Anatomy Flashcards
What is palpable at 4 & 8 o’clock on a vaginal exam?
Ischial spines
How long does the anterior fontanelle take to ossify?
9-18 months
How long does the posterior fontanelle take to ossify?
3 months
What is the ideal position for the delivery of a baby?
Occipitoanterior (OA)
How can the pouch of Douglas be drained?
Through the posterior fornix of the vagina
Where does the broad ligament join to the pelvis?
Uterus,lateral walls & floor of pelvis
What is contained within the broad ligament?
Uterine tubes & proximal part of round ligament
What is the round ligament attached to?
Lateral aspect of the uterus
What does the round ligament pass through?
Deep inguinal ring
What are the 3 layers of the body of the uterus?
Perimetrium
Myometrium
Endometrium
Where does implantation of the zygote occur?
Body of the uterus
What are the 2 most common positions of the uterus?
Anteverted & Anteflexed
Where are samples for cervical smears taken?
Transformation zone
Where does fertilisation occur?
The ampulla
How is the patency of theuterine tubes assessed?
Histerosalpingogram (HSG)
Where do the ovaries develop embryologically?
Posterior abdominal wal
What do the ovaries do
Secrete oestrogen & progesterone in response to LH & FSH
What is the perineal body important for?
Pelvic floor strength
What is the function of Bartholin’s glands?
Allow vaginal secretions - associated with arousal
Where is the bed of the breast?
Ribs 2-6
Where is the retromammary space?
Between fascia & breast?
What 2 muscles lie underneath the breast?
Pectoralis major & serratus anterior
Where does 75% of breast tissue drain?
Ipsilateral axillary lymph nodes then to supraclavicular nodes
What is a complication of axillary lymph node removal?
Lymphedema
What arteries supply the breast?
Axillary artery
Subclavian artery
Internal thoracic (internal mammary) artery
What nerve fibres innervate pelvic floor muscle contraction?
Somatic motor
What nerve fibres transmit pain from the adenexae & uterus?
Visceral afferents
What fibres transmit pain from the perineum?
Somatic sensory
Where is pain perceived from the superior aspect of pelvic organs (touching the peritoneum)?
Suprapubic (T11-L2)
Where is pain perceived from the inferior part of pelvic organs (not touching the peritoneum)?
In the peritoneum (S2,3,4)
At what level does the spinal cord become the cauda equina?
L2
What level does the subarachnoid space end?
S2
At what level is anaesthetic injected at?
L3/L4 (L5) region)
Where does sympathetic outflow exit the spinal cord?
T1-L2
What is a sign that a spinal anaesthetic is working?
Skin of lower limbs looks flushed, warm, reduced sweating
What spinal levels does the pudendal nerve come from?
S2,3,4
What does the pudendal nerve supply?
Somatic motor & somatic sensory to the structures of the perineum
What procedures can a pudendal nerve block be useful for?
Episiotomy incision
Forceps use
Perineal stitching post delivery
What is the pathofthe pudendalnerve?
Exits pelvis via the greater sciatic foramen
Passes posterior to sacrospinous ligament
Reenters pelvis/perineum via lesser sciatic foramen
Travels in pudendal canal
What direction do the external obliques run in?
Hands in pockets
What arteries supply the anterior abdominal wall?
Superior & inferior epigastric arteries
What are the advantages of a LSCS incision?
Don’t cut rectusmuscles just separate
Which incision might not heal well due to the lack of blood supply?
Laparotomy
What are you trying not to damage in a laparoscopy?
Inferior epigastric artery
What is the inferior epigastric artery a branch of?
External iliac
Where does the inferior epigastric artery emerge?
Just medial to DIR (halfway between ASIS & pubic tubercle)
How do you distinguish between the ureter & uterine artery in a hysterectomy?
“Water under the bridge”
Ureter will “vermiculate”
What are the 2 muscle groups of the pelvic floor?
Levator ani & coccygeus
What are the 3 parts of the levator ani?
Puborectalis
Pubococcygeus
Illiococcygeus
What can cause injurytothe pelvic floor?
Pregnancy & childbirth Chronic constipation Obesity Heavy lifting Chronic cough/sneeze
How does a vaginal prolapse tend to present?
Lump in vaginal wall
Dragging sensation
Dyspareunia
What are the different kinds of vaginal prolapse?
Urethrocoele
Cystocoele
Rectocoele
Enterocoele
What is there risk of damaging in sacrospinous fixation?
Pudendal NVB (runs around sacrospinous ligament) and sciatic nerve
Where are there anastamoses in the pelvis?
Between uterine & ovarian artery also between uterine & vaginal artery
Where do most of the veins in the pelvis drain?
Internal iliac vein
Where does lymph from the superior pelvic viscera drain?
External iliac nodes
Where does lymph from the inferior pelvic viscera drain?
Internal iliac nodes
Where does lymph from the superficial perineum drain?
Superficial inguinal nodes
