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JL Reproduction and Sexual Health > Week 3 part 1 > Flashcards

Week 3 part 1 Flashcards

1
Q

What insicion is used for lower segment caesarean section, laparotomy, abdo and vaginal hysterectomy and laparoscopy?

A

Common Surgical Incision (O&G)

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2
Q

Muscle layers of abdomen from outer to inner?

A

External oblique
Internal oblique
Transversus abdominus

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3
Q

What muscles attach between lower ribs and iliac crest, pubvic tubercle and linea alba?

A

External obliques

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4
Q

What is linea alba?

A

Midline blending of aponeuroses

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5
Q

What do fibres of external intercostals run in same direction as?

A

External obliques (

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6
Q

What do internal obliques attach between?

A

LOwer ribs, thoracolumbar fascia, iliac crest and linea alba

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7
Q

What is made up of the combined aponeuroses of anterolateral abdominal wall musclers and lies immediately deep to superficial fascia?

A

Rectus sheath

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8
Q

Nerve between transversus abdominus and internal oblique?

A

Ilioinguinal nerve

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9
Q

What do 7th to 11th intercostal nerves become?

A

Thoracoabdominal nerves

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10
Q

T12 nerve>?

A

Subcostal

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11
Q

L1 nerves?

A

Iliohypogastric and ilioinguinal

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12
Q

What arteries supply anterior abdominal wall?

A

Superior and ingerior epigastric arteries

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13
Q

continuation of internal thoracic
emerges at superior aspect of abdominal wall
lies posterior to rectus abdominis

A

Superior epigastric arteries

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14
Q

branch of the external iliac artery
emerges at inferior aspect of abdominal wall
lies posterior to rectus abdominis

A

Inferior epigastric arteries

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15
Q

What supplies lateral abdominal wall muscles?

A

Intercostal and subcostal arteries
Continuations of posterior intercostal arteries
Emerge at lateral aspect

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16
Q

In a lower section caesarian section what way are rectus muscles moved apart? They are not cut.

A

Lateral direction toward nerve supply

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17
Q

What layers are seen when opening laparotomy?

A

Skin and fascia
Linea alba
Peritoneum

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18
Q

In a laparoscopy - if a lateral port is required care must be taken to avoid what artery?

A

Inferior epigastric artery

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19
Q

What artery emerges just medial to deep inguinal ring (located halfway between ASIS and pubic tubercle)?

A

Inferior epigastric artery - branch of external iliac artery

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20
Q

From 20 weeks how often will pregnant women be seen/

A

At 4 week intervals

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21
Q

From 30 weeks how often will pregnant women be seen?

A

At 2 week intervals

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22
Q

At 28 weeks if rhesus negative what will be offered?

A

Anti D

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23
Q

In pregnancy: at 12 weeks what is offered?

A

FBC, antibodies, glucose, syphilis, rubella

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24
Q

In pregnancy: at 16 weeks what is done?

A

Triple test or alpha feto protein

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25
Q

When is first ultrasound down in pregnancy?

A

At 18 weeks

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26
Q

At 12 weeks gestation what will the uterus be at the level of?

A

Pubic symphisis

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27
Q

At 20 weeks gestation where will the uterus almost reach?

A

The umbilicus

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28
Q

At 28 weeks where will the uterus almost have reached?

A

Xiphisternum

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29
Q

In pregnancy when is booking scan performed?

A

Around 6 to 7 weeks

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30
Q

In embyonoc period how does the embryo receive nutrition?

A

From yolk sac via vitelline duct

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31
Q 
Learning disabilities
Palmar creasing
Short stature
Wide-brim nose
Reeding hair line
Small chin
Short digits
A

Downs syndrome

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32
Q

In first trimester - how is downs syndrome assessed risk?

A

Measure skin thickness behind fetal neck using utrasound = nuchal thickness
Combined with HCG and PAPP-A

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33
Q

When is down syndrome nuchal thickenss tested?

A

At 11 - 13 +6 weeks

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34
Q

In the second trimester how is downs risk assessd?

A
  1. Blood sample at 15-20 weeks

2. Assay of HCG and AFP

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35
Q

If the personal risk for downs syndrome baby is greater than 1:250 then it is high risk - what is then required?

A

Further investigation - amniocentesis

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36
Q

In downs syndrome risk assessment if AFP and HCG are normal what does risk depend on?

A

Maternal age

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37
Q

In downs syndrome risk assessment if afp IS HIGH and HCG low then what is risk ?

A

Low - but high spina bifida risk

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38
Q

In downs syndrome risk assessment if high HCG and lower AFP what is risk?

A

Hihg - irresepctive of maternal age

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39
Q

When is amniocentesis usually performed and what is the risk?

A

After 15 weeks

Risk of miscarriage 1%

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40
Q

Chorionic villus sampling is used for downs syndrome testing - what is risk and when is it performed?

A

12 weeks

Carries miscarriage rate of 2%

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41
Q

In days 5 - 7 what happens to blastocyst?

A

Implants

42
Q

In the blastocyst what do inner cells develop into?

A

Embryo

43
Q

In the blastocyst what do outer cells develop into?

A

Burrow into uterine wall and become placenta

44
Q

Is the trophoblast layer of blastocyst on surface of cell?

A

Yes

45
Q

At what day does blastocyst become buried in uterine lining?

A

By day 12

46
Q

What two tissue types make up the placenta?

A

Trophoblast (chorion)

Decidual

47
Q

In placental development what do trophoblast cells (chorion) differentiate into>

A

Syncytiotrophoblasts - these invade decidua and break down capillaries to form cavities filled with maternal blood

48
Q

What does each placental villi cpntain?

A

foetal capillaries separated from maternal blood by thin layer of tissue

49
Q

When do the placenta and foetal heart begin to function?

A

By 5th week of pregnancy

50
Q

In placental development Human Chorionic Gonadotropin HCG signals the corpus luteum to secrete progesterone - what does this stimulate?

A

Decidual cells to concentrate glycogen, proteins and lipids

51
Q

What structure works as a physiokogical arteriovenous hunt?

A

Placenta

52
Q

As placenta develops where does it extend hair like projections to?

A

Into uterine wall

53
Q

What is present in teh intervillous space?

A

Maternal blood

54
Q

What does circulation within the intervillous space act partyl as?

A

Arteriovenous shunt

55
Q

What is in umbilical blood?

A

Mixing of arterial and venous blood - oxygen poor

56
Q

How does fetal, oxygen saturated blood return to fetus?

A

Through umbilical vein.

57
Q

How does maternal oxygen poor blood flow back?

A

Through uterine veins

58
Q

What three factors allow sufficient supply of oxygen to fetus?

A
  1. Fetal Hb (increase ability to carry O2)
  2. Higher Hb (concentration in fetal blood)
  3. Bohr effect (fetal Hb can carry more O2 in low carbon dioxide than in high CO2 partial pressure)
59
Q

Water diffusion in placenta increases during pregnancy up to what week?

A

35th weeks

60
Q

In what direction of flow to iron and calcium only go?

A

From mother to child!

61
Q

What method of transport does glucose use to pass the placenta?

A

Siplified transport

62
Q

Name 4 teratogenic drugs?

A
  1. Thalidomide
  2. Carbamazepine
  3. Coumarins
  4. Tetracycline
63
Q

At what weeks gestation does HCG spike?

A

10 weeks

64
Q

What does HCG prvent in pregnancy?

A

Involution of corpus luteum

65
Q

At what week is human chorionic somatomammotropin produced?

A

Week 5

66
Q

Give three functions of HCS

A
  1. Growth hormone like - effects protein and tissue formation
  2. Decreaes insulin sensitivity in mother: more glucose for fetus
  3. Involved in breast development
67
Q

In pregnancy what hormone develops decidual cells, decreases uterus contractility, and prepares for lactation?

A

Progesterone

68
Q

In pregnancy what hormones are involved in breast development and relaxation of ligaments ?

A

Estrogens

69
Q

In pregnancy what is role of estradiol?

A

Enlargement of uterus

70
Q

In pregnancyt what is role of estriol?

A

Estriol level - indicator of vitality of fetus

71
Q

CRH produced by placenta can cause what adverse effect on mother?

A

ACTH - aldosterone (hypertension)

cortisol (oedema, insulin resistance leading to gestational diabetes)

72
Q

HCG and HC thyrotropin produced by placenta cause what adverse effects in motjers?

A

Hyperthyroidism

73
Q

Increase calcium demands by placenta cause what adverse effect in mothers?

A

Hyperparathyroidism

74
Q

What is increase in cardiac output during pregnancy due to?

A

Demands of uteroplacental circulation

75
Q

what percentage above normal is cardiac output in pregnancy?

A

30-50% (beginning week 6 and peaking 24)

76
Q

When does CO decrease in pregnancy?

A

In last 8 weeks (becomes sensitive to body position - uterus compresses VC)
Increases 30% more in labour

77
Q

In second trimester what happens to blood pressure?

A

It drops (uteroplacental circulation explans and peripheral resistance decreases)

78
Q

In pregnancy what does plasma volume increase proportionally with>

A

cARdiac output

79
Q

What happens to RBC in pregancy?

A

They increase - erythropoesis (thus Hb is decreased by dilution)

80
Q

In pr4egnancy; progesterone signals to brain to lower CO2 levels what then happens?

A
  1. RR increaes
  2. tidal volume increases
  3. pCO2 decreases
81
Q

In pregnancy what happens to GFR and Renal plasam flow?

A

Increases. Also increase in urine formation

82
Q

In opregnancy - ppstural changes in baby afffect renal functions. What happens if upright psoition?

A

Decrease renal function

83
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension and proteinuria

84
Q

In pre eclampsia what happens to BP, kidney function and RBF and GFR?

A

BP increases since 20th week
Salt and water retention oedema
RBF and GFR decrease

85
Q

In pregnancy: vascular spasms, extreme hypertension, chronic seizures & coma

A

Eclampsia treat with vasodilators and cesarean section

86
Q

How many more calories a day should be ingessted by mother?

A

250 to 300 extra (85% fetal metabolism, 15% stored as maternal fat)

87
Q

When is mothers anabolic phase?

A

1 - 20th week

88
Q

When is mothers accelerated starvation phase

A

21-40 week (esp last trimester) - high metabolic demands of fetus

89
Q

In anabolic mother phase what happens to sensitiity of insulin?>

A

Increased

90
Q

In catabolic mother phase what happens to senstiivity of insulin?

A

Resistance

91
Q

Before parturition what is given to prevent intracranial bleeding during labour

A

Vitamin K

92
Q

What hormone increases contractions and excitability of uterine tissue?

A

Oxytocin

93
Q

Braxton hicks contractions - do they increase or decrease towards end of pregnancy?

A

Increase

94
Q

What does strethc of cervix by fetal head do to contractility?

A

INcreases - cervical strethcing also causes further oxytocin release

95
Q

As well as oxytocin stimulating uterus contractions what does it also stimulate?

A

Placenta to make prostaglandins - stimulate more contractions

96
Q

What are the 3 stages of labour?

A
  1. Cervical dilation 8-24 hours
  2. Passage through birth canal (few mins to 30)
  3. Expulsion of placenta
97
Q

Lactation: what hormone causes growth of ductile system?

A

Estrogen

98
Q

Lactation: what hormone develops lobule-alveolar system?

A

Progesterone

99
Q

Lactation: what do E and P do to milk production?

A

Inhibit it = at birht sudden drop in these hormones

100
Q

Lactation: what hormone stimulates milk production?

A

Prolactin (1-7 days after birth prolactin induces high milk production)

JL Reproduction and Sexual Health (18 decks)

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