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Q's I got wrong Flashcards

1
Q

34-yr old women with known Endometriosis. Comes to GP complaining Endometriosis symptoms haven’t improved. Continues to get severe abdominal pain.
She’s tried mefenamic acid. What else can she be given to help her symptoms?

A

Combined oral contraceptive pill or progrestrogens

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2
Q

What Structure is Responsible for Replacing the Tissue lost during Menstruation?

A

Stratum Basalis

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3
Q

At which time point do ovaries contain the greatest number of Germ-Cells?

A

7 Months gestation

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4
Q

Women Presenting for first scan is found to have a normal pregnancy but 2 uteri, how does this occur?

A

Occurs as a result of an incomplete fusion of the paramesonephric duct.

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5
Q

What Structure develops to form the Vas Deferens in the male?

A

The Mesonephric Duct

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6
Q

What develops to form the superior portion of the vagina in women?

A

The Paramesonephric Duct.

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7
Q

Until which point can research be conducted on Human Embryos?

A

Until Day 14

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8
Q

A couple presents to the infertility clinic when he is found to have an obstructive azoospermia, what genetic condition is most likely?

A

Cystic Fibrosis

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9
Q

1 in how many couples require infertility assessment in the UK?

A

1 in 6

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10
Q

At what stage in embryonic development would the embryo transfer be most successful in IVF?

A

Blastocyst stage.

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11
Q

After 3 years of unexplained Infertility, the chance of spontaneous fertility is low, what is the best treatment option?

A

IVF

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12
Q

How long do male lice live for on average?

A

22 days… (why tf do I need to know this)

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13
Q

What percentage of couples undergoing infertility treatment are doing so as a result of the male factor?

A

30%

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14
Q

What is the Vertex?

A

Its the area midway between the Anterior fontanelle, Posterior Fontanelle and the 2 parietal eminences.

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15
Q

Non-sexually active women develops vaginal discharge with bubbles and an offensive smell, what is the most likely diagnosis?

A

Bacterial Vaginosis.

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16
Q

What percentage of Abnormal Uterine Bleeding will be caused by Dysfunctional Uterine Bleeding?

A

50%

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17
Q

A 17 yr old presents looking for emergency contraception. She had unprotected sexual intercourse 23 hours ago. Her last bleed was approximately 1 week ago. She has been using the combined patch but forgot to put this back on after a 7-day patch free interval. She was meant to restart using the patch 5 days ago but only remembered to restart it 2 days ago. She does not wish to have a cu IUD fitted even though she is fully aware this would be the most effective method. Which emergency contraception would you advice?

A

Give Levonorgestrel (Levonelle - “morning after pill”) as emergency contraception and advise her to carry on the patch. She will be able to rely on this again after contraception in 5 days.

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18
Q

A 35-year-old woman seeks contraception. She has heavy and painful periods. She smokes 10 cigarettes daily. Her BMI is 33 and BP 128/70. She is taking a drug for epilepsy that is a liver enzyme inducer. Which of the following options would be the best contraceptive for this woman?

A

Intrauterine System (IUS) / Mirena Coil.

The lady is on Carbamazepine most likely which has lots of drug interactions.

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19
Q

What problems can a multiple fibroid uterus cause when choosing contraceptive methods?

A

Difficulty in fitting an IUS or IUD.

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20
Q

When is the COCP contraindicated?

A

In a Patient over 35yrs smoking over 15 cigarettes a day.

High BMI
- BMI of ≥ 30-34 is UKMEC 2 (Benefits generally outweigh risks).
- BMI of ≥ 35 is UKMEC 3 (Risks outweigh benefits)

21
Q

What is the legal limit for social termination of pregnancy?

A

23 wks + 6 days

22
Q

How many signatures are required on the “green form” (HSA1 form) before a termination of pregnancy can take place?

A

2 signatures from 2 medical professionals.

23
Q

An Unconscious 48 yr old man with Type 1 respiratory failure. PCR of Broncho-Alveolar lavage has confirmed Pneumocistis jiroveci.
What is the most appropriate way to obtain an HIV test?

A

Obtain venous blood from the patient and request HIV antibody/antigen test.

No need for consent from patient or next of kin.

24
Q

What are some of the symptoms that patients with Primary HIV infection can present with?

A

Up to 80% of patients with primary HIV present with Symptoms.
- Usually 2 to 4 wks post infection.

  • Symptoms:
    • Fever
    • Rash (maculopapular)
    • Myalgia
    • Pharyngitis
    • Headache/aspetic meningitis

(there is a very high risk of transmission during this period)

25
Q

How is HIV tested for?

A

4th generation testing:
Involves sending venous blood to the lab.
- Checks for antibodies to HIV and the P24 Antigen.
- Has a “window period” of 45 days. (may take 45 days to show positive).
- negative after 45 exposure is reliable.

Point-of-care tests:
- Give the results within minutes.
- Check for HIV antibodies.
- Have a 90 day “window period”.

26
Q

What is the difference between Home self-sampling and Point-of-care testing kits?

A

Both test for HIV.
Both used for screening.

Self-sampling kits:
- Blood to be posted to the lab but taken by patient at home (4th gen test; Antibodies and P24 antigen)

Point-of-care:
- Antibodies only.
- Results in minutes.
- Also done by the patient.

27
Q

What Colour is discharge in Trichomonas Vaginalis?

A

Yellowish/green and frothy.
Also occurs along with itching and soreness.

28
Q

What colour is discharge in Candidiasis (Thrush)?

A

Creamy white discharge.
Occurs with redness as well.

29
Q

What is does HPV typically present with in Women.

A

Genital warts.

30
Q

How does Genital herpes present?

A

Extremely sore ulcerated lesions.
1st exposure is the worst - Never going to be as bad.

31
Q

What is the Antibiotic of choice for Chlamydia?

A

Doxycycline.

32
Q

Relating to the natural history of HIV.
What occurs in patients with advanced immunosuppression that is a result of reactivated infection?

A

Retinitis caused by Cytomegalovirus (CMV)

33
Q

What does AIDS-defining illness refer to?

A

AIDS-defining illnesses are associated with end-stage HIV infection where the CD4 count has become so low that unusual opportunistic infections and malignancies can occur.

34
Q

What are some examples of AIDS-defining Illnesses?

A

Kaposi’s Sarcoma,
- Rare type of skin cancer affecting skin, MOUTH and internal organs.

Pneumocystis jirovecii, pneumonia (PCP).
- Fungal infection of the lung causing respiratory failure.

Cytomegalovirus infection,
- Causes disseminated or localised end-organ disease.

Candidiasis (oesophageal or bronchial).

Lymphomas.

Tuberculosis,
- Caused by Mycobacterium tuberculosis bacteria.

35
Q

What is the preferred test for Chlamydia in an Asymptomatic Female?

A

First void urine NAAT.

36
Q

What type of consent is required in vaginal examination of a female patient?

A

Verbal consent is sufficient in a conscious patient.

37
Q

What percentage of LGBT people said they felt safe and supported by medical staff within the NHS in terms of their sexual orientation and/or gender identity?

A

57% Overall for LGBT people.

Lower for young women (43%) and Trans people (48%)

38
Q

What contributes to the development of HIV antiretroviral resistance?

A

Poor adherence to medication is the single biggest contributor to HIV antiretroviral drug resistance.

39
Q

What is a retrovirus?

A

A family of RNA viruses that have an enzyme (reverse transcriptase) capable of making a complementary DNA copy of the viral RNA which is then integrated into the hosts DNA.

e.g. HIV

40
Q

A 32 year old lady has been seen in the unplanned pregnancy assessment clinic.The report shows an intrauterine sac measuring 40 mmx 32 mmx 25 mm. The most likely diagnosis is?

A

A Missed Miscarriage.

41
Q

Which contraceptive protects against Ovarian Cancer?

A

Combined oral contraceptive Pill (COCP)

42
Q

What is the single best method of contraception for a 46 year old with a BMI of 42. She is in a stable relationship. She smokes 20 cigarettes/day . She also has history of pelvic inflammation due to diverticular disease in the past. She also has multiple fibroid uterus including intramural and submucosal fibroids.

A

Progesterone Only pill.

  • Sterilisation would be too risky given her History (BMI, Smoking).
  • Too difficult to fit Mirena with Fibroid Uterus.
  • Difficult to do Hysteroscopic Sterilisation with BMI and FIbroid Uterus.
  • COCP is contraindicated UKMEC 3 (> 35 BMI) (Age over 40 and smoking)
43
Q

A 40 year old woman seeks contraception. She smokes 30 cigarettes a day. Her BMI is 40 and she has heavy menstrual periods. She is sexually active. Her uterus is retroverted and normal size. What is her single best option?

A

Mirena IUS.

  • Surgery has high risk.
  • TCRE (Transcervical resection of endometrium) does not provide contraception.
  • COCP contraindicated.
44
Q

What is the other Tx of Chlamydia?

A

Azithromycin - one dose of 1g, followed by 500mg once a day for 2 days

(other is Doxycycline - taken everyday for a week)

45
Q

What factors are associated with regret with regard to sterilisation procedures?

A
  • Performed at the time of an abortion or childbirth.
  • Young age <30 yrs old.
  • Few or no children.
  • Not in a relationship.
  • Coercion by partner or medical personnel.
46
Q

What percentage of Lesbian, Gay and Bisexual people suffer from mental health conditions?
And what percentage of transgender people suffer?

A

LGB - 40%

Trans - 67%

47
Q

Facts about Oral Combined oral Contraceptive pill…

A
  • Should Ideally be started within 5 days after a period.
  • There is no need for additional contraception if pills are started in the first 7 days of starting a period.
  • Can start on day 21 post-partum if not breastfeeding.
  • Can be started within 5 days of termination of pregnancy less than 24 weeks of gestation.
  • There is no need for emergency contraception if one pill is missed, just take the pills regularly after taking the missed dose.
48
Q

A 31-year-old woman presents to her GP with progressively worsening menstrual pain that usually commences a few days before her period. She tried to take paracetamol and ibuprofen to alleviate the pain, but they are not effective in doing so. She also describes extreme discomfort when she has penetrative sex.

Digital vaginal examination reveals nodularity and marked tenderness in the posterior fornix of the cervix. Bimanual examination reveals a fixed, retroverted uterus.

Given the likely diagnosis, which of the following investigations is considered the gold standard?

A

Likely Diagnosis is Endometriosis.

The Dysmenorrhagia which isn’t alleviated with simple analgesia (NSAIDs) and Deep Dysparenunia indicate it so.

The Gold standard of Investigation for suspected Endometriosis is Laparoscopy. To Note the areas of Ectopic Endometrial Tissue.

  • Adhesions, peritoneal deposits and endometrial deposits on the ovaries (chocolate cysts) may be visualised during the procedure.

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