anatomy Flashcards
1
Q
which spinal structure ends at S2
A
dura
2
Q
what group of muscles attaches to ischial tuberosity
A
hamstrings (not short head of biceps)
3
Q
ischiopubic ramus is the site of attachment for
A
external genitalia
4
Q
which foramen is formed by the ischial and pubic rami
A
obturator foramen
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
6
Q
list the joints of the pelvis
A
sacroiliac joint hip joint (synovial) pubic symphysis (secondary cartilaginous)
7
Q
what makes the SI joint so stable
A
interosseous ligament
8
Q
which is more stable; SI joint or pubic symphysis
A
SI joint because it is fibrous not cartilaginous
9
Q
why is the pubic symphysis a cartilaginous joint
A
so it can stretch out in childbirth
10
Q
PSIS is in line with which vertebral level
A
S2
11
Q
the top of the iliac crest is at which vertebral level
A
L4
12
Q
where does the inguinal ligament attach
A
the ASIS and the pubic tubercle
13
Q
which nerve is associated with the sacrotuberous ligament
A
pudendal nerve
14
Q
where is the sacrospinous ligament
A
sacrum and ischial spine
15
Q
where is the sacrotuberous ligament
A
sacrum and ischial tuberosity
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)
17
Q
which two foramina do the pelvic ligaments form
A
greater and lesser sciatic foramina
18
Q
what is the pelvic inlet made up of
A
sacral promontory
ilium
superior pubic ramus
pubic symphysis
19
Q
what is the pelvic outlet made up of
A
pubic symphysis ischiopubic ramus ischial tuberosities sacrotuberous ligaments coccyx
20
Q
which muscle is also known as the pelvic floor
A
levator ani muscle
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
22
Q
what is moulding
A
movement of one bone over another to allow the foetal head to pass through the pelvis during labour
23
Q
what is the vertex
A
an area of the foetal skull outline by the anterior and posterior fontanelles and the parietal eminences
24
Q
which is longer; the occipitofrontal diameter or the biparietal diameter
A
occipitofrontal
25
which way should the foetus by facing when it enters the pelvic inlet and why
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
26
what is the station
the distance of the foetal head from the ischial spines
-ve means superior
+ve mean inferior
27
what should happen to the baby's head when it reaches the pelvic outlet and why
it should turn so it is in an occipitoanterior position
| the AP diameter of the pelvic outlet is wider than the transverse diameter
28
why is there a further rotation after the baby's head has been delivered
so the shoulders can fit through
29
which female reproductive organs are found in the pelvic cavity
ovaries
uterine tubes
uterus
superior part of vagina
30
which female reproductive organs are found in the perineum
```
inferior part of vagina
perineal muscles
Bartholin's glands
clitoris
labia
```
31
which muscle group separates the perineum and pelvic cavity
pelvic diaphragm
32
which pouches are formed by the peritoneum in the female pelvic cavity
vesicouterine pouch
| recto-uterine (pouch of Douglas
33
which structure forms the floor of the peritoneal cavity and the roof of the pelvic cavity
peritoneum
34
in which pouch is fluid most likely to collect in the anatomical position
pouch of Douglas
35
how can fluid in the pouch of Douglas be drained
culdocentesis
| fluid drained via a needle passed through the posterior fornix of the vagina
36
buzzword with regards to uterine ligaments
| "double layer of peritoneum'
broad ligament
37
buzzword with regard to uterine ligaments
| "embryological remnant"
round ligament
38
where is the broad ligament found
extending between the uterus and the lateral walls of the pelvis
39
function of the broad ligament
maintains the uterus in its correct midline position
40
what is contained within the broad ligament
uterine tubes
| proximal part of the round ligament
41
where is the round ligament found
attaches to the lateral aspect of the uterus
| passes through the deep inguinal ring to attach to the superficial tissue of the female perineum
42
what are the three layers of the uterus
permetirum
myometrium
endometrium
43
which uterine layer is shed during menstruation
endometrium
44
where does implantation of the zygote occur
body of uterus
45
what is an ectopic pregnancy
implantation not in the body of the uterus
46
what are the 3 layers of support holding the uterus in place
```
strong ligaments (eg uterosacral ligament
endopelvic fascia
muscles of the pelvic floor
```
47
what is a uterine prolapse
movement of the the uterus inferiorly
48
what is the most common position of the uterus
```
anteverted (cervix tipped anteriorly relative to the axis of the vagina)
ante flexed (uterus ripped anteriorly relative to the axis of the cervix)
```
49
what is a normal variation of the position of the vagina
retroverted (cervix tipped posteriorly relative to the axis of the vagina)
retroflexed (uterus tipped posteriorly relative to the axis of the cervix)
50
where does fertilisation normally occur
in the ampulla of the Fallopian tubes
51
what is a bilateral salpingo-oophrectomy
removal of both uterine tubes and ovaries
52
how is there communication between the genital tract and the peritoneal cavity
the fimbriae at the end of the uterine tubes actually open in to the peritoneal cavity
53
what are the 4 parts of the vaginal fornix
anterior
posterior
2 lateral
54
where can the ischial spines be palpated
laterally at 4 and 8 o'clock
55
what is the perineum
shallow space between pelvic diaphragm and the skin
56
what are the openings of the pelvic floor
passage of distal parts of the alimentary, renal and reproductive tracts
57
what type of muscle is levator ani
skeletal muscle
58
nerve supply to levator ani
S3, 4, 5
59
what is the perineal body
bundle of collagenous and elastic tissue into which the perineal muscles attach
60
where is the bed of the breast located
from ribs 2-6
| lateral border of the sternum to mid-axillary line
61
what structures lie deep to the breast
deep fascia
| pec major and serrates anterior
62
what is the retromammary space
space between the fascia and breast
63
how does the breast tissue attach to the skin
suspensory ligaments
64
where does the majority of the breast lymph drain to
ipsilateral axillary lymph nodes and then to the supraclavicular nodes
65
where does lymph from the inner breast quadrants drain to
ipsilateral (or contralateral) parasternal lymph nodes and the to the supraclavicular nodes
66
what clinical implications are there of axillary node clearance and why
lymphedema of the upper limb
| upper limb lymph also drains into the axillary lymph nodes
67
what are the levels used to describe the extent of axillary node clearance
level I - inferior and lateral to pec major
level II - deep to pec major
level III - superior and medial to pec major
68
blood supply to the breasts
internal thoracic artery
| axillary artery
69
what are the male reproductive organs
testes
70
what are the male accessory reproductive organs
vas deferens
seminal glands
prostate gland
penis
71
what are the stages of the male lower urinary tract
```
bladder
internal urethral orifice
internal urethral sphincter (involuntary)
prostatic urethra
external urethral sphincter (voluntary)
spongy urethra
external urethral orifice
```
72
what makes up the trigone
2 ureteric orifices
| internal urethral orifice
73
which muscle forms the bladder wall
detrusor muscle
74
what is the function of the internal urethral sphincter in males
contracts during ejaculation to prevent retrograde ejaculation
75
where do the testes originate
on the posterior wall of the abdominal cavity
76
which structures travel through the spermatic cord
```
testicular artery
testicular vein
vas deferens
lymphatic vessels
autonomic nerves
somatic nerves
```
77
three layers of fascia covering the spermatic cord
external spermatic fascia
cremastueric fascia
internal spermatic fascia
78
what is the name of the structure in which the testes sit
tunica vaginalis
79
what are the two layers of the tunica vaginalis
parietal layer
| visceral layer
80
what is a hydrocele
excess fluid in the tunica vaginalis
81
where is sperm produced
seminiferous tubules
82
which muscle helps control the temperature of the testes
dartos muscle
83
route of sperm out of the testes
rete testis
head of epididymis
vas deferens
84
average volume of testes
12-25 ml
85
venous drainage from testes
left testicular vein to left renal vein
| right testicular vein to IVC
86
arterial supply to testes
testicular arteries from lateral aspect of abdominal aorta
87
what is the function of the seminal glands
produce seminal fluid, rich in fructose
88
what is the function of the bulbourethral gland
mucus secretion
lubricates urethra
neutralises acidity
89
where do most prostate cancers occur
peripheral zone
90
route of sperm once it leaves the testes
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
where is the root of the penis attached
ischium of the pelvis
92
what are the 3 cylinders of penile erectile tissue
```
2x corpus cavernosum (contain deep arteries of penis)
corpus spongiosum (spongy urethra)
```
93
what is contained within the superficial perineal pouch (male)
```
bulb (corpus spongiosum, crura, corpus cavernosum)
associated muscles (bulbospongiosus and ischiocavernosus)
```
94
blood supply to penis
deep arteries of the penis
| branches from internal pudendal artery from internal iliac
95
blood supply to scrotum
internal pudendal and branches of external iliac
96
lymph drainage of scrotum and most of penis
superficial inguinal nodes
97
lymph drainage of testes
lumbar nodes
98
which types of nerves innervate structures in the pelvis
sympathetic, parasympathetic and visceral afferent
| body cavity
99
which types of nerves innervate structures in the perineum
somatic motor and sensory
| body wall
100
nerves that cause cramping
sympathetic/parasympathetic
| under hormonal control
101
nerves that cause uterine contraction
sympathetic/parasympathetic
| under hormonal control
102
nerves that cause pelvic floor muscle contraction
somatic motor
103
nerves that receive sense pain from adnexae
visceral afferents
104
nerves that sense pain from uterus
visceral afferents
105
nerves that sense pain from the vagina
```
visceral afferents (pelvic part)
somatic sensory (perineum)
```
106
nerves that sense pain from the perineum
somatic sensory
107
how does pain from the superior aspect of pelvic organs (touching the peritoneum) reach the CNS
visceral afferents run alongside sympathetic fibres
enter spinal cord between T11-L2
pain is perceived as suprapubic
108
how does pain from the inferior aspect of pelvic organs (not touching peritoneum) reach the CNS
visceral afferents run alongside parasympathetic fibres
enter spinal cord levels S2, 3, 4
pain perceived in S2, 3, 5 dermatome (perineum)
109
how pain from structures crossing from pelvis to perineum above levator ani reaches the CNS
visceral afferents run alongside parasympathetics
| enter CNS at spinal cord levels S2, 3, 4
110
how pain from structures crossing from pelvic to perineum below levator ani reaches the CNS
somatic sensory fibres in the pudendal nerve
enter spinal cord level S2, 3, 5
causes localised pain in the perineum
111
what are the 2 important spinal levels for gynaecologist pain
T11-L2
| S2-S4
112
what level is anaesthetic injected into in spinal and epidural anaesthesia
L3-L4 region
113
which layers does spinal anaesthetic pass through
```
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
dura mater
arachnoid mater
SAS
```
114
which layers does epidural anaesthetic pass through
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
115
arterioles are supplied by which type of nerves fibres
sympathetic fibres
116
what does blockade of sympathetic tone to all arterioles in the lower limb result in
vasodilatation
| skin of lower limbs looks flushed, warm lower limbs, reduced sweating
117
route of pudendal nerve
exits pelvis via greater sciatic foramen
passes posterior to sacrospinous ligament
re-enters pelivs/perineum via lesser sciatic foramen
travel in pudendal canal
118
which bony landmark is used to administer pudendal nerve block
ischial spine
119
which ligament is closely associated with the pudendal nerve
sacrospinous ligament
120
what can damage to the pudendal nerve or external anal sphincter during childbirth result in
weakened pelvic floor
| faecal incontinence
121
the urogenital system arises from which embryological origin
intermediate mesoderm
122
mesonephric duct aka
wollfian
123
paramesonephric duct aka
mullerian
124
weeks 4-6 sexual characteristics
wollfian and mullerian duct formation
| indifferent gonad
125
what hormone do Sertoli cells secrete in the presence of SRY protein
anti-mullerian hormone
126
what is the function of anti-mullerian hormone
degeneration of the paramesonephric duct
127
how do Sertoli cells influence the formation of leading cells
stimulate gonadal ridge cells to form testosterone secreting leading cells
128
formation of which structures induced by the presence of testosterone (embryology)
epididymis, vas deferens, seminal vesicles
129
what is the function of dihydrotestosterone
induces male specific external genitalia development and prostate
130
what causes persistent mullerian duct syndrome
mutations of anti-mullerian hormone or its receptors
131
how does persistent mullein duct syndrome present
uterus, vagina and uterine tubes
testes in ovarian location
male external genitalia
132
what spinal level do testes originate
T10
133
which structures pulls the testes caudally
gubernaculum
134
what is the commonest uterine abnormality
septated uterus
135
what are the three components that make up the pelvic floor
pelvic diaphragm
muscles of perineal pouches
perineal membrane
136
whats the deepest layer of the pelvic floor
pelvic diaphragm
137
which muscle groups make up the pelvic floor
levator ani
| coccygeus
138
three parts of levator ani
puborectalis
pubococcygeus
iliococcygeus
139
attachments of levator ani
pubic bones, ischial spines and tendinous arch of levator ani
perineal body, coccyx and walls of organ in midline
140
which structures form the roof and floor of the deep perineal pouch
```
roof = levator ani
floor = pelvic membrane
```
141
what lies within the deep perineal pouch
```
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
what is contained in the male superficial perineal pouch
```
bulb and corpus spongiosum
crura and corpus cavernosum
bulbospongiosus
ischiocavernosus
spongy urethra
superficial transverse perineal muscle
internal pudendal vessels and pudendal nerve
```
143
what is contained in the superficial perineal pouch (female)
clitoris and crura (corpus cavernosum)
bulbs of vestibule
bulbospongisus
ischiocavernosus
144
common O&G surgical incisions
vertical midline incision
| pfannenstiel incision
145
what are the layers of the anterolateral abdominal wall
```
skin
superficial fascia
rectus sheath
external oblique
internal oblique
rectus abdominis
transversus abdominis
```
146
attachments of the external obliques
attach between the lower ribs and iliac crest, pubic tubercle and linea alba
147
attachments of the internal obliques
attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba
148
attachments of traversus abdominis
attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba
149
what is the nerve supply to the anterolateral abdominal wall
7th-11th intercostal nerves (thoracoabdominal nerves)
subcostal (T12)
iliohypogastric (L1)
ilioinguinal (L1)
150
in which plane does the nerve supply to the anterolateral abdominal wall travel
between internal oblique and traverses abdominis
151
blood supply to the anterior abdominal wall
superior epigastric arteries
| inferior epigastric arteries
152
from which artery does the superior epigastric artery emerge
internal thoracic
153
from which artery does the inferior epigastric artery emerge
external iliac artery
154
blood supply to the lateral abdominal wall
intercostal and subcostal arteries
155
from which arteries do the intercostal and subcostal arteries arise
posterior intercostal arteries
156
which muscle do the superior and inferior epigastric arteries lie posterior to
rectus abdominis
157
how can traumatic injury to muscle be minimised when making an incision
incise in same direction as muscle fibre
158
layers incised through in an LSCS incision
```
skin and fascia
anterior rectus sheath
rectus abdominis (separate muscles laterally)
fascia and peritoneum
retract bladder
uterine wall
amniotic sac
```
159
layers to stitch closed after LSCS
uterine wall with visceral peritoneum
rectus sheath
fascial layer if increased BMI
skin
160
layers when opening a laparotomy (vertical midline incision)
skin and fascia
linea alba
peritoneum
161
layers to stitch closed in a laparotomy
peritoneum and linea alba
fascia if increased BMI
skin
162
why might healing of a midline incision be poor
limited blood supply
163
complications of middle incision
dehiscence
| incisional hernia
164
how to avoid inferior epigastric artery when localising a lateral port
outer third of the line from umbilicus and ASIS
165
how to distinguish between uterine artery and ureter
the ureter passes inferior to the artery
| 'water under the bridge'
166
which incision is often used in an abdominal hysterectomy
pfannenstiel
| same as LSCS
