STUDY GUIDE FOURTH EXAM IN BIOLOGY 261 AU 2010 THORAX, ABDOMEN, AND PELVIS 1.

. What are the five areas of the thorax? 2 pulmonary, 1 pericardial, and two mediastinal superior and posterior. (4th ed. p. 68, p. 80) Answer refers to how we teach the organshow they are organized by location. Two pulmonary areas contain lungs, pericardial area contains heart, superior mediastinum contains SVC, brachiocephalic veins, aortic arch, thoracic duct, trachea, esophagus, thymus, vagus nerves, left recurrent laryngeal nerve, and phrenic nerve, posterior mediastinum contains esophagus, thoracic aorta, azygos and hemiazygos veins, thoracic duct, vagus nerves, sympathetic trunks, and splanchnic nerves. 2. Identify the boundaries of the following thoracic cavities and the contents of each: a. Pleural (4th ed. p. 68) Pleural cavity = potential space between the visceral and parietal layers of pleura containing serous fluid. (PULMONARY CAVITY = Contain the lungs; 2 cavities; Boundaries = internal surface of thoracic wall, lateral aspect of the mediastinum, diaphragm, cupula of thorax) b. Pericardial (4th ed. p. 81) Pericardial cavity = potential space between the opposing layers of the parietal and visceral layers of the serous pericardium containing serous fluid. [PERICARDIUM = Contains heart and roots of great vessels; within pericardial sac; Boundaries = body of sternum & 2nd6th costal cartilages, thoracic vertebrae, diaphragm] c. Mediastinum (4th ed. p. 80 see Fig 1.23) Central cavity of thorax containing heart, great vessels [brachiocephalic veins, SVC, IVC], trachea & primary bronchi, esophagus, vagus nerve, recurrent laryngeal nerve, and thymus; Boundaries = superior thoracic aperture, diaphragm sternum & costal cartilages, bodies of thoracic vertebrae, pleural cavities Answer from department = Superior mediastinum = superior thoracic aperture = SVC, aortic arch, Brachiocephalic veins 3. Identify the bones and their markings plus the cartilages that make-up the bony thorax.(4th ed. pp. 4851) Answer from department = 12 pairs of ribs + cartilage (add sternum and thoracic vertebrae to this) Answers in Thorax lecture notes and slides. HINT look to see if any of the markings hold a clinical significance = sternal angle & xiphoid process (look at Surface Anatomy block pp. 65-66) 4. Be able to identify the boundaries of the following: (4th ed. p. 48, p. 80) a. Inlet of thorax AKA Superior thoracic aperture Intersection of the neck and thoracic cavity; Boundaries = upper end of the sternum (the manubrium), the first thoracic vertebra, and the first ribs and their cartilages = root of neck b. Outlet of thorax AKA inferior thoracic aperture Inferior border of thoracic cavity marked by diaphragm; Boundaries = T12 vertebrae, 11th & 12th pairs of ribs, joined costal cartilages of ribs 7-10 (costal margin), xiphisternal joint c. Mediastinum extends from superior thoracic aperture to the diaphragm inferiorly and from the sternum and costal cartilages anteriorly to the bodies of the thoracic vertebrae posteriorly 5. The xiphoid process is a midline marker for what structure(s)? central tendon of diaphragm (4th ed. p.51) Midline marker for superior level of liver, central tendon of diaphragm, and inferior border of the heart 6. Identify the intrinsic muscles of the thoracic wall. (4th ed. pp. 60-61) External intercostals, Internal intercostals, Innermost intercostals, Subcostals, Transverse thoracic

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7. Be able to give a general description of the right and left lymphatic drainage of the thorax both internal and external. (4th ed. p. 30, pp. 110-111) Lymphatic system dominant on left side; 2 major trunks carry lymph back to venous system = larger lymphatic vessels that empty into subclavian vein; Right lymphatic duct = only drains right upper quadrant of body (R. head, neck, thorax, and R. upper limb); Thoracic duct = left side of body and drains majority of body 8. What is a sentinel lymph node? What is its significance in breast cancer? The first lymph node in a lymphatic chain plus the first lymph node to test positive for cancer cells. (4th ed. blue box pp. 58-59 NOT specifically mentioned anymore) Sentinel nodes = nodes that cancer cells appear in before others; Instead of removing all of axillary nodes, just remove sentinel nodes to see if these are positive for cancer. 9. Identify the subdivisions of the bronchial tree? (4th ed. pp. 71-74) Trachea runs from larynx to thorax where it branches into bronchial tree: Right and left primary bronchi (main bronchi) = one to each lung; branches into: Secondary bronchi (lobar bronchi) = one to each lobe of lung; branch into: Tertiary bronchi (segmental bronchi) = supply specific segments of lung called bronchopulmonary segments; continue branching until turn into: Alveolar sacs = basic gas exchange units of lung 10. [27.] What is auscultation? Listening to breath sounds. (4th ed. Blue Box p. 78) Auscultation = assessing air flow through the tracheobronchial tree into the lung with a stethoscope; listening to breath sounds; Normally moist, smooth pleurae = make not detectable sounds; Inflammation of pleurae makes lung surfaces rough = can hear friction 11. [26.] Where is the primary location of gaseous exchange in the lungs? Alveoli (4th ed. p. 74) 12. The mammary gland is classified as what type of gland? Modified sweat gland (4th ed. p. 53) 13. Be able to trace the blood flow into, through and out of the heart starting at any point. Include both arterial and venous pathways. pp. 160-161 lab book (4th ed. pp. 87-90) 14. Be able to identify the vessels that form the coronary circulation? (4th ed. pp. 94-97) Left Coronary Artery - 2 branches Circumflex A. = left atrium and left ventricle Anterior Interventricular = right and left ventricle; anterior 2/3 interventricular septum to apex Right Coronary Artery 2 branches Marginal Branch = right ventricle and apex Posterior Interventricular = right and left ventricle; posterior 1/3 of interventricular septum Coronary veins Great Cardiac V., Middle Cardiac V., Small Cardiac V. all join to form Coronary Sinus 15. What are the structural differences between arteries and veins? (4th ed. pp. 23-28) Arteries = thicker walls then veins due to larger muscular layer & take blood AWAY from heart; Veins = thinner walls and valves & take blood TO the heart 16. What is the fibrous skeleton of the heart? Where is it located? (4th ed. pp. 99-100) Myocardium contains a fibrous component that forms the skeleton of the heart skeleton primarily found around the 4 valves to keep them open and prevent them from overly distending

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17. Capillary beds connect __venules____ and _____arterioles_. (4th ed. p. 28) 18. What is the origin of the azygos and the hemiazygos venous system? Where are are they connected? (4th ed. p. 111) Both systems originate from roots arising from the posterior aspect of the IVC and/or renal vein, which merge with the ascending lumbar veins in the abdomen. Both systems connect to each other by crossing the midline of the body (vertebral column). 19. Be able to identify all structures of the human heart both outside and inside. (p. 158-160 lab manual and p. 88 text) 20. When numbering the ribs what is the first landmark to identify before you start counting? Sternal angle (4th ed. p. 67 Surface anatomy box) 21. Be able to identify the lobes of the right and left lung and the markings on both the mediastinal and costal surfaces. (4th ed. p. 71) Right lung = superior, middle, and inferior lobes; Left lung = superior and inferior lobes; Mediastinal surface = contains hilum of lung and related medially to the mediastinum and posteriorly to sides of vertebrae; Costal surface = adjacent to sternum, costal cartilages, and ribs 22. [30.] What is the clinical significance of the apex of the lung? Located in the neck in an area called the cupola. The lung is easily collapsed when the neck is injured (knife wound). Identify the pleural region that extends above the first rib. Cupola (NOT discussed in 4th ed.) 23. What is the purpose of the fibrous pericardium? Helps prevent over filling of the heart, acts to protect, & acts as a stabilizer by attaching (fusing) with the central tendon of the diaphragm. (4th ed. p. 81) 24. The bronchial arteries arise from? (4th ed. p. 75) a. On the left side thoracic aorta b. On the right side superior posterior intercostal artery; common trunk for thoracic aorta with right third posterior intercostal artery; left superior bronchial artery 25. What is the innervation of the visceral and parietal pleura? Are the pleurae sensitive to pain? (4th ed. p. 78 Blue Box) Visceral pleura is insensitive to pain because its innervation is autonomic (motor and visceral afferent) it receives no nerves of general sensation. Supplied by parasympathetic fibers from vagus and sympathetic fibers from sympathetic trunks. Parietal pleura is sensitive to pain, particularly the costal pleura, because it is richly supplied by branches of the somatic intercostal and phrenic nerves; irritation of the parietal pleura produces local pain and referred pain to the areas sharing innervation by the same segments of the spinal cord 26. [11.] Where does gaseous exchange occur in the lungs? Alveoli 27. [10.] Define auscultation. P. 103 in text listening to the sound of the heart valves. 28. [16.] What is the fibrous skeleton of the heart? Where is it found? Be specific. p. 87 text; dense fibrous tissue at the base of the valves of the heart 29. Capillaries connect the ____venous___ and ____arterial____ sides of circulation. 30.[22.] Identify the pleural region that extends above the first rib. Cupola

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31. What is the relationship of the heart ventricles to the sternum? Heart lies posterior to sternum. (4th ed. not specifically stated) specifically right ventricle posterior to sternum 32. What is the direct venous drainage of the thoracic wall? Intercostal veins (4th ed. p. 63, p. 111) Posterior intercostal veins end in the azygos venous system, which drains right side of thoracic wall and empties into SVC. Hemiazygos system drains left side of thoracic cavity and drains into azygos vein. 33. What is the importance of the anastomosis between the superior and inferior epigastric blood vessels? If an internal (deep) vessel is blocked, blood can bypass the blockage by way of the inferior and superior epigastric vessels of the body wall. (4th ed. p. 126) Anastamoses = communications between multiple branches of an artery that provide numerous potential detours for blood flow in case the usual pathway is obstructed; if main channel is occluded, the smaller alternate channels can usually increase in size, providing for collateral circulation that insures blood supply to structures distal to blockage. Superior epigastric artery = continuation of internal thoracic artery enters superior rectus sheath to supply upper part of rectus abdominus Inferior epigastric artery = arises from external iliac artery superior to inguinal ligament runs superiorly to enter inferior rectus sheath to supply lower part of rectus abdominus Superior epigastric and inferior epigastric anastamose with each other help to supply all layers of abdominal muscles 34. Where does the main thoracic lymphatic duct empty into the venous system? Between the left subclavian vein and the left internal jugular vein. (4th ed. p. 110-111) Empties into venous system near the union of the left internal jugular and subclavian veins, the left venous angle, or origin of left Brachiocephalic vein 35. Name the endocrine organs that are found in the thorax, in the abdomen, and in the pelvis. Breast, thymus, pancreas, adrenal (suprarenal), ovary, and testis (4th ed. pp. 102, 177-178, 162-164, 244-245, 130131) Technically breast NOT endocrine gland since it doesnt produce hormones and release into bloodstream w/out ducts. THYMUS = Lymphoid organ in lower part of neck and anterior part of superior mediastinum. Posterior to manubrium. Produces lymphocytes to help immune system. After puberty, gland shrinks or INVOLUTES replaced by fat and not visible in adult cadavers. 36. What prevents the first rib from being palpated? Clavicle (4th ed. p. 67) 37. Identify the borders and surfaces of the lungs. (4th ed. p. 71) Surfaces: 1.) Costal surface = adjacent to sternum, costal cartilages, and ribs 2.) Mediastinal surface = includes hilum of lung and related medially to the mediastinum and posteriorly to sides of vertebrae 3.) Diaphragmatic surface = rests on convex dome of diaphragm Borders: 1.) Anterior border = where costal and mediastinal surfaces meet anteriorly and overlap the heart 2.) Inferior border = circumscribes the diaphragmatic surface of the lung and separates the diaphragmatic surface from the costal and mediastinal surfaces 3.) Posterior border = where the costal and mediastinal surfaces meet posteriorly is broad and rounded and lies adjacent to the thoracic region of the vertebral column 38. What are the three structural layers of the heart? Epicardium, myocardium, and endocardium. (4th ed. p.84)

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39. Be able to identify the structure and list the function of each part of the conduction system of the heart. (4th ed. pp. 97-98) SA node = pacemaker; initiates impulse that passes through muscle fibers to cause atria to contract AV node = distributes signal to ventricles through AV bundle Left and right bundle branches = pass on each side of IV septum Purkinje fibers = supply papillary muscles and walls of ventricles 40. What is the difference in the origin and the function of the sympathetic -(thoracolumbar fight or flight system) and parasympathetic nervous system (craniosacral resting system). (4th ed. pp. 36-37) Visceral motor innervation = efferent nerve fibers and ganglia of autonomic NS organized into: Sympathetic NS = origin is thoracolumbar; effects are catabolic = prep for flight or fight Parasympathetic NS = origin is craniosacral; effects are anabolic = normal function & conserve energy 41. Be able to identify the nine abdominal regions and give an example of a structure or organ that lies in each of the regions. (4th ed. pp. 117-118 + Spelled out in lecture notes) 42. How do the abdominal quadrants differ from the abdominal regions? Identify the boundaries of each? (4th ed. pp. 117-118) Nine regions are delineated by 4 planes; 2 horizontal = subcostal (passing through inferior border of 10th costal cart. on each side) & transtubercular (passing through the iliac tubercles and body of L5 vertebrae); 2 vertical = midclavicular planes (passing from midpoints of clavicles to midinguinal points midpoints of lines joining the ant. sup. iliac spines and superior edge of pubic symphysis) Quadrants have umbilicus at center; median plane divides body into right and left halves with spine marking vertical divider; transumbilical plane runs along top of hip bones as horizontal divider 43. What are the internal boundaries of the abdominal cavity? (4th ed. p. 117) Anterior = ribs 9, 10 & 11; Posterior = rib 12 & lumbar vertebrae; Superior = diaphragm; Inferior = upper margin of bony pelvis 44. Be able to identify the layers of the rectus sheath and identify from which abdominal wall muscle layer the sheaths originated. (4th ed. p. 120) Rectus sheath = formed by interlaced aponeuroses of flat abdominal muscles Anterior layer = formed by external oblique aponeruosis and anterior lamina of internal oblique aponeurosis Posterior layer = formed by posterior lamina of internal oblique aponeruosis and transverse abdominal aponeurosis 45. Be able to identify the abdominal openings of the respiratory diaphragm. (4th ed. p. 189) AKA the diaphragmatic apertures. Caval foramen/opening (IVC) Esophageal Hiatus (esophagus, vagal trunks), Aortic Hiatus (aorta, azygos vein, thoracic duct) 46. What is (are) the function of the abdominal wall muscles? Compress and support abdominal viscera. Assist in exhalation. Movement of the torso. (4th ed. p. 120) 47. Identify the structures that enter and leave the hilus of the liver. Where do these structures originate? (4th ed. p. 167) Portal triad = Common hepatic artery (from celiac trunk); Portal vein (from abdominal veins); Common bile duct (from fusion of common hepatic duct and cystic duct) 48. Identify the two main lobes of the liver and the subdivisions of the right lobe. (4th ed. p. 167) Left lobe & Right lobe (quadrate lobe and caudate lobe)

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49. What structure during embryonic development ran in the ligamentum teres of the liver? Left umbilical vein (4th ed. p. 167) 50. The bile, stored in the gallbladder, primarily breaks down what type of food materials? Ais in the emulsification of fats, increases peristalsis, and retards decomposition. (technically worded incorrectly because doesnt break downit emulsifies) (4th ed. p. 171) 51. Be able to identify the divisions, sphincters, and lining of the stomach. (4th ed. p. 143-144) Cardia, Fundus, Body, Pylorus = divisions; Rugae = lining; Pyloric sphincter 52. Name the mesentery, which attaches from the lesser curvature of the stomach to the hilus of the liver? What three structures run in the free margin of this mesentery? Lesser omentum, hepatic a., portal v., and common bile duct. (4th ed. p. 167) 53. In relationship to blood vessels what does the term anastomose mean? Two or more vessels that join together. (4th ed. p. 25) 54. Be able to give a definition of a portal system. (The body has two portal systems - hepatic and the hypophyseal). A venous system connecting/from one capillary bed to another capillary bed without an intervening arterial system. (4th ed. p. 173) 55. What structure attaches to the greater curvature of the stomach? GREATER omentum (NOTE incorrect answer given on study guide) (4th ed. p. 137) 56. Be able to identify the structures which form the stomach bed. (4th ed. p. 146) Stomach bed = on which the stomach rests when a person is in the supine position; formed by structures forming the posterior wall of the omental bursae = from superior to inferior are left dome of diaphragm, spleen, left kidney & suprarenal gland, splenic artery, pancreas, transverse meoscolon, and colon 57. With blockage of the superior mesenteric artery what is the significance of the marginal artery supplying the intestines? Blood can/will flow backwards through the marginal artery when there is a blockage therefore being able to supply all parts of the intestine. (4th ed. p. 158) 58. What is the clinical significance of the Z-line at the esophageal-gastric junction? (4th ed. p. 143) This is the point where the epithelium of the esophagus and stomach meet. In gastric reflux the acid of the stomach will eat away the lining of the esophagus causing ulceration of the esophagus. Changes could lead to cancerous cells developing in esophagus. 59. Define a mesentery. What is its importance? Double layered membrane surrounding the abdominal organs that contains blood vessels and nerves. (4th ed. p. 136) 60. Define a peritoneal ligament. A membrane providing support for an organ. (4th ed. p. 136) 61. Define an omentum. A membrane attached to the stomach. (4th ed. p. 136-137) 62. Identify the subdivisions of the small intestine. (4th ed. p. 146-154) Duodenum, jejunum, ileum 63. What is the action of the sympathetic (reduces mobility) and parasympathetic (distention and spasmonic pain) nervous system on the intestine? Sympathetic = inhibits digestion; Parasympathetic = stimulates digestion (4th ed. p. 154) 64. What are the subdivisions of the large intestine? (4th ed. p. 154-159) cecum, ascending, transverse, descending, sigmoid, rectum, and anal canal

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65. Be able to identify the following structures or areas from a written description. a. costodiaphragmatic recess between ribs & diaphragm (4th ed. p.70) this cleft-like extension of the pleural cavity between the diaphragm and the lower part of thoracic cage separates posterior of spleen from 9th-11th ribs b. gastrosplenic ligament between stomach & spleen (4th ed. p. 162) part of greater omentum running between the greater curvature of the stomach and the spleen c. splenorenal ligament between spleen & kidney (4th ed. p. 162) connects spleen to left kidney; splenic artery found within layers of ligament d. hilus of the liver where structures enter & leave liver (4th ed. p. 167- NOTE called porta hepatis) area where portal triad enter/exit liver e. portal vein arises from one venous capillary bed to another venous capillary bed without and intervening arterial system (4th ed. p. 173) splenic vein unites with superior mesenteric vein posterior to neck of pancreas to form portal vein 66. What are the three identifying characteristics of the large intestine that distinguishes it from small intestine? (4th ed. p. 154) Teniae coli, haustra, omental appendices 67. Be able to identify the structural differences between the male and female pelvic bone. (4th ed. p. 208) Inlet of pelvis pelvic brim (ilet)(linea terminalis) is larger in females; oval or rounded in females compared to heart shape in males Outlet of pelvis wider in females Lumbosacral angle is end of lumbar curvature and more pronounced in females Ischial spine distance between ischial spines greater in female this is narrowest part of the pelvic canal through which baby must pass Subpubic angle greater in female (finger test) Pelvic tilt more posterior in female Male pelvis = heavier and thicker with more prominent bone markings; make narrow v with 1st and 2nd digit on pubic arch; rounder obturator foramen and larger acetabulum Female pelvis = wider, shallower and has larger pelvic inlet and outlet; make wide V with thumb and 1st digit on pubic arch; oval obturator foramen and smaller acetabulum

68. What is the importance of intestinal gutters (paracolic gutters)? Infection travels along these peritoneal depressions (gutters) (4th ed. p. 139-140) 69. What are the structures of the pelvic bone? (4th ed. p. 205-209) Hip bones (ilium, ischium, pubis) + sacrum 70. Be able, by description, to identify the internal structures of the kidneys. (4th ed. pp. 176-178) Also covered in lecture. 71. Identify the three places where the ureter is constricted. (4th ed. p. 225, Blue Box) Exits the kidney, pelvic brim, enters urinary bladder 72. What is the relationship of the suprarenal (adrenal) glands to the kidneys and the diaphragm? On the superior pole of the kidney and inferior to the diaphragm (4th ed. p. 177) Located between superomedial aspects of kidneys and the diaphragmatic crura; Sit on top of superior pole of kidney and are enclosed by renal fascia by which they are attached to crura of diaphragm 73. Where do the blood vessles to the suprarenal glands originate? Inferior phrenic artery, abdominal aorta & renal artery (4th ed. p. 179) 74. What is the difference between the renal sinus and the renal pelvis? (4th ed. p. 176) The pelvis lies in the renal sinus. Renal sinus = hilus leads to an area within kidney called renal sinus = contains adipose tissue in which renal pelvis, calices, vessls and nerves are embedded. Renal pelvis = enlarged origin of ureter within kidney

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75. What is the relationship of the renal fascia and fat to the kidney? Fat is on the outside of the fascia (4th ed. p. 176) Perirenal fat capsule surrounds kidneys and suprarenal glands and is continuous with fat in renal sinus. Kidneys, suprarenal glands, and fat surrounding them are enclosed (except inferiorly) by membranous layer of renal fascia External to renal fascia is pararenal fat body, the extraperitoneal fat of lumbar region most obvious posterior to kidney 76. Identify the main muscles of the posterior abdominal wall. (4th ed. p. 193) Psoas major, iliacus, quadratus lumborum 77. Identify the three largest nerves of the lumbar plexus and in general what structures do they supply? (4th ed. p. 194) Femoral = anterior thigh; Obturator = medial thigh; Lumbosacral trunk = primarily sciatic nerve 78. What are the branches of the internal iliac artery? (4th ed. p. 263-264) Anterior Division = goes to anterior structures in the pelvis o Umbilical A. superior aspect urinary bladder in females; ductus deferens in males o Obturator A. superior aspect urinary bladder in females; ductus deferens in males o Inferior Vesical urinary bladder, ureter, seminal gland, prostate o Middle Rectal seminal gland, prostate, rectum o Internal Pudental main artery to perineum Perineal superficial perineal muscles; scrotum or vestibule Penis or Clitoris erectile tissue of organ o Inferior Gluteal piriformis, levator ani, and gluteal muscles o Uterine pelvic part of ureter, uterus, ligament of uterus, uterine tube, vagina Posterior Division = goes to posterior structures in the pelvis o Iliolumbar iliacus, psoas major, quadratus lumborum, and cauda equina o Lateral sacral piriformis and vertebral canal

79. What is the landmark for the division of the true pelvis from the false pelvis? Pelvic brim (4th ed. p. 207) - true pelvis AKA lesser pelvis and false pelvis AKA greater pelvis 80. Which of the male reproductive glands makes the largest contribution to semen? Seminal vesicle (4th ed. p. 233) AKA seminal glands 82. In the male this gland can obstruct the urethra. Prostate gland (4th ed. p. 235 Blue box) 83. Be able to give, in order, the pathway that sperm would travel through the male duct system into the urethra. p. 217 218 lab book. Covered in lecture Testis Seminiferous tubules contain Leydig cells that produce androgens (testosterone) Tubuli recti join seminiferous tubules to rete testis Rete testis network of canals at termination of seminiferous tubules Efferent ductules transport sperm from rete testis to epidiymis Epididymis storage for sperm while they mature Ductus (vas) deferens Passes from the testis via the spermatic cord through the inguinal canal into the pelvic cavity where the duct expands to form the ampulla of the ductus deferens Ampulla of the ductus deferens [Fig. 3.11 p. 227] Joins the duct of the seminal vesicle to form the ejaculatory duct, which ends by emptying into the prostatic part of the male urethra Ejaculatory duct = ampulla of ductus deferens + duct of seminal vesicle Prostatic Urethra

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84. What structures compose the spermatic cord? Ductus deferens, testicular artery, pampiniform plexus of veins, dartos muscle etc. (4th ed. p. 130) Testicular artery, testicular vein, ductus deferens. 85. What is the action of the cremaster and dartos muscles? (4th ed. p. 129) Cremaster = elevates testis towards abdomen in cold conditions; Dartos = wrinkles the scrotal sac and assists cremaster 86. What three layers make up the wall of the uterus? (4th ed. p. 239) Endometrium, myometrium, perimetrium 87. Trace the pathway of a fertilized ovum from the ovary to implantation. Infundibulum of uterine tube -> ampulla of uterine tube -> isthmus of uterine tube -> attaches to endometrium of uterus Ovary pass fimbriae into infundibulum - Ampulla (where fertilization takes place) isthmus of uterine tube fundus of uterus body of uterus implant in wall 88. What are the bones that form the pelvic girdle? Right and left hip bones (ilium, ischium, pubis) and sacrum (4th ed. p. 205) 89. What is the importance of the subpubic angle? The angle is a landmark to identify the male from the female pelvic bone. (4th ed. p. 208) 90. What muscles form the pelvic diaphragm? (4th ed. p. 211) Levator ani and coccygeus muscles 91. What are the boundaries of the urogenital triangle? Male? Female? (4th ed. p. 267 & 269) Boundaries: anterolaterally - inferior pubic ramus, ischial ramus; posteriorly - posterior margin of perineal membrane (corresponds to an imaginary line connecting the ischial tuberosities) Male: bulb and crus of penis Female: vaginal opening, urethal opening, clitoris Superficial Transverse Perineal Muscle forms base of urogenital triangle in both sexes

92. Which muscle of the pelvic floor can be torn in childbirth? Pubococcygeus (4th ed. p. 217) 93. Identify the divisions of the uterine tube. (4th ed. p. 243) Ampulla, infundibulum, isthmus 94. Where does fertilization normally take place? Ampulla of uterine tube (Not clearly stated in 4th ed.) 95. [78.] Be able to identify the following branches of the internal iliac artery. (Obturator, Vesicle, Gonadal, Rectal, and Internal Pudendal etc.) 96. Be able to identify the parts of the urinary bladder. Describe its relationship with the uterus and the prostate gland. (4th ed. p. 226) fundus, apex, body, neck and trigone. Superior to uterus. Inferior to prostate. 97. What is the vesicle trigone and what is its importance? This is the area between the entrance of the 2 ureters and the exit of the urethra. This area has a different epithelial lining and it is more common to find bladder cancer in this area because of the areas developmental origin. (4th ed. p. 243) 98. Be able to identify a structure in the pelvic region by a description of the surrounding anatomical structures. EX. The pubic symphysis lies anterior to the urinary bladder. 99. Describe the location of the urinary bladder. Directly posterior to the pubic symphysis when empty

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Identify the layers of the urinary bladder. Outer = fibrous adventitia surrounds the urinary bladder except on the superior surface which is covered by peritoneum. Middle = thick muscular layer called the Detrusor muscle = muscle of urinary bladder. Inner = lined by transitional epithelium 100. What is an ectopic pregnancy? Identify the most common area(s) of the body where they can be located. (4th ed. p. 249 Blue Box) Implantation of embryo outside of uterus. Ampulla of uterine tube. 101. What is the arterial supply to the perineum? Perineal artery (4th ed. p. 263) 102. What are hemorrhoids? What is the difference between external and internal hemorrhoids? (4th ed. p. 260 Blue Box) Swollen and inflamed veins in anus and lower rectum; AKA piles Internal hemorrhoids prolapses of the rectal mucosa containing the normally dilated veins of the internal rectal venous plexus; often compressed by anal sphincters so strangulate and ulcerate = bright red bleeding; INSIDE ANUS External hemorrhoids thromboses (blood clots) in veins of external rectal venous plexus and are covered by skin; UNDER SKIN SURROUNDING ANUS 103. What blood vessel(s) mark the difference between a direct and indirect inguinal hernia? (4th ed. p. 134 Blue Box) Inferior epigastric vessels

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