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38 Cards in this Set
- Front
- Back
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Define erectile dysfunction and describe the normal hypothalamic-pituitary-testicular axis.
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Impotence (erectile dysfunction) is the inability of male to achieve or sustain an erection adequate for satisfactory intercourse.
The normal hypothalamic-pituitary-testicular axis begins with secretion of GnRH from the hypothalamus. --> secretion of FSH and LH from the pituitary --> FSH acts on the Sertoli cells and causes secretion of Inhibin and helps in development of sperm. Inhibin reduces the secretion of FSH. LH acts on the Leydig cells and causes secretion of Testosterone. Testosterone acts on testes, and is also responsible for secondary sexual characteristics. Increase in Testosterone inhibits secretion of GnRH from the hypothalamus. |
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Define Prostatism.
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Prostatism is defined as the non-cancerous enlargement of prostate gland.
Prostatic carcinoma accounts for about 7% of all cancers in men and is the fourth most common cause of death from malignant disease. |
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Define the following
a. Kallmann’s syndrome |
a. Kallmann’s syndrome: it is isolated GnRH deficiency, often associated with decreased or absent sense of smell, and sometimes with other bony, renal and cerebral abnormalities.
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Describe the manifestations of Klinefelter's syndrome.
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Klinefelter’s syndrome (Seminiferous tubule dysgenesis) affects both the loss of Leydig cells and Seminiferous tubular dysgenesis. Patients usually present with poor sexual development, small or undescended testes, gynaecomastia or infertility. Sometimes, may be mentally retarded. Clinical examination would show small, pea-sized but firm testes, usually gynaecomastia and other signs of androgen deficiency.
It is confirmed by chromosomal analysis that will show presence of an extra X chromosome in the 47th pair. (47XXY) |
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Describe the rational of treatment of prostate and testicular cancers.
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Testicular tumours are broadly divided between seminoma and non-seminoma because seminoma is more sensitive to radiation therapy. Depending upon the cell type and stage of the disease, the treatment options can be:
- Retroperitoneal lymph node dissection - Chemotherapy - Radiation therapy - A combination of both after initial radical orchiectomy. - Endocrine therapy may also be useful in prostate tumours. |
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Discuss prostate cancer under the following headings.
a. Clinical features b. Prognostic factors c. Investigations d. Treatment |
Clinical features:
- Presentation may be with symptoms of lower urinary tract obstruction or metastatic spread particularly to bone. - Diagnosis may be made by incidental finding of a hard irregular gland on rectal examination. - Screening is done by measurement of PSA (prostate specific antigen) Investigations: - Transrectal ultrasound of the prostate and prostatic biopsy - Histological diagnosis is essential before treatment - Prostate specific antigen in blood - Pelvic MRI - Upper renal tracts can be examined by ultrasonography for evidence of dilatation. - Bone metastases may appear as osteosclerotic lesions on X-ray and detected by isotopic bone scans Prognostic factors - Histological appearance are graded and accorded a Gleason Score which together with the height of the serum PSA and accurate staging of the total extent of the disease with pelvic MRI and Transrectal USG can identify the prognostic group. - Patients with good prognosis require no active treatment and are kept under surveillance. Treatment - Curative surgery (radical prostatectomy) - Radiotherapy or brachytherapy - Adjuvant androgen deprivation treatment - Metastatic prostate cancer with either local or skeletal spread needs palliation - Survival rate up to 5 years in 85% cases - Psychological counselling and discussion between patient and clinician is vital before treatment is started. |
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b. Cryptorchidism
c. Azoospermia and Oligospermia |
. Cryptorchidism: failure of descend of the testes into the scrotum, which usually must occur by the age of 5 yrs.
c. Azoospermia and Oligospermia: Azoospermia is the absence of sperm in the ejaculate and Oligospermia is the reduced number of sperm in the ejaculate. |
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d. Prostatism
e. Gynaecomastia |
d. Prostatism: a symptom complex resulting from the compression or obstruction of the urethra.
e. Gynaecomastia: abnormal development of breast tissue in males. |
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Define endometriosis. What are the clinical features and investigations for Endometriosis?
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Endometriosis is the presence of ectopic endometrial tissue. Clinical features:
- Occurs mostly on the serosal aspect of the intestine - Bleeding, diarrhoea, constipation, adhesions - Lumbar ache - Manifests between 20 and 45 yrs of age - Investigations used in diagnosis o Manual examination o Endoscope o Laparoscopy |
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Define menopause. Discuss the clinical symptoms and hormone replacement therapy in menopausal women.
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Menopause or cessation of periods, naturally occurs about the age of 45-55 years. During late 40s FSH initially and then LH concentrations begin to rise, probably as follicle supply diminishes. Oestrogen levels fall and the cycle becomes disrupted. Most women notice irregular scanty periods coming over a variable period, though in some sudden amenorrhoea or menorrhagia occurs.
Clinical symptoms: Features of oestrogen deficiency are hot flushes, vaginal dryness, and atrophy of the breasts. There may also be vague symptoms of loss of libido, loss of self-esteem, non-specific aches and pains, irritability, depression , loss of concentration and weight gain. Women show a rapid loss of bone density in the 10 yrs following the menopause and premenopausal protection from ischemic heart disease disappears. Symptomatic patients are treated with Hormone replacement therapy. The overall benefits and risks of HRT are: - Symptomatic improvement in most menopausal symptoms for the majority of women. Oestrogen deficiency symptoms respond well to oestrogen replacement. - Vaginal symptoms respond to local oestrogen - Protection against fractures of wrist, spine and hip secondary to osteoporosis owing to protection of predominantly trabecular bone - Significant reduction in the risk of large bowel cancer - A significant increase in the risk of breast cancer but no change in the breast cancer mortality - Significant increase in the risk of endometrial cancer when unopposed oestrogens are given to women with a uterus. - Significant increase in the risk of IHD and stroke - Inconvenience of withdrawal bleeds unless a hysterectomy has been performed or regimens which include continuous oestrogen and progesterone are used. - Other disputed effects include possible reductions in the incidence of Alzheimer’s disease and increase in general well-being - Selective oestrogen receptor modulators SERMs offer a potentially attractive combination of positive oestrogen effects on bone and cardiovascular and breast, with possible reduction in breast cancer incidence. |
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Define Polycystic ovarian syndrome. Discuss the syndrome in terms of its clinical features and investigations. What could be the adverse effects of the treatment of PCOS on the body?
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PCOS is a disorder characterised by presence of multiple cyst in either one or both the ovaries and by excess androgen production from the ovaries. The ovarian cysts represent arrested follicular development in the ovaries. So, it is often associated with anovulation, hyperlipidemia and hyper insulinaemia.
Clinical features: Amenorrhoea/ oligomenorrhoea Infertility – generally resulting from chronic anovulation Hirsutism –excessive and increased body hair, typically a male pattern, affecting face, chest and legs Hair loss Acne, oily skin, seborrhoea Obesity – one of two women with PCOS are obese Depression Mild symptoms of hyper-androgenism, such as acne and hyperseborrhea are frequent in adolescent girls and are often associated with irregular menstrual cycles. In most instances, these symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovarian axis during first years following menarche. Investigation: A variety of investigations help the diagnosis: - Serum testosterone and other androgens - 17 a hydroxyprogesterone - Gonadotrophin levels - Oestrogen levels - Serum Prolactin - CT scan, MRI - USG pelvic for investigating the ovaries. |
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Describe the signs and symptoms in a premenopausal woman, at the onset of menopause.
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Menopause or cessation of menses usually occurs naturally about the age of 45-55 yrs. During this, the oestrogen levels fall and the cycles become disrupted.
- Irregular scanty periods coming on over a variable period. - Hot flushes - Mood changes, irritability and loss of libido. - Vaginal dryness - Atrophy of breast tissue - Loss of self-esteem, depression, loss of concentration, non-specific aches and pains - Weight gain - This may be followed by rapid loss of bone density in the 10 yrs following the menopause. |
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Give two specific tests of investigations for each of the following tumours of female reproductive system.
a. Breast cancer |
a. Breast cancer – mammography, USG, MRI, fine needle aspiration cytology, staging using the X rays and scan. Genetic presence of BRCA -1 and 2.
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b. Epithelial ovarian cancer
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b. Epithelial Ovarian cancer. Serum CA 125, transvaginal USG, Pelvic MRI
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c. Cervical cancer
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c. Cervical cancer – pap smear, per vaginal examination, pelvic examination
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What is polycystic ovarian disease/ syndrome?
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PCOS is characterized by multiple small cysts within the ovary and by excess androgen production from the ovaries and to a lesser extent from the adrenals.
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Describe the presenting features of PCOD/ PCOS.
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The patient presents with amenorrhoea, oligomenorrhoea, hirsutism and acne.
- Abnormal weight gain in young teenagers - irregular and painful menses - water retention in the body - It is a leading cause of infertility in females. - Obesity, hair loss, acne and depression. - May be associated with Type II DM and hypertension. Symptoms of PCOD would vary depending upon the cause of excess androgens. It can be due to adrenal, thyroids, ovary, pituitary or more general, metabolic defect. |
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Define any two complications of pregnancy and describe their management
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Eclampsia/ pre-eclampsia – presence of hypertension + proteinuria + oedema with seizures/ coma is called eclampsia. Treatment is manage the blood pressure and delivery of the baby.
Hyperemesis gravidarum – pathological vomiting during pregnancy. Treat the underlying cause. Gestational diabetes – glucose intolerance that develops in the course of pregnancy and usually remits following delivery. Treatment with diet modifications followed by insulin if necessary. Avoid oral medication as it can pass through the placenta. Ectopic pregnancy – implantation of the zygote outside the normal uterine endometrium. The most common site is fallopian tube. Treatment is surgery. Mastitis – inflammation of the breast tissue in connection with pregnancy, lactation or weaning usually caused by blocked milk ducts or excess milk. |
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Define Gestational Diabetes.
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The term Gestational Diabetes refers to glucose intolerance that develops in the course of pregnancy and usually remits following delivery.
The condition is typically asymptomatic. Women who have a previous history of gestational diabetes, older or overweight women, those with a history of large for gestational age babies and women from certain ethnic groups are at particular risk. |
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Describe the effects of increased blood sugar on the mother and the baby. How will you manage the case of Gestational diabetes?
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Complete screening of all pregnant women is thus recommended for gestational diabetes on the basis of random plasma glucose testing in each trimester and by oral glucose tolerance testing if the glucose concentration is more than normal.
There is no consensus concerning the level of blood glucose which is harmful for the baby, and therefore no consensus concerning cut-off levels for screening and intervention. Treatment is with the diet in the first instance. But most patients require insulin cover during pregnancy. Insulin does not cross the placenta. Many oral agents cross the placenta and are usually avoided because of potential risk to foetus. It has been associate d with all the obstetric and neonatal problems, except that there is no increase in the rate of congenital abnormalities. Poorly controlled diabetes is associated with still birth, mechanical problems in the birth canal due to foetal macrosomia, hydramnios, pre-eclampsia. Ketoacidosis in pregnancy has 50% foetal mortality rate. Maternal diabetes, esp. when poorly controlled can lead to foetal macrosomia. The infant of a diabetic mother is more susceptible to hyaline membrane disease than non-diabetic infants of similar maturity. In addition, neonatal hypoglycaemia may occur. These complications are due to hyperglycaemia in the third trimester. In hyperglycaemic mother, the maternal glucose passes the placenta, but the insulin does not. So, the foetal islets hypersecrete insulin to combat maternal hyperglycaemia and a rebound to hypoglycaemia levels occur when the umbilical cord is severed. |
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Define Infertility
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Sub fertility or infertility is defined as the inability of a couple to conceive after 1 year of unprotected intercourse.
There are various methods used for contraception. The selection of the methods depends on age, sex, past history, family history and many other methods. Temporary prevention of fertility includes numerous contraceptive methods except sterilization. |
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A young couple female 22 and male 24 comes to you for the advice of contraception. How will you advise this couple and what precautions would you take? Discuss the advantages and disadvantages of various methods of contraception and their possible side effects.
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Since this couple is young, it has the following options:
Barrier methods – pouch, condom, sponge, cervical cap or diaphragm can be useful Hormonal methods - Oral contraceptives for female – use of combination pills. As the side effects of these pills the woman may experience weight gain, irregular menses, and premenstrual symptoms and there is increased risk of breast cancer in later years. The use of IUCD would not be recommended in such a young patient as there is potential risk of uterine perforation and rejection, heavy bleeding during menstruation, endometriosis, endocarditis and other risk may follow. Natural methods – coitus interruptus, withdrawal method, knowing the fertility time and avoiding intercourse during that period are all the methods of natural contraception. But it has high percentage of failure rates, and the menses have to be regular. Cannot be useful to females with irregular menstrual cycle. |
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Describe the clinical assessment of an infertile couple.
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Both the partners are to be investigated.
• Male: previous testicular damage, orchitis, trauma, undescended testes, urethral symptoms, and venereal problems, local surgery and use of alcohol or drugs. Semen analysis early in the investigation. • Woman: previous pelvic inflammatory diseases, infections, irregular periods, smoking, age, alcohol intake, body weight, previous surgery • Together: frequency and adequacy of intercourse, use of lubricants, time of intercourse |
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Give at least three examples to outline the uses of drugs in pregnancy
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The medicines given to a pregnant woman can affect the growth and development of her baby. It may sometimes also lead to congenital defects in the foetus. Therefore the clinicians need to be extra careful with the administration of drugs during pregnancy.
Use of ACE inhibitors or Retinoids can cause oligohydramnios (decrease the amniotic fluid) Amioderone and carbamisol can cause neonatal goitre/ hypothyroidism Antiepileptics and NSAIDs cause neural tube defects, cleft palate and other congenital abnormalities. |
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What is Eclampsia?
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Eclampsia is characterised by the presence of hypertension, proteinuria and oedema along with seizures or coma during pregnancy.
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Why is it considered as a serious complication of pregnancy? Also mention the treatment for eclampsia
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It can lead to severe hepatic complications like sub capsular hematoma, infarction, and fulminant hepatic failure. A combination of haemolysis, elevated liver enzymes and a low platelet count can occur with severe pre-eclampsia. The best treatment for eclampsia is the delivery of the baby.
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Describe the clinical features, pathogenesis, investigation and management of syphilis.
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Syphilis is a chronic systemic disease, which is acquired or congenital.
Classes/CF are: Acquired early stages: Primary – hard chancre, painless, regional lymphadenopathy Secondary – general: fever, malaise, Arthralgia, sore throat and generalized lymphadenopathy. Skin: red/brown maculopapular non-itchy sometimes scaly rashes, mucous patches, small – track ulcers on oropharynx and on genitalia Acquired late stages: Tertiary – gumma (bone and viscera) aortitis and arotic regurgitation. Meningovascular involvement, general paralysis of the insane (GPI) and tabes dorsalis. Congenital early stages- still birth or failure to thrive, snuffles (nasal infection with discharge) Skin and mucous membrane lesions as in secondary syphilis Late signs: stigmata – Hutchinson’s teeth, sabre tibia and abnormalities of long bones keratitis, Uveitis, facial gumma and CNS disease. Investigations for diagnosis: • specific antibodies –treponemal non-specific antibodies. • EIA for IgM and IgG antibodies • CSF examination to rule out neurosyphilis • X-ray to find the cardiac extent Treatment: - Treponemocidal antibodies for at least 7 days in early stages. Later may be continued for longer period of time. - Primary and secondary syphilis is usually treated with penicillin or Jenacilln. Those who are sensitive to penicillin, may use doxycyclin or erythromycin 500 mg four times a day for about 2-4 weeks - Most of the patients with primary/secondary syphilis would present with fever, malaise, headache following the first injection. - The prognosis depends on the stage at which the treatment is commenced. |
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Define STD.
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Sexually transmitted Diseases refers to the group of diseases which spread through sexual contact or exchange of semen/vaginal discharge.
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Describe the clinical features of Gonorrhoea.
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Incubation period is about 2-14 days. In men it causes anterior urethritis causing dysuria and urethral discharge (gleet)
In women it causes increased or altered vaginal discharge, pelvic pain due to ascending infection, dysuria, intermenstrual bleeding. Disseminated GC may lead to arthritis with characteristic popular or pustular rash with an erythematous base with fever and malaise. |
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What can be the effect of Gonorrhoea in pregnant woman on her baby
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Complications - can cause Ophthalmia Neonatorum/ conjunctival infection in new born babies of infected mothers.
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Give two examples of sexually transmitted diseases caused by each of the following organism.
a. Bacteria |
Bacteria – Gonorrhoea, Chlamydia trachomatis, Syphilis, urethritis, chancroid
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Give two examples of sexually transmitted diseases caused by each of the following organism.
b. Viruses |
Viruses – Herpes simplex, genital warts, HIV-AIDS, hepatitis B, Kaposi’s sarcoma, human papilloma viruses
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Give two examples of sexually transmitted diseases caused by each of the following organism.
c. Fungi |
Fungi – Candidiasis, bacterial/ fungal vaginosis, Tinea cruris,
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Give two examples of sexually transmitted diseases caused by each of the following organism.
d. Parasites |
Parasites – Pubic Lice, Scabies,
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Give two examples of sexually transmitted diseases caused by each of the following organism.
e. protozoa |
Protozoa – trichomoniasis, Giardiasis
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Outline the principles of management of HIV infected patient.
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Social stigma must be removed and the patient should be educated about the spread and prevention of HIV along with the family, friends / carers.
- Full physical examination and lab investigations - Confidentially has to be maintained in regards to who has the knowledge of the diagnosis and who does not. - Psychological treatment and consultations for family, friends and carers. - Use of HAART (highly active antiretroviral therapy) - Management of signs and symptoms, palliative measures - Diet and lifestyle advice - General health promotion advice on use of drugs, alcohol, diet, exercise, smoking. - Monitor the progress by regular routine checkups including clinical history and examination, weight gain, HIV viral load, full Blood Count, liver and renal function , fasting lipid profile and blood glucose. |
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What is toxic shock syndrome?
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TSS is usually due to the toxin secreting staphylococcal infection and streptococci infection.
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Discuss the clinical features and management of TSS briefly
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Usually associated with vaginal colonisation and tampon use in the women. However, the exotoxin can causes abrupt onset of fever and shock, with diffused macular rash and desquamation of the palms and soles. Many patients are severely ill and the mortality is about 10%. The treatment is by eradication of the organism.
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