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You have scored 15%
You answered 18 correct out of 119 questions.
Your answers are shown below:
A 55 year old woman presents to ED complaining of severe colicky loin to groin pain. Imaging
shows renal calculi. At which of the following locations is the calculus likely to lodge:
a) Where the ureter is crossed by the uterine artery
b) In the midportion of the ureter
c) At the pelvic brim
d) Major calyx
e) Minor calyx
Something wrong?
Answer
The ureters are constricted at the ureteropelvic junction, where they cross the pelvic brim and where they enter the
bladder, denoting the most likely areas for renal calculi to lodge. The minor and major calcyes are proximal to the
ureter.
Notes
The ureters are muscular tubes that transport urine from the kidneys to the bladder. They are continuous superiorly
with the renal pelvis at the ureteropelvic junction (at the level of the renal hilum, vertebra L1).
Anatomical course and relations
Inferior to the ureteropelvic junction, the ureters descend retroperitoneally on the medial aspect of the psoas major
muscle, anterior to the tips of the transverse processes of the lower lumbar vertebrae. The ureters cross the pelvic
brim anterior to the bifurcation of the common iliac arteries to enter the pelvic cavity and continue their journey down
,brim anterior to the bifurcation of the common iliac arteries to enter the pelvic cavity and continue their journey down
the lateral pelvic walls.
Within the pelvic cavity, the ureters are crossed by the uterine artery lateral to the cervix in women, and by the ductus
deferens just posterior to the bladder in men.
At the level of the ischial spines, they turn anteromedially, moving in a transverse plane towards the bladder. The
ureters enters obliquely through the base of the bladder at the level of the pubic tubercle.
The right ureter lies in close relation to the appendix, and thus be irritated in acute appendicitis causing urinary
frequency.
Constrictions
At three points along their course, the ureters are constricted;
the rst point is at the ureteropelvic junction
the second point is where the ureters cross the pelvic brim
the third point is where the ureters enter the wall of the bladder.
Kidneys stones can become lodged at these constrictions.
Modi ed by FRCEM Success. Original by Jordi March i Nogué [1] (Own work) [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via
, (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via
Wikimedia Commons
Renal colic pain
Visceral afferent bres from the ureters enter the spinal cord at T11 – L2, with ureteric pain (usually from ureteric
distension) thus referred to the dermatomes supplied by T11 – L2; the posterior and lateral abdominal wall below the
ribs and above the iliac crest, the pubic region, the scrotum in males, the labia majora in females and the proximal
anterior aspect of the thigh (loin to groin pain).
Which of the following best describes the relationship of the prostate gland and rectum:
a) The prostate gland lies superior to the rectum.
b) The prostate gland lies inferior to the rectum.
c) The prostate gland lies anterior to the rectum.
d) The prostate gland lies posterior to the rectum.
e) The prostate gland is not in relation to the rectum.
Something wrong?
Answer
The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external
urethral sphincter (with the levator ani lying inferolaterally to the gland) and anterior to the rectum.
Notes
The prostate gland is an unpaired accessory structure of the male reproduction system that surrounds the prostatic
urethra in the pelvic cavity. It typically weighs between 20 – 40 g with an average size of 4 x 3 x 2 cm (its width being
the greatest).
Secretions from the prostate, together with secretions from the seminal vesicle, contribute to the formation of semen
during ejaculation. The ejaculatory ducts pass almost vertically in an anteroinferior direction through the posterior
aspect of the prostate to open into the prostatic urethra.
Relations
The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external
urethral sphincter (with the levator ani lying inferolaterally to the gland) and anterior to the rectum. The urethra
passes through the prostate.
Structure
Traditionally the prostate gland is divided anatomically into lobules, but more important clinically is speci c anatomical
zones rather than lobes:
, zones rather than lobes:
The transitional zone is the most central part of the gland that surrounds the prostatic urethra and the area
most prone to prostatic hyperplasia.
The central zone encircles the transitional zone and encompasses the ejaculatory ducts posterior to the
prostatic urethra.
The peripheral zone is the outermost region of the prostate and the area most prone to carcinomatous
transformation. This is the zone palpated on PR examination.
Lymphatic drainage
The prostate gland has several lymphatic drainage pathways primarily to the internal iliac nodes with some drainage to
external iliac and presacral nodes.
Modi ed by FRCEM Success. Original by Unknown Illustrator [Public domain or Public domain], via Wikimedia
Commons
The psoas major muscle originates from which of the following:
a) The T12 – L5 vertebrae
b) The 11th and 12th rib
c) The T11 – T12 vertebrae
d) The sacrum
e) The iliac crest
Something wrong?
You have scored 15%
You answered 18 correct out of 119 questions.
Your answers are shown below:
A 55 year old woman presents to ED complaining of severe colicky loin to groin pain. Imaging
shows renal calculi. At which of the following locations is the calculus likely to lodge:
a) Where the ureter is crossed by the uterine artery
b) In the midportion of the ureter
c) At the pelvic brim
d) Major calyx
e) Minor calyx
Something wrong?
Answer
The ureters are constricted at the ureteropelvic junction, where they cross the pelvic brim and where they enter the
bladder, denoting the most likely areas for renal calculi to lodge. The minor and major calcyes are proximal to the
ureter.
Notes
The ureters are muscular tubes that transport urine from the kidneys to the bladder. They are continuous superiorly
with the renal pelvis at the ureteropelvic junction (at the level of the renal hilum, vertebra L1).
Anatomical course and relations
Inferior to the ureteropelvic junction, the ureters descend retroperitoneally on the medial aspect of the psoas major
muscle, anterior to the tips of the transverse processes of the lower lumbar vertebrae. The ureters cross the pelvic
brim anterior to the bifurcation of the common iliac arteries to enter the pelvic cavity and continue their journey down
,brim anterior to the bifurcation of the common iliac arteries to enter the pelvic cavity and continue their journey down
the lateral pelvic walls.
Within the pelvic cavity, the ureters are crossed by the uterine artery lateral to the cervix in women, and by the ductus
deferens just posterior to the bladder in men.
At the level of the ischial spines, they turn anteromedially, moving in a transverse plane towards the bladder. The
ureters enters obliquely through the base of the bladder at the level of the pubic tubercle.
The right ureter lies in close relation to the appendix, and thus be irritated in acute appendicitis causing urinary
frequency.
Constrictions
At three points along their course, the ureters are constricted;
the rst point is at the ureteropelvic junction
the second point is where the ureters cross the pelvic brim
the third point is where the ureters enter the wall of the bladder.
Kidneys stones can become lodged at these constrictions.
Modi ed by FRCEM Success. Original by Jordi March i Nogué [1] (Own work) [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via
, (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via
Wikimedia Commons
Renal colic pain
Visceral afferent bres from the ureters enter the spinal cord at T11 – L2, with ureteric pain (usually from ureteric
distension) thus referred to the dermatomes supplied by T11 – L2; the posterior and lateral abdominal wall below the
ribs and above the iliac crest, the pubic region, the scrotum in males, the labia majora in females and the proximal
anterior aspect of the thigh (loin to groin pain).
Which of the following best describes the relationship of the prostate gland and rectum:
a) The prostate gland lies superior to the rectum.
b) The prostate gland lies inferior to the rectum.
c) The prostate gland lies anterior to the rectum.
d) The prostate gland lies posterior to the rectum.
e) The prostate gland is not in relation to the rectum.
Something wrong?
Answer
The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external
urethral sphincter (with the levator ani lying inferolaterally to the gland) and anterior to the rectum.
Notes
The prostate gland is an unpaired accessory structure of the male reproduction system that surrounds the prostatic
urethra in the pelvic cavity. It typically weighs between 20 – 40 g with an average size of 4 x 3 x 2 cm (its width being
the greatest).
Secretions from the prostate, together with secretions from the seminal vesicle, contribute to the formation of semen
during ejaculation. The ejaculatory ducts pass almost vertically in an anteroinferior direction through the posterior
aspect of the prostate to open into the prostatic urethra.
Relations
The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external
urethral sphincter (with the levator ani lying inferolaterally to the gland) and anterior to the rectum. The urethra
passes through the prostate.
Structure
Traditionally the prostate gland is divided anatomically into lobules, but more important clinically is speci c anatomical
zones rather than lobes:
, zones rather than lobes:
The transitional zone is the most central part of the gland that surrounds the prostatic urethra and the area
most prone to prostatic hyperplasia.
The central zone encircles the transitional zone and encompasses the ejaculatory ducts posterior to the
prostatic urethra.
The peripheral zone is the outermost region of the prostate and the area most prone to carcinomatous
transformation. This is the zone palpated on PR examination.
Lymphatic drainage
The prostate gland has several lymphatic drainage pathways primarily to the internal iliac nodes with some drainage to
external iliac and presacral nodes.
Modi ed by FRCEM Success. Original by Unknown Illustrator [Public domain or Public domain], via Wikimedia
Commons
The psoas major muscle originates from which of the following:
a) The T12 – L5 vertebrae
b) The 11th and 12th rib
c) The T11 – T12 vertebrae
d) The sacrum
e) The iliac crest
Something wrong?
