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Senoir 21-2 > OBGYN! Repo Anatomy > Flashcards

OBGYN! Repo Anatomy Flashcards

1
Q

What are the muscles of the pelvic diaphram

A

Levator ani

Coccygeus muscle

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2
Q

What is the “HART” line

A

“Hart Line:” demarcation between skin and mucous membrane on inner surface of labia minora

Outer surface to Hart Line: keratinized stratified squamous epithelium

Medial to Hart Line: nonkeratinized squamous epithelium

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3
Q

Where are bartholin glands

A

4 and 8 o’clock

Below hymenal ring; lubrication

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4
Q

Where are skenes glands

A

(largest paraurethral glands)
Fluid secretion to lubricate urethral opening

Near urethral meatus

Anterior wall of vagina

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5
Q

What are the anatomical borders of the vagina

A

Musculomembranous tube from hymenal ring to uterus

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6
Q

What is the cell type in the vagina

A

Nonkeratinized stratified squamous epithelium

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7
Q

What are the fornixes of the vagina

A

Recessed areas bordering cervix, “arch”

There are 4

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8
Q

What is the pouch of Douglas

A

AKA rectouterine pouch

Lowest point in abdominal cavity: fluid accumulation

-?Ectopic pregnancy

Procedure to drain fluid: Culdocentesis

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9
Q

What is Chadwick’s sign

A

early; blue tint (inc. vascularity)

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10
Q

What is Goodell Sign

A

cervical softening d/t edema

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11
Q

What is Hegar sign

A

isthmus (uterus) softening

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12
Q

What cells cover the ectocervix

A

Squamous epithelium

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13
Q

What are the cells of the Endo cervix

A

Columnar epithelium

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14
Q

What happens to the cervix under the influence of life

A

Everts

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15
Q

What is the most common site of fertilization

A

The Ampullla

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16
Q

What is the most common site for ectopic pregnancy

A

Ampulla

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17
Q

How does the fimbriae grab an egg from the ovarie

A

Salivary sweeping action

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18
Q

The Ovaries secrete what ?

A

Estrogen and progesterone in response to FSH and LH

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19
Q

What is the most common site for ovarian cancer

A

The outer epithelium of the ovary

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20
Q

Where do the L and R ovaries drain into

A

L ovary drains into L renal vein

R ovary drains into IVC

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21
Q

What is the línea terminalis

A

Linea terminalis is the boundary between the greater pelvis and lesser pelvis as well as the plane of the pelvic inlet. “pelvic brim”

Thelinea terminalisorinnominate lineconsists of the pubic crest,pectineal line(pecten pubis), thearcuate line, the sacral ala, and thesacral promontory.

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22
Q

What is the difference between the true and false pelvis

A

“True:” important in childbearing
Immobile; constrains delivery of fetus

“False:” above linea terminalis
Physically supports pregnant uterus

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23
Q

What is vertex presentation of a baby

A

Chin tucked small diameter

Good for baby and mom

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24
Q

What is sinciput and brow presentation of baby

A

Larger diameter of head and neck flexion

Not great for mom or baby

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25
Q

What are the two most favorable hip anatomies for birth

A

Gynecologist and Anthropoid

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26
Q

What is the in utero gonadal development

A

Begins at 5w; committed by ~7w

Testes develop: ~7w

Ovaries develop: ~12w

Decided by TDF and MIF

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27
Q

What is the dif between Mesonephric and Paramesonephric ducts

A

Mesonephric (Wolffian) ducts: male reproductive development

Paramesonephric (Mullerian) ducts: female reproductive development

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28
Q

What is the ovarian development at 16 weeks gestation

A

~16w: cortical cords break into cell clusters: “primordial follicles”

Each primordial follicle contains an oogonium (primordial germ cell → egg)

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29
Q

What is important about anti-mullarian hormone in utero in males

A

STOPS female sex anatomy production in developing baby

AMH suppresses development of paramesonephric (Mullerian) ducts, which form uterus and uterine/fallopian tubes

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30
Q

Paramesonephric ducts are responsible what development of what anatomy

A

Fallopian tubes, uterus, and upper third of vagina

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31
Q

What is ovotesticular DSD

A 
Rare
-Chromatin-positive nuclei (typically)
~70%: 46XX 
~20% mosaic: 46XX/46XY
~10%: 46XY

Most will have “ovotestis” (both testicular & ovarian components present)

Phenotype: male or female

External genitalia are always ambiguous

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32
Q

A pt presents with presetn and normal ovaries with ambitious external genitalia.

Think

A

Female fetal exposure to excess androgens -external genital
Virilization

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

46XX DSD

Most common CAH or tumors

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33
Q

A baby is supposed to look male however they have underveloped testicles

Think

A

46XY DSD

Caused by inadequate production of testosterone and MIS by the fetal testes

“Chromatin-negative” nuclei (no sex chromatin)

Testicular tissue present
Could be visible, undescended, or present with ovarian tissue

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34
Q

What are the features of AIS

A

Androgen Insenitivity syndrome

46XY
Normal external genitalia
+cryptorchid testes

Blind vaginal pouch
With testicles that are resistant to testosterone

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35
Q

Define the syndrome :

Hypogonadotropic hypogonadism
Anosmia
Infertile, poorly defined 2ndary sexual characteristics

Typically born with normal sexual differentiation!
Low FSH, LH, and estrogen

Failure in production/activity of GnRH (lack of GnRH, LH, FSH surge in infancy)

A

Kallman!

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36
Q

Define the syndrome:

47XXY
Low T, elevated FSH, elevated LH; FSH > LH

Presentation varies, but may include micropenis, hypospadias, cryptorchidism

Often not diagnosed, or diagnosed in adulthood d/t incomplete virilization

May present with s/sx of androgen deficiency, infertility

A

Klinefelter

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37
Q

Define the syndrome

45 XO
Hypergonadotropic hypogonadism
Elevated FSH and LH
Low estrogen

“Streak” gonads, short stature, webbing of neck, low hairline, short stature

“gonadal dysgenesis”

A

Turner Syndrome

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38
Q

Haploid vs Diploid cells

A

Diploid 46XY

Haploid 23

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39
Q

What is the purpose of the acrosome on a sperm

A

Enzymes to penetrate zona pellucida and dispersion of follicular cells of corona radiata

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40
Q

What is the difference between Spermatogenesis and Spermiogenesis

A

Spermatogensis is development of spermatocytes

Spermiogensis is transition into sperm

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41
Q

What is sperm capacitation

A

Physiologic process by which sperm acquire ability to fertilize ova

Occurs right after ejaculation

42
Q

What is the role of prostaglandins in sperm transport

A

Prostaglandins (in semen)

  • Stimulate uterine motility at time of intercourse
  • Aid in movement to site of fertilization in ampulla
43
Q

What hormones surges right before ovulation

A

LH

44
Q

What hormone causes proliferation of the endometrium

A

Estrogen

45
Q

This phase of the reproductive cycle is when estrogen proliferates endometrial glands and endometrial growth is maximized

A

Proliferative phase

46
Q

This phase of the reproduction cycle is when progesterone stimulates glands to secrete glycogen and mucus

A

Secretory phase

47
Q

What are the effects of high estrogen at ovulation

A

Increase amount of mucus that is alkaline and not viscous
With a favorable electrolyte content

Making it more favorable for sperm motility

48
Q

How many days post ovulation is the hCG starting to be secreted in a fertilization

A

8 days

49
Q

What is the acrosomal reaction of sperm and egg

A

enzymatic penetration of zona pellucida

50
Q

What is the zona reaction of the sperm and egg

A

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

51
Q

What is a morula

A

16-cell stage of a Zygote

52
Q

What does the trophoblast become

A

Placenta

53
Q

When does the Blastocyst make it to the endometrial cavity s/p ovulation

A

4 days

54
Q

What are the 3 phases of implantation

A

Apposition
(Contact with the uterine wall)

Adhesion
(Contact between the blastocyst and uterine epithelium)

Invasion
(Penetration of the uterine vasculature)

55
Q

What is the maternal component of the placenta

A

Decidua

56
Q

How does maternal blood get to the baby

A

Decidua

57
Q

3 parts of the Decidua

A

Decidua basalis

Decidua capsularis
(separates conceptus from uterine cavity)

Decidua parietalis

58
Q

When you think chorion

Think

A

Baby contribution to the placenta

59
Q

What two layers does the chorion turn into by day 8

A

Cytotrophoblast (inner layer)

Syncytiotrophoblast (outer layer)

60
Q

What is Nitabuchs Layer

A

Maintains maternal/placental separation

Zone of fibrinoid degeneration in decidua basalis

61
Q

What is placenta increta

A

When the placenta invades the myometrium

BAD!

62
Q

What is placenta percreta

A

When the placenta perforates through the myometrium

63
Q

What is placenta accreta

A

When the placenta adheres to the myometrium

BAD!

64
Q

IN a normal pregnancy what is the rate of hCG production

A

Doubles every 2 days

65
Q

When does hCG peak in a normal pregnancy

A

Peaks at around 60-70 days

Is thought to be a contributor to N/V in pregnancy

66
Q

What is the peak of hCG in a normal pregnancy

A

Peaks by 60-70 days

Then declines to plateau for remainder of pregnancy

Abnormally low in ectopic & spontaneous abortion

67
Q

What are is the HPO axis generally repressed?

A

Between age 4-10

68
Q

What is the first indication of puberty in female pts

A

Thelarche

69
Q

What is the association between obesity and early onset menarche

A

Leptin

Naturally found in adipocytes

70
Q

What is the critical body mass for menarche

A

48kg (106 lbs)

71
Q

What is the order of onset of puberty

A

Thelarche

Adrenal he

Pubarche

Peak Growth Velocity

Menarche

72
Q

What is the Endo function for the onset of Puberty

A

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

73
Q

When is the onset of menarche after thelarche

A

Menarche typically ~2.5 years after thelarche

74
Q

A pt presents with breast buds and straight pubic hair that appears of the labia majora

Think what tanner stage

A

Tanner stage II

75
Q

What is early puberty (precocious puberty)

A

Onset before 8 yo

76
Q

What is the tx approach to central precocious puberty

A

Treat w/ GnRH agonist to inhibit LH/FSH

Continuous GnRH exposure: negative feedback; inhibits LH/FSH

77
Q

What are the defining traits of central vs peripheral puberty

A

Central: High LH/FSH → ↑ estrogen

Peripheral: Exogenous source → ↑ estrogen
FSH/LH suppressed (low)

78
Q

What is the mean age of txt discontinuation for precocious puberty tx

A

11 y/o

79
Q

What is the most common type of delayed puberty

A

lack of thelarche by 12 and no menses by 16

Constitutional Delay

80
Q

What are the two presentations of delayed puberty

A

Due to gonads:
1° hypogonadism:
-High FSH/LH (hypergonadotropic)

Due to hypothalamus-pituitary: 2° hypogonadism:
-Low/nml FSH/LH (hypogonadotropic)

81
Q

What is the difference betweeen primary and secondary amenorrhea

A

Primary (no prior menses):
-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

Secondary (cessation of menses)
-Absence of menses for at least 3 months in women who were previously menstruating regularly

-All causes of secondary amenorrhea can cause primary amenorrhea!

82
Q

What is asherman syndrome

A

Intrauterine adhesions (cross links)

83
Q

What is the appraoch to amenorrhea

A

Is there breast development

Consider outlet obstruction (XX, NML Test)

Is there a uterine and cervix?
(US)

Determine FSH level

84
Q

What is the most common cause of secondary amenorrhea

A

Pregnancy

85
Q

What are the primary tests for amenorrhea

A 
β-HCG
FSH
Estradiol
Prolactin
TSH ± fT4
86
Q

SLIDE 64 !
All the mysteries of Amenorrhea

(Mental cycle lecture)

A
87
Q

What is PALM COIN for AUB

A

Polyps
Adenomyosis
Leiomyoma
Malignancy

Coag 
Ovulatory dysfunction 
Endometrial 
iatrogenic 
Not classified yet
88
Q

Slide 74 MEntral bleed flow chart

A
89
Q

What is the tx for AUB (ACUTE)

And stable

A

If stable:
Combined oral contraceptives (q6-8h x7d) or
Progestins: PO or IM

90
Q

What is the tx for AUB Acute and UNSTABLE

A

If unstable OR no response in first 12-24 hrs → surgery

1st: Dilation & curettage (D&C)

Balloon tamponade (if surgery unavailable or surgery delayed or as adjunct)

Uterine artery embolization (if above not working)

Hysterectomy (rarely, last resort)

91
Q

What is the Tx approach to chronic AUB

A

Normalize the prostaglandins
(if stable)
-NSAIDS

Use Medroxyprogesterone acetate (MPA) 10 mg daily for last 10 days of cycle
Combined contraceptives (oral, ring, patch)

Can try endometrial suppression , —Levonorgestrel (LNG) IUD → most effective, often first line for chronic HMB

Or TXA

92
Q

A Pt presents chronic pelvic pain, with pain during sex, and painful menses, and constipation + infertile

Think

A

Endometriosis

93
Q

What are the “D” of endometriosis

A

Dysmenorrhea

Dyspareunia

Dyschezia

InfetilitD

94
Q

Barbs located on uterosacral ligament …

Think

A

Endometriosis

95
Q

What is the definitive Dx for endometriosis

A

Laparoscopy!

96
Q

What is the tx for endometriosis

A

From watchful waiting to NSAIDs

If NSAIDs ineffective then cyclic hormones to suppress tissue growth

Can use Danzaol : analog that inhibits FSH./LH

GNRH agonistL Leuprolide

SRG Ablation (Fertility concerns and doesnt want OCP)

Refer to Chart in lecture 3 slide 103

97
Q

What phase of the cycle does PMS effect

A

Luteal Phase

98
Q

A pt presents with endometrial S.s during the luteal phase that is S/s free for 7 days in the first half of cycle x 3 consecutive cycles ..
think

A

PMDD

Think of mood charting for at least 2 cycles

99
Q

What are the top three S.s of PMDD

A

Fatigue and loading with Labile mood

100
Q

What is the primary tx for PMDD

A

SSRI

And An ovulatory agent (OCP)

101
Q

What is required to Dx Menopause

A

When the last period is 12 months ago

102
Q

What are the S/s of menopause

A

FSH,IUL!!

Flashes, Flushes Forgetfullness

Sad, Skin changes, Skeletaon, Stroke

headaches, HDz

Insomina

Urinary S/s

Libido Decrease

Senoir 21-2 (77 decks)

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