Revision

Question 1

Pathway for GHRH, CRH/VP

• inhibitory molecule for TSH
• draw out hypothalamus/pituitary diagram

Answer 1

GHRH /somatostatin (-) -> GH –> liver, tissues –> igf-1

CRH/VP –> acth –> adrenal cortex –> cortisol

Somatostatin inhibits TSH

Question 2

Chromophils - acidophils and basophils

Answer 2

Acidophiles - somatotrophs (GH), lactotrophos(PRL) - orange

Basophils - gonadotrophs (LH, FHS) , Thyrotrophs (tsh) , cortiotrophs (acth) - magenta

Question 3

Dating the endometrium

Answer 3

Proliferation stage

• tortuosity
• a bit of odema - when lined up with stromal mitses then in proliferation stage
• lots of stromal mitoses

Secretion phase (early luteal) - tortuous glands, basal vaculation, glandular secretions
(late luteal) - luekocyte infiltration , decidual reaction
-nutropholes - open wound after mestration - so need lots of them

Question 4

Sequence of sperm getting to vagina, until fertilisation , implantation, nidation

Answer 4

Coagulation
Liquefication
Vagina pH, mucous
Capacitation
Acrosomal reaction (increase calcium into cell, zona pellucida - stimulated by progesterone and zona pelluicda )
Sperm penetration - hyaluronidase - digests basemenet membrane sperm can get through cumulus cells, corona radiata, zone pellucida
Oolemmal membrane - fuse
Cortical reaction  
Implantation
Nidation

Question 5

Positive and negative feedback for PTH

Answer 5

Regulated - serum calcium (negative feedback)

• serum phosphate (positive)
• vit D (negative)

Question 6

Name of plugs in spiral arteries

Answer 6

endovascular trophoblastic plugs

Question 7

Function Amniotic fluid

Answer 7

• buoyant - allows symmetric growth
• cushions the embryo/fetus
• Prevents adhesion of fetus with membranes
• allows fetus to move
• develop GI/ resp tracts - breathign and swallowing

Question 8

What can you tell with amniotic fluid?

Answer 8

Polyhydramnios - excessive amniotic fluid - due to loss of swallowing - often found in diabetic pregnancy

Oligohydramnios - lack of amniotic fluid - potentially due to kidney problems

Also can screen karotype for fetus to see if it is born normal

Question 9

Placental arteries and viens

Answer 9

Arteires - carry deoxygenated blood from baby to mother

Viens - carry oxygenated blood from mother to fetus

Question 10

Management of PCOS

Answer 10

lose weight, can get ovulation

• medicaiton to induce ovulation, clomiphene citrate
• surgery - to induce ovulation, remove androgen producing tissue
• metformin - for insulin resistance e

Question 11

Premature ovarian insufficiencey

Answer 11

• will see how oestrogen and high fsh - this is because not enough oetrogen is being produced by the ovaries, and so the reduced negative feedback will stimulate more fsh to try and get oestrogen made
• less frequent menstruation and eventually ovulation stops
• need counselling, and fertility specialist

Question 12

Activation of myometrium

Answer 12

Activation of myometrium

• increase CAPs - gap junctions (not many in quiesence)
• more power to activate muscle

** -prostaglandin and oxytocin receptors

Question 13

Oxytocin

Answer 13

Not essential for initiation of labour

• requires gap junctions to be effective
• used to induce and augment labour
• primary prevention of post partum hemmorage (causes uterus to contract after baby is born)

Question 14

1st stage of labour

Answer 14

1st stage - until full dilation

• muscle contractions
• cervical effacement and dilation
• descent of presenting part
• rupture of membrane

Question 15

What needs to be acheived to placenta and mother when baby is born?

Answer 15

-involution - placental separation, cleavage through decidua basalis, contractions to prevent postpartum haemorrhage, increased uterine sensitivity to oxytocin

Question 16

Fetal fibronectin

Answer 16

high molecularweight glycoprotein
Present in cervico vaginal fluids in first trimester
-is stuck
-seen in many females who have preterm birth

negative predictive value - want to know this

Question 17

How to improve outcomes?

Answer 17

• Risk selection history taking
• stop smoking
• assess maternal health risks
• cervical length most powerful predictor
• use progesterone for short cervix
• confirm risk in threatened PTL - use steroids, magSO4 if delivery like

Question 18

congenital adrenal hyperplasia

Answer 18

cant make cortisol so make lots of male hormones instead

Question 19

Virilised (masculinaised) girl

cause

Answer 19

• Have ovaries
• Normal female internal genitalia (uterus)
• Karyotype - XX

-exposed to male hormone before birth (think where has this come from)

• fetal - congongenital adrenal hyperplasia - hard to make cortisol so make lots of male hormone instead
• Maternal - ingestion of male hormones - oral contraceptives, PCOS, andorgen secreting tumours

Question 20

Undervirilised Male

Answer 20

Have testis, no internal female genitalia, karyotype XY
-Implies lack of angrogen or resistant to its effects

• Fetal - LH receptor mutation (usually complete female - no breast development)
• Androgen receptor mutation

Normal formed phallus - hypothalamic - damage lH to make testosterone

Question 21

No testis and is XY, what could this be from?

Answer 21

a problem early on up (before gonadal differentiation)

Question 22

What can cause crushing syndrome?

Answer 22

Cause - primary functional adrenal tumour

• ACTH secreting tumour
• exogenous glucocoritcoid

Question 23

ACTH receptor loss of function mutation

Answer 23

low cortisol levels

• adrenal gland does not develop properly
• no cortisol and androgen formation
• same signs as glucocorticoid deficiencey

Question 24

Defect in cortisol synthesis

from early age

Answer 24

-low cortisol levels lead to high acth levels, which stimulates the adrenal cortex excess production of adrenal precursor and adnreal hyperplasia

not able to convert coritsol so it forms different androgens and makes more testosteroen and causes the virilisation in tehse girls

Question 25

Young boy, normal sized testis but large penis, growing very fast , high BP, high sodium, and low K, very dark

Answer 25

Dark skin - primary problem with acth - small testis - know that androgens did not come from testis - sex steroids - either form gonads or adrenlas - must be adrenals - congenital adrenal hyperpalsia or fucntional adrenal neoplasm - - more likely to be block in an enzyme makign coritsol because is dark and making msh - can make another androgen that cna bind to mineralcortiocid receptor - so get low renin and aldoesterone - lack of cortisol drives this to make increases levels of this hormone management - suppress acth - give glucocorticoids - bone age - advanced - turn of the outside hormones, turn off your own puberty - treat hypertension

Question 26

what would cause low levels of oestrogen in utero?

Answer 26

Ancephalic pregnancies - adrenals usually atrophic, have low levels because cannot convert progestrogen to androgens

Question 27

Pre eclampsia

Answer 27

- elevated maternal blood pressure w protein in urine - more common for first pregnancies - triggered by placenta (e.g toxin) - is an exaggerated inflammatory response leading to vascular dysfunction - failure of normal vascular adaptation to pregnancy - loss of normal maternal peripheral vascular resistance

Question 28

Emergency contraceptive pill

Answer 28

- levonorgestrel - take within 72 hours of unprotected sex - no effect if given after ovulation - good efficacy - doesn't work if large BMI

Question 29

Development of breast during pregnancy

Answer 29

- oestrogen - essential for breast growth - progesterone - induces side branching of ducts, but also prevents milk production (is a smooth muscle relaxant) - prolcatin - necessary for alveolar developments but also stimulates caesin and lacta albumin mRNAS - Insulin and cortisol - stimulate alveolar epithelial cell division -way more alveolar form for pregnancy , and ductile system grows

Question 30

Graves disease

Answer 30

causes thyrotoxicosis - and is when there is an autoimmune reaction to tsh receptor - overstimualtes it causes too much thryoid homrone

Question 31

thyroid hormone resistance syndrome

Answer 31

receptor mutations lead to pituitary insensitivity to T3, so tsh rises and causes rise in t4 and t3. -patient can presnet with hypo or hyperhtyroid features in different tissus and may have goiter

Question 32

Thyroditiis

Answer 32

- inflammation of thryoid gland (pre formed thyroid homrone is dumped from lumen with thryoglobulin) - patient presents as thyrotoxic, then has a hypothyoid phase and usually recovers - ciruclating thyroglobulin is increased and serves as a tumour maker

Question 33

* Main causes of hypercalcemia

Answer 33

PTH dependent - primary hyperparathyroidism PTH independent - Cancer e.g PTHrP * ** -Vit D intoxication

Question 34

Hyperphosphatemia

Answer 34

- Advanced renal failure, ability to secrete phosphate is reduced - hypoparathyoridism - PTH resistance

Question 35

Hypophosphatemia

Answer 35

vit D deficiencey - elderly - resp alkalosis (Drives phosphate into cells) - renal loss -increased PTH

Question 36

Phosphatonins

Answer 36

-comes from bone PHEX inhibits this FGF23 - derived from bone -decreases kidney and gut absorption of phosphate to cause hypophosphatemia Can get aquired and genetic problems - abnormality in transport across gut (hypophosphatemia)

Question 37

* Cause of hypocalcemia

Answer 37

Hypoparathyoridsm -surgery to neck, genetic (mutation in genes) Parathyroid hormone resistance - doesn't work, so cannot get increase in calcium Abnormality in vit D metabolism

Question 38

Autosomal dominant hypercalciuric hypocaclcemia

Answer 38

Activation of calcium sensitive receptor - Parathyroids read plasma ionised calcium level as being higher than it really is - will switch off processes that drive absorption and reabsorption of urine -if this receptor doesnt work then patients look like they have mild parathyrodism - no treatment if asymptomatic - can give vit D

Question 39

Immune system change in pregnancy

Answer 39

- Immune reaction to sperm when they enter the vagina - however repeated exposure may dapen the immune response and be beneficial to pre eclampsia - White cell count increases due to increase in neutrophil population, which commences in the luteal phase of the cycle and doesn't drop in pregnancy - neutrophils are important for preparing the cervix for labour -more th2 than th1 - drive immune system towards antibody mediated response Contains many NK cells - act by antibody dependent cell mediated cytotoxity