Anatomy- female reproductive system and breast

Question 1

Define what is meant by the perineum

Answer 1

Area below levator ani

Question 2

What are the two pouches of the female peritoneum?

Answer 2

Recto-uterine pouch (of Douglas)

Vesico-uterine pouch

Question 3

What is the clinical significance of the pouch of Douglas?

Answer 3

Most inferior part of the peritoneal cavity- this is where abnormal fluid will collect in the anatomical position

Question 4

How can abnormal fluid collection in the pouch of douglas be drained?

Answer 4

Needle passed through the posterior fornix of the vagina

Question 5

Double layer of peritoneum extending between the uterus and lateral walls/floor of the pelvis, maintaining the midline position of the uterus

Answer 5

Broad ligament

Question 6

Round ligament

Answer 6

Extends from the lateral uterus (within the broad ligament) to the superficial tissue of the female perneum

Question 7

What structure does the round ligament pass through?

Answer 7

Deep inguinal ring

Question 8

Three structures which help maintain the position of the uterus and prevent prolapse

Answer 8

Pelvic floor muscles
Uterosacral ligaments
Endopelvic fascia

Question 9

Typical position of the uterus within the pelvis

Answer 9

Anterverted and anteflexed (over the bladder)

Question 10

Which area of the cervix is sampled during a smear test?

Answer 10

The squamocolumnar junction

Question 11

Where does fertilisation usually occur?

Answer 11

The ampulla (widest part) of the fallopian tubes

Question 12

How can tubal patency be tested during hysterosalpingogram?

Answer 12

Radio-opaque dye should spill out into the peritoneal cavity

Question 13

Which structures suspend the ovary in the pelvis?

Answer 13

The ovarian ligament

The ovarian suspensory ligament

Question 14

At its deepest part what does the vagina form?

Answer 14

Four fornices around the cervix

Question 15

What can be palpated during bimanual vaginal examination?

Answer 15

The ischial spines (laterally at 4 and 8 oclock)
Position of the uterus
The adnexae (for any mass/tenderness)

Question 16

What nerve supplies the pelvic diaphragm?

Answer 16

Nerve to levator ani from sacral plexus

Question 17

Which nerve roots form the sacral plexus?

Answer 17

S3, 4, 5

Question 18

Which nerve supplies the perineal muscles?

Answer 18

Pudendal nerve branches

Question 19

Bundle of collagennous and elastic tissue between the lower part of the vagina and anus

Answer 19

Perineal body

Question 20

Alternative name for Bartholins gland

Answer 20

Greater vestibular gland

Question 21

Describe the position of the breast bed

Answer 21

From ribs 2-6, lying on deep fascia above the pec. major and serratus anterior muscles

Question 22

Space lying between fascia and breast

Answer 22

Retromammary space

Question 23

Extension of the breast into the axilla

Answer 23

Axillary tail of Spence

Question 24

How is the position of a breast lump described?

Answer 24

By clock face position, or quadrant e.g. upper inner

Question 25

What feature of any breast lump should be assessed by asking the patient to stand with hands firmly on hip?

Answer 25

Fixation of lump to underlying tissues

Question 26

Where does 75% of lymph from the breast drain to?

Answer 26

The ipsilateral axillary nodes, and from there to the supraclavicular

Question 27

What might be the consequence of axillary node clearance?

Answer 27

Upper limb lymphoedema

Question 28

How are the “levels” of axillary lymph nodes described?

Answer 28

By their relationship to pectoralis minor:
Level 1- lateral and inferior
Level 2- deep
Level 3- medial and superior

Question 29

Blood supply to the breast

Answer 29

Laterally- branches of the axillary
Medially- branches of the internal thoracic
(similar pattern for venous drainage)