Podcast
Questions and Answers
In renal physiology, which of the following is the most important driving force for filtration in the glomerulus?
In renal physiology, which of the following is the most important driving force for filtration in the glomerulus?
- Osmotic pressure in Bowman’s capsule
- Hydrostatic pressure in glomerular capillaries (correct)
- Oncotic pressure in glomerular capillaries
- Hydrostatic pressure in the renal tubules
A patient presents with chronic diarrhoea and steatorrhea. Which of the following is most consistent with malabsorption in the small intestines?
A patient presents with chronic diarrhoea and steatorrhea. Which of the following is most consistent with malabsorption in the small intestines?
- Decreased bile salt production
- Increased pancreatic enzyme secretion
- Decreased villous surface area (correct)
- Increased secretion of gastric acid
Which of the following is a common feature of obstructive lung disease?
Which of the following is a common feature of obstructive lung disease?
- Increased FEV1/FVC ratio
- Decreased residual volume
- Increased total lung capacity (correct)
- Decreased functional residual capacity
Regarding GFR regulation, which of the following would increase GFR?
Regarding GFR regulation, which of the following would increase GFR?
Which hormone is primarily responsible for water reabsorption in the collecting ducts?
Which hormone is primarily responsible for water reabsorption in the collecting ducts?
What vitamin is essential for calcium absorption in the gastrointestinal tract?
What vitamin is essential for calcium absorption in the gastrointestinal tract?
Which is NOT one of the primary roles of the juxtaglomerular apparatus in the kidney?
Which is NOT one of the primary roles of the juxtaglomerular apparatus in the kidney?
A patient with elevated ferritin and transferrin saturation, but no clinical symptoms, is likely in which stage of hereditary hemochromatosis?
A patient with elevated ferritin and transferrin saturation, but no clinical symptoms, is likely in which stage of hereditary hemochromatosis?
Which type of gastric cell produces hydrochloric acid?
Which type of gastric cell produces hydrochloric acid?
Which of the following electrolyte abnormalities is common in Addison's disease?
Which of the following electrolyte abnormalities is common in Addison's disease?
In respiratory physiology, what does an increase in the V/Q ratio indicate?
In respiratory physiology, what does an increase in the V/Q ratio indicate?
Which genetic disorder is diagnosed by detecting the C282Y mutation in the HFE gene?
Which genetic disorder is diagnosed by detecting the C282Y mutation in the HFE gene?
Which neurotransmitter is primarily involved in the retrograde signal in peristalsis?
Which neurotransmitter is primarily involved in the retrograde signal in peristalsis?
Which condition is most associated with elevated levels of alkaline phosphatase (ALP) without elevated GGT?
Which condition is most associated with elevated levels of alkaline phosphatase (ALP) without elevated GGT?
Which of the following is NOT a feature of nephrotic syndrome?
Which of the following is NOT a feature of nephrotic syndrome?
Which enzyme is responsible for the conversion of angiotensin I to angiotensin II?
Which enzyme is responsible for the conversion of angiotensin I to angiotensin II?
What is the major function of bile acids in digestion?
What is the major function of bile acids in digestion?
In liver function, which of the following tests is most indicative of synthetic function?
In liver function, which of the following tests is most indicative of synthetic function?
A patient with primary biliary cholangitis will most likely have which of the following antibodies?
A patient with primary biliary cholangitis will most likely have which of the following antibodies?
Which of the following is true regarding the cephalic phase of digestion?
Which of the following is true regarding the cephalic phase of digestion?
What is the effect of aldosterone on the kidneys?
What is the effect of aldosterone on the kidneys?
Which of the following is characteristic of respiratory acidosis?
Which of the following is characteristic of respiratory acidosis?
The primary defect in coeliac disease is due to:
The primary defect in coeliac disease is due to:
Which of the following laboratory values would most suggest acute liver failure?
Which of the following laboratory values would most suggest acute liver failure?
In renal clearance, what is a primary function of the proximal tubule?
In renal clearance, what is a primary function of the proximal tubule?
Which structure separates the functional left and right lobes of the liver?
Which structure separates the functional left and right lobes of the liver?
Which of the following is involved in gastric acid secretion regulation?
Which of the following is involved in gastric acid secretion regulation?
Which is a common early sign of chronic kidney disease?
Which is a common early sign of chronic kidney disease?
Which of the following conditions is likely to cause high anion gap metabolic acidosis?
Which of the following conditions is likely to cause high anion gap metabolic acidosis?
A common mutation in hereditary haemochromatosis is:
A common mutation in hereditary haemochromatosis is:
Which vitamin is crucial in preventing neural tube defects?
Which vitamin is crucial in preventing neural tube defects?
Which of the following drugs is most likely to cause renal toxicity?
Which of the following drugs is most likely to cause renal toxicity?
The bicarbonate buffer system is crucial in maintaining blood pH. What is the normal plasma bicarbonate concentration?
The bicarbonate buffer system is crucial in maintaining blood pH. What is the normal plasma bicarbonate concentration?
Which cell type produces insulin in the pancreas?
Which cell type produces insulin in the pancreas?
In acute pancreatitis, which of the following enzymes is typically elevated?
In acute pancreatitis, which of the following enzymes is typically elevated?
The intrinsic factor required for vitamin B12 absorption is produced by which type of gastric cell?
The intrinsic factor required for vitamin B12 absorption is produced by which type of gastric cell?
Which of the following is considered a risk factor for the development of gastric adenocarcinoma?
Which of the following is considered a risk factor for the development of gastric adenocarcinoma?
Which of the following conditions is most likely associated with prolonged use of NSAIDs?
Which of the following conditions is most likely associated with prolonged use of NSAIDs?
In which part of the nephron is most sodium reabsorbed?
In which part of the nephron is most sodium reabsorbed?
Which of the following is the primary mechanism of aldosterone’s effect on sodium?
Which of the following is the primary mechanism of aldosterone’s effect on sodium?
Which of the following is the characteristic abnormality seen in Wilson's disease?
Which of the following is the characteristic abnormality seen in Wilson's disease?
Which hormone promotes calcium absorption from the small intestines?
Which hormone promotes calcium absorption from the small intestines?
What is the most likely complication of untreated coeliac disease?
What is the most likely complication of untreated coeliac disease?
Which of the following factors most directly stimulates insulin secretion from beta cells in the pancreas?
Which of the following factors most directly stimulates insulin secretion from beta cells in the pancreas?
A patient presents with respiratory distress and cyanosis. Blood gas analysis reveals:
pH: 7.31
PaCO2: 50 mmHg
HCO3-: 26 mEq/L.
What is the most likely diagnosis?
A patient presents with respiratory distress and cyanosis. Blood gas analysis reveals: pH: 7.31 PaCO2: 50 mmHg HCO3-: 26 mEq/L. What is the most likely diagnosis?
In the liver, what is the primary function of Kupffer cells?
In the liver, what is the primary function of Kupffer cells?
Which of the following conditions results in hyperbilirubinaemia due to excessive red blood cell destruction?
Which of the following conditions results in hyperbilirubinaemia due to excessive red blood cell destruction?
In renal physiology, what does the term 'renal clearance' refer to?
In renal physiology, what does the term 'renal clearance' refer to?
In which organ does the urea cycle primarily take place?
In which organ does the urea cycle primarily take place?
A patient presents with pruritus and jaundice. Which of the following conditions is most likely the cause?
A patient presents with pruritus and jaundice. Which of the following conditions is most likely the cause?
Which of the following is a major site of bicarbonate reabsorption in the kidney?
Which of the following is a major site of bicarbonate reabsorption in the kidney?
Which of the following is a feature of metabolic acidosis with compensation?
Which of the following is a feature of metabolic acidosis with compensation?
What is the role of glucocorticoids in inflammation?
What is the role of glucocorticoids in inflammation?
In the gastrointestinal tract, which of the following hormones stimulates the release of bile from the gallbladder?
In the gastrointestinal tract, which of the following hormones stimulates the release of bile from the gallbladder?
Which of the following is NOT typically a symptom of nephritic syndrome?
Which of the following is NOT typically a symptom of nephritic syndrome?
Which of the following electrolyte disturbances is commonly seen in patients with chronic kidney disease?
Which of the following electrolyte disturbances is commonly seen in patients with chronic kidney disease?
Which of the following is TRUE regarding hereditary haemochromatosis?
Which of the following is TRUE regarding hereditary haemochromatosis?
Coeliac disease risk is associated with which genetic factors?
Coeliac disease risk is associated with which genetic factors?
Which of the following enzymes plays a key role in ammonia conversion in the liver?
Which of the following enzymes plays a key role in ammonia conversion in the liver?
In the presence of H. pylori, triple therapy includes all EXCEPT:
In the presence of H. pylori, triple therapy includes all EXCEPT:
The secretion of HCl in the stomach is primarily regulated by which hormone?
The secretion of HCl in the stomach is primarily regulated by which hormone?
In liver pathology, elevated levels of ALP and GGT with a normal ALT suggest?
In liver pathology, elevated levels of ALP and GGT with a normal ALT suggest?
Which of the following neurotransmitters is primarily responsible for stimulating peristalsis?
Which of the following neurotransmitters is primarily responsible for stimulating peristalsis?
Which of the following drugs is most likely to cause hyperkalaemia in patients with renal impairment?
Which of the following drugs is most likely to cause hyperkalaemia in patients with renal impairment?
The most likely diagnosis for a patient presenting with episodic blood diarrhoea, fever, and abdominal pain, with granulomatous inflammation seen on colonoscopy is:
The most likely diagnosis for a patient presenting with episodic blood diarrhoea, fever, and abdominal pain, with granulomatous inflammation seen on colonoscopy is:
Which test is considered the most reliable for diagnosing hereditary haemochromatosis?
Which test is considered the most reliable for diagnosing hereditary haemochromatosis?
Which of the following electrolyte imbalances is expected in metabolic acidosis?
Which of the following electrolyte imbalances is expected in metabolic acidosis?
What electrolyte disturbance is most likely in a patient with severe diarrhoea?
What electrolyte disturbance is most likely in a patient with severe diarrhoea?
Which of the following conditions is characterized by a raised AST/ALT ratio and increased GGT?
Which of the following conditions is characterized by a raised AST/ALT ratio and increased GGT?
Secretin primarily stimulates the secretion of:
Secretin primarily stimulates the secretion of:
In a patient with hereditary haemochromatosis, what is the primary treatment?
In a patient with hereditary haemochromatosis, what is the primary treatment?
Which substance catalyzes the conversion of angiotensinogen to angiotensin I?
Which substance catalyzes the conversion of angiotensinogen to angiotensin I?
Which of the following is a hallmark feature of Crohn’s disease as opposed to ulcerative colitis?
Which of the following is a hallmark feature of Crohn’s disease as opposed to ulcerative colitis?
The liver deaminates amino acids to form:
The liver deaminates amino acids to form:
What is the most common cause of primary bile acid malabsorption?
What is the most common cause of primary bile acid malabsorption?
Which liver enzyme is primarily elevated in cholestasis?
Which liver enzyme is primarily elevated in cholestasis?
Which of the following is NOT a common cause of metabolic acidosis?
Which of the following is NOT a common cause of metabolic acidosis?
Which of the following is NOT a renal condition associated with nephritic syndrome?
Which of the following is NOT a renal condition associated with nephritic syndrome?
Patients presenting with weight loss, jaundice, and elevated bilirubin with a palpable mass in the right upper quadrant likely has:
Patients presenting with weight loss, jaundice, and elevated bilirubin with a palpable mass in the right upper quadrant likely has:
Which of the following is most likely to cause toxicity in a patient with impaired renal function, given a conventional treatment dose?
Which of the following is most likely to cause toxicity in a patient with impaired renal function, given a conventional treatment dose?
A patient with chronic liver disease presents with confusion, and their plasma shows a raised concentration of ammonia. Which organ is primarily responsible for ammonia conversion into a less toxic form for excretion?
A patient with chronic liver disease presents with confusion, and their plasma shows a raised concentration of ammonia. Which organ is primarily responsible for ammonia conversion into a less toxic form for excretion?
In respiratory alkalosis, what is the compensatory mechanism?
In respiratory alkalosis, what is the compensatory mechanism?
Cholecystokinin (CCK) primarily acts on which pancreatic cells?
Cholecystokinin (CCK) primarily acts on which pancreatic cells?
During which phase of digestion is hydrochloric acid predominantly secreted?
During which phase of digestion is hydrochloric acid predominantly secreted?
In which segment of the renal tubule is the majority of water reabsorbed?
In which segment of the renal tubule is the majority of water reabsorbed?
A patient presents with low pH, high PCO2, and elevated bicarbonate levels. What is the most likely condition?
A patient presents with low pH, high PCO2, and elevated bicarbonate levels. What is the most likely condition?
A deficiency in which of the following enzymes results in jaundice and bilirubin accumulation in the liver?
A deficiency in which of the following enzymes results in jaundice and bilirubin accumulation in the liver?
The liver plays a major role in deaminating amino acids. What is the fate of the ammonia produced in this process?
The liver plays a major role in deaminating amino acids. What is the fate of the ammonia produced in this process?
Which vitamin deficiency leads to pernicious anemia by impairing the absorption of vitamin B12?
Which vitamin deficiency leads to pernicious anemia by impairing the absorption of vitamin B12?
Hepatocellular carcinoma most commonly arises in which of the following conditions?
Hepatocellular carcinoma most commonly arises in which of the following conditions?
The bile canaliculi in the liver are lined by which type of epithelium?
The bile canaliculi in the liver are lined by which type of epithelium?
A 60 year old male presents with RUQ pain and jaundice. His liver function tests show increased ALT and AST levels, with a normal ALP.
a) Suggest three possible causes of his condition (3 marks)
b) List two further investigations that would help narrow down the diagnosis (2 marks)
A 60 year old male presents with RUQ pain and jaundice. His liver function tests show increased ALT and AST levels, with a normal ALP.
a) Suggest three possible causes of his condition (3 marks)
b) List two further investigations that would help narrow down the diagnosis (2 marks)
Describe the regulation of aldosterone secretion in response to hypovolaemia (5 marks).
Describe the regulation of aldosterone secretion in response to hypovolaemia (5 marks).
A patient presents with a blood gas analysis showing a pH of 7.48, PCO2 of 50 mmHg, HCO3- of 30 mEq/L. a) What is the primary acid-base disorder? (2 marks) b) Is compensation present, if so, what type? (2 marks)
A patient presents with a blood gas analysis showing a pH of 7.48, PCO2 of 50 mmHg, HCO3- of 30 mEq/L. a) What is the primary acid-base disorder? (2 marks) b) Is compensation present, if so, what type? (2 marks)
Outline the genetic basis of coeliac disease, including the role of HLA alleles? (4 marks)
Outline the genetic basis of coeliac disease, including the role of HLA alleles? (4 marks)
Compare and contrast the pathophysiology of Crohn’s disease and ulcerative colitis (6 marks)
Compare and contrast the pathophysiology of Crohn’s disease and ulcerative colitis (6 marks)
A 26-year-old female with a family history of haemochromatosis is concerned about her risk. (a) What genetic test would you recommend, and why? (3 marks) (b) How would the results of this test affect her management? (2 marks)
A 26-year-old female with a family history of haemochromatosis is concerned about her risk. (a) What genetic test would you recommend, and why? (3 marks) (b) How would the results of this test affect her management? (2 marks)
Describe the role of the sodium-potassium pump in maintaining resting membrane potential in a neuron (4 marks)
Describe the role of the sodium-potassium pump in maintaining resting membrane potential in a neuron (4 marks)
Explain the physiological response to hypoxaemia at high altitudes, focusing on ventilation and blood gas changes (5 marks)
Explain the physiological response to hypoxaemia at high altitudes, focusing on ventilation and blood gas changes (5 marks)
A patient presents with fatigue and difficulty concentrating. Blood tests reveal a macrocytic anaemia. (a) List two potential causes of the condition (2 marks) (b) Describe the role of vitamin B12 in red blood cell production (2 marks)
A patient presents with fatigue and difficulty concentrating. Blood tests reveal a macrocytic anaemia. (a) List two potential causes of the condition (2 marks) (b) Describe the role of vitamin B12 in red blood cell production (2 marks)
Describe the countercurrent multiplier system in the loop of Henle. (5 marks)
Describe the countercurrent multiplier system in the loop of Henle. (5 marks)
A 45-year-old female presents with weight gain, muscle weakness, and easy bruising. Blood tests reveal elevated cortisol levels. (a) What is the most likely diagnosis? (2 marks) (b) Explain the feedback mechanism of cortisol regulation (3 marks)
A 45-year-old female presents with weight gain, muscle weakness, and easy bruising. Blood tests reveal elevated cortisol levels. (a) What is the most likely diagnosis? (2 marks) (b) Explain the feedback mechanism of cortisol regulation (3 marks)
Compare and contrast nephrotic syndrome and nephritic syndrome (6 marks)
Compare and contrast nephrotic syndrome and nephritic syndrome (6 marks)
Describe how oxygen and carbon dioxide are transported in the blood (5 marks).
Describe how oxygen and carbon dioxide are transported in the blood (5 marks).
Explain the mechanisms of action of proton pump inhibitors and H2 blockers in gastric acid suppression (4 marks)
Explain the mechanisms of action of proton pump inhibitors and H2 blockers in gastric acid suppression (4 marks)
A 65-year-old male resents with chronic cough, weight loss, and haemoptysis. His CT scan shows a mass in the right upper lobe of the lung. (a) What is the most likely diagnosis? (2 marks) (b) List two additional investigations you would request (2 marks)
A 65-year-old male resents with chronic cough, weight loss, and haemoptysis. His CT scan shows a mass in the right upper lobe of the lung. (a) What is the most likely diagnosis? (2 marks) (b) List two additional investigations you would request (2 marks)
A patient presents with jaundice and elevated conjugated bilirubin levels. Provide three possible differential diagnoses and suggest two laboratory tests to confirm the diagnosis (5 marks)
A patient presents with jaundice and elevated conjugated bilirubin levels. Provide three possible differential diagnoses and suggest two laboratory tests to confirm the diagnosis (5 marks)
A patient presents with blood gas results of: pH 7.32, PaCO2 40 mmHg, HCO3- 18mEq/L. (a) What is the primary acid-base disorder (3 marks) (b) Is there compensation? Explain. (3 marks)
A patient presents with blood gas results of: pH 7.32, PaCO2 40 mmHg, HCO3- 18mEq/L. (a) What is the primary acid-base disorder (3 marks) (b) Is there compensation? Explain. (3 marks)
A 30 year old male presents with multiple episodes of vomiting and diarrhoea after eating at a restaurant. His stool tests positive for Vibrio cholerae. (a) What is the pathophysiology of cholera? (3 marks) (b) What is the treatment of choice for cholera? (2 marks)
A 30 year old male presents with multiple episodes of vomiting and diarrhoea after eating at a restaurant. His stool tests positive for Vibrio cholerae. (a) What is the pathophysiology of cholera? (3 marks) (b) What is the treatment of choice for cholera? (2 marks)
Explain how the body compensates for respiratory acidosis (5 marks).
Explain how the body compensates for respiratory acidosis (5 marks).
Compare and contrast respiratory and metabolic acidosis in terms of causes (at least 3 of each), lab findings, and compensation mechanisms (5 marks)
Compare and contrast respiratory and metabolic acidosis in terms of causes (at least 3 of each), lab findings, and compensation mechanisms (5 marks)
Describe the mechanisms of action and clinical uses of ACE inhibitors and angiotensin receptor blockers (ARBs) (5 marks)
Describe the mechanisms of action and clinical uses of ACE inhibitors and angiotensin receptor blockers (ARBs) (5 marks)
A 55-year-old man with a history of alcohol abuse presents with fatigue, abdominal distention, and jaundice. His blood tests reveal elevated bilirubin and ALT/AST ratio, with low albumin. (a) Provide 3 differential diagnoses (3 marks) (b) List 2 further tests you would perform (2 marks)
A 55-year-old man with a history of alcohol abuse presents with fatigue, abdominal distention, and jaundice. His blood tests reveal elevated bilirubin and ALT/AST ratio, with low albumin. (a) Provide 3 differential diagnoses (3 marks) (b) List 2 further tests you would perform (2 marks)
Outline the physiological role of vitamin D and calcium homeostasis and bone metabolism (4 marks)
Outline the physiological role of vitamin D and calcium homeostasis and bone metabolism (4 marks)
A 40-year old woman is diagnosed with primary biliary cholangitis. What is the pathophysiology of the condition and how is it diagnosed? (5 marks)
A 40-year old woman is diagnosed with primary biliary cholangitis. What is the pathophysiology of the condition and how is it diagnosed? (5 marks)
Describe the role of the portal hepatic vein in nutrient absorption (3 marks)
Describe the role of the portal hepatic vein in nutrient absorption (3 marks)
A patient presents with hypokalaemia. Explain how the RAAS system contributes to potassium balance. (4 marks)
A patient presents with hypokalaemia. Explain how the RAAS system contributes to potassium balance. (4 marks)
Describe the mechanisms by which bicarbonate ions are secreted into the duodenum and the regulatory hormone involved. (4 marks)
Describe the mechanisms by which bicarbonate ions are secreted into the duodenum and the regulatory hormone involved. (4 marks)
Explain the physiological roles of the juxtaglomerular apparatus in regulating blood pressure and glomerular filtration rate (GFR) (5 marks)
Explain the physiological roles of the juxtaglomerular apparatus in regulating blood pressure and glomerular filtration rate (GFR) (5 marks)
A patient presents with signs of cirrhosis. Outline the key liver function tests that would be performed and what abnormalities you would expect in these tests. (4 marks)
A patient presents with signs of cirrhosis. Outline the key liver function tests that would be performed and what abnormalities you would expect in these tests. (4 marks)
Explain the process of tubular reabsorption of glucose in the kidneys and the consequences of exceeding the renal threshold for glucose. (4 marks)
Explain the process of tubular reabsorption of glucose in the kidneys and the consequences of exceeding the renal threshold for glucose. (4 marks)
Describe the role of parathyroid hormone (PTH) in calcium homeostasis, and outline the response of PTH to low plasma calcium levels, (3 marks)
Describe the role of parathyroid hormone (PTH) in calcium homeostasis, and outline the response of PTH to low plasma calcium levels, (3 marks)
In a patient with hyperbilirubinaemia, differentiate between pre-hepatic, hepatic, and post-hepatic causes, providing an example of each. (4 marks)
In a patient with hyperbilirubinaemia, differentiate between pre-hepatic, hepatic, and post-hepatic causes, providing an example of each. (4 marks)
Outline the major pathways by which metabolic waste is excreted by the kidneys, focusing on nitrogenous waste and the formation of urea. (3 marks)
Outline the major pathways by which metabolic waste is excreted by the kidneys, focusing on nitrogenous waste and the formation of urea. (3 marks)
Explain the differences in acid secretion in response to food stimuli in the cephalic, gastric, and intestinal phases of digestion. (4 marks)
Explain the differences in acid secretion in response to food stimuli in the cephalic, gastric, and intestinal phases of digestion. (4 marks)
Describe the function of podocytes in the kidney and their role in the filtration barrier. (3 marks)
Describe the function of podocytes in the kidney and their role in the filtration barrier. (3 marks)
Discuss the role of albumin in maintaining the oncotic pressure and the clinical consequences of hypoalbuminaemia. (4 marks)
Discuss the role of albumin in maintaining the oncotic pressure and the clinical consequences of hypoalbuminaemia. (4 marks)
What are the stages of alcoholic liver disease, and how does each stage differ histologically? (5 marks)
What are the stages of alcoholic liver disease, and how does each stage differ histologically? (5 marks)
Describe the process of bile salt reabsorption in the enterohepatic circulation and name one condition where this process is disrupted. (2 marks)
Describe the process of bile salt reabsorption in the enterohepatic circulation and name one condition where this process is disrupted. (2 marks)
A 55-year-old male presents with cirrhosis and ascites. List four complications of cirrhosis and explain how portal hypertension contributes to the development of ascites. (5 marks)
A 55-year-old male presents with cirrhosis and ascites. List four complications of cirrhosis and explain how portal hypertension contributes to the development of ascites. (5 marks)
Describe the mechanism by which H. pylori infection leads to peptic ulcer disease. (2 marks)
Describe the mechanism by which H. pylori infection leads to peptic ulcer disease. (2 marks)
A 45-year-old woman presents with jaundice and a history of intermittent abdominal pain. Lab results show elevated ALP, GGT, and bilirubin. What is the most likely diagnosis, and which imaging test would be used to confirm it? (4 marks)
A 45-year-old woman presents with jaundice and a history of intermittent abdominal pain. Lab results show elevated ALP, GGT, and bilirubin. What is the most likely diagnosis, and which imaging test would be used to confirm it? (4 marks)
Name the two main drugs used in the treatment of nausea and vomiting, and briefly describe their mechanisms of action. (2 marks)
Name the two main drugs used in the treatment of nausea and vomiting, and briefly describe their mechanisms of action. (2 marks)
A patient with ulcerative colitis develops signs of a toxic megacolon. What clinical features would you expect to see, and what is the treatment approach for this context? (4 marks)
A patient with ulcerative colitis develops signs of a toxic megacolon. What clinical features would you expect to see, and what is the treatment approach for this context? (4 marks)
A 35-year-old woman with a history of recurrent UTIs presents with flank pain and fever. Imaging reveals a perinephric abscess. Discuss the pathogenesis, complications, and treatment options for perinephric abscesses. (5 masks)
A 35-year-old woman with a history of recurrent UTIs presents with flank pain and fever. Imaging reveals a perinephric abscess. Discuss the pathogenesis, complications, and treatment options for perinephric abscesses. (5 masks)
Compare the histological differences between the small intestine and the colon, focusing on the presence of villi and goblet cells. (3 marks)
Compare the histological differences between the small intestine and the colon, focusing on the presence of villi and goblet cells. (3 marks)
Which of the following enzymes is responsible for the conversion of bilirubin into its conjugated form in the liver?
Which of the following enzymes is responsible for the conversion of bilirubin into its conjugated form in the liver?
In renal physiology, which structure of the nephron is most responsible for the reabsorption of bicarbonate?
In renal physiology, which structure of the nephron is most responsible for the reabsorption of bicarbonate?
Which of the following would decrease the GFR most significantly?
Which of the following would decrease the GFR most significantly?
Which of the following mutations is associated with Wilson's disease?
Which of the following mutations is associated with Wilson's disease?
Which of the following conditions is most associated with low levels of caeruloplasmin?
Which of the following conditions is most associated with low levels of caeruloplasmin?
In terms of acid-base disturbances, which of the following is most likely to result in a high anion gap metabolic acidosis?
In terms of acid-base disturbances, which of the following is most likely to result in a high anion gap metabolic acidosis?
Which of the following is a consequence of renal compensation for respiratory alkalosis?
Which of the following is a consequence of renal compensation for respiratory alkalosis?
Which of the following cytokines is most associated with granuloma formation in Crohn's disease?
Which of the following cytokines is most associated with granuloma formation in Crohn's disease?
A mutation in the CFTR gene affects chloride channels in multiple tissues. Which of the following organs is least likely to be affected by this mutation?
A mutation in the CFTR gene affects chloride channels in multiple tissues. Which of the following organs is least likely to be affected by this mutation?
Which of the following best describes the location of the macula densa within the nephron?
Which of the following best describes the location of the macula densa within the nephron?
The urea cycle occurs primarily in which two cellular compartments?
The urea cycle occurs primarily in which two cellular compartments?
Which of the following statements regarding coeliac disease is correct?
Which of the following statements regarding coeliac disease is correct?
A patient with nephrotic syndrome presents with oedema, proteinuria, and hypoalbuminaemia. What additional laboratory finding is expected?
A patient with nephrotic syndrome presents with oedema, proteinuria, and hypoalbuminaemia. What additional laboratory finding is expected?
Which of the following statements regarding aldosterone’s action in the kidney is INCORRECT?
Which of the following statements regarding aldosterone’s action in the kidney is INCORRECT?
In liver disease, what is the most common cause of hyperbilirubinaemia in the absence of elevated aminotransferases (ALT/AST)?
In liver disease, what is the most common cause of hyperbilirubinaemia in the absence of elevated aminotransferases (ALT/AST)?
A patient has metabolic alkalosis with a low chloride level. Which of the following is the most likely diagnosis?
A patient has metabolic alkalosis with a low chloride level. Which of the following is the most likely diagnosis?
Which of the following is a key function of histamine released by enterochromaffin-like (ECL) cells in the stomach?
Which of the following is a key function of histamine released by enterochromaffin-like (ECL) cells in the stomach?
What is the role of parathyroid hormone (PTH) in phosphate homeostasis?
What is the role of parathyroid hormone (PTH) in phosphate homeostasis?
Which of the following best describes the mechanism of action of furosemide?
Which of the following best describes the mechanism of action of furosemide?
Which of the following conditions is characterized by the presence of non-caseating granulomas in the gastrointestinal tract?
Which of the following conditions is characterized by the presence of non-caseating granulomas in the gastrointestinal tract?
A patient has elevated bilirubin, GGT, and ALP but normal AST and ALT. Which of the following is the most likely cause?
A patient has elevated bilirubin, GGT, and ALP but normal AST and ALT. Which of the following is the most likely cause?
Which of the following statements regarding beta-haemolytic streptococci is correct?
Which of the following statements regarding beta-haemolytic streptococci is correct?
Which of the following statements is true regarding the histology of the liver?
Which of the following statements is true regarding the histology of the liver?
A patient with severe protein-losing enteropathy is most likely to exhibit which of the following laboratory findings?
A patient with severe protein-losing enteropathy is most likely to exhibit which of the following laboratory findings?
Which of the following pathways is responsible for the conjugation of bilirubin in the liver?
Which of the following pathways is responsible for the conjugation of bilirubin in the liver?
Which of the following best explains the metabolic consequences of hyperaldosteronism?
Which of the following best explains the metabolic consequences of hyperaldosteronism?
In the context of the microbiome, what is the function of short-chain fatty acids produced by gut bacteria?
In the context of the microbiome, what is the function of short-chain fatty acids produced by gut bacteria?
A patient with liver cirrhosis develops hepatic encephalopathy. Which of the following is the most likely underlying mechanism?
A patient with liver cirrhosis develops hepatic encephalopathy. Which of the following is the most likely underlying mechanism?
Which of the following antibiotics is most likely to cause Clostridium difficile-associated diarrhea?
Which of the following antibiotics is most likely to cause Clostridium difficile-associated diarrhea?
Which of the following drugs is most likely to cause nephrotoxicity in patients with chronic kidney disease?
Which of the following drugs is most likely to cause nephrotoxicity in patients with chronic kidney disease?
Which of the following is a key function of the colon?
Which of the following is a key function of the colon?
Which of the following conditions is least likely to be associated with haematuria?
Which of the following conditions is least likely to be associated with haematuria?
A 42-year-old man presents with a liver mass. His alpha-fetoprotein (AFP) levels are elevated. Which of the following is the most likely diagnosis?
A 42-year-old man presents with a liver mass. His alpha-fetoprotein (AFP) levels are elevated. Which of the following is the most likely diagnosis?
In a patient with chronic renal failure, the most likely cause of secondary hyperparathyroidism is:
In a patient with chronic renal failure, the most likely cause of secondary hyperparathyroidism is:
Which of the following is true regarding renal ammoniagenesis?
Which of the following is true regarding renal ammoniagenesis?
A patient with polyuria and polydipsia is diagnosed with diabetes insipidus. Which hormone is deficient in this condition?
A patient with polyuria and polydipsia is diagnosed with diabetes insipidus. Which hormone is deficient in this condition?
Which of the following is a feature of post-hepatic jaundice?
Which of the following is a feature of post-hepatic jaundice?
In which of the following conditions is the serum-ascites albumin gradient (SAAG) typically elevated?
In which of the following conditions is the serum-ascites albumin gradient (SAAG) typically elevated?
Which of the following tests is most useful in distinguishing between an upper and lower gastrointestinal bleed?
Which of the following tests is most useful in distinguishing between an upper and lower gastrointestinal bleed?
Which of the following is characteristic of Fanconi syndrome?
Which of the following is characteristic of Fanconi syndrome?
Which of the following is the primary mechanism by which the kidneys regulate long-term blood pressure?
Which of the following is the primary mechanism by which the kidneys regulate long-term blood pressure?
A patient with renal cell carcinoma is most likely to present with which of the following findings?
A patient with renal cell carcinoma is most likely to present with which of the following findings?
A patient with obstructive jaundice presents with pale stools and dark urine. Which of the following laboratory abnormalities is most likely present?
A patient with obstructive jaundice presents with pale stools and dark urine. Which of the following laboratory abnormalities is most likely present?
Which of the following is true regarding haemochromatosis?
Which of the following is true regarding haemochromatosis?
A patient presents with dyspepsia and positive serology for Helicobacter pylori. Which of the following is most likely to develop without treatment?
A patient presents with dyspepsia and positive serology for Helicobacter pylori. Which of the following is most likely to develop without treatment?
Which of the following is a common finding in patients with diabetic nephropathy?
Which of the following is a common finding in patients with diabetic nephropathy?
Which of the following vitamins is essential for the activation of clotting factors in the liver?
Which of the following vitamins is essential for the activation of clotting factors in the liver?
A patient with a history of alcohol use disorder presents with signs of liver cirrhosis. Which of the following is most likely associated with this condition?
A patient with a history of alcohol use disorder presents with signs of liver cirrhosis. Which of the following is most likely associated with this condition?
A patient with primary sclerosing cholangitis is at increased risk of developing which of the following conditions?
A patient with primary sclerosing cholangitis is at increased risk of developing which of the following conditions?
Which of the following statements about Barrett’s oesophagus is correct?
Which of the following statements about Barrett’s oesophagus is correct?
Which of the following is characteristic of minimal change disease?
Which of the following is characteristic of minimal change disease?
Which of the following statements regarding nephrotic syndrome is NOT correct?
Which of the following statements regarding nephrotic syndrome is NOT correct?
Which of the following is NOT typically seen in metabolic acidosis with a normal anion gap?
Which of the following is NOT typically seen in metabolic acidosis with a normal anion gap?
Which of the following is NOT a cause of respiratory alkalosis?
Which of the following is NOT a cause of respiratory alkalosis?
Which of the following statements about the hepatic portal vein is NOT correct?
Which of the following statements about the hepatic portal vein is NOT correct?
Which of the following is LEAST likely to cause increased serum amylase levels?
Which of the following is LEAST likely to cause increased serum amylase levels?
Which of the following statements about aldosterone is NOT correct?
Which of the following statements about aldosterone is NOT correct?
Which of the following is LEAST likely to be a complication of cirrhosis?
Which of the following is LEAST likely to be a complication of cirrhosis?
Which of the following is NOT typically seen in Addison’s disease?
Which of the following is NOT typically seen in Addison’s disease?
Which of the following laboratory findings is NOT consistent with acute liver failure?
Which of the following laboratory findings is NOT consistent with acute liver failure?
Which of the following is NOT a characteristic feature of Crohn's disease?
Which of the following is NOT a characteristic feature of Crohn's disease?
Which of the following is NOT a consequence of chronic renal failure?
Which of the following is NOT a consequence of chronic renal failure?
Which of the following statements about coeliac disease is correct?
Which of the following statements about coeliac disease is correct?
Which of the following is NOT associated with an increased risk of hepatocellular carcinoma?
Which of the following is NOT associated with an increased risk of hepatocellular carcinoma?
Which of the following is NOT an effect of angiotensin II?
Which of the following is NOT an effect of angiotensin II?
Which of the following is NOT a component of the glomerular filtration barrier?
Which of the following is NOT a component of the glomerular filtration barrier?
Which of the following is LEAST likely to cause prerenal acute kidney injury (AKI)?
Which of the following is LEAST likely to cause prerenal acute kidney injury (AKI)?
Which of the following findings is NOT typical of acute tubular necrosis (ATN)?
Which of the following findings is NOT typical of acute tubular necrosis (ATN)?
Which of the following is NOT a cause of nephritic syndrome?
Which of the following is NOT a cause of nephritic syndrome?
Which of the following is NOT a potential complication of gastro-oesophageal reflux disease (GORD)?
Which of the following is NOT a potential complication of gastro-oesophageal reflux disease (GORD)?
Which of the following statements regarding liver cirrhosis is NOT correct?
Which of the following statements regarding liver cirrhosis is NOT correct?
Which of the following is NOT a common cause of acute pancreatitis?
Which of the following is NOT a common cause of acute pancreatitis?
Which of the following is NOT a feature of haemolytic uraemic syndrome (HUS)?
Which of the following is NOT a feature of haemolytic uraemic syndrome (HUS)?
Which of the following conditions is NOT associated with pleural effusion?
Which of the following conditions is NOT associated with pleural effusion?
Which of the following conditions is NOT associated with a normocytic, normochromic anaemia?
Which of the following conditions is NOT associated with a normocytic, normochromic anaemia?
Which of the following statements about primary biliary cholangitis (PBC) is NOT correct?
Which of the following statements about primary biliary cholangitis (PBC) is NOT correct?
Which of the following statements about coagulopathies in liver disease is NOT correct?
Which of the following statements about coagulopathies in liver disease is NOT correct?
Which of the following laboratory findings is NOT consistent with rhabdomyolysis?
Which of the following laboratory findings is NOT consistent with rhabdomyolysis?
Which of the following is NOT a complication of long-standing hypertension?
Which of the following is NOT a complication of long-standing hypertension?
Which of the following conditions is LEAST likely to cause secondary hypertension?
Which of the following conditions is LEAST likely to cause secondary hypertension?
Which of the following findings is NOT typically associated with diabetic nephropathy?
Which of the following findings is NOT typically associated with diabetic nephropathy?
Which of the following conditions is NOT associated with increased serum uric acid levels?
Which of the following conditions is NOT associated with increased serum uric acid levels?
Which of the following is NOT associated with the development of chronic kidney disease (CKD)?
Which of the following is NOT associated with the development of chronic kidney disease (CKD)?
Which of the following statements about membranous nephropathy is NOT correct?
Which of the following statements about membranous nephropathy is NOT correct?
Which of the following is NOT a typical feature of acute interstitial nephritis?
Which of the following is NOT a typical feature of acute interstitial nephritis?
Which of the following findings is NOT typical of a patient with acute cholecystitis?
Which of the following findings is NOT typical of a patient with acute cholecystitis?
Which of the following statements about acute pyelonephritis is NOT correct?
Which of the following statements about acute pyelonephritis is NOT correct?
Which of the following is NOT a cause of metabolic alkalosis?
Which of the following is NOT a cause of metabolic alkalosis?
Which of the following is NOT a complication of systemic lupus erythematosus (SLE)?
Which of the following is NOT a complication of systemic lupus erythematosus (SLE)?
Which of the following is NOT a cause of hepatomegaly?
Which of the following is NOT a cause of hepatomegaly?
What statement is NOT correct about renin's negative feedback loop?
What statement is NOT correct about renin's negative feedback loop?
Which of the following is NOT a feature of Wilson's disease?
Which of the following is NOT a feature of Wilson's disease?
Which of the following statements about acute hepatitis is NOT correct?
Which of the following statements about acute hepatitis is NOT correct?
Which of the following is NOT a potential complication of liver cirrhosis?
Which of the following is NOT a potential complication of liver cirrhosis?
Which of the following statements about glomerular filtration is NOT correct?
Which of the following statements about glomerular filtration is NOT correct?
Discuss GFR net filtration pressure (NFP) and describe all of the renal corpuscle pressures (5 marks)
Discuss GFR net filtration pressure (NFP) and describe all of the renal corpuscle pressures (5 marks)
Which of the following is LEAST likely to be associated with primary sclerosing cholangitis (PSC)?
Which of the following is LEAST likely to be associated with primary sclerosing cholangitis (PSC)?
Which of the following statements about amyloidosis is NOT correct?
Which of the following statements about amyloidosis is NOT correct?
Which of the following is NOT a feature of tubulointerstitial nephritis?
Which of the following is NOT a feature of tubulointerstitial nephritis?
Which of the following is LEAST likely to be a cause of glomerulonephritis?
Which of the following is LEAST likely to be a cause of glomerulonephritis?
Which of the following is NOT a characteristic of autosomal dominant polycystic kidney disease (ADPKD)?
Which of the following is NOT a characteristic of autosomal dominant polycystic kidney disease (ADPKD)?
Which of the following statements regarding glomerular diseases is NOT correct?
Which of the following statements regarding glomerular diseases is NOT correct?
Which of the following is NOT a feature of membranous glomerulonephritis?
Which of the following is NOT a feature of membranous glomerulonephritis?
Which of the following is NOT typically associated with Goodpasture syndrome?
Which of the following is NOT typically associated with Goodpasture syndrome?
Which of the following is NOT a cause of acute interstitial nephritis?
Which of the following is NOT a cause of acute interstitial nephritis?
Which of the following is LEAST likely to present with nephrotic syndrome?
Which of the following is LEAST likely to present with nephrotic syndrome?
Which of the following is NOT characteristic of lupus nephritis?
Which of the following is NOT characteristic of lupus nephritis?
Which of the following is NOT correct regarding amyloidosis in the kidney?
Which of the following is NOT correct regarding amyloidosis in the kidney?
Which of the following is NOT associated with rapidly progressive glomerulonephritis?
Which of the following is NOT associated with rapidly progressive glomerulonephritis?
Which of the following is NOT a risk factor for focal segmental glomerulosclerosis (FSGS)?
Which of the following is NOT a risk factor for focal segmental glomerulosclerosis (FSGS)?
Which of the following is NOT characteristic of focal segmental glomerulosclerosis (FSGS)?
Which of the following is NOT characteristic of focal segmental glomerulosclerosis (FSGS)?
Which of the following is LEAST likely to cause tubular necrosis?
Which of the following is LEAST likely to cause tubular necrosis?
Which of the following findings is LEAST likely to be associated with post-streptococcal glomerulonephritis?
Which of the following findings is LEAST likely to be associated with post-streptococcal glomerulonephritis?
Which of the following is NOT characteristic of membranoproliferative glomerulonephritis (MPGN)?
Which of the following is NOT characteristic of membranoproliferative glomerulonephritis (MPGN)?
Which of the following drugs is NOT used to treat helminth infections?
Which of the following drugs is NOT used to treat helminth infections?
What nerve supplies general sensation to the anterior 2/3 of the tongue? (1 mark)
What nerve supplies general sensation to the anterior 2/3 of the tongue? (1 mark)
Describe the main role of the circumvallate papillae. (1 mark)
Describe the main role of the circumvallate papillae. (1 mark)
Identify the arteries that supply the foregut, midgut, and hindgut. Give one example of their branches. (3 marks)
Identify the arteries that supply the foregut, midgut, and hindgut. Give one example of their branches. (3 marks)
What is the significance of the portal venous system in relation to gut blood supply? (2 marks)
What is the significance of the portal venous system in relation to gut blood supply? (2 marks)
List the three major salivary glands and state their primary secretions. (2 marks)
List the three major salivary glands and state their primary secretions. (2 marks)
Which cranial nerve innervates the submandibular gland? (1 mark)
Which cranial nerve innervates the submandibular gland? (1 mark)
Name two pancreatic enzymes responsible for protein digestion. (1 mark)
Name two pancreatic enzymes responsible for protein digestion. (1 mark)
What hormone stimulates the release of bicarbonate from the pancreas, and what cell is it secreted by? (1 mark)
What hormone stimulates the release of bicarbonate from the pancreas, and what cell is it secreted by? (1 mark)
Explain the role of bile salts in fat digestion. (1 mark)
Explain the role of bile salts in fat digestion. (1 mark)
Define glomerular filtration rate (GFR). (1 mark)
Define glomerular filtration rate (GFR). (1 mark)
Describe how changes in afferent and efferent arteriole diameter can increase GFR. (2 marks)
Describe how changes in afferent and efferent arteriole diameter can increase GFR. (2 marks)
What substance is commonly used to estimate GFR? (1 mark)
What substance is commonly used to estimate GFR? (1 mark)
What are the common genetic mutations associated with colorectal cancer?
What are the common genetic mutations associated with colorectal cancer?
Describe the adenoma-carcinoma sequence. (2 marks)
Describe the adenoma-carcinoma sequence. (2 marks)
What is the significance of the FOBT screening test in bowel cancer? (1 mark)
What is the significance of the FOBT screening test in bowel cancer? (1 mark)
Explain why drug doses often need to be adjusted in patients with renal insufficiency. (2 marks)
Explain why drug doses often need to be adjusted in patients with renal insufficiency. (2 marks)
Name one nephrotoxic drug that should be avoided in patients with renal insufficiency. (1 mark)
Name one nephrotoxic drug that should be avoided in patients with renal insufficiency. (1 mark)
How are carbohydrates absorbed in the small intestine and what transporter is involved? (3 marks)
How are carbohydrates absorbed in the small intestine and what transporter is involved? (3 marks)
List two main routes of transmission for hepatitis B virus. (2 marks)
List two main routes of transmission for hepatitis B virus. (2 marks)
Describe one possible long-term complication of chronic hepatitis B infection. (1 mark)
Describe one possible long-term complication of chronic hepatitis B infection. (1 mark)
Is there a vaccine for hepatitis B? (1 mark)
Is there a vaccine for hepatitis B? (1 mark)
What are the main pharmacological treatments for Helicobacter pylori-related peptic ulcer disease? (3 marks)
What are the main pharmacological treatments for Helicobacter pylori-related peptic ulcer disease? (3 marks)
How do proton pump inhibitors (PPIs) work? (2 marks)
How do proton pump inhibitors (PPIs) work? (2 marks)
During development, the midgut undergoes rotation. To what degree and direction does it rotate and around which artery does this occur? (2 mark)
During development, the midgut undergoes rotation. To what degree and direction does it rotate and around which artery does this occur? (2 mark)
What congenital abnormality can result from failure of midgut herniation return? (1 mark)
What congenital abnormality can result from failure of midgut herniation return? (1 mark)
Name one part of the adult intestine derived from the midgut. (1 mark)
Name one part of the adult intestine derived from the midgut. (1 mark)
Define sensitivity and specificity in the context of a screening test. (2 marks)
Define sensitivity and specificity in the context of a screening test. (2 marks)
Explain the concept of overdiagnosis in screening programs. (2 marks)
Explain the concept of overdiagnosis in screening programs. (2 marks)
List two common causes of acute liver injury. (2 marks)
List two common causes of acute liver injury. (2 marks)
What clinical symptoms would indicate acute liver failure? (2 marks)
What clinical symptoms would indicate acute liver failure? (2 marks)
Name two classes of immunosuppressant drugs used in organ transplantation. (2 marks)
Name two classes of immunosuppressant drugs used in organ transplantation. (2 marks)
What is the primary risk associated with the use of glucocorticoids and calcineurin inhibitors in organ transplantation?
What is the primary risk associated with the use of glucocorticoids and calcineurin inhibitors in organ transplantation?
Name two common pathogens involved in intra-abdominal infections. (2 marks)
Name two common pathogens involved in intra-abdominal infections. (2 marks)
Describe the clinical presentation of peritonitis. (2 marks)
Describe the clinical presentation of peritonitis. (2 marks)
List the four key steps in performing an abdominal examination. (2 marks)
List the four key steps in performing an abdominal examination. (2 marks)
What is the significance of rebound tenderness in diagnosing appendicitis? (2 marks)
What is the significance of rebound tenderness in diagnosing appendicitis? (2 marks)
Describe the two common causes of acute kidney injury (AKI). (2 marks)
Describe the two common causes of acute kidney injury (AKI). (2 marks)
What are two indications for initiating dialysis in a patient with acute kidney injury? (2 marks)
What are two indications for initiating dialysis in a patient with acute kidney injury? (2 marks)
Name a common electrolyte disturbance in acute kidney injury (AKI). (1 mark)
Name a common electrolyte disturbance in acute kidney injury (AKI). (1 mark)
What are the main types of gallstones? (2 marks)
What are the main types of gallstones? (2 marks)
How does acute cholecystitis present clinically? (3 marks)
How does acute cholecystitis present clinically? (3 marks)
Describe the progression stages and the chronic liver diseases associated with cirrhosis. (5 marks)
Describe the progression stages and the chronic liver diseases associated with cirrhosis. (5 marks)
What are the complications associated with portal hypertension? (2 marks)
What are the complications associated with portal hypertension? (2 marks)
A 52-year-old male presents with right upper quadrant pain, jaundice, and a history of excessive alcohol consumption. (a) List two likely causes of the patient’s symptoms based on his history. (2 marks) (b) What liver function tests would be elevated in this patient, and what do they indicate? (2 marks) ( c) Describe the pathophysiology of cirrhosis leading to portal hypertension. (2 marks)
A 52-year-old male presents with right upper quadrant pain, jaundice, and a history of excessive alcohol consumption. (a) List two likely causes of the patient’s symptoms based on his history. (2 marks) (b) What liver function tests would be elevated in this patient, and what do they indicate? (2 marks) ( c) Describe the pathophysiology of cirrhosis leading to portal hypertension. (2 marks)
A 35-year-old female presents with a 6-month history of chronic diarrhoea, weight loss, and fatigue. She has no significant past medical history but reports a family history of autoimmune diseases.
(a) List two possible differential diagnoses for this patient. (2 marks)
(b) What laboratory tests and imaging studies would you order to confirm a diagnosis? (2 marks)
( c) Describe the genetic markers and pathophysiology associated with the likely diagnosis. (2 marks)
A 35-year-old female presents with a 6-month history of chronic diarrhoea, weight loss, and fatigue. She has no significant past medical history but reports a family history of autoimmune diseases.
(a) List two possible differential diagnoses for this patient. (2 marks) (b) What laboratory tests and imaging studies would you order to confirm a diagnosis? (2 marks) ( c) Describe the genetic markers and pathophysiology associated with the likely diagnosis. (2 marks)
A 48-year-old male presents with urinary frequency, nocturia, and a weak urinary stream. He has no history of smoking or significant weight loss but mentions that his father had similar symptoms.
(A) Based on the patient's symptoms, what is the most likely diagnosis? (1 mark)(B) What clinical examination would you perform, and what findings would confirm diagnosis? (2 marks)
(C) Discuss one pharmacological treatment option and its mechanism of action. (2 marks)
(D) What potential complication might arise if left untreated? (1 mark)
A 48-year-old male presents with urinary frequency, nocturia, and a weak urinary stream. He has no history of smoking or significant weight loss but mentions that his father had similar symptoms.
(A) Based on the patient's symptoms, what is the most likely diagnosis? (1 mark)(B) What clinical examination would you perform, and what findings would confirm diagnosis? (2 marks) (C) Discuss one pharmacological treatment option and its mechanism of action. (2 marks) (D) What potential complication might arise if left untreated? (1 mark)
A 22-year-old male presents to the emergency department with severe epigastric pain and vomiting. He has a history of alcohol abuse, and his serum lipase levels are elevated.
(A) What is the most likely diagnosis? (1 mark)
(B) Explain the pathophysiology of the condition. (2 marks)
(C) What imaging modality would you use to assess the extent of the condition, and why? (1 mark)
(D) Discuss two potential complications of this condition. (2 marks)
e) Describe the initial management plan for this patient. (1 mark)
A 22-year-old male presents to the emergency department with severe epigastric pain and vomiting. He has a history of alcohol abuse, and his serum lipase levels are elevated.
(A) What is the most likely diagnosis? (1 mark) (B) Explain the pathophysiology of the condition. (2 marks) (C) What imaging modality would you use to assess the extent of the condition, and why? (1 mark) (D) Discuss two potential complications of this condition. (2 marks) e) Describe the initial management plan for this patient. (1 mark)
A 60-year-old male presents with a 3-month history of altered bowel habits, including intermittent constipation and diarrhoea. He has also noticed rectal bleeding and a significant unintentional weight loss of 10 kg.
(A) What are two possible differential diagnoses for this patient’s symptoms? (2 marks)
(B) What investigations would you order to rule out colorectal cancer? (2 marks)
(C) Explain the adenoma-carcinoma sequence in the development of colorectal cancer. (2 marks)
(D) What is the role of FOBT in bowel cancer screening? (1 mark)
A 60-year-old male presents with a 3-month history of altered bowel habits, including intermittent constipation and diarrhoea. He has also noticed rectal bleeding and a significant unintentional weight loss of 10 kg.
(A) What are two possible differential diagnoses for this patient’s symptoms? (2 marks) (B) What investigations would you order to rule out colorectal cancer? (2 marks) (C) Explain the adenoma-carcinoma sequence in the development of colorectal cancer. (2 marks) (D) What is the role of FOBT in bowel cancer screening? (1 mark)
A 45-year-old female presents with a 6-month history of fatigue, joint pain, and mild jaundice. She has a family history of autoimmune diseases.
(A) What is the most likely diagnosis? (1 mark) (B) Which laboratory tests would help confirm the diagnosis? (2 marks) (C) Explain the underlying immunological mechanism. (2 marks) (D) What is the first-line treatment? (1 mark).
A 45-year-old female presents with a 6-month history of fatigue, joint pain, and mild jaundice. She has a family history of autoimmune diseases.
(A) What is the most likely diagnosis? (1 mark) (B) Which laboratory tests would help confirm the diagnosis? (2 marks) (C) Explain the underlying immunological mechanism. (2 marks) (D) What is the first-line treatment? (1 mark).
A 28-year-old male presents with jaundice, dark urine, and general malaise. He recently traveled to a region where hepatitis A is endemic. (A) What is the most likely diagnosis? (1 mark) (B) How is hepatitis A transmitted, and what is its typical clinical course? (2 marks) (C) What laboratory findings would confirm the diagnosis? (2 marks) (D) Is there a vaccine for hepatitis A, and what is its role in prevention? (1 mark)
A 28-year-old male presents with jaundice, dark urine, and general malaise. He recently traveled to a region where hepatitis A is endemic. (A) What is the most likely diagnosis? (1 mark) (B) How is hepatitis A transmitted, and what is its typical clinical course? (2 marks) (C) What laboratory findings would confirm the diagnosis? (2 marks) (D) Is there a vaccine for hepatitis A, and what is its role in prevention? (1 mark)
Case Study: 50-year-old female with recurrent urinary tract infections (UTIs)
(Total: 6 marks)
A 50-year-old female presents with recurrent UTIs over the past year. She experiences dysuria, frequency, and lower abdominal pain with each episode. (A) What are two common pathogens that cause UTIs in women? (2 marks) (B) What investigations would you perform to identify the underlying cause of her recurrent UTIs? (2 marks) (C) Discuss one long-term complication of untreated recurrent UTIs. (1 mark) (D) What preventive strategies would you recommend to reduce the recurrence of UTIs? (1 mark)
Case Study: 50-year-old female with recurrent urinary tract infections (UTIs) (Total: 6 marks) A 50-year-old female presents with recurrent UTIs over the past year. She experiences dysuria, frequency, and lower abdominal pain with each episode. (A) What are two common pathogens that cause UTIs in women? (2 marks) (B) What investigations would you perform to identify the underlying cause of her recurrent UTIs? (2 marks) (C) Discuss one long-term complication of untreated recurrent UTIs. (1 mark) (D) What preventive strategies would you recommend to reduce the recurrence of UTIs? (1 mark)
A 40-year-old female presents with fatigue, joint pain, and skin hyperpigmentation. Blood tests reveal elevated serum ferritin and transferrin saturation.
a) What is the most likely diagnosis? (1 mark)
b) Explain the genetic basis of hereditary haemochromatosis. (2 marks)
c) What are the long-term complications of untreated hereditary haemochromatosis? (2 marks)
d) How is this condition managed? (1 mark)
A 40-year-old female presents with fatigue, joint pain, and skin hyperpigmentation. Blood tests reveal elevated serum ferritin and transferrin saturation.
a) What is the most likely diagnosis? (1 mark) b) Explain the genetic basis of hereditary haemochromatosis. (2 marks) c) What are the long-term complications of untreated hereditary haemochromatosis? (2 marks) d) How is this condition managed? (1 mark)
A 65-year-old female presents with weight loss, abdominal bloating, and a change in bowel habits over the past 6 months. She also complains of fatigue and has noticed blood in her stool.
a) What are two possible differential diagnoses based on her symptoms? (2 marks)
b) What investigations would you perform to diagnose? (2 marks)
c) Describe the role of tumour markers in the diagnosis and monitoring the diagnosis. (2 marks)
A 65-year-old female presents with weight loss, abdominal bloating, and a change in bowel habits over the past 6 months. She also complains of fatigue and has noticed blood in her stool.
a) What are two possible differential diagnoses based on her symptoms? (2 marks) b) What investigations would you perform to diagnose? (2 marks) c) Describe the role of tumour markers in the diagnosis and monitoring the diagnosis. (2 marks)
A 55-year-old male presents with progressive abdominal pain and distention. He has a history of chronic hepatitis B infection. On examination, his abdomen is distended with shifting dullness, and he has spider angiomata on his chest.
a) What is the most likely cause of his symptoms? (1 mark)
b) Explain the pathophysiology of ascites in the context of the diagnosis. (2 marks)
c) What are the key diagnostic tests to confirm ascites? (2 marks)
d) Discuss two complications associated with the diagnosis. (2 marks)
A 55-year-old male presents with progressive abdominal pain and distention. He has a history of chronic hepatitis B infection. On examination, his abdomen is distended with shifting dullness, and he has spider angiomata on his chest.
a) What is the most likely cause of his symptoms? (1 mark) b) Explain the pathophysiology of ascites in the context of the diagnosis. (2 marks) c) What are the key diagnostic tests to confirm ascites? (2 marks) d) Discuss two complications associated with the diagnosis. (2 marks)
A 35-year-old male presents with progressive difficulty swallowing (dysphagia) and frequent heartburn. He reports a long history of acid reflux but has not been on any regular treatment.
a) What are two possible differential diagnoses for his symptoms? (2 marks)
b) What diagnostic test would you order to evaluate the cause of his dysphagia? (1 mark)
c) Describe the complications if left untreated. (2 marks)
d) Name one pharmacological treatment for the diagnosis and its mechanism of action. (1 mark)
A 35-year-old male presents with progressive difficulty swallowing (dysphagia) and frequent heartburn. He reports a long history of acid reflux but has not been on any regular treatment.
a) What are two possible differential diagnoses for his symptoms? (2 marks) b) What diagnostic test would you order to evaluate the cause of his dysphagia? (1 mark) c) Describe the complications if left untreated. (2 marks) d) Name one pharmacological treatment for the diagnosis and its mechanism of action. (1 mark)
A 45-year-old male presents with right-sided abdominal pain, nausea, and vomiting. He has a history of gallstones but has not had any prior treatment. On examination, he is tender in the right upper quadrant.
a) What is the most likely diagnosis? (1 mark)
b) What imaging modality would you use to confirm the diagnosis, and why? (2 marks)
c) Explain the pathophysiology of the diagnosis. (2 marks)
d) What are two possible complications if left untreated? (2 marks)
A 45-year-old male presents with right-sided abdominal pain, nausea, and vomiting. He has a history of gallstones but has not had any prior treatment. On examination, he is tender in the right upper quadrant.
a) What is the most likely diagnosis? (1 mark) b) What imaging modality would you use to confirm the diagnosis, and why? (2 marks) c) Explain the pathophysiology of the diagnosis. (2 marks) d) What are two possible complications if left untreated? (2 marks)
A 55-year-old male with a history of type 2 diabetes and hypertension presents with worsening fatigue and swelling in his lower legs. Blood tests show elevated serum creatinine and reduced glomerular filtration rate (GFR).
a) What is the most likely diagnosis? (1 mark)
b) Describe the pathophysiology of the diagnosis related to diabetes. (2 marks)
c) What investigations would you perform to assess kidney function in this patient? (2 marks)
d) Discuss one pharmacological and one non-pharmacological treatment option for managing (2 marks)
A 55-year-old male with a history of type 2 diabetes and hypertension presents with worsening fatigue and swelling in his lower legs. Blood tests show elevated serum creatinine and reduced glomerular filtration rate (GFR).
a) What is the most likely diagnosis? (1 mark) b) Describe the pathophysiology of the diagnosis related to diabetes. (2 marks) c) What investigations would you perform to assess kidney function in this patient? (2 marks) d) Discuss one pharmacological and one non-pharmacological treatment option for managing (2 marks)
A 40-year-old female presents with sudden onset lower abdominal pain and blood in her urine. She has no history of trauma but mentions a recent history of recurrent urinary tract infections (UTIs).
a) What is the most likely diagnosis? (1 mark)
b) What imaging study would you order to confirm the diagnosis? (1 mark)
c) Explain the pathophysiology of urolithiasis. (2 marks)
d) List two potential complications of untreated urolithiasis. (2 marks)
A 40-year-old female presents with sudden onset lower abdominal pain and blood in her urine. She has no history of trauma but mentions a recent history of recurrent urinary tract infections (UTIs).
a) What is the most likely diagnosis? (1 mark) b) What imaging study would you order to confirm the diagnosis? (1 mark) c) Explain the pathophysiology of urolithiasis. (2 marks) d) List two potential complications of untreated urolithiasis. (2 marks)
A 70-year-old female presents with urinary incontinence that has progressively worsened over the past year. She reports leaking urine when coughing or sneezing and has difficulty holding urine.
a) What is the most likely diagnosis? (1 mark)
b) Describe the pathophysiology. (2 marks)
c) What non-pharmacological treatment options would you suggest? (2 marks)
d) Name one pharmacological treatment option for urinary incontinence. (1 mark)
A 70-year-old female presents with urinary incontinence that has progressively worsened over the past year. She reports leaking urine when coughing or sneezing and has difficulty holding urine.
a) What is the most likely diagnosis? (1 mark) b) Describe the pathophysiology. (2 marks) c) What non-pharmacological treatment options would you suggest? (2 marks) d) Name one pharmacological treatment option for urinary incontinence. (1 mark)
A 29-year-old female presents with fatigue, pale skin, and irregular menstrual periods. She reports heavy menstrual bleeding during her periods. Blood tests reveal microcytic hypochromic anemia.
a) What is the most likely diagnosis? (1 mark)
b) What laboratory tests would confirm the diagnosis? (2 marks)
c) Describe the pathophysiology. (2 marks)
d) What is the first-line treatment for this condition? (1 mark)
e) List one complication if left untreated. (1 mark)
A 29-year-old female presents with fatigue, pale skin, and irregular menstrual periods. She reports heavy menstrual bleeding during her periods. Blood tests reveal microcytic hypochromic anemia.
a) What is the most likely diagnosis? (1 mark) b) What laboratory tests would confirm the diagnosis? (2 marks) c) Describe the pathophysiology. (2 marks) d) What is the first-line treatment for this condition? (1 mark) e) List one complication if left untreated. (1 mark)
A 60-year-old male presents with abdominal pain, significant unintentional weight loss, and new-onset diabetes. He has a history of smoking.
a) What is the most likely diagnosis? (1 mark)
b) Describe the pathophysiology. (2 marks)
c) What imaging study would you use to evaluate the affected organ? (1 mark)
d) Discuss two possible complications. (2 marks)
A 60-year-old male presents with abdominal pain, significant unintentional weight loss, and new-onset diabetes. He has a history of smoking.
a) What is the most likely diagnosis? (1 mark) b) Describe the pathophysiology. (2 marks) c) What imaging study would you use to evaluate the affected organ? (1 mark) d) Discuss two possible complications. (2 marks)
A 42-year-old male presents with jaundice, abdominal pain, and severe itching (pruritus). He has a history of ulcerative colitis.
a) What is the most likely diagnosis? (1 mark)
b) Describe the pathophysiology (2 marks)
c) What laboratory findings would confirm the diagnosis? (2 marks)
d) Discuss one long-term complication. (2 marks)
A 42-year-old male presents with jaundice, abdominal pain, and severe itching (pruritus). He has a history of ulcerative colitis.
a) What is the most likely diagnosis? (1 mark) b) Describe the pathophysiology (2 marks) c) What laboratory findings would confirm the diagnosis? (2 marks) d) Discuss one long-term complication. (2 marks)
A 65-year-old male presents with fever, chills, and dark urine. He reports recent travel to a malaria-endemic region.
a) What is the most likely diagnosis? (1 mark)
b) What test would you use to confirm the diagnosis? (1 mark)
c) Describe the life cycle of the cause and how it causes the disease. (2 marks)
d) What is the first-line treatment ? (2 marks)
A 65-year-old male presents with fever, chills, and dark urine. He reports recent travel to a malaria-endemic region.
a) What is the most likely diagnosis? (1 mark) b) What test would you use to confirm the diagnosis? (1 mark) c) Describe the life cycle of the cause and how it causes the disease. (2 marks) d) What is the first-line treatment ? (2 marks)
Which of the following about neonatal immune responses is NOT correct?
Which of the following about neonatal immune responses is NOT correct?
Which statement about maternal infections and pregnancy outcomes is NOT correct?
Which statement about maternal infections and pregnancy outcomes is NOT correct?
Which of the following regarding the maternal-fetal interface is NOT correct?
Which of the following regarding the maternal-fetal interface is NOT correct?
Which statement regarding senescence is NOT correct?
Which statement regarding senescence is NOT correct?
Which of the following statements about maternal health and global disparities is NOT correct?
Which of the following statements about maternal health and global disparities is NOT correct?
What type of T cells increase in number to maintain fetal tolerance?
What type of T cells increase in number to maintain fetal tolerance?
How does the placenta contribute to preventing immune rejection of the fetus?
How does the placenta contribute to preventing immune rejection of the fetus?
Which part of the immune system remains intact to protect against maternal infections?
Which part of the immune system remains intact to protect against maternal infections?
Why do neonates rely heavily on passive immunity?
Why do neonates rely heavily on passive immunity?
Name one deficiency in the neonatal innate immune system.
Name one deficiency in the neonatal innate immune system.
When do neonates start producing their own IgG?
When do neonates start producing their own IgG?
What maternal condition is commonly associated with intrauterine growth restriction (IUGR)?
What maternal condition is commonly associated with intrauterine growth restriction (IUGR)?
How does IUGR affect long-term health in offspring?
How does IUGR affect long-term health in offspring?
What hypothesis explains the link between IUGR and chronic disease?
What hypothesis explains the link between IUGR and chronic disease?
Which statement regarding cervical changes during pregnancy and labour is NOT correct?
Which statement regarding cervical changes during pregnancy and labour is NOT correct?
Which statement about the immune changes during pregnancy is NOT correct?
Which statement about the immune changes during pregnancy is NOT correct?
Which of the following statements about maternal respiratory changes during pregnancy is NOT correct?
Which of the following statements about maternal respiratory changes during pregnancy is NOT correct?
Which of the following statements about maternal changes in the gastrointestinal system during pregnancy is NOT correct?
Which of the following statements about maternal changes in the gastrointestinal system during pregnancy is NOT correct?
Which statement about haematologic changes in pregnancy is NOT true?
Which statement about haematologic changes in pregnancy is NOT true?
Which of the following statements about maternal urinary system changes in pregnancy is NOT correct?
Which of the following statements about maternal urinary system changes in pregnancy is NOT correct?
Which statement about the stages of labour is NOT correct?
Which statement about the stages of labour is NOT correct?
Which statement about breast changes during pregnancy is NOT correct?
Which statement about breast changes during pregnancy is NOT correct?
Which of the following statements about placental hormone production is NOT correct?
Which of the following statements about placental hormone production is NOT correct?
Which of the following is NOT a physiological cardiovascular change in pregnancy?
Which of the following is NOT a physiological cardiovascular change in pregnancy?
Which statement about fetal monitoring during labour is NOT correct?
Which statement about fetal monitoring during labour is NOT correct?
Describe the endocrine changes in pregnancy.
Describe the endocrine changes in pregnancy.
Explain cardiovascular changes during labour.
Explain cardiovascular changes during labour.
Discuss maternal haematologic adaptations during pregnancy.
Discuss maternal haematologic adaptations during pregnancy.
Describe the stages of labour and key features of each.
Describe the stages of labour and key features of each.
Explain respiratory adaptations in pregnancy.
Explain respiratory adaptations in pregnancy.
Detail the anatomical changes in the uterus and cervix during pregnancy.
Detail the anatomical changes in the uterus and cervix during pregnancy.
Discuss the role of placental hormones in pregnancy.
Discuss the role of placental hormones in pregnancy.
Explain the mechanisms of maternal cardiac output change during pregnancy.
Explain the mechanisms of maternal cardiac output change during pregnancy.
Describe fetal positioning and its impact on labour.
Describe fetal positioning and its impact on labour.
Explain changes in the maternal urinary system during pregnancy.
Explain changes in the maternal urinary system during pregnancy.
Discuss skeletal and postural changes during pregnancy.
Discuss skeletal and postural changes during pregnancy.
Explain the physiological basis of maternal hypoxia during labour.
Explain the physiological basis of maternal hypoxia during labour.
What cardiovascular changes in pregnancy might explain shortness of breath, palpitations, and mild peripheral edema?
What cardiovascular changes in pregnancy might explain shortness of breath, palpitations, and mild peripheral edema?
What phase of labour is a 34-year-old woman in if she reports regular, painful contractions and has a cervical dilation of 5 cm?
What phase of labour is a 34-year-old woman in if she reports regular, painful contractions and has a cervical dilation of 5 cm?
What is the most likely diagnosis for a 32-year-old pregnant woman with frequent urination, back pain, and fever, and positive nitrites and leukocytes on urine dipstick?
What is the most likely diagnosis for a 32-year-old pregnant woman with frequent urination, back pain, and fever, and positive nitrites and leukocytes on urine dipstick?
What is the most likely fetal position contributing to back pain in a 30-year-old woman in active labour at 40 weeks?
What is the most likely fetal position contributing to back pain in a 30-year-old woman in active labour at 40 weeks?
What is the most concerning diagnosis to rule out for a 27-year-old woman at 38 weeks with increased swelling in her legs and face, and a blood pressure of 145/95 mmHg?
What is the most concerning diagnosis to rule out for a 27-year-old woman at 38 weeks with increased swelling in her legs and face, and a blood pressure of 145/95 mmHg?
What cardiovascular changes explain shortness of breath for a 24-year-old woman at 40 weeks gestation with strong contractions but has not progressed past 6 cm dilation?
What cardiovascular changes explain shortness of breath for a 24-year-old woman at 40 weeks gestation with strong contractions but has not progressed past 6 cm dilation?
What term describes the lack of progress in labor?
What term describes the lack of progress in labor?
What potential cause should be assessed in cases of labor arrest?
What potential cause should be assessed in cases of labor arrest?
What management options are available for labor arrest?
What management options are available for labor arrest?
What physiological change in pregnancy contributes to heartburn?
What physiological change in pregnancy contributes to heartburn?
Name one lifestyle modification that may help with heartburn in pregnancy.
Name one lifestyle modification that may help with heartburn in pregnancy.
What pharmacologic option is safe for treating heartburn in pregnancy?
What pharmacologic option is safe for treating heartburn in pregnancy?
What serious condition should be considered first in a pregnant woman with sudden onset dyspnea and chest pain?
What serious condition should be considered first in a pregnant woman with sudden onset dyspnea and chest pain?
Name one immediate diagnostic test to confirm pulmonary embolism.
Name one immediate diagnostic test to confirm pulmonary embolism.
What is the first step in management for suspected pulmonary embolism?
What is the first step in management for suspected pulmonary embolism?
What fetal condition might be indicated by meconium-stained amniotic fluid?
What fetal condition might be indicated by meconium-stained amniotic fluid?
What immediate monitoring should be conducted when meconium-stained fluid is present?
What immediate monitoring should be conducted when meconium-stained fluid is present?
What potential intervention should be prepared for during delivery when meconium-stained fluid is present?
What potential intervention should be prepared for during delivery when meconium-stained fluid is present?
What is the most likely diagnosis for severe itching on palms and soles with elevated bile acids in pregnancy?
What is the most likely diagnosis for severe itching on palms and soles with elevated bile acids in pregnancy?
Name one potential risk to the fetus associated with intrahepatic cholestasis of pregnancy.
Name one potential risk to the fetus associated with intrahepatic cholestasis of pregnancy.
What is a key component of management for intrahepatic cholestasis of pregnancy?
What is a key component of management for intrahepatic cholestasis of pregnancy?
What is the most significant risk factor for breast cancer related to estrogen exposure?
What is the most significant risk factor for breast cancer related to estrogen exposure?
Which drug is contraindicated during pregnancy due to its association with congenital abnormalities?
Which drug is contraindicated during pregnancy due to its association with congenital abnormalities?
What is the mechanism of action of selective estrogen receptor modulators (SERMs) like tamoxifen in breast tissue?
What is the mechanism of action of selective estrogen receptor modulators (SERMs) like tamoxifen in breast tissue?
Which of the following is most accurate regarding the safety of SSRIs during pregnancy?
Which of the following is most accurate regarding the safety of SSRIs during pregnancy?
Which genetic inheritance pattern is described in a consanguineous couple with recurrent neonatal deaths due to a genetic disorder?
Which genetic inheritance pattern is described in a consanguineous couple with recurrent neonatal deaths due to a genetic disorder?
What is the primary risk associated with hormone therapy in postmenopausal women using combined estrogen and progestogen therapy?
What is the primary risk associated with hormone therapy in postmenopausal women using combined estrogen and progestogen therapy?
Which of the following is a significant long-term benefit of menopause hormone therapy (MHT)?
Which of the following is a significant long-term benefit of menopause hormone therapy (MHT)?
What is a major concern with the use of ACE inhibitors during pregnancy?
What is a major concern with the use of ACE inhibitors during pregnancy?
In reproductive genetics, what is the risk calculation for having an affected child when one parent is a carrier for an autosomal recessive disorder?
In reproductive genetics, what is the risk calculation for having an affected child when one parent is a carrier for an autosomal recessive disorder?
What differentiates aromatase inhibitors from SERMs in terms of their mechanism in breast cancer therapy?
What differentiates aromatase inhibitors from SERMs in terms of their mechanism in breast cancer therapy?
Which statement regarding tamoxifen is NOT correct?
Which statement regarding tamoxifen is NOT correct?
Which statement about hormone therapy in menopause is NOT correct?
Which statement about hormone therapy in menopause is NOT correct?
Which statement regarding the pharmacokinetics of drugs in pregnancy is NOT correct?
Which statement regarding the pharmacokinetics of drugs in pregnancy is NOT correct?
Which statement regarding genetic carrier screening is NOT correct?
Which statement regarding genetic carrier screening is NOT correct?
Which of the following about aromatase inhibitors is NOT correct?
Which of the following about aromatase inhibitors is NOT correct?
Which statement about menopause is NOT correct?
Which statement about menopause is NOT correct?
Which of the following about the safety of SSRIs in pregnancy is NOT correct?
Which of the following about the safety of SSRIs in pregnancy is NOT correct?
Which statement about estrogen receptor activity is NOT correct?
Which statement about estrogen receptor activity is NOT correct?
Which statement about selective estrogen receptor modulators (SERMs) is NOT correct?
Which statement about selective estrogen receptor modulators (SERMs) is NOT correct?
Which statement regarding drugs in pregnancy is NOT correct?
Which statement regarding drugs in pregnancy is NOT correct?
What condition can NSAIDs cause if taken near delivery?
What condition can NSAIDs cause if taken near delivery?
What safer analgesic alternative is recommended for use during pregnancy?
What safer analgesic alternative is recommended for use during pregnancy?
What is a Robertsonian translocation?
What is a Robertsonian translocation?
How can balanced translocations lead to recurrent miscarriages?
How can balanced translocations lead to recurrent miscarriages?
What type of genetic analysis is used to detect translocations?
What type of genetic analysis is used to detect translocations?
What is the primary use of tamoxifen in premenopausal women?
What is the primary use of tamoxifen in premenopausal women?
Name one absolute contraindication for tamoxifen use.
Name one absolute contraindication for tamoxifen use.
What is a significant side effect associated with tamoxifen in the uterus?
What is a significant side effect associated with tamoxifen in the uterus?
What preventive therapy could be considered for a woman with a family history of ER-positive breast cancer?
What preventive therapy could be considered for a woman with a family history of ER-positive breast cancer?
What is the mechanism of action of tamoxifen?
What is the mechanism of action of tamoxifen?
Name one major side effect that needs to be monitored in patients taking tamoxifen.
Name one major side effect that needs to be monitored in patients taking tamoxifen.
What type of therapy can help prevent further bone loss in a woman diagnosed with osteoporosis after early menopause?
What type of therapy can help prevent further bone loss in a woman diagnosed with osteoporosis after early menopause?
Why would a selective estrogen receptor modulator (SERM) like raloxifene be considered?
Why would a selective estrogen receptor modulator (SERM) like raloxifene be considered?
What is one side effect of raloxifene?
What is one side effect of raloxifene?
What is a balanced translocation?
What is a balanced translocation?
How does a balanced translocation contribute to recurrent miscarriages?
How does a balanced translocation contribute to recurrent miscarriages?
What are potential reproductive options for couples with a balanced translocation?
What are potential reproductive options for couples with a balanced translocation?
What is the most likely diagnosis for a pregnant woman presenting with sudden severe chest pain, shortness of breath, and tachycardia?
What is the most likely diagnosis for a pregnant woman presenting with sudden severe chest pain, shortness of breath, and tachycardia?
What immediate test would confirm the diagnosis of a pulmonary embolism?
What immediate test would confirm the diagnosis of a pulmonary embolism?
What treatment should be initiated upon confirmation of a pulmonary embolism?
What treatment should be initiated upon confirmation of a pulmonary embolism?
What is the safest approach to hormone therapy for a postmenopausal woman with a history of DVT?
What is the safest approach to hormone therapy for a postmenopausal woman with a history of DVT?
Why is transdermal estrogen considered over oral formulations?
Why is transdermal estrogen considered over oral formulations?
What non-hormonal alternatives could be explored if hormone therapy is not suitable for managing vasomotor symptoms?
What non-hormonal alternatives could be explored if hormone therapy is not suitable for managing vasomotor symptoms?
Which category of anti-migraine drugs should be avoided during pregnancy?
Which category of anti-migraine drugs should be avoided during pregnancy?
What non-pharmacologic interventions can be recommended for managing migraines during pregnancy?
What non-pharmacologic interventions can be recommended for managing migraines during pregnancy?
Which pharmacologic treatment could be considered safer for migraines during pregnancy?
Which pharmacologic treatment could be considered safer for migraines during pregnancy?
Which microbe is associated with intrauterine infections and significant risk to the fetus if maternal infection occurs in the first 20 weeks? (Select all that apply)
Which microbe is associated with intrauterine infections and significant risk to the fetus if maternal infection occurs in the first 20 weeks? (Select all that apply)
What is the most common serious outcome of early-onset neonatal Group B Streptococcus (GBS) infection? (Select all that apply)
What is the most common serious outcome of early-onset neonatal Group B Streptococcus (GBS) infection? (Select all that apply)
Which immune component shows impaired function in neonates, increasing their susceptibility to bacterial infections? (Select all that apply)
Which immune component shows impaired function in neonates, increasing their susceptibility to bacterial infections? (Select all that apply)
What mechanism contributes to the reduced adaptive immune response observed in the elderly? (Select all that apply)
What mechanism contributes to the reduced adaptive immune response observed in the elderly? (Select all that apply)
Which statement best describes the main consequence of maternal CMV infection during pregnancy? (Select all that apply)
Which statement best describes the main consequence of maternal CMV infection during pregnancy? (Select all that apply)
Which physiological mechanism helps prevent maternal immune rejection of the fetus? (Select all that apply)
Which physiological mechanism helps prevent maternal immune rejection of the fetus? (Select all that apply)
Which age-related change is linked to decreased antibody diversity and quality in older adults? (Select all that apply)
Which age-related change is linked to decreased antibody diversity and quality in older adults? (Select all that apply)
What is a critical risk factor for neonatal sepsis in preterm infants? (Select all that apply)
What is a critical risk factor for neonatal sepsis in preterm infants? (Select all that apply)
What maternal intervention reduces the risk of severe congenital outcomes in neonates exposed to infections such as rubella? (Select all that apply)
What maternal intervention reduces the risk of severe congenital outcomes in neonates exposed to infections such as rubella? (Select all that apply)
What type of immune response is dominant in neonates and contributes to their susceptibility to certain pathogens? (Select all that apply)
What type of immune response is dominant in neonates and contributes to their susceptibility to certain pathogens? (Select all that apply)
Which statement correctly describes the aging immune system? (Select all that apply)
Which statement correctly describes the aging immune system? (Select all that apply)
Which factor contributes significantly to antenatal complications such as preterm birth? (Select all that apply)
Which factor contributes significantly to antenatal complications such as preterm birth? (Select all that apply)
What condition results from insufficient nutrient flow through the placenta and is associated with chronic disease risk later in life? (Select all that apply)
What condition results from insufficient nutrient flow through the placenta and is associated with chronic disease risk later in life? (Select all that apply)
What is a major immune alteration seen in preterm neonates? (Select all that apply)
What is a major immune alteration seen in preterm neonates? (Select all that apply)
What factor decreases the effectiveness of vaccines in the elderly? (Select all that apply)
What factor decreases the effectiveness of vaccines in the elderly? (Select all that apply)
Neonates have a fully functional complement system.
Neonates have a fully functional complement system.
Colonization by microbes begins before birth.
Colonization by microbes begins before birth.
Antibiotic exposure during cesarean delivery enhances the diversity of the gut microbiome.
Antibiotic exposure during cesarean delivery enhances the diversity of the gut microbiome.
There is an increased production of naïve T cells in the elderly.
There is an increased production of naïve T cells in the elderly.
IUGR is exclusively due to fetal chromosomal abnormalities.
IUGR is exclusively due to fetal chromosomal abnormalities.
The maternal immune system completely suppresses innate immunity.
The maternal immune system completely suppresses innate immunity.
Which of the following features is characteristic of primary syphilis?
Which of the following features is characteristic of primary syphilis?
What is the most common organ system affected by congenital cytomegalovirus (CMV) infection?
What is the most common organ system affected by congenital cytomegalovirus (CMV) infection?
Which of the following is NOT typically associated with secondary syphilis?
Which of the following is NOT typically associated with secondary syphilis?
Infections with which herpes virus have been linked to Burkitt's lymphoma?
Infections with which herpes virus have been linked to Burkitt's lymphoma?
What is the most common initial presentation of measles?
What is the most common initial presentation of measles?
A typical feature of diphtheria infection includes:
A typical feature of diphtheria infection includes:
What is a classic complication of mumps in post-pubertal males?
What is a classic complication of mumps in post-pubertal males?
Which statement about varicella-zoster virus is TRUE?
Which statement about varicella-zoster virus is TRUE?
Parvovirus B19 infection can lead to which condition in individuals with pre-existing haemolytic disorders?
Parvovirus B19 infection can lead to which condition in individuals with pre-existing haemolytic disorders?
Which of the following diseases is caused by Streptococcus pyogenes?
Which of the following diseases is caused by Streptococcus pyogenes?
What is the primary risk factor for developing Kaposi’s sarcoma in an immunocompromised patient?
What is the primary risk factor for developing Kaposi’s sarcoma in an immunocompromised patient?
Which complication of congenital rubella syndrome (CRS) is most commonly seen?
Which complication of congenital rubella syndrome (CRS) is most commonly seen?
Which symptom is commonly associated with erysipelas caused by Streptococcus pyogenes?
Which symptom is commonly associated with erysipelas caused by Streptococcus pyogenes?
What is the transmission mode for rubella?
What is the transmission mode for rubella?
Which disease can present with necrotising skin lesions known as mycetomas?
Which disease can present with necrotising skin lesions known as mycetomas?
Which statement about Epstein-Barr virus is NOT correct?
Which statement about Epstein-Barr virus is NOT correct?
Which of the following statements about congenital syphilis is NOT correct?
Which of the following statements about congenital syphilis is NOT correct?
Which of the following clinical features is NOT typical of secondary syphilis?
Which of the following clinical features is NOT typical of secondary syphilis?
Regarding Listeria monocytogenes, which of the following statements is NOT correct?
Regarding Listeria monocytogenes, which of the following statements is NOT correct?
Which of the following about HHV-8 is NOT correct?
Which of the following about HHV-8 is NOT correct?
Which statement about Streptococcus pyogenes and its complications is NOT correct?
Which statement about Streptococcus pyogenes and its complications is NOT correct?
Which statement about rubella infection is NOT correct?
Which statement about rubella infection is NOT correct?
Which of the following regarding varicella-zoster virus (VZV) is NOT correct?
Which of the following regarding varicella-zoster virus (VZV) is NOT correct?
Which of these complications is NOT associated with mumps infection?
Which of these complications is NOT associated with mumps infection?
Which of the following regarding the herpes simplex virus (HSV) is NOT correct?
Which of the following regarding the herpes simplex virus (HSV) is NOT correct?
Which of the following is NOT a typical feature of congenital syphilis in a surviving child?
Which of the following is NOT a typical feature of congenital syphilis in a surviving child?
Which of the following regarding actinomycosis is NOT correct?
Which of the following regarding actinomycosis is NOT correct?
Which statement regarding beta-haemolytic streptococci is NOT true?
Which statement regarding beta-haemolytic streptococci is NOT true?
Which of the following regarding childhood parvovirus B19 infection is NOT true?
Which of the following regarding childhood parvovirus B19 infection is NOT true?
Which of the following regarding diphtheria is NOT correct?
Which of the following regarding diphtheria is NOT correct?
List the typical lesion associated with primary syphilis and describe its key characteristics.
List the typical lesion associated with primary syphilis and describe its key characteristics.
Name two systemic features seen in secondary syphilis.
Name two systemic features seen in secondary syphilis.
What is the primary neurological complication associated with tertiary syphilis?
What is the primary neurological complication associated with tertiary syphilis?
What is the most common cardiac defect in congenital rubella syndrome (CRS)?
What is the most common cardiac defect in congenital rubella syndrome (CRS)?
Explain why early maternal infection is more dangerous to the fetus.
Explain why early maternal infection is more dangerous to the fetus.
What is the recommended prevention strategy for CRS?
What is the recommended prevention strategy for CRS?
Name one common food item that may be a source of Listeria.
Name one common food item that may be a source of Listeria.
Describe the condition 'granulomatosis infantiseptica.'
Describe the condition 'granulomatosis infantiseptica.'
What is the primary clinical concern for Listeria infection in pregnant women?
What is the primary clinical concern for Listeria infection in pregnant women?
Which type of HSV is most commonly implicated in herpes simplex encephalitis?
Which type of HSV is most commonly implicated in herpes simplex encephalitis?
Identify the brain regions typically involved in herpes simplex encephalitis.
Identify the brain regions typically involved in herpes simplex encephalitis.
What is the typical mortality rate without treatment for herpes simplex encephalitis?
What is the typical mortality rate without treatment for herpes simplex encephalitis?
List two complications associated with skin infections caused by Streptococcus pyogenes.
List two complications associated with skin infections caused by Streptococcus pyogenes.
What is the mechanism underlying rheumatic fever?
What is the mechanism underlying rheumatic fever?
What skin feature is associated with scarlet fever?
What skin feature is associated with scarlet fever?
What is the hallmark rash seen in children with parvovirus B19 infection?
What is the hallmark rash seen in children with parvovirus B19 infection?
Which complication can occur in patients with haemolytic disorders due to parvovirus B19 infection?
Which complication can occur in patients with haemolytic disorders due to parvovirus B19 infection?
What condition in pregnancy is associated with parvovirus B19 infection?
What condition in pregnancy is associated with parvovirus B19 infection?
Name one serious form of CMV infection in immunocompromised hosts.
Name one serious form of CMV infection in immunocompromised hosts.
What neurological sequelae can result from congenital CMV infection?
What neurological sequelae can result from congenital CMV infection?
What is the typical presentation of CMV infection in healthy adults?
What is the typical presentation of CMV infection in healthy adults?
Identify one early prodromal symptom of measles.
Identify one early prodromal symptom of measles.
What is the significance of Koplik spots?
What is the significance of Koplik spots?
Name one potential complication of measles.
Name one potential complication of measles.
What is the main virulence factor of Corynebacterium diphtheriae?
What is the main virulence factor of Corynebacterium diphtheriae?
Name one potential cardiac complication of diphtheria.
Name one potential cardiac complication of diphtheria.
What is a visual feature associated with diphtheritic pharyngitis?
What is a visual feature associated with diphtheritic pharyngitis?
What is the typical pattern of rash distribution in chickenpox?
What is the typical pattern of rash distribution in chickenpox?
Name one serious complication of shingles.
Name one serious complication of shingles.
What does the term 'dermatomal distribution' refer to in shingles?
What does the term 'dermatomal distribution' refer to in shingles?
What is the most common organ affected by mumps?
What is the most common organ affected by mumps?
Name one serious complication in post-pubertal males affected by mumps.
Name one serious complication in post-pubertal males affected by mumps.
Which neurological complication can occur from mumps?
Which neurological complication can occur from mumps?
What is the primary mode of transmission for neonatal herpes simplex infection?
What is the primary mode of transmission for neonatal herpes simplex infection?
Identify one serious complication in affected neonates from neonatal herpes simplex infection.
Identify one serious complication in affected neonates from neonatal herpes simplex infection.
Which HSV type is more commonly implicated in neonatal herpes simplex infection?
Which HSV type is more commonly implicated in neonatal herpes simplex infection?
How is rubella primarily transmitted?
How is rubella primarily transmitted?
What is the risk of CRS when rubella infection occurs in the first trimester?
What is the risk of CRS when rubella infection occurs in the first trimester?
How is rubella immunity commonly achieved?
How is rubella immunity commonly achieved?
Identify one clinical scenario where Streptococcus agalactiae is a pathogen.
Identify one clinical scenario where Streptococcus agalactiae is a pathogen.
What is the typical onset time for neonatal disease caused by S. agalactiae?
What is the typical onset time for neonatal disease caused by S. agalactiae?
How is maternal carriage of S. agalactiae screened for during pregnancy?
How is maternal carriage of S. agalactiae screened for during pregnancy?
Name one group at high risk for Kaposi’s sarcoma.
Name one group at high risk for Kaposi’s sarcoma.
What type of lesion characterizes Kaposi’s sarcoma?
What type of lesion characterizes Kaposi’s sarcoma?
What virus family does KSHV belong to?
What virus family does KSHV belong to?
Which strain of S. pyogenes is associated with post-streptococcal glomerulonephritis?
Which strain of S. pyogenes is associated with post-streptococcal glomerulonephritis?
What is a common clinical finding in post-streptococcal glomerulonephritis?
What is a common clinical finding in post-streptococcal glomerulonephritis?
Which region shows the highest incidence of post-streptococcal glomerulonephritis?
Which region shows the highest incidence of post-streptococcal glomerulonephritis?
What triggers reactivation of herpes zoster (shingles)?
What triggers reactivation of herpes zoster (shingles)?
What is one risk factor for postherpetic neuralgia?
What is one risk factor for postherpetic neuralgia?
Name one typical dermatological manifestation of shingles.
Name one typical dermatological manifestation of shingles.
Name two complications of non-suppurative complications of Streptococcus pyogenes.
Name two complications of non-suppurative complications of Streptococcus pyogenes.
What is the primary pathophysiological mechanism of rheumatic fever?
What is the primary pathophysiological mechanism of rheumatic fever?
What diagnostic feature is associated with post-streptococcal glomerulonephritis?
What diagnostic feature is associated with post-streptococcal glomerulonephritis?
What is the most common form of actinomycosis?
What is the most common form of actinomycosis?
What condition can actinomycosis mimic due to its presentation?
What condition can actinomycosis mimic due to its presentation?
Name one characteristic feature of actinomycosis.
Name one characteristic feature of actinomycosis.
What is a major risk factor for severe outcomes in congenital cytomegalovirus infection?
What is a major risk factor for severe outcomes in congenital cytomegalovirus infection?
Name one common clinical finding at birth for congenital cytomegalovirus infection.
Name one common clinical finding at birth for congenital cytomegalovirus infection.
Which type of maternal infection poses the highest risk to the fetus in congenital cytomegalovirus infection?
Which type of maternal infection poses the highest risk to the fetus in congenital cytomegalovirus infection?
What initial test should be conducted for a pregnant woman concerned about rubella?
What initial test should be conducted for a pregnant woman concerned about rubella?
What are the potential risks to the fetus if the mother is infected with rubella during the first trimester?
What are the potential risks to the fetus if the mother is infected with rubella during the first trimester?
What is the most likely diagnosis for a patient with a painful rash along the right side of the chest who had chickenpox?
What is the most likely diagnosis for a patient with a painful rash along the right side of the chest who had chickenpox?
What is a possible severe complication that should be monitored for in the patient with herpes zoster?
What is a possible severe complication that should be monitored for in the patient with herpes zoster?
What condition should be suspected in a neonate, born to a mother positive for group B Streptococcus, developing respiratory distress at 3 days old?
What condition should be suspected in a neonate, born to a mother positive for group B Streptococcus, developing respiratory distress at 3 days old?
What is the immediate management step for early-onset neonatal sepsis?
What is the immediate management step for early-onset neonatal sepsis?
Which pathogen should be suspected in a pregnant woman with a history of eating unpasteurized soft cheese and presenting with fever and chills?
Which pathogen should be suspected in a pregnant woman with a history of eating unpasteurized soft cheese and presenting with fever and chills?
A 28-year-old woman with a history of two miscarriages presents with fever, chills, and muscle aches. She recalls eating unpasteurised soft cheese. a) Which pathogen should be suspected? b) What is the risk to the current pregnancy if the woman is infected?
A 28-year-old woman with a history of two miscarriages presents with fever, chills, and muscle aches. She recalls eating unpasteurised soft cheese. a) Which pathogen should be suspected? b) What is the risk to the current pregnancy if the woman is infected?
A 55-year-old immunocompromised patient presents with blurred vision and floaters in the eye. Examination reveals retinal haemorrhages. Which opportunistic virus and complication is likely responsible?
A 55-year-old immunocompromised patient presents with blurred vision and floaters in the eye. Examination reveals retinal haemorrhages. Which opportunistic virus and complication is likely responsible?
What treatment should be considered for cytomegalovirus retinitis?
What treatment should be considered for cytomegalovirus retinitis?
A 6-year-old boy presents with fever, malaise, and a "slapped cheek" rash. His younger sibling has sickle cell anaemia. What is the likely diagnosis for the boy?
A 6-year-old boy presents with fever, malaise, and a "slapped cheek" rash. His younger sibling has sickle cell anaemia. What is the likely diagnosis for the boy?
A 6-year-old boy presents with fever, malaise, and a "slapped cheek" rash. His younger sibling has sickle cell anaemia. What complication should be monitored in the sibling of the patient?
A 6-year-old boy presents with fever, malaise, and a "slapped cheek" rash. His younger sibling has sickle cell anaemia. What complication should be monitored in the sibling of the patient?
What sexually transmitted infection should be considered in a patient with a history of IV drug use that presents with a fever, malaise, and diffuse maculopapular rash on his torso and palms?
What sexually transmitted infection should be considered in a patient with a history of IV drug use that presents with a fever, malaise, and diffuse maculopapular rash on his torso and palms?
What is the next diagnostic step for suspected secondary syphilis?
What is the next diagnostic step for suspected secondary syphilis?
A 70-year-old woman presents with a sudden high fever, headache, neck stiffness, and altered mental status. Imaging suggests temporal lobe involvement. What infection is most likely?
A 70-year-old woman presents with a sudden high fever, headache, neck stiffness, and altered mental status. Imaging suggests temporal lobe involvement. What infection is most likely?
What immediate treatment should be initiated for HSV-1 encephalitis?
What immediate treatment should be initiated for HSV-1 encephalitis?
A mother presents with her 4-week-old infant who has difficulty feeding, irritability, and fever. The infant was born at 36 weeks gestation. a) What neonatal infection should be suspected? b) Which bacterium is the most probable cause?
A mother presents with her 4-week-old infant who has difficulty feeding, irritability, and fever. The infant was born at 36 weeks gestation. a) What neonatal infection should be suspected? b) Which bacterium is the most probable cause?
Which bacterium is the most probable cause of late-onset neonatal sepsis?
Which bacterium is the most probable cause of late-onset neonatal sepsis?
A 30-year-old woman presents with a chronic ulcerative lesion on her cheek. She has no systemic symptoms but reports a history of minor trauma to the area months ago. a) What condition should be suspected? b) Which pathogen might be involved?
A 30-year-old woman presents with a chronic ulcerative lesion on her cheek. She has no systemic symptoms but reports a history of minor trauma to the area months ago. a) What condition should be suspected? b) Which pathogen might be involved?
What hormonal change contributes most to the increased glomerular filtration rate (GFR) during pregnancy?
What hormonal change contributes most to the increased glomerular filtration rate (GFR) during pregnancy?
Which stage of labor is characterized by the onset of regular, painful contractions that lead to full cervical dilation?
Which stage of labor is characterized by the onset of regular, painful contractions that lead to full cervical dilation?
What mechanism primarily supports fetal descent during the active phase of labor?
What mechanism primarily supports fetal descent during the active phase of labor?
Which cardiovascular change is typical during pregnancy?
Which cardiovascular change is typical during pregnancy?
What is the significance of 'engagement' during labor?
What is the significance of 'engagement' during labor?
Which of the following respiratory changes is NOT typical during pregnancy?
Which of the following respiratory changes is NOT typical during pregnancy?
What is the role of relaxin in pregnancy?
What is the role of relaxin in pregnancy?
What fetal position most optimally aids in the second stage of labor?
What fetal position most optimally aids in the second stage of labor?
Which change is a normal hematologic adaptation during pregnancy?
Which change is a normal hematologic adaptation during pregnancy?
What defines the latent phase of labor?
What defines the latent phase of labor?
Which of the following is NOT a risk associated with aortocaval compression in late pregnancy?
Which of the following is NOT a risk associated with aortocaval compression in late pregnancy?
During the expulsion phase of labor, what is the primary maternal response?
During the expulsion phase of labor, what is the primary maternal response?
Which maternal cardiovascular change during labor poses a risk for women with pre-existing heart conditions?
Which maternal cardiovascular change during labor poses a risk for women with pre-existing heart conditions?
What is the typical respiratory adaptation seen in pregnant women to manage increased oxygen demands?
What is the typical respiratory adaptation seen in pregnant women to manage increased oxygen demands?
Which condition can arise due to delayed gastric emptying in pregnancy?
Which condition can arise due to delayed gastric emptying in pregnancy?
Which statement regarding maternal blood volume during pregnancy is NOT correct?
Which statement regarding maternal blood volume during pregnancy is NOT correct?
Which of the following statements about the first stage of labor is NOT correct?
Which of the following statements about the first stage of labor is NOT correct?
Which statement about endocrine changes during pregnancy is NOT correct?
Which statement about endocrine changes during pregnancy is NOT correct?
Which statement about the cardiovascular adaptations in pregnancy is NOT correct?
Which statement about the cardiovascular adaptations in pregnancy is NOT correct?
What is the primary mechanism by which Her2 promotes cancer cell survival?
What is the primary mechanism by which Her2 promotes cancer cell survival?
Which breast cancer subtype is likely to exhibit the highest response to tamoxifen treatment?
Which breast cancer subtype is likely to exhibit the highest response to tamoxifen treatment?
Which diagnostic technique is commonly used to assess HER2 protein expression in breast cancer?
Which diagnostic technique is commonly used to assess HER2 protein expression in breast cancer?
What is a recommended surgical strategy for managing breast cancer with positive margins?
What is a recommended surgical strategy for managing breast cancer with positive margins?
Which of the following is a common risk factor associated with breast cancer?
Which of the following is a common risk factor associated with breast cancer?
What is the primary disadvantage of routine genome-wide expression profiling in breast cancer diagnosis?
What is the primary disadvantage of routine genome-wide expression profiling in breast cancer diagnosis?
What characterizes basal-like breast cancers in terms of receptor status?
What characterizes basal-like breast cancers in terms of receptor status?
What is a significant advantage of using targeted therapies like Trastuzumab in HER2 positive breast cancers?
What is a significant advantage of using targeted therapies like Trastuzumab in HER2 positive breast cancers?
What histopathological feature is indicative of lobular carcinoma in situ (LCIS)?
What histopathological feature is indicative of lobular carcinoma in situ (LCIS)?
What is a common risk factor associated with invasive breast cancer?
What is a common risk factor associated with invasive breast cancer?
What is the current recommendation regarding the surgical approach to LCIS found in a core biopsy?
What is the current recommendation regarding the surgical approach to LCIS found in a core biopsy?
Which of the following is TRUE about the staging of breast cancer as per the AJCC system?
Which of the following is TRUE about the staging of breast cancer as per the AJCC system?
What is the primary histological type of breast cancer, accounting for over 80% of cases?
What is the primary histological type of breast cancer, accounting for over 80% of cases?
What would be an appropriate action if surgical margins in excision are found to be positive for a high-risk lesion?
What would be an appropriate action if surgical margins in excision are found to be positive for a high-risk lesion?
Which biomarker is assessed for establishing the hormone receptor status in breast cancer?
Which biomarker is assessed for establishing the hormone receptor status in breast cancer?
How is the histological grade of breast cancer determined?
How is the histological grade of breast cancer determined?
What treatment is generally NOT recommended for patients with bilateral lobular carcinoma in situ?
What treatment is generally NOT recommended for patients with bilateral lobular carcinoma in situ?
Upon detection of ER+/PR+ breast cancer, what is the expected outcome in terms of treatment response?
Upon detection of ER+/PR+ breast cancer, what is the expected outcome in terms of treatment response?
What is the lifetime risk of breast cancer for individuals with a BRCA1 mutation?
What is the lifetime risk of breast cancer for individuals with a BRCA1 mutation?
Which type of breast carcinoma in situ is characterized by malignant cells confined to the duct spaces?
Which type of breast carcinoma in situ is characterized by malignant cells confined to the duct spaces?
What does the presence of atypical hyperplasia indicate regarding breast cancer risk?
What does the presence of atypical hyperplasia indicate regarding breast cancer risk?
Which histological characteristic differentiates high grade DCIS from low grade DCIS?
Which histological characteristic differentiates high grade DCIS from low grade DCIS?
Which hereditary mutations account for the majority of breast cancer syndromes?
Which hereditary mutations account for the majority of breast cancer syndromes?
What is the estimated 5-year survival rate for breast cancer as of 2017?
What is the estimated 5-year survival rate for breast cancer as of 2017?
Which of the following factors is NOT considered a breast cancer risk factor?
Which of the following factors is NOT considered a breast cancer risk factor?
What does Paget’s disease of the nipple usually indicate?
What does Paget’s disease of the nipple usually indicate?
Which of the following conditions is associated with a significant increased risk of developing invasive breast cancer?
Which of the following conditions is associated with a significant increased risk of developing invasive breast cancer?
How is the risk of breast cancer modified by environmental factors?
How is the risk of breast cancer modified by environmental factors?
To whom is the Breast Cancer Risk Assessment Tool applicable?
To whom is the Breast Cancer Risk Assessment Tool applicable?
Which characteristic distinguishes invasive breast cancer from in situ cancers?
Which characteristic distinguishes invasive breast cancer from in situ cancers?
Which treatment method is commonly recommended for DCIS following diagnosis?
Which treatment method is commonly recommended for DCIS following diagnosis?
What percentage of breast cancer cases are classified as carcinoma in situ at the time of diagnosis?
What percentage of breast cancer cases are classified as carcinoma in situ at the time of diagnosis?
What is the most common cancer in women, excluding non-melanoma skin cancer?
What is the most common cancer in women, excluding non-melanoma skin cancer?
List two major risk factors for developing breast cancer.
List two major risk factors for developing breast cancer.
Define breast carcinoma in situ (CIS).
Define breast carcinoma in situ (CIS).
What characterizes atypical ductal hyperplasia in terms of breast cancer risk?
What characterizes atypical ductal hyperplasia in terms of breast cancer risk?
What is the primary genetic mutation associated with hereditary breast cancer?
What is the primary genetic mutation associated with hereditary breast cancer?
Which type of breast disease has no increased risk of developing breast cancer?
Which type of breast disease has no increased risk of developing breast cancer?
What are the two classifications of breast carcinoma in situ?
What are the two classifications of breast carcinoma in situ?
How does Paget’s disease of the nipple typically present clinically?
How does Paget’s disease of the nipple typically present clinically?
What is the lifetime risk of breast cancer for individuals with BRCA1 mutations?
What is the lifetime risk of breast cancer for individuals with BRCA1 mutations?
Which breast condition is characterized by the presence of malignant cells within the epidermis of the nipple?
Which breast condition is characterized by the presence of malignant cells within the epidermis of the nipple?
What is the estimated 5-year survival rate for breast cancer as of 2018?
What is the estimated 5-year survival rate for breast cancer as of 2018?
What is the relationship between breast density and breast cancer risk?
What is the relationship between breast density and breast cancer risk?
What is the main histological feature classified in DCIS?
What is the main histological feature classified in DCIS?
What is the role of HER2 protein in breast cancer progression?
What is the role of HER2 protein in breast cancer progression?
How does the presence of ER+/PR+ receptors affect the response to tamoxifen in breast cancer?
How does the presence of ER+/PR+ receptors affect the response to tamoxifen in breast cancer?
What molecular profiling subsets exist for breast cancer, and how are they significant?
What molecular profiling subsets exist for breast cancer, and how are they significant?
What is the predictive value of HER2 positivity in breast cancer treatment?
What is the predictive value of HER2 positivity in breast cancer treatment?
What additional treatments might be recommended for high-risk breast cancer patients?
What additional treatments might be recommended for high-risk breast cancer patients?
How does gene amplification affect the prognosis of breast cancer?
How does gene amplification affect the prognosis of breast cancer?
What are the implications of performing routine genome-wide expression profiling in breast cancer?
What are the implications of performing routine genome-wide expression profiling in breast cancer?
What surgical approaches are typically used in breast cancer treatment?
What surgical approaches are typically used in breast cancer treatment?
What are common clinical symptoms associated with invasive breast cancer?
What are common clinical symptoms associated with invasive breast cancer?
How is lobular carcinoma in situ (LCIS) typically identified histologically?
How is lobular carcinoma in situ (LCIS) typically identified histologically?
What does the modified Bloom and Richardson method evaluate in breast cancer grading?
What does the modified Bloom and Richardson method evaluate in breast cancer grading?
What role do estrogen and progesterone receptors play in breast cancer prognosis?
What role do estrogen and progesterone receptors play in breast cancer prognosis?
What is the clinical significance of lymph node involvement in staging breast cancer?
What is the clinical significance of lymph node involvement in staging breast cancer?
How does the histological type of invasive breast cancer affect prognosis?
How does the histological type of invasive breast cancer affect prognosis?
What does the AJCC system assess in breast cancer staging?
What does the AJCC system assess in breast cancer staging?
What types of breast carcinomas are associated with favorable and poor prognosis?
What types of breast carcinomas are associated with favorable and poor prognosis?
What factors determine the need for increased surveillance after a core biopsy indicates LCIS?
What factors determine the need for increased surveillance after a core biopsy indicates LCIS?
How does the loss of E-cadherin expression relate to breast cancer pathology?
How does the loss of E-cadherin expression relate to breast cancer pathology?
Which of these options are correct? (Select all that apply)
Which of these options are correct? (Select all that apply)
Which condition is characterized by fever, hoarseness, and a barking cough?
Which condition is characterized by fever, hoarseness, and a barking cough?
What is the most common pathogen associated with chronic sinusitis?
What is the most common pathogen associated with chronic sinusitis?
Which of the following is a key feature of a granuloma in tuberculosis (TB)?
Which of the following is a key feature of a granuloma in tuberculosis (TB)?
What is the significance of a positive IGRA test?
What is the significance of a positive IGRA test?
Which infection control measure is most effective in preventing TB transmission in healthcare settings?
Which infection control measure is most effective in preventing TB transmission in healthcare settings?
Which type of lung cancer is most commonly found in non-smokers?
Which type of lung cancer is most commonly found in non-smokers?
Which of the following is a characteristic feature of squamous cell carcinoma of the lung?
Which of the following is a characteristic feature of squamous cell carcinoma of the lung?
Which diagnostic test would confirm active tuberculosis?
Which diagnostic test would confirm active tuberculosis?
Which of the following is the most likely diagnosis for a patient with a 40-pack-year history of smoking and a reduced FEV1/FVC ratio?
Which of the following is the most likely diagnosis for a patient with a 40-pack-year history of smoking and a reduced FEV1/FVC ratio?
What is the most appropriate initial treatment for a patient presenting with sudden onset of chest pain and shortness of breath?
What is the most appropriate initial treatment for a patient presenting with sudden onset of chest pain and shortness of breath?
What is the most likely causative organism for a patient with fever, productive cough, and pleuritic chest pain with consolidation in the right lower lobe?
What is the most likely causative organism for a patient with fever, productive cough, and pleuritic chest pain with consolidation in the right lower lobe?
Which of the following findings is most indicative of mesothelioma?
Which of the following findings is most indicative of mesothelioma?
What is the most appropriate management strategy for a patient with chronic productive cough and dilated bronchi?
What is the most appropriate management strategy for a patient with chronic productive cough and dilated bronchi?
Which long-term management is most appropriate for a 12-year-old with episodes of wheezing and a history of atopic dermatitis?
Which long-term management is most appropriate for a 12-year-old with episodes of wheezing and a history of atopic dermatitis?
What is the most likely cause of a pleural effusion in a patient with pneumonic symptoms and an exudative effusion?
What is the most likely cause of a pleural effusion in a patient with pneumonic symptoms and an exudative effusion?
What is the most likely causative organism for a patient with foul-smelling sputum and a right lower lobe cavity?
What is the most likely causative organism for a patient with foul-smelling sputum and a right lower lobe cavity?
What is the likely diagnosis for a patient with a honeycomb pattern on high-resolution CT scan?
What is the likely diagnosis for a patient with a honeycomb pattern on high-resolution CT scan?
Which paraneoplastic syndrome is most commonly associated with small cell lung carcinoma?
Which paraneoplastic syndrome is most commonly associated with small cell lung carcinoma?
What is the most likely causative organism for a 5-year-old with a productive cough and crackles?
What is the most likely causative organism for a 5-year-old with a productive cough and crackles?
What is the likely diagnosis for a patient with reticular opacities and honeycombing on CT scan?
What is the likely diagnosis for a patient with reticular opacities and honeycombing on CT scan?
Which statement is NOT correct about lung adenocarcinoma?
Which statement is NOT correct about lung adenocarcinoma?
Which statement is NOT correct about tuberculosis?
Which statement is NOT correct about tuberculosis?
Which statement is NOT correct about chronic obstructive pulmonary disease?
Which statement is NOT correct about chronic obstructive pulmonary disease?
Which treatment is NOT correct regarding pulmonary embolism?
Which treatment is NOT correct regarding pulmonary embolism?
What best defines cultural safety?
What best defines cultural safety?
What is the initial step in Coffin's Cultural Security Model?
What is the initial step in Coffin's Cultural Security Model?
What percentage of pharyngitis cases are caused by rhinoviruses?
What percentage of pharyngitis cases are caused by rhinoviruses?
What happens to alveolar partial pressure of oxygen (PAO2) when there is low ventilation but normal perfusion (low VA/Q ratio)?
What happens to alveolar partial pressure of oxygen (PAO2) when there is low ventilation but normal perfusion (low VA/Q ratio)?
Which condition is associated with a high ventilation-perfusion (VA/Q) ratio?
Which condition is associated with a high ventilation-perfusion (VA/Q) ratio?
What is the primary cause of hypoxaemia in cases of ventilation-perfusion mismatch?
What is the primary cause of hypoxaemia in cases of ventilation-perfusion mismatch?
What is atelectasis?
What is atelectasis?
Which respiratory centre is primarily responsible for generating the basic rhythm of breathing?
Which respiratory centre is primarily responsible for generating the basic rhythm of breathing?
Which area of the brainstem coordinates the transition between inhalation and exhalation?
Which area of the brainstem coordinates the transition between inhalation and exhalation?
Which nerve supplies the anterior 2/3 of the tongue for general sensation?
Which nerve supplies the anterior 2/3 of the tongue for general sensation?
What is the role of the greater petrosal nerve?
What is the role of the greater petrosal nerve?
Which cytokines are primarily involved in the stimulation of allergen-specific IgE production?
Which cytokines are primarily involved in the stimulation of allergen-specific IgE production?
Which immune cells are primarily responsible for the late-phase reaction in IgE-mediated hypersensitivity?
Which immune cells are primarily responsible for the late-phase reaction in IgE-mediated hypersensitivity?
What is the primary function of regulatory T (Treg) cells in allergic responses?
What is the primary function of regulatory T (Treg) cells in allergic responses?
What is the primary goal of allergen-specific immunotherapy (SCIT or SLIT)?
What is the primary goal of allergen-specific immunotherapy (SCIT or SLIT)?
The presence of which sign on a chest x-ray indicates pneumothorax?
The presence of which sign on a chest x-ray indicates pneumothorax?
What type of medication is tiotropium?
What type of medication is tiotropium?
What class of drugs includes medications like montelukast?
What class of drugs includes medications like montelukast?
What feature is characteristic of obstructive lung diseases?
What feature is characteristic of obstructive lung diseases?
Which disease is associated with alpha-1 antitrypsin deficiency?
Which disease is associated with alpha-1 antitrypsin deficiency?
Which clinical feature is NOT typical of chronic bronchitis?
Which clinical feature is NOT typical of chronic bronchitis?
What is the main cause of bronchiectasis?
What is the main cause of bronchiectasis?
Which term describes a high-pitched, polyphonic sound produced in the airways during expiration?
Which term describes a high-pitched, polyphonic sound produced in the airways during expiration?
Which of the following is NOT a feature of restrictive lung disease?
Which of the following is NOT a feature of restrictive lung disease?
What histological pattern is commonly associated with ARDS?
What histological pattern is commonly associated with ARDS?
Which disease is characterized by temporally heterogeneous fibrosis and honeycomb lung?
Which disease is characterized by temporally heterogeneous fibrosis and honeycomb lung?
Which restrictive lung disease is associated with tight non-necrotising granulomas and multisystem involvement?
Which restrictive lung disease is associated with tight non-necrotising granulomas and multisystem involvement?
What is the most common cause of Acute Lung Injury (ALI) leading to ARDS?
What is the most common cause of Acute Lung Injury (ALI) leading to ARDS?
Which type of interstitial pneumonia is characterized by polyploid plugs of loose organizing connective tissue in alveolar ducts and alveoli?
Which type of interstitial pneumonia is characterized by polyploid plugs of loose organizing connective tissue in alveolar ducts and alveoli?
What oxygen delivery device provides the highest concentration of oxygen?
What oxygen delivery device provides the highest concentration of oxygen?
What is the recommended target oxygen saturation for a patient with COPD?
What is the recommended target oxygen saturation for a patient with COPD?
Which test involves intradermal injection to detect TB infection?
Which test involves intradermal injection to detect TB infection?
What form of extrapulmonary TB involves the spine?
What form of extrapulmonary TB involves the spine?
What statement about pulmonary embolism (PE) is true?
What statement about pulmonary embolism (PE) is true?
Goodpasture syndrome involves autoantibodies against which structure?
Goodpasture syndrome involves autoantibodies against which structure?
Which is NOT a common clinical feature of diffuse pulmonary hemorrhage?
Which is NOT a common clinical feature of diffuse pulmonary hemorrhage?
Which pathogen is most commonly associated with healthcare-associated pneumonia (HCAP)?
Which pathogen is most commonly associated with healthcare-associated pneumonia (HCAP)?
Which of the following is a common cause of ventilator-associated pneumonia (VAP)?
Which of the following is a common cause of ventilator-associated pneumonia (VAP)?
What type of pleural effusion is characterized by low glucose levels, pleural fluid acidosis, and elevated LDH?
What type of pleural effusion is characterized by low glucose levels, pleural fluid acidosis, and elevated LDH?
What condition is characterized by abnormal and permanent dilation of bronchi?
What condition is characterized by abnormal and permanent dilation of bronchi?
Which organism is most commonly responsible for lung abscesses following aspiration?
Which organism is most commonly responsible for lung abscesses following aspiration?
What pathogen is associated with melioidosis?
What pathogen is associated with melioidosis?
What is the most common opportunistic infection in HIV patients with a CD4 count below 200 cells/mm3?
What is the most common opportunistic infection in HIV patients with a CD4 count below 200 cells/mm3?
Which pathogen is most commonly associated with community-acquired pneumonia (CAP) in children?
Which pathogen is most commonly associated with community-acquired pneumonia (CAP) in children?
What is the most common bacterial cause of pharyngitis?
What is the most common bacterial cause of pharyngitis?
Which treatment is recommended for acute epiglottitis caused by Haemophilus influenzae type B (Hib)?
Which treatment is recommended for acute epiglottitis caused by Haemophilus influenzae type B (Hib)?
What clinical features are characteristic of inflammatory breast cancer (IBC)?
What clinical features are characteristic of inflammatory breast cancer (IBC)?
Why is inflammatory breast cancer (IBC) often associated with a poorer prognosis compared to other breast cancers?
Why is inflammatory breast cancer (IBC) often associated with a poorer prognosis compared to other breast cancers?
What are the primary treatment strategies for inflammatory breast cancer (IBC)?
What are the primary treatment strategies for inflammatory breast cancer (IBC)?
Which region of the prostate is most commonly affected by benign prostatic hyperplasia (BPH)?
Which region of the prostate is most commonly affected by benign prostatic hyperplasia (BPH)?
What is the main mechanism of action of 5-alpha reductase inhibitors in the treatment of BPH?
What is the main mechanism of action of 5-alpha reductase inhibitors in the treatment of BPH?
Which subtype of breast cancer is associated with the poorest survival rate?
Which subtype of breast cancer is associated with the poorest survival rate?
Which of the following drugs is contraindicated in patients taking nitrates for cardiovascular disease?
Which of the following drugs is contraindicated in patients taking nitrates for cardiovascular disease?
What characteristic feature is associated with inflammatory breast cancer?
What characteristic feature is associated with inflammatory breast cancer?
Which prostate cancer treatment involves androgen receptor antagonism?
Which prostate cancer treatment involves androgen receptor antagonism?
What role does breast density play in breast cancer screening?
What role does breast density play in breast cancer screening?
Which drug class provides rapid symptom relief in BPH but does not affect prostate size?
Which drug class provides rapid symptom relief in BPH but does not affect prostate size?
What is the most commonly reported adverse effect of PDE-5 inhibitors?
What is the most commonly reported adverse effect of PDE-5 inhibitors?
Which factor is NOT considered a modifiable risk for breast cancer?
Which factor is NOT considered a modifiable risk for breast cancer?
What type of receptor is primarily involved in the mechanism of action for PDE-5 inhibitors in erectile dysfunction?
What type of receptor is primarily involved in the mechanism of action for PDE-5 inhibitors in erectile dysfunction?
Which breast cancer subtype is most associated with overexpression of HER2/neu?
Which breast cancer subtype is most associated with overexpression of HER2/neu?
Which drug used for BPH treatment may cause gynecomastia as a side effect?
Which drug used for BPH treatment may cause gynecomastia as a side effect?
Which population group is most likely to benefit from selective estrogen receptor modulators (SERMs) for breast cancer prevention?
Which population group is most likely to benefit from selective estrogen receptor modulators (SERMs) for breast cancer prevention?
What histological feature is most characteristic of prostate adenocarcinoma?
What histological feature is most characteristic of prostate adenocarcinoma?
Which statement regarding selective estrogen receptor modulators (SERMs) is NOT correct?
Which statement regarding selective estrogen receptor modulators (SERMs) is NOT correct?
Which of the following statements about maternal nutrition during pregnancy is NOT correct?
Which of the following statements about maternal nutrition during pregnancy is NOT correct?
Which statement about fetal heart monitoring is NOT correct?
Which statement about fetal heart monitoring is NOT correct?
Which statement about antenatal care is NOT correct?
Which statement about antenatal care is NOT correct?
Which statement regarding fetal growth assessments is NOT correct?
Which statement regarding fetal growth assessments is NOT correct?
Which statement about sexual health history taking is NOT correct?
Which statement about sexual health history taking is NOT correct?
Which statement regarding maternal immunizations is NOT correct?
Which statement regarding maternal immunizations is NOT correct?
What role does folic acid play in preventing neural tube defects (NTDs)?
What role does folic acid play in preventing neural tube defects (NTDs)?
Which factor is most likely to lead to fetal hypoxia during labor?
Which factor is most likely to lead to fetal hypoxia during labor?
What is a significant risk factor for congenital cytomegalovirus (CMV) infection?
What is a significant risk factor for congenital cytomegalovirus (CMV) infection?
Which hormone primarily supports the maintenance of pregnancy until the placenta takes over?
Which hormone primarily supports the maintenance of pregnancy until the placenta takes over?
Which feature of fetal alcohol syndrome (FAS) is most indicative of its diagnosis?
Which feature of fetal alcohol syndrome (FAS) is most indicative of its diagnosis?
Which of the following mechanisms contributes to increased risk of fetal anemia in maternal parvovirus B19 infection?
Which of the following mechanisms contributes to increased risk of fetal anemia in maternal parvovirus B19 infection?
What distinguishes congenital toxoplasmosis from other congenital infections in terms of common clinical presentations in the neonate?
What distinguishes congenital toxoplasmosis from other congenital infections in terms of common clinical presentations in the neonate?
Which aspect of fetal circulation is most affected by congenital diaphragmatic hernia (CDH)?
Which aspect of fetal circulation is most affected by congenital diaphragmatic hernia (CDH)?
What placental change is most commonly associated with asymmetrical intrauterine growth restriction (IUGR)?
What placental change is most commonly associated with asymmetrical intrauterine growth restriction (IUGR)?
Which type of genetic anomaly is most likely to result in recurrent pregnancy loss before 12 weeks gestation?
Which type of genetic anomaly is most likely to result in recurrent pregnancy loss before 12 weeks gestation?
Which fetal cardiovascular adaptation is most critical for maintaining blood flow during periods of reduced placental perfusion?
Which fetal cardiovascular adaptation is most critical for maintaining blood flow during periods of reduced placental perfusion?
What is the most significant risk associated with monochorionic twin pregnancies compared to dichorionic twin pregnancies?
What is the most significant risk associated with monochorionic twin pregnancies compared to dichorionic twin pregnancies?
Which fetal measurement is most sensitive for detecting asymmetrical growth restriction?
Which fetal measurement is most sensitive for detecting asymmetrical growth restriction?
What fetal abnormality is associated with an increase in maternal serum alpha-fetoprotein (AFP) during pregnancy?
What fetal abnormality is associated with an increase in maternal serum alpha-fetoprotein (AFP) during pregnancy?
Which placental disorder can lead to abrupt cessation of fetal blood flow and requires immediate intervention?
Which placental disorder can lead to abrupt cessation of fetal blood flow and requires immediate intervention?
What fetal consequence is most commonly associated with maternal phenylketonuria (PKU) if not well-managed during pregnancy?
What fetal consequence is most commonly associated with maternal phenylketonuria (PKU) if not well-managed during pregnancy?
What is the most definitive prenatal diagnostic test for detecting chromosomal abnormalities such as trisomy 21?
What is the most definitive prenatal diagnostic test for detecting chromosomal abnormalities such as trisomy 21?
Which type of congenital malformation is associated with polyhydramnios?
Which type of congenital malformation is associated with polyhydramnios?
What is the primary function of human placental lactogen (hPL) during pregnancy?
What is the primary function of human placental lactogen (hPL) during pregnancy?
What key feature on prenatal ultrasound suggests a diagnosis of anencephaly?
What key feature on prenatal ultrasound suggests a diagnosis of anencephaly?
What is the significance of LCIS as a risk marker?
What is the significance of LCIS as a risk marker?
What treatment options are considered for LCIS?
What treatment options are considered for LCIS?
What genetic alteration is commonly associated with ILC?
What genetic alteration is commonly associated with ILC?
How does ILC typically present on physical examination compared to other breast cancers?
How does ILC typically present on physical examination compared to other breast cancers?
What histological pattern is characteristic of ILC?
What histological pattern is characteristic of ILC?
What are the potential treatment options for CIN III?
What are the potential treatment options for CIN III?
What factors influence the choice of treatment for CIN III?
What factors influence the choice of treatment for CIN III?
What is the risk of progression to invasive cancer if CIN III is left untreated?
What is the risk of progression to invasive cancer if CIN III is left untreated?
What is the primary site of origin for choriocarcinoma?
What is the primary site of origin for choriocarcinoma?
Which marker is used for diagnosing and monitoring choriocarcinoma?
Which marker is used for diagnosing and monitoring choriocarcinoma?
Why is choriocarcinoma often highly responsive to chemotherapy?
Why is choriocarcinoma often highly responsive to chemotherapy?
What are common causes of placental insufficiency?
What are common causes of placental insufficiency?
How does placental insufficiency affect fetal growth?
How does placental insufficiency affect fetal growth?
Name one long-term consequence for the infant born after significant placental insufficiency.
Name one long-term consequence for the infant born after significant placental insufficiency.
What is the most common type of benign breast lesion in young women?
What is the most common type of benign breast lesion in young women?
How does fibrocystic change present histologically?
How does fibrocystic change present histologically?
What distinguishes a fibroadenoma from other benign breast conditions?
What distinguishes a fibroadenoma from other benign breast conditions?
What histological subtype of invasive breast carcinoma is associated with a single-file pattern of cells infiltrating the stroma?
What histological subtype of invasive breast carcinoma is associated with a single-file pattern of cells infiltrating the stroma?
Which type of ovarian tumor is associated with Call-Exner bodies on histology?
Which type of ovarian tumor is associated with Call-Exner bodies on histology?
What is the primary hormonal mechanism contributing to the development of polycystic ovary syndrome (PCOS)?
What is the primary hormonal mechanism contributing to the development of polycystic ovary syndrome (PCOS)?
Which marker is most commonly elevated in patients with epithelial ovarian cancer?
Which marker is most commonly elevated in patients with epithelial ovarian cancer?
What is the typical age group affected by seminomas?
What is the typical age group affected by seminomas?
What is the most common cause of a complete mole?
What is the most common cause of a complete mole?
Which breast pathology is characterized by stromal overgrowth and a 'leaf-like' pattern?
Which breast pathology is characterized by stromal overgrowth and a 'leaf-like' pattern?
What is the common presentation of placental site trophoblastic tumor (PSTT)?
What is the common presentation of placental site trophoblastic tumor (PSTT)?
Which genetic alteration is commonly associated with invasive ductal carcinoma of the breast?
Which genetic alteration is commonly associated with invasive ductal carcinoma of the breast?
What histological feature distinguishes endometrial hyperplasia with atypia from simple hyperplasia?
What histological feature distinguishes endometrial hyperplasia with atypia from simple hyperplasia?
How do phyllodes tumors typically present clinically?
How do phyllodes tumors typically present clinically?
What distinguishes benign from malignant phyllodes tumors histologically?
What distinguishes benign from malignant phyllodes tumors histologically?
What is the primary treatment approach for phyllodes tumors?
What is the primary treatment approach for phyllodes tumors?
What are the risk factors for developing placenta previa?
What are the risk factors for developing placenta previa?
How does placenta previa typically present during pregnancy?
How does placenta previa typically present during pregnancy?
What management strategies are used for a diagnosed case of placenta previa?
What management strategies are used for a diagnosed case of placenta previa?
What is the role of E-cadherin in normal breast tissue?
What is the role of E-cadherin in normal breast tissue?
How does the loss of E-cadherin contribute to the behavior of ILC?
How does the loss of E-cadherin contribute to the behavior of ILC?
What histological pattern is characteristic of ILC?
What histological pattern is characteristic of ILC?
What histological features distinguish ADH from DCIS?
What histological features distinguish ADH from DCIS?
How does ADH impact the risk of developing breast cancer?
How does ADH impact the risk of developing breast cancer?
What management strategy is recommended for patients diagnosed with ADH?
What management strategy is recommended for patients diagnosed with ADH?
What are common histological subtypes of type 2 endometrial carcinoma?
What are common histological subtypes of type 2 endometrial carcinoma?
What molecular marker is frequently associated with type 2 endometrial carcinoma?
What molecular marker is frequently associated with type 2 endometrial carcinoma?
Why does type 2 endometrial carcinoma often have a worse prognosis?
Why does type 2 endometrial carcinoma often have a worse prognosis?
What types of breast cancer are most responsive to hormonal therapy?
What types of breast cancer are most responsive to hormonal therapy?
How does tamoxifen function as a hormonal therapy agent?
How does tamoxifen function as a hormonal therapy agent?
What are common side effects associated with tamoxifen use?
What are common side effects associated with tamoxifen use?
What are the classic symptoms of testicular torsion?
What are the classic symptoms of testicular torsion?
How does testicular torsion differ from epididymitis on physical exam?
How does testicular torsion differ from epididymitis on physical exam?
What is the time frame for intervention to prevent testicular necrosis?
What is the time frame for intervention to prevent testicular necrosis?
What treatment is specifically targeted for HER2-positive breast cancer?
What treatment is specifically targeted for HER2-positive breast cancer?
How is HER2 status typically determined in breast cancer patients?
How is HER2 status typically determined in breast cancer patients?
What are potential side effects of HER2-targeted therapies?
What are potential side effects of HER2-targeted therapies?
Which condition is most likely to present with peau d’orange skin changes?
Which condition is most likely to present with peau d’orange skin changes?
What is the main difference in presentation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC)?
What is the main difference in presentation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC)?
Which statement about benign breast diseases is NOT correct?
Which statement about benign breast diseases is NOT correct?
Which statement regarding HPV and cervical cancer is NOT correct?
Which statement regarding HPV and cervical cancer is NOT correct?
Which statement regarding testicular germ cell tumors is NOT correct?
Which statement regarding testicular germ cell tumors is NOT correct?
Which statement about breast cancer risk factors is NOT correct?
Which statement about breast cancer risk factors is NOT correct?
Which statement regarding the pathology of endometrial carcinoma is NOT correct?
Which statement regarding the pathology of endometrial carcinoma is NOT correct?
Which statement about gestational trophoblastic diseases (GTD) is NOT correct?
Which statement about gestational trophoblastic diseases (GTD) is NOT correct?
Which statement about prostate cancer is NOT correct?
Which statement about prostate cancer is NOT correct?
Which statement regarding cervical pathology is NOT correct?
Which statement regarding cervical pathology is NOT correct?
Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?
Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?
Which statement about the menstrual cycle is NOT correct?
Which statement about the menstrual cycle is NOT correct?
Which statement regarding ovarian cancer is NOT correct?
Which statement regarding ovarian cancer is NOT correct?
Which statement about breast cancer subtypes is NOT correct?
Which statement about breast cancer subtypes is NOT correct?
Which statement about the histology of testicular tumors is NOT correct?
Which statement about the histology of testicular tumors is NOT correct?
Which statement regarding breast pathologies is NOT correct?
Which statement regarding breast pathologies is NOT correct?
Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?
Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?
What is the most common type of malignant ovarian tumor?
What is the most common type of malignant ovarian tumor?
Which ovarian tumor is often linked with endometriosis?
Which ovarian tumor is often linked with endometriosis?
What tumor marker is commonly used for monitoring epithelial ovarian cancer?
What tumor marker is commonly used for monitoring epithelial ovarian cancer?
What is the genetic composition of a complete mole?
What is the genetic composition of a complete mole?
What is the primary risk associated with neural tube defects (NTDs) if the anterior neuropore fails to close?
What is the primary risk associated with neural tube defects (NTDs) if the anterior neuropore fails to close?
How does a partial mole differ histologically from a complete mole?
How does a partial mole differ histologically from a complete mole?
Which of the following best explains why intrauterine growth restriction (IUGR) predisposes an individual to long-term metabolic disease?
Which of the following best explains why intrauterine growth restriction (IUGR) predisposes an individual to long-term metabolic disease?
What is the risk of developing choriocarcinoma from each type?
What is the risk of developing choriocarcinoma from each type?
Which congenital malformation is characterized by the herniation of brain tissue through a skull defect?
Which congenital malformation is characterized by the herniation of brain tissue through a skull defect?
Which high-risk HPV types are most commonly associated with cervical cancer?
Which high-risk HPV types are most commonly associated with cervical cancer?
What is a primary characteristic of Tetralogy of Fallot?
What is a primary characteristic of Tetralogy of Fallot?
How does HPV integrate into the host genome, contributing to carcinogenesis?
How does HPV integrate into the host genome, contributing to carcinogenesis?
What histological changes are seen in cervical intraepithelial neoplasia (CIN) III?
What histological changes are seen in cervical intraepithelial neoplasia (CIN) III?
What factor is essential for the transport of glucose across the placenta?
What factor is essential for the transport of glucose across the placenta?
In which zone of the prostate does BPH primarily occur?
In which zone of the prostate does BPH primarily occur?
Which statement regarding folic acid supplementation is NOT correct?
Which statement regarding folic acid supplementation is NOT correct?
Which statement about sexual health history taking is NOT correct?
Which statement about sexual health history taking is NOT correct?
How does dihydrotestosterone (DHT) contribute to the development of BPH?
How does dihydrotestosterone (DHT) contribute to the development of BPH?
Which statement regarding congenital heart defects is NOT correct?
Which statement regarding congenital heart defects is NOT correct?
What are common complications associated with untreated BPH?
What are common complications associated with untreated BPH?
Which of the following statements about fetal growth is NOT correct?
Which of the following statements about fetal growth is NOT correct?
What type of endometrial carcinoma is associated with prolonged unopposed estrogen exposure?
What type of endometrial carcinoma is associated with prolonged unopposed estrogen exposure?
Which statement about prenatal screening for congenital abnormalities is NOT correct?
Which statement about prenatal screening for congenital abnormalities is NOT correct?
What is the role of progesterone in protecting against endometrial hyperplasia?
What is the role of progesterone in protecting against endometrial hyperplasia?
Name one condition that can cause unopposed estrogen exposure.
Name one condition that can cause unopposed estrogen exposure.
Which statement about fetal growth restriction (FGR) is NOT correct?
Which statement about fetal growth restriction (FGR) is NOT correct?
Which statement regarding the use of ultrasound in pregnancy is NOT correct?
Which statement regarding the use of ultrasound in pregnancy is NOT correct?
How is DCIS typically detected?
How is DCIS typically detected?
What distinguishes DCIS histologically from invasive ductal carcinoma (IDC)?
What distinguishes DCIS histologically from invasive ductal carcinoma (IDC)?
Which statement regarding maternal diabetes and fetal growth is NOT correct?
Which statement regarding maternal diabetes and fetal growth is NOT correct?
What distinguishes structural from functional congenital abnormalities?
What distinguishes structural from functional congenital abnormalities?
Why is DCIS considered a precursor to invasive breast cancer?
Why is DCIS considered a precursor to invasive breast cancer?
What imaging techniques are used to diagnose structural abnormalities in utero?
What imaging techniques are used to diagnose structural abnormalities in utero?
What clinical signs are characteristic of inflammatory breast cancer?
What clinical signs are characteristic of inflammatory breast cancer?
What is the role of amniocentesis in prenatal diagnosis?
What is the role of amniocentesis in prenatal diagnosis?
What histological findings support the diagnosis of inflammatory breast cancer?
What histological findings support the diagnosis of inflammatory breast cancer?
Why does inflammatory breast cancer have a poorer prognosis compared to other types?
Why does inflammatory breast cancer have a poorer prognosis compared to other types?
How does the placenta facilitate nutrient transfer to the fetus?
How does the placenta facilitate nutrient transfer to the fetus?
What placental dysfunction can lead to intrauterine growth restriction (IUGR)?
What placental dysfunction can lead to intrauterine growth restriction (IUGR)?
What differentiates a complete mole from a partial mole on histology?
What differentiates a complete mole from a partial mole on histology?
What is the significance of persistently elevated β-hCG levels after evacuation of a mole?
What is the significance of persistently elevated β-hCG levels after evacuation of a mole?
Name one hormone produced by the placenta and its function in pregnancy.
Name one hormone produced by the placenta and its function in pregnancy.
Name one treatment option for invasive gestational trophoblastic neoplasia.
Name one treatment option for invasive gestational trophoblastic neoplasia.
What is the embryological basis of neural tube defects (NTDs)?
What is the embryological basis of neural tube defects (NTDs)?
Name one type of NTD and describe its main features.
Name one type of NTD and describe its main features.
What is the pathophysiological basis of adenomyosis?
What is the pathophysiological basis of adenomyosis?
What preventive measure is recommended to reduce the risk of NTDs?
What preventive measure is recommended to reduce the risk of NTDs?
How does adenomyosis typically present clinically?
How does adenomyosis typically present clinically?
What is the most common maternal condition associated with fetal macrosomia?
What is the most common maternal condition associated with fetal macrosomia?
What imaging modality is most useful for diagnosing adenomyosis?
What imaging modality is most useful for diagnosing adenomyosis?
How does fetal hyperinsulinemia contribute to macrosomia?
How does fetal hyperinsulinemia contribute to macrosomia?
What are two potential complications of macrosomia during delivery?
What are two potential complications of macrosomia during delivery?
What is the significance of early diagnosis for conditions like transposition of the great arteries?
What is the significance of early diagnosis for conditions like transposition of the great arteries?
How can fetal echocardiography help guide management before and after birth?
How can fetal echocardiography help guide management before and after birth?
What is the difference between symmetrical and asymmetrical intrauterine growth restriction (IUGR)?
What is the difference between symmetrical and asymmetrical intrauterine growth restriction (IUGR)?
Which trimester is most critical for diagnosing growth abnormalities?
Which trimester is most critical for diagnosing growth abnormalities?
What are the potential long-term health impacts of intrauterine growth restriction on the infant?
What are the potential long-term health impacts of intrauterine growth restriction on the infant?
Which maternal serum marker is commonly elevated in pregnancies with neural tube defects?
Which maternal serum marker is commonly elevated in pregnancies with neural tube defects?
What imaging technique is most effective in confirming neural tube defects?
What imaging technique is most effective in confirming neural tube defects?
How does genetic counselling play a role in pregnancies at risk of neural tube defects?
How does genetic counselling play a role in pregnancies at risk of neural tube defects?
What are two common congenital infections screened for during pregnancy?
What are two common congenital infections screened for during pregnancy?
How can maternal vaccination impact the risk of congenital rubella?
How can maternal vaccination impact the risk of congenital rubella?
What prenatal intervention is recommended to prevent vertical transmission of Group B Streptococcus?
What prenatal intervention is recommended to prevent vertical transmission of Group B Streptococcus?
What specific questions should be included when taking a sexual health history?
What specific questions should be included when taking a sexual health history?
Why is patient confidentiality essential in sexual health consultations?
Why is patient confidentiality essential in sexual health consultations?
How can sexual health history taking influence patient outcomes?
How can sexual health history taking influence patient outcomes?
How does maternal nutrition impact fetal brain development?
How does maternal nutrition impact fetal brain development?
Name one maternal infection that can disrupt fetal neurological development.
Name one maternal infection that can disrupt fetal neurological development.
What is the role of prenatal vitamins in supporting healthy brain development?
What is the role of prenatal vitamins in supporting healthy brain development?
How does cardiac output change during pregnancy?
How does cardiac output change during pregnancy?
What adaptations occur in maternal glucose metabolism?
What adaptations occur in maternal glucose metabolism?
What is the primary cause of polyhydramnios?
What is the primary cause of polyhydramnios?
What complications are associated with oligohydramnios?
What complications are associated with oligohydramnios?
What role does the maternal innate immune system play during pregnancy?
What role does the maternal innate immune system play during pregnancy?
What does an increased nuchal translucency measurement indicate?
What does an increased nuchal translucency measurement indicate?
At what stage of pregnancy is nuchal translucency measurement typically performed?
At what stage of pregnancy is nuchal translucency measurement typically performed?
What additional follow-up testing may be needed if increased nuchal translucency is found?
What additional follow-up testing may be needed if increased nuchal translucency is found?
Which statement regarding prenatal diagnostic techniques is NOT correct?
Which statement regarding prenatal diagnostic techniques is NOT correct?
Name two potential long-term complications of untreated PID.
Name two potential long-term complications of untreated PID.
What imaging modality is useful for assessing complications of PID?
What imaging modality is useful for assessing complications of PID?
What are the distinguishing histological features of a complete mole?
What are the distinguishing histological features of a complete mole?
What is the primary treatment for a complete mole?
What is the primary treatment for a complete mole?
How is persistent trophoblastic disease monitored post-treatment?
How is persistent trophoblastic disease monitored post-treatment?
Which histological pattern is characteristic of invasive ductal carcinoma with a poor prognosis?
Which histological pattern is characteristic of invasive ductal carcinoma with a poor prognosis?
What is the primary mechanism behind the formation of endometrial hyperplasia?
What is the primary mechanism behind the formation of endometrial hyperplasia?
Which of the following testicular tumors is most likely to produce both AFP and β-hCG?
Which of the following testicular tumors is most likely to produce both AFP and β-hCG?
What is a distinctive clinical feature of complete hydatidiform mole compared to partial mole?
What is a distinctive clinical feature of complete hydatidiform mole compared to partial mole?
What is a key distinguishing feature of invasive lobular carcinoma compared to invasive ductal carcinoma?
What is a key distinguishing feature of invasive lobular carcinoma compared to invasive ductal carcinoma?
Which of the following is least likely to be associated with fibrocystic changes in the breast?
Which of the following is least likely to be associated with fibrocystic changes in the breast?
What is the primary diagnostic feature of choriocarcinoma under histological examination?
What is the primary diagnostic feature of choriocarcinoma under histological examination?
What is the most common type of cervical cancer?
What is the most common type of cervical cancer?
Which germ cell tumor of the testis is most likely to show a “fried egg” appearance on histology?
Which germ cell tumor of the testis is most likely to show a “fried egg” appearance on histology?
Which ovarian tumor type is associated with Meigs syndrome?
Which ovarian tumor type is associated with Meigs syndrome?
Which statement about invasive ductal carcinoma (IDC) is NOT correct?
Which statement about invasive ductal carcinoma (IDC) is NOT correct?
Which statement about testicular torsion is NOT correct?
Which statement about testicular torsion is NOT correct?
Which statement regarding placental abruption is NOT correct?
Which statement regarding placental abruption is NOT correct?
Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?
Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?
Which statement about cervical intraepithelial neoplasia (CIN) is NOT correct?
Which statement about cervical intraepithelial neoplasia (CIN) is NOT correct?
Which statement regarding invasive lobular carcinoma (ILC) is NOT correct?
Which statement regarding invasive lobular carcinoma (ILC) is NOT correct?
Which statement about ovarian teratomas is NOT correct?
Which statement about ovarian teratomas is NOT correct?
Which statement about endometrial cancer is NOT correct?
Which statement about endometrial cancer is NOT correct?
Which statement about fibrocystic breast changes is NOT correct?
Which statement about fibrocystic breast changes is NOT correct?
Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?
Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?
How does the integration of high-risk HPV types into the host genome contribute to the development of cervical cancer?
How does the integration of high-risk HPV types into the host genome contribute to the development of cervical cancer?
What is the role of the HPV E6 and E7 oncoproteins in this process?
What is the role of the HPV E6 and E7 oncoproteins in this process?
How does HPV vaccination help reduce the incidence of cervical cancer?
How does HPV vaccination help reduce the incidence of cervical cancer?
What is the typical presentation of DCIS on mammography?
What is the typical presentation of DCIS on mammography?
Why is DCIS considered a non-invasive form of breast cancer, and what is its potential for progression?
Why is DCIS considered a non-invasive form of breast cancer, and what is its potential for progression?
What treatment options are available for DCIS, and how do they vary based on patient factors?
What treatment options are available for DCIS, and how do they vary based on patient factors?
What causes endometrial hyperplasia, and what differentiates atypical hyperplasia from non-atypical hyperplasia?
What causes endometrial hyperplasia, and what differentiates atypical hyperplasia from non-atypical hyperplasia?
What is the risk of progression to endometrial cancer for patients with atypical hyperplasia?
What is the risk of progression to endometrial cancer for patients with atypical hyperplasia?
What treatment strategies are used for patients with atypical hyperplasia who wish to preserve fertility?
What treatment strategies are used for patients with atypical hyperplasia who wish to preserve fertility?
What are the main differences in pathogenesis between type 1 and type 2 endometrial carcinoma?
What are the main differences in pathogenesis between type 1 and type 2 endometrial carcinoma?
Which type of endometrial carcinoma is typically more aggressive and associated with poorer prognosis?
Which type of endometrial carcinoma is typically more aggressive and associated with poorer prognosis?
How does the management of type 2 endometrial carcinoma differ from type 1?
How does the management of type 2 endometrial carcinoma differ from type 1?
What imaging modality is most commonly used to evaluate ovarian masses?
What imaging modality is most commonly used to evaluate ovarian masses?
How do functional cysts differ from pathological ovarian tumors in terms of presentation and management?
How do functional cysts differ from pathological ovarian tumors in terms of presentation and management?
What tumor markers are useful for assessing epithelial ovarian cancer?
What tumor markers are useful for assessing epithelial ovarian cancer?
Which germ cell tumor is most likely to produce β-hCG?
Which germ cell tumor is most likely to produce β-hCG?
How is AFP used in diagnosing and monitoring testicular cancer?
How is AFP used in diagnosing and monitoring testicular cancer?
What imaging study is initially used to evaluate a suspected testicular mass?
What imaging study is initially used to evaluate a suspected testicular mass?
What differentiates invasive mole from complete hydatidiform mole?
What differentiates invasive mole from complete hydatidiform mole?
How is gestational trophoblastic neoplasia monitored after initial treatment?
How is gestational trophoblastic neoplasia monitored after initial treatment?
What is the mainstay treatment for high-risk gestational trophoblastic neoplasia?
What is the mainstay treatment for high-risk gestational trophoblastic neoplasia?
What are the most common HPV types associated with squamous cell carcinoma and adenocarcinoma of the cervix?
What are the most common HPV types associated with squamous cell carcinoma and adenocarcinoma of the cervix?
How does the clinical presentation of adenocarcinoma of the cervix differ from squamous cell carcinoma?
How does the clinical presentation of adenocarcinoma of the cervix differ from squamous cell carcinoma?
Between squamous cell carcinoma and adenocarcinoma of the cervix, which subtype generally has a poorer prognosis and why?
Between squamous cell carcinoma and adenocarcinoma of the cervix, which subtype generally has a poorer prognosis and why?
How does the luteal phase support potential pregnancy?
How does the luteal phase support potential pregnancy?
What hormonal imbalance is associated with the development of polycystic ovary syndrome (PCOS)?
What hormonal imbalance is associated with the development of polycystic ovary syndrome (PCOS)?
How can ovulatory dysfunction impact fertility?
How can ovulatory dysfunction impact fertility?
A 30-year-old pregnant woman presents with mild fever and a rash. She mentions possible exposure to a colleague diagnosed with rubella.
a) What is the incubation period for rubella?
b) If rubella infection occurs in the first trimester, list two possible outcomes for the foetus.
c) What immediate test should be performed to assess maternal infection?
A 30-year-old pregnant woman presents with mild fever and a rash. She mentions possible exposure to a colleague diagnosed with rubella.
a) What is the incubation period for rubella? b) If rubella infection occurs in the first trimester, list two possible outcomes for the foetus. c) What immediate test should be performed to assess maternal infection?
A 47-year-old immunocompromised male presents with decreased vision and floaters. Ophthalmoscopic exam reveals retinal haemorrhages. a) Which virus is most likely implicated in this patient's condition? b) Name one systemic complication that can occur if this infection is untreated. c) What is the first-line treatment for this condition?
A 47-year-old immunocompromised male presents with decreased vision and floaters. Ophthalmoscopic exam reveals retinal haemorrhages. a) Which virus is most likely implicated in this patient's condition? b) Name one systemic complication that can occur if this infection is untreated. c) What is the first-line treatment for this condition?
A 65-year-old HIV-positive man presents with multiple purplish skin lesions on his legs. He has a history of poor medication adherence. a) What is the likely underlying condition? b) Name the causative agent of this condition. c) Which type of cells does this virus primarily affect for latency?
A 65-year-old HIV-positive man presents with multiple purplish skin lesions on his legs. He has a history of poor medication adherence. a) What is the likely underlying condition? b) Name the causative agent of this condition. c) Which type of cells does this virus primarily affect for latency?
What is the likely diagnosis for a 25-year-old woman with a history of abnormal Pap smears showing acetowhite changes?
What is the likely diagnosis for a 25-year-old woman with a history of abnormal Pap smears showing acetowhite changes?
What procedure should be performed to confirm the diagnosis for cervical intraepithelial neoplasia (CIN)?
What procedure should be performed to confirm the diagnosis for cervical intraepithelial neoplasia (CIN)?
What treatment options are available if CIN II/III is confirmed?
What treatment options are available if CIN II/III is confirmed?
What is the likely diagnosis for a 67-year-old man presenting with nocturia and enlarged, non-nodular prostate?
What is the likely diagnosis for a 67-year-old man presenting with nocturia and enlarged, non-nodular prostate?
What initial pharmacological treatment is recommended for BPH?
What initial pharmacological treatment is recommended for BPH?
What are potential side effects of the recommended treatment for BPH?
What are potential side effects of the recommended treatment for BPH?
What imaging technique could be used for further evaluation in a woman with dense breast tissue and a suspicious solid mass?
What imaging technique could be used for further evaluation in a woman with dense breast tissue and a suspicious solid mass?
What is the next diagnostic step if the mass in the breast appears suspicious?
What is the next diagnostic step if the mass in the breast appears suspicious?
What histological findings would confirm a diagnosis of invasive ductal carcinoma?
What histological findings would confirm a diagnosis of invasive ductal carcinoma?
What is the most likely cause of bone pain and elevated alkaline phosphatase in a 58-year-old man with a history of prostate cancer?
What is the most likely cause of bone pain and elevated alkaline phosphatase in a 58-year-old man with a history of prostate cancer?
What additional tests can confirm the diagnosis of bone metastases?
What additional tests can confirm the diagnosis of bone metastases?
What treatment options are available for bone metastases?
What treatment options are available for bone metastases?
What is the most likely diagnosis for a 32-year-old woman with a rapidly enlarging breast mass resembling peau d’orange?
What is the most likely diagnosis for a 32-year-old woman with a rapidly enlarging breast mass resembling peau d’orange?
What diagnostic tests are needed to confirm the diagnosis of inflammatory breast cancer?
What diagnostic tests are needed to confirm the diagnosis of inflammatory breast cancer?
What is the primary treatment strategy for inflammatory breast cancer?
What is the primary treatment strategy for inflammatory breast cancer?
What is the next best step for diagnosis in a postmenopausal woman with thickened endometrial lining?
What is the next best step for diagnosis in a postmenopausal woman with thickened endometrial lining?
What histological feature would confirm endometrial carcinoma?
What histological feature would confirm endometrial carcinoma?
What are common risk factors for endometrial carcinoma?
What are common risk factors for endometrial carcinoma?
What are common side effects of androgen deprivation therapy (ADT)?
What are common side effects of androgen deprivation therapy (ADT)?
What strategies can be used to mitigate the side effects of ADT?
What strategies can be used to mitigate the side effects of ADT?
What additional monitoring should be considered for patients on long-term ADT?
What additional monitoring should be considered for patients on long-term ADT?
What is the most likely diagnosis for a 29-year-old man with a painless testicular mass and elevated serum AFP?
What is the most likely diagnosis for a 29-year-old man with a painless testicular mass and elevated serum AFP?
What is the standard initial treatment for a non-seminomatous germ cell tumor?
What is the standard initial treatment for a non-seminomatous germ cell tumor?
How is the diagnosis of a non-seminomatous germ cell tumor confirmed post-surgery?
How is the diagnosis of a non-seminomatous germ cell tumor confirmed post-surgery?
How does atypical ductal hyperplasia (ADH) influence breast cancer risk?
How does atypical ductal hyperplasia (ADH) influence breast cancer risk?
What surveillance strategies should be considered for a patient with ADH?
What surveillance strategies should be considered for a patient with ADH?
What preventive options can be discussed for a patient with ADH?
What preventive options can be discussed for a patient with ADH?
What is the most likely diagnosis for a 50-year-old male presenting with hematuria and elevated PSA?
What is the most likely diagnosis for a 50-year-old male presenting with hematuria and elevated PSA?
What biopsy technique is used for confirmation of prostate cancer?
What biopsy technique is used for confirmation of prostate cancer?
What are common histological findings in prostate cancer?
What are common histological findings in prostate cancer?
What are the implications of a BRCA1 mutation for a patient with a family history of breast cancer?
What are the implications of a BRCA1 mutation for a patient with a family history of breast cancer?
What surveillance strategies should be implemented for a patient with a BRCA1 mutation?
What surveillance strategies should be implemented for a patient with a BRCA1 mutation?
What preventive surgical options could be considered for a patient with a BRCA1 mutation?
What preventive surgical options could be considered for a patient with a BRCA1 mutation?
What condition could findings of mild ventriculomegaly and a lemon-shaped skull suggest?
What condition could findings of mild ventriculomegaly and a lemon-shaped skull suggest?
What further imaging or diagnostic test would be appropriate for ventriculomegaly?
What further imaging or diagnostic test would be appropriate for ventriculomegaly?
What counseling should be provided regarding spina bifida?
What counseling should be provided regarding spina bifida?
What are common causes of polyhydramnios?
What are common causes of polyhydramnios?
What complications could arise for the mother and fetus due to polyhydramnios?
What complications could arise for the mother and fetus due to polyhydramnios?
What management strategies should be considered for polyhydramnios?
What management strategies should be considered for polyhydramnios?
What potential causes should be considered for oligohydramnios?
What potential causes should be considered for oligohydramnios?
How could oligohydramnios affect labor and delivery?
How could oligohydramnios affect labor and delivery?
What interventions should be recommended for oligohydramnios?
What interventions should be recommended for oligohydramnios?
What chromosomal abnormalities could an increased nuchal translucency measurement indicate?
What chromosomal abnormalities could an increased nuchal translucency measurement indicate?
What follow-up tests are advised to confirm the diagnosis related to nuchal translucency?
What follow-up tests are advised to confirm the diagnosis related to nuchal translucency?
How should the patient be counseled about findings associated with increased nuchal translucency?
How should the patient be counseled about findings associated with increased nuchal translucency?
What complications are associated with fetal macrosomia?
What complications are associated with fetal macrosomia?
How should labor be managed in a patient with suspected macrosomia?
How should labor be managed in a patient with suspected macrosomia?
What long-term risks should be discussed for the infant born with macrosomia?
What long-term risks should be discussed for the infant born with macrosomia?
What is the risk of congenital CMV infection, and what are the potential outcomes?
What is the risk of congenital CMV infection, and what are the potential outcomes?
What initial diagnostic tests can be performed to assess the risk of congenital CMV infection?
What initial diagnostic tests can be performed to assess the risk of congenital CMV infection?
What management options are available if congenital CMV infection is confirmed?
What management options are available if congenital CMV infection is confirmed?
What prenatal screening options are available to detect neural tube defects?
What prenatal screening options are available to detect neural tube defects?
How does folic acid supplementation affect the risk of neural tube defects?
How does folic acid supplementation affect the risk of neural tube defects?
What additional precautions should be taken if there is a strong family history of neural tube defects?
What additional precautions should be taken if there is a strong family history of neural tube defects?
What are the potential maternal and fetal causes of asymmetrical fetal growth restriction (FGR)?
What are the potential maternal and fetal causes of asymmetrical fetal growth restriction (FGR)?
How is asymmetrical FGR managed in the third trimester?
How is asymmetrical FGR managed in the third trimester?
What is the long-term impact on the child if born with asymmetrical FGR?
What is the long-term impact on the child if born with asymmetrical FGR?
What potential maternal and fetal conditions could cause oligohydramnios?
What potential maternal and fetal conditions could cause oligohydramnios?
How should a patient with oligohydramnios be monitored moving forward?
How should a patient with oligohydramnios be monitored moving forward?
What interventions may be necessary if oligohydramnios persists?
What interventions may be necessary if oligohydramnios persists?
What prenatal tests are available for diagnosing Down syndrome?
What prenatal tests are available for diagnosing Down syndrome?
How does maternal age influence the risk of trisomy 21?
How does maternal age influence the risk of trisomy 21?
What are the potential challenges in counseling a patient with a family history of Down syndrome?
What are the potential challenges in counseling a patient with a family history of Down syndrome?
What is a potential differential diagnosis for a thickened endometrial stripe with heterogeneous echotexture?
What is a potential differential diagnosis for a thickened endometrial stripe with heterogeneous echotexture?
What histological feature would confirm a diagnosis of endometrial carcinoma?
What histological feature would confirm a diagnosis of endometrial carcinoma?
What additional imaging or diagnostic tests would be appropriate for staging suspected endometrial carcinoma?
What additional imaging or diagnostic tests would be appropriate for staging suspected endometrial carcinoma?
What is a likely cause of bone pain and elevated serum calcium in a patient with a history of breast cancer?
What is a likely cause of bone pain and elevated serum calcium in a patient with a history of breast cancer?
Which imaging modality is best suited to evaluate for metastatic disease in this breast cancer patient?
Which imaging modality is best suited to evaluate for metastatic disease in this breast cancer patient?
What blood test could further support suspicion of metastatic breast cancer?
What blood test could further support suspicion of metastatic breast cancer?
What is the most likely diagnosis for a left adnexal mass combined with a serum AFP level of 300 ng/mL?
What is the most likely diagnosis for a left adnexal mass combined with a serum AFP level of 300 ng/mL?
What histological findings would support the diagnosis of a yolk sac tumor?
What histological findings would support the diagnosis of a yolk sac tumor?
What is the typical treatment approach for a yolk sac tumor?
What is the typical treatment approach for a yolk sac tumor?
What is the most likely diagnosis for a firm, irregular prostate as noted in a DRE?
What is the most likely diagnosis for a firm, irregular prostate as noted in a DRE?
What diagnostic test should be performed next for suspected prostate cancer?
What diagnostic test should be performed next for suspected prostate cancer?
What histopathological findings would confirm the diagnosis of prostate cancer?
What histopathological findings would confirm the diagnosis of prostate cancer?
What is a potential diagnosis for bloody nipple discharge and microcalcifications on a mammogram?
What is a potential diagnosis for bloody nipple discharge and microcalcifications on a mammogram?
What biopsy technique is appropriate for confirming the diagnosis of DCIS?
What biopsy technique is appropriate for confirming the diagnosis of DCIS?
What histological features would indicate ductal carcinoma in situ (DCIS)?
What histological features would indicate ductal carcinoma in situ (DCIS)?
What is the likely diagnosis for a postmenopausal woman with severe itching and white, atrophic plaques?
What is the likely diagnosis for a postmenopausal woman with severe itching and white, atrophic plaques?
What histological changes would confirm the diagnosis of lichen sclerosus?
What histological changes would confirm the diagnosis of lichen sclerosus?
What is the risk associated with lichen sclerosus if left untreated?
What is the risk associated with lichen sclerosus if left untreated?
What is the most likely diagnosis for a palpable right breast mass identified on ultrasound?
What is the most likely diagnosis for a palpable right breast mass identified on ultrasound?
What clinical feature supports the diagnosis of fibroadenoma?
What clinical feature supports the diagnosis of fibroadenoma?
What management approach is recommended for a fibroadenoma?
What management approach is recommended for a fibroadenoma?
What is the likely diagnosis for a patient with acetowhite epithelium during colposcopy?
What is the likely diagnosis for a patient with acetowhite epithelium during colposcopy?
What biopsy findings would confirm the diagnosis of CIN III?
What biopsy findings would confirm the diagnosis of CIN III?
What treatment options are available for CIN III?
What treatment options are available for CIN III?
What is the likely diagnosis for a pregnant woman with new onset hypertension and proteinuria?
What is the likely diagnosis for a pregnant woman with new onset hypertension and proteinuria?
What complications could arise if preeclampsia progresses?
What complications could arise if preeclampsia progresses?
What management strategies should be considered for preeclampsia?
What management strategies should be considered for preeclampsia?
What is the most likely diagnosis for a painless testicular mass found on ultrasound?
What is the most likely diagnosis for a painless testicular mass found on ultrasound?
What serum markers should be evaluated for suspected seminoma?
What serum markers should be evaluated for suspected seminoma?
What is the standard initial treatment for seminoma?
What is the standard initial treatment for seminoma?
What is the next best step in management for a patient with postmenopausal bleeding and atypical hyperplasia?
What is the next best step in management for a patient with postmenopausal bleeding and atypical hyperplasia?
What is the risk of progression to endometrial carcinoma if atypical hyperplasia is untreated?
What is the risk of progression to endometrial carcinoma if atypical hyperplasia is untreated?
What treatment options are available if a postmenopausal woman with atypical hyperplasia wishes to preserve fertility?
What treatment options are available if a postmenopausal woman with atypical hyperplasia wishes to preserve fertility?
What are potential differential diagnoses for a 50-year-old male with urinary symptoms and slightly elevated PSA levels?
What are potential differential diagnoses for a 50-year-old male with urinary symptoms and slightly elevated PSA levels?
What further diagnostic evaluation should be performed for suspected prostate issues?
What further diagnostic evaluation should be performed for suspected prostate issues?
How is benign prostatic hyperplasia (BPH) distinguished from prostate cancer?
How is benign prostatic hyperplasia (BPH) distinguished from prostate cancer?
What is the likely diagnosis for a 30-year-old woman with irregular menstrual cycles and multiple small ovarian cysts?
What is the likely diagnosis for a 30-year-old woman with irregular menstrual cycles and multiple small ovarian cysts?
What hormonal findings are expected in a woman with PCOS?
What hormonal findings are expected in a woman with PCOS?
What treatment options can be considered to improve fertility in patients with PCOS?
What treatment options can be considered to improve fertility in patients with PCOS?
What are common risk factors for vulvar squamous cell carcinoma?
What are common risk factors for vulvar squamous cell carcinoma?
What is the typical treatment approach for early-stage vulvar cancer?
What is the typical treatment approach for early-stage vulvar cancer?
What is the prognosis for localized vulvar squamous cell carcinoma?
What is the prognosis for localized vulvar squamous cell carcinoma?
What is likely the cause of new-onset jaundice and hepatomegaly in a woman with breast cancer?
What is likely the cause of new-onset jaundice and hepatomegaly in a woman with breast cancer?
What imaging studies would be appropriate for evaluating liver conditions in suspected metastatic breast cancer?
What imaging studies would be appropriate for evaluating liver conditions in suspected metastatic breast cancer?
What tumor marker can help support the diagnosis of metastatic breast cancer?
What tumor marker can help support the diagnosis of metastatic breast cancer?
What condition should be considered for a patient with hyperemesis gravidarum and markedly elevated β-hCG levels?
What condition should be considered for a patient with hyperemesis gravidarum and markedly elevated β-hCG levels?
What imaging findings would support the diagnosis of complete hydatidiform mole?
What imaging findings would support the diagnosis of complete hydatidiform mole?
What is the initial treatment for a complete hydatidiform mole?
What is the initial treatment for a complete hydatidiform mole?
What is the likely diagnosis for a painless scrotal mass characterized by a well-circumscribed hypoechoic lesion?
What is the likely diagnosis for a painless scrotal mass characterized by a well-circumscribed hypoechoic lesion?
What further steps should be taken for evaluation of a suspected testicular lesion?
What further steps should be taken for evaluation of a suspected testicular lesion?
What is the prognosis for a patient with a well-circumscribed hypoechoic lesion in the testicle?
What is the prognosis for a patient with a well-circumscribed hypoechoic lesion in the testicle?
What is a potential concern with long-term hormone replacement therapy (HRT) use?
What is a potential concern with long-term hormone replacement therapy (HRT) use?
What diagnostic steps should be taken for a woman on long-term HRT presenting with breast tenderness?
What diagnostic steps should be taken for a woman on long-term HRT presenting with breast tenderness?
What are alternative management strategies for menopausal symptoms?
What are alternative management strategies for menopausal symptoms?
What hormone is likely affected by stress in postpartum women experiencing breastfeeding difficulties?
What hormone is likely affected by stress in postpartum women experiencing breastfeeding difficulties?
How does stress impact lactation?
How does stress impact lactation?
What strategies can support successful breastfeeding in a postpartum woman dealing with stress?
What strategies can support successful breastfeeding in a postpartum woman dealing with stress?
What is the significance of a woman's history of deep vein thrombosis (DVT) when choosing contraception?
What is the significance of a woman's history of deep vein thrombosis (DVT) when choosing contraception?
Which methods of contraception should a woman with a history of DVT avoid?
Which methods of contraception should a woman with a history of DVT avoid?
What are safer contraceptive options for a woman with a history of DVT?
What are safer contraceptive options for a woman with a history of DVT?
What is a potential complication of long-term testosterone therapy?
What is a potential complication of long-term testosterone therapy?
What tests should be done to monitor complications from long-term testosterone therapy?
What tests should be done to monitor complications from long-term testosterone therapy?
How should secondary polycythemia from testosterone therapy be managed?
How should secondary polycythemia from testosterone therapy be managed?
What is the most likely diagnosis for a woman presenting with galactorrhea and amenorrhea and elevated prolactin levels?
What is the most likely diagnosis for a woman presenting with galactorrhea and amenorrhea and elevated prolactin levels?
What could be potential causes of hyperprolactinemia?
What could be potential causes of hyperprolactinemia?
What are the treatment options for hyperprolactinemia?
What are the treatment options for hyperprolactinemia?
What type of hypogonadism is indicated by having low testosterone and high LH/FSH levels?
What type of hypogonadism is indicated by having low testosterone and high LH/FSH levels?
What are potential causes of primary hypogonadism?
What are potential causes of primary hypogonadism?
What treatment options are available for primary hypogonadism?
What treatment options are available for primary hypogonadism?
Which of the following best describes the impact of stigma on testing and treatment for STIs?
Which of the following best describes the impact of stigma on testing and treatment for STIs?
Which approach is most effective for reducing the incidence of congenital syphilis?
Which approach is most effective for reducing the incidence of congenital syphilis?
Why are STIs such as gonorrhea considered significant public health concerns?
Why are STIs such as gonorrhea considered significant public health concerns?
What is a major limitation in controlling the spread of viral STIs compared to bacterial STIs?
What is a major limitation in controlling the spread of viral STIs compared to bacterial STIs?
What is the most effective approach to reducing HPV-related cancers at the population level?
What is the most effective approach to reducing HPV-related cancers at the population level?
What is the public health rationale for regular screening of high-risk populations for STIs?
What is the public health rationale for regular screening of high-risk populations for STIs?
Which of the following contributes most significantly to the global burden of STIs?
Which of the following contributes most significantly to the global burden of STIs?
What is a critical public health challenge in managing antibiotic-resistant STIs like gonorrhea?
What is a critical public health challenge in managing antibiotic-resistant STIs like gonorrhea?
What is a major driver of high STI transmission rates in populations despite the availability of treatment?
What is a major driver of high STI transmission rates in populations despite the availability of treatment?
What are three major risk factors for acquiring STIs?
What are three major risk factors for acquiring STIs?
What primary prevention strategies can reduce the spread of STIs?
What primary prevention strategies can reduce the spread of STIs?
What are the primary stages of syphilis?
What are the primary stages of syphilis?
What are the potential complications of untreated HSV infection?
What are the potential complications of untreated HSV infection?
Why is chlamydia often underdiagnosed?
Why is chlamydia often underdiagnosed?
What screening tests should be offered to asymptomatic individuals?
What screening tests should be offered to asymptomatic individuals?
What is the recommended treatment for syphilis in pregnancy?
What is the recommended treatment for syphilis in pregnancy?
What ligaments provide primary support to the uterus, and how do they function?
What ligaments provide primary support to the uterus, and how do they function?
What role do the round ligaments play in the positioning of the uterus?
What role do the round ligaments play in the positioning of the uterus?
What are the key hormones involved in regulating the menstrual cycle, and how do they interact?
What are the key hormones involved in regulating the menstrual cycle, and how do they interact?
What is the role of FSH during the follicular phase?
What is the role of FSH during the follicular phase?
How does the interplay of estrogen and progesterone influence the endometrial cycle?
How does the interplay of estrogen and progesterone influence the endometrial cycle?
What is the pathway of milk from production to ejection?
What is the pathway of milk from production to ejection?
What role do the lactiferous sinuses play during lactation?
What role do the lactiferous sinuses play during lactation?
What role do Sertoli cells play in spermatogenesis?
What role do Sertoli cells play in spermatogenesis?
What is the primary function of Leydig cells?
What is the primary function of Leydig cells?
What histological changes are seen in the endometrium during the proliferative phase?
What histological changes are seen in the endometrium during the proliferative phase?
How does the secretory phase prepare the endometrium for potential implantation?
How does the secretory phase prepare the endometrium for potential implantation?
What triggers the shedding of the endometrial lining during menstruation?
What triggers the shedding of the endometrial lining during menstruation?
How does the scrotum contribute to maintaining optimal temperature for spermatogenesis?
How does the scrotum contribute to maintaining optimal temperature for spermatogenesis?
What is the role of the cremaster muscle in temperature regulation?
What is the role of the cremaster muscle in temperature regulation?
How does the pampiniform plexus assist in cooling the blood supply to the testes?
How does the pampiniform plexus assist in cooling the blood supply to the testes?
What role does estrogen play during the follicular phase of the menstrual cycle?
What role does estrogen play during the follicular phase of the menstrual cycle?
How does estrogen influence secondary sexual characteristics in females?
How does estrogen influence secondary sexual characteristics in females?
What feedback mechanism does estrogen exert on the hypothalamus and pituitary during the late follicular phase?
What feedback mechanism does estrogen exert on the hypothalamus and pituitary during the late follicular phase?
Which hormone primarily facilitates milk ejection during breastfeeding?
Which hormone primarily facilitates milk ejection during breastfeeding?
What is the primary mechanism by which combined oral contraceptives prevent pregnancy?
What is the primary mechanism by which combined oral contraceptives prevent pregnancy?
Which anabolic effect is associated with the use of testosterone replacement therapy?
Which anabolic effect is associated with the use of testosterone replacement therapy?
What is the most common side effect of the progestogen-only 'mini-pill'?
What is the most common side effect of the progestogen-only 'mini-pill'?
What is a significant non-reproductive effect of estrogen on the cardiovascular system?
What is a significant non-reproductive effect of estrogen on the cardiovascular system?
Which of the following substances can inhibit milk production by interfering with oxytocin release?
Which of the following substances can inhibit milk production by interfering with oxytocin release?
What is the typical clinical presentation of hyperparathyroidism?
What is the typical clinical presentation of hyperparathyroidism?
Which radiopharmaceutical is most commonly used for myocardial perfusion imaging?
Which radiopharmaceutical is most commonly used for myocardial perfusion imaging?
Which clinical scenario would most likely prompt the use of an I-123 thyroid scan?
Which clinical scenario would most likely prompt the use of an I-123 thyroid scan?
Which condition is most commonly associated with episodic headaches, sweating, and tachycardia?
Which condition is most commonly associated with episodic headaches, sweating, and tachycardia?
What is the primary imaging feature of a toxic thyroid adenoma on a thyroid uptake scan?
What is the primary imaging feature of a toxic thyroid adenoma on a thyroid uptake scan?
What imaging modality is typically used for localizing a parathyroid adenoma?
What imaging modality is typically used for localizing a parathyroid adenoma?
In nuclear medicine, what property of beta particles makes them useful in therapeutic applications?
In nuclear medicine, what property of beta particles makes them useful in therapeutic applications?
Which statement about Tc-99m pertechnetate is NOT correct?
Which statement about Tc-99m pertechnetate is NOT correct?
Which statement regarding parathyroid scintigraphy is NOT correct?
Which statement regarding parathyroid scintigraphy is NOT correct?
Which statement about I-123 thyroid imaging is NOT correct?
Which statement about I-123 thyroid imaging is NOT correct?
Which statement regarding nuclear medicine in hyperthyroidism evaluation is NOT correct?
Which statement regarding nuclear medicine in hyperthyroidism evaluation is NOT correct?
Which statement about phaeochromocytoma imaging is NOT correct?
Which statement about phaeochromocytoma imaging is NOT correct?
Which statement regarding the use of beta particles in nuclear medicine is NOT correct?
Which statement regarding the use of beta particles in nuclear medicine is NOT correct?
Which statement about thyroid scintigraphy findings is NOT correct?
Which statement about thyroid scintigraphy findings is NOT correct?
Which statement about parathyroid imaging using Tc-99m sestamibi is NOT correct?
Which statement about parathyroid imaging using Tc-99m sestamibi is NOT correct?
Which statement regarding nuclear medicine imaging in oncology is NOT correct?
Which statement regarding nuclear medicine imaging in oncology is NOT correct?
Which statement about thyroid function tests in nuclear medicine is NOT correct?
Which statement about thyroid function tests in nuclear medicine is NOT correct?
What is the mechanism of action of Tc-99m sestamibi in parathyroid imaging?
What is the mechanism of action of Tc-99m sestamibi in parathyroid imaging?
Why is delayed imaging used in detecting parathyroid adenomas?
Why is delayed imaging used in detecting parathyroid adenomas?
How does SPECT-CT improve parathyroid localization?
How does SPECT-CT improve parathyroid localization?
What role does prolactin play during the lactation process?
What role does prolactin play during the lactation process?
Which condition is associated with a decreased level of testosterone and high levels of luteinizing hormone (LH)?
Which condition is associated with a decreased level of testosterone and high levels of luteinizing hormone (LH)?
Which of the following does NOT accurately describe the action of progesterone in the female body?
Which of the following does NOT accurately describe the action of progesterone in the female body?
What is the main factor affecting the synthesis of prolactin post-lactation initiation?
What is the main factor affecting the synthesis of prolactin post-lactation initiation?
Which hormone is primarily responsible for the development of male secondary sexual characteristics?
Which hormone is primarily responsible for the development of male secondary sexual characteristics?
What is the main function of estrogen in the regulation of the menstrual cycle?
What is the main function of estrogen in the regulation of the menstrual cycle?
Which contraceptive method has the highest risk of failure when not used consistently?
Which contraceptive method has the highest risk of failure when not used consistently?
Which type of androgenic agent is most likely to cause liver toxicity?
Which type of androgenic agent is most likely to cause liver toxicity?
What is a known side effect of long-term anabolic steroid use?
What is a known side effect of long-term anabolic steroid use?
Which statement regarding hormonal contraceptives is NOT correct?
Which statement regarding hormonal contraceptives is NOT correct?
Which statement about testosterone therapy is NOT correct?
Which statement about testosterone therapy is NOT correct?
Which statement regarding oxytocin’s role in lactation is NOT correct?
Which statement regarding oxytocin’s role in lactation is NOT correct?
Which statement about anabolic steroid use is NOT correct?
Which statement about anabolic steroid use is NOT correct?
Which statement regarding lactation physiology is NOT correct?
Which statement regarding lactation physiology is NOT correct?
Which statement about hormonal regulation in the male reproductive system is NOT correct?
Which statement about hormonal regulation in the male reproductive system is NOT correct?
Which statement about combined oral contraceptives is NOT correct?
Which statement about combined oral contraceptives is NOT correct?
Which statement regarding the physiology of testosterone is NOT correct?
Which statement regarding the physiology of testosterone is NOT correct?
Which statement regarding the action of progesterone in pregnancy is NOT correct?
Which statement regarding the action of progesterone in pregnancy is NOT correct?
Which statement about anabolic steroids is NOT correct?
Which statement about anabolic steroids is NOT correct?
What roles do LH and FSH play in the follicular phase?
What roles do LH and FSH play in the follicular phase?
How does the LH surge impact ovulation?
How does the LH surge impact ovulation?
What changes occur in progesterone levels during the luteal phase?
What changes occur in progesterone levels during the luteal phase?
How do combined oral contraceptives inhibit ovulation?
How do combined oral contraceptives inhibit ovulation?
What are potential risks associated with long-term use of combined oral contraceptives?
What are potential risks associated with long-term use of combined oral contraceptives?
What is the likely diagnosis for a woman presenting with irregular periods and signs of hyperandrogenism?
What is the likely diagnosis for a woman presenting with irregular periods and signs of hyperandrogenism?
What condition is characterized by low testosterone levels with high LH and FSH?
What condition is characterized by low testosterone levels with high LH and FSH?
What complications can arise from anabolic steroid use?
What complications can arise from anabolic steroid use?
What distinguishes primary from secondary hypogonadism?
What distinguishes primary from secondary hypogonadism?
Which anatomical structure is responsible for producing progesterone during the luteal phase?
Which anatomical structure is responsible for producing progesterone during the luteal phase?
What is the primary physiological effect of inhibin B secretion in females?
What is the primary physiological effect of inhibin B secretion in females?
Which phase of the menstrual cycle is characterized by the highest level of progesterone?
Which phase of the menstrual cycle is characterized by the highest level of progesterone?
Which hormone triggers the acrosome reaction during fertilization?
Which hormone triggers the acrosome reaction during fertilization?
What is the primary function of Leydig cells in the male reproductive system?
What is the primary function of Leydig cells in the male reproductive system?
During which stage of spermatogenesis does the primary spermatocyte undergo the first meiotic division?
During which stage of spermatogenesis does the primary spermatocyte undergo the first meiotic division?
What structural feature allows the mammary gland to produce milk during lactation?
What structural feature allows the mammary gland to produce milk during lactation?
Which phase of the uterine cycle corresponds with the proliferative phase of the endometrium?
Which phase of the uterine cycle corresponds with the proliferative phase of the endometrium?
What is the function of the pampiniform plexus in male reproductive anatomy?
What is the function of the pampiniform plexus in male reproductive anatomy?
Which ligament provides primary support to the uterus, preventing it from prolapsing?
Which ligament provides primary support to the uterus, preventing it from prolapsing?
Which anatomical structure in the breast is responsible for milk storage before ejection?
Which anatomical structure in the breast is responsible for milk storage before ejection?
What phase of the ovarian cycle involves the rupture of the dominant follicle and release of the oocyte?
What phase of the ovarian cycle involves the rupture of the dominant follicle and release of the oocyte?
Which nerve innervates the external anal sphincter?
Which nerve innervates the external anal sphincter?
Which cells in the male reproductive system are involved in forming the blood-testis barrier?
Which cells in the male reproductive system are involved in forming the blood-testis barrier?
Which hormone surge is primarily responsible for the onset of ovulation?
Which hormone surge is primarily responsible for the onset of ovulation?
Which statement about the male reproductive system is NOT correct?
Which statement about the male reproductive system is NOT correct?
Which statement regarding the pelvic viscera is NOT correct?
Which statement regarding the pelvic viscera is NOT correct?
Which statement about the phases of the menstrual cycle is NOT correct?
Which statement about the phases of the menstrual cycle is NOT correct?
Which statement about breast anatomy is NOT correct?
Which statement about breast anatomy is NOT correct?
Which statement about the hormonal control of spermatogenesis is NOT correct?
Which statement about the hormonal control of spermatogenesis is NOT correct?
Which statement about ovulation is NOT correct?
Which statement about ovulation is NOT correct?
Which statement regarding the anatomy of the pelvic floor is NOT correct?
Which statement regarding the anatomy of the pelvic floor is NOT correct?
Which statement about the corpus luteum is NOT correct?
Which statement about the corpus luteum is NOT correct?
Which statement regarding mammary gland development is NOT correct?
Which statement regarding mammary gland development is NOT correct?
Which statement about the pampiniform plexus is NOT correct?
Which statement about the pampiniform plexus is NOT correct?
Discuss the role of the corpus luteum in the female reproductive cycle: What is the primary function of the corpus luteum during the luteal phase?
Discuss the role of the corpus luteum in the female reproductive cycle: What is the primary function of the corpus luteum during the luteal phase?
Discuss the role of the corpus luteum in the female reproductive cycle: How is the corpus luteum maintained if pregnancy occurs?
Discuss the role of the corpus luteum in the female reproductive cycle: How is the corpus luteum maintained if pregnancy occurs?
Discuss the role of the corpus luteum in the female reproductive cycle: What hormonal changes lead to its degeneration if pregnancy does not occur?
Discuss the role of the corpus luteum in the female reproductive cycle: What hormonal changes lead to its degeneration if pregnancy does not occur?
Analyze the hormonal regulation of male reproductive function: What is the role of LH in the male reproductive system?
Analyze the hormonal regulation of male reproductive function: What is the role of LH in the male reproductive system?
Analyze the hormonal regulation of male reproductive function: Which hormone provides negative feedback to the hypothalamus and pituitary, regulating LH and FSH secretion?
Analyze the hormonal regulation of male reproductive function: Which hormone provides negative feedback to the hypothalamus and pituitary, regulating LH and FSH secretion?
Analyze the hormonal regulation of male reproductive function: What effect does inhibin have on FSH?
Analyze the hormonal regulation of male reproductive function: What effect does inhibin have on FSH?
Discuss the physiological changes in breast tissue during lactation: What role does prolactin play in lactation?
Discuss the physiological changes in breast tissue during lactation: What role does prolactin play in lactation?
Discuss the physiological changes in breast tissue during lactation: How does oxytocin contribute to the breastfeeding process?
Discuss the physiological changes in breast tissue during lactation: How does oxytocin contribute to the breastfeeding process?
Discuss the physiological changes in breast tissue during lactation: What structural adaptation in the breast supports milk ejection?
Discuss the physiological changes in breast tissue during lactation: What structural adaptation in the breast supports milk ejection?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: What are the main hormonal changes during the follicular phase?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: What are the main hormonal changes during the follicular phase?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: How do hormone levels shift during the luteal phase?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: How do hormone levels shift during the luteal phase?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: What triggers the menstrual phase, and how do hormone levels change during this time?
Compare the phases of the menstrual cycle with their corresponding hormonal profiles: What triggers the menstrual phase, and how do hormone levels change during this time?
Explain the role of Sertoli cells in spermatogenesis: How do Sertoli cells contribute to the formation of the blood-testis barrier?
Explain the role of Sertoli cells in spermatogenesis: How do Sertoli cells contribute to the formation of the blood-testis barrier?
Explain the role of Sertoli cells in spermatogenesis: What role do they play in nourishing developing sperm?
Explain the role of Sertoli cells in spermatogenesis: What role do they play in nourishing developing sperm?
Explain the role of Sertoli cells in spermatogenesis: What substance do Sertoli cells produce to regulate FSH?
Explain the role of Sertoli cells in spermatogenesis: What substance do Sertoli cells produce to regulate FSH?
Discuss the anatomical and physiological role of the pelvic diaphragm: Which muscles comprise the pelvic diaphragm?
Discuss the anatomical and physiological role of the pelvic diaphragm: Which muscles comprise the pelvic diaphragm?
Discuss the anatomical and physiological role of the pelvic diaphragm: What is the primary function of the pelvic diaphragm?
Discuss the anatomical and physiological role of the pelvic diaphragm: What is the primary function of the pelvic diaphragm?
Discuss the anatomical and physiological role of the pelvic diaphragm: How does the pelvic diaphragm contribute to the support of pelvic organs?
Discuss the anatomical and physiological role of the pelvic diaphragm: How does the pelvic diaphragm contribute to the support of pelvic organs?
Analyze the stages of spermatogenesis and their regulation: What are the stages of spermatogenesis from spermatogonia to mature sperm?
Analyze the stages of spermatogenesis and their regulation: What are the stages of spermatogenesis from spermatogonia to mature sperm?
Analyze the stages of spermatogenesis and their regulation: How is spermatogenesis regulated hormonally?
Analyze the stages of spermatogenesis and their regulation: How is spermatogenesis regulated hormonally?
Analyze the stages of spermatogenesis and their regulation: What is the significance of the first and second meiotic divisions in this process?
Analyze the stages of spermatogenesis and their regulation: What is the significance of the first and second meiotic divisions in this process?
Evaluate the impact of progesterone on the female reproductive system: What changes does progesterone induce in the endometrium during the luteal phase?
Evaluate the impact of progesterone on the female reproductive system: What changes does progesterone induce in the endometrium during the luteal phase?
Evaluate the impact of progesterone on the female reproductive system: How does progesterone affect the myometrium?
Evaluate the impact of progesterone on the female reproductive system: How does progesterone affect the myometrium?
Evaluate the impact of progesterone on the female reproductive system: What role does progesterone play in early pregnancy?
Evaluate the impact of progesterone on the female reproductive system: What role does progesterone play in early pregnancy?
Discuss the significance of the pampiniform plexus in testicular function: What is the primary function of the pampiniform plexus?
Discuss the significance of the pampiniform plexus in testicular function: What is the primary function of the pampiniform plexus?
Discuss the significance of the pampiniform plexus in testicular function: How does it contribute to temperature regulation of the testes?
Discuss the significance of the pampiniform plexus in testicular function: How does it contribute to temperature regulation of the testes?
Discuss the significance of the pampiniform plexus in testicular function: Why is temperature regulation important for spermatogenesis?
Discuss the significance of the pampiniform plexus in testicular function: Why is temperature regulation important for spermatogenesis?
Compare the structural and functional aspects of the uterus and its supportive ligaments: What are the main structural components of the uterus?
Compare the structural and functional aspects of the uterus and its supportive ligaments: What are the main structural components of the uterus?
What is the diagnosis for chronic pelvic pain and painful menstruation?
What is the diagnosis for chronic pelvic pain and painful menstruation?
What are the typical histological features of endometriosis?
What are the typical histological features of endometriosis?
How can endometriosis be managed?
How can endometriosis be managed?
What is the most likely diagnosis for sudden testicular pain and swelling?
What is the most likely diagnosis for sudden testicular pain and swelling?
What imaging test should be performed immediately for suspected testicular torsion?
What imaging test should be performed immediately for suspected testicular torsion?
What is the standard treatment for testicular torsion?
What is the standard treatment for testicular torsion?
What is the most likely diagnosis for difficulty urinating and increased urinary frequency in an older male?
What is the most likely diagnosis for difficulty urinating and increased urinary frequency in an older male?
Which zones of the prostate are most likely affected in benign prostatic hyperplasia?
Which zones of the prostate are most likely affected in benign prostatic hyperplasia?
What are the treatment options for benign prostatic hyperplasia?
What are the treatment options for benign prostatic hyperplasia?
Which statement about Type 2 diabetes is NOT correct?
Which statement about Type 2 diabetes is NOT correct?
Which statement regarding gestational diabetes is NOT correct?
Which statement regarding gestational diabetes is NOT correct?
Which statement about PTH's effects is NOT correct?
Which statement about PTH's effects is NOT correct?
Which statement about HbA1c testing is NOT correct?
Which statement about HbA1c testing is NOT correct?
What immune mechanism underlies Type 1 diabetes?
What immune mechanism underlies Type 1 diabetes?
How does insulin resistance contribute to the development of Type 2 diabetes?
How does insulin resistance contribute to the development of Type 2 diabetes?
How does glucagon maintain blood glucose levels during fasting?
How does glucagon maintain blood glucose levels during fasting?
What effect does insulin have on hepatic glucose production?
What effect does insulin have on hepatic glucose production?
Which signaling pathway is activated by insulin binding to its receptor in muscle and adipose tissue?
Which signaling pathway is activated by insulin binding to its receptor in muscle and adipose tissue?
Which enzyme deficiency is associated with a rare form of rickets that leads to hypocalcemia despite adequate vitamin D intake?
Which enzyme deficiency is associated with a rare form of rickets that leads to hypocalcemia despite adequate vitamin D intake?
Which hormone plays a key role in inhibiting bone resorption by osteoclasts?
Which hormone plays a key role in inhibiting bone resorption by osteoclasts?
What are the potential benefits of using SGLT2 inhibitors over metformin?
What are the potential benefits of using SGLT2 inhibitors over metformin?
What is the effect of chronic hyperglycemia on the basement membrane of blood vessels in diabetic patients?
What is the effect of chronic hyperglycemia on the basement membrane of blood vessels in diabetic patients?
What is the main cause of gestational diabetes?
What is the main cause of gestational diabetes?
What are the treatment options for acute hypocalcemia?
What are the treatment options for acute hypocalcemia?
What is the response of insulin secretion during a hypoglycemic event?
What is the response of insulin secretion during a hypoglycemic event?
Match the following conditions with their typical features:
Match the following conditions with their typical features:
What potential complications should a pregnant woman with gestational diabetes be aware of?
What potential complications should a pregnant woman with gestational diabetes be aware of?
What non-pharmacological management strategies can be recommended for gestational diabetes?
What non-pharmacological management strategies can be recommended for gestational diabetes?
When is pharmacological treatment indicated for gestational diabetes, and what is commonly used?
When is pharmacological treatment indicated for gestational diabetes, and what is commonly used?
What condition might a 63-year-old woman on long-term glucocorticoid therapy be developing?
What condition might a 63-year-old woman on long-term glucocorticoid therapy be developing?
How do glucocorticoids contribute to hyperglycemia?
How do glucocorticoids contribute to hyperglycemia?
What management options are available for steroid-induced hyperglycemia?
What management options are available for steroid-induced hyperglycemia?
What is the likely diagnosis for a 34-year-old male with signs of insulin resistance and elevated fasting blood glucose?
What is the likely diagnosis for a 34-year-old male with signs of insulin resistance and elevated fasting blood glucose?
What initial pharmacological treatment should be considered for a patient with type 2 diabetes and metabolic syndrome?
What initial pharmacological treatment should be considered for a patient with type 2 diabetes and metabolic syndrome?
What non-pharmacological measures can improve insulin resistance?
What non-pharmacological measures can improve insulin resistance?
What condition might indicate impaired glucose tolerance (IGT) in a 45-year-old woman with episodic fatigue and elevated postprandial levels?
What condition might indicate impaired glucose tolerance (IGT) in a 45-year-old woman with episodic fatigue and elevated postprandial levels?
What tests should be conducted to confirm the diagnosis of IGT?
What tests should be conducted to confirm the diagnosis of IGT?
What management strategies would be effective for someone with impaired glucose tolerance?
What management strategies would be effective for someone with impaired glucose tolerance?
What is the most likely underlying condition for a patient with polyuria, increased thirst, and significant weight loss?
What is the most likely underlying condition for a patient with polyuria, increased thirst, and significant weight loss?
What is indicative of the skin findings in a 40-year-old male with significant insulin resistance?
What is indicative of the skin findings in a 40-year-old male with significant insulin resistance?
What pharmacological management plan should be outlined for a patient with uncontrolled type 2 diabetes?
What pharmacological management plan should be outlined for a patient with uncontrolled type 2 diabetes?
Which metabolic pathway is upregulated during prolonged fasting to maintain blood glucose levels?
Which metabolic pathway is upregulated during prolonged fasting to maintain blood glucose levels?
Which enzyme's activity is directly inhibited by metformin to reduce hepatic gluconeogenesis?
Which enzyme's activity is directly inhibited by metformin to reduce hepatic gluconeogenesis?
Which of the following is the primary glucocorticoid in the human body?
Which of the following is the primary glucocorticoid in the human body?
Which class of antidiabetic drugs mimics the action of incretin hormones to increase insulin secretion?
Which class of antidiabetic drugs mimics the action of incretin hormones to increase insulin secretion?
What is the primary reason for including dietary fiber in the management plan for diabetes?
What is the primary reason for including dietary fiber in the management plan for diabetes?
Which hormone is responsible for promoting ketogenesis during prolonged fasting?
Which hormone is responsible for promoting ketogenesis during prolonged fasting?
Which condition is commonly associated with insulin resistance and hyperinsulinemia?
Which condition is commonly associated with insulin resistance and hyperinsulinemia?
Which glucose transporter mediates glucose uptake in pancreatic β-cells?
Which glucose transporter mediates glucose uptake in pancreatic β-cells?
What is a common side effect of thiazolidinediones (e.g., pioglitazone)?
What is a common side effect of thiazolidinediones (e.g., pioglitazone)?
Which statement about metformin is NOT correct?
Which statement about metformin is NOT correct?
What is the most common cause of secondary hyperparathyroidism?
What is the most common cause of secondary hyperparathyroidism?
Match the following conditions with their descriptions:
Match the following conditions with their descriptions:
Which statement regarding the structure of the male perineum is NOT correct?
Which statement regarding the structure of the male perineum is NOT correct?
Which statement about the female reproductive histology is NOT correct?
Which statement about the female reproductive histology is NOT correct?
Which statement regarding the development of the reproductive tract is NOT correct?
Which statement regarding the development of the reproductive tract is NOT correct?
Which statement about the male reproductive anatomy is NOT correct?
Which statement about the male reproductive anatomy is NOT correct?
Which statement regarding the embryological development of the gonads is NOT correct?
Which statement regarding the embryological development of the gonads is NOT correct?
Which statement about the pelvic diaphragm is NOT correct?
Which statement about the pelvic diaphragm is NOT correct?
Which statement regarding the histology of the ovary is NOT correct?
Which statement regarding the histology of the ovary is NOT correct?
Which statement about the perineal body is NOT correct?
Which statement about the perineal body is NOT correct?
Which statement regarding the development of the external genitalia is NOT correct?
Which statement regarding the development of the external genitalia is NOT correct?
Which statement about Sertoli cells is NOT correct?
Which statement about Sertoli cells is NOT correct?
Discuss the development of the male and female reproductive tracts.
Discuss the development of the male and female reproductive tracts.
Compare the histological features of the male and female gonads.
Compare the histological features of the male and female gonads.
Explain the formation and role of the perineal body in the pelvis.
Explain the formation and role of the perineal body in the pelvis.
Describe the role of Sertoli and Leydig cells in the testes.
Describe the role of Sertoli and Leydig cells in the testes.
Compare the structural and functional differences between the male and female perineum.
Compare the structural and functional differences between the male and female perineum.
Discuss the embryological development of external genitalia.
Discuss the embryological development of external genitalia.
Explain the structural differences and functions of the tunica albuginea in the male and female reproductive systems.
Explain the structural differences and functions of the tunica albuginea in the male and female reproductive systems.
Describe the hormonal regulation of the menstrual cycle.
Describe the hormonal regulation of the menstrual cycle.
Discuss the formation of the uterine tubes during embryological development.
Discuss the formation of the uterine tubes during embryological development.
Describe the anatomy and significance of the pelvic diaphragm.
Describe the anatomy and significance of the pelvic diaphragm.
What is the most likely diagnosis for the 28-year-old woman with pelvic pain and an ovarian cyst?
What is the most likely diagnosis for the 28-year-old woman with pelvic pain and an ovarian cyst?
What hormonal assessments should be performed for the 35-year-old male with infertility?
What hormonal assessments should be performed for the 35-year-old male with infertility?
What anatomical structure is most likely weakened in the 42-year-old woman with pelvic floor dysfunction?
What anatomical structure is most likely weakened in the 42-year-old woman with pelvic floor dysfunction?
What is the most likely diagnosis for the 22-year-old male with a painless scrotal mass?
What is the most likely diagnosis for the 22-year-old male with a painless scrotal mass?
What hormonal change is most likely responsible for the symptoms in the 50-year-old postmenopausal woman?
What hormonal change is most likely responsible for the symptoms in the 50-year-old postmenopausal woman?
What is the likely diagnosis for the pregnant woman with an abnormal mass adjacent to the fetus?
What is the likely diagnosis for the pregnant woman with an abnormal mass adjacent to the fetus?
What is the differential diagnosis for a 29-year-old male with haematospermia?
What is the differential diagnosis for a 29-year-old male with haematospermia?
What is a major side effect associated with the chronic use of thiazolidinediones (e.g., pioglitazone)?
What is a major side effect associated with the chronic use of thiazolidinediones (e.g., pioglitazone)?
Which statement regarding the pathophysiology of Type 1 diabetes is NOT correct?
Which statement regarding the pathophysiology of Type 1 diabetes is NOT correct?
Which statement about PTH function is NOT correct?
Which statement about PTH function is NOT correct?
Which statement regarding the effects of insulin is NOT correct?
Which statement regarding the effects of insulin is NOT correct?
Which statement about glucocorticoids is NOT correct?
Which statement about glucocorticoids is NOT correct?
Which statement about metformin is NOT correct?
Which statement about metformin is NOT correct?
Which statement about vitamin D metabolism is NOT correct?
Which statement about vitamin D metabolism is NOT correct?
Which statement about the role of GLP-1 in glucose regulation is NOT correct?
Which statement about the role of GLP-1 in glucose regulation is NOT correct?
Which statement about insulin secretion is NOT correct?
Which statement about insulin secretion is NOT correct?
Which statement about the hormonal changes during the fasting state is NOT correct?
Which statement about the hormonal changes during the fasting state is NOT correct?
Which statement about diabetic nephropathy is NOT correct?
Which statement about diabetic nephropathy is NOT correct?
Which enzyme is the rate-limiting step of glycolysis and is activated by insulin?
Which enzyme is the rate-limiting step of glycolysis and is activated by insulin?
What metabolic shift occurs in the liver during prolonged fasting to maintain blood glucose levels?
What metabolic shift occurs in the liver during prolonged fasting to maintain blood glucose levels?
Which intermediate of the TCA cycle is also an important substrate for gluconeogenesis?
Which intermediate of the TCA cycle is also an important substrate for gluconeogenesis?
Which enzyme is responsible for converting pyruvate to oxaloacetate in the first step of gluconeogenesis?
Which enzyme is responsible for converting pyruvate to oxaloacetate in the first step of gluconeogenesis?
What role does AMP-activated protein kinase (AMPK) play in metabolic regulation?
What role does AMP-activated protein kinase (AMPK) play in metabolic regulation?
Which of the following molecules acts as a feedback inhibitor of hexokinase in glycolysis?
Which of the following molecules acts as a feedback inhibitor of hexokinase in glycolysis?
What enzyme catalyzes the conversion of fructose-1,6-bisphosphate to fructose-6-phosphate in gluconeogenesis?
What enzyme catalyzes the conversion of fructose-1,6-bisphosphate to fructose-6-phosphate in gluconeogenesis?
Which molecule is an allosteric activator of pyruvate carboxylase, promoting gluconeogenesis?
Which molecule is an allosteric activator of pyruvate carboxylase, promoting gluconeogenesis?
What is the function of glucose-6-phosphatase in gluconeogenesis?
What is the function of glucose-6-phosphatase in gluconeogenesis?
Which enzyme in the liver is responsible for trapping glucose by phosphorylation, but is not subject to feedback inhibition by its product?
Which enzyme in the liver is responsible for trapping glucose by phosphorylation, but is not subject to feedback inhibition by its product?
Which of the following best describes the biochemical basis of insulin resistance in type 2 diabetes?
Which of the following best describes the biochemical basis of insulin resistance in type 2 diabetes?
What is the primary metabolic change during the fed state that supports glucose storage?
What is the primary metabolic change during the fed state that supports glucose storage?
Which of the following enzymes is activated by insulin to promote glycolysis in the liver?
Which of the following enzymes is activated by insulin to promote glycolysis in the liver?
Which pathway is upregulated in the liver to maintain blood glucose levels during prolonged fasting?
Which pathway is upregulated in the liver to maintain blood glucose levels during prolonged fasting?
Which drug is first-line therapy for type 2 diabetes due to its ability to reduce hepatic gluconeogenesis?
Which drug is first-line therapy for type 2 diabetes due to its ability to reduce hepatic gluconeogenesis?
What is the main consequence of chronic hyperglycemia on blood vessels in diabetic patients?
What is the main consequence of chronic hyperglycemia on blood vessels in diabetic patients?
What is the primary mechanism of action for SGLT2 inhibitors in managing hyperglycemia?
What is the primary mechanism of action for SGLT2 inhibitors in managing hyperglycemia?
Which enzyme in the liver catalyzes the final step of gluconeogenesis, allowing glucose to be released into the bloodstream?
Which enzyme in the liver catalyzes the final step of gluconeogenesis, allowing glucose to be released into the bloodstream?
Which glucose transporter is insulin-sensitive and primarily found in adipose tissue and skeletal muscle?
Which glucose transporter is insulin-sensitive and primarily found in adipose tissue and skeletal muscle?
What is the role of AMP-activated protein kinase (AMPK) in muscle cells under low-energy conditions?
What is the role of AMP-activated protein kinase (AMPK) in muscle cells under low-energy conditions?
Which of the following hormones counteracts the action of insulin by increasing blood glucose levels?
Which of the following hormones counteracts the action of insulin by increasing blood glucose levels?
Which hormone inhibits glycogenesis and promotes glycogenolysis in response to low blood glucose levels?
Which hormone inhibits glycogenesis and promotes glycogenolysis in response to low blood glucose levels?
What metabolic adaptation occurs in the liver during prolonged fasting to conserve glucose for the brain?
What metabolic adaptation occurs in the liver during prolonged fasting to conserve glucose for the brain?
What is the main side effect associated with long-term use of systemic glucocorticoids?
What is the main side effect associated with long-term use of systemic glucocorticoids?
Which of the following accurately describes the role of glucocorticoids in metabolism?
Which of the following accurately describes the role of glucocorticoids in metabolism?
Which enzyme's activity is inhibited by insulin in order to reduce gluconeogenesis in the liver?
Which enzyme's activity is inhibited by insulin in order to reduce gluconeogenesis in the liver?
Which enzyme is inhibited by metformin to decrease gluconeogenesis in the liver?
Which enzyme is inhibited by metformin to decrease gluconeogenesis in the liver?
What is the biochemical role of glucokinase in the liver during the fed state?
What is the biochemical role of glucokinase in the liver during the fed state?
What is a notable side effect of SGLT2 inhibitors?
What is a notable side effect of SGLT2 inhibitors?
Which structure serves as the functional unit for spermatogenesis in the male reproductive tract?
Which structure serves as the functional unit for spermatogenesis in the male reproductive tract?
During which developmental week do the primordial germ cells migrate into the dorsal body wall mesenchyme?
During which developmental week do the primordial germ cells migrate into the dorsal body wall mesenchyme?
Which of the following is true regarding the mechanism of glucocorticoids?
Which of the following is true regarding the mechanism of glucocorticoids?
Which statement about insulin's role in metabolism is NOT correct?
Which statement about insulin's role in metabolism is NOT correct?
What is the primary hormone responsible for inducing mesonephric duct development in the male embryo?
What is the primary hormone responsible for inducing mesonephric duct development in the male embryo?
Which statement regarding glucocorticoids is NOT correct?
Which statement regarding glucocorticoids is NOT correct?
Which ligament in females represents the remnant of the gubernaculum?
Which ligament in females represents the remnant of the gubernaculum?
The clitoris and the penis develop from which embryonic structure?
The clitoris and the penis develop from which embryonic structure?
Which statement about SGLT2 inhibitors is NOT correct?
Which statement about SGLT2 inhibitors is NOT correct?
Which statement about metformin is NOT correct?
Which statement about metformin is NOT correct?
Which type of epithelium lines the vagina, enabling its protective function?
Which type of epithelium lines the vagina, enabling its protective function?
Which statement regarding type 1 diabetes is NOT correct?
Which statement regarding type 1 diabetes is NOT correct?
What tissue structure provides mechanical support to the testes and encloses the seminiferous tubules?
What tissue structure provides mechanical support to the testes and encloses the seminiferous tubules?
Which statement about glucagon's role in metabolism is NOT correct?
Which statement about glucagon's role in metabolism is NOT correct?
In the male, which embryonic structure gives rise to the vas deferens?
In the male, which embryonic structure gives rise to the vas deferens?
The ampulla of the uterine tube is most notable for which reproductive function?
The ampulla of the uterine tube is most notable for which reproductive function?
Which statement about the action of insulin on lipid metabolism is NOT correct?
Which statement about the action of insulin on lipid metabolism is NOT correct?
Which cells within the seminiferous tubules provide nourishment to developing spermatozoa?
Which cells within the seminiferous tubules provide nourishment to developing spermatozoa?
Which statement about the GLUT4 transporter is NOT correct?
Which statement about the GLUT4 transporter is NOT correct?
Which statement regarding glucocorticoid therapy is NOT correct?
Which statement regarding glucocorticoid therapy is NOT correct?
What structure marks the boundary between the urogenital and anal triangles in the perineum?
What structure marks the boundary between the urogenital and anal triangles in the perineum?
Which statement about the mechanism of metformin is NOT correct?
Which statement about the mechanism of metformin is NOT correct?
Which component of the female reproductive system remains open to the peritoneal cavity, enabling ectopic pregnancies?
Which component of the female reproductive system remains open to the peritoneal cavity, enabling ectopic pregnancies?
What muscle within the male perineum aids in the expulsion of semen and residual urine?
What muscle within the male perineum aids in the expulsion of semen and residual urine?
Discuss the regulation of blood glucose levels during the fed state: What hormones are primarily involved during the fed state?
Discuss the regulation of blood glucose levels during the fed state: What hormones are primarily involved during the fed state?
Discuss the regulation of blood glucose levels during the fed state: How does insulin promote glucose uptake in muscle and adipose tissue?
Discuss the regulation of blood glucose levels during the fed state: How does insulin promote glucose uptake in muscle and adipose tissue?
Which structure is homologous to the male bulbourethral glands in females?
Which structure is homologous to the male bulbourethral glands in females?
Which structure anchors the ovaries and connects them to the uterus?
Which structure anchors the ovaries and connects them to the uterus?
Discuss the regulation of blood glucose levels during the fed state: Which metabolic pathways are activated in the liver?
Discuss the regulation of blood glucose levels during the fed state: Which metabolic pathways are activated in the liver?
Compare the mechanisms of action between insulin and glucagon: How does insulin affect glycogen synthesis in the liver?
Compare the mechanisms of action between insulin and glucagon: How does insulin affect glycogen synthesis in the liver?
Compare the mechanisms of action between insulin and glucagon: What is glucagon’s role in gluconeogenesis?
Compare the mechanisms of action between insulin and glucagon: What is glucagon’s role in gluconeogenesis?
Compare the mechanisms of action between insulin and glucagon: How do these hormones interact to maintain blood glucose homeostasis?
Compare the mechanisms of action between insulin and glucagon: How do these hormones interact to maintain blood glucose homeostasis?
Analyze the pathophysiological basis of type 2 diabetes: What are the primary defects in type 2 diabetes?
Analyze the pathophysiological basis of type 2 diabetes: What are the primary defects in type 2 diabetes?
Analyze the pathophysiological basis of type 2 diabetes: How does insulin resistance develop at the cellular level?
Analyze the pathophysiological basis of type 2 diabetes: How does insulin resistance develop at the cellular level?
Analyze the pathophysiological basis of type 2 diabetes: What long-term complications are associated with poor glycemic control?
Analyze the pathophysiological basis of type 2 diabetes: What long-term complications are associated with poor glycemic control?
Discuss the effects and therapeutic uses of glucocorticoids: What are the main metabolic effects of glucocorticoids?
Discuss the effects and therapeutic uses of glucocorticoids: What are the main metabolic effects of glucocorticoids?
Discuss the effects and therapeutic uses of glucocorticoids: In what clinical scenarios are glucocorticoids used?
Discuss the effects and therapeutic uses of glucocorticoids: In what clinical scenarios are glucocorticoids used?
Discuss the effects and therapeutic uses of glucocorticoids: What are potential side effects of long-term glucocorticoid therapy?
Discuss the effects and therapeutic uses of glucocorticoids: What are potential side effects of long-term glucocorticoid therapy?
Explain the role of metformin in the management of type 2 diabetes: What is the primary mechanism of action of metformin?
Explain the role of metformin in the management of type 2 diabetes: What is the primary mechanism of action of metformin?
Explain the role of metformin in the management of type 2 diabetes: How does metformin impact weight?
Explain the role of metformin in the management of type 2 diabetes: How does metformin impact weight?
Explain the role of metformin in the management of type 2 diabetes: What are contraindications for metformin use?
Explain the role of metformin in the management of type 2 diabetes: What are contraindications for metformin use?
Discuss the role of SGLT2 inhibitors in diabetes management: What is the mechanism of action of SGLT2 inhibitors?
Discuss the role of SGLT2 inhibitors in diabetes management: What is the mechanism of action of SGLT2 inhibitors?
Discuss the role of SGLT2 inhibitors in diabetes management: What are the benefits of using SGLT2 inhibitors in type 2 diabetes patients?
Discuss the role of SGLT2 inhibitors in diabetes management: What are the benefits of using SGLT2 inhibitors in type 2 diabetes patients?
Discuss the role of SGLT2 inhibitors in diabetes management: What are the potential side effects?
Discuss the role of SGLT2 inhibitors in diabetes management: What are the potential side effects?
Analyze how the feed-fast cycle regulates metabolism: What changes occur in hormone levels during the fasting state?
Analyze how the feed-fast cycle regulates metabolism: What changes occur in hormone levels during the fasting state?
Analyze how the feed-fast cycle regulates metabolism: How is gluconeogenesis regulated during prolonged fasting?
Analyze how the feed-fast cycle regulates metabolism: How is gluconeogenesis regulated during prolonged fasting?
Analyze how the feed-fast cycle regulates metabolism: What adaptations in metabolism occur during starvation?
Analyze how the feed-fast cycle regulates metabolism: What adaptations in metabolism occur during starvation?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: How do sulfonylureas stimulate insulin secretion?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: How do sulfonylureas stimulate insulin secretion?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What is the mechanism of action of DPP-4 inhibitors?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What is the mechanism of action of DPP-4 inhibitors?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What are the main differences in their side effect profiles?
Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What are the main differences in their side effect profiles?
Describe the regulation and impact of glucagon in the fasting state: How does glucagon stimulate gluconeogenesis?
Describe the regulation and impact of glucagon in the fasting state: How does glucagon stimulate gluconeogenesis?
Describe the regulation and impact of glucagon in the fasting state: What is its effect on glycogenolysis?
Describe the regulation and impact of glucagon in the fasting state: What is its effect on glycogenolysis?
Describe the regulation and impact of glucagon in the fasting state: How does prolonged glucagon release affect muscle protein?
Describe the regulation and impact of glucagon in the fasting state: How does prolonged glucagon release affect muscle protein?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the main pathophysiological mechanism behind type 1 diabetes?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the main pathophysiological mechanism behind type 1 diabetes?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What are common clinical signs at presentation?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What are common clinical signs at presentation?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the cornerstone of treatment for type 1 diabetes?
Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the cornerstone of treatment for type 1 diabetes?
Case 1: A 25-year-old woman presents with increased thirst, frequent urination, and unintentional weight loss over the past month. What is the most likely diagnosis?
Case 1: A 25-year-old woman presents with increased thirst, frequent urination, and unintentional weight loss over the past month. What is the most likely diagnosis?
Case 1: What initial laboratory tests should be performed?
Case 1: What initial laboratory tests should be performed?
Case 1: What is the primary treatment plan if the diagnosis is confirmed?
Case 1: What is the primary treatment plan if the diagnosis is confirmed?
Case 2: A 58-year-old man with a history of type 2 diabetes presents with polyuria and polydipsia. What additional class of diabetes medication could be considered?
Case 2: A 58-year-old man with a history of type 2 diabetes presents with polyuria and polydipsia. What additional class of diabetes medication could be considered?
Case 2: What factors should be considered when selecting this therapy?
Case 2: What factors should be considered when selecting this therapy?
Case 2: What are potential side effects of the chosen medication?
Case 2: What are potential side effects of the chosen medication?
Case 3: A 42-year-old woman presents with moon face, central obesity, and purple striae on her abdomen. What is the most likely diagnosis?
Case 3: A 42-year-old woman presents with moon face, central obesity, and purple striae on her abdomen. What is the most likely diagnosis?
Case 3: What is the pathophysiology behind this condition?
Case 3: What is the pathophysiology behind this condition?
Case 3: What management strategies should be considered to mitigate the side effects?
Case 3: What management strategies should be considered to mitigate the side effects?
Case 4: A 35-year-old male presents with fasting hyperglycemia despite being on glibenclamide for type 2 diabetes. What complication might this patient be experiencing?
Case 4: A 35-year-old male presents with fasting hyperglycemia despite being on glibenclamide for type 2 diabetes. What complication might this patient be experiencing?
Case 4: How should his medication regimen be adjusted?
Case 4: How should his medication regimen be adjusted?
Case 4: What alternative medication could reduce the risk of this complication?
Case 4: What alternative medication could reduce the risk of this complication?
Case 5: A 50-year-old man with obesity and a BMI of 35 presents with newly diagnosed type 2 diabetes. What initial treatment should be considered?
Case 5: A 50-year-old man with obesity and a BMI of 35 presents with newly diagnosed type 2 diabetes. What initial treatment should be considered?
Flashcards
Mesonephric duct
Mesonephric duct
The mesonephric duct gives rise to the male reproductive system, including the epididymis, vas deferens, and seminal vesicles.
Paramesonephric duct
Paramesonephric duct
The paramesonephric duct forms the female reproductive system, including the fallopian tubes, uterus, and upper vagina.
Anti-Müllerian Hormone (AMH)
Anti-Müllerian Hormone (AMH)
Hormone secreted by Sertoli cells in the testes that causes regression of the paramesonephric duct in males.
Ovarian follicle
Ovarian follicle
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Germinal epithelium
Germinal epithelium
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Sertoli cells
Sertoli cells
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Granulosa cells
Granulosa cells
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Pelvic diaphragm
Pelvic diaphragm
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Spermatogenesis
Spermatogenesis
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Spermatogonia
Spermatogonia
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Meiosis in spermatogenesis
Meiosis in spermatogenesis
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Primary spermatocytes
Primary spermatocytes
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Secondary spermatocytes
Secondary spermatocytes
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Spermatids
Spermatids
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Spermatozoa
Spermatozoa
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Inhibin
Inhibin
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Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone (FSH)
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Luteinizing hormone (LH)
Luteinizing hormone (LH)
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Progesterone
Progesterone
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Pampiniform plexus
Pampiniform plexus
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Endometrium
Endometrium
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Myometrium
Myometrium
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Perimetrium
Perimetrium
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Cardinal ligament
Cardinal ligament
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Uterosacral ligament
Uterosacral ligament
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Round ligament
Round ligament
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Gonadotropin-releasing hormone (GnRH)
Gonadotropin-releasing hormone (GnRH)
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Lactiferous ducts
Lactiferous ducts
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Lactiferous sinuses
Lactiferous sinuses
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Study Notes
Syphilis
- Primary syphilis is marked by a single, painless chancre with raised edges.
- Secondary syphilis is characterized by fever, lymphadenopathy, rash, and condyloma lata.
- Tertiary syphilis can lead to neurosyphilis, which can manifest as general paresis of the insane or tabes dorsalis.
- Neurosyphilis involves the central nervous system and the brain.
- Gummas are seen in tertiary syphilis but not secondary syphilis.
### Congenital Rubella Syndrome (CRS)
- CRS is caused by rubella virus infection during pregnancy
- CRS can lead to congenital heart defects, deafness, and other developmental problems.
- The risk of CRS is highest during the first trimester of pregnancy
- MMR vaccination is recommended prior to pregnancy to prevent CRS
Listeria monocytogenes
- Listeria monocytogenes can be found in soft cheeses, unpasteurized milk, and deli meats.
- Granulomatosis infantiseptica is rare but serious condition with widespread microabscesses and granulomas
- Pregnant women with Listeria infection face a risk of miscarriage, stillbirth, or neonatal sepsis.
Herpes Simplex Encephalitis (HSE)
- HSE is caused by HSV-1 and is linked to high mortality (70%) without treatment.
- It typically affects the frontal and temporal lobes.
Streptococcus pyogenes
- Skin infections caused by S.pyogenes can lead to cellulitis and necrotizing fasciitis.
- Rheumatic fever is an autoimmune response that can cause polyarthritis, carditis, and other complications.
- Post-streptococcal glomerulonephritis can present with dark urine and edema.
- Scarlet fever is characterized by a “strawberry tongue” followed by desquamation.
Parvovirus B19 Infection
- Parvovirus B19 commonly presents as erythema infectiosum with a "Slapped cheek" rash.
- It can cause aplastic crisis in patients with hemolytic disorders.
- Parvovirus B19 can cause hydrops fetalis during pregnancy by attacking red blood cells.
Cytomegalovirus (CMV) Infection
- CMV can cause serious complications like retinitis in immunocompromised individuals.
- Congenital CMV can lead to deafness, mental retardation, and other neurological issues.
- In healthy adults, CMV infection presents as a mononucleosis-like syndrome.
Measles
- Coryza is a early symptom of measles, along with other cold-like signs like cough and fever.
- Koplik spots are pathognomonic for measles, appearing before the rash.
- Complications of measles include pneumonia and encephalitis
Diphtheria
- Diphtheria is caused by Corynebacterium diphtheriae, which produces a potent exotoxin.
- Myocarditis is a potential cardiac complication of diphtheria.
- Diphtheritic pharyngitis can cause obstruction due to a thick, white, adherent membrane.
Varicella-zoster Virus (VZV)
- Chickenpox is a primary infection with VZV, and it presents with rash that starts the trunk and spreads centrifugally.
- Shingles is caused by reactivation of latent VZV, with painful vesicular rash following a dermatome.
- Postherpetic neuralgia is a serious complication of shingles.
Mumps Infection
- Mumps affects the parotid gland, causing swelling and inflammation.
- Mumps can cause orchitis in post-pubertal males.
- It can also result in aseptic meningitis.
Neonatal Herpes Simplex Infection
- Neonatal HSV infection transmission occurs during birth through an infected birth canal.
- It can cause multi-organ disease with possible encephalitis.
- HSV-2 is commonly implicated in neonatal infection.
Rubella Infection
- Rubella is transmitted by respiratory droplets.
- If infection occurs during the first trimester of pregnancy, there is a 90% chance of developing CRS.
- Rubella immunity is typically achieved through MMR vaccination
Group B Streptococcus (GBS)
- GBS can cause postpartum maternal sepsis and early-onset neonatal sepsis.
- Early-onset neonatal GBS disease happens within the first 7 days of life
- Maternal GBS carriage is screened for with rectovaginal swabs at 35–37 weeks of pregnancy
Kaposi’s Sarcoma-associated Herpesvirus (KSHV)
- KSHV is a member of the herpesviridae family.
- People with HIV are at higher risk for Kaposi's sarcoma.
- Kaposi's sarcoma presents with vascular tumor-like lesions.
Post-streptococcal Glomerulonephritis (PSGN)
- Nephritogenic strains of S.pyogenes cause PSGN.
- PSGN can cause dark urine, edema, hypertension, and other complications.
- PSGN is more common in Australian Aboriginal communities.
Herpes Zoster (Shingles)
- Shingles is caused by reactivation of latent VZV.
- Reactivation of the virus is triggered by immune suppression.
- Postherpetic neuralgia is more common in individuals over 60 years old.
- Shingles presents as a painful vesicular rash along a dermatome.
Non-Suppurative Complications of Streptococcus pyogenes
- Rheumatic fever involves an autoimmune response.
- PSGN is diagnosed based on hematuria and dark urine.
Actinomycosis
- Cervicofacial actinomycosis is the most common type.
- Actinomycosis can mimic malignancy.
- It is characterized by draining sinus tracts.
Congenital Cytomegalovirus Infection
- Primary maternal infection during pregnancy is a major risk factor.
- Congenital CMV can result in microcephaly or hearing loss at birth.
Case 1: Pregnant Woman with Rubella Exposure
- A rubella IgG and IgM serology test should be conducted to determine the patient's immune status.
- If the pregnant woman is infected during the first trimester, there is a risk of CRS
Case 2: Man Presenting with Shingles
- The most likely diagnosis is herpes zoster.
- The man should be monitored for postherpetic neuralgia, which can cause chronic pain even after the acute phase has passed.
Case 3: Neonate with Respiratory Distress
- Early-onset neonatal sepsis should be suspected.
- The neonate should be immediately started on empirical antibiotic therapy.
Case 4: Woman with Miscarriages and Fever
- Listeria monocytogenes should be suspected as a potential cause of the woman's symptoms.
- If she is infected with Listeria, there is a risk of miscarriage, stillbirth, or neonatal sepsis in her current pregnancy.
Maternal Blood Volume Changes
- Increases by 50-100% during pregnancy
- Leads to increased RBC production (up to 40%)
- Plasma volume expansion causes a decrease in hematocrit
The First Stage of Labour
- Begins with regular, painful contractions
- Ends when the cervix is fully dilated (10cm)
- Includes the latent and active phases
- Cervical dilation in the active phase typically progresses at 1cm per hour
Endocrine Changes in Pregnancy
- Pituitary gland enlarges
- Thyroid gland increases in size
- TBG levels double during pregnancy
- Total T3 and T4 levels increase, but free T3 and T4 remain the same
Cardiovascular Adaptations
- Heart rate increases by 15-20 bpm
- Cardiac output increases by up to 50%
- Systemic vascular resistance decreases
- Blood pressure usually decreases in the first trimester, lowest in the second trimester
Cervical Changes During Pregnancy
- The cervix is generally soft and malleable during pregnancy
- Cervical dilation is complete at 10cm
- Mucus plug protects against infection
- The process of effacement refers to the shortening and thinning of the cervix
Immune Changes in Pregnancy
- Humoral immunity becomes dominant
- Cellular immunity decreases, leading to increased susceptibility to infections
- Pregnancy involves a shift to a more tolerant immune state
Maternal Respiratory Changes
- Tidal volume increases
- Minute ventilation increases
- Residual volume decreases
- Respiratory rate typically remains stable
Gastrointestinal Changes
- Motility slows down due to hormones
- Stomach emptying time is delayed
- Increased risk of gastroesophageal reflux
- Gastric acidity decreases
Hematologic Changes in Pregnancy
- White blood cell count increases
- Fibrinogen and clotting factors increase
- Hematocrit levels decrease, due to plasma volume expanding more than RBC production
- Pregnancy is considered a hypercoagulable state
Urinary System Changes
- Renal blood flow increases
- Ureteral dilation is common
- Glycosuria can be a normal finding
- Urinary output is adequate, but frequency may increase due to fluid retention
Stages of Labour
- The first stage includes the latent and active phases
- The first stage ends when the cervix is fully dilated
- The second stage begins after full cervical dilation
- The third stage involves expulsion of the placenta
Breast Changes during Pregnancy
- Breast size increases due to hormonal stimulation
- Pigmentation of the nipple and areola increases
- Areolar glands, such as Montgomery tubercles, enlarge
- Colostrum production begins around 16 weeks
Estrogen and Breast Cancer
- Prolonged exposure to estrogen increases the risk of breast cancer
- Early menarche and late menopause increase the risk due to extended estrogen exposure
Pregnancy and Drug Safety
- Valproate is associated with congenital abnormalities, including spina bifida, making it contraindicated during pregnancy
SERMs and Breast Cancer
- Selective estrogen receptor modulators (SERMs), like tamoxifen, act as anti-estrogens in breast tissue
- They block the proliferative effects of estrogen on ER-positive cancer cells
SSRIs in Pregnancy
- Paroxetine, an SSRI, is associated with a higher risk of congenital abnormalities, particularly cardiac defects, especially in the first trimester
Consanguinity and Genetic Disorders
- Consanguineous relationships (closely related individuals) increase the chance of autosomal recessive disorders
- Shared genetic variants increase the probability of offspring inheriting two copies of a recessive gene, leading to the disorder
Hormone Therapy (HT) in Postmenopausal Women
- Combined HT, consisting of estrogen and progestogen, increases the risk of breast cancer compared to estrogen-only therapy.
- HT is effective in maintaining bone density and reducing the risk of fractures.
- Estrogen alone is not used in women with a uterus, as progestogen is needed to prevent endometrial hyperplasia.
- Transdermal estrogen administration has fewer effects on coagulation than oral estrogen.
Risks and Benefits of Medications in Pregnancy
- ACE inhibitors are associated with severe fetal effects, including renal failure and fetal death.
- Paroxetine, an SSRI, is associated with an increased risk of congenital heart defects during the first trimester.
- SSRIs can lead to neonatal withdrawal syndrome if used during late pregnancy.
- Most SSRIs are classified as Category C drugs during pregnancy, suggesting potential risks.
- High-dose aspirin is avoided in the third trimester due to risks like premature closure of the ductus arteriosus.
- NSAIDs are generally avoided in the third trimester due to risks like premature closure of the ductus arteriosus and persistent pulmonary hypertension in the neonate.
- Paracetamol is considered safe to use throughout pregnancy.
- Metformin is used safely during pregnancy.
Genetics and Reproductive Risks
- When one parent is a carrier for an autosomal recessive disorder and the other parent is not tested but has a population risk of 1 in 40, the risk for having an affected child is 1 in 99,200.
- Carrier screening primarily identifies autosomal recessive and X-linked disorders.
- Both partners need to be carriers for autosomal recessive disorders to pose a risk to their offspring.
Breast Cancer Therapy
- Tamoxifen acts as an estrogen receptor antagonist in breast tissue, preventing the proliferation of breast ductal cells.
- Tamoxifen increases the risk of endometrial cancer in postmenopausal women.
- Aromatase inhibitors block the production of estrogen by inhibiting its synthesis.
- Aromatase inhibitors are used primarily in postmenopausal women.
Menopause
- Menopause is defined as occurring 12 months after the last menstrual period.
- The diagnosis of menopause is clinical and doesn’t usually require routine blood tests for FSH and LH.
- Perimenopause can last up to a decade.
Selective Estrogen Receptor Modulators (SERMs)
- SERMs like tamoxifen can act as agonists in bone tissue.
- Raloxifene is used primarily for osteoporosis prevention.
- Tamoxifen can increase the risk of endometrial cancer.
Estrogen Receptor (ER) Activity
- ERα activation is critical for the proliferation of breast ductal cells.
- ERβ generally acts as a suppressor in breast cancer.
- Both ERα and ERβ play roles in bone health, with ERβ helping to modulate ERα's activity.
Pharmacokinetics in Pregnancy
- Increased renal blood flow enhances the clearance of certain drugs during pregnancy.
- Plasma protein binding decreases during pregnancy due to reduced albumin levels.
- Hepatic metabolism can be increased during pregnancy due to hormonal changes.
- Gastrointestinal motility is reduced, affecting drug absorption.
Pharmacological Approaches for ER-Positive Breast Cancer
- Aromatase inhibitors decrease estrogen production.
- Aromatase inhibitors are associated with an increased risk of osteoporosis but provide a survival benefit in postmenopausal ER-positive breast cancer.
Genetic Carrier Screening
- Autosomal dominant disorders are not usually identified through carrier screening.
- Carriers typically do not show symptoms of the disorder.
- Screening can inform reproductive decision-making.
Balanced Translocations
- A Robertsonian translocation involves the fusion of two acrocentric chromosomes.
- Balanced translocations can lead to recurrent miscarriages due to unbalanced gametes during meiosis.
- Karyotyping is used to detect translocations.
Clinical Case Summaries
- Tamoxifen can be considered for breast cancer prevention in premenopausal women with a family history of ER-positive breast cancer.
- Tamoxifen's major side effect to monitor is an increased risk of venous thromboembolism (VTE).
- Raloxifene is a selective estrogen receptor modulator (SERM) that can help preserve bone density in postmenopausal women with osteoporosis.
- Raloxifene’s side effects include an increased risk of VTE.
- Balanced translocations in a male partner can contribute to multiple recurrent first-trimester miscarriages.
- Potential reproductive options for couples with balanced translocations include preimplantation genetic testing (PGT) with IVF.
- Pulmonary embolism (PE) is a serious complication in pregnant women.
- Immediate confirmation of PE is done through CT pulmonary angiography or a ventilation-perfusion (V/Q) scan and is treated with anticoagulation therapy.
- Transdermal estrogen is considered safer than oral formulations in treating vasomotor symptoms in postmenopausal women with a history of DVT.
- Transdermal estrogen administration has a lower risk of VTE.
- Triptans, especially sumatriptan, should be avoided during pregnancy if possible.
- Non-pharmacologic interventions like lifestyle modifications, hydration, and relaxation techniques are encouraged for migraines during pregnancy.
- Low-dose propranolol could be considered with caution as a safer pharmacologic treatment for migraines during pregnancy.
- Estrogen-only MHT is suitable for postmenopausal women who have undergone a hysterectomy.
- MHT can provide relief from vasomotor symptoms during menopause and improve quality of life.
- Penicillins are generally considered the safest category of antibiotics during pregnancy.
- Tetracyclines should be avoided during pregnancy due to the risk of fetal dentition staining.
- Supporting care for mild coughs and fevers during pregnancy includes hydration and rest.
- MHT can worsen migraines in postmenopausal women.
Intrauterine Infections and Fetal Risks
- Parvovirus B19 infection during the first 20 weeks of pregnancy is associated with high risks for the fetus, including hydrops fetalis and fetal loss.
Neonatal Group B Streptococcus (GBS) Infection
- The most common serious outcome of early-onset GBS infection in newborns is sepsis, which can be fatal without prompt treatment.
Neonatal Immune System
- Neonates have a reduced TLR response, making them more vulnerable to bacterial infections.
- The immune system in neonates is Th2-dominant, which limits their ability to effectively fight certain bacterial infections.
Immunosenescence
- Thymic atrophy in older adults leads to a diminished production of naïve T cells, resulting in decreased adaptive immune responses.
- Aging leads to a decline in bone marrow plasma cell niches, contributing to lower antibody diversity and quality.
Maternal Infections and Pregnancy Outcomes
- Maternal CMV infection during pregnancy poses a significant risk of congenital abnormalities in the neonate, such as microcephaly and other birth defects.
- Maternal rubella vaccination before pregnancy is crucial to prevent severe congenital outcomes in neonates exposed to rubella.
Immune Adaptations During Pregnancy
- Regulatory T cells (Tregs) increase in number during pregnancy to help maintain fetal tolerance, preventing maternal immune rejection.
- The placental syncytiotrophoblast lacks MHC class I expression, helping evade detection by the maternal immune system.
- The innate immune system remains active during pregnancy to protect against maternal infections.
Neonatal Immune Vulnerabilities
- Neonates rely heavily on passive immunity from maternal antibodies due to their immature immune systems.
- Neonates have reduced production of mannose-binding lectin (MBL), impairing their immune response to pathogens.
- Neonates start producing their own IgG around 3 months of age.
Role of the Microbiome in Neonatal Immune Development
- Vaginal delivery promotes colonization by beneficial microbes such as Bacteroides, positively influencing gut microbiome composition.
- The gut microbiome is crucial for immune system development in neonates.
- Antibiotic exposure during delivery can disrupt the microbiome's natural colonization process, leading to reduced diversity and potential dysbiosis.
Intrauterine Growth Restriction (IUGR)
- Maternal hypertension is a common association with IUGR.
- IUGR increases the risk of chronic diseases like diabetes and cardiovascular disease later in life.
- The Barker hypothesis (thrifty phenotype) explains the link between IUGR and chronic disease, suggesting that the fetus adapts to limited nutrient availability, potentially setting the stage for long-term metabolic problems.
Maternal and Neonatal Health Disparities
- There are significant global disparities in maternal mortality rates, with much higher rates in low-income countries compared to high-income countries.
- Antenatal care accessibility varies greatly across regions, contributing to differences in maternal and neonatal outcomes.
- Maternal undernutrition is associated with higher rates of perinatal mortality.
- Female genital mutilation can increase the risk of neonatal death.
Breast Cancer Statistics
- Breast cancer (BC) is the most frequent cancer in women excluding non-melanoma skin cancer.
- In Australia, approximately 1 in 10 women will develop BC.
- BC is the second most common cause of cancer related death in women.
- 5 year survival is approximately 95%.
Risk Factors
- More than 99% of BC cases occur in women.
- Approximately 77% of BC cases occur in women over 50.
- Prior BC and other benign proliferative breast disease are risk factors.
- Oestrogen exposure can increase the risk of BC.
- Nulliparity and older age at first pregnancy are risk factors.
- Family history and genetics are associated with BC.
- Breast density is associated with BC.
Estimating Risk
- The Breast Cancer Risk Assessment Tool is available online from the US National Cancer institute.
- The tool estimates risk of developing BC in the next 5 years.
- The tool is appropriate for women over 35, without a diagnosis of LCIS or DCIS, and without family history suggesting a single gene mutation.
Genetics and Risk
- Genetics are responsible for 5-10% of all BC cases.
- Hereditary breast cancer tends to appear at a younger age and is often seen bilaterally.
- The BRCA1/BRCA2 gene mutation is the most common mutation associated with hereditary breast cancer.
- Individuals with BRCA1 or BRCA2 gene mutations have a 50-85% lifetime risk of developing BC.
Benign Lesions and Risk
- Benign breast diseases are more common than breast cancer.
- Most non-proliferative and many proliferative benign breast diseases are not associated with an increased risk of BC.
- Some proliferative conditions are associated with an increased risk of BC, specifically those with histological atypia.
Proliferative Breast Disease without Atypia
- Associated with a 1.5-2x increased risk of BC compared to the general population.
- Examples include:
- epithelial hyperplasia
- columnar cell change
- intraductal papilloma
- complex sclerosing lesion/radial scar
Proliferative Breast Disease with Atypia
- Associated with a 4-5x increased risk of BC compared to the general population.
- Examples include:
- atypical papilloma
- columnar cell change with atypia (‘flat epithelial atypia’)
- atypical hyperplasia (‘Atypical ductal hyperplasia’ or ‘atypical lobular hyperplasia’)
Breast Carcinoma in situ (CIS)
- Malignant BC cells confined to the ductal-lobular system without invasion through the basement membrane into stroma.
- Cells are morphologically and genetically similar to invasive BC.
- Approximately 20-25% of newly diagnosed BC are CIS.
- Associated with a 10x increased risk of invasive BC compared to the general population.
Ductal Carcinoma in situ (DCIS)
- BC cells confined within duct spaces.
- Morphological features are identical to invasive ductal carcinoma.
- DCIS is considered a 'premalignant' lesion.
- Theoretically curable by surgical excision: no invasion = no metastatic potential.
Lobular Carcinoma in situ (LCIS)
- BC cells confined within lobular spaces.
- The biological nature and potential of LCIS is less clear cut than DCIS.
- LCIS is also considered a 'premalignant' lesion.
- Theoretically curable by surgical excision: no invasion = no metastatic potential.
Invasive Breast Cancer
- Invasive BC cells extend beyond the basement membrane into stroma.
- Cells have access to vessels and lymphatics potential to metastasise.
- Most deaths result from metastasis to distant organs with impairment of function.
Workup for Invasive BC
- Examination – breast, axilla, general
- Pathology – Fine needle aspiration or core biopsy
- Radiology – MMG, US, MRI
Histopathological Classification of Invasive BC
-
80% of cases are invasive ductal carcinoma (IDC) of ‘no special type’ (NST)
- About 10% are invasive lobular carcinoma (ILC)
- The remainder are relatively uncommon ‘special’ types of carcinoma, most considered variants of IDC
Histological Grade
- Grading utilizes the modified Bloom and Richardson method (Nottingham grade).
- Grade is determined by:
- Tubule formation
- Nuclear atypia
- Mitotic rate
- Grade 1 has a better prognosis than Grade 3.
Stage
- Staging utilizes the AJCC system, the latest edition is the 8th edition.
- Staging is based on:
- Tumor size and local invasiveness
- Nodal burden
- Metastases
Biomarkers
- Three routinely used biomarkers in BC:
- ER
- PR
- HER2
Hormone Receptor Status
- Oestrogen and progesterone bind to ER/PR in the cytoplasm, migrate to the nucleus, and transcribe DNA to protein.
- ER+ and PR+ BCs are more responsive to anti-oestrogen therapy, and have a better prognosis.
HER2
- HER2 is a transmembrane tyrosine kinase (TK) protein.
- HER2 overexpression is present in 15-30% of BC cases.
- HER2+ BCs are more responsive to anti-HER2 therapies, and have a poorer prognosis.
Molecular Profiling
- Gene expression profiling has identified four distinct BC subtypes:
- Luminal A
- Luminal B
- HER2 enriched
- Basal-like
Management of Invasive BC
- Surgical excision with clear margins: Mastectomy or wide local excision (WLE)
- +/- axillary surgery – SLN biopsy, axillary clearance if SLN positive
- +/- radiotherapy
- +/- chemotherapy
Breast Cancer Overview
- Invasive breast carcinoma is the most common cancer in women (excluding non-melanoma skin cancer)
- Breast cancer is the second most common cause of cancer-related death in women.
- 5-year survival rate for breast cancer is 95%.
Risk Factors
- Gender: Over 99% of cases occur in women.
- Age: 77% of cases occur in women over 50.
- Previous breast carcinoma and other benign proliferative breast disease.
- Estrogen exposure:
- Young age at menarche
- Older age at menopause
- Obesity
- Oral contraceptive pill (OCP) / hormone replacement therapy (HRT)
- Nulliparity and older age at first pregnancy
- Family history/genetics
- Breast density
- Radiation
Genetics and Risk (Hereditary Breast Cancer)
- Accounts for 5-10% of all breast cancers.
- BRCA1/BRCA2 mutations are the most common, accounting for 47% of heritable breast cancer syndromes.
- These genes function to maintain DNA integrity.
- Lifetime risk of breast cancer is 50-85% for BRCA1/2 mutations.
- Increased risk of other cancers:
- BRCA1: Ovarian cancer, colon cancer, prostate cancer.
- BRCA2: Ovarian cancer, pancreas cancer, prostate cancer, oesophagus cancer, male breast cancer.
Benign Lesions and Risk
- Many benign proliferative breast diseases have no increased risk of breast cancer, including:
- Inflammatory conditions
- Fibrocystic change
- Adenosis
- Papillary apocrine hyperplasia (PASH)
- Fibroadenoma
- Some proliferative conditions do have increased risk of breast cancer:
- Usual hyperplasia
- Complex sclerosing lesion/radial scar
- Papilloma
- The magnitude of risk is related to the degree of histological atypia.
Proliferative Breast Disease without Atypia
- Associated with a mild increased risk of breast cancer (1.5-2x above the general population).
- Includes:
- Epithelial hyperplasia
- Columnar cell change
- Intraductal papilloma
- Complex sclerosing lesion/radial scar
Proliferative Breast Disease with Atypia
- Associated with a moderate increased risk of breast cancer (4-5x above the general population).
- Proliferative breast disease, but with the addition of histological atypia.
- Includes:
- Atypical papilloma
- Columnar cell change with atypia ('flat epithelial atypia')
- Atypical hyperplasia (‘atypical ductal hyperplasia’ or ‘atypical lobular hyperplasia’)
Breast Carcinoma In Situ (CIS)
- Malignant breast cancer cells confined to the ductal-lobular system without invasion through the basement membrane into the stroma.
- Cells are morphologically identical and genetically similar to invasive breast cancer.
- Associated with a high increased risk of invasive breast cancer (10x above the general population).
- Types:
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
DCIS
- Confined within duct spaces, occasionally lobular spaces.
- Considered a 'premalignant' lesion.
- Theoretically curable, as there is no invasion.
- Classified by grade of nuclear atypia: low, intermediate, high.
- Management:
- Surgical excision with clear margins.
- +/- Radiotherapy
LCIS
- Confined within lobular spaces, occasionally duct spaces.
- The biologic nature and potential of classical LCIS is less clear cut than for DCIS.
- Considered a 'premalignant' lesion; high risk of lobular type BC at the same site.
- Theoretically curable; no invasion = no metastatic potential.
- Often an incidental finding on biopsy.
- Management:
- Increased surveillance for isolated LCIS on core biopsy.
- No further action required for LCIS found in surgical margins.
- Consider anti-oestrogen risk reducing medication.
Invasive Breast Cancer
- Invasion of malignant epithelial cells beyond myoepithelial/basement membrane into stroma.
- Clinical presentation:
- Discrete mass (lump) or lumpiness
- Pain
- Nipple changes/discharge
- Skin changes
- Other (including distant manifestations)
- Workup:
- Examination: Breast, axilla, general
- Pathology: fine-needle aspiration or core biopsy.
- Radiology: Mammogram, ultrasound, MRI.
Pathology
- Classified in terms of type, grade, stage (degree of spread), biomarker expression.
- Classified into invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and ‘special’ types of carcinoma.
- Histological grade: Modified Bloom and Richardson method (Nottingham grade).
- Score of 1-3 for:
- Tubule formation
- Nuclear atypia
- Mitotic rate
- Sum is split into grade 1 (3,4,5 points), grade 2 (6,7 points), and grade 3 (8,9 points).
- Score of 1-3 for:
- Stage: AJCC system (8th edition).
- Takes into account:
- Primary tumour size and local invasiveness
- Nodal burden
- Metastases
- Takes into account:
- Biomarkers:
- Estrogen receptor (ER)
- Progesterone receptor (PR)
- Human Epidermal growth factor Receptor 2 (HER2)
Hormone Receptor Status
- ER and PR promote growth and differentiation in normal breast tissue.
- ER+ and PR+ tumors are associated with improved survival.
- Strong predictors of response to anti-oestrogen therapy.
Her2
- Transmembrane tyrosine kinase (TK) protein that promotes growth and differentiation in normal breast tissue.
- Her2 amplification and overexpression is present in ~15-30% of breast cancers.
- Prognostic: Her2 positive BC poor survival vs Her2 negative BC.
- Predictive: Strong predictor of response to anti-HER2 therapies.
Molecular Profiling
- Gene expression profiling studies identified four distinct breast cancer subsets:
- Luminal A
- Luminal B
- HER2-enriched
- Basal-like
- Prognostic and predictive significance.
- Some panels are now accepted in clinical use, such as Oncotype DX, Prosigna, and Mammaprint.
Management
- Surgical excision with clear margins: Mastectomy or Wide Local Excision (WLE).
- +/- Axillary surgery: Sentinel Lymph Node (SLN) biopsy or Axillary clearance if SLN positive.
- +/- Radiotherapy: To the chest wall, axilla, and supraclavicular nodes.
- +/- Chemotherapy: If high-risk clinicopathological features are present.
Lung Cancer
- Squamous Cell Carcinoma is often located centrally in the lung and features keratin pearl formation.
- Small Cell Lung Carcinoma is associated with SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion).
Tuberculosis
- Active Tuberculosis is confirmed by sputum acid-fast bacilli (AFB) smear and culture.
- Tuberculin skin test (TST) indicates prior exposure to tuberculosis antigens, not active infection.
- Cavitary lesions in the upper lobes are a common finding on chest x-ray.
Chronic Obstructive Pulmonary Disease (COPD)
- COPD is characterized by irreversible airflow obstruction, predominantly caused by smoking.
- Reduced FEV1/FVC ratio is a key indicator of COPD on pulmonary function tests.
- COPD is a common underlying cause of pulmonary hypertension.
Pulmonary Embolism
- Pleuritic chest pain is a common symptom of pulmonary embolism.
- Pulmonary embolism causes a ventilation-perfusion mismatch
- Thrombolytic therapy is not the first-line treatment, it is reserved for cases with significant hemodynamic compromise that don't respond to anticoagulation.
Community-Acquired Pneumonia (CAP)
- Antibiotic treatment for CAP is typically empirical, using broad-spectrum antibiotics.
- CAP can be caused by Mycoplasma pneumoniae, which is atypical.
- Transudative fluid accumulations are not specific to CAP, they are a common finding with other causes of pleural effusion.
Cultural Safety
- Cultural safety involves healthcare professionals reflecting on their own cultural identity and ensuring they provide culturally appropriate care.
Pharyngitis
- Rhinoviruses account for approximately 20% of pharyngitis cases.
Respiratory Physiology
- Low ventilation-perfusion (VA/Q) ratio leads to a decrease in alveolar partial pressure of oxygen (PAO2).
- High ventilation-perfusion (VA/Q) ratio is associated with pulmonary embolism.
- Hypoxaemia in ventilation-perfusion mismatch is primarily caused by shunted blood bypassing oxygenation.
- Atelectasis is the collapse of the alveoli.
- Ventral respiratory group (VRG) is responsible for generating the basic rhythm of breathing.
- Pneumotaxic center coordinates the transition between inhalation and exhalation.
Allergic Reactions
- IL-4 and IL-13 are cytokines involved in the stimulation of allergen-specific IgE production.
- Eosinophils and Th2 cells are primarily responsible for the late-phase reaction of IgE-mediated hypersensitivity.
- Regulatory T (Treg) cells suppress Th2 cell responses through IL-10 and TGF-B.
- Allergen-specific immunotherapy (SCIT or SLIT) aims to reduce Th2 cell responses and increase blocking antibodies (IgG4).
Pneumothorax
- Pneumothorax is indicated by a pleural line with no lung markings peripheral to it on chest x-ray.
Respiratory Medications
- Tiotropium is a long-acting muscarinic antagonist (LAMA).
- Montelukast belongs to the leukotriene receptor antagonist class of drugs.
Obstructive Lung Diseases
- Obstructive lung diseases are characterized by increased airway resistance.
- Alpha-1 antitrypsin deficiency is associated with emphysema.
Chronic Bronchitis
- Hyperinflation of the lungs is not a typical feature of chronic bronchitis.
- Chronic bronchitis is characterized by productive cough, frequent infections, and dyspnoea on exertion.
Bronchiectasis
- Bronchiectasis is primarily caused by recurrent infections.
Respiratory Sounds
- Wheezing is a high-pitched, polyphonic sound produced in the airways during expiration.
Restrictive Lung Diseases
- Restrictive lung diseases are characterized by reduced total lung capacity, decreased forced vital capacity (FVC), and reduced lung compliance.
- Increased airway resistance is not a feature of restrictive lung diseases.
Acute Respiratory Distress Syndrome (ARDS)
- ARDS is histologically characterized by diffuse alveolar damage (DAD).
Idiopathic Pulmonary Fibrosis (IPF)
- Honeycomb lung and temporally heterogeneous fibrosis are characteristic of IPF.
Sarcoidosis
- Tight non-necrotizing granulomas and multisystem involvement are associated with sarcoidosis.
Acute Lung Injury (ALI)
- Sepsis is the most common cause of ALI that leads to ARDS.
Cryptogenic Organizing Pneumonia (COP)
- Polyploid plugs of loose organizing connective tissue within alveolar ducts and alveoli are specific to COP.
Oxygen Delivery Devices
- Non-rebreather mask is the device that provides the highest oxygen concentration.
COPD Oxygen Therapy
- The recommended target oxygen saturation for patients with COPD is 88-92%.
Tuberculosis Testing
- Mantoux test involves intradermal injection to detect tuberculosis infection.
Extrapulmonary Tuberculosis
- Pott's disease is TB that affects the spine.
Pulmonary Embolism
- Pulmonary embolism causes ventilation-perfusion mismatch.
Goodpasture Syndrome
- Goodpasture syndrome involves autoantibodies against the basement membrane of the a3 chain of collagen IV.
Diffuse Pulmonary Hemorrhage
- Pleuritic chest pain is not a common feature of diffuse pulmonary hemorrhage.
Healthcare-Associated Pneumonia (HCAP)
- Streptococcus pneumoniae is commonly associated with HCAP.
Ventilator-Associated Pneumonia (VAP)
- Methicillin-Resistant Staphylococcus Aureus (MRSA) is a common cause of VAP.
Pleural Effusion
- Complicated parapneumonic effusion is characterized by low glucose levels, pleural fluid acidosis and elevated LDH.
Bronchiectasis
- Bronchiectasis involves abnormal and permanent dilation of the bronchi.
Lung Abscesses
- Klebsiella pneumoniae is the most common organism responsible for lung abscesses after aspiration.
Melioidosis
- Burkholderia pseudomallei causes melioidosis.
Opportunistic Infections
- Pneumocystis pneumonia (PCP) is the most common opportunistic infection in patients with HIV with a CD4 count below 200 cells/mm3.
Community-Acquired Pneumonia (CAP) in Children
- Streptococcus pneumoniae is the most common bacterial cause of CAP in children.
Pharyngitis
- Streptococcus pyogenes is the most common bacterial cause of pharyngitis.
Acute Epiglottitis
- Ceftriaxone is the recommended treatment for acute epiglottitis caused by Haemophilus influenzae type B (Hib).
Acute Otitis Media
- Streptococcus pneumoniae is the most common causative organism for acute otitis media.
Croup
- Croup is characterized by fever, hoarseness, and a barking cough.
Chronic Sinusitis
- Haemophilus influenzae and Staphylococcus aureus are common causes of chronic sinusitis.
Tuberculosis Pathology
- Granulomas in tuberculosis contain central caseous necrosis.
IGRA Test
- IGRA tests indicate prior exposure to tuberculosis antigens.
Preventing TB Transmission
- N-95 masks and natural ventilation are the most effective infection control measures to prevent TB transmission in healthcare settings.
Lung Cancer
- Adenocarcinoma is the most common type of lung cancer in non-smokers.
Neural Tube Defects
- Anencephaly: Failure of the anterior neuropore to close
- Spina Bifida: Incomplete closure of the spinal column
- Folic acid supplementation before conception and in early pregnancy is recommended to reduce the risk of neural tube defects
- Maternal serum alpha-fetoprotein (AFP) is commonly elevated in pregnancies with neural tube defects.
- Ultrasound is the most effective imaging technique in confirming NTDs.
- Genetic counseling provides families at risk of NTDs with information on recurrence risk and potential interventions.
Fetal Growth and Development
- Fetal macrosomia often results from poorly controlled gestational diabetes.
- Fetal hyperinsulinemia promotes excess nutrient storage and growth, leading to macrosomia.
- Potential complications of macrosomia during delivery: shoulder dystocia and increased risk of cesarean delivery.
- Placental insufficiency can reduce nutrient delivery and lead to intrauterine growth restriction (IUGR).
- IUGR is associated with long-term cardiovascular risks in the affected infant.
- Symmetrical IUGR affects the whole body proportionately, while asymmetrical IUGR often spares the head.
- Gestational age is crucial for assessing fetal growth, with the third trimester offering the best insights into IUGR.
- Maternal nutritional intake, including folic acid and omega-3 fatty acids, significantly impacts fetal brain development.
- Maternal CMV infection can disrupt fetal neurological development.
Prenatal Diagnostic Techniques
- Ultrasound is used to assess fetal anatomy and growth.
- Doppler studies evaluate blood flow in the umbilical artery, indicating potential placental insufficiency.
- Maternal serum screening can detect NTDs and some chromosomal abnormalities.
- Amniocentesis analyzes fetal DNA from amniotic fluid to diagnose genetic disorders.
- Chorionic villus sampling (CVS) analyzes fetal cells from the placenta for genetic testing.
- Non-invasive prenatal testing (NIPT) analyzes fetal DNA from maternal blood to detect chromosomal abnormalities, including trisomy 21.
Congenital Heart Defects
- Tetralogy of Fallot commonly includes a ventricular septal defect (VSD).
- Fetal echocardiography is the gold standard imaging technique for diagnosing congenital heart defects in utero.
- Transposition of the great arteries require surgical intervention shortly after birth.
- Patent ductus arteriosus can lead to heart failure if left untreated.
- Atrial septal defects do not always result in cyanosis, depending on the size and pressure gradient.
Sexual Health History Taking
- A comprehensive sexual history includes: sexual practices, partner history, contraception use, and history of sexually transmitted infections (STIs).
- Sensitive and non-judgmental approach is crucial for effective and honest disclosure.
- Confidentiality is fundamental to building trust and ensuring comprehensive patient care.
Maternal Physiology
- Cardiac output increases significantly during pregnancy to support increased blood flow.
- Maternal insulin resistance increases to provide more glucose to the growing fetus.
- These physiological changes optimize nutrient delivery and support fetal development.
Amniotic Fluid
- Polyhydramnios often results from fetal anomalies that impair swallowing.
- Oligohydramnios can lead to growth restriction and musculoskeletal deformities.
- Both conditions increase the risk of preterm birth and other complications.
- Nuchal translucency measurement is performed between 11 and 14 weeks of gestation to screen for chromosomal abnormalities.
- Increased nuchal translucency suggests a higher risk of Down syndrome, often leading to further genetic testing.
Maternal Immune System
- Regulatory T cells (Tregs) increase in number to promote tolerance of fetal antigens, preventing rejection.
- The placenta expresses low levels of classical MHC class I molecules, further contributing to immune tolerance.
- The maternal innate immune system remains active during pregnancy to protect against external pathogens.
Congenital Infections
- Cytomegalovirus (CMV) and rubella are two common congenital infections screened for during pregnancy.
- Maternal vaccination before pregnancy is crucial for preventing rubella and its congenital complications.
- Intrapartum antibiotic prophylaxis is recommended to prevent vertical transmission of Group B Streptococcus (GBS).
Prenatal Care
- Routine screening for gestational diabetes is typically performed at 24-28 weeks.
- Blood pressure checks during prenatal appointments help identify pre-eclampsia risk.
- Fetal anomaly scans are usually conducted at 18-20 weeks.
- Group B Streptococcus (GBS) screening is typically done at 35-37 weeks.
- Continuous electronic fetal monitoring is not always necessary for low-risk pregnancies.
High Difficulty MCQs
- Folic acid is necessary throughout pregnancy, not just in the first trimester, to prevent neural tube defects.
- Amniocentesis carries a small but real risk of miscarriage.
- Excessive vitamin A intake can be teratogenic and harmful to the fetus.
- NIPT can detect trisomy 21 with high sensitivity but cannot definitively diagnose all genetic disorders.
- Continuous electronic fetal monitoring is not always necessary in low-risk pregnancies; intermittent auscultation may suffice.
- GBS screening is typically performed at 35-37 weeks, not at the first prenatal visit.
Conclusion:
Understanding the complexities of fetal development, prenatal diagnostic techniques, and maternal health is essential for effective pregnancy care and managing potential complications.
Ovarian Tumors
- Clear cell carcinoma is associated with endometriosis and carries a poor prognosis.
- High-grade serous ovarian carcinoma often involves BRCA1/2 mutations, these mutations contribute to DNA repair defects.
- Complete hydatidiform moles exhibit extensive trophoblastic proliferation without any fetal tissue.
- Yolk sac tumors produce alpha-fetoprotein (AFP).
- Endometriomas contain old blood and are associated with endometriosis.
Testicular Germ Cell Tumors
- Seminomas are radiosensitive and usually present in young men.
- Teratomas in adult males can behave aggressively.
- Choriocarcinomas are associated with high levels of β-hCG.
Breast Cancer
- Paget's disease of the breast shows malignant cells within the epidermis, often associated with underlying DCIS.
- Invasive lobular carcinoma often presents with subtle thickening rather than a discrete mass.
- Inflammatory breast cancer can cause skin thickening and edema, creating a peau d’orange appearance.
- Atypical ductal hyperplasia actually increases the risk of developing breast cancer.
- Phyllodes tumors can recur if not fully excised.
Endometrial Carcinoma
- Type 1 endometrial carcinoma is typically estrogen-dependent.
- Type 1 carcinoma often arises from endometrial hyperplasia.
- Type 2 carcinoma generally has a poorer prognosis.
- Chronic anovulation leads to prolonged unopposed estrogen exposure, increasing the risk of endometrial hyperplasia.
HPV and Cervical Cancer
- HPV 16 and 18 are the most common high-risk types associated with cervical cancer.
- Persistent HPV infection is a significant risk factor for cervical cancer development.
- HPV can integrate into the host genome, causing genetic instability.
- HPV vaccination significantly reduces the incidence of cervical intraepithelial neoplasia (CIN) and cervical cancer.
Gestational Trophoblastic Diseases
- Complete moles have a higher risk of developing into choriocarcinoma compared to partial moles.
- Partial moles usually contain triploid karyotype with both paternal and maternal genetic material.
- β-hCG levels are markedly elevated in both complete and invasive moles.
Breast Cancer Risk Factors
- Early menarche and late menopause increase breast cancer risk.
- BRCA1 mutations are associated with a higher risk of triple-negative breast cancer.
- Obesity post-menopause increases estrogen levels and breast cancer risk.
- High parity and early first pregnancy are protective factors against breast cancer.
Other
- Adenomyosis involves endometrial glands and stroma within the myometrium, causing thickening.
- HPV 18 is more commonly associated with adenocarcinoma of the cervix.
- DCIS remains within the ducts and does not invade the basement membrane, while IDC invades surrounding tissues.
Additional Facts
- Type 2 endometrial carcinoma is not associated with PTEN mutations.
- Yolk sac tumors secrete AFP, not β-hCG.
- Seminomas typically spread to para-aortic lymph nodes.
- The hallmark histological feature of a complete hydatidiform mole is hydropic villi with central cisterns and no fetal tissue.
Ovarian Tumors
- High-grade serous carcinoma is the most common type of malignant ovarian tumor.
- Clear cell carcinoma is often linked with endometriosis.
- CA-125 is a tumor marker commonly used for monitoring epithelial ovarian cancer.
Complete vs Partial Hydatidiform Moles
- Complete moles are typically diploid and consist of only paternal DNA.
- Partial moles contain triploid karyotypes and can include fetal tissue.
- Complete moles have a higher risk of progression to choriocarcinoma compared to partial moles.
HPV Infection in Cervical Pathology
- HPV types 16 and 18 are most commonly associated with cervical cancer.
- Integration of HPV DNA into the host genome disrupts regulatory genes, leading to overexpression of oncogenes like E6 and E7.
- Full-thickness dysplasia without invasion of the basement membrane is seen in cervical intraepithelial neoplasia (CIN) III.
Benign Prostatic Hyperplasia (BPH)
- BPH primarily occurs in the transitional zone of the prostate.
- Dihydrotestosterone (DHT) stimulates the growth of prostate tissue, leading to hyperplasia.
- Common complications associated with untreated BPH include urinary retention, increased risk of urinary tract infections, and bladder hypertrophy.
Testicular Germ Cell Tumors
- Seminoma is the most common type of testicular germ cell tumor.
- AFP (alpha-fetoprotein) is elevated in non-seminomatous germ cell tumors.
- Scrotal ultrasound is the preferred imaging technique for initial evaluation of suspected testicular cancer.
Hormonal Exposure and Endometrial Pathology
- Type 1 endometrial carcinoma is associated with prolonged unopposed estrogen exposure.
- Progesterone counteracts the proliferative effects of estrogen on the endometrium.
- Chronic anovulation (e.g., polycystic ovary syndrome) can cause unopposed estrogen exposure.
Ductal Carcinoma in Situ (DCIS)
- DCIS is typically detected by mammography, often showing microcalcifications.
- DCIS does not invade the basement membrane, unlike invasive ductal carcinoma (IDC).
- DCIS has the potential to progress to invasive cancer if left untreated.
Inflammatory Breast Cancer
- Peau d’orange skin changes and rapid breast enlargement are characteristic signs of inflammatory breast cancer.
- Tumor cell invasion into dermal lymphatics is seen in inflammatory breast cancer.
- The aggressive nature and tendency for early metastasis of inflammatory breast cancer contribute to a poorer prognosis compared to other types.
Gestational Trophoblastic Diseases (GTD)
- Complete moles have diffuse trophoblastic proliferation without fetal tissue, while partial moles may contain fetal parts.
- Persistently elevated β-hCG levels after evacuation of a mole suggests the possibility of invasive mole or choriocarcinoma.
- Chemotherapy, such as methotrexate or actinomycin D, is a treatment option for invasive gestational trophoblastic neoplasia.
Adenomyosis
- Adenomyosis is characterized by the presence of endometrial glands and stroma within the myometrium.
- Common symptoms of adenomyosis typically include heavy menstrual bleeding, dysmenorrhea, and an enlarged, tender uterus.
- MRI or transvaginal ultrasound are most useful for diagnosing adenomyosis.
Prostate Cancer
- The peripheral zone of the prostate is most commonly affected by adenocarcinoma.
- PSA helps in detecting prostate cancer and monitoring treatment response, though it can be elevated in benign conditions as well.
- The Gleason grading system is used to evaluate prostate cancer.
High-Grade Serous Carcinoma of the Ovary
- BRCA1 and BRCA2 mutations are most commonly associated with high-grade serous carcinoma.
- Serous tubal intraepithelial carcinoma (STIC) is believed to give rise to many cases of high-grade serous carcinoma.
- High-grade serous carcinoma often presents at advanced stages due to nonspecific symptoms and rapid progression.
Endometriosis
- The ovaries are the most common site of endometriosis outside the uterus.
- Endometriosis can cause adhesions, distort pelvic anatomy, and impair ovulation.
- Pelvic pain, especially during menstruation, is a common symptom of endometriosis.
Cervical Intraepithelial Neoplasia (CIN)
- CIN is classified into CIN I (mild dysplasia), CIN II (moderate dysplasia), and CIN III (severe dysplasia/carcinoma in situ).
- CIN III can progress to invasive cervical cancer if not treated.
- Pap smear (cervical cytology) is commonly used to detect CIN.
Lobular Carcinoma in Situ (LCIS)
- LCIS involves the lobules and lacks E-cadherin expression, while DCIS involves the ducts.
- LCIS is a marker of increased risk for developing invasive breast cancer in either breast.
- Options for LCIS treatment include observation, chemoprevention, or prophylactic surgery in high-risk cases.
Invasive Lobular Carcinoma (ILC)
- Loss of E-cadherin expression is commonly associated with ILC.
- ILC may present as subtle thickening rather than a discrete mass.
- A single-file pattern of tumor cells infiltrating the stroma is characteristic of ILC.
High-Grade Cervical Intraepithelial Neoplasia (CIN III)
- Treatment options for CIN III include LEEP (loop electrosurgical excision procedure), cryotherapy, and cone biopsy.
- Treatment selection for CIN III considers factors such as patient age, reproductive plans, and lesion size.
- CIN III has a significant risk of progressing to invasive cancer if left untreated.
Choriocarcinoma
- The trophoblastic cells of the placenta are the primary site of origin for choriocarcinoma.
- β-hCG is used for diagnosing and monitoring choriocarcinoma.
- Choriocarcinoma cells are highly proliferative and sensitive to chemotherapeutic agents.
Congenital Anomalies Associated with Placental Insufficiency
- Maternal hypertension, preeclampsia, and placental infarctions are common causes of placental insufficiency.
- Placental insufficiency can lead to intrauterine growth restriction (IUGR) due to inadequate nutrient and oxygen delivery.
- Long-term consequences for infants born after significant placental insufficiency include increased risk of metabolic syndrome and cardiovascular disease in adulthood.
Benign Breast Disease
- Fibroadenoma is the most common type of benign breast lesion in young women.
- Cystic dilation of ducts, fibrosis, and epithelial hyperplasia are histologic findings suggestive of fibrocystic change.
- A fibroadenoma is a well-circumscribed, mobile mass with a biphasic pattern of glandular and stromal components.
10 More High-Difficulty MCQs (Standard Format)
- Invasive lobular carcinoma is associated with a single-file pattern of cells infiltrating the stroma.
- Granulosa cell tumor is associated with Call-Exner bodies on histology.
- Increased androgen production by the ovaries is the primary hormonal mechanism contributing to the development of polycystic ovary syndrome (PCOS).
- CA - 125 is the marker most commonly elevated in patients with epithelial ovarian cancer.
- Men aged 15-35 are the typical age group affected by seminomas.
Complete Mole
- Fertilization of an empty egg by a single sperm that duplicates its chromosomes results in a complete mole.
- Complete moles are diploid, containing only paternal chromosomes.
Phyllodes Tumor
- Phyllodes tumor is a rare breast pathology characterized by stromal overgrowth, creating a "leaf-like" pattern.
- Can be benign or malignant.
Placental Site Trophoblastic Tumor (PSTT)
- Presents with moderate β-hCG elevation and persistent postpartum bleeding.
Invasive Ductal Carcinoma of the Breast
- HER2 amplification is a common genetic alteration associated with invasive ductal carcinoma.
Endometrial Hyperplasia with Atypia
- Key difference between simple hyperplasia and endometrial hyperplasia with atypia: nuclear atypia in glandular cells.
Testicular Cancer
- Yolk sac tumors are more common in children, not adults.
Lobular Carcinoma in Situ (LCIS)
- LCIS is a non-invasive lesion that does not always progress to invasive lobular carcinoma.
HPV-related Cervical Pathology
- HPV vaccination does not prevent all types of cervical cancer; it covers high-risk types.
Benign Prostatic Hyperplasia (BPH)
- BPH is not a premalignant condition, and is not linked to increased risk of prostate cancer.
Complete Hydatidiform Moles
- Complete moles do not always progress to choriocarcinoma, although they have a higher risk.
Paget's Disease of the Breast
- Paget cells are found within the epidermis, not the dermis.
Seminomas
- Seminomas do not typically produce AFP; they may produce β-hCG in some cases.
Breast Cancer Markers
- Triple-negative breast cancers do not express estrogen, progesterone, and HER2 receptors.
Prostate Cancer Pathology
- High-grade prostate cancer often shows poor differentiation, not abundant glandular differentiation.
Menstrual Cycle
- Luteal phase lasts approximately 14 days – typically longer than the follicular phase.
Phyllodes Tumors
- Phyllodes tumors often present as a rapidly growing, firm breast mass.
- Malignant phyllodes tumors show increased mitotic activity, stromal overgrowth, and cellular atypia.
- Primary treatment for phyllodes tumors is wide local excision with clear margins.
Placenta Previa
- Risk factors for placenta previa: prior Cesarean section, multiparity, and advanced maternal age.
- Presents with painless vaginal bleeding in the second or third trimester.
- Management involves close monitoring, avoiding digital cervical exams, and planning Cesarean delivery.
Invasive Lobular Carcinoma
- E-cadherin loss in invasive lobular carcinoma results in a diffuse growth pattern and single-file infiltration.
- Single-file infiltration is characteristic of invasive lobular carcinoma.
Atypical Ductal Hyperplasia (ADH)
- ADH shows partial features of DCIS but does not involve the complete duct.
- ADH increases the risk of developing breast cancer.
- Management includes close surveillance and possibly chemoprevention.
Type 2 Endometrial Carcinoma
- Common subtypes for Type 2 endometrial carcinoma: serous and clear cell carcinoma
- p53 mutations are frequently associated with Type 2 endometrial carcinoma.
- Type 2 endometrial carcinoma often has a worse prognosis because it is usually diagnosed at an advanced stage and is aggressive.
Hormonal Therapy for Breast Cancer
- Hormonal therapy is most effective for ER-positive and PR-positive breast cancers.
- Tamoxifen is a selective estrogen receptor modulator (SERM) that blocks estrogen in breast tissue.
- Common side effects of tamoxifen: hot flashes, increased risk of venous thromboembolism, and endometrial hyperplasia.
Testicular Torsion
- Classic signs of testicular torsion: sudden, severe scrotal pain and swelling.
- Differentiation between testicular torsion and epididymitis: testicular torsion presents with an absent cremasteric reflex, while epididymitis may have fever and tenderness with a preserved reflex.
- Intervention within 6 hours is crucial to maximize testicular salvage.
HER2 Status in Breast Cancer
- Treatment targeted for HER2-positive breast cancer: trastuzumab (Herceptin)
- HER2 status is determined using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).
- Potential side effects of HER2-targeted therapies: cardiotoxicity and infusion reactions.
Pelvic Inflammatory Disease (PID)
- Common pathogens responsible for PID: Neisseria gonorrhoeae and Chlamydia trachomatis.
- Potential long-term complications of untreated PID: infertility and ectopic pregnancy.
- Imaging modality for assessing complications of PID: pelvic ultrasound or MRI.
Complete Hydatidiform Mole
- Complete moles display diffuse trophoblastic proliferation, hydropic villi, and absence of fetal tissue.
- Primary treatment for complete moles: uterine evacuation through suction curettage.
- Monitoring for persistent trophoblastic disease post-treatment involves serial β-hCG measurements.
Invasive Ductal Carcinoma (IDC)
- IDC is the most common type of invasive breast cancer.
- IDC often presents with microcalcifications on mammography.
- IDC does not show a “single-file” growth pattern - this is characteristic of invasive lobular carcinoma.
- IDC has a variable prognosis depending on grade and stage.
Testicular Torsion
- Testicular torsion presents with sudden, severe testicular pain.
- Cremasteric reflex is usually absent.
- Doppler ultrasound in testicular torsion typically shows reduced or absent blood flow.
- Surgical intervention within 6 hours can prevent testicular necrosis.
Placental Abruption
- Placental abruption can lead to severe fetal hypoxia and distress.
- It is associated with painful vaginal bleeding.
- Placental abruption is often diagnosed through ultrasound.
- Hypertensive disorders of pregnancy increase the risk of placental abruption.
Benign Prostatic Hyperplasia (BPH)
- BPH is characterized by hyperplasia of both glandular and stromal tissue.
- BPH most commonly affects the transitional zone of the prostate, not the peripheral zone.
- Dihydrotestosterone (DHT) plays a significant role in BPH pathogenesis.
- Symptoms include urinary retention and weak urine stream.
Cervical Intraepithelial Neoplasia (CIN)
- CIN I involves mild dysplasia limited to the basal third of the epithelium.
- CIN II involves moderate dysplasia extending into the middle third of the epithelium.
- CIN III is not considered carcinoma in situ, but it is high-grade dysplasia with full-thickness involvement of the epithelium.
Benign Prostatic Hyperplasia (BPH)
- The transition zone of the prostate is the most common site of BPH development
- 5-alpha reductase inhibitors reduce prostate volume by inhibiting testosterone’s conversion to DHT
- Alpha-adrenergic blockers provide rapid symptom relief for BPH
- Alpha-adrenergic blockers do not impact prostate size
- The most common side effect of PDE-5 inhibitors is headache
Breast Cancer
- Triple-negative breast cancer (TNBC) has the worst survival rate
- Inflammatory breast cancer is associated with rapid breast enlargement and peau d’orange skin appearance
- Breast density reduces the sensitivity of mammograms
- Dense breast tissue appears white on mammograms
Prostate Cancer
- Flutamide is a nonsteroidal androgen receptor antagonist for prostate cancer therapy
- Prostate adenocarcinoma is characterized by glandular structures with prominent nucleoli
- SERMs stimulate estrogen receptors in certain tissues, not all
Other
- Sildenafil (a PDE-5 inhibitor) is contraindicated in patients taking nitrates, as it can cause severe hypotension
- Family history of breast cancer is a non-modifiable risk factor for breast cancer
- Drugs like finasteride (5-alpha reductase inhibitor) used to treat BPH can cause gynecomastia
High-risk GTN
- High-risk GTN is treated with multi-agent chemotherapy
Endometrial Cancer
- Type 2 endometrial cancer is often more aggressive and has poorer prognosis
Ovarian Cancer
- CA-125 is a useful tumor marker for epithelial ovarian cancer
Testicular Cancer
- Choriocarcinoma is most likely to produce β-hCG
- Scrotal ultrasound is used in the initial diagnosis of a suspected testicular mass
Cervical Cancer
- Cervical cancer can be prevented by HPV vaccination
Menstrual Cycle
- Elevated LH levels and hyperandrogenism are associated with PCOS
- Ovulatory dysfunction can lead to infertility
Benign Prostatic Hyperplasia (BPH)
- BPH is commonly found in older men
- BPH can cause nocturia, decreased urinary flow, and difficulty starting urination
- PSA levels may be slightly elevated
- DRE reveals an enlarged, non-nodular prostate
BPH Treatment
- Alpha-adrenergic blockers such as tamsulosin are recommended for initial treatment
- Alpha-adrenergic blockers can cause dizziness, orthostatic hypotension, and ejaculatory dysfunction
Breast Imaging
- Ultrasound can be used to evaluate an area of concern in a mammogram, especially in women with dense breast tissue
- A suspicious solid mass on ultrasound requires further investigation
Next Diagnostic Steps
- If a mass on ultrasound appears suspicious, a biopsy should be performed to determine if it is benign or malignant
Invasive Ductal Carcinoma
- Histological findings confirming invasive ductal carcinoma include glandular structures with malignant cells and invasion beyond the basement membrane.
Bone Metastases from Prostate Cancer
- Bone metastases from prostate cancer cause osteoblastic lesions, resulting in bone pain and elevated alkaline phosphatase.
- Imaging modalities such as bone scan or PET-CT can confirm the diagnosis.
- Serum PSA levels are monitored to assess treatment effectiveness.
- Treatment options include androgen deprivation therapy, radiotherapy, and bisphosphonates.
Inflammatory Breast Cancer (IBC)
- Rapidly enlarging breast mass, erythema, and skin thickening resembling peau d’orange are characteristic of IBC.
- Diagnosis requires biopsy of the mass and affected skin, along with imaging studies like mammography or MRI.
- Treatment involves neoadjuvant chemotherapy followed by surgery and radiation.
Endometrial Carcinoma
- Postmenopausal bleeding warrants investigations, including an endometrial biopsy, to rule out endometrial carcinoma.
- Malignant glandular cells invading the myometrium confirm the diagnosis.
- Risk factors for endometrial carcinoma include obesity, unopposed estrogen use, and late menopause.
Androgen Deprivation Therapy (ADT)
- ADT is a common treatment for prostate cancer, but can cause side effects such as hot flashes, osteoporosis, and metabolic changes.
- Bisphosphonates or denosumab can be used for bone health.
- Lifestyle modifications help mitigate side effects.
- Long-term monitoring for bone density (DEXA) and cardiovascular health is essential.
Non-seminomatous Germ Cell Tumor
- Presentation includes painless testicular mass, elevated serum AFP, and ultrasound findings suggesting solid, hypoechoic lesion.
- Initial treatment is radical inguinal orchiectomy.
- Post-surgery, diagnosis is confirmed by histopathological examination of the excised tissue.
Atypical Ductal Hyperplasia (ADH)
- ADH increases the risk of developing breast cancer.
- Enhanced surveillance with regular mammograms and possibly MRI is crucial.
- Chemoprevention options include SERMs or prophylactic mastectomy.
Prostate Cancer
- Elevated PSA, hematuria, and a firm, irregular prostate on digital rectal examination are suggestive of prostate cancer.
- Transrectal ultrasound-guided prostate biopsy confirms the diagnosis.
- Common histological findings in prostate cancer include glandular structures with prominent nucleoli.
BRCA1 Mutation
- BRCA1 mutation dramatically increases the risk of breast and ovarian cancer.
- Individuals with a BRCA1 mutation require enhanced surveillance with mammograms and MRI.
- Genetic counseling is recommended.
- Prophylactic mastectomy and salpingo-oophorectomy are preventive surgical options for BRCA1 carriers.
Corpus Luteum's Role in the Female Reproductive Cycle
- The corpus luteum is formed after ovulation from the remnants of the Graafian follicle.
- It is primarily responsible for producing progesterone during the luteal phase of the menstrual cycle.
- The progesterone secreted by the corpus luteum prepares the endometrium for potential implantation.
- The corpus luteum is maintained by human chorionic gonadotropin (hCG) secreted by the developing embryo if pregnancy occurs.
- If pregnancy doesn't occur, the corpus luteum degenerates into the corpus albicans due to decreasing LH levels.
Hormonal Control of the Male Reproductive System
- Luteinizing hormone (LH) stimulates Leydig cells in the testes to produce testosterone.
- Testosterone, produced by Leydig cells, provides negative feedback to the hypothalamus and pituitary gland, regulating LH and FSH secretion.
- Inhibin, a hormone produced by Sertoli cells, inhibits FSH secretion, working in conjunction with testosterone for fine-tuning spermatogenesis.
Breast Tissue Changes During Lactation
- Prolactin, a hormone released after childbirth, stimulates the production of milk in the alveolar epithelial cells of the mammary glands.
- Oxytocin, another post-partum hormone, causes contraction of myoepithelial cells surrounding the alveoli, facilitating milk ejection.
- The contraction of myoepithelial cells pushes milk through the lactiferous ducts toward the nipple.
Comparing Phases of the Menstrual Cycle with Hormonal Profiles
- The follicular phase is characterized by increasing levels of estrogen as the dominant follicle matures.
- The luteal phase is characterized by high levels of progesterone produced by the corpus luteum after ovulation.
- The menstrual phase is triggered by a decline in both progesterone and estrogen, leading to the shedding of the endometrial lining.
Sertoli Cells' Role in Spermatogenesis
- Sertoli cells in the seminiferous tubules form tight junctions that create the blood-testis barrier, protecting developing sperm cells from the immune system.
- They provide structural support and nourishment to developing sperm cells during spermatogenesis.
- Sertoli cells also produce inhibin, which negatively regulates FSH secretion.
The Pelvic Diaphragm: Anatomy and Function
- The pelvic diaphragm is composed of the levator ani muscle (made up of the pubococcygeus, puborectalis, and iliococcygeus) and the coccygeus muscle.
- Its primary function is to support pelvic organs, including the bladder, uterus, and rectum.
- It acts as a muscular sling that resists intra-abdominal pressure, helping to maintain continence and prevent organ prolapse.
Stages of Spermatogenesis and Regulation
- Spermatogenesis progresses through several stages:
- Spermatogonia (immature sperm cells)
- Primary spermatocytes (undergo the first meiotic division)
- Secondary spermatocytes (undergo the second meiotic division)
- Spermatids (haploid cells containing half a chromosome set)
- Spermatozoa (mature sperm cells)
- Follicle-stimulating hormone (FSH) stimulates Sertoli cells, while LH stimulates Leydig cells to produce testosterone, which enhances spermatogenesis.
- The two meiotic divisions ensure genetic diversity in sperm cells.
Progesterone's Impacts on the Female Reproductive System
- During the luteal phase, progesterone thickens the endometrium, making it more glandular and vascularized to support a potential pregnancy.
- It also reduces contractions of the myometrium to help maintain a stable uterine environment.
- In early pregnancy, progesterone maintains the endometrial lining and prevents menstruation.
The Pampiniform Plexus and Testicular Function
- The pampiniform plexus is a network of veins that surrounds the testicular artery.
- It acts as a countercurrent heat exchanger, cooling arterial blood before it reaches the testes.
- Maintaining a slightly cooler temperature in the testes is crucial for spermatogenesis.
Uterus: Structure and Supporting Ligaments
- The uterus is composed of three layers:
- Endometrium (inner lining)
- Myometrium (muscular middle layer)
- Perimetrium (outer serous layer)
- The primary ligaments supporting the uterus are the uterosacral ligaments (anchor to the sacrum) and the cardinal ligaments (provide lateral support).
- Round ligaments, extending from the uterine horns to the labia majora, help maintain the anteverted position of the uterus.
Hormonal Regulation of the Menstrual Cycle
- The menstrual cycle is regulated by an interplay of hormones:
- GnRH (gonadotropin-releasing hormone) from the hypothalamus
- FSH (follicle-stimulating hormone)
- LH (luteinizing hormone)
- Estrogen
- Progesterone
- FSH promotes follicular development during the follicular phase.
- Estrogen stimulates endometrial proliferation during the follicular phase, while progesterone stabilizes and prepares the endometrium during the luteal phase.
Lactiferous Ducts and Sinuses
- The lactiferous ducts transport milk from the alveoli, the milk-producing units, to the lactiferous sinuses.
- Lactiferous sinuses function as storage reservoirs for milk before it is ejected through the nipple.
- The development and function of lactiferous ducts are influenced by hormones during pregnancy and lactation.
Hormonal Contraception
- Combined oral contraceptives suppress LH and FSH, preventing ovulation.
- Progestogen-only pills thicken cervical mucus and alter the endometrial lining, but do not consistently inhibit ovulation.
- Hormonal contraceptives can thin the endometrial lining and reduce menstrual flow.
Testosterone Replacement Therapy
- Testosterone replacement therapy increases red blood cell production.
Progestogen-Only "Mini-Pill"
- The most common side effect of the progestogen-only pill is breakthrough bleeding.
Estrogen and the Cardiovascular System
- Estrogen improves the HDL to LDL ratio, benefiting cardiovascular health.
Milk Production and Lactation
- Opiates can inhibit milk production by interfering with oxytocin release.
- Prolactin stimulates milk synthesis in the alveolar cells.
- Frequent suckling signals the hypothalamus to maintain prolactin production.
Hypogonadism
- Primary hypogonadism is associated with decreased testosterone levels and high LH levels.
Progesterone
- Progesterone prepares the endometrium for implantation and thickens cervical mucus.
- Progesterone does not increase uterine excitability - it decreases it to prevent premature contractions.
Male Secondary Sexual Characteristics
- Testosterone is primarily responsible for the development of male secondary sexual characteristics.
Menstrual Cycle Regulation
- Estrogen triggers the LH surge for ovulation.
Contraceptive Methods
- Natural family planning has the highest risk of failure when not used consistently.
Anabolic Steroid Use
- Oral anabolic steroids are most likely to cause liver toxicity.
- Long-term anabolic steroid use can suppress the hypothalamic-pituitary-gonadal axis, leading to reduced endogenous testosterone production.
Diagnosing STIs
- ** Herpes simplex virus (HSV)** causes painful ulcerations and bilateral tender inguinal lymphadenitis.
- Chlamydia trachomatis is the most common causative agent of epididymitis in young males under 35 years.
- Dark field microscopy is most effective for confirming a primary syphilitic chancre.
- Trichomonas vaginalis is most commonly associated with a "strawberry cervix" appearance, caused by punctate hemorrhages.
- Syphilis is primarily transmitted through sexual contact.
Syphilis
- Primary syphilis is characterized by a painless chancre lesion.
- Secondary syphilis presents with a rash, fever, and swollen lymph nodes.
- Tertiary syphilis can cause neurological and cardiovascular complications.
- Penicillin is the treatment of choice for all stages of syphilis.
Chlamydia
- Chlamydia trachomatis is the most common bacterial STI worldwide.
- Chlamydia can cause cervicitis, urethritis, and pelvic inflammatory disease (PID).
- Azithromycin or doxycycline are the usual treatments for Chlamydia.
Gonorrhea
- Neisseria gonorrhoeae is a gram-negative diplococcus.
- Gonorrhea can cause urethritis, cervicitis, and PID.
- Ceftriaxone is the treatment of choice for gonorrhea.
Trichomoniasis
- Trichomonas vaginalis is a protozoan parasite.
- Trichomoniasis can cause vaginitis, urethritis, and cervicitis.
- Metronidazole is the treatment of choice for trichomoniasis.
Genital Herpes
- Herpes simplex virus (HSV) is a common viral STI.
- HSV can cause blisters, ulcerations, and genital pain.
- Antiviral medications can help manage outbreaks of genital herpes.
Human Papillomavirus (HPV)
- Human papillomavirus (HPV) is a common viral STI.
- HPV can cause genital warts and cervical cancer.
- Vaccination is available to prevent HPV infection.
HIV
- Human immunodeficiency virus (HIV) is a retrovirus.
- HIV can cause AIDS.
- Antiretroviral therapy (ART) can help manage HIV infection.
Pelvic inflammatory disease (PID)
- PID is an infection of the upper reproductive tract.
- PID can cause pelvic pain, fever, and abnormal vaginal discharge.
- Treatment for PID includes antibiotics.
Key Risk Factors and Prevention Strategies for STIs
- Common risk factors for STIs include having multiple sexual partners, inconsistent condom use, and young age.
- Primary prevention methods include comprehensive sex education, consistent condom use, and regular screening programs.
- Social determinants of health, such as poverty, limited access to healthcare, and stigma, can significantly contribute to higher STI transmission rates.
Diagnosis and Treatment of Urethritis
- Non-gonococcal urethritis (NGU) is primarily caused by Chlamydia trachomatis and Mycoplasma genitalium.
- Nucleic acid amplification test (NAAT) is considered the most reliable diagnostic test for Chlamydia trachomatis.
- First-line treatment options for NGU include azithromycin or doxycycline.
Clinical Presentation and Complications of Gonorrhea and Chlamydia in Women
- Gonorrhea in women may present with symptoms like purulent cervical discharge, dysuria, and intermenstrual bleeding.
- Chlamydia is often asymptomatic or presents with mild discharge and dysuria.
- Untreated gonorrhea and chlamydia can lead to pelvic inflammatory disease (PID), infertility, and chronic pelvic pain.
Public Health Strategies for Managing Gonorrhea Outbreaks
- Key strategies for controlling gonorrhea at the population level include routine screening, partner notification, and promoting safe sex practices.
- Increasing antibiotic resistance in Neisseria gonorrhoeae is a major concern, limiting treatment options.
- Public health initiatives to mitigate resistance include surveillance programs and developing new treatment guidelines.
Pathophysiology and Treatment of Epididymitis
- Chlamydia trachomatis and Neisseria gonorrhoeae are common causative agents of epididymitis in young men.
- Epididymitis typically presents with unilateral scrotal pain, swelling, and fever.
- STI-related epididymitis is often treated empirically with ceftriaxone and doxycycline.
Characteristics and Diagnosis of Syphilis
- Syphilis progresses through primary, secondary, latent, and tertiary stages.
- Dark field microscopy is used to confirm a primary chancre.
- Secondary syphilis presents with a generalized rash, condyloma lata, and systemic symptoms.
Chlamydia Infections
- Chlamydia infections are often asymptomatic, making early diagnosis challenging.
- Routine screening is recommended for sexually active women under 25.
- Partner treatment is crucial for controlling the spread of chlamydia.
Pelvic Inflammatory Disease (PID)
- Causative agents: Neisseria gonorrhoeae and Chlamydia trachomatis.
- Clinical presentation: PID typically presents with lower abdominal pain, fever, and cervical motion tenderness, differing from urethritis which usually causes discharge, dysuria, and lower abdominal pain.
- Treatment: Moderate to severe PID is treated with combination intravenous antibiotics such as ceftriaxone and doxycycline, sometimes with metronidazole.
Genital Herpes
- Complications of untreated genital herpes include neonatal herpes, chronic pain, and psychological distress.
- Asymptomatic shedding can lead to unrecognized transmission.
- Preventive strategies include safe sex practices, regular screening, and suppressive antiviral therapy.
Genital Ulcers
- Common causes: Syphilis, chancroid, and herpes.
- Clinical differentiation: Syphilitic chancres are painless, while chancroid ulcers are painful.
- Diagnostic approach: Dark field microscopy, culture for Haemophilus ducreyi, and nucleic acid amplification testing for HSV.
Case 1: Dysuria and Vaginal Discharge
- Differential diagnoses: Gonorrhea, chlamydia, and trichomoniasis.
- Diagnostic tests: Nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea, wet mount microscopy for trichomonas.
- Treatment: Empirical treatment with ceftriaxone and doxycycline, pending test results.
Case 2: Scrotal Pain, Fever, and Dysuria
- Diagnosis: Epididymitis.
- Investigations: Urinalysis, NAAT for gonorrhea and chlamydia, scrotal ultrasound.
- Treatment: Ceftriaxone and doxycycline, if STI-related.
Case 3: Untreated Syphilis in Pregnancy
- Concern: Risk of congenital syphilis.
- Testing: Rapid plasma reagin (RPR) and confirmatory treponemal test.
- Treatment: Penicillin G.
Case 4: Painless Genital Ulcer
- Diagnosis: Primary syphilis.
- Diagnostic test: Dark field microscopy or nucleic acid amplification testing for Treponema pallidum.
- Treatment: Penicillin G injection.
Case 5: Lower Abdominal Pain, Fever, and Purulent Cervical Discharge
- Diagnosis: Pelvic inflammatory disease (PID).
- Diagnostic tests: NAAT for chlamydia and gonorrhea, pelvic ultrasound.
- Initial treatment: Ceftriaxone plus doxycycline and metronidazole.
Case 6: Painful Urination and Clear Urethral Discharge
- Differential diagnoses: Non-gonococcal urethritis, chlamydia, Mycoplasma genitalium.
- Diagnostic tests: NAAT for chlamydia and Mycoplasma genitalium.
- Treatment: Doxycycline or azithromycin depending on the causative agent.
Case 7: Asymptomatic STI Screening
- Screening tests: Nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea; HIV test.
- Importance of routine screening: Asymptomatic STIs contribute to unrecognized transmission.
- Preventive advice: Consistent condom use, regular testing, and HPV vaccination.
Case 8: Flu-like Symptoms, Generalized Rash and Genital Sore
- Diagnosis: Syphilis.
- Stage: Secondary syphilis.
- Treatment: Penicillin G injection.
Case 9: Painful Vesicular Lesions on External Genitalia
- Diagnosis: Genital herpes (HSV).
- Diagnostic test: Nucleic acid amplification test or PCR testing for HSV.
- Treatment options: Acyclovir or valacyclovir for episodic or suppressive therapy.
Case 10: Post-coital Bleeding, Abnormal PAP Smears, and Pelvic Pain
- Differential Diagnosis: Cervical cancer, advanced PID, or STIs like chlamydia.
- Diagnostic steps: Colposcopy and biopsy, NAAT for STIs.
- Treatment options: Antimicrobials for PID, surgery for cancer.
Tc-99m Sestamibi in Parathyroid Imaging
- Mechanism: Taken up by thyroid and parathyroid tissue, washes out more quickly from thyroid tissue.
- Delayed imaging: Distinguishes adenomas by their slower washout compared to normal thyroid tissue.
- SPECT-CT: Combines functional and anatomical imaging, enhances localization.
PET-CT in Oncological Imaging
- Radiopharmaceutical: Fluorodeoxyglucose (FDG).
- Advantages: Increased sensitivity in detecting tumors over other imaging techniques, metabolic and anatomical information.
- Applications: Tumor staging, treatment response monitoring, and detecting recurrent disease.
Radiation Therapy
- Beta particles: Cause localized DNA damage suitable for targeted therapy.
- Radioisotopes used: I-131, Y-90, and Sr-89.
- Therapeutic applications: Thyroid cancer treatment, bone metastases, and hematologic malignancies.
Thyroid Scintigraphy Findings
- "Cold" nodule: Indicates lower uptake, higher risk of malignancy, but can be benign.
- "Hot" nodule: Indicates increased uptake, functional adenoma, suppress surrounding thyroid tissue.
Hyperthyroidism
- Graves' disease: Characterized by diffuse thyroid uptake.
- Toxic multinodular goitre: Multiple "hot" nodules.
- Toxic adenoma: Single "hot" nodule with suppression of surrounding thyroid tissue.
Parathyroid Imaging with Tc-99m Sestamibi
- Early and delayed images: Differentiate single and multiple adenomas.
- SPECT-CT: Improves localization accuracy and helps distinguish benign and malignant nodules.
Nuclear Medicine Imaging in Oncology
- FDG-PET: Detects metabolically active tumor cells.
- Bone scans: Detects osteoblastic (sclerotic) metastases, used for staging and monitoring treatment response.
- Gallium scans: Useful for detecting lymphoma.
- Tc-99m sestamibi: Used for imaging myeloma, cardiac imaging, and parathyroid localization.
Thyroid Function Tests
- Scintigraphy: Evaluates thyroid gland function, but cannot definitively diagnose malignancy.
- Thyroid scans: Show diffuse uptake in Graves' disease, "hot" and "cold" nodules.
- Useful for: Assessing subclinical hyperthyroidism, evaluating response to treatment.
General Facts
- Radioactive isotope safety: Short-lived isotopes are preferred for minimizing radiation exposure to patients.
- Nuclear medicine: Essential for diagnosis, staging, treatment, and monitoring of various diseases.
- Imaging modalities: Provide functional and anatomical information to guide clinical decision-making.
Insulin and Glucagon
- Insulin is the primary hormone involved during the fed state and promotes glucose uptake in muscle and adipose tissue through GLUT4 translocation.
- Insulin stimulates glycogenesis and glycolysis in the liver.
- Glucagon promotes glycogenolysis and gluconeogenesis to raise blood glucose levels during fasting.
- These hormones oppose each other, maintaining blood glucose homeostasis.
Type 2 Diabetes
- Type 2 diabetes involves insulin resistance and relative insulin deficiency.
- Insulin resistance stems from impaired insulin signaling, leading to reduced GLUT4 translocation and glucose uptake.
- Long-term complications include nephropathy, neuropathy, and retinopathy.
Glucocorticoids
- Glucocorticoids have metabolic effects such as increasing gluconeogenesis, promoting protein catabolism, and stimulating lipolysis.
- They are used for their anti-inflammatory and immunosuppressive actions.
- Long-term use can lead to osteoporosis, hyperglycemia, and adrenal suppression.
Metformin
- Metformin decreases hepatic gluconeogenesis, improves insulin sensitivity, and is often associated with weight neutrality or modest weight loss.
- Contraindications include severe renal impairment and risk of lactic acidosis.
SGLT2 Inhibitors
- SGLT2 inhibitors block glucose reabsorption in the kidneys, leading to glycosuria and glycemic control.
- Benefits include glycemic control, weight loss, and reduced cardiovascular risk.
- Potential side effects include genitourinary infections and dehydration.
Feed-Fast Cycle
- Fasting state involves increased glucagon, cortisol, and decreased insulin.
- Gluconeogenesis is upregulated by enzymes like PEPCK and glucose-6-phosphatase during prolonged fasting.
- In starvation, ketogenesis increases for alternative energy production.
Sulfonylureas and DPP-4 Inhibitors
- Sulfonylureas stimulate insulin secretion by closing ATP-sensitive potassium channels in β-cells.
- DPP-4 inhibitors enhance glucose-dependent insulin secretion by prolonging the action of incretin hormones.
- Sulfonylureas are associated with hypoglycemia and weight gain, while DPP-4 inhibitors have a lower risk of hypoglycemia.
Glucagon in Fasting State
- Glucagon activates PEPCK and glucose-6-phosphatase to promote gluconeogenesis during fasting.
- It stimulates glycogenolysis to release glucose from the liver.
- Prolonged glucagon release can lead to muscle protein breakdown for gluconeogenic substrates.
Type 1 Diabetes
- Involves autoimmune destruction of pancreatic β-cells leading to absolute insulin deficiency.
- Characteristic signs include polyuria, polydipsia, weight loss, and hyperglycemia.
- Lifelong insulin therapy is essential for management.
Glucose Homeostasis and Metabolic Dysfunction
- Gluconeogenesis: The process of producing glucose from non-carbohydrate sources, like amino acids and glycerol, primarily in the liver. It is upregulated during prolonged fasting to maintain blood glucose levels.
- Glucose-6-phosphatase: An enzyme involved in gluconeogenesis, its activity is inhibited by metformin, leading to reduced hepatic glucose production.
- Cortisol: The primary glucocorticoid, playing a role in regulating metabolism and immune responses. During stress, it enhances gluconeogenesis and protein catabolism, increasing blood glucose levels.
- Incretin Hormones: Hormones released from the gut in response to food intake, enhancing glucose-dependent insulin secretion. GLP-1 receptor agonists mimic incretin action.
- Dietary Fiber: Slows gastric emptying, leading to a more gradual absorption of glucose, helping to reduce postprandial glucose spikes.
- Glucagon: A hormone that promotes ketogenesis by stimulating fatty acid oxidation in the liver.
- Polycystic Ovary Syndrome (PCOS): A common condition associated with insulin resistance and hyperinsulinemia.
- GLUT2: Facilitates glucose sensing and uptake in the liver and pancreatic beta cells.
- Thiazolidinediones (e.g., pioglitazone): Can lead to weight gain due to fluid retention and increased adipose tissue.
Complications of Diabetes
- Diabetic Retinopathy: Damage to the blood vessels in the retina, often leading to vision loss.
- Non-Proliferative Diabetic Retinopathy: Characterized by cotton wool spots and microaneurysms, indicating early-stage damage.
- Diabetic Ketoacidosis (DKA): A serious complication of type 1 diabetes, characterized by high blood glucose, ketone production, and acidosis.
- Hyperosmolar Hyperglycemic State (HHS): A complication more common in type 2 diabetes, characterized by extremely high blood glucose and dehydration, but typically without significant ketosis.
Calcium and Phosphate Homeostasis
- Parathyroid Hormone (PTH): A hormone that directly stimulates the reabsorption of calcium in the distal tubules of the kidneys. PTH secretion responds to changes in calcium levels.
- Chronic Kidney Disease (CKD): A common cause of secondary hyperparathyroidism. CKD leads to hyperphosphatemia and decreased calcium levels which stimulates PTH release.
- Fibroblast Growth Factor 23 (FGF23): The primary regulator of phosphate homeostasis; it reduces phosphate reabsorption in the kidneys.
- Humoral Hypercalcemia of Malignancy: A condition where tumor cells produce PTH-related peptide, leading to hypercalcemia even with low PTH levels
Medications Used in Diabetes Management
- Metformin: Inhibits gluconeogenesis in the liver and activates AMPK to reduce glucose production.
- SGLT2 Inhibitors: Reduce glucose reabsorption in the proximal tubules, increasing urinary glucose excretion. May promote weight loss and have cardiovascular benefits
- DPP-4 Inhibitors: Inhibit dipeptidyl peptidase- 4, preventing the degradation of incretin hormones.
- Insulin: Essential for both types of diabetes, but is typically required later in type 2 diabetes.
- Thiazolidinediones: Improve insulin sensitivity, but are not a first-line treatment due to potential side effects.
Additional Key Points For Studying
- HbA1c: Reflects the average blood glucose levels over the past 2-3 months, providing a good indicator of long-term glycemic control. It is not a direct measure of blood glucose levels.
- GLUT4: An insulin-dependent glucose transporter found in skeletal muscle, adipose tissue, and heart. It is not found in the liver.
- Gestational Diabetes: Increased insulin resistance during pregnancy due to placental hormones, which often resolves after delivery but increases the risk of developing type 2 diabetes later in life.
- Type 1 Diabetes: Characterized by autoimmune destruction of pancreatic beta cells, leading to insulin deficiency.
- Type 2 Diabetes: Characterized by insulin resistance and relative insulin deficiency.
Insulin and Glucagon Balance
- Insulin and glucagon are key hormones that regulate blood glucose levels.
- Insulin promotes glucose uptake and utilization by cells, lowers blood glucose, and stimulates anabolic pathways.
- Glucagon stimulates glycogenolysis and gluconeogenesis, raising blood glucose levels.
- The balance between these hormones coordinates glucose homeostasis in various metabolic states, such as feeding, fasting, and exercise.
HbA1c as a Diabetes Control Marker
- HbA1c reflects average blood sugar over 2-3 months, providing a long-term measure of diabetes control.
- Higher HbA1c levels indicate poor glycemic control and are linked to an increased risk of diabetic complications.
- Factors like hemoglobin variants, anemia, and recent blood transfusions can affect HbA1c accuracy.
Primary vs. Secondary Hyperparathyroidism
- Primary hyperparathyroidism is caused by a parathyroid adenoma (tumor), leading to excessive PTH secretion.
- Secondary hyperparathyroidism is usually a consequence of chronic kidney disease, where decreased vitamin D activation and calcium levels trigger compensatory PTH elevation.
- Primary hyperparathyroidism presents with elevated calcium and PTH levels, while secondary hyperparathyroidism demonstrates elevated PTH with normal or low calcium.
- Primary hyperparathyroidism is often treated with surgical removal of the adenoma while secondary hyperparathyroidism requires managing the underlying kidney disease and employing phosphate binders, vitamin D analogs, and calcium supplements.
Vitamin D's Role in Calcium Homeostasis
- Vitamin D increases calcium absorption in the intestines by boosting the expression of calcium-binding proteins in the intestinal mucosa.
- This crucial vitamin also promotes bone mineralization and orchestrates bone remodeling.
- Vitamin D is activated through two hydroxylation steps, one in the liver and the other in the kidneys, forming calcitriol (active vitamin D).
Diabetic Ketoacidosis (DKA)
- DKA occurs in diabetic patients due to insufficient insulin, leading to uncontrolled lipolysis and ketone production.
- This results in hyperglycemia (high blood glucose), metabolic acidosis (excess acid in the blood), and ketonemia (excess ketones in the blood).
- Managing DKA involves insulin administration, intravenous fluid replacement, and electrolyte monitoring.
PTH and Calcitonin in Calcium Homeostasis
- Parathyroid hormone (PTH) influences calcium and phosphate levels by increasing calcium reabsorption in the kidneys, promoting bone resorption to release calcium, and decreasing phosphate reabsorption.
- Calcitonin, secreted by the thyroid gland, counteracts bone resorption by inhibiting osteoclastic activity, lowering blood calcium levels.
- While both hormones have opposing effects on calcium, calcitonin plays a relatively minor role compared to PTH.
Insulin Resistance in Type 2 Diabetes
- Insulin resistance, a hallmark of type 2 diabetes, involves reduced insulin sensitivity and impaired glucose uptake.
- This occurs due to defects in insulin receptor signaling and inadequate GLUT4 translocation.
- Chronic inflammation contributes to insulin resistance by inducing cytokines that interfere with insulin signaling.
- Untreated insulin resistance can progress to type 2 diabetes, increase risk of cardiovascular disease, and contribute to metabolic syndrome.
Glucocorticoids in Stress Response and Metabolism
- Glucocorticoids, primarily cortisol, are stress hormones that play significant roles in metabolic regulation.
- They elevate blood glucose levels by boosting gluconeogenesis (glucose production) and reducing peripheral glucose uptake.
- Glucocorticoids promote protein catabolism (breakdown) and mobilize fatty acids for energy use.
- Chronic glucocorticoid use can lead to Cushing's syndrome (excessive cortisol), osteoporosis, and hyperglycemia.
Hormonal Regulation of Bone Remodeling
- Bone remodeling involves a delicate balance between bone resorption (breakdown) and bone formation.
- PTH, calcitonin, and vitamin D are key hormones involved in this process.
- Estrogen plays a crucial role in maintaining bone density by suppressing osteoclastic activity and promoting bone formation.
- Chronic hyperparathyroidism leads to increased bone resorption, contributing to osteopenia or osteoporosis.
Diabetic Retinopathy
- Diabetic retinopathy is a common eye complication of diabetes that affects the blood vessels in the retina.
- Non-proliferative retinopathy involves microaneurysms (small bulges in blood vessels) and retinal hemorrhages.
- Proliferative retinopathy features neovascularization (new blood vessel growth) in the retina, which can lead to vision loss.
- Hyperglycemia damages retinal vessels, causing ischemia (reduced blood flow) and subsequent neovascularization.
- Management includes laser photocoagulation, anti-VEGF injections, and strict glycemic control.
Hypocalcemia
- Hypocalcemia, characterized by low blood calcium levels, can result from vitamin D deficiency, hypoparathyroidism, or chronic kidney disease.
- Low calcium levels enhance neuromuscular excitability, causing symptoms like tetany (muscle spasms), muscle cramps, and tingling sensations.
- Treatment involves intravenous calcium administration and addressing the underlying cause.
Insulin, Glucagon, and Epinephrine in Hypoglycemia
- Glucagon is a key hormone that counteracts hypoglycemia (low blood glucose) by promoting glycogenolysis (glucose release from glycogen) and gluconeogenesis (glucose production from non-carbohydrate sources).
- Epinephrine, a hormone released during stress, raises blood glucose levels by stimulating hepatic glucose production and suppressing insulin secretion.
- Insulin secretion is reduced during hypoglycemia to prevent further lowering of blood glucose levels.
Diabetic Neuropathy
- Diabetic neuropathy is a nerve damage complication of diabetes affecting different types of nerves.
- Chronic hyperglycemia damages microvasculature and impairs nerve function, contributing to diabetic neuropathy.
- Common types include peripheral neuropathy (damage to peripheral nerves), autonomic neuropathy (affecting autonomic nerves), and focal neuropathy (damage to specific nerves).
- Management involves glycemic control, pain management, and monitoring for complications.
Case Studies - SAQs
- Case 1: A 45-year-old male with persistent polyuria, polydipsia, and blurred vision, along with a family history of diabetes and BMI of 32, is likely diagnosed with type 2 diabetes.
- Case 2: A 60-year-old woman with osteoporosis experiencing bone pain and elevated serum calcium levels is likely suffering from primary hyperparathyroidism.
- Case 3: A 25-year-old female with fatigue, muscle cramps, and positive Chvostek's sign (a sign of hypocalcemia), with labs showing low calcium and high phosphate levels, is likely diagnosed with hypoparathyroidism.
Male and Female Reproductive Tract Development
- The mesonephric (Wolffian) duct gives rise to the male reproductive duct system, including the epididymis, vas deferens, and seminal vesicles.
- The paramesonephric (Müllerian) duct contributes to the formation of the female reproductive tract, including the fallopian tubes, uterus, and upper vagina.
- Anti-Müllerian hormone (AMH), secreted by Sertoli cells in the testes, signals the regression of the paramesonephric ducts in males.
Comparing Gonads
- Seminiferous tubules in the testes are lined by germinal epithelium, which contains spermatogonia and other cells involved in sperm production.
- The ovarian follicle is the functional unit within the ovary. It houses the oocyte and releases it during ovulation.
- Sertoli cells support spermatogenesis in the testes, providing nourishment and forming the blood-testis barrier.
- Granulosa cells support oogenesis in the ovaries by providing nourishment and secreting hormones.
Perineal Body Function
- The perineal body is located at the midpoint between the ischial tuberosities in the pelvis.
- It serves as an attachment for several muscles, including the bulbospongiosus, superficial and deep transverse perineal muscles, and external anal sphincter.
- Its damage during childbirth can lead to pelvic floor disorders.
Sertoli and Leydig Cells
- Sertoli cells are stimulated by follicle-stimulating hormone (FSH), and their primary function is to support the development of sperm cells. They also contribute to the formation of the blood-testis barrier, which separates the developing sperm from the immune system.
- Leydig cells produce testosterone in response to luteinizing hormone (LH). Testosterone is essential for the development and maintenance of male secondary sexual characteristics.
Male Reproductive System
- Sertoli Cells and Leydig Cells:
- Sertoli cells nurture developing sperm, forming tight junctions to create the blood-testis barrier.
- Leydig cells produce testosterone in response to luteinising hormone (LH).
Perineum
- Boundaries:
- The perineum extends from the pubic symphysis anteriorly to the coccyx posteriorly, with the ischial tuberosities laterally.
- Muscles:
- The bulbospongiosus muscle plays a more prominent role during ejaculation in males.
External Genitalia Development
- Genital Tubercle:
- Develops into the penis in males and the clitoris in females.
- Urethral Folds:
- Fuse in males to form the penile urethra, remain unfused in females to form the labia minora.
- Androgens:
- Primarily testosterone, promote masculinisation of external genitalia.
Tunica Albuginea
- Testes:
- Encloses and supports the seminiferous tubules.
- Ovaries:
- Thinner than in the testes, helps maintain structural integrity and participates in follicle rupture during ovulation.
Menstrual Cycle
- Follicular Phase:
- Dominated by follicle-stimulating hormone (FSH) and oestrogen.
- Ovulation:
- Triggered by a surge in luteinising hormone (LH).
- Luteal Phase:
- Maintained by progesterone secreted by the corpus luteum.
Uterine Tubes
- Development:
- Develop from the paramesonephric (Müllerian) ducts.
- Ciliated Epithelium:
- Aiding in oocyte transport.
- Developmental Defects:
- Congenital absence or obstruction can affect fertility.
Pelvic Diaphragm
- Muscles:
- Primarily the levator ani and coccygeus muscles.
- Function:
- Supports pelvic organs, maintains continence.
- Clinical Issues:
- Weakening can lead to pelvic organ prolapse and incontinence.
Case Study Scenarios
- Ovarian Follicular Cyst:
- Characterised by a fluid-filled cyst lined by granulosa cells.
- Potential complications include rupture, torsion, or haemorrhage.
- Male Infertility:
- Low sperm count with poor motility, associated with testicular atrophy.
- Assess testosterone, LH, FSH levels.
- Evaluate Sertoli cell function by measuring inhibin B levels.
- Pelvic Floor Dysfunction:
- Weakening of the pelvic diaphragm, especially the levator ani muscles.
- Confirm with pelvic floor ultrasound and physical examination.
- Treated with pelvic floor physical therapy or surgical repair.
- Testicular Tumour:
- Firm, non-tender, non-transilluminating scrotal mass, potentially a seminoma.
- Seminomas involve germ cells.
- Diagnosed using markers like beta-human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH).
- Postmenopausal Changes:
- Oestrogen deficiency leading to vaginal dryness and UTIs.
- Thinning and reduced glycogen in the vaginal epithelium.
- Treated with topical or systemic oestrogen therapy.
- Teratoma:
- Cystic mass with solid areas, arising from pluripotent cells that failed to differentiate properly.
- Monitor for complications like torsion or growth impinging on the fetus.
- Haematospermia:
- Differential diagnosis includes seminal vesicle inflammation, prostate issues, or a vascular anomaly.
- Investigate with urinalysis, ultrasound, and possibly cystoscopy.
- Endometriosis:
- Endometrial tissue outside the uterine cavity, presenting with pelvic pain and painful menstruation.
- Histological features include endometrial glands and stroma outside the uterine cavity.
- Managed with hormonal therapy or surgical resection.
- Testicular Torsion:
- Sudden severe testicular pain and swelling following exercise.
- Perform scrotal ultrasound with Doppler flow immediately.
- Treat with immediate surgical detorsion and fixation (orchidopexy).
- Benign Prostatic Hyperplasia (BPH):
- Difficulty urinating and increased urinary frequency in older men.
- Enlarged, non-tender prostate.
- The transitional zone is most commonly affected.
- Treatment includes alpha-blockers, 5-alpha reductase inhibitors, or surgical intervention.
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Test your knowledge on renal physiology focusing on filtration mechanisms in the glomerulus. Understand the key forces that drive filtration and their importance in kidney function. This quiz is ideal for students studying physiology in detail.
