Reproductive System Flashcards
(601 cards)
1
Q
What are the female secondary sexual characteristics?
A
Enlargement of breasts Growth of body hair Greater development of muscle behind the femur Widening of hips, lower waist-hip ratio Smaller hands and feet Rounder face Smaller waist More subcutaneous fat Fat deposits in the buttocks, thighs, and hips
2
Q
What is the urogenital ridge?
A
A region of intermediate mesoderm giving rise to the embryonic kidney and gonad.
3
Q
Describe the migration of primordial germ cells.
A
Arise in the wall of the yolk sac and migrate to the retro peritoneum, travelling along the dorsal mesentry before arriving at the indifferent gonad. They then populate the mesodermal stroma.
4
Q
What causes retro peritoneal germ cell tumours to form?
A
They arise if the germ cells fail to migrate properly
5
Q
What genes on the Y chromosome allow development on the male reproductive system?
A
SRY
6
Q
Describe the tunica albuginea of the ovaries.
A
A thin layer of connective tissue surrounding the ovary.
7
Q
Describe the tunica albuginea of the testis.
A
A dense fibrous covering of the testis, which is covered by the tunica vaginalis
8
Q
Describe the differentiation of the mesonephric duct in males.
A
The ureteric buds and mesonephric ducts make independent openings in the urogenital sinus. The duct then forms the prostate and prostatic urethra.
9
Q
Describe the differentiation of the mesonephric duct in females.
A
It regresses so the ureteric buds alone enter the urogenital sinus.
10
Q
What cells produce mullerian inhibiting substance?
A
Leydig cells of the testis
11
Q
What is the function of mullerian inhibiting substance?
A
Force regression of the paramesonephric ducts in males
12
Q
Describe differentiation of the paramesonephric ducts in females.
A
Grow and enlarge, drawing together to form the uterus and Fallopian tubes. The paramesonephric ducts and sinus create inductive events, causing the tissue of the sinovaginal bulbs to differentiate and form the vagina, fornix, and hymen. The uterine septum regresses as the cervix forms.
13
Q
Describe uterus didelphys.
A
2 uterus and 2 vaginas form, resulting from a complete lack of fusion of the paramesonephric ducts.
14
Q
Describe uterus bicornis.
A
2 separate uteri which join at the cervix and have a common vagina. Caused by a failure of the paramesonephric ducts to fully fuse.
15
Q
Describe uterus arcuatus.
A
An indentation at the top of the uterus
16
Q
Describe uterus bicornis unicollis.
A
Complete or partial atresia of one paramesonephric duct, with the rudimentary part lying as an appendage.
17
Q
Describe cervical atresia.
A
Atresia in both paramesonephric ducts
18
Q
Describe vaginal atresia
A
The sinovaginal bulbs don’t develop. Small vaginal pouch at the opening of the cervix.
19
Q
Describe a double vagina.
A
Sinovaginal bulbs fail to fuse.
20
Q
What are the male secondary sexual characteristics?
A
Growth of body hair Greater mass of muscles in front of the femur Growth of facial hair Enlargement of the larynx (Adam's apple) Deeper voice Increased stature Heavier skull and bone structure Increased muscle mass and strength Larger hands, feet, and nose Square face Small waist but wider than females Increased secretions from oil and sweat glands Less subcutaneous fat Higher waist-to-hip ratio Lower body fat percentage
21
Q
What are the caudal and cranial attachments of the paramesonephric ducts before differentiation?
A
Caudally - cloaca
Cranially - abdominal cavity
22
Q
Describe the external undifferentiated genitalia in an embryo.
A
Genital tubercle
Urogenital sinus opening, surrounded by the genital folds, with genital swellings on either side.
23
Q
Describe the differentiation of the external genitalia in males.
A
The genital tubercle elongates and becomes the glans penis.
The genital folds fuse to form the spongy urethra
The genital swelling becomes the scrotum.
This occurs under the influence of dihydrotestosterone.
24
Q
Describe hypospadus.
A
Fusion of the urethral folds is incomplete so abnormal openings can form on the ventral surface of the penis.
25
Describe epispadus.
The urethral meatus is found on the dorsum of the penis.
| It is often associated with extrophy of the bladder.
26
Describe the differentiation of the external genitalia in the female.
The genital tubercle becomes the clitoris
The genital fold becomes the labia minora
The genital swelling becomes the labia majora
No fusion occurs due to the lack of androgens, and the urethra opens into the vestibule.
27
Describe the descent of the testes.
The gubernaculum pills the testis into the scrotum, through the inguinal canal.
The upper part of the gubernaculum then degenerates, and the lower part persists as the scrotal ligament, which secures the testis to the lower part of the scrotum.
28
Describe descent of the ovary.
The gubernaculum attaches the inferior part of the ovary to the labioscrotal folds. The ovary then descends into the pelvis.
The gubernaculum then develops into the round ligament of the uterus in the inguinal canal.
29
Describe the effects of congenital adrenal hyperplasia on development of reproductive systems.
Decreased steroid hormone production.
In females the effects range from partial masculinisation with a large clitoris to complete male appearance.
In males, masculinisation is inhibited.
30
Describe androgen insensitivity syndrome in males.
Occurs when there is a lack of androgen receptors or a failure of the tissues to respond. The male genitalia don't differentiate.
As mullerian inhibitory substance is still produced, the mesonephric system is suppressed, so uterine tubes and uterus don't develop.
31
Describe 5-alpha reductase deficiency on male development.
Causes ambiguous genitalia to form due to an inability to activate testosterone.
32
Describe Kleinefelter syndrome.
XXY
The patient is male with reduced fertility, small testes, and decreased testosterone. They male also have gynaecomastia.
Commonly caused by non-dysjunction of the X chromosomes.
33
Describe Swyer syndrome.
XY with mutations in the SRY genes.
| Individuals appear female but won't menstruate or develop secondary sexual characteristics.
34
Describe Turner syndrome.
45-X
Short stature, high arched palate, webbed neck, shield-shaped chest, cardiac and renal anomalies, inverted nipples, gonadal dysgenesis.
35
What is gametogenesis?
The process of production of mature haploid gametes
36
Briefly describe the difference between oogenesis and spermatogenesis.
Oogenesis - forms an ovum. Very few gametes, intermittent production. 1/400th of the reproductive potential.
Spermatogenesis - forms sperm. Huge number, continuous production. Forms "disposable" cells.
37
What is the function of meiosis?
Reduce the chromosome number to 23
Ensure every gamete is genetically unique
Produce 4 daughter cells
38
What are the stages of meiosis?
```
Prophase - chromosomes condense
Metaphase - align in the equator
Anaphase - migrate to opposite poles
Telophase - split
(Twice)
```
39
In what stage of meiosis does crossing over occur?
Prophase
40
Where does genetic variation arise from in gamete production?
Crossing over
Random segregation
Independent assortment
41
Describe crossing over in gamete production.
Exchange of regions of DNA between two homologous chromosomes (non-sister chromatids). Forms a chiasma.
42
Where does spermatogenesis occur?
Seminiferous tubules
43
What is the function of tight junctions in the seminiferous tubules?
They separate the basal and adluminal compartments, forming the blood-testes barrier.
This maintains the cellular environment for the sperm, and prevents an immune response for the sperm being triggered.
44
What is the function of the rate testis?
Removes fluid to concentrate the sperm.
45
Where does final maturation of the sperm?
Epididymis
46
What are spermatogonia?
The 'raw material' for spermatogenesis.
| 2n
47
Describe the stages in spermatid formation.
Spermatogonium divide to form Ad spermatogonium (maintain stock) and Ap spermatogonium (go into meiosis I).
The ap spermatogonium form secondary spermatocytes, which then go through meiosis II to form spermatids.
48
What is spermiogenesis?
When spermatids cytodifferentiate into spermatozoa.
49
What is the spermatogenic cycle?
The time taken for reappearance of the same stage within a given segment of tubule.
(~16 days in a human)
50
What is the spermatogenic wave?
The distance between the same stage in a tubule.
51
What is spermiation?
When spermatids are released into the lumen of seminiferous tubule.
52
Describe the path of the sperm as it remodels and matures.
Up the seminiferous tubule to the rete testis and through the ducti efferentes into the epididymis.
53
How are non-motile spermatids transported!
Via Sertoli cell secretions, assisted by peristaltic contractions.
54
How are sperm able to be motile?
Through the movement of the flagella
| Mitochondria utilise fructose
55
Describe the contributions from each gland towards semen.
Seminal vesicle - amino acid, citrate, fructose, prostaglandins
Prostate - proteolytic enzymes, zinc
Sperm
Bulbourethral - much proteins
56
What is capacitation?
The final maturation step before sperm become fertile, occurring in the female genital tract.
Removal of glycoproteins and cholesterol
Activation of sperm signalling pathways
Allow sperm to bind to the zona pellucida of the oocyte and initiate an acrosome reaction.
57
Describe the maturation of oocytes before birth.
Germ cells which arise from the yolk sac colonise the gonadal cortex and differentiate into oogonia, before proliferating rapidly by mitosis.
By the end of the 3rd months, oogonia are arranged in clusters surrounded by flat epithelial cells of gonadal origin.
The majority of oogonia continue to divide by mitosis, but some enter meiosis. They arrest in prophase I and are called primary oocytes.
Many primary oocytes degenerate by atresia.
All surviving primary oocytes enter meiosis I (committing step) and are individually surrounded by follicular cells.
58
Describe the pre-antral stage of oocyte maturation during puberty.
As primordial follicles begin to grow, the surrounding follicular cells change from flat to cuboidal and proliferate to produce a stratified epithelium of granulosa cells.
The granulosa cells secrete a layer of glycoproteins on the oocyte, forming the zona pellucida which protects the ova.
59
Describe the antral stage of oocyte maturation during puberty.
Fluid filled spaces appear between granulosa cells and coalesce to form the antrum.
Several follicles begin to develop with each ovarian cycle, usually only one reaches maturity.
60
Describe the ovulation stage of oocyte maturation during puberty.
FSH and LH stimulate rapid growth of the follicle several days before ovulation occurs. The mature follicle is now ~2.5cm and is known as a Graafian follicle.
The LH surge increases collagenase activity which facilitates release of the oocyte. Prostaglandins increase the response to LH and cause contraction of the ovarian wall. The oocyte is extruded and breaks free from the ovary.
61
Describe the appearance of the primary oocyte in the antral stage.
Surrounded by the zona pellucida, and cumulus oophorus which is a protective layer and nurtures the oocyte after ovulation.
The antrum is a space above the cell
This is all enclosed by the theca interna, an inner secretory layer which has receptors for LH which causes it to secrete oestrogen
The theca externa forms an outer fibrous layer.
62
Describe formation of the corpus luteum.
Forms as the remaining granulosa and theca interna cells become vascularised. They develop a yellowish pigment and change to lutein cells.
This secretes oestrogen and progesterone, stimulating up the uterine mucosa to enter the secretory phase in preparation for embryo implantation.
It is reabsorbed after 14 days if no fertilisation occurs.
63
Describe what happens when an oocyte is being ovulated.
Fibriae sweep over the surface of the ovary
The Fallopian tube rhythmically contracts.
Fibriae and cilia move the oocyte into the Fallopian tube.
The contractions and cilia move the oocyte into the uterine lumen.
64
What happens to the corpus luteum if fertilisation doesn't occur?
It degenerates to form fibrotic scar tissue, becoming the corpus albicans.
Progesterone production decreases, precipitating menstrual bleeding
65
What happens to the corpus luteum if fertilisation does occur?
Degeneration of the corpus luteum is prevented by HCG, secreted by the developing embryo. It grows into the corpus luteum of pregnancy (corpus luteum graviditatis)
The cells continue to secrete progesterone until approximately the fourth month, when secretions from the placenta become adequate.
66
What hormone stimulates follicle growth?
FSH
67
What hormone stimulates follicle maturation?
FSH and LH
68
What hormone promotes development of the corpus luteum?
LH
69
At what hormonal surge does ovulation occur?
LH
70
Where does the pituitary gland sit?
Beneath the hypothalamus in the sella turcica (pituitary fossa)
71
What are the alternative names for the anterior and posterior pituitary?
Anterior - adrenohypophysis
| Posterior - neurohypophysis
72
What is the pars tuberalis of the pituitary gland?
It wraps the pituitary stalk in a vascularised sheath
73
What hormones are secreted from the posterior pituitary?
ADH and oxytocin
74
What nuclei in the hypothalamus are ADH and oxytocin secreted from?
Paraventricular and supraoptic
75
What is the upper portion of the neural stalk which extends into the hypothalamus called?
Median eminence
76
What artery connects the anterior pituitary and hypothalamus?
Superior hypophyseal artery
77
What structure does the anterior pituitary arise from?
Rathke's pouch
78
What are the characteristics of hormones produced by the anterior pituitary?
Pulsatile release, synchronised with external signals
Act on specific receptors
Transduce signals via second messengers
Stimulate pituitary hormone release
Stimulate hormone synthesis
Cause hyperplasia and hypertrophy of target cells
Regulate their own receptors
79
What is the effect of corticotropin releasing hormone on the anterior pituitary?
Stimulate ACTH release
80
What is the effect of thyrotropin releasing hormone on the anterior pituitary?
Stimulates TSH and prolactin production
81
What is the effect of growth hormone releasing hormone on the anterior pituitary?
Stimulates growth hormone release
82
What is the effect of somatostatin on the anterior pituitary?
Inhibits growth hormone release
83
What is the effect of gonadotropin releasing hormone on the anterior pituitary?
Stimulate LH and FSH release
84
What is the effect of prolactin releasing hormone on the anterior pituitary?
Stimulate prolactin release
85
What is the effect of dopamine on the anterior pituitary?
Inhibit prolactin release
86
What cells do FSH and LH act on in females?
Ovarian granulosa and theca interna
87
What cells do LH and FSH act on in males?
Sertoli cells and Leydig cells
88
What effects does testosterone have on gonadotroph secretion?
Inhibits GnRH and subsequently causes LH and FSH to fall
89
What effects does oestrogen have on gonadotroph secretion?
Low titres of oestrogen inhibit GnRH secretion
High titres of oestrogen stimulate GnRH secretion, causing an LH surge
Progesterone inhibits the positive feedback effect of oestrogen
Oestrogen affects the amount of GnRH per pulse and progesterone affects the frequency of release
90
What is the effect of inhibin on gonadotropin secretion?
It selectively inhibits FSH secretion
91
What hormone(s) does Leydig cells secrete?
Testosterone
92
What hormone(s) does Sertoli cells secrete?
Androgen binding globulin
| Inhibin
93
What is the effect of testosterone on spermiogenesis?
Promotes spermiogenesis
94
When are testosterone levels highest?
In the morning
95
What is the difference between the uterine and ovarian cycle?
The uterine cycle is the preparation of the endometrium
| The ovarian cycle is the preparation of the gamete
96
Describe the changes in the ovary and to gonadotrophs on the at the start of the menstrual cycle (first day of menstruation).
Early development of a small group of follicles into the granulosa, which produces low amounts of steroids and inhibin.
Low inhibition of the HPA so FSH and LH increase.
FSH stimulates the mitosis of granuloma cells and follicular development continues.
The theca interna appears, and the follicle is now capable of oestrogen secretion.
97
Describe the mid follicular phase of the menstrual cycle.
A dominant follicle is nominated so further follicles stop developing.
Follicular inhibin increases which selectively inhibits FSH
Follicular oestrogen stimulates the production of gonadotropins in the hypothalamus, subsequently stimulating LH release from the anterior pituitary.
98
Describe the hormonal changes which prepare the body for ovulation.
Circulating oestradiol and inhibin rise, with oestradiol no longer dependent on FSH.
This leads to a surge in LH production, and progesterone production begins in the granulosa cells as they become responsive.
Oestradiol increases sensitivity of the gonadotrophs to increasing LH
99
Describe what happens to the oocyte at ovulation.
Meiosis I ends and meiosis II begins.
| The mature oocyte is extruded through the capsule of the ovary.
100
Describe the changes to the ovary and hormones after ovulation.
The follicle is lutenised, secreting oestrogen and progesterone in large quantities and inhibin continues to be produced.
Further gamete development is suspended so the waiting stage is established. Progesterone enhances inhibition by oestrogen so LH is suppressed.
101
Describe the luteal stage of the menstrual cycle.
Progesterone and oestrogens are produced
Increased blood flow causes the luteal layer to become hyperaemic, waiting for the second LH surge. This continues for approximately 14 days.
102
Describe the difference in hormonal changes depending whether fertilisation occurs or not.
No fertilisation causes a dramatic drop in gonadal hormones as the luteum regresses spontaneously, relieving the negative feedback so the HPA can reset.
If fertilisation occurs, the syncytiotrophoblast produces hCG which has a lutenising effect. The corpus luteum then produces steroid hormones to support the pregnancy until the placenta takes over.
103
What vascular changes occur to cause menses?
Ischaemia and necrosis of the spiral arteries
104
What are the effects of oestrogen throughout the body in the follicular phase of the menstrual cycle?
```
Increased motility of the fallopian tube
Thickened endometrium
Growth and motility of the myometrium
Thin, alkaline cervical mucosa
Vaginal changes
Changes to the skin, hair, and metabolism
```
105
Describe the effects of progesterone throughout the body.
Stimulate the secretory form of the endometrium
Increased thickness of the myometrium and reduced motility
Thick, acidic cervical mucosa
Changes to mammary tissue
Increased body temperature and changes to metabolism
Electrolyte changes
106
How long is the cell cycle?
21-35 days
107
What causes variation in the length of the cell cycle?
Due to variation in the length of the follicular phase.
| The luteal phase is strictly controlled to 14 days as this is the lifetime of the corpus luteum
108
What physiological factors can affect the menstrual cycle?
Low weight
Emotional stress
Pregnancy
Lactation
109
What is hydrosalpinx?
Infection of the fallopian tube which causes scarring and occlusion at both ends, with fluid accumulating in the centre.
110
How can appendicitis cause infertility?
Inflammation in the abdominal cavity with scarring around the fallopian tubes, blocking them.
111
How can an ectopic pregnancy cause infertility?
If it implants in the fallopian tube, it or surgery to remove it may cause scarring, which would block the tube.
112
Describe endometriosis.
Excessive endometrial growth, which may extend outside the uterus.
Causes heavy, painful, and long menstrual periods, with urinary urgency. There may also be rectal bleeding and premenstrual spotting.
They may be asymptomatic.
113
Give some causes of oligomenorrhoea.
Prolactinoma
Thyrotoxicosis
Grave's disease
Prader-Willi syndrome
114
What is the processus vaginalis?
An embryonic developmental outpouching of peritoneum which surrounds the testis, epididymis, and the first part of the spermatic cord.
115
Describe the scrotum.
A cutaneous sac which develops from the labioscrotal folds under the influence of dihydrotestosterone.
116
What is a hydrocoele in the testicles?
Serous fluid in the tunica vaginalis due to increased fluid production
Painless
Typically caused by trauma, infection, tumours, or tortion. May be congenital if in children
117
What is a haematocoele in the testicles?
Blood in the tunica vaginalis.
| Caused by injury to the scrotum or chronic haemorrhage due to inflammation of the testis.
118
What is a varicocoele in the testicles?
Varicosities in the pampiniform plexus, creating a lumpy swelling in the testicles.
They tend to form during puberty but get larger with age and are mainly unilateral.
They generally form on the left side.
119
What is a spermatocoele?
Epididymal cyst
A painless retention cyst in the epididymis which can be felt as a smooth, firm lump on the top of the testis.
The cause is unknown but may be due to obstruction of the epididymal ducts.
120
What is epididymitis?
Inflammation of the epididymis, commonly caused by STIs.
| Can cause a swollen, red, painful testicle.
121
What is the tunica albuginea?
A fibrous capsule surrounding the testis, which seeps into the body of the gonad to form fibrous septae.
122
What testicular layer does the intestinal coil penetrate through in an indirect inguinal hernia?
Tunica vaginalis
123
Describe the process of the descent of the testes.
1. Gonads develop in the mesonephric ridge near the kidneys
2. Descend via physical movement and trunk elongation
3. Cross the inguinal canal obliquely
4. Push through the deep and superficial inguinal rings
5. Site themselves in the scrotum
Pulled by the gubernaculum.
124
Where does the testicular artery originate?
Abdominal aorta
125
Where does the right testicular vein drain to?
Inferior vena cava
126
Where does the left testicular vein drain into?
Left renal vein
127
What is testicular tortion?
Twisting of the testes just above the upper pole.
| It is a surgical emergency due to occlusion of the testicular artery, which can lead to necrosis of the testes.
128
What connects the seminiferous tubules to the epididymis?
Efferent ductules and the rete testis
129
What is the spermatic cord?
A passage for structures entering and leaving the testis.
130
What are the branches of the testicular artery?
Cremasteric artery
| Artery to vas deferens
131
What is the name of the network of veins in the testicles?
Pampiniform plexus
132
What is the function of the pampiniform plexus?
Wrap around the testicular artery to act as a heat exchanger, cooling the blood entering the testicles
133
What nerve supplies the testes?
Genital branch of the genitofemoral nerve
134
What lymph nodes does the scrotum drain to?
Superficial inguinal nodes
135
What lymph nodes does the testis drain to?
Para-aortic nodes
136
What are the contents of the spermatic cord?
```
Testicular artery
Pampiniform plexus
Genital branch of the genitofemoral nerve
Lymphatics
Vas deferens
Processus vaginalis
```
137
What is the path of the spermatic cord?
```
Deep inguinal ring
Lateral to the inferior epigastric vessels
Inguinal canal
Superficial inguinal ring
Posterior border of the testis
```
138
Give the layers of the spermatic cord and testis from superficial to deep.
External spermatic fascia (aponeurosis of external oblique)
Cremasteric muscle and fascia (internal oblique)
Internal spermatic fascia (transversalis fascia)
139
Describe the path of the vas deferens
```
Ascends in the spermatic cord
Through the inguinal canal
Around the pelvic side wall
Joins with the urethra via an ampulla
Opens into the ejaculatory duct
```
140
Where are the seminal vesicles found
Between the bladder and rectum
141
What are the seminal vesicles?
Diverticulum of the vas deferens, forming a glandular structure
142
What is the prostate?
A fibromuscular gland
143
Describe the anatomical relationships of the prostate.
Base: surrounds the neck of the bladder
Apex: associated with the urethral sphincter and deep perineal muscles
Muscular anterior surface: urethral sphincter
Posterior surface: ampulla of the rectum
Inferolateral: levator ani
144
What zones tend to be affected by benign prostatic hyperplasia?
Central and transitional
145
What are the symptoms of benign prostatic hyperplasia?
Dysuria
Noctiuria
Urgency
146
What nodes does prostatic malignancy typically spread to?
Internal iliac
| Sacral
147
What are the two main dorsal and ventral structures in the penile body?
Dorsal - corpora cavernosum
| Ventral - corpus spongiosum
148
What artery supplies the penis?
Internal pudendal artery
149
What is the function of the bulbospongiosus muscle in males?
Helps to expel the last drops of urine
| Maintain an erection
150
What is the function of the ischiocavernosus muscle in men?
Compresses veins to maintain an erection
151
What are the parts of the male urethra?
Pre prostatic
Prostatic (receives ejaculatory ducts)
Membranous (least distensible as passes through perineum)
Spongy
152
What is the development of the breast known as?
Thelarche
153
What is development of the axillary and pubic hair known as?
Pubarche
154
What is the first menstrual period known as?
Menarche
155
What is the onset of an increase in adrenal secretions known as?
Adrenarche
156
What is puberty?
The stage of human development when sexual maturation and growth are completed, resulting in an ability to reproduce
157
Give the general sequence of events seen in puberty.
Accellerated somatic growth
Maturation of primary sexual characteristic
Appearance of secondary sexual characteristics
Menstruation and spermatogenesis begin
158
What ends the growth spurt?
Epiphyseal fusion
Oestrogen causes this earlier in girls
159
What is the evidence for body weight having a role in the age of puberty?
Obese girls go through early menarche
Malnutrition associated with late menarche
Primary amenorrhoea is common in lean female athletes
Bodyfat set point is very noticeable in girls with fluctuating bodyweight
160
What cells in males can secrete oestrogen?
Sertoli cells
161
What are the four stages of female puberty?
Growth spurt
Breast bud growth
Pubic hair growth
Onset of menstrual cycle
162
What are the four stages of male puberty?
Increased testicular volume
Increased genital size
Growth spurt
Pubic hair growth
163
What is the start age of female puberty?
8-13 years
164
What is the start age of male puberty?
9-14 years
165
What change in females initiates the first ovarian cycle?
The initial LH surge.
166
What is precocious puberty?
When puberty occurs younger than two standard deviations below the average age
Girls below 8
Boys below 9
167
Give some examples of gonadotrophin dependent (central) precocious puberty
```
Glioma
Astrocytoma
Hamartoma (pituitary or hypothalamus)
Pineal tumour
hCG secreting germ cell tumours
CNS trauma, infection, surgery, radiation
Hydrocephalus
Arachnoid cyst
```
168
What is precocious pseudopuberty?
The initiation of early puberty by mechanisms independent of the HPA
169
Give some examples of gonadotrophin independent (neurological) precocious puberty
Congenital adrenal hyperplasia
hCG secreting hepatoma or hepatoblastoma
Choriocarcinoma of the gonads/pineal gland/mediastinum
Ovarian cause masculinisation or feminisation
Leydig cell cause early virilisation
Testotoxicosis
Exogenous oestrogen or androgen exposure, usually iatrogenic
170
Describe testotoxicosis.
An autosomal dominant condition causing male precocious puberty.
Causes rapid physical growth, sexual maturation, and sexually aggressive behaviour in the first 2-3 years.
171
What is delayed puberty?
When the initial features of puberty aren't present by 13 for girls or 14 for boys
OR
When pubertal development is inappropriate, with more than 5 years between the first signs of puberty and menarche in girls or completion of genital growth in boys.
172
What are the causes of delayed puberty?
Gonadal failure
Turner's syndrome
Gonadal deficiency
Tumour or radiotherapy affecting hypothalamus or pituitary
Rare gene mutations affecting FSH/LH/receptors
173
What is Turner's syndrome?
45,X
Causes short stature, gonadal dysgenesis, skeletal abnormalities, cardiac and kidney malformation, dysmorphic face.
There is no mental deficit or impairment of cognitive function.
174
Describe pre-menopause.
Typically occurs from 40 years
Follicular phase of the menstrual cycle shortens. Ovulation is early or absent due to a reduction in oestrogen secretion. FSH and LH rises (FSH more).
Reduced feedback and reduced fertility
175
Describe menopause.
Cessation of menstrual cycles. Occurs at 49-50
No more follicles are left so oestrogen dramatically falls
FSH and LH rise, FSH dramatically as inhibin is lost
176
What are the physical effects of the menopause throughout the body?
Thin cervix
Regression of the endometrium and shrinkage of the myometrium
Vaginal rugae lost
Involution of breast tissue
Changes to skin
Changes to bladder (causes urinary incontinence)
Osteoporosis
177
What is the adult derivative of the gubernaculum in the female?
Round ligament of the ovary
178
What prevents the primitive ovary descending into the labioscrotal folds?
The formation of the uterus by the paramesonephric system, forming a physical barrier
179
Where does the ovarian artery originate?
Abdominal aorta
180
Where does the right ovarian vein drain into?
Inferior vena cava
181
What does the left ovarian vein drain into?
Left renal vein
182
What is the most superior part of the uterus?
Fundus
183
What part of the uterus is palpable during pregnancy?
Fundus
184
What are the recesses of the vagina which the cervix lies between known as?
Fornices
185
What is the space anterior to the uterus known as?
Uterovesicle pouch
186
What is the space directly behind the uterus known as?
Rectouterine pouch
| Pouch of Douglas
187
Describe the course of the round ligament of the uterus.
Reflects off the body of the uterus
Through the inguinal canal
Attaches to the labia majora
188
What lymph nodes drain the labia?
Inguinal nodes
189
What is the normal position of the uterus?
Anteverted with respect to the vagina
| Anteflexed with respect to the cervix
190
What are potential symptoms of a retroflexed and retroverted uterus?
```
Most have no problems.
Pelvic pain
Irregular or painful menses
Pain with sex
Recurrent urine retention or infections
Miscarriage and problems with IUDs
```
191
What ligament provides lateral stability of the cervix, and what is its other function?
Transverse cervical ligament
| Contributes to the support of the pelvic viscera
192
What ligament assists with maintaining anteversion of the uterus and opposes the anterior pull of the round ligament?
Uterosacral ligament
193
What is the origin of the uterine artery?
Anterior division of the internal iliac artery
194
What is the origin of the interior pudendal artery?
Anterior division of the internal iliac artery
195
What relationship does the ureter have with the uterine artery?
It passes beneath it
196
What lymph nodes does the ovary drain into?
Para aortic
Internal and external iliac
Sacral
Inguinal
197
What lymph nodes do the body and fundus of the uterus drain into?
Para aortic
| External iliac
198
What lymph nodes does the cervix drain to?
External and internal iliac
Rectal
Sacral
199
What lymph nodes does the upper vagina drain to?
Internal and external iliac
200
What lymph nodes does the lower vagina drain to?
Inguinal
| Sacral
201
Describe a bimanual examination.
Palpate the vaginal walls and cervix for size, shape, and mobility
Palpate the uterus by pressing between the right middle and index fingers, and your left hand on the lower abdomen
Try to palpate the ovaries by placing the internal fingers in the right fornix and trying to press the ovary between them and the other hand. Repeat for the left.
202
What are the classic signs and symptoms of an ectopic pregnancy?
Abdominal pain
Amenorrhoea
Spotting
203
What are some causes or precipitators for ectopic pregnancy?
```
Damage or abnormality in the fallopian tubes
PID
Tumours
Sterilisation
IUDs
Previous ectopic pregnancies
Cigarette smoking
```
204
What does the labia majora enclose?
Pudendal cleft
205
What does the labia minora enclose?
Vestibule of the vagina, including the bulbs and clitoris
206
Where are Bartholin glands located?
Posterior to the vagina
207
What is a Bartholin's cyst?
When the Bartholin's duct becomes blocked, causing inflammation of the gland.
Can be caused by an infection, inflammation, or by a physical blockage with mucus. May lead to an abscess.
208
What are the symptoms of a Bartholin's cyst?
Asymptomatic
| Pain when walking, sitting, or during sexual intercourse (dyspareunia)
209
Where are Skene's glands located?
Anterior wall of the vagina
210
What is the function of Bartholin's glands?
Secrete mucus to lubricate the vagina
211
Describe culdocentesis.
Drainage of fluid in the pouch of Douglas through the posterior fornix.
212
What nerve innervates the inferior fifth of the vagina?
Pudendal nerve
213
What innervates the superior 4/5 of the vagina?
Uterovaginal plexus
214
What innervates the uterus?
Uterovaginal plexus
215
What nerves provide sensation of the peritoneum?
Pudendal nerve
| Ilioinguinal nerve
216
What ganglia are pain afferents for the internal and external genitalia?
Inferior thoracolumbar spinal ganglia
| S2-4 spinal ganglia
217
Describe the course of the pudendal nerve from the pelvis to the perineum.
Greater sciatic foramen
Pudendal canal
Lesser sciatic foramen
218
What are the two significant holes in the pelvic floor?
Anterior urogenital hiatus
| Central rectal hiatus
219
What are the functions of the pelvic floor?
Support abdominopelvic visca
Resist increased intraabdominal or intrapelvic pressure
Prevent urinary and faecal incontinence
220
What muscles make up the levator ani, from inner to outer?
Puborectalis
Pubococcygeus
Iliococcygeus
221
What nerve innervates the levator ani?
Pudendal nerve
222
What is the anterior attachment for the levator ani?
Pubic bodies of the hip bone
223
What is the lateral attachment for the levator ani?
Tendinous arch
224
What is the posterior attachment for the levator ani?
Ischial spines of the hip bone
225
What is the main function of puborectalis?
Maintain faecal incontinence by creating a 90 degree angle at the anorectal junction
226
What is the innervation of coccygeus?
Anterior rami of S4-5
227
What are the attachments of coccygeus?
Ischial spines to the lateral aspect of the sacrum and coccyx.
Travels along the sacrospinous ligament
228
What structures are at particularly high risk during childbirth?
Pudendal nerve
Levator ani
(Specifically pubococcygeus and puborectalis)
229
What are the potential consequences of pelvic floor dysfunction?
```
Stress urinary incontinence
Rectal incontinence
Bladder prolapse
Vaginal prolapse (if damage to the perineal body)
Rectal herniation (if puborectalis torn)
```
230
What are the risk factors for pelvic floor dysfunction?
```
Age
Number of vaginal deliveries
Family history
Weight
Chronic coughing
```
231
What is the perineal body?
Fibromuscular mass at the junction of the urogenital and anal triangles
232
What are the functions of the perineal body?
Muscle attachment
| Tear-resistant body between the vagina and external anal sphincter
233
What muscles attach to the perineal body?
```
Levator ani
Bulbospongiosus
Superficial and deep transverse perineal muscles
External anal sphincter
External urethral sphincter
```
234
What organisms are particularly implicated in Bartholin's cysts?
Escherichia coli
| Staphylococcus aureus
235
What is the difference between an STI and an STD?
STI encompasses both asymptomatic and symptomatic cases of infection where sexual activity is the primary method of transmission.
STD is only symptomatic cases.
236
Who are the main people at risk of STIs?
Young
Ethnic groups
Low socioeconomic status
Aspects of sexual behaviours
237
What are some reasons for STIs increasing in incidence?
Increased transmission with changing sexual and social practices
Increased GUM clinic attendance
Greater public and medical awareness
Improved diagnostic measures
238
What are the symptoms of human papillomavirus infection?
Benign, painless, and verrucous warts
239
How can you diagnose infection with human papillomavirus?
Clinical presentation
Pap smear
Colposcopy with acetowhite test
Cervical swab
240
What are the consequences of Chlamydia trachomatis infection in men?
Urethritis
Epididymitis
Prostatitis
Proctitis
241
What are the consequences of Chlamydia trachomatis infection in women?
```
Urethritis
Salpingitis
Cervicitis
Perihepatitis
Pelvic inflammatory disease
```
242
What are the effects of neonatal chlamydial infection?
Conjunctivitis
| Pneumonia
243
What is the causative organism of chlamydia?
Chlamydia trachomatis
244
How can you diagnose a chlamydia infection?
Endocervical or urethral swabs with NAAT if pus present
| First void urine with NAAT
245
What are the treatments for chlamydial infection?
Azithromycin (single dose)
Doxacycline
Erythromycin (children)
246
What is the benefit of NAAT testing for sexually transmitted infections?
It allows dual testing
247
What is the causative organism in syphylis?
Treponema pallidum
248
What are the stages of syphylis disease?
Primary - painless ulcer (chancre)
Secondary - fever, rash, lymphadenopathy, mucosal lesions
(Latent)
Tertiary - neurosyphylis
249
How can you diagnose a syphylis infection?
Serology with an EIA antibody test
| Dark field microscopy
250
How can you treat syphylis?
Penicillin
251
What are the symptoms of Trichomonas vaginalis infection?
Vaginitis with thin, frothy, offensive discharge
Inflammation
Irritation
Dysuria
252
How can you treat Trichomonas vaginalis infection?
Metronidazole
253
What is the causative agent in vulvovaginal candidiasis?
Candida albicans
254
What are the predisposing factors for vulvovaginal candidiasis?
```
Antibiotics
Oral contraceptives
Pregnancy
Obesity
Steroids
Diabetes
```
255
What are the symptoms of vulvovaginal candidiasis?
Profuse, white, itchy, curd-like vaginal discharge
256
How can you diagnose vulvovaginal candidiasis?
High vaginal smear
257
How can you treat vulvovaginal candidiasis?
Azoles topical
Nystatin topical
Fluconiazole oral
258
What are the symptoms of bacterial vaginosis?
Scanty but offensive fishy smelling discharge
259
How can you diagnose bacterial vaginosis?
Test vaginal pH
KOH whiff test
Gram stained smear for lactobacilli
260
How can you treat bacterial vaginosis?
Metronidazole
261
What is granuloma inguinale?
Genital nodules which become ulcers
| Caused by Klebsiella granulomatis
262
What are the symptoms of primary genital herpes?
Painful genital ulceration
Dysuria
Inguinal lymphadenopathy
Fever
263
Why can genital herpes recur?
There is a latent infection in the dorsal root ganglia
264
How can you diagnose genital herpes?
PCR of vesicle fluid or a swab of the ulcer base
265
How can you treat primary genital herpes?
Aclovir
266
What are the consequences of a gonorrhoea infection in men??
```
Urethritis
Epididymitis
Procitis
Pharyngitis
Prostatitis
```
267
What are the consequences of a gonorrhoea infection in women?
Urethritis
Endocervicitis
Pelvic inflammatory disease
268
What is the causative agent in gonorrhoea?
Neisseria gonorrhoea
269
What are the rare complications of a gonorrhoea infection?
Disseminated disease
Arthritis
Skin lesions
270
How can you diagnose a gonorrhoea infection?
Swab from the infected site then culture or do NAAT
| On the spot diagnosis with a gram stain
271
How can you treat a gonorrhoea infection?
Ceftriaxone
| Azithromycin (if chlamydia co-infection)
272
What is chancroid?
Painful genital ulcers due to Haemophilus ducreyi
273
What is pelvic inflammatory disease?
Inflammation close to the womb as a result of infection ascending from the endocervix
274
What are the potential manifestations of pelvic inflammatory disease?
```
Endometritis
Salpingitis
Parametritis
Oophoritis
Tubo-ovarian abscess
Pelvic peritonitis
```
275
Why is there an increased risk of ectopic pregnancy in pelvic inflammatory disease?
If there is damage to the tubular epithelium, which alters cilial function and may not recover.
276
What is a tubo-ovarian abscess?
Inflammation with fibrous exudate into the fallopian tubes. The pus can form adhesions and the accumulation of fluid can lead to swelling of the tubules.
The omentum should contain the infection in the abdomen.
277
What are the risk factors for pelvic inflammatory disease?
```
Young
No use of barrier contraceptives
Multiple sexual partners
Low socioeconomic background
IUD after insertion or removal
```
278
What are the symptoms of pelvic inflammatory disease?
Lower abdominal pain
Deep pareunia
Abnormal vaginal or cervical discharge and bleeding
279
What are the signs of pelvic inflammatory disease?
```
Fever
Low, bilateral abdominal tenderness
Cervical motion tenderness
Purulent cervical discharge
Cervicitis
```
280
What are the differentials with pelvic inflammatory disease?
```
Ectopic pregnancy
Endometriosis
Ovarian cyst complications e.g. tortion
IBS
Appendicitis
UTI
Functional pain
```
281
How can you manage pelvic inflammatory disease?
Antibiotics - ceftriaxone, doxacycline, metronidazole
| Admit for possible surgery if severe
282
What are the potential complications of pelvic inflammatory disease?
```
Ectopic pregnancy
Infertility
Chronic pelvic pain
Fitz-hugh-curtis syndrome
Reiter syndrome
```
283
What is Fitz-Hugh-Curtis syndrome?
Right upper quadrant pain due to perihepatitis, generally following chlamydial infection
284
What contraception methods can prevent sperm entering the ejaculate?
Vasectomy
285
What contraception methods can prevent sperm reaching the cervix?
Condoms
Diaphragm
Cervical cap
+/- spermicide
286
What contraceptive methods alter cervical mucus to make it inhospitable for sperm, as well as preventing ovulation?
Combined oral contraceptive
Progesterone only pill
Depot progesterone
Progesterone implant
287
How does the combined oral contraceptive pill work?
Negative feedback to the HPA inhibits follicular development
| Oestrogen loses positive feedback mid-cycle so there is no LH surge
288
How can hormonal contraception impact implantation?
Alter the mucus, luteum, and endometrium
289
How can a copper IUD impact implantation?
Produces a foreign body reaction and interferes with endometrial enzymes
290
What are the options for emergency contraception?
High dose of mixed hormones/progesterone
| Mechanical or intrauterine device
291
What is infertility?
A failure to conceive within a year of trying.
292
What is the difference between primary and secondary infertility?
Primary: Neither partner has ever conceived a child, even if the pregnancy wasn't successful
Secondary: Either partner has conceived a child, regardless of whether the pregnancy was successful
293
What is vaginismus?
Premature contraction of the vaginal musculature, making the vagina too dry and tight to receive the penis.
It can be intolerably painful.
294
What are the symptoms of polycystic ovarian syndrome?
```
Excessive hair growth
High male hormones
Oligomenorrhoea/amenorrhoea
Acne
Weight gain
```
295
Give some conditions which can cause anovulation?
Polycystic ovarian syndrome
Hyperprolactinaemia
Pituitary dysfunction (micro/macroadenoma, Sheehan's syndrome)
Turners syndrome
Menopause
Radio/chemotherapy causing ovarian failure
296
What hormone changes would you expect to see in the menopause?
Raised LH and FSH
| Reduced oestrogen
297
What hormone changes would you expect to see in hypothalamic or pituitary failure?
Reduced LH and FSH
| Reduced oestrogen
298
What hormone changes would you expect to see in PCOS?
Raised LH:FSH ratio
| Normal oestrogen
299
What can you use to induce ovulation?
Tamoxifen
External synthetic gonadotrophins
GnRH agonist
300
How can you diagnose a tubular occlusion?
Hysterosalpingogram
| Laparoscopy and dye insufflation
301
What are the potential causes of abnormal sperm production?
Testicular disease
Testicular failure
Infection or vasectomy blocking ducts
Hypothalamic or pituitary dysfunction
302
How can you classify normal semen?
Volume over 2ml
>20 million sperm per ml
>32% with high motility
>15% normal morphology
303
How long do spermatozoa take to form?
74 days
304
Where are spermatozoa produced?
Seminiferous tubules (Sertoli cells)
305
Describe the process of spermiogenesis?
1. Nuclear condensation
2. Acrosome formation (Golgi produce hydrolytic enzymes so the sperm can enter the ovum)
3. Mitochondria in the midpiece are packed around the contractile filaments
4. The flagellum is produced by microtubules growing from the centriole to form the axoneme
5. Cytoplasm and organelles are stripped under the influence of testosterone
306
Where do sperm become motile?
Epididymis
307
Where can sperm be stored?
Epididymis
308
What happens to sperm if it is not expelled?
Phagocytosed by epididymal epithelial cells
309
Describe the excitement stage of coitus in males.
The limbic system is stimulated, activating sacral parasympathetic neurons, and inhibiting thoracolumbar sympathetic neurons.
Increased NO production from M3 stimulation causes arteriolar vasodilation in the corpora cavernosa, leading to increased penile blood flow.
The testes elevate and engorge, and the scrotal skin thickens and tenses
310
Describe the plateau stage of coitus in males.
The sacrospinous reflex is activated, contracting the ischiocavernosus muscle which compresses the crus penis, impeding venous return and arterial inflow, maintaining the erection.
Stimulation of Cowper's and Littre's glands which produce a fluid that neutralises acidic urine and lubricates the distal urethra.
Testes become completely engorged and elevated, the scrotum maintains its state.
311
Describe the emission stage of coitus in males.
Stimulation of the thoracolumbar sympathetic neurons, causing contraction of smooth muscle in ductus deferens, ampulla, seminal vesicles, prostate, urethral sphincters, so semen pools in the urethral bulb.
312
Describe the ejaculation stage of coitus in males.
The spinal sympathetic reflex is under cortical control, causing contraction of the smooth muscle of glands and ducts, and the internal urethral sphincter
Filling of the internal urethral sphincter stimulates the pudendal nerve, causing contraction of the genital organs, ischiocavernosus, and bulbocavernosus, causing the expulsion of semen.
313
Describe the resolution stage of coitus in males.
Activation of the thoracolumbar sympathetic pathway, contracting smooth muscle in the corpora cavernosa to increase venous return.
There is detumescence and flaccidity. The refractory period begins.
314
Describe the excitement stage of coitus in females.
Sacral parasympathetic output and inhibition of thoracolumbar sympathetic neurons due to limbic system stimulation.
Vaginal lubrication begins due to vasocongestion and the clitoris engorges with blood. The uterus elevates.
There is increased muscle tone, blood pressure, and heart rate.
315
Describe the plateau stage of coitus in females.
Further increase in muscle tone, blood pressure, and heart rate.
Labia minora deepen in colour and the clitoris withdraws under the hood.
Bartholin's gland secretion lubricates the vestibule for entry of the penis.
The outer third of the vagina forms the orgasmic platform and the inner 2/3 is fully distended
316
Describe the orgasm stage of coitus in women.
The orgasmic platform contracts rhythmically 3-15 times.
The uterus and anal sphincter also contract
The clitoris remains retracted
No refractory period so multiple orgasms are possible
317
Describe the resolution stage of coitus for women.
The clitoris descends and engorgement subsides
Labia return to normal
Uterus descends
Vagina shortens and narrows
318
What are the changes to the breasts during the sexual response?
Excitement - erect nipple, increased size, distended veins
Plateau and orgasm - greater size increase, areola increase in size, sex flush
Resolution - detumescence of areola, return to unaroused state
319
What is the G spot?
An area of erotic sensitivity of the anterior wall of the vagina.
The tissue is similar to the male prostate
320
What changes to the sexual response can be seen in older women?
```
Reduced sexual desire
Reduced vasocongestion
Loss of elasticity in the vagina and urethra
Number of orgasmic contraction reduces
Length and width of vagina decrease
```
321
What is Klüver-Bucci syndrome?
Bilateral medial temporal lobe lesions causing hyperphagia, hypersexuality, hyperorality, visual agnosia, and docility
322
Give some potential causes of male impotence.
Tear in the fibrous tissue of the corpora cavernosa
Psychological
Vascular - atherosclerosis/diabetes
Alcohol/antihypertensive
323
How does viagra work?
Inhibits cGMP breakdown to increase NO production, increasing blood flow to the penis.
324
What are the components of fluid produced by seminal vesicles?
Alkaline fluid
Fructose
Prostaglandins
Clotting factors (semenogelin)
325
What is the function of prostaglandins in seminal fluid?
Increased sperm motility and female genital smooth muscle contraction
326
What are the components of the fluid produced by the prostate?
Milky and slightly acidic
Proteolytic enzymes
Citric acid
Acid phosphatase
327
What are the components of fluid produced by the bulbourethral (Cowper's) glands?
Alkaline
| Mucus
328
What is the cervical mucus like when there is just oestrogen stimulation?
Abundant
Clear
Non viscous
329
What is the cervical mucus like when there is oestrogen and progesterone?
Thin
| Sticky
330
What is the nuclear oocyte maturation?
Mitosis I
Nuclear membrane disappears
First polar body separates and enters the perivitelline space
Second meiotic division stalls in metaphase II
331
What is the cytoplasmic oocyte maturation?
Organelle distribution - ER and mitochondria to the cortex
Protein and lipid synthesis - cortical granules and lipid droplets
Cytoskeleton dynamics - microfilaments migrate to the cortex
332
How long can sperm live in the female genital tract?
5 days
333
How long can oocytes last before phagocytosis if they are not fertilised?
6-24
334
Describe the layers of the oocyte before fertilisation.
Corona radiata (follicular cells)
Zona pellucida (glycoprotein membrane)
Cytoplasm
Nucleus
335
Where does capacitation of sperm take place and how long does it take?
Female genital tract
| 6-8 hours
336
What happens to capacitate sperm?
Protein coat of the cell membrane removed so the enzymes are exposed
Tail movement changes from beating to a whip-like motion
337
What triggers the acrosome reaction in fertilisation?
Proteins on the sperm head bind to ZP3 on the zona pellucida
338
What happens in the acrosome reaction?
Acrosomal enzymes digest a path through the zona pellucida
One sperm penetrates and the nuclei fuse
Polyspermy blocks are activated.
339
How is the covering of the oocyte directly overlying the chromosomes different to the rest?
Smooth and devoid of microvilli
340
What is the fast block to polyspermy?
Electrical change from -75mV to +20mV as sodium channels open
Wave of depolarisation begins at the site of entry of the sperm
341
What is the slow block to polyspermy?
Calcium released by the ER, inducing local release of cortical granules
Release enzymes to stimulate adjacent release.
342
What is syngamy?
When the oocyte completes meiosis II and expels the second polar body, then the pronuclei fuse
343
What is cleavage?
Rapid mitotic divisions and metabolic changes so cells divide to form more blastomeres, but the overall size remains the same (G1 and G2 are absent).
344
What is compaction?
At the 8 cell stage, blastomeres polarise and form tight junctions to create an inner embryo environment.
345
What is a morula?
The 16 blastomere stage, 3-4 days after fertilisation.
346
Approximately how many days after ovulation does implantation occur?
6
347
Where are Leydig cells found in the testis?
In the perilobular connective tissue surrounding the seminiferous tubules
348
What is the tunica albuginea of the testes?
Tough connective tissue covering
349
Where are Sertoli cells found in the testes?
Distal part of the seminiferous tubules
350
What is the tunica vasculosa of the testes?
Vascular layer divided into lobules by the invaginating tunica albuginea
351
Where are gametes produced in the testis?
Seminiferous tubules
352
Describe the path of sperm from the testes out.
```
Seminiferous tubules
Rete testis
Ductus efferentes
Epididymis
Ductus deferens
Ejaculatory duct
Urethra
```
353
What are layers of the ejaculatory duct?
Pseudostratified columnar epithelium with a few stereocilia
Lamina propria of loose connective tissue
Muscular coat of inner and outer longitudinal layers, and middle circular layers
354
What hormone do sertoli cells secrete?
Inhibin
355
What hormone do Leydig cells secrete?
Testosterone
356
What is the epithelium of the rete testis?
Simple cuboidal
357
What is the characteristic shape of the efferent duct epithelium?
Scalloped
358
What is the epithelia of the epididymis?
Pseudostratified
359
What are the anatomical borders of the perineum?
```
Pubic symphysis anterior
Inferior pubic rami and inferior ischial rami anterolateral
Sacrotuberous ligament posterolateral
Coccyx posterior
Pelvic floor roof
Skin and fascia base
```
360
What are the surface borders of the perineum?
Mons pubis/base of the penis - anterior
Medial surface of the thighs - lateral
Superior end of the gluteal cleft - posterior
361
What are the borders of the anal triangle in the perineum?
Superior - imaginary line between the ischial tuberosities
Lateral - sacrotuberous ligaments
Posterior - coccyx
362
How many layers of smooth muscle is in the ductus deferens?
3
363
What type of epithelium is the ductus deferens?
Pseudostratified columnar
364
What type of epithelium is the rete testis?
Low cuboidal
365
Is the innervation of the seminal vesicle sympathetic or parasympathetic?
Sympathetic
366
What makes up the prostate gland?
30-50 tubuloalveolar glands
Inner mucosal glands, middle submucosal, and outer main glands.
Ejaculatory ducts merge with the urethra in the prostate
Fibromuscular stroma
367
What epithelium is in the prostate?
Heterogenous (cuboidal, columnar, pseudostratified, simple squamous)
368
What can appear in the prostate gland in older men?
Lamellated bodies with proteins, nucleic acid, cholesterol, and calcium phosphate.
May calcify
369
What is the covering of the ovary?
Germinated epithelium (peritoneal layer)
370
What is present in the outer cortex of the ovary?
Germ cells in various stages of development
Primordial follicle
Single layer of squamous follicular or granulosa cells
371
What is present in the inner medulla of the ovary?
Nerves
Blood vessels
Connective tissue
Stromal cells
372
Describe the primordial follicle.
Small oocyte surrounded by flat follicular cells
373
Describe the primary follicle.
Single layer of cuboidal cells surrounding each oocyte
Granuloma cells give a stratified multilaminar primary follicle
Zona pellucida begins to develop between these layers
Ovarian stromal cells around the oocyte differentiate into theca folliculi which secrete steroid hormones
374
Describe the pre-antral follicle.
Theca folliculi is well-established
Well defined zona pellucida
Granulosa at greatest thickness and begins to secrete fluid
Theca folliculi differentiates into the theca interna, which becomes the theca lutein cells that secrete oestrogen
Theca externa forms which is mainly vascular connective tissue
375
Describe the early antral follicle.
Coalescing fluid creates spaces between cells of the granuloma layer
Antrum and dominant follicle continue to enlarge.
376
Describe the mature follicle.
Corona radiata around the oocyte, formed from a collection of granulosa cells
Growing antrum pushes the oocyte to one side of the follicle where it sits on the cumulus oophorus, which maintains contact with the granulosa, before breaking down just before ovulation so the oocyte and corona radiata can float in the antral fluid
Follicle ruptures as the tissue around it becomes thin and ischaemic
377
Describe the corpus luteum
Huge vascularisation
| Produces progesterone to prepare the uterine mucosa for implantation.
378
What changes happen to the corpus luteum if implantation doesn't occur?
Fibroses and hyalinised to white connective tissue
379
Why is the epithelium involved in 90% of ovarian cancers?
It is constantly being breached and repaired during ovulation
380
Describe the path of the oocyte from the ovary to the uterus
Enters the osteum
Widens into the infundibulum
Then becomes the ampulla
Wall thickens and tube narrows to form the isthmus before entry to the uterus
381
Describe the blood supply of the uterus?
Paired uterine arteries
Branch to form arcuate arteries in the myometrium
Give rise to straight arteries which supply the stratum basalis and coiled arteries which supply the stratum functionalis
382
What are the layers of the endometrium?
Stratum basalis: basal layer with an outer compact and deep spongy layer
Stratum functionalis: Glandular layer which responds to hormonal control. Completely shed in menstruation
383
What are the layers of the uterus?
Endometrium with the lamina propria and glands
| Myometrium with four layers of smooth muscle
384
Describe the endometrium in the early proliferative phase of the menstrual cycle.
Glands are sparse and straight because the endometrial lining has been shed
385
Describe the endometrium in the late proliferative phase of the menstrual cycle.
The functionalis is doubled and the glands are now coiled.
| This is under the influence of oestrogen, which causes the endometrium to grow.
386
Describe the endometrium in the early secretory phase of the menstrual cycle.
Reaches maximum thickness
| Pronounced, coiled glands
387
Describe the endometrium in the late secretory phase of the menstrual cycle
Glands adopt a 'sawtooth' appearance, waiting for maintenance of the endometrium by a conceptus.
If there is no implantation, the spiral arteries spasm, causing ischaemic necrosis.
388
What epithelium is in the endocervical canal?
Mucus-secreting simple columnar
389
What epithelium is on the ectocervix?
Squamous non-keratinised
390
Where in the cervix do the majority of neoplasms arise?
The transformation zone adjacent to the squamocolumnar junction?
391
What epithelium is present in the vagina?
Non-keratinised stratified squamous
392
What is the function of glycogen accumulating in the epithelium of the vagina?
Substrate for lactobacilli, which metabolise it to regulate vaginal pH
393
What are the layers of the vagina?
Epithelium
Mucosa
Submucosa
Muscular (smooth and skeletal)
394
What type of gland is the breast?
Compound tubulo-acinar gland
| A single lactiferous duct opens from multiple lobes.
395
Describe the difference between inactive and lactating breast tissue.
Inactive - limited ductal development, dense interlobular tissue
Lactating - highly developed glands, milk secretions in the alveolar lumen, thin interlobular tissue, vacuolation of secretory cells
396
Where is the location of the nipple in relation to the ribs in young women?
5th intercostal space
397
Approximately how many lobules radiate out from each nipple?
15-20
398
What connects each lobule to the nipple?
Lactiferous sinus
399
What delineates each lobule of the breast?
Suspensory ligaments
| Fibrous connective tissue
400
What is the rectomammary space?
Potential space formed by the breast and fascia overlying the anterior thoracic wall, allowing motility of the breast
401
What lymph nodes does each part of the breast drain into?
Lateral - axillary lymph nodes
| Medial - parasternal nodes or opposite breast
402
What veins drain the breast?
Axillary
Posterior intercostal
Internal thoracic
403
What arteries supply the breast?
Internal thoracic
Intercostal
Thoracoacromial
404
What breast changes caused by a tumour could cause dimpling and distortion?
Oedema
| Shortening of the suspensory ligaments
405
What are the layers of the fallopian tube wall?
Inner mucosa (epithelial cells and peg cells)
Muscular
Serosal
406
How does the muscular layer of the fallopian tube change throughout its length?
Mostly 2 layers
| Thicker in the isthmus with 3 layers
407
What are the function of peg cells in the fallopian tube?
Secrete mucus
408
Where is folding in the fallopian tube most pronounced?
Ampulla
409
Describe the contents of the anal triangle
Anal aperture in the centre, surrounded by the external anal sphincter. Ischioanal fossa laterally which contains fat and connective tissue.
410
What is the function of the ischioanal fossae?
Contain fat and connective tissue to aid expansion of the anal canal during defecation.
Extend from the anal region to the pelvic diaphragm.
411
What are the borders of the urogenital triangle?
Anterior - pubic symphysis
Lateral - ischiopubic rami
Base imaginary line between ischial tuberosities.
412
From deep to superficial, what are the layers of the urogenital triangle?
```
Deep perineal pouch
Perineal membrane
Superficial perineal pouch
Deep perineal fascia
Superficial perineal fascia
Skin
```
413
What is the deep perineal pouch?
A potential space between the pelvic floor and perineal membrane.
414
What are the contents of the deep perineal pouch?
Part of the urethra
External urethral sphincter
Bulbourethral glands (male)
Deep transverse perineal muscles (male)
415
What is the function of the perineal membrane?
To support the pelvic viscera
Attach muscles of superficial external genitalia
Perforated by the urethra and vagina
416
What is the superficial perineal pouch?
A potential space between the perineal membrane and fascia
417
What are the contents of the superficial perineal pouch?
```
Erectile tissue of the penis and clitoris
Ischiocavernosus
Bulbospongiosus
Superficial transverse perineal muscles
Bartholin's glands
```
418
What is the function of the deep perineal fascia?
Cover the superficial perineal muscles
419
What is the superficial perineal fascia continuous with?
Superficial fascia of the abdominal wall
420
What are the two layers of the superficial perineal fascia?
Superficial and deep
| Superficial is fatty, and forms the mons pubis and labia majora
421
As the embryo produces fluid, what happens to the amnion?
It is pushed against the chorionic sac to form the amniochorionic membrane, which then produces chorionic villi.
422
What does it mean if the placenta is described as haemochorial?
There is a single chorionic layer separating the maternal and foetal circulation
423
What are the aims of placental development?
Create a basic unit for exchange to move away from simple diffusion
Anchor the placenta by growth of the outermost cytotrophoblast
Establish maternal blood flow
424
Describe the difference between primary, secondary, and tertiary villi in the placenta.
Primary - simple outgrowths of cytotrophoplast and syncytiotrophoblast
Secondary - Mesenchyme grows out into the core during gastrulation
Tertiary - Foetal vessels invade, parenchyme and macrophages also appear
425
What is placenta previa?
When the conceptus implants in the lower uterine segment. The placenta may grow across in the internal cervical os, increasing the risk of haemorrhage and blocking the birth canal.
426
What hormone prepares the endometrium for implantation?
Progesterone
427
What are pre-decidual cells?
The balancing force for invasion of the trophoblast in implantation, preparing the endometrium and stopping implantation going too far.
428
What is placenta accreta?
When all or part of the placenta attaches abnormally to the myometrium. The chorionic villa attach to the myometrium rather than being restricted to the decidua basalis.
429
What is placenta increta?
Chorionic villi invade into the myometrium
430
What is placenta percreta?
Chorionic villi invade through the myometrium
431
How is blood flow improved to the placenta during development?
Elaboration of the spiral arteries, creating a low-resistance vascular bed.
432
What causes pre-eclampsia?
Inadequate migration of foetal cells so the endothelium remains maternal.
433
What are the effects of pre-eclampsia?
The maternal circulation tries to compensate, so blood pressure becomes very high.
434
What is eclampsia?
Fitting during pregnancy
435
What is placental insufficiency?
Invasion is complete so the developing foetus can't be fully supported.
436
What are the degrees of monozygotic twins?
Separate amnion and chorion
Separate amnion, same chorion
Shared amnion and chorion
(greater sharing changes the risk of problems occurring)
437
What is twin-to-twin transfusion syndrome?
A consequence of disproportionate blood supply, resulting in high morbidity and mortality.
Occurs in monochorionic twins
Causes are unknown
438
What is the organisation of the maternal aspect of the placenta?
Into cotyledons, which are chorionic villi separated by placental septum.
439
What is the difference between the placenta at the first trimester and the placenta at term?
First trimester - thick placental barrier, villi growing in number and size, complete cytotrophoblast layer beneath syncytiotrophoblast layer.
Term - dramatically increased surface area, cytotrophoblast layer lost, thin barrier
440
What hormones are produced by the placenta?
```
hCG
Progesterone
Oestrogen
hCS
hPL
```
441
What is the function of hCG produced by the placenta?
Supports the corpus luteum until the placenta is large enough.
442
What is the function of progesterone produced by the placenta?
Increases appetite to lay down stores
443
What is the function of hCS and hPL produced by the placenta?
Increase glucose availability for the foetus, even at the expense of the mother
444
Why is maintenance of oxygen flow to the foetus particularly important?
The foetal oxygen stores are very small.
445
What is moved by facilitated diffusion across the placenta?
Amino acids
Vitamins
Iron
446
How are immunoglobins transported across the placenta?
Mediated by receptors on the surface of the syncytiotrophoblast
Only transports IgG
The exact immunoglobin depends on the pathogens encountered by the mother
447
Give some examples of teratogens.
```
Thalidomide
Alcohol
Therapeutic drugs
Drugs of abuse
Maternal smoking
```
448
What is haemolytic disease of the newborn?
When the rhesus group of the foetus is incompatible with that of the bother, creating a problem in subsequent pregnancies as the IgG can pass through the placenta.
449
Why does the ABO blood type of the foetus and mother not matter?
The ABO antibodies are IgM so can't pass through the placental barrier
450
Give an example of an infectious agent that can be teratogenic.
```
Zika
Toxoplasma gondii
Cytomegalovirus
Treponema pallidum
Varicella zoster
Rubella
```
451
What change in the cardiovascular system occurs during pregnancy?
Blood volume increases
Dilation and hypertrophy of the heart
Cardiac output, stroke volume, heart rate increase
Systemic resistance and blood pressure fall
452
Why might there be normal auscultatory changes of the heart during pregnancy?
There is dilation and hypertrophy of the heart due to the increased blood volume
453
Why is a normal hypotension seen in trimester 1 and 2?
Progesterone relaxes vascular smooth muscle, reducing the total peripheral resistance.
454
Why might there be hypotension in trimester 3?
Aortocaval compression by the gravid uterus, reducing blood flow back to the heart.
455
What are the most common reasons for anaemia in pregnant patients?
Dilutational anaemia
Iron or folate deficiency
Haemoglobinopathy
456
What would you suspect if a pregnant patient had hypertension?
Pre-eclampsia
457
What are the changes in the urinary system during pregnancy?
GFR, creatinine clearance, protein clearance, and renal plasma flow increase.
Urea, uric acid, bicarbonate, and creatinine fall
Filtration capacity is intact, but the functional reserve is low.
458
Why would you be unhappy with a urea and creatinine within the usual bounds in a pregnant woman?
Creatinine clearance in greater and renal plasma flow is higher in pregnant women, so it should be lower than normal
459
Why are pregnant women at greater risk of hydroureter?
Progesterone can relax the smooth muscle of the ureter, or there may be obstruction, which causes urinary stasis
460
What are the complications of UTIs during pregnancy?
Pyelonephritis
| Pre-term labour
461
What are the changes to the respiratory system during pregnancy?
Diaphragm displaced upward, but AP and transverse diameters increase, as well as physiological drive
FRC decreases
462
What causes physiological hyperventilation during pregnancy?
Progesterone alters respiratory centres in the brainstem
| CO2 production by the foetus increases levels in the body
463
Why are pregnant women at increased risk of metabolic acidosis?
They have to compensate for the relative acidosis caused by the high CO2 in the blood, reducing their buffering capacity
464
What stimulates increased maternal peripheral insulin resistance during pregnancy?
Human placental lactogen (hPL)
465
What is gestational diabetes?
Carbohydrate intolerance confined to pregnancy
466
What are the risks associated with misdiagnosis or poor control of gestational diabetes?
Macrosomic foetus
Stillbirth
Congenital defects
467
Why is a pregnant woman at increased risk of ketoacidosis?
Lipolysis is increased so there is increased free fatty acid on fasting
468
What are the symptoms of ketoacidosis?
```
Sweet smelling breath
Abdominal pain
Confusion or agitation
Fatigue
Loss of appetite
Nausea and vomiting
```
469
What TBG, TSH and free T4 levels would you expect during pregnancy?
High TBG and T4
| Low TSH
470
What effect does progesterone production in pregnancy have on the GI tract?
Relaxes smooth muscle, causing delayed emptying of the bowel and stasis of the biliary tract. (Increases the risk of infection and pancreatitis)
471
Why are pregnant women at increased risk of DVT?
Clotting ability
Stasis
Venodilation
472
Why can you not give warfarin to a pregnant women?
It freely crosses the placenta
473
Why is pregnancy prothrombic?
Fibrinogen and clotting factors increase
474
What adaptions in foetal blood allow it to utilise maternal blood with a low partial pressure of oxygen?
Foetal haemoglobin has a higher affinity for oxygen and doesn't bind 2,3-BPG
High foetal haematocrit
475
Describe the 'double Bohr effect' and how it increases oxygen diffusion in the placenta.
The CO2 moving into the intervillous blood lowers the pH, and therefore lowers the oxygen affinity of the maternal haemoglobin.
The CO2 lost from the foetal blood increases its pH, increasing the oxygen affinity of the foetal haemoglobin.
476
Describe how the 'double Haldane effect' increases CO2 diffusion across the placenta.
The maternal haemoglobin must give up its oxygen to accept the carbon dioxide.
The foetal haemoglobin gives up carbon dioxide as oxygen is accepted.
477
What shunts blood past the liver in foetal circulation?
Ductus venosus
478
What shunts blood past the lungs in foetal circulation?
Ductus arteriosus
479
What shunts blood from the right to the left atrium in foetal circulation?
Foramen ovale
480
What separates blood streams in the right atrium to stop oxygenated and deoxygenated blood mixing?
Crista dividens
481
Why is it important to shunt blood past the liver in the foetus?
The liver is very metabolically active and this is the first entry from the placenta, so it would use up a lot of the oxygen saturated blood.
482
What is the function of the right to left atrial shunt in the foetus?
To stop blood circulating the lungs and mixing with unsaturated blood from the body
483
How does the foetus manage transient decreases in oxygenation?
Redirects flow to critical organs
| Slows the heart rate
484
How is the bradycardia caused when there is low oxygen to the foetus?
Low pO2 is detected by chemoreceptors, which stimulates the vagus nerve, subsequently causing a reduction in heart rate
485
What are the potential consequences of chronic hypoxaemia during birth?
Growth restriction
Behavioural changes which impact development
Cerebal palsy
486
What are the hormones of foetal growth?
Insulin
IGF I
IGF II
Leptin
487
What hormone of foetal growth is nutrient-dependent and at what stage of pregnancy is it used?
IGF I
| T2/3
488
What hormone of foetal growth is nutrient-independent, what stage of pregnancy is it used, and why is this important?
IGF II
T1
It is a time where nutrients may be in low supply due to factors such as morning sickness.
489
What is the dominant cellular growth mechanism in weeks 0-20?
Hyperplasia
490
What is the dominant cellular growth mechanism in weeks 20-28?
Hyperplasia and hypertrophy
491
What is the dominant cellular growth mechanism in weeks 28 to term?
Hypertrophy
492
What is the difference between symmetrical and asymmetrical growth restriction?
Symmetrical tends to occur during stages of development with hyperplasia and is irreversible.
Assymetrical tends to occur during stages of development with hypertrophy and is reversible.
It is generally head sparing.
493
Why is jaundice in a newborn common?
The foetus cannot conjugate bilirubin, so excretion is handled by the mother. The liver develops its ability to conjugate at birth when the neonate is exposed to light, so this may take time.
494
What periods of development is the crown-rump length important?
Pre-embryonic
Embryonic
Early foetal periods
495
What is the main cause of weight gain in the early foetal period?
Muscle deposition
496
What is the main cause of weight gain in the late foetal period?
Adipose deposition
497
What is the best way to assess foetal growth in the second and third trimesters?
Biparietal diameter
Abdominal circumference
Femur length
Using an ultrasound
498
What imaging would you use to assess a pregnancy before 9 weeks?
Transvaginal ultrasound
499
What is the main cause of macrosomia?
Gestational diabetes
500
What are some reasons for low birth weight?
Premature
Constitutionally small
Intrauterine growth restriction (placental insufficiency, twin-twin transfusion syndrome)
501
Describe the development of the respiratory system in weeks 8-16.
Pseudoglandular stage
| Duct systems form in the bronchopulmonary segments - bronchioles
502
Describe the stages of development of the respiratory system in weeks 16-26.
Canalicular stage.
| Budding of the respiratory bronchioles from the bronchioles
503
Describe the development of the respiratory system from 26 weeks to term?
Terminal sac stage
| They bud from the respiratory bronchioles and the type I and II pneumocytes differentiate.
504
What is the function of the 'breathing' movements by the foetus?
Condition the respiratory musculature ready for birth
| Fill the primitive lungs with fluid which is crucial for development.
505
What is neonatal respiratory distress syndrome?
Pre-term infants with inadequate surfactant production will have difficulty breathing as the alveoli will be unable to open sufficiently and remain open.
506
How can you reduce the risk of neonatal respiratory distress syndrome when pre-term labour is inevitable?
Give corticosteroids to the mother to increase surfactant production in the foetus
507
When is the definitive foetal heart rate established?
15 weeks
508
When does foetal kidney function begin?
Week 10
509
What needs to develop to allow voluntary, coordinated movement in the foetus?
Corticospinal tracts
510
Why are babies relatively uncoordinated and slow?
Myelination of the nervous system begins in the ninth month of gestation and continues after birth, so it takes time for them to be able to coordinate movements properly.
511
What is quickening and when does it generally begin?
```
Maternal awareness of foetal movements.
17 weeks (variation depending on the mother and whether it is the first pregnancy)
```
512
When do foetal movements first begin?
Week 7
513
What is parturition?
The transition from the pregnant state to the non-pregnant state at the end of gestation.
514
What are the three stages of labour (briefly)?
Creation of the birth canal
Expulsion of the foetus
Contraction of the uterus and expulsion of the placenta
515
When does the uterus become palpable?
12 weeks
516
When does the uterus become palpable at the level of the umbilicus?
20 weeks
517
When does the uterus become palpable at the level of the xiphisternum?
36 weeks
518
Describe what is meant by the lie of the foetus.
Its relationship to the long axis of the uterus
519
What is the normal lie of the foetus at term?
Longitudinal
| The foetus is usually flexed
520
What is meant by the presentation of the foetus?
Which part of the foetus is adjacent to the pelvic inlet?
521
What is the normal presentation of the foetus at term?
Cephalic (head first)
522
What is meant by the vertex of the foetus?
Relationship of the foetus along its axis and the orientation of the presenting part
523
What is the size of the head in the average foetus at term?
9.5cm
524
What is the maximum size of the birth canal in the average woman?
11cm
525
What may increase the size of the birth canal?
Softening of the ligaments
526
What soft tissues must expand to create the birth canal?
Cervix
Vagina
Perineum
527
What are the processes involved in cervical ripening?
Reduced collagen and aggregation of the fibres
| Increased glycosaminoglycans and hyaluronic acid
528
What are the changes in the myometrium during pregnancy?
It is thickened
| Produces force when intracellular calcium rises - triggered by action potentials from pacemaker cells
529
What are the uterine contractions which occur during early pregnancy?
Low amplitude
| Every 30 minutes
530
What are Braxton-Hicks contractions?
Small contractions which can be felt but are less frequent than labour as 'practice'.
531
What are the difference between contractions early and late in labour?
Early - variable but high amplitude
| Late - more frequent and higher amplitude
532
What hormones make contractions more forceful and how?
Prostaglandins release more calcium per action potential
| Oxytocin - lowers the threshold to create more action potentials
533
What controls prostaglandin levels?
Oestrogen:progesterone levels
| high = more
534
Describe the Ferguson reflex?
Oxytocin is increased by afferent impulses from the cervix and vagina and act on smooth muscle
535
How does high oestrogen:progesterone ratio promote labour?
Increases oxytocin receptors
Increase prostaglandin levels which stimulate uterine contractions
INcreases gap junction communication in smooth muscle cells
536
What is the function of oxytocin in labour?
Stimulate the uterus to contract
Stimulate the placenta to make prostaglandins
Increases excitability of the myometrium
537
What is the consequence of prostaglandins released at the onset of labour?
The cervix ripens
| Contractions become more forceful
538
What is effacement?
Thinning and flattening of the cervix
539
What is crowning?
When the top of the head appears in the birth canal
540
What is brachystasis?
The uterus contracts more than it relaxes as the fibers shorten in the body, driving the presenting part of the foetus to the cervix.
541
What is frank breech?
The buttocks in the birth canal with the knees extended
542
What is full breech?
The buttocks in the birth canal with the knees flexed.
543
What is a footling breech?
When there is a foot in the birth canal
544
Describe the process of the second stage of labour.
1. Head flexes
2. Head rotates internally
3. Head stretches the vagina and perineum
4. Head delivers, rotates, and extends
5. Shoulders rotate and deliver, rapidly followed by the rest
545
Describe the third stage of labour
The effect of uterine contractions is dramatically increased. The uterus contracts down hard, shearing off and expelling the placenta.
Usually occurs within 10 minutes
546
What physiological mechanisms prevent post-partum haemorrhage?
Uterine contractions which constricts the blood vessels
Muscle fibres form living ligatures around the maternal blood vessels
Pressure on the placental site by the uterine walls
Blood clotting mechanisms
547
What can be done medically to support the normal mechanisms which prevent post-partum haemorrhage?
Oxytocic drug
| Manual fundal massage
548
What physical mechanisms promote labour?
Mechanical stretching of the uterus increases contractility
| Cervical stretching elicits uterine contractions
549
What foetal components promote labour
Cortisol from the foetus inhibits progesterone, increasing the action of oestrogen
Foetal oxyytocin
550
What secretes prostaglandins during pregnancy?
Placenta
Decidua
Myometrium
Membranes
551
What hormones cause cervical ripening?
Oestrogen
Relaxin
Prostaglandins
552
What inhibits the action of oxytocin?
Progesterone
Relaxin
Low number of oxytocin receptors
553
What is the latent phase of the first stage of labour?
The onset of labour with slow cervical dilation to approximately 4cm, and variable duration
554
What is the active phase of the first stage of labour?
Faster rate of cervical change and regular uterine contractions
555
Describe the separation of the placenta from the uterus.
The blood in the intervillous space is forced into the veins of the spongy layer of the decidua basilis.
The veins become tense and congested, with pressure maintained by the underlying myometrium.
A living ligature appears around the maternal blood vessels and retract to seal them.
As the placenta pulls away , blood tracks between it and the decidua to complete separation
556
What is normal blood flow through the placental site after birth?
500-800ml/min
557
Describe the mammary glands.
Lobes containing alveoli, blood vessels, and lactiferous ducts.
There are 15-24 embedded in breast tissue
558
What separates the mammary glands in the breast?
Suspensory ligaments of Cooper
559
Describe the development of the breasts in utero.
Invagination causes the breast bud to grow
Pits and ducts form in the tissue
Lactiferous ducts are present which are unable to produce milk
560
Describe the development of the breasts in females after puberty?
Oestrogen acts on oestrogen receptor alpha to cause tubules to sprout.
Oestrogen acts on oestrogen receptor beta and progesterone on progesterone receptor B to cause squamous to columnar change in the alveoli and hypertrophy.
561
Why do males not usually develop breasts at puberty?
Dihydrotestosterone
562
What are the constituents of human milk?
90% water
7% sugar (lactose)
3% fat
Proteins, minerals, vitamins
563
What type of sugar is lactose?
Disaccharide
| Glucose and galactose
564
What is mammogenesis?
Substantial development of mammary tissue during pregnancy
565
Describe the changes to the breast during pregnancy
Hypertrophy of the system with prominent lobules
Alveolar cells differentiate, capable of lactation by the second trimester
Towards the end of pregnancy the nipple becomes erect and the areola darkens and enlarges. Montgomery tubercles form and the breast becomes more sensitive.
566
What are montgomery tubercles in the breast?
Sebaceous glands which fuse with ducts.
| Produce oils to protect the breast during feeding and pheromones to direct the baby.
567
What is lactogenesis?
The synthesis of milk in alveolar cells from the fat in the SER
568
What is the first thing produced by the mothers breast after giving birth?
Colostrum
569
What is colostrum?
The first breast secretions which have less water, fat, and sugar than milk produced later.
It is yellow and thick due to increased protein, particularly immunoglobin.
570
How much milk do women produce per day?
800ml/day
571
How does oestrogen affect the breast?
Stimulates proliferation of the breast and adipose tissue, increases fat metabolismm, and promotes angiogenesis in the surface of the skin (primigravida only).
572
Where is prolactin produced during pregnancy?
Decidua
| Anterior pituitary
573
What are the effects of prolactin during pregnancy?
Lactotroph hypertrophy in the anterior pituitary
| Stimulates the production of colostrum
574
What stimulates the production of prolactin after birth?
Suckling
575
What is galactokinesis?
The let-down reflex stimulated by suckling
576
Describe the let-down reflex
Receptors in the nipple stimulate the hypothalamus to produce oxytocin
Oxytocin acts on myoepithelial cells in the breast to eject the milk
577
What is galactopoeisis?
The maintenance of milk production
578
Why may the breasts feel lumpy during menstruation?
Progesterone and oestrogen cause the growth of alveoli, changing the breast texture.
579
Give some causes of lactation cessation?
Not enough suckling, causing turgor of the breast
Suppression of prolactin by ergot preparation, diuretics, retained placenta
Age - mammary gland shrinking begins around 35
580
What is the most likely cause of cyclical and diffuse breast pain?
Usually physiological
581
What could be the cause of non-cyclical and focal breast pain?
Ruptured cyst
Injury
Inflammation
Breast cancer (only occasionally)
582
What would a milky discharge from the nipple indicate?
Endocrine disorder
| Medication side effect (OCP)
583
What would a bloody discharge from the nipple indicate?
Benign lesion e.g. Duct ectasia, papilloma
| Malignant lesion
584
Give some benign causes of a lump in the breast.
```
Fibroadenoma
Fat necrosis
Lipoma
Leiomyoma
Fibrocystic change
Phyllodes tumour
```
585
Give some malignant causes of a lump in the breast.
```
Phyllodes tumour
Hamartoma
Ductal carcinoma in situ
Invasive ductal carcinoma
Invasive lobular carcinoma
Mucinous carcinoma
```
586
What is a fibroadenoma?
A common benign tumour in women below the age of 30.
Tend to be mobile, multiple, and bilateral.
White, fibrous, and rubbery macroscopically.
587
What are phyllodes tumours?
Fast growing breast tumours which tend to be benign, but are very aggressive when malignant and often recur.
Histologically: nodes of proliferating stroma covered by epithelium.
Appear leaf-like on the surface
588
Which men are at increased risk of breast malignancy?
Klinefelter's syndrome
MtoF transexual
Men treated with oestrogen for prostate cancer
589
What are the major risk factors for breast cancer?
Gender
Uninterrupted menses
Not breastfeeding
Late pregnancy
590
What is the most common presentation of ductal carcinoma in situ?
Calcification (linear and branching)
591
What is Paget's disease of the breast?
Inflammation and crusting of the nipple due to ductal carcinoma in situ extending into the nipple skin.
592
How does breast cancer usually metastasise?
Through the lymph nides
593
What is peau d'orange?
Blockage of the lymphatics in the breast by cancer, causing oedema and pitting.
594
Aside from a lump, what can indicate invasive breast cancer?
Paget's disease of the nipple
Peau d'orange
Inflammation and swelling of the breast
Inverted nipple
595
What is polythelia?
A third nipple along the milk line
596
What bacteria is the most common cause of acute mastitis?
Staphylococcus aureus
597
Who is most at risk from acute mastitis?
Breastfeeding mothers
598
What are the symptoms of acute mastitis?
Erythmatous painful breast
| Pyrexia
599
What is seen on histological examination of fibrocystic change in the breast?
Cyst formation
Fibrosis
Apocrine metaplasia
600
What causes gynaecomastia in men?
Transient at the start of puberty as androgen production catches up
Kleinefelter's syndrome
Oestrogen excess (liver cirrhosis/obesity)
Gonadotrophin excess (functioning testicular tumours, testicular germ cell tumours)
Drug related (spironolactone, cimetidine, alcohol, marijuana)
601
What is the most common type of breast cancer?
Invasive ductal carcinoma
