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91 Cards in this Set
- Front
- Back
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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 |
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Polycystic ovary syndrome: causes |
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 |
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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 |
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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. |
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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 |
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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 |
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Pre-eclampsia: definition pathophys signs (x6) complications (3 maternal, 3 foetal) Tx |
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 |
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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'. |
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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 |
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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. |
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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 |
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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 |
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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 |
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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: pneumonia meningitis generalised sepsis |
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Congenital toxoplasmosis: prophylaxis, effects x3 |
Zoonotic parasite. Hygiene measures preventive in pregnancy Early transmission to neonate may lead to IUGR hydrocephalus microcephaly |
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Congenital cytomegalovirus: transmission, effects x3 |
Vertical transmission intrauterine, intrapartum, or lactational May produce IUGR, haematological symptoms (jaundice, thrombocytopaenia) later sensorineural hearing loss. |
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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 |
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Congenital rubella: effect x3, prophylaxis |
20% risk of miscarriage. IUGR Severe multisystem syndrome including deafness, eye defects, neuro delay, congenital heart disease. Prevention with mass immunisation, rubella immunity screening at booking |
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Abnormal lie: types, management |
breech, shoulder, brow, face etc. presentations External/internal cephalic versions or spontaneous resolution If refractory, C-section recommended |
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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) |
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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 |
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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) |
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Intraventricular haemorrhage: definition, complications |
Bleeding into ventricular system, particularly from germinal matrix in immature neonates. May cause hydrocephalus and nervous atrophy if severe. |
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Periventricular leucomalacia definition |
PL: Necrosis of white matter in regions bordering arterial territories, mainly affecting preterm neonates. |
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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; |
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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 |
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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) |
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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. |
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Tetralogy of Fallot: features |
Pulmonary artery stenosis Hypertrophic right ventricle VSD Aortic valve overrides VSD |
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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. |
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Turner syndrome: definition, features x3 +4 anatomical |
Karyotype 45, X Infertile; anovulatory. Heart defects, diabetes etc. Anatomical features: short stature, webbed neck, 'shield' chest, genu + cubitus valgus |
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Neonatal heel-prick screening (x6) |
Maple syrup urine disease Congenital hypothyroidism Cystic fibrosis Phenylketonuria Medium chain acyl-CoA dehydrogenase deficiency Sickle cell/thalassaemia |
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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 |
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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 |
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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 |
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Ovulatory causes of female infertility (x6) |
HPG axis failure: anorexia, exercise/stress, PCOS Ovarian dysfunction: Turner's, surgery Menopause |
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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. |
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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 |
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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 |
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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. |
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Congenital parvovirus B19: effects |
Foetal heart failure with hydrops fetalis (foetal oedema) Foetal anaemia |
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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 |
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Sarnat grading in HIE - components 3 levels for each grading |
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) |
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Congenital syphillis - 4 effects |
IUGR fever/rash hearing loss/blindness Ophthalmia neonatorum |
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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) |
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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 |
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Neonatal clinical screening tests (x5) |
Ophthalmoscopy for congenital cataracts Congenital heart disease Congenital undescended testes Bartow and Ortolani tests Audiology exam |
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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 |
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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 |
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Anatomical maternal hypotension |
Due to compression of IVC by enlarged uterus, especially in supine position
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Reason for increased VTE risk in pregnancy |
Due to increase in hepatic expression of clotting factors, and increased platelet production |
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Neonate fontanelle signs bulging sunken enlargement/failure to close |
Bulging: meningitis, encephalitis, hydrocephalus Sunken: dehydration, malnutrition Enlargement/failure to close: Down's, hydrocephalus, intrauterine growth retardation |
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Absolute contraindications to breastfeeding x3 |
Metabolic errors in newborn eg. galactosaemia Maternal drug therapy eg. cytotoxics HIV+ve mother |
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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 |
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Foetal distress syndrome x2 |
Meconium-stained liquor Heart-rate abnormalities by CTG including brady/tachycardia, reduced variability, decelerations |
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2' post-partum haemorrhage time-frame causes |
24 hours to 6 weeks following delivery Due to infection and/or retained products of conception |
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CNS complications of LBW 2x acute 3x long-term |
Intraventricular haemorrhage Periventricular leucomalacia Long-term: cerebral palsy, cognitive/behavioural problems, visual/hearing impairments |
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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 |
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Reason why vaccines not effective in neonatal period |
Bound by maternal IgG received transplacentally and still in the system. |
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1' vs 2' amenorrhoea |
2' is cessation of menstruation 1' is absence of menarche |
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Causes of amenorrhoea x4 +conditions |
Pregnancy/lactation Rapid weight change/underweight Psychogenic stress Hormonal, cytotoxic drugs Hyperprolactinaemia, hypothyroidism, Turner's syndrome |
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Lab screening tests for pregnant women x6 +4 infectious |
Assessment of weight, BMI, BP Infections: HIV, Hepatitis B, syphilis, asymptomatic bacteriuria Anaemia Erythrocyte allo-antibodies Rubella immunity status Sickle-cell and thalassaemia Down’s syndrome |
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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 |
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Menopause treatment |
Bioidentical oestradiol (number of modes of administration) |
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Polycystic ovary syndrome symptoms (x4) |
Anovulation Oligomenorrhoea Virilisation: hirsutism, alopecia, central obesity (+increased CV risk) Acne |
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Polycystic ovary syndrome investigations x3 |
Hormonal screening for gonadotrophins, androgens Laparoscopy/ultrasound for cysts Tests for insulin resistance |
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Polycystic ovary syndrome treatment x3 |
CoCP to control menstrual irregularity Treatment of hyperinsulinaemia Clomifeme to induce ovulation |
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Polycystic ovary syndrome diagnosis |
2 of these 3:
>12 peripheral ovarian follicles or enlarged ovaries Anovulation Clinical/biochemical signs of hyperandrogenism |
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Tubal causes of infertility x4 |
PID Endometriosis Fimbrial clubbing (scarring, reducing uptake of ovum from ovary) Hydrosalpinx (oviduct inflamed and blocked with fluid) |
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Test for oviduct patency |
Hysterosalpingography X-ray of uterus and oviduct with contrast dye |
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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) |
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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 |
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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 |
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Management of IUGR x3 |
Corticosteroids to accelerate surfactant production Monitoring with doppler USS for diastolic umbilical artery flow - may be absent or reversed) C-section may be required |
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Risk factors for SIDS |
Maternal: smoking, alcohol/substance abuse, STD, age <20 etc. LBW Sleep factors: overheating, prone/side position, old mattress, sleeping outside parents' room |
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Congenital adrenal hyperplasia: Pathophys Presentation in girls, in boys Treatment |
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 |
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HPV carcinogenesis |
HPV 16 and 18 E6 inactivates p53 E7 inactivates RB |
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HPV vaccination Name, who given to, vaccine type |
Gardasil Administered to 12-18 year old girls HPV capsids spontaneously combine into virus-like particles |
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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 |
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Names for cervical cancer plus precancerous state |
Cervical squamous carcinoma Cervical intraepithelial neoplasia |
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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 |
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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 |
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HPV carcinogenesis |
Expresses:E6 -> binds to and inactivates p53 tumour suppressor E7 -> binds to and inactivates retinoblastoma tumour suppressor |
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Risk factors for HPV infection x5 |
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. |
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Normal and neoplastic cervical cytology +grades +method |
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) |
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Cervical intraepithelial neoplasia grading of biopsy |
1-3, according to the level in the epithelium at which cytoplasmic maturation is taking place (begins basally) |
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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 |
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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 |
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Treatment of CIN according to grade +progression |
Mild dysplasia, mild karyosis - observation10% progress to high-grade CIN Moderate/severe dysplasia and karyosis - surgery 10% progress to cervical squamous carcinoma |
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CIN screening invitation intervals |
Invited at 25, then 3-yearly until 50, then 5-yearly until 65 |
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UK HPV vaccination name who offered to vaccine type |
Gardasil 12-18 year old girls capsid proteins, spontaneously assembles into virus-like particles. |
