Anatomy Flashcards
Pudendal nerve route
- in relation to pudendal artery
- Upward in *lateral wall of the ischiorectal fossa
- contained in a sheath of the obturator fascia termed the *pudendal canal.
- Medial to pudenal Artery
Adominal aorta divides into two common iliac vessels at which spinal level?
L4
Which ascending artery can be damaged during open appendicectomy?
Deep circumflex artery
When you hold the bony pelvis in anatomical position which two landmarks are at the same level horizontally?
Symphysis pubis (aka pubic tubercle) and ischial spine
(think ‘at spines’ etc)
To which fascia is levator ani attached
Obturator internus fascia
Facial nerve of the baby gets injured during vaginal delivery because _____?
The mastoid process is under developed
Path of the ureters at the sacroiliac joint
Pass anterior to bifurcation of common iliac artery at the sacroiliac joint
Structure enters inguinal canal and is identified easily at laparoscopy
Round ligament
What bony landmark identifies the level that the aorta bifurcates at?
Uppermost edge of iliac crest
Structure in lateral wall of the ischiorectal fossa
Obturator internus fascia
Muscles of the pelvic diaphragm
Levator ani and coccygeus
Nerve supply to posterior 2/3 of labia majora
Perineal nerve (branch of pudendal nerve)
Blood supply to rectus abdominis below umbilicus
Inferior epigastric artery
What structure is attached to the anterior superior iliac spine?
Inguinal ligament
Multiparous woman with prolapsed uterus has injury to what structures?
The cardinal and uterosacral ligaments
What kind of joint is the sacroiliac joint?
Synovial
The rectus muscle is supplied by which nerve below this umbilicus
Inferior epigastric nerve
Nerve supply to the vagina.
Lower
Autonomic - two plexi
Lower vagina: The deep perineal nerve (of the pudendal nerve)
Autonomic:
Pelvic splanchnic plexus
Lumbar splanchnic plexus
Lymphatic drainage of the cervix and vagina
Internal iliac, external iliac, obturator, and sacral LN
What is the narrowest portion of the Fallopian tube?
Isthmus
Main supporting ligament of the uterus?
Cardinal ligament
/ ‘transverse cervical ligament’
IVC drains on the left
Right ovarian vein and right renal vein drain to the right IVC
left ovarian vein drains to the left renal vein, which then drains to the left IVC
What surfaces is levator ani attached to?
Posterior aspect of pubic bone
Fascia of side wall of pelvis
Ischial spine
What is the nerve root of the ilioinguinal and iliohypogastric nerve
L1
(note iliohypogastric gets some fibres from T12)
What is the blood supply of Bartholin’s gland?
Deep external pudendal artery
Which muscles are cut during a mediolateral episiotomy?
Bulbospongiosus and superficial transverse perineal muscles
What is the nerve supply (name) to the skin of the rectum
Inferior rectal nerve
At what vertebral level is the umbilicus
L3/L4
What structure demarcates the external iliac artery and the femoral artery?
The inguinal ligament
The round ligament of the uterus develops from which embryonic structure? / Homologue of the round ligament in males?
Gubernaculum
The ureter crosses in front of the internal iliac artery at what level (structure)?
The sacroiliac joint
At what level (structure) is the ureter crossed by the uterine artery?
The level of the internal os
‘Relationship of femoral artery’
Femoral artery branches x6
Superficial circumflex iliac
Profunda femoris (go laterally)
Superficial epigastric (go medially:)
Superficial external pudendal
Deep external pudendal
Descending genicular
‘Anatomy of the breast’
?
What level does the aorta bifurcate at?
L4
What level does the common iliac divide at
S1
What is the lymph node of the uterus
Internal iliac lymph node
What nerve passes below the inguinal ligament, medial to the anterior superior iliac crest
Lateral cutaneous nerve of the thigh
Blood from the umbilical vein passes through which structure to enter the IVC
Ductus venosus
Pain in the medial side of the thigh due to ovarian irritation can be felt through which nerve
Obturator nerve
What is the pathway of the piriformis muscle?
Ventral/pelvic surface of sacrum
Greater sciatic notch
Greater trochanter of femur
What is the nerve supply (roots) of the pelvic part of Levator ani muscles
S3, S4
pudendal nerve
perineal nerve
inferior rectal nerve
All arise from S3/S4 spinal nerves mainly
Most common site for endometriosis
Ovary
Most common site for tubal ectopic
Ampulla
Which artery supplies the distal portion of the round ligament of the uterus?
The inferior epigastric artery
What do the medial umbilical folds in the anterior abdominal wall contain in adults?
Obliterated umbilical arteries
MeidaL is LateraL
Total abdominal hysterectomy, postoperative loss of flexion of hip and numbness over anterior and medial thigh. Compression of which nerve is responsible?
Femoral nerve
Which nerve or plexus provides sensory innervation to the cervix?
Pelvic splanchnic nerve (parasympathetic)
What structure separate the superficial perineal pouch from the deep perineal pouch?
Perineal membrane
‘The inferior fascial layer of the urogenital diaphragm’
(B SpR)
Which nerve arises from ventral rami of lumbar plexus and emerges from the medial border of psoas major muscle?
Obturator nerve
Which artery gives rise to the deep dorsal penile artery?
Internal pudendal artery
At what anatomical landmark does the abdominal aorta bifurcate?
Highest point of the iliac crest
Embryological origin, beginning and ending of the round ligament?
Gubernaculum ovarii
Anterioinferior to uterine cornua
Labia majora
What structure blocks blood supply to the loop of small intestine at the femoral ring causing strangulated femoral hernia?
Lacunar ligament
The deep circumflex artery is a branch of which artery?
External iliac artery
Which nerve pierces the internal oblique muscle and passes through the inguinal canal
ilioinguinal nerve
At what spinal level does the ovarian artery arise from the abdominal aorta?
L1
Which artery supplies the anorectal canal superior to the pectinate line?
Inferior mesenteric artery
What is the name of the structure that shunts oxygenated blood from the right to the left atrium in the foetus?
Foramen ovale
What is the anatomical location of Bartholin’s gland?
Superficial perineal pouch
The immediate layer around the oocyte of the tertiary follicle is known as the ____
Zona pellucida
For an ELCS, the obstetrician makes a transverse suprapubic incision. Which of the abdominal wall layers will not be encountered?
Posterior rectus sheath
A 35-year-old diabetic woman underwent vaginal surgery. Postoperatively, she has Loss of cutanous sensation over the anterior and lateral surface of the thigh. The compression of which nerve is likely to be responsible?
Lateral cutaneous nerve
Which artery supplies the structures derived from the midgut of the embryo?
Superior mesenteric artery
Medial umbilical folds represent remnants of which of the following structures?
Obliterated umbilical arteries
Motor fibers to detrusor muscle of the urinary bladder are derived from which of the following nerves?
Pelvic splanchnic nerves
Parasympathetic - peeing
S2-S4 (Pelvic splanchnic nerves)
Detrusor contracts and internal urethral sphincter relaxes
Which of the following muscles leaves the lesser pelvis through the greater sciatic foramen?
Piriformis
To reduce postoperative pain after caesarean section, an obstetrician performs ilioinginal-iliohypogastric nerve block (IINB) on his 25-year-old patient. What is the nerve root of ilioinguinal and iliohypogastric nerve?
L1
Where is the epidural space located?
Between the wall of vertebral cavity and dura mater
During a difficult delivery an obstetrician uses forceps to extract the infant. Upon examining the baby you notice forceps impressions posteroinferior to the ear. Which of the following is very likely to be damaged?
Facial nerve
A 36-year-old woman who had supraspinous ligament fixation 2 days ago complains of pain over right mons pubis, right labia, and the perineum. Which nerve is most likely to be injured?
Pudendal nerve
Following radical hysterectomy and pelvic lymphadenectomy for Stage I carcinoma of the cervix, 63-year-old woman reports
Numbness along the medial thigh and weakness of hip adduction. Which nerve has been injured?
Obturator nerve
[This answer is from the good 2018 paper]
At the ventouse cup application area, the baby’s head is left with a “chignon”. In which layer of the skull chignon is found?
Subcutaneous
When the body is in the upright position, the expected angle between the brim of the pelvis to the horizontal plane is
60 degrees
Which of the following nerves enters the thigh by passing beneath the inguinal ligament, just medial to the anterior superior iliac spine?
Lateral cutaneous nerve of the thigh
Lymphatics of the sigmoid colon drain into
Inferior mesenteric and pre-aortic lymph nodes
Which of the following structures passes through the lesser sciatic foramen
Tendon of the obturator internus
PINT: Pudendal nerve, Internal pudendal vessels, Nerve to obturator interns, Tendon of obturator internus (all contents)
Which anatomical structure is effected by Sheehans syndrome? (PPH, failure to breastfeed)
Anterior pituitary
What nerve passes over the anterior surface of the psoas major muscle?
Genitofemoral nerve
The ovarian artery is a branch of which artery?
Abdominal aorta
Which artery supplies the foregut derivatives of the digestive system?
Coeliac trunk
Ductus venosus is completely obliterated after birth to form what adult structure?
Ligamentum venosum
Which of the following is a remnant of the mesonephric duct in the female?
Found in the lateral wall of the vagina
Gartner duct
The paramesonephric ducts for the female reproductive organs
Which of the following arteries may occasionally arise as a branch of the external iliac artery or inferior epigastric artery instead of as a branch of the internal iliac artery?
Obturator artery
Which of the following structure consists of two bands of connective tissue and also support the bladder?
Pubocervical ligament
Transversus abdominis plane block for analgesia: Where is the local anaesthetic deposited?
Between the transversus abdominis muscle and the internal oblique muscle
Which nerve or nerve plexus provides sensory innervation to the cervix?
Pelvic splanchnic nerve
- Caput medusae are due to engorgement of which of the following vessels?
superficial epigastric veins
What type of joint is formed at the symphysis pubis?
Secondary cartilaginous
Attempted pudendal nerve block, but blood seen on drawing back prior to injecting anaesthetic. What vessel has been entered?
Internal pudendal
There is injury to a vessel during right lateral port insertion. This vessel is a branch of which artery?
External Iliac artery
(Injured vessel: deep circumflex artery)
What is the relation of nerve with femoral artery and vein from lateral to medial?
NAV
Dorsal artery of clitoris and deep artery of clitoris are a branch of?
Internal pudendal artery
What is the dermatome level at suprapubic incision
L1
What is the level of dermatome for epidural at umblical region ?
T10
What is the nerve supply of external anal sphincter ?
Inferior anal nerve
(Busy SpR)
Which structure in female is homologous to male prostate?
Skene’s gland
Area between the labia majora is defined as____?
The pudendal cleft
Pyramidalis is supplied by which nerve?
Subcostal nerve
Pain due to ovarion irritation can be felt through which spinal segment?
T10
During Laparoscopy structure is seen which is a remnant of Mesonephric duct
Epoophoron
Paramesonephric ducts form the female reproductive organs
During sacrospinous ligament fixation which artery and which nerve can be damaged?
inferior gluteal artery (busy SpR)
Pudendal nerve
Superior vesiclular artery is a direct branch from which artery?
Anterior division of Internal iliac artery
In renal transplant, kidney is anastomosed to
external iliac artery
Brachial plexus diagram - what structure does D represent
Median nerve
What anatomical space does the external urethral sphincter occupy?
Deep perineal pouch
What nerve is most commonly injured during gynaecological laparotomy ?
Femoral nerve
(Busy SpR)
What artery is the umbilical artery a branch of?
The anterior division of the internal iliac artery
How is the diagonal conjugate diameter measured?
From lower border of symphsis pubis to sacral promontory.
Person in lithotomy for 2 hours, develops foot drop, what nerve causes this?
Common perineal nerve
What artery is the inferior vesicular artery a branch of?
Anterior division of internal iliac artery
What structure does ligamentum arteriosus come from?
Ductus arteriosus
What is the direct arterial blood supply of decidua ?
spiral arteries
In a multiparous woman with prolapse, which muscle is most likely to be injured
Pubococcygeus
Pelvic floor =
Pubococcygeus
Ileococcygeus
(Ischio)coccygeus
Levator ani = pubocyccygeus (around vagina etc at front)+ ilicoccygeus (+puborectalis)
Identify the bone of the foetal skull
Parietal bone
Anterior to posterior:
Bones: Frontal, parietal, occipital
Sutures: coronal, saggital, lamboid
Between which bones is the coronal suture located?
Between frontal and parietal
Are there two umbilical veins or two umbilical arteries?
one umbilical vein; two umbilical arteries
Image of ectropion, what do arrows point to here?
Columnar epithelium
What artery is the appendicular artery a branch of?
Ileocolic artery
Superior mesenteric artery branches:
Ileocolic
Right colic
Middle colic
Deep perineal and dorsal clitoral nerve are branches of ___?
Internal pudendal nerve
Remnants of the embryological umbilical arteries become which two structures
- ligament (obliterated)
- artery (patent)
Medial umbilical ligament
Umbilical artery, which gives rise to the superior vesical artery
Sympathetic supply of bladder comes from which nerve?
Hypogastric nerve
Sympathetic
T10 - L2 ~ hypogastric nerve
Detrusor relaxation; storage
Where is the vestibule?
Between the two labia minora
Where is a femoral hernia
Femoral: inferior and lateral to pubic tubercle
Contrast: Inguinal: Superior and medial to the pubic tubercle
What are the nerve roots of the perineal nerve
S2, S3, S4
In Horseshoe Kidney what is the structure preventing the kidney to ascend from pelvis to abdomen?
Inferior mesenteric artery
What muscle is found in the scrotum?
Dartos muscle
What is the angle of the vagina to the horizontal plane while standing?
60 degrees
What is the origin of the obturator artery?
The internal iliac artery
vagina / uterine / middle rectal
inferior vesical / superior vesical / umbilical
obturator / inferior gluteal / internal pudendal
Posterior branches
ileolumbar / lateral sacral / superior gluteal
Muscles of internal sphincter derived from _____?
Circular muscle
NOT external anal sphincter etc.
Where does the inferior rectal vein drain?
Internal pudendal vein
What type of epithelium is found in Fallopian tubes?
Simple columnar
Remember columnar can be ciliated
How many cm is the anteroposterior diameter of the pelvic inlet?
11cm
What is velamentous insertion?
Umbilical insertion into the membranes
What is battledore insertion?
Insertion into the periphery of the placenta
What is the epithelium of the distal urethra?
Stratified squamous epithelium
What is the submentobregmatic diameter?
Define + length
~ top of head to occiput
9.5cm
What creates the dimple landmark in the gluteal region
Posterior superior iliac spine
Which ligament is used to repair prolapse?
Sacrospinous ligament
Placenta accreta case. Which vessel should you ligate prophylactically during caesarean hysterectomy?
Uterine artery
Woman bled 4 litres after vaginal delivery. The anastomoses between uterine artery and which artery should be ligated to stop bleeding?
Ovarian artery
What is the blood supply and lymphatics of the sigmoid colon? Does it have mesentery?
Yes has mesentery
Inferior mesenteric artery
Pre-aortic LN
Which abdominal artery may bleed when you do a lower transverse CS
pfannestiel: superficial epigastric artery
Transverse suprapubic: inferior epigastric vessels
(Busy SpR)
Each is the answer when the other isn’t one of 5 options available.
Ratio of uterus corpus to cervix
2:1
Where does the uterine vein drain to?
Where does the uterine artery branch from?
Internal iliac vein
Anterior division of internal iliac artery
Innervation of external urethral sphincter
Pudendal nerve S2-S4
Which muscle does not insert into the perineal body?
Ischiocavernosus
Laparoscopy image, arrow marking a structure
Ureter
What lymph node does the scrotum drain to?
Superficial inguinal LN
What is the nerve supply of iliacus muscle?
Femoral nerve
Joint which resist horizontal rotation of the pelvis?
(i.e. prevents anterior/posterior tilt
Sacroiliac
The external pudendal artery is a branch of
The femoral artery
The common hepatic artery is a branch of the
Celiac trunk
Right: hepatic artery
Left: left gastric and splenic arteries
Nerve supply of the bladder
Sympathetic
Parasympathetic
Sympathetic - hypogastric (T10-L2)
Parasympathetic - pelvic splanchnic nerve (S2,3,4)
~Ligament hanging down between the lobes of liver
Falciform ligament
What is the nerve supply of the internal anal sphincter?
Pelvic splanchnic nerves
IAS - pelvic splanchnic nerves
EAS - inferior rectal branch of pudendal n, and perineal branch of S4
Bulb of the vestibule is engorged with blood following stimulation of which nerve during sexual arousal?
Labial branch of the perineal nerve
Which nerve supplies the area over the femoral triangle?
GenitoFEMORAL
Busy SpR says ilioinguinal nerve
Direct and indirect hernias are separated by which vessels?
Inferior epigastric
Renal hilum anterior to posterior
Vein, artery, renal pelvis,
Which structures divides the paravesical spaces from the pararectal spaces
cardinal ligament
?and uterine artery
Which vulval structure does not contain paracrine glands
Mons pubis
Features of
Jejunum vs terminal ileum
Jejunum shorter, thick walled
Ileum longer, thin walled
The pectinate line (dentate line) distinguishes ?
divides the upper two-thirds and lower third of the anal canal.
Embryology: hindgut-proctodeum junction.
Which muscle is the sacral plexus situated behind?
Piriformis
What is the mediaN umbilical ligament/fold a remnant of?
The urachus
(which connects allantois and cloaca)
Sacrotuberous and sacrospinous ligaments prevent rotation in which direction (ant/post) and plane?
Prevent posterior rotation at horizontal plane of sacrum
What is the blood supply of the transverse colon
Middle colic artery
Branch of the superior mesenteric artery
Ileocolic
Right colic
Middle colic
What vessel does interventional radiologist place balloons in to minimise blood loss at placenta accreta caesarean?
Internal iliac arteries
