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Women's Health > Phys and Pathophys - part 2 - Exam 1 > Flashcards

Phys and Pathophys - part 2 - Exam 1 Flashcards

1
Q

During pregnancy, PMI shifts ____ and heart size increases _____

A

PMI shifts laterally and heart size increases by 12%

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2
Q

What is supine hypotensive syndrome due to?

A

compression of the inferior vena cava that causes hypotension, bradycardia and syncope when the pregnant pt lies supine

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3
Q

What cardiovascular changes will all INCREASE when pregnanct?

A

-stroke volume
-heart rate
-cardiac output
-blood flow distribution to the uterus, kidneys, breast and skin
- LE venous pressure increases

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4
Q

What heart rate increase in normal for a preg pt?

A

~ 15 bpm more at term than nonpregnant rate

progressively increases as the preg progresses and can be increased more for multiple gestations

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5
Q

What 2 cardiovascular changes DECREASE in preg?

A

-BP decreases slightly
-peripheral vascular resistance

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6
Q

What does increased LE venous pressure result in?

A

edema and varicosities

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7
Q

Why does peripheral vascular resistance decrease in preg?

A

due to enhanced vasodilators

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8
Q

Where are systolic murmurs the most common in preg? Why? How common are they?

A

Murmurs or bruits at left sternal edge

internal thoracic (mammary) artery

up to 90%! very common

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9
Q

What are some EKG changes that may be seen in pregnancy?

A

May see left axis shift, ST depression, T-wave flattening

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10
Q

What are 2 respiratory anatomic changes seen in preg?

A

Capillary dilation

rib cage is increasingly displaced upward and thoracic circumference is increased

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11
Q

What is the net effect of respiratory changes due to preg? Often can result in _______

A

less overall lung space, but less “dead space” and increased tidal volume

aka respiratory rate is constance but gas exchange efficiency is better

mild respiratory alkalosis due to more CO2 being expelled

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12
Q

What renal changes are seen with pregnancy?

A

Increased renal size
Dilated renal calyces and pelves
Dilated and tortuous ureters
Bladder - displaced upward,
flattened, decreased tone

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13
Q

What 3 renal functions increase with pregnancy?

A

plasma flow
GFR
Creatinine clearance resulting in LOWER serium CR and BUN

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14
Q

_____ activity increases when pregnancy and is very resistant to _____ effect

A

renin

pressor effects

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15
Q

Why would renin increase if not to cause vasopressor effects?

A

renin causes increased Na and water absorption which helps maintain the higher blood volume needed when pregnant

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16
Q

What are 2 noteworthy GI system effects due to preg?

A

increased salivation

decreased intestinal transit times in the 2nd and 3rd trimester

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17
Q

______ is an extremely common GI complaint due to preg? What are the 3 reasons behind it?

A

Reflux/heartburn in 30-80% of gravidas

Greater production of gastrin
Decreased esophageal peristalsis
Hormone-mediated relaxation of LES

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18
Q

what 2 liver changes are seen during preg?

A

Mild decrease in protein, esp. albumin
Increased serum alkaline phosphatase: due to alk phos isoenzymes from placenta

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19
Q

What electrolyte is especially affected by albumin?

A

calcium, because it is protein bound

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20
Q

During preg the blood volume increases by ______. Describe the process that leads to this.

A

50%

increased estrogen → stimulates RAAS → increased aldosterone → Na+ reabsorption → water retention

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21
Q

Why do you think we see a physiologic anemia in pregnancy?

A

due to disproportional amount of increase of blood volume (50%) to increase in RBC (33%)

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22
Q

Why are preg pts more likely to clot? give 3 reasons

A

Increase in several clotting factors

Decrease in protein S, fibrinolytic activity

Platelet count decreases due to hemodilution

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23
Q

Does immune function increase or decrease with preg? Do AI diseases tend to get better or worse with preg?

A

slightly decrease

AI diseases tend to get better

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24
Q

What effect does preg have on the pituitary gland?

A

Enlarges by 135% during normal pregnancy

growth hormone is increased

prolactin is 10X greater than normal

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25
does prolactin increase or decrease after delivery? When is prolactin levels the highest?
decrease after delivery even in breastfeeding women highest during pregnancy
26
hCG structurally similar to _____. ____ naturally drops during pregnancy. Can be mistaken for ______. Low ______ can mask ______ in preg
TSH TSH hyperthyroidism (need to check free T4 levels) TSH, hypothyroidism
27
PTH is ____ in first trimester and _____ in 2nd/3rd trimester
decreased in first and increased in 2nd/3rd
28
Is calcium increased or decreased in pregnancy? Why?
calcium is decreased Due to ↑ plasma volume, ↑ GFR, fetal transfer, lower albumin
29
Is vit D increased or decreased?
increased
30
Are ACTH and free cortisol increased or decreased? Aldosterine? why?
increased increased- RAAS activity, can help protect against natriuresis
31
What is a common eye complaint for preg pts? is IOP increased or decreased?
contacts due not fit as well but visual function is normal IOP decreases
32
during preg, cornea ______. What are Krukenberg spindles?
cornea thickens brownish-red opacity on posterior cornea
33
What is the dark line on the abdomen called? What is melasma?
linea nigra uneven darkening on the face that is exacerbated by sun exposure also common in women who are on OCP
34
What is the technical term for stretch marks? what are they caused by?
Striae gravidarum Thick, hyperemic skin caused by decreased collagen adhesiveness and increased ground substance formation
35
What is Cutis marmorata?
mottled appearance of skin secondary to vasomotor instability
36
What are Beau's lines?
Nails - brittle; horizontal grooves
37
What is this?
spider angioma
38
What is the average weight gain recommended for a preg pt?
25-35 lbs
39
What change to carb metabolism is common in preg?
Hyperinsulinemia and insulin resistance because your body wants to keep glucose in the blood to help maintain fetal development
40
What 4 electrolyte metabolism are decreased?
sodium, potassium, calcium, magnesium little change in phosphate
41
_______ is decreased in preg and needs to be supplemented in a NORMAL preg. Is fetal RBC production impaired if it is NOT supplemented?
IRON fetal RBC production is NOT impaired, only harms the mother
42
What 4 specials "things" need to be supplemented in a preg pt's diet?
**iron, folic acid, calcium** and zinc these 3 especially
43
how many additional calories are needed during a preg females diet? during lactation?
pregnancy: 300 calories lactation: 500 calories
44
What is the protein requirement for a preg female?
1 g/kg/day, plus 20 g/d in 2nd half of pregnancy 60-80 g/d in the average woman
45
What is the calcium requirement for a preg female? At what level does the maternal skeleton demineralize?
1200 mg during pregnancy and lactation < 600 mg/d - maternal skeleton demineralization
46
How much iron is recommended per day for a preg pt?
60-120 mg/day
47
________ reduces the risk of neural tube defects. _____is needed 1 month prior to conception and through the first 3 months of pregnancy
folic acid 0.4mg/day
48
what is the recommended folic acid supplementation if the pt is insulin-dependent DM or taking valproic acid or carbamazepine? _____ is recommendation if hx of neural tube defects
1mg/day 4mg/day
49
__________ may help with N/V of pregnancy
B6 + doxylamine
50
What is the recommended dietary intake for Vit C? How does it compare to a non-preg pt?
80-85mg/day 20% more than nonpregnant
51
What macronutrient is crucial for embryonic development?
protein
52
What are the 3 functions of the placenta? Is the placenta fetal or maternal in orgin?
Release hormones and enzymes to maternal bloodstream Transport of all fetal nutrients and metabolic products Exchange of O2 and CO2 for fetal circulation placenta is fetal in origin
53
How is arterial bleeding controlled in the placenta?
bleeding is controlled by uterine contraction
54
What do placental secretions help with?
Help control intrauterine growth, maturation of vital organs, and childbirth including hCG, placental proteins, steroids
55
T/F: Very few drugs/substances will cross the placenta
FALSE!! most substances WILL CROSS the placenta large molecular size or charge will have a HARDER time crossing: heparin, insulin
56
If a drug is bound to albumin will it be less likely or more likely to cross the placenta?
MORE likely to cross the placenta
57
______ from uterine spiral arteries drains freely into sinuses around placental villi. _______ helps control the amount of blood flow.
Maternal blood The degree of uterine wall contraction
58
What antibody is small enough to cross the placental barrier?
maternal IgG
59
What is a zygote? Once it divides it forms a ball of cells known as the ______
a single sperm enters the egg cell morula
60
When does the morula enter the uterus?
3-5 days after fertilization
61
What causes a blastocyst to form?
Gradual accumulation of fluid between cells of morula
62
a blastocyst inner cell group becomes the _______. The outer cell group becomes ________
inner: embryo outer: supportive tissues
63
Day______: blastocyst implants and invades the endometrium and myometrium **Day ______ : blastocyst is totally encased in endometrium
6-7 **10 aka fully buried in the uterus
64
During weeks 1-4 of gestation, the outer cell group will form _______ and the inner cell group will form _____
Outer cell group - chorionic villi → becomes placenta Inner cell group → becomes major cell lines that eventually give rise to distinct tissues
65
What are the 3 layers of embryonic tissue? What give rise to each?
Endoderm - innermost layer: Epithelial lining of multiple systems Mesoderm - middle layer: connective tissue Ectoderm - outermost layer: pidermis, sweat glands, hair, nails, tooth enamel, "outer epithelium: lining of mouth, nostrils and anus, nervous system
66
What 4 things begin developing at week 5?
brain, spinal cord, heart and GI tract
67
What is important to remember about week 6-7 of gestation?
development of eyes, ears and some bones limb bud and some cranial nerves heart begins to beat
68
What is important to note about week 8?
lungs begin to develop
69
what is important to note about week 9?
all essential organs have begun to form
70
What is important to note about week 10?
fetal heart tones are audible by doppler US marks the END of embryonic period
71
What is important to note about weeks 11-14?
RBC are produced in the liver urine is produced and put into amniotic fluid center of ossification in most fetal bones
72
What is important to note about weeks 15-18?
fine hair called lanugo develops sucking movement starts meconium is produced in the intestinal tract
73
What is important to note about weeks 19-21?
fetus is capable of hearing mother may begin to feel "fluttering" fetal movement
74
What is considered midpoint of pregnancy?
week 20
75
What is important to note about week 23-25?
bone marrow begins to make blood cells fingerprints and footprints form fetus may respond to sounds
76
**What week does the fetus have up to 90% of survivability? Why?
Week 26 **alveoli form in the lungs**
77
What is important to note about week 26?
fetus has hand and startle reflex alveoli form in lungs
78
**What is super important to note about weeks 27-30?
**surfactant begins to be produced
79
What is important to note about weeks 31-42?
fetus begins storing iron, calcium and phosphorus (weeks 31-34) increase in body fat
80
During what months of pregnancy is there the greatest risk of major fetal malformations?
first 2 months specifically weeks 3-8
81
_______ is one of the highest embryologic malformations in the entire body system. 20% are due from _______
Malformations of GU tract Genetic/inheritance
82
_______ is needed for a male GU tract. When does formation of GU structures begin?
Functional Y chromosome Weeks 4-8
83
What is the embryological reproductive development order?
genetic → gonadal → ductal → genital
84
What does genetic reproductive embryologic development determine by?
determined at fertilization by sex chromosomes
85
How does the gonadal part of embryologic development work?
genetic sex is expressed on developing gonadal tissue Sex-determining region of Y chromosome encodes for testis-determining factor (TDF)
86
What is the purpose of testis-determining factor (TDF)? Where is it found? When does it begin?
gonad differentiates into a testis with production of antimüllerian hormone and testosterone Sex-determining region of Y chromosome begins about week 8
87
What are the 2 different names for "male" ducts?
Wolffian ducts mesonephric ducts
88
What are the 2 different names for female ducts?
Müllerian ducts paramesonephric ducts
89
What is the responsibility of antimullerian hormone?
suppresses “female” Müllerian (paramesonephric) ducts until ductal differentiation, the embryo has both female and male ducts
90
what is the role of testosterone in embryologic development?
persistence and differentiation of “male” Wolffian (mesonephric) ducts
91
What is the difference between agenesis and agonadism?
agenesis - gonad did not form at all agonadism - gonads formed initially and later degenerated
92
What are streak gonads? What are the possibly caused by?
primordial gonadal formation, no differentiation due to lack of germ cells May have release of antimüllerian hormone without any production of testosterone - suppresses both ducts
93
What is the cloaca? At what point does the urorectal septum form?
precursor of urogenital structures weeks 5-7
94
What does the urorectal septum divide?
divides cloaca into the urogenital sinus and the anorectal canal
95
What does the cloaca become in a male? female?
male: urinary bladder, urethra, and penis female: urinary bladder, urethra and vagina
96
What is vaginal atresia?
the lower portion of the vagina is only fibrous tissue
97
as a male develops the Wolffian ducts become _______, _______ and _______
Epididymis, ductus deferens, ejaculatory ducts
98
In males, what is the vestigial remnant of the Wolffian ducts? mullerian duct?
Wolffian: appendix epididymis Mullerian: appendix testis
99
at the _____ week the testes descend through the inguinal canal. _____ week the testes is in the scrotum
28th week: descend through inguinal canal 32nd week: testes in scrotum
100
In females, what happens to the Wolffian ducts?
mostly regress and becomes trigone of bladder
101
in females, what happens to the mullerian ducts? Do they require ovaries to differentiate?
Midline fusion → uterus Distal ducts → oviducts do NOT require ovaries to differentiate, unlike in males that DO NEED testes (to provide testosterone) to differentiate
102
What does a bifid/double clitoris indicate? what does a hypertrophic clitoris indicate?
failure of fusion of the embryonic clitoris intersex disorder
103
Quiz yourself over this slide deck before you take the test. View in presentation mode!!. DO IT!!!
https://docs.google.com/presentation/d/1HCpaf8zHsf9ziAQlaOrPGC8LPGP27ybT7t_sG5TZ3wo/edit#slide=id.gee8a4675b_0_100
104
In order to normally develop has a male what 3 things must be true
1. Need functional XY chromosomes 2. Need antimullerian hormone to "get rid" of mullerian ducts 3. Need Testosterone to be present to encourage the growth of Wolffian ducts
105

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