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OBGYN > normal lady bits > Flashcards

normal lady bits Flashcards

1
Q

essential for the __ of eggs

A

production

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2
Q

__ uterus for pregnancy

A

prepares

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3
Q

cycle begins with the first day of __

A

menstrual bleeding

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4
Q

length of cycle determined by __

A

preovulatory phase

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5
Q

the __ layer of the endometrium is shed during menstruation.

A

functional

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6
Q

ovaries contain approx __ primordial follicles

A

200k

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7
Q

when cells in the lining of the ruptured dominant follicle multiple

A

luteinization = corpus luteum

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8
Q

name of the first menstruation

A

menarche

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9
Q

time before onset of menses

A

premenarche

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10
Q

time when secondary sex characteristics appear

A

puberty

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11
Q

time beginning shortly before cessation of menstruation and lasting until 1 y after final period

A

perimenopause

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12
Q

begins 1 y following cessation of menstruations

A

menopause

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13
Q

< 21 d cycle

A

polymenorrhea

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14
Q

oligomenorrhea

A

> 35 d cycle

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15
Q

purpose of the ovarian cycle

A

to provide an ovum for fertilization

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16
Q

describe the ovarian cycle in 5 steps

A
  1. primordial follicles develop
  2. dominant follicle emerges
  3. ovulation occurs (egg released from dominant follicle)
  4. dominant follicle collapses into CL
  5. CL degenerates into corpus albicans
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17
Q

what are the 3 phases of the ovarian cycle

A
  1. follicular (1-13)
  2. ovulatory (14)
  3. luteal (15-28)
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18
Q

what is the purpose of the endometrial cycle

A

provide implantation site for fertilized ovum

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19
Q

describe the endometrial cycle in 4 steps

A
  1. cycle begins on first day of bleeding
  2. functional layer regrows
  3. spiral arteries and uterine glands enlarge (great for implantation time)
  4. spiral arteries constrict, endo shrinks (ischemia)
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20
Q

what are the 4 phases of the endometrial cycle

A
  1. menstrual (1-5)
  2. proliferative (6-14)
  3. secretory (15-26)
  4. premenstrual (27-28)
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21
Q

cyclical changes to the endo are controlled by __

A

ovaries

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22
Q

what causes the endometrium to grow to it’s maximal thickness and secrete mucous

A

presence of corpus luteum

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23
Q

what happens to the endo with the degeneration of the corpus luteum

A

endometrial ischemia

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24
Q

what is the purpose of the hormonal cycle

A

initiate and control the menstrual cycle

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25
Q

which hormones control the endometrium

A

estrogen and progesterone

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26
Q

describe the hormonal cycle in 3 steps

A
  1. developing follicles produce estrogen; thus functional endo regrows
  2. CL produces progesterone and estrogen; thus endo thickens
  3. corpus albicans does not produce hormones; thus endo ischemia and resultant shedding
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27
Q

what hormones control the ovaries

A

follicle stimulating hormone (FSH) and luteinizing hormone (LH)

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28
Q

where in the brain does the endocrine system produce the hormones that control the ovaries

A

anterior pituitary gland

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29
Q

describe the hormonal cycle in reference to LH and FSH

A
  1. increase in FSH causes follicles to develop
  2. surge in LH (and FSH) causes ovulation
  3. more LH leads to collapse of dominant follicle and formation of CL
  4. anterior pituitary gland stops producing LH and FSH so CL degenerates into corpus albicans
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30
Q

what would be the 3 ovulatory phases aligned to pituitary involvement

A
  1. FSH = preovulatory
  2. LH+FSH surge = ovulation
  3. LH = post ovulation
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31
Q

what hormones control the anterior pituitary gland?

A

GnRH, estrogen, progesterone

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32
Q

what does GnRH stand for

A

gonadotropin releasing hormone

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33
Q

where does GnRH come from

A

hypothalamus

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34
Q

does the pituitary gland control the ovaries

A

no. the estrogen and progesterone produced by the ovaries inhibits the pituitary from producing LH and FSH

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35
Q

what hormone stimulates the anterior pituitary gland

A

GnRH

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36
Q

what hormone inhibits the anterior pituitary gland

A

estrogen and progesterone

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37
Q

what inhibits the hypothalamus

A

ovaries - est and prog inhibit GnRH

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38
Q

what simulates GnRH production

A

peak levels of est only

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39
Q

what hormone forms and maintains the CL

A

LH

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40
Q

what would the follicle look like if ovary is sending out rising levels of est and prog

A

CL

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41
Q

low levels of est and prog allow for the __ of GnRH

A

production

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42
Q

which ovarian structure produces mostly progesterone

A

CL

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43
Q

which ovarian structure produces mostly estrogen

A

dominant follicle

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44
Q

what happens in the anterior pituitary gland when there are peak levels of estrogen

A

simulates GnRH causing a surge in FSH and LH

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45
Q

which hormones temporarily decrease after ovulation

A

estrogen and progesterone

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46
Q

postovulatory, residual LH maintains which ovarian structure

A

CL

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47
Q

why does CL degenerate

A

insufficient LH because increase in est and prog

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48
Q

menstrual cycle days 1-5 also called

A

follicular phase
menstrual phase

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49
Q

what will endo look like in early menstrual phase

A

thin, +/- debris
hyperechoic endo around cavity

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50
Q

what will endo look like in late menstrual phase

A

thin, hyperechoic line surrounded by hypoechoic inner myometrium
‘endometrial stripe’

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51
Q

menstrual cycle days 6-13 also called

A

follicular
proliferative

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52
Q

what days are early preovulatory

A

6-9

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53
Q

what days are late preovulatory

A

10-13

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54
Q

what does endo look like in early preovulatory phase

A

= proliferative
thin endo, no debris

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55
Q

average size of follicles in early preovulatory phase

A

5-10mm

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56
Q

average size of follicles in late preovulatory phase

A

20-25mm

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57
Q

what does the endo look like in late preovulatory phase

A

= late proliferative phase
‘3 line sign’

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58
Q

describe the ‘mid cycle stripe’

A

= 3 line sign

basal (hyper)
functional (hypo)
uterine cavity (hyper)
functional (hypo)
basal (hyper)

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59
Q

how to you measure the 3 line sign

A

through the whole thing (not the little stripe of uterine cavity)

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60
Q

what is a cumulus oophorus

A

follicular cells surrounding the ovum within the dominant follicle (looking like a daughter cyst)

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61
Q

menstrual cycle day 14 also called

A

proliferative (endo)

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62
Q

what does endo look like during proliferative phase at day 14

A

likely 3 line sign

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63
Q

what will the follicle look like in day 14

A

likely corpus hemorrhagicum (toward CL)

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64
Q

menstrual cycle days 15-26 also called

A

postovulatory
luteal (ovarian)
secretory (endo)

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65
Q

is fluid in the PCDS proof of ovulation

A

NO
but it is a sign

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66
Q

what day of the cycle is the endo at its thickest

A

21

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67
Q

when is the endo at it’s most hyperechoic

A

when its thickest - day 21
- may even show enhancement

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68
Q

menstrual cycle days 27-28 also called

A

premenstrual phase
ischemic phase
luteal (ovarian)
premenstrual (endometrial)

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69
Q

which hormone from the anterior pituitary gland will increase during the premenstrual/ischemic phase

A

FSH
no inhibition from est or prog

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70
Q

during what phase of the menstrual cycle are the basal and functional layers of the endo isoechoic to one another

A

postovulatory/ secretory phase

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71
Q

during what phase of the menstrual cycle is the basal layer hyperechoic to the functional layer

A

proliferative/ late preovulatory
mid cycle stripe/ 3 line sign

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72
Q

clinical sign of ovulation - rise in __

A

basal body temperature

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73
Q

clinical sign of ovulation - increased quantity and viscosity of __

A

cervical mucous

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74
Q

what hormone causes a rise in basal body temperature

A

progesterone

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75
Q

name for the pain associated with ovulation

A

Mittelschmerz

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76
Q

what causes withdrawal spotting

A

drop in estrogen at ovulation

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77
Q

is conception synonymous with implantation

A

no

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78
Q

__ takes place within 24 hours of ovulation

A

conception

fertilized ovum develops into a blastocyst

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79
Q

when does implantation occur

A

6 days after fertilization

day 20 of a 28 day cycle

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80
Q

what maintains the CL after implantation

A

a hormone released by the blastocyst

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81
Q

detectable sonographic findings of pregnancy expected after __ weeks GA

A

4.5-5 w

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82
Q

hormonal contraception can prevent pregnancy by preventing __ and altering __

A

preventing ovulation and altering endometrium

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83
Q

sonographic signs of hormonal contraception

A

absence of developing follicles, dominant, or CL

consistently thin endo

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84
Q

flow resistance __ in an active ovary

A

decreases
(more blood supply)

usually low resistance, high velocity

85
Q

flow resistance __ in inactive ovaries

A

remains relatively constant

86
Q

name of premature puberty and menarche before 9y

A

precocious puberty

87
Q

name of delayed menarche (never starts)

A

primary amenorrhea

88
Q

cessation of menses for >/= 6mo

A

secondary amenorrhea

89
Q

name for absence of menstruation during pregnancy, lactation and after menopause

A

physiologic amenorrhea

90
Q

name for more frequent cycles (<21d intervals

A

polymenorrhea

91
Q

name for less frequent cycles (>35d)

A

oligomenorrhea

92
Q

name for menses with less blood or shorter periods

A

hypomenorrhea

93
Q

more blood but normal duration of period

A

hypermenorrhea
menorrhagia

94
Q

longer periods OR bleeding between periods

A

metrorrhagia

95
Q

more blood AND longer periods / bleeding between periods

A

menometrorrhagia

(combo of menorrhagia and metrorrhagia)

96
Q

painful periods

A

dysmenorrhea

97
Q

name for painful periods with no underlying detectable pelvic pathology to explain why

A

primary dysmenorrhea

98
Q

painful periods with clinically detectable reason why (ie pelvic lesion)

A

secondary dysmenorrhea

99
Q

G

A

gravidity
no. of pregnancies a pt has had

100
Q

P

A

parity
no of pregnancies that have reached viability

101
Q

does a stillbirth count toward P

A

yes if it reached viabilityd

102
Q

do twins count as 1 or 2 points toward parity if reached viability

A

only 1

103
Q

how many weeks constitutes a viable pregnancy

A

> 20-24w GA
500g

104
Q

what would be the reproductive hx of a pt that is currently pregnant, had an ectopic, had a miscarriage at 17w, and had a twin pregnancy born via csec

A

G4P1

105
Q

what is T in GTPAL

A

term deliveries
>37w

counts living or stillborn

106
Q

what is P in GTPAL

A

preterm deliveries
20-37w

counts living or stillborn

107
Q

what is L in GTPAL

A

live births

108
Q

where do you comment on current pregnancy with GTPAL

A

you do not

109
Q

what is hCG

A

human chorionic gonadotropin

110
Q

where does hCG come from

A

trophoblastic cells (future placenta) in the blastocyst after implantation

111
Q

urine pregnancy tests detect __ of hCG

A

presence

112
Q

blood pregnancy tests detect __ of hCG

A

amount

113
Q

which type of pregnancy test is qualitative

A

urine test

114
Q

how early can a urine test prove pregnancy

A

10 days after fertilization (day 24 LMP)

115
Q

how early can a blood test prove pregnancy

A

5-6 days after fertilization (day 19-20 LMP)

116
Q

what will you expect to see EVS with beta hCG of 2500

A

a GS, maybe embryo

117
Q

what is the threshold for seeing a GS EVS

A

betas of 1700 mIU/mL or higher

118
Q

what is dyspareunia

A

painful intercourse

119
Q

what is a common cause of dyspareunia

A

endometrial implants in rectovaginal septum and posterior fornix

120
Q

name of procedure for removal of myoma

A

myomectomy
*for preservation of fertility

121
Q

name of plastic/reconstruction sx of ut

A

metroplasty
aka ureteroplasty
hysteroplasty

122
Q

sx removal of ectopic pregnancy through incision into fallopian tube

A

salpingostomy

123
Q

sx for incompetent cx

A

cervical cerclage

124
Q

why do we care if a pt taken tamoxifen

A

endometrial hyperplasia ++ risk of cancer from overstimulation of ut

125
Q

?complication in ovaries if pt use of infertility rx

A

ovarian hyperstimulation syndrome

126
Q

name of aspiration of pelvic fluid

A

culdocentesis
*through post fornix of vagina

127
Q

name of visual inspection of epithelium of cx for pt with abnormal pap smears

A

colposcopy (special microscope)

128
Q

what does D&C stand for

A

dilatation and curettage

129
Q

what layer is removed with D&C

A

functional endo

130
Q

what does CT stand for

A

computerized axial tomography
*combines series of xrays to form 360^ view

131
Q

most common cause of missing IUCD string

A

retraction into ut

132
Q

what are the 2 main types of IUCDs

A
  1. copper
  2. plastic hormonal
133
Q
A
134
Q

2 main functions of copper IUCDs

A

inhibit fertilization (shitty habitat)
inhibit implantation (irritates endo + Cu is ovicidal/spermicidal)

135
Q

how does hormonal IUCD inhibit fertilization

A

++cervical mucous, too thick for sperm to enter

may prevent ovulation with ++prog

136
Q

what is the failure rate of a chinese ring IUCD

A

10%

137
Q

main disadvantage of copper & hormonal IUCDs

A

hypermenorrhea

*additional risk of PID, ectopic, etc

138
Q

how far from ut cavity should top of IUCD rest

A

</= 3 mm

139
Q

copper IUCDs produce a __ amplitude echo

A

high

140
Q

when is most common time for an IUCD perforation

A

during insertion

141
Q

risk factors for perforation of IUCD

A

placement <6m post partum

lactating

abnormal ut

shitty MD

142
Q

what happens if you cant find an IUCD on u/s and pt is adamant it should be there

A

send for xray to r/o complete perforation and ectopic location

143
Q

PROM is __x higher risk if leaving in IUCD when it has failed

A

4x

144
Q

what is the chance of miscarriage if leaving IUCD in after failure

A

25-50%

145
Q

septic shock is __x higher risk if leaving IUCD in place after failure

A

26x

146
Q

3 types of permanent birth control measures for women

A

tubal ligation

essure

adiana

147
Q

is tubal ligation reverible

A

that’s debatable

148
Q

can you see tubal ligation with u/s

A

noo

149
Q

wtf is an essure

A

metal coil inserted through vagina into both fallopian tubes at cornu

scar tissue forms, blocking tubes within 3mo

150
Q

can you see essures with u/s

A

YES

151
Q

what does a pessary look like sonographically

A

hyperechoic ring with shadowing

152
Q

all embryos begin with __ ducts

A

4

153
Q

mullerian ducts aka

A

paramesonephric

154
Q

wolffian ducts aka

A

mesonephric

155
Q

what happens to the pair of ducts that do not develop (embryology)

A

remnants regress, but remain

156
Q

what determines which ducts develop

A

testosterone and MIF

157
Q

what is MIF

A

mullerian-inhibiting factor

158
Q

where does testosterone and MIF come from

A

fetal testes

159
Q

what GA does gender differentiation occur

A

8-18w GA

160
Q

mullerian ducts form __ of female repro sys

A

upper vagina
ut
fallopian tubes

161
Q

fallopian tubes are formed from unfused __ of mullerian ducts

A

cranial ends

162
Q

which female repro sys components have separate embryological origins

A

ovaries and lower vagina

163
Q

vaginal plate aka

A

sinus tubercle

164
Q

mullerian ducts pull together peritoneal folds to form __

A

broad ligament

PCDS

ACDS

165
Q

lower vagina formed from __

A

urogenital sinus

166
Q

ovaries develop from __

A

urogenital ridge

on the mesonephros (primitive kd)

167
Q

the wolffian duct becomes __

A

ureters

168
Q

mullerian anomalies are associated with __

A

kidney anomalies

169
Q

before the wolffian duct can degenerate, __ must arise

A

the ureteric bud
*required for kd development

170
Q

the bladder is formed from the __

A

urogenital sinus

171
Q

the ureter is formed from the __

A

distal wolffian duct

172
Q

in the ovaries (embryonically) the eggs migrate from the __

A

yolk sac

173
Q

remnants of wolffian ducts in female embryos can be found along the __

A

broad ligaments and vaginal walls

174
Q

remnants of wolffian ducts on vaginal wall aka

A

gartner duct cysts

175
Q

remnants of wolffian duct on broad ligament aka

A

cyst of morgagni (hydatid)

176
Q

external genetalia fully developed by __ GA

A

14w GA

177
Q

what is a genital tubercle

A

elevated area between coccyx and umb cord present in ALL embryos prior to 10w GA

178
Q

what are the 3 phases of mullerian duct deelopment

A
  1. organogenesis
  2. fusion
  3. septal resorption
179
Q

a normal hymen is made up of __ tissue

A

fibroelastic membranous tissue

180
Q

premenopause aka

A

perimenopause

begins shortly before menopause and lasts until 1 year following the final menstruation

181
Q

menopause is followed immediately by __

A

postmenopause

182
Q

term for vaginal inflammation caused by low levels of estrogen (thinning of tissues, decreased lubrication)

A

atrophic vaginalis

183
Q

physiological changes with menopause includes the cessation of __

A

menstrual periods
folliculogenesis
ovulation
estrogen production

184
Q

what is the fundus-cervix ratio of an adult uterus

A

2:1

185
Q

what is the fundus-cervix ratio of a postmenopausal ut

A

1.5:1

186
Q

what is the fundus-cervix ratio of a prepubertal uterus

A

1:1

187
Q

calcification in outer myometrium of the arcuate arteries often present in post menopausal patients

A

Monckeberg’s atherosclerosis

aka medial calcific sclerosis

188
Q

Monckeberg’s atherosclerosis affects the __ of the arcuate arteries

A

media

vessel lumen is not narrowed

189
Q

sonographic features of postmenopausal ovaries

A

small
hypoechoic
might still see small follicles

190
Q

uterine Doppler resistance __ the longer a pt has been postmenopausal

A

increases

191
Q

what is expected to happen to the diastolic flow in an ovary >10 years post menopausal

A

absence of diastolic flow (very high resistance)

192
Q

what resistance is expected in an active ovary

A

low resistance

193
Q

what hormonal changes are associated with perimenopause

A

FSH and LH overproduction due to low levels of estrogen (lack of negative feedback)

194
Q

insomnia and night sweats are common symptoms of

A

perimenopause

195
Q

endo cancer increases with what kind of HRT

A

unopposed estrogen

*similar to Tamoxifen effect

196
Q

advantages of HRT

A

reduces symptoms

decreases risk of osteoporosis and coronary artery disease in younger patients

197
Q

disadvantages of HRT

A

transient effects (mood swings, bloating)

endo hyperplasia and cancer if unopposed

thromboembolism

198
Q

blood within the endo cavity is called

A

hematometra

199
Q

pus within the endo cavity is called

A

pyometra

200
Q

large volumes of endo fluid are associated with __

A

cervical stenosis

201
Q

hydrometra is usually associated with __

A

nothing significant

202
Q

in utero, maternal hormonal stimulation causes __ in the fetus

A

temporary uterine enlargement

may cause follicle development as well

203
Q

normal fundus-cervix ratio of neonate

A

1:2

204
Q

typical uterine length of a neonate

A

3.5cm

205
Q

canal connecting bladder of fetus to umbilical cord

A

urachus

206
Q

lumen of urachus is normally obliterated during fetal development, becoming the __

A

median umbilical ligament

207
Q

patent urachus results in __

A

leakage of urine from umbilicus

208
Q

urachus develops from the embryonic __

A

allantois

209
Q

adult urachal remnant called the __

A

median umbilical ligament

OBGYN (8 decks)

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