Repro - week 1 and 2 Flashcards by Nathan Edgar

what is OHSS

over enlarged ovaries - excess follicles

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what are some signs of OHSS

central fluid accumulation:

ascites, pleural effusion, pericardial effusion
due to the membranes becoming leaky

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treatment of OHSS if it occurs before egg transfer

coasting
elective egg freeze
single embryo transfer

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what is coasting in IVF

withdraw the HCG and gonadotrophin treatments to let estradiol levels settle down and settle OHSS

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treatment of OHSS if it occurs after egg transfer

monitor:
bloods and scans 
antithrombotic: fluids, compression stockings, fragmin 
analgesia 
drain excess fluid

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what produces progesterone in the menstrual cycle

corpus luteum

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how many days post ovulation does luteolysis occur

day 14

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what is polymenorrhagia

increased bleeding and frequent cycle

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what is metorrhagia

regular intermenstrual bleeding

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why does ovulatory dysfunctional uterine bleeding occur

not enough progesterone being produced by the corpus luteum

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what steroid is mainly used to treat endometriosis

danazol

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1st line treatment for menorrhagia

mirena IUS

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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)

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describe how hCG multiply over 48hours

hCG levels double approx every 48hrs

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describe the differences in pain between placental abruption and placenta praaevia

painful vaginal bleeding in placental abruption

painless vaginal bleeding in placenta praevia

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what is a particular risk for women with PCOS who are undergoing IVF

OHSS

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which cancers does the COCP increase your risk of

breast and cervical

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which cancers does the COCP reduce your rusk of

ovarian and endometrial

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what is HELLP syndrome

a severe form of pre eclampsia

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what are the features of HELLP syndrome

Haemolysis
Elevated Liver enzymes
Low Platelets

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what antibiotic should be used as group B streptococcus prophylaxis

benzylpenicillin

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most common site for an ectopic pregnancy

ampulla of Fallopian tube

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how do you diagnose bacterial vaginosis

clinical diagnosis
vaginal pH >4.5
high vaginal swab for microscopy

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what is seen in microscopy for bacterial vaginosis

clue cells

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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: 1. follicular phase 2. ovulation 3. luteal phase uterine: 1. menstrual phase 2. proliferative phase 3. 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