Repro - week 1 and 2 Flashcards
what is OHSS
over enlarged ovaries - excess follicles
what are some signs of OHSS
central fluid accumulation:
ascites, pleural effusion, pericardial effusion
due to the membranes becoming leaky
treatment of OHSS if it occurs before egg transfer
coasting
elective egg freeze
single embryo transfer
what is coasting in IVF
withdraw the HCG and gonadotrophin treatments to let estradiol levels settle down and settle OHSS
treatment of OHSS if it occurs after egg transfer
monitor: bloods and scans antithrombotic: fluids, compression stockings, fragmin analgesia drain excess fluid
what produces progesterone in the menstrual cycle
corpus luteum
how many days post ovulation does luteolysis occur
day 14
what is polymenorrhagia
increased bleeding and frequent cycle
what is metorrhagia
regular intermenstrual bleeding
why does ovulatory dysfunctional uterine bleeding occur
not enough progesterone being produced by the corpus luteum
what steroid is mainly used to treat endometriosis
danazol
1st line treatment for menorrhagia
mirena IUS
where is hCG secreted from and what is its role
secreted from the syncytiotrophoblast into the maternal bloodstream
it acts to maintain progesterone production by the corpus luteum
(ie - prevent disintegration of corpus luteum)
describe how hCG multiply over 48hours
hCG levels double approx every 48hrs
describe the differences in pain between placental abruption and placenta praaevia
painful vaginal bleeding in placental abruption
painless vaginal bleeding in placenta praevia
what is a particular risk for women with PCOS who are undergoing IVF
OHSS
which cancers does the COCP increase your risk of
breast and cervical
which cancers does the COCP reduce your rusk of
ovarian and endometrial
what is HELLP syndrome
a severe form of pre eclampsia
what are the features of HELLP syndrome
Haemolysis
Elevated Liver enzymes
Low Platelets
what antibiotic should be used as group B streptococcus prophylaxis
benzylpenicillin
most common site for an ectopic pregnancy
ampulla of Fallopian tube
how do you diagnose bacterial vaginosis
clinical diagnosis
vaginal pH >4.5
high vaginal swab for microscopy
what is seen in microscopy for bacterial vaginosis
clue cells
what is the treatment for bacterial vaginosis/trichomonas vaginalis
PO metronidazole
what chromosome is the sex determining region on
the Y chromosome
how is androgen insensitivity disorder inherited
X linked recessive
what is the karyotype of androgen insensitivity disorder
46XY
where does testosterone production occur
the leydig cells
which hormone stimulates testosterone production
LH
LH –> leydig cells –> testosterone
which 4 organisms are part of the normal vaginal flora
lactobacillus
group B beta- haemolytic strep
candidia
strep viridians
treatment of candidia infection
topical clotrimazole pessary
or
PO fluconazole
what is released from the Sertoli cells and why
inhibin and activin hormones
regulates the FSH secretion (by -ive feedback) and controls spermatogenesis
what hormones stimulate spermatogenesis
testosterone and FSH
describe the endocrine features of non-obstructive male infertility
HIGH LH, FSH
LOW testosterone
what organisms cause bacterial vaginosis
gardnerella vaginalis
mobiluncus
anaerobes
what is the karyotype of a partial mole
69 XXX or 69 XXY or 69 XYY
why are patients with kallmann’s syndrome infertile
they don’t have any gonadotropin releasing hormone so cannot produce LH or FSH
what hormone is the growth of leiomyomas (uterine fibroids) dependant on
oestrogen
what is the karyotype for klienfelters
XXY
what is the treatment for acute bacterial prostatitis
ciprafloxicin 28 days
what are the 3 serological groupings of chlamydia and what infection does this correspond to
A-C = trachomonas D-K = genital infection L1-L3 = lymphogranuloma venereum
what is the treatment of N.Gonorrhoea
IM ceftriazone and
PO azithromycin
how do you diagnose syphilis
PCR of primary chancre
serology for antibodies (blood test)
IgM and IgG ELISA
what non-specific serological tests are used to tell you about the response to therapy in syphilis
VDRL
RPR
what specific antibodies are used to test for syphilis and why can’t they be used to test for response to therapy
TPPA
TPHA
they remain positive for life so cannot be used to measure response to therapy
what is the treatment of syphilis
IM long acting pencillin
how do you diagnose genital herpes
PCR of de-roofed blister
what is the treatment of pubic lice
malathion lotion
what is the medical management of an ectopic pregnancy
methotrexate IM or PO
at what endometrial thickness in postmenopausal women is an indication for biopsy
> 4mm (normally it should be 1mm)
what are the 3 phases of the ovarian cycle and the 3 phases of the uterine cycle that occur simultaneously
ovarian:
- follicular phase
- ovulation
- luteal phase
uterine:
- menstrual phase
- proliferative phase
- secretory phase
what is the griffin follicle
the dominant follicle
at what endometrial thickness in premenopausal women is an indication for biopsy
> 16mm
what effect does the oestrogen secreted by the granulosa cell have on FSH levels and what does this cause
rising oestrogen levels -ivley feedback on FSH and reduce its secretion
results in atresia of follicles other than the dominant follicle
what stimulates the differentiation of external male genitalia
dihydrotestosterone
which cells are responsible for spermatogenesis
sertoli cells (driven by FSH)
what is secreted by Sertoli cells and what is their purpose
inhibin and activin
feedback on FSH
what gram stain is lactobacillus
gram +ive bacilli
compare the 2 forms that chlamydia takes during its cycle
enters cell as an elementary body which is infectious
turns into a reticular body which isn’t infectious but allows it to replicate by binary fission
then transforms back into an elementary body and bursts, releasing the infected cells
what is the screening test done for syphilis
IgG and IgM ELISA
what are the 3 forms of emergency contraception
levonelle (3 days after UPSI)
ellaone (5 days after UPSI)
copper IUD (5 days after UPSI conception)
what are the 4 main risks of the progesterone depot
weight gain
delay in return of fertility
osteoporosis
irregular bleeding
Why should you avoid starting hormonal contraception for 5 days after ellaOne contraception
interferes with ulipristal acetate
what is a UKMEC 4 contraindication to the POP
current breast cancer
if you have the BRACA gene, CHC is what category of UKMEC
category 3
what contraception options are there for patients on liver enzyme inducers such as anti-epileptics
IUS
IUD
progesterone depot
how is pneumocystis pneumonia diagnosed
bronchoalveolar lavage and immunofluorescence
treatment of pneumocystis pneumonia
high dose co-trimoxazole +/- steroid
for patients with a CD4 <200, what prophylaxis for pneumocystis pneumonia do we offer
low dose co-trimoxazole
what is the incubation period of primary syphilis
up to 90 days
what is the incubation period of secondary syphilis
up to 6 months
when in the course of acquired syphilis does it become non-infectious
late latent phase
what disease in the eyes does CMV cause
retinitis
why do patients with CD4<50 all get ophthalmic screening
to look for CMV retinitis
what is the treatment for HPV
podophyllotoxin
imiquimod
cryotherapy
what can toxoplasma gondii cause in the brain
multiple cerebral abscesses
what does JC virus cause in HIV patients with CD4 counts <100
progressive multifocal leukencephalopathy
what organism causes kaposi’s sarcoma
human herpes virus 8
what organism causes non-hodgkins lymphoma
EBV
how do you test for HIV
p24 test - combined antigen and antibody serology
what should be used as VTE prophylaxis during pregnancy
LMWH
Given at delivery and for 7 days post partum
how do you treat suspected VTE in early pregnancy
LMWH - AVOID WARFARIN IN EARLY PREGNANCY
how do you treat suspected VTE in late pregnancy
LMWH - AVOID WARFARIN IN LATE PREGNANCY
risk of haemorrhage during delivery
