GYN Basics Flashcards
Human Chorionic Gonadotropin(hCG) is made by —- and peaks at —.
placental syncytiotrophoblast, 10 weeks
Human Placental Lactogen(hPL) is simular to —– and causes—-.
GH & Prolactin, antagonizes the cellular actions of insulin = pregnancy glucose intolerance
Estradiol
dominant during reproductive years = from granulosa cells
Estriol
dominant during pregnancy = from placenta
Estrone
dominant during menopause = from adipose tissue
Why do you get these skin changes in prego: Striae gravidarum, spider angiomas & palmer erythema, Chadwich Sign, Linea Nigra, Chloasma.
Striae gravidarum = stretch makrs, spider angiomas & palmer erythema = increased skin vascularity, Chadwich Sign = bluish or purple discoloration of the vagina and cervix as a result of increased vascularity, Linea Nigra = midline pigmentation, Chloasma = blotchy pigmentation fo the nose and face
Changes in Prego w/CV
decrease BP in 1st trimester, lowest at 24wks(should never see elevated arterial bp in prego). increase in plasma volume, decrease in SVR, increase in CO(loest in supine, highest in left later pos). left sternal systolic ejection murmer
Changes in Prego w/Endocrine
increase in pituitary size and vasculitty, increase cortisol, increase in TBG due to estrogen = elevated T3/T4 total but normal free T3/T4
Changes in Prego w/Renal
increase in volume = increase in kidney size, increase GFR, dec BUN, dec Cr, glucosuria
Changes in Prego w/Pulmonary
tidal volume increases due to elevated diaphragm, residual volume decreases ==> RESPIRATORY ALKALOSIS from dec Pco2 & inc pH
Changes in Prego w/GI
decreased GI motility & gastric motility due to increased progesterone
Changes in Prego w/Heme
increase in RBC MASS; will see dillutional anemia, increased WBC count(max 16,000 @3rd trimester), normal platlets, increased coag factors from liver
—- murmer can be normal in prego.
SYSTOLIC(left sternal) = due to increase blood volume. diastolic murmers are never normal and should be investigated
3 in utero shunts within fetus
- Ductus Venosus: umbilical vein –> IVC
- Foramen Ovale: RA –> LA
- Ductus Arteriosus: Pulmonary A —> descending aorta
puberty takes — yrs to complete and is usually done by age —.
3-4, 16 yoa
dafuq do the following do for lactation: Progest, Estro, Prolac, oxytocin
Progest: increase lobules, alveoli
Estrogen: increase ducts
Prolac: milk production
Oxy: milk let down
Colostrum
first secretion of mammary ducts after deliver, high in protein low in fat. contains IgA for passive immunity.
how many days after delivery for milk production to reach appreciable levels
1-3d
estrogens effect on prolactin
estrogen helps ducts develop but also antagonizes positive effect of prolactin on milk production; once placenta is removed prolactin can go to work.
What happens wk 1 postconception?
implantation of the blastocysts on the endometrium
What happens wk 2 postconception?
bilaminar germ disk with epiblast and hypoblast layers; invasion of material sinusoids by syncytiotrophoblast = 1st time bhCG prego test can be positive
What happens wk 3 postconception?
trilaminar germ disk with ectoderm, mesoderm & endoderm is formed
What happens wk 4-8 postconception?
Major organs formed most important time
after 9 wks teratogens will mostly effect..
organ hypertrophy and hyperplasia
Ionizing Radiation in pregnancy
no single diagnostic procedure results in radiation exposure to a degree that woudl threaten the developing baby.
Chemotherapy in prego..
greatest risk in first trimester; 2-3 is most resitant
Tobaccos fx on prego
causes intrauterine growth restriction(IUGR)
Fetal Alcohol Syndrome
midfacial hypoplasia, microcephaly, mental retardation, IUGR, short palpebral fissures, long philtrum, cardiac defects
Cocaine use in prego
assoc w/placental abruption, preterm deliver, intraventricular hemorrhage, IUGR
Marijuana use in prego
preterm delivery
Diethylstilbestrol(DES) in pregnancy..
“estrogen” that caused T-shaped uterus, vaginal adenosis w/risk of clear cell carcinoma, cervical hood, incomplete cervix, preterm delivery
Dilantin in pregnancy
aka phenytoin. can cause: fetal hydantoin syndrome(IUGR, craniofacial dysmorphism(epicanthal folds, depressed nasal bridge, oral clefts), mental retardation, microcephaly, nail hypoplasia, heart defects)
Isotretinoin(accutane) in pregnancy
congenital deafness, microtia, CNS defects, congential heart defects
Lithium in prego
ebsteins anomaly =atrialization of the right ventrical due to tricuspid valve being displaced down into the ventrical
streptomycin in prego
inhibits 30s ribosome. Causes CN8 dmg(hearing) = hearing loss
tetracyclin in prego
blocks 30s ribosome. teeth discoloration/anomalies after the 4th month
thalidomide in prego…what does this treat?
tx multiple myeloma. causes: phocomelia(malformed limbs), limb retardation, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis
Trimethadione in prego..
anticonvulsant. causes: facial dysmorphisms(short upturned nose, slanted eyebrows), cardiac defects, IUGF, mental retardation
Valproic acid(depakote) in prego
NTD(spina bifida), cleft lip, renal defects
Warfarin(Coumadin) in prego
Chondrdysplasia(strippled dpiphysis), microcephaly, mental retardatoin, optic atrophy
define: abortion
loss prior to 20 wks
define: antepartum death
death between 20 wks and labor
define: intrapartum death
death from onset of labor to birth
define: perinatal death
death between 20 wks and 28 days of life
define: infant death
death between birth and 1yr
define: maternal death
death during pregnancy or within 90 days after birth
MC trisomy causing 1st trimester lost
trisomy 16
MC trisomy @term
21
Klinefelter Syndrome
47XXY; dx usually made during puberty = tall, testicular atrophy, azopermia, gynecomastia, truncal obesity, learning disorder, AI dz, low IQ
Down Syndrome
trisomy 21: mental retardation short stature, muscular hypotonia, brachycephaly, short neck, oblique orbital fissure, flat nasal bridge, small ears, nystagmus, protruding tongue, congential heart disease, duodenal atresia
Edward Syndrome
trisomy 18: profound mental retardation, rocker bottom feet, clenched fist, F > M; mean survival = 14days
Patau Syndrome
trisomy 13: frofound mental retardation, IUGR, Cyclopia, Proboscis, holoprosencephaly, severe cleft lip w/palate. meav survual = 2days
AD dz’s
polydactyly, hunting chorea, achondroplasia, marfan, myotonic dystrophy, PCKD, NF, Osteogenesis imperfecta
AR dz’s
deafness, CF, thalassemia, albinism, SS anemia, Tay-Sachs dz, PKU, CAH, Wilson
XLR Dz’s
Hemophila A, Color blindness, complete androgen insensitivity, diabetes insipidus, hydrocephalus, G6PD deficiency, Duchenne muscular dystrophy
neural tube should close by —- postconception.
22-28 d
women at risk for NTD should consume —mg of folic acid. Those who are not shoudl take —mg.
risk = 4mg; no risk = 0.4 mg
