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Flashcards in OBGYN general concepts Deck (221)
1

Estrogen from ovaries

Estradiol

2

Estrogen from placenta

Estriol

3

Estrogen from adrenal cortex and converted in thecal cell

Estrone

4

Estrone and testosterone converted in theca cells

Estradiol

5

2 cells in testes

Leydig and Sertoli

6

2 cells in ovary

Theca cells and Granulosa cells

7

Sequence of puberty

1 thelarche 2 pubic hair growth 3 growth spurt 4 menarche

8

How many hours does the egg have to be fertilized

24 hours

9

How many days does the sperm have to fertilize the egg

1 to 5 days

10

Progesterone production in pregancy

1st trisem CORPUS LUTEUM 2nd and 3rd trisem PLACENTA

11

Growth hormone of pregnancy

human placental lactogen or human chorionic somatotrophin

12

Functional unit of ovary

ovarian follicle

13

oocytes at fetal period at birth at onset of puberty

oocytes at fetal period 6 TO 7 MILLION at birth 1 TO 2 MILLION at onset of puberty 400 000

14

2 arrests in fetal gameteogenesis

primary oocyte arrested ON 5th months AOG at PROPHASE I secondary oocyte arrested at METAPHASE II

15

Mid cycle pain

Mittelschmerz caused by Corpus hemorrhagicum

16

Luteal cells of the corpus luteum

Theca cells and Granulosa cells

17

After ovulation we get 9 to 11 days of corpus luteum releasing progesterone to maintain anticipated pregnancy until

It notes the absence of pregnancy

18

earliest histological sign of progesterone action

BASAL VACUOLATION

19

Menstrual cycle phase with LOW progesteron SLOWLY RISING estrogen levels

early follicular phase

20

Menstrual cycle phase with LOW progesteron RAPIDLY RISING estrogen levels

Late follicular phase

21

Elevated level of progesterone

Luteal phase and pregnancy

22

PREOVULATORY PHASE of ovarian cycle

follicular

23

PREOVULATORY PHASE of endometrial cycle

proliferative

24

PREOVULATORY PHASE length

variable 7 to 21 days

25

PREOVULATORY PHASE beginning and end

day 1 to ovulation

26

PREOVULATORY PHASE basal body temp

low basal

27

PREOVULATORY PHASE dominant hormone and source

estrogen from Follicular granulosa cells

28

PREOVULATORY PHASE histology

straight tubular glands

29

PREOVULATORY PHASE cervical mucus

thin and watery

30

PREOVULATORY PHASE function

replacement of the endometrial cells lost during menses

31

POSTOVULATORY PHASE of ovarian cycle

Luteal phase

32

POSTOVULATORY PHASE of endometrial cycle

Secretory

33

POSTOVULATORY PHASE length

constant 14 days

34

POSTOVULATORY PHASE beginning and end

day of ovulation til start of menses

35

POSTOVULATORY PHASE basal body temp

elevated over baseline

36

POSTOVULATORY PHASE dominant hormone and source

progesterone from Corpus luteum

37

POSTOVULATORY PHASE histology

tortuosus glands with secretions

38

POSTOVULATORY PHASE cervical mucus

thick and sticky

39

POSTOVULATORY PHASE function

prepares the uterus for implantation

40

what happens to the endometrium when you get pregnant

secretory endometrium turn into the DECIDUA the endometrium of pregnancy

41

Layers of decidua

1. decidua basalis 2 decidua capsularis 3 decidua parietalis

42

decidua that is part of the placenta invaded by trophoblasts with spiral arteries that are non responsive to vasoactive agents

Decidua basalis

43

decidua layer with spiral arteries and called the DECIDUA VERA lining the uterus

decidua parietalis

44

what enters uterine cavity blastocyst or morula

Morula on day 3 post conception AND this becomes the blastocyst

45

Blastocyst inner cell mass becomes

embryoblast

46

Blastocyst outer cell mass becomes

trophoblast with outer layer SYNCITIOTROPHOBLAST producing HCG and CYTOTROPHOBLAST

47

Implantation occurs on day ____ at _______________

day 7 at the posterior superior wall of uterus in the functional layer during the secretory phase

48

Embryoblast divides into ___ and ___ at week 2 post conception

EPIBLAST which will form the amniotic cavity and the HYPOBLAST which will form the yolk sac

49

Process establishing the 3 primary germ layers

gastrulation 1 ectoderm 2 endoderm 3 mesoderm

50

Ectoderm derivatives or outer layer

1 CNS neuroectoderm 2 PNS neural crest 3 SPECIAL SENSES hearing seeing 4 INTEGUMENT layer

51

Endoderm or internal layer

lining of Respiratory tract and Gastrointestinal tract

52

Mesoderm or middle layer 5

1 Muscles 2 Cartilages 3 CVS 4 Urogenital system 5 RBC

53

FDA category drug. Contraindicated in pregnancy. Fetal risk which outweighs any possible benefits

FDA CATEGORY X

54

FDA CATEGORY. No evidence of risk in humans. Controlled studies shows no risk to humans despite adverse findings in animals.

FDA CATEGORY B

55

FDA CATEGORY. Positive evidence of risk. Studies demonstrate risk but potential benefits may outweigh the risk.

FDA CATEGORY D

56

FDA CATEGORY. Controlled studies show no risk. Adequate studies show no risk to fetus in pregnancy.

FDA CATEGORY A

57

FDA CATEGORY. Risk cannot be ruled out. Control studies are lacking in humans and animals.

FDA CATEGORY C

58

Only part of fetus exposed to mothers blood

Syncitiotrophoblast

59

Abortion

20 weeks or less AOG with UTZ regardless of weight

60

What is the ovulation age of a fetus that is 8 weeks AOG

6 weeks. Subtract 2 weeks from AOG

61

Determine age of fetus 1st trisem

CRL

62

Determine age of fetus 2nd and 3rd t trisem

BPD

63

Functional closure of foramen ovale

minutes after birth

64

Anatomical closure of foramen ovale

1 year after birth

65

Functional closure of ductus arteriosus

10 to 12 hours after birth

66

Anatomical closure of ductus arteriosus

2 to 3 weeks after birth

67

Stage oflung development when surfactant detectible in amniotic fluid

Saccular stage 24 to 36 weeks

68

Completion of alveolar development

8 yrs old

69

Genetic or chromosomal sex dependent on

Y chromosome

70

Gonadal sex differentiation start at 6 weeks secondary to

SRY gene

71

Phenotypic sex

Hormones produced

72

Pregnancy hormone

HCG by syncitiotrophoblast. It maintains the corpus luteum.

73

HCG detectible at __ and doubles every

7 to 9 days post fertilization and doubles every 1.4 to 2 days

74

Progesteron production

Corpus luteum until 6 - 8 weeks PLACENTAL syncitiotrophoblast thereafter

75

Largest organ in fetus

adrenals

76

Softening and compressibility of isthmus at 6 to 8 wks AOG

Hegars sign PROBABLE EVIDENCE 6 to 8 wks AOG

77

softening of the cervix at 6 to 8 wks AOG

Goodels sign PROBABLE EVIDENCE 4-8 wks AOG

78

Bluish or purplish discooration of vagina at 6 wks aog due to inc vascularity

Chadwicks sign PRESUMPTIVE EVIDENCE 6 wks AOG

79

period when uterus is an abdominal organ and NOT a pelvic organ

2nd trisem ONLY becomes pelvic organ again near term

80

Are there gland in the vagina

None

81

Non STD female findings on cervical swab or pap smear

candidiasis and bacterial vaginosis. No need to treat partner

82

All coagulation factors increased during pregnancy except

Factor 11 and 13

83

unit similar between hCG and TSH

Alpha unit causing hyperplasia of thyroid gland during pregnancy

84

weight gain 1st 2nd and 3rd trimester

weight gain 1st T 2 LBS 2nd T 11 LBS 3rd T 11 LBS

85

Definitive evidence of pregnancy

1 identification of fetal heart action 2 perception of fetal movement by examiner 3 recognition of embryo or fetus by sonographic exam

86

Beading pattern

due to high PROGESTERONE during LUTEAL phase and PREGNANCY

87

Ferning pattern

due to high ESTROGEN during PRE OVULATORY phase of menstrual cycle

88

Phases of Ovarian cycle

1 Follicular or preovulatory phase 2 Ovulation 3 Luteal or postovulatory phase

89

Endometrial cycle

1 proliferative phase 2 secretory phase

90

What is detected by the pregnancy test

BETA subunit of B Hcg recall that it has the same alpha subunti as tsh

91

peak of B HCG at

8 to 10 weeks at 100 000

92

doubling of B Hcg

doubles every 1.5 to 2 days. Detected 8 to 9 days post ovulation.

93

Fetal heart action by ultrasound vaginal probe

5 weeks AOG

94

HR by doppler

10 wks AOG

95

HR by stethoscope

19 weeks AOG in all but can start at 17 wks

96

Quickening or fetal movement noted at

16 to 20 wks AOG OR 4 to 5 months

97

Braxton Hicks contractions

28 wks AOG

98

Oral glucose challenge test

75g OGCT at 24 to 28 wks AOG

99

Average weight gain during pregnancy

27.5 lbs

100

Variables to check for MATERNAL WELL BEING

1 BP 2 Weight gain 3 Uterine size

101

correlation of AOG to uterine size at

20 to 31 weeks AOG

102

12 weeks AOG at the level of

symphysis pubis

103

16 weeks AOG at the level of

midway between symphysis pubis and umbilicus

104

20 weeks AOG at the level of

umbilicus T10 dermatome

105

fetal kick counting

start of 28 weeks Normal is 8 to 10 kicks per 2 hours

106

screening for NTDs or chromosomal abn

18 to 18 wks BEFORE 20 wks AOG

107

Dilutional anemia at

28 TO 32 weeks AOG

108

GBS screening

35 to 37 wks AOG

109

Leupold maneuver

35 to 37 wks AOG

110

non stress test

GREATER than 41 wks

111

Test of fetal condition

NST

112

test of uteroplacental function

Contraction stress testing

113

What is Biophysical profile

UTZ plus electronic fetal tracing

114

test that measures reaction of fetal HR agains uterine contraction induced by oxytocin or nipple stimulation

Contraction stress testing

115

5 components of fetal well being BPP I Hear TAMBourines

FETAL 1 HR based on NST 2 tone flexion 3 AFI > 2 amniotic fluid index 4 movements 5 breathing

116

NST Acceleration

Fetal movement

117

NST Early deceleration

HEAD COMPRESSION. Deceleration simultanous with contraction duration. Vasovagal response.

118

NST Variable deceleration

UMBILICAL CORD COMPRESSION. Oligohydramnios or multiple pregnancy.

119

NST Late deceleration

UTEROPLACENTAL INSUFFICIENCY indicating comrpession of vessels. Delayed dec in HR in relation to uterine contraction.

120

Normall MSAFP

2 to 2.5 MoM

121

Prenatal test at 14 to 20 wks

amniocentesis for karyotyping

122

Prenatal test at 11 to 14 wks

early amniocentesis SE club foot

123

Prenatal test at 9 to 12 wks

chorionic villus sampling for karyotyping

124

Assessment of red cell anemia or alloimmunization at > 20 wks AOG

percutaneous umbilical cord sampling

125

Baterial vaginosis

Metronidazole 500mg tab_1 tab BID for 7 days

126

GBS prophylaxis intrapartum DOC and allergy alternative

DOC Pcn G IV. Alternative for allergy Cefazolin or Erythromycin or Clindamycin

127

Phases of parturition QASI

PHASE 1 Quiescence 2 Activation 3 Stimulation 4 Involution

128

prelude to parturition makes up 95 percent of pregnancy and refers to

Phase 1 Quiescence. PROGESTERONE high. From implantation to few wks before delivery.

129

preparation for labor

Phase 2 Activation. ESTROGEN high. Last 6 to 8 weeks of pregnancy. Prep for delivery.

130

process of labor

Phase 3 Stimulation

131

parturient recovery

Phase 4 Involution

132

Phase 3 or Stimulation refers to

Active Labor Stage I Stage II Stage III

133

Stage 1 of labor refers to

Latent LESS than 4cm. Active GREATER than 4 cm until 10 cm.

134

Stage 2 of labor refers to

10 cm to delivery of fetus

135

Stage 3 of labor refers to

from delivery of fetus to delivery of placenta lasting 5 minutes

136

Main hormone mediator of Phase III and IV

oxytocin

137

Source of PGE2 and OXYTOCIN during pregnancy

Amnion

138

Source of ENDOTHELUM 1 and PROSTAGLANDIN during pregnancy

Chorion

139

Most common fetal position

Occiput anterior left

140

FUNDAL GRIP

Leopolds Maeuver 1

141

Leopolds Maeuver 1

fetal part lying in the fundus

142

Leopolds Maeuver 2

location of fetal back or POSITION

143

Pawlicks maneuver

Leopolds Maeuver 3

144

Leopolds Maeuver 3

determine engagement of presenting part. ENGAGEMENT

145

Leopolds Maeuver 4

attitude or habitus of fetus. To determine the degree of flexion of fetal head.

146

BISHOP score criteria Cervix DEPS

1Consistency 2Dilatation 3Effacement 4Position 5Station GOOD SCORE at least 8

147

Cardinal movements of labor 7 EDFIEEE

1Engagement 2Descent 3Flexion 4Internal rotation 5Extension 6External rotation 7Expulsion

148

what movement is the PREREQUESITE for birth

Descent

149

CARDINAL MOVEMENT Allowing the narrowest fetal head diameter to pass through birth canal

Flexion

150

CARDINAL MOVEMENT allowing the fetal shoulder to present

External rotation

151

Duration of LATENT PHASE in Nullipara

LESS or EQUAL 20 hrs

152

Duration of LATENT PHASE in Multipara

LESS or EQUAL 14 hours

153

Duration CERVICAL DILATATION in ACTIVE PHASE Nullipara

LESS or EQUAL than 1.2 cm per hour

154

Duration of CERVICAL DILATATION in ACTIVE PHASE Multipara

LESS or EQUAL 1.5 cm per hour

155

Phases of ACTIVE PHASE

1 Acceleration phase 2 Phase of maximum slope 3 Deceleration phase

156

Descent begins at ___ cm

7 to 8 cm. fastest after 8 cm.

157

Duration of second stage of labor

Nulli 50 minutes. Multi 20 minutes.

158

predicts outcome of labor

Acceleration phase

159

measures overall efficiency of the machine

Phase of maximum slope

160

reflects fetopelvic relationship

Deceleration phase

161

Functional division oflabor parts 3

1preparatory 2 dilatational 3 pelvic

162

Preparatory

Latent phase PLUS acceleration phase of active labor

163

Dilatational

Phase of maximum slope of active labor

164

Pelvic

Fetopelvic relationship of active labor

165

laceration involving fourchette perineal skin vaginal mucous membrane

1st degree

166

laceration involving fascia and perineal muscles

2nd degree

167

laceration involving rectal mucosa

4th degree

168

laceration involving anal sphincter

3rd degree

169

Source of pain stage 1 of labor

Frankenhauser ganglion plexus T11 to T12

170

Location Frankenhauser ganglion plexus T11 to T12

Cervix 3 and 9 o clock pain fibers to uterus cervix and upper vagina

171

pain during the 2nd and 3rd stage

pudendal nerve S 2 to S 4

172

forceps used in nullipara delivery of fetus with molded head

sin son SIMPSON

173

forceps for deep transverse arrest of head

Kielland

174

forceps to deliver fetus with rounded head in multipara

Tucker mac lane

175

mc indication for primary CS

dystocia

176

mc indication for CS delivery

repeat CS

177

Causes of postpartum fever

Day PPD 0 wind 1 water 2_3 womb 4_5 wound 5_6 walk 7_21 mastitis

178

cause of 1st trisem abortion

fetus

179

2nd trisem abortion

maternal cause

180

Septic abortion etiology

clostridium serdeli

181

UTZ snow storm pattern

complete mole

182

UTZ swiss cheese pattern

incompelte mole

183

differentials for HTN prior to 20 wks AOG

H mole vs chronic HTN of pregnancy

184

differential for 1st trisem bleeding 3

abortion vs ectopic vs GTD

185

gestational trophoblastic tumor will follow

molar pregnancy more than normal pregnancy more than abortion

186

sites for GTT mets

lung then vagina

187

3 types of GTT gestational trophoblastic tumor

1 invasive mole 2 choriocarcinoma 3 placental site trophoblastic tumor

188

Rupture of tubal pregnancy isthmus vs ampulla vs cornual or interstitial

isthmus at LESS 2 mos AOG ampulla at GREATER than 2 mos cornua or interstitial at GREATER than 4 mos

189

predictor of spontaneous resoprtion

Hcg level LESS than 1000

190

MC risk factor of ecctopic pregnancy

tubal corrective surgery

191

Most identified risk factor

previous PID

192

presumptive evidence of ectopic pregnancy

b HCG of GREATER than 1500 miU per L with empty uterus

193

gestation sac in uterus seen at B HCG of

Greater than 1500

194

methrothrexate mgt of ectopic if

LESS than 6 wks AOG OR tubal mass LESS than 3.5 cm or B hCG LESS than 15000 OR no fetal heart sound

195

ectopic pregnanacy B HCG normalize in ___ days

20 days

196

UTZ retrochoreal hemorrhage

threatened or inevitable abortion

197

UTZ retroplacental blood clot

abruptio placenta

198

MCC 3rd trimester bleeding

abruptio placenta

199

MCC 3rd trimester painful bleeding

abruptio placenta

200

MCC 3rd trisemester painless bleeding

placenta previa

201

Placenta covers the internal os completely

Complete placenta previa

202

Placenta partially covers the internal os completely

Partial placenta previa

203

Edge of the placenta is at the margin of the placental os

Marginal placenta previa

204

Placenta is close to the opening of the cervical os but not touching it

low lying placenta previa. Vaginal possible

205

Bloody amniotic fluid

abruptio placenta

206

Anesthesia fo r stage II of labor

Pudendal block S2 to 4 using LIDOCAINE at ischial spine

207

Anesthesia for stage 1 labor AND gyne OPD

Paracervical block using lidocaine to 3 and 9 o clock position cervix

208

Anesthesia for eclampsia and pre eclampsia

Epidural anesthesia

209

Anesthesia for Stage I and II of labor

Epidural anesthesia

210

gold standard anesthesia in OB

Epidural anesthesia MC used

211

anesthesia of choice vaginal delivery

Epidural

212

anesthesia of choice in CS for complicated delivery

GA

213

MC uterine anomaly

septate uterus

214

MgSO4 dose hyporeflexic DTRs

6 to 12 mEq per ml

215

MgSO4 dose respiratory depression

15 mEq per ml

216

MC SE of MgSO4

flushing

217

Tocolytics used

Ca Blockers MgSO4, Nifedipine. B2 receptor agonist Ritrodrine and Terbutraline.

218

Dexamethasone dose

2 doses q12 hours apart DOS

219

post term pregnancy at

42 wks AOG

220

placental insufficiency due to aging and scarring

dysmaturity syndrome

221

BHcg vs Prolactin

B hCG same alpha unit as TSH, LH, FSH

Prolactin
- inhibited by Dopamine
- activated by TRH, serotonin