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1
Q

what does oestrogen do?

A

promote uterine tube secretions, motility and ciliary function
facilitate movement of oocyte through tube

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2
Q

what does oestrogen act on?

A

anterior pituitary to secrete LH and FSH

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3
Q

what is the primary hormone responsible for triggering ovulation?

A

LH surge triggers ovulation

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4
Q

what is shed of the endometrium during menstruation?

A

functional layer shed as is hormone sensitive

basal layer - stem cell layer from which new function layer develops- not lost during menstruation

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5
Q

what is the normal duration of the mensural cycle?

A

21-35 days

14 day luteal phase and a follicular phase of variable duration - between 7 to 21 days in length

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6
Q

what are the two cell layers of the ovary that are hormonally sensitive and what is the result of hormone stimulation of these layers?

A

granulosa cells- FSH- oestrogens
theca cells- LH- androgens
conversion of theca androgens by granulose cell aromatase

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7
Q

what is the primary hormone responsible for follicular growth during the follicular phase of the ovarian cycle?

A

FSH

from the ant pituitary promotes growth, development and steroidogenesis in the ovary

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8
Q

boy with low levels of GnRH and normal levels of LH and FSH

underlying defect?

A

constitutional delay

  • hyPOgonadatrophic hypogonadism
  • gonad not receiving the stimulus to produce testosterone from the hypothalamus and ant pituitary
  • normal puberty will eventually occur
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9
Q

boy with high levels of GnRH, LH and FSH

underling defect?

A

gonadal defect

  • hypERgonadatophic HYPOgonadism
  • despite production of GnRH and LH and FSH the gonad is not responding by producing testosterone
  • no (-) feedback and therefore GnRH, FSH and LH become elevated
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10
Q

by what age should the earliest sign of puberty normally be observed In boys and girls?

A

boys- 14 y/o

girls- 13 y/o

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11
Q

what is the first sign of puberty in boys?

A

testicular enlargement

- driven in response to trophic stimulation of the seminiferous tubules by FSH

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12
Q

what is the first sign of puberty in girls?

A

thelarche - breast bud development

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13
Q

which hormone stimulates endometrial proliferation? at which point of the cycle does this occur?

A

oestrogen- proliferative phase

  • build back up following menstruation
  • progesterone then prepares the already proliferated endometrium for potential blastocyst implantation during the secretory phase
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14
Q

hormones during a menstrual cycle?

A
  • LH surge
  • progesterone levels rise steeply as the corpus luteum is formed and as a result FSH and LH are suppressed due to (-) feedback mechanisms
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15
Q

in the mid follicular phase of the menstrual cycle what is responsible for the specific suppression of FSH release?

A

rising inhibit levels

  • rising oestrogen levels reach a conc whereby they have a (+) feedback on HPO axis
  • only LH rises as follicular inhibit levels also rise and have specific (-) feedback on FSH at ant pituitary
  • prevents recruitment of follicles to allow a dominant follicle to be selected
  • progesterone levels only start increasing at ovulation at the start of luteal phase
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16
Q

the hypothalamic-hypophyseal portal system allows which two structures to communicate?

A

hypothalamus and ant pituitary

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17
Q

in males- leydig cells are primary site of action for which hormone

A

LH

to produce testosterone

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18
Q

true or false

variation in the duration of the luteal phase accounts for the varying duration of a woman’s menstrual cycle

A

false
point at which ovulation occurs can vary
happens at the end of follicular phase - this phase can vary in terms of duration
- once ovulation has occurred- luteal phase is always typically 14 days long- life span of corpus luteum

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19
Q

15 y/o with no periods, cyclical pelvic pain and not sexually active. secondary sexual characteristics are present and LH, FSH, testosterone and oestrogen are all within normal range. what is the most likely cause of this patient’s primary amenorrhea?

A

outflow tract obstruction - eg imperforate hymen

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20
Q

what is least likely to cause menorrhagia?

A

endometriosis
think of PALM COEIN
- fibroids common cause of heavy menstrual bleeding - ask about excessive bleeding to rule out coagulation disorders

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21
Q

26y/o with previous normal menstrual cycles with no period for 3 months. what investigation should be carried out first in this patient?

A

hCG

- pregnancy most common cause for secondary amenorrhea with a patient with no history

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22
Q

periods occur between 18-21 days, lasting for about two days. how can this pattern be described?

A

frequent and regular
- frequent= cycle occurs less than every 24 days
each cycle is within 3 days of the other- normal limit of variation/ regularity= regular

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23
Q

identify the terms for:

  • heavy menstural bleeding
  • absence of periods
  • infrequent periods
  • painful periods
  • irregular periods
A
  • menorrhagia
  • amenorrhea
  • oligomenorrhea
  • dysmenorrhea
  • metrorrhagia
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24
Q

endometriosis

A

presence of endometrium in abnormal locations

can occur anywhere in the body

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25
Q

51 y/o complains of amenorrhea of 12 months duration and hot flushes, irritability and poor sleep. what is the most likely underlying cause for this woman’s symptoms ?

A

ovarian failure = menopause

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26
Q

what is the most effective management option for the treatment of vasomotor symptoms of menopause in a patient who has not had a hysterectomy

A

hormone replacement therapy with oestrogen and progesterone

  • don’t I’ve unopposed oestrogen with an intact uterus due to the risk of unopposed oestrogen theory to the endometrium which can lead to endometrial cancer
  • topical oestrogen therapy can be useful for localised symptoms of menopause eg vaginal dryness
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27
Q

in evaluation of the menopause in a woman, what are the findings for FSH level, oestradiol level and vaginal pH

A

elevated FSH
decreased oestradiol
vaginal pH > 4.5

depleted supply of ovarian follicles which decreases the production of oestradiol - reduces (-) feedback on the ant pituitary
this increases FSH in attempt to stimulate ovarian function
vaginal pH is maintained below 4.5 by dominance of growth by vaginal Lactobacilli which metabolises glycogen produced under the influence of oestrogen. when oestrogen levels decline, so does glycogen production leading to increase in vaginal pH

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28
Q

at the start of menopause, are FSH and LH levels low or high?

A

high

  • no follicles to develop so no oestrogen to (-) feedback on ant pituitary.
  • ant pituitary increases FSH production in order to promote follicular development
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29
Q

8 months of secondary amenorrhoea. pregnancy test (-), TSH and prolactin levels normal. FSH elevated above normal limits.

A

undergoing premature ovarian failure - pathological as under the age of 40.
the patient is therefore at an increased risk of osteoporosis

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30
Q

is endometrial cancer a risk associated with taking combined oestrogen and progesterone HRT?

A

no- only risk if oestrogen only HRT

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31
Q

from where does the artery suppling blood to the ovary arise?

A

aortic arch- inf to SMA, sup to IMA

  • reflects site at development
  • venous and lymph drainage follow the same course- lymph nodes are paraaortic not pelvic or inguinal
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32
Q

into which lymph nodes do the lymphatics of the body of the uterus drain?

A

internal iliac

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33
Q

into which lymph nodes does the ovary drain?

A

para-aortic

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34
Q

into which lymph nodes does the lower 1/3 of the vagina drain?

A

superficial inguinal nodes

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35
Q

to which structure is the lateral fornix of the vagina most closely related?

A

ureter

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36
Q

at which junction is the internal os of the cervix located?

A

body and cervix of uterus

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37
Q

in which part of the Fallopian tube do ectopic pregnancies most commonly occur?

A

ampulla

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38
Q

where is the most common site for fluid collection in females

A
  • rectouterine pouch (pouch of Douglas) lowest point of the peritoneal cavity in females
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39
Q

which ligament transmits blood vessels to the ovary?

A

suspensory ligament of the ovary

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40
Q

what is the normal position of the uterus?

A

anteverted and ante flexed

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41
Q

where does the gubernaculum connect to in males?

A

connect developing testis to developing scrotum- creates the ‘pull’ to guide the testis caudal through the abdomen to enter the scrotum by the end of gestation

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42
Q

structural anomaly of a urethral opening posteriorly along the ventral surface of the shaft of penis

A

failure of urogenital folds to fuse

  • fusion of these folds and labioscrotal folds is under the influence of testis derived androgens
  • Wollfian duct develops into the vas deferent and the ureteric bud induces development of the definitive kidney and the ureter
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43
Q

16y/o with primary amenorrhea
female external genitalia with high testosterone levels
karyotype of XY- what is the diagnosis

A

androgen insensitivity syndrome
- testis develop normally, but the tissues that should respond to tetis produced androgens are unable to do so due to problems with receptors. therefore individuals can look phenotypically female without female internal genitalia

44
Q

from which tissue do the gonads develop?

A

intermediate mesoderm in the abdomen

- as development proceeds, the gonad undergoes descent through the abdomen

45
Q

from which structure does the vas deferens develop

A

mesonephric duct

- supported by testicular androgens to develop into the vas deferens

46
Q

from which structure does the uterus develop?

A

paramesonephric duct

- develop in the absence of testis derived MIH to develop into the uterus, uterine tubes and upper vagina

47
Q

when is the population of oogonia established

A

during fatal life

48
Q

when is meiosis II completed in oogenesis?

A

after fertilisation

49
Q

how many spermatids are produced from one primary spermatocyte?

A

4 spermatids

50
Q

are germ cells diploid or haploid?

A

diploid

- only gametes produced by meiosis from the germ cells are haploid

51
Q

what element of the developing follicle is directly surrounding the developing oocyte (next to the zona pellucida)?

A

granulosa cells

  • line the fluid filled antrum on the innermost surface- therefore completely cover the developing oocyte.
  • granulose cells next to the zona pellucida are known as the corona radiata (part of the cumulus oophorus)
52
Q

which of the following pair of muscles are both part of the superficial perineal muscle group?

A
  • bulbospongiosus
  • ischiocavernosus
  • superficial transverse perioneal
53
Q

which muscles are part of levator ani?

A
  • iliococcygeus
  • pubococcygeus
  • puborectalis
54
Q

which muscles are part of levator ani?

A
  • iliococcygeus
  • pubococcygeus
  • puborectalis
55
Q

what is a symptom of a ‘middle compartment prolapse’

A

sensation of ‘something coming down’

56
Q

which muscle of the pelvic floor has a major role in maintaining faecal continence

A

puborectalis

57
Q

from where does the artery suppling blood to the testis arise?

A
  • abdo aorta, inf to SMA, sup to IMA
58
Q

identify:

  • the tunica vaginalis of the testis
  • bulb of penis
  • crus of penis
  • corpus cavernosum and corpus spongiosum
  • rete testis
A

use picture

59
Q

which gland supplies the majority of the volume of semen?

A

seminal vesicles

- nutrition for sperm, neutralise acidic environment of vagina and temporarily coagulate semen after ejactulation

60
Q

what is the venous drainage of the testes?

A

pampiniform plexus to the testicular vein

drains directly to the IVC on the R and via the L renal vein on the L

61
Q

what is the function of the bulbourethral glands?

A

produce secretions that reduce friction
- small amount of thick alkaline fluid - neutralise aside of urine in urethra, prior to ejaculation

( prostate gland secretes proteolytic enzymes)

62
Q

what structure with median lobe hypertrophy may block urine flow?

A

prostate

63
Q

site of final sperm maturation?

A

epididymis

64
Q

site of final sperm maturation?

A

epididymis

65
Q

list the origins of the fascial coverings of the spermatic cord in order from superficial to deep

A

external oblique- internal oblique- transverses abdominis- transversalis fascia

66
Q

testicular tumour- which nodes would the tumour metastasise initially?

A

para-aortic nodes

67
Q

19y/o sexually active patient presents GUM clinic with no symptoms to note. on speculum examination, a muco-purulent discharge and cervical motion tenderness was noted. what is the most likely infective organism?

A

Chlamydia trachomatis

-

68
Q

what is the most likely effective organism in a patient presenting with vaginitis and a thin, grey vaginal discharge with a fishy, amine odour?

A

bacterial vaginosis- Gardnarella vaginalis

69
Q

what Is the most likely infective organism in a male presenting with urethrits for whom a urine sample showed the presence of Gram (-) diplococci?

A

Neisseria gonorrhoeae

70
Q

what is the normal vaginal pH range?

A

3.5-4.5

71
Q

what is the dominant organism in normal vaginal flora?

A

Lactobacillus sp

72
Q

what micro-organism is the pathogen that can cause bacterial vaginosis?

A

Gardnarella vaginalis

73
Q

which micro organism is the pathogen that can cause conjunctivitis in newborns?

A

chlamydia trachomatis

74
Q

which microorganism is the pathogen causing syphilis?

A

treponema pallidum

75
Q

which microorganisms are the most common pathogens causing PID

A

neisseria gonorrhoea and chlaymdia trachomatis

76
Q

what is the most common cause of ectopic pregnancy?

A

previous salpingitis

- scarring of the epithelium of the tubes

77
Q

what is the mechanism of action of viagra as a treatment for erectile dysfunction?

A

inhibition of cGMP breakdown
increased NO production
vasodilation
- smooth muscle relaxation in vessel walls in corpora cavernous

78
Q

fusion of the sperm surface and which structure will trigger the acrosome reaction?

A

zona pellucida

79
Q

when does the process of capacitation occur?

A

when the spermatozoa reach the female reproductive tract
- sperm become motile at the tail of the epididymis
at capacitation, the sperm tail movement changes to help propel he sperm through the female reproductive tract

80
Q

what is the primary mechanism of action of the progesterone depot or progesterone implant?

A

prevention of ovulation

- inhibit positive feedback of oestrogen prevent LH surge ad therefore prevent ovulation

81
Q

what is the primary mechanism of action of the combined oral contraceptive pill?

A

prevention of ovulation

- mimic luteal phase of ovarian cycle, suppressing HPO axis

82
Q

what is the primary mechanism of action of the progesterone- only pill?

A

thickening of cervical mucus

  • inhibits sperm transport
  • no effect on HPG axis and so does not suppress ovulation
83
Q

what is the most common cause of male infertility?

A

abnormal semen analysis

84
Q

what is the most common cause of female infertility?

A

anovulation

85
Q

what is a possible cause of secondary anovulation?

A

polycystic ovarian syndrome (PCOS)

86
Q

what is a possible cause of primary anovulation?

A

dysgenetic gonads

87
Q

what process is responsible for the induction of the production of acellular mucus with low viscosity and high stretchability?

A

oestrogen action on cervical glands

88
Q

34y/o difficulty conceiving for about 12 months. treated for genital infection 10years ago. ongoing pelvic pain and BMI of 20. periods are regular, averaging 32 days cycle. which investigation would identify the most likely underlying cause of this patient’s sub fertility?

A

hysterosalpingogram
- looks at tubal patency which is likely to be abnormal in this case due to suspected previous history of PID (infection and chronic pelvic pain)

89
Q

what changes are seen in maternal tidal volume in pregnancy?

A

increase

90
Q

what changes are seen in maternal resp rate in pregnancy?

A

unchanged

91
Q

what changes are seen in maternal minute ventilation in pregnancy?

A

increase by 50%
- minute ventilation is the product of tidal volume and resp rate. although RR doesn’t change, the increase in TV increase the minute ventilation

92
Q

what changes are seen in maternal creatinine clearance in pregnancy?

A

increase by 50%

93
Q

what changes are seen in maternal glomerular filtration rate in pregnancy?

A

increase by 55%

94
Q

what changes are seen in maternal SV in pregnancy?

A

increase

95
Q

what changes are seen in maternal CO in pregnancy?

A

increase

96
Q

what changes are seen overall in maternal BP in pregnancy?

A

no change

  • SV and therefore CO increases, TPR decreases due to effects of progesterone
  • this maintains BP overall
97
Q

which class of antibodies is transferred across the placenta?

A

IgG

98
Q

by what process is immunoglobulin transported across the placenta?

A

receptor- mediated endocytosis

99
Q

by what process is oxygen transported across the placenta?

A

simple diffusion

100
Q

by what process is glucose transported across the placenta?

A

facilitated diffusion

101
Q

what are the cellular layers presenting a barrier to transfer between maternal and fetal circulations in first trimester chorionic villi?

A

cytotrophoblast, syncytiotrophoblast, fetal capillary endothelium

  • cytotrophoblast is a continuous sheet underlying the syncytiotrophoblast layer of the placental chorionic villi.
  • the chorionic villi are bathed in maternal blood lakes, so exchange does not have to involve maternal capillary endothelium
102
Q

what are the cellular layers presenting a barrier to transfer between maternal and fetal circulations in third trimester chorionic villi?

A

syncytiotrophoblast and fetal capillary endothelium

  • cytotrophoblast layer has regressed to an occasional cell underlying the syncytiotrophoblast layer of the placental chorionic villi
  • chorionic villi bathers in maternal blood lakes, so exchange does not have to involve maternal capillary endothelium
103
Q

if a fertilised ovum invades beyond the endometrium into the myometrium, what condition is this called?

A

placenta accreta
= excessive implantation

placental percreta= invade full width of the uterus

104
Q

if a fertilised ovum implants in the lower uterine segment, what condition is this called?

A

placenta praevia

typically covers the internal os

105
Q

how soon after fertilisation can HCG be detected reliably in maternal urine?

A

14 days

- detectable in serum 7 days after fertilisation, but a bit longer for urine.

106
Q

33 y/o at 32 weeks gestation in her second pregnancy. BP= 150/80 and evidence of proteinuria ++ on dipstick. what complication to the foetus is most common in this condition?

A
  • oligohydramnios ( low amniotic fluid)

patient showing signs of pre-clampsia, which is associated with shallow implantation of the embryo

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