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Block 5 AR > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is the pelvis?

A

Space bound by pelvic girdle

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2
Q

What is the great pelvis?

A

Upper abdo region of pelvic girdle, above pelvic inlet

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3
Q

What is the lesser pelvis?

A

Lower region of pelvic girdle, below pelvic inlet

Pelvic cavity and perineum

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4
Q

What is the pelvic cavity?

A

Region between inlet and pelvic floor

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5
Q

What is the perineum?

A

Region below the pelvic floor

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6
Q

What are differences between the male and female pelvis?

A

Female pelvic girdle is wider, thinner boned and has an approximately cylindrical cavity
Pubic arch in female is wider

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7
Q

What term describes the normal desirable shape of the pelvis?

A

Gynecoid

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8
Q

What term describes a female pelvis which is shaped more like a males?

A

Android

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9
Q

What is an anthropoid pelvis?

A

Anterior posterior distance much greater than the transverse

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10
Q

What is a platypelloid pelvis linked with?

A

Rickets

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11
Q

What measurements can be taken to determine whether a birth canal is the correct dimensions to permit birth?

A

Diagonal conjugate = (>12 cm) measured by vaginal exam
True Conjugate = (Diagonal conjugate – Pubic symphysis depth =10.5-11.0cm)
Intertuberous distance = (>12cm)
Interspinous distance = (>11cm)

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12
Q

Describe the plane of pelvic orientation

A

~60º

ASIS aligns with PT in vertical plane

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13
Q

Which direction do the urogenital and anal triangles face?

A

Anal triangle faces postero-inferiorly

Urogenital triangle faces inferiorly

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14
Q

What does the perineum contain?

A

External genitalia and distal anal canal

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15
Q

What are the female parts of external genitalia?

A

Labia (Majora & Minora)
Crura of clitoris
Bulb of vestibule
Greater vestibular gland

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16
Q

What are the male parts of the external genitalia?

A 
Crura & bulb of penis 
Urethra 
Testes (hanging from abdo wall) 
Scrotum 
Bulbourethral gland
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17
Q

What neurovascular structures do both male and female perineum contain?

A

Internal pudendal artery (& branches)
Pudendal nerve (& branches)
Perineal membrane

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18
Q

What is the pelvic floor?

A

Bowl-shaped group of sheet-like muscles that support pelvic viscera & assist with sphincters

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19
Q

What muscles make up the Levator Ani?

A

Iliococcygeus
Pubococcygeus
Puborectalis

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20
Q

What is the function of Puborectalis?

A

Maintains angle at anorectal junction to help in faecal continence
Loss of angle leads to increased risk of faecal incontinence

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21
Q

What is the Perineal body?

A

Only point of union between pelvic floor and perineal membrane
Important for integrity of pelvic floor
Support to posterior vaginal wall
Attachment point for anal sphincter

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22
Q

What is the nerve supply to levator ani?

A

S4

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23
Q

What are the borders of the Urogenital Triangle?

A

Ischial tuberosities to pubic symphysis

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24
Q

What are the borders of the anal triangle?

A

Ischial tuberosities to coccyx

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25
Q

What are female external genitalia?

A

Folds of skin guarding the vagina and clitoris

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26
Q

Where do the greater vestibular glands lie in the female? And what do they do?

A

Drain into vestibule at 5 & 7o’clock

Secrete lubricant

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27
Q

What is an Episiotomy?

A

Create a controlled increase in aperture size during childbirth to give a controlled tear

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28
Q

What types of incision can be used for an episiotomy?

A

Midline incision

Media lateral incision

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29
Q

What is the clitoris?

A

Erectile body very similar in structure to the penis

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30
Q

What is the male equivalent to the bulb of vestibule?

A

Corpus spongiosum of penis

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31
Q

What are the female equivalents to the bulbourethral glands?

A

Greater vestibular glands

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32
Q

What is the sensory innervation of the glans of the clitoris and penis?

A

Pudendal nerve S2-4

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33
Q

What does the Female reproductive tract connect the outside world to?

A

The peritoneal cavity

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34
Q

What are the 3 parts of the uterine tubes?

A

Infundibulum
Ampulla
Isthmus

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35
Q

What is the cervical canal?

A

Connects vagina and uterine cavity via the external and internal os

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36
Q

What can be used to directly view the uterine cavity?

A

Hysteroscopy

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37
Q

What can be used to determine whether there is a blockage in the uterine tubes?

A

Hysterosalpingogram - dye into cavity

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38
Q

What presents a route of infection spread by an STI?

A

Uterine tubes can allow spread from vagina

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39
Q

What is an ectopic pregnancy?

A

Blastocyst implantation can occur into most tissues and development will continue if a placenta is established

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40
Q

How might a tubal ectopic present?

A

6-8 weeks, pain

Rupture of tube can lead to peritonitis

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41
Q

What is normal nulliparous size for a uterus?

A

Approx 80x50x30mm HxWxD

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42
Q

What is the pelvic girdle?

A

Bony pelvis

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43
Q

What tool can be used to view the cervix?

A

Speculum

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44
Q

What are the fornices?

A

Superior portions of vagina extending into recess created by vaginal portion of the cervix

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45
Q

What tissue type are the ovaries derived from?

A

Intermediate mesoderm

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46
Q

What is the blood supply to the ovary?

A

Ovarian artery

Branch of the aorta at L2

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47
Q

Where do the ovaries sit? And what are they suspended in?

A

Sit close to lateral pelvic wall suspended in broad ligament

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48
Q

What is the ovary covered in? And what goes through this layer?

A

Covered in peritoneum which forms surface epithelium (germinal layer) covering
Ovulation takes place through this layer and into peritoneal cavity

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49
Q

What is the round ligament of the ovary similar to in males?

A

Gubernaculum

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50
Q

What could Ovulation/cysts/tumour impinge on?

A

Obturator nerve (L2-4)
Resulting in pain/ache in medial thigh, hip or knee; medial thigh
weakness/wasting

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51
Q

What is the blood supply to the uterus and vagina? And where do they pass?

A

Uterine: branch of internal iliac, Heads toward lateral cervix and fornix, Passes superior to ureter
Ovarian: From aorta at L2
Vaginal: Often a branch of the uterine, Can arise independently from internal iliac

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52
Q

Where does the ureter pass in relation to the uterine artery? And what is the significance of this?

A

Passes inferior to uterine artery (water under bridge)

Very delicate and must not be ligated, crushed or moved too much

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53
Q

Why can cervical cancer cause kidney failure?

A

Compression/obstruction of ureters as they run in close proximity to cervix

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54
Q

Where do Uterine & cervical lymphatics drain?

A

Pass to external, internal iliac & sacral nodes

Some go to palpable inguinal nodes via round ligament

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55
Q

What is a hysterectomy?

A

Removal of uterine body alone – cervix preserved

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56
Q

What is a Bilateral salpingo- oophorectomy?

A

Removal of tubes & ovaries

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57
Q

What is a radical hysterectomy?

A

Removal of everything including lymphactics

Distal vagina normally preserved

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58
Q

What is a normal position of a uterus and what supports it?

A

Anteverted anteflexed

Rests on bladder and is supported by it in this position

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59
Q

What is the angle of anteversion?

A

Between vagina and cervical canal

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60
Q

What is the angle of anteflexion?

A

Between cervical canal and uterus

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61
Q

Which position of the uterus carries the highest risk of prolapse?

A

Retroverted retroflexed

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62
Q

How can you estimate the size and position of the uterus?

A

Bimanual palpation

Vaginal exam with other hand on abdomen

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63
Q

What is the round ligament of the uterus?

A

Equivalent to male gubernaculum

Route for uterine lymphatic drainage to superficial inguinal nodes (palpable)

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64
Q

What does peritoneum cover in the pelvic region of a female?

A

Bladder, uterus, cervix and upper rectum

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65
Q

What is the folded peritoneum region between bladder and uterus called?

A

Vesico uterine pouch

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66
Q

What is the folded peritoneum pouch between the uterus and the rectum called? And what clinical significance does it have?

A

Recto uterine pouch (pouch of Douglas)
Relevant to infected fluid accumulation
Abscess & fistula formation
Home abortion – line of travel of inserted implements

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67
Q

What is the broad ligament?

A

Large double layered fold of peritoneum

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68
Q

What are the different parts of the round ligament?

A

Mesovarium
Mesosalpinx
Mesometrium

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69
Q

Where does the round ligament travel?

A

Passes through Inguinal canal and into labia majora

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70
Q

Where does ovulation take place?

A

Ovulation takes places through peritoneal covering

Germinal epithelium

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71
Q

What are the layers of pelvic fascia?

A

Visceral (covers organs)
Parietal (covers muscles & walls)
Endopelvic: Loose & fatty (fills spaces), Dense & fibrous (supportive ligaments)

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72
Q

What comes together at the tendinous arch?

A

Dense pelvic fascia

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73
Q

What ligament supports the cervix/uterus?

A

Cardinal ligament

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74
Q

What ligament supports the bladder?

A

Lateral ligament of the bladder

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75
Q

What ligament supports the rectum?

A

Lateral ligament of the rectum

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76
Q

Where does the tendinous arch run?

A

From pubis to sacrum

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77
Q

What is the Paracolpium?

A

Connection of vaginal fascia to tendinous arch

Important for support

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78
Q

What do uterine tubes develop from?

A

Paired paramesonephric ducts

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79
Q

What can Uterine & vaginal malformations lead to?

A

1° amenorrhoea, infertility or problematic pregnancy

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80
Q

Visceral sensory fibres from the uterus travel to the CNS via two different routes. What are they?

A

Pelvic organs above pelvic pain line covered in peritoneum Refer pain to T10-L1 (via Sympathetic nerves)
Pelvic organs not covered in peritoneum below pelvic pain line Refer pain to S2-4 (via Parasympathetic nerves)

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81
Q

Describe uterine innervation

A

Sensory Neurons above pelvic pain line run with Sympathetics (T10-T12)
Sensory Neurons below pelvic pain line run with Parasympathetics (S2-4)
Somatic sensory innervation to distal vagina (S2-4 Pudendal nerve)

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82
Q

How would you anaesthetise the uterus above the pelvic pain line?

A

Spinal Block @ L3/4 (inject into CSF)
& an epidural at the same level
(Combined spinal epidural – CES/CSE)

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83
Q

How would you anaesthetise the uterus below the pelvic pain line?

A

Caudal epidural (sacral hiatus & canal)

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84
Q

How would you anaesthetise the distal vagina?

A

Pudendal Nerve Block

Palpate ischial spine and inject around it via vaginal wall

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85
Q

What structures will be anaesthetised by a pudendal nerve block?

A

Perineum, distal vagina & anal canal

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86
Q

What is the testicle a derivative of?

A

Intermediate mesoderm

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87
Q

Where does the testicle lymph drainage go to?

A

Para-aortic nodes ~L2

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88
Q

What structure aids the descent of the testicle through the inguinal canal?

A

Gubernaculum

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89
Q

What is the path of sperm from their site of production?

A 
Produced in seminiferous tubules
Into Rete testis
Head of epididymis 
Body
Tail
Ductus deferens
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90
Q

What is a hydrocele?

A

Excess fluid in tunica vaginalis

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91
Q

What is a spermatocoele?

A

Swelling of epididymis

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92
Q

What is the Processus vaginalis?

A

Fold of parietal peritoneum

Future site of inguinal canal

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93
Q

What forms a potential weak spot and is the route taken by indirect inguinal hernias?

A

Processus vaginalis

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94
Q

Which layer of the abdo wall doesn’t contribute to the spermatic coverings?

A

Transversus abdominis

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95
Q

What forms the tunica vaginalis?

A

Lower part of processus vaginalis

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96
Q

Describe the Content of the spermatic cord

A
  1. Pampiniform plexus
  2. Ductus deferens
  3. Lymphatics
  4. Testicular artery
  5. Ductus deferens artery
  6. Cremasteric artery
  7. Genital nerve
  8. Autonomic nerves
  9. (Ilioinguinal nerve)
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97
Q

Describe the coverings of the spermatic cord

A 
Internal spermatic fascia 
Cremasteric fascia 
External spermatic fascia
Colles fascia
Dartos fascia
Skin
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98
Q

What are the origins of the internal and external spermatic and Cremasteric fascia layers?

A

Internal spermatic fascia: transversalis fascia
Cremasteric fascia: internal oblique
External spermatic fascia: external oblique

99
Q

What is the function of the pampiniform plexus?

A

Countercurrent heat transfer mechanism as it wraps around the arteries entering the cord

100
Q

If someone presents with a left sided varicocele what should be checked beyond the testicles?

A

Left kidney due to direct drainage route of testicular veins
Right kidney drains straight into IVC

101
Q

Which nerve is at risk during a vasectomy?

A

Ilioinguinal

102
Q

What is the ductus deferens?

A

Smooth muscule tube capable of peristaltic action via sympathetic innervation
Derived from embryonic mesonephric duct
Runs from tail of epididymis to ejaculatory duct

103
Q

Where does the ductus deferens run in relation to the ureter?

A

Superior to ureter in the pelvis

Only structure to do so and can be seen on abdominal endoscopy

104
Q

Where does the ductus deferens get its blood supply?

A

Branches from vesical & testicular arteries

105
Q

What is Male Sterilisation (Vas-ectomy)?

A

The ductus is cut & ligated just distal to superficial inguinal ring

106
Q

Describe the structure of the prostate

A

Fibromuscular (1/3) & glandular (2/3)

107
Q

Where is the blood supply to the prostate from?

A

Internal iliac artery (vesical & rectal arteries)

108
Q

Where is the venous and lymph drainage from the prostate?

A

Venous blood to prostatic venous plexus then to vertebral veins
Lymph to internal iliac nodes

109
Q

What is the visual landmark for the prostate in the urethra?

A

Urethral crest

110
Q

What are the three openings into the prostate in the urethra?

A

Utricle - blind ended pouch

2 Ejaculatory ducts

111
Q

What are anatomical relations of the prostate?

A

Bladder
Levator ani
Rectum
Pubic symphysis

112
Q

Where can prostate cancer spread?

A

Vertebrae via venous plexus

Valveless veins form the plexus which runs length of vertebral column into cranium & through vertebral bodies

113
Q

What are the lobes of the prostate and what are they described in relation to?

A

Anterior, posterior and median

Based on the positional relationship of prostate to urethra & ejaculatory duct

114
Q

What are the zones of the prostate?

A

Peripheral (PZ)
Central (CZ)
Transitional (TZ)

115
Q

What is the function of the seminal vesicles?

A

Produce alkaline fluid

Sperm can hang around in here for a few days

116
Q

How do the seminal vesicles develop?

A

Outgrowth of ductus deferens

Join ductus deferens to form ejaculatory duct

117
Q

What is the blood supply, venous drainage and lymph drainage of the seminal vesicles?

A

Internal iliac artery (Inferior vesical & middle rectal)
Vesical & prostatic venous plexus
Lymph Drainage: Internal iliac nodes, External iliac nodes, Sacral nodes

118
Q

What is the posterior relation of the seminal vesicle?

A

Recto vesical pouch

119
Q

What should you normally be able to feel on a digital rectal examination?

A

Walls of anal canal
Walls of inferior rectum
Sacrum, coccyx & sacral lymph nodes
Prostate (Post. & med. lobes and median sulcus)
Possibly Inferior bladder & seminal vesicles

120
Q

What forms an anchor point for the external genitalia?

A

Perineal membrane

121
Q

What are the different parts of the male urethra called from the bladder?

A 
Preprostatic
Prostatic
Membranous 
Spongy
Navicular fossa
122
Q

What is the most likely consequence of an enlargement of the prostate?

A

Compression of the urethra

123
Q

Why do a male catheterisation?

A

Inability to void bladder (urinary retention)
Incapacitated
Surgery

124
Q

What are difficulties and dangers of male catheterisation?

A

Navicular fossa (mucosal fold superiorly)
Angle at penile bulb & membranous urethra
Prostate (crest / enlarged lobes)
Sphincters

125
Q

What can blunt force trauma to the penile bulb cause?

A

Rupture of urethra resulting in extravasation of urine

126
Q

What are symptoms of bulbourethral gland stones or infection?

A

Perineal pain and pain on defecation / digital rectal examination

127
Q

What type of innervation controls muscles in the deep perineal pouch?

A

Voluntary muscles (pudendal nerve (S2-4))

128
Q

What structures are found in the male deep pouch?

A

External urethral sphincter

Bulbourethral glands

129
Q

What structures are found in the female deep pouch?

A

External urethral sphincter
Sphincter urovaginalis
Compressor urethrae
Vaginal canal

130
Q

What do the crura of the penis/clitoris attach to?

A

Pubic arch & lateral parts of the perineal membrane

131
Q

What does the Superficial perineal pouch contain?

A

Penis, urethra, scrotal contents & superficial perineal muscles

132
Q

If fluid leaked into the superficial pouch, where could it go?

A

Could spread to penis, urethra, scrotal contents, superficial perineal muscles and up abdo wall as the fascia is continuous with scarpers and campers fascia

133
Q

What is epispadias?

A

Urethral opening on dorsum of penis

134
Q

What is hypospadias?

A

Urethral opening on ventrum of penis

135
Q

Describe the structure of the corpus cavernosum

A

Open vascular structure

136
Q

What can be cut to give the penis a greater flaccid length?

A

Suspensory & Fundiform ligaments of the penis

137
Q

What is priapism?

A

Persistent (painful) non-stimulated erection that lasts more than 4 hours

138
Q

What is Phimosis?

A

Prepuce (Foreskin) can not be retracted

139
Q

What is Paraphimosis?

A

Prepuce (Foreskin) stuck in retracted position

140
Q

When could Paraphimosis occur?

A

Can occur post coitally if foreskin hasnt been put back into position

141
Q

How does the neurovascular supply to the penis get there?

A

Inferior to pelvic floor via deep perineal pouch and through pudendal (Alcock) canal

142
Q

Where does Somatic nerve supply to the penis come from?

A

Dorsal nerve of the penis (from Pudendal nerve)

143
Q

Where can the pudendal nerve be anaesthetised?

A

Close to the ischial spines

144
Q

Describe the blood supply to the penis

A

Internal pudendal artery (from internal iliac)

Deep & dorsal penile arteries (for erection)

145
Q

Describe the venous drainage of the penis?

A 
Dorsal Veins (superficial & deep) 
Drain to prostatic venous plexus  
Blood drains to vertebral plexus
146
Q

Which branch of nervous system is responsible for erection, secretion and ejaculation?

A

Erection: Point, Parasympathetic
Emission: Shoot, Sympathetic
Ejaculation: Score, Somatic

147
Q

What process occurs to cause erection?

A

Straightening of coiled helicine arteries by smooth muscle relaxation which allows blood to fill the corpus cavernosum
Bulbospongiosus & ischiocavernosus muscles compress venous plexus (retain blood in penis)

148
Q

What allows the penis to be flaccid in its resting state?

A

Arterio-venous anastamoses allows blood to bypass the corpus cavernosum

149
Q

Describe the parasympathetic nerve supply from the spine to the penis

A

Pelvic Splanchnic Nerves
Inferior hypogastric plexus
Prostatic plexus
Cavernous nerve

150
Q

What could result in cavernous nerve damage and therefore cause impotence?

A

Prostatectomy due to prostatic plexus disruption

151
Q

Where is the inferior hypogastric plexus located?

A

Lateral pelvic wall

152
Q

What effects does sympathetic stimulation have to result in secretion ready for ejaculation?

A

Closes internal urethral sphincter
Peristalsis of ductus deferens & seminal vesicles
Prostate smooth muscle contraction
Ejaculate squeezed into the penile bulb

153
Q

Which sympathetic nerves bring about Ejaculatory secretion?

154
Q

What are the somatic muscles of erection & ejaculation innervated by?

A

Branches of the pudendal nerve S2-4

155
Q

What are the somatic muscles of erection & ejaculation?

A

Bulbospongiousus: Covers bulb of penis, Helps urethral emptying, Essential for ejaculation
Ischiospongiousus: Covers crura of penis/clitoris, Helps maintain erection

156
Q

What is the lymph drainage of the Scrotal, penile & perineal skin

A

Superficial inguinal nodes

157
Q

What is the lymph drainage of the Glans of penis?

A

Deep inguinal nodes

158
Q

What is the lymph drainage of the Corpus Cavernosum?

A

Internal Iliac nodes

159
Q

What is the lymph drainage of the urethra?

A 
Proximal spongy & membranous (internal iliac)
Distal spongy (deep inguinal)
160
Q

What is the lymph drainage of the Prostate, seminal vesicles & ductus?

A

Mostly internal iliac nodes

161
Q

What factors can affect the shape size and structure of the breast?

A 
Age & sexual maturity 
Nutrition 
Inherited factors 
Menstrual cycle 
Pregnancy 
Lactation
162
Q

How many lactiferous ducts does the nipple receive?

163
Q

What are Montgomery glands?

A

Sweat & sebaceous glands in areolar of nipple

164
Q

Where might you find supernumerary nipples?

A

Along mammary ridge/milk line from anterior axillary fold to groin

165
Q

Where does the base of the breast sit?

A

Over ribs 2-6 and extends from the sternum to midaxillaryline and superolaterally into the axilla

166
Q

What muscles does the breast sit on?

A

Sits over the fascia of pectoralis major and serratus anterior

167
Q

Where does the breast receive its innervation from?

A

T4-T6 intercostal nerves

168
Q

What can mastalgia be?

A

Cyclical
Non-cyclical
Non-breast origin: Cardiac, Respiratory, Musculoskeletal, Infective - shingles

169
Q

What are the quadrants of the breast?

A

Upper and lower

Inner and outer

170
Q

What types of tissue are found in the breast?

A

Connective, glandular and fatty tissue

171
Q

What do cooper Ligaments do?

A

Support breast tissue - fibrous support

172
Q

Where is the retromammary space?

A

Between breast tissue and pectoralis fascia

173
Q

What occupies the retromammary space? And what is its function?

A

Loose connective tissue & fat occupies
Permits free movement of breast independent of pectoralis major
There should be no attachment to underlying muscle

174
Q

What is the blood supply to the breast?

A

Medial mammary: From internal thoracic/anterior intercostal

Lateral mammary: From lateral thoracic artery & posterior intercostals

175
Q

Where can breast lymph nodes drain to?

A 
Anterior & central axillary nodes 
Interpectoral (Rotter) nodes 
Parasternal (internal thoracic) nodes 
Contralateral parasternal nodes 
Contralateral breast 
Subdiaphragmatic/hepatic nodes 
Inguinal lymph node
176
Q

Where do breast skin lymph nodes drain to?

A

Axillary, deep cervical & infraclavicular nodes

177
Q

Where are infraclavicular lymph nodes?

A

Sit in the deltopectoral triangle/ infraclavicular fossa

178
Q

What can follow a mastectomy with axillary lymph node clearance?

A

Upper limb lymphoedema

179
Q

What is a gland?

A

Collection of epithelia cells that secrete substances

180
Q

What different forms can exocrine glands take?

A 
Tubular = straight 
Acini = islands connected to duct
181
Q

What does Actively lactating breast tissue look like?

A

clear glandular tissue in an acinar arrangement

182
Q

What visible features may indicate breast cancer?

A

Nipple retraction
Peau d’orange
Skin tethering

183
Q

Why do a clinical breast examination?

A

Screening
Monitoring
Presenting problem

184
Q

What is the triple approach in breast examination?

A

Clinical examination
Imaging: Mammography, Ultrasound
Pathology: Cytology (FNAC fine needle aspiration cytology), Core Biopsy

185
Q

What are patterns of breast metastasis?

A

Local: skin and muscle
Lymph nodes: axilla
Blood: bone, brain, liver, lung
Trans coelomic: pleura

186
Q

What are steps in examining the breast?

A

Visual Inspection: symmetry, skin changes

Palpation: breast tissue, lymph nodes

187
Q

What are landmarks for palpation of the breast?

A

Midaxillary line
Inframammary ridge-5th/7th rib
Lateral edge sternum
Across clavicle

188
Q

What are special considerations when performing a breast exam?

A

Timing of exam: when in cycle. Follicular phase after period best time
Large breasts: have her lean forwards
Implants / augmentation: may be scar tissue
Mastectomy

189
Q

Why monitor the foetus in utero?

A

Monitor growth: Identify IUGR (intrauterinegrowth restriction)
Monitor development: Identify anomalies
Optimise in utero conditions
Prevent / Intervene / Deliver / Be prepared

190
Q

What can be causes for still births?

A

Unexplained - inter uterine growth restriction 28%

Major congenital abnormality 9%

191
Q

How can you estimate foetal weight?

A

Estimated by head circumference, foetal length, abdominal circumference - glycogen stores in liver

192
Q

Describe interuterine growth restriction

A

Symmetric: Head Circumference & Abdo Circumfernce decreased
Asymmetric: Head Circumference preserved, abdo Circumfernce decreased. Brain sparing
Small for gestational age, Growth under 10th centile

193
Q

What biophysical measures can be take of the foetus in utero?

A

Heartbeat
Movement, kicking
Foetal breathing (12-14 weeks): diaphragmatic movements
Foetal responses: to sound, amniocentesis, move away from needle
Foetal urine, amniotic fluid volume

194
Q

Describe oxygen delivery to the foetus

A

Simple diffusion across placenta:

195
Q

What is a congenital abnormality? Give examples of types

A 
Abnormalities present at birth
Malformation
Deformation 
Dysplasia 
Disruption
196
Q

What is teratogenesis?

A

Abnormality induced in a developing organism during uterine life by foreign agents, teratogens

197
Q

What factors can cause teratogenesis?

A 
Chemicals/pollutants/radiation
Alcohol 
Dietary intake
Viruses 
Medication during pregnancy
198
Q

What type of teratogenesis does alcohol result in?

A

Fetal alcohol syndrome

199
Q

What type of teratogenesis does vitamin a lead to?

A

Cleft palate, mandibular hypoplasia, heart defects

200
Q

What type of teratogenesis does rubella or HSV lead to?

A

Deafness, cataracts, retinal dysplasia, microcephaly

201
Q

What type of teratogenesis does x ray lead to?

A

Microcephaly, spina bifida, cleft palate

202
Q

What type of teratogenesis does sodium valproate lead to?

A

Neural tube defects, facial defects, limbs

203
Q

How might pregnant women be exposed to teratogens?

A

Drug used prior to knowledge of pregnancy
Drugs necessary for condition independent of pregnancy
Drugs necessary due to pregnancy specific condition
Environmental agents which are impossible to avoid

204
Q

What dietary agents can cause teratogenic problems in pregnancy?

A

Folate deficiency
Zinc: too low or too high may cause problems
Glucose & ketone bodies: diabetic conditions
Retinoid excess

205
Q

When is the embryo/fetus at risk of damage by teratogens?

A

Weeks 3-14, when cell division is high, organogenesis is occurring, midline Union is occurring

206
Q

When can neural tube defects be induced by teratogens?

A

Weeks 3-16

207
Q

When can cardiac abnormalities be caused by teratogens?

A

Week 3 1/2 to week 6

208
Q

When are upper limbs at risk by teratogens?

A

Weeks 4+5, micromelia/ Amelia

209
Q

When is there a risk of causing a cleft lip by teratogens?

210
Q

When is there a risk of developing ear problems by teratogens?

211
Q

When are you at risk of developing a cleft palate by teratogens?

212
Q

What can influence the teratogenicity of a substance?

A

Teratogen must contact developing embryo/fetus
Period of development at exposure
Exposure timing & dosage
Foetus genotype influences susceptibility

213
Q

What are Wilsons 6 general principles of teratology?

A

Final manifestations of abnormal development: death, malformation,
growth retardation and functional disorder
Susceptibility of conceptus: varies with developmental stage at time of exposure
Teratogenic agents act in specific ways on developing cells and tissues in initiating abnormal embryogenesis
Manifestations increase from no-effect to totally lethal level as dosage increases
Access of adverse environmental influences to developing tissues
depends on nature of the agent
Susceptibility depends on genotype of conceptus and on the manner in which genotype interacts with environmental factors

214
Q

How can a substance be teratogenic?

A

Chromosomal abnormalities leading to changes in DNA
Interference with cell differentiation
Failure of normal cell-to-cell interactions
Failure of normal cell migrations
Interruption of DNA or RNA synthesis
Mutational changes in DNA sequences

215
Q

What are the key features of foetal alcohol syndrome?

A

Heart defects
Short palpebral fissure
Midline facial abnormalities (maxillary)
Lack of philtrum & thin top lip
Heavy epicanthic folds
Flattened nose
Neural problems - Behavioural & developmental

216
Q

What agents can cause teratogenic limb abnormalities?

A

Thalidomide (anti-nauseant, sleeping pill)
Retinoids (vitamin A derivatives)
Mechanical via amniotic bands strangle tissue

217
Q

What is Amelia, meromelia and phocomelia?

A

Amelia - no limb
Meromelia - shortened limb
Phocomelia - seal like limb

218
Q

What is polydactyly and syndactyly?

A

Poly - extra digits

Syn - webbed digits

219
Q

What cells can septal defects be associated with?

A

Neural crest cells

220
Q

What deficiency can lead to neural tube defects?

A

Folic acid

221
Q

What teratogens can lead to facial defects? And what defects could these cause?

A

Antiseizure drugs, retinoids, corticosteroids
Cleft palate & lip Cleft lip: abnormal neural crest cell migration
Tongue: macroglossia, microglossia

222
Q

Describe Treacher-Collins or Pierre Robin Syndrome

A

Autosomal dominant or teratogen-induced (alcohol, retinoids, maternal diabetes)
Mandibulofacial maldevelopment/dysostosis (zygoma, mandible & maxilla)
Downslanting palpebral fissure
Malformed ears & possible conductive deafness

223
Q

What can be done to reduce risk of teratogens exposure in pregnancy?

A

Advice pre-conception (Nutritional & Lifestyle)
Avoid prescribing where possible
Choose safest and prescribe minimal therapeutic dose

224
Q

What are the 3 tissue sources for the development of the gonad?

A 
Gonadal Ridge (intermediate mesoderm) 
Mesodermal epithelium (posterior abdominal wall)
Primordial Germ Cells (yolk sac)
225
Q

What type of internal reproductive tract is present at weeks 5-7?

A

Indifferent genital duct system

226
Q

What happens to the mesonephric and paramesonephric ducts?

A

Mesonephric duct: Males: testosterone production drives the development of mesonephric duct, Females: Degenerates Paramesonephric duct: Males: antimullerian hormone production causes paramesonephric duct regression, Females: Persist & develops

227
Q

What stimulates mesonephric ducts to form male derivatives?

A

Testosterone secretion by testis in week 8

228
Q

What does the mesonephric duct form?

A

Ductus deferens, ejaculatory duct, epididymis & seminal vesicle

229
Q

What results in persistence of paramesonephric duct and degeneration of mesonephric ducts?

A

Lack of testosterone & anti-mullerian hormone

230
Q

What do the paramesonephric ducts form?

A

Uterine tubes & join to form uterus & upper vagina

231
Q

How do the paramesonephric ducts form?

A

Invagination of the coelomic epithelium (future peritoneum)

232
Q

Paramesonephric ducts move to midline and fuse to form uterus. Also pull with them a covering fold of peritoneum, what is this?

A

Broad ligament

233
Q

What are the names of persistent mesonephric duct remnants called?

A

Around ovary: epoophoron

Lateral uterus: Gartner duct

234
Q

Name some types of uterine malformations

A 
Unicornate uterus 
Arcuate uterus 
Septate uterus 
Bicornate uterus 
Didelphic uterus with a septate vagina
235
Q

What does the urorectal septum do?

A

Divides cloaca into urogenital sinus & rectum

236
Q

What is the perineal body?

A 
Remnant of the urorectal sinus
Point of union between pelvic floor and perineal membrane 
Important for integrity of pelvic floor
Support to posterior vaginal wall 
Attachment point for anal sphincter
237
Q

What does the vagina develop from?

A

Uterovaginal canal and sinuvaginal bulb of urogenital sinus

238
Q

What canalises to form the vaginal lumen?

A

Solid vaginal plate formed from the sinuvaginal bulb

239
Q

What is the hymen?

A

Sits between vaginal lumen & urogenital sinus

240
Q

What is vaginal atresia?

A

Vaginal plate fails to canalise

241
Q

What is a transverse vaginal septa?

A

Failure of canalisation of vaginal plate and/or uterovaginal duct

242
Q

What are male and female homologues of genital development?

A

Urogenital Fold: Penile urethra, Labia minora
Labioscrotal Swelling: Scrotum, Labia majora
Genital tubercle: Glans penis & erectile tissue, Clitoris

243
Q

What is the midline raphe of the penis?

A

Point of midline fusion during development

Block 5 AR (7 decks)

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