HD OVERVIEW Flashcards
Define fertility/subfertility
a
Primary vs. secondary infertility
a
Type 1 ovulatory cause of infertility
a
Type 2 ovulatory cause of infertility
a
Type 3 ovulatory cause of infertility
a
Cause of PCOS
a
Main cause of pelvic inflammatory disease
a
Endometriosis
a
Uterine fibroids
a
Three drugs associated with infertility in women
a
Three drugs associated with infertility in men
a
First line advice for couples worried about infertility
a
Reasons for an early referral
a
Primary care investigations for infertility
a
Secondary care investigations for infertilty
a
Ovarian reserve test
a
HSG test
a
Tests to asses ovulation
a
NICE guidelines for unexplained infertility
a
WHO sperm count volume
1.5ml LRL
WHO sperm count motility
32% LRL
WHO sperm count morphology
4% normal LRL
Treatment for type 1 ovulatory failure
a
Treatment for type 2 ovulatory failure
a
Treatment for type 3 ovulatory failure
a
IUI what is involved?
a
IUI who is this offered to?
a
IVF - what is involved?
a
Ovarian hyperstimulation syndrome
a
ICSI
a
Main symptom of pelvic inflammatory disease
Most asymptomatic
Most common STI in England
a
Pathogen responsible for chlamydia
a
What is ceftriaxone and what is this used for?
a
Which STIs have no effect on the neonate?
a
Which STIs can affect the neonate?
a
Cause of gestational diabetes
a
GDM - problem for the mother or the neonate?
Neonate
Four foetal complications from GDM
Macrosomia
Hypoglycaemia
Hyperbilirubiniea
Respiratory distress syndrome
Increased risk of non-viral infections during pregnancy - why? Risk to mother or neonate?
Neonate mainly
Waters break - pathway for bacteria to travel to the placenta through the cervix
What type of non-viral infection is most common during pregnancy and why?
Group B streptococcus - present in the normal flora of the vagina in 25% of women
Consequence of group B strep infection in neonate
Pneumonia
Meningitis
Non-focal sepsis
Death
Polyhydramnios - increased risk of what?
Excess amniotic fluid in the amniotic sac
GDM
Listeriosis
a
Polyhydramnios - increased risk of what?
Excess amniotic fluid in the amniotic sac
GDM
Infections in which trimesters are most harmful to a) mother and b) foetus?
a) most harmful to mother in the third trimester
b) most harmful to foetus in the first trimester - this is where all of the foetal development is occurring
Infections in which trimesters are most harmful to a) mother and b) foetus?
a) most harmful to mother in the third trimester
b) most harmful to foetus in the first trimester - this is where all of the foetal development is occurring
How to diagnose bacterial infection in pregnancy?
Swab/sample and culture this
How to diagnose viral infection in pregnancy?
Serology and pCR (very sensitive and very quick)
First antibody produced to infection
IgM
Second antibody produced to infection - when has the person contracted the infection if this antibody is present?
IgG - within the past 24 to 48 hours
Infections routinely tested for antenatally
Hep B
HIV
Syphilis
+ regular ultrasound to monitor foetal development
Viral infection affecting the blood is?
a
Virus that is the most common cause of congenital sensorineural deafness and treatment?
CMV - herpes virus
Treat with antiviral gancyclovir
More common names for VZV (varicella zoster virus) and treatment
Congenital/neonate/infants - chicken pox
Adults - shingles
Treatment is (val)acyclovir
Two type of Herpes and what they are most responsible for plus treatment
HSV1 - oral
HSV2 - genital
NOW evidence that they are both responsible for both
Treatment is acyclovir
What is the worst infection for a foetus to contract and why?
Rubella
Eye abnormalities leading to blindness, sensorineural deafness, congenital heart disease, death
What is the treatment for syphilis?
Penicillin
What viral condition does ‘blueberry muffin appearance’ describe?
CMV
Also appears in rubella
What is the most common congenital infection in developed countries?
Congenital CMV
What viral infection is indistinguishable from glandular disease/fever?
CMV
How can you recognise congenital rubella from looking in an infants eye?
Cataracts will be present - shine a light into their eye and it will appear white
Will not see a red reflex
Which virus is responsible for gandular fever/disease?
Epstein Barr virus
How do the presentations e.g. on a penis of HSV2 and HPV differ?
HPV - genital wart
HSV2 - genital sore
What is septicaemia?
Blood poisoning i.e. infection of the blood
What are the signs of septicaemia?
Tachycardia Tachypnoea Rash Prolonged capillary refill Low BP - late sign
What is the definition/temperature for a fever?
Temperature greater than 37.5 (rectal temp)
Taken by mouth will be 0.5 degrees lower than rectal temp
Taken by armpit will be 1 degree lower than rectal temp
Give the names of three organisms that will cause septicaemia and meningitis
Streptococcus pneumonia
Neisseria meningitidis
Haemophilus influenzae B
What are the signs of meningitis?
High temperature Headache Vomiting Cannot tolerate bright lights Drowsy Stiff neck
What is the problem with meningitis symptoms in infants?
Non-specific symptoms e.g. high temperature, sleepy, vomiting, blotchy skin
What are the three most common bacterial infections in infants?
Group B strep
E. Coli
Listeria
How will tetanus present in a neonate and how might this be contracted?
Weak
Lethargic
Poor suck
Muscle spasms
Contracted from bacteria getting into wound - bacteria from soil e.g. unclean blade used to cut the cord
What is ALL and what is it’s relevance as a cancer in children?
Most common malignancy in children and most frequent cause of death in cancer children
What are the signs of ALL?
Bruising/bleeding
Pallor and fatigue
Infection (due to neutropenia)
Where will infiltration be seen in ALL?
Liver
Spleen
Lymph nodes
Mediastinum
What glycoproteins on the surface of cells are associated with ALL?
CD19+
CD10+
When is methotrexate used in the treatment of ALL/cancer?
Used in the treatment of tumours which have reached the brain
What is Wilm’s tumour?
This is a tumour of the kidney
Aka. Nephroblastoma
What is the cause of Wilm’s tumour?
Deletion of or part of chromosome 11
How does Wilm’s tumour present?
Asymptomatic abdominal mass on the back
NO metastasis
Is Wilm’s tumour genetic?
Both genetic and epigenetic
If present on multiple locations of the kidney then more likely to be genetic
Why is the use of radiotherapy dangerous in children?
Because you want to preserve all the tissues
What is a retinoblastoma?
Tumour of the retina - multifocal i.e. multiple tumours
What are the origin cells of retinoblastomas?
Cone precursor cells
Give two genes involved in the onset of retinoblastoma
Loss of RB1
Activation of MYCN
What is a neuroblastoma in children and where is this present?
Tumour of the sympathetic NS
Present on the adrenal gland or at the sympathetic ganglia
Three stages of pregnancy
Antepartum - prior to labour: early is <24 weeks and late is >24 weeks
Intrapartum - in labour: the first and second stages
Postpartum - from delivery of the foetus up to 6 weeks later
Line between miscarriage and stillbirth
24 weeks
Define spontaneous miscarriage
When a foetus dies/is delivered dead prior to 24 weeks
Six types of spontaneous miscarriage
Threatened Inevitable Incomplete Complete Septic Missed
Threatened miscarriage
Light and painless bleed, the foetus is alive and the uterus is at the expected size
Only 25% of these go on to miscarry
Inevitable miscarriage
Heavy bleeding The foetus may be alive at this point The cervical os is open Crampy pelvic pain will occur The miscarriage is about to occur - it is inevitable
Incomplete miscarriage
Only some parts of the foetus have passed
Bleeding continues
Cervical os is open
Requires medical aid for the removal of all foetal matter
Complete miscarriage
All foetal tissue is removed
The uterus is small
The cervical os is closed
Septic miscarraige
The contents of the uterus is infected and this causes endometritis
Tender uterus
Fever may be absent
May progress to a pelvic infection and this can cause abdominal pain and peritonism
Missed miscarriage
The foetus has not developed or has died in utero
Only recognised later with bleeding or scans
Uterus is smaller than expected
Cervical os closed
Minimal abdominal pain and vaginal bleeding
Presentation of missed miscarriage on a scan
Abnormally shaped amniotic sac with no embryo
Foetus with no heartbeat
Define recurrent miscarriage
Woman has three or more consecutive miscarriages
Define cervical incompetence
Where the cervix fails to retain the pregnancy
Define ectopic pregnancy
Implantation of a fertilised ovum outside of the endometrium
Pharmacological treatment for ectopic pregnancy
Methotrexate
Define molar pregnancy
Where a non-viable, fertilised egg implants into the uterus
This egg will fail to come to term
Explain molar pregnancy
Egg contains no maternal nucleus - entirely paternal in origin
The uterine trophoblast tissue differentiates and expands more aggressively than normal
Define partial molar pregnancy
Some presence of foetal tissue but not complete presence
Will not come to term
Define gestational trophoblastic disease
Pregnancy related tumours
The trophoblastic tissue
Define antepartum haemorrhage
a
Two types of antepartum haemorrhage
a
Define antepartum
a
Define placental abruption
a
Symptoms of placental abruption
a
Define placenta praevia
a
Symptoms of placenta praevia
a
What is a tense, ‘woody’ uterus characteristic of?
a
Two types of placenta praevia
a
How can you differentiate between placental abruption and placenta praevia if the patient has vaginal bleeding?
a
Define pre-eclampsia
a
Cause of pre-eclampsia
a
When does pre-eclampsia occur?
a
What is the main driving force for BHP (benign hypertrophy of the prostate)?
Testosterone
Does BHP have hypertrophy or hyperplasma?
Has both despite name
Why is there hypertrophy in BHP?
a
Why is there hyperplasia in BHP?
a
In which testicle does a variocele occur and why?
a
Normal birthweight for infants
Just under 3.5kg
Low birthweight for infant
<2.5kg
Very low birthweight for infant
<1.5kg
Extremely low birthweight for infant
<1kg
Generally not compatible with life
Full term range of gestational age
37-42 weeks
Preterm gestational age
<37 weeks
SGA parameter
a
What is IUGR
a
Main concern with SGA neonate
Barker hypothesis - development of CVD, hypertension, type 2 DM
Main concern with premature neonate
Neurological developmental issues
Monochorionic vs. dichorionic twins
Monochorionic - twins share a placenta
Dichorionic - twins have their own placenta
‘Twin-twin transfusion’
One twin receives more circulation than the other - grows larger
‘Edwards syndrome’
Trisomy 18
Foetus prioritises blood flow to which three regions?
Brain
Heart
Adrenal gland
Two consequences of foetal hypoglycaemia
a
Two presentations of feotal hypoglycaemia
a
Three reasons temperature control is a problem in SGA baby
a
‘Ductus arteriosus’
Between the aorta and pulmonary artery
‘Ductus venosus’
Between the left umbilical vein and IVC
‘Foramen ovale’
Between left and right atria
Function of ductus venosus
Allows the blood circulation to bypass the liver
Function of foramen ovale
Movement of blood from right atria to left atria
Nerve roots of the pudendal nerve
S2, S3, S4
Common pathology at the vesico-uterine pouch + presentation
Chronic endometriosis
Cyclical pain
NB. also important in retroversion of the uterus
Ground glass shadowing in x-ray of infant is significant of what?
Respiratory distress syndrome - lack of surfactant production
Presentation of necrotising enterocolitis
Tenderness
Discolouration
Distended abdomen
Generalised collapse
