Ovulation Disorders

Question 1

how long does bleeding normally occur?

Answer 1

3-8 days

Question 2

define oligomenorrhoea

Answer 2

infrequent menstrual periods - >35 days

Question 3

define amenorrhoea

Answer 3

absent menstruation

Question 4

amenorrhoea can either….

Answer 4

primary or secondary

Question 5

progesterone only exerts negative feedback on the _________ whereas estradiol exerts it on the ____________ and _________

Answer 5

progesterone only exerts negative feedback on the PITUITARY whereas estradiol exerts it on the HYPOTHALAMUS and PITUITARY

Question 6

GnRH stimulates what 2 things?

Answer 6

FSH and LH

Question 7

low frequency pulses =

high frequency pulses =

Answer 7

low frequency pulses = FSH

high frequency pulses = LH

Question 8

name the hormone:

secreted by anterior pituitary

stimulates follicular development

thickens endometrium

Answer 8

FSH

Question 9

name that hormone:

secreted by anterior pituitary

peak stimulates ovulation

stimulates corpus luteum development

thickens endometrium

Answer 9

LH

Question 10

ovulation predictor kits detects a surge of what?

Answer 10

LH

Question 11

name that hormone:

peaks before ovulation

Answer 11

estradiol

Question 12

name that hormone:

peaks after ovulation

Answer 12

progesterone

Question 13

name that hormone:

produced by corpus luteum

Answer 13

progesterone

Question 14

name that hormone:

secreted primarily by the ovaries (follicles) and adrenal cortex (and placenta in pregnancy)

stimulates thickening of the endometrium

responsible for the fertile cervical mucus

high estrogen concentration inhibits secretion of FSH and prolactin (-ve feedback)

Answer 14

estrogen

Question 15

name that hormone:

inhibits secretion of LH

responsible for infertile (thick) cervical mucus

maintain thickness of endometrium

has thermogenic effect (increases basal body temperature)

relaxes smooth muscles

Answer 15

progesterone

Question 16

what is the WHO group I classification of ovulation disorder?

Answer 16

hypothalamic pituitary failure

Question 17

hypothalamic pituitary failure other name?

Answer 17

hypogonadotrophic hypogonadism

Question 18

low FSH
low LH
oestrogen deficiency
normal prolactin
amenorrhoea

diagnosis?

Answer 18

hypogonadotrophic hypogonadism

Question 19

what causes hypogonadotrophic hypogonadism?

Answer 19

stress
excessive exercise
low BMI
brain/pituitary tumours
head trauma
kallman's syndrome
drugs - steroids and opiates

Question 20

hypogonadotrophic hypogonadism management?

Answer 20

stabilise weight

pulsatile GnRH - SC or IV

need US monitoring

Question 21

what is the WHO group II classification of ovulation disorder?

Answer 21

hypothalamic pituitary dysfunction

Question 22

normal gonadotrophins
excess LH
normal oestrogen levels
oligo/amenorrhoea

diagnosis?

Answer 22

PCOS

Question 23

what is the diagnostic criteria for PCOS called?

Answer 23

rotterdam

oligo/amenorrhoea

polycystic ovaries

clinical/biochemical signs

Question 24

resistance to what is seen in PCOS?

Answer 24

insulin

Question 25

PCOS pre-treatment?

Answer 25

weight loss lifestyle - smoking alcohol folic acid rubella immune patent fallopian tube

Question 26

name the 3 parts to ovulation induction in PCOS

Answer 26

clomifene citrate gonadotrophin therapy by daily injections laparoscopic ovarian diathermy

Question 27

for those who do not ovulate on clomifene, what other drug options are there?

Answer 27

metformin FSH injections laparoscopic ovarian drilling assisted conception treatment

Question 28

name some increased maternal pregnancy complication in multiple pregnancies

Answer 28

``` hyperemesis anaemia hypertension pre-eclampsia diabetes depression/stress ```

Question 29

Increased risk of: ``` early and late miscarriage low birth weight (<2.5kg) prematurity disability twin-twin transfusion syndrome (TTTS) ``` are all seen in what?

Answer 29

multiple pregnancy

Question 30

difference between monochorionic and dichorionic?

Answer 30

dichorionic - each baby has a separate placenta and is inside a separate sac which has its own outer membrane (chorion) monochorionic - babies share a placenta and chorion

Question 31

name the scan finding in dichorionic twins

Answer 31

lambda sign

Question 32

name the scan finding in monochorionic twins

Answer 32

T sign

Question 33

TTTS treatment?

Answer 33

laser division of placental vessels amnioreduction septostomy

Question 34

common syndrome seen in premature babies?

Answer 34

RDS - respiratory distress syndrome

Question 35

common problems in premature twins?

Answer 35

``` cerebral palsy impaired sight congenital heart disease lower IQ ADHD speech development ```

Question 36

``` amen/galactorrhoea visual fields normal FSH/LH low oestrogen Raised serum prolactin >1000 iu/l on 2 or more occasions TFT normal MRI to diagnose ``` diagnosis?

Answer 36

hyperprolactinaemia

Question 37

hyperprolactinaemia drug treatment?

Answer 37

dopamine agonist

Question 38

name a dopamine agonist

Answer 38

cabergoline

Question 39

when should dopamine agonists be stopped?

Answer 39

when pregnancy occurs

Question 40

what is the WHO group III classification of ovulation disorder?

Answer 40

ovarian failure

Question 41

high level gonadotrophin low oestrogen level amenorrhea menopausal diagnosis?

Answer 41

ovarian failure

Question 42

before what age classes premature ovarian failure?

Answer 42

age 40

Question 43

premature ovarian failure treatment?

Answer 43

hormone replacement therapy egg/embryo donation counselling/support

Question 44

what is the progesterone challenge test?

Answer 44

menstrual bleed in response to a five day course of progesterone: indicates estrogen levels normal

Question 45

what investigation is good for examining the pelvic anatomy?

Answer 45

US