GM1002 Practicals 9-13

While inserting a catheter through the penile urethra, you have to take great care where there are bends (sudden changes in direction). Describe the position of any bends of the penis?

2 Bends: (i) Where the urethra passes from root into body/shaft of the penis, (ii) in the bulb of the penis

Define a bronchopulmonary segment.Why is it important surgically?

A bronchopulmonary segment is a pyramid-shaped area of lung tissue, apex directed towards root of lung; its base towards outer lung surface.A bronchopulmonary segment can be removed surgically without affecting adjacent segments.

During transurethral resection of the prostate, a surgeon identifies the seminal colliculus. What is the seminal colliculus

A circular elevation on the urethral crest.

What is the mons pubis?

A mound of hairy skin and fat anterior to pubic bones

What is meant by testicular torsion?

A testis rotates, twisting the spermatic cord resulting in occlusion of the blood supply to the testis necrosis (death) of testis

Inferior vesicular artery(b) When is this vessel absent?

Absent in females

Left Renal Vein(b) An aneurysm of which vessels can compress this labelled vessel? Why?

An aneurysm of aorta or superior mesenteric artery may compress the left renal vein, as it passes in the angle between them

What is an episiotomy? When is it performed?

An incision of perineum and inferoposterior vaginal wall. It is performed to increase size of vaginal opening and decrease

Describe the pathway of an indirectinguinal hernia.

An indirectinguinal hernia protrudes from the abdominal cavity through the deep ring along the inguinal canal and emerges through the superficial inguinal ring

A digital rectal examination is performed on a patient suspected of having 'Benign prostatic hyperplasia/hypertrophy'. Describe location & features of the prostate which are palpable.

Anterior to rectum; prostate smooth and firm with vertical groove

Right/Left Testicular artery(b) Name the vessel from which this structure arises

Aorta

In the mediastinum, name the vessels which cross the trachea on each side

Arch of aorta on left side and arch of the azygos vein on right side

At what level in the mediastinum does the trachea bifurcate?

At the level of the sternal angle i.e. at the junction between the superior mediastinum and inferior mediastinum.

Seminal vesicle(b) Name the area/part of the urinary bladder which is in contact with this structure.

Base of the bladder

In quiet respiration, describe the approximate position of the left oblique fissure.

Begins between the spinous process of vertebra T3 and T4, crosses the 5thintercostal space laterally and follows contour of rib 6 anteriorly.

What is meant by a haemopnuemothorax?

Blood and air in the pleural cavity

During transurethral resection of the prostate, how is the position of the prostate identified?

By identifying the seminal colliculus, an elevation on the urethral crest of the prostatic urethra

List the 3 things which must occur during micturition and the nerves involved in each.

Contraction of detrusor muscle of bladder wall: ANS. Relaxation of internal urethral sphincter: ANS.Relaxation of external urethral sphincter: pudendal nerve (somatic nervous system

What is the function of the seminal vesicles?

Contribute a fluid secretion to the semen.

Glans penis(b) What mass of erectile tissue forms this structure?

Corpus spongiosum

Is the renal corpuscle located in the cortex or medulla of the kidney?

Cortex

What part of the pleural cavity lies posterior to the left kidney?

Costodiaphragmatic recess

Name the membrane/ligament which is pierced in emergency situations to open the airway.

Cricothyroid membrane

Cricoid cartilage(b)Name the membrane which joins this structure to the trachea

Cricotracheal membrane

Where do the ducts of the bulbourethral glands open? What is released?

Ducts open into spongy/penile urethra. Mucus-like secretion from glands lubricates glans penis during sexual arousal.

Ureter(b) What does this structure cross on the pelvic floor.

Ductus (vas) deferens

Epididymis(b) Name the continuation of the structure.

Ductus / Vas deferens

What section of the lung is suppliedby a segmental/ tertiary bronchus?

Each segmental/ tertiary bronchus supplies a bronchopulmonary segment of the lung.

Seminal vesicle(b) Name the structure formed by the union of this structure and the ductus deferens.

Ejaculatory duct

Internal pudendal artery(b) Describe the pathway this structure takes as it leaves the pelvis and enters perineum

Enters gluteal region through greater sciatic foramen inferior to piriformis. It descends on superficial aspect of sacrospinous ligament and immediately passes through lesser sciatic foramen, into perineum.

Narrowing of the laryngeal inlet which may result in breathing difficulties and require an emergency airway. Name the boundaries of the laryngeal inlet

Epiglottis, the aryepiglottic folds and interarytenoid folds

Perineal membrane (b) What are the limits of this structure?

Extends between the conjoined pubic and ischial rami on either side. Its apex lies close to the pubic symphysis; its base stretches across between the ischial tuberosities.

A patient recently has difficulty making a high pitch sound. Which nerve andmuscle(s) is most likely injured in this patient

External laryngeal nerve (branch of superior laryngeal nerve from vagus nerve (CN X)) innervates cricothyroid muscle

Where is testicular pain felt by the patient? Why?

Felt in the testes. Can radiate to upper thigh & lower abdomen, in peri-umbilical region (T10 dermatome). Due embryological origin & sympathetic innervation (aortic plexus) of testis.

A patient has an infection of the greater vestibular (Bartholin's) glands. Are they present in males or females or both? Where is the opening of the glands?

Females only. Open into vestibule of vagina

In quiet respiration, describe the approximate position of the horizontal fissure.

Follows the right 4thintercostal space from the sternum until it intersects the right oblique fissure as it crosses rib 5.

Obturator internus(b) What is the insertion of this muscle

Greater trochanter of femur.

What is the function of the transverse perineal muscles?

Help support pelvic floor.

Left Renal Vein(b) Into which blood vessel does this structure drain?

IVC

Right Testicular vein(b) Name the vessel into which this vessel drains

IVC

What are the components of the cremasteric reflex?

Ilioingiunal nerve (Sensory from skin of thigh) L1 region of spinal cord Genital branch of genitofemoral nerve (contraction of Cremaster muscle elevation of testis)

Perineal body(b) What is the function of this structure?

Important support to pelvic viscera as it links muscles across pelvic floor.

Pudendal nerve(b) At what location is local anaesthetic injected around this nerve, in order to facilitate certain obstetric procedures?

In the pudendal canal. A needle is inserted through the skin to the medial aspect of the ischial spine.

Base of bladder(b) What is the nerve supply to this structure?

Inferior hypogastric plexus

During a thyroidectomy a surgeon attempts to ligate an artery which is closely related to this nerve and so the surgeon must exercise great care to avoid nerve injury. Name this artery.

Inferior thyroid artery.

A needle is inserted into the pleural cavity in the midaxillary line to obtain a sample of fluid/ remove pus/blood. Where should the needle be inserted to avoid injuring the lung? Why?

Intercostal space 9, in mid-axillary line.Why? Costodiaphragmatic recess accessed through intercostal space 9. At mid-axillary line, lung will not be damaged as Inferior margin of lung crosses at rib 8.Inferior margin of pleura crosses at rib 10.

Vestibule of larynx(b)During laryngoscopy, this area is visualized.What is the sensory nerve supply to this compartment / area / chamber of the larynx?

Internal laryngeal branch of the superior laryngeal nerve which is a branch of the Vagus nerve

Following surgery, it was noted that a patient frequently aspirated (inhaled) fluid into her lungs. Upon examination it was found that the area of the laryngeal mucosa above the true vocal fold was numb.Which nerve provides sensory innervation here?

Internal laryngeal nerve (branch of superior laryngeal nervefrom the vagus nerve (CN X)).

Piriform fossa in laryngopharynx. (b)Why is this area clinically important

It is a common site of lodgement of sharp ingested bodies, such as fish bones

Obturator nerve(b) Describe the pathway this structure takes as it leaves the pelvis.

It passes through the obturator canal (in upper part of obturator foramen).

Right renal artery(b) At what level of the vertebral column does this vessel arise?

L2

A patient with enlarged mediastinal lymph nodes due to malignant disease develops a hoarse voice. Which nerve do you suspect is most likely damaged? Explain why?

Left recurrent laryngeal nerve (paralysis of the left vocal cord)Because it arises from left vagus in mediastinum, close to aortic arch. Whereas, right recurrent laryngeal nerve arises in the neck.

Left Testicular vein(b) Name the vessel into which this vessel drains

Left renal vein

Cricothyroid muscle(b)What is the action of this muscle?

Lengthens and increases tensions of vocal ligament / true vocal fold / vocal cord,which raises the pitch of the voice

At what vertebral level does the trachea bifurcate?

Level of junction of T4/T5vertebrae/ 4thintervertebral disc/ Sternal angle

What structures lie anterior to the right kidney?

Liver, duodenum, right colic flexure

What is the sensory innervation of the peripheral diaphragmatic pleura?

Lower 5 intercostal nerves

Name the lymph nodes which drain the ureter

Lumbar (lateral aortic) and iliac lymph nodes

Minor calyx(b) Name the structure into which urine flows from the flagged structure

Major calyx

Where are the bulbourethral glands located? Are they present in males or females or both?

Males only. Glands located in deep peroneal pouch.

Bulbospongiosus muscle(b) What is the action of this muscle?

May help to compress the veins draining masses of erectile tissue, thereby helping to maintain erect state of penis.By compressing urethra, helps to expel last drops of urine or semen from it.

Ischiocavernosus muscle(b) What is the action of this muscle?

May help to compress the veins draining the masses of erectile tissue, thereby helping to maintain the erect state of the penis

Describe the position of a direct inguinalhernia sac relative to the inferior epigastric vessels

Medial to inferior epigastric vessels.

Deep peroneal pouch What is the name given the part of the urethra which passes through this area?

Membraneous part of urethra

Deep perineal pouch(b) What part of the urethra which passes through this space?

Membraneous urethra

internal urethral sphincter(b) What type of muscle is located here and what is its function?

Muscle: Smooth muscle.Function: Continence as it is involuntary sphincter.Prevents sperm entering bladder during ejaculation

Pampiniform plexus of veins(b) A dilation of these vessels is known as a varicocele. List the vessels which drain blood from the left testis to the heart

Pampiniform plexus left testicular vein Left renal vein IVC heart

Tunica albuginea of testis(b) A patient has carcinoma of this structure. Name the lymph nodes which are the first to be involved in the spread of this carcinoma.

Para-aortic LN

What is the sensory innervation of the mediastinal pleura?

Phrenic nerve

What is normally contained within the pleural cavity?

Pleural fluid (small amount)

Parietal layer of tunica vaginalis(b) What is the embryological origin of this structure?

Processus vaginalis -a blind sac of peritoneum, descends alongside testis. Obliterated except adjacent to testis which becomes tunica vaginalis.

During childbirth, the perineal body was damaged. What are the possible consequences for the patient?

Prolapse of pelvic viscera

Carcinoma of the prostate can spread to the vertebrae -explain how.

Prostatic venous plexus drains into the internal vertebral venous plexus. Carcinoma of prostate spreads to vertebrae through these venous channels.

Left ureter(b) Name the muscle which lies posterior to this structure along much of its course.

Psoas major

Superficial transverse perineal muscle What is the nerve supply to this muscle

Pudendal nerve

Vestibular fold or false vocal fold(b) During laryngoscopy, this structure is visualised.Name the membrane whose free lower border forms the ligament which lies under this fold.

Quadrangular membrane

Fluid has accumulated in the peritoneal recess formed as the peritoneum reflects from the posterior surface of the uterus to the rectum. Name this recess.

Rectouterine pouch / pouch of Douglas

Rectum(b) Fluid has accumulated in the peritoneal recess between this structure and the bladder in a male patient. Name this recess

Rectovesicular pouch

Rectum(b) Name the peritoneal recess between this structure and the bladder in the male.

Rectovesicular pouch

Prostate gland(b) Name the viscus located posterior to this structure

Rectum

What is the sensory innervation the laryngeal mucous membrane below true vocal folds?

Recurrent laryngeal nerve (branch of the vagus nerve/CN X)

)Whichnerve(s)supplythe muscles which adduct and abduct the vocal folds?

Recurrent laryngeal nerves

Pyramid of medulla of kidney(b) What is the name given to the apex of this structure?

Renal papilla

Name the structures which lie at the hilum, anteriorly to posteriorly.

Renal vein, renal artery, renal pelvis

During quiet respiration, what is the surface projection of the inferior margin of the pleura at the midaxillary line?

Rib 10

During quiet respiration, what is the surface projection of the inferior margin of the lung at the midclavicular line

Rib 6

into which lymph channels do the tracheobronchial lymph nodes drain?

Right and left bronchomediastinal lymph trunks

During bronchoscopy, an inhaled peanut is seen. Which primary bronchusis the inhaled foreign bodies are more likely to enter? Why?

Right primary bronchus.The right primary bronchus is shorter, wider and more vertically orientated than the left

A patient with cancer of the apex of the right lung develops a hoarse voice. Which nerve do you suspect is most likely damaged? Explain why?

Right recurrent laryngeal nerve (paralysis of the right vocal cord). Arises in root of neck.

What is the position of the right renal artery relative to the IVC.

Right renal artery passes posterior to the IVC

Right/Left External Iliac Artery(b) Name the vessel from which this structure arises.

Right/Left common iliac artery

True vocal fold / vocal cord(b) During laryngoscopy, the space between this structure and the corresponding structure on the opposite side of the larynx is visualised.Name this space

Rima glottidis

Labus majus / Labia majora, (b) Name the structure which links the structure labeled here to the uterus?

Round ligament of uterus

List the spinal nerve roots found in the pudendal nerve.

S2, S3, S4

What is the costodiaphragmatic recess?Why would you insert a tube into this space?

Space between the costal pleura and diaphragmatic pleura Potential site for the accumulation of fluid so fluids can be removed from here.

In quiet respiration, describe the approximate position of the right oblique fissure.

Spinous process of vertebra T4, crosses the 5thintercostal space laterally and follows contour of rib 6 anteriorly.

Scrotum(b) A patient has an infection of the skin of this structure. Which lymph nodes which are likely to be enlarged & tender?

Superficial Inguinal LN

Ampulla of ductus (vas) deferens(b) Name the external opening in the abdominal wall through which this structure passes

Superficial inguinal ring

Name the blood vessels which supply the bladder.

Superior and inferior vesicular arteries (branches of internal iliac artery

How do sympathetic fibers reach the pelvic viscera?

Superior hypogastric plexus 2 hypogastric nerves pelvic plexuses (inferior hypogastric plexuses). Branches of plexuses follow arteries to organs. oSacral splanchnic nerves from sacral part of sympathetic trunks. They pass directly to pelvic viscera or enter inferior hypogastric plexuses

During a thyroidectomy a surgeon attempts to ligate an artery which is closely related to this nerve and so the surgeon must exercise great care to avoid nerve injury. Name this artery.

Superior thyroid artery

What is the action of levator ani

Supports pelvic viscera-helps maintain faecal continence -forms a sling at anorectal junction Forms incomplete sphincter for vagina

What nerves are responsible during ejaculation?

Sympathetic nerves (closure of internal urethral sphincter),Parasympathetic nerves S2-S4 (contraction of urethral muscle),Pudendal nerve (contraction of bulbospongiosus muscle)

Cricoarytenoid joint(b)What type of joint is this? What is the effect of movement at this joint?

Synovial joint.Narrowing or widening the rima glottidis

Explain why suprapubic catheterization does not damage structures in the abdominal cavity.

The catheter does not enter peritoneal cavity since as bladder fills, it extends upwards out of pelvis and lifts parietal peritoneum away from anterior abdominal wall

Describe the position of the pleural cupola. Why is this clinically relevant?

The cervical pleura (cupola) rises above the first rib and the clavicle (like the lung, it can be damaged in stab wound to neck).

Describe the position of the left primary bronchus relative to the heart.

The left primary bronchus passes posterior to the left atrium of the heart.

Describe the mucosa in the trigone of the bladder.

The mucosa is smooth in this triangular area between the openings of the ureters and the urethra

How does the shape of the pelvic inlet differ between the male and female

The pelvic inlet is more oval in female while it is heart -shaped in male

Why is the ureter liable to damage during hysterectomy (removal of uterus)

The uterine artery crosses ureter. It could be tied off while surgeon is tying off uterine artery

From which vessel do the bronchial arteries arise

Thoracic aorta or one of its branches

Hyoid bone(b)Name the membrane which joins this structure to the larynx

Thyrohyoid membrane

Which layer(s) of pleura (ie parietal or visceral) form the costomediastinal recess?

Two layers of parietal pleura

)A male patient has ureteric colic? Where is this pain often referred?

Ureteric pain is often referred to dermatomes T11-L2 i.e. posterolateral abdominal wall below the ribs, pubic region, scrotum.

Trigoneof bladder(b) Name the structures which open into the superolateral angles of this area.

Ureters

Corpus spongiosum(b) Name the structure located within this flagged structure

Urethra

Superior vesicular artery(b) What structure is supplied by this vessel?

Urinary bladder.

Fundus of urinary Bladder(b) Name the peritoneal recess posterior to this structure in the female.

Vesico-uterine pouch.

Following neck surgery, a patient complains of weakness of the voice and monotonus voice. Name the muscle with is used for animated speech andits nerve supply

Vocalis muscle. Recurrent laryngeal nerve.

A renal stone is stuck at one of the locations where the ureter is constricted. List where the ureter is constricted?

at the junction of renal pelvis with ureter, where ureter crosses common iliac vessels at pelvic brim, as it passes through wall of urinary bladder.