Repro

Question 1

Order of the layers of the testes from out to in:

Answer 1

• Skin
• Dartos Fascia & Musle
• Ext spermatic fascia
• Cremasteric Fascia & muscle
• Int Spermatic Fascia
• Parietal Tunica Vaginalis
• Visceral Tunica Vaginalis

Question 2

Where does fertilization occur?

Answer 2

In the AMpulla of the fallopian tube

Question 3

How does the ureter relate to the uterine artery?

Answer 3

UReter passes under the uterine artery

Question 4

What hormone triggers contraction of breast myoepithelium –> Lactation?

Answer 4

Oxytocin in response to suckling

Release of milk by epithelial cells is due to prolactin

Question 5

How does cOCP affect the risks of cancer?

Answer 5

Increases breast and cervical

But decreases ovarian and endometrial cancers

Question 6

What are the major forms of monozygotic pregnancy? (twins)

Answer 6

1st) 33% dichorionic where cleavage occurs before implantation
2) monochorionic diamniotic where cleavage occurs after implantation
3) monoamniotic (4%) where cleavage occurs after day 8

Question 7

Main causes of PID?

Answer 7

Chlamydia Trachomatis

Neisseria Gonorrhoea

Question 8

Presentation of PID?

Answer 8

lower abdominal pain
fever
deep dyspareunia
dysuria and menstrual irregularities may occur
vaginal or cervical discharge
cervical excitation

perihepatitis (Fitz-Hugh Curtis Syndrome) occurs in around 10% of cases. It is characterised by right upper quadrant pain and may be confused with cholecystitis

Question 9

Which of the following is a disadvantage of breastfeeding?

• Increased risk of ovarian cancer
• Increased risk of ear infection
• Increased risk of type 1 DM
• Inadequate Vit K
• Inadequate Lactoferrin

Answer 9

!!!Breast milk has inadequate levels of vitamin K.

Breastfeeding is protective against breast and ovarian cancer.

Breast milk has adequate levels of lactoferrin. Lactoferrin promotes rapid uptake of iron by the gut and has antibacterial properties.

Breastfeeding is associated with reduced incidences of ear infections and type 1 diabetes mellitus.

Question 10

What is a hydatiform mole?

Answer 10

A molar pregnancy where:

• 1 sperm fertilizes an empty egg ad duplicates its own DNA –> 46 chromosomes all paternal in origin (Total Hydatiform Mole)
• 2 sperm (or 1 duplicating) fertilize a normal egg –> excess chromosomes (Partial Hydatiform mole)

Question 11

When does the PoP become effective?

Answer 11

After 48hrs

Question 12

Prepubertal Atrophic Vaginitis can occur when a girl has not yet undergone puberty, what happens in it?

Answer 12

Low vaginal oestrogen –> infection-prone alkaline environment, as oestrogen increases levels of lactobacilli which facilitate the conversion of glucose to lactic acid.

It is an important diagnosis to consider in any prepubertal female patient presenting with vaginal itching and discharge.

Question 13

What’s the main cause of PPH?

Answer 13

Uterine Atony is responsible for most cases

4Ts = Tone, Trauma, Tears & thrombosis

Question 14

What does the broad ligament do?

Answer 14

Attaches Uterus, fallopian tubes and ovaries to pelvic wall

Question 15

What does the round ligament of the uterus do?

Answer 15

Attaches fundus of uterus to labia majora

Question 16

What does the suspensory ligament of the ovary do?

Answer 16

Attaches ovaries to pelvic wall

Question 17

What does the cardinal ligament do?

Answer 17

Attaches cervix to pelvic wall

Question 18

What are the phases of the uterine cycle?

Answer 18

Day 1-4 - menstruation
Day 5-13 = Proliferative or Follicular Phases
Day 14-28 = Secretory or Luteal phase

Question 19

What happens to the uterus during the proliferative phase?

Answer 19

Increased oestrogen leads to:

• Endometrial thickening
• endometrial glands
• vascularisation of endometrium

Question 20

How do we manage shoulder dystocia?

Answer 20

First try Mcrobert’s Maneuvre - Mum flexes and abducts hips, thus raising pelvis and widening pelvic outlet

Question 21

Which of the following is a complication of Rhesus disease in a newborn?

• FEtal Liver failure
• Kernicterus
• Hydrops Fetalis
• Myeloproliferative Disorders

Answer 21

Both hydrops fetalis ( fluid accumulating in compartments due to the heart pumping super hard because of the haemolysis)

And Kernicterus (due to excess unconjugated bilirubin from haemolysis)

Question 22

What happens to cause Haemolytic Disease of the Newborn?

Answer 22

Rh -ve mum produces Anti-D Abs that target foetal red cells

Question 23

What is Vasa Praevia?

Answer 23

Where the foetal vessels sit over the cervix, they are likely to be damaged once the membranes rupture. This is very dangerous for the baby

Question 24

How do we spot vasa praevia?

Answer 24

Classic Triad:

• Painless PV bleeding
• Membrane rupture
• Foetal Bradycardia

Can look with an US

Question 25

How do we manage Vasa Praevia?

Answer 25

Elective early C-section if possible to avoid membrane rupture

If not detected and the membranes rupture then do emergency C-section

Question 26

How do we determine what thromboprophylaxis to use in pregnancy?

Answer 26

Previous VTE –> Low dose aspirin from wk 8 & 6wks postnatal
3 RFs –> LMWH from wk 28 & 6wks postnatal
3+ RFs –> LMWH immediately & 6wks postnatal

Question 27

Risk factors for thromboprophylaxis in pregnancy?

Answer 27

Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia 
Multiple pregnancy 
IVF pregnancy

Question 28

What is contained in the broad ligament>

Answer 28

Ovaries
Fallopian Tubes
Round ligament

Question 29

What are the layers of the spermatic cord?

Answer 29

Internal spermatic fascia (Derived from Transversalis fascia)
Cremasteric fascia (From the fascial coverings of internal oblique)
External spermatic fascia (External oblique aponeurosis)

Question 30

Where does lymph from the testes and scrotum go?

Answer 30

Testes - Para-aortic

Scrotum - Inguinal

Question 31

Which of the following results in Hypergonadotrophic Hypogonadism?

• Turner’s Syndrome
• Sheehan’s Syndrome
• Anorexia Nervosa
• Kallman’s Syndrome

Answer 31

Turner’s –> Gonads that are insensitive to gonadotrophs

Sheehands, Anorexia and Kallman’s all cause hypogonadotrophic Hypogonadism (i.e. the problems in the pit)