2: PRINCIPLES OF APPLIED ANATOMY/PHYSIOLOGY

Question 1

Origin of inferior epigastric vessels

Answer 1

External iliac

Question 2

Medial umbilical ligament AKA

Answer 2

Obliterated umbilical artery

Question 3

What is the termination of the internal iliac artery

Answer 3

Medial umbilical ligament AKA obliterated umbilical artery

Question 4

Visualization of what structure confirms intrauterine location?

Answer 4

Tubal ostia

Question 5

What scope degree should be used on HSC?

Answer 5

30 degrees

Question 6

Borders of vesicovaginal space

Answer 6

Anterior: Bladder
Posterior: Vagina/endopelvic fascia
Lateral: Uterine arteries/bladder pillars

Question 7

Borders of rectovaginal space

Answer 7

Anterior: Vagina
Posterior: Rectum
Lateral: Uterosacral ligaments

Question 8

Borders of paravesical space

Answer 8

Caudad: Uterine artery
Medially: Bladder
Laterally: Medial umbilical ligament

Question 8

Borders of pararectal space

Answer 8

Cephalad: Uterine artery
Medial: Ureter
Lateral: Internal iliac artery

Question 9

Borders of retropubic space

Answer 9

Anterior: Pubic symphysis
Posterior: Bladder
Lateral: Pubic rami and obturator internus

Question 10

Retropubic space AKA

Answer 10

Space of retzius

Question 11

Presacral space AKA

Answer 11

Pouch of Douglas

Question 12

Borders of presacral space

Answer 12

Anterior: Rectum
Posterior: Sacrum
Lateral: Common iliac vessels and ureters

Question 13

Structures in presacral space

Answer 13

Middle sacral artery
Left common iliac vein (generally midline)
Inferior mesenteric artery (above L common iliac vein)
Right internal iliac is lateral aspect of the dissection

Question 14

% of ureteral injuries attributable to GYN surgery

Answer 14

75%

Question 15

Ureteral injury rate

Answer 15

0.03-1.5%

Question 16

Abdominal ureter pathway

Answer 16

Renal pelvis > courses inferiorly along psoas muscle > enters pelvis/crosses pelvic brim at bifurcation of iliac > medial/deep to IP > medial leaf of broad ligament

Question 17

Pelvic ureter pathway

Answer 17

Medial leaf of broad ligament > Passes within 1cm lateral to uterosacrals > into cardinal ligament complex > inferior to uterine vessels > medial along anterior vaginal to enter bladder at trigone

Question 18

Distance of ureter from internal os

Answer 18

1-1.5cm

Question 19

Fascial structures/ligaments of the pelvic floor

Answer 19

Endopelvic fascia
Cardinal ligaments
Uterosacral ligaments
Arcus tendineus of pelvic fascia

Question 20

Role of endopelvic fascia

Answer 20

Connects bladder, urethra, cervix, and lower portion of uterus to pelvic sidewall
Support for uterus and upper portion of vagina

Question 21

Role of cardinal ligaments

Answer 21

Fibromuscular condensation of pelvic fascia that directly attaches to cervix

Question 22

Role of arcus tendineus pelvic fascia/location

Answer 22

Attaches endopelvic fascia to pelvic sidewall
Can be found at interface of obturator internus and ischial spine
Formed by fascial attachments of the levator ani mm

Question 23

Female perineum: Perineal membrane layer

Answer 23

Deep transverse perineal mm
Compressor urethrae mm
Sphincter urethrae mm

Question 24

Female perineum: Superficial muscular layer

Answer 24

Superficial transverse perineal muscle Bulbospongiosus Ischiocavernosus

Question 25

Female perineum: Urogenital triangle

Answer 25

Spans entire anterior pelvic outlet Occupies area between pubic symphysis and ischial tuberosities Insertion of UG triangle forms perineal body

Question 26

Female perineum: Anal triangle

Answer 26

Includes external and internal anal sphincters

Question 27

Female perineum: Pelvic diaphragm AKA levator ani mm

Answer 27

Puborectalis Pubococcygeus Pubovaginalis?? Iliococcygeus *Contiguous with piriformis and obturator mm

Question 28

Level 1 pelvic support + Defects

Answer 28

APICAL SUPPORT Uterosacral/Cardinal ligament complex Defects: Uterus or vaginal vault prolapse

Question 29

Level 2 support and defects

Answer 29

LATERAL ATTACHMENTS Arcus tendineus fascia Pubocervical and rectovaginal fascia Defects: A/P vaginal wall prolapse

Question 30

Level 3 support and defects

Answer 30

LOWER SUPPORT Perineal body / Levator ani mm Defects: Rectal prolapse and anal incontinence

Question 31

Follicular cyst: Origin and US findings

Answer 31

Arises from ovarian follicle US: Thin-walled, anechoic/fluid filled

Question 32

Corpus luteal cyst: Origin and US findings

Answer 32

Arises from corpus luteum Thick walled and yellow US: Internal echoes, central lucency, thickened walls

Question 33

Management of pre-menopausal ovarian cyst based on size

Answer 33

Asymptomatic, 5cm: US 6-12w

Question 34

When to consider removal ovarian cyst, pre-menopausal

Answer 34

Persistent, enlarging, symptomatic Torsion Concern for underlying malignancy

Question 35

Risk of recurrence with cyst aspiration

Answer 35

30%