Anatomy Flashcards
1
Q
at what lumbar vertebrae is the iliac crest?
A
L4
2
Q
what nerve runs along the ischial spines and is useful for anesthetising the perineum?
A
pudendal nerve
3
Q
what bony prominences are palpable on vaginal examination at 4 and 8 oclock positions?
A
ischial spines
4
Q
what ligaments separate the greater and lesser sciatic foramen?
A
sacrotuberous ligaments
sacrospinous ligaments
5
Q
what does the sacrotuberous ligament run between?
A
sacrum and ischial tuberosity
6
Q
what does the sacrospinous ligament run between?
A
sacrum and ischial spine
7
Q
why is there more strain on the sacrospinous and sacrotuberous ligaments in pregnancy?
A
centre of weight is shifted anteriorly
8
Q
what happens to ligaments during pregnancy and why?
A
they relax due to relaxin hormone
9
Q
describe the course of the pudendal nerve?
A
leaves the pelvis out of the greater sciatic foramen, wraps around the sacrospinous ligament and goes back into the pelvis through the lesser sciatic foramen
10
Q
what separates the false and true pelvis?
A
pelvic inlet
11
Q
what makes up the pelvic inlet?
A
sacral promontory
ilium
superior pubic ramus
pubic symphysis
12
Q
what makes up the pelvic outlet?
A
pubic symphysis ischiopubic ramus ischial tuberosities sacrotuberous ligaments coccyx
13
Q
at what level does the abdominal aorta branch into the common iliac artery?
A
L4
14
Q
do the superior/inferior gluteal arteries come from the external or internal iliac arteries?
A
internal iliac artery
15
Q
compare the anterior-posterior and transverse diameter of the female and male pelvis?
A
female diameters are both larger
16
Q
compare the subpubic angle of the female and male pelvis?
A
females is wider
17
Q
compare the depth of the female and male pelvic cavity?
A
females pelvic cavity is shallower
18
Q
what are fontanelles?
A
soft spots on the fetal skull
19
Q
what parts of the fetal skull allows moulding during childbirth?
A
fontanelles
sutures
20
Q
what suture is between the frontal and parietal bones of the fetal skull?
A
coronal suture
21
Q
what suture is between parietal bones of the fetal skull?
A
sagittal suture
22
Q
what suture is between the occipital and parietal bones?
A
lambdoid suture
23
Q
what outlines the vertex of the fetal skull?
A
anterior and posterior fontanelles
parietal eminences
24
Q
compare the occipitofrontal diameter to the biparietal diameter of the fetal skull?
A
occipitofrontal diameter is longer than the biparietal diameter
25
at the pelvic inlet of a womens pelvis, which is wider- transverse diameter or AP diameter?
transverse diametter
26
at the pelvic outlet of a womens pelvis, which is wider- transverse diameter or AP diameter?
AP diameter
27
what is the 'station'? (a term used during childbirth)
the ischial spines
| negative number station = superior to the ischial spines
28
during delivery, should the foetal head be in flexion or extension?
extension
29
while descending through the pelvic cavity, should the foetal head be in flexion or extension?
flexion (chin on chest)
30
visceral afferents from the superior aspect of the pelvic organs (ie touching the peritoneum) runs alongside what nerve fibres? at what levels do they enter the spinal cord?
sympathetic fibres
| T11-L2
31
pain from inferior aspects of pelvic organs (ie not touching the peritoneum) runs alongside what nerve fibres? at what levels do they enter the spinal cord?
parasympathetic fibres
| S2,3,4
32
what nerve supplies somatic sensory fibres to organs/structures within the perineum?
pudendal nerve
33
what are the 3 methods of anesthetising the female reproductive tract?
spinal anaesthetic
epidural anaesthetic
pudendal nerve block
34
at what levels does the spinal cord become the cauda equina?
L2
35
at what level does the subarchnoid spae end?
S2
36
for a spinal/epidural anaesthetic procedure, at what lefvel is anaesthetic injected into?
L3-L4
37
for spinal anaesthetic, what 7 layers does the needle pass through?
```
supraspinous liament
interspinous ligament
ligamentum flavum
epidural space (fat/veins)
dura mater
arachnoid mater
subarachnoid space (CSF)
```
38
for epidural anaesthetic, what 4 layers does the needle pass through?
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat/veins)
39
what happens to the lower limbs during spinal anaesthetic and why?
skin looks flushed
warm
reduced sweating
(loss of sympathetic supply)
40
what is the name of the surgical cut in the area between the vagina and the anus during delivery?
episiotomy
41
what fossa is an episiotomy made in?
ischioanal fossa
42
how can the pouch of Douglas be drained?
needle aspiration through the posterior fornix of the vagina (culdocentesis)
43
what are the 2 ligaments of the uterus?
- broad ligament
| - round ligament
44
what is the broad ligament of the uterus actually made of?
double layer of peritoneum
45
what does the broad ligament of the uterus extend between?
uterus and lateral walls/floor of pelvis
46
what is the function of the broad ligament of the uterus?
helps maintain uterus in correct position
47
what is the round ligament of the uterus actually made of?
embryological remnant
48
what does the round ligament of the uterus extend between?
lateral aspect of uterus and superficial tissue of the female perineum
49
what inguinal ring does the round ligament of the uterus pass through?
deep inguinal ring
50
describe the most common position of the cervix?
anteverted
51
describe the most common position of the uterus?
anteflexed
52
whats the difference between a retroverted and retroflexed vagina?
retroverted- uterus tipped posteriorly relative to axis of vagina
retroflexed-uterus tipped posteriorly relative to axis of cervix
53
what area of the cervix must be sampled in a cervical smear?
squamo-columnar junction (Transformation zone)
54
what is a salpingo-oophrectomy?
removal of uterine tube and ovary
55
what is a salpingectomy?
removal of uterine tube
56
where do ovaries develop?
on the posterior abdominal wall
57
what are the 4 parts of the fornix of the vagina?
anterior fornix
posterior fornix
2 lateral fornices
58
what nerves supply the levator ani muscle?
nerve to levator ani muscle
| pudendal nerve
59
what is the perineal body?
bundle of collagenous and elastic tissue where perineal muscles attach
60
what nerve supplies the perineal muscles?
pudendal nerve
61
what glands are near the labia of the vagina and secrete fluids associated with sexual arousal?
bartholins glands
62
from what ribs does the bed of the breast extend?
ribs 2-6
63
to what line does the lateral border of the breast extend to?
mid-axillary line
64
what spaces lies between deep fascia and the breast?
retromammary space
65
what ligaments firmly attach the breast tissue to skin?
suspensory ligaments
66
what hormone causes lactation?
prolactin
67
what hormone causes descent of lactating milk to areola?
oxytocin
68
what are the 5 main areas of the female breast?
```
upper inner
lower inner
lower outer
upper outer
axillary tail
```
69
where does greater than 75% of lymph from the breast drain to?
ipsilateral axillary lymph nodes
70
describe the position of level 1 axillary lymph nodes?
inferior and lateral to pectoralis minor
71
describe the position of level 2 axillary lymph nodes?
deep to pectoralis minor
72
describe the position of level 3 axillary lymph nodes?
superior and medial to pectoralis minor
73
what is the venous drainage of the breast?
- internal thoracic vein
| - branches of the axillary vein
74
what is the blood supply to the breast?
- internal thoracic artery
| - branches of the axillary artery
75
what three orfices makes up the trigone of the bladder?
2 ureteric orifice
| internal urethral orifice
76
what muscle mainly forms the bladder wall?
detrusor
77
where do the testes develop?
posterior wall of the abdominal cavity
78
what canal do the testes descend through?
inguinal canal
79
what sac do the testes sit within the scrotum?
tunica vaginalis
80
what is the name of excess fluid within the tunica vaginalis?
hydrocele
81
what muscle of the testis controls temperature?
dartos muscle
82
how long does a sperm take to develop?
64 days
83
from the seminiferous tubules, where does the sperm then pass?
rete testis and then into head of epididymis
84
where does the left testicular vein drain?
left renal vein
85
where does the right testicular vein drain?
IVC
86
what part of the urethra is within the prostate gland?
prostatic urethra
87
what zone of the prostate do most prostate cancers arise from?
peripheral zone
88
what part of the prostate is felt on digital rectal exam?
peripheral zone
89
what bony feature does the root of the penis laterally attach to?
ischium of the pelvis
90
what are the 3 cylinders of erectile tissue in the penis?
```
corpus cavernosum (R/L)
corpus spongiosum (anteriorly)
```
91
what is the blood supply to the penis?
deep arteries of the penis from branches of internal pudendal artery (from internal iliac)
92
what is the blood supply to the scrotum?
internal pudendal artery (from internal iliac) and branches from external iliac
93
what is the lymph drainage of the scrotum and most of the penis?
to superficial inguinal lymph nodes
94
what is the lymph drainage of the testes?
to lumbar lymph nodes
95
what is the root of the penis made of?
```
corpus cavernosum (crura)
corpus spongiosum (bulb)
and associated muscles (bulbospongiosus and ischiocavernosus)
```
96
what are langer lines?
lines of skin tension
97
describe the layers of superficial fascia that make up the abdominal wall?
camper's fascia (most external)- thick and fatty
| scarpa's fascia- thin and membranous
98
what does the external oblique attach between?
lower ribs and
| iliac crest, pubic tubercle, linea alba
99
what is the linea alba?
midline blending of aponeuroses
100
the superior serrated edge of the external oblique interdigitates with which muscle?
serratus anterior
101
what does the internal oblique attach between?
lower ribs and
| thoracolumbar fascia, iliac crest, linea alba
102
what direction do transversus abdominis muscles run in?
transversely
103
what does the transversus abdominis attach between?
lower ribs, thoracolumbar fascia, iliac crest and linea alba
104
what divides the rectus abdominis?
tendinous intersections
105
what does the linea alba run from?
xiiphoid process to the pubic symphysis
106
what makes the rectus sheath?
combined aponeuroses of anterolateral abdominal wall muscles
107
what is the rectus sheath muscle immediately deep to?
superficial fascia of the abdominal wall
108
when undertaking a lower segment C section (LSCS), which rectus sheath will be cut- anterior, posterior or both?
only anterior rectus sheath
109
below which line is there an anterior rectus sheath but not a posterior rectus sheath?
arcuate line
110
what do 7th-11th intercosal nerves become?
thoracoabdominal nerves
111
in addition to thoracoabdominal nerves, what 3 other nerves supply the anterolateral abdominal wall? (give their roots)
subcostal T12
iliohypogastric L1
ilioinguinal L1
112
which plane do the nerves that supply the anterolateral abdominal wall travel in?
internal oblique and transversus abdominis
113
what arteries supply the anterior abdominal wall?
superior and inferior epigastric arteries
114
from what direction of the abdominal wall do the superior epigastric arteries emerge from?
superior aspect
115
what artery are the superior epigastric arteries continuations of?
internal thoracic artery
116
in what plane do the superior epigastric arteries travel in?
posterior to rectus abdominis
117
from what direction of the abdominal wall do the inferior epigastric arteries emerge from?
inferior aspect
118
what artery are the superior epigastric arteries branches of?
external iliac artery
119
in what plane do the inferior epigastric arteries travel in?
posterior to rectus abdominis
120
what arteries supply the lateral abdominal wall?
intercostal and subcostal arteries
121
what arteries are the intercostal and subcostal arteries continuations of?
posterior intercostal arteries
122
from what aspect of the abdominal wall do the intercostal and subcostal arteries emerge from?
lateral aspect
123
what layers need to be stitched closed after a LSCS incision?
-uterine wall with visceral peritoneum
-anterior rectus sheath
(-fascial layer if high BMI)
-skin
124
what layers need to be stitched closed after a laparotomy?
-peritoneum
-linea alba
(-fascial layer if high BMI)
-skin
125
why is there an increased chance of wound complications with a laparotomy compared to lower segmental C section?
relatively bloodless so healing is not as good
126
what incisions and ports are needed for and obs and gynae laparoscopy?
sub-umbilical incision
| sometimes lateral ports are required
127
when using lateral ports for an obs and gynae laparoscopy, what artery needs great care to be avoided?
inferior epigastric artery
128
describe the position of the inferior epigastric artery relative to the deep inguinal ring?
medial to deep inguinal ring
129
after passing medial to the deep inguinal ring, in which direction does the inferior epigastric artery pass?
superomedial direction
130
what makes up the borders of Hesselbach's triangle?
```
inferior epigastric vessels (superiolaterally)
inguinal ligament (inferolaterally)
lateral border of retus abdominis (medially)
```
131
what is the clinical significance of Hesselbach's triangle?
where direct hernias protrude through the abdominal wall
132
where does the uterine artery pass in relation to the ureter?
uterine artery passes over the ureter
133
what are the 3 components of the pelvic floor?
pelvic diaphragm
muscles of perineal pouches
perineal membrane
134
what is the deepest layer of the pelvic floor?
pelvic diaphragm
135
what two muscle groups does the pelvic diaphragm consist of?
levator ani and coccygeus
136
what are the 3 parts of the levator ani?
medial to lateral
puborectalis
pubococcygeus
iliococcygeus
137
which layer of the levator ani maintains anorectal tension by acting like a sling?
puborectalis
138
what is the function of the uterosacral ligament?
stops uterus sinking down
139
where is the deep perineal pouch in relation to perineal membrane?
the perineal membrane is superficial to the deep perineal pouch
140
what are the main three types of pelvis?
gynacoid
anthropoid
android
141
what is the root of penis made of?
bulb (corpus spongiosum)
crura (corpus cavernosum)
associated muscles (bulbospongiosus and ischiocavernosus)
142
why can menopause cause weakness to the pelvic floor?
ligaments become less fibrous
143
why do prolapses occur in general?
failure of support for pelvic organs
144
what is a vaginal prolapse?
herniation of urethra, bladder or rectum through vaginal wall fascia
(urethrocele, cystocele, rectocele, enterocele)
145
what is a uterine prolapse?
descent of uterus into vagina
146
how do you repair cervical/vault prolapse?
sacrospinous fixation
147
what is done in sacrospinous fixation?
sutures placed in sacrospinous ligament
148
what nerves can be injured in sacrospinous fixation?
pudendal nerve and sciatic nerve
149
what separates the true pelvis from the perineum?
the pelvic outlet
150
what membrane covers the obturator foramen?
obturator membrane
151
arteries which supply most of the pelvis and perineum mainly come from the internal iliac artery, what 2 arteries are the exception?
gonadal artery
| superior rectal artery
152
from what level of the abdominal aorta does gonadal artery come from?
L2
153
what artery is the superior rectal artery a continuation of?
inferior mesenteric artery
154
from what level of the abdominal aorta does the inferior mesenteric artery come from?
L3
155
what are the 2 divisions of the internal iliac artery? (which is visceral and which is parietal?)
anterior division- visceral
| posterior division- parietal
156
what is the name for the remnant of the umbilical artery?
medial umbilical ligament/
| medial umbilical fold
157
what did the umbilical artery run between?
internal iliac artery and placenta (via umbilical crd)
158
in males there are superior and inferior vesical arteries, what is this replaced with in females?
superior vesical artery
| vaginal artery
159
what three arteries are part of the posterior division of the internal iliac artery?
Iliolubar artery
lateral sacral artery
superior gluteal artery
160
what does the obturatory artery supply?
the medial compartment of the thigh
161
what does the inferior vesical artery supply in males?
the prostate (which is the inferior aspect of the male bladder)
162
compare the medial umbilical fold and median umbilical fold?
medial umbilical fold- remnant of umbilical artery
| median umbilical fold (urachus)- drains fetal bladder and runs with umbilical cord
163
what is contained within the lateral umbilical fold?
inferior epigastric vessels
164
compare a direct and indirect hernia in terms of relation to inferior epigastric vessels?
direct- medial to inferior epigastric vessels
| indirect- lateral to inferior epigastric vessels
165
the internal pudendal artery terminates as which two arteries?
deep artery of the penis
| dorsal artery of the penis (cavernous artery)
166
compare where the anterior and posterior scrotal arteries branch from?
anterior scrotal artery is a branch from the external iliac artery
posterior scrotal artery is a branch from the internal pudendal artery (from the internal iliac artery)
167
in females, the vaginal artery is a branch of what artery?
uterine artery
168
the ovarian artery splits into what 2 branches?
ovarian branch
| tubal branch
169
what is the venous drainage of the pelvis?
- mainly to internal iliac vein
- some to hepatic portal system via superior rectal vein
- some to itnernal vertebral venous plexus via lateral sacral vines
170
when ligating the uterine artery, what structure should you be careful to preserve?
the ureter
171
what plexus does the obturator nerve come from?
lumbar plexus L2,3,4
172
what are the roots for the pelvic splanchnic nerves?
S2,3,4
173
where does lymph from the scrotum and testes go?
scrotum- superficial inguinal
| testes- lumbar
174
where does lymph from the glans of the penis and the clitoris go?
deep inguinal lymph nodes
