The Reproduc-Tive System

King Abdul Aziz University Faculty of medicine Faculty of Medicine

KingKing AbdulAziz AbdulAziz UniversityUniversity

THE REPRODUCTIVE SYSTEM MODULE

Phase II Study Guide

REPRODUCTIVE SYSTEM Page 1 King Abdul Aziz University Faculty of medicine

كلمة ترحيبية :أخي / أختي الطالبة السلم عليكم ورحمة ا وبركاته يسعدني أن أرحب بكم في هذا الجهازالتناسلي ,أتمنى لكم كل توفيق وسعادة وأتمنى منكم أن ل تترددوا بالسؤال عن أي معضلة تواجهونها سواء كانت علمية أو تنظيمية , .أدعوا ا عز وجل أن يسدد خطانا جميعا ولكم تحياتي وتقديري د/عبد المعين الغا رئيس فريق عمل الجهاز التناسلي

WELCOME MESSAGE

Dear all students Al-salaam alikum, It is my pleasure to welcome you all for this reproductive module, wishing you all the best. Please don't hesitate to contact me for any inconvenience or any scientific queries on my e-mail. Allah prayers for all of us to make our steps in the right path.

Sincerely all, Dr. Abdulmoein Al-Agha, Chairman, Reproductive System Module, [email protected]

REPRODUCTIVE SYSTEM Page 2 King Abdul Aziz University Faculty of medicine TABLE OF CONTENTS

TOPIC Page

WELLCOME MESSAGE 2

THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 7

CURRICULUM MAP 9

PHASE II 9

STRUCTURE OF THE MODULE 10

INTRODUCTION 10

AIMS & OBJECTIVES 10

MODULE DETAILS 12

MODULE MEMBERS CONTACTS 13

MODULE GROSS THEMEMS 15

LIST OF SUGGESTED READING REFRENCES 20

ASSESSMENT 21

ICONS 22

TOPIC OUTLINES 24

Lectures Department

1 The Reproductive System : An overview. Physiology 25

2 Normal & Abnormal embryology of the male Reproductive Tract. Anatomy 27

3 Normal & Abnormal Embryology of the female Reproductive Tract. Anatomy 29

4 Gross anatomy of the female Reproductive Tract. Anatomy 31

5 Gross anatomy of the male Reproductive Tract. Anatomy 33

6 Histology of normal male Reproductive Tract. Anatomy 35

7 Histology of normal female Reproductive Tract. Anatomy 37

REPRODUCTIVE SYSTEM Page 3 King Abdul Aziz University Faculty of medicine 8 Male &Female gamete development Anatomy 39

9 The puberty onset & the major physiological changes Physiology 41

10 Clinical Testicular steroidogenisis & its endocrine control:I 42 Biochemistry

11 Clinical Testicular steroidogenisis & its endocrine control:II 42 Biochemistry

12 Clinical Female sex hormones :Part I 44 Biochemistry

13 Clinical Female sex hormones :Part II 44 Biochemistry

14 The menstrual Cycle Physiology 45

15 physiology of pregnancy Physiology 47

16 Embryonic period Anatomy 49

17 Fetus and placenta: part I Anatomy 51

18 Fetus and placenta: part II Anatomy 53

19 Maternal response to pregnancy Physiology 54

20 The physiology of parturition Physiology 56

21 Clinical Prenatal diagnosis 58 Biochemistry

22 Antenatal Care Obs. & Gyn. 59

23 Drugs during pregnancy Pharmacology 61

24 Fetal physiology Physiology 63

25 The menopause changes underlying the climacteric symptoms Physiology 65

26 Clinical Biochemical investigations of infertility 67 Biochemistry

27 Pathology of Vulva, Vagina & Cervix Pathology 68

28 Pathology Benign Uterine Pathology 70

29 Malignant neoplasms of the uterine corpus. Pathology 71

REPRODUCTIVE SYSTEM Page 4 King Abdul Aziz University Faculty of medicine 30 Tumors of the ovary. Pathology 72

31 Trichomoniasis Parasitology 73

32 Acquired Toxoplasmosis Parasitology 76

33 Ambiguous genitalia. Pediatric 79

34 Trophoblastic pathology. Pathology 80

35 Diseases of prostate. Pathology 81

36 .Congenital Toxoplasmosis Parasitology 82

37 Pathology of the testis & Testicular Adnexa Pathology 84

38 Reproductive Pharmacology : Oxolytics & Tocolytics drugs Pharmacology 86

Tutorials

1 Testicular & prostatic Pathology . Pathology 88

2 Female genital tract Pathology. Pathology 89

3 Development of male & female reproductive tracts Anatomy 90

4 Male & female sexual behavior Physiology 91

5 Radiology of reproductive system Radiology 93

6 Disorders of gonadal function in male Clinical 95 Biochemistry

7 Disorders of gonadal function in female Clinical 96 Biochemistry 8 Sexual Transmitted Disease. (Parasites) Parasitology 97 Practical

1 Dissection of male reproductive tract Anatomy 99

2 Dissection of female reproductive tract Anatomy 100

3 Diagnosis of pathological specimens of male genital system Pathology 101

4 Radiology of Reproductive System Radiology 102

5 Abnormal vaginal bleeding Obs. & Gyn. 103

REPRODUCTIVE SYSTEM Page 5 King Abdul Aziz University Faculty of medicine 6 Histology of the normal male reproductive tract Anatomy 105

7 Diagnosis of pathological specimens of female genital system I Pathology 106

8 Histology of the normal female reproductive tract Anatomy 107

9 Diagnosis of pathological specimens of female genital system II Pathology 108 Clinical Presentation

1 Puberty :normal & abnormal Pediatrics 110

2 Ectopic pregnancy Obs. & Gyn. 111 SDL

1 Review of hypothalamus- anterior pituitary- gonadal axes in male & Physiology 113 female

2 Normal Labor ( Video Show ) Obs. & Gyn. 114

3 Pregnancy loss & miscarriage Obs. & Gyn. 115

4 Fertilization & implantation Anatomy 116 PBL

OUTCOMES OF THE MEDICAL UNDERGRADUATE CURRICULUM

1) Knowledge

Undergraduate Program Learning Outcomes

REPRODUCTIVE SYSTEM Page 6 King Abdul Aziz University Faculty of medicine Learning Outcomes Code

Knowledge

By the end of the program the graduate will be able to:

A1 Describe normal human development across the life-span and how these affect normal structure and function.

A2 Describe normal structure and function of the major systems and how they interrelate.

A3 Describe the molecular, biochemical and cellular basis essential for maintaining homoestasis.

A4 Demonstrate knowledge of the basic medical sciences that explain causes and mechanisms of disease.

A5 Describe the alterations in structure and function of major body systems as a result of illness or injury.

A6 Demonstrate knowledge and understanding of the pharmacological principles of treatment using drugs, their efficacy in the management and symptomatic relief of diseases, as well as their side effects.

A7 Discuss the implications of basic ethical principles, including confidentiality, informed consent, truth telling, and justice, for the care of patients.

A8 recognize the legal background of medical practice

A9 Explain the causes and mechanisms of intoxication.

A10 Describe the role of family, community, and culture as factors influencing patient presentations, interpretations of illness episodes and adherence to treatment episodes.

A11 Demonstrate knowledge and understanding of the natural history of disease and relationships with risk factors and disease prevention.

A12 Recognize and discuss the principles of disease surveillance and screening, disease prevention, communicable disease control, health promotion, and health needs assessment.

A13 Describe strategies to support life-long learning via print and electronic sources to assist in making diagnostic and treatment decisions and to remain current with advances in medical knowledge and practice.

A14 Demonstrate knowledge of how to use the basic medical sciences and clinical skills for clinical decision making and problem solving in the care of

REPRODUCTIVE SYSTEM Page 7 King Abdul Aziz University Faculty of medicine patients.

A15 Recognize the scientific basis of health, disease, and medicine in the management of common and high impact conditions in the society.

A16 Demonstrate knowledge of the functional approach to managing chronic conditions, including knowledge of the impact of chronic illness on function.

A17 demonstrate basic knowledge of the global health care delivery system in the community including physicians, hospitals, outpatient centres, health agencies and the role of community agencies in that system.

A18 Recognize the management of common emergencies and the initial and the life saving management steps for other emergencies.

A19 Identify the "Red flags" indicating seriousness in the different clinical presentations.

Cognitive Skills

B1 Recognize, define and prioritize problems.

B2 Demonstrate the ability to acquire new information and data.

B3 Critically appraise validity and applicability of acquired information to one’s professional decisions.

B4 Organize, record, research, present, critique, and manage clinical information.

B5 Recognize the limitations of knowledge in medicine and the importance of triangulation of evidence before reaching a decision.

B6 Evaluate the patient’s medical problems.

B7 Formulate accurate hypotheses to serve as the basis for making diagnostic and treatment decisions.

B8 Reflect on one’s thinking process and decisions and apply rational processes.

B9 Use appropriate intellectual strategies to deal with uncertainties when they arise.

B10 Demonstrate an understanding of research methodology.

B11 Formulate research questions.

REPRODUCTIVE SYSTEM Page 8 King Abdul Aziz University Faculty of medicine B12 Draw research hypotheses.

B13 Choose appropriate research methodologies and designs.

B14 Select appropriate methods of data collection.

B15 Analyse and interpret collected data.

Interpersonal Skills & Responsibility

C1 Display the personal attributes of compassion, honesty, and integrity in relationships with patients, families, communities and the medical profession.

C2 Exhibit appropriate value for the sensitive nature of the doctor/patient relationship and the importance of active listening, with attention to the patient’s familial, cultural, and spiritual circumstances.

C3 Demonstrate professionalism and high ethical standards in all aspects of medical practice, specifically competence, honesty, integrity, respect for others, professional responsibility and social responsibility.

C4 Exhibit a capacity for self-evaluation, moral reflection and ethical reasoning to form the basis for a self-directed, lifelong engagement in the responsible, committed, compassionate practice of medicine.

C5 Apply the four principles of ethical and legal knowledge, namely respect for autonomy, beneficience, non-maleficience and justice.

C6 Demonstrate awareness and understanding of the legal and professional responsibilities; and report inappropriate medical practice.

Communication, Information Technology & Numerical Skills

D1 work effectively as part of a health care team

D2 communicate effectively with patients, their families and colleagues, both verbally and in writing

D3 retrieve information by all means including electronically

D4 present information clearly in written, electronic and oral forms

D5 work within a changing, multi-task environment

Psychomotor Skills

REPRODUCTIVE SYSTEM Page 9 King Abdul Aziz University Faculty of medicine By the end of the program the graduate will be able to:

E1 Elicit accurate comprehensive and focused medical history by employing techniques that facilitate the patient’s sharing of information.

E2 Conduct a both effective and accurate comprehensive and focused physical examination.

E3 Formulate a differential diagnosis.

E4 Select the appropriate laboratory tests and radiographic studies and interpret their results and use them in making diagnostic and treatment decisions.

E5 Formulate and implement a plan of care for both the prevention and treatment of disease.

E6 Educate patients about their health problems and to motivate them to adopt health promoting behaviors.

E7 Use pharmacotherapeutic agents and other therapeutic modalities effectively.

E8 Demonstrate appropriate technique for performing Basic Life Support and Advanced Life Support.

E9 Undertake tasks to initiate and be involved in the care of acutely ill patients.

CURRICULUM MAP

YOU ARE HERE… Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Internship

Phase I Phase II REPRODUCTIVE SYSTEM Page 10 King Abdul Aziz University Faculty of medicine

This phase will include knowledge, skills and attitudes, particularly attitudes toward the learning process. By the end of Phase 1, you should be ready for phase 2 of the learning process. PHASE I

Third YEAR

V- SEMESTER VI - SEMESTER

Gastrointestinal System/ Nutrition Medical Microbiology and metabolism

Medical Pharmacology Nervous System & Special Senses

Early Clinical Experience& Communication Skills Endocrine System (1) & (2)

Arabic Language Reproductive System (1) & (2)

Islamic Studies (3) Islamic Studies (4) & Medical Ethics

STRUCTURE OF THE MODULE

Module is composed of:

Course Course Title Contact Hours Credit .No Hours STS Reproductive L T/S P CL/P PBL SDL

System 38 8 9 2 1 4 5

INTRODUCTION

REPRODUCTIVE SYSTEM Page 11 King Abdul Aziz University Faculty of medicine Aims:

1. Understand the processes of human reproduction from the production of gametes, establishment of the embryo through to independent life by the newborn infant.

2. Understand common problems & disorders of the male& female reproductive tract, the mechanisms of contraception and the sexual transmission of diseases.

3. Acquire skills & working knowledge & understanding of the principles and concepts applicable to the Reproductive System, in general.

Objectives:

By the end of this module, the student should be able to:

1. Describe the development of the reproductive tract in the male & the female during fetal life, its genetic and hormonal control and abnormalities.

2. Describe the mechanisms underlying puberty in the male and the female and the sequence of associated changes.

3. Describe the anatomy of the male reproductive system, the histology of testis and accessory sexual organs and the formation of male gamete.

4. Describe the role of gonadotrophins in the control of male gamete production and steroid genesis, and the effects of androgens upon the body.

5. Describe common pathological changes of the male reproductive system, including prostatic and testicular cancer.

6. Describe the anatomy of the female reproductive tract, and the histology of the ovaries, uterus, cervix and vagina, including the ovarian cycle (the formation of the female gamete), the uterine cycles.

7. Describe and explain the endocrine control of the production of the female gamete and the effects of ovarian steroid hormones upon the reproductive tract which underlie the normal menstrual cycle. Describe some common menstrual abnormalities.

8. Describe the pathophysiology of the menopause.

9. Describe the common pathological changes of the female reproductive system, including cancers of the reproductive tract and the basic cellular changes and the precancerous lesions.

10. Describe reasons for infertility in the male and female and methods for assisted reproduction.

11. Describe the process of fertilization and implantation, the structure of the placenta, and the role of the endocrine activity of the placenta in the maintenance of pregnancy.

REPRODUCTIVE SYSTEM Page 12 King Abdul Aziz University Faculty of medicine 12. Describe the maternal adaptations to pregnancy, the underlying mechanisms involved and pregnancy-induced maternal disorders.

13. Describe the normal pattern of embryonic and fetal development, the ways in which it may be assessed, and the principles of detection of fetal abnormalities.

14. Describe the physiological adaptation of the fetus to intrauterine, the ways in which the neonate adapts to an extra uterine existence, and some common problems of neonates.

15. Describe the processes involved in a normal labor and delivery and some common problems of labor.

16. Understand the biochemistry of semen and physiology of ejaculation.

Transferable Skills:

By the end of this module, students will demonstrate the ability to:

1. Assimilate and integrate information from lectures, practical sessions, tutorials, clinical presentation sessions and independent learning activities.

2. Gain practical skills associated with the dissection of the cadaver and the examination of the living.

3. Interpret two-dimensional images of the Reproductive System from radiographic techniques.

4. Explain the pathology of Reproductive System and drug action in relation to the underlying processes.

Module details:

DEPARTMENT LECT. TUTOR. Clinical PRACT. PBL STUDENT Presentation DIR. L.

Anatomy 10 1 ---- 4 ---- 1

Pathology 7 2 ---- 3 ------

Physiology 8 1 ------1

Pharmacology 2 ------1 ------

Biochemistry 6 2 ------

Ob&Gyne 1 ---- 1 1 ---- 2

Pediatrics 1 ---- 1 ------

Urology. ------

Radiology ----- 1 ------1 ------

Parasitology 3 1 ------

Total 38 8 2 10 4

MODULE MEMBERS CONTACTS

Name Department E-mail

Dr. Abdulmoein Al-agha Pediatrics [email protected]

Dr. Layla Abdullah Pathology [email protected]

Prof. Manssour Suliman Pharmacology [email protected]

Prof. Asma Aldbbagh Radiology [email protected]

Dr. Hala saeed Parasitology [email protected]

Dr. Fayza Al-fayze Biochemistry [email protected]

Dr. Khidir Abdulgalil Physiology [email protected]

Dr. Magdy Omar Anatomy [email protected]

Dr. Ahmed Sayad Urology [email protected]

Dr. Nabeel bondagji O.B. Gynee [email protected]

Reproductive Module

Lectures on general aspects of the Reproductive System will be given for the purpose of conveying deeper understanding of the general concepts and principles underlying normal and abnormal structure and function during the module.

Practical sessions will be timetabled to enforce theoretical aspects of the subject but will be used for demonstrating skills/procedures and the use of electronic teaching material will be encouraged.

Tutorials & Clinical Presentations

Small Group tutorials on special topics will be organized for the purpose of enriching the students' general knowledge and overall understanding of the Reproduction. It allows students to apply newly acquired knowledge and it is suitable for higher order cognitive objectives. The use of clinical presentations, a series of multi-disciplinary sessions of small-group teaching led by staff from the appropriate clinical departments. These sessions also provide an opportunity for students to see patient-doctor interaction and the personal and social effects of illness. Satisfactory attendance and performance in practical classes and at clinical sessions are part of the final assessment at such level.

Problem-based learning sessions will be encouraged and timetabled to facilitate higher cognitive objectives: problem solving and decision making; can incorporate objectives that cross domains. They will be organized into small groups and facilitated by a staff faculty member.

REPRODUCTIVE SYSTEM Page 16 King Abdul Aziz University Faculty of medicine Gross module Themes

Department of Pathology Lectures

 Lecture 27: Pathology of Vulva, Vagina & Cervix.

 Lecture 28: Benign Uterine Pathology.

 Lecture 29: Malignant neoplasms of the uterine corpus.

 Lecture 30: Tumors of the ovary.

 Lecture 34: Trophoblastic pathology.

 Lecture 35: Diseases of Prostate.

 Lecture 37: Pathology of the testis & Testicular Adnexa.

Practical

 Practical 3: Diagnosis of pathological specimens of male genital system.

 Practical 7: Diagnosis of pathological specimens of female genital system I.

 Practical 9: Diagnosis of pathological specimens of female genital system II.

Tutorials

 Tutorial 1: Testicular & prostatic pathology.

 Tutorial 2: Female genital tract pathology.

Department of Physiology Lectures

 Lecture 1: The reproductive system: An overview.  Lecture 9: The puberty Onset of The major physiological changes.

 Lecture 14: The menstrual cycle.

 Lecture 15: Physiology of pregnancy.

 Lecture 19: Maternal response to pregnancy.

 Lecture 20: The physiology of Parturition

 Lecture 24: Fetal physiology.

 Lecture 25: The menopause changes underlying the climacteric symptoms.

Tutorials

 Tutorial 4: Male & female sexual behavior.

 Directed learning 1: Review Hypothalamus- anterior pituitary –gonadal axis in male and female.

Department of Pharmacology Lectures

 Lecture 23: Drugs during pregnancy.

 Lecture 38: Reproductive Pharmacology : Oxolytics & Tocolytics drugs.

Department of Clinical Biochemistry

REPRODUCTIVE SYSTEM Page 18 King Abdul Aziz University Faculty of medicine Lectures

 Lecture 10: Testicular steroidogenisis and its endocrine control :part I.

 Lecture 11: Testicular steroidogenisis and its endocrine control: part II.

 Lecture 12: Female sex hormones: part I.

 Lecture 13: Female sex hormones: part II.

 Lecture 21: Prenatal Diagnosis

 Lecture 26: Biochemical investigations of infertility

Tutorials

 Tutorial 6: Disorders of gonadal function in male.

 Tutorial 7: Disorders of gonadal function in female.

Department of Obstetrics and Gynecology

Lectures

 Lecture 22: Antenatal care.

Practical

 Practical 5: Abnormal vaginal bleeding.

 Directed Learning 2: Normal Labor (video show).

 Directed Learning 3: Pregnancy loss and miscarriages..

Clinical Presentation

 Clinical presentation 2 : Ectopic pregnancy.

Department of Pediatrics Lectures

 Lecture 33: Ambiguous genitalia.

Clinical Presentation

 Clinical presentation 1: Normal & abnormal Puberty.

Department of Radiology Tutorial

 Tutorial 5: Radiology of reproductive system.

Practical

 Practical 4: Radiology of reproductive system.

Department of Parasitology

Lectures

 Lecture 31 :Trichomoniasis.

 Lecture 32: Acquired Toxoplasmosis.

 Lecture 36: Congenital Toxoplasmosis.

Tutorial

 Tutorial 8: Sexual Transmitted Disease.

Department of Anatomy

Lectures

 Lecture 2: Normal & abnormal embryology of the male reproductive tract.

 Lecture 3: Normal and Abnormal Embryology of the female reproductive tract.

 Lecture 4: Gross anatomy of the female reproductive tract.

 Lecture 5: Gross anatomy of the male reproductive tract.

 Lecture 6: Histology of normal male reproductive tract.

 Lecture 7: Histology of normal female reproductive tract.

 Lecture 8: Male & Female gamete development.

 Lecture 16: Embryonic period.

 Lecture 17: Fetus and placenta: part I

 Lecture 18: Fetus and placenta: part II.

Tutorials

 Tutorial 3: Development of male & and female reproductive tracts.

Practical

 Practical 1: Dissection of male reproductive tract.

 Practical 2: Dissection of female reproductive tract.

 Practical 6: Histology of the normal male reproductive tract.

 Practical 8: Histology of the normal female reproductive tract.

 Directed Learning 4: Fertilization & Implantation

List of suggested reading references

Name of Book Authors

1) Clinical anatomy for medical Richerd S.Snell students (6th Ed)

2) Langman’s Medical T.W.Sadler Embryology

3) Color text book of Histology 2nd Gartner L.P.& Hiatt J.L. Ed

4) Grant Atlas of Anatomy Grant J.C.B.

5) Di Fiore’s Atlas of Histology Eroschenko V.P. with Functional Correlation 9th Ed.

6) Review of Medical Physiology Ganong W.F.

7) Text book of medical Guyton A.C.& Hall J.E. Physiology

8) MCQs in Human Physiology Roddie I.C. & Wallace W.F.M.

9) Basic Pathology Kumar, Cotran, Robbins

10) Pathological Basis of diseases Kumar, Cotran, Robbins & Collins

11) Wills’ Biochemical Basis of Gillham, B. J.H.Thomas Medicine

12) Clinical Biochemistry Marshall

13) Nelson Textbook of pediatrics Nelson

14) Basic & clinical Katzung pharmacology.

15) Radiology & imaging for David Sutton medical students

16) Current: Surgical diagnosis& Way, L.W., Doherty, GM Treatment

ASSESSMENT

REPRODUCTIVE SYSTEM Page 22 King Abdul Aziz University Faculty of medicine Formative: This form of assessment is designed to give you feedback to help you to identify areas for improvement. It includes a mixture of MCQs, short answer-questions (SAQs), extended matching questions (EMQs), problems-solving exercises and independent learning activities in all subjects.

Summative

This type of assessment is used for judgment or decisions to be made about your performance. It serves as: a) Verification of achievement for the student satisfying requirement. b) Motivation of the student to maintain or improve performance. c) Certification of performance. d) Grades.

In this Course your performance will be assessed according to the following:

1. Continuous Assessment 20 Marks 2. Assignment + Attendance 20 Marks 3. Final End of Semester Exam (Two Hours) 40 Marks 4. Final OSPE (Practical) 20 Marks

Total = 100 Marks

Icons (standards)

REPRODUCTIVE SYSTEM Page 23 King Abdul Aziz University Faculty of medicine The following icons have been used to help you identify the various experiences you will be exposed to.

Learning objectives

Content of the lecture

Independent learning from textbooks

Independent learning from the CD-ROM.

The computer cluster is in the 2nd floor of the medical library, building No. 7.

Independent learning from the Internet

Problem-Based Learning

Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)

The main concepts

Topic Outlines

REPRODUCTIVE SYSTEM Page 27 Lecture 1: The Reproductive System: An Overview. King Abdul Aziz University Faculty of medicine Department: Physiology Student Notes: Lecturer: Dr. Khidir Abdel Galil

Dr. Azra Karmani

At the end of the lecture you should be able to

1. An overview for human reproduction.

2. The functions of the gonads.

3. Sex differentiation.

* Gonadal Sex

*Genetic Sex.

4. Abnormalities in sexual development.

1. An overview for human reproduction.

The concept & definition of human reproduction.

2.Function of the gonads in the male & female: Gametogenesis & Sex hormone secretion.

3. Sex differentiation:

a) Gonadal sex:

1- Genetic male: Testosterone & MIS

2- Genetic female: No MIS

b) Genetic sex: XY,XX

4. Abnormalities of sexual development :

a) Genetic abnormalities:

…..Continue Lecture 1

REPRODUCTIVE Kleinfelter & Turners SYSTEM syndromes Page 28

Super female & True Hermaphrodite King Abdul Aziz University Faculty of medicine

Lecture 2: Normal and Abnormal Embryology of the male reproductive tract Department: anatomy Student Notes.

Lecturer: Prof. Saed Zaghloul

Dr. Fathia Ahmed

At the end of the lecture you should be able to:

1) Describe the embryological origin of the male reproductive tract

I. The primitive sex duct

ii. The genital duct

iii. The external genitalia

2) Describe the specific stages of the development of the males gonads, genital tract and external genitalia

3) Describe the influence of the chromosome complement of the primordial germ cell on sex differentiation

4) Describe the influence of the male sex glands and its hormones on further sex differentiation

5) Describe the male sex abnormalities as reflected in the duct system and external genitalia.

1) The urogenital system and its divisions

2) The key to sexual dimorphism including the testis determining factor gene

3) Indifferent stage of the development of both sex genital system including the gonads genital tract and external

REPRODUCTIVE SYSTEM Page 29 King Abdul Aziz University Faculty of medicine genitalia.

4) Stages of the development of testis, epididyms, seminal vesicles,vas deferens and ejaculatory duct

5) Hormonal control of the development of the male genital tract

6) Abnormalities associated with improper development of the male genital tract including: undescended testis and intersexuality(male psudohermaphrodites

1) Langman’s Medical Embryology, T.W.Sadler, 2000, Lippincot Williams & Wilkins.

Lecture 3 :Normal and Abnormal Embryology of the female reproductive tract Department: anatomy

Lecturer: Prof. Saed Zaghloul, Dr. Fathia Ahmed

1) Describe the embryological origin of the female reproductive tract.

2) Describe the specifics stages of the development of the females' gonads, genital tract and external genitalia.

3) Describe the influence of the chromosome of the primordial germ cell on female sex differentiation.

4) Describe the influence of the female sex glands and its hormones on further female sex differentiation.

5) Describe the female sex abnormalities as reflected in the duct system and external genitalia.

1) The genital ridge (gonadal ridge) and differentiation of the female genital tract.

2) Influence of the primordial germ cells on the differentiation of the female reproductive system.

3) Stages of the development of ovaries, uterine tubes, uterus and vagina.

4) Hormonal control of the development of the female genital tract.

5) Abnormalities associated with improper development of the female genital tract including: Klinefelter's syndrome, Turner's syndrome and female psudohermaphrodites (ambiguous Genitalia).

Lecture 4 : Gross Anatomy of the female reproductive Tract Department: anatomy

Lecturer: Dr. Gamal Said, Prof. Amira

1) Describe the gross anatomy of the normal female pelvis.

2) Describe the structures (surface anatomy) of the female external genitalia.

3) Describe the gross anatomy of the female pelvic organs including: the ovaries, uterine tubes, the uterus, the broad ligament and the vagina.

4) Describe the uterosesical pouch and the recto uterine pouch (Pouch of Douglas).

5) Explain the blood supply, the lymphatic drainage and the nerve supply of the female reproductive system.

6) Describe the factors supporting the female pelvic organs especially the uterus and vagina.

1) The normal female pelvis including the features characterizing the female pelvis from that in males.

2) True and false pelvis including the pelvic inlet and outlet.

3) Surface anatomy of the female perineum (external genitalia).

4) Gross anatomy of the ovaries, uterine tubes, uterus, uterosesical pouch, recto uterine pouch and vagina.

5) The broad ligament and its contents.

6) Blood supply, venous drainage, lymphatic drainage and nerve supply of the female reproductive tract.

7) The pelvic floor and its contents including levator ani muscle.

8) The ligaments supporting the uterus in its normal position

1) Clinical anatomy for medical students (6th Ed), Richerd S.Snell, 2000, Lippincot Williams & Wilkins.

Lecture 5 : Gross Anatomy of the Male reproductive Tract Department: anatomy Student Notes:

Lecturer: Prof. Amira, Dr. Gamal Said

1) Describe the gross anatomy and external features of the male external genitalia including: the penis, scrotum, testis and epididymis.

2) Describe the gross anatomy and the anatomotical relations of the male pelvic organs including: the prostate, vas deferens, seminal vesicles and ejaculatory duct.

3) Explain the blood supply, lymphatic drainage and nerve supply of the male reproductive system (external and internal sex organs).

4) Describe endocrinal component of the male sex organs.

1) The surface anatomy and external features of the male perineum including the external genitalia (penis, scrotum, testis and epididymis).

2) The structure and anatomical relations of the male pelvic organs including: the prostate, seminal vesicles, vas deferens and ejaculatory duct.

3) Blood supply venous drainage, lymphatic drainage and nerve supply of the male reproductive tract (both internal and external sex organs).

REPRODUCTIVE SYSTEM Page 35 King Abdul Aziz University Faculty of medicine 4) Androgen secretion and its pituitary control.

1) Clinical anatomy for medical students (6th Ed), Richerd S.Snell, 2000, Lippincot Williams & Wilkins.

Lecture 6: Histology of Normal Male reproductive Tract Department: anatomy Student Notes:

Lecturer: Dr. Gamal Said, Dr. Hanan

1) Describe the normal histology of the testis and seminiferous tubules including the interstitial tissue

2) Describe the normal structure of the spermatozoa

3) Describe the normal histology of the male accessory glands and excretory ducts including: the prostate, the epididymis, the vas deferens, seminal vesicles and the ejaculatory duct

4) Describe the normal histology of the penis and penile urethra

5) Describe the hormonal control of the male reproductive tract

1) Histology of the testis including the histological structure of seminiferous tubules and the interstitial tissue

2) Normal and abnormal structure of the sperm

3) The histological structure and the type of tissues forming the prostate, seminal vesicles, vas deferens, epididymis and ejaculatory duct

REPRODUCTIVE SYSTEM Page 37 King Abdul Aziz University Faculty of medicine 4) The histological structure of the penis and penile urethra

5) The androgenic steroid hormones secreted by the endocrine component of the testis (Leydig cell)

1) Color Textbook of histology, 2nd Edition, Gartner, L.P. & Hiatt, J.L., W.B. Saunders.

2) Di Fiore's Atlas of histology with Functional Correlation, 9th Edition, Eroschenko, V.P., Williams Ology of Normal Male reproductive Tract& wilkins.

REPRODUCTIVE SYSTEM Page 39 Lecture 7: Histology of Normal female reproductive Tract King Abdul Aziz University Faculty of medicine Department: anatomy

Lecturer: Dr. Gamal Said, Dr. Hanan

1) Describe the normal histology of the ovary including the ovarian follicle 2) Describe the normal histology of different stages of the ovarian follicles 3) Describe the normal histology of the uterine tubes, uterus, cervix and vagina 4) Describe the hormonal control of the female reproductive tract

1) Histology of the ovary including the histological structure of ovarian follicles at different stages

2) Histology of the uterine tubes

3) Histology of the uterus and specifically the cervix

4) Histology of the vagina

5) Effects of hormones on the ovary

Lecture 8: Male and Female gamete Development

Department: anatomy Student Notes

Lecturer: Dr. Hamid saleh

Dr. Fathia Ahmed

After this lecture student should be able to:

1. Define the process of spermatogenesis and oogenesis 2. Describe the stages of the spermatogenesis and oogenesis 3. Describe the series of changes resulting in the transformation of the spermatids into spermatozoa ( spermatogenesis ) and the maturation of the sperms 4. Describe the normal shape of the sperm 5. Describe the process of postnatal maturation of the primary oocytes 6. Describe the abnormal male and female gametes 7. Describe the process of ovulation

1) Definitions of spermatogenesis and oogenesis

2) The primordial germ cells and the mature male germ cells

3) Spermatogenesis and the transformation of spermatogonia into spermatozoa

4) Spermatogenesis and the process of sperm maturation including: acrosome formation, and the normal shape of the sperm

5) Abnormal sperms (such as double headed, short tailed) and

REPRODUCTIVE SYSTEM Page 41 King Abdul Aziz University Faculty of medicine its incidence

6) Definition of oogenesis

7) The primordial germ cells and the mature female germ cells

8) Oogenesis and the formation of the primary oocytes

9) Stages of the postnatal maturation of the primary oocytes

10) Abnormal ovarian follicles

11) The process of ovulation and the fate of corpus luteum

Lecture 9 :The Puberty Onset & the Major Physiological Changes Department: Physiology Student Notes:

Lecturer: Dr. Khidir Abdel Galil

Dr. Azra Karmani

1- To understand the hormonal changes during puberty. 2- To understand the somatic growth & major physiological changes accompanying puberty in both sexes. 3- To understand the hormonal control of puberty onset.

1- To study hormonal changes during puberty & their effects on both sexes. 2- To differentiate between puberty & adolescence, duration of puberty, age of onset & developmental stages in boys and girls (therache, pubarche & menarche & adrenarche). 3- To study the major physiological changes at puberty in both sexes: somatic growth, development of secondary sexual characteristics & sexual organs in boys & girls. 4- To understand the development of reproduction capacity in both sexes. 5- To understand the hormonal control of onset of puberty: effects of GnRH, gonadotropin,

REPRODUCTIVE SYSTEM Page 43 King Abdul Aziz University Faculty of medicine …..Continue Lecture 9

6- adrenal cortex (adrenarche), social, psychological, nutritional & environmental factors.

1. Guyton, AC and Hall, JE (2005). Textbook

Of Medical Physiology, WB Sunders Co.

2. Ganong, WF (2007).Review of Medical

Physiology, (2007). McGraw Hill)

3. Roddie, IC and Wallace WFM (2004). MCQs

In human physiology, (2004).Oxford Univ. Press.

The computer cluster is in the 2nd floor of the

Medical Library, building No. 13.

Lectures 10-11: Testicular steroidogenesis and its endocrine control

Department: Clinical Biochemistry

Lecturer: Prof. Mohammed S. Ardawy

Dr Fayza F. Al Fayez

By the end of this lecture you will be able to:

1- Identify the type of hormones involved in steroidogenesis and their origin. 2- Illustrate the pathway of formation of male sex hormones and factors controlling them. 3- Discuss mode of action of hormones.

Explain the pathological consequences due to biosynthetic defects.

 Testosterone and androgens:  Origin.  Biosynthesis.  Mode of transport.  Mode of action.  Control of steroidogenesis.

1. Clinical Biochemistry, William J. Marshall.

2. Applied Biochemistry of Clinical Disorders, Allan G. Gornall.

REPRODUCTIVE SYSTEM Page 45 King Abdul Aziz University Faculty of medicine Lectures 12-13: Female sex hormones Department: Clinical Biochemistry

Lecturer:

Prof. Mohammed S. Ardawi

TEACHING LOCATION: Auditorium

1- Define female sex hormones and their origin. 2- Describe the pathway of formation of female sex hormones and factors controlling it. 3- Relate the pathological consequences to biosynthetic and transport defects. 4- Demonstrate how to assess gonadal function.

 Estradiol and progesterone:  Origin.  Biosynthesis.  Mode of action.  Assessment of female sex hormones disorders.

REPRODUCTIVE SYSTEM Page 46 King Abdul Aziz University Faculty of medicine Lecture 14: The Menstrual Cycle Department: Physiology Student Notes:

Lecturer : Dr. Khidir Abdel Galil

Dr. Azra Karmani

1. To understand the functions of the various ovarian hormones.

2. To comprehend the various stages of the menstrual cycle.

3. To understand the physiological control of ovarian hormones.

1. To study progesterone, relaxin, inhibin & others on the body & reproductive tract of the Female.

2. To study the theme of the endocrine control in the female.

3. To study the various stages of the menstrual cycle mainly: the ovarian cycle, the uterine cycle, the cervical & vaginal cycles & the cyclical changes to the breast.

4. To learn the factors that control the ovarian hormones mainly: the

hypothalamic components, gonadotropin components, the negative feedback & the control through the cycle itself

(prostaglandins).

in human physiology,(2004).Oxford Univ. Press

Lecture 15: The physiology of Pregnancy Department: Physiology Student Notes:

Dr. Azra Karmani

1. To be able to describe the mode of sperm transport Up the female genital tract to the mid-oviduct. 2. To understand the physiological changes that occur In the sperm before the penetration of the ovum. 3. To understand the endocrinological changes during Pregnancy. 4. To describe other placental hormones & the activity Of other endocrine glands.

1. To describe the mode of sperm transport up the female genital tract to the site of fertilizing in the mid- oviduct. The effects of Oxytocin, prostaglandins & chemotactic factors 2. The study the physiological changes that occur in the sperm before penetration of the ovum.

a) Capacitation.

b) Acrosome reaction.

c) The effects of fertilin.

3. To study the endocrinological changes during

Pregnancy.

a) Human chorionic gonadotropin (HCG).

b) Estrogens. c) Progesterone. d) Human chorionic somatomammotropin (HCG). e) Other placental hormones & the interaction between the fetus & placenta in hormone Formation (fetoplacental unit). f) The activity of other endocrine glands namely: anterior pituitary, thyroid, Parathyroid & adrenal cortex.

1. Guyton, AC and Hall, JE (2005). Textbook Of Medical Physiology, WB Sunders Co. 2. Ganong, WF (2007).Review of Medical Physiology, (2007). McGraw Hill) 3. Roddie, IC and Wallace WFM (2004). MCQs in human physiology,(2004).Oxford Univ. Press

Independent learning from the CD-ROM. The computer cluster is in the 2nd floor of the Medical Library, building No. 13. Independent learning from the Internet.

Lecture 16: Embryonic Period Department: anatomy Student Notes:

Dr. Fathia Ahmed

1) Define the embryonic period

2) Describe the main stages of normal embryonic development from implantation till the establishment of the main organ systems.

3) Describe the major weekly changes of the embryo from the implantation till the formation of major organ systems (Till the end of week 8).

4) Describe the derivatives and differentiation of the three main germ layers (ectoderm, mesoderm and endoderm).

1) Definition of Embryonic period.

2) Main stages of development from implantation till the end of week 8, this includes: two cell stage, morula, blastocyst, trophoblast, trilaminar germ disc, somites, bronchial arches formation, arm and leg buds, formation of the face, and fetal membranes.

3) Describe the major changes and structural constituents of the main staged of embryonic development.

4) Derivatives of ectodermal, mesodermal and endodermal germ layers and embryonic tissue differentiation.

..Continue Lecture 16

Lecture 17: Fetus & Placenta (Part I) Department: anatomy Student Notes:

Lecturer: Dr. Hamid saleh, Dr. Fathia Ahmed

1) Define fertilization and implantation.

2) Describe the phases of fertilization.

3) Describe the process and sites of normal implantation.

4) Describe the normal placenta and its components.

5) Describe the placental changes at the end of pregnancy.

6) Describe the role of endocrinal activity of placenta in maintaining normal pregnancy.

7) Describe the normal umbilical cord and its contents.

8) Describe the fetal membranes.

1) Definition of fertilization and implantation.

2) The phases (stages) of fertilization including: penetration of corona radiate and zona pellucida and the fusion of oocytes- sperm cell membranes.

3) The process of implantation and its normal sites.

4) Normal placenta and its components.

5) The role placental endocrine functions in maintaining normal pregnancy.

6) Normal umbilical cord and its contents.

7) Normal changed of placenta at the end of pregnancy

8) Fetal membranes and the amniotic fluid

Lecture 18: Fetus & Placenta (Part II) Department: anatomy Student Notes:

Dr. Fathia Ahmed

1) Define the fetal period.

2) Describe the monthly developments changes (normal fetal growth) During the fetal period (3rd month to birth).

3) Describe the abnormal fetal growth.

4) Describe the length of the normal pregnancy.

1) Definition of fetal period.

2) Normal monthly changes during the fetal period including: length changes, weight changes, size of the head, and normal fetal movement.

3) Normal length of pregnancy and problems associated with early born baby (premature baby).

4) Abnormal fetal growth such as intrauterine growth retardation (IUGR) and small for gestational age (SGA).

Lecture 19: The Maternal Response To Pregnancy Department: Physiology Student Notes:

Lecturer : Dr. Khidir Abdel Galil

Dr. Azra Karmani

1. To understand the changes that occurs in the Maternal physiology. 2. To understand the changes in the maternal weight gain. 3. To understand the cardiovascular changes. 4. To understand the respiratory changes. 5. To understand the changes in the Gastrointestinal tract. 6. To understand the changes in the renal function

1. To study the changes that occurs in the maternal physiology in order to ensure the maternal well being & efficient fetal supply lines. 2. To understand the changes in the maternal weight gain: the fetus, amniotic fluid, uterus & breast. 3. To study the cardiovascular changes in maternal physiology: plasma proteins, blood volume, cardiac output, heart rate, stroke volume...etc. 4. To understand the respiratory changes in maternal physiology: increased ventilation, increased TV, MRV, FRC & RV...etc.

5. To study changes in the GIT in maternal physiology: morning sickness, dietary cravings, pica, nausea, salivation, decreased GIT motility, heartburn

6. To study the changes in renal function in maternal physiology: increased GFR increased Na, Cl & water reabsorption decreased Tm for glucose, increased urine formation...etc.

7 To understand the explanation of the above changes on the light of hormonal changes during pregnancy

Lecture 20: The Physiology of Parturition Department: Physiology Student Notes:

Lecturer Dr. Khidir Abdel Galil

Dr. Azra Karmani

1. To understand the changes of relaxin hormone on the pelvis and the cervix during the last few days Before parturition. To understand the hormonal interaction between .2

.Estrogen and Oxytocin receptors in the uterus

3. To study the positive feedback loop initiated between Oxytocin hormone & cervical dilation Up to delivery of the fetus. 4. To understand other factors contributing to Labor that help during delivery of the fetus.

1. To study the role of relaxin hormone on the genital tract, pelvis & cervix few days before labor. The effects of softening the pubic symphysis & pelvic joints & ligaments & also softening & dilation of the cervical canal to initiate labor.

2. To understand the relationship between estrogen release and the number of Oxytocin receptors in the myometrium & decidua which increase to about 100 folds; in addition to increased sensitivity of myometrium to Oxytocin.

3. To study the positive feedback loop initiated at the start of labor between uterine contraction, cervical dilation & the release of more Oxytocin & therefore more uterine contraction & more cervical dilation that help to deliver the fetus.

4. To understand the other factors that contributes to labor. The effects of other hormones like progesterone & prostaglandins. The spinal reflexes from the birth canal (involuntary) & the voluntary abdominal contraction (bearing down).

Lecture 21: Prenatal diagnosis Department: Clinical Biochemistry :Student Notes

Lecturer : Prof. Mohammed S. Ardawi

1- Explain maternal and fetal screening. 2- Discuss the genetic analysis of DNA. 3- Identify types of disease that can be screened by prenatal diagnosis. 4- Identify the metabolic changes found in the maternal blood indicating inherited metabolic defects.

 Fetal DNA analysis in maternal circulation in the detection of genetic diseases.  The value of biochemical information in prenatal diagnosis:  AFP  UE  BHCH (Urine / Semen)  Inhibin  Calculation of risk for Down’s syndrome  Investigation of Neural tube defects.

Abnormal metabolic changes in maternal / fetal sampling in relation to inherited genetic disorders.

1. Clinical Biochemistry, William J. Marshall. 2. Applied Biochemistry of Clinical Disorders, Allan G. Gornall.

Lecture 22: Antenatal Care

Department: Student Notes: Obstrics and Gynecology Lecturer: Dr: Nawal ALSenani& Dr: Tarik Zamzamy

Upon completion of this topic the students should learn:

 The effectiveness of ANC in reducing PNM (booked vs. un-booked patients).  ANC is an opportunity for health screening as Well as education.

 Milestone visits of ANC (first visit, 2nd and third Trimesters) objectives in each.

 The importance of identifying women at higher than average risk.  Significance and objective of the main interventions during pregnancy.

 Introduction on the development of ANC until its present status.  The major three basic components of ANC care: - (1) Early and continuing risk assessment ( includes a complete history, a physical examination , laboratory tests, and assessment of fetal growth and well-being )

- (2) Health promotion providing health information, enhancing general knowledge of pregnancy and parenting, and promoting and supporting healthful behaviors) - (3) Medical and psychosocial interventions and follow-up (treatment of any existing illness, and referral to and consultation with other specialized providers)

 Mile stone visits in ANC : - (first visit) Booking visit: history, physical and main tests and its objectives.

- 2nd Trimester: Screening for anomalies, GDM, Anemia, and BP. - 3ed Trimester: fetal growth, mode of delivery, and maternal preparation for delivery.

REPRODUCTIVE SYSTEM Page 63 Lecture 23: Drugs and pregnancy King Abdul Aziz University Faculty of medicine Department : Pharmacology Student Notes: :Lecturer Prof. M. Solaiman Prof. A. Moneim Prof. M. Hagras

1. Define teratogens, and recognize teratogenic drugs and agents 2. Understand the classification of drugs regarding their fetus toxicity and teratogenic effect. 3. Discuss the adverse effects of some special drugs on the mother and the fetus 4. Judgment of risk & benefit before prescribing to a pregnant women

1- Factors affecting transfer of drugs to the fetus : Maternal factors ; gestional age , Placental state , role of the fetus … Principles of Teratogens: Mechanism , factors such as gestational age, duration and route of administration

2- Classification of drugs regarding their safety during pregnancy ( FDA calcification ) 3- Examples of adverse effects of some drugs on the fetus: a. destruction of cells / abortion b. Various grades of fetal malformation. c. intra-uterine growth retardation/restriction d. cerebral damage / neurological damage e. mental retardation f. death of the fetus FDA Risk Categories?

..Continue Lecture 23

REPRODUCTIVE SYSTEM Page 64

 A- Studies on humans; no risk King Abdul Aziz University Faculty of medicine

REPRODUCTIVE SYSTEM Page 65 Lecture 24: Fetal Physiology King Abdul Aziz University Faculty of medicine Department: Physiology Student Notes:

Dr. Azra Kamani

1. To understand the features of placental and fetal

Circulation.

2. To understand metabolic & nutritional functions

Of the fetus.

3. To understand the respiratory functions of fetus.

4. To understand the excretory functions of the fetus.

5. To understand the protective functions of the fetus.

1. To learn that the blood flow of the uterus parallels the metabolic activity of the myometrium and endometrium and undergoes cyclic fluctuations in cyclic women. However, during pregnancy the blood flow increases rapidly with increased metabolism. 2. To study the metabolic & nutritional functions:

a) Proteins: the transfer of amino acids, albumins & some globulins across the placenta from maternal blood to fetus. b) Transfer of glucose and other carbohydrates via placenta to fetus. c) Transfer of degraded fats & phospholipids via placenta to fetus. d) Transfer of fat- soluble & water- soluble Vitamins to fetus. e) Transfer of minerals: Na, K, Mg, Fe, Ca & P

3. To understand respiratory function of the fetus: REPRODUCTIVE SYSTEM Page 66 4. Excretory function of the fetus: fetal waste

products like urea, uric acid, & creatinine are King Abdul Aziz University Faculty of medicine

REPRODUCTIVE SYSTEM Page 67 Lecture 25: The Menopause Changes Underlying Climacteric Symptoms King Abdul Aziz University Faculty of medicine Department: Physiology Student Notes:

Dr. Azra Karmani

1. To understand the definition, age of onset as an irregularity of sexual cycles & failure of ovulation before ceasing altogether.

2. To understand the causes of menopausal onset & its endocrine control. The relationship between levels of estrogen & gonadotropin (FSH & LH).

3. To understand the local & systemic effects on the body of the female.

1. To understand the definition of menopause & the age of onset as associated with the irregularity of sexual cycles & failure of ovulation before the cycles cease completely in few months to few years.

2. To study the causes of menopause including aging of the ovary & depletion of germ cells. Deceased secretion of estrogen & progesterone accompanied by increased secretion of FSH&LH.

3. To study the local & systemic changes that occur

in the body of the female including the following:-

a) Vasomotor symptoms e.g.: hot flushes.

b) Emotional & psychological problems:

Dyspnoea, irritability, anxiety, headache, dizziness…etc.

c) Decrease strength & calcification of the bones, increased bone resorption & loss of collagen leading to osteoporosis & boneREPRODUCTIVE fracture...etc. SYSTEM Page 68 King Abdul Aziz University Faculty of medicine

Lecture 26 : Biochemical investigations of infertility Department:Clinical Biochemical :Student Notes

Lecturer Prof. Mohammed S. Ardawi

TEACHING LOCATION: Auditorium

1- Identify a scheme of investigations in male and female. 2- Interpret the outcome of investigations for further decision.

 Types of abnormalities in male and female.  Endocrine causes of sub-fertilities in female.  Endocrine investigations in the sub-fertile man.  FSH, LH, testosterone, prolactin, progesterone

Lecture 27 : Pathology of Vulva, Vagina & Cervix Department: Pathology Student Notes:

Lecturer: Dr :Jaudah Almagrabi

Dr: Layla Abdullah

Dr: Salwa Baksh

At the end of the lecture you should be able to understand:

1. Non-neoplastic lesions of vulva. 2. Benign tumor of vulva. 3. Pre-malignant and malignant neoplasms of vulva. 4. Pre-malignant and malignant of the vagina. 5. Cervical dysplasia and carcinoma

1. Non-neoplastic epithelial lesions.

 Lichen sclerosis.  Squamous hyperplasia - The incidence of these lesions - Clinical appearance - Differential diagnosis. 2. Condyloma acuminatum pathogenesis and histological appearance; vulvar

Intraepithelial lesions (VIN).

3. VIN pre-malignant lesions, the incidence

and their different pathogenesis and the

Histological appearance.

4. Invasive Squamous cell carcinoma of the

Vulva.

….Continue Lecture 27

5. Other vulvar neoplasm:

 Extra mammary paget disease  Melanoma of the vulva 6. Pre-malignant lesions of the vagina,

Incidence, pathogenesis and morphology.

7. Invasive carcinoma of vagina:

 Squamous cell carcinoma  Adenocarcinoma

8. Other non-epithelial tumors:

 Embryonal rhabdomyosarcoma  Age incidence, clinical and gross features 9. Epidemiology of cervical cancer

10. Incidence of cervical cancer.

11. Short account on its relation to cervical

Intraepithelial lesions and risk factors.

12. Gross morphology.

13. Histological appearance.

1. Basic Pathology, Eight Edition, by: Kuman, Cotran, Robbins 2. Pathological Basis of Disease, Eight Edition, by: Robbins, Cotran, Kuman & Collins

REPRODUCTIVE SYSTEM Page 71 King Abdul Aziz University Faculty of medicine Lecture 28 : Benign Uterine Pathology Department: Pathology Student Notes:

Lecturer: Dr .Jaudah Almagrabi

Dr. Layla Abdullah

Dr: Salwa Baksh

1. Endometritis 2. Uterine adenomyosis 3. Endometriosis 4. Endometrial polyp 5. Endometrial hyperplasia

1. Definition & clinical presentation of uterine adenomyosis 2. Definition, pathological features & clinical presentation of endometriosis 3. Gross & microscopic features of endometrial polyp 4. Definition & types of endometrial hyperplasia 5. Pathologic features of endometrial hyperplasia & risk of endometrial carcinoma

- Basic Pathology, Eight Edition; by: Kumar, Cotran & Robbins - Pathological Basis of Disease, Eight Edition; by: Robbins, Cotran, Kumar & Collins

Lecture 29 : Malignant neoplasms of the Uterine corpus Department: Pathology Student Notes:

Dr. Layla Abdullah / Dr: Salwa Baksh

1. Carcinoma of the endometrium 2. Tumors of the myometrium, liomyoma and leiomyosarcoma. 3. Mixed mullerian tumors and mesenchymal tumors.

1. Incidence of endometrial cancer. 2. Pathogenesis and close association of hyperplasia and cancer to hypertorgenism. 3. Gross morphology 4. Histology and grading of endometrial carcinoma. 5. Short account on the epidemiology of tumors of myometrium. Liomyoma and leiomyosarcoma. 6. Incidence of liomyoma and leiomyosarcoma. 7. Criteria of liomyoma and leiomyosarcoma. 8. Gross morphology of liomyoma and leiomyosarcoma. 9. Histology of liomyoma and leiomyosarcoma. 10. Definition of mixed Mullerian tumor.

- Basic Pathology, Eight Edition; by: Kumar, Cotran & Robbins Pathological Basis of Disease, Eight Edition; by: Robbins, Cotran, Kumar & Collins.

REPRODUCTIVE SYSTEM Page 73 King Abdul Aziz University Faculty of medicine Lecture 30 : Tumors of the Ovary Department: Pathology Student Notes:

1. Describe types of non-neoplastic cysts of the ovary. 2. Know the morphology, clinical effect and hormonal changes associated with polycystic ovaries. 3. Classify tumors of the ovaries. 4. Know the percentage, age, incidence & morphology of each type of ovarian tumors. 5. How to diagnose malignancy in ovarian cyst. 6. Know the hormonal disturbance associated with functional ovarian tumors. 7. Know the methods of spread & staging of ovarian cancer.

1. Non-neoplastic cysts of ovary. 2. Polycystic ovaries. 3. Classifications of ovarian tumors. 4. Surface epithelial tumors. 5. Germ cell tumors. 6. Sex cord-stromal tumors.

Basic Pathology, Eight Edition; by: Kumar, Cotran & Robbins - Pathological Basis of Disease, Eight Edition; by: Robbins, Cotran, Kumar & Collins

Lecture 31: Trichomoniasis Department: Medical Parasitology :Student Notes

Lecturer: Prof. Adnan Amin

Dr. Hala Saeed

1. State the Geographical distribution of Trichomonas vaginalis parasite studied 2. Briefly describe the parasite life-cycle for Trichomonas vaginalis parasite studied 3. State the infective and diagnostic stage, pathogenic stage and mode of infection for Trichomonas vaginalis infection 4. Describe the pathogenesis pathway for Trichomonas vaginalis parasite studied 5. Discuss the clinical significance of the disease process (acute and chronic phases and main complication arising) for Trichomoniasis infection 6. Name the specimen of choice for recovery of Trichomonas vaginalis parasite studied 7. Name the drug(s) of choice and alternative therapy for Trichomonas vaginalis parasite studied 8. Briefly describe the main aspects of prevention and control for each parasite studied

Continue lecture 31

1) Main aspects of Life-cycle in relation to disease In man 2) Pathogenic stage and mode of infection 3) Pathogenesis of disease in man 4) Associated clinical manifestations 5) Main method of diagnosis and material Examined 6) Main drug of choice and alternative therapy 7) Main aspects of prevention and control

1) Urogenital disease 2) Sexually transmitted disease 3) Coexists with other STD’s, indicator for HIV infections in population 4) Main complications arising 6) Vaginal smear is main methods of diagnosis 7)Treatment and management of disease

1. Organ Based Parasitology for Medical Students, A.M. Amin et.al (2007), Dar Khawarizim for Academic Publishing and Distribution.

Continue… lecture31

2. Basic Clinical Parasitology, Franklin A. Neva and Harold W. Brown, (2007) Publisher Prentice Hall International Edition 3. Medical Parasitology, Edward K. Markell et.al. (2007) Publisher W.B. Saunders 4. Clinical Parasitology, A Practical Approach. Elizabeth A. Zeibig (2007) Publisher W.B. Saunders Company 5. Atlas of Medical Parasitology and Tropical Medicine, Peters and Gillies (2006)

Internet websites: Key word Medical Parasitology; Parasitology; Small Intestinal Parasites; Large Intestinal Parasites; Liver Parasites; emedicine.com (choice specific parasites); CDC.com; and many other web-links.

Briefly answer the following short question:

1) Briefly explain the clinical manifestation associated with the disease?

2) Describe the main method of diagnosis, mentioning the material examined and stage observed?

Lecture 32 : Acquired Toxoplasmosis Department : Medical Parasitology :Student Notes

Lecturer : Prof. Adnan Amin

Dr. Hala Saeed

1. State the Geographical distribution of Toxoplasma gondii parasite studied 2. Briefly describe the parasite life-cycle for Toxoplasma gondii parasite studied 3. State the infective and diagnostic stage, pathogenic stage and mode of infection for Toxoplasma gondii infection 4. Describe the pathogenesis pathway for Toxoplasma gondii parasite studied 5. Discuss the clinical significance of the Acquired Toxoplasmosis infection 6. Name the specimen of choice for recovery of Toxoplasma gondii parasite studied 7. Name the drug(s) of choice and alternative therapy for Toxoplasma gondii parasite studied 8. Briefly describe the main aspects of prevention and control for each parasite studied

Continue….lecture32

1) Main aspects of Life-cycle in relation to disease In man 2) Pathogenic stage and mode of infection 3) Pathogenesis of disease in man 4) Associated clinical manifestations 5) Main method of diagnosis and material Examined 6) Main drug of choice and alternative therapy 7) Main aspects of prevention and control

1) Acquired disease 2) Zoonotic infection 3) Self limiting and acute disease 4) Main complications arising (CNS, Skin and Eye) 6) Direct and Indirect methods of diagnosis 7)Treatment and management of disease

Continue….lecture32

1. Organ Based Parasitology for Medical Students, A.M. Amin et.al (2007), Dar Khawarizim for Academic Publishing and Distribution. 2. Basic Clinical Parasitology, Franklin A. Neva and Harold W. Brown, (2007) Publisher Prentice Hall International Edition 3. Medical Parasitology, Edward K. Markell et.al. (2007) Publisher W.B. Saunders 4. Clinical Parasitology, A Practical Approach. Elizabeth A. Zeibig (2007) Publisher W.B. Saunders Company 5. Atlas of Medical Parasitology and Tropical Medicine, Peters and Gillies (2006)

1) Briefly explain the clinical manifestation associated with the Acute phase of disease?

Lecture 33 : Ambiguous Genitalia Department: Pediatric Student Notes:

Lecturer: Dr. Al-Agha

By the end of the lecture you should be able to understand:

1. Learning the pathology of abnormal genital development 2. Learning various medical disorders (names only) that might result from abnormal genital development.

Finally, various disorders of normal sexual differentiations which, have resulted from

 chromosomal  genetic  Hormonal disorders.

will be discussed briefly in order to orient medical students of practical clinical diseases .At the end of this lecture, medical student should be able to differentiate normal from abnormal genital development

Nelson textbook of pediatrics, 18th. Edition, 2008

Lecture 34: Trophoblastic Pathology Department: Pathology Student Notes:

The incidence, morphology & Clinical course of trophoblastic tumors (Hydatiform mole & choriocarcinoma).

1. Incidence 2. Morphology 3. Clinical course

Gestational trophoblastic tumors:

1. Hydatidiform mole. 2. Invasive mole. 3. Choriocarcinoma.

Lecture 35: Diseases of Prostate Department: Pathology Student Notes:

Dr. Layla Abdullah/ Dr: Salwa Baksh

1. Benign prostatic hyperplasia. 2. Prostatic carcinoma.

1. Incidence, etiology and pathogenesis of benign prostatic hyperplasia. 2. Gross and histology of benign prostatic hyperplasia. 3. Incidence of prostatic carcinoma. 4. Etiology of prostatic carcinoma. 5. Morphology, gross and histology of prostatic carcinoma. 6. Grading, staging and clinical course of prostatic carcinoma. 7. Biochemical markers use in the diagnosis of prostatic carcinoma.

Lecture 36: Congenital Toxoplasmosis

Department: Medical Parasitology Student Notes:

Lecturer: Prof. Adnan Amin

Dr. Hala Saeed

1. State the ways of transmission of the disease to the fetus 2. Describe the pathogenesis pathway for congenital toxoplasmosis 3. Discuss the clinical significance of the infection 4. Name the specimen of choice for recovery of Toxoplasma gondii parasite both of mother and fetus. 5. significance of detection of IgM and IgG 6. discuss different methods for management the disease in mother and infant 7. Briefly describe the main aspects of prevention and control .

1) congenital disease 2) mainly affect brain and eye 3) not occur twice 3)Treatment and management of disease

REPRODUCTIVE SYSTEM Page 84 King Abdul Aziz University Faculty of medicine Continue….lecture36

1. Organ Based Parasitology for Medical Students, A.M. Amin et.al (2007), Dar Khawarizim for Academic Publishing and Distribution. 2. Basic Clinical Parasitology, Franklin A. Neva and Harold W. Brown, (2007) Publisher Prentice Hall International Edition 3. Medical Parasitology, Edward K. Markell et.al. (2007) Publisher W.B. Saunders 4. Clinical Parasitology, A Practical Approach. Elizabeth A. Zeibig (2007) Publisher W.B. Saunders Company 5. Atlas of Medical Parasitology and Tropical Medicine, Peters and Gillies (2006)

1) Briefly explain the clinical manifestation associated with the disease?

Lecture 37 : Pathology of the Testis & Testicular Adnexa Department: Pathology Student Notes:

1. Incidence of testicular tumor. 2. Pathogenesis of testicular tumor. 3. Classification of testicular tumor.

1. Classification:  Germ cell tumors  Sex cord-stromal tumors  Mixed forms

2. Emphasis on the most frequent testicular tumors from the point of view:  Incidence  Gross appearance  Histological appearance

3. Clinical features of testicular tumors and staging.

Lecture 38 : Reproductive pharmacology: Oxolytics & Tocolytics drugs Department Pharmacology Student Notes:

:Lecturer Prof. M.Solaiman Prof A. Moneim Prof. M. Hagras

1. To understand the pharmacological basis of using drugs for termination of labor, or induction of delivery 2. To identify the potential use of drugs for management of premature delivery.

 Drugs causing uterine contraction : Dinoprostone (Fervidly) Mifepristone with misoprostal (Cytotec)  Clinical pharmacology of some of these drugs :: mechanism , clinical use, pharmacokinetics, Adverse effects and contraindications  Use of Tocolytics drugs for management of premature delivery  Brief Clinical pharmacology of these drugs

- handout provided by the lecturer - Text book of therapeutics

Tutorials

Tutorial 1: Testicular & Prostatic Pathology Department: Pathology Student Notes:

Lecturer: Dr. Layla Abdullah Dr: Salwa Baksh Dr Taha Mohammad

At the end of the tutorial you should be able to understand:

To encourage students to discuss difficult points related to testicular & prostatic pathology based on their readings and lectures given.

 Guided discussion by a tutor.  Internet problematic cases discussion or images may be used.

Tutorial 2: Female Genital Tract Pathology Department: Pathology Student Notes:

Lecturer: Dr. Layla Abdullah Dr: Salwa Baksh Dr Taha Mohammad

At the end of the tutorial you should be able to understand:

To encourage students to discuss difficult issues related to female genital tract pathology in classroom based on their readings in books and lectures.

 Guided discussion by a tutor.  Internet problematic case discussion or Images may be used.

Tutorial 3: Development of Male & Female Reproductive Tract Department: anatomy :Student Notes Lecturer: Prof. Saed Zaghloul Dr. Fathia Ahmed

After this tutorial , student should be able to Describe and Demonstrate:

1) The main stage of normal embryonic development from implantation till the establishment of the main organ system 2) The major weekly changes of the embryo from implementation till the formation of major organ system ( till the end of week 8) 3) The derivatives and differentiation of the three main germ layers (ectoderm, mesoderm and endoderm)

Main stages of development from implantation till the end of week 8, this includes: two cell stage, morula, blastocyst, trophoblast, trilaminar germ disc, somites, bronchial arches formation, arm and leg buds, formation of the face, and fetal membranes. The major changes and structural constituents of the main stages embryonic tissue differentiation

Tutorial 4: Male & Female Sexual Behavior. Department: Physiology Student Notes:

Dr. Azra Karmani

1. To understand the composition & function of the secretion of the sexual organs in the male. 2. To describe the blood-testis barrier. 3. To understand the afferent & efferent pathways of sexual arousal in the male and the neural control Of the male sexual act. 4. To understand the normal composition of the fertilizing sample of semen and the physiology of The mature spermatozoa. 5. To understand the afferent & efferent pathways For sexual arousal and sexual act in the female.

1. To study the composition & function of the secretion of accessory sexual organs in male: prostate, seminal vesicle, ampulla, bulbourethral & urethral glands.

2. To describe the blood-testis barrier & its significance to spermatogenesis.

3. To understand the afferent & efferent pathways for sexual arousal in the male. The effect of psychic stimuli & sexual thoughts...etc.

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4. The neural control of the stages of the male sexual act: a) erection b) ejaculation

1- emission 2- ejaculation proper

5. To study the composition of the normal fertilizing sample of semen.

6. To understand the composition & function of the secretion of accessory sexual organ in the female. 7. To study the afferent & efferent pathways of sexual arousal in the female.

in human physiology,(2004).Oxford Univ. Press

REPRODUCTIVE SYSTEM Page 94 King Abdul Aziz University Faculty of medicine Tutorial 5 : Radiology of the Reproductive System Department: Radiolology Student Notes:

Lecturer: Dr. Naushad Ahamed

Dr. Samar Fatheddin

At the end of the tutorial you should be able to:

 Understand the indications for the different imaging modalities in the investigation of the Reproductive System.  Recognize different radiologic examinations of the reproductive system.  Recognize major radiologic signs of disease of the reproductive system.

Diagnostic imaging is extensively used for abnormalities of the reproductive system of both males and females. Ultrasound uses non-ionizing sound waves to investigate the pregnant uterus, e.g. location of placenta, number of fetuses, estimation of gestational age, cardiac and other visceral fetal abnormalities, sex of fetus, etc. In the non-pregnant uterus ultrasound may be used in the investigation of infertility, e.g. ovulation, polycystic and other cystic ovary disease, endometriosis, pelvic inflammatory disease, abscesses and pelvic masses, etc.In males, ultrasound can be used in the investigation of testicular abnormalities, diseases of the prostate and some penile problems. Magnetic Resonance Imaging uses a superconducting magnet to generate a very strong magnetic field. The strength of the magnetic field inside the MRI machine (0.5-2.0 tesla) is up to 20,000 times stronger than the Earth’s magnetic field. Despite the strength of the

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Field, it has no detrimental effects on the human body. As the machine generates the strong magnetic field inside the bore, hydrogen nuclei in the patient's body act like tiny magnets and align with the field. By altering the magnetic field and sending pulses of radio waves, MRI operators can determine what type of tissue exists at a particular point inside the patient's body. For example, tumors can be distinguished from normal tissue. As the machine scans different points inside the body, it sends this information to a computer that generates a map of the different tissue types.

MRI is free of ionizing radiation and therefore is the ideal tool to investigate the reproductive system in young patients. It also gives multiplanar images which are extremely helpful in image interpretation.

In clinical practice, MRI can be used to investigate congenital anomalies of the reproductive system, endometriosis, malignancy and some benign conditions in which ultrasound is not conclusive.

Hysterosalpingography is a procedure where x rays are taken of a woman's reproductive tract after a dye is injected. Hysterosalpingography is used to determine if the fallopian tubes are open, or if there are any apparent abnormalities or defects in the uterus.

Radiology and Imaging for Medical Students by David Sutton

Tutorial 6: Disorders of gonadal function in males Department : Clinical Biochemistry Student Notes:

Lecturer Prof. Mohammed S. Ardawi Dr Fayza F. Al Fayez

1- Explain the pathological processes in male gonadal function. 2- Demonstrate how biochemical tests are used to diagnose male gonadal disorders. 3- Interpret the outcome of investigations.

 Hypogonadism.  Gynecomastia.

Tutorial 7: Disorders of gonadal function in female

Department : Clinical Biochemistry :Student Notes Lecturer: Prof. Mohammed S. Ardawi

4- Explain the pathological processes in female gonadal function. 5- Demonstrate how biochemical tests are used to diagnose female gonadal disorders. 6- Interpret the outcome of investigations.

 The climacteric.  Amenorrhea and oligomenorrhea.  Hirsutism and virilism.

Tutorial 8: Sexually Transmitted Diseases Department :Medical Parasites Student Notes: tutor: Dr. Hala Salem

1- Define the parasites involved in STD. 2- Discuss its impact on the human welfare. 3- Awareness of the preventive measures.

Identify the different parasites involved in STD (Arthropodes: Sarcoptes scabii, Phthirius pubis; protozoa: Trichomonas vaginalis) Mention the mode of infection and the infective stage. Identify pathogenesis and the pathogenic stage. Describe the clinical presentation and the complications followed the infection. Discuss the diagnostic methods and identify the diagnostic stage for each. State the appropriate treatment for each. Describe the preventive and controllable measures.

Transferable skills:

Differentiation between the clinical presenting symptoms in relation to its underlying causative parasite.

Practical

Practical 1: Dissection of Male Reproductive Tract TUTOR: Dr. Gamal Said, Prof. Amira Student Notes: Department: Anatomy

SUMMARY:

a.The surface anatomy and external features of the male perineum including the external genetalia (penis, scrotum, testis and epididymis) b.The structure and anatomical relations of the male pelvic organs including: the prostate, seminal vesicles, vas deferens and ejaculatory duct c.Blood supply, venous drainage, lymphatic drainage and nerve supply of the male reproductive tract (both internal and external sex organs)

After this practical, student should be able to Describe and Demonstrate:

1. The gross anatomy and external features of the male external genitalia including: the penis, scrotum, testis and epididymis 2. The gross anatomy and the anatomical relations of the male pelvic organs including: the prostate, vas deferens, seminal vesicles and ejaculatory duct. 3. The blood supply, lymphatic drainage and nerve supply of the male reproductive system (external and internal sex organs)

Transferable skills: By the end of this practical, student will demonstrate the ability to: 1) Dissect dead bodies (cadaver) 2) Identify the gross anatomy of male reproductive organs

1) Clinical anatomy for medical students (6th Ed), Richard S. Snell, 2000, Lippincot Williams & Wilkins.

Practical 2: Dissection of Female Reproductive Tract

TUTOR: Dr. Gamal Said, Dr. Hanan Student Notes: Department: Anatomy

SUMMARY:  The normal female pelvis including the features characterizing the female pelvis from that of males  True and false pelvis including the pelvic inlet and outlet  Surface anatomy of the female perineum (external genitalia)  Gross anatomy of the ovaries, uterine tubes, uterus, uterovesical pouch, recto uterine pouch and vagina  The broad ligament and its contents  Blood supply, venous drainage, lymphatic drainage and verve supply of the female reproductive tract  The pelvic floor and its contents including levator ani muscle  The ligaments supporting the uterus in its normal position

1. The gross anatomy if the normal female pelvis 2. The gross anatomy (Surface anatomy) of the female external genitalia 3. The gross anatomy of the female pelvic organs including: the ovaries, the uterine tubes, the uterus, the broad ligament and the vagina 4. The uterovesical pouch and the recto uterine pouch (Pouch of Douglas) 5. The blood supply, the lymphatic drainage and the nerve supply of the female reproductive system. 6. The factors supporting the female pelvic organs especially the uterus and vagina. Transferable skills:

By the end of this practical, student will demonstrate the ability to:

1) Dissect dead bodies (cadaver) 2) Identify the gross anatomy of female reproductive organs

1) Clinical anatomy for medical students (6th Ed), Richard S.Snell, 2000, REPRODUCTIVE SYSTEM Page 102 Lippincot Williams & Wilkins. Practical 3: Diagnosis of Pathologies Specimen of Male Genital System King Abdul Aziz University Faculty of medicine TUTOR: Student Notes: . Dr Shereen Ibrahim . Dr Ayman Ghanim . Dr Shugufta mufti . Dr Shabnum Sultan . Dr Azhar Qayyum Department: Pathology

At the end of the practical you should be able to understand: 1. Describe the various gross pathological lesions of the testes and prostate. 2. Recognize the histological appearance of the most common examples of testicular and prostatic lesions.

1. Jars. 2. Histological slides. 3.Various images in Internet & Kodakromes

Practical 4: Radiology of Reproductive System TUTOR: Dr. Naushad Ahamed Student Notes:

REPRODUCTIVE Dr. Samar SYSTEM Fatheddin Page 103 Department: Radiology King Abdul Aziz University Faculty of medicine

Practical 5: ABNORMAL VAGINAL BLEEDING TUTOR: Prof. Hassan Jamal Student Notes:

Dr. Haifa Mansouri

Department: Obstetrics and Gynecology

Upon completion of this topic the students should learn:

- Definition of DUB - Incidence and age prevalence - Is a diagnosis of exclusion - The treatment depends on age, severity, patient wishes. Primarily treatment is hormonal only if failed in older women surgery may be considered

 DUB is abnormal uterine bleeding (AUB) is almost always caused by aberrations in the hypothalamic- pituitary-ovarian hormonal axis resulting in anovulation

Age prevalence:

- Peri menopausal years, anovulatory bleeding is mainly caused by the declining functional capacity of the ovary. - In Adolescence, the anovulatory bleeding may be caused by a failure of the hypothalamic-pituitary system to respond to the positive feedback effect of estrogen.

Patterns of DUB: The non-secretory endometrium contains less prostaglandin and is less apt to initiate an efficient menstrual period of short duration. With repeated cycles of un-opposed estrogen, endometrial hyperplasia or even cancer may develop. (Patterns include Polymenorrhea, menorrhagia, metrorrhagia, menometrorrhagia).

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 Diagnosis of DUB: (examinations investigations to exclude other causes of abnormal uterine bleeding, including systemic diseases and malignancy particularly in older age. (U/S and endometrial biopsy)  Management: Hormonal

For cases with massive intractable hemorrhage, for regular continued management For mild cases. Surgical treatment: its place and types (including recent methods of endometrial ablation)

Essentials of Obstetrics and Gynecology Hacker & Moore

Practical 6: Histology of the Normal Male Reproductive Tract TUTOR: Dr. Gamal Said, Dr. Hanan Mostafa Student Notes: Department: Anatomy

SUMMARY:

 Histology of the testis and seminiferous tubules including the interstitial tissue and Leydig cells  Normal structure of the sperm  The histological structure and the type of tissues forming the prostate, seminal vesicles, vas deferens, epididymis and ejaculatory duct  The histological structure of the penis and penile urethra

2. The normal histology of the testis and seminiferous tubules 3. The normal histology of the spermatozoa 4. The normal histology of the male accessory glands and excretory ducts including: the prostate, the epididymis, the vas deferens, seminal vesicles and the ejaculatory duct. 5. The normal histology of the penis

1- Color Textbook of histology, 2nd Edition, Gartner, L.P. & Hiatt, J.L.,

W.B. Saunders.

2- Di Fiore's Atlas of histology with Functional Correlation, 9th Edition,

Eroschenko, V.P., Williams Ology of Normal Male reproductive

Tract& wilkins.

Practical 7 : Diagnosis of Pathology specimen of Female Genital System I TUTOR: Student Notes: . Dr Shereen Ibrahim . Dr Ayman Ghanim . Dr Shugufta mufti . Dr Shabnum Sultan . Dr Azhar Qayyum

Department: Pathology

At the end of the practical you should be able to understand:

This practical will give the student knowledge about the morphologic appearance (gross & microscopy) the most common examples of benign and malignant uterine epithelial and mesenchymal tumors.

1. Jars. 2. Histological slides. 3. Images from internet.

Practical 8 : Histology of the Normal Female Reproductive Tract

TUTOR: Prof. Amira / Dr. Gamal Said Student Notes: Department: Anatomy

SUMMARY:

 Histology of the ovary including the histological structure of ovarian follicles at different stages  Histology of the uterine tubes  Histology of the uterus and specifically the cervix  Histology of the vagina

1. The normal histology of the ovary including the ovarian follicle. 2. The normal histology of different stages of the ovarian follicles 3. The normal histology of the uterine tube 4. The normal histology of the uterus and cervix 5. The normal histology of the vagina

1- Color Textbook of histology, 2nd Edition, Gartner, L.P. & Hiatt, J.L., W.B. Saunders. 2- Di Fiore's Atlas of histology with Functional Correlation, 9th Edition, Eroschenko, V.P., Williams Ology of Normal Male reproductive Tract& wilkins.

Practical 9: Diagnosis of Pathology Specimen of Female Genital System II TUTOR: Student Notes: . Dr Shereen Ibrahim . Dr Ayman Ghanim . Dr Shugufta mufti . Dr Shabnum Sultan . Dr Azhar Qayyum

Department: Pathology

At the end of the practical you should be able to understand:

1. The morphology (gross & microscopy) of the most common examples of primary and secondary ovarian tumors.

1. Jars. 2. Histological slides. 3. Images from Internet

- Basic Pathology, Eight Edition; by: Kumar, Cotran & Robbins - Pathological Basis of Disease, Eight Edition; by: Robbins, Cotran, Kumar

CLINICAL PRESENTATION

REPRODUCTIVE SYSTEM Page 110 CLINICAL PRESENTATION 1: PUBERTY: NORMAL & ABNORMAL King Abdul Aziz University Faculty of medicine TUTOR: Dr. Al-Agha Student Notes: Department: Pediatrics

1-. Learning the Pathophysiology of abnormal pubertal development. 2- Learning various medical disorders (names only) that might result from abnormal pubertal development.

Puberty originates from a Latin word of pubescere "to be covered with hair". Defined as the stage between the onset of secondary sexual characteristics and the completion of physical maturity in which reproductive capability is attained and manifested by spermatogenesis in males and ovulation in females. Between early childhood and approximately 8 – 9 years (prepubertal stage), the hypothalamic-pituitary-gonadal axis is dormant as reflected by immeasurable serum levels of LH, FSH and sex hormones (estrogen in females & testosterone in males). In this phase activity of the hypothalamus and pituitary gland is thought to be suppressed by neuronal restraint pathway and by the negative feed back provided in the young children by minute levels of the circulating gonadal steroids. In girls normal puberty starts by age of 8 - 12 (mean 10) years, while in boys starts by age 10 - 14 (mean12) years. In boys, first sign is testicular enlargement followed by pubic hair development and genital enlargement. In girls, first sign is breast enlargement followed by pubic hair and menstruation. Precocious Puberty, most commonly defined as the onset of puberty before 8 years in girls and before 9 years in boys. Delayed Puberty, most commonly defined as no pubertal changes in girls by age of 14 years. In boys no pubertal changes by age of 15 years.

At the end of this lecture, medical student should be able to differentiate normal from abnormal pubertal development and disorders related to the abnormal pubertal development.

CLINICAL PRESENTATION 2: Ectopic Pregnancy TUTOR: Prof. Rouzi Al-Khotani Student Notes: Dr. Fatmah AlEtebi DepartmentREPRODUCTIVE SYSTEM: Obstetrics and Gynecology Page 111

King Abdul Aziz University Faculty of medicine

– DIRECTED LEARNING 1: Review of Hypothalamus Anterior Pituitary Gonadal Axis in Male & Female

TUTOR :Dr. Khidir Abdel Galil Student Notes:

Dr. Azra Karmani

Department: Physiology

1- To understand the concept of hormonal control of reproduction. 2- To comprehend the hypothalamic- pituitary gonadal interaction in male & female. 3- To understand the control of gonadotropin both in males & females

1- To study the hypothalamic- pituitary gonadal axis both in males & females. 2- To study the effects of GnRH from the hypothalamus on the gonads of both sexes 3- To describe the function FSH on both sexes 4- To describe the function of LH in both sexes 5- To study the negative feedback control of gonadotropin 6- To learn the effects of Inhibin hormones in both sexes & their role in the feedback control 7- To study the cyclic pattern control of gonadotropin in the females reproduction.

Guyton, AC and Hall, JE (2005). Textbook .1

Of Medical Physiology, WB Sunders Co. 2. Ganong, WF (2007).Review of Medical Physiology, (2007). McGraw Hill) 3. Roddie, IC and Wallace WFM (2004). MCQs In human physiology, (2004).Oxford Univ. Press.

( DIRECTED LEARNING 2: Normal Labor (Video show TUTOR: Dr. Nabeel Bondagji Dr. Wafa Faqeh Student Notes: Department : Obstetrics and Gynecology

Upon completing this topic the students should learn:  Understand the process of normal labor and delivery and how to provide optimal care and reassurance for the parturient and timely recognition of abnormal events.  The diagnosis of labor  The stages of labor  The mechanism of labor  Outline of management of patient in labor

 Definition of labor  Preparation for labor: Engagement, Lightening, Braxton Hicks contractions, Cervical effacement  The stages and phases of labor  First stage and phases of labor:  Second stage and mechanism of delivery: Descent, flexion, internal rotation, extension, external rotation and expulsion  Third stage of labor: Mechanism of placental delivery  Fourth stage of labor  Management of women in labor: Fluid intake, basic investigations( CBC,Blood group, hepatitis)  Maternal monitoring and monitoring of progress of labor  Fetal monitoring in labor  Potential complication: Maternal and fetal

Essential of Obstetrics and Gynecology, Hacker & Moor

REPRODUCTIVE SYSTEM Page 114 King Abdul Aziz University Faculty of medicine DIRECTED LEARNING 3: Pregnancy Loss & miscarriage

TUTOR: Prof. Hassan Jamal Dr: Samar Nazer Student Notes:

Department : obstetrics and Gynecology

Upon completing this topic the students should learn:

 Should understand the different types of miscarriage

 The difference in the handling, management and of recurrent and single miscarriage

Difference between associated factors VS. causes of miscarriage

 Definition of miscarriage vs. labor  Incidence of clinical vs. total miscarriage  Associated factors of miscarriage  Causes associated with recurrent miscarriage  Diagnosis of the different types of miscarriage: Threatened, inevitable, incomplete and complete (S&S and investigations)and management in each case  DD of miscarriage early bleeding in pregnancy  Recurrent miscarriage: Definition, Diagnosis( test and investigations) Management of recurrent miscarriage

Essential of Obstetrics and Gynecology .Hacker & Moor

DIRECTED LEARNING 4: Fertilization & Implantation

TUTOR: Dr. Hamid saleh, Dr. Fathia Ahmed Student Notes:

Department : Anatomy

After this directed learning , student should be able to: 1. Define the process of Fertilization 2. Define the process of Implantation 3. Describe the phases of fertilization 4. Describe the outcome of fertilization 5. Explain the implantation stages and development 6. Describe the abnormal implantation sites & ectopic pregnancy.

 Def. Of fertilization  Phases of fertilization  Result of fertilization  Stages of implantation  Abnormal implantation sites  Ectopic pregnancy  Clinic Notes

REPRODUCTIVE SYSTEM Page 117