Anatomy Flashcards

1
Q

at what lumbar vertebrae is the iliac crest?

A

L4

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2
Q

what nerve runs along the ischial spines and is useful for anesthetising the perineum?

A

pudendal nerve

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3
Q

what bony prominences are palpable on vaginal examination at 4 and 8 oclock positions?

A

ischial spines

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4
Q

what ligaments separate the greater and lesser sciatic foramen?

A

sacrotuberous ligaments

sacrospinous ligaments

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5
Q

what does the sacrotuberous ligament run between?

A

sacrum and ischial tuberosity

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6
Q

what does the sacrospinous ligament run between?

A

sacrum and ischial spine

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7
Q

why is there more strain on the sacrospinous and sacrotuberous ligaments in pregnancy?

A

centre of weight is shifted anteriorly

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8
Q

what happens to ligaments during pregnancy and why?

A

they relax due to relaxin hormone

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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

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10
Q

what separates the false and true pelvis?

A

pelvic inlet

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11
Q

what makes up the pelvic inlet?

A

sacral promontory
ilium
superior pubic ramus
pubic symphysis

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12
Q

what makes up the pelvic outlet?

A
pubic symphysis
ischiopubic ramus
ischial tuberosities
sacrotuberous ligaments
coccyx
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13
Q

at what level does the abdominal aorta branch into the common iliac artery?

A

L4

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14
Q

do the superior/inferior gluteal arteries come from the external or internal iliac arteries?

A

internal iliac artery

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15
Q

compare the anterior-posterior and transverse diameter of the female and male pelvis?

A

female diameters are both larger

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16
Q

compare the subpubic angle of the female and male pelvis?

A

females is wider

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17
Q

compare the depth of the female and male pelvic cavity?

A

females pelvic cavity is shallower

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18
Q

what are fontanelles?

A

soft spots on the fetal skull

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19
Q

what parts of the fetal skull allows moulding during childbirth?

A

fontanelles

sutures

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20
Q

what suture is between the frontal and parietal bones of the fetal skull?

A

coronal suture

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21
Q

what suture is between parietal bones of the fetal skull?

A

sagittal suture

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22
Q

what suture is between the occipital and parietal bones?

A

lambdoid suture

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23
Q

what outlines the vertex of the fetal skull?

A

anterior and posterior fontanelles

parietal eminences

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24
Q

compare the occipitofrontal diameter to the biparietal diameter of the fetal skull?

A

occipitofrontal diameter is longer than the biparietal diameter

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25
Q

at the pelvic inlet of a womens pelvis, which is wider- transverse diameter or AP diameter?

A

transverse diametter

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26
Q

at the pelvic outlet of a womens pelvis, which is wider- transverse diameter or AP diameter?

A

AP diameter

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27
Q

what is the ‘station’? (a term used during childbirth)

A

the ischial spines

negative number station = superior to the ischial spines

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28
Q

during delivery, should the foetal head be in flexion or extension?

A

extension

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29
Q

while descending through the pelvic cavity, should the foetal head be in flexion or extension?

A

flexion (chin on chest)

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30
Q

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?

A

sympathetic fibres

T11-L2

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31
Q

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?

A

parasympathetic fibres

S2,3,4

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32
Q

what nerve supplies somatic sensory fibres to organs/structures within the perineum?

A

pudendal nerve

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33
Q

what are the 3 methods of anesthetising the female reproductive tract?

A

spinal anaesthetic
epidural anaesthetic
pudendal nerve block

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34
Q

at what levels does the spinal cord become the cauda equina?

A

L2

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35
Q

at what level does the subarchnoid spae end?

A

S2

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36
Q

for a spinal/epidural anaesthetic procedure, at what lefvel is anaesthetic injected into?

A

L3-L4

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37
Q

for spinal anaesthetic, what 7 layers does the needle pass through?

A
supraspinous liament
interspinous ligament
ligamentum flavum
epidural space (fat/veins)
dura mater
arachnoid mater
subarachnoid space (CSF)
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38
Q

for epidural anaesthetic, what 4 layers does the needle pass through?

A

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat/veins)

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39
Q

what happens to the lower limbs during spinal anaesthetic and why?

A

skin looks flushed
warm
reduced sweating
(loss of sympathetic supply)

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40
Q

what is the name of the surgical cut in the area between the vagina and the anus during delivery?

A

episiotomy

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41
Q

what fossa is an episiotomy made in?

A

ischioanal fossa

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42
Q

how can the pouch of Douglas be drained?

A

needle aspiration through the posterior fornix of the vagina (culdocentesis)

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43
Q

what are the 2 ligaments of the uterus?

A
  • broad ligament

- round ligament

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44
Q

what is the broad ligament of the uterus actually made of?

A

double layer of peritoneum

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45
Q

what does the broad ligament of the uterus extend between?

A

uterus and lateral walls/floor of pelvis

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46
Q

what is the function of the broad ligament of the uterus?

A

helps maintain uterus in correct position

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47
Q

what is the round ligament of the uterus actually made of?

A

embryological remnant

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48
Q

what does the round ligament of the uterus extend between?

A

lateral aspect of uterus and superficial tissue of the female perineum

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49
Q

what inguinal ring does the round ligament of the uterus pass through?

A

deep inguinal ring

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50
Q

describe the most common position of the cervix?

A

anteverted

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51
Q

describe the most common position of the uterus?

A

anteflexed

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52
Q

whats the difference between a retroverted and retroflexed vagina?

A

retroverted- uterus tipped posteriorly relative to axis of vagina
retroflexed-uterus tipped posteriorly relative to axis of cervix

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53
Q

what area of the cervix must be sampled in a cervical smear?

A

squamo-columnar junction (Transformation zone)

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54
Q

what is a salpingo-oophrectomy?

A

removal of uterine tube and ovary

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55
Q

what is a salpingectomy?

A

removal of uterine tube

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56
Q

where do ovaries develop?

A

on the posterior abdominal wall

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57
Q

what are the 4 parts of the fornix of the vagina?

A

anterior fornix
posterior fornix
2 lateral fornices

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58
Q

what nerves supply the levator ani muscle?

A

nerve to levator ani muscle

pudendal nerve

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59
Q

what is the perineal body?

A

bundle of collagenous and elastic tissue where perineal muscles attach

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60
Q

what nerve supplies the perineal muscles?

A

pudendal nerve

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61
Q

what glands are near the labia of the vagina and secrete fluids associated with sexual arousal?

A

bartholins glands

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62
Q

from what ribs does the bed of the breast extend?

A

ribs 2-6

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63
Q

to what line does the lateral border of the breast extend to?

A

mid-axillary line

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64
Q

what spaces lies between deep fascia and the breast?

A

retromammary space

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65
Q

what ligaments firmly attach the breast tissue to skin?

A

suspensory ligaments

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66
Q

what hormone causes lactation?

A

prolactin

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67
Q

what hormone causes descent of lactating milk to areola?

A

oxytocin

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68
Q

what are the 5 main areas of the female breast?

A
upper inner
lower inner
lower outer
upper outer
axillary tail
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69
Q

where does greater than 75% of lymph from the breast drain to?

A

ipsilateral axillary lymph nodes

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70
Q

describe the position of level 1 axillary lymph nodes?

A

inferior and lateral to pectoralis minor

71
Q

describe the position of level 2 axillary lymph nodes?

A

deep to pectoralis minor

72
Q

describe the position of level 3 axillary lymph nodes?

A

superior and medial to pectoralis minor

73
Q

what is the venous drainage of the breast?

A
  • internal thoracic vein

- branches of the axillary vein

74
Q

what is the blood supply to the breast?

A
  • internal thoracic artery

- branches of the axillary artery

75
Q

what three orfices makes up the trigone of the bladder?

A

2 ureteric orifice

internal urethral orifice

76
Q

what muscle mainly forms the bladder wall?

A

detrusor

77
Q

where do the testes develop?

A

posterior wall of the abdominal cavity

78
Q

what canal do the testes descend through?

A

inguinal canal

79
Q

what sac do the testes sit within the scrotum?

A

tunica vaginalis

80
Q

what is the name of excess fluid within the tunica vaginalis?

A

hydrocele

81
Q

what muscle of the testis controls temperature?

A

dartos muscle

82
Q

how long does a sperm take to develop?

A

64 days

83
Q

from the seminiferous tubules, where does the sperm then pass?

A

rete testis and then into head of epididymis

84
Q

where does the left testicular vein drain?

A

left renal vein

85
Q

where does the right testicular vein drain?

A

IVC

86
Q

what part of the urethra is within the prostate gland?

A

prostatic urethra

87
Q

what zone of the prostate do most prostate cancers arise from?

A

peripheral zone

88
Q

what part of the prostate is felt on digital rectal exam?

A

peripheral zone

89
Q

what bony feature does the root of the penis laterally attach to?

A

ischium of the pelvis

90
Q

what are the 3 cylinders of erectile tissue in the penis?

A
corpus cavernosum (R/L)
corpus spongiosum (anteriorly)
91
Q

what is the blood supply to the penis?

A

deep arteries of the penis from branches of internal pudendal artery (from internal iliac)

92
Q

what is the blood supply to the scrotum?

A

internal pudendal artery (from internal iliac) and branches from external iliac

93
Q

what is the lymph drainage of the scrotum and most of the penis?

A

to superficial inguinal lymph nodes

94
Q

what is the lymph drainage of the testes?

A

to lumbar lymph nodes

95
Q

what is the root of the penis made of?

A
corpus cavernosum (crura)
corpus spongiosum (bulb)
and associated muscles (bulbospongiosus and ischiocavernosus)
96
Q

what are langer lines?

A

lines of skin tension

97
Q

describe the layers of superficial fascia that make up the abdominal wall?

A

camper’s fascia (most external)- thick and fatty

scarpa’s fascia- thin and membranous

98
Q

what does the external oblique attach between?

A

lower ribs and

iliac crest, pubic tubercle, linea alba

99
Q

what is the linea alba?

A

midline blending of aponeuroses

100
Q

the superior serrated edge of the external oblique interdigitates with which muscle?

A

serratus anterior

101
Q

what does the internal oblique attach between?

A

lower ribs and

thoracolumbar fascia, iliac crest, linea alba

102
Q

what direction do transversus abdominis muscles run in?

A

transversely

103
Q

what does the transversus abdominis attach between?

A

lower ribs, thoracolumbar fascia, iliac crest and linea alba

104
Q

what divides the rectus abdominis?

A

tendinous intersections

105
Q

what does the linea alba run from?

A

xiiphoid process to the pubic symphysis

106
Q

what makes the rectus sheath?

A

combined aponeuroses of anterolateral abdominal wall muscles

107
Q

what is the rectus sheath muscle immediately deep to?

A

superficial fascia of the abdominal wall

108
Q

when undertaking a lower segment C section (LSCS), which rectus sheath will be cut- anterior, posterior or both?

A

only anterior rectus sheath

109
Q

below which line is there an anterior rectus sheath but not a posterior rectus sheath?

A

arcuate line

110
Q

what do 7th-11th intercosal nerves become?

A

thoracoabdominal nerves

111
Q

in addition to thoracoabdominal nerves, what 3 other nerves supply the anterolateral abdominal wall? (give their roots)

A

subcostal T12
iliohypogastric L1
ilioinguinal L1

112
Q

which plane do the nerves that supply the anterolateral abdominal wall travel in?

A

internal oblique and transversus abdominis

113
Q

what arteries supply the anterior abdominal wall?

A

superior and inferior epigastric arteries

114
Q

from what direction of the abdominal wall do the superior epigastric arteries emerge from?

A

superior aspect

115
Q

what artery are the superior epigastric arteries continuations of?

A

internal thoracic artery

116
Q

in what plane do the superior epigastric arteries travel in?

A

posterior to rectus abdominis

117
Q

from what direction of the abdominal wall do the inferior epigastric arteries emerge from?

A

inferior aspect

118
Q

what artery are the superior epigastric arteries branches of?

A

external iliac artery

119
Q

in what plane do the inferior epigastric arteries travel in?

A

posterior to rectus abdominis

120
Q

what arteries supply the lateral abdominal wall?

A

intercostal and subcostal arteries

121
Q

what arteries are the intercostal and subcostal arteries continuations of?

A

posterior intercostal arteries

122
Q

from what aspect of the abdominal wall do the intercostal and subcostal arteries emerge from?

A

lateral aspect

123
Q

what layers need to be stitched closed after a LSCS incision?

A

-uterine wall with visceral peritoneum
-anterior rectus sheath
(-fascial layer if high BMI)
-skin

124
Q

what layers need to be stitched closed after a laparotomy?

A

-peritoneum
-linea alba
(-fascial layer if high BMI)
-skin

125
Q

why is there an increased chance of wound complications with a laparotomy compared to lower segmental C section?

A

relatively bloodless so healing is not as good

126
Q

what incisions and ports are needed for and obs and gynae laparoscopy?

A

sub-umbilical incision

sometimes lateral ports are required

127
Q

when using lateral ports for an obs and gynae laparoscopy, what artery needs great care to be avoided?

A

inferior epigastric artery

128
Q

describe the position of the inferior epigastric artery relative to the deep inguinal ring?

A

medial to deep inguinal ring

129
Q

after passing medial to the deep inguinal ring, in which direction does the inferior epigastric artery pass?

A

superomedial direction

130
Q

what makes up the borders of Hesselbach’s triangle?

A
inferior epigastric vessels (superiolaterally)
inguinal ligament (inferolaterally)
lateral border of retus abdominis (medially)
131
Q

what is the clinical significance of Hesselbach’s triangle?

A

where direct hernias protrude through the abdominal wall

132
Q

where does the uterine artery pass in relation to the ureter?

A

uterine artery passes over the ureter

133
Q

what are the 3 components of the pelvic floor?

A

pelvic diaphragm
muscles of perineal pouches
perineal membrane

134
Q

what is the deepest layer of the pelvic floor?

A

pelvic diaphragm

135
Q

what two muscle groups does the pelvic diaphragm consist of?

A

levator ani and coccygeus

136
Q

what are the 3 parts of the levator ani?

A

medial to lateral
puborectalis
pubococcygeus
iliococcygeus

137
Q

which layer of the levator ani maintains anorectal tension by acting like a sling?

A

puborectalis

138
Q

what is the function of the uterosacral ligament?

A

stops uterus sinking down

139
Q

where is the deep perineal pouch in relation to perineal membrane?

A

the perineal membrane is superficial to the deep perineal pouch

140
Q

what are the main three types of pelvis?

A

gynacoid
anthropoid
android

141
Q

what is the root of penis made of?

A

bulb (corpus spongiosum)
crura (corpus cavernosum)
associated muscles (bulbospongiosus and ischiocavernosus)

142
Q

why can menopause cause weakness to the pelvic floor?

A

ligaments become less fibrous

143
Q

why do prolapses occur in general?

A

failure of support for pelvic organs

144
Q

what is a vaginal prolapse?

A

herniation of urethra, bladder or rectum through vaginal wall fascia
(urethrocele, cystocele, rectocele, enterocele)

145
Q

what is a uterine prolapse?

A

descent of uterus into vagina

146
Q

how do you repair cervical/vault prolapse?

A

sacrospinous fixation

147
Q

what is done in sacrospinous fixation?

A

sutures placed in sacrospinous ligament

148
Q

what nerves can be injured in sacrospinous fixation?

A

pudendal nerve and sciatic nerve

149
Q

what separates the true pelvis from the perineum?

A

the pelvic outlet

150
Q

what membrane covers the obturator foramen?

A

obturator membrane

151
Q

arteries which supply most of the pelvis and perineum mainly come from the internal iliac artery, what 2 arteries are the exception?

A

gonadal artery

superior rectal artery

152
Q

from what level of the abdominal aorta does gonadal artery come from?

A

L2

153
Q

what artery is the superior rectal artery a continuation of?

A

inferior mesenteric artery

154
Q

from what level of the abdominal aorta does the inferior mesenteric artery come from?

A

L3

155
Q

what are the 2 divisions of the internal iliac artery? (which is visceral and which is parietal?)

A

anterior division- visceral

posterior division- parietal

156
Q

what is the name for the remnant of the umbilical artery?

A

medial umbilical ligament/

medial umbilical fold

157
Q

what did the umbilical artery run between?

A

internal iliac artery and placenta (via umbilical crd)

158
Q

in males there are superior and inferior vesical arteries, what is this replaced with in females?

A

superior vesical artery

vaginal artery

159
Q

what three arteries are part of the posterior division of the internal iliac artery?

A

Iliolubar artery
lateral sacral artery
superior gluteal artery

160
Q

what does the obturatory artery supply?

A

the medial compartment of the thigh

161
Q

what does the inferior vesical artery supply in males?

A

the prostate (which is the inferior aspect of the male bladder)

162
Q

compare the medial umbilical fold and median umbilical fold?

A

medial umbilical fold- remnant of umbilical artery

median umbilical fold (urachus)- drains fetal bladder and runs with umbilical cord

163
Q

what is contained within the lateral umbilical fold?

A

inferior epigastric vessels

164
Q

compare a direct and indirect hernia in terms of relation to inferior epigastric vessels?

A

direct- medial to inferior epigastric vessels

indirect- lateral to inferior epigastric vessels

165
Q

the internal pudendal artery terminates as which two arteries?

A

deep artery of the penis

dorsal artery of the penis (cavernous artery)

166
Q

compare where the anterior and posterior scrotal arteries branch from?

A

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
Q

in females, the vaginal artery is a branch of what artery?

A

uterine artery

168
Q

the ovarian artery splits into what 2 branches?

A

ovarian branch

tubal branch

169
Q

what is the venous drainage of the pelvis?

A
  • 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
Q

when ligating the uterine artery, what structure should you be careful to preserve?

A

the ureter

171
Q

what plexus does the obturator nerve come from?

A

lumbar plexus L2,3,4

172
Q

what are the roots for the pelvic splanchnic nerves?

A

S2,3,4

173
Q

where does lymph from the scrotum and testes go?

A

scrotum- superficial inguinal

testes- lumbar

174
Q

where does lymph from the glans of the penis and the clitoris go?

A

deep inguinal lymph nodes