OB Exam 1 Review Cards

what does the scrotum contain?

holds epididymis, spermatic cord, and testicles in place

what are the functions of the scrotum?

• cremasteric reflex to control whether scrotum should be pulled away from body or towards the body

• temperature control: keeps the testicles slightly cooler compared to the rest of the body for proper sperm function

where is the sperm made?

seminiferous tubules within the testes

what cells produce testosterone?

leydig cells

what is contained in the testes?

• seminiferous tubules

• Leydig cells

what is the function of vas deferens?

transports sperm from epididymis to the ejaculatory ducts and urethra

what is the function of the epididymis?

maturation and temporary storage of sperm

what is the function of the ejaculatory ducts?

• carry sperm from vas deferens towards urethra

• add secretions necessary for sperm function

what is the function of the seminal vesicle?

producing most components that make up semen

what is the function of the prostate?

produce fluid for semen

what is the function of the urethra?

final exit for semen during ejaculation

steps of follicular phase

• 1. FSH (follicular stimulating hormone) released by the brain goes to follicles in the ovaries.

• 2. FSH matures a follicle and becomes the main egg that will be released during ovulation.

• 3. The mature follicle produces estrogen, which thickens the uterine lining to make a cushion for possible fertilization.

• 4. LH (luteinizing hormone) is released from the anterior pituitary gland that leads to the release of the mature follicle (egg).

what is ovulation?

occurs when LH causes release of the mature egg on Day 14, ovum survives 24 hours.

steps of luteal phase

• 1. Corpus luteum forms from the empty follicle that released the egg.

• 2. Corpus luteum releases progesterone to thicken the uterine lining and prepare for possible fertilization.

• 3. If the egg is not fertilized, the corpus luteum breaks down into corpus albicans.

• 4. The degradation of the corpus luteum into corpus albicans causes a drop in progesterone and estrogen that causes menstruation.

what occurs in the menstrual phase of the endometrial cycle?

shedding of endometrium; days 1-5

what occurs in the proliferative phase of the endometrial cycle?

• rapid growth and thickening of endometrium by estrogen (builder)

• lasting from day 5 to 14 (ovulation)

what occurs in the ischemic phase of the endometrial cycle?

• progesterone + estrogen levels drop because of no fertilization —> blood supply to the functional endometrium is blocked —> necrosis develops —> cramps develop

• Day 27/28

what occurs during the secretory phase of the endometrial cycle?

• progesterone secreted by corpus luteum maintains endometrium

• Days 14-28

what is a monozygotic pregnancy?

• Identical twins; 1 ovum 1 sperm

• common placenta

• 1 or 2 amnions/chorions

• same genotype, same sex

• division > 1000 cells

what is a dizygotic pregnancy?

• fraternal twins; 2 ova and 2 sperm

• 2 placentas

• 2 chorions/amnions

• different genotype, same or diff sex.

what is a transvaginal ultrasonography, and what is it used for?

• evaluates follicle maturation, uterine anatomy, and endometrial thickness

• used for determining infertility in females

what is hysterosalpingography, and what is it used for?

• insertion of radiopaque dye into uterus and fallopian tubes through the cervix

• help get rid of any clots or blockages

• used for determining infertility status in females

what does hyperprolactinemia cause?

• leads to the inhibition of gonadotropin releasing hormone (GnRH)

• can cause infertility in females

when should progesterone levels be tested for ovulation test?

• one week prior to menstruation

• it should be high, but if it is low something is wrong

how should basal body temp present around ovulation?

• should be slightly elevated around ovulation

what is the quality of cervical mucus during ovulation?

• thin, clear, stretchy around ovulation

what is mittelschermz (“middle pain”)?

• mid cycle pain during ovulation

what hormones are analyzed to test ovulation for females?

• endocrine function, prolactin, & thyroid levels

symptoms of chlamydia

• usually silent, post coital bleeding, purulent discharge

clinical manifestations of chlamydia

• ectopic pregnancy

• infertility

• cervicitis

• PID (pelvic inflammatory disease)

• salpingitis (inflammation of fallopian tubes)

• ophthalmia neonatorum (acute conjunctivitis impacting newborns)

how is chlamydia diagnosed?

cervical culture

how is chlamydia treated?

• azithromycin or doxycycline

• Treat ALL partners

• Retest in 3-4 weeks after treatment

what are causative agents of PID (pelvic inflammatory disease)?

• gonorrhea and chlamydia

what organs does PID impact?

• uterus and fallopian tubes

during menstruation, what factors facilitate the development of infection?

• cervical os is slightly open

• cervical mucus barrier is absent

• menstrual blood is an excellent medium for growth

risk factors for PID

• prior STIs

• 3 weeks after IUD

• risky sexual behaviors

signs & symptoms of PID

• pain, fever

• vaginal discharge

• cervical motion tenderness

problems associated with PID

• ectopic pregnancies

• infertility

• dyspareunia (pain during or after sexual intercourse)

• pelvic adhesions

• tuboovarian abscesses

screening and diagnosis of PID

• CBC documentation of prior STI

• Prevention includes education

management of PID

• analgesia and antibiotics

• avoid sex until resolved

what is gonorrhea caused by?

• neisseria gonorrhea

• 2nd most reported STI

risk factors for gonorrhea

• risky behaviors

• sexually active teens

• young adults

• black individuals don’t often seek treatment

signs & symptoms of gonorrhea

• Usually absent

• purulent discharge

• lower abdominal pain

• cervical motion tenderness

effects of gonorrhea

• similar to chlamydia

• prenatal problems

• ophthalmia neonatorum

how is gonorrhea diagnosed?

• endocervical culture

treatment of gonorrhea

• antibiotics

• ceftriaxone IM injection

• contact partners

what is syphilis caused by?

• Treponema Pallidum

• Spirochetes

signs and symptoms of syphilis

• initial sign is a small sore (chancre) — where the bacteria entered the body

• wart like sores in the mouth or genital area

• fatigue

• rash

• swollen lymph nodes

• weight loss

risk factors for syphilis

• risky sexual behaviors (unprotected sex, multiple partners, etc.)

• sharing needles

• HIV

• prior STIs

effects of syphilis

• severe inflammation caused by the infection can lead to cardiovascular damage (aneurysms, heart failure, improperly functioning valves)

• inflammation can destroy bone structure

• non-cancerous tumors (gummas) grow on internal organs +  damage function

diagnosis of syphilis

• Nontreponemal test = tests for the presence of nonspecific antibodies in the blood

• Treponemal = tests for the presence of syphilis specific antibodies

treatment for syphilis

• Preferred treatment is penicillin, although doxycycline can be used

• Avoid sex until treatment is complete + sores heal

• Partners should be treated as well

• Complete follow up serologic tests after treatment 

what is initial HSV (genital herpes) characterized by?

• multiple painful lesions

• fever

• chills

• malaise

• severe dysuria that may last 2 to 3 weeks

what are complications of genital HSV?

• miscarriage in first trimester

• neonatal herpes

how is genital HSV diagnosed?

• culture of secretions

how is genital HSV managed?

• Cleanse with normal saline

• analgesic

• acyclovir

• C-section recommended if visible lesions are present at time of delivery

risk factors of bacterial vaginosis (BV)?

• new or multiple sex partners

• douching (washing/cleaning out the inside of the vagina with water or other liquid)

• lack of lactobacilli (lactobacilli provide lactic acid that keeps vaginal pH acidic and without it, anaerobic bacteria proliferate because of alkalinity)

signs of BV

fishy odor, thin, gray frothy discharge

how is BV diagnosed?

• normal saline wet mount

• Whiff test (vaginal secretions mixed with KOH create fishy odor)

management of BV

• metronidazole (Flagyl), but not recommended if breastfeeding

s/s of trichomoniasis

• Mostly asymptomatic but has frothy yellow-green discharge

• malodorous

• vulval and vaginal inflammation

• strawberry spots (petechiae on cervix) (may bleed on contact)

tests for trichomoniasis

• nucleic acid amplification test (NAAT)

• wet mount

management of trichomoniasis

• metronidazole

• treat both partners

• no sex until course is completed

risk factors for candidiasis

• tight clothing

• damp clothing for long time

• antibiotic therapy

• DM (diabetes mellitus)

• pregnancy

s/s of candidiasis

• pruritus

• cottage cheese discharge

• dysuria

• yeasty smell

diagnosis of candidiasis

• history

• pelvic exam

• vaginal pH — normal with yeast infection, >4.5 with suspected trichomoniasis or BV.

what is a high risk associated with Group B Streptococcus (GBS)?

• neonatal morbidity and mortality — from vertical transmission through birth canal

risk factors for GBS

• positive prenatal culture of GBS

• preterm labor before 37 weeks

screening for GBS

• rectovaginal culture at 35-37 weeks pregnancy

management of GBS

• IAP (Intravenous Antibiotic Prophylaxis): given during labor — Pen G 5 million units as loading dose then 2.5mil Q4H until delivery

s/s of HIV

• Flu

• lymphadenopathy

• lab studies

• Presents with decreased WBC & platelet

• Increased ESR (erythrocyte sedimentation rate)

• destruction of T cells

• Decreased CD4 levels

• Increased transmission during pregnancy (perinatal)

risk factors for HIV

• IV drug use

• sex

• History of STIs

screening for HIV

• Confirmed with Western Blot test

treatment for HIV

• Counseling

• education

• use of condoms

• PREGNANCY: oral meds (zidovudine)

• In labor and prior to c/s — triple drug antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART)

mode of delivery for HIV

• depends on viral load

• If viral load <1000, can give birth vaginally

post delivery care for HIV

• no breastfeeding

• oral zidovudine for baby

what is a fibroadenoma?

• benign lump that slides easily under the skin (movable)

how is fibroadenoma diagnosed?

• ultrasound (young women)

• mammogram (older women)

• biopsy to determine if it’s cancerous

how is a fibroadenoma removed?

• removed through surgery or freezing (cryoablation)

what are fibrocystic changes?

• changes within the breast that can be rope-like in texture

• sometimes cause pain or tenderness

what are fibrocystic changes caused by?

• cysts (fluid filled sacs)

• fibrosis (scar tissue)

• hyperplasia of milk ducts

• adenosis (enlarged breast lobules)

diagnosis of fibrocystic changes

• Breast exam = palpation can lead to the feeling of fibrocystic changes

• Mammogram = X-ray done if a doctor feels a lump or change during palpation

• Ultrasound

treatment of fibrocystic changes

• Fine needle aspiration = hair thin needle used to drain fluid from cyst

• Surgical excision to remove cysts that continue to return after fine needle aspiration

what is mastitis?

• Inflammation of breast tissue usually caused by bacterial infection

diagnosis of mastitis

• Ultrasound to assess amount of fluid

treatment for mastitis

• I&D (incision and drainage) if needed

• Antibiotics

total simple mastectomy

• removal of breast tissue but NOT lymph nodes or muscle used for non invasive cancer

modified radical mastectomy

• Breast tissue plus some lymph nodes in axillary

radical mastectomy

• entire breast removed with lymph nodes and pectoralis muscle

• rarely done now

• mostly preventive/prophylactic

what is Paget disease?

• Nipple carcinoma

• Originates in nipple

• bleeding, crusting

what is inflammatory breast cancer?

• Aggressive cancer, rare

• Appears as a rash

how is inflammatory breast cancer diagnosed?

skin punch biopsy

what is inflammatory breast cancer classified as?

• Classified as stage II

what is oligomenorrhea?

• infrequent menstrual periods

• 40-45 days or longer between periods

what is metorrhagia?

• intermenstrual bleeding — any time that is not normal period

• Usually bleeding at irregular intervals or between normal periods

• Any amount

what is the treatment goal of metorrhagia?

cycles to become more predictable

what is menorrhagia?

• hypermenorrhea

• excessive menstrual bleeding in duration or amount

what is menometorrhagia?

heavy, infrequent bleeding

what is PCOS?

• Endocrine imbalance results in high levels of estrogen, testosterone, and LH

• decreased secretion of FSH

clinical manifestations of PCOS

• obesity

• hirsutism

• acne

• irregular menses

• infertility

• hyperinsulinemia