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PreClinEazy X Cardiff Medsoc REPRODUCTIVE ANATOMY Sophia RajaReproductive Anatomy Recap of the pelvic cavity Male Reproductive Anatomy + High yield SBA Female Reproductive Anatomy + High yield SBA Pelvic Cavity Parts of the Pelvis Contents Anterior: urogenital (part of ureters, bladder, urethra) False pelvis (superior pelvis): part of the abdominal cavity, Posterior: sigmoid colon, rectum contains upper parts of pelvic bones Peritoneum: lines superior surface Reproductive organs: (ductus deferens, seminal vesicles, ejaculatory ducts, and prostate. vagina, cervix, uterus, True pelvis (lesser pelvis): pelvic bones, sacrum and coccyx. fallopian tubes, and ovaries) Has an inlet and outlet Pelvic cavity: sits between pelvic inlet and outlet. Contains Perineum urinary, GI and reproductive elements Boundaries: pubic symphysis, ischial tuberosities, coccyx Urogenital triangle: perineal membrane, external genitalia, Perineum: inferior to the pelvic diaphragm (levator ani & urethra coccygeus muscles), external genitalia and external openings of GU and GI systems Anal triangle: pelvic diaphragm, anal apertureMALE REPRODUCTIVE ANATOMY Question 1 Identify labels A, B and C B C A A – Membranous urethra B – Corpus spongiosum A C – Corpus Cavernosum A – Spongy urethra Identify labels A, B and C B – Corpus spongiosum B C – Corpus Cavernosum B A – Corpus spongiosum C B – Spongy urethra INSERT KEY POINT C – Corpus Cavernosum A – Spongy urethra D B – Corpus cavernosum A C C – Corpus spongiosum A – Prostatic urethra B – Corpus cavernosum E C – Corpus spongiosum A – Membranous urethra A – Spongy urethra B – Corpus spongiosum A C – Corpus Cavernosum D B – Corpus cavernosum C – Corpus spongiosum A – Spongy urethra B B – Corpus spongiosum C – Corpus Cavernosum A – Corpus spongiosum C B – Spongy urethra C – Corpus Cavernosum A – Prostatic urethra E B – Corpus cavernosum C – Corpus spongiosum Structure of the penis MALE REPRODUCTIVE SYSTEM • root – attaches to abdomen • Body/ shaft – this is where the corpus cavernosum and spongiosum Urethra reside • Glans – cone shaped “head” of penis • Pre-prostatic – 1cm; from base of bladder to prostate • Prostatic – 3-4cm; surrounded by prostate • Corpus cavernosa and spongiosum become engorged with blood to allow penetration of the vagina • Membranous – passes through deep perineal pouch • Spongy/ penile - surrounded by corpus spongiosum Question 2 A 65 year old man presents to his GP with difficulty urinating. He reports a slow and hesitant stream and a feeling of incomplete emptying and nocturia. On examination he has an enlarged non-tender prostate. What is cause of his urinary retention? A Urinary Tract Infection A 65 year old man presents to his GP with B Beniin prr t tic hyperplal i difficulty urinating. He reports a slow and hesitant stream and a feeling of incomplete On examination he has an enlarged non-tender prostate. C Cystitis What is cause of his urinary retention? D Pyelonephritis E Overactive Bladder A Urinary Tract Infection difficulty urinating. He reports a slow and hesitBnt stream and a feeling of incompletea On examination he has an enlarged non-tender prostate. C Cystitis What is cause of his urinary retention? D Pyelonephritis Overactive Bladder EMALE REPRODUCTIVE SYSTEM Causes of urinary retention Enlarged prostate • Enlarged prostate – this can constrict the prostate part of the urethra • Benign Prostate Hyperplasia – prostate enlarged with age • Stricture – damage due to scarring • Prostatitis – inflammation; pain in groin, pelvic area or genitals; • Medications – antihistamines, antispasmodics, opiates and tricyclic may need antibiotics antidepressants can alter the function of the bladder muscle • Testosterone therapy – may have BPH as a side effect • Neurological issues – e.g. due to stroke, diabetes herniated disc • Prostate cancer – some are slow-growing and need minimal • UTI & STI – can cause swelling or weakness of the urethra treatment while others are more aggressive Question 3 A 55 year old man with a history of hypertension and type 2 diabetes presents with complaints of difficulty achieving and maintaining an erection. He is currently on anti-hypertensive medication On examination he has decreased sensation to lower extremities and diminished pedal pulses. What is the mechanism most likely contributing to his erectile dysfunction and which arterial supply is primarily affected? A Arterial Insufficiency; internal pudendal artery B Hormonal imbalance; dorsal artery of the penis and type 2 diabetes presents with complaints ofn difficulty achieving and maintaining an erection. He is currently on anti-hypertensive medication C Medication side effects: deep artery of the penis lower extremities and diminished pedal pulses. What is the mechanism most likely contributing to his erectile dysfunction and which arterial supply Neurological dysfunction; internal pudendal is primarily affected? D artery Arterial insufficiency; dorsal artery of the penis E B Hormonal imbalance; dorsal artery of the penis and type 2 diabeArterial Insufficiency; internal pudendal artery difficAlty achieving and maintaining an erection. He is currently on anti-hypertensive medication On examination he has decreased sensation to C Medication side effects: deep artery of the penis lower extremities and diminished pedal pulses. What is the mechanism most likely contributing to his erectile dysfunction and which arterial supply Neurological dysfunction; deep artery of the is primarily affected? D penis E Venous insufficiency; internal pudendal arteryMALE REPRODUCTIVE SYSTEM Blood supply of the penis Causes of erectile dysfunction • Usually vascular aetiology: hypertension, • aorta -> common iliac -> internal iliac -> internal pudendal hypercholesterolemia, smoking diabetes – • Internal pudendal: bulbourethral artery, deep damage to arterial vessels artery and dorsal artery •Psychological: depression •Neurological: spinal cord injuries, stroke Question 4 A 50 year old man presents with painless enlargement of the left testicle. Further tests confirm a testicular tumour. Which lymph node is most likely implicated? A Common iliac lymph node B External iliac lymph node A 50 year old man presents with painless enlargement of the left testicle. Further tests confirm a testicular tumour. C Inguinal lymph node Which lymph node is most likely implicated? D Inter-aortocaval lymph node Para-aortic lymph node E Common iliac lymph node A B External iliac lymph node A 50 year old man presents with painless enlErgement of the left testicle. Further tests confirm a testicular tumourC Inguinal lymph node Which lymph node is most likely implicated? D Inter-aortocaval lymph nodeMALE REPRODUCTIVE SYSTEM Lymphatic drainage • deep parts of perineum – internal iliac nodes • Superficial tissues of penis and scrotum – superficial inguinal node • Testes – para-aortic lymph node Question 5 35 year old man and his partner are having trouble conceiving. Semen analysis at the fertility clinic reveals and absence of fructose in his sample. Which condition is most likely contributing to this abnormality? Epididymitis A B Prostate cancer 35 year old man and his partner are having trouble conceiving. Seminal vesicle obstruction and absence of fructose in his sample. reveals C Which condition is most likely contributing to this abnormality? Testicular atrophy D E Absence of Vas Deferens A Epididymitis B Prostate cancer 35 year old man Seminal vesicle obstruction trouble conceiving. Semen analysis at the fertility clinic reveals and absence of fructose in his sample. Which condition is most likely contributing to this abnormality? Testicular atrophy D Absence of Vas Deferens EAccessory Glands Seminal vesicles Prostate gland • located near base of bladder attached to vas deferens • Found below bladder in front of rectum • Contribute fluid to sperm (make up to 60% volume) • makes prostatic fluid • Alkaline to neutralize the environment of urethra and • Increases sperm mobility in vagina vagina • Rich in fructose – mitochondria utilize for ATP Bulbourethral glands • Pea-sized structures on side of urethra below prostate • thick lubricant for urethra and vagina and neutralizes acids that may remain from urine Question 6 A 35 year old man is considering a vasectomy as a form of contraception. He wants to understand the procedure better. Which statement accurately describes the process of a vasectomy? The vas deferens is cut, and the testes are A removed The vas deferens is sealed or cut, preventing B sperm from reaching the ejaculate A 35 year old man is considering a vasectomy as a form of contraception. He wants to understand the procedure The epididymis is removed to prevent sperm better. C production Which statement accurately describes the process of a vasectomy? The prostate gland is removed to reduce sperm D viability The seminal vesicles are ligated to obstruct E sperm flow The vas deferens is cut, and the testes are A removed A 35 year oThe vas deferens is sealed or cut, preventing He wants to understand the procedure. The epididymis is removed to prevent sperm better. C production sperm from reaching the ejaculate the process of a vasectomy?describes D The prostate gland is removed to reduce sperm viability The seminal vesicles are ligated to obstruct E sperm flow Question 7 Which of the following is NOT an accessory gland of the male reproductive system? A Bartholin’s glands B Bulbo-urethral glands Which of the following is NOT an accessory gland of the C Prostate male reproductive system? D Seminal vesicles E Cowper’s glands B Bulbo-urethral glands A Bartholin’s glands Which of the following is NOT an accessory gland of the C Prostate male reproductive system? D Seminal vesicles E Cowper’s glands Question 8 A 30 year old man presents with scrotal swelling and Discomfort. Upon physical examination, varicoceles is identified on the left side. Which vein is most likely implicated? Cremasteric vein A B Deep dorsal vein A 30 year old man presents with scrotal swelling and Discomfort. left side.cal examination, varicoceles is CdenExternal pudendal vein Which vein is most likely implicated? D Pampiniform Plexus E Testicular vein A Cremasteric vein B Deep dorsal vein Pampiniform Plexus Discomfort.ld man presents with scrotal swelling and Upon physical examination, varicoceles is CdenExternal pudendal vein left side. Which vein is most likely implicated? E Testicular veinFEMALE REPRODUCTIVE ANATOMY Question 1 Identify labels A, B, C and D A C B D A – bladder B – Rectum A C – Uterus D - Vagina A – Rectum B – Uterus Identify labels A, B, C and D B C – Bladder D - Vagina A – Uterus B – Bladder C C – Rectum D - Vagina A C B D A – Bladder B – Vagina D C – Uterus D - Rectum A – Uterus B – Bladder E C – Rectum D - Cervix A – bladder B – Rectum A C – Uterus D - Vagina A – Uterus B – Bladder C C – Rectum D - Vagina A – Rectum B – Uterus Identify labelC – Bladder D - Vagina A A – Bladder B – Vagina B D D C – Uterus D - Rectum A – Uterus B – Bladder E C – Rectum D - Cervix Question 2 28 year old female presents to ED with vaginal bleeding and severe abdominal pain. She has missed a period and has a positive home pregnancy test. On examination there is rebound tenderness. What is the most common location for an ectopic pregnancy? A Abdominal cavity Cervix B 28 year old female presents to ED with vaginal missed a period and has a positive home has pregnancy test. Uterine tube On examination there is rebound tenderness. What is the most common location for an ectopic pregnancy? D Uterus E Ovary A Abdominal cavity B Cervix bleeding and severe abdominal pain. She hasnal missed a period and has a positive home On examination there is rebound tenderness. pregnancy?e most common location for an ectopic D Uterus E Ovary Question 3 A woman attends a gynaecological appointment, during which the doctor mentions a structure called ‘The pouch of Douglas’ What is the primary function of the Pouch of Douglas in the female reproductive system? Facilitation of childbirth A B Maturation of oocytes A woman attends a gynaecological appointment, ‘The pouch of Douglas’r mentions a structure called What is the primary function of the Pouch of Douglasduction of hormones in the female reproductive system? Protection of the fetus during childbirth D E Space for fluid and infection to collect A Facilitation of childbirth B Maturation of oocytes during which the doctor mentions a structure calledct ‘The pouch of Douglas’ C Production of hormones in the female reproductive system?e Pouch of Douglas Protection of the fetus during childbirth D Question 4 A woman in her 40s is scheduled to have a hysterectomy due to cancer in her ovaries. The surgeon is careful not to cut the ureters. How can she identify the uterine artery? A Uterine artery runs inferior to ureter B Uterine artery runs superior to ureter A woman in her 40s is scheduled to have a hysterectomy due to cancer in her ovaries. C Uterine artery can be traced by locating the How can she identify the uterine artery?eters. ovarian artery By using doppler ultrasound before the D surgery By using radioactive tracer in the artery E A Uterine artery runs inferior to ureter A woman in her 40s is scheduled to have a to ureter hysterectomy due to cancer in her ovaries. Uterine artery can be traced by locating the The surgeon is careful not to cut the ureters. ovarian artery How can she identify the uterine artery? By using doppler ultrasound before the D surgery E By using radioactive tracer in the artery Question 5 A 28 year old woman is giving birth and it is decided that she needs and episiotomy due to the baby having an irregular heart rate. A nerve blocking agent is given. What nerve is the nerve blocker typically injected? Femoral nerve A B Genitofemoral nerve A 28 year old woman is giving birth and it is decided having an irregular heart rate.ue to the baby A nerve blocking agent is given. C Ilioinguinal nerve What nerve is the nerve blocker typically injected? D Pudendal nerve E Obturator nerve A Femoral nerve B Genitofemoral nerve Pudendal nerve that she needs and episiotomy due to the baby decided having an irregular heart rate. C Ilioinguinal nerve A nerve blocking agent is given. What nerve is the nerve blocker typically injected? E Obturator nerve Question 6 Which muscle covers the crus of the clitoris? 1 2 3 A 1 – superficial transverse perineal muscle 1 – Ischiocavernosus muscle B Which muscle covers the crus of the clitoris? 1 C 2 – bulbospongiosus muscle 2 3 D 3 – superficial transverse perineal muscle 3 – Ischiocavernosus muscle E A 1 – superficial transverse perineal muscle B 1 – Ischiocavernosus muscle C 2 – bulbospongiosus muscle D 3 – superficial transverse perineal muscle E 3 – Ischiocavernosus muscle THANK YOU FOR LISTENING! PLEASE FILL OUT THE FEEDBACK FORM PLEASE TUNE IN TO OUR REMAINING SESSIONS THIS WEEK