Reproductive & Genetics Flashcards
The single gene responsible for sexual determination is:
SRY
The main cell responsible for the sexual differentiation of the internal genital tract is the:
Sertoli cell
Main hormone responsible for differentiation of the internal genital tract is:
Anti Mullerian Hormone - AMH
Main hormone responsible for differentiation of the external genitalia is:
Testosterone
Development of ___________ induces the development of the kidney
the ureter
Every individual goes through an __________ state of sexual differentiation with coexistence of both _____________ tracts
undifferentiated
male/female
What is hypospadias?
Birth defect in boys in which opening of urethra is not located at the tip of the penis
1 / 300
Name some side effects of DES - Diethylstillbestrol
Given in 1940-1970s, synthetic oestrogen to prevent miscarriage
DES daughters -Prenatal/ in utero exposure linked to clear cell adenocarcinoma - cervix/vagina cancer
Appears to be no known effects to DES sons
Most breast cancers derive from what tissue:
Lobular or Ductal
What is the % spread of invasive carcinomas of the breast?
75% Ductal
10% Lobular
Other rarer ones exist
4 molecular Subtypes of breast cancer and some features
(include rough survival %) -
-
Luminal A
- ER/ PgR +ve
- HER2 -ve
- Ki 67 low (mitotic factor)
-
Luminal B
- ER/ PgR +ve
- HER2 -ve or +ve (2 subtypes)
- Ki 67 hige (mitotic factor)
-
Erb-B2 overexpression
- ER + PgR absent
- HER2 +ve
-
Basal Like
- ER + PgR Absent
- HER2 -ve
What are the layers of endometrial “zona functionalis”
Zona compacta
Zona spongiosum
what are the 3 stages of implantation
- Apposition
- Adhesion
- Invasion
What are the 2 phases of the menstrual cycle?
Follicular phase → Day 0-14
Luteal Phase → Day 14-28
Where does Gonadotropin Releasing Hormone come from, and what does it stimulate?
GnRH (Gonadotropin Releasing Hormone) is released from the hypothalamus, and stimulates release of:
- Luteinising hormone (LH) and
- Follicle stimulating hormone (FSH)
Both from the anterior pituitary
Combined oral contraceptive pills (cocp) work by:
- Include oestrogen and progestogen → inhibit FSH and LH release, thus inhibiting follicular development and ovulation
Also:
- Progestogen increases cervical mucus to inhibit sperm access to uterus
- Decreases ability for implantation of fertilised ovum due to atrophic endometrium
Risk factors for breast cancer
- BRCA1 and BRCA2 mutations → 5-10% breast factors
- If you have these genes ~ 80% risk of developing
- Age > 40y
- F:M 100:1
- FHx
- Past Hx
- Hormonal influences
- age 1st pregnancy <30 reduces risk
- # pregnancies
- Diet/Etoh
- Obesity → inc risk post menopause, red risk pre menopause
- Exogenous hormones
- HRT - long term inc
- Oral contraceptives - slight inc breast, red risk others
- Tamoxifen → red risk breast, inc risk others
Steps of breast cancer development
- Normal ductal lumen
- Benign proliferative changes
- Atypical hyperplasia
- Ductal cancer in situ
- Invasive carcinoma
Most common metastases from breast cancer are:
Brain
Bones
Lungs
Liver
Define breast cancer in situ vs invasive carcinoma
In situ - The proliferation of ductal epithelial cells with all the morphologic features of malignancy but without evidence of basement membrane penetration or stromal invasion.
Name some prognostic and predictive factors for breast cancer
Prognostic markers – e.g., ER + good prognosis; HER2 + bad prognosis Predictive markers – e.g., ER+ responds to Hormone Therapy; HER2 + to Herceptin® Therapy
Name some genes involved in breast cancer progression
- Oncogenes
- KRAS
- ERBB2 (HER2/NEU)
- Mismatched Repair
- MLH1
- MLH2
- BRACA1
- BRACA2
- Tumour Suppressor
- PTEN
- P53
- BRACA1
- BRACA2
- Cell Adhesion
- CDH1 - e cadherin
Foetal blood is separated from maternal blood by:
- Foetal capillary endothelium
- Mesenchyme (embryonic connective tissue undifferentiated cells) and cytotrophoblasts (inner layer of trophoblasts)
- Thin layer of syncytiotrophoblasts (epithelial cells that cover villous tree)
Where does the placenta shear off after birth?
At the decidua basalis
What are the names of the foetal, and maternal portions of the placenta?
Foetal → villous chorion
Maternal → decidua basalis
These two are held together by anchoring villi that are anchored to the decidua basalis by the cytotrophoblastic shell
- Lactogenesis (secretion) is inhibited during pregnancy by high levels of what hormone?
- What triggers a sudden drop in this?
- Progesterone → has an inhibitory effect on prolactin
- Expulsion of the placenta
Note → “retained products” aka retention of placental tissue can result in early failure lactogenesis
Suckling at the breast stimulates:
Oxytocin release from the posterior pituitary
This leads to contraction of myoepithelial cells → milk ejection or “let down”
Also - prolactin bursts from anterior pituitary → aids milk production
This becomes a supply & demand situation → weaning must occur slowly as when done abruptly, can cause painful mastitis, and infection of the breast
5 D’s of endometriosis
- Dolor - (chronic pelvic pain)
- Dysmenorrhea - painful period
- Dyspareunia - painful intercourse
- Dysuria - painful urination
- Dyschezia - painful defecation
Define & describe persistent pelvic pain (PPP)
- “non-cancer pain, > 3-6months perceived in structures related to pelvis” → seems currently preferred to Chronic pelvic pain (CPP)
- 20% wome will experience at one stage in their lift
- Very common, assoc w poor outcomes, mental health and “suffering in silence”
Name some potential causes of PPP (persistent pelvic pain)
- Gynaecologic → Endometriosis, Ovarian cysts
- Urologic → Chronic UTI, Bladder dysfunction / stones
- Gastrointestinal → IBD, IBS, Hernia
- Musculoskeletal → Pelvic floor myalgia, Nerve entrapment, SIJ disorders
Rhesus (Rh) incompatibility occurs when:
- Rhesus (Rh) factor is a protein found on outside of red blood cells (RBCs).
- ~ 85% of people are Rh +ve
Problem occurs when:
- Mother is Rh -ve
- Pregnant with Rh +ve baby
- Mum’s immune system reacts, creates Rh antibodies, which facilitates an immune system attack against the baby.
Rhesus (Rh) antibody formation can happen due to:
Only occurs with Negative mum, Positive bub
Antibodies form when Foetal blood enters mother’s circulation or post blood transfusion, from causes such as:
- Injury to stomach area during pregnancy
- Bleeding during pregnancy
- Tests that require cells or fluids drawn from pregnant woman - ie amniocentesis, chorus villus sampling
- Early pregnancy complications such as miscarriages, ectopic pregnancies, termination
- Delivery of baby - vaginal or caesarian
Major risk factors for postnatal depression
- PHx Dep/Anx
- Antenatal Dep/Anx
- FHx Dep/MI
- Lack of social, practical, financial or emotional support
- Life stresses & adverse life events
- Stressful or complicated pregnancy
- Previous miscarriage/stillbirth
- Young maternal age
- Unwell/ unsetteld bub
Rx postnatal depression can include:
- Social support
- Psychological therapy
- Pharmacotherapy
General principles of Dep/Anx Rx in pregnancy
- Planned pregnancy allows time to discuss Rx options, and to switch if necessary to a med that appears safer in pregnancy
- Whenever possible, psychotherapy & psychosocial measures take precedence over pharmacotherapy or electroconvulsive therapy
- Pharmacotherapy goal → not max control of symptoms, but reduction of those that jeopardise mum or pregnancy
- All Rx recommendations discussed w patient, partner and obstetrician
Differentiation between stillbirth and miscarriage
“Expulsion from mother, embryo or fetus:”
Miscarriage
- < 20 weeks
- < 400g (NSW), <500g (WHO→ median wt @ 20w)
Stillbirth after these times/weights
Sperm had 3 major roles in fertilisation
- Induce change in zonal pellucida which prevents polyspermy
- Stimulate second meiotic division of ovum → generating a second polar body which then dies
- Deliver paretnal gene compliment to ovum
- haploid → diploid - which forms the zygote
- determine the gender of the zygote
What is the terminology of developing foetus
First 2 weeks:
- zygote → morula → blastocyst
2-8 weeks
- Embryo
9-40 weeks
- Foetus
3 stages of implantation
- Apposition
- Adhesion
- Invasion
Steps in Follicle development
- Female born with many many diploid (2N) Oogonium
- Pre puberty, these develop into Primordial Follicles (still 2N) → frozen in prophase 1 of Meiosis
-
Primary Follicles : Local androgens at puberty (not FSH or LH) convert some of the primordial follicles into primary follicles
- Primary Follicle → primary oocyte, still frozen in prophase 1, with single layer of cuboidal or columnar follicle cells
-
Early 2ndary Follicle: Secretion of FSH by the anterior pituitary stimulates development of primary follicle to early 2ndary
- Early 2ndary Follicle → has many layers of cuboidal follicle cells surrounding primary oocyte
- Has Zona Pellucida (glycoprotein membrane) surrounding oocyte
- FSH stimulates follicle now to begin production of oestrogen
-
Late 2ndary Follicle (still a primary oocyte → ie hasn’t finished meiosis 1) → develops via FSH & LH stimulation
- Production of pockets of follicular fluid → rich in hyaluronic acid
- More follicular cells
-
Graffian / Vecicular / Tertiary (3ry) Follicle
- 2ndary oocyte → 2 x (n), ie 2 haploid daughter cells - has finished meiosis I
- Frozen in metaphase II
- Pockets of follicular fluid merge to become antrum
- Releases Inhibin B → inhibits FSH production
- Proteolytic enzymes cut “stigma” to pop 2ndary oocyte out of Graffian follicle → Ovulation!! (~day 14)
-
Corpus Luteum → LH surge promotes Graffian follicle to ovulate.
- LH stimulates Corpus Luteum to produce Progesterone