Transcript Pelvis and Perineum Quiz

Pelvis and Perineum Quiz
YOU WILL HAVE 60 SECONDS PER QUESTION
Question #31
A three-day-old baby is undergoing a circumcision
procedure. Which of the following nerves will the
attending physician anesthetize?
A. Cavernous n.
B. Dorsal nerve of the penis
C. Genitalfemoral n.
D. Ilioinguinal n.
E. Superficial perineal n.
Question #32
As a catheter is placed in the penile urethra, which of
the following structures most immediately surrounds
the catheter?
A. Colles fascia
B. Corpus spongiosum
C. Deep (Buck’s) fascia
D. Loose areolar tissue
E. Tunica albuginea
Question #33
A 30-year-old female undergoing a hysterectomy
has her suspensory ligament cut. Which of the
following arteries has also been compromised?
A. Internal pudendal
B. Superior vesical
C. Ovarian
D. Vaginal
E. Uterine
Question #34
Identify the highlighted
structure:
A. Middle rectal artery
B. Ovarian artery
C. Obturator artery
D. Inferior vesical artery
E. Uterine artery
Question #35
A 15-year-old boy, after being punched in the
abdomen, has a large hematoma deep to his Scarpa’s
fascia. Which of the following areas could the
hematoma also pass into?
A. Corpora cavernosa
B. Deep perineal pouch
C. Ischio-anal fossa
D. Lesser pelvis
E. Superficial perineal pouch
Pelvis and Perineum Forum
Questions
Question #1
 A patient undergoing surgery requires a pudendal nerve
block.
Where would you inject the anesthetic agent?
What landmark(s) would be used to guide the injection?
What are the branches of the pudendal that would be affected
and what structures are affected?
Question #2
 A 32-year old patient is being evaluated for potential
complications during vaginal delivery.
What pelvic measurements would be necessary?
What are the potential shapes of the pelvic inlet of this
patient?
What would be the distinguishing features between the male
and the female pelvis?
Pelvic Measurements
Pelvic Shapes
Male and Female Pelvis
Question #3
 A 28-year old patient undergoes a midline episiotomy.
What pelvic and perianal structures are involved in this
procedure?
If the perineal body is disrupted during the procedure what
are potential complications for this patient in the future
(describe each)?
Episiotomy
Perineal Body
Fascia attaching to the perineal body:
• Colle’s fascia
• Perineal membrane
• Deep investing fascia
Muscles attaching to the perineal body:
•
•
•
•
Transverse Perineal (super and deep)
Bulbospongiosus
External anal sphincter
Pubococcygeus
Question #4
 A 10-year old male patient is seen in the emergency room.
The patient accidently fell and straddled his bike and since
the time of the accident he has had pain and swelling of his
perineal and scrotal area. After further examination it is
determinde that the patient has a ruptured urethra.
 Where are the potential anatomic locations for a urethral
rupture?
 What anatomy would be disrupted or intact with each type
of rupture?
 What would be the potential signs and symptoms
associated with each?
Question #5
 A 54-year old patient with a history of atherosclerotic
disease is seen in the emergency room complaining of pain
in his pelvic region. Upon further testing he is diagnosed
with an obstructed middle rectal vein.
What vessels would provide collateral circulation?
Trace the path of blood from each collateral vessel. This
scenario can also be used for the following arteries: uterine,
iliolumbar/circumflex iliac, lateral sacral, middle rectal,
inferior gluteal.
Blood Supply to the Pelvis
Question #6
 A patient is in the emergency room following a high speed
accident in which the pelvis sustained injury. The patient is
diagnosed with a fractured pelvis:
What structures are in danger if the fracture is of the superior
pubic ramus?
What future issues might arise from such a repaired injury?
Pelvic Fractures
Question #7
 A 64-year old patient is seen for a routine physical
examination.
In what way are the female pelvic viscera examined?
What structures can be assessed?
The physician notes that the patient’s uterus is lower in the
vaginal canal than expected. This anatomic finding would
mostly likely be a direct result from injury to what structures?
(be prepared to describe the normal and pathologic
structures).
Pelvic Examination
Prolapse
Question #8
 A 45-year old patient with portal hypertension is seen by
his primary care physician and complains of blood in his
stool. Following examination he is diagnosed with
hemorrhoids.
What would be the signs, symptoms and anatomic features to
distinguish as to the patients type of hemorrhoids?
Question #9
 A patient experiencing erectile dysfunction is seen in
the urology clinic. Upon further evaluation the
patient also expresses a heavy sensation in his lower
pelvis.
What types of physical examinations might be
performed and what anatomy would be assessed?
The urologist also performed a cystoscopy on the
patient, during the examination what anatomy would be
assessed?
Digital Rectal Examination
Question #10
 A 25-year gunshot victim is seen in the emergency room.
Upon physical examination it is determined that the bullet
entered the gluteal region near the piriformis muscle.
What anatomic structures are in danger of being damaged?
Question #11
 A 33-year old patient is seen by her primary care physician
concerned about an inflammation of her superficial
inguinal lymph nodes.
What areas should be inspected as possible sites of infection?
Superficial Inguinal Nodes