2. Female & Pelvic Floor

Question 1

Why do some women get a sharp pain at ovulation?

Answer 1

Egg breaches ovary wall and ruptures the capsule

Question 2

Should you burst an ovarian cyst? Why?

Answer 2

No, unknown whether its benign or malignant so bursting it could spread cancer cells into peritoneum

Question 3

Peg cells
-location
-function

Answer 3

In ampulla of oviduct
-nutrients to keep cperm alive
-help motility for egg to move down the tube to uterus

Question 4

How is anteversion-anteflexion maintained?

Answer 4

Round ligaments ‘pull’ on uterus

Question 5

Abundant organelle of vagina, why?

Answer 5

Epithelium vacuoles filled with glycogen to support lactobacilli, to maintain acidic pH

Question 6

Are the perineal muscles superficial?
Are they superficial to levator ani?

Answer 6

Yes superficial
But deep to levator ani

Question 7

Important perineal muscles

Answer 7

Superficial and deep transverse perineal muscles
Bulbospongiosus

Question 8

Blood supply to pelvic floor

Answer 8

Internal and external pudendal arteries
(Same veins)

Question 9

Lymphatic drainage of pelvic floor

Answer 9

Inguinal lymph nodes

Question 10

Nerve supply to pelvic floor

Answer 10

Pudendal nerve branches (dervied from second third and fourth sacral nerve)

Question 11

Name different prolapses that could occur in the anterior compartment

Answer 11

Cystocoele
Urethrocoele
Cystourethrocoele

Question 12

Name different prolapses that may occur in the middle compartment

Answer 12

Uterine prolapse
Post hysterectomy vault prolapse

Question 13

Name different types of prolapse that may occur in the posterior compartment

Answer 13

Rectocoele (revtum prolapse into vagina)
Enterocoele (loops of bowel into rectovaginal space)

Question 14

How might infection spread from peritoneum to repro tract?

Answer 14

Uterine tubes open into peritoneal cavity

Question 15

Possible consequences to infection in uterine tubes

Answer 15

Spread to peritoneal cavity, signs of inextion, fluid collects in cavity, scarring after inflammation. Can cause adhesions between organs e.g. bowel obstruction, chronic abdo pain

Fertility issues due to uterine scarring, sperm cant meet egg

Question 16

How to feel rectouterine pouch

Answer 16

Binmanual examination- one hand on tummy, other in vagina

Question 17

How does histology of vagina help transport of ovum to uterus?

Answer 17

Ciliated epithelium waft
Peg cells secrete nutrients to help motility

Question 18

Why might tou feel pain at shoulder tip fro, ectopic pregnancy?

Answer 18

Blood collects behind diaphragm, irritates it and the phrenic nerve. At C3/4 level, brain misinterprets as shoulder pain

Question 19

In terms of arterial supply, why is ectopic pregnancy an emergency?

Answer 19

Blood supply is via uterine and ovarian artery anastomoses, so not good enouh to supply a developing conceptus
The developing placenta invades structures e.g, iliac arteries to cause bleeding
Could cause intra peritoneal haemorrhage

Question 20

Investigations for suspected ectopic

Answer 20

Transvaginal US
Pregnancy test
Beta HCg from bloods if cant see fetus on US but positive pregnancy test- if level goes up too slowly over time shows abnormal pregnancy (ectopic)

Question 21

Venous drainage of
-uterus
-cervix
-vagina

Answer 21

-uterine vein, uterine venous plexus, internal iliac veins
-uterine venous plexus, internal iliac veins
-vaginal venous plexus

Question 22

Lypmhatic drainage of
-uterus
-cervix
-vagina

Answer 22

-fundus: para aortic, sup inguinal. Body: external iliac
-internal iliac and sacral
-iliac and superficial inguinal. Upper: external iliac