Week 2 - Core Clinical Problems

Question 1

Criteria for Lactational amenorrhoea

Answer 1

Exclusively breast feeding
Less than 6/12 post natal
Amenorrhoeic

Question 2

What effect does oestrogen have on the hypothalamus

Answer 2

Inhibits Gonadotropic Releasing Hormone

Question 3

What substance inhibits release of FSH and LH

Answer 3

Progesterone

Question 4

What risk factors do you need to be aware of before prescribing contraception

Answer 4

CV disease
Breast cancer
Osteoporosis

Question 5

Before prescribing CHC, what should you do?

Answer 5

Take a history
BP & BMI
Check smear status

Question 6

Legal limit for TOP

Answer 6

24 weeks

Question 7

Legal limit for TOP for a foetus with an abnormality

Answer 7

Any time

Question 8

Limits for TOP in Tayside

Answer 8

Surgical termination = 12 weeks

Medical termination = 19 weeks

Question 9

What are the 2 types of surgical TOP and what are the timescale limits?

Answer 9

Vacuum aspiration: 6-12 weeks

Dilatation and evacuation: 13-24 weeks

Question 10

What should you give the patient 72 hrs after the TOP (medical and other)?

Answer 10

Anti-D
Counselling
Contraception - DON’T GIVE PROGESTERONE DEPO INJECTION (as it reverses the effects of mifepristone)

Question 11

What receptor sites does the HIV target?

Answer 11

CD4+

Question 12

When testing for HIV what markers are you looking for?

Answer 12

Early stages - viral RNA and surface antigen (p24) will be raised
In the late stages (i.e. chronic disease) - antibodies against HIV will be raised

Question 13

Give a good HIV test for an early infection

Answer 13

RITA

Question 14

Give an advantage & disadvantage for the POCT HIV test

Answer 14

Adv - Simple (just a fingerprick specimen needed)

Disad - Not reliable in early infection stage

Question 15

HIV Treatment

Answer 15

HAART - Highly active anti-retroviral therapy) = A combo of 3 drugs from at least 2 drug classes
3 drugs can include; Tenofovir, Emtricitabine, Efavirenz

Question 16

What are the 3 targets for HIV drugs

Answer 16

Reverse transcriptase
Protease
Integrase

i.e. the drugs given are reverse transcriptase inhibitors or protease inhibitors etc

Question 17

How to prevent transmission of HIV to a sexual partner or to the affected mothers baby?

Answer 17

PrEP = Pre-exposure Prophylaxis

It comes in the form of a pill called Truvada - contains tenofovir & emtricitabine

Question 18

What is recommended for women to take prior to & during pregnancy?

Answer 18

Folic acid - 400ug pre-conception & 1st trimester
Vit D - 10ug throughout pregnancy & breastfeeding
Vit c - 70mg during pregnancy
Iron

Question 19

What should pregnant women avoid?

Answer 19

Alcohol
Vit A
Too many calories (only need extra 300 calories in 3rd trimester)
Dodgy foods - soft cheese, undercooked meats, partially cooked eggs etc

Question 20

By taking folic acid during pregnancy, what can be avoided?

Answer 20

Neural tube defects

Question 21

What vaccines are given to MSM?

Answer 21

Hep A/ Hep B/ HPV

Question 22

If someone has had sex with an HIV +ve person, what can they be given? (and in what time frame?)

Answer 22

Can have PEPSE - like a morning after pill for HIV 
Give HAART (3 antiretroviral) within 72 hrs

Question 23

If someone has had sex with Hep B +ve person, what can they be given? (and in what time frame?)

Answer 23

HPV vaccine (taken 7 days after)

Question 24

What method is used to look at in utero DNA?

Answer 24

Array CGH (aCGH)

Question 25

What is trisomy 14

Answer 25

miscarriage

Question 26

What does aneuploidy mean?

Answer 26

Too many or too few chromosomes

Question 27

What is robertsonian translocation?

Answer 27

Two acrocentric chromosomes (i.e. 2 different chromosomes) stuck end to end

Question 28

what type of translocation will array CGH pick up on - Balanced or Unbalanced?

Answer 28

Unbalanced.

Question 29

What type of infections are HIV people most likely to get?

Answer 29

Recurrnet bacterial pneumonia
Pneumocystis pneumonia
Cerebral toxoplasmosis