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Case 4 > Case 4 - LOs Mitesh Q's > Flashcards

Case 4 - LOs Mitesh Q's Flashcards

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1
Q

what is the anatomical position of the prostate gland in relation to the bladder?

A

inferior (prostate gland is located inferior to the urinary bladder)

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2
Q

what is the anatomical position of the prostate gland in relation to the rectum?

A

anterior (prostate gland is located anterior to the rectum)

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3
Q

what are the symptoms of benign prostatic hyperplasia?

A

difficulty starting to urinate (difficulty starting the stream, e.g dribbles)
urinary retention
dysuria
difficulty in emptying the bladder fully

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4
Q

what is the name given to cancers that arise in glandular epithelia?

A

adenocarcinoma

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5
Q

what terms should be used when referring to sex registered at birth

A

male and female

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6
Q

what terms should be used in clinical communication when referring to gender?

A

men, women, non-binary people, trans men, trans women, trans people

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7
Q

recurrent urinary tract infections are particularly common in who?

A

women, trans men and non-binary people with a female urinary system

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8
Q

when do medical practitioners need to consider for Gillick competency?

A

patients under 16 who request sexual health advice or treatment without parental/carers’ consent or knowledge

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9
Q

list three points that a medical practitioner must consider when assessing a child’s capacity to consent (Gillick competency)

A

if they can understand the reasons for treatment/issue, including the advantages and disadvantages
understand risks and complications of their choices
understand alternative options
if child has sufficient maturity
if child has mental capacity
how well they understand what you (the medical practitioner) have told them

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10
Q

when should a medical practitioner suspect or consider sexual abuse of a child

A

when an adult has sex with someone under 16.
also, remember that a child under 13 cannot legally consent to any form of sexual contact

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11
Q

is sexual activity between two teenagers under 16 years of age unlawful

A

yes, but it’s unlikely to involve a prosecution unless there’s abuse or exploitation

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12
Q

with regard to Gillick competency, could a girl aged b/w 15 and 16 years of age make decisions about their sexual health and treatment

A

yes if she is Gillick competent

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13
Q

explain why risk taking behaviour is higher in adolescents

A

self image within a social group
sense of excitement
exploring their limits
pleasure
identity development

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14
Q

what is menarche

A

first menstrual cycle after puberty

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15
Q

what is thelarche

A

onset of breast growth

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16
Q

which hormone from the hypothalamus stimulates the release of follicle stimulating hormone and luteinizing hormone from the pituitary gland and is essential for puberty

A

GnRH - gonadotropin releasing hormone

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17
Q

list three symptoms of early pregnancy

A

absence of period (amenorrhoea)
nausea
vomiting
breast enlargement
breast tenderness
increased frequency of micturition

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18
Q

A 32 year old woman attends the gynaecology clinic because of difficulty conceiving. she has a regular 28 day menstrual cycle. As part of the initial investigations for ovulation, the doctor asks her to attend for a blood test on day 21 of her cycle.

list 3 methods for testing for ovulation

A

check for her basal (resting) body temperature
cervical mucus changes
day 21 progesterone measurements
LH peaks

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19
Q

which hormone is produced by growing ovarian follicles?

A

oestrogen

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20
Q

what is the predominant hormone released by the corpus luteum during the luteal phase

A

progesterone

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21
Q

what hormone peaks prior to ovulation as a result of positive feedback of oestrogen at the anterior pituitary?

A

LH

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22
Q

what hormone’s release is selectively inhibited by inhibin produced in the developing follicle

A

FSH

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23
Q

in the maturation of a follicle, on day one of a normal menstrual cycle, is initiated by which hormone

A

FSH

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24
Q

(in a normal menstrual cycle) which hormone surges around ovulation and causes the release of the egg from the follicle?

A

LH

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25
which cells in the testicle does luteinizing hormone from the anterior pituitary act on and what does this produce
Leydig cells, in the testicles, are located between the seminiferous tubules and are responsible for producing testosterone
26
a 36 year old woman became pregnant two months after discontinuing the use of oral contraceptives containing progesterone and oestrogen. approximately 3 weeks later, she had an early spontaneous abortion. how do these hormones in birth control pills affect the ovulation and menstrual cycle?
estrogen and progesterone prevent ovulation by suppressing the release of LH and FSH. They also thicken cervical mucus and alter the uterine lining. After stopping the pill, fertility can return quickly, but it may take time for the menstrual cycle to fully normalize.
27
is there a link b/w discontinuation of oral contraceptives and spontaneous abortion
yes, because of chromosomal abnormality. chromosomal abnormality are higher in women who discontinue use of the birth control pill
28
a method of barrier contraception is the male condom. advantages of condoms
widely available protects from STIs non-hormonal so doesn't influence homeostasis not affected/compromised by current drug treatment
29
disadvantages of combined oral contraceptives
risk of clots therefore contra-indicated in women with thromboembolism migraines doesn't protect against STIs
30
disadvantages of condoms
(generally) less effective at preventing pregnancies than IUDs and hormonal contraceptives allergies to latex may break/split requires negotiation interrupts intimacy
31
advantages of combined oral contraceptives
lighter periods more regular periods less painful periods more effective than condoms at preventing pregnancies reduced risk of ovarian and endometrial cancers (this remains also after decades after you stop taking this pill)
32
advantages of progesterone-only pill
no oestrogen so it's good for women with higher BMI progesterone only so it can ve used when breastfeeding
33
disadvantages of progesterone-only pill
must be taken every day
34
advantages of progesterone only implant
protects from pregnancy for 3 years and it's very effective at this normal fertility when the implant is removed
35
disadvantages of progesterone only implant
doesn't protect from STIs risk of bleeding and complications
36
advantages of levonorgestrel intrauterine device
protective from pregnancy for 3-8 years periods become lighter and so can be used in women with heavy periods may reduce pain in endometriosis and amenorrhoea
37
disadvantages of levonorgestrel intrauterine device
doesn't protect from STIs takes 7 days to start being effective trained healthcare professional is reuired to insert and remove the device inspection of the female anatomy to see if the device is suitable
38
which nerve branch (from the pudendal nerve) gives a somatic nerve supply to the penis
dorsal nerve
39
what is the duct that joins with the duct from the seminal vesicle to form the ejaculatory duct
vas deferens
40
what is the name of the structure that produces pre-ejaculate
bulbourethral gland
41
name the muscle that helps with urethral emptying and covers the bulb of the penis
bulbospngiosus
42
list 2 barriers of healthcare experienced by a trans or non-binary person
difficulty in IT systems, e.g allows info put in to be male or female only stigma fear of confidentiality fear of clinician accepting their gender identity fear of being called by their birth name negative cultural and social beliefs by public and Dr
43
which healthcare professionals can prescribe medications for sexual health without teh need for supervision
nurses with PGD in each STI Doctors Pharmacist independent prescriber dentists nurse independent prescriber
44
list 4 physiological defense mechanisms of the genitourinary tract that prevents infection
innate immune system mucus secretion in female reproductive tract urine flow males have a longer urethra MALT - mucosal associated lymphatic tissue
45
list one chemical defense mechanism and one antibody found in the genitourinary tract that prevents infection
discharge and vagina secretion (vaginal secretions maintains acidic environments) IgA IgG
46
list 4 other systemic conditions associated with Herpes (other than painful small blisters on penis, itchiness and increased pain on urination)
fever headache body ache swollen lymph nodes in the groin
47
what's the treatment for Herpes and what is its mechanism?
aciclovir - inhibts viral DNA replication [aciclovir can be given as tablets or cream]
48
describe the principles of the NAAT test
amplifies genetic material to identify bacteria [men-urine sample]
49
how do Neisseria gonorrhoeae bacteria attach to the cells of the host and evade immune defences?
Neisseria gonorrhoeae has a capsule and fimbriae - uses these to attach to host cells Neisseria gonorrhoeae also has pili - this has proteases and these break down IgA
50
Patient has gonorrhoea. Dr explains the need to take antibiotics as there's a risk of developing swelling in wrists and skin lesions associated with dermatitis. what's the underlying explanation for the Dr's recommendations in this case?
disseminated gonococcus infection →occurs when gonorrhoea isn't treated. gonorrhoea phagocytoses and divides gonorrhoea also multiplies within the neutrophils and travels through the body
51
N.gonorrhoeae is associated with discharge of pus and infection in genital tract. whats this called?
discharge of pus in genital tract - urethritis infection in genital tract - cervicitis
52
N.gonorrhoeae is associated with urethritis and cervicitis. name 2 sites of extra genital infection and the symptoms infections at these sites would cause
rectum - mucopurulent discharge, pain, bleeding, rectal fullness, constipation pharynx - sore throat, lymph nodes enlarges in cervical region (cervical lymph nodes inflamed)
53
patient with N.gonorrhoeae at end of clinic appointment. You should ___1___ the course of antibiotics and during this time you should refrain from ___2___ until after the course of antibiotics has been taken
1 - complete 2 - sex
54
21 year old woman went to get smear test. she's been sexually active and used oral contraceptives without barrier contraception for birth control. Physician noted a 1cm shallow erythematous ulcer on her cervix, which wasn't tender to manipulation, the physician scraped the ulcer. Woman was diagnosed with syphilis. what organism is responsible for syphilis?
Treponema pallidum
55
what is a chancre
a painless ulcer
56
most recommended treatment for syphilis?
penicillin (B) in a penicillin allergy, doxycycline should be given
57
list 4 risk factors associated with acquiring syphilis infection
unprotected sex no. sexual partners chem sex previous STIs needle sharing - drug users social vulnerability - homeless people migrants and refugees
58
untreated syphilis is associated with severe, sometimes irreversible conditions. which three areas of the body are likely to be affected?
heart - cardiovascular CNS occulor
59
in early stages of disease, which areas of the body would be examined
eye exam neurological exam genital exam skin exam - looking for lesions →looking at mouth, palms of hands, soles of feet
60
chlamydia trachomatis is gram negative or gram positive bacterium?
gram negative
61
chlamydia trachomatis is said to have a biphasic life cycle, what is meant by this?
Elementary body (EB) - infectious stage Reticular body (RB)- non infectious stage
62
name 2 ways to get a specimen to test for C.trachomatis in women? in men?
in women: vaginal swab from endocervix (vulvovaginal swab can have some of the discharge), urine in men: urine, urethral swab in men (this is apparently very painful) [urine test is more sensitive in men than women]
63
getting a specimen to test for C.trachomatis - what laboratory test is used to test these samples?
NAAT
64
preferred treatment for C.trachomatis in absence of allergies?
Doxycycline
65
difference between EB and RB of C. trachomatis
EB (elementary body) is extracellular (outside of the cell, NOT inside the cell) RB (reticular body) are intracellular - intracellular reticulate bodies. these are bigger than EB
66
having noted a strawberry cervix (cervicitis), state why you would test the pH of the vaginal discharge and your expectation if there's a trichomoniasis infection?
if pH > 4.5 → indicates a T. Vaginalis normal vaginal pH is b/w 3.5 to 4.5
67
after testing pH for a suspected trichomoniasis infection, what 2 tests would you perform next?
NAAT, microscopy
68
general symptoms associated with Candida Albicans infection
[Candida Albicans is a UTI, not an STI, and women are very susceptible to this] itching, pain, blisters, soreness, burning, redness, lumpy white patches
69
apart from discharge, what are the other symptoms associated with vulvovaginal candidiasis?
dysuria (painful urination) intense pain during sexual intercourse
70
risk factors for developing Candida Albicans infection
being immunocompromised being on antibiotics uncontrolled diabetes use of the combined pill
71
the treatment for Candida Albicans infection
antifungus - can be given as a topical (cream) or orally (tablets or solution) or intra-vaginally
72
explain why infections of the urinary tract often contribute to infections of the reproductive system
close proximity of the urinary tract and the repro system. also, shared ducts b/w urinary tracts and repro system
73
25 year old office worker returned from holiday in Spain. she presents to GP with increased frequency of urination and pain on passing on urine. No other features. what are possible diagnoses?
lower UTI - urethritis (→this can be caused by chlamydia and gonorrhoea) cystitis (bladder infection) - bacterial or a bacterial cystitis
74
25 year old office worker returned from holiday in Spain. she presents to GP with increased frequency of urination and pain on passing on urine. No other features. what further questions should the GP ask?
questions about recent sexual history, ask about other systemic effects (e.g changes on skin→ruling out STIs), ask about last menstrual period
75
25 year old office worker returned from holiday in Spain. she presents to GP with increased frequency of urination and pain on passing on urine. No other features. this is 1st time she's has these symptoms, there's no fever, vomiting or loin pain (that might suggest pyelonephritis - infection of the kidney), and the Spain holiday was with her spouse. GP suspects bacterial cystitis. She had her LMP (last menstrual period) two weeks ago. what investigations are indicated?
dipstick test of urine unless it's atypical cystitis (then you would do a midstream urine analysis)
76
the 2 most common bacterial agents that cause cystitis
E.Coli, Klebsiella
77
the treatment for uncomplicated bacterial cystitis? [uncomplicated bacterial cystitis - this means no systemic features, not recurrent, no other features that suggest STI]
ciprofloxacin (an antibiotic)
78
what's Ciprofloxacin mechanism of action?
inhibits bacterial replication by inhibiting topoisomerase or DNA gyrase →so no unwinding of DNA→ so the bacteria can't divide

Case 4 (10 decks)

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