First Aid for the OB/GYN Clerkship- Reproductive anatomy

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The major blood supply to the pelvis is from what?
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internal iliac artery (hypogastric artery) and its branches
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lymphatic drainage from the pelvis is what?
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inguinal, pelvic, or para-aortic lymph nodes
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major parasympathetic innervation to the pelvis is via what?
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S2, S3, S4
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pudendal nerve is formed from which spinal roots?
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S2, S3, S4
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the major sympathetic innervation of the pelvis is via what?
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the aortic plexus, which gives rise to the internal iliac plexus
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bartholin glands are located where?
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4:00 and 8:00 of the vaginal orifice
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bartholin glands are homologous to what?
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bulbourethral glands in males
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ducts of the skene’s glands are located where?
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on either side of the urethral orifice
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blood supply of the vulva?
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from branches of the external and internal pudendal arteries, which are subdivisions of the hypogastric artery (internal iliac)
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lymphatic drainage of the vulva?
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medial group of superficial inguinal nodes
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nerve supply of the vulva?
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pudendal branches: 1. anterior parts of vulva: ilioinguinal nerves and the genital branch of the genitofemoral nerves 2. posterior parts: perineal nerves and posterior cutaneous nerves of the thigh
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what is the blood supply to the vagina?
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hypogastric artery (anastomotic network): 1. vaginal branch of the uterine artery is the primary supply to the vagina 2. middle rectal and inferior vaginal branches of the hypogastric artery (IIA) are secondary blood supplies 3. anastomoses with cervical arteries
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what is the sympathetic innervation to the vagina?
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hypogastric plexus
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what is the parasympathetic innervation of the vagina?
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pelvic nerve
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what are the 5 subdivisions of the cervix?
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1. Portio vaginalis 2. External os 3. ectocervix 4. endocervical canal 5. internal os
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what is the portio vaginalis?
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portion of the cervix projecting in to the vagina
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what is the external os?
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lowermost opening of the cervix into the vagina
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what is the ectocervix?
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portion of the cervix exterior to the external os
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what is the endocervical canal?
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passageway between the external os and the uterine cavity
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what is the internal os?
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uppermost opening of the cervix into the uterine cavity
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what portion of the cervix must be completely excised to ensure proper treatment of CIN-II?
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transformation zone
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stratified nonkeratinized squamous epithelium covers what part of the cervix?
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ectocervix
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columnar epithelium lines what part of the cervix?
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endocervical canal
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what is the transformation zone?
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the area of metaplasia where columnar epithelium changes to squamous epithelium
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what percent of lower genital tract neoplasias arise from the transformation zone?
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90%
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what is the blood supply to the cervix?
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cervical and vaginal branch of the uterine artery, which arises from the internal iliac artery
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what is the nerve supply to the cervix?
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hypogastric plexus
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what are the 4 components of the uterus?
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1. fundus 2. corpus 3. cornu 4. cervix
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what is the fundus?
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uppermost region of the uterus
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what is the corpus?
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body of the uterus
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what is the cornu?
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part of the uterus that connects to the fallopian tubes bilaterally
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what is the cervix?
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inferior part of the uterus that protrudes into the vagina
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what is the myometrium?
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the smooth the muscle layer of the uterus
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what are the 3 layers of the myometrium?
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1. outer longitudinal 2. middle oblique 3. inner longitudinal
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what is the endometrium?
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mucosal layer of the uterus, made up of columnar epithelium
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what is the blood supply to the uterus?
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1. uterine arteries: arise from the hypogastric artery 2. ovarian arteries: arise from the aorta, and anastomose with uterine vasculature
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what is the nerve supply to the uterus?
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1. superior hypogastric plexus 2. inferior hypogastric plexus 3. common iliac nerves
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what is the relation between the ureter and the uterine artery?
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the ureter travels under the uterine artery- water under the bridge
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what is the location of the fallopian tubes?
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extend from the superior lateral aspects of the uterus through the superior fold of the broad ligament laterally to the ovaries
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where are the fallopian tubes occluded to achieve permanent sterilization via laparoscopy?
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at the isthmus
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what are the anatomic sections, from lateral to medial, of the fallopian tubes?
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1. infundibulum 2. ampulla 3. isthmus 4. intramural part
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what is the infundibulum of the fallopian tube?
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the most distal part of the uterine tube. helps to sweep the egg that is released from the ovary into the tube
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what is the ampulla of the fallopian tube?
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widest section
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what is the isthmus of the fallopian tube?
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narrowest part
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what is the intramural part of fallopian tube?
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pierces uterine wall and connects to the endometrial cavity
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what is the most common location for ectopic pregnancy?
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ampulla of the fallopian tube
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what is the blood supply to the fallopian tubes?
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from the uterine and ovarian arteries
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what is the cause of fast dissemination of ovarian cancer in the abdomen?
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no peritoneum around the ovaries
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what is the nerve supply to the fallopian tubes?
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pelvic plexus (autonomic) and ovarian plexus
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what is the location of the ovaries?
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they lie on the posterior aspect of the broad ligament
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how are the ovaries attached to the broad ligament?
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they are attached by the mesovarium and are not covered by peritoneum
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what is the blood supply and venous drainage of the ovaries?
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aorta → bilateral ovarian arteries left ovarian vein → left renal vein right ovarian vein → inferior vena cava
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at what level do the ovarian arteries arise from the aorta?
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L1
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what is the nerve supply to the ovaries?
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derived from the aortic plexus
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what are the important histological features of the ovaries?
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the ovaries are covered by tunica albuginea, a fibrous capsule. the tunica albuginea is covered by germinal epithelium
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what is the broad ligament?
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peritoneal fold extends from the lateral pelvic wall to the uterus and adnexa
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the broad ligament contains what structures?
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fallopian tube round ligament uterine and ovarian blood vessels lymph ureterovaginal nerves ureter
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most hysterectomies start how?
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by ligation and transection of the round ligament
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function of the infundibulopelvic ligament (suspensory ligament of the ovary)?
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contains the ovarian artery and vein and connects the ovary to the pelvic wall
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features of the round ligament?
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the remains of the gubernaculum; extends from the corpus of the uterus down and laterally through the inguinal canal and terminates in the labia majora
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feautres of the Cardinal ligament (mackenrodt)?
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extends from the cervix (near the level of the internal cervical os) and lateral vagina to the pelvic side wall; it contains the uterine artery and vein
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what is the most important support structure of the uterus?
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Cardinal ligament (mackenrodt)
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what are the features of the uterosacral ligaments?
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each ligament extends from an attachement posterolaterally to the supravaginal portion of the cervix and inserts into the fascia over the sacrum. provides some support to the uterus
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what is the most common site for ureteral injury during hysterectomy?
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level of the cardinal ligament
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function of the pelvic diaphragm?
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forms a broad sling in the pelvis to support the internal organs
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pelvic diaphragm is composed of what?
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levator ani complex (iliococcygeus, puborectalis, pubococcygeus muscles) and the coccygeus muscles
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position of the urogenital diaphragm?
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external to the pelvic diaphragm
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urogenital diaphragm is composed of what?
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deep transverse perineal muscles, the constrictor of the urethra, internal and external fascial coverings
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function of the urogenital diaphragm?
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helps maintain urinary continence
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what is the perineal body?
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the central tendon of the perineum, which provides much of the support
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which structures converge at the central tendon of the perineum?
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median raphe of the levator ani, bulbocavernosus, superfiscial transverse perineal, external anal sphincter muscles
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pelvic organ prolapse is caused by what?
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defect in the pelvic diaphragm
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what is cut when an episiotomy is performed?
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perineal body
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what is the blood supply to the muscles of the pelvic floor?
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internal pudendal artery and its branches inferior rectal artery posterior labial artery
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what is the nerve supply to the pelvic floor?
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pudendal nerve from S2, S3, S4
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the adult pelvis is composed of which four bones?
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sacrum coccyx 2 innominate bones
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the innominate bones of the pelvis are formed from what?
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the fusion of the ilium, ischium, and pubis
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what is the sacral promontory?
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the first sacral vertebrae, it can be palpated during a vaginal exam
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pelvimetry assesses what?
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the shape and capacity of the pelvis in relation to the ability of a baby to pass through it
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what are the 4 major pelvic shapes?
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gynecoid, android, platypelloid, anthropoid
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what is the ideal pelvic shape for vaginal delivery?
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gynecoid
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the ischial spines serve as landmarks in determining what?
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station of the fetus
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leading edge of the fetus head at the ischial spine +? station?
answer

o station

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