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RHCN > Basic science > Flashcards

Basic science Flashcards

1
Q

What is the definition of puberty

A

Onset of sexual maturity marked by development of secondary sexual characteristics

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2
Q

What is precocious puberty

A

Early onset puberty. Onset before age 8 in girls and before age 9 in boys

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3
Q

How is delayed puberty classified

A

Girls: absence of breast development by age 13 or absence of menarche by age 16
Boys: absence of testicular enlargement by age 14

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4
Q

Describe the female reproductive axis

A

Hypothalamus releases gonadotrophin releasing hormone which stimulates the anterior pituitary to release LH and FSH. LH and FSH stimulate the ovaries to produce oestrogen and progesterone. These hormones then feed back to the hypothalamus and pituitary to control the release of GnRH and LH/FSH.

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5
Q

Describe the male reproductive axis

A

Hypothalamus releases gonadotrophin releasing hormone which stimulates the anterior pituitary to release LH and FSH. LH and FSH stimulate the testes to produce testosterone which feeds back to the hypothalamus and pituitary to control further production.

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6
Q

What is the first physical change in puberty (girls/boys)

A

Girls - breast development

Boys - testicular enlargement

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7
Q

5 physical changes in puberty specific to boys

A

testicular enlargement, ejaculation (nocturnal), widened shoulders, facial and body hair, deepening of voice (enlargement of larynx and laryngeal muscles)

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8
Q

3 physical changes in puberty specific to girls

A

breast development, widened hips, menarche

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9
Q

3 physical changes in puberty which happen in both genders

A

growth spurt (females = 26cm most age 9-10, males = 28cm most age 11-12), pubic hair development, body fat changes

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10
Q

3 biochemical changes in puberty

A
  1. blood lipids (males = higher LDL and lower HDL)
  2. haematological indices (Hb rises in boys and falls in girls)
  3. maturation of P450 enzymes
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11
Q

Which staging system is used to assess pubertal development

A

Tanner stages

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12
Q

Difference between primary and secondary amenorrhoea

A 
Primary = no menarche before age 16. If  no secondary sexual characteristics then consider hormonal issue, if 2 sexual characteristics are present consider an outflow obstruction.
Secondary = normal cycle previously developed then absence of menstruation for >6 months (think athletes, low BMI, ED)
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13
Q

Non-pathological causes of primary and secondary amenorrhoea

A

Primary - constitutional delay, drugs

Secondary - pregnancy, lactation, menopause, drugs

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14
Q

Pathological causes of both primary and secondary amenorrhoea

A

Anorexia nervosa, psychological, athleticism, hyperprolactinaemia, hypo/hyperthyroidism, adrenal tumours, PCOS, premature ovarian failure

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15
Q

Pathological causes of primary amenorrhoea only

A

Adrenal hyperplasia, Turner’s syndrome, androgen insensitivity, imperforate hymen, transverse vaginal septum

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16
Q

Pathological causes of secondary amenorrhoea only

A

Asherman’s syndrome (adhesions in uterine cavity), cervical stenosis

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17
Q

Which investigations should you do for amenorrhoea

A

Prolactin, TFTs, FSH, androgens, USS ovaries, pregnancy test

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18
Q

Describe the structure of an ovarian follicle

A

Granulosa cells inside, have receptors for FSH
Theca cells outside, have receptors for LH
Contains an oocyte inside

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19
Q

What are the 3 main stages of the menstrual cycle

A 
Follicular phase (day 1 to 15)
Ovulation (day 14)
Luteal phase (day 15-28)
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20
Q

Main features of the follicular phase of menstrual cycle

A

Menstruation (day 1-5), shedding of endometrial lining and fall in progesterone due to loss of corpus luteum
Rapidly growing follicles in the ovaries
Dominant follicle selected (day 5-7) and produces oestrogen which prevents selection of other follicles

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21
Q

Main features of ovulation

A

LH surge causes release of the egg from the dominant follicle
Thickening of the endometrium
High levels of oestrogen and progesterone

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22
Q

Main features of luteal phase of menstrual cycle

A

Endometrial lining continues to thicken to prepare for menstruation
Corpus luteum forms from empty follicle
Hormones begin to decrease again

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23
Q

What is the corpus luteum

A

Formed from the leftover follicle after an egg has matured and left the follicle (ovulation)
In the ovaries

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24
Q

A surge in which hormone causes egg release

A

LH

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25
Q

What is menorrhagia

A

Heavy bleeding in normal cycle

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26
Q

What is dysmenorrhoea

A

Painful bleeding in normal cycle

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27
Q

What is oligomenorrhoea

A

Irregular bleeding/cycle

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28
Q

6 structural issues that may cause menorrhagia

A

Fibroids, polyps, endometriosis, endometrial hyperplasia, endometrial carcinoma, adenomyosis

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29
Q

What is adenomyosis

A

Endometrial lining invades into myometrium causing bleeding

30
Q

What is DUB

A

Dysfunctional uterine bleeding, diagnosis of exclusion when no other cause of menorrhagia is present

31
Q

7 medical methods for managing menorrhagia

A

Mirena coil, TXA, mefenamic acid, COC, norethisterone (progesterone), Depo-Provera, GnRH analogues

32
Q

4 surgical methods for managing menorrhagia

A

Endometrial ablation, uterine artery embolisation, hysteroscopic myomectomy, hysterectomy

33
Q

Vaginal causes of IMB/PCB/PMB

A

Trauma, vaginitis, vaginal/vulval cancer

34
Q

Cervical causes of IMB/PCB/PMB

A

Cervicitis (STI), polyps, ectropion, cancer, cervical intrahelical neoplasia (CIN)

35
Q

Uterine causes of IMB/PCB/PMB

A

Endometritis, fibroids, polyps, adenomyosis, cancer

36
Q

Iatrogenic causes of IMB/PCB/PMB

A

Contraception, tamoxifen, anticoagulants, gynaecological procedures

37
Q

How is infertility classified

A

Failure to conceive after two years of regular unprotected sexual intercourse with no contraception

38
Q

What is primary infertility

A

Couple has never conceived at any stage

39
Q

What is secondary infertility

A

Couples who have previously conceived (pregnancy may not have been successful)

40
Q

3 categories of female factor infertility

A
  1. ovarian factor (anovulation)
  2. tubal factor
    3, uterine/structural factor
41
Q

3 groups of ovarian factor infertility

A

Group 1: hypothalamic-pituitary failure
Group 2: hypothalamic-pituitary-ovarian dysfunction
Group 3: ovarian failure

42
Q

Examples of hypothalamic-pituitary failure

A 
Anorexia
Stress
Hypogonadotrophic hypogonadism
Hypopituitarism 
Hyperprolactinaemia
43
Q

Examples of hypothalamic-pituitary-ovarian dysfunction

A

PCOS

44
Q

Examples of ovarian failure

A

Premature
Menopause
Turner’s syndrome

45
Q

Main investigation for ovarian factor infertility

A

Need to check is woman is ovulating
Mid-luteal progesterone level taken 7 days before expected menses
>30nmol/L = proof of ovulation

46
Q

Other investigations for ovarian factor infertility

A

Serum FSH, LH, oestradiol (day 2-6)
TSH
Prolactin
Testosterone and SHBG

47
Q

Raised FSH and LH in ovarian factor infertility

A

Ovarian failure

48
Q

Low FSH and LH in ovarian factor infertility

A

Hypopituitarism

Hypogonadotrophic hypogonadism

49
Q

Examples of tubal factor infertility

A 
Hydrosalpinx (blockage of fallopian tube leading to accumulation of clear fluid) due to PID, HIV etc.
Tubal occlusion (e.g. via hydrosalpinx)
Tubal dysfunction
50
Q

Investigation for tubal factor infertility

A

Hysterosalpingogram

51
Q

Examples of uterine/structural factor infertility

A

Uterine: endometriosis, uterine malformation, fibroids, asherman’s syndrome
Cervical: cervical stenosis, non-receptive cervical mucus
Vaginal factor: vaginismus

52
Q

Investigation for uterine/structural factor infertility

A

Ultrasound

53
Q

3 main categories of male factor infertility

A

Pre-testicular
Testicular
Post-testicular

54
Q

Pre-testicular causes of male factor infertility

A

Smoking
Drugs decreasing FSH e.g. phenytoin
Secondary hypogonadism: hypothalamic or hypopituitarism

55
Q

Hypothalamic causes of pre-testicular male factor infertility

A

Obesity

Kallmann syndrome

56
Q

Hypopituitarism causes of pre-testicular male factor infertility

A 
Adenoma
Brain tumours
Infection
Inflammation (autoimmune)
Radiation
Congenital
57
Q

Testicular causes of male factor infertility

A 
Testicular cancer
Trauma
Radiotherapy
Drugs decreasing sperm mobility e.g. sulfasalazine
Genetic factors 
Primary hypogonadism
58
Q

Post-testicular causes of male factor infertility

A 
Obstruction of vas deferens
CAVD (congenital absence of vas deferens)
Prostatitis
Ejaculatory duct obstruction
Retrograde ejaculation
Impotence
59
Q

Main investigation for male factor infertility

A

Semen analysis

60
Q

What is azoospermia

A

Total absence of sperm

61
Q

What is oligozoospermia

A

Too few sperm within ejaculate

62
Q

What is teratozoospermia

A

Abnormal sperm morphology

63
Q

What is asthenzoospermia

A

Reduced sperm motility

64
Q

Other investigations for male factor infertility

A 
Endocrine tests
Cystic fibrosis screening
Karyotype and chromosome studies
Genital tract infections
Imaging of genital tract
65
Q

Mechanism of action of clomifene

A

Selective oestrogen receptor modulator
Inhibits oestrogen receptors in the hypothalamus, inhibiting negative feedback therefore LH/FSH are continually synthesized and released
Promotes ovulation

66
Q

What is the regime for clomifene

A

Prescribed on day 3 of menstrual cycle and continued for 5 days
Ovulation should occur 6-7 days after course of clomifene

67
Q

What is AMH

A

Anti-mullerian hormone

Produced by granulosa cells in small ovarian follicles - measure of ovarian reserve

68
Q

4 causes of high serum hCG

A
  1. multiple pregnancy
  2. molar pregnancy
  3. hCG-producing tumour e.g. germ-cell tumour
  4. Down’s syndrome/genetic abnormality
69
Q

2 causes of low serum hCG

A
  1. early stage of pregnancy

2. plateauing +/- falling hCG indicates pregnancy which is no longer viable (confirm with USS)

70
Q

3 causes of false-positive urinary pregnancy tests

A
  1. hCG producing tumour (germ cell)
  2. use of fertility medication
  3. use of chlorprozamine or methadone
71
Q

causes of false-negative urinary pregnancy test

A
  1. use of diuretics or promethazine

2. not testing first urination of the morning

RHCN (5 decks)

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