1
Q
3 obstetrical hemorrhage causes of death
A
- abruption
- laceration
- uterine atony
2
Q
Placental abruption
A
Premature separation of normally implanted placenta, may be external or concealed, separation can be complete or partial, occurs in 1/200 deliveries, not always detected on ultrasound as it can be mistaken for the placenta itself, tends to be maternal blood
3
Q
Placental abruption 3 common contributing factors
A
- idiopathic
- prior abruption places at increased risk
- hypertensive disorders
4
Q
Placental abruption clinical presentation (4)
A
- vaginal bleeding
- uterine tenderness
- fetal distress
- shock
5
Q
Placental abruption management (3)
A
- if term or near term then deliver
- if hypovolemic shock deliver and save mother
- severe prematurity and hemodynamically stable mother then conservative management
6
Q
Placenta previa definition
A
Painless hemorrhage in the late 2nd trimester diagnosed by sonography, the bleeding tends to be more fetal blood, total previa when internal os is totally covered requires C section, partial or marginal can potentially get vaginal birth
7
Q
Vasa previa definition
A
condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue, hard to spot on ultrasound but if spotted prior then prognosis is muchbetter
8
Q
Previa management
A
- localize by ultrasound
- deliver those in labor, mature fetus, or hemorrhage so severe as to mandate delivery (typically 36-37 weeks)
9
Q
Postpartum hemorrhage, what qualifies as it thru vaginal vs cesarean delivery?
A
Hemorrhage following delivery either from placenta implatantion site, trauma to genitalia, or both, recognized as >500mL vaginal delivery and >1000mL cesarean delivery
10
Q
Postpartum hemorrhage etiology (6)
A
- uterine atony
- third stage bleeding (post placental delivery)
- placental accreta, increta, and percreta
- inversion of the uterus
- lacerations
- rupture of uterus
11
Q
Uterine atony
A
Refers to flaccid uterine muscle preventing it from acting as a tourniquet to cut off blood leakage from vessels
12
Q
Drugs for uterine atony (4)
A
- oxytocin IV
- methergine (uterine contractor)
- misoprostol
- prostaglandin
Can use multiple
13
Q
Bakri balloon
A
Saline filled balloon that uses a tampanode effect to treat uterine atony and stop bleeding
14
Q
Alternative treatments for uterine atony (3)
A
- bakri balloon
- b lynch suture
- hysterectomy
15
Q
Consumptive coagulopathy (DIC)
A
Complication of underlying pathological process in which treatment must be directed to reverse fibrination, often seen with excessive bleeding at sites of modest trauma as well as hypofibrinogenemia, thrombocytopenia, and prolongation of PT and PTT, can occur because of placental abruption as well as other complications
16
Q
DIC management (3)
A
- fluid volume replacement
- blood product replacement
- fix the underlying cause
17
Q
Third leading cause of maternal death
A
Puerperal fever
18
Q
Puerperal fever, what is it caused by, what is it treated by (2)
A
Uterine infection causing persistent fever after childbirth ocurring 30% after vaginal delivery and 70% after C section but typically after prolonged labor, typically mixed infection group A and B sterp and chlamydia, treated with clindamycin and gentamicin and ampiclillin (triple therapy) or dilation and curetage
19
Q
Puerperal fever differential diagnosis (3)
A
- respiratory engoregement
- respiratory infection
- pyelonephritis
20
Q
Postterm pregnancy
A
Pregnancy beyond 42 weeks or 294 days of start of last menstrual period, has increased risk of meconium and aspiration, shoulder dystocia (difficulty delivering shoulder due to size), etc.
21
Q
Post term baby skin appears…
A
….dry, cracked, and peeling
22
Q
Postmaturity syndrome
A
An infant that is delivered post term and due to failure of the placenta around 40 weeks becomes hypoxic and chronically ill, has wrinkled peeling skin and a long thin body suggestive of wasting, typically meiconium stained
23
Q
If the placenta is failing, then how does this cause oligohydramnios?
A
The fluid going into the baby is decreased so the baby becomes dehydrated and stops peeing
24
Q
Macrosomia
A
s used to describe a newborn who’s significantly larger than average. A baby diagnosed with fetal macrosomia has a birth weight of more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age
25
Asymmetrical vs symmetrical fetal growth retardation
Asymmetrical has an abnormally large head compared to body while symmetrical sees consistent proportion
26
Risk factors for intrauterine growth restriction (6)
- small mothers
- poor weight gain and nutrition
- tobacco and alcohol use
- fetal infection (TORCH)
- congenital malformations
- chromosome abnormalities
27
Doppler velocimetry
A further study if an ultrasound indicates the estimation of fetal weight is below 10% as there is normally flow during diastole in the umbilical artery that can be measured, absent or reversed end diastolic flow associated with increased perinatal mortality
28
Macrosomia risk factors (7)
- pre-pregnancy maternal obesity
- excessive gestational weight gain
- maternal interpregnancy weight gain
- maternal NON smokers
- maternal age less than 17
- diabetes
- prolonged gestation
29
Infants of diabetic mothers, regardless of birth rate, are at increased risk for... (3)
Shoulder dystocia, claviuclar fracture, and erbs palsey (brachial nerve damage)
30
Only definitive diagnosis of macrosomia
birthweight measurement
31
Macrosomia prevention (1)
- control of maternal hyperglycemia
- otherwise none
32
Prophylactic cesarean section is considered in what macrosomic patients?
Those >5000 g nondiabetic, and 4500 diabetic
33
Timeline day 0 (embryonic age)
- Day 0 is fertilization forming a zygote in distal third of fallopian tube
- Division into morula (ball of cells will become placenta and embryo, each cell is totipotential)
- Division into blastocyst (blastocele (cavity) containing embryoblast, trophoblast at other pole form placenta)
34
Timeline week 1 (embryonic age)
-up to week 1 implantation on uterine wall of blastocyst
35
"I was drinking when I believe I conceived, did I harm the baby?"
First 3 weeks -"All or nothing" insult or damage to fetus at this time will cause miscarriage immediately or no damage
36
Timeline week 2 (embryonic age)
- Bilaminar disk formation, evolution of embryoblast to bilaminar blastocyst with cell layers epiblast and hypoblast (primitive ecto and endoderms) sandwiched between 2 cavities - amniotic cavity and yolk sac
- Trophoblast divides into cystotrophoblast (inner single cell layered) and syncytiotrophoblast (thicker outer layer releases hGC to prevent menstruation)
37
"I just missed my period, what is embryonic age and gestational age?"
Week 2 embryonic age, week 4 gestational age
38
Zygote defnition
Union between sperm and egg, quickly begins divisions into morula
39
Morula definition
Ball of cells that will become placenta and embryo, divided from a zygote, each cell is totipotential
40
Blastocele definiiton
Part of a blastocyst, fluid filled cavity that forms from a morula and will house an embryoblast
41
Embryoblast definition
Part of a blastocyst, early embryo formed from a morula and contained in a blastocele
42
Bilaminar blastocyst definition
Continuation from blastocyst contains inner hypoblast and outer epiblast layers out of the embryoblast
43
Amniotic cavity definition
Forms around the epiblast to create a fluid filled cavity to house the embryoblast in a bilaminar blastocyst
44
Yolk sac definition
Forms extending out of the hypoblast to eventually give rise to the umbilical cord in a bilaminar blastocyst
45
Cystotrophoblast definition
Division from the trophoblast into a single inner cell layer in a bilaminar blastocyst, will be important for implantation
46
Snynctiotrophoblast definition
Division from the trophoblast into a thick outer cell layer in the bilaminar blastocyst, releases hCG to maintain high progesterone levels in the mother to prevent menstruation and maintain pregnancy
47
What occurs in week 3-8 (embryonic age) and why is this the most susceptible time?
-Organogenesis occurs, most susceptible because 90% of birth defects will occur here
48
Timeline week 3(embryonic age)
- Gastrulation (transition from blastocyst to a gastrula)
- Primitive streak (structure forming posterior side, determines site of gastrulation and bilateral symmetry), notochord (becomes nucleus pulposis of intevertebral disks), and neural plate (basis for nervous system) form here, as well as division of the hypo/epiblasts into ecto/meso/endoderms
49
Gastrulation definition
Transition of a blastocyst into a multilayered gastrula
50
Primitive streak definition
Stucture of the gastrula forming posterior side that determines site of gastrulation and creates bilateral symmetry
51
Notochord definition
Structure of the gastrula forming nucleus pulposis of intervertebral disks
52
Neural plate definition
Structure of gastrula forming nervous system basis (and dermatome distribution)
53
Ecto/meso/endoderm form...
- Ecto forms epithelium and nervous system
- Meso forms bone, muscle, cartilage, blood
- Endo forms excretory strutures, GI, respiratory, urinary
54
Folate deficiency at week 3 (embryonic age) can cause this developmental disorder
Spinal bifida upon neural plate formation
55
Timeline week 4 (embryonic age)
- Heartbeat, 4 chambers, 4 limb buds, 4 branchial arches (gill like structures that give rise to features of the head and neck)
- tongue lungs GI and diaphragm development too
56
Critical period for autism spectrum disorder, ventricular septal defect, and tricuspid atresia (in embryonic age)
Week 4-6 (embryonic age)
57
Critical period for limb defect (in embryonic age)
Week 4-5 (embryonic age)
58
Critical period for cleft lip defect (in embryonic age)
Week 5-6 (embryonic age)
59
Timeline weeks 5-7 (in embryonic age)
-gonad differentiation, kidney, bladder, rectum formation
60
Critical period for teeth/palate (in embryonic age)
Week 6-7 (embryonic age)
61
Timeline week 8 (embronic age)
fetal movement, strong resemblance to baby
62
Critical period for external genitalia formation (in embryonic age)
Week 8 (embryonic age)
63
At what time can you tell the sex of the fetus? (in embryonic age)
Week 10 (embryonic age)
64
2 phases of the female ovarian cycle
Follicular phase and luteal phase
65
GnRH is released by....
Arcuate nucleus of the hypothalamus in a pulsatile function into the hypophyseal portal system
66
Follicular phase can vary between ____ and ___ days, the luteal phase is almost always ____ days
10-20, 14
67
FSH and LH are released by...
anterior pituitary in response to GnRH
68
2 phases of the female menstrual cycle
Proliferative and secretory phases
69
Inhibitors of GnRH (6)
- Dopamine
- seratonin
- GABA
- CRH
- Opoid B endorphin
- Excess DHEAs
70
Activators of GnRH (6)
- Epi
- Norepi
- leptin
- Galantin
- neuropeptide Y
- Gulatmate
71
Activin is released by...
The ovary
72
Activin function
Positive effect on FSH secretion from the anterior pituitary, inhibit produciton of progesterone
73
Inhibin is released by...
The ovary
74
Inhibin function
Negative effect on FSH secretion from the anterior pituitary
75
Follistatin is released by...
The ovary
76
Follistatin function
Inhibits FSH secretion from the anterior pituitary AND inhibits activin activity from the ovary
77
Estrogen and progesterone must be used together hormone replacement therapy. Why?
Progesterone prevents the overgrowth of the endometrial lining preventing uterine cancer from unregulated estrogen levels
78
Neuropeptide Y function
Stimulates GnRH release from the hypothalamus at low levels, inhibits GnRH release at high levels, low estrogen causes an increase in neuropeptide Y levles
79
Too much DHEAs from obesity or PCOS causes....
...An inhibitory effect of GnRH release
80
Galanin function
Release from the hypothalamus and enters the portal circulation to have a positive effect on LH secretion from the anterior pituitary
81
Melatonin is released from...
Pineal gland
82
KISS1 gene
Gene that encodes for kisspeptin, linked to stimulate GnRH pulsatile release
83
A lack of KISS1 expression
Results in a lack of GnRH, --> hypogonadotropic hypogonadism
84
Genetic Hypogonadotropic hypogonadism causes...
Results in Kallmann syndrome with no sense of smell
85
Menses are brought on by declining levels of these 3 hormones, and an increase in this hormonal level
Estrogen, progesterone, inhibin / FSH
86
Highlights day 1 -7 follicular phase
- Menstruation as endometrial lining sloughs off due to low estrogen progesterone
- Low estrogen inhibits release of FSH LH, but FSH and LH release is slowly increasing the estrogen conc (Theca cells bind LH and produce androstedione) (Follicular cells bind FSH and produce aromatase that converts androstedione into estrogen)
87
Estrogen at low conc. has a ___ effect on LH and FSH, this changes at a high conc. to a ____
- Inhibitory
- Stimulatory (LH surge)
88
Highlights day 7-14 follicular phase
- LH surge occurs with positive feedback from estrogen, this triggers the follicle to secrete progesterone in low conc.
- Low conc. of progesterone (measured in ovulation predictor kits) stimulate FSH surge occurring immediately prior to ovulation
- Follicular rupture of mature follicle, remaining die via atresia
89
Highlights days 14-28 luteal phase
- Estrogen and progesterone and inhibin levels grow high from corpus luteum, this inhibits GnRH, FSH, and LH from the hypothalamus and pituitary
- Corpus luteum degenerates to corpus albicans unless stimulated by hCG to be retained, FSH levels begin to rise again, menses will begin
90
1st polar body
Creates a primary oocyte after dividing, the first meiotic division that occurs upon ovulation
91
2nd polar body
Creates a 2ndary oocyte, occurs after fertilization via sperm
92
Granulosa cells produce...., what targets it?
Estrogen using aromatase from androstendione precursor from theca cells, FSH
93
Thecal cells produce..., what targets it?
Androstendione, LH
94
Ocular manifestations of down syndrome
Appear with mongolian type face along with eye problems such as strabismus (eye wandering) as well as crossed eyes and early glaucoma - go on to eventually have heart and other problems as well
95
Ocular manifestations of marfan syndrome
Lens inside eyes have weakened fibrils that can cause the lens to slip out of place resulting in sudden blurry or distorted vision onset
96
Ocular manifestations of neurofibromatosis
Characterized by benign growths on all nervous tissue that can occur on the iris appearing as little nodules, glioma (glia matter surrounds central nerves) of the optic nerve can cause vision loss
97
Characteristic finding of neurofibromatosis on skin
6 or more hyperpigmented skin macules (cafe au lait spots)
98
What two nerves are actually part of the CNS?
```
Optic nerve (CN II)
Olfactory nerve (CN I)
```
99
Shaken baby syndrome ocular manifestations
Due to fragile blood vessels in retina not being capable of undergoing trauma causing hemorrhages, can also be seen in adults with extreme trauma such as from car crash
100
Hypertension ocular manifestations
-Flamed shaped hemorrhages and cotton wool spots (high bp causes capillaries to leak preventing perfusion and causing infarct resulting in yellowish or white spots that take a while to repair
101
Optic artery and vein on fundoscopic
Artery is smaller and vein is larger and darker, all have 4 branches to the top and bottom and nasal and temporal off of that
102
Normal optic disk size
1.5 mm
103
AV nicking
Spots on fundoscopic exam where arteries and veins cross that in the case of high blood pressure causes constriction creating a visible gap in venous flow
104
Fovea centralis definition
Dark spot on the fundoscopic exam that is the primary spot of focus where all the cones of the eye are located within the macula densa
105
Malignant hypertension
Uncontrolled hypertension resulting with papilledema (swelling of the optic disk) demonstrating them at high risk for developing heart failure or other diseases, treatment requires immediate but controlled blood pressure control so not to infarct the tissue
106
Copper/silver wiring
Demonstrated on the fundoscopic exam where in cases of severe atherosclerosis patients vessels will appear brown or silver instead of red indicating severe progression of atherosclerosis
107
Intracranial hypertension ocular manifestation
Occurs when high pressure in aqueous humor builds causing blurring of the vision that lasts shortly or prolonged periods of times, visible on fundoscopic exam with optic disc swelling (papilledema)
108
Common causes of intracranial hypertension and how to assess for the first 2 (4)
- brain tumor (CT scan)
- meningitis (spinal tap)
- hydrocephalus
- pseudomotor cerebri
109
Pseudomotor cerebri occurs in what population?
Obese young women, associated with vitamin toxicity or drug rxn
110
Embolic disease of eye
Sudden persistent visual loss that causes a pale retina in all areas except the fovea which is cherry red upon fundoscopic examination, retina dies within 50 min of obstructed flow that can occur even in healthy patients
111
Hollenhorst plaque
Cholesterol embolus that lodges in the arterial bifurcation that doesn't block the entire artery but may spontaneously resolve, if left untreated may not cause any issue immediately but can eventually lead to blindness or sequellae with stroke from larger embolus dislodging, treated with prednisone
112
Central retinal vein occlusion
Another cause of painless vision loss that is often associated with open angle glaucoma or systemic hypertension, ophthalmic exam reveals retinal hemorrhages and cotton wool spots
113
Migraines are most common in ____ (men or women) and at what age groups?
women, puberty or menopause
114
topical cyclosporine use
used for autoimmune inflammatory conditions to reduce dry eyes
115
Juvenile rheumatoid arthritis ocular manifestations (4)
iritis, cateract, retinal bulging (2 iris appearance looking like an ectopic pupil) and BAND keratohathy (deposits of calcium in cornea)
116
SLE ocular manifestations
Many similar manifestations of dry eye to rheumatoid arthirits but most common severe involves vasculature (see hemorrhages despite adequate perfusion and no atherosclerosis)
117
Giant cell arteritis (symptoms (3), definition, diagnosis (2) and treatment (1))
Ocular emergency systemic vasculitis that affects people over age of 60 resulting in symptoms such as scalp or hair pain, difficulty chewing, and acute visual loss, ischemic optic neuropathy causing unilateral loss of vision is very common, diagnosed via C reactive protein (not necessarily sed rate in case patient is on nsaids), treated with high dose corticosteroids
118
Most common extraocular muscle affected by thyroid disorder
Inferior rectus interfering with up gaze
119
Myasthenia gravis ocular manifestations and treatment
- Autoimmune dz at any age that blocks Ach receptors with antibodies causing weakness and droopy eyelid (often relieved with ice pack application)
- botox injection
120
Multiple sclerosis ocular manifestations, symptoms, diagnosis
Seen in 40% of women aged 20-40, optic neuritis with acute, painful vision loss in one or both eyes occurring over a few days to 2 weeks, may be initial episode that eventually manifests with MS in 5 years, presents with visual pain with upward eye movement despite optic nerve looking normal and red desaturation on visual assessment
-CT scan of white matter lesion
121
3 most common classic lesions seen with AIDS occular manifestations
- cotton wool spots
- cytomegalovirus retinitis
- kapoi's sarcoma
122
Types of diabetic retinopathy (3)
- early proliferative (visual fields unaffected)
- advanced nonproliferative (ischemia and infarct of retina)
- proliferative (most devastating visual loss, neovascularization that may grow on surface of iris and block aqueous outflow causing neovascular glaucoma)
123
Photocoagulation for proliferative diabetic retinopathy
Laser burns used to evenly distribute scatter pattern across entire retina except macula causing proliferating vessels to disappear
124
Orbit definition
Bony cavity that houses eye and surrounding tissues, composed of 4 walls and housing the nerves, blood vessels, lacrimal glands, and extraocular muscles
125
4 walls of the orbit
Roof, lateral wall (strongest), medial wall, and floor
126
LR6SO4
Refers to how lateral rectus muscle is innervated by abducens (CN VI) and superior oblique is innervated by abducens (CN IV), with the rest of them being innervated by CN III (oculomotor)
127
4 layers of the eyelid
- skin
- orbicularis oculi muscle (closes eyelid and innervated by facial nerve CN VII)
- tarsal plate (contains meibomian glands)
- conjunctiva
128
2 eyelid retractor muscles
- levator palpebrae superioris (CN III) provides majority of lift
- mueller's muscle (superior tarsal muscle) smooth muscle innervated by sympathetic fibers and not much lift is provided
129
Orbital septum
Important landmark because anterior infection to it is not as serious as one posterior to it
130
Lacrimal gland
Located superior and lateral in the anterior portion of the orbit and produces tears to lubricate the cornea and conjunctiva
131
Lacrimal drainage and percentages
20% from the upper punctum
80% from the lower punctum
132
Conjunctiva definition
Clear mucus membrane that covers sclera (bulbar) and posterior surface of the eyelids (palpebral) that creates a complete seal preventing it from traveling beyond the fornix, houses a lot of blood vessels
133
Sclera
Tough outer part of globe forming white part of eye, varries in thickness with thinnest portion at the limbus (junction between cornea and sclera and site where most likely to injure)
134
Cornea definition
Transparent avascular collagen that has the greatest focusing power of the eye, richly innervated by ophthalmic division of CN V (trigem), made of same tissue type as the conjunctiva
135
Anterior chamber definition
Space between the cornea and the iris, filled with aqueous humor produced by ciliary body that flows out to the front of the lens to the anterior chamber draining into schlemm's canal
136
Uveal tract definition
Middle layer of eye that houses 3 components from anterior to posterior being iris, ciliary body, and choroid
137
Iris definition
Colored part of eye that is a thin contractile pigmented diaphragm, allows light to enter eye and stimulate the retina and contains 2 muscles being the sphincter pupillae muscles that contract to constrict pupils and are innervated by parasympathetic fibers on CN III, and dilator muscles which result in dilation and are sympathetically innervated
138
Ciliary body definition
Posterior to iris and connects to the suspensory ligament of the lens (called a zonule), produces aqueous humor to nourish cornea and drain out thru trabecular meshwork, contraction of ciliary body allows for accommodation, provides blood supply to the outer retina
139
Lens definition
Biconvex, avascular transparent tissue 2nd most powerful refractive tissue, attaches to ciliary body via the zonule, opacification of lens is called cataracts
140
Accommodation
Ability of eye to focus at various distances by changing lens shape, loss begins at age 40's and results in presbyopia (diminished ability to focus)
141
Vitreous humor defninition
Clear gelatanous avascular structure that fills space between lens and retina and is mostly composed of water and hyaluronic acid, firmly adherant to the optic disc, blood vessels, and anterior most portion of retina
142
Vitreous detachment will have this manifestation that the patient will report
Causes sudden increase in floaters
143
Retina definition
Innermost layer of eye, supplied by central retinal artery, thin transparent neurovascular tissue that transmits info to the optic nerve
144
Macula definition
Area between the superior and inferior temporal vascular arcades where majority of cone cells are to allow for color vision
145
Fovea definition
Center of macula responsible for sharp focus vision, contains only cone cell receptors responsible for color vision
146
Optic disc definition
Most anterior portion of optic nerve, area where central retinal artery and vein enter the eye and divide into vascular arcades, enlarged in glaucoma, surrounded by meninges and bathed in CSF, transmits visula info from the retina to the brain, leaves orbit via optic canal
147
Scotomas definition
Areas of decreased or absent vision, often due to lesions of different pathways
148
Double vision (diplopia) common associated condition
Due to cranial nerve palsy until proven otherwise
149
Flashes of light common associated conditions
Indicates posterior vitreous detachment (floaters), retinal detachment, or migraine
150
Relative afferent pupillary defect (marcus gunn pupil)
Occurs upon flashlight testing of eye resulting in abnormal dilation upon exposure to the light indicating pathology of the optic nerve or severe retinal disease
151
Superior oblique allows eye to move ____. Inferior oblique allows eye to move ____
down and nasally, upward and nasally
152
Angle closure glaucoma finger technique
-Have patient close eyes then push down on it with fingers, if one eye feels much harder closer to a golf ball then that indicates the pressure is markedly elevated
153
AV nicking definition
Where artery and vein cross seeing an indent, a sign of high blood pressure
154
Retinal vessel differentiation between arteries and veins
Arteries are narrower than veins
Professional Development
flashcards
Decks in class (62)
# Cards
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Part 1122
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Part 2123
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Part 3120
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Part 4150
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Part 5124
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Part 6125
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Part 7148
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Part 8160
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Part 9198
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Part 10119
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Part 11131
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Part 12119
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Part 13126
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Part 14123
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Part 15133
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Part 16142
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Part 17124
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Part 18135
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Part 19127
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Part 20108
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Part 21160
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Part 22125
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Part 23145
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Part 24160
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Part 25170
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Part 26120
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Part 27130
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Part 28153
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Part 29124
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Part 30144
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Part 31181
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Part 32121
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Part 33165
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Part 34133
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Part 35116
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Part 36175
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Part 37170
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Part 38191
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Part 39222
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Part 40150
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Part 41124
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Part 42154
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Part 43183
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Part 44132
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Part 45103
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Part 46125
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Part 47165
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Part 48126
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Part 49114
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Part 50155
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Part 51151
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Part 52101
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Part 53128
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Part 54151
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Part 55130
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Part 56132
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Part 57149
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Part 58131
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Part 59151
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Part 60151
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Part 61136
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Part 62111
