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Year 2 HD > Overview > Flashcards

Overview Flashcards

1
Q

Ovarian artery comes off of the aorta at what level?

A

L2(/3)

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2
Q

Aorta bifurcates into the common iliacs at what level?

A

L4

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3
Q

Branches of the internal iliacs that exit the pelvis are? x3

A

Superior gluteal
Inferior gluteal
Internal pudendal

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4
Q

The branches of the internal iliac artery that exit the pelvis all pass through which structure?

A

Greater sciatic foramen

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5
Q

Branches of the internal iliac that remain in the pelvis? x5

A 
Umbilical artery
Obturator artery
Inferior vesical artery
Uterine/vaginal arteries
Middle rectal artery
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6
Q

Uterine artery anastomoses with which artery?

A

Ovarian

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7
Q

When does the external iliac artery become the femoral artery?

A

Once it passes under the inguinal ligament

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8
Q

Symptoms of ectopic pregnancy x8

A 
Light vaginal bleeding
Nausea and vomiting with pain 
Lower abdominal pain 
Sharp abdominal craps 
Pain on one side of the body 
Dizziness/weakness
Pain in shoulder, neck or rectum
Possible fainting
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9
Q

Most common location for ectopic pregnancy?

A

Ampulla of the fallopian tube

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10
Q

Why does ectopic pain present in the shoulders and neck?

A

Blood can irritate the diaphragm - nervous innervation C3, 4, 5

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11
Q

Artery to the body of uterus?

A

Uterine

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12
Q

Artery to the cervix of uterus?

A

Vaginal

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13
Q

Artery to upper part of uterus?

A

Vaginal

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14
Q

Artery to the fundus of uterus?

A

Uterine

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15
Q

What is the artery of sampson?

A

Anastomosis between uterine, ovarian and vaginal artery

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16
Q

Vaginal artery branches off of which artery with what?

A

Branches off of internal iliac with the uterine artery

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17
Q

Three ligaments that support the uterus are?

A

Transverse cervical/cardinal ligaments
Pubocervical ligaments
Sacrocervical ligaments

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18
Q

Rectouterine pouch is also known as?

A

Pouch of Douglas

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19
Q

External iliac vein and artery - which is medial and which is lateral?

A

VEIN - MEDIAL

ARTERY - LATERAL

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20
Q

Most important function of levator ani muscle?

A

Prevention of uterine prolapse

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21
Q

What is uterine prolapse?

A

Uterus slips down into/protrudes out of the vagina

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22
Q

What re enters the pelvis through the lesser sciatic foramen?

A

Internal pudendal artery/vein

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23
Q

Three branches of the pudendal nerve?

A

Inferior rectal nerve
Dorsal nerve of penis/clitoris
Perineal nerve

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24
Q

Function of bulbospongiosus muscle? x2

A

Reduces the size of the vaginal orifice

Compresses the dorsal vein of clitoris for excretion of moisture to the vagina

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25
Q

Bartholin’s gland - located anterior or posteriorly?

A

Posteriorly

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26
Q

Appearance of the clitoris?

A

Bulb shaped structure anteriorly located

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27
Q

Nerve roots of pudendal nerve?

A

Sacral plexus - S2, 3, 4

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28
Q

Bartholin’s gland is also known as?

A

Greater vestibular gland

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29
Q

Where are general visceral afferents sympathetic?

A

T1-L2

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30
Q

Where are general visceral afferents parasympathetic?

A

S2-S4

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31
Q

Spinal anaesthesia anaesthesis what area?

A

Complete anaesthesia below the waist

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32
Q

Where is spinal anesthesia carried out? (vertebral level)

A

L4-L5

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33
Q

What commonly follows spinal anesthesia?

A

Headache

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34
Q

Where is pudendal nerve block administered?

A

S2-S4

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35
Q

Perineal nerve block anaesthathises what region?

A

Perineum and the lower 1/4 of the vagina

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36
Q

What does caudal epidural anaesthesise?

A

Cervix and vagina

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37
Q

Which muscle of the levator ani forms a sling around the rectum?

A

Puborectalis

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38
Q

Which anaesthesia type is done most inferiorly?

A

Pudendal nerve block

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39
Q

Which anaesthesia type is done most superiorly?

A

Spinal block via lumbar puncture

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40
Q

What is cytocele?

A

Prolapse of the uterus

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41
Q

What is rectocele?

A

Prolapse of the rectum

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42
Q

What is enterocele?

A

Prolapse of the small intestine

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43
Q

What is urethrocele?

A

Prolapse of the urethra into the vagina (posteriorly)

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44
Q

What is the innervation of the perineum?

A

Perineal nerve arising from the pudendal nerve

Pudendal nerve is derived from

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45
Q

Nerve roots of the perineal nerve?

A

S2, 3, 4

Perineal nerve arises from the pudendal nerve
Pudendal nerve is derived from the somatic plexus - nerve roots S2, 3 and 4

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46
Q

Right ovarian vein drains to?

A

Inferior vena cava IVC

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47
Q

Left ovarian vein drains to?

A

Left renal artery

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48
Q

Urethra is located in which zone of the prostate?

A

Transitional

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49
Q

Prostate cancer occurs in which zone of the prostate?

A

Hyperplasia in peripheral zone

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50
Q

Benign hyperplasia of the prostate occurs in which zone?

A

Transitional

Natural transitional changes with age

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51
Q

Which cells are involved in BHP and which zones?

A

Stromal cells

In the transitional zone

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52
Q

Four factors that contribute to BHP

A

Increasing age
Testicular androgens
Oestrogens
Neurotransmitters (from gland)

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53
Q

Testosterone is normally converted to what? x2

A

Estradial

DHT

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54
Q

Effect of estradial on stromal cells is?

A

Proliferation

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55
Q

Enzyme involved in conversion of estradial to DHT?

A

5-alpha-reductase

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56
Q

Effect of oestrogen on epithelial cells?

A

Apoptosis

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57
Q

Five symptoms of BHP

A 
Weak/interupted flow of urine
Nocturia - frequent urination
Trouble urinating
Pain or burning during urination
Blood in urine or semen 
SHITE FUN
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58
Q

Of those that have BHP, how many will have histological changes?

A

50%

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59
Q

Four ways to diagnose BHP?

A

History
Digital rectal exam (DRE)
Ultrasound - biopsy
Blood test

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60
Q

What are you looking for in the blood test for BHP?

A

PSA levels - prostate specific antigen

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61
Q

PSA is specifically known as?

A

Gamma-seminoprotein

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62
Q

Two treatment types for BHP?

A

Alpha-1 adrenergic blockers

5-alpha reductase inhibitors

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63
Q

Function of alpha-1 adrenergic blockers for treatment of BHP?

A

Relaxation of smooth muscle in the bladder neck - urethra can dilate and aids urine flow

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64
Q

Function of 5-alpha reductase inhibitors?

A

Prevents conversion of testosterone to DHT

SO prevents apoptsis

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65
Q

Name two 5a reductase inhibitors

A

Dutasteride

Finasteride

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66
Q

Five surgical options for BHP?

A 
Transurethral resection of the prsotate
Open prostactectomy
Laser ablation
Transurethral microwave
High energy ultrasound therapy
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67
Q

Indication for use for open prostatectomy?

A

For very large prostate

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68
Q

PSA levels - BHP vs. prostatic cancer

A

PSA levels much greater in prostatic cancer than in BHP

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69
Q

Which inguinal hernia type will appear in the testes?

A

Indirect

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70
Q

Which inguinal hernia type will appear through the abdominal wall?

A

Direct

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71
Q

Which arteries undergo expansion during an erection?

A

Cavernosa arteries

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72
Q

What causes the veins of the penis to close to allow for an erection?

A

Blood pressure of the arteries rises about systolic pressure

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73
Q

Muscular involvement of erection is?

A

Smooth muscle relaxation - also occludes the veins

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74
Q

Chemical involved in erection is?

A

NO - smooth muscle relaxation

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75
Q

Receptors involved in ejaculation?

A

Noradrenaline - sympathetic

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76
Q

Treatment for erectile dysfunction is? x2

A

PDE-5 inhibitor - sildenafil/viagra

Penile prosthetics

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77
Q

Peyronie’s disease is recognised via?

A

Bent penis

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78
Q

What is variocele?

A

Varicose veins of the scrotum

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79
Q

Variocele more common in which testicle?

A

Left

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80
Q

Why does variocele lead to infertility?

A

Pooling of blood - 2 degree rise in temperature

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81
Q

How can you recognise the ureter from a prosection?

A

Ureter follows the same path as the internal iliac artery

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82
Q

Gleeson grading system is used for?

A

Assessment of development of prostate adenocarcinomas

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83
Q

Gleeson grade 1 vs. gleeson grade 5?

A

Gleeson grade 1 - well differentiated

Gleeson grade 5 - poorly differentiated

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84
Q

Sertoli/leydig cell - which of these is the interstitial cell located in interstitial tissue?

A

Leydig cell

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85
Q

What is meant by cryptcorchidism?

A

Undescended/maldescended testes

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86
Q

Maldescent of the testes is a risk factor for what?

A

Seminoma development - germ cell tumour

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87
Q

How can you differentiate between seminomas and non-seminomatous germ cell tumours?

A

Seminomas are usually pure and composed of one cell type

Non-seminomatous tumours are usually composed of a mix of tumours

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88
Q

Seminoma is in males or females?

A

Males

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89
Q

Seminoma equivalent in females?

A

Dysgerminoma

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90
Q

Seminoma/non-seminomatous germ cell tumours - which tend to be diagnosed at more/less advanced stages?

A

Seminomas - tend to be detected earlier on

Non-seminoma - tends to be detected at more advanced stage

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91
Q

What is a colposcopy?

A

Smear test

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92
Q

Changes to the breast with age - relating to adipose tissue

A

Increasing age, increased levels of adipose tissue in the breast

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93
Q

Benign breast tumour is often what tumour?

A

Fibroadenoma

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94
Q

What are the epithelial cells lining the prostate?

A

Pseudostratified epithelial cells

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95
Q

Alpha-fetoprotein (AFP) stains for what male tumour?

A

Yolk-cell tumour

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96
Q

Type 1 ovulatory cause of infertility is?

A

Hypopituitary failure

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97
Q

Type 2 ovulatory cause of infertility is?

A

Hypopituitary dysfunction

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98
Q

Type 3 ovulatory cause of infertility is?

A

Ovarian failure

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99
Q

Cause of type 1 ovulatory cause of infertility is?

A

Anorexia nervosa

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100
Q

Cause of type 2 ovulatory cause of infertility is? x2

A

PCOS

Prolactinaemia

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101
Q

Cause of type 3 ovulatory cause of infertility is?

A

Premature ovarian failure under 40 years old

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102
Q

Percentage of women in the UK with polycystic ovaries?

A

33%

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103
Q

Are polycystic ovaries the same as PCOS?

A

No

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104
Q

Presence of what condition must also be present for PCOS?

A

Metabolic abnormalities

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105
Q

Fibroids are what specifically?

A

Uterine leiomyoma - benign tumour of uterine smooth muscle myometrium

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106
Q

Drugs causing infertility in women x5

A 
Long term NSAIDs
Chemo
Neuroleptics
Spironolactone
Depo-provera
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107
Q

80% of couples that present with infertility are pregnant after how many cycles?

A

12

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108
Q

Early referral to specialist for infertility is made if? x2

A

Woman is over 36 years old

Known clinical cause of infertility/history of predisposing factors for infertility

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109
Q

Five tests done for PCOS screen?

A 
Day 21 progesterone
FSH levels
LH levels
Serum testosterone
Glucose levels
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110
Q

LRL volume of sperm count?

A

1.5

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111
Q

LRL progressive motility for sperm count?

A

32%

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112
Q

LRL morphology for sperm count?

A

4% normal

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113
Q

Ovarian reserve testing used to test?

A

Response in IVF

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114
Q

Investigation used to asses uterine function?

A

Laparoscopy

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115
Q

Investigation used to asses tubal function?

A

HSG dye to image tubes

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116
Q

Three treatments for type 1 ovulatory disorder?

A

Increase weight
Decrease exercise
Consider pulsatile GnRH

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117
Q

Treatment for type 2 ovulatory disorder?

A

Weight loss to BMI 30 or below

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118
Q

First line treatment for PCOS?

A

Consider clomiphene or metformin

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119
Q

Main side effect of metformin is?

A

GI side effects

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120
Q

Second line treatment for PCOS? x3

A

Combined clomiphene and metformin
Laparoscopic ovarian drilling
Gn therapy

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121
Q

Donor eggs should be considered in which type of ovulatory disorder?

A

Type 3 - ovulatory failure

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122
Q

Contraindication of clomiphene use?

A

Should not be offered in unexplained infertility

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123
Q

IVF should be offered for unexplained infertility when?

A

After two years

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124
Q

IUI offered to? x3

A

Cannot have vaginal intercourse e.g. disability
Sperm wash required
Same sex relationships

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125
Q

How many cycles of IUI before IVF is offered?

A

12

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126
Q

IVF offered to who? x2

A

Women under 42 who have not conceived for two years of unprotected sex

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127
Q

How many cycles of IVF offered to women under 40?

A

3

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128
Q

How many cycles of IVF offered to women between 40 and 42?

A

1

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129
Q

Gn or clomifene treatment has what adverse effect?

A

Ovarian hyperstimulation syndrome

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130
Q

Intracytoplasmic sperm injection (ICSI) indicated for use in? x4

A

Severe deficits in semen quality
Obstructive azoospermia
Non-obstructive azoospermia
Couple in whom prior IVF has failed/poor outcome

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131
Q

Ovarian tumours are a small risk of what fertility treatment?

A

IVF

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132
Q

Relation of pregnancy to diabetes?

A

Pregnancy is a state of insulin resistance and glucose intolerance

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133
Q

Secretion of what three anti-insulin hormones in pregnancy?

A

HPL
Cortisol
Glucagon

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134
Q

Percentage of women taht develop diabetes during pregnancy is?

A

1-2%

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135
Q

Risk factors for gestational diabetes? x6

A 
Previous GDM
Macrosomic baby
Previous unexplained stillbirth 
Obesity
Glycosuria
Polyhydramnios
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136
Q

Four maternal complications of gestational diabetes?

A

Hyper/hypoglycaemia
Pre-eclampsia
Infection
Thromboembolic disease

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137
Q

Four foetal complications of gestational diabetes?

A

Macrosomia
Respiratory distress syndrome
Hypoglycaemia
Hyperbilirubinaemia

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138
Q

Glucose tolerance test should be taken when in someone with gestational diabetes?

A

6 weeks following delivery

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139
Q

Ultrasound should be taken how often in someone with gestational diabetes?

A

Every two weeks

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140
Q

Most common bacteria causing infection in pregnancy?

A

Group B streptococcus

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141
Q

Group B strep is normal flora in what percentage of women?

A

25%

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142
Q

Four consequences of group B strep infection on the neonate?

A

Pneumonia
Meningitis
Non-focal sepsis
Death

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143
Q

Drug given if known that women has group B strep in vagina?

A

Benzylpenicillin

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144
Q

Two consequences of UTI on the foetus?

A

Growth restriction

Preterm labour

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145
Q

Consequence of UTI on the mother during pregnancy?

A

Pyelonephritis - inflammation of the kidney

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146
Q

Normal treatment for UTI is?

A

Trimethoprim

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147
Q

Why can trimethoprim not be given in pregnancy

A

It is teratogenic in first trimestor

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148
Q

First line treatment of UTI in pregnancy?

A

Penicillin

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149
Q

Second line treatment of UTI in pregnancy?

A

Cephalpsporin

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150
Q

Untreated syphilis in mother - what is the risk of congenital syphilis?

A

50% risk

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151
Q

Sign of primary syphilis?

A

Primary chancre

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152
Q

Sign of secondary syphilis?

A

Rash

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153
Q

Treatment for syphilis?

A

Penicillin

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154
Q

Antepartum is when?

A

Prior to labour

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155
Q

Early antepartum is when?

A

<24 weeks

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156
Q

Late antepartum is when?

A

> 24 weeks

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157
Q

Intrapartum is when?

A

First and second stages of labour

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158
Q

Postpartum is when?

A

Delivery to six weeks post partum

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159
Q

Miscarriage vs. stillbirth?

A

Miscarriage <24 weeks

Stillbirth >24 weeks

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160
Q

Hyperemesis gravidarum is?

A

Exaggerated nausea and vomiting in early pregnancy

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161
Q

Treatment of hyperemesis gravidarum? x4

A

Dietary advice
IV fluids
Thiamine
Antiemetics

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162
Q

What should be avoided in hyperemesis gravidarum?

A

Dextrose

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163
Q

Spontaneous miscarriage is?

A

Foetus dies/delivered dead <24 weeks

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164
Q

Uterine size in threatened miscarriage?

A

Expected size

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165
Q

Cervical os open or closed in threatened miscarriage?

A

Closed

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166
Q

What percentage of those who suffer from a threatened miscarriage will then go on to miscarry?

A

25%

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167
Q

Cervical os open or closed in inevitable miscarriage?

A

Open

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168
Q

Cervical os open or closed in incomplete miscarriage?

A

Open

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169
Q

Cervical os open or closed in complete miscarriage?

A

Closed

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170
Q

Uterine size in missed miscarriage?

A

Smaller than expected

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171
Q

Cervical os open or closed in missed miscarriage?

A

Closed

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172
Q

Three investigations for spontaeous miscarriage?

A

Ultrasound
Serum bHCG
Bloods - FBC, Rhesus

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173
Q

Serum bHCG increases by what percentage in a viable pregnancy?

A

66% in 48 hours

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174
Q

Recurrent miscarriage is?

A

Three or more consecutive miscarriages

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175
Q

Cervical incompetence is?

A

Cervix fails to retain the pregnancy

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176
Q

Ectopic pregnancy is?

A

Implantation of fertilised ovum outside of the endometrial cavity

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177
Q

Emergency contraception is a risk factor for what (relating to pregnancy)?

A

Ectopic pregnancy

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178
Q

Presentation of ectopic pregnancy?

A

PV bleeding - scanty and dark
Lower abdominal pain
Collapse
Amenorrhoea for 4-10 weeks

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179
Q

Gestational trophoblastic disease is also known as?

A

Molar pregnancy

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180
Q

What is gestational trophoblastic disease?

A

Trophoblast proliferates more aggressively than normal

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181
Q

Three signs of gestational trophoblastic disease?

A

PV bleeding
Hyperemesis gravidarum
Passage of vesicles via the vagina

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182
Q

Placental abruption is?

A

Placenta partially/completely separates from the uterus prior to birth

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183
Q

Description of uterus in placental abruption is?

A

Woody - tense/tender

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184
Q

Management of placental abruption?

A

Resuscitate

Steroids if <34 weeks

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185
Q

Placenta praevia is?

A

When the placenta inserts into the lower part of the uterus after 24 weeks

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186
Q

Major placenta praevia?

A

Covers the os

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187
Q

Minor placenta praevia?

A

Does not cover the os

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188
Q

Sign of placenta praevia?

A

Painless vaginal bleeding

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189
Q

What should NOT be done to investigate palcenta praevia?

A

Vaginal examination

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190
Q

Four characteristics of pre-eclampsia?

A

Hypertension
Renal impairment
Fluid retention/oedema
Weight gain

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191
Q

Cause of pre-eclampsia?

A

Abnormal maternal adaptation to the trophoblast

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192
Q

Cytomegalovirus CMV - what is the virus type?

A

Herpes virus

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193
Q

Treatment for CMV is?

A

Gancyclovir

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194
Q

Congenital CMV is the most common cause of what in neonates?

A

Sensorineural deafness

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195
Q

Varizella zoster virus VZV - four different types are?

A

Congenital - chicken pox
Neonatal - chicken pox
Infantile - chicken pox
Shingles - adult

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196
Q

VZV virus type is?

A

Herpes virus

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197
Q

Treatment for VZV is?

A

(Val)acyclovir

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198
Q

Presentation of shingles is?

A

Dermatomal rash along dorsal root ganglion from which virus is activated

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199
Q

HSV1 vs. HSV2?

A

HSV1 - oral

HSV2 - genital

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200
Q

Treatment for HSV?

A

Acyclovir

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201
Q

Rubella is important as a congenital disease why?

A

Rubella is the WORST INFECTION FOR THE FOETUS

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202
Q

Four consequences of congenital rubella?

A

Blind
Sensorineural deafness
Congenital heart disease
Death

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203
Q

Treatment for rubella?

A

No treatment

MMR vaccine

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204
Q

Can the MMR vaccine be given during pregnancy?

A

No

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205
Q

Parvovirus also known as?

A

Slap cheek syndrome

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206
Q

Consequence of parvovirus on the foetus is?

A

Hydrops fetalis - cardiac failure in feotus

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207
Q

Significance of parvovirus infection?

A

ANYTHING TO DO WITH BLOOD

208
Q

Treatment for parvovirus?

A

Intrauterine blood transfusion

209
Q

Two routes of spread of toxoplasmosis?

A

Infected food

Cat

210
Q

Toxoplasmosis carries the greatest risk in which trimester?

A

First

211
Q

Four consequences of toxoplasmosis on the neonate?

A

IUGR
Hydrocephalus
Microcephaly
Hepatosplenomegaly

212
Q

Virus responsible for glandular fever is?

A

Epstein Barr virus

213
Q

Which viral infection in pregnancy can result in cataracts in the neonate?

A

Congenital Rubella

214
Q

Peurperium is?

A

From delivery to six weeks after

215
Q

What happens to the uterus during the peurperium?

A

Uterus involutes

216
Q

Most common case of maternal death from 2012-2014?

A

Cardiac disease

217
Q

What is post-partum haemorrhage PPH?

A

Excessive bleeding following delivery

218
Q

Primary PPH is?

A

> 500ml blood loss from the genital tract within 24 hours

219
Q

Secondary PPH is?

A

Abnormal bleeding from genital tract from 24 hours after delivery up until 6 weeks after

220
Q

Primary/secondary PPH - which is more common?

A

Primary

221
Q

Incidence of PPH worldwide?

A

5%

222
Q

Four causes of PPH?

A

Tone - uterine atony
Tissue - retained
Trauma - laceration
Thrombin - coagulopathy

223
Q

Most common cause of PPH is?

A

Uterine atony

224
Q

Initial treatment for uterine atony?

A

Bimanual uterine massage and compressiion

225
Q

Hormones given to manage uterine atony? x2

A

Oxytocic agents e.g. syntometrin

Prostaglandins

226
Q

Two causes of secondary PPH?

A

Infection - endometritis

Tissue - retained products of conception

227
Q

Three symptoms of venous thromboembolism?

A

DVT
PE
Central vein thrombosis

228
Q

Three common post-partum mental health conditions are?

A

Postpartum blues
Postpartum depression
Postpartum psychosis

229
Q

Postpartum blues are?

A

Tearfulness and liability at times but mostly happy

230
Q

Postpartum blues tends to occur when?

A

3-5 days after delivery

231
Q

Four symptoms of postpartum psychosis?

A

Loss of contact with reality
Hallucinations
Severe thought disturbance
Abnormal behaviour

232
Q

Postpartum depression typically onsets when?

A

In the first 10 days following childbirth

233
Q

Fusion of the cardiac tube is complete at what day?

A

Day 21

234
Q

Heart starts beating at what day?

A

Day 23

235
Q

Atrial, ventricular and outflow tracts of the heart separate by what day of development?

A

Day 28

236
Q

Majority of cardiac development occurs in which trimester?

A

First

237
Q

What is the foramen ovale?

A

During foetal life - hole between the atria

238
Q

What is the ductus arteriosus?

A

Connection between the pulmonary artery and the aorta

239
Q

What is the ductus venosus?

A

Between left umbilical vein and vena cava

240
Q

Function of ductus venosus?

A

Blood bypasses the liver from the palcenta

241
Q

Foetal circulation - pulmonary circulation is high or low resistance?

A

High

242
Q

Foetal circulation - systemic circulation is high or low resistance?

A

Low

243
Q

Oxygenated blood is in umbilical vein or umbilical artery?

A

Umbilical vein

244
Q

Foetal circulation - pulmonary circulation and systemic circulation - which is greater pressure?

A

Pulmonary pressure > systemic pressure

245
Q

Foetal circulation - blood flow from R to L or L to R?

A

Foetal circulation blood flow right to left

246
Q

Transition circulation from foetus to adult - pulmonary and systemic pressure which is greater?

A

Systemic pressure > pulmonary pressure

247
Q

Transitional circulation - blood flow from R to L or L to R?

A

Left to right

248
Q

What is persistant pulmonary hypertension of the newborn?

A

Direction of blood shunting does not reverse at birth

249
Q

What is transposition of the great vessels?

A

Aorta takes blood from the right ventricle rather than teh left ventricle and PA takes blood from left ventricle rather than right ventricle

250
Q

Four features of teratology of fallot are?

A

Ventricular septal defect
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

251
Q

What is atresia?

A

Valve does not form properly and is completely blocked - no blood flow through here

252
Q

What is ventricular septal defect VSD?

A

Ventricular septum does not close at birth

253
Q

Blood flow in VSD?

A

High pressure on left side of heart so left to right shunting

254
Q

How can ductus arteriosus be reopened?

A

Prostaglandin E

255
Q

Myelomeningocoele is?

A

Meninges and neural tissue protrude out of the surface - can include the spinal cord

256
Q

What is gastroschisis?

A

Defect in abdominal wall lateral to umbilicus

257
Q

Presentation of gastrochisis?

A

Bowel is free within the amniotic cavity

258
Q

Gastrochisis - how long for the bowel to start functioning properly?

A

1-3 months

259
Q

Recognise gastrochisis from image?

A

Bowel/intestine has protruded out of the anterior abdominal wall in the neonate

260
Q

Apgar score is used to asses what?

A

Indication for birth asphyxia/neurological signs in neonate

261
Q

Five components of the apgar score are?

A 
Heart rate
Respiratory effort
Muscle tone
Reflexes
Colour
262
Q

How many grades from the apgar score?

A

Three
I - less severe
III - more severe, likely to die and definite neurological deficit

263
Q

Birth asphyxia results in what complication?

A

Hypoxic ischaemic encephalopathy

264
Q

Presentation of neonate with asphyxia? x4

A

No breathing
HR <60 (bradycardia)
Floppy - low tone
Seizures

265
Q

Treatment of seizures in birth asphyxia? x3

A

Phenobarbitone
Phenytoin
Clonazepam

266
Q

Temperature based treatment for HIE?

A

Cooling baby for

267
Q

Grading system to asses for HIE is?

A

Sarnat and sarnat

268
Q

HIE leads to what major neurological disorder?

A

Cerebral palsy

269
Q

Why are neonates with HIE cooled? (hypothermia treatment) x5

A 
Reduced cerebral metabolism
Reduced energy use
Reduced accumulation of amino acids
Reduced NOS activity
Reduced free radical activity
270
Q

Treatment for group B streptocossus infection in the neonate?

A

Benzylpenicillin

271
Q

Weight for normal term baby?

A

3.5kg

272
Q

Weight of low birthweight baby?

A

<2.5kg

273
Q

Weight of very low birthweight baby?

A

<1.5kg

274
Q

Weight of extremely low birth weight baby - significance?

A

1kg - not compatible with life

275
Q

Premature baby is?

A

Baby born <37 weeks gestation

276
Q

Should you cool a premature baby?

A

NO - can increase chance of death

277
Q

What is surfactant?

A

In the lungs to reduce the surface tension and prevent collapse

278
Q

Significance of surfactant in premature infants?

A

Premature - they are surfactant deficient

279
Q

Respiratory distress syndrome is?

A

Deficiency in surfactant in the neonate

280
Q

Hyaline membrane disease is?

A

Same as respiratory distress syndrome - this is the histological name

281
Q

Chronic lung disease of infancy is also known as?

A

Bronchopulmonary dysplasia

282
Q

What is chronic lung disease of infancy?

A

If the baby with RDS survives then they are likely to develop this

283
Q

What is an SGA baby?

A

Birth weight below 10th centile for gestation

284
Q

Is an SGA baby pathological?

A

No e.g. small parents

285
Q

Four causes of SGA baby

A

Chromosomal abnormalities
Normal
Smoking
Multiple pregnancy

286
Q

Methods to monitor foetal growth? x2

A

Abdominal circumference

Head circumference

287
Q

IUGR is?

A

Faltering growth of the foetus - failure to achieve normal foetal growth rate

288
Q

Incubator for premature infant is warm or cold?

A

Warm

289
Q

Incubator for HIE infant is warm or cold?

A

Cold

290
Q

Surfactant is composed of? x2

A

Lipids

Proteins

291
Q

Causes of nutritional challenges in preterm baby x4

A

Immature sucking
Presence of digestive enzymes
Poor gut motility
Cannot tolerate enteral feeds

292
Q

Preterm baby requires how many calories for growth?

A

110-135kcal

293
Q

Ig to baby transplacentally is?

A

IgG

294
Q

What happens to the gut if the baby is not fed?

A

Gut mucous atrophy

295
Q

What is necrotising enterocolitis?

A

Acute bacterial invasion/inflammation - necrosis of bowel

296
Q

Four risk factors of necrotising enterocolitis?

A

Prematurity
Hypoxia
Infection
Enteral feeding

297
Q

Presentation of necrotising enterocolitis? x5

A 
Abdominal distension
Tenderness
Discolouration
Blood in stools
Generalised collapse
298
Q

Treatment of respiratory distress syndrome? x2

A

Surfactant

Respiratory support

299
Q

Cause of persistant pulmonary hypertension of newborn PPHN?

A

Patent ductus arteriosus

300
Q

Surfactant composed of? x2

A

Phospholipids

Lipoproteins

301
Q

What is pneumotosis?

A

Gas formation in the bowel wall

302
Q

Most common infection in neonates <48 hours of birth?

A

Group B strep

303
Q

Most common infection in neonates >48 hours of birth?

A

Negative staphylococci

304
Q

Most common infection in neonates >48 hours of birth?

A

Negative staphylococci

305
Q

Most common cause of IUGR?

A

Utero-placental insufficiency

306
Q

Monochorionic twins are?

A

Twins share placenta

307
Q

Dichorionic twins are?

A

Each twin has their own placental unit

308
Q

Twin-twin transfusion is?

A

In monochorionic twins - one receives increased level of circulation than the other and grows larger

309
Q

Edwards syndrome cause?

A

Trisomy 18

310
Q

Age of survival with Edwards syndrome?

A

One year

311
Q

Three organs prioritised to receive blood flow in hypoxia are?

A

Brain
Heart
Adrenals

312
Q

Three organs prioritised to receive blood flow in hypoxia are?

A

Brain
Heart
Adrenals

313
Q

Two types of genetic markers are?

A

Single nucleotide polymorphism - SNP

Short tandem repeat STR

314
Q

What is a genetic marker?

A

This tags a piece of DNA and can be used to track genes in families or populations

315
Q

What is an exome?

A

All protein coding regions of DNA

316
Q

Preferential to sequence an exome or a genome?

A

Exome - much smaller

Genome consist of many tandem repeats which are not valuable

317
Q

How are genetic variants scaled?

A

1-5
1 - non-pathogenic
5 - pathogenic

318
Q

What is the problem with scaling genetic variants?

A

3 - variant of unknown significance - many variants fall into here

319
Q

What is the problem with scaling genetic variants?

A

3 - variant of unknown significance - many variants fall into here

320
Q

Turner syndrome genetic cause is?

A

45, X

321
Q

Turner syndrome - males or females?

A

Females

322
Q

Typical therapy administered to those with Turner syndrome?

A

Oestrogen replacement therapy

323
Q

Turner syndrome - fertile or infertile women?

A

Infertile (almost always)

324
Q

Klienfelter syndrome genetic cause is?

A

47, XXY

325
Q

Kleinfelter syndrome - male or females?

A

Males

326
Q

Primary feature of Kleinfelter syndrome?

A

Sterility

327
Q

Child mental health problems more in boys or girls?

A

Boys

328
Q

Four examples of conduct disorder - under 5yo

A

Aggression - physical and verbal
Destructive
Poor attention and concentration
Frequent, severe tantrums

329
Q

Five examples of conduct disorder 5-12yo

A 
Lying
Stealing
Defiance
Cruelty to animals
Disruption in school
Fire setting
330
Q

Five examples of conduct disorder in adolescence?

A 
Truancy
Delinquency
Violence
Sex offences
Drug/alcohol/substance abuse
331
Q

Conduct disorders - more common in boys or girls?

A

Boys

332
Q

Emotional disorders - more common in boys or girls?

A

No correlation to either sex

333
Q

Two most prevalent emotional disorders?

A

Anxiety and fearfulness

Depression

334
Q

Conduct disorders - relate to socioeconomic status

A

More prevalent with low socioeconomic status

335
Q

Emotional disorders - relate to socioeconomic status

A

No relation to socioeconomic status

336
Q

Three examples of adjustment disorders

A

Bereavement
Divorce
Physical illness

337
Q

Three signs of ADHD

A

Overactivity
Inattention
Impulsivity

338
Q

ADHD - more prevalent in boys or girls?

A

Boys (4:1 ratio)

339
Q

Child should be able to speak fluently by what age?

A

3/4

340
Q

Two diagnostic systems for mental health disorders are?

A

DSMV

ICD10

341
Q

Two diagnostic systems for mental health disorders are?

A

DSMV

ICD10

342
Q

Most common cause of chronic diarrhoea in childhood?

A

Irritable bowel syndrome

343
Q

Most common cause of failure to thrive/weight loss in childhood?

A

Coeliac/CF

344
Q

Most common cause of rectal bleeding/bloody stools in childhood?

A

IBS - Chohns or Ulcertaive colitis

345
Q

Constipation is?

A

Infrequent, hard stools - passing stools <3 times per weekC

346
Q

Soiling is?

A

Escape of stool into the underclothes

347
Q

Encopresis is?

A

Passage of normal stools in abnormal places - involuntary passing of stools

348
Q

Most common cause of encopresis?

A

Severe constipation in the child

349
Q

Constipation is teh cause of what percent of visits t the paediatric practise?

A

3%

350
Q

Delayed passage of meconium can result in waht in the child?

A

Organic cause of constipation

351
Q

Four red flags for GORD in children

A

Haematemesis
Failure to thrive
Sandifers syndrome
Aspiration pneumonia

352
Q

Sandifers syndrome is?

A

Back arching in infants

353
Q

pH study - oH of what indicates GORD?

A

<4

354
Q

What is ‘impedance’?

A

Both acid and non-acid reflux

355
Q

Abnormalities that can be identified by barrium swallow are? x5

A 
GORD
Hiatus hernia
Aspiration
Polyoric stenosis
Malrotation
356
Q

Two drugs that can be given to reduce acidity in children suffering from GORD?

A

H2 antagonists

Protein pump inhibitors

357
Q

Domperidone given to children with GORD why?

A

Promotility agent

358
Q

How can feeds be changed for children suffering with GORD?

A

Thickening of feeds

359
Q

Two surgical treatments for children suffering from GORD?

A

Jejunostomy feeds

Nissen’s funsoplication

360
Q

What is eosinophillic oesophagitis?

A

Treatment resistant symptoms of GORD

361
Q

Investigation to diagnose eosinophillic oesophagitis?

A

Endoscopy

362
Q

Drug treatment for esoinophillic oesophogitis?

A

Budenosine

363
Q

Drug treatment for esoinophillic oesophogitis?

A

Budenosine

364
Q

Differential diagnosis for recurrent abdominal pain? x3

A

Migraine
IBS
Non-ulcer dyspepsia

365
Q

Gastritis is?

A

Inflammation of gastric mucosa

366
Q

Two causes of gastrisis?

A

Helicobacter Pylori infection

NSAID usage

367
Q

Four symptoms of gastrisis?

A

Vomiting
Abdominal pain
Haematemesis
Anaemia

368
Q

Three ways to diagnose helicobacter pylori?

A

Endoscopy
Stool antigen
Urea breath test

369
Q

Enzyme produced by helicobacter pylori?

A

Urease

370
Q

Two treatments for HP infection?

A

Amoxycillin

Carithromycin

371
Q

Three symptoms of Crohn’s disease?

A

Abdominal pain
Weight loss
Diarrhoea

372
Q

Serum changes in Crohn’s disease? x4

A

Raised ESR and CRP

Low albumin and Hb

373
Q

Treatment for IBD x4

A

Exclusive enteral nutrition only (Crohn’s)
Steroids
5-ASA
Biologicals (anit-TNF infliximab)

374
Q

Cause of painless rectal bleeding in toddlers?

A

Juvenile polyps

375
Q

Juvenile polyps also known as?

A

Hamartoma

376
Q

Exotoxin is?

A

Protein secreted by pathogen

377
Q

Pathogen causing diptheria is?

A

Corynebacterium diphtheriae

378
Q

Endotoxin is?

A

Part of the outer membrane of teh pathogen

379
Q

What bacteria type have endotoxins?

A

Gram-negative bacteria

380
Q

When are endotoxins released?

A

During lysis of organism

381
Q

Endotoxin release causes what in the immune system?

A

Macrophage activation

382
Q

Three effects of meningococcal disease on the body?

A

Myocardial depression
Endothelial dysfunction - leak
Coagulopathy

383
Q

What is a fever?

A

Rectal temperature >37.8 degrees

384
Q

Taking temperature by mouth - significance?

A

Temperature will be 0.5 degrees lower than rectal temperature

385
Q

Taking temperature by underarm - significance?

A

Temperature will be 1 degree lower than rectal temperature

386
Q

Three organisms that cause septicaemia and meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae B

387
Q

Four early of septicaemia

A

Tachycardia
Tachypnoea
Prolonged capillary refill
Rash

388
Q

Late sign of septicaemia?

A

Low BP

389
Q

Signs of meningitis?

A 
High temperature
Headache
Cannot tolerate bright lights
Stiff neck
Drowsy
Vomiting
390
Q

How is meningitis diagnosed?

A

Lumbar puncture - CSF

391
Q

How to differentiate the cause of meningitis using CSF?

A

Protein content

392
Q

Three potential causes of meningitis?

A

Bacterial
Viral
TB

393
Q

Top 3 organisms causing infection in infants are?

A

Group B strep
E. Coli
Listeria

394
Q

Most common antibiotic used in older children?

A

Ceftriaxone

395
Q

Most common antibiotic used in younger children?

A

Cefotaxime

396
Q

Neonatal period is until what age?

A

First 28 days

397
Q

Streptococcus gram negative or gram positive?

A

Positive

398
Q

Invasive diseases typically enter the body where?

A

Nasopharynx

399
Q

Invasive disease - travels through what structure of the ear?

A

Eustachian tube

400
Q

Define empyema

A

Collection of pus in the pleural cavity

401
Q

Treatment for empyema x2

A

Chest drain + urokinase

Video assisted thoracoscopic surgery (VATS)

402
Q

Function of urokinase enzyme?

A

Conversion of plasminogen to plasmin - used to dissolve clots

403
Q

Location of urokinase enzyme in the body?

A

Kidney

404
Q

Urokinase enzyme also known as?

A

Urokinase-type plasminogen activator

405
Q

Vaccine for pneumococcal infection? x2

A

Pneumococcal polysaccharide vaccine (PPV)

Pneumococcal conjugate vaccine (PCV)

406
Q

PCV pneumococcal vaccine given when? x3

A

2 months
4 months
12 months

407
Q

Pathogen responsible for TB?

A

Mycobacterium tuberculosis

408
Q

Number of people infected with mycobacterium tuberculosis worldwide?

A

1/3

409
Q

Reactivation of TB has what effect in the lungs?

A

Forms cavity in the lungs

410
Q

Pathogen responsible for tetanus?

A

Clostridium tetani

411
Q

Clostridium tetani - gram positive or gram negative?

A

Positive

412
Q

Tetanus acts where in the body?

A

Via exotoxin at the NMJ

413
Q

Where is tetanus found non-pathogenically?

A

Spores in soil

414
Q

Five signs of tetanus in neonate?

A 
Weak
Lethargic
Poor suck
Spasms
Fits
415
Q

Clostridium tetani - responsible for what disease?

A

Tetanus

416
Q

Two classifications of fungi are?

A

Yeasts

Moulds

417
Q

Example of fungi yeast

A

Candida

418
Q

Example of fungi mould

A

Aspergillus

419
Q

Fungal infection nappy rash - organism responsible is?

A

Candidiasis

420
Q

Fungal infection ringworm - organism responsible is?

A

Tinea corporis

421
Q

Treatment for candidiasis and tinea corporis is?

A

Topical antifungal

422
Q

Give two rare fungal infections

A

Candidaemia

Pulmonary aspergillosis

423
Q

Effect of candidaemia in preterm infant? x2

A

Affects kidneys and brain

424
Q

Effect of pulmonary aspergillosis

A

Effects neutrophil function

425
Q

Chronic granulomatous disease effects impairs function of which cells?

A

Neutrophils

426
Q

Wiskott-Aldrich syndrome impairs function of which cells?

A

T-cells

427
Q

Rare fungal infections rely on what for invasion?

A

Immunosuppression

428
Q

Classification of protozoa x3

A

Sporozoa
Amoebae
Flagellates

429
Q

Protozoa species causing malaria are?

A

Plasmodium

430
Q

Plasmodium protozoa (malaria) are what type of protozoa?

A

Sprozoa

431
Q

Four plasmodia causing malaria?

A

P. falciparum
P. vivax
P. ovale
P. malariae

432
Q

Pathogen causing most severe strain of malaria is?

A

P. falciparum

433
Q

Malaria causes how many deaths of children per year?

A

1 million

434
Q

Four non-specific signs of malaria

A

Fever
Lethargy
Vomiting
Diarrhoea

435
Q

Pathogen responsible for toxplasmosis?

A

Toxoplasma gondii (protozoa)

436
Q

Splenectomy - risk of infection by what bacteria? x3

A

Encapsulated bacteria:
Pneumococcus
HiB
Meningococcus

437
Q

Birth of preterm baby <24 weeks not viable - why? x2

A

Insufficient levels of surfactant and insufficient lung development

438
Q

Pulmonary artery has a thin wall - why?

A

Low pressure blood to the lungs

439
Q

Cause of a wheeze?

A

Oscillations in narrowed airways

440
Q

Wheezes are inspiratory or expiratory?

A

Can be either

441
Q

Frequency of wheeze is dependent on what factors? x3

A

Degree of narrowing
Elasticity of airway wall
Local airflow

442
Q

Preschool wheeze is normally triggered by what?

A

Colds

443
Q

Three risk factors for preschool wheeze?

A

Smoking in pregnancy
Air pollution
Younger mother

444
Q

What is a transient early wheezer?

A

Wheeze only during first three years of life

445
Q

Difference in transient early wheezers at birth compared to normal?

A

Born with low lung function and hyper-reactive lung

446
Q

Transient early wheezers have normal lung function by what age?

A

11

447
Q

Non-atopic wheezers tend to wheeze at what age range?

A

3-6 years

448
Q

Asthma inflammation - lungs infiltrated with which two cells?

A

Lymphocytes

Eosinophils

449
Q

Three histological changes in atopic asthma?

A

Goblet cell hyperplasia
Thick sub basement membrane
Cellular infiltrate

450
Q

Wheeze in infants originates from where?

A

Intra-thoracic airways

451
Q

Most common childhood malignancy is?

A

Acute lymphoblastic leukaemia (ALL)

452
Q

Most frequent cause of death from cancer in the <20 age group is from?

A

Acute lymphoblastic leukaemia (ALL)

453
Q

Three presentations of ALL?

A

Bruising/bleeding
Pallor and fatigue
Infection

454
Q

Bruising/bleeding in ALL is due to?

A

Thrombocytopenia

455
Q

Pallor and fatigue in ALL is due to?

A

Anaemia

456
Q

Infection in ALL is due to?

A

Neutropenia

457
Q

Two mutations of ALL are?

A

MLL translocation

TEL-AML1 translocation

458
Q

MLL translocation in ALL occurs in which cells?

A

CD19+

459
Q

TEL-AML1 translocation occurs in which cells? x2

A

CD19+

CD10+

460
Q

Four phases of treatment for ALL are?

A

Induction
Consolidation
Maintenance
Bone marrow transplantation

461
Q

Wilms’ tumour is also known as?

A

Nephroblastoma

462
Q

Wilms’ tumour effects which organ?

A

Kidney

463
Q

Wilms’ tumour - common age of onset?

A

<5 years

464
Q

Prevalence of Wilms’ tumour?

A

1/10,000 children

465
Q

Presntation of Wilms’ tumour?

A

Asymptomatic abdominal mass

466
Q

Does Wilm’s tumour typically metastasis?

A

No

467
Q

Wilms’ tumour bilateral or unilateral?

A

Often bilateral

468
Q

Three cell types in Wilms’ tumour?

A

Blastema
Epithelia
Stroma

469
Q

Gene activated in Wilms’ tumour is?

A

CTNNB1

470
Q

Genes inactivated in Wilms’ tumour are? x3

A

WT1
WTX
TP53

471
Q

Retinal blastoma is?

A

Tumour of the retina

472
Q

Retinal blastoma occurs at what age?

A

<5 years

473
Q

Prevalence of retinoblastoma in the <5yo age group?

A

5%

474
Q

Three symptoms of retinoblastoma?

A

Leukocoria
Eye pain/redness
Vision problems

475
Q

Define leucocoria

A

White pupil when light is shone into it

476
Q

Retinoblastoma is metastatic in what percentage of patients?

A

10-15%

477
Q

Cellular origin of retinoblastoma is?

A

Cone precursor cells

478
Q

Loss of what gene/protein in retinoblastoma?

A

RB1

479
Q

Effect of non RB1?

A

Free E2F induces G1-S transition in cell cycle

480
Q

Activation of what gene in retinoblastoma?

A

MYCN - oncagene

481
Q

Amplification of what two genes in retinoblastoma?

A

MDM2

MDM4

482
Q

What pathway is inactivated in retinoblastoma?

A

p53 pathway inactivated

483
Q

Most common cancer in the first year of life is?

A

Neuroblastoma

484
Q

Three genes involved in development of neuroblastoma are?

A

MYCN
ALK
PHOX2B

485
Q

Five steps in the viral life cycle

A 
Attachment
Entry
Uncoating
Synthesis of viral components
Assembly and release
486
Q

Viruses have DNA or RNA?

A

Can have either

487
Q

Four stages of Hep B infection

A

Tolerance
Clearance
Latency
Reactivation

488
Q

Two consequences of chronic Hep B infection

A

Cirrhosis

Hepatocellular carcinoma

489
Q

What is palivizumab?

A

Monoclonal antibody given for the prevention of bronchiolitis

490
Q

Koplik spots are presnt in what vital infection?

A

Measles

491
Q

Increased methylation - switches genes on or off?

A

Off

492
Q

Decreased methylation - switches genes on or off?

A

On

493
Q

Hypothalamo-pituitary axis - dopamine is inhibitory to?

A

Prolactin

494
Q

Hypothalamo-pituitary axis - somatostatin s inhibitory to? x2

A

TSH

GH

495
Q

In which zone of the prostate gland is BHP most likely?

A

Transitional

496
Q

In which zone of the prostate gland is prostatic cancer most likely?

A

Peripheral

497
Q

In which zone of the prostate gland do the ejaculatory ducts open into?

A

Central

498
Q

In which zone of the prostate gland does the urethra run through?

A

Transitional

499
Q

The remnant of the uterus in the male is located where?

A

In the prostate

500
Q

What is located at the mid-inguinal point?

A

Femoral artery

501
Q

Keratin pearls are present in which histological diagnosis in female pathology?

A

Cervical squamous cell carcinoma

502
Q

Koilocytes form in which histological diagnosis in female pathology?

A

Cervical neoplasia due to HPV infection

503
Q

Basal layer is absent in what pathology of the prostate?

A

Adenocarcinoma of the prostate

504
Q

Varicose veins of the testicle is called?

A

Variocele

505
Q

Variocele is more common in right or left testicle?

A

Left

506
Q

Whey is variocele more common in left testicle than right?

A

Left testicular vein drains into the renal vein at a right angle

507
Q

Diagnostic test to differentiate between BHP and prostate cancer is?

A

PSA level

508
Q

Incontinence during childbirth occurs due to which levator ani muscle specifically?

A

Puborectalis

509
Q

Function of the trigone?

A

Signals to the brain when teh bladder is full

510
Q

How does the trigone carry out its function?

A

Sensitive to stretch

511
Q

Omphalocele vs. gastroschisis?

A

Gastroschisis - protrusion of the intestines through the ansterior abdominal wall
Omphalocele - protrusion of the intestines still contained within the peritoneum through the anterior abdominal wall

512
Q

What is the blood supply to the perineum?

A

Perineal artery

513
Q

What is the origin of the perineal artery?

A

Internal pudendal artery

514
Q

What is the origin of the superior rectal artery?

A

Inferior mesenteric artery

515
Q

What is the origin of the middle rectal artery?

A

Internal iliac artery

516
Q

What is the origin of the inferior rectal artery?

A

Internal pudendal artery

Year 2 HD (29 decks)

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