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Year 2 > Human Development > Flashcards

Human Development Flashcards

1
Q

What runs through lesser sciatic foramen?

A

Pudendal nerve
Internal pudendal artery and vein

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2
Q

What runs through greater sciatic foramen?

A

Gluteal arteries, veins, nerves
Sciatic nerve
Pudendal nerve

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3
Q

Where does abdominal artery bifurcate into common illiac?

A

L4

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4
Q

What is pelvic floor made up of?

A

Levator ani (puborectalis, pubococcygeus, iliococcygeus) + coccygeus

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5
Q

What are pudendal nerve roots?

A

S2, S3, S4

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6
Q

Where does uterine artery branch from?

A

Internal iliac

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7
Q

Where does BPH most commonly occur?

A

Transition zone

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8
Q

What converts testosterone to DHT?

A

5-alpha reductase (becomes more active with age, promotes survival of epithelial cells)

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9
Q

What converts testosterone to estrodiol?

A

aromatase

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10
Q

What are alfuzosin, tamsulosin, doxazosin examples of?

A

Alpha adrenergic blockers - relax smooth muscle in bladder neck and prostate. All end in sin

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11
Q

Name a 5-alpha reductase inhibitor for BPH

A

Finasteride (prevents conversion of testosterone into DHT)

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12
Q

What class of meds are slidenafil, vardenafil and tadalafil?

A

PDE5 inhibitors - prevents breakdown of CGMP

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13
Q

What are treatments for Peyronies

A

1) stretching
2) topical verapamil - calcium channel blocker, stops the secretion of ECM and collagen
3) surgery
4) injections of collagenase

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14
Q

Why does varicoele always occure in the left testes?

A

Bc the left internal spermatic vein drains into left renal vein at acute angle

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15
Q

Difference between type 1, type 2, type 3 and 4 ovulatory causes of infertility?

A

Type 1: hypothalamic
Type 2: pituitary
Type 3: ovarian
Type 4: PCOS

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16
Q

What might be raised in blood investigations for PCOS?

A

Raised LH, raised testosterone, normal FSH

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17
Q

What is the first-line for treating inferility caused by PCOS?

A

Clomiphene citrate - antagonist at hypothalamic oestrogen receptors. Induces ovluation

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18
Q

What are leiomyomas and what influences them to grow?

A

Fibroids (non cancerous smooth muslce growths) - grow under influence of oestrogen

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19
Q

Abnormal secretion of what, particularly on day 8 is linked to increased chance of miscarriage?

A

LH
(LH dependent on insulin sensitivity - weight reduction)

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20
Q

What anti sperm antibodies block the head from binding to ovum?

A

IgG
think G for G (at the front0

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21
Q

What antisperm antibody binds to sperm tail

A

IgA
Think A for ass as its on the back
decreased motility

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22
Q

Is chlamydia gram neg or gram pos?

A

Gram neg

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23
Q

what serovars is associated with Lymphogranuloma venereum (LGV)?

A

Serovars L1-L3

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24
Q

What is an elementary body?

A

The infectious extracellular form of chlamydia

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25
Q

What is the first-line for treatment of chlamydia?

A

Doxycycline
Can also use azithromycim

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26
Q

What is MAO of doxycycline ?

A

Tetracycline - binds to 30s subunit to prevent protein synthesis

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27
Q

What is MAO of azithromycin?

A

Macrolide- binds to 50s ribosomal subunit to prevent protein synthesis

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28
Q

What’s the management of gonorrhea?

A

Ceftriaxone

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29
Q

Treatment of syphillis?

A

IV penicillin shot(beta lactam) or doxy but not as effective

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30
Q

What is condyloma latum?

A

The wart like lesions you get with sphyllis

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31
Q

First-line for trich?

A

Metronidazole

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32
Q

What measurement shows HIV and AIDS disease progression?

A

CD4 count

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33
Q

When should PEP be started?

A

Within 72 hours of exposure

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34
Q

Why can babies of mums with gestastional diabetes get respiratory distress syndrome?

A

Bc foetal hyperglycaemia leads to decreased cortisol production and therefore decreased surfactant synthesis

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35
Q

What amniotic fluid effect do you get in gestational diabetes?

A

polyhydramnios - as foetal hyperglycaemia leads to osmotic diuresis

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36
Q

What should normal amniotic fluid amount plateau at in the 28th week?

A

Around 800ml

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37
Q

What third trimester level indicates oligohydramnious?

A

Less than 300m/ largest depth of amniotic fluid 2cm or less

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38
Q

What is the name for the effects you get from oligohydramnios?

A

Potter’s facies

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39
Q

What does the TORCH acronym of fetal infections stand for?

A

Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes simplex/ HIV/ hep

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40
Q

In what trimester is CMV most likely to cause congenital problems?

A

1st trimester

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41
Q

What is the leading cause of non-genetic hearing loss in childhood?

A

Congenital CMV

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42
Q

What are the most common side effects of rubella infection during pregnancy?

A

Heart defects - patent ductus arteriosus, low birth weight, hearing loss, glaucoma

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43
Q

What is the treatment for congenital toxoplasmosis?

A

Pyrimethamine (folic acid antagonist), folinic acid and sulfadiazine

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44
Q

if you test pos for Group B strep what is the prophylatic treatment?

A

IV benzylpenicillin

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45
Q

Why should patients ignore unpasteurised milk, undercooked meat, unwashed salads/ vegetables?

A

Bc of risk of listeriosis

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46
Q

What is pemphigus syphiliticus?

A

early presentation of congenital syphilis which is characterized by fluid-filled vesicles and bullae which appear mostly on the extremities

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47
Q

What are Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate a sign of?

A

Congenital syphilis

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48
Q

What is first-line for treatment of chlamydia and gonorrhea whilst pregnant?

A

Azithromycin (bc tetracyclines are teratogenic)

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49
Q

What do parvaovirus B19 target?

A

erythrocyte precursors

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50
Q

What does hyperemesis gravidarum correlate with?

A

beta hCG levels (which might stiumlate oestrogen production causing nausea and vomiting)

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51
Q

What is released from placenta that can cause morning sickness?

A

GDF15 - growth and differentiation factor 15- goes to area postrema

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52
Q

What vit deficiency might correlate with sickness?

A

Vit B

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53
Q

What’s the only miscarriage that can be salvageable?

A

Threatened

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54
Q

What medical treatment for miscarriage?

A

Misoprostol - prostaglandin E1 (increases strength of contractions and degrades collegen to reduce cervical tone)

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55
Q

When might you see a massive amount of HcG?

A

In gestational trophoblastic disease

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56
Q

When does a complete molar pregnancy occur?

A

when sperm fertalises an egg that contains no genes from the mother

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57
Q

What is a partial molar pregnancy?

A

Happens when two sperm fertilise the egg at same time (one set of chromosomes from mother, two from father)

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58
Q

what is the Kleihauer–Betke test?

A

Test to work out how much fetal haem has passed to mother

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59
Q

What do you do in placental abruption?

A

DELIVERRR
steroids for baby
anti d

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60
Q

What is major and minor placenta praevia?

A

Major - covers cervix and internal os
Minor - marginal <2cm from internal os

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61
Q

Which is worse placenta accreta/increta/percreta

A

percreta the worst
acreta>increta>percreta

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62
Q

What three features are a diagnosis of pre-eclampsia?

A

High BP from week 20
Proteinuria
Low placenta growth factor (means the spiral arteries stay narrow)

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63
Q

Pre-eclampsia risk management when can you give aspirin?

A

from 12 weeks 75mg

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64
Q

What is first line for treatment of pre-eclampsie and how does the drug work?

A

Labetalol - alpha and beta adrenergic blocker which causes vasodilation
(or hydralazine)

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65
Q

When is surgical cutterage important?

A

Aschemann’s syndrome - where scar tissue forms in the uterus

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66
Q

Where do the vessels attach in placenta accreta?

A

Chorionic villi attaches to myometrium rather than restricted within decidua basalis

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67
Q

How can you treat chronic pre-eclampsia?

A

Methyldopa - alpha 2 adrenergic receptor agonism
Nifedipine - calcium channel blocker

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68
Q

What is vasa previa?

A

fetal blood vessels run close to or over the opeming of uterus

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69
Q

What is stage 1 of labour and what is it further divided into?

A

onset of true contractions until 10cm dilation
divided into latent phase
active phase 3-7cm
transitional phase 7-10cm

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70
Q

What is stage 2 of labour?

A

From 10cm dilation to delivery of the baby

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71
Q

What is stage 4 of labour?

A

When there are contractions of uterus even after all products of conception has been expelled

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72
Q

What are classifications for failure to progress?

A

Lasting over 20 hours if first delivery, over 14 if given birth before

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73
Q

What is misoprostol?

A

A synthetic prostaglandin that can be used to induce labour

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74
Q

What is Cephalohematoma?

A

Accumulation of blood under the scalp from ventouse or forceps

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75
Q

When is forceps preferred to ventouse?

A

When the baby is in breach

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76
Q

What is a sign of fetal distress on a fetal heart monitor?

A

Late decelerations - linked to uteroplacental insufficiency - baby not getting O2 from placenta

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77
Q

What does APGAR stand for?

A

Appearance
Pulse
Grimace
Activity (tone)
Respiration

78
Q

What is Erb-Duchenne palsy?

A

damage to brachial plexus caused by shoulder dystocia?

79
Q

What is the name for trying to manually turn baby’s shoulders?

A

McRobert’s manoeuvre

80
Q

What medications could be given for PPH?

A

Tranexamic acid - decreases conversion of plasminogen to plasmin preventing fibrin degradation
Erogtamine - alpha-1 selective adrenergic agonist vasoconstrictor

81
Q

What is name of the alloppregnanolone drug given for post partum depression?

A

Brexanolone (must be given iV)

82
Q

How does Zuranolone work for post partum depression?

A

It is allosteric modulator of GABAa receptor

83
Q

What psychiatric meds should you avoid in breastfeeding mothers?

A

Valproic acid and carbamazepine

84
Q

What can cause PMDD?

A

Lower luteal estradiol levels or lower allopregnanolone

85
Q

What are the uncoordinated contractions 4-6 weeks before labour called?

A

Braxton Hicks contractions

86
Q

Which hormone gradually increases from 7 months onwards?

A

Oestrogen

87
Q

What is the Ferguson reflex?

A

The cycle of pos feedback from oxytocin during labour

88
Q

What does acceleration of babies heartbeat mean?

A

sympathetic activation in response to fetal movement or scalp stimulation

89
Q

What does late and early deceleration mean?

A

Early - parasympathetic response to head compression
Late - vagal stimulation or myocardial depression from placental insufficiency

90
Q

What is the most common presentation of fetal head?

A

Left occiput anterior

91
Q

What does the Bishops score show?

A

Whether labour is likely to start without induction or not
<5 unlikely
>9 likely

92
Q

What are the classifications for Low birth weight, v low birth weight and extremely low birth weight?

A

LBW <2500g
VLBW<1500g
ELBW<1000g

93
Q

Difference between type 1 and type 2 IUGR?

A

Type 1 = symmetrical, all paremeters below 10th percentile
Type 2 = asymmetrical - head is bigger

94
Q

What causes type 2 IUGR and when does growth restriction normally start?

A

Uteroplacental insufficiency and begins after week 28 in hypertrophic stage

95
Q

Why do neonates have difficulty maintaining temperature?

A

Absent brown fat and small body mass to surface area

96
Q

How many weeks lag in fundal height is suggestive of IUGR?

A

4 weeks
>6 weeks suggest severe IUGR

97
Q

What might you find in a middle cerebral artery doppler in IUGR?

A

Normally - little flow during diastole
in IUGR - increased flow in diastole due to redistribution of cardiac output

98
Q

What should the ratio between MCA and umbilical artery be on doppler ultrasound?

A

Between 1 -1.1 = brain sparing

99
Q

How many weeks is preterm?

A

less than 37

100
Q

What is given to enhance maturation of type 2 pneumocytes?

A

Corticosteroid injection

101
Q

What is periventricular leukomalacia an injury to?

A

White matters

102
Q

Difference between gastroschisis and exomphalos?

A

Gastroschisis - intestines extend outside of abdomen, exomphalos - intestines remain in umbilical cord

103
Q

What causes cleft lip?

A

Failure of maxilla to fuse with medial nasal prominence

104
Q

What causes cleft palate?

A

Failure of palatal shelves to fuse

105
Q

What brain anomalies could lead to SIDS?

A

alterations in serotonin signalling, underdevelopment of arcuate nucleus and thick pseudostratified ependymal later

106
Q

What is triad you find in shaken baby syndrome?

A

Encephalopathy, subdural haematoma, retinal haemorrhages

107
Q

How many aspects need to be affected to have global development delay?

A

2+

108
Q

What age do you get MMR vaccine?

A

one year and 3 years 4 months

109
Q

What are some gram pos cocci organisms? (sphere shaped)

A

Staphylococcus, streptococcus, enterococcus

110
Q

What are some gram pos bacilli organisms? (rod shaped)

A

corynebacterium, listeria, bacillus, clostridium

111
Q

When is pneumococal conjugate vaccine given?

A

12 weeks with booster at 12 months

112
Q

What vaccine is given at 8 weeks, 12 weeks and 16 weeks?

A

6 in 1 diptheria, tetanus, pertussis, polio, influenza type b, hep b

113
Q

How is predicted adult height calculated?

A

Mean of mum and dad’s height divided by 2, add 7cm to males and subtract 7 for females

114
Q

When would you need to investigate child’s weight/height?

A

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

115
Q

What causes Turner syndrome?

A

When part of X chromosome is partially or completely absent (45X, or 45X0)

116
Q

What causes the short stature of Turner syndrome

A

SHOX haploinsufficiency - lost from the missing X chromosome

117
Q

What is Leri-Weill dyschondrosteosis?

A

Causes dwarfism. Autosomal dominant skeletal dysplasia - haplo-insuffiency of SHOX

118
Q

What is Wilm’s tumour?

A

Also called nephroblastoma - tumour of kidney

119
Q

What gene has a role in ureteric branching that when inactivated can cause Wilm’s tumour?

A

WT1

120
Q

What cells does retinoblastoma originate from?

A

cone precursor cells

121
Q

What does the RB1 gene do?

A

It prevents cells moving into G1-S stage by inhibiting E2F

122
Q

What is the most common cancer in first year of life?

A

Neuroblastoma

123
Q

What key oncogenes are involved in development of neuroblastoma?

A

MCYN, ALK and PHOX2B

124
Q

How can criztotinib be used to treat neuroblastoma?

A

It targets ALK mutations

125
Q

Translocation of KMT2A on what chromosome can lead to ALL?

A

chromosome 11

126
Q

What is name of hypothesis that babies born of low birth weight have a higher chance of developing HTN, diabetes and coronary artery disease?

A

Barker hypothesis

127
Q

When is wheeze evident?

A

In expiration

128
Q

What is stridor?

A

High pitched harsh sound due to obstruction. Inspiratory

129
Q

What is treatment for precocious puberty?

A

GnRH to overstimulate pituitary and stop it producing gonadotrophins

130
Q

What Tanner stage is irreversible to treatment?

A

stage 3

131
Q

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?

A

Primary hypogonadism is the cause

132
Q

What will you see in a section of a seminoma?

A

Lymphocytic infiltrate

133
Q

What is the most common type of testicular tumour?

A

Germ cell tumours

134
Q

What ratio is elevated in men with BPH?

A

E2:T ratio

135
Q

What STI can’t be grwon in culture?

A

chlamydia as it is an intracellular bacteria

136
Q

What causes syphilis?

A

Treponema pallidum

137
Q

How is syphillis treated?

A

penicillin or doxycycline

138
Q

What are the Rotterdam criteria for PCOS?

A

1) hyperandrogenism
2) oligomenorrhoea
3) polycystic ovaries >12 follicles larger than 9mm

139
Q

If you have a short cervix what can be given to prevent misarriage?

A

progesterone supplement or gel

140
Q

What antibodies are associated with recurrent miscarriage?

A

anti cardiolipin antibodies or lupus anticoagulant antibodies

141
Q

What causes anti sperm antibodies in males?

A

breakdown of blood testes barrier

142
Q

mutations in what gene can cause intersex genitals, absence of puberty, and infertility?

A

NR5A1

143
Q

What hormone is able to tell you whether youre ovulatinr or no?

A

day 21 progesterone

144
Q

What is human menopausal gonadotrophin from?

A

it is purified preparations of urinary extracts from menopausal women

145
Q

What injection is used in the final preparation before retrieval in IVF?

A

HCG

146
Q

2nd line PCOS infertility treatment?

A

clomiphene citrate and metformin

147
Q

If sperm volume is less than 1ml what should be done?

A

a urine analysis to check for reterograde ejaculation

148
Q

What drugs can hinder the transport of spermatozoa?

A

SSRIs and alpha blockers (anti-hypertensive drugs)

149
Q

What does high LH and FSH and low testosterone suggest?

A

primary hypergonadotrophic hypogonadism ie a problem with the testes

150
Q

what does high lh and fsh and normal testosterone indicate?

A

seminiferous tubule damage

151
Q

what should you check for in infertility with low testosterone and low normal fsh/lh?

A

check other pituitary hormone deficiences including thyroid function

152
Q

What does a mutation in methylene tetrahydrofolate reductase mean?

A

the body can’t convert folic acid to folate. So need to take folate rather than folic acid

153
Q

What do sperm chromatin structure assays look for?

A

Detect high degree of DNA fragmentation

154
Q

In TUNEL asay sperm test what color do normal sperm stain?

A

normal = blue
sperm with damage = green

155
Q

What ratio is increased in men with BPH?

A

E2:T ratio
estrogens stimulate prolactin release which induces prostate enlargement

156
Q

Why is gestational diabetes thought to occur?

A

due to placental secretion of anti insulin hormones

157
Q

How often should someone with gestational diabetes have ultrasound?

A

every two weeks

158
Q

What is the classic triad of features in congenital toxoplasmosis infection?

A

chorioentitis, hydrocephalus, intracranial atherscelerosis

159
Q

What is mifepristone?

A

anti-progesterone. Causes contractions used for prolonged labour often with misoprotol

160
Q

what is name of fetal heart rate monitoring whilst in labour?

A

cardiotocography

161
Q

What imbalances can perinatal asphyxia lead to?

A

hypoxemia, high levels of CO2 and acidosis

162
Q

Treat for thromboembolic disease after labour?

A

heparin as does not cross into breast milk

163
Q

What is first line for post partum depression still?

A

SSRIs

164
Q

What causes type 1 IUGR?

A

result of growth inhibition in early stage (4-20 weeks hyperplastic stage). Causes by genes, infection or multiple gestation

165
Q

what type of growth restriction is associated with oligohydramnios?

A

type 2

166
Q

When is absent or reversed end diastolic flow observed in fetus?

A

type 2 and type 3 growth restriction

167
Q

what bed rest position increases uteroplacental blood flow?

A

left lateral position

168
Q

what vitamin deficiency can increase incidence of pre-term baby?

A

vit D

169
Q

what does surfactant do?

A

increases lung compliance

170
Q

what is broncho-vaxam?

A

inactivated whole cell bacteria, used in children with recurrent chest infections to sensitise them

171
Q

What would early and late failure of septation cause?

A

early - atrioventricular septal defect whereas late would just be one or the other

172
Q

what causes persistant truncus arteriosus?

A

trunoconal swellings fail to fuse

173
Q

what heart defect will baby die very quickly if ductus arteriosus not kept open?

A

transposition of the great vessels

174
Q

what is persistant pulmonary hypertension of new born?

A

elevated pulmonary vascular resistance resulting in right to left shunting of blood and hypoxemia

175
Q

What inflammatory mediators play a role in development of meningococcal disease?

A

IL-6 and TNF alpha (these are the same as in RA)

176
Q

What serotype of pneumonia causes majority of empyema?

A

serotype 1

177
Q

Difference between pnemococcal polysaccharide vaccine and conjugate vaccine?

A

polysaccharide given to those at great risk, protects against more serotypes

178
Q

what type of vaccines are the herpes viruses and hep b?

A

enveloped DNA viruses

178
Q

How is most viral diagnosis done?

A

via PCR

179
Q

what virus causes chickenpox?

A

varicella zoster virus

180
Q

When do you get MMR vacine?

A

MMR 1st dose 12 months
2nd dose 3 years and 4 months

181
Q

How do you work out the herd immunity threshold?

A

1 -1/R0

182
Q

deficiency of what causes short stature and might not be noticed until late infancy?

A

growth hormone

183
Q

what gene is linked to longevity?

A

FOXO3A
(think still being foxy when youre old, 3 bc 3 grannies)

184
Q

what gene can cause ageing and is shortened in amish comminities?

A

PAI-1

185
Q

What happens to RB1 to get it to release E2F?

A

it gets phosphorylated

186
Q

What type of ALL is most aggressive?

A

Pro-B ALL as it happens in earlier stage of haematopoiesis

187
Q

why do females develop a concentric pattern of hyperthrophy?

A

bc oestrogen receptor is on cardiomycytes and normally prevents hypertrophy then get a fall post menopause

188
Q

decreased levels of what immunogloblin mean elderly people are less likely to deal with resp viruses?

A

IgA

189
Q

What kind of vaccines are diptheria and tetanus?

A

toxoid

190
Q

What type of vaccines are MMR, BCG and yellow fever?

A

live attenuated

Year 2 (10 decks)

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