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3 REPRO > clinical anatomy > Flashcards

clinical anatomy Flashcards

1
Q

which bones make up the pelvis

A

midline sacrum
coccyx
hip bones (ilium, ischium and pubic bone)

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2
Q

functions of the pelvis

A

support of the upper body when standing and sitting
transference of weight from one long pole to two poles
attachment for muscle of locomotion and abdominal wall
protection of pelvic organs, blood and nerve supply etc
attachment for external genitalia
passage for childbirth

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3
Q

what are the boundaries of the true pelvis

A

superiorly: pelvic inlet
inferiorly: pelvic outlet

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4
Q

what makes up the pelvic inlet

A

sacral promontory of S!
alas of the sacrum
arcuate line of the ilium
pectineal line and pubic crest of the pubic bone

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5
Q

what are the borders of the pelvic outlet

A

the tip of the coccyx posteriorly
the inferior margin of the sacrotuberous ligament posterolaterally
the ischial tuberosities laterally
the pubic arch anteriorly

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6
Q

which diameter is wider at the pelvic inlet

A

transverse

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7
Q

which diameter is wider at the pelvic outlet

A

AP

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8
Q

what are the two most important pelvic ligaments

A

sacrospinous

sacrotuberous

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9
Q

where does the sacrospinous ligament attach

A

sacrum and ischial spine

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10
Q

where does the sacrotuberous ligament attach

A

ischial tuberosity and sacrum

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11
Q

features of a male pelvis

A 
thick, robust bone 
narrow, deep pelvis 
heart-shaped, narrow pelvic inlet
small pelvic outlet 
narrow subpubic angle 
round obturator foramen 
narrow greater sciatic notch
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12
Q

features of a female pelvis

A 
thin, light bone
wide, shallow pelvis
rounded, wide pelvic inlet
large pelvic outlet 
wide subpubic angle 
oval obturator foramen 
90 degree greater sciatic notch
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13
Q

where do pelvic fractures most commonly occur

A 
weaker areas 
pubic rami
acetabulum
sacroiliac joints 
alae of the ilium
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14
Q

which structures can be damaged in a pelvic fracture

A 
iliac vessel and their branches 
nerves of the lumbosacral plexus 
autonomic nerve supply 
lymphatic drainage 
muscles (pelvic floor, lateral pelvic walls, thigh, gluteal region, abdominal wall)
pelvic organs
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15
Q

palpable bony landmarks of the ilium

A

ASIS (and inguinal ligament)
iliac crest
PSIS

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16
Q

palpable bony landmarks of the ischium

A 
ischial tuberosities 
ischiopubic ramus (deep)
ischial spines (internal examination)
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17
Q

palpable bony landmarks of the pubic bone

A

pubic symphysis
pubic tubercle
ischiopubic ramus

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18
Q

palpable bony landmarks of the sacrum

A

median sacral crest
inferolateral angle
sacral hiatus
sacral promontory (internal examination)

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19
Q

what were roots make up the pudendal nerve

A

S2-4

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20
Q

what are the modalities of the pudendal nerve

A

sensory, sympathetic and somatic motor to the area and structures of the perineum

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21
Q

describe the clinically relevant course of the pudendal nerve (and its implication)

A

the nerve crosses the lateral aspect of the sacrospinous ligament, near its attachment to the ischial spine
injection of the pudendal nerve block near the ischial spine

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22
Q

which fontanelle is largest

A

anterior

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23
Q

what is the vertex

A

an area of the fatal skull bounded by the anterior and posterior fontanelles and the parietal eminences

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24
Q

which fontanelles are covered by the temporals muscle

A

sphenoidal and mastoid fontanelles

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25
Q

what is moulding

A

change of the shape of the skull during labour

bones pass over each other to allow passage through pelvis

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26
Q

what direction should the baby face when entering the pelvic inlet and why

A

left or right

the AP diameter of the babies head should line up with the transverse diameter of the pelvis

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27
Q

when descending through the pelvic cavity, what movements should the baby’s head make

A

rotate and flex

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28
Q

what is the preferred presentation when leaving the pelvic outlet

A

occipitoanterior

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29
Q

why is there a final rotation after the head has been delivered

A

to allow the shoulders and rest of the body to be delivered

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30
Q

how long does the anterior fontanelle remain open

A

18-24 months

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31
Q

when does the posterior fontanelle close

A

12 months

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32
Q

which fetal skull features are palpable in OA presentation

A

posterior fontanelle
sagittal suture
vertex
anterior fontanelle

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33
Q

which foetal skull features are palpable in OP presentation

A

anterior fontanelle

orbital margins

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34
Q

which fossa lies either side of the anal canal

A

ischio-anal fossa

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35
Q

where does the ischiopubic ramus pass

A

from the ischial tuberosity to the inferior aspect of the pubic body

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36
Q

which muscle passes though the greater sciatic foramen

A

piriformis (to attach to the greater trochanter)

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37
Q

which neuromuscular structures pass through the greater sciatic foramen

A

sciatic nerve

gluteal neurovascular bundles

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38
Q

what structure separates the deep and superficial perineal pouches

A

perineal membrane

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39
Q

why is the perineal membrane stronger in males

A

to support the penis

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40
Q

where does the perineal membrane attach

A

ischiopubic rami

perineal body

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41
Q

what is contained in the deep perineal pouch

A

deep layer of fascia
external urethral sphincter and deep transverse perineal muscle
perineal membrane

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42
Q

what is contained in the superficial perineal pouch

A

external genitalia

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43
Q

what is an episiotomy

A

a deliberate incision of the vagina and pelvic floor to prevent vaginal tears extending towards the rectum

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44
Q

where does the episiotomy incision commence

A

fourchette (small, transverse fold where the labia minora meet)
incision usually goes posterolateral

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45
Q

which muscle forms the lateral wall of the ischia-anal fossa

A

obturator internus

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46
Q

what does a pudendal nerve block do

A

local anaesthesia over dermatomes S2-S4

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47
Q

why might the facial nerve be damaged during labour

A

the fetal skull has no mastoid process, so there is no protection for the facial nerve emerging from the stylomastoid foramen
it can therefore be injured during forceps delivery

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48
Q

how can labour cause Klumpke’s palsy

A

if the arm is delivered first, and pulled to speed delivery, it can be moved into forced abduction resulting in traction on the lower trunk of the brachial plexus (C8 and T1)

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49
Q

how does Klumpke’s palsy present

A

loss of function of all small muscles in the hand

clawing of the fingers and sensory loss of the medial aspect of the upper limb

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50
Q

how can labour cause Erb’s palsy

A

if the head is derived but the shoulders are stuck, pulling on the head can put traction on the upper trunk of the brachial plexus (C5 and C6)

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51
Q

how does Erb’s palsy present

A

adduction and internal rotation of the arm at the shoulder
extension and pronation at the elbow
sensory loss of the lateral aspect of the upper limb

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52
Q

why might a women have a temporary foot drop after labour

A

too much time spent in a lithotomy position can cause neuropraxia of the common fibular nerve

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53
Q

what are the primary curvatures of the spine

A

thorax and sacrum

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54
Q

what are the secondary curvatures of the spine

A

cervical and lumbar

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55
Q

where does the adult spinal cord end

A

L1/L2

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56
Q

what anatomical structures does the needle pass through for a spinal anaesthetic

A 
ski
SC fat
supraspinous ligament 
interspinous ligament 
ligamentum flavum 
epidural space 
dura mater 
arachnoid mater in SAS
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57
Q

complications of spinal anaesthetic

A

post-spinal headache

respiratory arrest if reaches the cervical cord

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58
Q

what is the epidural space

A

potential space between the dura mater and the overlying bones and ligaments of the vertebral canal

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59
Q

where is the needle inserted for spinal/epidural anaesthetic

A

L3/4

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60
Q

what is the difference in onset between spinal and epidural anaesthetic

A 
spinal = fast acting 
epidural = slow acting
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61
Q

nerve supply to the vulva

A 
anterior = L1 via ilioinguinal
posterior = S2,3,4 via pudendal
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62
Q

describe the route of the afferents from the body and fundus of the uterus

A

travel with sympathetic and reach the spinal cord at T10-L2

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63
Q

nerve supply of the vagina

A

S2,3,4 via pudendal nerve

64
Q

which vertebral levels must be blocked during the first stage of labour

A

T10-L1

65
Q

which vertebral levels must be blocked int he 2nd stage of labour

A

S2-S5

66
Q

what position should the patient be in for spinal anaesthetic

A

head lowered, to curve the lumber spines and increase the IV space

67
Q

surface anatomy of the point of needle insertion for spinal anaesthetic

A

the plane between the two superior aspects of the iliac crests passes through the spinous process of L4

68
Q

what is the function of the darts muscle

A

to raise the testis closer to the body in cold conditions

69
Q

what is normal testicular volume

A

12-25 ml

70
Q

where does the epididymis lie

A

posterolateral border of the testis

71
Q

should the epididymis be palpable

A

normally it is difficult to palpate

if there is an obstruction it may be palpable

72
Q

what are the functions of the testis

A

spermatogenesis

secretion of testosterone

73
Q

what is the tunica albuginea

A

a tough fibrous capsule surrounding the testis

74
Q

what is the tunica vaginalis

A

a double layer of peritoneum that encloses the testis and epididymis in the scrotum

75
Q

what is a hydrocele

A

a collection of fluid between the parietal and visceral layers of the tunica vaginalis

76
Q

what are the three parts of the epididymis

A

head, body and tail

77
Q

where does the epididymis become the vas deferens

A

at the inferior pole of the testis the tail of the epididymis becomes the vas

78
Q

where does the vas deferens lie in relation to the epididymis

A

medial on the posterior aspect of the testis

79
Q

describe the course of the vas deferens from the scrotum into the pelvis

A

ascends within scrotum, through the spermatic cord to enter superficial inguinal ring
though inguinal canal and exits via the deep inguinal ring, lateral to the inferior epigastric artery
passed above and medial to the ureter as it descends into pelvis to meet seminal vesicle to form ejaculatory duct

80
Q

blood supply to the vas

A

artery to the vas, derived from the superior vesical artery

81
Q

which ducts lie laterally to the urethral crest

A

many prostatic ducts

seminal colliculus/veru montanum

82
Q

what is the seminal colliculus

A

opening of the ejaculatory ducts

83
Q

prostatic bloody supply

A

branches of the inferior vesical artery

drained by a plexus of prostatic veins to internal iliac

84
Q

how can tumour spread from the prostate

A

through an anastomosis between the prostatic venous plexus and valveless veins of the internal vertebral plexus

85
Q

course of sperm

A

pass through vas, expelled into prostatic urethra along with secretions from seminal vesicles and prostate
propelled along membranous urethra, then penile (spongy) urethra

86
Q

function of seminal vesicles

A 
produce semen into ejaculatory duct
supply fructose
secrete prostaglandins (motility)
secrete fibrinogen (clot precursor)
87
Q

function of prostate gland

A

produces alkaline fluid (neutralised vaginal acidity)

produces clotting enzymes to clot semen within female

88
Q

function of bulbourethral glands

A

secrete mucus to act as lubricant

89
Q

what structures form the root of the penis proximally and the body of the penis distally

A

corpus spongiosum

corpora cavernosum

90
Q

where is the bulb of the penis attached

A

perineal membrane

91
Q

which muscle surrounds the corpus spongiosum

A

bulbospongiosus

92
Q

why does the corpus spongiosum have a thin surrounding fascia

A

to prevent occlusion of the urethra

93
Q

where do the corpora cavernosum attach

A

ischiopubic rami

94
Q

which muscle surrounds the corpora cavernosum

A

ischiocavernosus

95
Q

what does the expression ‘point and shoot’ mean

A

point
parasympathetic control blocks sympathetic vasoconstriction and allow increased blood flow to form erection
shoot
sympathetic control of muscles involved in ejaculation

96
Q

where do the testicular/ovarian arteries arise

A

L2 aorta

97
Q

where does lymph from the testis drain

A

para-aortic nodes

98
Q

why is testicular and ovarian pain referred to the peri-umbilical region

A

the autonomic nerve supply is derived from T10 and T11, the area that supplies the skin around the umbilicus

99
Q

where does the right testicular (and ovarian) vein drain to

A

IVC

100
Q

where does the left testicular (and ovarian) vein drain to

A

left renal vein

101
Q

varicocele is more common in which testis

A

left

102
Q

what are the 9 abdominal regions

A 
epigastrium 
left and right hypochondrium
peri-umbilical 
left and right lumbar/loin
suprapubic
left and right inguinal
103
Q

at what stage gestation does the uterine fundus become palpable

A

12 weeks

104
Q

the inguinal ligament is formed from the aponeurosis of which muscle

A

external oblique

105
Q

which hormone allows the female pelvic ligaments to relax during childbirth

A

relaxin

106
Q

why might the fundal height start to decrease from around 36 weeks gestation

A

the fetal head starts to descend into the pelvis

107
Q

how does symphysiofundal height relate to gestation

A

gestation = symphysiofundal height +/- 3 cm

108
Q

which two incisions can be used to access the pelvis

A

midline vertical

lower transverse

109
Q

the midline vertical incision is made through which structure
give an advantage and disadvantage of this type of access

A

linea alba
relatively avascular to rapid, bloodless access is achieved and it can be easily extended
lack of vascularity means healing is difficult and there is increased risk of wound dehiscence and hernia formation

110
Q

what type of surgery is a midline vertical incision more commonly used and why

A

gynaecological oncology operations

allows for wide surgical access

111
Q

what are the benefits of a lower transverse incision over a midline incision

A

better cosmetic outcome
less pain
lower incidence of hernia formation

112
Q

what are the disadvantages of lower transverse incision

A

access is slower
blood loss is greater
nerve injury is more frequent

113
Q

what type of surgery is a lower transverse incision often used for

A

c-section

114
Q

what structures are incised during a c-section

A 
skin
superficial fascia 
rectus sheath 
(rectus muscles are separated)
parietal peritoneum 
visceral peritoneum
uterus 
amniotic sac
115
Q

how is risk of damage to the bladder rescued during c-section

A

the patient is catheterised to reduce the size of the bladder

116
Q

what is the surface marking of the inferior epigastric artery

A

immediately medial to the deep inguinal ring at the midpoint of the inguinal ligament
the artery passes obliquely up the abdomen towards a point about 2-3 cm lateral to the umbilicus

117
Q

blood supply to the uterus

A

uterine arteries, branches of the internal iliac

uterine arteries anastomose with ovarian arteries which tend to supply the fundus

118
Q

what are likely sites of spread of ovarian cancer

A

GI tract
bladder
liver
spleen

119
Q

which nodes are likely to be involved in lymphatic spread of ovarian cancer

A

pelvic nodes

para-aortic nodes

120
Q

at which two sites does lymph from the pelvis converge

A

para-aortic or lumbar nodes

121
Q

what is the cisterns chyli

A

convergence of the lumbar lymph trunks that continues as the thoracic duct

122
Q

lymph drainage of rectum

A

sacral and internal iliac

123
Q

lymph drainage of anal canal

A 
internal iliac
(lower canal to superficial inguinal)
124
Q

lymph drainage of bladder

A

internal and external iliac

125
Q

lymph drainage of prostate and proximal urethra

A

internal iliac

126
Q

lymph drainage of distal, penile urethra, penis and clitoris

A

superficial inguinal

127
Q

lymph drainage of testis and ovaries

A

para-aortic

128
Q

lymph drainage of uterine tube, uterine fundus and upper uterine body

A

para-aortic

129
Q

lymph drainage of lower uterus, cervix and proximal vagina

A

internal and external iliac and sacral

130
Q

lymph drainage of distal vagina and vulva

A

superficial inguinal

131
Q

nerve supply of detrusor muscle

A

parasympathetics derived from the pelvic splanchnic nerves (s2,3,4)

132
Q

nerve supply to urethral smooth muscle

A

sympathetic nerves derived from the spinal cord at T10 to L2

descends to bladder via the hypogastric nerves

133
Q

nerve supply of pelvic floor

A

pudendal nerve S2,3,4

134
Q

what sensation maintains the micturition reflex and which nerve senses it

A

sensation of urine in the urethra is sensed by the pudendal nerve

135
Q

which surfaces of the bladder are covered by peritoneum

A

posterior and superior

136
Q

which structures are given the collective name ‘vulva’

A 
female urogenital triangle structures
mons pubis 
labia minora and majora 
vestibule 
vaginal orifice 
orifices of the vestibular glands 
clitoris
137
Q

what type of epithelium lines the vagina

A

stratified squamous

138
Q

blood suupply to the vagina and urethra

A

variable branches from the uterine, vaginal and internal pudendal arteries

139
Q

venous drainage of the urethra and vagina

A

vaginal plexus, draining to the internal iliac veins

140
Q

structures supporting the cervix and upper vagina

A

uterosacral, transverse cervical and pubocervical ligaments

141
Q

structures supporting the middle vagina

A

pelvic fascia

142
Q

structures supporting the lower vagina

A

levator ani muscles and perineal body

143
Q

‘double fold of peritoneum extending laterally from uterus to the pelvic side wall’

A

broad ligament

144
Q

attachments of the transverse cervical ligaments

A

cervix and upper to vagina to the lateral walls of the pelvis

145
Q

loss of support of the cervix and upper vagina results in…

A

uterine and vaginal vault prolapse

146
Q

loss of support of the middle vagina results in…

A

cystocele and rectocele

147
Q

loss of support of the low vagina results in…

A

stress urinary incontinence

148
Q

what are the 3 parts of levator ani

A

puborectalis
pubococcygeus
iliococcygeus

149
Q

what factors contribute to damage to pelvic floor supports

A

increase intra-abdominal pressure (obesity, chronic cough, constipation, intra-abdominal mass)
pelvic floor muscle trauma and denervation (obstetric trauma, pelvic fracture or surgery, congenital)
connective tissue disorder (age related, oestrogen deficiency)

150
Q

attachments of coccygeus

A

ischial spine and inferior end of sacrum and coccyx

151
Q

attachments of puborectalis

A

body of pubis and perineal body

152
Q

attachments of pubococcygeus

A

pubic bone, tendinous arch of obturator fascia

vagina, perineal body, rectum and coccyx

153
Q

attachments of iliococcygeus

A

ischial spine and perineal body/coccyx

154
Q

why is puborectalis involved in maintaining faecal continence

A

it creates a sling around the rectum, creating an angle between the rectum and canal

155
Q

nerve supply of elevator ani

A

nerve to levator ani (S4)

branches of pudendal nerve (S2,3,4)

156
Q

which vessels pass through the obturator foramen

A

obturator artery
obturator vein
obturator nerve

3 REPRO (40 decks)

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