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190 Cards in this Set
- Front
- Back
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What is another name for the bony pelvis?
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The lesser pelvis. (true pelvis)
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What is another name for the greater pelvis?
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The false pelvis
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What is between the true and false pelvis’?
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The pelvic inlet
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What is the edge of the pelvic inlet called?
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The pelvic brim
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Does the pelvic brim include the sacral promontory?
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YES
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What forms the sciatic foramina?
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The sacrotuberous and sacrospinous ligaments
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What is the measurement of the obstetrical conjugate?
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>10cm
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Which diameter does the infants head have to fit through?
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The obstetrical conjugate
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What diameter is measure between the ischial spines?
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The interspinous diameter
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What diameter is the landmark for the station of the infants head?
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The interspinous diameter
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Where are the – station #?
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Above the interspinous diameter
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Where do all of the conjugates end?
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Sacral promontory
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Which sex has a narrow subpubic angle?
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Male
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What kind of pelvis do women have (most common kind)?
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Gynecoid
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What are the muscles of the pelvic floor?
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Coccygeneus, Levator ani (supports uterus, bladder, aids in defecation; breaks down to: iliococcygeus, pubococcygeus: breaks down to: puborectalis, pubovaginalis)
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What is the region that contains the urethsra, vagina and rectum called?
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The urogenital hiatus
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What is the order of the internal organs from Posterior to Anterior?
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Coccyx, intestine, uterus, bladder, pubic bone.
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What is the position of the uterus?
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Anteversion
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Does the bladder help hold the uterus in place?
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Yes
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What are the uterus, bladder and rectus covered by?
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Mesentary
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What is the space between the bladder and uterus called?
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Vesicouterine pouch
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What is the space between the uterus and rectum called?
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Rectouterine pouch (cul-de-sac; pouch of Douglas)
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What is the lowest point in the abdominal cavity found?
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Rectouterine pouch (cul-de-sac; pouch of Douglas)
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What is the ovary attached to the uterus by?
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Ovarian ligament
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What are the areas around the cervix called?
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Fornices (posterior, anterior and two laterals)
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What is the superior portion of the uterus called?
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Fundus
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What ligament carries the vessels and nerves to the ovary?
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Suspensory ligament
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Main suspensory ligaments of the uterus?
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Round ligament
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Where does the round ligament terminate?
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Labia majora
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Where does the ovarian artery originate?
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Abdominal aorta
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Where does the right ovarian vein drain?
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IVC
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Where does the left ovarian vein drain?
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Left renal vein (at a 90 degree angle) --> IVC
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Which artery can be confused with a ureter?
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Uterine artery
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Is the uterine artery superior or deep to the ureter?
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Superior (bridge over troubled water or water under the bridge- ureter is UNDER)
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What ligaments support the cervix?
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Cardinal ligaments
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What are the ovaries and fallopian tubes known as collectively?
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Adnexa
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What ligament covers the adnexa?
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Broad ligament
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What is the portion of the broad ligament that connects the ovary known as?
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The mesovarium
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What is the portion of the broad ligament that connects the to the uterus is known as?
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Mesometrium
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What is the portion of the broad ligament that connects to the fallopian tube known as?
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Mesosalpinx
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Where does fertilization typically take place?
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Ampulla of the fallopian tube
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What are the 3 layers of the uterus?
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Mesometrium, myometrium, endometrium
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What are the 2 layers of endometrium?
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Stratum basale, stratum functionalis
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What is the name describing a more vertical uterus?
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Retroversion
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What is softening of the uterine isthmus known as?
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Hagar's sign
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What is bluing of the cervix called?
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Chadwick's sign
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What is the most common type of reproductive tumor?
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Fibroids (leiomyoma)
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What is the most common type of fibroid?
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Submucosal
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Where do fibroids originate?
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Endometrium
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What are fibroids within the uterine wall known as?
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Intramural fibroid
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What are fibroids of the perimetrium called?
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Subserous fibroid
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What causes endometrial hyperplasia?
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Overproduction/unopposed estrogen stimulation
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Where is the most common location for endometriosis?
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Ovaries
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What is a cyst consisting of endometrial lining known as?
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Chocolate cyst
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What is the ectocervix made of?
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Epithelial cells
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What is the transformation zone made of?
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Squamous and columnar cells
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Where are most atypical cells detected?
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Transformation zone
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What are the categories that fall within LSIL?
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HPV/CIN1 and CIN2
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What are the categories that fall within HSIL?
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CIN3 and CIS
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What categories are likely to reverse on their own?
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CIN1/CIN2
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What is the treatment for CIN1?
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IDC3
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Which two strains of HPV are more likely to cause cervical cancer?
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16 and 18
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When should cervical cancer screening begin?
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Age 21 or time of first intercourse
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How large do cysts have to be to be categorized as significant?
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>3cm
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What is the most common kind of cyst?
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Follicular cyst
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What cyst type is associated with blood filled sacs?
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Corpus luteum cysts
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Where do the ovarian arteries originate?
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Inferior to the renal arteries and superior to the inferior mesenteric artery
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What ligament is the ovarian artery within?
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Suspensory ligament
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What artery supplies the majority of the uterus?
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The internal iliac artery, to the uterine artery.
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Where does the lymph from the reproductive organs drain?
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Internal iliac nodes, common iliac nodes, paraaortic nodes, to the thoracic duct
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Where do the sympathetic neurons originate for innervation of the pelvic viscera?
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T10-L2- Superior hypogastric plexus> hypogastric nerve> inferior hypogastric plexus
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What innervated the perineal area?
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Pudendal nerve
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What area will cause a nerve block from the waist down?
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L3/4 vertebral level (Spinal block)
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Where is an epidural block administered?
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The sacral hiatus, S2-4 affecting the pelvic splanchnic nerves
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What are the 2 triangles of the anatomic perineum?
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The urogenital triangle (anterior) and the anal triangle (posterior)
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What is the anatomic name of the female external genitalia?
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Vulva or pudendum
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What is the purpose of the bartholin glands?
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Lubrication of the vagina (although most lubrication for intercourse comes from within the vagina)
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What is the purpose of the skenes glands?
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Secrete fluid to prevent UTI, or female ejaculation
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What makes up the prepuce of the clitoris?
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Labia minora
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What is another name for the posterior or inferior frenulum?
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Forchette
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What is the name of the areas anteriorly and posteriorly for the area where the labia majora end?
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Commissure
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What is the name of the membrane that separates the superficial and deep perineal pouches?
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Perineal fascia
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What are the contents of the superficial perineal pouches?
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Bulb of the vestibule, cruz of the clitoris, bulbospongiosus muscle, ischiocavernosus muscle, superficial transverse perineal muscle, external anal sphincter (anal triangle)
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What muscles make up the perineal body?
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Bulbospongeousus, superficial transverse perineal muscle, external anal sphincter
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What are the contents of the deep perineal pouches?
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Deep transverse perineal muscle (smooth), compressor urethrae muscle, urethrovaginal sphincter
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What is the name of the erectile tissue found in the female?
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Bulb of the vestibule
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What muslce makes up the anal triangle?
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Levator ani muscle
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What are the grades of episeal tears?
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Grade I- wall of vagina, Grade II- Perineal body, Grade III- External anal sphincter, Grade IV- anal tissue
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Where are the granulosa cells?
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Inside of the ovary
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Where are the theca cells?
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Outer layer of the ovary
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What do the theca cells produce?
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Androgens
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How do androgens become estrogen?
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Process of aromatization in the granulosa cells
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What are the hormones that stimulate granulosa cells?
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FSH and LH
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What are the main effects of FSH?
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Regulation estrogen synthesis
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What are the main effects of LH?
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Regulating progesterone and androgen synthesis
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What is the predominant form of estrogen found in pre-menopausal women?
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Estradiol
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What is the predominant form of estrogen found in pregnancy?
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Estriol
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What are some effects of estrogen on the body?
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Neuroprotective, increase risk for breast CA, growth a differentiation of reproductive organs, increased risk of endometrial CA, arterial vasodilation which increased CVD (thrombus formation), increases LDL receptors which decreases LDL cholesterol, bone protection.
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Which hormone is responsible for decreasing the uterine threshold for contraction?
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Estrogen
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Where are alpha estrogen receptors found?
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Endometrium, ovarian stroma, breast CA cells
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Where are estrogen beta receptors found?
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Granulosa cells, bone, brain, endothelial cells, prostate gland
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Where is estrogen metabolized?
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Liver via hydroxylation
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What are the three phase of ovarian menstrual cycle?
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Follicular, ovulation, luteal
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What is the most variable phase of the menstrual cycle?
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Follicular
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What form of estrogen is predominant in the follicular phase?
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Estradiol
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What hormones if dominant in the luteal phase, following ovulation?
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Progesterone
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A peak in what hormone stimulates the secretion of LH and FSH?
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Estrogen
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A peak in LH leads to what? (LH surge)
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Ovulation
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What hormone does the corpus luteum produce?
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Progesterone
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What are some side effects of progesterone that are present before menses?
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Breast tenderness, water retention.
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What is the term for the follicle that is ovulated?
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Atretic follicle
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What is the term for the follicle that is no fertilized that degenerates?
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Corpus Albicans
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What must occur for the LH surge to happen?
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Follicle must be primed with FSH, estradiol level must reach 200pg/mL for 36-48 hrs
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Is FSH surge necessary for ovulation?
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NO
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What is the role of progestins in BCP?
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Inhibit ovulation by modifying mid cycle surges of LH/FSH, diminish ovarian hormone production, produce endometrial changes disrupting implantation, thickens cervical mucus.
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What is adenomyosis?
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Spread of the endometrial layer into the myometrium
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What is a common cause of DUB?
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Anovulation
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Who is most commonly affected by DUB?
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Menarche or Perimenopausal women
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How does unopposed estrogen secretion cause DUB?
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Causes hyperplasia of the endometrium, which forms a very “friable” endometrium. It sheds more readily.
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What causes the ovulatory form of DUB?
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A dysfunctional corpus luteum.
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When is cervical mucus thin and watery?
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Under the influence of estrogen, this allows fertilization (ferning)
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What is an estrogens effect on the vagina?
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It causes cornification of it.
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What form of estrogen is peaked during proliferation of the endometrium?
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Estradiol
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What is the dominant hormone in the luteal phase?
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Progesterone
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What is the proliferative phase?
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Mid-follicular to follicular phase.
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What is the secretory phase?
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Ovulation to mid luteal phase
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What phase occurs before the menstrual phase?
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Ischemic phase
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What causes the ischemic phase?
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Decrease in progesterone and estrogen, spiral artery constriction
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What define menopause?
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No menstruation for 12 months
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When does reproductive aging accelerate?
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35
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What is the earliest sign of reproductive aging?
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Elevated FSH at day 3
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What has a high predictive value of when a women will experience menopause?
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Anti-muellerian hormone
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Is perimenopause a low estrogen state?
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No, it is a variable state. *could be high or low*
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What is considered oligomenorrhea?
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>35 day cycle
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What is considered polymenorrhea?
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<21 day cycle
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What is the typical FSH level in menopausal women?
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15x higher than normal
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What does a rapid rising, more than double in 2 days, in hCG mean?
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Multiple pregnancy or molar pregnancy
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What is the function of hCS?
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Regulate fuel supply to fetus, increases blood glucose levels for fetus, decreased blood glucose levels for mom.
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What are examples of insulin antagonists?
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GH, PRL, glucagon and cortisol
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What is the dominant form of estrogen formed in pregnancy?
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Estriol
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How is most estriol made?
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Fetoplacental unit
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What estrogen level is measured in maternal urine as a marker for fetal health?
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Estriol
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What is the main stimulator of lactation?
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Prolactin
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What is the role of prolactin during the rest of pregnancy?
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Maturing the alveolar cells
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What suppresses prolactin?
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Dopamine and to a lesser extent progesterone
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What is the role of corticotropin releasing hormone?
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To increase cortisol levels in the mom and fetus to mature fetal lungs and form surfactant.
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What is an indicator of imminent delivery?
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Fetal fibronectin
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What can a sharp rise in cortisol indicate?
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Preterm labor
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What 2 prostaglnadins stimulate contraction?
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F2 beta and E2
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What part of the brain releases oxytocin?
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Posterior pituitary
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Other than stimulate contractions, what else does oxytocin do?
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Stimulates milk let down.
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The breast overlies which muscles?
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Pectoralis major, minor and serratus anterior
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What is breast tissue comprised of?
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Adipose and connective tissue (inc glandular) --> STROMA
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What ligament supports breast tissue?
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Cooper's ligament- in advanced breast cancer: can cause dimpling of skin
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Most of breast malignancy occurs where?
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Superior lateral quadrant and tail of spence (50%); subareolar 20%; remaning % divdied equally
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What hormones are responsible for breast development?
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Estrogen primarily for ductal formation; progesterone primarily responsible for alveolar gland differentiation
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When do breasts fully develop?
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Breasts do not fully develop until the 2nd trimester of pregnancy- progesterone leads to alveolar gland differentiation during the second trimester. The thought that women who have not had any pregnancies are at higher risk of breast cancer is thought to be linked to this.
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What is the lifetime risk of women developing breast cancer in the US?
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1 in 8
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Risk factors for breast cancer:
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Family history, smoking, alcohol use, OC use, nulliparous, HRT, hx of fibroadenoma, early menstruation <12yo, late menopause >55yo)
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What is the most significant prognostic factor for patients with early stage breast cancer?
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Disease status of the axillary lymph nodes is the most significant prognostic factor for patients with early stage breast cancer
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How to better identify if the tumor has spread to the lymph?
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Sentinal lymph node biopsy is done
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What makes up a triple negative?
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ER, PR HER2 all negative (poorer prognosis)
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What does ER/PR status in breast cancer mean?
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Estrogen receptor positive: better prognosis and response to chemo.
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What structure secretes GnRH?
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Hypothalamus
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How is FSH and LH secreted?
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GnRH targets the anterior pituitary to secrete: FSH and LH
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At puberty, there is a change in the secretion of GnRH- what is the change that occurs?
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Pulsatile- goes from continuous to pulsatile, this kicks puberty into gear. This starts the ovulatory cycles.
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Are the ovarian hormones on a negative or positive feedback system?
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Mostly negative feedback, except at one point just prior to ovulation. There is a positive feedback just before ovulation that occurs on the part of estrogen. As estrogen levels increase with the follicular phase, this causes a further increase of FSH and LH. This kicks in the LH surge.
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What is the role of FSH and LH on the ovaries?
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FSH and LH target the ovaries to increase release of progesterone and estradiol that have secondary effects on the reproductive tract and breast. Then typically they have negative feedback effects on the pituitary and hypothalamus although a positive feedback on the hypothalamus just before ovulation
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Which hormone secreted by the ovaries inhibits secretion of FSH and LH?
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Inhibin
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What is the name of the most mature follicle cell before ovulation?
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Graafian follicle- may be several mature graafian follicles at one time, but one is the 'most dominant'.
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Does FSH have affects on both granulosa and theca cells?
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NO, only granulosa cells
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Where does LH act on in reference to steroidogenesis?
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Granulosa, theca, stromal cells and corpus luteum
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What is the precursor for the steroidal hormones?
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Cholesterol
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What is Middleschmurts?
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Middle pain- ovulatory pain that can occur
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How does OC prevent LH surge?
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Constant levels of estrogen and progesterone that prevent the surge
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What stage has the oocyte been 'stuck' in since birth?
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Prophase I- not until ovulation that it resumes the meiotic cycle. The oocyte is then stuck in meiosis II until fertilization
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How does progesterone affect vaginal secretions?
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Inhibits sperm migration- thick mucous
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What does the menstrual phase consist of?
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Spiral artery vasospasm, proteolytic enzymes digest tissue, deqsquamation and sloughing of functionalis layer of endometrium (aka the female period)
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Why does reproductive aging increase after 35 years of age?
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Decline in numbers of ovarian follicles
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What happens with a molar pregnancy?
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Hydatiform mole- sperm triggers this formation of abnormla tissue- mostly benign. Can be malignant- choriocarcinoma
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What hormone is primarily responsible for weight gain in the first 1/2 of pregnancy?
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Progesterone
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How much longer is the diagonal conjugate vs the obstetric?
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1-1.5 cm
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What term is used to describe male pelvis?
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Android
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What muscle is responsible for the 80 degree angle 'bend' on the wall of the anal canal that helps to facilitate and maintain fecal continence?
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Puborectalis
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What is the gubernaculum?
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Structure that guidied ovaries to the pelvic cavity during embryologic life (originated in kidneys then descended)
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What is the order of structures on the uterine tube?
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Fimbriae, infundibulum, ampula, isthmus, uterine part
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What does a more retroverted uterus put a patient at risk for?
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Prolapse
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Which nerves have their origin from L1 and innervate the muscles and skin in the L1 dermatome? 0 Pelvic organs can have referred pain to the anterior abdominal wall via these nerves
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Iliohypogastric and ilioinguinal nerves
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What type of block would a patient get if they only wanted the perineum blocked?
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Lower 1/4 of vagina is the pudendal block
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What two 'lines' make up the pelvic brim?
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Arcuate line by the ileum and a pectinate line in the pubis
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