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mrcog part 1 > Revision notes: 6. Endocrinology > Flashcards

Revision notes: 6. Endocrinology Flashcards

1
Q

Ovulation occurs how long after LH surge

A

24-36 hours after commencement of LH surge

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2
Q

What happens to level of Sex hormone binding globulin during pregnancy

A

Levels increase

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3
Q

Treatment for gestational DI

A

DDAVP (Vasopressinase-resistant 1-deamino-8-D-arginine vasopressin)

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4
Q

Where is oxytocin synthesised

A

Paraventricular nucleus of hypothalamus

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5
Q

Which layer of the endometrium is shed during menstruation

A

Stratum Functionalis

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6
Q

Blood supply to endometrium

A

Spiral arterioles (originate from radial branches of arcuate arteries, which in turn arise from uterine arteries)

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7
Q

Which gene variant of LH reported in patients with PCOS

A

LH beta-subunit

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8
Q

Inheritance pattern of vit D resistant rickets

A

X-linked dominant

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9
Q

what are the three oestrogens

A

E1 Oestrone - MENOPAUSE
E2 Oestradiol - Non-pregnant state
E3 Oestriol - Pregnant

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10
Q

How does oestrogen increase coagulability

A

Decreases anti-thrombin 3
Increases levels of II, VII, IX, X
Increases plasminogen
Increases platelet adhesiveness

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11
Q

GI oestrogen effects

A

Reduced GI motility
Increased bile production

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12
Q

How much progesterone does placenta produce at term

A

250mg/day

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13
Q

Progesterone effects on uterus, cervix and vagina

A

Converts endometrium from proliferative to secretory
Withdrawal causes menstruation
Inhibits uterine contraction until term

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14
Q

What cell type secretes inhibin

A

Ovarian Granulosa cells

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15
Q

Inhibin selectively inhibits secretion of?

A

FSH

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16
Q

Where is testosterone secreted

A

Leydig cells of testes
Theca cells of ovary
Zona reticularis of adrenals
Placenta

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17
Q

Which enzyme catalyses conversion of testosterone to DHT (dihydrotestosterone)

A

5a reductase

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18
Q

Features of 5a reductase deficiency

A

High testosterone
Low DHT
Gynaecomastia
Ambiguous genitalia at birth

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19
Q

Sex-hormone binding globulin - which chromosome

A

17

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20
Q

Two types of neurones in paraventricular nucleus

A

Magnocellular
Parvocellular

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21
Q

Magnocellular neurones produce

A

Oxytocin
ADH

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22
Q

Parvocellular neurones produce

A

CRH
ADH
TRH

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23
Q

Dopamine inhibits

A

Prolactin

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24
Q

GnRH gene location

A

Chromosome 8

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25
Q

Structure of FSH

A 
Alpha subunit (chromosome 6) 
Beta subunit (chromosome 11)
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26
Q

Function of FSH in women

A

Stimulates ovary to produce Graafian follicle

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27
Q

Structure of LH

A 
Alpha subunit (chromosome 6) 
Beta subunit (chromosome 19)
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28
Q

LH function

A

Stimulates oestrogen and progesterone production
Induces ovulation
Prevents apoptosis of corpus luteum

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29
Q

Features of Kallmann syndrome

A

Delayed/absent puberty
Impaired sense of smell

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30
Q

Oxytocin causes smooth muscle contraction of:

A
  1. Uterine muscle
  2. Myoepithelial cells surrounding breast alveoli
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31
Q

Zona glomerulosa produces?

A

Mineralocorticoids e.g. aldosterone

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32
Q

Zona fasciculata produces

A

Glucocorticoids e.g. cortisol

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33
Q

Name of modified neural crest cells in adrenal medulla

A

Chromaffin cells

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34
Q

Angiotensinogen is secreted by the

A

Liver

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35
Q

Renin catalyses conversion of

A

Angiotensinogen to Angiotensin I

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36
Q

Drug causes of SIADH

A

SSRI
Carbamazepine
Thiazide
Vinblastine

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37
Q

Demeclocycline treats SIADH because…

A

It induces nephrogenic DI

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38
Q

Test for congenital hypothyroidism

A

Guthrie test

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39
Q

Carbimazole and Propylthiouracil are treatments for

A

hyperthyroidism

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40
Q

Diagnosis of phaeochromocytoma

A

measuring urinary levels of vanillylmandelic acid (VMA) & metanephrine

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41
Q

Treatment of prolactinoma

A

dopamine agonists

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42
Q

How does the fetus cause parturition

A

Fetal pituitary releases corticotrophin, acts on fetal adrenals
fetal adrenals release cortisol & DHEAS
Fetal adrenal DHEAS metabolised in placenta leading to increased oestrogen levels, which provoke release of prostaglandin F from decidua causing myometrial contractions

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43
Q

What neuronal reflex triggered by pressure on the cervix causes oxytocin release

A

Ferguson reflex

44
Q

Lactational amenorrhoea is reliable form of contraception if:

A

Baby exclusively breastfed
Amenorrhoea (<6 months post-partum)

45
Q

Which hypothalamic hormone stimulates release of prolactin

A

TRH
Thyrotrophin-releasing hormone

46
Q

What inhibits glucagon release

A

Free fatty acids

47
Q

What is the ratio of testosterone bound to sex hormone-binding globulin (SHBG) and albumin respectively?

A

1% free, 19% albumin-bound and 80% SHBG-bound

48
Q

Most common cause of hyperprolactinaemia

A

Primary hypothyroidism

49
Q

What is an appropriate endocrine response to low, detected serum calcium levels?

A

Increased PTH, increased phosphate excretion, increased calcitriol and reduced calcitonin

50
Q

With regard to the renin-angiotensin system, where are the juxtaglomerular cells located?

A

Afferent arteriole in the kidney

51
Q

What are the classical blood test results in Addison’s disease?

A

Hyperkalaemia, hyponatraemia, uraemia, hypercalcaemia and eosinophila

52
Q

Treatment of hyperthyroidism during pregnancy

A

Propylthiouracil

53
Q

Most common cause of delayed puberty

A

Constitutional delay

54
Q

Which three hormones consist of almost identical alpha chains?

A

HCG, FSH, LH

55
Q

Hormone secreted by acidophil cells in anterior pituitary

A

Growth Hormone

56
Q

Hormone significantly increased on day 0 of menstrual cycle

A

FSH

57
Q

Finite life span of corpus luteum

A

14 days

58
Q

Where in the body is calcidiol produced?

A

Liver

59
Q

How does oestrogen cause salt and water retention

A

stimulates renin and angiontensin –> inc aldosterone secretion

60
Q

hcg is produced by

A

syncytiotrophoblast

61
Q

when does hcg take over from LH in supporting corpus luteum

A

8 days after ovulation (1 day after implantation)

62
Q

Progesterone ………. HCG secretion

A

inhibits

63
Q

hcg level at 1) first missed period and 2) peak (10 weeks gestation)

A

100IU/L

100,000IU/L

They then fall to 10-20K at 18-20 weeks and remain this level to term

HIGHER IN FEMALE FOETUS

64
Q

The main placental oestrogen is

A

oestriol

Fetal DHEA-S is hydroxylated by foetal liver to 16-alpha-hydroxy-DHEA-S. This is used by placenta to make OESTRIOL

First detected at 9 weeks gestation

65
Q

relative levels of oestrogens during pregnancy

A

oestriol levels increase 1000 fold
oestradiol and oestrone increase 100 fold

MUM has more OESTRADIOL
BABY has more oestriol

66
Q

progesterone is produced by corpus luteum until

A

10 weeks gestation

Placenta starts making progesterone at 7 weeks gestation and is exclusive producer from 10 weeks onwards

67
Q

Biological half life of LH

A

20 minutes

68
Q

What stimulates granulosa cell proliferation

A

FSH

69
Q

half life of FSH

A

3-4 hours

70
Q

the zona pellucida seperates the …… from the ……

A

oocyte
granulosa cells

71
Q

inhibin effects on androgens and aromatisation

A

stimulates androgen secretion
reduces aromatisation capacity of granulosa cells

72
Q

Presence of what stops menstrual blood from clotting

A

fibrinolysin

73
Q

AMH is produced by

A

granulosa cells of the preantral and small antral follicles

it aids selection of the dominant follicle

74
Q

progesterone receptor type

A

nuclear receptor

75
Q

Sperm concentration in semen

A

20million/ml

76
Q

Erection : nerve supply

A

parasympathetic impulses from nervi erigentes (S2, 3, 4)

77
Q

Ejaculation: nerve supply

A

sympathetic via L1-L2 through hypogastric plexus

78
Q

Testosterone to oestrogen conversion happens in

A

sertoli cells

79
Q

thick inner foetal zone of foetal adrenal cortex produces DHEA-S. What is this converted to in placenta

A

oestradiol and oestrone

80
Q

Early growth of fetal adrenal gland is independent of

A

ACTH

81
Q

Activin ……….. fetal ACTH stimulated steroidogenesis

A

enhances

82
Q

Where is Human Placental Lactogen secreted

A

Trophoblast

It is NOT influenced by somatostatin or growth hormone releasing hormone

83
Q

HPL effects

A

Decreases insulin sensitivity
Stimulates insulin release
Stimulates lipolysis
Decreases glucose utilisation

RESULT: increased glucose and free fatty acid concentrations which can be transferred to fetus

84
Q

somatostatin production ………. with increasing gestation

A

decreases

85
Q

At what gestation does placental GH replace pituitary GH

A

15-20 weeks

86
Q

Gestational diabetes insipidus is caused by

A

excessive vasopressinase activity (enzyme expressed by placental trophoblasts
It metabolises ADH

87
Q

How does aspirin inhibit platelets

A

blocks thromboxane formation in platelets

88
Q

Dinoprostone is synthetic preparation identical to

A

PGE2

89
Q

Misoprostol is methyl ester analogue of

A

PGE1

90
Q

macroadenoma usually associated with prolactin levels greater than

A

5000

91
Q

medical management of prolactinoma

A

bromocriptine (dopamine agonist)
Cabergoline

92
Q

Most common cause of Conn’s syndrome

A

Idiopathic adrenal hyperplasia

93
Q

ratio of T4:T3 secreted from the thyroid gland

A

13:1

94
Q

where is calcitonin produced

A

parafollicular cells of THYROID gland

95
Q

Where is PTH produced

A

CHIEF cells of PARATHYROID (as a pre-prohormone)

96
Q

steroid hormone biosynthesis: diagram for review

A
97
Q

Fatty acids have what effect on insulin secretion

A

fuck all

98
Q

Which two amino acids stimulate insulin AND glucagon secretion

A

Alanine and arginine

99
Q

first hormone affected in sheehan syndrome

A

Growth hormone

100
Q

which tissues produce oxytocin

A

hypothalamus, ovary, testis

101
Q

half-life oxytocin

A

1 minute

102
Q

ADH is produced by

A

supra-optic nucleus of hypothalamus

103
Q

increased cortisol levels during pregnancy are caused by

A

placental corticotrophin releasing hormone (CRH)

104
Q

Thyrotrophin releasing hormone is a

A

tri-peptide hormone

105
Q
A

mrcog part 1 (14 decks)

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