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Basic science Flashcards

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1
Q

What is the definition of puberty

A

Onset of sexual maturity marked by development of secondary sexual characteristics

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2
Q

What is precocious puberty

A

Early onset puberty. Onset before age 8 in girls and before age 9 in boys

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3
Q

How is delayed puberty classified

A

Girls: absence of breast development by age 13 or absence of menarche by age 16
Boys: absence of testicular enlargement by age 14

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4
Q

Describe the female reproductive axis

A

Hypothalamus releases gonadotrophin releasing hormone which stimulates the anterior pituitary to release LH and FSH. LH and FSH stimulate the ovaries to produce oestrogen and progesterone. These hormones then feed back to the hypothalamus and pituitary to control the release of GnRH and LH/FSH.

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5
Q

Describe the male reproductive axis

A

Hypothalamus releases gonadotrophin releasing hormone which stimulates the anterior pituitary to release LH and FSH. LH and FSH stimulate the testes to produce testosterone which feeds back to the hypothalamus and pituitary to control further production.

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6
Q

What is the first physical change in puberty (girls/boys)

A

Girls - breast development

Boys - testicular enlargement

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7
Q

5 physical changes in puberty specific to boys

A

testicular enlargement, ejaculation (nocturnal), widened shoulders, facial and body hair, deepening of voice (enlargement of larynx and laryngeal muscles)

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8
Q

3 physical changes in puberty specific to girls

A

breast development, widened hips, menarche

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9
Q

3 physical changes in puberty which happen in both genders

A

growth spurt (females = 26cm most age 9-10, males = 28cm most age 11-12), pubic hair development, body fat changes

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10
Q

3 biochemical changes in puberty

A
  1. blood lipids (males = higher LDL and lower HDL)
  2. haematological indices (Hb rises in boys and falls in girls)
  3. maturation of P450 enzymes
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11
Q

Which staging system is used to assess pubertal development

A

Tanner stages

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12
Q

Difference between primary and secondary amenorrhoea

A 
Primary = no menarche before age 16. If  no secondary sexual characteristics then consider hormonal issue, if 2 sexual characteristics are present consider an outflow obstruction.
Secondary = normal cycle previously developed then absence of menstruation for >6 months (think athletes, low BMI, ED)
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13
Q

Non-pathological causes of primary and secondary amenorrhoea

A

Primary - constitutional delay, drugs

Secondary - pregnancy, lactation, menopause, drugs

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14
Q

Pathological causes of both primary and secondary amenorrhoea

A

Anorexia nervosa, psychological, athleticism, hyperprolactinaemia, hypo/hyperthyroidism, adrenal tumours, PCOS, premature ovarian failure

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15
Q

Pathological causes of primary amenorrhoea only

A

Adrenal hyperplasia, Turner’s syndrome, androgen insensitivity, imperforate hymen, transverse vaginal septum

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16
Q

Pathological causes of secondary amenorrhoea only

A

Asherman’s syndrome (adhesions in uterine cavity), cervical stenosis

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17
Q

Which investigations should you do for amenorrhoea

A

Prolactin, TFTs, FSH, androgens, USS ovaries, pregnancy test

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18
Q

Describe the structure of an ovarian follicle

A

Granulosa cells inside, have receptors for FSH
Theca cells outside, have receptors for LH
Contains an oocyte inside

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19
Q

What are the 3 main stages of the menstrual cycle

A 
Follicular phase (day 1 to 15)
Ovulation (day 14)
Luteal phase (day 15-28)
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20
Q

Main features of the follicular phase of menstrual cycle

A

Menstruation (day 1-5), shedding of endometrial lining and fall in progesterone due to loss of corpus luteum
Rapidly growing follicles in the ovaries
Dominant follicle selected (day 5-7) and produces oestrogen which prevents selection of other follicles

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21
Q

Main features of ovulation

A

LH surge causes release of the egg from the dominant follicle
Thickening of the endometrium
High levels of oestrogen and progesterone

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22
Q

Main features of luteal phase of menstrual cycle

A

Endometrial lining continues to thicken to prepare for menstruation
Corpus luteum forms from empty follicle
Hormones begin to decrease again

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23
Q

What is the corpus luteum

A

Formed from the leftover follicle after an egg has matured and left the follicle (ovulation)
In the ovaries

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24
Q

A surge in which hormone causes egg release

A

LH

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25
What is menorrhagia
Heavy bleeding in normal cycle
26
What is dysmenorrhoea
Painful bleeding in normal cycle
27
What is oligomenorrhoea
Irregular bleeding/cycle
28
6 structural issues that may cause menorrhagia
Fibroids, polyps, endometriosis, endometrial hyperplasia, endometrial carcinoma, adenomyosis
29
What is adenomyosis
Endometrial lining invades into myometrium causing bleeding
30
What is DUB
Dysfunctional uterine bleeding, diagnosis of exclusion when no other cause of menorrhagia is present
31
7 medical methods for managing menorrhagia
Mirena coil, TXA, mefenamic acid, COC, norethisterone (progesterone), Depo-Provera, GnRH analogues
32
4 surgical methods for managing menorrhagia
Endometrial ablation, uterine artery embolisation, hysteroscopic myomectomy, hysterectomy
33
Vaginal causes of IMB/PCB/PMB
Trauma, vaginitis, vaginal/vulval cancer
34
Cervical causes of IMB/PCB/PMB
Cervicitis (STI), polyps, ectropion, cancer, cervical intrahelical neoplasia (CIN)
35
Uterine causes of IMB/PCB/PMB
Endometritis, fibroids, polyps, adenomyosis, cancer
36
Iatrogenic causes of IMB/PCB/PMB
Contraception, tamoxifen, anticoagulants, gynaecological procedures
37
How is infertility classified
Failure to conceive after two years of regular unprotected sexual intercourse with no contraception
38
What is primary infertility
Couple has never conceived at any stage
39
What is secondary infertility
Couples who have previously conceived (pregnancy may not have been successful)
40
3 categories of female factor infertility
1. ovarian factor (anovulation) 2. tubal factor 3, uterine/structural factor
41
3 groups of ovarian factor infertility
Group 1: hypothalamic-pituitary failure Group 2: hypothalamic-pituitary-ovarian dysfunction Group 3: ovarian failure
42
Examples of hypothalamic-pituitary failure
``` Anorexia Stress Hypogonadotrophic hypogonadism Hypopituitarism Hyperprolactinaemia ```
43
Examples of hypothalamic-pituitary-ovarian dysfunction
PCOS
44
Examples of ovarian failure
Premature Menopause Turner's syndrome
45
Main investigation for ovarian factor infertility
Need to check is woman is ovulating Mid-luteal progesterone level taken 7 days before expected menses >30nmol/L = proof of ovulation
46
Other investigations for ovarian factor infertility
Serum FSH, LH, oestradiol (day 2-6) TSH Prolactin Testosterone and SHBG
47
Raised FSH and LH in ovarian factor infertility
Ovarian failure
48
Low FSH and LH in ovarian factor infertility
Hypopituitarism | Hypogonadotrophic hypogonadism
49
Examples of tubal factor infertility
``` Hydrosalpinx (blockage of fallopian tube leading to accumulation of clear fluid) due to PID, HIV etc. Tubal occlusion (e.g. via hydrosalpinx) Tubal dysfunction ```
50
Investigation for tubal factor infertility
Hysterosalpingogram
51
Examples of uterine/structural factor infertility
Uterine: endometriosis, uterine malformation, fibroids, asherman's syndrome Cervical: cervical stenosis, non-receptive cervical mucus Vaginal factor: vaginismus
52
Investigation for uterine/structural factor infertility
Ultrasound
53
3 main categories of male factor infertility
Pre-testicular Testicular Post-testicular
54
Pre-testicular causes of male factor infertility
Smoking Drugs decreasing FSH e.g. phenytoin Secondary hypogonadism: hypothalamic or hypopituitarism
55
Hypothalamic causes of pre-testicular male factor infertility
Obesity | Kallmann syndrome
56
Hypopituitarism causes of pre-testicular male factor infertility
``` Adenoma Brain tumours Infection Inflammation (autoimmune) Radiation Congenital ```
57
Testicular causes of male factor infertility
``` Testicular cancer Trauma Radiotherapy Drugs decreasing sperm mobility e.g. sulfasalazine Genetic factors Primary hypogonadism ```
58
Post-testicular causes of male factor infertility
``` Obstruction of vas deferens CAVD (congenital absence of vas deferens) Prostatitis Ejaculatory duct obstruction Retrograde ejaculation Impotence ```
59
Main investigation for male factor infertility
Semen analysis
60
What is azoospermia
Total absence of sperm
61
What is oligozoospermia
Too few sperm within ejaculate
62
What is teratozoospermia
Abnormal sperm morphology
63
What is asthenzoospermia
Reduced sperm motility
64
Other investigations for male factor infertility
``` Endocrine tests Cystic fibrosis screening Karyotype and chromosome studies Genital tract infections Imaging of genital tract ```
65
Mechanism of action of clomifene
Selective oestrogen receptor modulator Inhibits oestrogen receptors in the hypothalamus, inhibiting negative feedback therefore LH/FSH are continually synthesized and released Promotes ovulation
66
What is the regime for clomifene
Prescribed on day 3 of menstrual cycle and continued for 5 days Ovulation should occur 6-7 days after course of clomifene
67
What is AMH
Anti-mullerian hormone | Produced by granulosa cells in small ovarian follicles - measure of ovarian reserve
68
4 causes of high serum hCG
1. multiple pregnancy 2. molar pregnancy 3. hCG-producing tumour e.g. germ-cell tumour 4. Down's syndrome/genetic abnormality
69
2 causes of low serum hCG
1. early stage of pregnancy | 2. plateauing +/- falling hCG indicates pregnancy which is no longer viable (confirm with USS)
70
3 causes of false-positive urinary pregnancy tests
1. hCG producing tumour (germ cell) 2. use of fertility medication 3. use of chlorprozamine or methadone
71
causes of false-negative urinary pregnancy test
1. use of diuretics or promethazine | 2. not testing first urination of the morning

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