Obgy Flashcards
Timeline of development of different reproductive organs(8 points)
1) 5 weeks -genital Ridge appears
2) 6 weeks - both wolfian and mullerian ducts present
Genital folds and swellings appear
3) 7 weeks - i) if Y chromosome present = SRY gene present= testicular differentiation= earliest time for gonadal differentiation
ii)sertoli cells (7 wks ) = MIS = - Mullerian duct + abdominal. Test. Decent
iii) Leydig cells (8wks ) = Testosterone = + wolfian duct and inguinal decent
4) 8 weeks -if no SRY = Ovaries formed ( no need of 2 X )
5)9 weeks - one of the ducts disappear
6)10 weeks - internal genitalia developed( still cant differentiate sex)
7) 14 weeks - if DHT present = male external genitalia formed ( earliest sex differentiation)
8) 18-20 weeks - Cavitation of female internal genitalia ( caudal to cranial)
Chromosome of -AMH AMH receptor and SRY genes
1)AMH gene = Chr 19 (since male female both need it )
2) AMH R gene = chr 12
3) SRY = Yp ( short arm distal part)
Homologous, male and female external genitalia and glands
1) Genital tubercle = glans penis <—>clitoris
2) Genital fold = shaft <—>Labia minora
3) Genital swelling = Scrotum <—>Labia majora
4) UGS = i) prostrate gland <—->paraurethral gland (skene)
ii) bartholin’s gland <—>Bulbourethral gland ( cowper’s gland )
Batholin duct vs gartner’s duct
1)path and Opening = a) bartholin (located at ant 2/3rd and post 1/3rd jn of L minora)= (25 mm )to the groove between Hymen and labia minora
b) gartner = remanant of mesonephric duct via the broad ligament into the vagina
2) duct block = cyst a) Bartholin = posterolateral wall 7 o clock(bathroom peeche) in inferior 1/3rd of vagina
b) Gartner cyst = anterolateral wall (garden aage ) in proximal 1/3rd of vagina= a/w dysparenuia
3) management = a) Bartholin = Marsupilisation but if age >40 = excision ( risk of ca)
B) gartner = excision
Mcc infection and abscess in bartholin = E coli = needs IND (@7 o clock)
Best clue on image - if on either sides= bartholin ;but if coming out of vagina centrally = gardner cyst
Cause of effecement in cervix(collis)
1) more connective tissue
2) less muscular tissue(10-15% only)
Due to this -
a) more water uptake
b) more collagenbreak down
Therefore, easily softens
Relations of utero-ovarian pedicle
RFO(RO at same level)
superior most = fallopian tube
Ant most = round Ligament
Posterior most= ovarian ligament
Mullerian anomalies
1) most common
2) most common associated with infertility
3) worst pregnancy outcome
4) maximum association with renal abnormalities
5) Complications associated during pregnancy
6) one which always requires surgical correction and TOC. FOR IT
7)TOC for bicornuate and didelphius and when to do it
8) Type associated with ectopic ovary , unilateral dysmenorrhea , ectopic pregnancy
9) Anomalies due to DES exposure
10) ASRM classification
11) mc a/w longitudinal vaginal septum and its presentation
1,2,3) septate uterus
4) unicornuate uterus(40%)
5) PIMA = pre-term labour, IUGR, Mal presentations, T2 abortions
6) septate uterus( d/t 1,2,3)= transcervical hysteroscopic cervical resection
7)Strassman’s metroplasty only if there is history of recurrent preterm labour
8) Unicornuate uterus( 1 MD is rudimentary)
9) Males = hypospadias, renal abnormalities
Females= clear cell carcinoma, infantile uterus(MC) , T shaped uterus(most specific), cervical hood,adenosis
10) 1-MRKH(mullerian agenesis)
2-unicornuate uterus 3-uterine didephius 4-bicornuate uterus 5-septate uterus 6- DES exposure
M/c = type 5
11) uterine didelphius = endometriosis( blocked hemivagina)
Supports of uterus
1) most important
2) components of triradiate ligament
3) parts of Levator ani
4) angles of female genital tract
5) ligament maintaining angles and is blood supply
6) Content of broad ligament
7) ligament, connecting ovary to lateral pelvic wall and its content
1)Levator ani
2) pubocervical ligament, transverse, cervical ligament of Mackenrodt, uterosacral ligament
3)Iliococcygeus ,pubococcygeus ( not ischiococcygeus)
4) anteVersion = between cervix and Vagina=@ level of external os = 90 degree
Anteflexion = Between uterus and cervix=@ level of internal OS= 120 degree
5) round ligament> uterosacral ligament = homologous to gubernaculum = supplied by Sampson artery ( br of uterine A ) = goes into inguinal canal and attaches to labium majora
6) BROAD( ovary not a content)
7) infundibulopelvic / suspensory ligament= ovarian artery(from abdominal aorta)
1) blood supply of uterus
2) blood supply of fallopian tube
3) nerve supply of uterus
4) lymphatic drainage of female genital tract
5) location and boundaries of ovary
6) water under the bridge
1) uterine artery= branch of anterior division of internal iliac artery(hyppgastric A)= Comes at the level of internal os = divides into ascending( goes to FT) and descending arteries = descending cervical artery at 3 o’clock and 9 o’clock
Also goes into myometrium = outer1/3= arcuate A
Inner 2/3=radial A
Basalis = Basal A and Superficial layer= Spiral A
2) medial 2/3 = Uterine artery and lateral one third= ovarian artery
3) Uterus= T10-L1= FrankenHauser ganglion ; cervix and vagina= S2-S4. ; Lower vagina and perineum= peudendal nerve(s2-s4)
4) Fundus of uterus and interstitial part of fallopian tube= para aortic lymph node
Rest of uterus= internal and external iliac and obturator lymph nodes
Rest of fallopian tube and clitoris = superficial inguinal lymph nodes
Glans clitoris= deep inguinal lymph nodes
5) ovarian fossa of Waldeyer
Superior= external iliac vessels
Inferior= obturator nerve ( medial thigh pain)
Anterior= obliterated umblical artery
Posterior= internal iliac artery and ureter
6)ureter ( water) is posterior( under ) both -
i) uterine artery = 2 cm, lateral to internal os = second most common site of injury in OBG
ii) ovarian artery= at pelvic brim near suspensory ligament= most common site of injury
Max risk of injury= radical> laparoscopic hysterectomy
1) T1/2 of GnRH ,FSH,LH
2) site and cause of secretion of the 3
3) site of action of LH and FSH
4) association of GnRH
5) Actions of LH and FSH
6) timing of LH surge vs peak
7)Androgens not produced by ovary
8)Location of Receptor of sex steroids
9)Age wise types of estrogen and their potency
10)effect of different estrogen and progesterone concentration on FSH and LH
1)GnRH= 3-4 min
LH= 90 min
FSH = 3-4 hours
2)GnRH = decapeptide from arcuate nucleus = release d/t ^^Kisspeptin,leptin and glutamate and vv
in GABA and Neuropetide Y at puberty
FSH- Low frequency pulses of GnRH. (From gonadotrophs in ant pit)
LH - High “. “
3)LH= i) Leydig cells= Testosterone
ii) a]Theca interna = androgens
b]Lutenised GC = Progesterone
FSH = i) Sertoli cells= Inhibin B
ii) GC= Estrogen
4) a/w Olfactory placode = KAL-1 mutn = Kallman syndrome = Amenorrhoea + Anosmia
5) FSH= selection of group of follicles + dominant follicle + helps in ovulation
LH = Final growth of dominant follicle + ovulation + form and maintain corpus luteum
6) Surge = 36hr before ovulation (urine = 24h)
Peak = 12 hr before ovulation
7)DHEAS(by adrenal ) and DHT
8)E= intranuclear A and P= Intracytoplasmic
9)E1= Estrone =post menopause = peripheral conversion of Androstenedione by aromatase
E2=Estradiol= reproductive = 2 cell 2 gonanotrophin = GC+FSH -Estrogen and GC+LH-Progestrone
E3= Estriol = pregnancy = DHEAS of fetal adrenal by aromatase and sulphatase
E2>E1>E3
10) E2 (allconcn) = — FSH
E2( N concn)= — LH
E2^^ concn(>200pg) = + LH = surge initiation
P ( less concn) = + pituitary =^^ LH and FSH
P(high concn) = — pituitary = dec. LH and FSH
Initiate LH surge = E > P
Maintain LH surge = P>E
1)Life span of corpus luteum / Duration of Luteal phase
2)Max progesterone level ?when seen?
3)hormones produced by corpus luteum ? Inhibin B by ?inhibin action
4)CL regression? cause and effect
5) hormone for shedding of endo
for expulsion of menses
6)Last action of FSH on dominant follicle
7) selection of dominant follicle in which phase
8)GnRH pulse frequency in different phases of cycle
9)Metorrhagia vs Menometorrhagia
10)Figo classification and mcc
11) Oligomenorrhea vs Hypomenorrhea
1) always constant = 14 days so any variation in cycle is in follicular phase
2)8 days after ovulation= 22nd day of N cycle = 15ng/ml
3)PEA= Progesterone + E2 + inhibin A
Inhibin B - males= sertoli cells
females= Granulosa cells
both inhibin A and B = -FSH»LH
4) d/t ^^^ P = - pituitary = sp around 8th day = v v LH = CL regress (9-10 days) = corpus albicans = v v P= P withdrawal = menses d/t effect of PGF2a
5) Progesterone v v
PGF2a ++
6)induce LH receptor on it (facilitates progression to luteal phase)
7) Early follicular phase(not mid as only growth in mid follicular )
8) i)Luteal = has to induce FSH= Low = 1 in 4 hour
ii)Early follicular = start inducing LH = 1 in 90 min
iii) Late follicular = LH surge time = high freq = 1 in 60 min
9)Metorrhagia = Intermenstrual bleeding in a REGULAR cycle
Menometorrhagia= IRREGULAR ACYCLICAL bleeding (only irregular cycle )
eg- Cervical Ca, polyp
10) classifies AUB = PALM COEIN
mcc= DUB (ovarian and endometrial cause)
11) Oligo= less no.of cycles in a year = long cycle = >38(35) days
Hypo = less bleeding = <2 days of bleeding
A]Effect of E and P on -
1) Uterus
2) Cervix
3) Vagina
4) salt/water retention
5) Lipid profile
6)Bone
7)Breast
B] thickness of endo in
1) post menses
2) Around ovulation
3)Luteal phase
4) at implantation
C]Cervical effects of P and E
i) ferning timing
ii) name of method of contraception using this
iii) effect of OCP on Cx
iv) Progesterone relationship with PID
D] i)Maturation index formula
ii) cells taken from
iii) Cells with glycogen
iv)0:90: 10 suggestive of which phase ?
v) Function of vaginal cytology
A] 1) E = Hyperplasia = proliferation
P = Atrophy = Secretory (only acts on E primed endo)
2) E= thin copius secrn = spinbarkeit + ferning(d/t ^^ E and Nacl)
P= Thick scanty secrn with Tack (breaks on stretch )
3) E= superficial cells = glycogen (pink cyto ) + pyknotic nucleus= most mature
P= Intermediate cells = Blue cyto with bigger nucleus
No E/P= Basal /parabasal cell = ^^ N/C ratio and least mature cells
4)E= ^^ P = v v
5) E= ^ HDL ,v LDL, v cholesterol but ^ TG = cardioprotective
P = v HDL , ^ LDL
but E also ^ CF = 2,8,9,10 so C/I as HRT for cardioprotection or in pt with H/0 DVT / Stroke /CAD
6)Bones - P = no effect
E= ^ mineralisation and closure of epiphysis
menopause = osteoporosis
Precocious puberty = short stature
7) Breast = E-ducts and fat
P- Glands ( size of breast no relationship with breast feeding)
B]
1) 0.5 mm 2) 3 mm 3) 6 mm 4) 10-12 mm
C] i) start = d8 and end d18
ii) Billing’s method = no snu snu b/w 8-18 days
iii) ocp = ^ P = thick Cx mucus = Not permeable to sperm or bacteria
iv) Mirena and other P containing contraceptive = inhibit PID
D] i) parabasal : intermediate : Superficial (ulta hai )
ii) Lateral wall of vagina ( to avoid Cx cells)
iii) Superficial cells (most mature)
iv) s/o ^^ intermediate = ^^ P = Pregnancy > Luteal
v) Hormonal status of female
E] i) main = - LH surge = - ovulation
ii) E/P = - FSH = - follicular growth
iii) Thick Cx mucus = - entry of sperms
iv) Suppress HPO axis = regularise cycle
v) P> E = longterm a/w endo atrophy = v v risk of Endo Ca and also v v endo bleeding
1) sources of Testosterone /Androgen in female
2) Effects of androgen in female
Q1) i) 50% = Peripheral conversion
ii) 25% = Theca interna(d/t LH ) = Androstenedione + DHEA + Testosterone
iii) 25% = Adrenal gland = DHEAS
2) i) follicular growth excess = stop follicular growth(pcos) ii) Pubic /axillary Hair :excess = Hirsutism iii) Libido control iv) SHBG: ^^ strength of binding but inhibit liver synthesis of SHBG(opp of E)
