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Semester 4 > Repro Session 3 > Flashcards

Repro Session 3 Flashcards

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1
Q

What is pubarche?

A

Development of axillary and pubic hair

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2
Q

What is menarche?

A

1st menstrual period

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3
Q

What is adrenarche?

A

Onset of an increase in androgen secretion

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4
Q

What is puberty?

A

Stage of human development when sexual maturation and growth are completed form the primary sexual characteristics established before birth

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5
Q

What is the fixed order of events seen in puberty?

A

Accelerated somatic growth, maturation of primary sexual characteristics, appearance of secondary sexual characteristics, menstruation/spermatogenesis begin

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6
Q

What accounts for the 10% difference in height between men and women?

A

Women undergo somatic growth earlier and for less time due to closure of epiphysis by oestrogen

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7
Q

What does genital maturation depend on in males?

A

Testosterone

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8
Q

Why does the reproductive system not work before puberty?

A

Low GnRH secretion –> low hormone levels so LH and FSH are insufficient

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9
Q

Where is there low level androgen secretion from prior to puberty?

A

Adrenals

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10
Q

What initiates onset of puberty?

A

Brain increasing GnRH –> steady rise in LH and FSH

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11
Q

How does nutrition affect onset of puberty?

A

Critical weight of 47 kg of menarche needs to be met and correlation between leptin and menarche

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12
Q

What is the supporting evidence that nutrition influences the onset of puberty?

A

Obese girls experience early menarche, malnutrition –> delayed menarche, primary amennorhoea in lean athletes, body fat set point seen in girls with fluctuating weight due to anorexia nervosa

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13
Q

What suggests an association between onset of puberty and seasonal breeding seen in species where changes in day length alter pineal gland melanin secretion?

A

Pineal tumours influencing onset of puberty in humans

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14
Q

What action does TSH have in both sexes in the HPG axis?

A

Increases metabolic rate and promotes tissue growth

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15
Q

What are the results of increased growth hormone on the HPG axis in puberty?

A

Increases insulin to descrease sex-hormone binding globulin and IGF-gpbinding protein and acts on liver to increase IGF-1 to cause somatic and neuronal growth and myelin secretion

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16
Q

What precedes the phenotypic changes seen in puberty by several years?

A

Increase in nocturnal pulsatile LH secretion during REM sleep

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17
Q

What happens at 9-12 years to lead to gonadal development?

A

(Less sensitive hypothalamic neurones?) LH and FSH levels rise

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18
Q

What are the results of the LH and FSH rise at ~10 y.o. In males?

A

Spermatogenesis and androgen secretion

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19
Q

What are the affects of increased androgen secretion in males during puberty?

A

Growth of sex accessory structures (prostate), male secondary sex characteristics, retention of mineral in body for bone and muscle growth

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20
Q

Which cells in the male secrete oestrogen?

A

Sertoli

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21
Q

What is the pattern of phenotypic changes seen in male puberty?

A

Testicular volume increases –> public hair grows and spermatogenesis occurs –> growth spurt –> adult genitalia and pubic hair develop

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22
Q

What is the pattern of phenotypic changes seen in female puberty?

A

Thelarche and pubic hair growth –> adrenarche, growth spurt and onset of menstrual cycle –> menarche, adult pubic hair and breasts

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23
Q

What are the female secondary sex characteristics?

A

Growth of pelvis, SC fat, reproductive organ and genitalia growth

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24
Q

What effects does increasing androgen release by the adrenal glands have on the female during puberty?

A

Growth of public hair, lowering of voice, growth of bone and increased secretion from sebaceous glands

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25
Q

Is the LH surge in the first ovarian cycle usually enough for ovulation?

A

No

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26
Q

What is considered normal pubertal development in boys?

A

Age of start (yrs): 12.5

First sign of puberty: testicular volume

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27
Q

What is considered normal pubertal development in girls?

A

Age of start (yrs): 11.5
First sign of puberty: breast development
Growth velocity (cm/yr): 9.0
Duration (yrs): 2.4 +/- 1.1

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28
Q

What are the 5 stages of Tanner standard for girls?

A

Breast: B1-5
Pubic hair: Pu1-5
Axillary hair: A1-5
Menarche

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29
Q

What are the 5 stages of Tanner standard used in male puberty?

A 
Testicular volume > 4 ml: Te
Penis enlargement: G1-5
Pubic hair: Pu1-5
Axillary hair: A1-5
Spermarche
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30
Q

How does prepubertal and pubertal growth velocity compare?

A

Pubertal approx 2/3 X greater than prepubertal

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31
Q

When does male puberty usually occur?

A

9-14 y.o.

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32
Q

When does female puberty usually occur?

A

8-13 y.o.

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33
Q

What affects the precise timing of the LH surge during the ovarian cycle?

A

Environmental factors such as day length and altitude

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34
Q

What is precocious puberty?

A

Onset of puberty >2 s.d. before average age (girls

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35
Q

What is the prevalence of precocious puberty?

A

1 in 5000 to 1 in 10,000

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36
Q

What two types of precocious puberty are there?

A

Gonadotrophin dependent (central) and gonadotrophins independent (neurological)

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37
Q

What are the causes of central precocious puberty?

A

Tumours (gliomas, astrocytomas, hCG-secreting germ cell)
CNS trauma/injury (infection, radiation, surgery)
Harmatoma of the hypothalamus
Congenital: hydrocephalus, arachnoid cysts
Gonadotrophin secreting tumour

38
Q

Why is neurological precocious puberty known as precocious pseudopuberty?

A

Secondary sexual characteristics arise independent of the HPG axis therefore gonadotrophins are not involved

39
Q

What are the hormone changes in neurological precocious puberty?

A

Raised testosterone and oestrogen causing suppression of LH and FSH with no pulsatile GnRH

40
Q

What are the causes of neurological precocious puberty?

A

Congenital adrenal hyperplasia
Tumours (hCG-secreting in liver, pineal, mediastinal, choriocarcinomas of gonads)
Testotoxicosis
Therapeutic/accidental exogenous androgen exposure

41
Q

What is testotoxicosis?

A

Also known as familial male precocious puberty it is an autosomal dominant condition causing rapid physical growth, skeletal maturation and sexual aggression at 2-3 y.o.

42
Q

What can delayed puberty be define as?

A

Initial physical changes of puberty not present (girls 13 y.o. or 16 y.o. primary amennorhoea, boys 14 y.o.) or the interval between first signs of puberty and menarche/completed genital growth >5 years

43
Q

What are the two categories of cause of delayed puberty?

A

Gonadal failure (hypergonadotrophic hypogonadism) and gonadal deficiency

44
Q

What can cause gonadal failure leading to delayed puberty?

A

Turners syndrome, post malignancy (itself or Tx), polyglandular autoimmune syndromes

45
Q

How is Turner’s syndrome treated?

A

GH and sex hormone substitution

46
Q

What can cause gonadal deficiency leading to delayed puberty?

A

Rare gene defects inactivating FSH/LH/their receptors
Congenital hypogonadotrophic hypogonadism (+anosmia)
Hypothalamic/pituitary lesions due to tumour or radiotherapy

47
Q

What is thelarche?

A

Development of the breast

48
Q

What are the 3 stages of menopause?

A

Pre-menopause, menopause and post-menopause

49
Q

What happens in the pre-menopausal stage of the menopause?

A

~40 y.o. Changes in mestrual cycle seen as follicular phase shortens (seen earlier as decrease in oestrogen by asymptomatic)

50
Q

Describe the hormonal changes seen in premenopause.

A

Low oestrogen, raised LH, very raised FSH

51
Q

What is the affect on ovulation and fertility of premenopause?

A

Ovulation early/absent and fertility decreases

52
Q

What is the clinical definition of menopause?

A

12 continuous months with no menstrual activity

53
Q

When is the average age of menopause?

A

49-50

54
Q

How many follicles can develop at the menopause?

A

None

55
Q

What are the effects of the large decrease in oestrogen in the menopause?

A

Regression of endometrium, shrinkage of myometrium, thinning of cervix, reduction in vaginal and skin tone, involution of breast tissue, loss of pelvic and bladder tone causing urinary incontinence

56
Q

What is the name given to the symptom experienced when vascular changes in the menopause allow transient rises in skin temperature and flushing?

A

Hot flushes

57
Q

Why do some menopausal women experience osteoporosis?

A

Low oestrogen enhances osteoclasts and removes stimulation of osteoblasts

58
Q

At what rate does bone mass decrease following the menopause?

A

2.5% per year

59
Q

What are the benefits of HRT?

A

Relieves menopausal symptoms, improves well-being and limits osteoporosis

60
Q

What is HRT not advised for?

A

First line for osteoporosis or cardioprotective effect

61
Q

Describe the end of reproductive life in the male.

A

No obvious decline in androgen levels, only gradual decline in testosterone levels therefore sperm production continues

62
Q

When should LH and FSH be measured in menstrual dysfunction?

A

Beginning of cycle

63
Q

Describe the regularity of the menstrual cycle across reproductive life.

A

Best between 20-40 y.o. as cycle is longer after menarche and shorter premenopause

64
Q

How might a polyp in the female reproductive tract present?

A

Irregular bleeding +/- bleeding after intercourse

65
Q

If a polyp in the female reproductive tract has metaplastic or dysplastic tissue where in the polyp will this be?

A

At the base

66
Q

What pathology causes an irregular endometrial wall visible on hysterescopy?

A

Hyperplasia

67
Q

Why does endometrial cancer have a good mean 5 year survival rate?

A

Presents early

68
Q

What is the implication of a BRCA gene mutation in endometrial cancer?

A

Likely clear cell tumours and to be more aggressive

69
Q

How does endometrial cancer commonly present?

A

Post menopausal bleeding

70
Q

What type of pts are at an increased risk of endometrial cancer?

A

PCOS

71
Q

What is the mean blood loss per menstrual cycle?

A

37-43 ml

72
Q

When is the majority of blood lost in menses?

A

First 48 hours

73
Q

What proportion of the 9-14% of women that lose >80 ml of blood per menstrual cycle are anaemic?

A

60-70%

74
Q

Give some causes of menstrual dysfunction that present as an abnormality in the amount of blood lost.

A

Abnormal clotting, fibroids, IUCD, cancer, progesterone contraception, DUB

75
Q

What are fibroids?

A

Myometrium tissue arranged in a whirled pattern that can be subserous, intramural or submucous

76
Q

What is dysfunctional uterine bleeding?

A

Heavy bleeding with no recognisable pathology, pregnancy or general bleeding disorders

77
Q

When is DUB common?

A

Premenopause

78
Q

What does biopsy of the endometrium in DUB during premenopause show?

A

Evidence of dysynchronous hormones

79
Q

What questions are useful when considering menorrhagia?

A

Any flooding, passing large clots, need for double protection or time off work?

80
Q

What is the most likely cause of amennorhoea?

A

Pregnancy

81
Q

What is primary amennorhoea?

A

Absence/failure of ovary causing failure of menses by 16 y.o. or if secondary sexual characteristics have failed to appear by 13 y.o.

82
Q

What is secondary amennorhoea?

A

Cessation of menses following menarche

83
Q

What is cryptomenorrhoea?

A

Where blood is produced but cannot exit e.g. uterine stenosis or imperforate hymen

84
Q

What uterine/endometrial causes of amennorhoea are there?

A

Surgical menopause, laser ablation of basalis endometrium

85
Q

What ovarian causes of amennorhoea are there?

A

Turner syndrome, primary ovarian insufficiency/premature ovarian failure

86
Q

How can microprolactinoma cause amennorhoea?

A

Causes excess of prolactin causing HPG axis to fail leading to amennorhoea and galactorrhoea

87
Q

What hypothalamic disorders can lead to amennorhoea?

A

Eating disorders, exercise, stress, thyroid dysfunction, idiopathic

88
Q

How can low weight lead to amennorhoea?

A

Low weight –> lack of adipose –> low oestrogen so HPG axis uncontrolled

89
Q

Which arteries are found in the germinalis layer of the endometrium?

A

Spiral and basal

90
Q

Which arteries are found in the myometrium?

A

Arcuate arteries

Semester 4 (33 decks)

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