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Year 2 - Theme A > Block 11 > Flashcards

Block 11 Flashcards

(80 cards)

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0
Q

What percentage of sperm makes it to the cervix?

A

1%

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1
Q

Where does fertilisation occur most frequently?

A

Ampullary region of uterine tube

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2
Q

What steps must occur before the oocyte can be fertilised?

A

Capacitation

Acrosome reaction

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3
Q

What is Capacitation?

A

Lasts 7 hours
Destabilising of sperm head by removal of cholesterol
Acrosomal membrane removed
Sperm plasma membrane hyper polarisation
Influx of HCO3, increased Camp, influx Ca and decrease pH
Hyperactive motility

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4
Q

What are the 3 phases of fertilisation?

A

Penetration of corona radiata
Penetration of zona pellucida
Fusion of oocyte and sperm cell membrane

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5
Q

During one ejaculation, how many sperm are released?

A

300 000 000

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6
Q

What is the function of ZP3 in fertilisation?

A

Causes the release of acrosomal enzymes like acrosin
Allows the sperm to penetrate the zona pellucida
Allows contact with oocyte membrane

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8
Q

What is the Acrosome reaction?

A

When the sperm contacts the oocyte membrane the permeability of the zona pellucida changes
Lysosomal enzymes are released from cortical granules that line the plasma membrane of oocyte
Zona reaction
Prevents sperm penetration and Inactivates receptors on surface

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9
Q

What is the second polar body?

A

It is one of the daughter cells produces when the oocyte finishes its 2nd meitotic division, it receives hardly any cytoplasm

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10
Q

What is the morula and when does it form?

A

3 days

16 cells in the same space as the initial zygote

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11
Q

What is a blastocyst?

A

It is the next stage after the morula and it forms a cavity to allow for nutrition to get to all cells - blastocyst cavity.

inner cell mass and outer cell mass

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12
Q

What is the bilaminar disc?

A

It is the stage after the blastocyst. It is when the inner cell mass subdivide into the epiblast and the hypoblast.

The cells continue to divide and as a result the epiblast cells need a cavity for nutrition (amniotic cavity). Initial cavity = primitive yolk sac

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13
Q

When does gastrulation occur? What is it?

A

day 12

Primitive node, primitive pit and primitive streak form in epiblast.

Cells in the primitive streak multiply and fold under the epiblast to form new layers.

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14
Q

What happens during week 1 of embryogenesis?

A

Division of cells to form a blastocyst cavity. Formation of hypoblast, epiblast and trophoblast

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15
Q

What happens during week 2 of embryogenesis?

A

Implantation and development of the primary yolk sac

Formation of the primitive streak and node

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16
Q

What happens during week 3 of embryogenesis?

A 
Head and tail folding
Neuralation
Fore-mid-hind gut
Germ cells in allantois wall
Primitive vascular system - heart tube
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17
Q

What happens during week 4 of embryogenesis?

A 
Pharyngeal arches
trachea and lung buds
thyroid and liver
urorectal septum
mesonephrus, mesonephric duct and uteric bud
indifferent gonads
septum primum forms
forelimb bud
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18
Q

What happens during week 5 of embryogenesis?

A 
Optic cup and vesicle
primary bronchi
pharygeal pouches
pancreas
mullerian ducts
septation of ventricles
spleen
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19
Q

What happens during week 6 of embryogenesis?

A 
upper lip and palate
anterior lobe of pituitary
rotation of stomach
major calyces
testis differentiating
external genitalia indifferent
forelimb digit rays
hindlimb bud
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20
Q

What happens during week 7 of embryogenesis?

A 
posterior lobe of pituitary
membranous labyrinth
brochi division
midgut loop rotating
metanephric nephrons and minor calyces
septum secondum
cartilaginous part of skull
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21
Q

When does an embyro become a foetus?

A

8 weeks

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22
Q

What happens during week 8 of embryogenesis?

A

digits on hand
external ear
membranous part of skull

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23
Q

What components of the female reproductive system aid fertilsation?

A

Fluid current in tube from epithelial secretion
cilia beating towards uterus
weak contractions of fallopian tube

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24
Q

When does implantation occur?

A

1-3 days after fertilisation

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25
Before implantation, where does the embryo get its nutrition?
uterine milk secreted from the endometrium
26
What hormones are secreted by the placenta?
human chorionic gonadatropin oestrogens progesterone homan chorionic somatrotropin
27
Human chorionic gonadatropin - where is it secreted from?
synctial trophoblasts
28
Human chorionic gonadatropin - function?
Prevents menstruation and causes the persistence of the corpus luteum Increases to a peak at 10-12 weeks then decreases, can be measured in blood 8-9 days after ovulation Causes corpus luteum to secrete more sex hormones and causes decidual cells to swell. It also causes males to secrete testosterone and differentiate
29
Oestrogen - where is it secreted from and what are its functions?
Placenta Causes enlargement of uterus, breasts, breast ducts, external genitalia and relaxation of pelvic ligaments
30
Progesterone - where is it secreted from and what are its functions?
Placenta - concentration increases over time Causes decidual cells to develop and nurish early embryo, decreases contractility of uterus (preventing spontaneous abortion), increases secretions of fallopian tubes for nutrition, helps oestrogen prepare breasts for lactation
31
Human Chroionic somatomammotropin - where is it secreted from and what are its functions?
Placenta after 5th week Decreases insulin sensitivity, decreases use of glucose by the mother to provide more for the baby. Promotes the release of free fatty acids, can promote growth
32
Changes in mother during pregnancy?
``` Increased uterine blood flow Increased cardiac output increased blood volume increased BMR weight gain increased urine production increased GFR Increased blood pressure ```
33
What is the normal weight gain during pregnancy?
24 pounds - most in the last trimester ``` 7lb foetus 4lb amniotic fluid 2lb uterus 2lb breast 9lb other ```
34
What are the 3 antibody preparations used in pregnancy testing?
Reaction zone - monoclonal anti-HCG Ab-enzyme conjugate Test zone - immobilised polyclonal anti-HCG antibodies +dye Control zone - immobilised goat anti-mouse antibodies +dye
35
What are the foods to avoid during pregnancy?
``` Vitamin A - liver Pate (listeria) Soft cheese Unpasteurised milk Raw egg (salmonella) Rare meat (toxoplasmosis) tuna (mercury) raw shellfish caffeine ```
36
How many antenatal appointments for a nulliparous woman?
10
37
How many antenatal appointments for parous woman?
7
38
When are the antenatal appointments and what happens at each?
12 weeks - lifestyle advice, screening 16 weeks - review test and offer iron if anaemic 19 weeks - testing for foetal structural abnormalities 25 weeks NP - routine checks 28 weeks - routine checks, antiD prophylaxis for rhesus negative. pertussis vaccination 31 weeks NP - routine checks and review of screening 36 weeks - routine checks, checking of foetal position with external cephalic version offered if breech 38 weeks - routine checks 40 weeks - routine 41 weeks - membrane sweep and or labour induction
39
What are the normal routine checks carried out during an antenatal appointment?
BP check Proteinuria screening Symphysis fundal height + plotting
40
What diseases are screened for in pregnancy?
``` anaemia HIV hep B rubella syphilis sickle cell thalassaemia Downs ```
41
What are the dangers of alcohol in pregnancy?
``` Damages brain and affects childs behaviour Slow growth, development delay mental retardation foetal alcohol syndrome miscarriage risk ```
42
What are the signs of foetal alcohol syndrome?
facial deformities slow and retarded development brain and neurological problems
43
What are the dangers of smoking in pregnancy?
``` Still birth Premature delivery Low birth weight Stunted growth and development Under developed lungs Sudden infant death syndrome Learning disorders ```
44
What is ovulation induction and what are the risks?
Medications are used to stimulate the follicles in the ovaries to produce more than one egg per cycle Clomiphene citrate SERM gonadotropins Increase the chance of multiple births and of developing ovarian cysts Ovarian hyperstimulation syndrome
45
What are the stages of IVF?
1. Down Regulation - Switching off normal female hormone production 2. Stimulation of follicle production 3. Egg maturation 4. Preparing womb to receive embryos 5. Egg collection - oocyte capture 6. Embryo transfer
46
What is used for down regulation in IVF?
Gonadotropin-releasing hormone analogues Buserelin Goserelin
47
What is used for egg maturation in IVF?
Pregnyl - works like hCG Prepares them for collection Given 36 hours before
48
What is used for preparing the womb in IVF?
Utrogestran - works like progesterone to keep lining thick
49
What are the rules for embryo transfer in under 37s?
1st cycle - 1 embryo 2nd cycle - 1 embryo unless not top quality 3rd - 2 embryo maximum
50
What are the rules for embryo transfer between 37-39?
1st and 2nd cycle - one unless not top quality | 3rd - 2 embryos maximum
51
What are the rules for embryo transfer between 40-42?
Double egg transfer
52
What are the criteria for IVF referral?
Women under 40 who have not conceived after 2 years of regular unprotected intercourse OR - 12 cycles of artificial insemination = 3 IVF cycles If 40-42 years = 1 IVF cycle
53
What are the limitations of ART?
``` High cost of treatment Age of female partner Religious complications Access is limited Side effects of drugs Increased ectopic pregnancy ```
54
What are the success rates of artificial reproduction techniques?
41 = 12%
55
Describe the blood supply to the placenta
2 umbilical arteries (from the internal iliac arteries) | drained by 1 umbilical vein
56
Describe the flow of blood through the placenta
- Placental villus required for maternal exchange - Umbilical arteries enter placenta - Divide into many branches - Small arteries branch into placental villi - Foetal capillaries bring in foetal blood from umbilical arteries - Blood leaves through sinusoidal capillaries to venous - Mother forms a reservoir so blood envelopes placental villus
57
What are the 2 layers of the placental villus?
Syncytiotrophoblast (outermost) | Cytotrophoblast
58
What is the syncytiotrophoblast?
Outermost layer of placental villus Exchange via passive diffusion, facilitated diffusion and active transport and occurs through fully differentiated epithelial cels
59
What is the cytotrophoblast?
Less differentiated but can become syncytiotrophoblasts if required. As syncytiotrophoblast cells die they form synctial knots which eventually break off into mothers blood
60
Outline placenta formation
- Blastocyst escapes from zona pellucida - Trophoblast adheres to endometrium - Endometrium undergoes decidualisation - Decidual reaction as blastocyst implants - Trophoblast cells release proteases to invade endometrium - Trophoblasts differentiate into cytotrophoblasts surrounded by syncytiotrophoblasts
61
What happens in the decidual reaction?
Dilation of blood vessels Increased capillary permeability Oedema Increased proliferation of glandular and epithelial cells
62
Define pre-eclampsia
Systemic syndrome characterised by widespread maternal endothelial dysfunction presenting clinically with oedema, hypertension and proteinuria
63
When does pre-eclampsia occur?
3-5% of pregnancies Last trimester More common in first pregnancy
64
What is HELLP syndrome/
Haemolysis Elevated liver enzymes Low platelets
65
Define congenital defect
Any abnormality, structural or functional, identified at any age, which began before birth or the cause of which was present before birth
66
What is the incidence of congential physical defects?
2-3% of live born infants | Leading cause of peri-natal death (20-25%)
67
What are common single primary defects?
``` DDH Talipes Cleft lip/palate Cardiac septal defects Neural tube defects ```
68
How can single primary defects be categorised?
Malformation Disruption Deformation Sequence
69
What is a malformation?
Abnormal initial formation of embryo Result of genetic and or environmental factors during organogenesis e.g. neural tube defect
70
Describe the position of the breast
Sternal edge to midaxillary line 2nd to 6th rib
71
What is a disruption?
A destructive process which alters normal structures after their formation Amniotic bands - limb amputations Cardiovascular events - e.g. Poland anomaly
72
How is the breast of the skin attached to the dermis?
Suspensory ligaments of Cooper
73
What is the clinical importance of ligaments of cooper in breast cancer?
With cancer and fibrosis it causes a dimpling of the overlying skin Pitting of the oedematous skin (lymphatic)
74
What is a deformation?
Moulding of a body part that has differentiated normally by mechanical forces usually over a long period of time e.g. DDH, talipes
75
What is talipes?
1/ 1000 Club foot Foot turned inwards and upwards Short Achilles tendon - fixed flexion
76
What is DDH?
``` Development dysplasia of the hip 1-3% Screened Females and breech birth are risk factors Swaddling ```
77
What is a sequence?
Pattern of multiple anomalies that occurs early and produces a cascade of 2y and 3y error in morphogenesis Pierre Robin Sequence
78
Define teratogen
An environmental agent that causes abnormalities of form or function in an exposed embryo or foetus Sufficient amounts Appropriate time Susceptible individual
79
Give examples of teratogens
``` CMV Herpes Toxoplasmosis Alcohol Thalidomide Drugs Ionising radiation ```
80
What prevention and screening is available in pregnancy to reduce birth defects?
``` Oral folate supplementation Rubella vaccination Avoidance of risk factors Genetic counselling Donor gametes Antenatal screening (ultrasound) ```

Year 2 - Theme A (7 decks)

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