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1
Q

Syphilis - causative organism
non-specific tests (false +ves)
useful for?

A

Treponema pallidum
VDRL, RPR (SLE, malaria, pregnancy)
useful - monitor therapy

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2
Q

Syphilis - specific tests

useful for monitoring or not?

A

TPPA, TPHA (starting with TP - treponema pallidum)

specific but +ve for life

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3
Q

Screening test for syphilis?

If +ve, what further tests are carried out?

A

IgM and IgG ELISA
Further: IgM ELISA, VDRL, TPPA

(IgM - active, IgG - +ve for life)

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4
Q

Which bones form pelvic inlet?

A

Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis

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5
Q

Which bones form pelvic outlet?

A 
Pubic symphysis
Ischiopubic ramus
Ischial tuberosities
Sacrotuberous ligaments 
Coccyx
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6
Q

When fontanelles ossify?

A

Anterior -9-18 months

Posterior - 3-7 months

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7
Q

How much folic acid needed pre-conception? (assisted conc)

A

0.4 mg/day (or 5mg if increased risk of NTD) pre-conception until 12 week

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8
Q

Indications for intra-uterine insemination?

how is it done?

A

unexplained infertility, mild or moderate endometriosis, mild male factor infertility

(Can be injected around ovulation time)

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9
Q

Indications for IVF?

how is it done?

A

Unexplained (> 2 years durations)
Pelvic disease (endometriosis, tubal disease, fibriods)
Anovulatory infertility
Male factor infertility (if > 1 X 106 motile sperm)
Others (pre-implantation genetic diagnosis)

(give GnRH to downregulate to time things, then gonadotropin/hMG/FSH, risk of hyperstimulation, get eggs; guys 72 hrs abstinence)

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10
Q

Intra Cytoplasmic Sperm Injection - indications?

how is it done?

A

Severe male infertility
Previous failed IVF
Preimplantation genetic diagnosis

(Get sperm from epididymidis (obstructive) or testicular tissue (non-obstructive).)

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11
Q

Symptoms of Ovarian Hyperstimulation Syndrome (OHSS)?

A

Abdominal pain / bloating
Nausea / Diarrhoea
Breathless

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12
Q

pregnancy marker?

A

(beta) hCG - human chorionic gonadotrophic

as early as 10 days after fertilisation

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13
Q

Miscarriage - when is it threatened, inevitable or complete? incomplete? early fetal demise/silent miscarriage?

A

Threatened - closed os
inevitable - opened os
Incomplete - part of pregnancy lost already
Complete - in vagina

Silent - no heartbeat at 12 or 13 weeks

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14
Q

Strawberry vagina infection? (one word)

A

Trichomoniasis

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15
Q

Normal vaginal flora

A

Lactobacillus spp. (predominate; make lactic acid)
strep “viridans”
Group B beta-haemolytic Streptococcus
Candida spp (a bit)

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16
Q

Vaginal thrush/candida
Presenation
Diagnosis
Treat

A

P: itchy and white cheese discharge (not sexually transmitted)
D: clinical; high vaginal swab (most candida albicans)
T: Clotrimazole (cream, pessary) /fluclonazole (oral)

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17
Q 
Bacteral vaginosis
Organism
Diagnosis
Laboratory
Treat
A

O: Gardnerella vaginosis, Mobilincus sp, anaerobes
D: clinical, watery discharge, smelly (fish); raised pH (not sexually transmitted)
L: HVS, looking for CLUE CELLS
T: metronidazole orally (for anaerobic overgrowth)

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18
Q

Chlamydia - life cycle; stain;
treat;
3 serological groupings
risk of which infection?

A

biphasic cycle, no stain,
azithromycin;
sero: A-C trachoma in eye, D-K - genital, L1-3 - lymphogranulomna venereum (can mimic Crohn’s)
risk: pelvic infam disease; sexually acquired RA

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19
Q 
Neisseria gonorrhoeae
what organism?
Culture useful or not?
Discharge?
Treat?
Test of cure needed?
A 
O: Gram -ve diplococcus (two kidney beans)
Culture - sensitivities (might)
D: pus tap
T: IM ceftriaxone + oral azithromycin
Test recommended
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20
Q

Treat syphilis?

A

Penicillin.

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21
Q

Genital warts
organism
diagnosis
treat

A

O: HPV 6&11 (16&18 - cervical cancer)
D: clinical
T: cryotherapy, podophyllotoxin cream

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22
Q 
Genital herpes
Organism
transmission
pathogenesis
diagnosis
treat
A 
O: Herpes simplex virus type 1&2
T: close contact
P: cause painful disease -> nerve endings -> hide in root ganglions -> reactivate
D: swab (blister)
T: aciclovir
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23
Q 
Trichomonas vaginalis
organism
transmission
presentation
diagnosis
treat
A 
O: protozoal parasite
T: sex
P: vaginall discharge and urethritis (males)
D: HVS
T: metronidazole
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24
Q

Public lice
organism
treat

A

O: phthirus pubis
T: malathion lotion

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25
Wolffian and Mullerian ducts | Mullerian degenerates in male or female?
Male
26
Wolffian and Mullerian ducts | Wolffian degenerates in male or female?
Female
27
Leydig cells in testis release what?
Testosterone
28
What Sertoli cells (in testis) release?
Inhibin and activin (to control FSH and spermatogenesis); | Also support sperm and protect
29
What does Gonadotrophin Releasing Hormone do (reference to male)? What inhibits it?
It stimulates anterior pituitary for FSH (acts on Leydig cells) and LH (acts on Sertoli cells) negative feedback from testosterone
30
Normal testicular volume
12-25 ml
31
Chromosomes in Klinferters syndrome
46XXY
32
Tamoxifen (drug) - what effect on endometrium and breast?
Breast - anti-oestrogen | Endometrium - weak pro-estrogen
33
Adenomyosis in one sentence
Glands within smooth muscle, myometrium (and should be in endometrium)
34
Leiomyoma in one setence
usually benign tumour of the smooth muscle. In myometrium also called fibroids
35
Stages of medical abortion
Miepristone (anti-progesterone), 24-48 hours later vaginal prostaglandins. If failed in late pregnancy, repeated doses of prostaglandins
36
Levonelle - at what time? what cautions?
up to 72 hours, cautions: enzyme-inducers
37
ellaOne - at what time? cautions?
up to 120 hours; antacids - cautions
38
copper IUD as emergency contraception - at what time?
up to 120 hours post UPSI, up to 5 days after earliest expected day of ovulation
39
How does depo provera/saya work? How often to give? what to check before? when to start? when can get pregnant? risk of which disease?
inhibits ovulation; every 13 weeks (lasts 14) check BP and BMI start up to day 5 of cycle without more contraception (or not pregnant and 7 more days of contracept) Delayed fertility risk of osteoporosis
40
chlamydia presentation
Female: Post coital or intermenstrual bleeding, Lower abdominal pain, Dyspareunia (painful sex), Mucopurulent cervicitis Male: Urethral discharge, Dysuria, Urethritis, Epididymo-orchitis
41
Target site for HIV?
CD4+ cells (T helpers, Dentritic, Macrophages, Microglial)
42
Opportunistic infections in HIV associated conditions AIDS related
pneumocystis pneumonia (pneumocystis jiroveci - fungus), TB, cerebral toxoplasmosis (ring-enhancing lesions in CT), CMV, neurocognitive impairment, progressive multifocal leukoencephalopathy slim's disease (involuntary wasting) AIDS; Kaposi sarcoma, non-hodgkin's
43
Treat HIV
HAART (highly active antiretroviral therapy) | eg protease inhibitors, abacavir, nevirapine, tenofovir, zidovudine, nevirapine)
44
What happens if you missed a pill (progesteron+oestrogen)? Less than 48 hours (1) More than 48 hours (2)
(1) - take as soon as remembered, carry on (2) - Days 1-7: Consider Emergency Contraception Days 8-14: No extra instructions Days 15-21: Omit pill free interval
45
Migraine and aura and CHC (pill)? Good combination ro bad?
Bad - both increase risk of stroke, contraindicated
46
What happens if you missed a pill (POP)? | [one missed dose +UPSI]
emergency contraception plus 2 days extra protection
47
Pudendal nerve - roots?
S2, 3, 4 keep pelvis off the floor!
48
At which level spinal cord becomes cauda equina? At which level subarachnoid space ends? At which level you give anaesthetics is injected?
L2 S2 L3-4 (L5) [roughly level of superior iliac spine]
49
Down's risk assessment
1st trim - measure skin thickness behind neck, HCG and PAPP-A 2nd trim - HCG and AFP Amniocentesis or chorionic villus sampling if high risk
50
3 adjustements for foetal blood to improve O2 carrying capacity
``` Foetal Hb (increased ability to carry O2) Higher Hb concentration Bohr effect (can carry more O2 in low pCO2 than in high pCO2) ```
51
Changes for mother in pregnancy
``` CO increases (at the end small drop - compress SVC) HR increases BP drops More plasma volume, Hb decreased by dilution, iron requirements increase Tidal and minute volume increase Same vital capacity and pO2 Lower CO2 levels Glomerular filtration rate increases ```
52
Milk hormones and their role
Estrogen (ductile system grow, but inhibit milk production) Progesteron (lobule-alveoar system; inhibits milk) Prolactin (milk production, colostrum) Oxytocin (milk-let down reflex)
53
koilocytosis sign of?
``` HPV infection (can be either 6&11 warts or 16&18 cancer signs). Koilocytosis is cytoplasmic vacuolation Koilocytosis can progress into CIN... ```
54
Cervical Intraepithelial Neoplasia classification. | progress into?
CIN1 - Basal 1/3 of epithelium - abnormal cells. CIN2 - Abnormal cells extend to middle 1/3 CIN3 - full thickness (severe dyskariosis = dysplasia in cervix) -> invasive squamous carcinoma
55
Cervical Glandular Intraepithaelial Neoplasia - precursor of what? Some features of that?
Endocervical adenocarcinoma (late onset sexual activity, higher socioeconomic class, HPV 18)
56
Vulvar Paget's disease
crusting rash. Tumour cell in epidermis, contain mucin. Mostly no uderlying cancer, arises from sweat gland in skin (also Paget's disease of breast)
57
HELLP syndrome (pre-ecclampsia)
Haemolysis, Elevated Liver enzymes, Low Platelets
58
Medication for risk factors in pre-ecclampsia? Medications for high blood pressure? (resons for pre-existing HTN?)
aspirin labetalol, methyldopa, nifedipine (stop ACEi & ARBs) (renal/cardiac, Cushing’s, Conn’s, Phaeochromocytoma)
59
Medication for VTE risk in pregnancy? | Does it cross placenta?
LMWH | No, safe for babies!
60
Treatment/prophylaxis for seizures in eclamsia?
Magnesium phosphate, if persistent consider diazepam
61
Placenta accreta - what is it? Further stages?
Accreta - invades myometrium | -> Increta -> percreta (invaded serosa, may need hysterectomy)
62
Causes of post partum haemorrhage (4 Ts)
Tone (atonic uterus) Trauma Tissue (retained tissue, accreta) Thrombin (coagulopathies)
63
Management of PPH
Uterine massage Syntocinon (oxytocin) Syntocinon in Hartmanns
64
Overactive bladder pharmacological treatment: example SEs if that doesn't work
Anti-muscarinic (inhibits involuntary contractions) oxybutonin (will make Alzheimer's worse) dry mouth, constipation, somnolence (sleepy), blurred vision, another drug: b3 agonist (mirabegron) (increase relaxation)
65
Normal term dates and weight?
37-41 weeks, 2.5-4 kg
66
Apgar score
``` Appearance (blue) Pulse (100+) Grimace (cry, stimulation) Activity (flexion) Respiration (cry, gasping) ```
67
baby - green vomit. Is ___ until proven otherwise? | Milky vomit is what?
green - Malrotation (otherwise intususseption etc) | milky - pyloric stenosis
68
Neonatal bacterial infection (sepsis) - most common pathogen? Treat?
Group B streptococcus | Benzylpenicillin, gentamicin. If in NICU also flucloxacyllin and vancomycin for Staph Aureus
69
normal age for menopaus
45-54
70
Where sarcomas metastasise to? | how about carcinomas?
sarcomas - lungs (haem?) | Carcinomas - lymph nodes
71
When do endometrial polyps occur (most often)?
Around menopause
72
2 typed of endometrial carcinoma
1. Endometroid (mucinous), type 1, 80% [adenocarcinoma] unopposed oestrogen, atypical hyperplasia, (obesity) 2. Serous (clear cell), type 2, 20% post-menopausal, p53
73
Lynch syndrome - which cancers? what kind of genetics?
colorectal and endometrial (also ovarian) | microsatellite instability, mismatch repair genes, autosomal dominant
74
Spindle cell morphology - which cancer?
Leiomyosarcoma (malignant, uterus)
75
What are hydro and pyosalpinx?
Salpinx - fallopian tube. filled with clear fluid or serous (hydro) or pus (pyo)
76
Radial scar vs Complex sclerosing lesion
Size: RS 1-9mm, CSL 10mm+ | Arbitrary

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