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EndocrineJaz > Reproduction > Flashcards

Reproduction Flashcards

1
Q

oogenesis arrests in ___ and restarts at ___

A

prophase

puberty

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2
Q

1st polar body =

A

formed after the first meiotic division of an oocyte

1 haploid cell gets much less cytoplasm and so is infertile

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3
Q

if there are two polar bodies this indicates

A

sperm entry and completion of the 2nd meiotic division

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4
Q

__-___ oocytes are ovulated per female

A

300-400

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5
Q

GnRH frequencies of pulses to stimulate LH and FSH release

A 
LH = high freq
FSH = low frequency
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6
Q

FSH stimulates __ and ___

A

follicular development and thickens endometrium

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7
Q

LH surge stimulates

A

ovulation

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8
Q

the type of cervical mucus that oestrogen stimulates the production of

A

fertile - clear stringy, stretchable, slippery, fern patterns when dry

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9
Q

increased oestrogen inhibits __+__ and stimulates ___

A

FSH and PRL

stim.s LH

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10
Q

oestrogen causes the uterus’ water content to increase by

A

accelerating Na+ and H2O reabs by kidney tubules

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11
Q

the type of cervical mucus that progesterone stimulates the production of

A

infertile

opaque, sticky, thick, non stretchy, non-fern like when it dries

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12
Q

progesterone affects

A 
inhibits LH
thermogenic
relax SM
maintain thick endometrium
maintain pregnancy
infertile mucus production
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13
Q

after LH surge the oocyte resumes ___ it stops at ___ unless it is fertilised

A

meiosis

metaphase II

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14
Q

___hrs after LH surge = ovulation and formation of corpus luteum

A

36.5

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15
Q

in the menstrual phase there is no __/__ and so __ occurs and __ secretion is stimulated

A

oestrogen/progesterone
mensstruation/endometrial degeneration
FSH

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16
Q

lutein is a __

A

yellow carotenoid pigment found in corpus luteum

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17
Q

In males LH acts on __ to stimulate

A

Leydig cells

testosterone secretion

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18
Q

spermatogenesis occurs in the

A

seminiferous tubules of testes

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19
Q

In males FSH acts on ___ to ___

A

Sertoli cells

enhance spermatogenesis and for spermatid remodelling

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20
Q

Sertoli cells secrete __+__(inhibits ___ release_

A

ABG

inhibin - inhibits FSH release

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21
Q

Testosterone suppresses __ and decreases the sensitivity of ____ to ___

A

GnRH release

LH secreting cells to GnRH

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22
Q

it takes ___ days to make a sperm

A

72

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23
Q

golgi in a sperm cell =

A

acrosome

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24
Q

granulosa cells in female =

A

follicle cells in the ovaries

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25
Q

__+___ cells of the ovaries produce oestrogen

A

theca and granulosa cells

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26
Q

granulosa cells are stimulated by __ to produce ___ which diffuses to adjacent theca cells which produce ___ that goes back to the granulosa to be turned into oestrodiol

A

LH
pregnenolone
androstenedione

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27
Q

enzymes present in theca cells that convert pregnenolone to DHEA to androstenidione

A

17, 20 lyase + 3beta HSD

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28
Q

expression of aromatase and 17beta HSD stimulate __

A

FSH

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29
Q

aromatase causes __>___ in extraglandular tissues eg bone and fat

A

androgens to oestrone

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30
Q

pregnenolone is acted on by ___ in ++_ to produce progesterone

A

3beta HSD

corpus luteum placenta and adrenals

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31
Q

<9 periods a year =

A

oligomenorrhoea

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32
Q

primary amennorrhea =

A

failure of menarche by 16yo

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33
Q

2ndry amennorhea definition -

A

previously menstruated but ceased for >6months

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34
Q

congenital causes of primary amennorhea

A

Turner’s

Kallman’s

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35
Q

amennorhea + anosmia =

A

Kallman’s

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36
Q

Ix for all oligo/amennorhoeic patients

A 
LH
FSH
oestradiol
TFT
PRL
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37
Q

primary hypogonadism in females=

A

ovarian problem
high LH and FSH
hypergonadotrophic hypogonadism

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38
Q

2ndry hypogonadism in females =

A

low FSH/LH

hypogonadotrophic hypogonadism

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39
Q

causes of Prematur ovarian failure

A

Turners
Fragile X
FSH/LH receptor mutations
Addisons/AI thyroid

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40
Q

POF age =

A

<40yo

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41
Q

diagnosis of POF =

A

FSH >30 on 2 occasions >1 month apart

42
Q

causes of 2ndry hypogonadism =

A 
Kallmans
Idiopathic
functional
prader willi
haemochromatosis
43
Q

causes of functional hypogon hypogonadism

A 
stress
exercise
wt change
anabolic steroids
systemic illness
head trauma 
sarcoid
44
Q

Kisspeptin =

A

stimulates GnRH secretion

regulates M+F fertility

45
Q

idiopathic hypogon hypogonadism =

A

inability to activate pulsatile GnRH secretion
absent/delayed sexual development ass with inappropriately low LH/FSH and sex hormone wo anatomical/functional defects of HPG axis

46
Q

In Kallmann’s there is absence of ___ which causes ___
mode of inheritance
M:F

A

no olfactory bulbs so anosmic
auto dom/recessive or sporadic or x linked
M4:1F

47
Q

Rotterdam criteria for PCOS

A

normal oestrogen and >= 2 of:
oligomenorrhea
hyperandrogenism
polycystic ovaries => insulin resistance, hirsutism

48
Q

non-classical CAH usually presents

A

in adults as hirsute, menstrual disturbance and anovulation

49
Q

Rx for PCOS hirsutism

A

oral contraceptive
anti-androgens (cyproterone acetate PO / efflornithine cream)
electrolysis

50
Q

Rx for late onset CAH hirsutism

A

low dose glucocorticosteroid to suppress aCTH drive

51
Q

45X =

A

Turner’s

52
Q

short webbed neck, shield chest, wide spaced nipples, amennorhea, cubitus valgus =

A

Turner’s

53
Q

XY but androgen insensitive so phenotypically F =

A

pseudohermaphrodites

testicular feminisation

54
Q

Primary causes of male hypogonadism

A

trauma, chemo, haemochromatosis, cirrhosis

Klinefelter’s, SHBG

55
Q

47XXY

A

Klinefelter’s

56
Q

2ndry causes of male hypogonadism

A

CAH, IHH, Klinefelter’s, Prader Willi, hyperPRL, functional

57
Q

infertility definition =

A

failure to conceive after >= 12months of regular unprotected sex in couples with no kids previously

58
Q

difference between primary and secondary infertility =

A 
primary = have never conceived
2ndry = conceived but did not have a live birth
59
Q

hot flushes, atrophic vaginitis and night sweats are indicative of

A

POF

60
Q

non-infective tubal diseases that can cause infertility in Fs

A

endometriosis, Sx, fiboids, polyps, salpingitis isthmica nodosa

61
Q

endometriosis =

A

endometrial glands outside theuterine cavity

62
Q

causes of endometriosis

A

retrograde menstruation
abnormal cellular adhesion molecules
genes
abnormal immune system

63
Q

chocolate ovarian cysts on scan =

A

endometriosis

64
Q

s+s of endometriosis

A 
chocolate ovarian cysts on scan
dysmmenorrhea (prior to menstruation)
dyspareunia
menorrhagia
painful defaecation
chronic pelvic pain
uterus may be retroverted/fixed
65
Q

endocrine causes of male infertility

A 
hypog hypog
klinefelter
chemo
undescended testicle
hyperPRL
acromegaly
cushings
thyroid high or low
66
Q

obstructive causes of male infertility

A

CF (no vas)
infection
vasectomy

67
Q

results of test if obstructive cause of male fertility

A

Testosterone LH and FSH normal
normal testicular volume
2ndry sexual characteristics

68
Q

signs that the cause of male infertility is testicular

A 
reduced testicular volume
reduced 2ndry sexual characteristics
vas present
FSH and LH up
Testosterone low
69
Q

basic Ix for females with infertility

A 
BMI
examine
endocervical swab for chlamydia
smear test if due
blood for rubella immunity
midluteal progessterone levels (>30nmol/l = ovulation)
70
Q

Hysterosalpingiogram is used to Ix

A

infertility thought to be a tubal patency problem if no tubal/pelvic pathology
or if laparoscopic is contraindicated
however it misses adhesions and the cause of the block

71
Q

if known or suspected tubal/pelvic pathology the Ix for tubal infertility causes =

A

laparoscopy

72
Q

if suspect/know endometrial pathology then Ix for tubal infertility =

A

hysteroscopy

73
Q

if find an abnormality on pelvic exam then next Ix =

A

Pelvic US

74
Q

Features of semen analysed in fertility clinic

A 
volume
pH (7.2-7.8)
concn
motility
morphology
WBC
75
Q

if abnormal genital exam on males next Ix =

A

scrotal Ix

76
Q

regular menstrual cycle = __-__ days

A

28-35 days

77
Q

menstrual cycle >35days =

A

oligomenorrhea

78
Q

length of follicular and luteal phases

A 
follicular = variable
luteal = 14 days
79
Q

if bleed 5 days and the menstruation occurs every 30 days this is annotated as

A

5/30

80
Q

ovulation predictor kits are 3% unreliable because

A

not all females secrete LH in urine and it detects LH surge in urine

81
Q

oestradiol+progesterone peak before/after ovulation

A 
oest = before
prog = after
82
Q

if periods are regular then to assess ovulation use this Ix

A

midluteal (day21) serum progesterone
2 samples
>30mmol/l = ovulation

83
Q

Rx of anovulation in Group 1 ovulatory dysfunction (hypogon hypogonadism)

A

stabilise BMI >18.5
pulsatile GnRH S/C or IV
FSH and LH daily injections

84
Q

85% of ovulatory disorders are

A

Group 2

normal FSH/LH and oestrogen but oligo/amennorhoea

85
Q

in PCOS __ lowers SHBG and so cause there to be more free ___

A

insulin

testosterone => hyperandrogenism

86
Q

first line for ovulation induction in PCOS

A 
clomifene citrate
(other anti-oestrogens = tamoxifen
alternative = letrozole
87
Q

drug used in PCOS for ovulation induction that increases sensitivity to clomifen and improves insulin resistance

A

metformin

88
Q

risk of recombinant FSH daily injection for ovualtion induction in PCOS

A

multiple preg and overstimulation

89
Q

Sx option for PCOS ovulation induction and its risk =

A

laparoscopic ovarian diathermy

ovarian destruction

90
Q

TTTS=

description

A

twin twin transfusion syndrome
monochorionic - recipient = polyhydramnios
donor = oliguria, oligohydramnios, growth restriction

91
Q

Rx for TTTS

A

laser division of placental vessels

92
Q

Group 3 ovulatory dysfunction =

A

ovarian failure

93
Q

Rx for POF

A

HRT (doesnt restore ovulation - must cryopreserve eggs prior to POF to preserve fertility)

94
Q

scan that is a routine part of infertility consultation

A

US transvaginally

95
Q

drugs that cause galactorrhea

A 
oestrogen containing
opiates
simetadine - older H2 antagonists
metaclopramide
domperidone
phenothiazine, beloperidol
96
Q

rubella signs at birth

A 
rash
low birth wt
small head size
PDA
visual problems
bulging fontanelle
97
Q

Rx for chlamydia

A

azithromycin 1g stat

if allergy = doxycyline 100mg bd for 7 days

98
Q

in PCOS usually follicle arrangement =

A

peripherally arranged around an enlarged hyperechogenic central stroma

99
Q

aromatase inhibitors =

used in infertility treatment but not licensed in UK

A

letrozole/ anastrozole

100
Q

___ increases sensitivity to clomifene

A

metformin

101
Q

Ix for tubal infertility that can cause PID flare, vasovagal attack, palvic pain

A

hysterosalpingogram

EndocrineJaz (15 decks)

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