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ESA 4 Steven > Repro > Flashcards

Repro Flashcards

0
Q

What are the internal and external genitalia in females?

A

Internal - ovaries, uterine tubes, uterus, vagina

External - labia majora, labia minora, clitoris

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1
Q

What are the internal and external genitalia in males?

A

Internal - testis, epididymis, ductus deferens, seminal glands, ejaculatory duct, prostate, bulbourethral glands
External - glans penis, shaft of penis, scrotum

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2
Q

What are the male secondary characteristics?

A 
Increase in body size (compared to females)
Body composition
Fat distribution
Hair/skin changes
Facial hair and baldness
Smell
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3
Q

What are the secondary sexual characteristics in females?

A

Less increase in body size compared to makes
Fat distribution
Hair/skin changes
Breasts

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4
Q

What are the gonads embryonic origins?

A

Intermediate mesoderm

Primordial germ cells from the yolk sac

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5
Q

What gene drives the development of testis?

A

SRY gene in Y chromosome

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6
Q

What are alternative names for mesonephric and para mesonephric ducts?

A

Wolffian duct

Müllerian duct

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7
Q

Explain how having XY chromosomes leads to the ducts preservation/regression

A

Testes secretes androgen which keeps mesonephric and Müllerian inhibiting substance which degenerates the paramesonephric

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8
Q

Explain how having XX chromosomes leads to duct preservation/regression

A

No androgen so mesonephric duct regresses and no Müllerian inhibiting substance so the Müllerian duct is maintained

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9
Q

What are the 3 components of the embryonic external genital? What happens to the in males and females?

A

Genital tubercle, folds and swelling

Tubercle and folds fuse in males due to androgens but remain open in females

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10
Q

Explain the development of oocytes before puberty

A

Germ cells become oogonia which proliferate and then enter meiosis. They become a primary oocyte which is surrounded by a single layer of granulosa cells and thus becoming a primordial follicle

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11
Q

What are the 3 stages in ovulation

A

0-12 days: preparation, follicular, proliferative phase
12-14 days: ovulation
14-28 days: waiting, luteal, secretory phase

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12
Q

What happens to the primordial follicle during menstruation?

A

Primordial follicle–>pre antral follicle–>secondary follicle–>pre ovulatory follicle–>corpus luteum–>death

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13
Q

What is the path sperm travels through?

A

Seminiferous tubules–>rete testis–>ducti efferentes–>epididymus–>vas deferens

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14
Q

Explain spermatogenesis

A

Germ cells–>spermatogonia (2n)–>two primary spermatocytes (2n) via mitosis. One acts as raw material and one progresses to become–>two secondary spermatocyte (n) via meiosis–>four spermatids (n) via meiosis–>spermatozoa via spermatogenesis (remodelling)

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15
Q

What makes up semen?

A

Sperm
Seminal vesicle secretion
Prostate secretion
Bulbourethral gland secretion

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16
Q

What are the feedback effects of: testosterone, oestrogen, progesterone and inhibin?

A 
Testosterone - reduces GnRH, LH, FSH
Low oestrogen - reduce GnRH, LH, FSH
High oestrogen - increase LH, FSH and GnRH
Progesterone - reduce GnRH, LH, FSH
Inhibin - reduce FSH
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17
Q

Outline the hypothalamic pituitary gonadal axis

A

Hypothalamus releases GnRH which stimulates the pituitary to release LH (bind to leydig cells to release testosterone) and FSH (binds to Sertoli cells to release inhibin). Inhibin reduces FSH and testosterone negatively feedbacks to reduce FSH, LH and GnRH

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18
Q

What are some functions of oestrogen and progesterone?

A

Oestrogen - Fallopian tube function, thicken endometrium, thicken myometrium and increase its motility
Progesterone - thicken endometrium, thicken myometrium but reduce its motility

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19
Q

If there’s a successful pregnancy what maintains the corpus luteum?

A

Placenta releases HCG

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20
Q

What changes occur in girls during puberty and what is the usual age range?

A 
Breast bud (thelarche)
Pubic hair (adrenarche)
Growth spurt
Menstrual cycle (menarche)
8-13
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21
Q

What changes occur in boys during puberty and at what age?

A 
Genital development
Pubic hair
Spermatogenesis
Growth spurt
9-14
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22
Q

Why are men usually taller than women?

A

Their growth spurt is longer and faster. It ends when the epiphyseal plates fuse which happens earlier in girls due to oestrogen

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23
Q

What is the hormonal control for the following: adrenarche, thelarche, growth spurt and genital development.

A

Androgens
Oestrogen
GH and steroids
Testosterone

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24
Q

What is precocious puberty and some possible causes?

A

Puberty under 8 y/o

Pineal tumour, meningitis, hormone secreting tumours

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25
Q

Explain what occurs in pre-menopause

A

40 years

Shorter follicular phase causing lower oestrogen and higher LH and FSH. Fertility reduced

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26
Q

Explain menopause

A

Cessation of menstrual cycles 49-50

Lower oestrogen and higher LH and FSH

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27
Q

What changes may accompany menopause?

A

Hot flushes, regress/shrink endometrium/myometrium, thin cervix, lose vaginal rugae, involuted breast tissue, skin/bladder changes and reduced bone mass

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28
Q

Define amenorrhea

A

Absence of periods for 6+ months

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29
Q

Differ between primary and secondary amenorrhea

A

Primary - never had a period (by age 14 with no secondary sexual characteristics or 16 with them)
Secondary - established menstruation ceased for 3 months if regular or 6 if irregular

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30
Q

Define oligomenorrhoea, dysmenorrhea, menorrhagia and cryptomenorrhea

A

Infrequent
Painful
Heavy
Not visible due to obstruction

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31
Q

Differ between a ovulatory and ovulatory cycles

A

Anovulatory - no luteal phase, oligomenorrhoea and potentially heavy
Ovulatory - normal cycles with dysmenorrhea and mastalgia

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32
Q

Explain how hypothalamic/pituitary problems cause amenorrhe and give examples of primary and secondary types

A

Less FSH, less oestrogen so less lining
Kallmann syndrome
Exercise, stress, weight
Hypopituitarism

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33
Q

Explain how gonadal problems cause amenorrhea and give examples of primary and secondary types

A

Primary - dysgenesis and androgen insensitivity

Secondary - pregnancy, menopause, drug induced

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34
Q

What might cause outflow amenorrhea?

A

Müllerian agenesis
Vaginal atresia
Intra uterine adhesions

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35
Q

Explain dysfunctional uterine bleeding

A

No corpus luteum so no progesterone so oestrogen levels are higher and therefore the uterine lining is thicker

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36
Q

What is the difference between an STI and STD?

A

STI can be asymptomatic

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37
Q

Who is at risk of STIs?

A

Young people
Certain ethnicities
Low socio economic status
Behaviour - first intercourse, partners, orientation, unsafe

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38
Q

Why is incidence of STIs increasing?

A

Changing sexual/social behaviour
Better screening and diagnosis
Greater awareness

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39
Q

What is the burden of STIs?

A

Stigma, lead to PID, infertility, cancer, disseminate, transfer to foetus

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40
Q

In general how should STIs be managed?

A

Short course of antibiotics
Screen and treat for co infections
Contact tracing
Educate

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41
Q

Explain HPV and how it’s diagnosed/managed

A

Cutaneous, mucosal, painless anogenital warts
Increase risk of cervical cancer
Don’t treat unless prolonged (cyrotherapy/interferon)
Vaccine

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42
Q

What are the symptoms of chlamydia in a male and female?

A

Urethritis, epididymitis, prostatis, proctitis

Urethritis, cervicitis, salpingitis, peri hepatitis

Can affect eyes and neonates

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43
Q

How so chlamydia treated?

A

Doxycycline/azithromycin

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44
Q

What are the symptoms of herpes? How is it treated?

A

Painful genital ulceration, dysuria, inguinal lymphadenopathy, pyrexia

Aciclovir

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45
Q

How is gonorrhoea treated?

A

Ceftriaxone + testing and treatment for chlamydia (azithromycin)

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46
Q

What are the stages of syphilis?

A

1 - painless ulcer
2 - fever, rash, lesions, lymphadenopathy
Latent
3 - neuro/cardiovascular syphilis

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47
Q

Who is syphilis more common in, how is it diagnosed and how is it treated?

A

MSM
Serology/dark field microscopy
Penicillin

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48
Q

What symptoms does trichomonas vaginalis cause? How is it treated?

A

Thin, frothy, offensive discharge, irritation, dysuria, inflammation
Metronidazole

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49
Q

What is the cause of bacterial vaginosis? How is it diagnosed and treated?

A

Perturbed flora - gardnerella
Scanty, fishy discharge
pH>5, KOH whiff test, gram stain
Metronidazole

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50
Q

What is pelvic inflammatory disease?

A

Infection ascending from endocervix to uterus causing - endometritis, salpingitis, oophoritis, tubo-ovarian abscess

51
Q

What are the features of PID?

A

Pyrexia, pain, discharge and bleeding

52
Q

How is PID diagnosed and managed?

A

Triple swab - endocervix and high vagina
Analgesia
Antibiotics - ceftriaxone, doxycycline, metronidazole

53
Q

What else could PID be mistaken for?

A

Ectopic pregnancy, endometriosis, ovarian cyst, irritable bowel syndrome, appendicitis and UTI

54
Q

What is the blood supply to the ovaries and where do they come from/drain into?

A

Abdominal aorta–>ovarian artery

Right ovarian vein–>IVC
Left ovarian vein–>Left renal vein

55
Q

What are the parts of the uterus?

A

Fundus
Body
Cervix
Uterine tubes

56
Q

What are the uterus’ anterior and posterior pouches?

A

Anterior - uterovesical pouch

Posterior - recto uterine pouch (pouch of Douglas)

57
Q

What are the main ligaments that support internal female genitalia?

A

Broad ligament - sheet if peritoneum supporting ovaries and uterus
Suspensory ligament of ovary
Round ligament - remnant of gubernaculum

58
Q

How is the uterus normally positioned in regards to the vagina and cervix?

A

Vagina - anteVerted

Cervix - antefleXed

59
Q

What are the main parts of the uterine tube?

A

Ostium, fimbriae, infundibulum, ampulla, isthmus

60
Q

What are the main parts of the cervix?

A

Internal os
Endocervical canal
External os

61
Q

What artery does the uterine and internal pudendal artery come off of?

A

Anterior division of internal iliac

62
Q

Where does the ovary and uterus lymph drain to?

A 
Ovary - para aortic nodes
Uterus:
Fundus - aortic nodes
Body - external iliac nodes
Cervix - external, internal iliac and sacral nodes
63
Q

What is the nerve supply to the vagina?

A

Inferior 1/5 - pudendal

Superior 4/5 - uterovaginal plexus

64
Q

What is contained within the scrotum?

A

Testis, epididymus and spermatic cord

65
Q

Outline the anatomy of the testis

A

Tunica vaginalis
Tunica albuginea
Separated into lobules by fibrous septal

66
Q

Outline the blood supply to the testis

A

Testicular arteries directly from abdominal aorta

Right testicular vein to IVC
Left testicular vein to left renal vein

67
Q

What are the possible causes for scrotal swelling?

A

Hydrocoele - serous fluid in tunica vaginalis
Haematocoele - blood in tunica vaginalis
Varicocoele - pampiniform vein varicosities
Spermatocoele - cyst
Epididymitis
Testicular tortion
Indirect hernia

68
Q

What are the contents of the spermatic cord?

A 
Arteries - testicular, cremasteric, artery to vas
Nerves - genitofemoral, 2x autonomic
Pampiniform plexus
Vas deferens
Lymphatics
69
Q

What are the coverings of the spermatic cord?

A

External spermatic fascia - external oblique
Cremasteric fascia - internal oblique/transversalis
Internal spermatic fascia - transversalis

70
Q

What is the innervation to the scrotum?

A

Anteriorly - lumbar plexus

Posteroinferiorly - sacral plexus

71
Q

Where do the lymphatics drain from the testis and the scrotum?

A

Testis-paraaortic nodes

Scrotum - superficial Inguinal nodes

72
Q

What does the prostate interact with?

A

Base - neck of bladder
Anterior/apex - urethral sphincter
Posterior - rectum

73
Q

What is BPH and what are the symptoms?

A

Benign prostate hyperplasia - obstruct internal urethral orifice
Dysuria, nocturia and urgency

74
Q

What internal structures are found in the penis?

A

2x corpora cavernosa
1x corpus spongiosum
Internal pudendal artery
Bulbospongiosum - expel last urine and maintain erection
Ischiocavernosus - compress veins maintaining erection

75
Q

What are the four parts of the male urethra?

A

Preprostatic
Prostatic
Membranous
Spongy

76
Q

What are the functions of the pelvic floor?

A

Support pelvic organs
Continence
Child birth
Truncal stability

77
Q

How can the pelvic floor be damaged and what may this cause?

A

Childbirth, age, menopause, obesity, chronic cough

Prolapse and incontinence

78
Q

How is incontinence treated and what are some potential side effects?

A

Pelvic floor exercises
Surgery - vaginal tape

Voiding difficulties

79
Q

How is prolapse treated and what are some potential side effects?

A

Remove organs, restore connective tissue support, maintain function

Recurrence, incontinence and dysparenunia

80
Q

How long does sperm take to mature and how many are produced a second?

A

74 days

1000

81
Q

What are the phases of coitus?

A

Excitement, plateau, orgasmic, resolution +- refractory

82
Q

How does a male get an erection?

A

Stimulants - psychogenic or tactile
Efferents - pelvic nerve PNS, pudendal nerve somatic
Haemodynamic changes

83
Q

What are the causes of erectile dysfunction?

A 
Psychological
Tear copra cavernosa
Vascular
Drugs
Alcohol
84
Q

What happens during ejaculation?

A

Contract glands and ducts and internal bladder sphincter

Rhythmic striatal contractions

85
Q

What is abnormal sperm count?

A

30% abnormal morphology

86
Q

Explain the contents of seminal vesicle, prostatic and bulbourethral secretions

A

Alkaline to neutralise acid. Fructose and clotting factors

Acidic and proteolytic

Lubricate

87
Q

How does the cervical mucus differ during the menstrual cycle?

A

Progesterone and oestrogen - sticky plug at cervix

Oestrogen only - non viscous

88
Q

When is the fertile period?

A

3 days prior and up to ovulation

89
Q

How is an oocyte transported? How is polyspermy prevented?

A

Cilia and peristalsis

Cortical reaction

90
Q

What are the types of contraception?

A

Natural - abstinence, rhythm, coitus interruptus
Prevent sperm entering ejaculate - vasectomy
Prevent sperm reaching cervix - condom, diaphragm, cap, spermicide
Prevent ovulation + sperm pass cervix-OCP, implant, progesterone only
Prevent Fallopian tube movement - hormones and clip/ligate
Prevent implantation - hormones, post coital and intrauterine device

91
Q

What is primary and secondary infertility?

A

Never been pregnant

Been pregnant before

92
Q

What are some reasons for infertility?

A

Anovulation
Tubal occlusion
Abnormal sperm

93
Q

What does haemomonochorial mean?

A

The fetal and maternal blood is only separated by a single layer of trophoblast

94
Q

What are the aims of implantation?

A

Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta

95
Q

What are the primary, secondary and tertiary villi?

A

Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels

96
Q

What is decidualisation?

A

The endometrium resists the trophoblast invasive force

97
Q

What is the difference between the placenta in the 1st trimester and the term?

A

Greater surface area, thin barrier with just one layer cytotrophoblast

98
Q

What does the placenta synthesise?

A

Glycogen, cholesterol and fatty acids

99
Q

What are the endocrine functions of the placenta?

A

Synthesise hCG, progesterone and oestrogen

100
Q

What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?

A

Water
Glucose
Amino acids

101
Q

What maternal changes are there in the CVS?

A

Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR

102
Q

What are the differences between pre-eclampsia and normal pregnancy?

A

Eclampsia vasoconstrict and plasma contract as opposed to the opposite

103
Q

What changes are there in the urinary system?

A

Increase GFR, clearance and protein excretion

Decrease urea, bicarbonate and creatinine

104
Q

What changes are there in the respiratory system?

A

Decrease functional residual volume and PaCO2

Increase O2 consumption and tidal volume

105
Q

What does the physiological hyperventilation in pregnancy cause?

A

Respiratory alkalosis leading then to more bicarbonate being produced

106
Q

What metabolic changes accompany pregnancy?

A

Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4

107
Q

How does the GI system change in pregnancy?

A

Move appendix to RUQ

Delayed emptying and biliary stasis

108
Q

How does the blood change in pregnancy?

A

Pro-thrombolytic state. Can’t give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves’ disease

109
Q

What does haemomonochorial mean?

A

The fetal and maternal blood is only separated by a single layer of trophoblast

110
Q

What are the aims of implantation?

A

Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta

111
Q

What are the primary, secondary and tertiary villi?

A

Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels

112
Q

What is decidualisation?

A

The endometrium resists the trophoblast invasive force

113
Q

What is the difference between the placenta in the 1st trimester and the term?

A

Greater surface area, thin barrier with just one layer cytotrophoblast

114
Q

What does the placenta synthesise?

A

Glycogen, cholesterol and fatty acids

115
Q

What are the endocrine functions of the placenta?

A

Synthesise hCG, progesterone and oestrogen

116
Q

What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?

A

Water
Glucose
Amino acids

117
Q

What maternal changes are there in the CVS?

A

Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR

118
Q

What are the differences between pre-eclampsia and normal pregnancy?

A

Eclampsia vasoconstrict and plasma contract as opposed to the opposite

119
Q

What changes are there in the urinary system?

A

Increase GFR, clearance and protein excretion

Decrease urea, bicarbonate and creatinine

120
Q

What changes are there in the respiratory system?

A

Decrease functional residual volume and PaCO2

Increase O2 consumption and tidal volume

121
Q

What does the physiological hyperventilation in pregnancy cause?

A

Respiratory alkalosis leading then to more bicarbonate being produced

122
Q

What metabolic changes accompany pregnancy?

A

Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4

123
Q

How does the GI system change in pregnancy?

A

Move appendix to RUQ

Delayed emptying and biliary stasis

124
Q

How does the blood change in pregnancy?

A

Pro-thrombolytic state. Can’t give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves’ disease

ESA 4 Steven (3 decks)

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