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OBGYN Block 1 Flashcards

1
Q

The perineum is also AKA the ?

What is the anterior triangle called?

What is the posterior triangle called?

A

Inferior boundary of the pelvis

Urogenital

Anal

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2
Q

The urogenital and anal triangle is separated arbitrarily by ?

What makes up the urogenital diaphragm?

A

Transverse perineal muscles
Perineal body

Levator ani
Coccygus muscles

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3
Q

Vulva is AKA the ?

The labia majora, minora and clitoris are homologous to what male structures

A

Pudenda

Majora: scrotum
Minora: ventral shaft
Clitoris: erectile homologue

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4
Q

Labia majora taper posteriorly to form the ?

Labia minora fuse superiorly to form ? and infer/posterior to form the ?

A

Posterior commissure

Sup: clitoris/prepuce
Inf/Post: Fourchette

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5
Q

Define Hart Line

What do the outer and medial lines indicate?

A

Demarcation line in labia minora between skin and mucous membranes

Outer- Kerat Strat Squam epithelium
Medial: Non-kerat Squam Epithelium

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6
Q

? is the principle female erogenous zone

Define Vestibule

Vestibule runs from ? to ? and ? to ?

A

Glans of clitoris

Embryonic urogenital membrane derivative

Hart line to hymen
Clitoral frenulum to fourchette

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7
Q

Vestibule contains ? 4 structures

Define Hymen

A

Urethra
Vagina
Bartholin glands x 2
Skene gland ducts x 2

Elastic/collagen CT around vaginal orifice

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8
Q

Where are the Bartholin and Skene glands located

What type of hymen is of concern?

A

B: below hymen ring
S: largest paraurethral glands, near urethral meatus on anterior wall of vagina

Imperforate- retains all menses

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9
Q

What lubricates the inside of the vagina?

Why is this important to know?

A

Subepithelial capillaries Permeable epithelium

Inc secretions due to increase transudate from increased vascularity

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10
Q

Where is the fornix?

Why do post-menopause females complain of painful intercourse?

A

Recesses around cervix creating arch

Loss of rugae/transverse ridges due to atrophy

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11
Q

What are the three points of the fornix

Why is one of those landmarks important?

A

Lateral Anterior Posterior

Posterior fornix- access for culdocentesis: needle drainage of fluid from pouch of douglas

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12
Q

Pouch of Douglas is AKA ?

Fluid accumulation here can indicate ?

A

Retrouterine pouch between rectum and uterus

Ectopic pregnancy

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13
Q

What are the upper and lower boundaries of the cervix?

Define the Portio Supravaginalis

A

Upper- internal os, into uterus
Lower- external os, into vagina

Upper segment above the vagina’s attachment to the cervix

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14
Q

Define Nulliparous os

Define Parous os

A

Small, oval opening= no vaginal birth

Transverse slit= vaginal delivery

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15
Q

What are 3 signs/changes seen on the cervix during pregnancy

A

Chadwick: early blue tint from increased vascularity

Goodell: cervical softening due to edema

Hegar: Isthmus and uterus softening

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16
Q

Define Ectocervix

Define Endocervix

A

Cervix covered by stratified squamous epithelium

Cervical canal covered by columnar epithelium

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17
Q

Define the SCJunction

Define the T-Zone

A

Columnar cells meet squamous cells w/ position depending on age/hormone status

Transformation zone; area between original and new SCJ where 95% of cervical neoplasia occur

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18
Q

What is the sequence of cells and metaplasial changes at the cervical T-zone

A

Birth:
Columnar cells- endocervical
Squamous cells- cervix/vag

Puberty:
Columnar proliferate onto ectocervix, transforms back to squamous

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19
Q

What hormone affects the cell type and amount at the T-zone?

Define Corpus

Define Isthmus

A

Estrogen

Muscular upper portion of uterus

Joins corpus to cervix, forms lower uterine segment during pregnancy

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20
Q

Where is the visceral periotenum in the uterus?

What is the MC site of implantation of a fertilized egg within the uterus?

A

Posterior wall

Upper posterior wall

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21
Q

Uterus has ? general/normal position?

Define Myometrium and why is it useful

A

Anteroverted

Upper uterus smooth muscles and CT used for homeostasis during 3rd stage of labor

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22
Q

Who has a bigger uterus, 4y/o of newborn?

Why?

A

Newborn

Mother estrogen

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23
Q

Uterus and ovary are not connected but are both nested within ?

What is the most common site in the fallopian tube for fertilization and for extopic pregnancy

A

Mesosalpinx of broad ligament

Ampulla

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24
Q

What are the 4 parts of the fallopian tube

Ovaries secrete ? and are supplied w/ blood by ?

A

Infundibulum
Ampulla
Isthmus
Interstitial?intramural

Estrogen/Progesterone
Ovarian and uterine arteries

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25
What is the MC site of ovarian cancers? Where do ovaries drain blood into?
Epithelium, outer layer L- L renal vein R- R IVC
26
Ovarian ligament attaches ovary to and the suspensory ligament attaches ovary to ? Difference between True and False pelvis
O: lateral uterus S: wall of pelvis True: immobile, constrains delivery of fetus False: above linea terminalis, supports pregnant uterus
27
The two innominate bones of the pelvis are the fusion sites of ? 3 bones and join to sacrum at ? The two innominate bones meet at ?
Ilium Ischium Pubis SI joint Symphysis pubis
28
What is the name of the preferred baby head position during delivery? What are the 3 head positions seen during delivery
Occiput anterior- back of head facing maternal anterior in nose down position Vertex Sinciput Brow- usually seen microcephaly fetus
29
What are the 3 important pelvic landmarks What are the two pelvic types preferred for vaginal delivery and two that are least favorable
Interspinous diameters Transverse inlet Obstetrical conjugate- cant/not measured on living PT + Gynecoid, anthropoid - Android, platypelloid
30
What maternal delivery position may be used to increase the pelvic outlet diameter? What are the vessels that run diagonally toward umbillicus
Dorsal lithotomy inc by 1.5-2cm Superficial epigastric
31
All superficial vessels of the abdominal wall arise from the ? All inferior/deep vessels are branches of ? vessels and supply ?
Femoral artery below inguinal ligament in femoral triangle External iliac Muscle/fascia of abdominal wall
32
Maylard incisions may lacerate ? vessel and where Why are vertical incisions avoided when possible?
Inferior epigastric artery lateral to rectus belly High tension, wider scar
33
Low transverse incisions for delivery are AKA ? and follow ? dermatological line What are the risks of performing an incision here?
Pfannenstiel Langer lines Damage to Iliohypogastric nerve- loss of sensation over lateral glute/hypogastric region
34
What are the 4 parts of the HPO axis that compile the menstrual cycle and the hormones released by each
Hypothalamus- GnRH AntPit- PRL LH/FSH ACTH TSH GH Ovaries Endometrium
35
What effects do estrogen/progesterone have on the endometrium What is the only female reproductive organ that remains unchanged during pregnancy
E: proliferative, grow P: secretory Ovary
36
What are the 3 sources of gonad tissues in females? What is the progression of development into an ovary?
Mesothelium- posterior abdominal wall Mesenchyme- embryonic CT Primordial germ cells- earliest undifferentiated germ cells ``` Mesothelium Gonad ridge Gonad cord Indifferent gonad Ovary ```
37
Primordial germ cells take ? days for gestation, migrate along ? to ? and are incorporated into the ? by week 6 of gestation
24d Dorsal mesentery to gonadla ridges Gonad cord
38
Testes grow from ? Ovaries grow from ? What causes the distinguishing development
Mesonephric (Wolffian) duct Paramesonephic (Mullerian) duct Y chromosome releasing TDF= testes No TDF= ovary
39
Feetal ovaries grow in response to ? and not ? What causes these ovaries to not develop from paramesonephric/Mullerian ducts?
Lack of Y chromosome No estrogen effect Y chromosome and TDF
40
During fetal development oogonia undergo ? to replicate from their ? state After completing this development and replication, what stage of replication do they sit in until puberty?
Mitosis Diploid- 46XX Meiosis I
41
? peaks between 8-12wks of development and stimulates testosterone development ? other glycoprotein is produced, where and what does it do
Hcg AMH Sertoli cells Suppresses paramesonephric/Mullerian ducts
42
# Define Didelphys Define Bicornuate Uterus
Double uterus from failed fusion of inferior paramesonephric ducts Duplicated superior portion of uterus
43
# Define Bicornuate Uterus w/ Rudimentary horn Define Septate Uterus
Slowed growth of one paramesonephric duct that fails to fuse Internally divided uterus by thing septum due to failure of resorption
44
Define Unicornuate Uterus
One paramesonephric duct fails to develop | PT is fertile but w/ inc risk of preterm delivery/loss
45
Define Ovotesticular DSD
Chromatin pos nuclei PT has ovotestis M or F phenotype and ambiguous external genitals
46
# Define 46XX DSD What can this lead to?
+ normal ovaries Clitoral hypertrophy, partial fusion of labia, urogenital sinus Both Worlffian and Mullerian present Congenital adrenal hyperplasia- deficient 21 hydroxylase
47
Define 46XY DSD
Poor virilization of male fetus deu to defect enzyme synthesis of testosterone causing d/o of testicular development Chromatin negative nucli Caused by low testosterone production and MIS
48
Define AIS
Androgen Insensitivity Syndrome Externally female w/ testes and 46XY Blind pouch vagina
49
Define Kallmann syndrome
2* hypogonadism due to Gnrh failure Hypo Hypo Anosmia Low FSH LH and estrogen
50
Define Klinefelter
Primary Hypo | Lot T, Elevated FSH, LH
51
Define Turner Syndrome
``` Primary hypogonad 45XO Hyper Hypo Inc FSH LH, low estrogen Streak gonads/gonadal dysgenesis ```
52
Teen female PT w/ amenorrhea, absent uterus confirmed by US and genetically 46XX, what is the diagnosis Define Gametogenesis
Mullerian dysgenesis AKA MRKH Syndrome Formation and development of ova/sperm precursors into gametes, ooctye/spermatozoa
53
What type of duplication occurs in gametogenesis Where are premordial germ sperm cells stored until puberty
Meiosis I: diploid 46XY to haploid 23X and 23Y Meiosis II: 2 haploid 23X and 23Y Spermatogonia lie dormant in seminiferous tubules of testes until stimulated replication by GnRH
54
What are the two types of Spermatocytes One primary spermatocyte develops into ? mature/mobile sperm
Primary: largest, diploid Secondary: smaller, haploid Four 23 chromosome sperm
55
What is the last phase of spermatogenesis What is the use/function of an Acrosome
Spermiogenesis Enzymatic digestion of egg zona pellucida
56
What is the function and location of Sertoli cells? These also allow for passive transport from ? to ?
Seminiferous tubules Develop/regulate spermatogenesis Seminiferous tubule to Epididymis
57
How long does it take for sperm to mature? What are the components of sperm? What are found in each section
Spermiogenesis= 2mon + 1mon of maturation in seminiferous tubules Head/Tail Head: Acrosome, Nucleus Tail: 3 segments- middle, principle, end Mitochondria in middle
58
# Define Sperm Capacitation What is the function of the prostaglandins found in the semen?
Physiological process after ejaculation where sperm acquire ability to fertilize ova by readying acrosomal reaction Stimulate uterine motility Aids w/ movement to ampulla for fertilization
59
What are the 4 sub-cycles of the menstrual cycle A normal cycle can last how long?
Hypothalamus- GnRH Ant Pituitary- LH, FSH Ovaries- estrogen, progestin androgen for folliculr, ovulatory and luteal phases Endomtrium- mentrual, proliferative and secretory phases 28 +/- 7= 21-35 days
60
What immediately proceeds ovulation? What controls the whole menstrual cycle
Estrogen surge then, LH surge Gonadotropin from hypothalamus
61
Endometrium responds to ? 3 and what 3 phases occur What happens in the Proliferative and Secretory phases
Progestin Estrogen Androgen Menstrual Proliferative Secretory Pro: estrogen proliferates, spiral arteries lengthen, endometrial growth is max, straight glands, narrow lumen Sec: progesterone from corpus luteum (after ovulation) stims glycogen secretion, glands dilate,
62
High estrogen at ovulation also causes ? changes at the cervix What pattern would be seen under a microscope
Inc quantity of more alkaline mucus Ferning test- no progesterone to inhibit estrogen induced pattern
63
What change occurs after oocyte is contacted by sperm? What are the phases of fertilization?
Completes meiosis 2 via diploid event ``` Sperm passes through Corona Radiata Acrosoma reaction penetrates pellucida, changes permeability to other sperm Fusion Completion of meiosis 2 OOtid= zygote ```
64
What are estrogen, progesterone and prostaglandin effects on zygote implantation? By implantation, what is the name of the form of the thing that implants
Estro: + sticking Pro: - sticking Prosta E: relaxes tube Prosta F: stims tube motility Blastocyst
65
What are the two layers of the blastocyst What layer produces hCG
Embryoblast- embryo, amnion and cord Trophoblast- chorion; forms placenta Trophoblast produces hCG
66
What are the 3 phases of implantation What is the name of the fertilized egg as it leaves the fallopian tubes and enters the uterus
Apposition Adhesion Invasion Morula-Blastocyte-Implant
67
What are the two layers of implantation Define Decidua and what does it do Decidua may be AKA
Syncotiotrophoblast- outter Cytotrophoblast- inner Maternal component of placenta, establishes implantation of embryo Endometrium of pregnancy- functional layer of pregnancy that separates from uterus after birth
68
What are the 3 different regions of the decidua What parts separates conceptus from the uterine cavity
Basalis Capsularis Parietalis Capsularis
69
By day _ the trophoblast differentiate into ? two layers Upon implantation, it further develops into ?
8 Cytotropho/Cyncytiotrophoblast Villous trophobloasts- become chorionic villi, fetal aspect of placenta, for transport funtions Extravillous trophoblasts- migrate into maternal vasculature/decidua, anchor chorionic villi to uterus
70
What are the two types of extravillous trophoblasts that migrate into the decidua and myometrum When chromosomal testing is done on babies, what is being tested?
Interstitial: penetrate myometrium, surrounds spiral arteries Endovascular: penetrate spiral artery lumen, allows placenta blood flow to be low resistance Chorionic villi
71
How many vessels are in the umbilical cord? What is the name of the maternal surface of the placenta What is the name of the fetal surface?
3- AAV (artery carry deoxygenated blood) Vein: oxygenated and higher press Basal plate- cleft/lobules called cotyledon Chorionic plate- umbilical cord inserts at center
72
Where do vessels travel to after the cord? Define Nitabuch Layer
Chorionic plate Stem villi of platenal parenchyma Maintains maternal/placental separation and zone of degeneration in decidua Prevent placental invasion into uterus
73
What are the 3 abnormal variants to nitabuch layer What are the risk factors for these to occur
P accreta- adheres to myometrium P increta- invades myometrium P percreta- perforates myometrium Prior uterine surgery/C-section delivery
74
How long after conception does maternal blood enter the intervillous space from spiral arteries Upon pushing through and being released, what structure does the blood bathe?
1mon Synchytiotophoblast
75
What are the functional units of placental architecture and what do they contain At what point in development are placenta and fetus the same weight
Cotyledon- one vein to enhance o2/nutrient exchange w/ maternal blood 17 wk 1st trimester, placenta grows faster than fetus
76
? maintains the corpus luteum What makes this maintainer
Hcg Synchtiotrophoblast during the 1st trimester
77
When does Hcg level peak? What happens after the peak and what could a low or high amount mean
Doubles q2days, peaks by 60-70 days, plateau for pregnancy Low- ectopic, spot abortion High- gestational trophoblastic neoplasia
78
What hormone causes the n/v of morning sickness of pregnancy What other issue can it cause
Hcg Hyperemesis gravidarum
79
What is the purpose of the abrupt rise of hcg What are the 3 advantages of fetal gas exchange?
Maintain corpus luteum and progesterone Fetal Hgb higher affinity for o2 Bohr effect lowers o2 affinity w/ lower pH Fetus has higher Hgb
80
Chorionic villi drain nutrients/o2 from maternal blood using ? Define Nuchal cord
Bohr effect Umbilical cord around fetal neck
81
What are the 3 parts of fetal cardiology that allow for R to L shunting
D Arteriosus- connects A and PA, diverts blood to brain, heart and away from lungs F Ovale- shunts blood from RA to systemic circulation D Venosus- bypasses hepatic circulation, remnant of ligamentum venosum
82
What is the Tanner Staging for breasts
1: elevation of papilla 2: buds and areola enlargement 3: breast tissue growth 4: projection of areola/papilla and secondary mound formation 5: adult type contours
83
What is the Tanner staging for pubic hiar
1: villus only 2: sparse hair along labia 3: coarse pigmented hair 4: adult hair but doesn't spread to thighs 5: adult hair spreads to thighs
84
# Define Thelarche Define Adrenarche
Breast development due to estrogen Pubic hair growth due to androgens
85
What is the sequence of event changes for female PTs What is usually the first sign?
TAPP Me Thelarche Adrenarche Pubarche Peak growth Menarche Pubarche
86
Earlier onset of puberty can be due to ? body type ? hormone is proposed as the initiator hormone
Obesity Leptin from adipocytes
87
What is the critical weight in order for females to begin menarche What hormone sequence starts puberty
106lbs (48kg) Inc Gnrh from hypothalamus causes AntPit to release FSH/LH FSH/LH stimulate production of testosterone/estradiole/progesterone
88
What is the first sign of secondary sexual characteristics Define Precocious Puberty
Thelarche Appearance of secondary sex characteristics <8y/o
89
How is Precocious Puberty classified
Early + of HPO axis Central- gonadotropin dependent; isosexual- 2* characteristic same for phenotype Peripheral: gonadotropin independent; iso/heterosexual Can lead to tumors, CAH, Cushings

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