Repro Passmed Flashcards by Callum McCabe

Broad ligament attaches …

Lateral aspect of ovaries to the walls and floor of pelvis

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Cardinal ligament attaches…

Lateral cervix to the uterosacral ligament

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Round ligament attaches …

Uterus - maintains the uterus in an anteverted position

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Uterosacral ligament

Uterus to anterior sacrum.

Maintains the position of the uterus in the pelvis

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Suspensory ligament

Ovaries to the lateral pelvic wall#

Used as a landmark for differentiating between intraovarian and extraovarian pathology

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Pregnant diabetics have large or small babies ?

Large for gestational age

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Nulliparity =

Never been pregnant before

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Nulliparity increases the likelihood of big or small babies ?

Small babies

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What pregnancy supplement is recommended?

400mcg from before conception until 12 weeks

reduces risk of neural tube defects

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Endometriosis: extra-pelvic bleeding with pain on defecation = blood accumulating where ?

Pouch of Douglas (rectouterine pouch)

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Raised pH + low PCO2 in pregnancy - why ?

Increased pulmonary ventilation and tidal volume

(due to the effect of progesterone on respiratory centre)

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Role of lactoferrin (in breast milk)

Promotes rapid absorption of iron

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What causes nausea and vomiting in pregnancy ? (hyperemesis gravidarum)

Raised hCG

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What causes hyperemesis gravidarum in trophoblastic disease ? (while pregnant)

There is abnormal proliferation of trophoblastic tissue (e.g. hydatiform moles, invasive moles, choriocarcinomas).
These masses secrete beta hCG - which cause nausea and vomiting

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What causes the end of the menstrual cycle ?

The demise of ovarian follicles

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Foetal macrosomia leads to which obstetric emergency ?

Shoulder dystocia

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What lymph nodes does the scrotum drain to ?

Inguinal lymph nodes

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Main mechanism of action of combined oral contraceptive pill ? (+ 2 additional mechanisms)

Inhibition of ovulation

+ thickens cervical mucous
+ thins endometrial lining

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What cells produce and secrete testosterone in response to LH?

Leydig cells

(Luteinising = Leydig)

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What is the ‘temperature method’ of contraception?

Temperature rises during ovulation

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The bladder drains to which lymph nodes?

External iliac lymph nodes

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The glans penis drains to which lymph nodes?

Inguinal lymph nodes

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The prostate drains to which lymph nodes?

Internal iliac lymph nodes

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The rectum drains to which lymph nodes?

Pararectal and inferior mesenteric lymph nodes

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Prepubertal atrophic vaginitis is caused by what?

Lack of vaginal oestrogen causing infection-prone alkaline environment

Where do ectopic pregnancies tend to implant?

Ampulla

Pregnant female with hypertension on ramipril - what do you do?

Discontinue ramipril, start labetalol

What is the preferred option of delivery for a fetus in transverse lie?

Caesarean section

HELLP syndrome - what does HELLP stand for?

Haemolysis, Elevated Liver enzymes, Low Platelets

Which deficiency is most commonly responsible for neural tube defects?

Folic acid

Normogonadotropic normoestrogenic anovulation = ?

Polycystic ovarian syndrome (FSH, LH, oestradiol all normal)

Which pregnancy hormone reduces blood pressure?

Progesterone (smooth muscle relaxation)

What is the underlying pathology behind haemolytic disease of the newborn?

Maternal production of IgG antibodies against foetal RBC

Where is beta-HCG secreted from?

Placenta

Lymphatic drainage of the breast?

Axillary lymph nodes

Which hormone stimulates the production of milk?

Prolactin

Which hormone causes contraction of the myoepithelial cells surrounding the mammary alveoli (groups are called lobules), resulting in milk ejection from the breast?

Oxytocin

What type of epithelium lines the ectocervix?

Stratified squamous non-keratinized epithelium

What muscles does the breast lie over?

Pectoralis major and serratus anterior

What is the main structure that determines the descent path of the testicle?

Gubernaculum

What part of the follicle prepares the womb for embryo implantation?

Granulosa cells

Which hormonal changes occur in the menopause?

Cessation of oestradiol and progesterone production

Lymphatic drainage of the scrotum ?

Inguinal lymph nodes

Breast infection (breastfeeding) - most common organism

Staph aureus

Gestational trophoblastic disease causes...

1. Hyperemesis gravidarum 2. Very high serum hCG concentrations

Which combination of maternal and fetal Rh statuses would pose a risk of Rhesus disease?

Rhesus -ve mother, Rhesus +ve foetus

Where is hCG secreted from?

Syncytiotrophoblast (stimulates corpus luteum to produce progesterone)

Failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (e.g. breast development)

Primary amenorrhoea

Failure to establish menstruation by 13 years old in the absence of secondary sexual characteristics

Primary amenorrhoea

Pelvic pain occurring during her periods, with 'deep' pain during intercourse and pain on defecation during this time

Endometriosis (pain on defecation doesn't occur with PID)

2cm smooth lump in the right breast. Mobile and not fixed to the skin - no other concerning features

Fibroadenoma (not concerning, common in 15-25 y.o.)

↑ HCG, ↓ PAPP-A, thickened nuchal translucency

Increased risk of Down's syndrome

What is PAPP-A?

Pregnancy-associated plasma protein-A A protein produced by the placenta Needed for the implantation process and to maintain a healthy placenta (afterbirth) A marker measured as part of the combined pregnancy screening blood test which is offered around 11-14 weeks of pregnancy.

What attaches the cervix to the lateral pelvic wall?

Cardinal ligament

Gestational diabetes complications

Macrosomia Polyhydramnios Shoulder dystocia Congenital heart abnormalities Neural tube defects Neonatal hypoglycaemia

PPROM, abdominal pain, uterine contractions, 'flu-like symptoms', fever, and foul-smelling discharge

Chorioamnionitis - infection of the amniotic fluid and fetal membranes - usually caused by ascending bacterial infection from the vagina and cervix

Contraindication for labetalol

Asthma

Contraindication for methyldopa

Depression

Hormone used to test for female fertility

Day 21 progesterone (a.k.a. mid-luteal cycle progesterone)

Smoking is a protective factor for which gynae cancer?

Endometrial cancer

What causes anaemia in pregnancy?

Increase in plasma volume disproportionate to the increase in haemoglobin, causing an overall decrease in haemoglobin concentration

At what paternal age is the risk of miscarriage increased?

Paternal age of ≥40

COCP increases risk of which cancers? And decreases risk of which cancers?

Increases: breast, cervical Decreases: ovarian, endometrial

Which hormone stimulates uterine contractions and is useful in post-partum haemorrhage?

Oxytocin (Syntocinon = synthetic oxytocin)

Where does fertilisation usually occur?

Ampulla

Where does implantation usually occur?

Upper posterior wall of uterus

Most common bacterial cause of neonatal sepsis

Group B strep

Non-invasive test for trisomy

"Non-invasive prenatal screening test" - analyse small DNA fragments that circulate in the blood of a pregnant woman - this derives from placental cells and is usually identical to fetal DNA

Raised FSH/LH in primary amenorrhoea

Turner's syndrome

What is the first intervention that should be used to try and overcome shoulder dystocia?

McRoberts manoeuvre

What is the normal anatomical position of the uterus?

Anteverted and anteflexed

Increased tidal volume in pregnancy is caused by which hormone ?

Progesterone

MOA of anastrozole

Aromatase inhibitor - prevents androgen conversion to oestrogen ("reduces peripheral oestrogen synthesis")

Uterovaginal prolapse is caused by damage to which ligament?

Uterosacral ligament (a.k.a. recto-uterine ligament)

Menopause - why are oestrogen and progesterone prescribed?

Oestrogen - symptomatic relief Progesterone - protects against oestregenic adverse effects

Which anatomical structure must a needle pass through to drain fluid from the rectouterine pouch?

Posterior fornix of the vagina

Proliferative phase of menstruation =

Thickening of the endometrium due to oestrogen being secreted by the follicle

In which region of the breast do most breast cancers arise?

Upper lateral

Most common type of breast cancer?

Invasive ductal carcinoma

Low-level gonadotrophins in secondary amenorrhoea

Hypothalamic amenorrhoea

Origin of the testicular artery?

Abdominal aorta

What hormone is responsible for ovulation

Luteinising hormone (LH) surge

Which cells secrete testosterone in the testes?

Leydig cells

In which uterine ligament are the fallopian tubes?

Broad ligament

Postmenopausal bleeding - first investigation ?

Endometrial biopsy

Menopause blood test results ?

High FSH, LH Low oestrogen

Likely cause of Erb's palsy in the newborn?

Shoulder dystocia due to macrosomia

Uterine ligament which folds over the uterus - rupture causes spontaneous haematoma and is an obstetric emergency

Broad ligament

Definition of PPH

>500ml blood loss

4 Ts of PPH

Tone (uterine atony): the vast majority of cases Trauma (e.g. perineal tear) Tissue (retained placenta) Thrombin (e.g. clotting/bleeding disorder)

Turner's syndrome = hyper/hypogonadotrophic hyper/hypogonadism ?

Hypergonadotrophic hypogonadism (low sex steroids leads to high LH and FSH as part of a feedback response)

Right testicular vein drains into _______ ? Left testicular vein drains into _______ ?

Right = inferior vena cava Left = left renal vein

Why is symphysis pubis dysfunction common in late pregnancy?

Hormonal changes increases ligament laxity

26 weeks pregnant - severe abdominal pain + bleeding Older mother, high parity, the onset of clinical shock and (most importantly) a tender, hard uterus on examination

Placental abruption (separation of placenta before birth)

Ligament which attaches the ovary to the lateral pelvic wall

Suspensory ligament

Why does pregnant woman's heart rate increase?

Increased stroke volume due to increased plasma volume, secondary to activation of the renin-angiotensin system

Proliferative phase of the menstrual cycle =

The thickening of the endometrium in response to oestrogen secreted from the mature follicle

Fibroids causing difficulty conceiving - where are they likely to be implanted?

Submucosal layer of uterus

Most common cause of neonatal sepsis?

Group B strep

Temperature method of contraception: rise in temperature = what ?

Ovulation

Beta-hCG is secreted from ... ?

Placenta

Fitz-Hugh-Curtis syndrome = ?

Adhesions of liver to peritoneum - associated with Pelvic Inflammatory Disease (PID)

Most common cause of sepsis in neonates ?

Group B Strep

Breast cyst treatment ?

Should be aspirated those which are blood stained or persistently refill should be biopsied or excised

Low O2 + respiratory alkalosis in a pregnant woman. Why?

Increased pulmonary ventilation and tidal volume

Repro Passmed Flashcards

(106 cards)