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1
Q

briefly what occurs in the fetal period early and late

A

early - protein deposition. Late is adipose development of embryonic structures throughout

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2
Q

how does the last menstrual period relate to weeks of fertilisation

A

+2 weeks after fertilisation

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3
Q

what would you use to meaasure a babys progress in t1, 2, and 3?

A

t1 - crown rump length t2 - biparietal diameter t3 - head circumference

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4
Q

how assess antenatal wellbeing

A

mother and fetal movements, USS, uterine exapnsion (symphysis fundal height). Glucose tests, blood checked for rghesus, Hb, infection, urinalysis for preeclampsia

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5
Q

what is terms for too much or too little amniotic fluid

A

oligo and polyhydroamniosis

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6
Q

why is a scan done at weeks 7-13?

A

estimate delivery date and CRL

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7
Q

what is good and bad weights for child and why does it happen

A

>4500g - macrosomia, gestational diabetes

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8
Q

name the 3 stages of lung development and weeks involved and what happens

A

pseudoglandular - 8-14 wks, ducts + bronchioles develop from bronchiopulmonary trunk canalicular - 16-26 wks, resp bronchioles form terminal sac - 26+, terminal sacs form and type 1 and 2 (surfactant) pneumocytes differentiate

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9
Q

what aids lung development

A

amniotic fluid and breathing movements

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10
Q

what is the threshold for viability for baby

A

24 wks +

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11
Q

when does kidneys begin to function and what happens if they dont

A

10 wks oligohydroamnios if not

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12
Q

when does nervous system myelinate and when do voluntary coordinated movements occur

A

myelination at 9 mths and after birth voluntary coordinated movements - 4 mths +

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13
Q

when is fetus first movements

A

8 wks +

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14
Q

what and when is quickening of fetus

A

increased awareness of fetus at 17 wks

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15
Q

state fetal circulation

A

ductus venosus - bypass liver ductus arteriorus and FO - bypass lungs

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16
Q

how does the last menstrual period relate to weeks of fertilisation

A

+2 weeks after fertilisation

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17
Q

what is the metabolic funcitons of the placenta

A

synthesis glycogen, FAs, cholesterol

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18
Q

what does umbilical vein and artery carry

A

vein - blood to fetus artery - blood from fetus

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19
Q

what is amniotic fluid purpose`

A

swallowed to make urine and meconium protects against trauma aids development of urinary and GI

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20
Q

how much fetal urine produced at 25 weeks?

A

100-500 ml

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21
Q

why does fetal jaundice occur

A

fetus cant conjugate bilirubin

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22
Q

what is haemomonochorial mean

A

placenta has direct contact with blood, placental barrier at thinnest

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23
Q

explain formation of placenta after blastocyst has invaginated endometrium

A

1) trophoblast differentiates to cytotrophoblast and syncytiotrophoblast 2) SCT forms villi and lacunae. lacunae fill with blood 3) CT villi grow into SCT - primary villi, 2nd week 4) extraembryonic mesoderm grows into villi - 2nd villi, 3rd week. Soon after, embryonic blood vessels form in villi, 3rd villi 5) maternal blood in intervillous spaces

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24
Q

what happens to the SCT and CT in placenta

A

gets thinner and thinner allowing increased exchnage

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25
how is endometrium prepped for implantation
spiral arteries which are high flow and low resistance
26
what is decidualisation
pre decidual cells of mother balance invasive force of trophoblast
27
explain the placental and amniotic situation of dizygotic twins
2 placenta + 2 separate amniotic sacs
28
what is maternal aspect of placenta and what is it made of? what is fetal aspect made of
maternal - decidua basalis, made of cotyledons fetal - umbilicus
29
what substances diffuse into placenta and how
simple diffusion - gases, electrolytes, water, urea facilitated - glucose active transport - AAs, fe, folate RME - IgG
30
name the teratogenic drugs
TERATOWgenic thalidomide, epilepsy drugs, retinoid, ACEi, third element: lithium, OCP, warfarin
31
thyroid changes in pregnancy
increased T3/4 due to hCG stimulation
32
what is the endocrine functions of placenta
hCG, hPL, prog, oest, hCS, hCT (thyrotrophin)
33
what can increased hCG indicate in female
pregnancy, hydratiform mole, coriocarcinoma
34
what does hPL do
increase glucose available from mother
35
what does progesterone do
increase appetite
36
what are possible pregnancy complications
pre-eclampsia, placental insufficiency
37
what is preeclampsia and what can it lead to if untreated
high BP (\>140/90) and proteinuria. Can lead to seizures (eclampsia)
38
risk factors of preeclampsia
DM, obesity, hypertension,
39
treatment of preeclampsia
CCB, beta blocker
40
what is placental insufficiency
not enough blood flow to placenta \> reduced HR of fetus
41
why does gestational diabetes occur. Risk factors
hPL increases insulin resistance and decreases fasting blood glucose RF - PCOS, smoking
42
what is acrosome process
sperm penetrates ZP. cortical reaction blocks polyspermy
43
urinary changes in pregnancy
increase GFR and risk of UTI decrease urea and creatinine by 50% urinary stasis due to prog ureteral dilation
44
resp changes in pregnancy
increase AP and transverse diameter, tidal volume, RR (hyperventilation) decrease FRV
45
How does lipid metabolism change in pregnancy
increased lipolysis T2+
46
thyroid changes in pregnancy
increased T3/4 due to hCG stimulation
47
GI changes in pregnancy
appendix in RUQ increased risk biliary stasis, pancreatitis due to progesteron
48
blood changes in pregnancy
prothrombotic therefore increase risk of thrombus anemia - dilution of blood and fe and folate deficiency
49
symptoms of PCOS, diagnose, treat
diagnose USS increase LH and FSH and androgen, hirsutism, insulin resistance, infertile treat - weight loss, metformin
50
female sex response
blood engorgement of clit, vagina, breast and nips no refractory period
51
components of semen and origins
60% seminal vesicles - fructose, clotting factors, alkaline 30% prostate - proteolytic enzymes 10% bulbourethral - lubricate urethra
52
stats of sperm
2-4 ml, 20-200 million per ml \>50% morphology and movement
53
explain how erections happen
NO release in corpora cavernosa and corpora spongiosum, arteries dialte and release blood.
54
how does viagra work
inhibits cGMP breakdown (cGMP inhibits MLCK) which allows vasodilation of arteries of dick
55
ED causes
tears in corpora cavernosa, alcohol, psychological
56
what is sperm capacitation
in uterus, membrane changes to allow oocyte fusion and tail starts to whip
57
what is acrosome process
sperm penetrates ZP. cortical reaction blocks polyspermy
58
what happens after sperm + egg meet
meiosis 2 \> nuclei fuse \> mitosis
59
what is vasectomy
severing of vas deferens
60
what muscles make up levator ani
puborectalis, pubococcygeus, iliococcygeus
61
how does morning after pill work
high dose oestrogen and progesterone blocks implantation and luteal functions
62
what is in deep perineal space
deep transverse perineal muscle males - membranous urethra females - proximal urethra
63
casues of infertility. define infertility
anovulation (stress, PCOS, menopause), tubal occlusion, sperm problem cannot conceieve after 1 yr of trying
64
symptoms of PCOS, diagnose, treat
diagnose USS symptoms - increased LH and fsh and androgens, hirsutism, insulin resistance, infertile metformin treat and weight loss
65
how induce ovulation
antioestrogen
66
give arteries, veins and innervation and lymphatics of scrotum
anterior - lumbar plexus, ant scrotal art + vein posterior - sacral plexus, post scrotal art + vein lymph - superficial inguinal
67
what are spermatic cord contents
3x3+1 arteries - vas deferens, cremasteric, testicular nerves - genitofemoral, testicular, ilioinguinal others - pampiniform plexus, lymph, tunica vaginalis, vas deferns
68
give coverings of spermatic cord and what derived from
external - external spermatic fascia (external oblique) middle - cremasteric muscle and fascia (internal oblique)( internal - internal spermatic fascia (transversalis abdominis)
69
describe course of vas deferens
passes anterior to pubic bone then post to bladder and enters ejaculatory duct
70
waht are zones of prostate
central, transitional, peripheral
71
give lymph drainage of ovary, and uterus
ovary - paraaortic fundus - aortic + inguinal cervix and body - ext iliac
72
symptoms of BPH and carcinoma
dysuria, frequency, urgency
73
treatment for pelvic floor dysfunction
exercises and surgery
74
what is in superficial perinal space and function
ischiocavernosus - increase pressure to maintain erection bulbospongiosus - expel urine, maintain erection levator ani superficial transverse perineal exteernal anal sphincter cremaster muscle
75
what muscles make up levator ani
pubococcygeus, iliococcygeus, puborectalis
76
name the uterine ligaments
suspensory, mesovarium, round (keeps uterus anteflexed), broad, ovarian
77
draw out ischiocavernosus, bulbospongiosus, superficial transverse perineal, and perineal body
see book
78
function of perineal body
anchors muscles, rectum and aids in pelvic support
79
how can perineal body be damaged and what happens
childbirth - damage to pudendal nerves and ligaments of muscles damage results in prolapse of vagina and uterus and urinary incontinence
80
what can cause pelvic floor dysfunction
age, menopause, obesity
81
give ovarian blood supply
ovarian artery from AA. right vein from IVC left vein from left renal vein
82
give fallopian tubes anatomy
uterus \> isthemus \> ampulla \> infundibulum \> ovary
83
give cervix anatomy
vagina \> external os \> endocervical canal \> internal os
84
cervical blood supply
uterone + internal pudendal both from ant int iliac
85
give lymph drainage of ovary, and uterus
ovary - paraaortic fundus - aortic + inguinal cervix and body - ext iliac
86
where are bartholin glands found and their function
found left and right of vagina. secrete mucus
87
what causes bartholinitis
gonorrhoea or chlamydia
88
innervation of vagina and perineum
perineum - pudendal lower 1/5 vagina - pudendal upper 4/5 - uterovaginal plexus
89
differentials of PID
IBS, ectopic pregnancy, UTI, endometriosis
90
organism of chlamydia
chlamydia trachomatis
91
symptoms, diagnosis and treatment of chlamydia
symptoms - urethritis, conjunctivits diagnose - NAAT urine, urethral swab treat - doxycycline
92
organism, symptoms, diagnosis and treatment of gonorrhoea
organism - neiserria gonorrhoea symptoms - urethritis, pharyngitis, PID, bacteremia (severe) diagnosis - NAAT urine, pharyngeal swab treat - ceftriaxone + azithromycin
93
organism, symptoms, diagnosis and treatment of herpes
symptoms - primary = painful genital ulcers, dysuria, fever, recurrent (stays in DRG) treat - aciclovir
94
which herpes type does cold sores
typ1
95
organism, symptoms, diagnosis and treatment of genital warts. which types oncogenic
organism HPV. 16 + 18 oncogenic symptoms - painless warts treat - vaccine. self limiting diagnosis - colposcopy + acetowhite screening. cervical swab. visual diagnosis
96
organism, symptoms, diagnosis and treatment of syphilis
organism - treponema pallidum (spirochete) primary - hard painless ulcers. secondary - fever, rash, lymphadenopathy. third - tabes dorsalis, neurosyphalis diagnosis - serology treat - penicillin
97
diagnosis, symptoms, treatment trichomonas vaginalis
diagnosis - vaginal wet mount symptoms - frothy, greeny discharge. musty smell. dyrsuria treat - metronidazole
98
diagnosis, symptoms, treatment vulvovaginal candidiasis
symptom - curd like discharge. itchy vag diagnosis - vaginal wet mount treat - nystatin or flucanozole
99
diagnosis, symptoms, treatment bacterial vaginosis
symptom - fish odour discharge diagnosis - cervical smear treat - metronidazole
100
what is PID
infection of upper female repro
101
risk factors of PID
alcohol, drugs, smoking, IUCD COCP reduces risk
102
symptoms of PID
fever, lower abdo pain, adnexal tenderness, abnormal discharge +/- blood adhesions and fibrosis
103
differentials of PID
IBS, ectopic pregnancy, UTI, endometriosis
104
diagnosis and treatment of PID
diagnosis - triple smear treat - analgesia, doxycycline + ceftriaxone + metronidazole
105
what is fitz hugh curtis syndrome
post PID complication causes adhesion on liver and RUQ pain
106
explain fetal co2 levels and why
lower than in mother. progesterone stimulates hyperventilation in mother
107
name infectious agents that cross placental barrier
TORCH toxoplasma gondii, others, rubella, CMV, HSV2
108
cvs changes in pregnancy
increase - CO, SV (40%), HR (20%), BV decrease - TPR (30%), BP due to progesterone and uterine compressing IVC and aorta (normal in T3)
109
coitus phases
excitement \> plateau \> orgasm \> resolution
110
what zones are enlarged in BPH and carcinoma
BPH - transitional zone carcinoma - peripheral zone
111
what are the parts of the male urethra
preprostatic, prostatic, membranous, spongy

PPE (18 decks)

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