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Senoir 21-2 > OBGYN I, Underlined > Flashcards

OBGYN I, Underlined Flashcards

1
Q

What is the Chadwick sign?

A

Early blue tint to the cervix

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2
Q

What is goodell sign

A

Cervical softening due to edema

Can be an early sign of pregnancy

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3
Q

What is Hegarsign

A

Isthmus (uteral) softening

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4
Q

What is the ecto cervix covered by

A

Squamous cell epithelium

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5
Q

What is the Endo cervix covered by

A

Columnar epithelium

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6
Q

What are the bilateral MUSCULAR tubes that connect the uterus to the ovaries

A

Fallopian tubes

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7
Q

What type of cell lines the Fallopian tubes

A

Ciliated columnar

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8
Q

What is the most common site of ovarian cancer ?

A

The outer layer of the ovaries covered by epithelium

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9
Q

What are the most favorable hip formations for vaginal delivery

A

Gynecoid and anthropoid

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10
Q

What are the two least favorable pelvic formations for vaginal delivery

A

Android and Platypelloid

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11
Q

What is Mcroberts maneuver ?

A

Not underlined, but leg hyper flexion to assist in vaginal delivery for should dystocia

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12
Q

When do the “primordial follicles” develop in utero

A

At 16 weeks, gonadal cords/ Cortical cords break into cell clusters called primordial follicles

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13
Q

Do any oogonia form postnatally?

A

No

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14
Q

What is the hormone that suppress the formation of the uterus and uterine/ Fallopian tubes in utero

A

MIH/ AMH

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15
Q

What are the paramesonephric structures

A

Fallopian tubes, uterus and UPPER third of the vagina

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16
Q

If there is an arrest of development of utero vaginal primordium at 8 weeks what structures would not form properly?

A

Paramesonephric structures: Fallopian tubes, uterus, and upper third of vagina

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17
Q

What is the etiology of a double uterus ?

A

Failed fusion of the inferior paramesonephric ducts

May have single or double vagina

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18
Q

What is the etiology of a bicornuate uterus?

A

Duplication of ONLY the SUPERIOR part of the body of the uterus

Can be complete or partial

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19
Q

What is the etiology with a bicornuate uterus with a rudimentary horn ?

A

Slowed growth of 1 paramesonephric duct
- does not fuse w/ 2nd duct

Rudimentary horn may not connect w/ uterine cavity

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20
Q

What is the etiology of a septate uterus ?

A

Normal outer uterine appearance, divided internally by thin septum

Failure of resorption

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21
Q

Define ovotesticular DXD

A

When ovarian tissue AND testicular tissue is found in either same gonads or opposite gonads

Can happen in 46XX or XY

The external genitalia with ALWAYS be ambiguous

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22
Q

Define 46XX DSD

A

Ovaries present and normal, but ambiguous external genitalia

Female fetal exposure to excess androgens = external genital virilization

Clitoral hypertrophy, partial fusion of labia majora, persistent urogenital sinus

2/2 CAH (most common cause)

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23
Q

What is the most common cause to 46XX DSD

A

Congenital Adrenal Hyperplasia

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24
Q

Define 46 XY DSD

A

Inadequate virilization of the male fetus

2/2 defects in synthesis of testosterone

Disorder of testicular development

Presents with variable development of external and internal genitalia

2/2 inadequate production of testosterone and MIS by the fetal testes

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25
Q

Define Androgen Insenitivity Sydrome (AIS)

A

Normal external female genitalia; presence of testes & 46XY

Testes located in abdomen or inguinal canals

Pt is resistant to testosterone

At puberty will have normal development of breasts with no femal characteristics
NO MENSES

Can have ambiguous genitalia (partial)

2/2 point mutations in the sequence codes for androgen receptors

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26
Q

What is the increase Dz RSK for pts with AIS and what is the treatment approach to prevent it?

A

Developing malignancy By age 50

So testes are removed upon Dx

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27
Q

What is the big difference between AIS and 46 XY DSD

A

AIS has normal appearing female genitalia;

46XY ovotesticular DSD external genitalia potentially more ambiguous

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28
Q

A pt presetns with anosmia and poorly defines 2nd sex characteristics

With a LOW FSH, and LH

Think what syndomre

A

Kallman

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29
Q

What is 47XXY ?

A

Klinefelters

Low T, elevated FSH? LH

Micropenis, crytorchid

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30
Q

What is 45XO

A

Turners Syndrome

Elevated FSH/LH
Low Estrogen

“Streak gonads”

Webbed neck, low hairline, short

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31
Q

What is spermatogenesis

A

Taking primordial germ cells and making spermatids

Producing 4 mature mobile sperm from every primary spermatocyte

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32
Q

What is spermiogenesis

A

The conversion of the actual sperm

The LAST phase of spermatogensis

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33
Q

What is the time frame and location of spermiogenisis

A

2 month process + 1 month maturation

Located in the seminiferous tubules

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34
Q

What is the acrosome

A

Anterior 2/3 of the head of the sperm

Contains the enzymes to penetrate the zona pellucid a and dispersion of follicular cells of the corona radiata

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35
Q

What portion of the sperm contains the mitochondria

A

The middle of the sperm tail

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36
Q

What is “sperm capacitation”

A

Happens post ejaculation and is the process by which sperm acquire the ability to fertilize the ova

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37
Q

What is the function of the prostaglandins in semen

A

Stimulate uterine motility at time of intercourse

Aid in movement to site of fertilization in ampulla

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38
Q

Define the proliferative phase

A

Estrogen proliferates the endometrial glands

And endometrial growth is maximized

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39
Q

Define the secretory phase

A

PROGESTERONE produced by the corpus luteum stimulates the secretion of glycogen and mucus

Glands become tortuous and dilated

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40
Q

What is the effect of estrogen on the mucus during ovulation

A

Since there is high estrogen at ovulation

There is an increase in the amount of mucus that is more alkaline, with a low viscosity

FERNING appearance

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41
Q

What is the effect of progesterone on cervical mucus

A

Makes it thick and cellular

Otherwise at ovulation the mucus looks fern like

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42
Q

What is the differnce between an acrosomal reaction and a zona reaction

A

Acrosomal reaction: enzymatic penetration of zona pellucida

Zona reaction: change in solubility and binding of zona pellucida
- ovum now impermeable to other sperm

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43
Q

What is the stage of the fertilized egg that implants in the uterus

A

The blastocyst

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44
Q

What are the 2 cell layers of the blastocyst

A

Embryoblast forms embryo, amnion, umbilical cord

Trophoblast (chorion) forms placenta
-Produces hCG

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45
Q

What is the maternal component of the placenta

A

The decidua

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46
Q

What are the three portions of the decidua

A

The basalis, the capsularis, and the parietalis

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47
Q

Billows trophoblasts (growth support) become…

A

Chorionic villi

anchoring support

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48
Q

Define placenta accreta

A

When nitabuchs layer adheres to the myometrium

This is not good

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49
Q

Define placenta increta

A

When nitabuchs layer INVADES the myometrium

Really really not good

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50
Q

Define placenta percreta

A

When the placenta perforates THROUGH the myometrium

This is REALLY really bad

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51
Q

What is the hormone that maintains the corpus luteum

A

hCG

52
Q

What structure produces hCG

A

Produced by syncytiotrophoblast during 1st trimester

53
Q

What is the rate of production of hCG

A

Doubles every 2 days

Peaks by 60-70 days
Then declines to plateau for remainder of pregnancy

—Abnormally low in ectopic & spontaneous abortion

—High in gestational trophoblastic neoplasia (GTN)

54
Q

What are the 3 advantages of gas exchange for teh fetus

A
  1. Fetal hemoglobin has a high affinity for O2
  2. Bohr effect, there is low o2 affinity w./ low ph
    (Fetal environment is acidotic)
  3. Fetus has a higher hgB
55
Q

What are the vessels in fetal circulation

A

Umbilical Cord
-One vein: oxygenated & pressurized R side

-Two arteries: deoxygenated & flaccid L side

56
Q

TAPup ME ?

A

Thelarche (1st)
Adrenacrche
Pubarche
PEak Growth Velocity

MEnarche

Order of puberty onset

57
Q

What are the normal 1st signs of puberty

A

Thelarche is usually 1st, however some girls can presents with pubarche first

58
Q

What is the pulsatile hormone around age 8 that starts the onset of puberty

A

PULSATILE exposure of GnRH causes anterior pituitary to release FSH/LH
(onset of puberty)

59
Q

What is generally the 1st sign of secondary sexual characteristics

A

Thelarche, around age 10

Tanner stage 2

60
Q

What is the general time frame for menarche after Thelarche onset

A

Typically 2.5 years after thelarche

61
Q

What is the treatment for central precocious puberty

A

Onset will be before age 8

FSH and LH will be HIGH!!

Treat with Continuous GnRH exposure to negative feed back and inhibit LH/FSH production

62
Q

What is the tx approach to PERIPHERAL precocious puberty

A

Pt will have onset of puberty before age 8,

FSH and LH will be LOW!!!

Treat the underlying cause

63
Q

What is the most common type of delayed puberty

A

Constitutional Delay

Lack of thelarche by age 13 or no menses by age 16

64
Q

Is the follicular phase a set number of days?

A

No!

Variable duration

65
Q

Define the proliferative phase of the menstrual cycle

A

Aka the follicular phase

FSH stimulates a follicle

Granulosa cells convert androstenedione into estradiol

On day 14 LH spikes!! And starts ovulation

66
Q

Increasing estradiol levels in the follicular phase of menses leads to what..

A

An LH surge (ovulation)

67
Q

When does ovulation start after the LH surge ?

A

With 36-40 hours

68
Q

What is the only phase of menses with a defined duration .?

A

The luteal phase

9-10 days long

69
Q

If no corpus luteum is produces in an a ovulatory cycle

What happens?

A

Lots of estrogen
(not cyclically produced), but no corpus luteum
(no progesterone surge to balance)

“Unopposed estrogen” can lead to ↑ uterine lining (proliferation)

70
Q

What is the second most common cause of 2* amenorrhea after pregnancy

A

Anovulatory cycle

71
Q

Define primary amenorrhea

A

No menses by age 16 in presence of normal secondary sexual characteristics

No menses by age 14 in absence of secondary sexual characteristics

No menses w/in 3 yrs of thelarche

72
Q

Define 2* amenorrhea

A

Absence of menses for at least 3 months in women who were previously menstruating regularly

73
Q

What is the evaluation process for Amenorrhea

A

Progesterone withdrawal test

Give progesterone x 10 days

If bleeding ensues, assume 2 things:

  • Nml estrogen production to have developed endometrium
  • Patent outflow tract intact
74
Q

What is the DDx for AUB

PALM NOICE

A

Polyps
Adenomyosis
Leiomyoma
Malignancy

Not yet classified 
Ovulatory Dysfunction 
Iatrogenic 
Coagulopathy 
Endometrial
75
Q

What is the marker in mm for Endometrial thickness in post menopausal AUB

A

EMT less than 4 mm and abNML

EMT less than 4 mm w risks of cancer

Greater than 4mm
Or EMT not clearly seen

All lead to a Bx

76
Q

What is the tx for acute stable menorrhagia ?

A

Combined OCPs

If unstable or no response within 12-24 hours

Send for surgery!

77
Q

What is the tx approach to chronic recurrent menorrhagia

A

Levonorgestrel IUD is often the most effective 1st line tx

NSAIDs for pts that are mild and not already taking NSAIDs

78
Q

What is the tx for primary dysmenorrhea

A

NSAIDs

OCPS

79
Q

What are the Ds of endometriosis

A

Dysmenorrhea

Dyspareunia

Dyschezia

Infertility D

80
Q

What is the definitive Dx for Endometriosis

A

Laparoscopy

81
Q

What is the tx approach to endometriosis

A

If minimal: watchful waiting

Mild: NSAIDs
-if ineffective try cyclic hormones (progesterone/ OCPs)

-if above still unaffective, then send to OBGYN for lap Dx

82
Q

What are danazol and Leuprolide

A

Danazol is a androgen analog that inhibits FSH/LH and can be used in endometriosis Tx in pts older than 16

Leuprolide is a GnRH agonist that can decrease estrogen production and used in pts of adult age

83
Q

What is Premenstrual Dysphroic Disorder

A

DSM-5: at least 5 symptoms w/ significant psychosocial or functional impairment

84
Q

How do you DDx PMDD

A

Pt presents with s/s min the luteal phase and is s/s free for at least 7 days in the 1st Half of the menstrual cycle for at least 3 consecutive cycles

85
Q

What is the primary treatment for PMS/PMDD

A

SSRi

2* long anovulatory agents
-OCPs, GnRH Agonist

86
Q

What is FSHIUL for menopause s/s

A

FSH-
Flashes, Flushes, forgetful
Sad, Skin, skeleton, stroke
Headaches, HDz

IUL-
Insomina
Urinary S.s
Libido decrease

87
Q

What is the increased risk factor in all age groups taking hormone therapy

A

Increase stroke risk

88
Q

Why should you not give unopposed estrogen to women with uteruses

A

↑ risk of endometrial hyperplasia, neoplasia, and endometrial cancer

89
Q

If a pt has an intact uterus, and menopause symptoms

What topical agent can be used .?

A

Low dose topical estrogen

90
Q

What are the osteoporosis risk factors

SHATTERED

A 
Steroids 
Hyperthyroid, HyperCa+, hyper parathyroid 
Alcohol 
Tobacco 
Low Test 
Thin
Early Menopause 
Renal or liver failure 
Erosive bone Dz 
Dietary low Ca

Family Hx

91
Q

What scan should be done for all menopausal women

A

DEXA scan

For 65 y/o with 1 RSK fx for Osteoporisis or sustained fxs

Or is perimenopausal with a RSK fxs and low BMI or meds known to accelerate bone loss

92
Q

A z score less than what requires a workup for osteoporosis ?

A

-2.0

93
Q

What are the ADE of Bisphosphonates ( Rx used to treat osteoporosis)

A

ONJ AFF

GI inflammation/bleeding
Take on empty stomach, remain upright 30m

Adverse effects:
ONJ: osteonecrosis of the jaw
AFF: atypical femur fracture, often bilateral

94
Q

What type of bacteria are responsible for BV

A

Overgrowth of anaerobic species:

-Gardnerella vaginalis, Ureaplasma urealyticum, Mobiluncus spp, Mycoplasma hominis, & Prevotella spp

95
Q

What is the Rx for BV

A

Metronidazole
(500 x 7days or 5g intravag x 5 days)

Or

Clindamycin cream 5g intravag for 7 days

96
Q

What medication do you add on for chronic./ recurrent BV

A

Use Metro and clinda as regular and add 30d PV boric acid suppository

If more than 3 episodes of BV in last 12 months?
Maintenance regimen.
Metrogel or PO nitroimidazole x 7-10d, then metrogel 2 x weekly for 4-6m

97
Q

What are two risk factors for Candida infections

A

Pregnancy and Immunosupporesion

98
Q

What is the treatmetn for Recurrent candida infections

A

If acute then Oral Fluconazole q 72 hours or Vaginal azole x for 7-14 days

Suppressive therapy is fluconazole weekly for 6 months
May need to tx indefinitely

99
Q

What is the Rx for non albicans canidida infections

A

Not as responsive

Fluconazole q 72 hours
Boric Acid PV every day for 2 weeks

100
Q

Why would you give a steroid for a candida infection

A

Symptomatic treatment for external irritation

Topical mid-potency steroid can help symptoms associated w/ external inflammation

101
Q

A pt presents with forthy green yellow D/c and a strawberry cervix

A

Trichomoniasis

102
Q

Can BV and Trich present together ?

A

Yes both have high pH

If together treat the BV as well
Metro or clinda

103
Q

Inflammation of the vaginal dermis

Is called

A

Lichen sclerosus

104
Q

What is the major ADE of having lichen sclerosus

A

Increased risk of cancer

105
Q

What is the cause of lichen simplex chronicus

A

Itch scratch cycle

106
Q

A pt presents with excoriations w/ background erythema
With a thickening of the skin. Leathery grey appearance

Think

A

Lichen Simplex Chronicus

107
Q

If lichen simplex chronicus doesnt heal in 3 weeks…

A

Get a Bx

108
Q

How does psoriasis present in skin folds

A

more red w/ fine scale = inverse psoriasis

109
Q

What is the most common form of Lichen Planus?

A

Erosive

110
Q

What are the major criteria for Toxic shock Syndrome

A

HOTN
(Ortho Syncope, or BPP less than 90)

Macular erythoderma

Fever

Skin desquamation (1-2 weeks post rash onset)

111
Q

What are the minor criteria for toxic shock syndrome

A

GI upset: Diarrhea or Vomiting

Mucos Membranes

Muscular S/s

Renal (BUN/ Cr 2x greater than NML)

Platelets less than 100,000

Hepatic: Elevated ALT/ AST

AMS

112
Q

Most common vulvar cancer

A

Squamous cell that arrises predominantly on the vestibule

113
Q

What are the risk factors for vulvar cancer in women over 55+

A

Tend to be nonsmokers w/out STD

HPV related to only 15% of cases in this age group

Related to long-standing lichen sclerosus

114
Q

A pt presents with pruritus and visible lesion

With pain, bleeding and ulceration

That is chronic

Think

A

Vulvar cancer

115
Q

How does SCC of the vagina present

A

Presents as vaginal bleeding

Usually from metastatis

116
Q

Where do nearly all cervical neoplasias develop

A

With in the T zone

117
Q

What is nearly always the cause of cervical neoplasia

A

HPV

118
Q

What are the high risk HPV strains

A

Types 16, 18

119
Q

Persistent HPV infections lead to..

A

Cervical Cancer

120
Q

What is the role of the HPV vaccine and who should get it

A

Prevents cancer

And age 9-45

121
Q

How often should pap testing be done for HPV screening

A

q 3 years

122
Q

How often should primary HPV testing be conducted

A

Q 5 years

Do cotesting together

123
Q

When can you discontinue screening in cervical dysplasia and HPV

A

Older than 65 AND

NO history of CIN 2+ in last 20 years AND
-Two consecutive negative primary HPV tests within 10y (most recent in past 5y)

OR

Two consecutive negative co-tests within past 10y (most recent in past 5y)

OR
Three consecutive negative Pap tests within 10y (most recent in past 5y)

124
Q

What do you do if a pt has AGC

A

If atypical endometrial cells: endometrial and endocervical sampling + colposcopy

All other types: colposcopy + endocervical sampling
(if pregnant – no endocervical sampling)

If also 35+: colposcopy + endocervical and endometrial sampling

125
Q

What is the follow up for cervical cancer

A

Every 3 months for 2 years

Then every 6 months for 5 years post treatment

Then annually

Senoir 21-2 (77 decks)

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