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Endocrine > Ovulation disorders > Flashcards

Ovulation disorders Flashcards

1
Q

What is secondary amenorrhoea?

A

Cessation of periods for >6 months in someone who has menstruated

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2
Q

What is oligomenorrhoea?

A

Less than 9 periods/year

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3
Q

What congenital problems can cause primary amenorrhoea?

A

Turner’s syndrome

Kallman’s syndrome

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4
Q

What intrauterine problem could cause 2o amenorrhoea?

A

Uterine adhesions

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5
Q

What pituitary problems could cause 2o amenorrhoea?

A

high PRL, hypopituitarism

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6
Q

How is a PRLoma excluded from history?

A

Presence of galactorrhoea

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7
Q

What would be signs of oestrogen deficiency?

A

flushing
low libido
dyspareunia
breast atrophy

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8
Q

What symptom can be a sign of Kallman’s syndrome?

A

Anosmia

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9
Q

What tests should be ordered with ovulation disorders? (5)

A

LH FSH oestradiol

TFT prolactin

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10
Q

What is a primary hypogonadism?

A

Problem with ovaries

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11
Q

What hormone levels are present in 1o hypogonadism?

A

High LH and FSH

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12
Q

What is a secondary hypogonadism?

A

Problem with hypothalamus or pituitary

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13
Q

What hormone levels are present in 2o hypogonadism?

A

Low FSH and LH

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14
Q

What are symptoms of premature ovarian failure?

A

Amenorrhoea, oestrogen deficiency and elevated gonadotrophins

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15
Q

What causes premature ovarian failure?

A

Turner’s syndrome
Iatrogenic
Autoimmune e.g. Addisons

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16
Q

What hormone levels are diagnostic of POF?

A

FSH 430 twice more than 1 month apart

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17
Q

What can cause function 2o amenorrhoea?

A 
Stress
weight loss
steroids
recreational drugs
sarcoidosis
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18
Q

What is Kallman’s syndrome?

A

Genetic loss of GnRH

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19
Q

Why might anosmia be a sign of Kallman’s?

A

Absence of olfactory bulbs

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20
Q

Describe the release of GnRH from the hypothalamus

A

Pulsatile release.
Low frequency stimulates FSH
High frequency stimulates LH

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21
Q

Where is FSH secreted from?

A

Anterior pituitary

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22
Q

What does FSH do? (2)

A

Stimulates follicular development

thickens endometrium

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23
Q

When LH is at its peak what happens?

A

Ovulation is stimulated

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24
Q

What does LH do? (2)

A

Stimulates corpus luteum

Thickens endometrium

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25
Q

When is progesterone peaking?

A

Day 21

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26
Q

When is LH at its highest?

A

36 hours before ovulation

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27
Q

What produces progresterone?

A

Corpus luteum

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28
Q

Where does oestrogen come from? (3)

A

Follicles in ovaries
Adrenal cortex
Placenta

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29
Q

What does oestrogen do?

A

Thickens endometrium

Makes cervical mucus fertile

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30
Q

When progesterone is high, what happens to LH?

A

Suppressed

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31
Q

What does progesterone do?

A

Makes cervical mucus infertile

Increases basal temperature

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32
Q

What is a group I anovulatory disorder?

A

Hypothalamic pituitary failure e.g. hypogonadotrophic hypogonadism

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33
Q

In hypogonadotrophic hypogonadism, what are the hormone levels like?

A

Low FSH and LH

Deficient in oestrogen

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34
Q

What clinical sign is present in hypogonadotrophic hypogonadism?

A

Amenorrhoea

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35
Q

What can cause hypothalamic pituitary failure?

A 
Stress
exercise
anorexia
head trauma
steroids and opiates
Pituitary tumours
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36
Q

How can hypogonadotrophic hypogonadism be treated?

A

Pulsatile GnRH SC/IV

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37
Q

What is a group II anovulatory disorder?

A

PCOS

ovaries do not respond to hormones from pituitary

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38
Q

What are hormone activities like in PCOS?

A

LH high

oestrogen normal

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39
Q

What criteria must be filled to diagnose PCOS?

A

Rotterdam. 2 of
polycystic ovaries on USS
Oligo/Amenorrhoea
Clinical/biochem signs of acne or hirsuitsm

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40
Q

How may polycystic ovaries appear on USS?

A

12 or more of 2-9mm follicles
May be uni or bilateral
Increased ovarian volume

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41
Q

Why is DM2 more common in PCOS?

A

Insulin resistance common

Insulin lowers SBGH so more free testosterone

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42
Q

What is the increased risk with amenorrhoea?

A

Endometrial hyperplasia may cause endometrial Ca

43
Q

What folic acid are given if BMI >30?

44
Q

What oral therapy is given for ovulation induction in PCOS?

A

Clomifene citrate

45
Q

What are common side effects of clomifene citrate?

A

Visual disturbances & OHSS (withdraw both)
hot flushes
abdo pain
n&v

46
Q

What other options are there for PCOS treatment?

A

Metformin

FSH injections

47
Q

What are the benefits of metformin in PCOS?

A

Improves insulin resistance
Reduction in testosterone- hirsuitsm
Restoration of menstruation
No wt gain

48
Q

What is the risk of ovarian hyperstimulation?

A

DVT risk
Ascites
ARDS

49
Q

How might mild OHSS be recognised?

A

Abdominal bloating and pain

On USS, follicles less 8cm

50
Q

What are the risks of multiple pregnancy?

A 
Anaemia
Low birth weight/premature
Pre-eclampsia
GDM
Caesarean more likely
TTTS
51
Q

What does chorionicity mean?

A

Sharing of the same placenta

52
Q

What is the most dangerous chorionicity to have?

A

Monoamnionic monochorionic

53
Q

What is a lambda sign?

A

Dichorionic twins

54
Q

What is the sign in monochorionic twins?

55
Q

What is Twin-Twin Transfusion syndrome?

A

Two linked vascular supplies where one twin has the main one and drains from the other

56
Q

True or False

Twin pregnancies are more likely to have a child with a disability

A

True
Cerebral palsy
Congenital HD

57
Q

What major complication is clomifene citrate associated with?

A

Ovarian cancer

58
Q

What class of drug is given in hyperprolactinaemia?

A

Dopamine agonists

59
Q

Name a dopamine agonist

A

Cabergoline

60
Q

True or False

Cabergoline is safe in pregnancy

61
Q

What is a group III classification?

A

Ovarian failure

62
Q

What can cause premature ovarian failure?

A

Turner syndrom
Chemotherapy
Autoimmune ovarian failure

63
Q

What treatment is available for premature ovarian failure?

A

HRT
Assisted conception
Cryotherapy where POF anticipated

64
Q

What is a progesterone challenge test for?

A

Menstrual bleed in response to 5 day course of progesterone to check normal oestrogen levels

65
Q

What is secondary infertility?

A

Previous ability to concieve (not necessarily to term) and now no ability

66
Q

What issues give a poor prognosis?

A

Male infertility
Endometriosis
Tubal factor infertility

67
Q

When is the prime time for conception?

A

2 days before ovulation

68
Q

What is Sheehan’s syndrome?

A

Excessive blood loss during labour leading to low BP and postpartum hypopituitarism

69
Q

What is the hormone activity in anorexia nervosa?

A

Low FSH, LH and oestradiol

70
Q

What are the clinical features of premature ovarian failure?

A

Hot flushes
Night sweats
Atrophic vaginitis

71
Q

What causes atrophic vaginitis?

A

Low oestradiol

72
Q

What are infective causes of tubal disease?

A

STI
Transperitoneal spread e.g. appendicitis
IUCD insertion

73
Q

What are non-infective causes of tubal disease?

A

Endometriosis
Fibroids
Polyps
Salpingitis isthmica nodosa

74
Q

What is Salpingitis isthmica nodosa?

A

Nodular thickening of the Fallopian tube due to inflammation

75
Q

What is a hydrosalpinx ?

A

Blocked fallopian tube filled with fluid

76
Q

What are symptoms of a hydrosalpinx ?

A

Abdo pain
Dyspareunia
Febrile
Dysmenorrhoea

77
Q

What is endometriosis?

A

Endometrial glands outside the uterine cavity

78
Q

What are the clinical features of endometriosis?

A

Dysmenorrhoea
Dyspareunia
Painful defecation

79
Q

What may show on a scan with endometriosis?

A

Chocolate cysts on ovary

Fixed and retroverted uterus

80
Q

What is the most common cause of male infertility?

81
Q

What is cryptorchidism?

A

Missing testes

82
Q

What is a variocele?

A

Abnormalities in the veins in the testes which distracts blood supply.

83
Q

What is a normal testicular volume?

84
Q

If periods are irregular, when will progresterone be highest?

A

7 days prior to expected period

85
Q

What is a hysterosalpingiogram?

A

X-ray of uterus and fallopian tubes

86
Q

If PID is suspected which imaging would be done?

A

Laparoscopy

87
Q

When would a chromosome analysis need to be done?

A

If primary amenorrhoea or azoospermic

88
Q

What can a chlamydia infection lead to which may affect fertility/

A

Tubal block in men and women

89
Q

How can rubella affect a neonate?

A 
Microcephaly
PDA
Cataracts
Bulging fontanelle
Rash
90
Q

How is rubella prevented?

A

MMR vaccine.

91
Q

What cautions are needed with the MMR vaccine?

A

Contraception required for 1 month before concieving

92
Q

How is chlamydia treated?

A

Azithromycin

93
Q

What are the symptoms of chlamydia?

A

Dysuria
Abdo pain
Abnormal discharge
Haematuria

94
Q

How is clomifene citrate taken?

A

Day 2 - day 6

95
Q

Why is progesterone checked in clomifene citrate use?

A

To check dosage is high enough to stimulate ovulation

96
Q

What is letrozole an example of?

A

Aromatase inhibitors

97
Q

How do aromatase inhibitors work?

A

Prevents aromatase converting androgens from FSH to oestradiol so increases [FSH]

98
Q

True or False

There is no difference in FSH sensitivity in PCOS

A

False.

PCOS sufferers have a higher FSH threshold

99
Q

True or False

PCOS has a higher sensitivity to exogenous gonadotrophins

100
Q

When a sperm count is needed how is this carried out?

A

At home.
Keep in trousers.
To lab in

101
Q

How many sperm need to be normal in 100 for the sample to be normal?

102
Q

When can IU insemination be undertaken?

A

Sperm normal but blockage of vas deferens

103
Q

Where is sperm recovered from surgically?

A

Epididymis

104
Q

How many cells does a blastocyst have?

Endocrine (20 decks)

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