Extras Flashcards
pCO2 of 40 in pregnancy (otherwise would be normal) means …
BECAUSE PREGNANCY IS PRIMARY what with WHAT compensation?
Impending resp failure
Primary respiratory alkalosis with compensatory metabolic acidosis
Breast luminal epithelial is (shape/fxn) ….
cuboidal, secretory
Embryonically breast devleops from?
Ectoderm budding into mesenchyme
Neonate producing milk due to?
High PRL and low PROG in labor
Hormones for growth of duct?
Lobule?
E, GH, and IGF1 is the big one for ducts
Progesterone for lobules/alveoli and side branching (then PRL for maturation in preg/lact)
Milk production requires? And is held in check by?
hPL and PRL, held in check by prog
Human milk has more ___ than cow?
Oligosaccaharides, it is tailor made for human needs
Tight junction activity during lactation?
Open ealry for colostrum - lots of sIgA (IMMUNITY - high protein less fat)
Then close around day 2 - higher milk volume (NUTRITION)
Lactoferrin steadily rises
Foremilk vs hind milk
fore is more watery, the FAT is in the hindmilk
Effect of malnourishment of milk production?
same nutrients but less production
If dehydrated effect on milk?
Reduce H20 loss in urine before milk volume
Child’s energy source first few days?
Glycogen stores
Inadequate feeding requiring medical attn?
dehydration, hypERnatremia, jaundice
Breast Milk vs formula
Breast milk has less Fe and Vit D, but formula has no immune stuff
Where in the sperm are the enzymes necessary for fusion?
acrosome at the tip of the head, above nucleus
Role of protamine in sperm?
keep the DNA coiled tight using disulfide bonds
Axoneme in flagella of tail - structure?
Microtubules, 9 out, 2 in
Sperm capacitation happens in ____ and is driven by ____? And what is it?
Female genital tract, tyrosine kinase
It is sperm getting the ability to fertizile - bind the zona, and fuse with the acrosomal rxn
Acrosomal rxn enzymes?
hyalurondiase and acrosin
Sperm binds to which glycoprotein? And has to get through what to get to the what? And when it does it triggers?
ZP3, cumulus oophurus, zona pellucida, 2nd meiotic divsion - then protamines relax and DNA relaxes into PRONUCLEI
What stops a second sperm coming in?
?cortical? granules
Initial divisions of embryo take how long?
About a day each then day 4: morula, day 5: polarity and cavitation
How in fallopian tube after fertlization?
3 days, then is morula as leaving fallopian, becoming blastocyst around day 5 and begins to implant around day 6.5
When can you detect hCG is serum and urine?
Serum: day 21 (menstrual cycle) - week 3 (so day 6-7 after fert - when implanted)
Urine: weeks 4-5 - after missed period
What and when is hatching?
Blastocyst escaping ZP around day 6-7, EXPOSING THE TROPHOBLASTS right before implantation
Uterine receptivity?
days 20-24 of menstrual cycle
Decidualization changes?
incr glycogen and lipids ECN change PRL and IGF production COX2 activated and PGE2 synth dNK cells recruited (immune)
Cytotrophoblasts vs syncitiotophoblasts?
Cyto are anchors, syn surround and release hormones
3 stages of implantation?
Position of implanting blastocyst?
- apposition (blastocyst touches lumen)
- adhesion (molecular connection to epithelium)
- inversion (closure of epithelium with blastocyst inside)
IMPLANTS WITH INNER CELL MASS CLOSEST TO UTERINE WALL
DO syncitiotrophoblasts have MHC? Why not?
No, to stop rejection (ALSO SO LARGE influx of T and B cells into placenta)
Extravillous trophoblasts have what 3 HLA?
C, G, E
Layers of decidua
basalis (underlying the implantation)
capsularis (overlying it)
parietalis (rest of wall)
Suspect ectopic if serum hCG is …
But embryo BEGINS to make hCG at …
1500-2000 and baby not seen in uterus day 18 (menstrual) = day 4 (morula)
Ectopic locations
Is it viable
ampulla > isthmus > fimbriae NOT VIABLE (unlike previa, accreta)
Ectopic treatment …
methotrexate/surgery
normal rate of hCG rise?
purpose?
Super high in?
doubles every 2-3 days then peaks week 10/12 and falls off
purpose to maintain CL and prog production until placenta takes over week 8
super high in Tri21
Chorionic villi develop on days …
Most are what type? And what do they feed into?
13-18, most are floating for nutrient and waste exchange, others anchoring, they feed into lacunae
Placenta transports what by simple diffusion? Facilitated diffusion? Active transport?
Impaired transport is due to?
H2O, gas
glucose
amino acids
Due to syncitiotrophobalst problmes
Why does fetal O2 left shfit?
affifinity for 2-DPG
Intersitial cytotrophoblasts invade …?
Wherea endovascular?
ENTIRE enometrium and first 1/3 myometrium
uterine spiral arterioles, only termini of veins
Can the fetus itself produce estrogen?
No
Vaccines that can pass to fetus?
DZ A-Ab that can cross?
Flu, TDaP, as IgG
SLE, Hashimoto etc. - SLE Ab can cause fetal heart block
Amniotic fluid is made up of …
LEVELS?
plasma from mom, fetal urine and lung secretion
250ml at 16 weeks
1L at 32 weeks
Oligohydramnios assoc with:
Polyhydramnios assoc with:
ACEi, NSAIDs, poor placental perfusion, rupture of membranes, GU abnormalites in fetus
Neural tube defects, esophageal ataxia, GDM
Di-Di divides when and has what?
0-4 days (20-30%)
separate placenta TWIN PEAK SIGN, two layers
Mo-Di divides when and has what?
4-8 days (70%)
T-line - thin divide - JUST the amnion dividing them
MONOCHORIONIC MEANS shared placenta
Mo-Mo & conjoined
8-12 days (1%)
dangerous
Conjoined is 13-15 days + (
TTTS happens only to which twins?
And what is it?
Mo-Di (Di-Di’s have no connection, Mo-Mo’s have too much connection)
It’s unbalanced blood flow through arteriovenous connection - twin who gets more increases URINE to deal and thus polyhydramnios
and theo ne who gets less reduces URINE so oligohydramnios
VERY HIGH CHANCE OF DEATH OF ONE TWIN, then high chance of brain damage for other
Treating TTTS
induce labor, amnio fluid reduction, laser ablation if not v severe, make hole in septum (SAFEST)
Size limit to cross placenta
1200 D
so insulin and heparin, TBG and TSH can’t,
but glucose, cortisol, tyroid drugs, idoidne and B-blockers can (and somewhat T4)
P vs E, early and later preg
More P than E early
More E than P late
But both steadily increase
hCG, hPL and hPGH levels through preg
hCG peaks and drops off after 10-12 weeks
hPL and hPGH start to rise at 12 and keep rising until end
Insulin resistance early and late?
insulin sensitive early, insulin resistant late
Is hPGH regulated by GHRH?
No
Progesterone synthesis depends on?
LDL receptors on trophoblasts/placenta
Should you give thyroid meds in preg?
NO
Most maternal hypothyroid is due to?
And can delay what?
Hashimoto
Neurodevelopment
Normal pregnancy mimics what thryoid state?
HyPERthyroid
could be hCG - think lots of vomiting
Cholecystitis in 2nd trim is indication for?
SURGERY
Corticotropin RH can be inhibitor or stimulant of what?
Contraction. early inhibitor, late stimulant
CRH –> cortisol has what effect on developing fetus?
creates surfactant and induces labor late in preg
Labor happens during which myometrial phase?
phase 2 = stimulation
Effect of insulin on cortisol?
inhibits! so causes NRDS due to lack of surfactant production
Effect of A1C in 1st and 3rd trimesters?
1st: malformations
3rd: GDM
GDM cadiac abnomraity?
septal probs
Breast CA incidence and death rate?
Most common and second deadliest
Clinical breast exam finds what size lesions?
> 1cm
White on mammagram could be?
CA or dense breast tissue, and younger women have denser breasts
If probably benign found on screening mammogram? (3)
If suspicious? (4-5)
If malignant known? (6)
FU in 6 mo
Tissue biopsy
Excise
Start annual mammograms?
Over 40 or 45, educate 20s about self exam
55 and older maybe switch to every 2 years
OCPs increase breast CA risk?
Nope!
Protein C and Protein S levels in preg?
C constant, S sinks
