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z Clinical Sciences 2 > Topic 7 Reproductive Conditions > Flashcards

Topic 7 Reproductive Conditions Flashcards

Topic 7

1
Q

Describe the process of spermatogenesis

A

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

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2
Q

Role of Testosterone

A

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

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3
Q

Role of Dihydrotestosterone

A

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

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4
Q

What is phimosis

A

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

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5
Q

What is cryptorchism

A

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.

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6
Q

Dx of cryptorchism

A

Physical examination and ultrasound

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7
Q

Tx of cryptorchism

A

Orchidoplexy or surgical release between 1 – 2 yrs age

Regular examinations for testicular cancer

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8
Q

Risks of cryptorchism

A

Fertility issues
Testicular cancer
Torsion

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9
Q

What is testicular torsion

A

Twisting of the spermatic cord that suspends the testis

Surgical emergency due to ischaemia of the testes

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10
Q

CM of testicular torsion

A

Severe distress
Nausea
Vomiting
Severe swelling

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11
Q

Tx of testicular torsion

A

Surgical release < 6hrs only treatment

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12
Q

What is Benign Prostatic Hyperplasia

A

Age associated benign prostate gland enlargement which can disrupt urinary flow

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13
Q

CM of benign prostatic hyperplasia

A 
Backflow of urine into kidneys
Post renal failure
Alterations to urinary flow
Nocturia
Frequency
Hesitancy
Overflow incontinence
Poor stream
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14
Q

Dx of benign prostatic hyperplasia

A

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

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15
Q

Tx of benign prostatic hyperplasia

A

Surgical - trans urethral resection of prostate

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

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16
Q

Positive effects of oestrogen

A

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

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17
Q

Adverse effects of oestrogen

A

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

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18
Q

What is progestin

A

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

19
Q

Adverse effects of progestin

A

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

20
Q

What is menopause

A

Cessation of menstrual cycle

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

21
Q

When does menopause occur

A

Between 48 and 55 years

22
Q

CM of menopause

A 
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
23
Q

Tx of menopause

A

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

24
Q

What is endometriosis

A

Presence of functional endometrial tissue outside the uterus.

25
Q

CM of endometriosis

A 
Infertility
Pain
Dysmenorrhoea
Dyschezia
Dyspareunia
Constipation
Abnormal vaginal bleeding
Dyspareunuia – painful intercourse
26
Q

Tx of endometriosis

A

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

27
Q

Dx of endometriosis

A

Difficult as may be dysmenorrhoea
History
Laparoscopic exam

28
Q

What is PID

A

Pelvic imflammatory disease

Acute inflammatory disease caused by infection

29
Q

Types of PID

A

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

30
Q

Aetiology of PID

A

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

31
Q

CM of PID

A 
Asymptomatic 
Severe abdominal pain - worse on walking, jumping or intercourse
Dysuria 
Painful cervix
Increased WBC
Positive C reactive protein
Infertility
32
Q

Tx of PID

A 
Requires aggressive treatment
Hospitalisation
IV ABs
Avoid intercourse
Treat peritonitis or tubo-ovarian abscess
Treat partner with antibiotics
Remove IUD
33
Q

Risks of PID

A

16 -24 yr age group
Multiple partners
IUD

34
Q

How does hormonal contraception work

A

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

35
Q

Adverse effects of hormonal contraception

A 
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
36
Q

Positive effects of hormonal contraception

A

Protection from ovarian and cervical cancer

Treat fibroids and ovarian cysts

37
Q

Types of combination hormonal contraception

A

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

38
Q

How do combined contraception pills work

A

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

39
Q

How do progesterone contraception pills work

A

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

40
Q

How do IUDs work

A

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.

41
Q

How do spermicides work

A

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

42
Q

How does post coital contraception work

A

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)

43
Q

STI Still to do

A

Still to do

z Clinical Sciences 2 (5 decks)

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