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Anatomy > Repro > Flashcards

Repro Flashcards

1
Q

What are general features of the breast?

A

Modified and highly specialised sweat glands

No special capsule or sheath

Both males and females

Well developed in females

Breast size and shape result from genetic, racial and dietary factors

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2
Q

What is the breast location?

A

Extends vertically from the 2nd to 6th rib

Transversely from sternal edge to midaxillary line

Lies on deep pectoral fascia

Axillary tail (of spence) or process; small part may extend towards axillary fossa

Retromammary space helps some degree of movement

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3
Q

What are the breast relations?

A

2/3rd of breast rests on pectoralis fascia covering pectoralis major

1/3rd rests on fascia covering serratus anterior

Firmly attached to dermis by suspensory ligament of cooper; helps support lobules of the gland

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4
Q

What are structures of the breast?

A

Nipple; prominence
Areola; pigmented area around nipple

Each breast contains 15-20 lobules of glandular tissue (parenchyma))

Each lobule is drained by a lactiferous duct; opens independently on the nipple

Each duct has a dilated portion; lactiferous sinus

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5
Q

Describe the nipple

A

No fat or hair

Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle

Tips are fissures with lactiferous ducts opening into them

Position; variable or 4th intercostal space

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6
Q

Describe the areola

A

Skin covering nipple and areola contains numerous sweat and sebaceous glands

Enlarge during pregnancy

Oily materia secreted by sebaceous gland provides a protective lubricant for nipple and areola

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7
Q

What are the breast quadrants?

A

Used for anatomical location and description of pathology

Superolateral
Superomedial
Inferolateral
Inferomedial

Axillary tail is an extension in the superolateral quadrant

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8
Q

Describe the male breast

A

Rudimentary throughout life

Formed by small ducts without lobules or alveoli

Little supporting fibroadipose tissue

Temporary enlargement in newborn and during puberty

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9
Q

Describe the development of the breast

A

Mammary crests/ridges appear during 4th week

These extend from axillary to inguinal region

Crests usually disappear except in pectoral region

Primary mammary buds - secondary buds - lactiferous ducts and their branches

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10
Q

What are breast related conditions?

A

Gynecomastia; postnatal development of rudimentary lactiferous ducts in males, during midpuberty ~2/3 males develop varying degrees of hyperplasia of breast

Supernumerary breast and nipples

  • polymastia; extra breast
  • poluthelia; extra nipple

Athelia or amastia is absence of nipple or breast

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11
Q

Describe the blood supply of the breast

A

Branches of axilary artery, internal thoracic and some intercostal

  • thoraco-acromial artery
  • lateral thoracic artery
  • internal mammary (thoracic) artery
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12
Q

Describe the nerves of the breast

A

Anterior and lateral cutaneous branches of 4th - 6th intercostal nerves

They convey sensory fibres to skin of breast

Also carry sympathetic fibres to blood vessels and to smooth muscle around nipple

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13
Q

Describe the lymphatic drainage of the breast

A

Great clinical significance due to mets

Breast lymphatics branch extensively and do not contain valves

Most lymph (>75%) from lateral quadrants -> axillary lymph nodes

Some lymph may drain directly to supraclavicular/infraclavicular or inferior cervical nodes

Lymph from medial quadrants - parasternal or to opposite breast

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14
Q

What is the role of sentinel node biopsy and how is it carried out?

A

First draining node

Lymphatic mapping and staging of patients

A radiolabelled colloid used to locate sentinel node

At time of surgery a blue dye is injected

Combination of radioisotope and dye provides most accurate means

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15
Q

Describe the soft tissue of the breast

A

Made up of lobes which contain a network of glandular tissue consisting of branching ducts and secretory lobules

Terminal duct lobulr unit is the functional secretory component

Connective tissue stroma surrounding lobules; dense and fibrocollagenous

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16
Q

What lines the ducts and acini of the breast?

A

Epithelial cells and myoepithelial cells

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17
Q

What are age related pre-pubertal changes in the breast?

A

Neonatal breast contain lactiferous ducts but no alveoli

Until puberty, little branching of ducts occurs

Slight breast enlargement reflects growth of fibrous stroma and fat

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18
Q

What are age related pubertal changes in the breast?

A

Branching of lactiferous ducts

Solid sphenoidal masses of granular polyhedral cells (alveoli)

Accumulation of lipids in adipocytes

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19
Q

What are age related post-menopausal changes in the breast?

A

Progressive atrophy of lobules and ducts

Fatty replacement of glandular tissue

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20
Q

Describe changes in the breast during pregnancy

A

Enlarged lobules

Acini dilated

Epithelium vary from cuboidal to low columnar

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21
Q

Describe the lactating breast

A

Acini distended with milk

Thin septa between lobules

At higher magnification; acini with eosinophilic material containing clear vacuoles

Milk production; suckling (neurohormonal) prolactin and oxytocin

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22
Q

What are diagnostic investigation methods for the breast?

A

Imaging; mammography and US

Fine needle aspiration cytology

Core biopsy

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23
Q

Describe breast cancer commonality

A

20% of all cancers in women

Commonest cause of death in women 35-55

In UK any woman has 1 in 9 chance of developing breast cancer

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24
Q

What are some benign breast tumours?

A

Fibroadenomas
Duct papillomas
Adenomas
Connective tissue tumours

Paget’s disease of the nipple

  • erosion of nipple resembling eczema
  • associated with ductal or invasive carcinoma
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25
Q

What are the boundaries of the pelvic outlet? (inferior pelvic aperture)

A
  • Coccyx
  • Ischial tuberosities
  • Sacrotuberous ligament
  • Pubic symphysis
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26
Q

What type of joint is the sacroiliac joint?

A

Synovial plane

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27
Q

What type of joint is the pubic symphysis?

A

Secondary cartilaginous

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28
Q

Where does the piriformis muscle lie?

A

Most posterior pelvic wall muscle

Passes through greater sciatic foramen to upper part of greater trochanter

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29
Q

What is the innervation of the piriformis muscle?

A

Ventral rami of S1 and S2

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30
Q

What is the function of the piriformis muscle?

A

External rotation hip

Abduction of hip

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31
Q

Where does the obturator internus lie?

A

Lateral pelvic cavity wall

Wraps out and inserts on posterior aspect of femur

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32
Q

What is the innervation of the obturator internus?

A

Obturator internus nerve (L5-S2)

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33
Q

What is the function of the obturator internus?

A

External rotation

Stabilises head of femur in socket

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34
Q

What do the sacrospinous ligaments connect?

A

The sacrum to the ischial spines

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35
Q

What do the sacrotuberous ligaments connect?

A

The sacrum to the ischial tuberosities

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36
Q

What are the levator ani muscles?

A

From anterior to posterior

Puborectalis
Pubococcygeus
Iliococcygeus (beside other two)

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37
Q

What is the most inferior pelvic floor muscle?

A

Ischiocavernosus

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38
Q

What nerve/roots innervate the levator ani muscles?

A

Branches of pudendal nerve (S2,3,4) and anterior rami S4

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39
Q

What nerve roots innervate the coccygeus?

A

anterior rami S4 and 5

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40
Q

What is a cystocoele?

A

prolapsed bladder

woman’s bladder bulges into her vagina

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41
Q

What is a rectocoele?

A

Condition in which wall separating rectum from vagina weakens causing vaginal wall to bulge

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42
Q

Where do the superior and inferior vesical arteries originate and what do they supply?

A

Internal Iliac Artery

Bladder, seminal gland and prostate in males

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43
Q

Where does the uterine artery originate and what does it supply?

A

Internal Iliac Artery

Uterus

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44
Q

Where do the gonadal (testicular or ovarian) arteries originate and what do they supply?

A

Abdominal aorta (below renal arteries)

Testis or Ovary

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45
Q

Where does the superior rectal artery originate and what does it supply?

A

internal Iliac

Upper 1/3 rectum

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46
Q

Where do the middle and inferior rectal arteries originate and what do they supply?

A

Internal iliac

Lower 2/3 rectum

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47
Q

Where does the vaginal artery originate and what does it supply?

A

Uterine artery

vagina and base of bladder

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48
Q

Where does the internal pudendal artery originate and what does it supply?

A

Internal iliac

Main artery to perineum

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49
Q

Where does the obturator artery originate and what does it supply?

A

internal iliac

Ileum, pelvic muscles, head of femur, muscles and skin of middle thigh

50
Q

What rectal veins are part of the systemic circulation?

A

lower and middle rectal veins

51
Q

What does the prostatic venous plexus communicate with posteriorly?

A

vertebral venous plexus

52
Q

What nerves make up the somatic component of the repro neural supply?

A

Ilioinguinal
Genito-femoral
Pudendal

53
Q

Describe the ilioinguinal nerve

A

Root origin: L1

Enters pelvis via superficial inguinal ring

Supplies; skin at root of penis, labia

54
Q

Describe the genito-femoral nerve

A

Root origin; L1/L2

Enters pelvis via deep inguinal ring

Supplies; cremaster muscle, spermatic cord, anterior scrotal skin, labia majora and round ligament of uterus

55
Q

Describe the pudendal nerve

A

Root origin; S2-S4

Passes between piriformis and coccygeus, exits pelvis through lower part greater sciatic foramen then re-enters through lesser sciatic foramen

Supplies; skin and muscles of perineum, 3 branches dorsal clitoral, perineal, rectal

56
Q

What makes up the sympathetic component of the repro neural supply?

A

L1/2 via hypogastric plexus

Supplies vas deferens, seminal vesicles, prostate and epididymis

57
Q

What makes up the parasympathetic component of the repro neuro system?

A

S2/3/4 via hypogastric plexus

Supplies erectile tissues in male and female

58
Q

What are the main lymph nodes draining the pelvis?

A

External iliac nodes
Internal iliac nodes
Sacral nodes
Common Iliac nodes

59
Q

What do the external iliac lymph nodes drain?

A

Prostate, bladder, membranous urethra, cervix, upper vagina

60
Q

What dot he internal iliac lymph nodes drain?

A

Gluteal region, deep perineum, inferior pelvic viscera

61
Q

What do the sacral lymph nodes drain?

A

Posterior inferior pelvic viscera

62
Q

What do the common iliac lymph nodes drain?

A

The three other groups of pelvic lymph nodes

  • external iliac
  • internal iliac
  • sacral
63
Q

What do the bulbourethral glands do?

A

Add fluid to semen during ejaculation

Alkaline fluid

64
Q

What do the vas deferens do?

A

Transports mature sperm to urethra

65
Q

What does the prostate do?

A

Secrete prostatic fluid (component of semen)

66
Q

What are the layers of the inguinal canal?

A

From external to internal

  • skin
  • dartos muscle
  • 3 fascia layers
  • cavity of tunica vaginalis
  • epididymis and testis
67
Q

What are the main contents of the spermatic cord?

A

Vas deferens
Blood vessels
Nerves
Lymphatics

68
Q

What is the tunica albuginea?

A

Layer covering the testis; tough, fibrous layer

69
Q

What are the two layers of the tunica vaginalis and what material is present between them?

A

Visceral and parietal

thin fluid layer; reduces friction between testes and scrotum

70
Q

What vertebral level do testicular arteries arise from aorta?

A

L2

71
Q

What structures do the testicular arteries cross?

A

Ureter

Genito-femoral nerve

72
Q

What is the term for the anastomosing veins associated with testis?

A

8-12 veins

Pampiniform plexus

73
Q

What is the function of the pampiniform plexus?

A

Temperature regulation

Countercurrent heat exchanger with nearby arteries

74
Q

Into which veins do the testicular veins drain?

A

Right testicular vein –> IVC

Left testicular vein –> left renal vein

75
Q

What is varicoele?

A

Distended testicular veins (pampiniform plexus)

76
Q

Which lymph nodes receive lymph from testes?

A

Lateral aortic/lumbar
Pre-aortic

This is due to testes arising from abdominal region and migrating downward during development

77
Q

What do the seminal vesicles produce?

A

Semenogelin; makes semen sticky, protein

78
Q

What lymph nodes drain the prostate?

A

Internal iliac (primarily) and sacral nodes

79
Q

What lymph nodes drain the seminal vesicles?

A

Internal and external iliac nodes

80
Q

What lymph nodes drain the scrotum?

A

Inguinal lymph nodes

81
Q

What lymph nodes drain the penis?

A

Inguinal lymph nodes

82
Q

What is the innervation of the external anal sphincter?

A

Inferior anal nerve

83
Q

Which nerve network lies on piriformis muscle?

A

Sacral plexus

84
Q

What are functions of the pelvic floor?

A

Support pelvic viscera
Continence
Urine and faeces passage

85
Q

What is the perineal body?

A

Central tendon of perineum

86
Q

What is the annococcygeal body?

A

fibrous median raphe in floor of pelvis extending coccyx –> margin of anus

87
Q

How may an episiotomy prevent long term damage?

A

Prevent rupture of tissues

88
Q

Which parts of the rectum drain into the portal circulation?

A

upper third

89
Q

Describe neural supply of female genital tract

A

Symp nerve fibres from pelvic and ovarian plexuses and parasymp nerve fibres from pelvic splanchnic nerves (S2, 3 and 4)

90
Q

What are the male repro organs?

A 
Testis
Vas deferens
Seminal glands
Prostate
Epididymis
Bulbourethral glands
91
Q

What part of the urethra does the prostate surround?

A

Prostatic urethra

92
Q

What is the clinical significance of drainage from prostatic venous plexus?

A

Bone mets in prostate cancer

93
Q

What are histological features of testis?

A
  • convoluted tubules
  • 4-8 layers of cells
  • spermatazoa in lumen
  • leydig cells in interstitium
94
Q

What are histological features of prostate?

A
  • serous alveoli with infolding epithelium
  • trabeculae of muscular stroma
  • amorphous eosinophilic masses, called corpora amylacea
95
Q

What are histological features of seminal vesicle?

A
  • no sperm in lumen
  • highly recessed and irreg lumen forming crypts and cavities
  • honeycomb appearance
  • well-developed muscular externa
96
Q

What are histological features of vas deferens?

A
  • lumen stellate in shape
  • thick walled muscular tube
  • epithelial lining and supporting lamina propria are thrown into longitudinal folds
97
Q

What are the three structures of the birth canal?

A

Vagina
Cervix
Uterus

98
Q

What are the three layers of the uterus?

A

Endometrium (inner layer)
Myometrium (middle layer, thickest)
Perimetrium (outer layer, serous)

99
Q

What area of the uterine body does the lower segment develop from in pregnancy?

A

Isthmus

100
Q

What is the normal position of the uterus?

A

Anteflexed

Anteverted

101
Q

What are the fornices of the vagina?

A

Superior portions extending into recesses created by vaginal portion of cervix

102
Q

Through which vaginal fornix can you access the rectouterine pouch?

A

posterior fornix

103
Q

What are the ligaments anchoring the uterus and cervix in place?

A

Ligament of ovary
Suspensory ligament of ovary
Round ligament of uterus
Broad ligament

104
Q

Which ligament is called the cardinal ligament of the uterus?

A

lateral cervical ligament

105
Q

Apart from pelvic fascia, what other structure in the pelvis is also an important support of the uterus?

A

muscles of pelvic floor

106
Q

What are the parts of the uterine tube?

A

Infundibulum
Fimbria
Ampulla
Intramural/uterine part (isthmus)

107
Q

What part of uterine tube is longest and widest?

A

Ampulla

108
Q

Which part of uterine tube does fertilisation occur in?

A

Ampulla

109
Q

What is a cornual ectopic pregnancy?

A

Rare form of ectopic where implantation occurs in a cavity of a rudimentary horn of uterus

110
Q

What are the ligaments associated with the ovary?

A

From uterus to ovary; ovarian ligament

Ovary to lateral pelvic wall; suspensory ligament of ovary

111
Q

At what vertebral level do gonadal arteries originate?

A

L2

112
Q

Describe the route of the ovarian artery

A

descends within the suspensory ligament to supply the ovaries via broad ligament

113
Q

Where does the uterine artery cross over the ureter?

A

Level of ischial spine

114
Q

Which group of lymph nodes drain the labia and distal vagina?

A

External iliac

115
Q

Which group of lymph nodes drain the ovaries?

A

Para-aortic

116
Q

What lymph nodes drain the fundus and upper uterine body?

A

para-aortic lymph nodes

117
Q

What lymph nodes drain most of uterine body?

A

external iliac

118
Q

What lymph nodes drain uterine cervix and upper vagina?

A

Internal iliac and sacral

119
Q

What lymph nodes drain lower vagina?

A

superficial inguinal

120
Q

Which part of male urethra is widest and most dilatable?

A

Prostatic

121
Q

Which part of male urethra is narrowest and longest?

A

Spongy

122
Q

Which part of male urethra is shortest?

A

Membranous

Surrounded by external urethral sphincter

Anatomy (10 decks)

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