Reproductive-Endocrine System

COURSE OBJECTIVES

Students will be able to

identify and explain the nature of abnormalities seen in Reproductive / Endocrine/ Metabolic system in relation to normal structure and functions.
Outline the principles of therapeutic and behavioural management of patient and families
correlate the normal structure and functions of Reproductive / Endocrine/ Metabolic system to the signs, symptoms patho-physiological states, diagnosis and management of the following common conditions; bleeding per vagina; discharge per vagina; amenorrhoea; repeated abortion; infertility; contraception; pain in lower abdomen; non healing ulcer; breast lump; low back pain; prolapse uterus; obstructive labour; fibroid uterus; undescended testis; acromegaly; diabetes mellitus; cushing’s syndrome; syphillis; STD; HIV And AIDS.

ANATOMY

Students will be able to:

Explain the development and general structure of endocrine system; explain the nature of hormones and mechanisms of storage of secretion; distinguish the function of endocrine system compared to that of nervous system.
describe gross and microscopic anatomy of pituitary gland; visualize the sequalae to enlargement of the gland in each direction including its involvement in basal meningitis; list and define the various types of cells present in the adeno and neurohypophysis; identify the sella turcica and the sphenoidal air sinuses in an x-ray
describe gross and microscopic anatomy of pineal gland; visualize the structure likely to be impaired upon when it is enlarged; interpret the lateral skull radiograph and identify the displacement of the gland suggestive of expanding intracranial lesion. Note the presence of brain sand suggestive of its degeneration.
describe gross, microscopic anatomy and development of thyroid gland; explain the aberrant thyroid in relation to the development of the gland; explain the effect of enlargement of the gland on related structures; visualize the structure likely to be pressed upon in different direction in enlargement of the gland; describe the histology of thyroid gland; thyroid follicles, parafollicular cells and mention their functions.
describe gross, microscopic anatomy and development of parathyroid gland; mention the different types of cells and their functions; explain the effects of the removal of the parathyroid glands or their excess; explain aberrant parathyroid in relation to their development; list the effect of parathyroid adenoma.
describe microscopic anatomy of islets of Langerhans; explain neuro-insular complexes; mention the main types of cells present in the islet along with their functions.
define APUD cells, their distribution and function.
describe gross, microscopic anatomy and development of suprarenal glands; mention the masses that constitute the paraganglia of the body; explain their origin and their association with sympathetic ganglia; name the constituents of the sympathochromaffin or chromaffin system.

Reproductive system

Students will be able to

list the various parts of male and female reproductive organs.
describe gross and microscopic anatomy of testis and its endocrine functions; describe its coverings; explain the gross appearance of the testis in a sagittal section; list the common medical and surgical conditions affecting the testis; explain the collection of fluid in tunica vaginalis (hydrocele); explain the descent of testis.
list the layers of scrotum, the structures present in the spermatic cord.
define gross structures of epididymis, vas deferens and seminal vesicle and their microanatomy. List the common medical and surgical conditions affecting them, explain vasectomy.
explain the formation of wolffian duct and its derivatives.
mention the development of the reproductive system in male and female. Identify the mesonephric and paramesonephric ducts and their caudal terminations; identify the processus vaginalis and the gubernaculums and the location of the testis at different stages of development of the embryo, locate the tunica vaginalis in relation to the developing testis.
describe prostate gland and its microscopic anatomy; mention its function and explain benign prostatic hypertrophy.
describe gross anatomy of penis with its structure of corpora cavernosa, corpus spongiosum; innervation and mechanism of erection. Explain the common medical and surgical conditions with reference applied anatomy- hypospedias, epispedias, phymosis, paraphymosis, circumscision, disturbances in the normal functioning of the penis e.g. inability to erect. List the arteries and veins of the penis, their origin and termination, nerve supply, structures seen in cross section of the penis; muscles of the penis- ischeocavernosus and bulbospongiosus.
describe the development of penis from the phallic tubercle and incorporation of the urethra in it from the urogenital sinus; explain the common anomalies with reference to its development.
describe gross anatomy, microscopic anatomy, arterial supply, development and descent of ovary; distinguish between immature and mature follicles; mesoovarium and structures in the developing ovary and compare them with those in the developing testis; define ovarian fossa.
describe gross, microscopic anatomy and blood supply of fallopian tube; correlate with ectopic pregnancy.
describe gross and microscopic anatomy of uterus; describe its the ligamentous support of the uterus, the broad ligament and its contents; the structures related to the uterus; the peritoneal pouches in relation to the uterus; the vascular supply and nerve supply of the uterus and the tubes, identify the gubernaculums and its subdivisions caused by interruption by the broad ligament and the uterus into the ligament of the uterus.
describe the parts of female external genitalia, relations, arterial supply, venous drainage and innervation; explain the development of the parts of external genitalia and compare them with that of the male; identify labia majora, labia minora, perineal body, vestibule of the vagina, clitoris, superficial and deep perineal pouches boundaries and contents of the pouches, the arteries, veins and nerves of the perineal region. Compare the structures in the perineum and external genitalia in the male and female. Identify the phallic tubercle, the definitive urogenital sinus, and the margins of the cloacae, the labial swellings, labial folds, urorectal septum and its termination in the region of the perineal body.

CLINICAL PHYSIOLOGY

Endocrinology

Students will be able to

list different types of Endocrine glands.
classify Hormones,
discuss mechanisms of Hormone action.
describe hypothalamus & pituitary gland
describe the releasing hormones of hypothalamus.
describe the anterior Lobe of pituitary gland (hormones secreted from, regulation of secretion, functions: Applied: (Hyper & Hypo functions of Growth hormone, ACTH).
describe the posterior lobe (hormones secreted from, functions) and its applied importance
describe the synthesis of thyroid hormones, their release and mechanism of action of thyroid hormones and applied importance in relation to goitre, hyper and hypothyroidism.
describe the synthesis of cortisteroids; functions of Glucocorticoids, mineralocorticoids and sex steroids;
explain the applied aspects of hyper and hypo functions of Adrenal cortical hormone.
describe the synthesis of catecholamines; explain functions of adrenaline, noradrenaline & dopamine.
describe parathythyroid gland and functions of parathormone,
describe hormones controlling calcium metabolism: Parathormone, Calcitonin (Thyrocalcitonin) Calcitriol; applied importance hypo and hypercalcaemia
describe the functions of Insulin, Glucagon. Somatostatin, Pancreatic Polypeptide; Applied aspects: Diabetes Mellitus — Type I, Type II describe pineal gland, melatonin and it function (role in Circadian rhythm)

Reproductive Physiology

Students will be able to

describe functional anatomy of male genitalia
describe spermatogenesis
describe endocrine functions of testis
describe physiological basis of male contraceptive methods
describe functional anatomy of female genitalia
describe menstrual cycle
describe ovarian cycle
describe puberty, menarche, menopause
describe fertilization and Implantation
describe pregnancy and parturition
describe lactation
describe physiological basis of contraceptive methods

CLINICAL BIOCHEMISTRY

Students will be able to

describe receptor model of steroid hormones and peptide hormones.
describe steroid genesis and its regulation and functional zones of the adrenal glands.
describe causes and clinical features of Addison’s disease
describe short and long test (synacten estimation and other biochemical investigation for Addison’s disease.)
describe causes and clinical features of CusKng’s syndrome
describe overnight dexamethasone suppression test and other biochemical investigation.
describe Conn’s syndrome and its biochemical investigation.
explain biological actions and regulation of adrenal steroids androgens, oestrogens, progesterones.
describe formation of T3, T4 and their function and regulation.
describe hypothyroidism, hyperthyroidism thyroiditis and goitre (causes, molecular basis and biochemical investigation)
explain the mode of action, biological functions of insulin, glucagon and somatostatin.
list the hypothalmic releasing factors and describe their functions
list the pitutary glycoprotein hormones (LH, FSH, TSH, ACTH, GH, prolactin)- and their functions.
list posterior pituitary hormone (vasopressin or ADH and oxytocin) and describe their function.
describe diabetes insipidus.
describe water deprivation test and other biochemical test and measurement describe biological rhythm (circadian rhythm).
explain hormonal regulation of protein synthesis; biological actions of glucocorticoids mineralocorticosteroids, diagnostic chemical test for thyroid functions.
describe chemistry of prostaglandins and thromboxanes and explain their physiological effects.
list agents causing cancer. Classify chemical carcinogens.
describe the mechanism of action of chamical carcinogens,
explain sickle cell anaemia, thalassaemia and mutational diseases, describe the role of plasmids in antibiotic resistance.

PATHOLOGY

Reproductive System

Students will be able to

define dysfunctional uterine bleeding and list its causes,
define adenomyosis and list the gross and microscopic features, define endometriosis and list the gross and microscopic features, define endometrial atrophy,
define and classify endometrial hyperplasia.
enumerate the microscopic features of simple and complex (typical and atypical)
hyperplasia of endometrium.
Describe etiopathogenesis, gross and microscopic features of endometrial carcinoma.
define leiomyoma and list the gross and microscopic features of leiomyoma.
define salpingitis; enumerate the gross and microscopic features of tuberculous salpingitis and its complications.
define infertility and list its causes.
define ectopic pregnancy and describe the etiopathogensis of ectopic pregnancy list common sites of ectopic pregnancy,
define abortion and list its causes.
define cervicitis and enumerate the causes of acute and chronic cervicitis define cervical polyp and list its gross and microscopic features.
define cervical intraepithelial neoplasia (CIN) / dysplasia and classify it according to Bethesda system; describe the role of Pap smear in screening Ca cervix.
describe etiopathogenesis of cervical intraepithelial neoplasia and list the microscopic features of CIN.
describe etiopathogenesis of carcinoma of cervix and list the gross and microscopic features of squamous cell carcinoma of cervix and adenocarcinoma of cervix; list compication of Ca cervix.
classify ovarian tumors.
describe morphology of following ovarian tumors: serous and mucinous tumors, teratoma, dysgerminoma.
list gestational trophoblastic diseases.
define hydatidiform mole and list its types.
enumerate the gross and microscopic features of complete and partial mole.
describe morphology of choriocarcinoma.
define hydrocele and list its causes.
classify testicular tumors.
enumerate the predisposing factors of testicular tumors.
describe morphology of seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma.
list common tumor markers of testicular tumors.
define phimosis and list its causes.
list the pre-invasive lesions of penis.
describe the etiopathogensis and morphology of carcinoma, of penis.
define prostatitis and enumerate the causes of acute and chronic prostatitis.
define nodular hyperplasia and list the morphology of nodular hyperplasia of prostate.
list the predisposing factors, morphology and tumor markers of carcinoma of prostate.

Breast

Students will be able to

list the causes of breast lump.
define fibrocystic changes and list the gross and microscopic features.
define fibroadenoma and phylloides tumor and list their gross and microscopic features.
list the precursor lesions of carcinoma of breast.
describe gross and microscopic features of Paget’s disease of nipple.
describe etiopathogenesis of carcinoma of breast.
classify carcinoma of breast.
describe morphology of infiltrating ductal carcinoma — NOS, infiltrating lobular carcinoma and medullary carcinoma.
list the prognostic factors of carcinoma of breast.
define gynaecomastia.
list the causes of gynaecomastia and describe its morphology.

Endocrine System

Students will be able to

list the tumors of pituitary gland.
describe the morphology and complications of pituitary adenoma.
describe Sheehan’s syndrome.
define Cushing’s syndrome and explain its etiopathogenesis.
define pheochromocytoma and list its gross and microscopic features.
list the causes of thyroid nodule.
define hypothyroidism & hyperthyroidism and list their causes and clinical features.
describe cretinism and myxedema.
list different types of thyroiditis.
Describe Hashimoto’s thyroiditis under following headings- definition, etiopathogenesis, morphology and complications.
define thyrotoxicosis.
describe Grave’s disease under following headings- definition, etiopathogenesis, morphology and complications.
define goiter and explain the etiopathogenesis and clinical features of nodular goiter.
list the gross and microscopic features and complications of nodular goiter
classify the tumors of thyroid gland.
list the gross and microscopic features of follicular adenoma, follicular carcinoma and papillary carcinoma.
define diabetes mellitus and classify it.
explain the etiopathogenesis of diabetes mellitus.
describe the acute and chronic complications of diabetes mellitus.
describe the morphology of pancreas, kidney, and eyes in diabetes mellitus.
list the tests used in the diagnosis of diabetes mellitus.

CLINICAL MICROBIOLOGY

Student will be able to

list and describe the important pathogens affecting the Reproductive system;
describe the morphology, pathogenesis, laboratory diagnosis, transmission &
prevention of the following organisms:

Bacteria

Neisseria gonorrhoeae
Treponema pallidum
Haemophius ducreyii
Clamydia
Gardenella vaginalis

Viruses

HIV
Herpes simplex II
Cytomegalovirus
Hepatitis B Virus

Parasite

Trichomonas vaginalis

Fungi

Candida albicans

CLINICAL PHARMACOLOGY

Drugs used in thyroid disorders

Students will be able to

name the hormones of thyroid gland.
list drugs used for hypothyroidism.
mention the major advantages and/or disadvantages of each.
classify antithyroid drugs.
discuss the mechanism of action and adverse reactions of each of them.

Corticosteroids

Students will be able to

name hormones secreted by adrenal cortex.
describe the pharmacological actions, therapeutic uses and adverse reactions of corticosteroids.
compare and contrast natural and synthetic glucocorticoids.
rank the corticosteroids by anti-inflammatory potency and sodium retaining potency.

Drugs used in diabetes mellitus

Students will be able to

list the various insulin preparations and differentiate by their type, approximate onset and duration of action.
name the major adverse reactions of insulin.
classify oral hypoglycaemic drugs and describe how they differ in their mechanism of action, adverse reactions and indication.
name insulin sensitizers and their role in diabetes mellitus.
describe the importance of non-pharmacological management of diabetes mellitus.
Describe the management of ambulatory diabetic patient and diabetic coma.

Drugs used in endocrine related gynaecological problems

Students will be able to

name oestrogens and state the advantages of oestrogen derivatives over the natural oestrogens.
give indications, contraindications and common side effects of both types of oestrogens.
name progestins.
list the important indications, contraindications and adverse reactions of progestins.

Drugs for fertility control

Students will be able to

name the different types of oral and other hormonal contraceptives.
explain the mechanism of action, adverse reactions and administrative regimen of oral contraceptives including emergency contraceptives.

Anabolic steroids and male sex hormones

Students will be able to

name anabolic steroids and describe in what situation it is rational to use anabolic steroids.
give the important adverse reactions of anabolic steroids.

Drugs used in calcium disorder and bone disease

Students will be able to

name the hormones involved in the regulation of calcium metabolism, describe their actions;
name the drugs useful in hypercalcaemia, state how tetany is treated.
list the main types of Vitamin D preparations and give their important adverse reactions.

Drugs used in labour and puerperium

Students will be able to

list different oxytocics.
describe mechanism of action, indications and contra-indications of oxytocics.
list their adverse effects.
list the drugs of choice for post-partum bleeding.
describe drugs used as abortifacients.
describe tocolytics and list their indications and contraindications.

Teratogenicity and placental transfer of drugs

Students will be able to

define teratogen and dysmorphogen.
relate factors influencing drug transport across the placenta and milk.
list the drugs which are to be avoided during pregnancy or at the time of delivery and lactation.

Drugs used in sexually transmitted infections

Students will be able to

Explain the treatment of common sexually transmitted diseases; syphilis, gonorrhoea, chancroid, trichomoniasis, lymphogranuloma venerum, lymphogranuloma inguinale, HIV/AIDS.