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Anatomy > Reproduction > Flashcards

Reproduction Flashcards

1
Q

3 components that fuse together to form the hip bone

A

Ilium; Ischium and the Pubis

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2
Q

The points at either end of the iliac crest

A

Anterior superior iliac spine (ASIS)

Posterior superior iliac spine (PSIS)

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3
Q

Point where the inguinal ligament attaches

A

Pubic tubercle

ASIS

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4
Q

Which type of joint is the Sacroiliac joint?

A

Posteriorly = fibrous
Anteriorly = synovial
Allows movement at the front

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5
Q

The name of the gap between the ischiopubic ramus and the superior pubic ramus

A

Obturator foramen

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6
Q

The attachments of the sacrospinous ligament

A

The sacrum and the ischial spine

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7
Q

The attachments of the sacrotuberous ligament

A

The sacrum and the ischial tubercle

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8
Q

The purpose of sacrotuberous and sacrospinous ligaments

A

Ensure the inferior part of the sacrum does not move superiorly after weight is suddenly transferred vertically through the spinal column (e.g. jumping)

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9
Q

2 foraminae formed by the sacrotuberous and sacrospinous ligaments

A

The greater and lesser sciatic forminae

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10
Q

Features making up the pelvic inlet

A

Sacral promontory; ilium; superior pubic ramus; pubic symphysis

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11
Q

Features making up the pelvic outlet

A

Pubic symphysis; ischiopubic ramus; ischial tuberosities; sacrotuberous ligaments; coccyx

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12
Q

List the differences between the male and female pelvis

A

Female has larger AP and transverse pelvic diameters
Female has a wider subpubic angle (pubic arch)
Female - pelvic cavity is much shallower and much wider

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13
Q

Name the three fontanelles found on the foetal skull

A

Anterior, posterior and lateral

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14
Q

When do the fontanelles start to close over?

A

Around 18 months after birth

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15
Q

What does the term moulding mean?

A

Movement of one bone over the other to allow the foetal head to pass through the pelvis during labour via the presence of sutures and fontanelles.

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16
Q

In terms of the foetal skull - what is the vertex?

A

The area outlined by the anterior and posterior fontanelles and the parietal eminences

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17
Q

In which direction does the foetus face when it enters the pelvic cavity?

A

Head will lie transversely and so will face either to the right or left (more commonly faces the right).

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18
Q

During labour, what is meant by the station?

A

The distance of the foetal head from the ischial spines. A negative number means the head is superior to the spines, positive number means the head is inferior to the spines

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19
Q

What happens to the foetal head as it passes though the pelvic cavity?

A

Rotates so that it faces posteriorly and flexes (chin on chest)

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20
Q

What position is the foetal head in as it leaves the pelvic cavity?

A

In an occipitoanterior position (baby facing back the way) with the foetal head in extension.

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21
Q

What happens (in regards to rotation) once the head has been delivered?

A

Baby continues to rotate so that the shoulders and the rest of the baby can be delivered.

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22
Q

Name the pouches formed by the parietal peritoneum in the female

A

Vesico-uterine pouch

Recto-uterine pouch (Pouch of Douglas)

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23
Q

Where will excess fluid within the peritoneal cavity usually collect?

A

Within the pouch of Douglas as it is the most inferior part in the anatomical position

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24
Q

Where can fluid collected in the pouch of Douglas be drained via?

A

Needle is passed through the posterior fornix of the vagina

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25
Q

What is the broad ligament made up of?

A

Double layer of the peritoneum

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26
Q

What is the function of the broad ligament?

A

Helps maintain the uterus in the midline position

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27
Q

Name the ligament that extends between the uterus and the lateral walls and floor of the pelvis

A

The broad ligament

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28
Q

Name the ligament that is a embryological remnant of the Gubernaculum

A

The round ligament

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29
Q

Where does the round ligament attach?

A

Attaches to the lateral aspect of the uterus and passes through the deep inguinal ring to attach to the superficial tissue of the female perineum

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30
Q

Name the three layers of the uterus body

A

Perimetrium
Myometrium
Endometrium

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31
Q

Where does implantation of the zygote occur?

A

In the body of the uterus

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32
Q

Name the three tissue types involved in supporting the uterus

A

Ligaments
Endopelvic fascia
Muscles of the pelvic floor
(bladder can also help support the uterus)

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33
Q

Uterus tipped anteriorly relative to the axis of the vagina

A

Anteverted

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34
Q

Uterus tipped anteriorly relative to the axis of the cervix (mass of the uterus lies over the bladder)

A

Anteflexed

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35
Q

Uterus tipped posteriorly relative to the axis of the vagina

A

Retroverted

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36
Q

Uterus tipped posteriorly relative to the axis of the cervix

A

Retroflexed

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37
Q

What happens at the transformation zone?

A

The squamous epithelium becomes columnar epithelium

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38
Q

Where does fertilisation commonly occur?

A

In the ampulla of the uterine tubes

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39
Q

What is a bilateral salpingo-oophrectomy

A

Removal of both uterine tubes and ovaries

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40
Q

Name the two hormones secreted by the ovaries

A

Oestrogen and progesterone in response to pituitary hormones FSH and LH

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41
Q

Name the four parts of the fornix

A

Anterior
Posterior
2 lateral

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42
Q

Is the vagina normally patent?

A

No - walls are normally in contact - with the exception of the fornix at the superior end of the vagina

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43
Q

On digital examination of the vagina - where are the ischial spines palpable?

A

Laterally in the 4 and 8 o’clock position

44
Q

What is the nerve supply of the levator ani muscle?

A

Lot of debate - dual supply?

Pudendal nerve and S3,4,5 sacral plexus

45
Q

Name the bundle of collagenous and elastic tissue into which the perineal muscles attach

A

The perineal body

46
Q

What happens if the perineal body is damaged?

A

Severely impacts the pelvic floor’s strength and a risk of prolapse develops

47
Q

What are the typical borders of the female breast?

A

From ribs 2-6

Lateral border of the sternum to the mid-axillary line

48
Q

Name the space that lies between the fascia and the breast tissue and what is it’s purpose?

A

The retromammary space - allows the breast to be mobile

49
Q

How does the breast tissue attach to the skin?

A

Via suspensory ligaments

50
Q

What does the breast tissue lie on?

A

The deep fascia covering pectoralis major and serratus anterior

51
Q

Where is the Bartholin’s Gland in the female?

A

They lie laterally and slightly posteriorly to the vaginal opening.

52
Q

What is the function of the Bartholin’s Glands?

A

To secrete mucous that provides lubrication for the labia and superficial part of the vagina

53
Q

What is the is male equivalent of Bartholin’s gland?

A

Cowper’s gland

54
Q

What are the four quadrants of the breast?

A 
Upper outer
Upper inner
Lower outer
Lower inner
(Axillary tail of Spence)
55
Q

Why can some breast cancer treatment cause lymphedema in the arm?

A

Axillary node clearance used in the treatment for cancers affects the drainage of lymph from the upper limb as it also drains via the axillary node.

56
Q

Describe the three levels of the axillary lymph nodes

A

Level I = inferior and lateral to pectoralis minor
Level II = deep to pectoralis minor
Level III = superior and medial to pectoralis minor

57
Q

Name the structure found in the abdomen that is the midline blending of the aponeuroses

A

The linea alba

58
Q

Name the attachment and insertions of the external oblique muscles

A

The lower ribs and the iliac crest, pubic tubercle and linea alba

59
Q

Name the attachments and insertions of the internal obliques

A

The lower ribs, thoracolumbar fascia, iliac crest and linea alba

60
Q

Name the attachments and insertions of transversus abdominis

A

Lower ribs, thoracolumbar fascia, iliac crest and linea alba

61
Q

Name the structures that divide the rectus abdominis muslces

A

The tendinous intersections

62
Q

Where does the linea abla run from?

A

From the xiphoid process to the pubic symphysis

63
Q

What is the rectus sheath?

A

The combined aponeuroses of the anterolateral abdominal wall muscles

64
Q

At which point on the abdomen is there only an anterior part of the rectus sheath?

A

About 1/3 below the umbilicus

65
Q

What is the nerve supply to the anterolateral abdominal wall?

A

7-11th intercostal nerves (thoracoabdominal nerves)
subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)

66
Q

Blood supply to the anterior abdominal wall

A

Superior epigastric artery

Inferior epigastric artery

67
Q

Blood supply to the lateral abdominal wall

A

Intercostal and subcostal arteries

68
Q

During surgery in which direction should muscles be incised to minimise traumatic injury?

A

In the same direction as the muscle fibre.

69
Q

Which layers are opened in a LSCS?

A 
Skin and fascia
rectus sheath
Rectus abdominis (pulled laterally)
deep fascia and peritoneum
Move bladder out the way
Uterus wall
Amniotic sac
70
Q

Which layers are stitched together in a LSCS?

A

Uterine wall
Rectus sheath
Skin

71
Q

What factor needs to be considered when carrying out a abdominal midline incision?

A

Relatively bloodless area - means healing may not be as good, more prone to wound complications such incisional hernia

72
Q

What is the course of the inferior epigastric artery?

A

Emerges just medial to the deep inguinal ring and passes in a superomedial direction posterior to the rectus abdominis. Runs about 2 fingers breadth lateral to the umbilicus

73
Q

What is the difference between an abdominal hysterectomy and a vaginal hysterectomy?

A 
Abdominal = removal of the uterus via an incision in the abdominal wall
Vaginal = removal of uterus via the vagina
74
Q

How can the ureter be differentiated from the uterine artery?

A

The ureter passes under the uterine artery - “water under the bridge”.
The ureter tends to vermiculate (wiggle) when touched

75
Q

How is the pain sensation felt from superior aspect of pelvic organs (touching the peritoneum)?

A

Via VISCERAL AFFERENTS
Run alongside the sympathetic fibres and enter the spinal cord between levels T11-L2
Pain is felt in the suprapubic region

76
Q

How is the pain sensation felt from inferior aspect of pelvic organs ( not touching the peritoneum)?

A

Via VISCERAL AFFERENTS
Run alongside the parasympathetic fibres and enter the spinal cord at S2,3,4
Pain is perceived in the perineum

77
Q

How is the pain sensation felt in structures crossing from the pelvis to the perineum (urethra, vagina)?

A

ABOVE levator ani: via visceral afferents and enter the spine at levels S2,3,4
BELOW levator ani: via somatic sensory - pudendal nerve. Enters spinal cord at levels S2,3,4. Feel localised pain within the perineum

78
Q

At which vertebra does the spinal cord become the cauda equina?

A

L2

79
Q

On giving an epidural/spinal anaesthetic, how is the site of injection identified.

A

Line drawn between the most superior point of the iliac crests (intercrystal line) which goes just under L4’s spinous process.

80
Q

Which structures will the needle pass through in a spinal anaesthetic?

A 
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)
Dura mater
arachnoid mater
into the subarachnoid space which contains CSF
81
Q

What are the advantages of using a spinal anaesthetic?

A

Quick-acting - starts working within ~5mins

Can travel further and so cover a greater area

82
Q

Which structures does the needle pass through in an epidural anaesthetic?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Into epidural space

83
Q

With which spinal nerves do the sympathetic nerves exit the spinal cord?

A

T1-L2

84
Q

What effect does blocking the sympathetic tone have on arterioles in the lower limb?

A

Vasodilation:

  • skin looks flushed
  • warm lower limbs
  • reduced sweating
85
Q

Why should blood pressure be considered when giving anaesthetic, especially via spinal anaesthetic?

A

Risk of hypotension due to vasodilation

86
Q

Innervation of the internal and external anal sphincters

A

The pudendal nerve

87
Q

Which nerve supplies the structures of the perineum?

A

The pudendal nerve

88
Q

What’s the rhyme to help you remember the pudendal nerve?

A

S2,3,4 keeps the pelvis off the floor

89
Q

Through which structure does the pudendal nerve exit the pelvis?

A

The greater sciatic foramen

90
Q

Describe the pudendal’s course through the pelvic cavity.

A

Leaves the pelvis via the greater sciatic foramen passing behind the sacrospinous ligament. I then re-enters the pelvis via the lesser sciatic foramen and travels through the pudendal canal with the internal pudendal artery and the pudendal vein.

91
Q

Describe the four degrees of tearing of the perineum that can occur as a result of labour.

A

1st Degree = tearing of the skin
2nd Degree = tearing of the skin and of the perineal muscle (often needs stitching)
3rd Degree = tearing of the skin, perineal muscle and external anal sphincter (often require stitching in the OT)
4th Degree = tearing of the skin, perineal muscle, EAS and the mucosa of the rectum ( stitching in OT, can take up to 18mnths to recover)

92
Q

What procedure is carried out if tearing of perineum is likely and what does it involve?

A

Episiotomy - Incising posterolaterally into the fat-filled ichioanal fossa to avoid the external anal sphincter.

93
Q

What are the two muscle groups that make up the pelvic diaphragm?

A

Levator ani

Coccygeus

94
Q

Name the anterior gap between the medial borders of the pelvic diaphragm muscles and what passes through it?

A

The urogenital hiatus - the urethra and the vagina (females only)

95
Q

Name the three parts of levator ani

A

Puborectalis
Pubococcygeus
Iliococcygeus

96
Q

At which points are the levator ani muscles relaxed?

A

During urination and defecation, and labour

97
Q

Which nerve innervates the levator ani muscles?

A

The pudendal nerve

98
Q

Name the thin sheet of tough, deep fascia that lies superifical to the deep perineal pouch.

A

The Perineal Membrane

99
Q

Name the structure that contains the root of the penis in males and the female erectile tissue in females

A

The superficial perineal pouch

100
Q

Name the two arteries that supply the pelvis and perineum that do not arise from the internal iliac artery.

A 
Superior rectal artery (continuation of inferior mesenteric artery)
Gonal artery (L2 abdominal aorta)
101
Q

Name the artery found in the male perineum that arises from the external iliac artery

A

The anterior scrotal artery

102
Q

Name the artery that runs along the top of the penis

A

The dorsal artery of the penis

103
Q

Name the suture between the parietal bone and the occipital bone on the foetal skull

A

The lambdoid suture

104
Q

Name the diameter that goes from the front to the back of the foetal skull

A

The occipitofrontal diameter

105
Q

Name the diameter that from the two most lateral point on a foetal skull

A

The biparietal diameter

106
Q

What happens to the transformation zone as females age.

A

It moves internally

Anatomy (5 decks)

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