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Year 5 - Obstetrics and Gynaecology > Anatomy, Physiology and Embryogenesis > Flashcards

Anatomy, Physiology and Embryogenesis Flashcards

1
Q
A
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2
Q

What % of pregnancies miscarry in first trimester?

A

15-20%

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3
Q

What is the diagnosis?

A

Trisomy 18

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4
Q

What is he diagnosis?

A

47 XXY

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5
Q

What is the diagnosis?

A

Patau’s syndrome

Trisomy 13

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6
Q

What is the diagnosis?

A

Monosomy X

Turner’s syndrome

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7
Q

What are the features of Patau’s?

A

Cleft lip and palate

Development of nasal palate

Not compatible with reaching term

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8
Q

What is a feature of Edward’s syndrome?

A

Rocker bottom feet

Heart defects

Anencephaly

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9
Q

Is Kleinfelter male or female?

A

Male with some intersex features

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10
Q

Abnromalities of fertilisation: If there is more paternal material than maternal in fertilisation, what is this called?

A

Molar pregnancy aka Gestational trophoblastic disease

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11
Q

What are the clinical features of molar pregnancy?

A

Measure large for dates - increased proliferation of trophoblasts of the bplacenta

PV bleeding

Must explain that this is not a viable pregnancy

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12
Q

What is a US feature of molar pregnancy?

A

Snow storm appearance

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13
Q

Abnormalities at implantation: what is shown?

A

Ectopic pregnancy - 98% will implant in fallopian tubes

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14
Q

Abrnomalities at implantation: what is placenta praevia?

A

Placenta implanted wholly or in part into the lower part of the uterus

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15
Q

What are the abnormalities of placental depth?

A
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16
Q

What is early detachment of the placenta called?

A

Placental abruption

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17
Q

What are the clinical features of placental abruption?

A

Pain

Tense ‘woody’ uterus

Bleeding - may be ‘concealed’ by enlarging uterus

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18
Q

What are the risk factors for placental abruption?

A
  • Pre-eclampsia
  • HTN
  • Abdominal trauma
  • Cocaine
  • Smoking
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19
Q

Describe urogenital development.

A
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20
Q

Describe genital development.

A
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21
Q

What is shown?

A

Blind ending fallopian tube - not full development.

Mullerian duct abnormality

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22
Q
A
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23
Q

What is shown?

A

Biconate uterus - associated with mscarriage in later life

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24
Q

What is shown?

A
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25
Q

What is shown?

A

Vaginal atresia - usually present at 12yr

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26
Q

What is shown?

A

Hematocolpos - dilated blood filled vagina

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27
Q
A

Failure of Mullerian duct fusion

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28
Q
A

Wolffian duct OR mesonephric duct (as these then go on to give rise to genital system)

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29
Q
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30
Q
A

Additional shunts in circulation - clinical problems if they persist

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31
Q

What is the goal of the ductus arteriosus?

A

Bypasses blood from non-functional lungs

Right to left shunt

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32
Q

When does the DA close? What structures are found around it?

A
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33
Q

What is the direction of shunt in PDA?

A

Left to right

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34
Q

How do you close the PDA? How do you keep it open and when?

A

Indomethacin (NSAID) to close PDA

In TGA - keep open by giving prostaglandins

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35
Q

What is the goal of the foramen ovale? What % do not close and what is the clinical problem?

A

Right to left shunt

36
Q

What is the goal of the ductus venosis?

A

Bypass liver and go straight to heart - shunts 30%

Umbilical vein (blood from placenta) bypasses IVC

3-7 days closes and forms ligamentum venosus

37
Q

What is the umbilical cord formed of?

A

2 arteries - carries deoxygenated blood

1 vein - oxygenated blood

38
Q

What is the purpose of the ductus venosus in pregnancy?

A

Shunts 30% of blood past the fetal liver

39
Q

What happens to umbilical cord post-natally? What does the umbilical vein become?

A

Closes 3-7 days post-natal

Umbilical vein –> round ligament/ligamentum teres

40
Q

What is the use of umbilical vein in pre-term?

A

Takes longer to close in pre-term infants so can be used as a site for central line and be catheterised as shown below

41
Q

What do the umbilical arteries regress to form? What is the use of these?

A

MediaL umbilical ligaments

These are used as a laparoscopic landmark

42
Q

What do the allantoic duct/urachus regress to become?

A

MediaN umbilical ligaments

43
Q

How long post-natally can you take blood from the umbilical arteries for?

A

Until 1 week old - used like arterial line

44
Q
A

Ductus arteriosus

45
Q
A

Ductus venosus

46
Q
A

Umbilical vein

47
Q
A

MediaN umbilical ligament arises from allaNtoic duct

48
Q

What is GTD in terms of malignancy?

A

This is a molar pregnancy which is a pre-malignant stage

49
Q

What are the different incisions used in Obs and Gynae?

A
50
Q

What is this a consequence of?

A

Inferior and superior epigastric vessels damage

51
Q

Why might you use Palmer’s point and where is it?

A

Laparoscopy to avoid adhesions

  • Advocated by French gynaecologist Raoul Palmer in the 1940s because visceral-parietal adhesions are rarely found here*
  • Gynaecologists still favor this entry site when intra-abdominal adhesions are likely, especially in patients with a history of significant adhesions or multiple previous pelvic surgeries*
52
Q

What is the widest diameter of the pelvic inlet?

A

Transverse diameter between arcuate lines (13sm)

The vertical line between sacral promontory and pubic symphysis is 11cm

53
Q

What are the landmarks of the pelvic outlet?

A
54
Q

In delivery, what is the positioning of the head?

A

There is twisting according to the sizes of the pelvic inlet and outlet

55
Q

Where does the pudental nerve travel?

A
56
Q

How is pudental nerve block done?

A
57
Q

When is episiotomy done?

A

NOT done prophylactically

Performed during second stage of labour (usually instrumental delivery) under pudendal block to enlarge opening and avoid tearing damage to:

  • anal sphincter (incontinence)
  • perineal body (reduce postpartum pelvic floor dysfunction)
  • reduce blood loss (muscles well supplied)

60o angle from midline

Postnatally sutured up

58
Q

What should you avoid in episiotomy?

A

Perineal body - prolapse may result

Bartholin’s glands - these usually provide lubrication

59
Q

What are the parts of the levator ani? What is their function? What does damage cause?

A

Levator ani muscles support urethra, vagina, and rectal canal

Damage can result in: urinary stress incontinence, anal incontinence, pelvic organ prolapse (POP)

60
Q
A
61
Q
A

46 XX

Epmpty ovum - replication of the sperm causes 46 XX

Snowstorm appearance is characteristic of a complete mole than the partial mole which is why it is not 69 XXY

62
Q

What are the layers dissected during Caesarean?

A
    1. Skin
    1. Fat
    1. Rectus sheath
    1. Rectus
    1. Parietal peritoneum
    1. Visceral peritoneum
    1. Uterus muscular layer
63
Q

What is the HPG axis?

A
64
Q

What is the pattern of FSH, LH, progesterone and oestrogens during the menstrual cycle?

A
65
Q

What is the purpose of LH, FSH, etradiol, progesterone?

A

LH - androgen production and ovulation

FSH - oestrogen production and recruitment of follicles

Estradiol - preparation of endometrium for implantation and 2o sexual characteristics

Progesterone - maintenance of pregnancy and inhibits lactation

66
Q

What are the patterns of hormones in pregnancy?

A
67
Q

What hormone drop are most symptoms of menopause associated with?

A

Oestrogen

Menopause - no periods for a year

68
Q

What is premature ovarian insufficiency?

A

Irregular periods and infertility in patients ~35-40yrs +/- menopausual symptoms

69
Q

What are the causes of POI?

A

90% unknown cause but often have family history

Can also be caused by chemo/radiotherapy; Fragile X syndrome; Turner syndrome; thyroiditis; Addison disease; viral infections

70
Q

How do you diagnose POI and what is the management?

A

Diagnosis: measure FSH twice 4-6 weeks apart, should be high on both occasions

Treatment:

  • HRT/COCP for bone health and menopausal symptoms
  • ART (inc egg donation + IVF) for fertility
71
Q

Is LH or FSH higher in PCOS?

A
72
Q

How is PCOS diagnosed? What criteria is used? What are the long term complications?

A
73
Q
A

Posterior rectus sheath (we are below the articuate line)

74
Q
A

Coccyx

75
Q
A

Perineal body

You do it at 60 degress to avoid Bartholin’s glands too

76
Q
A

Cystocele

77
Q

Is premature ovarian failure the same as premature ovarian insufficiency?

A

Yes - moving away from failure now

78
Q
A

Progesterone

79
Q
A

Corpus luteum –> placenta

80
Q
A

3 - Menopause - last period 1 year ago independent of other symptoms.

81
Q
A

Stroke

The rest are all associated with PDA

82
Q
A

Prior to instrumental delivery

83
Q
A

Estradiol (oestrogen)

84
Q

How soon after conception is hCG detected in the serum? What is it secreted by?

A

8 days after CONCEPTION

Syncytiotrophoblasts - its main role is to mainatin corpus luteum and prevent its disintegration

85
Q

What is the pattern of hCG levels during pregnancy? When do levels peak?

A

hCG levels double approx. every 48 hours in the first few weeks of pregnancy

Levels peak at around 8-10 weeks gestation.

Year 5 - Obstetrics and Gynaecology (87 decks)

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