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91 Cards in this Set

  • Front
  • Back

Male causes of infertility

4 categories

Epididymo-orchitis, esp. due to mumps

Testicular cancer, iatrogenic causes

Congenital factors: congenital undescended testes, cystic fibrosis, Klinefelter's

Idiopathic presentations: oligospermia, asthenospermia, tetarozoospermia, azoospermia

Polycystic ovary syndrome:


Excess LH causes increased theca cell testosterone

AND/OR hyperinsulinaemia stimulates testosterone production

and suppresses hepatic production of sex hormone binding globulin, increasing free testosterone

Benign prostatic hyperplasia: cause, investigation, symptoms, Tx (2 drugs)

Caused by age and prevention of apoptosis of transitional zone cells by testosterone.

Enlarged prostate, smooth in DRE. Rectal USS +/- biopsy

Urinary symptoms ('shite'): slow stream, hesitancy, intermittent flow, terminal dribbling, emptying incompletely.

Tx: α1 adrenergic blockers to relax bladder. 5α-reductase inhibitor to prevent DHT production. Surgery

Hernia: types

Indirect inguinal: bowel pushed entirely through inguinal canal into scrotum

Direct inguinal: abdo wall weakness allows section of bowel to protrude; rarely enters scrotum

Femoral: bowel passes through femoral ring.

Erectile dysfunction: risk factors (x4), treatment

Diabetes, vascular disease, radical surgery, spinal injury

Tx: sildenafil - PDE5 inhibitor; prevents NO-mediated smooth muscle relaxation in the corpus cavernosa, maintaining engorgement

Gestational diabetes: pathophys, risk, complications (x2 pregnancy, x4 foetal)

Exaggeration of physiological insulin resistance/hyperinsulinaemia

Risk: same as T2D

Complications: maternal complications as in T2D, pre-eclampsia, TED, macrosomia, RDS, foetal hypoglycaemia, jaundice




signs (x6)

complications (3 maternal, 3 foetal)


Perinatal HT (>140/90mmHg) with proteinuria.

Related to abnormal placental development, underperfusion, maternal inflammation

Signs: thrombocytopaenia, headache, oedema, liver dysfunction, visual disturbance, abdo pain/vomiting

Complications: seizures, DIC, renal failure, RDS, SGA, preterm delivery

Tx: Anti-HT Tx, seizure prophylaxis with magnesium sulfate, induction of labour considered

Morning sickness: definition, if refractory

1st trimester nausea due to hCG. 90% resolve by 16 weeks

Persistent vomiting with weight loss and increased ketones is 'hyperemesis gravidarum'.

Categories of miscarriage + definitions

Threatened - light, painless bleeding. Foetus NGA

Inevitable: heavy bleeding, cramps, open cervical os. Delivery imminent

Incomplete - delivery of some foetal parts with continued bleeding.

Complete - Stillbirth of all foetal parts and cessation of bleeding

Septic - with endometritis, offensive vaginal discharge, uterine tenderness. Risk of wider sepsis

Missed - failure of foetal development. Minimal pain/bleeding

Ectopic pregnancy: definition, symptoms/signs (x4), management

Implantation of fertilised ovum outside endometrial cavity. 95% tubal. 70% live births.

Symptoms: PV bleeding, lower abdo pain, Uterus small for gestation, closed cervical os.

Management: β-hCG monitoring, USS/endoscopy. Surgical removal/methotrexate if required.

Gestational trophoblastic disease: cause, signs (x4), diagnosis, management

Molar pregnancy

Aggressive trophoblast proliferation. Due to triploidy/complete paternal DNA.

Signs: bleeding PV, hyperemesis gravidarum, PV trophoblastic vesicles, enlarged uterus.

USS diagnosis ('snowstorm' appearance)

Evacuation of retained products of conception with suction curettage; chemo if malignant

Placental abruption: definition, signs (x4), management

Partial/complete separation of placenta and decidua prior to parturition.

Signs: intense, constant abdo pain, shock/oliguria/DIC, tense uterus, (+/- PV blood)

Mother may need stabilisation and early labour/C-section may be indicated

Placenta praevia: definition, presentation (x2), complications (x4)

Insertion of placenta into lower section of uterus

Painless PV bleeding with soft, non-tender uterus

Complications: cervical obstruction (C-section), malpresentation, postpartum haemorrhage,

Implantation in prior C-section scar = placenta accreta (hysterectomy required)

Management: no vaginal investigations

Congenital group B streptococcus: transmission, foetal effects (x3)

Normal maternal bacterial flora - risk of transmission in preterm ROM, GBS bacteriuria at parturition

ABX prophylaxis in labour possible

Neonates may develop:



generalised sepsis

Congenital toxoplasmosis: prophylaxis, effects x3

Zoonotic parasite. Hygiene measures preventive in pregnancy

Early transmission to neonate may lead to




Congenital cytomegalovirus: transmission, effects x3

Vertical transmission intrauterine, intrapartum, or lactational

May produce


haematological symptoms (jaundice, thrombocytopaenia)

later sensorineural hearing loss.

Congenital Varicella zoster: effects x3, prophylaxis

May lead to:

maternal pneumonitis

IUGR/preterm delivery

congenital varicella syndrome (severe developmental disorder)

Immunonaive maternal contact may be treated with prophylactic VZV-specific IgG

Congenital rubella: effect x3, prophylaxis

20% risk of miscarriage.


Severe multisystem syndrome including deafness, eye defects, neuro delay, congenital heart disease.

Prevention with mass immunisation, rubella immunity screening at booking

Abnormal lie: types, management

breech, shoulder, brow, face etc. presentations

External/internal cephalic versions or spontaneous resolution

If refractory, C-section recommended

Post-partum haemorrhage: causes (x4), management (x3)

Tone - uterine atony

Tissue - retained placental material

Trauma - usually vulval/vaginal lacerations

Thrombin - coagulopathy

Medical management; surgical intervention; bimanual uterine compression; uterotonics eg. syntocinon (oxytocin)

Respiratory distress syndrome: definition, causes, complications (x3), management

Tachypnoea, expiratory grunting, recession under 4/24

May reflect lack of surfactant, infection

Complications: pneumonia, neonatal apnoea, bronchopulmonary dysplasia

Prophylaxis: antenatal steroids, surfactant administration, positive pressure ventilation

Hypoxic-ischemic encephalopathy:

pathophys - initial + 3x delayed

treatment x2

Asphyxia at birth causes ischemic damage and secondary (delayed) neurodegeneration due to excitotoxicity, inflammation, oxidative stress.

Tx: immediate full resuscitation in asphyxia; therapeutic hypothermia (33-34'C)

Intraventricular haemorrhage: definition, complications

Bleeding into ventricular system, particularly from germinal matrix in immature neonates. May cause hydrocephalus and nervous atrophy if severe.

Periventricular leucomalacia definition

PL: Necrosis of white matter in regions bordering arterial territories, mainly affecting preterm neonates.

Pathological neonatal jaundice:

major causes x3

Txs x2

Causes: rhesus/ABO incompatibility; G6PD deficiency (favism); congenital spherocytosis; sepsis.

Tx may include: intrauterine/neonatal transfusion, phototherapy to conjugate cutaneous bilirubin;

Necrotising enterocolitis: definition, signs (x4), Tx (x4)

Gut infection related to prematurity, ischemia

Signs: abdo distension, D&V, PR bleed, X-ray bowel distension

Tx: NG suction, IVABX, feed restriction with TPN, surgery if perforated or necrotic bowel

Transient neonatal hypoglycaemia: causes, Tx

Related to IUGR (limited reserves, relatively large brain) and maternal diabetes (hyperinsulinaemia). Exaggeration of normal 'sluggish' glucose regulation after birth.

Tx with IV dextrose, early breastfeeding (can fortify)

Bronchopulmonary dysplasia: definition, features (x5)

Pathophysiological changes occuring with prolonged artificial ventilation such that oxygen is needed at 36 weeks.

Signs: randomly distributed bronchial collapse (atelactasis) and hyperinflation, inflammation, proliferation, fibrosis, vascular changes etc.

Tetralogy of Fallot: features

Pulmonary artery stenosis

Hypertrophic right ventricle


Aortic valve overrides VSD

Transposition of the great vessels: definition, management

Conotruncal septum does not follow spiral course: RV empties into aorta; LV into PA. DA usually patent. Presents with cyanosis.

Surgery. Prostaglandin to reopen DA, angioplasty to widen foramen ovale may be indicated acutely.

Turner syndrome:


features x3 +4 anatomical

Karyotype 45, X

Infertile; anovulatory. Heart defects, diabetes etc. Anatomical features: short stature, webbed neck, 'shield' chest, genu + cubitus valgus

Neonatal heel-prick screening (x6)

Maple syrup urine disease

Congenital hypothyroidism

Cystic fibrosis


Medium chain acyl-CoA dehydrogenase deficiency

Sickle cell/thalassaemia

Short-term symptoms of menopause (4 categories)

Vasomotor: hot flushes, diaphoresis

Psychological: depression, mood swings etc,

Urogenital: urinary incontinence, dyspareunia

Collagen: onycholysis, hair loss, MSK pain

Long-term complications of menopause (4 categories)

CV - hyperlipidaemia, CAD, truncal weight gain

Skeletal - OP, kyphosis/scoliosis

Urogenital - atrophic change, risk of prolapse

Neurological - risk of AD

Pelvic inflammatory disease: definition, symptoms (x3), complications (x2), Tx

Infection of upper female genital tract (uterus, oviduct, ovaries)

Usually caused by ascending infection, particularly chlamydia and gonorrhoea

Symptoms: bilateral lower abdo pain, deep dyspareunia, PV bleeding/discharge

Complications: infertility, ectopic pregnancy

Broad-spectrum ABX w/ contact tracing

Ovulatory causes of female infertility (x6)

HPG axis failure: anorexia, exercise/stress, PCOS

Ovarian dysfunction: Turner's, surgery


Whooping cough: definition, stages, Tx

Droplet-spread Bordatella pertussis infection.

Stages: incubation; catarrhal (mucus); paroxysmal (long-lasting, severe characteristic cough); convalescent.

Tx with ABX. Most dangerous in neonates prior to possibility of immunisation.

Medium chain acyl co-A dehydrogenase deficiency: definition, management

Impaired β-oxidation and gluconeogenesis. Hypoglycaemia and hypoketonuria emerge in fasting/illness/intoxication - can be life threatening

Routine blood spot screening since 2008

Avoidance of fasting; genetic counselling

Screening for Down's syndrome: 4 tests

Combined test: nuchal translucency, β-hCG, PAPP-A

Quad: α-fetoprotein, oestradiol, β-hCG, inhibin-A

Integrated: combined + quad

CVS - genetic confirmation 11-14 weeks

Amnioscentesis - genetic confirmation 15-20 weeks. Lower miscarriage risk than CVS

Aetiology of Down's syndrome

95% trisomy 21 due to failure of anaphase (non-disjunction). Related to maternal age. May be mosaic.

Robertsonian translocation: long arms of 14:21 or 21:21 may be joined, preventing normal segregation. May be balanced, giving normal phenotype, but risk of offspring miscarriage, balanced translocation, or translocated DS.

Congenital parvovirus B19: effects

Foetal heart failure with hydrops fetalis (foetal oedema)

Foetal anaemia

Agpar score - components, 3 levels for each, when taken

Appearance (cyanosis/peripheral c./normal)

Pulse (absent/<100/>100)

Grimace (no response/some/normal)

Activity (none/some flexion/resists extension)

Respiration (none/weak, irregular/lusty cry)

1 minute after birth; 5 minutes after birth

subsequent 5 minute intervals if low

Sarnat grading in HIE -


3 levels for each


Consciousness (coma/lethargic/hyperalert)

Tone (flaccid/hypotonic/normal or increased)

Seizures (uncommon/frequent/none)

Pupillary reflexes (fixed/small/reactive)

Respiration (apnoeic/periodic/regular)

Duration (weeks/<2 weeks/<24 hours)

graded 1 (mild) to 3 (severe)

Congenital syphillis - 4 effects



hearing loss/blindness

Ophthalmia neonatorum

Major complications of Down's syndrome (x7)

AV/ventricular septal defects

Conductive/sensorineural hearing loss

Opthalmological disorders

GI atresia, fistulae, stenoses

Learning difficulties

Risk of AD

Increased risk of leukaemia (2' to transient neonatal myelodysplasia)

Failure to thrive: diagnosis, causes

Longitudinal measurement of BMI/weight for length, weight for age, height for age

Complications of IUGR, preterm, congenital anomaly

Lack of intake due to anaemia (fatigue), vomiting, cleft palate etc.

Lack absorption: coeliac, metabolism error etc

Metabolic demand: hyperthytoidism, malignancy etc.

Functional causes eg. abuse

Neonatal clinical screening tests (x5)

Ophthalmoscopy for congenital cataracts

Congenital heart disease

Congenital undescended testes

Bartow and Ortolani tests

Audiology exam

HRT: 3 pros, 3 cons

Pro: treats specific symptoms, reduces AD risk, reduces colon cancer risk

Con: TED/CAD risk, increases breast cancer risk transiently, side effects eg. menorrhagia

Menopause pathophysiology

Decline of follicle number with age

Reduction in ovarian oestradiol and inhibin production

Disinhibition of pituitary gonadotrophins

Reduced ovarian gonadotrophin sensitivity

Cessation of ovulation and ovarian oestrogen synthesis

Anatomical maternal hypotension

Due to compression of IVC by enlarged uterus, especially in supine position

Reason for increased VTE risk in pregnancy

Due to increase in hepatic expression of clotting factors, and increased platelet production

Neonate fontanelle signs



enlargement/failure to close

Bulging: meningitis, encephalitis, hydrocephalus

Sunken: dehydration, malnutrition

Enlargement/failure to close: Down's, hydrocephalus, intrauterine growth retardation

Absolute contraindications to breastfeeding


Metabolic errors in newborn eg. galactosaemia

Maternal drug therapy eg. cytotoxics

HIV+ve mother

Ophthalmia neonatorum

Seen in intrapartum transmission of C. trachomatis and N. gonorrhoeae.

Conjunctivitis usually <2/52, particularly serious in gonorrhoea. Intrapartum transmission 40-50% in untreated women

Foetal distress syndrome


Meconium-stained liquor

Heart-rate abnormalities by CTG including brady/tachycardia, reduced variability, decelerations

2' post-partum haemorrhage



24 hours to 6 weeks following delivery

Due to infection and/or retained products of conception

CNS complications of LBW

2x acute

3x long-term

Intraventricular haemorrhage

Periventricular leucomalacia

Long-term: cerebral palsy, cognitive/behavioural problems, visual/hearing impairments

Cyanotic vs. acyanotic heart defects

Cyanotic - right to left shunt, introducing deoxygenated blood into the systemic circulation. eg. conotruncal defects.

Acyanotic - left to right shunts, less severe. Eg. VSD, patent ductus arteriosus

Reason why vaccines not effective in neonatal period

Bound by maternal IgG received transplacentally and still in the system.

1' vs 2' amenorrhoea

2' is cessation of menstruation

1' is absence of menarche

Causes of amenorrhoea




Rapid weight change/underweight

Psychogenic stress

Hormonal, cytotoxic drugs

Hyperprolactinaemia, hypothyroidism, Turner's syndrome

Lab screening tests for pregnant women


+4 infectious

Assessment of weight, BMI, BP

Infections: HIV, Hepatitis B, syphilis, asymptomatic bacteriuria


Erythrocyte allo-antibodies

Rubella immunity status

Sickle-cell and thalassaemia

Down’s syndrome

Conditions of excess and causes x2

insufficient amniotic fluid and effects x2

Polyhydramnios - foetal swallowing defects eg. cleft palate, maternal cardiovascular disease

Oligohydramnios - causes foetal deformities, hypoplastic lungs in foetus

Menopause treatment

Bioidentical oestradiol (number of modes of administration)

Polycystic ovary syndrome symptoms (x4)



Virilisation: hirsutism, alopecia, central obesity (+increased CV risk)


Polycystic ovary syndrome investigations x3

Hormonal screening for gonadotrophins, androgens

Laparoscopy/ultrasound for cysts

Tests for insulin resistance

Polycystic ovary syndrome treatment


CoCP to control menstrual irregularity

Treatment of hyperinsulinaemia

Clomifeme to induce ovulation

Polycystic ovary syndrome diagnosis

2 of these 3:

>12 peripheral ovarian follicles or enlarged ovaries


Clinical/biochemical signs of hyperandrogenism

Tubal causes of infertility




Fimbrial clubbing (scarring, reducing uptake of ovum from ovary)

Hydrosalpinx (oviduct inflamed and blocked with fluid)

Test for oviduct patency


X-ray of uterus and oviduct with contrast dye

Measures used for assessment of foetal development

(x3: inc. for 'head-sparing')

Estimated foetal weight (low in IUGR)

Abdominal circumference (low in IUGR)

Head circumference:abdominal circumference (raised in asymmetric IUGR)

Median, low, very low, extremely low birthweights

SGA criteria

Criteria for prematurity

Median - 3.5kg

low - <2.5kg

very low - <1.5kg

extremely low - <1kg

SGA: weight below 10th centile for gestation

Premature <37 weeks delivered

SGA causes x6

Normal small stature

Chromosomal disorders (eg. Edward's syndrome - trisomy 18)

Utero-placental insufficiency (asymmetric)

Congenital infection

Maternal risk-factors eg. smoking, chronic illness

Multiple pregnancy

Management of IUGR


Corticosteroids to accelerate surfactant production

Monitoring with doppler USS for diastolic umbilical artery flow - may be absent or reversed)

C-section may be required

Risk factors for SIDS

Maternal: smoking, alcohol/substance abuse, STD, age <20 etc.


Sleep factors: overheating, prone/side position, old mattress, sleeping outside parents' room

Congenital adrenal hyperplasia:


Presentation in girls, in boys


Recessive inherited 21-hydroxylase deficiency leading to aberrant steroidogenesis

Leads to excess androgen production and mineralocorticoid deficiency.

Virilisation in girls leads to early recognition

Boys go undiagnosed and may suffer vomiting, dehydration, collapse etc. in week 2

Tx with hormone replacement

HPV carcinogenesis

HPV 16 and 18

E6 inactivates p53

E7 inactivates RB

HPV vaccination

Name, who given to, vaccine type


Administered to 12-18 year old girls

HPV capsids spontaneously combine into virus-like particles

Cervical transformation zone

Reason for site of carcinogenesis

Region around cervical os where endocervical columnar epithelium migrates in puberty.

Undergoes hyperplasia due to acidic vaginal environment

Immature epithelial cells susceptible to HPV infection

Names for cervical cancer plus precancerous state

Cervical squamous carcinoma

Cervical intraepithelial neoplasia

Screening for cervical intraepithelial neoplasia

2 tests

Cervical brush sample, prepared in liquid-based cytology. Examined under microscopy for dyskaryosis

+biopsy for assessment of neoplasia

Neoplasia and dyskaryosis grading in cervical intraepithelial neoplasia

Management based on grading

Neoplasia: 1-3 according to level at which cytoplasmic maturation occurs

Dyskaryosis: mild/moderate/severe

first level of each: observation

2-3, moderate/severe: surgery

HPV carcinogenesis

Expresses:E6 -> binds to and inactivates p53 tumour suppressor

E7 -> binds to and inactivates retinoblastoma tumour suppressor

Risk factors for HPV infection


Sexual history (number of partners, frequency of sex, sex history of male partners, early age of first intercourse)

Family history of CSC

Sex with men with penile carcinoma

Urban living

Cigarette smoking.

Normal and neoplastic cervical cytology



Normal - low nuclear:cytoplasmic ratio

Neoplastic - high nuclear:cytoplasmic ratio, nuclear pleomorphism, hyperchromasia

Staged mild, moderate or severe according to degree of dyskaryosis

With cervical brush and liquid-based cytology (involving preservation and centrifugation)

Cervical intraepithelial neoplasia grading of biopsy

1-3, according to the level in the epithelium at which cytoplasmic maturation is taking place (begins basally)

Normal vs. neoplastic cervical biopsy

Normal: maturation of cells as they progress luminally (becoming more squamous)

Neoplastic: cells are hyperchromatic and pleomorphic and do not mature luminally

Anatomical origin of CIN and why

Cervical transformation zone

Due to migration of endocervical columnar cells to around external os in puberty

Acid environment leads to squamous hyperplasia

Naive hyperplastic cells vulnerable to HPV, which cannot infect mature endothelia

Treatment of CIN according to grade


Mild dysplasia, mild karyosis - observation10% progress to high-grade CIN

Moderate/severe dysplasia and karyosis - surgery

10% progress to cervical squamous carcinoma

CIN screening invitation intervals

Invited at 25, then 3-yearly until 50, then 5-yearly until 65

UK HPV vaccination


who offered to

vaccine type


12-18 year old girls

capsid proteins, spontaneously assembles into virus-like particles.