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MB3 Obstetrics and Gynaecology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what aspects of female reproductive tract are located in pelvic cavity

A

ovaries
uterine tubes
uterus
superior portion vagina

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2
Q

what aspect of female repro tract are located in perineum

A 
inferior vagina
perineal muscles 
bartholins glands 
clitoris 
labia
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3
Q

what two pouches does the inferior parietal peritoneum form in females

A

rectouterine pouch of douglas

vesicouterine

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4
Q

what pouch does the inferior parietal peritoneum form in males

A

rectovesical

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5
Q

what is the borad ligament of the uterus, what does it do and what does it contain

A

double layer peritoneu from uterus to lateral walls/floor pelvis
keeps uterus midline
contains prox broad ligament and uterine tubes

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6
Q

what is the round ligament of uterus, what does it attach

A

embryological remnant

lateral aspect uterus, through deep inguinal ring to superficial tissue perineum

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7
Q

most common uterine position

A

anteflexed
cervix tipped anterior to vagina
uterus tipped anterior to cervix

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8
Q

true/false - the most common uterine position is retroverted

A

false - it is normal variation however

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9
Q

during a cervical smear, what aspect of the cervix is smeared

A 
squamocolumnar junction (transition zone)
external cervical os sampled
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10
Q

the fact that the uterine tubes are open ended is clinically relevant for what 2 reasons

A

potential for ectopic pregnancy

potential for infection spread

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11
Q

sections of uterine tube?

A

infundibulum
ampulla
isthmus

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12
Q

what are the 4 fornix?

A

anterior
posterior
lateral right/left

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13
Q

nerve to levator ani has what nerve roots?

A

S3,4,5

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14
Q

surface anatomy of the perineum

A 
mons pubis 
labia majora 
labia minora 
clitoris 
external urethral meatus 
vaginal orifice 
vestibule 
anus
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15
Q

what do the greater vestibular glands secrete

A

lubricating fluid

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16
Q

what is the perineal body

A

bundle of collagenous and elastic tissue where perineal muscles attach
can be damaged by labour

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17
Q

what nerve innervates all muscles of perineum

A

pudendal

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18
Q

describe how the perineum can be diamond shaped and what triangles it is split into

A

diamond shaped with points from pubic symphysis to ischial spines, to coccyx
anal triangle and urogenital triangle

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19
Q

on what fascia does the breast lie

A

deep fascia of pec major and serratus anterior

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20
Q

what ribs do the breast extend from

A

2-6

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21
Q

what space is between breast and deep fascia

A

retromammary space

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22
Q

quadrants of the breast?

A 
upper outer
upper inner
lower outer
lower inner
axillary tail
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23
Q

if a lump is felt in breast and is fixed it is attached to

A

deep fascia

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24
Q

if a lump is felt in breast and is mobile it is attached to

A

breast tissue

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25
Q

lymph drainage of the breast

A

most are to ipsilateral axillary nodes then onto supraclavicular
inner quadrants can drain parasternal
lower can drain abdominal

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26
Q

if lymph nodes are removed due to breast cancer what upper limb condition can this cause and why

A

lymphoedema of upper limb as lymph from upper limb can also drain to axillary lymph nodes

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27
Q

level I axillary lymph nodes ?

A

inferolateral to pec minor

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28
Q

level II axillary lymph nodes?

A

deep to pec minor

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29
Q

level III axillary lymph nodes?

A

superomedial to pec minor

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30
Q

blood supply to breast

A

internal thoracic makes up most
lateral aspect supplied by
thoracic, thoracoacromial, lateral mammary branches by posterior intercostals

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31
Q

venous drainage from breast

A

axillary vein mainly but also internal thoracic

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32
Q

functions of the pelvic floor

A

seperates pelvic cavity from perineum
supports organs
continence

33
Q

what is the urogenital hiatus

A

gap in pelvic diaphragm to allow passage of urethra and vagina

34
Q

segments of levator ani and nerve innervation

A

iliococcygeus
puborectalis
pubococcygeus

35
Q

levator ani attachments

A

ichial spines, pubic bones, tendinous arch levator ani
perineal body, coccyx, walls of midline organs
nerve to levator ani and pudendal nerve

36
Q

what is endopelvic fascia

A

loose tissue with collagen and elastic fibres

37
Q

what ligaments support organs within perineum

A 
fibrous endopelvic fascia 
uterosacral
transverse cervical/cardinal
lateral ligament of bladder
lateral rectal ligaments
38
Q

what is the deep perineal pouch

A

lies below fascia covering inferior pelvic diaphragm

above perineal membrane

39
Q

what structures are found in the deep perineal pouch

A

part of urethra and vagina
bulbourethral glands (M), neurovascular bundle for penis/clitoris
extension of ischioanal fat pads

40
Q

what muscles are found in deep perineal pouch

A

external urethral sphincter
compressor urethrae
deep transverse perineal muscle in men
smooth muscle to replace DTPM in females

41
Q

what is the perineal membrane

A

superficial to deep perineal pouch and thin sheet of tough deep fascia

42
Q

contents of the superficial perineal pouch in females

A 
corpus cavernosum - clitoris and crura - erectile 
bulbs of vestibule 
bulbospongiosus and ischiocavernosus 
bartholins glands 
superficial transverse perineal muscle 
pudendal nerve and vessels
43
Q

contents of the superficial perineal pouch in males

A

root of penis
corpus spongiosum, corpus cavernosum
bulbospongiosus
ischiocavernosus

44
Q

perineal support from deep to superficial

A 
pelvic diaphragm 
deep perineal pouch
perineal membrane
erectile tissue superficial perineal pouch
muscles superficial perineal pouch
45
Q

what links layers of perineal support

A

perineal body

46
Q

muscles maintaining urinary continence?

A

external urethral sphincter, compressor urethrae, levator ani

47
Q

muscles maintaining faecal continence?

A

tonic contraction of puborectalis beds anorectum anterior

active contraction after rectal filling

48
Q

cause of injury to pelvic floor?

A 
pregnancy 
childbirth 
constipation 
obesity 
heavy lifting 
chronic cough 
previous injury 
menopause
49
Q

what is a vaginal prolapse

A

herniation of urethra, bladder, rectum or rectouterine pouch through fascia

50
Q

what is a uterine prolapse

A

descent of cervix/uterus to vaginal wall

51
Q

1st degree uterine prolapse

A

cervix dropping to vagina

52
Q

2nd degree uterine prolapse

A

cervix drops deeper to vagina but not external

53
Q

3rd degree uterine prolapse

A

cervix visible from external and uterus telescoped into vagina

54
Q

4th degree uterine prolapse

A

entire uterus present externally

55
Q

mechanism of repair for uterine prolapse?

A

sacrospinous fixation

risks injury to sciatic nerve or pudendal NV bundle

56
Q

what surgery can be given for incontinence

A

transobturator mesh surgery

very controversial

57
Q

attachments of the sacrospinous ligament

A

sacrum

ischial spine

58
Q

attachments of the sacrotuberous ligament

A

sacrum

ischial tuberosity

59
Q

what foramen do the sacrospinous/sacrotuberous ligaments form

A

greater/lesser sciatic foramen

60
Q

what covers the obturator foramen

A

obturator membrane, with gap for obturator NV bundle

61
Q

tendinous arch of levator ani is made up of what muscle

A

obturator internus

62
Q

what is the main arterial supply to the pelvis and what are the main exception

A

internal iliac
gonadal arteries direct from abdo aorta
superior rectal as continuation of IMA

63
Q

what are the two main anastomoses in females in the pelvis

A

uterine artery and ovarian artery

uterine artery and vaginal artery

64
Q

what does the posterior division of internal iliac supply

A

body wall

blood to gluteal arteries

65
Q

what is the significance of the median umbilical ligament

A

embryological remnant of the umbilical artery which supplied foetus with blood during pregnancy

66
Q

what are the main divisions of the anterior division of the internal iliac

A 
obturator artery
superior vesicle arteries 
uterine artery/vas deferens 
internal pudendal artery 
middle rectal
67
Q

branches of internal pudendal in females and what else contributes to blood supply to perineum

A

inferior rectal
dorsal artery clitoris
perineal artery
external iliac

68
Q

branches of internal pudendal in males

A

perineal artery
deep artery
dorsal artery penis
anterior scrotal - from external iliac

69
Q

true/false - hysterectomy can often lead to damage of the ureter

A

true

70
Q

what vein does most perineal blood drain to

A

internal iliac

71
Q

what are the 2 plexuses that perineal blood can drain to that is of clinical relevance

A

via superior rectal to hepatic portal
lateral sacral into internal vertebral venous plexus
can be clinically relevant in metastatic disease

72
Q

nerve roots of obturator nerve and passage through gluteal/perineal area

A

L2-4

passes on extraperitoneal fatty tissue and into medial thigh by obturator membrane

73
Q

nerve roots of pudendal nerve and passage through gluteal/perineal area

A

S2-4

passes through greater sciatic foramen, loops round sacrospinous and back through lesser sciatic foramen

74
Q

main groups of lymph nodes associated with the pelvis

A 
lumbar 
inferior mesenteric 
common iliac
internal/external iliac 
superficial/deep inguinal 
sacral 
pararectal
75
Q

where do the ovaries/testes lymph drain to

A

lumbar nodes as per embryological origin

76
Q

where does superficial perineal lymph drain to

A

superficial inguinal

77
Q

where does superior pelvic viscera lymph drain to

A

external iliac nodes, to common iliac, to aortic and to thoracic duct

78
Q

where does lower pelvic viscera lymph drain to

A

internal iliac nodes, common iliac, aortic, thoracic duct

79
Q

what is transperitoneal spread of malignancy

A

disease penetration of peritoneal layer, leading to dissemination of disease in the peritoneal cavity

MB3 Obstetrics and Gynaecology (12 decks)

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