1
Q
essential for the __ of eggs
A
production
2
Q
__ uterus for pregnancy
A
prepares
3
Q
cycle begins with the first day of __
A
menstrual bleeding
4
Q
length of cycle determined by __
A
preovulatory phase
5
Q
the __ layer of the endometrium is shed during menstruation.
A
functional
6
Q
ovaries contain approx __ primordial follicles
A
200k
7
Q
when cells in the lining of the ruptured dominant follicle multiple
A
luteinization = corpus luteum
8
Q
name of the first menstruation
A
menarche
9
Q
time before onset of menses
A
premenarche
10
Q
time when secondary sex characteristics appear
A
puberty
11
Q
time beginning shortly before cessation of menstruation and lasting until 1 y after final period
A
perimenopause
12
Q
begins 1 y following cessation of menstruations
A
menopause
13
Q
< 21 d cycle
A
polymenorrhea
14
Q
oligomenorrhea
A
> 35 d cycle
15
Q
purpose of the ovarian cycle
A
to provide an ovum for fertilization
16
Q
describe the ovarian cycle in 5 steps
A
- primordial follicles develop
- dominant follicle emerges
- ovulation occurs (egg released from dominant follicle)
- dominant follicle collapses into CL
- CL degenerates into corpus albicans
17
Q
what are the 3 phases of the ovarian cycle
A
- follicular (1-13)
- ovulatory (14)
- luteal (15-28)
18
Q
what is the purpose of the endometrial cycle
A
provide implantation site for fertilized ovum
19
Q
describe the endometrial cycle in 4 steps
A
- cycle begins on first day of bleeding
- functional layer regrows
- spiral arteries and uterine glands enlarge (great for implantation time)
- spiral arteries constrict, endo shrinks (ischemia)
20
Q
what are the 4 phases of the endometrial cycle
A
- menstrual (1-5)
- proliferative (6-14)
- secretory (15-26)
- premenstrual (27-28)
21
Q
cyclical changes to the endo are controlled by __
A
ovaries
22
Q
what causes the endometrium to grow to it’s maximal thickness and secrete mucous
A
presence of corpus luteum
23
Q
what happens to the endo with the degeneration of the corpus luteum
A
endometrial ischemia
24
Q
what is the purpose of the hormonal cycle
A
initiate and control the menstrual cycle
25
which hormones control the endometrium
estrogen and progesterone
26
describe the hormonal cycle in 3 steps
1. developing follicles produce estrogen; thus functional endo regrows
2. CL produces progesterone and estrogen; thus endo thickens
3. corpus albicans does not produce hormones; thus endo ischemia and resultant shedding
27
what hormones control the ovaries
follicle stimulating hormone (FSH) and luteinizing hormone (LH)
28
where in the brain does the endocrine system produce the hormones that control the ovaries
anterior pituitary gland
29
describe the hormonal cycle in reference to LH and FSH
1. increase in FSH causes follicles to develop
2. surge in LH (and FSH) causes ovulation
3. more LH leads to collapse of dominant follicle and formation of CL
4. anterior pituitary gland stops producing LH and FSH so CL degenerates into corpus albicans
30
what would be the 3 ovulatory phases aligned to pituitary involvement
1. FSH = preovulatory
2. LH+FSH surge = ovulation
3. LH = post ovulation
31
what hormones control the anterior pituitary gland?
GnRH, estrogen, progesterone
32
what does GnRH stand for
gonadotropin releasing hormone
33
where does GnRH come from
hypothalamus
34
does the pituitary gland control the ovaries
no. the estrogen and progesterone produced by the ovaries inhibits the pituitary from producing LH and FSH
35
what hormone stimulates the anterior pituitary gland
GnRH
36
what hormone inhibits the anterior pituitary gland
estrogen and progesterone
37
what inhibits the hypothalamus
ovaries - est and prog inhibit GnRH
38
what simulates GnRH production
*peak* levels of est only
39
what hormone forms and maintains the CL
LH
40
what would the follicle look like if ovary is sending out rising levels of est and prog
CL
41
low levels of est and prog allow for the __ of GnRH
production
42
which ovarian structure produces mostly progesterone
CL
43
which ovarian structure produces mostly estrogen
dominant follicle
44
what happens in the anterior pituitary gland when there are *peak* levels of estrogen
simulates GnRH causing a surge in FSH and LH
45
which hormones temporarily decrease after ovulation
estrogen and progesterone
46
postovulatory, residual LH maintains which ovarian structure
CL
47
why does CL degenerate
insufficient LH because increase in est and prog
48
menstrual cycle days 1-5 also called
follicular phase
menstrual phase
49
what will endo look like in *early* menstrual phase
thin, +/- debris
hyperechoic endo around cavity
50
what will endo look like in *late* menstrual phase
thin, hyperechoic line surrounded by hypoechoic inner myometrium
'endometrial stripe'
51
menstrual cycle days 6-13 also called
follicular
proliferative
52
what days are *early* preovulatory
6-9
53
what days are *late* preovulatory
10-13
54
what does endo look like in *early* preovulatory phase
= proliferative
thin endo, no debris
55
average size of follicles in *early* preovulatory phase
5-10mm
56
average size of follicles in *late* preovulatory phase
20-25mm
57
what does the endo look like in *late* preovulatory phase
= late proliferative phase
'3 line sign'
58
describe the 'mid cycle stripe'
= 3 line sign
basal (hyper)
functional (hypo)
uterine cavity (hyper)
functional (hypo)
basal (hyper)
59
how to you measure the 3 line sign
through the whole thing (not the little stripe of uterine cavity)
60
what is a cumulus oophorus
follicular cells surrounding the ovum within the dominant follicle (looking like a daughter cyst)
61
menstrual cycle day 14 also called
proliferative (endo)
62
what does endo look like during proliferative phase at day 14
likely 3 line sign
63
what will the follicle look like in day 14
likely corpus hemorrhagicum (toward CL)
64
menstrual cycle days 15-26 also called
postovulatory
luteal (ovarian)
secretory (endo)
65
is fluid in the PCDS proof of ovulation
NO
but it is a sign
66
what day of the cycle is the endo at its thickest
21
67
when is the endo at it's most hyperechoic
when its thickest - day 21
- may even show enhancement
68
menstrual cycle days 27-28 also called
premenstrual phase
ischemic phase
luteal (ovarian)
premenstrual (endometrial)
69
which hormone from the anterior pituitary gland will increase during the premenstrual/ischemic phase
FSH
no inhibition from est or prog
70
during what phase of the menstrual cycle are the basal and functional layers of the endo isoechoic to one another
postovulatory/ secretory phase
71
during what phase of the menstrual cycle is the basal layer hyperechoic to the functional layer
proliferative/ late preovulatory
mid cycle stripe/ 3 line sign
72
clinical sign of ovulation - rise in __
basal body temperature
73
clinical sign of ovulation - increased quantity and viscosity of __
cervical mucous
74
what hormone causes a rise in basal body temperature
progesterone
75
name for the pain associated with ovulation
Mittelschmerz
76
what causes withdrawal spotting
drop in estrogen at ovulation
77
is conception synonymous with implantation
no
78
__ takes place within 24 hours of ovulation
conception
fertilized ovum develops into a blastocyst
79
when does implantation occur
6 days after fertilization
day 20 of a 28 day cycle
80
what maintains the CL after implantation
a hormone released by the blastocyst
81
detectable sonographic findings of pregnancy expected after __ weeks GA
4.5-5 w
82
hormonal contraception can prevent pregnancy by preventing __ and altering __
preventing ovulation and altering endometrium
83
sonographic signs of hormonal contraception
absence of developing follicles, dominant, or CL
consistently thin endo
84
flow resistance __ in an active ovary
decreases
(more blood supply)
usually low resistance, high velocity
85
flow resistance __ in inactive ovaries
remains relatively constant
86
name of premature puberty and menarche before 9y
precocious puberty
87
name of delayed menarche (never starts)
primary amenorrhea
88
cessation of menses for >/= 6mo
secondary amenorrhea
89
name for absence of menstruation during pregnancy, lactation and after menopause
physiologic amenorrhea
90
name for more frequent cycles (<21d intervals
polymenorrhea
91
name for less frequent cycles (>35d)
oligomenorrhea
92
name for menses with less blood or shorter periods
hypomenorrhea
93
more blood but normal duration of period
hypermenorrhea
menorrhagia
94
longer periods OR bleeding between periods
metrorrhagia
95
more blood AND longer periods / bleeding between periods
menometrorrhagia
(combo of menorrhagia and metrorrhagia)
96
painful periods
dysmenorrhea
97
name for painful periods with no underlying detectable pelvic pathology to explain why
primary dysmenorrhea
98
painful periods with clinically detectable reason why (ie pelvic lesion)
secondary dysmenorrhea
99
G
gravidity
no. of pregnancies a pt has had
100
P
parity
no of pregnancies that have reached viability
101
does a stillbirth count toward P
yes if it reached viabilityd
102
do twins count as 1 or 2 points toward parity if reached viability
only 1
103
how many weeks constitutes a viable pregnancy
>20-24w GA
>500g
104
what would be the reproductive hx of a pt that is currently pregnant, had an ectopic, had a miscarriage at 17w, and had a twin pregnancy born via csec
G4P1
105
what is T in GTPAL
term deliveries
>37w
counts living or stillborn
106
what is P in GTPAL
preterm deliveries
20-37w
counts living or stillborn
107
what is L in GTPAL
live births
108
where do you comment on current pregnancy with GTPAL
you do not
109
what is hCG
human chorionic gonadotropin
110
where does hCG come from
trophoblastic cells (future placenta) in the blastocyst after implantation
111
urine pregnancy tests detect __ of hCG
presence
112
blood pregnancy tests detect __ of hCG
amount
113
which type of pregnancy test is qualitative
urine test
114
how early can a urine test prove pregnancy
10 days after fertilization (day 24 LMP)
115
how early can a blood test prove pregnancy
5-6 days after fertilization (day 19-20 LMP)
116
what will you expect to see EVS with beta hCG of 2500
a GS, maybe embryo
117
what is the threshold for seeing a GS EVS
betas of 1700 mIU/mL or higher
118
what is dyspareunia
painful intercourse
119
what is a common cause of dyspareunia
endometrial implants in rectovaginal septum and posterior fornix
120
name of procedure for removal of myoma
myomectomy
*for preservation of fertility
121
name of plastic/reconstruction sx of ut
metroplasty
aka ureteroplasty
hysteroplasty
122
sx removal of ectopic pregnancy through incision into fallopian tube
salpingostomy
123
sx for incompetent cx
cervical cerclage
124
why do we care if a pt taken tamoxifen
endometrial hyperplasia ++ risk of cancer from overstimulation of ut
125
?complication in ovaries if pt use of infertility rx
ovarian hyperstimulation syndrome
126
name of aspiration of pelvic fluid
culdocentesis
*through post fornix of vagina
127
name of visual inspection of epithelium of cx for pt with abnormal pap smears
colposcopy (special microscope)
128
what does D&C stand for
dilatation and curettage
129
what layer is removed with D&C
functional endo
130
what does CT stand for
computerized axial tomography
*combines series of xrays to form 360^ view
131
most common cause of missing IUCD string
retraction into ut
132
what are the 2 main types of IUCDs
1. copper
2. plastic hormonal
133
134
2 main functions of copper IUCDs
inhibit fertilization (shitty habitat)
inhibit implantation (irritates endo + Cu is ovicidal/spermicidal)
135
how does hormonal IUCD inhibit fertilization
++cervical mucous, too thick for sperm to enter
may prevent ovulation with ++prog
136
what is the failure rate of a chinese ring IUCD
10%
137
main disadvantage of copper & hormonal IUCDs
hypermenorrhea
*additional risk of PID, ectopic, etc
138
how far from ut cavity should top of IUCD rest
139
copper IUCDs produce a __ amplitude echo
high
140
when is most common time for an IUCD perforation
during insertion
141
risk factors for perforation of IUCD
placement <6m post partum
lactating
abnormal ut
shitty MD
142
what happens if you cant find an IUCD on u/s and pt is adamant it should be there
send for xray to r/o complete perforation and ectopic location
143
PROM is __x higher risk if leaving in IUCD when it has failed
4x
144
what is the chance of miscarriage if leaving IUCD in after failure
25-50%
145
septic shock is __x higher risk if leaving IUCD in place after failure
26x
146
3 types of permanent birth control measures for women
tubal ligation
essure
adiana
147
is tubal ligation reverible
that's debatable
148
can you see tubal ligation with u/s
noo
149
wtf is an essure
metal coil inserted through vagina into both fallopian tubes at cornu
scar tissue forms, blocking tubes within 3mo
150
can you see essures with u/s
YES
151
what does a pessary look like sonographically
hyperechoic ring with shadowing
152
all embryos begin with __ ducts
4
153
mullerian ducts aka
paramesonephric
154
wolffian ducts aka
mesonephric
155
what happens to the pair of ducts that do not develop (embryology)
remnants regress, but remain
156
what determines which ducts develop
testosterone and MIF
157
what is MIF
mullerian-inhibiting factor
158
where does testosterone and MIF come from
fetal testes
159
what GA does gender differentiation occur
8-18w GA
160
mullerian ducts form __ of female repro sys
upper vagina
ut
fallopian tubes
161
fallopian tubes are formed from unfused __ of mullerian ducts
cranial ends
162
which female repro sys components have separate embryological origins
ovaries and lower vagina
163
vaginal plate aka
sinus tubercle
164
mullerian ducts pull together peritoneal folds to form __
broad ligament
PCDS
ACDS
165
lower vagina formed from __
urogenital sinus
166
ovaries develop from __
urogenital ridge
on the mesonephros (primitive kd)
167
the wolffian duct becomes __
ureters
168
mullerian anomalies are associated with __
kidney anomalies
169
before the wolffian duct can degenerate, __ must arise
the ureteric bud
*required for kd development
170
the bladder is formed from the __
urogenital sinus
171
the ureter is formed from the __
distal wolffian duct
172
in the ovaries (embryonically) the eggs migrate from the __
yolk sac
173
remnants of wolffian ducts in female embryos can be found along the __
broad ligaments and vaginal walls
174
remnants of wolffian ducts on vaginal wall aka
gartner duct cysts
175
remnants of wolffian duct on broad ligament aka
cyst of morgagni (hydatid)
176
external genetalia fully developed by __ GA
14w GA
177
what is a genital tubercle
elevated area between coccyx and umb cord present in ALL embryos prior to 10w GA
178
what are the 3 phases of mullerian duct deelopment
1. organogenesis
2. fusion
3. septal resorption
179
a normal hymen is made up of __ tissue
fibroelastic membranous tissue
180
premenopause aka
perimenopause
begins shortly before menopause and lasts until 1 year following the final menstruation
181
menopause is followed immediately by __
postmenopause
182
term for vaginal inflammation caused by low levels of estrogen (thinning of tissues, decreased lubrication)
atrophic vaginalis
183
physiological changes with menopause includes the cessation of __
menstrual periods
folliculogenesis
ovulation
estrogen production
184
what is the fundus-cervix ratio of an adult uterus
2:1
185
what is the fundus-cervix ratio of a postmenopausal ut
1.5:1
186
what is the fundus-cervix ratio of a prepubertal uterus
1:1
187
calcification in outer myometrium of the arcuate arteries often present in post menopausal patients
Monckeberg's atherosclerosis
aka medial calcific sclerosis
188
Monckeberg's atherosclerosis affects the __ of the arcuate arteries
media
vessel lumen is not narrowed
189
sonographic features of postmenopausal ovaries
small
hypoechoic
might still see small follicles
190
uterine Doppler resistance __ the longer a pt has been postmenopausal
increases
191
what is expected to happen to the diastolic flow in an ovary >10 years post menopausal
absence of diastolic flow (very high resistance)
192
what resistance is expected in an active ovary
low resistance
193
what hormonal changes are associated with perimenopause
FSH and LH overproduction due to low levels of estrogen (lack of negative feedback)
194
insomnia and night sweats are common symptoms of
perimenopause
195
endo cancer increases with what kind of HRT
unopposed estrogen
*similar to Tamoxifen effect
196
advantages of HRT
reduces symptoms
decreases risk of osteoporosis and coronary artery disease in younger patients
197
disadvantages of HRT
transient effects (mood swings, bloating)
endo hyperplasia and cancer if unopposed
thromboembolism
198
blood within the endo cavity is called
hematometra
199
pus within the endo cavity is called
pyometra
200
large volumes of endo fluid are associated with __
cervical stenosis
201
hydrometra is usually associated with __
nothing significant
202
in utero, maternal hormonal stimulation causes __ in the fetus
temporary uterine enlargement
may cause follicle development as well
203
normal fundus-cervix ratio of neonate
1:2
204
typical uterine length of a neonate
3.5cm
205
canal connecting bladder of fetus to umbilical cord
urachus
206
lumen of urachus is normally obliterated during fetal development, becoming the __
median umbilical ligament
207
patent urachus results in __
leakage of urine from umbilicus
208
urachus develops from the embryonic __
allantois
209
adult urachal remnant called the __
median umbilical ligament
OBGYN
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