7/4/22

Question 1

What do you ask in a sexual history taking under BBV risk?

Answer 1

BBV = BBC = MOTD = MMOTDD

MSM or you had sex with man?
Money - paid or been paid for sex?
Overseas - had sex with someone not born in UK?
Tattoo - dodgy tattoo?
Drugs - PWID you or partner? Use drugs to enhance sex?
Diagnosis - you or partner have ever been told have BBV?

Question 2

What is a good thing to ask in drug history in sexual history?

Answer 2

Ever used an online pharmacy to manage your symptoms

Question 3

What do you include under the gynae part of a gynae/sexual history?

Answer 3

• Ever visited a gynae before for any reason?
• Any surgeries or procedures down there?
• When was your last period?
• Any change?
• Any bleeding between periods or after sex?
• Any menopause symptoms?

Smear test

• when was last one?
• ever had any follow up

Question 4

A woman presenting at her 12 week booking appointment has trace glycosuria on her dipstick. is this normal?

Answer 4

Yes

Question 5

What two hormones are responsible for lactation and how?

Answer 5

Prolactin = production of milk

Oxytocin - let down hormone and causes muscle contraction = ejection of milk

Question 6

What is chloramphenicol used for?

Answer 6

Bacterial eye infections

Question 7

What is sodium cromoglycate used for?

Answer 7

Anti-inflammatory/anti-allergy eye conditions

Question 8

What is the treatment of impetigo?

Answer 8

Topical hydrogen peroxide

If spread:
- fluoxacillin

Question 9

What is the first line management of tonsillitis?

Answer 9

Penicllin V

Question 10

What is a quinsy?

Answer 10

Peritonsollar abscess

Question 11

How do you manage PID as outpatient?

Answer 11

Ofloxacin + metronidazole

Question 12

What is meant by salpingo-oophorectomy?

Answer 12

Remove ovaries and fallopian tubes

Question 13

What causes a “whirlpool sign” on TVUSS?

What is the main pathology?

How would a patient present?

How is it managed?

Answer 13

Ovarian torsion

Partial or complete torsion of the ovary (if involves fallopian tube as well = adnexal torsion)
Caused by either hypermobility of ovary or >5cm ovarian mass -most commonly dermoid cyst (one with hair and skin in it)

Sudden onset of unilateral abdo pain w N+V

Laproscopy => salpingo-oophorectomy

Question 14

We have many types of ovarian cysts/masses and there are very nice ways to remember them all.

• Yolk sac
• Dysgerminoma
• Teratoma
• Fibroma
• Sertoli-Leydig
• Granulosa Theca Cell

Answer 14

Yolk sac = think SAC

• schiller-duval bodies
• AFP raised
• Children (girls and boys)

Dysgerminoma = think dysGERMANoma (Nazis -> bad nazis -> bad = malignant)

• High LDH
• High hCG

Teratoma = think TERROR-toma

• looks terrifying made up of multiple different tissues
• teeth
• thyroid hormone
• hair

Fibroma (FAP) (think fi-BRO-ma = ‘hey BRO pass me a beer = distended tummy from drinking beer)

Sertoli-leydig tumour (think ley-DIG)

• DIG for crystals = Reinke crystals
• virilization (females develop seocondary sex characterisitcs similar to males) in response to increase androgens
• fibroma
• ascietees
• pleural effusion

Granulosa Theca cell tumour ("call GRANny Exner)
- Gran = granulosa
- call-exner bodies 
- excess oestrogen production 
= kids = early puberty
= adults = endometrial hyperplasia

Question 15

What is the most common type of cervical cancer?

Answer 15

Squamous cell carcinoma

Question 16

What produces CSF in the brain and where is it found?

Answer 16

Choroid plexus - in the ventricles

Question 17

Describe the pathway of CSF from production.

Answer 17

Produced in all ventricles but this is taking from route of lateral ventricles

Lateral ventricles
Interventricular foramen
3rd ventricle
Cerebral aqueduct
4th ventricle
Medial and lateral apetures
Subarachonid space

Question 18

Through what layer of the meninges do blood vessels travel?

Answer 18

Sub-arachnoid space

Question 19

What makes up the walls of the superior sagittal sinus?

What is found in it?

Answer 19

Splitting of the two layers of the dura mater

Drains venous blood and also contains CSF which has drained in from the subarachnoid space via. arachnoid granulations

Question 20

What level is lumbar puncture at?

What layers do you have to go through to get to the CSF?

What is different about epidural

Answer 20

L3-4

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
SUBARACHNOID SPACE

Epidural L1-2

Stop at epidural space

Question 21

What is the complication that can arise from spinal anasthetic and why?

Answer 21

Blockade of sympathetic tone to all arterioles = vasodilation = hypotension

MUST closely monitor

Question 22

What pathway are you putting any woman aged >55 w/postmenopausal bleeding on?

Answer 22

Endometrial cancer pathway immediately