Anatomy and physiology

Question 1

What is the development of eggs in the fetus -> birth?

Answer 1

1. 4th week gestation - primordial germ cells appear in yolk sac
2. 16th week gestation - clumped cells become primary follicles
3. They undergo mitotic division and by 20 weeks gestation, there are 7 million oogonia. After this, no further cell division occurs and no more ova are produced.
4. By birth, the oogonia have begun the first meiotic division and are primary oocytes
5. From birth onwards, the number of primary oocytes falls progressively

Question 2

By birth, how many rounds of meiosis have the primary oocytes been through?

Answer 2

1

Question 3

How many chromosomes do the primary oocytes have?

Answer 3

46 XX

Question 4

What does an oocyte undergo its 2nd round of meiotic division?

Answer 4

After fusion of the sperm and the egg occurs
but
Before the 23 chromosomes of the male gamete joins the 23 chromosomes of the female game within the nucleus of the cell

Question 5

What are the 4 phases of meiosis?

Answer 5

1. Prophase
2. Metaphase
3. Anaphase
4. Telophase

Question 6

What phase of meiosis are primary oocytes suspended in?

Answer 6

Prophase

Question 7

What is the sequence of follicular development?

Answer 7

1. Enlargement of ovum with aggregation of stromal cells to form thecal cells
2. When a dominant follicle is selected at day 6 of cycle, the inner layers of granulosa cells adhere to the ovum and form the corona radiata

Question 8

What is the role of FSH?

Where does it bind to?

Answer 8

1. Stimulates follicular growth and development

2. Binds exclusively to granulosa cells in the growing follicle

Question 9

What is the action of hormones in follicular development and ovulation?

1. FSH
2. Oestrogen
3. LH

Answer 9

1. FSH
   - Stimulates follicular growth and development, binding exclusively to granulosa cells in the growing follicle
2. Granulosa cells produce oestrogen which feeds back on the pituitary to suppress FSH release, with only the dominant follicle then getting enough FSH to continue development. At the same time, FSH stimulates receptors for LH
3. LH stimulates the process of ovulation, the reactivation of meosis 1 and sustains development of corpus luteum

Question 10

Where are receptors for FSH?

Answer 10

Granulosa cells in growing follicle

Question 11

Where are receptors for LH?

Answer 11

On theca and granulosa cells and in the corpus luteum

Question 12

What hormone initiates the hormonal events associated with ovulation?

Answer 12

Gonadotrophin-releasing hormone (GnRH) is produced by the hypothalamus

It results in the release of FSH and LH from the pituitary

Question 13

Describe the hormonal events associated with ovulation regarding:
GnRH
FSH
LH
Oestrogen
Progesterone

Answer 13

1. GnRH is released in episodic fluctuations
2. Levels of FSH are slightly higher during menses to stimulate development of the next follicles and subsequently decline due to negative feedback effect of oestrogen production by the dominant follicle
3. LH remains constant in the first half of the cycle but there is a marked surge of LH just before ovulation
4. LH and FSH levels are slightly lower in the 2nd half of the cycle than in pre-ovulatory phase, but continued LH release by the pituitary is necssary for normal corpus luteum function
5. Oestrogen production increases in the first half of the cycle, falls to about 60% of its follicular phase peak following ovulation and a 2nd peak occurs in luteal phase.
6. Progesterone levels are low prior to ovulation but are elevated throughout most of the luteal phase

Question 14

What are the 4 phases of the endometrial cycle?

Answer 14

1. Menstrual phase
2. Phase of repair
3. Follicular or proliferative phase
4. Luteal or secretory phase

Question 15

What are the 2 layers of the uterus?

Answer 15

1. Inner layer of endometrium
   - made up of 3 layers
2. Outer myometrium

Question 16

What are the 3 layers of the endometrium from out to in?

Answer 16

1. Zona basalis
2. Zona spongiosa
3. Zona compacta

Question 17

Of the 3 zones of the endometrium, which ones are shed in menstruation?

Answer 17

The outer 2

Question 18

What are the features of the menstrual phase of the endometrial cycle?

Answer 18

1. Occurs in the first 4 days
2. Shedding of the outer 2 layers of the endometrium
3. Associated with fall in both oestrogen and progesterone levels

Question 19

What are the features of the phase of repair of the endometrial cycle?

Answer 19

1. Day 4-7

2. Formation of a new capillary bed arising from arterial coils and regeneration of epithelial surface

Question 20

What are the features of the follicular or proliferative phase of the endometrial cycle?

Answer 20

1. Day 7-ovulation (day 14)

2. Period of maximal growth of endometrium and expansion of glands and stromal development

Question 21

What are the features of the luteal or secretory phase of the endometrial cycle?

Answer 21

1. From ovulation and continues until 14 days later when menstruation starts again
2. Endometrial glands become convoluted and ‘saw-toothed’ in appearance
3. Epithelial cells secrete fluid which becomes thick by mid-luteal phase (around day 20 of a 28 day cycle)
4. As menstruation approaches, there is oedema of the stroma and a pseudodecidual reaction

Question 22

Is the mucus in the endometrium more receptive to sperm during the follicular or luteal phase?

Answer 22

Follicular phase

Question 23

What is capacitation?

Answer 23

When sperm travel through the Fallopian tubes, the sperm undergo the final stage of maturation (capacitation), which are enzyme-induced, enabling penetration of the zona pellucida

Question 24

Where in the fallopian tube do the sperm and egg meet?

Answer 24

Ampulla

Question 25

What is the sequence of fertilsation and implantation?

Answer 25

1. Adherence of sperm and egg initiates the acrosome reaction, involving the loss of plasma membrane over the acrosomal cap. this allows the release of lytic enzymes which facilitates penetration of the oocyte membrane
2. The sperm head decondenses to form the male pronucleus and eventually becomes apposed to the female pronucleus in the female egg to form the zygote
3. 36 hours after fertilisation, the conceptus is transported through the tube by musclar peristaltic action
4. The zygote undergoes cleavage and at the 16-cell stage, it is a solid ball of cells known as a morula
5. A fluid-filled cavity develops in the morula to form the blastocyst
6. Six days after ovulation, the embryonic pole of the blastocyst attaches itself to the endometrium, near the mid-portion of the uterine cavity.
7. By the 7th day post-ovulatory day, the blastocyst has penetrated deeply into the endometrium
8. Decidual reaction of the endometrium occurs

Question 26

What is the decidual reaction?

Answer 26

After implantation, the endometrial cells are destroyed by the cytotrophoblast and the cells are incorporated by fusion and phagocytosis into the trophoblast. The endometrial stromal cells become large and pale

Question 27

Qs to ask in gynae history?

Answer 27

Menstruation - how long cycle is/how long they bleed for/when their period started/any intermenstrual or post-coital bleeding/heavy/LMP
Obstetric - been pregnant/had children/ectopics/miscarriages
Sexual - contraception/partners/STDs/when they were last checked
Smear - had it/up to date/ever had abnormal

Question 28

How to manage a pregnant woman with problems (osce)?

Answer 28

Acute - check mother is ok, haemodynamically stable, group+save

Fetus - fetal movement