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The Structural Basis of Medical Practice (SBMP) - Human Gross Anatomy, Radiology, and Embryology

Answer Guide for Abdomen, Pelvis, and Perineum: Written Examination Part III (58 pts) - 1998

The College of Medicine at The Pennsylvania State University

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Note:  This guide indicates key points to address in answering the question. This is not the "answer."

Part  III.    Answer in the space provided.  (58 pts)

1. A 57-year old professor is taken to the emergency room with sudden and severe pain in the abdomen.  He has a history of stomach ulcers.  Further tests and examinations reveal a perforation of the posterior wall of the stomach, with gastric contents spilling into the lesser sac. Define the boundaries (including spaces and/or recesses of the lesser sac (omental bursa)).  Explain why damage to the stomach would produce sharp pains in the abdomen.  Discuss the pathway of materials that appear in the greater sac, and provide infromation about the location of these fluids/food contents with respect to body position.  (10 pts)

  1. General comments:
  2. Superior recess - posterior to liver, begins at epiploic foramen
  3. Inferior recess - inferior ot the right gastropancreatic fold (common hepatic a.)
  4. Splenic recess - left of gastroepiploic fold (left gastric a.)
  5. Epiploic foramen - communication between lesser and greater sacs
  6. Why sharp pain?
  7. Pathway of Materials?

2.  The relationship of the ovary to reproduction demands a through knowledge of this structure.  Discuss the anatomy of the ovary, and include a) structure and support, b) relationships, c) innervation (motor and sensory), and d) blood supply and lymphatics.  (10 pts)

  1. structure and support
  2. relationships
  3. innervation (motor and sensory)
  4. blood supply and lymphatics

3.  While a riding a bicycle, a 14-year old boy skids on a rain-soaked street, lacerates the perineal membrane (inferior fascia of the urogenital diaphragm) and damages the urethra.  In the emergency room the patient is found to have extravasation of urine.  Discuss the boundaries and fascial relationships that define the accumulation of urine.  In your discussion be specific as to terminology of fascial planes and elaborations.  (8 pts.)

  1. General Comment
  2. Anterior abdominal wall - between Scarpa's fascia and deep fascia of external oblique
  3. Thigh - between Scarpa's fascia and fascia lata
  4. Scrotum - between Darto's tunic (Scarpa's derivative) and external spermatic fascia (deep fascia)
  5. Penis - between Colle's fascia (Scarpa's derivative) and Bucks fascia (deep fascia)
  6. Urogenital triangle - between superficial perineal fascia (derivative of Scarpa's fascia) and perineal membrane (deep fascia)

4.  Discuss the course and branches of the internal pudendal artery in the pelvis, gluteal region, ischiorectal fossa, and perineum.  Please include anatomical relationships of the artery, fascial layers involved, as well as spaces/recesses encountered by the internal pudendal artery and its branches.  (8 pts)

  1. General Comments and Overview
  2. Internal pudendal artery enters pudendal canal
  3. elaborates terminal branches

5.  Discuss the structure, relationship(s) to the peritoneum and surrounding viscera and at the hilum, sensory and motor innervation, vascular supply, and lymphatic drainage of the left kidney.  (12 pts)

  1. Structure
  2. Position
  3. Relations to peritoneum and fascia
  4. Relations to surrounding viscera (left kidney)
  5. Relations at the hilum
  6. Sensory and motor innervation
  7. vascular supply
  8. lymphatic drainage

6.  Indicate your understanding of the anatomy of the diaphragm and include discussion of muscles, ligaments, site(s) of weakness and attachment, the location and structures coursing between the thorax and abdomen, as well as the innervation, vascular supply, and lymphatics of the diaphragm.  (10 pts)

  1. Parts of the diaphragm
  2. Apertures
  3. Pathways of structures coursing between thorax and abdomen
  4. Relations (limited to abdomen) - consider that the diaphragm is domed shaped
  5. Blood supply
  6. Innervation
  7. Lymphatic Drainage (note: the lumbar nodes were most important to mention)

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The Structural Basis of Medical Practice - Human Gross Anatomy
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