Repro Flashcards
Syphilis - causative organism
non-specific tests (false +ves)
useful for?
Treponema pallidum
VDRL, RPR (SLE, malaria, pregnancy)
useful - monitor therapy
Syphilis - specific tests
useful for monitoring or not?
TPPA, TPHA (starting with TP - treponema pallidum)
specific but +ve for life
Screening test for syphilis?
If +ve, what further tests are carried out?
IgM and IgG ELISA
Further: IgM ELISA, VDRL, TPPA
(IgM - active, IgG - +ve for life)
Which bones form pelvic inlet?
Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis
Which bones form pelvic outlet?
Pubic symphysis Ischiopubic ramus Ischial tuberosities Sacrotuberous ligaments Coccyx
When fontanelles ossify?
Anterior -9-18 months
Posterior - 3-7 months
How much folic acid needed pre-conception? (assisted conc)
0.4 mg/day (or 5mg if increased risk of NTD) pre-conception until 12 week
Indications for intra-uterine insemination?
how is it done?
unexplained infertility, mild or moderate endometriosis, mild male factor infertility
(Can be injected around ovulation time)
Indications for IVF?
how is it done?
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)
Intra Cytoplasmic Sperm Injection - indications?
how is it done?
Severe male infertility
Previous failed IVF
Preimplantation genetic diagnosis
(Get sperm from epididymidis (obstructive) or testicular tissue (non-obstructive).)
Symptoms of Ovarian Hyperstimulation Syndrome (OHSS)?
Abdominal pain / bloating
Nausea / Diarrhoea
Breathless
pregnancy marker?
(beta) hCG - human chorionic gonadotrophic
as early as 10 days after fertilisation
Miscarriage - when is it threatened, inevitable or complete? incomplete? early fetal demise/silent miscarriage?
Threatened - closed os
inevitable - opened os
Incomplete - part of pregnancy lost already
Complete - in vagina
Silent - no heartbeat at 12 or 13 weeks
Strawberry vagina infection? (one word)
Trichomoniasis
Normal vaginal flora
Lactobacillus spp. (predominate; make lactic acid)
strep “viridans”
Group B beta-haemolytic Streptococcus
Candida spp (a bit)
Vaginal thrush/candida
Presenation
Diagnosis
Treat
P: itchy and white cheese discharge (not sexually transmitted)
D: clinical; high vaginal swab (most candida albicans)
T: Clotrimazole (cream, pessary) /fluclonazole (oral)
Bacteral vaginosis Organism Diagnosis Laboratory Treat
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)
Chlamydia - life cycle; stain;
treat;
3 serological groupings
risk of which infection?
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
Neisseria gonorrhoeae what organism? Culture useful or not? Discharge? Treat? Test of cure needed?
O: Gram -ve diplococcus (two kidney beans) Culture - sensitivities (might) D: pus tap T: IM ceftriaxone + oral azithromycin Test recommended
Treat syphilis?
Penicillin.
Genital warts
organism
diagnosis
treat
O: HPV 6&11 (16&18 - cervical cancer)
D: clinical
T: cryotherapy, podophyllotoxin cream
Genital herpes Organism transmission pathogenesis diagnosis treat
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
Trichomonas vaginalis organism transmission presentation diagnosis treat
O: protozoal parasite T: sex P: vaginall discharge and urethritis (males) D: HVS T: metronidazole
Public lice
organism
treat
O: phthirus pubis
T: malathion lotion
Wolffian and Mullerian ducts
Mullerian degenerates in male or female?
Male
Wolffian and Mullerian ducts
Wolffian degenerates in male or female?
Female
Leydig cells in testis release what?
Testosterone
What Sertoli cells (in testis) release?
Inhibin and activin (to control FSH and spermatogenesis);
Also support sperm and protect
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
Normal testicular volume
12-25 ml
Chromosomes in Klinferters syndrome
46XXY
Tamoxifen (drug) - what effect on endometrium and breast?
Breast - anti-oestrogen
Endometrium - weak pro-estrogen
Adenomyosis in one sentence
Glands within smooth muscle, myometrium (and should be in endometrium)
Leiomyoma in one setence
usually benign tumour of the smooth muscle. In myometrium also called fibroids
Stages of medical abortion
Miepristone (anti-progesterone), 24-48 hours later vaginal prostaglandins. If failed in late pregnancy, repeated doses of prostaglandins
Levonelle - at what time? what cautions?
up to 72 hours, cautions: enzyme-inducers
ellaOne - at what time? cautions?
up to 120 hours; antacids - cautions
copper IUD as emergency contraception - at what time?
up to 120 hours post UPSI, up to 5 days after earliest expected day of ovulation
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
chlamydia presentation
Female: Post coital or intermenstrual bleeding, Lower abdominal pain, Dyspareunia (painful sex), Mucopurulent cervicitis
Male: Urethral discharge, Dysuria, Urethritis, Epididymo-orchitis
Target site for HIV?
CD4+ cells (T helpers, Dentritic, Macrophages, Microglial)
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
Treat HIV
HAART (highly active antiretroviral therapy)
eg protease inhibitors, abacavir, nevirapine, tenofovir, zidovudine, nevirapine)
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
Migraine and aura and CHC (pill)? Good combination ro bad?
Bad - both increase risk of stroke, contraindicated
What happens if you missed a pill (POP)?
[one missed dose +UPSI]
emergency contraception plus 2 days extra protection
Pudendal nerve - roots?
S2, 3, 4 keep pelvis off the floor!
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]
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
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)
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
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)
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...
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
Cervical Glandular Intraepithaelial Neoplasia - precursor of what? Some features of that?
Endocervical adenocarcinoma (late onset sexual activity, higher socioeconomic class, HPV 18)
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)
HELLP syndrome (pre-ecclampsia)
Haemolysis, Elevated Liver enzymes, Low Platelets
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)
Medication for VTE risk in pregnancy?
Does it cross placenta?
LMWH
No, safe for babies!
Treatment/prophylaxis for seizures in eclamsia?
Magnesium phosphate, if persistent consider diazepam
Placenta accreta - what is it? Further stages?
Accreta - invades myometrium
-> Increta -> percreta (invaded serosa, may need hysterectomy)
Causes of post partum haemorrhage (4 Ts)
Tone (atonic uterus)
Trauma
Tissue (retained tissue, accreta)
Thrombin (coagulopathies)
Management of PPH
Uterine massage
Syntocinon (oxytocin)
Syntocinon in Hartmanns
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)
Normal term dates and weight?
37-41 weeks, 2.5-4 kg
Apgar score
Appearance (blue) Pulse (100+) Grimace (cry, stimulation) Activity (flexion) Respiration (cry, gasping)
baby - green vomit. Is ___ until proven otherwise?
Milky vomit is what?
green - Malrotation (otherwise intususseption etc)
milky - pyloric stenosis
Neonatal bacterial infection (sepsis) - most common pathogen?
Treat?
Group B streptococcus
Benzylpenicillin, gentamicin. If in NICU also flucloxacyllin and vancomycin for Staph Aureus
normal age for menopaus
45-54
Where sarcomas metastasise to?
how about carcinomas?
sarcomas - lungs (haem?)
Carcinomas - lymph nodes
When do endometrial polyps occur (most often)?
Around menopause
2 typed of endometrial carcinoma
- Endometroid (mucinous), type 1, 80% [adenocarcinoma]
unopposed oestrogen, atypical hyperplasia, (obesity) - Serous (clear cell), type 2, 20%
post-menopausal, p53
Lynch syndrome - which cancers? what kind of genetics?
colorectal and endometrial (also ovarian)
microsatellite instability, mismatch repair genes, autosomal dominant
Spindle cell morphology - which cancer?
Leiomyosarcoma (malignant, uterus)
What are hydro and pyosalpinx?
Salpinx - fallopian tube. filled with clear fluid or serous (hydro) or pus (pyo)
Radial scar vs Complex sclerosing lesion
Size: RS 1-9mm, CSL 10mm+
Arbitrary
