Repro review Flashcards
what does the round ligament of the uterus connect?
the uterus with the labia majora
what investigations can be used if external genitalia ambiguous at birth?
hormonal tests
gonadal sex
karyotyping
anatomy e.g. gonad palpation, length and diameter of any phallus (penis), urethral meatus position
determination of gonadal sex?
presence/absence of Y chromosome which has an SRY gene on its short arm= sex-determining region of Y chromosome
if a Y chromosome is present in the germ cells, testes will always be produced
In turner’s syndrome, ovaries develop normally until 15th wk of gestation, ova then begin to degenerate and disapperar, what may be presentation at puberty?
short stature
primary amenorrhoea
poor breast development
what gonads would be produced if sex chromosome mosaic of XY,XX (or XO) cells?
both male and female gonadal tissues
This is true/primary hermaphroditism, but has not been described in humans
how is spontaneous development of female genitalia stopped in male?
MIH secretion from sertoli cells
testosterone secretion from leydig cells from 9wks gestation
what does the prostate develop from?
urogenital sinus, formed from division of cloaca
what does the vagina develop from?
upper part from paramesonephric ducts
lower part from urogenital sinus
what do the urethral folds give rise to in the male?
ventral aspect of shaft of penis, including the spongy urethra
example of a disorder of sex development where the genotypic (chromosomal) sex does not match the phenotype- physical appearance?
congenital adrenal hyperplasia
characteristics of a patient with androgen insensitivity syndrome?
patients are male with Y chromosome and testes, BUT lack of androgen receptors or failure of tissues to respond to receptor-dihydrotestosterone complexes, so androgens ineffective at inducing differentiation of male genitalia.
PM system suppressed by MIH from testes, so no uterine tubes or uterus.
Ambiguity of external genitalia as dihydrotestosterone necessary for fold fusion of genital swellings to form scrotum, and urethral folds to form ventral aspect of shaft of penis and penile urethra
outcome of dihydrotestosterone lack in a male during sexual development?
external genitalia do not develop normally as this hormone causes fusion of LS folds and urethral folds, so they may appear male but be underdeveloped with hypospadias- urethral fold fusion incomplete with abnormal openings of urethra along inferior aspect of penis, on ventral surface, or they may appear to be female with clitoromegaly.
symptoms of Klinefelter’s (47, XXY)?
reduced fertility
small testes
reduced testosterone gynecomastia
commonly result of nondisjunction of XX homologues
Gonadal dysgenesis- oocytes absent, ovaries appear as streak gonads as comprise mainly fibrous tissue, occurs in Turner’s, what are the symptoms?
webbed neck short stature shield-like chest cardiac and renal anomalies inverted nipples
how may a bifid penis occur?
splitting of genital tubercle
what is epispadias?
urethral meatus found on dorsum of penis
assoc with exstrophy of bladder and abnormal closure of ventral body wall
what is a bicornate uterus and how does it occur?
uterus has 2 horns entering a common vagina
result of incomplete fusion of paramesonephric ducts
how do germ cells reach the indifferent gonad?
diploid cells originate from epiblast and arise in the yolk sac, then migrate along doral mesentery into retroperitoneum to enter gonadal ridge
what is mullerian agensis?
characterized by a failure of the müllerian duct to develop, resulting in a missing uterus, fallopian tubes, and variable malformations of the upper portion of the vagina
why does cryptorchidism occur?
gubernaculum fails to develop or fails to pull testes into scrotum
reflection of androgen abnormalities
changes to spermatids to form spermatozoa?
cell elongation
flagellum formation
organelle reorientation
cytoplasmic removal
How much body weight does brain account for at birth
12%
difference between anterior pituitary and hypothalamus, where does A pituitary arise from?
A pituitary= endocrine gland
hypothalamus= nervous tissue
A pituitary arises from Rathke’s pouch
summarise target tissues and actions of FSH, LH, TSH, ACTH, MSH, GH and prolactin
Gonads Growth of reproductive system
Gonads Sex hormone production
Thyroid Gland Secretion of thyroid hormones
Adrenal Gland Secretion of glucocorticoids
Melanocytes in Skin and Hair Production and release of melanin
Liver, adipose tissue Promotes growth, lipid and carbohydrate metabolism
Ovaries, mammary glands Secretions of oestrogen, progesterone, milk production
common causes of early puberty in boys?
CAH
pineal tumours
meningitis
how could puberty be delayed?
androgen receptor blockers
treat underlying condition e.g. CNS lesion
drugs to inhibit anter. pituitary gonadotropin secretion
what adrenal gland disorders may cause virilisation in males but no more development?
congenital adrenal hyperplasia- adrenal hyperfunction due to enzyme deficiency
adrenocortical tumour
how can CAH and adrenocortical tumour be differentiated between?
CAH- high level of 17-hydroxyprogesterone
US then CT for tumour, biopsy if imaging shows tumour
effects of oestrogen depletion that menopausal women might experience?
hot flushes poor sleep vaginal/urethral atrophy dysparenuria, dysuria breast atrophy mood changes/depression OP changing cholesterol/lipid profile, poss increased CHD risk
tments for menopause problems?
HRT- oestrogen or combined
calcium
function of progesterone administered in addition to oestrogen in HRT to women not having had a hysterectomy?
reduce risk of endometrial cancer as progesterone inhibits proliferation of uterine lining stimulated by oestrogen
why do fibroids regress after the menopause?
they are hormone dependent
how are fibroids diagnosed?
US
bimanual examination
how to assess menstrual blood loss?
pad and tampon counts, and measure HB/haematocrit levels
menstrual loss defining menorrhagia?
> 80ml, which will lead to anaemia
non-surgical approach of treating menorrhagia?
GnRH agonist
surgical approach of treating menorrhagia?
endoscopic resection or abdom. myomectomy or hysterectomy
describe how hormones from hypothalamus reach anter pituitary to exert their action?
releasing hormones neurosecreted from median eminence of hypothalamus and travel to A pituitary in hypophyseal portal circulation, so don’t need to prod a lot as travel directly in a small amount of blood for a short distance, so are not diluted before exerting their action
testosterone in medium to long term is constant as spermatogenesis occurs continuously, but how do its levels vary?
circadian rhythm- highest in early morning
effects of environ stimuli e.g. light/dark
what causes variation in reproductive cycle length?
variation in timing of ovulation- affected by environ e.g. stress
when is a common time for miscarriage and why?
10-14 wks as support of pregnancy changing from CL to placenta
how is cervical mucus made receptive to sperm transport?
oestrogen action on cervical glands
what is the contraceptive action of oestrogen?
acts by -ve feedback to inhibit FSH release and hence prevent follicle development
when is the 1st meiotic division of the oocyte completed?
following the LH surge, with LH acting on LH receptors present on the granulosa cells following the action of oestrogen
which muscle extends between the perineal body and the ischial ramus?
superficial transverse perineus
what is the lateral fornix of the vagina closely related to?
the ureter
muscles forming lateral wall of pelvic cavity?
obturator internus
piriformis- also forms posterior wall
what forms inferior part of pelvic cavity?
pelvic floor/diaphragm= levator ani and cocyygeus (ischio)
how is the pelvic cavity separated from the perineum?
by the pelvic floor
2 holes of significance in structure of pelvic floor?
UG hiatus= situated anteriorly, allows passage of urethra and vagina in females
rectal hiatus= centrally positioned for passage of anal canal
what lies between the UG hiatus and the rectal hiatus?
perineal body
3 roles of pelvic floor muscles?
maintain urinary and fetal continence
support of abdominal and pelvic viscera
resistance to increase in intra-pelvic or abdominal pressure
levator ani attachements?
pubic bones anteriorly
thickened fascia of obturator internus laterally (tendinous arch)
ischial spines posteriorly
main function of puborectalis?
maintain fecal continence
what attaches to perineal body located midway between ischial tuberosities?
fibres of levator ani
bulbospongiosus
superficial transverse perineus
anal sphincters
coccygeus muscle innervation?
A.rami of S4 and S5
course of coccygeus muscle?
It originates from the ischial spines and travels to the lateral aspect of the sacrum and coccyx, along the sacrospinous ligament.
anatomical borders of perineum?
Anterior – Pubic symphysis.
Posterior- The tip of the coccyx.
Laterally – Inferior pubic rami and inferior ischial rami, and the sacrotuberous ligament.
Roof – The pelvic floor.
Base – Skin and fascia.
The perineum can be subdivided by a theoretical line drawn transversely between the ischial tuberosities. This split forms the anterior urogenital and posterior anal triangles. These triangles are associated with different components of the perineum
components of urogenital triangle? (anterior part of perineum, separated from posterior by imaginary line between ischial tuberosities)
deep perineal pouch perineal memebrane superficial perineal pouch deep and superficial perineal fascia skin
in which pouch are bartholin’s glands located?
superficial perineal pouch
in which pouch are bulbourethral glands located?
deep perineal pouch
why can vaginal delivery in childbirth cause pelvic floor dysfunction?
damage to levator ani muscles forming pelvic floor
damage to perineal body
stretching of pudendal nerve which innervates pelvic floor muscles
stretching of ligaments which support the muscles
why might removal of prostate lead to impotence?
autonomic nerves supplying erectile tissues in perineum pass around sides of prostate in pelvis so may be damaged
3 ways baby could be delivered with help?
ventouse delivery
forceps
caesarean section
A patient has primary amenorrhoea and anosmia, what is the likely cause?
Kallman syndrome: genetic defect producing hypogonadotropic hypogonadism in which fetal GnRH neurosecretory neurones fail to migrate normally from the olfactory placode to the medial basal hypothalamus so olfactory bulb doesn’t develop properly
2 most common causes of gonadal dysgenesis?
Klinefelter’s syndrome: testes have a limited capacity to secrete testosterone so low, high FSH and LH due to -ve feedback lack, and so oestrogen prod. proportionally increased produced gynaecomastia
Turner’s syndrome: streak gonads as ovaries replaced by fibrous tissue
risks associated with pre-term birth?
cranial sutures too wide open so pressures of birthing process fail to result in interlocking of cranial bones, so high probability of brain damage in birthing proocess
insufficient surfactant production so susceptibility to respiratory distress syndrome
whens does surfactant prod begin in newborn and when is it markedly increased?
around wk 20
increased after wk 30 when alveoli open in a significant number and SA dramatically increases
why is neonatal jaundice not uncommon?
neonate may not be able to immediately deal with bilirubin after birth as this function was not carried out in utero as fetus unable to excrete bilirubin via gut so remained unconjugated and passed across placenta into maternal circulation
what happens as a result of continued swallowing of amniotic fluid by fetus?
fetal gut absorbs water and electrolytes leaving debris to accumulate together with debris from developing gut in fetal large bowel= MECONIUM- usually only excreted by fetus in distress e.g. fetal hypoxia
when does amniotic fluid reach maximum?
38 wks at 1 litre
where is amniotic fluid derived from in early pregnancy?
by dialysis of fetal and maternal EC compartments with some exchange occurring across fetal skin
when do thalamo-cortical projections reach maturity?
wk 29
what can be measured to assess liver’s functioning in fetus to store glycogen?
fetal abdominal circumference
average birth weight at term in england?
3.5kg
below 2.5 is considered low birth weight
what is the obstetric conjugate?
distance between the sacral promontory and midpoint of PS= narrowest fixed distance the fetal head must pass through during delivery (10.5cm)
why can the obstetric conjugate not be measured directly?
due to presence of the bladder
what is measured instead of the obstetric conjugate prior to labour to assess the female pelvis in pregnancy?
diagonal conjugate: distance from the sacral promontory at the level of the ischial spines to the inferior border of the PS
this is 1.5-2cm longer than the obstetric conjugate
diameter of mid-cavity between pelvic inlet and outlet?
12cm, circular
where is the pelvic outlet narrowest?
mediolaterally (11cm)
reasons for failure to progress in labour? **
POWER: insufficient uterine contractions
PASSENGER: too big e.g. macrosomic fetus due to gestational diabetes, fetal presentation
PASSAGE: abnormal bony pelvis, rigid perineum
which diameter of the pelvis is being measured by the obstetric and diagonal conjugates?
antero-posterior
importance of progesterone action before labour to prevent spontaneous abortion?
it prevents oxytocin from evoking contractions during pregnancy as it reduces the responsiveness of the myometrium to oxytocin, and it reduces uterine PG release again reducing myometrial activity as PGs stimualte contractions by increasing availability of intracellular Ca2+
oestrogen mediated changes in cervix and pelvis that facilitate labour?
cervical softening
relaxation of pelvic ligaments
during advancing pregnancy, what postural change may result from collagenase activity?
a lordosis due to relaxation of vertebral ligaments and additional weight of fetus
what fetal landmark is used to assess fetal head position in birth canal?
fetal fontanelles
what spinal segments are blocked in an epidural for pain relief?
T9-S4
why is there a risk of hypotension after an epidural?
blockage of sympathetic outflow which mediates vasoconstriction of arterioles which normally increases TPR to increase BP
what is post-partum haemorrhage?
blood loss of >500ml after vaginal delivery
most common cause of post-partum haemorrhage?
uterine atony= loss of tone in uteroine musculature so myometrium unable to contract down hard on blood vessels to reduce blood loss
what physiological mechanism prevents PPH?
strong contractions of uterus after 3rd stage of labour, uterus contracted down so arterial supply to the placental bed of the endometrium is clamped
what is at risk of damage in a hysterectomy?
ureter, due to clamping of the uterine artery which lies directly superior to the ureter
what may you consider as a cause for PPH if uterus firm on palapation with contin. bleeding?
retained placenta/ laceration or trauma to genital tract
how does sheehan’s syndrome (possible cause of secondary amenorrhoea) arise?
Thrombosis of vessels supplying the anterior lobe secondary to severe haemorrhage, leading to
necrosis of the anterior pituitary gland which increases in size during pregnancy increasing its
susceptibility to necrosis.
why is poster. pit. unaffected in sheehan’s syndrome?
it receives a relatively rich arterial supply
how to calculate mean aBP?
1/3systolic + 2/3diastolic
triad of symptoms in pre-eclampsia?
hypertension- vasospasm (constriction)
oedema- capillary leak- increased vascular permeability and increased hydrostatic pressure?
proteinuria- renal cell damage secondary to hypoperfusion
renal symptoms of pre-eclampsia?
renal failure
proteinuria
oliguria
what may be the 1st sign in a fetus for pre-eclampsia in mother?
fetal growth restriction
RFs for pre-eclampsia?
occured in previous prg 1st preg multiple gestation diabetes pre-exisiting hypertension
what gestatational disease predisposes to pre-eclampsia?
hydatidiform mole: gestational trophoblast disease with placental overgrowth
pathogenesis of pre-eclampsia?
defect in placentation
failure of invading trophoblast to remodel spiral arteries in endometrium- may be failure of epithelial to endothelial transition
final result in endothelial dysfunction and injury, vessels vasoconstricted and plasma contracted
vascular injury causes coagulation (*Virchow’s triad: blood vessel wall, blood constituents, blood flow abnormalities) and alters vessel smooth muscle responsiveness to vasodilators
why would a breast feeding mother use the progesterone only pill for contraception rather than the combined OCP?
because oestrogen in the combined OCP inhibits the action of prolactin on the breast and so inhibits lactation necessary if breastfeeding
normal day 21 progesterone level?
> 30 nmol/L
what to look for on a semen analysis?
sperm count= 20-200 million sperm per ml
>50% motility
>30% morphology
how could an ovarian cancer metastasise to the lung?
ovaries lymphatic drainage is to para aortic LNs which then drain into intra-thoracic LNs which may allow access to lung?
RFs for ectopic pregnancy?
1 previously prior PID prior tubal surgery current IU device past history of infertility
how can fetal age be measured?
symphysis-fundal height
biparietal diameter of head
CR length
how can the neonatal liver be stimulated to conjugate bilirubin?
exposure to light (phototherapy)
quickest way to diagnoses suspected ectopic pregnancy when patient going into shock?
culdocentesis: needle into posterior fornix of vagina and through into pouch of Douglas where can retrieve non-clotting blood
functions of amniotic fluid?
mechanical protection against trauma
moist environment
fetal temperature control
contributes to fetal pulmonary development
volumes of amniotic fluid in development?
10ml at 8 wks
1L at 38 wks
then falls to 300 ml at 42 wks
reasons for oligohydramnios?
congential renal anomalies: bilateral renal agenesis- could be problem with ureteric bud inducing metanephric blastema to develop into definitive kidney, renal dysplasia, ACEI exposure, urethral or bladder outlet obstruction
uteroplacental insufficinecy: poor perfusion to fetal kidneys e.g. pre-eclampsia, placental abruption
defect in placenta- uteroplacental circulation compromised
premature rupture of membranes
fetal cardiac defects, neural tube defects, NSAIDs
blood test for ovarian cancer?
CA125
how could maternal state be responsible for polyhydramnios?
diabetes meillitus as amniotic fluid vol is dependent on degree of glycaemic control
when does placenta development begin?
days 4 to 5 after fertilisation where cells of morula undergo compaction, producing and outer and inner cell mass comprising pluripotent cells
what is the chorion?
combination of extra-embryonic mesodern and the 2 layers of trophoblast: cytotrophoblast and syncytiotrophoblast
how is a tertiary villus/definitive placental villus formed?
primary villi= cytotrophoblast core covered by syncytium. Mesodermal cells then penetrate villi core and grow toward decidua, forming secondary villus. Mesodermal cells differentiate into blood cells and vessels, forming villous capillary system so now a tertiary villus. Capillaries of villus make contact with those in mesoderm of chorionic plate and in connecting stalk which joint with intraembryonic circulatory system so placenta connected to embyro.
what is the Barker hypothesis?
fetal origins of adult disease: impaired fetal growth linked to LT adult health problems
why might a retained placenta occur and what problems does this cause?
if placenta fragments during labour, part of placenta may remain in uterus which impairs shut-down of utero-placental circulation, so serious post-partum haemorrhage can occur= >500ml blood loss after vaginal delivery
how does the placenta reduce the interhaemal distance and when might this become exaggerated?
margination of fetal capillaries
thinning of trophoblast layer (s)
increased branching of villi to increase SA
exaggerated when defecit if restriction on maternal side or demand for transported materials, e.g. in smokers, or at living at high altitude. Smokers: reduce placental b.flow so poorer fetal nutrition, and so birth weight on average reduced by 200g.
importance of hCG action on corpus luteum when pregnancy occurs?
maintains corpus luteum and actually increases its secretion of oestrogen and progesterone which is vital to maintain the endometrium and hence the pregnancy (remember progest decrease initiates menses via spasm of spiral arteries).
which oestrogen level in maternal serum/urine best indicates fetal progress and why?
oestriol, as only made by fetus and is not converted into anything else
which hormones mediate altered glucose metabolism in pregnancy?
hPL, prolactin, oestrogen and progesterone
name 4 changes occurring in mother during pregnancy related to glucose metabolism?
reduction in maternal blood glucose and aa concs
diminshed maternal responsiveness to insulin in 2nd half
increase in maternal free FA, ketone and triglyceride levels, which can increase risk of gallstones
increased insulin release in response to a normal meal
RAAS activation in pregnancy is necessary to increase circulating blood volume in the mother, but what other important function does it perform?
compensates for expected Na+ loss as a result of increased GFR (increases by 55%)
acid base state of mother in pregnancy?
compensated respiratory alkalosis
how does TV change in pregnancy?
increase by 40%
why is VC unchanged in pregnancy?
VC= IC+ERV, IC is increased with an increase in TV but ERV is reduced as increase in TV and reduction in FRC due to elevation of diaphragm as result of gravid uterus.
why does heartburn occur in pregnancy?
increased reflux due to progesterone mediated relaxation of GI smooth muscle
how does placenta increase calcitriol prod. in mother so that more Ca2+ can be provided to fetus?
placenta produces renal 1 alpha hydroxylase
why does palmar erythema occur in preganancy?
increased oestrogen
diagnostic investigations for pre-eclampsia?
BP >_140mmHg sytolic or 90 diastolic on 2 separate occasions taking at least 4-6hrs apart after 20 wks gestation in woman with previously normal BP proteinuria thrombocytopenia raised urea/creatinine, oliguria impaired LFTs
by when does cytotrophoblast and CT of villi disappear forming a haemomonochorial placenta?
by 4th mnth (wk 16)
why are isolated cytrotrophoblast cells left when forming a haemomonochorial placenta?
act as stem cells to replace and repair overlying syncytium
define preeclampsia
new-onset significant hypertension and proteinuria after 20wks’ gestation
define significant proteinuria in pre-eclampsia
> or equal to 300mg of protein in a 24 hr urine sample
why is BP control important in pre-eclampsia?
it doesn’t change disease course for mother or fetus BUT does prevent cerebrovascular accident-stroke, ao antihypertensives can be used while affecting delivery
what is the HELLP syndrome of pre-eclampsia?
haemolysis
elevated LFTs
low platelets= thrombocytopenia
3 aims of implantation?
establish maternal bflow within placenta
anchor placenta to to endometrium
establish basic unit of exchange= chorionic villi
CNS symptoms of eclampsia?
seizures coma blindness headaches hyperreflexia
signs and symptoms of worsening pre-eclampsia?
pulmonary oedema oliguria thrombocytopenia oligohydramnios increased iastolic BP headache visual complaints lack of fetal growth elevated LFTs e.g. gamma-GT, AST
how to distinguish between CAH and adrenocortical tumour causing isosexual precocity?
measure 17-hydroxyprogesterone in blood- elevated in CAH
can US, then CT and biopsy
average weight of fetus?
3.5 kg
weight of a macrosomic fetus?
> 4.5kg
weight of fetus with growth restriction?
<2.5kg
describe the double Bohr effect in pregnancy
CO2 produced by fetus diffuses across placenta to maternal circulation where it acidifies maternal blood, so maternal Hb more readily gives up O2, and blood of fetus subsequently alkalifies which means fetal Hb more readily binds O2, so a Bohr shift occuring in both circulations allows O2 to be readily picked up by fetal Hb.
possible diagnoses of a breast lump?
inflammatory e.g. fat necrosis phyllodes tumour fibroadenoma carcinoma cyst
when do gonads stop being indifferent?
7th wk of development
germ cells don’t appear in gonadal ridges until 6th wk
where do paramesonephric ducts originate?
invagination of epithelium on AL surface of the urogenital ridge= intermediate mesoderm
what does the metanephric blastema form?
nephrons: glomerulus and tubules
what 3 precursors are common in male and female which external genitalia develop from?
genital tubercle
labioscrotal swellings
urethral folds
contents of broad ligament of uterus?
uterus (mesometrium) fallopian tubes (mesosalpinx) ovaries (mesovarium) round ligament of uterus suspensory ligament of the ovary ovarian ligament ovarian artery uterine artery
why is breast feeding milk?
babies fewer infections
bonding
actions of progesterone in pregnancy?
increase appetite- so mother builds up fat stores in body for 2nd half of preg where fetal demands fro glucos increase so mother turns to FA for her own metabolism
stimulates respiratory centres so more CO2 blown off- physiological hyperventilation
increase renin production- increases maternal circulating blood volume
smooth muscle relaxation- decreases TPR, increased risk of pyelonephritis, heartburn, constipation
constituent of AT which means obese patients at increased risk of endometrial cancer?
aromatase enzyme production- converts androgens into oestrogens which stimulate endometrial cell proliferation
age range for menarche?
11-15 years
age range for growth spurt in girls?
10-14 years
age range for adrenarche in girls?
11-12 years
age range for thelarche in girls?
8-11 years
why is implantation at a site other than the endometrium common in different areas of the FTs and the ovaries?
lack of pre-decidual cells, so conceptus isn’t limited in its ability to invade
other than the pampiniform venous plexus, how else is an appropriate temperature maintained in testes?
cremaster muscle- raises and lowers testes to control temperature of them to create optimum temp for spermatogenesis enzymes
dartos muscle- wrinkles scrotal skin to reduce heat loss by reducing SA
describe capacitation and the acrosomal reaction
these are necessary for full maturation of sperm so that it is capable of fertilising the oocyte. capacitation: glycoprotein coat removed which causes changes in the sperm cell memebrane. tail movements change from waves to whip like thrashing movement, and sperm becomes responsive to signals from oocyte.
acrosomal reaction: release of sperm contents. start of reaction marked by capacitated sperm coming in contact with oocyte ZP, membranes fuse and then proteolytic enzymes of acrosome of sperm released.
both changes induced by Ca2+ influx and increase in cAMP in spermatozoa.
contents of spermatic cord?
cremasteric artery artery to vas deferens testicular artery vas deferens pampiniform venous plexus remnant of processus vaginalis genital branch of genitofemoral nerve (L1, L2) testicular lymphatic vessels autonomic nerves
when does puberty occur?
when the brain initiates pulsatile GnRH secretion
girls: 8-13 yrs
boys: 9-14 yrs
how may a female with CAH be treated?
given glucocorticoids to induce -ve feedback so inhibit androgen production by adrenals
reconstructive surgery on external genitalia
what can the combined OCP be used to treat other than its use for contraception?
menorrhagia: reduce gonadotrophins
why is the combined OCP protective against endometrial and ovarian cancers?
endometrium: reduce turnover of endometrium
ovarian: reduce follicle rupture so reduce damage and repair of overlying simple cuboidal epithelium
tments of menorrhagia?
mefenamic acid= NSAID
antifibrinolytics e.g. tranexamic acid
GnRH agonist
combined OCP
what is a hydrocele of the spermatic cord?
collection of excess fluid in a persistent processus vaginalis due to excess serous fluid secretion from the visceral layer of the tunica vaginalis
contents of the scrotum?
testes
epididymis
spermatic cord
difference between a spermatocele and an epididymal cyst?
spermatocele= retention cyst= collection of fluid in the epididymis, usually near head
epididymal cyst= collection of fluid anywhere in epididymis
what increases your risk of preterm labour?
smoking
polyhydramnios- may also cause UC prolapse
multiple gestation
pyelonephritis
how could a cancer be prevented from coming back?
adjuvant therapy e.g. chemotherapy and radiotherapy
what is used most commonly to detect VIN and how does it work?
dilute acetic acid
stains white- stains keratotic cells- protein
why is combined OCP protective against ovarian cancer?
inhibited ovulation
each breach and repair of the
surface epithelium at ovulation causes epithelial turnover. Long term oc use is
definitely protective
how does testosterone influence descent of testes?
stimulates movement through inguinal canal in to scrotum
why does cryptorchidism occur in androgen insensitivity syndrome?
androgens necessary for descent of testes from their position on posterior abdomonal wall
disadvantages of ventouse delivery?
chignon
cephalohaematoma
how is cervical effacement different from cervical thinning?
effacement refers to the parts of cervix moving outwards to allow cervical opening*
disadvantages of using diaphragm as a barrier contraception method?
bladder or vaginal infections
require spermicide use in diaphragm as some sperm may bypass the diaphragm ,and spermicide can cause inflammation of genital tract and may increase transmission of STIs
layers of the scrotum?
skin dartos fascia external spermatic fascia cremasteric fascia internal spermatic fascia tunica vaginalis tunica albuginea tunica vasculosa
describe the blood supply of the endometrium
uterine arteries arise from the anterior division of the internal iliac artery
these form arcuate arteries that give off radial arteries that travel inward to myometrium where they give off basal arteries and spiral arteries
basal to stratum basale
and spiral to stratum functionalis
2 disadvantages of using an IUD for contracpetion?
increased risk of PID
risk of ectopic pregnancy
a woman has transmitted an STI onto her partner but she is asymptomatic, what is the likely causative organism?
neisseria gonorrhoea
risks of early onset of sexual activity?
increased risk of cervical cancer in women
increased risk of PID in women
what % of breast cancers are hereditary?
10%
25% of these related to mutations in BRCA1 or 2, and 3% of all breast cancers due to BRCA mutations
presentation of androgen insensitivity syndrome and why
testicular feminisation:
Y chromosome so testes, but in abdomen as require androgens for descent
no other internal genitalia as MIH inhibits PMN development, and lack testosterone to maintain mesonephric ducts
external genitalia female as in absence of dihydrotestosterone they form as don’t require any hormones, so will have labia majora, minora and clitoris, and lower part of vagina- short from UG sinus, fusion to form male external requires dihydrotestosterone
breasts often well devloped- oestrogen as little -ve fbk from androgens to hypothalamus and pit?
little pubic hair as androgen lack
primary amenorrhoea as no uterus
why might female fetus XX have internal genitalia of both sexes?
CAH: excessive secretion of androgens means mesonephric ducts remain to form male internal genitali, but no MIH from testes as ovaries present so paramesonephric ducts develop aswell to form female internal genitalia
would testes descend in patient with low MIH?
no, would be found in abdomen
may be mechanical obstruction by fibrous adhesions
patient would have both male and female internal genitalia if androgen levels normal
during what days of menstrual cycle is clomiphene given to treat infertility?
given for 5 days at start of menstrual cycle
how will high dose progesterone affect gonadotropins?
will inhibit +ve feedback of oestrogen so no LH surges so no ovulation
and enhances -ve feedback of oestrogen to suppress LH, FSH and GnRH release
how will low dose progesterone affect gonadotropins?
will probably still get ovulation as dose insufficient to prevent +ve feedback of oestrogen so will still get LH surge, but thick and acidic cervical mucous plug created which inhibits sperm transport
where does the spermatic cord terminate?
posterior border of testis
originates at deep inguinal ring lateral to inferior epigastric vessels
smooth muscle of which structures contract during emission?
vas deferens
seminal vesicle
prostate gland
blood supply to prostate?
inferior vesical artery from internal iliac artery
why does prostate cancer spread to the vertebrae?
veins of prostate connect to the Batson venous plexus- a collection of valveless veins which connect with the internal vertebral venous plexuses so spread via venous drainage
what is assessed in a bimanual examination?
cervix
can assess uterine size, consistency, regularity, pain, mobility and position
why might a patient with breast cancer become anaemic?
metastasis of cancer to bone marrow
