8: Anatomy - female reproductive tract and breast

Question 1

In which cavity does the female reproductive system lie?

Answer 1

Pelvic cavity

Question 2

Which space is found inferior to the levator ani muscle?

Answer 2

Perineum

Question 3

What separates the pelvic cavity and the perineum?

Answer 3

Pelvic floor

levator ani, perineal muscles etc.

Question 4

What type of peritoneum forms the floor of the peritoneal cavity and the roof of the pelvic cavity?

Answer 4

Parietal peritoneum

Question 5

From anterior to posterior, which organs are found in the female pelvic cavity?

Answer 5

Bladder

Uterus

Rectum

Question 6

In the female peritoneal cavity, which pouches are formed by the

a) bladder and uterus
b) uterus and rectum?

Answer 6

a) Vesico-uterine pouch

b) Recto-uterine pouch (of Douglas)

Question 7

Which two pouches are found in the female peritoneal cavity?

Answer 7

Vesico-uterine pouch

Recto-uterine pouch

Question 8

What is the most inferior part of the female peritoneal cavity?

Answer 8

Recto-uterine pouch

Question 9

Which ligament connects the uterus to the walls and floor of the pelvis?

Answer 9

Broad ligament

Question 10

What parts of the pelvic cavity are connected by the broad ligament?

Answer 10

Uterus

Pelvis walls and floor

Question 11

What structures are contained within the broad ligament?

Answer 11

Uterine tubes

Proximal part of the round ligament

Question 12

Which ligament, connecting the uterus to the walls and floor of the pelvis, contains the uterine tubes?

Answer 12

Broad ligament

Question 13

What is the purpose of the broad ligament?

Answer 13

Keeps uterus in the midline

Question 14

Which ligament’s proximal part is contained within the broad ligament?

Answer 14

Round ligament

Question 15

Which structures are connected by the round ligament?

Answer 15

Uterus

Superficial perineum

Question 16

Which structures does the round ligament pass through to connect the uterus and the superficial perineum?

Answer 16

Broad ligament

Deep inguinal ring

Question 17

The (proximal / lateral) part of the round ligament is found in the broad ligament.

Answer 17

proximal part

Question 18

What are the three layers of the uterus, from superficial to deep?

Answer 18

Endometrium

Myometrium

Perimetrium

Question 19

What are the three layers of the uterus from deep to superficial?

Answer 19

Perimetrium

Myometrium

Endometrium

Question 20

Which layer of the uterus is sloughed off during menstruation?

Answer 20

Endometrium

Question 21

What are the two areas of the uterus?

Answer 21

Body

Cervix

Question 22

The cervix is the space between which parts of the uterus?

Answer 22

Internal and external os

Question 23

What area is found between the uterus and the perineum?

Answer 23

Vagina

Question 24

Where in the uterus does implantation occur?

Answer 24

Body of uterus

Question 25

Which **ligaments** attach the **uterus** to the **sacrum?**

Answer 25

**Uterosacral ligaments**

Question 26

Which **muscles** form the floor of the pelvis?

Answer 26

**Pelvic floor muscles** e.g levator ani

Question 27

**Inferior movement** of the uterus is called **uterine \_\_\_.**

Answer 27

**uterine prolapse**

Question 28

In which **two positions** can the uterus sit?

Answer 28

**Anteversion** **Retroversion**

Question 29

**(Anteversion / Retroversion)** is the most common uterine position in women.

Answer 29

**Anteversion**

Question 30

What are the **three important axes** when determining whether the uterus is **anterverted** or **retroverted?**

Answer 30

**Axis of the vagina** **Axis of the cervix** **Axis of the uterus**

Question 31

Is uterine **retroversion** normal?

Answer 31

**Yes - normal variant**

Question 32

The walls of the **vagina** are usually **(straight / collapsed).**

Answer 32

**collapsed**

Question 33

What device is used to hold the walls of the vagina apart during a gynae exam?

Answer 33

**Speculum**

Question 34

What type of epithelium lines the **vagina**?

Answer 34

**Squamous epithelium**

Question 35

What type of epithelium lines the **cervix**?

Answer 35

**Columnar epithelium**

Question 36

At which point does the **squamous epithelium** of the vagina transition to the **columnar epithelium** of the cervix?

Answer 36

**Squamocolumnar junction** Or '**transformation zone**'

Question 37

At which structure is a smear inserted to sample the **squamocolumnar junction**?

Answer 37

**External os** of uterus

Question 38

What is another name for the **uterine tubes?**

Answer 38

**Fallopian tubes** **Oviduct**

Question 39

What is another name for the **Fallopian tubes?**

Answer 39

**Uterine tubes** **Oviduct**

Question 40

Where in the **uterine tubes** does **fertilisation** occur?

Answer 40

**Ampulla**

Question 41

Are the **uterine tubes** symmetrical?

Answer 41

**No** - length and curvature are different

Question 42

What are the **hairs of the uterine tube** which collect the eggs from the ovaries?

Answer 42

**Fimbriae**

Question 43

The **fimbriae** of the uterine tubes push the egg into which area?

Answer 43

**Infundibulum** ("funnel" - leads to the ampulla)

Question 44

At their **distal ends** (nearest to the ovaries), what are the **uterine tubes** continuous with?

Answer 44

**Peritoneal cavity**

Question 45

Why can infection pass between the **female genital tract** and the **peritoneal cavity**?

Answer 45

**Uterine tubes are open-ended**

Question 46

What size are **ovaries**?

Answer 46

**About the size of an almond**

Question 47

Similarly to the **testes**, where do the **ovaries** develop?

Answer 47

**Posterior abdominal wall**

Question 48

Which **ligaments** are formed as the **ovaries** descend through the abdominal cavity to the pelvis?

Answer 48

**Round ligaments**

Question 49

The walls of the vagina are made of ___ \_\_\_.

Answer 49

**smooth muscle**

Question 50

At the superior end of the vagina, the cervix holds the vaginal walls apart in four places. What are these areas called?

Answer 50

**Anterior, posterior** and **2 lateral fornixes**

Question 51

What are the **four parts** of the **vaginal fornix**?

Answer 51

**Anterior** **Posterior** **Left and right lateral**

Question 52

What **bony features** can be palpated on **internal examination?**

Answer 52

**Ischial spines**

Question 53

What areas of the **uterine tubes** are closest to the **uterus**?

Answer 53

**Adnexae**

Question 54

The **adnexae** are found at the **(proximal / distal)** ends of the **uterine tubes.**

Answer 54

**proximal**

Question 55

The **levator ani** is a **\_\_\_ muscle.**

Answer 55

**skeletal muscle** under voluntary control

Question 56

Which **muscle** forms the majority of the **pelvic floor?**

Answer 56

**Levator ani**

Question 57

Which **specific nerves** supply the a) **superior** b) **inferior** aspects of levator ani? What are their nerve roots?

Answer 57

**a)** **Superior** - nerve to levator ani (S3-5) **b) Inferior** - pudendal nerve (S2-4)

Question 58

What does the **levator ani** do?

Answer 58

**Relaxes in defaecation** **Reflex contraction when intra-abdominal pressure increases** **Physical barrier**

Question 59

The **levator ani** prevents ___ of the pelvic organs.

Answer 59

**prolapse**

Question 60

Apart from the **levator ani**, which other muscles make up the **pelvic floor?**

Answer 60

**Perineal muscles**

Question 61

Which nerve supplies the **perineal muscles?**

Answer 61

**Pudendal nerve** (S2,3,4)

Question 62

Where do all the **perineal muscles** originate from?

Answer 62

**Perineal body**

Question 63

The **perineal body** acts as the origin of which muscles?

Answer 63

**Perineal muscles**

Question 64

When can the **perineal body** be damaged? What happens as a result?

Answer 64

**Childbirth** **Incontinence / prolapse**

Question 65

Which **glands** are found in the perineum, just inferior and lateral to the **vaginal orifice**?

Answer 65

**Bartholins glands**

Question 66

What is the other name for the **Bartholins glands?**

Answer 66

**Greater vestibular glands**

Question 67

What is the **function** of the **Bartholins glands**?

Answer 67

**Produce lubrication**

Question 68

What is the difference between the **vestibule** and **vaginal orifice**?

Answer 68

**Vaginal orifice** surrounds vagina only **Vestibule** surrounds vaginal orifice and external urethral orifice

Question 69

Which **ribs** do the breasts cover?

Answer 69

**Ribs 2 - 6**

Question 70

Which **space** exists between the **breast** and the **pectoralis** muscles?

Answer 70

**Retromammary space**

Question 71

**Where does 75% of lymph from the breast drain to?**

Answer 71

**Axillary nodes** on the same side

Question 72

Where does lymph from the **inner breast quadrants** (upper inner and lower inner) drain?

Answer 72

**Parasternal nodes** on the same or contralateral sides

Question 73

Where can lymph from the **lower inner** breast drain?

Answer 73

**Parasternal nodes** **OR** **Abdnominal nodes**

Question 74

Where does lymph from the **axillary** and **parasternal nodes** drain to?

Answer 74

**Supraclavicular nodes**

Question 75

Axillary lymph nodes supply both the breasts and upper limbs. They are surgically cleared out for some types of breast cancer. What **muscle** are the different **levels** of axillary nodes described in relation to?

Answer 75

**Pectoralis minor**

Question 76

Which **branches of the subclavian artery** supply the **breast**?

Answer 76

**Axillary artery** **Internal thoracic/mammary artery**

Question 77

Which **specific branches** of the **subclavian artery** supply the breast?

Answer 77

**Axillary artery** **Internal thoracic artery**

Question 78

Which **branches** **of the subclavian artery supply the** a) upper and lower INNER b) upper and lower OUTER quadrants of the breast?

Answer 78

**a) Internal thoracic artery** supplies **inner quadrants** **b) Axillary artery** supplies **outer quadrants**

Question 79

Via which **vaginal structure** can fluid be drained from the **rectouterine pouch?** What is this procedure called?

Answer 79

**Posterior fornix** **Culdocentesis**

Question 80

The **broad ligament** is made of which **material?**

Answer 80

**Peritoneum**

Question 81

The **broad ligament** can be divided into different sections depending on the structures it envelops. What are these **three** sections?

Answer 81

**Mesosalpinx** - surrounding uterine tubes **Mesovarium** - surrounding ovary **Mesometrium** - surrounding uterus

Question 82

The **broad ligament** (is / isn't) a **peritoneal formation**.

Answer 82

**IS a peritoneal formation**

Question 83

The **round ligament** (is / isn't) a peritoneal formation.

Answer 83

**ISN'T a peritoneal formation** Embryological remnant (of the gubernaculum, which the ovaries descended through from the posterio abdominal wall)

Question 84

Which **embryological structure** allows the **testes** and **ovaries** to descend from the **posterior abdominal wall** to the **pelvis**?

Answer 84

**Gubernaculum**

Question 85

Which **ligament** is thought to contribute to the **anterverted, anteflexed** position of the uterus in most women?

Answer 85

**Round ligament**

Question 86

Which **infection** can be mimicked by **infection tracking through** the **right uterine tube**?

Answer 86

**Appendicitis**

Question 87

Which part of the **vagina** is **culdocentesis** performed via?

Answer 87

**Posterior fornix**

Question 88

Which **triangle** is made by the right and left ischial spines and the pubic symphysis?

Answer 88

**Urogenital triangle**

Question 89

What is the **central focus** of most of the pelvic floor muscles called?

Answer 89

**Perineal body**

Question 90

The **vaginal** and **external urethral orifices** are found in which area of the perineum?

Answer 90

**Vestibule**

Question 91

Which **breast quadrant** is the **axillary tail** found in?

Answer 91

**Upper outer quadrant**

Question 92

Which hormones are responsible for a) **production of breast milk** b) **ejection of breast milk**?

Answer 92

**a) Prolactin** **b) Oxytocin**

Question 93

If pathology is found in one breast, what should you do first?

Answer 93

**Examine the other breast** As parasternal lymph node pathology can track to contralateral breast **Check both axillae for lumps** (axillary node invasion)

Question 94

What is the **clinically significant** venous drainage of the breast? Why?

Answer 94

**Intercostal veins** Drain posteriorly, allowing breast cancer to spread to the thoracic spine