Adolescence (W3 KPH) Flashcards
define puberty
stage of physical maturation in which an individual becomes physiologically capable of sexual reproduction
what is puberty characterised by?
appearance of secondary sexual characteristics
pubertal growth spurt resulting in final adult height
physiological, cognitive and social changes
what does kisspeptin do?
stimulates GnRH secretion in the hypothalamus during the onset of puberty
what are the first signs of puberty?
M - testicular enlargement
F - breast development
what are the secondary signs of puberty?
axillary hair
body odour
pubic hair
acne
growth spurt
body composition changes
facial hair growth (M)
menstrual cycle beginning (F)
what is tanner staging?
a stating system of 5 stages
stage 1 - pre-pubescent
stage 5 - adult
in M - genitals and pubic hair growth
in F - breast and pubic hair growth
what is precocious puberty?
puberty occuring at an usually early age
in M - below 9
in F - below 8
what is delayed puberty?
when a person lacks or has incomplete development of specific sexual characteristics past the usual age of puberty onset
in M - 14
in F - 13
what are the gonadotropin dependant causes of precocious puberty?
hypothalamus/pituitary tumour
cerebral malformations
CNS injuries
idiopathic
genetic
what are the gonadotropin independent causes of precocious puberty?
gonad/liver tumour
adrenal gland hyperplasia (CAH)
exogenous androgenic or oestrogenic steroids
genetic
what are some of the basic investigations for precocious puberty?
gonadotropin blood test
sex steroids
bone age
what are the main reasons for delayed puberty?
hypergonadotropic hypogonadism
hypogonadotropic hypogonadism
constitutional delay of growth
what are the general investigations for delayed puberty?
visual field exam (tumours)
dysmorphic features
height/weight
family history
where is kisspeptin found?
hypothalamus:
AVPV nucleus and ARC nucleus
what does kisspeptin act with and how does it function?
kisspeptin (+) acts with GABA (-) to initiate reproductive development, induce puberty and regulate the HPG axis
describe what happens to kisspeptin during puberty
KiSS1 neurons increase in the AVPV of the hypothalamus
number of neurons that contact GnRH increases
increase is larger in the female reproductive tract
describe the secretion style of kisspeptin
pulsatile style every 60 mins during puberty
correlates with GABA pulses
explain the role of leptin in puberty
leptin is released from adipose tissue when a certain body weight and body fat composition is reached
leptin stimulates increase in kisspeptin molecules
what can mutations in kisspeptin cause?
precocious puberty
delayed puberty (idiopathic hypogonadotropic hypogonadism)
what do GnRH pulses stimulate?
LH and FSH in the anterior pituitary
what is kisspeptin feedback controlled by?
oestrogen, progesterone and testosterone in the testis or ovaries
explain the positive and negative feedback of kisspeptin
positive - increases secretion in the hypothalamus and AVPV
negative - inhibition through separate neuron to reduce secretion in ARC
explain the role of kisspeptin in the placenta
placental extravillous trophoblast cells express kisspeptin receptor
stimulation activates intracellular signalling pathways to increase Ca
kisspeptin also inhibits trophoblast cell migration
what does kisspeptin do during pregnancy?
stimulates oxytocin during late pregnancy and lactation
involved in labour and milk maturation
what is a proband?
a person who brings a family to the attention of genetics services
what is a consultand?
someone who has come to genetic services for advice
what features can indicate the type of genetic transmission in a pedigree?
vertical transmission
male to male transmission
both sexes affected
knights move (2 related males affected bypassing unaffected female)
explain briefly the fraser guidelines for adolescent sexual activity
UPSSI
U - understanding
P - parental involvement
S - sexual activity ongoing
S - suffering
I - interests
what is the gold standard for emergency contraception?
copper IUD
use within 5 days of unprotected sex
briefly explain the 2 pill options for emergency contraception
ulipristal acetate - progesterone receptor modulator, can be used 120 hours after unprotected sex
LNG - delays ovulation, can be used 72 hours after unprotected sex, BMI over 26 or over 70kg needs double dose
briefly explain how the contraceptive implant works and a pro and con of using it
small rod in upper arm preventing ovulation
pro - lasts or 3 years
con - unpredictable effect on periods
briefly explain the LNG-IUD form of contraception and a pro and con of using it
IUD with LNG hormone, thins endometrium
pro - lasts 3-8 years
con - risk of perforation/bleeding
briefly explain the non-hormonal IUD form of contraception and a pro and con of using it
IUD insertion, copper killls sperm and stops implantation
pro - lasts 5-10 years
con - risk of heavier periods
briefly explain the progesterone injection form of contraception and a pro and con of using it
subcutaneous or intramuscular injection preventing ovulation
pro - likely to stop periods
con - can delay return to fertility
what is the most effective form of birth control?
progesterone-only implant
what are the 3 conditions that must be kept for the lactation amenorrhoea method of contraception to work?
fully breastfeeding
no periods
less than 6 months post-partum
how long after sex does a pregnancy test become accurate?
21 days
what are the direct impacts of increased temperature on health?
head cramps (muscular pain)
heat exaustion (body fluid loss)
heat stroke
what are the indirect impacts of increased temperature on health?
water
food
disease carrying vectors
wildfires
ecosystems
what are some of the causes of changes in distribution of vectors?
temperature rise
rising sea levels
urban environment
population mobility
animal population shifts
why are children more vunerable to the adverse effects of climate change?
childrens ability to deal with environmental threats relies on resources provided to them
physical/mental immaturity causes risks to development
what are some of the susceptability factors of children in relation to climate change and health?
longer exposure over lifetime
increased air/water intake
worsening nutrition
extreme weather displacement
developing organs
more permeable skin/BBB
what are some of the chemical components in a cigarette?
acrolein
arsenic
cadmium
formaldehyde
benzene
chromium
nitrosamines
what are some of the other components in a cigarette?
lead
hydrogen cyanide
CO
nitrogen oxides
ammonia
nicotine
what are some of the main health effects of smoking?
stroke
gum disease
cancer (lung, oral cavity, kidney, bladder)
asthma
COPD
what are some of the main reasons for smoking uptake?
relation who smokes
low socioeconimic status
low parental supervision
tobacco marketing exposure
mental health condition
peer pressure
what is the recommended maximum alcohol intake per week?
14 units
what are the physiological effects of exercise on mood state?
endorphin hypothesis
mitochondrial function
mTOR
neurotransmitters (seratonin/dopamine)
HPA axis (A - adrenal)
how does exercise reduce inflammation?
visceral fat reduction
change in cytokine release
increase in vagal tone
down regulation of toll-like receptors
what are the main risk factors for non-communicable diseases?
unhealthy diet
tobacco smoking
alcohol
lack of physical activity
air pollution
explain lifestyle medicine
lifestyle changes to prevent or treat chronic disease
adopted alongside conventional practices
focuses on root of disease rather than treating symptoms
