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Repro > repro huge review - minus pregnancy foetus and giving birth and gametogenesis and peritoneum > Flashcards

repro huge review - minus pregnancy foetus and giving birth and gametogenesis and peritoneum Flashcards

1
Q

what makes up the testes

A

seminiferous tubules, made up of sertoli cells (site of spermatogenesis)

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2
Q

what surround seminiferous tubules

A

tunica albuginea - leydig cells secrete testosterone (lipid)

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3
Q

Blood supply to testes

A

abdominal artery- gonadal artery

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4
Q

venous drainage

A

right - right testicuar to IVC
left- left testicular to left renal to IVC

pampimiform plexus

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5
Q

lymph drainage of testes

A

para aortic

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6
Q

scrotal lymphatic drainage

A

inguinal lymph notes

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7
Q

spermatic cord made up of

A

3 fascia layers (internal, cremasteric, external0
3 arteries (testicular, to vas, cremasteric)
3 veins (testicular, to the vas, cremasteric0
3 nerves (ilioinguinal, cremasteric, sympathetic)
vas deferens

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8
Q

layers of scrotum

A

S skin
D dartos fascia and muscle
E external spermatic fascia (EO muscle)
C cremasteric fascia and muscle (IO)
I internal spermatic fascia (transverse abdominus)
T tunica vaginalis
T tunica albuginea

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9
Q

cremasteric muscle supply

A

cremasteric artery vein and nerve

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10
Q

functions of prostate

A

prevent urine escaping, produce alkaline solution

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11
Q

BPH and prostate cancer location

A

transitional zone BPH
peripheral zone cancer

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12
Q

what goes through prostate as well as urethra

A

vas deferens, joined by ejaculatory duct before, bringing fructose rich solution from seminal vesicle

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13
Q

ejaculate make up

A

65% seminal fluid
25% prostate
10% testes

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14
Q

penis blood supply

A

internal iliac artery, smaller vessels can get blocked by atherosclerosis giving erectile problems

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15
Q

Erection nerve control

A

vasodilation PNS
vasoconstriction to terminate erection SNS

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16
Q

nervous system for ejaculation

A

sympathetic

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17
Q

external os pre and post baby

A

pre is hole, post is slit

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18
Q

uterus in pregnancy

A

push up on stomach - acid reflux
push down on bladder - frequency
push back on LI - constipation

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19
Q

vagina

A

full of glycogen for lactobacillus, lactic acid. Less oestrogen = less glycogen = less respiration altering ph

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20
Q

What is pouch of douglas

A

recto uterine pouch, fluid build up can cause shoulder tip pain due to parabolic gutters irritating diaphragm supplied by phrenic nerve C3,4,5

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21
Q

peritoneal ligaments

A

Broad ligament- mesometrium, mesosalpinx, mesovarium

Suspensary ligament to the ovary - covers blood vessels and nerves to uterus

Round ligament and ligament to ovary- remnants of gubernaculum

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22
Q

blood supply female repro system

A

uterine artery (internal iliac), ovarian artery (abdominal aorta), pam-uniform venous plexus

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23
Q

important in hysterectomy

A

ureter travels under uterine artery - must not damage ureter

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24
Q

lymph nodes of uterus drain to

A

para aortic sinus

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25
Q

lymph nodes of cervix drain to

A

internal/external iliac and sacral

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26
Q

normal uterus position

A

anteverted and ante flexed (less than 180 degrees)

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27
Q

journey of egg

A

1- burst through peritoneal membrane of ovary, fimbrae in fallopian tubes
2 - goes through infundibulum, ampulla (fertilisation/ectopic pregnancy), isthmus (ciliated cells help)

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28
Q

fallopian tubes features

A

infection can spread from fallopian tubes into peritoneal cavity eg STI, contain peg cells (secrete factors to nourish and maintain egg), and ciliated cells

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29
Q

ovarian cancer

A

egg bursts through ovary causing trauma

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30
Q

cervical cancer

A

columnar epithelium of cervix exposed to acidic environment of vagina in transitional zone, this exposed area is not used to this unlike stratified squamous cells, metaplasia occurs

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31
Q

ovarian cysts

A

fluid filled lesions, pain due to stretching of peritoneum, rupture, direct pressure and torsion. DO not burst due to seeding

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32
Q

Ectopic pregnancies

A

felt as severe pain on side of implantation, confused with appendicitis. Rupture - uterine and ovarian arteries can cause haemorrhage

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33
Q

Endometriosis

A

endometrial tissue which is normally found lining inside of uterus is found elsewhere, possibly pouch of douglas

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34
Q

embryonic development of girl or boy

A

start with primordial germ cells

SRY from Y chromosome = testes and vas deferens and epididymis

No SRY (XX) - gonads develop into ovaries and uterus tubes and vagina

following this external genitalia will develop (either penis/scrotum or vulva)

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35
Q

urogenital and GI tract development

A

3 systems from hindgut (tube from yolk sac folding), dilated end (cloaca)

Cloaca has no surrounding mesoderm, no blood supply, so causes orifice

Urogenital ridge - area of intermediate mesoderm, produces kidneys and gonads

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36
Q

how do primordial germ cells get to urogenital ridge

A

come from allantois into wall of yolk sac and migrate along retroperitoneum to urogenital ridge

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37
Q

Duct differentiation

A

paramesonephric (mullerian) and mesonephric (wollfian)

Men - SRY causes androgens, testis produce Mullein inhibiting hormone, paramesonephric ducts regress. Androgens support development of mesonephric ducts - vas deferens and epididymis. Testis migrate down gubernaculum

Women - no SRY, no androgens, no MIH, paramesonephric ducts develop and mesonephric ducts degenerate. PM ducts move towards each other and fuse to form one tube, meets urogenital sinus, produces uterus and vagina

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38
Q

what can go wrong in duct differentiation

A

exogenous androgens but no testis to produce MIH = both ducts develop

Androgen insensitivity syndrome = testosterone receptors don’t work so both ducts degenerate as MIH still present

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39
Q

external genitalia production

A

genital tubercle, folds and swellings in both genders

Male - genital tubercle elongates, genital folds fuse to form spongy urethra, driven by androgen dihydrotestosterone

Female - no fusion, genital swelling grows to labia majora and minor, genital tubercle forms clitoris

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40
Q

Descent

A

male - testis are retroperitoneal, descend down gubernaculum (attaches gonads to future scrotum), takes layers of muscle wall with it

Female - ovary descends down gubernaculum, has some remnants (round ligament and ligament to ovary)

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41
Q

what influences puberty

A

pineal gland; melatonin
47kg in girls - leptin will sense amount of adipose to sense if adequate for reproductive life
nutrition

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42
Q

puberty scale

A

Tanner scale

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43
Q

precocious puberty causes (pre 8)

A

congenital adrenal hyperplasia, hydrocephalus, brain injury, pineal tumour, meningitis (GnRH pulsations interfered with)

shorter child as epiphyseal growth plates fuse earlier, GnRH analogues block pituitary hormones = treatment

44
Q

Delayed puberty

A

If LH and FSH hormones are normal, blockage preventing menstruation, ovaries don’t respond to oestrogen

LH and FSH low due to weight or malnutrition

gonadal or pituitary problem

45
Q

Female puberty

A

9-13, breast buds and pubic hair (testosterone)
Adrenarche - growth spurt and menstruation
Menarche - adult pubic hair and breasts

Aromatase = testosterone into oestrogen
Oestrogen closes epiphyseal growth plates and maintain bone mass

46
Q

Male puberty

A

begins 10-14 with testicular development (4ml)
pubic hair growth and spermatogenesis
growth spurt (12 months after start), adult genitalia and pubic hair

47
Q

initial levels of pre puberty testosterone and oestrogen boys and girls

A

same

48
Q

HPG axis - hypothalamus - pituitary - gonadal

A

HPG axis switches on by gradual increase of GnRH in pulses from hypothalamus, controlled by Leptin and Photoperiod

GnRH travels in blood to AP, LH and FSH produced

pulsation avoids down regulation of GnRH receptor

GH needed for growth spurt

49
Q

HPG axis control

A

positive and negative feedback, androgens and oestrogens prevents GnRH being produced

natural rise in pulsating of LH during sleep (hence high morning testosterone)

50
Q

HPG in females

A

FSH target ovarian cells known as granulose cells to produce oestrogen

LH targets ovarian cells known as Theca internal cells to produce androgens

stimulate sex hormone production of oestrogen, progesterone and inhibit

51
Q

feedback of HPG female

A

normal oestrogen = negative GnRH production

High = positive GnRH = LH surge

Progesterone prevents positive feedback from oestrogen and will increase negative feedback

52
Q

Inhibit role women

A

produced by granulose cells in corpus lute to inhibit FSH

53
Q

HPG in males

A

LH - leading cells, testosterone 9affected vy circadian cycle and environment)

FSH - sertoli cells, maturation of sperm cells and inhibin secretion (causes negative feedback on FSH0

54
Q

sertoli cells features

A

gives blood barrier due to tight junctions, good as sperm is foreign antigens ( non self) and would be destroyed by bodies immune system

55
Q

corpus luteum produces

A

oestrogen and progesterone

56
Q

menopause hormones

A

follicle cells depleted, sex steroid hormones decrease, initially low oestrogen causes negative feedback so FSH and LH increase (FSH by more as less inhibin)

57
Q

progesterone contraception

A

mucus sticky and stops sperm entry

58
Q

ovarian cycle

A

follicle stage, luteal stage (corpus lute)

59
Q

endometrial cycle

A

proliferative and secretory stage
oestrogen - proliferative
progesterone - specialise

Functional layer = hormone responsive, sheds if no pregnancy
Basal layer = grows functional layer

60
Q

thickening of lining and mucous

A

Thickening occurs during follicular stage due to oestrogen thickening endometrium and myometrium

progesterone causes thickening of cervical mucous and endometrium to specialise into secretory form

Increases body temp, metabolic changes

61
Q

Endometriosis

A

causes irritation to peritoneum giving adhesions, these areas respond to oestrogen

GnRH agonist would stop FSH and LH but this would cause osteoporosis

62
Q

stages of menstrual cycle

A

preparation of gamete
ovulation
luteal/waiting phase
fertilisation

63
Q

Preparation of gamete

A

FSH increases = primordial follicle into graafian follicle (mature), binds to granulose cells and allows theca interna development (day 1)

Mature follicle secretes oestrogen and inhibin secretion begins

FSH allowed to increase due to lack of inhibin up to this point

Low oestrogen levels prevents FSH and LH rising too much

Oestrogen and inhibin rise due to follicle secreting oestrogen

Positive feedback causes LH surge, but little FSH due to inhibin

Progesterone production begins as granulose cells become responsive to LH

64
Q

Ovulation

A

rise in LH causes oocyte to complete meiosis 1 and 2 will start as well as ovulation

corpus luteum produces oestrogen and progesterone and inhibin

neg feedback - LH and FSH suppressedL

65
Q

Luteal/waiting phase

A

corpus luteum producing all 3, regress in 14 days if no further rise in LH

fall in ovarian and gonadal hormones = cycle reset unless fertilisation occurs

66
Q

Fertilisation

A

Syncytiotrophoblast produces HcG, same effect as LH, maintains neg feedback so no more FSH or new gametes maturing

corpus luteum and placental HcG = hormones to support pregnancy until placenta capable

67
Q

Amenorrhoea

A

primary = failure to establish menstruation by 16
secondary = stopping of previously normal menstruation for over 6 months

main causes = pregnancy and menopause, or hormonal problems

68
Q

Common menorrhagia causes

A

fibroids, polyps, endometrial cancer, bleeding diathesis, warfarin

69
Q

Fibroids

A

benign tumours of smooth muscle of myometrium, hormone dependant, can go away at menopause. Cause heavy bleeding due to large surface area

Treated with GnRH agonists

70
Q

Dysmenorrhea

A

primary = idiopathic
secondary = endometriosis or obstructed menses

71
Q

Turners syndrome

A

XO, problems with ovary so it would respond to GnRH, FSH or LH

72
Q

semen

A

seminal vesicles = fructose
prostate gland = citric acid
bulbourethral = alkaline

73
Q

Gonorrhoea

A

gram negative diplococcus

males - urethral/anal discharge, dysuria
Females - asymptomatic, discharge, abdo pain

IM ceftriazone and oral azithromycin (good for chlamydia)

74
Q

Abnormal discharge

A

chlamydia, gonorrhoea, trich (frothy), BV (fishy white thin), candida albicans (thick white)

75
Q

ulceration

A

herpes painful, syphilis not painful

76
Q

skin manifestations

A

anogenital warts, scabies, pubic lice

77
Q

systemic complications

A

PID, reactive arthritis

78
Q

chlamydia

A

chlamydia trachoma’s

male- dysuria, urethritis
female - asymptomatic, increased discharge and intermensterual bleeding

Conjunctivitis and pharyngeal infection

doxycycline

79
Q

why can you gram stain chlamydia

A

doesn’t have cel wall, use serology, urine tests and PCR

urine test in men and endocervical swabs in women

80
Q

syphilis

A

treponema pallidum

painless ulcer, 10 weeks after get rash, latent stage, tertiary stage (systemic eg aortic regurgitation)

congenital syphillis

PCR and serology

early syphilis = benzathine pencicillin

81
Q

testing for STIs

A

men = urine sample for chlamydia, bloods, rectal samples, swab ulcers

women = endocervical swabs for chlamydia and gonorrhoea

high vaginal swabs for BV

bloods/urine sample/swab ulcers

82
Q

trichomonas vaginalis

A

protozoa

frothy discharge, dysuria, strawberry cervix

metronidazole

83
Q

HSV

A

HSV 1 = oral and labial
HSV 2 = recurrent symptoms

painful ulceration, dysuria and discharge, fever

virus detection from vesicle fluid serology

aciclovir

84
Q

anogenital warts

A

benign, HPV virus 6 and 11

physical excision/prevent with vaccination

85
Q

BV

A

imbalance of pH, fishy discharge, metronidazole

86
Q

candidiasis

A

candida albicans, COCP increases risk

vaginal discharge, itching, soreness

high vaginal smear

topical and oral antifungals

87
Q

PID

A

infection ascending from endocervic causing endomertritis, salpingitis and ovarian abscesses

can cause adhesions, infmallatory exudate can fill tubes, can cause peritonitis

abdo pain, pyrexia, abnormal discharge, vaginal bleeding

88
Q

causes of PID

A

chlamydia, gonorrhoea, BV, copper coil insertion

89
Q

consequences of PID

A

future ectopic pregnancies, infertility, chronic pelvic pain (fixed retroverted uterus), Fitz Hugh Curtis syndrome (RUQ pain and hepatitis as peritonitis spreads to liver, seen in chlamydia)

90
Q

PID treatment

A

ceftriazone, doxycycline and metronidazole for 14 days

surgery for adhesions and abscesses

91
Q

menopause

A

end of menstruation for 12 months with no biological cause

45-55

pathological pre 40

92
Q

histology of cervical cancer

A

dyskaryosis (abnormal nuclei0, increased nuclear:cytoplasmic ratio, abnormal chromatin, mitotic figures

93
Q

cervical cancer risk factors

A

HPV 16 and 18, E6 and E7 produced, inhibit tumour suppressing p53 and pRB

94
Q

Screening for cervical cancer

A

Pap test and colposcopy

95
Q

CIN

A

Cin I = some dysplasia but mostly regresses
CIN II = some more
CIN III = carcinoma in situ, not invaded basement membrane, can cone excise

96
Q

Invasive cervical cancer

A

SSC most common, can be adenocarcinoma

Exophytic (polyps) or infiltrative (through basement membrane). Spreads to bladder, ureter, rectum, vagina and para-aortic lymph notes

Screening abnormality, vaginal bleeding

excision/hysterectomy/chemotherapy

97
Q

Ovarian cancer presentation

A

functional (hormones) or non

Non functional = ascites, distension, pain

CA - 125

BRAC associated

COCP protective

98
Q

Classification of ovarian tumours

A

Mullerian epithelial tumours - serous, mucinous, endometriod

Germ cell tumours - teratomas mostly, rarely malignant or mono dermal (thyroid), can get yolk sac tumours and choriocarcinomas (malignant)

Sex cord stromal cell - endocrine areas of ovaries (feminising or masculinising)

Mets to ovaries - kruckenberg tumour = from stomach

99
Q

vulvar tumours

A

usually SSC, HPV and lichen sclerosis are risk factors

VIN = precursor (not in basement membrane)

Vulval cell carcinoma = spreads initially to inguinal, pelvic, iliac and para-aortic lymph nodes. Can then spread to lungs and liver

100
Q

endometrial cancer

A

endometrial hyperplasia caused by increased oestrogen (an ovulation, obesity and exogenous oestrogen)

In obesity, adipose tissue contains aromatase to convert androgens into oestrogen so there’s more circulating

101
Q

endometrial adenocarcinoma

A

presents with vaginal bleeding, can be polyploid or infiltrative, endometriod or serous

Endometrioid endometrial adenocarcinoma = most common, usually from hyperplasia

Serous carcinoma = more aggressive as cells can drop off, spread to other locations and still be viable

102
Q

Leiomyomas

A

fibroids = benign smooth muscle tumours ,white and well shaped

Heavy/painful periods, urinary frequency due to bladder compression, infertility

rarely become malignant to cause uterine leiomyosarcoma which mets to lungs

103
Q

testicular cancer

A

AFP and HCG

risk: testes fail to descend: Cryptorchidism = orchiopexy needed

2 types germ cell (NS or Seminomatous), or sex cord stromal (sertoli or Leydig)

104
Q

Non seminomatous testicular tumours

A

mix of yolk sac tumours, embryonal carcinomas, choriocarcinomas and teratomas

teratomas are malignant post puberty

seminomas spread to iliac and para aortic lymph nodes

Non seminomatous spread earlier

105
Q
A

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