lectures extra questions Flashcards
What are autosome?
chromosomes 1-22
What are the 4 stages of gametogenesis?
migration + mitosis
meiosis (I+II)
Maturation
How many primary oocytes are made in mitosis in females?
7million (peak month 5)
40,000 at puberty (due to degen.)
What is the difference between sister chromatids and homologous chromosomes?
Sister chromatids = split in M2
Homologous chromosomes = split in M1
What is dictyate?
primary oocytes arrest in prophase I
What is the secondary oocyte arrested in before fertilisation?
metaphase II
what are the 2 commonest teratomas?
sacrococygeal > oropharyngeal
What is a translocation? What are the two types? What is the most common translocation?
Where part of 1 chromosome breaks off and joins another chromsome (commonest = 14–>21)
Balanced
Unbalanced
What are the 3 causes of T21?
95%: non-dysjunction (M1 most between homologous chromosomes and M2 less common between sister chromatids)
4% unbalanced translocation
1% mosaicism
What are the causes of aneuploidy?
Unbalanced translocation
mosaicism
Non-dysjunction
What is non-dysjunction?
Missegregation of chromsomes during M1 or M2 (meiosis)
What is mosaicism? Use it to explain why there might be different severities of T21?
Missegregation of chromsomes during mitosis (of the zygote)
Causes 2 cell populations –> some normal and some trisomy
Clinical features of Down’s?
Learning disability
Clinical features of Down’s?
Learning disability, single palmar creese, brushfield spots, small mouth, protruding tongue, low birth weight,
Clinical features of turner’s?
Characteristically female, webbed neck, wide-spaced nipples, lymphoedema, short, no ovaries
Complications of Down’s
CHD (VSD), early onset dementia, hypothyroid, coeliac, constipation, refluc, cataract, glaucoma
What cardiac defect is Turner’s linked to?
coarctation of the aorta
What complications are associated w/ turner’s?
infertile (no ovaries), coarctation Ao
What is the usual cause of Turner’s?
Non-dysjunction in spermatogenesis
How do sperm mature?
condensation of the nucleus, formation of the acrosome, formation of the neck/middle piece/tail –> shedding of the cytoplasm
What is inadequate implantation of the blastocyst linked to?
PROM, pre-eclampsia, IU fetal death, IUGR, preterm, placental abruption
describe fertilisation
corona radiata then ZP penetration –> fusion of cell membranes of oocyte + sperm –> oocyte completes M2
What does the sperm undergo in the female tract?
Capacitation
acrosome reaction (when it binds to ZP)
Give 3 female structural causes for abnormal implantation / subfertility?
Fibroids
Congenital uterine defects
endometriosis
How many pregnancies are ectopic?
2%
What is an ectopic?
Extra-uterine pregnancy
if a women has an endocrine disorder (PCOS), how might you induce ovulation?
- clomiphene citrate
- GnRH analogue (PULSATILE) + hCG
- FSH/LH + hCG
What does hCG do in inducing ovulation + IVF?
It causes an LH surge + causes woman to ovulate
How does clomiphene citrate work?
Oestrogen antagonist
Suppresses the -ve feedback to hypothalamus + pituitary
Causes ^ GnRH –> ^ FSH/LH
What are the steps of IVF?
- Induction of ovulation / gamete production
- gamete retrieval (including sperm)
- IVF (culture dish + incubated)
- embryo culture until 8 cell stage
- embryo transfer
What drugs do you use to induce ovulation in IVF?
Leuprolide acetate (GnRH agonist)
FSH daily
hCG
What’s the alternative to IVF in women who have PCOS? Why would you do this?
In vitro gamete maturation
PCOS at high risk of OHSS and this method doesn’t use ovulation stimulation step of IVF
What is the basic principle behind ovarian hyperstimulation syndrome?
^ oestrogen (a powerful vasodilator) –> fluid shift extravascular compartment
How can you preserve embryos and gametes?
freezing/cryopreservation using cryoprotectant chemicals (prevent ice crystals forming)
Who is IVF indicated for?
Tbal disease, endometriosis, mild male infer, unexplained infertility
Who is IVF contraindicated in? What might you use?
Severe male infertility –> ICSI (intracytoplasmic sperm injection)
PCOS –> in vitro gamete maturation
Define severe male infertility?
Problems w/ sperm morphology, motility and low sperm count (or non-obstructive azospermia)
How might a male with obstructive azospermia have sperm obtained?
PESA
TESA
What are the 3 fates of the epiblast cells?
o Stay put ectoderm
o Form new layer between epiblast + hypoblast mesoderm
o Displace hypoblast cells endoderm
what factor is produced cranially and what does it do?
HNF-3beta
specifies brain regions
What is the pathway that establishes left sidedness?
5HT (expressed L) –> FGF8 –> Nodal + Lefty 1+2 –> PITX2 (establishes left sidedness)
what gene products are produced on the right of the bilaminar disc?
SHH (inhibits left-sided products)
SNAIL
where is Brachyury produced and what does it do?
L/R of primitive node
what it does:
1) ANTEROPOSTERIOR/cranio-caudal patterning –> mesoderm development middle/caudal regions
2) essential for nodal + lefty 1+2 expn
What occurs if there is absence/problem w/ brachyury?
Caudal dysgenesis
no anteroposterior patterning
Failure of formation of caudal mesoderm structures –> limbs fused/unformed, urogenital problems)
What is caudal dysgenesis associated w/?
Maternal DM
What is HPE associated w/?
^ Alcohol intake
What is caudal dysgenesis?
AP shortening due to brachyury dysfunction –> loss of caudal middle mesoderm development
SIRENOMELIA
What is HPE? What are some features?
Midline defect - deficiency of midline tissues
Single midline ventricle, fused/underdeveloped forebrain, eyes fused midline, narrow head, absent nose…etc
REMEMBER: HPE is an example of aberrant gastrulation
What causes laterality problems (situs inversus)?
PITX2 ectopic production R
5HT pathway disruption (SSRIs)
Retinoic acid analogues (isotretinoin)
What do 20% of people w/ situs inversus have?
Kartanger’s syndrome
Give 4 examples of aberrant gastrulation?
- caudal dysgenesis
- Situs invertus / laterality seqyences
- HPE
- Teratomas
What occurs on day 16-18 of heart development?
progenitor heart cells migrate to lateral plate mesoderm + become PHF
What does the primary heart field give rise to?
Atria, LV and most of RV
What inhibits heart development?
WNT proteins
What patterning induces heart development?
BKP expn + WNT blocking substances (from endothelial cells) –> NKX2.5 expressed (master gene for heart developemnt)
NKX2.5 Upregulates Hand 1 + 2 expn –> cardiac looping
5HT, PITX2 and retinoic acid involved in establishing L/R patterning
retinoic acid also specifies caudal structures / atria
What is the role of NKX2.5
MASTER HEART GENE
- Causes Primary HF to become cardiogenic region (myoblast proliferation)
- Upregulates Hand 1 + 2 expn –> cardiac looping
What occurs on day 20-21 of heart development
2HF appears (regulated by NCCs) –> outflow tracts + rest of RV
What occurs day 23-28 heart development? how does it occur?
Heart tube dilatations and LOOPING happens
NKX2.5 –> upregulates Hand 1+2 (involved in cardiac looping)
What substances are involved in cardiac looping?
Hand 1 + 2
How would you treat HF in babies?
- duct dep: PGs
- diuretics
- NG tube
- O2
- Upright
What is the most common ASD?
High septal ASD (ostium secundum defect)
When do pts w/ ASD usually present?
30s/40s w/ HF/atrial arrhythmias
What is total anomalous pulmonary venous return?
Pulmonary veins drain into RA therefore survival only if ASD or PDA
What are the 4 features of hypoplastic LH syndrome?
- Underdeveloped LV
- ASD
- PDA
- Small aorta
How have some pre-natal screening methods been developed?
markers for disease produced by placenta or fetus (increased or decreased compared to normal pregnancy)
Why would you screen?
- manage remaining pregnancy
- Parents can plan
- decide whether to continue pregnancy or not
- plan for labour complications or complications of fetus
- find conditions that affect future preg (e.g. Rh)
What is the percentage of false +ves in combined test?
What is its detection rate?
5%
80%
When do you do the combined test? What is it comprised of?
10-14w (1st trimester) (11-14 NT)
nuchal translucency (US) + PAPP-A / hCG
What is important for 2nd trimester testing?
Need fetal age for accurate intepretation
What is involved in 2nd trimester screening?
quadruple test: AFP, Estriol e3, hCG, Inhibin A
triple test: without estriol 3 (do for Edward’s)
when do you do 2nd trimester screening?
15-22 weeks
What are the results for in Down’s?
AFP: decreased
E3: decreased
hCG: increased
Inhibin A: increased
When is nuchal translucency performed?
11-14 weeks
How can you estimate gestational age from US?
crown rump length > baparietal diameter + femoral length
What can you use US for in pregnancy?
- detect multiple pregnancy
- detect/monitor fetal anomaly
- monitor preg. in maternal disease
- placental localisation / problems
- estimate GESTATIONAL AGE
What are the indications for diagnostic tests in pregnancy?
- screening suggests ^ risk
- mother >35
- previous child w/ abnormality
- parent w/ chromosomal disorder