Overview Flashcards
(516 cards)
1
Q
Ovarian artery comes off of the aorta at what level?
A
L2(/3)
2
Q
Aorta bifurcates into the common iliacs at what level?
A
L4
3
Q
Branches of the internal iliacs that exit the pelvis are? x3
A
Superior gluteal
Inferior gluteal
Internal pudendal
4
Q
The branches of the internal iliac artery that exit the pelvis all pass through which structure?
A
Greater sciatic foramen
5
Q
Branches of the internal iliac that remain in the pelvis? x5
A
Umbilical artery Obturator artery Inferior vesical artery Uterine/vaginal arteries Middle rectal artery
6
Q
Uterine artery anastomoses with which artery?
A
Ovarian
7
Q
When does the external iliac artery become the femoral artery?
A
Once it passes under the inguinal ligament
8
Q
Symptoms of ectopic pregnancy x8
A
Light vaginal bleeding Nausea and vomiting with pain Lower abdominal pain Sharp abdominal craps Pain on one side of the body Dizziness/weakness Pain in shoulder, neck or rectum Possible fainting
9
Q
Most common location for ectopic pregnancy?
A
Ampulla of the fallopian tube
10
Q
Why does ectopic pain present in the shoulders and neck?
A
Blood can irritate the diaphragm - nervous innervation C3, 4, 5
11
Q
Artery to the body of uterus?
A
Uterine
12
Q
Artery to the cervix of uterus?
A
Vaginal
13
Q
Artery to upper part of uterus?
A
Vaginal
14
Q
Artery to the fundus of uterus?
A
Uterine
15
Q
What is the artery of sampson?
A
Anastomosis between uterine, ovarian and vaginal artery
16
Q
Vaginal artery branches off of which artery with what?
A
Branches off of internal iliac with the uterine artery
17
Q
Three ligaments that support the uterus are?
A
Transverse cervical/cardinal ligaments
Pubocervical ligaments
Sacrocervical ligaments
18
Q
Rectouterine pouch is also known as?
A
Pouch of Douglas
19
Q
External iliac vein and artery - which is medial and which is lateral?
A
VEIN - MEDIAL
ARTERY - LATERAL
20
Q
Most important function of levator ani muscle?
A
Prevention of uterine prolapse
21
Q
What is uterine prolapse?
A
Uterus slips down into/protrudes out of the vagina
22
Q
What re enters the pelvis through the lesser sciatic foramen?
A
Internal pudendal artery/vein
23
Q
Three branches of the pudendal nerve?
A
Inferior rectal nerve
Dorsal nerve of penis/clitoris
Perineal nerve
24
Q
Function of bulbospongiosus muscle? x2
A
Reduces the size of the vaginal orifice
Compresses the dorsal vein of clitoris for excretion of moisture to the vagina
25
Bartholin's gland - located anterior or posteriorly?
Posteriorly
26
Appearance of the clitoris?
Bulb shaped structure anteriorly located
27
Nerve roots of pudendal nerve?
Sacral plexus - S2, 3, 4
28
Bartholin's gland is also known as?
Greater vestibular gland
29
Where are general visceral afferents sympathetic?
T1-L2
30
Where are general visceral afferents parasympathetic?
S2-S4
31
Spinal anaesthesia anaesthesis what area?
Complete anaesthesia below the waist
32
Where is spinal anesthesia carried out? (vertebral level)
L4-L5
33
What commonly follows spinal anesthesia?
Headache
34
Where is pudendal nerve block administered?
S2-S4
35
Perineal nerve block anaesthathises what region?
Perineum and the lower 1/4 of the vagina
36
What does caudal epidural anaesthesise?
Cervix and vagina
37
Which muscle of the levator ani forms a sling around the rectum?
Puborectalis
38
Which anaesthesia type is done most inferiorly?
Pudendal nerve block
39
Which anaesthesia type is done most superiorly?
Spinal block via lumbar puncture
40
What is cytocele?
Prolapse of the uterus
41
What is rectocele?
Prolapse of the rectum
42
What is enterocele?
Prolapse of the small intestine
43
What is urethrocele?
Prolapse of the urethra into the vagina (posteriorly)
44
What is the innervation of the perineum?
Perineal nerve arising from the pudendal nerve
| Pudendal nerve is derived from
45
Nerve roots of the perineal nerve?
S2, 3, 4
Perineal nerve arises from the pudendal nerve
Pudendal nerve is derived from the somatic plexus - nerve roots S2, 3 and 4
46
Right ovarian vein drains to?
Inferior vena cava IVC
47
Left ovarian vein drains to?
Left renal artery
48
Urethra is located in which zone of the prostate?
Transitional
49
Prostate cancer occurs in which zone of the prostate?
Hyperplasia in peripheral zone
50
Benign hyperplasia of the prostate occurs in which zone?
Transitional
Natural transitional changes with age
51
Which cells are involved in BHP and which zones?
Stromal cells
In the transitional zone
52
Four factors that contribute to BHP
Increasing age
Testicular androgens
Oestrogens
Neurotransmitters (from gland)
53
Testosterone is normally converted to what? x2
Estradial
| DHT
54
Effect of estradial on stromal cells is?
Proliferation
55
Enzyme involved in conversion of estradial to DHT?
5-alpha-reductase
56
Effect of oestrogen on epithelial cells?
Apoptosis
57
Five symptoms of BHP
```
Weak/interupted flow of urine
Nocturia - frequent urination
Trouble urinating
Pain or burning during urination
Blood in urine or semen
SHITE FUN
```
58
Of those that have BHP, how many will have histological changes?
50%
59
Four ways to diagnose BHP?
History
Digital rectal exam (DRE)
Ultrasound - biopsy
Blood test
60
What are you looking for in the blood test for BHP?
PSA levels - prostate specific antigen
61
PSA is specifically known as?
Gamma-seminoprotein
62
Two treatment types for BHP?
Alpha-1 adrenergic blockers
| 5-alpha reductase inhibitors
63
Function of alpha-1 adrenergic blockers for treatment of BHP?
Relaxation of smooth muscle in the bladder neck - urethra can dilate and aids urine flow
64
Function of 5-alpha reductase inhibitors?
Prevents conversion of testosterone to DHT
| SO prevents apoptsis
65
Name two 5a reductase inhibitors
Dutasteride
| Finasteride
66
Five surgical options for BHP?
```
Transurethral resection of the prsotate
Open prostactectomy
Laser ablation
Transurethral microwave
High energy ultrasound therapy
```
67
Indication for use for open prostatectomy?
For very large prostate
68
PSA levels - BHP vs. prostatic cancer
PSA levels much greater in prostatic cancer than in BHP
69
Which inguinal hernia type will appear in the testes?
Indirect
70
Which inguinal hernia type will appear through the abdominal wall?
Direct
71
Which arteries undergo expansion during an erection?
Cavernosa arteries
72
What causes the veins of the penis to close to allow for an erection?
Blood pressure of the arteries rises about systolic pressure
73
Muscular involvement of erection is?
Smooth muscle relaxation - also occludes the veins
74
Chemical involved in erection is?
NO - smooth muscle relaxation
75
Receptors involved in ejaculation?
Noradrenaline - sympathetic
76
Treatment for erectile dysfunction is? x2
PDE-5 inhibitor - sildenafil/viagra
| Penile prosthetics
77
Peyronie's disease is recognised via?
Bent penis
78
What is variocele?
Varicose veins of the scrotum
79
Variocele more common in which testicle?
Left
80
Why does variocele lead to infertility?
Pooling of blood - 2 degree rise in temperature
81
How can you recognise the ureter from a prosection?
Ureter follows the same path as the internal iliac artery
82
Gleeson grading system is used for?
Assessment of development of prostate adenocarcinomas
83
Gleeson grade 1 vs. gleeson grade 5?
Gleeson grade 1 - well differentiated
| Gleeson grade 5 - poorly differentiated
84
Sertoli/leydig cell - which of these is the interstitial cell located in interstitial tissue?
Leydig cell
85
What is meant by cryptcorchidism?
Undescended/maldescended testes
86
Maldescent of the testes is a risk factor for what?
Seminoma development - germ cell tumour
87
How can you differentiate between seminomas and non-seminomatous germ cell tumours?
Seminomas are usually pure and composed of one cell type
| Non-seminomatous tumours are usually composed of a mix of tumours
88
Seminoma is in males or females?
Males
89
Seminoma equivalent in females?
Dysgerminoma
90
Seminoma/non-seminomatous germ cell tumours - which tend to be diagnosed at more/less advanced stages?
Seminomas - tend to be detected earlier on
| Non-seminoma - tends to be detected at more advanced stage
91
What is a colposcopy?
Smear test
92
Changes to the breast with age - relating to adipose tissue
Increasing age, increased levels of adipose tissue in the breast
93
Benign breast tumour is often what tumour?
Fibroadenoma
94
What are the epithelial cells lining the prostate?
Pseudostratified epithelial cells
95
Alpha-fetoprotein (AFP) stains for what male tumour?
Yolk-cell tumour
96
Type 1 ovulatory cause of infertility is?
Hypopituitary failure
97
Type 2 ovulatory cause of infertility is?
Hypopituitary dysfunction
98
Type 3 ovulatory cause of infertility is?
Ovarian failure
99
Cause of type 1 ovulatory cause of infertility is?
Anorexia nervosa
100
Cause of type 2 ovulatory cause of infertility is? x2
PCOS
| Prolactinaemia
101
Cause of type 3 ovulatory cause of infertility is?
Premature ovarian failure under 40 years old
102
Percentage of women in the UK with polycystic ovaries?
33%
103
Are polycystic ovaries the same as PCOS?
No
104
Presence of what condition must also be present for PCOS?
Metabolic abnormalities
105
Fibroids are what specifically?
Uterine leiomyoma - benign tumour of uterine smooth muscle myometrium
106
Drugs causing infertility in women x5
```
Long term NSAIDs
Chemo
Neuroleptics
Spironolactone
Depo-provera
```
107
80% of couples that present with infertility are pregnant after how many cycles?
12
108
Early referral to specialist for infertility is made if? x2
Woman is over 36 years old
| Known clinical cause of infertility/history of predisposing factors for infertility
109
Five tests done for PCOS screen?
```
Day 21 progesterone
FSH levels
LH levels
Serum testosterone
Glucose levels
```
110
LRL volume of sperm count?
1.5
111
LRL progressive motility for sperm count?
32%
112
LRL morphology for sperm count?
4% normal
113
Ovarian reserve testing used to test?
Response in IVF
114
Investigation used to asses uterine function?
Laparoscopy
115
Investigation used to asses tubal function?
HSG dye to image tubes
116
Three treatments for type 1 ovulatory disorder?
Increase weight
Decrease exercise
Consider pulsatile GnRH
117
Treatment for type 2 ovulatory disorder?
Weight loss to BMI 30 or below
118
First line treatment for PCOS?
Consider clomiphene or metformin
119
Main side effect of metformin is?
GI side effects
120
Second line treatment for PCOS? x3
Combined clomiphene and metformin
Laparoscopic ovarian drilling
Gn therapy
121
Donor eggs should be considered in which type of ovulatory disorder?
Type 3 - ovulatory failure
122
Contraindication of clomiphene use?
Should not be offered in unexplained infertility
123
IVF should be offered for unexplained infertility when?
After two years
124
IUI offered to? x3
Cannot have vaginal intercourse e.g. disability
Sperm wash required
Same sex relationships
125
How many cycles of IUI before IVF is offered?
12
126
IVF offered to who? x2
Women under 42 who have not conceived for two years of unprotected sex
127
How many cycles of IVF offered to women under 40?
3
128
How many cycles of IVF offered to women between 40 and 42?
1
129
Gn or clomifene treatment has what adverse effect?
Ovarian hyperstimulation syndrome
130
Intracytoplasmic sperm injection (ICSI) indicated for use in? x4
Severe deficits in semen quality
Obstructive azoospermia
Non-obstructive azoospermia
Couple in whom prior IVF has failed/poor outcome
131
Ovarian tumours are a small risk of what fertility treatment?
IVF
132
Relation of pregnancy to diabetes?
Pregnancy is a state of insulin resistance and glucose intolerance
133
Secretion of what three anti-insulin hormones in pregnancy?
HPL
Cortisol
Glucagon
134
Percentage of women taht develop diabetes during pregnancy is?
1-2%
135
Risk factors for gestational diabetes? x6
```
Previous GDM
Macrosomic baby
Previous unexplained stillbirth
Obesity
Glycosuria
Polyhydramnios
```
136
Four maternal complications of gestational diabetes?
Hyper/hypoglycaemia
Pre-eclampsia
Infection
Thromboembolic disease
137
Four foetal complications of gestational diabetes?
Macrosomia
Respiratory distress syndrome
Hypoglycaemia
Hyperbilirubinaemia
138
Glucose tolerance test should be taken when in someone with gestational diabetes?
6 weeks following delivery
139
Ultrasound should be taken how often in someone with gestational diabetes?
Every two weeks
140
Most common bacteria causing infection in pregnancy?
Group B streptococcus
141
Group B strep is normal flora in what percentage of women?
25%
142
Four consequences of group B strep infection on the neonate?
Pneumonia
Meningitis
Non-focal sepsis
Death
143
Drug given if known that women has group B strep in vagina?
Benzylpenicillin
144
Two consequences of UTI on the foetus?
Growth restriction
| Preterm labour
145
Consequence of UTI on the mother during pregnancy?
Pyelonephritis - inflammation of the kidney
146
Normal treatment for UTI is?
Trimethoprim
147
Why can trimethoprim not be given in pregnancy
It is teratogenic in first trimestor
148
First line treatment of UTI in pregnancy?
Penicillin
149
Second line treatment of UTI in pregnancy?
Cephalpsporin
150
Untreated syphilis in mother - what is the risk of congenital syphilis?
50% risk
151
Sign of primary syphilis?
Primary chancre
152
Sign of secondary syphilis?
Rash
153
Treatment for syphilis?
Penicillin
154
Antepartum is when?
Prior to labour
155
Early antepartum is when?
<24 weeks
156
Late antepartum is when?
>24 weeks
157
Intrapartum is when?
First and second stages of labour
158
Postpartum is when?
Delivery to six weeks post partum
159
Miscarriage vs. stillbirth?
Miscarriage <24 weeks
| Stillbirth >24 weeks
160
Hyperemesis gravidarum is?
Exaggerated nausea and vomiting in early pregnancy
161
Treatment of hyperemesis gravidarum? x4
Dietary advice
IV fluids
Thiamine
Antiemetics
162
What should be avoided in hyperemesis gravidarum?
Dextrose
163
Spontaneous miscarriage is?
Foetus dies/delivered dead <24 weeks
164
Uterine size in threatened miscarriage?
Expected size
165
Cervical os open or closed in threatened miscarriage?
Closed
166
What percentage of those who suffer from a threatened miscarriage will then go on to miscarry?
25%
167
Cervical os open or closed in inevitable miscarriage?
Open
168
Cervical os open or closed in incomplete miscarriage?
Open
169
Cervical os open or closed in complete miscarriage?
Closed
170
Uterine size in missed miscarriage?
Smaller than expected
171
Cervical os open or closed in missed miscarriage?
Closed
172
Three investigations for spontaeous miscarriage?
Ultrasound
Serum bHCG
Bloods - FBC, Rhesus
173
Serum bHCG increases by what percentage in a viable pregnancy?
66% in 48 hours
174
Recurrent miscarriage is?
Three or more consecutive miscarriages
175
Cervical incompetence is?
Cervix fails to retain the pregnancy
176
Ectopic pregnancy is?
Implantation of fertilised ovum outside of the endometrial cavity
177
Emergency contraception is a risk factor for what (relating to pregnancy)?
Ectopic pregnancy
178
Presentation of ectopic pregnancy?
PV bleeding - scanty and dark
Lower abdominal pain
Collapse
Amenorrhoea for 4-10 weeks
179
Gestational trophoblastic disease is also known as?
Molar pregnancy
180
What is gestational trophoblastic disease?
Trophoblast proliferates more aggressively than normal
181
Three signs of gestational trophoblastic disease?
PV bleeding
Hyperemesis gravidarum
Passage of vesicles via the vagina
182
Placental abruption is?
Placenta partially/completely separates from the uterus prior to birth
183
Description of uterus in placental abruption is?
Woody - tense/tender
184
Management of placental abruption?
Resuscitate
| Steroids if <34 weeks
185
Placenta praevia is?
When the placenta inserts into the lower part of the uterus after 24 weeks
186
Major placenta praevia?
Covers the os
187
Minor placenta praevia?
Does not cover the os
188
Sign of placenta praevia?
Painless vaginal bleeding
189
What should NOT be done to investigate palcenta praevia?
Vaginal examination
190
Four characteristics of pre-eclampsia?
Hypertension
Renal impairment
Fluid retention/oedema
Weight gain
191
Cause of pre-eclampsia?
Abnormal maternal adaptation to the trophoblast
192
Cytomegalovirus CMV - what is the virus type?
Herpes virus
193
Treatment for CMV is?
Gancyclovir
194
Congenital CMV is the most common cause of what in neonates?
Sensorineural deafness
195
Varizella zoster virus VZV - four different types are?
Congenital - chicken pox
Neonatal - chicken pox
Infantile - chicken pox
Shingles - adult
196
VZV virus type is?
Herpes virus
197
Treatment for VZV is?
(Val)acyclovir
198
Presentation of shingles is?
Dermatomal rash along dorsal root ganglion from which virus is activated
199
HSV1 vs. HSV2?
HSV1 - oral
| HSV2 - genital
200
Treatment for HSV?
Acyclovir
201
Rubella is important as a congenital disease why?
Rubella is the WORST INFECTION FOR THE FOETUS
202
Four consequences of congenital rubella?
Blind
Sensorineural deafness
Congenital heart disease
Death
203
Treatment for rubella?
No treatment
MMR vaccine
204
Can the MMR vaccine be given during pregnancy?
No
205
Parvovirus also known as?
Slap cheek syndrome
206
Consequence of parvovirus on the foetus is?
Hydrops fetalis - cardiac failure in feotus
207
Significance of parvovirus infection?
ANYTHING TO DO WITH BLOOD
208
Treatment for parvovirus?
Intrauterine blood transfusion
209
Two routes of spread of toxoplasmosis?
Infected food
| Cat
210
Toxoplasmosis carries the greatest risk in which trimester?
First
211
Four consequences of toxoplasmosis on the neonate?
IUGR
Hydrocephalus
Microcephaly
Hepatosplenomegaly
212
Virus responsible for glandular fever is?
Epstein Barr virus
213
Which viral infection in pregnancy can result in cataracts in the neonate?
Congenital Rubella
214
Peurperium is?
From delivery to six weeks after
215
What happens to the uterus during the peurperium?
Uterus involutes
216
Most common case of maternal death from 2012-2014?
Cardiac disease
217
What is post-partum haemorrhage PPH?
Excessive bleeding following delivery
218
Primary PPH is?
>500ml blood loss from the genital tract within 24 hours
219
Secondary PPH is?
Abnormal bleeding from genital tract from 24 hours after delivery up until 6 weeks after
220
Primary/secondary PPH - which is more common?
Primary
221
Incidence of PPH worldwide?
5%
222
Four causes of PPH?
Tone - uterine atony
Tissue - retained
Trauma - laceration
Thrombin - coagulopathy
223
Most common cause of PPH is?
Uterine atony
224
Initial treatment for uterine atony?
Bimanual uterine massage and compressiion
225
Hormones given to manage uterine atony? x2
Oxytocic agents e.g. syntometrin
| Prostaglandins
226
Two causes of secondary PPH?
Infection - endometritis
| Tissue - retained products of conception
227
Three symptoms of venous thromboembolism?
DVT
PE
Central vein thrombosis
228
Three common post-partum mental health conditions are?
Postpartum blues
Postpartum depression
Postpartum psychosis
229
Postpartum blues are?
Tearfulness and liability at times but mostly happy
230
Postpartum blues tends to occur when?
3-5 days after delivery
231
Four symptoms of postpartum psychosis?
Loss of contact with reality
Hallucinations
Severe thought disturbance
Abnormal behaviour
232
Postpartum depression typically onsets when?
In the first 10 days following childbirth
233
Fusion of the cardiac tube is complete at what day?
Day 21
234
Heart starts beating at what day?
Day 23
235
Atrial, ventricular and outflow tracts of the heart separate by what day of development?
Day 28
236
Majority of cardiac development occurs in which trimester?
First
237
What is the foramen ovale?
During foetal life - hole between the atria
238
What is the ductus arteriosus?
Connection between the pulmonary artery and the aorta
239
What is the ductus venosus?
Between left umbilical vein and vena cava
240
Function of ductus venosus?
Blood bypasses the liver from the palcenta
241
Foetal circulation - pulmonary circulation is high or low resistance?
High
242
Foetal circulation - systemic circulation is high or low resistance?
Low
243
Oxygenated blood is in umbilical vein or umbilical artery?
Umbilical vein
244
Foetal circulation - pulmonary circulation and systemic circulation - which is greater pressure?
Pulmonary pressure > systemic pressure
245
Foetal circulation - blood flow from R to L or L to R?
Foetal circulation blood flow right to left
246
Transition circulation from foetus to adult - pulmonary and systemic pressure which is greater?
Systemic pressure > pulmonary pressure
247
Transitional circulation - blood flow from R to L or L to R?
Left to right
248
What is persistant pulmonary hypertension of the newborn?
Direction of blood shunting does not reverse at birth
249
What is transposition of the great vessels?
Aorta takes blood from the right ventricle rather than teh left ventricle and PA takes blood from left ventricle rather than right ventricle
250
Four features of teratology of fallot are?
Ventricular septal defect
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
251
What is atresia?
Valve does not form properly and is completely blocked - no blood flow through here
252
What is ventricular septal defect VSD?
Ventricular septum does not close at birth
253
Blood flow in VSD?
High pressure on left side of heart so left to right shunting
254
How can ductus arteriosus be reopened?
Prostaglandin E
255
Myelomeningocoele is?
Meninges and neural tissue protrude out of the surface - can include the spinal cord
256
What is gastroschisis?
Defect in abdominal wall lateral to umbilicus
257
Presentation of gastrochisis?
Bowel is free within the amniotic cavity
258
Gastrochisis - how long for the bowel to start functioning properly?
1-3 months
259
Recognise gastrochisis from image?
Bowel/intestine has protruded out of the anterior abdominal wall in the neonate
260
Apgar score is used to asses what?
Indication for birth asphyxia/neurological signs in neonate
261
Five components of the apgar score are?
```
Heart rate
Respiratory effort
Muscle tone
Reflexes
Colour
```
262
How many grades from the apgar score?
Three
I - less severe
III - more severe, likely to die and definite neurological deficit
263
Birth asphyxia results in what complication?
Hypoxic ischaemic encephalopathy
264
Presentation of neonate with asphyxia? x4
No breathing
HR <60 (bradycardia)
Floppy - low tone
Seizures
265
Treatment of seizures in birth asphyxia? x3
Phenobarbitone
Phenytoin
Clonazepam
266
Temperature based treatment for HIE?
Cooling baby for
267
Grading system to asses for HIE is?
Sarnat and sarnat
268
HIE leads to what major neurological disorder?
Cerebral palsy
269
Why are neonates with HIE cooled? (hypothermia treatment) x5
```
Reduced cerebral metabolism
Reduced energy use
Reduced accumulation of amino acids
Reduced NOS activity
Reduced free radical activity
```
270
Treatment for group B streptocossus infection in the neonate?
Benzylpenicillin
271
Weight for normal term baby?
3.5kg
272
Weight of low birthweight baby?
<2.5kg
273
Weight of very low birthweight baby?
<1.5kg
274
Weight of extremely low birth weight baby - significance?
1kg - not compatible with life
275
Premature baby is?
Baby born <37 weeks gestation
276
Should you cool a premature baby?
NO - can increase chance of death
277
What is surfactant?
In the lungs to reduce the surface tension and prevent collapse
278
Significance of surfactant in premature infants?
Premature - they are surfactant deficient
279
Respiratory distress syndrome is?
Deficiency in surfactant in the neonate
280
Hyaline membrane disease is?
Same as respiratory distress syndrome - this is the histological name
281
Chronic lung disease of infancy is also known as?
Bronchopulmonary dysplasia
282
What is chronic lung disease of infancy?
If the baby with RDS survives then they are likely to develop this
283
What is an SGA baby?
Birth weight below 10th centile for gestation
284
Is an SGA baby pathological?
No e.g. small parents
285
Four causes of SGA baby
Chromosomal abnormalities
Normal
Smoking
Multiple pregnancy
286
Methods to monitor foetal growth? x2
Abdominal circumference
| Head circumference
287
IUGR is?
Faltering growth of the foetus - failure to achieve normal foetal growth rate
288
Incubator for premature infant is warm or cold?
Warm
289
Incubator for HIE infant is warm or cold?
Cold
290
Surfactant is composed of? x2
Lipids
| Proteins
291
Causes of nutritional challenges in preterm baby x4
Immature sucking
Presence of digestive enzymes
Poor gut motility
Cannot tolerate enteral feeds
292
Preterm baby requires how many calories for growth?
110-135kcal
293
Ig to baby transplacentally is?
IgG
294
What happens to the gut if the baby is not fed?
Gut mucous atrophy
295
What is necrotising enterocolitis?
Acute bacterial invasion/inflammation - necrosis of bowel
296
Four risk factors of necrotising enterocolitis?
Prematurity
Hypoxia
Infection
Enteral feeding
297
Presentation of necrotising enterocolitis? x5
```
Abdominal distension
Tenderness
Discolouration
Blood in stools
Generalised collapse
```
298
Treatment of respiratory distress syndrome? x2
Surfactant
| Respiratory support
299
Cause of persistant pulmonary hypertension of newborn PPHN?
Patent ductus arteriosus
300
Surfactant composed of? x2
Phospholipids
| Lipoproteins
301
What is pneumotosis?
Gas formation in the bowel wall
302
Most common infection in neonates <48 hours of birth?
Group B strep
303
Most common infection in neonates >48 hours of birth?
Negative staphylococci
304
Most common infection in neonates >48 hours of birth?
Negative staphylococci
305
Most common cause of IUGR?
Utero-placental insufficiency
306
Monochorionic twins are?
Twins share placenta
307
Dichorionic twins are?
Each twin has their own placental unit
308
Twin-twin transfusion is?
In monochorionic twins - one receives increased level of circulation than the other and grows larger
309
Edwards syndrome cause?
Trisomy 18
310
Age of survival with Edwards syndrome?
One year
311
Three organs prioritised to receive blood flow in hypoxia are?
Brain
Heart
Adrenals
312
Three organs prioritised to receive blood flow in hypoxia are?
Brain
Heart
Adrenals
313
Two types of genetic markers are?
Single nucleotide polymorphism - SNP
| Short tandem repeat STR
314
What is a genetic marker?
This tags a piece of DNA and can be used to track genes in families or populations
315
What is an exome?
All protein coding regions of DNA
316
Preferential to sequence an exome or a genome?
Exome - much smaller
| Genome consist of many tandem repeats which are not valuable
317
How are genetic variants scaled?
1-5
1 - non-pathogenic
5 - pathogenic
318
What is the problem with scaling genetic variants?
3 - variant of unknown significance - many variants fall into here
319
What is the problem with scaling genetic variants?
3 - variant of unknown significance - many variants fall into here
320
Turner syndrome genetic cause is?
45, X
321
Turner syndrome - males or females?
Females
322
Typical therapy administered to those with Turner syndrome?
Oestrogen replacement therapy
323
Turner syndrome - fertile or infertile women?
Infertile (almost always)
324
Klienfelter syndrome genetic cause is?
47, XXY
325
Kleinfelter syndrome - male or females?
Males
326
Primary feature of Kleinfelter syndrome?
Sterility
327
Child mental health problems more in boys or girls?
Boys
328
Four examples of conduct disorder - under 5yo
Aggression - physical and verbal
Destructive
Poor attention and concentration
Frequent, severe tantrums
329
Five examples of conduct disorder 5-12yo
```
Lying
Stealing
Defiance
Cruelty to animals
Disruption in school
Fire setting
```
330
Five examples of conduct disorder in adolescence?
```
Truancy
Delinquency
Violence
Sex offences
Drug/alcohol/substance abuse
```
331
Conduct disorders - more common in boys or girls?
Boys
332
Emotional disorders - more common in boys or girls?
No correlation to either sex
333
Two most prevalent emotional disorders?
Anxiety and fearfulness
| Depression
334
Conduct disorders - relate to socioeconomic status
More prevalent with low socioeconomic status
335
Emotional disorders - relate to socioeconomic status
No relation to socioeconomic status
336
Three examples of adjustment disorders
Bereavement
Divorce
Physical illness
337
Three signs of ADHD
Overactivity
Inattention
Impulsivity
338
ADHD - more prevalent in boys or girls?
Boys (4:1 ratio)
339
Child should be able to speak fluently by what age?
3/4
340
Two diagnostic systems for mental health disorders are?
DSMV
| ICD10
341
Two diagnostic systems for mental health disorders are?
DSMV
| ICD10
342
Most common cause of chronic diarrhoea in childhood?
Irritable bowel syndrome
343
Most common cause of failure to thrive/weight loss in childhood?
Coeliac/CF
344
Most common cause of rectal bleeding/bloody stools in childhood?
IBS - Chohns or Ulcertaive colitis
345
Constipation is?
Infrequent, hard stools - passing stools <3 times per weekC
346
Soiling is?
Escape of stool into the underclothes
347
Encopresis is?
Passage of normal stools in abnormal places - involuntary passing of stools
348
Most common cause of encopresis?
Severe constipation in the child
349
Constipation is teh cause of what percent of visits t the paediatric practise?
3%
350
Delayed passage of meconium can result in waht in the child?
Organic cause of constipation
351
Four red flags for GORD in children
Haematemesis
Failure to thrive
Sandifers syndrome
Aspiration pneumonia
352
Sandifers syndrome is?
Back arching in infants
353
pH study - oH of what indicates GORD?
<4
354
What is 'impedance'?
Both acid and non-acid reflux
355
Abnormalities that can be identified by barrium swallow are? x5
```
GORD
Hiatus hernia
Aspiration
Polyoric stenosis
Malrotation
```
356
Two drugs that can be given to reduce acidity in children suffering from GORD?
H2 antagonists
| Protein pump inhibitors
357
Domperidone given to children with GORD why?
Promotility agent
358
How can feeds be changed for children suffering with GORD?
Thickening of feeds
359
Two surgical treatments for children suffering from GORD?
Jejunostomy feeds
| Nissen's funsoplication
360
What is eosinophillic oesophagitis?
Treatment resistant symptoms of GORD
361
Investigation to diagnose eosinophillic oesophagitis?
Endoscopy
362
Drug treatment for esoinophillic oesophogitis?
Budenosine
363
Drug treatment for esoinophillic oesophogitis?
Budenosine
364
Differential diagnosis for recurrent abdominal pain? x3
Migraine
IBS
Non-ulcer dyspepsia
365
Gastritis is?
Inflammation of gastric mucosa
366
Two causes of gastrisis?
Helicobacter Pylori infection
| NSAID usage
367
Four symptoms of gastrisis?
Vomiting
Abdominal pain
Haematemesis
Anaemia
368
Three ways to diagnose helicobacter pylori?
Endoscopy
Stool antigen
Urea breath test
369
Enzyme produced by helicobacter pylori?
Urease
370
Two treatments for HP infection?
Amoxycillin
| Carithromycin
371
Three symptoms of Crohn's disease?
Abdominal pain
Weight loss
Diarrhoea
372
Serum changes in Crohn's disease? x4
Raised ESR and CRP
| Low albumin and Hb
373
Treatment for IBD x4
Exclusive enteral nutrition only (Crohn's)
Steroids
5-ASA
Biologicals (anit-TNF infliximab)
374
Cause of painless rectal bleeding in toddlers?
Juvenile polyps
375
Juvenile polyps also known as?
Hamartoma
376
Exotoxin is?
Protein secreted by pathogen
377
Pathogen causing diptheria is?
Corynebacterium diphtheriae
378
Endotoxin is?
Part of the outer membrane of teh pathogen
379
What bacteria type have endotoxins?
Gram-negative bacteria
380
When are endotoxins released?
During lysis of organism
381
Endotoxin release causes what in the immune system?
Macrophage activation
382
Three effects of meningococcal disease on the body?
Myocardial depression
Endothelial dysfunction - leak
Coagulopathy
383
What is a fever?
Rectal temperature >37.8 degrees
384
Taking temperature by mouth - significance?
Temperature will be 0.5 degrees lower than rectal temperature
385
Taking temperature by underarm - significance?
Temperature will be 1 degree lower than rectal temperature
386
Three organisms that cause septicaemia and meningitis?
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae B
387
Four early of septicaemia
Tachycardia
Tachypnoea
Prolonged capillary refill
Rash
388
Late sign of septicaemia?
Low BP
389
Signs of meningitis?
```
High temperature
Headache
Cannot tolerate bright lights
Stiff neck
Drowsy
Vomiting
```
390
How is meningitis diagnosed?
Lumbar puncture - CSF
391
How to differentiate the cause of meningitis using CSF?
Protein content
392
Three potential causes of meningitis?
Bacterial
Viral
TB
393
Top 3 organisms causing infection in infants are?
Group B strep
E. Coli
Listeria
394
Most common antibiotic used in older children?
Ceftriaxone
395
Most common antibiotic used in younger children?
Cefotaxime
396
Neonatal period is until what age?
First 28 days
397
Streptococcus gram negative or gram positive?
Positive
398
Invasive diseases typically enter the body where?
Nasopharynx
399
Invasive disease - travels through what structure of the ear?
Eustachian tube
400
Define empyema
Collection of pus in the pleural cavity
401
Treatment for empyema x2
Chest drain + urokinase
| Video assisted thoracoscopic surgery (VATS)
402
Function of urokinase enzyme?
Conversion of plasminogen to plasmin - used to dissolve clots
403
Location of urokinase enzyme in the body?
Kidney
404
Urokinase enzyme also known as?
Urokinase-type plasminogen activator
405
Vaccine for pneumococcal infection? x2
Pneumococcal polysaccharide vaccine (PPV)
| Pneumococcal conjugate vaccine (PCV)
406
PCV pneumococcal vaccine given when? x3
2 months
4 months
12 months
407
Pathogen responsible for TB?
Mycobacterium tuberculosis
408
Number of people infected with mycobacterium tuberculosis worldwide?
1/3
409
Reactivation of TB has what effect in the lungs?
Forms cavity in the lungs
410
Pathogen responsible for tetanus?
Clostridium tetani
411
Clostridium tetani - gram positive or gram negative?
Positive
412
Tetanus acts where in the body?
Via exotoxin at the NMJ
413
Where is tetanus found non-pathogenically?
Spores in soil
414
Five signs of tetanus in neonate?
```
Weak
Lethargic
Poor suck
Spasms
Fits
```
415
Clostridium tetani - responsible for what disease?
Tetanus
416
Two classifications of fungi are?
Yeasts
| Moulds
417
Example of fungi yeast
Candida
418
Example of fungi mould
Aspergillus
419
Fungal infection nappy rash - organism responsible is?
Candidiasis
420
Fungal infection ringworm - organism responsible is?
Tinea corporis
421
Treatment for candidiasis and tinea corporis is?
Topical antifungal
422
Give two rare fungal infections
Candidaemia
| Pulmonary aspergillosis
423
Effect of candidaemia in preterm infant? x2
Affects kidneys and brain
424
Effect of pulmonary aspergillosis
Effects neutrophil function
425
Chronic granulomatous disease effects impairs function of which cells?
Neutrophils
426
Wiskott-Aldrich syndrome impairs function of which cells?
T-cells
427
Rare fungal infections rely on what for invasion?
Immunosuppression
428
Classification of protozoa x3
Sporozoa
Amoebae
Flagellates
429
Protozoa species causing malaria are?
Plasmodium
430
Plasmodium protozoa (malaria) are what type of protozoa?
Sprozoa
431
Four plasmodia causing malaria?
P. falciparum
P. vivax
P. ovale
P. malariae
432
Pathogen causing most severe strain of malaria is?
P. falciparum
433
Malaria causes how many deaths of children per year?
1 million
434
Four non-specific signs of malaria
Fever
Lethargy
Vomiting
Diarrhoea
435
Pathogen responsible for toxplasmosis?
Toxoplasma gondii (protozoa)
436
Splenectomy - risk of infection by what bacteria? x3
Encapsulated bacteria:
Pneumococcus
HiB
Meningococcus
437
Birth of preterm baby <24 weeks not viable - why? x2
Insufficient levels of surfactant and insufficient lung development
438
Pulmonary artery has a thin wall - why?
Low pressure blood to the lungs
439
Cause of a wheeze?
Oscillations in narrowed airways
440
Wheezes are inspiratory or expiratory?
Can be either
441
Frequency of wheeze is dependent on what factors? x3
Degree of narrowing
Elasticity of airway wall
Local airflow
442
Preschool wheeze is normally triggered by what?
Colds
443
Three risk factors for preschool wheeze?
Smoking in pregnancy
Air pollution
Younger mother
444
What is a transient early wheezer?
Wheeze only during first three years of life
445
Difference in transient early wheezers at birth compared to normal?
Born with low lung function and hyper-reactive lung
446
Transient early wheezers have normal lung function by what age?
11
447
Non-atopic wheezers tend to wheeze at what age range?
3-6 years
448
Asthma inflammation - lungs infiltrated with which two cells?
Lymphocytes
| Eosinophils
449
Three histological changes in atopic asthma?
Goblet cell hyperplasia
Thick sub basement membrane
Cellular infiltrate
450
Wheeze in infants originates from where?
Intra-thoracic airways
451
Most common childhood malignancy is?
Acute lymphoblastic leukaemia (ALL)
452
Most frequent cause of death from cancer in the <20 age group is from?
Acute lymphoblastic leukaemia (ALL)
453
Three presentations of ALL?
Bruising/bleeding
Pallor and fatigue
Infection
454
Bruising/bleeding in ALL is due to?
Thrombocytopenia
455
Pallor and fatigue in ALL is due to?
Anaemia
456
Infection in ALL is due to?
Neutropenia
457
Two mutations of ALL are?
MLL translocation
| TEL-AML1 translocation
458
MLL translocation in ALL occurs in which cells?
CD19+
459
TEL-AML1 translocation occurs in which cells? x2
CD19+
| CD10+
460
Four phases of treatment for ALL are?
Induction
Consolidation
Maintenance
Bone marrow transplantation
461
Wilms' tumour is also known as?
Nephroblastoma
462
Wilms' tumour effects which organ?
Kidney
463
Wilms' tumour - common age of onset?
<5 years
464
Prevalence of Wilms' tumour?
1/10,000 children
465
Presntation of Wilms' tumour?
Asymptomatic abdominal mass
466
Does Wilm's tumour typically metastasis?
No
467
Wilms' tumour bilateral or unilateral?
Often bilateral
468
Three cell types in Wilms' tumour?
Blastema
Epithelia
Stroma
469
Gene activated in Wilms' tumour is?
CTNNB1
470
Genes inactivated in Wilms' tumour are? x3
WT1
WTX
TP53
471
Retinal blastoma is?
Tumour of the retina
472
Retinal blastoma occurs at what age?
<5 years
473
Prevalence of retinoblastoma in the <5yo age group?
5%
474
Three symptoms of retinoblastoma?
Leukocoria
Eye pain/redness
Vision problems
475
Define leucocoria
White pupil when light is shone into it
476
Retinoblastoma is metastatic in what percentage of patients?
10-15%
477
Cellular origin of retinoblastoma is?
Cone precursor cells
478
Loss of what gene/protein in retinoblastoma?
RB1
479
Effect of non RB1?
Free E2F induces G1-S transition in cell cycle
480
Activation of what gene in retinoblastoma?
MYCN - oncagene
481
Amplification of what two genes in retinoblastoma?
MDM2
| MDM4
482
What pathway is inactivated in retinoblastoma?
p53 pathway inactivated
483
Most common cancer in the first year of life is?
Neuroblastoma
484
Three genes involved in development of neuroblastoma are?
MYCN
ALK
PHOX2B
485
Five steps in the viral life cycle
```
Attachment
Entry
Uncoating
Synthesis of viral components
Assembly and release
```
486
Viruses have DNA or RNA?
Can have either
487
Four stages of Hep B infection
Tolerance
Clearance
Latency
Reactivation
488
Two consequences of chronic Hep B infection
Cirrhosis
| Hepatocellular carcinoma
489
What is palivizumab?
Monoclonal antibody given for the prevention of bronchiolitis
490
Koplik spots are presnt in what vital infection?
Measles
491
Increased methylation - switches genes on or off?
Off
492
Decreased methylation - switches genes on or off?
On
493
Hypothalamo-pituitary axis - dopamine is inhibitory to?
Prolactin
494
Hypothalamo-pituitary axis - somatostatin s inhibitory to? x2
TSH
| GH
495
In which zone of the prostate gland is BHP most likely?
Transitional
496
In which zone of the prostate gland is prostatic cancer most likely?
Peripheral
497
In which zone of the prostate gland do the ejaculatory ducts open into?
Central
498
In which zone of the prostate gland does the urethra run through?
Transitional
499
The remnant of the uterus in the male is located where?
In the prostate
500
What is located at the mid-inguinal point?
Femoral artery
501
Keratin pearls are present in which histological diagnosis in female pathology?
Cervical squamous cell carcinoma
502
Koilocytes form in which histological diagnosis in female pathology?
Cervical neoplasia due to HPV infection
503
Basal layer is absent in what pathology of the prostate?
Adenocarcinoma of the prostate
504
Varicose veins of the testicle is called?
Variocele
505
Variocele is more common in right or left testicle?
Left
506
Whey is variocele more common in left testicle than right?
Left testicular vein drains into the renal vein at a right angle
507
Diagnostic test to differentiate between BHP and prostate cancer is?
PSA level
508
Incontinence during childbirth occurs due to which levator ani muscle specifically?
Puborectalis
509
Function of the trigone?
Signals to the brain when teh bladder is full
510
How does the trigone carry out its function?
Sensitive to stretch
511
Omphalocele vs. gastroschisis?
Gastroschisis - protrusion of the intestines through the ansterior abdominal wall
Omphalocele - protrusion of the intestines still contained within the peritoneum through the anterior abdominal wall
512
What is the blood supply to the perineum?
Perineal artery
513
What is the origin of the perineal artery?
Internal pudendal artery
514
What is the origin of the superior rectal artery?
Inferior mesenteric artery
515
What is the origin of the middle rectal artery?
Internal iliac artery
516
What is the origin of the inferior rectal artery?
Internal pudendal artery
