Week 1 - Core clinical problems Flashcards
Before starting assisted conception treatment, what lifestyle advice would you give your patient?
Limit alcohol intake to 4 units per week Weight - 19-29 BMI Stop smoking Folic acid - 0.4mg day Go for a cervical smear
What are the indications for Intra-uterine insemination? (IUI)
Couple have sexual problems
Same sex relationships
What are the indications for In Vitro-Fertilisation? (IVF)
Couple have been trying for >2 years
Pelvic disease
Failed IUI
Give the overview steps of IVF
Down regulation Ovarian Stimulation Semen retrieval Oocyte retrieval Fertilisation Embryo transfer Luteal Support
What are the indications for Intra-cytoplasmic sperm injection
Severe male factor infertility
Previous failed IVF
Name 3 potential complications of assisted conception treatment
Over-stimulating the ovaries (leads to lots of yuck symptoms such as N&V)
Multiple pregnancies
Ectopic pregnancy
What 2 hormones do the male testes secrete?
Testosterone and Mullerian Inhibiting Factor
Name 2 genital tracts and whether they belong in males or females
Wolffian ducts - males
Mullerian ducts - females
Medical term for undescended testes?
Cryptorchidism
Treatment of cryptorchidism?
<14 years - Orchidopexy
Adults - Orchidectomy
Where does spermatogenesis occur?
Seminiferous tubules
Where is testosterone produced?
Leydig cells
Role of Sertoli cells?
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
Causes of Male Infertility
Idiopathic
Obstructive (vasectomy, cystic fibrosis)
Non-obstructive - endocrine (pituitary tumours), infection, Kleinfelder’s syndrome, genetic, anorexia
How would you go about assessing male infertility?
History, Examination, Semen analysis, Endocrine profile (LH, FSH, TSH etc)
Would the endocrine profile be abnormal or normal in:
a) obstructive
b) non-obstructive
a) Normal
b) Abnormal (high LH/FSH, low testosterone)
Name a bacteria that you would EXPECT to find in normal vaginal flora
Lactobacillus spp.
Symptoms of bacterial vaginosis
Discharge containing bubbles
Fishy odour
What infections of the vagina are NOT STIs
Bacterial vaginosis and Candida Albicans
Woman comes in complaining of an intense itch alongside white discharge which looks pussy/cheesy in appearance
Candida Infection (most common form = candida albicans)
Where in the body can both gonorrhoea and chlamydia affect?
Urethra, rectum, throat, eyes, endocervix
Symptoms of gonorrhoea
Discharge + Pain on urination
Symptoms of chlamydia
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
What does gonorrhoea look like on gram stain?
2 kidney beans (diplococci)
What does chlamydia look like on gram stain?
HA, trick question.
It does not gram stain due to it having no peptidoglycan in its cell wall
How do you diagnose Gonorrhoea and Chlamydia - what tests and what samples in:
a) Males
b) Females
NAATs
PCR
a) Males - first pass urine
b) Females - high vaginal swab or Vulvo-vaginal swab (can be self taken)
Advantage of using culture as your diagnostic test
Can test antibody sensitivities
Can track antibody resistance
What 2 STIs are MSM most at risk of?
HIV - most common group
Gonorrhoea - MSM are also more likely to have gonorrhoea just isolated to the pharynx or rectum compared to other groups
What is proctitis? And when is it seen?
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)
Patient presents with proctitis, tenesmus and blood, what could this be?
Lymphogranuloma Venereum
At what stage does a chancre appear in syphilis
Primary stage
What happens in the secondary stage of syphilis?
Bacteriuria
Snail track mouth ulcers
Generalised rash
Flu like symptoms
Screening test for syphilis?
Dark ground microscopy - look for spirochetes
Enzyme linked immunosorbent assay (ELISA) - IgG & IgM
Swab lesions for PCR
Tests to monitor response to syphilis medication?
VDLR
RPR
Transmission of herpes
Genital-Genital
Oropharyngeal-genital
What is herpes caused by?
Herpes simplex virus type 1 & 2
Where does the herpes simplex virus ‘hide’ from the immune system?
Sacral root ganglion
Diagnosis of Herpes?
PCR
How is trichomonas vaginalis transmitted?
Sexual contact
Symptoms of trichomonas vaginalis:
Males and Females
Females - Vaginal discharge & Irritation
Urethritis in males
Name a few causes for bleeding in early pregnancy
Implantation problems Miscarriage Chronic haematoma Ectopic pregnancy Cervical or vaginal causes - infection, malignancy, polyp
What substance do you need to administer to the women after a miscarriage?
Anti-D
Give reasons for a women having recurrent miscarriages
Antiphospholipid syndrome
Thrombophilia
Uterine abnormality
Age
By taking what drug, is said to lower the chances of women having a miscarriage?
Progesterone
How do the symptoms of a miscarriage compare to that of an ectopic pregnancy?
Miscarriage - LOTs more bleeding. Pain is cramp like
Ectopic - PAIN > bleeding. Includes heart & lung symptoms such as dizziness, SOB
What investigations do you perform for both miscarriage and ectopic
FBC, G&S, betaHCG, USS
Management of ectopic pregnancy
Medical - if women is stable, low betaHCG . Give Methotrexate
How does a chronic haematoma form?
Due to separation of the embryo from the endometrium and a layer of blood forms in between
End result of a haematoma
Some may be resolve
Others can result in a miscarriage
Organic causes of menorrhagia
Local - polyps, fibroids, malignancy, pelvic inflammatory disease
Systemic - Endocrine disorder, Von Willebrand’s disease
Pregnancy - Miscarriage, Ectopic etc
Non-organic causes of menorrhagia
Dysfunctional uterine bleeding
Investigations of Dysfunctional uterine bleeding
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
Management of DUB (Medical & Surgical)
Medical - Progesterone, COP, GnRH analogues, NSAIDs, Anti-fibrinolytics, Danazol
Surgical - Endometrial resection (more minor procedure) or Hysterectomy (more major procedure)
Common causative organisms of BV ?
Anaerobes such as:
Gardnerella
Risk factors of getting candida?
Recent antibiotic therapy
High oestrogen levels (e.g. during pregnancy)
Poorly controlled diabetes
Immunocompromised
