Gyenocology
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2017-08-07 15:42
GYNECOLOGY
| Question | Answer |
|---|---|
| What does the Seminal Vesicle give to sperm? | Food (fructose) and clothes (semen) |
| What do the Bulbourethral = Cowper's glands secrete? | Bicarbonate (neutralize lactobacilli) |
| What does the Prostate secrete? | “The Prostate HAZ it” (1) Hyaluronidase Acid phosphatase |
| What is the Capacitation reaction? | Zinc (Zn) used to peel semen off |
| What is the Acrosomal reaction? | Sperm release enzymes to eat corona radiata |
| What is the Crystalization reaction? | Wall formed after 1 sperm enters (to prevent polyspermy) the egg |
| Where does Testosterone come from? | Adrenal gland and testicles |
| Where does DHT come from? | Testicles (at puberty) |
| What is a Pseudohermaphrodite? | External genitalia problem; does not match genotype |
| What is a True Hermaphrodite? | Internal genitalia problem → has both sexes genatalia |
| What is a Female Hermaphrodite? | Impossible b/c the default is female |
| What is a Female Pseudohermaphrodite? | XX with low 21-OHase → High testosterone |
| What is a Male Hermaphrodite? | XY with no MIF |
| What is a Male Pseudohermaphrodite? | XY that has low 17-OHase → low testosterone |
| What is Hirsuitism? | Hairy |
| What is Virulization? | Man-like features in female child |
| What is Testicular Feminization = Androgen Insensitivity? | Bad DHT receptor → XY with blind pouch vagina |
| What is McCune-Albright? | Precocious sexual development, polyostotic fibrous dysplasia “Whorls of CT”, “Coast of Maine” pigmented skin macules |
| What is Cryptochordism? | Testes never descended → sterility after 15mo, seminomas |
| Which stage of the menstrual cycle has the highest estrogen levels? | Follicular stage (has proliferative endothelium) |
| What stage of the menstrual cycle has the highest temperature? | Ovulatory stage |
| What stage of the menstural cycle has the highest progesterone levels? | Luteal stage (has secretory endothelium) |
| What form of estrogen is highest at menopause? | “E1” → Estrone (made by fat) |
| What form of estrogen is highest in middle-age females? | E2 → Estradiol (made by ovaries) |
| What form of estrogen is highest at pregnancy? | E3 → Estriol (made by placenta) |
| What states have increased estrogen? | Pregnancy, liver failure, p450 inhibition, obesity |
| What is Adenomyosis? | Growth of endometrium → myometrium, enlarged “boggy” uterus w/ cystic areas |
| What does DES taken by Mom causes in her daughter? | (1) Adenomyosis → menorrhagia, (2) Clear cell carcinoma of Vagina, (3) Recurrent abortions from cervical incompetence |
| What is Kallman's syndrome? | No GnRH, anosmia (can't smell) |
| What is Polycystic Ovarian Sndrome? | Increase Cysts; No ovulation → No Progesterone, (Increase endometrial CA) → can't inhibit LH, Obese, hairy, acne |
| What is Savage's Syndrome? | Ovarian resistance to FSH/LH |
| What is Turner's syndrome (XO)? | 1) High FSH, 2) Low E2 (estradiol), and 3) Ovarian dysgenesis |
| What does the Progesterone challenge test tell you? | Bleeds → she has estrogen. Not Bleed → she has no E2 or Ovaries. (1) Increase FSH → Ovary problem, (2) Decrease FSH → Pituitary problem |
| What is Sheehan syndrome? | (1) Post-partum hemorrhage → pitutitary, (2) Hyperplasia infarcts → No lactation |
| What is Asherman's syndrome? | Previous D&C → Uterine scars |
| What is Oligomenorrhea? | Too few periods |
| What is Polymenorrhea? | Too many Periods |
| What is the MCC of post-coital vaginal bleeding? | Cervical cancer |
| What is the MCC of post-coital vaginal bleeding in pregnant women? | Placenta Previa |
| What is the MCC of vaginal bleeding in post-menopause women? | Endometrial cancer |
| What is Chronic Pelvic Pain? | “Endometriosis” until proven otherwise |
| What is Dysfunctional Uterine Bleeding? | Diagnosis of exclusion, usually due to anovulation |
| What is Dysmenorrhea? | PG-F causes painful menstrual cramps (teenagers miss school/work) |
| What is Endometriosis? | Painful cyclical heavy menstrual bleeding → “Powder burns, chocolate cysts” due to ectopic endometrial tissue |
| What is Kleine Regnung? | Scant bleeding at ovulation |
| What is Menorrhagia? | Heavy Menstrual bleeding |
| What is Fibroids = Leiomyoma? | Benign uterus smooth muscle (SM) tumor, (1) Sub-mucosal type → bleeding, (2) Sub-serosal type → Pain |
| What is Metrorrhagia? | Bleeding or spotting in between periods |
| What is Mittelschmerz? | Pain at ovulation |
| What causes Syphilis? | Treponema Pallidum (Spirochete) |
| What is Herpes? | Double stranded DNA virus (Ds DNA Virus) |
| What is HPV? | Ds DNA virus |
| What is Chlamydia? | Obligate intracellular parasite |
| What causes Gonorrhea? | Gram negative (-) diplococcus |
| What causes Chancroid? | H. Ducreyi |
| What causes Lymphogranuloma Venereum? | Chlamydia trachomatis |
| What causes Granuloma Inguinale? | C. granulomatosis |
| What causes Epididymitis? | Chlamydia or GC |
| What is Condyloma lata? | (1) Flat fleshy warts, (2) ulcerated, (3) and (sencondary syphilis) |
| What is Condyloma Accuminata? | Verrucous “Cauliflower” warts, koilocytes, (HPV → 6, 11) |
| How does Herpes present? | (1) primary – painful grouped vesicles on red base, (2) painful solitary lesion |
| How does Syphilis present? | (1) primary – painless chancre (1-6 wks), (2) Secondary - rash, condyloma lata (6 wks), and (3) titiary – Neuro involvement, cardio, bone (6 yrs) |
| How does Chancroid present ? | Painful w/ necrotic center, Gram negative (-) rods, and “School of fish” pattern |
| How does Lymphogranuloma Venereum present? | Painless ulcers → abscessed nodes → genital elephantiasis |
| How does Granuloma Inguinale present? | Spreading ulcers, Donovan bodies, granulation testicular |
| How does Chlamydia present? | Cervicitis (yellow pus), conjuctivitis, PID |
| How does Gonorrhea present? | Palmar pustules, arthritis, urethral discomfort with vary purulent urethritis |
| What is Epididymitis? | Unilateral scortal pain, which decreased by support |
| What causes Congenital blindness? | CMV |
| What causes Neonatal blindness? | Chlamydia |
| What is Lichen simplex chronicus? | Raised white lesions, chronic scratching in vulva |
| What is Lichen sclerosis? | Paper-like vulva, itching, cancer risk |
| What is Hidradenoma? | Sweat gland cysts |
| What causes Non-bacterial fetal infections? | “TORCHES”, (1) Toxoplasma → multiple ring-enhancing lesions, cat urine, parietal lobe, (2) Others, (3), Rubella → Cataracts, hearing loss, PDA, meningoencephalitis, penumonia, “Blueberry muffin” rash, (4) CMV → Spastic diplegia of legs, hepatosplenomegaly, blindness, central calcifications, (5) HSV-2 → Temporal lobe hemorrhagic encephalitis, needs C/S prophylaxis, (6) Syphilis → Rhagade's (lip fissure), saber shin legs, Hutchinson's razor teeth, mulberry molars, saddle nose |
| What is Paget's disease of the breast? | Rash and ulcer around Nipple & Breast cancer |
| What is Lobular carcinoma? | Cells line up single file, contralateral primary |
| What is Comedocarcinoma? | Multiple focal areas of necrosis, “blackheads” |
| What is inflammatory carcinoma? | Infiltrates lymphatics, pulls on Cooper's ligaments, “Peau d'Orange” → dimpleling skin of the breast |
| What is Cystosarcoma phylloides? | “Exploding mushroom”, firm, rubbery, moveable, good prognosis |
| What is Intraductal papilloma? | Nipple bleeding |
| What is Ductal carcinoma? | Worst prognosis breast cancer |
| What is Sarcoma Botyroides? | Vagina Cancer, ball of grapes appearance |
| What is a Sister Mary Joseph Nodule? | Ovarian CA spread to umbilicus |
| What is Meig's syndrome? | Pleural effusion, ovarian fibroma, ascites |
| What are the S/E of Estrogen? | Weight gain, Breast tenderness, Nausea |
| What are the S/E of Progesterone? | Acne, Depression, HTN |
| Fluid Filled baby | Hydrops Fetalis |
OBSTETRICS
| Question | Answer |
|---|---|
| Why do pregnant women get anemia? | Dilutional effect, RBC rises 30% but volume rises 50% |
| What are the degrees of Vaginal lacerations? | (1) 1st Degree → Skin, (2) 2nd Degree → Muscles, (3) 3rd Degree → Anus, (4) 4th Degree → Rectum |
| What is Vernix? | Cheesy baby skin |
| What is Meconium? | Green baby poop |
| What is Lochia? | Endometrial slough |
| What is normal blood loss during a C-section? | 1L |
| How do you treat A1 Gestational DM? | Diet |
| How do you treat A2 Gestational DM? | Insulin |
| What are Identical twins? | Egg split into perfect halves “monochorionic” |
| What are Fraternal twins? | Multiple eggs fertilized by different sperm |
| What is Ovarian Hyper-stimulation Syndrome? | Weight gain and enlarged ovaries after “Clomiphene use” |
| Who makes the Trophoblast? | Baby |
| Who makes the Cytotrophoblast? | Mom → GnRH, CRH, TSH, Inhibin |
| Who makes the Syncito-trophoblast? | Mom and baby → HcG, HPL |
| When does implantation occur? | 1 week after fertilization |
| When is b-HCG found in urine? | 2 weeks after fertilization |
| What is the fx of Estrogen? | Muscle relaxant, constipation, increase protein production, irritability, varicose veins |
| What is the fx of Progesterone? | Increase Appetite, Increase Acne, dilutional anemia, quiescent uterus, pica, Hypotention, melasma |
| What makes Progesterone <10 week gastation? | Corpus Luteum |
| What makes Progesterone >10 weeks gastation? | Placenta |
| What is the fx of b-HCG? | Maintains Corpus Luteum, sensitized TSHr → act hyperthyroid to (Increase BMR) |
| What makes b-HCG? | Placenta |
| How fast should b-HCG rise? | Doubles every 2 days until 10 weeks (when placenta is fully formed) |
| What is the fx of AFP? | Regulates fetal intravascular volume |
| What is the fx of HPL? | Blocks insulin receptors → sugar stays high (baby's stocking up on stuff needed for the journey) |
| What is the fx of Inhibin? | Inhibits FSH → no menstruation |
| What is the fx of Oxytocin? | Milk ejection, baby ejection |
| What is the fx of the Cortisol in pregnancy? | (1) Decreases immune rejection of baby, (2) lung maturation |
| What are the thyroid hormone levels during pregnancy? | Increase TBG → Increase T4, normal free T4 levels, Increase Total T4 |
| When can you first detect fetal heart tone? | 20 Weeks |
| When can you tell the sex of a fetus by Ultra Sound? | 16 Weeks |
| What does an AFI <5 indicate? | Oligohydramnios (cord compression) |
| What does an AFI >20 indicate? | Polyhydramnioes (DM) |
| How fast should fundus height change? | Uterus grows 1cm/wk |
| What is the pool test? | Fluid in vagina |
| What is Ferning? | Estrogen crystallizes on slide |
| What is Nitrazine? | Shows presence of amniotic fluid |
| What is the risk of chorionic villus sampling? | Fetal limb defects |
| What is the risk of amniocentesis? | Abortion (2% risk) |
| What is a normal biophysical profile? | >8 |
| What is a biophysical profile? | “Test the Baby, MAN!”, (1) Tones of the heart, (2) Breathing, (3) Movement: BPD, HC, AC, FL, (4) AFI, (5) Non-stress test (normal = “Reactive”) |
| What pelvis types are better for vaginal delivery? | Gynecoid, Anthropoid |
| What pelvis types will need C/S? | Platypelloid, Android |
| How do you predict a due date with Nagele's Rule? | 9 months from last menses → add 1 week |
| Why is Nagele's Rule inaccurate? | Because it does not start from ovulation date |
| How do you correct Nagele's Rule for cycles >28 days? | Add x days if cycle is x longer |
| How much weight should a pregnant women gain? | 1lb/week |
| When should intercourse be avoided during pregnancy? | 3rd trimester because PG-F in semen may cause uterine contractions |
| What are the Leopold maneuvers? | (1) Feel fundus, (2) Feel baby's back, (3) Feel pelvic inlet, (4) Feel baby's head |
| What is Stage I of labor? | Up to full dilation, (1) Latent Phase (<20h) → contractions → 4cm cervical dilation, (2) Active phase (<12h) → 4-10 cm cervical dilation (1cm/hr) |
| What is Stage II of labor? | Full dilation → delivery, station 0 – Baby above pelvic rim (most uteri are anteverted), (1) Engage, (2) Descend, (3) Flex head, (4) Internal rotation, (5) External head, (6) Externally rotate, (7) Expulsion → LOA most common presentation |
| What is Stage III of labor? | Delivery of Placenta (due to PG-F) blood gush → cord lengthens → fundus firms |
| How do you monitor baby's HR? | Doppler, Scalp electrode |
| How do you monitor uterus? | Tocodynamics, uterine pressure catheter |
| What Bishope's score predicts delivery will be soon? | >8 |
| What are Braxton-Hicks contractions? | Irregular contractions with closed cervix |
| What is a Vertex presentation? | Posterior fontanel (triangle shape) presents first, normal |
| What is a Sinciput presentation? | Anterior fontanel (diamond shape) present first |
| What is a Face presentation? | Mentum anterior → forceps delivery |
| What is a Compound presentation? | Arm or hand on head → vaginal delivery |
| What is a Complete breech? | Butt down, thighs, and legs flexed |
| What is a Frank breech? | Butt down, thigh flexed, legs extended (Pancake) |
| What is a Footling breech? | Butt down, thigh flexed, one toe is sticking out of cervical os |
| What is a Double footling breech? | Two feet sticking out of cervical os |
| What is a Transverse Lie? | Head is on one side, butt on the other |
| What is Shoulder Dystocia? | Head out, shoulder stuck |
| Can you try vaginal delivery on a women who has had a Classic Horizontal C/S previously? | No, must have C/S for all future pregnancies |
| Can you try vaginal delivery on a women who has had a Low Transverse C/S previously? | Yes |
| What is early deceleration? | Normal, due to head compression |
| What is late deceleration? | Uteroplacental insufficiency b/c placenta can't provide O2/nutrients |
| What is Variable deceleration? | Cord compression |
| What is Increased beat-to-beat variability? | Fetal hypoxemia |
| What is decreased beat-to-beat variability? | Acidemia |
| What is Pre-eclampsia? | Ischemia to placenta → HTN (>140/90) |
| What is the treatment for Pre-eclampsia? | Delivery |
| What is HELLP syndrome? | Hepatic injury causing: (1) Hemolysis, (2) Elevated Liver enzymes, (3) Low Platelets |
| What is Eclampsia? | HTN + Seizures |
| What are the symptoms of eclampsia? | H/A, changes in vision, epigastric pain |
| What is the treatment for eclampsia? | 4mg Magnisium Sulfate as seizure prophylaxis |
| What is Chorioamnionitis? | Fever, Uterine tenderness, decrease fetal HR |
| What are the symptoms of Amniotic Fluid Emboli? | Mom just delivered baby and has SOB → PE, death (amniotic fluid → lungs) |
| What is Endometritis? | Post-partum uterine tenderness |
| What is an incomplete molar pregnancy? | 2 sperm + 1 egg (69, XXY), has embryo parts |
| What is a complete molar pregnancy? | 2 sperm + no egg (46, XX – both paternal), no embyo |
| What is Pseudocyesis? | Fake pregnancy with all the signs and symptoms |
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