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Easter revision 2018 > Repro > Flashcards

Repro Flashcards

1
Q

State the layers of the testes

A 
Skin
Dartos
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
Tunica vaginalis
Tunica albuginea
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2
Q

How do the abdominal wall layers change as they go into the testes

A

Abdo: External abdo oblique, internal abdo oblique, transversus abdominus
Testes: External spermatic fascia, Cremasteric spermatic fascia, Internal spermatic fascia

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3
Q

Which blood vessels are in the penis

A

Superficial (outer layer) and deep (one layer in) dorsal veins, plus dorsal artery and cavernous artery (in the cavernosum)

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4
Q

Which nerve is in the penis

A

Dorsal nerve

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5
Q

Tell me about the contents and structure of the spermatic cord

A

3 fascial layers: ex sperm fas, cremasteric, int sperm fasc
3 arteries: cremasteric, testicular, artery to vas
3 veins: cremasteric, testicular, vein to vas
3 nerves: ilioinguinal, cremasteric, sympathetics

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6
Q

Tell me about the lymphatic drainage of testes vs scrotum

A

Testes drained by para-aortic (that’s where they came from)

But scrotum via superficial inguinal

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7
Q

Tell me about the content of ejaculate

A

Prostate: 30%, enzymes to cut ejaculate clot and zinc for motility
Seminal vesicles: 60%, fructose for food
Bulbourethral glands: 10% alkaline and lube
5% sperm

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8
Q

Three zones of prostate and their locations

A

Central at the top and anterior, transitional in the middle and where BPH is, peripheral is inferior and posterior and what you feel on DRE where prostate cancer is

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9
Q

What are the 3 parts of the urethra and which is the narrowest and least distensible

A

Prostatic urethra, membranous urethra (narrowest and least distensible), spongy urethra

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10
Q

What are the 4 muscles in the root of the penIS

A

x2 ischiocavernosus

x2 bulbospongiosus

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11
Q

Fractured penis =

A

ruputured tunica albuginea

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12
Q

Describe the route of sperm

A

Out of seminiferous tubules, through epididymis, into vas deferens, joined by seminal vesicle stuff to make ejaculatory duct, join with prostatic urethra, joined by bulbourethral stuff in membranous urethra, then spongy urethra and out

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13
Q

Name scrotal swelling differentials

A

Hydrocoele, varicocele, spermatocele, epididymitis, inguinal hernia, testicular cancer, torsion, haematocoele, epididymal cysts

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14
Q

What’s a varicocoele and what would make it more concerning?

A

Distension of paminiform plexus. More concerning if on the right because this has acute angle of entry to IVC so suggests IVC compression

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15
Q

Where is a hydrocoele

A

Excess fluid in tunica vaginalis

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16
Q

Describe the progression of an ovarian follicle

A

Primary follicle, secondary follicle (antral follicle), tertiary follicle (Graafian follicle), ruptured follicle, active corpus luteum, regressing corpus luteum, corpus albicans

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17
Q

What’s the ovary covered by

A

Parietal peritoneum

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18
Q

What’s cervical ectropion?

A

Around the cervical external os appears red and inflamed but its a normal response to oestrogen during a menstrual cycle where the cervix unfurls a bit and you see the columnar cells come out

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19
Q

Where’s the commonest site for ectopic pregnancies and where does fertilisation normally occur

A

Ampulla for both- but once its fertilised it should move down to uterine cavity

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20
Q

What cells in the ampulla nourish the egg?

A

Peg cells!

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21
Q

Name uterine and ovarian ligaments

A

Broad ligament is big sheet of peritoneum over them all
Round ligament is remnant of gubernaculum and connects uterus to labia majora
Suspensory ligament connects ovaries to lateral wall
Ovarian ligaments connect ovary to uterus

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22
Q

What are the three components of the broad ligament

A

Mesovarium (supports ovary), mesosalpinx (supports ovary and uterine tube), mesometrium (supports inferior rest of it)

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23
Q

What are the parts of the uterine tube

A

Infundibulum (wide to catch eggs), ampulla (fertilisation and ectopic site), isthmus

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24
Q

On a microscope looking at the vagina, what would you see?

A

White gaps are glycogen to feed lactobacilli for low pH, cells are stratified squamous epi

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25
Q

What components make an indifferent gonad

A

Primordial germ cells and intermediate mesoderm

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26
Q

What is the cloaca

A

Caudal opening shared by GI, uro and genital, closed by cloacal membrane

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27
Q

Where does the uterus come from

A

The paramesonephric duct (which is part of urogenital ridge)

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28
Q

What controls formation of the Mullerian and Wolffian ducts?

A

Mullerian duct forms if no MIH is made by testis

Wolffian duct forms if androgens are made

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29
Q

What cells make MIH and androgens?

A

MIH made by sertoli cells

Androgens made by leydig cells

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30
Q

What makes the prostate?

A

Urogenital sinus

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31
Q

What does the mullerian duct make?

A

Vagina, cervix, uterine tubes

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32
Q

What does the wolffian duct make?

A

Vas deferens, seminal vesicles, epididymis

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33
Q

What makes the external gentials?

A

The genital folds, tubercles and swellings
Genital tubercles: glans penis and clitoris
Genital folds: spongy urethra and labia minora
Genital swellings: scrotum and labia majora

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34
Q

When do mitosis, meiosis I and meiosis II happen with eggs

A

Mitosis happens before birth when PGCs proliferate and colonise ovary
Meiosis I happens at birth to form primordial follicles
Meiosis II happens post puberty pre ovulation

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35
Q

When do eggs enter meiosis II

A

Pre-ovulatory, induced by LH surge. THey freeze in meiosis II 3 hours before ovulation and only complete meiosis II if they are fertilised, ad die 24hrs later if not

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36
Q

What does the corpus luteum do

A

The remaining granulosa and theca interna cells become lutein cells and produce oestrogen and progesterone. Normally dies after 14 days but if HcG is present it will survive

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37
Q

What’s spermiogenesis

A

Spermatid –> spermatozoa

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38
Q

What type of cells make primary spermatocytes

A

Ap spermatogonia (the Ad are the resting reserve stock)

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39
Q

Where does mitosis, meiosis I and meiosis II occur in sperm

A

Mitosis is between spermatogonia and primary spermatocytes. Meiosis I is primary spermatocytes to secondary spermatocytes. Meisosi II is secondary spermatocytes to spermatids

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40
Q

What’s a spermatogenic cycle and wave

A

A cycle is the amount of time it takes for one bit of seminiferous tubule to see the same sperm stage again, and the wave is the distance in a tubule between one stage and the next

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41
Q

What is spermiation

A

Release of spermatids into lumen of seminferous tubule

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42
Q

Since spermatids are non motile until they get to the epididymis, how do they get there?

A

In sertoli cell secretions and peristaltic movements

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43
Q

What’s the final stage of sperm maturation?

A

Capacitation in the female genital tract. Removes glycoprotein and cholesterol from sperm membrane, activates sperm signalling (AC, PKA), and allows sperm to start acrosome reaction

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44
Q

WHen does puberty end?

A

With epiphyseal fusion

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45
Q

Give average puberty ages with stages

A

F- 11.5 (8-13), thelarche first sign (8-11), adrenarche (11-12), 9cm/yr growth, duration 2.4 years
M- 12.5 (9-14), first sign testicular vol up to 4ml, 104cm/yr growth for 3,2 years

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46
Q

What connects the hypothalamus and the anterior pituitary

A

The superior hypophyseal artery

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47
Q

When does LH increase

A

In the night

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48
Q

What does GHRH do

A

Released from hypothalamus, stimulates GH release from anterior pituitary which activates liver to produce IGF-1 which leads to

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49
Q

What does GH do

A

Released from anterior pituitary in response to GHRH from hypothalamus. Causes IGF-1 release from liver to cause bone growth plus GH by itself increases metabolic rate and increases muscle mass

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50
Q

What do LH and FSH do?

A

Fs- LH causes theca cells to release androgens, FSH causes granulosa cells to release oestrogens
Ms- LH causes leydig cells to release androgens, FSH causes sertoli cells to release inhibin

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51
Q

What does moderate oestrogen do to GnRH?

A

Decreases GnRH

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52
Q

What does high oestrogen do to GnRH?

A

Increase GnRH

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53
Q

What does high oestrogen + progesterone do to GnRH?

A

Decrease GnRH

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54
Q

Name layers of the endometrium

A

Myometrium is the muscle, basal layer stays there and produces functional layer, functional layer is hormone responsive and sheddable

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55
Q

How does clomiphene work?

A

Antagonist to oestrogen Rs in hypothalamus so the hypothalamus thinks oestrogen is low, increases GnRH and thus FSH and LH so increases fertility

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56
Q

Secondary causes of dysmenorrhea

A

HMB, imperforate hymen, vaginal septae, endometriosis

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57
Q

Define dysfunctional uterine bleeding

A

Heavy and irregular bleeding secondary to anovulation

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58
Q

Give chromosomal causes of primary amenorrhea

A

Turner’s syndrome (45 XO) and Swyer syndrome (46 XY but female externally with undeveloped streak gonads)

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59
Q

Define oligomenorrhea

A

4-9 periods/yr

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60
Q

Describe epididymal maturation

A

Nuclear condensation, membrane glycoproteins added, acrosomal shaping, rigid flageullum and stronger beat

61
Q

What prevents retrograde movement of sperm into bladder?

A

Contraction of internal sphincter of bladder

62
Q

Name the nerves involved in erection and ejaculation

A

Parasymp is pelvic N, symp is hypogastric N, somatic is pudendal (which contracts ischiocavernosus and bulbospongiosus)

63
Q

What causes vasodilation in erection?

A

Activation of parasymp and inhibtion of symp. Parasym releases ACh which binds to M3R on endothelial cells, NO released and diffuses into vascular SM

64
Q

Name causes of erectile dysfunction

A

Vascular probs (diabetes), psychogenic, tears in tunica albuginea, antidepressants, antihypertensives

65
Q

How does viagra work

A

Slows rate of cGMP degradation to increase NO’s vasodilation

66
Q

Describe the steps in sperm binding to egg

A

Sperm team effort to push through the corona radiata
Acrosomal reaction occurs in order to bind with zona pellucida
To bind with the zona pellucida its surface Rs bind with ZP3 glycoprotein of pellucida
Once it enters the pellucida the cortical reaction occurs to block polyspermy
Meiosis II in egg continues, F pronucleus forms, M and F pronucleus fuse

67
Q

What do the oocyte and the spermatozoa uniquely hae

A

Egg has mitochondria, sperm has centriole

68
Q

What’s the primary mechanism of depo provera and progesterone implant?

A

Inhibits ovulation

69
Q

Which contraceptives will cause a delay to fertility returning

A

Depo provera

70
Q

How does referral for subfertility work?

A

Subfertility is no conception in couple w regular 2-3day sex for a year. Early referral if F >36yrs or known reason for infertility

71
Q

Give causes of M and F infertility

A

M: ED, diabetes, chlamydia, varicocele, torsion, hypothyroidism
F: PCOS, premature ovarian failure, endometriosis, chlamydia, ectopic pregnancy tubal damage, no GnRH, prolactinemia, fibroids

72
Q

Prolactin inhibits ____

____ inhibits prolactin

A

Prolactin inhibits GnRH

Dopamine inhibits prolactin

73
Q

How do we test if ovulation has occurred

A

Test for progesterone on day 21

74
Q

What do we give bromocriptine for?

A

It’s a dopamine agonist, and dopamine inhibits prolactin which decreases GnRH so it’s a drug to treat hyperprolactinemia eg in infertility

75
Q

Give physiological and non physiological causes of secondary amenorrhea

A

Physiological pregnancy and menopause

Non physiological primary ovarian failure, weight loss, stress, hyperprolactinemia

76
Q

What test would you do to test for blocked uterine tubes?

A

Hysterosalpingogram (a contrast USS)

77
Q

What happens in PCOS

A

Abnormal secretion of GnRH resulting in increased androgens made by theca cells and follicles arrest in antral stage so don’t secrete progesterone so unopposed action of oestrogen on endometrium causes endometrial hyperplasia and risk of endometrial cancer. Increased androgens result in hirsutism and androgenic alopecia.

78
Q

What makes up the placenta

A

Embryo- trophoblast and extraembryonic mesoderm (chorionic plate)
Mumma endometrium

79
Q

How do chorionic villi change

A

Primary villi are outgrowths of cytotrophoblast
Secondary have mesenchyme core
Tertiary have fetal blood vessels

80
Q

How does the positioning of villi change

A

Early on all around embryo, in third month there is chorion frondosum at embryo end and chorion laeve at other end

81
Q

What does endometrium become if a conceptus is there

A

Decidua

82
Q

What’s the problem with ectopic pregnancies

A

Growing in a place without decidua so invasion isn’t controlled

83
Q

What can cause preeclampsia

A

Placental insufficiency or shallow invasion

84
Q

What are the lobes of the placenta called

A

Cotyledons

85
Q

What hormones does the placenta secrete

A

Progesterone and oestrogen

hCG, hCS, hCT, hCC

86
Q

What part of the placenta makes the hCG

A

Syncytiotrophoblast

87
Q

Which ig can cross the placenta

A

IgG

88
Q

What happens in haemolytic disease of the newborn

A

A rhesus negative Mother makes antibody against rhesus D present on a rhesus positive baby’s RBCs. The mother must have been sensitised to the antigen eg ABO incompatibility, childbirth, abortion, ectopic pregnancy

89
Q

Which infectious disease can cross the placenta

A

Rubella, CMV, TB, listeria, syphilis

90
Q

Describe circulation in the foetus

A

Oxygenated blood arrives via one umbilical vein. Goes to liver but shunted to pass it by ductus venosus. Goes up IVC and enters RA, some blood enters RV then PA to oxygenate lungs but not too much so have ductus arteriosus, shunted to LA via foramen ovale, goes LV, aorta, then body, exits through two umbilical arteries returning to mother

91
Q

Name some teratogens

A 
Thalidomide
Alcohol 
Warfarin 
Anti epileptics
ACEi
Drugs of abuse
92
Q

When is the baby most sensitive to teratogens

A

3-8 weeks

93
Q

Describe metabolic changes in pregnancy

A

Gluconeogenesis increases
Response to insulin decreases
Insulin release post meal increases
Maternal blood glucose decreases
Increased use of FAs, TAGs, and ketones as fuel
Progesterone makes you hungry so more fat storage

94
Q

Describe blood and heart changes in pregnancy

A

Plasma volume increases by fifty percent
Blood 6l/min
SV and BP increase
Increased blood flow to boobs, kidneys, GI
heart bigger and shifted upwards and left
St depression and t wave inversion

BP decreases in late pregnancy though which plus increase in plasma volume can cause venous distension so haemorrhoids and varicose veins

95
Q

Define preeclampsia

A

Bp more than 140/90 and proteinuria

Papillodema and ischaemic optic neuropathy
Hyperreflexia from HTN affecting brain

96
Q

How does pregnancy affect kidneys

A

More blood flow
Uterus presses on bladder so incontinence
Uterus presses on ureter so pyelonephritis
GFR increases by 160%
Progesterone means that kidneys and ureters dilate so loss of tone so increased urinary stasis and UTIs

97
Q

What stimulates pregnancy breast growth

A

Prolactin and growth hormone

98
Q

How does hCG affect maternal immune system

A

Decreases iga IgG Igm

99
Q

Name three risk factors for preeclampsia

A

Autoimmune disease
Diabetes
HTN

100
Q

If your BMI is more than forty, what should you have in pregnancy

A

Thromboprophylaxis

101
Q

Name mechanisms for gas exchange in foetus

A

Increased haematocrit
Double Bohr effect
Double haldane effect
HbF has increased affinity for oxygen
Foetus has lower oxygen and higher CO2 than mother for diffusion gradients
Respiratory alkalosis in mother induces 2,3 BPG so gives up oxygen more easily

102
Q

What can you give the mother to increase surfactant production in foetus

A

Glucocorticoids

103
Q

Describe fetal formation of the lung

A

8-16 weeks is pseudoglandular stage where bronchioles form
16-26 is canalicular stage where respiratory bronchioles form
24-term is terminal sac stage where sacs bud off from bronchioles

104
Q

What can you use to assess fetal growth

A

CRL before 13 weeks

At 20w USS for biparietal diameter, femur length, abdominal circumference

105
Q

What ways could you see a fetal heart beat and in which weeks

A

Transvaginal USS 5-6 weeks
USS 10 weeks
Stethoscope 20weeks

106
Q

What is BPP biophysical profile?

A

Assesses fetal tone, movements, breathing movements, amniotic fluid volume and HR in non stress test

107
Q

What is the fetal non stress test

A

In fetal movements hr should go up, watch for 30mins. Reassuring or non reassuring

108
Q

What two growth restriction types occur and when

A

In early pregnancy symmetrical growth restriction

In late pregnancy asymmetrical because this is when abdo grows

109
Q

Causes of olighydramnios and polyhydramnios

A

Oligo from renal problem

Poly from duodenal atresia, swallowing problem, blind ending oesophagus, maternal hypertension

110
Q

What might class a foetus as at risk

A

Cardiac anomaly
Chromosomal abnormality
Unexplained polyhydramnios

111
Q

When might meconium be in amniotic fluid

A

In fetal stress or asphyxia

112
Q

What controls breast growth at different stages

A

Oestrogen at start of puberty stimulates growth of lactiferous ducts
Progesterone at menarche for further duct growth
In pregnancy hCG stimulates rapid growth and branching of terminal lobules and lots of vascularisation

113
Q

How does milk work

A

Prolactin steadily rises in pregnancy but oestrogen is inhibiting this
Once birth has occurred, source of placental oestrogen removed so prolactin no longer inhibited
Prolactin controls milk secretion
Oxytocin stimulated by nipple sucking controls milk let down

114
Q

Why isn’t milk released until after birth

A

Placental oestrogen inhibits prolactin

115
Q

Why is it unlikely you’ll get pregnant straight after birth

A

Sucking inhibits GnRH so no ovulation

116
Q

Why does lactation stop

A

Prolactin levels gradually fall

117
Q

What prevents uterine contractions earlier in pregnancy and how?

A

Progesterone by decreasing the uterine response to oxytocin and decreasing uterine prostaglandin release

118
Q

What causes cervical ripening

A

Decidua and fetal membranes produce prostaglandins which decrease collagen and increase GAGs and hyalauronic acid

119
Q

Describe fundal heights to estimate gestation

A

Three months pubic bone
Five months umbilicus
Eight nine months xiphisternum

120
Q

Which levels does an epidural block

A

T10-L1

121
Q

Define post partum haemorrhage

A

Blood loss of more than 500ml less than 24hrs after delivery

122
Q

What Sheehan’s syndrome

A

Postpartum pituitary gland ischaemic necrosis from loss of blood and hypovolemia shock. Signs are agalactorrhea, loss of pubic and axillary hair, hypoglycaemia

123
Q

Describe blood flow post partum

A

Initially red flow which is Lochia rubia to white flow lochia alba
Clot passed d3/4
Periods return week 6 if no lactation

124
Q

When can you feel low after birth

A

Postnatal blues peak at d4/5

Postnatal depression is within 4 weeks

125
Q

What is the contents of breast milk

A

IgA
Foremilk high water
Hindmilk high fat
Lactoferrin to bind iron to prevent E. coli proliferation

126
Q

Risk factors for pelvic floor dysfunction

A

Obesity, chronic increase in intra abdo pressure eg constipation COPD, childbirth, ageing, marfans

127
Q

What muscles make up levator ani

A

Puborectalis, pubococcygeus, ileococcygeus

128
Q

What attaches to the perineal body

A

Ischiocavernosus, bulbospongiosus, levator ani, external anal sphincter, superficial and deep transverse perineal muscles

129
Q

What symptoms might you have with POP

A

Stress urinary incontinence, sensation of bulge or something descending, dysparenuria, bladder doesn’t feel empty

130
Q

Describe stages of FGM

A
  1. clitoridectomy
    • labia major and or min
  3. infibulation (others plus sew vagina)
  4. anything else
131
Q

How can you avoid tearing the perineal body in labour?

A

Perform an episiotomy: cut the perineum

132
Q

What comprises the pelvic diaphragm

A

Levator ani + coccygeus

133
Q

Which muscle maintains the ano-rectal angle and stops anus filling?

A

Puborectalis

134
Q

Where is the deep perineal pouch found?

A

Between the pelvic diaphragm (superior) and perineal membrane

135
Q

What is in the deep perineal pouch

A

Deep transverse perineal muscle, external urethral sphincter, bulbourethral glands

136
Q

What’s the Ferguson reflex?

A

Positive feedback involving increased oxytocin caused by pressure on the cervix increasing uterine contractions

137
Q

How should you manage post partum haemorrhage

A

Fluid, transfusion, A-E, manual fundal massage, oxytocin to increase contraction of uterus, intrauterine balloon tamponade

138
Q

What is Fitz Hugh Curtis syndrome?

A

Complication of PID causing perihepatitis due to transabdominal spread (infects liver capsule and anterior peritoneum but not liver itself)

139
Q

Neisseria gonorrhea is what type of bug

A

Gram negative diplococcus

140
Q

Give complications/symptoms for chlamydia, gonorrhea and syphilis

A

Chlamydia- conjunctivitis, fitz hugh curtis syndrome, PID
Gonorrhea- PID, reactive arthritis
Syphilis- initially chancre, later rash and feverm then neuro and cardiac effects

141
Q

Name respiratory effects in pregnancy

A

Increased tidal volume (ribs are relaxed due to relaxin), physiological hyperventilation

142
Q

Name growth factors involved in pregnancy and at which stages

A

IGF II in trimester 1 which is nutrient-independent

IGF I in tri 2/3 which is nutrient dependent

143
Q

Name the three stages of lung development

A

Pseudoglandular, canalicular, terminal sac

144
Q

What is colposcopy?

A

Looking at the cervix

145
Q

Define CIN

A

Dysplasia of squamous cells within cervical epithelium infected with high risk HPVs

146
Q

What are the two types of endometrial adenocarcinoma?

A

Endometrioid and serous

147
Q

What are the 4 types of ovarian cancer

A
  1. Epithelium (serous, mucinous, endometrioid)
  2. Germ cell (tissues from any 3 of germ layers)
  3. Sex cord-stromal (Sertoli-Leydig, or Granulosa)
  4. Mets
148
Q

What are the types of testicular tumours

A

Germ cell tumours are either seminomatous or non-seminomatous (e.g. teratoma, chorioarcarcinoma, yolk sac tumours). Seminomatous met late and very responsive, non-seminomatous met early and need more aggressive chemo.
Or sex cord stromal tumours (Sertoli or Leydig)

149
Q

What markers do testicular tumours release

A

Choriocarcinoma hCG
AFP yolk sac tumour
(both non-seminomatous germ cell tumours)

Easter revision 2018 (11 decks)

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