Practice material is not intended to be the sole source of studying. Please refer to lecture recordings and/or your textbook for the most accurate information. Page numbers listed refer to the 4th edition of the book.

1. Which of the following is the innervation of the Stapedius muscle?a. Oculomotor nerveb. Abducens nervec. Facial nerved. Vestibulocochlear nerve

2. Which of the following is the innervation of the Lateral Rectus muscle of the eye?a. Optic nerveb. Oculomotor nervec. Trochlear nerved. Abducens nerve

3. Which of the following is the primary innervation of the Medial Rectus muscle of the eye?a. Optic nerveb. Oculomotor nervec. Trochlear nerved. Abducens nerve

4. Which is the innervation for the Tensor Tympani muscle? (pg. 673)a. CN V.1b. CN V.2c. CN V.3 d. CN VII

5. What is the innervation of the Stapedius muscle? (pg. 673)a. CN V.1b. CN V.2c. CN V.3d. CN VII

Clinical Questions

1. Identify and describe the layers of the scrotum (pg. 350):a. Skin from ab wall continues down to scrotumb. Dartos Fasciac. External Spermatic Fasciad. Cremasteric Fascia e. Internal Spermatic Fasciaf. Tunica Vaginalis

2. Lymphatics of the scrotum drains to Superficial __Inguinal___ _Lymph Nodes_

3. Which of the following conditions does NOT lead to oral pigmentation? (pg. 569)a. Peutz-Jeghers Sxb. Addison’s Dx

c. Herpes Simplex 1d. Heavy metal toxicity

4. What does Waldeyer’s Ring of Lymphoid Tissue consist of? (pg. 573)a. All of these:

i. Pharyngeal tonsilii. Tubal tonsiliii. Palatine tonsiliv. Lingual tonsils

5. Describe Radical Neck Dissection (pg. 569)a. Operation done to remove cancerous tissue from the neck.

6. When is macroglossia often seen? (pg. 567)a. Hypothyroidismb. Amyloidosisc. Cretinism

7. Identify the nerve that BEST entails (pg. 564-66):a. Taste from anterior ⅔ of tongue: CN VII (Facial n.)b. Primary motor nerve of tongue: CN XII (Hypoglossal n.)c. Taste from posterior ⅓ of tongue: CN IX (Glossopharyngeal n.)d. Muscles of the soft palate: CN X (Vagus n.)

Pelvic structures and perineum

● Parts: ● Urinary bladder

● Lies in the lesser pelvis in adults, beneath the peritoneum behind the pubic bone. (in newborn it lies upper than the pubic bone).

● Urinary bladder is for urine reservation. It can hold over 700 ml of urine voluntarily, however, 350 ml of urine urges us to urinate unless we don’t do it voluntarily

● Both ureters enter the bladder at its base (trigone) and the urethra leaves it from there. ● Urinary bladder has a transitional type epithelium and the mucosa is soft-reddish in

lifeMales

● Male internal genital organs ■ composed of testis, epididymis, vas deferens, seminal vesicle, ejaculatory

duct, prostate and bulbourethral glands● Male urethra:

● A muscular tube about 20 cm long■ Pre-prostatic urethra■ Prostatic urethra

● most dilated part of urethra , ends where the urethra is covered by the external urethral sphincter

● has the urethral crest on its posterior wall, on both sides of which, are the prostatic sinuses into which most prostatic ductules open

■ Membranous urethra● the part surrounded by the external urethral sphincter and perineal

membrane. ● Posterolateral to this part of the urethra, are the Cowper’s (men are

cows) (bulbourethral) glands which open into the spongy urethra● membranous part is the most vulnerable part to injuries due to

being fixed and less mobile■ Spongy urethra

● 15-16 cm long● it starts from the bulb of the penis and ends at the external urethral

orifice of the glans penis● Testis

● Testis (orchis) is suspended in the scrotum by the spermatic cord● Left testis is hung more inferiorly● Testis is tightly enveloped by a capsule called Tunica albuginea● Septae divide the testicle into 200-300 lobules

● Each lobule contains many seminiferous tubules● These tubules lead into the Rete testis with straight endings:

tubuli recti. ● These are interconnected and lead to the efferent ductules.

● Efferent ductules then reach the ducts (lobules) of epididymis.

● These in turn merge into the ductus deferens● Spermatosoa produced in the lumen of the seminiferous tubules are transported

through this pathway to the prostate and urethra

● Scrotum● Layers:

● Skin ● Dartos fascia [containing the dartos muscle which is attached to the skin of

the scrotum and thereby its contraction causes the scrotum to wrinkle when cold and prevents heat loss;

● External spermatic fascia ● Cremaster muscle and fascia

● Internal spermatic fascia ● Tunica vaginalis

● Epididymis and ductus deferens:● Consists of a head, a body and a tail● It lies on the posterior surface of the testis, covered by tunica vaginalis except for its

posterior border● Head consists of the convoluted tubules which become smaller toward the tail,

producing the epididymal duct● This continues as the ductus deferens

● Spermatozoa is produced in the lumen of the seminiferous ducts, transported to the rete testis and efferent ductules and then to the epididymis to be stored.

● Ductus deferens cont.● Ductus deferens is 50-60cm long, ● it ascends in the spermatic cord and runs through the inguinal canal,

● turns toward the pelvis external to the parietal peritoneum, ● and ends by joining the duct of the seminal vesicle

● to form the ejaculatory duct. ● It crosses superior to the ureter ● It has a strong muscle. ● Contraction, suction and pressure mechanism are assumed to play

role in the quick passage of the spermatozoa. ● The mucosa has high columnar double layered epithelium with stereocilia. ● Before joining the duct of the seminal vesicle, it has a dilation called: ampulla of

ductus deferens. ● Seminal vesicle:

● are bag-like glands, 5-10 cm long, convoluted structures, which lie posterior to the bladder between rectum and fundus of the bladder— superior to the prostate

● Its alkaline secretion (pH 7.29) which together with the prostatic fluid constitute the bulk of semen (seminal fluid) contains fructose from which the spermatozoa derive their energy.

● Seminal vesicles open into the ductus deferenses, producing the ejaculatory ducts which enter the prostate

● Prostate:● Prostate is 3 cm long ● and the largest accessory gland of the male reproductive organ behind the pubic

symphysis● it has the size and shape of a chestnut● It lies between the urinary bladder and the deep transverse perineal muscle in male

only● Prostate has a posterior, 2 lateral, and a middle lob● produces a thin, opaque, weakly acidic secretion (pH 6.45) which contains

proteases (liquefaction of the ejaculate), citric acid (buffer effect), spermine and spermidine (influencing the fertility of the spermatozoa), and prostaglandins stimulating the uterus.

● Penis● Penis is composed of 3 cylindrical parts:

● Corpora cavernosa x2 which are erectile tissues ● corpus spongiosum

● all of which are enclosed by a fibrous capsule, the tunica albuginea● corona of the glans— Neck of the glans● Prepuce (foreskin)

● is the prolongation of the skin and fascia of penis extended as a double layer over the glans

● External urethral orifice ● opens at tip of the glans

● Mechanism of:● Erection

● is accompanied by relaxation of helicine arteries due to stimulation of the Parasympathetic nerves (S2-S4 through cavernous nerves from the prostatic plexus)

● Blood rushes to fill the sinuses of the corpora cavernosa● tunica albuginea become tightened; the bulbospongiosus and ischiocavernosus

muscles also contract ● and all together the veins in corpora cavernosa are compressed,

● thus, the out flow of the blood is restricted● As a result, both corpora cavernosa and spongiosum become

enlarged, rigid, and the penis erects● Emission

● sympathetic stimulation (L1-L2 nerves) causes the ductus deferens and seminal vesicle to deliver the semen to the prostatic urethra by means of peristalsis

● Ejaculation● projectile outflow of semen from external urethral orifice● First the semen passes the internal urethral orifice and then,

● the same sympathetic nerves lead to the closure of the internal urethral sphincter, ● which is proceeded by contraction of the urethral muscle (parasympathetic,

S2-S4) accompanied by contraction of the bulbospongiosus muscle by the somatic nerve (pudendal N., S2-S4).

● Following ejaculation, penis becomes flaccid again and the helicine arteries contract (sympathetic stimulation) which allow the blood to flow out. Meanwhile the muscles of the penis also relax

Females

● Female external genitalia is composed of:● Mons pubis, labia majora, labia minora, clitoris, vestibule of vagina, bulbs of the

vestibule, greater vestibular (Bartholin) gland● female urethra:

● 4-6 cm long. ● starts from the internal urethral orifice to the external urethral orifice in the vestibule

of vagina, anterior to the vaginal opening● The urethra accompanied by the vagina pass through the pelvic diaphragm and

perineal membrane● The urethra is surrounded by the external urethral sphincter● The inferior part of the urethra is in the perineum● Urethral glands open into the urethra (mostly upper parts)

● Paraurethral glands (homologues to the prostate)● **Female urinary tract is more prone to get infection

● Female external genitalia (vulva):● Clitoris:

● originates as 2 limbs, the crura of the clitoris, from the lower rami of the pubic bone. Beneath the pubic symphysis the crura form the 3-4cm long shaft, the body of the clitoris which turns backward and ends in the glans clitoris

● It is an erectile organ and functions only as an organ of sexual arousal ● Enlarges upon tactile stimulation.● Each crus of the clitoris is covered by one ischiocavernosus muscle ● Vestibule:

● is the space between the labia minora that contains the opening of the urethra, vagina and the greater and lesser vestibular glands. On each side of the external urethral orifice, are the ducts of the paraurethral glands

● The vaginal orifice is covered by Hymen which is a thin fold of mucous membrane in a virgin

● Later, a few remnants of the membrane called hymenal caruncles may be visible

● Bulbs of the Vestibule:● (corpus spongiosum of the vestibule) consist of venous plexus

which are covered by the bulbospongiosus muscles● These are homologous with the bulb of the penis

Unisex ● Parts:

● Perineum:● the area between the ischial tuberosities, extending from the pubic symphysis to the

coccyx bone. ● It is the lowest part of the trunk between the thighs and buttocks

● Perineum in male includes the penis, scrotum and the testis and in the female, the vulva (external genitalia) and anus.

● The perineum is separated from the lesser pelvis by levator ani and the coccygeous muscles (pelvic diaphragm)

● Perineum is divided into the anal and the urogenital triangles by drawing a line across the ischial tuberosities.

● Anal triangle contains the anus and urogenital triangle contains the external genitalia.● Perineal body:

● is the center of the perineum at the midpoint of the line joining ischial tuberosities, which is the site of attachment of the perineal muscles

● muscles of perineum● external anal sphincter:

● Origin: skin and fascia surrounding anus and inserted to the perineal body● function: closes the anal canal and supports the perineal body

● Blood supply● Male urethra—

● Inferior vesical and middle rectal arteries and the internal pudendal artery to the lower parts

● veins have similar names ● female urethra—

● by internal pudendal and vaginal arteries and the veins have similar names.● Testis—

● testicular (gonadal) arteries from abdominal aorta● blood from epididymis and the testis gets into the pampiniform plexus and from there

to the testicular vein

● Left testicular vein drains into the left renal vein and right testicular vein directly into the IVC

● Pampiniform venous plexus is a thermosregulator of the testis to keeps the temperature constant

● Ductus deferens—● from inf. vesical artery● veins of the same name

● prostate—● inferior vesical, middle rectal and internal pudendal arteries● produce a venous plexus around the sides and the base of the prostate which drain

into the internal iliac veins● Prostatic venous plexus communicates with the vesical venous plexus and the

internal vertebral venous plexus● Innervation

● Male urethra—● pudendal N., pelvic splanchnic NN and sympathetic system

● Testis—● sympathetic from T7 and parasympathetic from Vagus coming along the testicular

artery as testicular plexus.● Lymphatic drainage to the pre-aortic and lumbar lymph nodes.

● Scrotum—● genitofemoral (anterolateral) Ilioinguinal (anterior), pudendal (posterior)

and posterior femoral cutaneous N (inferior)● Lymphatics: to the superficial inguinal lymph nodes

● Prostate—● Sympathetic and parasympathetic (S2-S4)

● Perineal muscles—● are all innervated by the pudendal nerve

● External anal sphincter—● inferior anal nerve (from pudendal nerve)

● Clinical examination/ tools● Prostate is palpable in front of the rectum (it is done by rectal examination)

● *Pathology*/* Clinical points*● Hypospadias

● congenital anomaly. External urethral orifice opens on ventral aspect of the glans penis (glandular hypospadias) Due to failure of fusion of the urogenital folds in embryonic life.

● Phimosis● when prepuce of the penis is too tight over the glans and cannot be retracted

to uncover the glans penis.

● In these cases, smegma, the oily and cheesy-like secretion of the sebaceous glands in the prepuce cause irritation of the glans

● This is also carcinogen to the female cervix ● Paraphimosis: when the retraction of the prepuce over the glans constricts the neck

of the glans and interferes with the blood supply● Circumcision should be performed.

● Perineum, levator ani, and pelvic fascia may be injured during childbirth● Pubococcygeus, the main part of the levator ani, that is usually torn