Human development Flashcards by Louis Woodward

Give two features of passive first stage of birth

Irregular painful contractions (braxton hicks?)

Some cervical dilation (up to 4cm)

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Give three features of Active first stage of labour

Cervix dilated 4cm
Painful regular contraction
cervix dilates 0.5 cm per hour

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Give main feature of passive second stage of labour

Full cervix dilation (10cm)

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Give two features of active second stage of labour

Expulsive contraction/ uncontrollable urge to push

Baby visible

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What are the three components of the combined test for trisomies

Nuchal translucency
beta-hCG (only T21 has raised )
PAPP-A

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What are the combined screening test results for T21

high nuchal
high b hCG
low PAPP -A

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What are the combined screening test results for T13 and T18?

High nuchal
Low beta hCG
Low PAPP-A

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Give four puberty milestones in the order they appear for girls

Thelarchy (breasts) age 10ish
Growth spurt
Pubarchy (pubic hair)
Menarchy

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Give four puberty milestones for boys in the order they appear

increase in teseticular volume (3ml to 4ml) Age 11 and a half ish

pubarchy

growth spurt

sperm, facial hair, strength spurt

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How to differentiate True central precocious puberty from periferal precocious puberty?

True central follows normal order of developmental milestones and is sex appropraite. Periferal does neither

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What is the cut off for precocious puberty?

8 for girls

9 for boys

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Give 7 causes of periferal precocious puberty

Ovarian cysts/tumors
Sertoli/leydig tumors
Germ cell tumors (hCG secreating upregulates LH receptor on leydig cells ) - boys only
familial testotoxicosis (boys)
Hypothyroidism (TSH has similar structure to FSH)
Adrenal tumor
Exogenous sex steroid

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Give 8 non endocrine adaptations in pregnancy

Increased blood volume (may cause innocent systolic murmur)
Increased cardiac output/ stroke volume
Hypotension (due to vasodilation)
Increased tidal volume
Respiratory alkalosis
Decreased heamatocrit (aneamia risk)
Decreased gut motility
Increased kidney size (due to increased GFR)

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Apart from asking about regular cycle, what test can be done to assess ovulation and when is it performed?

Midluteal progesterone (do at days 23-28, 7 days before period)

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What three tests can be used to assess tubule patency/

Dye + laproscopy
Hysterosaplingiogram HSG (Dye + Xray)
Hysterocontrast sonography (HyCoSy) - (Dye and Ultrasound)

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Give three tests used to assess Ovarian reserve (and their findings)

Early follicular FSH (high = low OR)
Antral follicular count (visually count how many follicles released per cycle)
Anti Mullerian hormone (AMH) - High = high OR)

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How do you diagnose PCOS?

Hirsutism

Failed midluteal progesterone test (shows anovulation)

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what drug can be used to induce ovulation in PCOS patients?

Clomiphene citrate

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Give 4 treatments to induce ovulation in PCOS patients (in order of indication)

Weight loss (may add metformin)
Clomiphene citrate
gonadotrophins
Laproscopic ovarian drilling

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Give 5 symtoms of hyperprolactinaemia in women

Anovulatory infertility
amenhorrea
gallactorea
decreased libido
vaginal driness

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Give four symptoms of hyperprolactinaemia in men

Gyneacomastia
Galactorea
decreased libido
erectile dysfunction

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Give two drugs used to treat hyperprolacinaemia

bromocriptine

Carbogaline (both D2 agonists)

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What three hormones are in HRT?

Oestrogen
Progesterone (protects endometrium)
Testosterone (increase energy and libido)

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Give four treatments to manage post menopausal symptoms

HRT
Clonidine (alpha 2 agonist to stop flushes)
SSRI
Vaginal lubricants

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Which is the FSH level above which permature ovarian insufficiency is diagnosed?

What three criteria used to disgnose premature ovarian insufficiency?

4 months amenhorrea FSH >30 <40 yro

Where does the UK-WHO Growth Chart data come from?

WHO worldwide data

Give six situations where a specialist growth chart is needed

``` Head Growth deformity V preterm (<32w) Downs Turners noonans Achondroplasia ```

Define short stature

>2.5 SD below mean

Give two definitions of decreased growth velocity

<4cm per year in mid childhood | <25th centile for velocity for >12 months

Define faltering growth

drops 2 lines on the centile thing on the growth chart in 12 months

Give 6 indications for Gh therapy in children w short stature

``` GH deficency Turners Prader-Willi Short for gestational age and poor catch up (<10th percentile and no catch up by age 2) chronic renal failiue SHOX deficiency ```

what is the mean weight gain in pregnancy?

13kg

What is mean bloop volume increase in pregnancy?

1.5l

Give 4 ABG changes in pregnancy

``` increased pH (7.35/7.45 - 7.40/7.47) Decreased paCO2 (35/40 - <30) Increased paO2 (90/100 - 100/104) Decreased HCO3- (20/28 - 18/22) ```

exclusing oestrogen and progesterone, give 8 hormonal changes in pregnancy

``` LH/FSH (undetectable) GH rise ACTH rise Renin/aldosterone rise prolactin rise thyroxine rise cortisol rise parathyroid hormone rise ```

How much folate do you give to low and high risk mothers?

``` lowrisk (400micrograms daily) High risk (BMI<30, Fx of neural tube defect, diabetes) -5 milligrams daily ```

Give three actions of increased oestrogen levels in pregnancy?

vasodilation RAS stimulation Anti-insulin

Give four actions of raised progesterone in pregnancy

Maintains endometrium induced over breathing substrate for the increase in gluco/mineralocorticoids Supressed immune response against fetus

Give two actions of raised hCG in pregnancy

Maintains corpus luteum (until placental takes over progesterone production) Stimulatess TSH receptors - increases metabolic rate

Give three actions of hPL in pregnancy

anti insulin Boosts lipolysis angiogenic for fetal vasculature.

Decribe patterns of hCG and hPL in pregnancy

hCG rises then falls off after 10 weeks | hPL continues to rise through pregnancy

What action does cortisol have on developing fetus?

Stimulates surfactant production

How do you treat cushings?

Somatostatin analougue | Dopamine receptor agonist (Carbogaline, bromocriptine)

Give 6 symptoms of cushings

``` weight gain lethargy acne gonadal dysfunction Buffalo hump Stretch marks ```

How do you treat acromelagy?

``` transphenoidal Surgury Somatostatin analougue (octreotide, Lanreotide) ```

Give 6 symptoms of acromelagy?

``` Change in facial features snoring amenhorrea lowered libido headache sweating ```

Give four symptoms of addisons disease (adrenal insufficiency)

hyperpigmentation hypotension weightloss weakness

Give two somatostatin analouges

Octreotide, Lanreotide

Give 4 treatments for thyrotoxicosis (2 beinng drugs)

Carbimazole Propyl Thiouracil Radioiodine Surgury

Hashimotos thyroiditis involves autoantibodies against what 2 substances

Thyroid peroxidase | Thyroglobulim

Give two symptoms that are exclusive to graves disease (and not other causes of thyrooxicosis)

``` Bulging eyes (exophthalmos) Pretibeal myxodema ```

Give 6 causes of gyneacomastia

``` Liver failiure Psysiological - puberty Androgen deficiency (eg. Klinefelters) Hyperthyroid Testicular failiure / cancer Spirolactonone (most common drug causes) ```

Give 5 symptoms of hyperprolactineamia

``` Infertility Irregular periods/amenhorrea Galactorea Gyneacomastia impotence ```

Give 2 drugs used to treat hyperprolactinaemia

Carbergoline | Bromocriptine

Give three hormones that dopamine inhibits

Prolactin GH ACTH

Give 5 symptoms of addisons disease

``` Low BP (esp orthostatic) Hyperpigmentation Weightloss Loss of armpit hair D + V ```

Give 2 acute managements for addisons disease

IV fluid resus | IV hydrocortisone

Give two long term treatments for addisons

Mineralocorticoid + glucocorticoid replacement

Give two investiations for Addisons

``` Blood cortisols (will be low) Blood ACTH (will be high) ```

Does the choryon sit inside out outside the amnion

outside

What type of twinning occurs if cleavage occurs between days 6-8

Monochorionic, diamniotic

What type of twinning occurs if cleaveage occurs after day 8 (but before embryogenesis)

monochorionic, monoamniotic

What type of twinning occurs if cleaveage occurs before implantation of the blastocyst

Dichorionic

What is the most common type of monozygotic twinning?

Monochorionic, diamniotic

What are the features of 46XX testicular DSD

Male, small testis, gyneacomastia, infertiity

What are the features of 46XX gonadal dysgenesis

Female, femae genitalia, amerhorrea

What are the features of congenital adrenal hyperplasia

Female with ovaries and mullarian ducts as normal but may have virilisation at birth, may have salt wasting

What is a severe complication of fetal adrenal hyperplasia

salt wasting

Give four presentations of androgen insensitivity syndrome

Short vagina undecended testis (inguinal lumps) amenhorrea infertility

What is the structure of the genitalia in androgen insensitivity syndrome

Female external | Complete lack of internal genitalia (short vagina)

How does 46XY complete gonadal dysgenesis present

female int and ext genitalia | amenhorrea

What is the presentation of 5 alpha reductase deficeincy

Male internal genitalia w female external | Virilisation at puberty due to androgen boost

Give 3 features of hydatiform mole presentation

Exagurated pregnancy symptoms v high hCG bleeding in first or second trimester

Give 2 features of placenta preavia

Painless bleeding | non tender uterus

Give 4 symptoms/signs of placental abruption

Constant painful abdomen more shocked than expected for volume of blood loss Hard tender uterus Fetal heart disstressed

What is Sjogrens syndrome?

Autoimmune destruction of exocrine glands. results in dry mucosal membrane/ eyes ect. Assocaited w many conditions eg. RA, coeliac, SLE and hashimoto thyroiditis

Give 2 features of preeclampsia

``` New onset HTN Kidney problems (proteinuria, raised creatinine) ```

What symptoms would make you suspect HELLP syndrome from preeclampsia

jaundice

Give 4 symptoms/signs of addisons disease

Hyperpigmentation Hypotension Weightloss weakess

Give 4 managements of addisons disease

fluid/Na replacement IV hydrocortisone Hydrocortisone and aldosterone replacement Must give IV hydrocortisone before surgury

Give 3 symptoms of hyperprolactinaemia

amenhorrea infertility galactorea

What is the mechanism of primary hypothyroidism

decreased production at level of throid gland

Give two drugs to treat hyperthyroidism (apart from radioiodine)

Propylthiouracil | Carbimazole

what is the most common causes of primary (<24 hours after) post partum heamhorrage?

Uterine atony (doesnt contract to seal the spiral arteries)

give one pro and one con of Chorionicvillus sampling over amniocentisis?

Can be done earlier (11w compared to 16w) | Higher chance of miscarriage

When are the 2 fetal anomolie scans done

12w and 20w

When is chorionic villus sampling done?

11w

When is amniocentisis done?

16w

When does a fetus start to produce its own insulin?

9-11 weeks

Human development Flashcards

(90 cards)