HD2 Revision1 Flashcards
Which of the following is the sacrotuberous ligament? [1]
20
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
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 is an episiotomy?
What are the two types? [2]
Surgical incision of the perineum and posterior vaginal wall
Two types:
Midline episiotomy: Posterior aspect of labia minora (fourchette) along midline
Mediolateral episiotomy” Fourchette diagonally towards midpoint between ischial tuberosity and anus
The uterine artery passes over the []. The [] is therefore at risk during [].
The uterine artery passes over the ureter. The ureter is therefore at risk during hysterectomies.
What is the normal position of the uterus? [2]
The normal position of the uterus is anteverted and anteflexed.
What can cause uterine prolapse? [2]
Secondary to pelvic floor and uterine ligament dysfunction
Multifactorial in etiology
Which structure can be inserted to stop uterine prolapse? [1]
Ring Pessary
Label A-C of female ligaments
A: Broad ligament
B: Ovarian ligament
C: Round ligament
which muscle is highlighted here? [1]
piriformis
Lesser sciatic foramen structures? [3]
Pudendal nerve
Internal pudendal artery
Internal pudendal vein
Which is the ligament highlighted?
Sacrospinous ligament
Sacrotuberous ligament
Anterior sacroiliac ligament
Ischial tuberosity
Which is the ligament highlighted?
Sacrospinous ligament
Sacrotuberous ligament
Anterior sacroiliac ligament
Ischial tuberosity
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
Which of the following is piriformis?
A
B
C
D
E
F
Which of the following is piriformis?
A
B
C
D
E
F
Label A-C
a iliococcygeus muscle
b pubococcygeus muscle
c puborectalis muscle
label A-F
A - coccygeus
B - iliococcygeus
C - pubococcygeus
D - puborectalis
E - tendinous arch of levator ani
F - obturator internus
what is autonomic supply to pelvis like?
PNS: pelvic splachnic nerves from S2, S3 & S4
SNS: via superior hypogastric plexus (continuation of the aortic plexus). contains sympathetic, ascedending PNS and viseceral afferent fibres.
superior hypogastric –> left and right inferior hypogastric plexi eitherside of the rectum
which muscle is highlighted here? [1]
piriformis
What type of bacteria is Chlamdydia trachomatis? [1]
Is it gram postive or gram negative? [1]
Obligate aerobic intracellular pathogen
Chlamydia trachomatis is a gram-negative bacteria
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 complications of Chlamdydia trachomatis? [2]
What are treatments for Chlamdydia trachomatis? [2]
Complications
* Reactive arthritis
* INFERTILITY – can cause ectopic pregnancy due to scarring of uterus
Treatment
* Azithromycin
* Doxycycline
What are male [5], female [4] and neonate [1] from having Neisseria gonorrhoea
Males:
* Urethritis
* proctitis
* sore throat
* epididymitis
* prostatitis
Females:
* Cervicitis,
* PID
* ,Peri-hepatitis
* septic abortion - gets into amniotic sac and infects baby
Neonates
* Conjunctivitis
What are systemic complications of Neisseria gonorrhoea? [4]
- Septic arthritis
- blindness
- infertility
- septicaemia
How do you treat Neisseria gonorrhoea? [1]
Ceftriaxone
Which variants of HPV are linked to cancer? [4]
Which variants of HPV are targeted by Gardasil vaccine? [2]
Cancerous: HPV 16, 18, 31,33
Vaccine: HPV 16 and 18
What are the two types of Herpes Simplex Virus? [2]
What are the modes of transmission for each? [2]
HSV-1 oral
HSV-2 genital
What are the two types of Chlamdydia trachomatis (that need to know) [2]
What do they cause? [2]
Serovars D-K: infects genital tract epithelial cells
Males: Urethritis, epipdidymitis, prostatitis
Females: Cervicitis, PID, Fitz-Hugh Curtis (liver capsule adhesions)
Neonate - conjunctivitis and pneumonia
Serovars L1-3
Causes: Lymphogranuloma venereum
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
Explain life cycle of Syphilis (Treponema pallidum) [4]
Primary:
* single sore or multiple sores. The sore is the location where syphilis entered your body. These sores usually occur in, on, or around the penis; vagina; anus; rectum; and
lips or in the mouth
* 3 to 6 weeks and heals regardless of whether you receive treatment.
Secondary:
* Rash, fever, lymphadenopath, Condyloma latum (wart like lesions on genitals)
* This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can be on the palms of your hands and/or the bottoms of your feet
Latent:
* No signs or symptoms
Tertiary:
* However, when it does happen, it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system.
* Tertiary syphilis is very serious and would occur 10–30 years after your infection began
* Can result in death
Which stages of HIV lifecycle to HAART target / what are the drug types? [5]
Protease Inhibitors (PIs)
Integrase Inhibitors (IIs)
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Entry Inhibitors (EIs; fusion inhibitors, CCR5 antagonist)
What are short term [4] and long term [5] problems of HAART treatment?
Problems with HAART
- Short-term side effects: nausea, vomiting, headache, sleep disturbance (caused by efavirenz)
- Long term: lipodystrophy (NRTIs and PIs), renal dysfunction (tenofovir), peripheral neuropathy (d4T, AZT, DDI), lactic acidosis (may be fatal, d4T, DDI)
Name 3 opportunisitic infections and 3 malignancies caused by HIV infection
- Opportunistic infections cause viral, fungal, bacterial, mycobacterial and parasitic infections
- Malignancies: Kaposi’s sarcoma, lymphoma, carcinoma of cervix
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 pathophysiology of PCOS
Oocytes develop in the ovary, but have become ovarian cysts (follicles that have not ovulated - become fluid filled and cover outer surface)
Occurs because of hyperandrogenism (increased testosterone) in reproductve system
highly genetic
What scoring system is used to ID PCOS? [1]
What score need to diagnose PCOS? [1]
Name 3 things that could get a point for this system? [3]
Rotterdam criteria: need 2/3
* Clinical hyperandrogenism (high testosterone)
* Oligomenorrhoea (less than 6-9 menses per year)
* PCOS on ultrasound
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
What would levels of LH, FSH & free testosterone be like in PCOS patients? [3]
FSH: Raised
LH: normal
Free Testosterone: Raised
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
What test would you use to check sperm DNA integrity? [1]
Sperm chromatin integrity test
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 you 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
