Gynaecology Pg No 11 -20
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Questions and Answers

What is the most common type of cancer associated with the Squamo-columnar junction?

  • Adenocarcinoma
  • Cervical lymphoma
  • Endometrial carcinoma
  • Squamous cell carcinoma (correct)

    • The transformation zone is a static area that does not change over time.

    False

    Where is the external os located?

    It is the point where the cervix opens into the vagina.

    The cervix connects to the uterus at the __________.

    <p>internal os</p> Signup and view all the answers

    Match the cervix types with their descriptions:

    <p>Nulliparous = Pin-point Multiparous = Transverse slit-like</p> Signup and view all the answers

    What type of vaginal epithelial cells are pink and eosinophilic?

    <p>Superficial cells</p> Signup and view all the answers

    Intermediate cells have big nuclei.

    <p>False</p> Signup and view all the answers

    Which vaginal epithelial cells are observed when no hormone predominates?

    <p>Parabasal cells</p> Signup and view all the answers

    What is the deepest fornix called?

    <p>Posterior fornix</p> Signup and view all the answers

    The Pouch of Douglas is located anterior to the ampulla of the rectum.

    <p>False</p> Signup and view all the answers

    The vaginal epithelial cells observed when estrogen predominates are called __________ cells.

    <p>superficial</p> Signup and view all the answers

    Match the type of vaginal epithelial cells with their characteristics:

    <p>Superficial cells = Pyknotic nuclei Intermediate cells = Small nucleus Parabasal cells = Big nuclei Not hormone predominating = Blue, basophilic cells, hazy outline</p> Signup and view all the answers

    What procedure is associated with the applied aspect of the cul-de-sac?

    <p>Culdocentesis</p> Signup and view all the answers

    The __________ is a ligament that runs laterally and supports the cervix.

    <p>transverse cervical ligament</p> Signup and view all the answers

    Match the following anatomical structures with their corresponding relations:

    <p>Bladder = Anterior Pouch of Douglas = Posterior Bartholin gland = Lateral Uterus = Superior</p> Signup and view all the answers

    What is the endometrial thickness immediately after menstruation?

    <p>1-2 mm</p> Signup and view all the answers

    The endometrial thickness during the late proliferative phase can reach up to 11 mm.

    <p>True</p> Signup and view all the answers

    What is the range of endometrial thickness during the secretory phase?

    <p>7-16 mm</p> Signup and view all the answers

    The endometrial thickness during the early proliferative phase is ___ mm.

    <p>5-7</p> Signup and view all the answers

    Match the time of the menstrual cycle with its corresponding endometrial thickness:

    <p>Immediately after menstruation = 1-2 mm Early proliferative phase = 5-7 mm Late proliferative phase = Until 11 mm Secretory phase = 7-16 mm</p> Signup and view all the answers

    Which artery is a direct branch of the abdominal aorta and located anterior to the ureter?

    <p>Ovarian artery</p> Signup and view all the answers

    The most common area of ureteral injury during a hysterectomy is at the internal os.

    <p>False</p> Signup and view all the answers

    What is the best way to identify the ureter during surgery?

    <p>visualize peristalsis of ureter</p> Signup and view all the answers

    The measurement between the median sacral artery and the ureter is ___ cm.

    <p>3</p> Signup and view all the answers

    Match the following areas of susceptibility for ureteral injury to their descriptions:

    <p>Pelvic brim = Most common area of injury, crosses over iliac vessels Water under the bridge = Uterine artery crossing, located 2cm lateral to internal os Internal os = Near the cervix</p> Signup and view all the answers

    Which artery supplies blood to the vagina?

    <p>Vaginal artery</p> Signup and view all the answers

    The lower part of the vagina receives nerve supply primarily from the S2 - S4 segments.

    <p>False</p> Signup and view all the answers

    What is the anatomical description of the vagina?

    <p>Fibromuscular hollow tube</p> Signup and view all the answers

    The upper part of the vagina drains lymph into the _____ nodes.

    <p>HOPE</p> Signup and view all the answers

    Match the vaginal characteristics with their descriptions:

    <p>Rugae = Transverse folds within the vagina Angle of anteversion = 90° angle made with cervix Anterior wall = Shorter wall of the vagina Posterior wall = Longer wall of the vagina, by 2cm</p> Signup and view all the answers

    What is the primary composition of the cervix?

    <p>Collagen and smooth muscle fibers</p> Signup and view all the answers

    Ectropion or eversion of the cervix results in both red and pink epithelium at the external os.

    <p>True</p> Signup and view all the answers

    What appearance does the endocervix have during per speculum examination?

    <p>Red</p> Signup and view all the answers

    The exocervix is lined with __________ epithelium.

    <p>stratified squamous</p> Signup and view all the answers

    Match the following components of the cervix with their descriptions:

    <p>Endocervix = Lining: Columnar epithelium, appears red Exocervix = Lining: Stratified squamous epithelium, appears pink Ectropion = Red epithelium outside external os Effacement = Breakdown of collagen during labor</p> Signup and view all the answers

    Which arteries are primarily responsible for the blood supply of the cervix?

    <p>Uterine artery</p> Signup and view all the answers

    The hypogastric lymph nodes are also known as internal iliac lymph nodes.

    <p>True</p> Signup and view all the answers

    What is the mnemonic used to remember the lymphatic drainage of the cervix?

    <p>HOPE</p> Signup and view all the answers

    The sensory nerve supply to the cervix is provided by the _______ ganglion.

    <p>Franken Hauser</p> Signup and view all the answers

    Match the following lymph nodes with their names:

    <p>Hypogastric = Internal iliac lymph nodes Obturator = Located near the obturator foramen Paracervical = Adjacent to the cervix External iliac = Located along the external iliac artery</p> Signup and view all the answers

    What is the primary nature of vaginal pH during the reproductive age?

    <p>Acidic: 4-4.5</p> Signup and view all the answers

    Doderlein bacilli disappear after puberty.

    <p>False</p> Signup and view all the answers

    What type of epithelium lines the vagina?

    <p>Non Keratinized stratified squamous epithelium</p> Signup and view all the answers

    The vaginal pH is slightly _______ during the first two weeks of life due to maternal estrogen.

    <p>acidic</p> Signup and view all the answers

    Match the following age groups with their corresponding vaginal pH and reasons:

    <p>Birth - 2 wks = Slightly acidic: Maternal estrogen At puberty = Acidic: Doderlein bacilli Menopause = Alkaline: ↓ Doderlein bacilli Menstruation = Alkaline: Blood</p> Signup and view all the answers

    Which type of hysterectomy has the highest risk of ureteric injury?

    <p>Modified/Wertheim's Radical Hysterectomy</p> Signup and view all the answers

    In a simple hysterectomy, the ovaries are usually removed.

    <p>False</p> Signup and view all the answers

    What structures are removed during a Radical Hysterectomy?

    <p>Uterus, Cervix, Fallopian Tubes, Ovaries</p> Signup and view all the answers

    The procedure known as __________ involves a Total Abdominal Hysterectomy plus the removal of ovaries and fallopian tubes.

    <p>Panhysterectomy</p> Signup and view all the answers

    Match the types of hysterectomy with the structures removed:

    <p>Type 1 = Uterus + Cervix Type 2 = Uterus + Cervix + Fallopian tubes + Ovaries Type 3 = Uterus + Cervix + Fallopian tubes + Ovaries Panhysterectomy = Uterus + Cervix + Fallopian tubes + Ovaries + Ovaries</p> Signup and view all the answers

    Study Notes

    Squamo-columnar Junction (SCJ)

    • Transformation zone: area between new and old SCJ
    • Most common type of cervical cancer: Squamous cell carcinoma (SCC)
    • Most frequent site of cervical cancer: Transformation zone > SCJ
    • Adenocarcinoma: Endocervix

    External os

    • Point where cervix opens into vagina
    • Pin-point (Nulliparous)
    • Transverse slit-like (Multiparous)

    Internal os

    • Point where cervix connects to the uterus

    Fornices

    • 4 fornices (Posterior: Deepest fornix)
    • Peritoneal covering: only on upper 1/3rd of posterior wall, called Pouch of Douglas/Rectouterine pouch/Cul-de-sac
    • Applied aspect: Culdocentesis, performed for Ruptured ectopic

    Relations

    • Anterior: Bladder, Urethra
    • Lateral: Transverse cervical/Mackenrodt's/Cardinal Ligament, Ureter, Bartholin gland
    • Posterior: Pouch of Douglas (POD), Ampulla of rectum, Perineal body

    Vaginal Epithelial Cells

    • Superficial cells: Pink, eosinophilic cells, pyknotic nuclei, seen when Estrogen predominates
    • Intermediate cells: Blue, basophilic cells, small nucleus, seen when Progesterone predominates
    • Parabasal cells: Blue, basophilic cells, hazy outline, large nucleus, seen when no hormone predominates

    Vaginal Cytology

    • Can predict hormonal profile of patient
    • Sample: upper 1/3rd of lateral vaginal wall (hormonally sensitive)

    Endometrial Thickness During Various Phases

    • Immediately after menstruation: 1-2 mm
    • Early proliferative phase: 5-7 mm
    • Late proliferative / preovulatory phase: Until 11 mm
    • Secretory phase: 7-16 mm
    • Postmenopausal females:

    URETER

    • Arteries anterior to ureter: Ovarian artery (Direct branch of abdominal aorta), Uterine artery (Branch of Anterior division of Internal Iliac A)
    • Arteries posterior to ureter: Common Iliac A. (Divides after ureteric crossing), Internal Iliac A.
    • Landmark for entry of ureter into pelvis: Distance between median sacral artery & ureter = 3cm.
    • Lateral relation of external iliac artery: Iliopsoas muscle + Genitofemoral Nerve.
    • Best way to identify ureter during surgery: Visualize peristalsis of ureter.

    Ureteral Injury in Hysterectomy

    • Areas of susceptibility: At pelvic brim (most common) crosses over iliac vessels, Water under the bridge (most common) uterine artery crossing (2cm lateral to internal os), At the internal os (near cervix)

    Types of Hysterectomy

    • Simple/Total Abdominal Hysterectomy: (most common for benign lesions) Uterus + Cervix
    • Modified/Wertheim's Radical: Uterus + Cervix + Fallopian tubes + Ovaries, medial half of CL and USL removed, upper 1/3rd(1cm) of vagina removed
    • Radical Hysterectomy: Uterus + Cervix + Fallopian tubes + Ovaries, Complete CL and USL removed, upper 2/3rd of vagina (2cm) removed
    • CL = cardinal ligament
    • USL = uterosacral ligament

    Hysterectomy with Highest Risk of Ureteric Injury

    • Wertheim's (Type 2) hysterectomy

    Simple Hysterectomy (Type 1)

    • Most frequent cause of ureteric injury

    Panhysterectomy (TAH + BSO)

    • Removal of ovaries and fallopian tubes (Total Abdominal Hysterectomy + Bilateral Salpingo-oophorectomy - TAH+BSO)

    VAGINA

    • Blood supply: Vaginal artery (Branch of internal iliac artery), supplies vagina + base of bladder
    • Nerve supply: Upper part: S2 - S4, Lower part: Pudendal nerve
    • Lymphatic drainage: Upper part: "HOPE", Lower part: Superficial inguinal nodes

    General Points & Anatomical Relations of Vagina

    • Description: Fibromuscular hollow tube
    • Walls: Anterior, Posterior (Longer by 2cm)
    • Angle of anteversion: 90° angle made with cervix.
    • Angle with horizontal: 45°.
    • Rugae: Transverse folds, Most specific feature.

    Applied Anatomy: Cervix and Vagina

    Cervix

    • Composition: Major: Collagen (Connective tissue), 10-15%: Smooth muscle fibers
    • Applied Aspect: Effacement during labor (due to breakdown of collagen + increased water content)

    Per Speculum (P/S) Findings

    • Endocervix: Part of cervix close to the uterus, lining: Columnar epithelium, appears red
    • Exocervix: Part of cervix inside the vagina, lining: Stratified squamous epithelium, Aka portio vaginalis, appears pink

    Ectropion/Eversion

    • Red epithelium (Endocervix) (+) outside external os, normally only pink epithelium (+), physiological: common in pregnancy, C/o: Post coital bleeding, Biopsy: Not required

    Neurovascular Supply & Lymphatic Drainage of Cervix & Vagina

    Cervix

    • Blood Supply: Descending cervical artery: Branch of uterine artery, located at 3 o'clock and 9 o'clock positions
    • Lymphatic Drainage: "HOPE", Hypogastric lymph nodes (AKA internal iliac lymph nodes), Obturator lymph node, Paracervical lymph node, External iliac lymph node
      • Cancer cervix + superficial inguinal node involvement = Implies distant metastases (Stage 4B)
      • Paracervical block: Given at 2 & 4 o'clock/8 & 10 o'clock positions, C/1: 3 & 9 o'clock position
    • Nerve Supply: S2-S4, Sensory supply: Franken Hauser ganglion
    • Peritoneal covering: Posterior surface (+), Anterior surface (-)

    Vagina Histology and Applied Aspects

    • Histology of Vagina: Lining: Non Keratinized stratified squamous epithelium, Glands: Absent
    • Applied Aspect: Vaginal discharge: Cervical discharge (mainly) + Endometrial gland discharge + Bartholin gland discharge (only during intercourse)

    pH of Vagina

    • Acidic, due to Doderlein bacilli
    • Estrogen (glycogen) involved

    Nature of Vaginal pH in Different Age Groups

    • Birth - 2 wks: Slightly acidic, Maternal estrogen
    • 2 wks - puberty: Alkaline: 6-8, Cervical secretions
    • At puberty: Acidic: 4-5, Doderlein bacilli
    • Reproductive age: Acidic: 4-4.5, ↑ Doderlein bacilli
    • Menopause: Alkaline: 6-8, ↓ Doderlein bacilli
    • Menstruation: Alkaline: 6-8, Blood: Alkaline
    • Pregnancy: ↑ Acidic: 3.5-4, ↑ Doderlein bacilli

    Doderlein Bacilli

    • Inhabitant bacteria of vagina, Lactobacilli, Glycogen (due to estrogen) and lactic acid, Appear: At puberty, Disappear: menopause

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    Description

    Test your knowledge on the cervical anatomy, including the squamo-columnar junction and the external and internal os. Explore the connections and clinical significance of various structures, including the fornices and their relations. This quiz covers essential aspects that are crucial for understanding cervical health and disease.

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