Week 3 part 1 Flashcards Preview

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Flashcards in Week 3 part 1 Deck (100):
1

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

Common Surgical Incision (O&G)

2

Muscle layers of abdomen from outer to inner?

External oblique
Internal oblique
Transversus abdominus

3

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

External obliques

4

What is linea alba?

Midline blending of aponeuroses

5

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

External obliques (

6

What do internal obliques attach between?

LOwer ribs, thoracolumbar fascia, iliac crest and linea alba

7

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

Rectus sheath

8

Nerve between transversus abdominus and internal oblique?

Ilioinguinal nerve

9

What do 7th to 11th intercostal nerves become?

Thoracoabdominal nerves

10

T12 nerve>?

Subcostal

11

L1 nerves?

Iliohypogastric and ilioinguinal

12

What arteries supply anterior abdominal wall?

Superior and ingerior epigastric arteries

13

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

Superior epigastric arteries

14

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

Inferior epigastric arteries

15

What supplies lateral abdominal wall muscles?

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

16

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

Lateral direction toward nerve supply

17

What layers are seen when opening laparotomy?

Skin and fascia
Linea alba
Peritoneum

18

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

Inferior epigastric artery

19

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

Inferior epigastric artery - branch of external iliac artery

20

From 20 weeks how often will pregnant women be seen/

At 4 week intervals

21

From 30 weeks how often will pregnant women be seen?

At 2 week intervals

22

At 28 weeks if rhesus negative what will be offered?

Anti D

23

In pregnancy: at 12 weeks what is offered?

FBC, antibodies, glucose, syphilis, rubella

24

In pregnancy: at 16 weeks what is done?

Triple test or alpha feto protein

25

When is first ultrasound down in pregnancy?

At 18 weeks

26

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

Pubic symphisis

27

At 20 weeks gestation where will the uterus almost reach?

The umbilicus

28

At 28 weeks where will the uterus almost have reached?

Xiphisternum

29

In pregnancy when is booking scan performed?

Around 6 to 7 weeks

30

In embyonoc period how does the embryo receive nutrition?

From yolk sac via vitelline duct

31

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

Downs syndrome

32

In first trimester - how is downs syndrome assessed risk?

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

33

When is down syndrome nuchal thickenss tested?

At 11 - 13 +6 weeks

34

In the second trimester how is downs risk assessd?

1. Blood sample at 15-20 weeks
2. Assay of HCG and AFP

35

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

Further investigation - amniocentesis

36

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

Maternal age

37

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

Low - but high spina bifida risk

38

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

Hihg - irresepctive of maternal age

39

When is amniocentesis usually performed and what is the risk?

After 15 weeks
Risk of miscarriage 1%

40

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

12 weeks
Carries miscarriage rate of 2%

41

In days 5 - 7 what happens to blastocyst?

Implants

42

In the blastocyst what do inner cells develop into?

Embryo

43

In the blastocyst what do outer cells develop into?

Burrow into uterine wall and become placenta

44

Is the trophoblast layer of blastocyst on surface of cell?

Yes

45

At what day does blastocyst become buried in uterine lining?

By day 12

46

What two tissue types make up the placenta?

Trophoblast (chorion)
Decidual

47

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

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

48

What does each placental villi cpntain?

foetal capillaries separated from maternal blood by thin layer of tissue

49

When do the placenta and foetal heart begin to function?

By 5th week of pregnancy

50

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

Decidual cells to concentrate glycogen, proteins and lipids

51

What structure works as a physiokogical arteriovenous hunt?

Placenta

52

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

Into uterine wall

53

What is present in teh intervillous space?

Maternal blood

54

What does circulation within the intervillous space act partyl as?

Arteriovenous shunt

55

What is in umbilical blood?

Mixing of arterial and venous blood - oxygen poor

56

How does fetal, oxygen saturated blood return to fetus?

Through umbilical vein.

57

How does maternal oxygen poor blood flow back?

Through uterine veins

58

What three factors allow sufficient supply of oxygen to fetus?

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

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

35th weeks

60

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

From mother to child!

61

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

Siplified transport

62

Name 4 teratogenic drugs?

1. Thalidomide
2. Carbamazepine
3. Coumarins
4. Tetracycline

63

At what weeks gestation does HCG spike?

10 weeks

64

What does HCG prvent in pregnancy?

Involution of corpus luteum

65

At what week is human chorionic somatomammotropin produced?

Week 5

66

Give three functions of HCS

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

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

Progesterone

68

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

Estrogens

69

In pregnancy what is role of estradiol?

Enlargement of uterus

70

In pregnancyt what is role of estriol?

Estriol level - indicator of vitality of fetus

71

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

ACTH - aldosterone (hypertension)
cortisol (oedema, insulin resistance leading to gestational diabetes)

72

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

Hyperthyroidism

73

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

Hyperparathyroidism

74

What is increase in cardiac output during pregnancy due to?

Demands of uteroplacental circulation

75

what percentage above normal is cardiac output in pregnancy?

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

76

When does CO decrease in pregnancy?

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

77

In second trimester what happens to blood pressure?

It drops (uteroplacental circulation explans and peripheral resistance decreases)

78

In pregnancy what does plasma volume increase proportionally with>

cARdiac output

79

What happens to RBC in pregancy?

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

80

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

1. RR increaes
2. tidal volume increases
3. pCO2 decreases

81

In pregnancy what happens to GFR and Renal plasam flow?

Increases. Also increase in urine formation

82

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

Decrease renal function

83

What is pre-eclampsia?

Pregnancy induced hypertension and proteinuria

84

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

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

85

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

Eclampsia treat with vasodilators and cesarean section

86

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

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

87

When is mothers anabolic phase?

1 - 20th week

88

When is mothers accelerated starvation phase

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

89

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

Increased

90

In catabolic mother phase what happens to senstiivity of insulin?

Resistance

91

Before parturition what is given to prevent intracranial bleeding during labour

Vitamin K

92

What hormone increases contractions and excitability of uterine tissue?

Oxytocin

93

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

Increase

94

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

INcreases - cervical strethcing also causes further oxytocin release

95

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

Placenta to make prostaglandins - stimulate more contractions

96

What are the 3 stages of labour?

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

97

Lactation: what hormone causes growth of ductile system?

Estrogen

98

Lactation: what hormone develops lobule-alveolar system?

Progesterone

99

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

Inhibit it = at birht sudden drop in these hormones

100

Lactation: what hormone stimulates milk production?

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