Key Facts Flashcards
1
Q
What does the Trophoblast become in the week of 2s?
A
Syncitiotrophoblast, Cytotrophoblast
2
Q
What does the embryoblast becomes?
A
Hypoblast and epiblast
3
Q
What does the hypoblast form?
A
Yolk sac and chorionic cavity
4
Q
What week does gastrulation occur in?
A
Week 3
5
Q
What week does neurulation occur in?
A
Week 4
6
Q
What does the epiblast form?
A
Ecto, Meso, Endoderms
7
Q
Describe the layout of the testes
A
Seminiferous tubules lead to epididymis via rete testis, which leads to vas deferens
Surrounded by tunica vaginalis, which has a viseral and parietal pleura
8
Q
What happens in the Seminiferous tubules?
A
Spermatogenesis
9
Q
How should you test if a testicular lump is a hydrocoele?
A
Water fills the tunica vaginalis
Transilluminates
10
Q
What is the role of Sertoli cells?
A
Spermatogenesis support
11
Q
What is the role of Leydig cells?
A
Produce testosterone
12
Q
Where does the testicular artery come from?
A
Branch of Internal Iliac from Common Iliac
13
Q
Where does the testicular vein drain into?
A
Renal vein (left) IVC (right)
14
Q
What do the testicular arteries and veins form?
A
Pampiniform plexus - allows for counter-current exchange for temperature purposes
15
Q
What is the lymphatic drainage of the testes?
A
Para-aortic lymph nodes
16
Q
Describe testicular torsion
A
Tunica vaginalis + testis twist around eachother in a bell-clapper deformity, which cuts off venous drainage
Eventually ischaemia and compartment syndrome
17
Q
Name 3 causes of scrotal swelling
A
Varicocoele
Hydrocoele
Testicular cancer
18
Q
What is a varicocoele?
A
Pampiniform plexus swelling - most likely to occur on left side as drains into the renal vein
19
Q
What does the ureter pass under in men and women?
A
Men: Vas deferens
Women: Uterine artery
20
Q
What are the 3 layers of the spermatic cord?
A
External spermatic fascia - external oblique
Cremasteric muscle - internal oblique
Internal spermatic fascia - transversalis fascia
21
Q
What are the contents of the spermatic cord?
A
3 nerves - testicular, nerve to vas, nerve to cremasteric nerve
3 arteries - testicular, artery to vas, cremasteric artery
3 veins - testicular, vein to vas, cremasteric vein
3 fascial layers - external spermatic fascia, cremasteric muscle, internal spermatic fascia
3 random - vas deferens, cremasteric muscle, iliolingual nerve
22
Q
Name the accessory glands and what they contribute to sperm
A
Seminiferous tubules (maybe not) - make sperm
Seminal vesicles - nutrition - fructose, high pH to neutralise acid
Prostate - proteolytic enzymes
Bulbourethral glands - reduce friction
23
Q
Name the prostate zones from top to bottom and the disease associated with each
A
Central
Transitional - BPH
Peripheral - Prostate cancer
24
Q
Name the symptoms of BPH
A
Frequency
Weak stream
Dribbling
25
Which out of BPH and Prostate cancer prevents full emptying?
Prostate cancer causes incomplete voiding
26
What is the role of the tunica albuginea?
Helps penis maintain its shape
27
What is the role of the corpus cavernosum? (the eyes)
Fills with blood
28
What is the role of the corpus spongiosum?
Stops urethral occlusion
29
How is an erection formed?
Point and shoot
Parasympathetics cause vasodilation of arteries and constriction of veins
Sympathetics cause ejaculation
30
What does the ovarian artery travel through?
Suspensory ligament of the ovary
31
How does the ovarian artery drain?
Same as the testicular artery
32
What is the top of the uterus called?
The fundus
33
What is the zone between the internal and external cervical os called?
Transformation zone (NOT TRANSITION)
34
What are the 3 sections of the fallopian tubes from fimbriae to uterus?
Infundibulum, ampulla, isthmus
35
Name 2 ectopic pregnancy sites
Ampulla, peritoneum
36
Why is pain felt in the pelvis in ectopic pregnancy?
Flows down paracolic gutters, irritates phrenic nerve, which has roots 3, 4, 5 - this transmits to C3, 4, 5 dermatomal regions
37
Name the ligaments of the uterus
- Suspensory ligament
- Broad ligament
- Round ligament - to labia majora
- Ovarian ligament - to round ligament
38
What does the uterine artery travel through?
Mesovarium
39
What is the standard uterine position?
Anteverted anteflexed
40
Describe the cellular make up of the vagina
Stratified squamous epithelia with glucose pouches for lactobacilli - if killed, leads to thrush (candida albicans invasion)
41
What embryological origin do the reproductive tracts form from?
Intermediate mesoderm
42
What is the male genotype?
XY
43
What gene is activated in male children?
SRY
44
What are the two duct types?
Paramesonephric - women
| Mesonephric - men
45
What do the testes produce and what does it inhibit?
Mullerian inhibiting hormone - destroys paramesonephric ducts
46
What is produced to maintain the mesonephric ducts?
Testosterone
47
What does exogenous androgens lead to?
In women: Both develop
48
What does AIS lead to?
In men: no genitals
49
What does the genital tubercle become in men and women?
Spongy urethra
| Clitoris
50
What is Turner's syndrome?
45X - short stature, non-functioning ovaries, amenorrhoea
51
What is Klinefelter's syndrome?
47XXY - males with small testes, reduced libido, infertility, enlarged breast tissue
52
What hormones mediate somatic growth in puberty?
GH, IGFs
53
Describe the order of secondary sex characteristics in females
Breast (thenarche), pubes, growth, menarche, pubes, breast
54
Describe the order of secondary sex characteristics in males
Genitals, pubes, sperm, growth, genitals, pubes
55
What are the age ranges for puberty in females and males?
9-13
| 10-14
56
What is early puberty called?
Precocious puberty
57
What is the puberty weight?
47kg
58
What initiates puberty?
GnRH -> FSH + LH
59
What is the role of Leydig cells and what hormone are they acted on by?
LH -> Testosterone
60
What is the role of Sertoli cells and what hormone are they acted on by?
FSH -> Spermatogenesis
| Inhibin release
61
What is the effect of low level Oestrogen on GnRH?
Inhibits GnRH
62
What is the effect of high level Oestrogen on GnRH?
Increases GnRH
63
What does progesterone do at high Oestrogen?
Inhibits GnRH - stops LH surge
64
What does GH do in puberty?
Releases TSH, increases metabolic rate and storage for growth
65
Why are girls shorter with precious puberty?
Oestrogen inhibits growth
66
What is the difference between central and peripheral precocious puberty?
```
Central = due to brain inflammation
Peripheral = due to excess testosterone from a tumour
```
67
What happens with the daughter cells in females after meiosis?
3 polar bodies, 1 oocyte
68
Name 3 sources of genetic variation and the phase they occur in
Crossing over - Prophase 1
Independent assortment of chromosomes - Metaphase 1
Random segregation
69
Describe the process of spermatogenesis
Spermatogonia -> 2 Spermatocytes via Mitosis, with one replacing original spermatogonia -> secondary spermatocyte via meiosis, ends as a spermatid
70
What is a germ cell sperm called?
Spermatogonia
71
What is the process of a sperm travelling down the rete testis to the epididymis to become more motile called?
Spermiogenesis
72
What does capacitation of sperm involve?
Removal of glycoproteins and cholesterol in the vagina to prepare for acrosome reaction
73
Describe the process of oogenesis
Oogonia -> Proliferate by mitosis -> Enter meiosis 1 to become primary oocytes -> surrounded by primordial follicles -> primordial follicles -> atresia begins
74
Describe the process of ovulation, naming each stage
Pre-antral - Granulosa cells formed from granulosa cells, which form the zona pellucida
Antral - antrum develops, theca externa and interna develop, becomes secondary follicle
Pre-ovulatory - LH surge induced, meiosis 1 is completed, 1 polar body and 1 oocyte
75
What is formed around the oocyte after ovulation and by what?
Theca and Granulosa cells form the corpus luteum
76
What is the lifespan of the corpus luteum?
14 days
77
What is released by the fertilised embryo to keep the corpus luteum alive? What part of the embryo releases it?
B-hCG
| Syncitiotrophoblast
78
What hormone triggers ovulation?
LH surge
79
What hormone causes follicles to grow?
FSH
80
What causes inhibin release and from where?
FSH, from the Granulosa cells
81
What are the two overall phases of the menstrual system?
Ovarian and Uterine
82
What 2 phases is the Ovarian phase of menstruation split into?
Follicular and Luteal
83
What 2 phases is the Uterine phase of menstruation split into?
Proliferative and Secretory
84
Describe the Follicular phase of the Ovarian cycle.
FSH stimulates Theca interna, which combined with Granulosa cells in pre-antral phase, lead to Oestrogen production.
Oestrogen promotes thickening of the endometrium and thinning of the mucous.
Oestrogen levels rise slowly.
LH surge begins due to raised oestrogen.
85
Describe the Luteal phase of the Ovarian cycle.
LH surge leads to positive feedback and more oestrogen production.
Corpus luteum is produced, which starts producing Progesterone.
Ovulation occurs.
86
What hormones does the Corpus Luteum produce?
Progesterone, Oestrogen, Inhibin
87
Describe the Proliferative phase of the Uterine cycle.
Oestrogen released from Granulosa cells causes proliferation of the endometrium.
88
Describe the Secretory phase of the Uterine cycle.
Progesterone from corpus luteum leads to secretory gland production.
If corpus luteum stops outputting hormones, then the endometrium will shed.
89
Describe the actions of progesterone on the uterus and mucous
Causes secretory proliferation
| Causes thickening of cervical mucous
90
Describe the actions of Clomiphene
Induces ovulation by masking oestrogen levels to the hypothalamus, causing GnRH release and so FSH/LH release
91
Define Amenorrhoea
Absence of menstruation
92
What is the difference between Primary and Secondary amenorrhoea?
Primary - never had a period by 16 eg. due to imperforate hymen/ turner's syndrome
Secondary - cessation of periods for over 6 months after having had periods - usually pregnancy
93
Define Oligomenorrhoea
Reduction in frequency of periods
94
What is the most common cause of Oligomenorrhoea?
PCOS - causes hormone changes, including less oestrogen release
95
Define Menorrhagia and give a cause
Heavy periods - commonly caused by fibroids, polyps and cancer - can lead to anaemia
96
Define Dysmenorrhoea and give a cause
Painful periods - commonly endometriosis/PID
97
What happens in Dyfunctional Uterine Bleeding?
Period of anovulation followed by heavy bleeding
98
How is an erection started?
Arterial dilatation via NO release via parasympathetics
| Venous compression by corpus cavernosum filling with blood
99
How does ejaculation occur?
Sympathetic induced movement of semen into the prostatic urethra
The smooth muscle of the prostate/vas/seminal vesicles contract
100
What prevents retrograde ejaculation?
Internal urethral sphincter
101
What part of the blastocyst interacts with the placenta?
Trophoblast
102
What can implantation over the cervix lead to?
Placenta praevia
103
What can placenta praevia lead to?
Pre-eclampsia
104
What are the clinical signs of pre-eclampsia?
Hypertension
| Proteinuria
105
What cells prevent deep implantation?
Decidual cells
106
Describe the hormonal methods of contraception
- POP - thickens mucous
- COCP - prevents ovulation + thickens
- Progesterone depot - prevents ovulation + thickens - every 12 weeks
- Progesterone implant
- IUS - progesterone releasing
- IUD - copper
107
What is the risk with high doses of oestrogen?
Endometrial cancer
| Oestrogen is thrombogenic, can cause clots
108
Name 2 permanent contraception methods
Vasectomy
| Tubal ligation
109
What is the difference between primary and secondary infertility?
```
Primary = never had a child before
Secondary = dad a child before
```
110
Give 5 infertility causes for women
```
PID
PCOS
Turner's
Uterine fibroids
Endometriosis -> adhesions and scarring
```
111
Give 5 infertility causes for men
```
Poor general health
ED
STIs
GnRH deficiency
Klinefelter's
```
112
What is the outer layer that attaches to the placenta called and what are its attachments called?
Chorionic layer
| Chorionic villi
113
What takes oxygenated blood from the placenta to the baby?
Umbilical vein
| 2 Umbilical arteries bring it back
114
Describe the effect of progesterone generally on the mother
Causes increased appetite
| Causes smooth muscle relaxation - KEY
115
Describe the effect of hPL on the mother
Increases glucose availability for the baby by causing insulin resistance in the mother
116
Name 3 CVS changes in the mother during pregnancy
- Reduced vascular resistance - progesterone dilates - leads to hypotension
- Increased heart rate
- Increased plasma volume and haematocrit - but not equally, can get anaemia
117
What happens to blood pressure during pregnancy?
Hypotension
118
What is given pre-emptively to women at risk of Pre-eclampsia?
Aspirin
119
Name 3 Renal changes in the mother during pregnancy
- GFR - 150%
- RAAS release
- Increased EPO production
120
Name 3 GI changes during pregnancy
- Constipation - due to progesterone
- Haemorrhoids - due to smooth muscle relaxation in rectal arteries
- Bloating
121
Name 2 Respiratory changes in the mother during pregnancy
- Stable respiratory rate, but 40% increase in minute volume due to tidal volume increase
- Hyperventilation (deeper breathing)
122
Name 1 haematological change in the mother during pregnancy
Oestrogen is pro-thombotic - increased clotting risk
123
Describe the glucose changes in the mother during pregnancy
```
First trimester (12 weeks): Increased fat deposition, progesterone increases appetite, B cell hyperplasia
Second and third trimester: hPL maternal insulin resistance
```
124
Why does gestational diabetes occur?
When B cell hyperplasia is not enough to keep up with insulin resistance from hPL
125
What does gestational diabetes lead to in the baby and why?
Macrosomia + Hypoglycaemia
Permanent high glucose levels - baby has to undergo b cell hyperplasia
Will have hypoglycaemia on birth, since too much insulin being produced
126
Name one complication of gestational diabetes other than macrosomia
PPH
127
How is gas exchange at the placenta increased? (4)
- Increased 2,3-BPG production in mother red blood cells
- Low foetal pO2
- Foetal haemoglobin
- Double bohr effect
128
Name the 3 foetal shunts and what they shunt over
Ductus venosus - Liver
Foramen ovale - shunts right to left heart
Ductus arteriosus - from pulmonary artery to aorta
129
Describe the foetal response to hypoxia and what this is called
Heart rate slows to reduce heart oxygen supply
HbF concentration increased
"Foetal distress syndrome"
130
What are the symptoms of foetal distress syndrome?
Reduced movement, vaginal bleeding, abnormal amniotic fluid level
131
What is the primary growth factor in trimester 1?
IGF 2
132
Name the dominant type of cell growth is Semesters 1 and 2
1: Hyperplasia
2: Hypertrophy
133
Name 3 ways of measuring growth in the foetus
- Crown rump length
- Symphysis-fundal height
- USS - main, at 20 weeks
- Femur length
134
What is a bimanual exam and what can you feel?
Uterus
| External Os of the cervix
135
What is the normal birth weight?
3.5kg
136
What is the treatment for pre-term birth to prevent RDS?
Glucocorticoids
137
What is the process of "quickening"?
Movements of the baby felt by the mother after 17 weeks
138
Define "Parturition"
Going from pregnant -> non-pregnant
139
Describe the stages of the creation of the birth canal
- Progesterone loosens sacro-iliac joint
- Cervical ripening - prostaglandins cause reduction in collagen and increase in GAGs
- Effacement and dilation of the cervix - thinning and opening by prostaglandins/oestrogen
140
Describe the stages of the initiation of labour
- Triggered by rise in oestrogen:Progesterone ratio
- Increased prostaglandin synthesis
- Increased contraction strength and frequency due to prostaglandins and oxytocin
141
Describe the stages of the expulsion of the foetus
- Contractions increased due to Prostaglandins (more Ca2+ per contraction) and Oxytocin (more frequent)
- Ferguson reflex = positive feedback loop where contractions increase oxytocin release from posterior pituitary
- Oestrogen increases oxytocin receptor production
- Head faces down, shoulders rotate
142
What is a breach birth?
Legs first
143
What is the inability of the placenta to be expelled after labour called?
Uterine atony
144
Name a property of the myometrium that helps with labour
Brachystasis
145
What are the boundaries of the Brachial Plexus?
C5-T1
146
Describe Erb's Palsy
Elbow extended, wrist flexed, arm pronated
147
Describe Klumpke's Palsy
Loss of abduction, adduction, flexion, extension of fingers - Claw hand
148
What are the natural processes in the female body that prevent PPH?
- Living ligature - contraction of muscles around blood vessels
- Natural clotting mechanisms
- Pressure on placental site by walls of uterus
149
What is the score used to measure an infant's breathing?
APGAR
150
What does CURB-65 stand for?
```
Confusion
Urea in blood
Respiratory
Blood pressure
Over 65
```
151
What causes most issues in the Post Partum Period?
Low Oestrogen
152
Name the 3 mental health conditions associated with the post partum period
- PTSD
- PP depression
- Puerperal psychosis
153
Describe the hormones involved in breast feeding
- Prolactin - released due to suckling, inhibits dopamine release, which usually inhibits GnRH
- Oxytocin - let down reflex, causes ejection of milk
154
What is Puerperal mastitis?
Milk accumulation leading to inflammation and potential infection (staph aureus)
155
List 5 complications of STIs
```
PID
Infertility
Ectopic pregnancy
Cervical cancer
Fitz-Hugh-Curtis syndrome
```
156
How does PID travel to the liver?
Down the paracolic gutters
157
How should STIs be tested for in men?
Urinalysis (NAAT)
| Bloods
158
How should STIs be tested for in women?
High vaginal swab - random ones
Endocervical swab - chlamydia
Vulvovaginal swab - asymptomatic chlamydia/ gonorrhoea
159
What is the causative organism of Chlamydia?
Chlamydia trachomatis
160
What symptoms does Chlamydia trachomatis cause?
Men: painful urination
Women: none
161
What is the treatment for Chlamydia trachomatis?
Doxycycline/Erythromycin (if pregnant)
162
What is the causative organism of Gonorrhoea?
Neisseria Gonorrhoea
163
What symptoms does Neisseria Gonorrhoea cause?
Men: Urethral discharge
Women: none
164
What is the treatment for Neisseria Gonorrhoea?
IM ceftriaxone and erythromycin
165
What is the causative organism of Syphilis?
Treponema pallidum
166
What are the Primary, Secondary and Tertiary symptoms of Treponema pallidum?
Primary: Ulcer - painless
Secondary: Rash, mucosal lesions
Tertiary: Neurosyphilis
167
What is the treatment of Treponema Pallidum?
Ben-Pen-G, procaine penicillin if late
168
What causes Herpes?
HSV 1 and 2
169
What causes Genital warts?
HPV 16 and 18
170
What HPV strains are covered in the vaccine?
HPV 6, 11, 16, 18
171
What is the treatment for Trichomonas Vaginalis?
Metronidazole
172
Name 2 non-STI infections
- Bacterial vaginosis - Gardnerella vaginalis
- Vaginal candidiasis - Candida albicans
Both treated by Metronidazole
173
What is the commonest cause of vaginal discharge in women?
Gardnerella vaginalis
174
What is the definition of PID?
Infection of the endocervix (channel of the cervix), causing salpingitis, endometritis, tubo-ovarian abscesses, adhesions and peritonitis
175
Name the deep muscles of the pelvis (front to back)
The Levator Ani
- Puborectalis
- Pubococcygeus
- Iliococcygeus
- Coccygeus
176
What do the levator ani attach to?
Perineal body
177
What can be caused by weakened levator ani?
Stress Urinary Incontinence
Prolapse
Faecal incontinence
178
Name the superficial muscles of the pelvis
- Bulbospongiosus
- Superficial transverse perineal
- Ischiocavernosus
179
What does a "dragging sensation" and pain on sex imply?
Uterine prolapse
180
What treatment can be given to help with prolapses?
Pessaries
"Mesh" surgeries to support levator ani
Kegel exercises
181
Name the classes of FGM and what each involves
1. Removal of clitoris
2. Clitoris and labia minora
3. Everything
4. Any other alteration
182
What is the definition of Menstruation?
Cessation of menstruation for 12 months
183
Describe the 4 phases of menstruation
Pre-menstrual - reduced oestrogen
Peri-menopause - night sweats, hot flushes, mood swings, insomnia, depression
Menopause - Complete cessation of period for 12 months
Post-menopause - osteoporosis risk, CVS risk, alzheimer's risk
184
What is the average age of Menopause?
50
185
What are the main risks of post-menopause?
CVS - lipid profile changed, increased atherosclerosis risk
Osteoporosis risk - oestrogen inhibits osteoclasts normally, without it they breakdown bone faster
Alzheimer's risk
186
What are the bodily changes women undergo post-menopause?
```
Skin loses elasticity
Hair loss
Thickening of vocal cords
Weight gain
Loss of breast tissue
```
187
What hormone goes down during menopause?
Oestrogen
188
Name 3 non-hormonal treatments for menopause
- Light clothing
- Statins
- Vitamin D
189
What does HRT help with?
Symptoms
Osteoporosis
NOT CVS
190
What type of cancer is Vulval cancer?
SCC
191
What does VIN stand for?
Vulval intraepithelial neoplasia
192
What does VIN involve?
Dysplasia of the vulval cells with no basement membrane invasion
193
Name a cause of VIN
Young: HPV
Old: not
194
What type of cancer is Cervical cancer?
SCC
195
Where does cervical cancer happen?
Transformation zone
196
What type of cells are there inside the cervix and outside the cervix?
Inside: simple columnar
Outside: stratified squamous
197
What are the high risk HPV subtypes and why?
16 and 18 - they have E6 and E7 which inhibit p53 and Rb tumour suppressors
198
What is CIN caused by?
HPV
199
Name 4 risk factors for cervical cancer
Early pregnancy
Early puberty
Smoking
HPV
200
What is the main treatment for cervical cancer?
Large Loop excision of the transformation zone/ hysterectomy
201
What type of cancer is endometrial cancer?
Adenocarcinoma
202
What are the risk factors for endometrial cancer?
Unopposed HRT
Early menarche
PCOS
Obesity - more androgens, more oestrogen
203
Name the two types of endometrial cancer
Endometroid
| Serous - aggressive - pasmmoma bodies
204
What is the main treatment for endometrial cancer?
Hysterectomy
205
What is the word for the removal of the uterus?
Hysterectomy
206
What are the two types of myometrial cancer?
Leiomyoma
| Leiomyosarcoma
207
What is the serum marker for Ovarian cancer?
Ca-125
208
What gene is Ovarian cancer associated with?
BRCA-1/2
209
Name the 3 types of ovarian cancer
Germ cell - Teratoma
Epithelial - serous/endometroid/mucinous
Sex cord stromal - Granulosa/theca
210
Name the two classifications of testicular cancer
Germ cell - seminomatous/non-seminomatous
| Sex cord stromal - sertoli/leydig
211
Name the different classifications of
Teratomas
Yolk sac
Choriocarcinoma
212
What is the removal of the testicles called?
Radical orchiectomy
