Unit 1 Flashcards
This type of pelvis is rounded, slightly ovoid. spacious posterior segment, adequate sacrosciatic notch, hollow sacrum with backward sacral inclination. straight side walls. bones medium weight
Gynecoid
pelvis with wedge shaped inlet, narrow forepelvis, flat posterior segment, narrow sacrosciatic notch with sacrum inclining forward. side walls converge. bones medium to heavy
Android
This pelvis has long narrow oval inlet. extended and narrow anterior and posterior segment. wide sacrosciatic notch. long narrow sacrum
Anthropoid
This pelvis has very oval inlet with very wide rounded retropubic angle and wide flat posterior segment. sacrosciatic notch is narrow. normal but short sacral inclination. straight side walls
Platypelloid
period of formation of all major internal and external structures
embryonic period
week of development of identifiable testes and ovary
testes- 8 weeks, ovary-9 to 10 weeks
week of development when kidneys can excrete urine. genital duct of opposite sex degenerates
week 10
week of development: testis at deep inguinal ring, uterus and vagina recognizable
week of 18
months of development : scrotum solid until sacs and testes descend
months 7-8
normal age of puberty for boys and girls
boys: age 9 to 14, girls: age 8 to 13
increase in secretion of adrenal androgens before puberty
adrenarche
first event of puberty for girls
development of breasts: thelarche
what happens after development of breasts during puberty
development of axillary and pubic hair :pubarche
name for 1st menstrual period
menarche
when does ovulation begin?
1 year after menarche
hormones responsible for breast development
ovarian hormones: estradiol, progesterone
hormones responsible for axillary and pubic hair
adrenal androgens
early development of secondary sexual characteristics without gametogenesis. caused by abnormal exposure of males to androgen or females to estrogen
precocious pseudopuberty
pubertal development before age 8 in girls and 9 in boys
precocious puberty
age of delayed or absent puberty
absence of secondary sexual development by age 14 or failure of menarche by age 17
menopause
human ovary gradually becomes unresponsive to gonadotropins with age. sexual cycles and menstruation disappear. age 45 to 55
This means a girl has not had her first period by age 16.
primary amenorrhea
describes women who experience an absence of more than three menstrual cycles after having regular periods
Secondary amenorrhea
term meaning pregnant
gravid
term meaning number of births
parity
pregnancies ending before 20 weeks, induced or spontaneous
abortion
birth between 20 and 37 weeks
preterm
birth after 42 weeks
postterm infant
weight if LGA baby
over 4000g
weight of low birth weight infant
less than 2500 g
presumptive pregnancy signs (7)
- amenorrhea, 2. nausea and vomiting, 3. breast changes, 4. fetal movement, 5. elevated basal body temperature, 6. skin changes, 7. pelvic organ changes
nausea and vomiting during pregnancy (time frame and treatment)
lasts from 2 weeks to 13-16 weeks. treat with small meals dry diet and emotional support
breast tenderness during pregnancy
mastoidynia
areolar glands visible on skin surface more prominent during pregnancy
Montgomery tubercles
protein and antibody production occuring during pregnancy as early as 16 weeks
colostrum secretion
fetal movement occurring between 18 and 20 weeks
quickening
cause of elevated basal body temp during pregnancy
progesterone
skin darkening during pregnancy on forehead, bridge of nose, or cheek bones. occurs after 16 weeks
chloasma
darkening of lower midline from umbilicus to pubis caused by melanocyte stimulating hormone
linea nigra
skin lesions during pregnancy caused by elevated plasma estrogen
spider telangiectasia
congestion of pelvic vasculature causing bluish discoloration of vagina and cervix
Chadwick’s sign
widening and softening of uterus. occurs at 6 to 8 weeks caused by estrogen and progesterone
hegar’s sign
increase in vaginal discharge during pregnancy
leukorrhea
painless uterine contractions beginning at 28 weeks. stop with walking or exercise
Braxton hicks contractions
pregnancy diagnosis types (4)
- fetal heart tones, 2. uterine size/ fetal palpation, 3. ultrasound (heart sounds at 5-6 weeks), 4. pregnancy test
naegele’s rule
LMP- 3 months + 7 days
uterine size during pregnancy stages (up to 20 weeks)
8 weeks -pubic symphysis, 12 weeks-in abdomen, 16 weeks- halfway between pubic symphysis and umbilicus, 20 weeks at umbilicus
weeks of fetal heart tones
fetoscope- 18 to 20 weeks, doppler- 10 weekd
early pregnancy failure diagnosis
ultrasound - recognition of fetus without cardiac activity; lab-serial hcg test without increase
late pregnancy failure diagnosis
absence of fetal movement, absence of fetal heart tones
std tests performed at initial visit for pregnancy
syphilis, chlamydia, gonorrhea, herpes, job, trich, and candida
subsequent ob visits: what to check for
maternal weight gain, blood pressure, fundal height, fetal heart tones, edema, fetal size and position
3rd trimester labs
gestational diabetes screening, cbc, group b step
immunization during pregnancy
may receive killed virus, toxoid, or recombinant vaccines. may have flu shot, diphtheria, tetanus, hepatitis b and killed polio vaccine. live vaccines should be given 3 months postpartum
cardiac change during pregnancy
heart size increases by 12%, blood volume increases, cardiac output increases 40%, pulse pressure widens, murmurs (first heart sound may be split) 10% of women develop supine hypotension. bp decreases by 2nd trimester
lung changes in pregnancy
tidal volume and inspiratory capacity increase; lung capacity decreased; decrease in expiratory reserve. increased vascularization. diaphragm elevates
renal change during pregnancy
kidney length increases, hydronephrosis and hydroureter, urinary flow and sodium excretion double. renin and angiotensin II increase. gfr by 40 to 65%
bladder change during pregnancy
displaced upward and flattened. muscle tone decreased. urinary frequency
GI changes during pregnancy
stomach pushed upward, bowels pushed laterally. salvation increases. reflux problems (increased production of gastrin), constipation. swollen gums
hematologic changes during pregnancy
rbcs expand by 33%, iron deficiency, increase in WBC count, clotting factors increase, anemia, increases platelets . clotting: hypercoagulable
skin changes during pregnancy
hyperpigmentation ( linea nigra, melasma [darkening of forehead, bridge of nose, cheek bones]), striae, angioma, thickened hair, thinned nails
metabolism changes in pregnancy
decreased appetite, nausea, vomiting, weight gain, insulin resistance, risk for hyperglycemia
apgar scoring
done at 1 and 5 minutes of life; less than 7 at 5 minutes repeat every 5 minutes until score of 7 or at 20 minutes. score 0 to 10
immediate initial exam of infant
check airway for potency, suction, assess chest wall movement.. may hear crackles initially, heart rate should be greater than 100… should be mostly pink. examine genitalia. assess alertness, activity, tone, and movement of extremities
at birth normal forehead movement but difficulty closing eye and asymmetric facial expression with crying
peripheral facial nerve injury
reason for vitamin k dose and .5% erythromycin/1% silver nitrate/ 1% tetracycline
stop bleeding and prevent infectious conjuctivitis
normal resp for newborn; normal heart rate
respirations: 40 to 60; heart rate 100 to 160
head evaluation in newborn
check for asymmetry, premature suture line fusion. No tension or bulging of fontanelle
caput succedaneum
localized collection of blood under dura mater that crosses suture lines
cephalohematoma
localized collection of blood under the dura mater confined by suture lines.. related to hyperbilirubinemia and possible skull fxs
what should you do? absent red reflex
immediate opthalmologic eval to rule out cataract, retinoblastoma or glaucoma
causes of tachypnea in newborn
pneumonia, amniotic fluid, meconium aspiration, sepsis
chest asymmetry newborn means…
atelectasis, infection, mass, pneumothorax
split second heart sound in newborn means..
aortic and pulmonary valves are present
cause of innocent murmur
closing ductus arteriosus or foramen ovale
most common innocent murmur caused by
pulmonic stenosis
complex chd presentation
cyanosis, tachypnea, shock
omphalocele
midline abdominal wall defect where bowel and liver herniate through
gastroschisis
defect of abdomen to the right of umbilicus. bowel may be externalized but liver stays in
genital and anal exam newborn
check for ambiguous genitalia. check for rectogenital fistula
purpose of ortolani and barlow test and check for gluteal fold asymmetry
detect hip dysplasia
signs of spina bifida and diagnostics
sacral dimple or tuft of hair over sacral spine. eval with ultrasound then mri at 3 months of age
when should be first pee and poop of newborn
pee within 24 hours; poop within first 48 hours
standard newborn screening tests (5)
Guthrie test (for phenylalanine level), thyroid function test (congenital hypothyroidism), RPR or VDRL test for congenital syphilis, coombs test for abo incompatibility, otoacoustic emissions for hearing loss
how long does postpartum period last
6 weeks
immediately after pregnancy, what size is uterus
1 kg or size of 20 week pregnancy at level of umbilicus
abnormal uterine involution could mean??
infection, retained products of conception
contractions that occur 2 to 3 days postpartum
myometrial contractions or after pains
when is uterine involution complete? what is the size of the uterus then
6 weeks postpartum at 100 g
subinvolution of placental site
complete obliteration of vessels in placental site doesn’t occur. these patients are at risk for hemorrhage and persistent lochia
how to treat subinvolution of placental site
uterotonics
describe lochia rubra
1st stage of postpartum discharge. contains blood, shreds of tissue, decides. reddish brown
describe lochia serosa
2nd stage of postpartum discharge. serous to mucopurulent, paler, malodorous
describe lochia alba
happens during the second or third postpartum week. discharge is thicker, mucoid, yellowish white (because of leukocytes) ends by week 5 or 6
why is there ovulation suppression in lactating women
due to high prolactin levels which are elevated until 6 weeks postpartum. lactation may suppress periods as well due to suppressed estrogen levels
postpartum urinary retention caused by…
swelling and increased bladder capacity
when does gfr and creatinine clearance return to normal postpartum
gfr and creatinine clearance return to normal 8 weeks postpartum
when does bun return postpartum
end of 1st week postpartum
weight loss after pregnancy
10 to 13 lb immediately postpartum , and an additional 9 lbs 6 months postpartum
when do fatty acids and triglycerides return to normal after pregnancy
6 to 7 weeks
postpartum immunization (4)
rh, rubella, tdap, flu
What gland is needed for lactation
hypothalamic pituitary axis
mammogenesis
mammary growth and development
lactogenesis
initiation of milk secretion
galactopoiesis
maintenance of established milk secretion
hormone responsible for ductal tissue growth
estrogen
hormone necessary for milk progesterone
prolactin, ESTROGEN LEVELS MUST BE DOWN
colostrum
premilk section. yellowish, alkaline, has immunoglobulin (especially igA)
painful nipple tx
dry heat for 20 minutes 4 times a day, manual expression
engorgement: when and how to treat
expect starting days 3 and 4 postpartum. Tylenol, cold compress, partial expression, cabbage leaves
mastitis tx
local heat, antibiotic tx (cephalosporin, methicillin sodium, dicloxacillin sodium
when should self breast exam be done
same time every month, 1 week after period starts
when should mammogram be done
every 1 to years from age 40 to 50, then annually
What infections can be seen on a plain saline slide
trichomomas (swim), Candida (segmented and branching filaments), bacterial vaginosis ( clue cells covered by short coccobacilli bacteria)
What solution/ technique is used to diagnose bacterial vaginosis
potassium hydroxide. look for mycelia and fishy odor
fern test
for ovulation. cervical mucous spread on slide and allowed to dry. in non frondlike pattern shows (absence of progesterone) ovulation has occurred
Schuller test
use lugols solution that marks glycogen rich cells of the cervix. any portion that doesn’t accept dye is abnormal due to scar tissue, neoplasia, or precursors or columnar epithelium. biopsy is next step
vulva and vagina biopsy procedure
use 1 to 2% aqueous solution of local aesthetic solution. inject around suspicious area. use skin punch or scalpel. control bleeding with pressure or monsel solution
colposcopy
use for biopsy of cervical lesions
test for chlamydia and gonorrhea
nucleic acid amplification testing
how often to perform pap
after 3 normal Paps, only needed every 2 to 3 years.
when to do initial pap
start annually for 3 years after start of sex but no later than age 21
newborn genitals
breast budding (may have discharge from nipples, no tx needed), labia are bulbous, clitoris is protruding. hymen covers urethra orifice. vaginal discharge may occur. ovaries are abdominal organs at this time
young children genitals look
flattened labia, hymen is thinned, cervix is flush with vaginal vault.
older children genitals look (age 7 to 10)
mons pubis thickens, labia fill out, hymen thickens vagina elongates. cervix still at vagina vault. at age 9 or 10 ovaries descend to pelvis, uterus grows
young adolescents genitals (10 to 13)
genitals take adult appearance, bartholin gland starts to produce mucous. vagina reaches adult length. cervix movement. rounded shoulders and hips and fuller breasts from estrogen . leukorrhea present
young adolescents genitals (10 to 13)
genitals take adult appearance, bartholin gland starts to produce mucous. vagina reaches adult length. cervix movement. rounded shoulders and hips and fuller breasts from estrogen . leukorrhea present
Tanner stage 1
no breast buds, no pubic hair
Tanner stage 2
breast buds and papillae (and age 7.5 to 8) slightly elevated, sparse slightly pigmented pubic hair
Tanner stage 3
breasts and areola confluent and elevated, barker coarser curly pubic hair
Tanner stage 4
areola and papillae project above breasts, adult type pubis
Tanner stage 5
papillae projected, mature. lateral distribution of pubic hair
enlarged clitoris art birth could mean…
congenital adrenal hyperplasia, hermaphroditism, or neoplasoms
pelvic masses in newborn is likely…
Wilms tumor
seminal fluid can be seen with a…
wood lamp. semen will be fluorescent
mayer rokitansky kuster Hauser syndrome
congenital absence of the vagina accompanied by variable mullerian duct development
vaginal atresia
urogenital sinus falls to contribute to lower portion of vagina
turners syndrome
disorder in females, characterized by lymphedema, short stature, gonadal dygenesis, broad chest, webbed neck, coarctation of aorta, renal abnormalities
diagnosis and tx of vulvovaginitis
most common for premenarche, inflamed tissue, numerous leukocytes and occasional rbc on wet mount. treat with amoxicillin
lichen sclerosus
hypertrophic dystrophy of vulva. whitish ivory coloured lesion that doesn’t extend beyond middle of labia majora laterally or into vagina medially. pt presents with itching and status. tx: ultrapotent topical corticosteroids for 4 to 8 weeks
labial adhesion
labia adhere in midline and reepithelialization occurs. cardinal symptoms: dysuria and recurrent uti. tx symptomatic with estrogen cream for 3 to 12 weeks. after puberty will resolve
embryonal rhabdomyosarcomas
most commonly seen in girls under 3 yo. tumor. presentation: vaginal bleeding , tumor seen as polypoid projection in vaginal Cavity. tx now chemo and radiation to preserve normal anatomy and function and improve survival
ovarian torsion
symptom: abdomen pain, ovary enlargement. diagnostic: doppler study. needs urgent sx
tx for malignant ovarian tumor in young children
unilateral salpingooophorectomy
central precocious puberty or GNRH dependent
pubertal development that happens before age 8. may be associated with cns abnormalities but usually okay
peripheral GNRH independent precocious puberty
appearance of pubertal development but presence of sex steroids is independent of pituitary gonadotropin release. caused by congenital adrenal hyperplasia, tumors on adrenal, exposure to exogenous sex steroid hormones or mccune Albright syndrome
mccune Albright syndrome
presents: cafe au lait skin pigmentation and autonomous endocrine hyperfunction, early vaginal bleeding, could have pathologic fxs
premature thelarche
isolated development of breast tissue before 8 years old
premature pubarche
appearance of pubic or axillary hair before age 8 without signs of precocious puberty
tx for GNRH dependent precocious puberty
GNRH dialogues, which preserves skeletal maturation (better for normal growth)..tx until reaches puberty age
When to give 1st dose of hep b vaccine
at birth; if mother is positive give vaccine and 0.5ml of hep b immunoglobulin within 12 hours of birth. test infant between 9 to 12 months or 1 to 2 months after hep b series of delayed
When to give 2nd dose of hep b (normal)
age 1 to 2 months
following birth, if baby doesn’t get hep b dose at birth
get 3 doses at 0, 1 to 2 months, and 6 months
persistent amenorrhea tx
progestins every other month
menstrual cycle
cyclic vaginal bleeding that occurs with shedding of uterine mucousa. average length is 28 days from start of to start of next.
ovarian cycle
primordial follicles enlarge and cavity forms around ovum. 1 follicle in 1 ovary grows rapidly on the 6th day and becomes dominant follicle. singled out for development in follicular phase and makes estrogen. the mature follicle (graafian). at day 14 follicle ruptures and ovum is released into abdomen (ovulation). uterine tubes picks up and transports to uterus and degenerates if no fertilization. corpus luteum forms during luteal phase. fibrous tissue left behind from released ovum is corpus albicans
uterine cycle
endometrium regenerates under influence of estrogen from 5th to 16th day. uterine glands lengthen (proliferative/follicular). after ovulation, endometrium become vascularized and slightly edematous because of estrogen and progesterone from corpus luteum. in luteal phase endometrium produces prolactin. when corpus luteum regresses, causing endometrium shedding
vaginal cycle
under influence of estrogen, vaginal epithelium become cornified. under influence of progesterone, thick mucous is secreted and epithelium proliferates and becomes infiltrated with leukocytes.
anterior pituitary gland hormones
acth, growth hormone, thyroid stimulating hormone, fsh, lh, prolactin. controls ovarian secretion
posterior pituitary hormones
oxytocin and arginine vasopressin. secreted directly into systemic circulation by neurons
gonadotropins
fsh and lh - regular cyclic secretion of the ovarian hormones
hypothalamic hormones
control secretion of anterior pituitary hormones
fsh
released from anterior pituitary. responsible fit early maturation of ovarian follicles
LH
released by anterior pituitary. triggers ovulation and formation of corpus luteum
gnrh
secreted by hypothalamus. stimulates secretion of fsh and lh
hormones during menstrual cycle
regression of corpus (luteolysis), estrogen and progesterone levels fall. fsh and levels increase. new follicles develop and one matures (because of fsh and lh). estrogen rises causing spike in LH secretion and ovulation. corpus luteum starts. estrogen drops then steadily rises with progesterone then luteolysis reoccurs
how do estrogen and progesterone contraceptives work
interfere with gonadotropic secretion or implantation or inhibit union of sperm with ovum
prolactin role
released by anterior pituitary. causes milk secretion. inhibits gonadotropins making it a natural contraceptive. excessive in males causes impotence. normal level 5 ng/mL in men 8 in women
hyperprolactinemia
causes by tumor on anterior pituitary. may cause galactorrhea. happens in women with secondary amenorrhea
umbilical cord make up
2 arteries and 1 vien
placental previa
implantation of placenta over cervical os
Polydactyly or syndactyly are often associated with….
chromosomal abnormalities
ortolani test
push downward on femur while abducting the hips
barlow test
bring knees together at midline and then pushing down and out on the upper inner thighs
moro reflex
extension and then flexion and abduction of arms (embrace) opening of eyes and crying after being dropped a few centimeters back in bed
contraindications for breastfeeding
use of street drugs or excess alcohol, human t cell leukemia virus, breast cancer, active herpes, active tb, t cell lymphotropic, use of cancer drugs, hiv
hemangioma
benign tumor of vascular endothelium, not present at birth. involute after 6 to 12 months. need intervention if near eyes or airways
vascular malformations
ex portwine stains and salmon patches. present at birth . do not resolve spontaneously.
anterior fontanelle
1 to 4 cm, may be enlarged with hypothyroidism or increased intracranial pressure
torticollis
result of ischemia to or hemorrhage to sternocleidmastoid muscle at birth. manifests as head tilt with or without fibrous mass palpable in muscle . managed with home stretching
upper resp sounds in baby
congestion and stridor is normal
umbilical stump assessment
assess for redness or induration :signs of infection
when do insulin requirements return to normal after delivery
insulin requirements in Type I and II diabetics will return to their non-pregnant state at about 1 week after delivery
when do clotting factors return after pregnancy
10 days
blood loss amount from vaginal delivery vs c section
You should know the mean blood loss from a vaginal delivery is about 400mL and from a c/s is about 1L.
how long before hcg levels return to normal after delivery
2 weeks to return to normal after a vaginal delivery and even longer after a 1st trimester abortion.
rubella titer and pregnancy
All pregnant women should get titer. if non immune give vaccine before discharge
rhogam postpartum
given to women postpartum to prevent sensitization in rh negative women who’ve had fetal to maternal transfusion of rh positive fetal rbcs
visible jaundice in the 1st 24 hrs
never normal, indicates a hemolytic process, or congenital hepatitis
where to find pallor and cyanosis in dark skinned infants
lips, mouth, and nail beds
when is 3rd fontanelle present
in syndromes like down syndrome
craniosynostosis
prematurely fused suture causing abnormal cranial shape
iris speckling occurs in
down syndrome. also known as brushfield spots
age of nose breathers
less than 1 month…watch for nasal obstruction that can put baby in respiratory distress
purulent nasal discharge at birth means
congenital syphilis
3 components of medical history
- maternal and paternal medical and genetic history, 2. maternal past obstetric hx, 3. current antepartum and intrapartum ob history
apgar acronym
appearance, pulse, grimace, activity, respirations. taken an 1 and 5 minutes after birth
normal HR, RR, SBP for 1st day infant
hr: 120 to 160, rr: 30 to 60 per min, sbp: 50 to 70 mmHg
prominent tongue with which diseases
trisomy 21 and beckwith wiedemann syndrome
signs of Turner syndrome
redundant neck skin or webbing with low posterior hair line 0
1 to 2 month activities
lifts head, turns side to side, follows objects in visual field, drops toys, alert to voice, recognises parents, smiles
3 to 5 month activities
grasp, reach for and brings things to mouth, makes raspberry sound, sits with support, laughs, anticipates food on sight, turns from back to side
6 to 8 month activities
sits alone, reaches with 1 hand, imitates bye bye, passes object from hand to hand, babbles, rolls from back to stomach, inhibited by word no
9 to 11 month activities
stands alone imitates pat a cake and peek a boo. use thumb and index finger to pick things up, walks with furniture, follows 1 step command
1 year activities
walks independently, says mama and dada, pincer grasp, follow simple demonstration, gives toy on request, tries to build tower of toys, points to toys
18 month activities
throws balls, seats self in char, walks up and down stairs with help, says 4 to 20 words, understand 2 step command, carries and bugs doll, feeds self
24 month activities
speaks short phrases, kicks ball, points to named objects, jumps off floor, stands on 1 ft, uses pronouns, verbalize toilet needs, puts on simple garment
sensorimotor stage piaget
age birth to 2 years, sensory organs and muscles become more functional
preoperational stage piaget
age 2 to 7, emerging ability to think, egocentric, use of symbolism
concrete operational stage piaget
7 to 11 years old, learns to reason about events in here and now
formal operational stage piaget
age 11+ able to see relationships and to reason in abstract
Erickson stage 1
stage 1. trust vs mistrust (hope) 0 to 1.5 yo
erikson stage 2
autonomy vs shame ( will) 1.5 to 3 yo
erikson stage 3
initiative vs guilt (purpose) 3 to 5 yo
erikson stage 4
industry vs inferiority (competency) 5 to 12 yo
erikson stage 5
ego identity vs role confusion (fidelity) age 12 to 18
Freud staged
oral (0 to 18 mo) weaning, anal (18mo to 3/4yo) toilet training, phallic (3/4 to 5/7 yo) sexual identity, latent (5/7 to puberty) learning, genital (puberty +) genital intercourse
enuresis
repeated clothes wetting older than age 5, happens at least twice a week for 3 months
monosymptomatic enuresis
bedwetting only at night (every night for 6 months) after age 5, means delay of maturation of urologic and neurologic systems. usually genetic. can also be caused by overproduction of urine from decreased production of demopressin or resistance to antidiuretic hormone
non monosymptomatic enuresis
underlying pathology cystitis, diabetes insipid, diabetes mellitus, seizure disorder, neurogenic bladder, obstruction
encopresis
constipation, 2 months with (2 or more): fewer than 3 bowel movements per week, more than 1 episode per week, impaction of rectum with stool, passage of large stool that obstructs toilet, retentive posturing and fecal withholding, pain with defecation
colic: rule of 3s
colicky infant is healthy and well fed but cries for more than 3 hours, for more than 3 days a week, for more than 3 weeks
fragile x syndrome
most common cause of intellectual disability, caused by fmr1 gene. pt presents with shyness, social anxiety, learning problems. cognitive and language delays
