Reproduction Flashcards
(187 cards)
1
Q
Which structures form the ‘walls’ of the pelvic cavity?
A
Superior - no real wall, continuous with abdominal cavity.
Inferior - pelvic diaphragm
Lateral - hips bones and obturator
Anterior - pubic bones + pubic symphysis
Posterior - sacrum + coccyx + piriformis muscle
2
Q
What are the 3 pairs of Pelvic apertures and what structures pass through them?
A
- Obturator foramen - for obturator nerve
- Lesser sciatic foramen - for perineal structures
- Greater sciatic foramen - literally everything else
3
Q
Which structures pass above the piriformis and which structures pass below?
A
Superior gluteal nerves and vessels pass through the greater sciatic foramen above the piriformis.
Everything else, including the inferior gluteal and sciatic nerves, passes below piriformis.
4
Q
What are the muscles of the pelvic wall?
A
Obturator internus and the piriformis (virtually horizontal). Both joint to greater trochanter of the femur. Obturator internus basically covers obturator foramen.
5
Q
Functions of the pelvic floor?
A
- Supports pelvic organs
- lift the floor to release feaces
- resist changes to abdo pressurisation - i.e so you don’t piss yourself when you cough
6
Q
What is the main muscle group of the pelvic floor, what muscles makeup this group and weakness in these muscles leads to what?
A
Levator Ani, made up by muscles with either pubo- or coccygeus in them. Weakness in this area can lead to incontinence.
7
Q
Which muscle of the levator ani is most important for me to know and what does it split into?
A
Pubococcygeus muscle - becomes the muscle that holds onto all the structures that pierce the pelvic floor and others. Puboanalis, pubovaginalis, puboprostatatis. Puborectalis is most important runoff as it controls fecal continence - like a sling.
8
Q
What are the two holes of the pelvic floor?
A
Urogenital hiatus and anal aperture.
9
Q
Where does the peritoneum end? What pelvic structures are covered in peritoneum?
A
The peritoneum does not cover the pelvic floor, it rests on the superior part of it. The only organ totally covered in peritoneum are the uterine tubes.
10
Q
The draped nature of the peritoneum over the pelvic floor forms what structures in females and males?
A
2 pouches in females: vescio-uterine pouch and recto-uterine pouch.
In males: recto-vesical pouch.
11
Q
The peritoneum is loose over which structure?
A
Bladder, to allow for expansion.
12
Q
Name the pelvic floor ligament I must know:
A
hypogastric sheath - all important structures must pass through.
13
Q
What unrelated structure could a hysterectomy damage?
A
The uterine vessels lie next to the ureters, so could damage them.
14
Q
Describe the blood supply of the pelvis.
A
The abdominal aorta turns into the common iliac artery which turns into the internal iliac which does pelvis and the external iliac which becomes the femoral artery.
The internal iliac then splits into posterior and anterior trunks.
Posterior - iliolumbar, lateral sacral, superior gluteal
Anterior - umbilical, internal pudendal (perineum) and middle rectal.
15
Q
Where do most perineal structures attach?
A
To the perineal body (gooch).
16
Q
List the layers of the anterior perineal triangle in order.
A
Skin, superficial fascia, deep fascia, superficial perineal pouch, perineal membrane, deep perineal pouch, muscles.
17
Q
Describe the erectile bodies in males and females.
A
Both of Corpus cavernosa.
Females then have clitoris and males have corpus spongiosim (continues as head of penis).
18
Q
Where are the external urethral sphincters?
A
These voluntary sphincters for voiding are present in the deep perineal pouch.
Males also have an involuntary internal urethral sphincter.
19
Q
What nerves supply the perineum?
A
The nerve is the pudendal nerve (S2-S4) which splits into all the rectal, perineal, penis nerves etc. Pudendal nerve exits greater sciatic foramen and renters pelvis through the pudendal canal - really interesting course.
20
Q
What arteries/veins supply the perineum?
A
Pudendal artery off the internal iliac, just follows the pudendal nerve.
Most empty into internal iliac vein.
Exception is penis dorsum which is the deep dorsal vein for.
21
Q
Where do testes empty their lymph?
A
Unlike other perineal structures which tend to do inguinal nodes, the testes empty into the para-aortic and lumbar nodes, so any pain (often not present) will present with abdo pain.
22
Q
What are the broad steps of oocyte/zygote growth.
A
- Ovulation
- Fertilisation
- Cleavage
- Morula - ball
- Blastocyst - hollow ball
- Implantation - after a week
- Gastrulation - germ layers
23
Q
What are the two divisions of the blastocyst before implantation?
A
Trophoblast (will become placenta) and inner cell mass (will become embyro)
24
Q
Explain Gastrulation
A
Starts with primitive streak.
Invaginates one end of the epiblast. Cells migrate through the invaginated groove between the epiblast and hypoblast (yolk) to form endoderm and then mesoderm. Remaining epiblast cells become ectoderm.
All cells will come from these layers except germ cells.
25
What is situs invertus?
Incorrect positioning of organs due to issue with left-right cilia of primitive node.
26
Which germ layer gives rise to the notochord?
Mesoderm.
27
What happens if the primitive streak does not disappear as the notochord forms?
Teratoma
28
Explain the formation and development of the neural tube and neural crest.
The neural tube is ectoderm that starts as neural plate and will become spine.
Neural crest are cells left out of the neural tube as it joins and they migrate to the sides and become the ganglia, melanocytes and schwann cells.
29
What structures does the ectoderm become?
CNS, melanocytes, epidermis
30
What structures does the mesoderm become?
Paraxial - somites (dermis, muscles, bones)
Intermediate - urogenital system
Lateral - heart, gut wall, vessels, some bones
31
What are the 3 embryonic stages of the kidneys?
1. Pronephros - disintegrates quickly
2. Mesonephros - embryonic kidney
3. Metanephros - becomes adult kidney
32
Explain the Wolffian and Mullerian tubules and which hormones are involved.
Embryonic kidney system starts off as Wolffian tube.
Wolfian tube needs testosterone to survive and needs AMH (anti-mullerian hormone) to kill Mullerian system (XY).
Mullerian duct grows in absence of testosterone and AMH (XX).
33
What structures does the endoderm become?
Digestive tube and respiratory structures.
34
Why do pregnant women take folate?
To help the neural tube grow properly
35
What can parvovirus cause congenitally?
Anemia, heart issues
36
Why does rhesus blood group matter in pregnancy?
If Mum is negative and baby is positive (from dad) can get autoantibodies. Would only be after first baby.
37
What are the screening options for pregnancy?
Combined screening (blood test for Hcg and Papp-A) and ultrasound for nuchal translucency)
OR
Non-invasive pre-natal testing (NIPT).
- checks fetus DNA in mums bloodstream
38
What are the diagnostic congenital genetic abnormality tests?
Amniocentesis and chorionic villous testing (CVT).
39
Which vital factors go up and down in pregnancy?
Due to increased fluid movement needs, CO (HR and SV) goes up. BV goes up for baby. As a result of all of the above, TPR goes down to try to mitigate pressure.
40
What molecules does the posterior pituitary release?
Oxytocin and ADH
41
Describe the meiotic stages in a female in terms of chromosomal number.
Meiosis 1 makes the secondary oocyte (2n) and the first polar body - done at ovulation. Second polar body will be shed on fertilisation to make the egg 1n.
42
What are the hormone 'stages' for reproductive hormones?
Hypothalamus - kisspeptin stimulates GnRH release.
Anterior Pituitary: GnRH stimulates LH and FSH.
LH will do the Leydig cells in men and the Theca cells in women.
FSH will do the Sertoli cells in men and the granulosa cells in women.
43
What is the path of sperm?
Testes --> Semeniferous tubules --> epydydimis (storage) --> ductus deferens (vas deferens) --> through prostate into urethra and up through corpus spongiosum.
44
Which 3 cell types do I need to know if the Seminiferous tubes and which layer are they in? What do these cells do?
Spermatogonia - progenitor cells for sperm
Sertoli cells - support sperm, make liquid to help them move, provide nutrients - in the same epithelial layer as the spermatogonia.
Leydig cells - in the outside interstitial layer - make testosterone after puberty.
45
What is Androgen Binding Protein and what does it do?
A molecule made by Sertoli cells to keep testosterone at a good level in the testes.
46
What feedback pathways are available in male reproduction?
All negative.
-Testosterone will turn off GnRH and LH/FSH.
-Inhibin from Sertoli cells will turn off FSH.
47
How many oocytes are made from a single follicle?
ONLY EVER 1
48
List the basic layers of the follicle in order
Innermost is the oocyte, then the granulosa cells, then the theca cells, then the surface epithelium.
49
When is a follicle mature?
It completes meiosis 1 and makes the first polar body (first ovulation).
50
What do Theca cells do and what do granulosa cells do?
Theca cells - make androgens
Granulosa cells - use aromatase to make estrogen
51
What are the 3 stages of the ovarian cycle?
- follicular phase, ovulation, luteal phase.
52
What happens in the follicular phase and what hormones are important?
Day 0-13.
All starts with FSH. FSH does granulosa cells, so they will start making estrogen.
Estrogen will inhibit LH/FSH from the pituitary but will have a positive feedback on the granulosa themselves.
FOLLICLE IS INDEPENDANT ESTROGEN FACTORY.
Note - one follicle will become dominant by using estrogen and inhibin to downregulate FSH to kill other active follicles.
53
What happens during ovulation and what hormones are important?
DAY 14.
Very high estrogen has built up.
LH and FSH surge due to progesterone levels having modestly built up).
Primary oocyte completes meiosis 1.
Egg breaks free and starts its journey after giving off its first polar body.
54
What happens during the luteal phase and what hormones are important?
Day 15-28.
It's mostly a game of progesterone.
The leftover follicular granulosa cells become the corpus luteum and becomes a progesterone factory.
Progesterone and estrogen grow the endometrium and inhibit virtually every other hormone.
These levels will be maintained if fertilised, if not, the corpus luteum will degrade and LH and FSH will rise again, restarting the process.
55
What are the uterine phases?
-Menses
- Proliferative phase (follicle developing)
- Secretory phase (starts at ovulation) - temp rises.
56
What functions does semen have besides carrying sperm?
- Neutralises the vaginal acid.
- it is pro-coagulatory to help sperm climb
- Prostaglandins to reduce cervical mucosal thickness
- has anti-immune properties
57
Which 3 structures create the semen?
1. Seminal vesicles - sperm motility, ph, fructose.
2. Prostate - enzymes
3. Bulbourethral glands
58
What changes happen during ejaculation and what nerve system is involved.
Parasympathetic for erection (vasodilates and compresses veins).
Sympathetic for ejaculation.
Bladder sphincter contracts to prevent backflow.
Ducts contract to release semen.
Peristalsis of urethral tissues.
RESOLUTION PHASE
59
What features of sperm specifically help it in fertilisation?
CAPACITATION
Enzymes in sperm head to erode egg.
Cortical reaction to prevent polyspermy
- there is only ever one sperm per egg. EVER.
60
Name 3 extra-embyronal features of a pregnancy.
Trophoblast becomes chorion, which becomes placenta.
Amnion is fluid.
Allantois becomes umbilical cord.
61
Where is HCG made?
In the chorion
62
Does the mum's blood mix with the baby's?
No. The Decidua of the endometrium is very close to the chorionic vessels of the placenta which allows for exchange without touching.
63
Which area takes on the role of the corpus lutuem as the estrogen/progesterone factory during pregnancy?
Chorion.
64
Which hormone lowers mum's glucose use during pregnancy?
Relaxin - so baby can use glucose.
65
What are the 3 stages of pregnancy, when do they occur and what are the biggest risks during these periods?
1. Early pregnancy (1-2 weeks).
- not susceptible to teratogens
- very susceptible to chromosomal/implantation issues
2. Embyronic stage (3-8 weeks)
- MOST susceptible to teratogens
3. Fetal stage -to term
- only minor abnormalities occur
66
Aside from cardio features, what other physiological changes occur during pregnancy?
Hunger but constipation, greater tidal wave in resp, GFR up in kidneys.
67
Which hormones prevent and promote first contractions?
Progesterone prevents, estrogen promotes.
High progesterone prevents early contractions.
68
Explain how contractions begin?
Baby drops low in uterus and pushes on cervix, stretching releases oxytocin which as positive feedback for contractions.
69
Which hormones grow breasts, create milk and release milk.
Estrogen grows boobs, prolactin makes milk, oxytocin releases milk.
Both estrogen and progesterone block prolactin - don't need milk during pregnancy.
70
What are the symptoms of an enlarged prostate?
Hesitancy, poor flow, poor emptying, double voiding, nocturia, frequency.
If bad - acute urinary retention.
71
Compare BPH to Prostatic adenocarcinoma on histology.
Both are prostatic glandular tissue.
BPH shows enlarged glands and lumens.
The basal layer of the glands will still be present.
Prostatic adenocarcinoma shows smaller than usual ducts, like donuts. The basal layer will be absent.
72
What are the typical locations of BPH vs prostatic adenocarcinoma and how does this impact the digital rectal exam?
BPE tends to grow peri-urethral - so it impacts urination more and won't be felt on a rectal exam.
Carcinoma tends to grow peripherally, so it is often felt on rectal exam.
73
Where does metastatic prostate cancer love to go?
Loves to form sclerosing lesions in bone.
74
Which infections can cause epidydmo-orchitis?
In kids - mumps
In young adults - chlamydia and gonnorhea
In adults - E.coli, Pseudomonas due to obstruction.
75
Name a key risk factor for testicular cancer and one for torsion?
Undescended testicle for cancer. (infertility also raises cancer risk).
Horizontal (bell clapper) testicle for torsion.
76
Which testicular cancers are common in young people and common in old people?
Seminoma in young, lymphoma in old.
77
Where do cervical cancers tend to develop?
The squamous and columnar junction - transitional zone.
78
Which histo features indicate HPV infection?
-bi-nucleation, white halo around nucleus, large nuclei.
79
Ovarian cancers may make which hormone?
Estrogen - eg. Thecoma (not Granulosa cell tumour though).
80
What is condyloma?
Warts
81
Post-coital bleeding is a red flag for which STI in females?
Chlamydia
82
Which signs are used to check for testicular torsion?
Prehn's sign - cupping balls should relieve pain unless it is torsion.
Positive - pain relief = epidydmitis
Negative = pain worse = torsion
Cremasteric reflex
- stroke inner thigh to see if scrotum raises
- if absent = torsion
83
Which STI's typically cause ulcers?
Painful = Herpes
Painless = syphilis stage 1
84
Syphilis phase 2 presents how?
Rash - palms of hands and soles of feet.
85
Which organisms cause prostatitis?
Urinary pathogens like E. coli.
86
List some AIDS defining illnesses
PJP, cryptococcus, CMV and HSV are worse, candida too.
87
What are the 3 points of constriction of the ureters?
1. Utero-pelvic junction
2. Crossing of the iliac vessels at the pelvic brim
3. Entrance to the bladder
88
Which structures cross anteriorly to the ureters in males and females?
The uterine artery in females, the ductus deferens in males.
89
What are the orientation points of the bladder?
Apex is at pub symphysis
Fundus is posterior surface
Base faces rectum (ureters enter here)
90
Which muscle makes up the smooth part of the bladder?
Trigone
91
What are the sections of the urethra in males?
Pre-prostatic, prostatic, (membranous), spongy.
92
Which structure stops sperm entering the bladder in males?
Internal urethic sphincter
93
Describe the structure of the rectum
Taeniae coli become smooth, has transverse rectal folds (flexures) and ends in ampullae for fecal storage.
94
What is the rectal blood supply?
1. Superior rectal - off inferior mesenteric
2. Middle rectal - off internal iliac
3. Inferior rectal - of pudendal - for anus
95
Which rectal vein empties into the portal system?
Superior rectal vein
96
What are the sections of the uterine tube?
I Am In Uterus
I - Infundibulum
2 - Ampullae - where fertilisation usually happens
3 - Isthmus
4 - Uterine
97
What are the 3 uterine layers?
1. Perimetrium
2. Myometrium (does contractions, most changed in pregnancy).
3. Endometrium - where blastocyst implants
98
The uterine broad ligament can be split into 3 parts, what are they?
Mesometrium, mesoalpinx (for tubes) and mesovarium (for ovaries).
99
Which ligament anchors the uterus to the body and where does it travel?
The round ligament, travels through the inguinal canal.
100
What is the relationship between the testes and the peritoneum?
They are abdominal structures, so they are intra-pertitoneal.
101
The ductus deferens ends its journey as what?
The ejaculatory ducts in the prostate (combine with seminal glands).
102
What is the best test for detecting chromosomal variations eg. insertions or deletions?
G-banded Karyotype
103
What is the best test for detecting copy number variants?
Chromosomal microarray/molecular karyotype
104
What is the best test for detecting changes within a gene? eg. nucelotide insertions
Sequencing - exome, genome etc.
105
What is the best test for detecting short tandem repeats (expansions)?
PCR
106
What are 'penetrance' and 'expressivity' in gene terms?
Penetrance - whether or not a trait shows up phenotypically
Expressivity - the level to which the trait shows up
107
What is WES and what are the positives/negatives of it.
Whole Exome Sequencing: it sequences all exons, for broad differentials, can detect nucleotide changes but can't detect chromosome/copy number stuff, repeats or mtDNA (whole genome sequencing can).
108
What is the most common genetic congenital disease?
Trisomy 21 - Down Syndrome.
109
In terms of Down Syndrome, what are the two time periods for screening tests?
First trimester - combined screening, blood and scan, nuchal translucency can only be done here, bloods most sensitive to Trisomy 21.
Second trimester screening (free) - not as good as above but has the advantage of being able to check the neural tube.
110
What are unbalanced vs balanced karyotypes?
Balanced - incorrect number of chromosomes the right amount of data - a part of the acrocentric chromosome has translocated to another chromosome. NORMAL PHENOTYPE.
Chromosomal description will have 'der' in it. (derivative).
Unbalanced - correct number of chromosomes but the translocation has still occurred so they have too much data, 3 copies of a chromosome but one of them is elsewhere in the karyotype.
ABNORMAL PHENOTYPE.
111
In the blood test for trimester 1 screening, explain the molecule marker partners for down syndrome.
HCG is raised and PAPP-A is low in down syndrome.
If both are low it might be trisomy 18.
112
In the blood test for trimester 2 screening, explain the molecule marker partners for down syndrome.
HIH LAO
High: Inhibin and HCG raised
Low: a-fetprotein and oestriol
113
What is the worst complication of primary congenital VZV infection, how might mum present and what is the treatment?
Mum could get pneumonitis and present with haemoptysis.
Baby can get developmental defects.
tx is VZIG if mum has no Ig and treat acyclovir.
114
Where does CMV famously spread and how can we test a pregnant woman for it?
Day care.
Igm sucks for CMV so we do IgG comparison to prior tests or do IgG avidity (crap avidity = new).
115
What is a special complication of CMV and what is the treatment?
Calcifications in the brain.
tx = ganciclovir
116
A pregnant woman presenting with lymphadenopathy and arthritis may have:
Rubella
117
How does parvovirus present and what can it cause congenitally?
Slapped Cheek - causes anemia and heart problems.
118
Which vaginal bacteria may cause peri-natal meningitis, sepsis or pneumonia?
Group B strep - S. agalctiae
119
Broad causes of breast lumps:
1. trauma - fat necrosis
2. inflammation - mastitis (breadt feeding infection)
3. Neoplasia
120
Most common benign breast neoplasm?
Fibroadenoma - similar description to lipoma. No increased risk of malignancy.
121
Which in-situ breast neoplasm do I need to know?
Ductal carcinoma in situ: high risk of cancer. looks like a basophil on histo. Can present with red, itchy, scaly nipple.
122
What is the biggest risk for breast cancer?
UNOPPOSED ESTROGEN - early menarche, late menopause, no kids, HRT, late pregnancy.
123
What is the go to treatment for most breast cancers?
Surgical removal.
124
What is the most common malignant breast cancer?
Invasive carcinoma of no special type (ductal).
125
How do we test for gonorrhea and what is the treatment?
First Pass urine or swab - PCR
Tx - Ceftriaxone and Azithromycin
126
What is the chlamydia lifecycle and does it grow on agar?
Life cycle:
Elementary bodies: infective
Reticular bodies: replicative
It is an OBLIGATE intracellular pathogen unlike gonnorhea so it won't grow on culture.
127
Which STI commonly causes Pelvic Inflammatory Disease?
Chlamydia
128
How do we test for and treat chlamydia?
First pass urine/swab - PCR
Tx - azithromycin
129
Treatment for trichomoniasis?
Metronidazole
130
What is the pathogen that causes syphilis, how do we detect infection and what is the treatment?
Treponema pallidum.
Detect treponemal (EIA) and non-treponomel antibodies (RPR) - latter tests damage (acute).
Tx - Inject Penicillin
131
Treatment for mycoplasma genitalium?
Doxycycline then Azithromycin.
132
What are the 3 main HIV gene segments and what do they code for?
env - envelope including gp120
gag - capsid, nucleocapsid, matrix proteins
pol - all the good shit like RT, integrase, protease
133
What is the HIV life cycle?
Attach, release, RT to cDNA, integration, transcription, splicing/translation, assembly, release via budding.
134
Describe HIV entry into cells.
gp120 binds to CD4 molecule on T-helpers, which causes a conformational change that exposes co-receptors such as CCR5 and CXCR4, these allows gp41 to bind and inject virus inside cell.
135
Which part of the HIV life cycle has the highest error rate?
RT to cDNA reverse transcription.
Mutation in env proteins makes vaccines especially hard
136
How can CD4s help HIV spread?
Not only do they migrate around the body and provide lifelong places to hide (memory cells), but the NF-KB pathway actually promotes HIV release.
137
Why does T cell infection make someone sick in HIV?
Sick T cells make other cell types shit at their job: macrophages, NKs, B-cells, neutrophils.
138
What are the 5 classes of HIV drugs?
Protease, Integrase, Entry, nucleoside RT inhibitors and non-nucleoside RT inhibitors.
139
What is a PUO?
Pyrexia of Unknown Origin - unexplained fever for 2-3 weeks.
140
Which temperature monitor is most accurate?
Ear probe
141
Name 2 risk factors for sepsis
spleen removal and neutropenia (eg. from chemo).
142
Typical PUO causes?
Infections: TB, subacute infection like subacute endocarditis, abscesses, HIV.
Cancers.
143
Which random bacteria can cause PUO due to HIV infection?
Mycobacterium avium
144
Which organism is the biggest worry for febrile neutropenia?
Pseudomonas auregionosa.
Also loves burns, hospitals and cystic fibrosis.
145
Which virulence factor is key for Pseudomonas?
BIOFILMS (quorum sensing)
146
What are some key physiological impacts of estrogen aside from reproductive factors?
1. Inhibits bone resorption
2. Increases blood coagulability
3. Aids in creating progesterone receptors
147
Which drug is a full agonist for estrogen receptors and what would it be used for?
Oestradiol (literally just estrogen itself).
used in kids for hypogonadism.
used in adults for menopause, contraception, amennorhea, osteoporosis.
148
What are complications of estrogen agonists?
HTN, coagulability, reproductive cancers (though may actually be protective against endometrial cancers).
149
Side effects of estrogen antagonists? Why would we use these?
To treat things caused by estrogen, namely cancers.
Side effects: menopause, endometrial cancer, thrombosis.
TAMOXIFEN
150
Impact of aromatase inhibitors?
Totally shut off estrogen production, works to solve cancer risk but will cause menopause, osteoporosis etc, worse than tamoxifen.
151
What are some side effects of elevated testosterone?
In kids: epyphyseal plate stops growing, premature sexual maturation.
Females: acne, hirsutism.
Males: impotence, low sperm, gyno.
Athletes: liver damage, psychosis, CVD, high LDL.
152
Which medications involve testosterone directly and what are they used for?
Testosterone Receptor antagonists - used for prostate cancer.
5a reductase inhibitor - used for baldness and BPH.
153
Which STIs are on the rise in Australia and which are on the decline?
Decline: HIV and HPV
Rise: literally everything else
154
3 ways to reduce R-naught of a disease?
Infectivity (protection), protect the susceptible (reduce partners), reduce infection duration (treat early).
155
What is the difference between sterilisation and disinfection?
Disinfection is reducing/clearing as many organisms as possible.
Sterilisation is trying to kill all of the organisms.
156
What is the typical blood collection regime for most infections, what is the exception?
Typically will collect 3 lots of bloods 30 minutes apart from each other (before treatment) when an infection is suspected due to potential episodic shedding. The exception are CNS infections such as meningitis which must receive empirical treatment immediately.
157
What disease does C. diff cause and what 3 features are needed to diagnose it?
Pseudomembranous colitis.
Need: toxins, bacteria, symptoms.
158
Risk factors for cervical cancer:
early sex, many partners, sex with men with many partners
159
Which HPV strains cause cancer and which cause warts?
16 and 18 cause cancer, 6 and 11 cause warts.
160
What is the grading system of cervical biopsies, explain.
the CIN system.
CIN 3 = 3/3 (all) of epithelial layer shows dysplasia. = high grade (bad).
161
Why do pathologists check multiple cell types are present in a cervical biopsy?
Need to check both squamous and columnar are present to show it is the transition zone.
162
How can we divide causes of testicular lumps and what are some examples?
Tender: torsion or epidydmo-orchitis.
Non-tender: any type of coele, cancer or hernia.
163
When is the ideal time to biopsy a testicular lump?
NEVER. We NEVER biopsy testicular lumps due to risk of seeding.
164
What cancer markers are used for testicular cancer and list which conditions are indicated by their rise.
AFP and HCG (both also in down syndrome trimester 2 test).
If AFP only is really high: yolk sac tumour
If HCG us up only - Chorionoma (remember Hcg if made by chorion)
If both are up: embryonal carcinoma
If HCG is slightly up - may be seminoma.
If nothing is up - could be another cause or could be a seminoma or teratoma.
165
Describe endometriosis macro presentation and histo presentation
Macro: powder burn presentation and haemorrhage. If in ovary - chocolate cyst.
Histo: glandular tissue but stroma is sort of swirly.
166
What imaging is used for potential prostate cancers?
TRUS - trans rectal ultra sound (makes sense. as prostate hides behind rectum.
Think Liz TRUS was cancerous.
167
What is the most common prostate cancer?
Prostate adenocarcinoma - small donuts on histo.
168
What is the biggest risk factor for uterine cancer?
Endometrial hyperplasia
169
Why is a frozen section done of endometrial biopsies?
To check for outer myometrium spread - bad prognosis, will remove nearby lymph nodes in same surgery.
170
What is IgM rheumatoid factor?
Ability of IgM to bind to IgG and form immune complexes.
Can cause false positives in an ELISA as the complex could take the place of the antigen.
= CROSS REACTING IGM
171
Will someone with chronic HBV have surface antibody to HBV?
No, it will not show up on tests. If it is present it is mopping up the antigen still being produced.
172
What diseases can rubella cause congenitally?
The rubella triad - deafness, blindness, heart disease.
173
Where is the neurovascular supply of the ovary located?
the suspensory ligament of ovary
174
Which lymph nodes do the scrotum flow into?
DON'T CONFUSE WITH TESTES.
Scrotum use superior inguinal nodes
175
What is the most anterior pelvic muscle? most posterior?
Puborectalis - anterior
coccygeus - posterior
176
What condition can cause white/grey discharge of the nipple?
mammary duct ectasia
177
Where does the pudendal nerve exit the pelvis?
Greater sciatic foramen inferior to the piriformis
178
What can cause a non-translucent testicle?
Typically blood.
Heamatocele = due to trauma
Varicoele - unknown cause
179
What malignant potential does BPH pose?
zero.
180
What score is used for grading prostate tumours?
Gleason score
181
Which congenital infection causes hepatosplenomegaly?
Syphilis
182
Which congenital infection causes purulent conjunctivitis?
Gonorrhea
183
Which congenital infection causes deafness?
CMV
184
Which congenital infection causes hydrops fetalis and anemia?
Parvovirus
185
Which lymph nodes does the ovaries drain to?
Same as testes - para-aortic
186
Leiomyomas arise from what tissue?
Smooth muscle
187
Raisin looking cells on histo/cytology are evidence of what cervical grade neoplasia?
CIN1
