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My Phase 3a Revision > WOMENS HEALTH - PHYSIOLOGY > Flashcards

WOMENS HEALTH - PHYSIOLOGY Flashcards

1
Q

NEWBORN SCREENING
What types of newborn screening are there?

A
  • Newborn infant physical examination (NIPE)
  • Newborn blood spot conditions
  • Newborn hearing screen
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2
Q

NEWBORN SCREENING
When is the NIPE done?
What for?

A
  • First within 72h of birth + Second by GP at 6–8w
  • Screens for problems with hips, eyes, heart + genitalia
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3
Q

NEWBORN SCREENING
What is the process of the newborn blood spot conditions screen (Guthrie/heel-prick)?

A
  • Screening on day 5–9
  • Residual blood spots stored for 5 years (part of consent process) for research
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4
Q

NEWBORN SCREENING
What conditions does the newborn blood spot screen for?

A

3 genetic –
- Sickle cell disease
- Cystic fibrosis
- Congenital hypothyroidism
6 inherited metabolic –
- Phenylketonuria
- Medium-chain acyl-CoA dehydrogenase deficiency
- Maple syrup urine disease
- Isovaleric acidaemia
- Glutaric aciduria type 1
- Homocystinuria

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5
Q

NEWBORN SCREENING
What is the rough incidence of…

i) sickle cell disease?
ii) cystic fibrosis?
iii) congenital hypothyroidism?
iv) phenylketonuria?
v) MCADD?
vi) MSUD?
vii) IVA?
viii) GA1?
ix) homocystinuria?

A

i) 1 in 2000
ii) 1 in 2500
iii) 1 in 3000
iv) 1 in 10,000
v) 1 in 10,000
vi) 1 in 150,000
vii) 1 in 150,000
viii) 1 in 300,000
ix) 1 in 300,000

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6
Q

NEWBORN SCREENING
What specifically is tested for in…

i) cystic fibrosis?
ii) congenital hypothyroidism?
iii) phenylketonuria?

A

i) Immunoreactive trypsinogen
ii) TSH
iii) Phenylalanine

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7
Q

NEWBORN SCREENING
What is phenylketonuria?
What are the features of phenylketonuria?
What is the management?

A
  • AR defect in phenylalanine hydroxylase (C12)
  • LDs, seizures, ‘musty’ odour to urine + sweat, (fair hair, blue eyes)
  • Phenylalanine restricted diet
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8
Q

NEWBORN SCREENING
What is the management of MCADD?

A
  • Avoid long periods with no food
  • High sugar drinks when ill
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9
Q

NEWBORN SCREENING
What does MSUD, IVA and GA1 have in common?
What are their differences?
What is the management?

A
  • Issues with processing amino acids
  • MSUD = leucine, isolecine + valine
  • IVA1 = leucine
  • GA1 = lysine, hydroxylysine + tryptophan
  • Limit high protein foods
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10
Q

NEWBORN SCREENING
What is homocystinuria?
How does it present?
What is the management?

A
  • Cystathionine synthetase deficiency
  • Developmental delay, MSK like Marfan, fair complexion, brittle hair, dislocation of lens
  • Pyridoxine (vitamin B6)
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11
Q

NEWBORN SCREENING
What is the newborn hearing screening?
Why is it done?

A
  • All babies screened within 4w of birth ideally (up to 3m)
  • Early identification crucial for developing speech, language + social skills
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12
Q

NEWBORN SCREENING
What does the newborn hearing screen involve?
What is the outcome?

A
  • Automated otoacoustic emission (AOAE) test with some babies needing automated auditory brainstem response (AABR) test
  • Refer to audiology within 4w if no clear response with one or both ears
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13
Q

PREGNANCY PHYSIOLOGY
What hormones increase in regards to the anterior pituitary gland?

A
  • ACTH = rise in steroid hormones (cortisol, aldosterone) = improves autoimmune conditions (RA) but susceptible to DM + infections
  • Prolactin = suppresses FSH + LH
  • Melanocyte stimulating hormone = increased skin pigmentation (linea nigra + melasma = brown pigmentation)
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14
Q

PREGNANCY PHYSIOLOGY
What other hormones rise in pregnancy?

A
  • T3/T4
  • HCG = doubles every 48h until plateau at 8–12w then gradual fall
  • Progesterone
  • Oestrogen
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15
Q

PREGNANCY PHYSIOLOGY
What changes occur to the uterus in pregnancy?

A
  • Increase from 100g–1.1kg
  • Hyperplasia + hypertrophy of myometrium
  • Decidual spiral arteries remodelled for wide bore low resistance
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16
Q

PREGNANCY PHYSIOLOGY
What changes occur to the cervix in pregnancy?

A
  • Increased oestrogen = ?cervical ectropion + increased discharge
  • Before delivery, prostaglandins break down collagen in cervix = dilate + efface
  • Chadwick’s sign = early pooled deoxygenated blood > blue tinge
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17
Q

PREGNANCY PHYSIOLOGY
What changes occur to the vagina in pregnancy?

A
  • Oestrogen > hypertrophy of vaginal muscles + increased PV discharge
  • Makes bacterial + candida infection more common
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18
Q

PREGNANCY PHYSIOLOGY
What changes occur to the breasts?

A
  • Increased size with increased gestation
  • Fat deposition around gland tissue
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19
Q

PREGNANCY PHYSIOLOGY
In terms of the cardiovascular system in pregnancy, what…

i) increases?
ii) decreases?

A

i) Blood volume, plasma volume, CO (as increased SV + HR)
ii) Peripheral vascular resistance (can cause flushing + hot sweats) + BP in early-mid pregnancy but returns to normal by term

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20
Q

PREGNANCY PHYSIOLOGY
What changes can occur to the vascular system?

A
  • Varicose veins due to peripheral vasodilation + obstruction of IVC by uterus
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21
Q

PREGNANCY PHYSIOLOGY
What CVS anatomical changes are there?

A
  • Diaphragmatic elevation > heart displaced upwards/left so apex moved laterally
  • Increased ventricular muscle mass + increased LV/LA size
  • Altered QRS (LAD), ECG changes (inverted T waves) + flow (ES) murmurs
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22
Q

PREGNANCY PHYSIOLOGY
In terms of the respiratory system, what are the mechanical changes?

A
  • Increased subcostal angle, pulmonary blood flow + tidal volume
  • Decreased vital capacity + functional residual capacity
  • Progesterone causes trachea-bronchial smooth muscle relaxation
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23
Q

PREGNANCY PHYSIOLOGY
In terms of the respiratory system, what are the biochemical changes?

A
  • Increased oxygen consumption (20%) + RR
  • Compensated resp alkalosis may occur as increased pO2 + reduced pCO2 (facilitates foetal CO2 excretion), renal HCO3- excretion to prevent this
  • Increased 2,3 DPG to promote maternal Hb to release oxygen
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24
Q

PREGNANCY PHYSIOLOGY
In terms of the renal system, what…

i) increases?
ii) decreases?

A

i) Blood flow to kidneys (so GFR), aldosterone (Na + water reabsorption + Retention), protein excretion
ii) Serum creatinine, urate + albumin

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25
Q

PREGNANCY PHYSIOLOGY
What can happen in terms of the urinary system?
What is a consequence of this?
What else contributes?

A
  • Dilatation of ureters + collecting system > physiological hydronephrosis (more R)
  • Increased risk of UTIs
  • Decreased ureter tone/peristalsis = urinary stasis
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26
Q

PREGNANCY PHYSIOLOGY
What 4 forces/pressures govern fluid retention in pregnancy?

A
  • Capillary (hydrostatic) pressure of blood in vessel = draws fluid OUT
  • Interstitial fluid colloid oncotic pressure of proteins in interstitial fluid = draws fluid OUT
  • Interstitial fluid pressure of tissues surrounding vessel = draws fluid IN
  • Plasma colloid oncotic pressure (albumin) = draws fluid IN
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27
Q

PREGNANCY PHYSIOLOGY
Why does pregnancy cause dilutional anaemia?
What is the purpose of this?

A
  • Increased RBC production = higher iron, folate + B12 requirements
  • Increased ECF + plasma volume MORE than RBC volume leading to lower red cell conc (haematocrit) + lower Hb conc
  • Facilitates placental perfusion
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28
Q

PREGNANCY PHYSIOLOGY
What happens in terms of clotting in pregnancy?

A
  • Clotting factors (fibrinogen, VII, VIII + X) increase
  • Plasminogen activator inhibitor increases (plasmin usually breaks clots down)
  • Hypercoaguable state
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29
Q

PREGNANCY PHYSIOLOGY
In terms of haematology in pregnancy, what…

i) increases?
ii) decreases?

A

i) WBCs, ESR, d-dimers, ALP
ii) Platelets, albumin

30
Q

PREGNANCY PHYSIOLOGY
What are the metabolic changes are there in pregnancy?

A
  • Early = post-prandial glucose plasma peak lower due to fat deposition + glycogen storage
  • Late = higher for longer + maternal insulin resistance (via hPL) for foetal glucose sparing
  • Maternal insulin rises during most of pregnancy
31
Q

PREGNANCY PHYSIOLOGY
What are the changes to the skin and hair in pregnancy?

A
  • Linea nigra + melasma
  • Striae gravidarum
  • General pruritus (?OC)
  • Spider naevi + palmar erythema
  • PP hair loss normal, improves within 6m
32
Q

PREGNANCY PHYSIOLOGY
What facilitates blastocyst implantation in pregnancy?

A
  • Increased GFs, proteolytic enzymes + inflammatory mediators
  • Not rejected as change in self/non-self pattern recognition molecules (HLA + MHC proteins)
33
Q

PREGNANCY PHYSIOLOGY
In pregnancy, what changes to the humoral and cell-mediated immunity?

A
  • Humoral = unchanged, plenty of circulating Th2 cells to fight infections (antibodies)
  • Cell-mediated = reduced as progesterone down regulates production of Th1 cells (phagocytes, cytotoxic T lymphocytes)
34
Q

PREGNANCY PHYSIOLOGY
What is the impact of dampening Th1 production?
What are the implications?

A
  • Shift to increased Th2 production (bias) to protect foetus
  • Pre-eclampsia, IUGR + miscarriage do not have a Th2 bias
35
Q

REPRODUCTION
What are the different stages in follicular genesis and what stage in the cell cycle are they?

A
  • Primordial follicles = diploid, arrested at prophase I
  • Primary follicle = diploid, undergoing meiosis I
  • Secondary follicle = haploid, once meiosis I complete
  • Antral (Graafian) follicle = haploid, frozen in metaphase II
36
Q

REPRODUCTION
What are the structures of…

i) primordial follicles?
ii) primary follicles?

A

i) Each contain primary oocyte (germ cells) that eventually form mature ovum
ii) Primary oocyte > zona pellucida > cuboidal granulosa cells, zona pellucida secreted from granulosa cells

37
Q

REPRODUCTION
What happens when follicles reach the secondary follicle stage?

A
  • Granulosa cells express FSH receptors = oestrogen production to grow
  • Theca cells express LH receptors = steroidogenesis
38
Q

REPRODUCTION
How is a dominant follicle chosen?

A
  • Fluid-filled chamber (antrum) starts to develop causing rapid growth
  • Rising LH leads to rising oestrogen
  • Dominant follicle with lots of FSH receptors outgrows the others
39
Q

REPRODUCTION
What happens at ovulation?

A
  • LH surge = smooth muscle of theca externa contracts
  • Follicle bursts + secretes enzymes puncturing hole in ovary
  • Fimbriae of fallopian tubes sweeps oocyte up, surrounded by zona pellucida
  • Leftover follicle > corpus luteum
40
Q

REPRODUCTION
How does fertilisation occur?

A
  • Sperm enters fallopian tube + attempts to penetrate through corona radiata + zona pellucida via acrosome reaction
  • Fusion of sperm + egg = zygote
41
Q

REPRODUCTION
What happens immediately after fertilisation?

A
  • Cell rapidly divides > mass of cells (morula) travels to uterus
  • Fluid filled cavity (blastocele) expands to form blastocyst (>80 cells) with outer layer (trophoblast) + inner layer (embryoblast)
42
Q

REPRODUCTION
When does the blastocyst reach the uterus?
What happens?

A
  • 8–10d after ovulation
  • Trophoblast cells undergo adhesion to stroma of endometrium
  • Outer layer of trophoblast (syncytiotrophoblast) forms projections into the stroma
43
Q

REPRODUCTION
Once the blastocyst has implanted, what happens to the stroma?
What signifies blastocyst implantation?

A
  • Cells of stroma convert into decidua to provide nutrients (decidual reaction)
  • Syncytiotrophoblast produces hCG to maintain corpus luteum
44
Q

REPRODUCTION
What happens to the embryoblast after implantation?

A
  • Divides into yolk sac + amniotic cavity on opposing sides with embryonic disc between
  • Chorion surrounds this complex with inner cytotrophoblast + outer syncytiotrophoblast which is embedded in endometrium
45
Q

REPRODUCTION
How does the chorion develop over time?

A
  • Chorionic cavity forms around the yolk sac, embryonic disc + amniotic sac + these structures suspended from the chorion by the connecting stalk (eventually umbilical cord)
46
Q

REPRODUCTION
When does the embryonic disc develop further?
What does it develop into?

A
  • 5w
  • Foetal pole with 3 layers = ectoderm (outer), mesoderm (mid), endoderm (inner)
47
Q

REPRODUCTION
What tissues does the…

i) ectoderm
ii) mesoderm
iii) endoderm

produce?

A

i) Skin, hair, nails, teeth, CNS
ii) Heart, muscle, bone, connective tissue, kidneys, blood
iii) GI tract, lungs, liver, pancreas, thyroid, reproductive

48
Q

REPRODUCTION
When do actual organs begin to develop?

A
  • 6w foetal heart forms + starts to beat
  • 8w all major organs start development
49
Q

REPRODUCTION
How does the placenta develop?

A
  • Syncytiotrophoblast forms chorionic villi with foetal blood vessels
  • Those nearest connecting stalk most vascular, cells proliferate + become placenta at about 10w
50
Q

REPRODUCTION
How is nutrient diffusion facilitated in terms of how the placenta develops?

A
  • Spiral arteries reduce their vascular resistance (narrow bore high resistance > wide bore low)
  • Makes them more fragile so blood flows out causing pools of blood (lacunae) at 20w surrounding chorionic villi for diffusion
51
Q

REPRODUCTION
What role does the placenta play in immunity?

A
  • IgG crosses placenta to give foetus immunity
  • Primary immune deficiency hypogammaglobulinaemia can occur in babies whose mothers did not have high enough IgG during pregnancy
52
Q

REPRODUCTION
What role does the placenta play in respiration?

A
  • Oxygen source for foetus, foetal Hb has higher affinity for oxygen so extracts it from maternal blood
  • CO2, H+, HCO3- + lactic acid exchanged to maintain acid-base balance
53
Q

REPRODUCTION
What role does the placenta play in nutrition and excretion?

A
  • Main source = glucose, can transfer vitamins + minerals as well as alcohol + meds
  • Similar function to kidneys, filters foetal waste (urea + creatinine)
54
Q

REPRODUCTION
What are the main hormones produced by the placenta?

A
  • hCG (maintain corpus luteum)
  • Oestrogen
  • Progesterone
  • Human placenta lactogen
55
Q

REPRODUCTION
What is the role of oestrogen in pregnancy?

A
  • Softening tissue > more flexible, allows muscles + ligaments of uterus and pelvis to expand + cervix become soft
  • Enlarges + prepares breasts + nipples for breast feeding
  • E3 declines with foetal distress, E2 increases endometrial progesterone receptors
56
Q

REPRODUCTION
What is the role of progesterone in pregnancy?

A
  • Produced by corpus luteum until 10w
  • Initially prepares endometrium for implantation by proliferation, vascularisation + decidual reaction
  • Later, maintains pregnancy by preventing contraction
  • Relaxation elsewhere > heartburn, constipation, hypotension
57
Q

REPRODUCTION
What is the role of human placental lactogen in pregnancy?

A
  • Diabetogenic as raises blood glucose levels to help increase nutrient supply + helps convert mammary glands into milk secreting tissue
58
Q

MENSTRUAL CYCLE
When is the last menstrual period?

A
  • 1st day of last period (cycle runs from 1st day of last to 1st day of next
59
Q

MENSTRUAL CYCLE
What 2 cycles exist within the menstrual cycle?

A
  • Ovarian cycle (development of follicle + ovulation)
  • Uterine cycle (functional endometrium thickens + shreds)
60
Q

MENSTRUAL CYCLE
What happens in the menstrual phase?

A
  • Old endometrial lining from previous cycle shed marking day 1 (lasts 5d)
61
Q

MENSTRUAL CYCLE
What happens in the follicular phase?

A
  • Independently primordial follicles mature into primary + secondary follicles with FSH receptors
  • Low oestrogen + progesterone = pulses of GnRH > LH + FSH release
  • FSH leads to follicular development + recruitment
62
Q

MENSTRUAL CYCLE
What happens as secondary follicles grow during follicular phase?

A
  • Theca cells develop LH receptors + secrete androgens
  • Granulosa cells develop FSH receptors + secrete aromatase
  • Leads to increased oestrogen > -ve feedback on pituitary to reduce LH + FSH leading to some follicles to regress
63
Q

MENSTRUAL CYCLE
What occurs during ovulation?

A
  • Follicle (dominant) with most FSH receptors continues developing
  • Secretes further oestrogen which at a threshold causes spike in LH (+ slight rise in FSH) causing release of ovum on day 14
64
Q

MENSTRUAL CYCLE
What occurs during the luteal phase?

A
  • Dominant follicle > corpus luteum + luteinised granulosa cells converts cholesterol into progesterone for 10d to facilitate implantation + reduce FSH/LH + oestrogen
  • Also secretes inhibin to reduce FSH
65
Q

MENSTRUAL CYCLE
What happens if the egg is fertilised?

A
  • Syncytiotrophoblast of embryo secretes human chorionic gonadotropin (hCG) which maintains corpus luteum
66
Q

MENSTRUAL CYCLE
What happens if the egg is not fertilised?

A
  • hCG absence > corpus luteum degenerates into corpus albicans
  • Fall in progesterone + oestrogen causes endometrium to breakdown + menstruation occurs
  • FSH + LH levels rise
  • Stromal cells of endometrium release prostaglandins to encourage endometrium breakdown + uterine contraction
67
Q

MENSTRUAL CYCLE
What happens in the early secretory phase of the menstrual cycle?

A
  • Progesterone mediated + signals ovulation occurred to make endometrium receptive, cause spiral arteries to grow longer + uterine glands to secrete more mucus
68
Q

MENSTRUAL CYCLE
What happens in the late secretory phase of the menstrual cycle?

A
  • Cervical mucus thickens + less hospitable for sperm
  • Decrease in oestrogen + progesterone > spiral arteries collapse + constrict + functional layer prepares to shred
69
Q

MENSTRUAL CYCLE
What are the stages of the menstrual cycle?

A
  • Menstruation (Days 1-5)
  • Proliferation (Days 6-14)
  • Ovulation (Day 14)
  • Secretion (Days 16-28)
70
Q

MENSTRUAL CYCLE
What happens in the proliferative phase?

A
  • High oestrogen > thickening of endometrium, growth of endometrial glands + emergence of spiral arteries from stratum basalis to feed the functional endometrium
  • Consistency of cervical mucus changes to make more hospitable for sperm

My Phase 3a Revision (27 decks)

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