Endocrine and reproductive teach Flashcards
A 48yr old presents to day surgery for bilateral saplingo-oophorectomy. Which ligament would the surgeon have to open to access the ovaries and Fallopian tubes
Broad ligament
Broad ligament
Connects interns, Fallopian tubes and ovaries to the pelvic wall
Suspensory ligaments of the ovaries
Connects ovaries to the lateral pelvic wall
Ovarian ligament
Connects ovaries to uterus
Central perineal tendon
Provides the main structural support to the uterus - damage to this associated with pelvic organ prolapse
During ejaculation the bladder sphincter contracts this prevents what
Urine mixing with the semen
Where is the most likely place for fertilisation to occur
Ampulla
What nerve supplies the Breast
Branch of intercostal T4-6
Main arterial branch to Breast
Internal mammary artery
What does prolactin do in the breast
Causes milk production
What does oxytocin do in the breast
Cause contraction of myoepithial cells surrounding the mammary alveoli to reusult in milk ejection from the breast
Suckling of baby stimulates mechanoreceptoes in the nipple which results in the release of both prolactin and oxytocin form the pituitary gland
The breast itself lies on a layer of pectoral fascia and the following muscles
Pec major
Serratus anterior
External oblique
Spermatogeneis
Process of germ cell to mature sperm
Spermatocytogeneis
Germ cell to spermatid
Spermiogenesis
Spermatid to mature sperm - golgi phase, across mall phase, tail phase and maturation phase
Released from sertoli into lumenn of seminiferous tubules and transported to epididymis and then gas deferesjs where they become motile
Spermiation
Mature spermatid are made motile
How are sperm made fertile
Low levels of FPP and heparin remove glycoproteins coat over the acrosome and make it fertile
what cell in the pituitary release growth hormone and are stimulated by GnRH
somatotropes
what basophils cells in the anterior pituitary secrete ACTH are stimulated by CRH
corticotropes
what cells in the anterior pituitary are stimulated by TRH and release TSH
thyrotropes
what cells in the anterior pituitary release LH and FHS and are stimulated by GnRH
Gonadotropes
what cells secrete prolactin and are under inhibitory control by dopamine
Lactotropes
what days of the menstrual cycle signify the secretory phase
15-28
progesterone luteal phase
ovulation - day 14, due to oestrogen , induced LH surge
what cells readily produce androgens but have limited capacity to convert them into estrogens
Theca cells ( associated with ovarian follicles)
what cells contain the enzyme aromatase so they can covert androgens into oestrogen’s but they cannot produce androgens in the first place
Granulosa cells
what hormone stumuleastes thecal cells to stimulate androgen production
LH
what hormone stimulates granulosa cells to promote conversion of androgen
FSH
describe high and low level of oestrogen effects on other hormones
Oestrogen on a low level has -ve feedback on pituitary for LH and FSH, oestrogen on a high level has positive feedback on hypothalamus- which will ultimately result in the spike of LH- that’s whats thought to happen (Oestrogen usually has a negative feedback on LH.
However, in high concentrations, oestrogen appears to have positive feedback causing release of LH.)
So, something to understand: small/rising, moderate levels of estrogen will cause -ve feedback loop - inhibiting LH BUT high levels of estrogen will result in positive feedback loop
in what phase does the spike in LH cause ovulation and stimulates the development of the corpus lute which then begins producing progesterone. FSH also spikes, progesterone release at higher level has a positive feedback effect in FSH release. The function of this rise is not known .Oestrogen level decline immediately after Lh spike. ( maybe because follicle is no longer producing oestrogen and progesterone inhibits the synthesis of oestrogen.
ovulatory phase
in what phase does FSH and LH levels fall due to negative feedback
corpus lute continues to produce progesterone and tis thickens the endometrium further to prepare for implantation
progesterone also thickens the cervical mucus to prevent further sperm adn bacteria from entering the uterus
CL produces oestrogen that why there is a small rise in luteal phase.
luteal phase
If fertilisation and implantation do not occur then the corpus luteum degenerates (and stops releasing progesterone). Due to reduced FSH and LH, oestrogen levels also decrease. Reduced levels of oestrogen and progesterone causes the endometrium to shed which starts the cycle again
If fertilisation and implantation do occur then human chorionic gonadotrophin (HCG) is released which stimulates the corpus luteum. The corpus luteum then continues to produce progesterone to support the pregnancy until the pregnancy/ placenta can make its own hormones
The sperm penetrates the corona radiata (outer layer of ovum) via membrane-bound enzymes in the plasma membrane of the head of the sperm.
What receptors to they bind to on the zona pellucida (next inner layer of ovum)?
ZP3 (zona-pellucida sperm binding protein 3) receptors
sperm penetrates corona radiate and binds to ZP3 receptors on bona pellucida. This trigger acrosome reaction reaction ( hydrolytic enzymes) released into bona pellucida. Enzymes digest bona pellucida creating pathway for membrane to ovum - sperm fuse. Spermatids stimulates release of of enzymes stored in cortical granules in the ovum , which in turn, inactivate ZP3 receptors and Harden like bona pellucida leading to the block to polyspermy.
You are an eager third-year medical student watching the delivery of a term infant who is delivered vaginally to a gravida 1 para 1 mother. His Apgar score at 1 minute is 9 and at 5 minutes is 10. There are no complications during delivery. Postnatally, it is discovered that the ductus arteriosus has remained patent.
What is the mechanism behind the normal closure of this structure?
Decreased prostaglandin concentration
what vessels shunts oxygenated blood away from major organs like the liver in fatal circulation
ductus venous
after birth what do all the vessels form ductus arteriosus foramen ovale ductus venous umbilical vein umbilical arteires
ligamentum arteriosum fossa ovalis ligamentum venosum ligamentum teres medial umbilical ligaments
what non-selective COX inhibitors is used to close patent arteriosus in neonates and premature infants
indomethacin
why must you not give NSAIDs to pregnant women
because it stops PGE2 as it maintains shunts
ductus arteriosus closes with first breath
why can’t you use a COX inhibitor such as an NSAID to pregnant women
inhibits the production of prostaglandins
You’re a medical student on placement with the GP in early December and a patient comes in who has noticed that she has gained quite an intense tan even though she hasn’t had a sunbed in months or been abroad. The GP examines her legs and this is what she sees:
What can this be a sign of?
Addison’s
Cushing syndrome is high cortisol what can they present as
Weight gain
Purple striae
Hirsutism - growth of male like hair
lemon on a stick
Addison’s ( adrenal insufficiency) presents as what
Fatigue
Weight loss
Hyperpigmentation
primary hyperaldosteronism ( conns) presents as what
Treatment resistant hypertension
You’re a 2nd year medical student who is at a GP placement and a lady in her mid-forties explains that she has been feeling very tired all the time, has gained weight and has noticed that her skin is very dry.
What could be the pathology here?
Hashimoto thyroiditis
level of the thyroid gland
C5-T1
follicular cels release what
T3,4
hypothyroidism symptoms
lethargy/fatigue, weight gain, cold intolerance, bradycardia, slow reflexes + speech, dry skin/thinning hair, myxoedema
LOW T3
LOW T4
HIGH TSH
hyperthyoridism - graves
Weight loss, heat intolerance, tremor, tachycardia, muscle weakness, diarrhoea, goitre, eye signs (exophthalmos)
HIGH T3
HIGH T4
LOW TSH
You’re on placement in A+E and are shadowing a Junior Dr. All is calm and serene until a major haemorrhage call is made suddenly. You rush to the scene with the doctor to find a patient bleeding out and in need of some blood. The patient is blood type B, however the hospital have none at hand.
What does the team do?
Gives the patient O negative blood for the time being
what hormone does this
Smooth muscle relaxation- prevents fetal expulsion- inhibits oxytocin
Cervical plug formation- microbial barrier
Respiratory centre- hyperventilation
Renin-angiotensin- Na+ reabsorption
Inhibits action of prolactin - stops milk production
Lobular tissue development
progesterone
Progesterone increases sensitivity to co2- central chemoreceptros cause hyperventilation to decrease co2
Progesterone causes aldosterone to increase as otherwise sodium loss would be too high- causes sodium ion and water reabsorption- fluid into interstitium- swollen ankles
what hormones does this
Myometrial cell growth - for growing fetus
Oxytocin receptor insertion- prepares for labour
PGE2 production stimulated- softens cervix
Breast duct development
Inhibits action of prolactin - stops milk production
oestrogen
what hormone does this
Nipple stimulation- enhances further prolactin release
Breast tissue development during pregnancy
Suppresses ovulation
Post delivery milk production
prolactin
what hormone
Uterine contractions during labour
Post delivery milk ejection
oxytocin
what is turners syndrome
X in females
Web necking, widely spaced nipples, short stature, early loss of ovarian function
what is klinefelters syndrome
XXY in males
Infertile, small testicles
what is pre eclampsia
Placental vessels fail to develop normally —> placental perfusion inadequate —> interpreted as shock from blood loss —> vasoconstricting substances released —> hypertension and proteinuria!!!
