Repro Flashcards
0
Q
What are the internal and external genitalia in females?
A
Internal - ovaries, uterine tubes, uterus, vagina
External - labia majora, labia minora, clitoris
1
Q
What are the internal and external genitalia in males?
A
Internal - testis, epididymis, ductus deferens, seminal glands, ejaculatory duct, prostate, bulbourethral glands
External - glans penis, shaft of penis, scrotum
2
Q
What are the male secondary characteristics?
A
Increase in body size (compared to females) Body composition Fat distribution Hair/skin changes Facial hair and baldness Smell
3
Q
What are the secondary sexual characteristics in females?
A
Less increase in body size compared to makes
Fat distribution
Hair/skin changes
Breasts
4
Q
What are the gonads embryonic origins?
A
Intermediate mesoderm
Primordial germ cells from the yolk sac
5
Q
What gene drives the development of testis?
A
SRY gene in Y chromosome
6
Q
What are alternative names for mesonephric and para mesonephric ducts?
A
Wolffian duct
Müllerian duct
7
Q
Explain how having XY chromosomes leads to the ducts preservation/regression
A
Testes secretes androgen which keeps mesonephric and Müllerian inhibiting substance which degenerates the paramesonephric
8
Q
Explain how having XX chromosomes leads to duct preservation/regression
A
No androgen so mesonephric duct regresses and no Müllerian inhibiting substance so the Müllerian duct is maintained
9
Q
What are the 3 components of the embryonic external genital? What happens to the in males and females?
A
Genital tubercle, folds and swelling
Tubercle and folds fuse in males due to androgens but remain open in females
10
Q
Explain the development of oocytes before puberty
A
Germ cells become oogonia which proliferate and then enter meiosis. They become a primary oocyte which is surrounded by a single layer of granulosa cells and thus becoming a primordial follicle
11
Q
What are the 3 stages in ovulation
A
0-12 days: preparation, follicular, proliferative phase
12-14 days: ovulation
14-28 days: waiting, luteal, secretory phase
12
Q
What happens to the primordial follicle during menstruation?
A
Primordial follicle–>pre antral follicle–>secondary follicle–>pre ovulatory follicle–>corpus luteum–>death
13
Q
What is the path sperm travels through?
A
Seminiferous tubules–>rete testis–>ducti efferentes–>epididymus–>vas deferens
14
Q
Explain spermatogenesis
A
Germ cells–>spermatogonia (2n)–>two primary spermatocytes (2n) via mitosis. One acts as raw material and one progresses to become–>two secondary spermatocyte (n) via meiosis–>four spermatids (n) via meiosis–>spermatozoa via spermatogenesis (remodelling)
15
Q
What makes up semen?
A
Sperm
Seminal vesicle secretion
Prostate secretion
Bulbourethral gland secretion
16
Q
What are the feedback effects of: testosterone, oestrogen, progesterone and inhibin?
A
Testosterone - reduces GnRH, LH, FSH Low oestrogen - reduce GnRH, LH, FSH High oestrogen - increase LH, FSH and GnRH Progesterone - reduce GnRH, LH, FSH Inhibin - reduce FSH
17
Q
Outline the hypothalamic pituitary gonadal axis
A
Hypothalamus releases GnRH which stimulates the pituitary to release LH (bind to leydig cells to release testosterone) and FSH (binds to Sertoli cells to release inhibin). Inhibin reduces FSH and testosterone negatively feedbacks to reduce FSH, LH and GnRH
18
Q
What are some functions of oestrogen and progesterone?
A
Oestrogen - Fallopian tube function, thicken endometrium, thicken myometrium and increase its motility
Progesterone - thicken endometrium, thicken myometrium but reduce its motility
19
Q
If there’s a successful pregnancy what maintains the corpus luteum?
A
Placenta releases HCG
20
Q
What changes occur in girls during puberty and what is the usual age range?
A
Breast bud (thelarche) Pubic hair (adrenarche) Growth spurt Menstrual cycle (menarche) 8-13
21
Q
What changes occur in boys during puberty and at what age?
A
Genital development Pubic hair Spermatogenesis Growth spurt 9-14
22
Q
Why are men usually taller than women?
A
Their growth spurt is longer and faster. It ends when the epiphyseal plates fuse which happens earlier in girls due to oestrogen
23
Q
What is the hormonal control for the following: adrenarche, thelarche, growth spurt and genital development.
A
Androgens
Oestrogen
GH and steroids
Testosterone
24
What is precocious puberty and some possible causes?
Puberty under 8 y/o
| Pineal tumour, meningitis, hormone secreting tumours
25
Explain what occurs in pre-menopause
40 years
| Shorter follicular phase causing lower oestrogen and higher LH and FSH. Fertility reduced
26
Explain menopause
Cessation of menstrual cycles 49-50
| Lower oestrogen and higher LH and FSH
27
What changes may accompany menopause?
Hot flushes, regress/shrink endometrium/myometrium, thin cervix, lose vaginal rugae, involuted breast tissue, skin/bladder changes and reduced bone mass
28
Define amenorrhea
Absence of periods for 6+ months
29
Differ between primary and secondary amenorrhea
Primary - never had a period (by age 14 with no secondary sexual characteristics or 16 with them)
Secondary - established menstruation ceased for 3 months if regular or 6 if irregular
30
Define oligomenorrhoea, dysmenorrhea, menorrhagia and cryptomenorrhea
Infrequent
Painful
Heavy
Not visible due to obstruction
31
Differ between a ovulatory and ovulatory cycles
Anovulatory - no luteal phase, oligomenorrhoea and potentially heavy
Ovulatory - normal cycles with dysmenorrhea and mastalgia
32
Explain how hypothalamic/pituitary problems cause amenorrhe and give examples of primary and secondary types
Less FSH, less oestrogen so less lining
Kallmann syndrome
Exercise, stress, weight
Hypopituitarism
33
Explain how gonadal problems cause amenorrhea and give examples of primary and secondary types
Primary - dysgenesis and androgen insensitivity
| Secondary - pregnancy, menopause, drug induced
34
What might cause outflow amenorrhea?
Müllerian agenesis
Vaginal atresia
Intra uterine adhesions
35
Explain dysfunctional uterine bleeding
No corpus luteum so no progesterone so oestrogen levels are higher and therefore the uterine lining is thicker
36
What is the difference between an STI and STD?
STI can be asymptomatic
37
Who is at risk of STIs?
Young people
Certain ethnicities
Low socio economic status
Behaviour - first intercourse, partners, orientation, unsafe
38
Why is incidence of STIs increasing?
Changing sexual/social behaviour
Better screening and diagnosis
Greater awareness
39
What is the burden of STIs?
Stigma, lead to PID, infertility, cancer, disseminate, transfer to foetus
40
In general how should STIs be managed?
Short course of antibiotics
Screen and treat for co infections
Contact tracing
Educate
41
Explain HPV and how it's diagnosed/managed
Cutaneous, mucosal, painless anogenital warts
Increase risk of cervical cancer
Don't treat unless prolonged (cyrotherapy/interferon)
Vaccine
42
What are the symptoms of chlamydia in a male and female?
Urethritis, epididymitis, prostatis, proctitis
Urethritis, cervicitis, salpingitis, peri hepatitis
Can affect eyes and neonates
43
How so chlamydia treated?
Doxycycline/azithromycin
44
What are the symptoms of herpes? How is it treated?
Painful genital ulceration, dysuria, inguinal lymphadenopathy, pyrexia
Aciclovir
45
How is gonorrhoea treated?
Ceftriaxone + testing and treatment for chlamydia (azithromycin)
46
What are the stages of syphilis?
1 - painless ulcer
2 - fever, rash, lesions, lymphadenopathy
Latent
3 - neuro/cardiovascular syphilis
47
Who is syphilis more common in, how is it diagnosed and how is it treated?
MSM
Serology/dark field microscopy
Penicillin
48
What symptoms does trichomonas vaginalis cause? How is it treated?
Thin, frothy, offensive discharge, irritation, dysuria, inflammation
Metronidazole
49
What is the cause of bacterial vaginosis? How is it diagnosed and treated?
Perturbed flora - gardnerella
Scanty, fishy discharge
pH>5, KOH whiff test, gram stain
Metronidazole
50
What is pelvic inflammatory disease?
Infection ascending from endocervix to uterus causing - endometritis, salpingitis, oophoritis, tubo-ovarian abscess
51
What are the features of PID?
Pyrexia, pain, discharge and bleeding
52
How is PID diagnosed and managed?
Triple swab - endocervix and high vagina
Analgesia
Antibiotics - ceftriaxone, doxycycline, metronidazole
53
What else could PID be mistaken for?
Ectopic pregnancy, endometriosis, ovarian cyst, irritable bowel syndrome, appendicitis and UTI
54
What is the blood supply to the ovaries and where do they come from/drain into?
Abdominal aorta-->ovarian artery
Right ovarian vein-->IVC
Left ovarian vein-->Left renal vein
55
What are the parts of the uterus?
Fundus
Body
Cervix
Uterine tubes
56
What are the uterus' anterior and posterior pouches?
Anterior - uterovesical pouch
| Posterior - recto uterine pouch (pouch of Douglas)
57
What are the main ligaments that support internal female genitalia?
Broad ligament - sheet if peritoneum supporting ovaries and uterus
Suspensory ligament of ovary
Round ligament - remnant of gubernaculum
58
How is the uterus normally positioned in regards to the vagina and cervix?
Vagina - anteVerted
| Cervix - antefleXed
59
What are the main parts of the uterine tube?
Ostium, fimbriae, infundibulum, ampulla, isthmus
60
What are the main parts of the cervix?
Internal os
Endocervical canal
External os
61
What artery does the uterine and internal pudendal artery come off of?
Anterior division of internal iliac
62
Where does the ovary and uterus lymph drain to?
```
Ovary - para aortic nodes
Uterus:
Fundus - aortic nodes
Body - external iliac nodes
Cervix - external, internal iliac and sacral nodes
```
63
What is the nerve supply to the vagina?
Inferior 1/5 - pudendal
| Superior 4/5 - uterovaginal plexus
64
What is contained within the scrotum?
Testis, epididymus and spermatic cord
65
Outline the anatomy of the testis
Tunica vaginalis
Tunica albuginea
Separated into lobules by fibrous septal
66
Outline the blood supply to the testis
Testicular arteries directly from abdominal aorta
Right testicular vein to IVC
Left testicular vein to left renal vein
67
What are the possible causes for scrotal swelling?
Hydrocoele - serous fluid in tunica vaginalis
Haematocoele - blood in tunica vaginalis
Varicocoele - pampiniform vein varicosities
Spermatocoele - cyst
Epididymitis
Testicular tortion
Indirect hernia
68
What are the contents of the spermatic cord?
```
Arteries - testicular, cremasteric, artery to vas
Nerves - genitofemoral, 2x autonomic
Pampiniform plexus
Vas deferens
Lymphatics
```
69
What are the coverings of the spermatic cord?
External spermatic fascia - external oblique
Cremasteric fascia - internal oblique/transversalis
Internal spermatic fascia - transversalis
70
What is the innervation to the scrotum?
Anteriorly - lumbar plexus
| Posteroinferiorly - sacral plexus
71
Where do the lymphatics drain from the testis and the scrotum?
Testis-paraaortic nodes
| Scrotum - superficial Inguinal nodes
72
What does the prostate interact with?
Base - neck of bladder
Anterior/apex - urethral sphincter
Posterior - rectum
73
What is BPH and what are the symptoms?
Benign prostate hyperplasia - obstruct internal urethral orifice
Dysuria, nocturia and urgency
74
What internal structures are found in the penis?
2x corpora cavernosa
1x corpus spongiosum
Internal pudendal artery
Bulbospongiosum - expel last urine and maintain erection
Ischiocavernosus - compress veins maintaining erection
75
What are the four parts of the male urethra?
Preprostatic
Prostatic
Membranous
Spongy
76
What are the functions of the pelvic floor?
Support pelvic organs
Continence
Child birth
Truncal stability
77
How can the pelvic floor be damaged and what may this cause?
Childbirth, age, menopause, obesity, chronic cough
Prolapse and incontinence
78
How is incontinence treated and what are some potential side effects?
Pelvic floor exercises
Surgery - vaginal tape
Voiding difficulties
79
How is prolapse treated and what are some potential side effects?
Remove organs, restore connective tissue support, maintain function
Recurrence, incontinence and dysparenunia
80
How long does sperm take to mature and how many are produced a second?
74 days
| 1000
81
What are the phases of coitus?
Excitement, plateau, orgasmic, resolution +- refractory
82
How does a male get an erection?
Stimulants - psychogenic or tactile
Efferents - pelvic nerve PNS, pudendal nerve somatic
Haemodynamic changes
83
What are the causes of erectile dysfunction?
```
Psychological
Tear copra cavernosa
Vascular
Drugs
Alcohol
```
84
What happens during ejaculation?
Contract glands and ducts and internal bladder sphincter
| Rhythmic striatal contractions
85
What is abnormal sperm count?
30% abnormal morphology
86
Explain the contents of seminal vesicle, prostatic and bulbourethral secretions
Alkaline to neutralise acid. Fructose and clotting factors
Acidic and proteolytic
Lubricate
87
How does the cervical mucus differ during the menstrual cycle?
Progesterone and oestrogen - sticky plug at cervix
| Oestrogen only - non viscous
88
When is the fertile period?
3 days prior and up to ovulation
89
How is an oocyte transported? How is polyspermy prevented?
Cilia and peristalsis
Cortical reaction
90
What are the types of contraception?
Natural - abstinence, rhythm, coitus interruptus
Prevent sperm entering ejaculate - vasectomy
Prevent sperm reaching cervix - condom, diaphragm, cap, spermicide
Prevent ovulation + sperm pass cervix-OCP, implant, progesterone only
Prevent Fallopian tube movement - hormones and clip/ligate
Prevent implantation - hormones, post coital and intrauterine device
91
What is primary and secondary infertility?
Never been pregnant
Been pregnant before
92
What are some reasons for infertility?
Anovulation
Tubal occlusion
Abnormal sperm
93
What does haemomonochorial mean?
The fetal and maternal blood is only separated by a single layer of trophoblast
94
What are the aims of implantation?
Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta
95
What are the primary, secondary and tertiary villi?
Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels
96
What is decidualisation?
The endometrium resists the trophoblast invasive force
97
What is the difference between the placenta in the 1st trimester and the term?
Greater surface area, thin barrier with just one layer cytotrophoblast
98
What does the placenta synthesise?
Glycogen, cholesterol and fatty acids
99
What are the endocrine functions of the placenta?
Synthesise hCG, progesterone and oestrogen
100
What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?
Water
Glucose
Amino acids
101
What maternal changes are there in the CVS?
Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR
102
What are the differences between pre-eclampsia and normal pregnancy?
Eclampsia vasoconstrict and plasma contract as opposed to the opposite
103
What changes are there in the urinary system?
Increase GFR, clearance and protein excretion
| Decrease urea, bicarbonate and creatinine
104
What changes are there in the respiratory system?
Decrease functional residual volume and PaCO2
| Increase O2 consumption and tidal volume
105
What does the physiological hyperventilation in pregnancy cause?
Respiratory alkalosis leading then to more bicarbonate being produced
106
What metabolic changes accompany pregnancy?
Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4
107
How does the GI system change in pregnancy?
Move appendix to RUQ
| Delayed emptying and biliary stasis
108
How does the blood change in pregnancy?
Pro-thrombolytic state. Can't give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves' disease
109
What does haemomonochorial mean?
The fetal and maternal blood is only separated by a single layer of trophoblast
110
What are the aims of implantation?
Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta
111
What are the primary, secondary and tertiary villi?
Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels
112
What is decidualisation?
The endometrium resists the trophoblast invasive force
113
What is the difference between the placenta in the 1st trimester and the term?
Greater surface area, thin barrier with just one layer cytotrophoblast
114
What does the placenta synthesise?
Glycogen, cholesterol and fatty acids
115
What are the endocrine functions of the placenta?
Synthesise hCG, progesterone and oestrogen
116
What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?
Water
Glucose
Amino acids
117
What maternal changes are there in the CVS?
Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR
118
What are the differences between pre-eclampsia and normal pregnancy?
Eclampsia vasoconstrict and plasma contract as opposed to the opposite
119
What changes are there in the urinary system?
Increase GFR, clearance and protein excretion
| Decrease urea, bicarbonate and creatinine
120
What changes are there in the respiratory system?
Decrease functional residual volume and PaCO2
| Increase O2 consumption and tidal volume
121
What does the physiological hyperventilation in pregnancy cause?
Respiratory alkalosis leading then to more bicarbonate being produced
122
What metabolic changes accompany pregnancy?
Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4
123
How does the GI system change in pregnancy?
Move appendix to RUQ
| Delayed emptying and biliary stasis
124
How does the blood change in pregnancy?
Pro-thrombolytic state. Can't give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves' disease
