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.