Reproduction Flashcards
(239 cards)
1
Q
What do the Sertoli cells do?
A
Spermatogenesis
2
Q
What do Leydig cells do?
A
Secrete Androgens
3
Q
What are he cell types of the testis and what do they do?
A
Sertoli - spermatogenesis
Leydig - Androgen production
4
Q
Where in the ovaries are the oocytes matured?
A
Stromal tissue
5
Q
What do follicular cells in the ovaries do?
A
Secrete oestrogen and progesterone
6
Q
What does FSH stimulate (M and F)?
A
M - Sertoli cell, F - follicular development
7
Q
What does LH stimulate (M and F)?
A
M - Leydig cells, F - Ovulation
8
Q
When is puberty?
A
F = 9-14 M = 10-16
9
Q
What stages of oogenesis happen before birth?
A
Primordial germ cells into oogonia where it undergoes mitosis. Matures into primary oocyte.
10
Q
What happens to the primary oocyte at ovulation?
A
Meiosis 1. It becomes a secondary oocyte and releases the first polar body containing ‘waste’ chromosomes
11
Q
What happens to the secondary oocyte at fertilisation?
A
Meiosis 2 - becumes an ovum and releases the second polar body
12
Q
Which are 2n and which are n?
Primordial germ cell, oogonia, primary oocyte, secondary oocyte, ovum
A
2n = Primordial germ cell, oogonia, primary oocyte n = secondary oocyte, ovum
13
Q
What effects does oestrogen have?
A
Contracts fallopian tubes
Mucus in cervix softens
Fluid retention in kidney
14
Q
What effects does progesterone have?
A
Breast development
Mucus in cervix hardens
Increased body temperature
15
Q
What happens in the pre antral stage?
A
Primordial follicle > primary follicle
16
Q
What happens in the antral stage?
A
Follicular development
Oestrogen surge, LH receptors increase on granulosa cells
17
Q
What happens in the Pre - ovulatory stage?
A
Progesterone secretion starts
18
Q
What happens in the ovulatory stage?
A
LH surge causes follicle rupture
19
Q
What happens in the luteal stage?
A
Follicle becomes corpus luteum and secretes progesterone and some oestrogen. It is dependent upon LH.
20
Q
What are the stages of the menstrual cycle?
A
Preantral, antral, pre-ovulatory, ovulatory, luteal
21
Q
What happens to the hormones if there is NO pregnancy at the end of the cycle?
A
LH decreases, corpus luteum breaks down = decreased progesterone = endometrium breaks down
22
Q
What happens to the hormones if there is a pregnancy at the end of the cycle?
A
Foetus releases HCG which acts on LH receptors to sustain the corpus luteum for 10-12 weeks until the placenta takes over.
23
Q
What receptors does HCG work on?
A
LH receptors
24
Q
Just before ovulation, what is there a surge of?
A
Oestrogen
25
At ovulation, what is there a surge of?
LH
26
What does a surge in LH do?
Causes a follicle to rupture to release an egg
27
What is the difference between spermatogenesis and spermiogenesis?
```
Spermatogenesis = spermatagonium > (primary, secondary and haploid) Spermacytes
Spermiogenesis = Spermacytes > Spermatids > Spermatazoa
```
28
What is the progression from Spermatogonia to mature sperm?
Spermatogonium > diploid spermatagonia > primary spermatocytes > secondary spermatocytes > Haploid spermatocytes > differentiation spermatids > Mature sperm and residual bodies.
29
What is spermiation?
The release of sperm from Sertoli cells
30
Which sperm precursors are 2n and which are n?
```
2n = Spermatogonium, diploid spermatagonia, primary spermatocytes
n = secondary spermatocytes, Haploid spermatocytes, differentiation spermatids, Mature sperm
```
31
What % of sperm are normal?
4%
32
How many sperm are produced per day?
300-600 million
33
What features do sperm have to help them?
Acrosome, mitochondria, flagella containing microtuules
34
Where is sperm stored?
Epididymus
35
Where are the Sertoli cells found?
Seminiferous tubules
36
Where does the sperm go from the seminiferous tubules?
Sem tubules > rete testis > epididymus > ductus deferens > Urethra
37
Where is fluid reabsorbed in the male repro tracts?
Epididymus
38
What 'defence' does the female tract have against sperm?
Acidic vagina, cervical mucus
39
What stages do the sperm undergo in the female tract?
Capacitation - Follicular fluid causes sperm to be stripped of its glycoprotein to make it more motile
Acrosome reaction - Pores generated in the acrosome to allow chemoattraction to the egg.
40
What is capacitation?
Capacitation - Follicular fluid causes sperm to be stripped of its glycoprotein to make it more motile
41
What is the acrosome reaction?
Pores generated in the acrosome to allow chemoattraction to the egg.
42
What is polyspermy?
More than one sperm getting in to the egg at once
43
What defences are there to stop polyspermy?
Fast block - ion channels change membrane potential
| Slow block - ZP3 receptors break down zona pellucida which causes it to harden.
44
What is the Zona Pellucida
Glycoprotein membrane surrounding an oocyte
45
What are ZP3 receptors and where are they found?
Sperm receptors on the Zona Pellucida
46
What does the rete testis do?
Connects seminiferous tubules to ducts
47
Why does a vasectomy not cause fluid build up?
Fluid reabsorbed in epididymus
48
What happens to the sperm in a male who has had a vasectomy?
Destroyed by phagocytosis
49
What is infertility?
Inability to concieve after 1 year of trying
50
How many lobules in a testicle?
About 250
51
Where in the testis does sperm collect?
Rete testis
52
What are the layers of the tunica of the testes and what do they do?
The tunica vasculosa is the inner layer (blood vessels and CT)
Tunica albuginea is a dense layer of tissue - creates partitions between seminiferous tubules
Tunica vaginalis - visceral and parietal layers (reduces friction between the testes and the scrotum)
53
What happens if there is xs fluid between the layers of the tunica vaginalis?
Hydrocele
54
What are the contractile cells in the testes called?
Myoid cells
55
What do the seminal vesicles secrete?
AA, fructose etc. to nourish sperm
56
What joins together to form the ejaculatory duct?
Ductus deferens and seminal vesicles
57
What cell type is in the ductus deferens?
Columnar cilliated
58
What is special about the lumen of the ductus deferens?
Star shaped
59
How many muscle layers does the ductus deferens have?
3
60
What does the prostate do?
Secretes prostatic fluid (fluid component of semen)
61
What is the arterial supply to the prostate?
Prostatic arteries
62
What is the venous drainage of the prostate?
Prostatic veins to the internal Iliac
63
What is the sympathetic innervation to the prostate?
Inferior hypogastric
64
What is the parasympathetic innervation to the prostate?
Pelvic splanchnics
65
What are the bulbourethral glands?
Secretes milky and alkaline secretions before ejactulation, to clear and lubricate urethra
66
What are corpora cavernosa and how do they work?
Fill with blood to cause an erection - allows penis to become turgid because it is restricted by tunica albuginea
67
What are the 3 parts to the male urethra?
Membranous, prostatic and penile
68
What is corpus spongiosum?
Spongy tissue around the urethra which prevents obstruction to urethra during erection
69
What is the somatic nerve supply to the penis?
S2 - S4 (pudendal)
70
What is the parasympathetic supply to the penis and what is it responsible for?
S2- S4
| Vasodilation, prostate and bulbourethral secretion
71
What is the sympathetic supply to the penis and what is it responsible for?
L1-L2
| Contraction to cause ejaculation
72
What is detumescence?
After ejaculation when the penis becomes flaccid again
73
What are the embryological stages of the kidneys?
Pronephros
Mesonephros
Metanephros
74
How do testes form in utero?
Genital ridges -> Primitive sex cords -> cords penetrate medulla = Medullary cords -> primative germ cells develop around here under the influence of testosterone from the Leydig cells
75
How do ovaries form in utero?
Genital ridges -> Primitive sex cords -> cluster together in medulla but then disappear and are replaced with vascula stroma
Follicular cells form
76
What are the 2 ducts involved in the embryo repro tract called?
Mesonephric ducts and Paramesonephric ducts
77
What happens to the Mesonephric ducts and Paramesonephric ducts in males?
Mesonephric - seminal vesicles, epididymus and ductus deferens
Paramesonephric - degenerates
78
What happens to the Mesonephric ducts and Paramesonephric ducts in females?
Mesonephric - degenerates
| Paramesonephric - Meets in midline to form uterine cavity and the fallopian tubes
79
How does the vagina form in utero?
```
Wk 4-7
Cloaca divides into urogenital sinus and anal canal, separated by urorectal septum
Sinovaginal bulbs (from paramesonephric ducts) become vaginal fornices at 5 months
```
80
How does the male external genitalia form in utero?
Genital tubercle (from cloaca) > Phallus
Urethral folds > Penile urethra
Genital swellings > Scrotum
81
What is hypospadia?
Urinary meatus in the wrong place?
82
What do testes follow when they descend?
Gubernaculum
83
How does the female external genitalia form in utero?
Genital tubercle (from cloaca) > Clitoris
Urethral folds > labia minora
Genital swellings > labia majora
84
What methods of combined contraception are there?
Combined Oral contraceptive pill (Mono - Zoely, quad - Qlaira)
Transdermal patch - Evra
Vaginal ring - Nuvaring
85
What are the contraindications of the COCP?
Smoking, overweight, over 35, migraines, CVD
86
What are the S/E of COCP?
clots, nausea, sodium and water retention
87
What are the single hormonal contraception methods?
Progesterone only Pill (Norethisterone)
Subdermal implant
Injectable progesterones
IUS (Mirena) - Levonorgestrel
88
What are the S/E of single hormonal contraception?
Amenorrhoea, nausea, sodium and water retention, fat deposition
89
What are the non hormonal contraceptive methods?
IUD - copper coil (only for fit and healthy!)
Barriers
Sterilisation
Natural family planning
90
What are the side effects of the IUD?
heavy, painful periods, increased discharge
91
What are the emergency contraceptives?
1. Ulipristal (120h)
2. Levonorgestrel (72h)
3. Copper coil
92
What is the Fraser guidance?
For under 16s or vulnerable under 18s
```
Understands
Parents
Sex - going to do it anyway
Suffer without help
Interest - in their best interest
```
93
What does the DSM use to describe PMS?
1987 - Late luteal phase dysphoric disorder - depressive condition
94
Where is cervical cancer most likely to occur?
On the transition between stratified squamous ectocervix and simple columnar endocervix
95
What is the most common type of cervical cancer and what is it caused by?
Squamous cell carcinoma - HPV
96
What hormone increases the chances of endometrial cancer?
Oestrogen
97
What is a Leiomyoma?
Benign smooth muscle tumour/fibroids
| NOT THE SAME AS LEIOMYOSARCOMA
98
What are the types of Leiomyoma?
Subserosal, intramucosal, submucosal
99
What are the symptoms of Leimyoma?
Abnormal bleeding, miscarriage risk, inc postpartum haemorrhage.
100
What is endometriosis?
Presence of endormetrial tissue in other places - bleeds and shed as usual = pain and damage to fallopian tubes
101
What are the 2 subclasses of Testicular germ cell tumours?
SEMINOMA and NONSEMINOMATOUS
102
What are some examples of a nonseminomatous germ cell tumour?
Teratoma, embryonal carcinoma
103
How do testes tumours present?
Testicular lumps
| Mets - more common as men often won't see a GP about testes lumps.
104
What might a Leydig tumour secrete?
xs Androgens - Precocious puberty or masulinising effects in females
Oestrogen - Gynacomastia
105
What type of tumour is a prostate tumour?
Usually Adenocarcinoma
106
Where do prostate tumours often metastasise to?
Bone
107
What are the 3 criteria for PCOS?
Polycystic ovaries
Inc Androgen signs
Oligoamenorrhoea
108
What is the difference between primary and secondary Amenorrhoea?
Primary - never started
| secondary - stopped
109
What does the progesterone test for PCOS show?
If they bleed, then there was oestrogen present, which makes PCOS are possibility.
110
What might a negative progesterone test but high FSH and LH suggest?
Ovarian failure, no ovaries, menopause
111
What might a negative progesterone test and low FSH and LH suggest?
Pituitary failure, hypothalamus failure
112
What are some causes of pituitary failure?
Tumour, infarction, idiopathic
113
What may cause hypothalamus failure?
Trauma, weight loss, stress, exercise
114
What are some risk factors for PCOS?
Obesity, DM2, family history
115
What happens during Meiosis 1 (female)?
Nuclear membrane breaks and chromosomes separate
116
What is syngamy?
The fusion of the oocyte and sperm's pronuclei
117
What is the fusion of the oocyte and sperm's pronuclei called?
syngamy
118
What is a blastocoel?
A morula (ball of cells) with fluid in the middle, restricted by Zona Pellucida
119
What is hatching (zygote)?
ZP thins, blastocoel enlarges and eventually splits into 2.
120
When is the implantation window?
Day 19-24
121
What are the risk factors for a pregnancy of unknown location?
previous ectopic, PID, over 40, IVF, smoking
122
What is a trophoblast?
Layers of blastocysts which make up the placenta
123
What is trophoblastic disease?
Trophoblasts invade endometrium and prolieferate excessively
124
What are the 2 types of trophoblastic disease and what is it caused by?
Partial - 2 sperm enter egg
| Complete - Only half the chromosomes are availible
125
What is a choriocarcinoma?
A malignant tumour of the trophoblast
126
What methods are there to treat infertility?
```
Ovulation induction
Insemination
IVF
ICSI (Intracytoplasmic sperm injection)
Fertility preservation
```
127
What ways are there of prenatal diagnosis?
Chorionic villus sampling
Amniocentesis
FISH
Anomaly scan
128
What is the difference between a diagnostic test and screening?
Diagnostic - accounts for signs/symptoms
| Screening - Cohorts or high risk groups, no path needed.
129
What is cascade screening?
Systematically approaching relatives of patients with genetic disorders for screening.
130
What is empirical risk?
An averaged risk based upon observed recurrence when cause is unknown.
131
When is hyperemesis gravadium most common and what might be a problem which arises because of it?
5-6 weeks into pregnancy
| Dehydration
132
What antiemetics may be given to a woman with morning sickness?
Domperidone
133
What is TTTS?
Monochorionic twins. Veins to arterial anastamoses = unbalanced blood flow.
134
What metabolic changes are seen in a mother during pregnancy?
Protein and fat reserves increase. Maternal tissue becomes insulin resistant in late pregnancy to allow more glucose to foetus.
135
What cardiovascular changes are seen in a mother during pregnancy?
Increased uterine flow
NO causes vasodilation = dec. TPR = inc CO
Slight dec in MABP
136
What renal changes are seen in a mother during pregnancy?
Increased plasma volume to help remove foetal waste (fluid retention and thirst)
Decrease in osmoreceptor threshold to prevent ADH decline to keep volume up!
Inc GFR
Dec. Hb conc.
137
What respiratory changes are seen in a mother during pregnancy?
Inc O2 delivery
Inc tidal volume - mild resp alkalosis
Anaemia risk due to dec. conc as a result of high blood volume.
More 2,3, DPG to displace O2
138
What to IGFs stimulate in foetal life?
DNA and cell division
139
What is measured in an ultrasound?
Crown to rump length
Femur length
Abdominal circumference
Head circumference
140
What is macrosomia?
Birthweight in the 95th centile
141
What is IUGR?
Birthweight below 10th centile
142
What causes IUGR?
Placental insufficiency
Chronic disease
Drugs and toxins
143
What are the 2 types of IUGR?
Symmetric - slow to develop, early gestation
| Asymmetric - late gestation, weight restriction then length restriction.
144
What is the placenta formed from?
Embryonic trophoblast cells
Cytotrophobasts - unicellular
Syncyticotrophoblasts - multicellular, main barrier between mother and foetus.
145
How does the placenta form (in each trimester)?
1 - villi containing capillaries from cytotrophoblasts invade spiral arteries
2 - Villi branch out
3 - Villi mature and capillaries dilate
146
What happens if there aren't enough chorionic villi?
Stunted placental development
147
What happens if there is poor cytotrophoblast invasion?
Pre eclampsia
148
How does IgG cross the placenta and why?
Passive immunity to foetus.
IgG binds to Fc receptor, internalised, Endosome transcytosis, released on other side, receptor recycled.
149
Can Cortisol cross the placenta?
No
150
Can Insulin cross the placenta?
No
151
Can Anaesthetics cross the placenta?
Yes
152
What is folate needed for in pregnancy?
DNA synth and cell division
153
What is vit D needed for in pregnancy?
brain development, immune system, bone mineralisation
154
What is Iodine needed for in pregnancy?
neuro development
155
Which hormones relax the uterus?
progesterone, relaxin, NO
156
Which hormones stimulate contractions of the uterus?
Oestrogen, Oxytocin, PGs
157
What role does PGE2 play in labour?
Potentiates Oxytocin
158
Where is PGE2 from?
Decidua and foetal membranes
159
What happens during cervical ripening?
PGE2 changes collagen fibres
| Relaxin is released
160
What helps the foetus engage?
Braxton Hicks
161
What happens in the first stage of labour?
Cervix dilates, amniotic sac ruptures
Latent phase - slow dilation (to 3-4cm)
Active phase - fast dilation (to 10cm)
162
What is brachystasis?
muscle cells contract but don't return to their full length
163
What happens in the second stage of labour?
Expulsion
164
What happens in the third stage of labour?
Placenta delivery
165
What causes the start of labour?
Cortisol from the foetus causes decreased progesterone and increased oestrogen.
Cortisol also stimulates Corticotrophin releaseing hormone (CRH) to be released from the placenta which allows PG release
166
How do oxytocin and PGs work?
Activates GPCRs and causes calcium release which binds with calmodulin to cause actin-myosin complexes.
167
What tocolysis drugs are there?
DINOPRISTONE - mimics PGs
| Synthetic oxytocin
168
When is the perinatal mortality period?
24wks gestation to 1 week after birth
169
What problem to the foetus may be caused by strong contractions?
Blood vessel compression = foetal distress
170
What risks are there to the mother during childbirth?
Perineal tears
Haemorrhage
Severe pain
171
What analgesia is available during childbirth?
ENTONOX
FENTANYL
PETHIDINE
BUPIVACAINE
172
What drugs prevent post partum haemorrhage?
Oxytocin
ERGOMETRINE
MISOPROSTOL
173
What would you give to treat Herpes?
ACICLOVIR
174
What would you give to treat Gonorrhoea, Chlamydia and Urethritis?
AZITHROMYCIN
175
What would you give to treat Syphylis or HPV?
PENECILIN
176
What are some features of HIV?
Glycoprotein envelope, 2 single DNA strands, reverse transcriptase
177
What are some symptoms of HIV?
fever, lethargy, rash, headache, lymphadenopathy
178
What are the methods of antiretroviral treatments?
Inhibit reverse transcriptase
| Inhibit viral protease
179
What is a teratogen?
A drug which causes permanent structural change to foetal organs
180
When is the critical period for teratogenicity?
18-55 days
181
What would you need to do to the loading dose and the maintenance doses of a drug in pregnancy?
Increase both
182
What is preterm?
Before 37 weeks gestation
183
What is placental abruption?
Placenta separates from the wall so the foetus has no blood supply
184
What are the symptoms of pre-eclampsia?
Hypertension, proteinuria, vascular organ damage
185
What is early neonatal death?
Death during first week of life
186
What is late neonatal death?
Death in the first month of life
187
What causes preterm births?
Spontaneous
Infection
Ruptured membranes
Cervical insufficiency
188
How do you manage a potential pre-term?
BETAMETHASONE - mature foetal lungs
Tocolysis (NIFEDIPINE, ATOSIBAN)
Provide good location for birth
treat infection
189
What is surfactant, what is it made of and where is it from?
Lipoproteins from type 2 pneumocytes - prevents alveolar collapse.
DPCC, SPA, SPB, SPC, SPD
190
Where do the alveoli in breasts drain?
lactiferous ducts > lactiferous sinus > nipple
191
What do mammary glands do?
hormonal control - prolactin
192
What is PIH?
Dopamine, inhibits prolactin secretion from pituitary
193
Where does lymph from the breast drain?
Subareolar plexus
Axillary nodes
Parasternal nodes
194
What is the arterial supply to the breast?
Internal thoracic
Lateral thoracic
thoracoacromial
195
What is the venous drainage of the breasts?
Superficial venous plexus (around areola) to axillary vein
196
Does Oestrogen inc or dec PIH?
increase
197
What does progesterone do to prolactin receptors?
Decreases them
198
What happens to levels of Oestrogen and Progesterone after birth?
They fall
199
What is galactopoiesis and what is it stimulated by?
sustained prolactin = milk secretion
| Stimulus = suckling
200
Which hormones help milk let down?
Oxytocin - contraction of myoepithelial cells
201
What drug supresses lactation?
BROMOCRIPTINE
202
What drug stimulates lactation?
DOMPERIDONE
203
What is in breastmilk?
fat, AA, lactose, vit D, Iron
204
How does lactational amenorrhoea come about?
xs prolactin = dec. GnRH = dec. FSH and LH
205
What is Galactorrhoea?
milk production without pregnancy (pit tumour)
| - Witchs milk
206
Why is cows milk not suitable before 12 months?
Too high sodium
207
When should you ween a baby?
4-6 months
| Some foods later (wheat, eggs, fish etc.)
208
What is allometric growth?
Growth where proportion changes
209
What is the decidua?
modified endometrium where the conceptus implants - the bulge of decidua around it becomes the placenta.
210
What are the layers of the decidua?
Decidua basalis, decidua capsularis, decidua parietalis
211
What is catch up growth?
Rapid growth, faster than normal - stops when appropriate centile is reached.
212
What are the 4 stages of Piaget?
0-2 sensory motor
2-7 preoperational
7-12 concrete operational
12-19 - formal operational
213
What are the types of attachment?
Secure
Resistant
Avoidant
214
When is puberty precocious?
F - before 8
| M - before 9
215
What is the problem with precocious puberty?
```
Bones fuse (short stature)
Psychological
```
216
What might cause precocious puberty?
Obesity, genetic, hypothyroidism, CAH, cushings, ovarian cysts etc.
217
What is thelarche?
Onset of breast development
218
What is adenarche?
onset of pubic hair, acne, sweat etc.
219
When is menopause 'early'?
Before 40
220
What is the average age for the menopause?
52
221
What is the menopause?
The final period
222
IN what period does the menopause occur?
Climacteric period
223
What is the Climacteric period?
The transition between fertile and infertile states
224
What is given to reduce the symptoms of the menopause?
HRT
225
What are the characteristic features of cancer?
Angiogenesis
Uncontrolled proliferation
mets
Ignores apoptosis signals
226
What treatments are there for cancer?
Chemo, Radio, Surgery, hormonal treatment
227
What is the triple assessment for breast cancer?
Imaging
Needle aspiration
cytology
228
What is penetrance?
The change of the disease if a mutation is present
229
What is MEN2?
A protooncogene which predisposes for a lot of cancers
230
What gene mutation is significant for breast cancer?
BRCA1 BRCA2
231
How do cancer cells resist drugs?
Reduce uptake
Increase efflux
Alter drug targets
Increased repair activity
232
Why do we use cancer drug combos?
Reduce resistance
233
What are the rules regarding cancer drug combos?
Different mechanism and different target.
234
What are the classes of cancer drugs?
```
Direct DNA
Antimetabolites
Microtubule function
Protein Synthesis
Biologicals
```
235
Name some Direct DNA drugs.
```
Alkylating agents - CYCLOPHOSPHAMIDE
Platinum compound - CISPLATIN
Cytotoxic antibiotics - DOXORUBICAN
Topoisomerase 1 inhibitor - TOPETECAN
Sex hormones - TAMOXIFEN, ANASTRAZOLE
```
236
Name the cancer antimetabolites.
Folic acid antagonist - METHOTREXATE
HYDROXYUREA
5 FLUOROURACIL
237
Name a microtubule cancer drug.
VINCRISTINE
238
Name a protein assembley cancer drug.
ASPARAGINASE
239
Name a biological cancer drug.
HERCEPTIN
