OBGYN Cummulative Flashcards
Labia Majora is homologous to ?
Labia minora is homologous to ?
Glans of clitoris is homologous to ? and is principle ?
Scrotum
Ventral shaft
Erectile of penis;
Erogenous zone
? demarcation line is present in the minora
? glands are located in vestibule and their functions
Hart Line- skin and mucous membrane line
Outer: keratinized
Inner: non-keratinized
Bartholin, lubrication- 4, 8 position
Skene- largest paraurethral galnds; lubricate urethral opening
? type of cells are in vagina
Define Adventitia
Since no glands are located here, how is this structure lubricated
Non-keratinzed stratified squamous epithelium
Collagen elastin
Sub-epithelial capillaries and permable epithelium
Define Fornix
What vaginal changes occur during menopause
Define Pouch of Douglas
Arch/recess around cervix
Loss of rugae
Rectouterine pouch; lower point in abdominal cavity
? name of upper segment of cervix
Define Chadwick Sign
Define Goodell Sign
Define Hegar sign
Portio Supravaginalis
Blue tint d/t inc vascularity
Cervical softening d/t edema
Uterine isthmus softening
Define Ectocervix
Define Endocervix
Define Squamocolumnar Junction
Portion covered by stratified squamous epithelium
Portion covered by columnar epithelium
Columnar cells meet squamous cells
Define T-Zone
Why is this zone important to know
Define Metaplasia and when it occurs
Transformation zone- between original and new SCJ
95% of neoplasms occur here
Transformation of cell types Birth: Endocervical: columnar Cevix/Vagina: squamous Puberty: Columnar onto ectocervix, then back to squamous
Define Corpus
Define Isthmux
Define Visceral Peritoneum and why this structure is important
Muscular upper portion of uterus
Joins corpus and cervix
Posterior wall of uterus;
Upper, posterior wall- MC site of implantation
Uterus generally have ? position
Define Myometrium and why is this structure important
What are the 4 parts of the fallopian tube from lateral to medial
Anteroverted
Upper uterus smooth muscle; hemostasis at placenta during 3rd stage of labor
Infudibulum
Ampulla
Isthmus
Interstitial/Intramural
Fallopian tubes are enclosed by ? structure
What type of tissue are they lined w/
What two MCs does the ampulla own
Broad ligament
Ciliated columnar epithelium
MC site for fertilization and ectopic pregnancies
? supplies blood to ovaries
? is the MC site for ovarian cancers
Where do ovaries drain blood to
Ovarian/uterine arteries
Epithelium, outer layer
L: left renal vein
R: IVC
Define Ovarian Ligament
Define Suspensory Ligament
Where is the ‘false’ pelvis located and its function
Ovary to lateral uterus
Ovary to pelvic wall
Above linea terminalis;
supports pregnant uterus (outter rim of pevlis from superior view)
? two pelvis structures are most favorable for delivery
? two pelvis structures are least favorable
Where do the superficial and deep arteries supplying lower abdominal wall arise from
Gynecoid*, anthropoid
Android, Platypelloid
S: femoral artery below inginal ligament in femoral triangle
D: external iliac; supply muscle/fascia
Define Maylard incision and the concern for it
What is the risk w/ vertical incision in abdominal wall
What is the benefit but risk of lower transverse incisions
Cesarean incision- inferior epigastric artery can be lacerated
High tension, wider scars
Less scar, better cosmetics;
Severeed iliohypogastric nerve= lost sensation over gluteal/hypogastric region
Where is GnRH released from
What is made/stored in anterior pituitary
Where do round ligaments insert onto the uterus
Hypothalamus
FSH LH ACTH TSH PRL GH
Mid/Upper third
3 sources of gonads
Sequence of progressing development into gonad
Embryotic sex is undifferentiated until ? week
Mesothelium- lines posterior abdominal wall
Mesenchyme- embryonic CT
Primordial germ- earliest, undifferentiated cells
Mesothelium, Gonad ridge, Gonad cord, Indifferent gonad, Ovary
Begins at week 5, Committed at week 7;
Testes: 7wks
Ovaries: 12wks
What causes undifferentiated gonads to develop into either ovary or testis
Define Mesonephric Ducts
Define Paramesonephric Ducts
+TDF, + MIF, Mullerian regression= testis
+TDF, -MIF, Wolffian regression= ovary
Wolffian
Mullerian
Female phenotype requires ? and is not ?
? stimulates for testosterone development to begin testis development
How is the uterus/fallopian tubes stimulated into development
Requires two X-chromosomes;
Not hormone dependent
HCG
AMH suppresses paramesonephric ducts
What are the 5 types of uterine malformations
Didelphys: failed fusion of paramesonephric ducts
Bicornuate: duplicate superior uterus body
Bicornuate w/ rudimentary horn: failed fusion
Septate: internally thin septum d/t failed resorption
Unicornuate: one paramesonephric duct fails to develop, risk for preterm delivery/loss
Define Ovotesticular DSD
What do these Pts look like
What are three etiologies
Ovarian and Testicular tissue found in Pt
Most are 46XX- Mullerian Dysgenesis
Male or female phenotype, ambiguous external genitals
Congenital Adrenal Hyperplasia- MCC
Androgenic administration
Masculinizing maternal tumors
Define 46XY DSD
This is a d/o of ? and contain ? chromatin
What causes this form
Inadequate male virilization d/t defected testosterone synthesis
Testicular development, chromatin negative
Deficient testosterone and MIS production
Define AIS
What would be seen on exam
What c/c could bring Pts in
Normal female genitals
Testis present somewhere in body
46XY
Vaginal blind pouch w/ uterus
Secondary characteristics develop w/out menses
Define Kallmann Syndrome
What would be seen on lab results
Why is the cause of this syndrome
Secondary Hypogonadism: Hypo Hypo
Anosmia
Infertile w/ poorly defined/developed secondary characteristics
Low FSH, LH and Estrogen
GnRH failure
Define Klinefelter Syndrome
What would be seen on lab results
What could be presenting c/c
Primary Hypogonadism
47XXY
Low T
Inc FSH>LH
Micropenis, infertility
Define Turner Syndrome
What would be seen on lab results
What is the cause of this condition
Primary Hypogonadism, Hyper Hypo
45XO
Inc FSH and LH
Dec E
Gonad dysgenesis
How does Mullerian Dysgenesis present on PE
What are the 4 sub-cycles of the menstrual cycle
What is “Day 1” of a period and how long do they last for
Primary amenorrhea
Absent uterus
Hypothalamus
Anterior pituitary
Ovaries
Endometrium
First day of physiological endometrial shedding
28d +/- 7d
How does a theca cell become a granulosa cell
The endometrium responds to what 3 stimuli
Cholesterol \+ LH Androstenedione/Testosterone \+ FSH Estrone, Estradiol
Progestin Estrogen Androgen
Define Proliferative Phase
Define Secretory Phase
Estrogen causes endometrial proliferation/maximized
Spiral arteries lengthen
Glands are straight/narrow d/t glycogen
Progesterone from corpus luteum stimulates glycogen/mucus release
Glands dilate
Spiral arteries extend into endometrium
How does cervical mucus change w/ cycles
What would be seen under microscopy
Ovulation= high estrogen, more alkaline, dec spinnbarkehit (viscocity)
Ferning d/t favorable E+ balance
What would be seen under microscopy of cervical mucus fern test at ovulation
What would be seen under microscopy of cervical mucus fern test during mid-luteal phase
No progesterone to inhibit estrogen induced fern pattern
Progesterone makes mucus thicker w/ less ferning
Where does fertilization and implantation MC occur
What happens during fertilization
In order for sperm to fertilize eggs, they must pass through ? structure
F: Ampulla <24hrs of ovulation
I: upper, posterior wall
Oocyte contacts sperm- complete meiosis 2
Corona radiata
What are the two reactions during fertilization
What are the roles of E/P during implantation
What are the roles of Prostaglandin E and F
Acrosomal- enzymatic penetration of zona pellucida
Zona: solubility changes d/t zona pellucida binding, impermeable egg
E: facilitates sticking
P: inhibits sticking
E: relaxes tube
F: stimulates motility
? stage of cellular material implants in uterus after fertilization
What are the two layers of the implanted cell and what does each make
Once implanted, what does this group of cells make
Blastocyst
Embryoblast- embryo, amnion, cord
Trophoblast- chorion, placenta
hCG- preserves corpus luteum and stops menses until placenta takes over
What are the 3 phases of implantation
? establishes implantation of embryo
What is it’s purpose
Apposition- blastocyst contacts uterine wall
Adhesion- inc contact
Invasion- sync/cyto-blasts enter endometrium
Decidua- maternal component of placenta
Functional layer; separates from uterus after birth
Decidua is dependent on ? three things for survival
What are the 3 layers
What layer separates conceptus from uterine cavity
E, P, blastocyst factors
Basalis, Capsularis, Parietalis
Capsularis
? is the critical part of the fetal-maternal interface of pregnancy
Why is this so important
When does this key part become relevant
Trophoblast- chorion
Becomes placenta
Day 8-
Cytotrophoblast (outer)
Synctiotrohoblast (inner)
After implantation, trophoblast further differentiates into ? two parts that perform ? functions
What is the maternal side of the placenta called and what is it divided into
What is the fetal surface of the placenta called and what landmark is found here
Villous:
Chorionic villi- produces hormones, nutrient transport
Extravillous- vasculature
Basal plate- cotyledon
Chorionic plate- umbilical cord insertion
How many vessels are in the cord
Placenta is AKA ? layer
What are the 3 layers
3
Nitabuchs
Accreta: adheres
Increata: invades
Percreta: perforates
How long into pregnancy for maternal blood to reach placenta
? is the functional unit of placenta architecture
Since placenta grows more rapidly at first, when do fetus and placenta growth equalize
1mon- enters synctiotrophoblast
Cotyledon veins
17wks
At term, placenta will weigh ? fraction of fetus
? hormone maintains the corpus luteum
Where is this hormone created
1/6th
b-hCG
Synctiotrophoblast during 1st trimester
? do Pts experience morning sickness
What are the 3 advantages of fetal gas exchange
? is a normal pH environment for fetus
b-hCG
FHgb > affinity for o2
Bohr effect: low o2 affinity w/ dec pH
Higher hgb 15-18
Acidic
How are nutrients/o2 from maternal blood drained
How many vasculature structures are found in umbilical cord
How many R-L shunts are found in fetal circulation
Chorionic villi via Bohr effect
1 vein- oxygenated, pressurized R-side
2 arteries- deoxygenated, flaccid L-side
Ductus venosus- bypasses hepatic circulation to heart
Ductus arteriosus- diverts blood to brain/heart
Foramen ovale- shunts from RA to systemic circulation
Tanner Stages for breast/pubic hairs
1: elevated papilla/villus hair
2: buds under areola/sparse labial hair
3: non-contour breast tissue/coarse curled hair w/ pigment
4: secondary mound/adult hair stops above thigh
5: adult contour w/ papilla projection/adult hair spreads to medial thigh
How is HPO axis suppressed in pre-puberty females
When does this change
Define Thelarche and Adrenarche
Estradiol
Intrinsic CNS inhibition of GnRH
Loss of intrinsic CNS inhibition at 11y/o; inc FSH/LH
Th: breast development
Ad: pubic hair growth
What is the sequence of changes in females through puberty
Earlier puberty onset has relation w/ ? issue
What starts puberty and what is the relation with the above issue
TAPuP Me Thelarche Adrenarche Pubarche Peak growth velocity Menarche
Obesity
Leptin- produced in heptocytes
What is the critical body weight needed for menarche initiation
Although the sequence of pubertal changes if TAPuP Me, what may be the first sign and is normal
What hormone release marks onset of puberty
48kg/106lbs
Pubarche
Pulsatile GnRH causes anterior pituitary to release FSH/LH
Define Precocious Puberty
What are the two types
Secondary characteristics <8y/o
Central: gonadotropin dependent (Isosexual)
Peripheral: gonadotropin independent (Iso/heterosexual)
What can cause Central Precocious Puberty
What can cause Peripheral Precocious Puberty
Idiopathic Tumor CNS anomaly Trauma Ischemia Iatrogenic
Tumor producing E/T CAH McCune Albright Ovarian cysts Primary hypothyroid Aromatase excess Glucocorticoid resistance
How is Central Precocious Puberty Tx
What are the risks of not Tx Precocious Puberty
What are the Tx goals
GnRH agonist to inhibit LH/FSH
Short stature
Advanced bone age
Psych distress
Maximize height
Synch puberty w/ peers
Dec psych distress
Define Delayed Puberty
What is the MC
What can cause this
Lack of thelarche by 13y/o
Lack of menses by 16y/o
Constitutional/physiological delay
Hypergonadotropic Hypogonadism (1* hypogonadism (dec ovarian function w/ absent sex steroid feedback= high FSH/LH)
Hypogonadotropic Hypogonadism (2* hypogonadism) d/t GnRH deficiency; low FSH/LH
Stopped
Slide 30, Deck 3
