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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
Q

What is the MC site of ovarian cancers?

Where do ovaries drain blood into?

A

Epithelium, outer layer

L- L renal vein
R- R IVC

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26
Q

Ovarian ligament attaches ovary to and the suspensory ligament attaches ovary to ?

Difference between True and False pelvis

A

O: lateral uterus
S: wall of pelvis

True: immobile, constrains delivery of fetus
False: above linea terminalis, supports pregnant uterus

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27
Q

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 ?

A

Ilium
Ischium
Pubis

SI joint

Symphysis pubis

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28
Q

What is the name of the preferred baby head position during delivery?

What are the 3 head positions seen during delivery

A

Occiput anterior- back of head facing maternal anterior in nose down position

Vertex
Sinciput
Brow- usually seen microcephaly fetus

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29
Q

What are the 3 important pelvic landmarks

What are the two pelvic types preferred for vaginal delivery and two that are least favorable

A

Interspinous diameters
Transverse inlet
Obstetrical conjugate- cant/not measured on living PT

+ Gynecoid, anthropoid
- Android, platypelloid

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30
Q

What maternal delivery position may be used to increase the pelvic outlet diameter?

What are the vessels that run diagonally toward umbillicus

A

Dorsal lithotomy inc by 1.5-2cm

Superficial epigastric

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31
Q

All superficial vessels of the abdominal wall arise from the ?

All inferior/deep vessels are branches of ? vessels and supply ?

A

Femoral artery below inguinal ligament in femoral triangle

External iliac
Muscle/fascia of abdominal wall

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32
Q

Maylard incisions may lacerate ? vessel and where

Why are vertical incisions avoided when possible?

A

Inferior epigastric artery lateral to rectus belly

High tension, wider scar

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33
Q

Low transverse incisions for delivery are AKA ? and follow ? dermatological line

What are the risks of performing an incision here?

A

Pfannenstiel
Langer lines

Damage to Iliohypogastric nerve- loss of sensation over lateral glute/hypogastric region

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34
Q

What are the 4 parts of the HPO axis that compile the menstrual cycle and the hormones released by each

A

Hypothalamus- GnRH

AntPit- PRL LH/FSH ACTH TSH GH

Ovaries

Endometrium

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35
Q

What effects do estrogen/progesterone have on the endometrium

What is the only female reproductive organ that remains unchanged during pregnancy

A

E: proliferative, grow
P: secretory

Ovary

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36
Q

What are the 3 sources of gonad tissues in females?

What is the progression of development into an ovary?

A

Mesothelium- posterior abdominal wall
Mesenchyme- embryonic CT
Primordial germ cells- earliest undifferentiated germ cells

Mesothelium 
Gonad ridge 
Gonad cord 
Indifferent gonad
Ovary
37
Q

Primordial germ cells take ? days for gestation, migrate along ? to ? and are incorporated into the ? by week 6 of gestation

A

24d
Dorsal mesentery to gonadla ridges
Gonad cord

38
Q

Testes grow from ?
Ovaries grow from ?

What causes the distinguishing development

A

Mesonephric (Wolffian) duct
Paramesonephic (Mullerian) duct

Y chromosome releasing TDF= testes
No TDF= ovary

39
Q

Feetal ovaries grow in response to ? and not ?

What causes these ovaries to not develop from paramesonephric/Mullerian ducts?

A

Lack of Y chromosome
No estrogen effect

Y chromosome and TDF

40
Q

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?

A

Mitosis
Diploid- 46XX

Meiosis I

41
Q

? peaks between 8-12wks of development and stimulates testosterone development

? other glycoprotein is produced, where and what does it do

A

Hcg

AMH
Sertoli cells
Suppresses paramesonephric/Mullerian ducts

42
Q

Define Didelphys

Define Bicornuate Uterus

A

Double uterus from failed fusion of inferior paramesonephric ducts

Duplicated superior portion of uterus

43
Q

Define Bicornuate Uterus w/ Rudimentary horn

Define Septate Uterus

A

Slowed growth of one paramesonephric duct that fails to fuse

Internally divided uterus by thing septum due to failure of resorption

44
Q

Define Unicornuate Uterus

A

One paramesonephric duct fails to develop

PT is fertile but w/ inc risk of preterm delivery/loss

45
Q

Define Ovotesticular DSD

A

Chromatin pos nuclei
PT has ovotestis
M or F phenotype and ambiguous external genitals

46
Q

Define 46XX DSD

What can this lead to?

A

+ normal ovaries
Clitoral hypertrophy, partial fusion of labia, urogenital sinus
Both Worlffian and Mullerian present

Congenital adrenal hyperplasia- deficient 21 hydroxylase

47
Q

Define 46XY DSD

A

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
Q

Define AIS

A

Androgen Insensitivity Syndrome
Externally female w/ testes and 46XY
Blind pouch vagina

49
Q

Define Kallmann syndrome

A

2* hypogonadism due to Gnrh failure
Hypo Hypo
Anosmia
Low FSH LH and estrogen

50
Q

Define Klinefelter

A

Primary Hypo

Lot T, Elevated FSH, LH

51
Q

Define Turner Syndrome

A 
Primary hypogonad
45XO
Hyper Hypo
Inc FSH LH, low estrogen
Streak gonads/gonadal dysgenesis
52
Q

Teen female PT w/ amenorrhea, absent uterus confirmed by US and genetically 46XX, what is the diagnosis

Define Gametogenesis

A

Mullerian dysgenesis
AKA MRKH Syndrome

Formation and development of ova/sperm precursors into gametes, ooctye/spermatozoa

53
Q

What type of duplication occurs in gametogenesis

Where are premordial germ sperm cells stored until puberty

A

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
Q

What are the two types of Spermatocytes

One primary spermatocyte develops into ? mature/mobile sperm

A

Primary: largest, diploid
Secondary: smaller, haploid

Four 23 chromosome sperm

55
Q

What is the last phase of spermatogenesis

What is the use/function of an Acrosome

A

Spermiogenesis

Enzymatic digestion of egg zona pellucida

56
Q

What is the function and location of Sertoli cells?

These also allow for passive transport from ? to ?

A

Seminiferous tubules
Develop/regulate spermatogenesis

Seminiferous tubule to Epididymis

57
Q

How long does it take for sperm to mature?

What are the components of sperm?

What are found in each section

A

Spermiogenesis= 2mon + 1mon of maturation in seminiferous tubules

Head/Tail

Head: Acrosome, Nucleus
Tail: 3 segments- middle, principle, end
Mitochondria in middle

58
Q

Define Sperm Capacitation

What is the function of the prostaglandins found in the semen?

A

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
Q

What are the 4 sub-cycles of the menstrual cycle

A normal cycle can last how long?

A

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
Q

What immediately proceeds ovulation?

What controls the whole menstrual cycle

A

Estrogen surge then,
LH surge

Gonadotropin from hypothalamus

61
Q

Endometrium responds to ? 3 and what 3 phases occur

What happens in the Proliferative and Secretory phases

A

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
Q

High estrogen at ovulation also causes ? changes at the cervix

What pattern would be seen under a microscope

A

Inc quantity of more alkaline mucus

Ferning test- no progesterone to inhibit estrogen induced pattern

63
Q

What change occurs after oocyte is contacted by sperm?

What are the phases of fertilization?

A

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
Q

What are estrogen, progesterone and prostaglandin effects on zygote implantation?

By implantation, what is the name of the form of the thing that implants

A

Estro: + sticking
Pro: - sticking
Prosta E: relaxes tube
Prosta F: stims tube motility

Blastocyst

65
Q

What are the two layers of the blastocyst

What layer produces hCG

A

Embryoblast- embryo, amnion and cord
Trophoblast- chorion; forms placenta

Trophoblast produces hCG

66
Q

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

A

Apposition
Adhesion
Invasion

Morula-Blastocyte-Implant

67
Q

What are the two layers of implantation

Define Decidua and what does it do

Decidua may be AKA

A

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
Q

What are the 3 different regions of the decidua

What parts separates conceptus from the uterine cavity

A

Basalis
Capsularis
Parietalis

Capsularis

69
Q

By day _ the trophoblast differentiate into ? two layers

Upon implantation, it further develops into ?

A

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
Q

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?

A

Interstitial: penetrate myometrium, surrounds spiral arteries
Endovascular: penetrate spiral artery lumen, allows placenta blood flow to be low resistance

Chorionic villi

71
Q

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?

A

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
Q

Where do vessels travel to after the cord?

Define Nitabuch Layer

A

Chorionic plate
Stem villi of platenal parenchyma

Maintains maternal/placental separation and zone of degeneration in decidua
Prevent placental invasion into uterus

73
Q

What are the 3 abnormal variants to nitabuch layer

What are the risk factors for these to occur

A

P accreta- adheres to myometrium
P increta- invades myometrium
P percreta- perforates myometrium

Prior uterine surgery/C-section delivery

74
Q

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?

A

1mon

Synchytiotophoblast

75
Q

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

A

Cotyledon- one vein to enhance o2/nutrient exchange w/ maternal blood

17 wk
1st trimester, placenta grows faster than fetus

76
Q

? maintains the corpus luteum

What makes this maintainer

A

Hcg

Synchtiotrophoblast during the 1st trimester

77
Q

When does Hcg level peak?

What happens after the peak and what could a low or high amount mean

A

Doubles q2days, peaks by 60-70 days, plateau for pregnancy
Low- ectopic, spot abortion
High- gestational trophoblastic neoplasia

78
Q

What hormone causes the n/v of morning sickness of pregnancy

What other issue can it cause

A

Hcg

Hyperemesis gravidarum

79
Q

What is the purpose of the abrupt rise of hcg

What are the 3 advantages of fetal gas exchange?

A

Maintain corpus luteum and progesterone

Fetal Hgb higher affinity for o2
Bohr effect lowers o2 affinity w/ lower pH
Fetus has higher Hgb

80
Q

Chorionic villi drain nutrients/o2 from maternal blood using ?

Define Nuchal cord

A

Bohr effect

Umbilical cord around fetal neck

81
Q

What are the 3 parts of fetal cardiology that allow for R to L shunting

A

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
Q

What is the Tanner Staging for breasts

A

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
Q

What is the Tanner staging for pubic hiar

A

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
Q

Define Thelarche

Define Adrenarche

A

Breast development due to estrogen

Pubic hair growth due to androgens

85
Q

What is the sequence of event changes for female PTs

What is usually the first sign?

A

TAPP Me
Thelarche Adrenarche Pubarche Peak growth Menarche

Pubarche

86
Q

Earlier onset of puberty can be due to ? body type

? hormone is proposed as the initiator hormone

A

Obesity

Leptin from adipocytes

87
Q

What is the critical weight in order for females to begin menarche

What hormone sequence starts puberty

A

106lbs (48kg)

Inc Gnrh from hypothalamus causes AntPit to release FSH/LH
FSH/LH stimulate production of testosterone/estradiole/progesterone

88
Q

What is the first sign of secondary sexual characteristics

Define Precocious Puberty

A

Thelarche

Appearance of secondary sex characteristics <8y/o

89
Q

How is Precocious Puberty classified

A

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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