OB/GYN 2023 with verified questions and answers

Adnexa Appendages or accessory structures of an organ. Bony pelvis The 4 bones of the pelvis that make up the lower part of the trunk of the body; serves to support the upper body and protect the pelvic organs. Breech Intrauterine position of a fetus in which that buttocks or feet present first. Cesarean section (C-section) A surgical procedure in which the abdomen and uterus are incised to deliver a baby. Corpus luteum A small mass of yellow-colored tissue that develops on the ovary and that grows within the ruptured ovarian follicle after ovulation; responsible for secreting progesterone to maintain the high level of vascular supply to the uterine endometrium for the purposes of implantation and pregnancy. Curettage Removal of tissue with a blunt or sharp curette by scraping the surface; performed to remove abnormal tissue, to obtain tissue for examination and diagnostic purposes, or to remove tissue from infected areas. DUB Dysfunctional Uterine Bleeding; abnormal uterine bleeding that is not due to a tumor, pregnancy, or infection, and occurs when menstruation is not taking place. Dystocia Difficult birth due to various reasons, such as cephalopelvic distortion, fetus size, or condition or position of fetus. Dysmenorrhea Painful menstruation. Episiotomy The surgical incision of perineum to enlarge the vaginal opening and prevent tearing of the perineum and muscles during delivery. Exenteration Refers to total removal of; usually used in reference to the surgical procedure of total pelvic exenteration, which involves the removal of the vagina, uterus, and cervix, fallopian tubes, ovaries, bladder, and rectum for surgical treatment of cancer. Fimbria Finger-like structures that form on an edge, such as the fimbria of the fallopian tubes. Fistula Abnormal communication between to normally seperate internal structures, or an abnormal communication between an internal structure and the body surface. Gravida Refers to the pregnant female; the first pregancy is referred to as gravida I; additional pregnancies are numbered sequentially. LEEP Loop Electrosurgical Excision; Surgical procedure that uses the electrosurgical unit coupled to a loop electrode on the cautery pencil; used to excise a cone of tissue to remove an area of neoplasia. Ligament A band of fibrous tissue composed of collagen that connects bone to bone. Marsupialization Incision of a closed cavity with the suturing of the opened edges to the wall of the wound to form an open wound that will heal by second intention. Myoma A benign fibroid tumor of the uterus. Occiput anterior The most common relationship between the presenting fetal part and the maternal body pelvis. Parity The classification used to indicate the number of live and stillborn births that a female has delivered at more than 20 weeks of gestation. Perineum The area between the posterior portion of the vagina or scrotum and the opening to the anus. Forms the base of the perineal floor and posterior wall of the vagina. The levator ani muslces form a sling to keep the pelvic contents intacts during coughing, straining, or bearing down in labor. Pfannenstiel Surgical transverse incision made in the lower abdomen, uaully employed when performing a C-section. Vestibule An opening that serves as the entrance to a passageway, such as the vestibule of the vagina. What is the fornix? The annular recess created by the cervical-vaginal junction. What are the 3 layers of he uterine wall? Peritoneum, myometrium, and endmetrium. Where are the Bartholon's glands located and that is their function? They are located within the vestibule and they secrete a lubricating mucoid substance. List the structures contained within the borad ligament. Uterine fallopian tube, the round and ovarian ligaments, various blood vessles, nerves, and lymphatics. What are the 2 other names for the fallopian tubes? Uterine tubes and oviducts. Name the 2 hormones from the anterior pituitary that stimulate the ovarian cycle. Luteinizing hormone (LH) and follicle stimulating hormone (FSH). Name the 2 hormones that are produced by the ovary. Estrogen and progesterone. What is the main muscle of the pelvic floor? Name it's 3 components. Levator ani mucsle; it's 3 components are, 1) iliococcygeal 2) pubococcygeal and 3) puborectalis. Labia Majora Rounded prominent longitudinal flaps, the large outer lips. Contains sebaceous and sweat galnds, covered in a triangle of hair - after menopause the labia majora atrophies. Vulva The external female genitalia. Mons pubis Rounded prominence over symphysis pubis, top part of the labia majora. Clitoris Erectile structure of the female anatomy, it's the female equivalent to the penis. Labia minora Connective tissue within the labia majora, they are the 2 smaller lips that contain sebaceous glands. The anterior portion forms the prepuce of the clitoris. Anus Rectal oriface. Hymen Thin fold of membrane just inside the vaginal oriface. T or F; The uterus is pear shaped with a fundus, body, and cervix. True T or F; The ligaments connecting to the pelvic wall include the cardinal, ovarian, and broad. False; Cardinal, round, and infundibulopelvic. T or F; The graafian follicle releases the oocyte. True T or F; The corpus luteum is responsible for releasing estrogen to maintain the endometrial lining. False; progesterone. T or F; The pituitary glnad releases LH and FSH to stimulate development of an oocyte or ovum. True T or F; Blood flow is supplied to the uterus via branches of the internal iliac artery. True T or F; The isthmus of the fallopian tube is important in the prevention of endometriosis. True Are Braxton-Hicks contractions an indication that delivery of the fetus is imminent? No, they are normal contractions not associated with progressive cervical dialation=false labor. Effacement Cervix softens and thins. Dilation Opening of the cervix. Presentation Fetal part overlying pelvic inlet. Para Number of times giving birth. Crowning Largest diameter of head encircled by vulvular ring. Station Descent of presenting part of fetus in relation to ischial spines. Bonding Mother and infant relationship. CPD Cephalopelvic disproportion; Fetus' head is too large for maternal birth canal. Usually ends up being delivered via C-Section. First stage of vaginal delivery Onset of true labor and is considered complete when the cervix is fully dialated. Second stage of vaginal delivery. Complete dialation of the cervix and terminates with the birth of the infant. Third stage of vaginal delivery. Initiated with the birth of the infant and ends when the placenta is delivered. Fourth stage of vaginal delivery. Begins at the point and is completed when the mother's condition has stabilized. What surgical intervention is commonly done during a normal vaginal delivery? Episiotomy. Cord blood is collected routinely with every delivery. Why? To check cord gases. Also, it's collected for it is rich with stem cells which can be preserved and used for later use if needed. What does "fetal distress" mean? Sustained low heart rate. List the possibe sites for ectopic pregnancy. Fallopian tubes, peritoneal cavity, ovary, or uterine cervix. Leiomyoma Benign leisons of the uterus. What are the two great curses that haunted natural childbirth from ancient times? Shrunken pelvis and obstructed labor. Puerperal fever Infection after childbirth, happened quite frequently. The mother usually became septic and died shortly after (48 hours). Normal birthing in the early days of human civilization was most often handled by trained__________. Midwives. They adhered to a strict level of cleanliness and employed natural means to assist women in childbearing. They also participated in educating yound women about their bodies, having children, and healthy pregnancies. During the middle ages and renaissance, midwifery almost died out when_____________ began trying to monopolize childbirth services. barber-surgeons. Women were forbidden to practice medicine or midwifery and many midwives were accused of being witches and killed. Chamberlen Birthing Forceps Developed by Peter Chamberlen (1674). Dr. Ignaz Semmelweiss In 1847, he instituted rules in his ward that physicians MUST wash hands between patients. By the end of the 1800's many drs were finally beginning to accept the research of Dr. Semmelweiss and others. Chloroform Discovered in July 1831 by American physician Samuel Guthrie. In 1847, Chloroform was used by James Young Simpson for childbirth. Eventually_______replaced Chloroform. Ether. In 1940, __________ was introduced. This heavy dose of narcotics and amnesiacs caused laboring women to loose control (they were stuck in the stage 2, excitement phase of anesthesia). Twilight sleep What were the complications that arose from Twilight sleep? Recovery was a long process b/c of the drugs and breastfeeding was more impossible than before. Twilight sleep was also difficult on the babies for they were born sleepy and unable to respond or suck. Also, breathing was difficult and babies had to be watched carefully to insure that they didn't stop breathing. Dr. Grantley Dick-Reed In 1944 he wrote Childbirth Without Fear. He studied midwives with laboring women and learned how these women assited laboring women to give birth without medication using relaxation techniques. He also studied the fear-pain cycle and discovered that women who were not afraid of childbirth had less pain and fewer problems. Dr. Fernand Lamaze In 1953 he published his findings about labor and delivery in Russia. His philosophy substained scientism for faith and introduced self-hypnotism as a method of coping and a way to remove God from the birth arena. He also started the Lamaze classes which opened the door the childbirth education classes and helped bring fathers back into the picture. Eventually, natural childbirth was reborn in the 1960's The Female Genitourinary system consist of... the organs, glands, secretions and other elements of reproduction referred to as pudendum. The female reproductive organs are both internal and external. Vestibule Location of the urethra, space posterior to clitoris, it's enclosed by the labia minora and it's anterior to the vagina. Bartholin's glands Secrete vaginal lubricant, lies deep in the bulbocavernosus. Hymen Thin, vascular membrane of connective tissue that surround the vaginal oriface. Wide variations of thickness and elasticity. The presence or absense of a hyminal ring does not indiacte sexual activity. The reproductive organs lie in the_______ _________protected by the bony pelvis. pelvic cavity. ________ and _________ form the pelvic outlet. bones, ligaments The ________ _______ of the uterus and the ________ constitute the birth canal. dialated cervix, vagina. D&C Dialation and Curettage. Done within 10 minutes, done on women that have polyps, blood clots, and can't stop bleeding. Usually goes on for about a month or more. D&E Dialation and Evacuation. Done up to 12 weeks, possibly 16 weeks (1st trimester). Cone Biopsy Done w/or without laser, looks for cancerous cells on the cervix. Hysterectomy Can be done vaginally, abdomenally, or LAVH (Laproscopic Assisted Vaginal Hysterectomy) which is becoming more common. Tubal ligation Usually done after giving birth (PPTL: Post Partam Tubal Ligation), Fallopian tubes are cut and tried off to prevent further pregnancies, a permanent procedure. Cesarean Section (C-section) Usually done if the baby is to big to be passed out of the vaginal canal, it's a breech baby, or if it's in distress. Diagnostic and surgical procedures may be carried out using a... Vaginal, abdominal, or both vaginal and abdominal approach. Each approach requires... different positions, preparations, and drapes and set-ups. Alot of the drapes have 2 holes, one for the abdomen and a flap for the vagina. When doing a prep for a Lap Assisted Vaginal Hysterectomy, how would you do it? Have 2 seperate preps, first one you use on the vagina, then the second prep you would use on the abdomen, nipples-knees. Why is a foley catheter used? To prevent bladder distension and possible injury. If one is being used, make sure you keep your eye on the output. Changes in volume, color, or presense of blood needs to be reported immediately. What happens if the ureter is accidentally cut? The patient will most likely die. DVT Deep vien thrombosis; which can lead to pulmonary thrombosis, a heart attack, or stroke. What is used to prevent DVT? Heparin injection, antiembolitic stockings, sequential compression devices, and early ambulation. Why are lasers used over ESU? Lasers can make fine cuts that don't have the effect of a deep thermal burn like the ESU. Why is a poole suction tip used? More holes=more suction power Hypertrophied overgrowth of tissue. Vaginal packing may be used with_____________ or ____________ cream. Antibiotic, hormone. Make sure they are held in your room. Make sure the patient is totally clean prior to the placement of packing. A __________ _____ is placed against the perineum for vaginal discharge. sanitary pad. Why would the patient be put into Trendelenburg postion for an abdominal apporach? It shifts the organs upward so the surgeon can get a better view. If an abdominal-vaginal procedure is to be done concurrently and because of the possibility of infection _______ ________ ________ are used. seperate sterile setups. One for the vaginal approach and one for the abdominal approach. Ex: hysterectomy/vaginal hysterectomy and a TAH with anterior vaginal colporrhapy which is the repair of the inside of the vagina to prevent prolapse. When doing a skin prep that requires abdominal and vagina approach, why is the vagina done first? To prevent splashing the freshly prepped abdomen. How long should the prep dry for before placing the drapes? 3 minutes. What are adhesions? bands of scar tissue. Adhesions may cause? Infertility, intestinal obstruction, and chronic pain. What are some diagnostics that are used when looking at the vagina? Pelvic exam, Pap smear (Papanicolaou), cytological aspirations for cancer of the endometrium, fallopian tubes, ovaries or cervix, and the Schiller Test. What is the Schiller test? It's the staining of the vaginal vault and cervix with Lugol's solution to determine areas of abnormal tissue for biopsy. Normal tissue satins brown/abnormal stains white or does not take up the iodine. Uterine Cancer consists of: Cervical cancer (cervix) and Endometrial cancer (w/i the uterine lining). Endometrial cancer is more common than_______ and occurs more in _______________ women. Cervical cancer, postmenopausal. Cervical cancer effects.... Those with early sexual intercourse, multiple partners, non barrier contraceptives, poor sexual hygiene, chronic cervical infections of hx of STD's. When will a PEA (pelvic exam under anesthesia) be done? On young (7,8,9,10 etc year) old girls that have been sexually assulted, on women with mental illnesses who don't understand, or on women that need to have one done and they are having surgery anyways. Why is a pelvic exam done? To determine size, shape and positon of the uterus and to detect any masses. Why is a sound used before any procedure is done? A sound is placed to determine uterine depth so the uterus dosen't get perferated. What are some complications that can arise with a D&C and a D&E? Perforation of the uterus, laceration of the cervix, tear in the internal OS, damage to other pelvic organs, excessive bleeding (monitered for 6 hours), post-op infection. Excisional biopsy on the cervix is the removal of the... entire lesion, may require sutures and hemostasis for the cervix is highly vascular (have raytecs handy). Insisional biopsy on the cervix can be done by a_______ _______ or a _______. Punch biopsy, LEEP (Loop-Electrocautery Excisional Procedure). Colposcope Is an instument that shines a light on the cervix and magnifies the view for the doctor. A _______ ________ is applied to the cervix and vagina with a cotton ball or swab. The solution turns abdnormal tissue ______ for identification of areas that may need further evaluation. vinegar solution, white. Colposcopy-directed biopsy Is a procedure in which the cervix is examined with a colposcope for abnormalities and a tissue sample is taken. Cervical biopsy Done on patients that have been diagnosed by PAP smear for severe cervical dysplasia or intraepithelial cancer of the cervix. Cold cone biopsy Is a surgical procedure requiring general anethesia and is done from the presense of precancerous changes in the cervix. A large area of tissue around the cervix is excised for examination in Pathology. Cervical punch biopsy The cervix may be stained with iodine solution (Lugols) in order to see abnormalities better. A small tissue samples are taken from the cervix and examined for disease or other problems. Usually done in a drs office. Tubal Perfusion To test tubal patency using methylene blue and saline. Using a laparoscope, dye entering the uterus from the fallopian tubes indicate patency. Hysterosalpingography Infertility radiologic study of the uterus and tubes after repeated negative Ruben testing. Pelvic laparoscopy a sx procedure that examines and treats pelvis organs through a small sx viewing instrument (laproscope) inserted into the abdomen at the naval. When will a pelvic laparoscopy be recommended? Pelvic pain due to Endometriosis (uterine tissue found outside of the uterus), abdominal infections, suspected twisting/torsion of an ovary, ovarian cyst, scar tissue, perforation of the uterus following a D&C or by and IUD, evaluation of infertility, sterilization, evaluation and removal of an abnormal pelvic mass, removal of uterine fibroids (myomectomy), removal of the uterus (hysterectomy), sx tx of tubal pregnancy, and evaluation of a women who may have appendicitis or salpingitis. Complications and considerations with pelvic laparoscopy. Care must be taken not to perforate blood vessels, the uterus or bladder, Perforation leads to infection, this is a sterile procedure, and surgeon expertise, patient selection, and adequate anesthesia and safe equipment are essential. Hysteroscopy Is used to diagnose and treat many uterine disorders, including extremely heavy periods and abnormal bleeding. Diagnostic hysteroscopy Is performed to examine the uterus for signs of normalcy or abnormality (myomas). Operative hysteroscopy Is performed to treat a disorder after it has been diagnosed. Can a diagnostic and operative hysteroscopy be performed together? Yes, depending on the patient and the nature of the patient's medical condiditon. Abnormal bleeding may be caused by a _______ _______, it may also be caused by benign growths, such as ______ ______ or ______. hormonal inbalance, fibroid tumors, polyps. In some cases, abnormal bleeding may be a sign of __________ ________, particularly in women over 45 (postmenopausal bleeding). endometrial cancer. Why is postmenopausal bleeding a concern? It is usually a key sign that someone has endometrial cancer. You are considered postmenopausal when you have experienced no bleeding for 1 year. If you start bleeding after that time frame, you need to see your dr. Conditions that can be diagnosed or treated with hysteroscopy include... infertility caused by blockages or adhesions, abnormally painful periods, post-menopausal bleeding, irregular or unusally light periods, uterine abnormalities, recurrent miscarriage, pelvic pain, removal of intra-uterine devices (IUD's), removal of small polyps or fibroids. Although hysteroscopy is not used to treat endometrial cancer, it can be used to obtain _______ samples for _______ when a malignancy is suspected. tissue, biopsy. Air or gas are not used to expand the uterus for danger of air or gas embolism. What is used instead? Pre-warmed high viscosity 1.5% Glycine (liquid glucose) and 0.9% normal saline can also be used. A pressure controlled infusion pump is used to prevent fluid and elctrolyte imbalances. Intrauterine pressures should be maintained at or below the mean arterial pressure and also to prevent uterine rupture. T or F: When using a liquid glucose solution for distension, immediately clean instruments in warm H20. True, the solution will make the instruments sticky which can aquire bacteria over time, have warm sterile H2O on your back table. Complications with a hysteroscopy. Air or gas embolism, laceration of cervix, and specific complication secondary to intervention. Diagnostic laparoscopy Is used to view a women's reproductive organs-uterus, ovaries, tubes, and bearby organs. When would it be recommended? When other diagnostic tests, such as US (ultrasound) and X-ray cannot confirm the cause of condition such as; pevic or abdominal pain, examine a tissue mass, confirm endometriosis or pelvic inflammatory disease, look for blockages of the tubes or other causes of infertility. When doing a laparoscopic procedure, make sure you have _________ _________ on your feild. defogger solution. The CO2 in the abdomen is inflated at a pressure of ____mmHg max. 15 Complications with laproscopy. Hemorrhage, wound infection, viscus perforation, damage to structures. Vaginal procedures are done to... repair the pelvic outlet post childbirth. Colporrhaphy (Kelly procedure) For prolapsed vaginal wall r/t urethrocystocele (herniation of bladder into vaginal canal) Enterocele (Cul-de-sac Hernia) Bowel herniates in the vaginal Cul-de-sac Vesicovaginal Bladder/vagina fistulas Rectovaginal rectum/vagina fistulas