Topic 7 Reproductive Conditions

Question 1

Describe the process of spermatogenesis

Answer 1

Spermatagonia (germ cells)
Mitosis to form primary spermatocytes
1st Meioisis to form secondary spermatocyte
2nd Meiosis to form spermatids
Mature to form spermatozoa (sperm) in 64 days

Head: genetic material
Midpiece: mitochondria
Tail: locomotion

Question 2

Role of Testosterone

Answer 2

Powerful hormone causing major changes it the male body
Essential for spermatogenesis, changes in puberty and maintenance of function and size of reproductive organs.
Major function is to drive anabolism: increased muscle and bone growth

Question 3

Role of Dihydrotestosterone

Answer 3

Converted from testosterone by 5-alpha-reductase.
More potent than testosterone.
Major function in the prostate, skin and hair. Responsible for differentiation of male tissues, essential for the prostate and other male reproductive functions.
Excess amounts can promote the growth of unwanted body hair

Question 4

What is phimosis

Answer 4

Tightening of the foreskin preventing retraction
Foreskin that has retracted back over the glans of the penis and cannot be returned to the normal position having a tourniquet effect
Normal in young boys up to 3, may need circumcision

Question 5

What is cryptorchism

Answer 5

Undescended testes
Testes may be retracted but not undescended as cremaster muscle is powerful and can pull the testes up into the groin and perineum.

Question 6

Dx of cryptorchism

Answer 6

Physical examination and ultrasound

Question 7

Tx of cryptorchism

Answer 7

Orchidoplexy or surgical release between 1 – 2 yrs age

Regular examinations for testicular cancer

Question 8

Risks of cryptorchism

Answer 8

Fertility issues
Testicular cancer
Torsion

Question 9

What is testicular torsion

Answer 9

Twisting of the spermatic cord that suspends the testis

Surgical emergency due to ischaemia of the testes

Question 10

CM of testicular torsion

Answer 10

Severe distress
Nausea
Vomiting
Severe swelling

Question 11

Tx of testicular torsion

Answer 11

Surgical release < 6hrs only treatment

Question 12

What is Benign Prostatic Hyperplasia

Answer 12

Age associated benign prostate gland enlargement which can disrupt urinary flow

Question 13

CM of benign prostatic hyperplasia

Answer 13

Backflow of urine into kidneys
Post renal failure
Alterations to urinary flow
Nocturia
Frequency
Hesitancy
Overflow incontinence
Poor stream

Question 14

Dx of benign prostatic hyperplasia

Answer 14

Digital rectal examination
- (normal prostate feels like smooth and soft donut, BPH smooth and symmetrical but firmer like bagel)

Prostate specific antigen
- non specific, only determines if cellular changes are present

Question 15

Tx of benign prostatic hyperplasia

Answer 15

Surgical - trans urethral resection of prostate

Pharmacological management - alpha blockers as prostate has lots of alpha receptors

Question 16

Positive effects of oestrogen

Answer 16

Bone mass - block bone resorption (only pre menopause)

Cholesterol - reduces LDL and increases HDL due to actions in liver (reduce incidence of MI premenopausal)

Blood coagulation - suppress and promote blood coagulation. Increases coagulation factors but encourage breakdown of fibrin

Question 17

Adverse effects of oestrogen

Answer 17

Endometrial hyperplasia and carcinoma - oestrogen causes proliferation and hyperplasia.

Promotes growth of existing breast cancer and ovarian cancer - postmenopausal hormone therapy increases breast cancer risk

Cardiovascular events - oestrogen increases risk of DVT, stroke, coronary heart disease and MI (60+)

Nausea - response to oetrogens, diminishes with continued use

Question 18

What is progestin

Answer 18

Compounds that act like progesterone prior to gestation to prepare the uterus for implantation and help maintain the uterus during pregnancy.

Question 19

Adverse effects of progestin

Answer 19

Teratogenic effects - high dose therapy during first four months is associated with birth defects

Gynecologic effects - birth control, leads to decreased cervical mucous, involution of endometrial layer, spotting, breakthrough bleeding and irregular menses

Increased risk of breast cancer
Depression
Breast tenderness
Bloating

Question 20

What is menopause

Answer 20

Cessation of menstrual cycle

Ovarian follicles and oestrogen decline as women grow older, ceasing several years after menstruation has ceased

Question 21

When does menopause occur

Answer 21

Between 48 and 55 years

Question 22

CM of menopause

Answer 22

Menstrual cycle becomes irregular, eventually cease 
Vasomotor instability (hot flushes) 
Sleep disturbances 
Urogenital atrophy (dry, itchy, burning) 
Osteoporosis (bone loss) 
Altered lipid metabolism 
↓Body hair and skin elasticity 
↓Breast tissue

Question 23

Tx of menopause

Answer 23

Physiologic doses of oestrogen taken to manage symptoms caused by loss of oestrogen with menopause.
Hormone replacement therapy.

Question 24

What is endometriosis

Answer 24

Presence of functional endometrial tissue outside the uterus.

Question 25

CM of endometriosis

Answer 25

``` Infertility Pain Dysmenorrhoea Dyschezia Dyspareunia Constipation Abnormal vaginal bleeding Dyspareunuia – painful intercourse ```

Question 26

Tx of endometriosis

Answer 26

Suppressing ovulation with medication - NSAIDS - combination OCPs - medroxyprogesterone - GnRH analogues Laparoscopic ablation of endometriosis to treat pain and infertility Surgery using laser cautery but 40% recurrence within 5 y

Question 27

Dx of endometriosis

Answer 27

Difficult as may be dysmenorrhoea History Laparoscopic exam

Question 28

What is PID

Answer 28

Pelvic imflammatory disease | Acute inflammatory disease caused by infection

Question 29

Types of PID

Answer 29

Salpingitis: inflammation of the uterine tubes Oophoritis: inflammation of the ovaries

Question 30

Aetiology of PID

Answer 30

Sexually transmitted diseases migrate from vagina to upper genital tract (mostly initiated by gonorrhoea or chlamydia which induce necrosis with repeated infections)

Question 31

CM of PID

Answer 31

``` Asymptomatic Severe abdominal pain - worse on walking, jumping or intercourse Dysuria Painful cervix Increased WBC Positive C reactive protein Infertility ```

Question 32

Tx of PID

Answer 32

``` Requires aggressive treatment Hospitalisation IV ABs Avoid intercourse Treat peritonitis or tubo-ovarian abscess Treat partner with antibiotics Remove IUD ```

Question 33

Risks of PID

Answer 33

16 -24 yr age group Multiple partners IUD

Question 34

How does hormonal contraception work

Answer 34

Feedback to hypothalamus and pituitary to suppress LH and FSH inhibiting ovulation - low oestrogen stimulates corpus luteum to secrete oestrogen and progesterone.

Question 35

Adverse effects of hormonal contraception

Answer 35

``` GIT upset Decrease ovary size Ovary unresponsive to LH and FSH Exacerbate menopausal symptoms Menorrhagia Thrombotic issues CVD Infertility Breast cancer Cervical cancer x2.5 ```

Question 36

Positive effects of hormonal contraception

Answer 36

Protection from ovarian and cervical cancer | Treat fibroids and ovarian cysts

Question 37

Types of combination hormonal contraception

Answer 37

Monophasic (21 tablets followed by 7 tablets placebo) Biphasic (10/11 tabs followed by 7 placebo) Triphasic (7/9/5 tablets) Quadriphasic

Question 38

How do combined contraception pills work

Answer 38

Pills contain oestrogen and progesterone. They are taken for 21 days, FSH and LH suppressed, follicle doesn’t develop, endometrium develops and maintained by steroids in pill. Placebo for 7 days causing endometrium to break down

Question 39

How do progesterone contraception pills work

Answer 39

Inhibits ovulation, inhibits development of endometrium, causes thickening of cervical mucous making it impenetrable (lasts 22-26 hours), must be taken at the same time every day

Question 40

How do IUDs work

Answer 40

Reliable, reversible birth control. Remain in place for 5 to 10 years. Produce a harmless local inflammatory response that is spermicidal. Copper inhibits implantation. Levonorgestrel causes endometrial involution and thickening of the cervical mucous.

Question 41

How do spermicides work

Answer 41

Chemical surfactants that kill sperm by destroying their cell membrane. Available in foam, gel, jelly, suppository, vaginal film and sponge. Moderately effective when used alone, increases efficacy when combined with a diaphragm or condom

Question 42

How does post coital contraception work

Answer 42

Given up to 120 hours post sex Causes as lack of hormonal synchronisation - fertilised egg cannot implant Progesterone only preparations Morning After Pill Combined pill (prevent pregnancy or cause abortion)

Question 43

STI Still to do

Answer 43

Still to do