Anatomy Flashcards
The median umbilical ligament is the embryological remnant of what fetal structure?
Urachus
The medial umbilical ligament is the embryological remnant of what fetal structure?
Fetal umbilical arteries
The superficial inguinal ring is strengthened posteriorly by which structure?
Conjoint tendon (Falx inguinalis)
In women, the inguinal canal transmits the round ligament to the labia majora. Which nerve also traverses the inguinal canal, exiting via the superficial inguinal ring?
Ilioinguinal nerve
Ilioinguinal nerve has motor supply to which muscles?
Internal oblique and transverses abdominus, so strengthens conjoint tendon
A urinary catheter is vigorously inflated in the urethra at the time of caesarean section. Urine leaks from the rupture into which anatomical space?
Anterior abdominal wall and mons pubis
The inferior hypogastric plexus is an important plexus supplying the hind gut. The sympathetic components are derived from the superior hypogastric plexus. What are the three nerve root origins of the parasympathetic components?
The parasympathetic components are carried by branches from S2, S3 and S4, which are the pelvic splanchnic nerves.
Which three muscles form the superficial group of muscles of the perineum?
Bulbospongiosus, superficial transverse perineal muscles and ischiocavernous
Sympathetic supply to the bladder is derived from which segments of the spinal cord?
L1/L2
The lower third of the vagina has lymphatic drainage to which lymphatic nodes?
- Created via canalization of ectodermal thickening
- Superficial inguinal nodes
Upper 2/3 vagina lymph drainage
External and internal iliac nodes
- Created from fusion of mesonephric ducts
A baby’s birth was complicated by shoulder dystocia and he was subsequently diagnosed with Erb’s palsy. Which component of the brachial plexus is most likely to be involved?
-C5/C6
- Pronation of forearm, internal rotation of shoulder, adduction of shoulder
A woman presents as an emergency with a painful lump in the vagina, and examination confirms that she has a Bartholin’s abscess. Which gland is involved?
Greater vestibular gland
If a woman sustains an ischaemic injury to the pelvic ureter, which artery supplying it has been occluded?
Superior or inferior vesicle
Abdominal ureter blood supply
Renal artery, ovarian artery and direct branches from aorta
What pelvic structure is lined by non-keratinised stratified squamous epithelium?
Vagina
Epithelium endocervix
Simple columnar (non-stratified)
Epithelium ectocervix
Stratified squamous, non-keratinized
Epithelium fallopian tubes
Simple columnar ciliated
Epithelium uterus
Simple columnar
Epithelium kidney
Simple cuboidal
Epithelium bladder/ureters
Transitional
Epithelium male urethra
Prostatic is transitional, membranous is stratified columnar, urethral opening is stratified squamous
A 28-year-old woman presents to the gynaecology clinic with a history of dysmenorrhoea, premenstrual pain and dyspareunia. Vaginal examination reveals a thickened nodule in the posterior fornix. Which anatomical structure is most likely to be affected?
Uterosacral ligament
A consultant anaesthetist is teaching a junior anaesthetist how to administer a spinal anaesthetic for a caesarean section. At what level in the spine does the spinal cord end and the cauda equina begin?
Spinal cord ends L1/L2, so performed at L3/L4 or L4/L5
Cauda equine exists in lumbar cistern, between arachnoid membrane and pia mater.
What is the lymphatic drainage of the ovaries?
Lateral aortic and pre/para aortic
Lymphatic drainage bladder
External (most), internal and common iliac
Lymphatic drainage ureters
Internal iliac nodes
Fallopian tubes + fundus of uterus lymphatic drainage
External and superficial iliac via round ligament or para-aortic (passMRCOG)
Cervix lymph drainage
External iliac (most), internal iliac, sacral, rectal and obturator
Uterus lymph drainage
Internal iliac nodes
An obstetric trainee is repairing a medio-lateral episiotomy following a ventouse delivery. Which nerve supplies the area of skin being sutured?
Pudendal nerve
What part of the spermatozoa has the highest concentration of mitochondria?
Middle piece
What type of cells are sertoli cells as defined by shape?
Tall columnar
What is the layer between the theca cells and the mural granulosa?
Basal lamina
With regard to ovulation, what is the fluid filled space in a follicle called?
Antrum
What size is a resting follicle?
0.02mm
What size is a follicle that is ready to ovulate?
20mm
What coats luminal surface of bladder?
A glycosaminoglycan layer coats the luminal surface of the bladder mucosa
The internal pudendal artery leaves the pelvis via what structure?
Greater sciatic foramen (branch of anterior internal iliac artery) and re-enters via lesser sciatic foramen
The most favourable pelvic shape of the bony pelvis for childbirth is the gynaecoid pelvis. Which is the largest diameter of the maternal pelvic inlet in this type of pelvis?
Between the farthest two points on the iliopectineal lines
Pelvic inlet boundaries
- Sacral promontory
- Alae of sacrum
- Sacroiliac joints
- Pubic tubercles
- Pubic crests
- Iliopectinal lines
- Iliopectinal eminences
- Upper border superior pubic rami
- Upper border pubic symphysis
Through which foramen does the facial nerve exit the cranium?
Stylomastoid foramen
Mento-vertical presentation
14cm brow presentation
Occipito-frontal presentation
11.5cm deflexed vertex OP
Submento-bregmatic presentation
9.5cm Face presentation
Suboccipito-bregmatic presentation
9.5cm flexed vertex
Suboccipito-frontal 10.5cm
Partially deflexed vertex
Which ligament has been pierced by the epidural needle when ‘loss of resistance’ is experienced?
Ligamentum flavum
Skin, subcutaneous fat, supraspinous ligament, interspinous ligament ,ligaments flavum, epidural space –> dura mater
What is the narrowest part of the Fallopian tube?
Isthmus
There is a portal system which allows the hypothalamus to communicate with the anterior pituitary via the release of neurotransmitters into the bloodstream. Which artery directly supplies this portal system?
Superior hypophyseal artery (branch of internal carotid)
Which arteries directly contribute blood into the Circle of Willis?
Terminal branches of internal carotid and vertebral arteries.
- Anterior cerebral (internal carotid) , posterior cerebral (basilar artery) and internal carotid
- Anterior and posterior communicating provide connections.
Which nerve fibres lie in the ovarian fossa?
Obturator nerve
Which part of the adrenal gland exhibits the chromaffin reaction (catecholamine precursor molecules within the cytoplasm of the cells which are coloured brown by chromium salts)?
Adrenal medulla
Which pelvic muscle is the sacrospinous ligament part of?
Coccygeus
Which muscle does the deep part of the external anal sphincter blend with?
Puborectalis
Which of these ligaments are a supporting structure for the uterus?
- Uterosacral, transverse cervical (cardinal) and pubocervical liagaments
Infundibulopelvic ligament is ovarian suspensory ligament, in broad ligament and carries ovarian vessels - Round ligament: anterverts uterus but does not provide support.
As a result of electrophysiological studies, the motor supply to the levator ani group of muscles is now thought to enter the muscle from above via perineal branches of nerves.
Which nerve roots are the origin of these nerves?
S3/S4 (perineal branch pudendal nerve)
Pain from the uterus in labour is referred to the lumbo-sacral region, lower abdomen and loins. Which is the route that the afferent pain fibres take to the spinal cord?
Sympathetic fibers via inferior hypogastric plexus
The most common and favourable type of pelvis for vaginal birth is wide and open in shape, giving the baby plenty of room during delivery. Which type of female pelvis is this?
Gynecoid pelvis
What is Anthropoid pelvis?
long narrow oval shape pelvis, occurring in 25%.
What is Platypelloid pelvis?
wide pelvis flattened at the brim, present in 5% of women.
During this operation, ligation of which artery poses the greatest risk to the integrity of the ureter?
Uterine artery
Abdominal ureter blood supply
Renal artery, ovarian artery and direct from aorta
Pelvic ureter
superior/inferior vesicle artery
Ovaries epithelium
cuboidal
Separation of deep and superficial perineal pouches
Superior border deep = superior fascia of urogenital diaphragm
Inferior border = perineal membrane (inferior fascia of urogenital diaphragm)
Superior border superficial pouch = perineal membrane (inferior fascia of urogenital diaphragm)
In the process of fertilisation, what is the correct sequence for sperm penetration into the oocyte?
Corona radiata, zona pellucida, perivitelline space, plasma membrane
With regard to cardiovascular changes in pregnancy, what are the physiological changes by the third trimester?
The answer is 30% increase in blood volume, 45% increase in plasma volume and 20–30% increase in red blood cell volume. There is a relative increase in the plasma volume compared to red cell volume that causes dilutional anaemia.
What is the primary haemoglobin type in the baby at 32 weeks of gestation?
Hb F is produced from 6 weeks gestation and the levels remain high until the baby is a couple of months old.
Hb Gower-1 is a form of haemoglobin existing only during embryonic life and has two zeta chains and two epsilon chains.
Gower-2 exists at low levels during embryonic and fetal life and has two alpha chains and two epsilon chains. Portland-1 exists at low levels during embryonic and fetal life and has two zeta chains and two gamma chains. Portland-2 also exists at low levels and is composed of two zeta chains and two beta chains.
At what gestation does fetal urine become the major contributor to amniotic fluid volume?
18 weeks
Who should take 5mg folic acid?
As well as diabetics, women with spina bifida, a family history or previous affected pregnancy and women who are on epileptic or anti-retroviral medication are advised to take 5mg per day. The higher dose is also recommended for obese women (BMI >30), women with sickle cell anaemia, thalassaemia and coeliac disease.
Patients with coeliac disease or who eat a vegan diet may be short of iron and vitamin B12.
At what gestational age does the formation of the definitive alveoli take place?
The alveolar stage starts at 36 week and may take up to 2 years postnatal to complete.
Which test is used to diagnose haemolytic anaemia in a newborn?
Direct Coombs test
Signs of hypoglycaemia and hypocalcaemia are often similar. Which sign will help differentiate the two in a newborn?
Increased muscle tone
The physiological changes in pregnancy are associated with a change in serum concentration of various hormones. Which blood test is most appropriate in diagnosing thyroid dysfunction in pregnancy?
Free thyroxine (T4)
Total T4 and T3 levels are raised in pregnancy. hyroid-stimulating hormone levels fall in the first trimester as concentration of human chorionic gonadotropin rise, however they may occasionally rise. The levels of free T4 are altered less in pregnancy.
Pregnancy is associated with a relative iodine deficiency, which has two major causes. Maternal iodine requirement increases because of active transport to the fetoplacental unit. Also there is increased iodine excretion due to increased glomerular filtration and decreased renal tubular excretion.
A woman presents to the antenatal clinic at 30 weeks of gestation with vulval varicosities. What is the most likely cause?
Pressure effect of the gravid uterus on the inferior vena cava
What is the normal circulatory lifespan of a red blood cell?
The answer is 120 days. The process of erythropoiesis takes 7 days from a stem cell.
What is the average lifespan of platelets?
The answer is 5–10 days. Platelets are produced from megakaryocytes
What is the physiological function of bile salts?
Facilitate the absorption of fats
Which vitamin found in liver should be avoided in excess in pregnancy?
Vitamin A
During the postpartum period the uterine cavity develops new endometrial layers.
How long does it take the placental bed to acquire a new endometrial layer?
Within 1 week the uterine cavity has a new endometrial layer, with the exception of the placental bed which takes around 3 weeks.
At what gestation is physiological anaemia most pronounced?
32 weeks
By what percentage does oxygen consumption rise in pregnancy?
20%
Which subunits are found in fetal haemoglobin?
Fetal haemoglobin is composed of two alpha subunits and two gamma subunits. It has a greater affinity for oxygen than adult haemoglobin which is composed of two alpha and two beta subunits.
Which two hormones are required for maintenance of milk secretion?
Prolactin and Oxytocin
What biochemical disturbance most commonly associated with hyperemesis?
hypokalemia
What sort of junctions are found within uterine myometrical cells?
Gap junctions
Which hormone is responsible for relaxation of the blood vessels in pregnancy?
Progesterone
With regard to gestational diabetes, what is the likely change in plasma free fatty acids (FFA) and plasma ketone bodies?
Increased FFA and increased ketone bodies
What cells are transformed by spermeogenesis?
Spermatids
How many times the normal range is alkaline phosphatase increased in pregnancy?
3 x
What is the increase in oxygen consumption in pregnancy?
50 ml/min
What is the change in total lung capacity in pregnancy?
Decreased by 200 mls
What proportion of body calcium is stored in the skeletal system?
99%
What is the WHO definition of osteoporosis?
The correct answer is a T score < –2.5
What happens to gallbladder motility and bile composition in pregnancy?
Decreases gallbladder motility and increases the lithogenicity of bile
Regarding rheumatoid arthritis in pregnancy, which of the following is correct?
Exacerbation tends to occur in puerperium
A primiparous 18-year-old woman presents to the maternity assessment unit at 39 weeks of gestation. Urinalysis reveals a proteinuria value of 3+. The woman has a blood pressure of 170/110 mmHg and she is suffering from a headache. What underlying pathology would brisk reflexes indicate?
Cerebral irritation
A woman from South East Asia books for antenatal care at 12 weeks of gestation. Her BMI is calculated at 40, she has no comorbidities and is already taking folic acid.
What vitamin should be prescribed for this woman during pregnancy?
Vitamin D deficiency is especially an issue for obese women and causes rickets in children.
A primiparous woman with a BMI of 40 from South East Asia is seen by you in antenatal clinic. The woman is at 24 weeks of gestation and has a fundal height of 30 cm. What initial investigation do you organise?
Glucose tolerance test.
Which food substance is especially rich in vitamin D?
Oily fish
After 24 weeks’ gestation, type II pneumocytes begin to appear in the developing alveoli of the fetus.
What is the function of these type II alveolar cells?
Secrete surfactant
What is their function within the cell?
Breaking down bacteria and worn-out cell part
The Golgi apparatus forms lysosomes, secretory vesicles and other cytoplasmic components. At term the maternal cardiac output is increased by 1.5 L/minute.
At term the maternal cardiac output is increased by 1.5 L/minute.
What percentage of this increased blood flow is distributed to the uterus?
Increased blood flow to the uterus is 400 ml/minute at term - therefore roughly 30%.
Which steriod hormone is produced by the placenta?
PROGESTERONE ONLY STEROID HORMONE. others are protein (peptide) hormones.
The human placenta acts as both a transport organ and an endocrine organ, producing important hormones such as chorionic gonadotrophin, progesterone, estrogens (especially estriol) and human placental lactogen.
The placenta also produces relaxin, melatonin, serotonin, oxytocin and kisspeptin.
At what gestation are the primordial follicles maximum in number in a female fetus?
20 weeks
Which wave form occurs at the end of atrial systole?
X wave
X wave occurs at the end of atrial systole.
A wave = atrial systole
C wave = ventricular systole
V wave = atrial filling against closed tricuspid valve
Y descent occurs following tricuspid valve opening
By what percentage does total blood volume usually increase above pre-pregnancy levels at term?
40%
Patient has had multiple vaginal deliveries and now has incontinence - which muscle is weak?
Pubococcygeal (or other levator ani muscles)
Principle of the Haldane effect:
Affinity of deoxygenated blood is increased for CO2
Patient complaining of weakness + muscle spasms. Likely electrolyte disturbance:
Hypocalaemia
Patient had paralytic ileum - which electrolyte disturbance makes it worse?
Hypokalaemia
HPL maximum production at:
35 weeks
Cite of prolactin production without effect of dopamine:
Maternal decidua
Piezoelective crystals used in which mode of imaging?
USS
What is raised in Down’s syndrome in the quadruple test?
Increased inhibin + HCG
Female Kleinfelter patient will have:
Normal stature (or tall stature), small gonads + infertile
Commonest cancer during pregnancy + puerperium
Breast cancer
Vulval cancer with hard base:
Squamous cell cancer
Which cells are involved in innate + adaptive immunity?
Lymphocytes
Enzyme needed for catecholamine synthesis:
catecholamines dopamine, norepinephrine, and epinephrine are synthesized by Tyrosine hydroxylase .
In prostaglandin, OH is attached at which position?
15
Nerve injured during sacrospinous fixation surgeries:
pudendal nerve.
Warfarin teratogenicity occurs when?
6-12 weeks
Enzyme required for synthesis of ammonia?
Glutaminase
MOA of Dalteparin:
Inhibition of Xa
MOA of Raltegavir
Inhibit integrase
Nerve root value of obturator nerve:
L2 L3 L4
Patient with VIN, which HPV involved?
16
Transverse suprapubic incision during C/S is at which spinal level?
T12/L1 (L1 most likely)
Which one of the following structures is the origin of the labia minora?
Urethral folds
GFR is maximum at which gestation
16 weeks
Metabolism of isoniazid is by:
Acetylation
Appearance/hemolysis of strep on agar is by:
Beta hemolysis
Chief characteristic of fetal Hb:
Resists denaturation by acid
Properties of ultrasound waves:
Absorption, scattering & reflection
Bacterial load increases as which compliment decreases?
C5
What is the chief function of the glucose-6-phosphate dehydrogenase enzyme?
NADPH production in red blood cells
What is the function of the enzyme glucose 6 phosphatase in carbohydrate metabolism?
Converts glucose 6 phospahte to glucose
Remnant of upper mesonephric duct commonly seen on laparoscopy?
Garnet’s duct cyst
Antibodies of Grave’s disease:
Thyroid peroxidase antibodies (raised in Hashimoto’s + Graves)
Thyroid stimulating hormone receptor antibodies (Graves)
MOA of Clomefine Citrate
selective estrogen receptor modulator
Significant p-value =
0.05
Lowest level of dermatome to abolish pain of uterus/labour pain?
L1
Patient with fibroid on ulipristal acetate then requiring additional contraception - which one should be used?
Barrier contraception
CMV lab tests:
A positive test for CMV IgG indicates that a person was infected with CMV at some time during their life but does not indicate when a person was infected.
The presence of CMV IgM cannot be used by itself to diagnose primary CMV infection because IgM can also be present during secondary CMV infection. IgM positive results in combination with low IgG avidity results are considered reliable evidence for primary infection, with limitations of avidity testing described below.
Advantage of Co2 later for endometriosis/endometrium because?
Prevents lateral thermal spread/no lateral spread
Implant MOA:
Inhibits ovulation
Patient with lung cancer + abdominal pain + polyuria. Electrolyte abnormality?
Hypercalcaemia
CTG paper speed
1cm/minute
Endometrial hyperplasia without atypia - risk of cancer?
5%
PPH ongoing - at what point would a patient have a platelet transfusion?
10,000
10 x 10^9
Chlamydia treatment:
Azithromycin or Doxycycline
Which growth factor is in granular tissue in a wound?
vascular endothelial growth factor
Melanoma prognosis is assessed by?
Lesional thickness
Chief hormone in the acrosome reaction?
hyaluronidase
Which nerve passes below the inguinal ligament?
Lateral cutaneous nerve of thigh
Which nerve passes in front of the psoas muscle?
Genitofemoral nerve
Oocytes develop from which structure?
Yolk sac
Passage of free fatty acids is by:
Passive diffusion
What is the nerve supply to the cervix?
hypogastric and pelvic splanchnic nerves
Torturous glands in endometrium after ovulation:
Secretory
Sacroiliac joint type:
Synovial
Definition of massive blood loss:
- Greater or equal to 150mls per min
- OR 100% blood volume per 24 hours
- 50% blood volume in 2 hours
How much FFP given in massive bleeding?
15 to 20 ml/kg or 3 to 6 units (given after 4 units of RBCs)
How much oxytocin is given during CS?
5IU
How long is uplistrail contraceptive effective?
120 hours
What criteria used to diagnose BV?
Hay/Ison Criteria
Grade 3 = BV
Suspected PPROM + no liquor on speculum examination. Next steps?
Swab to detect the presence of amniotic fluid in the vaginal canal. High concentrations of AFP and PP12
Largest/long diameter fetal presentation is:
Mento-vertical
Pregnant women with twins + sudden rupture of membranes - first action:
vaginal exam to check for cord prolapse.
What amount of the body’s iron in hemoglobin:
75%
COCP UKMEC 4 conditions (A condition which represents an unacceptable health risk if the method is used)
<6 weeks postpartum (breastfeeding)
<3 weeks postpartum (not breastfeeding) + other risk factor VTE
Age ≥ 35 and smoking ≥15 cigarettes/day
History VTE
Migraine with aura
7 Stages of labour:
engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
Contraindications to instrumental delivery:
- Unengaged fetal head
- Incompletely dilated cervix
- True cephalo-pelvic disproportion
- Breech and face presentations, and most brow presentations.
- Preterm gestation (<34 weeks) for ventouse.
- High likelihood of any fetal coagulation disorder for ventouse.
Which antibody will associate in blood cell coagulation?
IgM
Ciprofloxacin acts by inhibiting:
DNA gyrase
Cancer from pelvic viscera can deposits cancerous cells in the
vertebrae this communication occur between the internal iliac veins
and the vertebral veins through the:
Prosatatic plexus
Lipoprotein lipase does what:
Hydrolyses TAG in chylomicrons and VLDL
Female known case of ovarian CA presented with
Medial thigh Parasethia the nerve involved by CA is
Obturator nerve
How do free radicals cause cell damage:
ROS-induced peroxidation of polyunsaturated fatty acids in the cell membrane bilayer
Comment about left ureter:
Has lumeneal construction when enters the pelvic brim
Inguinal lymph nodes means cancer from where?
Vulval and anal cancer
Internal iliac lymph nodes mean cancer from where?
Uterus
Breakdown of 1gm Haemoglobin produces:
35mg of bilirubin
The active transport system for hepatic uptake
of bilirubin is congenitally defective in:
Gilbert’s disease
Excretion of conjugation bilirubin from liver
cells into biliary canaliculi is defective in:
Rotor’s syndrome
Half life of oxytocin:
3-6 mins
Biological activity of ACTH is completely
lost on removal of :
24 C-terminal amino acids
Measles is characterized by:
Koplik’s spots
Assessment of fetal anemia :
Middle cerebral artery
Red infarction develop in:
Intestine
very efficient inhibitor of steroid
biosynthesis is:
Aminoglutethimide
In the synthesis of Angiotensin I, rennin acts
on Angiotensinogen and cleaves the:
Leucine - leucine at 10 and 11 position
normal range of ionized
calcium in plasma is:
4-5 mg/dl
Lymphogranuloma venerum (LGV) is
sexually transmitted disease is caused by:
Chlamydia trachomatis
Scrup typhus is caused by:
Orientia tsutsugamushi
grading of tumour is best described as:
degree of differentiation
pure hypertrophy is seen in:
muscle of athletes
Healing by first intention means:
the surface of wound is rapidly covered by
epithelium
Tetanus is caused by spread of:
exotoxin in sympathetic system
Phenotype is determined by:
sex chromosome (XX- XY) karyotyping
After treatment of myocardial infarction,
injury occurs because of:
free radical
mature placenta composed of:
maternal blood vessels, syncytiotrophoblast,
fetal blood vessels
Genital tubercle gives rise to the:
Clitoris
Poly-A tails are found in:
eukaryotic mRNA
MOA Tamoxifen
selectively binds to estrogen receptors, producing both estrogenic and anti-estrogen effects
Complement based agglutination reaction is
known as:
haemagglutination
The technique involved in comparing the
DNA component of two sample is known as:
DNA finger printing
furosemide MOA
inhibtion of Na k cl co-transporter
Amiloride potent diuretic action by:
reversibly blocking luminal epithelial sodium channels
Benzodiazepine MOA:
Enhanced Cl channels that act on GABA neurotransmitters
45 years old treated for ovarian cancer developed difficulty hearing the cause is:
Cisplatin
Coombs test is positive and associated with heamolytic anaemia in :
Methyldopa
female diagnosed with TB. before prescribing treatment you should be aware of that one antituberculus induce cytochrome P450 enzyme in the liver
rifampicin
A nucleophilic attack on deoxyribonucleic acid which cause disruption of base pairing occurs as a result
Cyclophosphamide
Cardiotoxicity limits the clinical usefulness of which antitumor antibiotics:
Doxorubicin
SPIROMETRY CHART PASSMRCOG
SPIROMETRY CHART - IDENTIFY ALL VALUES
Reversible inhibition of cycloxgenase in platelets is caused by which drug?
Ibuprofen
Malignant tumer in trigone of the bladder metastasize to the following lymph nodes
Internal + External iliac nodes
Femoral ring definition:
1.25 inch lateral and below the pupic tubercle
Ammonia is a good buffer in urine because
Kidneys produce large amounts of NH3 in chronic acidosis
Which substance increases renal blood flow/renal surface area?
Dopamine
ECG p wave =
Atrial depolarization
ECG QRS complex =
Ventricular depolarisation
T wave ECG =
Ventricular repolarisation
U wave ECG =
repolarisation of the interventricular septum
Hypokalaemia ECG =
Flat T waves
U waves
Hypercalcaemia ECG =
short QT
Hypocalcaemia ECG =
long QT
Glomerular filteration rate would be increased by:
increase in afferent arteriolar pressure
Patient with HBV +ve (hepatitis B) and has co-infection with hepatitis D. Which blood factor would prove whether there is co-infection?
HBc IgM (IgM anti-HBc )
newborn with periventricular calcification commonly associated with:
Cytomegalovirus
Pyruvate carboxylase MOA
Converts pyruvate to oxaloacetate
Krukenberg Tumor of the Ovary is an example of what kind of spread?
Transcolomic Spread
-The class of antibiotics known as the quinolones are bactericidal. MOA:
Inhibition of DNA gyrase
N. gonorrhoeae is a fastidious pathogen and found in sites often contaminated with normal flora. The best medium for isolation is
Thayer-Martin agar
The latest and most effective therapy for AIDS patients includes azidothymidine (AZT), dideoxyinosine (DDI), and saquinavir or similar agents. Use
of these three drugs would inhibit which of the following viral processes?
Reverse transcriptase, protease
Which of the following viruses causes an acute febrile rash and pro- duces
disease in immunocompetent children but has been associated with transient
aplastic crises in persons with sickle cell disease?
Parvovirus
leukocyte adhesion by which molecules?
selectin
Exudate is caused by:
Chronic inflammation
Cell of chronic inflammation are:
macrophages with giant cell
Central chemoreceptors are signaled by:
CO2
In what condition do babies have Snuffles, aka “syphilitic rhinitis”?
Congenital syphilis
Thyroperoxidase used H2O2 as oxidative
agent. Hydrogen peroxide MOA:
NADPH dependent enzyme
Thyroid hormones in pregnancy:
Total T3 and T4 increase in pregnancy
TSH levels are typically lower in pregnancy than non-pregnant state
Free T3 and T4 levels drop from 1st to 3rd trimester (free T4 affected less than T3 and can be normal)
Mother has flu-like symptoms + then baby has fetal bradycardia + hepatosplenmegaly. Cause?
Listeria = listeria causes flu-like syndrome as opposed to CMV
Old inferior MI on ECG:
2, 3 AVF - q waves
Which USS resolution is maximum at the focal point or interface?
Axial resolution
How does USS damage tissue?
Cavitation
Power of electro-cautery SI unit
Watt
Iodine transport in the thyroid by which ion?
Chloride
CTPA to breast - what is the dosage?
20 Gy
Pseudomonas on Mac Conkey colour:
Colorless or pale yellow
Patient had history of colon cancer + surgery was done - picture of ovary post-hysterectomy. Diagnosis?
Ovarian metastasis
Male ejaculation from:
seminle vesicle
Phagocytosis cells include:
Macrophages
In ongoing PPH, fibrinogen should be maintained above:
2-4 ul
When is gestational sac visible on USS?
4wks+3d
3mm when visible
When is Yolk sac visible on USS?
5 to 5+3wks
3mm when visible
Gestational sac 10mm when yolk sac visible
When is Embryonic pole visible on USS?
5wks+3d to 6 wks
3mm when visible
Gestational sac 16mm when embryonic pole visible
TVS mean sac 23mm with no fetal pole visualized. Outcome?
Unknown viability
Commonest uterine sarcoma?
Leiomyosarcoma
What is the percentage of lymphocytes?
20-40%
Hypotension from a spinal is caused by?
preganglionic autonomic blockade
What is the main action of parathyroid hormone?
Decrease calcium excretion
Which inflammatory marker is not affected by prostaglandins?
Cytokines
What is the precursor for Warfarin?
Pro-thrombin
Which immune cells clear viruses?
CD8 T cells
Which factor enables Vitamin B12 to be absorbed?
Intrinsic factor
What is the antidote for Methotrexate?
folinic acid.
What is the MOA of Trimethoprim?
Antifolate inhibitor that inhibits bacterial dihydrofolate reductase
(anti-metabolite)
In a patent with megaloblastic anaemia, which test should be performed?
Serum Vit B 12
TAP block at suprapubic level passes through which structures?
Transversus abdominus muscle and internal oblique muscle
What are the chances of brachial plexus injury during shoulder dystocia?
2.3 -16%
Fatty acids cross placenta by?
Passive transport
What group of patients would you give antibiotics to if they have a catheter?
Diabetic
What is the commonest verres needle injury just below bifurcation of aorta?
Superior hypogastric plexus
The sex determining gene is on which chromosome?
Short arm of chromosome Y
The sigmoid colon anatomy includes:
Mesentery
Inferior mesentery artery
Pre-aortic + inferior mesenteric nodes
An indirect inguinal hernia is divided by:
Inferior epigastric artery
Chorioamnionitis transfer is by which sort of spread?
Hematological
The paravesicle + infra rectal structures are divided by which artery?
Uterine artery
How long does it take for resting ovarian follicles to reach maturity?
300 days
Which enzyme is used in NAAT testing?
TAQ polymerase
Ammonia production includes which enzyme?
Glutamase
In clear cell ovarian cancer, which electrolyte rises?
Calcium
Epiphyseal plates are closed at puberty by which hormone?
Estradiol
Post-menopausal with dysfunctional uterine bleeding with granuloma cell tumour. Endometrial changes are:
proliferative
Which bands are in DNA?
G bands
In pre-eclampsia, what are the main physical symptoms?
Hyper-reflexia + clonus
The sacro-iliac joint fixation is by which nerve value?
S2-S4 pudendal nerve
Which hormone maintains the corpus luteum?
HCG
What is the other name for omega 3?
α-Linolenic acid
Chlamydia causes which congenital infection?
Ophathalmoa neonatorum
GBS Rx if pancillin allergy
Erytheromycin
pt pregnant developed goiter
Which nerve injured or compressed:
Recurrent laryngeal nerce
pt has eclampsia cause intracranial hemorrhage to which artery?
Middle cerebral Artery
2nd arch structures:
Facial nerve
facial expression muscles
stapedius
stapedial artery
platysma
stylohyoid
posterior belly digastric
Which gynecological cancer has miss match mutation?
Ovarian cancer
Origin of allantois
Endoderm
Spindle shape cells formation
With pulmonary pneumonia With Meigs syndrome. What will the patient have?
Fibroma
Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor. Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome.
ureteric bud formed from
Mesonephric duct
Bladder trigone forms from:
Mesonephric duct
Arterial supply to the anterior abdominal wall:
Inferior epigastric artery
Where does ovarian pain radiate to?
Umbillicus
Iliacus muscle (picture) nerve supply?
Femoral nerve
Primary hyperaldosteronism will cause which biochemical defects?
Hypertension
Hypernatremia
Hypokalemia
metabolic alkalosis
Ductus venosus joins which two structures?
IVC + umbilical vein in RA
CRISPR contains what?
DNA + enzyme
Which structure is on the medial side of Ant iliac spine?
Lateral cutaneous nerve
Finasteride MOA:
competitive inhibitor of 5 alpha-reductase
reduces dihydrotestosterone
What is the most common cause of the female urethral caruncle?
Hypoestrogenism
contraindication of the use of oxybutynin?
Myasthenia gravis
narrow angle Glaucoma
Active form of Vit-D is produced in which organ?
Kidney
A 60-year-old with erythematous erosive lichen planus on the vulva. What type of cancer is linked to lichen planus?
Squamous cell carcinoma
Which class I major histocompatibility complex human leucocyte antigen (HLA) is
Not expressed in extravillous trophoblast?
HLA-A + HLA-B
The most biologically active form of vitamin D is
1, 25-Dihydroxycholecalciferol (calcitrol
Joint which resist horizontal rotation of the pelvis
Sacroiliac
Most common dermatitis in pregnancy( not around the umbilicus)
Polymorphic (PUPP)
Pruritic urticarial papules and plaques of pregnancy - begins in striae around umbillicus
Most common protozoan causes zoonotic infection(cerebral calcification, retinitis)
Toxoplasma
Prophylaxis dose of Anti D in 2 doses are prescribed at which Gest age?
28 + 34 weeks
Which immunoglobulin is secreted in mucosa?
IgA
Primary amenorrhea with blind pouch vagina + absent uterus + inguinal hernias =
Congenital androgen insensitivity syndrome
46,XY karotype
Macrophages develop from:
Monocytes
Which structure differentiates superficial perineal pouch from deep pouch?
Perineal membrane
Maximum radiation exposure seen in:
Hysterosalpingogram
Blood test done on mother to check fetal DNA?
Prenatal cell-free DNA
Layer of endometrium ablated for menorrhagia?
Basal layer (functional layer of endometrium)
Which hormones affect post-natal lactation?
Prolactin
Oxytocin
Gestational age is which type of data?
Interval
The spiral arteries invade into?
Syncytiotrophoblast
Extravilous trophoblast
Endovascular trophoblast
25-year-old woman patient presents with number of small genital blisters. A swab results reveals a diagnosis of genital herpes. Which of the following is the best drug to be used to treat this patient?
Topical acyclovir
Aspirin MOA
irreversibly inhibits both COX-1 and COX-2 (but mostly COX-1)
External pudendal artery is branch of
Femoral artery
Patient having hepatic surgery +
Hepatic artery pressed because of bleeding +
Some maneuver applied - where is the artery compressed?
Hapatic porta
Co-factor of DNA synthesis:
Folate/folic acid
Which complements are part of the MAC?
C5-9 (C5b-9)
Pulmonary capillary wedge pressure:
between 4 to 12 mmHg (unchanged in pregnancy)
post op TAH after 26 hrs fever 38c , what is the reason?
Physiological cytokines release
65 yrs old - what is the residual volume?
100 mls
shelf life of whole blood
7 weeks
In pph first surgical intervention
Ballon tamponade
Sacrospinous fixation which artery injured ?
Pudendal art
prolactine secret from lactotrophes
How many lactotrophes in ant pituitary
20%
Bile acid level harm for baby during pregnancy needs to deliver the baby ?
40
Abortion risk at 30-34 years old?
10-15%
Dabigatran anticoagulation MOA:
Inhibits thrombin
A 22-year-old primiparous woman books her pregnancy at 11 weeks’ gestation. Her booking blood tests reveal a haemoglobin level of 10.1 g/dL. Electrophoresis reveals haemoglobin karyotype HbAS. What is the diagnosis?
Sickle cell trait
32-year old woman complains of amenorrhea since delivery of a baby 15 months ago. The delivery was complicated by excessive hemorrhage that required transfusion of 2.5 liters of blood. Few days later she complained of failure to produce any breast milk. The most likely cause for this is damage to which of the following endocrine glands?
Anterior pituitary
How to calculate risk of type 2 error?
1 - power
40-year-old woman who had a laparoscopic tubal ligation 6 hours previously complains of abdominal pain, not relieved with analgesics. On examination a tender cystic mass felt under umbilicus with oozing pus from one of the port sites.
What is the likely diagnosis?
Urinary retention
fetus with abdominal anomaly
Liver and intestinal parts not covering with Amnion
Diagnosis?
gastroschisis
major blood supply to transverse colon
SMA
major nerve innervation to detrusor bladder
hypogastric
sympathetic via hypogastric N. T12-L2
parasympathetic via pelvic N. S2-S4
Somatic inervation via pudendal N. S2-S4
diagram showing laparoscopy view of d pelvis. A vessel was pointed at stating dt one wouldn’t go beyond that during pelvic lymphadenectomy
umbilical artery (obliterated)
Vitelline duct connects
Mid gut (small intestine) and yolk sac
the developing liver and billiary duct arises from
Ventral mesentry
choroid plexus develops from:
pia and ependyma
During development of liver and biliary system , hepatic bud invaginate into which structure
Septum transversum
Lowest part of vagina is derived from
Endoderm
Paroxetine effects which system in the fetus?
CVS
Allantois is derived from:
Endoderm
Which condition is characterized by eosinophilia + hyponatremia?
Addison’s
Test for Addison’s:
9am Cortisol & Synacthen test
Synacthen test < 100 = Admit
100-500 =refer endocrinology
>500 = normal
Hypotension, hyponatraemia & hyperkalaemia
Test for cushing’s:
Dexamethasone suppression test or 24-hour urinary cortisol
Test for Conn’s:
Renin/aldosterone ratio, saline (salt) suppression or fludrocortisone suppression test
Organelle where lipids are synthesized
SER
Organelle that contains the enzymes for glycolysis:
Cytoplasm
What type of organism is Chlamydia?
Obligate intracellular
Risk of gestational diabetes continuing as type-2 diabetes?
50%
Anatomy of heart vessels from R - L
Svc , aorta, pulm A
Which syndrome also results in premature menopause?
Turner’s syndrome
menopause precedes menarche as no ovarian function
Which type of diathermy uses return pad technology/pad placed on body?
Monopolar
Listeria treatment in pregnancy?
Ampicillin + Amoxicillin (both)
Chromosomes involved in robertsonian translocation?
13 14 15 21 22 (13/14 most common)
Female homologue of prostate?
skenes gland (paraurethral gland)
Risk of transmission to baby in vaginal delivery in case of primary herpes infection?
40%
1% with recurrent attacks
How many active TRH copies are produced from its precursor ??
6
Bartholin gland Art supply??
External pudendal
Innervation from perineal nerve
What is the upper limit of post void urine in a 65 yr old
100 mls
The postvoid residual volume less than 50 mL is considered normal,
Nevirapine MOA
non-nucleoside reverse transcriptase inhibitor (NNRTI) of HIV-1.
Somatotrophs are what percentage of anterior pituitary?
50%
Which hormone is present in granulosa cells n not in theca cells?
Aromotase
Scenario of numbness and parasthesia in pat with chrones dis and hex of gastric operation which vit deficiency
B12
What is the origin of the hypothalamus?
Neural tube
Which hormone produced by the fetus helps in increasing pulmonary surfactant?
Cortisol
For detection of receptor of estrogen in endometrial sample use :
Western Blotting
what physiological event happen during preg to make her able to breast feed
Ductal dilatation post natal
Stromal hyperplasia during pregnancy
Carcinosarcoma histopathology description:
Epithelial and mesenchymal tissues
Percentage of Brenner tumor of ovary are malignant
2-5%
Diagram of rectus muscles below umbilicus asking for during suprapubic incision after cutting rectus sheath u will encounter
fascia transversalis
Complication with retroverted uterus
Incarceration
Woman with 28days menstrual cycle when to perform hysterosalpingography
6-12
Decrease in amplitude of U\S due to absorption, scattering, reflection is called as
Attenuation
For overactive bladder a new drug called Mirabegron is used. Which is the singlemechanism of action for this drug?
Selective Beta-3 antagonist
Antineoplastic drugs causing hemorrhagic cystitis?
Cyclophosphamide
ligamentum arteriosus is completely obliterated after birth to form what adult structure?
truncus arteriosus
The most common in Utero infection causing fetal anemia in the UK is
Parvovirus B19
Location of Bartholin glands
superficial perineal pouch
location of external anal sphincter
deep perineal pouch
Mechanism of action of Apixaban
factor X inhibitor
SI unit of radiation is
becquerel
Botulinum toxin is now used to treat neurogenic bladder because of its ability to
Inhibit the release of acetylcholine
Schiller Duval Bodies is found in
Endodermal Sinus Tumor
bHCG tumor marker for
choriocarcinoma
Mycoplasma genitalium shape
flask shaped and do not have a cell wall
Group A streptococcus on Lancefield shows
B-hemolytic
Most common cause of secondary hyperparathyroidism
chronic renal failure
Innate and adaptive system are linked together via
Cytokines
TRH structure:
tripeptide
Carboprost MOA
Prostaglandin F2a
Mitochondial DNA genes
37 genes
Carbohydrate I breast milk
Lactose
Dimer immunity + mucosal immunity antibody
IgA
Internal anal sphincter
continuation of circular rectal muscles
Nevirapine MOA
Non-competitively inhibit reverse transcriptase
Only HRT breast cancer risk
low risk or no risk
Female , early pregnancy , doesn’t know about her vaccination status for VZV , she may have immunity against it ?
60-80%
vitamin d conversion in pregnancy is:
unchanged
DmPA injection given
every 12 weeks
Cardiac output increases in first stage of labor
50%
Fetal cardiac output to fetal kidney
Less than 5%
Remnant of patent umbilical artery
Superior vesical artery
Type of necrosis in brain
Liquefactive
HRT INCREASES WHAT?
increases thyroid binding globulin
Which organism produce exotoxin that causes toxic shock syndrome
Staphylococcus aureus
Fetal kidneys mature to form urine at
10 weeks
Test done on pregnant patients; serum x is positive in a patient. How likely she may develop preeclampsia
80%
Placenta previa early confirmed at what gestational age
32 weeks
Monochorionic and diamniotic occurs at which stage
Morula
ovaries contain enzyme for androgen production
3β-hydroxysteroid dehydrogenase
In PKU there is deficiency of enzyme known as hydroxylase. This enzyme catalyze the reaction and converting phenylalanine to
Tyrosine
one spontaneous mutation in human over years
One in 10 million years
During the cell cycle second meiotic division occurs at which stage
Secondary oocyte
Ebola virus is
Single standard RNA virus
Herpes simplex virus 1
Double stranded DNA virus
Pelvic diaphragm is formed by
Levator ani and coccygeus
Increase in caloric requirements after first trimester
200 calories
Cushing disease blood tests:
Increase ACTH, increase Cortisol, Increase GH
Identify the muscle involved in episiotomy
bulbospongiosus
Scenario of woman presented with amenorrhea, galactorrhea. Labs were advised which shows high TSH, high FSH, high prolactin
Hypothyroidism
patient blood group O positive. Antibodies present would be
Anti A, Anti B
Mechanism of action of POP implants
inhibition of ovulation
Forest plot horizontal lines represent
95% CI
Distal portion of Round ligament blood supply
inferior epigastric artery
Free fatty acid are transported via
Albumin
Patient on estrogen only HRT since 5years risk of breast cancer
Low risk or no risk
Hepatocytic hematopoiesis commence at which week
6 weeks
Man in infertility clinic for azoospermia with regular exercise
steroid overuse
Menstrual cycle of 25days
ovulate at 11 days
5 weeks Beta-hcg
4800
Inhibin synthesis in which cells?
Granulosa cells
Vitamin c promotes
hydroxylation in protein synthesis
Which organelles do type II pneumocytes utilize for surfactant release?
Lamellar Bodies
Dopamine agonist to suppress lactation
Quingolide
Albumin synthesized in
HEPATOCYTES
MCDA twins - split occurs at which stage?
Morula
A woman have got stillbirth at 34 weeks,her thrombophilia screening shows: Hb:10.1 Platelates:135 Protein C:normal protein S :decreased
Anticardiolipin antibodies: -ve
Diagnosis?
Normal pregnancy changes
Convex outline of uterus, lap and dye shows two uterine cavities
Septate uterus
patient have normal menstrual cycles but now she have amenorrhea for 8 months,she is taking metoclopramide and valproate for epilepsy,she have no visual symptoms,no hirsutism,her serum prolactin is 1000,your further management?
stop metoclopramide and repeat test
25 years old with chronic left lower abdominal pain for 3 months,she have previously received treatment for chlamydia,her ultrasound revealed a 4cm diffuse homogenous hypoechoic focal lesion with little fluid in pouch of douglas:
Endometrioma
Patient having severe pre- eclampsia symptoms, BP 160/110,blurring of vision, severe headache, pulse 85,she is known case of asthma, drug you will give to decrease her BP:
I/v hydralazine
Patient pregnant , PID due to gonorrhea, appropriate treatment:
Ceftriaxone + Azithromycin
MRI picture of intramural fibroid
Look up intramural fibroid
Combined oral contraception can be used in woman had GTD when:
After Bhcg titer return to normal, not rising at all.
Which structure does not contain paracrine glands:
Mons pubis
Difference between jejunum + ileum
Jejunum
Thick walled
Shorter
Longer arcades
Less arcades
Ileum
Thin walled
Longer
Shorter arcades
More arcades
What line denotes junction between hindgut and lower anal canal?
dentate line
sacral plexus situated behind which muscle :
Pyriformis
During laparoscpy surgeons have limitization of lymphectomy on lateral abdominal wall due this structure:
Obliterated umblical artery
What structure passes immediately anterior to SI joint?
Ureter
Sacrotuberous and sacrospinous ligaments prevent from
Posterior rotation at horizontal line of sacrum
hepatic artery is a branch of:
Coeliac trunk
Difference between inguinal and femoral hernia:
Inguinal:
Superior and medial to pubic tubercle
Femoral:
inferior and lateral to pubic tubercle
Rate limiting step in urea synthesis
N acetylglutamate dehydrogenase
Left uterine vein drain into
Internal iliac vein
Important function of glucagon
Gluconeogenesis
glycogenolysis
Prostaglandins are synthesized from:
Unsaturated fatty acids
Which organel can attach to tRNA and can synthesise protein
Ribosomes
Bending used for Cytogenic analysis:
G banding
Which metabolic processes produce the most energy needed for uterine contraction
Oxidative phosphorylation
At 4 weeks primordial germ cells are within what structure:
Yolk sac
Posterior fontanelle closes by
3 months
when does the Odds ratio approximate risk ratio:
When the disease being studied is rare
Histogram shows which variable:
Continuous variable
Throid profile in pregnancy is checked by:
TSH
T4
In girls puberty indicated by:
Growth spurt,Thelarchae,adrenarchae,menarchae
Which hormone leads to nutrient transfer from mother to fetus:
HPL
FNN act through :
Integrin
Hormone raised in post menopausal woman :
FSH
What is the component of placental barrier at term:
synchtrophoblast+endothelium
Miscarriage occur due to withdraw of this hormone:
Progesterone
POF may have karyotype or mutant gene:
46XX
Oligohydroamnios,low set ears,limb hypoplasia,renal,agenesis;
Potter syndrome
SS RNA viruses
Hepatitis ACDE
Rubella
HIV
DS RNA virus
rotavirus
SS DNA virus
Parvovirus B19
DS DNA virus
Hep B
CMV
VZV
Herpes 1 & 2
Epstein Barr
Patient have history of ca colon,ureter is fixed in colon,sigmoid audit is performed,shunts are left inside
gram negative bacilli in ureter:
psuedomonas aurginosa
Red degeneration of fibroid occur due to:
Ischemia
Postmenopausal women having typical complex hyperplasia progress to endometrial cancer:
<5%
24 years old sexual contact with her new boyfriend,she is concerned about development of new lesions on vulva.On examination you note pearly white ,non tender,dome shaped ulcers:
Molloscum Contagiosum
What percentage of lymphocytes is present in blood
20-40%
Complemt system synthesized in:
Liver
Radiation exposure with ventilation perfusion scan:
3 months
ultrasound resolution maximum at:
Interface
Type of TVS probe used in obese woman;
high frequency linear probe
radiation dosing in:
Sievert
Joint which resists horizontal rotation of pelvis
Ileolumbar
Electrosurgery long loop is used for :
To complete circuit with high density current
A small square of ECG represents:
0.04 sec
Normal ECG changes in pregnancy
Q waves lead 3
Earliest FH is detected on TV scan?
6 weeks
In a study comparison of singleton and twin pregnancy is made:
If cervical length less than 20mm then double chances of preterm before 34 weeks in twins than singletons
Normal level of fibrinogen in blood
1-2g
Mechanism of action of neostigmine
Anti cholinesterase
Mechanism of action of Indomethacin
cyclo oxygenase inhibitor
Midazolam acts on which receptors?
GABA
Depoprovera MOA
Inhibits ovualtion
Nifedipine MOA
calcium channel blocker
Non ergot dopamine agonist used after stillbirth
quinagolide
Drug excretion decreases in pregnancy due to:
Dec albumin and binding proteins
Indirect action of Warfarin on:
prothrombin II
Hepatitis serology blood results:
HBsAg = Indicates current infection either acute or chronic
Anti HBs = Indicates immunity either due to infection or vaccination
Anti HBc = Indicates either current or past infection
Anti HBc persists for life after infection so is a marker of past infection.
IgM Anti HBc = Indicates recent infection
Oligohydramnios
Oligohydramnios
AFI< 5cm or deepest amniotic fluid pocket < 2cm
Polyhydramnios
AFI > 25cm or deepest amniotic fluid pocket > 8cm
Endometrial measurements
Post menopausal <4mm
Reproductive years 5 to 14mm
Anaemia definitions
1st trimester Hb < 110 g/l
2nd and 3rd trimester Hb < 105 g/l
Postpartum Hb less than 100 g/l
What is responsible for Aquaporin-2 protein channel openings in the collecting duct?
ADH
Biopsy is taken and reported as showing
epithelial nuclear atypia, loss of surface differentiation and increased mitosis. What is the diagnosis?
Vulval intraepithelial neoplasia (VIN)
Fetal testing methods - when do we use amniocentesis/CVS:
- Nuchal Thickness imaging is part of the combined
The quadruple test is another screening test - RCOG guidelines advise amniocentesis should be performed after 15 weeks gestation.
- CVS offers rapid results and is suitable for karyotyping/genotype analysis for chromosomal abnormalities such as Down’s
Chromosomal abnormalities + biochemical markers
Down’s = trisomy 21
Basic Screening by Nuchal Thickness & PAPP-A and beta-hCG blood markers
- From 14 + 2 to 20 + 0 weeks gestation quadruple test can be used
PAPP A - reduced
AFP - reduced
Unconjugated estriol - reduced
Inhibit A - elevated
HCG - elevated
Edward’s = trisomy 18
90%+ detected on 18-20 week ultrasound fetal anomaly scan
PAPP A - reduced
AFP - reduced
Unconjugated estriol - reduced
Inhibit A - reduced
HCG - reduced
Patau’s = trisomy 13
AFP - raised in neural tube defects (like spina bifida) + multiple pregnancy
What is the antibiotic prophylaxis for surgical abortions?
Doxycycline or metronidazole is advised as a single agent.
Modification of Diet in Renal Disease Study GFR calculator uses:
creatinine
sex
age
ethnicity
Ondansetron MOA
Serotonin 5-HT3 receptor antagonist
Rotterdam Criteria For Diagnosis of PCOS
Two of the three following criteria are diagnostic of the condition:
Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3)
Oligo-ovulation or anovulation
Clinical and/or biochemical signs of hyperandrogenism
Typical Biochemistry
Elevated LH
LH:FSH >2 (normal is 1:1 ratio)
Which are the 2 major onco-proteins associated with high risk HPV?
E6 and E7
Treatments for overactive bladder
1st line treatments:
1. Oxybutynin (immediate release)*
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)
*Do not offer Oxybutynin to frail elderly patients
Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsiutable for surgical treatment
According to RCOG guidance antenatal steroids should be offered to which group undergoing elective C-section?
C-section prior to 38+6 weeks gestation
What is the incubation period for CMV?
3-12 weeks
What proportion of pregnancies are affected by gestational diabetes?
2-5%
A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks you if this will be permanent. What percentage of babies will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?
<10%
Diffuse homogeneous low level echoes
Echoes sometimes described as ‘ground glass’ the result of haemorrhagic material
Endometrioma
Advice for breastfeeding with HIV?
Mothers who are HIV positive regardless of viral load should be advised not to breastfeed. If they breastfeed against advice the infant should undergo additional testing on a monthly basis.
What treatments for genital warts cannot be used in pregnancy?
Podophylline + 5-fluorouracil is considered potentially teratogenic and shouldn’t be used.
From which germ layer does the myenteric plexus of the GI tract developed:
Neural crest of Ectoderm
What is the relative risk of VTE in pregnancy?
Relative risk of VTE in pregnancy is increased 4 to 6 fold in pregnancy
What is the typical daily dose (fraction) of radiotherapy for cancers?
1.8-2.0 Gy
What is the mortality rate associated with disseminated neonatal herpes assuming appropriate antiviral treatment is given?
30%
Management 3rd trimester Acquisition of Genital Herpes (from 28 weeks)
Initiate acicolvir 400 mg TDS and continue until delivery
C-section delivery is advised for these patients in whom this is a 1st episode of HSV
Following 1st or 2nd trimester acquisition, daily suppressive aciclovir 400 mg TDS from 36 weeks of gestation reduces HSV lesions at term and hence the need for delivery by caesarean section
Management 1st or 2nd trimester Acquisition of Genital Herpes
Initial episode treated acicolvir 400 mg TDS for 5 days
Risk factors/protective factors for fibroids:
Risk Factors
Black Ethnicity
Obesity
Early Puberty
Increasing age (from puberty until menopause)
Protective Factors
Pregnancy
Increasing number of pregnancies
What is the half life of Ergometrine?
30-120 minutes
Definition: frequency shift of reflected sound waves associated with movement of an object towards or away from their source (transducer)
Doppler effect
Definition: change in wave direction as it passes from one medium to another
Refraction
Definition: effect when sound waves are greater than the structure they come into contact with (e.g. red blood cells) causing uniform amplitude waves in all directions with little or no reflection returning to the transducer.
Scatter
Definition: decreasing intensity of a sound wave as it passes through a medium
Attenuation
Definition: bending of waves around small obstacles
Deffraction
The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical reactions:
Suppress LH
Suppress FSH
Elevate SHBG
Reduce adrenal androgen secretion
Decrease ovarian androgen synthesis
How long does uterine involution after delivery take?
4-6 weeks
Which test is used to detect antibodies or complement bound to red blood cell antigens in vivo?
Direct coombs test
When to restart Warfarin after delivery?
5-7 days (due to risk of PPH) + can breastfeed safely
Definitions of placenta attachments:
Accreta = chorionic villi attached to myometrium rather than decidua basalis
Increta = chorionic villi invade into the myometrium.
Percreta = chorionic villi invade through the myometrium
The juxtaglomerular apparatus (JGA) lies within which part of the kidney?
Renal cortex
1st line anti-emetics in pregnancy:
Cyclizine and Promethazine are 1st line in pregnancy according to NICE.
Metoclopramide however is not licensed for people under 20 years old and is known to cause oculogyric crisis, especially in young adults.
Hepatitis C is what kind of virus?
Flaviviridae
What happens to blood volume during pregnancy?
During pregnancy blood volume increases slowly by 40-50%. The increase is thought to be due to increased Aldosterone. The rise in volume mostly occurs during the 1st trimester.
What is the most common Type II congenital thrombophilia?
Factor V leiden is the most common congenital thrombophilia
Protein C and S deficiencies are type 1 (Not type 2) thrombophilias
Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
The following 4 hormones are structurally similar:
HCG
FSH
LH
TSH
The following 3 hormones are structurally similar:
Prolactin
GH
HPL
Drugs for uterine atony:
If uterine atony is perceived to be a cause of the PPH the following measures should be taken in turn
1. Syntocinon 5 units by slow intravenous injection (may have repeat dose)
2. Ergometrine 0.5 mg by slow intravenous or intramuscular injection (contraindicated in
women with hypertension)
3. Syntocinon infusion unless fluid restriction is necessary
4. Carboprost 0.25 mg by IM injection repeated at intervals of not less than 15
minutes to a maximum of 8 doses (contraindicated in women with asthma)
5. Direct intramyometrial injection of carboprost 0.5 mg
6. Misoprostol 1000 micrograms rectally
Fentanyl MOA
Mu receptor agonist
When assessing a women who has failed to conceive NICE advise 2 tests be performed in ALL women:
- Chlamydia screen
- Mid luteal phase Progesterone
What is the role of DHEA produced by the fetal adrenal glands?
Stimulate placenta to form oestragen
Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from
cholesterol (via Pregnenolone) by the adrenal glands.
Treatment of chlamydia:
Doxycycline 100mg bd for 7 days OR
Azithromycin 1gm orally in a single dose
In pregnant patients:
Azithromycin OR Ezithromycin
Common biochemical and haematological findings in patients who abuse alcohol:
Macrocytosis
Low Platelets
Can reduce WCC and RBC counts
Low serum urea
B12 deficiency
Raised GGT and deranged LFTs
Myeloma biochemical markers:
ALP = normal
Calcium = high
PTH = normal/high
phosphate = normal/high
Calcium Alkali Syndrome biochemical markers:
ALP = normal
calcium = high
PTH = low
phosphate = normal/high
Regarding heart rate in pregnancy which of the following statements is true?
Heart rate increases by 15 beats per minute
What is the composition of mature breast milk?
Fat 4%, Protein 1%, Sugar 7%
From what gestation is CTG assessment of RFM advised?
28 weeks
Significant proteinuria is considered when:
Urinary protein:creatinine ratio is >30 mg/mmol OR
24-hour urine collection >300 mg protein
What frequency would typically be used for monopolar diathermy?
500KHZ
Infertility investigations:
If there is likely tubal pathology (previous PID or pelvic surgery) then laparoscopy and dye testing is 1st line
Hysterosalpingography Typically performed using iodine based water soluble contrast
Piezoelectric crystal resonance is used in what imaging modality?
USS
Cardiac output is calculated by
stroke volume x heart rate
Mifepristone (RU 486) when used to for management of abortion works via what mechanism?
Anti-progestogen
You are asked to see a 42 year old women due to pelvic pain and PV discharge. She had IUCD fitted for emergency contraception 4 years ago. You send swabs. The microscopy reveals sulphur granules. What is the likely causative organism?
Actinomyces israelii
Mullerian agenesis patients are karyotype
46XX
CAIS patients are karyotype
46XY
pheochromocytoma arises from which cells?
The main cell type of the adrenal medulla is the Chromaffin cell; neuroendocrine tumor of the medulla of the adrenal glands
Forms of non-ionizing radiation:
MRI
USS
LASER
Elevated JVP normal waveform
Right sided heart failure
Fluid Overload
Bradycardia
Elevated JVP no pulsation
SVC obstruction
Absent A-waves JVP
Atrial fibrillation
Paradoxical JVP (Kussmauls)
Pericardial constriction
Large V wave
Absent X wave JVP
Tricuspid Regurgitation
Large A wave
Slow Y descent JVP
Tricuspid Stenosis
What is the average lifespan of a basophil (white blood cell)?
3-4 days
muscles assessed by urodynamic testing?
Detrusor and urethral sphincter muscles
Primary Hyperparathyroidism biochemical markers
High PTH with hypercalcaemia is seen in Primary Hyperparathyroidism.
parathyroid adenoma accounts for 97% of cases of primary hyperparathyroidism.
High PTH with hypercalcaemia is also seen in tertiary hyperparathyroidism. Tertiary hyperparathyroidism usually follows a long period of secondary hyperparathyroidism (most commonly due to renal failure).
What is the incubation period of Rubella (in days)?
14 (12-23)
You diagnose cellulitis. What is the most common causative organism?
Streptococcus Pyogenes
99% of body calcium is in what form?
Calcium Phosphate
Menorrhagia management:
1st Line
Levonorgestrel-releasing intrauterine system (IUS eg Mirena)
2nd Line
Tranexamic Acid, NSAIDs (eg Mefenamic Acid), COCP
3rd Line
Norethisterone (15 mg) daily from days 5 to 26 of the menstrual cycle, or injected long-acting progestogens
Tocolytic drug use may prolong pregnancy for
Up to 7 days
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban
What is the average volume of blood loss during one menstrual cycle?
35-40 pls
Which changes to biliary physiology occurs during pregnancy?
The lithogenic index increases in pregnancy hence the greater risk of gallstones.
Warfarin targets:
2.0 - 3.0 Most common used for DVT,PE & tissue valve replacement treatment
2.5 - 3.5 Used in mechanical mitral valve replacement & some aortic mech.valve replacements
3.0 - 4.0 Used in mechanical valve replacement where PE has occurred despite anticoagulation at lower range
A patient develops hypocalcaemia as a result of pancreatitis. What is the appropriate homeostatic response to hypocalcaemia?
Increased PTH, Increased 1,25 dihydroxycholecalciferol & Decreased phosphate
The luteinizing hormone (LH) surge during ovulation causes:
Increases cAMP resulting in increased progesterone and PGF2 production
PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
When do hormones peak during menstruation?
LH, FSH and Oestrogen have their peaks just before ovulation on day 14 whereas progesterone peaks around day 21.
Cabergoline and Bromocriptine are agonists of which receptor?
D2 (Dopamine agonists )
Laser ablation in TTTS - which laser?
Diode or ND:YAG
Pre cancerous lower genital tract changes (CIN) and condylomata (primarily HPV) - which laser?
CO2 laser
Factors shown to decrease risk of ovarian cancer are:
Oral contraceptive use
Higher Parity
Breast feeding
Hysterectomy
Tubal Ligation
Statins
SLE
What is the average lifespan of a platelet?
5-9 days
What is the normal rage for adjusted serum calcium?
2.2-2.6
What percentage of patients with PROM will go into labour within 24 hrs?
60%
In patients with endometriosis what is the infertility rate?
40%
During the inflammatory phase of wound healing what is the predominant cell type found in the wound during days 3-4?
Macrophages
What percentage of patients with cancer have hypercalcaemia?
Hypercalcaemia effects 10-30% of cancer patients. The main mechanism is through osteoclastic bone resorption which can occur with or without bony mets.
A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. She tells you he was born with a ‘blueberry muffin’ rash. What was the most likely infection?
Rubella
In type 2 necrotising fasciitis what is the most likely causative organism?
The most common single causative organism is Group A streptococcus (streptococcus pyogenes).
Paraventricular nucleus of the hypothalamus releases which 5 hormones?
Thyrotropin-releasing hormone
Corticotropin-releasing hormone
Oxytocin
Vasopressin
Somatostatin
What is the mode of action of Tranexamic acid?
Inhibits Plasminogen Activation
Features of functional ovarian cysts on ultrasound are:
Thin walled and unilocular
Must be >3cm diameter (if <3cm described as follicle)
Anechoic (absence of internal echoes)
No colour flow
No solid components
According to NICE guidelines what HBA1C level would prompt you to strongly advise this women NOT to get pregnant due to the signifiant risks it presents?
> 10.0% or 86mmol/mol
At what stage of fetal development does fetal haemoglobin (HbF) replace embryonic haemoglobin (HbE) as the primary form of haemoglobin?
10-12 weeks
Pelvic inlet diameters:
Anteroposterior Sacrum to Pubic Symphysis 11
Oblique SIJ - ileopectinal line 12
Transverse = Ileopectinal lines 13
When do patients have gestational diabetes screening?
Screening for gestational diabetes should be offered and performed between 24-28 weeks.
Screening is via a 2-hour post 75 g oral glucose tolerance test.
What is the mechanism of action of Cefalexin?
inhibit peptidoglycan cross-links in bacterial cell wall
In the earliest phase of wound healing platelets are held together by what?
Fibrin
metronidazole MOA
Inhibits nucleic acid synthesis via radical formation
The UK National Screening Committee (UK NSC) currently recommends routine antenatal screening for the following 3 infectious diseases:
HIV
Hepatitis B
Syphilis
A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 60mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?
A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 60mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?
Which serum markers are measured when undertaking the combined test?
hCG and PAPP A
Although hormone levels are not diagnostic of PCOS (and may be normal) the typical picture is:
Elevated LH
LH:FSH ratio increased (normally should be 1:1, in PCOS often 3:1)
FSH normal or low
Testosterone, Oestragen and Prolactin all typically normal or elevated
Sex Hormone Binding Globulin typically normal or reduced
Which group of beta haemolytic streptococci is associated with chorioamnioitis?
Group B Streptococcus is associated with chorioamnioitis
What family of virus does Rubella belong to?
Togaviruses
correct gestational window for using the combined test for chromosomal screening?
11 weeks + 2 days and 14 weeks + 1 day gestation
You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows a large irregular haemorrhagic mass that appears to be invading into the myometrium. What is the likely diagnosis?
These are the typical features of choriocarcinoma. 20% occur after TOP.
What is the maximum dose of lidocaine (without adrenaline)?
The maximum dose of lidocaine (without adrenaline) is 3mg/kg
When is Varess needle entry inappropriate?
Morbid Obesity (BMI>40):
Hasson technique or entry at Palmers point
Reason: difficult penetration with Varess needle
Very Thin Patients:
Hasson technique or insertion at Palmers point
Reason: higher risk of vascular injury
Blood supply to piriformis?
Superior and Inferior gluteal arteries and lateral sacral arteries
Nerve: L5-S2
The HPV vaccine Gardasil® is what type of vaccine?
Recombinant vaccine of virus-like particles (VLPs)
HPV Types 6, 11, 16, and 18
A 29 year old patient who is 8 weeks pregnant comes to see you. She currently has chickenpox. She is concerned her baby may get congenital fetal varicella syndrome (FVS). What would you advise her the risk of this is?
The risk of FVS to babies born to mothers who have chickenpox during the first 20 weeks gestation is 0.4% (1-12 weeks) - 2.0% (13-20 weeks).
FVS can cause the following abnormalities
Hypoplasia of one limb
Cicatricial lesions with a dermatomal distribution
CNS abnormalities
Eye abnormalities
Delayed puberty in girls is defined as?
absence of breast development in girls beyond 13 years old
The yolk sac reaches its maximum diameter at what week of gestation?
The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy.
Biopsy confirms VIN. What is the approximate risk of developing squamous cell carcinoma?
15%
What type of virus is HIV?
HIV is a retrovirus/Its genus is lentivirus
effects of the COCP on a patients hormone profile?
FSH decreased, LH decreased, E2 decreased
anti-thyroid peroxidase (anti-TPO) and also anti-thyroglobulin (anti-Tg) antibodies seen in:
Hashimoto’s
The World Health Organisation define the maternal mortality ratio as
Maternal deaths per 100,000 live births
What is the typical oxygen consumption in a 75kg non-pregnant women?
The typical Oxygen Consumption (VO2) is 250ml/min.
In pregnancy this increases by around 20% to 300ml/min
what is the most appropriate suture option for repairing the anal mucosa?
The RCOG suggests 3.0 polyglactin for repair of the AM (either interrupted or continuous)
HPV genotypes 6 and 11 are associated with
Low grade squamous intraepithelial lesions of the cervix
What is the maximum dose of lidocaine with adrenaline?
The maximum dose of lidocaine with adrenaline is 7mg/kg
What is the causative organism of Scarlet Fever?
Streptococcus pyogenes
What percentage of women with a diagnosis of Gonorrhoea will develop pelvic inflammatory disease?
15$
