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Flashcards in Repro review Deck (199):
1

what does the round ligament of the uterus connect?

the uterus with the labia majora

2

what investigations can be used if external genitalia ambiguous at birth?

hormonal tests
gonadal sex
karyotyping
anatomy e.g. gonad palpation, length and diameter of any phallus (penis), urethral meatus position

3

determination of gonadal sex?

presence/absence of Y chromosome which has an SRY gene on its short arm= sex-determining region of Y chromosome
if a Y chromosome is present in the germ cells, testes will always be produced

4

In turner's syndrome, ovaries develop normally until 15th wk of gestation, ova then begin to degenerate and disapperar, what may be presentation at puberty?

short stature
primary amenorrhoea
poor breast development

5

what gonads would be produced if sex chromosome mosaic of XY,XX (or XO) cells?

both male and female gonadal tissues
This is true/primary hermaphroditism, but has not been described in humans

6

how is spontaneous development of female genitalia stopped in male?

MIH secretion from sertoli cells
testosterone secretion from leydig cells from 9wks gestation

7

what does the prostate develop from?

urogenital sinus, formed from division of cloaca

8

what does the vagina develop from?

upper part from paramesonephric ducts
lower part from urogenital sinus

9

what do the urethral folds give rise to in the male?

ventral aspect of shaft of penis, including the spongy urethra

10

example of a disorder of sex development where the genotypic (chromosomal) sex does not match the phenotype- physical appearance?

congenital adrenal hyperplasia

11

characteristics of a patient with androgen insensitivity syndrome?

patients are male with Y chromosome and testes, BUT lack of androgen receptors or failure of tissues to respond to receptor-dihydrotestosterone complexes, so androgens ineffective at inducing differentiation of male genitalia.
PM system suppressed by MIH from testes, so no uterine tubes or uterus.
Ambiguity of external genitalia as dihydrotestosterone necessary for fold fusion of genital swellings to form scrotum, and urethral folds to form ventral aspect of shaft of penis and penile urethra

12

outcome of dihydrotestosterone lack in a male during sexual development?

external genitalia do not develop normally as this hormone causes fusion of LS folds and urethral folds, so they may appear male but be underdeveloped with hypospadias- urethral fold fusion incomplete with abnormal openings of urethra along inferior aspect of penis, on ventral surface, or they may appear to be female with clitoromegaly.

13

symptoms of Klinefelter's (47, XXY)?

reduced fertility
small testes
reduced testosterone gynecomastia

commonly result of nondisjunction of XX homologues

14

Gonadal dysgenesis- oocytes absent, ovaries appear as streak gonads as comprise mainly fibrous tissue, occurs in Turner's, what are the symptoms?

webbed neck
short stature
shield-like chest
cardiac and renal anomalies
inverted nipples

15

how may a bifid penis occur?

splitting of genital tubercle

16

what is epispadias?

urethral meatus found on dorsum of penis
assoc with exstrophy of bladder and abnormal closure of ventral body wall

17

what is a bicornate uterus and how does it occur?

uterus has 2 horns entering a common vagina
result of incomplete fusion of paramesonephric ducts

18

how do germ cells reach the indifferent gonad?

diploid cells originate from epiblast and arise in the yolk sac, then migrate along doral mesentery into retroperitoneum to enter gonadal ridge

19

what is mullerian agensis?

characterized by a failure of the müllerian duct to develop, resulting in a missing uterus, fallopian tubes, and variable malformations of the upper portion of the vagina

20

why does cryptorchidism occur?

gubernaculum fails to develop or fails to pull testes into scrotum
reflection of androgen abnormalities

21

changes to spermatids to form spermatozoa?

cell elongation
flagellum formation
organelle reorientation
cytoplasmic removal

22

How much body weight does brain account for at birth

12%

23

difference between anterior pituitary and hypothalamus, where does A pituitary arise from?

A pituitary= endocrine gland
hypothalamus= nervous tissue

A pituitary arises from Rathke's pouch

24

summarise target tissues and actions of FSH, LH, TSH, ACTH, MSH, GH and prolactin

Gonads Growth of reproductive system
Gonads Sex hormone production
Thyroid Gland Secretion of thyroid hormones
Adrenal Gland Secretion of glucocorticoids
Melanocytes in Skin and Hair Production and release of melanin
Liver, adipose tissue Promotes growth, lipid and carbohydrate metabolism
Ovaries, mammary glands Secretions of oestrogen, progesterone, milk production

25

common causes of early puberty in boys?

CAH
pineal tumours
meningitis

26

how could puberty be delayed?

androgen receptor blockers
treat underlying condition e.g. CNS lesion
drugs to inhibit anter. pituitary gonadotropin secretion

27

what adrenal gland disorders may cause virilisation in males but no more development?

congenital adrenal hyperplasia- adrenal hyperfunction due to enzyme deficiency
adrenocortical tumour

28

how can CAH and adrenocortical tumour be differentiated between?

CAH- high level of 17-hydroxyprogesterone
US then CT for tumour, biopsy if imaging shows tumour

29

effects of oestrogen depletion that menopausal women might experience?

hot flushes
poor sleep
vaginal/urethral atrophy
dysparenuria, dysuria
breast atrophy
mood changes/depression
OP
changing cholesterol/lipid profile, poss increased CHD risk

30

tments for menopause problems?

HRT- oestrogen or combined
calcium

31

function of progesterone administered in addition to oestrogen in HRT to women not having had a hysterectomy?

reduce risk of endometrial cancer as progesterone inhibits proliferation of uterine lining stimulated by oestrogen

32

why do fibroids regress after the menopause?

they are hormone dependent

33

how are fibroids diagnosed?

US
bimanual examination

34

how to assess menstrual blood loss?

pad and tampon counts, and measure HB/haematocrit levels

35

menstrual loss defining menorrhagia?

>80ml, which will lead to anaemia

36

non-surgical approach of treating menorrhagia?

GnRH agonist

37

surgical approach of treating menorrhagia?

endoscopic resection or abdom. myomectomy or hysterectomy

38

describe how hormones from hypothalamus reach anter pituitary to exert their action?

releasing hormones neurosecreted from median eminence of hypothalamus and travel to A pituitary in hypophyseal portal circulation, so don't need to prod a lot as travel directly in a small amount of blood for a short distance, so are not diluted before exerting their action

39

testosterone in medium to long term is constant as spermatogenesis occurs continuously, but how do its levels vary?

circadian rhythm- highest in early morning
effects of environ stimuli e.g. light/dark

40

what causes variation in reproductive cycle length?

variation in timing of ovulation- affected by environ e.g. stress

41

when is a common time for miscarriage and why?

10-14 wks as support of pregnancy changing from CL to placenta

42

how is cervical mucus made receptive to sperm transport?

oestrogen action on cervical glands

43

what is the contraceptive action of oestrogen?

acts by -ve feedback to inhibit FSH release and hence prevent follicle development

44

when is the 1st meiotic division of the oocyte completed?

following the LH surge, with LH acting on LH receptors present on the granulosa cells following the action of oestrogen

45

which muscle extends between the perineal body and the ischial ramus?

superficial transverse perineus

46

what is the lateral fornix of the vagina closely related to?

the ureter

47

muscles forming lateral wall of pelvic cavity?

obturator internus
piriformis- also forms posterior wall

48

what forms inferior part of pelvic cavity?

pelvic floor/diaphragm= levator ani and cocyygeus (ischio)

49

how is the pelvic cavity separated from the perineum?

by the pelvic floor

50

2 holes of significance in structure of pelvic floor?

UG hiatus= situated anteriorly, allows passage of urethra and vagina in females
rectal hiatus= centrally positioned for passage of anal canal

51

what lies between the UG hiatus and the rectal hiatus?

perineal body

52

3 roles of pelvic floor muscles?

maintain urinary and fetal continence
support of abdominal and pelvic viscera
resistance to increase in intra-pelvic or abdominal pressure

53

levator ani attachements?

pubic bones anteriorly
thickened fascia of obturator internus laterally (tendinous arch)
ischial spines posteriorly

54

main function of puborectalis?

maintain fecal continence

55

what attaches to perineal body located midway between ischial tuberosities?

fibres of levator ani
bulbospongiosus
superficial transverse perineus
anal sphincters

56

coccygeus muscle innervation?

A.rami of S4 and S5

57

course of coccygeus muscle?

It originates from the ischial spines and travels to the lateral aspect of the sacrum and coccyx, along the sacrospinous ligament.

58

anatomical borders of perineum?

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.
The perineum can be subdivided by a theoretical line drawn transversely between the ischial tuberosities. This split forms the anterior urogenital and posterior anal triangles. These triangles are associated with different components of the perineum

59

components of urogenital triangle? (anterior part of perineum, separated from posterior by imaginary line between ischial tuberosities)

deep perineal pouch
perineal memebrane
superficial perineal pouch
deep and superficial perineal fascia
skin

60

in which pouch are bartholin's glands located?

superficial perineal pouch

61

in which pouch are bulbourethral glands located?

deep perineal pouch

62

why can vaginal delivery in childbirth cause pelvic floor dysfunction?

damage to levator ani muscles forming pelvic floor
damage to perineal body
stretching of pudendal nerve which innervates pelvic floor muscles
stretching of ligaments which support the muscles

63

why might removal of prostate lead to impotence?

autonomic nerves supplying erectile tissues in perineum pass around sides of prostate in pelvis so may be damaged

64

3 ways baby could be delivered with help?

ventouse delivery
forceps
caesarean section

65

A patient has primary amenorrhoea and anosmia, what is the likely cause?

Kallman syndrome: genetic defect producing hypogonadotropic hypogonadism in which fetal GnRH neurosecretory neurones fail to migrate normally from the olfactory placode to the medial basal hypothalamus so olfactory bulb doesn't develop properly

66

2 most common causes of gonadal dysgenesis?

Klinefelter's syndrome: testes have a limited capacity to secrete testosterone so low, high FSH and LH due to -ve feedback lack, and so oestrogen prod. proportionally increased produced gynaecomastia
Turner's syndrome: streak gonads as ovaries replaced by fibrous tissue

67

risks associated with pre-term birth?

cranial sutures too wide open so pressures of birthing process fail to result in interlocking of cranial bones, so high probability of brain damage in birthing proocess
insufficient surfactant production so susceptibility to respiratory distress syndrome

68

whens does surfactant prod begin in newborn and when is it markedly increased?

around wk 20
increased after wk 30 when alveoli open in a significant number and SA dramatically increases

69

why is neonatal jaundice not uncommon?

neonate may not be able to immediately deal with bilirubin after birth as this function was not carried out in utero as fetus unable to excrete bilirubin via gut so remained unconjugated and passed across placenta into maternal circulation

70

what happens as a result of continued swallowing of amniotic fluid by fetus?

fetal gut absorbs water and electrolytes leaving debris to accumulate together with debris from developing gut in fetal large bowel= MECONIUM- usually only excreted by fetus in distress e.g. fetal hypoxia

71

when does amniotic fluid reach maximum?

38 wks at 1 litre

72

where is amniotic fluid derived from in early pregnancy?

by dialysis of fetal and maternal EC compartments with some exchange occurring across fetal skin

73

when do thalamo-cortical projections reach maturity?

wk 29

74

what can be measured to assess liver's functioning in fetus to store glycogen?

fetal abdominal circumference

75

average birth weight at term in england?

3.5kg
below 2.5 is considered low birth weight

76

what is the obstetric conjugate?

distance between the sacral promontory and midpoint of PS= narrowest fixed distance the fetal head must pass through during delivery (10.5cm)

77

why can the obstetric conjugate not be measured directly?

due to presence of the bladder

78

what is measured instead of the obstetric conjugate prior to labour to assess the female pelvis in pregnancy?

diagonal conjugate: distance from the sacral promontory at the level of the ischial spines to the inferior border of the PS
this is 1.5-2cm longer than the obstetric conjugate

79

diameter of mid-cavity between pelvic inlet and outlet?

12cm, circular

80

where is the pelvic outlet narrowest?

mediolaterally (11cm)

81

reasons for failure to progress in labour? **

POWER: insufficient uterine contractions
PASSENGER: too big e.g. macrosomic fetus due to gestational diabetes, fetal presentation
PASSAGE: abnormal bony pelvis, rigid perineum

82

which diameter of the pelvis is being measured by the obstetric and diagonal conjugates?

antero-posterior

83

importance of progesterone action before labour to prevent spontaneous abortion?

it prevents oxytocin from evoking contractions during pregnancy as it reduces the responsiveness of the myometrium to oxytocin, and it reduces uterine PG release again reducing myometrial activity as PGs stimualte contractions by increasing availability of intracellular Ca2+

84

oestrogen mediated changes in cervix and pelvis that facilitate labour?

cervical softening
relaxation of pelvic ligaments

85

during advancing pregnancy, what postural change may result from collagenase activity?

a lordosis due to relaxation of vertebral ligaments and additional weight of fetus

86

what fetal landmark is used to assess fetal head position in birth canal?

fetal fontanelles

87

what spinal segments are blocked in an epidural for pain relief?

T9-S4

88

why is there a risk of hypotension after an epidural?

blockage of sympathetic outflow which mediates vasoconstriction of arterioles which normally increases TPR to increase BP

89

what is post-partum haemorrhage?

blood loss of >500ml after vaginal delivery

90

most common cause of post-partum haemorrhage?

uterine atony= loss of tone in uteroine musculature so myometrium unable to contract down hard on blood vessels to reduce blood loss

91

what physiological mechanism prevents PPH?

strong contractions of uterus after 3rd stage of labour, uterus contracted down so arterial supply to the placental bed of the endometrium is clamped

92

what is at risk of damage in a hysterectomy?

ureter, due to clamping of the uterine artery which lies directly superior to the ureter

93

what may you consider as a cause for PPH if uterus firm on palapation with contin. bleeding?

retained placenta/ laceration or trauma to genital tract

94

how does sheehan's syndrome (possible cause of secondary amenorrhoea) arise?

Thrombosis of vessels supplying the anterior lobe secondary to severe haemorrhage, leading to
necrosis of the anterior pituitary gland which increases in size during pregnancy increasing its
susceptibility to necrosis.

95

why is poster. pit. unaffected in sheehan's syndrome?

it receives a relatively rich arterial supply

96

how to calculate mean aBP?

1/3systolic + 2/3diastolic

97

triad of symptoms in pre-eclampsia?

hypertension- vasospasm (constriction)
oedema- capillary leak- increased vascular permeability and increased hydrostatic pressure?
proteinuria- renal cell damage secondary to hypoperfusion

98

renal symptoms of pre-eclampsia?

renal failure
proteinuria
oliguria

99

what may be the 1st sign in a fetus for pre-eclampsia in mother?

fetal growth restriction

100

RFs for pre-eclampsia?

occured in previous prg
1st preg
multiple gestation
diabetes
pre-exisiting hypertension

101

what gestatational disease predisposes to pre-eclampsia?

hydatidiform mole: gestational trophoblast disease with placental overgrowth

102

pathogenesis of pre-eclampsia?

defect in placentation
failure of invading trophoblast to remodel spiral arteries in endometrium- may be failure of epithelial to endothelial transition
final result in endothelial dysfunction and injury, vessels vasoconstricted and plasma contracted
vascular injury causes coagulation (*Virchow's triad: blood vessel wall, blood constituents, blood flow abnormalities) and alters vessel smooth muscle responsiveness to vasodilators

103

why would a breast feeding mother use the progesterone only pill for contraception rather than the combined OCP?

because oestrogen in the combined OCP inhibits the action of prolactin on the breast and so inhibits lactation necessary if breastfeeding

104

normal day 21 progesterone level?

>30 nmol/L

105

what to look for on a semen analysis?

sperm count= 20-200 million sperm per ml
>50% motility
>30% morphology

106

how could an ovarian cancer metastasise to the lung?

ovaries lymphatic drainage is to para aortic LNs which then drain into intra-thoracic LNs which may allow access to lung?

107

RFs for ectopic pregnancy?

1 previously
prior PID
prior tubal surgery
current IU device
past history of infertility

108

how can fetal age be measured?

symphysis-fundal height
biparietal diameter of head
CR length

109

how can the neonatal liver be stimulated to conjugate bilirubin?

exposure to light (phototherapy)

110

quickest way to diagnoses suspected ectopic pregnancy when patient going into shock?

culdocentesis: needle into posterior fornix of vagina and through into pouch of Douglas where can retrieve non-clotting blood

111

functions of amniotic fluid?

mechanical protection against trauma
moist environment
fetal temperature control
contributes to fetal pulmonary development

112

volumes of amniotic fluid in development?

10ml at 8 wks
1L at 38 wks
then falls to 300 ml at 42 wks

113

reasons for oligohydramnios?

congential renal anomalies: bilateral renal agenesis- could be problem with ureteric bud inducing metanephric blastema to develop into definitive kidney, renal dysplasia, ACEI exposure, urethral or bladder outlet obstruction
uteroplacental insufficinecy: poor perfusion to fetal kidneys e.g. pre-eclampsia, placental abruption
defect in placenta- uteroplacental circulation compromised
premature rupture of membranes
fetal cardiac defects, neural tube defects, NSAIDs

114

blood test for ovarian cancer?

CA125

115

how could maternal state be responsible for polyhydramnios?

diabetes meillitus as amniotic fluid vol is dependent on degree of glycaemic control

116

when does placenta development begin?

days 4 to 5 after fertilisation where cells of morula undergo compaction, producing and outer and inner cell mass comprising pluripotent cells

117

what is the chorion?

combination of extra-embryonic mesodern and the 2 layers of trophoblast: cytotrophoblast and syncytiotrophoblast

118

how is a tertiary villus/definitive placental villus formed?

primary villi= cytotrophoblast core covered by syncytium. Mesodermal cells then penetrate villi core and grow toward decidua, forming secondary villus. Mesodermal cells differentiate into blood cells and vessels, forming villous capillary system so now a tertiary villus. Capillaries of villus make contact with those in mesoderm of chorionic plate and in connecting stalk which joint with intraembryonic circulatory system so placenta connected to embyro.

119

what is the Barker hypothesis?

fetal origins of adult disease: impaired fetal growth linked to LT adult health problems

120

why might a retained placenta occur and what problems does this cause?

if placenta fragments during labour, part of placenta may remain in uterus which impairs shut-down of utero-placental circulation, so serious post-partum haemorrhage can occur= >500ml blood loss after vaginal delivery

121

how does the placenta reduce the interhaemal distance and when might this become exaggerated?

margination of fetal capillaries
thinning of trophoblast layer (s)
increased branching of villi to increase SA

exaggerated when defecit if restriction on maternal side or demand for transported materials, e.g. in smokers, or at living at high altitude. Smokers: reduce placental b.flow so poorer fetal nutrition, and so birth weight on average reduced by 200g.

122

importance of hCG action on corpus luteum when pregnancy occurs?

maintains corpus luteum and actually increases its secretion of oestrogen and progesterone which is vital to maintain the endometrium and hence the pregnancy (remember progest decrease initiates menses via spasm of spiral arteries).

123

which oestrogen level in maternal serum/urine best indicates fetal progress and why?

oestriol, as only made by fetus and is not converted into anything else

124

which hormones mediate altered glucose metabolism in pregnancy?

hPL, prolactin, oestrogen and progesterone

125

name 4 changes occurring in mother during pregnancy related to glucose metabolism?

reduction in maternal blood glucose and aa concs
diminshed maternal responsiveness to insulin in 2nd half
increase in maternal free FA, ketone and triglyceride levels, which can increase risk of gallstones
increased insulin release in response to a normal meal

126

RAAS activation in pregnancy is necessary to increase circulating blood volume in the mother, but what other important function does it perform?

compensates for expected Na+ loss as a result of increased GFR (increases by 55%)

127

acid base state of mother in pregnancy?

compensated respiratory alkalosis

128

how does TV change in pregnancy?

increase by 40%

129

why is VC unchanged in pregnancy?

VC= IC+ERV, IC is increased with an increase in TV but ERV is reduced as increase in TV and reduction in FRC due to elevation of diaphragm as result of gravid uterus.

130

why does heartburn occur in pregnancy?

increased reflux due to progesterone mediated relaxation of GI smooth muscle

131

how does placenta increase calcitriol prod. in mother so that more Ca2+ can be provided to fetus?

placenta produces renal 1 alpha hydroxylase

132

why does palmar erythema occur in preganancy?

increased oestrogen

133

diagnostic investigations for pre-eclampsia?

BP >_140mmHg sytolic or 90 diastolic on 2 separate occasions taking at least 4-6hrs apart after 20 wks gestation in woman with previously normal BP
proteinuria
thrombocytopenia
raised urea/creatinine, oliguria
impaired LFTs

134

by when does cytotrophoblast and CT of villi disappear forming a haemomonochorial placenta?

by 4th mnth (wk 16)

135

why are isolated cytrotrophoblast cells left when forming a haemomonochorial placenta?

act as stem cells to replace and repair overlying syncytium

136

define preeclampsia

new-onset significant hypertension and proteinuria after 20wks' gestation

137

define significant proteinuria in pre-eclampsia

> or equal to 300mg of protein in a 24 hr urine sample

138

why is BP control important in pre-eclampsia?

it doesn't change disease course for mother or fetus BUT does prevent cerebrovascular accident-stroke, ao antihypertensives can be used while affecting delivery

139

what is the HELLP syndrome of pre-eclampsia?

haemolysis
elevated LFTs
low platelets= thrombocytopenia

140

3 aims of implantation?

establish maternal bflow within placenta
anchor placenta to to endometrium
establish basic unit of exchange= chorionic villi

141

CNS symptoms of eclampsia?

seizures
coma
blindness
headaches
hyperreflexia

142

signs and symptoms of worsening pre-eclampsia?

pulmonary oedema
oliguria
thrombocytopenia
oligohydramnios
increased iastolic BP
headache
visual complaints
lack of fetal growth
elevated LFTs e.g. gamma-GT, AST

143

how to distinguish between CAH and adrenocortical tumour causing isosexual precocity?

measure 17-hydroxyprogesterone in blood- elevated in CAH
can US, then CT and biopsy

144

average weight of fetus?

3.5 kg

145

weight of a macrosomic fetus?

>4.5kg

146

weight of fetus with growth restriction?

<2.5kg

147

describe the double Bohr effect in pregnancy

CO2 produced by fetus diffuses across placenta to maternal circulation where it acidifies maternal blood, so maternal Hb more readily gives up O2, and blood of fetus subsequently alkalifies which means fetal Hb more readily binds O2, so a Bohr shift occuring in both circulations allows O2 to be readily picked up by fetal Hb.

148

possible diagnoses of a breast lump?

inflammatory e.g. fat necrosis
phyllodes tumour
fibroadenoma
carcinoma
cyst

149

when do gonads stop being indifferent?

7th wk of development
germ cells don't appear in gonadal ridges until 6th wk

150

where do paramesonephric ducts originate?

invagination of epithelium on AL surface of the urogenital ridge= intermediate mesoderm

151

what does the metanephric blastema form?

nephrons: glomerulus and tubules

152

what 3 precursors are common in male and female which external genitalia develop from?

genital tubercle
labioscrotal swellings
urethral folds

153

contents of broad ligament of uterus?

uterus (mesometrium)
fallopian tubes (mesosalpinx)
ovaries (mesovarium)
round ligament of uterus
suspensory ligament of the ovary
ovarian ligament
ovarian artery
uterine artery

154

why is breast feeding milk?

babies fewer infections
bonding

155

actions of progesterone in pregnancy?

increase appetite- so mother builds up fat stores in body for 2nd half of preg where fetal demands fro glucos increase so mother turns to FA for her own metabolism
stimulates respiratory centres so more CO2 blown off- physiological hyperventilation
increase renin production- increases maternal circulating blood volume
smooth muscle relaxation- decreases TPR, increased risk of pyelonephritis, heartburn, constipation

156

constituent of AT which means obese patients at increased risk of endometrial cancer?

aromatase enzyme production- converts androgens into oestrogens which stimulate endometrial cell proliferation

157

age range for menarche?

11-15 years

158

age range for growth spurt in girls?

10-14 years

159

age range for adrenarche in girls?

11-12 years

160

age range for thelarche in girls?

8-11 years

161

why is implantation at a site other than the endometrium common in different areas of the FTs and the ovaries?

lack of pre-decidual cells, so conceptus isn't limited in its ability to invade

162

other than the pampiniform venous plexus, how else is an appropriate temperature maintained in testes?

cremaster muscle- raises and lowers testes to control temperature of them to create optimum temp for spermatogenesis enzymes
dartos muscle- wrinkles scrotal skin to reduce heat loss by reducing SA

163

describe capacitation and the acrosomal reaction

these are necessary for full maturation of sperm so that it is capable of fertilising the oocyte. capacitation: glycoprotein coat removed which causes changes in the sperm cell memebrane. tail movements change from waves to whip like thrashing movement, and sperm becomes responsive to signals from oocyte.
acrosomal reaction: release of sperm contents. start of reaction marked by capacitated sperm coming in contact with oocyte ZP, membranes fuse and then proteolytic enzymes of acrosome of sperm released.
both changes induced by Ca2+ influx and increase in cAMP in spermatozoa.

164

contents of spermatic cord?

cremasteric artery
artery to vas deferens
testicular artery
vas deferens
pampiniform venous plexus
remnant of processus vaginalis
genital branch of genitofemoral nerve (L1, L2)
testicular lymphatic vessels
autonomic nerves

165

when does puberty occur?

when the brain initiates pulsatile GnRH secretion
girls: 8-13 yrs
boys: 9-14 yrs

166

how may a female with CAH be treated?

given glucocorticoids to induce -ve feedback so inhibit androgen production by adrenals
reconstructive surgery on external genitalia

167

what can the combined OCP be used to treat other than its use for contraception?

menorrhagia: reduce gonadotrophins

168

why is the combined OCP protective against endometrial and ovarian cancers?

endometrium: reduce turnover of endometrium
ovarian: reduce follicle rupture so reduce damage and repair of overlying simple cuboidal epithelium

169

tments of menorrhagia?

mefenamic acid= NSAID
antifibrinolytics e.g. tranexamic acid
GnRH agonist
combined OCP

170

what is a hydrocele of the spermatic cord?

collection of excess fluid in a persistent processus vaginalis due to excess serous fluid secretion from the visceral layer of the tunica vaginalis

171

contents of the scrotum?

testes
epididymis
spermatic cord

172

difference between a spermatocele and an epididymal cyst?

spermatocele= retention cyst= collection of fluid in the epididymis, usually near head
epididymal cyst= collection of fluid anywhere in epididymis

173

what increases your risk of preterm labour?

smoking
polyhydramnios- may also cause UC prolapse
multiple gestation
pyelonephritis

174

how could a cancer be prevented from coming back?

adjuvant therapy e.g. chemotherapy and radiotherapy

175

what is used most commonly to detect VIN and how does it work?

dilute acetic acid
stains white- stains keratotic cells- protein

176

why is combined OCP protective against ovarian cancer?

inhibited ovulation
each breach and repair of the
surface epithelium at ovulation causes epithelial turnover. Long term oc use is
definitely protective

177

how does testosterone influence descent of testes?

stimulates movement through inguinal canal in to scrotum

178

why does cryptorchidism occur in androgen insensitivity syndrome?

androgens necessary for descent of testes from their position on posterior abdomonal wall

179

disadvantages of ventouse delivery?

chignon
cephalohaematoma

180

how is cervical effacement different from cervical thinning?

effacement refers to the parts of cervix moving outwards to allow cervical opening*

181

disadvantages of using diaphragm as a barrier contraception method?

bladder or vaginal infections
require spermicide use in diaphragm as some sperm may bypass the diaphragm ,and spermicide can cause inflammation of genital tract and may increase transmission of STIs

182

layers of the scrotum?

skin
dartos fascia
external spermatic fascia
cremasteric fascia
internal spermatic fascia
tunica vaginalis
tunica albuginea
tunica vasculosa

183

describe the blood supply of the endometrium

uterine arteries arise from the anterior division of the internal iliac artery
these form arcuate arteries that give off radial arteries that travel inward to myometrium where they give off basal arteries and spiral arteries
basal to stratum basale
and spiral to stratum functionalis

184

2 disadvantages of using an IUD for contracpetion?

increased risk of PID
risk of ectopic pregnancy

185

a woman has transmitted an STI onto her partner but she is asymptomatic, what is the likely causative organism?

neisseria gonorrhoea

186

risks of early onset of sexual activity?

increased risk of cervical cancer in women
increased risk of PID in women

187

what % of breast cancers are hereditary?

10%
25% of these related to mutations in BRCA1 or 2, and 3% of all breast cancers due to BRCA mutations

188

presentation of androgen insensitivity syndrome and why

testicular feminisation:
Y chromosome so testes, but in abdomen as require androgens for descent
no other internal genitalia as MIH inhibits PMN development, and lack testosterone to maintain mesonephric ducts
external genitalia female as in absence of dihydrotestosterone they form as don't require any hormones, so will have labia majora, minora and clitoris, and lower part of vagina- short from UG sinus, fusion to form male external requires dihydrotestosterone
breasts often well devloped- oestrogen as little -ve fbk from androgens to hypothalamus and pit?
little pubic hair as androgen lack
primary amenorrhoea as no uterus

189

why might female fetus XX have internal genitalia of both sexes?

CAH: excessive secretion of androgens means mesonephric ducts remain to form male internal genitali, but no MIH from testes as ovaries present so paramesonephric ducts develop aswell to form female internal genitalia

190

would testes descend in patient with low MIH?

no, would be found in abdomen
may be mechanical obstruction by fibrous adhesions
patient would have both male and female internal genitalia if androgen levels normal

191

during what days of menstrual cycle is clomiphene given to treat infertility?

given for 5 days at start of menstrual cycle

192

how will high dose progesterone affect gonadotropins?

will inhibit +ve feedback of oestrogen so no LH surges so no ovulation
and enhances -ve feedback of oestrogen to suppress LH, FSH and GnRH release

193

how will low dose progesterone affect gonadotropins?

will probably still get ovulation as dose insufficient to prevent +ve feedback of oestrogen so will still get LH surge, but thick and acidic cervical mucous plug created which inhibits sperm transport

194

where does the spermatic cord terminate?

posterior border of testis
originates at deep inguinal ring lateral to inferior epigastric vessels

195

smooth muscle of which structures contract during emission?

vas deferens
seminal vesicle
prostate gland

196

blood supply to prostate?

inferior vesical artery from internal iliac artery

197

why does prostate cancer spread to the vertebrae?

veins of prostate connect to the Batson venous plexus- a collection of valveless veins which connect with the internal vertebral venous plexuses so spread via venous drainage

198

what is assessed in a bimanual examination?

cervix
can assess uterine size, consistency, regularity, pain, mobility and position

199

why might a patient with breast cancer become anaemic?

metastasis of cancer to bone marrow