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Yr 2 EOYS > HD EOYS1 > Flashcards

HD EOYS1 Flashcards

1
Q

State the name [1] and function [1] of these devices?

A

Ring pessary

Stops vaginal / uterine prolapse

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2
Q

Label this muscle [1]

A

Piriformis

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3
Q

A is the piriformis

Label B-F

A

B: gluteus medius
C: quadratus femoris muscle
D: common fibular nerve
E: tibial nerve
F: Inferior gluteal vessels

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4
Q

Label this image of the right gluteal region after reflecting gluteus maximus muscle

A

CFn — common fibular nerve; Tn — tibial nerve; Pfm — piriformis muscle; QF — quadratus femoris muscle; Sn — sciatic nerve.

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5
Q

Label nerve A [1]

A

Sciatic nerve

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6
Q

Which of the following is associated with reactive arthtitis

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

A

Which of the following is associated with reactive arthtitis

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

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7
Q

Which of the following is associated with septic arthtitis

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

A

Which of the following is associated with septic arthtitis

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

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8
Q

What is this pathology depicted? [1]

Which pathogens are most likely to have caused this? [1]

A

Fitz-Hugh syndrome

C. trachomatis and N. gonorrhea

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9
Q

A diagnostic laparoscopy was performed that showed extensive adhesions between the liver and abdominal wall (anterior wall). What is the next step in the management of the patient?

A. Ceftriaxone plus doxycycline
B. Lyse the adhesion with electrocautery
C. Metronidazole and doxycycline
D. No management is required

A

A diagnostic laparoscopy was performed that showed extensive adhesions between the liver and abdominal wall (anterior wall). What is the next step in the management of the patient?

A. Ceftriaxone plus doxycycline
B. Lyse the adhesion with electrocautery
C. Metronidazole and doxycycline
D. No management is required

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10
Q

Ceftrioxone is the standard treatment for

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

A

Ceftrioxone is the standard treatment for

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

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11
Q

This symptom indicates infection from which of the following

Gonorrhoea
Syphilis
HIV
CMV
Chlamydia

A

This symptom indicates infection from which of the following

Gonorrhoea
Syphilis - tertiary. symptom: gumma
HIV
CMV
Chlamydia

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12
Q

How many polycystic ovaries are required for US diagnosis? [1]

A

defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in

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13
Q

What clinical symptoms would indicate hyperandrogenism (for a PCOS diagnosis) [2[
What measurable sign would indicate hyperandrogenism? [1]

A

Hirsutism: condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
Acne
Elevated levels of total or free testosterone

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14
Q

A 22-year-old man presents with a two-day history of discharge from the urethral meatus, and pain on urination. When asked, he explains he has had several new sexual contacts recently. On examination, the discharge contains yellow pus and mucous. A first void urine sample is taken to test for the suspected diagnosis.

How should this most likely diagnosis be treated?

Trimethoprim
Ceftriaxone
Cirpofloxacin
Nitrofurantoin
Benzylpenicillin

A

Ceftriaxone

This patient has presented with gonorrhoea, which can be confirmed with nucleic acid amplification testing (NAAT). This requires a first void urine sample in men, or a vulvovaginal swab in women.

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15
Q

A 37-year-old female presents to her general practitioner with complaints of a green, frothy discharge and vulval itchiness for the last five days. The patient has been in a monogamous relationship with her husband for nine years. She has no significant past medical history and takes no medications. A speculum examination shows small punctate areas of haemorrhage on the cervix. Vulvar erythema is also present.

What is the most likely diagnosis in this patient?

Trichomoniasis
Gonorrhoea
Primary syphilis
Vaginal candidiasis
Secondary syphilis

A

Trichomoniasis
This patient’s presentation is consistent with Trichomoniasis which is a sexually transmitted infection caused by Trichomonas vaginalis. Typically, this infection leads to a frothy, green discharge accompanied by pruritus, vaginitis and post-coital bleeding. Small punctate haemorrhages are also commonly seen on speculum examination (often referred to as a ‘strawberry cervix’).

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16
Q

From where in the hip bone does the gluteus medius originate?

Iliac fossa

Anterior aspect of the iliac crest

Greater sciatic notch

External surface of the ileal wing

A

From where in the hip bone does the gluteus medius originate?

Iliac fossa

Anterior aspect of the iliac crest

Greater sciatic notch

External surface of the ileal wing

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17
Q

The piriformis seperates which neurovascular structures?

A

Suprapiriform foramen:
* The superior gluteal artery and nerve

Infrapiriform foramen
* Posterior cutaneous nerve of thigh
* Inferior gluteal vessels and nerves
* Nerve to quadratus femoris
* Pudendal nerve
* Internal pudendal vessels
* Nerve to obturator internus
* Sciatic nerve

PINS & PINS

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18
Q

In a women:

Which arteries split from the common iliac arteries and dont stay in the pelvis? [4]

Which arteries split from the common iliac arteries and stay in the pelvis? [3]

A

Leaves:
* obturator
* femoral
* gluteal
* internal pudendal arteries

Remains:
* middle rectal artery
* uterine artery
* superior vesicular artery

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19
Q

What is an episiotomy?

What are the two types? [2]

A

Surgical incision of the perineum and posterior vaginal wall

Two types:

Midline episiotomy: Posterior aspect of labia minora (fourchette) along midline

Mediolateral episiotomy” Fourchette diagonally towards midpoint between ischial tuberosity and anus

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20
Q

What can cause uterine prolapse? [2]

A

Secondary to pelvic floor and uterine ligament dysfunction

Multifactorial in etiology

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21
Q

which muscle is highlighted here? [1]

A

piriformis

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22
Q

Which of the following is sacrotuberous ligament?
A
B
C
D
E
F

A

Which of the following is sacrotuberous ligament?
A
B
C
D
E
F

23
Q

Label A-C

A

a iliococcygeus muscle
b pubococcygeus muscle
c puborectalis muscle

24
Q

label A-F

A

A - coccygeus

B - iliococcygeus

C - pubococcygeus

D - puborectalis

E - tendinous arch of levator ani

F - obturator internus

25
Q

what is autonomic supply to pelvis like?

A

PNS: pelvic splachnic nerves from S2, S3 & S4

SNS: via superior hypogastric plexus (continuation of the aortic plexus). contains sympathetic, ascedending PNS and viseceral afferent fibres.

superior hypogastric –> left and right inferior hypogastric plexi eitherside of the rectum

26
Q

Explain lifecycle of Chlamdydia trachomatis
- what are the two different forms? [2]
- Which type is infectious? [1]
- which type of replicative? [1]

A

Exists in two different forms:
- the elementary body, which is the infectious form
- the reticulate body, which is the replicative form

Infect as an elementary body, then turns in to reticulate body, after a while becomes elementary body and bursts and infects

27
Q

What are complications of Chlamdydia trachomatis? [2]

What are treatments for Chlamdydia trachomatis? [2]

A

Complications
* Reactive arthritis
* INFERTILITY – can cause ectopic pregnancy due to scarring of uterus

Treatment
* Azithromycin
* Doxycycline

28
Q

What are systemic complications of Neisseria gonorrhoea? [4]

A
  • Septic arthritis
  • blindness
  • infertility
  • septicaemia
29
Q

How do you treat Neisseria gonorrhoea? [1]

A

Ceftriaxone

30
Q

Which variants of HPV are linked to cancer? [4]
Which variants of HPV are targeted by Gardasil vaccine? [2]

A

Cancerous: HPV 16, 18, 31,33

Vaccine: HPV 16 and 18

31
Q

What are the two types of Chlamdydia trachomatis (that need to know) [2]

What do they cause? [2]

A

Serovars D-K: infects genital tract epithelial cells
Males: Urethritis, epipdidymitis, prostatitis
Females: Cervicitis, PID, Fitz-Hugh Curtis (liver capsule adhesions)
Neonate - conjunctivitis and pneumonia

Serovars L1-3
Causes: Lymphogranuloma venereum

32
Q

What are the treatment options for herpes? [3]

A

Management:
Topical podophyllotoxin
imiquimod
Cryotherapy

33
Q

What type of cells does herpes virus intergrate into?

epithelial cells
nerve cells
muscle cells
endothelial cells

A

What type of cells does herpes virus intergrate into?

epithelial cells
nerve cells
muscle cells
endothelial cells

34
Q

Drug management for herpes? [3]

A

Acyclovir, Famciclovir, Valaciclovir

35
Q

Explain life cycle of Syphilis (Treponema pallidum) [4]

A

Primary:
* single sore or multiple sores. The sore is the location where syphilis entered your body. These sores usually occur in, on, or around the penis; vagina; anus; rectum; and
lips or in the mouth
* 3 to 6 weeks and heals regardless of whether you receive treatment.

Secondary:
* Rash, fever, lymphadenopath, Condyloma latum (wart like lesions on genitals)
* This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can be on the palms of your hands and/or the bottoms of your feet

Latent:
* No signs or symptoms

Tertiary:
* However, when it does happen, it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system.
* Tertiary syphilis is very serious and would occur 10–30 years after your infection began
* Can result in death

36
Q

What are short term [4] and long term [5] problems of HAART treatment?

A

Problems with HAART

  • Short-term side effects: nausea, vomiting, headache, sleep disturbance (caused by efavirenz)
  • Long term: lipodystrophy (NRTIs and PIs), renal dysfunction (tenofovir), peripheral neuropathy (d4T, AZT, DDI), lactic acidosis (may be fatal, d4T, DDI)
37
Q

What are the 4 types of ovulatory causes of infertility? [4]

A

Type 1: hypothalamic
* hypothalamic amenorrhea
* anorexia nervosa (both men and women)

Type 2: pituitary:
* Hyperprolactinaemia - increase prolactin (mimics that you are breasfeeding: causes decrease in LH & FSH)

Type 3: ovarian:
* Premature ovarian failure

Type 4:
* polycystic ovary syndrome (PCOS)

38
Q

What scoring system is used to ID PCOS? [1]

What score need to diagnose PCOS? [1]

Name 3 things that could get a point for this system? [3]

A

Rotterdam criteria: need 2/3
* Clinical hyperandrogenism (high testosterone)
* Oligomenorrhoea (less than 6-9 menses per year)
* PCOS on ultrasound

39
Q

Explain why testosterone is raised in PCOS [3]

A

PCOS:

Initial response to LH from follicle.
At around 8cm follicle development stops: granulosa cells are lost.
Normally testosterone would be converted to oestrogen, but now doesnt: so secreted out

40
Q

Explain 5 tubal / uterine causes of infertility

A

Pelvic inflammatory disease:
* Bacterial infection spreading to vagina or cervix causes blockages / inflammation of uterine tubes OR adhesions that stick uterus to uterine tubes
* Commonly chlamdyia or gonorrhoea

Previous tubal surgery
* E.g for ectopic pregnancy

Endometriosis
* Bits of endometrium are outside of uterine cavity (e.g. on fallopian tube or bowell - will grow and develop due to oestrogen and progesterone. But when stop during in menstrual cycle: will bleed. Causes discomfort

Fibriods
* uterine smooth muscle growth and creates nodules (causing discomfort)
* stops uterus wall expanding properly when pregnant
* causes heavy periods & pain on intercourse

cervical mucus defects
* transforms into hostile environment all the time (instead of changing to hostile environment mid-cycle)

41
Q

Explain the main pathophysiology that causes repeated miscarriages? [2]

A

(lots of reasons)

Main: blood coagulation protein / platelet defects
* Defects in factor XIII and factor XII
* Having anti-cardiolpin antibodies, lupus anticoagulant or antiphospholipid syndrome

others include:

  • Anatomical anomalies - cervical incompetence
  • Genetic / chromsome abnormalities - trisomy 21 etc
  • Endocrine / hormonal abnormalities

MOST ARE TREATABLE

42
Q

How can you treat blood coagulation protein / platelet defects causing repeated miscarriages? [1]

A

Aspirin

43
Q

Name 4 reasons why male infertility may occur

A
  • less than 120 million sperm
  • Hormone imbalance (hypogonadism)
  • Anti-sperm antibodies
  • Varicocele (varicous veins of testes)
  • Sperm quality and movement
  • Undescended testis
  • Obstruction (vasectomy, cystic fibrosis)
  • Ejaculatory problems (retrograde and premature)
  • Erectile dysfunction
44
Q

Explain immunological causes of combined infertility

A

Develop antisperm antibodies (ASA): IgG, IgA and IgM

Causes a breakdown of blood testis barrier (usually blood shouldn’t come in contact with sperm) because its only haploid - is recognised as foreign so is broken down

45
Q

Explain a genetic cause of combined infertility

A

During male development SRY downfeeds to SF-1 which causes get rid of uterus when developing in men.

Mutation in gene NR5A1 that codes for SF-1 causes 46XY but with non obstructive male infertility:

Can develop female external external genitalia, uturus and uterine BUT no gonads

OR can have low testosterone and develop azoospermia

46
Q

What are 4 reasons why unexplained infertility may occur

A

Celiac disease
Thyroid imbalance
Folate deficiency
High sperm DNA damage

47
Q

What test would you use to check sperm DNA integrity? [1]

A

Sperm chromatin integrity test

48
Q

Investigating infertility with a PCOS screen - what would you assess? [5]

A
  • Day 21 progesterone - if greater than 30nmol / L indicates ovulation viable.
  • Raised LH
  • Normal / Slightly raised FSH
  • Raised testosterone
  • Abnormal glucose (because DMT2 is big risk factor)
49
Q

Investigating infertility apart from PCOS - would blood screen parameters would you investigate? [5]

A

Thyroid (TSH / TFT levels)
Vitamin D levels (increased vit D is better)
HbA1C
Viral screen - Rubella, HIV, hepatits
STI screen (undiagnosed chlamydia or gonorrheaa)

50
Q

What are secondary care investigations would conduct to assess ovulatory function?

A

Bloods from primary care
Ovarian reserve: Response to gonadotrophin stimulation in IVF
Assess tubal function: Hysterosalpingogram
Assess uterine function
Laparoscopy

51
Q

Which pathology is consequence of long term assisted reproduction techniques? [1]

A

Ovarian hyperstimulation syndrome: consequence of drugs used to stimulate ovarian function in IVF.

Presents similarly to PCOS as get cysts developing

52
Q

What is a potential risk for children who are born from women over 35 with IVF? [1]

What is a potential risk for mothers who have children, who are over 35 and use IVF? [1]

A

Increase in congenital defects

Increase in cancer for the mothers

53
Q

Which best describes the MoA of Tamulosin

alpha 1 agonist
alpha 1 antagonist
alpha 2 agonist
alpha 2 antagonist

A

Which best describes the MoA of Tamulosin

alpha 1 agonist
alpha 1 antagonist: cause IUS to stop having SNS action and causes it to relax
alpha 2 agonist
alpha 2 antagonist

54
Q

Which drug inhibits SNS action where the arrow is pointing? [1]

A

Tamulosin

Yr 2 EOYS (58 decks)

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