Part 1 MRCOG > endocrine > Flashcards

endocrine Flashcards

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1
Q

in the adrenal gland, cholesterol is converted to pregnenolone to 17 OH progesterone. What is it then converted into?

A

aldosterone, cortisol and androgens

so even though ACTH is mainly to stimulate cortisol production, it also causes increased aldosterone and androgens

21 hydroxylase and 11 hydroxylase are needed for production of aldosterone and cortisol but NOT androgens

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2
Q

describe pathophysiology of CAH

A

21 (or 11) hydroxylase deficient
so 17 OH progesterone cannot become aldosterone or cortisol (which requires 21 or 11 hydroxylase)
so it all becomes androgens
there’s lots of ACTH made made trying to produce cortisol and aldosterone because there’s no negative feedback
so there is hyperplasia of the adrenal glands from all the ACTH

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3
Q

describe phenotype in CAH

A

virilization of female fetus due to excessive androgens (female pseudohermaphrodism / ambiguous external genitalia) (but they have normal internal female organs)
but in a male, the excess androgens are not a big deal for the external genitalia

also, due to aldosterone deficiency, there is low sodium, high potassium
and low BP from cortisol deficiency

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4
Q

The rate of growth hormone secretion follows a circadian rhythm. When is the highest peak of growth hormone release?

A

early sleep

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5
Q

Is hyper or hypo-thyroidism a cause of hyperprolactinaemia?

A

hypO

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6
Q

is prostaglandin autocrine, endocrine, axocrine, paracrine or eccrine?

A

paracrine
a secretion released by (endocrine) cells into the adjacent cells or surrounding tissue rather than into the bloodstream.

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7
Q

name the 3 types of sex hormone

A

The sex hormones include the androgens, estrogens, and progestogens
(important for when you are asked ‘where are androgens made’. There are some androgens in women, e.g. androstenedione)

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8
Q

What is the purpose of the fetal adrenals producing DHEA

A

The fetus manufactures DHEA, which stimulates the placenta to form estrogen, thus keeping a pregnancy going.

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9
Q

What cancers have Cushings as a paraneoplastic syndrome?

A

Small Cell lung cancer
Pancreatic cancer

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10
Q

What cancers have SIADH as a paraneoplastic syndrome?

A

small cell lung cancer
Brain tumours

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11
Q

which cells make androgens?

A

male - leydig cells (TT, DHEA, androstenedione - in presence of LH)
and sertoli cells?

female - theca cells

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12
Q

describe prostaglandin types and actions in the menstrual cycle

A

PGF2 alpha - vasoconstricts the endometrial vessels during menstruation and contracts the smooth muscle of the myometrium.

PGE2 vasodilates the vessels of the endometrium

PGI2 relaxes smooth muscle, vasodilates the vessels of the myometrium and inhibits thrombocyte aggregation.

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13
Q

(according to given answers) what is the Ig that increases in a term pregnant cervix?

A

IgA

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14
Q

which hormone increases the amount of glucose that is available to the fetus?
How does it do it?

A

hPL
by increasing maternal resistance to insulin
decreasing maternal glucose utilisation
increasing lipolysis (as free fatty acids can’t cross the placenta but can be used by mum as energy)

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15
Q

hPL is a potent agonist at which receptor?

A

prolactin

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16
Q

effect on glucagon of protein-rich meal

A

apparently it increases, according to a bit of google research…

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17
Q

most common cause of ACTH syndrome

A

IATROGENIC STEROIDS

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18
Q

what does inhibin do? What secretes it?

A

inhibin inhibits FSH secretion

granulosa (follicular) cells
and
sertoli cells
and
placenta
and
corpus luteum

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19
Q

PTH function in the kidney is…

A

reduce calcium excretion

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20
Q

the pulsatile release of GnRH is due to…

A

oestrogen (according to the answers given)

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21
Q

where are ADH and oxytocin synthesised?

A

hypothalamus

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22
Q

T4 to T3 ratio

A

14:1

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23
Q

progesterone has how many carbons

A

20

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24
Q

where, other than the hypothalamus, secretes GnRH

A

duodenum

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25
TRH is made in which nucleus of the hypothalamus? And how many copies of TRH are made from its precursor molecule?
paraventricular nucleus 6 copies
26
somatotrophs make up what percentage of anterior pituitary cells? What do they make?
50%, GH
27
lactotrophs make up what percentage of anterior pituitary cells? What do they make?
20%, Prolactin
28
GnRH is from which nucleus of the hypothalamus? What is its embryological origin?
Preoptic. Neural crest.
29
COCP missed pill rules: If you're late restarting the pill after the pill-free week, with or without UPSI
if >48h late and had UPSI in the pill-free time, consider emergency contraception +/- UPT at least 21 days after the UPSI Whether UPSI or not in that interval, use additional barrier contraception until 7 consecutive pills have been taken
30
COCP missed pill rules: in week 1 of pill-taking, missing one pill or week 2 or 3 of pill-taking, missing one pill
week 1, if one missed pill and otherwise sterling compliance to the regime in week 1 and the week before the pill-free interval then it's okay week 2/3, if one missed pill but otherwise sterling compliance in past 7 days then it's okay
31
for COCP missed pill rules, if you forget 1-7 pills in weeks 2 or 3 specifically, what are the rules?
If you took the pills beautifully in the preceding 7 days, then you don't need emergency contraception If you forgot 1 pill, you don't even need additional barrier contraception But if you forgot 2 - 7 pills, you should use additional barrier contraception for 7 days
32
for COCP missed pill rules, if you forget more than 7 consecutive pills, what do you do?
Take a pregnancy test restart the pill additionally use condoms for 7 days take another pregnancy test 21+ days after the last act of UPSI
33
POP missed pill rules for norethisterone, desogestrel and drosperinone, respectively
norethisterone (first generation): if >3h late use condoms for 48h and emergency contraception if you had UPSI in pill-free time desogestrel (third generation): if >12h late use condoms for 48h and emergency contraception if you had UPSI in pill-free time drosperinone (fourth generation): if >24h late use condoms for 7 days and emergency contraception if UPSI in interval + not having taken 7 preceding active pills (drosperinone regime has 4 inactive pills)
34
hPL plateaus after what gestational age?
35 weeks
35
what is dinoprostone
Naturally occurring PGE2
36
HCG peak in pregnancy is at what gestation?
8-11 weeks
37
ADH increases the permeability of which part of the nephron?
Collecting duct
38
what happens to T3 and T4 in pregnancy
total T3 and T4 levels increase but FREE levels of both DECREASE (it rhymes so it must be true) and TSH is lower
39
HRT decreases the risk of which cancer?
colorectal
40
timing of LH surge vs LH peak
LH surge starts 36h pre-ovulation but the PEAK is 10-12h pre-ovulation that's where I've been getting confused
41
How long does it take for a primordial follicle to grow and develop to the ovulatory stage?
approximately 1 year! 300 days for a recruited primordial follicle to complete the whole preantral period 50 days from antrum formation to preovulatory follicle 15 - 20 days for a dominant folicle to grow and develop to the preovulatory stage https://www.glowm.com/section-view/heading/Follicle%20Growth%20and%20Development/item/288
42
When percentage of testosterone is unbound? What is the rest bound to? What gives you low or high SHBG?
1.5% - 3% of testosterone is free in men (1% in women) 70% testosterone bound to SHBG, 25-30% testosterone bound to albumin Low SHBG is from things that make you high androgen (obesity, PCOS) High SHBG is from things that give you oestrogen (anorexia, pregnancy, hyperthyroidism)
43
according to the given answers, what's the ratio of esTRIol to estraDIol at term?
20:1
44
how does mifepristone work
progesterone antagonist
45
Which neurotransmitter is secreted onto the adrenal medulla?
acetylcholine Think of the adrenal medulla as the sympathetic ganglion
46
In the follicular phase, granulosa cells produce aromatase which makes estradiol be formed from androgens from the theca cells what do the granulosa cells do after ovulation?
They turn into granulosa lutein cells and produce progesterone (so do the theca-lutein cells, but to a lesser extent_.
47
what makes angiotensinogen?
liver
48
what makes renin
kidney - juxtaglomerular cells
49
what does renin (from kidney) do?
cleaves angiotensinogen (from liver) into angiotensin 1
50
what does ACE do?
makes angiotensin 1 into the active angiotensin 2
51
fancy name for anterior and posterior pituitary
anterior pituitary = adenohypophysis posterior pituitary = neurohypophysis This reflects their different embryological origins and the makeup of their tissue - adeno being glandular and neuro being nervous
52
what is the embryological structure which develops into the anterior pituitary?
Rathke's pouch (from the oral cavity)
53
what is secreted by the acidophils of the anterior pituitary? (stain dark red)
Growth hormone and Prolactin
54
what is secreted by the basophils of the anterior pituitary? (stain blue)
MSH, ACTH, LH, FSH, TSH
55
what are Herring bodies of the posterior pituitary
dilated nerve terminals where oxytocin and ADH (carried from the hypothalamus) are released
56
are the neurons in the posterior pituitary myelinated or unmyelinated?
unmyelinated
57
what is between the part between the anterior and posterior pituitary
pars intermedia
58
which nuclei of the hypothalamus make ADH and oxytocin
paraventricular and supraoptic
59
does the pituitary dwell inside or outside the dura mater
outside!
60
are the acini of the pancreas endocrine or exocrine
exocrine - they make digestive juices to go down the duct
61
what's the purple fluid inside a thyroid follicle
colloid - this stores thyroglobulin until it's ready to be converted to T4 (thyroxine) and T3 (triiodothyronine)
62
what cells produce HCG to maintain the corpus luteum?
syncytiotrophoblast (hence, HCG is detectable after implantation, i.e. around day 8 for blood test)
63
what does the corpus luteum make and why?
progesterone, to maintain the endometrium and therefore maintain pregnancy
64
which 2 other hormones are structurally similar to prolactin?
hPL and growth hormone
65
which 3 other hormones are structurally similar to TSH?
LH, FSH, HCG
66
what is the most common cause of hyperprolactinaemia?
microprolactinoma
Part 1 MRCOG
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