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Em CVS Revisin > Repro Revision > Flashcards

Repro Revision Flashcards

1
Q

Which ligament in the female is a remnant of the gubernaculum?

A

The round ligament

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2
Q

What does the round ligament attach to?

A

It originates at the uterine horns and attaches to the labia majora passing through the inguinal canal

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3
Q

What is the Pouch of Douglas (in females) also known as?

A

Retrouterine pouch

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4
Q

What is the role of the perineal body?

A

irregular fibromuscular mass at junction of urogenital and anal triangles

Central point of the perineum

Contains skeletal muscle, smooth muscle, collagenous/elastic fibres

Lies just deep to the ski

Functions as a point of attachment for muscle fibres from pelvic for and perineum

Supports posterior part of vaginal wall against prolapse

(Lies between bulb of penis and anus in men)

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5
Q

What is tunica vaginalis derived from?

A

Peritoneum

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6
Q

The tunica albuginea is a fibrous capsule- true or false?

A

True

Penetrates parenchyma of each testis dividing the lobules

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7
Q

Where does the left testicular vein drain into?

A

The left renal vein

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8
Q

Where does the right testicular vein drain into?

A

The inferior vena cava

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9
Q

What are the three fascial layers of the spermatic cord?

A

External spermatic fascia
Cremaster muscle and fascia
Internal spermatic fascia

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10
Q

What are the contents of the spermatic cord? (9)

A 
Testicular artery
Cremasteric artery and vein 
Artery to vas deferens
Pamphinform plexus to testicular veins 
Genital branch of genitofemoral nerve
Vas deferens
Lymph vessels
Processus vaginalis 
Autonomic nerves

3 nerves 3 arteries 3 veins 3 fascial coverings, 3 others (vas, processus vaginalis, lympathics)

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11
Q

What male structures are derived from the mesnephric ducts?

A

SEED

Seminal glands
Ejaculator ducts
Epididymis
Ductus (vas) deferens

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12
Q

How does the semen suppress the female immune response?

A

Prostaglandins

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13
Q

Is innervation to the seminal vesicle parasympathetic or sympathetic?

A

Sympathetic

Think Shoot

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14
Q

What area of the prostate usually becomes hyperplased and causes BPH?

A

The transitional zone

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15
Q

How much of the prostate is glandular?

A

2/3rds

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16
Q

Where is cancer of the prostate most likely found?

A

The peripheral zone

Makes up the main body of the gland (65%) and is located posteriorly

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17
Q

What is the most common cystic condition within the scrotum?

A

Spermatocele (epididymal cyst)

Retention cyst of the rate testes or head of epididymis

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18
Q

What are the two main functions of the testis?

A

Sexual intercourse

Micturition

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19
Q

What does the bulb form in the penis?

A

Corpus spongiosum

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20
Q

What do the two crus form in the penis?

A

Corpus cavernosa

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21
Q

What is the glans penis formed of?

A

Corpus spongiosum

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22
Q

What are the four muscles located in the root of the penis?

A

Bulbospongiosus x2 - contracts to empty the spongy urethra of any residual semen
The anterior fibres also aid in maintaining an erection by increasing the pressure in the bulb of the penis

Ischiocavernosus x2
Surround the left and right curry of the penis
It contracts to force blood from the cavernous spaces in the crura into corpus cavernosa - helps to maintain an erection

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23
Q

What are the two fascial coverings of the erectile tissue?

A

Deep fascia of the penis - superficial layer

Tunica albuginea - forms a individual capsule around each cavernous body

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24
Q

What are the three arterial sources of blood to the penis?

A

Dorsal arteries of the penis
Deep arteries of the penis
Bulbourethral artery

All branches of the internal pudental artery
Arises from the internal iliac artery

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25
Q

What is the venous drainage of the penis?

A

The cavernous spaces are drained by the deep dorsal vein of the penis - empties into prostatic venous plexus

The superficial dorsal veins drain the superficial structures of the penis such as the skin and cutaneous tissue

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26
Q

What is the parasympathetic innervation of the penis?

A

Cavernous nerves from the PROSTATIC NERVE PLEXUS - responsible for the vascular changes which cause erection

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27
Q

What is hypsospadias?

A

A congenital condition in which patients are born with the opening of their urethra on the ventral aspect of their penis

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28
Q

What is priapism?

A

Priapism is an erection that persists for more than 4 hours despite lack of sexual stimulation

Results from blood becoming trapped in the erectile bodies

Untreated may lead to scarring and erectile dysfunction

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29
Q

Which structure lies directly beneath the deep fascia of the penis?

A

Tunica albuginea

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30
Q

What are the two ligaments of the penis?

A

Suspensory ligament - attaches from top of penis to pubic symphysis - condesation of deep fascia

Fundiform ligament - condensation of abdominal subcutaneous tissue - runs down Linda alba wraps round like a sling and attaches to pubic symphysis

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31
Q

What are the external female genitalia?

A 
Vestibule
Labia minora
Labia majora
Clitoris 
Perineum
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32
Q

When do secondary characteristics arise and why?

A

Arise at puberty when gametes begin to be produced creating an opportunity for reproduction

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33
Q

When do germ cells arise?

A

3 weeks after conception

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34
Q

Which cells secrete testosterone?

A

Leydig cells

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35
Q

What causes the persistence the Wolffian ducts?

A

The presence of testosterone secreted from the leydig cells

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36
Q

How is Mullerian (paramesonephric duct) growth inhibited?

A

Mullerian Inhibitory Hormone

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37
Q

What does the genital tubercle become in men and women?

A

Men - the glans of the penis

Female- the clitoris

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38
Q

What causes male external genitalia?

A

Stimulation of testosterone from Leydig cells

39
Q

What would happen to internal and external genitalia in congenital adrenal hyperplasia?

A

Excessive secretion of androgens (including testosterone)
If the individuals genotype is XX then the gonads will be female (no SRY region) yet the internal genitalia will be both male and female (no MIH to prevent growth of Müllerian ducts)
External genitalia will be male - under the influence of testosterone

40
Q

What lies in the inguinal canal in females?

A

The round ligament

41
Q

What causes precocious puberty?

A

Extreme androgen/oestrogen increases

42
Q

What cells is inhibin secreted from in males?

A

Sertoli cells

43
Q

What is progesterones effect on the HPG axis?

A

Progesterone increases the inhibitory effect of low oestrogen

Progesterone prevents positive feedback of high oestrogen

44
Q

Which cells produce inhibin in the female?

A

Granulosa cells

45
Q

What do theca cells produce?

A

Androgens that can be converted to oestrogen by FSH-induced aromastase

46
Q

How does prolactin suppress fertility?

A

It disturbs the pulsatile release of GnRH

47
Q

What is the treatment of fibroids ?

A

Treatment of GnRH agonists to induce pseudo-menopause

MOA: desensitises the pituitary (by causing GnRH downregulation) to GnRH therefore reduces LH + FSH secretion

Long term use not recommended as reduces bone mineral density

48
Q

Where do the gonadal arteries come off the aorta?

A

In the abdominal aorta just below the kidneys

49
Q

What are the layers of the spermatic fascia?

A

External spermatic fascia: derived from the aponeurosis of the external oblique muscle
Cremasteric fascia: derived from the internal oblique
Internal fascia: fascia transversalis

50
Q

Which nerve is carried through the inguinal canal?

Think its in the name

A

Ilioinguinal nerve

51
Q

Where does fertilisation occur in the Fallopian tube?

A

The isthmus

52
Q

How is the uterus anchored into the pelvis? (3 ligaments)

A

The round ligament
Cardinal ligament - connect uterus to anterior wall
Uterosacral ligament - attach posteriorly at the level of the cervix and connect to sacral bones

53
Q

What is the lymph drainage of the uterus?

A

Fundus and upper part of body - para-aortic

Lower part + cervix - internal and external iliac vessels

54
Q

What is the vulva?

A

The lower 1/3 of the vagina, the clitoris and the labia

55
Q

What is the blood supply, venous drainage and lymph drainage of the vulva?

A

Blood: internal pudental artery (from the posterior division of the internal iliac artery)
Lymph drainage: inguinal nodes

56
Q

What is the angle of anteversion?

A

The angle between the cervix and the vagina

Think anteVersion –> v for vagina

57
Q

What is the angle of anteflexion?

A

The angle between the cervix and the uterus

58
Q

What does a low dose progesterone pill do?

A

Doesn’t prevent the LH surge therefore ovulation likely

However it THICKENS CERVICAL MUCUS preventing implantation

59
Q

How does viagra work?

A

Prevents degradation of cGMP in the corpus cavernosum

NO binds to guanylate cyclase receptors which increase cGMP and increases vasodilation –> erection

60
Q

How is retrograde ejaculation prevented?

A

The bladder internal sphincter contracts

61
Q

What happens during ejaculation?

A

Contraction of glands and ducts
Contraction of internal sphincter - to prevent retrograde ejaculation
Contraction of striatal muscles: pelvic poor and perianal muscles - ischiocavernosus, bulbospongiosus

62
Q

What is the parasympathetic nerve that causes an erection?

A

Pelvic nerve and nerve plexus

63
Q

What is the role of NO in an erection?

A 
Post ganglionic fibres release ACh
This acts on M3 receptor
Causes a rise in Intracellular Ca2+ 
This actives NOS and formation of NO
NO diffuses into vascular smooth muscle and causes relaxation (vasodilation) 
NO also released directly from nerves
64
Q

What is the effect of progesterone on the uterus in pregnancy?

A

Maintains the decidual lining
Relaxes the smooth muscle of the myometrium

Also has peripheral effects on vascular smooth muscle and other organs

65
Q

What enzyme aromatises androgen precursors to oestrogen?

A

Aromatase

66
Q

What is the name of the major androgen precursor for placental oestrogen?

A

DHEA-S

DHEA-S is an adrenal androgen and mainly supplied by the mother

67
Q

What does hPL do?

A

Structurally related to prolactin and growth hormone

Closely mimics GH - effects on fat and carbohydrate metabolism include inhibition of peripheral glucose uptake, stimulation of insulin release by the pancrea and increase in free fatty acids

HPL production directly proportional to placental mass

68
Q

What is preeclampsia?

A

New onset hypertension and proteinuria- marker of kidney damage

Development of abnormal placenta –> fibrous spiral arteries therefore less blood to placenta - can lead to intrauterine growth restriction and foetal death if severe

The hypoperfused placenta starts releasing PRO INFLAMMATORY PROTEINS - these go into the mothers circulation and endothelial cells become dysfunctional - causing vasoconstriction

Can lead to haemorrhagic stroke or placental abruption

Local vasospasm can cause kidney damage due to reduced perfusion –> can get oliguria and proteinuria

Blurred vision due to reduced blood flow to retina

Injury + swelling to the liver- elevation of liver enzymes
Stretches capsule - can get right upper quadrant pain

Formation of thrombi - uses up platelets

HELLP 
Hemolysis 
Elevated 
Liver enzymes
Low 
Platelets

Endothelial damage causes increased permeability therefore fluid in the tissues with generalised oedema due to reduced oncotic pull of veins

Cerebral oedema- headaches, confusion and seizures - eclampsia

Treatment: delivery of foetus + placenta
+ manage end organ damage

69
Q

Why is thromboembolitic disease more of a problem in pregnancy?

A

Pregnancy = prothrombitic state
+++ fibrin deposits @ implantation site
Increased fibrinogen and clotting factors
Reduced fibrinolysis

Added to this: stasis and venodilation - thromboembolitic disease in pregnancy

However warfarin crosses the placenta - teratogenic

70
Q

Why do pregnant people get anaemia?

A

Plasma volume increases
Red cell mass increases
Physiological anaemia

However anaemia due to folate and iron deficiency can occur

Also haemoglobinopathies

71
Q

Why does ectopic pregnancy cause such problems with haemorrhage?

A

In ectopic sites there is a lack of decidual cells meaning that invasion occurs too much and severe haemorrhage can result. ]]

72
Q

Are the spiral arteries creating a high or low resistance in pregnancy? What is the benefit of this?

A

Low resistance meaning a high flow is maintained to meet the demands of the foetus

73
Q

What is the difference in the placental barrier at the start of pregnancy and then full term? (Think layers)

A

start of pregnancy:
Capillary endothelium, mesoderm, cytotrophoblast and syncytiotrophoblast

Full term:
Surface area has increased alongside barrier becoming smaller

Cytotrophoblast and mesoderm layers lost

74
Q

What conditions can cause placental insufficiency?

A

Diabetes
Smoking
Hypertension
Idiopathic

Affects fetus CNS development and can cause oligohydramnios or intrauterine growth restrictions

75
Q

What produces hCG?

A

The synchitiotrophoblast

76
Q

In which week does the placenta take over the corpus luteum in producing the steroid hormones/

A

Week 11

77
Q

Is gas exchange in the placenta flow or diffusion limited?

A

Flow

78
Q

How does cigarette smoke affect the fetus?

A

Cigarette smoke acts on the placental barrier to increase the intrahaemal distances by preventing its thinning

This has an effect on the diffusion of nutrients from mother to baby

Carbon monoxide also increases Hb affinity for O2 in the maternal blood meaning there will be a reduced O2 extraction by the fetus - not able to meet its O2 demands

79
Q

The foetal partial pressure of oxygen is 4kPa, how does the foetal blood adapt to increase its oxygen content?

A

The foetal haemoglobin HbF has a much higher affinity for o2 than normal Hb - made up of 2 alpha nad two gamma subunits

The concentration of HbF is much higher than adult Hb meaning the O2 content of foetal blood is further increased

Foetal Hb also has non beta subunits that the 2,3 DPG will normally bind to reduce the affinity of Hb - this allows the affinity of Hb to remain high for all O2.

80
Q

How does the mother ensure that the fetus does not have high pCO2

A

‘Physiological hyperventilation’ via progesterone

Causes hypocapnea in the mother

81
Q

Is the fetus able to conjugate its bilirubin?

What is sometimes a consequence after birth?

A

No, the fetus has to keep the bilirubin unconjugated so it can pass back to maternal circulation

Upon birth the baby quickly has to change to conjugating bilirubin for its own excretion - neonatal jaundice is not uncommon and usually rectifies itself

82
Q

What does suckling do?

A

Suckling is part of a neuroendocrine reflex - receptors in the breast respond to suckling by reducing levels of dopamine in the brainstem and thus increasing the levels of prolactin.

This prolactin then causes increased milk in the breast ready for the next feed.

Suckling causes an increase in oxytocin from the posterior pituitary which allows milk to be ‘let down’ and squeezed out of the breast

The mother can also cause oxytocin release from thinking about the baby

83
Q

Where is oxytocin released from?

A

The posterior pituitary

84
Q

What is the name of the agent causing genital warts?

A

Papillomavirus

85
Q

What is the name of the organism causing chlamydia?

A

Chlamydia trachomatis

86
Q

What is the name of the organism causing herpes?

A

Herpes simplex virus

87
Q

What antibiotic would you use for chlamydia?

A

Doxycycline

88
Q

What do you use to treat trichomonas vaginalis?

A

Metronidazole - do NOT drink

89
Q

What is the causative organism in syphyllis?

A

Treponema pallidum

90
Q

What is the causative organism in BV?

A

Gardnerella

91
Q

What is the disease process in pelvic inflammatory disease?

A

Infection causes inflammation
Inflammation results in damage e.g. Adhesions
Chlamydia trachomatis and neisseria gonorrhoeal are the main causes of PID

92
Q

Why is there a low threshold for empirical treatment of PID?

A

Due to the severe long term consequences

93
Q

What would be outpatient treatment of PID?

A

IM ceftriaxone
PO doxyxycline
P metronidazole

Em CVS Revisin (5 decks)

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