Repro Flashcards

Question

How does progesterone affect the blood vessels in pregnancy?

Answer 1

Relaxes smooth muscle | Decreases TPR

Answer 2

``` aortocaval compression decreases return of blood to heart decreases pre load decreases stroke volume decreases blood pressure ```

Answer 3

increase in renal plasma flow increase in GFR decrease in functional renal reserve as there is limited capacity for compensation

Answer 4

``` the diaphragm is displaced and the AP and transverse diameters of the thorax increase Leading to... decreased functional residual capacity increased tidal volume increased ventilation ```

Answer 5

there is increased CO2 production progesterone increases the respiratory drive by acting at the respiratory centres in the brain this leads to respiratory alkalosis this is compensated by increased renal bicarbonate excretion

Answer 6

Human placental lactogen (as well as prolactin, cortisol and oestrogen/progesterone) increases maternal peripheral insulin resistance. Metabolism switches to gluconeogenesis and alternative fuels Lipolysis increases in T2, leaving glucose for the fetus to use

Answer 7

increase in Thyroid binding globulin production therefore increase in T3/T4 hCG decreases TSH production, so it's levels stay within normal range

Answer 8

smooth muscle relaxes delayed emptying stasis in the biliary tract leading to gall stones and pancreatitis

Answer 9

Pregnancy is a pro-thrombotic state increased fibrinogen and clotting factors reduced fibrinolysis therefore PE etc can occur

Answer 10

there is non-specific suppression of the local immune response at the materno-fetal interface.

Answer 11

Defect in placentation, leading to poor uteroplacental circulation. Systemic endothelial dysfunction leads to vasoconstriction of blood vessels and the plasma contraction.

Answer 12

Progesterone relaxes smooth muscle ureters become obstructed Can cause UTI. Pyelonephritis increases the risk of preterm labour

Answer 13

carbohydrate intolerance first recognised in pregnancy and not persisting after delivery

Answer 14

Macrosomic fetus stillbirth congenital defects

Answer 15

``` new hypertension new proteinuria headache swelling of hands, face and feet liver tenderness visual disturbance fetal distress - reduced movements ```

Answer 16

Haemolysis, Elevated Liver enzymes, Low Platelets

Answer 17

Fatigue dyspnoea dizziness pallor

Answer 18

Superior hypophyseal artery

Answer 19

Prolactin releasing hormone and prolactin inhibiting hormone Hypothalamus

Answer 20

Mammary glands Testes

Answer 21

Inhibin Sertoli cells

Answer 22

Testosterone Leydig cells

Answer 23

Granulosa cells Inhibin

Answer 24

Theca cells Oestrogen and progesterone

Answer 25

Follicular | Luteal

Answer 26

Menses Proliferative Secretory

Answer 27

Follicular phase

Answer 28

``` Fimbria Infundibulum Ampulla Isthmus Intramural part ```

Answer 29

Inner mucosa - folded. Columnar. Some are Ciliated. Peg cells secrete mucus. Muscular layer (x2 in ampulla, x3 in isthmus) Serosa

Answer 30

Stratum functionalis - this is shed. Coiled arteries Stratum basalis. Straight arteries.

Answer 31

Proliferative phase - oestrogen Secretory phase - progesterone Menstrual - drop in progesterone

Answer 32

Spiral arteries in the stratum functionalis spasm It is deprived of nutrients Necrosis

Answer 33

Internal os | External os

Answer 34

Simple columnar epithelium Changes to non-keratinised stratified squamous on the inner aspect of the external os Mucus secreting glands

Answer 35

Non-keratinised stratified squamous

Answer 36

Causes them to accumulate glycogen This is a substrate for lactobacillus Leads to acidic pH

Answer 37

It has no glands of its own | The cervical glands and vestibular glands secrete mucus

Answer 38

alkaline fluid fructose prostaglandins clotting factors - fibroinogen, holds sperm in place after ejaculation

Answer 39

milky slightly acidic fluid proteolytic enzymes - breakdown clotting factors, causing liquefaction of sperm citric acid phosphotase

Answer 40

alkaline fluid | mucous - lubricates the end of the penis and urethral lining

Answer 41

excitement plateau orgasm resolution

Answer 42

limbic system activated sacral parasympathetic neurons are activated thoracolumbar sympathetic neurons are inhibited ACh to M3 leads to increased [Ca2+]. NO synthase activated NO leads to vasodilation in the corpora cavernosa penis fills (latency) and undergoes tumescence (erection)

Answer 43

activation of sacrospinous reflex contraction of ischiocavernosus so crus of penis is compressed. venous return impeded. venous engorgement accessory glands stimulated to secrete fluid and lubricate distal urethra and neutralise acidic urine

Answer 44

Emission thoracolumbar spinous reflex activated smooth muscle of vas deferens, ampulla, seminal vesicle and prostate contract internal and external urethral sphincters contract semen pools in urethral bulb Ejaculation under cortical control sympathetic nervous system (L1-2) activated contraction of smooth muscle of glands, ducts and urethral sphincter filling of urethra stimulates the pudendal nerve genital organs, ischiocavernosus and bulbocavernosus muscles contract semen is expelled

Answer 45

thoracolumbar sympthtic pathway activated arteriolar smooth muscle in corpora cavernosa contracts causes increased venous return detumescence refractory period

Answer 46

limbic system activated sacral parasympathetic neurons are activated thoracolumbar sympathetic neurons are inhibited ACh to M3 leads to increased [Ca2+]. NO synthase activated NO leads to vasodilation in the clitoris vaginal lubrication begins uterus elevates increase in muscle tone, heart rate and blood pressure

Answer 47

further increase in muscle tone, heart rate and blood pressure labia minora deepen in colour clitoris withdraws under its hood bartholin glands secrete fluid to lubricate the vestibule formation of orgasmic platform in lower 1/3rd of vagina full elevation of uterus

Answer 48

the orgasmic platform contracts rhythmically 3-15 times uterus and anal sphincter contract no refractory period, so multiple orgasms are possible

Answer 49

clitoris descends and engorgement subsides labia return to unaroused size uterus descends vagina shortens and narrows

Answer 50

* Psychological (descending inhibition of spinal reflexes) * Tears in fibrous tissue of corpora cavernosa * Vascular: atherosclerosis, diabetes * Drugs: Alcohol, anti-hypertensives (β-blockers, diuretics)

Answer 51

inhibits cGMP breakdown | more NO

Answer 52

abundant mucus clear non-viscous

Answer 53

thick, sticky mucus plug

Answer 54

reduced desire reduced vasocongestion response, causing reduced vaginal lubrication vaginal and urethral tissues lose their elasticity and the length and width of the vagina decrease and hence there is reduced expansible ability of inner vagina during arousal. The number of orgasmic contractions is often reduced and a more rapid resolution occurs.

Answer 55

clotting factors lead to coagulation of semen - prevents sperm falling out of vagina reliquefaction of sperm occurs 20 minutes later most sperm leak out of the vagina transport into the uterus is by their own propulsive capacity the ciliated cells in the uterine tract help oxytocin stimulates uterine contraction

Answer 56

maturation of sperm in the female reproductive tract | removal of the glycoprotein coat - allows fusion with the oocyte cell surface

Answer 57

sperm binding to the ZP3 of the zona pellucida triggers the acrosome reaction exocytosis of the contents of the acrosome

Answer 58

influx of calcium | rise in cAMP

Answer 59

smooth surface directly overlying the metaphase chromosome Microvilli cover the rest. Sperm bind and fuse here.

Answer 60

male and female pronuclei unite to form one diploid gamete

Answer 61

wave of depolarisation starting at site of entry of sperm into the oocyte prevents polyspermy

Answer 62

embryo contains three or more pronuclei

Answer 63

maximum of 7 days

Answer 64

vas deferens is divided bilaterally

Answer 65

creates thick cervical mucus plug, preventing sperm from entering uterus thins uterus lining making implantation less likely negative feedback at the hypothalamus decreases GnRH, so follicular development is inhibited

Answer 66

negative feedback at hypothalamus and anterior pituitary inhibits follicular development loss of positive feedback mid-cycle, so no LH surge

Answer 67

copper interferes with endometrial enzymes | interferes with implantation

Answer 68

high dose of oestrogen and progesterone/progesterone only up to 72 hours after coitus disrupts ovulation blocks implantation impairs luteal function

Answer 69

failure to conceive within one year

Answer 70

``` primary = no previous pregnancy secondary = previous pregnancy, successful or not ```

Answer 71

abnormal sperm production duct obstruction hypothalamic/pituitary dysfunction

Answer 72

Increased gonadotrophin-releasing hormone (GnRH) pulsatility or high levels of insulin caused by insulin resistance. leads to excess LH produced by the anterior pituitary ovaries are stimulated to produce excessive amounts of male hormones, particularly testosterone.

Answer 73

``` Oligomenorrhoea (defined as light or infrequent menstrual periods) Infertility or subfertility Acne Hirsutism - excessive hair growth Alopecia Obesity or difficulty losing weight Psychological symptoms - mood swings, depression, anxiety, poor self-esteem Sleep apnoea ```

Answer 74

transition from the pregnant state to the non-pregnant state

Answer 75

Before 24 weeks = spontaneous abortion Before 36 weeks = pre-term Between 37 and 42 weeks = term After 42 weeks = post-term.

Answer 76

creation of the birth canal full cervical dilation regular uterine contractions

Answer 77

expulsion of the fetus rapid bear down and push presenting part of the fetus appears in the birth canal

Answer 78

head = crowning buttocks, shoulder or knee = breech foot = footling breech

Answer 79

``` head flexes as it reaches pelvic floor (reducing presentation diameter) head internally rotates head stretches the vagina and perineum head delivers shoulders rotate and deliver rest of baby follows! ```

Answer 80

effect of uterine contractions increased as the fetus has been expelled contraction of the uterus and expulsion of the placenta

Answer 81

uterus contracts down hard blood vessels compressed, closing them off oxytocic drug

Answer 82

bony pelvis | surrounding ligaments - soften to increase size

Answer 83

the softening of the cervix

Answer 84

cervix is made of tough, thick, coiled collagen The actions of Prostaglandins PG E2 and F2x cause: • Reduction in collagen production (Turnover altered) • Increase in glycosaminoglycans (Disrupts the matrix) • Increase in hyaluronic acid (draws water in) • Reduces aggregation of collagen fibres (Uncoils)

Answer 85

the thinning and flattening of the cervix

Answer 86

contractions of the uterus

Answer 87

practice contractions | irregular in intensity and timing

Answer 88

progesterone supresses the contractions

Answer 89

prostaglandins | oxytocin

Answer 90

increase the [Ca2+] per action potential

Answer 91

lowers the threshold, increasing the frequency of contractions

Answer 92

the oestrogen : progesterone ratio If Progesterone > Oestrogen (as in most of pregnancy), there will be low levels of prostaglandins If Oestrogen > Progesterone (as at the end of pregnancy) Leads to increased Prostaglandin levels This means that the cervix is ripened and uterine contractions are promoted

Answer 93

endometrium

Answer 94

posterior pituitary

Answer 95

Ferguson Reflex prostaglandins cause contraction of the myometrium positive feedback to hypothalamus more oxytocin released from the posterior pituitary stimulates increased contractions and more prostaglandin release

Answer 96

uterine muscle relaxes less than it contracts fibres shorten in the body of the uterus forces the presenting part of the fetus into the cervix

Answer 97

the more the cervix stretches, the more oxytocin is released | the more the uterus contracts!

Answer 98

trauma cold light noise

Answer 99

the clamping of the umbilical cord

Answer 100

fetus takes first breath, decreases tissue resistance in the lungs as they expand decreases vascular resistance in lungs blood flows into lungs drop in P on right side of heart higher P in left atrium forces foramen ovale to close

Answer 101

decrease in P in right atrium results in reversal of flow through ductus arteriosus (aorta to pulmonary) increased pO2 causes muscle wall to contract

Answer 102

longitudinal cephalic well flexed vertex presents to pelvic inlet

Answer 103

``` inadequate power inadequate passage - abnormal bony pelvis - rigid perineum abnormalities of the passenger - too big - breech ```

Answer 104

prostaglandins | oxytocic drugs

Answer 105

suprapubic incision linea alba and rectus sheaths resected superiorly incision through uterus removal of baby

Answer 106

loss of blood estimated to be >500 ml, from the genital tract, within 24 hours of delivery

Answer 107

embryonic kidney | gonad

Answer 108

intermediate mesoderm | primordial germ cells

Answer 109

yolk sac wall | migrate to retroperitoneum along the dorsal mesentery

Answer 110

testes | ovaries

Answer 111

Wolffian duct

Answer 112

Mullerian duct

Answer 113

the urorectal septum divides the hindgut

Answer 114

on the epithelium of the urogenital ridge as invaginations of epithelium open into the abdominal cavity and make contact with cloaca

Answer 115

no androgen secretion

Answer 116

the paramesonephric duct to degenerate

Answer 117

dihydrotestosterone

Answer 118

uterine tubes, uterus and upper portion of vagina

Answer 119

testes begin in peritoneum testes descend close to processus vaginalis, pulled by the gubernaculum end in scrotum with tunica vaginalis surrounding

Answer 120

gubernaculum attaches inferiorly to labio-scotal folds ovary descends into pelvis round ligament of the uterus lies in the inguinal canal

Answer 121

identical! genital tubercle anteriorly urogenital sinus with surrounding genital folds and genital swelling

Answer 122

androgens genital tubercle elongates genital folds fuse to form spongy urethra

Answer 123

there is no fusion of the genital folds | urethra opens into vestibule

Answer 124

lack of fusion of the paramesonephric ducts

Answer 125

incomplete fusion of urthral folds on inferior surface of penis abnormal openings into the urethra

Answer 126

insufficient androgen stimulation | primary hypogonadism or hypothalamic/pituitary dysfunction

Answer 127

``` 21-hydroxylase deficiency cortisol cannot be made low cortisol means high ACTH constant stimulation leads to hyperplasia of adenal gland high amount of androgens male-like features in females ```

Answer 128

``` XY genotype with testes lack of androgen receptors tissues fail to respond to androgens male genitalia are not stimulated to develop sexual ambiguity ```

Answer 129

seminiferous tubules

Answer 130

``` seminiferous tubules straight tubule rete testis efferent ductule epididymis ```

Answer 131

head - most proximal body tail

Answer 132

tunica vaginalis - peritoneum | tunica albuginea - fibrous

Answer 133

peritoneum

Answer 134

anterior surface | sides

Answer 135

between the tunica albuginea and the seminiferous tubules

Answer 136

between seminiferous tubules Leydig cells - secrete testosterone

Answer 137

Lateral - spermatogonia spermatocytes medial - spermatids

Answer 138

in the seminiferous tubule epithelium extend from basement membrane to lumen connected by tight junctions - creating the blood testis barrier

Answer 139

support of the germ cells provide nutrients phagocytose excess spermatid cytoplasm

Answer 140

mitosis of spermatogonia to form primary spermatocyte meiosis of primary spermatocytes to form 4 spermatids seminiferous tubules

Answer 141

spermatids develop into spermatozoa rete testis, efferent ducts, completed in epididymis

Answer 142

peristaltic contractions | sertoli cell secretions

Answer 143

time taken for the reappearance of the same stage of spermatogenesis within the same segment of the tubule 16 days

Answer 144

distance between the same stage of spermatogenesis within the tubule

Answer 145

fluid reabsorption | sperm concentration

Answer 146

head stores sperm until it is ready to undergo maturation

Answer 147

transports mature sperm to the ejaculatory duct

Answer 148

union of the vas deferens and the duct of seminal vesicle

Answer 149

columnar ciliated cells - for movement of sperm | cuboidal non-ciliated cells - for absorption

Answer 150

pseudostratified columnar with stereocilia | smooth muscle on outside layer

Answer 151

folded pseudostratified columnar epithelium lamina propria three layers of smooth muscle - longitudinal, circular, longitudinal

Answer 152

highly folded pseudostratified columnar | glandular elements surrounded by muscular coat - sympathetic stimulation

Answer 153

``` mucosal glands - inner submucosal glands main glands - outer all drain separately into the urethra fibromuscular capsule separates into lobules epithelium is heterogenous ```

Answer 154

prostatic concretions | lamellated bodies - proteins, nucleic acids, cholesterol and calcium phosphate

Answer 155

oestrogens accumulation of adipose tissue lactiferous ducts enlarge

Answer 156

lined by cuboidal to columnar epithelium changes to stratified squamous at level of the lactiferous sinuses ducts surrounded by myoepithelial cells

Answer 157

oestrogen peak induces duct proliferation enlargement oedema tenderness

Answer 158

during pregnancy

Answer 159

oestrogen results in hypertrophy of the ductular-lobular-alveolar system progesterone influences alveolar cells differentiation from squamous to columnar cells in order to be capable of milk production from mid gestation

Answer 160

extends from lateral border of sternum to the mid-axillary line overlies the second to sixth ribs. within the skin overlying the muscles of the anterior thoracic wall. nipple overlies the fifth intercostal space circular body and axillary tail

Answer 161

suspensory ligaments = fibrous connective tissue septa extend from skin to deep fascia

Answer 162

underlying areolar glands

Answer 163

between the breast and fascia overlying the chest wall muscles

Answer 164

internal thoracic artery, intercostal artery and from the lateral thoracic and thoracoacromial arteries. axillary vein, the posterior intercostal veins and the internal thoracic vein

Answer 165

lateral quadrants of the breast drain to the axillary lymph nodes. The medial quadrants drain to the parasternal nodes or the opposite breast

Answer 166

lobulated masses of tissue | made up of lobules of alveoli, blood vessels and Lactiferous ducts

Answer 167

alveolar cells of the mammary glands Fats - SER Protein - Golgi Apparatus Sugar - Synthesised and secreted

Answer 168

* Mammogenesis = preparation of the breast * Lactogenesis = synthesis and secretion from the breast alveoli * Galactogenesis = ejection of milk * Galactopoiesis = maintenance of lactation

Answer 169

milk produced in the first week after birth

Answer 170

contains less: water soluble vitamins fat sugar much more: protein fat soluble vitamins immunoglobulins

Answer 171

``` Water – 90% Lactose – 7% (Galactose and Glucose disaccharide) Fat – 2% Proteins found in mature milk: • Lactoglobulin (maternal IgG) • Lactalbumin Minerals Vitamins ```

Answer 172

birth -> progesterone and oestrogen levels fall | breast becomes more responsive to prolactin

Answer 173

release from anterior pituitary under control of hypothalamus suckling of the breast -> release of prolactin stimulating hormone from hypothalamus = stimulation dopamine = inhibition

Answer 174

polypeptide

Answer 175

anterior pituitary

Answer 176

suckling -> oxytocin released from posterior pituitary

Answer 177

causes the myoepithelial cells surrounding the alveoli to contract

Answer 178

regular suckling, to promote prolactin secretion to produce milk and oxytocin secretion to remove milk

Answer 179

milk secretion | milk production for next feed

Answer 180

no suckling lower prolactin levels turgor-induced damage of breast

Answer 181

Terminal duct lobular units (TDLUs) decrease in number and size Interlobular stroma replaced by adipose tissue

Answer 182

6th decade

Answer 183

>50 years rare before 25

Answer 184

Clinical - History, family history, examination Radiographic Imaging - Mammogram and ultrasound scan Pathology - Fine needle aspiration cytology (FNAC) and core biopsy

Answer 185

usually Staph aureus entering nipple cracks during lactation

Answer 186

Erythematous painful swollen breast | fever

Answer 187

expressing milk | antibiotics

Answer 188

breast abscess

Answer 189

dilation and inflammation of lactiferous duct | can mimic carcinoma clinically

Answer 190

50's and 60's

Answer 191

mass skin changes ill-defined and irregular, spiculated mass-like area on mammogram

Answer 192

Enlargement of the male breast | Seen at puberty and in the elderly

Answer 193

relative androgen decrease and increase in oestrogen Can indicate hormonal abnormality, cirrhosis of the liver (oestrogen not metabolised effectively) or functioning testicular tumour Can occur with drugs – Alcohol, marijuana, heroin, anabolic steroids

Answer 194

Benign Epithelial Lesion presents as a mass or mammographic abnormality Mass often disappears after fine needle aspiration (FNA) Can mimic carcinoma clinically and mammographically

Answer 195

Cyst formation, fibrosis apocrine metaplasia

Answer 196

Intraduct lesion | multiple branching fibrovascular cores covered by myoepithelial and epithelial cells

Answer 197

a mass, usually mobile | mammographic abnormality

Answer 198

Well defined boundaries rubbery greyish/white

Answer 199

a stromal tumour | mixture of stromal and epithelial elements

Answer 200

stromal breast tumour

Answer 201

Nodules of proliferating stroma covered by epithelium (phullon = leaf). Stroma is more cellular and atypical than in fibroadenomas.

Answer 202

breast cancer

Answer 203

excised with a wide margin to prevent recurrence

Answer 204

Female gender Long interval between menarche and menopause Number of children Age at first full term pregnancy (greater age = more risk) Not breast feeding No interruption of oestrogen levels Obesity and high fat diet Exogenous oestrogens – HRT slightly increases risk, OCP does not appear to affect risk Radiation Genetics

Answer 205

BRCA1 or BRCA2 tumour suppressor genes - 3% of all breast cancers and 25% of familial cancers attributed to mutations in these. Lifetime risk for female carriers is 60 – 85% Median age at diagnosis ~20 years earlier than sporadic cases

Answer 206

prolonged oestrogen exposure

Answer 207

adenocarcinomas

Answer 208

Neoplastic population of cells limited to ducts and lobules by basement membrane Myoepithelial cells are preserved Does not invade into vessels and therefore cannot metastasise

Answer 209

in situ carcinoma of the breasr extends to the skin of the nipple without crossing the basement membrane

Answer 210

``` Itching. Erythema. Scale formation. Erosions. Nipple discharge including bleeding ```

Answer 211

as mammographic calcifications - Clusters or linear and branching mass

Answer 212

central necrosis with calcification

Answer 213

Carcinoma invaded beyond the basement membrane into the stroma Can invade vessels and therefore can metastasise to lymph nodes and other sites

Answer 214

mass mammographic abnormality peau d'orange - impaired lymphatic drainage

Answer 215

Lungs bones liver brain

Answer 216

Infiltrating cells in a single file | cells lack cohesion

Answer 217

``` peritoneum retroperitoneum leptomeninges gastrointestinal tract ovaries uterus ```

Answer 218

Intraoperative lymphatic mapping with dye/radioactivity to find the first draining lymph node - most likely to contain breast cancer metastases If sentinel node is negative, axillary dissection can be avoided

Answer 219

nonsteroidal agent that binds to oestrogen receptors (ER), inducing a conformational change in the receptor. results in blockage or change in the expression of oestrogen dependent genes prevents stimulation of growth of tumour

Answer 220

used in Her2 (human epidermal growth factor receptor) positive cancers monoclonal antibody binding to HER2 receptors inhibits proliferation of cells flags cells for destruction by immune system

Answer 221

``` Early detection - Awareness of disease, importance of family history, self-examination, mammographic screening Neo-adjuvant chemotherapy - Early treatment of metastatic disease Gene expression profiles Prevention in familial cases - Genetic screening - Prophylactic mastectomies ```

Answer 222

Herpes simplex virus types 1 and 2

Answer 223

Chlamydia trachomatis

Answer 224

Neisseria gonorrhoeae

Answer 225

Treponema pallidum

Answer 226

Trichomonas vaginalis

Answer 227

gram -ve intracellular cocci

Answer 228

columnar | transitional

Answer 229

Women: PID ectopic pregnancy tubal infertility Men: epididymitis epididymo-orchitis

Answer 230

Offers testing to all previously or currently sexually active patients (male and female) aged 25 years or under opportunistically Testing should be repeated annually or after a change in sexual partner. Testing for men = first-void urine sample and, for women = a self-taken vaginal swab or urine sample

Answer 231

ASYMPTOMATIC in 50% urethritis with dysuria and urethral discharge epididymo-orchitis presenting as unilateral testicular pain ± swelling. Fever Epididymal tenderness. Perineal fullness due to prostatitis

Answer 232

ASYMPTOMATIC in 80% Mucopurulent endocervical discharge. Dysuria (always consider chlamydia as a cause of sterile pyuria). Vague lower abdominal pain and abdominal tenderness. Fever. Intermenstrual or postcoital bleeding. Dyspareunia = painful sexual intercourse A friable, inflamed cervix, sometimes with a follicular or 'cobblestone' appearance, with contact bleeding. Pelvic adnexal tenderness on bimanual palpation.

Answer 233

* Reactive arthritis, common in young adults. Reiter's syndrome is a * Upper abdominal pain due to perihepatitis (Fitz-Hugh and Curtis syndrome) is a presenting feature. * Proctitis with mucopurulent discharge which may be due to rectal chlamydia following anal intercourse. * Pharyngeal infection (although this is uncommon and usually asymptomatic with chlamydia).

Answer 234

triad of urethritis, arthritis and conjunctivitis that can be triggered by chlamydial infection (amongst other pathogens), usually in conjunction with HLA-B27.

Answer 235

doxycycline | azithromycin - single dose

Answer 236

gram -ve intracellular diplococcus

Answer 237

* urethral infection - Mucopurulent or purulent discharge and/or dysuria * Rectal infection - usually asymptomatic; may cause anal discharge or perianal/anal pain, pruritus or bleeding * Pharyngeal infection - usually asymptomatic * Epididymal tenderness/swelling or balanitis (rare)

Answer 238

* Endocervical infection - frequently asymptomatic, increased or altered mucopurulent vaginal discharge is the most common symptom, although lower abdominal pain may also be present. Rare cause of intermenstrual bleeding or menorrhagia. * Urethral infection - cause of dysuria without frequency. * Rectal infection (in women, may develop by spread of infected genital secretions or anal intercourse) - usually asymptomatic. * Pharyngeal infection - usually asymptomatic * Easily induced contact bleeding of the endocervix. * Normal examination (very common).

Answer 239

ceftriaxone - IM also azithromycin for chlamydia

Answer 240

encapsulated double stranded DNA

Answer 241

oral - cold sores | genital herpes

Answer 242

anogenital infection

Answer 243

May be asymptomatic! o Febrile flu-like symptoms for 5-7 days. Myalgia and fever are the main systemic symptoms. o Tingling neuropathic pain in the genital area/buttocks/legs. o Extensive painful crops of blisters/ulcers in the genital area (including the vagina and cervix in women and the urethra in men). o Lesions are usually bilateral in primary disease (usually unilateral in recurrent cases). o Tender lymph nodes (inguinal). Usually bilateral in primary disease. o Local oedema. o Dysuria. o Vaginal or urethral discharge.

Answer 244

Following primary infection, the virus becomes latent in local sensory ganglia near to the skin.

Answer 245

lesions - virus travels from ganglia to skin. VERY INFECTIOUS often unilateral

Answer 246

double stranded | DNA

Answer 247

painless lesions itching bleeding

Answer 248

o None – frequent spontaneous resolution | o Topical podophyllin, cryotherapy, intralesional interferon

Answer 249

incubation period 2-3 weeks. Local infection. small, painless papule rapidly forms an ulcer = the chancre.

Answer 250

``` incubation period 6-12 weeks. Generalized infection, night time headaches, malaise, slight fever aches. generalized polymorphic rash often affects the palms, soles and face ```

Answer 251

``` round or oval painless, urrounded by a bright red margin, indurated with a clean base discharging clear serum. ```

Answer 252

early = asymptomatic for less than 2 years late = asymptomatic for more than 2 years

Answer 253

cardiovascular syphilis, neurosyphilis, | gummatous syphilis

Answer 254

penicillin

Answer 255

protozoa | flagellated

Answer 256

o vaginal discharge - usually a frothy yellowish discharge o vulval itching, o dysuria o offensive odour o Lower abdominal discomfort can occur in some women. o There may be signs of local inflammation with vulvitis and vaginitis. o Cervicitis may be present which leads to the cervix having the appearance of the surface of a strawberry; sometimes referred to a 'strawberry cervix'.

Answer 257

o usually asymptomatic. o dysuria o urethral discharge. o The vast majority of men will have no abnormal signs on examination.

Answer 258

metronidazole

Answer 259

``` Pregnancy, Diabetes mellitus, Treatment with broad-spectrum antibiotics (occurs in 28-33%), Chemotherapy, Vaginal foreign body, Contraceptives. ```

Answer 260

* Pruritus vulvae = itchiness of the vulva * Vulval soreness. * White, 'cheesy' discharge. The discharge is non-offensive. * Dyspareunia - difficult or painful sexual intercourse(superficial). * Dysuria (external). * Vulval erythema, possibly with fissuring. * Vulval oedema. * Satellite lesions.

Answer 261

• Topical azoles or nystatin, oral fluconazole

Answer 262

overgrowth of predominantly anaerobic organisms in the vagina. These replace lactobacilli The pH increases from less than 4.5 to as high as 6.

Answer 263

* Offensive, fishy-smelling vaginal discharge without soreness or irritation. * Approximately half of all women infected are asymptomatic. * On examination there is usually a thin layer of white discharge covering the vaginal wall

Answer 264

metronidazole

Answer 265

The result of infection ascending from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis

Answer 266

``` inflammation -> damaged epithelium -> adhesions infertility ectopic pregnancy tubo-ovarian abscess formation chronic pelvic pain peri-hepatitis Reiter's syndrome preterm delivery maternal and fetal mortality ```

Answer 267

Chlamydia trachomatis Neisseria gonorrhoeae Gardnerella vaginalis Mycoplasma hominis

Answer 268

* Risk factors for acquiring sexually transmitted infections - eg, young age, new sexual partner, multiple sexual partners, lack of barrier contraception, lower socio-economic group. * There may be an increased risk in those women who have had an intrauterine contraceptive device (IUCD) inserted in the previous 20 days. * Termination of pregnancy.

Answer 269

* Bilateral lower abdominal pain. * Deep dyspareunia - difficult or painful sexual intercourse * Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia). * Vaginal or cervical discharge that is purulent. * Lower abdominal tenderness (usually bilateral). * Mucopurulent cervical discharge and cervicitis seen on speculum examination. * Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination. * Fever above 38°C (but may be apyrexial). * Nausea or vomiting, urinary symptoms, proctitis and an adnexal mass.

Answer 270

pain relief outpatient - oral doxycycline and metronidazole inpatient - IM ceftriaxone

Answer 271

hip bones sacrum coccyx

Answer 272

sacrum | ischial spine

Answer 273

sacrum | ischial tuberosity

Answer 274

* wider and broader structure * lighter in weight * An oval-shaped pelvic inlet compared with the heart-shaped android pelvis. * Less prominent Ischial spines, allowing for a greater bispinous diameter * A greater angled sub-pubic arch, more than 80-90 degrees. * sacrum shorter, more curved and with a less pronounced sacral promontory.

Answer 275

``` o Round inlet o Straight side walls o Ischial spines not too prominent o Well-rounded greater sciatic notch o Well-curved sacrum (to fit with foetal head) o Sub-pubic arch > 900 ```

Answer 276

* Posterior: The sacral promontory (the superior portion of the sacrum). * Lateral: The arcuate line on the inner surface of the ilium, and the pectineal line on the superior ramus. * Anterior: The pubic symphysis.

Answer 277

pelvic inlet

Answer 278

end of the lesser pelvis | beginning of the pelvic wall

Answer 279

* Posterior: The tip of the coccyx * Lateral: The ischial tuberosities and the inferior margin of the sacrotuberous ligament * Anterior: The pubic arch (the inferior border of the ischiopubic rami).

Answer 280

The angle beneath the pubic arch

Answer 281

1. Obstetric Conjugate determines the narrowest fixed distance that the foetus would have to negotiate This is the distance between the sacral promontory and the midpoint of the pubic symphysis. 2. Diagonal Conjugate measure manually via the vagina the distance from the inferior border of the pubic symphysis to the sacral promontory

Answer 282

the presence of the bladder

Answer 283

use the tip of your middle finger to measure the sacral promontory use the other hand to mark the level of the inferior margin of the pubic symphysis on the examining hand. You then use the distance between the index finger and the pubic symphysis to measure the obstetric conjugate, ideally 11cm or greater

Answer 284

funnel shaped

Answer 285

urogenital hiatus | rectal hiatus

Answer 286

perineal body

Answer 287

* Support of abdominopelvic viscera (bladder, intestines, uterus etc.) through their tonic contraction. * Resistance to increase in intra-pelvic/abdominal pressure during activities such as coughing or lifting heavy objects. * Urinary and fecal continence. The muscle fibres have a sphincter action on the rectum and urethra. Separates the pelvic cavity and the perineum

Answer 288

* Anterior – Pubic symphysis. * Posterior– The tip of the coccyx. * Laterally – Inferior pubic rami and inferior ischial rami, and the sacrotuberous ligament. * Roof – The pelvic floor. * Base – Skin and fascia.

Answer 289

a theoretical line drawn transversely between the ischial tuberosities.

Answer 290

* Anteriorly: Mons pubis in females, base of the penis in males. * Laterally: Medial surfaces of the thighs. * Posteriorly: Superior end of the intergluteal cleft.

Answer 291

A potential space between the pelvic floor superiorly, and the perineal membrane inferiorly found in the urogenital triangle

Answer 292

part of the urethra external urethral sphincter In males, it also contains the the bulbourethral glands and the deep transverse perineal muscles.

Answer 293

A layer of tough fascia, which is perforated by the urethra and vagina. separates the deep and superficial perineal pouches found in the urogenital triangle

Answer 294

perineal membrane

Answer 295

provide attachment for the muscles of the superficial external genitalia help support the pelvic viscera

Answer 296

A potential space between the perineal membrane superiorly, and the perineal fascia inferiorly

Answer 297

erectile tissues that form the penis and clitoris ischiocavernosus bulbospongiosus superficial transverse perineal muscles. Bartholin’s glands

Answer 298

Fascia covering the superficial perineal muscles.

Answer 299

layer of fascia continuous with the superficial fascia of the abdominal wall.

Answer 300

* Anal aperture – the opening of the anus. * External anal sphincter muscle – voluntary muscle responsible for opening and closing the anus. * Two ischioanal fossae – spaces located laterally to the anus.

Answer 301

fat | connective tissue

Answer 302

the pelvic diaphragm superiorly | the skin of the anal region inferiorly

Answer 303

pudendal nerve, roots S2, S3 and S4.

Answer 304

puborectalis, pubococcygeus iliococcygeus.

Answer 305

* Anterior – The pubic bodies * Laterally – Thickened fascia of the obturator internus muscle, known as the tendinous arch. * Posteriorly – The ischial spines

Answer 306

maintain faecal continence | relaxes during defecation

Answer 307

anterior rami S4 and S5

Answer 308

posterior to levator ani

Answer 309

joins the pelvic floor to the perineum tear resistant body between the vagina and the external anal sphincter, supports the posterior part of the vaginal wall against prolapse

Answer 310

trauma to pelvic floor | poor muscular tone of pelvic floor

Answer 311

* old age * high number of vaginal deliveries * Family history of pelvic floor dysfunction * large weight * Chronic coughing (e.g from a lung disorder)

Answer 312

pelvic floor exercises squeeze and hold the muscles 10 to 15 times in a row. (the muscles used to stop the flow of urine when you go to the toilet) Do not hold your breath or tighten your stomach, buttock or thigh muscles at the same time.

Answer 313

* Levator ani (part of the pelvic floor). * Bulbospongiosus muscle. * Superficial and deep transverse perineal muscles. * External anal sphincter muscle. * External urethral sphincter muscle fibres.

Answer 314

• pregnancy and vaginal delivery o stretch of pudendal nerve o stretch of pelvic floor and perineal muscles o stretch/rupture of supporting ligaments • hysterectomy • Increasing age • Increasing parity • Overweight (BMI 25-30) and obesity (BMI >30) • Menopause • Chronic cough • Intrinsic connective tissue laxity

Answer 315

pelvic floor muscles are weakened if there is sudden extra pressure within abdomen and on the bladder, the pelvic floor muscles cannot support the bladder and urethra as well as they should. The pressure is too much to withstand and so urine leaks out.

Answer 316

Colposuspension = lifting up the neck of your bladder, and stitching it in this lifted position. This can help prevent involuntary leaks in women with stress incontinence. Tension-free vaginal tape = plastic tape is inserted through an incision inside the vagina and threaded behind the urethra. By holding the urethra up in the correct position, the piece of tape can help reduce the leaking of urine associated with stress incontinence

Answer 317

keratotic warty ulcerated lesions

Answer 318

inguinal, pelvic, iliac and para-aortic lymph nodes | lungs and liver

Answer 319

vulvectomy | lymphadenopathy

Answer 320

* Cervix accessible to visual examination (colposcopy) and sampling = test criteria * Slow progression from precursor lesions to invasive cancers (years) = disease criteria * Papanicolaou (Pap) test detects precursor lesions and low stage cancers = test criteria * Allows early diagnosis and curative therapy = treatment criteria

Answer 321

cells from the transformation zone are scraped off, stained with Papanicolaou stain and examined microscopically If the test is abnormal the patient is referred for colposcopy and biopsy.

Answer 322

Screening starts age 25 and continues every 3 years until the woman turns 50 and every 5 years for those aged 50-65.

Answer 323

HPV 16 | HPV 18

Answer 324

produce viral proteins E6 & E7 which interfere with the activity of tumour suppressor proteins cause inability to repair damaged DNA and increased proliferation of cells.

Answer 325

* Sexual intercourse * Early first marriage * Early first pregnancy * Multiple births * Many partners * Promiscuous partner * Long term use of OCP * Partner with carcinoma of the penis – also caused by HPV * Low socio-economic class * Smoking * Immunosuppression – HPV remains in cells

Answer 326

Cervical Intraepithelial Neoplasia | = Dysplasia of squamous cells within the cervical epithelium, induced by infection with high risk HPVs

Answer 327

* CIN I – most regresses spontaneously, only a small percentage progresses to further stages * CIN II * CIN III (carcinoma in situ) – 10% progresses to invasive carcinoma in 2-10 years, 30% regresses

Answer 328

* CIN I – follow-up or cryotherapy | * CIN II & CIN III – superficial excision (cone, large loop excision of the transformation zone (LLETZ))

Answer 329

squamous cell - 80% | adenocarcinomas -15%

Answer 330

– Locally to para-cervical soft tissues, bladder, ureters, rectum, vagina – Lymph nodes – para-cervical, pelvic, para-aortic

Answer 331

screening abnormality | postcoital, intermenstrual or postmenopausal vaginal bleeding

Answer 332

cervical cone excision

Answer 333

hysterectomy, lymph node dissection if advanced, radiation and chemotherapy

Answer 334

prolonged oestrogentic stimulation: • Annovulation • Increased oestrogen from endogenous sources (e.g., adipose tissue) • Exogenous oestrogen

Answer 335

adenocarcinoma

Answer 336

irregular or postmenopausal vaginal bleeding

Answer 337

* Typically arises in setting of endometrial hyperplasia * Mimics proliferative glands * Associated with unopposed oestrogen and obesity

Answer 338

myometrial invasion | direct extension to adjacent structures, to local lymph nodes and distant sites

Answer 339

• Poorly differentiated, aggressive, worse prognosis

Answer 340

Exfoliates, travels through Fallopian tubes, implants on peritoneal surfaces

Answer 341

fibroid! | Benign tumour of myometrium

Answer 342

asymptomatic can cause heavy/painful periods, urinary frequency (bladder compression), infertility round firm and whitish

Answer 343

40-60 years

Answer 344

often spread beyond the ovary at time of presentation - when they become large, invade adjacent structures or metastasize

Answer 345

regional nodes and elsewhere e.g., liver, lungs | Approximately 50% spread to other ovary

Answer 346

serum CA-125

Answer 347

* Nulliparity or low parity * OCP protective * Heritable mutations, e.g., BRCA1 and BRCA2 * Smoking * Endometriosis

Answer 348

serous mucinous endometrioid

Answer 349

Often spread to peritoneal surfaces and omentum,

Answer 350

large, cystic masses – can be >25kg Filled with sticky, thick fluid Usually benign or borderline

Answer 351

Contain tubular glands resembling endometrial glands Can arise in endometriosis (15-20% of cases) 15-30% have associated endometrial endometrioid adenocarcinoma, probably arising separately

Answer 352

α-fetoprotein

Answer 353

dermoid cysts! benign contain skin-like structures Usually contain hair and sebaceous material, can contain tooth structures Often tissue from other germ layers also present

Answer 354

malignant | composed of tissues that resemble immature foetal tissue

Answer 355

– Struma ovarii • Benign • Composed entirely of mature thyroid tissue • May be functional and cause hyperthyroidism – Carcinoid • Malignant • May be functional producing 5HT and can cause carcinoid syndrome (even without hepatic metastases!)

Answer 356

ovarian stroma

Answer 357

Sertoli and Leydig cells | granulosa and theca cells

Answer 358

``` – Uterus – Fallopian tubes – Contralateral ovary – Pelvic peritoneum Also gastrointestinal tumours (colon, stomach, biliary tract, pancreas, appendix) and breast ```

Answer 359

= Tumours and tumour-like conditions which show proliferation of placental tissue

Answer 360

Cystic swelling of chorionic villi and trophoblastic proliferation Friable mass of thin-walled, translucent, grape-like structures = swollen oedematous villi

Answer 361

abnormality on ultrasound scan | miscarriage

Answer 362

teenagers | 40-50

Answer 363

curettage | hCG monitoring

Answer 364

* Mole that penetrates or perforates uterine wall | * Locally destructive – can cause uterine rupture requiring hysterectomy

Answer 365

vaginal bleeding uterine enlargement persistently elevated hCG

Answer 366

chemotherapy

Answer 367

Malignant neoplasm of trophoblastic cells derived from previously normal or abnormal pregnancy

Answer 368

vaginal spotting | high hCG levels

Answer 369

uterine evacuation and chemotherapy

Answer 370

bodily process that happens between the ages of 6 and 8. androgens begin to increase and may go unnoticed or can cause pubic hair growth and increased secretion from sebaceous glands. In girls, the androgens are secreted by the adrenal glands.

Answer 371

onset of female breast development | dependent on oestrogen

Answer 372

first onset of pubic hair

Answer 373

first menstrual cycle in female

Answer 374

beginning of development of sperm in boys' testicles at puberty

Answer 375

a way to classify pubertal development

Answer 376

``` testicular volume, penis enlargement, pubic hair, axillary hair spermarche ```

Answer 377

breast size, pubic hair growth, axillary hair growth menarche

Answer 378

9-14 years

Answer 379

thelarche - breast bud forming

Answer 380

males: 10.3 females: 9

Answer 381

rise in pulsatile GnRH increase freq and amp of nocturnal LH pulses sex steroids released elevation of IGF-1, adrenal steroids, GH and TSH

Answer 382

initiates spermatogenesis and androgen secretion from the testes Androgens initiate the growth of sex accessory structures and male secondary sexual characteristics. The androgens also cause retention of minerals in the body to support bone and muscle growth.

Answer 383

Oestrogen induces the secondary sex characteristics, such as: growth of the pelvis deposition of subcutaneous fat growth of internal reproductive organs and external genitalia. The androgens released by the adrenal glands initiate growth of pubic hair, lowering of the voice, bone growth and increased secretion from sebaceous glands.

Answer 384

47kg = critical weight

Answer 385

oestrogen | closes epiphyseal growth plates

Answer 386

males: 9 females: 8

Answer 387

Hormone secreting tumours eg. pineal tumours, germ cell tumours

Answer 388

 Early stimulation of central maturation  Meningitis or trauma leads to prevention of GnRH inhibition so GnRH is secreted by the hypothalamus  Congenital adrenal hyperplasia  HCG secreting tumours in the liver  Adrenal tumours  Testotoxicosis  Exogenous oestrogen or androgen exposure

Answer 389

appearance of secondary sexual characteristics due to increased hormone production occurring independently to the HPG axis.

Answer 390

low LH and FSH | high testosterone/oestrogen

Answer 391

initial physical changes have not appeared by males: 14 females: 13 or >5year interval between first signs and completion

Answer 392

``` • Gonadal Failure Turner’s syndrome Post malignancy Polyglandular autoimmune syndromes • Gonadal deficiency Congenital hypogonadotrophic hypogonadism Hypothalamic/pituitary lesion Genetic mutations inactivating FSH/LH or their receptors ```

Answer 393

less oestrogen secreted less -ve feedback so more LH and FSH loss of inhibin so FSH rises more

Answer 394

follicular phase shortens | ovulation early or absent

Answer 395

Cessation of menstrual cycles for a clear 12 months

Answer 396

oestrogen levels fall dramatically less -ve feedback so more LH and FSH loss of inhibin so FSH rises dramatically

Answer 397

Hot flushes

Answer 398

``` o Uterus Regression of endometrium Srinkage of myometrium o Thinning of cervix o Vaginal rugae lost Thinner, less distensible o Involution of some breast tissue o Changes in skin o Reduction in bladder tone, leading to urinary incontinence ```

Answer 399

Reduced Oestrogen enhances osteoclast activity Increased reabsorption relative to production Osteoporosis!

Answer 400

relieves symptoms of the menopause | can limit osteroporosis

Answer 401

breast and ovarian cancer risk

Answer 402

absence of periods for at least 6 months

Answer 403

primary = never had a period. Absence of menses by age 14 with absence of Secondary Sexual Characteristics (SSC) Secondary = established menstruation has ceased

Answer 404

Infrequent periods occurring at intervals of 35 days – 6 months

Answer 405

painful periods

Answer 406

Heavy periods. Excessive (>80ml), prolonged (> 7 day) uterine bleeding usually secondary to distortion of the uterine cavity

Answer 407

Periods occur but not visible due to obstruction in outflow tract

Answer 408

Inadequate levels of FSH lead to inadequately stimulated ovaries, overies fail to produce enough oestrogen to stimulate the endometrium of the uterus, giving amenorrhoea

Answer 409

o Primary Hypothalamic Amenorrhoea Kallmann Syndrome – Inability to produce GnRH (& FSH subsequently) o Secondary Hypothalamic Amenorrhoea Exercise Amenorrhoea – Related to physical exercise Stress Amenorrhoea Eating disorders and weight loss (Obesity, anorexia or bulimia). Fall below critical weight of 47kg menses will cease o Secondary Pituitary Amenorrhoea Sheehan syndrome – Hypopituitarism Hyperprolactinaemia Haemochromatosis – ‘Iron overload’

Answer 410

the ovary does not respond to pituitary stimulation, giving low oestrogen levels. The lack of –‘ve feedback from oestrogen leads to elevated FSH levels in the menopausal range

Answer 411

``` o Primary Gonadal/End-Organ Gonadal dysgenesis – E.g. Turner Syndrome (45, X) Androgen Insensitivity Syndrome Receptor abnormalities for FSH and LH Specific forms of congenital adrenal hyperplasia o Secondary Gonadal/End-Organ Pregnancy Anovulation Menopause (Or premature menopause) Polycystic Ovarian Syndrome Drug-induced ```

Answer 412

irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. A diagnosis of exclusion

Answer 413

constant, noncycling estrogen levels that stimulate endometrial growth Proliferation without periodic shedding causes the endometrium to outgrow its blood supply tissue breaks down and sloughs from the uterus.

Answer 414

anterior scrotal artery - from external pudendal | posterior scrotal artery - from internal pudendal

Answer 415

scrotal veins - into external pudendal

Answer 416

anterolateral aspect = Genital branch of genitofemoral nerve – derived from the femoral plexus anterior aspect = Anterior scrotal nerves – derived from the ilioinguinal nerve posterior aspect = Posterior scrotal nerves – derived from the perineal nerve inferior aspect = Perineal branches of posterior femoral cutaneous nerve – derived from the sacral plexus

Answer 417

superficial inguinal nodes

Answer 418

a collection of serous fluid within the tunica vaginalis. | most commonly due to a failure of the processus vaginalis to close.

Answer 419

collection of blood in the tunica vaginalis

Answer 420

by transillumination | Due to the dense nature of blood, light is unable to pass through.

Answer 421

dilation of the veins draining the testes.

Answer 422

Left | testicular vein drains into left renal vein - smaller and at an acute angle

Answer 423

posterolateral aspect

Answer 424

testicular plexus – a network of nerves derived from the renal and aortic plexi.

Answer 425

paired testicular arteries arise directly from the abdominal aorta. pass into the scrotum via the inguinal canal, contained within the spermatic cord

Answer 426

pampiniform plexus in the scrotum paired testicular veins left testicular vein drains into the left renal vein, right testicular vein drains directly into the inferior vena cava.

Answer 427

paired lumbar and preaortic nodes, located at the L1 vertebral level.

Answer 428

formed at the deep inguinal ring, laterally to the inferior epigastric vessels. passes through the inguinal canal, entering the scrotum via the superficial inguinal ring. continues into the scrotum, ending at the posterior border of the testes.

Answer 429

External spermatic fascia Cremasteric muscle Internal spermatic fascia

Answer 430

* External spermatic fascia – aponeurosis of the external oblique. * Cremasteric muscle and fascia – internal oblique and its fascial coverings. * Internal spermatic fascia – transversalis fascia

Answer 431

afferent - ilioiguinal or genitofemoral nerve efferent - genital branch of the genitofemoral nerve

Answer 432

stroking the superior and medial part of the thigh.

Answer 433

contraction of the cremasteric muscle, elevating the testis on the side that has been stimulated.

Answer 434

* Testicular artery * Cremasteric artery and vein * Artery to the vas deferens – a branch of the inferior vesicle artery, which arises from the internal iliac. * Pampiniform plexus of testicular veins * Genital branch of the genitofemoral nerve * Vas deferens * Lymph vessels * Processus vaginalis * Autonomic nerves

Answer 435

from the aorta just inferiorly to the renal arteries.

Answer 436

occlusion of the testicular artery, | necrosis of the testes.

Answer 437

severe, sudden pain in one or both of the testes, where the onset is often during exercise or physical activity

Answer 438

continuous with the tail of the epididymis. Ascends in spermatic cord Travels through the inguinal canal. Moves down the lateral pelvic wall in close proximity to the ischial spine. Turns medially to pass between the bladder and the urethra. Forms dilated ampulla Joins the duct from the seminal vesicle to form the ejaculatory duct.

Answer 439

between the bladder fundus and the rectum

Answer 440

Seminal glands, Ejaculatory ducts, Epididymis Ductus (vas) deferens

Answer 441

internal iliac artery

Answer 442

external and internal iliac lymph nodes

Answer 443

rupture | pus enters peritoneal cavity

Answer 444

inferior to the neck of the bladder superior to the external urethral sphincter, levator ani muscle lies inferolaterally to the gland

Answer 445

Central zone Transitional zone Peripheral zone

Answer 446

* Central zone – the Wolffian duct. * Transitional zone – the urogenital sinus. * Peripheral zone – the Urogenital Sinus.

Answer 447

prostatic arteries - mainly derived from the internal iliac arteries.

Answer 448

prostatic venous plexus, draining into the internal iliac veins also connects posteriorly by networks of veins, including the Batson venous plexus, to the internal vertebral venous plexus.

Answer 449

drains into Batson venous plexus, which drains to the internal vertebral venous plexus.

Answer 450

increase in size of the prostate, without the presence of malignancy.

Answer 451

urinary frequency, urinary urgency difficulty in initiating micturition due to compression of bladder and urethra

Answer 452

transitional zone (central)

Answer 453

peripheral zones

Answer 454

hard irregular prostate gland.

Answer 455

root body glans

Answer 456

three erectile tissues (two crura and bulb of the penis) two muscles (ischiocavernosus and bulbospongiosus).

Answer 457

three cylinders of erectile tissue | two corpus cavernosa, and the corpus spongiosum

Answer 458

distal expansion of the corpus spongiosum | external urethral orifice

Answer 459

corpus cavernosa

Answer 460

corpus spongiosum

Answer 461

corpus spongiosum

Answer 462

Bulbospongiosus (x2) | Ischiocavernosus (x2)

Answer 463

contracts to empty the spongy urethra of any residual semen and urine. anterior fibres also aid in maintaining erection by increasing the pressure in the bulb of the penis.

Answer 464

surrounds the left and right crura of the penis. contracts to force blood from the cavernous spaces in the crura into the corpus cavernosa – this helps maintain erection.

Answer 465

superficial - deep fascia of penis. continuation of deep perineal fascia deep - tunica albuginea

Answer 466

Suspensory ligament – condensation of deep fascia. connects the erectile bodies of the penis to the pubic symphysis. • Fundiform ligament – condensation of abdominal subcutaneous tissue. It runs down from the linea alba, surrounding the penis like a sling, and attaching to the pubic symphysis.

Answer 467

``` internal iliac artery -> internal pudendal artery -> • Dorsal arteries of the penis • Deep arteries of the penis • Bulbourethral artery ```

Answer 468

deep dorsal vein drains cavernous spaces and empties into the prostatic venous plexus. The superficial dorsal veins drain the superficial structures of the penis

Answer 469

Sensory = dorsal nerve of the penis, a branch of the pudendal nerve. sympathetic = dorsal nerve of the penis, a branch of the pudendal nerve. Parasympathetic = cavernous nerves from the prostatic nerve plexus

Answer 470

the prepuce fits tightly over the glans and cannot be retracted. It can cause irritation when smegma accumulates in the preputial sac.

Answer 471

potential space between the glans and prepuce

Answer 472

median fold of skin on the ventral surface of the penis connected to the prepuce

Answer 473

retraction of the prepuce and the glans that constricts the neck of the glans, interfering with venous and lymphatic drainage. This may cause the glans to enlarge to the extent that the prepuce cannot be drawn over it.

Answer 474

abnormal curvature of the shaft of the penis caused by a build-up of scar tissue.

Answer 475

``` hypertension hypercholesterolemia diabetes anxiety depression ```

Answer 476

an erection that persists for more than four hours despite a lack of sexual stimulation. It is often painful and results from blood becoming trapped in the erectile bodies.

Answer 477

membranous - least distensible | passes through perineum and pelvic floor

Answer 478

the posterior surface of the broad ligament of the uterus by the mesovarium - a fold of peritoneum

Answer 479

surface cortex medulla

Answer 480

simple cuboidal epithelium,

Answer 481

connective tissue stroma that supports thousands of follicles.

Answer 482

inner part | supporting stroma - neurovascular network which enters at the hilum of the ovary

Answer 483

fluid-filled masses, most commonly derived from the ovarian follicles

Answer 484

suspensory ligament - extends from mesovarium to pelvic wall ligament of the ovary - from ovary to fundus of uterus.

Answer 485

uterus inguinal canal labia majora

Answer 486

abdominal aorta | ovarian arteries - arise below renal arteries

Answer 487

ovarian veins. left ovarian vein drains into the left renal vein, right ovarian vein drains directly into the inferior vena cava.

Answer 488

para-aortic nodes

Answer 489

upper border of broad ligament

Answer 490

abdominal ostium

Answer 491

uterine arteries - from internal iliac | ovarian arteries- from abdominal aorta

Answer 492

uterine and ovarian veins

Answer 493

liac, sacral and aortic lymph nodes

Answer 494

inflammation of the uterine tubes that is usually caused by bacterial infection.

Answer 495

adhesions of mucosa infertility ectopic pregnancy

Answer 496

fundus body cervix

Answer 497

entry of the fallopian tubes

Answer 498

anteverted - with respect to vagina | anteflexed - with respect to cervix

Answer 499

Rotated forward, towards the anterior surface of the body.

Answer 500

Flexed, towards the anterior surface of the body.

Answer 501

retroverted | positioned directly above the vagina

Answer 502

progesterone

Answer 503

round ligament

Answer 504

to maintains the anteverted position of the uterus.

Answer 505

provides support to the uterus, opposing the anterior pull of the round ligament.

Answer 506

internal iliac artery | uterine artery

Answer 507

uterine veins

Answer 508

``` body = iliac, sacral fundus = aortic, inguinal ```

Answer 509

The uterine artery crosses the ureters approximately 1 cm laterally to the internal os

Answer 510

presence of ectopic endometrial tissue at sites outside the uterus

Answer 511

endocervical canal | ectocervix

Answer 512

using a speculum

Answer 513

external and internal iliac nodes | sacral nodes

Answer 514

around the cervix

Answer 515

anterior lateral x 2 posterior

Answer 516

long and traumatic childbirth the foetus cuts off blood supply necrosis open communication between vagina and adjacent pelvic organ

Answer 517

* Vesicovaginal – Between the vagina and the bladder. Urine enters the vagina constantly. * Urethrovaginal – Between the vagina and the urethra. Urine only enters the vagina during urination. * Rectovagina – Between the vagina the rectum. Fecal matter can be enter the vagina in this type of fistula

Answer 518

condition making any sort of vaginal penetration (sexual intercourse, insertion of tampons) painful or impossible. Reflex of the pubococcygeus muscle

Answer 519

uterine and vaginal arteries, branches of the internal iliac artery.

Answer 520

vaginal venous plexus, which drains into the internal iliac veins, via the uterine vein.

Answer 521

iliac and superficial inguinal lymph nodes

Answer 522

Inferior 1/5th = Pudendal Nerve (S2-4) Superior 4/5th = Uterovaginal plexus

Answer 523

genital swellings

Answer 524

genital folds

Answer 525

genital tubercle

Answer 526

pudendal arteries

Answer 527

pudendal veins

Answer 528

superficial inguinal lymph nodes

Answer 529

anterior portion = ilioinguinal nerve and the genital branch of the genitofemoral nerve posterior portion = pudendal nerve and the posterior cutaneous nerve of the thigh.

Answer 530

Pre-Embryonic Period = Fertilisation - 3 weeks Embryonic Period = 3 - 8 weeks Fetal Period = 8 - 38 weeks

Answer 531

organs are generated | very little absolute growth

Answer 532

structures created during the embryonic period grow and mature. Weight gain accelerates.

Answer 533

Pseudoglandular Stage The duct systems begin to form within the bronchopulmonary segments created during the embryonic period Bronchioles are formed

Answer 534

Canalicular Stage | The respiratory bronchioles are formed due budding from the bronchioles

Answer 535

Terminal Sac Stage Terminal sacs (alveolar membranes) begin to bud from the respiratory bronchioles Differentiation of pneumocytes occurs Type 1 – Gas exchange Type 2 – Surfactant production from week 20. Significant at 30 weeks

Answer 536

Alveolar Period | 95% of Alveoli are formed post-natally

Answer 537

conditions the respiratory musculature

Answer 538

Maternal awareness of fetal movements from Week 17 onwards

Answer 539

myelination of the brain - corticospinal tracts

Answer 540

Corticospinal tract myelination is incomplete at birth | myelination occurs in the first year of birth

Answer 541

fetal urine fetal lung fluid placenta and fetal membranes

Answer 542

oligohydraminos = too little amniotic fluid

Answer 543

terminal sac stage of lung development (after 24 weeks).

Answer 544

insufficient surfactant production because of the small number of type II pneumocytes.

Answer 545

Glucocorticoid treatment to mother | increases surfactant production in the fetus

Answer 546

its weight is below the 10th percentile for gestational age.

Answer 547

* Placental insufficiency * Fetal renal impairment * Pre-eclampsia

Answer 548

• Fetal abnormality inability to swallow Structural – blind-ended oesophagus Neurological – unable to coordinate swallowing movements

Answer 549

Growth restriction is generalised and proportional

Answer 550

fetal abdominal circumference (AC) classically reduced out of proportion to other fetal biometric parameters and is below the 10th percentile

Answer 551

malnutrition in weeks 28-term, when the dominant cellular growth mechanism is hypertrophy

Answer 552

malnutrition in weeks 0-20, when the dominant cellular growth mechanism is hyperplasia.

Answer 553

states that Nutritional and hormonal status during fetal life can influence health in later life

Answer 554

deprivation of nutritional and oxygen supply to fetus

Answer 555

experienced in first trimester | IGF II is nutrient independent

Answer 556

IGF I is nutrient dependent

Answer 557

ductus venosus maintain oxygen saturation - the brain needs more oxygen than the liver!

Answer 558

foramen ovale

Answer 559

‘crista dividens’ = free border of the septum secundum

Answer 560

maintain the oxygen saturation. | A minor proportion of blood flows into the right ventricle, mixing with the deoxygenated blood from the SVC

Answer 561

ductus arteriosus

Answer 562

blood in the pulmonary artery is deoxygenated | so that the drop in o2 saturation in minimised

Answer 563

heart rate SLOWS | to reduce O2 demand

Answer 564

growth restriction and behavioural changes for the child

Answer 565

10 ml at 8 weeks 1 litre at 38 weeks. volume decreases post-EDD.

Answer 566

``` 98% water, electrolytes, creatinine, urea, bile pigments, renin, glucose, hormones fetal cells, lanugo vernix caseosa ( ```

Answer 567

hair covering the fetus

Answer 568

waxy or cheese-like white substance that protects the skin of the fetus

Answer 569

first bowel movement after birth debris from the amniotic fluid, plus intestinal secretions

Answer 570

During gestation, the clearance of fetal bilirubin is handled by the placenta. The fetus is unable to conjugate bilirubin due to the immaturity of the liver and intestinal processes for metabolism, conjugation and excretion.

Answer 571

doesn’t bind 2,3-BPG as well

Answer 572

As CO2 passes into the intervillous blood from the fetus, the maternal pH decreases = Bohr effect, decreasing the affinity of maternal Hb for O2 At the same time, as CO2 is lost from the fetal blood, pH rises = Bohr effect, increasing the affinity of fetal Hb for O2

Answer 573

Progesterone-driven hyperventilation

Answer 574

Deoxygenated blood can carry increasing amounts of carbon dioxide, whereas oxygenated blood has a reduced carbon dioxide capacity.

Answer 575

As maternal Hb gives up O2 at the placenta, it can accept increasing amounts of CO2 due to this lower pO2. Fetus is able to give up more CO2 as O2 is accepted

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