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Phase 3A Sam Harper > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

1
Q

Explain the role of the Hypothalamic-Pituitary-Gonadal Axis and the roles of LH and FSH

A

The hypothalamus releases GnRH. GnRH stimulates the anterior pituitary to produce LH and FSH

LH and FSh stimulate the development of follicles in the ovaries. The theca granulosa cells around the follicles secrete oestrogen. Oestrogen has a negative feedback on the anterior pituitary and hypothalamus to suppress the release GnRH, LH and FSH

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2
Q

Explain the role of Oestrogen

A

It stimulates: Breast tissue development, Growth and development of the female sex organs at puberty, Blood vessel development in the uterus and development of the endometrium

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3
Q

Explain the role of progesterone

A

Prodcued by the corpus luteum after ovulation. It acts to: Thicken and maintain the endometrium, Thicken the cervical mucus, Increase the body temperature

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4
Q

Why do overweight children start puberty earlier

A

Aromatase, an enzyme foudn in adipose tissue, has an important role in making oestrogen. Therefore the more adipose tissue the higher the quantity of the enzyme that produces oestrogen.

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5
Q

What is the first episode of menstruation called?

A

Menarche

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6
Q

What are the five stages of puberty according to Tanner staging?

A

1 - Under 10 - No pubic hair, no breast development
2 - 10-11 - Light and thin pubic hair - Breast buds develop from behind areola
3 - 11-13 - Coarse and curly - Breasts begin to elevate
4 - 13-14 - Adult like but no reaching thigh - Areolar mound forms and projects
5 - Above 14 - Hair extending to medial thigh - Areolar mounds reduce, and adult breasts form

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7
Q

What are the two phases of the menstrual cycle

A

Follicular and luteal phase

Follicular - from menstruation to ovulation (at day 14)

Luteal - From day 14 to 28

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8
Q

What are immature ovums called

A

oocytes

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9
Q

What cells surround oocytes to from follicles

A

granulosa cells

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10
Q

What are the four keys stages in follicle development in the ovaries

A

Primordial follicles, Primary follicles, Secondary follicles, Antral follicles (aka Graafian follicles)

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11
Q

What is required for further developemnt after the secondary follicle stage

A

FSH

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12
Q

What does oestrogen do during the follicular phase of the menstrual cycle

A

Oestrogen has a -ve feedback effect on the pituitary gland, reducing the quantity of LH and FSH produced. It also causes the cervical mucus to become more permeable so that sperm can penetrate during ovulation

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13
Q

Role of LH in the follicular phase

A

Spikes during ovulation causing the dominant follicle to release the ovum from the ovary.

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14
Q

What does the corpus luteum do

A

It forms from the follicle once the ovum is released. It releases high levels of progesterone which maintains the endometrial lining. It also secretes a small amount of oestrogen

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15
Q

Role of progesterone in the luteal phase

A

Causes the cervical mucus to thicken and no longer penetrable

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16
Q

After fertilisation occurs what is secreted from the embryo

A

HCG from the synctiotrophblast

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17
Q

What does HCG do

A

Maintains the corpus luteum

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18
Q

What happens when no fertilisation occurs

A

The corpus luteum degenerates and stops producing oestrogen and progesterone. This causes the endometrium to break down and for menstruation to occur. Also the stromal cells of the endometrium release prostaglandins which encourage the endometrium to break down and the uterus to contract. Menstruation is on the first day of menstrual cycle

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19
Q

Explain the three stages of labour

A

First stage: From onset of labour (true contractions) until 10cm cervical dilatation

Second stage: From 10cm to delivery

Third stage: From delivery of the baby to delivery of the placenta

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20
Q

Role of prostaglandins

A

Local hormones. Play a crucial role in menstruation and labour by stimulating contraction of uterine muscles, role in ripening of the cervix before delivery

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21
Q

Key prostaglandin to be aware of

A

Prostaglandin E2 - used in pessaries to induce labour

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22
Q

What is a Braxton-Hicks contraction

A

Occasional irregular contractions of the uterus. Felt during second and third trimester. Temporary and irregular tightening or mild cramping. They don’t progress or become regular. Stay hydrated and relax

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23
Q

What is cervical effacement

A

The cervix gets thinner from back to front

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24
Q

What is the cervical ‘show’?

A

Refers to the mucus plug falling out and creating space for the baby to pass through

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25
Q

Explain the three phases of the first stage of labour

A

Latent: From 0 to 3cm dilation, progress at 0.5cm per hour

Active: From 3 to 7cm, progress at 1cm per hour, regular contractions

Transition: From 7 to 10cm. 1cm an hour, strong and regular contractions

26
Q

What does the success of the second stage of labour depend on?

A

Power, Passenger and Passage

27
Q

Explain power

A

The strength of uterine contractions

28
Q

What are the four descriptive qualities of the fetus

A

Size, Attitude, Lie and Presentation

29
Q

Explain the descriptive qualities of the fetus

A

Size: Particularly head size
Attitude: posture of the fetus, how the back is rounded and how the head and limbs are flexed
Lie: position of fetus in relation to mothers body e.g. longitudinal (fetus is straight up and down), Transverse (side to side), Oblique (at an angle)
Presentation: Cephalic, Shoulder, Breech
Passage: Size and shape on the passageway, mainly the pelvis

30
Q

What are the different types of breech presentation?

A

Complete: Hips and knees flexed (like a canonball)
Frank: Hips flexed knees extended
Footling: Foot hanging through the cervix

31
Q

What are the seven cardinal movements of labour

A

Engagement, Descent, Flexion, Internal rotation, Extension, Restitution and external rotation and expulsion

32
Q

Explain descent

A

Position of the babys head in relation to the mothers ischial spines during the descent phase, measured in centimetres from: -5 baby is high up around inlet
0 - when head is at the ischial spines
+5 - fetal head has descended further out

33
Q

What is physiological management in the third stage

A

Where the placenta is delivered by maternal effort without meds or cord traction

34
Q

What is active management of the third stage of labour

A

Midwife or doctor assist. Reduces risk of bleeding. Haemorrhage or more than a 60 minute delay in placental delivery triggers active management. Associated with N/V

35
Q

What drug is given in active management of the third stage of labour

A

IM Oxytocin to help the uterus contract and expel the placenta

36
Q

What is cord traction

A

Applied to the umbilical cord to guide the placenta out of the uterus and vagina

37
Q

Causes of primary amenorrhoea

A

When the patient has never developed periods

Due to: Abnormal functioning of the hypothalamus or pituitary gland (hypogonadotrophic hypogonadism), Abnormal functioning of the gonads (hypergonadotrophic hypogonadism) or imperforate hymen or other structural abnormality

38
Q

Causes of secondary amenorrhoea

A

Pregnancy, Menopause, Physiological stress due to excessive exercise, low body weight, chronic disease, psychosocial, PCOS, Meds such as contraceptives, Premature ovarian insufficiency, thyroid issue, Excessive prolactin, Cushings

39
Q

Causes of irregular menstruation

A

Extremes of reproductive age, PCOS, Physiological stress, Meds (prog only pill, antidepressants and antipsychotics), Hormonal imbalance such as thyroid, Cushings and high repro age

40
Q

Urgency of Intermenstrual bleeding

A

Red flag as it should make you consider cervical and other causes

41
Q

Causes of IMB

A

Hormonal contraception, Cervical ectropion, polyps or cancer, STI, Endometrial polyps or cancer, Vaginal pathology, Pregnancy, Ovulation, Meds

42
Q

Causes of dysmenorrhoea

A

Primary, Endometriosis or adenomyosis, Fibroids, PID, Copper coil, Cervical or ovarian cancer

43
Q

Causes of Menorrhagia

A

Dysfunctional uterine bleeding, Extremes of repro age, Fibroids, Endometriosis or adenomyosis, PID, Contraceptives, Anticoags, Bleeding disorders, Endocrine disorders, Connective tissue disorders, Endometrial hyperplasia, PCOS

44
Q

Urgency of post coital bleeding

A

Red flag for cancer

45
Q

Causes of PCB

A

Cervical cancer, Trauma, Atrophic vaginitis, Polyps, Endometrial cancer, Vaginal cancer

46
Q

Causes of vaginal discharge

A

BV, Candidiasis, Chlamydia, Gonorrhoea, Trichomonas vaginalis, Foreign body, Cervical ectropion, polyps, malignancy, pregnancy, ovulation, Hormonal contraception

46
Q

Causes of pelvic pain

A

UTI, Painful periods, IBS, Ovarian cyst, Endometriosis, PID, Ectopic, Appendicitis, Mittelschmerz, Pelvic adhesions, Ovarian torsion, IBD

47
Q

Causes of pruritus vulvae

A

Irritants, Atrophic vaginits, Infections such as candida and lice, Skin conditions, Vulval malignancy, Pregnancy related, Urinary or faecal incontinence, Stress

48
Q

Definition of primary amenorrhoea

A

Not starting menstruation by age 13 if no other evidence of pubertal development or by age 15 if there are other signs such as development of breast buds

49
Q

Explain the two types of hypogonadism

A

Hypogonadotrophic hypogonadism - deficiency of LH and FSH

Hypergonadotrophic hypogonadism - lack of response to LH and FSH by the gonads

50
Q

Causes of Hypogonadotrophic hypogonadism

A

Hypopituitarism, Damage to the hypothalamus or pituitary, significant chronic conditions (CF or IBD), Excessive exercise or dieting, constitutional delay in growth and development, endocrine disorders such a hypothyroid/cushings/hyperprolactin, Kallman syndrome

51
Q

Causes of Hypergonadotrophic hypogonadism

A

Previous damage to the gonads (e.g. torsion, cancer or infections), Congenital absence of ovaries, Turners

52
Q

What is Kallman syndrome

A

Genetic condition causing hypogonadotrophic hypogonadism with failure to start puberty, associated with a reduced or absent sense of smell (anosmia)

53
Q

Summarise congenital adrenal hyperplasia

A

Genetic condition causing underproduction of cortisol, aldosterone and an overproduction of androgens. Typical features are tall for age, facial hair, absent periods (pri amen), deep voice and early puberty

54
Q

Summarise androgen insensitivity syndrome

A

Condition where tissues are unable to respond to androgens so typicall male sexual characteristics dont develop, resulting in a female phenotype. Normal external female genitalia and breast tissue, testes in abdo, absent uterus, upper vagina, fallopian tubes and ovaries

55
Q

What structural abnormalities can cause primary amenorrhoea?

A

Imperforate hymen, Transverse vaginal septae, vaginal agenesis, absent uterus, FGM

56
Q

Initial investigations for primary amenorrhoea

A

FNC and ferritin for anaemia, U&E for CKD, Anti-TTG or anti-EMA antibodies for coeliac

57
Q

Hormonal blood tests for primary amenorrhoea

A

FSH and LH, TFT, Insulin like growth factor 1 for GH def, Prolactin, Testosterone is raised in PCOS/androgen insen, congenital adrenal hyperplasia

58
Q
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59
Q
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Phase 3A Sam Harper (5 decks)

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