Session 3

Question 1

What term is used to describe development of the breasts?

Answer 1

Thelarche

Question 2

What term is used to describe development of axillary and pubic hair?

Answer 2

Puberache

Question 3

What term is used to describe the first menstrual period?

Answer 3

Menarche

Question 4

What term is used to describe the onset of an increase in the secretion of androgens?

Answer 4

Adrenarche

Question 5

Puberty is initiated by a rise in secretion of which hormone?

Answer 5

GnRH

Question 6

Which hormone is responsible for the early epiphyses closure in girls?

Answer 6

Oestrogen

Question 7

In the Western world, what is considered to be the average age of menarche in girls?

Answer 7

<13 years

Question 8

What weight is said to be critical in girls in order for them to undergo a reproductive cycle?

Answer 8

47kg

Question 9

What are the first phenotypic changes observed in puberty?

Answer 9

Breast development/testicular enlargement

Question 10

How can pubertal development be staged?

Answer 10

Tanner standard

Question 11

On average, at what age does puberty occur in females?

Answer 11

9-13 years

Question 12

On average, at what age does puberty occur in males?

Answer 12

10-14 years

Question 13

How is precocious puberty defined?

Answer 13

Onset of puberty occurring younger than two standard deviations before the average age
Girls <8 years (5-10 times more common in girls)
Boys <9 years

Question 14

Give examples of causes of gonadotropin-dependent precocious puberty.

Answer 14

Tumours (gliomas, astrocytomas, hamartomas, pineal tumours, hCG-secreting germ cell tumours)
CNS trauma or injury
Hydrocephalus
Arachnoid cysts

Question 15

How is gonadotropin-independent precocious puberty more accurately defined?

Answer 15

Precocious pseudopuberty
It is the appearance of secondary sexual characteristics due to increased production of sex hormones (i.e. occurs independently of the HPG axis)

Question 16

Give examples of causes of gonadotropin-independent precocious puberty.

Answer 16

Congenital adrenal hyperplasia
hCG-secreting tumours in the liver
Testotoxicosis (familial male precocious puberty)
Exogenous oestrogen or androgen exposure

Question 17

How is delayed puberty defined?

Answer 17

Initial physical changes of puberty are not present by age 13 in girls, age 14 in boys OR
Primary amenorrhoea at age 16 in girls OR
The interval between the first signs of puberty and the completion of puberty is >5 years

Question 18

Give example of causes of delayed puberty.

Answer 18

Gonadal failure (hypergonadotropic hypogonadism):
Turner’s syndrome
Chemo/radiotherapy
Polyglandular autoimmune syndromes

Gonadal deficiency:
Congenital hypogonadotropic hypogonadism
Hypothalamic/pituitary lesions

Question 19

What changes occur in the female during the pre-menopause?

Answer 19

Shortened follicular phase of the menstrual cycle
Ovulation early or absent
Reduced fertility

Question 20

What changes occur in the female during the menopause?

Answer 20

Cessation of menstrual cycles
No more follicles to develop
Oestrogen levels fall dramatically
FSH and LH levels rise

Question 21

What effects are seen in females as a result of the menopause?

Answer 21

Vascular changes (transient rises in skin temperature)
Regression of endometrium and shrinkage of myometrium
Thinning of cervix
Loss of vaginal rugae (leading to dryness)
Involution of some breast tissue
Changes in skin
Loss of pelvic tone (leading to urinary incontinence)
Loss of bone mass (oestrogen no longer inhibits osteoclasts leading to osteoporosis)

Question 22

What name is given to a particularly heavy menstrual bleeding?

Answer 22

Menorrhagia

Question 23

Give examples of causes of menorrhagia.

Answer 23

Abnormal clotting
Fibroids
IUCD (intrauterine contraceptive device)
Cancer
Progesterone contraception

Question 24

What is a uterine fibroid?

Answer 24

A benign growth in the uterine cavity (can sometimes grow large enough to mimic a pregnancy)

Question 25

Name five different types of uterine fibroids.

Answer 25

Intracavity
Submucosal
Intramural
Subserosal
Pedunculated

Question 26

What is DUB?

Answer 26

Dysfunctional uterine bleeding - heavy bleeding with no recognisable pelvic pathology, pregnancy or general bleeding disorders

Question 27

When is irregular bleeding likely to occur?

Answer 27

During the first three months of starting hormonal contraception
After missing doses of contraceptive pills
After vomiting/diarrhoea whilst on COCP
Whilst taking certain medications (or St John’s Wort) whilst using hormonal contraception

Question 28

Give examples of hormonal contraception.

Answer 28

Combined oral contraceptive pill (COCP)
Progesterone-only contraceptive pill
Contraceptive (transdermal) patch
Contraceptive implant/injection
Intrauterine contraceptive device (IUCD)