can be readily defined in a female laparoscopic procedure?

<p>A Uterus, Ovaries, and Fallopian Tubes</p>
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For embryology, the reference can be derived from Langman's medical embryology by T.W. Sadler and ______ Essential of Human Embryology

<p>Larsen's</p>
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Flashcards

Bony Pelvis

The bony structure formed by the ilium, ischium, pubis, sacrum and coccyx.

Angle of inclination

Angle between the sacral promontory/upper pubic symphysis margin and a vertical plane, typically 50-60 degrees.

Pelvic Inlet

The opening into the true pelvis, delineated by the sacral promontory, arcuate line, and pubic symphysis.

Pelvic outlet

The inferior opening of the true pelvis, bounded by the coccyx, ischial tuberosities, and pubic arch.

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Greater Pelvis

The space above the pelvic inlet, containing abdominal organs.

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Lesser Pelvis

The space inferior to the pelvic inlet, containing the pelvic organs.

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Pelvic Diaphragm

The pelvic floor formed by the levator ani and coccygeus muscles.

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Perineum

Region inferior to the pelvic diaphragm, between the thighs.

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Perineal Body

Central point of the perineum where muscles converge.

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Perineal muscles

Include the Bulbospongiosus, Ischiocavernosus and Transverse perineal muscles

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Early Embryonic Development

Embryos have similar appearance until 7th week.

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Spermatic Cord

Cord-like structure containing testicular artery, pampiniform plexus, and vas deferens.

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Layers of Spermatic fascia

External, cremasteric, and internal spermatic fascia.

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Arteries of the spermatic cord

Includes testicular artery, cremasteric artery, and deferential artery.

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Veins of the Spermatic Cord

Pampiniform plexus, testicular vein, cremasteric vein, and deferential vein.

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Nerves of spermatic cord

Includes genital branch of genitofemoral nerve, ilioinguinal, autonomic nerves.

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Rectovesical pouch

The pouch between the rectum and bladder in males.

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Male Reproductive Tract

Includes the penis, scrotum, testes, prostate, seminal vesicles, bulbourethral glands, ejaculatory ducts, and urethra.

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Seminal Vesicles

Glands that produce seminal fluid in males.

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Female Reproductive Tract

Includes the uterus, cervix, vagina, uterine tubes, ovaries, vestibule, labia majora and minora, and clitoris.

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Myometrium

The thick, muscular layer of the uterus that contracts during labor.

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Endometrium

Inner lining of the uterus that changes during the menstrual cycle.

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Study Notes

  • Pelvic and Reproductive Anatomy

Learning Objectives

  • Outline bony pelvis
  • Describe pelvic diaphragm and perineum
  • Overview male and female reproductive tracts
  • An@tomedia anatomy software with cadaveric and radiology images is available at King's Library
  • Acland's videos resources are available

Bony Pelvis

  • Consists of the ilium, ischium, pubis, sacrum and coccyx
  • Coxal bone includes the ilium, ischium and the pubis
  • Key joints include lumbosacral, sacroiliac, pubic symphysis and sacrococcygeus
  • Sacral promontory and the upper margin of pubic symphysis creates an angle of inclination of 50-60 degrees
  • Tip of the coccyx and the lower margin of pubic symphysis creates an angle of inclination of 10 to 15 degrees
  • The pelvic inlet is the superior pelvic aperture/pelvic brim
  • The pelvic outlet is outlined

False vs True Pelvis

,- Greater (false) pelvis is located above the pelvic brim and contains the abdominal cavity

  • Lesser (true) pelvis is located below the pelvic brim

Male vs Female Pelvis

  • Male pelvis is different to the female pelvis

Pelvic Diameters

  • The ideal obstetric pelvic inlet transverse diameter is 13cm and the AP diameter is 12cm
  • The ideal obstetric pelvic outlet transverse diameter is 11cm and the AP diameter is 12.5cm

Pelvic Diaphragm

  • Levator ani is composed of puborectalis, pubococcygeus and iliococcygeous
  • The other muscle in the pelvic diaphragm is the coccygeus

Perineum

  • In females, the perineum includes the intergluteal cleft
  • Anatomical borders include anterior, lateral and inferior
  • Surface borders include anterior, lateral and inferior
  • Perineal muscles include perineal body, ischiocavernosus, bulbospongiosus and transverse perineal muscles

Embryology

  • Embryos appear morphologically identical up to the beginning of the 7th week
  • Descent occurs

Male Inguinal Canal

  • Consists of the deep inguinal ring and superficial inguinal ring

Inguinal Canal Contents

  • 3 fascia - external spermatic fascia, cremasteric fascia, internal spermatic fascia
  • 3 arteries - testicular, cremasteric, deferential artery
  • 3 veins - pampiniform plexus and testicular vein, cremasteric vein, deferential vein
  • 3 nerves - genital branch of the genitofemoral nerve, ilioinguinal and autonomic nerves
  • Lymphatics are present
  • In females the inguinal canal contents consist of the round ligament of uterus, genital branch of the genitofemoral nerve and ilioinguinal nerve

Male Reproductive Tract

  • Consists of the penis, scrotum, testis, prostate, seminal vesicles, bulbourethral gland, ejaculatory duct and urethra

Female Reproductive Tract

  • Consists of the uterus, cervix, vagina, uterine tubes, ovaries, vestibule, labia majora, labia minora and clitoris
  • Layers of the uterus are the perimetrium, myometrium and endometrium

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