HD OVERVIEW Flashcards
(149 cards)
1
Q
Define fertility/subfertility
A
a
2
Q
Primary vs. secondary infertility
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a
3
Q
Type 1 ovulatory cause of infertility
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a
4
Q
Type 2 ovulatory cause of infertility
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a
5
Q
Type 3 ovulatory cause of infertility
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a
6
Q
Cause of PCOS
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a
7
Q
Main cause of pelvic inflammatory disease
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a
8
Q
Endometriosis
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a
9
Q
Uterine fibroids
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a
10
Q
Three drugs associated with infertility in women
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a
11
Q
Three drugs associated with infertility in men
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a
12
Q
First line advice for couples worried about infertility
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a
13
Q
Reasons for an early referral
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a
14
Q
Primary care investigations for infertility
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a
15
Q
Secondary care investigations for infertilty
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a
16
Q
Ovarian reserve test
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a
17
Q
HSG test
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a
18
Q
Tests to asses ovulation
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a
19
Q
NICE guidelines for unexplained infertility
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a
20
Q
WHO sperm count volume
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1.5ml LRL
21
Q
WHO sperm count motility
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32% LRL
22
Q
WHO sperm count morphology
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4% normal LRL
23
Q
Treatment for type 1 ovulatory failure
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a
24
Q
Treatment for type 2 ovulatory failure
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a
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Treatment for type 3 ovulatory failure
a
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IUI what is involved?
a
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IUI who is this offered to?
a
28
IVF - what is involved?
a
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Ovarian hyperstimulation syndrome
a
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ICSI
a
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Main symptom of pelvic inflammatory disease
Most asymptomatic
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Most common STI in England
a
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Pathogen responsible for chlamydia
a
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What is ceftriaxone and what is this used for?
a
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Which STIs have no effect on the neonate?
a
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Which STIs can affect the neonate?
a
37
Cause of gestational diabetes
a
38
GDM - problem for the mother or the neonate?
Neonate
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Four foetal complications from GDM
Macrosomia
Hypoglycaemia
Hyperbilirubiniea
Respiratory distress syndrome
40
Increased risk of non-viral infections during pregnancy - why? Risk to mother or neonate?
Neonate mainly
| Waters break - pathway for bacteria to travel to the placenta through the cervix
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What type of non-viral infection is most common during pregnancy and why?
Group B streptococcus - present in the normal flora of the vagina in 25% of women
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Consequence of group B strep infection in neonate
Pneumonia
Meningitis
Non-focal sepsis
Death
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Polyhydramnios - increased risk of what?
Excess amniotic fluid in the amniotic sac
| GDM
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Listeriosis
a
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Polyhydramnios - increased risk of what?
Excess amniotic fluid in the amniotic sac
| GDM
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Infections in which trimesters are most harmful to a) mother and b) foetus?
a) most harmful to mother in the third trimester
| b) most harmful to foetus in the first trimester - this is where all of the foetal development is occurring
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Infections in which trimesters are most harmful to a) mother and b) foetus?
a) most harmful to mother in the third trimester
| b) most harmful to foetus in the first trimester - this is where all of the foetal development is occurring
48
How to diagnose bacterial infection in pregnancy?
Swab/sample and culture this
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How to diagnose viral infection in pregnancy?
Serology and pCR (very sensitive and very quick)
50
First antibody produced to infection
IgM
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Second antibody produced to infection - when has the person contracted the infection if this antibody is present?
IgG - within the past 24 to 48 hours
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Infections routinely tested for antenatally
Hep B
HIV
Syphilis
+ regular ultrasound to monitor foetal development
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Viral infection affecting the blood is?
a
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Virus that is the most common cause of congenital sensorineural deafness and treatment?
CMV - herpes virus
| Treat with antiviral gancyclovir
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More common names for VZV (varicella zoster virus) and treatment
Congenital/neonate/infants - chicken pox
Adults - shingles
Treatment is (val)acyclovir
56
Two type of Herpes and what they are most responsible for plus treatment
HSV1 - oral
HSV2 - genital
NOW evidence that they are both responsible for both
Treatment is acyclovir
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What is the worst infection for a foetus to contract and why?
Rubella
| Eye abnormalities leading to blindness, sensorineural deafness, congenital heart disease, death
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What is the treatment for syphilis?
Penicillin
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What viral condition does 'blueberry muffin appearance' describe?
CMV
| Also appears in rubella
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What is the most common congenital infection in developed countries?
Congenital CMV
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What viral infection is indistinguishable from glandular disease/fever?
CMV
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How can you recognise congenital rubella from looking in an infants eye?
Cataracts will be present - shine a light into their eye and it will appear white
Will not see a red reflex
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Which virus is responsible for gandular fever/disease?
Epstein Barr virus
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How do the presentations e.g. on a penis of HSV2 and HPV differ?
HPV - genital wart
| HSV2 - genital sore
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What is septicaemia?
Blood poisoning i.e. infection of the blood
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What are the signs of septicaemia?
```
Tachycardia
Tachypnoea
Rash
Prolonged capillary refill
Low BP - late sign
```
67
What is the definition/temperature for a fever?
Temperature greater than 37.5 (rectal temp)
Taken by mouth will be 0.5 degrees lower than rectal temp
Taken by armpit will be 1 degree lower than rectal temp
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Give the names of three organisms that will cause septicaemia and meningitis
Streptococcus pneumonia
Neisseria meningitidis
Haemophilus influenzae B
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What are the signs of meningitis?
```
High temperature
Headache
Vomiting
Cannot tolerate bright lights
Drowsy
Stiff neck
```
70
What is the problem with meningitis symptoms in infants?
Non-specific symptoms e.g. high temperature, sleepy, vomiting, blotchy skin
71
What are the three most common bacterial infections in infants?
Group B strep
E. Coli
Listeria
72
How will tetanus present in a neonate and how might this be contracted?
Weak
Lethargic
Poor suck
Muscle spasms
Contracted from bacteria getting into wound - bacteria from soil e.g. unclean blade used to cut the cord
73
What is ALL and what is it's relevance as a cancer in children?
Most common malignancy in children and most frequent cause of death in cancer children
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What are the signs of ALL?
Bruising/bleeding
Pallor and fatigue
Infection (due to neutropenia)
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Where will infiltration be seen in ALL?
Liver
Spleen
Lymph nodes
Mediastinum
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What glycoproteins on the surface of cells are associated with ALL?
CD19+
| CD10+
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When is methotrexate used in the treatment of ALL/cancer?
Used in the treatment of tumours which have reached the brain
78
What is Wilm's tumour?
This is a tumour of the kidney
| Aka. Nephroblastoma
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What is the cause of Wilm's tumour?
Deletion of or part of chromosome 11
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How does Wilm's tumour present?
Asymptomatic abdominal mass on the back
| NO metastasis
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Is Wilm's tumour genetic?
Both genetic and epigenetic
| If present on multiple locations of the kidney then more likely to be genetic
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Why is the use of radiotherapy dangerous in children?
Because you want to preserve all the tissues
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What is a retinoblastoma?
Tumour of the retina - multifocal i.e. multiple tumours
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What are the origin cells of retinoblastomas?
Cone precursor cells
85
Give two genes involved in the onset of retinoblastoma
Loss of RB1
| Activation of MYCN
86
What is a neuroblastoma in children and where is this present?
Tumour of the sympathetic NS
| Present on the adrenal gland or at the sympathetic ganglia
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Three stages of pregnancy
Antepartum - prior to labour: early is <24 weeks and late is >24 weeks
Intrapartum - in labour: the first and second stages
Postpartum - from delivery of the foetus up to 6 weeks later
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Line between miscarriage and stillbirth
24 weeks
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Define spontaneous miscarriage
When a foetus dies/is delivered dead prior to 24 weeks
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Six types of spontaneous miscarriage
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Threatened
Inevitable
Incomplete
Complete
Septic
Missed
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Threatened miscarriage
Light and painless bleed, the foetus is alive and the uterus is at the expected size
Only 25% of these go on to miscarry
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Inevitable miscarriage
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Heavy bleeding
The foetus may be alive at this point
The cervical os is open
Crampy pelvic pain will occur
The miscarriage is about to occur - it is inevitable
```
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Incomplete miscarriage
Only some parts of the foetus have passed
Bleeding continues
Cervical os is open
Requires medical aid for the removal of all foetal matter
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Complete miscarriage
All foetal tissue is removed
The uterus is small
The cervical os is closed
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Septic miscarraige
The contents of the uterus is infected and this causes endometritis
Tender uterus
Fever may be absent
May progress to a pelvic infection and this can cause abdominal pain and peritonism
96
Missed miscarriage
The foetus has not developed or has died in utero
Only recognised later with bleeding or scans
Uterus is smaller than expected
Cervical os closed
Minimal abdominal pain and vaginal bleeding
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Presentation of missed miscarriage on a scan
Abnormally shaped amniotic sac with no embryo
| Foetus with no heartbeat
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Define recurrent miscarriage
Woman has three or more consecutive miscarriages
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Define cervical incompetence
Where the cervix fails to retain the pregnancy
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Define ectopic pregnancy
Implantation of a fertilised ovum outside of the endometrium
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Pharmacological treatment for ectopic pregnancy
Methotrexate
102
Define molar pregnancy
Where a non-viable, fertilised egg implants into the uterus
| This egg will fail to come to term
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Explain molar pregnancy
Egg contains no maternal nucleus - entirely paternal in origin
The uterine trophoblast tissue differentiates and expands more aggressively than normal
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Define partial molar pregnancy
Some presence of foetal tissue but not complete presence
| Will not come to term
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Define gestational trophoblastic disease
Pregnancy related tumours
| The trophoblastic tissue
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Define antepartum haemorrhage
a
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Two types of antepartum haemorrhage
a
108
Define antepartum
a
109
Define placental abruption
a
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Symptoms of placental abruption
a
111
Define placenta praevia
a
112
Symptoms of placenta praevia
a
113
What is a tense, 'woody' uterus characteristic of?
a
114
Two types of placenta praevia
a
115
How can you differentiate between placental abruption and placenta praevia if the patient has vaginal bleeding?
a
116
Define pre-eclampsia
a
117
Cause of pre-eclampsia
a
118
When does pre-eclampsia occur?
a
119
What is the main driving force for BHP (benign hypertrophy of the prostate)?
Testosterone
120
Does BHP have hypertrophy or hyperplasma?
Has both despite name
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Why is there hypertrophy in BHP?
a
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Why is there hyperplasia in BHP?
a
123
In which testicle does a variocele occur and why?
a
124
Normal birthweight for infants
Just under 3.5kg
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Low birthweight for infant
<2.5kg
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Very low birthweight for infant
<1.5kg
127
Extremely low birthweight for infant
<1kg
| Generally not compatible with life
128
Full term range of gestational age
37-42 weeks
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Preterm gestational age
<37 weeks
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SGA parameter
a
131
What is IUGR
a
132
Main concern with SGA neonate
Barker hypothesis - development of CVD, hypertension, type 2 DM
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Main concern with premature neonate
Neurological developmental issues
134
Monochorionic vs. dichorionic twins
Monochorionic - twins share a placenta
| Dichorionic - twins have their own placenta
135
'Twin-twin transfusion'
One twin receives more circulation than the other - grows larger
136
'Edwards syndrome'
Trisomy 18
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Foetus prioritises blood flow to which three regions?
Brain
Heart
Adrenal gland
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Two consequences of foetal hypoglycaemia
a
139
Two presentations of feotal hypoglycaemia
a
140
Three reasons temperature control is a problem in SGA baby
a
141
'Ductus arteriosus'
Between the aorta and pulmonary artery
142
'Ductus venosus'
Between the left umbilical vein and IVC
143
'Foramen ovale'
Between left and right atria
144
Function of ductus venosus
Allows the blood circulation to bypass the liver
145
Function of foramen ovale
Movement of blood from right atria to left atria
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Nerve roots of the pudendal nerve
S2, S3, S4
147
Common pathology at the vesico-uterine pouch + presentation
Chronic endometriosis
Cyclical pain
NB. also important in retroversion of the uterus
148
Ground glass shadowing in x-ray of infant is significant of what?
Respiratory distress syndrome - lack of surfactant production
149
Presentation of necrotising enterocolitis
Tenderness
Discolouration
Distended abdomen
Generalised collapse
