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Yr 2.0 Sem 3 > Reproductive System > Flashcards

Reproductive System Flashcards

1
Q

What’s the point of sexual reproduction?

A

Introduces genetic diversity

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2
Q

Which endocrine axis is responsible for the development of secondary sexual characteristics?

A

The Hypothalamic-Pituitary-Gonadal axis

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3
Q

Why is being male a risk factor for inguinal hernia?

A

Vas deferens passes through the inguinal canal

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4
Q

Where does sperm mature?

A

Sperm matures in the epididymis

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5
Q

Where does spermatogensis occur?

A

Spermatogenesis occurs in the seminiferous tubules

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6
Q

Which lymph nodes do the testes drain to?

A

Para-aortic

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7
Q

Describe how testicular torsion can lead to infarction

A

Testis twists on the spermatic cord, occluding the veins supplying it. This causes a build up of blood within the testis, the increased pressure of which occludes the arteries.

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8
Q

What predisposes to testicular torsion?

A

Bell-Clapper deformity

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9
Q

What 3 fascial layers are cut through during a vasectomy?

A

External fascia, cremasteric fascia and internal fascia

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10
Q

What 3 arteries travel in the spermatic cord?

A

Cremasteric artery, testicular artery and artery to vas

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11
Q

Which nerve supplies the muscle fibers within the fascia of the spermatic cord?

A

Nerve to cremaster

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12
Q

Why is a vasectomy performed with a scrotal approach?

A

To avoid the ureter which passes beneath the vas in the pelvis

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13
Q

Where is most of the fluid in ejaculate produced?

A

The seminal vesicles!

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14
Q

Why are the secretions of the prostate alkaline?

A

To neutralize the acidic female reproductive tract in copulation, creating a more favourable environment for the sperm

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15
Q

Why can you detect prostate cancer via a digital rectal exam?

A

Prostate cancers tend to form in the peripheral zone which sits just anterior to the rectum. They also tend to have a craggy hard consistency.

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16
Q

Why is benign prostatic hyperplasia more likely to be the cause of problems with urinary flow in males than prostate cancer?

A

BPH occurs in transitional zone where it can easily compress the urethra. Prostate cancers tend to be in the peripheral zone which is not directly adjacent to the urethra.

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17
Q

How can smoking cause impotence?

A

Can cause vascular disease which can affect blood supply to the penis

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18
Q

2 Embryology What does the gubernaculum do?

A

Aids decent of gonads into pelvic region

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19
Q

2 What would happen to the developing external genitalia if there is insensitivity to androgens?

A

If stimulation from dihydro-testosterone is blocked the genital tubercle will not elongate and the genital folds will not fuse. These will develop to form clitoris and labia respectively, i.e. female external genitalia.

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20
Q

2 How does the presence of a Y chromosome prompt development of male genitalia?

A

Its SRY region influences the indifferent gonads to become testes.

These then produce testosterone, stimulating development of penis and scrotum.

Androgens from the testes also stimulate development of Wolffian / paramesonephric duct into epididymis, vas deferens and rete testis.

Also secretes Mullerian Inhibitory hormone which suppresses development of mesonephric / Mullerian ducts.

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21
Q

2 How might a septate, heart shaped or double uterus develop?

A

Partial or complete failure of paramesonephric / Mullerian ducts to fuse as they develop into uterus (and upper 1/3 of vagina).

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22
Q

2 What is the transformational zone of the cervix?

A

Area between the internal and external os in which the epithelium changes from non-keratinised stratified squamous to simple cuboidal. (Moves towards internal os with age.)

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23
Q

2 Why does the vaginal epithelium have glycogen inclusions?

A

To support the resident lactobacilli which maintain the low pH of the vagina, protecting from inappropriate microbe growth.

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24
Q

2 Name the phases an ovarian follicle goes through if it develops

A

Primordial follicle -> primary follicle -> pre-antral -> antral -> mature / Graafian (degenerates into -> corpus luteum -> corpus albicans)

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25
Q

2 What is the normal positioning of the uterus?

A

Anteverted and anteflexed

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26
Q

2 Why is the ureter vulnerable in a hysterectomy?

A

Ureter passes under uterine artery which will be clamped during this operation.

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27
Q

2 What is the clinical relevance of the greater vestibular / Bartholin glands?

A

Can become enlarged if infected and can impinge on rectum.

Location of most vulvar adenomas

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28
Q

2 What are the 3 parts of the broad ligament and where are they located?

A

Mesometrium - over uterus, attaching to post. pelvic wall
Mesosalpinx - encloses and hangs off uterine tubes and contains suspensory ligament of ovary
Mesovarium - attaches to the hilum of the ovary, supporting it and enclosing its neurovascular supply

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29
Q

2 Which cells in the ovary secrete progesterone?

A

Granulosa lutein cells

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30
Q

2 Which cells of mature / Graafian follicle are needed to produce oestradiol?

A

Theca intera (secrete androgens), and granulosa cells (aromatise into oestrogen)

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31
Q

2 What type/s of glands does the cervix have?

A

Cervix has mucous and serous glands

32
Q

3 Name the cells of each stage of spermatogenesis

A

Spermatogonium, 1’ spermatocytes, 2’ spermatocytes, spermatids, spermatozoa

33
Q

3 Why is capacitation of sperm needed to allow fertilisation to occur?

A

Remove glycoproteins and cholesterol to allow binding to zona pellucida and activation of sperm signally pathways.

34
Q

3 Differentiate between the spermatic cycle and the spermatic wave

A

Cycle is time taken for reappearance of same stage of spermatogenesis in a given segment of seminiferous tubule
Wave is distance between parts of seminiferous tubules at which spermatogenesis is in the same stage

35
Q

3 When do oocytes complete meiosis 2?

A

Only on fertilisation, otherwise stay arrested in meiosis 1.

36
Q

3 What does Androgen Binding Globulin do?

A

Retains testosterone within seminiferous tubules

37
Q

Yr1 List the 3 ways meiosis introduces genetic variation

A

Crossing over of bivalents in prophase
Independent assortment of chromatids at metaphase
Random segregation of chromosomes when cells become haploid

38
Q

3 Why does progesterone usually drop at the end of the menstrual cycle?

A

The corpus luteum producing it degenerates after 14 days if no fertilisation has occurred.

39
Q

3 In females, where is inhibin produced and what does it do?

A

Granulosa cells of developed ovarian follicle produce inhibin which exerts negative feedback on hypothalamus.

40
Q

3 What’s the normal onset puberty range for boys and girls?

A

Boys - 10-14
years old

Girls - 9-13 years old

41
Q

3 What is the first sign of puberty, in girls, and in boys?

A

Girls - thelarche / breast bud development

Boys - increased testicular volume

42
Q

3 What is the underlying mechanism for the onset of puberty?

A

Gradually increasing pulsatile release of GnRH and thus increasing activation of hypothalmic-pituitary-gonadal axis.

43
Q

3 What scale can you use to assess pubertal development?

A

Tanner scale

44
Q

11 What is generally the cause of most vulval cancers?

A

Longstanding inflammatory and hyperplastic conditions of the vulva, such as lichen sclerosis

45
Q

11 Which strain of HPV is related to vulval cancers?

A

HPV16

46
Q

11 Where would you expect a vulval cancer to spread?

A

Inguinal, pelvic iliac and para-aortic lymph nodes

Later, lungs and liver

47
Q

11 Which type of endometrial adenocarcinoma is more common?

A

Endometrioid endometrial adenocarcinomas

48
Q

11 Why does serous endometrial adenocarcinoma tend to have a worse prognosis?

A

More aggressive, tend to exfoliate and travels through Fallopian tubes to settle on peritoneal surfaces

49
Q

11 What is the most common age range in patients presenting with endometrial cancer?

A

Over 40, usually 55-75 year olds

50
Q

11 Explain why we don’t give unopposed oestrogen with women with uteruses

A

Prolonged oestrogen stimulates development of endometrial hyperplasia which is a frequent precursor to adenocarcinoma.

51
Q

11 What’s the 10 year survival like for endometrial cancer? Suggest why this might be

A 
Really good (75%) 
Often present early as symptoms are post-menopausal or irregular bleeding.
52
Q

11 What would endometrial hyperplasia look like on histology?

A

Increased gland : stroma

53
Q

11 What are the symptoms of a uterine leiomyosarcoma?

A

Heavy / painful periods, urinary frequency, infertility.

Metastatic symptoms esp lung - persistent cough, haemyptsis, shortness of breath etc

54
Q

11 Does the presence of fibroids / leiomyoma increase your risk of uterine cancer and why?

A

No, malignant transformation rarely occurs

55
Q

11 What age group has the peak incidence of uterine leiomyosarcoma?

A

40-60 year olds = peak incidence of uterine leiomyosarcomas

56
Q

11 Which classification of testicular tumours is most common?

A

Germ cell tumours (95%)

57
Q

11 Give 2 markers that can be used for germ cell tumours

A

AFP (alpha foetal protein - yolk sac tumours or mixed)

hCG (human chorionic gonadotrophin -choriocarcinomas or mixed)

58
Q

11 What is the pre-invasive precursor for testicular germ cell tumours / seminomas & non-seminomas?

A

Intratubular germ cell neoplasia

59
Q

11 Which tumour marker is used for ovarian cancer?

A

CA 125

60
Q

11 Suggest why the 10 year survival rate for malignant ovarian cancer patients is quite low?

A

Tends to have metastasised before causing symptoms so patients will often present late

61
Q

11 Are ovarian cancers likely to be functional (produce hormones)?

A

No, most aren’t

62
Q

11 Besides benign, borderline and malignant, how would you classify a Mullerian / epithelial ovarian tumour?

A

Serous, mucinous or endometrioid

63
Q

11 Suggest why serous ovarian cancer often causes ascites

A

Friable mass, often spreads to peritoneal surfaces and omentum (where the metastatic cells induce overproduction of peritoneal fluid)

64
Q

11 Give 3 risk factors for Mullerian /epithelial ovarian tumours

A

Lots of ovulations: Not taking oral contraceptive pill / Nulliparity or low parity etc
Smoking
Endometriosis

65
Q

11 In what type of ovarian tumour might you find hair or teeth?

A

Mature / benign teratomas, also known as dermoid cysts

66
Q

11 What is struma ovarii?

A

Struma ovarii = monodermal benign ovarian teratoma consisting of mature and functional thryoid tissue

67
Q

11 What’s the most likely source of metastases in the ovary?

A

Mets in ovary most likely from = Uterus, cervix, contralateral ovary, pelvic peritoneum

68
Q

11 Which type of ovarian tumour would you suspect in a patient with breast atrophy, voice changes and amenorrhoea?

A

Sertoli-Leydig cell tumours

69
Q

11 Why is immunosuppression a risk factor for cervical cancer?

A

Neoplasia and hence carcinoma of cervix induced by infection with high risk strains of HPV. Immuno-suppressed patients more likely to internalise the virus into cells and infection is more likely to be prolonged due to their inadequate immune response.

70
Q

11 If a lady’s partner has carcinoma of the penis why is she more at risk of cervical cancer?

A

Both induced by infection with the HPV virus which is transmitted sexually.

71
Q

11 Why is screening for cervical cancer still necessary if you have had the vaccine?

A

Vaccination doesn’t protect against all types of HPV that are high risk of causing cancer. Also some may have inadequate immune response to vaccine.

72
Q

11 Why is cervical cancer screening successful? Give 3 reasons

A

Cervix easily accessible for sampling and visual examination
Slow progression from neoplasm to cancer allowing time for intervention
Pap test detects low stage and precursor changes

73
Q

11 How would you treat a high grade cervical neoplasm?

A

Cone biopsy or large loop excision of transformational zone

74
Q

11 What is the prognosis for a CINI (grade 1 cervical epithelial neoplasm)

A

Good, most cases regress spontaneously, small proportion progress to CINII

75
Q

11 What is the average age of presentation for invasive cervical carcinoma?

A

45 years old

76
Q

11 How can HPV cause cancer?

A

HPV 16 and 18 produce viral proteins E6 and E7 which interfere with tumour suppressor genes.

77
Q

11 To which lymph nodes does cervical cancer typically spread to?

A

Para-cervical, pelvic and para-aortic

Yr 2.0 Sem 3 (5 decks)

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