Repro Flashcards
Which microorganism causes conjunctivitis in newborns?
Chlamyydia Trachomatis
What is the primary mechanism of action of the progesterone implant?
Prevention of ovulation (not thickening of mucus)
What is the primary mechanism of action of the progesterone only pill?
Thickening of cervical mucus
What is a possible cause of secondary anovulation?
Polycystic Ovarian Syndrome (PCOS)
What is a possible cause of primary anovulation?
Dysgenetic gonads
A woman is having infertility tests. What process is responsible for the production of acellular mucus with low viscosity and high stretchibility?
Oestrogen action on cervical glands
What changes are seen in maternal resp rate in pregnancy?
Unchanged
What changes are seen in maternal minute ventilation in pregnancy?
Increase by 50%
What changes are seen in maternal creatinine clearance in pregnancy?
Increase by 50%
What changes are seen overall in maternal blood pressure in pregnancy?
No change (sometimes slight decrease)
A woman is seen at 32 weeks gestation. Her BP is 150/80 with evidence of proteinuria ++ on urine dip. What complication to the fetus is most common in this conditon?
Oligohydramnios (low amniotic fluid volume)
How soon after fertilisation can human chorionic gonadotropin be detected in maternal urine? (pregnancy test)
14 days
Which prenatal diagnostic test has the highest risk of pregnancy loss?
Chorionic Villus Sampling
What is the most common fundal height at 36 weeks’ gestation?
Xiphisternum (smallest/lowest part of sternum)
What is the most common fundal height at 20 weeks’ gestation?
Umbilicus
What is the most common fundal height at 16 weeks’ gestation?
Mid-way between pubis and umbilicus
What is the most common fundal height at 12 weeks’ gestation?
Pubic symphisis
What supplement do you need to give pregnant women to help development of the fetal nervous system and prevent neural tube defects?
Folic acid
A woman has Hb, platelets and fibrinogen are reduced but D-dimer is raised. What is the most common cause for her PPH?
Disseminated Intravascular Coagulation
Which hormone is responsible for milk ejection?
Oxytocin
Which hormone is responsible for milk secretion?
Prolactin
What hormonal change is responsible for the secretion of milk after delivery?
Decreased progesterone and oestrogen
What is the most common invasive cancer of the female genital tract?
Endometrial adenocarcinoma
What are risk factors for the development of endometrial cancer?
- History of PCOS
- Increased years of menstruation
What is the most significant risk factor for the development of germ cell tumours?
Cryptorchidism (undescended testicle)
A 62 year old post-menopausal women reports a small lump in her vulva. She reports a 10 year history of vulval itching. What is the most likely diagnosis in this case?
Vulval Cancer
Which lymph nodes does the uterus drain into?
Body - External iliac arteries
Fundus - para-aortic & superficial inguinal
Which lymph nodes does the ovary drain into?
Para-aortic
Which lymph nodes does the lower third of the vagina drain into?
Superficial inguinal nodes
Which structure is closely related to the lateral fornix of the vagina?
Ureter
At which junction is the internal os of the cervix located?
Body & cervix of the uterus
What is the external os?
Opening between the cervix and vagina
From which tissues do the gonads develop from?
Intermediate mesoderm in the abdomen
What part of the developing follicle directly surrounds the developing oocyte?
Granulosa cells
What muscles make up the superficial perineal muscles?
Bulbospongiosus
Ischiocavernous
What muscles make up the levator ani muscles? (deep muscles)
Puborectalis (front - rectum)
Pubococcygeus (front - coccyx)
Iliococcygeus (ischial spine - coccyx)
What is the primary hormone responsible for triggering ovulation?
LH
At what age should the first sign of male puberty be seen and what it is?
14 years latest - testicular enlargement
At what age should the first sign of female puberty be seen and what it is?
13 years at latest - breast bud development
What hormone stimulates endometrial proliferation and at what point of the cycle does that occur?
Oestrogen - proliferative phase
What system allows the hypothalamus and anterior pituitary to communicate?
Hypothalamic-hypophyseal portal system
What are the FSH, oestradiol and vaginal pH findings for menopausal women?
FSH - High
Oestradiol - Decreased
Vaginal pH - > 4.5
Which investigation is used to asses the uterus and fallopian tubes?
Hysterosalpingogram
What is the normal fetal pO2?
4kPa
What nerve supplies the levator ani?
Pudendeal nerve
How does the perineal body function to maintain pelvic organ support?
Central point for attachment of the perineal muscles
Give some risk factors for pelvic organ prolapse?
Vaginal delivery of childbirth
Obesity
Occupational - heavy lifting
Gynae surgery
Menopause
Why can vaginal delivery cause pelvic floor dysfuction?
Stretching of pudendal nerve
Stretch/damage to pelvic floor musculature
Injury to perineal body
What is the normal sperm count and normal range of volume in ejaculate?
20-200 10^6 per ml
2-4 ml
What is the difference between spermatogenesis and spermiogenesis?
Spermatogenesis - Formation of spermatids from spermatogonia in seminiferous tubules
Spermiogenesis - Formation of spermatazoa from spermatids in seminiferous tubules
Which cells drive the differentiation of the gonad to form the testis and where in the embryo do they come from?
Primordial germ cells
from the yolk sac
Define CIN and give some risk factors for it
Dysplasia of squamous cells within the cervical epithelium
HPV infection
Early first pregnancy
Multiple births
Smoking
What is the function of cervical glands and what hormone activates them?
Produces thick, sticky mucus to prevent further sperm or microoaganisms (progesterone)
Where is the transformational zone of the cervix found?
External os
What is the lymphatic drainage of the cervix?
Superior - Internal iliac nodes
Inferior Sacral nodes
Which cells secrete HCG?
Syncitiotrophoblasts (2 weeks after implantation)
What is the changes to the placenta from 1st to 3rd trimester?
Syncitiotrophoblast - thins
Cytotrophoblasts - disappears
How can a pregnant woman develop anaemia during the 2nd trimester?
Expansion of plasma volume is greater than the increase in red cell mass
(Dilutional/physiological anaemia of pregnancy)
What’s the lymphatic drainage of the vas defernes and seminal vesicles?
Internal and external iliac nodes
What’s the lymphatic drainage of the testis?
Para-aortic nodes
What’s the lymphatic drainage of the testis?
Para-aortic nodes
Are germ cells haploid or diploid?
Diploid (have chromosomes from each parent)
Is the entire endometrium shed during menstruation?
No
A girl with amenorrhea has secondary sexual characteristics and her hormones are all in normal range, what is the cause?
Outflow tract obstruction
What’s the urogenital hiatus?
An anterior gap which allows passage of the urethra (and Vagina in females)
How does the mother allow sufficient Ca to the fetus?
By increasing synthesis of 1,25 vitamin D3
What’s the most likely place for testicular cancer to metastasis?
Brain
Liver
Lung
Which gene and chromsome is important for gonadal differentiation?
SRY gene on the Y chromosome
What’s the order of female puberty?
- Thelarche
- Adrenarche
- Menarche
FSH and LH - what cells do they act on and what is the function of these cells?
FSH – stimulates granulosa cells which convert androgen to oestrogen
LH – stimulates theca interna cells which release androgens.
LH surge leads to ovulation.
What adaptions does the fetus have for optimal oxygen transport?
Lower PaO2 than mother
HbF has greater affinity for O2
Double Bohr effect
Increased maternal production of 2,3DPG (less maternal affinity for o2)
What swabs can you use for a patient presenting with vaginal discharge?
Vulvo-vaginal - chlamydia & gonnorhoea (asymptomatic)
High vaginal (posterior fornix) - CD, BV
Endocervical - chlamydia & gonnorhoea (symptomatic)
Risk factors for candiadisis?
Oestrogen medication (^yeast growth)
Diabetes/HIV (immunosupressed)
Antibitoic usage
Anti fungal treatments (candidiasis)?
Nystatin
Fluconazole
What causes syphilis and give some features of the microorganism?
Treponema Pallidum
(Spiral - not a normal commensal of body)
What is the difference between syphillus and herpes?
Syphillus - painless ulcer (HIV associated)
Herpes (HSV 2) - painful ulcer
What is Prehn’s sign and what does it show?
Pain relieved when the testis is elevated
(+ve = Epididymo-orchitis)
How would you know a patient has trichomoniasis (trichomonas vaginalis)? What’s the treatment?
Mobile protozoa
Yellow, offensive discharge
Increased vaginal pH
METRONIDAZOLE
What test to diagnose a STI in men and why?
First catch urine
(urethra has sexual and urinal properties in men)
What’s a non-STI cause of PID?
Bacterial Vaginosis (Gardinella vaginalis)
Why can PID increase risk of ectopic pregnancy?
Salpingitis (fallopian tube inflammation) causes adhesions blocking the fallopian tube so implantation occurs in ampulla
Why can PID cause secondary peritonitis?
Fallopian tube is open to peritoneum at fimbrae
What are some complication of PID?
Peritonitis
Fitz-Hugh Curtis syndrome (peri-hepatitis)
Ectopic pregnancy
Subfertility
What hormone change is responsible for the suppression of FSH release?
Rise in Inhibin levels
