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Key ALS facts > Block 11 > Flashcards

Block 11 Flashcards

1
Q

Why does total blood volume increase in pregnancy?

A

due to activation of RAAS in response to decreased diastolic BP + peripheral vascular resistance mediated by increased progesterone lvls

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2
Q

Why might pregnant women become more frequently constipated?

A

increased progesterone — increases SM relaxation – decreases gut motility

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3
Q

Why does GFR increase by 50-60% during pregnancy?

A

increased CO – increases renal blood flow – more blood to kidneys — more filtration

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4
Q

Duchenne’s is caused by

A

frameshift/nonsense mutation in dystrophin gene -> no functional dystrophin made

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5
Q

Role of oestrogens in breast development

A
  • stimulates ductal proliferation + differentiation

- ducts lengthen + branch out causing breasts to enlarge

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6
Q

Role of prolactin in breast development

A

stimulates nipple growth

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7
Q

Role of serum hPL (human placental lactogen) in breast development

A

stimulates areola growth

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8
Q

Role of progesterone in breast development

A

stimulate growth of the lobes, lobules + alveoli

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9
Q

What are milk streaks?

A

thickening of epithelial cells

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10
Q

Glandular secreting structures of mammary glands

A

= ALVEOLI

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11
Q

At which gestational age do the primary milk ducts arise?

A

~32 WEEKS

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12
Q

How do the breasts grow during childhood

A

ISOMETRICALLY - i.e in proportion to limbs

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13
Q

Breast growth during puberty is

A

ALLOMETRIC - each reproductive cycle causes proliferation + active growth → causes irreversible mammary development

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14
Q

Electrolyte abnormalities seen in hyperemesis gravida

A
  • hyponatremia
  • hypokalaemia
  • hypochloraemia
  • metabolic alkalosis - H+ ions from stomach lost, makes blood to alkaline as acid depleted
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15
Q

Most common breast lumps in women aged 15-25.

A

Fibroadenomas

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16
Q

How many ducts approximately in an adult mammary gland?

A

15-20 lactiferous ducts

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17
Q

LACTIFEROUS SINUS

A

terminal expansion of lactiferous duct for milk storage

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18
Q

Function of suspensory ligaments:

A

maintain stability and shape of breast

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19
Q

site of progesterone production in luteal phase

A

corpus luteum

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20
Q

How long does epithelialisation of the endometrium take after menstruation?

A

4-7 days

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21
Q

How long is an egg viable for after ovulation?

A

24hrs

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22
Q

Which enzyme do sperm release to digest the egg ECM?

A

hylauronidase

  • once ECM digested, ZP exposed
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23
Q

What triggers the acrosome reaction?

A

interaction of sperm head with ZP2 + ZP3 glycoproteins of the zona pellucida

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24
Q

site of early embryo development

A

fallopian tube

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25
Q

At what cell stage does the embryo leave the fallopian tube and enter the uterus?

A

when the embryo is a blastocyst

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26
Q

Factors stimulating uterus to become receptive to blastocyst implantation

A

OESTROGEN

EGF

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27
Q

Describe the term apposition in relation to implantation

A

process by which blastocyst orientates itself so trophoectoderm cells are in direct contact with the endometrium

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28
Q

How is the dorsal-ventral axis of the embryo established during implantation?

A

when blastocyst orientates itself so the inner cell mass is adjacent to the endometrium lining

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29
Q

Which substances secreted during decidualisation promote invasion?

A

histamine AND prostaglandins

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30
Q

Most common site of implantation

A

posterior uterine wall

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31
Q

Amniotic cavity is the space between the

A

inner cell mass(specifically Epiblast) and the syncytiotrophoblasts (digestive trophoblasts that burrowed into endometrium)

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32
Q

Which embryonic cavity acts as a source of germ cells?

A

Blastocoel (yolk sac) lies between outer trophoectoderm + hypoblasts

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33
Q

Where does the primitive streak form?

A

dorsal surface of epiblast

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34
Q

Which cells form the chorionic membrane?

A

syncytiotrophoblast cells + outer TE(cytotrophoblasts) + extraembryonic mesoderm cells

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35
Q

Main contributor to increased cardiac output during pregnancy

A

increased STROKE VOL.

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36
Q

Why do you get increased tidal volume during pregnancy?

A

progesterone relaxes the intercostal muscles + diaphragm

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37
Q

Hormone used in superovulation

A

FSH - stimulate follicular growth

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38
Q

Role of GnRH agonist in IVF

A

DOWNREGULATION

  • suppress body’s own natural hormone production of FSH + LH
  • desensitises AP receptors in prep for FSH+LH admin later in IVF cycle
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39
Q

What hormone can be given to prevent premature LH surge and follicle rupture in IVF?

A

GnRH antagonist

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40
Q

Key features in superovulation?

A
  • high levels of FSH given to stimulate growth of cohort follicles + allow them to reach preantral phase
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41
Q

How come the FSH administered in Superovulation doesn’t cause a negative feedback effect on the AP?

A

because FSH levels are so high they overcome this

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42
Q

What hormone is given when it is confirmed that follicles are mature in IVF?

A

hCG which induces the final stage of follicular development + ovulation

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43
Q

Ovarian hyperstimulation syndrome

A
  • too many follicles matured -> lrg increase in plasma oestrogen lvls
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44
Q

Briefly explain the process of ICSI - intracytoplasmic sperm injection

A

tiny needle used to take single sperm and inject it into egg

v valuable in case of low sperm count

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45
Q

What proportion of infetility causes are due to the female?

A

1/3:
- ovulatory disorders

  • endometriosis
  • tubal disease
46
Q

Most common reason for infertility

A

MALE INFERTILITY

47
Q

Azoospermia

A

absence of sperm in ejaculate

48
Q

Which 4 main drugs can have an affect on female fertility?

A
  • NSAIDs long-term use
  • Chemotherapy
  • Antipsychotics => can caused missed periods + infertility
  • Spironolactone, fertility recovers ~2months after you stop taking it
49
Q

Low sperm count

A

oligozoospermia

50
Q

Uterus position

A

anteverted AND anteflexed

51
Q

Which muscle lies posterior to the sacral plexus?

A

piriformis

52
Q

What structure determines the size and shape of the birth canal?

A

PELVIC INLET

53
Q

Which type of pelvis do women have?

A

GYNAECOID PELVIS

54
Q

How can the pelvic ligaments aid childbirth?

A

sacrotuberous + sacrospinous ligaments can stretch under the influence of progesterone to increase size of the pelvic outlet

55
Q

The minimum antero-posterior distance of the pelvic inlet/Narrowest portion of the pelvis the foetus must navigate through

A

= diameter between the sacral promontory AND the public symphysis midpoint

56
Q

Which ligaments divide the sciatic notch into the greater and less sciatic foramina?

A

Sacrotuberous ligament + Sacrospinous ligament

57
Q

Which uterine ligament passes through the inguinal canal?

A

ROUND LIGAMENT

=> remnant of embryonic gubernaculum

58
Q

Do the ovaries sit posteriorly or anteriorly in the pelvic cavity in the anatomical position?

A

POSTERIORLY

59
Q

Most superior part of the broad ligament is formed from the

A

Suspensory ligament of the ovary

60
Q

structures contained with the suspensory ligament of ovary

A

ovarian artery, ovarian vein, ovarian nerve plexus and lymphatic vessels

61
Q

Where does the bulbospongious muscle lie in females?

A

within each of the LABIA MINORA

62
Q

Which structures meet at the perineal body?

A

The posterior fibres of the bulbospongiosus muscle and the anterior fibres of the external anal sphincter

63
Q

Which muscle runs parallel to the ischiopubic rami?

A

ISCHIOCAVERNOSUS MUSCLE

64
Q

Which structure do the bulbospongious muscles surround in the female?

A

Bulb of the vestibule => erectile tissue

65
Q

Which structures lie within the ischiocavernosus muscles in the female?

A

CRURA of the clitoris

66
Q

Which structure lies directly behind the bulb of the vestibule?

A

The GREATER VESTIBULAR GLANDS => Bartholin’s glands; produces watery secretion tht lubricates vaginal opening

67
Q

Flat sheet-like structure that bridges the gap between the ischiopubic rami

A

PERINEAL MEMBRANE

68
Q

Role of the foramen ovale

A

shunt blood straight to the LA from the RA bypassing the RV, lungs

69
Q

Embryologically what is the name given to the gaps that form the foramen ovale

A

septum secundum and ostium secundum

70
Q

When is the embryonic period?

A

The first 8weeks after fetilisation

71
Q

most accurate estimation of gestational age in early pregnancy

A

Crown rump length - little biological variability at this time increases from ~ 5cm at 9wks to ~36cm - 36wks

72
Q

What can be measured btwn 7+13wks to date pregnancy and estimate the delivery date?

A

CROWN RUMP LENGTH => length of the embryo or fetus from the top of its head to bottom of torso

73
Q

Explain why there is little weight gain in the foetus during the embryonic foetal period?

A

Because foetus is undergoing intense differentiation + morphogenesis but placental growth needs to be established to allow nutrient + oxygen supply for foetal growth

74
Q

Dominant cellular growth mechanism in foetal growth

A

0-20 wks - hyperplasia

20-28wks - hyperplasia + hypertrophy

28wks - term - hypertrophy

75
Q

How long does it take for a fully mature placenta to be established?

A

12 WEEKS

76
Q

Nutrient dependent hormone needed for foetal growth that dominates in T2 + T3:

A

IGF-I

77
Q

Nutrient INDEPENDENT hormone needed for foetal growth

A

IGF-II

78
Q

Average birth weight of a term baby

A

3.5kg ~7.7 pounds

79
Q

Birth weight > 4.5kg suggests

A

Macrosomia

80
Q

Birth weight < 2.5kg

A

suggest foetal growth restriction

81
Q

Approx what gestational age is the fundus of the uterus palpable at the umbilicus

A

22 WEEKS

82
Q

Early signs of foetal hypoxia on a doppler ultrasound

A

raised umbilical artery pulsatility index AND absent end diastolic flow

83
Q

Decidua

A

tissue that has changed in the presence of trophoblasts

84
Q

TORCH

A 
T - Toxoplasma gondii
O - other agents
R- rubella
C - cytomegalovirus(CMV)
H- herpes simplex virus (HSV)
85
Q

Oligohydraminos

A

reduced amniotic fluid volume

86
Q

Consequences of prematurity in foetus

A
  • Breathing problemsdue to immature respiratory system - less type II pneumocytes → reduced surfactant → Respiratory distress syndrome
  • Heart problems
    • *Patent ductus arteriosus**
    • ductus arteriosus doesn’t close
    • no blood flow to lungs → no oxygenated blood circulating
    • extra blood gets pumped from aorta to pulmonary arteries
      • extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested
      • child may breathe faster and harder than normal
      • high pressure in lung blood vessels as they receive more blood → might permanently damage them
87
Q

Late changes in a previously normal structure:

A

DEFORMATION (mechanical effect)

88
Q

secondary disturbance due to early influence of external factors

A

DISRUPTION

89
Q

primary disturbance of embryogenesis

A

MALFORMATION

90
Q

Agents that have capacity to disrupt normal development

A

TERATOGENS

91
Q

function of relaxin

A

regulates adenylate cyclase

relaxes pelvic ligaments AND widens+softens the cervix

92
Q

Forces of release overwhelm forces of retention in pregnancy: list some forces of release

A

FORCES of release
- prostaglandins - increase contractility

  • cortisol produced by foetal adrenal gland inhibits progesterone
  • oestrogen -> sensitises tissues to oxytocin
  • oxytocin - main hormone tht induces uterine muscle contraction
  • mechanical stretch on uterus -> increases excitability of muscle fibres
  • vasopressin -> acts alongside vasopressin
93
Q

Purpose of latent phase

A

short, irregular contractions to induce cervical ripening a few days before labour starts => enables cervix to offer less resistance to the presenting part

94
Q

regular contractions, 3-4cm dilated, cervix fully effaced =

A

1st STAGE of labour

95
Q

in what stage of labour is the amniotic sac oft. ruptured

A

FIRST stage

96
Q

Stage of labour where cervix FULLY DILATED

A

SECOND STAGE

97
Q

4 foetal factors tht affect the 2nd stage of labour

A

foetal size -> head size mainly

foetal lie -> axis of baby shld be longitudinal in relation to the mother

foetal presentation -> cephalic presentation(head first)

foetal attitude -> bby shld be fully flexed

98
Q

which 2 hormones inhibit early pregnancy levels of oxytocin?

A

relaxin + progesterone

99
Q

How does oestrogen sensitise the myometrium to oxytocin?

A

around 36wks gestation oestrogen will upregulate the no. of oxytocin receptors in myometrium

100
Q

When the baby’s head reaches the pelvic floor its shoulders

A

INTERNALLY ROTATE => so widest part of shoulders are in line w widest part of pelvic inlet

101
Q

Site of growth hormone production

A

anterior lobe of pituitary gland

102
Q

Direct effects of growth hormone on fat metabolism

A

GH binds Rs on adipocytes:

  • stimulates triglyceride breakdown
  • suppresses adipocyte ability to accumulate + take up lipids
  • stimulates protein anabolism
  • suppresses insulin’s ability to stimulate glucose uptake in peripheral tissues
103
Q

Indirect effects of growth hormone:

A

signals to liver to produce IGF-1 which:

  • stimulates chondrocyte proliferation
  • stimulates both the differentiation and proliferation of myoblasts
  • stimulates amino acid uptake and protein synthesis in muscle and other tissues.
104
Q

Effect of somatostatin on GH

A

inhibits GH release in resp to Growth hormone releasing hormone AND low glucose conc.

105
Q

Effect of ghrelin on GH

A

binds somatotrophs and potently stimulates GH secretion

106
Q

Relationship btwn. IGF-1 and GH

A

high lvls of IGF-1 directly inhibit GH

IGF-1 secretion is independent of GH before birth

BUT stimulated by GH after birth

107
Q

5 key places insulin like growth factors are made

A

liver

kidneys

muscles

cartilage

bone

108
Q

Role of T3 + T4 thyroid hormones in growth

A
  • GENERALLY: normal differentiation + maturation of skeleton + nervous tissue
  • protein synthesis in foetal brain + young children
  • promote linear growth of bone til puberty
  • promote ossification of bone + maturation of epiphyseal growth regions
109
Q

Effect of XS cortisol on growth

A

INHIBITORY EFFECT

=> increases rate of skeletal maturation so reduces potential for further growth

110
Q

Common form of dwarfism in humans

A

Achondroplasia

  • autosomal dominant condition; mutation in Chr 4 - gain of function in FGF receptor 3:

decreased endochondral ossification

inhibits chondrocyte proliferation -> decreased cartilage matrix production

epiphyseal growth plates in long bones close early

inhibits cellular hypertrophy

**Other organs develop normally!!

111
Q

Hypersecretion of GH

A

ACROMEGALY

usually caused by adenoma of pituitary somatoproph cells

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