Human Development Flashcards
What runs through lesser sciatic foramen?
Pudendal nerve
Internal pudendal artery and vein
What runs through greater sciatic foramen?
Gluteal arteries, veins, nerves
Sciatic nerve
Pudendal nerve
Where does abdominal artery bifurcate into common illiac?
L4
What is pelvic floor made up of?
Levator ani (puborectalis, pubococcygeus, iliococcygeus) + coccygeus
What are pudendal nerve roots?
S2, S3, S4
Where does uterine artery branch from?
Internal iliac
Where does BPH most commonly occur?
Transition zone
What converts testosterone to DHT?
5-alpha reductase (becomes more active with age, promotes survival of epithelial cells)
What converts testosterone to estrodiol?
aromatase
What are alfuzosin, tamsulosin, doxazosin examples of?
Alpha adrenergic blockers - relax smooth muscle in bladder neck and prostate. All end in sin
Name a 5-alpha reductase inhibitor for BPH
Finasteride (prevents conversion of testosterone into DHT)
What class of meds are slidenafil, vardenafil and tadalafil?
PDE5 inhibitors - prevents breakdown of CGMP
What are treatments for Peyronies
1) stretching
2) topical verapamil - calcium channel blocker, stops the secretion of ECM and collagen
3) surgery
4) injections of collagenase
Why does varicoele always occure in the left testes?
Bc the left internal spermatic vein drains into left renal vein at acute angle
Difference between type 1, type 2, type 3 and 4 ovulatory causes of infertility?
Type 1: hypothalamic
Type 2: pituitary
Type 3: ovarian
Type 4: PCOS
What might be raised in blood investigations for PCOS?
Raised LH, raised testosterone, normal FSH
What is the first-line for treating inferility caused by PCOS?
Clomiphene citrate - antagonist at hypothalamic oestrogen receptors. Induces ovluation
What are leiomyomas and what influences them to grow?
Fibroids (non cancerous smooth muslce growths) - grow under influence of oestrogen
Abnormal secretion of what, particularly on day 8 is linked to increased chance of miscarriage?
LH
(LH dependent on insulin sensitivity - weight reduction)
What anti sperm antibodies block the head from binding to ovum?
IgG
think G for G (at the front0
What antisperm antibody binds to sperm tail
IgA
Think A for ass as its on the back
decreased motility
Is chlamydia gram neg or gram pos?
Gram neg
what serovars is associated with Lymphogranuloma venereum (LGV)?
Serovars L1-L3
What is an elementary body?
The infectious extracellular form of chlamydia
What is the first-line for treatment of chlamydia?
Doxycycline
Can also use azithromycim
What is MAO of doxycycline ?
Tetracycline - binds to 30s subunit to prevent protein synthesis
What is MAO of azithromycin?
Macrolide- binds to 50s ribosomal subunit to prevent protein synthesis
What’s the management of gonorrhea?
Ceftriaxone
Treatment of syphillis?
IV penicillin shot(beta lactam) or doxy but not as effective
What is condyloma latum?
The wart like lesions you get with sphyllis
First-line for trich?
Metronidazole
What measurement shows HIV and AIDS disease progression?
CD4 count
When should PEP be started?
Within 72 hours of exposure
Why can babies of mums with gestastional diabetes get respiratory distress syndrome?
Bc foetal hyperglycaemia leads to decreased cortisol production and therefore decreased surfactant synthesis
What amniotic fluid effect do you get in gestational diabetes?
polyhydramnios - as foetal hyperglycaemia leads to osmotic diuresis
What should normal amniotic fluid amount plateau at in the 28th week?
Around 800ml
What third trimester level indicates oligohydramnious?
Less than 300m/ largest depth of amniotic fluid 2cm or less
What is the name for the effects you get from oligohydramnios?
Potter’s facies
What does the TORCH acronym of fetal infections stand for?
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes simplex/ HIV/ hep
In what trimester is CMV most likely to cause congenital problems?
1st trimester
What is the leading cause of non-genetic hearing loss in childhood?
Congenital CMV
What are the most common side effects of rubella infection during pregnancy?
Heart defects - patent ductus arteriosus, low birth weight, hearing loss, glaucoma
What is the treatment for congenital toxoplasmosis?
Pyrimethamine (folic acid antagonist), folinic acid and sulfadiazine
if you test pos for Group B strep what is the prophylatic treatment?
IV benzylpenicillin
Why should patients ignore unpasteurised milk, undercooked meat, unwashed salads/ vegetables?
Bc of risk of listeriosis
What is pemphigus syphiliticus?
early presentation of congenital syphilis which is characterized by fluid-filled vesicles and bullae which appear mostly on the extremities
What are Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate a sign of?
Congenital syphilis
What is first-line for treatment of chlamydia and gonorrhea whilst pregnant?
Azithromycin (bc tetracyclines are teratogenic)
What do parvaovirus B19 target?
erythrocyte precursors
What does hyperemesis gravidarum correlate with?
beta hCG levels (which might stiumlate oestrogen production causing nausea and vomiting)
What is released from placenta that can cause morning sickness?
GDF15 - growth and differentiation factor 15- goes to area postrema
What vit deficiency might correlate with sickness?
Vit B
What’s the only miscarriage that can be salvageable?
Threatened
What medical treatment for miscarriage?
Misoprostol - prostaglandin E1 (increases strength of contractions and degrades collegen to reduce cervical tone)
When might you see a massive amount of HcG?
In gestational trophoblastic disease
When does a complete molar pregnancy occur?
when sperm fertalises an egg that contains no genes from the mother
What is a partial molar pregnancy?
Happens when two sperm fertilise the egg at same time (one set of chromosomes from mother, two from father)
what is the Kleihauer–Betke test?
Test to work out how much fetal haem has passed to mother
What do you do in placental abruption?
DELIVERRR
steroids for baby
anti d
What is major and minor placenta praevia?
Major - covers cervix and internal os
Minor - marginal <2cm from internal os
Which is worse placenta accreta/increta/percreta
percreta the worst
acreta>increta>percreta
What three features are a diagnosis of pre-eclampsia?
High BP from week 20
Proteinuria
Low placenta growth factor (means the spiral arteries stay narrow)
Pre-eclampsia risk management when can you give aspirin?
from 12 weeks 75mg
What is first line for treatment of pre-eclampsie and how does the drug work?
Labetalol - alpha and beta adrenergic blocker which causes vasodilation
(or hydralazine)
When is surgical cutterage important?
Aschemann’s syndrome - where scar tissue forms in the uterus
Where do the vessels attach in placenta accreta?
Chorionic villi attaches to myometrium rather than restricted within decidua basalis
How can you treat chronic pre-eclampsia?
Methyldopa - alpha 2 adrenergic receptor agonism
Nifedipine - calcium channel blocker
What is vasa previa?
fetal blood vessels run close to or over the opeming of uterus
What is stage 1 of labour and what is it further divided into?
onset of true contractions until 10cm dilation
divided into latent phase
active phase 3-7cm
transitional phase 7-10cm
What is stage 2 of labour?
From 10cm dilation to delivery of the baby
What is stage 4 of labour?
When there are contractions of uterus even after all products of conception has been expelled
What are classifications for failure to progress?
Lasting over 20 hours if first delivery, over 14 if given birth before
What is misoprostol?
A synthetic prostaglandin that can be used to induce labour
What is Cephalohematoma?
Accumulation of blood under the scalp from ventouse or forceps
When is forceps preferred to ventouse?
When the baby is in breach
What is a sign of fetal distress on a fetal heart monitor?
Late decelerations - linked to uteroplacental insufficiency - baby not getting O2 from placenta
What does APGAR stand for?
Appearance
Pulse
Grimace
Activity (tone)
Respiration
What is Erb-Duchenne palsy?
damage to brachial plexus caused by shoulder dystocia?
What is the name for trying to manually turn baby’s shoulders?
McRobert’s manoeuvre
What medications could be given for PPH?
Tranexamic acid - decreases conversion of plasminogen to plasmin preventing fibrin degradation
Erogtamine - alpha-1 selective adrenergic agonist vasoconstrictor
What is name of the alloppregnanolone drug given for post partum depression?
Brexanolone (must be given iV)
How does Zuranolone work for post partum depression?
It is allosteric modulator of GABAa receptor
What psychiatric meds should you avoid in breastfeeding mothers?
Valproic acid and carbamazepine
What can cause PMDD?
Lower luteal estradiol levels or lower allopregnanolone
What are the uncoordinated contractions 4-6 weeks before labour called?
Braxton Hicks contractions
Which hormone gradually increases from 7 months onwards?
Oestrogen
What is the Ferguson reflex?
The cycle of pos feedback from oxytocin during labour
What does acceleration of babies heartbeat mean?
sympathetic activation in response to fetal movement or scalp stimulation
What does late and early deceleration mean?
Early - parasympathetic response to head compression
Late - vagal stimulation or myocardial depression from placental insufficiency
What is the most common presentation of fetal head?
Left occiput anterior
What does the Bishops score show?
Whether labour is likely to start without induction or not
<5 unlikely
>9 likely
What are the classifications for Low birth weight, v low birth weight and extremely low birth weight?
LBW <2500g
VLBW<1500g
ELBW<1000g
Difference between type 1 and type 2 IUGR?
Type 1 = symmetrical, all paremeters below 10th percentile
Type 2 = asymmetrical - head is bigger
What causes type 2 IUGR and when does growth restriction normally start?
Uteroplacental insufficiency and begins after week 28 in hypertrophic stage
Why do neonates have difficulty maintaining temperature?
Absent brown fat and small body mass to surface area
How many weeks lag in fundal height is suggestive of IUGR?
4 weeks
>6 weeks suggest severe IUGR
What might you find in a middle cerebral artery doppler in IUGR?
Normally - little flow during diastole
in IUGR - increased flow in diastole due to redistribution of cardiac output
What should the ratio between MCA and umbilical artery be on doppler ultrasound?
Between 1 -1.1 = brain sparing
How many weeks is preterm?
less than 37
What is given to enhance maturation of type 2 pneumocytes?
Corticosteroid injection
What is periventricular leukomalacia an injury to?
White matters
Difference between gastroschisis and exomphalos?
Gastroschisis - intestines extend outside of abdomen, exomphalos - intestines remain in umbilical cord
What causes cleft lip?
Failure of maxilla to fuse with medial nasal prominence
What causes cleft palate?
Failure of palatal shelves to fuse
What brain anomalies could lead to SIDS?
alterations in serotonin signalling, underdevelopment of arcuate nucleus and thick pseudostratified ependymal later
What is triad you find in shaken baby syndrome?
Encephalopathy, subdural haematoma, retinal haemorrhages
How many aspects need to be affected to have global development delay?
2+
What age do you get MMR vaccine?
one year and 3 years 4 months
What are some gram pos cocci organisms? (sphere shaped)
Staphylococcus, streptococcus, enterococcus
What are some gram pos bacilli organisms? (rod shaped)
corynebacterium, listeria, bacillus, clostridium
When is pneumococal conjugate vaccine given?
12 weeks with booster at 12 months
What vaccine is given at 8 weeks, 12 weeks and 16 weeks?
6 in 1 diptheria, tetanus, pertussis, polio, influenza type b, hep b
How is predicted adult height calculated?
Mean of mum and dad’s height divided by 2, add 7cm to males and subtract 7 for females
When would you need to investigate child’s weight/height?
If they drop 2 or more centiles, if they are below the 0.4th centile or if their height is 3 centiles below mid parental height
What causes Turner syndrome?
When part of X chromosome is partially or completely absent (45X, or 45X0)
What causes the short stature of Turner syndrome
SHOX haploinsufficiency - lost from the missing X chromosome
What is Leri-Weill dyschondrosteosis?
Causes dwarfism. Autosomal dominant skeletal dysplasia - haplo-insuffiency of SHOX
What is Wilm’s tumour?
Also called nephroblastoma - tumour of kidney
What gene has a role in ureteric branching that when inactivated can cause Wilm’s tumour?
WT1
What cells does retinoblastoma originate from?
cone precursor cells
What does the RB1 gene do?
It prevents cells moving into G1-S stage by inhibiting E2F
What is the most common cancer in first year of life?
Neuroblastoma
What key oncogenes are involved in development of neuroblastoma?
MCYN, ALK and PHOX2B
How can criztotinib be used to treat neuroblastoma?
It targets ALK mutations
Translocation of KMT2A on what chromosome can lead to ALL?
chromosome 11
What is name of hypothesis that babies born of low birth weight have a higher chance of developing HTN, diabetes and coronary artery disease?
Barker hypothesis
When is wheeze evident?
In expiration
What is stridor?
High pitched harsh sound due to obstruction. Inspiratory
What is treatment for precocious puberty?
GnRH to overstimulate pituitary and stop it producing gonadotrophins
What Tanner stage is irreversible to treatment?
stage 3
If a patient has delayed puberty and they are found to have elevated FSH after 13 yrs in girls, 14 in boys, what does this mean?
Primary hypogonadism is the cause
What will you see in a section of a seminoma?
Lymphocytic infiltrate
What is the most common type of testicular tumour?
Germ cell tumours
What ratio is elevated in men with BPH?
E2:T ratio
What STI can’t be grwon in culture?
chlamydia as it is an intracellular bacteria
What causes syphilis?
Treponema pallidum
How is syphillis treated?
penicillin or doxycycline
What are the Rotterdam criteria for PCOS?
1) hyperandrogenism
2) oligomenorrhoea
3) polycystic ovaries >12 follicles larger than 9mm
If you have a short cervix what can be given to prevent misarriage?
progesterone supplement or gel
What antibodies are associated with recurrent miscarriage?
anti cardiolipin antibodies or lupus anticoagulant antibodies
What causes anti sperm antibodies in males?
breakdown of blood testes barrier
mutations in what gene can cause intersex genitals, absence of puberty, and infertility?
NR5A1
What hormone is able to tell you whether youre ovulatinr or no?
day 21 progesterone
What is human menopausal gonadotrophin from?
it is purified preparations of urinary extracts from menopausal women
What injection is used in the final preparation before retrieval in IVF?
HCG
2nd line PCOS infertility treatment?
clomiphene citrate and metformin
If sperm volume is less than 1ml what should be done?
a urine analysis to check for reterograde ejaculation
What drugs can hinder the transport of spermatozoa?
SSRIs and alpha blockers (anti-hypertensive drugs)
What does high LH and FSH and low testosterone suggest?
primary hypergonadotrophic hypogonadism ie a problem with the testes
what does high lh and fsh and normal testosterone indicate?
seminiferous tubule damage
what should you check for in infertility with low testosterone and low normal fsh/lh?
check other pituitary hormone deficiences including thyroid function
What does a mutation in methylene tetrahydrofolate reductase mean?
the body can’t convert folic acid to folate. So need to take folate rather than folic acid
What do sperm chromatin structure assays look for?
Detect high degree of DNA fragmentation
In TUNEL asay sperm test what color do normal sperm stain?
normal = blue
sperm with damage = green
What ratio is increased in men with BPH?
E2:T ratio
estrogens stimulate prolactin release which induces prostate enlargement
Why is gestational diabetes thought to occur?
due to placental secretion of anti insulin hormones
How often should someone with gestational diabetes have ultrasound?
every two weeks
What is the classic triad of features in congenital toxoplasmosis infection?
chorioentitis, hydrocephalus, intracranial atherscelerosis
What is mifepristone?
anti-progesterone. Causes contractions used for prolonged labour often with misoprotol
what is name of fetal heart rate monitoring whilst in labour?
cardiotocography
What imbalances can perinatal asphyxia lead to?
hypoxemia, high levels of CO2 and acidosis
Treat for thromboembolic disease after labour?
heparin as does not cross into breast milk
What is first line for post partum depression still?
SSRIs
What causes type 1 IUGR?
result of growth inhibition in early stage (4-20 weeks hyperplastic stage). Causes by genes, infection or multiple gestation
what type of growth restriction is associated with oligohydramnios?
type 2
When is absent or reversed end diastolic flow observed in fetus?
type 2 and type 3 growth restriction
what bed rest position increases uteroplacental blood flow?
left lateral position
what vitamin deficiency can increase incidence of pre-term baby?
vit D
what does surfactant do?
increases lung compliance
what is broncho-vaxam?
inactivated whole cell bacteria, used in children with recurrent chest infections to sensitise them
What would early and late failure of septation cause?
early - atrioventricular septal defect whereas late would just be one or the other
what causes persistant truncus arteriosus?
trunoconal swellings fail to fuse
what heart defect will baby die very quickly if ductus arteriosus not kept open?
transposition of the great vessels
what is persistant pulmonary hypertension of new born?
elevated pulmonary vascular resistance resulting in right to left shunting of blood and hypoxemia
What inflammatory mediators play a role in development of meningococcal disease?
IL-6 and TNF alpha (these are the same as in RA)
What serotype of pneumonia causes majority of empyema?
serotype 1
Difference between pnemococcal polysaccharide vaccine and conjugate vaccine?
polysaccharide given to those at great risk, protects against more serotypes
what type of vaccines are the herpes viruses and hep b?
enveloped DNA viruses
How is most viral diagnosis done?
via PCR
what virus causes chickenpox?
varicella zoster virus
When do you get MMR vacine?
MMR 1st dose 12 months
2nd dose 3 years and 4 months
How do you work out the herd immunity threshold?
1 -1/R0
deficiency of what causes short stature and might not be noticed until late infancy?
growth hormone
what gene is linked to longevity?
FOXO3A
(think still being foxy when youre old, 3 bc 3 grannies)
what gene can cause ageing and is shortened in amish comminities?
PAI-1
What happens to RB1 to get it to release E2F?
it gets phosphorylated
What type of ALL is most aggressive?
Pro-B ALL as it happens in earlier stage of haematopoiesis
why do females develop a concentric pattern of hyperthrophy?
bc oestrogen receptor is on cardiomycytes and normally prevents hypertrophy then get a fall post menopause
decreased levels of what immunogloblin mean elderly people are less likely to deal with resp viruses?
IgA
What kind of vaccines are diptheria and tetanus?
toxoid
What type of vaccines are MMR, BCG and yellow fever?
live attenuated
