Endocrine and reproductive teach Flashcards by HARRY RICHARDSON

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

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Broad ligament

Connects interns, Fallopian tubes and ovaries to the pelvic wall

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Suspensory ligaments of the ovaries

Connects ovaries to the lateral pelvic wall

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Ovarian ligament

Connects ovaries to uterus

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Central perineal tendon

Provides the main structural support to the uterus - damage to this associated with pelvic organ prolapse

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During ejaculation the bladder sphincter contracts this prevents what

Urine mixing with the semen

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Where is the most likely place for fertilisation to occur

Ampulla

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What nerve supplies the Breast

Branch of intercostal T4-6

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Main arterial branch to Breast

Internal mammary artery

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What does prolactin do in the breast

Causes milk production

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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

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The breast itself lies on a layer of pectoral fascia and the following muscles

Pec major
Serratus anterior
External oblique

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Spermatogeneis

Process of germ cell to mature sperm

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Spermatocytogeneis

Germ cell to spermatid

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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

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Spermiation

Mature spermatid are made motile

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How are sperm made fertile

Low levels of FPP and heparin remove glycoproteins coat over the acrosome and make it fertile

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what cell in the pituitary release growth hormone and are stimulated by GnRH

somatotropes

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what basophils cells in the anterior pituitary secrete ACTH are stimulated by CRH

corticotropes

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what cells in the anterior pituitary are stimulated by TRH and release TSH

thyrotropes

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what cells in the anterior pituitary release LH and FHS and are stimulated by GnRH

Gonadotropes

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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

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!!!