What Do You Know About Urogenital Triangle? Trivia Quiz

1. A 29-year-old female presents to the clinic with pain during defecation. Ultrasound reveals a large amount of fluid in the pouch of Douglas, presumably due to an infection. Which identifies the correct procedure and landmark for this patient's treatment?

Culdocentesis/Posterior Fornix of the Vagina

Culdoscopy/Anterior Fornix of the Vagina

Paracentesis/Pubic Symphysis

Cystoscopy/Anterior Fornix of the Vagina

Culdocentesis is the medical procedure of draining fluid from the rectouterine pouch or pouch of Douglas. The physician will enter the pouch through the posterior fornix of the vagina and remove the fluid accumulating there. (B) Culdoscopy refers to an investigation of the rectouterine pouch by the camera and is performed through the posterior fornix of the vagina. (C) Paracentesis refers to drainage of fluid from the abdominal cavity. It is typically performed through the linea alba in the midline of the abdomen or laterally, just above the iliac fossae. (D) Cystoscopy refers to the camera investigation of the bladder either by a transurethral or suprapubic method.

Explanation

Culdocentesis is the medical procedure of draining fluid from the rectouterine pouch or pouch of Douglas. The physician will enter the pouch through the posterior fornix of the vagina and remove the fluid accumulating there. (B) Culdoscopy refers to an investigation of the rectouterine pouch by the camera and is performed through the posterior fornix of the vagina. (C) Paracentesis refers to drainage of fluid from the abdominal cavity. It is typically performed through the linea alba in the midline of the abdomen or laterally, just above the iliac fossae. (D) Cystoscopy refers to the camera investigation of the bladder either by a transurethral or suprapubic method.

2. As part of her birthing plan, a 32-year-old woman and her doctor agree that she will have a pudendal nerve block to provide analgesia to her lower vagina during the delivery of her baby. From which of the following segments does the pudendal nerve arise and which of the following is its terminal branch?

L4, L5, S1; dorsal nerve of the clitoris

L5, S1, S2; perineal nerve

S2, S3, S4; dorsal nerve of the clitoris

S1, S2, S3; posterior labial nerve

S3, S4, S5; perineal nerve

The pudendal nerve originates in the sacral plexus from S2, S3, and S4; it gives off 3 branches (inferior rectal nerve, perineal nerve, and posterior labial nerve) before terminating as the dorsal nerve of the clitoris.

Explanation

The pudendal nerve originates in the sacral plexus from S2, S3, and S4; it gives off 3 branches (inferior rectal nerve, perineal nerve, and posterior labial nerve) before terminating as the dorsal nerve of the clitoris.

3. In the urogenital triangle, the superficial pouch contains the Corpus spongiosum and Corpus cavernosum erectile tissue as well as the Ischiocavernosus and Bulbospongiosus muscles. Which layers of fascia make up the boundaries for the superficial pouch?

Perineal fascia (Colles) and the Peritoneum

Perineal membrane and the Inferior fascia of the Pelvic Diaphragm

Perineal fascia (Colles) and the perineal membrane

The Superior fascia of the pelvic diaphragm and the Inferior fascia of the Pelvic Diaphragm

The perineal fascia makes up the superficial boundary and the perineal membrane is the deep boundary of the superficial pouch.

Explanation

The perineal fascia makes up the superficial boundary and the perineal membrane is the deep boundary of the superficial pouch.

4. The pouches in the urogenital triangle have significant structures relating to genitalia. In the female urogenital triangle where are the greater vestibular glands located?

Perineal pouch

Superficial perineal pouch

Subcutaneous pouch

Deep perineal pouch

There are many important structures in the superficial pouch, but the greater vestibular gland, bulb of the vestibule and clitoris are present in the female.

Explanation

There are many important structures in the superficial pouch, but the greater vestibular gland, bulb of the vestibule and clitoris are present in the female.

5. What statement is NOT correct concerning the pelvic pain line?

Marks the inferior limit of the peritoneum

Above pain line is innervated by they sympathetic nervous system T12-L2.

Above the pain line is innervated by PNS S2-S4

Below the pain line is innervated by PNS S2-S4.

The pain line demarcates the lower limit of the peritoneum. Above the line is innervated by the SNS T12-L2 and below is PNS S2-S4.

Explanation

The pain line demarcates the lower limit of the peritoneum. Above the line is innervated by the SNS T12-L2 and below is PNS S2-S4.

6. During the delivery of your first child, there was a tear in the perineal body, to prevent this tear the Doctor should have performed an episiotomy in which direction?

Midline

Posterior lateral

A median excision can tear through the external anal sphincter and rectum. A posterior lateral incision is considered safer

Explanation

A median excision can tear through the external anal sphincter and rectum. A posterior lateral incision is considered safer

7. A 35-year-old woman is diagnosed with high-grade cervical dysplasia. She is very indifferent about her recent diagnosis and does not go to the OB/GYN regularly, as she was advised to do so for continuous monitoring. 7 years later, she presents to the OB/GYN once again with a complaint of irregular vaginal bleeding. After a pap screening, colposcopy, and biopsy, she is diagnosed with advanced cervical carcinoma. Which of the following group of lymph nodes will this carcinoma first metastasize to?

Deep inguinal nodes

Internal & external iliac nodes

Superficial inguinal nodes

Para-Aortic nodes

Sacral nodes

The internal and external iliac nodes are responsible for the lymph drainage of the cervix.

Explanation

The internal and external iliac nodes are responsible for the lymph drainage of the cervix.

8. During surgery in the pelvic region, the attending surgeon decides to ligate the internal iliac artery. She turns to the resident intern and asks him for the various collateral circulation patterns of the pelvic neurovascular. Which of the following collateral circulations should the intern eliminate from his responses since it will not work to continue providing blood supply to the pelvic region?

Superior gluteal and inferior gluteal arteries

Middle rectal and superior rectal arteries

Lateral sacral and median sacral arteries

Inferior gluteal and deep artery of the thigh

Iliolumbar and lumbar arteries

The superior gluteal and inferior gluteal arteries both come off the internal iliac artery, the posterior and anterior division respectively, so they will not serve as a collateral circulation.

Explanation

The superior gluteal and inferior gluteal arteries both come off the internal iliac artery, the posterior and anterior division respectively, so they will not serve as a collateral circulation.

9. The bulbourethral glands are founded adjacent to which segment of the urethra?

Pre-prostatic

Prostatic

Membranous

Bulbous

Penile

Although the glands empty into the bulbous urethra, the location of the glands themselves is in proximity to the membranous

Explanation

Although the glands empty into the bulbous urethra, the location of the glands themselves is in proximity to the membranous

10. A 34-year-old victim of a rollover motor vehicle accident is taken to emergency surgery for internal bleeding. The surgeon is forced to ligate the internal iliac artery to control the hemorrhage. Which correct anastomosis will provide collateral circulation to pelvic structures during the procedure?

Middle Rectal A./Inferior Rectal A

Internal Pudendal A./Lumbar Aa.

Inferior Gluteal A./Deep Artery of the Thigh

Iliolumbar A./Inferior Gluteal A.

The inferior gluteal artery (internal iliac) and the deep artery of the thigh (external iliac/femoral A.) anastomose around the ischium to provide collateral circulation to pelvic structures. The other three anastomoses you should be aware of in this area are Lumbar/Iliolumbar, Median Sacral/Lateral Sacral and Superior Rectal/Middle Rectal Arteries. The other three answer choices are not actual anastomoses.

Explanation

The inferior gluteal artery (internal iliac) and the deep artery of the thigh (external iliac/femoral A.) anastomose around the ischium to provide collateral circulation to pelvic structures. The other three anastomoses you should be aware of in this area are Lumbar/Iliolumbar, Median Sacral/Lateral Sacral and Superior Rectal/Middle Rectal Arteries. The other three answer choices are not actual anastomoses.

11. A patient has pain in the lower abdomen, vaginal bleeding and has not had a period for 3 months. Upon examination you suspect an ectopic pregnancy, where might you perform a culdoscopy to confirm your differential diagnosis?

Cervix

Uterine tube

Lateral fornix

Posterior fornix

The best place is posterior fornix to appropriately enter the pouch of Douglas to visualize a tubal pregnancy. Laparoscopy is now more commonly used

Explanation

The best place is posterior fornix to appropriately enter the pouch of Douglas to visualize a tubal pregnancy. Laparoscopy is now more commonly used

12. The umbilical artery that is obliterated in the adult and is a branch off the Internal iliac artery anterior to the bladder vessels is called?

Median umbilical artery

Median umbilical ligament

Medial umbilical artery

Medial umbilical ligament

Median iliac ligament

The correct answer is "Medial umbilical ligament." In the adult, the umbilical artery becomes obliterated and forms a fibrous cord called the medial umbilical ligament. It is a branch off the internal iliac artery and is located anterior to the bladder vessels. The median umbilical artery is a different structure that is present during fetal development but typically obliterates completely before birth. The median iliac ligament is not related to the umbilical artery.

Explanation

The correct answer is "Medial umbilical ligament." In the adult, the umbilical artery becomes obliterated and forms a fibrous cord called the medial umbilical ligament. It is a branch off the internal iliac artery and is located anterior to the bladder vessels. The median umbilical artery is a different structure that is present during fetal development but typically obliterates completely before birth. The median iliac ligament is not related to the umbilical artery.

13. Which measurement is taken the female pelvis and used to determine if the opening of the lesser pelvis is compatible with the size of the head of the fetus for birth?

Obstetric Conjugate

Anatomical Conjugate

Diagonal Conjugate

Transverse Diameter

The diagonal conjugate is measured and used to calculate the true Obstetric Conjugate (AP diameter of the opening of the lesser pelvis).

Explanation

The diagonal conjugate is measured and used to calculate the true Obstetric Conjugate (AP diameter of the opening of the lesser pelvis).

14. A 4-year-old male is brought to the pediatrician after biting the lateral, posterior surface of his tongue. The physician can see a lesion developing but sends the boy home without treatment. Which will be true of subsequent infection of his injury?

Will drain unilaterally to submental lymph nodes

Will drain bilaterally to submandibular lymph nodes

Will drain first to preauricular lymph nodes

Will drain eventually to jugulo-digastric lymph nodes

The lateral surface of the tongue (with exception of the tip) will drain first to submandibular lymph nodes, unilaterally. In addition, as you travel more posteriorly along the tongue, the more superior the lymph drainage. When this infection reaches deep cervical lymph nodes, it will most likely empty into jugulo-digastric (aka upper deep cervical) lymph nodes. Conversely, if the infection was more anterior on the tongue, it would most likely drain to the lower deep cervical lymph nodes or jugular-omohyoid. (A,B,C) The lateral portions of the tongue drain unilaterally to submandibular lymph nodes. Preauricular nodes will drain external ear structures, scalp and parts of the eyelid. Submental nodes drain the tip of the tongue.

Explanation

The lateral surface of the tongue (with exception of the tip) will drain first to submandibular lymph nodes, unilaterally. In addition, as you travel more posteriorly along the tongue, the more superior the lymph drainage. When this infection reaches deep cervical lymph nodes, it will most likely empty into jugulo-digastric (aka upper deep cervical) lymph nodes. Conversely, if the infection was more anterior on the tongue, it would most likely drain to the lower deep cervical lymph nodes or jugular-omohyoid. (A,B,C) The lateral portions of the tongue drain unilaterally to submandibular lymph nodes. Preauricular nodes will drain external ear structures, scalp and parts of the eyelid. Submental nodes drain the tip of the tongue.

15. During your OBGYN rotation, a patient asks you for a caudal epidural block, which nerves will NOT be blocked?

Pelvic splanchnics

Sacral splanchnics

Pudendal

S2 dorsal root

S2 ventral primary ramus

These nerves come from the sacral splanchnic ganglia, off the sympathetic trunk. The sacral splanchnic nerves contribute to the inferior hypogastric plexus and provide sympathetic innervation to the vascular smooth muscle of the pelvic viscera.

Explanation

These nerves come from the sacral splanchnic ganglia, off the sympathetic trunk. The sacral splanchnic nerves contribute to the inferior hypogastric plexus and provide sympathetic innervation to the vascular smooth muscle of the pelvic viscera.

16. A 65-year-old male patient complains of urinary problems. On physical exam, you feel an enlarged prostate, and suspect Benign Prostatic Hyperplasia, which part of his urinary urethra could be constricted?

Preprostatic

Prostatic

Intermediate

Spongy

Bulbous

Prostatic urethra travels through the prostate gland. So, if the periurethral zone of the prostate hypertrophied, the nearby prostatic urethra would be occluded.

Explanation

Prostatic urethra travels through the prostate gland. So, if the periurethral zone of the prostate hypertrophied, the nearby prostatic urethra would be occluded.

17. The Obturator Artery is normally one of the arteries seen branching off of the anterior division of the internal iliac artery and passes anteriorly and inferiorly towards the lateral wall of the pelvis to the obturator foramen and the obturator canal. An anatomical variant known as the Aberrant Obturator Artery is found branching off of which artery?

Femoral Artery

Superior Epigastric

External Iliac

Inferior Epigastric

The aberrant obturator artery is a branch of the Inferior Epigastric artery and runs over the superior pubic ramus and is susceptible to injury during surgeries for hernias. urethra.

Explanation

The aberrant obturator artery is a branch of the Inferior Epigastric artery and runs over the superior pubic ramus and is susceptible to injury during surgeries for hernias. urethra.