Reproductive System Anatomy and Physiology

Question 1

what is the blood supply of the breast?

Answer 1

branches of lateral thoracic artery
branches of internal thoracic (mammary) artery
branches of thoracoacromial artery

Question 2

what is the venous drainage of the breast?

Answer 2

lateral thoracic vein

internal thoracic vein

Question 3

what is the lymphatic drainage of the breast?

Answer 3

axillary (apical, central, brachial, anterior, posterior) lymph nodes
parasternal lymph nodes
supraclavicular lymph nodes

Question 4

describe the course milk takes in the breast from production to expulsion

Answer 4

produced in acini in lactiferous lobules
from lobules, milk travels through lactiferous ducts
at the nipple lactiferous ducts dilate to become lactiferous sinuses
lactiferous sinuses open up at the nipple

Question 5

when does breast development start in embryology?

Answer 5

during week 4

Question 6

what is the nerve supply to the breast?

Answer 6

anterior and lateral cutaneous branches of 4th to 6th intercostal nerves

Question 7

what are the four quadrants of the breast called?

Answer 7

inferolateral
inferomedial
superolateral
superomedial

Question 8

what is the vertical and transverse extent of the breast?

Answer 8

vertically: 2nd to 6th rib
transverse: midaxillary line to sternal edge

Question 9

what are the ligaments of Cooper in the breast?

Answer 9

they are fibrous tissue ligaments which anchor alveoli and lobules to the connective tissue

Question 10

how many lobules are contained in each breast?

Answer 10

15 to 20

Question 11

what fibres do nerves to the breast carry?

Answer 11

• sensory fibres to the skin/breast

- sympathetic fibres to blood vessels/smooth muscle in areola

Question 12

what are the axillary lymph nodes?

Answer 12

apical
central
anterior
posterior
brachial

Question 13

what are the two layers of epithelium that surround acini and ducts in the breast?

Answer 13

• luminal epithelial cells

- myoepithelial cells

Question 14

in terms of pharmacokinetics, how does pregnancy affect absorption of drugs?

Answer 14

oral absorption: reduced due to reduced gastric motility/morning sickness
inhaled absorption: increased due to increased blood flow to lungs and reduced tidal volume
intramuscular absorption: increased due to increased blood flow to the muscle

Question 15

in terms of pharmacokinetics, how does pregnancy affect distribution of drugs?

Answer 15

increased distribution due to:

• increase in fat
• increase in plasma volume, so less plasma proteins and more free drug in the circulation

Question 16

in terms of pharmacokinetics, hoe does pregnancy affect metabolism of drugs?

Answer 16

can either increase or decrease metabolism, as pregnancy can have different effects on CP450

Question 17

in terms of pharmacokinetics, how does pregnancy affect excretion of drugs?

Answer 17

increased excretion, due to the higher renal blood flow and increased glomerular filtration rate

Question 18

name the four features of a molecule which allow it to easily transfer through the placenta and to the fetus

Answer 18

• small size
• lipophilic
• non-polar
• protein-bound

Question 19

when is a drug classed as teratogenic vs fetotoxic?

Answer 19

teratogenic if it affects baby’s development between weeks 3 and 8
fetotoxic if it affects baby’s development after week 8

Question 20

name a few examples of drug classes which are unsafe in pregnancy, and give a general idea of what they cause

Answer 20

anticonvulsants - neural tube defects
antihypertensives - renal dysfunction
NSAIDS - early closure of ductus arteriosus/septal defects
retinoids - widespread abnormalities
alcohol - fetal alcohol syndrome

Question 21

is trimethoprim safe in pregnancy? justify answer

Answer 21

only safe after first trimester, teratogenic if given between week 3 and 8

Question 22

what are the mechanisms through which drugs can be teratogenic? give examples

Answer 22

folate antagonism (inhibit cell growth) - methotrexate, trimethoprim, anticonvulsants
neural crest cell disruption - retinoids
enzyme-mediated teratogenicity - NSAIDS
fetotoxicity - antihypertensives (ACEi/ARB)

Question 23

what is an important consideration of drug excretion by the fetus?

Answer 23

drug is excreted into the amniotic fluid, which can be swallowed by fetus and re-enter circulation

Question 24

what precautions should be taken when putting a woman of child-bearing age onto retinoid drugs?

Answer 24

she should be put on two contraception methods to avoid pregnancy while taking retinoids as they are severely teratogenic

Question 25

what is the pouch of Douglas in males and females?

Answer 25

males: rectovesical pouch
females: rectouterine pouch

Question 26

what is culdocentesis?

Answer 26

aspiration of peritoneal fluid, often from Pouch of Douglas