Anatomy and Embryology Flashcards
(264 cards)
1
Q
What does the bony pelvis consist of?
A
Two innominate bones
Sacrum
Coccyx
2
Q
What is the role of the bony pelvis?
A
Support upper body
Transference of weight from vertebral column to femurs
Attachment for muscles and external genitalia
Protection of pelvic organs
3
Q
What connects the ASIS and PSIS on the ilium?
A
Iliac crest
4
Q
What is the attachment site of the iliacus muscle on the ilium?
A
Iliac fossa
5
Q
Which is more superior the ischial spine or ischial tuberosity?
A
Spine
6
Q
What part of the ischium do you “sit on” ?
A
Ischial tuberosity
7
Q
Where does the inguinal ligament attach to the pubis?
A
Pubic tubercle
8
Q
What type of joint is the pubic symphysis?
A
Secondary cartilaginous
9
Q
What type of joint is the hip joint?
A
Synovial
10
Q
What are the borders of the true pelvic cavity?
A
Pelvic inlet and outlet
11
Q
Which muscle forms the musculofascial part of the pelvic cavity?
A
Levator ani
12
Q
Which structures can be damaged in a pelvic fracture?
A
Iliac vessels Lumbosacral plexus Autonomic nerve supply Lymphatics Muscles Organs
13
Q
Where does the sacrotubeous ligament attach?
A
Sacrum
ischial tuberosity
14
Q
Where does the sacrospinous ligament attach?
A
Sacrum
Ischial spine
15
Q
What would cause the ligaments to relax?
A
Pregnancy
16
Q
What is the purpose of the ligaments of the pelvis?
A
To ensure sacrum is not pushed superiorly when weight transferred through vertical column
17
Q
What is the difference between the male and female cavity?
A
AP and transverse diameters larger in female
Sub-pubic angle winder in female
Pelvic cavity shallower in female
Bones thin/light in female
Oval rather than round obturator foramen in female
18
Q
What are the name of the fontanelles?
A
Anterior
Posterior
Sphenoid
Mastoid
19
Q
What is the vertex?
A
Area of foetal skull outlined by the fontanelles and parietal eminences
20
Q
Which diameter of a baby’s head is bigger?
A
Occipitofrontal
21
Q
In which position should the foetus enter the pelvic cavity?
A
Occiput-transverse
22
Q
Which pelvic diameter is bigger at the pelvic inlet?
A
Transverse
23
Q
Which pelvic diameter is bigger at the pelvic outlet?
A
AP
24
Q
What position should a baby ideally be in for delivery?
A
Direct occiput-anterior
25
What is the "station" of the foetal head?
Distance from foetal head to ischial spine
26
Into which two regions can the pelvic be divided?
False/greater
| True/lesser
27
Describe the bony ring which defines the pelvic inlet
Formed by sacral promontory, alae of sacrum, arcuate line, pectineal line and pubic crest
28
Describe the pelvic outlet
Bordered by tip of coccyx posteriorly
Inferior margin of sacrotuberous posterolaterally
Ischial tuberosities laterally
Pubic arch anteriorly
29
Which palpable bony landmark is used as a guide to administer a pudendal nerve block?
Ischial spine
30
Which muscle covers the sphenoid and mastoid fontanelles?
Temporalis
31
What are gametes?
Haploid cells
Spermatozoa in males
Oocyte in females
32
Which organs produce gametes?
```
Male = testes
Female = ovaries
```
33
Where is the perineum located?
Inferior to pelvic floor
| Superior to the skin and fascia
34
What forms the pelvic roof?
Peritoneum
35
What is the Pouch of Douglas?
Space between the rectum and the uterus which is the most inferior part of the peritoneal cavity when standing
36
Where is the vesico-uterine pouch?
Between the bladder and uterus
37
What are the three layers of the uterus?
Perimetrium
Myometrium
Endometrium
38
Describe ovulation and fertilisation
1 ovum released from surface of the ovary into peritoneal cavity
Gathered by fimbrae into infundibulum of uterine tube
Moved along by cilia
Normally fertilised in ampulla
39
Which layer of the uterus is responsible for cramping?
Myometrium
40
Define ectopic pregnancy
A fertilised egg implants out with the uterine cavity
41
Where do the testes originate?
On the posterior wall of the abdominal cavity
42
Through which structure do the testes descend?
Inguinal canal
43
Where is sperm produced?
Seminiferous tubules
44
Which muscle helps to control the temp of testes?
Dartos muscle
45
Describe the route of sperm from production to ejaculation
```
Produced in sem. tubules
Pass to rete testis
Then head of epididymis
Then vas def
Ejec duct
Right and left ducts join
Prostatic urethra
Membranous urethra
Spongy urethra
External urthral meatus
```
46
What does the spermatic cord contain?
```
Vas def
Testicular artery
Pampiniform plexus of veins
Sympathetics
Genital branch of genitofemoral nerve and lymphatics
```
47
Which structures pass through levator ani in the male?
Rectum and urethra
48
What is the function of the levator ani muscle?
Supports pelvic organs and maintains continence
49
What is the role of the external anal sphincter?
Voluntary control of faecal continence
50
What are the nerves roots of the pudendal nerve?
S2,3,4
51
What type of nerve fibres does the pudendal nerve contain?
Somatic motor and sensory
| Sympathetics
52
What is the most common space for a perianal abscess?
Ischioanal fossa
53
Why may a peri-anal abscess spread through the ischioanal fossa?
Large space
| Filled with fat - poor blood supply and few immune cells
54
Which important structure may be accidentally damaged during hysterectomy?
Ureter
55
How may fluid be drained from the Pouch of Douglas?
Needle placed through posterior fornix of vagina
56
What is the broad ligament?
Ligament formed by double layer of peritoneum
| Extends from uterus to lateral pelvic walls and floor
57
What is a cystocoele?
Hernial protrusion of the bladder into the vaginal wall
58
What is a rectocoele?
Hernial protrusion of rectum into vaginal wall
59
List the components of the fluid secreted by seminal vesicles
```
Proteins
Enzymes
Fructose
Mucous
Vit C
Flavins
Phosphoylcholine
Prostaglandin
```
60
What is the main function of the fluid secreted by prostate gland?
Activate sperm
61
What are the main function of the fluid secreted by the bulbourethral glands?
Lubricates urethra and helps to neutralise acid in urethra
62
What are the common surgical incision site sin obstetrics?
Lower segment Caesarean section
Laparotomy
Abdominal/vaginal hysterectomy
63
Which three muscles make up the abdominal wall?
```
Ext oblique (out)
Int oblique (mid)
Transversus abdominis (in)
```
64
Which two types of fascia are found in the abdominal wall?
Campus fascia
| Scarpus fascia
65
Which fascia found in the abdominal wall fades in ascend through to the thorax?
Scarpus
66
What is the difference between scarpus and campus fascia?
Campus is fattier
| Scarpus is more membranous
67
Which abdominal muscle is in the midline?
Recuts abdominis
68
Which muscle has a "hands in pockets" alignment?
External oblique
69
Where does external oblique attach superiorly?
Ribs 5-11
70
Which muscle has a "hands on chest" alignment?
Internal oblique
71
At what point does external oblique become its aponeurosis?
Mid-clavicular line
72
What happens to the aponeurosis of internal oblique?
Splits in two to sandwich the rectus abdominis
73
Which is recuts abdominis split into segments?
Mechanical efficiency
74
How is the linea alba formed?
Intertwining of the aponeuroses
75
Where does the linea alba run from/to?
From xiphoid process to pubic symphysis
76
Which is the arcuate line?
1/3 distance between umbilicus and pubic symphysis
77
Where is the rectus sheath?
Immediately deep to the superficial fascia
78
Which fascia make the internal spermatic fascia in the cord?
Transversalis fascia
79
What can be found in extra-peritoneal fat?
Vessels
80
Which nerves become the thoracoabdominal nerves?
7th-11th intercostals
81
What is the nerve root of subcostal nerve?
T12
82
What is the nerve root of iliohypogastric?
L1
83
What is the nerve root of ilioinguinal?
L1
84
When do the intercostals become the thoracoabdominal nerves?
When they pass the costal cartilage of the false ribs
85
Where do the nerves which supply the anterolateral abdominal wall run?
Between the int oblique and transversus abdominis
86
Which arteries supply the anterior abdominal wall?
Superior and inferior epigastric
87
What is the superior epigastric artery a continuation of?
Internal thoracic
88
Where can superior and inferior epigastric arteries be found?
Posterior to rectus abdominis
89
What are the inferior epigastric arteries a branch of?
External iliac
90
Which arteries supply the lateral abdominal wall?
Intercostal and subcostal arteries
91
What are the intercostal and subcostal arteries a continuation of?
Posterior intercostals
92
What pre-emptive alteration can be made to the vascular of the abdominal wall before surgery?
Ligate inferior epigastric before it is damaged/removed
| So that the sup epigastric has time to accommodate for the loss of blood supply
93
How is a lower segment caesarean section carried out?
Cut made in suprapubic region across subcut tissues
Through deep fascia/rectus sheath
Rectus abdominis moved out the way towards nerve supply
Cut through transversalis fascia then peritoneum
94
Why is a midline incision not ideal?
Not very vascular so healing is poor and risk of complication is increased
95
If lateral port is required in laparoscopy which structure may be injured?
Inferior epigastric
96
Where is the deep inguinal ring?
Halfway between ASIS nad pubic tubercle
97
Which female reproductive organs/accessory organs are found in the pelvic cavity?
Ovaries
Uterine tubes
Uterus
Superior part of vagina
98
Which female reproductive organs/accessory organs are found in the perineum?
```
Inferior part of vagina
Perineal muscles
Bartholin's glands
Clitoris
Labia
```
99
Which type of tissue is found beneath the perineal muscles?
Erectile tissue
100
What is culdocentesis?
When fluid is drained from the Pouch of Douglas
101
What is the role of the pouch of Douglas?
Maintains uterus in midline position
102
What does the broad ligament contain?
Uterine tubes and round ligament
103
What does the round ligament attach to?
Lateral aspect of uterus
| Superficial tissue of perineum
104
What structure does the round ligament pass through?
Deep inguinal ring
105
What is the round ligament a remnant of?
Gubernaculum
106
Which layer of the uterine body sheds during menstruation?
Endometrium
107
How much of the uterus is taken up by the cervix?
1/3rd
108
What holds the uterus in position?
Ligaments
Endopelvic fascia
Muscles of pelvic floor
109
How should the uterus be positioned?
Anteverted
110
Describe an "anteverted" uterus
Cervix tipped anteriorly relative to axis of vagina
111
Describe an "anteflexed" uterus
Uterus tipped anteriorly relative to axis of cervix
112
Describe a "retroverted" uterus
Uterus tipped posteriorly relative to the axis of the vagina
113
Describe a "retroflexed" uterus
Uterus tipped posteriorly relative to the axis of the cervix
114
What type of epithelium is found in the cervix?
Secretory columnar epithelium
115
Where does fertilisation normally occur?
Ampulla
116
What is a bilateral salpingo-oophrectomy?
Removal of uterine tubes and ovaries
117
What could an ectopic pregnancy on the right hand side be mistaken for?
Appendicitis
118
When do the fimbrae open up into?
The peritoneal cavity
119
What hormones do the ovaries secrete?
Oestrogen and progesterone
120
What stimulates the ovaries to produce hormones?
FSH and LH
121
What are the 4 parts of the vaginal fornix?
Lateral x2
Anterior
Posterior
122
At what positions can the ischial spine be palpated on digital vaginal examination?
4 and 8 o'clock
123
How is the position of the uterus assessed on examination?
Bimanual palpation
124
Which two triangles can the perineum be split into?
Urogenital and anal triangle
125
What type of muscle is levator ani?
Skeletal
126
Which nerves supply the levator ani?
Nerve to the levator ani - superior
| Pudendal - inferior
127
What are the nerve roots of nerve to levator ani?
S3,4,5
128
What is the perineal body?
A bundle of collagenous and elastic tissue into which the perineal muscles attach
129
Where is the perineal body?
Posterior to the vagina, just deep to skin
| At the junction of the anal and urogenital triangles
130
Which nerve supplies the perineal muscles?
Pudendal
131
Where are the Bartholin's glands located?
4 and 8 o'clock positions around the orifice of the vagina
132
What do Bartholin's glands do?
Produce lubrication
133
Where are the breasts located?
From ribs 2-6 at the lateral border of the sternum to the mid-axillary line
On deep fascia
134
What is the retromammary space?
Space between fascia and breat
135
How does the breat attach to skin?
Suspensory ligaments
136
How is a mass described in the breast?
What quadrant
| Fixed to underlying tissue
137
What position should a breast exam be conducted in?
Standing with hands on hips to contract pec major
138
Where does lymph from breast tissue drain to?
From outer to ipsilateral axillary then supraclavicular from inner can go to ipsi or contralateral
Lower inner can drain to abdo lymph
139
Which artery does the internal thoracic come off of?
Subclavian
140
Name the male accessory reproductive organs
Vas deferens
Seminal glands
Prostate glands
Penis
141
How long is the male urethra?
20cm
142
What is the spongy urethra within?
Corpus spongiosum
143
What is the rectovesical pouch?
Space between the rectum and the bladder in males
144
What is the trigone of the bladder?
Triangle on the internal bladder
| Made of 2 ureteric orifices and internal urethral orifice
145
Which muscle mostly makes up the bladder wall?
Detrusor
146
What is the role of the detrusor muscle?
Contract around the ureteric orifices to prevent backflow of urine (or ejaculate) when contracting to expel urine
147
Where do the testes originate?
Posterior wall of abdominal cavity
148
Through which structure do the testes descend?
Inguinal canal
149
What nerve types are found in the spermatic cord?
Autonomic (vas def)
| Somatic (cremaster)
150
What is the conjoint tendon?
Medial end of combined aponeuroses of internal oblique and transversus abdominis
151
What is the role of the conjoint tendon?
Anchor muscles inferiorly to pubic bone
152
Which sac do the testis sit in?
Tunica vaginalis
153
What is a hydrocoele?
Excess fluid within the tunica vaginalis
154
What term is given to twisting of the somatic cord?
Torsion
155
Where is the epididymis located?
Prox end - posterior aspect of superior testis
156
Where can the vas deferens be palpated?
In spermatic cord in the scrotum superior to the testis
157
How is blood drained from the testis?
Left
Testicular vein to renal vein
Right
Testicular vein to IVC
158
Which part of the urethra does the prostate surround?
Prostatic urethra
159
Where do most prostate cancers occur?
Peripheral zone
160
What is paraphimosis?
Retraction of the prepuce constricting the neck of the glans causing it to swell
161
What is the root of the penis attached to?
The ischium of the pelvis
162
What are the 3 cylinders of erectile tissue called?
Right and left corpus cavernosum and the corpus spongiosum
163
What runs in the corpus cavernosum?
Deep arteries of penis
164
What runs in the corpus spongiosum?
Spongy urethra
165
What does the perineal pouch in the male contain?
```
Root of penis
Spongy urethra
Transverse perineal muscle
Internal pudendal vessels
Pudendal nerve
```
166
Which muscles are found in the penis?
Ischiocavernosus
| Bulbospongiosus
167
Describe the blood supply to the penis
Deep arteries of penis from internal pudendal from internal iliac
168
Describe the blood supply to the scrotum
Internal pudendal and branches from external iliac
169
Describe the lymph drainage from scrotum and penis
Superficial inguinal lymph nodes
Note does not include glans
170
Where does lymph from the testes drain?
Lumbar nodes around abdominal aorta
171
What nerve types are structure in the pelvis innervated by?
Symps, parasymps and visceral afferents
172
What nerves types are structures in the perineum innervated by?
Somatic motor and sensory
173
With nerve types are responsible for uterine cramping?
Symps/parasymps
174
With nerve types are responsible for uterine contraction?
Symps/parasymps
175
With nerve types are responsible for pelvic floor muscle contraction?
Somatic motor
176
With nerve types are responsible for pain from the adnexae?
Visceral afferents
177
With nerve types are responsible for pain from the uterus?
Visceral afferents
178
With nerve types are responsible for pain from the vagina?
Visceral afferents - pelvic part
| Somatic sensory - perineum
179
With nerve types are responsible for pain from the perineum?
Somatic sensory
180
Describe the pain sensation from pelvic organs touching the perineum
Visceral afferents pick it up
Run alongside sympathetic fibres
Enter spinal cord T11-L2
Perceived as suprapubic
181
Describe the pain sensation from pelvic organs not touching peritoneum
Visceral afferents pick it up
Run alongside parasympathetic fibres
Enter spinal cord at S2,3,4
Pain perceived in that dermatome - in perineum
182
How is pain sensed from the uterus, uterine tubes and ovaries?
visceral afferents back to T11-L2
183
How is pain sensed from the cervix and superior vagina?
Visceral afferents back to S2-4
184
How is pain sensed from the inferior vagina, perineal muscles, glands and skin of perineum?
Pudendal nerve to S2-4
185
At which vertebral level does the subarachnoid space end?
S2
186
At which level is a spinal/epidural anaesthetic performed?
L3/4
187
Which structures are passed through for a spinal anaesthetic?
```
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
```
188
Which structures are passed through for an epidural anaesthetic?
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Into epidural space
189
Describe sympathetic outflow
Originates in autonomic centres in the brain
Exits spinal cord at T1-L2
Travels to sympathetic chains
Passes into all spinal nerves
190
Which type of nerve supply do arterioles get?
Sympathetic
191
What needs to be monitored when giving a spinal anaesthetic?
Blood pressure
192
What are the signs a spinal anaesthetic is working?
Reduced sweating
Warm lower limbs
Flushed skin in lower limbs
193
Which nerve is responsible for motor control of external anal and urethral sphincters?
Pudendal
194
In which cases would you need an pudendal nerve block?
Episiotomy incision
Forceps use
Perineal stitching
195
Describe the course of the pudendal nerve
Exits pelvis via greater sciatic foramen
Passes posterior to sacrospinous
Re-enters pelvis/perineum via lesser sciatic foramen
Travels in pudendal canal
196
What travels in the pudendal canal?
Pudendal artery and vein
Nerve to obturator internus
Pudendal nerve
197
What is the pudendal canal?
Passageway within the obturator fascia
198
In which location is an episiotomy usually performed?
Ischioanal fossa
199
Which two muscle groups make up the pelvic floor?
Levator ani
| Coccygeus
200
What is the urogenital hiatus?
The anterior gap between the medial borders of the pubococcygeus
201
What passes through the urogenital hiatus?
Urethra
| Vagina
202
Name the three parts of the levator ani
Puborectalis
Pubococcygeus
Iliococcygeus
203
Name the pelvic ligaments
Transverse cervical
Utero-sacral
Lateral ligament of bladder
Lateral rectal
204
What does the deep perineal pouch contain?
```
Part of the urethra
Bulbourethral glands (male)
NVB for penis/clitoris
Ischioanal fat pads
Compressor urethrae
Deep transverse perineal muscle
```
205
What is the perineal membrane?
Thin, tough, deep fascia which lies superficial to the deep perineal pouch
206
What does the superficial perineal pouch contain in the male?
```
Root of penis
Proximal spongy urethra
Superficial transverse perineal muscle
Internal pudendal vessels
Pudendal nerve
```
207
What does the superficial perineal pouch contain in the female?
Clitoris
Bulbs of vestibule
Bulbospongiosus and ischiocavernous
208
When does the pelvic floor actively contract?
Coughing
Sneezing
Vomiting
Basically any increase in intra-abdo pressure
209
What is involved in maintaining urinary continence?
External urethral sphincter
Compressor urethrae
Levator ani
Bladder neck support
210
What is involved in maintaining faecal continence?
Puborectalis bending rectum anteriorly
211
What can cause injury to pelvic floor?
```
Pregnancy/childbirth
Chronic constipation
Obesity
Heavy lifting
Chronic cough/sneeze
Menopause
```
212
How may vaginal prolapse be treated?
Sacrospinous fixation
| Incontinence surgery
213
Describe sacrospinous fixation for prolapse
Sutures placed in sacrospinous medial to ischial spine
214
Describe incontinence surgery for prolapse
Mesh put in to create a sling around the urethra
215
Where does the gonadal artery branch from?
L2 abdominal aorta
216
Where does the superior rectal artery branch from?
Continuation of the inferior mesenteric
217
What is the median umbilical ligament a remnant of?
Umbilical artery
218
Which sex has the inferior vesical artery?
Male
219
Where does the anterior scrotal branch from?
External iliac
220
What does the uterine artery anastomose with?
Ovarian artery
| Vaginal artery
221
Where do the venous plexuses of the pelvis mainly drain to?
Internal iliac
222
Where does blood in the superior rectal vein drain to?
Hepatic portal system
223
Where does blood from lateral sacral veins drain to?
Internal vertebral venous plexus
224
Which ureter is more likely to be damaged and why?
Left
| More medial and crosses common iliac which makes it more vulnerable
225
What are the ant and post borders of the perineum?
Pubic symphysis
| Tip of coccyx
226
What are the contents of the anal triangle?
Anal aperture
External anal sphincter
Ischioanal fossa
Pudendal nerve
227
What is the perineal membrane?
Deep, strong fascia found in the urogenital triangle with pouches on the surfaces
Provides attachment for muscles
228
What is the deep perineal pouch?
Potential space between the deep fascia of the pelvic floor and the perineal membrane
229
What is the superficial perineal pouch?
Space between the perineal membrane and the perineal fascia
230
What does the superficial perineal pouch contain?
Erectile tissues
| Bartholin's glands
231
What are the two components of the perineal fascia?
Deep fascia
| Superficial fascia
232
What are the two components superficial perineal fascia?
Superficial layer
| Deep layer
233
What is the superficial layer of the superficial perineal fascia a continuation of?
Camper's fascia from the abdomen
234
What is the deep layer of the superficial fascia continuous with?
Scarpa's fascia
235
Which structures travel through Alcock's canal?
Pudendal nerve
Internal pudendal artery
Internal pudendal vein
236
Which cartilage separates the three bones of the hip?
Triradiate cartilage
237
What is the acetabulum?
Part of the hip bone which articulates with the femur
238
What do the inferior and superior rami of the pubis create?
Obturator foramen
239
Pubic rami fractures usually require surgery
| true/false
False
| Usually stable
240
What are the two holes in the pelvic floor?
Urogenital hiatus
| Rectal hiatus
241
What are the three main components of the pelvic floor?
Levator ani
Coccygeus
Fascial coverings
242
Which three paired muscles make up the levator ani?
Pubucoccygeus
Puborectalis
Iliococcygeus
243
Which nerves innervate coccygeus muscle?
Anterior rami of S4 and S5
244
Where does the renal pelvis collect urine from?
Major calyces
245
What is the point where the renal pelvis narrows to make the ureter called?
Ureteropelvic junction
246
Along the anterior surface of which muscle do the ureters travel?
Psoas major
247
At what level do the ureters cross the pelvic brim to enter the pelvic cavity?
SI joints
248
In which two operations are the ureters most at risk?
Oophorectomy
| Hysterectomy
249
What is the blood supply to the abdominal ureter?
Renal artery and testicular/ovarian artery
250
What is the blood supply to the pelvic ureter?
Superior and inf vesical arteries
251
Where do sensory fibres from the ureter enter the spinal cord?
T11-L2
252
Approx how much urine does the bladder hold?
300-400ml
253
What connects the bladder to the umbilicus?
Median umbilical ligament
254
What is the main arterial supply to the bladder?
Superior vesical artery (of internal iliac)
255
Where does the superolateral part of the bladder drain lymph to?
External iliac lymph nodes
256
Where do the neck and the fundus of the bladder drain lymph to?
Int iliac
Sacral
Common iliac
257
What nerve gives sympathetic innervation to the bladder?
Hypogastric nerve (T12-L2)
258
What nerve gives parasympathetic innervation to the bladder?
Pelvic nerve (S2-S4)
259
What is the somatic nerve supply to the bladder?
Pudendal nerve (S2,3,4)
260
What lines the urethra?
Stratified columnar epithelium
261
What is the arterial supply to the prostatic urethra?
Inf vesical artery
262
What is the arterial supply to the membranous and bulbar urethra?
Bulbourethral artery (branch of internal pudendal)
263
What is the arterial supply to the spongy urethra?
Internal pudendal
264
What is the blood supply to the female urethra?
Internal pudendal
