HD1 Flashcards
State the name [1] and function [1] of these devices?
Ring pessary
Stops vaginal / uterine prolapse
A is the piriformis
Label B-F
B: gluteus medius
C: quadratus femoris muscle
D: common fibular nerve
E: tibial nerve
F: Inferior gluteal vessels
Label this image of the right gluteal region after reflecting gluteus maximus muscle
CFn — common fibular nerve; Tn — tibial nerve; Pfm — piriformis muscle; QF — quadratus femoris muscle; Sn — sciatic nerve.
What is this pathology depicted? [1]
Which pathogens are most likely to have caused this? [1]
Fitz-Hugh syndrome
C. trachomatis and N. gonorrhea
A diagnostic laparoscopy was performed that showed extensive adhesions between the liver and abdominal wall (anterior wall). What is the next step in the management of the patient?
A. Ceftriaxone plus doxycycline
B. Lyse the adhesion with electrocautery
C. Metronidazole and doxycycline
D. No management is required
A diagnostic laparoscopy was performed that showed extensive adhesions between the liver and abdominal wall (anterior wall). What is the next step in the management of the patient?
A. Ceftriaxone plus doxycycline
B. Lyse the adhesion with electrocautery
C. Metronidazole and doxycycline
D. No management is required
This symptom indicates infection from which of the following
Gonorrhoea
Syphilis
HIV
CMV
Chlamydia
This symptom indicates infection from which of the following
Gonorrhoea
Syphilis - tertiary. symptom: gumma
HIV
CMV
Chlamydia
How many polycystic ovaries are required for US diagnosis? [1]
defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in
A 22-year-old man presents with a two-day history of discharge from the urethral meatus, and pain on urination. When asked, he explains he has had several new sexual contacts recently. On examination, the discharge contains yellow pus and mucous. A first void urine sample is taken to test for the suspected diagnosis.
How should this most likely diagnosis be treated?
Trimethoprim
Ceftriaxone
Cirpofloxacin
Nitrofurantoin
Benzylpenicillin
Ceftriaxone
This patient has presented with gonorrhoea, which can be confirmed with nucleic acid amplification testing (NAAT). This requires a first void urine sample in men, or a vulvovaginal swab in women.
A 37-year-old female presents to her general practitioner with complaints of a green, frothy discharge and vulval itchiness for the last five days. The patient has been in a monogamous relationship with her husband for nine years. She has no significant past medical history and takes no medications. A speculum examination shows small punctate areas of haemorrhage on the cervix. Vulvar erythema is also present.
What is the most likely diagnosis in this patient?
Trichomoniasis
Gonorrhoea
Primary syphilis
Vaginal candidiasis
Secondary syphilis
Trichomoniasis
This patient’s presentation is consistent with Trichomoniasis which is a sexually transmitted infection caused by Trichomonas vaginalis. Typically, this infection leads to a frothy, green discharge accompanied by pruritus, vaginitis and post-coital bleeding. Small punctate haemorrhages are also commonly seen on speculum examination (often referred to as a ‘strawberry cervix’).
From where in the hip bone does the gluteus medius originate?
Iliac fossa
Anterior aspect of the iliac crest
Greater sciatic notch
External surface of the ileal wing
From where in the hip bone does the gluteus medius originate?
Iliac fossa
Anterior aspect of the iliac crest
Greater sciatic notch
External surface of the ileal wing
The piriformis seperates which neurovascular structures?
Suprapiriform foramen:
* The superior gluteal artery and nerve
Infrapiriform foramen
* Posterior cutaneous nerve of thigh
* Inferior gluteal vessels and nerves
* Nerve to quadratus femoris
* Pudendal nerve
* Internal pudendal vessels
* Nerve to obturator internus
* Sciatic nerve
PINS & PINS
In a women:
Which arteries split from the common iliac arteries and dont stay in the pelvis? [4]
Which arteries split from the common iliac arteries and stay in the pelvis? [3]
Leaves:
* obturator
* femoral
* gluteal
* internal pudendal arteries
Remains:
* middle rectal artery
* uterine artery
* superior vesicular artery
What can cause uterine prolapse? [2]
Secondary to pelvic floor and uterine ligament dysfunction
Multifactorial in etiology
Which of the following is sacrotuberous ligament?
A
B
C
D
E
F
Which of the following is sacrotuberous ligament?
A
B
C
D
E
F
label A-F
A - coccygeus
B - iliococcygeus
C - pubococcygeus
D - puborectalis
E - tendinous arch of levator ani
F - obturator internus
Explain lifecycle of Chlamdydia trachomatis
- what are the two different forms? [2]
- Which type is infectious? [1]
- which type of replicative? [1]
Exists in two different forms:
- the elementary body, which is the infectious form
- the reticulate body, which is the replicative form
Infect as an elementary body, then turns in to reticulate body, after a while becomes elementary body and bursts and infects
What are the treatment options for herpes? [3]
Management:
Topical podophyllotoxin
imiquimod
Cryotherapy
What type of cells does herpes virus intergrate into?
epithelial cells
nerve cells
muscle cells
endothelial cells
What type of cells does herpes virus intergrate into?
epithelial cells
nerve cells
muscle cells
endothelial cells
Drug management for herpes? [3]
Acyclovir, Famciclovir, Valaciclovir
What are the 4 types of ovulatory causes of infertility? [4]
Type 1: hypothalamic
* hypothalamic amenorrhea
* anorexia nervosa (both men and women)
Type 2: pituitary:
* Hyperprolactinaemia - increase prolactin (mimics that you are breasfeeding: causes decrease in LH & FSH)
Type 3: ovarian:
* Premature ovarian failure
Type 4:
* polycystic ovary syndrome (PCOS)
Explain why testosterone is raised in PCOS [3]
PCOS:
Initial response to LH from follicle.
At around 8cm follicle development stops: granulosa cells are lost.
Normally testosterone would be converted to oestrogen, but now doesnt: so secreted out
Explain 5 tubal / uterine causes of infertility
Pelvic inflammatory disease:
* Bacterial infection spreading to vagina or cervix causes blockages / inflammation of uterine tubes OR adhesions that stick uterus to uterine tubes
* Commonly chlamdyia or gonorrhoea
Previous tubal surgery
* E.g for ectopic pregnancy
Endometriosis
* Bits of endometrium are outside of uterine cavity (e.g. on fallopian tube or bowell - will grow and develop due to oestrogen and progesterone. But when stop during in menstrual cycle: will bleed. Causes discomfort
Fibriods
* uterine smooth muscle growth and creates nodules (causing discomfort)
* stops uterus wall expanding properly when pregnant
* causes heavy periods & pain on intercourse
cervical mucus defects
* transforms into hostile environment all the time (instead of changing to hostile environment mid-cycle)
Explain the main pathophysiology that causes repeated miscarriages? [2]
(lots of reasons)
Main: blood coagulation protein / platelet defects
* Defects in factor XIII and factor XII
* Having anti-cardiolpin antibodies, lupus anticoagulant or antiphospholipid syndrome
others include:
- Anatomical anomalies - cervical incompetence
- Genetic / chromsome abnormalities - trisomy 21 etc
- Endocrine / hormonal abnormalities
MOST ARE TREATABLE
How can you treat blood coagulation protein / platelet defects causing repeated miscarriages? [1]
Aspirin
Name 4 reasons why male infertility may occur
- less than 120 million sperm
- Hormone imbalance (hypogonadism)
- Anti-sperm antibodies
- Varicocele (varicous veins of testes)
- Sperm quality and movement
- Undescended testis
- Obstruction (vasectomy, cystic fibrosis)
- Ejaculatory problems (retrograde and premature)
- Erectile dysfunction
Explain immunological causes of combined infertility
Develop antisperm antibodies (ASA): IgG, IgA and IgM
Causes a breakdown of blood testis barrier (usually blood shouldn’t come in contact with sperm) because its only haploid - is recognised as foreign so is broken down
Explain a genetic cause of combined infertility
During male development SRY downfeeds to SF-1 which causes get rid of uterus when developing in men.
Mutation in gene NR5A1 that codes for SF-1 causes 46XY but with non obstructive male infertility:
Can develop female external external genitalia, uturus and uterine BUT no gonads
OR can have low testosterone and develop azoospermia
What are 4 reasons why unexplained infertility may occur
Celiac disease
Thyroid imbalance
Folate deficiency
High sperm DNA damage
Investigating infertility with a PCOS screen - what would you assess? [5]
- Day 21 progesterone - if greater than 30nmol / L indicates ovulation viable.
- Raised LH
- Normal / Slightly raised FSH
- Raised testosterone
- Abnormal glucose (because DMT2 is big risk factor)
Investigating infertility apart from PCOS - would blood screen parameters would you investigate? [5]
Thyroid (TSH / TFT levels)
Vitamin D levels (increased vit D is better)
HbA1C
Viral screen - Rubella, HIV, hepatits
STI screen (undiagnosed chlamydia or gonorrheaa)
What are secondary care investigations would conduct to assess ovulatory function?
Bloods from primary care
Ovarian reserve: Response to gonadotrophin stimulation in IVF
Assess tubal function: Hysterosalpingogram
Assess uterine function
Laparoscopy
Which pathology is consequence of long term assisted reproduction techniques? [1]
Ovarian hyperstimulation syndrome: consequence of drugs used to stimulate ovarian function in IVF.
Presents similarly to PCOS as get cysts developing
What is a potential risk for children who are born from women over 35 with IVF? [1]
What is a potential risk for mothers who have children, who are over 35 and use IVF? [1]
Increase in congenital defects
Increase in cancer for the mothers
Which best describes the MoA of Tamulosin
alpha 1 agonist
alpha 1 antagonist
alpha 2 agonist
alpha 2 antagonist
Which best describes the MoA of Tamulosin
alpha 1 agonist
alpha 1 antagonist: cause IUS to stop having SNS action and causes it to relax
alpha 2 agonist
alpha 2 antagonist
Which drug inhibits SNS action where the arrow is pointing? [1]
Tamulosin
Treatment for syphilis? [1]
(benzathine) benzylpenicillin
Name this sign of late congenital syphilis [1]
Saddle nose
What is this diagnosis of a premature baby? [1]
Interventricular haemorrhage
A baby is born at 26 weeks and this slide is taken from their lungs.
What has caused this?
A lack of surfactant
An infection
High oxygen tension
Pulmonary hypertension
Mechanical ventilation
A lack of surfactant
When during gestation is surfactant started to be made? [1]
By how many weeks gestation is it that babies produce enough to breathe normally by? [1]
Starts between weeks 24 and 28 of pregnancy.
By 34 weeks babies produce enough to breathe normally by.
A fetal ultrasound identifies a congenital defect.
What is this defect?
Gastroschisis
Myelomeningocele
Omphalocele
Placental abruption
Spina bifida occulta
A fetal ultrasound identifies a congenital defect.
What is this defect?
Gastroschisis
Myelomeningocele
Omphalocele
Placental abruption
Spina bifida occulta
Below the a schematic of an abnormal fundal height measurement at 28 weeks, prior to this the fundal height was within normal parameters. What is a possible explanation for this result?
Gestational diabetes
Intrauterine growth restriction type 1
Intrauterine growth restriction type 2
Polyhydramnios
Pre-eclampsia
Below the a schematic of an abnormal fundal height measurement at 28 weeks, prior to this the fundal height was within normal parameters. What is a possible explanation for this result?
Gestational diabetes
Intrauterine growth restriction type 1
Intrauterine growth restriction type 2
Polyhydramnios
Pre-eclampsia
Which of the following does parvovirus B19 attack? [1]
What condition does this cause? [1]
Red blood cell: fetal anaemia
Which pathogen has infected this child?
Syphilis
CMV
Parvovirus B19
Listeria
Measles
Parvovirus B19
Image: Erythema infectiosum
Symptoms include a mild fever, slapped-cheek red rash on the face, and a lacy rash on the arms, legs, and trunk.
Erythema infectiosum, often referred to as fifth disease, is caused by human parvovirus B19 and occurs most often during the spring months, often in geographically limited outbreaks among children, particularly school age children.
What is typically the first symptom of an ectopic pregnancy?
lower abdominal pain
vaginal bleeding
dizziness
breast tenderness
syncope
What is typically the first symptom of an ectopic pregnancy?
lower abdominal pain
vaginal bleeding
dizziness
breast tenderness
syncope
If a baby suffers from these symptoms, they are most likely to be suffering from:
Toxoplama gondii
CMV
Parvovirus B19
Listeria
Measles
Toxoplama gondii
Intracranial calcification
Hydrocephalus
Chorioretinitis
Hyperemesis gravidarum is associated with a peak in
Progesterone
Oestrogen
bHCG
FSH
LH
Hyperemesis gravidarum is associated with a peak in
Progesterone
Oestrogen
bHCG
FSH
LH
hCG may stimulate oestrogen production from ovary causing vomiting and nausea
A patient is suspect as suffering from toxoplamosis gondii
What is the most appropriate management for this patient?
A. Ceftriaxone and ampicillin
B. Aciclovir
C. Voriconazole
D. Pyrimethamine and sulfadiazine
A patient is suspect as suffering from toxoplamosis gondii
What is the most appropriate management for this patient?
A. Ceftriaxone and ampicillin
B. Aciclovir
C. Voriconazole
D. Pyrimethamine and sulfadiazine
How do you treat congenitial Listeria? [2]
Ampicillin plus an aminoglycoside
Label A-F
Label: 2, 3, 7, 8 and 10 [5]
2: uterine tube
3: ovarian ligament
7: ureter
8: rectum
10: bladder
Label 1-3 & 6-9
1 Body of clitoris
2 Crus of clitoris
3 Bulb of vestibule
4 Prepuce of clitoris
5 Glans of clitoris
6 Frenulum of clitoris
7 Labium minus
8 Vaginal orifice
9 Greater vestibular gland
