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medical sciences > module 1.07 > Flashcards

module 1.07 Flashcards

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USMLE® Step 1 flashcards
1
Q

Hoe does oestrogen levels change during pregnancy?

A

Oestrogen levels continuously rise during pregnancy. (drops right at the end to allow for labour)

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2
Q

How do progesterone levels change during pregnancy?

A

Progesterone levels rise continuously during pregnancy. Orignially produced by corpus luteum but then placenta takes over the role. (drops right at the end to allow for labour)

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3
Q

How does oestrogeon prepare the maternal body for delivery?

A

It does this by increasing the number of oxytocin receptors in the uterus.

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4
Q

What. is progesterones role in pregnancy?

A
  • maintain uterine lining

- smooth muscle relaxant

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5
Q

how does breathing change for the mother during pregnancy and why?

A
  • More diaphragmatic breathing
  • increased tidal volume
  • relative hyperventillation
  • > because there is an increase in intra abdominal pressure due to the enlargment of the uterus.
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6
Q

What cardiovascular changes are there for the mother in pregnancy?

A
  • increased cardiac output ( cardiac output= heart rate x stroke volume)
  • decreased systemic vascular resistance (causes increased stroke volume)
  • drop in blood pressure
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7
Q

What haematological changes are there for the mother during pregnancy?

A
  • increase in plasma volume -> 40%
  • increase in red blood cell volume -> 25%
    (plasma volume increases more than red blood cell volume so a net lower volume of RBCs making anaemia common in pregnancy)
    -increase in clotting factors (pregnancy is a hyper-coagulable state)
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8
Q

what musculoskeletal effects does the mother experience during pregnancy? (due to uterine enlargment)

A
  • increased BMI
  • stretch marks
  • lower back pain
  • lordosis
  • sciatica
  • calf cramp
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9
Q

what dermatological changes are there for the mother in pregnancy?

A
  • increased skin pigmentation

- distention and proliferation of blood vessels

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10
Q

what are some of the physical effects of increased progesterone and oestrogeon in the body?

A
  • breast enlargment
    -areolar pigmentation
    -uterine hypotrophy and stretching
    cervical gland hypotrophy -> increase in mucus secretion at the cervix forming mucus plug
  • increase of lactic acid in vagina
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11
Q

What are the changes to the mothers breasts during pregnancy? (by oestrogen and progesterone)

A

oestrogen:
- increase in adipose tissue
- lactiferous duct system gets ready for breast feeding

progesterone:
-enlargment of breast lobules

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12
Q

What are the urological changes to the mother during pregnancy?

A
  • increase in renal blood flow (40%) –> more frequent urination
  • increased kidney size
  • ureter dialation (due to smooth muscle relaxing effects of progesterone)
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13
Q

main changes to gastro-inteastinal system for the mother during pregnancy?

A
  • increased intra abdominal pressure
    effects of increased progesterone:
    -oesophageal relaxation (reflux)
  • reduced bowel motility
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14
Q

How is a constant supply of thyroxin to the foetus ensured early in pregnancy and why is this important?

A
  • increase in oestrogeon levels means an increase in thyroid-binding globulin (TBG).
  • meaning more free T3 andT4 to bing to TBG which will increase the amount of thyroxin secreted by the anterior pituatry gland
  • (levels of free T3 and T4 stays the same but overall levels rise)
  • thyroxin is important for neuralation
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15
Q

How does the endocrine system help ensure there is a continuous supply of glucose to the foetus?

A
  • during pregnancy (mainly second trimester) there is an increase in anti- insullin hormones (human placental lactogen, prolactin and cortisol)
  • this increases insullin resistance in the mother and reduces peripheral uptake
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16
Q

During pregnancy the mother switches to a different energy source through lipolysis to provide substrate for maternal metabolism, what risk does this cause?

A
  • increased lipolysis means an increase in fatty acids in the blood plasma
  • breakdown of lipids can cause ketogenesis, meaning the mother is at a higher risk of ketoacidosis.
17
Q

what causes an increase in total blood volume during pregnancy?

A

Pregnancy results in the activation of the renin-angiotensin-aldosterone system, leading to an increase in sodium levels and water retention.

18
Q

what are the effects of an increase metabollic rate on the mother during pregnancy?

A
  • increased demand for oxygen causes :
  • increased tidal volume
  • increased minute ventillation rate
19
Q

describe the latent phase of the first stage of labour

A
  • stretching of cervix sends nerve impulses to the hypothalmus and posterior pituatry gland to release oxytocin
  • oxytocin stimulates uterus contractions
  • placenta produces prostaglandins which also stimulates uterine contractions
  • these contractions cause the cervix to stretch even more so the cycle continues (positive feedback loop)
20
Q

when does the active phase of the first stage start and what does it consist of?

A
  • once the cervix dilated to 3/4 cm active phase begins
  • cervix continues to dilate
  • contractions are regular and more painful
  • crowning at 10cm dilated
21
Q

What happens in the 2nd stage of labour?

A
  • cervix is fully dilated

- from crowning to when the baby is born

22
Q

what happens in the third stage of labour?

A
  • placental delivery
  • placenta is slowly detaching
  • uterus is still contracting
  • risk of haemorrhage
23
Q

what criteria means labour has begun?

A
  • regular painful contractions

- cervix effacment

24
Q

what does cervix effacement mean?

A
  • thinning and shortening
25
Q

what happens when the waters break?

A

-regular contractions causes an increase in uterus pressure which causes a rupture of the amniotic sac. (spontaneous rupture of membrane)

26
Q

What are 4 clinical methods to diagnose pregnancy?

A
  • home pregnancy tests
  • urine drip- hCG
  • ultra sound - yolk sac cane be seen by 4-5 weeks
  • pelvic examination- cervix changes colour and becomes softer
27
Q

what are the different labatory methods of diagnosing pregnancy?

A
  • blood tests
    -EPF = early pregnancy factor
    a protein detected in maternal serum shortly after conception
28
Q

explain example of invasive genetic screening

A

amniocentesis
- babies position is determined by ultra sound, skin is prepared with antiseptic and local anesthetic
- a hypodermic needle is used to withdraw amniotic fluid
- test for Chromosomal abnormalities e.g. Down’s,
Detects sex linked disorders

chorionic villi sampling

  • catheter used to suction tissue
  • can be peformed earlier than amnicentesis
29
Q

two examples of non invasive genetic screening

A

Maternal AFP test - AFPs are passed on to maternal circulation. 95% accurate. Detects neural tube defects.

Quad AFP plus - Looks for AFP and 3 other molecules. Permits screening for Down's Syndrome (trisomy 21)
Trisomy 18 (Edward’s syndrome)
Neural tube defects
30
Q

what is the milk ejection reflex?

A

Suckling of baby on nipple → Touch sensitive sensory neurons on nipple → Input to hypothalamus + Post Pit → Output: inc oxytocin in blood → Contraction of myoepithelial cells in mammary glands → milk ejection → Positive Feedback: milk availability encourages suckling, so touch sensations on nipple and oxytocin release continue.

medical sciences (11 decks)

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