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Block 5- Kim > Block 5 Revision > Flashcards

Block 5 Revision Flashcards

1
Q

Give some examples of primative reflexes

What are they an indication of?

A

Moro (arm aduction, abduction, crying) , Asymmetrical Tonic Neck Reflex (turn head one side & see ipsilateral extension of limbs & contralateral flexion of limbs), Rooting, Grasping

Indication of motor development- underlying myelination of higher cortical motor pathways

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2
Q

What are the stages of childhood?

A

Baby 0-1 yrs

Infant 0-2yrs

Childhood 2-10yrs

Early Adolesence 11-13yrs

Middle Adolescence 14-17yrs

Late Adolescence 18-21yrs

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3
Q

What are the 1001 Critical Days?

A

From conception –> Birth for building optimum security & healthy brain development

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4
Q

Which region develops almost fully after birth?

A

Orbitofrontal cortex develops almost completely post-natally

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5
Q

Female Repro: What is the tendinous arch? What is its role?

A

Thickening of fascia over obturator internus. Provides attachment for pelvic floor

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6
Q

What is the perineum?

A

Space between plevic floor and thighs. Split into Urogenital and Anal triangle. Uses Sacrum, Pubic Symphesis & Ischial Spines as landmarks.

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7
Q

What is covered in perineal membrane?

What is it?

What is its role?

A

The urogenital triangle

Tough fibrous sheet

Attachment point for external genitalia

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8
Q

What is the perineal body?

What is its function?

A

Sits between the vagina & anus and is a mass of fibres

Functions:

Union between pelvic floor & perineal membrane

Important for pelvic floor integrity

Supports posterior vaginal wall

Attachment point for anal sphincters

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9
Q

What are the ischioanal fossae? What is the function of it?

A

Fat filled regions. Deep to the pelvic floor either side of the anus. Extensions into urogenital triangle. Helps support the pevlic floor & anal canal

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10
Q

What musculature does the deep perineal pouch contain in females? What is the innervation?

A

Compressor urethrae

External urethral sphincter

Sphincter Urethrovaginalis

Deep transverse perineal muscle

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11
Q

What is the contents of the deep perineal pouch in males?

If there is a muscle in here what is it’s innervation?

A

Bulbourethral glands (although open into urethra superficial to perineal membrane)

External urinary sphincter

Deep Transverse muscles

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12
Q

What structures are considered external genitalia for females?

Which is in the superficial perineal pouch? What provides an attachment point?

A
  • Mons Pubis
  • Clitoris (Formed by paried Corpora Cavernosa & Vestibular bulb)
  • Labia majora
  • Labia menora (surrounds the vestibule-space between L.menora where vag/urethra open onto)
  • Opening of the Greater Vestibular Glands (bartholian glands)/ (actual) Bartholian Glands

​

Superficial Perineal Pouch

  • Vestibular bulb (spongy explansile vascular tissue w/ overlying muscles. Lies deep to skin w/ on either side of vestible. Helps form clitoris w/ corpora cavernosa)
  • Corpora Cavernosa (form cura of clitoris)
  • Overlying: Ischiocavernous muscle (over Cura or Clitoris) & Bulbospongiosus muscle ( over greater vestibular glands & greater vestibule)

Attachment: Perineal membrane

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13
Q

What is sensory to the clitoris (& distal vagina & urethra)?

A

Pudendal

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14
Q

You perform a midline episiotomy, what are you going to cut through?

A

Skin & Subcut tissue

Transverse perineal muscles & bulbospongiosus muscle

Perineal membrane

Levator ani

Posterior wall of the vagina

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15
Q

How does the epithelium change in the cervix proximal to distal?

A

Proximal = Columnar

Distal = Squamous

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16
Q

Female Repro: What is the are the fornix?

A

Where the cervix projects into the vaginal vault forming a recess.

Posterior fornix is deepest and adjacent to rectouterine pouch

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17
Q

Where is the uterus linked to the uterine tubes?

A

Uterine horns (cornua)

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18
Q

Female Repro: What are fibroids and where do they form (think layers)

A

Benign smooth muscle tumors

Can form in uterus

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19
Q

If an ectopic pregnancy occurs in the uterine tubes and ruptures what does this lead to?

A

Haemoperitoneum

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20
Q

What nerve can ovarian pathologies impinge on?

A

Obturator nerve

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21
Q

What are the key ligaments of female repro?

A

Broad ligament

Suspensory ligament of ovary (contains lymph & vessels)

Round ligament of ovary (ovary –> uterus)

Round ligament of uterus (uterus –> labia majora via inguinal canal)

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22
Q

What is the broad ligament?

What is its function?

What are the 3 parts?

A

Double layered fold of peritoneum

Support & Surround: Ovary, Uterine tubes, Uterus

Mesovarium, Mesosalpinx, Mesometrium

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23
Q

The round ligaments (of ovary & uterus):

a) What are they remnanents of?
b) Clinically why is the round ligament of the uterus important?

A

a) Remanents of Gubernaculum
b) Provides a route of travel for cancer from ovary and uterus to the superficial inguinal lymph nodes

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24
Q

What has been removed in:

a) TAH
b) Subtotal hysterectomy
c) Radical hysterectomy
d) Bilateral Salpingoophorectomy

A

a) Uterus & Cervic
b) Cervix preserved
c) Uterus, Cervix, Associated supporting tissue Lymphatics
d) Uterine tubes & ovaries

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25
Q

Where is pelvic fascia?

What are the types?

Where does it lie?

A

Pelvic fascia is below the peritoneum

Types: Parietal, Visceral, Endopelvic

Parietal- Covers walls/ muscle

Visceral- Covers organs

Endopelvic fascia fillis in gaps (loose and fatty CT). In certain areas its very dense & forms fibrous supporting ligaments

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26
Q

Where do supporting ligaments of the female repro tract arise from?

What do they form? And where does this run?

What are the key parametrial ligaments formed from? What is there role?

What else connects to the the structure the support ligamnets forms? What is the function of this?

A

a) Endopelvic fascia which is very dense in certain areas)
b) collectively form Tendinous Arch (Pubis to Sacrum) runs over the obturator internus. [I believe this is different from tendinous arch of pelvic floor]
c) Cardinal/ Transverse Cervical, Sacrocerivcal/ Uterosacral, Pubocerical. Provide support to uterus
d) Paracolpium fascia around vagina connects to Tendinous Arch to support vagina

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27
Q

Cytocele

Rectocele

Where do these prolapse through?

A

a) Anterior vaginal wall
b) Posterior vaginal wall

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28
Q

What 2 key branches supply the female repro tract? Talk about the branching patterns- what do they supply?

What has an anastomtic supply?

A
  • Internal Iliac
    • Internal pudendal- Perineum
    • Vaginal
    • Uterine
    • (middle & inferior rectal)
  • Ovarian Artery from aorta
    • Tubal branches

Uterus has an anastomotic supply from Internal Iliac & Ovarian artery

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29
Q

Where do the uteters pass in relation to one of the above arteries?

A

Water under the bridge!

Uterine artery anterior to ureters thus at risk of damage during a hysterectomy

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30
Q

What is the lymphatic drainage of the female reproductive organs?

A

Para Aortic: Ovaries, Uterine Tubes, Fundus of Uterus

Internal & External Iliac (& sacral): Body of Uterus, Cervix, Proximal Vagina

Inguinal Lymph nodes- Deep & Superficial (external iliac): Distal Vagina, External Genitalia

NOTE: Round ligament provide of uterus route of ca spread from fundus of uterus to superficial inguinal lymph nodes via the inguinal canal

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31
Q

Describe the innervation of the female repro tract

And therefore the type of anaesthesia you could give

A

Above pelvic pain line:

  • Uterine tubes, Uterus, Bladder roof, Upper Anal canal
  • Travel w/ sympathetics T11-L1/2
  • Epidural/ Spinal

Below pelvic pain line:

  • Cervix, Proximal vagina
  • Travel w/ parasympathetics S2-S4
  • Caudal (insert @ sacral hiatus) which targets sacral spinal nerves. Do not advance too far or you’ll give a spinal or epidural!

Distal vagina

  • Sensory (including clitoris) via Pudendal nerve
  • Pudendal nerve block- feel for the ischial spines
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32
Q

Pudendal nerve:

a) What does it supply? (males as well)
b) Branches? (males as well)
c) Route?
d) How can you anethatise

A

a) Perineal skin

External genitalia

Perineal pouch muscles (Deep & Superfical transverse, Compressor urethrae- F only)

Sphincters (External urethral, Sphincter urethrovaginalis-F)

b) Inferior rectal, Perineal, Dorsal nerve of Penis
c) Out via Greater Sciatic Foramen, loop round sacrospinal ligamnet near ischial spine then to perineum via Lesser sciatic Foramen

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33
Q

The uterine cycle: how does menses occur

A

Corpus luteum degrades so decreased progesterone

–> Spiral arteries in functional endometrium to contract causing ischeamia & necrosis –> menstruation

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34
Q

The uterine cycle: What happens to the endometrial glands after menses?

A

Tubular glands with columnar cells of the functional endometrium: proliferate, thicken, straighten & extend into finger like projections

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35
Q

The uterine cycle: What happens during the proliferative phase- what does oestrogen do? (5)

In general what else does it do?

A

Repair and growth of functional endometrium by:

1) Increased vascularity- spiral arteries grow into functional endometrum
2) Increased endometrial thickness
3) Development of secretory glands
4) Thins cervical mucus & makes it alkaline
5) Increases muscular contractions of uterine tubes
- Affects female fat distrubtion, hair, genitals and supports bone growth
- Supports breast development @ puberty & in pregnancy

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36
Q

The uterine cycle: The secretory phase

A

Endometrial glands secrete substances in preparation for pregnancy

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37
Q

What are the 4 functional windows of the menstural cycle?

A

1) Fertile
2) Implantation
3) Selection
4) Menstruation

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38
Q

Menstural Cycle Windows: Fertile- define, when does this occur and what happens?

A

When the probabilty of intercourse resulting in pregnancy is > 5%

4-5 days prior to ovulation and 1-2 days after

Changes in cervical mucus & contraction of the inner myometrium (junctional zone)

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39
Q

Menstural Cycle Windows: Implantation

When does this occur?

What happens?

A

5 days after ovulation and lasts for 2-4 days

Endometrium expresses molecules necessary for attachemnt & invasion of the blasocyst

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40
Q

Menstural Cycle Windows: Selection window

When is this?

What is it characteristed by? What is it triggered by?

What happens in the absence of pregnancy?

A

Days 21-23

Characterised by spontaneous decidualisation- endometrial stromal cells transform into specialised secretory epithelium (form nutrative matrix for trophoblast invasion). Triggered by ovarian hormones

In absence of pregnancy: progesterone –> breakdown of decidual cells

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41
Q

Menstural Cycle Windows: What is the role of decidual cells- apart from providing a welcoming environement for the invading trophoblast?

What happens if there is failure to decidualize properly?

A

Sense quality of implanting embryo

Rapid disposal of poor quality embryos and rapid support for good quality embryos

Failure to decidualise properly –> Miscarriage

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42
Q

The uterine cycle- what are the phases?

If there is variation in the cycle where does this occur?

A

Menses, Proliferative, Secretory

Variation occurs in proliferative phase

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43
Q

What is the framework to separate lower respiratory tract symptoms?

A
  • Physical reproducive tract
  • Functional reproductive tract
    • Eg: defects in hormone production or responsivness of uterus
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44
Q

What is menometrorrhagia?

A

Menorrhagia but irregular

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45
Q

Define quantiatively menorrhagia?

A

>80mls lost or greater than 7days

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46
Q

What hormones does the corpus luteum cause the release of?

What do they do?

A

Progesterone & Oestrogen: Stimulate endometrial growth

Inhibin- inhibits FSH

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47
Q

Define Adolescence

A

Transitional phase of growth & development between childhood & adulthodo

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48
Q

Define puberty?

What is the average age?

A

The biological change of adolescence- the ability to reproduce

11yrs

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49
Q

What are the bones affected by bone growth in puberty and adolescence and which is the exception?

What happens to the bone mineral mass in G vs B and why?

In general the bone mineral mass growth is due to what?

How much more is skeletal mass at the end of puberty?

What happens to the building speed of the spine & hips?

In G- what happens to the bone the accumulate during ___ to ___yrs?

A

All long bones are affected EXCEPT female pelvis which follows a smooth & continous growth until adulthood

Bone mineral mass increases more in boys due to prolonged growth period

Growth in bone mineral mass as there is bone growth and very little change in density

Skeletal mass is x2 more than at the beginning of puberty

Spine and hips buidling speed increase x5

The accumulation of bone between 11-13yrs equals the amount loss during the menopause

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50
Q

Give an outline of what happens during female puberty

A

Breat develops & enlarges

Axillary and pubic hair grow

Growth spurt & Pelvis widens

Increase in subcut tissue around hips and breasts

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51
Q

Female: Tanner’s stage 2

A

Breast: Areolar enlargement and breast buds

Pubic hair: Few dark hairs along labia

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52
Q

Female: Tanner’s stage 3:

A

Breast: Enlargement of breast & areolar as single mound

PH: Curly pigmented hair across pubes

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53
Q

Female: Tanner’s stage 4:

A

Breast: Projection of areolar above breast as double mound

PH: Small adult configuration

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54
Q

Female Tanner Stage 5:

A

Breast: Mature adult breast w/ single contour

PH: Adult pubic hair distribution

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55
Q

What are the 6 peptide hormones produced by the AP?

A

GH

ACTH

TSH

FSH
LH

Prolactin

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56
Q

Where is oxytocin produced from? What is it involved in?

A

Posterior pituitary. Invovled in labour and MILK LETDOWN

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57
Q

GnRH

What time of hormone?

How is it released- which pathway does it go down?

A

Decapeptide (therefore short half life and acts on membrane receptors w/ intracellular transduction via second messengers)

Pulsitile release every 1-2 hrs

Causes release of LH and FSH from AP therefore tuberoinfundibular

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58
Q

What type of hormone is testosterone?

What is it produced by?

Where does it migrate to?

What cells convert it into _____

Then it binds to ___ receptors in ___ cells and this leads to (2)

A

Steroid hormone

Produced by leidig cells (from activation via LH)

Migrates to seminiferous tubules

Coverted into Dihydrotestosterone by Sertoli cells

Binds to Androgen receptor in Sertoli cells –> Sperm production & secondary sex characteristics

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59
Q

Tanners stage- what are they looking at in females and males?

A

Females: Breast development & Pubic Hair

Males: Genital Maturity & Pubic Hair

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60
Q

Male Tanner stage 1:

A

Genital Maturity: Prepubertal less 2mls

PH: None

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61
Q

Male Tanner stage 2:

A

GM: Enlargement of Testes >4ml, Scrotum reddening

PH: Few darks hairs at basis of penis

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62
Q

Male Tanner stage 3:

A

GM: Lengthening of Penis, Further testicular enlargment 6-10mls

PH: Curley pigmented hair across pubes

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63
Q

Male Tanner stage 4:

A

GM: Broadening of Glands Penis, Testicular growth 10-15mls

PH: Small adult configuration- thighs spared

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64
Q

Male Tanner stage 5:

A

GM: Genitalia adult size & shape, Testes 15-25mls

PH: Adult pubic hair disribution

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65
Q

Beyond the Tanner’s stage what else occurs at puberty in males?

A

Increase in height, weight, muscle mass & bone

Larynx enlarges- voice deepens & breaks

Hair growth: Face, axillae, chest, pubis, abdomen

Scrotum, Penis & Prostate gland enlarges

Seminiferous tubules mature & spermatazoa produced

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66
Q

Deinfe precocious puberty

A

Before 8yrs in females

Before 9.5yrs in males

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67
Q

What is delayed puberty?

A

Lack secondary sexual characteristics by: 13yrs Girls & 14yrs Boys

OR lack of progression through tanner’s stages within 4.5/5yrs of onset

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68
Q

In general what happens in the adolescent brain just before puberty?

Where in particular does this happen?

A

Just before puberty there is exuberent synaptogenesis in PFC

Weaker connections are pruned espeically in frontal lobes

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69
Q

What happens in the adolescent brain- what ‘kicks in’ first and then what matures later?

A

Limbic system kicks into high gear during early adolescence therefore you percieve reward from risk

Frontal lobes matures later

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70
Q

What is the role of the PFC?

A

Executive functioning

Personality

Reward

Decision making

Social decision making

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71
Q

On Piaget’s scale of Cognitive development which catagory do adolsecents fall into?

A

Formal operational:

Ability to think abstractly- logical thought, deduction, reasoning, systematic planning emerges

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72
Q

What area of the brain is most invovled w/ social recognition?

A

Amygdala

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73
Q

What stage of Erickson’s Psychosocial development is an adolescent in?

A

Stage 5- Identity & Confusion

They need to develop a strong personal identity, failure –> role confusion & weak sense of self

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74
Q

What sort of social development tasks must adolescents achieve?

A

Emotional separation from parents

Development

  • 1. Peer identity/ social autonomy
  • 2. intimate relationships
  • 3. vocational ability and financial independence

Exploratory behaviours

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75
Q

What are the key areas of forming an identity?

A
  • Become independent
  • Mastery/ sense of competence
  • Establish Social Status
  • Experience Intimacy
  • Determine Sexual identity
  • Develop autonomy:
    • Physical
    • Psychological
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76
Q

Where are adolsecents in Kolberg’s Moral Development theory?

A

Stage 2: Conventional

Good girl/ boy (attitude to seek approval of others) and Law and order

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77
Q

How does alcohol affect the adolescent brain?

A

More -ve affects on hippocampus

Less sensitive to sedative effects of alcohol

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78
Q

How does tobacco affect the brain?

A

Cell damage is worse in hippocampus

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79
Q

How much sleep does an adolescent need?

What happens to their circadian rhythm?

A

9-10hrs

Circadian rhythm shifts forwards- melatonin switched on later @ night and switches off later in the morning

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80
Q

Emotional intelligence

What is it?

What are the 3 parts of it?

Does it happen automatically during adolescent development?

A

Skills necessary for managing succesful relationships & managing emotions

Parts: Self-awareness, Social awareness, Self management

Does not automatically develop

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81
Q

What do drugs do to the adolescent brain? What NT do they target?

A

May affect brain development in areas of impulse control & ability to experince reward

Affects DA NT

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82
Q

What predicts the quality of romantic relationships in early adulthood?

A

Quality of PI interaction in first 42 months of life

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83
Q

When is the best indicator of psychopathy in adolescence?

A

Disorganised attachment (Group D) at 1yrs

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84
Q

What stage of Bilbace & Walsh’s Children’s Explanation of illness is an early/ mid adolescent in?

A

11-16yrs: Physiological- Illness caused my malfunction in system and organs which may be due to infection

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85
Q

What is the approach used to consider adolescent development in a clincal setting?

A

STEP

Sexual maturation & growth

Thinking

Employment/ Education

Peers/ Parents

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86
Q

What is cognitive ideation?

A
  • Advanced reasoning
  • Meta cognition
  • Logical thought process
  • Abstract thinking
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87
Q

What areas of the male repro tract secrete stuff that go into ejaculate?

What does each part secrete?

A

Testicles/ Epididymis (Sperm/ Testosterone)

Seminal vesicles (Semen Clotting Factor, Fructose, IL, PgE)

Prostate Gland (PSA, Coagulase, Phospahte/ Bicarb buffers, Zinc, Citric Acid)

Bulbourethral & Urethral Glands (Lubricating mucus)

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88
Q

Define infertility

A

1-2 years of attempting pregnancy without success

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89
Q

Which phase of Meiosis is the mature Oocyte in prior to fertilisation?

A

Metaphase II

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90
Q

What secretes hCG?

A

Trophoblast

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91
Q

How is Polyspermy prevented?

A

Fusion of the plasma membranes of sperm & oocyte

Fast Block: Depolarisation of the cell membrane- influx Ca2+ & sodium. Second polar body released

Slow Block: Increased Ca2+ Concentration. Cortical granules released

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92
Q

What hormone is used to determine the ovarian reserve?

A

Anti- Mullerian Hormone

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93
Q

What are the 2 reactions by which mature sperm nurrow into oocytes?

A

Hypersensitivity reaction

Acrosome reaction

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94
Q

Where does the majority of ejaculate arise from?

A

Seminal vesicles

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95
Q

What is sperm capacitation?

A

Membrane change

Change of the glycoprotein coat = fully mature and able to fertilise an ova

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96
Q

What are the stages of early embryo development?

A

Pronucleate (6-20hrs)

Cleavage (18hrs -3 Days)

Compaction (Days 3-4)

Blastocyst (Days 5-6)

Hatching (Day 5-7)

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97
Q

What could causes an IVF diagnosis of infertility?

A

1) Ova anomoly (genetic, cytoplasmic or maturation)
2) Fertilisation failure or abnormality
3) Abnormal embryo development
4) Implantation issue

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98
Q

What would cause a medical diagnosis of female infertility?

A

1) Oligo/Amenorrhoea (PCOD/ Primary or Secondary Ovarian failure)
2) Structural abnormality of tubes
3) Structural abnormailty of uterus/ cervix

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99
Q

What position (eg: intrapetrioneal) does the tesicle develop in?

A

Retroperitoneal

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100
Q

What is a patent processus vaginalis?

What can also develop from here?

Where does it develop from?

A

a) Connection between the peritoneal cavity and scrotum
b) Indirect hernia
c) Originally the Processes vaginalis of which the majority is obliterated to become the tunica vaginalis

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101
Q

What is the function of the dartos muscle?

What is it made of?

A

Wrinkles the skin of the scrotum, decreasing the surface area reducing heat loss

Formed from smooth muscle

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102
Q

What is the blood supply of the scrotum?

A

Anterior (from external pudendal) & Posterior (from internal pudendal) Scrotal Arteries

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103
Q

Describe the layers of the tunica vaginalis

A

From parietal peritoneum- visceral and parietal layers

Serous fluid inbetween to allow testicles to move easily in scrotum

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104
Q

What is the name of the condition where there is too much fluid in the tunica vaginalis?

A

Hydrocele

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105
Q

What gives rise to Septa in the tesicles?

What is the function of the septa?

A

a) Tunica Albuginea (white fibrous outter testicular coating)
b) To divide tesis into lobules

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106
Q

Describe the route of sperm through the testicles

A

Seminiferous tubules –> Rete testis –> Efferent Ductules –> Epididymis

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107
Q

What are the parts of the epipdidymis and what recieves what?

A

Head connects to efferent ductules

Body

Tail connects to ductus deferens

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108
Q

What are the coverings of the spermatic cord and where are these from?

A

External Spermatic Fascia from Aponeurosis of EO

Cremasteric Fascia from IO muscle

Internal Spermatic Fascia from Transversalis Fascia

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109
Q

Describe the Cremasteric Reflex

A

Internal thigh stroked

Sensory via Ilioinguinal

Motor via Genitofemoral

Cremaster muscle contracts –> Testes lifting

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110
Q

What is the contents of the spermatic cord?

A

Rule of 3’s

Arteries:

  • Testicular
  • Cremasteric
  • Ductus Deferens

Nerves:

  • Genital branch of Genitofemoral
  • Autonomic
  • Ilioinguinal- not in spermatic cord all the way

Others:

  • Ductus Deferens
  • Pampiniform Plexus
  • Lymphatics
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111
Q

Where can testicular pain refer to?

A

The abdomen

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112
Q

What is wrapped around the testicular artery?

Why is this good?

A

Pampiniform plexus

Helps keep testes cool via counter current heat exchange mechanism

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113
Q

What is the name of venous dilations of the pampinform plexus?

A

Varicocele

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114
Q

What embyological structure develops the Epididymis, Ductus Deferens & Seminal Vesicles?

What week of embryology and what drives this?

A

Mesonephric ducts

Week 8 and tesosterone

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115
Q

What movement are the ductus deferens capable of?

What innervation is this?

A

Peristalsis

via Sympathetic Innervation

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116
Q

What importnant structure do the ductus deferens cross in the pelvic cavity? And how?

A

Superior to the Ureter

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117
Q

What forms the ejaculatory duct?

A

Seminal vesicles

Ductus Deferens (it has widened forming ampulla)

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118
Q

What is the blood supply of the ductus deferens?

A

Local, on route of travel

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119
Q

Where are the seminal vesicles located?

A

Posterior to the bladder

Related posteriorly to Rectovesical Pouch

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120
Q

Describe the location of the prostate gland

A

Below the Bladder

Superior to Perineal membrane & Levator Anti

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121
Q

What type of tissue if the prostate gland made up of?

A

1/3 Fibromuscular

2/3 Glandular

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122
Q

What is the blood supply of the prostate gland?

A

Branches of Internal Iliac Artery- Vesicle & Rectal

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123
Q

Name the different parts of the urethra

A

Prostatic

Membranous

Spongy

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124
Q

What is the raised central area of the urethra called?

What opens onto here?

A

Seminal Colliculus

Ejaculatory ducts open here

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125
Q

Where do secretions of the prostate gland/ducts open up into?

A

Prostatic sinus

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126
Q

What is the homologue of the uterus in the prostate gland?

A

Prostatic utricle

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127
Q

What prevents retrograde ejaculation?

A

Internal Urethral sphincter under ANS innervation. Sympathetics cuase it to close during ejaculation

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128
Q

What is the naming system of the lobes in the prostate based on?

A

Position of the ejaculatory ducts and urethra to prostate tissue

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129
Q

Name the lobes of the prostate and describe their relation

What lobe may push into bladder in BPH?

A

Anterior (in front of urethra)

Middle (posterior to urethra and above ejaculatory duct)

Posterior (posterior to urethra and below ejaculatory duct)

b) Middle

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130
Q

What are zones of the prostate gland based upon?

Name them

A

Distribution of Glandular Tissue

Central

Transitional (BPH normally affects here- around urethra)

Peripheral (ca affects here normally)

131
Q

Where does the prostatic plexus drain into?

Where can it also drain into?

A

Internal Iliac veins

Can also pass into vertebral venous plexus

132
Q

Which structure forms the Glans Penis?

A

Corpus Spongiosum

133
Q

Which tissue in the penis contains the urethra?

A

Corpus spongiosum

134
Q

What embyrological feature forms the erectile tissue and Glans?

A

Genitle tubercle

135
Q

What is the Root of the penis made up of?

A

Bulb (Corpus spongiosum) and Cura (Corpus cavernosum)

136
Q

What is the root of the penis attached to?

A

Perineal membrane

137
Q

What is the body of the penis?

A

The suspended part of the penis

138
Q

What supports the base of the body of the penis?

A

Suspensory ligaments and fundiform ligament

139
Q

What are the the Cura and Bulb covered by?

A

Ischiocavernous muscle

Bulbospongiosus muscle

Both Pudendal nerve innervated

140
Q

What anchors the foreskin to the Glans?

A

Frenulum

141
Q

Where are the majority of NV strucures located on the penis?

A

Dorsal side

142
Q

Why is the tissue less erectile in the corpus spongiosum?

A

So you don’t squish the urethra

143
Q

What is priapism?

A

Persistant and painful erection lasting >4hrs. Unrelieved by ejaculation

144
Q

Where are the Bulbourethral glands located

What is their function?

A

In the deep perineal pouch but open up superifically

Secrete lubricating fluid

145
Q

What can cause # of the penis?

A

Traumatic rupture of the corpus cavernosum

146
Q

What is Phimosis?

A

Foreskin cannot be retracted over the glands

Causes: Recurrent infection- can cause fibrosis and narrowing of foreskin

147
Q

What is Paraphimosis?

A

Foreskin stuck in retracted position behind glans

148
Q

What is Hypospadias?

A

Urethra opens up on ventral side of penis but not at tip

149
Q

What is Epispadius?

A

Urethra opens onto dorsal side of penis

150
Q

What is the Ischioanal Fossae? Where is it located?

What are on each side of it?

Where can it extend into?

What are it’s functions?

A

Fat filled region below the pelvic floor- can communicate across midline

Anterior Recesses which project to pubic bone

Can extend into Urogenital triagnle/ Deep Perineal Pouch

Supports pelvic floor and anal canal

151
Q

Where does the superficial perineal pouch lie?

A

Between Perineal membrane and Superficial perineal fascia (colle’s fascia)

152
Q

What layer of superficial fascia continues from the anterior abdo wall to the perineum?

A

Scarpa’s fasica

153
Q

The superficial fascia from abdo wall gets different names as it passes over different strucutres- name these

A

Penis, Scrotum as Dartos Fascia

Urogenital triangle and attached to posterior aspect of perineal membrane: Colle’s fascia

154
Q

Where can fluid in the superficial perineal pouch track to?

A

Anterior abdominal wall

155
Q

What does the Superficial perineal pouch contain?

A

Penis, Urethra, Scrotal contents, Superfical perineal muscles, OPENING of bulbourethral glands

156
Q

Why does fluid in the superficial perineal pouch NOT track down to the lower limb

A

Scarpa’s fascia binds to Fascia Lata of the thigh

157
Q

What is necrotising fascitis of the perineal region called?

A

Fournier Gangrene

158
Q

What is a perianal fistula?

A

Abnormal connection between anal canal & skin due to infection

159
Q

Male Repro: How does the major NV travel to penis?

A

Deep to pelvic floor through deep perineal pouch & pudendal canal

160
Q

Where is the pudendal canal?

A

Within fascia over obturator internus

161
Q

What is the internal pudendal artery a branch of?

How does it enter the pelvic cavity?

What does it supply?

A

Branch of Internal Iliac

Leaves via greater sciatic foramen and enters pelvic cavity via lesser sciatic foramen

Supplies: Rectum (inferior branch), Perineum and Penis

162
Q

What is the venous drainage of the penis?

A

Dorsal Penile Veins (superficial and deep) –> Prostatic Venous Plexus –> Internal Iliac veins

Can also go via vertebral plexus

163
Q

What lymphatic drainage of male repro goes to the Superficial Inguinal Nodes?

A

Scrotal, Penile & Perineal skin (and distal anal canal)

164
Q

What lymphatic drainage of male repro goes to the Deep inguinal Nodes?

A

Glans of Penis

165
Q

What drains to the para aortic nodes?

A

Testicles

166
Q

What other strucutre drains to the deep inguinal nodes in males?

A

Spongy urethra

167
Q

Where do most other parts of the male repro tract drain to? Including the proximal urethra

A

Internal iliac nodes

168
Q

What does the pudendal nerve branches supply?

A
  • Anal sphincter
  • Perineal skin
  • Penis- Dorsal nerve of the penis (including distal spongy urethra)
  • Bulbospongiosum & Ischiocavernous

This is all SOMATIC innervation

169
Q

What is sympathetics to pelvic organs

A

Hypogastric nerves and Sacral Splanchnic Nerve from sympathetic chain

170
Q

Where do the Parasympathetics (Pelvic Splanchinc nerves) and Sypathetics unite?

A

Inferior Hypogastric plexus (on lateral plevic wall)

171
Q

What nerves extend from the prostatic plexus and what do they supply?

Where has the prostatic plexus originated from? Therefore what division of the NS system is this?

A

Cavernous nerves

Travel into the penis

From: Inferior Hypogastric plexus thus ANS

172
Q

What allows blood to bypass the corpora cavernosa in the flaccid penis

A

AV anastomoses

173
Q

How is erection achieved?

A

Parasympathetic innervation allows straightening of coiled helicine arteries so blood fills corpora cavernosa (NO mediated)

Ischiocavernous and Bulbospongiosus muscles compress venous plexus

174
Q

How is emission achieved?

A

Via sympathetics (L1/2)

Secretion from Glands, Peristalsis of Ductus deferens & Closure of Internal Urethral Sphincter

Seminal fluid & Spermatazoa –> Bulb of Penis

175
Q

What can damage sympathetics that are needed for emission?

A

Surgery around paravertebral plexus

176
Q

What causes ejaculation?

A

Sympathetic innervation

Bulbospongiosus squeezes penile bulb & urethra (Pudendal nerve)

177
Q

Name the 4 types of contraception

A
  • Natural
  • Barrier
  • Hormonal
  • Surgical
178
Q

How does the Lactation contraceptive method work?

A

Prolactin inhibits FSH this supressing HPG axis which prevents follicular maturation and ovulation

179
Q

What are the barrier methods of contraception?

A

Condoms

Diaphragm/ Cervical cap

+/- spermicide

180
Q

What are the disadvanatges of the diaphragm or cap?

A
  • Professional fitting
  • Leave in after 6hrs post sex
  • No STI protection
  • Education for proper use
181
Q

What are the main methods of termination of pregnancy?

A

1) Misoprostol/ Mifepristone (meds) before 9/40
2) Surgical:

  • Vacuum Aspiration (up tp 15/40)
  • Dilation & Curettage (>15/40)
182
Q

Define abortion

A

The death and expulsion of a foetus from uterus either spontaneously or by induction before 22/40

(eg: Spontaneous or Threatened)

183
Q

What is the IUCD Copper MOA ?

A

Copper = Spermicide & Mechanically prevent implantation

184
Q

What are the SE of IUCD?

A
  • Cramping
  • Bleeding
185
Q

What are the complications of IUCD?

A
  • Expulsion
  • Perforation
  • PID
  • Ectopic Pregnancy
186
Q

When PO or Intra-Uterine System Progesterone what do they decrease risk of?

A

Endometrial Cancer

187
Q

What are the advantages of IUCD?

A
  • Long lasting -12yrs
  • Don’t limit sexual activity
  • IUCD- Copper: NO artificial hormones
  • Amenorrhea
  • Decreases Dysmenorrhea
188
Q

When else can the IUCD also be used?

A

Emergency contraception within 5 days of unprotected sex

189
Q

Which oral contraceptive may be used during breast feeding?

A

Progesterone only pill

190
Q

How do Inta-uterine systems work?

A

Incorporate a progesterone release polymer (lasts up to 5yrs)

191
Q

What are the endometrial effects of Progesterone? (contraception)

A

Asynchronus high levels:

  • Thickens cervical mucus
  • Inhibits endometrial glands- implantation less favourable
192
Q

What are the disadvantages of the IUCD?

A
  • Partner unaware of strings
  • Decreased libido
  • Iregular bleeding
  • Cost
  • Invasive
193
Q

Define Atresia

A

Degeneration in ovarian follicles which do not ovulate during menstural cycle

194
Q

What is the average age of menopause?

A

51yrs

Normal range: 45-60yrs

195
Q

How is inhibin stimulated?

A

a) When FSH binds to ovaries it releases inhibin which has a negative effect on the hypothalamus
b) Corpus Luteum

196
Q

What are the triad of symptoms for the menopause?

A
  • Hot flushes
  • Sweats
  • Vaginal dryness
197
Q

Menopause: What is meiotic non disjunction

Give an example of what this can lead to

A

When there is failure to separate of homologus chromosomes-Meiosis I

–> Triosmy 21 (Down’s Syndrome)

198
Q

What are the non-specific menopause symptoms?

A
  • Headache
  • Migranes
  • Palpitations
  • Joint and Muscle aches
  • Distrubed sleep
199
Q

Urogenital symptoms associated with menopause?

A
  • Vaginal dryness
  • Increased frequency
  • Urinary invontinence
  • Cystitis
200
Q

Psychological symptoms associated w/ menopause

A
  • Decreased concentration
  • Irritable
  • Poor memory
  • Lack of libido
  • Panic attack
201
Q

Connective tissue disorders associated w/ menopause

A
  • Hair loss
  • Brittle nails
  • Skin thinning
  • Aches & Pain
  • Osteoporosis
202
Q

Diagnostic criteria for menopause

A

Amennorhea for 12 months

FSH > 30mlU/mL (only tested in women under 40)

203
Q

Why does FSH increase in menopausal women?

A

Decline in Oocyte number (wrapped in follicle- Granulosa and outter layer of theca cells in antral follicle)

Follicle maturation produces oestrogen which at high levels inhibits FSH, also causes inhibin release (when FSH binds to Granulosa cells) inhibiting FSH. In menopause less follicle maturation (so less oestrogen to have -ve feedback on AP) and less binding/ sensitivity of FSH to granulosa cells so less inhibin so less -ve feedback on FSH.

204
Q

What are the benefits of HRT?

A
  • Improved vasomotor symptoms
  • Improved urogenital symptoms- dyspareunia, vaginal atropgy, vulvovaginitis
  • Reduced fracture risk and osteoporosis
205
Q

Define premature menopause

A

Premature Ovarian Failure Occurs before age of 40

206
Q

What are some of the risks of premature menopause?

A
  • Premature death
  • Osteoporosis
  • Neurological disease
  • Psychosexual function
  • Mood disorder
  • IHD
  • Infertility
207
Q

What is premature ovarian failure?

A

Disconnect between hormones and ovarian function or autoimmune problem. Not necessarily due to to lack viable follicles

208
Q

What are the causes of premature ovarian failure?

A
  • Idiopathic
  • Familiar tendancy, Genetic- Fragile X syndrome
  • Autoimmune
  • Radiation/ Chemotheraphy/ Tamoxifen, Surgical- Total hysterectomy, Oophrectomy
209
Q

What does Progestin and Oestrogen HRT help to do (aside from improve the triad of symptoms)?

A

Avoid cystic endometrial hyperplasia

210
Q

What are the route of administration of HRT?

A
  • Oral
  • Transdermal patch (lasts 2 weeks)
  • Subcut Oestrogen implant
    • Lasts up to 5 months
    • Progesterone taken orally to avoid uterine symptoms
  • Topical Oestrogen Creasm
211
Q

What is the average age in a decline in fertility?

What is the main cause? What can this increase?

What else can it increase?

A

37yrs

Meiotic non-disjunction –> Triosmy eg:21

Miscarriage

212
Q

Outline the Menopause stages?

A
  • Pre-menopausal
  • Premature menopause
  • Perimenopausal
  • Menopause
  • Post menopause
213
Q

What happens to the mesntural cycles during perimenopause?

A

Oligomennorhea

214
Q

Describe the lymph node drainage of the axilla

A

Humeral, Subscapular, Pectoral (Anterior) –> Central

–> Apical

–> Supraclavicular

215
Q

Where do breasts develop?

A

Along mammary ridge (groin to axilla)

216
Q

Breast surface anatomy

A

2-6 rib

Parasternally to MAL

Axillary tail of Spence: Along inferior boarder of pec major/ anterior axillary fold

217
Q

What type of glands open onto the AREOLAR? What are they called? What do they produce?

A

Sweat and Sebaceous glands called Montgomery Glands

Produce oil lubricant

218
Q

What are the muscular relations of the breast?

A

Anterior to the Fascia of Pec Major and Serratus Anterior

219
Q

What is in the retromammary space?

Where is it located?

What is the importantance of it- give a test

A

Space between breast tissue and pectoralis fascia

Filled with LOOSE CT and Adipose tissue

Permits: Free movement of breast from pec major. If breast moves with pec major it suggests pathology. Test via getting patient to press their hands on their hips

220
Q

What are the Ligaments of Cooper?

What is the clincal relevance?

A

Fibrous suspensory ligaments in fatty tissue (helps divide brest up and support)

Attach to dermis. Cancer can cause fibrosis of these ligaments causing: Dimpling (? Nipple retraction and tethering)

221
Q

What is a gland?

A

Epithelical cells that secrete a substance

222
Q

Describe the breast microstrucutre

A

Lobes (Glandular Secretory units) in Fat and Connective Tissue

Lobes made of Lobules which are made of Acini (Spheres of secretory cells around a duct). Lobules drain via Terminal ducts into a SINGLE Lactiferous Duct. 15-20 Lactiferous Ducts open onto the nipple

223
Q

How do ductal and lobular carcinomas of the breast present?

What is this called?

A

Paget’s disease of the breast

Cancer may spread along duct system and out onto nipple giving ECZEMA type apperance

224
Q

Describe the microstrucutre of an actively lactating duct

A

Glandular secretory epithelium in ACINAR arrangement surrounded my myoepithelial cells- contract in response to oxytocin

225
Q

What hormones lead to proliferation of the: duct system, glandular cells and hence milk production?

A

Oestrogen, Progesterone and Prolactin

226
Q

Describe how the composition of breast tissue changes as you age and hence the imaging modality?

A

Younger- Non Pregnant: Fibrous (Use USS)

Pregnant: Glandular

Older: Adipose (Use Xray- less radioopaque)

227
Q

Define mastitis

A

Inflammation of the glandular epithelium of the breast tissue

228
Q

What is the word for painful breasts?

What could this be related to?

A

Mastalgia

b) Cyclic, Non-cyclic or non-breast origin

229
Q

Innervation of the breast

A

T4-T6 Intercostal nerves

230
Q

Blood supply of the breast

A

Interal Thoracic –> Medial Mammary branches

Lateral Thoracic (from axillary) –> Lateral Mammary branches

231
Q

Describe where the Nipple, Areolar and Breast Tissue mainly drain to?

What should you always be aware of with breast lymphatic drainage?

A

Axillary & Parasternal Nodes

Lateral Side:

  • Pectoral (Anterior) and Central Axillary Nodes

Medial Side:

  • Parasternal nodes

Additional:

  • Rotter Nodes
  • Contralateral pectoral nodes
  • Contralateral breast
  • Subdiaphrgmatic
  • Inguinal lymph nodes

As shown above lymphatic drainage may cross the midline into the other breast so cancer may spread to the other breast

232
Q

Describe where the BREAST SKIN lymphatic drainage is?

A
  • Infraclavicular
  • Deep Cervical
  • Axillary nodes
233
Q

How might breast disease PRESENT?

A
  • Lumps
  • Pain
  • Nipple Discharge
  • Skin changes
  • Nipper inversion
234
Q

How can you elict skin thethering in breast?

A

Ask patient to raise arms

235
Q

Give some examples of how breast cancer my present- why does it present like this?

A
  • Asymetrical/ New onset nipple retraction (suspensory ligaments)
  • P’eau d’ Orange (APPEARANCE OF ORANGE LIKE TEXTURE) (lympahtics are blocked)
  • Nipple discharge
  • Dimpling (suspensory ligaments)
  • Tethering (suspensory ligaments)
  • Paget’s disease of nipple (Eczema like changes)
  • Inflammatory changes
236
Q

Causes of wheeze in children

A

URTI

Asthma

Bronchiolitis

237
Q

Childhood conditions: Characteristic od Eczema rash

A
  • Erythematous
  • Scaley
  • Weeping
  • MACULAR
  • Itchy/ Dry
  • Excoriated
238
Q

Neonatal Milia

How does it present?

What proportion does it affect?

A

Few –> Numerous White spot lesions

Face, Chest, Nose, Scalp, Upper Trunk

Self limiting

Affects 40-50% newborns

239
Q

Name some common childhood skin conditions

A
  • Eczema
  • Neonatal Milia
  • Cradle Cap (Seborrhic dermatitis. Common in first 2 weeks of life)
  • Paranychia (STAPHLOCOCCAL infection often. Nailbed swelling, Pus, Erythema)
240
Q

When assessing a vulnerable child what things do you consider in the Hx?

A
  • Age: <6months serious infections more common
  • Activity: Happy/ Miserable/ Sleepy
  • Function: E&D, Vomiting, Wet nappies
  • Length of Illness: Unexplained fever >5days
  • Other symptoms: Breathing, Rash, Posture
241
Q

What are the key respiratory differences in a child?

A
  • Ribs go horizontal –> Less able to increase TV so INCREASE RR instead
  • Fewer Alveoli
242
Q

What is the cardiac difference in children?

A
  • Myocardium less contractile so to increase SV must increase HR
243
Q

Why is Gluocse an importnat consideration in Neonates?

A

Hypoglycaemic = RED FLAG- stress response to illness

244
Q

Children have a larger surface area to weight ratio- what does this put them at risk of?

A
  • Increased dehydration
  • Poor temperature control
245
Q

What is the anatomical difference in airways in children?

A
  • Shorter neck
  • Larger tongue
  • Larger head
246
Q

What other anatomical differences are there?

A

Liver and Kidney- both immature so less able to process stuff

247
Q

Give some causes of Fever

A
  • Post immunisation
  • URTI
  • LRTI- Pneumonia
  • UTI
  • GI- Gastroentertiris
  • CNS- Meningitis
  • Osteomyelitis
  • Septicaemia
248
Q

Give some symptoms/ signs you would see with BACTERIAL MENINGITIS

A
  • Neck stiffness
  • Buldging fontenelle
  • Decreased conciousness
  • Convulsive satus epilepticus
  • Non blanching Rash- Purpura
249
Q

What are the classic symptoms with childhood pneumonia?

A

Increased RR

  • 0-5m: >60
  • 6-12m: >50
  • 12m: >40

Cyanosis

Chest drawing

Nasal Flaring

Crackes in chest

O2 sats <95%

250
Q

What are the catagories for the traffic light system for identifying serious illness?

A
  • Respiratory
  • Circulation
  • Colour
  • Activity
  • Other- Age, Temp, dehydration
251
Q

Give some general causes of childhood illness

A
  • URTI
  • LRTI
  • Rash
  • Fever
  • D & V
  • Cough/ Wheeze
  • Abdo pain
  • Chronic eg: T1DM
  • Cognitive
  • Congenital
252
Q

Traffic light system: Red

A
  • Grunting (trying to keep alveolar sacs open)
  • RR >60
  • Cyanosed
  • Does not wake
  • High, Weak Pitched cry
  • Chest drawing
  • Reduced Skin turgour
  • Bulging fontenelle
253
Q

Traffic Light System Amber:

A
  • Pallor reported by parents
  • Nasal Flaring
  • Not responding to social cues/ smile
  • Wakes with only prolonged stimulation
  • Decreased activity
  • Dry mucus membranes
  • Poor UO
  • Rigors
  • Poor feeding
254
Q

Traffic light system: Green

A
  • Cared at home with appropriate advice
  • No red/ amber flads

SAFTEY NET!!

255
Q

What is the triad of asthma?

A

Airway Hyperesponsivness

Airway Obstruction

Airway Inflammation

256
Q

What is the first and second stages of management of DIAGNOSED asthma in children?

A

Stage 1:

  • B2 agonist and
  • Corticosteroid Inhaler
  • OR <5yrs LTRA

Stage 2:

  • B2 Agonist &
  • Corticosteroid Inhaler &
  • >5yrs: LABA
  • <5yrs LATRA
257
Q

What are the classic symptoms according to BTS for asthma?

A
  • Chest tightness
  • Wheeze
  • Shortness of Breath
  • Cough
258
Q

On a structure clincal assessment (history, exam, previous notes) according to BTS what would you see?

A
  • Recurrent episodes symptoms
  • Symptom variability
  • PEF or FEV1 variable
  • Wheeze
  • History of Atopy
  • Absence of symptoms of alternative Dx
259
Q

In ACUTE asthma for CHILREN over 1yrs

What would you see in Acute severe?

A
  • O2 sats <92%
  • PEF 35-50% best/ predicted
  • HR
    • >5yrs: 125
    • <5yrs: 140
  • RR:
    • >5yrs: 30
    • <5yrs: 50
260
Q

In ACUTE asthma for CHILREN over 1yrs

What would you see in LIFE THREATENING asthma?

A
  • O2 <92%
  • PEF 33% best or predicted
  • Silent chest
  • Cyanosis
  • Exhaustion
  • Hypotension
  • Confusion
261
Q

According the BTS guidelines how do you manage tx according the high, intermediate and low risk catagories of asthma?

A

High- Initate Tx

Intermediate- Test for airway obstruction (spirometry and bronchodilator reversibilty)

Low- Look for other causes

262
Q

How do manage Acute asthma?

A

OSHIT

  • Oxygen if less than 94%
  • Salbutamol- Inhaler or Nebuliser (one puff every 30-60 seconds. max 10puffs). Consider adding MgSO4
  • Hydrocortisone (Dampen the inflammatory response)
  • Ipatroium Bromide (Anti-cholinergic)
  • Theophyline (Methylxanthine)- SEVERE/ LIFE THREATENING ONLY
263
Q

Define embryonic and foetal period

A

Embryonic: First 8 weeks

Foetal: 8 weeks to Term

264
Q

Define:

First Trimester

Second Trimester

Third Trimester

A

a) 1-12 Weeks
2) 13-28 Weeks
3) 29-40 Weeks

265
Q

What is considered term?

What is post term?

A

37-42 weeks

Singleton: 41 weeks

Twins: 37 Weeks

Post Term: 42 weeks + (Induction from 41 weeks)

266
Q

What are the 3 ways to measure EDD?

A
  • LMP
  • CRL
    • Sonogram
    • If greater than 84cm use Head circumference
  • Symphsio Fundal Height (SFH)
    • After 24 weeks
    • Measure from fundus to Pubic Symphesis
    • Use tape measure upside down
267
Q

What 5 systems need to be addresses in the antenatal check?

A
  • CVS
  • Blood
  • Respiratory
  • Urinary/ Renal
  • Glucose metabolism
268
Q

What takes over Oestrogen and Progesterone production after the CL?

A

Placenta

269
Q

When is the perinatal period

A

20th-28th week gestation & ends 1-4th week post birth

270
Q

Define Foetal programming

A

Adverse influences during foetal life can affect structure/ function of distinct cells

Therefore programming the individual to be at increased risk of developing diseases

Mechanisms:

  • Overexposure to glucocorticoid
  • Decreased blood flow to foetus
  • Stress on Transplacentral transfer
271
Q

How does maternal stress affect the foetus?

A

Changes filtering capacity of placenta

Cortisol = Toxic & affects HPA axis –> individuals experiencing higher levels of stress in childhood/ adulthood

272
Q

What are the OBSTETRIC consequences of Antenatal Anxiety?

A
  • Low BW
  • Premature labour
  • Impaired blood flow OR increased resistance index to foetus through materal uterine arteries –>
    • IUGR
    • Pre-eclampsia
273
Q

If parental stress occurs what are the neuodevelopment outcomes in children between 3-16yrs?

A
  • Emotional Problems- Anxiety and Depression
  • Symptoms of ADHD
  • Conduct disorder
274
Q

Unborn Baby: What x2 things happen in the antenatal period?

A
  • Psychic re-organisation
  • Materal Representation
275
Q

What is Psychic reorganisation?

A

Psychic re-organisation and old psychological conflicts may be reviwed

May reflect on relationship with own mother and evaluate they way they were parented –> May awaken negative emotions

276
Q

What is maternal representation?

A

Thoughts of what the unborn baby will be like.

Develops in the 2nd or 3rd Trimester

Balanced Respresentation: Securely attached infant at 12 months (more likely)

Distored/ Disengaged Representation: Insecurely attached or Disorganised Infant @ 12 months

277
Q

How is Ax of the maternal representation made?

A

The working model of the child

278
Q

What are the catagories of the working model of a child?

A
  • Balanced
  • Distorted
  • Disengaged
  • Disrupted
279
Q

What is maternal representation affected by?

A

Psychological

Social- Environemental and relationship with other mothers to be

280
Q

Who are more likely to be at risk of developing a negative MR?

A

Women experiencing domestic violence.

More likely to result in babies than have insecure attachment

281
Q

What does the relationship with the unborn baby predict?

A
  • Quality of parent-infant interaction postnatally
    • PI Interaction = indicator of attchment security
  • Infant Attachment by 1yrs
282
Q

What are the 3 things than can happen postnatally? (1 may happen pre-natally)

A
  • Ghosts in the nursery
  • Unresolved parents
  • Reflective functioning
283
Q

Ghosts in the nursery

A
  • Ghosts from parents childhood influence the way parents think & behave towards own baby
  • Parents may re-enact w/ their baby scenes
  • Can appear during pregnancy during Psychic reorganisation and MR
284
Q

What are unresolved parents?

What happens?

What do they believe?

What happens to their parenting style?

A

Parents who carry issues from their childhood that have not been addressed

Infant distress triggers their own stress/ painful memories of vulnerability and dependence –> Unable ro respond to child

Unable to understand the infant’s distress and make inaccurate assumptions about the reasons for the behaviours

Parents can become very withdrawn or intrusive if NOT resolved

285
Q

How can parents go from unresolved to resolved?

A

Opportunity to address the issues from their childhood and learn how to understand the mental state of oneself and others

286
Q

What is Reflective Functioning?

Why is this useful?

A

Capacity to experience the baby as an intentional being rather than viewing them in term of phsyical characteristics or behaviour

Helps baby to develop understanding of mental state in other people & regulate their own internal experiences

287
Q

Why is reflective functining importnant?

A

In pregnancy, high RF is associated with a securely attached infant @ 12 months

Associated with postive (flexibility & responsivness) maternal behaviours and the baby’s use of a mother as a secure base

Low RF associated with emotionally unresponsive behaviours- withdrawal, hostile, intrusivness

288
Q

How is RF measured?

A

Working model of the Child interview along with MR

289
Q

When does long term nutrition from maternal circulation begin?

A

Day 12

290
Q

What gives out hCG?

A

Syncitiotrophoblast

291
Q

Placenta Lecture: What happens on Day 7?

A

Decidualisation- uterine cells accumulate glycogen & lipids in response to progesterone

Trophoblast differentiates

292
Q

Placenta Lecture: What happens on Day 8?

A
  • Invasion
  • Bilaminar disc forming
  • Amniotic cavity formation
  • Syncitiotrophoblast produces hCG
  • Decidual cells degenerate = nutrition
293
Q

What can happen as the syncitiotrophoblast invades blood vessels between days 9-12?

A

Bleeding can occur- can be mistaken for menstural bleeding (although a bit early)

294
Q

Where does implantation take place ideally?

A

Upper Uterine Wall

295
Q

What is the role of the junctional zone?

A

Forms a bed for the placenta to sit on. Decidua Basalis is just above

296
Q

Functions of the placenta?

A

HIT

Hormone:

  • Progesterone
  • Oestrogen
  • hCG

Immunity:

  • IgG can cross

Transfer of nutrition/ waste:

  • Oxygen, Glucose, Ions, Proteins, Globulins
297
Q

What days do lacunae form? And where? What opens up into them? What is the venous return?

A

Days 10-12

Lacunae form in Syncitiotrophoblast

Maternal Spiral Arteries and Veins invade the lacunae

Materal blood returns via Endometrial veins

298
Q

What are anchoring villi?

A

Some chorionic villi attach to the Cytotrophoblastic shell

Shell attaches to the Decidua Basalis

Placental anchoring is important for attaching placenta to endometrium

299
Q

How does the Placental Membrane Change?

A
  • Arborisation
  • Cytotrophoblast degerates at week 20
    • Prior = 4 layers: Maternal Blood, Syncitiotrophoblast, Cytotrophoblast, Endothelium of fetal capillaries
300
Q

What are the 4 broad types of placental dysfunction?

A
  • Position & Development
  • Growth
  • Transport
  • Blood flow compromise
301
Q

Placental development: Types of problem

A
  • Uncontrolled invasion
    • Accrete or Percreta
  • Inapproriate site
    • Previa
  • Abruption
302
Q

Define placental previa

A

Placenta develops over Internal Os

Can cause tearing or bleeding in late pregnancy

(type of development issue. subclass- inappropriate site)

303
Q

Define Placental Abruption

A

Placental separation from uterine wall with subplacental haemorrhage

Concealed or Revelaed OR both

304
Q

Give some causes of Placental growth problems

A
  • Choriocarcinoma
  • Gestational trophoblastic disease
305
Q

Give the types of Placental Dysfunctions in BLOOD FLOW COMPROMISE

A
  • Inadequete placentation –> Pre-eclampsia (failure of normal invasion of trophoblast cells causing maladpatation of spiral arteries)
  • Impairment
    • Maternal vascular disease
    • Gestation age-post date
  • Mechanical
  • Volume

–> Fetal growth problems or Death

306
Q

What does the smooth chorion fuse with?

A

The amniotic cavity as it expands

307
Q

What is the Umbilical Cord made up of?

A

x2 arteries (if only one check for cardiac defects)

x1 vein (this carries arterial blood)

Wharton’s Jelly

Amnion

308
Q

What is the immunisation schedule?

What are they?

A

8, 12, 16 weeks

  • Meningitis B
  • Rotovirus
  • Pneumococcus
  • Polio
  • Diptheria
  • Hep B
  • Haemophilus inflenzae B
  • Tetanus
  • Whooping cough (Pertussis)

MMR at one year

309
Q

Describe the Suckling reflex

A

Prolactin stimulates nipple receptors

Stimulates Endocrine neurones –> PIF decrease

PIF releases the lactotrophes from inhibitory catecholamines

Promotes synthesis & release of prolactin

310
Q

Describe the let down reflex

A

Suckling stimulates sensory nerve fibres of nipple –> Oxytocin release

Oxytocin –> Myoepithelial cell contraction –> release milk into lactiferous ducts and sinuses

Oxytocin release becomes conditioned: Visual stimulation or conscious thought

311
Q

When observing the parent-infant interaction what are the 3 dimensions of interactional behaviour Svanberg 2015?

A
  • Engagement
  • Predictibilty
  • Genuiness
312
Q

Attachment cycle: Healthy

Attachment cycke: Disturbed

A

Baby has a need –> Baby cries –> Need met by PC –> Trust develops –> Secure attachement promoted

Baby has a need –> Baby cries –> Need not met by Pc –> Range of trust issues develop –> Disorganised attachment

313
Q

Secure attachement- 5 domains infants have optimal functioning across

A
  • Emotional
  • Social
  • Behavioural adjustment
  • School achievement
  • Peer-related social status
314
Q

Common Framework Assessment Domains

A
  • Child development needs
  • Parenting capacity
  • Family & Environmental factors
315
Q

What is the function of hCG?

A

Produced by the Trophoblast (Syncitiotrophoblast)

Supports CL to produce progesterone and oestrogen in first trimester

316
Q

What is the function of Oestrogen DURING pregnancy?

A
  • Promote Gap junctions between myometrial cells
  • Increase myometrial sensitivity to oxytocin
  • Increases PGE2 –> Soften Cervix

1 & 2 increase uterine contractions

317
Q

What does progesterone promote during pregnancy?

A
  • Promote cervical plug
  • Inhibit uterine contractions
  • Milk gland development
318
Q

What hormones are high during 2nd and third trimester?

A

Progesterone dominates

Oestrogen high

319
Q

What happens to levels of progesterone and oestrogen near term?

A

Progesterone levels drop off.

Oestrogen increases

320
Q

What happens after Week 12 to hCG?

A

Levels drop off

After week 24 it levels off

321
Q

When does hCG peak?

A

Between weeks 8 and 12

322
Q

What inhibits prolactin during pregnancy?

A

Oestrogen

323
Q

When does Colostrum first appear?

What hormones cause active secretion of it post deliver?

A

Appears in 2nd trimester.

Breast alveoli contain significant amounts during 3rd trimester

Decrease in oestrogen and progesterone causes active secretion

324
Q

Mitosis/ Meosis I and II

A

Mitosis- Spearation of sister chromatids

Meosis I: Separation of Chromosomes- sister chromatids still attached

Meosis II: Separation of Sister Chromatids

Block 5- Kim (12 decks)

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