Week 3 part 2 Flashcards by Joanna Lowrie

What kind of nerves are involved in pelvic floor muscle contraction e.g. during sneezing?

Somatic motor

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Uterine cramping/menstruation and contraction involve what types of nerve?

Sympathetic/parasympathetic

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What carries pain from pelvic part of vagina and from perineum?

Pelvic vagina - visceral afferents

Perineal vagina - somatic sensory

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Pain runs alongside what fibres in inferior aspect of pelvic organs (not touching perititneum) and in what fibres when touching the peritoneum?

Inferior - parasympathetic fibres

Superior - sympathetic fibres

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Name two structures crossing from pelvis to perineum?

Urethra

Vagina

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What fibres deal with pain sensation above levator ani (pelvis)

Patasympathetic

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What fibres deal with pain sensation below levator ani (perineum)?

Pudendal nerve

S2-4

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Visceral afferents for pain travel back to T11-L2 from pelvic organs which touch the peritoneum. Give three of these structures? (sympathetic)

Uterine tubes
uTERUS
Ovaries

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In the cervix and superior vagina where do pain sensation visceral afferents travel back to?

S2-S4

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In relation to spinal and epidural anaesthetic: at what level does s[inal cord become cauda equina?

L2 vertebra

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When does subarachnoid space end?

Level of S2

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In relation to spinal and epidural anaesthetic: what region is anaesthetic injected into?

L3-L4 region (L4 spinous process at most superior point on iliac crest)

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Where does needle pass through for spinal anaesthetic?

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)
dura mater
arachnoid mater
finally reaches subarachnoid space (contains CSF)

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What does needle pass through for epidural?

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)

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What do all spinal nerves and their named nerves contain?

Sympathetic fibres

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How do you know if spinal anaesthetic is working?

Blockade of sympahtetic tone to all arterioles leading to vasodilation. Skin of lower limbs looks flushed, warm and reduced sweating
HYPOTENSION

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The pudendal nerve exits pelvis via … It passes posterior to … ligament. It reenters via … It travels in pudendal canal (passageway within … with … artery and vein), also nerve to obturator internus

Greater sciatic foramen
Sacrospinous ligament
Lesses sciatic foramen
Obturator fascia
Internal pudendal artery

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What landmark is used for administration of pudendal nerve block?

Ischial spines

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During labour damage to what nerve and muscle could occur?

Pudendal nerve stretched
Excternal anal spincter muscle torn when weakened
Faecal incontinence

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In an episiotomy - where is the mediolateral incision made into?

Ischioanal fossa (fat filled)

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What triggers male/female differentiation?

Germ cells

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What is the origin of male duct system?

Mesonephric

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What is origin of female duct system?

Paramesonephric

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What controls descent of the testis?

Gubernaculum

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What do the paramesonephric ducts fuse to create?

Broad ligament of the uterus

Name three methods of doing a DNA or chromosome test on baby in utero?

Placenta - chorionic villus biopsy (good tissue) Skin/urine cells - amniocentesis (poor tiossue) Blood - fetal blood sampling (good tissue)

When can chorionic villus biopsy and amniocentesis be performed?

CVS - 12 weeks | Amniocentesis - 15 weeks

When can fetal blood samplimg be done?

18+ weeks

fetal blood sampling miscarriage risk?

What fetal DNA method of testing has a risk of confined placental mosaicism?

CVS

When can fetal DNA from maternal blood test be done?

8+ weeks (stable tissue)

A method to analyse whole genome?

Array CGH

A method to analyse targeted genome?

FISH

If ther eis high risk of chromosomal trisomyt on screening, fetal abnormality on scanning, and balanced chromosomal rearrangement in parent what should be done?

Array CGH or chromosome analysis

Name a method of non-invasibe prenatal testing (currently - sex determination and trisomy testing)?

Free fetal DNA in maternal circulation

Trisomy 13

Patau syndrome

45 X Neck webbing Oedema

Turner syndrome

Bilateral cleft lip | Postaxial polydactyly

Patau syndrome trisomy 13

What is a robertsonian translocation?

Two acrocentric chromosomes stick end to end

Robertsian translocation trisomy 14

Misscarriage

What are the two broad catagoeries for the small baby?

1. Pre term delivery | 2. Small for gestational age (intra uterine growth restriction/constitutionally small)

Definition of preterm birht?

Delivery between 24 and 36.6 weeks

What are survival rates for pre-term borht at 24 weeks and 32 weeks?

24 - 20/30% | 32 - greater than 95%

Give two causes of over distension that can lead to pre-term birht?

Multipel pregnanyc | Polyhydramnios

Give a vascular cause of pre-term birht?

Placental abruption

If you've had a pre term labour once before what is riks and what is risk if twice before?

Once - 20% Twice - 40% multiple pregnancies - 50% risk

What is a pregnant women who has uterine anomalies, is a teenager, smokes, does cocaine and is skinny have an increased risk of?

Pre term birth

Infant with a birthweight that is less than 10th centile for gestation corrected for maternal height, weight, fetal sex and birth order.

Small for Gestational Age

Give three fetal factors for poor growth?

1. Infection e.g. rubella, CMV, toxoplasma 2. Congenital anomalies e.g. absent kidneys 3. Chromosomal abnormalities e.g. Downs

What are placental factors causing poor growth often secondary to?

Hypertension

describe symmetrical IUGR?

Small head | Small abdomen

describe asymmetrical IUGR

Normal head | Small abdomen

What four things are done to assess fetal wellbeing?

1. Assessment of growth 2. Cardiotocography 3. Biophysical assessment 4. Ultrasound (umbilical arterial dioppler)

Are accelerations on CTG good or bad?

Good - indicates good reflex reactivity of the fetal circulation

Normal doppler ultrasound in pregnancy will show what?

Continuous high forward flow at the end of diastole

Is IUGR a public health concern?

Yes

What can monochorionic twin pregnancy, fetal anomaly, maternal diabetes, hydrops fetalis all cause which leads to large for dates pregnancy?

Polyhydramnios

Discomfort Labour Membrane Rupture Cord prolapse

Polyhydramnios Diagnose with ultrasound

Are Monochorionic / monozygous twins at higher risk of pregnancy complications ?

Yes

Lamda sign on US?

Diachorionic twins

Exaggerated pregnancy symptoms e.g. excessive sickness High AFP Large for dates uterus

Multiple pregnancy

Give three consequences of maternal diabetes?

1. Overgrowth of insulin sensitive tissues and macrosomia 2. hYPOXIC STATE in utero 3. Fetal metabolic reprogramming leading to long term diabetes and obesity risk

What is diagnosis of Gestation diabetes based on?

GTT at 28 weeks Fasting greater than 5.1 2 hours greater than 8.5

In mother with diabetes in pregnancy what scan is offered at 18 weeks?

Fetal anomaly

What is the transformation zone of cervix?

Squamo-columnar junctioj between ectocervical squamous and endocervical columnar epithelia

Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia.

Cervical erosion or ectropion

What occurs sometimes when when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus)?

Nabothian follicles

sub epithelial reactive lymphoid follicles present in cervix.

Follicular cervicitis

Is a cervical polyp pre malignant?

Give the two major types of cervical cancer?

Squamous carcinoma | Adenocarcinoma

What do HPV 16 and 18 cause?

Cervical cancer

What triples the risk of cervical cancer?

Smoking

Vulnerability of SC junction in early reproductive age can increase risk for cervical cancer - name three?

1. Age at first intercourse 2. Long term oral contraceptive use 3. Non-use of barrier contraception

What types of HPV cause genital warts?

6 and 11

What causes condyloma acuminatum?

Thickened papillomatous squaous epithelium with cytoplasmic vacuolation (koilocytosis) - HPV

wHAT DOES HIGH RISK hpv TYPES 16 and 18 lead to?

Cervical Intraepithelial Neoplasia

What is detected in cervical smears to indicate cervical intraepithelial neoplasia?

Infected epithelium remains flat, but shows koilocytosis

What is the time line for HPV infection causing high grade CIN

6 months - 3 years

What is the time line for high grade CIN causing invasive cance?

5-20 years

What is the preinvasive stage of cervical cancer?

Cervical Intraepithelial Neoplasia

Where does CIN occur?

At transformation zone

What three things are assessed in histology of CIN?

1. Delay in maturation/differentiation (immature basal cells occupy) 2. Nuclear abnormalities (hyperchromasia, increased NC ration, pleomorphism) 3. Excess mitotic activity (above basal layers, abnormal mitotic forms)

What stage of CIN is: basal 1/3 of epithelium occupied by abnormal cells, raised mitotic figures in lower 1/3, surface cells quite mature but nuclei slightly abnormal?

CIN I

What stage of CIN is: abnormal cells extend to middle 1/3, mitoses in middle 1/3, abnormal mitotic figures?

CIN II

What stage of CIN is: Abnormal cells occupy full thickness of epithelium, mitoses, often abnormal in upper 1/3?

CIN III

What are 75-95% of malignant cervica tumours? and the 2nd commonest female cancer worldside?

Invasive Squamous Carcinoma

What does invasive squamous carcinoma develop from ?

Pre-existing CIN, therefore most cases preventable by screening

Stage IB ISC?

Confined to cervix

Name some symptoms of invasive carcinoma of cervix?

1. Abnormal bleeding 2. Pelvic pain 3. Haematuria/UTI 4. Ureteric obstructin

Give some types of abnormal bleeding in Invasive carfcinoma of cervix?

Post coital Post menopausal Brownish or blood stained vaginal discharve Contact bleeding - friable epithelium

Where does Cervical Glandular Intraepithelial Neoplasia (CGIN) originate from?

Endocervical epithelium

What is the preinvasive phase of endocervical adenocarcinoma?

Cervical Glandular Intraepithelial Neoplasia (CGIN)

5-25% of cervical cancers?

Endocervical adenocarcinoma - worse prognosis than squamopuse carcinoma

Higher S.E. Class Later onset of sexual activity Smoking HPV again incriminated, particularly HPV18.

Adenocarcinoma

What disease is associated with vulvar intraepithelial neoplasia?

Pagets disease

Young women: often multifocal, recurrent or persistent causing treatment problems.

Vulvar Intraepithelial neoplasia

Older women: greater risk of progression to invasive squamous carcinoma.

Vulvar intraepithelial neoplasia

Who usually gets Vulvar Invasive Squamous Carcinoma

Elderly women, ulcer or exophytic mass

what are verrucous an extremely well differentiated type of?

Vulvar Invasive Squamous Carcinoma

Where does Vulvar Invasive Squamous Carcinoma spread to (nodes)?

Inguinal lymph nodes - most important prognostic factor