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3 REPRO > anatomy > Flashcards

anatomy Flashcards

1
Q

which spinal structure ends at S2

A

dura

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2
Q

what group of muscles attaches to ischial tuberosity

A

hamstrings (not short head of biceps)

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3
Q

ischiopubic ramus is the site of attachment for

A

external genitalia

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4
Q

which foramen is formed by the ischial and pubic rami

A

obturator foramen

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5
Q

how to differentiate male and female pelvis

A

pubic arch flares out more in female (wider subpubic angle)
pelvic cavity is shallower in females
pubic arch is thicker in males

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6
Q

list the joints of the pelvis

A 
sacroiliac joint 
hip joint (synovial)
pubic symphysis (secondary cartilaginous)
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7
Q

what makes the SI joint so stable

A

interosseous ligament

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8
Q

which is more stable; SI joint or pubic symphysis

A

SI joint because it is fibrous not cartilaginous

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9
Q

why is the pubic symphysis a cartilaginous joint

A

so it can stretch out in childbirth

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10
Q

PSIS is in line with which vertebral level

A

S2

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11
Q

the top of the iliac crest is at which vertebral level

A

L4

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12
Q

where does the inguinal ligament attach

A

the ASIS and the pubic tubercle

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13
Q

which nerve is associated with the sacrotuberous ligament

A

pudendal nerve

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14
Q

where is the sacrospinous ligament

A

sacrum and ischial spine

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15
Q

where is the sacrotuberous ligament

A

sacrum and ischial tuberosity

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16
Q

function of the macro-tuberous and -spinous ligaments

A

ensure the inferior part of the sacrum is not pushed superiorly when weight is suddenly transferred vertically through the vertebral column (eg jumping or during late pregnancy)

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17
Q

which two foramina do the pelvic ligaments form

A

greater and lesser sciatic foramina

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18
Q

what is the pelvic inlet made up of

A

sacral promontory
ilium
superior pubic ramus
pubic symphysis

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19
Q

what is the pelvic outlet made up of

A 
pubic symphysis 
ischiopubic ramus 
ischial tuberosities 
sacrotuberous ligaments 
coccyx
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20
Q

which muscle is also known as the pelvic floor

A

levator ani muscle

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21
Q

functions of bony pelvis

A

support of body when sitting and standing
transference of weight from spine to legs to allow standing and walking
attachment for muscles of locomotion and abdominal wall
attachment of external genitalia
protection of pelvic organs
passage for childbirth

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22
Q

what is moulding

A

movement of one bone over another to allow the foetal head to pass through the pelvis during labour

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23
Q

what is the vertex

A

an area of the foetal skull outline by the anterior and posterior fontanelles and the parietal eminences

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24
Q

which is longer; the occipitofrontal diameter or the biparietal diameter

A

occipitofrontal

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25
Q

which way should the foetus by facing when it enters the pelvic inlet and why

A

left or right
the transverse diameter of the pelvic inlet is wider than the AP diameter so the occipitofrontal diameter of the foetal head can fit through easier if it is sideways

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26
Q

what is the station

A

the distance of the foetal head from the ischial spines
-ve means superior
+ve mean inferior

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27
Q

what should happen to the baby’s head when it reaches the pelvic outlet and why

A

it should turn so it is in an occipitoanterior position

the AP diameter of the pelvic outlet is wider than the transverse diameter

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28
Q

why is there a further rotation after the baby’s head has been delivered

A

so the shoulders can fit through

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29
Q

which female reproductive organs are found in the pelvic cavity

A

ovaries
uterine tubes
uterus
superior part of vagina

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30
Q

which female reproductive organs are found in the perineum

A 
inferior part of vagina 
perineal muscles 
Bartholin's glands 
clitoris 
labia
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31
Q

which muscle group separates the perineum and pelvic cavity

A

pelvic diaphragm

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32
Q

which pouches are formed by the peritoneum in the female pelvic cavity

A

vesicouterine pouch

recto-uterine (pouch of Douglas

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33
Q

which structure forms the floor of the peritoneal cavity and the roof of the pelvic cavity

A

peritoneum

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34
Q

in which pouch is fluid most likely to collect in the anatomical position

A

pouch of Douglas

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35
Q

how can fluid in the pouch of Douglas be drained

A

culdocentesis

fluid drained via a needle passed through the posterior fornix of the vagina

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36
Q

buzzword with regards to uterine ligaments

“double layer of peritoneum’

A

broad ligament

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37
Q

buzzword with regard to uterine ligaments

“embryological remnant”

A

round ligament

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38
Q

where is the broad ligament found

A

extending between the uterus and the lateral walls of the pelvis

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39
Q

function of the broad ligament

A

maintains the uterus in its correct midline position

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40
Q

what is contained within the broad ligament

A

uterine tubes

proximal part of the round ligament

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41
Q

where is the round ligament found

A

attaches to the lateral aspect of the uterus

passes through the deep inguinal ring to attach to the superficial tissue of the female perineum

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42
Q

what are the three layers of the uterus

A

permetirum
myometrium
endometrium

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43
Q

which uterine layer is shed during menstruation

A

endometrium

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44
Q

where does implantation of the zygote occur

A

body of uterus

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45
Q

what is an ectopic pregnancy

A

implantation not in the body of the uterus

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46
Q

what are the 3 layers of support holding the uterus in place

A 
strong ligaments (eg uterosacral ligament 
endopelvic fascia 
muscles of the pelvic floor
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47
Q

what is a uterine prolapse

A

movement of the the uterus inferiorly

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48
Q

what is the most common position of the uterus

A 
anteverted (cervix tipped anteriorly relative to the axis of the vagina)
ante flexed (uterus ripped anteriorly relative to the axis of the cervix)
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49
Q

what is a normal variation of the position of the vagina

A

retroverted (cervix tipped posteriorly relative to the axis of the vagina)
retroflexed (uterus tipped posteriorly relative to the axis of the cervix)

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50
Q

where does fertilisation normally occur

A

in the ampulla of the Fallopian tubes

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51
Q

what is a bilateral salpingo-oophrectomy

A

removal of both uterine tubes and ovaries

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52
Q

how is there communication between the genital tract and the peritoneal cavity

A

the fimbriae at the end of the uterine tubes actually open in to the peritoneal cavity

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53
Q

what are the 4 parts of the vaginal fornix

A

anterior
posterior
2 lateral

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54
Q

where can the ischial spines be palpated

A

laterally at 4 and 8 o’clock

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55
Q

what is the perineum

A

shallow space between pelvic diaphragm and the skin

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56
Q

what are the openings of the pelvic floor

A

passage of distal parts of the alimentary, renal and reproductive tracts

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57
Q

what type of muscle is levator ani

A

skeletal muscle

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58
Q

nerve supply to levator ani

A

S3, 4, 5

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59
Q

what is the perineal body

A

bundle of collagenous and elastic tissue into which the perineal muscles attach

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60
Q

where is the bed of the breast located

A

from ribs 2-6

lateral border of the sternum to mid-axillary line

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61
Q

what structures lie deep to the breast

A

deep fascia

pec major and serrates anterior

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62
Q

what is the retromammary space

A

space between the fascia and breast

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63
Q

how does the breast tissue attach to the skin

A

suspensory ligaments

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64
Q

where does the majority of the breast lymph drain to

A

ipsilateral axillary lymph nodes and then to the supraclavicular nodes

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65
Q

where does lymph from the inner breast quadrants drain to

A

ipsilateral (or contralateral) parasternal lymph nodes and the to the supraclavicular nodes

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66
Q

what clinical implications are there of axillary node clearance and why

A

lymphedema of the upper limb

upper limb lymph also drains into the axillary lymph nodes

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67
Q

what are the levels used to describe the extent of axillary node clearance

A

level I - inferior and lateral to pec major
level II - deep to pec major
level III - superior and medial to pec major

68
Q

blood supply to the breasts

A

internal thoracic artery

axillary artery

69
Q

what are the male reproductive organs

A

testes

70
Q

what are the male accessory reproductive organs

A

vas deferens
seminal glands
prostate gland
penis

71
Q

what are the stages of the male lower urinary tract

A 
bladder 
internal urethral orifice 
internal urethral sphincter (involuntary)
prostatic urethra 
external urethral sphincter (voluntary)
spongy urethra 
external urethral orifice
72
Q

what makes up the trigone

A

2 ureteric orifices

internal urethral orifice

73
Q

which muscle forms the bladder wall

A

detrusor muscle

74
Q

what is the function of the internal urethral sphincter in males

A

contracts during ejaculation to prevent retrograde ejaculation

75
Q

where do the testes originate

A

on the posterior wall of the abdominal cavity

76
Q

which structures travel through the spermatic cord

A 
testicular artery
testicular vein
vas deferens 
lymphatic vessels 
autonomic nerves 
somatic nerves
77
Q

three layers of fascia covering the spermatic cord

A

external spermatic fascia
cremastueric fascia
internal spermatic fascia

78
Q

what is the name of the structure in which the testes sit

A

tunica vaginalis

79
Q

what are the two layers of the tunica vaginalis

A

parietal layer

visceral layer

80
Q

what is a hydrocele

A

excess fluid in the tunica vaginalis

81
Q

where is sperm produced

A

seminiferous tubules

82
Q

which muscle helps control the temperature of the testes

A

dartos muscle

83
Q

route of sperm out of the testes

A

rete testis
head of epididymis
vas deferens

84
Q

average volume of testes

A

12-25 ml

85
Q

venous drainage from testes

A

left testicular vein to left renal vein

right testicular vein to IVC

86
Q

arterial supply to testes

A

testicular arteries from lateral aspect of abdominal aorta

87
Q

what is the function of the seminal glands

A

produce seminal fluid, rich in fructose

88
Q

what is the function of the bulbourethral gland

A

mucus secretion
lubricates urethra
neutralises acidity

89
Q

where do most prostate cancers occur

A

peripheral zone

90
Q

route of sperm once it leaves the testes

A

spermatic cord passes trough the anterior abdominal wall within the inguinal canal to reach the pelvic cavity
travels superiorly, then poster-inferiorly to the bladder
vas deferent connects to the seminal duct to form ejaculatory duct
rights and left ejaculatory ducts join together within prostate and drain into urethra
urethra opens at the external urethral meatus

91
Q

where is the root of the penis attached

A

ischium of the pelvis

92
Q

what are the 3 cylinders of penile erectile tissue

A 
2x corpus cavernosum (contain deep arteries of penis)
corpus spongiosum (spongy urethra)
93
Q

what is contained within the superficial perineal pouch (male)

A 
bulb (corpus spongiosum, crura, corpus cavernosum)
associated muscles (bulbospongiosus and ischiocavernosus)
94
Q

blood supply to penis

A

deep arteries of the penis

branches from internal pudendal artery from internal iliac

95
Q

blood supply to scrotum

A

internal pudendal and branches of external iliac

96
Q

lymph drainage of scrotum and most of penis

A

superficial inguinal nodes

97
Q

lymph drainage of testes

A

lumbar nodes

98
Q

which types of nerves innervate structures in the pelvis

A

sympathetic, parasympathetic and visceral afferent

body cavity

99
Q

which types of nerves innervate structures in the perineum

A

somatic motor and sensory

body wall

100
Q

nerves that cause cramping

A

sympathetic/parasympathetic

under hormonal control

101
Q

nerves that cause uterine contraction

A

sympathetic/parasympathetic

under hormonal control

102
Q

nerves that cause pelvic floor muscle contraction

A

somatic motor

103
Q

nerves that receive sense pain from adnexae

A

visceral afferents

104
Q

nerves that sense pain from uterus

A

visceral afferents

105
Q

nerves that sense pain from the vagina

A 
visceral afferents (pelvic part)
somatic sensory (perineum)
106
Q

nerves that sense pain from the perineum

A

somatic sensory

107
Q

how does pain from the superior aspect of pelvic organs (touching the peritoneum) reach the CNS

A

visceral afferents run alongside sympathetic fibres
enter spinal cord between T11-L2
pain is perceived as suprapubic

108
Q

how does pain from the inferior aspect of pelvic organs (not touching peritoneum) reach the CNS

A

visceral afferents run alongside parasympathetic fibres
enter spinal cord levels S2, 3, 4
pain perceived in S2, 3, 5 dermatome (perineum)

109
Q

how pain from structures crossing from pelvis to perineum above levator ani reaches the CNS

A

visceral afferents run alongside parasympathetics

enter CNS at spinal cord levels S2, 3, 4

110
Q

how pain from structures crossing from pelvic to perineum below levator ani reaches the CNS

A

somatic sensory fibres in the pudendal nerve
enter spinal cord level S2, 3, 5
causes localised pain in the perineum

111
Q

what are the 2 important spinal levels for gynaecologist pain

A

T11-L2

S2-S4

112
Q

what level is anaesthetic injected into in spinal and epidural anaesthesia

A

L3-L4 region

113
Q

which layers does spinal anaesthetic pass through

A 
supraspinous ligament 
interspinous ligament 
ligamentum flavum 
epidural space 
dura mater 
arachnoid mater 
SAS
114
Q

which layers does epidural anaesthetic pass through

A

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space

115
Q

arterioles are supplied by which type of nerves fibres

A

sympathetic fibres

116
Q

what does blockade of sympathetic tone to all arterioles in the lower limb result in

A

vasodilatation

skin of lower limbs looks flushed, warm lower limbs, reduced sweating

117
Q

route of pudendal nerve

A

exits pelvis via greater sciatic foramen
passes posterior to sacrospinous ligament
re-enters pelivs/perineum via lesser sciatic foramen
travel in pudendal canal

118
Q

which bony landmark is used to administer pudendal nerve block

A

ischial spine

119
Q

which ligament is closely associated with the pudendal nerve

A

sacrospinous ligament

120
Q

what can damage to the pudendal nerve or external anal sphincter during childbirth result in

A

weakened pelvic floor

faecal incontinence

121
Q

the urogenital system arises from which embryological origin

A

intermediate mesoderm

122
Q

mesonephric duct aka

A

wollfian

123
Q

paramesonephric duct aka

A

mullerian

124
Q

weeks 4-6 sexual characteristics

A

wollfian and mullerian duct formation

indifferent gonad

125
Q

what hormone do Sertoli cells secrete in the presence of SRY protein

A

anti-mullerian hormone

126
Q

what is the function of anti-mullerian hormone

A

degeneration of the paramesonephric duct

127
Q

how do Sertoli cells influence the formation of leading cells

A

stimulate gonadal ridge cells to form testosterone secreting leading cells

128
Q

formation of which structures induced by the presence of testosterone (embryology)

A

epididymis, vas deferens, seminal vesicles

129
Q

what is the function of dihydrotestosterone

A

induces male specific external genitalia development and prostate

130
Q

what causes persistent mullerian duct syndrome

A

mutations of anti-mullerian hormone or its receptors

131
Q

how does persistent mullein duct syndrome present

A

uterus, vagina and uterine tubes
testes in ovarian location
male external genitalia

132
Q

what spinal level do testes originate

A

T10

133
Q

which structures pulls the testes caudally

A

gubernaculum

134
Q

what is the commonest uterine abnormality

A

septated uterus

135
Q

what are the three components that make up the pelvic floor

A

pelvic diaphragm
muscles of perineal pouches
perineal membrane

136
Q

whats the deepest layer of the pelvic floor

A

pelvic diaphragm

137
Q

which muscle groups make up the pelvic floor

A

levator ani

coccygeus

138
Q

three parts of levator ani

A

puborectalis
pubococcygeus
iliococcygeus

139
Q

attachments of levator ani

A

pubic bones, ischial spines and tendinous arch of levator ani
perineal body, coccyx and walls of organ in midline

140
Q

which structures form the roof and floor of the deep perineal pouch

A 
roof = levator ani
floor = pelvic membrane
141
Q

what lies within the deep perineal pouch

A 
part of urethra (and vagine)
bulbourethral glands (male)
neuromuscular bundle for penis/clitoris (dorsal vein of clitoris/penis)
extensions of sischioanal fat pads
external urethral sphincter 
compressor urethrae 
deep transverse perineal muscle (male)
142
Q

what is contained in the male superficial perineal pouch

A 
bulb and corpus spongiosum
crura and corpus cavernosum
bulbospongiosus
ischiocavernosus
spongy urethra 
superficial transverse perineal muscle 
internal pudendal vessels and pudendal nerve
143
Q

what is contained in the superficial perineal pouch (female)

A

clitoris and crura (corpus cavernosum)
bulbs of vestibule
bulbospongisus
ischiocavernosus

144
Q

common O&G surgical incisions

A

vertical midline incision

pfannenstiel incision

145
Q

what are the layers of the anterolateral abdominal wall

A 
skin
superficial fascia 
rectus sheath 
external oblique 
internal oblique 
rectus abdominis 
transversus abdominis
146
Q

attachments of the external obliques

A

attach between the lower ribs and iliac crest, pubic tubercle and linea alba

147
Q

attachments of the internal obliques

A

attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba

148
Q

attachments of traversus abdominis

A

attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba

149
Q

what is the nerve supply to the anterolateral abdominal wall

A

7th-11th intercostal nerves (thoracoabdominal nerves)
subcostal (T12)
iliohypogastric (L1)
ilioinguinal (L1)

150
Q

in which plane does the nerve supply to the anterolateral abdominal wall travel

A

between internal oblique and traverses abdominis

151
Q

blood supply to the anterior abdominal wall

A

superior epigastric arteries

inferior epigastric arteries

152
Q

from which artery does the superior epigastric artery emerge

A

internal thoracic

153
Q

from which artery does the inferior epigastric artery emerge

A

external iliac artery

154
Q

blood supply to the lateral abdominal wall

A

intercostal and subcostal arteries

155
Q

from which arteries do the intercostal and subcostal arteries arise

A

posterior intercostal arteries

156
Q

which muscle do the superior and inferior epigastric arteries lie posterior to

A

rectus abdominis

157
Q

how can traumatic injury to muscle be minimised when making an incision

A

incise in same direction as muscle fibre

158
Q

layers incised through in an LSCS incision

A 
skin and fascia 
anterior rectus sheath 
rectus abdominis (separate muscles laterally)
fascia and peritoneum
retract bladder 
uterine wall
amniotic sac
159
Q

layers to stitch closed after LSCS

A

uterine wall with visceral peritoneum
rectus sheath
fascial layer if increased BMI
skin

160
Q

layers when opening a laparotomy (vertical midline incision)

A

skin and fascia
linea alba
peritoneum

161
Q

layers to stitch closed in a laparotomy

A

peritoneum and linea alba
fascia if increased BMI
skin

162
Q

why might healing of a midline incision be poor

A

limited blood supply

163
Q

complications of middle incision

A

dehiscence

incisional hernia

164
Q

how to avoid inferior epigastric artery when localising a lateral port

A

outer third of the line from umbilicus and ASIS

165
Q

how to distinguish between uterine artery and ureter

A

the ureter passes inferior to the artery

‘water under the bridge’

166
Q

which incision is often used in an abdominal hysterectomy

A

pfannenstiel

same as LSCS

3 REPRO (40 decks)

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