OBGYN Cummulative Flashcards by brandon lovin

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

How well did you know this?

Not at all

Perfectly

? 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

How well did you know this?

Not at all

Perfectly

? 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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

? 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

How well did you know this?

Not at all

Perfectly

Define Ectocervix

Define Endocervix

Define Squamocolumnar Junction

Portion covered by stratified squamous epithelium

Portion covered by columnar epithelium

Columnar cells meet squamous cells

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

? 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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

? 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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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