BREAST/SEXUAL HEALTH Flashcards

Question 1

Q

BREAST CANCER
What are some protective factors of breast cancer?

Answer

A

Breastfeeding
Multiparity
Late menarche + early menopause

Question 2

Q

BREAST CANCER
What are the 2 main genes involved in breast cancer and how do they act?

Answer

A

BRCA1 = mutation of C17, 60-80% lifetime risk, stronger incidence
BRCA2 = mutation of C13, 45% lifetime risk
Tumour suppression genes that act as inhibitors of cellular growth

Question 3

Q

BREAST CANCER
What warrants an urgent 2ww cancer referral?
What happens under the 2ww referal?

Answer

A

≥30 with unexplained breast lump ± pain
≥50 with nipple discharge, retraction or other change of concern in one nipple only
Triple assessment

Question 4

Q

BREAST CANCER
What tumour marker can be used to monitor response to breast cancer treatment and disease recurrence?

Question 5

Q

BREAST CANCER
What are some complications of breast cancer?

Answer

A

Locally advanced (rare), try shrink with radio, chemo, or hormone therapy to try operate, salvage surgery + stage for mets
Metastatic breast cancer (2Ls 2Bs) = Lungs, Liver, Bones, Brain

Question 6

Q

BREAST INFECTION
What is the management of lactational mastitis?

Answer

A

Continue breastfeeding
Rx if systemically unwell with FLUCLOXACILLIN or erythromycin/clarithromycin if allergic
May develop abscess (lump + erythema) so need drainage

Question 7

Q

BREAST INFECTION
What is the management of non-lactational mastitis?

Answer

A

co-amoxiclav 500/125mg TDS for 10-14 days
erythromycin/clarithromycin + metronidazole for 10-14 days

Question 8

Q

BREAST PAIN
What is the management of cyclical mastalgia?

Answer

A

Supportive bra, reassurance, PO/topical analgesia
Danazol (weak androgen) but SEs = breast shrinkage, acne, weight gain
Tamoxifen (risk of endometrial cancer)
Goserelin

Question 9

Q

GYNAECOMASTIA
What are some pathological causes of gynaecomastia?

Answer

A

Drugs (spironolactone, oestrogen, anabolic steroids, digoxin, finasteride)
Marijuana
Liver failure
Testicular failure or tumour (Can produce beta-hCG)

Question 10

Q

METASTATIC BREAST CANCER
What is the management?

Answer

A

Bisphosphonates + denosumab, radio/chemo + Sx control

Question 11

Q

BREAST CANCER
what is tamoxifen?

Answer

A

tamoxifen inhibits the oestrogen receptor on breast cancer cells
It increases survival by 15-25% in woman with ER+ cancer
give for 10 years in higher risk women

Question 12

Q

BREAST CANCER
what are the complications of tamoxifen?

Answer

A

hot flushes
nausea
vaginal bleeding
rarely thrombosis and endometrial cancer

Question 13

Q

BREAST CANCER
what are aromatase inhibitors?

Answer

A

letrozole
Inhibit aromatase enzyme responsible for the conversion of androgens to oestogen in post-menopausal woman
slightly better anticancer efficacy than tamoxifen

Question 14

Q

BREAST CANCER
what are the side effects of aromatase inhibitors?

Answer

A

hot flushes
reduced bone density
joint pains

Question 15

Q

PAGET’S DISEASE OF THE NIPPLE
what are the risk factors?

Answer

A

old age
FHx of breast cancer
Previous breast cancer
overweight
excess alcohol
smoking
risk factors for breast cancer

Question 16

Q

BREAST IMPLANTS
what are the complications?

Answer

A

capsule formation
infection
rupture and shape changes with age
can hamper sensitivity of mammograms
breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Question 17

Q

BREAST INFECTION
what is the management of breast abscesses?

Answer

A

aspiration + antibiotics + supportive care
surgical intervention only if aspiration and antibiotics repeatedly fail

Question 18

Q

PAPILLOMA
what is the clinical presentation?

Answer

A

bloody or clear discharge from a single duct
typically in a premenopausal woman

Question 19

Q

PAPILLOMA
what is the management?

Answer

A

removal via vacuum assisted excision (VAE)

Question 20

Q

PHYLLODES TUMOUR
what is the characteristic appearance on histology?

Answer

A

leaf-like architecture

Question 21

Q

CHLAMYDIA
How would you manage chlamydia?

Answer

A

Test for other STIs, contraceptive advice, ?safeguarding if child.
Doxycycline 100mg BD for 7d (C/I pregnancy or breastfeeding).
1g azithromycin stat dose in pregnancy (erythromycin or amoxicillin safe too)
Referral to GUM for partner notification + contact tracing.

Question 22

Q

GONORRHOEA
What is the management of gonorrhoea?

Answer

A

1g single dose IM ceftriaxone
if needle phobic = oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
Follow-up test of cure with NAAT testing or cultures

Question 23

Q

BACTERIAL VAGINOSIS
What diagnostic criteria is used in BV?

Answer

A

Amsel’s (3/4)
- Thin, white discharge
- Vaginal pH >4.5
- Clue cells on cervical swab MC&S (endocervical or self-taken vaginal)
- Positive whiff test (add potassium hydroxide to get very strong fishy odour)

Question 24

Q

TRICHOMONAS VAGINALIS
What is the clinical presentation of TV?

Answer

A

PV discharge classically offensive, frothy + yellow/green.
Vulvovaginitis, itching, dysuria + dyspareunia.
May cause urethritis + balanitis in men

Question 25

Q

SYPHILIS
What is the clinical presentation of primary syphilis?

Answer

A

SYMPTOMS
- single painless ulcer (chancre) on genitals
- occasionally chancre on throat, anus or intravaginally

Question 26

Q

SYPHILIS
What is the clinical presentation of secondary syphilis?

Answer

A

SYMPTOMS
- fever
- headaches

SIGNS
- diffuse maculopapular rash on palms and soles
- patchy oral ulceration (snail track ulcers)
- condylomata lata (wart-like lesions at sites of skin friction)
- patchy alopecia (moth-eaten appearance)
- generalised lymphadenopathy (non-tender)

Question 27

Q

SYPHILIS
What is the clinical presentation of tertiary syphilis?

Answer

A

NEUROSYPHILIS
- meningovascular syphilis (stroke due to arteritis)
- argyll-robertson pupil (constricts to accommodation, but not to light)
- loss of intellect, insight, memory, spastic paraparesis
- tabes dorsalis (inflammaiton + degeneration of spinal dorsal columns)

CARDIOVASCULAR
- aortic aneurysm
- aortic regurgitation
- coronary ostia stenosis
- conduction defects

GUMMATOUS
- gumma = nodule that heals with central scarring

Question 28

Q

SYPHILIS
What is an Argyll-Robertson pupil?

Answer

A

“Accommodates but does not react”
- Constricted pupil that accommodates when focusing on near object but does not react to light, often irregularly (small) shaped

Question 29

Q

SYPHILIS
How would you manage syphilis?

Answer

A

Specialist GUM (full STI screening, contact tracing, contraceptive information).
early syphilis = Single dose IM benzathine benzylpenicillin or PO doxycycline if allergic
late latent/gummatous = 3 doses IM benzathine benzylpenicillin once weekly for 3 weeks
cardiovascular syphilis = 3 days of PO prednisolone + 3 once weekly doses IM benzathine benzylpenicillin
neurosyphilis = 14 days IM procaine penicillin + oral probenecid

Question 30

Q

SYPHILIS
What is a potential adverse effect of treating syphilis?

Answer

A

Jarisch-Herxheimer reaction within a few hours of treatment
Fever, rash + tachycardia thought to be due to release of endotoxins following bacterial death

Question 31

Q

GENITAL HERPES
What is the clinical presentation of genital herpes?

Answer

A

Multiple painful ulcers
Neuropathic type pain (tingling, burning, shooting)
Flu Sx (fatigue, headaches, fever, myalgia)
Dysuria

Question 32

Q

GENITAL HERPES
What other specific symptoms may be seen in genital herpes?

Answer

A

Aphthous ulcers (small painful oral sores)
Herpes keratitis (inflammation of the cornea = blue)
Herpetic whitlow (painful skin lesion on finger/thumb)

Question 33

Q

GENITAL HERPES
What is the management or primary genital herpes contracted before 28w gestation?

Answer

A

Aciclovir during infection
Prophylactic aciclovir from 36w gestation onwards to reduce risk of genital lesions during labour + delivery
Asymptomatic at delivery can have vaginal if >6w from initial infection, if Sx then c-section

Question 34

Q

GENITAL HERPES
What is the management of primary genital herpes after 28w gestation?

Answer

A

Aciclovir during infection + immediate prophylactic aciclovir
C-section in all cases

Question 35

Q

GENITAL HERPES
What is the management of recurrent genital herpes in pregnancy?

Answer

A

Occurs if woman known to have genital herpes before pregnancy
Low risk of neonatal infection even if lesions at delivery
Prophylactic aciclovir from 36w to reduce risk of Sx at delivery

Question 36

Q

GENITAL HERPES
What is the management of genital herpes?

Answer

A

Specialist GUM Mx
Conservative (paracetamol, topical lidocaine 2% instillagel, clean with warm saltwater, topical vaseline, PO fluids, loose clothing, avoid sex).
Aciclovir may be used

Question 37

Q

GENITAL WARTS
What causes genital warts?

Answer

A

Human papilloma virus 6 + 11
Can stay in skin + warts can develop again

Question 38

Q

CANDIDIASIS
What is the management of candidiasis?

Answer

A

1st line = oral fluconazole 150mg single dose
2nd line = clotrimazole 500mg intravaginal pessary single dose

if there are vulval symptoms, consider topical imidazole in addition to oral/intravaginal antifungal
if pregnant, only local treatments (creams/pessaries) may be used - oral is contraindicated

Question 39

Q

HIV
What is HIV?
What is the pathophysiology of HIV?

Answer

A

RNA retrovirus that encodes reverse transcriptase
Binds to GP120 envelope glycoprotein to CD4 receptors which migrate to lymphoid tissue where virus replicates + produces billions of new virions
Reverse transcriptase makes single strand RNA > double stranded DNA + viral DNA is integrated to host cell’s DNA with enzyme integrase + core viral proteins synthesised + cleaved by viral protease
These then released + in turn infect new CD4 cells

Question 40

Q

HIV
what are the first line investigations

Answer

A

HIV antigen/antibody test
HIV RNA viral load

Question 41

Q

HIV
What are the considerations with HIV and pregnancy?

Answer

A

Normal vaginal delivery if viral load <50 copies/ml
Consider c-section if >50, but mandatory in >400
IV zidovudine 4h before c-section
Neonatal PO zidovudine if maternal viral load <50 if not triple ART both for 4–6w
No breastfeeding

Question 42

Q

HIV
What are the 4 main groups of HIV treatment?

Answer

A

Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors (PIs)
Integrase inhibitors (IIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Question 43

Q

HIV
What are some examples of and the mechanism of action of…

i) NRTIs?
ii) PIs?
iii) IIs?
iv) NNRTIs?

Answer

A

i) Zidovudine, tenofovir, emtricitabine – inhibits synthesis of DNA by reverse transcriptase
ii) Indinavir (end –navir) – acts competitively on HIV enzyme involved in production of functional viral proteins
iii) Raltegravir (end –gravir) – inhibits insertion of HIV DNA to genome
iv) Nevirapine – binds directly to + inhibits reverse transcriptase

Question 44

Q

HIV
What is the role of post-exposure prophylaxis (PEP) in HIV?

Answer

A

Given within 72h of exposure to HIV+ (sooner = better)
ART therapy = Truvada (emtricitabine + tenofovir) + raltegravir for 28d
HIV test done immediately + 3m after, should abstain for 3m

Question 45

Q

BACTERIAL VAGINOSIS
What causes BV to occur less frequently?

Answer

A

Less frequent if COCP or effective condom usage

Question 46

Q

TRICHOMONAS VAGINALIS
What can it increase the risk of?

Answer

A

Contracting HIV by damaging vaginal mucosa
BV,
cervical cancer,
PID
pregnancy-related complications.

Question 47

Q

SYPHILIS
What is the causative organism?

Answer

A

Treponema pallidum – spirochete (spiral-shaped) bacteria

Question 48

Q

HIV
Explain the process of PCR testing

Answer

A

P24 antigen tests directly for viral antigen in blood + can give +ve earlier in infection compared to antibody test, HIV RNA levels tests directly for number of viral copies in blood giving a viral load

Question 49

Q

BALANITIS
what is the clinical presentation?

Answer

A

red, swollen, itchy and sore penis
pain when peeing
thick discharge from under foreskin
unpleasant smell
difficulty pulling back foreskin

Question 50

Q

BALANITIS
what is the general management for balanitis?

Answer

A

gentle saline washes
ensuring to wash foreskin properly
1% hydrocortisone for short period

Question 51

Q

BALANITIS
what is the treatment for bacterial infection?

Answer

A

flucloxacillin or clarithromycin if penicillin allergic

Question 52

Q

BALANITIS
what is the treatment for anaerobic balanitis?

Answer

A

saline washing
oral metronidazole

Question 53

Q

BALANTITIS
what is the specific treatment for balanitis caused by dermatitis?

Answer

A

mild topical corticosteroids (hydrocortisone)

Question 54

Q

LYMPHOGRANULOMA VENEREUM
what is it?

Answer

A

STI caused by serovars L1, L2 or L3 or chlamydia trachomatis

Question 55

Q

LYMPHOGRANULOMA VENEREUM
what are the clinical features?

Answer

A

Painless genital ulcer
Painful Inguinal lymph nodes

Proctitis, rectal pain, rectal discharge (in rectal infections)
Systemic symptoms such as fever and malaise

Question 56

Q

LYMPHOGRANULOMA VENEREUM
what is the management?

Answer

A

Treatment is with antibiotics. Common regimes include:

Oral doxycycline 100 mg twice daily for 21 days
Oral tetracycline 2 g daily for 21 days
Oral erythromycin 500 mg four times daily for 21 days

Question 57

Q

CHANCROID
what are the causes?

Answer

A

Haemophilus ducreyi

Given its relatively high incidence in topical areas and Greenland, it is important to inquire in the history about recent travel.

Question 58

Q

CHANCROID
what are the clinical features?

Answer

A

painful genital ulcer
tender unilateral inguinal lymphadenopathy

Question 59

Q

CHANCROID
what is the management?

Answer

A

single dose AZITHROMYCIN
alternatives = ceftriaxone, erythromycin or ciprofloxacin
partner notification + treatment
abscess drainage

Question 60

Q

COCP
What are the benefits of the COCP?

Answer

A

Effective contraception, rapid return of fertility after stopping.
Improvement in PMS, menorrhagia + dysmenorrhoea (acne in some).
Reduced risk of endometrial, ovarian, colon cancer + benign ovarian cysts.

Question 61

Q

COCP
What are some side effects + risks with the COCP?

Answer

A

Unscheduled bleeding common in first 3m.
Breast pain + tenderness.
Mood changes + depression.
Headaches, HTN, VTE.
Small raise in risk of breast + cervical cancer (risk normalises after 10y taking pill).
Small raise in risk of MI + stroke.

Question 62

Q

COCP
What are the UKMEC4 criteria for the COCP?

Answer

A

Uncontrolled HTN.
Migraine with aura.
> 35 smoking >15/day.
Major surgery with prolonged immobility (stop 4w before major surgery)
Hx of stroke, IHD, AF, VTE.
Active breast cancer.
Liver cirrhosis or tumours.
SLE + antiphospholipid syndrome.
Breastfeeding before 6w postpartum (UKMEC2 after).

Question 63

Q

COCP
What are the UKMEC3 criteria for the COCP?

Answer

A

> 35 smoking <15/day.
BMI >35kg/m^2.
Controlled HTN.
VTE FHx in 1st degree relatives.
Immobility.
Known carrier of BRCA1/2.

Question 64

Q

POP
What are the rules regarding switching from COCP to POP?

Answer

A

Best time to change is days 1–7 of the hormone-free period after finishing the COCP pack as no additional contraception required.
Any other time requires 48h contraception.

Answer 64

A

Increased risk of ovarian cysts, small risk of ectopic pregnancy with traditional POP due to reduced ciliary action, minimal increased risk of breast cancer (returns to normal 10y after stopping).

Answer 65

A

Changes to bleeding schedule main issue
- Bleeding often more irregular, heavier + last longer.
- Usually temporary, >1y of regular use most become amenorrhoeic.
- Exclude other causes of bleeding.
- Can use COCP for 3m if problematic bleeding.
- Short course (5d) of mefenamic acid can halt bleeding.

Answer 66

A

Weight gain
Reduced BMD (oestrogen maintains BMD + mostly produced by follicles in ovaries)
– Makes depot unsuitable for those >45
Takes 12m for fertility to return after stopping

Answer 67

A

UKMEC4 = active breast cancer.
UKMEC3 = IHD + stroke, unexplained vaginal bleeding, severe liver cirrhosis + liver cancer.

Answer 68

A

Inhibits ovulation.
Thickens cervical mucus.
Alters endometrium to make it less accepting to implantation.

Answer 69

A

Effective + reliable.
Can improve dysmenorrhoea + can make periods lighter or stop altogether.
No weight gain, effect on BMD, no VTE risk, no restrictions for obese patients.

Answer 70

A

Problematic bleeding (20% amenorrhoeic, 25% frequent/prolonged bleeding, 33% infrequent, rest normal, can use COCP for 3m if problematic bleeding + no C/Is).
Can worsen acne, no STI protection.

Answer 71

A

Can be bent/fractured or impalpable/deeply implanted needing extra contraception until located (USS/XR), may need specialist removal.
Very rarely can enter vessels + migrate through body to lungs.

Answer 72

A

Reliable contraception.
Insert at any time in cycle + immediate protection.
No hormones so safe in VTE risk of Hx or cancer.
May reduce risk of endometrial + cervical cancer.

Answer 73

A

Procedure with risks for insertion/removal.
Can cause HMB/IMB which often settles.
Some women have pelvic pain.
No STI protection.
Increased risk of ectopic pregnancies.
Occasionally falls out.

Answer 74

A

Progesterone component thickens cervical mucus.
Alters endometrium making less hospitable + inhibits ovulation in small # of women.

Answer 75

A

Can make periods lighter or stop.
May improve dysmenorrhoea or pelvic pain related to endometriosis.
No effect on BMD, VTE, no restrictions in obese pts.

Answer 76

A

Procedure with risks for insertion/removal.
Can cause spotting or irregular bleeding.
Some women experience pelvic pain.
No STI protection.
Increased risk of ectopic pregnancies.
Occasionally falls out.
Increased incidence of ovarian cysts.
Systemic absorption can lead to progesterone Sx (acne, headaches, breast tenderness).

Answer 77

A

i) 99% regardless of time in cycle
ii) <120h of UPSI or 120h after earliest estimated date of ovulation
iii) Toxic to sperm + ovum so inhibits fertilisation + implantation.
iv) Keep in until at least next period

Answer 78

A

i) Single 30mg dose
ii) Second most effective but decreases with time
iii) <120h
iv) Selective progesterone receptor modulator that inhibits ovulation
v) Vomiting within 3h then repeat dose
vi) Spotting + changes to next menstrual period, abdo/pelvic/back pain, mood changes, headaches, dizziness, breast tenderness

Answer 79

A

Pros
- More effective than levonorgestrel
- Can be used >1 in one cycle
Cons
- Avoid breastfeeding for 1w (express but discard)
- Avoid in severe asthma
- Wait 5d before starting COCP or POP with 7 or 2d extra contraception needed

Answer 80

A

i) Single 1.5mg dose (3mg if BMI >26kg/m^2)
ii) Least effective of group 84%
iii) <72h
iv) Stops ovulation + inhibits implantation
v) Spotting + changes to next menstrual period, diarrhoea, breast tenderness, dizziness, depressed mood

Answer 81

A

Pros
- Safe during breastfeeding (Avoid for 8h to avoid infant exposure though).
- COCP/POP can start instantly but with extra contraception for 7/2d
- Use more than once in a menstrual cycle
Cons
- Less effective

Answer 82

A

After >1y or…
- Female >35
- Menstrual disorder
- Previous abdo/pelvic surgery
- Previous PID/STI
- Abnormal pelvic exam

Answer 83

A

PCOS
POI,
pituitary tumours,
hyperprolactinaemia,
Turner syndrome,
Sheehan’s,
previous radio/chemo

Answer 84

A

Indication of ovulation
7d before end of cycle (usually day 21)
<16 = anovulation, >30 is ovular

Answer 85

A

Serum FSH + LH on days 2–5 (high = poor ovarian reserve)
Anti-mullerian hormone (released by granulosa cells in growing follicles so falls as eggs depleted)
Antral follicle count on USS (Few suggest poor ovarian reserve)

Answer 86

A

Weight loss
Clomiphene (selective oestrogen receptor modulator on days 2–6 to inhibit oestrogen + cause more GnRH + so FSH + LH release) or letrozole (aromatase inhibitor) to stimulate ovulation.
Gonadotrophins to stimulate ovulation if resistant to clomiphene
Ovarian drilling may be used in PCOS

Answer 87

A

After >1y or…
- Previous genital pathology or urogenital surgery
- Previous STI
- Systemic illness
- Abnormal genital exam

Answer 88

A

Pre-testicular causes
Testicular causes
Post-testicular causes
Genetic/congenital causes of defective/absent sperm production
Azoospermia or teratozoospermia

Answer 89

A

Pituitary/hypothalamus pathology,
suppression due to stress,
chronic conditions,
hyperprolactinaemia,
Kallmann’s

Answer 90

A

Klinefelter’s,
Y chromosome deletions

Answer 91

A

Multiple pregnancy
Miscarriage + ectopics
Ovarian hyperstimulation syndrome
Bleeding + infection at egg collection
Failure

Answer 92

A

Mild = abdo pain + vomiting
Mod = N+V + ascites on USS
Severe = ascites, oliguria
Critical = anuria, VTE, ARDS

Answer 93

A

Younger age.
Lower BMI.
PCOS.
Higher antral follicle count.

Answer 94

A

Activation of RAAS > high renin
Haematocrit raised as less fluid in intravascular space
USS + serum oestrogen (high = risk) – monitor these to identify those at risk.

Answer 95

A

PO fluids
Monitor urine output
LMWH
Paracentesis for ascites
IV colloids

Answer 96

A

Up to day 7 = immediate protection.
> Day 7 = extra contraception for 7d

Answer 97

A

Damage from mumps, undescended testes, trauma, cancer, radio/chemo

Answer 98

A

Retrograde ejaculation,
scarring from epididymitis (chlamydia),
absence of vas deferens (may be associated with cystic fibrosis, even carriers),
damage to testicle or vas (trauma, surgery, cancer).

Answer 99

A

Steroid abuse,
vasectomy

Answer 100

A

Testicular cancer

Answer 101

A

Gonadotrophins if hypogonadotrophic hypogonadism, bromocriptine if hyperprolactinaemia + sexual dysfunction

Answer 102

A

Increased vascular endothelial growth factor (VEGF) from granulosa cells increases vascular permeability so fluid leaks from intravascular>extravascular space (oedema, ascites + hypovolaemia).
Gonadotrophins to mature follicles.

Answer 103

A

Ovarian cycle (development of follicle + ovulation)
Uterine cycle (functional endometrium thickens + shreds)

Answer 104

A

Independently primordial follicles mature into primary + secondary follicles with FSH receptors
Low oestrogen + progesterone = pulses of GnRH > LH + FSH release
FSH leads to follicular development + recruitment

Answer 105

A

Theca cells develop LH receptors + secrete androgens
Granulosa cells develop FSH receptors + secrete aromatase
Leads to increased oestrogen > -ve feedback on pituitary to reduce LH + FSH leading to some follicles to regress

Answer 106

A

Follicle (dominant) with most FSH receptors continues developing
Secretes further oestrogen which at a threshold causes spike in LH (+ slight rise in FSH) causing release of ovum on day 14

Answer 107

A

Dominant follicle > corpus luteum + luteinised granulosa cells converts cholesterol into progesterone for 10d to facilitate implantation + reduce FSH/LH + oestrogen
Also secretes inhibin to reduce FSH

Answer 108

A

Syncytiotrophoblast of embryo secretes human chorionic gonadotropin (hCG) which maintains corpus luteum

Answer 109

A

hCG absence > corpus luteum degenerates into corpus albicans
Fall in progesterone + oestrogen causes endometrium to breakdown + menstruation occurs
FSH + LH levels rise
Stromal cells of endometrium release prostaglandins to encourage endometrium breakdown + uterine contraction

Answer 110

A

Progesterone mediated + signals ovulation occurred to make endometrium receptive, cause spiral arteries to grow longer + uterine glands to secrete more mucus

Answer 111

A

Cervical mucus thickens + less hospitable for sperm
Decrease in oestrogen + progesterone > spiral arteries collapse + constrict + functional layer prepares to shred

Answer 112

A

Menstruation (Days 1-5)
Proliferation (Days 6-14)
Ovulation (Day 14)
Secretion (Days 16-28)

Answer 113

A

High oestrogen > thickening of endometrium, growth of endometrial glands + emergence of spiral arteries from stratum basalis to feed the functional endometrium
Consistency of cervical mucus changes to make more hospitable for sperm

Answer 114

A

induction = oral fluconazole every 3 days for 3 doses
maintenance = oral fluconazole weekly for 6 months

Answer 115

A

HTN
diabetes mellitus
hypercholesterolaemia
drug induced
depression
anxiety
chronic stress

Answer 116

A

HbA1c (to assess for diabetes)
serum testosterone levels (to assess for hypogonadism)
serum TSH (assess for hypo/hyperthyroidism)
serum lipid profile (assess for hyperlipidaemia)
international index of erectile dysfunction
sexual inventory for men (survey to assess severity)

to consider
- penile doppler USS
- nocturnal penile tumescence testing
- neurological evaluation
- psychological assessment

Answer 117

A

1st line
- lifestyle modification (weight loss, physical activity, reduced alcohol, smoking cessation, BP control)
- psychosexual counselling
- phosphodiesterase-5 (PDE-5) inhibitors = SILDENAFIL (viagra)
- vacuum erection device

2nd line
- intracavernous injection therapy
- surgical intervention (penile prosthesis implant)

Answer 118

A

phthirus pubis - found on pubic and perianal hairs

Answer 119

A

permethrin 5% or Malathion 0.5%

advice to prevent transmission
- decontamination of clothing + bedding by washing at 50 degrees
- avoid close body contact + sharing of clothes, bedding and personal hygiene products

Answer 120

A

solitary lesion
peripheral tumour
small lesion in large breast
DCIS < 4cm

Answer 121

A

multifocal tumour
central tumour
large lesion in small breast
DCIS > 4cm

Answer 122

A

failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse

Answer 123

A

couples who have never conceived

Answer 124

A

couples who have conceived at least once before (with same or different sexual partner)

Answer 125

A

previous or current STI
obesity
low body weight
smoking
stress
exposure to occupational environmental hazards
NSAID use
chemotherapy
antidepressants
antipsychotics
marijuana or cocaine use

Answer 126

A

hyperstimulated ovaries release vasoactive mediators
inscreased capillary permeability causes fluid to shift from intravascular compartment to 3rd space compartment
SOB due to pleural effusion

Answer 127

A

headache
confusion
drowsiness

Answer 128

A

single or multiple ring enhancing lesions

Answer 129

A

sulfadiazine
pyrimethamine

Answer 130

A

EBV infection

Answer 131

A

single or multiple homogenous enhancing lesions

Answer 132

A

steroids
chemotherapy
whole brain radiotherapy

Answer 133

A

CNS LYMPHOMA
- single lesion
- solid (homogenous) enhancement
- thallium SPECT positive

TOXOPLASMOSIS
- multiple lesions
- ring or nodular enhancement
- thallium SPECT negative

Answer 134

A

CSF test with india ink = positive

Answer 135

A

cryptococcus