HD1

Question 1

The single follicle that reaches full maturity during this process of follicular phase is referred to as theWHAT follicle (the oocyte develops within this)?

Answer 1

The single follicle that reaches full maturity during this process of follicular phase is referred to as the Graafin follicle (the oocyte develops within this)?

Question 2

label A-C

Answer 2

A: luteal phase
B: follicular phase
C: ovulation

Question 3

what differnce occurs in the menstrual cycle if fertlisation occurs? [4]

Answer 3

19. If an ovum is fertilised it produces hCG which is similar in function to LH.
20. hCG prevents degeneration of the corpus luteum (resulting in the continued production of progesterone).
21. Continued production of progesterone prevents menstruation.

22. The placenta eventually takes over the role of the corpus luteum (from 8 weeks gestation).

Question 4

label A-D

Answer 4

A: FSH
B: Estradoil
C: LH
D: Progesterone

Question 5

what is the inside lining of the uterus called? [1]

what are the two layers of the uterus? [2]

which one is shed during menstruation? [1]

Answer 5

what is the inside lining of the uterus called? [1]
endometrium

what are the two layers of the uterus? [2]
functional layer
basal layer

which one is shed during menstruation? [1]
functional layer (this grows thicker in response to oestrogen and is shed during menstruation)

Question 6

what are the three stages of the uterine cycle? (simple) [3]

Answer 6

proliferative, secretory and menstrual phases.

Question 7

what is happenind during the proliferative phase of uterine cycle?

Answer 7

the endometrium is exposed to increasing levels of oestrogen as a result of FSH and LH stimulating its production.

Oestrogen stimulates repair and growth of the functional endometrial layer allowing recovery from the recent menstruation (increasing endometrial thickness, vascularity and the number of secretory glands).

Question 8

what is happening during the secretory phase of uterine cycle?

Answer 8

The secretory phase begins once ovulation has occurred.

This phase is driven by progesterone produced by the corpus luteum and results in the secretion of various substances by the endometrial glands, making the uterus a more welcoming environment for an embryo to implant.

Question 9

explain the menstrual phase of menstrual cycle

Answer 9

At the end of the luteal phase, the corpus luteum degenerates (if no implantation occurs).

The loss of the corpus luteum results in decreased progesterone production.

The decreasing levels of progesterone cause the spiral arteries in the functional endometrium to contract.

The loss of blood supply causes the functional endometrium to become ischaemic and necrotic.

As a result, the functional endometrium is shed and exits through the vagina as menstruation.

Question 10

how does the combined pill work? (which hormones?

Answer 10

oestrogen and progesterone

Inhibits LH and FSH: prevents ovulation

Thickens cervical mucus: natural sperm barrier

Thins endometrium: prevents implantation

Question 11

the combined pill is a combination of which two hormones? [2]

Answer 11

oestrogen and progesterone

Question 12

what is the mode of action of progesterone only pill? [3]

Answer 12

Thickens cervical mucus –> natural sperm barrier

Thins endometrium –> prevents implantation

Inhibits ovulation (97% desogestrel, 60% others)

Question 13

how does emergency contraception work?

Answer 13

Oral

Mode of action: Delay ovulation

Levonelle. Levonorgestrel 1.5mg single dose. Licensed up to 72 hours post-UPSI. Pregnancy rate 0.6 – 2.6%

EllaOne. Ullipristal acetate 30mg single dose. Licensed up to 120 hours post-UPSI. Pregnancy rate 1 – 2%

Question 14

how does IUD work? [4]

Answer 14

• Inhibits fertilisation by direct toxicity
• Affects implantation by causing endometrial inflammation
• Overall pregnancy rate <0.1%
• Licensed up to 5 days after UPSI / earliest possible ovulation

Question 15

which type of contraception works by being spermicidal?

IUD
combined pill
progesterone only pill
copper coil
pull out method

Answer 15

which type of contraception works by being spermicidal?

IUD
combined pill
progesterone only pill
copper coil
pull out method

Question 16

what is natural family planning / rhythm method / fertility awareness MoA? [4]

Answer 16

charting of various indicators of female fertility including:

• Temperature
• Consistency of cervical mucus
• Position of cervix
• Day of cycle

Question 17

what is MoA of female sterilisation?

Answer 17

Typically, laparoscopic bilateral tubal occlusion with clips/ligation/rings/diathermy

Can be done under local or general anaesthetic

Question 19

male sterilisation MoA? [1]

Answer 19

Ligation/diathermy/excision of vas deferens bilaterally

Question 20

how does emergency contraception work with IUD?

Answer 20

The intrauterine device (IUD) is a small, T-shaped plastic and copper device that’s put into your womb (uterus) by a doctor or nurse. It releases copper to stop the egg implanting in your womb or being fertilised.

• Inhibits fertilisation by direct toxicity
• Affects implantation by causing endometrial inflammation
• Overall pregnancy rate <0.1%
• Licensed up to 5 days after UPSI / earliest possible ovulation

Question 21

the emergency pill causes a big bleed because of an increased level of:

LH
FSH
oestrogen
progesterone
​ADH

Answer 21

the emergency pill causes a big bleed because of an increased level of:

LH
FSH
oestrogen
progesterone
​ADH

Question 22

which patient populations would not be advised to have the combined pill? [3]

Answer 22

if already have blood clots [1]
if suffer from migraines [1]
already have high BP [1]

Question 23

what is the dosing regimen for combined pill? [1]
what is the dosing regimen for pop? [1]

Answer 23

what is the dosing regimen for combined pill? [1]
3 weeks on, 1 week off

what is the dosing regimen for pop? [1]
everyday

Question 24

explain the mechanism of pregnancy tests working?

Answer 24

Pregnancy testing relies upon the detection of the beta subunit of human chorionic gonadotrophin in the mother’s urine after overnight concentration. The test is usually positive from the first day of the last missed period.

With the advent of monoclonal antibodies, pregnancy tests are now more specific and sensitive

the women must dip the hCG urine stick into a small pot of her urine and allow it to travel up the stick. Free monoclonal antibodies specific to hCG, which is a glycoprotein, are conjugated to an enzyme that changes the colour of a dye²², and a second set of monoclonal antibodies will be immobilised to the dye substrate^{<strong>2</strong>2}. If there is hCG present in the urine, it will interact with both sets of monoclonal antibodies, causing the enzyme that changes the colour of the dye to interact with its substrate and change the colour of the stick. There is also a control due to a third set of monoclonal antibodies, and these bind to any unattached enzyme-linked antibodies.

Question 25

what can cause false postivies in pregnancy test? [1]

Answer 25

False positive results can occur if pituitary gonadotrophin levels are elevated in the urine, for example, in older women when ovulation is failing and the pituitary excretes more gonadotrophins to stimulate the failing ovary

False negatives can occur if the test is done too early in pregnancy since their is insufficient chorionic gonadotrophin.

Question 26

what is the corpus luteum?

Answer 26

follicle that releases the egg, forms an endrocine gland that releases progesterone

Question 27

tutor notes:

name a non-biochemical method for the detection and confirmation of pregnancy [1]

Answer 27

ultrasound; transvaginal or transabdominal