Anatomy 1 Flashcards Preview

3rd Year General Revision > Anatomy 1 > Flashcards

Flashcards in Anatomy 1 Deck (282):
1

Where do the presynaptic sympathetic axons for the heart synapse?

T1 or cervical PARAvertebral gangli

2

Where are post-synaptic axons for the heart?

They pass through cardiopulmonary splanchnic nerves to the SA&AV nodes and the myocardium

3

What does the T9 myotome supply?

The 8th-10th intercostal spaces and some of the anterolateral abdominal wall muscles

4

Where do the presynaptic sympathetic axons for the lung synapse?

Synapse in the upper thoracic PARAvertebral ganglia

5

Where do the post-synaptic sympathetic axons for the lung travel

Pass in cardiopulmonary splanchnic nerves to the bronchiolar smooth muscle and mucous glands

6

Where do the abdominopelive sympathetic presynaptic axons synapse?

Synapse in one of the PREvertebral ganglia

7

Foregut ganglia

Celiac ganglion of celiac plexus

8

Kidney ganglia

Aorticorenal ganglion

9

Midgut ganglion

Superior mesenteric ganglion of the SM plexus

10

Hindgut and pelvic/perineal organ ganglion

Inferior mesenteric ganglion

11

What is special about the sympathetic supply to the kidney?

Presynaptic axons pass directly through the aorticorenal ganglion to synapse directly onto the adrenaline/noradrenaline secreting cells of the adrenal medulla

12

How do parasympathetic axons reach the eye?

Via the ciliary ganglion

13

Which glands in the head are under parasympathetic supply?

The lacrimal and salivary glands

14

How do PARAsympathetic axons reach the hindgut, pelvis and perineum?

They are "carried" on sacral spinal nerves

15

What do the extrinsic back muscles do?

Move the upper limb

16

Where does the trapezius attach to superiorly?

The occipital bone

17

Where do the levator scapulae attach superiorly?

To the cervical vertebrae

18

Superficial intrinsic back muscles

Erector spinae

19

Deep intrinsic back muscles

Transversospinalis

20

Function of the intrinsic back muscles?

Maintain back posture

21

The 3 parts of the trapezius

Descending part (to spine of scapula)
Middle part
Ascending part (to spine of scapula)

22

Low back pain may be due to what

Erector spinae strain

23

Which muscles allow extension of the spine?

Intrinsic back muscles

24

Nerve supply to the intrinsic back muscles?

The posterior rami (of cervical, thoracic, lumbar etc)

25

Primary curvatures of the vertebral column?

Thoracic primary curvature
Sacral primary curvature

(Cervical and lumbar are secondary)

26

What makes the vertebral canal for the spinal cord?

The vertebral foraminae combine to form the vertebral canal

27

Which foraminae do the spinal nerves emerge from?

Intervertebral foramen

28

Which joints affected in arthritis?

Facet joints

29

What makes the facet joint?

Between 2 articular processes

30

Intervertebral discs are between all vertebrae except?

Except C1-C2 and the fused sacrum/coccyx

31

What attaches the laminae together?

The ligamentum flavum

32

Function of the posterior longitudinal ligament?

Prevents over-flexion of spin

33

Function of the anterior longitudinal ligament?

Prevents over-extension of the spine

34

This ligament connects tips of spinous processes

Supraspinous ligament

35

This ligament connects superior and inferior surfaces of adjacent spinous processes

Interspinous ligament

36

This vertebra doesn't have a body or spinous process

C1
(has a posterior and anterior arch instead)

37

Atlas

C1

38

Axis

C2

39

This vertebrae has an odontiod process

C2

40

First palpable spinous process

C7

41

Main movements of the atlanto-occipital joints

Flexion and extension (i.e. nodding)
This is a synovial joint

42

Main movement of the atlanto-axial joint?

Rotations (i.e. head looking side to side)

This joint is made of 3 synovial joints

43

What are the anterior sacral foraminae for?

For the anterior rami of the sacral spinal nerves

44

In caudal anasthaesia, where is local anaesthetic injected into?

Into the sacral hiatus

(numbs the sacral spinal nerves of the cauda equina)

45

Where does the spinal cord begin?

C1

46

Where does the spinal cord end?

L2 (conus medullaris)

(this then continues as the filum terminale)

47

What makes up the cauda equina?

All the spinal nerve roots from L2 to C0 that have to descend to their numbered verterbae where there spinal nerve is lovated within the intervertebral foramen

48

Why is a laminectomy performed?

To access the spinal cord

49

How do you perform a laminectomy?

Removal of one or more of the spinous processes and the adjacent lamina

50

Common location of a CVA?

Internal capsule

51

When you are examining dermatomes, what do the following mean:
-0
-1
-2
-NT

0 - absent
1 - impaired
2 - normal
NT - not testable

52

C1

Spinal nerve has no significant cutaneous sensory axons

53

C2

Back of scalp and adam's apple

54

C3

Back of neck and jugular notch

55

C4

Clavicle and shoulder tip

56

C5

Badge patch

57

C6

Thumb

58

C7

Middle finger

59

C8

Little finger

60

T1

Medial forearm

61

T2

Medial arm and sternal angle

62

T4

Male nipple

63

T8

Xiphoid process

64

T10

Umbilicus

65

T12

Pubic symphysis

66

L1

Groin

67

L2

Anterior thigh

68

L3

Anterior knee

69

L4

Medial malleolus

70

L5

Dorsum of foot

71

S1

Heel

72

S2

Posterior knee

73

S3

Buttock

74

S4

Perinuem

75

S5

Perianal skin

76

Femoral nerve roots

L2, L3, L4

(so will supply anterior thigh, anterior knee and medial malleolus)

77

Great auricular nerve?

C2, C3

78

Supraclavicular nerve?

C3, C4

79

Nerve supply to the upper anterolateral abdominal wall

T2-T11

80

Nerve supply to the lower anterolateral abdominal wall

Iliohypogastric and ilioinguinal nerves (formed from L1)

81

Nerve supply to the posterior parts of the dermatome

Supplied by posterior rami
- supplied segmentally by the intercostal nerves

82

What is special about T1 and T2 dermatomes?

Explains the pain from an MI! (because the dermatome extends into the arm etc)

83

Axillary nerve

C5, C6

84

Cutaneous branch of the musculocutaneous nerve

C5, C6, C7

85

Radial nerve

C6, C7, C8

86

Median nerve

C6, C7, C8, T1

87

Ulnar nerve

C7, C8, T1

88

What does the cervical motor plexus supply?

Neck postural & strap muscles
Diaphragm

89

What does the brachial motor plexus supply?

The upper limb muscles
The extrinsic back muscles

90

Which motor axons supply:
-postural back muscles (via posterior rami)
-intercostal muscles (via anterior motor rami)
-anterolateral abdominal wall muscles (via thoracoabdominal, subcostal, iliohypogastic and ilioinguinal nerves)

T2-L3

91

What does the lumbosacral motor plexus supply?

Plexus= L1 -S4
-Supplies lower limb muscles &
-Perineal skeletal muscles

92

What is the intracranial part of the spinal nerve course?

Between their base of skill foraminae and their connection with the CNS

93

V1, V2, V3

V1 - sensory
V2 - sensory
V3 - sensory and motor

94

The only cranial nerve to attach to the pons

CN V

95

Which foramen does V1 pass through?

Superior orbital fissure

96

Which foramen does V2 pass through?

Foramen rotundum

97

Which foramen does V3 pass through?

Foramen ovale

98

This nerve supplies the:
-upper eyelid
-the cornea
-all the conjunctiva
-the skin of the root/bridge/tip of the nose

V1

99

This nerve supplies:
-the skin of the lower eyelid
-the skin over the maxilla
-the skin of the ala of the nose
-the skin/mucosa of the upper lip

V2

100

This nerve supplies:
-the skin over the mandible and temperomandibular joint (apart from the angle of the mandible - supplied by C2, C3 spinal nerves)

CN V3

101

Which nerve supplies the skin over the angle of the mandible and some of the external ear

The great auricular nerve (C2, C3)

102

This nerve supplies the:
-bones and soft tissue of the orbit
-the upper anterior nasal cavity
-all paranasal sinuses (except antrum)
-the anterior and posterior cranial fossa

CN V1 (deep sensory territory)

103

This nerve supplies:
-the lowest posterior nasal cavity
-the maxilla and maxillary sinus
-the floor of the nasal cavity/palate
-the maxillary teeth and the associated soft tissues (gingivae and mucosae)

CN V2 (deep sensory territory)

104

Which nerve supplies:
-the MIDDLE cranial fossa
-the mandible
-the anterior 2/3rds of the tongue
-the floor of the mouth
-the buccal mucosa
-the mandibular teeth

CN V3 (deep territory)

105

Recap: which CN supplies the paranasal sinuses?

CN V1 (except antrum)

106

Recap, which CN supplies the anterior and posterior fossa?

CN V1

107

Recap, which CN supplies the antrum? (maxilla and maxillary sinus)

CN V2

108

Recap, which CN supplies the middle fossa?

CN V3

109

Where does the masseter attach?

From the angle of the mandible TO
the zygomatic arch / bone

110

Where does the temporalis attach?

From the CORONOID process of the mandible to the neurocranium

111

Where does the middle pterygoid attach?

From the (medial) part of the angle of the mandible TO
the ptyergoid plates (of sphenoid bone)

112

Where does the lateral pterygoid attach?

From the CORACOID process AND articuar disc of TMJ to the ptyergoid plates of spehnoid bone

113

Which nerve supplies the tensor veli palatini?

CN V

114

Which nerve supplies the tensor tympani?

CN V

115

These nerves supply the first part of the afferent limb of the corneal (blink) reflex?

Ciliary nerves

116

Which foraminae does the facial nerve pass through?

The internal acoustic meatus and the stylomastoid foramen


(stylomastoid foramen really visible if you look at skull from the bottom)

117

This supplies taste to the anterior 2/3rds of the tongue

Chorda tympani

118

This supplies parasympathetic supply to the submandibular and mandibular glands

Chorda tympani

119

This muscle reduces stapes movement to protect the internal ear from excessive noise

Right stapedius

120

Where would you find the facial nerve in the facial canal?

In the petrous temporal bone

121

Why is the facial canal nice?

It connects the internal acoustic meatus to the stylomastoid foramen

122

What nerve does the chorda tympani attach to?

Attaches to CN V3 and then carries taste axons (to anterior 2/3rds of tongue) and parasympathetic axons (to salivary glands)

123

This border must be carefully sutured by a specialist

Vermillion border

124

Loss of this special pad in illness leads to sunken cheek- what is this pad and why is this sign important?

Buccal fat pad
-important as a clinical sign of malnutrition

125

Which foramen does the glosspharyngeal nerve pass through?

The jugular foramen

126

Special sensory to the vallat papillae

Glossopharyngeal

127

Parasympathetic to the parotid salivary gland

Glossopharyngeal

128

Visceral afferent to the carotid sinus baroreceptors and carotid body chemoreceptors

Glossopharyngeal

129

General sensory to the posterior 1/3rd of tongue

Glossopharyngeal

130

General sensory to the mucosa of most of the nasopharynx

Glossopharyngeal

131

General sensory to the mucosa of the oropharynx

Glossopharyngeal

132

General sensory to the palatine tonsil

Glossopharyngeal

133

General sensory to the eustachian tube

Glossopharyngeal

134

General sensory to the middle ear cavity

Glossopharyngeal

135

Somatic motor to the stylopharyngeus

Glossopharyngeal

136

Which foramen does the vagus nerve pass through?

The jugular foramen

137

How does the vagus nerve pass through the neck?

In the carotid sheath

138

Which muscles does the spinal accessory nerve supply?

The trapezius and the sternocleidomastoid

139

In relation to the triangle of the neck, where would you find the spinal accessory nerve?

It crosses the posterior triangle of the neck

(named nerves of the cervical plexus ALSO pass the posterior border of the sternocleidomastoid but they do NOT pass DEEP to the trapezius like the spinal accessory nerve does)

140

Which foramen does the hypoglossal nerve pass through?

Hypoglossal canal

141

At which level does the hypoglossal nerve pass anteriorly?

At the level of the hyoid bone
--> passes anteriorly towards the lateral aspect of the tongue (because it supplies muscles of the tongue obv)

142

Five layers of the SCALP

Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium

143

Which layer of the scalp contains the arteries of the scalp?

Layer 2 (connective tissue)

144

How can you tell the difference between the internal and external carotid artery?

The internal doesn't have any branches in the neck

145

The opthalmic artery is a branch of which artery?

The internal carotid

146

Pterygoid is a joint between which bones?

Frontal
Temporal
Parietal
Spehnoid

147

Which artery crosses the deep aspect of the pterion?

The middle meningeal artery

148

The optic canal is in which bone?

The sphenoid bone

149

There is a groove across the deep surface of the pteriod, what is this made by?

Made by the middle meningeal artery

150

Parts of the ethmoid bone i probably shouldn't forget

Crista galli
Cribriform plate

151

This is a tough sheet of dura mater forming a roof over the pituitary fossa

Diaphragm sellae

152

This separates the right and left cerebral hemispheres

Falx cerebri

153

Where does the left sigmoid sinus drain into?

Drains into the internal jugular at the jugular foramen

154

Where is the confluence of the sinuses?

In the midline at the internal occipital protuberance (this is deep to the external occipital protuberance)

155

What arteries form the basilar artery?

The vertebral arteries

156

What level would you access the spinal cord?

Lumbar puncture at L3/L4 or L4/L5 intervertebral disc

157

This connects the third and fourth ventricles in the midline

Cerebral aqueduct

158

IMPORTANT
How does the CSF pass from the lateral ventricles to the 3rd ventricle?

FORAMINAE OF MUNRO

159

IMPORTANT
How does CSF pass from 3rd ventricle to 4th ventricle

Cerebral aqueduct!

160

Treatment of hydrocephalus

Ventricular peritoneal shunt

161

What type of haemorrhage:
-middle meningeal artery
-trauma to the pterion

Extradural haemorrhage

162

Which type of haemorrhage:
-torn cerebral veins
-falls in the elderly and alcoholics

Subdural

163

Which type of haemorrhage:
-into the CSF of the subarachnoid space
-ruptured circle of willis "berry aneurysm"
-congenital aneurysm

Subarachnoid haemorrhage

164

In epidural anaesthesia/lumbar puncture, where is the needle most safely inserted?

1) the subarachnoid space that surrounds the cauda equina NOT the spinal cord
2) where the vertebrae are not fused (i.e. NOT the sacrum)

This is why they usually go for L3/L4

165

Where does the subarachnoid space end?

S2

166

Which nerves make up the cauda equina?

L2-C0

167

Which level does the spinal cord end?

L2

168

How do you know if its an uncal/transtentorial herniation?

The uncus (medial part) of the temporal love herniates INFERIOR to the tentorium cerebelli

169

An uncal herniation could compress which nerve?

The occulomotor nerve

--> this leads to an IPSILATERAL, fixed DILATED pupil
-a "blown" pupil

170

What is a downward/tonsillar herniation

The cerebellar tonsils herniate into the foramen magnum

171

Where are the ischial spines palpable on vag exam?

About a finger breadth into the vagina, at 4 and 8 o'clock

172

Which ligaments form the greater and lesser sciatic foraminae?

The sacrotuberous and sacrospinous ligaments

173

What forms the pelvic inlet?

-sacral promontory
-ilium
-superior pubic ramus
-pubic symphysis

174

What forms the pelvic outlet?

-pubic symphysis
-ischiopubic ramus
-ischial tuberosity
-sacrotuberous ligaments
-coccyx

175

Why is trauma to the pelvis bad

You can get a life-threatening haemorrhage (common iliac artery, common iliac vein etc)

176

Difference between the occipitofrontal and the biparietal diameter?

The occipitofrontal diameter is longer than the biparietal diameter

177

What is the "station"? What does a negative number mean?

The distance of the fetal head from the ischial spine
-a negative number means that the head is above the spines

178

While descending through the pelvic cavity, the fetal head should what?

-rotate
-be in a flexed position (i.e chin on chest)

179

Baby should ideally leave the cavity in which postition?

OA (occiput anterior)

180

During delivery, the baby's head should be in which position?

Extension

(descending through cavity = flexed)

181

What happens once the baby's head has been delivered?

There is further rotation so the rest of the baby can then be delivered

182

Ovaries

Pelvic cavity

183

Uterine tubes

Pelvic cavity

184

Uterus

Pelvic cavity

185

Superior part of vagina

Pelvic cavity

186

Inferior part of vagina

Peirneum

187

Perineal muscles

Perineum

188

Bartholin's glands

Perineum

189

Clitoris

Perineum

190

Labia

Perineum

191

Where is the perineum?

Inferior to the levator ani

192

Where does excess fluid collect in the peritoneal cavity?

Collects in the pouch of douglas

193

How can you get fluid out of pouch of douglas?

By passing a needle through the posterior fornix of the vagina

194

Structure and function of the broad ligament?

-Double layer of peritoneum
-Helps maintain the uterus in the correct midline position

195

Which ligament is an embryological remnant?

Round ligament

196

Course of the round ligament?

Passes through the deep inguinal ring to attach to the superficial tissue of the female peritoneum

197

The 3 layers of the uterus and which one is shed

-perimetrium
-myometrium
-endometrium (shed)

198

Where does implantation of the zygote occur?

Occurs in the body of the uterus

199

Name a ligament which helps support the uterus

Uterosacral ligament

200

What is uterine prolapse?

Movement of the uterus inferiorly

201

Anteverted

Uterus is tipped anteriorly relative to the axis of the VAGINA

202

Anteflexed

Uterus is tipped posteriorly relative to the axis of the VAGINA

203

Retroverted?

Uterus tipped posteriorly in relative to axis of VAGINA

204

Retroflexed?

Uterus tipped posteriorly relative to axis of CERVIX

205

Which part of the cervix are you sampling in a smear?

The squamo-columnar junction

206

Removal of both uterine tubes and ovaries

Bilateral salpingo-oophrectomy

207

Removal of one of the uterine tubes

Salpingectomy

208

How can you assess patency of the uterine tubes?

Hysterosalpingogram !!!

209

What size are the ovaries

Almond sized

210

What hormones do the ovaries secrete?

Oestrogen and progesterone

211

Where do the ovaries develop?

On the posterior abdominal wall

212

Where is the ovum released into?

Ovum released into the peritoneal cavity !!

213

How can you check the position of the uterus?

Bimanual palpation

214

How can you feel the adnexae

-place examining fingers into lateral fornix
-press deeply with other hand in the iliac fossa of the same side
-repeat on other side
-can detect large masses or tenderness affecting these structures.

215

Nerve supply to levator ani

"nerve to levator ani" S3, S4, S5 sacral plexus

216

Nerve supply to the perineal muscles?

Pudendal nerve

217

This is a bundle of collagenous and elastic tissue into which the perineal muscles attach - what is it call, why is it important and where is it located?

-Perineal body
-important to pelvic floor strength
-located just deep to the skin

218

Breast correlates to which ribs?

Ribs 2-6 !!!

219

What is the retromammary space?

Lies between fascia and breast

220

What does the breast lie on top of?

Lies on top of deep fascia covering pec major and serratus anterior

221

Where does most breast lymph drain to?

Drains to ipsilateral axillary lymph nodes and THEN to supraclavicular lymph nodes!!

(problemz with upper limb also draining here etc)

222

Where could lymph from the lower inner breast drain to?

Drain to the abdominal lymph nodes

223

Where is the brachial plexus?

In the axilla

224

Level I

Inferior and lateral to pectoralis minor

225

Level II

Deep to pectoralis minor

226

Level III

Superior and medial to pectoralis minor

227

Incision for lower segment caesarian section

Suprapubic incision

228

Layers of the anterolateral abdominal wall

Skin
Superficial fascia
External oblique
Internal oblique
Transversus abdominus

Skin
Superficial fascia
Rectus sheath
Rectus abdominus

229

Where does the external oblique attach?

-lower ribs
-iliac crest
-pubic tubercle
-linea alba

230

Linea alba of external oblique, internal oblique and transversus abdominus?

Made from midline blending of aponeuroses

231

Where does the internal oblique attach?

-lower ribs
-thoracolumbar fascia
-iliac crest
-linea alba

232

Where does the transversus abdominus attach?

-lower ribs
-thoracolumbar fascia
-iliac crest
-linea alba

233

How is the aponeuroses of the rectus abdominus made?

From the interweaving of the muscle aponeuroses

234

Where do the rectus abdominus attach?

Xiphoid process and costal cartilage
Pubic bones

235

Rectus sheaths above and below umbilicus?

Above umbilicus = anterior and posterior rectus sheath
Below umbilicus = anterior rectus sheath only

236

Which layer would you find the ilioinguinal nerve?

In between the internal oblique and transversus abdominus

237

The 7th-11th intercostal nerves become what?

The thoracoabdominal nerves

238

Subcostal

T12

239

Iliohyogastric

L1

240

Ilioinguinal

L1

241

Thoracoabdominal, subcostal, iliohypogastric and ilioinguinal nerves travel in which plane?

In between the iliohypogastric and ilioinguinal

242

Superior epigastric arteries are a branch of which artery?

Internal thoracic

(lie posterior to rectus abdominus)

243

Inferior epigastric arteries are a branch of which artery?

Branch of external iliac

(lie posterior to rectus sheath)

244

The intercostal and subcostal arteries are continuations of which arteries?

Posterior intercostal arteries

245

LSCS layers incised through

Skin and fascia
Rectus sheath
Rectus abdominus
Fascia and peritoneum
Retract bladder
Uterine wall
Amniotic sac

246

Layers to incise through during lapartomy

Skin and fascia
Linea alba
Peritoneum

247

Why can a midline laparotomy be bad?

Relatively bloodless - increases chances of wound complications

248

If you need a lateral port in a laparoscopy, what artery MUST you avoid?

MUST avoid inferior epigastric artery

249

Route of the interior epigastric artery?

-branch of external iliac
-emerges just medial to the deep inguinal ring
-then passes in a SUPEROMEDIAL direction posterior to the rectus abdominus

250

Which incision would you use for an abdominal hysterectomy?

LSCS

251

How can you tell if you are touching the ureter or the uterine artery

Ureter:
-passes inferior to the artery
-will "vermiculate" when touched

252

Uterine "cramping" (e.g menstruation)

Hormonal (sympathetic/parasympathetic)

253

Uterine contraction (e.g. during labour)

Hormonal (sympathetic/parasympathetic)

254

Pelvic floor muscle contraction (e.g. during sneezing)

Somatic motor

255

Pain from adnexae

Visceral afferents

256

Pain from uterus

Visceral afferents

257

Pain from the vagina

Visceral afferents (pelvic part)
Somatic sensory (perineum)

258

Pain from the perineum

Somatic sensory

259

Pain sensation from superior aspect of pelvic organs/touching the peritoneum

Uterine tubes, uterus, ovaries

Visceral afferents carry the info!
These then run alongside the SYMPATHETIC fibres and enter the spinal cord between T11- L2
(pain perceived as suprapubic)

260

Pain sensation from inferior aspect of pelvic organs/ not touching the peritoneum

Cervix and superior vagina

Visceral afferent also carry the info!
These run alongside the PARASYMPATHETIC fibres and enter the spinal cord at S2, S3, S4
(pain percieved as S2, S3, S4 dermatome i.e. the perineum)

261

Pain sensation from structures ABOVE levator ani

Visceral afferents carry the infor
Parasympathetic
Levels S2, S3 and S4

262

Pain sensation from BELOW levator ani

Inferior vagina
Perineal muscles
Glands
Skin

SOMATIC SENSORY !!!
Pudendal nerve
Spinal cord levels S2, S3 and S4
Localised pain with perineum

263

The 2 most important spinal cord levels for pain from the repro system

T11-L2
and
S2-S4 (as in S2,S3,S4)

264

Spinal cord becomes cauda equina at which level

L2

265

Subarachnoid space ends at which level

S2

(s for subarachnoid)

266

Where is the anaesthetic injected into for a spinal/epidural anaesthesia

Injected into subarachnoid space of L3-L5
=anaesthetises the cauda equina
no infection

(LP usually L3/L4 or L4/L5)

267

Layers the needle is passed through for spinal anaesthetic

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Finally reaches subarachnoid space (contains CSF)

268

Layers needle is passed through for epidural

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)

269

Sympathetic outflow leaves the spinal column in which levels?

T1 - L2

270

All spinal nerves and their named nerves contain what?

They all contain sympathetic fibres
-including femoral, sciatic, obturator, pudendal

271

There fibres supply all arterioles

Sympathetic

272

Signs that spinal anaesthesia is working

Skin of lower limbs looks flushes
Warm lower limbs
Reduced sweating
(Hypotension)

Remember this is because you are blocking the sympathetic tone to all the arterioles in the lower limb :)

273

Pudendal nerve is from which plexus

Branch of sacral plexus S2, S3, S4

274

When might you consider a pudendal nerve block?

Useful for episiotomy incision, forceps use and perineal stitching post delivery

(anaesthetises majority of perineum)

275

What is in the pudendal canal?

Pudendal nerve, artery and vein
Also the nerve to obturator internus

276

Where could you find the nerve to obturator internus?

In the pudendal canal

277

Which bony landmark can you use to administer pudendal nerve block?

Ischial spine

278

During labour, the branches of which nerve can become stretched?

Pudendal nerve

279

If your pudendal nerve is stretched in labour, which muscles could be weakened?

Levator ani and external anal sphincter

-this can result in weakened pelvic floor and faecal incontinence

280

This incision is made into the relatively "safe" fat filled ischioanal fossa and avoids extending into the rectum

Epesiotomy

281

The 3 parts of the levator ani

-puborectalis
-pubococcygeus
-iliococcygeus

282

Innervation of levator ani

Pudendal nerve
Nerve to coccygeus