Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBChB 4 > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

You may prefer our related Brainscape-certified flashcards:
WSET ® Level 4 D2 Business of Wine flashcards
1
Q

Explain the menstrual hormonal axis?

A
  • Hypothalmus secrets GnRH
  • GnRH acts on anterior pituitary to secrete FSH
  • FSH recruits ovarian follicles to grow
  • Growing ovarian follicles secrete ostrogen and inhibin A –> negative feedback to inhibit FSH release
  • One follicle becomes dominant follicle ( Graffian follicle) - remaining follicles decrease as FSH level decrease
  • Ostreogen levels peak day before LH surge
  • High levels of oestrogren create a postive feedback
  • –> small release of FSH which induces large surge of LH
  • LH Surge induces ovulation
  • Corpus leutuem forms to produce progesterone –> inhibits effects of ostrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the corpus leutuem form from?

A

Remainder of the dominant follicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What prevents continued LH surge during pregnancy?

A

Corpus leutuem producing progesterone

(Inhibits LH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the phases of the menstrual cycle?

Which one may change in length, and which one is static?

A

Normal cycles: 21-35 days

Follicular phase: Accounts for most variability in length

Luteal phase: 14-15 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long is the follicular phase?

A

Day 1 of bleeding to LH surge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What produces ostrogen?

A

Granulosa cells of follicles

Ostrogen produced inhibits FSH via negative feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is the Graafian follicle selected?

A
  • Graafian follicle will have higher sensitivity FSH receptors
  • Will produce more ostrogen than other follicles
  • Suppresses FSH to other follicles, therefore suppresses their growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain the endometrial changes on day 1 -4 of the menstrual cycle?

A
  • Abscence of pregnancy leads to regression of the corpus leuteum (no LH to maintain it)
  • Progesterone concentration decrease cause vasospam of spiral arteries
  • Ischaemia and sloughing of endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain the endometrial changes from day 4 -14?

A
  • Growing follicles secrete oestrogen, stimulates growth and proliferation of endometrial lining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do granulosa cells secrete oestrogen?

A
  • Surrounding thecca cells have LH receptors - binding of LH secretes oestrogen precursor
  • Granulosa cells ave FSH receptors - binding of FSH secrete aromatase
  • Aromatase converts oestrogen precursor into oestrgoen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the histology of the endometrium during the follicular phase?

A
  • Proliferation of endometrial epithelial cells (cells show high mitotic activity)
  • Endometrial glands are straight, tubular, and lined by simple columnar epithelium.
  • Stromal cells start to divide, enlarge, and accumulate glycogen.
  • Uterine spiral arteries start to regenerate and extend two-thirds of the way into the endometrium.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the graafian follicle release the ova at day 14? And how does the follicle become the corpus leuteum?

A

Follicle ruptures releasing the ova following day 14 LH surge

Granulosa cells of the Graafian follicle secrete LH receptors

LH surge on day 14 transforms follicle into corpus leutuem

Thecca cells produce progesterone and granulosa cells produce Inhibin A - inhibits FSH production from pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why does the corpus leuteum regress if there is no pregnancy?

A

Corpus leuteum is requires trophic effect to maintain itself

It requires LH’s trophic effect for its growth - however LH is inhibited by progesterone

During pregnancy corpus leuteum requires Beta- HCG for it to maintain itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the word trophic mean?

A

An endocrine needing the stimulation of another endocrine gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How the release of GnRH change from before and after puberty?

A

Before puberty: GnRH release in steady manner

After: GnRH released in pusatile manner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the structure of a follicle cell?

A

Primary oocyte surrounded granulosa cells, with an outer layer of theca cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the pituitary secrete LH on day 14?

A

Graafian follicle has been secrete oestrgen

Oestrogen levels peak a day 13 and sensitise pituitary to GnRH

Pulsatile GnRH acts as a postive feedback causing a lot of FSH and LH to be secreted on day 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Explain what happens if fertilisation does not occur?

A
  • Progesterone levels fall, as the corpus leuteum cannot be maintained
  • Corpus leuteum becomes the corpus albicans (a white scar that doesn’t secrete homrone)
  • Spiral arteries collapse in the endometrium and lining is sloughed off
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is primary dysmenorrhea?

A

Recurrent lower abdominal pain shortly before or during menstruation (in the absence of pathologic findings that could account for those symptoms)

20
Q

What is the pathophysiological mechanism behind primary dysmenhorrhea?

A

increased endometrial prostaglandin (PGF2 alpha) production → vasoconstriction/ischemia and stronger, sustained uterine contractions

21
Q

What are caused of secondary dysmenorrhea?

A

Endometriosis

Pelvic inflammatory disease (PID)

Intrauterine device (IUD)

Uterine leiomyoma

Adenomyosis

Psychological factors

22
Q

What is primary amennorhea?

A

Abscence of periods at age of 15 or older

23
Q

What is the aetiology of ammenorrhea?

A

Patients with normal puberty

Anatomical anomalies: (Uterine septum, hymenal atresia)

Competitive sports ( suppresses hypothalamus/pituitary)

Patients with growth delay and developmental delay

Hypogonadism (hypergonadotrophic gonadism or hypogonadotrophic gonadism)

Patients with virulisation

PCOS

Congenital adrenal hyperplasia

24
Q

What is secondary amennorrhea?

A

Absence of menses for more than 3 months (in women with previously regular cycles) or 6 months (in women with previously irregular cycles)

25
Q

What is the aetiology of secondary amenorrhea?

A

Pregnancy → most common cause of secondary amenorrhea

Ovarian disorders (e.g., polycystic ovary syndrome )

Endometriosis

Hypergonadotropic hypogonadism

Hypogonadotropic hypogonadism

26
Q

What is polymennhorrhea?
And what are its commonest causes?

A

Cycles with intervals less than 21 days

Causes:

Menarche

Menopause

Psycological stress

27
Q

What is oligomennorrhea?

A

Cycles with intervals of 35 - 90 days

Commonest causes

Pregnancy

PCOS

Insufficient calories

28
Q

What is hypermenorrhea?

A

Greater than 150 ml of blood lost in period

29
Q

What is menhorragia?

A

> 80 ml of blood lost in period

30
Q

What are cause of increased bleeding during period?

A
  • Endometriosis
  • Endometrial cancer
  • Endometrial hyperplasia
31
Q

What is hypomennorrhea?

A

< 25 ml of blood in period

32
Q

What are causes of hypomennorrhea?

A

Endometrial atrophy

Eating disorders (e.g., anorexia nervosa)

Chronic endometritis

Oral contraceptive use

33
Q

What is metorrhagia?

A

Bleeding in between periods

34
Q

What is menometorrhagia?

A

Bleeding in between periods that is heavy

35
Q

What are causes of menometorrhagia and menorrhagia?

A

Ovarian insufficiency

Myoma, endometrial cancer/hyperplasia, cervical cancer

Oral contraceptive use

36
Q

What are causes of spotting?

A
  • After ovulation ( due to decrease in oestrgoen)
  • Breakthrough bleeding: (mid-cycle bleeding caused by hormone imbalances (usually after starting new OCP therapy))
  • Endometriosis
  • Myomas, polyps, carcinomas, contact bleeding (e.g., in patients with cervical carcinoma or during gynecological examination)
  • During pregnancy: may indicate imminent abortion
37
Q

Why does oestrgoen levels fall during the luteal phase?

A
  • Leutenised thecca cells and granulosa cells secrete progesterone
  • Progesterone inhibits FSH secretion from pituitary
  • FSH production is required for granulosa cells to make armatase, which converts oestrogen precursors into oestrogen
38
Q

What is mittleschmerz?

A

Epidemiology: occurs in ovulating women

Cause: Enlargement and rupture of the follicular cyst during ovulation midcycle leads to transient peritoneal irritation (“midcycle pain”).

Clinical features: recurrent, unilateral, lower abdominal pain

Management: symptomatic treatment with NSAIDs as needed

39
Q

What produces oestrogen?

A

Ovaries (mostly)

Adrenal gland

Adipose tissue

40
Q

What are the types of oestrogen found in the body?

A

Estradiol (most abudant + strongest)

Estrone

Estriol

41
Q

What is the gential effects of oestrogen?

A

Female sexual development

Uterus: endometrial proliferation

Cervix: increased production of cervical mucus → facilitates passage of sperm, furthermore cervical dilation during labor is suggested by studies

Vagina: proliferation of epithelium

Pubis: hair growth

Breast: breast growth

42
Q

What are the extra-genital effects of oestrogen?

A

Bones: promotes bone formation by inhibiting bone resorption (induces osteoclast apoptosis)

Blood vessels: protective effect against atherosclerosis

Blood clotting: increased risk of thrombosis

Kidneys: increased water and sodium retention → may contribute to edema

Protein synthesis: slightly increased (anabolic effect)

Liver: decreased bilirubin excretion

43
Q

What cancers does oestrogen increase the incidence of?

A

Endometrial

Breast cancer

44
Q

What are the adverse effects of oestrogen?

A

Weight gain (edema)

Liver toxicity

Breast hypertrophy, gynecomastia (in men), galactorrhea

Thrombosis

Depressive moods

Spider nevi, gynecomastia, and testicular atrophy in cirrhosis

45
Q

What cancer does oestrogen reduce in incidence?

A

Colon cancer

46
Q

What conditions are associated with decreased oestrogen?

A
  • Menopause
  • Ovarian insufficiency
  • Congenital aromatase deficiency (↓ aromatase → ↑ androgens and ↓ estrogen)
  • Hyperprolactinemia (e.g., in pituitary adenomas, hypothyroidism)
47
Q
A

MBChB 4 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions