Reproduction Disorders

Question 1

Define oligomenorrhoea

Answer 1

Reduced frequency of periods (less than 9/year)

Question 2

Define primary amenorrhoea

Answer 2

Failure of having a period before the age of 16

Question 3

Define secondary amenorrhoea

Answer 3

Cessation of periods for greater than 6mths in someone who has previously had a period

Question 4

What is the main cause of primary amenorrhoea?

Answer 4

Congenital abnormality

Turner’s, Kallman’s

Question 5

List ovarian causes of secondary amenorrhoea

Answer 5

Polycystic ovarian syndrome

Ovarian failure

Question 6

High prolactin and hypopituitarism can cause amenorrhoea. True/False?

Answer 6

True

Question 7

What triad of symptoms are classic of amenorrhoea/oestrogen deficiency?

Answer 7

Flushing
Lack of libido
Dyspareunia (painful sex)

Question 8

List investigations that all patients with oligo-/amen- orrhoea get

Answer 8

LH, FSH, oestradiol levels
Thyroid function tests
Prolactin levels

Question 9

List additional investigations for oligo-/amen- orrhoea

Answer 9

Ovarian USS, endometrial thickness
Testosterone levels if hirsutism
Pituitary function

Question 10

In primary hypogonadism in females, the problem is arising from where - ovaries or pituitary/hypothalamus?

Answer 10

Ovaries

Question 11

In secondary hypogonadism in females, the problem is arising from where - ovaries or pituitary/hypothalamus?

Answer 11

Pituitary/hypothalamus

Question 12

Describe LH and FSH levels in primary hypogonadism

Answer 12

High LH
High FSH
i.e. hypergonadotrophic hypogonadism

Question 13

Describe LH and FSH levels in secondary hypogonadism

Answer 13

Low LH
Low FSH
i.e. hypogonadotrophic hypogonadism

Question 14

Give an example of a condition where primary hypogonadism occurs

Answer 14

Premature ovarian failure

Question 15

What happens in premature ovarian failure?

Answer 15

Loss of ovarian function causes amenorrhoea, low oestrogen and elevated gonadotrophins

Question 16

What is idiopathic hypogonadotrophic hypogonadism?

Answer 16

Absent/delayed sexual development assoc. with low levels of gonadotrophins in the absence of anatomical/functional defect in the H-P-gonadal axis

Question 17

Which syndrome is like idiopathic hypogonadotrophic hypogonadism but includes anosmia (inability to smell)?

Answer 17

Kalmann’s syndrome

Question 18

What is the major defect/identified cause of idiopathic hypogonadotrophic hypogonadism?

Answer 18

Mutated GnRH receptor (thus inability to sense GnRH from hypothalamus)

Question 19

What is the function of kisspeptin?

Answer 19

Regulates GnRH secretion and thus puberty

Regulates fertility

Question 20

What is Kallman’s syndrome?

Answer 20

Genetic disorder of loss of GnRH secretion characterised by anosmia and hyposmia

Question 21

Males are more affected by Kallman’s syndrome. True/False?

Answer 21

True

4:1

Question 22

What causes hirsutism?

Answer 22

Excess androgen at the hair follicle

Question 23

What is the most common cause of hirsutism?

Answer 23

Polycystic ovarian syndrome

Question 24

Which chromosome is missing in Turner syndrome?

Answer 24

X

so women only have one X

Question 25

List clinical features of Turner syndrome

Answer 25

``` Short stature Failure/delayed puberty Coarctation of aorta Poor breast formation Infertility ```

Question 26

Define primary hypogonadism in males in terms of testosterone and LH/FSH levels

Answer 26

Low testosterone | High FHS/LH

Question 27

Define secondary hypogonadism in males in terms of testosterone and LH/FSH levels

Answer 27

Low testosterone | Low FSH/LH

Question 28

What is the most common congenital form of primary hypogonadism?

Answer 28

Klinefelter's syndrome (XXY)

Question 29

List clinical features of Klinefelter's syndrome

Answer 29

Reduced testicular volume Gynaecomastia Eunuchoidism

Question 30

Infertility risk increases with chlamydia infections. True/False?

Answer 30

True

Question 31

List some male factors contributing to infertility

Answer 31

Decreased quality sperm Increased testicular cancer Cryptoorchidism Hypospadias

Question 32

Define infertility

Answer 32

Failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child

Question 33

What is the difference between primary + secondary infertility?

Answer 33

Primary: never conceived Secondary: unsuccessful pregnancy

Question 34

List factors increasing the chance of conception

Answer 34

``` Women less than 30yrs Less than 3yrs trying to conceive Intercourse during 6days before ovulation Women BMI 20-30 Non-smokers Low caffeine intake ```

Question 35

What are the main causes of female infertility?

Answer 35

``` Ovulation failure (50%) Tubal damage (25%) Endometriosis (10%) Misc. (15%) ```

Question 36

List hypothalamic causes of anovulatory infertility

Answer 36

Anorexia, bulimia | Excessive exercise

Question 37

List pituitary causes of anovulatory infertility

Answer 37

Hyperprolactinaemia Sheehan syndrome Tumours

Question 38

What is a hydrosalpinx?

Answer 38

Fallopian tube dilation by fluid (due to blockage)

Question 39

What is endometriosis?

Answer 39

Condition where endometrial tissue grows outside of the womb/uterus

Question 40

What is the characteristic sign of endometriosis on USS?

Answer 40

Chocolate cysts on ovary

Question 41

What is the most common cause of male infertility?

Answer 41

Varicocele

Question 42

What is a varicocele?

Answer 42

"varicose veins" of the testis

Question 43

List endocrine disorders that can cause male infertility

Answer 43

``` Hypogonadotrophic hypogonadism (Kallman's) Testicular failure Klinefelter's syndrome (XXY) Hyperprolactinaemia Acromegaly Cushing's ```

Question 44

List investigations for causes of infertility in females

Answer 44

``` Endocervical swab (chlamydia) Cervical smear Pelvic USS Bloods (rubella) Mid-luteal progesterone Hormone levels (PRL, FSH, LH) Hysterosalpingiogram (tubal patency) ```

Question 45

List causes of WHO group I ovulatory disorders

Answer 45

``` (hypothalamic causes) Hypogonadotrophic hypogonadism Kallman's syndrome Anorexia, bulimia Excessive exercise ```

Question 46

List causes of WHO group II ovulatory disorders

Answer 46

(pituitary dysfunction) Normogonadotrophic hypogonadism Polycystic ovarian syndrome

Question 47

List causes of WHO group III ovulatory disorders

Answer 47

Hypergonadotrophic hypogonadism | Ovarian failure