Clinical Skills in Reproductive and Haematology Systems

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Questions and Answers

Which of the following is NOT a key focus in clinical skills related to the reproductive system?

History, investigations and contraception

History and examination

Treatment of anaemia (correct)

Reproductive system clinical reasoning

What is a major component of haematology concerning infection susceptibility?

Blood transfusion

Anaemia and WBC abnormalities (correct)

Haemostasis and thrombosis

Myeloid diseases

Which area of pharmacology is specifically concerned with agents that reduce blood clotting?

Immunosuppressants

Immunomodulation

Anticoagulant agents (correct)

Treatment of anaemia

Which component of microbiology addresses infections primarily transmitted through sexual contact?

Genital infections Signup and view all the answers

In the context of clinical skills related to haematology, which area describes clinical reasoning?

History and examination Signup and view all the answers

Which finding would indicate that a 50-year-old woman has entered menopause?

An increased FSH and LH, decreased progesterone and oestrogen Signup and view all the answers

Which investigation finding is MOST indicative of polycystic ovary syndrome (PCOS) in a 36-year-old woman with amenorrhea?

Her serum testosterone level was elevated Signup and view all the answers

What change in the Cerebrospinal Fluid (CSF) is observed in aseptic meningitis?

An increased lymphocyte count and normal to slight increase in glucose levels Signup and view all the answers

Which option BEST DESCRIBES the main mental state phenomenon in the scenario of paranoid beliefs concerning neighbors?

Delusional thought content Signup and view all the answers

Which approach is MOST likely to increase national immunization rates through the national immunization program?

Funding free vaccine programs and administering the Australian Childhood Immunization Register Signup and view all the answers

Select the statement regarding the public health impacts of climate change that is NOT TRUE.

Climate change has no effect on vector-borne diseases. Signup and view all the answers

Which clinical feature would NOT be expected in a patient presenting with symptoms consistent with PCOS?

Low serum testosterone levels Signup and view all the answers

What is the MOST likely biochemical abnormality suggested by a patient with amenorrhea and increased insulin levels?

Hyperandrogenism Signup and view all the answers

What is the primary reason for the susceptibility of infections in patients with hematological disorders?

Decreased immune system activity Signup and view all the answers

Which of the following is a characteristic feature of myeloid diseases?

Increased granulocyte production Signup and view all the answers

What is the main purpose of blood transfusion in patients with anemia?

To increase oxygen carrying capacity Signup and view all the answers

Which of the following describes a key mechanism of hemostasis?

Formation of a fibrin clot Signup and view all the answers

What is a common characteristic of anemia related to white blood cell abnormalities?

Increased risk of infection Signup and view all the answers

Which sexually transmitted infection is known to cause significant long-term complications if untreated?

Syphilis Signup and view all the answers

What is the primary treatment goal for patients with iron deficiency anemia?

Iron supplementation Signup and view all the answers

What is a major concern when prescribing immunosuppressants?

Increased susceptibility to infections Signup and view all the answers

Which anticoagulant agent directly inhibits thrombin?

Dabigatran Signup and view all the answers

When conducting a reproductive system history, what aspect is critical to inquire about?

Menstrual cycle regularity Signup and view all the answers

What is the primary use of azithromycin in clinical practice?

To treat syphilis Signup and view all the answers

Which of the following side effects is commonly associated with valproate treatment?

Weight gain Signup and view all the answers

What is the most likely cause of an elevated aPTT in a preoperative patient?

Factor VIII deficiency Signup and view all the answers

In the context of a midline neck mass, which structure is commonly implicated?

Foramen cecum Signup and view all the answers

Which part of the brain is likely damaged in a chronic alcoholic showing increased postural sway?

Cerebellar vermis Signup and view all the answers

Following a C5/C6 spinal cord injury, which symptom is most likely to manifest?

Fine touch loss in lower limbs Signup and view all the answers

What laboratory finding typically supports a diagnosis of iron deficiency anemia?

Low serum ferritin Signup and view all the answers

In a 61-year-old man unable to achieve erection, which statement is true?

The condition is linked to parasympathetic dysfunction. Signup and view all the answers

Which drug is considered the best option to combine with Levo-dopa in Parkinson’s disease?

COMT inhibitor Signup and view all the answers

Symptoms of a large anterior pituitary tumor commonly include which of the following?

Galactorrhea Signup and view all the answers

Which of the following components are part of the implanting blastocyst?

Trophoblast cells, inner cell mass, blastocyst cavity Signup and view all the answers

An aneurysm of the anterior inferior cerebellar artery can affect eye function; what would be the likely effect when looking straight ahead?

Depressed eye position Signup and view all the answers

A patient displaying rapid speech but maintaining logical progression is exhibiting which mental state phenomenon?

Rapid stream of thought Signup and view all the answers

What function would the accessory nerve primarily be tested by asking the student to do?

lift her shoulders against resistance Signup and view all the answers

Which structure is most closely associated with the left recurrent laryngeal nerve?

Ligamentum arteriosum Signup and view all the answers

Which cognitive deficit is depicted by the inability of the elderly man to recall your name during the interview?

Short term recall Signup and view all the answers

What does the active structure indicated in a stained cross-section image degenerate into?

Corpus luteum Signup and view all the answers

Which nerves are responsible for the gag reflex being tested in the 84-year-old female?

glossopharyngeal nerve/vagus nerve Signup and view all the answers

Where are Leydig cells located within the testis?

Interstitial space Signup and view all the answers

What is the most likely organism causing urethral discharge in the 24-year-old male based on the provided symptoms?

Chlamydia trachomatis Signup and view all the answers

What structure could potentially be life-threatening if injured during a stab wound to the neck just lateral to the sternocleidomastoid?

subclavian artery Signup and view all the answers

What is a true statement about the 13-year-old girl who hasn't attained menarche and shows no breasts development?

Her LH and FSH levels are likely to be low. Signup and view all the answers

In a patient who has fallen from scaffolding and is in a coma with a CT scan indicating a type of hemorrhage, what type is it likely to be?

extradural; skull bone and dura mater Signup and view all the answers

What is the most likely diagnosis for the man with significantly elevated white blood cell count showing neutrophil peaks and eosinophilia?

Chronic myeloid leukaemia Signup and view all the answers

In a patient with pernicious anemia, what levels are likely to be low?

Vitamin B12 Signup and view all the answers

What is the muscle responsible for keeping the glottis open?

Posterior cricoarytenoid muscle Signup and view all the answers

Which nerve block is most likely to affect the lingual nerve?

Inferior alveolar nerve Signup and view all the answers

What is the correct action following damage to axons in the lateral corticospinal tract regarding motor reflexes?

Are initially lost but may return at an exaggerated level Signup and view all the answers

Which of the following statements is true regarding the trigeminal nerve examination?

Deviations occur towards the side of a trigeminal lesion Signup and view all the answers

What is the blood group of a mother presenting with a baby diagnosed with haemolytic disease of the foetus and newborn?

O positive Signup and view all the answers

Which area is the most appropriate for assessing bony tenderness in a haematological examination?

Sternum Signup and view all the answers

Following an oophorectomy, which peritoneal fold contains the ovarian vessels?

Suspensory ligament Signup and view all the answers

Which vessel needs ligation during a hysterectomy to the supravaginal part of the uterus?

Uterine artery Signup and view all the answers

What type of microorganism is responsible for CNS infections via the peripheral nerves?

Rabies virus Signup and view all the answers

What is the effect of a blockage in the inferior alveolar nerve during dental work?

Total loss of sensation in the lower lip Signup and view all the answers

Which of the following clinical findings suggests occlusion of the left middle cerebral artery?

Right facial weakness with arm > leg weakness Signup and view all the answers

Which inflammatory condition is associated with syphilis?

Gonorrhea Signup and view all the answers

Which statement correctly describes the effects of climate change?

It can exacerbate food security issues globally. Signup and view all the answers

What is a documented effect of climate change on public health?

Increased respiratory diseases Signup and view all the answers

Study Notes

Clinical Skills

Reproductive system history and exam - Understand the female reproductive system and how to obtain a thorough history.
Reproductive system: History, investigations and contraception - Understand the common investigations used for reproductive system disorders.
Reproductive system clinical reasoning - Be able to reason and diagnose common disorders of the reproductive system.
Haematology Systems: History, examination & clinical reasoning - Ability to take a history and conduct examinations related to haematological disorders.
Haemotology: History, examination & investigation - Understand the appropriate investigations to conduct when a patient presents with haematological symptoms.
Eye and Ear - Clinical examination and reasoning skills related to the eye and ear.
Breast - Clinical examination and reasoning skills related to the breast.

Haematology

Susceptibility of infections - Understand the link between haematopoietic disorders and an increased risk of infection, consider the immune response.
Myeloid diseases - Understand the variety of myeloid diseases such as leukaemias and myelodysplastic syndromes, consider symptoms and treatment options.
Blood transfusion - Understand the principles of blood transfusion, including indications, complications, and management.
Haemostasis and thrombosis - Understand the mechanisms of haemostasis and thrombosis, and related disorders such as inherited thrombophilias.
Anaemia and WBC abnormalities - Be familiar with different types of anaemia and their diagnosis, management, and treatment options.

Microbiology

Sexually transmitted & genital infections - Understand the common sexually transmitted infections, including their presentation, diagnosis, and treatment.

Pharmacology

Treatment of anaemia - Understand the different treatment options for anaemia, including iron supplements, vitamin B12, and erythropoietin.
Immunosuppressants and immunomodulation - Understand the different classes of immunosuppressants and their uses in various conditions, such as transplant rejection.
Anticoagulant agents - Understand the different types of anticoagulant agents, their mechanisms of action, indications, and potential adverse effects.

Menopause

Menopause is characterized by an increase in FSH and LH, and a decrease in progesterone and estrogen.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS often have elevated serum testosterone levels.

Aseptic Meningitis

Aseptic meningitis is characterized by an increased lymphocyte count and normal to slightly increased glucose levels.

Delusions

Delusions are characterized by a fixed, false belief that is not amenable to reason or evidence.

National Immunization Program (NIP)

Increasing national immunization rates is achieved through funding free vaccine programs, administering the Australian Childhood Immunization Register, and providing up-to-date information to GPs on vaccines.

Climate Change and Public Health

Climate change has a significant impact on public health.
There is evidence that climate change can influence the epidemiology of Dengue fever.
Climate change can create water shortages and affect the quality of water supplies.
Food security is a global problem that is being negatively impacted by climate change.

Tectospinal Tract

The Tectospinal tract is responsible for reflexes involving head movement in response to auditory or visual stimuli.

General Hematological Examination

The sternum is the best area to assess for bony tenderness in a general hematological system examination. This helps to assess for possible involvement of the bone marrow.

Cranial Nerve V: Trigeminal Nerve

Testing the corneal reflex is a test of both the trigeminal and facial nerves.

Hemolytic Disease of the Fetus and Newborn (HDFN)

Haemolytic disease of the foetus and newborn (HDFN) in an O positive mother and A-negative baby is due to maternal anti-A antibodies.

Ovaries and Ligaments

The ovarian vessels are found within the suspensory ligament of the ovary.

Laryngeal Intubation

The posterior cricoarytenoid muscle is responsible for keeping the glottis open and must be paralyzed during general anesthesia.

Motor Reflexes

Damage to axons in the lateral corticospinal tract initially results in loss of motor reflexes, which then return at an exaggerated level due to the loss of descending inhibition.

Amenorrhea

The first blood test for a 25-year-old female presenting with a four-month history of amenorrhoea should check for pregnancy with a β-HCG test.

Stroke

A stroke affecting the left middle cerebral artery is the most likely cause of sudden onset loss of speech and right-sided weakness, with symptoms including global aphasia, right facial weakness, right hemiparesis (arm > leg), and right homonymous hemianopia.

Hysterectomy

The uterine artery, which lies anterior to the ureter, has to be ligated during a hysterectomy.

Mandibular Nerve

The lingual nerve is most likely to be blocked along with the inferior alveolar nerve during dental work.

Central Nervous System (CNS) Infections

Cryptococcus neoformans can infect the CNS via the olfactory tract.

Syphilis

Syphilis is caused by a Gram-negative spirochete, not a Gram-negative rod.
The antibiotic most commonly used to treat syphilis is penicillin.
Aortic aneurysm is a feature of tertiary syphilis.

Generalized/Tonic Clonic Seizures

Valproate targets and inhibits the enzyme GABA transaminase.

Antipsychotics

The antiemetic effect of antipsychotics is not related to their actions on the dopamine receptor.

Coagulation

A prolonged aPTT with a normal PT most likely indicates Factor VIII deficiency.

Neck Mass

A midline neck mass just below the hyoid that is mobile when the patient sticks out their tongue is likely from the thyroglossal duct, which originates from the foramen cecum.

Postural Sway

Damage to the cerebellar vermis is the most likely cause of increased postural sway in a chronic alcoholic.

Spinal Cord Injury

A lesion on the dorsal margin of the spinal cord at C5/C6, just to the right of the midline and confined to the white matter, will most likely cause decreased fine touch sensation in the right upper limb and right lower limb.

Anemia

Low serum ferritin is a supporting investigation finding for iron deficiency anemia.

Erectile Dysfunction

Erectile dysfunction can be caused by dysfunction of the parasympathetic nervous system.

Parkinson's Disease

MAO-B inhibitors are the best drugs to combine with Levo-dopa for the treatment of Parkinson's disease.

Pituitary Tumours

A large anterior pituitary tumour is likely to cause galactorrhea.

Implantation

The implanting blastocyst consists of trophoblast cells, the inner cell mass, and the blastocyst cavity.

Anterior Inferior Cerebellar Artery (AICA) Aneurysm

An aneurysm of the AICA near its branching point from the basilar artery could cause adduction of the eye (movement towards the midline).

Rapid Stream of Thought

Rapid stream of thought is characterized by a rapid flow of speech, often difficult to interrupt or understand, but the ideas progress logically.

Accessory Nerve

The accessory nerve is tested by asking the patient to lift their shoulders against resistance.

Recurrent Laryngeal Nerve

The left recurrent laryngeal nerve is intimately related to the ligamentum arteriosum.

Cognitive Decline

The patient’s difficulty recalling the doctor’s name after being introduced suggests a problem with short-term recall.

Corpus Luteum

The active structure in the image will degenerate into a corpus albicans.

Gag Reflex

The gag reflex is mediated by the glossopharyngeal nerve (afferent limb) and the vagus nerve (efferent limb).

Leydig Cells

Leydig cells are located in the interstitial space between the seminiferous tubules.

Urethritis

Chlamydia trachomatis is the most likely organism to cause urethral discharge and dysuria in a heterosexual male with no Gram-negative diplococci on Gram stain.

Stab Injury

A stab injury located above the right clavicle, just lateral to the sternocleidomastoid, could be life-threatening due to possible injury to the subclavian artery.

Puberty

A 13-year-old girl with Tanner stage 1 pubic hair and breast development likely has low LH and FSH levels.

Extradural Hemorrhage

The CT scan shows an extradural hemorrhage because extravasated blood is present between the skull bone and the dura mater.

Myeloproliferative Disorder

The blood count findings (high white cell count, peak of neutrophils and myelocytes, eosinophilia, and blast cells) most likely indicate a myeloproliferative disorder.

Pernicious Anaemia

Patients with pernicious anaemia typically have low levels of intrinsic factor.
Intrinsic factor is a protein produced by the stomach lining.
It's essential for the absorption of vitamin B12 in the small intestine, which is crucial for red blood cell production.

Mechanical Regulation of Lactation

Mechanical stimulation of the breast through suckling initiates prolactin and oxytocin release.
Prolactin stimulates milk production.
Oxytocin triggers milk ejection (let-down reflex).

Autoimmune Haemolytic Anaemia

The patient's symptoms, including pallor, shortness of breath, and low haemoglobin levels, with spherocytes and polychromatic cells in the peripheral blood film suggest autoimmune hemolytic anemia (AIHA).
AIHA is a condition where the body's immune system mistakenly attacks its own red blood cells.

Oculomotor Nerve Compression

Compression of the left oculomotor nerve (CN III) by the posterior communicating artery aneurysm is the most likely cause.
The signs consistent with this are left-sided ptosis (drooping eyelid), a dilated left pupil that is directed upwards and outwards, and unreactive to accommodation.

Ischemic Stroke

Alteplase (tissue plasminogen activator) is the most effective treatment for acute ischemic stroke when administered within 4.5 hours of symptom onset.
It helps dissolve the blood clot blocking the artery, restoring blood flow to the affected area.

Pudendal Nerve Block

The ischial spine serves as the landmark for palpating the pudendal nerve during a pudendal nerve block during labor.
This nerve block helps manage pain during vaginal delivery by anesthetizing the perineum.

Etonogestrel Implant (Implanon NXT®)

Implanon NXT® is a long-acting, reversible contraceptive implant effective for up to three years.
It delivers etonogestrel, a progestin hormone, into the bloodstream.
With typical use, it is greater than 99% effective.

Haem - Susceptibility of Infections

Neutropenia (low neutrophil count) increases the risk of bacterial infections.
Immunodeficiency (inadequate immune system function) can cause recurrent or serious infections.
Severe Combined Immunodeficiency (SCID) is a condition where the immune system is severely compromised, increasing vulnerability to a wide range of infections.

Myeloid Diseases

Acute myeloid leukemia (AML) is characterized by rapid proliferation of immature myeloid cells (blasts) in the bone marrow, leading to a decrease in normal blood cell production.
Chronic myeloid leukemia (CML) is characterized by the overproduction of mature myeloid cells.
Myelodysplastic syndromes (MDS) are a group of disorders where the bone marrow produces abnormal, poorly functioning blood cells, leading to anemia, neutropenia, and thrombocytopenia.

Blood Transfusion

Blood transfusion is used to replace blood volume or specific components of blood in cases of severe anemia, excessive blood loss, or other hematological disorders.
Cross-matching is a crucial step before transfusion to ensure compatibility between the donor and recipient's blood.

Haemostasis and Thrombosis

Haemostasis is the process of blood clotting to stop bleeding.
Thrombosis is the formation of a blood clot (thrombus) within a blood vessel.
Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, typically in the legs.
Pulmonary embolism (PE) is a blood clot that travels from the legs to the lungs.

Anaemia and WBC Abnormalities

Iron deficiency anemia is the most common type of anemia, caused by inadequate iron intake or absorption.
Vitamin B12 deficiency anemia is caused by inadequate vitamin B12 absorption, often due to pernicious anemia.
Folic acid deficiency anemia is caused by inadequate folic acid intake or absorption.
Leukemia is a group of cancers that affect blood-forming cells in the bone marrow.
Lymphoma is a type of cancer that affects the lymphatic system.

MICRO - Sexually Transmitted & Genital Infections

Chlamydia trachomatis is the most commonly reported sexually transmitted infection (STI) in the United States.
Neisseria gonorrhoeae is another common STI that can cause serious complications if left untreated.
Human papillomavirus (HPV) is a common viral infection transmitted through sexual contact.
Herpes simplex virus (HSV) causes genital herpes, characterized by painful blisters.
Syphilis is a bacterial infection that can cause serious complications if left untreated.

PHARM - Treatment of Anaemia

Iron supplements are used to treat iron deficiency anemia.
Vitamin B12 injections are used to treat vitamin B12 deficiency anemia.
Folic acid supplements are used to treat folic acid deficiency anemia.
Erythropoietin (EPO) stimulates red blood cell production in chronic kidney disease and other conditions causing anemia.

PHARM - Immunosupressants and Immunomodulation

Immunosuppressants are drugs that suppress the immune system to prevent organ rejection after transplantation or to treat autoimmune diseases.
Immunomodulators are drugs that modify the immune system to promote the production of antibodies and other immune cells.

PHARM - Anticoagulant Agents

Anticoagulant agents prevent blood clotting and are used to treat or prevent DVT, PE, and stroke.
Warfarin is a vitamin K antagonist that blocks the production of clotting factors.
Heparin is a heparin-based anticoagulant that prevents blood clotting by binding to antithrombin III.
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation.

CS - Reproductive System History and Exam

A comprehensive reproductive history includes menstrual history, sexual history, contraceptive use, and past pregnancies.
A pelvic exam can be part of the reproductive system assessment.
Cervical cytology is a screening test for cervical cancer.
Pap smear is a common method of cervical cytology.

CS - Reproductive System: History, Investigations and Contraception

Investigate any menstrual irregularities to determine the underlying cause.
Hormonal contraceptives include oral pills, injectable preparations, patches, and implants.
Barrier methods of contraception include condoms, diaphragms, and spermicides.

CS - Reproductive System Clinical Reasoning

Evaluate reproductive health complaints to identify underlying causes.
Consider factors such as age, menstrual history, and sexual history when reasoning about reproductive health issues.

CS - Haematology Systems: History, Examination & Clinical Reasoning

Obtain a detailed medical history to understand past hematological conditions, medications, and family history.
Conduct a physical examination to assess for pallor, jaundice, lymphadenopathy, and other signs of hematological dysfunction.
Interpret laboratory test results to confirm or rule out hematological disorders.
Use clinical reasoning to formulate a differential diagnosis and determine the appropriate investigations and treatment.

CS - Haemotology: History, Examination & Investigation

History taking focuses on symptoms of anemia, bleeding disorders, or infections.
Physical exam includes assessment of vital signs, skin color, presence of enlarged lymph nodes, and organomegaly.
Investigations include complete blood count (CBC), peripheral blood smear, bone marrow aspiration and biopsy, coagulation studies, and specialized genetic testing.

CS - Eye and Ear

Visual acuity is tested using a Snellen chart or other visual acuity methods.
Ophthalmoscopy is used to examine the interior of the eye.
Audiometry tests hearing ability.
Otoscopy involves visual examination inside the ear canal.

CS - Breast

Breast self-exam is encouraged to detect any changes in breast tissue.
Mammography is a screening test for breast cancer.
Ultrasound can be used to further evaluate breast lesions or abnormalities.
Biopsy is used to confirm the diagnosis of breast cancer.

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Description

This quiz covers essential clinical skills in the assessment of the reproductive system, haematological disorders, and related examinations. Participants will learn to take thorough histories, conduct relevant investigations, and apply clinical reasoning skills to diagnose common disorders. It is designed for those studying clinical skills in medicine and healthcare.