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3rd year > Reproductive > Flashcards

Reproductive Flashcards

1
Q

When should women who have undergone colposcopy have a repeat smear?

A

6 months

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2
Q

Which imaging modality is used for staging of ovarian cancer?

A

CT

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3
Q

What is the first investigation for suspected endometrial cancer?

A

Transvaginal ultrasound

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4
Q

How is sensitivity calculated?

A

True pos/ (pos + false neg)

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5
Q

How is specificity calculated?

A

True neg/ (neg + false pos)

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6
Q

How is gestational age estimated in the 1st trimester?

A

Crown to rump length

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7
Q

How is gestational age estimated in the 2nd trimester?

A

Head circumference

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8
Q

Risk factors for gestational diabetes

A 
BMI > 30
Previous baby > 4.5kg
Previous GD
1st degree relative T2DM
South Asian
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9
Q

Causes of inaccurate symphysis-fundal height

A

Obesity
Fibroids
Polyhydramnios

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10
Q

Risk factors for pre-eclampsia

A 
Previous gestational hypertensive disease
CKD
Autoimmune disease
Chronic hypertension
DM
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11
Q

What is the chromosomal abnormality in XY females?

A

Missing/mutated short arm of Y chromosome

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12
Q

What is the chromosomal abnormality in XX males?

A

Translocation of part of the Y (SRY)

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13
Q

Which two cell types form the gonads?

A

Somatic mesenchyme

Primordial germ cells

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14
Q

What is the action of SRY protein?

A

Stimulates formation of Sertoli cells

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15
Q

What are the actions of Sertoli cells in the male embryo?

A

Secretion of anti-Mullerian hormone

Stimulation of genital ridge cells to form Leydig cells

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16
Q

When do the mesonephric and paramesonephric ducts form?

A

7-8 weeks gestation

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17
Q

Which embryological structure forms the lower vagina?

A

Sinovaginal bulb

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18
Q

Which embryological structure forms the fallopian tube?

A

Mullerian duct

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19
Q

Which embryological structure forms the kidney?

A

Metanephros

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20
Q

Which structures are formed by the urogenital sinus?

A

Bladder and urethra

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21
Q

Which structures are formed by the mesonephric ducts?

A

Vas deferens and ejaculatory ducts

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22
Q

What is the embryological precursor of the round ligament?

A

Gubernaculum

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23
Q

What are the content of the inguinal canal in males?

A

Vas deferens
Testicular vessels
Ilioinguinal nerve
Genital branch of genitofemoral nerve

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24
Q

What are the contents of the inguinal canal in females?

A

Round ligament
Ilioinguinal nerve
Genital branch of genitofemoral nerve

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25
Q

What findings are seen on speculum exam for a threatenedmiscarriage?

A

Closed os

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26
Q

What findings are seen on speculum exam for ainevitablemiscarriage?

A

Products of conception at open os

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27
Q

What findings are seen on speculum exam for acompletedmiscarriage?

A

Products of conception in vagina

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28
Q

Symptoms of cervical shock

A

Cramps, nausea + vomiting, sweating, fainting

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29
Q

Causes of miscarriage

A

Embryo abnormality
Immune conditions e.g. antiphospholipid syndrome
Infection (CMV, rubella, toxoplasmosis, listeria)Environmental factors
Emotional upset
CVS

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30
Q

How is early foetal demisedefined?

A

Pregnancy in-situ, no heartbeat, mean sac diameter >25mm, foetal pole >7mm

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31
Q

Management of pregnancy in women with anti-phospholipid syndrome

A

Low dose aspirin, daily fragmin injection.Recent trials - progesterone pessary

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32
Q

Which surgical intervention is preferred in ectopic pregnancy?

A

Salpingectomy (if contralateral tube is healthy - if not, salpingotomy can be used)

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33
Q

How do complete molar pregnanciesform?

A

An egg without DNA is fertilised by 1 or 2 sperm, result in a non-viable fertilised egg

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34
Q

How do partial molar pregnanciesform?

A

Normal haploid egg fertilised by 2 sperm, or by 1 diploid sperm, resulting in triploid fertilised egg.

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35
Q

In which type of molar pregnancy may a foetus be present?

A

Partial

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36
Q

When does implantation bleeding occur?

A

10 days post-ovulation

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37
Q

Management of hyperemesis gravidarum

A 
Rehydration and electrolyte replacement
Parenteral antiemetics (cyclizine/prochlorperazine, ondansetron)
Nutritional supplements
NG feeding
Thromboprophylaxis
Severe cases - steroids
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38
Q

How many IVF/ICSI cycles are offered on the NHS for couples with reasonable chance of live birth?

A

Up to 3

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39
Q

What is the most common indication for assisted conception treatment?

A

Male factor infertility

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40
Q

How is ovarian reserve assessed in ACT?

A

Antral follicle count or anti-Mullerian hormone

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41
Q

How long is the growth phase of folliculogenesis?

A

20 days

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42
Q

How long is the tonic phase of folliculogenesis?

A

65 days

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43
Q

How are ovaries stimulated in IVF?

A

Synthetic/urinary FSH, +/- LH

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44
Q

How many mature follicles is optimal for an IVF cycle?

A

7-10

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45
Q

How long before oocyte recovery should HCG be administered?

A

36 hours

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46
Q

Symptoms of OHSS

A 
Abdominal bloating +/- ascites (severe)
Abdominal pain
Inc. ovarian size on US
Nausea + vomiting
Oliguria (severe)
Electrolyte imbalances (severe)
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47
Q

How many IVF cycles can be funded for women age 40 to 42?

A

One cycle, if good chance of success and no ethical issues.

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48
Q

How far in development is embryo research permitted?

A

14 days

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49
Q

Lichen sclerosis vs lichen planus

A

Sclerosis shiny white

Planus purple

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50
Q

What is the best antihypertensive for preggos?

A

Labetolol

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51
Q

Which structure is dilated in varicocele?

A

Pampiniform plexus

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52
Q

Which breast condition characteristically causes green discharge?

A

Duct ectasia

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53
Q

Where does cervix refer pain?

A

Perineum and posterior thigh

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54
Q

What is the characteristic appearance of a complete mole on uterine US?

A

Snowstorm

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55
Q

What type of organism is Treponema pallidum?

A

Bacterium

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56
Q

Increased levels of which hormone can indicate premature ovarian failure?

A

FSH

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57
Q

Which hormone causes enlargement of the mammary glands in pregnancy?

A

Prolactin

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58
Q

Which hormone is tested to see whether a woman has ovulated?

A

Progesterone

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59
Q

Why is tetracycline contraindicated in breastfeeding?

A

Can discolour baby’s teeth

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60
Q

What four bones make up the bony pelvis?

A

Sacrum, and coccyx, and the two innominate bones

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61
Q

Where does the iliac tubercle lie?

A

5cm posterior to ASIS on the iliac crest.

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62
Q

At what spinal level is the PSISfound?

A

S2

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63
Q

What two aspects of bone make up the ischiopubic ramus?

A

Inferior pubic ramus and inferior ischial ramus

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64
Q

Which muscles attach to the ischial tuberosity?

A

Hamstrings

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65
Q

Where does the obturator foramenlie?

A

Between the superior pubic ramus and ischiopubic ramus

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66
Q

What type of joint is the pubic symphysis?

A

Secondary cartilaginous

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67
Q

At what spinal level is the iliac crest?

A

L4

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68
Q

Which two structures does the inguinal ligamentrun between?

A

ASIS and pubic tubercle

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69
Q

Which ligaments form the greater sciatic foramen?

A

Sacrotuberous and sacrospinous ligaments

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70
Q

Which seven nerves run through the greater sciatic foramen?

A 
Sciatic
Superior and inferior gluteal
Pudendal
Posterior femoral cutaneous
Nerve to quadratus femoris
Nerve to obturator internis
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71
Q

What the boundaries of the greater sciatic foramen?

A

Superiorly - anterior sacroiliac ligament
Inferiorly - sacrospinous ligament and ischial spine
Anterolaterally - greater sciatic notch of ilium
Posteromedially - sacrotuberous ligament.

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72
Q

Which two structures does the sacrotuberous ligament run between?

A

Sacrum and ischial tuberosity

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73
Q

Which two structures does the sacrospinous ligament run between?

A

Sacrum and ischial spine

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74
Q

What bones make up the pelvic inlet?

A

Sacral promontory, ilium, superior pubic ramus, pubic symphysis

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75
Q

What bones make up the pelvic outlet?

A

Pubic symphysis, ischiopubic ramus, ischial tuberosities, coccyx

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76
Q

Which vessels are likely to be injured in trauma to the pelvis?

A

Common iliac

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77
Q

Which sex has a shallower pelvic cavity?

A

Female

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78
Q

Which sex has a wider subpubic angle?

A

Female

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79
Q

At what age does the posterior fontanelle fuse?

A

3-6months

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80
Q

At what age does the anterior fontanelle fuse?

A

9-18 months

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81
Q

How long can sperm survive in the female reproductive tract?

A

5 days

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82
Q

How is pearl index calculated?

A

No. accidental pregnancies x 1200 / total months of exposure

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83
Q

How does combined hormonal contraception work?

A

By inhibiting ovulation

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84
Q

What newer POP is used?

A

Desogestel

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85
Q

Failure rate of combined hormonal contraception

A

0.2%

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86
Q

Failure rate of contraceptive implant

A

0.05%

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87
Q

How long can contraceptive implant be used?

A

3 years

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88
Q

How often is depo given?

A

Every 13 weeks

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89
Q

Failure rate of depo

A

0.2%

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90
Q

How long is Mirena used?

A

Up to 5 years

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91
Q

How do IUS work?

A

Make endometrium unfavourable for implantation

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92
Q

How does depo work?

A

Inhibits ovulation

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93
Q

How do IUDs work?

A

Prevention of fertilisation

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94
Q

How long can IUDs be used?

A

5-10 years

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95
Q

Failure rate of IUS

A

0.2%

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96
Q

Failure rate of IUD

A

0.6%

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97
Q

Criteria for being reasonably certain a woman is not pregnant

A

(One or more)
• No sex since last period
• Consistently using reliable contraception
• < 7 days since last normal period
• < 4 weeks post-partum (not breast feeding)
• Fully breastfeeding, amenorrhoeic and < 6/12 post-partum
• Negative pregnancy test AND > 3 weeks since UPSI

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98
Q

Which contraceptive methods cannot be quick started?

A

IUD, pills containing cyproterone acetate

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99
Q

Methods of emergency contraception

A

IUD
LNG
UPA

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100
Q

How long can LNG-EC be used?

A

Up to 72 hours

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101
Q

How long can UPA-EC be used?

A

Up to 120 hours

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102
Q

When can IUD be used as emergency contraception?

A

Up to 120 hours post intercourse, or up to 5 days after earliest expected date of ovulation

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103
Q

When does implantation occur?

A

At least 6 days after ovulation, most often 8-10

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104
Q

What is LNG-EC?

A

High dose progestogen (levonorgestrel)

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105
Q

What is UPA-EC?

A

Anti-progestogen (ulipristal acetate)

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106
Q

How does oral emergency contraception work?

A

Delaying ovulation

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107
Q

Which oral emergency contraception can be used during the LH surge?

A

UPA

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108
Q

When should UPA-EC be avoided?

A

If wishing to quick start hormonal contraception, as ongoing contraception must be delayed for 5 days. It should also be avoided if hormonal contraception has been used in the past 7 days, or if the patient has severe asthma uncontrolled by oral steroids.

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109
Q

Typical use failure rate for combined hormonal contraception

A

9%

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110
Q

Weight over which women may have decreased efficacy of combined hormonal contraception

A

90kg

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111
Q

Starting COCP

A

Ideally first 5 days of cycle

Or any time reasonably certain not pregnant, with condom use for 7 days

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112
Q

How does combined hormonal contraception increase clot risk?

A

Reduced protein S and antithrombin III levels

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113
Q

Anti-androgen used for acne and hirsutism

A

Cyproterone acetate

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114
Q

Cancers increased by combined hormonal contraception

A

Breast, cervical

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115
Q

Cancers decreased by combined hormonal contraception

A

Ovarian, endometrial

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116
Q

Side effects of contraceptive patch

A

More breast pain, nausea, and period pain than other methods

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117
Q

When should progestogen only contraceptives be started?

A

Day 1-5 of cycle

Or any time if reasonably certain not pregnant, using condoms for 7 days (2 for POP)

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118
Q

Risk factors for low bone mineral density

A 
Age <18 or >45
Smoking
BMI <20
Malabsorption
Hyperthyroidism
Amenorrhoea
Non-weight bearing
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119
Q

Failure rate for vasectomy

A

0.1%, or 0.05% after clearance given

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120
Q

Which age group has highest rates of TOP?

A

20-24 year olds

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121
Q

Legal forms for abortion

A

HSA1/certificate A - two doctors must sign

HSA2/certificate B - to be completed by doctor within 24 hours of emergency TOP

HSA4 - completed by doctor and sent to CMO within 7 days

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122
Q

Criteria for giving contraception/TOP to under 16s

A
  • the young person will understand the professional’s advice;
  • the young person cannot be persuaded to inform their parents;
  • the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;
  • unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer;
  • the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.
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123
Q

Legal limit for social TOP

A

23 weeks 6 days

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124
Q

Medical TOP process

A

200mg oral mifepristone
then
24-48 hours, vaginal or oral prostaglandin

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125
Q

What gestation is considered early TOP?

A

<9 weeks

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126
Q

What gestation is considered late TOP?

A

9-12 weeks

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127
Q

Surgical methods of TOP

A 
Vacuum aspiration (6-12 weeks)
Dilatation and evacuation (13-24 weeks)
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128
Q

Which contraceptive method cannot be started during medical TOP?

A

DMPA - interferes with mifepristone effectiveness

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129
Q

Immune effects of HIV

A

Sequestration of cells in lymphoid tissue
Reducing CD4+ proliferation
Reducing CD8+ cytotoxic T cell activation
Reduced antibody class switching
Chronic immune activation

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130
Q

At what CD4 level do opportunistic infections occur?

A

<200

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131
Q

When do symptoms of primary HIV infection occur?

A

2-4 weeks after infection

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132
Q

Symptoms of primary HIV infection

A

Fever, maculopapular rash, myalgia, pharyngitis, headache

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133
Q

CXR findings in pneumocystis pneumonia

A

Interstitial infiltrates, reticulonodular markings

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134
Q

Diagnosis of pneumocystis pneumonia

A

Bronchioalveolar lavage, immunofluorescence

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135
Q

Treatment of pneumocystis pneumonia

A

Co-trimoxazole

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136
Q

What CD4 level does pneumocystis pneumonia occur below?

A

<200

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137
Q

What CD4 level does cerebral toxoplasmosis occur below?

A

150

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138
Q

What CD4 level does CMV occur as an opportunistic infection below?

A

50

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139
Q

Symptoms of cerebral toxoplasmosis

A

Headache, fever, focal neurology, seizures, reduced LOC, raised ICP

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140
Q

Presentation of CMV

A

Reduced visual acuity, floaters, abdo pain, diarrhoea, PR bleeding

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141
Q

Which organism causes progressive multifocal leukoencephalopathy in HIV?

A

JC virus

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142
Q

Which substances are detected by 3rd gen HIV tests?

A

IgM and IgG antibodies

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143
Q

What is the window period for 3rd gen HIV tests?

A

20-25 days

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144
Q

Which substances are detected by 4th gen HIV tests?

A

IgM, IgG, p24 capsular protein

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145
Q

Window period for 4th gen HIV tests

A

14-28 days

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146
Q

What is HAART?

A

A HIV treatment regimen consisting of 3 drugs from at least 2 drug classes

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147
Q

Prevention of vertical transmission of HIV

A

HAART during pregnancy
4 weeks PEP for neonate
C-section if detectable

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148
Q

Eligibility for HIV PrEP

A

Over 16, HIV negative, can commit to 3-monthly follow up, willing to stop if criteria no longer apply, resident in Scotland.

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149
Q

Criteria for being high risk of HIV

A

HIV+ partner with detectable viral load, or MSM or transwoman with UPAI with more than two partners in the last year, or confirmed rectal STI in last year.

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150
Q

Which hormones released by the dominant follicle inhibit FSH, causing atresia of other follicles?

A

Oestrogen, inhibin

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151
Q

Which hormone causes the dominant follicle to rupture and release the oocyte?

A

LH

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152
Q

What is metrorrhagia?

A

Regular intermenstrual bleeding

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153
Q

What is polymenorrhagia?

A

Increased bleeding and frequent cycle

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154
Q

What is menometrorrhagia?

A

Prolonged menses and intermenstrual bleeding

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155
Q

Medical management of dysfunctional uterine bleeding

A

Progestogens, COCP< danazol, GnRH analogues, NSAIDs, anti-fibrinolytics, IUS

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156
Q

Advantages of endometrial ablation over hysterectomy

A

Shorter operating time and recovery, fewer complications

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157
Q

Advantages of hysterectomy over endometrial ablation

A

No cervical smears required (if total), only oestrogen HRT required

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158
Q

Risk factors for candida infection

A

Recent antibiotic therapy, high oestrogen levels, diabetes, immunocompromise

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159
Q

Treatment of candida infection

A

Clotrimazole pessary or cream, or oral fluconazole

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160
Q

Presentation of candida balanitis

A

Spotty rash

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161
Q

Causes of acute bacterial prostatitis

A

UTI (E coli etc)
Gonorrhoea
Chlamydia

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162
Q

Treatment of acute bacterial prostatitis?

A

Ciprofloxacin, or trimethoprim if high risk for C diff.

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163
Q

Most common organism in the health vagina

A

Lactobacillus

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164
Q

Normal vaginal pH

A

4 to 4.5

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165
Q

What is the appearance of discharge in BV?

A

Homogenous, often bubbly

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166
Q

What are clue cells?

A

Vaginal epithelial cells coated with coccobacilli resulting in obscured edges, seen in BV

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167
Q

Treatment of BV

A

Metronidazole 7 days

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168
Q

Most common bacterial STI

A

Chlamydia

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169
Q

Which STI is an obligate intracellular bacteria with a biphasic life cycle?

A

Chlamydia

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170
Q

What type of organism is Chlamydia trachomatis?

A

Gram negative bacterium

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171
Q

Which chlamydia serovars cause trachoma?

A

A-C

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172
Q

Which chlamydia serovars cause genital infection?

A

D-K

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173
Q

Which chlamydia serovars cause lymphomogranuloma venereum?

A

L1-L3

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174
Q

Treatment of chlamydia

A

Doxycycline 100mg bd 7 days

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175
Q

Diagnosis of gonorrhoea and chlamydia

A

NAAT or PCR
Male: first-pass urine
Female: vulvo-vaginal or high vaginal swab

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176
Q

What type of bacteria is Neisseria gonorrhoeae?

A

Gram negative diplococcus (two kidney beans)

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177
Q

Treatment of gonorrhoea

A

IM ceftriaxone

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178
Q

When should test of cure for gonorrhoea be performed?

A

5-6 weeks after treatment

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179
Q

Primary syphilis

A

Chancre

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180
Q

Secondary syphilis

A

Large numbers of bacteria circulating

Mouth ulcers, rash, flu-like symptoms

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181
Q

Latent stage syphilis

A

Asymptomatic, low-level multiplication in intima of blood vessels

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182
Q

Non-specific tests for syphilis

A

VDRL, RPR

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183
Q

Specific tests for syphilis

A

TPPA, TPHA

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184
Q

Treatment of syphilis

A

Long-acting injectable penicillin

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185
Q

Test for HSV

A

PCR of swab from deroofed blister

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186
Q

What type of organism is trichomonas vaginalis?

A

Single-celled protozoal parasite

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187
Q

Diagnosis of trichomonas vaginalis

A

High vaginal swab for microscopy

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188
Q

Treatment of trichomonas vaginalis

A

Oral metronidazole

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189
Q

Treatment of phthirus pubis

A

Malathion lotion

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190
Q

What is the outermost layer of the ovary?

A

Germinal epithelium

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191
Q

When does meiosis pause in oocytes before birth?

A

Prophase 1

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192
Q

What is the zona granulosa?

A

Cuboidal cells surrounding a follicle

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193
Q

What layer lies between the oocyte and the zona granulosa in a follicle?

A

Zona pellucida

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194
Q

Layers of Graafian follicle

A 
Theca externa
Theca interna
Basal lamina
Granulosa cells
Antrum
Oocyte
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195
Q

What stage of meiosis do secondary oocytes pause at?

A

Metaphase II

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196
Q

Epithelium of the cervix

A

Stratified squamous on vaginal surface, transitioning to simple columnar further up

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197
Q

Layers of the vagina

A

Non-keratinised stratified squamous epithelium
Lamina propria
Fibromuscular layer
Adventitia

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198
Q

What is the first haploid stage of sperm development?

A

Secondary spermatocytes

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199
Q

Release of gonadotrophin releasing hormone

A

From hypothalamus every 2-3 hours starting at 8-12 years

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200
Q

Which hormones released by the Sertoli cells regulate FSH?

A

Inhibin, activin

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201
Q

Which substances are provides by the seminal vesicles?

A

Fructose, prostaglandins, fibrinogen

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202
Q

Which substances are produced by the prostate?

A

Alkaline fluid, clotting enzymes

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203
Q

Which substance is produced by the bulbourethral glands?

A

Mucus

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204
Q

Route sperm travel from testes

A

Epididymis, vas, ejaculatory duct, urethra

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205
Q

Which area of the penis is filled by blood in erection?

A

Corpora cavernosa

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206
Q

Causes of premature and retrograde ejaculation

A

Neuropathy, prostate surgery, anticholinergics

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207
Q

Normal testicular volume

A

1-3ml pre-puberty

12-25ml in adults

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208
Q

Success of vasectomy reversal

A

75% within 3 years
55% 3-8 years
30-40% 9+

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209
Q

Which form of azoospermia has better success rates with surgical sperm aspiration?

A

Obstructive

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210
Q

Which type of mole has a higher chance of developing into choriocarcinoma?

A

Complete

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211
Q

What is adenomyosis?

A

Endometrial glands and stroma grow within the myometrium

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212
Q

Which type of syphilis tests are positive for life?

A

Specific

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213
Q

Which diameter is wider at the pelvic inlet?

A

Transverse

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214
Q

Which diameter is wider at the pelvic outlet?

A

Anteroposterior

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215
Q

Which sex has a heart-shaped pelvic inlet?

A

Male

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216
Q

Which ligament does the pudendal nerve cross?

A

Sacrospinous, near its attachment to the ischial spine

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217
Q

Which diameter of the foetal skull is longer?

A

Occipitofrontal

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218
Q

Recommended supplementation for pregnancy

A

400ug folic acid, 10mcg vitamin D

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219
Q

Which women should take 5mg folic acid during and pre-pregnancy?

A

Obese women, women with diabetes, women on antiepileptics, those with previous child with neural tube defect

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220
Q

Risks of vitamin D deficiency in pregnancy

A

For mother - osteomalacia, pre-eclampsia, GD, BV, C-section

For foetus - SGA, neonatal hypocalcaemia, asthma, rickets

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221
Q

What is the major risk of iron deficiency in pregnancy?

A

Increased risk of still birth

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222
Q

Which group of women should have vitamin A supplementation in pregnancy?

A

Women with cystic fibrosis

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223
Q

What supplements are provided in the healthy start scheme?

A

400ug folic acid
10ug vitamin D
70mg vit C

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224
Q

Foods to avoid in pregnancy

A

Soft cheese, undercooked/cured meats, tuna, raw eggs, pate, liver, vitamin and fish oil supplements

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225
Q

Calories expended breastfeeding

A

640/day

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226
Q

Calories expended in 2nd and 3rd trimesters

A

300/day

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227
Q

Dietary recommendations for GD

A

No more than 30-50 complex carbs per meal
Dairy <150ml/day
Avoid foods >25.5g sugar per 100

228
Q

How much weight gain is recommended for underweight women in pregnancy?

A

28-40lbs

229
Q

How much weight gain is recommended for healthy weight women in pregnancy?

A

25-35lbs

230
Q

How much weight gain is recommended for overweight women in pregnancy?

A

15-25lbs

231
Q

How much weight gain is recommended for obese women in pregnancy?

A

11-20lbs

232
Q

Which type of HSV has more viral shedding?

A

Type 1

233
Q

Is gonorrhoea or chlamydia more likely to be asymptomatic?

A

Chlamydia

234
Q

Presentation of chlamydia in women

A

Often asymptomatic. Post-coital or intermenstrual bleeding, lower abdo pain, dyspareunia, mucopurulent cervicitis

235
Q

Presentation of chlamydia in men

A

Often asymptomatic. Milky urethral discharge, dysuria, urethritis, epididymo-orchitis, proctitis

236
Q

Which STI can cause sexually-acquired reactive arthritis?

A

Chlamydia

237
Q

Symptoms of lymphogranuloma venereum

A

Rectal pain, discharge, bleeding

238
Q

Which drugs is mycoplasma genitalium increasingly resistant to?

A

Macrolides

239
Q

Incubation period of urethral gonorrhoea in men

A

2-5 days

240
Q

Presentation of gonorrhoea in men

A

Mucopurulent discharge, dysuria

241
Q

Presentation of gonorrhoea in women.

A

Often asymptomatic. Altered vaginal discharge, dysuria, and rarely pelvic pain

242
Q

Second line treatment of gonorrhoea

A

Cefixime 400mg oral

243
Q

Incubation time of primary genital herpes

A

3-6 days

244
Q

Primary genital herpes symptoms

A

Blistering, pain, external dysuria, discharge, local lymphadenopathy, fever, myalgia, lasting 2-3 weeks.

245
Q

Which type of HSV has more recurrences?

A

HSV2 - 4-6 per year

246
Q

Treatment of genital herpes

A

Oral acyclovir 400g TDS 5-7 days
Topical lidocaine
Analgesia
Saline baths

247
Q

Most common viral STI

A

HPV

248
Q

Which types of HPV cause genital warts?

A

6, 11

249
Q

Which types of HPV cause cervical cancer?

A

16, 18

250
Q

Which types of HPV cause palmar and plantar warts?

A

1, 2

251
Q

Incubation period of HPV

A

3 weeks to 9 months - 3 months on average

252
Q

Treatment of HPV warts

A 
Podophyllotoxin
Imiquimod
Cryotherapy
Electrocautery
Last resort - surgery
253
Q

Incubation period of primary syphilis

A

9-90 days - 21 on average

254
Q

Presentation of primary syphilis

A

Painless chancre, usually on genitals, with non-tender local lymphadenopathy

255
Q

Incubation period of secondary syphilis

A

6 weeks - 6 months

256
Q

Presentation of secondary syphilis

A

Rash on palms and soles, lesions of mucous membrane, generalised lymphadenopathy, patchy alopecia, condylomata lata.

257
Q

Treatment of early syphilis

A

2.4mu benzathine penicillin, split doses injected into buttock

258
Q

Treatment of late syphilis

A

2.4mu benzathine penicillin x3

259
Q

What should response to treatment be in early syphilis?

A

Titres should quarter within 3-6 months

260
Q

How long should early syphilis be followed up after treatment?

A

Until RPR is negative

261
Q

Look-back period for partner notification in primary syphilis

A

90 days

262
Q

Look-back period for partner notification in secondary syphilis

A

2 years

263
Q

Look-back period for partner notification in HIV

A

4 weeks before negative test, or before most likely time of infection

264
Q

Look-back period for partner notification in chlamydia

A

6 months (unless male urethral, then 4 weeks)

265
Q

Look-back period for partner notification in gonorrhoea

A

6 months (unless male urethral, then 2 weeks)

266
Q

Who should get the hep B vaccine?

A

MSM, high prevelance countries, victims of sexual assault, contacts of an infected person

267
Q

Who should get the hep A vaccine?

A

MSM

268
Q

Which drugs are used as PrEP for HIV?

A

Tenofovir disoproxil, emtricitabine

269
Q

PEP for HIV

A

Antiretrovirals within 72 hours, used for 28 days

270
Q

Which fold of peritoneum contains the uterine tubes?

A

Broad ligament

271
Q

Which fold of peritoneum passes through the deep inguinal ring?

A

Round ligament

272
Q

Nerve supply of levator ani

A

Nerve to levator ani (S3,4,5)

273
Q

Boundaries of the breast

A

Ribs 2-6, lateral border of sternum, mid-axillary line

274
Q

Which axillary nodes are level I?

A

Inferior and lateral to pec minor

275
Q

Which axillary nodes are level II?

A

Deep to pec minor

276
Q

Which axillary nodes are level III?

A

Superior and medial to pec minor

277
Q

Side effect of Nexplanon implant most commonly complained about

A

DUB

278
Q

Disadvantages of depo

A

Risk of weight gain
Can not be stopped once injected
Delayed return of fertility (up to a year)

279
Q

Which GI drugs can UPA-EC not be used with?

A

PPI

280
Q

Which type of nerves carry pain from the uterus and upper vagina?

A

Visceral afferents

281
Q

Which type of nerves carry pain from the lower vagina?

A

Somatic sensory

282
Q

Which area do the superior aspects of pelvic organs refer pain to?

A

Suprapubic region - nerves run along side sympathetic fibres

283
Q

Which area do the inferior aspects of pelvic organs refer pain to?

A

S2, 3, 4 dermatomes - nerves run alongside parasympathetic fibres

284
Q

Layers passed through in spinal anaesthesia

A 
Skin
Fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
285
Q

Why does vasodilation occur in spinal anaesthesia?

A

Blockade of sympathetic tone to lower limbs

286
Q

Procedures pudendal block is used for

A

Episiotomy, forceps, perineal stitching

287
Q

Which area should episiotomy be done towards?

A

Ischioanal canal

288
Q

Which foramen does the pudendal nerve leave the pelvis through?

A

Greater sciatic foramen

289
Q

Path of pudendal nerve

A

Originates from sacral plexus
Leaves pelvis through greater sciatic foramen
Re-enters through lesser sciatic foramen
Travels in pudendal/Alcock’s canal

290
Q

What is Naegele’s rule?

A

Estimating a due date by adding 9 months 7 days to LMP

291
Q

What is placenta previa?

A

Low lying placenta covering all or part of the cervix

292
Q

Which two types of tissue is the placenta derived from

A

Trophoblast, decidual

293
Q

Which structure delivers oxygen-saturated blood to the foetus?

A

Umbilical vein

294
Q

What is the function of HCG?

A

Prevents involution of the corpus luteum

295
Q

Which placental hormone can result in maternal hyperthyroidism?

A

HC thyrotropin

296
Q

How much does cardiac output increase during pregnancy?

A

30-50%

297
Q

When does cardiac output decrease in pregnancy?

A

Last 8 weeks

298
Q

How much does plasma volume increase in pregnancy?

A

Around 50%

299
Q

How much does erythropoiesis increase in pregnancy?

A

25%

300
Q

Why do CO2 levels decrease in pregnancy?

A

Progesterone increases CO2 sensitivity in respiratory centres

301
Q

How much does oxygen consumption increase in pregnancy?

A

20%

302
Q

Which lung volume remains normal throughout pregnancy?

A

Vital capacity

303
Q

How much does GFR increase in pregnancy?

A

30-50%

304
Q

Changes in anabolic phase of pregnancy

A

Normal/increased insulin sensitivity, lower glucose level, increase lipogenesis

305
Q

Changes in catabolic phase of pregnancy

A

Insulin resistance, increased transport of nutrients, lipolysis

306
Q

Which hormones cause insulin resistance in late pregnancy?

A

Cortisol, growth hormone

307
Q

How does progesterone impact uterine contractility?

A

Inhibits it

308
Q

How does oestrogen impact uterine contractility?

A

Increases it

309
Q

Which gland release oxytocin?

A

Posterior pituitary

310
Q

Release of which hormone is stimulated by stretching of the cervix?

A

Oxytocin

311
Q

Which hormones are involved in development of the breasts in pregnancy?

A

Oestrogen - growth of ductile system

Progesterone - development of lobule-alveolar system

312
Q

Anterior wall of inguinal canal

A

External oblique

313
Q

Posterior wall of inguinal canal

A

Conjoint tendon medially, transversalis fascia laterally

314
Q

Roof of inguinal canal

A

Internal oblique and transversus abdominis

315
Q

Floor of inguinal canal

A

Inguinal ligament

316
Q

What is considered extreme preterm?

A

24 - 27+6 weeks

317
Q

What is considered very preterm?

A

28 - 31+6 weeks

318
Q

What is considered moderate to late preterm?

A

32 - 36+6 weeks

319
Q

What proportion of preterm births are planned C-sections?

A

25%

320
Q

What is a low birth weight?

A

<2.5kg

321
Q

What is considered large for dates?

A

Symphyseal-fundal height 2cm greater than expected

322
Q

Diagnostic criteria of polyhydramnios

A

Amniotic fluid index >25cm, deepest pool >8cm

323
Q

When does the fertilised ovum split to form DCDA twins?

A

Days 1-3

324
Q

When does the fertilised ovum split to form MCDA twins?

A

Days 4-8

325
Q

When does the fertilised ovum split to form MCMA twins?

A

Days 8-13

326
Q

When does the fertilised ovum split to form conjoined twins?

A

Days 13-15

327
Q

When should MCMA twins be delivered?

A

C-section 32-34 weeks

328
Q

Management of pre-existing diabetes in pregnancy

A

HbA1c aim below 48. Low dose aspirin from 12 weeks, 5mg folic acid. Growth scans 4 weekly from 28 weeks.

329
Q

Diagnosis of gestational diabetes

A

Fasting >=5.1 or 2 hour >=8.5

330
Q

C-section should be used if foetal weight above _

A

4.5kg

331
Q

Most common cancer in women under 35

A

Cervical

332
Q

How often should women have cervical cancer screening?

A

3 yearly age 25-49

5 yearly age 50-64

333
Q

How is coverage of a screening programme calculated?

A

(screened population/eligible population) x 100

334
Q

How is uptake of a screening programme calculated?

A

(screened population/invited population) x 100

335
Q

What type of joint are the sacro-iliac joints?

A

Synovial

336
Q

What is Klumpke’s palsy?

A

Injury to the lower trunk of the brachial plexus (C8, T1) during birth, resulting in loss of function of small muscles of the hand and sensory loss of the medial aspect of the upper limb

337
Q

What is Erb’s palsy?

A

Injury to upper trunk of brachial plexus (C5, 6) during birth, resulting in arm adducted and internally rotated at shoulder and elbow extended and pronated, with sensory loss to lateral aspect.

338
Q

What is the nerve supply of the anterior labia?

A

L1 via ilioinguinal nerve

339
Q

What is the nerve supply of the posterior labia?

A

S2,3,4 via pudendal nerve

340
Q

At what gestation can nuchal translucency be assessed?

A

11-14 weeks

341
Q

Normal nuchal translucency

A

<3.5mm

342
Q

Causes of increased nuchal translucency

A

T12/18/21, Turner’s, triploidy, cardiac defects

343
Q

Why do conditions such as gastroschisis and spina bifida result in increased maternal alpha feto protein?

A

Exposure of internal organs to surface makes foetal circulation in closer contact with amniotic fluid

344
Q

Why is hydralazine used in pre-eclampsia?

A

It is a vasodilator, so reduces BP, and acts quickly. Given during labour

345
Q

Why is magnesium sulphate used in pre-eclampsia?

A

Decreases calcium uptake by smooth muscles, preventing fits and lowering BP

346
Q

Dose of anti-D when given before 20 weeks

A

250iu

347
Q

Dose of anti-D when given after 20 weeks

A

500iu

348
Q

Attachments of external oblique

A

Lower ribs

Iliac crest, pubic tubercle, linea alba

349
Q

Attachments of internal oblique

A

Lower ribs and thoracolumbar fascia

Iliac crest, linea alba

350
Q

Attachments of transversus abdominis

A

Lower ribs and thoracolumbar fascia

Iliac crest, linea alba

351
Q

Nerve supply to anterolateral abdominal wall

A

Thoracoabdominal nerves from 7-11 intercostal
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)

352
Q

Where do the nerves of the anterolateral abdominal wall lie?

A

Enter from lateral aspect and run between internal oblique and transversus abdominis

353
Q

Blood supply to anterior abdominal wall

A

Superior and inferior epigastric arteries

354
Q

What is the Ferguson reflex?

A

The self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls

355
Q

Which substance causes cervix softening in labour?

A

Hyaluronic acid

356
Q

Which substance increases in cervical ripening?

A

Cervical decorin

357
Q

Which scoring system is used to determine if it is safe to induce labour?

A

Bishop score

358
Q

Stages of labour

A

1st stage: Latent phase up to 3-4cm, active phase up to 10cm
2nd stage: From 10cm to delivery of baby
3rd stage: placenta time

359
Q

Normal progress in active labour

A

1-2cm per hour

360
Q

When is the 2nd stage of labour considered prolonged?

A

For primiparous women, 2 hours, or 3 if using regional anaesthesia
For multiparous, 1 hour, or 2 if using regional anaesthesia

361
Q

How many contractions should occur in a 10 minute period?

A

Up to 3-4

362
Q

Cardinal movements of labour

A 
Engagement
Descent
Flexion
Internal rotation
Crowning and extension
Restitution and external rotation
Expulsion
363
Q

How often should vaginal examination be performed in normal labour?

A

4 hourly

364
Q

Normal blood loss in childbirth

A

<500ml

365
Q

Stages of lochia

A

3-4 days - rubra, red
Up to 14 days - serosa, brownish and watery
10-20 days, alba, yellow.

366
Q

What proportion of couples suffer from infertility?

A

1 in 6

367
Q

How long before ovulation does LH surge occur?

A

24-36 hours

368
Q

Which cells secrete testosterone?

A

Leydig

369
Q

Most common cause of maternal mortality

A

Cardiac disease

370
Q

Maternal mortality in the UK

A

9.8 per 100,000

371
Q

What type of acid-base disturbance occurs in pregnancy?

A

Respiratory alkalosis

372
Q

Why does functional residual capacity decrease in pregnancy?

A

Elevation of the diaphragm

373
Q

Where do most DVTs occur in pregnancy?

A

Left leg - specifically ileo-femoral

374
Q

Which anticoagulants are used in antenatal thromboprophylaxis?

A

LMWH - enoxaparin, dalteparin, tinzaparin.

375
Q

Teratogenic effects of sodium valproate

A

NTDs, facial cleft, hypospadias

376
Q

Teratogenic effects of phenobarbitol

A

Cardiac malformations

377
Q

What gestation is considered early pre-eclampsia?

A

<34 weeks

378
Q

Triad of signs in pre-eclampsia

A

Hypertension, proteinuria, oedema

379
Q

What is HELPP syndrome?

A

A variant of pre-eclampsia with high mortality - haemolysis, elevated liver enzymes, low platelets

380
Q

Risk factors for pre-eclampsia

A

Age >40, high BMI, family history, nulliparity, multiple pregnancy, previous PE, birth interval >10 years, molar pregnancy, pre-existing renal disease/hypertension, diabetes, connective tissue disease, thrombophilia

381
Q

Which condition can cause very early pre-eclampsia?

A

Molar pregnancy

382
Q

What sign on maternal uterine artery doppler can be predictive of pre-eclampsia?

A

Notch

383
Q

Second line antihypertensives in pregnancy

A

Doxazocin, hydralazine

384
Q

Which antihypertensives should be avoided in pregnancy?

A

Diuretics, ACE inhibitors

385
Q

Management of seizures in eclampsia

A

Mag sulphate - loading dose 4g IV over 5 minutes, maintenance 1g/hour.

386
Q

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

A

57%

387
Q

What percentage of LGB people have a mental health condition?

A

40%

388
Q

What percentage of LGB people have a mental health condition?What percentage of transgender people have a mental health condition?

A

What percentage of LGB people have a mental health condition?

389
Q

What dose is LNG-UC given in?

A

1.5mg

390
Q

When should the fundus be palpable in a normal singleton pregnancy?

A

12 weeks

391
Q

What proportion of maternal deaths are due to suicide?

A

1 in 7

392
Q

What percentage of female suicide occur up to 12 weeks postnatally?

A

Half

393
Q

When does baby blues occur?

A

Days 3-10

394
Q

When does puerperal psychosis occur?

A

Within 2 weeks of delivery

395
Q

When does postnatal depression occur?

A

2-6 weeks postnatally

396
Q

Which SSRI increases risk of foetal heart defects in the 1st trimester?

A

Paroxetine

397
Q

Which SSRIs should be avoided in breastfeeding?

A

Citalopram, doxepin

398
Q

What is the risk of benzodiazepine use in the 3rd trimester?

A

Floppy baby syndrome

399
Q

Why is clozapine avoided in pregnancy?

A

Risk of agranulocytosis

400
Q

When does the neural tube close?

A

Day 28

401
Q

Which drug increases the risk of fingernail hypoplasia if taken in pregnancy?

A

Carbamazepine

402
Q

Which drug increases risk of Stevens-Johnsons syndrome in breastfeeding infants?

A

Lamotrigine

403
Q

What is minor antepartum haemorrhage?

A

<50ml

404
Q

What is major antepartum haemorrhage?

A

50-1000ml without shock

405
Q

What is massive antepartum haemorrhage?

A

> 1000ml and/or shock

406
Q

Symptoms and signs of placental abruption

A

Severe continuous abdo pain, bleeding, preterm labour, maternal collapse, uterine tenderness, hard woody uterus

407
Q

Symptoms of placenta previa

A

Painless bleeding, high presenting part

408
Q

When is C-section required in placenta praevia?

A

If placenta covers os or is <2cm from it

409
Q

Which intrapartum complication can cause shoulder-tip pain?

A

Uterine rupture

410
Q

Symptoms of uterine rupture

A

Severe abdo pain, shoulder pain, maternal collapse, PV bleeding, loss of contractions, rising of the presenting part, peritonism, foetal distress

411
Q

Type I vs II vasa praevia

A

Type I - vessel connected to umbilical cord

Type II - vessel connects the placenta with succenturiate or accessory lobe

412
Q

What is minor PPH?

A

500-1000ml

413
Q

4 main causes of PPH

A

Tone, trauma, tissue, thrombin

414
Q

What is frank breech?

A

Butt first

415
Q

When should delay be suspected in the 1st stage of labour?

A

<2cm in 4 hours

416
Q

Normal foetal heart rate

A

110-150

417
Q

Normal foetal heart rate variability

A

5-25bpm

418
Q

Normal pH in foetal blood sampling

A

> 7.25

419
Q

Layers of pelvic floor

A 
(Deep)
Pelvic diaphragm
Fascia
Deep perineal pouch
Perineal membrane
Superficial perineal pouch
420
Q

How does mirabegron act in incontinence?

A

B3 adrenoreceptor agonist - relaxes detrusor, inhibiting spontaneous contractions and increasing voiding interval

421
Q

Stage I pelvic organ prolapse

A

1cm above hymen

422
Q

Stage II pelvic organ prolapse

A

-1 and +1 in relation to hymen

423
Q

Stage III pelvic organ prolapse

A

> 1cm beyond hymen

424
Q

Stage IV pelvic organ prolapse

A

Complete vaginal eversion

425
Q

Which structure lies along the posterolateral border of each testis?

A

Epididymis

426
Q

What is the tough fibrous capsule around each testis called?

A

Tunica albuginea

427
Q

What is the double layer of peritoneum that encloses the testis and epididymis called?

A

Tunica vaginalis

428
Q

Where does fluid collect in hydrocele?

A

Between the two layers of the tunica vaginalis

429
Q

Where is the vas in relation to the epididymis?

A

Medial

430
Q

Arterial supply of the prostate

A

Branches of the inferior vesical artery

431
Q

What level do the testicular/ovarian arteries arise from the aorta?

A

L2

432
Q

When does the fundus of the uterus reach the umbilicus in pregnancy?

A

Around 20 weeks

433
Q

When does the fundus of the uterus reach the xiphisternum in pregnancy?

A

36 weeks

434
Q

Which structure is the ligamentum teres the remnant of?

A

Ductus venosus

435
Q

When is physiological anaemia in newborns at its peak?

A

8-10 weeks

436
Q

How much vitamin D should breast fed babies be given?

A

8.5-10ug

437
Q

How does breastmilk change throughout a feed?

A

Initially high in water, sugars, and protein; later, fat and calorie content rise

438
Q

How much weight do breast-fed babies lose in the first few days?

A

Up to 10%

439
Q

Good breastfeeding latch

A 
Nose not digging in
Areola visible more above top lip
Cheeks full and rounded
Large mouthful of breast
Chin indenting breast
440
Q

How long can leftover formula be kept?

A

2 hours

441
Q

Average formula intake in first 6 months

A

150ml/kg/day

442
Q

which types of formula are approved by European Commission regulations?

A

Cow’s milk, goat’s milk, and soy based formula

443
Q

Normal body fat percentage at birth

A

15%

444
Q

What Apgar score is considered normal?

A

8 or above

445
Q

Teratogenic effects of ACE inhibitors

A

Renal hypoplasia

446
Q

Teratogenic effects of lithium

A

Cardiovascular defects

447
Q

Teratogenic effects of methotrexate

A

Skeletal defects

448
Q

Teratogenic effects of retinoids

A

Ear, cardiovascular, skeletal defects

449
Q

Which drug previously used to prevent recurrent miscarriage has been associated with vaginal and urological malignancies?

A

Diethylstilbestrol

450
Q

Which diabetic drugs are unsafe in pregnancy?

A

Sulfonylureas

451
Q

Safest drug for N+V in pregnancy

A

Cyclizine

452
Q

Which cardiac drug can cause neonatal hypothyroidism if used in breastfeeding?

A

Amiodarone

453
Q

Normal RR in newborn

A

40-60

454
Q

Normal HR in newborn

A

120-150

455
Q

Potter sequence

A

Clubbed feet, pulmonary hypoplasia, cranial anomalies

456
Q

What % of babies are preterm?

A

6-7%

457
Q

Most common causes of preterm birth

A

Spontaneous preterm labour
Premature rupture of membranes
Multiple pregnancy
Hypertension

458
Q

What is classified as early neonatal sepsis?

A

First 72 hours

459
Q

Common organisms in early neonatal sepsis

A

Group B strep, gram negatives

460
Q

Common organisms in late neonatal sepsis

A

Coagulase negative staph, staph aureus, gram negatives

461
Q

Treatment of patent ductus arteriosus

A

Indomethacin

462
Q

Prognosis of grade 1-2 intraventricular haemorrhage

A

Mortality 10%

Developmental delay 20%

463
Q

Prognosis of grade 3-4 intraventricular haemorrhage

A

Mortality 50%

Developmental delay 80%

464
Q

Cancer most attributable to obesity

A

Uterine

465
Q

Which type of vulvodynia is physio more effective for?

A

Provoked

466
Q

When can chorionic villous sampling be performed?

A

From 11 weeks

467
Q

When can amniocentesis be performed?

A

From 15-16 weeks

468
Q

Which method of genetic analysis is used to screen from chromosomal deletions and duplications?

A

Array comparative genomic hybridisation

469
Q

Which type of pessary is ideal as an initial trial?

A

Ring

470
Q

Which types of pessary may fall out easily?

A

Ring, gelhorn

471
Q

Which types of pessary interfere with sex?

A

Shelf, gelhorn

472
Q

Which type of pessary has a high risk of ulceration?

A

Shelf

473
Q

Which chromosome is responsible for change in Hb composition after birth?

A

11

474
Q

When should you suspect pathological jaundice in a newborn?

A

Jaundice occurring within 24 hours of birth

475
Q

Symptoms of kernicterus

A

Decreased awareness, hypotonia.

Later - hearing loss, CP, twitching, eye movement abnormalities, poor feeding

476
Q

Treatment of neonatal sepsis

A

Benzylpenicillin, gentamicin

477
Q

Normal temp for newborn

A

36.6-37.5

478
Q

Management of neonatal abstinence syndrome

A

Replacement

Phenylbarbitone for sedative effect

479
Q

Which artery does the superior rectal arise from?

A

Inferior mesenteric

480
Q

Which structure is the medial umbilical ligament a remnant of?

A

Umbilical artery

481
Q

Which structure is the median umbilical fold the remnant of?

A

Urachus

482
Q

What is the female equivalent of the inferior vesical artery?

A

Vaginal artery

483
Q

Which artery does the anterior scrotal arise from?

A

External iliac

484
Q

Which ureter is more commonly damaged in pelvic surgery?

A

Left

485
Q

Which nodes do superior pelvic viscera drain to?

A

External iliac

486
Q

Which nodes do inferior pelvic viscera drain to?

A

Internal iliac

487
Q

Which nodes does the superficial perineum drain to?

A

Superficial inguinal

488
Q

Where do cervical polyps mostly occur?

A

Endocervix

489
Q

How long does it take for HPV to cause high grade CIN?

A

6 months - 3 years

490
Q

How long does high grade CIN take to develop into invasive cancer?

A

5-20 years

491
Q

Histological abnormalities in CIN

A

Koilocytosis, hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism, mitotic figure

492
Q

What proportion of cervical cancer is squamous carcinoma?

A

75-95%

493
Q

Stage 2 cervical cancer

A

Spread to adjacent organs

494
Q

Stage 3 cervical cancer

A

Involvement of pelvic wall

495
Q

Stage 4 cervical cancer

A

Distant metastases or involvement of rectum or bladder

496
Q

Origin of CIN and CGIN

A

CIN - transformation zone

CGIN - endocervical epithelium

497
Q

Which HPV type is associated with adenocarcinoma?

A

18

498
Q

Major prognostic factor in vulvar invasive squamous carcinoma

A

Inguinal node spread

499
Q

Early menopause

A

<45 years

500
Q

Premature menopause

A

<40 years

501
Q

Late menopause

A

> 54 years

502
Q

Benefits of HRT

A

Improved QOL
Reduced osteoporotic fracture
Reduced bowel cancer
Possible protection against Alzheimer’s and Parkinson’s

503
Q

Non-HRT medical options in menopause

A

Clonidine, SSRI, vaginal moisturisers

504
Q

Which type of HRT increases breast cancer risk?

A

Combined

505
Q

Which type of HRT does not increase VTE or CVA?

A

Transdermal

506
Q

What is the precursor of endometrioid carcinoma?

A

Atypical hyperplasia

507
Q

Which type of endometrial hyperplasia affects both glands and stroma?

A

Simple

508
Q

What is the precursor of serous endometrial carcinoma?

A

Serous intraepithelial carcinoma

509
Q

Type 1 endometrial carcinomas

A

Endometrioid, mucinous

510
Q

Type 2 endometrial carcinomas

A

Serous, clear cell

511
Q

Which type of endometrial carcinoma is associated with unopposed oestrogen?

A

Type 1 (endometrioid, mucinous)

512
Q

Which type of endometrial carcinoma is associated with TP53 mutations?

A

Type 2 (serous, clear cell)

513
Q

Inheritance of Lynch syndrome

A

Autosomal dominant

514
Q

Stage 2 endometrioid carcinoma

A

Invasion of cervical stroma

515
Q

Stage 3 endometrioid carcinoma

A

Local or regional tumour spread

516
Q

Stage 4 endometrioid carcinoma

A

Invasion of bladder, bowel, or distant metastases

517
Q

Which type of uterine cancer has both epithelial and stromal elements?

A

Carcinosarcoma

518
Q

Which uterine tumour has a spindle cell morphology?

A

Leiomyosarcoma

519
Q

Which ethnicity are fibroids most common in?

A

Afro-Caribbean

520
Q

Which tumours of the ovary secrete oestrogens?

A

Granulosa cell

521
Q

Which tumours of the ovary secrete androgens?

A

Theca and Leydig cell

522
Q

What is Meig’s syndrome?

A

Triad of benign ovarian tumour with ascites and pleural effusion, most commonly due to fibroma

523
Q

Which ovarian tumours can cause thyrotoxicosis?

A

Dermoid cysts/benign cystic teratomas

524
Q

Genetic causes of ovarian cancer

A

BRCA1/2, Lynch syndrome

525
Q

Risk factors for ovarian cancer

A

Age
Nulliparity
Family history

526
Q

Tumour markers for ovarian cancer

A 
CA125
Carcinoembryonic antigen (CEA)
527
Q

What is a borderline epithelial ovarian tumour?

A

Has cytological abnormalities but no stromal invasion

528
Q

Which ovarian cancers are associated with endometriosis?

A

Endometrioid, clear cell

529
Q

Which tissue do Brenner tumours of the ovary arise from?

A

Transitional epithelium

530
Q

Most common site of ectopic pregnancy

A

Fallopian tube

531
Q

Main chemo agents used in ovarian cancer

A

Carboplatin, paclitaxel

532
Q

Which drugs are a promising upcoming treatment for BRCA-related ovarian cancer?

A

PARP inhibitors

533
Q

What type of fibroids cause back pain?

A

Subserosal

534
Q

Three biopsy features of endometriosis

A

Endometrial glands
Endometrial stroma
Haemosiderin-laden macrophages

535
Q

First line treatment for lichen sclerosus

A

Topical steroids

536
Q

Second line treatment for lichen sclerosus

A

Tacrolimus

537
Q

Where is the obturator nerve in relation to the ovary?

A

Lateral

538
Q

Where are the internal iliac vessels in relation to the ovary?

A

Posterior

539
Q

Attachments of coccygeus

A

Proximal - ischial spine

Distal - sacrum and coccyx

540
Q

Attachments of puborectalis

A

Proximal - body of pubis

Distal - perineal body

541
Q

Attachments of pubococcygeus

A

Proximal - pubic bone, tendinous arch of obturator

Distal - vagina, perineal body, rectum, coccyx

542
Q

Attachments of iliococcygeus

A

Proximal - ischial spine

Distal - perineal body, coccyx

543
Q

Path from lobule of breast to nipple

A 
Terminal ductules ->
Intralobular collecting duct ->
Lactiferous duct
->
Lactiferous sinus
544
Q

Epithelium of the nipple

A

Keratinised stratified squamous

545
Q

Changes in breast in luteal phase

A

Epithelial cells increase in height

Lumina of ducts enlarged

546
Q

Triple assessment in breast disease

A

Clinical history and exam
Imaging
Pathology

547
Q

Risk of breast cancer for BRCA carriers

A

45-65%

548
Q

Most common type of breast cancer

A

Ductal carcinoma

549
Q

HER2 status predicts breast cancer response to which treatment?

A

Trastuzamab/herceptin

550
Q

How do different receptors affect breast cancer prognosis?

A

ER pos and PgR pos improve prognosis

HER2 pos poorer prognosis

551
Q

Which breast cancer spreads with a histologic Indian file pattern?

A

Invasive lobular carcinoma

552
Q

Most common cause of spontaneous nipple discharge

A

Intraductal papilloma

553
Q

What is Mondor’s disease?

A

Phelibitis and clot formation in the superficial veins of the breast, presenting as a firm, vertical cord-like structure. Associated with trauma, usually self-resolving

554
Q

Standard chemo for breast cancer

A

FEC100 and taxane

555
Q

Aromatase inhibitors used in breast cancer

A

Letrozole, anastrozole

556
Q

Which drug is used to help with tamoxifen side effects?

A

Clonidine

557
Q

Which type of breast cancer is associated with CNS metastasis?

A

HER2 pos

558
Q

Which drug is used for bony mets in breast cancer?

A

Bisphosphonates such as ibandronic acid

559
Q

Level of the nipple in young women

A

4th intercostal

560
Q

When should women start getting mammograms?

A

50

561
Q

Lymph drainage of the ovary

A

Para-aortic nodes

562
Q

Lymph drainage of the uterus

A

Fundus - para-aortic

Body and cervix - sacral and iliac, mostly external iliac

563
Q

Which gland release oxytocin?

A

Posterior pituitary

564
Q

Which glands release prolactin?

A

Anterior pituitary

565
Q

Muscarinic antagonists used in urge incontinence

A

Tolterodine
Oxybutynin
Solifenacin

3rd year (6 decks)

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