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Wound Sinus And Fistula Question And Answers

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Wound Sinus And Fistula Important Notes

Definitions

Wound: Wound is discontinuity or break in the surface epithelium

Healing: Replacement of destroyed tissue by living tissue

Regeneration: Replacement of lost tissue by tissue similar in type

Repair: Replacement of lost tissue by granulation tissue followed by fibrosis and scar tissue formation

Asepsis: Precautions taken before surgical procedure against the development of infection

Nosocomial Infection: Infection acquired from hospital

Sinus: Sinus is a blind tract leading from the surface down into the tissues

Fistula: Fistula is an abnormal communication between 2 epithelial surfaces commonly between a hollow viscus and skin or between 2 hollow viscera

Wound sinus and fistula questions and answers

  1. Causes Of Wound
    • Trauma
    • Physical, chemical, and microbial agent
    • Ischaemia
  2. Types Of Wounds
    • Open Wounds
      • Incised wound
      • Lacerated
      • Penetrating wound
      • Crushed wound
    • Closed wounds
      • Contusion
      • Abrasion
      • Haematoma
  3. Types Of Wound Healing
    • Healing by the first Intention
      • When a wound is sutured primarily, the wound healing occurs with minimum scaring
    • This is known as healing by the first intention
    • Healing by Second Intention
      • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible
      • In such cases, the wound heals with more scar tissue and takes longer time to heal
      • This is known as healing by secondary intention
  4. Process Of Wound Healing
    • Inflammation
    • Epithelisation
    • Granulation tissue formation
    • Scar remodeling
  5. Complications Of Wound Healing
    • Implantation cyst
    • Painful scar
    • Cicatrization
    • Keloid formation
    • Neoplasia
  6. Factors Affecting Wound HealingWound Sinus And Fistula Factors Affecting Wound Healing
  7. Types Of Sinus
    • Congenital
      • Preauricular
      • Umbilical
    • Acquired
      • Pilonidal
      • Osteomyelitis
      • Actinomycosis
      • Tuberculosis

Sinus and fistula Questions & Answers in surgery

Wound Sinus And Fistula Long Essays

Question 1. What is wound healing? What are the types? How do you manage compound fracture of the mandible?
Answer:

Wound Healing: Wound healing means replacement of lost tissues by living tissues

Read And Learn More: General Surgery Question and Answers

Wound Healing Types:

  1. Healing By The First Intention
    • When a wound is sutured primarily, the wound healing occurs with minimum scarring
    • This is known as healing by the first intention
  2. Healing By Secondary Intention
    • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible
    • In such cases, the wound heals with more scar tissue and takes a longer time to heal
    • This is known as healing by secondary intention

Management Of Compound Fracture

  • Immediate splinting and first aid are done
  • Assessment of associated problems is done, like
    • Shock
    • Associated injuries
    • Vessels and nerve involvement
    • Type of fracture
  • Resuscitation Is Carried Out By
    • Blood transfusion
    • Antibiotics
    • 4 fluids
    • Analgesics
    • Wound debridement
  • X-Ray Of The Fracture Part Is Taken
    • The reduction of the part is done
    • It means restoration of anatomical alignment
    • It is done under general anesthesia with muscle relaxation
    • A compound fracture requires open reduction
    • It is carried out by screws, plates, and wires
  • Immobilization
    • Once reduced, it should be maintained by proper immobilization
    • United fractured site is stiff due to immobilization
  • Physiotherapy And Rehabilitation
    • Stiffness is corrected by it
  • A final x-ray is taken to confirm the proper union of fracture segments.

Wound healing, sinu, and fistula questions

Question 2. Describe types of wounds and their management.
Answer:

Wound:

  • The wound is a discontinuity or break in the surface epithelium.
  • It May Be Caused By.
    • Trauma.
    • Physical-chemical and microbial agents.
    • Ischaemia.

Types Of Wounds:

According To The Morphology.

  1. Open Wounds.
    • Incised Wounds
      • These are usually caused by a sharp knife or razor.
      • They are relatively clean wounds.
      • The wound can bleed a lot and quickly.
    • Open Wounds Management:
      • Application of pressure to stop bleeding.
      • Cleaning with septic solution.
      • Closure by primary suturing.
      • Repair of all damaged tendons, nerves, and major blood vessels within 6 hours of injury.
    • Lacerated Wounds
      • It commonly occurs following road traffic accidents.
      • Edges of wounds are jagged with certain lacerated and devitalized structures inside the wound.
      • Bleeding may be severe.
      • Injury may involve skin and subcutaneous tissue.
    • Lacerated Wounds Management:
      • Thorough debridement of the wound.
      • Trimming of edges.
      • Repair of tendons and nerves is delayed till complete healing of the wound occurs due to the risk of contamination.
    • Penetrating Wound
      • Occurs due to a stab injury.
      • Involves more depth than an incised wound.
      • Example: stab injuries of the abdomen.
    • Penetrating Wound Management:
      • Observe the patient for at least 24 hours.
      • Layer-by-layer exploration followed by primary suturing is done.
    • Crushed Wounds
      • Occurs due to industrial, road traffic, and wear injuries.
      • They cause severe hemorrhage, death of the tissues, and crushing of blood vessels.
    • Crushed Wounds Management:
      • Good debridement.
      • Removal of all necrotic and dead tissues.
      • Late,r delayed primary suturing should be performed.
  1. Closed Wounds
    • Closed Wounds Contusion
      • Minor soft tissue injury without a break in the skin.
      • It produces discoloration of the skin due to the collection of blood underneath.
    • Closed Wounds Management:
      • Rest the injured site.
      • Apply ice for 10-15 min for every 2 hours to close blood vessels.
      • Compress and wrap firmly with a bandage.
    • Abrasion
      • In it, the epidermis of the skin is scraped off.
      • Caused by a sliding fall onto a rough surface.
    • Abrasion Management:
      • Heal on their own within 1-2 weeks.
      • Just needs cleaning of the area with a septic solution.
    • Hematoma
      • Hematoma refers to the collection of blood.
      • Common in patients who have bleeding tendencies.
    • Hematoma Management:
      • Pressure is applied in the form of bondage to reduce hemorrhage and swelling.

Differences between sinus and fistula Questions & Answers

According To The thickness of the Wound:

  1. Superficial – involves epidermis and dermis upto dermal papillae.
  2. Partial Thickness – involves upto the lower dermis.
  3. Full Thickness – involves the skin and subcutaneous tissues.
  4. Deep Wounds – wounds penetrate an organ or tissue.

According To The Involvement Of Other Structures:

  1. Simple Wounds – comprise only one organ/tissue.
  2. Combined Wounds – mixed tissue trauma.

According To Time Elapsed:

  1. Fresh Wounds – upto 8 hours from trauma.
  2. Old Wounds – after 8 hours from trauma.

According To Bacterial Contamination Of Wound:

  1. Clean Wounds – made by the doctor during an operation or under sterile conditions.
  2. Clean-Contaminated wounds.
  3. Contaminated wounds.
  4. Dirty wounds.

Question 3. Discuss the pathology and healing of wounds.
Answer:

Pathology Of Wounds: Pathology Of Wound Healing Consists Of The Following Events:

1. Inflammation: Inflammation begins immediately at the time of injury and causes:

Aggregation of platelets.
↓
Initiation of coagulation cascade
↓
Formation of platelet plugs to stop bleeding.
↓
Transient vasoconstriction.
↓
Vasodilation.
↓
Release of histamine which produces local vasodilation and increases vascular permeability.
↓
Release of kinins, kalikerin enzyme, and prostaglandin.
↓
Chemotaxis.
↓
Initially, migration of polymorphonuclear leucocytes occurs followed by monocytes at the site.
↓
Phagocytosis occurs to ingest cell debris.

2. Wound Contraction:

  • Wound contraction occurs 3-4 days after injury.
  • The period when there is no wound contraction is called an initial lag period.
  • After this period, there is a period of rapid contraction, which is completed by the 14th day.
  • The wound is reduced to approximately 80% of its original size.
  • The amount of contraction depends on the amount of skin available surrounding the wound to be stretched over the wound.
  • It Occurs Due To
    • Removal of fluid by drying.
    • Contraction of collagen.
    • Contraction of granulation tissue.

3. Epithelisation:

  • The epidermis immediately adjacent to the wound edge thickens on the first day.
  • Marginal basal cells lose their attachment to the underlying dermis and migrate into the wound.
  • Basal cells proliferate, and the daughter cells formed migrate to the site.
  • Within 48 hours, the entire wound surface is re-epithelialized.

4. Granulation Tissue Formation:

  • Hematoma within the wound is replaced by granulation tissue consisting of new capillaries and fibroblasts.

5. Scar Remodeling:

  • Scar Remodeling is the last stage of wound healing.
  • On about the 7th day, wounds show a delicate fine reticulum of young collagen fibers to form a scar.
  • Scar strength increases gradually.
  • Maturation takes many months.
  • As Time Proceeds, The Following Changes Occur.
    • Change in bulk and form of scar.
    • Anatomical arrangement.
    • Fibers become thicker.
    • Non-oriented fibers disappear.
    • Fibers form 3-dimensional networks.

Healing Of Wound:

  1. Healing By The First Intention.
    • When a wound is sutured primarily, wound healing occurs with minimum scarring.
    • This is known as healing by first intention.
    • It occurs in wounds in which the anatomical location and the size allow the skin continuity to be restored.
  2. Healing By The Second Intention.
    • When there is irreparable skin loss or the wound becomes infected, primary suturing is not possible.
    • In such cases, the wound heals with more scar tissue and takes a longer time to heal.
    • This is known as healing by secondary intention.
    • Example: healing of abrasions, ulcers, etc.

Short and long answer questions on wound sinus fistula

Question 4. Discuss the stages of wound healing for closed and open wounds. What are the factors affecting wound healing?
Answer:

Stages Of Wound Healing: Whether it is closed or open wounds, the stages of healing remain the same.

Factors Affecting Wound Healing:

  1. General Factors:
    • Age: In young age, healing is faster, while in old age it is delayed due to the presence of debilitating diseases.
    • Nutrition:
      • Protein Deficiency: Protein Deficiency causes impairment of granulation tissue and collagen formation.
      • Vitamin C Deficiency: Causes failure of collagen formation.
      • Vitamin A Deficiency: Vitamin A is required for proper epithelialization.
      • Zinc, copper, calcium, and manganese deficiency.
        • Causes failure of granulation tissue formation.
    • Hormones:
      • Corticosteroids may delay wound healing because of their anti-inflammatory activity.
      • Cortisone decreases the rate of protein synthesis and inhibits normal inflammatory reactions.
      • Anabolic steroids like testosterone increase the speed of wound healing.
    • Cytotoxic Drugs: Prevent or delay wound healing.
    • Jaundice and Uraemic: Delay wound healing due to poor fibroblastic repair.
    • Diabetes: Causes a delay in healing.
    • Generalized Infection: The Presence of pus delays healing
    • Malignancy, Anemia: Delays healing
  2. Local Factors:
    • Position Of Skin Wound:
      • When skin wounds are parallel to the lines of langer, they heal faster.
      • If wounds are present at the right angle to these lines, healing is delayed.
    • Blood Supply: Wounds with poor blood supply heal slowly.
    • Tension: Tension at the wound while suturing delays healing.
    • Infection: The presence of infection delays healing.
    • Haemotoma: Precipitates infection and delays healing.
    • Oxygen: Oxygen enhances the killing of pathogens by macrophage, increases the production of fibroblasts, and enhances healing
    • Movement: Movement of the injured site delays healing.
    • Radiation Exposure:
      • Radiation affects vascularity.
      • Causes delay in the formation of granulation tissue.
      • Inhibits wound contraction.
      • Wound healing is delayed.
    • Ultraviolet Light: Increases the rate of healing.
    • Other Factors Which Delay Healing Are:
      • Faulty technique of wound closure.
      • Presence of foreign bodies.
      • Adhesion to bony surface.
      • Necrosis.
      • Impairment of lymphatic drainage.

Question 5. Classify wound infections. Write briefly about hospital-acquired infections and their prevention.
Answer:

Hospital-Acquired/Nosocomial Infections:

  • Nosocomial Infections is defined as an infection that results from treatment in a hospital or any health service unit.
  • Infection can be from the patient’s organism or external sources.

Causative Organisms: They are classified as:

  1. Conventional Pathogens could cause disease in healthy persons in the absence of any immunity.
  2. Conditional Pathogens could cause disease only in persons with lower resistance.
  3. Opportunistic Pathogens that could cause generalized infections.
    • Example: staphylococci, gram-negative organisms.

Wound Infections Types:

  • Surgical wounds and other soft tissue are infectious through discharging wounds.
  • Urinary tract infections – infected urine, feces.
  • Respiratory tract infection – infected sputum.
  • Gastroenteritis.
  • Meningitis.

Wound Infections Prevention:

  • Isolation.
  • Proper ventilation of the ward.
  • Cleaning of the hospital environment.
  • Preventing transmission from the environment.
  • Surface sanitation.
  • Proper scrubbing and gloving before any procedure.
  • Autoclaving, sterilisation of instrument.
  • Safe injection practice.
  • Proper disposal of wastes.
  • Uses of disinfectant.
  • Avoid unnecessary use of antibiotics to prevent the development of resistance.

Sinus and fistula MCQs with answers

Question 6. Discuss bleeding wounds on the face.
Answer:

Bleeding Wounds On The Face

Wound Sinus And Fistula Bleeding Wounds Of Face

Types of wounds sinus and fistula questions

Wound Sinus And Fistula Short Essays

Question 1. Discuss factors affecting wound healing.
Answer:

Factors Affecting Wound Healing

Wound Sinus And Fistula Factors Affecting Wound Healing-1

Wound Sinus And Fistula Factors Affecting Wound Healing-2

Question 2. Healing by primary Intention.
Answer:

Primary Intention Definition:

  • When a wound is sutured primarily, wound healing occurs with minimum scarring.
  • This is known as healing by primary or first intention.

Primary Intention Stages:

1. Initial Bleeding.

  • The space between the surfaces of the incised wound is filled with blood.
  • Disruption of blood vessels occurs.
  • Results in formation of fibrin-rich haemal- toma.

2. Acute Inflammation.

  • Following Changes Occur.

Vasoconstriction
↓
Increased capillary permeability
↓
Release of vasoactive substances
↓
Migration of polymorphs to the site
↓
Phagocytosis.

3. Organization: Minimum granulation tissue formation occurs

4. Proliferation: Basal cells present at the wound margin proliferate and migrate towards the space.

5. Remodeling: New matrix synthesis occurs.

Primary Intention Contraindications:

  • An acute wound of more than 6 hours old.
  • Presence of foreign bodies.
  • Active oozing of blood from the wound.
  • Dead space under the skin closure.
  • Too much tension is present while suturing.

Surgical management of sinus and fistula Questions & Answers

Question 3. Healing by secondary intention.
Answer:

Secondary Intention Definition:

  • When there is irreparable skin loss, primary suturing is not possible.
  • So the wound heals with more scar tissue and takes a longer time to heal.
  • This is known as healing by secondary intention.

Secondary Intention Stages:

  1. Initial Inflammation.
    • Inflammation is prolonged due to the presence of more necrotic tissues and bacteria.
    • It affects surrounding tissues.
    • The wound is filled with coagulum.
  2. Wound Contraction.
    • Occurs due to stretching of the surrounding skin to close the defect.
    • After 2-3 days, dermal edges move towards each other.
    • After 5-10 days, it moves rapidly while after 2 weeks it slows down.
  3. Granulation Tissue Formation.
    • Granulation tissue completely covers the exposed wound gradually.
    • Granulation Tissue Formation forms a temporary protective layer till epi-realization begins.
  4. Epithelialisation.
    • Epithelium gradually grows over granulation tissue.
    • Epithelial cells slide into the wound forming a thin tongue of cells between granulation tissue and clot.
  5. Remodeling.
    • Remodeling is prolonged.
    • Remodeling of granulation tissue and scar occurs.
    • As a result, the wound area forms a flat scar.

Question 4. What is sinus and fistula? What are its causes?
Answer:

Sinus and fistula

  • A sinus is a blind track leading from the surface down to the tissues.
  • There may be a cavity in the tissues that is connected to the surface through the sinus.
  • The sinus is lined by granulation tissue.

Fistula:

  • A fistula is a communicating track between two epithelial surfaces, commonly between a hollow viscus and the skin.
  • The fistulais lined by granulation tissue.
  • Fistula may be abnormal communication between vessels.

Fistula Types:

  1. Blind – with only one open end.
  2. Complete – with both external and internal openings.
  3. Incomplete, with an external skin opening which does not connect to any internal organ.

Fistula Causes:

  1. Congenital – preduricular sinus, branchial fistula, trachea-oesophageal fistula, arteriovenous fistula.
  2. Acquired.
    • Bursting of sinus-example: fistula-in-ano.
    • Trauma or medical treatment.
    • Due to tooth abscess – median mental sinus.
    • The pilonidal sinus and thyroglossal fistula are examples of the acquired type.

Question 5. Difference between sinus and fistula.
Answer:

Difference Between Sinus And Fistula

Wound Sinus And Fistula Differences Between Sinus And Fistula

Wound care and fistula treatment questions

Wound Sinus And Fistula Short Answers

Question 1. Types of wounds.
Answer:

According To The Morphology:

  1. Open Wounds.
    • Incised wounds
    • Lacerated wounds
    • Penetrating wounds
    • Crushed wounds
  2. Closed Wounds
    • Contusion
    • Abrasion
    • Hematoma.

According To The Thickness Of The Wound:

  • Superficial
  • Partial thickness
  • Full-thickness.
  • Deep wounds.

According To The Involvement Of Other Structures.

  • Simple wound
  • Combined wounds

According To The Time Elapsed:

  • Fresh wounds
  • Old wounds.

According To The Bacterial Contamination:

  • Clean wounds
  • Clean contaminated wounds
  • Contaminated wounds
  • Dirty wounds.

Question 2. Healing by primary intention.
Answer:

Healing Primary Intention Stages:

  • Initial bleeding
  • Acute inflammation
  • Organization
  • Proliferation
  • Remodeling

Clinical features of fistula and sinus questions

Question 3. Healing by secondary intention.
Answer:

Secondary Intention Stages:

  • Initial inflammation
  • Wound contraction
  • Granulation tissue formation
  • Epithelisation
  • Remodeling.

Question 4. Enumerate three factors influencing wound healing.
Answer:

Factors Influencing Wound Healing

Wound Sinus And Fistula Three Factors Influencing Wound Healing

Healing of wounds sinus and fistula notes

Question 5. Causes of persistence of sinus and fistula.
Answer:

Causes Of Persistence Of Sinus And Fistula

  • Causes of persistence of sinus and Fistula:
  • Presence of foreign body or necrotic tissue
  • Absence of rest.
  • Non-dependant or inadequate drainage of the abscess.
  • Presence of chronic infections like tuberculosis, actinomycosis, etc.
  • Epithelialization of the track.
  • Distal obstruction of the track.
  • Malignancy.
  • Irradiation.
  • Dense fibrosis around the wall of the track.

Question 6. Hypertrophic scar.
Answer:

Hypertrophic Scar

  • A hypertrophic scar is characterized by hypertrophy or proliferation of mature fibroblasts or fibrous tissues without any proliferation of blood vessels.
  • Hypertrophic Scar remains localized and gradually regresses.

Hypertrophic Scar Features:

  • Hypertrophic Scar never gets worse.
  • Hypertrophic Scar is non-tender.
  • Doesn’t spread to surrounding normal tissue.
  • Once treated it does not recur.
  • Hypertrophic Scar regresses after 6 months.
  • Common in.
    • Young individual
    • The scar crossing normal skin creases
    • Over sternum.

Hypertrophic Scar Treatment:

  • Regress on its own.
  • If necessary excision can be done.

Question 7. Keloid scar.
Answer:

Keloid Scar

Keloid scar is characterized by the proliferation of immature fibroblasts and immature blood vessels.

Keloid Scar Features: Commonly in:

  • Black race
  • Tuberculosis patients
  • Over sternum.
  • In women.

Keloid Scar Etiology

  • Tuberculosis.
  • Hereditary.
  • Dislocation of hair follicles.
  • Incision crossing lines of Langer.

Keloid Scar Presentation

  • Has claw-like processes.
  • Keloid Scar always itch.
  • Looks smooth, and pink, and raised patch.
  • Gets worse even after 1 year.
  • Recurs after excision.
  • The margin is tender, and vascular.
  • Spreads and affects normal surrounding tissue

Keloid Scar  Treatment:

  1. Conservative treatment:
    • Intrakeloidal injection of steroids.
    • Intrakeloidal hyaluronidase injection.
    • Intrakeloidal injection of Vitamin A.
    • Intrakeloidal injection of methotrexate.
    • Deep. X-ray therapy.
    • Ultrasonic therapy.
  2. Surgical treatment.
    • Excision and resuturing
    • Shaving away the excess scar tissues and then resurfacing the area with a skin graft.

Pathophysiology of sinus and fistula

Question 8. Lacerated wound
Answer:

Lacerated Wound Causes:

  • Injury by blunt objects
  • Fall on a stone
  • Road traffic accidents

Lacerated Wound Features

  • Involves skin and subcutaneous tissue
  • Crushing of tissues
  • Edges are jagged
  • Results in
    • Necrosis of tissues
    • Bruising
    • Hematoma

Lacerated Wound Treatment

  • Wound excision and primary suturing

Question 9. Pre auricular sinus
Answer:

Pre Auricular Sinus

  • May be unilateral or bilateral
  • Usually asymptomatic
  • If infected it causes pain

Pre Auricular Treatment

  • Uninfected sinus can be left untreated
  • Infected pro-auricular sinus is treated as
    • Antibiotics
    • Drainage
    • Excision

Question 10. Types of healing
Answer:

Types Of Healing

  1. Healing By Primary Intention
    • When a wound is sutured primarily, the wound healing occurs with minimum scarring
    • This is known as healing by primary intention
  2. Healing By Secondary Intention
    • When there is irreparable skin loss or the wound becomes infected primary suturing is not possible
    • In such cases, the wound heals with more scar tissue and takes longer time to heal
    • This is known as healing by secondary intention

Management of non-healing wounds and fistulas

Question 11. Abscess
Answer:

Abscess Definition: Abscess is a collection of pus in the body

Abscess Classification

  • Pyogenic
  • Pyaemic
  • Cold abscess

Abscess Clinical Features

  • Rubor – redness over the area
  • Dolor – throbbing pain
  • Color – the inflamed area is hot
  • Tumor – swelling of the involved area
  • Functlolacsa – Impairment of function

Abscess Treatment

  • Incision and drainage of pus

Difference between abscess sinus and fistula

Question 12. Orocutaneous fistula
Answer:

Orocutaneous Fistula

  • Orocutaneous Fistula is pathological communication between the cutaneous surface of the face and the oral cavity
  • Orocutaneous Fistula leads to esthetic and functional problems due to continuous leakage of saliva

Orocutaneous Fistula Causes

    • Malignancy
    • Osteoradionecrosis
    • Residual lesions of cysts and tumors of the oral cavity
    • Inflammation
    • Trauma

Ulcers Upper Gastrointestinal Bleeding

Causes and complications of sinus and fistula

Wound Sinus And Fistula Viva Voce

  1. The pilonidal sinus is usually found in the natal cleft
  2. Granulation tissue formation occurs by 2 processes – stage of vascularization and stage of vascular- citation
  3. Type 1 collagen is found in tendons, ligaments, skin, and bone
  4. Type 2 collagen is in cartilage
  5. Type 3 collagen is found in the fetal dermis
  6. The period when no wound contraction is seen is called the initial lag period
  7. Within 48 hours of the wound, the entire wound gets re-epithelioid
  8. Wound contraction occurs from the 4th day to the 14thday
  9. In the first 48 hours, polymorphonuclear leukocytes are dominant
  10. Monocytes become the dominant cell type by the 5th day.

Diseases Of Bone And Joints Oral Pathology Essay Question And Answers

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Diseases Of Bone And Joints Important Notes

  1. Fibrous Dysplasia Definition: It is an idiopathic condition, in which an area of normal bone is gradually replaced by abnormal fibrous connective tissue, which then again undergoes osseous metaplasia, and eventually the bone is transformed into a dense lamellar bone.
    • Fibrous Dysplasia Classification:
      • Monostotic – Only one bone is involved
      • Polyostotic – More than one bone is involved
        • Jaffe’s type -Polyostotic along with cafe-au-lait-skin pigmentation
        • Albright syndrome – characterized by polyostotic fibrous dysplasia, cafe-au-lait skin pigmentation, and endocrine disturbances
    • Diseases Of Bone And Joint Features
      • Cafe au lait pigmentation of skin
      • Unilateral swelling of the jaw
      • Precocious puberty
      • Egg crackling of the cortex of the bone is present
      • Later ground glass appearance is seen
      • Maxillary lesions causes obliteration of maxillary sinus
      • Spindle-shaped fibroblasts are arranged in a whorled pattern
  2. Paget’s disease
    • It is characterized by excessive and abnormal remodeling of bone
    • Affects the adult skeleton
    • Patients suffer from deafness, blindness, and facial paralysis
    • There is a progressive enlargement of the skull and maxilla because of which the patient has to change the hats and dentures frequently
  3. Cherubism
    • Manifests by the age of 3-4 years
    • Painless symmetric swelling of the mandible or maxilla occurs
    • Results in chubby face appearance
    • The deciduous teeth shed prematurely and numerous teeth are absent
    • X-ray shows numerous unerupted teeth floating in cyst-like spaces
  4. Cleidocranial dysplasia
    • it is characterized by abnormalities of the skull, shoulder girdle, jaws, and teeth
    • Skull – delayed closure of sutures and wormian bones
    • Shoulder – partial or complete absence of clavicles
    • Teeth – prolonged retention of deciduous and delayed eruption of permanent
    • Numerous supernumerary teeth are found in the mandibular premolar and incisor areas
  5. Blue sclera Is seen In
    • Osteogenesis imperfecta
    • Marfan syndrome
    • Cherubism
    • Ehlers Danlos syndrome
    • Osteopetrosis
    • Fetal rickets
    • Normal infants
  6. Marfan’s syndrome
    • Long thin extremities
    • Hyperextensibility of joints
    • Spidery fingers
    • Arachnodactyly
    • Bifid uvula
    • CVS complications
  7. Albright’s syndrome
    • Precocious puberty
    • Polyostotic fibrous dysplasia
    • Cafe-au- lait pigmentation
  8. Down syndrome
    • It occurs due to trisomy 21
    • Features
      • Hypermobility
      • Macroglossia
      • Flat face
      • Large anterior fontanelle
      • Sexual underdevelopment
      • Cardiac abnormalities
  9. Cotton wool appearance is seen in
    • Paget’s disease
    • Chronic sclerosing diffuse osteomyelitis
    • Fibrous dysplasia
    • Cemento-osseous dysplasia
  10. Radiographic features in different disease
    Diseases Of Bone And Joints Radiographic Feature In Different Disease
    Serum affine phosphatase is elevated In  

    • Malignancy
    • Abscess of Ihrer
    • Amyloidosis
    • Leukemia
    • Sarcoidosis
  11. Pierre Robin syndrome
    • Features
      • Micrognathia
      • Geffc palate
      • Glossoprosis
  12. Diseases with cafe-Au lait spots are
    • Albright syndrome
    • Yon Recklinghausen neurofibromatosis
    • Bloome’s syndrome
    • Fanconi’s syndrome
    • Cowden’s syndrome
    • Tuberculosis sclerosis
    • Watson’s syndrome
    • Ataxia telangiectasia

Diseases Of Bone And Joints Short Question And Answer

Question 1. Classify the diseases of TMJ. Write etiology and clinical features of ankylosis
Answer:

Classification of Diseases of Temporomandibular Joint:

  1. Disorders due to extrinsic factors
    • Masticatory muscle disorders
      • Myofunctional pain dysfunction syndrome
      • Myositis
    • Problems due to trauma
      • Traumatic arthritis
      • Fracture
      • Internal disc derangement
      • Tendonitis
  2. Disorders due to intrinsic factors
    • Trauma
      • Dislocation
      • Fracture
    • Internal disc displacement
      • Anterior disc displacement with reduction
      • Anterior disc displacement without reduction
    • Arthritis
      • Osteoarthritis
      • Rheumatoid arthritis
      • Juvenile arthritis
      • Infantile arthritis
    • Developmental defects
      • Agenesis
      • Hypoplasia
      • Hyperplasia
    • Ankylosis
    • Neoplasm
      • Benign
      • Malignant

Read And Learn More: Oral Pathology Questions and Answers

Ankylosis: Ankylosis means stiff joint

Ankylosis Etiology:

  • Trauma
  • Congenital
  • Infections- osteomyelitis
  • Inflammation- Osteoarthritis
  • Systemic diseases-typhoid
  • Measles
  • Prolonged trismus

Ankylosis Types:

  • False or true ankylosis
  • Extra articular or intra articular
  • Fibrous or bony
  • Unilateral or bilateral
  • Partial or complete

Ankylosis Clinical Features:

  1. Unilateral ankylosis
    • Deviation of the chin on the affected side
    • The fullness of the face on the affected side
    • Flatness on the unaffected side
    • Crossbite
    • Angle’s class 2 malocclusion
    • Condylar movements absent on the affected side
  2. Bilateral ankylosis
    • Inability to open mouth
    • Neck chin angle reduced
    • Class 2 malocclusion
    • Protrusive upper incisors
    • Multiple carious teeth

Question 2. Enumerate bone disorders affecting the jaws. Describe the pathogenesis, clinical features, radiographic appearance, and histopathology of fibrous dysplasia.
Answer:

Bone Disorders Affecting the Jaws:

  • Osteogenesis imperfecta
  • Osteopetrosis
  • Fibrous dysplasia
  • Cheruhism
  • Mandibulofaci dysostosis
  • Pierre Robin malformation
  • Achondroplasia
  • Chondroectodermal dysplasia
  • Cleidocranial dysplasia
  • Down’s syndrome
  • Marfan syndrome
  • Infantile cortical hyperostosis

Fibrous Dysplasia:

  • Fibrous dysplasia is a skeletal developmental anomaly of the bone-forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation

Fibrous Dysplasia Pathogenesis:

Diseases Of Bone And Joints Oral Pathology

Fibrous Dysplasia Types:

  • Monostotic form
  • Polyostotic form
  • Jaffe’s type
  • Albright syndrome

Fibrous Dysplasia Clinical Features:

  • Age- Occurs in the first and second decade of life
  • Sex- common in females
  • Site involved
    • Skull
    • Facial bones
    • Clavicles
    • Pelvic bones
    • Long bones-femur, tibia, humerus
  • Skeletal lesions
    • Unilateral distribution of lesions
    • Swelling on the affected side
    • Recurrent bone pain
    • Cessation of growth
    • Pathological fractures
  • Skin lesions
    • Cafe-au- Jail pigmentations
    • It consists of irregularly, pigmented, light brown, flat, melanotic spots
  • Oral manifestations
    • Slow enlarging, painless, unilateral swelling of the jaw
    • Facial deformity
    • Expansion and distortion of cortical plates,
    • Displacement of regional teeth
    • Disturbances in teeth eruption
    • Severe malocclusion
    • Maxillary lesions lead to Exophthalmos, proptosis, and nasal obstruction
    • Mandibular protuberance
  • Precocious puberty
    • Premature vaginal bleeding
    • Breast development
    • Presence of axillary and pubic hairs at the age of 2-3 years

Fibrous Dysplasia Radiographic Features:

  • Initially, it produces unilocular or multilocular radiolucent areas in bone
  • Expansion and distortion of cortical plates occurs
  • Displacement of teeth
  • The egg-cell crackling of the cortex of the bone is present
  • Later a classical ground glass or orange peel appearance of bone is seen
  • The margin of the lesion blends with the surrounding normal bone
  • Mandibular lesions cause bulging of the US inferior border
  • Narrowing of periodontal ligament
  • Thinning of lamina dura
  • Maxillary lesions causes obliteration of maxillary sinus

Fibrous Dysplasia Histopathology:

  1. Monostatic fibrous dysplasia
    • Consists of proliferating fibroblasts in the stroma of interlacing collagen fibers
    • Trabeculae of bone are multiple, coarse, irregular, and immature
    • This produces a Chinese letter pattern
    • Spheroidal areas of calcification are seen
    • Presence of giant cells
    • At the margin, the lesion blends with the surrounding bone
    • Gradually the amount of cellularity decreases and the amount of bone tissue increases
    • There is remodeling of woven bone
  2. Polyostotic fibrous dysplasia
    • Areas of fibrous metaplasia within flat and tubular bones
    • Well defined lesions
    • Rich in spindle-shaped fibroblasts arranged in a whorled pattern
    • Presence of giant cells
    • Collagen fiber bundles lack orientation

Question 3. Enumerate the osteodystrophies. Write in detail about Paget’s disease of bone.
Answer:

Osteodystrophies: Osteodystrophies are disorders of bone other than neoplastic and inflammatory conditions

Osteodystrophies Classification:

  1. Fibro-osseous lesions
    • Fibrous dysplasia
    • Periapical cementitious dysplasia
    • Focal cementitious dysplasia
  2. Giant cell lesions
    • Cheru be
    • Central giant cell granuloma
    • Peripheral giant cell granuloma
  3. Developmental disorders of bone
  4. Metabolic disorders of bone
    • Brown’s tumor
  5. Miscellaneous
    • Rickets
    • Osteomalacia

Paget’s Disease: It is a bone disorder characterized by excessive, tin- coordinated phases of bone resorption and subsequent deposition of new bone in the same area

Paget’s Disease Clinical Features:

  • Age- fifth, sixth, seventh decade of life
  • Sex- common in males
  • Sites involved
    • Weight-bearing areas- vertebral column, femur
    • Skull
    • Pelvis
    • Sternum
    • Common in maxilla than mandible
  • Present as deep and aching bone pain
  • Bilateral swelling of the involved bone
  • Bowing deformity of weight-bearing areas
  • Results in monkey-like stance
  • Waddling gait
  • Involvement of facial bones is referred to as dementia- sis ossa
  • Headache
  • Deafness, blindness
  • Facial paralysis
  • Enlargement of skull
  • Bowing of legs
  • The increased localized temperature of the skin

Paget’s Disease Histopathology:

  • The initial stage shows osteoclastic bone resorption
  • Bone is replaced by highly vascularised cellular connective tissue
  • Osteoclasts are larger and multinucleated
  • The later stage shows the deposition of new lamellar bone by osteoblast cells
  • Fatty bone marrow is replaced by fibrous stroma
  • Bone resorption and deposition produce prominent reversal and resting lines
  • The irregular pattern of such lines produces a jigsaw- puzzle or mosaic pattern
  • The affected bone is thick, sclerotic
  • Obliteration of the medullary cavity occurs
  • Chronic inflammatory cells and dilated blood capillaries are present

Paget’s Disease Radiographic Features:

  • Initially, there is the presence of radiolucent areas in the affected bone
  • In the next stage, involved bone shows haphazardly arranged newly formed bone in radiolucent areas
  • This produces the cotton wool appearance
  • The radiopacity of lesions increases due to increased osteosclerosis
  • Prognathic and pagetoid mandible
  • Obliteration of maxillary sinus
  • Hypercementosis of tooth
  • Loss of lamina dura
  • Obliteration of periodontal ligament space
  • Root resorption

Question 4. Clinical features of monostotic fibrous dysplasia
Answer:

Monostotic Fibrous Dysplasia: It is a form of fibrous dysplasia that involves single-bone

Monostotic Fibrous Dysplasia Clinical Features:

  • Common in children and young adults
  • Painless swelling of the jaw
  • Common in mandible
  • The protuberance of its inferior border
  • Misalignment or displacement of regional teeth
  • The overlying mucosa is intact
  • Maxillary lesions involve the maxillary sinus, the floor of the orbit, and the zygomatic process
  • There is a bulging of canine fossa

Question 5. Cleidocranial dysplasia
Answer:

Cleidocranial dysplasia

It is a hereditary disorder characterized by abnormal growth of the bones in the face, skull, and clavicles with a tendency for the failure of tooth eruption

Cleidocranial dysplasia Clinical Features:

  • Absence or hypoplasia of one/ both clavicles
  • Hypermobility of shoulder joints
  • Elongated frontal and occipital skull plates
  • Underdeveloped entire mid-face
  • Delayed closure of fontanelles
  • High and narrow arched palate
  • Underdeveloped paranasal sinuses
  • Photophobia
  • Multiple unerupted and impacted teeth

Cleidocranial dysplasia Radiographic Features:

  • Open sutures
  • Open fontanelles
  • Partial/complete loss of clavicles
  • Multiple impacted teeth
  • Thin roots of teeth

Question 6. Etiopathogenesis and Histopathology of cherubism
Answer:

Cherubism: It is a rare benign hereditary condition characterized by bilaterally symmetrica] enlargement of the mandible

Cherubism Etiopathogenesis:

  • It results due to
    • Anomalous development of bone
    • Latent hyperparathyroidism
    • Hormone dependent neoplasm
    • Trauma
    • Disturbance in the development of bone-forming mesenchyme

Cherubism Histopathology:

  • The presence of numerous multinucleated giant cells
  • Stroma consists of a large number of spindle-shaped fibroblasts
  • Numerous small vessels and capillaries are present
  • They are lined by endothelial cells and perivascular cuffing
  • Advanced lesions show
  • Increase in fibrous tissue
  • Decrease in giant cells
  • Formation of new bone

Question 7. MPDS
Answer:

MPDS

  • It is a disorder characterized by facial pain limited to mandibular function, muscle tenderness, joint sounds, absence of significant organic and pathologic changes in TMJ
  • It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of the joint
  • Coined by Laskin

MPDS Etiology:

  1. Extrinsic factors
    • Occlusal disharmony
    • Trauma
    • Environmental influences
    • Habits
  2. Intrinsic factors
    • Internal derangement of TMI
    • Anterior locking of disc
    • Trauma

MPDS Features:

  • Unilateral preauricular pain
  • Dull constant sound
  • Muscle tenderness
  • Clicking noise
  • Altered jaw function
  • Absence of radiographic changes
  • Absence of tenderness in ext. auditory meatus

MPDS Management:

  1. Reassurance
  2. Soft diet
  3. Occlusal correction: 7 ‘R’s
    • Remove-extract the tooth
    • Reshape grind the occlusal surface
    • Reposition orthodontically treated
    • Restore conservative treatment
    • Replace by prosthesis
    • Reconstruct TMJ surgery
    • Regulate control habits
  4. Isometric exercises
    • Opening and closing of mouth 10 times a day
  5. Medicaments
    • Aspirin: 0.3-0.6 gm/ 4 hourly
    • NSAIDS: for 14-21 days
    • Pentazocine: 50 mg/ 2-3 times a day
  6. Heat application
    • It increases circulation
  7. Diathermy
    • Causes heat transmission to deeper tissues
  8. LA injections
    • 2% lignocaine into trigger points
  9. Steroid injection
    • As anti-inflammatory
  10. Anti-anxiety drugs
    • Diazepam-2-5 mg * 10 days
  11. TENS
  12. Acupuncture

Question 8. Cherubism
Answer:

Cherubism

It was described by Jones in 1933

Cherubism Classification:

  • Based on the severity and location of the lesion
    • Grade 1- Affects Minus of the mandible
    • Grade 2- Affects ramous and body of the mandible and maxillary tuberosity
    • Grade 3 – after maxilla ami mandible entirely

Cherubism etiology:

  • Autosomal dominant trail latent hyperparathyroidism
  • Trauma
  • Disturbance in bone-forming mesenchymal

Cherubism Clinical Features:

  • Age and sex- 2-3 years males are affected
  • Site-angle of mandible bilaterally
  • Bilateral, painless, symmetrical swelling giving a chubby appearance
  • Swelling is firm to hard in consistency
  • Maxillary swelling causes pressure over the floor of the orbit
  • Due to this, pupils turn upwards giving a “heavenward look”
  • Difficulty in speech, deglutition, mastication, and respiration
  • Limited jaw movements
  • Expansion and widening of alveolar ridge
  • Flattening of palatal vault
  • Chronic lymphadenopathy
  • Malocclusion

Question 9. Osteogenesis Imperfecta
Answer:

Osteogenesis Imperfecta

It is a genetically transmitted disease of bone characterized by defective matrix formation and lack of mineralization

Osteogenesis Imperfecta Clinical Features:

Diseases Of Bone And Joints Osteogenesis Imperfecta Clinical Features

Osteogenesis Imperfecta Oral Manifestations:

  • Large head
  • Frontal bossing
  • Maxillary hypoplasia
  • Bulbous crowns of teeth
  • Class 3 malocclusion
  • Severe attrition of deciduous teeth
  • Multiple impacted permanent teeth
  • Increased incidence of osteomyelitis

Question 10. Osteopetrosis
Answer:

Osteopetrosis

  • It is also known as marble disease
  • It is a rare bone disorder characterized by increased bone density

Osteopetrosis Clinical Features:

  • Decreased bone marrow activity leading to anemia, leukopenia, and pancytopenia
  • Hepatosplenomegaly
  • Deafness, blindness, and facial paralysis due to narrowing of cranial foramina
  • Defective enamel formation
  • Short roofs
  • Pathological fractures
  • Increased incidence of osteomyelitis

Question 11. Blue sclera
Answer:

Blue sclera

  • Blue sclera is due to unusually transparent or thin sclera which causes increased visibility of choroids
  • It is seen in
    • Osteogenesis imperfecta
    • Marfan syndrome
    • Cherubism
    • Ehlers-Danlos syndrome
    • Osteopetrosis
    • Fetal rickets
    • Normal infants

Question 12. Leontiasis ossa
Answer:

Leontiasis ossa

The involvement of facial bones in Paget’s disease is known as leontiasis ossa

Leontiasis ossia Features:

  • Progressive enlargement of the maxilla
  • Widening of alveolar ridges
  • Loosening of teeth
  • Flattening of palate
  • Mouth remains open
  • In edentulous patients, there is difficulty in wearing dentures

Question 13. Albright’s syndrome
Answer:

Albright’s syndrome Features:

  • Common in females
  • It is a severe form of fibrous dysplasia involving nearly all the bones in the body
  • It is accompanied by pigmentations of the skin and endocrine disorders
  • Endocrine disorders
    • Precocious puberty
    • Goitre
    • Hyperthyroidism
    • Hyperparathyroidism
    • Cushing’s syndrome
    • Acromegaly
  • Skin lesions
    • These are coffee with milk color spots
    • There is an irregular flat area of increased skin pigmentation
  • Vaginal bleeding occurs
  • Long bones are frequently affected

Question 14. Marfan’s syndrome
Answer:

Marfan’s syndrome

It is a hereditary syndrome

Marfan’s Syndrome Clinical Features:

  • Long, thin extremities resembling spider fingers
  • Hyperextensibility of joints
  • Habitual dislocations
  • Kyphosis
  • Aortic regurgitation
  • Cardiac aneurysm
  • Mitral valve prolapse
  • Myopia, cataract
  • Retinal detachment
  • Psychological trauma

Marfan’s Syndrome Oral Manifestations:

  • Long and narrow face
  • High arched palate
  • Bifid uvula
  • Presence of multiple odontogenic cysts
  • Malocclusion
  • Temporomandibular joint dysarthrosis

Question 15. Mandibulofacial dysostosis
Answer:

Mandibulofacial dysostosis

It is a hereditary- disease characterized by defects in structures derived from 1st and 2nd branchial arches

Mandibulofacial dysostosis Clinical Features:

  • Malformation of the external ear- the absence of an external auditor canal, deformity in the middle and internal ear
  • Antimongoloid palpebral fissures
  • Coloboma of the outer portion of lower eyelids
  • Hypoplasia of the mandibular body and zygoma
  • Narrow face and depressed cheek
  • Results in bird-face appearance
  • Crowding and malocclusion of teeth
  • High arched palate
  • Atypical hair growth
  • Parotid hypoplasia
  • Narrowing of larynx and trachea
  • Difficulty in speech and respiration

Question 16. Serum alkaline phosphatase
Answer:

Serum alkaline phosphatase

  • Alkaline phosphatase occurs in many tissues of the body, especially in osteoblasts
  • It is elevated in
    • Malignancy
    • Abscess of liver
    • Amyloidosis
    • Leukemia
    • Sarcoidosis

Question 17. Pierre Robin syndrome
Answer:

Pierre Robin syndrome

It is a hereditary disease

Pierre Robin syndrome Features:

  • Mandibular micrognathia giving bird face appearance
  • Downward and backward placement of tongue
  • Difficulty in breathing, airway maintenance, feed- ind and speech
  • Malocclusion of teeth
  • Presence of multiple missing teeth or supernumerary teeth
  • Absence of TMJ
  • Mongolism
  • Congenital heart defects
  • Hydrocephaly, microcephaly
  • Mental retardation
  • Psychological trauma

Question 18. Cotton wool appearance
Answer:

Cotton wool appearance

  • Cotton wool appearance is a radiographic feature of Paget’s disease
  • In the later stage of the disease, new bone is formed in the present radiolucent areas
  • It results from thickened, disorganized trabeculae which lead to areas of sclerosis in previously lucent areas of bone
  • These areas are poorly calcified

Question 19. Peaud orange radiographic appearance
Answer:

Peaud orange radiographic appearance

  • It is seen in the later stage of fibrous dysplasia
  • Initially, there is the presence of unilocular or multi-locular radiolucent areas
  • Later quite opaque areas develop due to delicate trabeculae
  • This results in a proud orange or orange peel appearance
  • It is not well-circumscribed
  • Its margins blend with the surrounding bone

Question 20. Down syndrome
(or)
Trisomy 21
Answer:

Down syndrome

  • Down’s syndrome/trisomy 21/mongolism affects approximately 1 in 1000 births.
  • It is the most common chromosomal disorder and is the commonest cause of mental retardation.

Down syndrome or Trisomy 21 Etiology:

  • Late maternal age
  • Nondisjunction of chromosome 21 during an early stage of embryogenesis.

Down Syndrome or Trisomy 21 Clinical Features:

  • Epicanthal folds and flat facial profile,
  • Slanting eyes produce a mangoloid appearance.
  • Hands are short with a transverse single palmar crease.
  • Abnormalities of ears, trunk, pelvis, and phalanges
  • Cardiac malformations
  • Congenital malformations are common and quite disabling
  • Risk of developing acute leukemia, especially megakaryocytic leukemia.

Down syndrome or Trisomy 21 Oral Manifestation:

  • Deficient maxilla- class 3 relation,
  • Open mouth,
  • Large tongue,
  • Caries free teeth due to excess salivation.

Question 21. Brown tumor
Answer:

Brown tumor

  • The brown tumor is also known as hyperparathyroidism
  • It is an endocrine disorder occurring due to an excess of circulating parathyroid hormone

Brown tumor Types:

  • Primary hyperparathyroidism
  • Occurs due to tumour of glands
  • Secondary hyperparathyroidism
  • Occurs in response to hypocalcemia
  • Tertiary hyperparathyroidism
  • Occurs after long-standing secondary hyperparathyroidism

Brown Tumour Clinical Features: Age and sex- common in middle-aged women

  1. Classic triad
    • Kidney stones
    • Bone resorption
    • Duodenal ulcers
  2. Renal symptoms
    • Renal calculi
    • Hematuria
    • Back pain
  3. Psychological symptoms
    • Emotionally unstable
  4. GIT symptoms
    • Anorexia
    • Nausea, vomiting
  5. Skeletal
    • Bone pain
    • Pathologic fractures
    • Bone deformities
    • Hypercalcaemia
  6. Generalised symptoms
    • Muscle weakness
    • Fatigue
    • Weight loss
    • Insomnia
    • Headache
    • Polydipsia and polyuria
  7. Oral manifestations
    • Intraoral and extraoral swelling
    • Gradual loosening of teeth
    • Drifting and loss of teeth
    • Malocclusion

Question 22. Philadelphia chromosome
Answer:

Philadelphia chromosome

  • Philadelphia chromosome is the translocation of chromosomal material from chromosome 22 to chromosome 9
  • It is seen in leukemic patients

Question 23. Cafe au lait spots
Answer:

Cafe au lait spots

  • Cafe-au-lait spots are pigmented macules
  • They are arranged in linear or segmental patterns near the midline of the body

Diseases with Cafe-Au-Lait Spots are:

  • Albright syndrome
  • Von Recklinghausen’s neurofibromatosis
  • Bloome’s syndrome
  • Fanconi’s anaemia
  • Cowden’s syndrome
  • Tuberculosis sclerosis
  • Watson’s syndrome
  • Ataxia telangiectasia

 

Diseases Of Bone And Joints Viva Voce

  1. Pathognomic feature of osteogenesis imperfecta is blue sclera
  2. Ankylosis means stiff joint
  3. Cotton wool appearance is seen in Paget’s disease
  4. Ground glass appearance is seen in monostotic fibrous dysplasia
  5. Mosaic bone and jigsaw puzzle appearance is seen in Paget’s disease
  6. Chinese letter appearance is seen in Monostotic fibrous dysplasia
  7. The brown tumor occurs due to an excess of circulating parathyroid hormone
  8. Philadelphia chromosome is the translocation of chromosomal material from chromosome 22 to chromosome 9

 

 

Bacterial Infections Question And Answers

by

Bacterial Infections Important Notes

  1. Different InfectionsBacterial Infections Different Infections

Bacterial infections questions and answers

  1. Pyaemia
    • A condition characterized by formation of secondary foci of suppuration in various parts of the body
  2. Bacteraemia
    • Indicates bacteria circulating in the bloodstream
  3. Septicaemia
    • Indicates presence of bacteria in bloodstream as well as liberation of toxins
  4. Toxaemia
    • Condition in which toxins circulates in the bloodstream
  5. Classification Of Granuloma
    • Caseous
    • Gummatous
    • Suppurative
    • Fibrinoid
  6. Lymph Nodes In Different Infections
    • Rubbery in syphilis
    • Matted in tuberculosis
  7. Abscess
    • It is a cavity filled with pus and lined by a pyogenic membrane
    • Types
      • Pyaemic abscess
      • Pyogenic abscess
      • Cold abscess
    • Principle of treatment
      • Drainage of pus
      • Culture and sensitivity test
      • Use of proper antibiotics
  8. Tuberculosis
    • Causative organism – mycobacterium tuberculosis
    • Routes of inhalation of tubercle bacilli
      • Direct spread to the lungs
      • Through tonsils
      • Enter the bloodstream
    • Stages of tubercular lymphadenitis
      • Stage of lymphadenitis
      • Stage of periadenitis
      • Stage of cold abscess
      • Stage of collar stud abscess
  9. Syphilis
    • Causative agent – Treponema pallidum
    • Types:Bacterial Infections Syphilis Types And Features
  10. Tetanus
    • Causative agent – Clostridium tetani
    • Toxins produced – tetanolysin, tetanospasmin
    • The interval between the first symptom and first reflex spasm is known as period of onset
    • If it is less than 48 hours, the condition is almost fatal
    • Incubation period is followed by period of onset
    • Types
      • Tetanus neonatal/ eighth day disease
        • Occurs usually around 6-8 day of birth due to contamination of the umbilical cord
      • Post-abortal/ puerperal tetanus
        • Due to unsterile manipulation during abortion or during labor
      • Postoperative tetanus
        • Following elective surgery
      • Latent tetanus
        • Develops after few months to years following wound
      • Bulbar tetanus
        • Involves muscles of deglutition and respiration
      • Cephalic tetanus
        • Occurs after wound of face and neck
  11. DPT Vaccine
    • Involves Diphtheria, Pertussis and Tetanus toxoid
    • 3 doses are given at 6,10 and 14 weeks of age
    • Booster dose is given at 18 months and 5 years of age
  12. Gas Gangrene
    • Etiological agent – cl. Perfringes
    • Toxins produced by it are
      • Alpha toxin
      • Beta toxin
      • Theta toxin
      • Hyaluronidase
      • Collagenase
      • Leucocidin

Bacterial infections Questions & Answers for students

Read And Learn More: General Surgery Question and Answers

Bacterial Infections Long Essays

Question 1. Describe the etiology, pathology, clinical features, and management of Bacterial Infections.

Answer:

Actinomycosis:

  • Actinomycosis is a chronic, suppurative granulomatous disease.

Bacterial Infections Etiology:

  • Actinomyces israelii, an anaerobic gram-positive filamentous organism causes it.

Bacterial Infections Pathology:

Bacterial Infections Pathology

Bacterial diseases MCQs with answers

Bacterial Infections Clinical Features: Three clinical forms of actinomycosis are identified.

  1. Facio-cervical actinomycosis.
    • Frequently involves lower jaw.
    • Present as a painless firm mass called lumpy jaw.
    • Underlying .connective tissue, muscle, and bone are destroyed and replaced by granulation tissue.
    • Gradually softening occurs at some places forming abscess.
    • It later burst to form sinuses.
    • Overlying skin becomes indurated and bluish in colour.
    • Pus contains sulphur granules.
    • Lymph nodes are not involved.
  2. Abdominal form.
    • Mainly affects the caecum or appendix.
    • Submucosa contains flat grey nodules which later enlarges.
    • Suppuration within it leads to abscess formation.
    • Later abdominal wall is involved with multiple discharging sinuses.
    • Liver is involved through portal vein.
    • Lesion is a honeycomb mass.
  3. Lungs.
    • It is common in children.
    • Involves direct spread from neck or from the abdomen.
    • Lungs becomes jumbled with multiple abscesses cavity surrounded by abundant fibrous tissue.

Bacterial Infections Management:

  • As it is a chronic disease, it is difficult to treat.
  • In crystalline penicillin – 10 lakh units once a day for 6 -12 months is given.
  • Later it is reduced to 4 lakh units.
  • Tetracycline and lincomycin are other alternatives.
  • Actinomycosis of the abdomen needs. Hemocolectomy.
  • Surgical treatment includes incisions and drainage of abscesses, excision of the sinus tract, and relieving obstruction.

Common bacterial infections and their treatment Q&A

Question 3. Discuss pathogenesis, clinical features, and treatment of gas gangrene.

Answer:

Gas Gangrene:

  • Gas Gangrene is a rapid spreading infective gangrene of the muscle characterized by a collection of gas in the muscles and subcutaneous tissue.

Gas Gangrene Pathogenesis:

Gas gangrene is caused by an anaerobic, gram-positive, spore-forming bacillus, Clostridium per-fringes.

Develops in wounds where there is heavy contamination.

This causes low oxygen tension.
↓
Multiplication of Clperfringes.
↓
Release of exotoxins by them.
↓
Causes lysis of erythrocytes, leucocytes, platelets, fibroblasts, and muscle cells.
↓
Further tissue damage occurs.

Gas Gangrene Clinical Features:

1. General:

  • Anaemia anxiety.
  • Low-grade fever.
  • Rapid pulse.
  • Hypotension – due to toxin production.
  • Nausea, vomiting.

2. Local:

  • Sudden onset of pain in affected part.
  • Pain worsens as time passes.
  • Gradual swelling and gross edema of the part.
  • Profuse discharge of brownish and foul swelling fluid.
  • Discoloration of skin – khaki to greenish due to hemolysis.
  • Crepitus follows gas production.
  • Muscle becomes green to black in color.

Gas Gangrene Treatment:

  1. Surgery.
    • Multiple longitudinal incisions for decompression and drainage.
    • Aggressive surgical debridement in the form of excision of all devitalized tissues.
    • In severe type of gas gangrene, amputation is carried out.
  2. Supportive treatment.
    • Penicillin 10 lac units every 4 hours.
    • Supplemented by tetracycline 2 g daily or chloramphenicol 2g or streptomycin 1 – 2g.
    • Blood transfusion.
    • Administration of anti-gas-gangrene serum.
    • Hyperbaric oxygen.

Question 4. Define carbuncle. Mention its etiology, clinical features, and treatment of carbuncle.

Answer:

Carbuncle Definition: Carbuncle is infective gangrene of the subcutaneous tissue.

Carbuncle Etiology:

  • Staphylococcus aureus.
  • Gram-negative bacilli.
  • Streptococci.

Carbuncle Clinical Features:

  • Sites involved are.
    • Commonly back, nape of the neck.
    • Rarely – cheek, shoulders, dorsum of the hand.
  • Age and sex: generally affects males above 40 years of age.
  • Presentation.
    • Painful, stiff swelling.
    • Spreads very rapidly.
    • Overlying skin becomes red, dusky, and oedematous
    • Central part softens and multiple vesicles appear on the skin.
    • Vesicles transform into pustules.
    • Pustule burst and allow the discharge to come out over the skin through various openings.
    • This results in a cribiform appearance.
    • Openings enlarge, coalesce, and form ulcers containing ashy-grey slough.
    • Patient in diabetic.

Carbuncle Treatment:

  • Improvement of the general health of the patient.
  • Diabetic control through insulin injections.
  • Antibiotics are administered, like cloxacillin, flucloxacillin, erythromycin, and some cephalosporin.
  • Surgery required if.
    • Toxaemia and pain persist even after the antibiotic course.
    • When the carbuncle is more than 2xh inch in diameter.
    • Cruciate incision is preferred which extends the opto margin of the inflammatory zone.

Question 5. Describe signs, symptoms, and treatment of alveolar abscess.

Answer:

Alveolar Abscess

An abscess is a collection of pus. Alveolar abscess is an abscess in the alveolar ridge of the jaw, usually caused by the spread of infection from a non-vital tooth.

Alveolar Abscess Clinical features:

  • Produced severe pain in the affected tooth.
  • Localized swelling.
  • Reddening of the overlying mucosa.
  • Pain aggrevates on application of pressure.
  • Application of heat intensifies pain while application of cold may relieve pain.
  • Elevated body temperature.
  • Affected tooth is non-vital and can be mobile.
  • Pus discharging sinus are formed.

Alveolar Abscess Treatment:

  • Incision and drainage of pus
  • Pulpectomy.
  • Analgescis – for relieving pain.
  • Antibiotic – to treat infection.
  • Extraction of offending tooth,

Question 6. Describe the etiology, clinical features, diagnosis, and treatment of chronic osteomyelitis of the jaw.

Answer:

Osteomyelitis:

  • Osteomyelitis is defined as an inflammation of bone and bone marrow along with the surrounding periosteum.

Osteomyelitis Types:

  1. Acute
  2. Sub-acute
  3. Chronic

Chronic Osteomyelitis Of Jaw:

  • The disease persisting for more than a mouth is called chronic osteomyelitis.

Osteomyelitis Etiology:

  • Fracture of mandible.
  • Alveolar abscess.
  • Radiation
  • Chemical necrosis.
  • Rarely tuberculosis, syphilis, and actinomycosis.

Osteomyelitis Clinical Features:

  • Local osteitis:
  • Formation of a cavity due to osteolytic lesion with surrounding sclerosis.
  • It is called Brodie’s abscess.
  • Sequestrum may or may not be present.
  • Bone necrosis occurs.
  • Mandible is more often affected than maxilla.
  • Pain is mild and dull in nature.
  • Jaw swelling with sinus tract formation occur.

Osteomyelitis Diagnosis:

  1. Radiology:
  • Shows periosteal reaction.
  • Brodie’s abscess is seen on X-rays.
  • Sequestrum is present can be detected.
  • Involucrum is identified.

Osteomyelitis Treatment:

  1. Medical therapy.
    • Systemic antibiotics – given for 2 – 4 months.
      • Penicillin.
      • Metronidazole.
      • Clindamycin.
    • Topical antibiotics.
      • Used as systemic cannot reach the site.
  2. Surgical management.
    • Sequestromy is done.

Suitable incision is made at dependent part.
↓
Involucrum is chiselled out
↓
Cavity is made open
↓
Sequestrum is removed.
↓
Cavity is packed with petroleum jelly gauze
↓
Antibiotics are administered.

Bacterial infections pharmacology questions and answers

Question 7. Define gangrene. Write types, causes, and management of gangrene.

Answer:

Gangrene It is death of a portion of the body with putrefaction

Gangrene Types:

  • Dry gangrene – due to slow occlusion of arteries
  • Wet gangrene – due to sudden occlusion of arteries

Gangrene Causes

  1. Arterial occlusion – atherosclerosis, embolism, Raynaud’s disease, Buerger’s disease, cervical rib
  2. Venous obstruction – deep vein thrombosis
  3. Nervous disease – peripheral neuritis, hemiplegia, paraplegia
  4. Traumatic gangrene – direct injury to main artery, indirect injury
  5. Infective gangrene – carbuncle, cancrumoris, gas gangrene
  6. Physical gangrene
    • Heat – bums and scalds
    • Cold – frostbite
    • Escharotics – acids and alkalis
    • Electricity
    • X-ray

Gangrene Treatment

  • General treatment
    • Nutritious diet
    • Control of diabetes
    • Relief of pain
  • Local treatment
    • Conservative
      • Affected part is
        • Kept dry
        • Kept elevated
        • Not heated
        • Protected from local pressure
        • Carefully observed and toileted
    • Surgical
      • Sympathectomy
      • Amputation
      • Direct arterial surgery
        • In chronic occlusion of artery

Bacterial Infections Short Essays

Question 1. Ludwig’s Angina.

Answer:

Ludwig’s Angina:

Ludwig’s angina refers to rapidly spreading cellulitis involving simultaneously all three spaces – submandibular, sublingual, and submental spaces.

Ludwig’s Angina Etiology:

  • Odontogenic infection.
  • Traumatic injuries.

Ludwig’s Angina Clinical Features:

  • Brawny hard swelling of neck involving all three spaces.
  • Reddening of the overlying skin.
  • Local rise in temperature.
  • Oedema of the floor of the mouth which pushes tongue upwards and results in difficulty in swallowing.
  • Dehydration.
  • High-grade fever.
  • Hoarseness of voice.
  • Putrid halitosis.
  • Increased salivation.

Ludwig’s Angina Treatment:

  • Airway maintenance.
  • Administration of antibiotics.
    • Pencillin G- 24 million units number 4, 4 – 6 hourly.
    • Gentamycin – 80 mg IM BD.
    • Metronidazole – 400 mg 8 hourly.
  • 4 fluids – to correct dehydration.
  • Removal of causative agent.
  • Surgical management.

General anaesthesia.
↓
Curved incision over most prominent part of the sub-mandibular gland.
↓
Mylohyoid muscle is divided
↓
Pus is drained.
↓
Irrigate the cavity.
↓
Place drainage tube.
↓
Close the woimd with loose sutures.

Bacterial infection short and long answers

Question 2. Trismus Or Lockjaw.

Answer:

Trismus Or Lockjaw:

Trismus: It is defined as the inability to open the mouth.

Trismus Or Lockjaw Etiology:

  • Pericoronitis.
  • Inflammation of masseter muscle.
  • Peritonsillar abscess.
  • TMJ disorders.
  • Submucous fibrosis.
  • Treatment:
  • Treat the cause
  • Analgesic – to relieve pain.
  • Muscle relaxant – for masseter muscle.
  • Hot fomentation.
  • Physiotherapy.

Question 3. Boil.

Answer:

Boil Definition: It is an acute staphylococcal infection of a hair follicle with perifolliculitis.

Boil Clinical Features:

  • Common on the back and neck.
  • Boil of the external auditory meatus is very painful.
  • Starts with a painful and indurated swelling.
  • Later softening occurs at the centre which leads to pustule formation.
  • It burst to discharge a greenish small amount of slough.
  • Next a deep cavity develops lined by granulation tissue.

Boil Complication:

  • Cellulits:
  • Infection of neighboring hair follicles.
  • Secondarily infect lymph nodes.

Boil Treatment:

  • Improvement of general health of patient.
  • Drainage of pus.
  • Clean the area with suitable disinfectant.
  • Antibiotic cloxacillin is given if necessary.

Question 4. Erysipelas.

Answer:

Erysipelas Definition: It is an acute inflammation of the lymphatics of the skin and mucous membrane.

Erysipelas Etiology: Streptococcus haemolyticus group A is the causative organism.

Erysipelas Clinical Features:

  • Poor general health.
  • Starts as a rose-pink rash which spreads to adjacent normal skin.
  • Vesicles appears which burst to discharge serous secretion.
  • Fever
  • Toxaemia.
  • Oedema of eyelids or scrotum.
  • When it involves pinna, it is described as Millian’s ear sign positive.

Erysipelas Complication:

  • Gangrene of skin and subcutaneous tissue.
  • Septicaemia.
  • Rarely lymphoedema.

Erysipelas Treatment:

  • Inj. Crystalline penicillin 10 Ink units 6 hourly IM/IV for 5 -10 days.

Question 5. HIV or AIDS.

Answer:

HIV or AIDS:

  • Human Immunodeficiency virus (HIV) is the causative agent for AIDS (Acquired immune deficiency syndrome).
  • HIV has the capability of destroying T-cells and thus harms the entire immune system.

HIV Or AIDS Spread Of Infection:

  • Through sexual contact.
  • Through blood transfusion.
  • From infected mother to foetus.

HIV or AIDS Clinical Features:

  • Patients remains asymptomatic for 1 – 2 months.
  • Later it may have following symptoms.

Bacterial Infections HIV Or AIDs

Question 6. Syphilis.

Answer:

Syphilis:

  • Syphilis is a venereal disease caused by treponema pallidum.

Syphilis Clinical Features: Disease is divided into four stages.

  1. Primary syphilis.
    • Hard chancre gradually develops at the site of entry of organisms.
    • Initially, it appears as a papule which gradually becomes eroded and forms an ulcer.
    • Edges of ulcer are raised.
    • Surrounding skin is oedematous.
    • Occurs over the glans of the penis and coronal sulcus in males and the inner side of the labia minora and cervix in females.
    • Extra genital chancres occur in the anal or perianal region, lip, tongue, nipple, etc.
    • Regional lymph nodes are involved.
    • They are enlarged with a rubbery consistency.
  2. Secondary syphilis.
    • Appears in 2 – 3 months after primary syphilis.
    • Produces generalized rash – dull red in color.
    • Snail track ulcers appear.
    • There are wart-like growths called condylo-malta.
    • Generalized painless lymphadenopathy occurs.
    • Other symptoms include:
      • Sore throat.
      • Alopecia.
      • Bone and joint pain.
      • Hepatitis.
      • Malaise
      • Headache, backache.
      • Pyrexia.
  3. Tertiary syphilis.
    • Affects the blood vessels.
    • There is a perivascular collection of lymphocytes and plasma cells.
    • Gumma is another characteristic feature.
    • It is an accumulation of granulation tissue with central necrosis.
  4. Latent syphilis.
    • It is asymptomatic.
    • Serum tests are positive.

Syphilis Treatment:

  1. Early syphilis.
    • Procaine penicillin G 6 lacs units daily for 15 days,
  2. Late syphilis.
    • Procaine penicillin G 6 lacs units daily for 3 weeks.
  3. Patient is allergic to penicillin.
    • Doxycycline 100 mg thrice daily for 15 days.

Question 7. Precautions for surgeons in HIV-infected patients.

Answer:

In OPD:

  • Any patient with open wounds, examine after wearing gloves.
  • Use disposable instrument.
  • Reusable instrument clean with soap and water and immerse in glutaraldehyde.

In The Operating Room:

  • Dental chair is covered with single sheet of polythene.
  • Minimize the number of personnel in room.
  • Any staff member with abrasions or lacerations is not allowed.
  • All staff members should wore shoes, gloves, gowns, and protective glasses.
  • Use sterilization techniques.
  • AZT should be given to health workers following exposure.

Question 8. Active immunity.

Answer:

Active Immunity: Active immunity is the resistance developed by an individual as a result of antigenic stimulus.

Active Immunity Mechanism: it stimulates humoral and cell-mediated immunity.

Active Immunity Types:

  1. Natural active immunity.
    • Acquired by natural subclinical or clinical infectious.
  2. Artificial active immunity.
    • It is produced by vaccination.
    • Vaccines are prepared from live, attenuated, or killed micro-organisms or their antigens or toxoids.
    • Vaccines stimulate a primary response against the antigen without causing symptoms of the disease.

Question 9. Passive immunity.

Answer:

Active Immunity:

  • It is received passively by the host.
  • It is induced by preformed antibodies against infective agent or toxin.
  • Protection starts immediately after the transfer of immune serum.
  • It is short lasting.

Active Immunity Types:

  1. Natural.
    • Transferred from mother to foetus or infants.
    • To foetus – transplacentally and to infant through milk.
  2. Artificial.
    • Transferred through parenteral administration of antibodies.

Active Immunity Uses:

  • To provide immediate short-term protection in a nonimmune host.
  • For suppression of active immunity.
  • For treatment of serious infection.

Medical microbiology bacterial diseases Questions & Answers

Question 10. Diagnostic tests for HIV.

Answer:

  1. Specific Tests:
    • Screening Tests.
      • ELISA Test.
        • Enzyme-linked immunosorbent assay is most widely used test.
        • It requires only microlitre quantities of specimen to detect.
        • In it an enzyme acts on substrate to produce a color in a positive test.
        • Most laboratory uses a commercial ELISA -kit.
      • Rapid Tests.
        • Requires less than 30 minutes.
        • Includes.
        • Dot-blot assay.
        • Praticle agglutination.
        • HIV spot
        • Comb tests.
    • Supplemental Tests.
      • Western Blot Test:
        • HIV proteins are separated by electrophoresis.
        • These are then blotted on strips of nitrocellulose paper.
        • These stips are reacted with test sera.
        • Position of the colour band on the strip indicates fragment of antigen with which antibodies have reacted.
        • Indirect immunofluorescence test.
        • HTV-infected cells are fixed on glass slide.
        • Reacted with serum and then with fluoresain conjugated antihuman gammaglobulin.
        • Positive test produces apple-green fluorescence.
  2. Non-Specific Test:
    • Total leucocyte count.
      • Lymphocyte count is less than 400 per mm3 in AIDS patients.
    • T-lymphocyte subset assays.
      • In normal individual CD4 : CDS is 2:1
      • In AIDS patients -CD4 : CD8 is 0.5:1

Question 11. Tubercle bacilli/Koch’s bacilli.

Answer:

Tubercle Bacilli:

  • Tubercle bacilli is slender, straight or slightly curved bacillus with rounded ends.
  • Arrangement – occurs singly, in pairs, or in small clumps.
  • Size -1 – 4 pm x 0.2 – 0.8 pm
  • They are acid-fast, non-sproing, non-capsulated & non-motile bacilli.
  • With Zienl – Neelsen staining, tubercle bacilli are seen bright red in color.
  • It is called Koch’s bacilli on the name of its dis- corver.

Tubercle Bacilli Types:

  • Human type – M tuberculosis.
  • Bovine type – M bovis.
  • Vole type – M microti.
  • African type – M africanum.

Question 12. Tetanus bacilli.

Answer:

Tetanus Bacilli: Clostridium tetani causes tetanus.

  • It is gram-positive, slender bacilli.
  • Size- 4 – 8 pm x 0.5 pm
  • It has spherical, terminal spores.
  • The spore is about 3-4 times wider than the bacillary
  • body, giving rise to a drumstick appearance.
  • It is non-capsulated and motile with peritrich flagella.
  • It is mainly found in manure and soil.
  • It is a normal inhabitant of the intestines of human beings and animals.

Bacterial Infections Clostridium Tetani

Question 13. Endotoxins.

Answer:

Endotoxins: Endotoxins are lipopolysaccharides in nature.

  • They form an integral part of cell wall of bacteria.
  • Produced by gram negative bacteria.
  • They are released from the bacterial surface by natural lysis of the bacteria or by the disintegration of the cell wall.
  • They are heat stable.
  • Is toxicity depends on the lipid component
  • They cannot be toxoided.
  • Poor antigenic.
  • Has no enzymatic action.
  • They are non-specific in their action.
  • Usually produces fever.
  • Thus, this area is called the dangerous area of the face.

Question 14. Septicaemia.

Answer:

Septicaemia: Septicaemia is a condition in which bacteria circulate and actively multiply in the bloodstream and liberate toxins produced by them.

Septicaemia Clinical Features:

  • Pyrexia.
  • Rigors
  • Hypotension.
  • Intravascular coagulation defects.
  • Petechial hemorrhages.
  • Jaundice due to liver damage.
  • Septic shock.
  • Peripheral circulatory failure.
  • Decrease/Absence 6f Urine output.

Septicaemia Routes of Spread:

  • Streptococcus, are main causative organism.
  • It spread to other organs by.
    • Direct extension into open vessels.
    • Release of infected emboli.
    • Discharge of infected lymph.

Septicaemia Treatment:

  • 4 administration of antibiotics – aminoglycosides and metronidazole.
  • Blood transfusion.
  • Plasma expanders.
  • Inj. Hydrocortisone is given.

Antibiotics used for bacterial infections questions

Question 15. Dangerous Area Of Face.

Answer:

Dangerous Area Of Face:

  • The area from the corners of the mouth to the bridge of the nose including the nose and maxilla forms the dangerous area of the face.
  • The facial vein communicates with the cavernous sinus through communication between the supraorbital and pterygoid plexus via a deep facial vein.
  • The cavernous sinus is present in the cranial cavity between the layers of the meninges.
  • Infections from the face especially from the upper lip and lower part of the face can spread in a retrograde direction and cause thrombosis of the cavernous sinus.
  • Thus this area is called a dangerous area of the face.

Bacterial Infections Dangerous Area Of The Face

Question 16. Boundaries of the back of the neck.

Answer:

Back Of Neck Boundaries:

  • Anteriorly – posterior border of sternocleidomastoid.
  • Posteriorly – anterior border of trapezius.
  • Inferiorly/base-middle third of clavicle.
  • Apex lies on the superior nuchal line where the trapezius and sternocleidomastoid meet.
  • Roof – investing layer of deep cervical fascia.
  • Floor.
    • Splenius capitus.
    • Levator scapulae.
    • Scalenusmedius.
  • Back Of Neck Contents.
    • Occipital triangle.
      • Nerves.
        • Spinal accessory.
        • Four cutaneous branches of cervical plexus.
        • Muscular branches.
        • C5, C6 roots of branchial plexus.
        • Third and fourth cervical nerves.
        • Dorsal scapular nerve.
      • Vessels.
        • Transverse cervical artery and vein.
        • Occipital artery.
      • Lymph nodes.
        • Supraclavicular nodes.
    • Subclavian triangle.
      • Nerves.
        • Three trunks of branchial plexus.
        • Nerve to serratus anterior.
        • Nerve to subclavius.
        • Suprascapular nerve.
      • Vessels.
        • Third part of subclavian artery and vein.
        • Suprascapular artery and vein.
        • Commencement of transverse cervical artery and termination of the corresponding vein.
        • Lower part of the external jugular vein.
      • Lymph nodes.
        • Few members of the supraclavicular chain.
        • Posteroinferior group of the deep cervical lymph node.

Question 17. TB cervical lymphadenitis.

Answer:

TB Cervical Lymphadenitis:

TB Cervical Lymphadenitis Etiopathogenesis:

1. In the anterior triangle of the neck.

Mycobacteria pass through tonsillar crypts.
↓
Affects tonsillar node or jugulodigastric node.

2. In posterior triangle.

  • Lymph nodes are affected due to the involvement of adenoids.

3. Spread from the apex of the lung.

  • Organisms penetrate Sibson’s fascia and cause enlargement of supraclavicular nodes.

Bacterial Infections TB Cervical Lymphadenitis

Question 18. dry gangrene

Answer:

Dry Gangrene:

  • Dry Gangrene is a form of gangrene occurring due to ischemia

Dry Gangrene Causes:

  • Ischaemia
  • Atherosclerosis
  • Buerger’s disease
  • Raynaud’s disease
  • Trauma
  • Ergot poisoning

Dry Gangrene Features:

  • Begins in the distal part of the limb
  • Occurs in one of the toes which is far from the blood supply where bacteria fail to grow
  • Spreads slowly upwards
  • The line of demarcation is seen between the gangrenous part and viable part as a bright red line
  • Color changes from greenish to black due to hemolysis of RBCs

Dry Gangrene Treatment:

  • General
    • Nutritious diet
    • Relief of pain
  • Conservative
    • Affected part is
      • Kept dry
      • Kept elevated
      • Not heated
      • Protected from local pressure
      • Carefully observed and toileted
  • Surgical
    • Limited amputation

Gram-positive bacterial infections questions

Bacterial Infections Short Answers

Question 1. Cellulitis.

Answer:

Cellulitis Definition: It is a nonsuppurative inflammation spreading along the subcutaneous tissues and connective tissue planes and across interstitial spaces.

Cellulitis Etiology:

  • Causative organisms are
    • Streptococcus pyogenes.
    • Variety of aerobic and anaerobic bacteria.

Cellulitis Clinical features:

  • Fever
  • Toxaemia.
  • Diabetic patient are commonly affected.
  • Affected part is warm, swollen and tender.
  • Pitting edema with brawny induration is present.
  • Enlargement and tenderness of regional lymph nodes.
  • Common sites are
    • Lower limb
    • Face
    • Scrotum.

Cellulitis Treatment:

  • Diabetic control by insulin.
  • Rest and elevation of the part.
  • Glycerine MgSO4 dressing to reduce edema.
  • Antibiotics.
    • Crystalline penicillin 10 lac units IM/IV 6 hourly for 5-7 days or.
    • Ciprofloxacin 500 mg twice daily.
  • If antibiotics fail, incision and drainage of pus are carried out.

Question 2. Complications of cellulitis.

Answer:

Complications Of Cellulitis:

  • Abscess
  • Necrotizing fasciitis
  • Toxaemia.
  • Septicaemia.
  • Precipitates ketoacidosis.

Question 3. Alveolar abscess.

Answer:

Alveolar Abscess:

  • An alveolar abscess is an abscess in the alveolar ridge of the jaw, usually caused by the spread of infection from non-vital tooth.

Alveolar Abscess Clinical Features:

  • Dull and constant pain.
  • Seen in childhood and early adult life.
  • Swelling of the cheek.
  • Redness and oedema of overlying mucosa.
  • Inflamed and tender regional lymph nodes.
  • Complications:
  • Osteomyelitis.
  • Ludwig’s angina.

Types of bacterial infections with examples

Question 4. Apical abscess/Root abscess.

Answer:

Apical Abscess:

Apical Abscess Definition: It can be defined as a localized, acute or chronic suppurative infection in the periapical region of the tooth.

Apical Abscess Synonyms:

  • Dentoalveolar abscess.
  • Periapical abscess.

Apical Abscess Clinical features:

  • Severe pain in the affected tooth.
  • The tooth is non-vital and mobile.
  • Swelling and redness of overlying mucosa.
  • Extrusion of tooth.
  • Fever.
  • Localized lymphadenitis.
  • Pus discharging sinus may develop.

Question 5. Cold abscess.

Answer:

Cold Abscess: A cold abscess is non-reacting in nature.

  • Cold Abscess is a sequel of tubercular infection.
  • Cold Abscess occurs due to caseation necrosis of lymph nodes resulting in fluctuant swelling in the neck.

Cold Abscess Clinical features:

  • Sites involved.
    • Neck and axilla.
    • Loin from caries spine.
    • Chest wall-side and back.
  • Caseation of lymph nodes.
  • Nodes are soft and matted.
  • Cystic and fluctuant swelling.
  • Transillumination is negative.

Cold Abscess Treatment:

  • Antitubercular regimen.
  • Oblique aspiration,
  • Excised as a whole

Question 6. Osteomyelitis

Answer:

Osteomyelitis Classification:

  1. According to duration and severity,
    • Acute
    • Chronic,
  2. Clinical types,
    • Acute suppurative
    • Primary chronic,
    • Secondary chronic,
    • Non-suppurative,
  3. Presence of pm.
    • Suppurative,
    • Non-suppurative.

Osteomyelitis Treatment:

  • Administration of antibiotics,
  • Sequestromy,
  • Hyperbaric oxygen therapy.

Question 7. Sequestrum.

Answer:

Sequestrum:

  • Sequestrum is a fragment of dead tissue usually bone that has separated from healthy tissue as a result of injury/disease,
  • Sequestrum is avascular.

Sequestrum Types:

  1. Primary sequestrum.
    • Completely separated from bone,
  2. Secondary sequestrum.
    • Partially separated from bone.

Sequestrum Management:

  • Removed by sequestrum.

Bacterial pathogenesis questions and answers

Question 8. Pyaemia.

Answer:

Pyaemia:

Pyaemia is a condition clmmUtfamni by formation of secondary foci of suppuration in various parts of the body by pyogenic bacteria,

  • These foci are caused by the lodgement of septic emboli formed as a result of breaking up of an infected thrombus.
  • It is occasionally associated with,
    • Acute osteomyelitis,
    • Acute Inflammation of intracranial sinus,
    • Acute bacterial endocarditis.

Question 9. Hilton’s method of drainage.

Answer:

Hilton’s Method Of Drainage:

Hilton’s Method Of Drainage Indication: When there are plenty of important structures Jike nerves and vessels around the abscess cavity.

Hilton’s Method of Drainage Technique:

Incision of skin and subcutaneous tissue on the most prominent and most dependent part,
↓
Sinus forceps is forced through the deep fasica into the abscess cavity,
↓
Blades are gradually opened.
↓
Pus drains out.
↓
Forcep is taken out with jaws open,
↓
Abscess cavity is explored by finger.

Question 10. Tetanus prophylaxis.

Answer:

Tetanus Prophylaxis:

1. Active immunization.

  • Tetanus toxoid either as plain toxoid or adsorbed on aluminum phosphate APT is used.
  • 0.5 ml is given intramuscularly.
  • It is given as DPT vaccine i.e., along with toxoid of diphtheria and pertusis vaccine.

Bacterial Infections Tetanus Prophylaxis

2. Passive immunization.

  • Antitetanus toxoid prepared from horse serum is used (ATS).
  • 1500 TU is given intramuscularly immediately after wounding.
  • To avoid the risk of hypersensitivity, human anti-tetanus immune globulins (HTIG) is used.
  • Dose – 250 units.

3. Combined prophylaxis.

  • First dose of tetanus toxoid in one site with administration of ATS or HTIG in another arm.

4. Proper debridement of the wound.

5. Penicillin 10 lacs IM twice daily.

Diagnosis and management of bacterial diseases Questions & Answers

Question 11. Gangrene.

Answer:

Gangrene Definition: Gangrene is the death of a portion of the body with putrefaction.

Gangrene Types:

  1. Dry gangrene.
  2. Wet gangrene.

Bacterial Infections Gangrene

Gangrene Causes:

  • Arterial occlusion.
  • Venous obstruction.
  • Nervous diseases.
  • Traumatic gangrene.
  • Infective gangrene.
  • Diabetic gangrene.
  • Physical gangrene -Heat, cold.

Question 12. Dry Gangrene.

Answer:

Dry Gangrene: Dry gangrene is a form of gangrene occurring due to ischemia.

Dry Gangrene Causes:

  • Ischaemia.
  • Atherosclerosis.
  • Buerger’s disease
  • Raynaud’s disease.
  • Trauma.
  • Ergot poisoning.

Dry Gangrene Features:

  • Begins in the distal part of a limb.
  • Occurs in one of the toes which is far from the blood supply where bacteria fails to grow.
  • Spreads slowly upwards.
  • A line of demarcation is seen between the gangrenous part and the viable part.

Question 13. Actinomycosis.

Answer:

Actinomycosis:

Actinomycosis is a chronic, suppurative granulomatous disease caused by actinomyces Isrealli.

Actinomycosis Clinical Forms:

  • Cervicofacial.
  • Abdominal form.
  • Lungs.

Actinomycosis Treatment:

  • In crystalline penicillin initially 10 lakh units once a day for 6-12 months, later 4 lakh units daily.
  • Hemicolectomy for abdominal forms.
  • Incision and drainage of abscess.
  • Excision of sinus.
  • Releiving obstruction.

Question 15. Syphilis.

Answer:

Syphilis:

Syphilis is a venereal disease caused by treponema-pallidum.

Syphilis Route of Transmission:

  • Sexual contact.
  • From mother to foetus.
  • Through blood transfusion.
  • Through infected needles.

Syphilis Stages:

  • Primary syphilis.
  • Secondary syphilis.
  • Tertiary syphilis.
  • Latent syphilis.

Questions on bacterial infections in the human body

Question 16. Congenital syphilis.

Answer:

Congenital Syphilis:

Congenital syphilis occurs in children born of an infected mother.

Congenital Syphilis Features:

  • Hutchison’s triad which consists of.
    • Hypoplasia of incisor and molar teeth.
    • Eight nerve deafness and
    • Interstitial keratitis in the eye.
  • Mulberry molars with constricted and atrophic cusps.
    • Screwdriver-shaped incisor.
    • Fissuring and scarring of comer of mouth.
    • Frontal bossing.
    • Saddle nose.
    • Short maxilla with high palatal arch.
    • Mandibular prognathism.
    • Delayed eruption of teeth.

Question 17. Hutchison’s teeth.

Answer:

Hutchison’s Teeth: It is a characteristic feature of congenital syphilis.

  • In it, the affected permanent incisors exhibit tapering of mesial and distal surfaces towards the incisal edge rather than towards the cervical margin.
  • This gives a typical screwdriver appearance.
  • Such teeth also have a central notch at their incisal edge.
  • Hence called Hutchison’s incisors.
  • These changes are more pronounced in maxillary central incisors.

Question 18. HIV.

Answer:

HIV:

  • The human immune deficiency virus belongs to the family retroviridae.
  • It causes AIDS.

HIV Morphology:

  • HIV is a spherical enveloped virus.
  • Size – 90 – 120 nm in diameter.
  • The envelope contains projecting spikes.
  • HIV contains two identical copies of the single-stranded RNA genome.
  • The core is surrounded by a nucleocapsid composed of proteins.

HIV Modes of Transmission:

  • Sexual contact.
  • From mother to fetus or infant.
  • Parenteral transmission.
    • Blood transfusion.
    • Contaminated needles and syringes.
    • Intravenous drug abusers.

Question 19. Orbital cellulitis.

Answer:

Orbital Cellulitis: When cellulitis affects the eyes, it is called ocular cellulitis.

Orbital Cellulitis Forms:

  1. Periorbital.
  2. Orbital.

Orbital Cellulitis:

  • It is an infection of the soft tissue in the eye socket.
  • The disease starts in the ethmoid sinus arid the infection spreads into the subperiosteal lining of the orbit.
  • It can cause permanent damage to eye.
  • It is more common in children above 5 years.
  • In severe cases, the infection can spread to the optic nerve, causing impaired vision.

Orbital Cellulitis Causes:

  • Bacterial or fungal infections of the sinuses.

Question 20. Active immunity.

Answer:

Active Immunity:

Active immunity is the resistance developed by an individual as a result of antigenic stimuli.

Active Immunity Types:

  1. Natural.
    • Acquired by natural subclinical or clinical infections.
  2. Artificial
    • Acquired by vaccination.

Bacterial infection case-based questions

Question 21. Pressure sores/bedsores/Decubitus ulcer.

Answer:

Pressure Sores:

Pressure sores appear on the points of pressure when a patient is long bedridden. It occurs on the skin covering bony areas.

Pressure Sores Sites Involved:

  • Hips
  • Back
  • Ankles
  • But locks.

Pressure Sores Cause:

  • Undue pressure on the part.
  • Lying in certain areas for long periods.
  • Thinner skin is present next to bone or cartilage.

Pressure Sores Predisposing Factors:

  • Old age.
  • Sensory loss of the part.
  • Malnutrition.
  • Moisture.
  • Anaemia.
  • Improper nursing.

Pressure Sores Features:

  • Discoloration of the skin.
  • Pain in the affected area.
  • Infection.
  • Open skin.
  • The skin may be softer or firmer than the surrounding skin.

Question 22. Cross Infection.

Answer:

Cross Infection:

Cross-infection refers to the transmission of a pathogenic organism from one person to another. When it occurs in hospitals, it is called nosocomial infection.

Cross Infection Causes:

  • Streptococcal infection.
  • Viral hepatitis.
  • Fecal-oral infections
  • Fungal infections.

Cross Infection Prevention:

  • Maintain good personal hygiene
  • Better sanitation.
  • Better Nursing.

Question 23. Epltaxls.

Answer:

Epltaxls:

  • Epltaxls is nasal bleeding.

Epltaxls Causes:

  • Trauma.
  • Exposure to warm, dry air for long time.
  • Nasal and sinus infections.
  • Allergic rhinitis.
  • Nasal foreign body.
  • Vigorous nose blowing.
  • Deviated nasal septum.
  • Cocaine use.
  • Use of anti-coagulant.
  • Hypertension.
  • Bleeding disorders.

Antibiotic resistance questions and answers

Question 24. Antibiotic.

Answer:

Antibiotic:

  • Antibioma is antibiotic-induced swelling.
  • Due to continuous administration of antibiotics given after abscess formation, the following changes occurs.
    • Wall becomes fibrosed.
    • Pus becomes sterile.
    • Whole mass becomes firm.
  • This condition is known as antibioma.

Antibiotic Sites involved:

  • Breast
  • Thigh
  • Ischiorectal fossa.

 

Kidney Ureter And Suprarenal Gland Question And Answers

by

Kidney Ureter And Suprarenal Gland Question And Answers

Question 1. Describe the anatomical features of kidney.
Answer:

The Anatomical Features Of Kidney

Kidney Ureter And Suprarenal Gland Segments Of The Kidney

  • Bean-shaped excretory organ
  • Situated on either side of the vertebral column in the posterior abdominal wall
  • Right kidney is slightly lower than the left
  • Vertebral Level: T12–L3
  • Length: 11 cm
  • Breadth: 6 cm
  • Thickness: 3 cm
  • Weight
    • Male: 150 g
    • Female: 130 g
  • Color: Reddish brown
  • Orientation: Directed downwards and laterally

Read And Learn More: Abdomen And Pelvis

Kidney Ureter And Suprarenal Gland Questions And Answers

External Features Of Kidney: It has

  • Two Poles:
    • Broad upper pole
    • Pointed lower pole, which lies 2.5 cm above the iliac crest.
  • Two Surfaces:
    • Anterior Surface: Irregular, faces anterolaterally
    • PosteriorSurface: Flat, faces posteromedially.
  • Two Borders:
    • Medial Border
      • Concave
      • The middle part of concavity shows a depression, called hilum
    • Lateral Border
      • Convex.

Hilum of Kidney:

  • Hilum is present on the central part of the medical border
  • Hilum Transmits The Following Structures (From Anterior To Posterior)
    • Renal vein
    • Renal artery
    • Renal pelvis
    • Branch of renal artery
    • Lymphatics and sympathetic nerves.

Kidney Relations

Kidney Ureter And Suprarenal Gland Visceral Relations Of Anterior Surface Of Right And Left Kidneys

Kidney Ureter And Suprarenal Gland Posterior Relations Of Kidneys

Question 2. What are the relations of kidney?
Answer:

The Relations Of Kidney

Kidney Ureter And Suprarenal Gland Relations Of Kidney

Kidney And Adrenal Gland Anatomy MCQs

Question 3. Write a note on coverings of kidney.
Answer:

Coverings Of Kidney

Kidney Ureter And Suprarenal Gland Four Coverings Of Kidney

  • The kidney has 4 coverings
  • They Are (From Inside To Outside):
    • Fibrous capsule or true capsule
    • Perinephric fat or fatty capsule
    • Fascial capsule/false capsule/renal fascia/fascia of Gerota
    • Perinephric fat.
  • True Capsule Of Kidney
    • True Capsule Is Made Up Of:
      • Collagen fibers
      • Elastic fibers
      • Smooth muscle fibers
    • True capsule gives a shining appearance to the kidney
    • Normally true capsule can be easily stripped of
    • But The Capsule Becomes Adherent In Renal Diseases.
    • Fatty Capsule Or Perinephric Fat Of Kidney
      • It is an adipose tissue layer
      • Numerous fibrous strands connecting the true and false capsules pass through the fatty capsule.
  • False Capsule Of Kidney
    • False Capsule provides common covering to kidney and suprarenal glands
    • False Capsule Consists Of Two Layers:
      • Anterior layer: Fascia of Toldt
      • Posterior layer: Fascia of Zuckerkandl
    • On Horizontal Tracing Of False Capsule:
      • Two layers fuse along the lateral border of the kidney and become continuous with transversal fascia
      • Medially
        • The anterior layer passes anterior to renal vessels and joins with the anterior layer on the opposite side, in front of the abdominal aorta and inferior vena cava
        • Posterior layer blends with psoas fascia and gets attached to lumbar vertebral bodies
    • On vertical Tracing Of False Capsule:
      • Superiorly: Anterior and posterior layers fuse above the suprarenal gland and become continuous with the diaphragmatic fascia
      • Inferiorly: Two layers run downwards along the ureter and merge with fascia iliaca and are open inferiorly.
  • Perinephric Fat Of Kidney
    • Perinephric Fat is a part of retroperitoneal fat
    • Lies outside the fascial capsule
    • Found more on the posterior aspect of the kidney.

Ureter Anatomy Important Questions

Question 4. What is Morrison’s parallelogram? And how is it drawn?
Answer:

Morrison’s Parallelogram

Kidney Ureter And Suprarenal Gland Morrison'd Parallelogram Illustrating Surface Marking Of Kidneys On The Back

  • It is the surface marking of the kidney from the back
  • Morris Parallelogram Is Drawn In The Following Way:
    • Two horizontal lines are drawn, one at the level of the spine of T11 and the other at the level of the spine of L3
    • Then two vertical lines are drawn, one 2.5 cm and the other 9 cm lateral to the median plane
    • Hilum lies opposite to the lower border of 1st lumbar spine. Lower on the right side.

Question 5. Describe in detail the blood supply of the kidney. Mention vascular segments of the kidney.
Answer:

The Blood Supply Of Kidney

  • Each kidney is supplied by one renal artery (branch of the abdominal aorta)
  • In 30% of individuals accessory renal arteries are also seen

Course Of Kidney:

  • Renal arteries arise directly from the abdominal aorta (between L1 and L2)
  • The right renal artery passes to the right side and the left renal artery to the left side
  • A further course is similar for both

Kidney Ureter And Suprarenal Gland Segment Of Kidney Course

Venous Drainage Of Kidney

  • Drained by right and left renal vein into inferior vena cava
  • Course Of Venous Blood From Renal Substance Is As Follows:

Kidney Ureter And Suprarenal Gland Venous Drainge Course

Kidney And Suprarenal Gland Viva Questions

Vascular Segments Of Kidney

Kidney Ureter And Suprarenal Gland Opened Book View From Lateral Aspect Showing Five Vascular Segments Of Right Kidney

  • Based on the distribution of five segmental arteries, each kidney is divided into five vascular segments:
    • Apical: It occupies both anterior and posterior surfaces
    • Upper Anterior: It occupies the anterior surface only
    • Middle Anterior: It occupies the anterior surface only
    • Lower: It occupies the entire inferior pole and includes both anterior and inferior surfaces
    • Posterior: It occupies the posterior surface only.

Applied Anatomy Of Kidney: Just like the liver, surgical resection of the kidney is done on the basis of vascular segments—which helps to preserve the healthy parenchyma.

Lymphatic Drainage Of Kidney: Drains into para-aortic lymph nodes.

Nerve Supply Of Kidney

  • Supplied by renal plexus of nerves
  • Renal plexus consists of sympathetic and parasympathetic nerve fibers
    • Sympathetic supply from T10–L1 spinal segments
    • Parasympathetic supply from vagus nerves.

6. Write a note on the development of the kidney.
Answer:

The Development Of Kidney

Kidney Ureter And Suprarenal Gland Development Of Kidney

  • The kidney develops from the intermediate cell mass
  • Intermediate cell mass lies between the paraxial mesoderm and lateral plate mesoderm
  • Paraxial mesoderm gives rise to somites
  • Intermediate cell masses extend craniocaudally on both sides of the primitive dorsal aorta
  • In the cervical and upper thoracic region, it shows segmentation called nephrotomes
  • The remaining unsegmented portion below gives rise to the nephrogenic cord
  • The nephrogenic cord later divides into 3 parts, from above to below pronephros, mesonephros, metanephros
  • Excretory tubules of the kidney are formed from metanephros
  • The collecting part of the kidney is formed from a diverticulum called the ureteric bud
  • The ureteric bud is derived from the lower part of the mesonephric duct
  • Horseshoe kidney—the lower pole of two kidneys fuse together to form an isthmus.

Anatomy Of Kidney Ureter And Adrenal Gland Exam Questions

Question 7. Describe briefly about the external features of suprarenal glands.
Answer:

The External Features Of Suprarenal Glands

Kidney Ureter And Suprarenal Gland Location Of Right And Left Suprarenal Glands

  • They are endocrine glands present on the upper pole of the kidney enclosed by renal fascia
  • Location: Lies in the epigastric region, anterosuperior to the upper part of the kidney, in front of the crus of the diaphragm

Suprarenal Glands Shape:

  • Right Suprarenal Gland: Pyramidal in shape
  • Left Suprarenal Gland: Semilunar in shape

Suprarenal Glands Size:

  • Length: 5 cm
  • Breadth: 3 cm
  • Thickness: 1 cm
  • Weight: 5 g

Suprarenal Glands External Features

  • Right Suprarenal Gland: it has
    • Apex
    • Base
    • Two Surfaces: Anterior and posterior
    • Three Borders: Anterior, medial, and lateral
  • Left Suprarenal Gland: it has:
    • Two Ends: Narrow upper end and rounded lower end
    • Two Surfaces: Anterior and posterior
    • Two Borders:
      • Medial Border: Convex
      • Lateral Border: Concave.

Kidney Ureter And Suprarenal Gland Short Questions And Answers

Question 8. Write a note on the blood supply of the suprarenal gland. Also, mention its lymphatic drainage and nerve supply.
Answer:

Suprarenal Gland:

Kidney Ureter And Suprarenal Gland Arterial Supply Of Suprarenal Glands

Suprarenal Glands Arterial Supply

  • Superior Suprarenal Artery: Branch of the inferior phrenic artery
  • Middle Suprarenal Srtery: Branch of the abdominal aorta
  • Inferior Suprarenal Srtery: Branch of the renal artery.

Suprarenal Glands Venous Drainage

  • Drained by right and left suprarenal veins:
    • Right suprarenal vein drains into the inferior vena cava
    • The left suprarenal vein drains into the left renal vein.

Suprarenal Glands Lymphatic Drainage: Drain into lateral aortic nodes.

Suprarenal Glands Nerve Supply: Receive mainly myelinated preganglionic sympathetic fibers derived from splanchnic nerves.

Renal System Clinical Anatomy Questions

Question 9. Describe in detail the features, division, course, and relations of the ureter.
Answer:

Ureters:

  • Ureters are a pair of narrow muscular tubes that transports urine from the kidney to the bladder
  • Extent: From the ureteropelvic junction to base of the urinary bladder
  • Length: 25 cm, upper half lies in the abdomen and lower half in the pelvis
  • So, The Ureter Is Divided Into Three Parts Based On Its Location, Namely:
  1. Abdominal Part: Renal pelvis—pelvic brim
  2. Pelvic Part: Pelvic brim—base of the urinary bladder
  3. Intravesical Part.

Ureter Course:

Kidney Ureter And Suprarenal Gland Ureter Course

Suprarenal Glands Relations:

Kidney Ureter And Suprarenal Gland Ureter Relations

Suprarenal Glands Intravesical Part

  • Narrowest part
  • This part has an oblique course in the wall of the bladder
  • This oblique passage acts as a flap valve and prevents the reflux of urine from the urinary bladder back to the ureter
  • Ureteric openings are 5 cm and 2.5 cm apart in distended and empty bladders respectively.

Suprarenal Glands Blood Supply

Suprarenal Glands Arterial Supply:

Kidney Ureter And Suprarenal Gland Ureter Blood Supply

These branches further divide into ascending and descending branches and they form a plexus in the connective tissue sheath on the surface of ureter and then supply it.

Suprarenal Glands Venous Drainage: Drained by veins corresponding to the arteries

Kidney And Suprarenal Gland MBBS Notes

Suprarenal Glands Lymphatic Drainage

  • Lateral aortic nodes
  • Iliac nodes.

Suprarenal Glands Nerve Supply

  • Sympathetic Supply: From T10 to L1 spinal segments through renal, aortic, and hypogastric plexuses
  • Parasympathetic Supply: From S2 to S4 through pelvic splanchnic nerves.

Question 10. Name the constrictions of ureter.
Answer:

The Constrictions Of Ureter

Kidney Ureter And Suprarenal Gland Normal Sites Of Constrictions In Ureter

The Ureter Presents With 5 Constrictions:

  • At the pelvic ureteric junction at the level of the tip of the transverse process of L2 vertebrae
  • At the brim of the true pelvis
  • At the point of crossing of the ureter by ductus deferens
  • Intravesical or intramural: During its passage through the bladder wall
  • At the ureteric orifice in the interior of the urinary bladder.

Ureter Applied Anatomy: These constrictions can act as the site of lodgment of kidney stones.

Kidney And Ureter NEET PG Questions

Kidney Ureter And Suprarenal Gland  Multiple Choice Questions And Answers

Question 1. The kidney is related posteriorly to all the structures except:

  1. Iliohypogastric nerve
  2. Subcostal nerve
  3. Small intestine
  4. Renal fascia

Answer: 3. Small intestine

Question 2. Renal angle lies between:

  1. 11th rib and lateral border of sacrospinalis
  2. 12th rib and lateral border of sacrospinalis
  3. 10th rib and lateral border of sacrospinalis
  4. 12th rib and lateral border of quadratus lumborum

Answer: 2. 12th rib and lateral border of sacrospinalis

Question 3. The structures in the hilum of the kidney are:

  1. Renal vein
  2. Renal artery
  3. Ureter
  4. All of the above

Answer: 4. All of the above

Kidney And Suprarenal Gland Labeled Diagram With Questions

Question 4. The suprarenal gland has:

  1. 1 artery 3 veins
  2. 2 arteries 2 veins
  3. 3 arteries 3 veins
  4. 3 arteries 1 vein

Answer: 4. 3 arteries 1 vein

Question 5. Regarding the relations of the ureter, which is incorrect?

  1. Cross the vas deferens in males
  2. Medial to the transverse processes of lumbar spine
  3. Cross the genitofemoral nerve
  4. Narrowest at the PUJ

Answer: 1. Cross the vas deferens in males

Question 6. Which of the following structures is normally NOT found at the L1 vertebral level?

  1. Hilum of kidneys
  2. Origin of the celiac trunk
  3. Pylorus of stomach
  4. 3rd part of duodenum.

Answer: 4. 3rd part of duodenum.

Posterior Abdominal Wall Question And Answers

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Posterior Abdominal Wall Question And Answers

Question 1. What is thoracolumbar fascia? What are its attachments?
Answer:

Thoracolumbar Fascia

Posterior Abdominal Wall Vertebral Attachments Of Posterior, Middle And Anterior Layers Of Lumbar Fascia

  • It is the deep fascia covering the deep muscles on the posterior aspect of the trunk
  • It attaches erector spinae to the posterolateral surface of vertebral bodies
  • Thoracolumbar Fascia Can Be Divided Into Two Parts:
    1. Lumbar Part
    2. Thoracic Part.

Read And Learn More: Abdomen And Pelvis

1. Thoracolumbar Fascia Lumbar Part

  • Made Up Of 3 Strong Layers Of Deep Fascia, Namely:
    • Anterior Layer: The layer
    • Middle And Posterior Layers: Thick and strong layers
  • Between the anterior and middle layers lies the quadratus lumborum muscle
  • Between the middle and posterior layers lies the erector spinal muscle and transversal spinal muscle
  • Laterally the 3 layers fuse to form an aponeurotic sheet
  • Internal oblique and transversus abdominis muscles gets there origin from this aponeurotic sheet.

Posterior Abdominal Wall Important Questions

Thoracolumbar Fascia Attachments

  • Anterior Layer
    • Superiorly: Forms the lateral arcuate ligament
    • Inferiorly: Iliac crest
    • Medially: Transverse process of lumbar vertebrae
  • Middle Layer
    • Superiorly: Lower border of 12th rib
    • Inferiorly: Iliac crest
    • Medially: Tips of the transverse process of lumbar vertebrae, intertransverse ligaments
  • Posterior Layer
    • Superiorly: Thracic part of the thoracolumbar fascia
    • Inferiorly: Iliac crest
    • Medially: Spinous process of lumbar vertebrae.

2. Thoracolumbar Fascia Thoracic Part

Thoracolumbar Fascia Attachments

  • Superiorly: Continuous with the superficial lamina of investing layer of cervical fascia
  • Laterally: Angles of ribs
  • Medially: Spinous process of thoracic vertebrae.

Question 2. Write a note on psoas major.
Answer:

Psoas Major

Posterior Abdominal Wall Attachments Of Illiopsoas

  • The Psoas major is one of the important muscles in the posterior abdominal wall
  • Other Muscles Are Psoas minor, iliacus, and quadratus lumborum.

Posterior Abdominal Wall Viva Questions

Psoas Major Origin

  • Psoas arises from 14 fleshy Slips:
    • Five Slips: Each slip arises from bodies and intervertebral discs between two adjacent vertebrae, from T12 – L5
    • Five Slips: Each slip arises from the anterior surface and lower borders of the transverse process of five lumbar vertebrae (L1 – L5)
    • Four Slips: Each slip arises from tendinous arches connecting the constricted parts of the lumbar vertebrae.

Psoas Major Insertion

  • Psoas major descends along the pelvic brim
  • Passes anterior to the inguinal ligament and anterior to the hip joint
  • Enter the thigh
  • And ends on the medial side of a tendon (the lateral side of this tendon receives fiers of iliacus)
  • This tendon is inserted into the anterior surface of tip of the lesser trochanter
  • Since psoas major and iliacus have a common insertion and action they are together called Iliopsoas.

Psoas Major Nerve Supply: Ventral rami of L2, L3, and L4 spinal nerves.

Psoas Major Actions

  • Chief flexor of thigh
  • Maintain stability at hip
  • Lateral flexion of the trunk on same side.

Psoas Major Relations:

  • At Abdomen
    • Anterolaterally
      • Kidney
      • Ureter
      • Renal vessels
      • Gonadal vessels
      • Psoas fascia
      • Medial arcuate ligament
      • Psoas minor
    • Medially
      • Lumbar vertebral bodies and vessels
    • Posteriorly
      • Lumbar plexus
      • Transverse process of lumbar vertebrae

Anatomy Of Posterior Abdominal Wall Exam Questions

  • At Thigh
    • Anteriorly
      • Femoral artery
      • Fascia lata
    • Posteriorly
      • Synovial bursa separating capsule of the hip joint from the muscle
    • Medially
      • Femoral vein
      • Pectineus muscle
    • Laterally
      • Iliacus muscle
      • Femoral nerve

Question 3. What is psoas sheath?
Answer:

Psoas Sheath

  • Psoas Sheath is a fascial sheath enclosing the psoas major muscle
  • Psoas Sheath is derived from psoas fascia.

Question 4. Write a note on cisterna chyli.
Answer:

Cisterna Chyli

  • Elongated lymphatic sac
  • Length: 5–7 cm
  • Breadth: 4 mm
  • Vertebral level: L1 – L2
  • Location: Between aorta and azygos vein, in front of L1 and L2
  • It is overlapped by right crus of the diaphragm
  • Formed by union of right and left lumbar lymph trunks
  • It continues superiorly as the thoracic duct

Psoas Sheath Tributaries:

  • Two lymph vessels from lower intercostal lymph nodes (open superiorly).
  • Right and left intestinal lymph trunks (opens in the middle)—arising from preaortic lymph nodes.
  • Right and left lumbar lymph trunks (opens inferiorly)—arising from lateral aortic lymph nodes.

Posterior Abdominal Wall Short Questions And Answers

Posterior Abdominal Wall Multiple Choice Questions

Question 1. Thoracolumbar fascia:

  1. Is also known as lumbar ventral fascia
  2. Encloses all the intrinsic muscles of the back
  3. Encloses the trapezius, rhomboids, and serratus anterior muscles
  4. Terminates at the first rib

Answer: 2. Encloses all the intrinsic muscles of the back

Posterior Abdominal Wall Anatomy MCQs

Question 2. Which is not true about the psoas major?

  1. It arises from the lower border of T12–L5 vertebrae and intervertebral discs between them
  2. It crosses the pelvic brim and passing deep to the inguinal ligament, gets attached to the lesser trochanter of the femur
  3. It is supplied by L1, L2, L3
  4. It causes flexion and lateral rotation movements at hip joint

Answer: 4. It causes flexion and lateral rotation movements at hip joint

Question 3. The cisterna chyli lies adjacent to the:

  1. T12 vertebral body on the right side, posterior to the aorta
  2. T12 vertebral body on the left side, anterior to the aorta
  3. L1 vertebral body on the left side, anterior to the aorta
  4. L1 vertebral body on the right side, posterior to the aorta

Answer: 4. L1 vertebral body on the right side, posterior to the aorta

 

Urinary Bladder And Urethra Question And Answers

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Urinary Bladder And Urethra Question And Answers

Question 1. Explain in detail about the external features and relations of the urinary bladder in males and female.
Answer:

Urinary Bladder

Urinary Bladder And Urethra Tetrahedral Shape Of Urinary Bladder And Its Surfaces And Angles

  • Hollow muscular organ acting as a temporary reservoir of urine
  • It receives urine through the ureter and is passed out via the urethra by micturition

Urinary Bladder In Male And Female Location:

In adults, an empty bladder lies in the front part of the lesser pelvis below the peritoneum and behind the pubic symphysis

  • In male, it lies in front of the rectum
  • In female, it lies in front of the uterus

Urinary Bladder Anatomy Important Questions

Urinary Bladder In Male And Female Shape: Empty bladder is tetrahedral, distended bladder is globular

Read And Learn More: Abdomen And Pelvis

Urinary Bladder In Male And Female Capacity: Normally 120–320 ml of urine is present in the urinary bladder, maximum capacity – 500 ml.

Urinary Bladder In Male And Female External Features

  • Empty Bladder Has A Tetrahedral Shape, It Has:
    • Apex
    • Base
    • Neck
    • The surfaces—superior and two inferolateral surfaces
    • Four borders—anterior, posterior, and two lateral.

Urinary Bladder Apex Or Anterior Angle

  • Urinary Bladder is the meeting point of the superior and two inferolateral surfaces
  • Lies posterior to the upper margin of the pubic symphysis
  • It provides attachment to the median umbilical ligament.

Urinary Bladder Base Or Posterior Surface

  • Urinary Bladder is almost like an inverted triangle
  • Urinary Bladder has broad and narrow ends
  • The broad end (posterior border) is directed superiorly
  • The narrow end is directed inferiorly.

Urinary Bladder Apex Or Anterior Angle Urinary Bladder Base Or Posterior Surface Relations Of Base

Urinary Bladder And Urethra Relations Of Base Of Urinary Bladder In Male

  • Male
    • The Upper Part Of Base
      • Rectovesical pouch
      • Coils of intestine
    • Lower Part Of Base
      • Seminal vesicles
      • Termination of vas deferens
  • Female
    • Uterine cervix
    • Vagina

Urethra Anatomy MCQs With Answers

Urinary Bladder Neck Or Inferior Angle

  • The lowest and most fixed part of the urinary bladder lies about 3–4 cm behind the lower part of the pubic symphysis
  • It is the meeting point of inferolateral surfaces and the narrow end of the base
  • It is pierced by the internal urethral meatus and continues as the urethra
  • Circular fiers of the detrusor muscle get modified at the neck to form an internal urethral sphincter.

Urinary Bladder Neck Or Inferior Angle Relations

  • Male
    • Base of prostate
  • Female
    • Pelvic fascia
    • Urogenital diaphragm

Urinary Bladder Superior Surface

  • Triangular in shape
  • Bounded on each side by inferolateral surface
  • Base of this triangle is formed by the posterior border which lies between two ureteric orifices.

Urinary Bladder Superior Surface Relations

  • Male
    • Peritoneum
    • Coils of intestine
    • Sigmoid colon
  • Female
    • Peritoneum
    • Uterine cervix (supravaginal part)

Urinary Bladder Inferolateral Surfaces

  • Two in number
  • Directed downward, forward, and medially
  • They meet each other in the midline and are separated by the anterior border
  • Lateral borders separate inferolateral surfaces from superior surfaces
  • They are devoid of peritoneum.

Urinary Bladder And Urethra Viva Questions

Urinary Bladder Inferolateral Surfaces Relations

  • Common For Both Males And Females.
    • Anteriorly
      • Retropubic space/Cave of Retzius
      • Puboprostatic ligaments in males and pubovesical ligaments in female
      • Pubis
    • Posteriorly
      • Obturator internus muscle
      • Levator ani muscle

Urinary Bladder And Urethra Peritoneal And Visceral Realtions Of Urinary Bladder In Male

Urinary Bladder And Urethra Peritoneal Relations Of Urinary Bladder In Female

Question 2. Write a note on the ligaments supporting the urinary bladder.
Answer:

The urinary bladder is supported by true and false ligaments:

1. True Ligaments: These are the condensation of pelvic fascia around the base and neck of the bladder and developmental remnants:

  • Median Umbilical Ligament
    • Remnant of urachus
    • Extends from apex to umbilicus
  • Medial And Lateral Puboprostatic (m)/Vesical Ligaments (f)
    • Formed from the condensation of pelvic fascia and smooth muscle fibers
    • They fit the neck of the bladder and also forms the floor of the Cave of Retzius
    • They Are Closely Related To Vesical Venous Plexus
      • Medial Puboprostatic (m)/Vesical Ligaments (f)
        • Extend from neck of the bladder to pubic symphysis
        • Directed downwards and backward
      • Lateral Puboprostatic (m)/Vesical Ligaments (f)
        • Extend from the neck of the bladder to the tendinous arch of the obturator fascia
        • Directed medially and backward
  • Lateral Ligament
    • Condensation of pelvic fascia
    • Extend from inferolateral surface to tendinous arch of pelvic fascia
  • Posterior Ligaments
    • Condensation of pelvic fascia
    • Extend from neck and base of the bladder to lateral pelvic wall
    • They contain vesical venous plexus
    • Directed backward and upwards along the vesical venous plexus.

2. False Ligaments: They are raised peritoneal folds that do not form any support to urinary bladder, they are:

  • Median umbilical fold formed by median umbilical ligament
  • Medial umbilical fold formed by obliterated umbilical arteries
  • Lateral false ligament formed by the peritoneum of the paravesical fossa
  • Posterior false ligament formed by the peritoneum of urogenital folds.

Anatomy Of Urinary Bladder And Urethra Exam Questions

Question 3. Write a note on the interior of the urinary bladder and what is trigone of the bladder is.
Answer:

Interior Of The Urinary BLadder

  • In an empty bladder, the mucus membrane is pale in color
  • Most of the mucosa appears as irregular folds or rugae since they are loosely attached to the muscular layer
  • But over a triangular area, located in the lower part of the base of the urinary bladder, the mucosa is fully attached to the muscular coat
  • This does not show rugae or irregular fold
  • This area is known as the trigone of the bladder.

Trigone Of Bladder

Urinary Bladder And UrethraInternal Trigone Of Urinary Bladder And Internal Features Of Prostatic Urethra

  • Trigone Of Bladder has the shape of an equilateral triangle
  • Trigone Of Bladder Has:
    • Apex/Anterior Angle
      • Directed downward and forward
      • The internal urethral orifice is present at the apex
    • Posterolateral Angles
      • Two in number
      • Ureters open at these angles
      • These openings are 5 cm apart in the distended bladder and 2.5 cm apart in the empty bladder
  • The upper margin of the trigone is formed by fibers of the inner longitudinal muscle coat of the ureter
  • Two sides of trigone are formed by ureters-ureteral ridges (modification of inner longitudinal muscle coat of ureter)
  • In male, there is a slight elevation of trigone, above and behind the internal urethral orifice (which is produced by the projection of the median lobe of the prostate).

Trigone Of Bladder Applied Anatomy

  • In BPH, the median lobe enlarges and blocks the internal urethral meatus, leading to urinary retention
  • The Mucosa of trigone is more vascular and sensitive than other parts of urinary bladder.

Question 4. Write a short note on blood supply, lymphatic drainage, nerve supply, and development of urinary bladder.
Answer:

Urinary Bladder Arterial Supply

  • Male: Branches of superior vesical and inferior vesical arteries
  • Female: Branches of superior vesical and vaginal arteries, and minor contribution from uterine arteries.

Venous Drainage of Urinary Bladder

  • Veins of the bladder from the vesical venous plexus
  • The vesical venous plexus drains into internal iliac veins
  • The vesical venous plexus communicates with the prostatic venous plexus.

Lymphatic Drainage of Urinary Bladder: Lymphatics drain into external iliac lymph nodes.

Nerve Supply Of Urinary Bladder

  • Sympathetic Nerves: Derived from T11, T12, L1, L2 spinal segments through the vesical venous plexus
  • Parasympathetic Nerves: Derived from S2, S3, and S4 spinal segments.

Development of Urinary Bladder

  • Cloaca Is Subdivided By Urorectal Septum Into:
    • Anterior primitive urogenital sinus
    • Posterior anorectal canal
  • The Cranial and largest part of the urogenital sinus is called the vesicourethral canal
  • The vesicourethral canal forms most of the urinary bladder
  • Trigone of the bladder is formed by absorption of the mesonephric duct
  • The apex of the bladder is derived from the urachus
  • Splanchnopleuric mesoderm gives rise to muscular and serous walls of the bladder
  • Ectopia vesicae: Congenital anomaly in which the posterior wall of the bladder is exposed to the outside, and the anterior wall of the bladder is missing
  • Hourglass bladder: The urinary bladder becomes divided into upper and lower parts by a middle constriction, thus giving the appearance of an hourglass.

Urinary Bladder And Urethra Short Questions And Answers

Question 5. Describe about male urethra and write briefly about the external urethral orifice.
Answer:

Male Urethra

Urinary Bladder And Urethra Gross Anatomy Of Male Urethra

  • It is 18–20 cm long
  • Extent: Internal urethral orifice to external urethral orifice
  • Shape:
  • Erected Penis: J-shaped
  • In the Flaccid State Of The Penis: S-shaped
  • Division

Based On The Location, The Urethra Is Divided Into 3 Parts, Namely Prostatic Part, Membranous Part, And Penile Part

Urethra Prostatic Part

  • Urethra Prostatic is the widest and most dilatable part
  • Urethra Prostatic is 3–4 cm long
  • This portion passes through the prostate
  • Internally The Posterior Wall Of The Prostatic Part Shows The Following Features:
    • Urethral Crest
      • Urethral Crest is a midline ridge, present throughout the posterior wall of the prostatic part of the urethra
      • This ridge projects into the lumen, giving the lumen a crescentic appearance on the transverse section
    • Colliculus Seminalis Or Verumontanum
      • Colliculus Seminalis is an elevation in the middle of the urethral crest
      • Colliculus Seminalis has a slit-like orifice, which is the opening for the prostatic utricle
      • Ejaculatory ducts open on both sides of the opening for prostatic utricle
    • Prostatic Sinuses
      • They are shallow depressions present on both sides of urethral crest
      • Each sinus has 15–20 openings for the prostatic glands.

Urethra Membranous Part

  • The Urethra Membranous is the shortest and least dilatable part of the urethra
  • Urethra Membranous is about 1.5–2 cm long
  • Urethra Membranous passes through the urogenital diaphragm
  • Runs downwards and just 2.5 cm above pubic symphysis, it pierces the perineal membrane
  • The wall of the membranous urethra has a muscular coat provided by the sphincter urethrae muscle
  • Urethra Membranous act as a voluntary external sphincter of the bladder
  • The membranous part also contains numerous mucus glands.

Urethra Penile Part

  • Also called the spongy part
  • It is 15–16 cm long (flaccid penis)
  • This portion passes through the corpus spongiosum of the penis
  • Extent: Membranous urethra to the external urethral orifice

Urinary Bladder And Urethra Clinical Questions

Urethra Penile Part Course:

Urinary Bladder And Urethra Urethra Course

  • During its course, the penile part shows two dilatations, they are:
  • Intrabulbar Fossa: At the bulb of penis
  • Navicular Fossa: At the glans penis

Urethra Other Features

  • All portions of the penile urethra except that at the terminal navicular fossa contain urethral glands called Littre’s glands
  • These glands open into the penile part through small pit-like mucus recesses called urethral lacunae
  • But the roof of navicular fossa contains one lacunae called lacuna magna.

External Urethral Orifice

  • The narrowest part of the urethra, about 6 mm long
  • It is like a sagittal slit
  • It is limited on both sides by a small labium.

Epithelial Lining Of Urethra

  • Part Of The Urethra
    • Prostatic Part
      • Above seminal colliculus
      • Below seminal colliculus
      • Membranous part
      • Spongy urethra above navicular fossa
      • Stratified columnar epithelium
      • Navicular fossa
    • Epithelial Lining
      • Transitional epithelium
      • Stratified columnar epithelium
      • Stratified columnar epithelium
      • Stratified squamous epithelium

Blood Supply Of Urethra

  • Arterial Supply
    • Urethral Artery: Branch of the internal pudendal artery
    • Dorsal penile artery.
  • Venous Drainage
    • The penile part of the urethra drains into → Dorsal veins of the penis → Internal pudendal vein → Prostatic venous plexus
    • Prostatic and membranous part of urethra → Prostatic and vesical venous plexus → Internal iliac veins.
  • Lymphatic Drainage
    • Prostatic and membranous urethra → Internal iliac nodes
    • Penile part of urethra → Deep inguinal nodes.
  • Nerve Supply
    • Sympathetic Supply: From L1 and L2 spinal segments through superior hypogastric plexus
    • Parasympathetic Supply: From S2, S3, S4 segments through pelvic splanchnic nerves
    • The terminal part of the urethra is supplied by somatic nerves derived from the urethral branches of the pudendal nerve.

Urinary Bladder And Urethra MBBS Notes

Question 6. Write a brief about the female urethra.
Answer:

Female Urethra

  • Shorter than the male urethra
  • The female urethra corresponds to prostatic and membranous parts of the male urethra
  • Extent: From the neck of the bladder to the external urethral orifice in the vestibule of the vagina
  • Anterior Relations: Anterior wall of the vagina and pubic symphysis
  • The urethral wall is made of an inner longitudinally arranged smooth muscle layer and outer circularly arranged sphincter urethrae.

Urinary Bladder And Urethra Multiple Choice Questions

Question 1. Lymphatics from penile part of urethra drain into which of the following lymph nodes?

  1. Internal iliac nodes
  2. Deep inguinal nodes
  3. Sacral nodes
  4. Para-aortic lymph nodes

Answer: 2. Deep inguinal nodes

Question 2. The __________ space is located between the body of the urinary bladder and the pubic symphysis:

  1. Retropubic space
  2. Vesicouterine space
  3. Uterosacral space
  4. Rectopubic space

Answer: 1. Retropubic space

Urinary Bladder And Urethra NEET PG Questions

Question 3. A student while passing a catheter into male urethra suddenly injured it. The rupture is in?

  1. Prostate gland
  2. Spongy part of urethra
  3. Membranous part of urethra
  4. Prostatic part of urethra

Answer: 3. Membranous part of urethra

Question 4. Pubovesical ligament holds the ___________________ of the urinary bladder in place:

  1. Fundus
  2. Body
  3. Base
  4. Neck

Answer: 4. Neck

Question 5. The urinary bladder is attached to the anterior abdominal wall via the________ligament:

  1. Median umbilical
  2. Medial umbilical
  3. Lateral umbilical
  4. Round

Answer: 1. Median umbilical

Male And Female Reproductive Organs Question And Answers

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Male And Female Reproductive Organs Question And Answers

Question 1. Describe about the external and internal features, lobes, and relations of the prostate.
Answer:

Prostate

  • Accessory sex gland in the male
  • It secretes acid phosphatase, citric acid, fibrinolysin, prostate specific antigens, PGs, amylase, etc.
  • These secretions contribute to the bulk of the seminal fluid
  • Paraurethral glands of skene are homologous to the prostate in female.

Prostate Location

  • In the lesser pelvis between the neck of the urinary bladder above and the urogenital diaphragm below:
  • Anteriorly related to the lower part of the pubic symphysis and the upper part of pubic arch
  • Posteriorly related to the ampulla of the rectum

Read And Learn More: Abdomen And Pelvis

Relations Of The Prostate:

Male And Female Reproductive Organs Relations Of Prostate

  • Shape: Inverted cone, with broad base—directed upward and pointed apex directed downward
  • Weight: 3 g
  • Length: 3 cm
  • Breadth: 4 cm
  • Thickness: 2 cm

Reproductive System Important Questions

Prostate External Features

Male And Female Reproductive Organs Sagittal Section Through The Prostate To Show Its Lobes

  • The prostate has an apex, four surfaces—anterior, posterior, and two inferolateral surfaces and a base
    • Apex
      • Directed downward
      • It is continuous with the neck of the urinary bladder
      • The junction between the base and neck of the urinary bladder is marked by a circular groove
      • Numerous venules of the prostatic plexus and the urinary bladder are present inside the groove
      • Base is pierced in the median plane by the urethra approximately at the junction of its anterior 1/3rd and posterior 2/3rd.
    • Anterior surface
      • Narrow and convex from side to side
      • Location: 2 cm behind the pubic symphysis
      • This 2 cm gap is filled up by retropubic fat and forms the retropubic space of Retzius.
      • The lower end of the anterior surface (just a little above the apex) is pierced by the urethra.
    • Posterior Surface
      • It is triangular in shape
      • Posteriorly, it is separated from the ampulla of the rectum by the fascia of Denonvilliers
      • The posterior surface is divided into an upper smaller area and a lower larger area by a transverse sulcus passing through it
      • The transverse sulcus is pierced on each side by the ejaculatory duct
      • A lower large area is again divided by a posterior median sulcus into two lateral lobes
      • The upper smaller area is called the median lobe
      • The median lobe is wedge-shaped, its base has an elevation known as uvula vesicae and is composed mainly of glandular tissue.
      • Lobes Of Prostate

Male And Female Reproductive Organs Features Of The Posterior Wall Of The Prostatic Urethra

Male And Female Reproductive Organs Transverse Section Through The Prostate To Show Its Lobes

Human Reproductive System Question Answers

The Prostate Is Incompletely Divided Into Five Lobes:

  1. Anterior lobe
  2. Posterior lobe
  3. Median lobe
  4. Two lateral lobes

1. Anterior Lobe (isthmus)

  • Situated in front of the urethra
  • Bridges the two lateral lobes in front of the urethra
  • Devoid of glandular tissue, so adenomas never occur here

2. Posterior Lobe

  • Situated behind urethra and below the ejaculatory duct
  • Connects the two lateral lobes behind the urethra
  • Contains glandular tissue and is the main site of carcinoma

3. Median Lobe

  • Lies posterior and superior to prostatic utricle and ejaculatory ducts
  • Utricle lies within lobe
  • Common site for adenoma

4. Two Lateral Lobes (right and left)

  • Contains numerous glands
  • Also can become a site for carcinoma.

Internal Features Of Prostate

  • Prostatic urethra—it passes through the gland
  • There are openings for ducts of prostatic follicles into the prostatic sinuses of the prostatic urethra
  • Right and left ejaculatory ducts pass through the gland and open into the prostatic urethra
  • Prostatic utricle saw inside the prostate.

Male And Female Reproductive System MCQs With Answers

Question 2. Classify the zones of the prostate.
Answer:

Prostate Gland Has Been Divided Into Different Zones On The Basis Of Its Composition By Mcneal. They Are:

  • Peripheral Zone
    • Forms about 70% of the fraction of gland
    • Location: Subcapsular portion of posterior aspect of mprostate gland which surrounds distal urethra
    • Most common site of prostatic carcinomas.
  • Central Zone
    • Forms about 25% of the fraction of gland
    • It is the part of the gland surrounding the ejaculatory duct.
  • Transitional Zone
    • Approximately 5% of the fraction of gland
    • This is the region of the gland responsible for benign prostatic hypertrophy.
    • Anterior Fibromuscular Zone
    • Area devoid of glandular components
    • Composed of muscle and fibrous tissue.

Question 3. Write briefly on the capsules of the prostate.
Answer:

The Prostate Has A True Capsule And A False Capsule:

Male And Female Reproductive Organs True And False Capsules Of The Prostate

True Capsule Of Prostate:

  • Formed by condensation of connective tissue stroma of the gland and is continuous with stroma of gland
  • True Capsule Of Prostate is devoid of venous plexus
  • The true Capsule Of the Prostate is adherent to the prostate.

False Capsule Of Prostate:

  • Located outside true capsule
  • False Capsule Of Prostate is derived from pelvic fascia
  • False Capsule Of Prostate covers the prostate gland and urinary bladder
  • False Capsule Of Prostate contains prostatic venous plexus on each side
  • Anteriorly it is continuous with puboprostatic ligaments
  • And posteriorly with true ligaments of bladder and rectovesical fascia.

Applied Anatomy Of Prostate

  • During BPH, the prostate gets an additional pathological capsule
  • Adenoma compresses the peripheral part of the gland which acts as the third capsule.

Reproductive Organs NEET Questions

Question 4. What are the supports of the prostate?
Answer:

  • Puboprostatic ligaments—on the anterior aspect
  • Urogenital diaphragm
  • The rectovesical fascia of Denonvilliers—on the posterior aspect.

Question 5. Describe the blood supply, lymphatic drainage, and nerve supply of the prostate. What are the communications of prostatic venous plexus and what is its importance?
Answer:

  • Arterial Supply Of Prostate
    • Inferior vesical artery
    • Middle rectal artery
    • Internal pudendal artery
  • Venous Drainage Of Prostate
    • Veins of prostate form the prostatic venous plexus
    • They drain into the inferior vena cava through iliac veins
    • They also have valveless communications with internal and external vertebral plexus through which they drain into the intracranial dural venous sinuses.
    • Applied: Carcinoma prostate can metastasise to the heart via internal iliac veins and vertebral column and through internal and external vertebral plexus.
  • Lymphatic Drainage Of Prostate
    • Lymphatics Drain:
      • Mainly into internal iliac nodes and sacral group of lymph nodes
      • Partly into external iliac nodes.
  • Nerve Supply Of Prostate
    • Sympathetic Supply: From L1, L2 spinal segments through superior hypogastric plexus
    • Parasympathetic Supply: From S2, S3, and S4 spinal segments by pelvic splanchnic nerves.

Reproductive System Viva Questions

Question 6. Briefly mention the age changes in the prostate.
Answer:

The Age Changes In The Prostate

  • Childhood: Small
  • Puberty: Sudden increase in size
  • 20–30 Years: Marked proliferation
  • 30–45 Years: Size remains constant and involution starts
  • 45 Years And Above: May be enlarged (BPH) or reduced (senile atrophy).

Question 7. Write a note on the development of the prostate.
Answer:

Prostate Develops From A Large Number Of Buds Arising From The Prostatic Urethra

  • Buds arising from the endodermal part of the prostatic urethra form the glandular part of the prostate
  • Buds arising from the mesodermal part of the prostatic urethra form the stroma of the prostate.

Question 8. Write a note on the location, size, and position of the uterus. Describe the different parts of the uterus.
Answer:

Uterus

  • Also called hysteria
  • Location Of Uterus: In the lesser pelvis between the bladder and rectum
  • Shape Of Uterus: Pear­shaped, flattened anteroposteriorly backward
  • Size Of Uterus:
    • Length: 7.5 cm
    • Breadth: 5 cm
    • Height/thickness: 2.5 cm
    • Weight: 30–40 g

Male And Female Reproductive Organs Normal Anteverted And ANteflexed Positions Of Uterus

The Normal Position Of The Uterus: Uterus normally lies in the position of anteversion and anteflexion

  • Anteversion—the long axis of the uterus forms an angle of about 90 degrees with the long axis of the vagina. This forward angle is known as the angle of anteversion
  • Anteflxion—the long axis of the body of the uterus is bent forward at the level of internal os on the axis of the cervix. They make an angle of 170 degrees with each other. This position is known as anteflexion and the angle is known as the angle of anteflexion.

Male And Female Reproductive Organs Uterus, Uterine Tune And Ovary Seen From Posterior Aspect

Parts Of Uterus

  • Body: Upper 2/3rd (extends from fundus to isthmus)
  • Cervix: Lower 1/3rd

The Junction Between the Body And Cervix Is Called The Isthmus.

  • Body It includes:
    • Fundus
    • Two Surfaces:
      • Anterior/vesical
      • Posterior/intestinal
    • Two lateral borders—right and left.
  • Fundus
    • Free upper end of the uterus
    • Convex dome­like in appearance
    • It lies above the openings of the uterine tubes
    • It is covered by peritoneum.

Two Surfaces Of Uterus

  • Anterior Surface/Vesical Surface
    • Flat surface
    • Directed downward and forward
    • It is covered with the peritoneum up to the isthmus
    • From this point, the peritoneum sets reflected onto the upper surface of the urinary bladder and becomes the ureterovesical pouch.
  • Posterior Surface/Intestinal Surface
    • Convex
    • Directed upward and backward
    • It is covered by the peritoneum
    • It also forms the anterior wall of the rectouterine pouch.

Two Lateral Borders Of Uterus:

  • Rounded and convex
  • The nonperitoneal part, since it provides attachment to the broad ligament of the uterus
  • The uterine tube opens in the upper end of the lateral border
  • The round ligament of the uterus is attached anteroinferior to the opening of the uterine tube and the ligament of the ovary is attached posteroinferior to the opening of the uterine tube.

Cervix Of Uterus

  • Lower cylindrical part
  • Length: 2.5 cm
  • Wider in the middle
  • Its lower part projects into the anterior wall of the vagina, dividing the cervix into two parts:
    • Supravaginal Part—upper part
    • Vaginal Part—lower part
  • Vaginal Fornices: Space between the vaginal part of the cervix and the vaginal wall.

External OS Of Uterus : Opening of Cervix into Vagina

  • Nulliparous Women: Small and circular
  • Multiparous Women: Large and transverse

Internal Os Of Uterus: Opening of the body of the uterus into cervix

  • Uterine Cavity Proper/Cavity Of The Body—triangular in shape
  • Cervical Canal/Cavity Of The Cervix—spindle­shaped.

Reproductive System Short Questions And Answers

Question 9. What are the relations of different parts of the uterus?
Answer:

The Relations Of Different Parts Of The Uterus

Male And Female Reproductive Organs Relations Of Different Parts Of Uterus

Male And Female Reproductive Organs Some Ligaments Of The Uterus

Question 10. Classify the ligaments of uterus. Write a note on broad ligament.
Answer:

Ligaments Of Uterus classified Into Two Types:

  1. False Ligaments: Peritoneal folds, provide no support to uterus
  2. True Ligaments: Fibromuscular bands, provide support to the uterus.

1. False Ligaments Of Uterus

  • Broad Ligaments (Right And Left)
    • Folds of peritoneum
    • Have two layers—anterior and posterior
    • Connects the uterus to the lateral pelvic wall.
    • False Ligaments Of Uterus External Features
      • When the bladder is full, it has:
        • Two Surfaces—anterior and posterior
        • Four Borders—upper, lower, medial, lateral.
    • Parts of Broad Ligament
      • Mesosalpinx—the part between the uterine tube and the ligament of ovary
      • Mesometrium—part below the ligament of the ovary
      • Mesovarium—it attaches the posterior layer of the ligament with the ovary
      • Suspensory ligament of ovary
      • Part of the broad ligament extends from the upper pole of the ovary and infundibulum of the uterine tube to the lateral wall of the lesser pelvis.
    • Contents of Broad Ligament
      • Uterine tube
      • Ligaments—round ligament of uterus, ligament of ovary
      • Arteries—uterine artery, ovarian artery
      • Nerves—uterovaginal plexus, ovarian plexus
      • Vesicular appendices
      • Lymphatics
  • Anterior Ligaments—ureterovesical fold of peritoneum
  • Posterior Ligaments—rectovaginal fold of peritoneum.

2. True Ligaments Of Uterus

  • Round ligament of uterus
  • Transverse cervical ligaments
  • Uterosacral ligaments.

Question 11. Write briefly about the blood supply, lymphatic drainage, and nerve supply of uterus.
Answer:

Arterial Supply Of Uterus

  • Two Uterine Arteries:
    • Branch of the anterior division of the internal iliac artery
    • It ascends along the side of the uterus
    • Terminates by anastomosing with the ovarian artery.
  • Two Ovarian Arteries
    • Branch of abdominal aorta.

Venous Drainage Of Uterus

  • Veins correspond to arteries
  • They form venous plexus
  • Drains into uterine and vaginal veins and then to internal iliac veins.

Lymphatic Drainage Of Uterus

  • Fundus and upper part of the body—pre­ and paraaortic lymph nodes
  • The lower part of the body—external iliac nodes
  • Cervix:
    • Lateral part—external iliac nodes obturator nodes
    • Posterolaterally—internal iliac nodes
    • Posteriorly—sacral nodes.

NCERT Class 12 Biology Chapter Reproductive System Questions

Nerve Supply Of Uterus

  • Sympathetic Supply: Derived from T12–L2 spinal segments
  • Parasympathetic Supply: Derived from S2–S4 spinal segments.

Question 12. What are the supports of the uterus? Write briefly about some of the important supports.
Answer:

  • They keep the uterus in position
  • And prevent it from sagging down.

Primary Supports Of Uterus

  • Muscular
    • Pelvic diaphragm
    • Perineal body
    • Urogenital diaphragm.
  • Fibromuscular
    • Pubocervical ligaments
    • Transverse cervical ligaments of Mackenrodt
    • Uterosacral ligaments
    • Round ligament of uterus.
  • Visceral
    • Urinary bladder
    • Vagina
    • Uterine axis.

Secondary Supports Of Uterus

  • Broad ligaments
  • Uterovesical fold of peritoneum/anterior ligament
  • The rectovaginal fold of the peritoneum/posterior ligament.
  • Pubocervical ligaments Of Uterus
    • Derived from the endopelvic fascia
    • Connects cervix to the posterior surface of the pubis
    • Corresponds to puboprostatic ligaments in males.
  • Transverse cervical ligaments Of Uterus
    • Fan­shaped fibromuscular band
    • Derived from the endopelvic fascia
    • Present on both sides
    • Extent: From the lateral aspect of the cervix and upper vaginal wall to the lateral pelvic wall
    • They form a hammock, which supports the uterus.
  • Uterosacral ligaments Of Uterus
    • Two In Number
      • Derived from the endopelvic fascia
      • Extent: From cervix to posterior aspect of 5–2 and 5–3 vertebrae
      • They are enclosed within rectouterine folds of the peritoneum
      • The ligaments pull the cervix backward against the forward pull of the round ligament.
  • Round Ligament Of The Uterus
    • Length: 10–12 cm
    • Lives between the 2 layers of broad ligaments

Course Of Uterus:

Uterine Axis

  • Anteversion position prevents the uterus from sagging down through the vagina
  • Because of the anteversion, during an increase in intraabdominal pressure, the uterus gets pushed against urinary bladder and pubic symphysis.

Question 13. Write a note on the development of the uterus.
Answer:

The Development Of The Uterus

Male And Female Reproductive Organs Development Of Uterus And Uterine Tubes

  • Paramesonephric ducts (Müllerian ducts) get fused to form a uterovaginal canal
  • Epithelium of uterus is developed from the uterovaginal canal
  • Myometrium is formed from the surrounding mesoderm
  • Unfused horizontal parts of two paramesonephric ducts partially get embedded in the substance of myometrium to form ‘fundus of uterus’
  • Soon after, the cervix is also recognized as a separate region
  • Didelphys uterus: Complete duplication of uterus
  • Unicornuate uterus: One­half of uterus absent.

Reproductive System Exam Questions And Answers

Question 14. Explain in detail about the uterine tubes and mention its development.
Answer:

The Uterine Tubes

Male And Female Reproductive Organs Parts Of Uterine Tube And Length Of Each Part

  • Also known as fallopian tubes
  • Length: 10 cm
  • Location: Upper free margin of broad ligament of uterus.

Uterine Tubes External Features: It has two ends and four parts

Uterine Tubes External Features Ends

  • Medial End: Opens into lateral angle of the uterine cavity
  • Lateral End:
    • Also called infundibulum
    • Funnel­shaped
    • It has a number of figer­like projections called fimbriae
    • One fimbriae is longer and is attached to a tubal pole of the ovary. It is called ovarian fimbriae.

Uterine Tubes External Features Parts: From lateral to medial, the fallopian tube is divided into

  1. Infundibulum
  2. Ampulla
  3. Isthmus
  4. Intramural

1. Infundibulum

  • Funnel­shaped
  • Length: 1 cm
  • Lateral­: most end

2. Ampulla

  • Length: 5 cm
  • Lateral 2/3rd of tube
  • Widest and longest part
  • Thin­walled and tortuous

3. Isthmus

  • Narrow and rounded
  • Medial 1/3rd of tube

4. Intramural/Uterine Part

  • Length: 1 cm
  • Lies within the walls of the uterus
  • Opens at the superior angle of the uterine cavity.

Blood Supply Of Uterine

  • Arterial Supply
    • Medial 2/3rd of tube­uterine artery
    • Lateral 1/3rd of tube­ovarian artery
  • Venous Drainage
    • Uterine vein
    • Ovarian vein.
  • Lymphatic Drainage
    • Internal iliac lymph nodes
    • Pre­ and para­aortic lymph nodes.
  • Nerve Supply
    • Sympathetic Supply
      • Though ovarian and superior hypogastric plexus
      • Derived from T–10 to L–2 spinal segments.
    • Parasympathetic Supply
      • Medial part – derived from S2, S3, S4 spinal segments through pelvic splanchnic nerves
      • Lateral part – derived from vagus nerve.

Development Of Uterine Tube: Derived from unfused parts of paramesonephric ducts.

Male And Female Reproductive Organs Questions And Answers

Male And Female Reproductive Organs Multiple Choice Questions And Answers

Question 1. Anatomically how many lobes are noticed in the prostate gland?

  1. 2 lobes
  2. 4 lobes
  3. 3 lobes
  4. 5 lobes

Answer: 4. 5 lobes

Question 2. Which lobe of prostate is more prone to malignancy?

  1. Anterior lobe
  2. Median lobe
  3. Lateral lobe
  4. Posterior lobe

Answer: 2. Median lobe

Question 3. Which best describes the prostate gland?

  1. Surrounds the base of the bladder and pierces the membranous urethra
  2. Is most prone to cancer in the inferior­posterior region and lateral lobes
  3. Has a superior lobe that is most readily palpable by digital rectal exam
  4. Is supplied mainly by the superior rectal artery

Answer: 2. Is most prone to cancer in the inferior­posterior region and lateral lobes

Question 4. Lymph from the uterine body drains into __________ nodes:

  1. Superficial inguinal
  2. External iliac
  3. Internal iliac
  4. Lumbar

Answer: 2. External iliac

Question 5. Which statement most accurately describes the body of the uterus?

  1. The thick, convex superior portion
  2. Inferior­most portion
  3. Contains most of the uterine cavities
  4. Has a tapered region leading to the cervix called the uterine cornu

Answer: 3. Contains most of the uterine cavities

Question 6. Which ligament transmits the uterine arteries from the internal iliac to the uterus?

  1. Uterosacral ligament
  2. Round ligaments of the uterus
  3. Suspensory ligament of the ovary
  4. Transverse cervical ligament

Answer: 4. Transverse cervical ligament

 

 

Pelvis And Perineum Anatomy Question And Answers

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Perineum And True Pelvis Question And Answers

Question 1. What is perineum and what are its boundaries?
Answer:

Perineum

Perineum And True Pelvis Boundaries And Subdivisions Of Perineum

Lowest region of the trunk in the erect position, lying below the pelvic diaphragm.

Superficial Boundary Of Perineum

  • Anteriorly
  • Male: Scrotum
  • Female: Mons pubis
  • Posteriorly: Buttocks
  • Each side: Upper medial aspect of thigh

Deep Boundary Of Perineum

  • Anteriorly: Lower margin of the pubic symphysis
  • Posteriorly: Tip of the coccyx
  • Each side: Sacrotuberous ligament, ischial tuberosity, conjoint ischiopubic rami

Read And Learn More: Abdomen And Pelvis

Question 2. What is the urogenital and anal triangle?
Answer:

Perineum Is Divided Into Two Triangles, Namely:

  1. Anteriorly—urogenital triangle
  2. Posteriorly—anal triangle
  • The apex of both triangles are directed opposite to each other
  • The base of both triangles are formed by a horizontal plane passing through the anterior end of ischial tuberosities
  • The perineal body is located at the midline of the base of both triangles.

Pelvis And Perineum Anatomy Questions And Answers

Question 3. Write a note on the boundaries and contents of the superficial perineal pouch.
Answer:

Perineum And True Pelvis Muscles Of Superficial Perineal Pouch In Male And Female

Superficial Perineal Pouch Boundaries: Same for both males and females

  • Superiorly: Perineal membrane
  • Inferiorly: Membranous layer of the superficial fascia of the perineum (Colles fascia)
  • Laterally: Conjoint ischiopubic rami
  • Posteriorly: The pouch is closed by the fusion of superior and inferior walls
  • Anteriorly: The pouch is open, and is continuous with the anterior abdominal wall through scrotum and penis (in males).

Superficial Perineal Pouch Contents

  • Male
    • Root of penis
    • Duct of bulbourethral glands
    • Superficial transverse perineal muscles
    • Urethra
    • Branches of internal pudendal artery and nerve
  • Female
    • Root of clitoris
    • Urethra
    • Greater vestibular glands
    • Superficial transverse perineal muscles
    • Branches of internal pudendal artery and nerve

Question 4. Write a note on the boundaries and contents of the deep perineal pouch.
Answer:

Deep Perineal Pouch

Perineum And True Pelvis Muscles Of Deep Perineal Pouches In Male And Female

Deep Perineal Pouch Boundaries: Same for both males and females

  • Superiorly: Superior fascia of urogenital diaphragm
  • Inferiorly: Perineal membrane (Inferior fascia of urogenital diaphragm)
  • Laterally: Conjoint ischiopubic rami
  • Posteriorly: It is limited by the fusion of two fascial layers
  • Anteriorly: It is closed due to the fusion of superior and inferior fascial layers.

Deep Perineal Pouch Contents

  • Male
    • Membranous urethra
    • Bulbourethral glands on both sides of the urethra
    • Two striated muscles: Sphincter urethrae and deep transverse perineal muscles
    • Dorsal nerve of the penis
    • Branches of internal pudendal artery and nerve
  • Female
    • Urethra
    • Vagina
    • Two Striated Muscles:
      • Sphincter urethra and deep transverse perineal muscles
      • The dorsal nerve of the clitoris
      • Internal pudendal artery and its terminal branches

Pelvis And Perineum Important Questions

Question 5. What is the urogenital diaphragm?
Answer:

Urogenital Diaphragm

  • Urogenital is a muscular sheet consisting of sphincter urethrae muscle and deep transverse muscle
  • Urogenital is enclosed between the superior and inferior fascia of the urogenital diaphragm
  • Structures Piercing Urogenital Diaphragm:
    • Male: Membranous urethra
    • Female: Urethra and vagina
  • It Acts As A Support For:
    • Male: Prostate and neck of the urinary bladder
    • Female: Vagina and neck of the urinary bladder
  • It also reinforces the pelvic diaphragm at the urogenital hiatus.

Perineum And True Pelvis Urogenital Diaphragm In Male And Female

Pelvis And Perineum MCQs With Answers

Question 6. Write a note on the perineal membrane.
Answer:

Perineal Membrane

Perineum And True Pelvis Structures Piercing Perineal Membrance In Female And Male

  • Inferior fascia of the urogenital diaphragm
  • It lies between deep and superficial perineal pouches
  • Triangular in shape
  • Apex is directed anteriorly
  • Base is directed posteriorly

Perineal Membrane Relations

  • Superiorly: Deep perineal pouch
  • Inferiorly: Superficial perineal pouch

Perineal Membrane Attachments

  • Apex: Attached to the arcuate ligament of the pubis as transverse perineal ligament
  • Laterally: Ischiopubic rami
  • Base: Perineal body
  • The posterior border is continuous with the fascia over deep transverse perineal muscles

Perineal Membrane Is Pierced By:

  • Male
    • Urethra in the midline
    • Ducts of bulbourethral glands
    • Artery to the bulb of penis
    • Deep artery and dorsal artery of penis
    • Urethral artery
    • Dorsal nerve of penis
    • Two posterior scrotal nerves and vessels on each side of the base
  • Female
    • Urethra
    • Vagina
    • Arteries to the bulb of the vestibule on each side of the vagina
    • Deep artery of clitoris
    • Dorsal nerves and vessels of the clitoris
    • Posterior labial nerves and vessels
    • The perineal membrane of the female is very thin because it is pierced by the vagina in addition to other structures.

Pelvis And Perineum Viva Questions

Question 7. Write briefly on the perineal body.
Answer:

Perineal Body

Perineum And True Pelvis Perineal Body

  • Perineal Body is a mass of fibromuscular tissue situated in the midline at the junction of the urogenital triangle and anal triangle
  • In males, it lies between the bulb of the penis and the anal canal
  • In females, it lies between the anal canal and the lower part of the posterior wall of the vagina
  • It Provides Attachment To 10 Muscles Of The Perineum Which Are:
    • Right and left superficial transverse perineal muscles
    • Right and left deep transverse perineal muscles
    • Right and left bulbospongiosus muscles
    • Two levator ani muscles
    • One sphincter ani muscle
    • One longitudinal muscle coat of anal canal.

Perineal Body Applied Anatomy

  • In males, the perineal body supports the prostate and anal canal
  • In females, the perineal body is an important contributor for the maintenance of pelvic diaphragm
  • Sometimes during episiotomy, the perineal body can get a cut which results in prolapse of the uterus, urinary bladder, and rectum.

Anatomy Of Pelvis And Perineum Exam Questions

Question 8. What is the pudendal canal?
Answer:

Pudendal Canal

  • Fascial canal within the obturator fascia lining the lateral wall of the ischiorectal fossa
  • Also known as Alcock’s canal
  • Situated about 1 inch above the ischial tuberosity
  • Extent: From lesser sciatic notch to the posterior boundary of perineal pouches
  • The canal is bounded by obturator fascia and lunate fascia

Pudendal Canal Contents:

  • Pudendal nerve
  • Internal pudendal vessels.

Question 9. Write a note on the pelvic diaphragm.
Answer:

Pelvic Diaphragm

Perineum And True Pelvis Pelvic Diaphragm In Female

  • V-shaped flor of true pelvis
  • Also called pelvic floor
  • It separates the pelvis from the perineum
  • Formation: By the right and left levator ani and coccygeus muscles enclosed in the superior and inferior layers of the fascia of the pelvic diaphragm
  • Structures Passing Through It:
    • Males: Urethra and anorectal junction
    • Females: Vagina, urethra, and anorectal junction

These Structures Pass Through Two Openings:

Hiatus Urogenital:

  • Hiatus Urogenital is a triangle-shaped opening formed between the anterior fibers of levator ani muscles
  • The urethra in males and females and the vagina in females pass through it

Hiatus Rentals:

  • Hiatus Rentals is a circular opening formed between the anococcygeal raphe and perineal body
  • Anorectal Junction Passes Through It
    • The pelvic diaphragm is covered in its superior and inferior aspects by the superior and inferior fascia of the pelvic diaphragm.

1.  The Superior Fascia Of The Pelvic Diaphragm

  • Attached anteriorly to the superior ramus of the pubis and to the back of the body of pubis
  • Superior Fascia Of The Pelvic Is continuous:
    • Anteriorly: With sacrococcygeal ligament
    • Posteriorly : With fascia on the piriformis
    • Laterally: With obturator fascia

Pelvis And Perineum Short Questions And Answers

2. Inferior Fascia Of The Pelvic Diaphragm

  • Also covers the medial wall of the ischiorectal fossa
  • Laterally, it is continuous with the obturator fascia.

Relations Of Pelvic Diaphragm

Perineum And True Pelvis Relations Of Pelvic Diaphragm

Question 10. Describe in detail about the functions, boundaries, and contents of the ischiorectal fossa. Name the three recesses in relation to the ischiorectal fossa.
Answer:

The Ischiorectal Fossa

Perineum And True Pelvis Boundaries And Contents Of Ischiorextal Fossa

  • Now called the ischioanal fossa, since it is located between ischial tuberosity and anal canal, not in the rectum
  • It is a wedge-shaped fat-filed space on either side of the anal canal

Ischiorectal Fossa Functions:

  • Allows distension of anal canal during defecation
  • Allows dilatation of vagina during parturition.

Ischiorectal Fossa Boundaries

  • Apex
    • Formed by the junction of fascia covering obturator internus and inferior fascia of pelvic diaphragm
    • Apex directed anteromedially towards the pubic symphysis
  • Laterally: Fascia covering obturator internus muscle and ischial tuberosity
  • Medially:
    • On The Upper Part: Fascia covering external anal sphincter
    • On The Lower Part: Fascia covering levator ani muscle
  • Posteriorly:
    • Lower margin of gluteus maximus muscle
    • Sacrotuberous ligament
  • Anteriorly: Posterior margin of perineal pouches
  • Base/Floor: Deep transverse perineal fascia.

Ischiorectal Fossa Contents

  • Ischiorectal pad of fat
  • Pudendal canal and its contents (pudendal nerve, internal pudendal vessels)
  • Posterior scrotal vessels and nerves
  • Perineal branch of 4th scrotal nerve
  • Inferior rectal branches of the pudendal nerve
  • Perforating cutaneous nerve
  • Lymphatic trunks.

TThere Are 3 Recesses Or Narrow Extensions Of The Ischiorectal Fossa, Namely:

  1. Anterior Recess: Extends from the urogenital diaphragm to body of the pubis
  2. Posterior Recess: Lies deep to the sacrotuberous ligament
  3. Horseshoe Recess:
    • Lies posterior to the anal canal
    • Connects the two ischioanal/rectal fossa.

Question 11. Write a note on celiac ganglion.
Answer:

Celiac Ganglion

  • Largest ganglion in the body
  • Two in number
    • Location: On each side of the celiac trunk
    • Shape: Irregular
    • Division: Each ganglion is divided into:
      • Large upper part—receives greater splanchnic nerve
      • The smaller lower part or aorticorenal ganglion receives lesser splanchnic nerve.

Question 12. Write a note on the formation and branches of the celiac plexus.
Answer:

The Formation And Branches Of Celiac Plexus

  • A dense network of nerve fibers connecting the two celiac ganglia
  • It is the largest major autonomic plexus
  • Location: In front of the abdominal aorta around the celiac trunk and around the root of the superior mesenteric artery
  • Vertebral level: T12 – L1
  • Celiac Plexus Is Formed By The Following Incoming Fibers:
    • Preganglionic sympathetic fibers through greater and lesser splanchnic nerves
    • Postganglionic sympathetic fibers from celiac ganglion
    • Preganglionic vagal fibers from the posterior vagal trunk containing fiers from both right and left vagus, with predominant fiers from the right vagus
    • Sensory fibers from the diaphragm reach the plexus along the inferior phrenic artery

Celiac Plexus Branches: The Celiac plexus gives rise to a number of secondary plexus, which surround the branches of the aorta. These are:

  • Hepatic plexus
  • Phrenic plexus
  • Suprarenal plexus
  • Left gastric plexus
  • Splenic plexus
  • Renal plexus
  • Testicular plexus
  • Ovarian plexus
  • Superior mesenteric plexus
  • Intermesenteric plexus
  • Inferior mesenteric plexus

Pelvis And Perineum Clinical Anatomy Questions

Question 13. Write a brief on the sacral plexus.
Answer:

Sacral Plexus

  • Sacral Plexus is a network of nerve fibers that supplies the skin and muscles of the pelvis and lower limb
  • Location: On the surface of the posterior pelvic wall, anterior to the piriformis muscle
  • Sacral Plexus is derived from the anterior rami of spinal nerves— L4, L5, S1, S2, S3, and S4
  • Sacral Plexus also receives contributions from the lumbar spinal nerves L4 and L5 to form the lumbosacral trunk
  • Each anterior rami divides into anterior and posterior branches.

Sacral Plexus Branches:

  1. Superior gluteal nerve
  2. Inferior gluteal nerve
  3. Sciatic nerve
  4. Posterior femoral cutaneous nerve
  5. Pudendal nerve
  6. Other branches: Nerve to piriformis, nerve to obturator internus, nerve to quadratus femoris.
    • Anterior branches supply the flexor muscles of the lower limb
    • Posterior branches supply the extensor and abductor muscles

Perineum And True Pelvis Multiple Choice Question And Answers

Question 1. The contents of the ischiorectal fossa are all except:

  1. Pudendal nerve
  2. Pudendal artery
  3. Perineal branch of the obturator nerve and nerve to obturator internus
  4. None

Answer: 3. Perineal branch of the obturator nerve and nerve to obturator internus

Question 2. The contents of the ischiorectal fossa lie in the:

  1. Medial wall
  2. Lateral wall
  3. The floor of the fossa
  4. Near the apex

Answer: 2. Lateral wall

Pelvis And Perineum MBBS Notes

Question 3. What structure represents the posterolateral boundary of the perineum?

  1. Ischial tuberosity
  2. Sacrospinous ligament
  3. Gluteus maximus
  4. Sacrotuberous ligament

Answer: 4. Sacrotuberous ligament

Question 4. Where is celiac plexus situated?

  1. Anteromedially to the sympathetic chain
  2. Posteromedially to left sympathetic chain
  3. Posteriorly to the abdominal aorta
  4. Anteriorly to abdominal aorta
  5. Posteriorly to arch of aorta

Answer: 4. Posteriorly to arch of aorta

Question 5. Th membranous layer of superfiial fascia of perineum is called:

  1. Fascia lunata
  2. Colles’ fascia
  3. Scarpa’s fascia
  4. Camper’s fascia

Answer: 2. Colles’ fascia

Question 6. The pelvic diaphragm is comprised of which of the following muscles?

  1. Piriformis, obturator internus, levator ani, and ischiococcygeus
  2. Obturator internus, levator ani, and ischiococcygeus
  3. Levator ani and ischiococcygeus
  4. Levator ani

Answer: 3. Levator ani and ischiococcygeus

Rectum And Anal Canal Question And Answers

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Rectum And Anal Canal Question And Answers

Question 1. Describe in detail the anatomical features and relations of the rectum.
Answer:

Rectum:

Rectum And Anal Canal Extent Of Rectum And Its Intertnal Features

  • Part of large intestine between sigmoid colon and anal canal
  • Lies in the true pelvis
  • Location: Posterior part of lesser pelvis, in front of the lower three pieces of sacrum and coccyx
  • Length: 12 cm
  • Rectum Diameter:
    • Upper Part: 4 cm (same as sigmoid colon)
    • Lower Part: Dilated—rectal ampulla
  • Rectum Extent:
    • Upper end—continuous with a sigmoid colon at the level of S3 vertebrae
    • Lower end—lies a little below and in front of the tip of the coccyx

Rectum And Anal Canal Important Questions

Read And Learn More: Abdomen And Pelvis

Rectum Course:

Rectum And Anal Canal Rectum Course

Rectum Curvatures: There are two anterior-posterior curvatures and three lateral curvatures.

Anteroposterior Curvature

  • Sacral Curvature: It follows the concavity of the sacrum and coccyx
  • Perineal Curvature: It is the backward bend of the anorectal junction

Lateral Curvature

  • Upper Lateral Curvature: It is convex to the right at the S3–S4 junction
  • Middle lateral curvature: It is convex to the left at the sacrococcygeal junction and is most prominent
  • Lower Lateral Curvature: It is convex to the right at the level of tip of the coccyx

Rectum Mucosal Folds: The mucous membrane of rectum shows a number of longitudinal and transverse folds.

  • Transverse Folds/Houston’s Valves:
    • Permanent folds
    • Located against the concavities of lateral curvatures of the rectum

They Are Four In Number:

  1. First, Fold: lies near the upper end close to the rectosigmoid junction, projects from the right or left wall of rectum
  2. Second Fold
    • Lies 2.5 cm above 3rd fold
    • Projects from the left wall of the rectum
  3. Third Fold: largest fold
    • Projects from the anterior and right walls of the rectum
    • Lies at the level of the upper end of the ampulla.
  4. Fourth fFold
    • Lies 2.5 cm below the third valve
    • Projects from the left wall of the rectum.

Rectum And Anal Canal Viva Questions

Rectum Longitudinal Folds

  • Transitory/temporary folds
  • Seen in the lower part of the rectum
  • Disappears when rectum distended

Rectum Peritoneal Relations

Rectum And Anal Canal Peritoneal Relations

Rectum Visceral Relations

  • Rectum Anterior Relations

Rectum And Anal Canal Rectum Visceral Relations

  • Rectum Posterior Relations
    • Lower part of the sacrum
    • Coccyx
    • Muscles
      • Piriformis muscles (right and left)
      • Coccygeus muscles
      • Levator ani muscles
    • Blood Vessels
      • Median sacral vessels
      • Lateral sacral vessels
      • Superior rectal vessels
  • Ganglion impar
  • Pelvic splanchnic nerves and sympathetic chains
  • Fascia of Waldeyer.

Rectum And Anal Canal Posterior Relations Of Entire Rectum

Rectum And Anal Canal Posterior Relations Of Upper One Third Of Rectum In Transverse Section

Rectum Arterial Supply

  • Superior rectal artery
  • Middle rectal arteries
  • Inferior rectal arteries
  • Median sacral artery

Rectum Venous Drainage: Internal and external venous plexus of rectum and anal canal:

  • Superior rectal vein
  • Middle rectal vein
  • Inferior rectal vein

Rectum Lymphatic Drainage

Rectum And Anal Canal Short Questions And Answers

  • The upper half of the rectum—pararectal and sigmoid nodes, inferior mesenteric nodes.
  • The lower half of the two rectums—internal iliac nodes.

Rectum Nerve Supply

  • Sympathetic supply—derived from L1, L2 spinal segments
  • Parasympathetic supply—S2, S3, S4 spinal segments.

Question 2. What are the supports of rectum?
Answer:

The Supports Of Rectum

  • Lateral Ligaments Of The Rectum:
    • Present on each side of the rectum
    • Formed by condensation of pelvic fascia
  • Puborectalis sling of the pelvic diaphragm
  • Fascia of Waldeyer
  • Pelvic floor-formed by levator and muscles
  • The rectovesical fascia of Denonvilliers
  • Pelvirectal and ischiorectal fat—surrounds the rectum
  • Pelvic peritoneum and related vascular pedicles
  • Perineal body.

Rectum Applied Anatomy

  • Prolapse Of Rectum: The pelvic diaphragm is an important support for the rectum
  • When the pelvic diaphragm is weakened (for example, damage during parturition), the rectum can prolapse out of anus.

Question 3. Describe in detail the anatomical features and relations of the anal canal.
Answer:

The Anatomical Features

  • Terminal part of the large intestine
  • Length: 3.8 cm
  • Location: In the anal triangle between the ischiorectal fossa
  • Extent: Anorectal junction to the anal orifice
  • Direction: Downwards and backward
  • It is surrounded by inner involuntary and outer voluntary sphincters
  • They keep the lumen closed.

Interior Of Anal Canal

  • The pectinate line divides the anal canal into upper and lower parts
  • The pectinate line, also called the watershed line, is a transverse line, running along the lower limit of anal valves
  • It is a dividing line between endodermal and ectodermal parts of anal canal
  • The lower part of the anal canal can again be subdivided into upper and lower regions by the Hilton’s line.

Rectum And Anal Canal Subdivisions And Internal Features Of Anal Canal

Interior Of Anal Canal Upper Part

  • Length: 15 mm
  • Extent anorectal junction to pectinate line
  • Lined by a mucous membrane:
    • Reddish in color

Anatomy Of Rectum And Anal Canal Exam Questions

Interior Of Anal Canal Shows The Following Features:

  • Anal Columns Of Morgagni
    • There are 6–10 longitudinal folds seen in the mucous membrane
    • They contain terminal radicles of the superior rectal artery and vein.

Anal Columns of Morgagni Applied Anatomy: Radicles are well developed in the right anterior, right posterior, and left lateral positions. As a result, piles are more common at these sites.

Anal Valve of Morgagni: They are transverse folds of the mucous membrane, which connect the lower ends of adjacent anal columns.

Anal Valve of Morgagni Applied Anatomy: Passage of hard stools could injure the anal valve leading to anal fissure formation.

  • Anal Sinuses
    • They are vertical recesses above each anal valve and between anal columns
    • Anal glands often into the floor of the anal sinuses.

Interior Of Anal Canal Lower Part

  1. Upper Region/Pecten
    • Known as transition zone
    • It is 15 mm long
    • Extent: Pectinate line to Hilton’s line
    • Lined by non­keratinized stratified squamous epithelium
    • Mucosa is less mobile than the upper part
    • Mucosa appears bluish in color due to the presence of rich venous plexus underneath
    • White Line Of Hilton
      • It is whitish in color compared to bluish color of pecten, so known as white line of Hilton
      • It corresponds to inter sphincteric groove in the wall of anal canal.
  2. Lower Region
    • Shortest part of anal canal
    • It is 8 mm long
    • Extent: White line of Hilton to anal verge
    • It is lined by true skin with sweat and sebaceous glands

Rectum Relations

  • Anteriorly
    • Male
      • Membranous urethra
      • Bulb of penis
    • Female: Lower end of vagina
    • Both: Perianal body
  • Posteriorly
    • Anococcygeal ligament
    • Tip of coccyx.
  • Laterally: ischiorectal fossa

Rectum Anal Musculature: Anal musculature is divided into four groups, namely

  1. Internal sphincter
  2. External sphincter
  3. Anorectal ring
  4. The conjoint longitudinal muscle layer

1. Internal Sphincter

  • Involuntary
  • Made up of thickened circular smooth muscle coat, surrounding upper 2/3rd of the anal canal
  • Extent: From anorectal junction to Hilton’s line
  • Above it is continuous with a circular muscle coat of rectum

Rectum And Anal Canal Clinical Anatomy Questions

2. External Sphincter

  • Voluntary
  • Made up of striated muscle
  • Surrounding the entire length of the anal canal

External Sphincter Is Divisible Into Three Parts:

  1. Deep
  2. Superficial
  3. Subcutaneous
  1. Deep Part
    • Located outer to the internal sphincter
    • Deep Part has no bony attachment
    • Few fires from deep part are attached to the anorectal raphe
  2. Superficial Part
    • The superficial Part lies below the deep part
    • Extends up to inter-sphincteric groove
    • Superficial Part is the only part of the external sphincter with bony attachments
    • Origin from the last piece of coccyx
    • Insertion on either side of perineal body
    • It does not completely encircle the anal canal (does not support the anal canal in the midline posterior)
  3. Subcutaneous Part
    • Lies below the internal sphincter in the perianal space
    • Subcutaneous Part encircles the lowest part of anal canal below inter sphincteric groove
    • Subcutaneous Part also has no bony attachment.

3. Anorectal Ring

  • Muscular Ring Present At The Anorectal Junction Made Up Of:
  1. Puborectalis part of levator ani
  2. Fibers of the deep part of the external sphincter
  3. Fibers of internal sphincter
  • Anorectal ring forms a sling from the pubic bones
  • Contraction of the puborectalis pulls the anorectal junction forward, which increases the angulation between the rectum and anal canal (an important factor in the continence mechanism).

4. Conjoint Longitudinal Muscle Layers

  • It is the continuation of the longitudinal muscle layer of the rectum which fuses with few fiers of puborectalis (conjoint)
  • It separates the internal and external sphincters
  • As it goes downwards, this layer becomes ferroelastic and breaks into a number of fibrous septa at the level of the white line of Hilton
  • The fibrous septa spread out fanwise and get attached to the skin around the anus
  • Most medial septum forms—anal intermuscular septum
  • Most lateral septum forms—perianal fascia.

Rectum And Anal Canal Notes For MBBS

Blood Supply Of Anal Canal

  • Arterial Supply
    • Superior Rectal Artery: above the pectinate line
    • Below The Level Of Pectinate Line: inferior rectal artery.
  • Venous Drainage
    • Above The Level Of Pectinate Line: superior rectal vein, from there to portal vein
    • Below The Level Pf Pectinate Line: inferior rectal vein.
  • Lymphatic Drainage
    • Upper Part: Internal iliac nodes
    • Lower Part: Horizontal group of superficial inguinal nodes.
  • Nerve Supply
    • Above The Pectinate Line:
      • Sympathetic (L1 and L2) through inferior hypogastric plexus
      • Parasympathetic (S2, S3, S4) through pelvic splanchnic nerve
    • Below The Pectinate Line: somatic supply through inferior rectal nerve
    • Internal Sphincter:
      • Sympathetic Nerves: contract
      • Parasympathetic Nerves: relax
    • External Sphincter: inferior rectal nerve and perineal branch of S4 nerve.

Rectum And Anal Canal Arterial Supply Of Anal Canal

Rectum And Anal Canal Venous Drainage Of Anal Canal

Question 4. Which are the surgical spaces related to the anal canal?
Answer:

The Surgical Spaces Related To The Anal Canal

  • Ischioanal space or ischiorectal space.
  • Perianal Space: Lies below the level of Hilton’s line between the perianal fascia and skin. A perianal abscess occurs here.
  • Submucous Space: Lies above Hilton’s line between the internal anal sphincter and mucous membrane lodges the internal rectal venous plexus.

Question 5. Write a note on the development of the rectum and anal canal.
Answer:

The Development Of The Rectum And Anal Canal

  • The upper part of the rectum develops from the endoderm of hindgut
  • The lower part of the rectum and upper part of the anal canal is developed from the anorectal canal
  • The lower part of the anal canal developed from the proctodeum.

Rectum And Anal Canal NEET PG Questions

Rectum And Anal Canal Multiple Choice Questions And Answers

Question 1. Lymph from the superior rectum drains into ______ nodes:

  1. Superficial inguinal
  2. External iliac
  3. Lumbar
  4. Sacral

Answer: 3. Lumbar

Question 2. Which lymph nodes drain the lower anal canal?

  1. External iliac
  2. Deep inguinal
  3. Para­aortic
  4. Superfiial inguinal

Answer: 4. Superfiial inguinal

Question 3. Which of the following is true about the internal anal sphincter?

  1. Is skeletal muscle
  2. Has longitudinal fibers
  3. Has no bony attachment
  4. None of these

Answer: 3. Is skeletal muscle

Rectum And Anal Canal Labeled Diagram With Questions

Question 4. Which of the following pelvic organs is not a content of the spermatic cord?

  1. Rectum
  2. Pelvic appendix
  3. Ovary
  4. Urinary bladder

Answer: 1. Rectum

Question 5. Conjoint longitudinal coat of the anal canal is formed by the fusion of?

  1. Pubococcygeus with longitudinal muscle coat of rectum
  2. Iliococcygeus with longitudinal muscle coat of rectum
  3. Internal with external anal sphincter
  4. Deep with the superficial part of the external anal

Answer: 1. Pubococcygeus with longitudinal muscle coat of rectum
sphincter

Scalp Temple And Face Question And Answers

by

Surface Landmarks And Features Introduction

Forehead: Part of the face between hairline of the adolescent scalp and eyebrows.

Frontal Eminence: Superolateral prominence of the forehead.

Dorsum Of The Nose: Prominent ridge separating right and left halves of the nose.

Root Of Nose: The upper narrow end of nose just below forehead.

Columella: The soft median partition that separates two nostrils.

Palpebral Fissure: An elliptical opening between two eyelids.

Canthi: The lateral and medial angles of the eye.

Oral Fissure: The opening between upper and lower lips.

Philtrum: Median vertical groove on the upper lip.

Auricle/pinna: The superficial projecting part of the external ear.

Supraorbital Margin: Lies beneath the upper margin of the eyebrow.

Supraorbital Notch: Palpable at the junction of medial one-third and lateral two thirds of supraorbital margin.

Glabella: Median elevation connecting the superciliary arches and corresponding to an elevation between two eyebrows.

Scalp Temple And Face Question And Answers

Question 1. Describe the layers of the scalp.
Answer:

The Layers Of The Scalp

Scalp Temple And Face Layers Of The Scalp(Schematic)

Scalp Temple And Face Layers Of The Scalp

Scalp Temple And Face Sagittal Section Of Cranial Vault Showing Continuity Between Dangerous Area Of Scalp With Upper Eyelid

Layers Of The Scalp: Scalp refers to the soft tissues covering the cranial vault.

Layers Of Scalp Extent:

  • Anteriorly: Up to the eyebrows
  • Posteriorly: Up to superior nuchal line and external occipital protuberance
  • Laterally: Superior temporal lines.

Layers Of Scalp Layers: Consist of 5 layers (from outside to inside)

  • Skin: Thick and hairy, contain sebaceous glands and sweat glands, and is adherent to epicranial aponeurosis.
  • Superficial Fascia: Fibrous and dense in the center than in the periphery. Binds skin to the aponeurosis vessels and nerves are present in this layer.
  • The Third Layer Formed By:
    • Mainly the epicranial aponeurosis (Galea aponeurotic)—the aponeurosis of occipitofrontalis muscle
    • Occipitofrontalis Muscle Consisting Of:
      • Occipital bellies arising from superior nuchal line
      • Frontal bellies arising from the skin of the forehead
      • Supplied by branches of the facial nerve.
  • Fourth Layer Made Of Loose Areolar Tissue Which Extends
    • Anteriorly into eyelids
    • Posteriorly up to superior nuchal line
    • Laterally to superior temporal lines.
    • Emissary veins from the scalp to the sinuses traverse through this layer.
  • Fifth Layer: Pericranium, which is loosely attached to the surface of bones, and at the sutures, the sutural ligaments bind it firmly to the endocranium.
    • The first three layers are fully united to one another and they move together over the fourth layer.

Layers Of Scalp Applied

  • Scalp bleed profusely due to rich blood supply.
  • Loose areolar tissue layer is also known as a dangerous area of scalp because emissary veins that open here may transmit infection from the scalp to cranial venous sinuses.
  • Avulsed portions of the scalp can be stitched back into position and heal well due to adequate blood supply even through the narrow areas of attachment.
  • Due to the abundance of sebaceous glands, sebaceous cysts are common in the scalp.
  • Bleeding in the scalp can be arrested by applying direct pressure over the wound against the bone.
  • Bleeding in layer of loose areolar tissue forms a generalized swelling or spread widely reaching nuchal line posteriorly or temporal lines laterally, or can reach orbital margin and eyelids causing black eye.
  • Cephalohematoma refers to the subperiosteal collection of blood bound by suture lines and assumes the shape ofrelated bones because periosteum loosely covers the bones except at the suture lines.
  • Caput succedaneum is a subcutaneous edema occurring over the presenting part of the fetal head at delivery. It occurs due to interference of venous return during passage through the birth canal.

Mnemonics: SCALP

From Superficial To Deep:

  • Skin
  • Connective tissue
  • Aponeurosis
  • Loose areolar tissue
  • Pericranium

Question 2. Describe the blood supply of the scalp and superficial temporal region.
Answer:

The Blood Supply Of The Scalp

Scalp Temple And Face Arteries Of the Scalp

  • Arterial Supply
    • The scalp on each side of the midline is supplied by five arteries, three in front of the auricle and two behind the auricle.
    • These arteries enter from the periphery and freely anastomose with arteries of same side and cross anastomose with the other side.
    • The scalp is a potential site of collateral circulation between internal and external carotid arteries.
    • In front Of The Auricle
      • Internal carotid artery → Ophthalmic artery → Supratrochlear artery → Supraorbital artery → External carotid artery → Superficial temporal artery
    • Behind The Auricle
      • External carotid artery → Posterior auricular artery → Occipital arteries
  • Venous Drainage
    • The scalp on each side of the midline is drained by fine veins and these accompany the arteries and have similar names.
    • These Include:  Supratrochlear and supraorbital veins unite to form an angular vein at medial angle of eye and continue as facial vein.
  1. The superficial temporal vein and maxillary vein unite to form the retromandibular vein and its anterior division in turn joins with the facial vein to form common facial vein.
  2. The posterior division of the retromandibular vein unites with the posterior auricular vein to form the external jugular vein which drains into the subclavian vein.
  3. The occipital veins drain into the suboccipital venous plexus.
  4. Emissary veins connect extracranial veins with intracranial venous sinuses.
  5. The diploic veins like the frontal diploic vein open into a supraorbital vein, the anterior temporal diploic vein drains to the anterior deep temporal vein, the posterior temporal diploic vein drains to the transverse sinus, and the occipital diploic vein drains to either occipital vein or the transverse sinus.

Scalp Temple And Face Nerves And Arteries Of Anterior And Posterior Quadrants Of Scalp

Question 3. Describe the nerve supply of the scalp and superficial temporal region.
Answer:

The Nerve Supply Of The Scalp

Scalp Temple And Face Nerves Of The Scalp

The scalp and the temple is supplied by ten nerves on each side. Out of this 4 are sensory and 1 is motor and 5 enter in front of the auricle and 5 enter behind the auricle.

Scalp Temple And Face Temporial Region

Mnemonic: GLASSZ

  • Greater occipital/Greater auricular
  • Lesser occipital
  • Auriculotemporal
  • Supratrochlear
  • Supraorbital
  • Zygomaticotemporal

Scalp Temple And Face Facial Skeleton Seen From The Side To Show Some Muscle Attachments

Scalp Temple And Face The Orbicularis Oris And Its Relationship To Various Muscles Attached To The Lips

Scalp Temple And Face Muscles Of facial Expressions

Scalp Temple And Face Buccinator Muscle

Since derived from the mesoderm of 2nd branchial arch they are supplied by the facial nerve

Topographically, Muscles Are Grouped Into Six Headings:

  1. Muscles Of Scalp
    • Occipito frontalis
  2. Muscles Of Auricle
    • Auricularis anterior
    • Auricularia superior
    • Auricularis posterior
  3. Muscles Of Eyelid
    • Orbicularis oculi
    • Corrugator supercilii
    • Levator palpebrae superioris
  4. Muscles Of Nose
    • Procerus
    • Compressor naris
    • Dilator naris
    • Depressor septi
  5. Muscles Of Neck
    • Platysma
  6. Muscles Around Mouth
    • Orbicularis oris
    • Levator anguli oris
    • Depressor anguli oris
    • Zygomaticus major
    • Zygomaticus minor
    • Levator labii superioris
    • Depressor labii inferioris
    • Levator labii superioris alaeque nasi
    • Mentalis
    • Risorius
    • Buccinator

Main Muscles And Their Attachments

Scalp Temple And Face Muscles And Their Attachments

Superficial Temporal Region Applied: The involuntary part (smooth part) of the levator palpebrae superioris or Muller’s muscle is supplied by fibers from superior cervical ganglion and the paralysis of this muscle leads to partial ptosis in Horner’s syndrome.

Question 5. Describe the nerve supply of face.
Answer:

The Nerve Supply Of Face

Scalp Temple And Face Sensory Nerves Of face, Scalp And Auricle

Scalp Temple And Face Nerve Supply Of Face

Nerve Supply Of Face Applied

  • In case of supranuclear lesions of the facial nerve associated with hemiplegia usually the lower part of the opposite side of face is paralyzed.
  • Bell’s palsy: It is the lower motor neuron paralysis of facial muscles due to compression of facial nerve in the facial canal. Here the whole of the face of the same side gets paralysed. As a result, wrinkles are absent on the forehead, the inability to close eye is present, deviation of angle of the mouth to the normal side, and food accumulates between the cheek and teeth.

Question 6. Describe the venous drainage of face.
Answer:

The Venous Drainage Of Face

Scalp Temple And Face Dangerous Are Of The Face Superior Ophthalmic Vein Connecting The Angular Vein To the Cavernous Sinus

Scalp Temple And Face Deep Facial Vein Connecting Dangerous Area Of The Cavernous Sinus Via Pterygoid Plexus-Sphenodial Emissary Vein

  • The veins accompany arteries of the face and drain into a common facial vein and retromandibular vein and they communicate with cavernous sinus
  • The vein on each side form a ‘W’ shaped arrangement and each corner of ‘W’ is prolonged upwards to the scalp and downwards to the neck
  • The deep connections include:
    • Communication between supraorbital and superior ophthalmic veins
    • Communication with pterygoid plexus through deep facial vein.

Venous Drainage Of Face

Scalp Temple And Face Drainage Of Face Venous Drainage Flow Chart

Venous Drainage Of Face Applied

  • Since, the facial vein communicates with the cavernous sinus, retrograde infection from face is possible and result in thrombosis of cavernous sinus.
  • Mostly infection in the upper lip, lower part of nose and adjoining cheek area can result in thrombosis. So these areas are called ‘dangerous area of face’.

Question 7. Describe the lymphatic drainage of the face.
Answer:

The Lymphatic Drainage Of The Face

It can be studied under three headings based on the territories of face.

  1. Upper territory: A greater part of the forehead, lateral halves of eyelids, conjunctiva, lateral part of cheek, and parotid area
  2. Middle territory: Median part of the forehead, external nose, upper lip, medial halves of the eyelid, medial part of the cheek, the greater part of jaw
  3. Lower territory: Central part of lower lip and chin.

Scalp Temple And Face Lymphatic Drainage Of Face Lower Territory Flowchart

Question 8. Write a note on the lacrimal apparatus.
Answer:

Lacrimal Apparatus

Scalp Temple And Face Parts Of The Lacrimal Apparatus The Arrows Indicates bThe Direction Of flow Of lacrimal Fluid

Scalp Temple And Face Components Of Lacrimal Apparatus

  • It consists of structures that are involved in the secretion and drainage of lacrimal fluid
  • Consist Of Mainly The Following Parts
    1. Lacrimal gland
    2. Lacrimal ducts
    3. Conjunctival sac
    4. Lacrimal puncta and lacrimal canaliculi
    5. Lacrimal sac
    6. Nasolacrimal duct.

1. Lacrimal Gland

  • Serous gland situated in the lacrimal fossa on the anterolateral part of the roof of the bony orbit and upper eyelid
  • Consists of an orbital part and a palpebral part
  • Involved in the secretion of lacrimal fluid along with accessory lacrimal gland
  • Supplied by lacrimal nerve and lacrimal branch of ophthalmic artery.

2. Secretomotor Fiers

Scalp Temple And Face Lacrimal Apparatus Secretomotor Fibers

  • Lacrimal Ducts: Arises from the lacrimal gland, pierce the conjunctiva of the upper lid, and opens into a conjunctival sac near the superior fornix.
  • Conjunctival Sac: The space between the palpebral and bulbar conjunctiva is known as the conjunctival sac.
  • Lacrimal Puncta And Canaliculi: These are small openings on the lid margin:
    • Each lacrimal canaliculi begin at lacrimal punctum and is 10 mm long
    • Has a vertical part 2 mm long and horizontal part 8 mm long
    • Both canaliculi open into the lateral wall of sac close to each other.
  • Lacrimal Sac:
    • Membranous sac situated in the lacrimal groove behind medial palpebral ligament
    • Upper end of the sac is blind and lower end is continuous with the nasolacrimal duct.
  • Nasolacrimal Duct:
    • It is an 18 mm long membranous passage
    • It begin at lower end of the lacrimal sac and opens into the inferior meatus of nose
    • A fold of mucous membrane forms an imperfect valve called the valve of Hasner at the lower end of duct.

Lacrimal Apparatus Applied

  • For the purpose of clinical evaluation, the palpebral conjunctiva is examined for anemia and bulbar conjunctiva for jaundice.
  • Excessive secretion of lacrimal fluid overflowing on the cheeks is called Epiphora and occurs as a result of an obstruction in the lacrimal fluid pathway.
  • Inflammation of the conjunctiva is known as conjunctivitis and is a common disease of the eye caused due to infection or allergy.
  • Inflammation of the lacrimal sac is known as dacryocystitis.
  • Ducts from the orbital part traverse the palpebral part to open into the conjunctival sac. So the removal of the palpebral part is equivalent to the removal of the entire gland.

Scalp Temple And Face Multiple Choice Questions and Answers

Question 1. Which layer of scalp is regarded as the ‘dangerous layer’?

  1. Subcutaneous layer
  2. Aponeurotic layer
  3. Layer of loose areolar tissue
  4. Pericranium

Answer: 3. Layer of loose areolar tissue

Question 2. Regarding muscles of facial expression which of the following statements is incorrect:

  1. They are present in the superficial fascia
  2. They are developed from the first pharyngeal arch
  3. Their motor supply is derived from the facial nerve
  4. Morphologically they represent panniculus carnosus

Answer: 2. They are developed from first pharyngeal arch

Question 3. 26 October 2016 2:08 PMAll of the following arteries supply the anterior quadrant of the scalp except:

  1. Supratrochlear
  2. Supraorbital
  3. Posterior auricular
  4. Superficial temporal

Answer: 3. Posterior auricular

Question 4. All of the following innervate the posterior quadrant of the scalp except:

  1. Auriculotemporal
  2. Great auricular
  3. Greater occipital
  4. Lesser occipital

Answer: 1. Auriculotemporal

Question 5. Regarding the lacrimal gland which of the following statements is not correct?

  1. It consists of a larger orbital part and a smaller palpebral part
  2. It is a mucus gland
  3. It receives a secretomotor supply through the lacrimal nerve
  4. The two parts of the lacrimal glands are separated from each other by levator palpebrae superioris.
  5. Answer: 2. It is a mucus gland