Reproduction Flashcards
Explain the pathway of a sperm.
They are synthesised in the seminiferous tubules. They then drain into:
- Straight tubules.
- Rete testis.
- Efferent ductules.
- Epididymis.
- Vas deferens.
- Ejaculatory duct.
- Urethra.
What are the two types of epithelium in the efferent ductules, and what are each of their functions?
Columnar ciliated epithelium - aid the movement of sperm.
Non-ciliated cuboidal epithelium - absorption of most of the fluid secreted by the seminiferous tubules.
What is the muscular coat surrounding in the seminal vesicles, and what stimulates it to contract?
It surrounds the glandular elements.
It is stimulated to contract by the sympathetic nervous system, during ejaculation.
What can happen to the glandular elements of the prostate in older men, and why?
They can become calcified, due to the content of calcium that it contains.
How do the testes descend from the abdominal canal?
During utero, through the inguinal canal, into the scrotum.
Where are the sperm cells stored before ejaculation, and what is its structure?
It is stored in the epididymis.
It has a head, a body and a tail.
What does the spermatic cord travel through?
The inguinal canal.
At which parts of the urethra are the internal and external urethral sphincters located?
Internal - pre-prostatic urethra.
External - membranous urethra.
What does the membranous part of the urethra pass through?
The deep perineal pouch.
What are the bulbourethral glands surrounded by, and what structure are they found in?
The external urethral sphincter.
They are found in the deep perineal pouch.
What do the prostatic ducts drain into?
The urethral sinus.
What parts and where do the corpora cavernosa attach to?
The crus attach at the ischial rami.
What is the bulb of the corpus spongiosum attached to?
The perineal membrane.
What makes up the base of the penis?
The crura of the corpus cavernosa and the bulb of the corpus spongiosum.
What does the suspensory ligament attach between?
The base of the penis to the pubic symphysis.
What does the fundiform ligament attach to?
The linear alba, to form a ring round the base of the penis.
What is the function of the testicular tunica albuginea?
Surrounding the seminiferous tubules to give structure, holding them together.
What is the function of the epididymis?
To store the sperm and facilitate maturation of them, allowing them to become motile.
What are the locations of the two cells associated with the seminiferous tubules?
The sertoli are found in the seminiferous tubule walls.
The leydig cells are found between the seminiferous tubules.
How do the Sertoli cells support spermtogenesis?
Removing cytoplasm, facilitating maturation.
What do the right and left testicular veins drain into?
The right testicular vein drains into the IVC.
The left testicular vein drains into the renal vein.
Why can inflammation of the lymph nodes supplying the testes not be felt?
The are para-aortic lymph nodes, which are deep within the abdomen and cannot be palpated.
What does the lymph from the scrotal skin drain to?
The inguinal lymph nodes.
What is the bell-clapper deformity, and what is the issue with this?
Where the tunica vaginalis completely envelops the testes and epididymis, increasing the risk of testicular torsion.
How does testicular torsion present as an emergency?
The twisting of the spermatic cord leads to compression of the venous and then arterial supply, leading to ischemia and infarction. This can lead to a decrease in fertility.
What can prevent testicular torsion from occurring again?
Suturing between the testicles and scrotum.
What does the gubernaculum do, and how does this occur?
It guides the testes from the abdomen into the scrotum.
It does this by the connective tissue attaching from the base of the scrotum to the lower pole of the testes.
What are the 3 fascias of the spermatic cord, and what are they formed from?
Internal spermatic fascia - transversalis fascia.
Cremasteric fascia - aponeurosis of the internal oblique.
External spermatic fascia - aponeurosis of the external oblique.
What is the motor nerve supply for the cremaster and what does stimulation of this do?
The genital branch from the genitofemoral nerve.
It contracts to pull the testicles up into the abdomen.
Apart from venous drainage, what is the secondary function of the pampiniform plexus, and why does this occur?
It has a concurrent flow to keep the testicular arteries cool.
This is because the optimum temperature for spermatogenesis is 35 degrees Celsius.
What parts of the prostate does benign prostatic hyperplasia (BPH) and prostate cancers effect?
BPH - transitional zone.
Prostate cancer - peripheral zone.
What does parasympathetic innervation to the penis cause?
Vasodilation of the arterioles and compression of the veins, resulting in erection.
What is the sympathetic innervation of the penis?
Vasoconstriction of the penile arterioles, leading to the termination of the erection.
It stimulates the ejaculation.
Why is there increased risk of varicoele to the left testicular vein?
The right testicular vein drains into the IVC at an oblique angle, as opposed to the left draining into the renal vein vertically.
There is an increased risk of pathology to the kidney, meaning the renal vein may become distended with an increased pressure.
Why do hydrocoeles often get bigger when coughing or crying?
There is an increased pressure in the abdomen, leading to fluid moving down into the tunica vaginalis.
This only occurs in children as there is still communication to the peritoneum.
How can a hydrocoele be distinguished from a tumour?
The hydrocoele will transilluminate.
What is the tunica albuginea of the penis, and what is the function of it?
A white sheet of elastic tissue that surrounds corpus cavernosa and corpus spongiosum.
This is to give the penis the cylindrical shape when erect.
What is a fractured penis?
Rupture of the tunica albuginea of the penis, leading to bleeding and deformation of the penis.
Why is knowing the angles between the vagina and cervix, and between the cervix and uterus important?
For IUD implants - making not to penetrate into or through the cervical or uterine wall.
Complete the following:
What can the sharp pain during ovulation be due to?
The egg bursting through the ovary, disrupting the capsule.
What is the main complications with ovarian cysts?
They can twist, forming ovarian torsion. This can cut off the ovarian and/ or uterine arteries.
What are the uterine and vaginal arteries branches of?
Internal iliac artery.
What connective tissue structure is the ovary held within?
Tunica albuginea.
What are ovarian cysts usually derived from, and what is the normal function of this?
Follicles of the ovary - stimulated by FSH to produce the primary follicle.
Describe the 3 components of the round ligament.
What is the remnant of the gubernaculum in females?
The round ligament.
Where do primordial germ cells originate from, where do they go, and how?
They originate from the endodermal yolk sac.
They go to the genital ridge, travelling along the dorsal mesentry of the hindgut.
What is the embryological origin of the genital ridge?
Intermediate mesoderm.
What forms the indifferent gonad, and what determines what gonad is formed?
Indifferent gonad is formed from the primordial germ cells and the primitive sex cords.
The presence of the SRY gene determines whether it will become testes. If it is absent then the ovaries will form (default).
What is the primitive sex cord formed from?
The proliferation of the genital ridges, penetrating the intermediate mesoderm.
What is required for the medullary cords to form, what are they made of and what do they become?
The SRY protein is required for their formation.
They consist of germ cells and Sertoli cells.
They become the seminiferous tubules.
What cells are seen between the medullary cords, and what are their function?
Leydig cells that produce testosterone.
In females, other than the ovary, what else is formed from the indifferent gonad, and what is their function?
Cortical cords - these surround the germ cells, forming the primordial follicle.
How does the paramesonephric duct form its products?
The two ducts fuse together, forming the uterus.
They also fuse to the sinovaginal bulb, forming the upper part of the vagina.
The remnants of the ducts form the fallopian tubes.
In Turner syndrome, 45,XO, what is the clinical presentation?
They have internal and external female genitalia.
They often have a wide neck and low set ears.
Amenorrhea.
Streak ovaries - wavy connective tissue.
How is Turner syndrome treated?
As oestrogen is not released, they are treated with hormone replacement.
What is the clinical presentation of Kleinfelter syndrome, 47,XXY?
Delayed puberty.
Small testes - hypogonadism.
Lack of male secondary sex characteristics with breast development.
Male internal and external genitalia.
In complete androgen insensitivity syndrome, what is the outcome of the ducts with 46,XY, why?
Neither mesonephric or paramesonephric ducts develop.
Mesonephric duct - the insensitivity to testosterone means that it does not develop.
Paramesonephric duct - the testes still produce MIH.
What is the clinical presentation of a patient with complete androgen insensitivity syndrome, 46,XY?
Male internal genitalia with female external genitalia.
They often develop a blind-ended vagina and breasts.
What is the function of Sertoli cells?
Provide nutrients and growth factors for the cytodifferentiation of indifferent gametes into sperm.
Help to form the blood-testis barrier, in the seminiferous tubules.
What do type B spermatogonia give rise to?
Primary spermatocytes.
What is spermiation?
The release of spermatids into the lumen of the seminiferous tubules.
How does sperm capacitation occur in in-vitro fertilisation?
The sperm must be incubated in a capacitation media.
What is the function of follicular cells?
To maintain and aid in the development of the primary oocytes.
What are primordial follicles?
Primary oocytes that are surrounded by follicular cells.
What do follicular cells metaplaise from and to in the preantral stage, and what is their new function?
They metaplaise from flat cells to stratified cuboidal cells, after proliferation, which are now called granulosa cells.
These secrete a layer of glycoprotein surrounded the oocyte, forming the zona pellucida.
What does a surge in luteinising hormone do?
Stimulates the preovulatary stage:
- Meiosis I completes forming a secondary oocyte (lots of cytoplasm) and a polar body (almost none).
- Meiosis II starts but arrests in metaphase.
When would meiosis II of the secondary oocyte complete, and what is formed from it?
If fertilisation occurs.
An ovum, when fertilised becomes a zygote, and a polar body.
Where do the 3 polar bodies come from?
The first polar body is from meiosis I.
The second polar body is from meiosis II.
The third polar body is from the division of the first polar body.
Why is prostaglandin synthesis increased during ovulation, and what does it cause?
It is increased as a result of an increase in luteinising hormone.
It causes muscular contractions in the ovarian wall.
What other cells are released with the oocyte in ovulation?
Cumulus oophorus.
If fertilisation occurs, what is the function of the corpus luteum?
To secrete oestrogens and progesterone.
Stimulates the uterine mucosa to enter the secretory stage for preparation of embryo implantation.
If fertilisation does not occur, what does the corpus luteum become?
The corpus albicans - a mass of fibrotic scar tissue.
What does the embryo release to prevent the degeneration of the corpus luteum?
Human chorionic gonadotropin.
What is the prostate formed from?
An outgrowth of urethral endoderm.
How does the broad ligament form?
Through the fusion of the paramesonephric ducts.
How does prostatic enlargement lead to incontinence?
Desensitisation of the stretch receptors in the bladder, due to an increase in urine retention.
Why does the external genitalia of a baby with the genotype 46,XX appear ambiguous?
The paramesonephric duct is present due to the absence of MIH.
The mesonephric duct (partially) develops, due to the presence of androgens.
Which cells of the anterior pituitary gland produce LH and FSH?
Gonadotropes.
What forms the hypophyseal portal system?
Primary capillary plexus.
Hypophyseal portal veins.
Secondary capillary plexus.
What is the pattern of GnRH release, after puberty?
Pulsatile, every 1-3 hours.
What does FSH stimulate in males, and what is the outcome?
Sertoli cells - spermatogenesis in the seminiferous tubules occurs. Inhibin is released.
What does LH stimulate in males, and what is the outcome?
Leydig cells - testosterone is released.
What does FSH stimulate in females, and what is the outcome?
Granulosa cells - follicular development and the formation of the zona pellucida. Inhibin also released.
What does LH stimulate in females, and what is the outcome?
Theca interna cells - androgen release, which is converted to oestrogen and progesterone.
What converts androgens into oestrogen and progesterone?
Granulosa cells.
How long after hormone secretions do physical signs of puberty show, roughly?
1 year.
What are the hormonal changes seen at the onset of puberty?
Increasing frequency and amplitude of GnRH secretions, which first occurs at night and then progressively throughout the day.
Steady increase in FSH and LH.
State the meaning of the following terms:
- Gonadarche
- Adrenarche
- Thelarche
- Menarche
- Pubarche.
State the rough order in which pubertal changes occur in males, and what they are.
Genital development - increased testicular size, and then increased penis size and scrotal changes.
Pubic hair growth.
Spermatogenesis.
Growth spurt.
What are the secondary sex characteristics of males?
Increased and thickened hair on the trunk, pubis, axillae and face.
Increased laryngeal size - adams apple.
Deepening of voice.
Increased bone mass.
Increased muscle mass and strength.
State the rough order in which pubertal changes occur in females, and what they are.
Thelarche - breast bud development.
Adrenarche - pubic hair growth.
Growth spurt.
Menarche - menstrual cycle begins.
What are the secondary sex characteristics of females?
Pubic and axillary hair.
Enlargement of the labia majora and minora.
Keratinisation of vaginal mucosa.
Uterine enlargement.
Increased fat in hips and thighs.
What is the growth spurt size dependent on, and why are males taller?
Depends on growth hormone, insulin-like growth factor 1 and sex steroids.
Males’ growth spurt occurs later, so epiphyseal growth plates fuse later, and their growth spurt is longer and slightly faster.
What causes female epiphyseal growth plate fusion?
Oestrogen.
What is the average menstrual cycle length?
28 days.
What are the 3 phases of the uterine cycle?
Menstrual.
Proliferative.
Secretory.
Which phase of the ovarian cycle is variable, and why is the other not?
Follicular phase is variable.
Lateral phase is not as the corpus luteum has a life span of 14 days, should fertilisation not occur.
What occurs in the early follicular phase, and how long is it?
Days 0 to 5.
No ovarian hormone production, initially, with granulosa cells secreting activin to increase FSH production. FSH receptors on granulosa cells increase.
This increased level of FSH then stimulates follicle growth and the theca interna formation, with secretion of oestrogen.
Inhibin is then released from the granulosa cells of the dominant follicle, preventing the development of any other follicles.
What occurs in the late follicular phase?
Oestrogen increases the FSH receptors on the follicle, and increases LH receptors on granulosa cells. It has a negative feedback on FSH production.
Inhibin helps LH to increase theca cell androgen production. Decrease FSH production.
What is the corpus luteum made from?
Granulosa and theca interna cells.
What is the outside of the uterus called?
Perimetrium - visceral peritoneum.
Outline the changes in the endometrium in the early proliferative, later proliferative and secretory phases.
What cells produce hCG?
Syncytiotrophoblasts.
What is precocious puberty, and what are the two types?
Puberty that occurs before the age of 9 in males, and 8 in females.
There is central (true) or peripheral (pseudo).
What is central precocious puberty?
Puberty that occurs before the age of 9 in males, and 8 in females.
Follows the normal pattern of puberty - breast bud development first in females and testicular growth in males.
It is due to GnRH rises.
What is peripheral precocious puberty?
Puberty that occurs before the age of 9 in males, and 8 in females.
It does not follow the normal pattern of puberty.
It is GnRH independent - oestrogen and/ or testosterone released early which cause early signs of puberty.
What is the most common first sign of peripheral precocious puberty?
Pubic or axillary hair growth.
What are the causes of precocious puberty?
How is central precocious puberty diagnosed?
GnRH stimulation test.
LH and FSH elevations.
What are some causes of peripheral precocious puberty?
How is peripheral precocious puberty diagnosed?
Increased oestrogen or testosterone levels in the blood.
Decreased LH and FSH due to negative feedback.
What is delayed puberty?
No pubertal changes before the age of 13 in females and 14 in males, or no developmental progression over a 2 year period.
What are some causes of delayed puberty?
What is hypogonadotrophic hypogonadism?
Where the hypothalamus or pituitary don’t stimulate the gonads, leading to low LH and FSH levels, and so no testosterone, or oestrogen and/or progesterone.
How can the cause of delayed puberty be determined?
Look at the BMI of the patient - check their nutritional intake. Could be the reason if BMI less than 18.
Karyotype for any chromosomal abnormalities.
Check for any chronic diseases.
Blood tests - LH, FSH and testosterone/ oestrogen.
What is hypergonadotrophic hypogonadism?
Where there is increased GnRH, FSH and LH, with low testosterone, or oestrogen and/or progesterone.
This is due to gonadal dysfunction.
A decrease in which hormone causes the corpus luteum to atrophy?
LH.
What is the issue with precocious puberty?
It will lead to short stature as fusion of the epiphyseal growth plates will occur sooner.
When does thelarche, adrenache, growth spurt and menarche occur in females?
What can be done to delay puberty, and what other help may the patient need?
Weight loss - decrease leptin.
Medroxiprogesterone to negatively feedback against GnRH, LH and FSH.
GnRH analogues in high doses to switch of the receptors.
Androgen blockers.
Therapy may be given to the patient.
What is primary amenorrhea?
The failure to establish menstruation by 15 years old with normal secondary sexual characteristics.
The failure to establish menstruation by 13 years old with no secondary sexual characteristics.
What is secondary amenorrhea?
Cessation of menstruation for 3-6 months in women with previously normal menses.
Cessation of menstruation for 6-12 months in women with previous oligomenorrhoea.
What are some causes of amenorrhea?
Hint: physiological, hypothalamic, pituitary, ovarian, uterine and vaginal.
What are some genitourinary malformations that can cause amenorrhea?
Imperforate hymen.
Vaginal septum.
Absent vagina.
Absent uterus.
What is an imperforate hymen, and how can it present?
Sinovaginal bulb fails to canalise, so the epithelium of the hymen remains.
It presents with amenorrhea as the blood cannot pass through, and can be painful, and appear as a bulge.
If there are no secondary sex characteristics, what does the cause of amenorrhea suggest?
An underlying chromosomal or hormonal cause.
Why can hypothyroidism cause amenorrhea?
Increased TRH secretions from the hypothalamus.
This increase prolactin secretions.
Prolactin inhibits GnRH secretions.
Why can hyperthyroidism cause amenorrhea?
Decreased free oestrogen.
This means there cannot be positive feedback on the anterior pituitary for LH secretions.
No LH surge for ovulation.
What is Asherman syndrome?
Adhesions and scarring in the uterus.
This prevents growth or shedding of the endometrium, leading to amenorrhea.
What is primary ovarian insufficiency?
Premature menopause, where there is depletion of oocytes before the age of 40.
What is the triad associated with polycystic ovarian syndrome?
Menstrual irregularity.
Androgen excess.
Obesity.
Why is PCOS associated with obesity?
There is increased insulin resistance, leading to increased adipose deposition.
How is PCOS diagnosed?
2 out of 3 of the following:
What are PCOS symptoms?
Hair loss.
Hirsutism.
Pelvic pain.
Weight gain.
Acne.
Irregular periods.
Infertility.
What is functional hypothalamic amenorrhea?
Weight loss and excessive exercise, or emotional or illness stress, causing cessation in periods.
What is oligomenorrhoea?
Infrequent menstruation with a cycle length between 6 weeks and 6 months.
What are causes of oligomenorrhoea?
How is menorrhagia diagnosed?
Menstrual blood loss of 80ml or more.
Duration of menstruation of more than 7 days.
The requirement of changing menstrual products 1-2 hourly.
Passage of clots or very heavy periods being reported by the woman.
What are some uterine and ovarian causes of menorrhagia?
Why does PCOS cause menorrhagia?
It prolongs the follicular phase.
This means there is an increase in size of the functional endometrial layers and so when it is shed, there is more bleeding.
What are some iatrogenic causes of menorrhagia?
Anticoagulant treatment.
Intrauterine contraceptive device.
What are some systemic diseases that can cause menorrhagia?
Coagulation disorders - Von willerbrand, factor V Leiden, etc.
Hypothyroidism.
Diabetes mellitus.
Hyperprolactinaemia.
Liver or renal disease.
What are uterine fibroids?
Leimyomas- benign tumours where there is proliferation of smooth muscle cells and fibroblasts, found within the myometrium.
What are risk factors for uterine fibroids?
Increasing age - until menopause where they regress (oestrogen).
Early menarche.
Older age at first pregnancy.
Black and Asian ethnicity.
Family history.
What is the first thing a doctor does when presented with a patient with menorrhagia?
Full blood count - often have anaemia.
What is the treatment for dysfunctional uterine bleeding?
What are some red flag signs for menorrhagia?
Post-menopausal bleeding.
Persistent inter-menstrual bleeding.
Persistent post-coital bleeding.
Pelvic mass/ bloating/ early satiety.
Ascites.
What is primary dysmenorrhea?
Painful cramping of the lower abdomen which occurs shortly before or during menstruation, or both - its onset is 6-12 months after menarche with no identifiable pelvic pathology.
What is the pathophysiology of primary dysmenorrhea?
Uterine prostaglandin production during menstruation causes the uterus to contract.
What is secondary dysmenorrhea?
Painful cramping in the lower abdomen, which occurs shortly before or during menstruation, or both, which starts several years after painless periods.
What are the causes of secondary dysmenorrhea?
What is the pathophysiology of endometriosis?
Ectopic endometrial gland and stroma outside the endometrial cavity, that produces oestrogen and leads to inflammation, fibrosis and scarring.
This is due to not all of the lining of the uterus being shed and some moving superiorly - retrograde menstruation.
Why can endometriosis be seen outside of the pelvis?
Because the female internal reproductive tract is continuous with the peritoneal cavity and so it can enter the peritoneal cavity.
How is endometriosis diagnosed?
Laparoscopy.
What are some common sites for endometriosis?
Fallopian tubes.
Rectum.
Bladder.
What are some risk factors for endometriosis?
Early menarche.
Late menopause.
Delayed childbearing.
Nulliparity - never given birth.
Family history.
Vaginal outflow obstruction - imperforate hymen.
White ethnicity.
Low BMI.
Autoimmune disease.
Late first sexual encounter.
Smoking.
What is adenomyosis?
Endometrial tissue found deep within the myometrium, causing heavy and painful periods.
What are some complications of endometriosis?
Deep pain during intercourse.
Painful bowel movements or urination during period.
Endometriomas - ovarian cysts contain blood and endometrial-like tissue.
Adhesions.
Bowel obstructions.
Chronic pain.
Reduced quality of life.
Infertility due to scarring in the fallopian tube.
Ovarian cancer.
What is the management of primary dysmenorrhea?
NSAIDs or paracetamol.
Oral contraceptive trials of 3-6 months - combined oral contraceptive pill, or progesterone oral pill.
Conservative advice.
What is the management of secondary dysmenorrhea, caused my endometriosis?
Define the terms:
- Menopause.
- Perimenopause.
- Menopause transition.
- Early menopause.
- Premature menopause.
- Surgical menopause.
What is pathological menopause?
The cessation of menstruation before the age of 40.
What is the period regularity, hormonal and age appearance of a pre-menopausal woman?
Regular periods with some symptoms experienced.
Slight elevations to FSH/ LH levels, with a low oestrogen.
Typically above the age of 40 with decreased fertility.
What is the peri-menopause characterised by?
Physiological changes decreasing the reproductive capacity with abnormal ovulations due to a decrease in follicle number.
Why does the quality of the oocytes change as a woman ages?
The oocytes have been arrested in meiosis I for longer, increasing the risk of abnormalities for any potential children.
When is FSH test used to diagnose menopause?
How?
Women aged 40-45 with menopausal symptoms.
Women under the age of 40 - primary ovarian insufficiency - 2 blood samples taken 4-6 weeks apart.
What are vasomotor symptoms due to?
Decreased oestrogen levels.
State some symptoms of menopause.
What are some dysfunctional uterine bleedings?
What are they often caused by?
Intermentrual bleeding - between periods.
Heavy bleeding.
Mid-cycle bleeding.
Irregular cycles.
Often caused by changes in oestrogen.
What are psychological changes seen in menopausal women?
Irritability.
Confusion.
Lethargy.
Memory loss.
Loss of libido.
Depression.
What are anatomical changes seen in the GI and urinary tracts due to menopause?
GI - motor activity diminished.
Urinary - drying, thinning and decreased elasticity of the bladder, and the lining of the urethra.
What are some symptoms seen in the urinary system, due to menopause?
Loss of pelvic tone.
Urinary incontinence.
Urinary urgency, nocturia and dysuria.
Increased risk of UTIs.
Why is there an increased risk of UTIs in post-menopausal women?
How is this prevented?
The absence of oestrogen decreases the vaginal glycogen stores meaning lactobacillus decreases in number and function, increasing the pH from 4.0 to 7.0.
It is prevented by treating with topical oestrogens.
What are some genital organ changes in post-menopausal women?
Thinning of the vaginal skin - can cause superficial dyspareunia and bleeding.
Regression of the endometrium.
Shrinkage of myometrium.
Thinning of the cervix.
Why do breasts sag after menopause?
Low oestrogen levels decreases the elasticity of the connective tissue.
What contraceptive advice should be given to menopausal women?
Contraception is needed until periods have stopped for 1 year if over 50, if under 50 then they need to have stopped for 2 years.
This is because peri-menopausal women can still get pregnant.
What are the benefits of HRT?
Reduction in vasomotor symptoms.
Improvement in mood changes.
Improvement in urogenital symptoms.
Reduction in osteoporosis risk.
Lower risk of colorectal cancer.
Maintenance of muscle mass and strength, and connective tissue.
Which HRT increases the risk of endometrial and breast cancer?
Oestrogen-only HRT.
What is the drawback of oral HRT?
Increased risk of venous thrombo-embolism.
Outline the advantages and disadvantages of oral, transdermal, vaginal and mirena intrauterine device HRT.
What is PCOS associated with (cause)?
A lack of pulsatile GnRH.
What is metrorrhagia?
Irregular periods.
What are the functions of seminal plasma?
Acts as a transport medium for sperm.
Gives nutritional support to sperm.
Acts as a pH buffering capacity for vaginal pH.
Contains prostaglandins which stimulate muscular activity within the female tract.
What is tested for in semen analysis?
What is the refractory period in the male sex response?
The time between the male can next orgasm - can be minutes to days.
How does the blood in a flaccid penis run?
Arterio-venous anastomoses allows blood to bypass the corpus cavernosum.
What changes are seen in blood vessels for an erection to occur?
The smooth muscle of the helicine arteries relax and straighten.
Which muscles of the pelvic floor compress the venous plexus during erection?
Blubospongiosus and ischiocavernosus.
State some causes of erectile dysfunction.
What is ejaculatory expulsion?
The expulsion of semen through the urethra, out the external urethral meatus.
During the menstrual cycle, how does the cervical mucus change?
Follicular phase - thick mucus.
Ovulation - watery mucus.
Lateral phase - thick mucus.
What occurs in the 4 phases of the female sexual response?
Excitement - clitoral enlargement, swelling of the labia and vaginal lubrication is formed.
Plateau - uterus elevates, labia change colour and the vagina expands (tenting). The orgasmic platform forms.
Orgasm - uterine contractions, rhythmic contractions of the vagina and anal sphincter contractions.
Resolution - seminal pool forms, the vagina returns to normal and the orgasmic platform disappears.
What can be seen in a gram stain of bacterial vaginosis?
Clue cells.
What are some symptoms of pelvic inflammatory disease?
What are some clinical signs of PID?
Where is the extraembryonic mesoderm found between on day 12 post-fertilisation, and what is it divided into?
The cytotrophoblasts and embryoblasts.
It is divided into splanchnic and somatic mesoderm.
What are the different types of placenta praevia?
What are some infections that can pass through the placenta?
What are some causes of oligohydraminos?
What constitutes the maternal-fetal exchange?
What is the composition of amniotic fluid?
What is CTG and how is it interpreted?
Cardiotogoraphy - continuous monitoring, looking at uterine contractions and the heart rate of the fetus in high risk pregnancies.
What are the risk factors for gestational diabetes?
What are the risk factors for pre-eclampsia?
State the 7 phases of the second stage of labour.
What is the apgar score?
What are the 3 types of breech?
What are the different cephalic presentations?
What is done for an obstetric abdominal examination for determining fetal position?
Leopold manoeuvre:
- Superior surface of the fundus is palpated for consistency, shape and mobility.
- Both sides of the uterus are palpated to find which slide the back is facing.
- Which part of the fetus is at the inlet and its mobility.
- Determines fetal attitude and degree of fetal extension into the pelvis.
What are the different frequencies and durations of the contractions during the latent 1st stage, the active 1st stage and second stage of labour?
State what happens to the intensity of the contractions.
The intensity of the contractions increase as labour progresses.
What are the risk factors for shoulder dystocia?
Why may a caesarean section be required?
What is the histology of serous endometrial adenocarcinoma?
Papillae formed - projections of cells that can break off.
Psammoma bodies.
What are the two different ring of fires that can be seen on Doppler ultrasound?
Corpus luteum cyst - has a fluid-filled centre (left).
Ruptured ectopic pregnancy - has an empty uterus (right).
What are some lower genital tract changes that occur postpartum?
State why they occur.
What are the constituents of breast milk?
What composes the levator ani muscle?
Puborectalis.
Pubococcygeus.
Iliococcygeus.
