26/03

Question 1

layers of the scrotum

Answer 1

Some Damn Englishman Called It The Testes

S: skin
D: dartos fascia and muscle
E: external spermatic fascia
C: cremasteric fascia
I: internal spermatic fascia
T: tunica vaginalis
T: tunica albuginea

Question 2

Blood supply to fallopian tube

Answer 2

uterine (medial 2/3rd) (from internal iliac) + uterine plexus

ovarian arteries (lateral 1/3rd) (from aorta) + pampiniform plexus

Question 3

USS torsion

Answer 3

edema
peripheralization of follicles
pain when scanning over the adnexa

Doppler flow within a torsed ovary may be present (normal), decreased, or absent.

Question 4

Cardinal ligament

Answer 4

The female ureter, uterine artery, and inferior hypogastric (nervous) plexus course within the cardinal ligament.

Question 5

Broad ligament subdivisions

Answer 5

Mesometrium
Runs laterally
covers external iliac vessels and proximal part of the round ligament

Mesovarium
post surface of broad lig –> posterior surface of ovaries (but does not cover the surface of the ovary itself).

Mesosalpinx
superiorly to the mesovarium, enclosing the fallopian tubes.

Question 6

Contents of the broad ligament

Answer 6

uterus, fallopian tubes and ovaries

ovarian (in suspensory/infundo lig) and uterine (in cardinal lig) arteries

Question 7

3 ligs within the broad ligament

Answer 7

Ovarian ligament.
inf ovary –> side of uterus

Round ligament of uterus.
gubernaculum
uterine horns- lab maj

Suspensory ligament of ovary (also known as the infundibulopelvic ligament).
–> contains ovarian vessels

Question 8

Cardinal Ligaments

Answer 8

arise from the side of the cervix and the lateral fornix of the vagina —> lateral pelvic wall at the level of the ischial spines

Note: When a hysterectomy is being performed due to a malignancy, the cardinal ligaments are often removed as they are common reservoir of cancerous cells.

Question 8

Which ligaments play a part in pelvic organ prolapse?

Answer 8

cardinal and uterosacral ligaments

Question 9

Neisseria

Answer 9

• nonmotile
• non-sporeforming
• Gram NEG diplococci with adjacent sides flattened. The KIDNEY-shaped concave sides face each other.

OXIDASE (+)
- possess cytochrome C
- will oxidize dimethyl- or tetramethyl-paraphenylenediamine → purple (oxidase test)

CATALASE (+)
- catalyzes decomposition of H₂O₂ → H₂O + O₂
- bubbles are rapidly formed.

Present as normal flora: N. lactamica, N. sicca, N. flavescens, N. mucosa, and N. subflava.

Two pathogenic species:
1. N. gonorrhoeae (gonococcus)
→ gonorrhea
2. N. meningitidis (meningococcus)
→meningitis and septicemia

N. meningitidis:
- capsule= virulence factor

Some N. gonorrhoeae possess a loosely associated capsule or slime layer

**NATURAL COMPETENCY—take up free DNA by TRANSFORMATION. This helps to repair DNA damaged by ROS in neutrophils

Human beings are the only known reservoir of these two species.B

Question 10

Neisseria growth and cultivation

Answer 10

• obligate aerobes
• somewhat delicate bacteria
• require special culture techniques
• sensitive to drying and to certain toxic trace metals and fatty acids present in blood agar and other ordinary media

Thayer-Martin medium (Chocolate agar containing vancomycin, colistin, nystatin, and sometimes trimethoprim) has been used for this purpose.

chocolate agar = brown color&raquo_space; contains blood which has been heated to 80°C (chocolatized)

somewhat capnophilic (need high concentration of CO₂), especially N. gonorrhoeae → chocolate agar plates are incubated at 37°C in a 5% CO₂ atmosphere

Question 11

lipopolysaccharide (LPS) vs lipooligosaccharide (LOS)

Answer 11

Gram-negative bacteria possess LPS or LOS in their outer membrane

Both are endotoxins → fever, shock, and other pathophysiologic changes

LOS DOES NOT have the long O-antigen polysaccharide chain present in typical Gram negative lipopolysaccharide (LPS).

LOS has core oligosaccharide + lipid A
- can incorporate sialic acid and thus mimic the host cell for immune evasion
- appears to play a role in ADHESION to host cells.

Question 12

Pili

Answer 12

mediate the initial stage of attachment to mucosal surfaces. Piliated strains are usually capable of infecting mucosal surfaces, while non-piliated strains are not. Pili are long and thin.

Question 13

GC pathogenesis

Answer 13

• colonize mucosal surfaces
• attach to cells using pili, outer membrane proteins including Opa, and LOS
• can become intracellular in mucosal cells where they multiply
• can also enter and multiply within neutrophils
• can be transferred to the submucosa by exiting the epithelial cells (transcytosis), entering in areas with damage to the cellular monolayer, or through phagocytes.

Question 13

GC pen resistance

Answer 13

Developed trough chromosomal mutations and plasmid acquisition.

Low-level resistance is due to mutations in the bacterial chromosome,

High-level resistance is due to plasmid-mediated production of penicillinase.

Question 14

other Gram-negative coccobacilli of the normal flora of the oropharynx, nasopharynx, and vaginal tract

Answer 14

Moraxella, Kingella, Acinetobacter

Question 15

Bactericidal abx

Answer 15

Very Finely Proficient At Cell Murder

V ancomycin

F luoroquinolones

P enicillin

A minoglycosides

C ephalosporins

M etronidazole

+ Rifampicin

Question 17

Bacteria gram positive make up

Answer 17

1, THICK peptidiglycan layer

2, Tightly bound acid polysac –> teichoic and lipoteichoic acid

3, retain CV

Question 18

Gram neg bacteria

Answer 18

1, Thin later of peptidoglycan sandwiched between surface and plasma memb

2, outer membrane containing LPS - lipid A plus O plus other thing

Question 19

Sildenafil

Answer 19

sildenafil (Viagra) = selective for PDE5.

inhibit cGMP-specific PDE5 enzyme on endothelial cells –> sm muscle relaxation –> increased BF

Within endothelial cells there is an enzyme NO synthase (converts L-arginine –> o2 into NO).

NO goes from endothelial cells –> sm muscle cells where it activates guanylyl cyclase (GTP -> cGMP). cGMP induced sm m relaxation.

PDE5 breaks down cGMP - causing its inactivation.

PDE5 inhibitors - inhibit
cGMP-specific PDE5 in CC (and retina) –> less breakdown of cGMP - more increased sm m relaxation in response to NO –> increase BF/ enhanced response.

Half life approx 1 hour therefore take one hour before SI

SE
Hypotension
Flushing
Headach
Dyspepsia
Impair vision
** CANNOT GIVE WITH NITRATES**

Question 20

Capasases in apoptosis

Answer 20

2, 3, 6-10

Question 21

Capasases in Pyroptosis

Answer 21

1, 4, 5, 11, 12

Question 22

Apoptosis vs Pyroptosis

Answer 22

both forms of programmed cell death,

Apoptosis= “silent” process that doesn’t cause inflammation

Pyroptosis=lytic cell death that triggers inflammation and immune responses, characterized by cell swelling, pore formation, and release of intracellular contents

Answer 23

Hypersensitivity rxns can be classified in into four types: * Type I: fast and it occurs within min to hrs. EX= allergic rxn * Type II: complement activation rxn induced due to antibodies binding to cell surface antigens. It occurs within hrs to days * Type III: complement activation induced by soluble antigen-antibody complex that occurs in serum. It occurs within hrs to days * Type IV: delayed type hypersensitivity rxn. The cells that participate in the type IV rxn include macrophages and T cells. It takes 2 to 4 days.

Question 24

Actinomyces israeli

Answer 24

Gram positive (purple branching filaments) Rod shaped Faculative anaerobe Non motile Dont form spores Non- acid fast bacteria Z-N stain - BLUE Catalase NEG Molar tooth appearance on blood agar culture

Question 25

Clotting cascase

Answer 25

Extrinsic PT(playing tenis) 3 (TF) and 7 Intrinsic APTT (table tenis) 12, 11, 9, 8 Common 10 2 (a = thrombin) 1 (a = fibrin) heparin - antithrombin III (ATIII) vit k - 2, 7, 9, 10

Question 26

HSV Antibody Tests

Answer 26

Type Specific Tests IgG Tests (commonly used) → Detect past infection but cannot determine when it occurred. IgM Tests (not recommended) → Not type-specific, cannot distinguish recent vs. recurrent infections, short-lived (7–14 days). IgG Avidity Tests → Measure binding strength over time but cannot confirm recent primary infection (primary from past but not recent primary) detecting seroconversion only by paired serum samples looking at IgG Up to 12% of patients lose IgG antibodies over time, complicating serology interpretation.

Question 27

When to do hsv ab testing

Answer 27

Recurrent genital lesions with negative HSV PCR → Helps rule out HSV infection. Pregnant women with first-time genital herpes in the third trimester → Helps determine need for C-section. Asymptomatic partners of preg patients → Helps detect serodiscordant couples (important for pregnancy planning).

Question 28

pyknosis karyorrhexis karyolysis apoptosis or necrosis

Answer 28

pyknosis both shirnking karyorrhexis fragmenting both but diff mechanisms karyolysis nuclear fading/ disolution necrosis only

Question 29

PCOS dx

Answer 29

1. Irregular cycles + clinical hyperandrogenism (HA) (exclude other causes) = diagnosis 2. If no clinical hyperandrogenism, test for biochemical HA (exclude other causes) = diagnosis 3. If only irregular cycles or hyperandrogenism: >>Adolescents: consider at risk of PCOS and reassess >> Adults: USS for PCOM or AMH (exclude other causes) = diagnosis

Question 30

Turners synd

Answer 30

45XO No barr body, can be mosiac Non disjunction meiosis - paternal gamete LOW OESTROGEN HIGH FSH/LH Congen malformations horseshoe kidney bicuspid a / coarctation lymphatic disease streak ovaries - ammen and infertility Clinical fts short stature webbed neck extensively spaced nipples shorted 4th metacarpals

Question 31

Kleinfelters

Answer 31

47 XXY Barr body present LOW testosterone (leydig) and inhibin B (sertoli) HIGH LH/FSH/oestrogen Clinical fts Eunuchoid body shape Less facial and body hair Gynaecomastia Hypogonadism -> dysgenesis of SN tubules and testicular atrophy -> infertility

Question 32

Voiding and filling urine nerves

Answer 32

Peeing = PNS Pelvic N (S2-4) Muscarinic (Ach) M3 in bladder PP MAM PNS Pelvic N (S2-4) Muscarinic Ach M3 Stop (filling) = SNS Hypogastric N (T12-L2) Adrenergic (NE/NA) Α1, β3 in bladder SHAT (can't pee while you shit) SNS Hypogastric A1, β3 , Adrenergic (Adrenaline) T12-L2 (hypogastric)

Question 33

Onuf’s nucleus

Answer 33

S2-4 = the micturition centre/ Onuf’s nucleus Receives afferent from stretch receptors in bladder wall Sends efferent signals – both somatic (pudendal nerve) and autonomic (e.g. parasympathic pelvic nerve)