RDA Flashcards

Question

Describe the structure of the cervix

Answer 1

Endocervix is continuous with the body of the uterus, ectocervix with the vagina. It also has a transitional zone. Therefore, the endocervix has columnar epithelium, but it changes to stratified squamous epithelium at the junctional area. This is the site of many neoplasms

Answer 2

Secretes mucus into the cervical, which changes is response to hormones of the menstrual. It is permissive to sperm transport only during a short window, becoming abundant and stretchy when exposed to estrogen. In contrast, high progesterone makes it hostile.

Answer 3

``` Stimulates epithelial and stromal cell proliferation Causes stromal oedema Increases glandular secretions Synthesizes progesterone receptors Stimulates myometrial activity ```

Answer 4

Stimulates glandular secretions in the luteal phase (with oestrogen background) Causes stromal cell proliferation Inhibits myometrial activity

Answer 5

It implants and sinks entirely into the wall of the uterus To do this, the endometrium undergoes the decidual change, where the stroma becomes odematous, and fibroblasts and stroma fill with glycogen to give it energy. This only occurs in women

Answer 6

They grow faster than the surrounding stroma, forcing them to coil

Answer 7

In the proliferative phase, as they grow so fast.

Answer 8

A structure in the brain secreting hormones involved with fluid balance, smooth muscle, and controlling hormones of the ant. pituitary gland. Formed from the diencephalon

Answer 9

Secretes multiple hormones that regulare the endocrine activities of the adrenal cortex, thyroid and reproductive organs, as well as melanin

Answer 10

Anterior pituitary formed from the hypophyseal pouch, forming the adenohypophysis. Posterior pituitary formed rom the neuroectoderm, forming the neurohypophysis. (from median eminence and pars nervosa.

Answer 11

Suprachiasmic nucleus: above the optic chiasm Arcuate nucleus- most inferior Ventromedial: above arcuate Posterior: Most posterior

Answer 12

Anterior: Pars tuberalis and anterior lobe Posterior: Median eminence, hypothalamo-hypophyseal tract, stalk and posterior lobe

Answer 13

Blood runs from the superior hypophyseal plexus, down the hypophyseal portal veins, to the secondary plexus on the ant. pituitary. These are drained by ant hypophyseal veins. The post pituitary just has inf. hypo artery and post hypo veins

Answer 14

Hormones are produced in the hypothalamus that travel down the portal vein to the ant lobe, which then stimulate release of pituitary hormones.

Answer 15

Hormones are produced by the hypothalamus and passed into the post pituitary via the nerves, before being released into the blood

Answer 16

The posterior has many axonal processes, while the ant is mainly vascular and hormonal secretory cells. In the ant pituitary, it is mainly acidophils, with somatotrophs and mammotrophs. There are also some basophils, with corticotrophs, thyrotrophs and gonadotrophs.

Answer 17

Stimulated by GHRH and inhibited by GHIH | Acts on epithelia, adipose tissue etc. to stimulate growth of cartilage, skeletal muscle and other tissues.

Answer 18

Inhibited by dopamine Placental lactogens bypass feedback, and cause reduced dopamine, causing increased prolactin, as does sucking stimulus. This causes an increased rate of prolactin transport to the brain

Answer 19

GnRH released from hypothalamus, triggering FSH and LH release from ant pituitary. Negative feedback from testosterone. They may have long or short loop feed back (ie to ant pit or all the way to hypothalamus)

Answer 20

It is critical for normal fertility, so it is scattered to help preserve it

Answer 21

FSH acts on granulosa cells, LH on thecal cells to stimulate androgen production Estrogen and progesterone give long and short loop feedback Estrogen at sustained high levels switches to positive feedback

Answer 22

Kisspeptin regulates positive feedback and pulse synchronization of GnRH in the arcuate nucleus, which is the trigger for puberty

Answer 23

Due to migration of the testes from intra abdominal to an outside the body position Development of a countercurrent venous plexus called the pampiniform plexus

Answer 24

``` Spermatogonia (germ cells, make gametes) Sertoli cells (epithelium, surround, support and nourish germ cells) Leydig cells (interstitial stromal tissue for making testosterone) Myoid cells (contractile) ```

Answer 25

Exocrine: sperm Endocrine: testosterone

Answer 26

It's the differentiation of spermatids which become spermatozoa Stem cells at the base of the germinal epithelium, proliferate by mitosis and meiosis to produce spermatocytes and spermatids. This then results in spermatozoa production. Daughter cells are linked by cytoplasmic bridges, so coordinated development occur

Answer 27

Transit time is 74 days | A new wave of sperm development occurs every 16 days

Answer 28

Have 46 chromosomes When mitosis is complete, they move between sertoli cells into the adluminal compartment of the seminifferous tubules. They then perform meiosis to become primary spermatocytes. At the end of meiosis they are secondary spermatocytes. These divide rapidly into 4 spermatids with 23 chromosomes each. Cytodifferentiation occurs and the cells become sperm

Answer 29

Unnecessary cytoplasm is formed into residual bodies. Tails form and they move to the lumen The acrosome and increased mitochondria also form

Answer 30

They ofrm in gonadal ridges in the lumbar area, between caudal and gaubernaculum ligaments. As the testes grow, they drag downwards. ISL-3 (from leydig cells) causes the migration of the gametes towards and dilation of the inguinal canal. The two phases of testicular descent are the transabdominal abdominal, and the inguinoscrotal (where androgen is important)

Answer 31

Presperm cells in adjacent sections of the tubule are retarded or advenced at the same time

Answer 32

They produce testosterone. Their initial function (7-8 weeks gestational age) is not dependent on gonadotrophin stimulation, but from 14 weeks onwards it depends on LH Empbryonic leydigs are derived from different progenitors to adult ones (derived from stem cells at puberty)

Answer 33

They are responsible for minipuberty at 2 months postpartum Also masculize neonatal brain Trigger sertoli cell proliferation Timing of orcidopexy (descent of testes)

Answer 34

They stretch from basement membrane to lumen of the seminiferous tubules. Nourish the spermatogonia Absorb excess cytoplasm into residual bodies Produce seminiferous tubule fluid Maintain spermatogonial stem cell niche Form the blood-testis barrier (making the testes an immune prigvileged site). Their number is proportional to sperm count

Answer 35

The body's innate immune learning occurs in utero- as sperm are produced after this they will be seen as foreign bodies and a reaction will occur. The sertoli cells also actively secrete compounds that turn off the immune sytem, and so can be useful in transplant surgeries etc.

Answer 36

A comma shaped organ superoposterior to the testes | Efferent tubules drain into the head. It is 7.5cm long, but 4-6m in length.

Answer 37

Concentration of sperm, some fluid resorption using the stereocilia

Answer 38

A 45cm tube used for sperm storage. | It has an inner and outer longitudinal, middle oblique muscle layer, leading into an ampulla

Answer 39

Hypothalamus releases GnRH, promoting release of LH and FSH - FSH targets sertoli cells, causing them to secrete androgen binding protein - LH targets leydig cells, causing them to secrete testosterone - Testosterone binds to ABP on sertoli cells, stimulating spermatogenesis along with FSH - Testosterone is also converted to dihydrotestosterone, which causes male embryonic development, secondary sex characteristics, anabolism and enlargement of male sex organs. - Testosterone inhibits the ant pituitary and hypothalamus - Inhibin from sertoli cells inhibits the ant pituitary

Answer 40

They are androgen and LH responsive Produce 60% of seminal fluid, which includes fructose, semenogelin I (forms a coagulum in the vagina) antioxidants, and alkaline fluid to counteract vaginal pH It contains smooth muscle for ejaculation, as well as forming part of the ejaculatory duct when joined to the vas

Answer 41

A donut shaped gland the size of a walnut. Secretes a slightly alkaline fluid as well as PSA, responsible for semen liquefication after coagulum formation Four zones- Central 25% is resistant to carcinoma Peripheral 70% is most at risk Transitional 5% most commonly benign hyperplasia Periurethral can also contribute to BPH

Answer 42

2 corpora cavernosa | Corpus spongiosum prevents constriction of the penile urethra

Answer 43

Parasympathetic stimulation causes ACh release, and this triggers NO release. This increased cGMP, causing vasodilation, so the cavernosa relax and increase blood flow, squashing the veins, and reducing outflow Viagra helps this by blocking type V phosphodiesterases, which break down cGMP

Answer 44

Primordial germ cells first seen 3-4 weeks post conception First found in the yolk sac of extraembryonic tissues, and migrate into gonadal ridges via the hindgut Stem cell factor important for driving migration (PGCs die with insufficient levels) Ectopic germ cells can be origins of germ cell tumours (ie in pancreas) Germ cells become spermatogonia

Answer 45

Failure of the testicles to descend into the scrotup Affects up to 9% of full term and 30% of preterm boys Most self correct in 3mos, with orchidopexy a surgical option

Answer 46

Infertility due to excess temperature Testicular cancer (3-4 fold risk, assoc. with ethnicity (maori, then euro, the pacific/asian) Breastfed infants are less likely to remain cryptorchid

Answer 47

Often caused by a tumour on the pituitary. gland. Presents as an enlarged pituitary gland with headche, visual disturbances, coarse facial features, hypertrophy of soft tissues, enlargement of small hand/feet bones

Answer 48

Mutation of autosominal dominant GPR4 leads to prolonged activation of signalling pathways in response to kisspeptin This results in increased amplitude pulses of GnRH and development of pubertal changes before normal

Answer 49

GnRH deficiency, causing extremely low FSH, LH and estrogen, with amenorrhea, olfactory disturbances, reduced bone density etc.

Answer 50

Can be due to 47XXX chromosomal abnormality, causing early activation of the HPG axis, and blunted ovarian function. It results in increased FSH and LH secretion, causing precocious puberty (as early as infancy)

Answer 51

They sit in the zona pellucida

Answer 52

Undergoes capacitation (removal of glycoprotein coat) Matures- causes hyperexcitability Acrosome reaction: Release of proteases and hyaluronidase. Allows it to penetrate zona pellucida and plasma membrane to fuse with the egg

Answer 53

Only achievable when mucus is penetrable Mucus filters for poor sperm. Sperm vibrate in unison to break down the barrier- those that can't do this don't tend do succeed in getting through

Answer 54

2.5h in vagina 48h in cervix 24h in uterus 48h in oviducts (may slow tail beating to wait for an egg)

Answer 55

Sperm induce leukocytosis in the female, to help break down dead or dying sperm Exposure to paternal antigens may also allow the mother to tolerate foreign antigens

Answer 56

ZP3 binds to sperm heads via a receptor on the head of the sperm This initiates the acrosome reaction as exposure to the zona pellucida causes Ca2+ release in the sperm, causing membrane fusion etc Exposure of the acrosomal membrane reveals new binding sites for ZP2 Proteolytic enzymes are activated and begin to break down the ZP Fusion with surface membrane of the egg leads to cortical granule release ZP1 corsslinks ZP2 and 3, hardening the shell and making it impermeable. Progesterone from the cumulus makes the acrosome leaky prior to the acrosome reaction Hyaluronidase digests the cumulus basement membrane

Answer 57

ZP3 is the primary sperm receptor and induces the acrosome reaction

Answer 58

Touches the oolemma, and enters, causing increased calcium, followed by regular calcium spikes, which induce resumption of meiosis

Answer 59

Active mitotic division, and passage into the uterus 4-5 days after ovulation. Formation of morula (8-16 cells) and blastocyst- shows differentiation into trophoblast (future placenta) and inner cell mass (fetus) This then hatches out of the zona pellucida, with the blastocyst attaching and sinking into the decidua.

Answer 60

Failure to conceive after 12 months of unprotected intercourse

Answer 61

Semen analysis, for count, motility, volume, total number and morphology

Answer 62

``` Sperm count: 15million/mL Motility: 40% need to be progressive Volume: Must be more than 1.5mL Total number of sperm: 39 million in an ejaculate Morphology: 4% with normal shape ```

Answer 63

Ovulation- regularity of periods, with an estrogen spike at day 12, progesterone at day 21, FSH at day 2-4 with AMH levels above a certain parameter per age Timing of intercourse for ovulation STI presence

Answer 64

Can treat with weight gain or loss Treat with GnRH Treat with clomiphene citrate, for selective estrogen receptor modulation Treat with letrazole- prevents conversion of androgens to estrogen to increase monofollicular development (THese should cause the body to produce more FSH) Treat with FSH

Answer 65

Problem presents as infrequent or no periods, with overweightness as a consequence of the assoc metabolic syndrome and increased androgens Treated with weight loss, letrozole, metformin to treat the metabolic syndrome, or with IVF

Answer 66

Surgery or IVF

Answer 67

Cervical problems: Treated with IUI (intrauterine insemination) Endometriosis: Hormonal contraceptives, surgery, IVF Premature menopause: Donor egg No uterus: Surrogacy

Answer 68

1. Stimulate ovary with FSH. Prevent ovulation with GnRH antagonists until want to trigger- GnRH agonist. Then give progesterone for luteal support 2. Egg released 3. Sperm sample produced 4. Egg and sperm combined for fertilisation 5. Fertilised eggs introduced into uterus 6. Embryo freezing if possible

Answer 69

Need several follicles with estrogen at 1000 units per follicle, and progesterone at less than 6 picomol per L

Answer 70

They can be used to take timelapses of morula development, to track cell division without disturbing the culture, and produce an algorithm for those with the best potential

Answer 71

Oligospermia- Can have intra-cytoplasmic sperm injection (ICSI), donor sperm Oligoasthenotetraspermia- triad of few sperm, slow sperm and abnormal sperm Need ICSI or donor sperm Can have azoospermia- due to Kallman's syndrome (no GnRH/FSH/LH)- need donor insemination No spermatogenesis- donor insemination Obstruction/vasectomy- Testicular sperm aspiration (TESA) Congenital absence of Vas (CAVD)- need TESA or ICSI or donor sperm

Answer 72

Fine needle aspirates epididymis to take sperm If doesn't work, stick fine needle in testis and take testicular tissue If doesn't work, take chunk of testis

Answer 73

1. Select mobile, normal sperm 2. Immobilize it by cutting tail 3. Aspirate tail 4. Position tail in needle 5. Position egg and hold with suction pipette 6. Insert needle into egg 4. Rupture egg membrane by aspirating 5. Expel egg

Answer 74

Can be due to unknown aetiology, fertilisation issue or age. Can treat with midl ovarian stimulation with intrauterine insemination, or IVF

Answer 75

AMH decreases with age, reducing egg quality | Increased chromosomal abnormalities

Answer 76

1. Make hole in ZP on day 3 2. Select blastocysts with herniating cells at day 5 3. Aspirate 8-10 cells with pipette and cut off with lazer 4. Freeze biopsied embryos 5. Wash biopsied cells 6. Place in tube and store 7. Lyse cells and PCR 9. Genetic analysis

Answer 77

Less successful- need 10 eggs for a successful pregnancy Can preserve fertility before chemo, radiation etc Social egg freezing possible

Answer 78

Pre-eclampsia refers to high maternal blood pressure with proteinuria in the second half of human pregnancy. More likely in first paternity pregnancies. It is so important as it is very closely linked to CVD, as women with early onset, and to some extent late onset, are at high risk of early CVD mortality. If it develops into eclampsia, it can be fatal.

Answer 79

- Self maintenance/renewal - Exchange/transfer/transport - Separation of blood circuits - Protection from maternal infections - Protection from maternal immune reactions The placenta brings maternal and fetal blood into close apposition, but does not allow the two to mix. Some fetal vessels are contained within the placenta.

Answer 80

When the embryo undergoes nidation, it implants with the inner cell mass at the leading edge. Trophectoderm starts to eat its way into the wall, and the embryo follows. The syncytiotrophoblast is at the leading edge.

Answer 81

Trophectoderm invades under the syncitiotrophoblast on the fetal side, now called cytotrophoblast which proliferates and invades the trabeculae, becoming primary villi. The lucanar system is now the intervillous space, containing pools of maternal blood The syncytiotrophoblast covers the whole placental surface, made of only a single cell. Some mesencymal tissue comes from the embryo itself, and its presence indicates secondary villi. When endothelial cords (small fetal blood vessels in the villi) are seen, the villi are now called tertiary

Answer 82

11-13m squared

Answer 83

Suspended in a pool of maternal blood, but don't actually have contact with walls. Responsible for exchange and barrier functions of placenta

Answer 84

Initially the villi form a sphere around the embryo. Those to the sides and luminal edge of the placenta regress, leaving the smooth chorion laeve. Those at the base of implantation form the chorion frondosum, with thickened villi.

Answer 85

Some cytotrophoblasts break through the syncytiotrophoblast, and spread laterally around the implantation site to form a shell. These contact maternal tissue throughout gestation. Through them exit cytotrophoblast columns, which invade the decidua and spiral arteries. These are called extravillous trophoblasts

Answer 86

They enter the endometrium, eating the decidua and growing into the spiral arteries to replace endothelial cells and musculature. This keeps the arteries patent and gives a good blood supply through pregnancy. This prevents activation of the flight or fight response cutting off the baby's blood supply

Answer 87

They may not invade deeply enough, or can fail to invade some vessels. This can cause IUGR, where babies are more likely to be born prematurely or stillborn

Answer 88

Trophoblasts are able to plug the spiral arteries, reducing maternal blood pressure reaching the placenta, preventing damage. Normal early fetal development occurs in less than 1% Oxygen. Increased pressure in the placenta occurs in missed miscarriages.

Answer 89

Produce glandular milk, rich in glycogen that sustains the embryo in terms of nutrition. This is the major energy source in the first few weeks after implantation.

Answer 90

A progenitor cell type found in the first trimester, underlying the syncytiotrophoblast

Answer 91

The surface layer of the placenta, made of a single cell. It is formed by the fusion of villous cytotrophoblasts into the syncytial layer. Replaced by fusion of further ones.

Answer 92

Differentiated cells that have migrated out of the villous placenta towards the maternal tissues

Answer 93

Early pregnancy- the stroma become more cellular and vascularized. Fetal vessels sit deep within the villi, while maternal blood is covering them, so they need to thin In the second trimester, their thinning is complete- the number of villi doesn't increase, but the placenta grows In the 3rd trimester, villous cytotrophoblast is sparse, with increased branching

Answer 94

Beneath the implantation site is the decidua basalis, which comes away with the placenta The part covering the luminal side of the embryo is the decidua capsularis, while the rest is the decidua peritalis. Eventually, the capsualis fuses with the opposite side of the decidua peritalis, obliterating the uterine cavity.

Answer 95

The amnion is the avascular covering of the cord and placenta. The chorion covers the fetal vessels The decidua is not a fetal membrane

Answer 96

2 umbilical arteries and 1 umbilical vein (O2 blood). Formed from the yolk sac and allantois (bit of gut sticking out). Between the vessels and within the epithelium is Wharton's jelly. This is a network of myofibroblasts, filled with mucopolysaccharides, helping to keep the cord turgid, even when knots form in the cord

Answer 97

- Villous structures are tortuous, with a large surface area - The syncytiotrophoblast has a microvillous surface, which also slows maternal blood - In the third trimester, most villi are tertiary, and fetal capillaries are close to the syncytiotrophoblast

Answer 98

Fetal blood has a greater affinity for oxygen as it contains HbF. It is normally 80% saturated, compared to 50% in adults. It also has more haemoglobin- 20-25ml/dl vs 15.3 in adults Maternal blood pH lowers as it picks up fetal metabolites, causing decreased oxygen affinity and allowing it to dissociated. The opposite of this happens in the fetus.

Answer 99

It is an ultrafiltrate of maternal plasma, with a large contribution from fetal urine from midgestation. Aprox .5-1.2 mL are produced daily.

Answer 100

Gives the fetus buoyancy, allowing symmetrical growth Cushions the embryo, preventing its adhesion to the membrane Allows fetus to move for muscle tracts Allows breathing movements and swallowing

Answer 101

Leaves by fetal swallowing May also move across the skin prior to keratinization at 24w. Can move across fetal membrane into the maternal circulation, or into fetal vessels of placenta and umbilical cord.

Answer 102

Polyhydramnios: Excessive amniotic fluid due to potential loss of swallowing. More common in diabetic pregnancy Oligohydramnios: Lack of fluid potentially due to kidney issues

Answer 103

Diagnosis of fetal genetic disease, using amniocentesis, chorionic villi sumpling.

Answer 104

It can prevent hepB, rabies, measles and malaria (although this clogs it). Transmits HIV, cytomegalovirus, small pox etc, rubella and toxoplasmosis Lets through some drugs (most dangerous in 20-70day period of organogenesis). Ethanol and recreational drugs can cross, causing IUGR and developmental delay Heparin doesn't cross, warfarin does (dangerous) and so does aspirin/paracetamol (safe)

Answer 105

A two-chain hormone sharing its alpha chain with TSH, LH and FSH. All have unique beta chains Produced exclusively by syncytiotrophoblast of preimplantation blastocyst and placenta. Proportional to how much syncytiotrophoblast there is Binds to LH/hCG receptor, transmitting signals similar to LH, allowing progesterone production to occur in first 6-8 weeks of pregnancy, stopping CL regression After 8 weeks, the placenta produces the progesterone hCG prevents return to uterine cyclic pattern

Answer 106

Can indicate a trophoblastic tumour Important for male pregnancies, as it stimulates leydig cells to produce testosterone- responsible for the LH independent stage of testosterone production

Answer 107

Synthesized by the syncytiotrophoblast of the placenta after CL regression Trophoblasts synthesize it from LDL cholesterol it maintains uterine quiescence, maintains the uterine environment, induces decidua formation. Receptors are found in the stroma and uterine glands

Answer 108

Increases by 1000x, made by the feto-placental unit. Cannot produce testosterone de novo, but aromatises various androgens. Fetal adrenal produce these androgens, but cannot convert them.

Answer 109

``` CO increase by 10-15%, HR increase SV increase by 10% Reduced PVR esp in reproductive tissues. Alters type1:2 collagen in vessel walls. Progesterone induces vascular relaxation in reproductive tissues Increased angiotensin II and RAA system some NO vasodilation ```

Answer 110

Expansion of blood and plasma volume (plasma faster, causing decreased haematocrit). 500mL loss in singleton birth- hypervolemia modifies this, not needing compensation

Answer 111

Diminution of maternal immune response- white cell count rises due to more neutrophils, with more Th2 cells compared to Th1, allowing more antibody responses rather than cytotoxic

Answer 112

The decidua contains specialized killer cells NK cells can act by antibody dependent cytotoxicity Increased T cell density in placenta can cause repeated miscarriage

Answer 113

Increased blood flow- warm, clammy skin. Esp hands and feet Pigmentation in skin, nipples are areola. Linea digra Chloasma (areas of pigmentation) in the neck and face, lost after pregnancy (due to elevated melanocyte stimulating hormone) Striae gravid arum (red depressed streaks in abdomen, thighs and breasts Hair loss reduced, but excess gain is lost in the pueperium (immediately after birth)

Answer 114

Primary amenorrhea is the lack of ability to start a period | Secondary amenorrhea is when periods stop after a normal pattern

Answer 115

Can present with long cycles with no real blood, no other symptoms apart from milk expression on breast examination Diagnose using blood sample. High prolactin with normal others indicate the diagnosis Lactotrophs reduce pulsatile GnRH secretion through negative feedback. Dopamine has negative feedback on this. Dopamine inhibitors can increase prolactin May be due to a prolactinoma, psychotropic drugs, stress, lactation. Can be treated with drugs or surgery depending on cause

Answer 116

``` Exclude pregnancy Hypothalamic issue Stress Exercise Anorexia Low body fat PCOS Tumour of ant pituitary Absent/atrophic endometrium Imperforate hymen Vaginal septum ```

Answer 117

Less frequent menses, normal smears, normal exam | Investigate with labs- find inadequate estrogen, causing decreased GnRH.

Answer 118

Oligo or Anovualation, evidence of hyperandrogenism, polycystic ovaries on ultrasound (need 2/3)

Answer 119

Hirtuism (facial hair) Metabolid disorder- insulin resistance Obesity Acne Large ovaries with multiple small follicles and stromal hyperplasia. Increased androgens and free testosterone Acanthrosis Nigracans (dark velvety skin) LH to FSH ratio of 3

Answer 120

Weight loss, medication for insulin, clomiphene citrate to increase FSH taken at the beginning of cycles, surgery

Answer 121

No LH surge, causing no progesterone rise and no drop to allow menses The endometrium proliferates, possibly leading to hyperplasia Can induce a withdrawal bleed every 4-6 weeks, preventing endometrial proliferation

Answer 122

Babies born small have increased chance of perinatal mortality, lower IQ, inattention, and behavioural issues Almost half of stillborn babies have growth deficits Large babies have increased chance of trauma, neonatal admission, and increased risk of noncommunicable disease in adulthood

Answer 123

``` LBW is <2500g VLBW is <1500g ELBW is <1000g HBW is >4500g SGA is less than 10th centile LGA is greater than 90th centile ```

Answer 124

Increase in body size and mass from the end of organogenesis Hyperplasia occurs more than hypertrophy- gain 16-17g/Kg/day Normally constrained by maternal environment and substrate supply, provided minimal endocrine requirements (IGFs and insulin) are met

Answer 125

- Glucose: Enters fetal circulation by facilitated diffusion. Gives energy and carbon for tissue accretion - Amino acids: Enter fetal circulation by active transport. Allows metabolic balance of oxidation to growth - Lactate: Produced by placenta. Mostly oxidised - Fatty acids: Enter fetal circulation through diffusion. Form cell membranes and used as a store of energy

Answer 126

Maternal nutrition, metabolic and endocrine status communicate with the maternal circulation. This then travels through uterine blood, placental transport and umbilical blood into fetal circulation, where it is taken up by tissues to determine fetal metabolic, nutrition and endocrine status.

Answer 127

In utero growth potential is limited by bathology Decreased fat and lean tissue with poor placental function Increased risk of asphyxia, stillbirth etc.

Answer 128

Allows increased glucose uptake, fat deposition, protein anabolism and promotion of placental growth In early pregnancies, amino acids stimulate fetal insulin secretion. Then it is predominantly made up of already absorbed amino acids

Answer 129

Growth hormones are present in high concs, with receptors everywhere but the liver. They affect length, but have minimal effect on weight. Adrenal activation occurs near term, turning on the somatotrophic axis by inducing growth hormones in the liver. It promotes cell differentiation and maturation.

Answer 130

Ability of the uteroplacental unit to supply oxygen and nutrients affects how large the fetus will be Determined by maternal size, adolescence, parity, short inter pregnancy interval or macronutrient imbalance Twins and periconceptual undernutrition can also trigger this

Answer 131

Placental insufficiency (idiopathic or vascular) Trophoblast invasion insufficient Maternal undernutrition (severe) Fetal pathology (toxin, infection, congenital defects) Switching off of paternal growth promoting allele

Answer 132

Called beckwith wiedemann syndrome. Maternal imprinted allele not working, so paternal allele causes macrosomia, macroglossia, hemihypertrophy and omphalocoele, as well as embryonic tumours

Answer 133

Short fetus, SGA, normal head | Due to underexpression of IGF2

Answer 134

Phenotype is thrifty- low nephron mass, low lean mass, endothelial dysfunction, arterial stiffness, insulin resistance, dyslipidaemia, central adiposity, exaggerated stress response Health risks including hypertension, IHD, stroke, diabetes, metabolic syndrome and osteoporosis

Answer 135

Glucose intolerance developing in pregnancy, causing excess fetal substrate and fetal insulin, causing excess growth This results in LGA, resp distress, jaundice, hypoglycemia, polycythemia, hypocalcemia Increased future diabetes risk, obesity, etc Mother at higher risk of preeclampsia, birth trauma and type 2 diabetes

Answer 136

The process of giving birth- uterine and cervical activity acting to expel the conceptus (fetus, placenta and membranes) from the uterus, and prevention of hemorrhage so mother survives, breastfeeds and nurtures the newborn

Answer 137

Uterine contractions using to cervical dilation and expulsion of the conceptus

Answer 138

Quiescence of uterus: Growth, distension and pressure of fetus, but uterus remains relaxed Timing of birth Activation: Musculature is stimulated, cervical ripening, softening, shortening and effacing, membrane rupture Birth: Fetal-neonatal transition Involution: Haemostasis, retraction, lactation

Answer 139

Effacement of cervix and widening of pelvis. Head drops down, waters break (presenting part important as head must move 90 degrees in the second stage of labour)

Answer 140

Ratio of activity of progesterone on receptors A and B causes a simulated progesterone withdrawal. Prostaglandins are also synthesized, and there is an increase in beta agonists. The fetus has a central role in determining time. The normal inflammatory response is activated in labour. Once labour is established, ongoing cervical changes, membrane rupture and myometrial contractility occur Can also be affected by ethnicity, parity, infection and stress

Answer 141

In preterm labour, one or more factors involved in the triggering of normal labour is changed. The inflammatory reaction is a potent trigger. Timing, process and consequence is a key distinguisher

Answer 142

Poorly synchronised contractions- cervix is firm and closed, with painless and low frequency contractions. Progesterone is responsible for this, as it decreases Ca2+, (produced by corpus luteum and then placenta) Withdrawal of quiescence agents can start labour

Answer 143

Not essential for initiation, and requires gap junctions to work. Can induce and augment labour, and prevents postpartum haemorrhage

Answer 144

You need a whole fetus, with ability to activate the fetal HPA axis. Need uterine stretch and membrane rupture Increased prostaglandins, oxytocin receptors and gap junctions with high connectivity is needed to start coordinated labour This causes increased contractility (due to actin and myosin- antagonised by Ca2+ channel blockers) Increased excitability (Ca2+ voltage regulation, blocked with B2 sympathetic stim) Increased connectivity- block with COX 1 & 2

Answer 145

It prevents ascending infection in pregnancy. It consists of fibroblasts, smooth muscle and blood vessels. In birth, it softens due to the degradtion of collagen (triggered by prostaglandin trop, leukocyte inflammation etc.

Answer 146

Activation: Mifepristone, PGs, NO- induces labour priming Stimulation: PGs, oxytocin, causes augmentation and induction of labour Involution: Oxytocin, PG analogues, tranexamic acid- causes prophylacctic treatment of haemorrhage

Answer 147

Amnion and chorion. Responsible for producing prostaglandins. Rupture is not essential for labour. Zone of altered morphology is where ruptured occurs, and an amniotomy may help induce labour

Answer 148

Establish continuous breathing- foramen ovale closes, so pulmonary vascular resistance must fall fast The baby also needs to maintain heat- brown fat is more common here, allowing non shivering thermiogenesis. The baby must be dried. Baby needs to feed- it also causes uterine contraction, as well as the letdown reflex of milk, in addition to bonding

Answer 149

Placenta separates from uterus, cleaved through the decidua basalis Contraction prevents haemorrhage. Helped by oxytocin, cord clamping

Answer 150

Preterm is labour before 37 weeks | Very preterm is before 32 weeks

Answer 151

A failure of uterine quiescence, causing neonatal complications, individual, family and societal costs

Answer 152

Uterine over-distension Fetal Endocrine activation Intrauterine bleeding Intrauterine infection

Answer 153

Mechanical forces activate expression of genes involved in parturition. This can be due to multiple gestations, polyhydramnios, and fetal maturation

Answer 154

Activation of the fetal HPA axis can lead to increased adrenal hormones, increased estrogen etc. This can be caused by stress in early pregnancy. It can also cause increased estrogen receptors and decreased progesterone receptor activity, leading to decreased uterine quiescence.

Answer 155

This can activate the clotting cascade leading to the release of thrombin, plasminogen activators, and plasmin. This can cause protease activation leading to cervical ripening and membrane rupture

Answer 156

Pathogenic microbes may travel through the decidua or ascend through the cervix, initiating an inflammatory response accompanied by cytokines, leukocytes, MMp activity (causing tissue change) and membrane apoptosis. This can cause chorioamnionitis, fetal infection and premature rupture of membranes

Answer 157

It is an active process, with inflammatory like features. Leukocytes, cytokines and MMPs increase

Answer 158

Fetal growth hormone release PG release Poor attachment of the placenta

Answer 159

Damage to the cervix- congenital, surgery, previous birth | Fetal genome- including growth, HPA, and myometrial upregulation

Answer 160

They are produced by arachidonic acid for increaesd myometrial activity, cervical changes, and membrane rupture.

Answer 161

Decreased smoking Progesterone- good for prior preterm birth and short cervixes Preterm clinics Stricturing the cervix

Answer 162

Once concern is the switching of gas exchange from the placenta to the lungs- lund development is the min limiting factor in viability due to atelectasis because of low surfactant (treated with antenatal glucocorticoids) Increased risk of cerebral palsy- treat with MgSO4

Answer 163

Risks include maternal infection, previous preterm birth, smoking, multiple gestation, previous surgery, polyhydramnios, anomaly, age, and lack of prenatal care Can screen short cervixes, presence of fetal fibronectin in the vagina (glycoprotein holding membranes together- should have disappeared after first trimester). 30% of those detected deliver in 7-10 days

Answer 164

``` General health Pregnancy journey Partner health Family pregnancy health Medications Previous medical conditions Family support Smoking Drugs/alcohol Screening or not Baby's movements later in pregnancy ```

Answer 165

- Blood pressure. Maternal pressure goes down in the second trimester and returns to normal in the third - Radial pulse, check for oedema - Ask friend whether they look 'puffy) - IPPA (but no percussion) - Feel symmetry of uterus, check its height (should be within a week of date in a less than 100kg person) - Check whether fluid can be felt

Answer 166

Bipyramidal head diameter- best for figuring out how far along the pregnancy is Head circumference Abdominal circumference is the most important measure Fetal heart doppler and maternal blood doppler- determines whether enough blood is getting through to the placenta Check amniotic fluid- at least 2cm

Answer 167

Prepregnancy Pregnancy/birth/postnatal Infancy/parenting

Answer 168

``` Identify the at risk group in whom it is hoped to improve the health outcome 5% have chromosomal abnormalities 5% have IUGR 5% have preeclampsia 5% have diabetes 5% have obstetric problems 5% have historical problems 3% have fetal abnormalities 7% at risk of preterm birth Although this is not diagnostic ```

Answer 169

Reduced vessels within the placenta, preventing adequate perfusion of the placenta. Causes very high resistance of blood flow, and lots of fibrous tissues

Answer 170

It is caused by abnormal placental development with no diastolic velosity- an abnormal umbilical doppler will show forward flow only in systole. As a result, fetal hypoxemia occurs, redistributing blood to the brain, causing myocardial dysfunction, reversal in venous circulation, acidosis and death.

Answer 171

Pregnant women should sleep on their side to reduce IVC compression New parents should sleep the baby on its own, on the back

Answer 172

PTH is the most important, and provides minute to minute regulation of the ECF calcium 1,25(OH)2D (vitamin d) is also important, and partly regulated by PTH

Answer 173

Can be bound to protein (mostly albumin) Can be bound in ionic compounds Can be ionized and free (active, regulates PTH)

Answer 174

The intestines are responsible for absorption through active and paracellular routes The kidneys regulate excretion and respond to variations The bones are a reservoir for Ca2+ and P

Answer 175

It stimulates bone resorption by osteogclasts Stimulates renal tubular reabsorption of Ca2+ Stimulates hydroxylation to produce vitamin D, increasing Ca2+ absorption in the gut It therefore increases serum calcium by acting on the bones and kidneys directly, and the intestine indirectly

Answer 176

Formed by parathyroid glands made up of chief cells. There are 4 of these, though a fifth may occur in the mediastinum Triggered by low serum calcium, high serum phosphate, or low vitamin D If there is high binding of Ca2+ to the CaR, it inhibits formation and secretion of PTH

Answer 177

The renal tubules- these receptors sense serum calcium and either increase or decrease reabsorption from the kidneys as a result

Answer 178

Calciferol comes from sunlight and the diet, converted into calcidiol and inactive biliary metabolites in the liver. The kidney then converts it to calcitriol with high PTH or low phosphate. This increased Ca2+ and P absorption in the gut

Answer 179

Important paracrine regulator of breast, skin and bone development, not normally involved in Ca2+ regulation due to extremely low levels at normal function Produced in excess in some cancers, especially epithelial cell tumours, causing cancer-assoc hypercalcaemia

Answer 180

Can be PTH dependent, with increased serum calcium, and no change or increased PTH. Examples are primary hyperparathyroidism, or FHH/ other mutations inactivating CaR May be PTH independent, showing high serum calcium and low PTH Due to cancer (PTHrP), lytic bone myelomas, or issues with vit D Can also be vitamin D dependent, stimulating increased gut absorption- sarcoidosis, vit D intoxication

Answer 181

- Hypoparathyroidism, seen postsurgical, activating CaR mutations, autoimmune, infiltrative causes or hypomagnesaemia - Parathyroid hormone resistance (pseudohypothyroidism) - Vit D deficiency/ abnormal hydroxylation/renal failure/ resistance

Answer 182

Vitamin D PTH Phosphatonins

Answer 183

Kidneys (excretion) Bone (reservoir) Intestine (absorption)

Answer 184

Increased input: IV phosphate, cell death | Decreased excretion: Renal failure, PTH resistance or deficiency

Answer 185

Inadequate absorption, eg. vit D deficiency Intracellular shift of P due to resp alkalosis, prolonged intense exercise, or refeeding malnourished patients Renal loss Increased PTH Increased phosphotonins

Answer 186

FGF23 derived from osteoblasts in the bone is converted acts to inhibit conversion to vitamin D, resulting in decreased phosphate absorption It also acts at transporters in the kidney to decrease reabsorption This causes hypophosphatemia overall FGF23 is converted to an inactive form in the liver

Answer 187

Phosphotonin inactivation is mediated by a gene called PHEX. If it is mutated, there is less inactivation, causing hypophosphatemia (x linked) Defective Pi transport in the kidneys due to fanconi syndrome Ectopic FGF23 beyond inactivation capacity, eg. due to osteomalacia Abnormal FGF23 (eg autosomal dominant hypophosphatemic rickets)

Answer 188

``` No specific symptoms High calcium High PTH May present with haematuria due to calcified renal stones Can be due to parathyroid adenoma ```

Answer 189

Chest pain, history of smoking, mass on CXR- squamous cell cancer If progresses, can cause melaena, pyloric ulceration, with high calcium, low phosphate and low PTH High levels of PTHrP This stimulates calcium release from the bones, as we;; as increasing renal reabsorption of calcium and decreasing renal reabsorption of phosphate

Answer 190

Uncontrolled coeliac disease can lead to villous atrophy, resulting in decreased ability to absorb iron, folate and calcium for vitamin D. Associated with sunlight deficiency, it can cause calciopenic osteomalacia, with low dietary calcium due to decreasd absorption This causes the bone to be unable to properly mineralise, resulting in a lot of unmineralised osteoid. Will show muscle wasting, bone pain and disability, with low calcium and phosphate, high phosphatase and low vitamin D.

Answer 191

Bone pain Proximal myopathy Fracture Valgus/varus deformities, prominent costochondral joints, poor growth

Answer 192

- Inadequate sunlight exposure - Reduced dietary intake - Induction of enzymes converting it to inactive biliary metabolites - Impaired 1a hydroxylate - GI disease preventing absorption

Answer 193

``` Low calcium High phosphate High PTH Short stature Short 4h metacarpal Due to mutations in signalling proteins, causing resistance to PTH ```

Answer 194

Flu like illness, young patient, with muscle cramps, abdominal pain, n&v, afebrile, high BP, some neuromuscular irratability low calcium, high phosphate- appears to be hypoparathyroidism ADHH is autsosomal dominant hypercalciuric hypocalcaemia- constitutive activation of CaRs, meaning parathyroids read calcium as higher than it actually is. This means PTH secretion is low. Additionally, renal reabsorption is reduced as the CaRs there also read high serum calcium

Answer 195

No treatment if asymptomatic- can cause nephrocalcinosis if vit D is given, as it will result in way too much calcium in the urine Small doses of vitamin D if symptomatic

Answer 196

Familial hypocaciuric hypercalcemia Suspected if PTH is normal with family history of hypercalcemia Diagnosed by screening immediate relatives, checking urinary creatinine to calcium, and CaR genotyping

Answer 197

ADHH has decreased PTH, very low sCa, and increased uCa. It causes the CaRs to think Ca2+ is high-decreased PTH and increased calcium wasting FHH has normal or increased PTH, increased sCa and decreased uCa. It causes the CaRs to think calcium is low, increasing PTH and decreasing calcium wasting

Answer 198

Can be oncogenic, eg due to a mesenchymal tumour, and presenting with osteomalacia The increased production of FGF23 causing renal phosphate wasting and osteomalacia, causing low phosphate, high PTH and poor bone mineralisation.

Answer 199

Necessary for normal growth and development, especially during pregnancy. For the first twenty weeks, the fetus is dependent on maternal thyroid hormone Needed for metabolic activity and O2 requirements. Regulates lipid and carbohydrate metabolism, and therefore weight Controlled by the HP axis

Answer 200

By week 4 it is shown as endodermal cells The gland decends through the thyroglossal duct from week 5, placing itself anterior to the trachea in week 7. In week 10, the thyroglossal duct disappears, and by 12-20 it is functional, but still dependent on maternal hormone. Failure to migrate causes lingual thyroid, presenting as a child with hypothyroidism Thyroglossal cysts can persist, and move upon tongue protrusion

Answer 201

It is located deep to the sternohyoid muscle, and has two halves joined by an isthmus. Posterior to it are the recurrent laryngeal nerves, with the oesophagus to the left. It is supplied by the sup thyroid artery from the external carotid, and the inf thyroid artery from the subclavian. It is innervated by the ANS

Answer 202

It is made up of follicles formed by a single layer of hormone producing cuboidal epithelium, which form a circle around the lumen. Newly formed hormone is stored in the lumen as colloid, made up mostly of thyroglobulin. When TSH is secreted, the cells become columnar with scalloped edges due to endocytosis of hormone containing colloid. Cells between are called parafollicular cells responsible for secreting calcitonin. When there is medullary thyroid cancer, they cause increased calcitonin secretion.

Answer 203

Iodine is ingested in the diet and concentrated in the thyroid- approx 50 days' worth. This comes from fish, salt and bread, and is especially important during pregnancy to avoid fetal cretinism. Deficiency leads to compensatory thyroid enlargement called goitre. Plasma iodine is low, and it is trapped by the sodium/iodine symporter called NIS. This is found on all thyroid cells, and can be used in treating cancer by giving radioactive iodine to be taken up. Iodine is oxidised by thyroid peroxidase and moved into the colloid to form MIT and DIT

Answer 204

The NIS transporters are also found in the breast, gastric mucosa, ciliary body of the eye, salivary gland etc. Therefore you can get dry eye/mouth, increased risk of gastric cancer, and cannot give the compound to lactating mothers.

Answer 205

T3 is made up of a monoiodotyrosine and a diiodotyrosine | T4 is made up of 2 dis.

Answer 206

Thyroid hormone is found attached to the thyroglobulin in the lumen. When it is needed, the colloid is endocytosed, separating T4 and T3 so that they can enter the bloodstream

Answer 207

Hypothyroidism as there is a deficiency in the iodine transporter. The I cannot reach the colloid. As this transporter is also involved in Cl- transport, it can cause deafness.

Answer 208

Ant pit tumor/ T3 receptor mutation: The body produces high levels of TSH and T4 Overactive thyroid: Low TSH, High T4 An ill patient will present with low T4 but no response from TSH Thyroidectomy or primary hypothyroidism will show low T4 but high TSH Secondary hypothyroidism will show low T4 and no TSH response

Answer 209

Blocks the peroxidase enzyme- used to treat thyrotoxicosis, when not due to thyroiditis

Answer 210

There is a negative feedback response between T3 and TSH. Although 80% of the hormones released are T4, these get converted to T3 at the tissues themselves. After a thyroidectomy, enough T3 is needed to prevent TSH release

Answer 211

It stimulates production of thyroglobulins, iodine trapping, and T3 and 4 synthesis. It increases colloid endocytosis, proteolysis of Tg and T3/4 to increased their secretion. Also increases blood flow, increases thyroid peroxidase and H2O2 It also has the same alpha subunit as LH, FSH and hCG, causing thyroid stimulation. This also means TSH is lower in pregnancy, and regulation due to increased T3 is less effective.

Answer 212

Autoantibodies to the TSH receptor cause ongoing stimulation and thyrotoxicosis.

Answer 213

Pre-formed T4 & T3 is dumped into the blood, then causes hypothyroid as there is a long time taken for the T3 &4 stores to recover.

Answer 214

Presents with low TSH, high T3 and 4 Symptoms include nervousness, increased sweating, weight loss, vasodilation and heat sensitivity tachycardia and atrial fibrillation, and weakness due to hypokalemia Signs include bruits over the thyroid and tachycardia due to increased blood flow. It also can show goitre, skin changes, tremor and eye signs It may be caused by Graves disease, multinodular goitre (with some regions autonomous and hyperactive), thyroiditis, some drugs (eg. amnioderone) and toxic nodule, with a self-stimulating TSH receptor mutation

Answer 215

Shows low T4 and T3, with high TSH Causes decreased energy metabolism and a slow adult onset Called hashimotos disease Shows weight gain, cold, hair loss and dry skin, constipation, fatigue and oedema

Answer 216

Increased glycosaminoglycans push the eyes forward, and cause the eyelids to retract. The eye becomes very red and inflamed treated with steroids.

Answer 217

Young female with: Weight loss, lots of hunger and deating. Leg weakness, eyelid retraction, tremor, temperature, shortened periods, palpitations and fatigue. High T4 No neck pain Likely graves disease as no neck pain, young age, sex Treat with drugs for heart rate, carbimazole

Answer 218

Palpitations, sweating, anxiety, weight loss, atrial fibrillation, loss of upper body strength, tremor, proximal myopathy Lump in the neck. Shows toxic nodule Treatment is Carbimazole Can get radioactive iodine or surgery

Answer 219

Increases metabolic rate and head production Increased HR and SV Important for intrauterine CNS growth and development Metabolism control

Answer 220

Legal age of consent is 16, but there is no restriction on prescription of contraception to under 16s without parental consent, so long as they have sufficient understanding and maturity to comprehend the proposed treatment

Answer 221

Conception is the union of egg and sperm, followed by implantation of the blastocyst Contraception is a method of preventing pregnancy via interference with ovulation, fertilisation or implantation.

Answer 222

``` Combined pill Progesterone pill Condoms Janelle Depo Provera Jadelle Copper IUD Mirena ```

Answer 223

Most- IUD/implant | Least: Fertility planning, spermicide

Answer 224

It suppresses ovulation Reduces sperm transport in the upper genital tract Alters the endometrium to inhibit implantation Thickens cervical mucus

Answer 225

Advantages are that you can stop whenever you want, it's available almost everywhere, and there are also non contraceptive benefits including reduced ovarian and endometrial cancer. Disadvantages are that there is a 9% failure rate, it is complicated to take, lots of things prevent its use, there is a very small breast cancer risk, and the pill free interval can cause the ovaries to wake up as the rising FSH can trigger an LH surve and ovulation

Answer 226

``` Focal migraines (aura, flashing) Smoking Weight BP Other meds Diabetes STI status Personal and family history ```

Answer 227

If started on D1-5, protection is immediate. If started later, 7 days are needed as a precaution

Answer 228

Good for breastfeeding, or if you are unable to take the combined pill Thickens cervical mucus, but must be taken within 3-4h of the same time every day. Some also suppress ovulation

Answer 229

Suppresses hormones responsible for ovulation Thickens cervical mucus Can cause prolonged amenorrhea and weight gain Delayed fertility return

Answer 230

Long acting reversible contraception | Good as it is cost effecteive even after 1 year of use. Issues with training and accessibility

Answer 231

Alters the endometrium to prevent endometrial reception of sperm Stops ovulation Thickens cervical mucus Bleeding is the main side effect, which may be prolonged or frequent

Answer 232

Toxic to sperm Creates an inflammatory response in the endometrium to prevent implantation Can cause heavier periods Gold standard for contraception

Answer 233

Creates an unfavourable uterine environment Thins the endometrium Thickens cervical mucus Indicated for heavy bleeders, contraception, endometrial protection with HRT Used for dysmenorrhea, endometriosis, endometrial hyperplasia

Answer 234

ECP- up to 72 hours after upsi, efficiacy decreases with time. Postpones ovulation but cannot do anything if ovulation has already occured Copper iud- >99% efficacy. Anti implantation as it takes 8 days for a blastocyst to implant.

Answer 235

Nutrition of young | Spacing of pregnancies

Answer 236

Modified sweat glands derived from tissue identified in mammary crests that arise between the armpit and groin

Answer 237

Downgrowth of the dermis to form the primary breast buds. Secondary buds develop from these, becoming the lactiferous ducts Buds develop lumens and become canalized under the influence of estrogen and progesterone By birth, 15-20 lactiferous ducts are present and the breasts could make milk under hormonal stimulus

Answer 238

The fetus hasbeen exposed to placental steroids and the maternal lactation hormones, which can cause it to produce a clostrum like secretion called witch's milk

Answer 239

- Body of the breast - Nipple- raised cylindrical pigmented structure. Can be inverted. Point where lactiferous ducts join the skin - Areola: Prominent circle of tissue surrounding the nipple, containing sebaceous glands without hair follicles, giving the surface a grainy structure

Answer 240

Adipose tissue of the pectoral fat (texture and shape) Cooper's ligaments support the breast- affected by age and childbearing 15-20 lobes made up of milk secreting lobules, each connected to a lactiferous duct, which leads to a lactiferous sinus

Answer 241

The breast ducts only develop alveoli under the influence of estrogen during pregnancy. The resting breast is dominated by the duct system and fat, but during the menstrual cycle, alveolar buds grow, and increase with successive cycles.

Answer 242

Oestrogen causes breast growth Progesterone induces side branching of ducts Prolactin causes alveolar development, and stimulates casein and alpha lactalbumin Insulin and cortisol stimulate alveolar epithelial cell division Ducts grow, branch and bud, causing potential quadrupling of breast weight

Answer 243

Promotes milk production, but is inhibited by high progesterone during pregnancy Suckling of the infant induces prolactin secretion by the ant pituitary, through a neuroendocrine reflex This also decreases dopamine which normally inhibits prolactin. Increases vasoactive intenstinal peptide secretion by the paraventricular nucleus This induces milk protein production, correlated with duration and extent of suckling

Answer 244

Suckling stimulates synthesis and secretion of oxytocin by the posterior pituitary. This induces contraction of myoepithelial cells of the alveoli, causing milk ejection from the ducts, and potentially from the nipple. Stimulation such as baby smell, hungry crying and intercourse may cause it

Answer 245

Usually this additional breast tissue is found along the line of the embryonic milk ridge. Lactiferous ducts may exit the breast at sites outside the nipple.

Answer 246

Stage 1: Mid gestation to day 2 postpartum. Preparation, involving increasing alveoli, ducts. Capable of lactation, but normally doesn't occur until day2 postpartum Stage 2: is postpartum day 3-8 with the start of large-scale milk production. There is increased alpha lactalbumin (for producing glucose) and decreased sodium and chloride in the milk due to tight junctions in alveolar epithelium

Answer 247

- Galactopoiesis: Maintenance of established milk secretion | Involution: Reduction in breast size about 40 days after the last feed, due to buildup of inhibiting substances

Answer 248

This contains less sugar and fat, so less energy. It is much more protein rich. It is especially rich in IgA antibodies (for the mucosal immune system) specific to the mother's exposure. Antibodies from the mother cross the placenta during pregnancy, but this is lost after birth

Answer 249

Bipotential gonads emerge around 6 weeks, the internal genitalia at 7 weeks at external genitalia at 8

Answer 250

Equivalent to genial ridge. Arise as paired structures in the intermediate mesoderm and divide into three areas Pronephros forms the adrenals Mesonephros forms the gonads and internal structures Metanephros forms the kidneys Its development depends on nuclear transcription factor activation, which bind and form the protein complex aorund the DNA, altering gene transcription and expression. As the adrenals, gonads and kidneys arise from here, mutations can affect more than one organ system.

Answer 251

IGFR1 WT1 (wills tumor- putation can result in pediatric renal cancer) SF1 (steroidal factor) DAK1

Answer 252

From the bipotential gonad, if it is exposed to SRY, SOX-9 and FGF9 it will become a testis. This is because earlier and greater gene activation occurs in testicular development. It is initated by the SRY gene. SRY then triggers SOX9 etc. Testicular development suppresses ovarian development and vice versa. The female ovary will form if not exposed to these, and exposed to FOXL2

Answer 253

SRY determines male gamete development. In females where it has been transferred by recombination onto their X chromosome, they develop a testis It is found only in the pre-sertoli cell in the testis, and activation precedes development of the sertoli cell, which precedes other testicular cell lines. It stimulates SOX 9 to complete testicular differentiation. Initially SOX-9 is transcribed by SF1. SOX-9 up-regulates itself via a positive feedback loop, as well as being stimulated by prostaglandin D2 and FGF-9. These also inhibit ovarian transcription factors

Answer 254

They arise from the interstitium of the testis. They produce steroids. The initial leydig cells regress and are replaced by adult ones postnatally

Answer 255

These arise from the yolk sac and migrate to the genital ridges following Stem Cell factor Once there they lose motility and aggregate. In the testis, germ cells enter cords and have mitotic errest. In the ovaries they continue into early meiosis before arresting Spermatogenesis is determined soon after reaching the genital ridge. They are involved in ovarian development If germ cells do not populate the ovary, only stromal tissue evolves

Answer 256

They develop from wolffian and mullerian ducts. Wolffian ducts form the internal male genitalia, while the mullerian ducts form as invaginations of these that become female internal genitalia. This is determined by presence of leydig and sertoli cells, as testosterone stabilises wolffian structures at high local concentrations, and sertoli cells secrete antimullerian hormone, causing regression of mullerian structures As there is no vasculature at this stage it is all paracrine signalling, meaning there can be bilateral differences

Answer 257

It can produce normal male or female genitalia Male results if the genital tubercle is exposed to high concentrations of dihydrotestosterone. Lower concentrations can result in partial virilisation (eg. hyperspadius with the urethra low in the penis). Absence or resistance to androgens results in femal external genitalia Note that Placental HCG takes the place of LH in the first trimester, allowing leydig cells to be activated.

Answer 258

``` XY chromosomes Presence of a testis Produces testosterone, but resistant Lack of internal structures Female external structures All androgens converted to estrogen No secondary sexual characteristics- no body odour, no pimples etc. ```

Answer 259

Karyotype XX Normal female internal genitalia with the presence of a uterus Male external genitalia Can be due to prenatal androgen exposure Fetal causes are congenital adrenal hyperplasia Maternal causes are steroid ingestion, severe polycystic ovary disease and androgen secreting tumour

Answer 260

``` Presence of a testis No female internal genitalia Karyotype XY Lack of prenatal androgen or inability to respond to it (LH receptor mutation/enzyme defect/androgen receptor mutation) Hypothalamic/pituitary defect Kleinfelter's Presents with a small normal phallus ```

Answer 261

Shows presence of mullerian structures, with femal external genitalia and an XY karyotype. Testis has failed to develop

Answer 262

SRY mutation causes campomelic dysplasia, with 75% of xy having sex reversal WT1 mutation can result in kidney tumour in childhood SF1 mutation regulates gonadal, adrenal, pituitary and steroidogenic functions. It is first released in the urogenital ridge, and then in fetal sertoli and steroidogenesis. Having only one copy leads to hyperspadia in men and women with early menopause

Answer 263

Glucocorticoids are cortisol | Mineralocorticoids are aldosterone

Answer 264

Regulates sodium, blood pressure and especially glucose in the body Its loss can lead to hyponatremia, meaning water is unable to be excreted Can cause hypoglycaemia due to to reduced hepatic gluconeogenesis Can cause hypotension due to loss of cortisol effects of vascular tone

Answer 265

Released in response to low blood volume Regulates sodium balance Regulates H+ balance Regulates K+ balance If not working, will see hyponatremia due to urine sodium loss and ADH secretion Will also see hyperkalemia due to reduced K+ excretion Can also reduce H+ excretion, causing metabolic acidosis

Answer 266

Can be primary (adrenal gland issue) | Can be secondary (pituitary/hypothalamic issue)

Answer 267

The hypothalamus releases CRF, prompting to the pituitary to release ACTH- this acts on the adrenal cortex to produce cortisol, which has negative feedback on the ant pituitary and hypothalamus However, ACTH is a product of POMC, which also produces MSH. ACTH also has the same alpha chain as MSH. Increased POMC and ACTH produces increased MSH, increasing pigmentation. This is especially notable on skin flexures, mouth, freckles and nails

Answer 268

Check old photos for pattern of change- simple obesity is observable by 3-4 years old. Childhood glucocorticoid excess leads to generalized obesity, while in adulthood it leads to truncal Simple obesity drives growth, so obese children are often tall for their age.

Answer 269

``` Short fat body Moon face Thinning skin with bruising, v red marks Androgen excess causing hirsutism and amenorrhoea Myopathy causing proximal weakness Glucose intolerance causing diabetes mellitus Hypertension Osteoporosis ```

Answer 270

Cortisol also binds to mineralocorticoid receptors. While it has no mineralocorticoid effect at physiological state, it can cause it at excess levels

Answer 271

- primary functional adrenal tumour - ACTH secreting tumour (pituitary/ectopic) - Exogenous glucocorticoid

Answer 272

You get increased cortisol Secondary mineralocorticoid effects including alkalosis, hypokalemia, and hypertension Hyperandrogenism Fatigue This is because the brain thinks cortisol is low, so releases increased ACTH, causing hyperglycaemia

Answer 273

Mineralocorticoid resistance (pseudohypoaldoseronism) Causes high aldosterone and renin levels Depletes ECF space High serum K+ and low serum Na+ Increased urine osmolarity

Answer 274

``` Nonfunctioning zona reticularis and fasciculata Cortisol deficiency from birth Hypotension Hyponatremia Hypoglycemia Frequent collapsing and potential death ```

Answer 275

Defect in cotisol synthesis, leading to high ACTH with secondary stimulation of the adrenal precursors- these are androgens Patients often also have mineralocorticoid deficiency and are salt wasting Causes female internal genitalia with uterus, but male external genitalia

Answer 276

Due to defect in 11B hydroxylase. Causes low cortisol, high deoxycorticosterone, high 11deoxycortisol and old bone age Very dark skin, very tall, large phallus, pubic hair, high BP and hypokalemia Managed with glucocorticoid therapy to suppress ACTH. Also need to suppress central precocious puberty and treat the hypertension

Answer 277

Depends on good general health Normal nutrition and genetics Caring environment

Answer 278

Genetic disorders Endocrine disorders Cartilage/bone disorders Chronic disease

Answer 279

Infant- rapid growth at birth declining rapidly in the first 2 years of life Childhood- constant annual growth- GH dependent Puberty- Rapid growth dependent on sex steroids and GH release. The legs grow relatively faster than other areas

Answer 280

An estimate of height potential based on parental height Boys it's Dad + (Mum +13) /2 Girls it's Dad - 13 + mum /2

Answer 281

The rate of change of height in children. It differentiates normal short stature from pathological Normal has decreasing across childhood, rapid increase and then decrease at puberty. Girls have earlier peaks

Answer 282

Common, may be normal or pathological | Normal short stature grows with normal height velocity

Answer 283

Familial short stature- within MPH. See same bone age | Constitutional delay- family history of delayed puberty. Slow late childhood height velocity and delayed bone age

Answer 284

Proportionate (endocrine/chronic) | Disproportionate (skeletal dysplasia)

Answer 285

Picture of hand x ray matched with 'standard' x ray for that age. The age should be within a year of the age the child is at Can tell based on epiphyseal growth plates etc

Answer 286

Pulsatile, low baseline Primarily secreted at night Increased by sleep, exercise stress, hypoglycemia, amino acids, malnutrition, sex steroids Decreased by obesity, psychological issues, deprivation Needs normal insulin and nutrition

Answer 287

Metabolic functions, inhibiting glucose uptake and promoting glycogenolysis Stimulates protein synthesis Promotes lipolysis Functions as an endocrine, paracrine and autocrine hormone

Answer 288

There are I and II varieties Both have a great amount of homology with insulin, and have cross reactivity with each other IGF I is the major postnatal growth promotor, bound to IGF binding proteins It is prinicpally produced in the liver, and bone It causes cell proliferation and differentiation

Answer 289

Has effects on the skeleton and body composition. Responsible for epiphyseal maturation and closure If there is no estrogen growth does not stop

Answer 290

Thyroid hormone has a facilitatory role in growth, necessary for GH secretion and growth plate development Without it, severe short stature, developmental delay and deafness can occur

Answer 291

Provides the substrates for growth

Answer 292

Fetus needs IGF II, Insulin, PDGF, EGF and FGF Infant needs GH, IGF-I and T4/T3 Pubescent needs GH, IGF-I, T4/3, E2 and Insulin

Answer 293

``` Proportionate may be cause by IUGR Syndromes Chronic illness Psych factors Disproportionate may be caused by Syndromes Hypothyroidism Skeletal dysplasia ```

Answer 294

Makes baby small for gestational age Catch up growth above the 3rd percentile usually occurs by 6 months of age, but can drag on to two year By 2 years it is normally assoc with short final height, and unlikely to reach MPHs

Answer 295

Loss of X chromosome, normal Thyroid, but loss of some growth related areas of the X chromosome May have short stature, failure to enter puberty, neck webbing, hand and food oedema, side spaced nipples, increased carrying angle, cardiac abnormalities, and renal/urinary tract abnormailities

Answer 296

The brain has an abligatory requirement, consuming approx. 80% of whole body glucose in the fasting state. Uptake is not insulin dependent. Blood cells account for the other 20%, with renal medulla accounting for the rest

Answer 297

Insulin prevents uncontrolled rise in blood glucose after eating Glucagon keeps blood glucose from falling into the hypoglycaemic range

Answer 298

Alpha cells produce glucagon Beta cells produce insulin Delta cells produce somatostatin Also rich in capillaries- receives 20% of pancreatic blood flow, but makes up 1-2% of pancreatic mass

Answer 299

ANS and peptidergic neurons

Answer 300

Facilitated transport. Most is Non-insulin mediated glucose uptake, and most of the rest is GLUT2 facilitated glucose uptake. GLUT-4 is the most important insulin sensitive transporter in muscle and fat

Answer 301

GLUT2 functions in the pancreas and liver | GLUT 4 is primarily active in fat and muscle

Answer 302

The glucose undergoes glycolysis to form ATP, thanks to an enzyme called glucokinase This causes closure of ATP sensitive K+ channels The cell depolarizes Calcium enters via voltage gated channels Increased calcium triggers insulin translocation and exocytosis

Answer 303

Insulin is first produced as pre-pro-insulin, and as it completes its transition to proinsulin and then insulin, each molecule releases a molecule of C peptide C peptide can be used to distinguish people with type 1 vs type II diabetes as well as being able to tell whether people are injecting their own insulin or not Type II diabetes will have normal levels of peptide C as they are producing insulin. Type I diabetics will have low peptide C as they are not. People injecting insulin will have low peptide C as the insulin comes pre-formed People with insulin secreting tumours will have high peptide C

Answer 304

Note that these receptors are not needed by the brain or red blood cells Increased GLUT 4 vesicles travel to the cell surface, allowing glucose to enter muscle and fat cells, reducing blood glucose levels. It also increases fat and protein storage, and carbs stored as glycogen

Answer 305

``` Insulin increases in respose to Glucose Glucagon Vagal nerve stimulation Incretin hormones (GLP-1) ```

Answer 306

When food is consumed, the GI tract releases incretin gut hormones. These act on the alpha cells of the pancreas to reduce glucagon, and the beta cells to increase insulin As a consequence there is reduced hepatic gluconeogenesis, and increased peripheral glucose uptake

Answer 307

Baselin secretion is pulsatile | High glucose elicits a fast initial acute release, then a slower second phase. This causes a big peak, then regulation

Answer 308

Insulin increases glucose uptake in adipose tissue and muscle, increases glycogen sythesis in the liver and muscle, and decreases gluconeogenesis in the liver It increases lipogenesis and decreases lipolysis in adipose tissue, increases lipid and protein sythesis in the liver It also increase ketone uptake in the muscles, and decrease ketogenesis in the liver

Answer 309

Patients with diabetes may have an increase in blood sugar after exercise, as they are unable to shove glucose into their cells. They rely on other forms of glucose production- ie glycolysis

Answer 310

50% of glucose is burned, 5% to glycogen and 45% stored as fat Excess carbs are stored as glycogen- mainly in the muscle, but 70g in the liver Glycogenolysis results in glucose release. Excess energy is stored as fat Fat is stored in adipocytes, which produce hormones like resistin, TNF alpha and adiponectin. Lipolysis results in glycerol release, to be transported to the liver into the krebs cycle. Associated free faty acids are oxidised to ketone bodies Protein has no specific deposits and makes up about 20% of stored energy. It can be broken into amino acids to gluconeogenesis, oxidation to energy, or reincorporation to proteins

Answer 311

First converted to glucose - 6- phosphate, which can be converted to glucose Alternatively, if energy is needed, it can be converted to pyruvate, then to acetylCoA which takes it through the krebs cycle, producing 38 ATP

Answer 312

Converted to lactate, then given into the krebs cycle for 38ATP. However, lactic acid buildup can occur

Answer 313

Can be broken down into alanine and used in the krebs cycle

Answer 314

Glycerol put into the krebs cycle, as are free fatty acids- although these come out of the cycle as ketones

Answer 315

Can get ketoacidosis if insulin deficient- this is the result of uncontrolled protein hydrolysis, gluconeogenesis and inactive GLUT4 It presents as vomiting, abdominal pain, drowsiness and a high anion gap

Answer 316

Receptors sense low glucose, causing release of ACTH from the ant pituitary. This acts on the adrenal cortex to produce cortisol The hypothalamus also stimulates the adrenal medulla to produce adrenaline Along with SNS activation and hypothalamic innervation, the alpha cells of the pancreas produce glucagon

Answer 317

Insulin in patients with diabetes Sulphoylurea therapy (drug prevents K+ channel opening) Insulinoma Severe hormone deficiency- eg. addison's disease where patient cannot produce cortisol

Answer 318

The hypothalamus adjusts to low glucose, and stops activating at low levels. However, the brain doesn't adapt, so the patient is prone to random bouts of unconsciousness as their SNS doesn't activate in response to lowering glucose

Answer 319

Subnormal glucose repsonse to a given concentration of insulin High insulin with normal or high glucose. This starts before diabetes It can be pre receptor or receptor, but most commonly it is a post receptor issue

Answer 320

Clustering of multiple risk factors with obesity Involves central obesity as well as two of - Hypertension - Elevated triglycerides - Reduced HDL cholesterol - Abnormal glucose

Answer 321

Metabolic syndrome Acanthrosis nigracans- black, velvety skin on the back of the neck due to increased IGF production PCOS

Answer 322

Visceral adipocytes are metabolically active cells producing hormones and cytokines. They may get larger, and take up more fat. This means they don't stop performing lipolysis, and can't soak up glucose This causes insulin resistance in muscles, liver and fat. It also causes release of non esterified fatty acids (NEFA), which causes toxicity at beta cells, and reduced insulin release. High insulin prevents ketosis in most patients with type II diabetes.

Answer 323

``` Genetic components (eg. south asian populations) May have Beta cell dysfunction, may be caused by drop in B cell mass or functionality Intrauterine environment- SGA babies who become obese have increased diabetes risk ```

Answer 324

Firstly, decrease glucose- too high levels may switch off B cells reversibly Can also be treated with hyperinsulinaemia. This is because the liver increases its glucose output and triglyceride synthesis, which leads to fatty liver disease

Answer 325

May be preceded by insulin resistance by many years. Causes hyperglucaemia due to loss of incretin response coupled with progressive B cell inability to produce insulin Presents as high fasting and resting glucose

Answer 326

Measure HbA1C- this is the portion of haemoglobin that binds to glucose. In a person with diabetes, the circulating high glucose triggers formation of increased HbA1c concentration It can also assess average glucose levels

Answer 327

Microvascular disease- hyperglycaemia causes endothelial dysfunction, allowing retinopathy (oedematous, ischaemic retina), neuropathy and nephropathy to occur Macrovascular disease- increased atherosclerosis acceleration leading to stroke, myocardial infarction and peripheral vascular disease

Answer 328

Lifestyle modification Drugs that control hyperglycemia (metformin, sulphonylureas) Drugs for hypertension, dyslipidaemia and platelet aggregation

Answer 329

Autoimmune disease resulting in progressive beta cell destruction End result is absolute insulin deficiency, causing hyperglycaemia and ketoacidosis, as well as micro and macrovascular effects

Answer 330

``` Weight loss Frequent urination Frequent drinking and thirst Mosquito bites would become very infected High blood sugar on test ```

Answer 331

Back then, pig insulin was the standard course of treatment. However, this caused insulin resistance in many patients as they would produce antibodies to the porcine tissue. Now, human analogues are used, and the main problem is allergy to the preservative used.

Answer 332

Some ketoacidotic episodes Increased hyperglycemic ketoacidosis after partying and drinking Diabetic retinopathy Charcot's foot- now her foot arches out instead of up, causing ulceration etc Peripheral neuropathy in the feet- no sensation at all Some gastroparesis due to neuropathy- does not absorb food properly. Causes abnormal sweating and hot flushes Depression Also has MS

Answer 333

Lantis- a long acting drug taken twice a day (11units morning, 10 at night). This has a fatty acid chain, meaning it is released slowly over the time period Humalog is her one to take with meals- 15 mins before, max. Has an amino acid switch, meaning it won't clump in the body for more aspirin

Answer 334

Initially presented as imbalance, with frequent falls. Difficulty in speaking, fine motor movements etc. Progressive disease Begun to affect memory and mobility, with some double vision

Answer 335

The appearance and maturation of secondary sex characteristics, the adolescent growth spurt, achievement of fertility and psychological development Changes result directly or indirectly from maturation of the HPG axis, stimulation of sex organs and secretion of sex steroids

Answer 336

For girls: Breast development, followed by a growth spurt | For boys: Increased testicular enlargement followed by a growth spurt later in life

Answer 337

One occurs as a fetus- the HPG axis is active for sexual differentiation One occurs at birth, which is called minipuberty. This may affect development os sexual characteristics later in life Puberty occurs at the start of adolescence Between these stages, the gonadostat is active- a process that shuts off the HPG axis. Brain injury can damage it, causing precocious puberty

Answer 338

In girls, breast development begins normally 9.5-10.5yo | In boys, testicular volume increases drom 11.5y

Answer 339

``` Breast development Pubic hair development Gonadal development First menstrual period Breast development in boys Adrenals make the first sterioids ```

Answer 340

Small pulses of GnRH are needed to release the gonadotriphins Gonadotriphins base levels increase in early puberty, and night pulses begin At mid puberty, the baseline increases further, and higher amplitude night pulses develop In late puberty, day and night pulses are shown.

Answer 341

Give a GnRH agonist as this binds wholly to the GnRH receptors, preventing pulsatile activation

Answer 342

Intrinsic CNS inhibitory mechanism dependent on sex steroids GABA is a potent inhibitor of pulsatile GnRH secretion GABA receptor blockers lead to rises in GnRH. GAD converts GLUT to GABA, and is detectable in childhood In childhood, the negative feedback from any reproductive hormone secretion is very high, so even if any hormones are produced, they will have little impact

Answer 343

Gonadastat is turned off, and GnRH and LH/FSH increases in pulsatile release Kisspeptin is a ligant of GPR54, and activates this receptor. Kisspeptin administration stimulates LH and ovulation Both of these are expressed increasingly at the start of puberty GPR54 regulates GnRH secretion and release from the hypothalamus

Answer 344

Stimulated by FSH Negative feedback to FSH secretion Produced by sertoli cells and granulosa cells

Answer 345

Increased adrenal androgen production of dehydroepiandrosterone sulfate (DHEAS) occurs in late childhood and assoc with beginning of pubic hair in girls- but this is not a sign of puberty Unknown trigger

Answer 346

Increased with fat mass Can facilitate timing of puberty as obese children have an earlier onset of puberty Levels peak just prior to onset of puberty in boys

Answer 347

Same prepuberty After puberty, males have 1.5x the lean and skeletal mass of females Females have twice the fat mass of males Male fat is truncal, while females' is generalised. Bone mass increases in puberty, with peak in the early 20s

Answer 348

Modern life means we live to an age where we run out of follicles Protects aging women from hazards of childbirth Protects human gene pool against age related increase in chromosomal abnormalities Presence of mother/grandmother not in reproductive years provides extended maternal care of offspring

Answer 349

Occurs between 50-52 years Defined by the state of the uterus- the last menstrual bleed is the menopause Caused by atresia and ovulation of the follicular reserve Early menopause comes between 40-45 Ovarian failure occurs under 40

Answer 350

While the quality of follicles declines, the quality of the folicles also decreases

Answer 351

Malnourishment leads to earlier menopause Smoking starts menopause 1-2 years early Mothers and daughters have a similar menopausal age

Answer 352

Decline in testosterone in men, causing change in attitudes, fatigue, loss of energy, sex drive and agility

Answer 353

Premanopause Menopausal transition (til menopause from stoping regular bleeds) Menopasue (after last bleed) Perimenopause (from stopping regular bleeds to ovarian senescence (extra .5-1y) Ovarian senescence- after the ovary stops functioning

Answer 354

Longer cycle lengths and less likely to ovulate Older women are more likely to have anovulatory cycles Climacteris- physical and emotional symptoms Erratic hormone fluctuation

Answer 355

Follicle levels fall, and stop making so much inhibin Causes FSH rise, accelerating follicle loss by shortening follicular phase and increasing early follicular estrogen Increased numbers of primordial follicles are recruited Increased chance of twinning Ovulation is always possible and contraception is difficult Later, after menopause, estrogen and androgen levels fall (about 10% of estrogen remains)

Answer 356

No endocrine test, but can be 98% certain when a woman over 45 has had no bleed for at least 12 mos Some non responsive follicles may be left

Answer 357

Ovary ceases to produce estrogen, so estrogen is less than 1/10th of previous levels- estradiol is very low All is from stromal cells of adispose tissue, by aromatisation of androstenedione from adrenals Estrone is the predominant estrogen, but only has 10% of estradiol's function

Answer 358

``` Symptoms of estrogen deprivation, following or preceding the menopausal transition Includes vasomotor (hot flushes), vaginal dryness and reduced vaginal lubrication ```

Answer 359

Can try hormone replacement therapy with estrogen However, benefits of reducing osteopoprosis risk and improving symptoms must be balanced with increased risk of breast or uterine cancer, heart disease, stroke and alzheimers Therefore should be the lowest dose for the shortest time Only appropriate for moderate to severe menopausal symptoms

Answer 360

Exposure to exogenous estrogen- ie. eaten contraceptive pills - Premature thelarche- Partial early maturation of the HPG axis with increased FSH, but no increased LH. Can show this with a GnRH stim test. If both FSH and LH increase it is precocious puberty. Only results in small amount of breast development

Answer 361

Defective enzyme in the cortisol pathway- 21-hydroxyase deficiency. This causes reduced cortisol production, increasing ACTH and adrenal precursors which are androgens Causes glucocorticoid and mineralocorticoid deficiency, as well as virilisation of a female child. Need to measure 17-OH progesterone, do ultrasound for a uterus and tive ACTH and see whether 17OHP increases

Answer 362

``` The external signs of aging Affected by chronological age, attitude to self, how old others see you as, and biological changes (affected by physiology and illness) Risk of dying doubles every 8 years Mortality changes from CVD to infection Genetic factors explain 25% of longevity Reproductive processes shorten longevity ```

Answer 363

Unfair treatment based on a person's age. Has psychological consequences and impacts on life opportunities

Answer 364

Bombaratdment of cellular mechanisms by free radicals. Repair mechanisms are costly, and as cells replicate themselves they also become less and less accurate. Protection mechanisms of the cell fail (disposable soma theory) Gradual buildup of unrepaired faults in cells and tissues makes us vulnerable to acute and chronic illness Can be altered a little with nutrition etc. (low weight, vitamin E, C, curcumin)

Answer 365

Psychological reduction in: - Verbal vs performance skills - Attention - Processing speed - Working memory Physiological reduction in: - Muscle strength (increased stiffness) - Cardiac output - Lung volume - Renal function Acute illness sharpens this decline, while aerobic exercise flattens the curve

Answer 366

Psychological- Cognitive decline and dementia Physiological - Frailty, disability, arthritis - Congestive heart failure - COPD - Renal failure Increased risk from - Medications - Minor illnesses - Immobility

Answer 367

5-20% of over 80s have dementia. Greater incidence in non europeans High financial cost Low income contries have higher incidence as well as a more rapidly growing older poulation Causes a more significant decline in cognitive function

Answer 368

Education Midlife hearing loss, hypertension, obesity Smoking, depression, reduced physical activity, social isolation, diabetes Traumatic brain injury

Answer 369

Dating the pregnancy itself is from the last menstrual period, with conception happening approx 2 weeks later For imaging purposes, we use the age from implantation, which occurs in week 3 of pregnancy- 6 week fetuses are therefore actually 9 weeks 'pregnant'

Answer 370

First thing is the gestation sac- a black bubble transvaginally, usually off to one side Then can see the ring of trophoblasts setting up the blood and hormone supply Can see a yolk sac begin to form Embryo develops very quickly between 5 and 9 weeks, doubling in size between 5 and 6 weeks

Answer 371

Threatened abortion is bleeding and cramping in the first 20 weeks of pregnancy. However, in up to 30% of women, it can be due to subchorionic bleeds, where the trophoblasts leak, causing a blood bubble. This isn't concerning unless it is under the embryo, as it can prevent the embryo from getting enough blood

Answer 372

Abnormal gestation sac, with lack of yolk sac, lack of double decidual reaction or lack of an embryo Lack of cardiac activity by 7mm length Low implantation, irregularly shaped trophoblasts, very small gestational sac Large yolk sac

Answer 373

The baby has died. Also called missed abortion. Can see the embryo, but lacks a heart beat.

Answer 374

90% occur in the fallopian tubes, but can also appear in the ovary, pelvis or bowel. Can show fluid buildup in the pouch of douglas Present with collapse, very low blood pressure, bleeding into flank (if ruptures)

Answer 375

Fluid may be in the pouch of douglas due to menstruation or ovulation Some pain in the flank due to the size of the corpus luteum

Answer 376

Caused by gestational trophoblastic disease. Occurs when trophoblasts become malignant, proliferating and forming a tumour in the placental site. Causes extreme morning sickness, and very high bHCG levels.

Answer 377

Early on to establish estimated delivery date At twelve weeks to see nuchal translucency Anatomy scan at 20 weeks- depending on high or low risk population, have a 1-34% chance of seeing an abnormality - Growth scan at the 3rd trimester

Answer 378

Most accurate in the first trimester- +/- 5 days | This increases to +/- 10 days in second trimester, or 3 weeks in third

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