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3rd Year General Revision > Anatomy 1 > Flashcards

Anatomy 1 Flashcards

1
Q

Where do the presynaptic sympathetic axons for the heart synapse?

A

T1 or cervical PARAvertebral gangli

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2
Q

Where are post-synaptic axons for the heart?

A

They pass through cardiopulmonary splanchnic nerves to the SA&AV nodes and the myocardium

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3
Q

What does the T9 myotome supply?

A

The 8th-10th intercostal spaces and some of the anterolateral abdominal wall muscles

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4
Q

Where do the presynaptic sympathetic axons for the lung synapse?

A

Synapse in the upper thoracic PARAvertebral ganglia

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5
Q

Where do the post-synaptic sympathetic axons for the lung travel

A

Pass in cardiopulmonary splanchnic nerves to the bronchiolar smooth muscle and mucous glands

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6
Q

Where do the abdominopelive sympathetic presynaptic axons synapse?

A

Synapse in one of the PREvertebral ganglia

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7
Q

Foregut ganglia

A

Celiac ganglion of celiac plexus

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8
Q

Kidney ganglia

A

Aorticorenal ganglion

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9
Q

Midgut ganglion

A

Superior mesenteric ganglion of the SM plexus

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10
Q

Hindgut and pelvic/perineal organ ganglion

A

Inferior mesenteric ganglion

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11
Q

What is special about the sympathetic supply to the kidney?

A

Presynaptic axons pass directly through the aorticorenal ganglion to synapse directly onto the adrenaline/noradrenaline secreting cells of the adrenal medulla

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12
Q

How do parasympathetic axons reach the eye?

A

Via the ciliary ganglion

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13
Q

Which glands in the head are under parasympathetic supply?

A

The lacrimal and salivary glands

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14
Q

How do PARAsympathetic axons reach the hindgut, pelvis and perineum?

A

They are “carried” on sacral spinal nerves

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15
Q

What do the extrinsic back muscles do?

A

Move the upper limb

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16
Q

Where does the trapezius attach to superiorly?

A

The occipital bone

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17
Q

Where do the levator scapulae attach superiorly?

A

To the cervical vertebrae

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18
Q

Superficial intrinsic back muscles

A

Erector spinae

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19
Q

Deep intrinsic back muscles

A

Transversospinalis

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20
Q

Function of the intrinsic back muscles?

A

Maintain back posture

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21
Q

The 3 parts of the trapezius

A 
Descending part (to spine of scapula)
Middle part
Ascending part (to spine of scapula)
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22
Q

Low back pain may be due to what

A

Erector spinae strain

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23
Q

Which muscles allow extension of the spine?

A

Intrinsic back muscles

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24
Q

Nerve supply to the intrinsic back muscles?

A

The posterior rami (of cervical, thoracic, lumbar etc)

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25
Q

Primary curvatures of the vertebral column?

A

Thoracic primary curvature
Sacral primary curvature

(Cervical and lumbar are secondary)

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26
Q

What makes the vertebral canal for the spinal cord?

A

The vertebral foraminae combine to form the vertebral canal

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27
Q

Which foraminae do the spinal nerves emerge from?

A

Intervertebral foramen

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28
Q

Which joints affected in arthritis?

A

Facet joints

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29
Q

What makes the facet joint?

A

Between 2 articular processes

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30
Q

Intervertebral discs are between all vertebrae except?

A

Except C1-C2 and the fused sacrum/coccyx

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31
Q

What attaches the laminae together?

A

The ligamentum flavum

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32
Q

Function of the posterior longitudinal ligament?

A

Prevents over-flexion of spin

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33
Q

Function of the anterior longitudinal ligament?

A

Prevents over-extension of the spine

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34
Q

This ligament connects tips of spinous processes

A

Supraspinous ligament

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35
Q

This ligament connects superior and inferior surfaces of adjacent spinous processes

A

Interspinous ligament

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36
Q

This vertebra doesn’t have a body or spinous process

A

C1

has a posterior and anterior arch instead

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37
Q

Atlas

A

C1

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38
Q

Axis

A

C2

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39
Q

This vertebrae has an odontiod process

A

C2

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40
Q

First palpable spinous process

A

C7

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41
Q

Main movements of the atlanto-occipital joints

A

Flexion and extension (i.e. nodding)

This is a synovial joint

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42
Q

Main movement of the atlanto-axial joint?

A

Rotations (i.e. head looking side to side)

This joint is made of 3 synovial joints

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43
Q

What are the anterior sacral foraminae for?

A

For the anterior rami of the sacral spinal nerves

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44
Q

In caudal anasthaesia, where is local anaesthetic injected into?

A

Into the sacral hiatus

numbs the sacral spinal nerves of the cauda equina

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45
Q

Where does the spinal cord begin?

A

C1

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46
Q

Where does the spinal cord end?

A

L2 (conus medullaris)

this then continues as the filum terminale

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47
Q

What makes up the cauda equina?

A

All the spinal nerve roots from L2 to C0 that have to descend to their numbered verterbae where there spinal nerve is lovated within the intervertebral foramen

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48
Q

Why is a laminectomy performed?

A

To access the spinal cord

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49
Q

How do you perform a laminectomy?

A

Removal of one or more of the spinous processes and the adjacent lamina

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50
Q

Common location of a CVA?

A

Internal capsule

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51
Q

When you are examining dermatomes, what do the following mean:

  • 0
  • 1
  • 2
  • NT
A

0 - absent
1 - impaired
2 - normal
NT - not testable

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52
Q

C1

A

Spinal nerve has no significant cutaneous sensory axons

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53
Q

C2

A

Back of scalp and adam’s apple

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54
Q

C3

A

Back of neck and jugular notch

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55
Q

C4

A

Clavicle and shoulder tip

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56
Q

C5

A

Badge patch

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57
Q

C6

A

Thumb

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58
Q

C7

A

Middle finger

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59
Q

C8

A

Little finger

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60
Q

T1

A

Medial forearm

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61
Q

T2

A

Medial arm and sternal angle

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62
Q

T4

A

Male nipple

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63
Q

T8

A

Xiphoid process

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64
Q

T10

A

Umbilicus

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65
Q

T12

A

Pubic symphysis

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66
Q

L1

A

Groin

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67
Q

L2

A

Anterior thigh

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68
Q

L3

A

Anterior knee

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69
Q

L4

A

Medial malleolus

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70
Q

L5

A

Dorsum of foot

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71
Q

S1

A

Heel

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72
Q

S2

A

Posterior knee

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73
Q

S3

A

Buttock

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74
Q

S4

A

Perinuem

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75
Q

S5

A

Perianal skin

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76
Q

Femoral nerve roots

A

L2, L3, L4

so will supply anterior thigh, anterior knee and medial malleolus

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77
Q

Great auricular nerve?

A

C2, C3

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78
Q

Supraclavicular nerve?

A

C3, C4

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79
Q

Nerve supply to the upper anterolateral abdominal wall

A

T2-T11

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80
Q

Nerve supply to the lower anterolateral abdominal wall

A

Iliohypogastric and ilioinguinal nerves (formed from L1)

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81
Q

Nerve supply to the posterior parts of the dermatome

A

Supplied by posterior rami

- supplied segmentally by the intercostal nerves

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82
Q

What is special about T1 and T2 dermatomes?

A

Explains the pain from an MI! (because the dermatome extends into the arm etc)

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83
Q

Axillary nerve

A

C5, C6

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84
Q

Cutaneous branch of the musculocutaneous nerve

A

C5, C6, C7

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85
Q

Radial nerve

A

C6, C7, C8

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86
Q

Median nerve

A

C6, C7, C8, T1

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87
Q

Ulnar nerve

A

C7, C8, T1

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88
Q

What does the cervical motor plexus supply?

A

Neck postural & strap muscles

Diaphragm

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89
Q

What does the brachial motor plexus supply?

A

The upper limb muscles

The extrinsic back muscles

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90
Q

Which motor axons supply:

  • postural back muscles (via posterior rami)
  • intercostal muscles (via anterior motor rami)
  • anterolateral abdominal wall muscles (via thoracoabdominal, subcostal, iliohypogastic and ilioinguinal nerves)
A

T2-L3

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91
Q

What does the lumbosacral motor plexus supply?

A

Plexus= L1 -S4

  • Supplies lower limb muscles &
  • Perineal skeletal muscles
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92
Q

What is the intracranial part of the spinal nerve course?

A

Between their base of skill foraminae and their connection with the CNS

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93
Q

V1, V2, V3

A

V1 - sensory
V2 - sensory
V3 - sensory and motor

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94
Q

The only cranial nerve to attach to the pons

A

CN V

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95
Q

Which foramen does V1 pass through?

A

Superior orbital fissure

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96
Q

Which foramen does V2 pass through?

A

Foramen rotundum

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97
Q

Which foramen does V3 pass through?

A

Foramen ovale

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98
Q

This nerve supplies the:

  • upper eyelid
  • the cornea
  • all the conjunctiva
  • the skin of the root/bridge/tip of the nose
A

V1

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99
Q

This nerve supplies:

  • the skin of the lower eyelid
  • the skin over the maxilla
  • the skin of the ala of the nose
  • the skin/mucosa of the upper lip
A

V2

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100
Q

This nerve supplies:
-the skin over the mandible and temperomandibular joint (apart from the angle of the mandible - supplied by C2, C3 spinal nerves)

A

CN V3

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101
Q

Which nerve supplies the skin over the angle of the mandible and some of the external ear

A

The great auricular nerve (C2, C3)

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102
Q

This nerve supplies the:

  • bones and soft tissue of the orbit
  • the upper anterior nasal cavity
  • all paranasal sinuses (except antrum)
  • the anterior and posterior cranial fossa
A

CN V1 (deep sensory territory)

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103
Q

This nerve supplies:

  • the lowest posterior nasal cavity
  • the maxilla and maxillary sinus
  • the floor of the nasal cavity/palate
  • the maxillary teeth and the associated soft tissues (gingivae and mucosae)
A

CN V2 (deep sensory territory)

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104
Q

Which nerve supplies:

  • the MIDDLE cranial fossa
  • the mandible
  • the anterior 2/3rds of the tongue
  • the floor of the mouth
  • the buccal mucosa
  • the mandibular teeth
A

CN V3 (deep territory)

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105
Q

Recap: which CN supplies the paranasal sinuses?

A

CN V1 (except antrum)

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106
Q

Recap, which CN supplies the anterior and posterior fossa?

A

CN V1

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107
Q

Recap, which CN supplies the antrum? (maxilla and maxillary sinus)

A

CN V2

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108
Q

Recap, which CN supplies the middle fossa?

A

CN V3

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109
Q

Where does the masseter attach?

A

From the angle of the mandible TO

the zygomatic arch / bone

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110
Q

Where does the temporalis attach?

A

From the CORONOID process of the mandible to the neurocranium

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111
Q

Where does the middle pterygoid attach?

A 
From the (medial) part of the angle of the mandible TO
the ptyergoid plates (of sphenoid bone)
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112
Q

Where does the lateral pterygoid attach?

A

From the CORACOID process AND articuar disc of TMJ to the ptyergoid plates of spehnoid bone

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113
Q

Which nerve supplies the tensor veli palatini?

A

CN V

114
Q

Which nerve supplies the tensor tympani?

A

CN V

115
Q

These nerves supply the first part of the afferent limb of the corneal (blink) reflex?

A

Ciliary nerves

116
Q

Which foraminae does the facial nerve pass through?

A

The internal acoustic meatus and the stylomastoid foramen

stylomastoid foramen really visible if you look at skull from the bottom

117
Q

This supplies taste to the anterior 2/3rds of the tongue

A

Chorda tympani

118
Q

This supplies parasympathetic supply to the submandibular and mandibular glands

A

Chorda tympani

119
Q

This muscle reduces stapes movement to protect the internal ear from excessive noise

A

Right stapedius

120
Q

Where would you find the facial nerve in the facial canal?

A

In the petrous temporal bone

121
Q

Why is the facial canal nice?

A

It connects the internal acoustic meatus to the stylomastoid foramen

122
Q

What nerve does the chorda tympani attach to?

A

Attaches to CN V3 and then carries taste axons (to anterior 2/3rds of tongue) and parasympathetic axons (to salivary glands)

123
Q

This border must be carefully sutured by a specialist

A

Vermillion border

124
Q

Loss of this special pad in illness leads to sunken cheek- what is this pad and why is this sign important?

A

Buccal fat pad

-important as a clinical sign of malnutrition

125
Q

Which foramen does the glosspharyngeal nerve pass through?

A

The jugular foramen

126
Q

Special sensory to the vallat papillae

A

Glossopharyngeal

127
Q

Parasympathetic to the parotid salivary gland

A

Glossopharyngeal

128
Q

Visceral afferent to the carotid sinus baroreceptors and carotid body chemoreceptors

A

Glossopharyngeal

129
Q

General sensory to the posterior 1/3rd of tongue

A

Glossopharyngeal

130
Q

General sensory to the mucosa of most of the nasopharynx

A

Glossopharyngeal

131
Q

General sensory to the mucosa of the oropharynx

A

Glossopharyngeal

132
Q

General sensory to the palatine tonsil

A

Glossopharyngeal

133
Q

General sensory to the eustachian tube

A

Glossopharyngeal

134
Q

General sensory to the middle ear cavity

A

Glossopharyngeal

135
Q

Somatic motor to the stylopharyngeus

A

Glossopharyngeal

136
Q

Which foramen does the vagus nerve pass through?

A

The jugular foramen

137
Q

How does the vagus nerve pass through the neck?

A

In the carotid sheath

138
Q

Which muscles does the spinal accessory nerve supply?

A

The trapezius and the sternocleidomastoid

139
Q

In relation to the triangle of the neck, where would you find the spinal accessory nerve?

A

It crosses the posterior triangle of the neck

(named nerves of the cervical plexus ALSO pass the posterior border of the sternocleidomastoid but they do NOT pass DEEP to the trapezius like the spinal accessory nerve does)

140
Q

Which foramen does the hypoglossal nerve pass through?

A

Hypoglossal canal

141
Q

At which level does the hypoglossal nerve pass anteriorly?

A

At the level of the hyoid bone

–> passes anteriorly towards the lateral aspect of the tongue (because it supplies muscles of the tongue obv)

142
Q

Five layers of the SCALP

A 
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium
143
Q

Which layer of the scalp contains the arteries of the scalp?

A

Layer 2 (connective tissue)

144
Q

How can you tell the difference between the internal and external carotid artery?

A

The internal doesn’t have any branches in the neck

145
Q

The opthalmic artery is a branch of which artery?

A

The internal carotid

146
Q

Pterygoid is a joint between which bones?

A

Frontal
Temporal
Parietal
Spehnoid

147
Q

Which artery crosses the deep aspect of the pterion?

A

The middle meningeal artery

148
Q

The optic canal is in which bone?

A

The sphenoid bone

149
Q

There is a groove across the deep surface of the pteriod, what is this made by?

A

Made by the middle meningeal artery

150
Q

Parts of the ethmoid bone i probably shouldn’t forget

A

Crista galli

Cribriform plate

151
Q

This is a tough sheet of dura mater forming a roof over the pituitary fossa

A

Diaphragm sellae

152
Q

This separates the right and left cerebral hemispheres

A

Falx cerebri

153
Q

Where does the left sigmoid sinus drain into?

A

Drains into the internal jugular at the jugular foramen

154
Q

Where is the confluence of the sinuses?

A

In the midline at the internal occipital protuberance (this is deep to the external occipital protuberance)

155
Q

What arteries form the basilar artery?

A

The vertebral arteries

156
Q

What level would you access the spinal cord?

A

Lumbar puncture at L3/L4 or L4/L5 intervertebral disc

157
Q

This connects the third and fourth ventricles in the midline

A

Cerebral aqueduct

158
Q

IMPORTANT

How does the CSF pass from the lateral ventricles to the 3rd ventricle?

A

FORAMINAE OF MUNRO

159
Q

IMPORTANT

How does CSF pass from 3rd ventricle to 4th ventricle

A

Cerebral aqueduct!

160
Q

Treatment of hydrocephalus

A

Ventricular peritoneal shunt

161
Q

What type of haemorrhage:

  • middle meningeal artery
  • trauma to the pterion
A

Extradural haemorrhage

162
Q

Which type of haemorrhage:

  • torn cerebral veins
  • falls in the elderly and alcoholics
A

Subdural

163
Q

Which type of haemorrhage:

  • into the CSF of the subarachnoid space
  • ruptured circle of willis “berry aneurysm”
  • congenital aneurysm
A

Subarachnoid haemorrhage

164
Q

In epidural anaesthesia/lumbar puncture, where is the needle most safely inserted?

A

1) the subarachnoid space that surrounds the cauda equina NOT the spinal cord
2) where the vertebrae are not fused (i.e. NOT the sacrum)

This is why they usually go for L3/L4

165
Q

Where does the subarachnoid space end?

A

S2

166
Q

Which nerves make up the cauda equina?

A

L2-C0

167
Q

Which level does the spinal cord end?

A

L2

168
Q

How do you know if its an uncal/transtentorial herniation?

A

The uncus (medial part) of the temporal love herniates INFERIOR to the tentorium cerebelli

169
Q

An uncal herniation could compress which nerve?

A

The occulomotor nerve

  • -> this leads to an IPSILATERAL, fixed DILATED pupil
  • a “blown” pupil
170
Q

What is a downward/tonsillar herniation

A

The cerebellar tonsils herniate into the foramen magnum

171
Q

Where are the ischial spines palpable on vag exam?

A

About a finger breadth into the vagina, at 4 and 8 o’clock

172
Q

Which ligaments form the greater and lesser sciatic foraminae?

A

The sacrotuberous and sacrospinous ligaments

173
Q

What forms the pelvic inlet?

A
  • sacral promontory
  • ilium
  • superior pubic ramus
  • pubic symphysis
174
Q

What forms the pelvic outlet?

A
  • pubic symphysis
  • ischiopubic ramus
  • ischial tuberosity
  • sacrotuberous ligaments
  • coccyx
175
Q

Why is trauma to the pelvis bad

A

You can get a life-threatening haemorrhage (common iliac artery, common iliac vein etc)

176
Q

Difference between the occipitofrontal and the biparietal diameter?

A

The occipitofrontal diameter is longer than the biparietal diameter

177
Q

What is the “station”? What does a negative number mean?

A

The distance of the fetal head from the ischial spine

-a negative number means that the head is above the spines

178
Q

While descending through the pelvic cavity, the fetal head should what?

A
  • rotate

- be in a flexed position (i.e chin on chest)

179
Q

Baby should ideally leave the cavity in which postition?

A

OA (occiput anterior)

180
Q

During delivery, the baby’s head should be in which position?

A

Extension

descending through cavity = flexed

181
Q

What happens once the baby’s head has been delivered?

A

There is further rotation so the rest of the baby can then be delivered

182
Q

Ovaries

A

Pelvic cavity

183
Q

Uterine tubes

A

Pelvic cavity

184
Q

Uterus

A

Pelvic cavity

185
Q

Superior part of vagina

A

Pelvic cavity

186
Q

Inferior part of vagina

A

Peirneum

187
Q

Perineal muscles

A

Perineum

188
Q

Bartholin’s glands

A

Perineum

189
Q

Clitoris

A

Perineum

190
Q

Labia

A

Perineum

191
Q

Where is the perineum?

A

Inferior to the levator ani

192
Q

Where does excess fluid collect in the peritoneal cavity?

A

Collects in the pouch of douglas

193
Q

How can you get fluid out of pouch of douglas?

A

By passing a needle through the posterior fornix of the vagina

194
Q

Structure and function of the broad ligament?

A
  • Double layer of peritoneum

- Helps maintain the uterus in the correct midline position

195
Q

Which ligament is an embryological remnant?

A

Round ligament

196
Q

Course of the round ligament?

A

Passes through the deep inguinal ring to attach to the superficial tissue of the female peritoneum

197
Q

The 3 layers of the uterus and which one is shed

A
  • perimetrium
  • myometrium
  • endometrium (shed)
198
Q

Where does implantation of the zygote occur?

A

Occurs in the body of the uterus

199
Q

Name a ligament which helps support the uterus

A

Uterosacral ligament

200
Q

What is uterine prolapse?

A

Movement of the uterus inferiorly

201
Q

Anteverted

A

Uterus is tipped anteriorly relative to the axis of the VAGINA

202
Q

Anteflexed

A

Uterus is tipped posteriorly relative to the axis of the VAGINA

203
Q

Retroverted?

A

Uterus tipped posteriorly in relative to axis of VAGINA

204
Q

Retroflexed?

A

Uterus tipped posteriorly relative to axis of CERVIX

205
Q

Which part of the cervix are you sampling in a smear?

A

The squamo-columnar junction

206
Q

Removal of both uterine tubes and ovaries

A

Bilateral salpingo-oophrectomy

207
Q

Removal of one of the uterine tubes

A

Salpingectomy

208
Q

How can you assess patency of the uterine tubes?

A

Hysterosalpingogram !!!

209
Q

What size are the ovaries

A

Almond sized

210
Q

What hormones do the ovaries secrete?

A

Oestrogen and progesterone

211
Q

Where do the ovaries develop?

A

On the posterior abdominal wall

212
Q

Where is the ovum released into?

A

Ovum released into the peritoneal cavity !!

213
Q

How can you check the position of the uterus?

A

Bimanual palpation

214
Q

How can you feel the adnexae

A
  • place examining fingers into lateral fornix
  • press deeply with other hand in the iliac fossa of the same side
  • repeat on other side
  • can detect large masses or tenderness affecting these structures.
215
Q

Nerve supply to levator ani

A

“nerve to levator ani” S3, S4, S5 sacral plexus

216
Q

Nerve supply to the perineal muscles?

A

Pudendal nerve

217
Q

This is a bundle of collagenous and elastic tissue into which the perineal muscles attach - what is it call, why is it important and where is it located?

A
  • Perineal body
  • important to pelvic floor strength
  • located just deep to the skin
218
Q

Breast correlates to which ribs?

A

Ribs 2-6 !!!

219
Q

What is the retromammary space?

A

Lies between fascia and breast

220
Q

What does the breast lie on top of?

A

Lies on top of deep fascia covering pec major and serratus anterior

221
Q

Where does most breast lymph drain to?

A

Drains to ipsilateral axillary lymph nodes and THEN to supraclavicular lymph nodes!!

(problemz with upper limb also draining here etc)

222
Q

Where could lymph from the lower inner breast drain to?

A

Drain to the abdominal lymph nodes

223
Q

Where is the brachial plexus?

A

In the axilla

224
Q

Level I

A

Inferior and lateral to pectoralis minor

225
Q

Level II

A

Deep to pectoralis minor

226
Q

Level III

A

Superior and medial to pectoralis minor

227
Q

Incision for lower segment caesarian section

A

Suprapubic incision

228
Q

Layers of the anterolateral abdominal wall

A 
Skin
Superficial fascia
External oblique
Internal oblique
Transversus abdominus

Skin
Superficial fascia
Rectus sheath
Rectus abdominus

229
Q

Where does the external oblique attach?

A
  • lower ribs
  • iliac crest
  • pubic tubercle
  • linea alba
230
Q

Linea alba of external oblique, internal oblique and transversus abdominus?

A

Made from midline blending of aponeuroses

231
Q

Where does the internal oblique attach?

A
  • lower ribs
  • thoracolumbar fascia
  • iliac crest
  • linea alba
232
Q

Where does the transversus abdominus attach?

A
  • lower ribs
  • thoracolumbar fascia
  • iliac crest
  • linea alba
233
Q

How is the aponeuroses of the rectus abdominus made?

A

From the interweaving of the muscle aponeuroses

234
Q

Where do the rectus abdominus attach?

A

Xiphoid process and costal cartilage

Pubic bones

235
Q

Rectus sheaths above and below umbilicus?

A

Above umbilicus = anterior and posterior rectus sheath

Below umbilicus = anterior rectus sheath only

236
Q

Which layer would you find the ilioinguinal nerve?

A

In between the internal oblique and transversus abdominus

237
Q

The 7th-11th intercostal nerves become what?

A

The thoracoabdominal nerves

238
Q

Subcostal

A

T12

239
Q

Iliohyogastric

A

L1

240
Q

Ilioinguinal

A

L1

241
Q

Thoracoabdominal, subcostal, iliohypogastric and ilioinguinal nerves travel in which plane?

A

In between the iliohypogastric and ilioinguinal

242
Q

Superior epigastric arteries are a branch of which artery?

A

Internal thoracic

lie posterior to rectus abdominus

243
Q

Inferior epigastric arteries are a branch of which artery?

A

Branch of external iliac

lie posterior to rectus sheath

244
Q

The intercostal and subcostal arteries are continuations of which arteries?

A

Posterior intercostal arteries

245
Q

LSCS layers incised through

A 
Skin and fascia
Rectus sheath
Rectus abdominus
Fascia and peritoneum
Retract bladder
Uterine wall
Amniotic sac
246
Q

Layers to incise through during lapartomy

A

Skin and fascia
Linea alba
Peritoneum

247
Q

Why can a midline laparotomy be bad?

A

Relatively bloodless - increases chances of wound complications

248
Q

If you need a lateral port in a laparoscopy, what artery MUST you avoid?

A

MUST avoid inferior epigastric artery

249
Q

Route of the interior epigastric artery?

A
  • branch of external iliac
  • emerges just medial to the deep inguinal ring
  • then passes in a SUPEROMEDIAL direction posterior to the rectus abdominus
250
Q

Which incision would you use for an abdominal hysterectomy?

A

LSCS

251
Q

How can you tell if you are touching the ureter or the uterine artery

A

Ureter:

  • passes inferior to the artery
  • will “vermiculate” when touched
252
Q

Uterine “cramping” (e.g menstruation)

A

Hormonal (sympathetic/parasympathetic)

253
Q

Uterine contraction (e.g. during labour)

A

Hormonal (sympathetic/parasympathetic)

254
Q

Pelvic floor muscle contraction (e.g. during sneezing)

A

Somatic motor

255
Q

Pain from adnexae

A

Visceral afferents

256
Q

Pain from uterus

A

Visceral afferents

257
Q

Pain from the vagina

A 
Visceral afferents (pelvic part)
Somatic sensory (perineum)
258
Q

Pain from the perineum

A

Somatic sensory

259
Q

Pain sensation from superior aspect of pelvic organs/touching the peritoneum

A

Uterine tubes, uterus, ovaries

Visceral afferents carry the info!
These then run alongside the SYMPATHETIC fibres and enter the spinal cord between T11- L2
(pain perceived as suprapubic)

260
Q

Pain sensation from inferior aspect of pelvic organs/ not touching the peritoneum

A

Cervix and superior vagina

Visceral afferent also carry the info!
These run alongside the PARASYMPATHETIC fibres and enter the spinal cord at S2, S3, S4
(pain percieved as S2, S3, S4 dermatome i.e. the perineum)

261
Q

Pain sensation from structures ABOVE levator ani

A

Visceral afferents carry the infor
Parasympathetic
Levels S2, S3 and S4

262
Q

Pain sensation from BELOW levator ani

A

Inferior vagina
Perineal muscles
Glands
Skin

SOMATIC SENSORY !!!
Pudendal nerve
Spinal cord levels S2, S3 and S4
Localised pain with perineum

263
Q

The 2 most important spinal cord levels for pain from the repro system

A

T11-L2
and
S2-S4 (as in S2,S3,S4)

264
Q

Spinal cord becomes cauda equina at which level

A

L2

265
Q

Subarachnoid space ends at which level

A

S2

s for subarachnoid

266
Q

Where is the anaesthetic injected into for a spinal/epidural anaesthesia

A

Injected into subarachnoid space of L3-L5
=anaesthetises the cauda equina
no infection

(LP usually L3/L4 or L4/L5)

267
Q

Layers the needle is passed through for spinal anaesthetic

A 
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Finally reaches subarachnoid space (contains CSF)
268
Q

Layers needle is passed through for epidural

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)

269
Q

Sympathetic outflow leaves the spinal column in which levels?

A

T1 - L2

270
Q

All spinal nerves and their named nerves contain what?

A

They all contain sympathetic fibres

-including femoral, sciatic, obturator, pudendal

271
Q

There fibres supply all arterioles

A

Sympathetic

272
Q

Signs that spinal anaesthesia is working

A

Skin of lower limbs looks flushes
Warm lower limbs
Reduced sweating
(Hypotension)

Remember this is because you are blocking the sympathetic tone to all the arterioles in the lower limb :)

273
Q

Pudendal nerve is from which plexus

A

Branch of sacral plexus S2, S3, S4

274
Q

When might you consider a pudendal nerve block?

A

Useful for episiotomy incision, forceps use and perineal stitching post delivery

(anaesthetises majority of perineum)

275
Q

What is in the pudendal canal?

A

Pudendal nerve, artery and vein

Also the nerve to obturator internus

276
Q

Where could you find the nerve to obturator internus?

A

In the pudendal canal

277
Q

Which bony landmark can you use to administer pudendal nerve block?

A

Ischial spine

278
Q

During labour, the branches of which nerve can become stretched?

A

Pudendal nerve

279
Q

If your pudendal nerve is stretched in labour, which muscles could be weakened?

A

Levator ani and external anal sphincter

-this can result in weakened pelvic floor and faecal incontinence

280
Q

This incision is made into the relatively “safe” fat filled ischioanal fossa and avoids extending into the rectum

A

Epesiotomy

281
Q

The 3 parts of the levator ani

A
  • puborectalis
  • pubococcygeus
  • iliococcygeus
282
Q

Innervation of levator ani

A

Pudendal nerve

Nerve to coccygeus

3rd Year General Revision (17 decks)

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