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3rd year medicine > repro anatomy > Flashcards

repro anatomy Flashcards

1
Q

bony pelvis made up of?

A
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2
Q

ileum features

A
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3
Q

ischium features

A

sacrotuberous + sacrospinous ligament

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4
Q

pubis features

A
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5
Q

significance of pubic tubercle?

A

attachment of inguinal ligament (ASIS to pubic tubercle)

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6
Q

pelvic inlet made up of?

pelvic outlet?

A
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7
Q

true vs false pelvis?

A

greater/false pelvis

true pevlis = once through pelvic inlet

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8
Q

palpable surface landmarks of the pelvis

A
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9
Q

x-ray of pelvic features

A
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10
Q

joints of the pelvis

A
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11
Q

ligaments of the pelvis

A

+ obturator membrane, ilofemoral, ischiofemoral, pubofemoral

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12
Q

which ligaments form the greater and lesser sciatic foramen?

A

sacrotuberous + sacrospinous

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13
Q

structures related to obturator foramen

A
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14
Q

life threatening complications of pelvic fracture?

A

haemorrhage!

* common iliac!!

damage to pelvic organs

remember - pelvis is a ring bone so likely to have multiple fractures

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15
Q

male vs female pelvis

A

AP and transverse diameters larger in female

subpubic ange (pubic arch) wider in female

pelvic cavity more shallow in female

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16
Q

bones of foetal skull

+ moulding?

A
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17
Q

vertex?

A
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18
Q

foetal descent through pelvis

A

pelvic inlet = wider transversely so foetal head + body is transverse

when descening foetal head should roatate + FLEX

pelvic outlet is wider AP so foetus ideally in OA position

during delivery foetal head should EXTEND

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19
Q

foetal station?

A

distance of foetal head from ischial spines

negative number = head superior to spines

positive number = head inferior to spines

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20
Q

again, foeal descent + position in pelvis

A
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21
Q

following delivery of head - foetal position?

A
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22
Q

what dictates whether structure in pelvis or perineum?

A

levator ani!

pelvis = above levator ani muscle

below = perineum

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23
Q

how do visceral afferents get from pelvic organs to CNS?

A

superior pelvic organs i.e. touching peritoneum

* visceral afferents run alongside sympathetic fibres

* enter spinal cord levels T11-L2

* pain is percieved as suprapubic

inferior pelvic organs i.e. not touching peritoneum

* visceral afferents run alongside parasympathetic fibres

* enter spinal cord levels S2, S3, S4

* pain percieved in perineum

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24
Q

how do visceral afferents travel from pelvic organs above perineum to CNS?

in perineum?

A

above levator ani = in the pelvis

* visceral afferents - parasympathetic S2, S3, S4

below levator ani = in perineum

* somatic sensory = pudenal nerve

* spinal levels S2, S3, S4

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25
Q

autonomic nerves of pelvis

A

sympathetics

* T11-L2

* superior hypogastric plexus

parasympathetics

* sacral outflow (S2, 3, 4)

* pelvic splanchnic nerves

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26
Q

if spinal level is S2, 3, 4, does pudendal nerve therefore contain parasympathetics?

A

NO - parasympathetic outflow is seperate

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27
Q

summary of pain - female

A
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28
Q

2 important spinal cord levels in pain from female repro system?

A

T11-L2

S2, 3, 4

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29
Q

epidural and spinal anaethetic injected?

A

spinal cord becomes cauda equina at level L2

so inject into L3-L4

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30
Q

what layers does epidural needle pass through

A

supraspinous ligament

interspinous ligament

ligamentum flavum

epidural space

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31
Q

what layers does spinal anaesthetic needle pass through

A

supraspinous ligament

interspinous ligament

ligamentum flavum

epidural space (fat + veins)

dura mater

arachnoid mater

subarachnoid space (contains CSF)

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32
Q

spinal vs epidural?

A

spinal much faster acting

but epidural much longer acting

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33
Q

important side effect spinal anaesthetic?

A

blockage of sympathetic fibres = vasodilation

HYPOTENSION

signs its working = skin red, flushed, reduced sweating

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34
Q

pudendal nerve branches

A

S2, 3, 4

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35
Q

pudendal nerve block used when?

landmark

A

used during labour for: forceps delivery, painful vaginal delivery, episiotomy, perineal suturing post-delivery

landmark = ischial spines 4+8 o’clock

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36
Q

episiotomy

what structures are nearby

A

ishioanal fossa

mediolateral incision most common

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37
Q

where is incisision made for LSCS + hysterectomy?

laparotomy?

A

LCS + hysterectomy = suprapubic

laparotomy = vertical midline incision

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38
Q

abdominal muscles + fascia

A

fascia that lies deep to transversus abdominus = transversalis fascia

39
Q

external oblique attachments?

where does external oblique aponeurosis attach?

fibre direction?

A

attachments = ribs 5-12, iliac crest, pubic tubercle + linea alba

aponeurosis combines with internal oblique aponeurosis before inserting into linea alba

fibre direction = hands in pockets (same as external intercostals)

40
Q

internal oblique attachments?

fibre direction?

A

ribs 10-12, thoracolumbar fascia, iliac crest, linea alba

(external oblique does not connect to thoracolumbar fascia, its open back hehe)

fibre direction = hands on chest (same as internal intercostals)

41
Q

where is neurovascular plane abdominal muscles?

A

between transversus abdominus and internal oblique

42
Q

transversus abdominus attachments?

A

ribs 11-12, thoracolumbar fascia (like internal oblique), iliac crest and linea alba

43
Q

rectus abdominis divisions

linea alba formed from?

attachments

A

divisions = tendinous intersections divide into 3 or 4 smaller muscles

linea alba formed from abdominal wall aponeuroses

runs from xiphoid process to pubic symphysis

44
Q

following abdominal surgery what muscle must be stitched?

A

rectus sheath

45
Q

Arcuate line?

A

divides rectus sheath into ones that have only anterior part and ones that have anterior + posterior part (i.e. transversus abdominus switches to anterior)

found 1/3rd between umbilicus and pubic crest

46
Q

internal surface of abdominal wall

A
47
Q

transversalis fascia?

A

internal lining of abdominal wall

48
Q

nerve supply to anterolaeral abdominal wall

A
49
Q

blood supply to anterolateral abdominal wall

A

superior and inferior epigastric tucked into rectus abdominis :)

50
Q

40 week symphyseal fundal height

A

40 weeks fundus lower than 36 weeks due to baby becoming engaged

51
Q

are rectus muscles cut during LSCS?

A

no they are pulled apart

52
Q

layers cut during LSCS?

layers to stitch?

A

skin and fascia

rectus sheath (anterior)

rectus abdominus

fascia and peritoneum

retract bladder

uterine wall

amniotic sac

layers to stitch = uterine wall, rectus sheath, skin

53
Q

laparotomy layers cut through?

layers to stitch closed

complications?

A

layers cut open = skin and fascia, linea alba, peritoneum

layers to stitch closed = peritoneum and linea alba, fascia + skin

complications = relatively bloodless so not as good for healing, dehiscence, hernia

54
Q

laparoscopy incision?

lateral port?

A

sub-umbilical incision or lateral incision

lateral port = care must be taken to avoid the inferior epigastric artery

* branch of external iliac artery

* emerges medial to deep inguinal ring then goes superomedially posterior to rectus abdominus

55
Q

how to locate deep inguinal ring

what artery is this important for

A

halfway between ASIS and pubic tubercle

inferior epigastric artery - place port lateral to deep inguinal ring to avoid

56
Q

during hysterectomy care must be taken to?

A

differentiate ureter form uterine artery

* ureter passes inferiorly to artery (water under the bridge)

* ureter will often “vermiculate” when touched

57
Q

female organs in pelvic cavity?

perineum?

A
58
Q

peritoneum?

pouches?

A

peritoneum = floor of peritoneal cavity + roof of pelvic organs

forms pouches:

* vesico-uterine

* recto-uterine (pouch of Douglas) = most dependent part when upright

59
Q
A

..

60
Q

round ligament of uterus?

attachments?

contained within?

A

embryological remnant (gubernaculum)

attaches to lateral aspect of uterus

passes through deep inguinal ring to attach to superfical tissue of female peritoneum

proximal part contained within broad ligament

61
Q

3 layers of uterus

implantation occurs?

A

perimetrium

myometrium

endometrium

implantation occurs in body of uterus

62
Q

how is uterus held in position?

weakness of these supports?

A

uterosacral ligaments

endopelvic fascia (like bubble wrap)

muscles of pelvic floor (levator ani)

weakness of these supports can result in uterine prolapse

63
Q

normal uterus position

+ common variation

A
64
Q

fertilastion occurs where?

A

ampulla

65
Q

uterine tubes open into?

test for patency?

A

peritoneal cavity (this is why STIs + PID can cause peritonitis)

test for patency = HSG (dye should spill into peritoneal cavity)

66
Q

fornix?

A

anterior

posterior

2 lateral

67
Q

ischial spine palpation?

A

4 + 8 o’clock positions

68
Q

perineum?

divided into?

A

space between pelvic diaphragm and the skin

divided into 2 triangles: urogenital and anal

69
Q

levator ani?

forms?

function?

innervation?

A

skeletal muscle - voluntary control

forms most of pelvic diaphragm

function = provides support for pelvic organs + contracts during increased abdominal pressure e.g. cough

innervation = nerve to levator ani (NOT pudendal) - S3, 4, 5

70
Q

perineal body?

A

bundle of collagen and elastic tissue

attachment for perineal muscles

71
Q

bartholins gland also called?

where is it found?

A

greater vestibular gland

(called Cowper’s glands in males)

72
Q
A

…

73
Q

breast quadrants

A
74
Q

contents of axilla?

axillary node levels?

A

brachial plexus

axillary artery + axillary vein

axillary lymph nodes

level 1 = inferior and lateral to pectoralis minor

level 2 = deep to pectoralis minor

level 3 = superior and medial to pectoralis minor

75
Q

pelvic floor made up of?

A

pelvic diaphragm

muscles of perineal pouches

perineal membrane

76
Q

pelvic diaphragm?

made up of?

appearance?

A

deepest layer of pelvic floor

levator ani + coccygeus

has appearance of sling

77
Q

levator ani attachments?

3 parts?

A

pubic nones, ischial spines, tendinous arch of levator ani

perineal body, coccyx

3 parts = iliococcygeus, pubococcygeus, puborectalis

78
Q

pelvic ligaments?

A

uterosacral ligaments

transverse cervical (cardinal)

lateral ligament of bladder

lateral rectal ligaments

endopelvic fascia

79
Q

deep perineal pouch found?

contents?

A

lies above perineal membrane

females = urethra, vagina, NVB to clitoris, ischioanal fat pads

males = urethra, bulbourethral glands (Cowper’s), NVB to penis, ishioanal fat pads

80
Q

perineal membrane foundd?

what is it?

A

supericial to deep perineal pouch

thin sheet of tough fascia (has openings for urethra - and vagina in females)

81
Q
A

…

82
Q

superficial perineal pouch female?

A

lies superficial to perineal membrane

contains:

clitoris + crura - corpus cavernosum

bulbs of vestibule

muscles - bulbospongiosus, ischiocavernosus, superficial transvserse perineal (pudendal nerve)

greater vestibular glands - Bartholin’s

83
Q

superficial perineal pouch male?

A

lies superficial to perineal membrane

contains:

bulb - corpus spongiosum

crura - corpus cavernosum

muscles - bulbospongiosus, ischiocavernosus, superficial transverse perineal (pudendal nerve)

spongy (penile) urethra

84
Q

perineal body found females?

males?

A

females = posterior to vagina

males = anterior to rectum

85
Q
A

..

86
Q

injury to pelvic floor Ax?

A

pregnancy + childbirth

chronic constipation

obesity

heay lifting

chornic cough/sneeze

previous injury

menopause

87
Q

urinary continence depends on?

A

external urethral sphincter

compressor urethrae

levator ani

88
Q

uterine prolapse degree?

A

1st degree - cervix dropping into vagina

2nd degree - cervix dropping to opening of vagina

3rd degree - cervix is now outside of the vgina

4th degree - entire uterus outside of the vagina

89
Q

Tx uterine prolapse?

risks?

A

sacrospinous fixation

risks = injury to pudenal and sciatic nerve

90
Q

Surgical Tx incontinence?

A

trans-obturator approach

i.e. mesh through obrutator canal, creates sling around urethra

91
Q

write up embryology

A
92
Q

uterine anatomical variations

A
93
Q

hypospadias

A

failure of fusion of urethral groove

external urethral opening lies in abnormal position along ventral aspect of penis

3rd year medicine (13 decks)

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