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MRCOG Part one > Female Repoductive Physioogy > Flashcards

Female Repoductive Physioogy Flashcards

1
Q

How much did the follicle grow from resting phase to pre ovulation phase?

A

1000 fold 0.2mm to 20mm

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2
Q

The granulosa cells develop a receptor for which hormone?

When do the follicle become depart on FSH to grow?

A

FSH

When they develop an antrum

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3
Q

What does LH drive in the theft cells?

A

Conversion of cholesterol to testosterone

Testosterone is then converted to estradiol in the graulosa cells under the inflamed of FSH

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4
Q

What hormone is responsible for the selection of the dominant follicle?

A

FSH it rises for 3 days increasing the number liber of granulosa cells meaning the production of inhibin and estadiol increase.

Negative feedback to FSH and FSH levels fall

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5
Q

What happens when the estradiol level increases above 300nmol/l for 2-3 days

A

Negative feedback switches to posited - causes LH surge

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6
Q

What happens to the level of estradiol after ovulation

A

Dramatic decrease as the thexa and granulosa layers are disrupted. As the corpus luteum form slow increase reaching peak after 1 week

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7
Q

What other effect does the LH surge have on the picture

A

Causes oocyte to complete first meiotic division with polar body leaving
Enter second meiotic diversion

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8
Q

When does the second meiotic division take place?

A

Spermatozoon penetrating oocyte

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9
Q

What hormone does the blastocyst form to support the corpus luteum

A

Human chorionic gonadotropin

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10
Q

What happens to the endometrium in the follicular stage under the influence of rising oestrogen

A

Rapid division
Glandular cells grow
Growth of blood vessels
Progesterone receptors on endometrial cells

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11
Q

What happens to the endometrium in the luteul phase?

A

Oedema
Secrete glycoproteins
Reach peak of 6mm

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12
Q

What is the effect of progesterone on the cervix

A

Reduced oedema
Mucus becomes thicker
Glycoproteins form mesh

Barrier for spermatozoa

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13
Q

How long is the epidermis

How long goes it take to go move down the epididymis

A

5 m

8-14 days

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14
Q

Cardiac output increases by how much

A

40%

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15
Q

When does cardiac output fall again

A

Lots in first 6 weeks but maybe take a several months to reach pre pregnancy level

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16
Q

How much does heart rate increase

A

10%

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17
Q

What changes are seen to the peripheral vascular resistance and BP?
When is nadir of BP

A

Reduces
SBP reduces by 10mmHg
DBP reduces by 5mmHG
24 weeks

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18
Q

What is supine hypotensive syndrome

A

Lies supine compressed inferior vena cava impeding venous return leading to fall in cardiac output,
Fall in BP feel dizzy/faint/nauseous
Fetal distress

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19
Q

How does the increased cardiac output change the anatomy of the heart

A

Hypertrophic
Dilation of the left ventricle and atrium

Raised diaphragm causes heart to be shifted anterior to the left

LAD by 15 degrees
Inverted T wave in lead 3

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20
Q

What changes to ventilation are seen in pregnancy? How does this affect the blood gas?

A

Increase in ventilation by 40% - high progesterone

Falll on PaCo2 to 4.1kPa, alkaline pH, increased bicarbonate from the kidneys

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21
Q

What changes causes this change in ventilation

A

Tidal volume increases by 40% no change in RR

Residual volume decrease/exploratory reserve/inspiraotry reserve volume

22
Q

What changes are seen to the anatomy of the kidney during pregnancy?

A

Kidneys increase in size
Ureters dilate ( progesterone and obstruction)
Renal blood flow and GFR increase
U

23
Q

How does urea and creatinine change in pregnancy?

A

Urea falls 4.3 to 3.1

Creatinin falls 73 to 47

24
Q

Why is constipation common in pregnancy

A

Slower small and larger bowel motility in response to progesterone the

25
Q

Why are pregnant women more likely to develop gallstones?

A

Drop in cholecystokinin causes decrease in gall bladder contractility

26
Q

What happens to the level of alkaline phosphatase in pregnancy, why?

A

Increases up to 3 times

27
Q

In pregnancy what change is sen to plasma volume?

A

Increases by 45% starting from early in pregnancy and peaks at 32 weeks.

28
Q

What happens to red cell mass/haemoglobin conc/haematorcrit?

A

Increases red cell mass by 20-30%, rise in plasma is greater so the heamoglobin concentration and haemtocrit fall.

‘Physiological anaemia’ - most marked at 32 weeks

29
Q

What happens to leucocyte count in pregnancy?

A

Modest rise, prilimary neutrophils

30
Q

What happens to platelet count?

A

Debated but slightly decreases

31
Q

How much more iron is needed in pregnancy?

A

Increase from 2.8mg/day to 6.6mg/day

32
Q

What factors make pregnancy a hypercoaguable state?

A

Increase in coagulation factors

Decrease in fibrinolytic

33
Q

Which clotting factors are increased/unchanged

A

Increased VII, VIII, X

Same IX and XIII

34
Q

What happens to ESR and why?

A

Raised ESR, rise in fibrinogen

Increased coag → stop bleeding after delivery of the placenta

35
Q

Does coag screening change?

A

No

36
Q

What physiological changes are seen to the breast during pregnancy?

Which hormones cause this change?

A

Hyperplasia of alveolar cells and lactiferous ducts
Alveolar hypertrophy

Stimulated by proactive + human placental lactose + oestrogen + progesterone

Milk production only occurs once oestrogen + progesterone levels drop

37
Q

How much milk is produced a day

A

500-1000ml/day

Will be tailored to baby by 3-4 weeks

38
Q

What hormone stimulates prolactin production

A

Thyrotrophin-releasing hormone

39
Q

Where is oxytocin produced/released from

A

Produced supraoptic and paraventricular nuclei of hypothalamus
Release from posterior pituitary gland

40
Q

What is oxytocin role in breastfeeding

A

Binds to receptors on myoepithelial cells that allows the release of the milk

41
Q

How is colostrum (early milk) differ to milk produce later?

A

Higher protein level relative to lactulose

High IgA

42
Q

What are the constituents of breast milk?

A

Protein (casein (40%) + whey protein (60%)), lactose, fat , sodium, chloride

  • varies between babies and is dependant on what the baby needs
43
Q

What vitamins is carried in the fat of the breast milk?

A

A, D, E and K

44
Q

Why is breast feeding so important in developing countries?

A

IgA is poorly absorbed an stays in GI tract, protects against diarrhoea where access to clean water is poor.

45
Q

What percentage of women who are using breastfeeding as contraception will be pregnancy after 1 year?

A

10%

46
Q

How does progesterone prevent labour

A

suppresses formation of myometial gap junctions
decreases effect interleukin 8 (cervical ripening)
Decreases uterine sensitivity to oxytocin

47
Q

What type of drugs is mifepristone?

A

Antiprogesterone - cervical ripening and increased myometial activity

48
Q

What causes cervical ripening?

A

Prostaglandins and interleukin 8 attract neutrophils to the cervix which release collagenase leading to gradual proteolysis of collagen fibres

49
Q

How does myometrial contraction occur

A

Interaction of actin and myosin, controlled by calcium modulated protein kinase. Myometial cells communicate through gap junctions.

50
Q

What changes in myometiral receptors are seen before the onset of labour

A

Increased oxytocin

Progesterone from type 1 to type 2

51
Q

The delivery of the placenta is depends on which hormones?

A

Prostaglandin F2a

No changes to oxytocin

52
Q

How long does it take for the endometrium take to reform?

A

1 week, 3 weeks at placental bed

Within 7 days halted in size

MRCOG Part one (28 decks)

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