Anatomy

Question 1

What is palpable at 4 & 8 o’clock on a vaginal exam?

Answer 1

Ischial spines

Question 2

How long does the anterior fontanelle take to ossify?

Answer 2

9-18 months

Question 3

How long does the posterior fontanelle take to ossify?

Answer 3

3 months

Question 4

What is the ideal position for the delivery of a baby?

Answer 4

Occipitoanterior (OA)

Question 5

How can the pouch of Douglas be drained?

Answer 5

Through the posterior fornix of the vagina

Question 6

Where does the broad ligament join to the pelvis?

Answer 6

Uterus,lateral walls & floor of pelvis

Question 7

What is contained within the broad ligament?

Answer 7

Uterine tubes & proximal part of round ligament

Question 8

What is the round ligament attached to?

Answer 8

Lateral aspect of the uterus

Question 9

What does the round ligament pass through?

Answer 9

Deep inguinal ring

Question 10

What are the 3 layers of the body of the uterus?

Answer 10

Perimetrium
Myometrium
Endometrium

Question 11

Where does implantation of the zygote occur?

Answer 11

Body of the uterus

Question 12

What are the 2 most common positions of the uterus?

Answer 12

Anteverted & Anteflexed

Question 13

Where are samples for cervical smears taken?

Answer 13

Transformation zone

Question 14

Where does fertilisation occur?

Answer 14

The ampulla

Question 15

How is the patency of theuterine tubes assessed?

Answer 15

Histerosalpingogram (HSG)

Question 16

Where do the ovaries develop embryologically?

Answer 16

Posterior abdominal wal

Question 17

What do the ovaries do

Answer 17

Secrete oestrogen & progesterone in response to LH & FSH

Question 18

What is the perineal body important for?

Answer 18

Pelvic floor strength

Question 19

What is the function of Bartholin’s glands?

Answer 19

Allow vaginal secretions - associated with arousal

Question 20

Where is the bed of the breast?

Answer 20

Ribs 2-6

Question 21

Where is the retromammary space?

Answer 21

Between fascia & breast?

Question 22

What 2 muscles lie underneath the breast?

Answer 22

Pectoralis major & serratus anterior

Question 23

Where does 75% of breast tissue drain?

Answer 23

Ipsilateral axillary lymph nodes then to supraclavicular nodes

Question 24

What is a complication of axillary lymph node removal?

Answer 24

Lymphedema

Question 25

What arteries supply the breast?

Answer 25

Axillary artery Subclavian artery Internal thoracic (internal mammary) artery

Question 26

What nerve fibres innervate pelvic floor muscle contraction?

Answer 26

Somatic motor

Question 27

What nerve fibres transmit pain from the adenexae & uterus?

Answer 27

Visceral afferents

Question 28

What fibres transmit pain from the perineum?

Answer 28

Somatic sensory

Question 29

Where is pain perceived from the superior aspect of pelvic organs (touching the peritoneum)?

Answer 29

Suprapubic (T11-L2)

Question 30

Where is pain perceived from the inferior part of pelvic organs (not touching the peritoneum)?

Answer 30

In the peritoneum (S2,3,4)

Question 31

At what level does the spinal cord become the cauda equina?

Answer 31

L2

Question 32

What level does the subarachnoid space end?

Answer 32

S2

Question 33

At what level is anaesthetic injected at?

Answer 33

L3/L4 (L5) region)

Question 34

Where does sympathetic outflow exit the spinal cord?

Answer 34

T1-L2

Question 35

What is a sign that a spinal anaesthetic is working?

Answer 35

Skin of lower limbs looks flushed, warm, reduced sweating

Question 36

What spinal levels does the pudendal nerve come from?

Answer 36

S2,3,4

Question 37

What does the pudendal nerve supply?

Answer 37

Somatic motor & somatic sensory to the structures of the perineum

Question 38

What procedures can a pudendal nerve block be useful for?

Answer 38

Episiotomy incision Forceps use Perineal stitching post delivery

Question 39

What is the pathofthe pudendalnerve?

Answer 39

Exits pelvis via the greater sciatic foramen Passes posterior to sacrospinous ligament Reenters pelvis/perineum via lesser sciatic foramen Travels in pudendal canal

Question 40

What direction do the external obliques run in?

Answer 40

Hands in pockets

Question 41

What arteries supply the anterior abdominal wall?

Answer 41

Superior & inferior epigastric arteries

Question 42

What are the advantages of a LSCS incision?

Answer 42

Don't cut rectusmuscles just separate

Question 43

Which incision might not heal well due to the lack of blood supply?

Answer 43

Laparotomy

Question 44

What are you trying not to damage in a laparoscopy?

Answer 44

Inferior epigastric artery

Question 45

What is the inferior epigastric artery a branch of?

Answer 45

External iliac

Question 46

Where does the inferior epigastric artery emerge?

Answer 46

Just medial to DIR (halfway between ASIS & pubic tubercle)

Question 47

How do you distinguish between the ureter & uterine artery in a hysterectomy?

Answer 47

"Water under the bridge" | Ureter will "vermiculate"

Question 48

What are the 2 muscle groups of the pelvic floor?

Answer 48

Levator ani & coccygeus

Question 49

What are the 3 parts of the levator ani?

Answer 49

Puborectalis Pubococcygeus Illiococcygeus

Question 50

What can cause injurytothe pelvic floor?

Answer 50

``` Pregnancy & childbirth Chronic constipation Obesity Heavy lifting Chronic cough/sneeze ```

Question 51

How does a vaginal prolapse tend to present?

Answer 51

Lump in vaginal wall Dragging sensation Dyspareunia

Question 52

What are the different kinds of vaginal prolapse?

Answer 52

Urethrocoele Cystocoele Rectocoele Enterocoele

Question 53

What is there risk of damaging in sacrospinous fixation?

Answer 53

Pudendal NVB (runs around sacrospinous ligament) and sciatic nerve

Question 54

Where are there anastamoses in the pelvis?

Answer 54

Between uterine & ovarian artery also between uterine & vaginal artery

Question 55

Where do most of the veins in the pelvis drain?

Answer 55

Internal iliac vein

Question 56

Where does lymph from the superior pelvic viscera drain?

Answer 56

External iliac nodes

Question 57

Where does lymph from the inferior pelvic viscera drain?

Answer 57

Internal iliac nodes

Question 58

Where does lymph from the superficial perineum drain?

Answer 58

Superficial inguinal nodes