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Repro Flashcards

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
Q

Wolffian and Mullerian ducts

Mullerian degenerates in male or female?

A

Male

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26
Q

Wolffian and Mullerian ducts

Wolffian degenerates in male or female?

A

Female

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27
Q

Leydig cells in testis release what?

A

Testosterone

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28
Q

What Sertoli cells (in testis) release?

A

Inhibin and activin (to control FSH and spermatogenesis);

Also support sperm and protect

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29
Q

What does Gonadotrophin Releasing Hormone do (reference to male)? What inhibits it?

A

It stimulates anterior pituitary for FSH (acts on Leydig cells) and LH (acts on Sertoli cells)
negative feedback from testosterone

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30
Q

Normal testicular volume

A

12-25 ml

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31
Q

Chromosomes in Klinferters syndrome

A

46XXY

32
Q

Tamoxifen (drug) - what effect on endometrium and breast?

A

Breast - anti-oestrogen

Endometrium - weak pro-estrogen

33
Q

Adenomyosis in one sentence

A

Glands within smooth muscle, myometrium (and should be in endometrium)

34
Q

Leiomyoma in one setence

A

usually benign tumour of the smooth muscle. In myometrium also called fibroids

35
Q

Stages of medical abortion

A

Miepristone (anti-progesterone), 24-48 hours later vaginal prostaglandins. If failed in late pregnancy, repeated doses of prostaglandins

36
Q

Levonelle - at what time? what cautions?

A

up to 72 hours, cautions: enzyme-inducers

37
Q

ellaOne - at what time? cautions?

A

up to 120 hours; antacids - cautions

38
Q

copper IUD as emergency contraception - at what time?

A

up to 120 hours post UPSI, up to 5 days after earliest expected day of ovulation

39
Q

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?

A

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
Q

chlamydia presentation

A

Female: Post coital or intermenstrual bleeding, Lower abdominal pain, Dyspareunia (painful sex), Mucopurulent cervicitis

Male: Urethral discharge, Dysuria, Urethritis, Epididymo-orchitis

41
Q

Target site for HIV?

A

CD4+ cells (T helpers, Dentritic, Macrophages, Microglial)

42
Q

Opportunistic infections in HIV
associated conditions
AIDS related

A

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
Q

Treat HIV

A

HAART (highly active antiretroviral therapy)

eg protease inhibitors, abacavir, nevirapine, tenofovir, zidovudine, nevirapine)

44
Q

What happens if you missed a pill (progesteron+oestrogen)?
Less than 48 hours (1)
More than 48 hours (2)

A

(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
Q

Migraine and aura and CHC (pill)? Good combination ro bad?

A

Bad - both increase risk of stroke, contraindicated

46
Q

What happens if you missed a pill (POP)?

[one missed dose +UPSI]

A

emergency contraception plus 2 days extra protection

47
Q

Pudendal nerve - roots?

A

S2, 3, 4 keep pelvis off the floor!

48
Q

At which level spinal cord becomes cauda equina?
At which level subarachnoid space ends?
At which level you give anaesthetics is injected?

A

L2
S2
L3-4 (L5) [roughly level of superior iliac spine]

49
Q

Down’s risk assessment

A

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
Q

3 adjustements for foetal blood to improve O2 carrying capacity

A 
Foetal Hb (increased ability to carry O2)
Higher Hb concentration
Bohr effect (can carry more O2 in low pCO2 than in high pCO2)
51
Q

Changes for mother in pregnancy

A 
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
Q

Milk hormones and their role

A

Estrogen (ductile system grow, but inhibit milk production)
Progesteron (lobule-alveoar system; inhibits milk)
Prolactin (milk production, colostrum)
Oxytocin (milk-let down reflex)

53
Q

koilocytosis sign of?

A 
HPV infection (can be either 6&11 warts or 16&18 cancer signs). Koilocytosis is cytoplasmic vacuolation
Koilocytosis can progress into CIN...
54
Q

Cervical Intraepithelial Neoplasia classification.

progress into?

A

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
Q

Cervical Glandular Intraepithaelial Neoplasia - precursor of what? Some features of that?

A

Endocervical adenocarcinoma (late onset sexual activity, higher socioeconomic class, HPV 18)

56
Q

Vulvar Paget’s disease

A

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
Q

HELLP syndrome (pre-ecclampsia)

A

Haemolysis, Elevated Liver enzymes, Low Platelets

58
Q

Medication for risk factors in pre-ecclampsia?
Medications for high blood pressure?

(resons for pre-existing HTN?)

A

aspirin
labetalol, methyldopa, nifedipine (stop ACEi & ARBs)

(renal/cardiac, Cushing’s, Conn’s, Phaeochromocytoma)

59
Q

Medication for VTE risk in pregnancy?

Does it cross placenta?

A

LMWH

No, safe for babies!

60
Q

Treatment/prophylaxis for seizures in eclamsia?

A

Magnesium phosphate, if persistent consider diazepam

61
Q

Placenta accreta - what is it? Further stages?

A

Accreta - invades myometrium

-> Increta -> percreta (invaded serosa, may need hysterectomy)

62
Q

Causes of post partum haemorrhage (4 Ts)

A

Tone (atonic uterus)
Trauma
Tissue (retained tissue, accreta)
Thrombin (coagulopathies)

63
Q

Management of PPH

A

Uterine massage
Syntocinon (oxytocin)
Syntocinon in Hartmanns

64
Q

Overactive bladder pharmacological treatment:
example
SEs

if that doesn’t work

A

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
Q

Normal term dates and weight?

A

37-41 weeks, 2.5-4 kg

66
Q

Apgar score

A 
Appearance (blue)
Pulse (100+)
Grimace (cry, stimulation)
Activity (flexion)
Respiration (cry, gasping)
67
Q

baby - green vomit. Is ___ until proven otherwise?

Milky vomit is what?

A

green - Malrotation (otherwise intususseption etc)

milky - pyloric stenosis

68
Q

Neonatal bacterial infection (sepsis) - most common pathogen?
Treat?

A

Group B streptococcus

Benzylpenicillin, gentamicin. If in NICU also flucloxacyllin and vancomycin for Staph Aureus

69
Q

normal age for menopaus

A

45-54

70
Q

Where sarcomas metastasise to?

how about carcinomas?

A

sarcomas - lungs (haem?)

Carcinomas - lymph nodes

71
Q

When do endometrial polyps occur (most often)?

A

Around menopause

72
Q

2 typed of endometrial carcinoma

A
  1. Endometroid (mucinous), type 1, 80% [adenocarcinoma]
    unopposed oestrogen, atypical hyperplasia, (obesity)
  2. Serous (clear cell), type 2, 20%
    post-menopausal, p53
73
Q

Lynch syndrome - which cancers? what kind of genetics?

A

colorectal and endometrial (also ovarian)

microsatellite instability, mismatch repair genes, autosomal dominant

74
Q

Spindle cell morphology - which cancer?

A

Leiomyosarcoma (malignant, uterus)

75
Q

What are hydro and pyosalpinx?

A

Salpinx - fallopian tube. filled with clear fluid or serous (hydro) or pus (pyo)

76
Q

Radial scar vs Complex sclerosing lesion

A

Size: RS 1-9mm, CSL 10mm+

Arbitrary

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