CLINICAL ANATOMY

EYE

 Openings of the orbital cavity: Supraorbital notch, Sup/inf orbital
fissure, Optic canal, Post/ant ethmoidal foramina
 Eyelid: Levator palpebrae muscle, Medial and lateral ligament,
Meibomian glands, Lacrimal papilla and punctum, Lacrimale
caruncle
 Glands
o Glads of Zeis – at the opening of hair follicle
o Glands of Molls – between hair follicles
o Tarsal / Meibomian glands – behind tarsal plate
 Conjunctiva: Palpebral, Ocular/bulbar
 Disorders of the Glands of the Eyelids
 Sty
o Internal hordeoulum – affects Meibomian
o External ordeoulum – affects Zeis or Moll
 Chalazion – granulomatous inflammation of Mibmomian
 Conjunctivitis – bacterial infection (H. influenza (80%), S.
pneumoniae (20%))
o Bacterial purulent conjunctivitis – gonococcal or chlamydial
o Allergic conjunctivitis – seasonal or perennial
 Cataract – opacity of the lens: senile, congenital, traumatic, others
o Phacoemulsification – cataract surgery
 Glaucoma – obstruction of the flow of aqueous humor leading to
increased intraorbital pressure that can lead to blindness when
retina is damaged
o Signs: peripheral blurring of vision, cupping of optic disc
o Open angle glaucoma – angle is open but flow is too slow;
“great thief” of eyesight because it may be asymptomatic
o Tx: drugs, laser, surgery
o Other types: angle is partially / completely closed by iris
 Retinal tears – round shaped or U-shaped holes, precursor to
retinal detachment
 Retinal detachment – separation of retina from underlying cell
layers which causes it to lose its blood supply, obstruction of
peripheral vision, sudden shower of floaters and flashes
o Tx: scleral buckling – silicone replacement
 Presbyopia – physiologically blurred near vision, occurs >40 y/o
 Myopia – nearsightedness, too much focusing power, cornea is too
curved (?)

o Giant papillary conjunctivitis – 2° to contact lens & prostheses  Hypermyopia – farsightness

 Ligaments in the Eyeball - Medial check, Lateral check, Suspensory  Orbital Blunt Trauma – fracture of orbital floor affects inf. oblique,
ligament of Lockwood diplopia on upward gaze

 Pterygium – triangular growth of tissue from conjunctiva to cornea  Blunt Trauma – hemorrhage of retina, vitreous chamber, subertina
due to excessiove sun exposure  Open-eye trauma
 Pingucculae – same as pterygium but does not affect cornea  Metal corneal foreign body

EAR
 Ear blockage
 Acute otitis media
 Otitis externa – inflammation / infection of external ear; S. aureus  Otitis media with air bubbles
 Obstruction of Eustachian tube
 Perichondritis – infection of ear lobe cartilage (?)
 Pre-auricular sinus – due to upper respiratory disease
 Refraction Pocket Formation – due to negative pressure
o Myringotomy – incision in tympanic membrane
 Microtia – small or no opening
 Tympanic membrane perforations
 Foreign body – cotton, pellet gun, insects  Mastoid fistula
 Ear maggot – bathing in dirty water  Cholesteatoma – skin cyst caused by retraction pocket
 Glomus tympanicum
 Otomycosis – fungal growth, Aspergillus flavus
 Hearing loss – noise-induced
 Bony protrusions in the EAC o Treatment: cochlear implant, hearing aid
o Ostreoma – bening tumor of bone and cartilage  Vertigo
o Exostosis – multiple benign tumors  Tinnitus – ringing in the ears
o Due to exposure to cold
 Acoustic (?) neuroma – tumor of CNVIII
 Tympanosclerosis – scarring of tympanic membrane

Female Reproductive System 1

 Obstetrics – child birth; Gynecology – females

 Bartholin’s glands – moisten vulva
 3 Openings – urethral, vaginal, anal – in close proximity vs males = more prone to UTI  Wipe towards anus or just dab
 Diagnostics: in a lithotomy position: Internal exam, Speculum exam
 Pelvic exam – pelvic complaint, gynecologic exam
 Speculum – different sizes, metal or plastic,
 Bimanual palpation – 2 fingers in vagina, other hand presses above symphysis pubis
 Rectovaginal palpation – index finger in vagina, middle in rectum
 Palpatory findings – normal cervix feels like tip of nose, pregnant feels like lips
 Pap Smear – cytological test of cervix and vagina, biopsies, culdoscopy, start @ 18 y/o, sooner if sexually active, annual
o Other tests - Vaginal discharge (infection (STD), yeast), cultures, Gram stain, pregnancy test
 Gonorrhea – acute urethritis, Bartholin abcess (cyst, swelling of posterior portion of labia, tender, requires incision and drainage)
 Tumors (benign)
 Condyloma acuniata (?) – viral, warts, itchy, mother lesion on one side, STD, Tx: cautery, excision
o Cervical cancer – most common, for promiscuous women, at squamocolumnar junction
o Corpus cancer- next common, for non-sexually active
o Vulva tumor – requires vulvectomy

 Uterine Position – anteversoflex

o Retroversion – pushed backwards, primary to tertiary
o Retroflexion – bent back on itself
o Retrocession – pushed down and backwards
o Anteflexed – bent forward on itself, 170°
o Anterversion – almost horizontal
 Fistulae – abnormal connection between 2 organs, 2° to trauma
o Anovaginal – septum between anus and vagina destroyed
o Cystocoele – bulging of posterior part of urinary bladder
o Weakening of pubovesical fascia, urinary bladder sags down to vagina, may drag uterus down to vagina (prolapse)
o Rectocoele – rectum comes out
o Tx: surgery – reposition bladder

 Varices – varicose veins in vulva, during pregnancy or repeated gravidities

 Injury to vagina – sexual abuse, rape, perversion, picket fence injury (falling on sharp object)
 Episiotomy – cutting of perineum to assist pregnancy
 Congenital Disorders
o Absence or malformations
o Uterus didelphys – 2 uteri, 2 vagina
o Uterus arcuatus – indentation in fundic region
o Uterus bicornis – partial fusion only
o Uterus bicornis unicollis – 1 rudimentary horn
o Vaginal atresia
o Cervical atresia
o Imperforate hymen – causes no menstrual flow, may lead to extreme weight gain or loss
 Hematocolpos – blood in vagina
 Hematometra – blood in endometrium
 Hematosalpix – blood in oviduct
 Tx: cross incision on hymen
 Pudendal nerve block – predelivery, preepisiotomy
 Pelvic pain – dysmenorrheal (menses), pelvic mass, Mittelschmerz – pain during ovulation
 PMS – 85-90% of women, hormonal imbalances, bloated, edematous, fatigue
 Ultrasound – high frequency sound waves, can see heartbeat or masses, transabdominal or transvaginal (more accurate)
 Abnormal Bleeding – pregnancy or tumor
 D&C – Dilator and Cunette
 Laparoscopy – inflate abdomen  2 incisions (1 for camera)
 Hysterectomy – removal of uterus, beware of closeness of ureters
 Culdocentesis
 Hysterosalphingography

Female Reproductive System 2

 Fertilization – at oviduct ampulla

 Implantation – after 7 days, as blastocyst
 In vitro fertilization / Test tube babies – harvest egg  put in dish  add sperm  fertilize  implant in uterus as blastocyst
 Infertility – inability to conceive within one year of regular sexual activity, due to ↓ sperm count, anatomical defects, diseases, oviduct searing,
adhesions or ligation
 Hydrosalpinx
Pregnancy
 Uterus - ↑ size and weight, softens
o @ 12th week felt through abdominal cavity above symphysis pubis,
 o @ 5th mo. at umbilicus,
o @ 9th mo. reaches xyphoid process, 20cm, 1kg,
o Shrinks after delivery, @ 8th week near normal size
 Vagina - ↑ size and capacity (due to hypertrophy)
 Signs
o Hegar’s – softening of uterus especially isthmus
o Goodel’s – lip-like softening of cervix, violacious color
o Chadwick’s – bluish color of vagina
 Positive Anatomical Signs
o Active fetal movements felt
o Direct palpation of fetal parts
o Fetal heart beat
o Ballottable mass with restriction – bouncing of finger on head on palpation
 Ultrasound – black is liquid, white is solid or mass
 Fullterm – 40 weeks
 Premature – < 37 weeks
 Normal Fetal Position – longitudinal, head down
o Malpositions – breech (head up): complete (sitting down), incomplete (cross-legged), or frank (feet up)
o Prolapsed umbilical cord – requires immediate delivery, fetal nutrition at risk, strangulation possible
 Anaesthesia – epidural (regional, does not inhibit contractions) and pudendal (for episiotomy)
 Caesarian section – abdominal incision
o Horizontal cut – classical, ↑ chance to rupture
o Bikini cut – low transverse, more durable, more aesthetic
 Ectopic Pregnancy – implantation other than in the uterus; tubal, ovarian, abdominal, cervical, infundibular
o Rarely develops to 4-5th mo. without complications
o Culdocentesis
 Vaginal bleeding – 1st trim = miscarriage; 2nd-3rd trim = placenta previa (planceta covers internal os, may be partial or total)
 Placenta abruptio – premature detachment of placenta, due to hypertension or trauma
 Birth control – natural or artificial
o Artificial methods – condoms, IUD, intradermal norplant (prevents pregnancy for a duration of time), tubal ligation (cautery or cutting)
 Abnormal uteri – septate (cavity is branched, fundus is fused), Asherman’s (adhesions in cavity), bicornuate (whole uterus is branched)
 Tumors – myomas (fibroids) – most common, hormonal imbalance; submucous (most prone to bleeding), intramural, subserosal, intraligamentary
or aborting (hangs out of cervix)
 Cancer
o cervical – most common, @ squamocolumnar junction, due to early sexual activity or pregnancy, or ↑ # sexual partners
 Schiller’s test
 Dx: pap smear
o Endometrial – 2nd most common, earlier symptoms (bleeding)
o Ovarian – most commonly epithelial
o Chocolate cyst - endometriosis