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Download PG Medical 4th Year OG Handwritten Notes

Download PG Medical ( Post Graduate Medical degree) 4th Year OG Handwritten Notes

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Medical PG Handwritten Notes 1st Year, 2nd Year, 3rd Year and 4th Year (Study Material)


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(perm cell differentiation.

what determines Sex in fetus : SRY gene on short arm, chromosome y.

Others:

If SRY gene is present

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Gonads = Testis (7WKS)

(Gonads develop from

Genital ridge)

Sertoli cells

Mullerian inhibiting factor

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(A glycoprotein, secreted at 7wks)

It has paracrine action

ie it acts locally.

Leads to ipsilateral regression of

Mullerian ducts in males by

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9 wks.

Remanants of Mullerian duct in

males: Appendix of Testis

Prostatic utricle

Appendix of Testis

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Hydatid of Morgagni

Leydig cells

Testosterone.

(Its production begins at

9wks (intra-uterine)

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maxm product @ 14-18 wks

Promotes the

growth of

wolffian duct

in males

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Int-Genitalia

S- Seminal vesicle

E-Ejaculatory duct

E - Epididymis

V-Vas deferens

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21. Cells which lie outside blood testis barrier.

Spermatogenesis.

Spermatogonia (46 xy)

Mitosis

Primary spermatocyte

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(46 xy)

Meiosis I

23x

Sec.

spermatocyte

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23y

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Imp. points pn spermatogenesis :

Begins at Puberty.

Time taken : 72-75 days.

one spermatogonia forms 16 primary spermatocyte.

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se spermatocyte gives rise to 4 sperms/spermatids.

one spermatogonia gives rise to 64 sperms/spermatids.

Spermiogenesis:

Spermatids change to sperms

No mitosis/No meiosis

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Time taken: 14 days.

Part of spermatid

Part in sperm.

Nuclear material

Head of sperm.

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Golgi body

Acrosomal cap.

Mitochondria

Middle piece.

Microtubules

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Tail/axial filament.

* sperms lack ER (especially RER)...

sperms : €55 µm

life span - 72 hrs.

sperms attain motility & maturity in Cranial end of epididymis.

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Hormonal support of spermatogenesis :

Hypothalamus

GnRH

Ant. pituitary

* 1st stimulus for Leydig cells to produce testosterone : HCG.

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sperm pathway-

Spermatogenesis OCCUR @seminiferous tubules of Testis.

(Sertoli cells)

Motility & maturity @ Epididymis (cranial end).

Vas deferens.

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They are released along with seminal vesicle fluid. (60% volm +

Fructose).

+ Protastic fluid. ** Bulbo urethral gland secretion.

The semen which is released should liquify in 20-30 minutes.

(Liquifacs d/t: prostatic fluid)

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Ideally semen analysis is done on Liquified semen.

But if no liquifios occurs cin 60 mis & semen analysis on unliquified

semen.

Note: If there is azoospermia with low semen volume &

absent fructose ? Block is below the level of seminal vesicle.

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tmen congenital absence of vas def., Suffer I seminal vesicle agénei

(CAVO)

They have low semen volume, Low PH & Low fructose.

Spermatogenesis is, however, normal !

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* Absence of spermatozoa in semen

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But presence of Fructose

Likely diagnosis may be : Mumps orchitis.

Capacitation :

- Ability of sperms to fertilize ova

- Begins in female reproductive tract (cervix)

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- Major part occurs in Fallopian tube

- Time taken: 7 hours

- After capacitation, sperms become hyper-motile, !!

Acrosomal rx2 :

- occurs after the sperm binds to zona pellucida

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- Zona pellucida has sperm. receptors: ZP1, ZP2 &ZP3, which

mediate acrosomal ru (main : zp3).

- Acrosomal or occurs because enzymes like hylauronidase,

acrosin, etc. are released.

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In females

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Whether ovary is Present/absent

depends on Y chromosome.

For dev. of ovary 2x chromosomes

are needed.

SRY gene Absent

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Gronads = ovary.

Sertoli cells absent

Leydig cells absent

Mullerian I. F. absent

Testosterone absent

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Mullerian duct grows into

Fallopian tube

uterus

Cervix.

upper 3/5th Vagina.

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wolffion duct

regresses.

Ext-genitalia

looks like

female.

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lower part of vagina develops from urogenital sinus (sino-vaginal bulb)

Mast common cause of ambiguous female genitalia: Presence of

testosterone in intra- uterine life [congenital adrenal hyperplasia]

Remnants of wolffian ducts in femates :-

Part of wolffian duct

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Remnants: in females.

1. Pronephros forms Hydatid of Morgagni/Kobelt.

tubercle.

2. Mesonephros.

Cranial end. Epo-ophron/organ of Rasenmiller

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Caudal end. Para-oophron.

3. Wolffian duct proper. Gartner's duct

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All resinames of wolffian duct is present in lateral part of

broad ligament, except para.cophron, which is present in

medial paru- of broad ligament.

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*wolffian duct Mesonephric duct

Mullerian duct para-mesonephric duct.

organ of Rossenmuller :

- consists Vertical tubules (Not Horizontal tubules)

- Lined by cuboid epithelia (Not by columnar epithelia).. !!

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Oogenesis.

46

XX

oogonia

MITOSIS.

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46

XX

- Primary oocyte.

MEIOSIS I: arrested in Diplotene (Prophase).

* This arrested stage is known as

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Dictyate stage (uptp puberty).

This stage is absent in per spermatogenesis.

At puberty,

Meiosis I is resumed

Meiosis is hormone dependent. Dent. LH

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. Meiosis I is resuned 24-36 hours before ovulation.

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At puberty:

The arrest is over.

23x

23X

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Sec. oocyte

Ist polar body.

Release of Sec. oocyte from. Primary is k/a ovulation.

Sec. oocyte.

MEIOSIS II (arrested in METAPHASE

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Completed @ Fertilization!!

Female pronucleus.

Second polar body

size of ova 120 microns (largest cell of body).

Follicles :

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Primory

oocyte

PRIMORDIAL Follicle. (size: 0.02 mm)

* Size of follicle just before ovel² = 18-20mm

#maxm no. of follicles @ 20 wks (5th month of intra-uterine life)

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At birth : 1-2 millions 6-7 millions.

At Puberty: 4-5 lanhs.

400-500 follicles mature in entire lifetime:

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1000 follicles every month.

Germ cells are derived from Epiplast/ectodern.

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Reach youk sac (by 3wks)

Genital ridge (6?)

Oogonia are formed (qwks)

1st oocytes (12 wks)

follicle form begins@ 14 wks!.

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& Completed by 24 wks.

Fertilization:

Site : ampulla (FT)

zygote undergoes cell division,

2,4,8, 16 celled zygote.

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16 celled zygote (Morula).

* zygote stays in Fallopian tube for 3 days

Then it moves towards uterine cavity d/t:-

(1) Peristalsis of tube

(ii) Movement of cilia

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Nutrition to the zygote in F.T. is provided by secretory cells of

FT. in the form of pyruvate.

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6.

oot zygote enters the uterine cavity : Day 4. after fertiliza.

Eda

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14th day

18th day.

Ovulation

zygote

enters Uterine

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Cavity.

Morula

zona pellucida

(on 5th day zona pellacida, is lost

& this is kla zona Hatching).

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As the Morula enters uterine cavity,

fluid enters into it. & Now it is kla BLASTOCYST.

In Blastocyst, cells are arranged in 2 manners

some TROPHOBLAST : which lises the Blastocyst

? Inner cell moss:

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Implantation :

occurs in the form of Blastocyst.

6-7100003 days after fortilization : Beginning

Completed by 10 days after fertilization

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Endometrium

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Dexiduca

capsularis

(separates blastocyst

from uterine cavity)

Interstitial implantation.

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Blastocyst.

Decidua basalis

(Future placenta forms hore)

+ Forms maternal side of placenta.

Dedidua pariefalis

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(Remaining decidua)

:: !!

- Thickness of endometrium at time of implantation = 8mm

In some females, bleeding occurs at the time of implanths

HARTMAN'S sign.

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- After Implantation, Endometrium is kla Decidua.

- As the fetus grow, Decidua basalis & decidua parietalis fuse by

16 wxs. (uterine cavity obliteration).

:: Superfetation could be possible only before uterine cavity Obliter

ie. by 16 wns.

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Gestational

Sac.....

Decidua

capsularis

Decidua

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Parietali's

Double ring sign-

Cat

Double ring sign is absent in Ectopic Pregnancy:

Embryonic period.: 3-8. wks after fertilization.

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(5-10 WKS after pregnancy).

Most teratogenic period.

Fetal period : From 9 WKS after fertilization uptil delivery.

10 First germ layer fromed in fetus: Endoderm.

This differntiation occurs

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Syncytio-trophoblast 8th day after fertilis.

( Trophoblast < Cyta-trophoblast

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chorion leevae.

churion frondosum.

(Farms fetal side

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•Placenta)

Blastocyst.

Villi

Decidua basalis..

(Forms maternal side of

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Placenta)

• Fetal membranes.

Amnion.

Formed @ Day 10, 11. after fertilish.

Derived from ectoderm

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Innermost Fetal memb.

Avascular : Provides tensile strength to fetal memb.

Chorion.

formed 8 days after fertilis

Chorion leevae : Fuses & amnion,

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•Chorion frundosum:

York sac.

first site for hematopoiesis

Allantois.

- A diverticula that arises from hindgut & grows into connecting

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stalk.

+ Prostaglandin predominanrly preseni in fetal memb. - PGE2

... when fetal memb. are ruptured during labour

Prostaglandins are released. & labour proceeds@faster rate

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Site of hematopoiesis

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1. yolk sac.

3-6 WKS Gower 1, 2

Portland.

2. Liver (mainly) 6 WKS HbF

& spleen.

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3. Bone marrow 20 ? ?.

* Petal RBCs have Langer size.

but short life span. (go days)

fetal Hb. at term = 18 gmy. (75-80% is HbF)

Switch over of fetal Hb. to Adult Hb. begins at 36 wus

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is completed by 6 months after birth. (HbF <1% @ 6 months)

This shift is carried by Gluco-corticoids

HbF ? A

- less of 2,3 DPG. More 2,3-DPG.

- Higher affinity for O2.. Less affinity for 02

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::

Less of carbonic anhydrase More:

Resistant to acid & alkali Sensitive to acid & alkali

gets hemolysed.

* Apt test/singer alkali denaturation test.

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It is a qualitative test- done in vasa previa, to differnficate

b/w matemas & fetal blood.

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Blood coming from mother's Vagina is collected in

a test tube

Add NaOH

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1. If color of blood remains same, blood is not hemolysed.

... It contains HbF. ? Indicates Vasa previa

(-ve test)

2. If color of blood is brown. it means blood has

hemolysed

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....It contains HbA ? Indicates placenta previa

(4)ve test).

!!

* Thus, Apt test is used to differentiate fetal blood from

maternal blood.

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* Test to differentiate fetal RBC too & maternal RBC

Placenta

Kleihauer Betke test.

Reagent : citric acid phosphate buffer.

This is a quantitative test:

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originally, this test was used to calciate

the dose of anti-o in RhEve females.

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? Villous Feral blood = 350 ml.

Inter-villous space = Maternal blood (150m2).

Volume of placenta = 350ml+150ml = 500 ml.

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Villi formation stages:

Feto placental circulation is established by 17-21 days

In the placenta, maternal & fetal blood donot mix & each other

are separated by

(1) cyto & syntaytio - trophoblool-

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((i?) Extra-embryonic mesoderm : : Placental membrane...

(ii) Fetal capillary endothelium of

Placental barrier.

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wt of placenta at term = 500 grams.

Ratto of it. of placenta: Fetus = 1:6.

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Fetal side of placenta

Maternal side of placenta

) - shiny & grey.

(1) - Dull red

(1?)-. Membranes attached toit (i) – Divided into polygonal

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Cord attached to it." areas - Lobes:

(ii) - Formed by trophoblast or ..: Each lobe is divided into

chosion frundosum. lobules / cotyledon

(iv) - Forms 4/5th Part of placenta. (iii)- formed by decidua basalis

(iv)- forms 1/5th of placenta

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*- functional unit of placerita: cotyledon/Lobule

*? Placenta forms begins by 6. wrs .

& completed fariatomically) by 16wks.

Physiologically, Placenta Keeps On maturing till 3rd trimester,

Term placenta

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1. No cytotrophoblast

2. Syncytio-trophoblast thickness ?

3. stroma decreases

4. Petal capillaries increase move towards periphery

5. Hoffbarum cells are present

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* USG done for placental localisation in. 3rd trimester

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Placental circulation:

1) Uteroplacental circulation:

No. of spiral arterioles in Inter villous space: 120

On Saturation in Ivs 65-15%

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utero-placental blood flow at term 450-650 ml/min

(* uterine blood flow

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