Case 2 Flashcards
What causes the maturation of primordial follicles?
High levels of FSH and Lh at puberty
What is the significance of the pouch of Douglas
Is recto uterine pouch can accumulate with fluid
What is the first stage of follicular development? Describe the cells at this stage
Primordial follicles; Pre-granulosar cells on basement membrane
What happens to the primordial follicles at puberty?
- oocyte enlarges - granulosa cells increase and are cuboidal cells (unilayered) - oocyte produces zona pellucida
What is zona pellucida?
It is the glycoprotein/proteoglycan layer produced by oocyte, important in spermatozoa binding
primary follicle characteristics?
See case 2 notes on Hannah Shaw’s lecture
Describe characteristic of secondary follicle.
See hannah shaw case 2 notes
What are theca externa and theca interna?
Theca interna- steroid hormone producing cells - produce oestrogen Theca externa - small compact cells that are continuous with stroma
Name the stages of the uterine/mestrual cycle. Mention how long it lasts
1) Menstrual phase 2) Proliferative phase 3) Secretory phase Usually lasts 28 days
What are the stages of the ovarian cycle?
1) Follicular phase 2) Ovulation 3) Luteal phase
What happens to the endometrium if no fertilisation occurs?
- Progesterone (and oestrogen) not produced, corpus luteum degenerates - Endometrium is not maintained, so outer layer is shed along with blood from burst blood vessels - corpus albicans formed
What happens to endometrium if egg is fertilised?
Fertilisation (usually at ampulla of uterine tube) induces a reaction that cause fertilised ovum to move and implant in endometrium - blastocyst develops and produced HUMAN CHRORIONIC GONADOTROPHIN (hcG) - HcG prevents corpus luteum from regressing and continues progesterone secretion (maintaining endothelium)
What is the corpus luteum that the human chorionic gonadotrophin called?
Corpus Graviditatis
What is the function if sertoli cells?
4 functions; never buy curly pasta sauce Nourishes sperm - lactate production for sperm Barrier - blood testis barrier created by tight junctions between sertoli cells (see notes for details) Control- has receptors for testosterone, produces inhibin to control FSH Phagocytosis - phagocytoses excess cytoplasm in spermatozoa Secretes- androgen-binding protein which binds to testosterone preventing from diffusing across plasma membrane
What are the different arteries that supply the the endometrium?
Straight arteries - supply the basilar zone Spiral arteries - supply the functional zone
What happens to the SPIRAL arteries during the menstrual phase?
They constrict leading to degeneration of functional zone (basilar zone is supplied by straight arteries)
What can you palpate during a rectal examination in males? What about in females?
Males - prostate Females - uterus
Describe erectile tissue in the resting state and what happens to cause it to become erect?
In resting state 1- blood vessels are constricted 2- therefore reduction in blood flow During erection Parasympathetic innervation to penile arteries causes smooth muscle to relax, vessels to dilate.. 2- therefore increase in blood flow 3- filling with blood 4 - penis becomes erect
Describe the control of ejaculation?
Ejaculation is controlles by sympathetic nerves of S2,3,4 - sympathetic nervous system keeps internal urethra, sphincter tonically contracted to prevent urine leakage
What is ejaculation?
Release of sperm and semen from urethra
Which part of the male urethra is most likely to rupture or be penetrated?
Membranous part
What is hypspadias?
Congenital malformation where genital cleft fails to fuse correctly, you get an abnormal opening of the urethral meatus..
What is benign prostatic hyperplasia?
Non-cancerous enlargement of the prostate as; - hyperplasia of mucous and submucosal glands and become overdistended - increase in bulk of stroma
Symptoms of benign prostatic hyperplasia?
- Get frequent urination as glands are over-distended obstructing blood flow - therefore mistaken for diabetes
Why is Benign Prostatic hyperplasia mistaken for diabetes?
Similar symptoms of frequent urination, esp. At night Difference is that with BPH you get increased frequency and volume of urination
Transurethral resectioning of prostate is a treatment for BPH, what does this involve?
See case 2 microanatomy notes. TURP is where you cut the part of the prostate, done when medication fails
What are the complications involved with TURP?
Retrograde ejaculation. Men unable to ejaculate sperm and and semen due to damage to internal urethral sphincter, semen instead backs up into the bladder
In the case of prostate cancer, the prostate may need to be removed. What is the procedure called and what are the side effects?
Radical prostatectomy (ectomy - surgical removal of) May get damage to bladder muscles.. Leading to incontinence
Zona pellucida contains gap junctions between oocyte and gransulosar cells, what is the significance of this?
Glucose, amino acids and nutrients delevered from granulosar cells via these gap junctions which the egg stockpiles
What is varicocele?
Where veins in the scrotum become dilated due to defective valvs cause backflow of blood Feels like a bundle of worms at scrotal area
Components of the cervix?
Internal os External os Cervical canal 2 lateral fornices Anterior fornix Posterior fornix
What site of the cervix is prone to cancerous changes?
Sqaumo-columnar junction (transformation zone)
What is a spaculum used for?
Holding the walls of the vagina apart to observe the external os
What is aspiration?
When you pierce posterior fornix, to sample peritoneal fluid at recto-uterine pouch in females
How does oestrogen act as a steroid hormone?
See case 2 notes, contraceptives lecture
Transcription regulation by oestrogen-receptor complex leads is associated with what genes?
Spec-obs - secondary sexual characteristics - progesterone receptor synthesis on uterus, vagina - endometrium and uterine growth - clotting factors increase/platelet adhesion - ovulation - bone density increase and bone loss decrease - suppresses gonadotrophin release
What effects does progesterone have as a steroid hormone during transcriptional regulation of genes?
Veluss Viscosity change and pH change if cervical mucus, makes it inhospitable for sperm Endometrium made hospitable for implantation Lactation inhibited Uterine contractility decreases Suppresses immune system during pregnancy Suppresses gonadotrophin release and GnRH from hypothalamus
What contraceptives are the most effective? Least Effective?
Hormonal contraceptives Barrier methods- least
Mechanism of action of combined oral contraceptive pill
See case 2 contraceptive notes, dr.coffey lecture
What is the oestrogen found in the oran contraceptive pill called? What about prgesterone?
Ethinylestradiol Levenorgestrel
When is the progesterone only pill used?
When oestrogen is contraindicated
A lady come in to see her GP urgently asking for the morning after pill. What does this pill contain and what are the side effects associated?
- LARGE dose of levornegestrel: progesterone - likely to cause nausea, vomiting, headache, irregular bleeding
Chronic use of contraceptives causes adverse side effects, what are they?
Thems Thrombo-embolism** Hypertension Exposure to STIs Myocardial Infarction Stroke **as oestrogen has a role on clotting factors and platelet adhesion
What are the contraindications for taking the pill?
- being pregnant - being obese (see notes for why) - hypercholesterolemic - smoker over 40 (see notes) - liver cirrhosis
What is the role of prostaglandins in terms of labour?
Induces uterine muscle contractions 1) induce labour 2) induce abortion 3) minimise blood loss ** prostaglandin E can be given as a gel intravaginally ** remember that during pregnancy uterine muscle more sensitised to prostaglandins
A 33 year old woman has just gone into labour, what hormone has brought this about and in response to what?
In response to cervical dilatation and suckling, oxytocin is secreted from the posterior pituitary gland.. Causing uterine contractions
Emma is a 15 year old who recently got pregnant. After thinking over it, she has decided not to keep the baby and would like an abortion. The doctor has ensured that gestation has been less than 63 days and medical termination is legal. What are the two drug options and how do they work?
See case 2 notes, Dr coffey lecture
What is the most sensitive test for sexually transmitted diseases?
NAAT testing - nucleic acid probe and amplification based tests Directly detects chlamydia trachomitis and neisseria gonorrhoeae, you aplify genetic material of bacteria causing the sti
List some lower uti symptoms, what about upper uti?
Lower UTI - cystitis - dysuria - suprapubic pain - frequency of urinating Upper UTI - pylonephritis - dysuria - fever - loin pain - frequency of urinating
Ellen, a 15 year old, comes in with loin pain, a fever and chills. She mentions that she feels she always needs to urinate. You take a mid stream urine sample from her. The sample shows that there are 10^7 organisms per mL or urine. What does this demonstrate? Is this amount significant?
Ellen could have a lower urinary tract infection, bacteriuria is significant above 10^5 organisms Remember if more than one species of bacteria is present, and if organisms are less than 10^4, it is usually a contaminated sample
What treatment would you give Ellen?
Ellen seems to be suffering from an Upper UTI, would give her.. - oral anti-bacterial for at least 10 days - most common one to give is Trimethoprim To prevent a recurrent infection give cranberry juice - inhibits adhesion factors of bacteria fimbrae
A young woman who is struggling to get pregnant is told by the doctor she has a leiomyoma. Which layer of the uterine wall does this affect?
Affects the myometrium. A leiomyoma is also known as an intramural fibroid
Which hormone do the thecal cells in the zona pellucida of the antral follicle develop a receptor for?
Thecal cells - LH
Granulosa cells have receptors for which hormones?
FSH and Oestrogen
In rural areas puberty is delayed by an average of how many years in comparison with urban areas?
2 years
Poor communities reach puberty on average how many months later than rich communities?
6-12 months
What is puberty?
Process of becoming sexually mature i.e. Fertile
What is adolescence?
Process of rapid physical and psychological maturation between childhood and adulthood
What influences the timing of puberty?
1) Genetics (gender, familial, race)
2) Endocrine pathology (gonadal, adrenal, hypothalamic-pituitary)
3) Environmental (socio-economic etc)
4) Health (stress, drugs, emotional)
How does income and the environment affect the age of menarche (first period)
Environment —- living in urban/cities may mean earlier pubery
Income —— higher income, earlier puberty
When fo males/females get their growth spurt?
Males - 14 yo
Females - 12 yo
What is the normal pattern of male testicular growth? How is it measured?
Prepubertal - 1-3ml
Pubertal - 4-12 ml
Adult - 15-25 ml
Prader orchidometer
A 13 yo patient comes in to the clinic as his parents are concerned he hasn’t started puberty yet. According to the prader orchidometer, he is pre-pubertal (3ml) What does this indicate and why is it a good way of measuring signs of puberty?
- Indicates that patient has primary or secondary hypogonadism
- Testicular growth is the first true sign of puberty
What is the effect of age on uterine volume?
As you get older, uterine volume increases. By the age of about 14, uterine volume is 40 ml
What is the effect of age on ovarian volume?
As you get older, ovarian volume increases.
At age 16, it is 20 ml
What is the hypothalamic-pituitary axis in females?
What is the male hypothalamic-pituitary axis?
What are the phases of testicular function?
Neonatal - mini puberty (half testosterone volume than in adult)
Pubertal- testosterone levels increase to 20 mmol
Adult - 20 mmol
Old age - decreases
What is the effect of age on gonadal feedback to hypothalamus?
As you get older, gonadorpohin release increases and feedback to hypothalamus increases
What is the effect of age and gender on height velocity?
- See graph but know that girls velocity increases at 10 year old (2 years before boys)
- Boys height velocity is slightler higher than girls after growth spurt
What are the function of leptin in relevance to puberty?
1- Gonadal function
2- Adrenal function
3- Decreased appatite (see case 3)
4- Increased energy expendature
A patient come into clinic and is deemed to have leptin deficiency. What are the consequences of this?
What are the causes of delayed puberty?
1- Hypogonadotrphic hypogonadism
CNS tumours
Pituitary hormone deficiency
Congenital disorders
2- Hypergonadotrophic hypogonadism
Klinefelter syndrome
Crytochridism
Turner’s syndrome
XX/XY gonadal dysgenesis
What are the effects of delayed puberty?
This is Marina, she is 13 and hasn’t started puberty yet. She has a
- short stature
- low self-confidence
- distrured relationship with parents
- immature behaviour and is likely to have physcological features in later adult life
What treatment would you give Marina, who started puberty late?
1) Reassurance!
- 2) Ethinyloestradiol (5-10mg until puberty is established) -*
- 3- growth hormone is no use*
What is Kallman’s syndrome?
Hypogonadotrophin hypogonadism
KAL 1 Gene
Results in delayed puberty and lack of sense of smell (anosmia)
- In boys; undescended testes, smaller penis, do not develop secondary characteristics
- In girls, no menstruation, little breast development
What is Prader-Willi Syndrome? It is what you patient Marge has, what do you think are the features of this syndrome..
Hypogonadotrophin hypogonadism
Marge will have behavioural problem, poor growth,
What is Turner’s syndrome
- Genetic condition affecting females
- 45X (monosomy X, i.e.deletion of X chromosome)
A patient walks into clinic with a cystitis infection; they state that they have painful urination, pain in the lower middle abdomen. . Which of the following is the most likely bacteria this person has given the following options and without taking a history?
E.Coli is the most likely cause UTI Infection
What is diabetes insipidus?
- Where the actions of ADH/vassopressin are inhibited so water is not reabsorbed
- Excessive water in urine is indicated by almost colourless urine
