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OBSTETRICS and GYNE > ANATOMY > Flashcards

ANATOMY Flashcards

1
Q

Layers of the abdominal wall

A

Skin
Campers fascia (fatty)
Scarpas fascia (membranous)
Muscles

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2
Q

Blood supply to skin, subcu and mons pubis

A

Superficial epigastric artery

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3
Q

Bllod supply to abdominal muscle and fascia

A

Deep/inferior epigastric artery

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4
Q

Male homologues

Labia minora

A

Penile urethra and skin of prnis

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5
Q

Male homologues

Labia majora

A

Scrotum

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6
Q

Male homologues

Clitoris

A

Penis

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7
Q

Male homologues

Skenes glands

A

Prostate gland

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8
Q

Male homologues

Bartholins glands

A

Cowpers glands

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9
Q

Border of vulva

Superior

A

Mons pubis

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10
Q

Borders of the vulva

Lateral

A

Labiocrural fold

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11
Q

Border of the vulva

Inferior

A

Perineal body

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12
Q

Six openings of the vestibule

A

Urethra
Vagina
2 bartholin gland ducts (5 and 7 oclock)
2 skene gland ducts (paraurethral)

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13
Q

Perineum

Urogential triangle boundaries

A 
Pubic symphysis (tip)
Ischiopubic rami (lateral)
Ischial tuberosities
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14
Q

Anal (posterior) triangle

Boundaries

A

Ischial tuberosities
Sacrotuberous ligaments (lateral)
Coccyx (tip)

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15
Q 
Anterior (pubic) triangle
Superficial space (7)
A 
Bartholins glands
Vestibular bulbs (veins)
Clitoral body and crura
Pudendal vessels and nerves
Ischiocavernosus muscle
Bulbocavernosus muscle
Superficial transverse perineal muscle
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16
Q 
Anterior (pubic) triangle
Deep space (2)
A

Compressor urethrae muscles

Urethrovaginal sphincter muscles

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17
Q

Posterior triangle contains

A

Ischioanal fossae (fat-filled)
Anal canal
Anal sphincter complex
Puborectalis muscle

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18
Q

Internal anal sphincter

Innervation

A

Pelvic splanchnic nerve

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19
Q

Internal anal sphincter blood supply

A

Superior, middle, inferior rectal arteries

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20
Q

External anal sphincter

Innervation

A

Inferior branch of pudendal nerve

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21
Q

External anal sphincter

Blood supply

A

Inferior rectal artery

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22
Q

Striated urogenital sphincter complex

A

Sphincter urethrae
Compressor urethrae
Urethrovaginal urethrae

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23
Q

Bridge over water

A

Ureter lies underneath the uterine artery

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24
Q

Ovaries in relation to internal iliac vessels

A

Ovaries are medial

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25
Q

Uterus boood supply

A

Ovarian artery

Uterine artery

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26
Q

Blood supply to vaginal

Proximal portion

A

Vaginal artery

Uterine artery

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27
Q

Vaginal blood supply

Posterior vaginal wall

A

Middle rectal artery

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28
Q

Vaginal blood suoply

Distal portion

A

Internal pudendal artery

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29
Q

Ligaments of uterus

A

Round ligament
Broad ligament
Cardinal or Transverse cervical or Mackenrodt ligament (thick base of broad ligament)
Uterosacral ligament

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30
Q

Main support of the uterus

A

Cardinal ligament

Uterosacral ligament

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31
Q

Structures in broad ligament

2-fold peritoneum

A 
Uterine tube (and mesosalpinx)
Ureter
Ovarian ligament (and mesovarium)
Round ligament
Uterine vessels, lymph nodes, nerves
Ovarian vessels, lymph nodes, nerves
Parametrium
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32
Q

Peritoneum

A

Mesosalpinx - around fallopian tube
Mesoteres - around round ligament
Mesovarium - over the uterovarian ligament

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33
Q

Tissues

Connetive tissue lateral to the uterus within the broad ligament

A

Parametrium

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34
Q

Tissue lateral tot eh cervix

A

Paracervical tissues

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35
Q

Tissue lateral to the vagina

A

Paracolpium

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36
Q

Arteries entering the true pelvis

A 
MISO
Median sacral 
Internal iliac
Superior rectal
Ovarian
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37
Q

Blood volume in pregnancy

A

40-45% above the nonpregnant by 32 to 34 wks aog

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38
Q

Pregancy is a state of hypervolemia secondary to

A

Blood volume expansion (both plasma ans RBC)

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39
Q

Abnormal hemoglobin levels

1sr tri

A

Less than 10

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40
Q

Abnormal hemoglobin

2nd tri

A

Less than 10.5

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41
Q

Abnormal hemoglobin

3rd tri

A

Less than 11

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42
Q

Average hemoglobin at term

A

12.5 g/dl

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43
Q

The arterial supply of the placenta which vasodilates but completely loses contractility

A

Spiral arteries

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44
Q

Potent vasodilator with central role in reduced vascular resistance

A

Nitric oxide

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45
Q

Hormones and growth factors that augment NO syntase and NO production

A 
Estrogen
Progesterone 
Activin
Placental growth factor
Vascular endothelial growth factor
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46
Q

Cervical mucus shows poor crystallization

A

Beading

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47
Q

Hormone responsible for poor crystallization in pregnancy

A

Progesterone

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48
Q

Presumptive signs of pregnancy

A 
Cessation of menses
Beading cervical mucus
Chadwicks sign
Changes in breast
Skin changes 
— chloasma
— melasma
— linea nigra
— striae gravidarum
— spider telangiectasia
Increased temperature
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49
Q

seen on glass slide, result of amniotic fluid leakage, arborization of ice crystals

A

Ferning

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50
Q

Endocervical gland hyperplasia and hypersecretory appearance which is difficult to differentiate from atypical glandular cells

A

Arias Stella reaction

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51
Q

Greater vascularity and hyperemia in the skin and muscles of perineum, vulva, vagina, and cervix resulting in violet color

A

Chadwick sign

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52
Q

Presumptive symptoms of pregnancy

A

Morning sickness
Fatigue
Frequency in urination
Quickening

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53
Q

slightly elevated clear or red patches that bleed easily seen on and just beneath the ovarian surface. Arise from subcoelemic mesenchyme or endometriotic lesions

A

Decidual reaction

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54
Q

Protein hormone secreted by corpus luteum, decidua, placera, brain, heart and kidney. Aids in remodeling the reproductive tract connective tissue to accomodate labor

A

Relaxin

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55
Q

Exaggerated physiological follicle stimulation. Usually bilateral, moderately to massively enlarged cystic ovaries due to markedly elavated serum hCG

A

Theca Lutein Cysts

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56
Q

Hormone involved in decidual reaction

A

progesterone

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57
Q

Hormone involved in theca lutein cyst

A

Serum hCG — markedly elevated

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58
Q

peak of hCG

A

8-10 weeks

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59
Q

Plateau of hCG

A

16 errks

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60
Q

Morning sickness usually occurs during which AOG.

A

6-18 weeks

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61
Q

Quickening in primigravid

A

18-20

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62
Q

Quickening in multigravid

A

16-20

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63
Q

amenorrhea is not reliable until how long after expected menses?

A

10 days or more

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64
Q

When does beading usually occur?

A

6 weeks

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65
Q

Shen does chadwick sign usually occur

A

6 weeks

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66
Q

Breast engorgement usually starts at?

A

6-8 weeks

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67
Q

Skichloasma and melasma in pregnancy due to what hormone?

A

MSH

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68
Q

Striae gravidarum is due to what?

A

Collagen breakdown

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69
Q

Spider telangiectssia is due to what hormone?

A

Increased estrogen

70
Q

Mask of pregnancy

A

Chloasma/melasma

71
Q

Darkening of linea alba

A

Linea nigra

72
Q

Hormone responsible for increase in temperature in pregnancy

A

Progesteorone at 6 weeks

73
Q

Probable evidence

A 
Enlargment of abdomen
Hegars
Goodells
Braxton hicks
Physical outlining of the fetus
Ballotememt
Detection of B hCG
74
Q

enlargement of abdomen starts at?

75
Q

When does the uterus become an abdominal organ?

76
Q

Softening of the uterine isthmus;

Firm cervix now contrasts with softer fundus and isthmus

A

Hegars sign

77
Q

Softening of the cervix

A

Goodells sign

78
Q

When does goodells and hegars sign appear?

79
Q

When do braxton hicks start?

80
Q

when does BhCG get detected?

A

6 days after fettilization

8-9 days post implantation

81
Q

Sensitivity of pregnancy test?

A

12.5 mIU/ml (very sensitive)

82
Q

Rare causes of fale positive pregnancy test

A 
Exogenous hCG injection
Renal failure with impaired hCG clearance
Physiologic pituitary hCG
hCG-producing tumors 
— usually GI, ovarian, bladder or lung
83
Q

Mormal pregnancy carbohydrate metabolism is characterized by?

A

Mild fasting hypoglycemia
Postprandial hyPERglycemia
HYPERinsulinemia

84
Q

Factors responsible for insulin resistance

A 
Progesterone
Placental growth factor
Cortisol
Lectin
TNF
85
Q

Hormone secreted by adipose tissue
Important for implantation, cell proliferation, angiogenesis
Important for development of pancreas, kidney, heart, brain

86
Q

Low levels of leptin causes what?

A

Fetal greoth restriction

87
Q

In pregnancy what happens to lipid, lipoproteins, apolipoproteins, TAG, Ce,

88
Q

Increased or Decreased?

Iron requirements

89
Q

Increased or Decreased?

Iodine requirements

90
Q

Increased or Decreased?

Sodium

91
Q

Increased or Decreased?

potassium

92
Q

Increased or Decreased?

Total serum calcium

93
Q

Increased or Decreased?

Serum magnesium

94
Q

Increased or Decreased?

Blood volume

95
Q

Increased or Decreased?

Hgb

96
Q

Increased or Decreased?

Hct

97
Q

Increased or Decreased?

Whole blood viscosity

98
Q

Increased or Decreased?

Immunity

99
Q

Increased or Decreased?
Th1 response
Th1 secretion of IL2, IF-g, TNG-B

100
Q

Increased or Decreased?

Th2 secretion of IL4, IL6, IL13

101
Q

Increased or Decreased?

IgA and IgG in cervical mucus

102
Q

Increased or Decreased?

Chemotaxis and adherence

103
Q

Increased or Decreased?

WBC count

104
Q

Increased or Decreased?

ESR

A

Increased

*pregnancy is a post inflammatory state

105
Q

Increased or Decreased?

CRP

106
Q

Increased or Decreased?

Procalcitonin

A

Increased in 3rd Tri

107
Q

Is Pregnancy a hypercoagulable state?

108
Q

Increased or Decreased?

Fibrinogen

109
Q

Increased or Decreased?

Factor VII

110
Q

Increased or Decreased?

Factor X

111
Q

Increased or Decreased?

Plasminogen

112
Q 
Increased or Decreased?
APTT
tPA
Anticoagulants
— protein C 
— Protein S
— Antithrombin III
113
Q

Increased or Decreased?

Platelet count

114
Q

Increased or Decreased?

Cardiac output

A

Increases at 5th week

115
Q

Increased or Decreased?

SVR

116
Q

Increased or Decreased?

Plasma volume

A

Increases at 10-20 weeks

117
Q

Increased or Decreased?

Preload

118
Q

Increased or Decreased?

Arterial pressure

A

Dec

Nadir at 24-26 weeks

119
Q

Increased or Decreased?

Diastolic pressure

120
Q

Increased or Decreased?

Renin and angiotensin

121
Q

ECG changes due to elevated diaphragm in 3rd tri?

A

Leftward deviation of the mean QRS axis

122
Q

Secreted in response to chamber wall stretching

A

ANP and BNP

123
Q

principal prostaglandin of the endothelium

A

Prostacyclin

PGI2

124
Q

increases in late pregnancy and regulates blood pressure and platelet function, maintains vasodilation

125
Q

Regulates blood volume by natriuresis and diuresis and vascular smooth muscle relaxation

A

ANP and BNP

126
Q

Preeclampsia molecular changes

A 
increase
— BNP
— endothelin 1
Decreased
— prostacyclin PGI2
Abnormal synthesis of NO
127
Q

Produced in endothelial and vascular smooth muscle

A

Endothelin 1

128
Q

Production of endothelin 1 is stimulated by which hormones?

A

Angiotensin II
arginine vasopressin
Thrombin

129
Q

Potent vasodilator

A

Nitric oxide

130
Q

Released by endothelial cells

Mediator of placental vascular tone and development

A

Nitric oxide

131
Q

Stimulates secretion of ANP, aldosterone and cathecholamines

A

Endothelin 1

132
Q

Increase/Decrease

Peak inspiratory flow rates in pregnancy

A

Increase progressively

133
Q

Increase/Decrease

Airway conductance

A

Inc due to progesterone

134
Q

Increase/Decrease

Total pulmonary resistance

A

Dec due to progesterone

135
Q

Increase/Decrease

Lung compliance

136
Q

Increase/Decrease

Thoracic circumference

137
Q

Increase/Decrease

Thoracic cage

138
Q

Increase/Decrease

Serum creatinine

139
Q

Increase/Decrease

Crea clearance

A

Inc by 30%

140
Q

Urinalysis in pregnancy

A

May have glucosuria
No proteinuria
May have hematuria

141
Q

Increased risk of urinary tract infection in pregnancy is due to?

A 
Ureter displacement (lateral) and compression (at pelvic brim)
And dilatation (right ureter) and elongation
142
Q

Urinary incontinence during pregnancy is due to?

A

Hyperplasia of the bladder muscle which elevates trigone

Reduced bladder capacity due to uterine compression

143
Q

When to investigate for DM?

UA results of

A

Glucosuria
Inc GFR
Dec tubular resorption

144
Q

When is Proteinuria in pregnancy significant?

A

> 300 mg/dl

145
Q

Increase/Decrease

GFR in pregnancy

A

Inc by 50%

146
Q

How does GFR increase in pregnancy? What hormone is involved?

A

RELAXIN boosts NITRIC OXIDE production leading to renal vasodilation and lower renal arteriolar resistance

147
Q

Increase/Decrease

Alkaline Phosphatase

148
Q

Increase/Decrease
AST
ALT

149
Q

Increase/Decrease

GGT

150
Q

Increase/Decrease
Bilirubin
Albumin

151
Q

Increase/Decrease

Globulin

152
Q

Increase/Decrease

Leucine aminopeptidase

153
Q

Gallbladder contractility

A

Decrease
Due to progesterone
Prone to gallstones

154
Q

Increase/Decrease

Pituitary size

155
Q

Increase/Decrease

Maternal growth hormone

156
Q

Increase/Decrease

Placental growth hormone

157
Q

Increase/Decrease

Prolactin

158
Q

This organ Increases due to estrogen-stimulated hyperplasia of lactotrophs

A

Pituitary gland

159
Q

Increase in the pituitary size may lead to?

A

Compression of optic chiasm and reduction of visual fields

160
Q

During 10-20 weeks, absence of growth hormone causes regression or cessation of fetal growth. True or false?

A

False. Fetal growth continues even in the complete absence of maternal growth hormone

161
Q

Secreted by syncytiotrophoblasts which upregulates insulin-like growth factor for fetal growth

A

Placental growth hormone

162
Q

Increased placental growth hormone levels is associated with what disease condition?

A

Preeclampsia

163
Q

Increases during normal pregnancy and drops after delivery. Initiates DNA synthesis and mitosis of glandular epithelial cells and presecretory alveolar cells of the breast

164
Q

Increase/Decrease

Thyrotropin

165
Q

When does fetal thyroid begin to concentrate iodine?

A

10-12 weeks

166
Q

When does fetal thyroid synthesize thyroid hormone?

167
Q

Increase/Decrease

Cortisol

168
Q

Increase/Decrease

Aldosterone

169
Q

How does the principal glucocorticoid, cortisol, increase in pregnancy?

A

Decreased metabolic clearance

There is no increase in adrenal secretion

170
Q

Why is there elevated free cortisol in pregnancy

A

Balance elevated progesterone
Prepare for stress
Modulates trophoblastic growth and placental size

171
Q

What is the principal mineralocorticoid of pregnancy

A

Aldosterone

172
Q

Why is aldosterone increased in pregnancy?

A

Protect against natriuretic effects of ANP and progesterone

Modulates trophoblastic growth and placental size

OBSTETRICS and GYNE (5 decks)

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