Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Part 1 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Vertebral levels: T2, T5, T9, L1, L3, L4, S2

A

Suprasternal notch - T2
Angle of Louis - T5
Xiphoid - T9

Transpyloric plane of Addison - L1 - one hand width beneath xiphoid, crosses pancreatic neck, duodenojejunal flexure, fundus of gallbladder, tip of 9th costal cartilage, renal hilum
- where the spinal cord terminates

(umbilicus around L3-5, dermatome is T10)

Subcostal plane - L3 (bottom of 10th rib)
Iliac crest plane - L4 - bifurcation of aorta
Posterior superior iliac spines - S2 - termination of dural sheath, posterior superior iliac spines, see dimple above buttocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

McBurney’s point
Palmer’s point

A

McBurney - 2/3 of the way from umbilicus to ASIS on right

Palmer - 2/3 of the way from umbilicus to point of intersection between midclavicular line and costal margins of 9th rib - used as laparotomy entry point if v obese or v thin, or midline adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Arcuate line of Douglas

A

Where inferior epigastric vessels enter rectus sheath, where posterior rectus sheath terminates
Halfway between umbilicus and pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Linea alba

A

Fusion of abdominal muscle aponeuroses
Stretches from xiphoid to pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fascia of abdomen

A

Fatty layer of Camper
Deep fibrous layer of Scarpa - blends with deep fascia of upper thigh, in perineum becomes Colles’ fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muscles of anterior abdominal wall

A

Rectus abdominus
- originate at 5-7th costal cartilage
- insert at pubic crest
- tendinous insertions on anterior rectus, superior epigastric vessels pierce at these sites

External oblique
- originate at outer surface of lower 8 ribs
- insert at xiphoid, linea alba, pubic crest, pubic tubercle, ant half of iliac crest
- innervate by ant primary rami of T7-12

Internal oblique
- originate at lumbar fasciae, ant 2/3 iliac crest, lateral 2/3 inguinal ligament
- insert at lower 6 costal cartilages, linea alba, pubic crest
- innervate by ant primary rami of T7-12

Transversus abdominus
- originate at lower 6 costal cartilages, lumbar fascia, ant 2/3 iliac crest, lateral 2/3 inguinal ligament
- insert at linea alba and pubic crest
- innervate by ant primary rami of T7-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Muscles of posterior abdominal wall

A

Psoas major
- originate at transverse process of lumbar vertebrae
- insert at lesser trochanter of femur
- innervate by ant primary rami of L1/2, acts as hip flexor

Psoas minor
- originate at bodies of T12/L1
- insert at ileopectineal eminence
- lies on psoas major, absent in 40%

Iliacus
- originates at upper 2/3 inner iliac crest
- inserts at lateral side of psoas major tendon
- innervation by femoral nerve, acts as hip flexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inguinal canal

A

Contains round ligament of uterus (or spermatic cord) and ilioinguinal nerve

Parallel and above inguinal ligament
- which runs from ASIS to pubic tubercle, aponeurosis by external oblique

Internal ring
- on transversalis fascia, midpoint of IngLig, medially demarcated by inferior epigastric vessels

External ring
- V shaped defect in external oblique aponeurosis
- above and medial to puic tubercle

BORDERS
- superior - internal oblique, transversus abdominus
- inferior - inguinal lig
- anterior - skin, fascia, oblique aponeurosis, internal oblique
- posterior - conjoint tendon (fusion of IO and TA), transversalis fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spermatic cord

A

3 fascial layers
- external spermatic (external oblique aponeurosis)
- cremasteric (internal oblique)
- internal spermatic (transversalis fascia)

3 arteries
- testicular (from aorta)
- vas (from inf vesicle)
- cremasteric (from inf epigastric)

3 nerves
- ilioinguinal
- cremasteric (from genitofemoral)
- sympathetic

3 others
- vas deferens
- pampiniform plexus
- lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Femoral triangle contents

A

Femoral nerve, artery, vein
Deep inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Femoral triangle boundaries

A

Lateral - sartorius

Medial - adductor longus

Superior - inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Femoral sheath

A

From extraperitoneal intra-abdominal fascia
Anterior - transversalis fascia
Posterior - iliacus fascia

Contains femoral canal, femoral artery, femoral vein
NOT femoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Femoral ring

A

Entrance to femoral canal
Oval, larger in females
Contains fat and lymph node (Cloquet’s)

Anterior - inguinal ligament
Medial - lacunar ligament
Posterior - pectineus, pectineal fascia, Astley Cooper ligament
Lateral - femoral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lacunar ligament

A

= Gimbernat’s ligament
Part of the aponeurosis of external oblique, reflected back and lateral, attached to pectineal line of pubis
Medial wall of inguinal canal
Larger in males
Posterior margin - pectineal ligament
Anterior margin - inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adductor canal

A

= Subsartorial / Hunter’s
Aponeurotic tunnel in middle 3rd of thigh
Apex of femoral triangle to adductor hiatus
Contains femoral vessels and saphenous nerve

Anterior/lateral boundary - vastus medialis
Posterior - adductor longus and magnus
Sartorius muscle lies on aponeurosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hesselbach’s triangle

A

Aka inguinal triangle, site of direct inguinal hernia

Lateral - inferior epigastric artery
Medial - rectus abdominus
Inferior - inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Peritoneal cavity

A

Primitive coelomic cavity of embryo
Serous lined
Closed in male

Lesser sac - cavity formed by lesser and greater omentum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epiploic foramen

A

= foramen of Winslow
entrance to lesser sac

Superior - caudate lobe of liver
Anterior - free border of lesser omentum
Inferior - 1st part duodenum, hepatic artery
Posterior - inferior vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lesser omentum

A

= gastrohepatic omentum
Double layer peritoneum from liver to lesser curvature of stomach

4 ligaments - hepatogastric, hepatoduodenal, hepatophrenic, hepato-oesphageal

Free border of lesser omentum contains portal vein, common bile duct, hepatic artery (enclosed in Glisson’s capsule)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Greater omentum

A

= gastrocolic omentum
Peritoneum fold from stomach to posterior abdominal wall, encasing transverse colon

Duodenum on right
Gastrolineal ligament on left
Right and left gastroepiploic vessels supply

4 ligaments - gastrocolic, gastrosplenic, gastrosphenic, splenorenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ligaments in peritoneal cavity

A

Umbilical ligaments
- mediaN (urachus, embryological remnant of allantois)
- mediaL (embryological remnant of umbilical artery)
- lateral (overlies inferior epigastric artery)

Falciform ligament - umbilicus to liver

Ligamentum teres - remnant of umbilical vein, passes between quadrate and left liver lobes, attaches to free border of falciform ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intraperitoneal fossae

A

4
Lesser sac
Intersigmoid
Paraduodenal (between duodenojejunal junction and inferior mesenteric vessels)
Retrocaecal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Subphrenic spaces

A

5
Subphrenic - R and L, divided by falciform ligament
R subhepatic (Morison’s)
L subhepatic (lesser sac)
R extraperitoneal (between bare area of liver and diaphragm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ileopectineal eminence

A

Point of fusion between pubis and ilium
Lateral to this, 2 muscles pass in a groove (iliacus and psoas major)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acetabulum

A

Fusion point of the 3 innominate bones of pelvis: ilium, ischium, pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sacrum

A

5 fused vertebrae, triangular
Sacral promontory is anterior border of sacrum
Ala (wings) laterally, form the anterior and posterior foramina

Sacral hiatus transmits the 5th sacral nerve

Dural sheath terminates at S2, beyond this sacral canal contains - fatty tissue of extradural space, cauda equina, filum terminale

(+ coccyx is 3-5 fused vertebrae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pelvic joints

A

Symphysis pubis - secondary cartilagenous

Sacroiliac - synovial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pelvic brim boundaries

A

Pectineal line
Arcuate line
Sacral promontory
Upper margins of symphysis pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pelvic outlet boundaries

A

Pubic arch (ischiopubic rami)
2x sciatic notch
Coccyx

(diamond shape)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Greater sciatic foramen

A

Superior - sacroiliac ligament
Posteromedial - sacrotuberous ligament (sacrum to ischial tuberosity)
Inferior - sacrospinous ligament (ischial spine to sacrum)
Anterolateral - greater sciatic notch

Divided from lesser sciatic by sacrospinous ligament

Contains:
- Sciatic and pudendal nerves
- Superior gluteal artery, vein and nerve
- Inferior gluteal artery, vein and nerve
- Posterior femoral cutaneous nerve, nerve to obturator internus, nerve to quadratus femoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Lesser sciatic foramen

A

Anterior - ischial tuberosity
Lateral - lesser sciatic notch
Posterior - sacrotuberous ligament
Superior - sacrospinous ligament

Contains:
- Internal pudendal artery and vein
- Pudendal nerve (first leaves the pelvis via the greater sciatic foramen, and then re-enters via the lesser sciatic foramen)
- Obturator internus tendon
- Nerve to obturator internus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Male vs female pelvis

A

Male - large acetabulum, round obturator foramen, inturned ischial tuberosity, heart shaped pelvic inlet, long pelvic canal, small pelvic outlet, acute pubic rami angle, long and narrow sacrum

Female - small acetabulum, oval obturator foramen, everted ischial tuberosity, oval pelvic inlet, short pelvic outlet, wide pubic rami angle, 4 knuckle ischial tuberosity angle, short and wide sacrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pelvis measurements

A

Plane of inlet 60deg to horizontal

Transverse outlet = distance between ischial tuberosities
- 12.7cm at inlet, 11.5cm at mid, 10cm at outlet

Oblique outlet = midpoint of sacrotuberous ligament to junction of opposite ischial and pubic rami
- 11.5cm at inlet, mid and outlet

Anteroposterior outlet = from midpoint of pubic symphysis to apex of coccyx
- 10cm at outlet, 11.5cm at mid, 12.7cm at inlet

(INVERT TRANSVERSE AND AP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Piriformis

A

Origins - ant sacrum, greater sciatic foramen, ant surface of sacrotuberous ligament

Insertion - greater trochanter of femur

  • exits pelvis via greater sciatic foramen
  • pierced by common peroneal nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Obturator internus

A

Origins - med surface of obturator membrane, ischium, pubis

Insertion - greater trochanter of femur

  • exits pelvis via lesser sciatic foramen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Obturator externus

A

Origins - obturator membrane, obturator foramen

Insertion - greater trochanter of femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pelvic fasciae and ligaments

A

Pelvic fascia -connective tissue covering of pelvis, inc fascia of levator ani and obturator internus

Endopelvic fascia - extraperitoneal tissue of uterus (parametrium), vagina, bladder, rectum
- gives rise to 3 sets of ligaments which support cervix and vaginal vault, are lengthened in pelvic floor prolapse
– cardinal - laterally from cervix and upper vagina to pelvic side wall along line of insertion of levator ani, pierced by ureters, ACROSS/DIAGONAL
– uterosacral - from posterolateral aspect of cervix at level of isthmus, to periosteum of sacroiliac joints and lat part of S3, encircling the POD, BACK
– pubocervical (from cardinal ligaments to pubis) UP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pelvic floor

A

PELVIC DIAPHRAGM
Levator ani
- origins - post aspect of pubic bone, fascia of pelvic side wall, ischial spine
- insertion - perineal body, anal sphincter, coccyx, median fibrous raphe
- forms levator prostate, sphincter vaginae, puborectalis, pubococcygeus, iliococcygeus
Coccygeus
- origins - sacrospinous ligament, ischial spine
- insertion - coccyx

+ superficial muscles of perineum, forming the anterior (urogenital) triangle and posterior (anal) triangle, separated by line across ischial tuberosities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Perineal membrane

A

Covers urogenital triangle, pierced by urethra and vagina

Deep perineal pouch
- between perineal membrane and levator ani fascia
- contains external urethral sphincter, deep transverse perineal muscle, and bulbourethral (Cowper’s) glands

Superficial perineal pouch
- between perineal membrane and perineal fascia (Colles’)
- contains superficial perineal muscles, bulbospongiosus, ischiocavernosus, Bartholin’s glands (greater vestibular), crura of clitoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Perineal body

A

Fibromuscular node at midline of junction anterior posterior perineum
Point of attachment for external anal sphincter, bulbospongiosus, transverse perineal muscles, levator ani

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Posterior / anal triangle

A

Between ischial tuberosities and coccyx

Contains:
Levator ani
Anus
Ischiorectal fossa
- lobulated fat, anus, ext anal sphincter (attach to perineal body, coccyx and puborectalis, Alcock’s canal
- fossae on either side communicate behind the anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Stomach

A

J shape
Body secretes pepsin and HCl (oxyntic cells)
Pyloric antrum secretes alkaline juices and gastrin
- incisura angularis marks junction between body and antrum
- vein of Mayo marks the junction between pylorus and duodenum

Sphincters at cardia and pylorus

Borders
- anterior - left costal margin, diaphragm, left lobe liver
- posterior - lesser sac, pancreas, transverse mesocolon, spleen, splenic artery, left kidney + suprarenal gland
- superior - left dome diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Blood supply of stomach

A

COELIAC AXIS
Left gastric

Splenic
- short gastric
- left gastroepiploic

Hepatic
- right gastric
- cystic
- gastroduodenal
- - right gastro-epiploic
- - superior pancreatoduodenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Lymphatic and nerve supply of stomach

A

LYMPH
Area 1 - superior 2/3 stomach - direct to aortic nodes
Area 2 - right side of inferior 1/3 - via subpyloric node to aortic nodes
Area 3 - left 1/3 of inferior 1/3 - via suprapancreatic node to aortic nodes

NERVE
- vagus and posterior nerve of Latarjet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Duodenum

A

C shaped, 25.5cm
Initial 2.5cm covered by peritoneum, then is retroperitoneal

4 parts:
1st - 5cm long; liver and gallbladder anterior; IVC, portal veins, CBD, GD artery posterior
2nd - 7.5cm long; curves around head of pancreas
- contains major duodenal papilla aka ampulla of Vater (opening of major panreatic duct and CBD); minor duodenal papilla (opening of accessory panceatic duct); and sphincter of oddi
3rd - 10cm long; transversely to left; SMA and mesenteric root anterior, IVC, aorta and L3 posterior
4th - 2.5cm long

Superior pancreatoduodenal artery (branch of coeliac), and inferior pancreatoduodenal artery (branch of SMA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Duodenojejunal junction

A

L2
Ligament of Treitz identifies
= peritoneal fold from right crus of diaphragm, containing smooth and skeletal muscle fibres

Inferior mesenteric vessels descend from behind pancreas immediately to left of junction

Mesentery starts here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Small intestine

A

3-10cm long, with valvulae conniventes

Mesentery - 15cm long, starts at duodenojejunal junction (L2) and ends at right sacroiliac joint

Jejunum vs ileum
- J thicker, larger diameter, in umbilical region
- I has thicker mesentery with more fat, more arcades formed from vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Large intestine segments and length

A

Caecum (+ appendix)
Ascending colon - 20cm
Transverse colon - 45cm
Descending colon - 25cm
Sigmoid - 12cm
Rectum - 12cm
Anal canal - 4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Features of large intestine

A
  • Appendices epiploicae (fat filled peritoneal tags) - except appendix, caecum, rectum
  • Taenia coli - 3 flattened bands from appendix to rectosigmoid junction
  • sacculations
  • goblet cells and no villi in mucosa
  • Meissner’s submucosal nerve plexus, Auerbach’s muscular layer nerve plexus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Peritoneal coverings of large intestine

A

Peritonised - transverse colon and sigmoid

Non-peritonised - ascending and descending colon

Inconsistent - caecum and appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Rectum

A

From S3, to lower 1/4 vagina or apex of prostate

Peritoneal covering at upper 1/3 posterior, middle 1/3 posterior/lateral, entire lower 1/3

3 lateral inflexions (left right left), valves of Houston at each inflexion

Denonvillier’s fascia separates rectum from anterior structures
Levator ani on either side laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Anal canal

A

Upper half - columnar epithelium with columns of Morgagni
- superior rectal vessel (if these dilate get haemorrhoids)
- lumbar nodes
Valves of Ball separates this junction (pectinate line)
Lower half - squamous epithelium
- inferior rectal vessel
- inguinal nodes

Anteriorly perineal body, posteriorly coccyx, laterally ischiorectal fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Appendix

A

= vermiform appendix
- connected to caecum posteriomedially
- base is 2.5cm below ileocaecal valve
- ileocolic artery supplies
- 2 folds of peritoneal attachment - ileocaecal fold and appendix mesentery (containing ileocolic artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Portal vein system

A

Drains from alimentary tract (not anus) to liver
- IMV joins splenic at L3
- SMV joins splenic at L1 behind neck of pancreas, giving rise to portal vein
- portal vein then divides into L and R

Collaterals between portal and systemic venous systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Meckel’s diverticulum

A

Remnant of vitello-intestinal duct (communication between midgut and yolk sac)

2% prevalence
2:1 more in males
2inches (5cm) long
2ft (61cm) from ileocaecal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Liver

A

Largest organ, 4 lobes (right, left, ant quadrate and post caudate)

Contains falciform ligament, ligamentum teres (left umbilical vein remnant), ligamentum venosum (ductus venosum remnant)

Lesser omentum from porta hepatis (containing bile duct, portal vein, hepatic artery) and ligamentum venosum

3 veins - left, right, central
3 arteries - left, right, cystic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Biliary system

A

GALLBLADDER (holds 50ml bile, columnar epithelium, separates R and quadrate lobes of liver)

into CYSTIC DUCT (3.8cm long)

Merges with COMMON HEPATIC DUCT (fusion of right and left ducts, 3.8cm long)

to form COMMON BILE DUCT (10cm long)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Pancreas

A

Retroperitoneal
Endocrine and exocrine
Supplied by splenic and pancreatoduodenal arteries

Anterior - stomach, lesser sac
Posterior - left kidney + gland, diaphram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Development of pancreas

A

Ventral bud - smaller, forms part of head and uctinate process
- drained by duct of Wirsung (major pancreatic duct)

Dorsal bud - larger, forms body, tail, and part of head and uctinate process
- contains accessory duct of Santorini (accessory pancreatic duct, non functional)

60
Q

Islets of Langerhans secrete…

A
  • glucagon from alpha cells
  • insulin from beta cells
  • somatostatin from delta cells
  • pancreatic polypeptide from F cells
61
Q

Splenic ligaments

A

Intraperitoneal

Gastrosplenic ligament to greater curve of stomach, containing short gastric and left gastroepiploic artery
Lienorenal ligament to posterior abdominal wall, containing splenic artery and tail of pancreas

62
Q

Kidney

A

Retroperitoneal
R slightly lower than L
Supplied by sympathetic nerve fibres

3 capsules - renal fascia, perinephric fat, true capsule
- renal fascia blends with diaphragm above, IVC and aorta medially, transversalis fascia laterally, ureteric tracts inferiorly
- suprarenal glands NOT in the renal fascia

63
Q

Ureters

A

25cm long, valveless

Pass anterior to medial edge of psoas major, cross into pelvis at bifurcation of common iliac A in front of SI joint. On lateral wall of pelvis in front of internal iliac A and under uterine A.
Cross into bladder at level of ischial spine.
Pierce the cardinal and broad ligaments.

64
Q

Bladder

A

Extraperitoneal
(intra-abdominal in children <3yo)
Ureteric orifices 2.5cm apart
Trigone is triangular area bounded by ureteric orifices and internal meatus

65
Q

Urethra

A

3.8cm long in females
25cm long in males - 3 portions including prostatic, membranous, spongy

Spiral grooves inside
Mucus containing urethral glands.
Epithelium - transitional near bladder, stratified columnar in middle, then stratified squamous near external urethral orifice

66
Q

Urethral sphincter

A

Internal - at junction of urethra and bladder
- smooth muscle (continuation of detrusor)
- autonomous sympathetic control from inferior hypogastric plexus
- not anatomically distinct in females, in males it prevents retrograde ejaculation

External - at junction of urethra and bladder in females, and after prostate in males
- skeletal muscle
- voluntary control via perineal branch of pudendal nerve

67
Q

Scrotum

A

Contains median longitudinal raphe, sebaceous glands, dartos muscle
Divided into 2 sacs
2.5 degrees cooler than body temperature

68
Q

Epididymes

A

Efferent ductules in from testes
Head, body, tail
6m long
Lined by ciliated epithelium
Passage of sperm through takes 8-14days

69
Q

Vas deferens

A

From epididymis to seminal vesicles in spermatic cord
45cm long - similar length to femur/spinal cord
Ejaculatory ducts connect to urethra

70
Q

Seminal vesicles

A

Irregular shaped sacs between bladder and rectum
5cm long
Reservoir for and secrete nourishing fluid for sperm

71
Q

Testes structure

A

L lower than R
3 layers - tunica vaginalis, albuginea, vasculosa

Sertoli cells - spermatozoa
Leydig cells - testosterone

Divided into 300 lobules, each containing 1-3 seminiferous tubules, each tubule 60cm long

72
Q

Seminiferous tubules

A

Make up lobules of testes, 90%
Anastamose at rete testes (way into epididymis)
Lined with germinal epithelium
Basement membrane acts as blood barrier

73
Q

Vascular/lymph/nerve supply of testes

A

Testicular artery (branch off aorta) anastamoses with vas artery (branch of inferior vesical, off external iliac)

Lymph drainage via para-aortic nodes, and cervical nodes

Nerve supply via T10

74
Q

Cells of testes

A

Sertoli
- WITHIN seminiferous tubules
- nourish spermatozoa
- produce inhibin and oestrogen
- contain FSH receptors

Leydig
- BETWEEN seminiferous tubules
- produce testosterone
- contains LH receptors

75
Q

Development of testes

A

3 month - reach iliac fossa
7 months - traverse inguinal canal
8 months - at external ring
9 months - descend into scrotum

Appendix testes is remnant of paramesonephric duct
Appendix epididymis is remnant of mesonephros

76
Q

Prostate

A

3x4cm, pyramidal
Between bladder neck and external urethral sphincter
Two capsules - true capsule, false capsule (extraperitoneal fascia - which continues with bladder and Denonvillers’ fascia)
Blood supply by inferior vesical artery
Prostatic plexus lies between 2 capsules, from dorsal vein of penis and then drains into internal iliac vein and valveless vertebral veins of Batson

77
Q

Labia majora

A

Analogous to scrotum
Hair bearing skin, sebaceous glands, smooth muscle (tunica Dartos), and nerve endings
Insertion point of round ligament

Nerve supply - iliohypogastric (L1), ilioinguinal (L1), genitofemoral (L1-2), posterior femoral cutaneous (S1-3), pudendal nerve (S2-4)

78
Q

Labia minora

A

Hairless skin folds
Give rise to prepuce, frenulum, fourchette
Contain sweat and sebaceous glands

Encloses the vestibule, which contains urethral and vaginal orifice
- blood supply by azygous A of vagina and pudendal A

79
Q

Clitoris

A

Erectile tissues
Glans, shaft attached to pubis, and paired crura attached to inferior pubic rami

Ischiocavernosus muscles overlie crura, orginate from ischial tuberosity
Bulbospongiosus muscles originate from perineal body, insert into clitoral shalft and overlies vestibular bulb and Bartholin’s glands

80
Q

Bartholin’s glands

A

Paired pea-sized, lying between perineal membrane and bulbospongiosus muscle at tail end of vestibular bulb, deep to posterior labia majora
At 5 and 7 o clock positions between hymen and labium minus

Remnants of hymen are carunculae myrtiformes

81
Q

Vagina

A

Anterior wall 7.5cm, posterior wall 10cm - proportional to height
NO glands. Kept moist by cervical glands and seepage of fluid from blood capillaries
- vaginal fluid pH 4, high K low Na, but alkaline for 6hrs post coitus
- Doderlein’s bacilli converts glycogen to lactic acid

Only posterior upper 1/4 is covered by peritoneum
Ureters above and lateral to fornix, 1.5cm from cervix

4 layers in the wall - inner squamous epithelium in arbour vitae folds, connective tissue, muscular layer (inner circular and outer longitudinal), connective tissue

82
Q

Blood and lymphatic supply of vagina

A

Blood supply from (sup to inf) uterine, vaginal, internal pudendal arteries - all branches of internal iliac

Upper 1/3 - lymph to external and internal iliac nodes
Middle 1/3 - internal iliac nodes
Lower 1/3 - inguinal nodes

Sacral plexus nerve supply

83
Q

Uterus

A

50g in P0, 70g in multip, 1kg at term
Flexion at level of internal os, to ante or retroflex, usually 170degrees
Ante or retroversion at axis of cervix on vagina, usually 90degrees

Endometrium - functional and basal layer
Myometrium - inner circular, middle oblique, outer longitudinal
Primetrium = peritoneum

84
Q

Supply to uterus

A

Nerve - sacral plexus

Blood
- basal layer - straight arterioles
- functional layer - spiral arterioles

Lymph
- fundus via round ligament to inguinal node, and via ovarian vessel to para-aortic node
- body via broad ligament to external iliac node

85
Q

Cervix

A

Supravaginal epithelium - columnar
Vaginal epithelium - stratified squamous

Mucosa has arbour vitae ridges, spinnbarkeit (stretchy) mucus

Lymph drainage
- lateral via broad ligament to external iliac node
- posterolateral via uterine vessels to internal iliac node
- posterior via sacral node

86
Q

Uterine changes in pregnancy

A

Lower segment formed 70% isthmus, 30% cervix
Retraction to shorten upper segment

Decidua is endometrium under influence of progesterone, high glycogen content, produces prolactin and insulin-like growth factor

25mmHg pressure can cause cervical dilatation. Braxton Hicks can be as early as 8w.

87
Q

Fallopian tubes

A

10cm long, isthmus, ampulla, infundibulum, fimbriae

4 layers
- ciliated columnar epithelium
- inner circular muscle
- outer longitudinal muscle
- peritoneum

Nerve supply via ovarian plexus

88
Q

Uterine ligaments

A

Broad ligaments - double fold of peritoneum

Round ligaments - from cornua to labia majora

Cardinal ligaments - from cervix to lateral wall of pelvic cavity

Uterosacral ligaments - from cervix to periosteum of sacrum

Pubocervical ligaments - from cervix to pubic bone

89
Q

Infundibulopelvic ligaments

A

= IFPs
Folds of broad ligament, from infundibulum (end of fallopian tubes) to lateral wall of pelvis
Contain ovarian vessels

90
Q

Ovaries

A

3x2x1cm, around 5-8g, almond shape

4 layers - germinal epithelium (CUBOIDAL), tunica albuginea, cortex (containing ovarian follicles), medulla (containing vessels)

Supported by IFP ligament, broad ligament (attached by mesovarium), ovarian ligament

Nerve supply T10

91
Q

Ovarian fossa

A

AKA Waldeyer’s
Shallow depression on lateral wall of pelvis
Contains obturator nerve

External iliac vessel above, obliterated umbilical artery anterior, internal iliac vessels and ureter posterior

92
Q

Breasts

A

Modified sudoriferous glands that produce milk. Ectoderm origin.

Over 2-6th ribs, serratus anterior, pec major, rectus sheath

20 lobules, draining to nipple via lactiferous ducts. Separated by ligaments of Cooper which run subcut tissue to fascia of chest wall.

Glands of Montgomery are modified sebaceous glands to lubricate the areola

93
Q

Supply to breast

A

BLOOD
- axillary artery via lateral thoracic and acromiothoracic
- internal thoracic
- intercostal

NERVE
- breast from T4-6
- nipple from T4

LYMPH
- axillary
- parasternal
- abdominal

94
Q

Branches of abdominal aorta

A

Enters abdomen at T12

Inferior phrenic
Coeliac trunk
Suprarenal
Superior mesenteric
Renal
Gonadal
Lumbar (4 paired lateral arteries)
Inferior mesenteric
Median (/middle) sacral

At L4, bifurcates to common iliac

95
Q

Common iliac arteries

A

Commence at L4 bifurcation
End at L5/S1 sacroiliac joints, where they bifurcate again to external and internal

External - will branch further to inferior epigastric and deep circumflex iliac

Internal - aka hypogastric. Supply pelvic organs, buttocks, medial compartments of thigh. Divide at the margin of greater sciatic foramen.

96
Q

Branches of internal iliac artery

A

Anterior - uterine, vaginal, vesical, umbilical, obturator, gluteal, rectal, internal pudendal

Posterior - ilio lumbar, lateral sacral, superior gluteal

97
Q

Relations of internal iliac artery

A

Anterior - ureter, fallopian tubes, ovary

Posterior - internal iliac vein, lumbosacral trunk, piriformis

Medial - small bowel

Lateral - external iliac vessels, obturator nerve, psoas major

98
Q

Femoral arteries

A

Branches of external iliac

Pass under inguinal ligament, lie in femoral triangle on tendon of psoas major

Branches into:
- profunda femoris
- superficial artery (epigastric and circumflex iliac)
- descending genicular
- external pudendal (superficial and deep)

Run medial to femur, cross via adductor hiatus (hole in tendon of adductor magnus), enter into popliteal fossa and become popliteal arteries

99
Q

Obturator arteries

A

Arise from anterior division of internal iliac (usually)

Pass anteroinferiorly on lateral wall of pelvis to obturator foramen
Leave pelvic cavity via obturator canal

Inside pelvis branch to iliac, pubic and vesical branch

Outside pelvis branch to anterior and posterior

100
Q

Internal pudendal arteries

A

Branch of internal iliac (terminal branch of anterior division) to supply external genitalia
Smaller in females

Exit pelvis via greater sciatic foramen, curve around sacrospinous ligament, enter ischio-anal fossa via lesser sciatic foramen and travel in pudendal canal

Branch into inferior rectal, perineal, posterior labial, dorsal A of clitoris, deep A of clitoris, anterior bulb of vestibule

101
Q

Homologous male and female arteries

A

Vaginal = inferior vesical in males

Uterine = middle rectal in males

102
Q

IVC, gonadal and saphenous veins

A

IVC commences at L5, terminates T8

Gonadal veins - right drains directly in, left drains to left RENAL vein

Greater saphenous - large superficial veins originating at dorsal vein of big toe, pass anterior to medial malleolus, enters fascia lata via saphenous opening on anterior aspect of thigh, joins femoral vein in femoral triangle
- receives the tibial veins and femoral vein branches

Thoracoepigastric veins connect femoral and axillary, running lateral to superficial epigastric veins

103
Q

Lymphatic system

A

Thoracic duct originates T12, from cisterna chyli
Drains into left subclavian vein
45cm long

Right lymphatic duct arises anterior to scalenus anterior, drains into right subclavian vein
10mm long

Pelvic nodes drain to para-aortic nodes drain to cisterna chyli drains to thoracic duct

104
Q

4 principal parts of brain

A

Brain stem - midbrain, pons, medulla oblongata
Cerebellum
Diencephalon - thalamus, hypothalamus, pineal gland
Cerebrum

105
Q

Cerebrum

A

Cerebral cortex = grey matter, superficial layer. Contains gyri and sulci.

Corpus collusum = white matter, connecting cerebral hemispheres.
- frontal, parietal, temporal, occipital lobes

Precentral gyrus - anterior to central sulcus, primary motor area

Postcentral gyrus - posterior to central sulcus, primary somatosensory area

106
Q

Basal ganglia

A

Several groups of nuclei in each cerebral hemisphere
Corpus striatum (inc caudate and lenticular nuclei), substantia nigra, red nuclei, subthalamic nuclei

107
Q

Cerebrospinal fluid

A

In subarachnoid space, and 4 cavities in the brain - 2x lateral ventricles, third ventricle, fourth ventricle

Total 80-150ml in body, produced and absorbed at around 20ml/hr
- produced by choroid plexus, via filtration of blood plasma
- reabsorbed via arachnoid villi in superior sagittal sinus, and choroid plexus

CSF journey:
- lateral ventricles, to foramina of Monro, to third ventricle, to Aqueduct of Sylvius, to Fourth ventricle, to subarachnoid space

108
Q

Cranial nerves and routes

A

Olfactory - exits via olfactory foramina
Optic - exits via optic canal
Occulomotor - from midbrain, via cavernous sinus, exits via superior orbital fissure
Trochlear - from midbrain, via cavernous sinus, exits via superior orbital fissure
Trigeminal - from pons, via cavernous sinus, exits in three divisions (ophthlamic - sup orbital, maxillary - foramen rotundum, mandibular - foramen ovale)
Abducens - from pons, via cavernous sinus, exits via sup orbital fissure
Facial - from cerebellopontine angle, via internal acoustic canal, exits via stylomastoid foramen
Vestibulocochlear - from cerebellopontine angle, exits via internal acoustic canal
Glossopharyngeal - from medulla, exits via jugular foramen
Vagus - from medulla, via carotid sheath, exits via jugular foramen
Accessory - runs via foramen magnum to jugular foramen
Hypoglossal - from medulla, via carotid sheath, exits via hypoglossal canal

109
Q

Somatic pathways

A

Motor - pyramidal tract and extrapyramidal pathway (rubrospinal, tectospinal, vestibulospinal tracts)

Sensory - posterior and spinothalamic columns

110
Q

Spinothalamic tract

A

3 neurone sets:
- pseudounipolar neurones in dorsal root ganglion - to cord
- tract cells (secondary neurones) - along cord
- thalamic nuclei (third order neurones) - to brain

Pathway decussates at level of spinal cord in anterior white commissure

Anterior tract - crude touch and pressure
Lateral tract - pain and temperature

111
Q

Posterior column

A

aka dorsal column-medial lemniscus pathway

3 neurone sets:
- Meissner’s corpuscles 1st
- Gracile and cuneate nucleus (medial lemniscus) 2nd
- Ventral posteromedial nucleus of thalamus 3rd

For proprioception, discriminative touch, pressure, vibration

Test with Romberg’s

112
Q

Corticospinal tract

A

Lateral - 90% - decussate in medulla to contralateral side
Anterior - 10% - stay on ipsilateral side

Motor neurones originating in precentral gyrus

113
Q

Spinal meninges

A

Cover brain and spinal cord

3 layers:
space between wall of vertebral canal and dura is epidural space
Dura matter - brain to 2nd sacral vertebrae
** space between is subdural**
Arachnoid
** space between is subarachnoid**
Pia matter

114
Q

Spinal cord

A

From medulla oblongata to vertebral level (L1 adults, L3/4 in infants)

At end there is conus medullaris bulge, giving rise to filum terminale (extension of pia matter, ending at coccyx)
- inferior to conus medullaris, nerve roots are cauda equina

115
Q

Spinal nerves

A

31 pairs
- 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Posterior / dorsal root - SENSORY
Anterior / ventral root - MOTOR

116
Q

Nerve plexuses

A

Cervical C1-5
Branchial C5-T1
Lumbar T12-L5
Sacral L4-S5

117
Q

Lumbar plexus gives rise to…

A

Iliohypogastric L1
Ilioninguinal L1
Genitofemoral L1-2
Lateral femoral cutaneous L2-3
Obturator L2-4
Femoral L2-4

I (twice) Get Laid On Fridays

Originates from anterior primary rami of L1-4
Traverses the psoas major and emerges from its lateral border (except obturator from medial border and genitofemoral from anterior aspects)

118
Q

Iliohypogastric nerve

A

From L1 (and some T12 fibres), emerges lateral border of psoas major
Perforates transversus abdominus muscle
Branches into lateral cutaneous and anterior cutaneous
Communicates with ilioinguinal nerve

119
Q

Genitofemoral nerve

A

From L1 - L2, emerges anterior surface of psoas major

Branches:
- femoral (lumboinguinal) - travels lateral to external iliac artery beneath inguinal ligament
- genital - via deep inguinal ring to innervate cremaster, scrotum, mons pubis, labia majora

120
Q

Obturator nerve

A

From L2-L4, emerges from medial border of psoas major
Passes behind common iliac vessels, lateral to internal iliac vessels and ureter, along lateral wall of lesser pelvis, above and in front of obturator vessels, then into thigh via obturator canal and divides into anterior and posterior (both are then divided by obturator externus and adductor brevis muscles)

Innervate medial thigh, knee joint, adductor muscles of lower limb (external obturator, pectineus, adductor longus/brevis/magnus, gracialis)

121
Q

Femoral nerve

A

L2-L4, largest branch of lumbar plexus
From lateral border of psoas major, then passes between PM and iliacus muscles, behind iliac fascia, divides anterior/posterior beneath inguinal ligament (straddling lateral circumflex femoral artery)

Anterior - intermediate anterior cutaneous nerve, medial anterior cutaneous nerve

Posterior - saphenous nerve, vastus lateralis, vastus medialis, vastus intermedius

Innervates hip and knee joints, and anterior compartment of thigh (quadriceps, sartorius, pectineus)

122
Q

Saphenous nerve

A

Branch of femoral
Descends in femoral triangle into adductor canal, continues with long saphenous vein, crosses anterior to medial malleolus

123
Q

Sacral plexus

A

S1-S4
Between piriformis muscle and pelvic fascia
Behind internal iliac vessels, ureter, sigmoid colon

Gives rise to:
- superior gluteal nerve L4-S1
- sciatic nerve L4-S3
- inferior gluteal nerve L5-S2
- posterior cutaneous nerve S1-S3
- pudendal nerve S2-S4

124
Q

Posterior cutaneous nerve

A

S1-S3
Innervates perineum and skin of posterior thigh and leg
- exits pelvis via greater sciatic foramen, descends beneath gluteus maximus with inferior gluteal artery, runs down back of thigh beneath fascia lata then pierces the deep fascia at the knee and accompanies small saphenous vein

125
Q

Superior gluteal nerve

A

L4-S1
Innervates gluteus medius, gluteus minimus, tensor fascia lata
- leaves pelvis via greater sciatic foramen above piriformis, accompanies superior gluteal vessels

126
Q

Pudendal nerve

A

S2-S4
Passes between piriformis and coccygeus, leaves via greater sciatic foramen, crosses ischial spines, re-enters pelvis via lesser sciatic foramen, runs along pudendal vessels in ischiorectal fossa, within obturator internus fascia aka Alcock’s canal

Branches into inferior anal nerve, perineal (superficial), and dorsal nerve of penis/clitoris

126
Q

Inferior gluteal nerve

A

L5-S2
Innervates gluteus maximus
- leaves pelvis via greater sciatic foramen below piriformis

127
Q

Sciatic nerve

A

L4-S3, longest nerve in body
Innervates most of skin of leg, obturator internus, biceps femoris, semitendinosus, semimembranosus, adductor magnus, hip joint

Exits pelvis via greater sciatic foramen below piriformis, descends between greater trochanter of femur and tuberosity of ischium, divides around lower 1/3 or posterior thigh. Travels with posterior femoral cutaneous nerve and inferior gluteal artery, covered by gluteus maximus.

Tibial - via popliteal fossa, innervates most muscles of foot via plantar branch (except extensor digitorum brevis), knee joint, ankle joint, skin over lateral foot (sural branch).

Fibular / common peroneal - divides into deep and superficial

128
Q

Autonomic plexuses

A

Coeliac - by coeliac ganglia, supplied by greater splanchnic nerve and vagus nerve

Superior mesenteric
Aortic
Inferior mesenteric
Superior hypogastric - at bifurcation of aorta
Inferior hypogastric - one on either side of pelvic side wall, together form the pelvic hypogastric plexus

129
Q

Splanchnic nerve

A

Preganglionic sympathetic fibres:
Greater splanchnic T5-T9
Lesser splanchnic T10-T11
Least splanchnic T12
Lumbar splanchnic S1-S4 - joins sup hypogastric plexus
Sacral splanchnic L1-L4 - joins inf hypogastric plexus

Preganglionic parasympathetic fibres:
Pelvic splanchnic nerve S2-S4 joins inf hypogastric plexus

130
Q

Pelvic splanchnic nerve

A

= nervi erigentes
On side of rectum
Motor innervation to beyond left 1/3 of transverse colon, uterus and bladder
Sensory innervation to bladder, urethra, rectum, anal canal, cervix, upper vagina, prostate

131
Q

Inferior hypogastric plexus postganglionic sympathetic innervations

A

Motor - seminal vesicles, prostate, anal sphincter, urethral sphincter

Sensory - upper rectum, body of uterus

132
Q

Hypothalamus

A

Below thalamus, above brainstem, forms the floor of the 3rd ventricle

2 portions:
- posteromedial - symptathetic innervation
- anterolateral - parasympathetic innervation

133
Q

Pituitary gland

A

= hypophysis
Pea sized, sits on sella turcica (pituitary fossa) in sphenoid bone, covered by dural fold (sella diaphragm), below optic chiasm
Develops from ectoderm

3 parts:
Anterior lobe (adenohypophysis) - develops from Rathke’s pouch
Posterior lobe (neurohypophysis)
Pars intermedia

134
Q

Pituitary gland blood supply

A

ANTERIOR blood supply from internal carotid and posterior communicating arteries, into superior hypophyseal artery, forms primary plexus at base of hypothalamus, into hypophyseal portal veins, secondary plexus, into anterior hypophyseal vein

POSTERIOR blood supply direct from ICA, inferior hypophyseal artery, plexus of infundibular process, posterior hypophyseal vein

135
Q

Anterior pituitary

A

3 cell types - chromophobe, eosinophilic, basophilic

6 hormones secreted
- gonadotrophins LH/FSH
- prolactin
- growth hormone
- adrenocorticotrophic ACTH
- thyroid stimulating TSH
- melanocyte-stimulating hormone

136
Q

Posterior pituitary

A

Secretes and stores two hormones, both produced by the hypothalamus
- oxytocin
- antidiuretic ADH

137
Q

Pineal gland

A

Secretes melatonin
Often calcified
Attached to roof of third ventricle
Covered by capsule of pia matter

138
Q

Thyroid gland structure and supply

A

1st endocrine organ to appear, at day 24 embryonic development
Enclosed in pretracheal fascia

Isthmus - over 2-3rd tracheal ring
Lateral lobes - to 6th tracheal ring
Pyramidal lobe

Arterial supply - superior thyroid (branch of external carotid), inferior thyroid (branch of subclavian), thyroid ima (branch of aortic arch/brachiocephalic)
Venous drainage - superior thyroid and middle thyroid (to internal jugular), inferior thyroid to left brachiocephalic

139
Q

Thyroid function

A

Follicles contain 2 cell types, follicular and parafollicular (C cells)

Secrete 3 principal hormones
- T4 thyroxine
- T3 triiodothyronine
- calcitonin (from C cells)

140
Q

Parathyroid glands

A

Usually 4, pea sized yellow/brown
To control calcium and phosphate levels - PTH increases calcium and reduces phosphate
Two cell types - chief and oxyphilic

141
Q

Carotid sheath

A

From base of skull to 1st rib + sternum

Contents:
- internal carotid artery (medial)
- internal jugular vein (lateral)
- vagus nerve
- deep cervical lymph node

Pierced by glossopharyngeal, accessory and hypoglossal nerves

142
Q

Adrenal glands function

A

Cortex - from mesoderm, in 3 zones
- zona glomerulosa - secretes mineralcorticoids
- zona fasciculata - secretes glucocorticoids
- zona reticularis - secretes androgens

Medulla - from ectoderm, contains chromaffin cells (sympathetic postganglionic, secrete catecholamines adrenaline and noradrenaline)

143
Q

Adrenal glands supply

A

Arterial - from renal artery, phrenic artery and aorta

Venous drainage - right suprarenal to IVC, left suprarenal to left renal vein

Nervous - preganglionic sympathetic fibres only, NO parasympathetic supply

144
Q

Fetal skull

A

9 bones
- 2 frontal
- 2 parietal
- 2 temporal
- 2 sphenoidal
- 1 occipital

8 sutures
- 1 frontal
- 1 sagittal
- 2 coronal
- 2 lambdoidal
- 2 squamous (between parietal and temporal bones)

6 fontanelles
- 1 anterior
- 1 posterior
- 2 sphenoidal
- 2 mastoid

Vertex top of head, occiput behind posterior fontanelle, sinciput in front of anterior fontanelle (brow and face)

145
Q

Fetal skull fontanelles

A

Anterior - between frontal and parietal bones
- diamond shaped
- closes at 18months

Posterior - between parietal and occipital bones
- closes at 2 months

Sphenoidal (anterolateral) - between frontal, parietal, temporal and sphenoidal bones, one each side

Mastoid (posterolateral) - between parietal, temporal and occipital bones, one each side

146
Q

Pelvic Organ Prolapse Quantification (POPQ) system

A

0 No prolapse
1 >1 cm above hymen
2 Within 1 cm (proximal or distal) to the plane of the hymen
3 > 1 cm below the plane of the hymen but protrudes < 2 cm less than the total length of the vagina
4 Complete eversion of the vagina

MRCOG Part 1 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions