Obs and Gyne

Question 1

Are FSH and LH levels controlled by positive or negative feedback?

Answer 1

Both! Initially negative feedback at the hypothalamus and anterior pituitary causes increase in FSH and LH in response to low oestrogen levels.However, at around D13, +ive feedback comes into play and an LH surge is produced, resulting in ovulation,By mid-luteal phase, -ive feedback returns, and high oestrogen levels lead to lower FSH and LH levels.

Question 2

In the follicular phase, what cause increased oestrogen production?

Answer 2

FSH acting on follicular cells in ovaries ; the developing follicles produce oestrogen.

Question 3

What changes within the reproductive organs during follicular/proliferative phase?

Answer 3

Vagina - tends to be dryer with a thicker mucous.Uterus - lining thickens (proliferates)Ovum - follicles develop, and one follicle becomes dominant.

Question 4

When does ovulation occur and what causes it?

Answer 4

Day 14 (occurs halfway through cycle, which is roughly 14 days after last menstruation). Occurs in response to the LH surge, which happens in response to threshold levels of oestrogen causing +ive feedback.

Question 5

In the secretory/luteal phase, where are oestrogen and progesterone produced?

Answer 5

Corpus luteum, which continues to produce these hormones until about 4 days prior to menstruation, when it regresses if it is not stimulated to continue by human chorionic gonadotrophin (secreted by the implanted zygote).

Question 6

What changes in reproductive organs during secretory/luteal phase?

Answer 6

Vagina - thinner mucous, becomes thicker again at the end of the phase when progesterone levels drop.Uterus - progesterone causes the lining to alter, ready to receive the egg; the endometrium is oedematous and more vascular, the glandular component more coiled and tortuous.Ovaries - corpus luteum formed, and then regresses 4 days prior to menstruation if no pregnancy.

Question 7

Why does menstruation occur?

Answer 7

Corpus luteum regresses, levels of progesterone and oestrogen decrease, necrosis and bleeding of endometrium results in sloughing off.

Question 8

How can menstruation be postponed? (2 options).

Answer 8

1) Norethistrone 5mg TDS (menstruation occurs 2-3/7 after stopping).
2) Back to back COC. (withdrawal bleed when 2nd pack finished).

Question 9

How does the COC pill work?

Answer 9

By keeping oestrogen levels high from the start of the cycle, low FSH and LH levels are maintained by -ive feedback, meaning no follicle develops.

Question 10

How long after intercourse can POP or copper containing IUD be used as emergency contraception?

Answer 10

POP - 72 hours.Copper coil - 5 days.

Question 11

What are the failure rates of COC, POP, progesterone implant, and progesterone injection?

Answer 11

COC - 0.2-0.3 / 100 women yearsPOP - 0.3-0.5/100 women yearsProgesterone implant -(implanon) - 0.1/100 women years. -(norplant) - 0.2/100 women years Progesterone injection - 0.1/100 women years.

Question 12

What benefits, other than contraception, does being on the COC bestow?

Answer 12

Lighter, more regular, and less painful menstrual cycles, with a decreased risk of ovarian and endometrial cancer.

Question 13

What are oestrogen and progesterogenic s/e’s of the COC?

Answer 13

Oestrogenic: weight gain, headaches, VTE, N&V, fluid retention.Progestogenic: acne, increased risk of cervical cancer, breast enlargement, depression.

Question 14

What are contraindications to COC?

Answer 14

Focal migraine.Prev VTE.Over 50 yr old.Over 35 yrs if smoker.BMI >39Previous breast cancer.Smoker of >40/day (any age)BP > 160/100Breastfeeding (though can be on COC)Liver disease.

Question 15

What is levonell?

Answer 15

POP - can be used as morning after pill, up to 72hrs following intercourse.

Question 16

What is the shape of the cervical opening?

Answer 16

Varies - in nulliparous women it is circular. But in parous women it is a slit.

Question 17

How many women have a fully mobile retroverted, retroflexed uterus?

Answer 17

20%
This can be difficult to palpate bimanually.
Rarely, it may cause urinary retention during pregnancy due to failure of the uterus to lift out of the pelvis at 12 weeks. This problem usually resolves at 16-22 weeks.

Question 18

What worries are there if a pregnant women develops chickenpox/varicella zoster? What s the risk of this happening?

Answer 18

If a pregnant women gets chicken pox, there is the risk of foetal varicella syndrome.
90% of women are immune to chickenpox at the time of pregnancy, and even if they are not immune, the chance of maternal chickenpox leading to foetal varicella syndrome is low, less than 1% when gestation is less than 20 weeks, rarer between 20-28 week, and there are no reported cases after 28 weeks.
However, it is important to be aware of this condition/risk and take it seriously, because it can cause a range of problems including limb hypoplasia and skin scarring. It is also one of the causes of bilateral cataract in an infant.

Question 19

When considering the exposure of a pregnant women to a virus, what counts as exposure? (3)

Answer 19

1) Being in the same room for 15 minutes.
2) Any face to face contact (e.g., a conversation with the infected person, even if only for 1 minute!)
3) Measles is a special case, and should be assessed more conservatively, as it is highly infectious.

Question 20

What can induce an early menopause? (2)

Answer 20

1) Chemotherapy.

2) Bilateral oopherectomy.

Question 21

When is chickenpox contagious?

Answer 21

From two days before the development of the rash until all the lesions have crusted over (usually about 5 days in total).

Question 22

What is uterus unicornis?

Answer 22

Failure to develop both mullarian ducts, resulting in the absence of one fallopian tube and ova, and a “hemi-uterus”.

Question 23

What is the consequence of having an absence of one mullarian duct?

Answer 23

Usually asymptomatic until labour, which is associated with increased incidence of late abortion, premature labour, and breech birth. Results in a unicornuate uterus.

Question 24

How long after intercourse can POP or copper IUD be used as emergency contraception?

Answer 24

POP- 72 hours (5 days in the case of one specific POP - can you name it?)
Copper coil - 5 days..