Ovulatory Disorders

Question 1

what is oligmenorrhea?

Answer 1

cycles > 35 days

Question 2

what is amenorrhea

Answer 2

no menstruation

Question 3

what does GnRH do?

Answer 3

stimulate FSH and LH synthesis and release

Question 4

what does FSH do?

Answer 4

follicular development

thickens endometrium

Question 5

what does LH do?

Answer 5

stimulate ovulation
stimulate corpus luteum development
thickens endometrium

Question 6

when does estradiol peak?

Answer 6

before ovulation

Question 7

when does progesterone peak?

Answer 7

after ovulation

Question 8

what does oestrogen do?

Answer 8

thickens endometrium

makes fertile cervical mucus

Question 9

what does progesterone do?

Answer 9

makes infertile thick mucus
maintains endometrium thickness
increases basal body temp
relaxes smooth muscles

Question 10

how can you confirm regular cycles?

Answer 10

midluteal serum progesterone (should be >30nmol/L) take 2 samples

Question 11

group 1 WHO classification ovulatory disorders

Answer 11

hypothalamic pituitary failure

Question 12

what type of ovulatory disorder is hypogonadotrophic hypogonadism

Answer 12

hypothalamic pituitary failure (group 1)

Question 13

is there oestrogen deficiancy in hypogonadotrophic hypogonadism and low FSH and LH?

Answer 13

yes

Question 14

what can cause hypogonadotrophic hypogonadism?

Answer 14

stress
too much exercise
anorexia
brain/pituitary tumours
head trauma
kallmans syndrome
drugs-steroid, opitaes

Question 15

how can you manage hypogonadotrophic hypogonadism?

Answer 15

stabalise weight

gonadotrophin (FSH and LH) daily injections -needs Ultrasound monitoring

Question 16

group 2 WHO classification ovulatory disorders

Answer 16

Hypothalamic pituitary dysfunction

Question 17

what type of disorders account for most (85%) of ovulatory disorders?

Answer 17

Hypothalamic pituitary dysfunction

Question 18

what is the main/ most common Hypothalamic pituitary dysfunction?

Answer 18

PCOS

Question 19

is insulin resistance seen in PCOS?

Answer 19

YES- in 50-80% of cases

Question 20

what is the first line treatment for ovulation induction in PCOS?

Answer 20

clomifene citrate

this can also be taken with metformin to improve insulin resistance

Question 21

second treatment of ovulation induction in PCOS?

Answer 21

gonadotrophin injections (daily)

Question 22

last resort treatment for ovulation induction in PCOS?

Answer 22

laparoscopic ovarian diatherny

Question 23

risk of ovulation induction

Answer 23

multiple pregancy
ovarian hyperstimulation
ovary destruction

Question 24

risk of multiple pregnancy

Answer 24

increase maternal complications
increase miscarriage
increase low birth weight
increase prmaturity
increase disability 
increase still birth

twin twin transfusion syndrome

Question 25

lambda sign on USS

Answer 25

dichorionic

Question 26

T sign on USS

Answer 26

monochorionic

Question 27

what causes twin twin transfusion syndrome?

Answer 27

unbalanced vascular communications within placental bed- recipient gets more stuff so gets bigger, grows better and the donor has growth restriction

Question 28

long term disabilities due to prematurity?

Answer 28

cerebral palsy impaired eye sight congenital heart disease struggle with language development

Question 29

medical treatment for hyperprolactinaemia?

Answer 29

dopamine agonist

Question 30

group 2 WHO classification ovulatory disorders

Answer 30

ovarian failure

Question 31

menopause before 40

Answer 31

premature ovarian failure

Question 32

how do you treat premature ovarian failure?

Answer 32

hormone replacement

Question 33

in the progesterone challenge test, if you bleed within 5 day course of progesterone what does this mean|?

Answer 33

oestrogen levels are normal

Question 34

what is primary amenorrhea?

Answer 34

failure of menarche by age 16

Question 35

what is secondary amenorrhea?

Answer 35

cessation of periods >6 months in an individual who previously menstruated

Question 36

what can cause functional hypothalamic amenorrhea?

Answer 36

``` iatrogenic weight change stress exercise anabolic steroid systemic illness infiltrative disorders e.g sarcoidosis head trauma recreational drugs ```

Question 37

what hormones should be checked in someone with oligo/amenorrhea?

Answer 37

``` LH FSH Oestradial thyroid function tests prolactin testosterrone if hairy/acne ```

Question 38

difference between primary and secondary hypogondism?

Answer 38

primary- problem with ovaries, high FSH/LH e.g premature ovarian failure secondary-problem with hypo/pit. low FSH/LH e.g high prolactin/hypopituitarism

Question 39

what happens in kallmans syndrome?

Answer 39

loss of GnRH secretion and ansmia or hyposmia

Question 40

common causes of hyperprolactinemia?

Answer 40

prolactinomas drugs hypothyroidism idiopathic

Question 41

what is hirsutism?

Answer 41

excess hair, females usually get it

Question 42

short stature webbed neck shield chest, wide spaced nipples XO chromosome

Answer 42

turners syndrome

Question 43

difference between primary and secondary male hypogonadism?

Answer 43

primary- low testosterone with high LH and FSH secondary- low testosterone and low LH and FSH usually pituitary/hypo disease

Question 44

what is the most common cause of male hypogonadism?

Answer 44

Klinefelters syndrome

Question 45

reduced testicular volume gynaecomastia eunuchoidism low testosterone, high LH and FSH

Answer 45

Klinefleters syndrome

Question 46

health benefits of testosterone therapy?

Answer 46

``` improved sex function improved bone health decrease fat mass increase muscle strength small improvement in insulin sensitivity ```

Question 47

causes of gynaecomastia?

Answer 47

``` drugs physiological hypogonadism tumours endocrine disorders systemic illness hereditary ```