Block 7 Repro Perineum & Pelvis MCQ's

The levator ani muscle is the most important muscle in creating the pelvic diaphragm. It is a broad, thin muscle that forms the majority of the pelvic floor. It supports the pelvic organs and plays a crucial role in maintaining continence and providing stability to the pelvis. The levator ani muscle helps to control the opening and closing of the urethra, vagina, and anus. It also assists in the process of childbirth by aiding in the relaxation and stretching of the pelvic floor muscles.

The "usual" position of the uterus and vagina in a female is anteverted and anteflexed. Anteverted means that the uterus is tilted forward towards the bladder, while anteflexed means that the uterus is bent forward at the cervix. This position is considered normal and common in most females.

The obstetrician should use the ischial spine as the bony landmark to locate the pudendal nerve. This is because the pudendal nerve passes posterior to the ischial spine and can be blocked effectively at this location to provide local anesthesia to the perineum during the third stage of labor.

Erection, which refers to the process of achieving and maintaining a firm penis, is primarily controlled by parasympathetic nervous innervation. The parasympathetic nervous system is responsible for promoting relaxation and increased blood flow to the penis, leading to an erection. On the other hand, ejaculation and remission, which involve the release of semen and the return of the penis to its flaccid state, are primarily controlled by sympathetic nervous innervation. The sympathetic nervous system triggers the contraction of muscles involved in ejaculation and the constriction of blood vessels, causing the penis to become flaccid again.

The rectouterine pouch, also known as the pouch of Douglas, is the deepest part of the peritoneal cavity in females. It is located between the rectum and the uterus. In this case, the patient has peritonitis with a perforated rectum, which means that bacteria and inflammatory fluid from the perforation can accumulate in the rectouterine pouch, leading to an abscess. This is the most likely location for the abscess to accumulate based on the given information.

During a radical hysterectomy procedure, the surgeon must expose the broad ligament to ligate the uterine arteries. The uterine arteries travel within the transverse cervical ligament. The uterers, which are tubes that carry urine from the kidneys to the bladder, are located in close proximity to the broad ligament and transverse cervical ligament. Therefore, they are most likely to be injured during this procedure if proper care is not taken.

The suspicion is that there is a fistula between the vagina and anal canal due to a tear in the perineum during childbirth. This is supported by the fact that the woman has brownish vaginal flow with a bad odor, which could indicate the presence of fecal matter in the vaginal discharge. Additionally, the woman also experiences pain during defecation, which further suggests a connection between the vagina and anal canal.

During childbirth, the perineal body, which is the area between the anus and the vestibule of the vagina, is at risk of tearing. To prevent uncontrolled tearing, an episiotomy may be performed intentionally in this area. An episiotomy is a surgical cut made to enlarge the vaginal opening and prevent severe tearing during delivery. Therefore, the correct answer is "Anus and vestibule of vagina."

When the patient is in a supine position, any excess fluid resulting from endometriosis is likely to accumulate in the rectouterine pouch. The rectouterine pouch, also known as the pouch of Douglas, is the deepest point in the peritoneal cavity in females. It is located between the rectum and the uterus, making it a potential space for fluid accumulation. This anatomical knowledge helps in understanding the potential complications and symptoms associated with endometriosis.

The perineal nerve is a branch of the pudendal nerve. It innervates the perineum, which is the area between the anus and the external genitalia. It provides sensory innervation to the skin and mucous membranes in this region, as well as motor innervation to the muscles involved in urination and sexual function.

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The superior rectal vein drains into the portal system of veins. The portal system carries blood from the digestive organs to the liver for processing before it is returned to the heart. Since the rectum and anal canal are part of the digestive system, the blood from these areas is also drained into the portal system. The other veins listed in the options do not drain into the portal system.

Based on the symptoms described, the most likely injured structure is the penile (spongy) urethra. The swelling around the penis and scrotum suggests trauma to the area, which could result in damage to the penile urethra. The other options, such as the prostatic, intermediate, and pre-prostatic urethra, are not typically associated with swelling in this context.

The cardinal ligament must be weakened or compromised in this case. The cardinal ligament provides significant support for the uterus and cervix, so if it is weakened or compromised, it can lead to the appearance of the cervix at the vulva, also known as procidontia.

Based on the symptoms described, including severe stabbing pain in the right lower abdomen, vaginal bleeding, intermittent pain in the right shoulder, missed period, fainting, dizziness, and low blood pressure, the most likely diagnosis would be rupture of the fallopian tube. This is a medical emergency known as ectopic pregnancy, where a fertilized egg implants outside of the uterus, usually in the fallopian tube. The symptoms are indicative of internal bleeding and the need for immediate medical attention.

The genitofemoral nerve can be used to check for reflex and integrity of the spinal cord at L2. This nerve arises from the lumbar plexus and provides sensory innervation to the upper anterior thigh and motor innervation to the cremaster muscle in males. By testing the reflex and integrity of the genitofemoral nerve, healthcare professionals can assess the functioning of the L2 spinal cord segment.

The perineum is the area between the scrotum and anus in males. The spongy urethra is located within the penis and can be injured in cases of trauma. When the spongy urethra is ruptured, urine can leak into the surrounding tissues. Camper's fascia is a superficial layer of fatty tissue, while Colle's fascia is a deeper layer of connective tissue in the perineum. Therefore, urine leaking from the ruptured spongy urethra is most likely to collect between Camper's and Colle's fascia.

the "PIN" go out through the greater and re-enter through lesser
P-udendal nerve
I-nternal pudendal vessels
N-erves to obturator internus
(slide 4 pelvis perine-Barrenk)
(also mentioned at 8:45 in media site jan 2012)

The internal iliac nodes would be the first lymph nodes to be infiltrated with cancer cells in case of prostate cancer. This is because the prostate gland drains into the internal iliac nodes, which are located in the pelvis. These nodes are responsible for filtering and draining lymphatic fluid from the pelvic organs, including the prostate gland. Therefore, if cancer cells are present in the prostate, they are likely to spread to the internal iliac nodes first.

The diagonal conjugate is a measurement used in obstetrics to estimate the size of the pelvic inlet. It is measured between the sacral promontory, which is a bony prominence at the base of the spine, and the inferior edge of the pubic symphysis, which is the joint where the two halves of the pelvis meet in the front. This measurement helps determine if the pelvis is large enough for a baby to pass through during childbirth.

The anterior recess of the ischioanal fossa is continuous with the deep perineal space. This space is located above the pelvic diaphragm and contains various structures such as the urethra, vagina, and deep transverse perineal muscles. It is important for understanding the anatomy and function of the perineal region.

The combination of pudendal and ilioinguinal nerve blocks would be the most suitable type of anesthesia for this patient. These nerve blocks would completely anesthetize the external genitalia, providing pain relief during the delivery process. This would allow the patient to have a normal vaginal delivery and witness the birth of her child, as she desires. General anesthesia would not be necessary in this case, as the patient is suitable for vaginal delivery. Epidural block may provide pain relief, but it may not completely anesthetize the external genitalia. Pudendal nerve block alone may not be sufficient to fully anesthetize the area, but when combined with ilioinguinal nerve block, it would provide the desired effect.

The correct answer is External spermatic fascia & buck's fascia. These two types of fascia can be found in the deep layer of fascia in the pelvis and perineum. The external spermatic fascia is a continuation of the external oblique fascia, while buck's fascia is a continuation of the deep fascia of the abdomen. Both fascia play a role in supporting and protecting structures in the pelvis and perineum.

The torn sacrospinous ligament is located in the pelvic region. The coccygeus muscle is also located in the pelvic region and is in close proximity to the sacrospinous ligament. Therefore, it is likely that if the sacrospinous ligament is torn, the coccygeus muscle may also be affected. Additionally, the pudendal nerve passes through the pelvic region and is in close proximity to both the sacrospinous ligament and the coccygeus muscle. Therefore, there is a possibility that the pudendal nerve may also be compromised in this injury.

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