ANTR 510 ABPP Exam LATEST 2024 WITH 300+ EXPERT CERTIFIED QUESTIONS AND ANSWERS I ALREAD, Exams of Biology

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ANTR 510 ABPP Exam LATEST 2024 WITH 300+ EXPERT CERTIFIED QUESTIONS AND ANSWERS I ALREADY GRADED A+ Fatty layer = Camper's Fascia - CORRECT ANSWER - 1. predominantly adipose "fatty" layer 2. is sandwiched between dermis and deep‐superficial fascia 3. continuous with mammary gland 4. crosses inguinal ligament to merge with superficial fatty fascia of thigh Membranous layer = Scarpa's Fascia - CORRECT ANSWER - 1. the "membranous" layer 2. thicker and stronger than superficial fatty fascia and can hold sutures 3. in midline is fused with linea alba 4. continuous in chest as deep layer of the superficial fascia 5. foreshadowing: fuses tightly to the deep fascia of the thigh 6. foreshadowing: continuous with superficial perineal fascia of the pelvis Investing fascia - CORRECT ANSWER - Deep fascia 1. completely coats all of the skeletal muscles and their neurovascular 2. is extremely thin and delicate and difficult to separate from the muscle 3. NOTE: this is a separate layer distinct from the membranous superficial fascia but because of old age and some pathologies, they may be adherent in the gross anatomy lab donors Abdominal skeletal muscle - CORRECT ANSWER - 1. External abdominal oblique (EAO) -continuation of external intercostal muscle; most superficial layer of anterolateral wall mm. 2. Internal abdominal oblique (IAO) -continuation of internal intercostal muscle; intermediate layer of anterolateral wall muscles 3. Transversus abdominis -deepest layer of anterolateral wall muscles 4. EAO, IAO, & Transversus abdominis mm insert via aponeuroses that interweave to form rectus sheath and linea alba Transversalis fascia - CORRECT ANSWER - Top of extraperitoneal fatty layer (NOT Pinnable object) Extraperitoneal fat - CORRECT ANSWER - Males, in general, will have more of this than females 1. Layer of loose connective tissue lying between the endoabdominal fascia and the parietal peritoneum 2. Where we will find the structures that form the folds in lab (median umbilical fold, medial umbilical folds, and lateral umbilical folds) 2. Anteriorly much more prominent in males than females and much more prominent in obese males. 3. Continuous posteriorly in both male and females where it becomes abundant on the posterior wall of the abdomen to provide support and protection to (retroperitoneal structures) such as the kidneys, ureters, aorta and inferior vena cava Parietal peritoneum - CORRECT ANSWER - A serous membrane lining located deep to the extraperitoneal fat. In the anatomic position, the parietal peritoneum is deep to the extraperitoneal fat and endoabdominal fascia layers of the posterior wall . The parietal peritoneum is continuous with the visceral peritoneum of intraperitoneal abdominal organs Parietal peritoneum is richly innervated with somatic afferent neurons traveling back to the CNS in the anterior primary rami of segmental spinal nerves. irritation & pain of the parietal peritoneum is easily localizable because of these somatic afferent neurons Hemidiaphragm (Left and right) - CORRECT ANSWER - Caval foramen - CORRECT ANSWER - Esophageal hiatus - CORRECT ANSWER - Aortic hiatus - CORRECT ANSWER - External abdominal oblique - CORRECT ANSWER - most superficial layer, continuation of external intercostal muscles "hands in pockets" Unilateral (rotation of trunk) Bilateral (flexion of trunk) Insertion (linea alba and crest of ilium) Origin (costal cartilages of 512) Innervation (ventral rami of T8L1 spinal nerves) Functions (increases intraabdominal pressure, childbirth, respiration, antagonistic to diaphragm, straining, lifting, sit ups, defecation, urination, ) At right angle with IAO Internal abdominal oblique - CORRECT ANSWER - 2 layer, continuation of internal intercostal muscles -"hands on hips" -Unilateral (rotation of trunk) -Bilateral (flexion of trunk) -Insertion (linea alba and crest of ilium) -Origin (costal cartilages of 710) Innervation (ventral rami of T8L1 spinal nerves) Functions (increases intraabdominal pressure, childbirth, respiration, antagonistic to diaphragm, straining, lifting, sit ups, defecation, urination) At right angle with EAO Transversus abdominis - CORRECT ANSWER - Runs laterally -long strap‐like muscles on each side of midline that span between the rib cage and pubic symphysis; sheathed by the aponeuroses of EAO, IAO, and this to form the rectus sheath and the linea alba Insertion (pubis, linea alba, sternum, xiphoid process) -Origin (crest of ilium, inguinal ligament, thoracolumbar fascia, costal cartilage) Innervation (ventral rami of T8L1 spinal nerves) Deep inguinal ring - CORRECT ANSWER - Entrance to the inguinal canal and is located immediately above the midpoint of the inguinal ligament which is midway between the anterior superior iliac spine and pubic tubercle Transmits the spermatic cord in the male and the round ligament of the uterus in the female Inguinal canal - CORRECT ANSWER - Passage in the anterior abdominal wall that conveys the spermatic cord and round ligament of the uterus Larger and more prominent in males When abdominal contents exit through the inguinal canal the condition is known as an indirect or oblique inguinal hernia. This condition is more common in males and can cause infertility Spermatic cord - CORRECT ANSWER - Many structures form THIS, Located in the scrotum and inguinal canal Extends from deep inguinal ring to the testis Consists of a paired bundle of vessels, nerves, lymphatics, and vas deferens There are three (spermatic) fascial layers derived from the anterior abdominal wall Round ligament of the uterus - CORRECT ANSWER - Paired fibrous cords extending laterally from the body of the uterus, passes through the inguinal canal and ends in labium majus Embryonic remnant of ovarian gubernaculum which helps guide ovary into the pelvis Insignificant function in the adult Diaphragm - CORRECT ANSWER - Quadratus lumborum - CORRECT ANSWER - Unilaterally it promotes lateral flexion of the trunk and bilaterally it promotes extension of the trunk Originates at the crest of the ilium and inserts at rib 12 and l1 vertebrae (transverse processes) Innervation at the ventral rami of T12L4 spinal nerves Functions in respiration Psoas major - CORRECT ANSWER - Acts to flex the thigh, laterally rotate the thigh, and to flex the trunk Originates at the body of T12 and L15 and inserts at the lesser trochanter of the femur Has innervation of the ventral rami of L2L3 spinal nerves Unites with iliacus to form the iliopsoas muscle which is the most powerful flexor of the hip Iliacus - CORRECT ANSWER - Acts to flex the thigh Originates in the ilium (fossa) and sacrum (pelvic surface of ala) and inserts in the lesser trochanter of the femur Has femoral nerve innervation Unites with the psoas major to form the iliopsoas muscle which is the most powerful flexor of the hip Subcostal n. (T12 anterior ramus) - CORRECT ANSWER - #A Located inferior to rib 12 Contributes to ventral ramus of the T12 spinal nerve Provides motor function to the abdominal wall and general sensation of the abdominal skin and parietal peritoneum Contributes to the T12 dermatome Iliohypogastric n. - CORRECT ANSWER - #2 DON"T NEED TO DISTINGUISH -The Iliohypogastric n. and Ilioinguinal n. are sometimes bound together in the same connective tissue sheath on the posterior or posterolateral abdominal wall -Located in the abdominal wall and courses inferiorly laterally from the posterior to anterior between the layers of abdominal muscles -Contributes to the ventral ramus of the L1 spinal nerve -Contributes to motor functions of the abdominal wall and sensory functions of the lateral and anterior skin of the abdomen -Arises from the L1 ventral ramus with the ilioinguinal nerve. Ilioinguinal n. - CORRECT ANSWER - #3 -Located in the abdominal wall and course inferolaterally from posterior to anterior between layers of abdominal muscles Contributes to the ventral ramus of the L1 spinal nerve -Provides motor function to the muscles of the abdominal wall and sensory functions to the skin of the abdomen (laterally and anteriorly), the skin over the suprapubic region, and the skin over the anterior scrotum/labia majora -Sensory distribution overlaps with sensory distribution for the genital branch of the genitofemoral nerve L1 anterior ramus - CORRECT ANSWER - #B,C Iliohypogastric n. Ilioinguinal n travel anterior to the quadratus lumborum Genitofemoral n. - CORRECT ANSWER - JUST MEDIAL TO #E (On psoas major) anterior aspect of the psoas major muscle belly. -Located in the abdomen (posterior wall), false pelvis, spermatic cord, and thigh (proximal anterior and medial) -Contributes to the ventral rami of L12 spinal nerves -Contributes to motor functions of the genital branch (cremaster muscle of the male) and general sensations of the skin of the anterior scrotum and root of the penis (male) or the mons pubis and labium majus (female) [GENITAL branch]and the skin over the proximal thigh (anterior and medial) [FEMORAL branch} -Typically it divides into the genito and femoral branches -Sensoray distribution for the genital branch overlaps with the sensory distribution for the ilioinguinal nerve Lateral femoral cutaneous n. (Lat. cutaneous n. of the thigh) - CORRECT ANSWER - #D crosses the iliac fossa anterior to the iliacus muscle. Located in the posterior abdominal wall and lateral thigh Contributes to the ventral rami of the L23 spinal nerves Contributes to sensory function of the lateral thigh Enters thigh near the anterior superior iliac spine R and L Subphrenic recesses - CORRECT ANSWER - Hepatorenal recess - CORRECT ANSWER - L colic flexure or splenic flexure (I) - CORRECT ANSWER - E Tenia coli - CORRECT ANSWER - Note that there are a total of three bands of smooth muscle, although you may only be able to ID only one of them in lab (all depending on the mobility of the donor's colon) Haustra (I) - CORRECT ANSWER - TESTED ON IMAGING ONLY Parietal peritoneum - CORRECT ANSWER - Deepest layer of the anteriolateral abdominal wall Visceral peritoneum - CORRECT ANSWER - Organ covering Subphrenic recesses (R and L) - CORRECT ANSWER - anterior and superior to the liver, beneath the diaphragm falciform ligament divides it into right and left Hepatorenal recess - CORRECT ANSWER - the Pouch of Morison -a deep recess of the peritoneal cavity on the right side only between t he inferior surface of the liver and the right kidney -most frequently infected abdominal space Paracolic gutter - CORRECT ANSWER - left: groove lateral and parallel to descending colon right: groove lateral and parallel to the ascending colon Rectovesical pouch (Male only) - CORRECT ANSWER - Blind recess in the peritoneal cavity of the male between urinary bladder and rectum and represents the most inferior region of the male peritoneal cavity Vesicouterine pouch (Female only) - CORRECT ANSWER - Recess in peritoneal cavity between uterus and urinary bladder (sizes vary with position of uterus and size like with the amount of urine present in the bladder) Rectouterine pouch (of Douglas) (Female only) - CORRECT ANSWER - Blind recess in the peritoneal cavity of the female between the rectum and uterus and represents the most inferior region of the femal eperitoneal cavity, also know as the Pouch of Douglas or cul-de-sac Lesser sac or omental bursa - CORRECT ANSWER - located posterior to the stomach and liver. Epiploic foramen - CORRECT ANSWER - -Opening or "gateway" between the greater peritoneal sac and lesser peritoneal sac -contains the portal triad: common bile duct proper hepatic artery hepatic portal vein Falciform ligament - CORRECT ANSWER - Between anterior abd wall and liver and represents a double layer of peritoneum, contains round ligament of liver which is the remnant of the fetal umbilical vein), also contains small veins from anterior abd wall that empty into portal vein Gallbladder - CORRECT ANSWER - Left hepatic duct - CORRECT ANSWER - Receives bile from the left, caudate, and quadrate lobes of the liver Right hepatic duct - CORRECT ANSWER - Receives bile from right lobe of liver, right and left hepatic ducts unite just inferior to porta hepatis to form common hepatic duct Common hepatic duct - CORRECT ANSWER - Formed by union of right and left hepatic ducts from liver, joins cystic duct (from gallbladder) to form bile duct, collects and transports bile from liver Cystic duct - CORRECT ANSWER - Short duct between gallbaldder and common bile duct; joins common hepatic duct to form bile duct, transports bile, bile passes from liver to gallbladder for storage and from gallbladder to duodenum for emulsification of lipids Common bile duct - CORRECT ANSWER - Formed in lesser omentum by union of cystic and common hepatic ducts, ends near head of pancreas where it joins main pancreatic duct to form hepatopancreatic ampulla, collects and transports bile Pancreas - CORRECT ANSWER - Panreas - CORRECT ANSWER - Neck of pancreas - CORRECT ANSWER - Between head and body of pancreas Body of pancreas - CORRECT ANSWER - Between neck and tail of pancreas Head of pancreas - CORRECT ANSWER - "C" shape conforms to duodenum, contains junction of bile and main pancreatic ducts that form hepatopancreatic ampulla Main pancreatic duct - CORRECT ANSWER - Begin in tail, joins bile duct in head of pancreas to form hepatopancreatic ampulla, transmits digestic enzymes (pancreatic juice) secreted by acinar cells to duodenum via the hepatopancreatic ampulla Major duodenal papilla - CORRECT ANSWER - Small intestine - CORRECT ANSWER - Fourth part (acsending) duodenum (imaging) - CORRECT ANSWER - Between the horizontal (third) part of the duodenum and the jejunum, terminal portion of the duodenum, ascends slightly along body of pancreas Jejunum - CORRECT ANSWER - B Ileum - CORRECT ANSWER - Third (terminal) part of small intestine, 3.5 meters in length, wall contains abundant Peyer-s patches (lymphoid nodules), serves final stages of nutrient absorption and protection against microorganisms Ileocecal junction - CORRECT ANSWER - Junction between ileum (small intestine) and cecum (large intestine), contains smooth muscle valve (ileocecal) that controls entry of material into large intestine Cecum - CORRECT ANSWER - In right inguinal region, portion of the large intestines on the right side, pouch ("blind-ended" sac) inferior to the ileocecal junction and approximately 6 cm in length, continous with vermiform appendix (inferior) and ascending colon (superior), functions to absorb electrolytes and water McBurney's point - CORRECT ANSWER - #1 Retrocecal recess - CORRECT ANSWER - The space directly posterior to cecum Small intestine - CORRECT ANSWER - Located in all abd quadrants, coiled, thin- walled muscular tube appoximately 6-7 meters long, has three parts the duodenum, jejunum, and ileum, continuous with pylorus of stomach and cecum of large intestine Small intestine (imaging) - CORRECT ANSWER - First part (superior) duodenum - CORRECT ANSWER - The part of the duodenum between the pylorus of the stomach and descending (second) part of the duodenum; ascends slightly toward the right First part (superior) duodenum (imaging) - CORRECT ANSWER - The part of the duodenum between the pylorus of the stomach and descending (second) part of the duodenum; ascends slightly toward the right Second part (descending) duodenum - CORRECT ANSWER - Between the superior (first) and horizontal (third) parts of the duodenum, passed vertically along head of pancreas, receives bile and pancreatic secretions Second part (descending) duodenum (imaging) - CORRECT ANSWER - Between the superior (first) and horizontal (third) parts of the duodenum, passed vertically along head of pancreas, receives bile and pancreatic secretions Third part (inferior, horizontal) duodenum - CORRECT ANSWER - Between descending (second) and ascending (fourth) parts of duodenum, passes toward left along head of pancreas Third part (inferior, horizontal) duodenum (imaging) - CORRECT ANSWER - Between descending (second) and ascending (fourth) parts of duodenum, passes toward left along head of pancreas Fourth part (ascending) duodenum (imaging) - CORRECT ANSWER - Between the horizontal (third) part of the duodenum and the jejunum, terminal portion of the duodenum, ascends slightly along body of pancreas Duodenum - CORRECT ANSWER - Ileum - CORRECT ANSWER - Third (terminal) part of small intestine, 3.5 meters in length, wall contains abundant Peyers patches (lymphoid nodules), serves final stages of nutrient absorption and protection against microorganisms retrocecal recess - CORRECT ANSWER - One of several small pockets sometimes found extending alongside the right margin of the ascending colon near the cecum. The appendix frequently can be found in this area (64% of the time). Appendix - CORRECT ANSWER - RLQ, attached to cecum and contains collection of lymph nodes, 2-20 cm in length, functions to defend against infection. Blockage of lumen leads to appendicitis. Right colic flexure (hepatic flexure) - CORRECT ANSWER - RUQ, junction of ascending and transverse colon Left colic flexure (splenic flexure) - CORRECT ANSWER - RUQ, junction of ascending and transverse colon Transverse colon - CORRECT ANSWER - Between ascending colon at the right colic flexure (proximal) and descending colon at left colic flexure (distal); part of large intestine, variable in length, usually 50 cm in length, passes horizontally across abdominal cavity, suspended from posterior abdominal wall by transverse mesocolon, most mobile part of large intestine Descending colon - CORRECT ANSWER - Left side of abdomen, between transverse colon (superior) and sigmoid colon (inferior), portion of large intestine on left side, approximately 25 cm in length Sigmoid colon - CORRECT ANSWER - Located in pelvis, begins in left iliac fossa and ends at S3 vertebra (sacrum), part of large intestine, characteristic "S" shape, continuous with descending colon (superior) and rectum (inferior) Rectum - CORRECT ANSWER - In pelvis, begins at S3 vertebra (sacrum), ends at pelvic floor, part of large intestine, between sigmoid colon and anal canal, approximately 15 cm in length, lacks haustra, stores poo Haustra - CORRECT ANSWER - Large intestine, sacculations (small sacs) of wall of colon between taeniae coli, most obvious on ascending and transverse colon, absent on cecum and rectum *Will only be tested on with imaging* Abdominal aorta - CORRECT ANSWER - Origin: thoracic aorta Course: Parallels vertebral column, slightly left of midline, divides into common iliac arteries on body of L4 vertebra Course: Within transverse mesocolon, divides into right and left branches Distribution: Transverse colon Anastomosis with right colic artery (from superior mesenteric) and left colic artery (from inferior mesenteric) Marginal artery (of Drummond) - CORRECT ANSWER - Inferior mesenteric artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Descends long anterior surface of abdominal aorta Unpaired branch of abdominal aorta Left colic artery - CORRECT ANSWER - Origin: Inferior mesenteric Course: Descends to left on posterior abd wall, divides into ascending and descending branches Distribution: Descending and left part of transverse colon Anastomosis with middle colic (from superior mesenteric) and sigmoid arteries (from inferior mesenteric) Sigmoid artery - CORRECT ANSWER - Origin: Inferior mesenteric Course: Descends in sigmoid mesocolon toward sigmoid colon Distribution: Descending colon (lower part) and sigmoid colon Branches: Three to five Anastomosis with left colic and superior rectal arteries Superior rectal artery - CORRECT ANSWER - Origin: Inferior mesenteric Course: Single vessel that is direct continuation of inferior mesenteric, crosses pelvic inlet (pelvic brim) anterior to left common iliac vessels, descends into true pelvis to rectum Distribution: Rectum Largest of three rectal arteries (superior, middle, inferior), forms anastomosis with middle and inferior rectal arteries Right renal artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Passes laterally to enter kidney Right renal artery is usually longer than left renal artery Right renal artery (imaging) - CORRECT ANSWER - Origin: Abdominal aorta Course: Passes laterally to enter kidney Right renal artery is usually longer than left renal artery Left renal artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Passes laterally to enter kidney Left renal artery shorter than right renal artery Left renal artery (imaging) - CORRECT ANSWER - Origin: Abdominal aorta Course: Passes laterally to enter kidney Left renal artery shorter than right renal artery Right and Left lumbar segmental artery - CORRECT ANSWER - artery on lumbars Right and left common iliac artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Begin anteriorly to L4 vertebral body, passes obliquely across L4-L5 vertebral bodies, ends at the level of the sacro-iliac joint (L5-S1) Branches: Internal iliac and external iliac Left common iliac atherosclerotic plaque (imaging) - CORRECT ANSWER - Right and left common iliac artery (imaging) - CORRECT ANSWER - Right and left external iliac artery - CORRECT ANSWER - Origin: Common iliac Course: Descends laterally along medial boarder of psoas muscle from level of sacro-iliac joint to inguinal ligament Distribution: Inferior abd wall and lower limb At origin usually crossed by ureter and gonadal vessels, formed by bifurcation of common iliac Right and left external iliac artery (imaging) - CORRECT ANSWER - Origin: Common iliac Course: Descends laterally along medial boarder of psoas muscle from level of sacro-iliac joint to inguinal ligament Distribution: Inferior abd wall and lower limb At origin usually crossed by ureter and gonadal vessels, formed by bifurcation of common iliac Right and left internal iliac artery - CORRECT ANSWER - Origin: Common iliac Course: Begins at the level of the sacro-iliac joint (L5-S1), descends into pelvis and passes posteriorly toward superior margin of greater sciatic notch (ilium) Divides into anterior and posterior divisions, branching has considerable variation Right and left internal iliac artery (imaging) - CORRECT ANSWER - Origin: Common iliac Course: Begins at the level of the sacro-iliac joint (L5-S1), descends into pelvis and passes posteriorly toward superior margin of greater sciatic notch (ilium) Divides into anterior and posterior divisions, branching has considerable variation Right and left gonadal artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Descends on posterior abd wall, Male (testicular artery): enters inguinal canal to join contents of spermatic cord; Female (ovarian artery): in pelvis enter suspensory ligaments of ovary Distribution: Ureter, male (testis and spermatic cord), female (ovary and uterine tube) Ovarian artery - CORRECT ANSWER - Travels within suspensory ligament (from the sky) Testicular artery/testicular vein - CORRECT ANSWER - Branches from the abdominal aorta. Enters deep inguinal ring with spermatic cord Hepatic portal v. (I) - CORRECT ANSWER - Superior mesenteric v. - CORRECT ANSWER - Splenic v. - CORRECT ANSWER - Inferior mesenteric v. - CORRECT ANSWER - Superior rectal v. - CORRECT ANSWER - bifurcates at the end of the inferior mesenteric vein Inferior vena cava - CORRECT ANSWER - Inferior vena cava (imaging) - CORRECT ANSWER - Hepatic vein - CORRECT ANSWER - Drainage: Liver Course: Multiple vessels exit liver Terminates: IVC Right and left external iliac vein - CORRECT ANSWER - Drainage: Lower limb, anterior abd wall (inferior) Course: Begins at inguinal ligament, courses along pelvic brim Termination: Over sacro-ilic joint joints internal iliac to form common iliac Near termination, usually crossed by ureter and gonadal vessels Right and left internal iliac vein - CORRECT ANSWER - Drainage: Pelvis, perineum, gluteal region, posterior abd wall Course: Ascends along lateral pelvis, ends at the level of sacro-iliac joint (L5-S1) Termination: Common iliac Right and left common iliac vein - CORRECT ANSWER - Drainage: Pelvis, perineum, lower limb Course: Begins t the level of the sacro-iliac joint (L5-S1), passes obliquely across L4- L5 vertebrl bodies, ends anterior to L4 vertebral body Terminates: IVC Right and left gonadal vein - CORRECT ANSWER - Drainage: Uretral (both sexes) Male: testes and spermatic cord Female: ovary and uterine tube Course: Male (testicular vein): from pampinform venous plexus in scrotum, passes in spermatic cord through inguinal canal and then ascends on posterior abd wall Femle (ovarian vein): leaves pelvis in suspensory ligament of ovary then and ascends on posterior abd wall Termination: Right: inferior vena cava Left: Left renal vein Right and left renal veins - CORRECT ANSWER - Left renal vein is longer than right renal vein Pre-aortic plexus/ganglia (as a group) - CORRECT ANSWER - Celiac plexus, superior mesenteric plexus, inferior mesenteric plexus, superior hypogastric plexus Superior hypogastric plexus - CORRECT ANSWER - #8 Sacrospinous ligament - CORRECT ANSWER - Located in pelvis between dorsal sacrum and *ischial spine*, cord-like ligament, contributes to border of greater and lesser sciatic foramina Sacrotuberous ligament - CORRECT ANSWER - Situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends, runs from the sacrum to the *tuberosity of the ischium* Anterior sacroiliac ligament - CORRECT ANSWER - Consists of numerous thin bands, which connect the anterior surface of the lateral part of the sacrum to the margin of the auricular surface of the ilium and to the preauricular sulcus. Posterior sacroiliac ligament - CORRECT ANSWER - Situated in a deep depression between the sacrum and ilium behind; it is strong and forms the chief bond of union between the bones. Greater sciatic foramen - CORRECT ANSWER - An opening (foramen) at the back of the human pelvis. It is formed by the sacrotuberous and sacrospinous ligaments. The piriformis muscle passes through the foramen and occupies most of its volume. The greater sciatic foramen is wider in women than in men. Greater sciatic notch - CORRECT ANSWER - The foramen contains:[2] 7 nerves: Sciatic Nerve: Superior Gluteal Nerve: Inferior Gluteal Nerve: Pudendal Nerve: Posterior Femoral Cutaneous Nerve Nerve to Quadratus Femoris Nerve to Obturator Internus 3 Vessel Sets: Superior Gluteal Artery & Vein Inferior Gluteal Artery & vein Internal Pudendal Artery & vein 1 Muscle: Piriformis Lesser sciatic Notch - CORRECT ANSWER - Opening (foramen) between the pelvis and the back of the thigh. The foramen is formed by the sacrotuberous ligament which runs between the sacrum and the ischial tuberosity and the sacrospinous ligament which runs between the sacrum and the ischial spine. The lesser sciatic foramen has the following boundaries: Anterior: the tuberosity of the ischium Superior: the spine of the ischium and sacrospinous ligament Posterior: the sacrotuberous ligament The following pass through the foramen: the tendon of the Obturator internus internal pudendal vessels pudendal nerve nerve to the obturator internus Obstetrical conjugate diameter - CORRECT ANSWER - This is measured from the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero-posterior diameter., is the shortest diameter through which the fetal head must pass in its course through the inlet. Usually 11 cm or more Diagonal conjugate diameter - CORRECT ANSWER - Is the shortest distance between the lower margin of the pubic symphysis and the sacral promontory is measured per vaginal exam. usually 11.5 cm Bispinous diameter - CORRECT ANSWER - Between the tips of ischial spines, approximately 10.5 cm Piriformis muscle - CORRECT ANSWER - Origin: Anterior aspect of sacrum Insertion: Greater trochanter of femur Action: Lateral rotation of the thigh Exits pelvis through greater sciatic foramen Obturator internus muscle - CORRECT ANSWER - Origin: Pubis, ischium, obturator membrane (pelvic surface) Insertion: Greater trochanter of femur *lab manual says trochanteric fossa* Action: Lateral rotation of thigh Tendon exits pelvis through lesser sciatic foramen Obturator internus muscle - CORRECT ANSWER - Origin: Pubis, ischium, obturator membrane (pelvic surface) Insertion: Greater trochanter of femur *lab manual says trochanteric fossa* Action: Lateral rotation of thigh Tendon exits pelvis through lesser sciatic foramen Tendinous arch of the pelvic diaphragm - CORRECT ANSWER - At the level of a line extending from the lower part of the pubic symphysis to the spine of the ischium is a thickened whitish band in this upper layer of the diaphragmatic part of the pelvic fascia. It is termed the tendinous arch or white line of the pelvic fascia, and marks the line of attachment of the special fascia (pars endopelvina fasciæ pelvis) which is associated with the pelvic viscera. It joins the fascia of the pubocervical fascia that covers the anterior wall of the vagina. If this fascia falls, the ipsilateral side of the vagina falls, carrying with it the bladder and the urethra, and thus contributing to urinary incontinence *Pictured is the tendinous arch of the levator ani muscle which helps control Pelvic diaphragm - CORRECT ANSWER - Contributes to pelvic floor, supports pelvic viscera, Oringin: ischiococcygeus ischium spine, levator ani: tendinous arch (thickenened fascia of obturator internus), pubis (body), and ischium (spine) Insertion: ischiococcygeus: coccyx and inferior sacrum, levator ani: coccyx, anoccygeal ligament, perineal body and midline viscera (prostate or vagina, rectum, and anal canal) Pubic symphysis - CORRECT ANSWER - Joint formed by two pubic bones and intervening fibrocartilage disc, in the female the fibrocartilage softens in late pregnancy to allow slight separation of public bones Ischiopubic ramus - CORRECT ANSWER - This is a compound structure consisting of the following two structures: from the pubis, the inferior pubic ramus from the ischium, the inferior ramus of the ischium, It serves as part of the origin for the Obturator internus muscle. It also marks a vertex of the anal triangle and the urogenital triangle. Ischial tuberosity - CORRECT ANSWER - On ischium, roughened elevation, provides attachment for sacrotuberous ligament, hamstring, adductor magnus, and quadratus femoris muscles Pelvic diaphragm - CORRECT ANSWER - b/w true pelvic and peritoneum Ischial spine - CORRECT ANSWER - From the posterior border of the body of the Ischium there extends backward a thin and pointed triangular eminence, the ischial spine, more or less elongated in different subjects. Obturator foramen - CORRECT ANSWER - Large opening created by the ischium and pubis bones of the pelvis through which nerves and blood vessels pass (obturator artery, obturator vein and obturator nerve pass out of the pelvis) Obturator foramen (imaging) - CORRECT ANSWER - Large opening created by the ischium and pubis bones of the pelvis through which nerves and blood vessels pass (obturator artery, obturator vein and obturator nerve pass out of the pelvis) Sacrum - CORRECT ANSWER - Five fused vertebra between L5 and Co1 Sacral hiatus - CORRECT ANSWER - Arched opening that communicates with sacral canal, functions to transmit filum terminale, formed by failure of fusion of laminae of S5 vertebra Inferior lateral angle or ILA - CORRECT ANSWER - This is located at the level of the transverse process of S5. Sacroiliac joint - CORRECT ANSWER - Synovial joint between sacrum and ilium Sacral promontory - CORRECT ANSWER - Anterior sacrum, prominent projecting edge of base of sacrum formed by superior border of S1 vertebral body, forms posterior part of pelvic brim at midline, landmark in establishing female pelvic dimensions Iliac crest - CORRECT ANSWER - The highest point on the iliac crest is used to define the supracristal line Anterior superior iliac spine or ASIS - CORRECT ANSWER - Anterior end of iliac crest, small rounded bony projection, provides attachment for lateral end of inguinal ligament, Sartorius, and tensor fasciae latea muscles (processus vaginalis), potential space between parietal and visceral layers of tunica vaginalis testis is common site for fluid accumulation or hydrocele* Right and left ductus deferens or Vas deferens - CORRECT ANSWER - Location: Scrotum, inguinal canal, pelvis Muscular tube between epididymis and ejaculatory duct, transports sperm and fluid from epididymis during emission R/L ductus deferens (Vas deferens) - CORRECT ANSWER - Location: Scrotum, inguinal canal, pelvis Muscular tube between epididymis and ejaculatory duct, transports sperm and fluid from epididymis during emission Right and left pampiniform venous plexus - CORRECT ANSWER - Drainage: Testis, epididymis, vas deferens Course: Network of veins that ascends within spermatic cord Termination: Testicular veins *Right testicular vein drains into IVC, left testicular vein drains into left renal vein* Latin: Pampinus=tendril Testicular artery - CORRECT ANSWER - Origin: Abdominal aorta Course: Descends on posterior abdominal wall, passes through inguinal canal and enters scrotum within spermatic cord Testicular artery (at origin of aorta) - CORRECT ANSWER - The term gonadal artery is a generic term for a paired artery, with one arising from the abdominal aorta for each gonad. Specifically, it can refer to: the testicular artery in males; the ovarian artery in females. Because the testis is found in a different location than that of its female equivalent, it has a different course than the ovarian artery. They are two slender vessels of considerable length, and arise from the front of the aorta a little below the renal arteries. Each passes obliquely downward and lateralward behind the peritoneum, resting on the Psoas major, the right lying in front of the inferior vena cava and behind the middle colic and ileocolic arteries and the terminal part of the ileum, the left behind the left colic and sigmoid arteries and the iliac colon. Each crosses obliquely over the ureter and the lower part of the external iliac artery to reach the abdominal inguinal ring, through which it passes, and accompanies the other constituents of the spermatic cord along the inguinal canal to the scrotum, where it becomes tortuous, and divides into several branches. Right and left testicular veins - CORRECT ANSWER - Rectovesical pouch - CORRECT ANSWER - Blind recess in peritoneal cavity of the male between the bladder and rectum and represents the most inferior region of male peritoneal cavity Prostate gland - CORRECT ANSWER - Posterior to pubic symphysis, glandular and muscular regions, contains prostatic urethra, ejaculatory ducts, and 15-20 prostatic ducts, dense outer capsule, accessory reproductive gland, contributes 30% of semen volume, secretes thin milky and slightly acidic fluid that contains citric acid, seminal plasmin, PSA Prostatic urethra - CORRECT ANSWER - Passes through prostate between preprostatic and membranous urethra, receives two ejaculatory ducts and 15-20 prostatic ducts, transmits urine, semen formed here by combining secretions from epididymides, seminal vesicles, and prostate Seminal vesicles or glands - CORRECT ANSWER - In pelvis between bladder and rectum, paired, contorted muscular tube, duct connects to vas deferens, accessory to reproductive gland, contributes 60% of semen volume, secretes thick alkaline fluid that contains fructose and prostaglandins, duct of seminal vesicle and vas deferens unite to form ejaculatory duct Corpus spongiosum - CORRECT ANSWER - Body of penis, single erectile body on ventral aspect, continuation of bulb of penis, contains spongy urethra, surrounded by tunica albuginea (thick, fibrous coat), contains less erectile tissue than corpora cavenerosa Glans of the penis - CORRECT ANSWER - Expanded distal tip of corpus spongiosum, erectile tissue, contains terminal part of spongy urethra and external urethral orifice, contains dense network of sensory nerve endings, usually hooded by prepuce if male is uncircumcised Bulb of penis - CORRECT ANSWER - Midline erectile tissue, attached to perineal membrane, contains spongy urethra, covered by bulbospongiosus muscle, enters body of penis to become corpus spongiosum Bulb of penis - CORRECT ANSWER - Midline erectile tissue, attached to perineal membrane, contains spongy urethra, covered by bulbospongiosus muscle, enters body of penis to become corpus spongiosum Corpora cavernosa (right and left crus) - CORRECT ANSWER - Paired, proximally the crura (vascular erectile tissue) directly contact the inferior pubic ramus each is covered by the thin ischiocavernus skeletal muscle Ischiocavernosus muscle - CORRECT ANSWER - Skeletal muscle that is very thin and covers crura and compresses the erectile tissue of the crus of the penis, helps maintain erection Origin: Ischium Insertion: Fasicia of crus of penis Innervation: Pudendal nerve Bulbospongiosus muscle - CORRECT ANSWER - Skeletal muscle that is very thin and covers the bulb of the penis, compresses erectile tissue of bulb of penis and compresses spongy urethra (helps expel urine) Origin: Perineal body, median raphe on bulb of penis Insertion: Fascia of bulb of penis and corpus spongiosum Innervation: Pudendal nerve Spongy urethra or penile urethra - CORRECT ANSWER - Longest part of male urethra (approximately 15 cm in length), within bulb and corpus spongiosum of penis, ends at external urethral orifice - skin (continuous with scrotum and scrotal septum) - external spermatic fascia - cremaster m. - cremasteric fascia - internal spermatic fascia - vestige of processus vaginalis - CORRECT ANSWER - LIst the layers in order from superficial to deep of the spermatic cord "SEVEN UP" Seminiferous tubules Epididymis Vas deferens Ejaculatory duct (Nothing) Urethra Penis - CORRECT ANSWER - SEVEN UP (Path of sperm) Vesicouterine pouch - CORRECT ANSWER - Between uterus and urinary bladder (in females only) Rectouterine pouch (of Douglas) - CORRECT ANSWER - Blind recess in peritoneal cavity of the female located between the rectum and the uterus, closely related to the vagina (posterior fornix) Also known as cul-de-sac Most inferior region of the female peritoneal cavity Size varies with volume in the rectum and with the positioning of the uterus Fundus of the uterus - CORRECT ANSWER - Dome-shaped, muscular portion of the uterus superior to the entry of the uterine tubes, contracts to expel fetus and placenta during parturition Fundus of the uterus (imaging) - CORRECT ANSWER - Dome-shaped, muscular portion of the uterus superior to the entry of the uterine tubes, contracts to expel fetus and placenta during parturition Body of uterus - CORRECT ANSWER - Pear-shaped, muscular portion of uterus, has narrow cavity lined by endometrium, contacts urinary bladder (anterior) and intestine (posterior), continues with cervix inferiorly, functions to conduct sperm and implantation site for blastocyst *The normal position of the uterus is anteflexed and anteverted Body of uterus (imaging) - CORRECT ANSWER - Pear-shaped, muscular portion of uterus, has narrow cavity lined by endometrium, contacts urinary bladder (anterior) and intestine (posterior), continues with cervix inferiorly, functions to conduct sperm and implantation site for blastocyst of clitoris, contains sebaceous glands that lubricate vestibule, helps direct stream of urine, *vestibule is the region between labia minor* *Embryological homologue of the ventral side of the penis* Clitoris - CORRECT ANSWER - Perineum (urogenital triangle), erectile tissue, has paired crura and body with glans (distal expansion), prepuce covers glans clitoris, organ for female sexual response Vestibular bulbs - CORRECT ANSWER - Perineum (urogenital triangle), paired erectile bodies, covered by bulbospongiosus muscle, functions to engorge with blood during sexual response Urogenital triangle - CORRECT ANSWER - this is the area bound by a triangle with one vertex at the pubic symphysis and the two other vertices at the ischial tuberosities of the pelvic bone. Internal iliac artery - CORRECT ANSWER - Origin: Common iliac, begins at the level of the sacro-iliac joint (L5-S1), descends into pelvis and passes posteriorly toward superior margin og greater sciatic notch (ilium), commonly divides into anterior and posterior divisions, branching has considerable variation Internal iliac artery (imaging) - CORRECT ANSWER - Origin: Common iliac, begins at the level of the sacro-iliac joint (L5-S1), descends into pelvis and passes posteriorly toward superior margin of greater sciatic notch (ilium), commonly divides into anterior and posterior divisions, branching has considerable variation Superior gluteal artery - CORRECT ANSWER - Origin: Internal iliac Course: Passes between lumbosacral trunk and S1 ventral ramus, exits pelvis through greater sciatic foramen, superior to piriformis muscle, largest branch of internal iliac artery, anastomosis with inferior gluteal and branches of femoral artery Inferior gluteal artery - CORRECT ANSWER - Origin: Internal iliac Course: Descends anterior to piriformis muscle, passes posterior to coccygeus muscle and enters gluteal region through greater sciatic foramen Often arises from common trunk with internal pudendal artery, anastomosis with superior gluteal and branches of femoral artery Internal pudendal artery - CORRECT ANSWER - Origin: Internal iliac Course: Exits pelvis via greater sciatic foramen, exits gluteal region via lesser sciatic foramen, lies in lateral wall of ischio-anal fossa, courses anteriorly to external genitalia Obturator artery - CORRECT ANSWER - Origin: Internal iliac Course: Passes along lateral pelvic wall to superior part of obturator foramen, passes through obturator canal to reach medial thigh Distribution: Muscles and skin of medial thigh, head and neck of femur Umbilical artery - CORRECT ANSWER - Origin: Internal iliac Course: Passes onto anterior abdominal wall, ascends to umbilicus Distribution: Superior vesicle Only portion in pelvis is patent, portion on anterior abdominal wall becomes fibrous cord; carries blood between placenta and fetus Superior vesical branches - CORRECT ANSWER - Origin: Umbilical Course: Passes medially to reach superior surface of urinary bladder Distribution: Urinary bladder Uterine artery - CORRECT ANSWER - Origin: Internal iliac (anterior division) Course: Passes medial to reach uterus at junction of uterine body and cervix, reflects along side of uterus Distribution: Uterus and vagina Branches: Vaginal Commonly a branch of umbilical artery, forms anastomosis with ovarian and vaginal arteries Inferior rectal artery - CORRECT ANSWER - Origin: Internal pudendal Course: Crosses medially through adipose tissue of ischio-anal fossa Distribution: Anal canal (muscle and lining), perianal skin Anastomosis with middle and superior rectal arteries and with contralateral inferior rectal artery Lumbosacral trunk - CORRECT ANSWER - S1-S4 Ventral rami Location: Ventral sacral foramina, enters pelvis to form sacral plexes Contains motor and sensory components, distributes to skin and muscle of perineum, gluteal region, thigh, leg, and foot, each ventral ramus receives a gray ramus communicans from sympathetic trunk Obturator nerve - CORRECT ANSWER - Location: Posterior abd wall, lateral pelvic wall, medial thigh Contributions: Ventral rami of L2-S4 spinal nerves Motor: Muscles of medial thigh (adducter group) Enters thigh via obturator canal of hip bone Obturator nerve - CORRECT ANSWER - Location: Posterior abd wall, lateral pelvic wall, medial thigh Contributions: Ventral rami of L2-S4 spinal nerves Motor: Muscles of medial thigh (adducter group) Enters thigh via obturator canal of hip bone Sacral plexus - CORRECT ANSWER - Contribution: Ventral rami of S2-S4 spinal nerves S1 anterior ramus - CORRECT ANSWER - Location: Posterior wall of pelvis Contribution: Ventral ramus of S1 spinal nerve Joins sacral plexus, contributes to both sciatic and gluteal nerves S2 anterior ramus - CORRECT ANSWER - 2nd below lumbosacral trunk S3 anterior ramus - CORRECT ANSWER - 3rd below lumbosacral trunk Pudendal nerve - CORRECT ANSWER - Location: Pelvis, gluteal region, perineum Contribution: Ventral rami of S2-S4 spinal nerves Exits pelvis through greater sciatic foramen, commonly anesthetized in preparation for childbirth (pudendal nerve block) Inferior rectal nerve - CORRECT ANSWER - Location: Ischio-anal fossa Contributions: Ventral rami of S2-S4 spinal nerves Motor: External anal sphincter Inferior rectal nerve (branch of pudendal nerve) crosses ischio-anal fossa from lateral to medial, lining of anal canal inferior to pectinate line, innervated by inferior rectal nerve and is sensitive to somatic pain, touch, and temperature, lining of anal canal superior to pectinate line receives autonomic innervation and is sensitive to distension (stretching) and visceral pain Pre-aortic plexuses - CORRECT ANSWER - Right and left inferior hypogastric nerves - CORRECT ANSWER - Most lower part plexus Right and left hypogastric plexesus - CORRECT ANSWER - Complex meshwork of postganglionic sympathetic axons (from the aortic plexus and lumbar region of the sympathetic trunk) and preganglionic parasympathetic axons from the pelvic splanchic nerve, axons innervate viscera within the pelvic cavity Right and left sympathetic trunks or chains - CORRECT ANSWER - Rami communicans - CORRECT ANSWER - #2 Right and left splanchnic nerve - CORRECT ANSWER -