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ESA3 revision decks > ESA3 revision session 1 > Flashcards

ESA3 revision session 1 Flashcards

1
Q

Amenorrhea

A

absent periods

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2
Q

Primary amenorrhea

A

Failure to start menstruation by 16

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3
Q

Secondary

A
  • Previously had periods
  • Not had for 6 months
  • Include pregnancy and menopause
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4
Q

Most common cause of primary amenorrhoea?

*

A
  • Turners
    • 45XO
    • Coarctation of aorta
    • Streaky ovaries
    • Short
    • Web neck
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5
Q

Secondary amenorrhea causes x2

A

Problem with HPG axis

outlflow problem

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6
Q
  • Problem with HPG axis
A
  • Hypothalamus (GnRH)
    • Exercise
    • Stress
    • Anorexia nervosa, bulimia nervosa
  • Pituitary (LH, FSH)
    • Sheehans syndrome (when lots of blood loss during pregnancy)
    • hyperprolactinemia
  • Gonads (oestrogen and progesterone)
    • Menopause
    • PCOS
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7
Q

Diagnosing amenorrhoea

A
  • Age
    • If patient is between 45-55–> menopause?
  • Family history
  • Sexual history
  • Mental health
    • Eating disorders
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8
Q

16 yo Beth visits the GP concerned about having irregular periods for a year and subsequent amenorrhoea for 6 months. She’s also noticed weight gain, more facial hair, and is feeling insecure about it. what are the differential

A

Gonadal: PCOS, ovarian cancers

Adrenal: Adrenal cortical adenoma/ adrenal hyperplasia

Pituitary: Pituitary tumours, also causing Cushing’s syndrome, gigantism or acromegaly

External sources: Abuse of Anabolic sterorids

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9
Q

Hirsutism

A

– excessive, male pattern hair growth in women / pre-pub boys

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10
Q

Hirsutism causes

A

Increased level of male hormones or oversensitivity of hair follicles to hormones

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11
Q
A
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12
Q

What is the term for excessive, non male pattern hair growth?

A
  • Hypertrichosis
  • Cause unknown but can be congenital
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13
Q

The GP highly suspects that Beth has PCOS. What can she do to confirm the diagnosis?

A

blood test

US of ovaries

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14
Q

what is PCOS

A
  • Multiple fluid filled space in the ovary
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15
Q

hyperandronism causes

A

cyst and hirsutism

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16
Q

PCOS LH/FSH blood test results

A
  • LH produces androgens
  • Therefore more androgen
  • Less FSH–> less androgen converted to oestrogen
  • More androgen overall = hirsutism and acne
  • No ovulation due to no LH surger
  • Insulin resistance – hyperandronism
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17
Q

Insulin resistance

  • Increased risk for
A
  • T2DM
  • CVD
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18
Q

management of insulin resistance

A
  • Lifestyle
    • Diet
    • Smoking
    • Exercise
  • Drug
    • Metformin
    • Statin
    • COCP
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19
Q

Diagnosis of PCOS made based on exclusion

A

2 out of 3
• Chronic Anovulation- History

  • Hyperandrogenism - Blood test
  • Polycystic ovaries- US
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20
Q

summary of menstrual cycle

A
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21
Q

difference between hormonal interactions in PCOS to normal

A

insuffieicnt FSH to stimulate granulosa cells

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22
Q

PCOS can also cause depression in women. The GP guides Beth through a self- assessment questionnaire and determines she has a mild form of depression. What are the three core symptoms of depression?

A
  • Low mood
  • Lack of energy
  • Anhedonia (lack of interest + enjoyment)
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23
Q

treatment for PCOS

A

COCP

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24
Q

what is a herbal remedy which will reduce the effectiveness of the COCP

A
  • St Johns Wart
  • Induces P450–> which speeds up metabolism of COCP
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25
Q

Placenta praevia

*

A

Placenta attached over internal cervical os

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26
Q

Placental abruption

A

placenta detaches

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27
Q

Placenta accreta

A
  • placenta attached to myometrium
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28
Q

Placenta increta

A
  • penetrates myometrium
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29
Q

Placenta percata

A
  • placenta perforated through myometrium into the uterine serosa
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30
Q

Why do pregnant women have a raised body temp?

A

Higher progesterone levels

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31
Q

Progesterone causes

A
  • Systemic smooth muscle relaxation
  • Dropping blood pressure
  • Therefore heart rate increases in response
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32
Q

Explain why Beth requires a caesarean section with placenta praevia

A
  • Birth canal obstructed by placenta
  • Foetus has to be expelled from the uterus by other means
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33
Q

Give two reasons why it is normal for pregnant women to have a low blood pressure.

A
  • Progesterone
  • Gravid uterus compressing on vena cava
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34
Q

Beth is suffering from a UTI. What might her urine dipstick results show to support this?

A
  • Raised/ Positive for leukocyte esterase • Raised/ positive for nitrites
  • Turbid urine (cloudy)
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35
Q

hydronephrosis in pregnancy

A
  1. Raised Progesterone levels during pregnancy
    • Smooth Muscle dilation
    • Renal Pelvis + Ureter have SM –>hydronephrosis
  2. Compression of ureters by gravid uterus)
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36
Q

identify risk factors for UTI

A

Catheterisation – infection from surfaces

Gender – Women have shorter urethras

Decreased renal glucose threshold during pregnancy

Hydronephrosis (stasisàinfection)

Immunosuppression during pregnanc

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37
Q

Suggest two (most common) organisms that could have caused her UTI.

A

E.coli

S.aureus

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38
Q

E.coli is a gram

A

gram negatuce bacilli

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39
Q

Staphylococcus aureus

A

gram positive

  • bunches of cocci
40
Q

AKI and pregnancy

*

A
  • Why is it important if someone has just undergone labour
    • Creatinine clearance increases (higher eGFR in pregnancy)
    • Serum creatinine decreases
    • So a pregnant women with normal creatinine clearance is likely to have AKI
  • Could be due to increases in:
    • Metabolic waste products
    • Blood volume
      • Kidney perfusion and GFR
41
Q

Suggest a suitable management of her UTI.

A

Drug and Length of treatment

Complicated UTI

Trimethoprim, nitrofurantoin

7 day course

Remember: culture before empirical Abx

Check local guidelines – factor in local resistance pattern

42
Q

Give two reasons why amoxicillin should not be used to treat this patient

A
  • This patient is penicillin sensitive / allergic
  • Anyway, amoxicillin is not used for complicated UTI’s because it increases risk of bacterial resistance
43
Q

Identify the 3 stages of the triple approach to the investigation and diagnosis of breast cancer?

A
  • History
  • Examine
  • Scan- mammogram
  • Histology
44
Q

Beth’s lump is diagnosed as early stage ductal cell carcinoma. At what age bracket are women typically invited for mammographic screening?

A

• 47-73 years (every 3 years)

45
Q

tamoxifen is a

A

Selective Oestrogen Receptor Modulator- - Binds to the Oestrogen Receptor (ER)

46
Q

why is tamoxifen used for breast cancer

A

Antagonist to Oestrogen receptor at breast
- Inhibits proliferation of cells

(need to make sur epatient is estrogen receptor (ER) positive before giving tamoxifne

47
Q

Why is Beth at risk of endometrial cancer by taking Tamoxifen

A
  • Endometrium also an oestrogen sensitive tissue
  • ButTamoxifenactsdifferentlyatthebreastand
  • at the endometrium
  • Partialagonistattheendometrium
  • Stimulates tissue proliferation there
  • More cell cycles Increased risk of mutation Cancer
48
Q

A 45 year old Man, Mr X, presents with urinary frequency and a burning sensation on urination. List three differentials that could explain the symptoms Mr X is experiencing.

A
  • UTI
  • STI
  • BPH
  • Pyelonephritis
  • Chronic prostatitis
  • Urethral stricture
  • Ureteric calculi
    • Loin to groin pain
49
Q

Discharge coming out of tip of penis

A
  • Gonorrhoea
    • Yellow
  • Chlamydia
    • creamy
50
Q

Upon taking further history, Mr X admits to having multiple sexual partners and mentions he has noticed discharge coming out of the tip of his penis. What is your next step to confirm a diagnosis?

A

Take a swab of the discharge

MSU sample

Swab collected from other affected areas

51
Q

MSU

A

midstream urine sample

52
Q

what is this

A

Neisseria gonorrhoea

diplococci,gram-negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis

53
Q

How would you treat Neisseria Gonorrhoea?

A

Ceftriaxone + azithromycin

54
Q

Mr X mentions how none of his partners had STI symptoms before his presentation, and asks you to explain how its possible that he got it from them.

A

women are often asymptomatic

May only present once they develop PID

55
Q
A
56
Q

Mr X, presents to clinic 3 months later with a lump in his right groin. Suggest three differentials for it.

A
  • inguinal hernia
    • direct
    • indirect
  • inguinal lymph node
  • femoral hernia
  • femoral aneurysm
  • saphenous varix
  • psoas abscess
57
Q

On closer inspection, the lump is firm, immobile and has irregular edges. What do you suspect is the most likely cause of the lump and how could you confirm this?

A

Neoplasia - lymph metastases (lump is firm, immobile, irregular edges)

  • Bedside: DRE, PSA
  • Imaging: mpMRI, CT abdo & pelvis
  • Special test: Template biopsy, TRUS biopsy
58
Q

Following a series of investigations, you find that Mr X has prostate cancer of a high grade. What does this mean at a histological level and at a clinical level?

A

Histological - a high grade tumour has poorly differentiated tissue i.e. Does not resemble the normal tissue well

Clinically, this translates to having a poorer prognosis.

59
Q

what is used to stage prostate cancer

A

Gleasons pattern

60
Q

what makes up the floor of the inguinal canal

A

inguinal liagment and lacunar ligament (medially)

61
Q

what is the posterior wall of the inguinal canal made up of

A

transversalis fascia and conjoint tendon (medially)

62
Q

what is the roof of the inguinal canal made up of

A

internal oblique/transverse abdominus (muscular arches and aponeurosis)

63
Q

anterior wall of the inguinal canal

A

aponeurosis of external oblique

64
Q

deep ring of the inguinal ligament found

A

posterior wall closest to the ASIS

65
Q

superficial ring found

A

anterior wall closest to the pubic tubercles

66
Q

A hernia is defined as

A

the protrusion of part or whole of an organ or tissue through the wall of the cavity that normally contains it.

67
Q

direct inguinal hernia

A

(20%) – Bowel enters the inguinal canal “directly” through a weakness in the posterior wall of the canal, termed Hesselbach’s triangle (superficial inguinal ring)

  • medial to the inferior epigastric artery and lateral to the rectus muscle.

They occur more commonly in older patients, often secondary to abdominal wall laxity or a significant increase in intra-abdominal pressure

68
Q

indirect inguinal hernia

A

Indirect inguinal hernia (80%) – Bowel enters the inguinal canal via the deep inguinal ring

They arise from incomplete closure of the processus vaginalis, an outpouching of peritoneum allowing for embryonic testicular descent, therefore are usually deemed congenital in origin

  • passes down the inguinal canal lateral to the inferior epigastric artery.
69
Q

hesselbach triangle

A

same as superficial inguinal ring

Medial – lateral border of the rectus abdominis muscle.

Lateral – inferior epigastric vessels.

Inferior – inguinal ligament.

70
Q

How to clinically differentiate between indirect and direct hernias?

A
  • indirect will be latral to ifneiror epigastric vesse
    • not palpable
    • common in children
  • direct will be medial to inferior epigastric vessel
    • may be palpable above the pubic tubercle
    • common in old age
71
Q

indirect versuss direct inguinal herniasz

A
72
Q

Framework for breaking bad news?

*

A
  • Setup
  • Perception
  • Information
  • Knowledge
  • Emotions
73
Q

List the 5 stages of grief he may go through following this bad news, to adjust to the idea of dying.

A
74
Q

The patient now tells you he has a severe pain in his left flank spreading to his groin area, which starts and stops abruptly.
What might be going on?

A

Prostate cancer ↓

increases PTHrp↓

Hypercalcaemia ↓

Ureteric calculi (stone) ↓

Ureteric Colic (pain from loin to groin)

75
Q

PTH hormone

A

increases conc of calcium in the blood

76
Q

The patient develops oliguria. He has a reduced GFR and high creatinine. What complication might have arisen?

A

AKI
- Renal calculi obstructing the ureter

  • Prostate cancer compressing the ureter

Could also have pre-renal acute kidney injury: - Hypercalcaemia causes dehydration!

77
Q

symptoms of hypercalcaemia

A

painful bones

renal stones

abdominal groans

psychiatric moans

78
Q

A hospital research team perform a cohort study, looking into the risk of developing hypercalcaemia in patients with prostate cancer. List two advantages of performing a cohort study.

A

Allows researchers to establish temporal sequence – can establish that exposure (prostate cancer) precedes outcome (Hypercalcaemia).

Can study a range of outcomes from a range of exposures

79
Q
A
80
Q

relative risk

A

to calculate the risk associated with an exposure, we must compare the risk (incidence) among the exposed to those not expose

81
Q

what is the relative risk equation

A

incidence in exposed/ incidence in non-exposed

82
Q

Mr X comes to you reporting depressive symptoms, possibly due to his hypercalcaemia. Outline a non-pharmacological method of treating his depression.

A

CBT

Education of cognitive model Monitoring negative thoughts

Examine/challenge negative thoughts

Cognitive rehearsal; role play

Reinforcement and reward of positive thoughts

83
Q

pre renal causes of AKI

A

caridac failure

sepsis

blood loss

dehydration

vascular occlusion

84
Q

renal causes of AKI

A

glomerulonephritis

small vessel vasculitis

acute tubular necrosiss

  • drugs
  • toxins
  • prolonged hypotension

interstitial nephritis

  • drugs

toxins

  • inflammatory disease
  • infection
85
Q

post renal cause sof AKI

A

urinary calculi

retroperintoneal fibrosiss

benign prostatic enelaregement

prostate cancer

cerbical cancer

urethral stricture/valves

metal sentosis/ phimosis

86
Q

Unfortunately, despite your best efforts, the patient passes away. Suggest some symptoms of bereavement that his family may experience.

A

Physical - fatigue, infection from reduced immunity as part of a stress response, aches, nausea

Behavioural - insomnia, social isolation, loss of appetite Emotional - guilt, anxiety, depression, anger

Cognitive - lack of memory and concentration

87
Q

Why might a person with vomiting have a metabolic alkalosis?

A

Severe vomiting also causes loss of potassium and sodium. The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.

88
Q

List the macroscopic and microscopic differences between UC and Crohn’s

A

Macroscopic
• UC: Pseudopolyps, ulcers, hypervascular, oedema

• Crohn’s: Trasnmural, skip lesions, cobblestoneappearance

Microscopic
• UC: Neutrophil infiltration, crypt abscess, goblet cell hyperplasia, inflamed mucosa
• Crohn’s: Non-caseating granulomatous

89
Q

What are the causes of Pancreatitis?

A

I GET SMASHED

idiopathic

gall stones

ethanol (alcohol)

trauma

sterordis

mumps/ malignancy

autoimmune

scoprion string

hypercalcemia/ hypertriglyceridemia

ERCP

Drugs

90
Q

modifiable risk factors for gall storns

A
  • obese
  • fatty acids
  • crohns/IBS
  • drugs: ceftriaxone
  • combined pill, oestrogen therapy
91
Q

non-modifiable risk factors for gall storns

A

female

age

ethnic origin: caucasian

family history

92
Q

what is a murphys sign

A
  1. ask pts to exhale
  2. examiner palces hand below costal margin on the right side at the mid-clavicular line
  3. patient is intstructed to inspire

the patient will stop breathign in and wince with a catch ib breath (due to the inflammed gall bladder being palpated as it descends on inspiration)

93
Q
  1. What investigations would you perform for a patient with suspected colorectal cancer?
A

Bedside
• FBC: mainly to check Hb

  • Tumour marker: CEA
  • Fecal Occult Blood testing

Imaging
• CT&MRI

• Barium Enema: Apple core sign

Special Test

  • Colonoscopy
  • Flexible sigmoidoscopy
94
Q

How would you manage a peptic ulcer?

A

Conservative: Diet, Smoking cessation, reduce alcohol intake

Pharmacological: Proton pump inhibitor (H. pylori eradication therapy if indicated)

Surgical/interventional: For complications e.g. Bleeding peptic ulcer

95
Q

List the risk factors for renal cancers

A

Smoking

Aromatic hydrocarbon exposure

Dialysis

Obesity

Polycystic Kidney Disease

ESA3 revision decks (12 decks)

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