Case 2 Flashcards
(175 cards)
1
Q
MOA of combined oral contraceptive pill
A
Oestrogen - inhibits FSH, therefore stops follicle development
Progesterone - inhibits LH, therefore stops ovulation. Also prevents sperm traffic since P causes vagina to have thicker mucus and be more acidic
2
Q
ADRs of combined oral contraceptive pill
A
Thromboembolism Stroke/MI Increased risk of breast cancer Hypertension Skin pigmentation Weight gain Nausea Irregular bleeding Mood changes
3
Q
Contraindications for combined oral contraceptive pill
A
Hx of thrombosis,
Risk factors for thromboembolism - obese, immobile, >35yrs, smoking, family hx
Heart disease with pulmonary hypertension/embolism
Migraines
Hx or family Hx of breast cancer
4
Q
Methods of emergency contraception
A
Levonorgestrel - Inhibits GnRH release by binding to O and P receptors. Can be used up to 70 hours after unprotected sex.
Ulipristal - Inhibits ovulation by binding to progesterone receptor. Can be used up to 120 hours after unprotected sex.
IUD - more effective than levonorgestrel (unknown comparison to ulipristal). Can be used up to 120 hours after unprotected sex.
5
Q
Methods of Contraception: Cap/Diaphragm
A
Inserted up to 2 hrs before sex
Left in for at least 6 hours after sex.
Can be used during period.
Used with spermicide gel.
6
Q
Methods of Contraception: Depo Provera
A
Medroxyprogesterone injection, lasting 12-14wks
ADRs
Little or no bleeding, mood problems, bone density problems, long lasting effects (can be more than one year)
7
Q
Methods of Contraception: Implanon
A
Etonergestrol Lasts 3 yrs 15-20% risk of abnormal bleeding Regain fertility very quickly after removal **Most effective form of contraception**
8
Q
Methods of Contraception: Intrauterine System
A
Progesterone impregnated coil.
Progesterone creates an unfavourable environment for sperm - thick mucus and acidic
Lasts 5 yrs
Sometimes causes hormonal problems and irregular bleeding
9
Q
Methods of Contraception: Intrauterine Device
A
Copper coil (copper is spermicidal)
Lasts 10yrs
Often causes heavy bleeding
Almost 100% effective
10
Q
Effects of FSH
A
Development of primary follicles
11
Q
Effects of LH
A
Ovulation
Stimulates theca cells to convert cholesterol to androgens
12
Q
Effects of oestrogen
A
Inhibits FSH
Stimulates granulosa cells to convert androgens to oestrogens
Makes cervical mucus thinner and therefore easier for sperm to swim
Stimulates proliferation of stratum basalis to form stratum functionalis (thickening of endometrium) AND elongation of endometrial glands
Increased movement in uterine tubes
Increased clotting factors and platelet adhesion
Reduced bone loss
13
Q
Effects of progesterone
A
Thickening of endometrium
Increased viscosity and acidity of cervical mucus
Stimulates uterine glands to secrete uterine milk (high in protein and glycogen)
Suppresses maternal immune response during pregnancy
Decreased uterine contractility
Inhibits lactation
14
Q
LH and FSH are released from:
A
Anterior pituitary
15
Q
Progesterone is secreted by…
A
Granulosa cells
16
Q
How does the secondary follicle differ from primary?
A
Larger
More follicular/granulosa cells
Follicular fluid spaces have formed and will coalesce to form the antrum.
Theca layer differentiates into an interna and externa
17
Q
How do theca interna and externa cells differ?
A
Theca interna - large, steroid hormone-producing cells
Theca externa - small, compact cells, continuous with stroma
18
Q
Function of thecal cells
A
Production of steroid
19
Q
Function of granulosa cells
A
Converts steroids into oestrogen
20
Q
Peg cell
A
Non ciliated epithelial cell within uterine tube. Secretes a watery solution to nourish gametes.
21
Q
LH surge occurs as a result of…
A
High levels of oestrogen
22
Q
Formation of corpus luteum
A
LH stimulates proteolytic activity in theca externa and tunica albuginea - therefore breakdown of collagen
23
Q
Corpus luteum appears yellow due to…
A
Fat
24
Q
Formation of corpus albicans
A
Progesterone secretion by corpus luteum inhibits FSH and LH
After 10 days, leutolysis of CL
Corpus albicans is formed at day 25.
It is a fibrous, ovoid structure.
25
Cholesterol to Oestrogen
Theca cells convert cholesterol to androgens (stimulated by LH). Androgens converted to oestrogen by granulosa cells (stimulates by FSH and oestrogen)
26
Epithelium found in uterine tubes
Simple cuboidal
| Secretory peg cells and ciliated
27
Epithelium found in ectocervix
Non keratinised, stratified squamous epithelium - protection from abrasion
28
Epithelium found in endocervix
Simple columnar epithelium. Contains crypts which secrete mucous.
29
Nervous innervation of Clitoris and Vestibule (Anterior vulva)
Anterior ilioinguinal branch of genitofemoral nerve.
| Parasympathetic innervation from cavernous nerves of uterovaginal plexus
30
Nervous innervation of Posterior vulva
Posterior pudendal nerve and cutaneous nerve of thigh
31
Lymphatic drainage of vulva
Superficial inguinal lymph nodes
32
Venous drainage of vulva
Pudendal vein
33
Arterial supply of vulva
Pudendal artery
34
Epithelium found in vagina
Stratified squamous - protection, lubrication, stimulated by oestrogen to secrete glycogen
35
Arterial supply of vagina
Uterine and vaginal arteries branching from internal iliac vein
36
Venous drainage of vagina
Vaginal venous plexus, drains into internal iliac vein
37
Lymphatic drainage of vagina
Iliac and superficial inguinal lymph nodes
38
Nervous innervation of vagina
Superior portion - inferior uterovaginal plexus
| Inferior portion - deep perineal branch of pudendal nerve
39
Tissues of the penis
```
Corpus cavernosum (x2)
Corpus spongiosum (x1) contains urethra
```
40
Muscles involved in maintaining an erection
Ischiocavernosus - surrounds crura, contracts to push blood into corpus cavernosum.
Bulbospongiosus - associated with bulb of penis, contracts to empty urethra of residual semen and urine
41
Arterial supply of penis
Internal pudendal (branch of internal iliac)
42
Venous drainage of penis
Deep dorsal vein of penis - drains cavernous spaces into prostatic venous plexus
Superficial dorsal veins - drain superficial structures such as skin and cutaneous tissues
43
Sensory and sympathetic innervation of penis
Dorsal nerve (branch of pudendal nerve)
44
Parasympathetic innervation of penis
Cavernous nerves from prostatic plexus
45
Tunica Albuginea of testis
Divides testi into lobules
46
Nervous innervation of testis and epididymis
Testicular plexus - derived from renal and aortic plexus)
47
Arterial supply of testis and epididymis
Testicular arteries - branch from aorta
48
Venous drainage of testis and epididymis
Pampiniform plexus forms testicular veins
49
Layers of spermatic cord
```
Skin
Dartos
External spermatic fascia
Cremaster muscle
Internal spermatic fascia
Tunica vaginalis - parietal and Visceral
Testis
```
Some Damned Englishman Called It The Testis
50
Contents of spermatic cord
3x Arteries: Testicular, Cremasteric and artery to vas deferens
Pampiniform plexus and cremasteric vein
Lymph vessels (drain into paraaortic nodes (lumbar)
Vas deferens
Genital branch of genitofemoral nerve
51
Arterial supply of scrotum
Posterior scrotal artery (branch of internal pudendal artery)
Anterior scrotal artery (branch of external pudendal artery)
52
Venous drainage of scrotum
Scrotal vein - into external pudendal
53
Seminal Vesicles
Secrete 70% of semen
Alkaline fluid - neutralises vagina
Fructose - nourishment of sperm
Prostaglandins - suppress female immune response to foreign bodies
Clotting factors - keeps semen in female reproductive tract
54
Bulbourethral glands
Produce an alkaline lubricant to carry sperm
55
Prostate cancer
```
Peripheral zone (adjacent to rectum) - most common site of prostate cancer (carcinoma)
Transitional zone - most common site of benign prostatic hyperplasia
```
56
Nervous innervation of prostate
Inferior hypogastric plexus
57
Venous drainage of prostate
Prostatic venous plexus
58
Arterial supply of prostate
Prostatic arteries
59
Function of dartos muscle
Temperature regulation - contracts to decrease surface area of scrotum, therefore reducing heat loss
60
Nervous innervation of anterolateral scrotum
Genital branch of genitofemoral nerve
61
Nervous innervation of anterior and posterior scrotum
Scrotal nerve
62
Nervous innervation of inferior scrotum
Perineal branches of posterior femoral cutaneous nerve (from sacral plexus)
63
Sertolli Cells
Tall, simple columnar epithelial cells
Provide nutrients to sperm
Phagocytose excess spermatoid cytoplasm
Have tight junctions between them, forming the blood-testis barrier
64
Leydig Cells
Intersitial cells, lying between tubules in the testis.
Have an eosinophilic, cholesterol containing cytoplasm
Secrete testosterone in response to LH
65
Direct inguinal hernia
Medial to epigastric vessels
Weakness in posterior wall of inguinal canal - inguinal contents emerges medial to deep ring
Seen in elderly with chronic conditions
66
Indirect inguinal hernia
Lateral to epigastric vessels
Inguinal contents pass through inguinal canal and exit through superficial inguinal ring
Seen in children and young people
Can descend into scrotum
67
Deep inguinal ring is located...
At the midpoint between ASIS and pubic tubercle
68
Symptoms of lower UTI
Dysuria (pain on urination) and nocturia
Smelly, cloudy, foul-smelling urine
Urgency
Frequency
(Suprapubic tenderness and haematuria in cystitis)
69
Symptoms of upper UTI
```
Loin pain
Chills
Fever
Dysuria (pain on urination)
Smelly, cloudy urine
Urgency
Frequency
```
70
Management of UTI
Encourage fluids inc. Cranberry Juice
Uncomplicated - Trimethoprim
Complicated - Amoxycillin +/- gentamycin
71
Complicated UTI?
```
Children under 5
Pregnant women
Men
Patient who is immunocompromised
Patient with renal impairment or renal tract abnormality
Pyelonephritis
Recurrent or relapsed UTI
```
72
MOA of beta lactam antibiotics
Inhibit cell wall synthesis
73
Beta Lactam Antibiotics examples
Penicillins - amoxycillin, flucloxacillin
| Cephalosporins - cefalexin
74
MOA of aminoglycoside antibiotics
Binds to 30s of ribosome, causing mRNA to be read incorrectly. Inhibitor of protein synthesis
75
Aminoglycoside Antibiotic examples
Gentamycin
Steptomycin
Kanamycin
76
MOA of glycopeptide antibiotics
Inhibit cell wall synthesis
77
Glycopeptide antibiotic examples
Vancomycin
78
MOA of Quinolone antibiotics
Interfere with DNA replication and transcription
79
Quinolone antibiotic examples
Ciprofloxacin
| Levofloxacin
80
MOA of Oxazolidinones
Inhibit protein synthesis
81
Oxazolidinone antibiotic examples
Linezoid
Posizoid
Cycloserin
82
ADRs of beta lactam penicillins
GI disturbance
Type I and IV hypersensitivity reactions
Cholestatic jaundice (with co-amoxiclav)
83
Indication for beta lactam antibiotics
Gram positive and negative organisms
84
Amoxicillin is indicated for...
Oral infections: Lyme Disease, Anthrax, H-Pylori
85
ADRs of Quinolones
```
Tendon rupture (elderly)
Decreased seizure threshold
Peripheral neuropathy
Hypoglycaemia
High C. Diff risk
```
86
Co amoxiclav is indicated for...
Animal bites
GU infection
Joint/bone infection
87
Indication for Quinolones (Ciprofloxacin)
Gram +ve and -ve bacteria
| Pseudomonas, chlamydia, gonorrhoea and typhoid
88
MOA of Macrolides
Bind to 50s of ribosome, inhibiting binding of tRNA.
| Protein synthesis inhibition.
89
Example of macrolide antibiotic
Clarithromycin
90
Indication for Cephalosporins (Beta Lactam)
```
Septicaemia
Pneumonia
Biliary tract infection
Meningitis
Epiglottitis
Gonorrhoea
```
91
Indication for clarithromycin
Atypical pneumonias
| Campylobacter
92
ADRs of macrolides
QT Prolongation
| SJS/TENS (potentially fatal skin reaction)
93
ADRs of Aminoglycosides/Gentamyci
Nephrotoxicity
| Irreversible ototoxicity
94
MOA of nitrofurantoin
Acetyl CoA inhibitor. Interferes with CHO metabolism
95
Indication for nitrofurantoin
UTIs
96
ADRs of nitrofurantoin
Pulmonary fibrosis
Retroperitoneal fibrosis
Peripheral neuropathy
97
MOA of Trimethoprim
Inhibits dihydrofolate reductase.
| Therefore, reduced folate metabolism.
98
Indication for trimethoprim
UTI
Bronchitis
Pneumocystic Pneumonia
99
ADRs of Trimethoprim
Hyperkalaemia
100
Indication for glycopeptides/vancomycin
Gram positive cocci
| C.Diff
101
ADRs for glycopeptides/vancomycin
Nephrotoxicity
| Ototoxic
102
MOA of metronidazole
Disrupts DNA structure and inhibits nucleic acid synthesis
103
Indication for metronidazole
Anaerobic infection
Protozoal infection
H. Pylori
Crohn's
104
ADRs of metronidazole
Disulfram reaction with alcohol
105
Acute pyelonephritis
Inflammation of kidney tissue
| Pain in loins, fever, shivering, fits, N+V, Malaise
106
Perinephrosis
Obstruction and infection of the kidney - usually caused by a kidney stone.
Leading to pus formation
```
Signs/Symptoms:
Loin pain/swelling
Weight loss
Night sweats and rigor
Scoliosis
```
107
Staghorn calculus
Branched kidney stone forms a cast of collecting system of kidney. Fills calyx and pelvis.
Can cause perinephric abscess or pyonephrosis.
108
Vesico-ureteric reflux
On contraction of the bladder, valve between ureter and bladder is not closed off (due to damage or congenital abnormality). Back flow of urine into ureter, where it sits as a stagnant pool - infected urine can reach the kidneys.
109
Recurrent UTI
Different organism causing UTI each time
110
Relapse UTI
Same organism causing another UTI within 2 weeks
111
Treatment of non pregnant, adult female with symptoms of lower UTI
Trimethprim or nitrofurantoin
112
Treatment of non pregnant, adult female with symptoms of upper UTI
Ciprofloxacin or co-amoxiclav
113
Treatment of adult male with symptoms suggestive of prostatitis
Ciprofloxacin (Quinolones)
114
Treatment of UTI in pregnant woman
Nitrofurantoin
| Amoxicillin
115
UTI antibiotics contraindicated in pregnancy
Trimethoprim - Folate antagonist
| Ciprofloxacin - causes bone development problems
116
Why does pregnancy increase risk of UTI?
Reduced hygiene
Compression of bladder by uterus - incomplete voiding
Increased GFR - glc filtered out more rapidly, more glc in urine attracting bacteria
117
Function of internal urethral sphincter
Only found in males
Contracts during ejaculation to prevent seminal regurgitation
In response to sympathetic innervation
118
Mechanisms of prevention of UTI by the body:
Complete urinary voiding (vesicoureteric junction)
Bactericidal secretions
Low pH of urine
High [urea] in urine
119
Clinical measure of GFR
Creatinine
120
Arterial supply of ureters
Abdominal region - renal and testicular/ovarian arteries
| Pelvic region - vesical arteries
121
Venous drainage of ureters
Abdominal region - renal and testicular/ovarian veins
| Pelvic region - vesical veins
122
Nerve supply of ureters
T11-L2
| Renal, testicular/ovarian hypogastric plexuses
123
Epithelium found in bladder
Transitional - able to stretch in response to increasing volume of bladder
Looks like stratified squamous epithelium
124
Detrusor Muscle
Smooth muscle found in walls of bladder.
| Contracts during voiding
125
Trigone
Smooth, triangular area of the bladder, marking the internal urethral orifice
Borders: 2 ureteric openings and 1 urethral opening.
126
Nervous innervation of bladder
Sympathetic (retention) - hypogastric nerve T12-L2
Parasympathetic (micturition) - Pelvic nerve S2-S4
Somatic - Pudendal nerve S2-S4
127
Function of external urethral orifice
Skeletal muscle involved in micturition (in both sexes)
128
Bartholin's Glands
Posterior and to the left and right of the vaginal opening.
Secrete mucus to lubricate the vagina.
Homologous to bulbourethral glands in males.
129
Epithelium found in proximal convoluted tubule
Simple, tall cuboidal
| Convoluted surface, increases surface area for reabsorption
130
Function of PCT
Responsible for 2/3s of reabsorption of H2O, Na+, K+, Cl- and HCO3-
131
Glucose transporters found in PCT
Proximal 2/3: GLUT2 and SGLT2 (low affinity, act when [Glc] is high)
Distal 1/3: GLUT1 and SGLT1 (high affinity)
132
SGLT
Sodium Glucose Transport Proteins. Reabsorption of Glc in PCT coupled with movement of Na+ down its concentration gradient.
133
AQP1
Aquaporin. Allows reabsorption of water from descending loop of Henle
134
How does epithelium in DCT differ from that of the PCT?
DCT also has cuboidal epithelium
| But has fewer villi (since it is less important for absorption)
135
Calcium reabsorption in kidney nephrons
TRPV5 and TRPV6 (increased expression in response to PTH, in order to increase plasma Ca2+)
70% occurs in PCT and ascending loop
136
How does ADH/vasopressin bring about increased water reabsorption?
Released from posterior pituitary.
Binds to GPCRs on basolateral membrane.
Activation of AC, increased cAMP and activation of PKA.
PKA initiates fusion of vesicles containing water channels - Aquaporins 2 and 3
137
Progression of acquired syphilis
Painless but highly infectious rash for 2-6wks
Followed by sore throat, fever and skin rash.
Can lead to gummatous (15%), CVD - aortitis or aneurysm (6%) and neurological problems - dementia, psychosis, paresis (10%
138
Characteristics of congenital syphilis
```
Rash
Periostitis
Enlarged lymph nodes, spleen and liver
Neuro and ocular movement changes
Swelling of joints
Tooth deformity (Hutchinson's - spikey)
High palatal arch
Short maxilla
Saddle nose
```
139
Treatment of syphilis
Early - Penicillin for 10 days
Late - Daily penicillin, Probenecid 4x/day (increases uric acid secretion in urine, enhances action of penicillin)
140
Signs/Symptoms of Chlamydia
80% Asymptomatic
Urethritis
Proctitis
Epididymitis
141
Treatment of chlamydia
Single dose of azithromycin (protein synthesis inhibitor)
Doxycycline (protein synthesis inhibitor) BTD for 7 days
142
Signs/Symptoms of Gonorrhoea
```
10% asymptomatic
Urethritis
Proctitis
Discharge (anal, vaginal, urethral)
Pharyngitis and eye infections
```
143
Treatment of Gonorrhoea
Ceftriaxone I/M
1g Azithromycin Orally
(Single dose)
144
Clinical presentation of genital warts (HPV)
Painless, soft, fleshy growths around genitalia
145
Treatment of genital warts (HPV)
Removal (surgical, freezing, chemical)
146
Types of HSV
Type I - Oral cold sores
Type 2 - STI/Painful genital ulcers
147
Effect of compression of pudendal nerve during childbirth
Sensory loss surrounding skin of perineum
| Motor loss of urethral sphincters (incontinence)
148
Pouch of Douglas
Rectouterine pouch
149
How does the female pelvis differ from the male pelvis
Female has a wider suprapubic angle and pubic inlet
150
Effects of relaxin hormone
```
Increased laxity of pubic symphysis and sacroiliac joints during pregnancy - allowing expansion during childbirth.
Increased CO
Induces constipation
Increased renal perfusion
Cervix dilatation
```
151
How do the structures palpated during a DRE differ in a male and female?
Male: seminal vesicle and prostate gland. Female: Uterus
152
Hypospadias
Congenital malformation causing there to be an abnormal opening to the urethral meatus
153
Transurethral Resection of Prostate
Removal of part of prostate through urethra using a cauterising loop.
Risk of removing part of the internal urethral sphincter - resulting in retrograde ejaculation.
154
'Water under the bridge'
Ureters run underneath the uterine artery.
| Important when carrying out an ovariectomy, when ovarian arteries are ligated, to avoid damage to ureters.
155
Pap smear
Used to detect changes to the cells (dysplasia) in and around the cervix.
156
Description of Pap smear showing Low grade squamous intraepithelial lesion
```
Mild dysplasia (CIN I) Often associated with HPV/Genital warts
Normally resolved without intervention within 18-24 months
```
157
Description of Pap smear showing high grade squamous intraepithelial lesion
Severe dysplasia - shrivelled membranes, enlarged nuclei with less cytoplasm, giants cells and RBCs (CIN II and III)
Precancerous lesions
158
Cervical Intraepithelial Neoplasia Grade II
Moderate dysplasia
| Confined to basal 2/3 of epithelium
159
Cervical Intraepithelial Neoplasia Grade III
Severe dysplasia
Spans more than 2/3 of epithelium (may be full thickness)
Also referred to as Carcinoma in situ
160
Tanner Scale
Measures male and female development (puberty)
161
Prader Orchometer
Measures volume of testis (4ml at the onset of puberty)
162
Female growth spurt occurs at age
11
163
Male growth spurt occurs at age
13
164
Effect of age on gonadal feedback
Prepuberty - gonadal steroids and gonadotrophins are LOW but feedback mechanism is very sensitive.
Puberty - gonadal steroids and gonadotrophins are HIGH but decreasing in sensitivity
Adult - maximum gonadal steroids and gonadotrophins, lowest sensitivity
165
Leptin deficiency in puberty
Causes biochemical Hypothalamic Hypogonadism - adult women not menstruating or are prepubertal developmentally
166
Effects of delayed onset puberty
```
Short stature
Low self confidence
Rejection
Inadequacy
Disturbed relationship with parents
Attention seeking behaviour
Persistence of psychological characteristics into adult life
```
167
Treatment of delayed onset puberty in males
Testosterone from 14yrs until testicular volume reaches >8mls
Pituitary-gonadal testing if no testicular enlargement occurs
168
Treatment of delayed onset puberty in females
Ethinyloestradiol until puberty established
169
Treatment of delayed onset puberty in females
Ethinyloestradiol until puberty established
170
Conditions associated with hypogonadotrophic hypogonadism
Kallman's Syndrome - Mutations in KAL1 gene causing olfactory hypogenesis and failure of GnRH neuronal migration.
Prader-Willi Syndrome - impaired response to LH and FSH
171
Treatment of precocious puberty in females
Aromatase inhibitor - enzyme normally converts testosterone to oestrogen
172
Abortifacients
Mifepristone - Progesterone receptor antagonist. Causes endometrial degeneration and sensitises uterine contractions to prostaglandins
Gemeprost - Analogue of PGE2, used with mifepristone. Reduces obstetric bleeding by causing vasoconstriction.
173
3 forms of chlamydia
Infection of eyelids
STI
Lymphogranuloma Venereum (of lymph nodes)
174
Consequences of untreated chlamydia
```
Pelvic inflam disease
Ectopic pregnancy
Tubal infertility
Chronic pain
Increased HIV transmission
Reiter's Syndrome (arthritis, conjunctivitis, urethritis)
Transmission to baby during childbirth.
```
175
Antibiotics which delay metabolism in the liver
Metronidazole, Isoniazid, chloramphenicol
