Obstetrics 1

  1. What is the type of endometrium made by estrogen and progesterone?
    • Estrogen – Proliferative change – UNSTABLE endometrium - causes irregular unpredictable bleeding if there is only estrogen
    • Progesterone - Secretory change - STABLE endometrium
  2. How can you subcatagorise the    Proliferative phase (Follicular phase) ?
    A. First half - recruitment of many follicles - rise of FSH – estradiol level  constant -   depends on number of follicles – if there are larger  number of follicles,  this  phase is longer, and if there are few follicles as in onset of menopause, the phase is shorter

    B. Second half - Growth of one follicle predominates – FSH level falls - even the level of FSH falls, there is increase in secretion of estradiol because of increase  in number of receptors of FSH on dominant follicle 

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  3. How can you subcatagorise the    Secretory  phase (Luteal phase) ?
    A. First half  - progesterone level raised 

    • B. Second half – if no hCG 7 days after ovulation, corpus luteum regresses and  progesterone level falls -  apoptosis of endometrial cells. [AIIMS 03] 
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  4. Which phase of menstruation is always constant?
    • Luteal phase  always constant is 14 days.
    • It is because the corpus luteum persists for 14 days if ovum is not fertilized.  [PGI 00]
  5. If a woman has 21-23 days cycle, then her ovulation will be at ...th day of menstruation. [IOM 12]

    A) 7-9 days
  6. A woman comes with menstrual cycle of 24 days. When did ovulation occur?
    Ovualtion day = menstruation cycle-14 =  ovulation on 10th day
  7. Which cells  produce androgens and estrogens in female reproductive system?
    • Theca cells -  androgens 
    • Granulosa cells – estrogen   

    [@ GrEAT-  Granulosa cells secrete Estrogens, Androgens by Theca cells]

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  8. Ovarian follicles stimulated by [IOM 10]

    C) FSH
  9. Why estrogen cannot be produced in adrenals?
    • Although estrogens are produced from androgens, it cannot be  produced in adrenals. 
    • It is because adrenals do not have aromatase  enzyme.
    • This enzyme is responsible for production of estrogens from androgens in granulosa cells.
  10. What is the effect of estrogen on LH, is it positive or negative feedback?
    Estrogen has both positive and negative feedback on LH. Until  the certain level, estrogen has negative feedback to the secretion of LH. Once certain level is reached, the negative feedback is switched to positive feedback resulting in more secretion of LH. This increased secretion of LH causes increased secretion of estrogen and this cycle continues to cause LH  and FSH surge.
  11. Ovulation is caused by [IOM 08]

    B) LH surge

    LH surge is primarily caused by 'Positive feedback' from sustained high levels of estrogen. [AI 12]
  12. What is the major product of  corpus luteum?

    It cannot make estrogen because the  granulose cells are ruptured after ovulation.
  13. What  is the effect of progesterone on cervical mucus and body temperature?
    • Progesterone makes cervical mucous thick  and increases the body temperature [AIIMS 03]  by 0.5-1.0 F.
    • Progesterone also increases the appetite.
  14. What is the best initial therapy for decreased appetite in cachectic patient in cancer?
    • Medroxyprogesterone
    • Progesterone  stimulates apetite.
  15. From which part is vaginal cytology taken for detecting hormonal changes? [AIIMS 94]
    Lateral wall of upper third of the vagina.
  16. What is the difference in cervical mucus  in preovulatory and  postovulatory period?
    • Preovulatory mucus is of fern pattern.
    • Estrogen is responsible for fern pattern of cervical mucus. [AI 96,AIIMS 98,UP 93,IOM 02]
    • When high level of estrogen are present, just before ovulation, the cervical mucus forms fern like patterns due to crystallization of sodium chloride on mucus fibers. 
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    Post ovulatory, there is loss of fern pattern and cervical mucus is thick and sticky.
  17. What is spinnbarkeit?
    • Spinnbarkeit = spinnability, fibrosity
    • The term Spinnbarkeit  is used especially with reference to cervical mucus at the time just prior to or during ovulation, and to sputum, particularly in cases of cystic fibrosis.
    • Under the influence of estrogens, cervical mucus becomes abundant, clear, elastic and stretchable, somewhat like egg white. The stretchability of the mucus is described by its spinnbarkeit. [AIIMS 95] Only such mucus appears to be able to be penetrated by sperm. After ovulation, the character of cervical mucus changes, and under the influence of progesterone it becomes thick, scant and tacky. Sperm typically cannot penetrate it.
  18. How can you find the when female will ovulate by  urine examination?
    • The amount of sex steroids excreted in urine can be used to monitor the menstrual cycle:
    • Low progesterone and low but slowly  rising estrogen metabolites – early follicular phase 
    • Low progesterone and rapidly rising estrogen metabolite – latter part of follicular phase just before ovulation
    • Elevated progesterone metabolites – luteal phase and pregnancy. In early luteal phase, the progesterone is rising and in later half, it is falling.
  19. Which of the following methods for assessemnt of femal fertility during the menstrual cycle can best predict the timing of ovulation? [AI 10]

    C) Hormonal study

    • The best method of assessment of female fertility that allows accurate prediction of ovulation is the measurement of urinary surge (Hormonal test).
    • Ovulation predictor kits (LH kits) are non invasive and widely available, require relatively little time and effort.
    • Their greatest advantage over other methods is the ability to accurately predict when ovulation will occur.
  20. What mediates increase in basal body temperature during ovulation?
    • Biphasic change in basal body temperature are typical of the ovulatory cycle and are mediated by alterations in progesterone [UP 01] level.
    • An increase in basal body temperature by 0.3-0.5oC begins after ovulation, persists during the luteal phase, and returns to the normal baseline after the onset of subsequent menses.
  21. Why is there amenorrhea in eating disorders?
    When body fat falls below certain level, there is amenorrhea because that critical time  of starvation is not good for pregnancy and body shuts off the menstruation cycle to prevent pregnancy.  Same is the reason for amenorrhea in some female athletes.
  22. Why  is there  amenorrhea in hypothyroidism?
    In hypothyroidism, there is excess TRH  and this TRH stimulates  release of prolactin.
  23. What is Hirsutism and  Virilization?
    • These both are because of excess adrenal androgens. 
    • Hirsutism  -  male pattern hair growth. 
    • Virilization - voice change, Cliteromegaly(only if there is excess androgens in prepubertal stage), increased muscle bulk, breast atrophy.
  24. What are the drugs used in Hirsutism?
    • Dexamethasone inhibits ACTH and decreases production of  adrenal androgens. 
    • Spironolactone – antiandrogenic effect
  25. On which day after fertilization does implantation occurs? When is hCG produced?
    • After 5-7 days of fertilization implantation occurs.[PGI 94]
    • Implantation occurs in day 20 and hCG production occurs after day 25.
    • Corpus luteum has the life of only 14 days, and hCG should rescue the coupus luteum before its expiry in day 28.  
    • Ovulation occurs on day 14, fertilization on day 15. There are 5 more days to implant on day 20, 5 more extra days to save corpus luteum on day 25 by releasing hCG form trophoblast.
  26. Which is the most sensitive test for assessing β-hCG in maternal serum?
    The most sensitive test is a radioimmune assay (RIA) [AI 11] for hCG which can detect serum levels as low as 2-4 mU/ml and as early as one day after implantation.
  27. Corpus luteum secretes progesterone of pregnancy till end of [IOM 12]

    D) 4 month

    • hCG is secreted by syncytiotrophoblast into the maternal blood to help corpus luteum for progesterone secretion during the early stages of pregnancy.
    • By week 13, the placenta itself produces enough progesterone to support pregnancy. So, corpus luteum srcretes progesterone till 13 weeks. After that, we can physiologically remove ovary in pregnant woman.
  28. During  pregnancy,  when there is need of more and more estrogen and progesterone,  how can the fetus help the  mother to produce more hormones?
    The fetal  adrenal gland produces more androgens, that reaches the placenta and is converted to estrogens  by aromatase.
  29. What is the effect of estrogen in milk production in a pregnant mother?
    It stimulates the prolactin that prepares the machinery (glands) to produce the milk. In the same time, it prevents milk flow from breast.
  30. Which hormone is responsible for gestational diabetes in genetically predisposed females?
    Human Placental lactogen (hPL)

    – It decreases maternal glucose utilization.
  31. In a starvation state and there is limited food, who gets food first, fetus or mother?
    • In starvation state, fetus gets food first.
    • It is because of production of human placental lactogen ( hPL). 
    • hPL causes resistance of insulin and decreased uptake of glucose by maternal tissue.
    • Thus, fetus gets glucose first. hPL acts as antiinsulin for mother.
    • No species would survive in starvation if hPL is absent.
  32. Why is there no HTN although there is 50% increase in plasma volume?
    It is because there is decrease in total peripheral resistance.
  33. Why is milk produced only after birth of  baby and not during  pregnancy?
    • Estrogen stimulates prolactin to produce the  breast glands and milk production. On the same time, it inhibits the release of milk, and thus, there is no release of milk.
    • After birth,  the level of estrogen falls, and  thus, there no inbihition  in release of milk and thus, milk is released.
  34. A primagravida mother gave birth to baby and is upset because there is no flow of milk. What is the etiology?  

    D) High estrogen level

    Milk only flows when there is drop in estrogen level.
  35. What are two important effects  in  hypothalamus when baby sucks milk?
    • Decreased release of Prolactin inhibitory factor (Dopamine) - increases secretion of prolactin – increased milk production
    • Decreased GnRH – decrease in FSH and LH.
  36. Which of the following is not seen in humans? [AI 11]

    D. Estrous cycle

    The estrous cycle is typically seen in non menstruating species, including most mammals. Such animal reabsorb the endometrium if conception does not occur.
Card Set
Obstetrics 1
female reproductive tract