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CPR Midterm > Anatomy > Flashcards

Flashcards in Anatomy Deck (199):
1

ectopia cordia

baby born with heart outside chest wall

2

pectus excavatum

"bowl shaped"overgrowth of costal cartilage. push sternum/xiphoid INWARD to chest

3

pneumothorax

lung deflates due to break in intraplural sealSx: absent breath soundsdyspnea

4

sternal angle of louis

2nd costal cartilage

5

mediastinum

"midway"central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, the esophagus, the trachea, the phrenic nerve, the cardiac nerve, the thoracic duct, the thymus, and the lymph nodes of the central chest.surrounded by loose connective tissue. superior and inferior portions divide at T4/T5

6

valvular areas for auscultation

places to put stethoscope where valvular sounds project to the chest surface (A,P, T, M)
aortic valve: 2RICS
pulmonic vlave: 2LICS
Tricuspid vavle: 4LICS
Mitral valve: apex, 4LICS or 5LICS at midclavicular line

7

primary mover of air in/out of lung

diaphragm

8

ventilation: movement of costovertebral joints and sternum

ribs rotate up and out to increase chest volume= "bucket handle"sternum pushes anterior= "pump handle"

9

chest tube btwn what muscles?

pect. major and latissimus dorsimid- or anterior- axillary line

10

placement of chest tube: where in ribs?

btwn 5th and 6th rib5th intercostal spacerun along TOP of rib to avoid V.A.N.mid- or anterior- axillary line

11

hemothorax

blood accumulates in the pleural spacelimiting the amount that the heart's ventricles are able to fillSx: dyspnea, diminished (distant) blood soundspercussion= Dull resonance

12

flail chest

thoracic segment is loose and moves independently with "paradoxial motion"Sx: dyspnea

13

In expiration, the diaphragm rises to what level?

4th intercostal space at the level of the nipple, and thus chest drains should be placed above this level

14

pectus carinatum

pigeon chest/ "keel shaped"deformity of the chest characterized by a protrusion of the sternum and ribs.

15

dyspnea

Difficult or labored breathing; shortness of breath

16

what causes an elevated hemidiaphragm

see on XRAY: diaphragmatic position is not symmetricphrenic nerve palsy/damage"C3/C4/C5 keeps the diaphragm alive"

17

which fascia lines the entire thoracic cage

ENDOTHORACIC FASCIA

18

what is the hilum of the lung

the doorway of the lungthe vessels and bronchi pass through this ('the root")

19

XRAY: widened mediastinum

trauma/ rapid deceleration accident (MVA)torn aorta

20

posterolateral thoracotomy

an incision through fifth intercostal space on the back, and is often widened with rib spreaders. common approach for operations on the lung/mediastinum/ esophagus/pulmonary hilum (pulmonary artery and pulmonary vein)

21

poland syndrome

congenital abnorm: absence of stertnocostal head of pectoralis majorshortening of upper extremities/digitis

22

coarctation of the aorta

congenital abnormstenotic aorta (narrowed)intercostal arteries enlargedxray: notched/remodeling ribs(typically constriction found on aorta distal to branching of L subclavian artery)

23

arrangement of neurovascular bundle in costal grove

main intercostal Vein, Artery,m Nerve (VAN)superior to inferior

24

What as the embryonic origin of the respiratory system (trachea, bronci, lungs)?

respiratory diverticulum

25

at what age are the lungs fully mature?

8 years

26

compare development of right and left lungs/bronchi

right grows faster, and more vertically (has 3 lobes)left grows slower, more laterally- bronchi are oriented similarly (right is more vertical and wider)

27

Describe the most common tracheoesophageal fistula?

Proximal esophagus is closed off; distal esophagus communicates with trachea - Failure of primitive foregut to divide into ansterior trachia and posterior esophagus - Gastric acid could reflux into the lung

28

What develops from the M2A tube?

FILL IN

29

What is the origin of the pleural space?

Coelom (pocket of mesoderm)

30

Contrast the visceral and parietal pleura.

Visceral (splanchic) is adhered to the lung surface (can't be separated). - autonomic innervation (no pain sens.)Parietal (somatic) lines the outside of the cavity, lines the inside of the ribcage; - innervated (intercostal and phrenic n.), can feel pain

31

Significance of rubbing sounds from the triangle of auscultation?

Pleurisy- inflammation of parietal pleura assc. w pneumonia- exudate is released (becomes invaded by fiboblasts)- rubbing causes pain and can be heard

32

What is pleural fluid?

a consituent of blood

33

What is the lowest portion of pleural cavity? Significance?

costodiaphragmatic recess- the site where fluid will accumulate when the patient is upright

34

What is another related association of shoulder pain?

pain sensation to the parietal pleura to the phrenic nerve (from same roots as nerves that supply the shoulder)

35

What is the origin of the visceral pleura?

derived from splanchnic mesoderm - innervated by pulmonary plexus (pressure/stretch, but not pain)

36

What lines the visceral pleura?

Simple squamous mesothelium

37

A trachial deviation is the hallmark of what underlying problem?

Tension pneumothorax- trachea will be pushed away from the pneumothorax by the influx of air pressure

38

What is a consolidation of the lung?

A lobe of lung that has filled with fluid; will appear opaque on chest radiograph

39

Where is the first division of the bronchi where air exchange occurs

respiratory bronchial

40

At which phase of lung development is gas exchange possible?

1. Pseudoglandular period (6-16 weeks)2. Early Canalicular period (16-20 weeks)3. Late Canalicular period (20-26 weeks): fetus survival rare, but possible (answer)4. Sacular period (26-40 weeks)5. Alveolar period (term birth to 8 years)

41

What produces surfactant?

Type II Pneumocytes

42

most common site of FB/aspiration in lungs: R or L bronchus?

R bronchus intermediusR mainstem bronchus is shorter/straighter than the 90* L mainstemxray: airspace opacity in a lobe

43

In patients who aspirate while in a supine/recumbent position, which lung lobe is effected

superior segments of the RLL and the posterior segments of the RUL (right upper lobe)

44

In patients who aspirate while in a erect position, which lung lobe is effected

right lower lobe basilar segments

45

what are the five parts of the mediastinum?


* superior Inferior
* anterior
* middle
* posterior

46

what is located in the superior mediastinum (5)?

thymus
* great vessels (SVC, arch of Azygos, arch of Aorta) trachea
* esophagus thoracic duct

47

what is located in the anterior (inferior) mediastinum (1)?

THE THYMUS

48

what is located in the middle (inferior) mediastinum?


* heart
* pericardium
* roots of the great vessels

49

what is in the posterior (inferior) mediastinum (4)?

1. thoracic aorta2. thoracic duct3. esophagus4. azygous venous system

50

in a trauma patient, what does an abnormally widened mediastinum indicate? 

a torn aorta

51

what is usually torn in a trauma patient when the aorta tears?

the ligamentum arteriosum

52

What are the segments of the right superior lobe?

apical, posterior, anterior

53

what are the segments of the right middle lobe?

lateral and medial

54

what are the segments of the right inferior lobe?

superior, anterior basal, medial basal, lateral basal, posterior basal

55

what are the segments of the left superior lobe?


* apical, posterior (usu apicoposterior segment)
* anterior
* superior lingular
* inferior lingular 

56

what are the segments of the left inferior lobe?


* superior
* anterior basal and medial basal (usu anteriomedial basal)
* lateral basal
* posterior basal

57

what are the three levels of brionchioles?

ConductingTerminalRespiratory

58

the mediastinum is a what vertebral level?

T4-T5 (T5 vertebral disc)

59

the phrenic nerve is right against what tissue?

The pericardium

60

what nerve is located between the trachea and the arch of the aorta?

the left recurrent laryngeal nerve

61

what is hemopericardium? What does it cause?

blood in the paricardial cavityproduces cardiac tamponade

62

what is pericardiocentesis? what level is the wide-bore needle placed into?

drainage of fluid from the paricardial cavity the 5th or 6th intercostal space

63

where do you listen to pleural rubs on a patient (be specific)?

in the triangle of ausculatation: bordered by trapezius, latissimus dorsi and rhomboid major (or medial border of scapula)

64

the phrenic nerve is sourced by which parts of the cervical nerve?

"C3, 4, and 5 keep the diaphragm alive."

65

what is the difference between pneumothorax and tension pneumothorax?

in tension pneumothorax, the air is not excaping the pleural space wheras in pneumothorax, air is flowing freely through a hole in the pleura

66

what are the two layers of the pericardial sac?

the outer fibrous pericardium and inner serous pericardium

67

what is the sinus venarum?

the smooth part of the right atrial wall that is derived from the sinus venosus

68

what is the sulcus terminalis?

the groove between the sinus venarum and the rest of the right atrium(*separates the rest of the atrium from the sinus venarum)

69

what is the crista terminalis?

the ridge deep to the sulcus terminalis

70

what is the musculi pectinati?

the pectinate muscles. The are found in the anterior wall as muscular ridges.(pectin= comb)

71

what is the fossa ovalis?

a remnant of the foramen ovale that is now simply a depression (in the righ atrium)

72

what is the infundibulum in the right ventricle?

the conus arteriosusinfundibulum is latin for funnel. It is a narrowing of the r.ventricle before the pulmonary semilunar valve.

73

what are the trabeculae carnae?

meaty columns that are not musculi pectinatialso, pillars of cardiac muscles

74

what are the papillary muscles connected to?

the chordae tendineae

75

what is the function of papillary muscles?

the contract early in the cardiac cycle IOT anchor the cusps of the atrioventricular valve and prevent regurgitation or backwards flow of blood into the atrium.

76

what are the chordae tendineae and what is their function?


* tendinous cords that attach the leaflets of the tricuspid valve to the papillary muscles
* they assist the papillary muscles in preventing regurgitation

77

what is the moderator band? What is significant about it

septomarginal trebeculaethis band of muscle connects the interventricular septum to the papillary muscles.the moderator band contains electrical conducting fibers

78

where is the atrioventricular node located?

between the valve of the coronary sinus and the tricuspid valve

79

where is the SA node located?

between the SVC and the Right atrium

80

the right recurrent laryngeal vein loops around what structure?

the right subclavian artery

81

the transverse pericardial sinus runs under what two structures?

the ascending aorta and the pulmonary trunk

82

the roght coronary artery runs in what feeature of the heart?

the coronary sulcus

83

the fibrous skeleton wraps around what structures?

the 4 valves: semilunar (aortic and pulmonary) and atrioventricular (mitral and tricuspid)

84

identify one feature of the heart that makes it susceptible to blockage

the vessels do not highly anastomose (feed into each other)

85

list the vessels, chambers and valves a drop of blood would flow through beginning at the R atrium:

through the tricsupid valve to the R ventricle through the pulmonary valve into the pulmonary trunk  into the pulmonary arteries to the lungs back through the pulmonary veins into the L atrium through th mitral valve into the L ventricle  through the aortic valve into the ascending aorta, to the arch of the aorta to systemic circulation via the brachiocephalic trunk (R subclavian and common carotid arteries) , L common carotid, L subclavian and thoracic aorta, to the arterioles, into the capillaries of organs out through the venules, into the IVC, (if on the left side) hemiazygous and accessory hemiazygous veins, (if on the right side) azygous vein, SVC (fed from the R and L brachiocephalic vein), and coronary sinus (from the heart) and back into the R atrium.

86

what is an aortic lunule? an aortic nodule?

the lunule is the thickened edge of a valve cusp while the nodule is the apex of the angulated lunules (free edges)

87

what does the right coronary (RCA) artery supply (4)?

right atriumSA and AV nodesthe posterior interventricular sulcus

88

what is the artery to the SA node called? 

the SA nodal artery 

89

what does the right marginal artery supply?

the right ventricle and the apex of the heart

90

what does the posterior interventricular artery supply? 

the right and left ventricles and the posterior third of the interventricular sulcus 

91

what does the circumflex artery supply? What artery does it branch from?

the left atrium and ventricleLCA

92

what does the left marginal branch supply?

left ventricle

93

what are the branches of the left ccoronary artery?

the anterior interventricular artery or LAD (left anterior descending)left circumflexleft marginal

94

what are the branches of the right coronary artery?

sinuatrial (SA/AV nodes)right marginalposterior interventricular

95

what is the dividing point between the great cardiac vein and the coronary sinus?

the oblique vein of Marshall (aka the oblique vein of the left atrium)

96

what is a myocardial infarction? What happens?

necrotic myocardiuma heart attack: when an embolus occludes a vessel and blocks blood flow to the heart (ie. in a coronary artery) thus leading to necrosis of that part of the heart due to lack of oxygen

97

what are the three most common sites of coronary artery occlusion?

anterior IV (LAD) branch of the LCA (aka the "widow-maker")right coronary artery (RCA)circumflex branch of the LCA

98

How can a coronary occlusion affect the conducting system?

if the RCA is blocked, blood supply to the SA and AV node could be dirupted and cause a heart block (a problem with the heart's electrical system)

99

what is a heart block? what is the resulting effect?

damage to the heart's electrical systemit can change the rate and rhythm of the heart rate

100

what is myogenic conduction? What does it produce? How is it regulated?

muscle propagated conductionproduces a late asynchronous contractionregulate/fix with a cardiac pacemaker

101

if you were to injure yourself through the sternum, which part of the heart would be damaged?

the right ventricle

102

What connects the aorta to the pulmonary artery?

the ligamentam arteriosus (previously the ductus arteriosus)

103

if you sweep your hand up and behind the heart but stop right behind the veins, there is your hand located?

in the oblique pericardial sinus

104

(T/F) The pulmonary valve is attached to the cardiac skeleton.

False. the pulmonary valve is not attached.

105

In the aortic valve, there are ostiums that lead to what to arteries?

the left and right coronary arteries

106

the heart has four valves. which are passive and which are active?

the semilunar valves are passive and the aorticoventricular valves are active

107

what is Virchow's triangle for thrombosis?


* Hypercoagulability (risk for blood clots)
* Endothelial injury (intima of blood vessels)
* Hemdynamic changes (blood flow) 

108

Thrombosis is more common in the L or R heart? If there is a clot in the Left heart, what could it lead to?

Right heart. There is a lot of empty space in the left heart.stroke

109

What muscular structure is the first thing activated by the AV node? What does it do (what is the muscle's function)?

the moderator bandit closes the AV valve

110

How does angina present in men?

as cardiac referred pain in the left shoulder

111

How does the thymus change with age? Does it have any function past puberty?

initially it helps to develop and support the immune system.at puberty, it begins to shrinkin adulthood, it is replaced with fat but continues to produce T-lymphocytes

112

What are the 5 auscultatory areas of the chest? Where are they located?

1. Mitral area (5th left intercostal space-5LICS)2. Tricuspid area (4LICS)3. Secondary pulmonic area (3LICS)4. Pulmonic area (left upper sternal border-LUSB)5. Aortic area (RUSB)

113

what is valvular stenosis?

the failure of a valve to fully open so that blood flow is slowed

114

what is valvular insufficiency?

the valves do not shut completely therefore blood flow regurgitates. Nodule formation also arises along with scarring or  conrtaction of the cusps. This prevents the valve from sealing properly.

115

When valvular insufficiency or stenosis is present, what effect does it have on the heart? 

The heart has an increased workload

116

what is a murmur? what causes it?

murmurs are audible vibrations caused by small whirlpools (eddies) resulting from turbulence. turbulence usually arises from stenosis or regurgitation)

117

What is a thrill?

a superficial vibratory sensation felt on the skin over an area of turbulence

118

what separates the trachea from the esophagus?

the tracheoesophageal septum

119

what is a transesophageal fistula? What is the most common form?

an abnormal connection (fistula) between the trachea and esophagus.the proximal part of the esophagus has a blind end and the distal part has a narrow opening right at the bifurcation of the trachea 

120

what does vagal nerve stimulation cause

negative chronotropic effect= bradycardia

121

what does adrenergic stimulation cause

positive chronotropic effect= tachycardia
positive inotropic efect= increased force of contraction

122

why does BP drop in a pneumothorax

increased pressure in the pleural space= pressure on IVC decreases blood flow into the heart
*insert a chest tube/needle decompression

123

Tension pneumothorax: where do you insert a needle into the chest for needle decompression

A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line.

The needle is advanced until air can be aspirated into a syringe.

124

classic signs of a tension pneumothorax

pushes the mediastinum to the opposite hemithorax
obstructs venous return to the heart.
circulatory instability
deviation of the trachea away from the side with the tension
a hyper-expanded chest increased percussion note
tachycardic
hypoxic
cyanotic
hypotensive
Dyspnea
Tachypnea
Hyper resonance of the chest wall on the affected side
Diminished breath sounds on the affected side
JVD

125

classic signs of cardiac tampanode

blood in pericardium:
increased JVD
decreased heart sounds
hypotensive
cyanotic
tachycardic
**need pericardiacentesis

126

Beck's Triad

signs of cardiac tamponade:
low arterial blood pressure
distended neck veins
distant (muffled) heart sounds

127

how to treat cardiac tampanode

pericardialcentesis
insert needle to L of xiphoid process into pericardium and drain off blood

128

Diaphragmatic hernia

tear/hole in the diaphragm that allows the abdominal contents to move into the chest cavity

common on L side after MVA
high-force blunt trauma
Treatment: surgery

129

aortic transection

Traumatic aortic rupture
mostly after MVA, rapid deceleration
site: proximal descending aorta, near where the left subclavian artery branches off; near ligamentum arteriosum
xray: widened mediastinum

130

signs of aortic transection

widened mediastinum
tracheal/L bronchus/esophagus displacement
decompression main stem process
apical cap
risk: 1st rib fracture

131

complications of repair of transected aorta

damage to L recurrent pharengeal nerve and
anterior spinal artery

132

signs of damage to L recurrent pharengeal nerve

hoarse voice
Vocal cord paralysis

133

explain cardiac referred pain

heart attack pain is referred to the shoulder/neck/back/arm
percardium nerves cross others on their path to spinal cord

134

CABG

Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease
"heart bypass"

135

when is the mitral valve open

during mid diastole, diastasis, and atrial systole

136

what is isovolumic systole

phase btw mitral valve closure and aortic valve opening
both valves closed
ventricle volume is constant

137

“circulation dominance” of the coronary arterial system

“right dominance” pattern = PDA (posterior descending/interventricular coronary artery) comes from the RCA
"Left dominance"= PDA comes from the LCX

138

heart block

"AV node block"
electrical signal that controls the heartbeat is partially or completely blocked from reaching the ventricles (in AV node or bundle of His)

139

bundle branch block

blocks R or L bundle branches
delay or obstruction along the pathway of electrical impulses

140

predicted area of myocardial damage that results from acute occlusion of the: left main coronary a.
(LCA)

L atrium/ventricle
IVS
AV bundles

141

predicted area of myocardial damage that results from acute occlusion of the: right main coronary a (RCA)

SA and AV node
nodal dysfunction= bradycardia or heart block
also serves posterior part IVS

142

predicted area of myocardial damage that results from acute occlusion of the: left anterior descending coronary a (LAD)

common site of occlusion: huge MI
L ventricle surface
most interventricular septum (IVS)
anterior papillary muscle

143

Which coronary artery most commonly supplies: The interventricular septum and apex of the heart (left ventricle) ?

Left anterior descending coronary a (LAD)

144

when in cardiac cycle do coronary arteries fill with blood?

during diastole
aortic valve occlude openings to coronary arteries in systole

145

complications of an enlarged L atrium

compressed esophagus= difficulty swallowing (dysphagia)
compressed L recurrent laryngeal nerve= hoarseness

146

Cerebrovascular accident (CVA)

A stroke - blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel

147

valvular stenosis

narrowing of the valve

148

valvular insufficiency

regurgitation – retrograde flow; incompetency

149

valvular prolapse

enlarged, floppy, redundant valve
billowing of valve leaflets

150

myocardial infarction

occlusion of artery
myocardial area becomes bloodless
necrosis

151

3 most common sites for coronary artery occlucion

(50%) LAD branch of LCA
(30%) RCA
(20%) circumflex branch of LCA

152

fibrillation

many rapid contractions/twitchings of muscular fibers
irregular
uncoordinated

153

Are right or left indirect hernias more common? Why?

Right. The right testicle descends later, so the patent opening stays open for longer (more opportunity to fail to close).

154

Are hernias always due to herniation of intestines?

No. Fat or other tissue could come through.

155

What is the earliest point in development that the testis should be located in the scrota sac?

7 months: in the inguinal canal
9 months (33rd week)): anchored in the scrotum

156

Why are indirect hernias less common in women in men?

The size of the necessary opening in development is smaller in women than men.

(Note: indirect hernias are still the most common hernias in women, but incidence is less than in men.)

157

Where do you look for blood/fluid collection in the female pelvis (both standing up and supine)?

Recto-uterine pouch of Douglas
- diagnose w ultrasound

158

What is the innervation for the internal vs external rectal sphincters?

Internal: pelvic splanchnics (S2, S3, S4)
External sphincter: pudendal nerve (S2, S3, S4)

159

What is a patent urachus?

Failure of the allantois to atrophy
- babies in utero pee both via the urethra and via the umbilical cord (allantois)
- if it doesn't close, properly at birth, babies can pee via their umbilicus

160

What can tear with a urinary catheter?

Membranous urethra
- more vulnerable bc it's fixed between the bones

161

What is the prostatic utricle?

Blind opening. Homologous to the female uterus.

162

indirect hernia

-goes through the triangle of Hesselbach MEDIAL to epigastric vessels
-acquired
-weak abdominal wall

163

direct hernia

-congenital
-lateral to epigastric vessels
-goes through inguinal canal inside processes vaginalis
-young males

164

hydrocele

accumulation of excess peritoneal fluid in a persistent processes vaginalis

165

torsion of spermatic cord

twisting of cord against venous drainage. leads to edema and hemorrhage and arterial damage
-can lead to necrosis.
treat with surgery

166

nerves of the lumbar plexus in order

subcostal
genitofemoral
iliohypogastric
ilioinguinal
lateral femoral cutaneous
obturator
femoral

167

superficial lymphatic vessels below the transumbilicated plane drain:

to superficial inguinal nodes

168

lymphatic vessels superior to the transumbilicated plane drain:

axilliary lymph nodes?

169

remnant of the embryonic ventral mesentery

falciform ligament

170

remnant of the umbilical vein

round ligament

171

the falciform ligament encloses which ligament?

the ligament of teres (round ligament)

172

lateral umbilical folds are

ridges of parietal peritoneum that cover the inferior epigastric vessels

173

medial umbilical ligaments were once

umbilical arteries

174

median umbilical ligaments is a remnant of the

urachus.

175

significance of inguinal triangle of Hasselbach

direct hernias pooch through the abdominal wall here

176

the round ligament is a remnant of

the gubernaculum

177

the processus vaginalis does what in females?

recedes

178

the deep inguinal ring is lateral to the

inferior epigastric artery

179

in the inguinal canal, males have a what? women have what?

males have a spermatic cord, women have the round ligament of the uterus

180

most commonly, abdominal weakness for direct hernias is below the _1_ line. This is because there is no __2__ (internal oblique aponeurosis) behind the rectus muscle.

1- arcuate
2-rectal sheath

181

Subcutaneous tissue in the abdomen becomes what in the spermatic cord?

Dartos muscle or fascia

182

external oblique muscle and fascia in the abdomen becomes what in the spermatic cord?

external spermatic fascia

183

internal oblique muscle in the abdomen becomes what in the spermatic cord?

Cremaster muscle

184

transversus abdominis muscle in the abdomen becomes what in the spermatic cord?

NOTHING

185

transversalis fascia in the abdomen becomes what in the spermatic cord?

internal spermatic fascia (Buck's)

186

Peritoneum in the abdomen becomes what in the spermatic cord?

parietal layer, cavity and visceral layer of the tunica vaginalis

187

cremasteric reflex

rubbing a male's inner thigh elevates the testis. Used to asses a spinal cord injury

188

cremasteric muscle is innervated by the

ilioinguinal nerve for sensory, genital branch (of genitofemoral) for motor

189

pampiniform plexus of veins drains into the

IVC on right and renal vein on left.

190

3 stages of labor

1- thinning of cervix to 10cm dilation
latent phase and active phase of labor
2- complete dilation to delivery of baby's head
3- delivery of baby and placenta

191

Cardinal movements of labor (5)

engagement
internal rotation
extension
external rotation
expulsion

192

define prolapse

falling of an organ into the vaginal area
cause:weak ligaments from age, chronic pressure

193

define cystocele

prolapse of bladder into vagina

194

define rectocele

prolapse of rectum into the vagina

195

define urethrocele

prolapse of the female urethra into the vagina

196

define effacement during birth

thinning of the cervix

197

urogenital triange

pubic symphysis, ischial rami, ischial tuberosities

198

anal triangle

coccyx, ischioanal tuberosities

199

describe different blood flow in ovarian veins (Lvs R)

R ovarian vein returns to inferior vena cava
L ovarian vein drains into L renal vein