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Reproduction > Week 1 - Core clinical problems > Flashcards

Week 1 - Core clinical problems Flashcards

1
Q

Before starting assisted conception treatment, what lifestyle advice would you give your patient?

A 
Limit alcohol intake to 4 units per week 
Weight -  19-29 BMI 
Stop smoking 
Folic acid - 0.4mg day 
Go for a cervical smear
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2
Q

What are the indications for Intra-uterine insemination? (IUI)

A

Couple have sexual problems

Same sex relationships

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3
Q

What are the indications for In Vitro-Fertilisation? (IVF)

A

Couple have been trying for >2 years
Pelvic disease
Failed IUI

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4
Q

Give the overview steps of IVF

A 
Down regulation
Ovarian Stimulation 
Semen retrieval 
Oocyte retrieval 
Fertilisation 
Embryo transfer 
Luteal Support
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5
Q

What are the indications for Intra-cytoplasmic sperm injection

A

Severe male factor infertility

Previous failed IVF

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6
Q

Name 3 potential complications of assisted conception treatment

A

Over-stimulating the ovaries (leads to lots of yuck symptoms such as N&V)
Multiple pregnancies
Ectopic pregnancy

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7
Q

What 2 hormones do the male testes secrete?

A

Testosterone and Mullerian Inhibiting Factor

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8
Q

Name 2 genital tracts and whether they belong in males or females

A

Wolffian ducts - males

Mullerian ducts - females

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9
Q

Medical term for undescended testes?

A

Cryptorchidism

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10
Q

Treatment of cryptorchidism?

A

<14 years - Orchidopexy

Adults - Orchidectomy

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11
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

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12
Q

Where is testosterone produced?

A

Leydig cells

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13
Q

Role of Sertoli cells?

A

Basically - ASSISTS in spermatogenesis:

Form a blood testes barrier - protects the sperm from antibody attack

Provides nutrients for developing cells

Produces seminiferous tubule fluid

Secretes androgen binding globulin - binds to testosterone

Secrete inhibin and activin hormones - they regulate FSH which enhances spermatogenesis

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14
Q

Causes of Male Infertility

A

Idiopathic

Obstructive (vasectomy, cystic fibrosis)

Non-obstructive - endocrine (pituitary tumours), infection, Kleinfelder’s syndrome, genetic, anorexia

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15
Q

How would you go about assessing male infertility?

A

History, Examination, Semen analysis, Endocrine profile (LH, FSH, TSH etc)

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16
Q

Would the endocrine profile be abnormal or normal in:

a) obstructive
b) non-obstructive

A

a) Normal

b) Abnormal (high LH/FSH, low testosterone)

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17
Q

Name a bacteria that you would EXPECT to find in normal vaginal flora

A

Lactobacillus spp.

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18
Q

Symptoms of bacterial vaginosis

A

Discharge containing bubbles

Fishy odour

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19
Q

What infections of the vagina are NOT STIs

A

Bacterial vaginosis and Candida Albicans

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20
Q

Woman comes in complaining of an intense itch alongside white discharge which looks pussy/cheesy in appearance

A

Candida Infection (most common form = candida albicans)

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21
Q

Where in the body can both gonorrhoea and chlamydia affect?

A

Urethra, rectum, throat, eyes, endocervix

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22
Q

Symptoms of gonorrhoea

A

Discharge + Pain on urination

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23
Q

Symptoms of chlamydia

A

pain or burning while peeing.
pain during sex.
lower abdo pain
abnormal vaginal discharge (may be yellowish and have a strong smell)
bleeding between periods.
pus or a watery/milky discharge from the penis.
swollen or tender testicles

24
Q

What does gonorrhoea look like on gram stain?

A

2 kidney beans (diplococci)

25
Q

What does chlamydia look like on gram stain?

A

HA, trick question.

It does not gram stain due to it having no peptidoglycan in its cell wall

26
Q

How do you diagnose Gonorrhoea and Chlamydia - what tests and what samples in:

a) Males
b) Females

A

NAATs
PCR

a) Males - first pass urine
b) Females - high vaginal swab or Vulvo-vaginal swab (can be self taken)

27
Q

Advantage of using culture as your diagnostic test

A

Can test antibody sensitivities

Can track antibody resistance

28
Q

What 2 STIs are MSM most at risk of?

A

HIV - most common group

Gonorrhoea - MSM are also more likely to have gonorrhoea just isolated to the pharynx or rectum compared to other groups

29
Q

What is proctitis? And when is it seen?

A

Inflammation of the lining of the rectum
Can occur in gonorrhoea & other STIs - herpes, syphilis, chlamydia
It can also occur in non-STI situations such as Crohn’s, anal fissures, rectal lacerations, UTIs (esp if elderly)

30
Q

Patient presents with proctitis, tenesmus and blood, what could this be?

A

Lymphogranuloma Venereum

31
Q

At what stage does a chancre appear in syphilis

A

Primary stage

32
Q

What happens in the secondary stage of syphilis?

A

Bacteriuria
Snail track mouth ulcers
Generalised rash
Flu like symptoms

33
Q

Screening test for syphilis?

A

Dark ground microscopy - look for spirochetes
Enzyme linked immunosorbent assay (ELISA) - IgG & IgM
Swab lesions for PCR

34
Q

Tests to monitor response to syphilis medication?

A

VDLR

RPR

35
Q

Transmission of herpes

A

Genital-Genital

Oropharyngeal-genital

36
Q

What is herpes caused by?

A

Herpes simplex virus type 1 & 2

37
Q

Where does the herpes simplex virus ‘hide’ from the immune system?

A

Sacral root ganglion

38
Q

Diagnosis of Herpes?

A

PCR

39
Q

How is trichomonas vaginalis transmitted?

A

Sexual contact

40
Q

Symptoms of trichomonas vaginalis:

Males and Females

A

Females - Vaginal discharge & Irritation

Urethritis in males

41
Q

Name a few causes for bleeding in early pregnancy

A 
Implantation problems 
Miscarriage 
Chronic haematoma
Ectopic pregnancy 
Cervical or vaginal causes - infection, malignancy, polyp
42
Q

What substance do you need to administer to the women after a miscarriage?

A

Anti-D

43
Q

Give reasons for a women having recurrent miscarriages

A

Antiphospholipid syndrome
Thrombophilia
Uterine abnormality
Age

44
Q

By taking what drug, is said to lower the chances of women having a miscarriage?

A

Progesterone

45
Q

How do the symptoms of a miscarriage compare to that of an ectopic pregnancy?

A

Miscarriage - LOTs more bleeding. Pain is cramp like

Ectopic - PAIN > bleeding. Includes heart & lung symptoms such as dizziness, SOB

46
Q

What investigations do you perform for both miscarriage and ectopic

A

FBC, G&S, betaHCG, USS

47
Q

Management of ectopic pregnancy

A

Medical - if women is stable, low betaHCG . Give Methotrexate

48
Q

How does a chronic haematoma form?

A

Due to separation of the embryo from the endometrium and a layer of blood forms in between

49
Q

End result of a haematoma

A

Some may be resolve

Others can result in a miscarriage

50
Q

Organic causes of menorrhagia

A

Local - polyps, fibroids, malignancy, pelvic inflammatory disease
Systemic - Endocrine disorder, Von Willebrand’s disease
Pregnancy - Miscarriage, Ectopic etc

51
Q

Non-organic causes of menorrhagia

A

Dysfunctional uterine bleeding

52
Q

Investigations of Dysfunctional uterine bleeding

A 
FBC 
Cervical smear 
TSH, Coagulation screen, Renal/Liver function tests - to rule out any organic causes of menorrhagia  
Transvaginal ultrasound scan 
Endometrial sampling - pipelle biopsies
53
Q

Management of DUB (Medical & Surgical)

A

Medical - Progesterone, COP, GnRH analogues, NSAIDs, Anti-fibrinolytics, Danazol
Surgical - Endometrial resection (more minor procedure) or Hysterectomy (more major procedure)

54
Q

Common causative organisms of BV ?

A

Anaerobes such as:

Gardnerella

55
Q

Risk factors of getting candida?

A

Recent antibiotic therapy
High oestrogen levels (e.g. during pregnancy)
Poorly controlled diabetes
Immunocompromised

Reproduction (15 decks)

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