RHCN Block 4 Flashcards
Which of these is not a characteristic of the menopause?
a. Urge incontinance
b. FSH <20
c. Atrophic vaginitis
d. Decreased libido
e. Night sweats
b. FSH >20 on 2 samples, 4-6 weeks apart
True or false, HRT increases the risk of breast cancer
True
True or false, HRT increases the risk of colon cancer
False - decreases the risk
True or false, HRT decreases the risk of osteoporosis
True
True or false, NICE recommends the use of bioidentical hormones as an alternative treatment for the menopause
False - not licensed in the UK
True or false, increased caffeine and exercise are recommended to increase energy levels during the menopause
False, caffeine should be limited, but exercise should be encouraged.
Which of the following are NOT indications to use transdermal HRT:
- Individual preference
- Poor symptom control with oral
- Egg allergy
- Previous or family Hx of VTE
- BMI >28
- Variable BP control
- Migraine
- Renal stone disease
- Liver-inducing enzyme medication use
Egg allergy - no reason to avoid oral therapy
BMI >28 - transdermal therapy indicated when BMI >30
Renal stone disease - transdermal therapy indicated in gallbladder disease, not renal stone disease
In a 48 year old woman, with menopausal symptoms and an FSH level of 23 IU/L, whom has had a hysterectomy, with a PMHx of migraines, what is the most appropriate HRT choice?
Oestrogen-only gel
She does not need combined HRT because she has no uterus. She should not have oral oestrogen because of her Hx of migraines
What is premature ovarian insufficiency?
POI is menopause before the age of 40 due to a decline in normal activity of the ovaries, characterised by hypergonadotropic hypogonadism
What is primary amenorrhoea?
When menstruation has not occurred by 16y/o
What is secondary amenorrhoea?
When previously normal menstruation ceases for >6/12
Offer 3 causes of primary amenorrhoea
Constitutional delay Drugs Anorexia nervosa Hyperprolactinaemia Hyper/Hypothyroidism Imperforate Hymen Androgen insensitivity
Offer 3 causes of secondary amenorrhoea
Pregnancy Lactation Menopause Drugs Polycystic ovarian syndrome Premature ovarian failure
True or false, the definition of delayed puberty in girls includes the absence of breast development by age 13 or menarche at the age of 16
True
True or false, GnRH released from the hypothalamus stimulates the release of LH and FSH from the posterior pituitary
False - GnRH is released from the ANTERIOR pituitary
What is often the first sex-specific change in puberty seen in males?
Testicular enlargement
What is NOT a biochemical change observed in puberty?a. Males develop lower LDL and higher HDL cholesterol levels
b. Haemoglobin indices rise in boys and fall in girls
c. Maturation of enzyme systems including liver cytochrome P-450
a - Males develop HIGHER LDL and LOWER HDL cholesterol levels
At what testicular volume is spermarche usually achieved?
8-12ml
What is the name of the scale used to assess pubertal development?
Tanner
True or false, FSH binds to granulosa cells and converts cholesterol to androgens
False
True or false, FSH binds to granulosa cells and converts androgens to estradiol
True
True or false, the corpus luteum produces both oestrogen and progesterone
True, but mainly progesterone
True or false, after fertilisation it is the corpus luteum that produces hCG
False - it is the developing placenta
True or false, in the absence of fertilisation, the corpus luteum degenerates, progesterone levels fall and this marks the start of menses
True
What does the corpus luteum degenerate into?
Corpus albicans
Name 3 structural abnormalities that can lead to sub-fertility:
Uterine malformation
Fibroids
Asherman’s syndrome
Endometriosis
In a woman with a regular 32-day cycle, on which day would you take a mid-luteal progesterone?
Day 25
A woman is being assessed for tubal factor infertility. She is booked for a hysterosalpingogram. Which of the following is NOT a contraindication to having this procedure?
- Active pelvic infection
- Recent uterine surgery
- Previous ectopic pregnancy
- Known allergy to contrast
- Previous HPV infection
- Previous HPV infection
Which of the following genetic abnormalities are associated with female subfertility? Choose all that apply:
- Cystic fibrosis
- Kallman’s
- Kartagener’s
- Klinefelter’s
- Turner’s syndrome
- Cystic fibrosis
- Kallman’s
- Kartagener’s
- Turner’s syndrome
Define ‘infertility’:
Failure to conceive after two years of unprotected sexual intercourse without using any type of contraception
Define ‘primary infertility’:
A couple that has never been able to conceive
A couple with 2 children have been unable to conceive after trying for 3 years. What type of infertility is this?
Secondary infertility
‘92% couple conceive within 1 year of trying’. True or false?
False - that is the conception rate within 2 years of trying
Name the three groups of ovarian factor infertility, and at least 1 example of each:
GROUP I - Hypothalamic pituitary failure
E.g. Anorexia, stress, hypopituitarism, hyperprolactinaemia
GROUP II - Hypothalamic pituitary ovarian dysfunction
E.g. PCOS
GROUP III - Ovarian failure
E.g. Menopause, Turner’s syndrome
True or false - cystic fibrosis screening is done in suspected cases of obstructive azoospermia
True
How does CF causes azoospermia?
Absence of the vas deferens
What investigations can be done regarding male factor infertility?
Endocrine tests Cystic fibrosis screening Chromosome studies Genital tract infections - swabbing Imaging of genital tract
What is the first line drug used to induce ovulation?
Clomifene
How long can clomifene be used for?
6 months (6 cycles)
Normally, blood pressure returns to pre-pregnancy levels at birth - true or false?
True
Name three changes occur in pregnancy to the cardiovascular system?
Any three of the following:
- Cardiac output increases
- Pulse increases, can be bounding or collapsing
- Blood pressure falls in first trimester
- Blood pressure increases in seed and third trimester
- Ankle oedema
- ECG changes – left axis deviation, t wave inversion, ST depression
- Ejection systolic murmur, ectopic beats
Physiological changes in pregnancy include an alkalotic shift in blood pH, Fall in CO2 and bicarbonate - true or false?
True
Hyperemesis Gravidarum is a complication in pregnancy whereby the mother develops what triad of signs?
a. Excessive vomiting, physical and emotional distress, constipation
b. Loss of 5%+ of pre-pregnancy body weight, ketosis, excessive vomiting
c. Intermittent vomiting, epigastric pain and nausea, significant increase in blood pressure
d. Pedal oedema, proteinuria, increased blood pressure
B
Which of the following is least likely to happen in pre-eclampsia?
HTN Proteinuria Oedema Itchiness Headache
Itchiness
What medication is given in eclampsia?
Magnesium sulfate
What is the first line antihypertensive in pre-eclampsia?
Labetalol
HELLP syndrome is a complication of pre-eclampsia. What is it a triad of?
Hemolysis
Elevated Liver enzymes
Low Platelets
Why do we give vitamin K from 36 weeks in obstetric cholestasis?
To reduce risk of maternal and fetal haemorrhage
Changes to which clotting factors lead to pregnancy being a hypercoagulable state?
a) Increased Factor VIII, Increased Factor IX, Decreased Protein S
b) Increased Factor X, Decreased Factor IX, Decreased Antithrombin
c) Increased Protein S, Decreased Factor VIII, Decreased Factor IX
d) Increased Factor X, Increased Factor IX, Increased Protein S
a) Increased Factor VIII, Increased Factor IX, Decreased Protein S
Name 3 changes to the skin that can occur in pregnancy
Any three of the following:
a) Post-partum hair loss
b) Melasma
c) Spider naevi
d) Increased pigmentation
e) Striae gravidarum
f) Palmar erythema
g) Non-rash pruritis
In normal pregnancy, how quickly will hCG levels increase in the first trimester?
Doubles every 48 hours
How early is hCG detectable after fertilization?
Serum 7-9 days
Urine 8-12 days
