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Reproduction > Clinical- Week 1 > Flashcards

Clinical- Week 1 Flashcards

1
Q

after 1 episode of chlamydia, what is the chance of tubal blockage?

A

10%

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2
Q

after 3 episodes of chlamydia, what is the chance of tubal blockage?

A

50%

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3
Q

what is the maximum waiting time for IVF treatment?

A

12 months

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4
Q

what is the most common reason for requiring assisted conception therapy?

A

male factor

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5
Q

what is the optimal BMI for males and females before starting assisted contraception therapy?

A

19-29

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6
Q

what folic acid supplementation should be taken preconception and up to 12 weeks gestation?

A

0.4mg per day

5mg per day if high risk

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7
Q

what does folic acid supplementation during/before pregnancy prevent?

A

neural tube defects

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8
Q

what kind of vaccine is the rubella vaccine?

A

live attenuated vaccine

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9
Q

what does the antral follicle count measure?

A

a womens ovarian reserve (number of eggs she has left)

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10
Q

what are the 5 main treatments available for assisted conception?

A
  • donor insemination
  • intra-uterine insemination (IUI)
  • in vitro fertilisation (IVF)
  • intra-cytoplasmic sperm injection (ICSI)
  • surrogacy
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11
Q

how is intra-uterine insemination achieved?

A

semen inserted into uterine cavity around time of ovulation

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12
Q

what is the main pro and con for using a stimulated menstrual cycle in intra-uterine insemination?

A
  • improves success rate

- increases rate of multiple pregnancy

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13
Q

below what motile sperm count should ICSI be used instead of IVF?

A

below 1 x 10^6 motile sperm

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14
Q

how long must a couple be trying to conceive unsuccessfully (unexplained) for IVF to be an option?

A

over 2 years of unexplained infertility

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15
Q

during IVF treatment, why is the first step down regulation?

A

to artificially put women in menopause, so the doctor can time IVF cycle precisely with no spontaneous ovulation

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16
Q

what are the main side effects of down regulation during IVF?

A

hot flushes
mood swings
headaches
nasal irritation

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17
Q

how do you achieve down regulation during IVF?

A

synthetic gonadotrophin releasing hormone analogue (buserelin)
-injection or nasal spray

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18
Q

in down regulation during IVF treatment, what does the endometrium look like?

A

thin endometrium (similar to menopausal women)

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19
Q

what is the next step in IVF treatment after down regulation?

A

ovarian stimulation

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20
Q

how do you achieve ovarian stimulation during IVF?

A

gonadotrophin hormone

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21
Q

what is the purpose of ovarian stimulation in IVF treatment?

A

causes follicular development

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22
Q

what are the 2 main side effects of gonadotrophin hormone given during ovarian stimulation in IVF?

A
  • mild allergic reactions

- ovarian hyperstimulation syndrome (OHSS)

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23
Q

in IVF treatment, after gonadotrophin hormone is given, what is the next step?

A

HCG injection

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24
Q

what is the purpose of the HCG injection given in IVF treatment?

A

mimics spontaneous LH surge

caused resumption of meiosis in oocyte

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25
Q

how long after the HCG injection in IVF treatment are oocytes collected?

A

36 hours

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26
Q

how long before a sperm sample is collected for IVF must the male abstain?

A

72 hours

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27
Q

what are the main risks of egg collection in IVF?

A
  • bleeding
  • pelvic infection
  • failure to obtain oocytes
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28
Q

what happens to the eggs when they are collected for IVF?

A

eggs are separated from follicular fluid and collected in cell culture medium
incubated at 37 degrees

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29
Q

in the normal development of a human embryo, at what day is a blastocyst formed?

A

day 5

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30
Q

in the normal development of a human embryo, at what day should it be entering the uterus?

A

day 5

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31
Q

in the normal development of a human embryo, at what day should it be starting to implant?

A

day 7

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32
Q

compare the number of embryos that can be transferred in patients under 40 and over 40?

A

under 40- no more than 2 embryos (usually just 1)

over 40- 3 in exceptional circumstances

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33
Q

what luteal support is given after embryo transfer in IVF?

A

progesterone (cyclogest) pesaries for 2 weeks

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34
Q

when do you do a pregnancy test in the process of IVF?

A

2 weeks after embryo transfer

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35
Q

if the pregnancy test is positive during IVF treatment, what is the next scan?

A

transvaginal scan, 5 weeks after embryo transfer

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36
Q

what is ovarian hyperstimulation syndrome? (OHSS)

A

over-enlarged ovaries- excess follicles

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37
Q

why do patients with ovarian hypestimulation syndrome accumulate fluid centrally? eg ascited, pleural effusion, pericardial effusion

A

membranes become leaky

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38
Q

what is the treatment of ovarian hyperstimulation syndrome if it occurs before embryo transfer?

A
  • coasting
  • elective egg freeze
  • single embryo transfer
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39
Q

what is coasting in IVF?

A

withholding gonadotrophins and HCG injection in order to reduce estradiol to let ovarian hyperstimulation syndrome settle

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40
Q

what is the treatment of ovarian hyperstimulation syndrome if it occurs after embryo transfer?

A
  • monitor with scans/bloods
  • antithrombotic: fluids, TED stockings, fragmin
  • analgesia
  • drain fluid
  • hospital admission if required
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41
Q

as you increase the age of the patient, what happens to the rate of IVF success?

A

success rate decreases

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42
Q

what authority regulates assisted reproductive technologies?

A

human fertilisation and embryo authority (HFEA)

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43
Q

up to how many days gestation, is embryo research permitted by the law?

A

14 days

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44
Q

up to how many weeks gestation, is abortion permitted by the law?

A

24 weeks

later if severely handicapped or significant risk to maternal life

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45
Q

what are the 7 requirements for NHS funded fertility treatments?

A
  • unexplained infertility for at least 2 years
  • female partner under the age of 40
  • female partner BMI between 18.5 and 30
  • both partners non smoking
  • both partners abstaining from illegal substances
  • no alcohol for both partners before and during treatment
  • dont already have a genetic child
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46
Q

what is menorrhagia?

A

abnormally heavy amd prolonged bleeding at menstruation

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47
Q

at what day in the menstrual cycle is there a peak of FSH, LH and oestrogen?

A

day 12

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48
Q

in the follicular phase of the menstrual cycle, what hormone stimulates follicle development and causes granulosa cells o produce oestrogens?

A

FSH

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49
Q

in the menstrual cycle, what happens to the levels of FSH when levels of oestrogen (and inhibin) produced by the dominant follicles increase?

A

FSH production becomes inhibited

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50
Q

in the menstrual cycle, what happens to the follicles when FSH production become inhibited by oestrogen?

A

atresia of all the follicles but the dominant follicle

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51
Q

in the menstrual cycle, what hormone surge causes ovulation?

A

LH

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52
Q

in the menstrual cycle, what happens to the follicle during ovulation?

A

follicle ruptures and releases oocyte

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53
Q

in the menstrual cycle, what produces progesterone?

A

corpus luteum

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54
Q

in the menstrual cycle, at how many days post-ovulation does luteolysis occur?

A

14 days post-ovulation

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55
Q

in the menstrual cycle, at what day does the endometrial proliferative phase begin?

A

day 5

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56
Q

what hormone induces growth of endometrial glands and stroma in the proliferative phase?

A

oestrogen

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57
Q

what hormone induces endometrial glandular secretory activity in the luteal phase?

A

progesterone

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58
Q

in the endometrial menstruation phase of the menstrual cycle, what causes shedding of the functional endometrial layer?

A

arteriolar constriction

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59
Q

why do scars not form during endometrial menstruation and shedding of the functional endometrial layer?

A

fibrinolysis inhibits scar tissue formation

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60
Q

how long does menstruation usually occur? when does the peak occur?

A

4-6 days

peak day 1-2

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61
Q

what is the normal menstrual cycle length?

A

21- 35 days

average 28 days

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62
Q

what volume of blood is usually lost in a normal menstruation?

A

<80ml

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63
Q

is intermenstrual bleeding or post-coital bleeding normal?

A

no

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64
Q

what is metorrhagia?

A

regular intermenstrual bleeding

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65
Q

what is polymenorrhoea?

A

menses occuring at <21 day interval

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66
Q

what is polymenorrhagia?

A

increased bleeding and frequent cycle

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67
Q

what is menometorhagia?

A

prolonged menses and intermenstrual bleeding

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68
Q

what is amenorrhoea?

A

absence of menstruation >6 months

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69
Q

what is oligomenorrhoea?

A

menses at intervals of >35 days

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70
Q

what is dysfunctional uterine bleeding?

A

non-organic menorrhagia

absence of pathology

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71
Q

what are uterine fibroids?

A

benign smooth muscle tumours (leiomyoma) of the uterus

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72
Q

what is adenomyosis?

A

a condition where endometrial glands and stroma iare found in the myometrium of the uterus

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73
Q

what are endocervical or endometrial polyps?

A

benign tumours on the surface of the endocervix or endometrium

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74
Q

what is cervical eversion?

A

when the columnar epithelium of the endocervix come out onto the ectocervix and undergoes transformation into squamous cells

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75
Q

what is pelvic inflammatory disease?

A

infection of the upper part of the female reproductive tract (uterus, uterine tubes, ovaries, inside of pelvis)

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76
Q

what is endometriosis?

A

when the endometrium lining grows outside of the uterus (this will bleed every month at mensturation)

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77
Q

what type of drugs can cause organic menorrhagia?

A

anticoagulants

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78
Q

what is gestational trophoblastic disease?

A

when abnormal trophoblastic cells grow inside the uterus after conception

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79
Q

what is postpartum bleeding?

A

loss of lots of blood within 24 hours following childbirth

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80
Q

what can dysfunctional uterine bleeding be subdivided into?

A

anovulatory DUB

ovulatory DUB

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81
Q

at what ages does anovulatory dysfunctional uterine bleeding occur?

A

extremes of reproductive life

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82
Q

at what ages does ovulatory dysfunctional uterine bleeding commonly occur?

A

35-45 years olds

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83
Q

compare the cycles of anovulatory and ovulatory dysfunctional uterine bleeding?

A

anovulatory- irregular cycle

ovulatory- regular cycle

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84
Q

why does ovulatory dysfunctional uterine bleeding occur?

A

corpus luteum not producing enough progesterone

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85
Q

what is danazol primarily used for?

A

steroid with main use in endometriosis

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86
Q

how is endometriosis treated?

A
  • gonadotrophin releasing hormone analogues

- danazol

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87
Q

compare the HRT needed for endometrial ablation vs hysterectomy? (when treating menorrhagia)

A

endometrial ablation- combined HRT required

hysterectomy- oestrogen only-HRT

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88
Q

compare retention of fertility with medical and surgical treatments for menorrhagia?

A

medical- fertility can be retained

surgery-fertility is lost

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89
Q

what non-medical non-surgical method of treating menorrhagia is there?

A

progestogen-releasing IUCD

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90
Q

what is oligoasthenospermia?

A

low sperm count and low motility

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91
Q

what is teratoasthenospermia?

A

abnormal sperm and low motility

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92
Q

what is the normal pH of the vagina?

A

less than 4.5 (acidic)

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93
Q

what bacteria is part of the normal vaginal flora and helps to maintain the acidic pH of the vagina?

A

Lactobacillus spp

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94
Q

what 2 substances do Lactobacillus spp produce to maintain acidic pH of the vagina and suppress growth of other bacteria?

A

lactic acid and hydrogen peroxide

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95
Q

what 4 organisms are part of the normal vaginal flora?

A

Lactobacillus spp.
Strep viridans
Group B beta-haemolytic Strep
Candida spp.

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96
Q

what are the 3 most common genital tract infections which are non-sexually transmitted?

A

candida infection
bacterial vaginosis
prostatitis (can sometimes be sexually transmitted)

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97
Q

what are the 4 most predisposing factors for candida infection? (candida overgrowth)

A
  • recent antibiotic therapy
  • high oestrogen levels (pregnancy, some contraceptives)
  • poorly controlled diabetes
  • immunocompromised patients
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98
Q

what is the presentation of candida infection? (vaginal thrush)

A

intensely itchy white vaginal discharge

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99
Q

how do you diagnose candida infection? (vaginal thrush)

A

-clinical diagnosis
-high vaginal swab for culture
(posteriof fornix of vagina)

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100
Q

what type of candida are most thrush infections?

A

Candida albicans

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101
Q

what is the treatment of candida infection?

A

topical clotrimazole pessary or cream

PO fluconazole

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102
Q

what organisms cause bacterial vaginosis?

A

Gardnerella vaginalis
Mobiluncus sp.
Anaerobes

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103
Q

what are the symptoms of bacterial vaginosis?

A

thin, watery, fishy smelling vaginal discharge

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104
Q

how do you diagnose bacterial vaginosis?

A
  • clinical diagnosis
  • vaginal pH above 4.5
  • high vaginal swab for microscopy
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105
Q

what is seen in microscopy for bacterial vaginosis?

A

clue cells

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106
Q

what is the treatment of bacterial vaginosis?

A

PO metronidazole

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107
Q

what are the 3 classifications of prostatitis?

A
  1. acute bacterial prostatitis
  2. chronic bacterial prostatitis
  3. chronic prostatitis/chronic pelvic pain syndrome
108
Q

what are the symptoms of acute bacterial prostatitis?

A

symptoms of UTI but may also have lower abdominal pain/back/perineal/penile pain and tender prostate on examination

109
Q

what are the 2 primitive genital tracts? (indicate which is for which remains for sex)

A 
wolffian duct (males)
mullerian duct (females
110
Q

what cause the development of the wolffian duct and degeneration of mullerian duct in males?

A

testosterone

mullerian inhibiting factor

111
Q

what does the wolffian duct develop into in males?

A

reproductie tract

112
Q

what causes the development of the mullerian duct and the degeneration of wolffian duct in females?

A

lack of testosterone and mullerian-inhibiting factor

113
Q

around how many weeks can you start to tell the sex of a fetus?

A

16 weeks

114
Q

on what chromosome is the sex determining region?

A

chromosome Y

115
Q

how is androgen insensitivity disorder inherited?

A

X-linked recessive disorder

116
Q

what is the karotype of androgen insensitivity disorder?

A

46XY

117
Q

what happens to the wolffian duct and mullerian duct in androgen insensitivity disorder?

A

wolffian duct is not developed

mullerian inhibition occurs

118
Q

describe the phenotype of androgen insensitivity syndrome?

A 
female genitals, short vagina
absence of uterus and ovaries
primary amenorrhoea
lack of pubic hair
(looks like a female until puberty)
119
Q

what is the normal volume of a testis?

A

12-25ml

120
Q

what condition is a congenital absence of vas deferens associated with?

A

CF

121
Q

what muscle surround the testes?

A

cremasteric muscle

122
Q

describe the position of the epididymis in compared to the testes?

A

superior and posterior to the testes

123
Q

what is the tunica vaginalis made from?

A

descended peritoneum

124
Q

when should the testes drop into the scrotal sac from the abdominal cavity?

A

before birth

125
Q

why is it important that the testes descend?

A

lower temperature outside body to facilitate spermatogenesis

126
Q

what muscle contracts in the scrotal sac to lower or tests according to external temperature?

A

dartos muscle

127
Q

what is the name for undescended testes in adulthood?

A

cryptorchidism

128
Q

are patients with cryptorchidism fertile?

A

if unilateral usually fertile

129
Q

what should be performed in patients with cryptorchidism and why?

A

orchidopexy before age of 14 years to minimise risk of testicular germ cell cancer

130
Q

if an adult have undescended testes what should you consider?

A

orchidectomy

131
Q

where does spermatogenesis occur?

A

seminiferous tubules

132
Q

where does testosterone production occur?

A

leydig cells

133
Q

in the seminiferous tubules, where are the most mature sperm?

A

in the lumen

134
Q

what hormones do sertoli cells secrete?

A
  • inhibin hormones

- activin hormones

135
Q

what cells form the blood-testes barrier?

A

sertoli cells

136
Q

what hormones stimulate spermatogenesis?

A

FSH and testosterone

137
Q

what hormone decreases the secretion of FSH?

A

inhibin

138
Q

what hormone stimulates testosterone secretion?

A

LH

139
Q

what does testosterone do to the release of GnRH and LH?

A

decreases it

140
Q

is testosterone an anabolic or catabolic hormone?

A

anabolic

141
Q

how often is gonadotrophin releasing hormone released from the hypothalamus in males?

A

every 2-3 hours

142
Q

what cells does LH act on?

A

leydig cells

143
Q

what cells does FSH act on?

A

sertoli cells

144
Q

what hormone stimulates FSH production?

A

GnRH

activin

145
Q

what capacitation of sperm?

A

biochemical and electrical events before fertilisation

146
Q

what is an acrosome reaction?

A

when the sperms head which is full of enzymes breaks through the egg

147
Q

after fertilisation what happens to the zona pellucida and why?

A

thickens to stop another egg getting in

148
Q

what 3 substances are released from the seminal vesicles? what are they for?

A

fructose- energy
prostaglandins- stimulates motility
fibrinogen- clot precursor

149
Q

what duct does the seminal vesicles release fluid into?

A

ejaculatory duct

150
Q

what is the pH of fluid from the prostate? why is this important?

A

alkaline (neutralises vaginal acidity)

151
Q

what enzymes are produced by the prostate gland?

A

clotting enzymes

152
Q

what is the function of the bulbourethral glands?

A

secretes mucous for lubrication of semen

153
Q

what fills with blood during an erection?

A

corpora cavernosa

154
Q

what autonomic nervous system controls erection and ejaculation?

A

erection- parasympathetic

ejaculation- sympathetic

155
Q

what is a retrograde ejaculation?

A

when ejaculate goes into the bladder

156
Q

what is the definition of male infertility?

A

infertility resulting from failure of the sperm to normally fertilise the egg

157
Q

what is hypospadias?

A

urethra opening is not at the tip of the penis

158
Q

what is the most common tumour in young males?

A

seminoma

159
Q

what is the most common cause of male infertility?

A

idiopathic

160
Q

what are the 3 common causes of obstructive male infertility?

A

cystic fibrosis
vasectomy
infection

161
Q

why are patients with Kallmann’s syndrome infertile?

A

hypothalamus doesn’t produce gonadotrophin releasing hormone

162
Q

what sensory deficit is kallmanns syndrome associated with?

A

loss of smell

163
Q

how to you measure testicular volume?

A

orchidometer

164
Q

describe the testicular volume of obstructive male infertility?

A

normal testicular volume

165
Q

describe the endocrine features of obstructive male infertility?

A

normal LH, FSH and testosterone

166
Q

what is the karotype of kleinfelters?

A

XXY

167
Q

describe the testicular volume of non-obstructive male infertility?

A

low testicular volume

168
Q

is the vas deferens present in non-obstructive male infertility?

A

yes

169
Q

describe the endocrine features of non-obstructive male infertility?

A

high LH, FSH

low testosterone

170
Q

how long does an IVF treatment take in average?

A

about 6 weeks

-if baseline scans are appropriate

171
Q

in obstructive azoospermia where do you aspirate the sperm from?

A

epidiymis

172
Q

in non-obstructive azoospermia where do you aspirate the sperm from?

A

testicular tissue

173
Q

what are the 3 phases of the uterine cycle?

A

menstrual phase
proliferative phase
secretory phase

174
Q

what defines post menopausal bleeding?

A

abnormal uterine bleeding after a year after cessation of menstruation

175
Q

what defines dysfunctional uterine bleeding?

A

abnormal/irregular uterine bleeding with no organic cause

176
Q

what can tamoxifen be used for?

A

to treat an oestrogen sensitive breast cancer

177
Q

why can tamoxifen cause abnormal uterine bleeding?

A

encourages endometrium to proliferate

178
Q

at what endometrial thickness in postmenopausal women is an indication for biopsy?

A

greater than 4mm (should usually be 1mm)

179
Q

what camera allows you to look into the endometrial cavity?

A

hysteroscope

180
Q

what are the 2 ways of sampling the endometrium?

A

endometrial pipelle

dilatation and curretage

181
Q

what is disynchrony of the endometrium?

A

when some glads respond to progesteone and so go into the secretory phase while others dont

182
Q

why do anovulatory women’s endometriums not go into a secretory phase?

A

no corpus luteum to secrete progesterone

183
Q

endometrial hyperplasia or carcinomas are derived from what cells?

A

glandular cells

184
Q

endometrial sarcomas are derived from what cells?

A

stromal cells

185
Q

which is the more thorough sampling method- endometrial pipelle or dilatation and curretage?

A

dilatation and curretage

186
Q

why does the endometrium in anovulatory dysfunctional bleeding not go into the secretory phase?

A

no corpus luteum so no progesterone secretion

187
Q

when do endometrial polyps tent to occur?

A

around/after menopause

188
Q

what causes a complete mole?

A

1 or 2 sperms combine with an egg which has lost it’s DNA- only paternal DNA

189
Q

what is the karotype of a complete mole

A

46 XX or 46 YY or 46 XY

if only single sperm, it duplicates to form a complete set

190
Q

what causes a partial mole?

A

egg is fertilised by 2 sperms of 1 sperm which has reduplicated itself

191
Q

what is the kartype of a partial mole?

A

69 XXX or 69 XYY or 69XXY

192
Q

which type of moles are more likely to develop into a choriocarcinoma?

A

complete moles

193
Q

what is a choriocarcinoma?

A

malignant tumour of trophoblast

194
Q

what hormone is the growth of leiomyomas (uterine fibroids) dependent on?

A

oestrogen

195
Q

why is there a much reduced rate of leiomomas in post-menopausal women?

A

reduced oestrogen

196
Q

what organisms cause acute bacterial prostatitis?

A 
UTI organisms:
E. coli and other coliforms
Enterococcus sp.
STI organisms in under 35 year olds:
Chlamydiatrachomatis
Neisseria gonorrhoea
197
Q

how do you diagnose acue bacterial prostatitis?

A

clinical signs
+MSSU for culture and sensitivity
+first pass urine (if considering STI)

198
Q

what is the treatment for acute bacterial prostatitis? (Not STI cause)

A

ciprofloxacin 28 days

or trimethoprim 28 days

199
Q

what organism causes chlamydia?

A

Chlamydia trachomatis

200
Q

what organisms causes gonorrhoea?

A

Neisseria gonorrhoeae

201
Q

what organisms causes syphilis?

A

Treponema pallidum

202
Q

what virus causes genital warts?

A

human papilloma virus

203
Q

what parasite causes pubic lice/crabs?

A

phthirus pubis

204
Q

where can chlamydia trachomatis infect?

A

endocervix, urethra, rectum, throat and eyes

205
Q

what is the most common bacterial STI in UK?

A

Chlamydia trachomatis

206
Q

chlamydia is an obligate intracellular bacteria, what does this mean?

A

cannot reproduce outside a host cell

207
Q

why can chlamydia not stain with Gram stain?

A

no peptidoglycan in the cell wall

208
Q

what are the 3 serological groupings of chlamydia and what infection does this respond to?

A

Serovars A-C: trachoma
Serovars D-K: genital infection
Serovars L1-L3: lymphogranuloma venereum

209
Q

what is the treatment of uncomplicated chlamydia?

A

Azithromycin 1g PO stat dose

210
Q

why can lymphogranuloma venerum be mistaken for crohns disease?

A

inflammation of the rectus, irritation and tenesmus

if treated with normal azithromycin 1g stat dose, fistulas will form

211
Q

what group of patients get lymphogranuloma venerum?

A

patients with receptive anal sex

biggest outbreak in men who have sex with men

212
Q

what does neisseria gonorrhoea look like on Gram stain?

A

gram negative diplococcus

  • often intracellular
  • look like 2 kidney beans
213
Q

compare the amount of discharge in gonorrhoea and chlamydia?

A

gonorrhoea- lots of discharge

chlamydia- less discharge

214
Q

what tests are done for the diagnosis of chlamydia and gonrrohoea?

A

nucleic acid amplification tests (NAAT) or PCR

additionally for gonorrhoea: microscopy and culture and sensitivies

215
Q

how are samples for or chlamydia and gonorhoea testing taken?

A

males: 1st pass urine
females: high vaginal swab or vulvo-vaginal swab or endocervical swab

both: rectal and throat swabs

216
Q

what are the only swabs that can be used for gonorrhoea culture on selective agar plates?

A

high vaginal swabs

217
Q

why are swabs from GP patients looking for gonorrhoea often falsetly culture negative?

A

organism would die during transit to lab

218
Q

when taking swabs for chlamydia and gonorrhea, compare what swabs are needed for screening vs symptomatic?

A

asymptomatic: high vaginal swab/vulvo-vaginal swab
symptomatic: endocervical swab

219
Q

how long after chlamydia and gonorrhoea do you do test of cure tests?

A

5 weeks

220
Q

why does it take 5 weeks to do a test of cure test for chlamydia and gonorrhoea?

A

because you can still pick up dead organisms on PCR/NAAT up until then
-dont want a falst positive

221
Q

what is the treatment for N. gonorrhoea?

A

IM ceftriazone and PO azithromycin

222
Q

how do you diagnose Treponema pallidum? (syphyllis)

A
  • swab of primary chancre for PCR

- serology for non-specific and specific antibodies (blood test)

223
Q

what are the 4 stages of syphilis?

A

1- primary chancre
2- bacteria circulating in blood, multiple manifestations
3- latent period (no symptoms)
4- late stage (cardiovascular or neurovascular complications)

224
Q

what is tarbes?

A

slow degeneration of neural tracts (particularly DMCL) in syphilis, loss of touch, vibration and proprioception

225
Q

why do patients with syphilis present with a high-stamping get?

A

loss of proprioception in feet due to tarbes

rely on their ears to find out where feet are

226
Q

what condition do you get pseudotabes in?

A

diabetes

227
Q

the widespread rash found in the second stage of syphilis affects which parts of the body primarily?

A

palms and soles

228
Q

what non-specific serological tests are used to tell to you about response to therapy for syphilis?

A

venereal diseases research laboratory (VDRL)

rapid plasma reagin (RPR)

229
Q

what specific antibodies are used to test for syphilis?

A

T. pallidum particle agglutination assay (TPPA)
T. pallidum haemagglutination assay (TPHA)
IgM and IgG ELISA (screening)

230
Q

why are TPPA and TPHA not useful for monitoring response to therapy in syphilis?

A

remain positive for life

231
Q

why can syphilis not be cultured for sensitivities?

A

organism cannot be grown in artificial culture medium

232
Q

what is the treatment of syphilis?

A

IM long-acting penicillin

233
Q

what is the most common viral STI?

A

genital warts

234
Q

does HPV contain DNA or RNA?

A

DNA

235
Q

what types of HPV most commonly cause genital warts?

A

6 and 11

236
Q

what types of HPV are associated with cervical cancer?

A

16 and 18

237
Q

how do you diagnose genital warts?

A

clinical diagnosis

238
Q

what is the treatment of genital warts?

A

cryotherapy

podophyllotoxin cream/lotion

239
Q

do genital warts recur?

A

yes

240
Q

the vaccine given to 11-13 year old girls immuneses against which types of HPV?

A

6, 11, 16, 18

241
Q

does HSV contain DNA or RNA?

A

DNA

242
Q

where does the herpes simplex virus hide from the immune system?

A

sacral root ganglion

243
Q

how do you diagnose genital herpes?

A

swab of deroofer blister for PCR

244
Q

describe trichomonas vaginalis?

A

single celled protozoal parasite

245
Q

how does trichmonas vaginalis divide?

A

binary fission

246
Q

how do you diagnose trichomonas vaginalis?

A

high vaginal swab for microscopy

no good test for males

247
Q

what is the treatment of trichomonas vaginalis?

A

PO metronidazole

248
Q

what is the treatment of pubic lice? (phthirus pubis)

A

malathion lotion

249
Q

when do the 1st, 2nd and 3rd trimesters complete?

A

1st completes at 12 weeks
2nd completes at 28 weeks
3rd completes at 40 weeks

250
Q

how many weeks is term?

A

37-42 weeks

251
Q

how do we estimate gestation dates?

A

using ultrasound

252
Q

how early can pregnancy be detected by a urine test?

A

10 days after fertilisation

253
Q

what type of US scan is gold standard for suspected miscarriage?

A

transvaginal scan

254
Q

what is seen on speculum exam for a threatened miscarriage?

A

os is closed

255
Q

what is seen on speculum exam for an inevitable miscarriage?

A

products are sited at open os

256
Q

what is seen on speculum for a complete miscarriage?

A

products sited in vagina

257
Q

what is early fetal demise?

A

pregnancy has been lost but not expelled
mean sac diameter over 25mm
fetal pole over 7mm

258
Q

compare MVA to surgical treatment of abortion?

A

MVA- local anaesthetic

surgical- general anaesthetic

259
Q

compare a miscarriage and ectopic pregnancy in terms of main presenting symptom- bleeding or pain?

A

miscarriage- bleeding > pain

ectopic- pain > bleeding

260
Q

what is the drug treatment for a medical termination of pregnancy?

A
  • mifepristone

- misoprostol

261
Q

what is the medical management for a ectopic pregnancy?

A

methotrexate IM or PO

262
Q

what is seen on USS of a molar pregnancy?

A

snow storm appearance +/- fetus

263
Q

in a molar pregnancy, what does the overgrowth of placental tissue look like?

A

grape like clusters

264
Q

when does implantation bleeding occur?

A

10 days post-ovulation (can be mistaken for a period)

265
Q

what is a chorionic haematoma?

A

pooling of blood between endometrium and embryo due to separation

266
Q

at what stage in pregnancy does a chorionic haematoma occur?

A

first trimester, early pregnancy

267
Q

what is the treatment for a chorionic haematoma?

A

self limited so resolves

reassurance and surveillance

Reproduction (9 decks)

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