Week 203 - Puberty

Question 1

Where is the common place for the nipple?

Answer 1

4th intercostal space (mid-clavicular line)

Question 2

When do you examine lactating breasts?

Answer 2

After breastfeeding

Question 3

On examination how would a breast cancer feel?

Answer 3

Firm, Hard, Irregular

Usually painless

Question 4

What is a fibroadenoma of the breast?

Answer 4

Benign lump (part of terminal duct lobule)
Smooth, Mobile, Discrete & Rubbery
2nd most common cause of breast mass in women <35 yrs

Question 5

What are the characteristics of a breast cyst?

Answer 5

Smooth-fluid filled sac
Most common in women 35-50yrs
May be hard and painful
Benign

Question 6

What is cyclical mastalgia?

Answer 6

Breast pain that coincides with the period (usually 3 days before)

Question 7

What drugs can cause gynaecomastia?

Answer 7

Cannabis
Oestrogen (used in treatment of prostate cancer)
Spironolactone
Cimetidine
Digoxin

Question 8

What are the risk factors for breast cancer?

Answer 8

↑age
Early menarche
Nulliparity
Late menopause
Prolonged HRT
Postmenopausal obesity

Question 9

What does LH act on?

Answer 9

Leydig cells (testes) - ↑testosterone
Ovary - ↑Oestrogen

Question 10

What does FSH act on?

Answer 10

Gonads
↑Sperm (acts on Sertoli cells)
↑Ova

Question 11

What are first signs of puberty?

Answer 11

↑Size of testes (>4 mls) - Male

Breast Development - Female

Question 12

What is Oxandrolone and what is it used for?

Answer 12

Given to boys to induce puberty & growth, has no compromising effect in final height (non-aromatizable anabolic steroid)

Question 13

What is early puberty?

Answer 13

<8 yrs in Girls

Question 14

What is late puberty?

Answer 14

No testicular development (14 yrs

Absence of breast development >13 yrs or menstruation has not occurred within 3 yrs of breast formation

Question 15

What hormones would be elevated in Adrenache?

Answer 15

Androstenedione & DHEA

Question 16

What hormones are elevated in Gonadarche?

Answer 16

Primarily GnRH (LH, FSH and their subsequent hormones)

Question 17

What is the commonest cause of precocious puberty following a disconcordant pattern?

Answer 17

Congenital Adrenal Hyperplasia (CAH)
↑17 hydroxy progesterone –> testosterone
↓Cortisol

Question 18

What is Thelarche?

Answer 18

Isolated Breast Development

LHRH test = FSH>LH

Question 19

What is McCune Albright Syndrome?

Answer 19

(G protein act) Genetic disorder of bones, skin pigmentation & hormonal problems along with premature puberty
Cafe au lait spots

Question 20

What is given for premature puberty?

Answer 20

GnRHa

Cyprosterone can be given to block the initial LH/FSH surge (peripherally)

Question 21

Why is hypothyroidism associated with premature non-consonant development?

Answer 21

TRH stimulates both TSH & FSH receptors

Question 22

Which hormone secreted by Sertoli cells induces regression of Mullerian ducts in males?

Answer 22

Anti-Mullerian Hormone

Question 23

What are the dominant adrenal hormones involved in puberty?

Answer 23

DHEAS

Testosterone

Question 24

What do hamartomas cause?

Answer 24

Secrete cytokines that promote Gonadotrophin secretion

Central Precocious Puberty

Question 25

What do the mesonephric ducts form?

Answer 25

efferent ductules and epididymis, ductus deferens and ejaculatory duct
seminal vesicles form as an outgrowth of ductus deferens