Lect 4 - Female Pelvis and Perineum

Question 1

What is another name for the rectouterine pouch?

Answer 1

Pouch of Douglas

Question 2

The ovaries and testes are both what type of organs?

Answer 2

Gonadal

Question 3

The ovaries lie on which surface of the broad ligament?

Answer 3

posterior

Question 4

The ovaries are held to the uterus through which ligament? The ovaries are held to the broad ligament through which tissue?

Answer 4

1) proper ovarian ligament

2) mesovarium

Question 5

The ovarian arteries come off which arterial supply?

Answer 5

aorta

Question 6

Where do the ovarian veins feed into?

Answer 6

Left: renal vein, right: IVC

Question 7

Where does ovarian pain refer to?

Answer 7

T10/11

Question 8

Where does lymph from the ovaries flow to?

Answer 8

Lumbar nodes

Question 9

What are the four sections of the uterine tubes?

Answer 9

1) intramural
2) isthmus
3) ampulla
4) infundibulum

Question 10

Which portion of the uterine tube is widest? Which is narrowest? Which is the most common site of ectopic pregnancy?

Answer 10

Widest: infundibulum
Narrowest: isthmus
Ectopic: ampulla

Question 11

Where does fertilization occur?

Answer 11

ampulla, usually

Question 12

A woman of child-bearing age comes into the ER with abdominal pain. She is not sexually active. Do you still rule out ectopic pregnancy?

Answer 12

Yes.

Question 13

Visceral afferents above the pelvic pain line travel with which fibers?

Answer 13

Sympathetic

Question 14

What are the four regions of the uterus?

Answer 14

1) fundus
2) body
3) cervix
4) cavity

Question 15

What are the three parts of the cervix?

Answer 15

1) internal os
2) external os
3) cervical canal

Question 16

What is the relation of the uterus to the cervix? The cervix to the vagina?

Answer 16

Uterus-cervix: anteflexed (bent forward)

Cervix-vagina: anteverted (turned foward)

Question 17

What complication can a retroverted uterus cause?

Answer 17

BACK PAIN

Question 18

What part of the uterus can be visualized in the vaginal canal?

Answer 18

external os of the cervix

Question 19

What is another name for the internal os?

Answer 19

endocervix

Question 20

What changes happen to the cervix with parity?

Answer 20

Nulliparous women have small, pinpoint cervices, while those of multiparous women have larger, linear openings

Question 21

What types of changes are seen in HPV infection which lead to cancer?

Answer 21

dysplasia

Question 22

What does a hysterosalpingogram detect?

Answer 22

patency of the fallopian tubes

Question 23

What are the three parts of the broad ligament called?

Answer 23

1) mesosalpinx
2) mesovarium
3) mesometrium

Question 24

What are the major ligaments of the uterus?

Answer 24

1) pubocervical
2) transverse cervical/cardinal
3) uterosacral

Question 25

Which of the major ligaments are anterior? Which are posterior?

Answer 25

Anterior: pubocervical
Posterior: uterosacral

Question 26

Which of the major ligaments of the uterus is the strongest?

Answer 26

Uterosacral

Question 27

What is the posterior wall of the vagina?

Answer 27

rectovaginal septum

Question 28

What are the domes around the cervix which protrude past the uterus called?

Answer 28

fornices

Question 29

Which fornix is clinically significant? Why?

Answer 29

Posterior fornix is clinically significant because behind it is where fluid will accumulate in the Pouch of Douglas

Question 30

What is the operation used to fix uterine prolapse?

Answer 30

The Manchester operation

Question 31

What are risk factors associated with uterine prolapse?

Answer 31

1) obesity
2) smoking
3) multiparity
4) chronic constipation

Anything that increases intra-abdominal pressures

Question 32

What are the STIs which cause pelvic inflammatory disease?

Answer 32

1) chlamydia

2) gonorrhea

Question 33

What more serious infection can PID lead to?

Answer 33

peritonitis

Question 34

Through what mechanism can PID lead to peritonitis?

Answer 34

through uterine tubes

Question 35

What is the pathognomonic sign for PID?

Answer 35

cervical motion tenderness

Question 36

What does PID increase the chances for?

Answer 36

tubal pregnancies

Question 37

What are the five major blood supplies for the uterus?

Answer 37

1) uterine artery
2) middle rectal artery
3) vaginal artery
4) superior vesical artery
5) internal pudendal artery

Question 38

What is the name of anastomoses of the blood supply of the uterus?

Answer 38

Uterovaginal arterial plexus

Question 39

What does the anastomosis of the arterial blood supply of the uterus facilitate?

Answer 39

metastasis of cancer

Question 40

What are the fibers which travel along with visceral afferents above and below the pelvic pain line?

Answer 40

Above the PPL: sympathetics (T10-L2)

Below the PPL: parasympathetics (S2-S4)

Question 41

What is the innervation of the lower 1/4 of the vagina?

Answer 41

Somatic innervation via the pudendal nerve

Question 42

Where does lymph flow from the uterine fundus? What about the uterine body, cervix, and upper vagina? What about the lower vagina and round ligament?

Answer 42

Fundus: lumbar nodes
Uterus/cervix/upper vagina: external/internal iliac nodes
Lower vagina/round ligament: superficial inguinal

Question 43

What is analogous body part of the labia majora in males? what about the labia minora?

Answer 43

Labia majora: scrotum

Labia minora: urogenital folds

Question 44

What is the purpose of an episiotomy?

Answer 44

spare the perineal body

Question 45

What muscles are likely damaged in an episiotomy?

Answer 45

1) bulbospongiosus

2) superifical transverse perineal

Question 46

What is the perineal body?

Answer 46

fibrous body where all the perineal muscles converge