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MCQ knowledge > Pregnancy and Reproduction > Flashcards

Pregnancy and Reproduction Flashcards

1
Q

Cystic fibrosis causes infertility in both sexes, what are different the mechanisms for males and female.

A

Males: maldeveloped vas deferens

Females: viscous cervical secretions

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2
Q

A young couple has a 3 year history of recurrent miscarriages in the 1st trimester. What should be tested?

A
  1. Maternal and paternal karyotyping

2. Lupus anticoagulant

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3
Q

Which complications of pregnancy is bacterial vaginosis associated with?

A
  1. 2nd trimeter miscarriage

2. Premature labour

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4
Q

What is the effect of metformin in the treatment of polycystic ovarian syndrome?

A

Improves the chances of conception.

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5
Q

What is the effect of oestrogen levels upon:

  1. Th1 response
  2. Th2 response
  3. Regulatory T-cell levels
A
  1. Th1 response increases with high oestrogen levels
  2. Th2 response increases with low oestrogen levels
  3. Regulatory T-cell levels with high oestrogen levels
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6
Q

What are the 10 main hormones that mediate normal pregnancy?

From which site are most of them secreted from?

A

Hormones are mainly secreted from placenta

Secreted ‘mostly’ by Placenta:

  1. Human chorionic gonadotropin (hCG)
  2. Human chorionic somatolactotropin (hCS)
  3. Oestrogen
  4. Progesterone

Hypothalamus:

  1. Gonadotropin-releasing hormone (GnRH)
  2. Corticotropin-releasing hormone (CRH)

Posterior Pituitary:

  1. Oxytocin
  2. Prolactin (PL)

Anterior/Intermediate Pituitary:

  1. Growth hormone (GH)
  2. Proopiomelanocortin (POMC)
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7
Q

With which of the following hormones does hCG have the closest structural homology:

  1. LH
  2. FSH
  3. TSH

What do they ALL share in common and how does hCG differ?

Does structural homolgy confer similar function in this case?

A
  • hCG is structurally closest to LH and shares similar function to LH
  • they ALL share a common alpha-subunit and hCG has a different beta-subunit
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8
Q

During pregnancy what are the approximate levels of hCG at the following times:

  1. 10d after ovulation
  2. 3 wks after last mentrual period
  3. 10 wks after last mentrual period
  4. 16 wks onwards

When does the PEAK hCG level occur?

A
  1. 10d after ovulation: first detectable
  2. 3 wks after last mentrual period: 5-50 mIU/mL
  3. 10 wks after last mentrual period: 100,000 mIU/mL (PEAK)
  4. 16 wks onwards: decreases back to 20,000 mIU/mL for remainder
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9
Q

What secretes Human chorionic somatolactotropin (hCS)?

When does this start to occur during pregnancy?

A

hCS is a protein hormone produced by the placenta from approximately the 5th week of pregnancy

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10
Q

Which of the 10 pregnancy hormones are secreted in the largest amount?

A

Human chorionic somatolactotropin (hCS)

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11
Q

Which 2 other hormones is hCS structurally similar to?

A

Prolactin (PL) and Growth Hormone (GH)

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12
Q

What are the 3 postulated functions of hCS?

How do these functions relate to the pathophysiology of gestational diabetes (GDM)?

A
  1. Breast development and lactation - initially known as human placental lactogen (in animal models only)

Similar functions to growth hormone (GH)

  1. Anti-insulin effects and decreased insulin sensitivity in the mother - leading to increased glucose provision to developing foetus
  2. Increases levels of free fatty acids in the mother - providing an alternative source of energy during pregnancy.

The latter 2 mechanisms may explain the development of GDM.

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13
Q

What secrete oestrogen during pregnancy?

A

Oestrogen is secreted by the syncitial trophoblast cells, and is derived from androgen steroid precursors dehydroepiandrosterone and hydroxydehydroepiandrosterone. These are then converted to estradiol, estrone and estriol by the trophoblast cells.

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14
Q

Describe the pathway of oestrogen synthesis during pregnancy.

A

Androgen precursors* are converted to oestrodiol, oestrone and oestriol by the trophoblast cells.

*Androgen precursors = DHEA (dehydroepiandrosterone) + OH-DHEA (hydroxydehydroepiandrosterone)

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15
Q

Which 2 sites take turn secreting progesterone during pregnancy? What is the timing of this?

A

Progesterone initially secreted by corpus luteum, until 3-4 months, after which the placenta takes over.

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16
Q

What are the effect of oestrogen and progesterone on uterine contraction?

What happens in the the latter part of pregnancy (i.e. after 7m)?

A
  • Progesterone inhibits uterine contraction.
  • Oestrogen increases uterine contractions.
  • Both increase with pregnancy, with progesterone being greater than oestrogen for most of the pregnancy.
  • After 7m, progesterone tapers off and the increased ratio allows for increased uterine contractility.
17
Q

Removal of the neurohypophysis from a pregnant animal has what effect on labour?

A

Prolongation due to inability to secrete oxytocin.

18
Q

How does the foetus contribute to the ‘timing’ of labour?

A
  • Activation of the foetal HPA-axis controls the timing of labour by increasing the supply of androgen precursors (DHEAS) for estriol production
  • This causes a hyperoestrogenic state, together with placental oestrone and oestradiol derived from maternal androgens.

DHEAS = dehydroepiandrostenedione sulphate

19
Q

How does activation of the foetal HPA-axis lead to increased uterine contractions?

A
  • Hypothalamus secretes CRH that triggers the anterior pituitary to secrete ACTH that triggers the adrenal to secrete oestrodiol
  • Increased oestrodiol leads to 3 things:
    1. Increased expression of oxytocin receptors
    2. Increased prostaglandin
    3. Increased gap junctions in uterine muscle
  • This all leads to increased uterine contractions
20
Q

What would be anticipated in the following thyroid tests in a pregnant woman WITHOUT thyroid disease:

  1. TSH
  2. free T4
  3. free T4 index
  4. Total T4
  5. Total T3
  6. T3RU

T3RU = Triiodothyronine Resin Uptake

A
  1. TSH = no change
  2. free T4 = no change
  3. free T4 index = no change
  4. Total T4 = increase
  5. Total T3 = increase
  6. T3RU = decrease
21
Q

AMH (anti-mullerian hormone) is secreted by cell of developing follicles (egg sacs).

A. What is it a good measure of?
B. Do AMH levels change during menstruation?
C. Are AMH levels affected by OCP?

A

A. What is it a good measure of?
Female ovarian reserve

B. Do AMH levels change during menstruation?
No

C. Are AMH levels affected by OCP?
No

22
Q

Which of the following drugs is NOT contraindicated in pregnancy:

A. Sirolimus
B. Mycophenolate Mofetil
C. ACEi
D. Azathioprine
E. Leflunomide
A

D. Azathioprine - is safe in pregnancy

MCQ knowledge (22 decks)

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