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Dr. Omar's Deck of Secret Knowledge > OB Basics > Flashcards

OB Basics Flashcards

1
Q

Adult Derivatives of the Urogenital Sinus, Female

A

Lower 3/4 of the vagina
Vestibule (including vestibular glands)
Bladder
Urethra (including urethral and paraurethral glands)

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2
Q

Adult Derivatives of the Urogenital Sinus, Male

A

Bladder
Urethra
Prostate
Bulbourethral glands

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3
Q

Scrotal ligament (male) : _________ (female)

A

Gubernaculum testis

Female: Round ligament of the uterus

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4
Q

Timeline for the hormones of sexual differentiation

A

7th week: SRY gene activated -> TDF
8th week: MIH and Testosterone
9th-12th week: DHT secretion begins

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5
Q 
Male Development:
Primary sex cords:
Rete testes + mesonephric remnants:
Mesenchymal thickening:
Mesothelial cells:
A

Primary sex cords: Testis cords (middle) + rete testis (end)
Rete testes + mesonephric remnants: Efferent ductules
Mesenchymal thickening: Tunica albuginea
Mesothelial cells: Sertoli and Leydig Cells

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6
Q

Disorders of Sex Development:

Primordial germs cells do not form/migratePatient is female

A

Gonadal agenesis

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7
Q

Disorders of Sex Development:

One testis, one ovary, external genitalia of both sexes

A

True hermaphroditism

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8
Q

Disorders of Sex Development:
46XY
Ambiguous external genitalia until puberty
Deficiency of DHT

A

5a-reductase type 2 deficiency

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9
Q

Adult Derivatives of the Mesonephric Ducts, Male

A 
SEED
Seminal vesicles
Epipdydymis
Ejaculatory Duct
Ductus Deferens
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10
Q

Adult Derivatives of the Mesonephric Ducts, Female

A

Appendix of vesiculosis

Gartner’s Duct

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12
Q

Adult Derivatives of the Paramesonephric Ducts, Female

A 
FUUH
Fallopian tubes
Uterus and Cervix
Upper 1/4 of vagina
Hydatid of Morgagni
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13
Q

Congenital Malformations

Diagnosis of Cryptorchidism is made after how many months of undescended testis

A

3-6 months

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14
Q

Congenital Malformations
Most common penile anomaly
Pathogenesis?

A

Hypospadias

Failure of the closure of the urogenital sinus

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15
Q

OOgonia
What phase from before birth until puberty?
Until ovulation?
At fertilization?

A

Meiosis 1 prophase
Meiosis 2 metaphase with formation of 1st polar body
Completion of Meiotic division with formation of 2nd polar body

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16
Q

Female Pelvic Ligaments

Suspensory ovarian ligaments

A

Connects ovary to lateral wall

Contains ovarian vessels

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17
Q

Female Pelvic Ligaments

Ovarian round ligament

A

Ovary to uterus

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18
Q

Female Pelvic Ligaments

Broad ligament

A

Uterus, fallopian tubes, and ovaries to lateral pelvic wall

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19
Q

Female Pelvic Ligaments

Cardinal ligament of Mackenrodt

A

Connects cervix to lateral pelvic wall

Major support to uterus and cervix

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20
Q

Female Pelvic Ligaments

Uterine round ligament

A

Uterus to labia majora via the inguinal canal
Contains the artery of Sampson
Maintains anteversion during pregnancy

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21
Q

Congenital Malformations

Mayer-Rokitansky-Kuster-Hauser Syndrome

A

Mullerian agenesis
2nd most common cause of primary amenorrhea
Tx: Mackendow procedure

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22
Q

Congenital Malformations

Uterus Didelphys

A

2 hemiuterus, 2 cervix

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23
Q

Congenital Malformations

Most common Mullerian duct abnormality

A

Septate uterus

Most common cause of 2nd trimester abortion

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24
Q

Female Anatomy:

Define vulva

A

All structures visible externally from the pubis to the perineal body

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25
Q

Female Anatomy:

What are the contents of the vestibule?

A

HymenVaginal openingUrethral openingPeriurethral glands (Skenes glands)Vulvovaginal glands (Bartholin glands)

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26
Q

Female Anatomy:

Differentiate labia majora and minora

A

Majora: KSSE (outer), NKSSE (inner) (+) hair follicles, sweat glands, Montgomery glands
Minora: NKSSE, (-) hair follicles, sweat glands

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27
Q

Pathology of the Skenes glands (particularly if menopausal)

A

Urethral diverticulum
Sx: recurrent UTI
Tx: Treat UTI and resect

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28
Q

Pathology of the Bartholins glands

A

Bartholin’s cyst / Abscess

Tx: marsupialization

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29
Q

Female Anatomy:

Area of paucity in the vagina

A

Upper & middle third

Area where tampons can be forgotten

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30
Q

Female Anatomy:

Vaginal length

A

Ant: 6-8 cm

Post 7-10 cm

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31
Q

Female Anatomy:

Blood supply of the Vagina?

A

Upper: Cervico-vaginal branch of the uterine art
Middle: Inferior vesical arteries
Lower: Middle rectal & Int. Pudendal art

Venous drainage: Vaginal plexus drains into int. iliac vein.

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32
Q

Fallopian Tube:

What are the 4 segments?

A

Intramural: within uterus muscular wall
Isthmus: narrowest portion
Ampulla: widest and most tortous
Infundibulum: (+) fimbriae

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33
Q

Adult Derivatives of the Paramesonephric Ducts, Male

A

Appendix of the testes

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34
Q

Ectopic pregnancy rates within the Fallopian tubes

A

80% ampulla
12% isthmus
~5% intramural
~1-2% interstitial

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35
Q

Ovary: Attaches the ovary to the broad ligament

A

Mesovarium

Note: the ovary is not covered by peritoneum

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36
Q

Ovary: Layers of the ovary

A

Cortex:
Germinal Epithelium of Waldeyer / Surface epithelium
Tunica albuginea
Primordial and Graafian follicles

Medulla:
Loose connective tissue
Smooth muscles
Stroma and blood vessels
Few to No follicles
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37
Q

Nerve injuries during obstetric procedures

Radical hysterectomy

A

Genitofemoral nerve & obturator nerve

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38
Q

Nerve injuries during obstetric procedures

Improper dorsal lithotomy position

A

Peroneal nerve

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39
Q

Fallopian tube:Longest fimbriae

A

Fimbria ovarica

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40
Q

Nerve injuries during obstetric procedures

Inguinal node dissection

A

Femoral nerve

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41
Q

Complication during node dissection of the obturator fossa

A

Ext. iliac artery

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42
Q

Bony Pelvis:

Boundaries

A

Superior: pelvic inletInferior: pelvic outletAnt: Pubic bones, ascending rami, obturator foraminaLat: ischial bones and sacrosciatic notch

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43
Q

Complication due to straddle / anesthesia for the second stage of labor

A

Pudendal artery damage

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44
Q 
Diameters of the Pelvic Inlet
Transverse:
Oblique:
Post Sagittal:
AP:
A 
Transverse: 13 cm
Oblique: 13 cm
Post. Sagittal: 4 cm
True conjugate: 11 cm
Obstetrical conjugate: 10 cm
Diagonal conjugate: >11.5 cm - only one measured clinically.
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45
Q

Signs of a contracted midpelvis

A

Prominent ischial spine
Convergent sidewalls
Shallow sacrum
Narrow sacroiliac notch

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46
Q

Laxity of the pelvic joints

A

Due to hormonal changes during pregnancyEsp. affects the symphysis pubisIncreases mobility of sacroiliac joint

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47
Q

How is the midpelvis measured? Pelvic outlet?

A

Midpelvis: at the level of the ischial spines
Outlet: intertuberous diameter

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48
Q

Ischial spines as a landmark:

A

1) Plane of least pelvic dimensions
2) Levator ani muscle at this level
3) Engagement at this level
4) IR of head when occiput
5) Mid forceps, low if beyond this
6) Pudendal nerve block
7) Normal external cervical os
8) Location for ring pessary for pelvic organ prolapse

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49
Q

Pelvis types:

Most to least common type

A

Gynecoid
Anthropoid
Android
Platypelloid

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50
Q

Pelvis type:

Prone to Deep transverse arrest

A

Android (with worst prognosis)

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51
Q

Pelvis type:

Prone to face delivery

A

Anthropoid

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52
Q

Pelvis type:

Poor prognosis for vaginal delivery

A

Android

Platypelloid

53
Q

Pelvis typesMost to least common type

A

Gynecoid
Anthropoid
Android
Platypelloid

54
Q

Pelvis type:Prone to face delivery

A

Anthropoid

55
Q

Follicular Phase Goal

A

Restore endometrium, prepare for pregnancy

56
Q

Follicular Phase

Theca Cell

A

LH stimulation
Desmolase active (cholesterol to pregnenolone)
Androgens produced

57
Q

Follicular Phase

Granulosa Cell

A

FSH stimulation

Converts androgens to estrogen

58
Q

Follicular Phase

Estrogen

A

Inhibits FSH and LH release
Increases Granulosa cell sensitivity to FSH
Initiate release of inhibin - allowing only 1 secondary follicle to develop

Uterine cells to increase rate of mitotic division
Cervical mucous : ferning (7th-18th day crystal arborization)

59
Q

LH Surge

A

Triggers ovulation and follicular rupture in 12-24 hours
Cumulus-oocyte complex
Luteinization of Granulosa Cells
Resumption of oocyte maturation

60
Q

Ovulation

A

~Day 14 of the cycle

Spinnbarkeit formation

61
Q

What is Spinnbarkeit?

A

Egg white cervical mucous, stretches 6cm.

62
Q

Post-Ovulatory Phase
Corpus Luteum?
Corpus Hemorrhagicum?

A

Luteum: granulosa + theca cells
Hemorrhagicum: mittelschmerz

63
Q

Post-Ovulatory Phase

Progesterone

A

**Table in First Aid

64
Q

Menstruation:

Most striking and constant event:

A

Period of vasoconstriction preceding menstruation.

65
Q

Menstruation:

By what day has the endometrium been restored?

A

5th.

66
Q

Urine Metabolites during the Menstrual cycle

A

Early follicular: low pro, inc est
Late follicular: low pro, rapid inc est
Luteal phase / pregnancy: progesterone

67
Q

Preovulatory or Postovulatory?

Constant (14 days)

A

Postovulatory

68
Q

Preovulatory or Postovulatory?

Low basal temp

A

Preovulatory

69
Q

Preovulatory or Postovulatory?

Thin and watery cervical mucous

A

Preovulatory

70
Q

Preovulatory or Postovulatory?

Dominant hormone: estrogen

A

Preovulatory

71
Q

Endometrium of pregnancy?

What are its layers?

A

Decidua Basalis, Capsularis, Parietalis

Later, the capsularis and parietalis fuse to become the Decidua vera

72
Q

Decidua Basalis

A

Implantation site

73
Q

Decidua capsularis

A

Overlies the enlarging blastocyst

More prominent during the 2nd month of pregnancy, eventually fuses with parietalis

74
Q

Decidua parietalis

A

Remainder of the uterus

75
Q

Key event in fertilization allowing the sperm to penetrate the zona pellucida

A

Acrosome reaction

76
Q

Cycle day: 22-24

A

Predecidual reaction (ready for zygote implantation)

77
Q

Earliest histologic sign of progesterone action

A

Basal vacuolation

78
Q

Postconception: Week 1

A

Cleavage
Blastocyst
Implantation

79
Q

Postconception: Week 2

A

Embryoblast differentiated

Trophoblast differentiated

80
Q

Differences between syncytiotrophoblast and cytotrophoblast?

A

Cytotrophoblast: divides mitotically
Syncytiotrophoblast: produces HCG

81
Q

Postconception: Weeks 3-8

A

Gastrulation

Period of high susceptibility to teratogens

82
Q

Formation of Organs/Limbs

A

CNS: first to develop, continues postnatally
Heart: completed by 8 weeks
Upper limb: completed by 8 weeks
Lower limb: completed by 8 weeks
Ext. Genitalia: differentiated by 12 weeks

83
Q

Amniotic fluid, by the numbers

A

12 weeks: 60 mL
34-36 weeks: 1 L
Term: 840 mL
42 weeks: 540 mL

84
Q

Production and Regulation of Amniotic fluid

A

Production: amniotic epithelium, fetal kidneys
Regulation: fetal swallowing, fetal aspiration, exchange between skin and fetal membranes

85
Q

Placenta at Term, by the numbers

A

450-500g

15-20 irregularly shaped and sized cotyledons

86
Q

Fetal Development:

Embryonic period

A

3rd week after ovulation until 8th week AOG

87
Q

Fetal Development:

Abortus

A

20 weeks or less

Birth weight < 500g

88
Q

Fetal Development:

Week 12

A

Uterus becomes an abdominal organ

(+) breathing movements

89
Q

Fetal Development:

Week 14

A

Gender can be identified by experienced examiners

90
Q

Fetal Development:

Week 16

A

(+) quickening

91
Q

Fetal Development:

Week 20

A

(+) vernix caseosa

Lanugo covers the whole body

92
Q

Fetal Development:

Week 28

A

Starts eye opening

90% chance of survival

93
Q

Fetal Development:

Week 32

A

Testis descend

94
Q

Fetal Development:

Week 34

A

Mature hair appears

95
Q

Fetal Development:

Week 36

A

More rotund body, (+) fat deposition

96
Q

Fetal Development:

Week 40

A

Testes in inguinal canal / scrotum

97
Q

Determining Fetal Age by UTZ

A

1st trim: CRL
2nd trim: BPD / FL
3rd trim: BPD

98
Q

Head Circumference
Smallest?
Greatest?

A

Smallest: sub-occipitobregmatic (32 cm)
Greatest: Occipitofrontal (34.5 cm)

99
Q

Head Diameters

Greatest transverse

A

Bitemporal (8.0 cm)
BPD (9.5 cm) - greatest transverse
Occipitomental (12.5 cm)

100
Q

Fetal circulatory shunts

A

Ductus venosus -> ligamentum venosum
Foramen ovale -> closes
Ductus arteriosus -> fxn closed 10-12 hours post birth, anat closed 2-3 weeks

101
Q

Fetal Hematopoeisis

A

Embryonic period: yolk sac
2nd trim: Liver & spleen = Hemoglobin F
3rd trim: Bone marrow (starts at 4months AOG) persists until adulthood.

102
Q

Test for fetomaternal hemorrhage

A

Kleihauer-Betke Test

Fetal RBCs are resistant to denaturing effects of alkali - adult RBCs become ghosts.

103
Q

Surfactant

A

Produced by type 2 pneumoncytes

As early as 28 weeks but a sufficient amount is present only at 34-36 weeks.

104
Q

When does alveolar development complete?

A

8 years of age

105
Q

Hormones of Pregnancy:

HCG

A

Produced by syncytiotrophoblast
Plasma within 7-9 days of fertilization
Doubles every 1.4-2 days, max level around 8-10 weeks
Nadir at 18-20 weeks

106
Q

Hormone of pregnancy that:
Rescues the corpus luteum
promotes male sexual differentiation
Promotes secretion of relaxin (vascular vasodilation and myometrial smooth muscle relaxation)

A

HCG

107
Q

Hormone of pregnancy that:
Prolactin and growth hormone like activity
Diabetogenic

A

HPL / Chorionic somatomammotropin

108
Q

Hormone of pregnancy that:
Ensures uterine quiesence during pregnancy
Inhibits T-lymphocyte mediated tissue rejection

A

Progesterone

109
Q

Hormone of pregnancy that:

Is produced from the fetal adrenals

A

DHEAS - processed into estriol

110
Q

Hormone of pregnancy that:

Dominates during week 1- week 6 of gestation

A

Estradiol

111
Q

Maternal Adaptation to Pregnancy

Softening of and compressibility of the isthmus occurring in the 6th-8th week AOG.

A

Hegar’s sign

112
Q

Maternal Adaptation to Pregnancy

Softening of the cervix from 6th-8th week AOG

A

Goodell’s sign

113
Q

Maternal Adaptation to Pregnancy

Edema and engorgement of vasculature: bluish discoloration at 6 weeks AOG

A

Chadwick’s sign

114
Q

Maternal Adaptation to Pregnancy

Changes in Skin

A

MSH: linea nigra, chloasma
Hyperestrogenemia: spider nevi
Corticosteroids: striae

115
Q

Maternal Adaptation to Pregnancy

Cardiac Changes

A

HR: Inc 10bpm
Volume: Inc 40-45%
CO: significant increase 30-40% (if patient is supine, decreased by 20%)
BP: no change in systolic, decreased diastolic
Heart displaced upwards and to the left

116
Q

Maternal Adaptation to Pregnancy

Genito-urinary changes

A

Urinary stasis due to increased peristalsis
Asymptomatic bacteruria
Nocturia

117
Q

Maternal Adaptation to Pregnancy

Renal changes

A

Kidneys hypertrophy
GFR inc by 50%
Inc: GRF, RPF, Crea Cl.
Dec. BUN, Crea, Uric acid

118
Q

Maternal Adaptation to Pregnancy

Physiologic Hydroureter

A

Estrogen: hypertrophy and muscle elongation
Progesterone: atony
Right > Left

119
Q

Maternal Adaptation to Pregnancy

GI Changes

A

Appendix displaced upward and viscerally
Dec: GIT motility, LES tone, CCK (gallbladder stasis)
Inc: Water absorption
Inhibited intraductal transmission of bile acid = Pruritus gravidarum, Intrahepatic cholestasis

120
Q

Maternal Adaptation to Pregnancy

Hematologic

A

Hemoglobin: 12.5, Anemia: 11
Hematocrit: decreased
Decreased platelet count

Slightly hypercoagulable
All coag factors increased except 11 and 13

121
Q

Maternal Adaptation to Pregnancy

Endocrine

A

Pituitary gland enlarges 135% (-) increase in blood supply
Adrenal hyperplasia,
Inc: cortisol (most bound to transcortin), aldosterone, deoxycorticosterone, testosterone
Thyroid: increased production (40-100%), but still euthyroid
Parathyroid: PTH: Decrease 1st trim, increase during the rest; Calcitonin: increased
Ovaries at rest

122
Q

Maternal Adaptation to Pregnancy

Pulmo

A

RR unchanged
Inc: TV and resting minute ventilation
Dec: FRC and RV (Diaphragm elevates ~4cm during pregnancy)

123
Q

Maternal Adaptation to Pregnancy

Weight gain

A 
12.5kg or 27.5lbs
BMR inc 10-20%
"convention"
1st trim: 2lbs
2nd: 11lbs
3rd: 11 lbs
124
Q

Maternal Adaptation to Pregnancy

Immunologic

A 
Suppressed T helper Cells (Th4)
Increased Th8
PMN leukocyte chemotaxis decreased
Increased leukocytes
Increase in cervical IgA and IgG
125
Q

Maternal Adaptation to Pregnancy

Eyes

A

Decreased IOP

Corneal sensitivity

126
Q

Maternal Adaptation to Pregnancy

CNS

A

Attention, concentration and memory problems

127
Q

Maternal Adaptation to Pregnancy

Skeletal

A

Progressive lordosis

Increased pelvic joint mobility

128
Q

FDA Classification of Drugs for Pregnancy

A 
A: Ayos sa fetus!
B: Bad sa hayop
C: Culang [sic] sa pag-aaral
D: Desperate measures (benefit>risk)
X: X_X

Dr. Omar's Deck of Secret Knowledge (57 decks)

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