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(S6) Other than infertility, what other main indications for ACT?
(S7) Factors to check before IVF treatment begins?
(S8) Categories of ACT available?
(S9) Method of IUI?
(S10) Indications for IVF?
(S11) Treatment prescribed during IVF cycle?
(S12) What is buserelin?
(S12) Sfx of buserelin?
(S21) What happens at the ‘action scan’ during IVF?
(S22) What is ovitrelle?
(S22) What does HCG injection mimic?
Spontaneous LH surge
(S22) When are eggs collected during IVF?
36 hours after HCG injection
(S25) How are sperm samples assessed?
(S32) What are the major stages of embryo development prior to embryo transfer in IVF?
(S37) How many embryos may be transferred?
Subject to change in law; currently, if under 40 no more than 2, may allow 3 if over 40. Likely to change to allow only 1 to minimise risk of twins
(S40) What is offered during the luteal phase of IVF?
(S41) What are the indications for intra cytoplasmic sperm infection – ICSI?
(S42) Procedure required in case of azoospermia?
Surgical sperm aspiration
(S44) What are the steps of ICSI fertilisation?
Egg is stripped, sperm immobilised, single sperm injected, incubated at 37 degrees overnight
(S52) Key stages in IVF?
(S3) What are the broad phases of the menstrual cycle?
(S3) Describe the follicular phase?
(S3) Describe the ovulation phase?
(S3) Describe the luteal phase
(S4) Endometrial changes during proliferative phase?
(S4) Endometrial changes during luteal phase?
(S5) What characterises normal menstrual loss?
(S5) Normal menstrual cycle length?
(S6) Dff. Menorrhagia?
Prolonged and increased menstrual flow
(S6) Dff. metrorrhagia?
Regular intermenstrual bleeding
(S6) Dff. polymenorrhoea?
Menses occurring at < 21 day interval
(S6) Dff. polymenorrhagia?
Increased bleeding and frequent cycle
(S6) Dff. Menometrorrhagia?
Absence of menstruation > 6 months
(S6) Dff. Oligomenorrhoea?
Menses at intervals of > 35 days
(S7) What are the two categories of menorrhagia causes?
(S8) Local causes of menorrhagia?
(S8) What is a fibroid?
Leiomyoma (benign tumor from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus
(S15) What does ITP stand for?
Idiopathic thrombocytopenic purpura
(S16) Why might pregnancy cause menorrhagia?
(S17) What are the two categories of dysfunction uterine bleeding – DUB?
(S17) What is ovulatory dysfunctional uterine bleeding caused by?
Inadequate progesterone production by corpus luteum
(S18) How should DUB be investigated?
(S24) Non-surgical management of DUB?
(S27) Surgical management of DUB?
(S27) Methods of endometrial resection/ablation?
(S27) Methods of hysterectomy?
(S1) What are most likely to cause bleeding in early pregnancy?
(S3) What is the incidence rate of spontaneous miscarriage?
(S4) What are the types of spontaneous miscarriage?
(S4) Describe threatened miscarriage?
(S9) Abnormal conceptus causes of spontaneous miscarriage?
(S9) Uterine causes of spontaneous miscarriage?
Bicornuate uterus; uterine septae; marked uterine ante/retroflexion; fibroids; incompetent cervix
(S9) Acquired disease causes of spontaneous miscarriage?
Infections (TORCH), listeria, malaria, influenza virus; hypertension, renal; disease, diabetes mellitus, thyroid disorders
(S9) Toxin causes of spontaneous miscarriage?
alcohol; smoking; anti-metabolites, chemotherapy; anaesthetic gases
(S9) Immunological causes of spontaneous miscarriage?
antiphospholipid syndrome; lupus anticoagulent
(S9) Endocrine causes of spontaneous miscarriage?
(S9) Trauma causes of miscarriage?
Amniocentesis, abdominal surgery; coitus
(S16) Dff. of recurrent miscarriage?
3 or more consecutive occasions
(S17) Incidence rate of ectopic pregnancy?
(S17) Main cause of death in ectopic pregnancy?
(S17) Main aetiological factors of ectopic pregnancy?
(S18) Clinical features of ectopic pregnancy?
(S18) Clinical outcomes of ectopic?
(S21) Investigations of ectopic pregnancy?
(S21) Treatment of ectopic pregnancy?
(S22) What is a hydatidiform mole?
Developmental anomaly of the trophoblast or placenta in which there is a local or general vesicular change in the chorionic villi
(S22) Type of hydatidiform mole?
Complete and incomplete
(S22) Clinical features of hydatidiform mole?
(S22) Investigations for hydatidiform mole?
(S23) Treatment for hydatidiform mole?
Malignant transformation – choriocarcinoma
(S25) What is cervical incompetence?
(S25) Aetiology of cervical incompetence?
(S25) Treatment of cervical incompetence?
(S3) Indications for EC?
(S4) Three main methods of EC in UK?
(S6) What is the mode of action of copper IUD?
(S19) What are the two stages of medical TOP?
(S20) For surgical TOP, what is cervical priming?
Administration of vaginal prostaglandin
(S4) What are the primitive genital tracts?
(S5) What would the Mullerian duct become if it did not degenerate in the presence of testosterone?
(S5) What does the Wolffian tube become?
Testosterone and Mullerian-inhibiting factor
Dihydrotestosterone (converted from testosterone)
(S7) The absence of what leads to the degeneration of the Wolffian ducts?
Androgen insensitivity syndrome / Testicular feminisation
(S8) In terms of primitive genital tracts, what occurs in androgen insensitivity?
(S11) When do testes descend?
Develop in utero and descend before birth in presence of androgens
(S11) Which muscle controls teste height and thus temperature?
(S11) What is the clinical term for undescended testes?
(S11) What should be done to treat undescended testes?
(S12) Where does spermatogenesis occur in the teste?
Enzymes to penetrate the ovum
(S16) What stimulates sertoli cells and thus spermatogenesis?
FSH and testosterone
(S16) What suppresses FSH?
(S16) What decreases GnRH and LH?
(S17) What releases GnRH and what role does it have?
Hypothalamus releases GnRH every 2-3 hours – acts on anterior pituitary to release LH and FSH
(S18) What releases LH and FSH?
(S18) In males what does LH act on?
Leydig cells to regulate testosterone secretion
(S18) In males, what does FSH act on?
(S18) What is the difference between males and females in the production of LH and FSH?
Females – cyclical
(S19) Which cells produce testosterone?
(S20) Effects of testosterone?
(S21) Where are inhibin and activin secreted?
From sertoli cells
(S21) What do inhibin and activin provide feedback for the secretion of?
(S22) Events of sperm from ejaculation to fertilisation?
(S24) Role of epididymis and vas deferens?
(S24) Role of seminal vesicles?
(S24) Role of prostate gland?
Secrete mucus for lubrication
(S25) What does blood fill to sustain an erection?
Corpora cavernosa (PS control)
(S25) What controls ejaculation?
(S25) What might cause prematurity or retrograde ejaculation?
(S26) What is hypospadias?
Birth defect of urethra (males and females)
(S28) What are the main aetiological aspects of male infertility?
(S29) Typical clinical picture of obstructive male infertility?
(S29) Typical clinical picture of non-obstructive male infertility?
(S2) In the context of contraception, what do CHC, POP, and EHC stand for?
(S6) What are the common non-contraceptive benefits of CHC?
(S7) What do all variants of CHC have in common?
(S8) What are the three forms of CHC?
(S11) What is the failure rate of CHC in perfect and typical conditions?
(S11) In terms of body size, what would influence the use of CTP?
If > 90KG then probable decrease in efficacy
(S13) What is the regime for taking COC?
(S14) Regime for CTP?
(S15) Regime for CVR?
(S16) Can COCs be taken continuously?
Yes, and some are marketed specifically for this. Pill-free days and withdrawal bleeds are more for patient reassurance
(S19) Which common factors might change effectiveness of CHC?
(S20) What are the main metabolic effects concerning CHC sfx?
(S36) Given the slightly increased risks associated with CHC, which medical factors should be screened for when prescribing?
(S38) Basic examinations before first prescription of CHC?
(S40) Cancers reduced by CHC?
(S41) In terms of overall safety, how safe are CHCs?
(S42) What is ethinylestradiol cyproterone acetate?
(S45) Which sfx are most associated with CTP?
Breast pain, nausea, painful periods
(S59) Types of progesterone-only pills?
(S60) Efficacy of perfect and typical use of POPs?
(S61) Mode of action of POPs?
EC + two days of extra protection
Vaginal, oral, anal intercourse
(S12) Which complication is associated with chlamydia in women, and what other risk does it carry?
(S13) Typical presentation of chlamydia in females?
(S14) Typical presentation of chlamydia in males?
(S15) Main complications of chlamydia infections?
(S17) Diagnosis of chlamydia?
(S17) Treatment of chlamydia?
Gram –ve intracellular dipplococcous
(S19) What is the incubation period of gonorrhoea in men?
Short – for urethral infection usually 2-5 days
(S21) Presentation of gonorrhoea in men?
(S28) Treatment of gonorrhoea?
(S29) Which organism causes syphilis?
Treponema Pallidum (spirochete)
(S30) How can syphilis be transmitted?
(S32) What is the incubation period for primary syphilis?
9-90 days (mean = 21)
(S32) With what does primary syphilis usually present with first?
6 weeks to 6 months
(S34) Presentation of secondary syphilis?
(S34) Why are condylomata lata the most infectious syphilitic lesions?
Exude serum with high concentration of trepnemes
(S38) Diagnosis of syphilis?
(S40) Treatment of syphilis?
(S41) How should syphilis treatment be followed up?
(S43) Symptoms of genital herpes primary infection?
(S45) Which viral strain is most associated with recurrent herpes?
(S48) Which viral type is associated with high viral shedding in genital herpes?
(S50) Most common viral STI in the UK?
HPV – lifetime risk of acquiring may be as high as 80%
(S51) How many types of HPV are there?
(S55) How successful is genital herpes treatment?
(S56) Which strain of HPV usually causes anogenital warts?
More than 90% of cases are due to HPV 6/11
(S57) Treatment of HPV?
(S63) Which infection is known as the great imitator?
(S3) Life expectancy after HIV dx?
Normal with early dx and prevention of AIDS
(S5) What are the target site for HIV?
(S5) What is CD4+ and where is it found?
(S6) Key roles of CD4+ T helper lymphocytes?
(S7) What effect does HIV infection have on the host immune response?
(S8) What are normal CD4+ parameters?
(S10) Average time to death after infection with HIV without treatment?
(S12) Symptoms of primary HIV infection (2-4 weeks post infection)?
(S14) What is an opportunistic infection?
Insidious onset – SOB, dry cough
(S15) Causative organism for pneumocystis pneumonia?
(S15) Treatment for pneumocystis pneumonia?
Co-trimoxazole +/- steroid
(S17) Causative organism in cerebral toxoplasmosis?
(S17) Sx/sings of cerebral toxoplasmosis?
(S18) CD4 threshold for cytomegalovirus?
(S18) What does infection with cytomegalovirus cause?
(S18) Presentation of cytomegalovirus?
(S18) Treatment for cytomegalovirus?
Ophthalmic screening for all with CD4 < 50
(S19) Presentation of H Zoster in immunocompromised patient?
(S19) presentation of HPV in immunocompromised patient?
HIV-1: Macrophage and microglial neurotoxins
(S20) Management of HIV-associated neurocognitive impairment?
(S21) What does the JC virus cause in immunosuppressed patients?
Progressive multifocal leukoencephalopathy
Demyelination (no inflammation)
(S21) Presentation of PML?
(S21) Dx of PML?
(S21) Treatment for PML?
(S22) Less typical neurological presentations of HIV?
(S23) What is Slim’s disease?
(S24) Typical AIDS related cancers?
(S24) infective agent associated with Kaposi’s sarcoma?
Herpes 8 – HHV8
(S25) Organism associated with non-hodgkins lymphoma?
(S26) What should be offered to all complicated HPV patients?
(S8) Molecular targets for anti-retroviral drugs?
(S9) What is zidovudine?
Nucleoside analogue reverse transcriptase inhibitor
(S9) Dff. Of HAART?
Highly active anti-retroviral therapy = a combination of three drugs from at least 2 categories
(S9) Therapeutic goals of HAART?
(S17) Typical HAART toxicity effects?
Potent liver enzyme inhibitors
(S29) Prevention of mother to child HIV transmission?
(S35) When is a person most likely to transmit HIV?
High viral load – e.g. early and asymptomatic hence universal screening and early treatment needed
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