Studiesal Uge 1 Flashcards
1
Q
Explain the main features of os coxae, and relate them to the articulated skeleton
A
2
Q
Describe the correct orientation of the pelvis with the anterior superior iliac spine and the upper margin of the pubic symphysis in the same vertical plane
A
3
Q
Identify/locate crista pubica
A
4
Q
Identify/locate pecten ossis pubis
A
5
Q
Identify/locate linea arcuata ossis illi
A
6
Q
Identify/locate linea arcuata ossis illi
A
7
Q
Identify/locate ala ossis illi
A
8
Q
Identify/locate promontorium ossis sacri
A
9
Q
Identify/locate foramen obturatum
A
10
Q
Identify/locate insicura ischiadica major and insicura ischiadica minor
A
11
Q
Identify/locate ligamentum sacrotuberale and ligamentum sacrospinale
A
12
Q
What is the pelvic inlet/apertura pelvis superior?
A
The pelvic inlet or superior aperture of the pelvis is a planar surface which defines the boundary between the pelvic cavity and the abdominal cavity (or, according to some authors, between two parts of the pelvic cavity, called lesser pelvis and greater pelvis).
13
Q
What is the pelvic outlet/apertura pelvis inferior?
A
14
Q
Why is foramen obturatum not completely closed?
A
Foramen obturatum er som regel næsten fuldstændigt dækket af membrana obturatoria, en stærk bindevævsmembran, som kun har hul helt øverst i foramen obturatum. Dette hul benævnes canalis obturatorius og herigennem løber nervus-, vena- og arteria abturatoria, som alle sammen løber ned af låret.
15
Q
What structures are transmittet through the greater sciatic notch?
A
The notch holds the piriformis, the superior gluteal vein and artery, and the superior gluteal nerve; the inferior gluteal vein and artery and the inferior gluteal nerve; the sciatic and posterior femoral cutaneous nerves; the internal pudendal artery and veins, and the nerves to the internal obturator and quadratus femoris muscles.
16
Q
What type of joint is the sacroiliac joint?
A
The sacroiliac joint is a synovial plane joint (glideled)
17
Q
Are there variations in female pelvis morphology?
A
The shape of the pelvis often differs between males and females. A female’s pelvis is generally wider and more open than a male’s pelvis. This helps with vaginal childbirth.
Even among females, though, pelvis shape varies. Generally speaking, there are four main pelvis types. The type you have may affect the ease in which you can give birth vaginally.
- Genetics and environmental factors determine the ovarall shape of your pelvis
18
Q
Name the types of pelvis shapes
A
The four different pelvis shapes are:
- Gynecoid: The most common type of pelvis in females and is thought to be the most favorable pelvis type for a vaginal birth
- Android: It’s narrower than the gynecoid pelvis and it can make labor difficult
- Anthropoid: The elongated shape of the anthropoid pelvis makes it roomier from front to back than the android pelvis. But it’s still narrower than the gynecoid pelvis. Some women with this pelvis type may be able to have a vaginal birth, but their labor might last longer
- Platypelloid: The shape of the platypelloid pelvis can make a vaginal birth diffucult because the baby may have trouble passing through the pelvic inlet. Many pregnant women with a platypelloid pelvis need to have a C-section
19
Q
What are the major differences in the morphology of the bony pelvis in male and female?
A
20
Q
What is the reason for differences in the morphology of the bony pelvis in male and female?
A
A male pelvis is designed to support a heavy body build and a stronger muscle structure while a female pelvis mainly serves for the purpose of childbearing.
21
Q
Identify musculus obturatorius internus
A
22
Q
Identify musculus piriformis
A
23
Q
What are the actions of musculus obturatorius internus?
A
Abducts & laterally rotates the extended hip and abducts the flexed thigh at the hip, and stabilizes the hip during walking.
24
Q
What are the actions of musculus piriformis?
A
he piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion.
25
Describe the placement and attachments of musculus obturatorius internus
26
Describe the placement and attachments of musculus piriformis
27
Where does nervus obturatorius arise?
Nervus obturatorius arises from L2-L4 spinal nerves and supplies the medial compartment of the thigh.
28
What foramen does nervus obturatorius pass through to reach the medial compartment of the thigh?
Nervus obturatorius pass though foramen obturatum through canalis obturatorius.
29
What is the pelvic diaphragm?
The pelvic diaphragm forms the muscular floor of the pelvic cavity.
30
What are the muscle forming the pelvic diapgrahm collectively called?
Musculus levator ani
31
How does musculus levator ani act during defecation?
While in quiescent state, the urethra and the rectum are mechanically closed at the levator hiatus. The muscle relaxes at the beginning of urination and defecation. By this means the levator ani muscle plays a crucial role in the preservation of urinary and bowel continence.
32
What is the anatomical region inferior to the pelvic diaphragm?
The perineum
33
Identify and locate membrana perinei
34
Identify and locate crus clitoridis
35
Identify and locate musculus ischiocavernosus
36
Identify and locate musculus bulbospongiosus
37
Identify and locate bulbus vestibuli
38
Identify and locate glandula vestibularis major/Bartholin's gland
39
Identify the structures
40
Identify the structures
41
Identify and locate spatium profundum perinei
42
Identify and locate spatium superficiale perinei
43
Which regions are the perineum divided into?
Regio urogenitalis & Regio analis
44
What are the Bartholin's glands (landulae vestibulares majores) function?
Their primary function is the production of a mucoid secretion that aids in vaginal and vulvar lubrication
45
What are the Skene's glands (glandulae vestibulares minores) function?
The Skene's glands primary function is to lubricate the urethra and vagina during sexual arousal
46
Hvad er fossa ischioanalis?
Fossa ischioanalis er den kileformede region, som ligger på hver side under diaphragma pelvis mellem canalis analis og bækkenvæggen.
47
Which motor and sensory nerves supplies the perineum?
The motor and sensory nerve supply to the perineum is derived from the
pudendal nerve (S2, S3 and S4), a branch of the sacral plexus.
48
What is the blood supply of the perineum?
Perineum fornynes hovedsageligt fra aa. pudendae internae, som på hver side lige bag ved diaphragma urogenitale afgiver a. perinealis til musklerne, og som desuden afgiver overfladiske grene til huden som rr. scrotales posteriores et rr. perineales. Desuden afgiver a. pudenda interna også a. rectalis inferior, som forsyner regio analis, især sphincter ani externus.
49
What is the venous drainage of the perineum?
Venerne følger arterierne
50
What is the lymph drainage of the perineum?
Lymfen dræneres bilateralt til lymphonodi inguinales superficiales. Lymfen fra de dybere lag ledsages af a. pudenda interna til lymphonodi iliaci interni.
51
Describe the innervation of the perineum?
Huden i perineum innerveres af to nervesæt, nn. labiales posteriores og nn. rectales inferiores, som begge er grene fra nn. pudendi.
Musklerne i diaphragma urogenitale innerveres af nn. pudendi.
52
Hvad er episiotomi?
Episiotomi er et mindre kirurgisk indgreb, der anvendes for at lette fødslen.
For at undgå eller begrænse læsioner i diaphragma pelvis ved barnets passage under fødslen, kan pladsforholdende bedre ved et indklip i vaginas bagvæk og tilstødende del af perineum, når vævet her står udspændt. Ingrebet kaldes en episiotomi. Klippet skal udgå bøjagtig fra midten svarende til commisura posterior, så man undgår bulbus vestibuli og musculus bulbocavernosus, og gå dorsolateralt i en vinkel på 45 grader, så man undgår at lædere sphinctermuskulaturen omkring anus.
53
Identify ostium urethra externum
54
Identify the vagina
55
Identify cervix uteri
56
Identify fornix vaginae
57
Identify all the structures
58
Identify fundus uteri
59
Identify cavitas uteri
60
Identify cavitas uteri
61
Identify canalis cervicalis uteri
62
Identify tuba utera including it's compartments
63
Identify ovarium
64
Identify the myometrium and endometrium
65
Identify ligamentum ovarii proprium
66
Identify ligamentum latum uteri (broad ligament)
67
Identify ligamentum teres uteri (round ligament)
68
What is the function of the round ligemants (ligamentum teres uteri)?
The round ligament of uterus acts to hold the uterus anterior-ward to in anteflexion and anteversion, especially by counteracting any posterior-ward forces that may be being exerted upon the uterus (e.g. distended bladder, or gravity while in a recumbent postition).
69
What is the function of the broad ligament (ligamentum latum uteri)?
The broad ligament serves as a mesentery for the uterus, ovaries, and the uterine tubes. It helps in maintaining the uterus in its position, but it is not a major contributing factor.
70
Ligamentum latum uteri (broad ligament) can be divided into which subdivisions?
- Mesometrium: Mesentery for the uterus
- Mesosalpinx: Mesentery for tuba uterina
- Mesovarium: Mesentary for ovarium
71
What are the spaces in front and behind the uterus called?
The space in front of the uterus is called excavatio vesicouterina (utero-vesical pouch) and the space behind the uterus is called excavatio rectouterina (recto-uterine pouch of Douglas).
72
What is the normal position of the uterus?
The normal position is an anteverted uterus
73
Why is the position of the uterus important?
It is important that the uterus is somehow normal, but about 20-25% of women have a retroverted uterus. The position of the uterus does not affect the sperm's ability to reach the egg. However, an extremely severe tilted uterus may interfere with the sperm's ability to fertilize the egg.
74
What is ectopic pregnancy?
An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.
75
How is ectopic pregnancy diagnosed?
The clinical diagnosis of ectopic pregnancy is based on a combination of serum quantitative human chorionic gonadotropin levels and transvaginal ultrasound findings.
76
Which arteries supply the uterus and ovaries?
Uterus forsynes fra de to aa. uterinae, som når uterus ved overgangen mellem corpus og cervix. Arterien fortsætter, efter at have afgivet grene til cervix uteri, op langs lateralkanten af uterus, hvor den ender som ramus tubarus og ramus ovaricus.
A. ovarica forsyner overierne og ender som rami tubarii arteriae ovaricae, som forsyner ovarierne samt tubae uterinae
77
What structures are closely related to the uterine arteries?
Aa. uterinae ligger i parametriet, hvor de 1,5-2 cm fra lateralfladen af uterus krydser foran ureter. Denne tætte erlation er vigtig at erindre sig ved underbinding af a. uterina ved f.eks. hysterektomi - fjernelse af uterus
78
Where do the ovarian arteries come from?
Arteria ovarica arise from aorta abdominalis
79
What is the lymphatic drainage of the uterus and ovary?
Lymfekarrene er talrige og danner plexer i endometriet, myometriet og under mesotelet i perimetriet. Fra perimetriet spreder lymfekarrene sig til mange forskellige lymfeknuder.
Fra fundus uteri løber langt de fleste lymfekar lateralt i den øverste del af ligamentum latum uteri og fortsætter til lymphonodi lumbales sammen med lymfekarrene fra tuba og ovariet.
Fra cervix uteri tager et ret varierende forløb, men følger dog normalt tre veje, idet de forløber fremad, lateralt og bagud
- Fremad dræneres de til lymphonodi iliaci externi
- Lateral dræneres de til lymphonodi iliaci interni
- Bagud dræneres de til lymphonodi sacrales
80
What is the relation between hormonal changes of the anatomical structure of the female reproductive organs?
81
EMBRYOLOGI
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82
HISTOLOGI
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83
What is oogenesis?
Oogenesis is a series of steps in which a oocyte differentiates into a mature ovum.
84
What is the first step of oogenesis?
The first step of oogenesis is the development of primordial germ cells to oogonium or primordial ovum.
During early embryonic development, primordial germ cells from the dorsal endoderm of the yolk sac migrate along the mesentery of the hindgut to the outer surface of the ovary, which is covered by a germinal epithelium, derived embryologically from the epithelium of the germinal ridges. During this migration, the germ cells divide repeatedly. Once these primordial germ cells reach the germinal epithelium, they migrate into the substance of the ovarian cortex and become oogonia (oogonium) or primordial ova (primordial ovum).
85
What is the second step of oogenesis?
Each primordial ovum collects a layer of spindle cells from the ovarian strom (the supporting tissue of the ovary) and causes them to take on epitheloid charachteristics; these epitheloid-like cells are called granulosa cells. The ovum surrounded by a single layer of granulosa cells is called a primordial follicle.
At this stage, the ovum is still immature and is called a primary oocyte, requiring two more cell divisions before it can be fertilized by a sperm.
86
How does the primordial germ cell replicate?
The primordial germ cell complete mitotic replication
87
When does the first stage of meiosis start?
The first stage of meiosis starts by the fifth month of fetal development
88
What happens when the meiosis starts?
The germ cell mitosis then ceases and no additional oocytes are formed
88
How do the primordial germ cell differentiate to oogonium or primordial ovum?
Primordial germ cells migrate to the outer surface of the ovary, which is covered by a germinal epithelium. During this migration, the germ cells divide repeatedly. Once these primordial germ cells reach the germinal epithelium, they migrate into the substanse of the ovarian cortex and become oogonia or primodial ova.
89
How many primary oocytes do the ovaries contain at birth?
At birth the ovary contains about 1 to 2 million primary oocytes
90
What is the third step of the oogenesis?
The first stage of meiosis starts during fetal development but is arrested in the late stage of prophase I until puberty, which usually occurs between ages 10 and 14 in females. The first meiotic division of the oocyte is completed after puberty.
Each oocyte divides into two cells, a large secondary oocyte and a small first polar body. Each of these cells contains 23 duplicated chromosomes.
- The first polar body may or may not undergo a second meiotic division and then degenerates
- The secondaty oocyte undergoes a second meiotic division, and after the sisterchromatids separate, there is a pause in meiosis
91
What is needed to resume the meiotic division after the sister chromatids seperate?
The secondary oocyte needs to be fertilized in order for the final step in meiosis to occur, and the sister chromatids in the ovum go to separate cells.
92
What is ovulation?
Ovulation is when the ovary releases the ovum
93
What is the fourth step of the oogenesis?
When the ovary releases the ovum (ovulation), and if the ovum is fertilized, the final meiosis occurs. Half of the sister chromatids remain in the fertilized ovum, and the other half are released in a second polar body, which then degenerates.
94
How many oocytes remain in the ovaries at puberty?
Only about 300.000 oocytes, and only a small percentage of these oocytes become mature.
95
How mantyWhat happens to the oocytes that doesn't mature?
The many thousands of oocytes that do not mature degenerate.
96
How many ovum on average develop enough to get ovulated?
400-500
97
What is the end of reproductive capability called?
Menopause
98
From which cells are oogonia derived?
Primodial germ cells
99
In which structure does one find a primary oocyte?
A primary oocyte is found in the primary follicle
100
In which structure is a secondary oocyte formed?
A secondary oocyte is formed in the preovulatory (mature) follicle
101
At ovulation, what are the posible fates of a secondary oocyte?
If the oocyte gets fertilized it develops into an embryo, but if it doesn't then the menstruation occurs
102
Which hormone is responsible for the proliferation stage?
Both **follicle stimulating hormone** and luteinizing hormone stimulate their ovarian target cells by combining with highly specific FSH- and LH-receptors in the ovarian target cell membranes. In turn, the activated receptors increase the cells' secretion rates and usually the growth and proliferation of the cells as well.
103
Which hormone is responsible for ovulation?
Luteinizing hormone is necessary for final follicular growth and ovulation.
104
Which hormone is responsible for the growth of the corpus luteum?
During the first few hours after expulsion of the ovum from the follicle, the remaining granulosa and theca interna cells change rapidly into luein cells. The change of granulosa and theca interna cells into lutein cells depends mainly on luteinizing hormone secreted by the anterior pituitary gland.
105
Which hormone is responsible for the surge of luteinizing hormone at midcycle?
A hypothalamic releasing hormone, called gonadotropin-releasing hormone (GnRH)
106
What is the role of inhibin?
The lutein cells in copus luteum secretes inhibin, which inhibits FSH-secretion by the anterior pituitary gland
107
Of the numerous estrogens that exist, which one exerts the major effect?
Only three estrogens are present in significant quantities in the plasma of the human female - Beta-estradiol, estrone and estriol.
- The principal estrogen secreted by the ovaries is Beta-estradiol
- Small amounts of estrone are also secreted by the ovaries, but most of this is formed. inperipheral tissues from androgens secreted by the adrenal cortices and by ovarian thecal cells
- Estriol is a weak estrogen which is derived from both estradiol and estrone
The estrogenic potency of Beta-estradiol is 12 times that of estrone. and80 times that of estriol. Considering these relative potencies, one can see that the total estrogenic effect og Beta-estradiol is usually many times that of the other two toghether. For this reason, Beta-estradiol is considered the major estrogen.
108
What are the main pharmacological approaches to contraception?
The main pharmacological approaches to contraception is hormonal suppression of fertility - "The pill".
Administration of either estrogen or progesterone, if given in appropriate quantitites during the first half of the monthly cycle, can inhibit ovulation.
108
What is the mechanism of action for the combined oral contraceptive (COC)?
The mechanism of action for the combined oral contraceptive is that appriopriate administration of estrogen and progesterone can prevent the preovulatory surge of LH secretion by the pituitary gland, which is essential in causing ovulation.
109
What is the mechanism of action for the progesterone-only contraceptive?
The mechanism of action for the progesterone-only contraception is that appropriate administration of progesterone can prevent the preovulatory surge of LH secretion by the pituitary gland, which. is essential in causing ovulation.
109
Explain the pharmacological correction of reproductive cycle irregularities?
About 5% to 10% of women are infertile. Occasionally, no abnormality can be discovered in the female genital organs, in which case the infertility is assumed to be due to either abnormal physiological function of the genital system or abnormal genetic development of the ova.
Lack of ovulation caused by hyposecretion of the pituitary gonadotropic hormones can sometimes be treated by appropriately timed administration of human chorionic gonadotropin, a hormone that is extracted from the human placenta.
110
What effect does estrogen and progesterone have on FSH and LH concentrations?
Estrogen and progesterone exhibits negative feedback effects on LH and FSH secretion
111
From which endocrine tissues are FSH and LH secreted?
FSH and LH are produced by gonadotropic cells in the anterior pituitary gland/adenohypophysis.
112
List the major mechanisms by which the combined oral contraceptives prevents pregnancy
Combined oral contraceptives contain a combination of estrogen and progestin.
- Work by preventing ovulation
- Thinning the endometrium
- Thickens the cervical mucus, which prevents sperm from getting into the uterus
113
For how long in a cycle is the combined oral contraceptive pill taken?
It depends on the categories
- Monophasic: Constant dose of estrogen and progestin throughout the entire cycle
- Biphasic: Level of progestin hormones are change once (halfway) during the menstrual cycle
- Triphasic: Three different doses of progestin hormones, changing every seven days during the first three weeks of pills
114
What are the names of the major synthetic hormones in the combined oral contraceptive?
Two of the most commonly used synthetic estrogens are ethinyl estradiol and mestranol
Among the most commonly used progestins are norethindrone, norethynodrel, ethynodiol and norgestrel
115
What are the major adverse effects of the combined oral contraceptive tablet?
- Bleeding while taking the active pills
- Breast tenderness
- Headaches
- Nausea
- Mood swings
116
What are the advantages and disadvantages of the progesterone only tablet compared to the combined oral contraceptive?
It is possible to be nursing mothers while taking progesterone only tablet but not while taking combined oral contraceptive, because estrogen reduces milk production.
Women with pre-existing risk of blood clots will be prescrived progestin-only because combined oral contraceptive increases the risk of blood clots.
The disadvantage of the progesterone only tablet is that in order to work effectively, they must be taken at a certain time every 24 hours - making it not so flexible, because missing even one pill can greatly reduce effectiveness.
117
Which hormone is used in the Emergency Pill (morning after pill) and how does it work?
Emergency contraception pills include levonorgestrel or ulipristal acetate
- Levonorgestrel works by preventing or delaying ovulation and impairing luteal function. It may also increase the thickness of the cervical mucus or affect sperm migration and function in the genital tract, thereby preventing fertilization of an egg
- Ulipristal acetate inhibit or delay ovulation for 24-48 hours even on the day of the luteinizing hormone peak. It also reduces the endometrial thickness, delays endometrial maturation, and alterations in the progesterone-dependent markers required for implantation
118
What is the Yuzpe method?
The Yuzpe method uses estrogen combined with levonorgestrel
119
What are the major adverse effects of the emergency contraception pill?
- It causes nausea, mood swings, heart-burn and vomiting
- It can disrupt menstrual cycle
- Repeated use can lead to difficulties in conception later
120
What alternatives are there to oral contraceptives?
- Behaviornal (natural) contraception: Rhythm method of contraception, Pullout before ejaculation
- Barrier methods: Spermicides, Male condom, Female condom, Diaphragm, Cervical cap
- Hormonal contraception: Injection contraception (Depo-Provera), Vaginal Ring (NuvaRing), The Patch, Contraceptive implant, Intrauterine devices (Copper T or Progestasert)
- Sterilization: Tubectomy (female), Vasectomy (male)
