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Questions and Answers

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?

  • 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?

  • 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?

    <p>Increasing systemic blood pressure</p> Signup and view all the answers

    Which hormone is primarily responsible for water reabsorption in the collecting ducts?

    <p>ADH</p> Signup and view all the answers

    What vitamin is essential for calcium absorption in the gastrointestinal tract?

    <p>Vitamin D</p> Signup and view all the answers

    Which is NOT one of the primary roles of the juxtaglomerular apparatus in the kidney?

    <p>Regulation of sodium excretion</p> Signup and view all the answers

    A patient with elevated ferritin and transferrin saturation, but no clinical symptoms, is likely in which stage of hereditary hemochromatosis?

    <p>Biochemical</p> Signup and view all the answers

    Which type of gastric cell produces hydrochloric acid?

    <p>Parietal cells</p> Signup and view all the answers

    Which of the following electrolyte abnormalities is common in Addison's disease?

    <p>Hyperkalaemia</p> Signup and view all the answers

    In respiratory physiology, what does an increase in the V/Q ratio indicate?

    <p>Dead space ventilation</p> Signup and view all the answers

    Which genetic disorder is diagnosed by detecting the C282Y mutation in the HFE gene?

    <p>Hereditary haemochromatosis</p> Signup and view all the answers

    Which neurotransmitter is primarily involved in the retrograde signal in peristalsis?

    <p>Nitric oxide</p> Signup and view all the answers

    Which condition is most associated with elevated levels of alkaline phosphatase (ALP) without elevated GGT?

    <p>Bone metastasis</p> Signup and view all the answers

    Which of the following is NOT a feature of nephrotic syndrome?

    <p>Haematuria</p> Signup and view all the answers

    Which enzyme is responsible for the conversion of angiotensin I to angiotensin II?

    <p>ACE</p> Signup and view all the answers

    What is the major function of bile acids in digestion?

    <p>Emulsification of fats</p> Signup and view all the answers

    In liver function, which of the following tests is most indicative of synthetic function?

    <p>Albumin</p> Signup and view all the answers

    A patient with primary biliary cholangitis will most likely have which of the following antibodies?

    <p>Anti-mitochondrial antibodies</p> Signup and view all the answers

    Which of the following is true regarding the cephalic phase of digestion?

    <p>It is mediated by the parasympathetic nervous system</p> Signup and view all the answers

    What is the effect of aldosterone on the kidneys?

    <p>Sodium reabsorption</p> Signup and view all the answers

    Which of the following is characteristic of respiratory acidosis?

    <p>Increased PaCO2</p> Signup and view all the answers

    The primary defect in coeliac disease is due to:

    <p>An autoimmune response to gluten</p> Signup and view all the answers

    Which of the following laboratory values would most suggest acute liver failure?

    <p>Elevated bilirubin with decreased albumin</p> Signup and view all the answers

    In renal clearance, what is a primary function of the proximal tubule?

    <p>Reabsorption of glucose</p> Signup and view all the answers

    Which structure separates the functional left and right lobes of the liver?

    <p>Principal plane</p> Signup and view all the answers

    Which of the following is involved in gastric acid secretion regulation?

    <p>Somatostatin from D cells</p> Signup and view all the answers

    Which is a common early sign of chronic kidney disease?

    <p>Proteinuria</p> Signup and view all the answers

    Which of the following conditions is likely to cause high anion gap metabolic acidosis?

    <p>Diabetic ketoacidosis</p> Signup and view all the answers

    A common mutation in hereditary haemochromatosis is:

    <p>C282Y</p> Signup and view all the answers

    Which vitamin is crucial in preventing neural tube defects?

    <p>Folic acid</p> Signup and view all the answers

    Which of the following drugs is most likely to cause renal toxicity?

    <p>Ibuprofen</p> Signup and view all the answers

    The bicarbonate buffer system is crucial in maintaining blood pH. What is the normal plasma bicarbonate concentration?

    <p>22-26 mEq/L</p> Signup and view all the answers

    Which cell type produces insulin in the pancreas?

    <p>Beta cells</p> Signup and view all the answers

    In acute pancreatitis, which of the following enzymes is typically elevated?

    <p>Amylase</p> Signup and view all the answers

    The intrinsic factor required for vitamin B12 absorption is produced by which type of gastric cell?

    <p>Parietal cells</p> Signup and view all the answers

    Which of the following is considered a risk factor for the development of gastric adenocarcinoma?

    <p>H. pylori infection</p> Signup and view all the answers

    Which of the following conditions is most likely associated with prolonged use of NSAIDs?

    <p>Peptic ulcer disease</p> Signup and view all the answers

    In which part of the nephron is most sodium reabsorbed?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    Which of the following is the primary mechanism of aldosterone’s effect on sodium?

    <p>It increases sodium reabsorption in the DCT</p> Signup and view all the answers

    Which of the following is the characteristic abnormality seen in Wilson's disease?

    <p>Increased urinary copper excretion</p> Signup and view all the answers

    Which hormone promotes calcium absorption from the small intestines?

    <p>Vitamin D</p> Signup and view all the answers

    What is the most likely complication of untreated coeliac disease?

    <p>Osteoporosis</p> Signup and view all the answers

    Which of the following factors most directly stimulates insulin secretion from beta cells in the pancreas?

    <p>High blood glucose</p> Signup and view all the answers

    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?

    <p>Respiratory acidosis</p> Signup and view all the answers

    In the liver, what is the primary function of Kupffer cells?

    <p>Phagocytosis of bacteria and debris</p> Signup and view all the answers

    Which of the following conditions results in hyperbilirubinaemia due to excessive red blood cell destruction?

    <p>Haemolytic anaemia</p> Signup and view all the answers

    In renal physiology, what does the term 'renal clearance' refer to?

    <p>The amount of plasma cleared of a substance per minute</p> Signup and view all the answers

    In which organ does the urea cycle primarily take place?

    <p>Liver</p> Signup and view all the answers

    A patient presents with pruritus and jaundice. Which of the following conditions is most likely the cause?

    <p>Primary sclerosing cholangitis</p> Signup and view all the answers

    Which of the following is a major site of bicarbonate reabsorption in the kidney?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    Which of the following is a feature of metabolic acidosis with compensation?

    <p>Decreased PaCO2</p> Signup and view all the answers

    What is the role of glucocorticoids in inflammation?

    <p>To suppress the immune response</p> Signup and view all the answers

    In the gastrointestinal tract, which of the following hormones stimulates the release of bile from the gallbladder?

    <p>Cholecystokinin (CCK)</p> Signup and view all the answers

    Which of the following is NOT typically a symptom of nephritic syndrome?

    <p>Hyperlipidaemia</p> Signup and view all the answers

    Which of the following electrolyte disturbances is commonly seen in patients with chronic kidney disease?

    <p>Hyperkalaemia</p> Signup and view all the answers

    Which of the following is TRUE regarding hereditary haemochromatosis?

    <p>It leads to increased serum ferritin and transferrin saturation</p> Signup and view all the answers

    Coeliac disease risk is associated with which genetic factors?

    <p>DQ2 and DQ8 alleles</p> Signup and view all the answers

    Which of the following enzymes plays a key role in ammonia conversion in the liver?

    <p>Glutaminase</p> Signup and view all the answers

    In the presence of H. pylori, triple therapy includes all EXCEPT:

    <p>Doxycycline</p> Signup and view all the answers

    The secretion of HCl in the stomach is primarily regulated by which hormone?

    <p>Gastrin</p> Signup and view all the answers

    In liver pathology, elevated levels of ALP and GGT with a normal ALT suggest?

    <p>Biliary obstruction</p> Signup and view all the answers

    Which of the following neurotransmitters is primarily responsible for stimulating peristalsis?

    <p>Acetylcholine (ACh)</p> Signup and view all the answers

    Which of the following drugs is most likely to cause hyperkalaemia in patients with renal impairment?

    <p>Lisinopril</p> Signup and view all the answers

    The most likely diagnosis for a patient presenting with episodic blood diarrhoea, fever, and abdominal pain, with granulomatous inflammation seen on colonoscopy is:

    <p>Crohn’s disease</p> Signup and view all the answers

    Which test is considered the most reliable for diagnosing hereditary haemochromatosis?

    <p>Genetic testing for C282Y and H63D mutations</p> Signup and view all the answers

    Which of the following electrolyte imbalances is expected in metabolic acidosis?

    <p>Hyperkalaemia</p> Signup and view all the answers

    What electrolyte disturbance is most likely in a patient with severe diarrhoea?

    <p>Hypokalaemia</p> Signup and view all the answers

    Which of the following conditions is characterized by a raised AST/ALT ratio and increased GGT?

    <p>Alcoholic hepatitis</p> Signup and view all the answers

    Secretin primarily stimulates the secretion of:

    <p>Bicarbonate from the pancreas</p> Signup and view all the answers

    In a patient with hereditary haemochromatosis, what is the primary treatment?

    <p>Phlebotomy</p> Signup and view all the answers

    Which substance catalyzes the conversion of angiotensinogen to angiotensin I?

    <p>Renin</p> Signup and view all the answers

    Which of the following is a hallmark feature of Crohn’s disease as opposed to ulcerative colitis?

    <p>Transmural inflammation with skip lesions</p> Signup and view all the answers

    The liver deaminates amino acids to form:

    <p>Urea</p> Signup and view all the answers

    What is the most common cause of primary bile acid malabsorption?

    <p>Ileal resection</p> Signup and view all the answers

    Which liver enzyme is primarily elevated in cholestasis?

    <p>ALP</p> Signup and view all the answers

    Which of the following is NOT a common cause of metabolic acidosis?

    <p>Nephritic syndrome</p> Signup and view all the answers

    Which of the following is NOT a renal condition associated with nephritic syndrome?

    <p>Membranous nephropathy</p> Signup and view all the answers

    Patients presenting with weight loss, jaundice, and elevated bilirubin with a palpable mass in the right upper quadrant likely has:

    <p>Pancreatic cancer</p> Signup and view all the answers

    Which of the following is most likely to cause toxicity in a patient with impaired renal function, given a conventional treatment dose?

    <p>Lithium</p> Signup and view all the answers

    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?

    <p>Liver</p> Signup and view all the answers

    In respiratory alkalosis, what is the compensatory mechanism?

    <p>Decreased bicarbonate reabsorption</p> Signup and view all the answers

    Cholecystokinin (CCK) primarily acts on which pancreatic cells?

    <p>Acinar cells</p> Signup and view all the answers

    During which phase of digestion is hydrochloric acid predominantly secreted?

    <p>Gastric</p> Signup and view all the answers

    In which segment of the renal tubule is the majority of water reabsorbed?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    A patient presents with low pH, high PCO2, and elevated bicarbonate levels. What is the most likely condition?

    <p>Respiratory acidosis with metabolic compensation</p> Signup and view all the answers

    A deficiency in which of the following enzymes results in jaundice and bilirubin accumulation in the liver?

    <p>Glucuronyl transferase</p> Signup and view all the answers

    The liver plays a major role in deaminating amino acids. What is the fate of the ammonia produced in this process?

    <p>It is excreted as urea</p> Signup and view all the answers

    Which vitamin deficiency leads to pernicious anemia by impairing the absorption of vitamin B12?

    <p>Vitamin B12</p> Signup and view all the answers

    Hepatocellular carcinoma most commonly arises in which of the following conditions?

    <p>Cirrhosis</p> Signup and view all the answers

    The bile canaliculi in the liver are lined by which type of epithelium?

    <p>Simple cuboidal</p> Signup and view all the answers

    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)

    <p>a) Viral hepatitis, alcoholic liver disease, autoimmune hepatitis b) Hepatitis viral serology (Hep A,B,C), Autoimmune markers (ANA, ASMA)</p> Signup and view all the answers

    Describe the regulation of aldosterone secretion in response to hypovolaemia (5 marks).

    <p>Aldosterone secretion is primarily regulated by the renin-angiotensin-aldosterone system (RAAS), which is activated in response to hypovolaemia. When blood volume decreases it is detected by baroreceptors in the juxtaglomerular apparatus, leading to the secretion of renin, which converts angiotensinogen to angiotensin I. This is further converted to angiotensin II by ACE in the lungs. Angiotensin II stimulates aldosterone secretion from the adrenal cortex, promoting sodium and water retention to increase blood volume.</p> Signup and view all the answers

    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)

    <p>a) Metabolic alkalosis b) Yes, Respiratory compensation</p> Signup and view all the answers

    Outline the genetic basis of coeliac disease, including the role of HLA alleles? (4 marks)

    <p>Coeliac disease is strongly associated with the presence of HLA-DQ2 and HLA-DQ8 alleles, which encode proteins involved in presenting gluten peptides to T-cells. In genetically predisposed individuals, ingestion of gluten triggers an immune response, leading to intestinal inflammation and villous atrophy</p> Signup and view all the answers

    Compare and contrast the pathophysiology of Crohn’s disease and ulcerative colitis (6 marks)

    <p>Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, often involving the ileum and colon. It is transmural inflammation with skip lesions and granulomas. Can have complications such as strictures and fistulas. Ulcerative colitis is limited to the colon and rectum. It is continuous inflammation limited to the mucosa or submucosa and ulceration. There are no granulomas and it is associated with a higher risk of colon cancer.</p> Signup and view all the answers

    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)

    <p>(a) HFE gene mutation test for C282Y and H63D mutations (b) If the patient is homozygous for C282Y or compound heterozygous for C282Y/H63D, she is at risk of developing iron overload and should be monitored. If heterozygous, she is a carrier and unlikely to develop the disease</p> Signup and view all the answers

    Describe the role of the sodium-potassium pump in maintaining resting membrane potential in a neuron (4 marks)

    <p>The sodium-potassium pump actively transports 3x Na+ out of the cell and 2x K+ into the cell against their concentration gradients. This creates a negative charge inside the cell relative to the outside and maintains the electrochemical gradient necessary for action potential generation.</p> Signup and view all the answers

    Explain the physiological response to hypoxaemia at high altitudes, focusing on ventilation and blood gas changes (5 marks)

    <p>At high altitudes, low atmospheric oxygen levels cause hypoxaemia, stimulating peripheral chemoreceptors to increase ventilation. This hyperventilation leads to a decrease in PaCO2, causing respiratory alkalosis. Over time, the kidneys compensate by excreting bicarbonate to normalise pH, allowing for better oxygen unloading from haemoglobin.</p> Signup and view all the answers

    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)

    <p>(a) Vitamin B12 deficiency, Folate deficiency (b) Vitamin B12 is necessary for DNA synthesis, especially in rapidly dividing cells like erythroblasts. Without adequate B12, cells undergo ineffective erythropoiesis, leading to macrocytosis</p> Signup and view all the answers

    Describe the countercurrent multiplier system in the loop of Henle. (5 marks)

    <p>The countercurrent multiplier system in the loop of Henle generates a concentration gradient in the renal medulla. The descending limb is permeable to water but not solutes, so water is reabsorbed, concentrating the filtrate. The ascending limb is impermeable to water but actively reabsorbed NaCl, diluting the filtrate. This process maintains a hyperosmotic medullary interstitium that facilitates water reabsorption from the collecting ducts under the influence of ADH</p> Signup and view all the answers

    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)

    <p>(a) Cushing's syndrome (b) Cortisol is regulated by a negative feedback loop involving the hypothalamus, anterior pituitary, and adrenal cortex. Increased cortisol inhibits the release of CRH from the hypothalamus and ACTH from the pituitary</p> Signup and view all the answers

    Compare and contrast nephrotic syndrome and nephritic syndrome (6 marks)

    <p>Nephrotic syndrome is characterised by significant proteinuria (&gt;3.5 g/day), hypoalbuminaemia, oedema, and hyperlipidaemia. It is caused by damage to the glomerular filtration barrier. Nephritic syndrome is characterised by haematuria, hypertension, oliguria, and mild proteinuria. It is caused by inflammation of the glomeruli, often due to immune complex deposition.</p> Signup and view all the answers

    Describe how oxygen and carbon dioxide are transported in the blood (5 marks).

    <p>Oxygen is transported bound to haemoglobin (98%) and dissolved in plasma (2%). CO2 is transported as bicarbonate (70%), bound to haemoglobin as carbaminohaemoglobin (20%), and dissolved in plasma (10%)</p> Signup and view all the answers

    Explain the mechanisms of action of proton pump inhibitors and H2 blockers in gastric acid suppression (4 marks)

    <p>Proton pump inhibitors (PPIs) irreversibly inhibit the H+/K+ ATPase enzyme in gastric parietal cells, preventing H+ secretion into the stomach lumen. H2 blockers competitively inhibit histamine (H2) receptors on gastric parietal cells, leading to reduced acid production.</p> Signup and view all the answers

    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)

    <p>(a) Lung cancer (b) Bronchoscopy with biopsy, and CT-guided fine-needle aspiration</p> Signup and view all the answers

    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)

    <ol> <li>Hepatitis; 2. Primary biliary cholestasis; 3. Biliary obstruction. Laboratory tests: 1. Liver function tests (ALT, AST, ALP, GGT); 2. Imaging (ultrasound or MRCP)</li> </ol> Signup and view all the answers

    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)

    <p>(a) Metabolic acidosis (b) No compensation present, as PaCO2 remains normal. In compensated metabolic acidosis, PaCO2 would be decreased due to hyperventilation (respiratory alkalosis)</p> Signup and view all the answers

    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)

    <p>(a) The cholera toxin produced by Vibrio cholerae activates adenylate cyclase, increasing cAMP in intestinal epithelial cells. This leads to chloride and water secretion into the intestinal lumen, causing profuse watery diarrhoea. (b) Oral rehydration therapy and antibiotics (e.g., doxycycline)</p> Signup and view all the answers

    Explain how the body compensates for respiratory acidosis (5 marks).

    <p>In respiratory acidosis, the kidneys compensate by increasing the reabsorption of bicarbonate and excreting hydrogen ions . This helps buffer the excess CO2 and raise blood pH. The compensation is slow and can take several days.</p> Signup and view all the answers

    Compare and contrast respiratory and metabolic acidosis in terms of causes (at least 3 of each), lab findings, and compensation mechanisms (5 marks)

    <p>Metabolic acidosis is excessive acid production or bicarbonate loss. Compensation occurs through hyperventilation to reduce PaCO2. Causes of high anion gap: M - methanol, U - Ureamia, D - Diabetic ketoacidosis, P - Propylene glycol, I - Iron tablets,isoniazid, L - Lactic acidosis, E - Ethylene glycol, S - Salicylates (MUDPILES) and causes of low anion gap: H - Hyperalimentation, A - Addison’s disease, R - Renal tubular acidosis, D - Diarrhoea, A - Acetazolamide, S - spironolactone, S - Saline infusion (HARDASS) and Respiratory acidosis (hypoventilation) is increased PaCO2 and is compensated by renal bicarbonate retention. Causes are: S - Sedative use, A - Acute lung disease, D - Drugs (opioids), C - Chronic lung disease, O - Obstruction (airways), W - Weakened resp muscles.</p> Signup and view all the answers

    Describe the mechanisms of action and clinical uses of ACE inhibitors and angiotensin receptor blockers (ARBs) (5 marks)

    <p>ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to vasodilation, decreased aldosterone secretion and reduced blood pressure. ARBs block the action of angiotensin II at its receptor. Both are used to treat hypertension, heart failure, and chronic kidney disease.</p> Signup and view all the answers

    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)

    <p>(a) Alcoholic liver disease, cirrhosis, hepatitis. (b) Liver biopsy and abdominal ultrasound</p> Signup and view all the answers

    Outline the physiological role of vitamin D and calcium homeostasis and bone metabolism (4 marks)

    <p>Vitamin D increases intestinal absorption of calcium and phosphate, promotes calcium reabsorption in the kidneys, and stimulates bone reabsorption to release calcium into the bloodstream. It is essential for maintaining adequate serum calcium levels and bone mineralisation.</p> Signup and view all the answers

    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)

    <p>Primary biliary cholangitis is an autoimmune disease characterised by the destruction of intra-hepatic bile ducts, leading to cholestasis and fibrosis. It is diagnosed by the presence of anti-mitochondrial antibodies (AMA) and elevated ALP and GGT.</p> Signup and view all the answers

    Describe the role of the portal hepatic vein in nutrient absorption (3 marks)

    <p>The portal hepatic vein transports nutrient-rich blood from the gastrointestinal tract and spleen to the liver, where nutrients are processed, stored, or detoxified before entering systemic circulation.</p> Signup and view all the answers

    A patient presents with hypokalaemia. Explain how the RAAS system contributes to potassium balance. (4 marks)

    <p>The RAAS system promotes the release of aldosterone, which increases sodium reabsorption in the distal nephron in exchange for potassium excretion in urine. In hypokalaemia, aldosterone levels are typically high, further promoting potassium loss in the urine.</p> Signup and view all the answers

    Describe the mechanisms by which bicarbonate ions are secreted into the duodenum and the regulatory hormone involved. (4 marks)

    <p>When acidic chyme enters the duodenum, the hormone secretin in released by S cells which stimulates the secretion of bicarbonate ions primarily by the pancreas</p> Signup and view all the answers

    Explain the physiological roles of the juxtaglomerular apparatus in regulating blood pressure and glomerular filtration rate (GFR) (5 marks)

    <p>The juxtaglomerular apparatus regulates blood pressure and GFR by releasing renin, which activates the renin-angiotensin-aldosterone system (RAAS) to increase blood pressure, and by detecting changes in sodium concentration and blood flow to adjust the GFR accordingly.</p> Signup and view all the answers

    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)

    <p>Expect elevated liver enzymes (ALT, AST), increased bilirubin levels, decreased albumin levels, and prolonged prothrombin time.</p> Signup and view all the answers

    Explain the process of tubular reabsorption of glucose in the kidneys and the consequences of exceeding the renal threshold for glucose. (4 marks)

    <p>Glucose is reabsorbed in the proximal convoluted tubule through sodium-glucose transporters (SGLTs), which use sodium gradients to transport glucose against its concentration gradient. If blood glucose levels exceed the renal threshold (approximately 180 mg/dL), glucose will not be fully reabsorbed, resulting in glucose appearing in the urine (glycosuria).</p> Signup and view all the answers

    Describe the role of parathyroid hormone (PTH) in calcium homeostasis, and outline the response of PTH to low plasma calcium levels, (3 marks)

    <p>PTH increases blood calcium levels by stimulating osteoclast activity, enhancing renal tubular reabsorption of calcium, and promoting the activation of vitamin D to increase intestinal absorption of calcium.</p> Signup and view all the answers

    In a patient with hyperbilirubinaemia, differentiate between pre-hepatic, hepatic, and post-hepatic causes, providing an example of each. (4 marks)

    <p>Pre-hepatic causes involve conditions that increase bilirubin production (e.g., haemolytic anaemia). Hepatic causes are related to liver pathology (e.g., hepatitis). Post-hepatic causes are due to obstruction in the bile ducts (e.g., cholelithiasis).</p> Signup and view all the answers

    Outline the major pathways by which metabolic waste is excreted by the kidneys, focusing on nitrogenous waste and the formation of urea. (3 marks)

    <p>Nitrogenous waste is primarily excreted in the form of urea, which is produced in the liver through the urea cycle from ammonia. The kidneys filter blood, reabsorbing necessary substances while excreting urea and other waste products in urine.</p> Signup and view all the answers

    Explain the differences in acid secretion in response to food stimuli in the cephalic, gastric, and intestinal phases of digestion. (4 marks)

    <p>In the cephalic phase, acid secretion is stimulated by sensory stimuli such as sight, smell, and taste of food, primarily mediated by the vagus nerve. During the gastric phase, the presence of food in the stomach stimulates further acid secretion through local mechanisms and gastrin release. In the intestinal phase, the secretion of acid is reduced due to the presence of acidic chyme in the duodenum and the release of hormones like secretin, which inhibit gastric activity.</p> Signup and view all the answers

    Describe the function of podocytes in the kidney and their role in the filtration barrier. (3 marks)

    <p>Podocytes are specialized epithelial cells in the kidneys that wrap around the glomerular capillaries. They have foot-like processes called pedicels that interdigitate to form filtration slits, which are crucial for the filtration barrier. This structure allows selective filtration of blood, preventing the passage of large proteins and cells while allowing smaller molecules, such as water, electrolytes, and waste products, to pass into the urine.</p> Signup and view all the answers

    Discuss the role of albumin in maintaining the oncotic pressure and the clinical consequences of hypoalbuminaemia. (4 marks)

    <p>Albumin helps maintain oncotic pressure by holding water in the bloodstream, and hypoalbuminaemia can lead to edema, ascites, and hypotension.</p> Signup and view all the answers

    What are the stages of alcoholic liver disease, and how does each stage differ histologically? (5 marks)

    <p>The stages are: fatty liver (steatosis), alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver shows accumulation of fat in hepatocytes, alcoholic hepatitis is characterised by inflammation and necrosis, and cirrhosis involves fibrosis and nodule formation.</p> Signup and view all the answers

    Describe the process of bile salt reabsorption in the enterohepatic circulation and name one condition where this process is disrupted. (2 marks)

    <p>Bile salts are reabsorbed primarily in the ileum of the small intestine through active transport mechanisms into the bloodstream, then transported back to the liver via the portal vein. One condition that disrupts this process is ileal resection or Crohn's disease.</p> Signup and view all the answers

    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)

    <ol> <li>Hepatic encephalopathy, 2. Esophageal varices, 3. Spontaneous bacterial peritonitis, 4. Hepatocellular carcinoma. Portal hypertension leads to increased pressure in the portal venous system, causing fluid to leak from blood vessels into the abdominal cavity, resulting in ascites.</li> </ol> Signup and view all the answers

    Describe the mechanism by which H. pylori infection leads to peptic ulcer disease. (2 marks)

    <p>H. pylori causes inflammation of the gastric mucosa, leading to increased acid production and weakens the stomach's protective mucosal layer, making it susceptible to damage from gastric acid and digestive enzymes, which can result in ulcer formation.</p> Signup and view all the answers

    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)

    <p>Primary biliary cholangitis; Magnetic resonance cholangiopancreatography (MRCP)</p> Signup and view all the answers

    Name the two main drugs used in the treatment of nausea and vomiting, and briefly describe their mechanisms of action. (2 marks)

    <p>Promethazine: H1 receptor antagonist; Ondansetron: 5-HT3 receptor antagonist</p> Signup and view all the answers

    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)

    <p>Clinical features include abdominal distension, fever, tachycardia, and electrolyte imbalance. Treatment involves bowel rest, intravenous fluids, and possibly surgical intervention.</p> Signup and view all the answers

    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)

    <p>Pathogenesis includes infection leading to inflammation and pus collection around the kidney. Complications can involve renal damage, sepsis, and chronic infection. Treatment options typically include antibiotics and drainage of the abscess.</p> Signup and view all the answers

    Compare the histological differences between the small intestine and the colon, focusing on the presence of villi and goblet cells. (3 marks)

    <p>The small intestine has numerous villi and fewer goblet cells, while the colon has no villi and a higher concentration of goblet cells.</p> Signup and view all the answers

    Which of the following enzymes is responsible for the conversion of bilirubin into its conjugated form in the liver?

    <p>Bilirubin glucuronosyltransferase</p> Signup and view all the answers

    In renal physiology, which structure of the nephron is most responsible for the reabsorption of bicarbonate?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    Which of the following would decrease the GFR most significantly?

    <p>Dilating the efferent arteriole</p> Signup and view all the answers

    Which of the following mutations is associated with Wilson's disease?

    <p>ATP7B</p> Signup and view all the answers

    Which of the following conditions is most associated with low levels of caeruloplasmin?

    <p>Wilson's disease</p> Signup and view all the answers

    In terms of acid-base disturbances, which of the following is most likely to result in a high anion gap metabolic acidosis?

    <p>Salicylate poisoning</p> Signup and view all the answers

    Which of the following is a consequence of renal compensation for respiratory alkalosis?

    <p>Decreased reabsorption of bicarbonate</p> Signup and view all the answers

    Which of the following cytokines is most associated with granuloma formation in Crohn's disease?

    <p>TNF-a</p> Signup and view all the answers

    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?

    <p>Spleen</p> Signup and view all the answers

    Which of the following best describes the location of the macula densa within the nephron?

    <p>Adjacent the afferent arteriole in the distal convoluted tubule</p> Signup and view all the answers

    The urea cycle occurs primarily in which two cellular compartments?

    <p>Cytosol and mitochondria</p> Signup and view all the answers

    Which of the following statements regarding coeliac disease is correct?

    <p>Genetic testing is used to exclude, not confirm, the diagnosis of coeliac disease.</p> Signup and view all the answers

    A patient with nephrotic syndrome presents with oedema, proteinuria, and hypoalbuminaemia. What additional laboratory finding is expected?

    <p>Hyperlipidaemia</p> Signup and view all the answers

    Which of the following statements regarding aldosterone’s action in the kidney is INCORRECT?

    <p>It decreases hydrogen ion secretion in the collecting duct</p> Signup and view all the answers

    In liver disease, what is the most common cause of hyperbilirubinaemia in the absence of elevated aminotransferases (ALT/AST)?

    <p>Haemolysis</p> Signup and view all the answers

    A patient has metabolic alkalosis with a low chloride level. Which of the following is the most likely diagnosis?

    <p>Vomiting</p> Signup and view all the answers

    Which of the following is a key function of histamine released by enterochromaffin-like (ECL) cells in the stomach?

    <p>Stimulation of parietal cell acid production</p> Signup and view all the answers

    What is the role of parathyroid hormone (PTH) in phosphate homeostasis?

    <p>Increases urinary excretion of phosphate</p> Signup and view all the answers

    Which of the following best describes the mechanism of action of furosemide?

    <p>Inhibition of the Na+/K+/2Cl- cotransporter in the thick ascending limb of the loop of Henle</p> Signup and view all the answers

    Which of the following conditions is characterized by the presence of non-caseating granulomas in the gastrointestinal tract?

    <p>Crohn’s disease</p> Signup and view all the answers

    A patient has elevated bilirubin, GGT, and ALP but normal AST and ALT. Which of the following is the most likely cause?

    <p>Biliary obstruction</p> Signup and view all the answers

    Which of the following statements regarding beta-haemolytic streptococci is correct?

    <p>Group A beta-haemolytic streptococci can cause rheumatic fever.</p> Signup and view all the answers

    Which of the following statements is true regarding the histology of the liver?

    <p>Kupffer cells are specialised macrophages located in hepatic sinusoids.</p> Signup and view all the answers

    A patient with severe protein-losing enteropathy is most likely to exhibit which of the following laboratory findings?

    <p>Hypoalbuminaemia</p> Signup and view all the answers

    Which of the following pathways is responsible for the conjugation of bilirubin in the liver?

    <p>Glucuronidation</p> Signup and view all the answers

    Which of the following best explains the metabolic consequences of hyperaldosteronism?

    <p>Hypokalaemia and alkalosis</p> Signup and view all the answers

    In the context of the microbiome, what is the function of short-chain fatty acids produced by gut bacteria?

    <p>Reduction of colonic mucosal inflammation</p> Signup and view all the answers

    A patient with liver cirrhosis develops hepatic encephalopathy. Which of the following is the most likely underlying mechanism?

    <p>Increased ammonia levels due to impaired detoxification</p> Signup and view all the answers

    Which of the following antibiotics is most likely to cause Clostridium difficile-associated diarrhea?

    <p>Amoxicillin-clavulanate</p> Signup and view all the answers

    Which of the following drugs is most likely to cause nephrotoxicity in patients with chronic kidney disease?

    <p>Ibuprofen</p> Signup and view all the answers

    Which of the following is a key function of the colon?

    <p>Absorption of water and electrolytes</p> Signup and view all the answers

    Which of the following conditions is least likely to be associated with haematuria?

    <p>Minimal change disease</p> Signup and view all the answers

    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?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    In a patient with chronic renal failure, the most likely cause of secondary hyperparathyroidism is:

    <p>Hypocalcaemia due to reduced vitamin D synthesis</p> Signup and view all the answers

    Which of the following is true regarding renal ammoniagenesis?

    <p>It serves to excrete hydrogen ions and regenerate bicarbonate.</p> Signup and view all the answers

    A patient with polyuria and polydipsia is diagnosed with diabetes insipidus. Which hormone is deficient in this condition?

    <p>ADH</p> Signup and view all the answers

    Which of the following is a feature of post-hepatic jaundice?

    <p>Increased conjugated bilirubin</p> Signup and view all the answers

    In which of the following conditions is the serum-ascites albumin gradient (SAAG) typically elevated?

    <p>Congestive heart failure</p> Signup and view all the answers

    Which of the following tests is most useful in distinguishing between an upper and lower gastrointestinal bleed?

    <p>Blood urea nitrogen (BUN)</p> Signup and view all the answers

    Which of the following is characteristic of Fanconi syndrome?

    <p>Glycosuria in the presence of normal serum glucose</p> Signup and view all the answers

    Which of the following is the primary mechanism by which the kidneys regulate long-term blood pressure?

    <p>Regulation of sodium and water balance</p> Signup and view all the answers

    A patient with renal cell carcinoma is most likely to present with which of the following findings?

    <p>Hypertension</p> Signup and view all the answers

    A patient with obstructive jaundice presents with pale stools and dark urine. Which of the following laboratory abnormalities is most likely present?

    <p>Increased conjugated bilirubin</p> Signup and view all the answers

    Which of the following is true regarding haemochromatosis?

    <p>It is characterised by the accumulation of iron in the liver and other organs.</p> Signup and view all the answers

    A patient presents with dyspepsia and positive serology for Helicobacter pylori. Which of the following is most likely to develop without treatment?

    <p>Peptic ulcer disease</p> Signup and view all the answers

    Which of the following is a common finding in patients with diabetic nephropathy?

    <p>Hyperfiltration</p> Signup and view all the answers

    Which of the following vitamins is essential for the activation of clotting factors in the liver?

    <p>Vitamin K</p> Signup and view all the answers

    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?

    <p>Portal hypertension</p> Signup and view all the answers

    A patient with primary sclerosing cholangitis is at increased risk of developing which of the following conditions?

    <p>Cholangiocarcinoma</p> Signup and view all the answers

    Which of the following statements about Barrett’s oesophagus is correct?

    <p>It involves the metaplasia of esophageal squamous epithelium into columnar epithelium.</p> Signup and view all the answers

    Which of the following is characteristic of minimal change disease?

    <p>Podocyte effacement</p> Signup and view all the answers

    Which of the following statements regarding nephrotic syndrome is NOT correct?

    <p>Haematuria is a frequent finding.</p> Signup and view all the answers

    Which of the following is NOT typically seen in metabolic acidosis with a normal anion gap?

    <p>Ketoacidosis</p> Signup and view all the answers

    Which of the following is NOT a cause of respiratory alkalosis?

    <p>Chronic obstructive pulmonary disease (COPD)</p> Signup and view all the answers

    Which of the following statements about the hepatic portal vein is NOT correct?

    <p>It drains into the inferior vena cava.</p> Signup and view all the answers

    Which of the following is LEAST likely to cause increased serum amylase levels?

    <p>Crohn's disease</p> Signup and view all the answers

    Which of the following statements about aldosterone is NOT correct?

    <p>It promotes the excretion of hydrogen ions in the proximal tubule.</p> Signup and view all the answers

    Which of the following is LEAST likely to be a complication of cirrhosis?

    <p>Hyperalbuminaemia</p> Signup and view all the answers

    Which of the following is NOT typically seen in Addison’s disease?

    <p>Hypernatraemia</p> Signup and view all the answers

    Which of the following laboratory findings is NOT consistent with acute liver failure?

    <p>Normal coagulation profile</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of Crohn's disease?

    <p>Continuous colonic involvement</p> Signup and view all the answers

    Which of the following is NOT a consequence of chronic renal failure?

    <p>Hypernatraemia</p> Signup and view all the answers

    Which of the following statements about coeliac disease is correct?

    <p>The majority of patients express HLA-DQ2 or HLA-DQ8.</p> Signup and view all the answers

    Which of the following is NOT associated with an increased risk of hepatocellular carcinoma?

    <p>Gilbert's syndrome</p> Signup and view all the answers

    Which of the following is NOT an effect of angiotensin II?

    <p>Inhibition of renin secretion</p> Signup and view all the answers

    Which of the following is NOT a component of the glomerular filtration barrier?

    <p>Juxtaglomerular cells</p> Signup and view all the answers

    Which of the following is LEAST likely to cause prerenal acute kidney injury (AKI)?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    Which of the following findings is NOT typical of acute tubular necrosis (ATN)?

    <p>Hypokalaemia</p> Signup and view all the answers

    Which of the following is NOT a cause of nephritic syndrome?

    <p>Membranous nephropathy</p> Signup and view all the answers

    Which of the following is NOT a potential complication of gastro-oesophageal reflux disease (GORD)?

    <p>Achalasia</p> Signup and view all the answers

    Which of the following statements regarding liver cirrhosis is NOT correct?

    <p>It is associated with increased production of albumin.</p> Signup and view all the answers

    Which of the following is NOT a common cause of acute pancreatitis?

    <p>Hepatitis C</p> Signup and view all the answers

    Which of the following is NOT a feature of haemolytic uraemic syndrome (HUS)?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following conditions is NOT associated with pleural effusion?

    <p>Chronic bronchitis</p> Signup and view all the answers

    Which of the following conditions is NOT associated with a normocytic, normochromic anaemia?

    <p>Iron deficiency anaemia</p> Signup and view all the answers

    Which of the following statements about primary biliary cholangitis (PBC) is NOT correct?

    <p>It is often associated with cholangiocarcinoma.</p> Signup and view all the answers

    Which of the following statements about coagulopathies in liver disease is NOT correct?

    <p>Factor VIII levels are decreased in cirrhosis.</p> Signup and view all the answers

    Which of the following laboratory findings is NOT consistent with rhabdomyolysis?

    <p>Hypophosphataemia</p> Signup and view all the answers

    Which of the following is NOT a complication of long-standing hypertension?

    <p>Hypercalcaemia</p> Signup and view all the answers

    Which of the following conditions is LEAST likely to cause secondary hypertension?

    <p>Addison's disease</p> Signup and view all the answers

    Which of the following findings is NOT typically associated with diabetic nephropathy?

    <p>Haematuria</p> Signup and view all the answers

    Which of the following conditions is NOT associated with increased serum uric acid levels?

    <p>Fanconi syndrome</p> Signup and view all the answers

    Which of the following is NOT associated with the development of chronic kidney disease (CKD)?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    Which of the following statements about membranous nephropathy is NOT correct?

    <p>It often presents with haematuria.</p> Signup and view all the answers

    Which of the following is NOT a typical feature of acute interstitial nephritis?

    <p>Proteinuria &gt;3.5 g/day</p> Signup and view all the answers

    Which of the following findings is NOT typical of a patient with acute cholecystitis?

    <p>Elevated serum amylase</p> Signup and view all the answers

    Which of the following statements about acute pyelonephritis is NOT correct?

    <p>It typically presents with nephrotic syndrome.</p> Signup and view all the answers

    Which of the following is NOT a cause of metabolic alkalosis?

    <p>Aldosterone deficiency</p> Signup and view all the answers

    Which of the following is NOT a complication of systemic lupus erythematosus (SLE)?

    <p>Rheumatoid nodules</p> Signup and view all the answers

    Which of the following is NOT a cause of hepatomegaly?

    <p>Hepatolithiasis</p> Signup and view all the answers

    What statement is NOT correct about renin's negative feedback loop?

    <p>Increased angiotensin II levels stimulate renin release.</p> Signup and view all the answers

    Which of the following is NOT a feature of Wilson's disease?

    <p>H63D gene mutation</p> Signup and view all the answers

    Which of the following statements about acute hepatitis is NOT correct?

    <p>Most patients with acute hepatitis A will develop chronic hepatitis.</p> Signup and view all the answers

    Which of the following is NOT a potential complication of liver cirrhosis?

    <p>Hyperglycaemia</p> Signup and view all the answers

    Which of the following statements about glomerular filtration is NOT correct?

    <p>Glomerular filtration is dependent on capsular oncotic pressure (COP).</p> Signup and view all the answers

    Discuss GFR net filtration pressure (NFP) and describe all of the renal corpuscle pressures (5 marks)

    <p>NFP is around 10 mmHg and is determined by the balance between the filtration-driving force, Glomerular Blood Hydrostatic Pressure (GBHP) and the two opposing forces, Blood Colloid Oncotic Pressure (BCOP) and Capsular Hydrostatic Pressure (CHP). NFP = GBHP - (BCOP + CHP). GBHP is the driving force of blood through the glomerular capillaries in the Bowman’s space. This pressure is typically around 55 mmHg and works to push fluid and small solutes through the filtration membrane. Capsular Oncotic Pressure (COP) is typically negligible in driving filtration. Proteins do not normally filter into Bowman’s space, therefore has an oncotic pressure near 0 mmHg. BCOP represents the osmotic pressure exerted by proteins (like albumin) in the blood, which pulls water back into the capillaries. It is around 30 mmHg. CHP is the pressure exerted by the fluid already in Bowman’s space, which also resists the incoming filtrate. It is around 15 mmHg.</p> Signup and view all the answers

    Which of the following is LEAST likely to be associated with primary sclerosing cholangitis (PSC)?

    <p>Sjogren's syndrome</p> Signup and view all the answers

    Which of the following statements about amyloidosis is NOT correct?

    <p>Basement membrane spikes alternating with sub epithelial deposits on EM.</p> Signup and view all the answers

    Which of the following is NOT a feature of tubulointerstitial nephritis?

    <p>HAematuria</p> Signup and view all the answers

    Which of the following is LEAST likely to be a cause of glomerulonephritis?

    <p>Macroscopic polyangiitis</p> Signup and view all the answers

    Which of the following is NOT a characteristic of autosomal dominant polycystic kidney disease (ADPKD)?

    <p>PKHD1 gene mutation</p> Signup and view all the answers

    Which of the following statements regarding glomerular diseases is NOT correct?

    <p>Minimal change disease is primarily seen in NSAIDs use.</p> Signup and view all the answers

    Which of the following is NOT a feature of membranous glomerulonephritis?

    <p>Mesangial cell proliferation</p> Signup and view all the answers

    Which of the following is NOT typically associated with Goodpasture syndrome?

    <p>IgA deposition in the glomeruli</p> Signup and view all the answers

    Which of the following is NOT a cause of acute interstitial nephritis?

    <p>Penicillin</p> Signup and view all the answers

    Which of the following is LEAST likely to present with nephrotic syndrome?

    <p>Post-streptococcal glomerulonephritis</p> Signup and view all the answers

    Which of the following is NOT characteristic of lupus nephritis?

    <p>Class IV Podocytopathy</p> Signup and view all the answers

    Which of the following is NOT correct regarding amyloidosis in the kidney?

    <p>Amyloidosis results in crescent formation.</p> Signup and view all the answers

    Which of the following is NOT associated with rapidly progressive glomerulonephritis?

    <p>Subendothelial immune deposits</p> Signup and view all the answers

    Which of the following is NOT a risk factor for focal segmental glomerulosclerosis (FSGS)?

    <p>Microcytic anaemia</p> Signup and view all the answers

    Which of the following is NOT characteristic of focal segmental glomerulosclerosis (FSGS)?

    <p>Diffuse thickening of the basement membrane</p> Signup and view all the answers

    Which of the following is LEAST likely to cause tubular necrosis?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following findings is LEAST likely to be associated with post-streptococcal glomerulonephritis?

    <p>Hyperkalaemia</p> Signup and view all the answers

    Which of the following is NOT characteristic of membranoproliferative glomerulonephritis (MPGN)?

    <p>Crescent formation in the glomeruli</p> Signup and view all the answers

    Which of the following drugs is NOT used to treat helminth infections?

    <p>Acyclovir</p> Signup and view all the answers

    What nerve supplies general sensation to the anterior 2/3 of the tongue? (1 mark)

    <p>Lingual branch of the mandibular nerve (CN V3)</p> Signup and view all the answers

    Describe the main role of the circumvallate papillae. (1 mark)

    <p>Circumvallate papillae contain taste buds that are primarily responsible for sensing bitter flavors.</p> Signup and view all the answers

    Identify the arteries that supply the foregut, midgut, and hindgut. Give one example of their branches. (3 marks)

    <p>Foregut: Coeliac trunk and splenic artery. Midgut: Superior mesenteric artery and ileocolic artery. Hindgut: Inferior mesenteric artery and left colic artery.</p> Signup and view all the answers

    What is the significance of the portal venous system in relation to gut blood supply? (2 marks)

    <p>The portal venous system drains blood from the gut to the liver for detoxification and nutrient processing</p> Signup and view all the answers

    List the three major salivary glands and state their primary secretions. (2 marks)

    <p>Parotid gland: serous secretion. Sublingual gland: mucous secretions. Submandibular gland: mixed secretions.</p> Signup and view all the answers

    Which cranial nerve innervates the submandibular gland? (1 mark)

    <p>Facial nerve (CN VII) via the chorda tympani branch.</p> Signup and view all the answers

    Name two pancreatic enzymes responsible for protein digestion. (1 mark)

    <p>Trypsin and chymotrypsin</p> Signup and view all the answers

    What hormone stimulates the release of bicarbonate from the pancreas, and what cell is it secreted by? (1 mark)

    <p>Secretin and duodenal S cells</p> Signup and view all the answers

    Explain the role of bile salts in fat digestion. (1 mark)

    <p>Bile salts emulsify fats, breaking them into smaller droplets, increasing surface area for pancreatic lipase action.</p> Signup and view all the answers

    Define glomerular filtration rate (GFR). (1 mark)

    <p>GFR is the volume of filtrate formed per minute by the kidneys</p> Signup and view all the answers

    Describe how changes in afferent and efferent arteriole diameter can increase GFR. (2 marks)

    <p>Dilating the afferent arteriole increases GFR. Constricting the efferent arteriole increases GFR</p> Signup and view all the answers

    What substance is commonly used to estimate GFR? (1 mark)

    <p>Creatinine</p> Signup and view all the answers

    What are the common genetic mutations associated with colorectal cancer?

    <p>APC, KRAS, and TP53</p> Signup and view all the answers

    Describe the adenoma-carcinoma sequence. (2 marks)

    <p>The adenoma-carcinoma sequence is a multistep progression of normal epithelium to benign adenomas (polyps) then to invasive carcinomas. This progression typically involves a series of genetic mutations that lead to increased cell proliferation, altered cell differentiation, and eventually the loss of normal regulatory mechanisms.</p> Signup and view all the answers

    What is the significance of the FOBT screening test in bowel cancer? (1 mark)

    <p>FOBT detects hidden blood in the stool, which may indicate bowel cancer.</p> Signup and view all the answers

    Explain why drug doses often need to be adjusted in patients with renal insufficiency. (2 marks)

    <p>Drug doses need to be adjusted because of impaired renal clearance of drugs and their metabolites. Impaired kidney function can lead to prolonged drug half-life, increased drug accumulation, and a higher risk of toxicity.</p> Signup and view all the answers

    Name one nephrotoxic drug that should be avoided in patients with renal insufficiency. (1 mark)

    <p>NSAIDs</p> Signup and view all the answers

    How are carbohydrates absorbed in the small intestine and what transporter is involved? (3 marks)

    <p>Carbohydrates are absorbed as monosaccharides through active transport and facilitated diffusion. Glucose and galactose are transported by SGLT1 cotransporter, and fructose is transported by GLUT5 transporter.</p> Signup and view all the answers

    List two main routes of transmission for hepatitis B virus. (2 marks)

    <p>Blood-borne route and mucosal route (e.g., intravenous drug use &amp; sexual contact).</p> Signup and view all the answers

    Describe one possible long-term complication of chronic hepatitis B infection. (1 mark)

    <p>Cirrhosis of the liver</p> Signup and view all the answers

    Is there a vaccine for hepatitis B? (1 mark)

    <p>Yes</p> Signup and view all the answers

    What are the main pharmacological treatments for Helicobacter pylori-related peptic ulcer disease? (3 marks)

    <p>PPI-Based Triple Therapy: proton pump inhibitors (omeprazole), antibiotics (clarithromycin, amoxicillin, metronidazole)</p> Signup and view all the answers

    How do proton pump inhibitors (PPIs) work? (2 marks)

    <p>PPIs work by irreversibly inhibiting the H+/K+ ATPase enzyme in the gastric parietal cells, thus reducing gastric acid secretion.</p> Signup and view all the answers

    During development, the midgut undergoes rotation. To what degree and direction does it rotate and around which artery does this occur? (2 mark)

    <p>The midgut rotates 270-degrees counterclockwise around the superior mesenteric artery.</p> Signup and view all the answers

    What congenital abnormality can result from failure of midgut herniation return? (1 mark)

    <p>Omphalocele</p> Signup and view all the answers

    Name one part of the adult intestine derived from the midgut. (1 mark)

    <p>Ascending colon</p> Signup and view all the answers

    Define sensitivity and specificity in the context of a screening test. (2 marks)

    <p>Sensitivity is the ability of the test to correctly identify those with the disease (true positives). Specificity is the ability of the test to correctly identify those without the disease (true negatives).</p> Signup and view all the answers

    Explain the concept of overdiagnosis in screening programs. (2 marks)

    <p>Overdiagnosis occurs when screening detects abnormalities that will never cause symptoms or death, leading to unnecessary treatment.</p> Signup and view all the answers

    List two common causes of acute liver injury. (2 marks)

    <p>Paracetamol overdose and viral hepatitis</p> Signup and view all the answers

    What clinical symptoms would indicate acute liver failure? (2 marks)

    <p>Jaundice, confusion (encephalopathy), cloagulopathy, and ascites.</p> Signup and view all the answers

    Name two classes of immunosuppressant drugs used in organ transplantation. (2 marks)

    <p>Corticosteroids (prednisolone) and calcineurin inhibitors (cyclosporin, tacrolimus).</p> Signup and view all the answers

    What is the primary risk associated with the use of glucocorticoids and calcineurin inhibitors in organ transplantation?

    <p>Increased susceptibility to infection</p> Signup and view all the answers

    Name two common pathogens involved in intra-abdominal infections. (2 marks)

    <p>Escherichia coli and Klebsiella spp</p> Signup and view all the answers

    Describe the clinical presentation of peritonitis. (2 marks)

    <p>Peritonitis typically presents with severe abdominal pain, rebound tenderness, rigidity, and signs of sepsis (fever, tachycardia).</p> Signup and view all the answers

    List the four key steps in performing an abdominal examination. (2 marks)

    <p>Inspection, palpation, percussion, auscultation.</p> Signup and view all the answers

    What is the significance of rebound tenderness in diagnosing appendicitis? (2 marks)

    <p>Rebound tenderness indicates peritoneal irritation, suggesting an inflamed appendix.</p> Signup and view all the answers

    Describe the two common causes of acute kidney injury (AKI). (2 marks)

    <p>Dehydration (pre-renal) and glomerulonephritis (intrinsic).</p> Signup and view all the answers

    What are two indications for initiating dialysis in a patient with acute kidney injury? (2 marks)

    <p>Fluid overload or refractory hyperkalaemia</p> Signup and view all the answers

    Name a common electrolyte disturbance in acute kidney injury (AKI). (1 mark)

    <p>Hyperkalaemia</p> Signup and view all the answers

    What are the main types of gallstones? (2 marks)

    <p>Cholesterol stones and pigment stones (bilirubin).</p> Signup and view all the answers

    How does acute cholecystitis present clinically? (3 marks)

    <p>Acute cholecystitis typically presents with right upper quadrant pain, fever, nausea, vomiting, and Murphy’s sign.</p> Signup and view all the answers

    Describe the progression stages and the chronic liver diseases associated with cirrhosis. (5 marks)

    <p>Chronic liver diseases such as alcoholic liver disease (ALD), hepatitis, and non-alcoholic steatohepatitis (NASH) progress through stages including chronic inflammation, fibrosis, and formation of regenerative nodules, leading to cirrhosis.</p> Signup and view all the answers

    What are the complications associated with portal hypertension? (2 marks)

    <p>Ascites, variceal bleeding, hepatic encephalopathy, and splenomegaly.</p> Signup and view all the answers

    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)

    <p>(a) Alcoholic liver disease and acute cholangitis. (b) ALT, AST, and bilirubin, indicating hepatocellular injury and cholestasis.( c) Cirrhosis causes increased resistance in the portal vein, leading to portal hypertension.</p> Signup and view all the answers

    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)

    <p>(A) Coeliac disease and inflammatory bowel disease (B) Tissue transglutaminase (tTG) antibodies, small bowel biopsy, and genetic testing. (C) HLA-DQ2 and HLA-DQ8. It involves an autoimmune response to gluten, leading to villous atrophy in the small intestine.</p> Signup and view all the answers

    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)

    <p>(A) Benign prostatic hyperplasia. (B) Digital rectal examination, where a firm, enlarged prostate without nodules would suggest BPH. (C) Alpha-blockers (e.g., tamsulosin) relax smooth muscle in the bladder neck, improving urinary flow. (D) Untreated it can lead to urinary retention and bladder stones.</p> Signup and view all the answers

    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)

    <p>(A) Acute pancreatitis. (B) Alcohol causes premature activation of in-active enzymes within the pancreas, leading to auto-digestion and inflammation. (C) A CT scan to assess severity and detect complications like necrosis. (D) Initial management includes fluid resuscitation, pain relief, and nil by mouth.</p> Signup and view all the answers

    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)

    <p>(A) Colorectal cancer, diverticular disease. (B) Colonoscopy and biopsy. (C) Adenoma-carcinoma sequence usually occurs in chromosomal instability pathway. It is stepwise mutation in genes like APC, KRAS, p53 which progress normal mucosa to mucosa at risk, then dysplastic adenoma and finally carcinoma. (D) FOBT detects occult blood in the stool, an early sign of colorectal cancer.</p> Signup and view all the answers

    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).

    <p>(A) Autoimmune hepatitis. (B) A chronic liver inflammation caused by an immune response to hepatocytes. (C) Serology for elevated anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA). (D) Corticosteroids.</p> Signup and view all the answers

    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)

    <p>(A) Hepatitis A infection. (B) Foecal-oral route, symptoms include fever, fatigue, nausea, and jaundice. (C) IgM antibodies against Hep A. (D) Yes, provides immunity and prevents outbreaks.</p> Signup and view all the answers

    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)

    <p>(A) Escherichia coli and Staphylococcus saprophyticus. (B) Urine culture and sensitivity for causative organism and antibiotic sensitivity, and renal ultrasound or CT scan for structural abnormalities or urinary obstruction. (C) Chronic pyelonephritis leading to renal scaring and eventually chronic kidney disease. (D) Increased hydration, perineal hygiene awareness, prophylactic antibiotics in certain cases.</p> Signup and view all the answers

    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)

    <p>(A) Hereditary haemochromatosis. (B) Autosomal recessive disorder caused by mutations in the HFE gene, most commonly C282Y, then H63D. These mutations dysregulate iron absorption in the gut leading to iron over load in tissues. (C) Liver cirrhosis, diabetes mellitus, cardiomyopathy, arthritis. (D) Therapeutic phlebotomy.</p> Signup and view all the answers

    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)

    <p>(A) Colorectal cancer, ovarian cancer. (B) CT scan of the abdomen and pelvis and colonoscopy. (C) Carcinoembryonic antigen (CEA) is a tumour marker elevated in CRC that can aid diagnosis and be used for monitoring disease progression and response to treatment.</p> Signup and view all the answers

    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)

    <p>(A) Ascites secondary to liver cirrhosis. (B) In cirrhosis, portal hypertension causes increased pressure in the portal venous system, leading to fluid transduction into the abdominal cavity (ascites). Additionally, hypoalbuminaemia due to impaired liver function reduces plasma oncotic pressure, further contributing to fluid accumulation. (C) Abdominal ultrasound to confirm fluid in peritoneal cavity. Paracentesis, to analyse ascitic fluid for albumin and cell count (SAAG calculation). (D) Hepatic encephalopathy, esophageal varices.</p> Signup and view all the answers

    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)

    <p>(A) GORD, esophageal stricture. (B) Endoscopy to detect structural abnormalities, inflammation or strictures. (C) Barrett’s oesophagus, oesophagitis, and oesophageal strictures. (D) Proton pump inhibitors, such as omeprazole, inhibit H+/K+ ATPase enzyme in gastric parietal cells, reducing stomach acid production.</p> Signup and view all the answers

    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)

    <p>(A) Acute cholecystitis. (B) Ultrasound of the abdomen to detect gallstones, gallbladder wall thickening, and pericholecystic fluid. (C) Occurs when a gallstone obstructs the cystic duct, leading to inflammation of the gallbladder. (D) Gallbladder perforation, leading to peritonitis, biliary sepsis, septicaemia.</p> Signup and view all the answers

    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)

    <p>(A) Chronic kidney disease, likely secondary to diabetes and hypertension. (B) In diabetes, hyperglycaemia damages the glomerular capillaries, leading to glomerulosclerosis and reduced GFR. Overtime this results in CKD. (C) Serum creatinine and GFR to assess kidney function, urine albumin-to-creatinine ratio to check for proteinuria.</p> Signup and view all the answers

    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)

    <p>(A) Urolithiasis. (B) Non-contrast CT scan of the abdomen and pelvis. (C) Urolithiasis occurs when minerals, such as calcium or uric acid, crystallise and form stones within the kidneys, The stones obstruct the urinary tract, causing pain, haematuria, and potential infection. (D) Hydronephrosis (swelling of kidney due to blocked ureter) and UTI.</p> Signup and view all the answers

    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)

    <p>(A). Stress urinary incontinence. (B). Weakness of the pelvic floor muscles leads to decreased urethral closure pressure during abdominal stress. (C) Pelvic floor muscle training, weight loss. (D) Duloxetine increases sphincter tone.</p> Signup and view all the answers

    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)

    <p>(A) Iron deficiency anaemia. (B) A complete blood count (CBC), serum ferritin, serum iron levels. (C) Decreased haemoglobin synthesis, causing microcytic anaemia. (D) Oral iron supplements. (E) Fatigue, poor circulation, pallor.</p> Signup and view all the answers

    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)

    <p>(A) Pancreatic cancer. (B) Arises from ductal cells and is associated with smoking and chronic pancreatitis. (C) CT scan. (D) Metastasis and obstructive jaundice.</p> Signup and view all the answers

    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)

    <p>(A) Primary sclerosing cholangitis (PSC) (B) Involves chronic inflammation and fibrosis of the bile ducts, leading to bile stasis. (C) Elevated alkaline phosphatase (ALP) and bilirubin. (D) Cholangiocarcinoma.</p> Signup and view all the answers

    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)

    <p>(A) Malaria. (B) Blood smear to detect Plasmodium parasites. (C) Plasmodium parasite infects RBCs, leading to their destruction, haemolysis, adn fever cycles. (D) Artemisinin-based combination therapy (ACT).</p> Signup and view all the answers

    Which of the following about neonatal immune responses is NOT correct?

    <p>The innate immune system in neonates is hyperactive.</p> Signup and view all the answers

    Which statement about maternal infections and pregnancy outcomes is NOT correct?

    <p>Parvovirus B19 infection poses no risk to the fetus if acquired during pregnancy.</p> Signup and view all the answers

    Which of the following regarding the maternal-fetal interface is NOT correct?

    <p>Placental syncytiotrophoblasts express MHC class II molecules.</p> Signup and view all the answers

    Which statement regarding senescence is NOT correct?

    <p>The accumulation of senescent cells enhances tissue repair in aging individuals.</p> Signup and view all the answers

    Which of the following statements about maternal health and global disparities is NOT correct?

    <p>Antenatal care accessibility is uniform across all regions.</p> Signup and view all the answers

    What type of T cells increase in number to maintain fetal tolerance?

    <p>Regulatory T cells (Tregs)</p> Signup and view all the answers

    How does the placenta contribute to preventing immune rejection of the fetus?

    <p>The syncytiotrophoblast lacks MHC class I expression, preventing immune detection.</p> Signup and view all the answers

    Which part of the immune system remains intact to protect against maternal infections?

    <p>The innate immune system</p> Signup and view all the answers

    Why do neonates rely heavily on passive immunity?

    <p>Neonates have immature immune systems and rely on maternal antibodies for protection.</p> Signup and view all the answers

    Name one deficiency in the neonatal innate immune system.

    <p>Reduced production of mannose-binding lectin (MBL)</p> Signup and view all the answers

    When do neonates start producing their own IgG?

    <p>Around 3 months of age</p> Signup and view all the answers

    What maternal condition is commonly associated with intrauterine growth restriction (IUGR)?

    <p>Maternal hypertension</p> Signup and view all the answers

    How does IUGR affect long-term health in offspring?

    <p>It increases the risk of chronic conditions like type 2 diabetes and cardiovascular disease.</p> Signup and view all the answers

    What hypothesis explains the link between IUGR and chronic disease?

    <p>The Barker hypothesis, or the 'thrifty phenotype' hypothesis.</p> Signup and view all the answers

    Which statement regarding cervical changes during pregnancy and labour is NOT correct?

    <p>The cervix is rigid and unchanging until the onset of labour.</p> Signup and view all the answers

    Which statement about the immune changes during pregnancy is NOT correct?

    <p>Cellular immunity remains strong during pregnancy.</p> Signup and view all the answers

    Which of the following statements about maternal respiratory changes during pregnancy is NOT correct?

    <p>Respiratory rate decreases.</p> Signup and view all the answers

    Which of the following statements about maternal changes in the gastrointestinal system during pregnancy is NOT correct?

    <p>There is an increase in gastric acidity.</p> Signup and view all the answers

    Which statement about haematologic changes in pregnancy is NOT true?

    <p>Hematocrit levels increase due to higher RBC production.</p> Signup and view all the answers

    Which of the following statements about maternal urinary system changes in pregnancy is NOT correct?

    <p>Urinary output decreases due to fluid retention.</p> Signup and view all the answers

    Which statement about the stages of labour is NOT correct?

    <p>The first stage involves full cervical dilation.</p> Signup and view all the answers

    Which statement about breast changes during pregnancy is NOT correct?

    <p>Areolar glands remain unchanged.</p> Signup and view all the answers

    Which of the following statements about placental hormone production is NOT correct?

    <p>Placental hormones contribute to insulin sensitivity.</p> Signup and view all the answers

    Which of the following is NOT a physiological cardiovascular change in pregnancy?

    <p>Increased systemic vascular resistance</p> Signup and view all the answers

    Which statement about fetal monitoring during labour is NOT correct?

    <p>Continuous electronic monitoring is always required for low-risk labours.</p> Signup and view all the answers

    Describe the endocrine changes in pregnancy.

    <p>The anterior pituitary increases in size and activity; total T3 and T4 levels increase due to higher TBG levels; free levels remain stable; progesterone induces vasodilation, reducing vascular resistance.</p> Signup and view all the answers

    Explain cardiovascular changes during labour.

    <p>Cardiac output increases by 15% in the first stage and 50% in the second stage; the increase in cardiac output can lead to pulmonary edema; cardiac output returns to normal approximately 2 weeks postpartum.</p> Signup and view all the answers

    Discuss maternal haematologic adaptations during pregnancy.

    <p>Physiologic anemia is due to the expansion of plasma volume outpacing the increase in RBC production; fibrinogen and most coagulation factors increase, except for factors II, V, and XII; gestational thrombocytopenia is a mild, pregnancy-related decrease in platelet count that typically does not cause significant bleeding.</p> Signup and view all the answers

    Describe the stages of labour and key features of each.

    <p>Transition occurs at around 4-6 cm of cervical dilation; the second stage includes the propulsive phase (no urge to push) and the expulsive phase (active pushing); the third stage is defined by the expulsion of the placenta and membranes.</p> Signup and view all the answers

    Explain respiratory adaptations in pregnancy.

    <p>Progesterone stimulates increased tidal volume and ventilation; increased minute ventilation aids in managing the elevated metabolic demands and CO2 clearance from the fetus; reduced oxygen reserves and increased oxygen consumption lead to quicker onset of hypoxia.</p> Signup and view all the answers

    Detail the anatomical changes in the uterus and cervix during pregnancy.

    <p>The uterus increases from 50 g to approximately 1,000 g by term; cervical effacement is the thinning and shortening of the cervix, allowing for dilation; the mucus plug is composed of cervical secretions that form a barrier against infection during pregnancy.</p> Signup and view all the answers

    Discuss the role of placental hormones in pregnancy.

    <p>The ovary produces hormones early in pregnancy, later taken over by the placenta; human placental lactogen contributes to maternal insulin resistance to ensure glucose availability for the fetus; progesterone maintains the uterine lining and reduces uterine contractions.</p> Signup and view all the answers

    Explain the mechanisms of maternal cardiac output change during pregnancy.

    <p>Increased heart rate and stroke volume contribute to higher cardiac output; systemic vascular resistance decreases due to hormonal effects; blood pressure generally decreases in the second trimester but rises slightly towards term.</p> Signup and view all the answers

    Describe fetal positioning and its impact on labour.

    <p>Fetal lie refers to the relationship between the long axis of the fetus and the long axis of the maternal spine; the direct occipito-anterior position is optimal as it facilitates smooth passage through the birth canal; a posterior position can lead to prolonged labour and increased back pain.</p> Signup and view all the answers

    Explain changes in the maternal urinary system during pregnancy.

    <p>The ureters dilate due to mechanical pressure and smooth muscle relaxation; progesterone reduces bladder and ureteric tone, contributing to stasis; increased urinary stasis heightens the risk for UTIs and pyelonephritis.</p> Signup and view all the answers

    Discuss skeletal and postural changes during pregnancy.

    <p>Lumbar lordosis increases to accommodate the growing uterus; hormones such as relaxin increase the flexibility of pelvic ligaments; these changes can lead to a shifted center of gravity and increased fall risk.</p> Signup and view all the answers

    Explain the physiological basis of maternal hypoxia during labour.

    <p>Increased respiratory rate and deeper breaths due to exertion; maternal oxygen consumption increases due to the physical effort of labour; hypoxia should be managed with high-flow oxygen and position changes to improve ventilation.</p> Signup and view all the answers

    What cardiovascular changes in pregnancy might explain shortness of breath, palpitations, and mild peripheral edema?

    <p>Increased cardiac output and decreased systemic vascular resistance during pregnancy can cause symptoms such as palpitations and shortness of breath.</p> Signup and view all the answers

    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?

    <p>She is in the active phase of the first stage of labour.</p> Signup and view all the answers

    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?

    <p>The most likely diagnosis is a urinary tract infection (UTI).</p> Signup and view all the answers

    What is the most likely fetal position contributing to back pain in a 30-year-old woman in active labour at 40 weeks?

    <p>Occipito-posterior position.</p> Signup and view all the answers

    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?

    <p>Pre-eclampsia.</p> Signup and view all the answers

    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?

    <p>Increased cardiac output and decreased systemic vascular resistance during pregnancy can cause symptoms such as palpitations and shortness of breath.</p> Signup and view all the answers

    What term describes the lack of progress in labor?

    <p>Arrest of labour</p> Signup and view all the answers

    What potential cause should be assessed in cases of labor arrest?

    <p>Inadequate uterine contractions</p> Signup and view all the answers

    What management options are available for labor arrest?

    <p>Oxytocin augmentation or artificial rupture of membranes</p> Signup and view all the answers

    What physiological change in pregnancy contributes to heartburn?

    <p>Relaxation of the lower esophageal sphincter due to progesterone</p> Signup and view all the answers

    Name one lifestyle modification that may help with heartburn in pregnancy.

    <p>Elevating the head of the bed or avoiding meals before lying down</p> Signup and view all the answers

    What pharmacologic option is safe for treating heartburn in pregnancy?

    <p>Antacids like calcium carbonate</p> Signup and view all the answers

    What serious condition should be considered first in a pregnant woman with sudden onset dyspnea and chest pain?

    <p>Pulmonary embolism (PE)</p> Signup and view all the answers

    Name one immediate diagnostic test to confirm pulmonary embolism.

    <p>CT pulmonary angiography or a ventilation-perfusion (V/Q) scan</p> Signup and view all the answers

    What is the first step in management for suspected pulmonary embolism?

    <p>Initiate anticoagulation therapy immediately</p> Signup and view all the answers

    What fetal condition might be indicated by meconium-stained amniotic fluid?

    <p>Fetal distress</p> Signup and view all the answers

    What immediate monitoring should be conducted when meconium-stained fluid is present?

    <p>Continuous fetal heart rate monitoring</p> Signup and view all the answers

    What potential intervention should be prepared for during delivery when meconium-stained fluid is present?

    <p>Prepare for neonatal resuscitation at delivery</p> Signup and view all the answers

    What is the most likely diagnosis for severe itching on palms and soles with elevated bile acids in pregnancy?

    <p>Intrahepatic cholestasis of pregnancy (ICP)</p> Signup and view all the answers

    Name one potential risk to the fetus associated with intrahepatic cholestasis of pregnancy.

    <p>Increased risk of preterm delivery or stillbirth</p> Signup and view all the answers

    What is a key component of management for intrahepatic cholestasis of pregnancy?

    <p>Ursodeoxycholic acid and close fetal monitoring</p> Signup and view all the answers

    What is the most significant risk factor for breast cancer related to estrogen exposure?

    <p>Early menarche and late menopause</p> Signup and view all the answers

    Which drug is contraindicated during pregnancy due to its association with congenital abnormalities?

    <p>Valproate</p> Signup and view all the answers

    What is the mechanism of action of selective estrogen receptor modulators (SERMs) like tamoxifen in breast tissue?

    <p>Antagonist activity in breast tissue</p> Signup and view all the answers

    Which of the following is most accurate regarding the safety of SSRIs during pregnancy?

    <p>Paroxetine is associated with a higher risk of congenital abnormalities.</p> Signup and view all the answers

    Which genetic inheritance pattern is described in a consanguineous couple with recurrent neonatal deaths due to a genetic disorder?

    <p>Autosomal recessive inheritance</p> Signup and view all the answers

    What is the primary risk associated with hormone therapy in postmenopausal women using combined estrogen and progestogen therapy?

    <p>Increased risk of breast cancer</p> Signup and view all the answers

    Which of the following is a significant long-term benefit of menopause hormone therapy (MHT)?

    <p>Prevention of osteoporosis</p> Signup and view all the answers

    What is a major concern with the use of ACE inhibitors during pregnancy?

    <p>Renal failure and fetal death</p> Signup and view all the answers

    In reproductive genetics, what is the risk calculation for having an affected child when one parent is a carrier for an autosomal recessive disorder?

    <p>1 in 99,200</p> Signup and view all the answers

    What differentiates aromatase inhibitors from SERMs in terms of their mechanism in breast cancer therapy?

    <p>They block the production of estrogen by inhibiting its synthesis.</p> Signup and view all the answers

    Which statement regarding tamoxifen is NOT correct?

    <p>It is associated with a decreased risk of endometrial cancer.</p> Signup and view all the answers

    Which statement about hormone therapy in menopause is NOT correct?

    <p>Estrogen alone is used in women with a uterus.</p> Signup and view all the answers

    Which statement regarding the pharmacokinetics of drugs in pregnancy is NOT correct?

    <p>Plasma protein binding is unaffected during pregnancy.</p> Signup and view all the answers

    Which statement regarding genetic carrier screening is NOT correct?

    <p>Carrier screening primarily identifies autosomal dominant disorders.</p> Signup and view all the answers

    Which of the following about aromatase inhibitors is NOT correct?

    <p>They are used primarily in premenopausal women.</p> Signup and view all the answers

    Which statement about menopause is NOT correct?

    <p>Diagnosing menopause requires routine blood tests for FSH and LH.</p> Signup and view all the answers

    Which of the following about the safety of SSRIs in pregnancy is NOT correct?

    <p>Paroxetine is safe to use in all trimesters.</p> Signup and view all the answers

    Which statement about estrogen receptor activity is NOT correct?

    <p>ERβ has no role in bone health.</p> Signup and view all the answers

    Which statement about selective estrogen receptor modulators (SERMs) is NOT correct?

    <p>SERMs uniformly act as antagonists in all tissues.</p> Signup and view all the answers

    Which statement regarding drugs in pregnancy is NOT correct?

    <p>High-dose aspirin is safe in the third trimester.</p> Signup and view all the answers

    What condition can NSAIDs cause if taken near delivery?

    <p>Risk of premature closure of the ductus arteriosus.</p> Signup and view all the answers

    What safer analgesic alternative is recommended for use during pregnancy?

    <p>Paracetamol.</p> Signup and view all the answers

    What is a Robertsonian translocation?

    <p>A chromosomal rearrangement involving the fusion of two acrocentric chromosomes.</p> Signup and view all the answers

    How can balanced translocations lead to recurrent miscarriages?

    <p>Segregation during meiosis can lead to unbalanced gametes.</p> Signup and view all the answers

    What type of genetic analysis is used to detect translocations?

    <p>Karyotyping.</p> Signup and view all the answers

    What is the primary use of tamoxifen in premenopausal women?

    <p>Treatment of ER-positive breast cancer.</p> Signup and view all the answers

    Name one absolute contraindication for tamoxifen use.

    <p>Active pregnancy.</p> Signup and view all the answers

    What is a significant side effect associated with tamoxifen in the uterus?

    <p>Increased risk of endometrial cancer.</p> Signup and view all the answers

    What preventive therapy could be considered for a woman with a family history of ER-positive breast cancer?

    <p>Tamoxifen.</p> Signup and view all the answers

    What is the mechanism of action of tamoxifen?

    <p>Tamoxifen acts as an estrogen receptor antagonist in breast tissue, preventing the proliferative effects of estrogen.</p> Signup and view all the answers

    Name one major side effect that needs to be monitored in patients taking tamoxifen.

    <p>Increased risk of venous thromboembolism (VTE).</p> Signup and view all the answers

    What type of therapy can help prevent further bone loss in a woman diagnosed with osteoporosis after early menopause?

    <p>Menopause hormone therapy (MHT) or SERMs.</p> Signup and view all the answers

    Why would a selective estrogen receptor modulator (SERM) like raloxifene be considered?

    <p>Raloxifene acts as an estrogen receptor agonist in bone, helping maintain bone density.</p> Signup and view all the answers

    What is one side effect of raloxifene?

    <p>Increased risk of VTE.</p> Signup and view all the answers

    What is a balanced translocation?

    <p>A balanced translocation involves a rearrangement of chromosomal material without a net gain or loss.</p> Signup and view all the answers

    How does a balanced translocation contribute to recurrent miscarriages?

    <p>Balanced translocations can result in unbalanced gametes during meiosis, leading to miscarriages.</p> Signup and view all the answers

    What are potential reproductive options for couples with a balanced translocation?

    <p>Options include preimplantation genetic testing (PGT) with IVF.</p> Signup and view all the answers

    What is the most likely diagnosis for a pregnant woman presenting with sudden severe chest pain, shortness of breath, and tachycardia?

    <p>Pulmonary embolism (PE).</p> Signup and view all the answers

    What immediate test would confirm the diagnosis of a pulmonary embolism?

    <p>CT pulmonary angiography or a ventilation-perfusion (V/Q) scan.</p> Signup and view all the answers

    What treatment should be initiated upon confirmation of a pulmonary embolism?

    <p>Anticoagulation therapy.</p> Signup and view all the answers

    What is the safest approach to hormone therapy for a postmenopausal woman with a history of DVT?

    <p>Transdermal estrogen with caution, considering her DVT history.</p> Signup and view all the answers

    Why is transdermal estrogen considered over oral formulations?

    <p>Transdermal estrogen has a lower risk of VTE compared to oral estrogen.</p> Signup and view all the answers

    What non-hormonal alternatives could be explored if hormone therapy is not suitable for managing vasomotor symptoms?

    <p>SSRIs or SNRIs for vasomotor symptom management.</p> Signup and view all the answers

    Which category of anti-migraine drugs should be avoided during pregnancy?

    <p>Triptans, especially sumatriptan (Category B3), should be avoided if possible.</p> Signup and view all the answers

    What non-pharmacologic interventions can be recommended for managing migraines during pregnancy?

    <p>Lifestyle modifications, hydration, and relaxation techniques.</p> Signup and view all the answers

    Which pharmacologic treatment could be considered safer for migraines during pregnancy?

    <p>Low-dose propranolol may be considered with caution.</p> Signup and view all the answers

    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)

    <p>Parvovirus B19</p> Signup and view all the answers

    What is the most common serious outcome of early-onset neonatal Group B Streptococcus (GBS) infection? (Select all that apply)

    <p>Sepsis</p> Signup and view all the answers

    Which immune component shows impaired function in neonates, increasing their susceptibility to bacterial infections? (Select all that apply)

    <p>Toll-like receptor (TLR) response</p> Signup and view all the answers

    What mechanism contributes to the reduced adaptive immune response observed in the elderly? (Select all that apply)

    <p>Thymic atrophy</p> Signup and view all the answers

    Which statement best describes the main consequence of maternal CMV infection during pregnancy? (Select all that apply)

    <p>High risk of congenital abnormalities</p> Signup and view all the answers

    Which physiological mechanism helps prevent maternal immune rejection of the fetus? (Select all that apply)

    <p>Increase in regulatory T cells (Tregs)</p> Signup and view all the answers

    Which age-related change is linked to decreased antibody diversity and quality in older adults? (Select all that apply)

    <p>Decline in bone marrow plasma cell niches</p> Signup and view all the answers

    What is a critical risk factor for neonatal sepsis in preterm infants? (Select all that apply)

    <p>Preterm birth and low birth weight</p> Signup and view all the answers

    What maternal intervention reduces the risk of severe congenital outcomes in neonates exposed to infections such as rubella? (Select all that apply)

    <p>Maternal vaccination before pregnancy</p> Signup and view all the answers

    What type of immune response is dominant in neonates and contributes to their susceptibility to certain pathogens? (Select all that apply)

    <p>Th2-dominant response</p> Signup and view all the answers

    Which statement correctly describes the aging immune system? (Select all that apply)

    <p>Reduced CD8+ T cell response to novel antigens</p> Signup and view all the answers

    Which factor contributes significantly to antenatal complications such as preterm birth? (Select all that apply)

    <p>High maternal BMI</p> Signup and view all the answers

    What condition results from insufficient nutrient flow through the placenta and is associated with chronic disease risk later in life? (Select all that apply)

    <p>Intrauterine growth restriction (IUGR)</p> Signup and view all the answers

    What is a major immune alteration seen in preterm neonates? (Select all that apply)

    <p>Reduced production of mannose-binding lectin (MBL)</p> Signup and view all the answers

    What factor decreases the effectiveness of vaccines in the elderly? (Select all that apply)

    <p>Limited affinity maturation in antibodies</p> Signup and view all the answers

    Neonates have a fully functional complement system.

    <p>False</p> Signup and view all the answers

    Colonization by microbes begins before birth.

    <p>True</p> Signup and view all the answers

    Antibiotic exposure during cesarean delivery enhances the diversity of the gut microbiome.

    <p>False</p> Signup and view all the answers

    There is an increased production of naïve T cells in the elderly.

    <p>False</p> Signup and view all the answers

    IUGR is exclusively due to fetal chromosomal abnormalities.

    <p>False</p> Signup and view all the answers

    The maternal immune system completely suppresses innate immunity.

    <p>False</p> Signup and view all the answers

    Which of the following features is characteristic of primary syphilis?

    <p>A single painless chancre with raised edges</p> Signup and view all the answers

    What is the most common organ system affected by congenital cytomegalovirus (CMV) infection?

    <p>Neurological system</p> Signup and view all the answers

    Which of the following is NOT typically associated with secondary syphilis?

    <p>Gummatous lesions</p> Signup and view all the answers

    Infections with which herpes virus have been linked to Burkitt's lymphoma?

    <p>Epstein-Barr virus (EBV)</p> Signup and view all the answers

    What is the most common initial presentation of measles?

    <p>Conjunctivitis and coryza</p> Signup and view all the answers

    A typical feature of diphtheria infection includes:

    <p>A thick, adherent membrane in the pharynx</p> Signup and view all the answers

    What is a classic complication of mumps in post-pubertal males?

    <p>Orchitis</p> Signup and view all the answers

    Which statement about varicella-zoster virus is TRUE?

    <p>Latency occurs in dorsal root ganglia.</p> Signup and view all the answers

    Parvovirus B19 infection can lead to which condition in individuals with pre-existing haemolytic disorders?

    <p>Aplastic crisis</p> Signup and view all the answers

    Which of the following diseases is caused by Streptococcus pyogenes?

    <p>Scarlet fever</p> Signup and view all the answers

    What is the primary risk factor for developing Kaposi’s sarcoma in an immunocompromised patient?

    <p>Human herpesvirus 8 (HHV-8)</p> Signup and view all the answers

    Which complication of congenital rubella syndrome (CRS) is most commonly seen?

    <p>Cataracts</p> Signup and view all the answers

    Which symptom is commonly associated with erysipelas caused by Streptococcus pyogenes?

    <p>Painful, sharply demarcated skin redness</p> Signup and view all the answers

    What is the transmission mode for rubella?

    <p>Airborne respiratory droplets</p> Signup and view all the answers

    Which disease can present with necrotising skin lesions known as mycetomas?

    <p>Nocardiosis</p> Signup and view all the answers

    Which statement about Epstein-Barr virus is NOT correct?

    <p>It primarily establishes latency in sensory nerve ganglia.</p> Signup and view all the answers

    Which of the following statements about congenital syphilis is NOT correct?

    <p>It commonly results in neonatal sepsis.</p> Signup and view all the answers

    Which of the following clinical features is NOT typical of secondary syphilis?

    <p>Gummas on skin and bone</p> Signup and view all the answers

    Regarding Listeria monocytogenes, which of the following statements is NOT correct?

    <p>It forms spores that survive refrigeration.</p> Signup and view all the answers

    Which of the following about HHV-8 is NOT correct?

    <p>It establishes latency primarily in sensory ganglia.</p> Signup and view all the answers

    Which statement about Streptococcus pyogenes and its complications is NOT correct?

    <p>Puerperal fever is typically associated with erysipelas.</p> Signup and view all the answers

    Which statement about rubella infection is NOT correct?

    <p>It is more common in adult males than in children.</p> Signup and view all the answers

    Which of the following regarding varicella-zoster virus (VZV) is NOT correct?

    <p>Latency occurs in lymphoid cells.</p> Signup and view all the answers

    Which of these complications is NOT associated with mumps infection?

    <p>Aplastic anaemia</p> Signup and view all the answers

    Which of the following regarding the herpes simplex virus (HSV) is NOT correct?

    <p>Encephalitis due to HSV has a lower mortality rate when untreated.</p> Signup and view all the answers

    Which of the following is NOT a typical feature of congenital syphilis in a surviving child?

    <p>Microcephaly</p> Signup and view all the answers

    Which of the following regarding actinomycosis is NOT correct?

    <p>It typically respects tissue planes.</p> Signup and view all the answers

    Which statement regarding beta-haemolytic streptococci is NOT true?

    <p>Post-streptococcal glomerulonephritis only follows skin infections.</p> Signup and view all the answers

    Which of the following regarding childhood parvovirus B19 infection is NOT true?

    <p>It is commonly treated with antiviral medications.</p> Signup and view all the answers

    Which of the following regarding diphtheria is NOT correct?

    <p>The organism forms endospores.</p> Signup and view all the answers

    List the typical lesion associated with primary syphilis and describe its key characteristics.

    <p>The lesion is a chancre: painless, raised, firm edges.</p> Signup and view all the answers

    Name two systemic features seen in secondary syphilis.

    <p>Fever, lymphadenopathy.</p> Signup and view all the answers

    What is the primary neurological complication associated with tertiary syphilis?

    <p>Neurosyphilis, specifically general paresis of the insane or tabes dorsalis.</p> Signup and view all the answers

    What is the most common cardiac defect in congenital rubella syndrome (CRS)?

    <p>Patent ductus arteriosus.</p> Signup and view all the answers

    Explain why early maternal infection is more dangerous to the fetus.

    <p>The highest risk of severe congenital defects occurs during the first trimester, when the fetal organs are forming.</p> Signup and view all the answers

    What is the recommended prevention strategy for CRS?

    <p>Vaccination with MMR vaccine prior to pregnancy.</p> Signup and view all the answers

    Name one common food item that may be a source of Listeria.

    <p>Soft cheeses.</p> Signup and view all the answers

    Describe the condition 'granulomatosis infantiseptica.'

    <p>A rare neonatal disease characterized by widespread microabscesses and granulomas.</p> Signup and view all the answers

    What is the primary clinical concern for Listeria infection in pregnant women?

    <p>Risk of miscarriage, stillbirth, or neonatal sepsis.</p> Signup and view all the answers

    Which type of HSV is most commonly implicated in herpes simplex encephalitis?

    <p>HSV-1.</p> Signup and view all the answers

    Identify the brain regions typically involved in herpes simplex encephalitis.

    <p>Frontal and temporal lobes.</p> Signup and view all the answers

    What is the typical mortality rate without treatment for herpes simplex encephalitis?

    <p>70%.</p> Signup and view all the answers

    List two complications associated with skin infections caused by Streptococcus pyogenes.

    <p>Cellulitis, necrotising fasciitis.</p> Signup and view all the answers

    What is the mechanism underlying rheumatic fever?

    <p>Autoimmune response due to molecular mimicry between streptococcal antigens and host tissue.</p> Signup and view all the answers

    What skin feature is associated with scarlet fever?

    <p>Strawberry tongue followed by desquamation.</p> Signup and view all the answers

    What is the hallmark rash seen in children with parvovirus B19 infection?

    <p>Slapped cheek rash.</p> Signup and view all the answers

    Which complication can occur in patients with haemolytic disorders due to parvovirus B19 infection?

    <p>Aplastic crisis.</p> Signup and view all the answers

    What condition in pregnancy is associated with parvovirus B19 infection?

    <p>Hydrops fetalis.</p> Signup and view all the answers

    Name one serious form of CMV infection in immunocompromised hosts.

    <p>Retinitis.</p> Signup and view all the answers

    What neurological sequelae can result from congenital CMV infection?

    <p>Deafness and mental retardation.</p> Signup and view all the answers

    What is the typical presentation of CMV infection in healthy adults?

    <p>Mononucleosis-like syndrome.</p> Signup and view all the answers

    Identify one early prodromal symptom of measles.

    <p>Coryza.</p> Signup and view all the answers

    What is the significance of Koplik spots?

    <p>They are pathognomonic for measles, appearing before the rash.</p> Signup and view all the answers

    Name one potential complication of measles.

    <p>Pneumonia.</p> Signup and view all the answers

    What is the main virulence factor of Corynebacterium diphtheriae?

    <p>Exotoxin production.</p> Signup and view all the answers

    Name one potential cardiac complication of diphtheria.

    <p>Myocarditis.</p> Signup and view all the answers

    What is a visual feature associated with diphtheritic pharyngitis?

    <p>Thick, white, adherent membrane.</p> Signup and view all the answers

    What is the typical pattern of rash distribution in chickenpox?

    <p>Rash starts on the trunk and spreads centrifugally.</p> Signup and view all the answers

    Name one serious complication of shingles.

    <p>Postherpetic neuralgia.</p> Signup and view all the answers

    What does the term 'dermatomal distribution' refer to in shingles?

    <p>Rash following the sensory nerve path associated with the latent virus.</p> Signup and view all the answers

    What is the most common organ affected by mumps?

    <p>Parotid glands.</p> Signup and view all the answers

    Name one serious complication in post-pubertal males affected by mumps.

    <p>Orchitis.</p> Signup and view all the answers

    Which neurological complication can occur from mumps?

    <p>Aseptic meningitis.</p> Signup and view all the answers

    What is the primary mode of transmission for neonatal herpes simplex infection?

    <p>Passage through an infected birth canal.</p> Signup and view all the answers

    Identify one serious complication in affected neonates from neonatal herpes simplex infection.

    <p>Multi-organ disease with possible encephalitis.</p> Signup and view all the answers

    Which HSV type is more commonly implicated in neonatal herpes simplex infection?

    <p>HSV-2.</p> Signup and view all the answers

    How is rubella primarily transmitted?

    <p>Respiratory droplets.</p> Signup and view all the answers

    What is the risk of CRS when rubella infection occurs in the first trimester?

    <p>Up to 90%.</p> Signup and view all the answers

    How is rubella immunity commonly achieved?

    <p>MMR vaccination.</p> Signup and view all the answers

    Identify one clinical scenario where Streptococcus agalactiae is a pathogen.

    <p>Postpartum maternal sepsis.</p> Signup and view all the answers

    What is the typical onset time for neonatal disease caused by S. agalactiae?

    <p>Early-onset disease within the first 7 days.</p> Signup and view all the answers

    How is maternal carriage of S. agalactiae screened for during pregnancy?

    <p>Rectovaginal swab at 35–37 weeks.</p> Signup and view all the answers

    Name one group at high risk for Kaposi’s sarcoma.

    <p>HIV-positive patients.</p> Signup and view all the answers

    What type of lesion characterizes Kaposi’s sarcoma?

    <p>Vascular tumour-like lesions.</p> Signup and view all the answers

    What virus family does KSHV belong to?

    <p>Herpesviridae.</p> Signup and view all the answers

    Which strain of S. pyogenes is associated with post-streptococcal glomerulonephritis?

    <p>Nephritogenic strains.</p> Signup and view all the answers

    What is a common clinical finding in post-streptococcal glomerulonephritis?

    <p>Dark urine.</p> Signup and view all the answers

    Which region shows the highest incidence of post-streptococcal glomerulonephritis?

    <p>Australian Aboriginal communities.</p> Signup and view all the answers

    What triggers reactivation of herpes zoster (shingles)?

    <p>Immune suppression.</p> Signup and view all the answers

    What is one risk factor for postherpetic neuralgia?

    <p>Age over 60.</p> Signup and view all the answers

    Name one typical dermatological manifestation of shingles.

    <p>Painful vesicular rash along a dermatome.</p> Signup and view all the answers

    Name two complications of non-suppurative complications of Streptococcus pyogenes.

    <p>Rheumatic fever, post-streptococcal glomerulonephritis.</p> Signup and view all the answers

    What is the primary pathophysiological mechanism of rheumatic fever?

    <p>Autoimmune cross-reactivity.</p> Signup and view all the answers

    What diagnostic feature is associated with post-streptococcal glomerulonephritis?

    <p>Hematuria with dark urine.</p> Signup and view all the answers

    What is the most common form of actinomycosis?

    <p>Cervicofacial actinomycosis.</p> Signup and view all the answers

    What condition can actinomycosis mimic due to its presentation?

    <p>Malignancy</p> Signup and view all the answers

    Name one characteristic feature of actinomycosis.

    <p>Draining sinus tracts</p> Signup and view all the answers

    What is a major risk factor for severe outcomes in congenital cytomegalovirus infection?

    <p>Primary maternal infection</p> Signup and view all the answers

    Name one common clinical finding at birth for congenital cytomegalovirus infection.

    <p>Microcephaly or hearing loss</p> Signup and view all the answers

    Which type of maternal infection poses the highest risk to the fetus in congenital cytomegalovirus infection?

    <p>Primary infection during pregnancy</p> Signup and view all the answers

    What initial test should be conducted for a pregnant woman concerned about rubella?

    <p>Rubella IgG and IgM serology</p> Signup and view all the answers

    What are the potential risks to the fetus if the mother is infected with rubella during the first trimester?

    <p>Risk of congenital rubella syndrome, including deafness and cardiac defects</p> Signup and view all the answers

    What is the most likely diagnosis for a patient with a painful rash along the right side of the chest who had chickenpox?

    <p>Herpes zoster (shingles)</p> Signup and view all the answers

    What is a possible severe complication that should be monitored for in the patient with herpes zoster?

    <p>Postherpetic neuralgia</p> Signup and view all the answers

    What condition should be suspected in a neonate, born to a mother positive for group B Streptococcus, developing respiratory distress at 3 days old?

    <p>Early-onset neonatal sepsis</p> Signup and view all the answers

    What is the immediate management step for early-onset neonatal sepsis?

    <p>Initiation of empirical antibiotic therapy</p> Signup and view all the answers

    Which pathogen should be suspected in a pregnant woman with a history of eating unpasteurized soft cheese and presenting with fever and chills?

    <p>Listeria monocytogenes</p> Signup and view all the answers

    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?

    <p>a) Listeria monocytogenes b) Risk of miscarriage or stillbirth</p> Signup and view all the answers

    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?

    <p>Cytomegalovirus (CMV) retinitis</p> Signup and view all the answers

    What treatment should be considered for cytomegalovirus retinitis?

    <p>Antiviral therapy such as ganciclovir</p> Signup and view all the answers

    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?

    <p>Parvovirus B19 infection (erythema infectiosum)</p> Signup and view all the answers

    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?

    <p>Aplastic crisis</p> Signup and view all the answers

    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?

    <p>Secondary syphilis</p> Signup and view all the answers

    What is the next diagnostic step for suspected secondary syphilis?

    <p>Serological testing for syphilis using Treponemal-specific tests (RPR, TPPA)</p> Signup and view all the answers

    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?

    <p>HSV-1 encephalitis</p> Signup and view all the answers

    What immediate treatment should be initiated for HSV-1 encephalitis?

    <p>Intravenous acyclovir</p> Signup and view all the answers

    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?

    <p>a) Late-onset neonatal sepsis b) Streptococcus agalactiae</p> Signup and view all the answers

    Which bacterium is the most probable cause of late-onset neonatal sepsis?

    <p>Streptococcus agalactiae</p> Signup and view all the answers

    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?

    <p>a) Actinomycosis b) Actinomyces israelii</p> Signup and view all the answers

    What hormonal change contributes most to the increased glomerular filtration rate (GFR) during pregnancy?

    <p>Elevated progesterone</p> Signup and view all the answers

    Which stage of labor is characterized by the onset of regular, painful contractions that lead to full cervical dilation?

    <p>First stage</p> Signup and view all the answers

    What mechanism primarily supports fetal descent during the active phase of labor?

    <p>Uterine contractions</p> Signup and view all the answers

    Which cardiovascular change is typical during pregnancy?

    <p>Increased cardiac output by up to 50%</p> Signup and view all the answers

    What is the significance of 'engagement' during labor?

    <p>It occurs when the biparietal diameter of the fetal head passes through the pelvic brim.</p> Signup and view all the answers

    Which of the following respiratory changes is NOT typical during pregnancy?

    <p>Decreased respiratory rate</p> Signup and view all the answers

    What is the role of relaxin in pregnancy?

    <p>Reduces uterine tone</p> Signup and view all the answers

    What fetal position most optimally aids in the second stage of labor?

    <p>Direct occipito-anterior</p> Signup and view all the answers

    Which change is a normal hematologic adaptation during pregnancy?

    <p>Physiologic anemia due to plasma volume expansion</p> Signup and view all the answers

    What defines the latent phase of labor?

    <p>Initial onset of contractions until cervical dilation of 4 cm</p> Signup and view all the answers

    Which of the following is NOT a risk associated with aortocaval compression in late pregnancy?

    <p>Increased venous return</p> Signup and view all the answers

    During the expulsion phase of labor, what is the primary maternal response?

    <p>Active pushing using abdominal muscles and diaphragm</p> Signup and view all the answers

    Which maternal cardiovascular change during labor poses a risk for women with pre-existing heart conditions?

    <p>Increase in cardiac output by 70% during the third stage</p> Signup and view all the answers

    What is the typical respiratory adaptation seen in pregnant women to manage increased oxygen demands?

    <p>Elevated minute ventilation</p> Signup and view all the answers

    Which condition can arise due to delayed gastric emptying in pregnancy?

    <p>Gastroesophageal reflux</p> Signup and view all the answers

    Which statement regarding maternal blood volume during pregnancy is NOT correct?

    <p>It leads to a decrease in cardiac output.</p> Signup and view all the answers

    Which of the following statements about the first stage of labor is NOT correct?

    <p>Cervical dilation progresses at approximately 2 cm per hour in active labor.</p> Signup and view all the answers

    Which statement about endocrine changes during pregnancy is NOT correct?

    <p>The thyroid gland decreases in size.</p> Signup and view all the answers

    Which statement about the cardiovascular adaptations in pregnancy is NOT correct?

    <p>Blood pressure typically rises in the first trimester.</p> Signup and view all the answers

    What is the primary mechanism by which Her2 promotes cancer cell survival?

    <p>Inhibition of apoptosis through the activation of the RAS-MAPK pathway</p> Signup and view all the answers

    Which breast cancer subtype is likely to exhibit the highest response to tamoxifen treatment?

    <p>Luminal A</p> Signup and view all the answers

    Which diagnostic technique is commonly used to assess HER2 protein expression in breast cancer?

    <p>Immunohistochemistry (IHC)</p> Signup and view all the answers

    What is a recommended surgical strategy for managing breast cancer with positive margins?

    <p>Mastectomy or wide local excision followed by radiotherapy</p> Signup and view all the answers

    Which of the following is a common risk factor associated with breast cancer?

    <p>All of the above</p> Signup and view all the answers

    What is the primary disadvantage of routine genome-wide expression profiling in breast cancer diagnosis?

    <p>High cost and impracticality for everyday use</p> Signup and view all the answers

    What characterizes basal-like breast cancers in terms of receptor status?

    <p>ER-/PR- and usually HER2 negative</p> Signup and view all the answers

    What is a significant advantage of using targeted therapies like Trastuzumab in HER2 positive breast cancers?

    <p>Improved survival rates compared to HER2 negative cancers</p> Signup and view all the answers

    What histopathological feature is indicative of lobular carcinoma in situ (LCIS)?

    <p>Expansion of lobules by discohesive, uniform neoplastic cells</p> Signup and view all the answers

    What is a common risk factor associated with invasive breast cancer?

    <p>Nulliparity or having the first child after age 30</p> Signup and view all the answers

    What is the current recommendation regarding the surgical approach to LCIS found in a core biopsy?

    <p>Increased surveillance and monitoring</p> Signup and view all the answers

    Which of the following is TRUE about the staging of breast cancer as per the AJCC system?

    <p>T stage assesses primary tumor size and local invasiveness.</p> Signup and view all the answers

    What is the primary histological type of breast cancer, accounting for over 80% of cases?

    <p>Invasive ductal carcinoma of no special type</p> Signup and view all the answers

    What would be an appropriate action if surgical margins in excision are found to be positive for a high-risk lesion?

    <p>Re-excision or further surgical intervention</p> Signup and view all the answers

    Which biomarker is assessed for establishing the hormone receptor status in breast cancer?

    <p>ER and PR</p> Signup and view all the answers

    How is the histological grade of breast cancer determined?

    <p>By the modified Bloom and Richardson method</p> Signup and view all the answers

    What treatment is generally NOT recommended for patients with bilateral lobular carcinoma in situ?

    <p>Bilateral mastectomy</p> Signup and view all the answers

    Upon detection of ER+/PR+ breast cancer, what is the expected outcome in terms of treatment response?

    <p>Strong predicted response to anti-oestrogen therapy</p> Signup and view all the answers

    What is the lifetime risk of breast cancer for individuals with a BRCA1 mutation?

    <p>50-85%</p> Signup and view all the answers

    Which type of breast carcinoma in situ is characterized by malignant cells confined to the duct spaces?

    <p>Ductal carcinoma in situ (DCIS)</p> Signup and view all the answers

    What does the presence of atypical hyperplasia indicate regarding breast cancer risk?

    <p>Moderate increased risk</p> Signup and view all the answers

    Which histological characteristic differentiates high grade DCIS from low grade DCIS?

    <p>Presence of necrosis</p> Signup and view all the answers

    Which hereditary mutations account for the majority of breast cancer syndromes?

    <p>BRCA1 and BRCA2</p> Signup and view all the answers

    What is the estimated 5-year survival rate for breast cancer as of 2017?

    <p>95%</p> Signup and view all the answers

    Which of the following factors is NOT considered a breast cancer risk factor?

    <p>Daily aerobic exercise</p> Signup and view all the answers

    What does Paget’s disease of the nipple usually indicate?

    <p>Underlying high grade DCIS</p> Signup and view all the answers

    Which of the following conditions is associated with a significant increased risk of developing invasive breast cancer?

    <p>Lobular carcinoma in situ</p> Signup and view all the answers

    How is the risk of breast cancer modified by environmental factors?

    <p>It can vary among individuals with the same genetic mutations.</p> Signup and view all the answers

    To whom is the Breast Cancer Risk Assessment Tool applicable?

    <p>Women over 35 years</p> Signup and view all the answers

    Which characteristic distinguishes invasive breast cancer from in situ cancers?

    <p>Invasive cancers have spread beyond the ductal-lobular system.</p> Signup and view all the answers

    Which treatment method is commonly recommended for DCIS following diagnosis?

    <p>Surgical excision with clear margins</p> Signup and view all the answers

    What percentage of breast cancer cases are classified as carcinoma in situ at the time of diagnosis?

    <p>20-25%</p> Signup and view all the answers

    What is the most common cancer in women, excluding non-melanoma skin cancer?

    <p>Invasive breast carcinoma.</p> Signup and view all the answers

    List two major risk factors for developing breast cancer.

    <p>Gender and age.</p> Signup and view all the answers

    Define breast carcinoma in situ (CIS).

    <p>Malignant breast cells confined to the ductal-lobular system without invasion into the stroma.</p> Signup and view all the answers

    What characterizes atypical ductal hyperplasia in terms of breast cancer risk?

    <p>It is associated with a moderate increase in breast cancer risk, 4-5 times above the general population.</p> Signup and view all the answers

    What is the primary genetic mutation associated with hereditary breast cancer?

    <p>BRCA1/BRCA2 mutation.</p> Signup and view all the answers

    Which type of breast disease has no increased risk of developing breast cancer?

    <p>Non-proliferative breast disease.</p> Signup and view all the answers

    What are the two classifications of breast carcinoma in situ?

    <p>Ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).</p> Signup and view all the answers

    How does Paget’s disease of the nipple typically present clinically?

    <p>It presents as a red, weeping, 'eczematous' nipple.</p> Signup and view all the answers

    What is the lifetime risk of breast cancer for individuals with BRCA1 mutations?

    <p>50-85%.</p> Signup and view all the answers

    Which breast condition is characterized by the presence of malignant cells within the epidermis of the nipple?

    <p>Paget's Disease of the Nipple.</p> Signup and view all the answers

    What is the estimated 5-year survival rate for breast cancer as of 2018?

    <p>95%.</p> Signup and view all the answers

    What is the relationship between breast density and breast cancer risk?

    <p>Higher breast density is associated with an increased risk of breast cancer.</p> Signup and view all the answers

    What is the main histological feature classified in DCIS?

    <p>Grade of nuclear atypia.</p> Signup and view all the answers

    What is the role of HER2 protein in breast cancer progression?

    <p>HER2 promotes cell proliferation and inhibits apoptosis, contributing to cancer growth.</p> Signup and view all the answers

    How does the presence of ER+/PR+ receptors affect the response to tamoxifen in breast cancer?

    <p>ER+/PR+ tumors have an 80% response rate to tamoxifen, indicating better treatment efficacy.</p> Signup and view all the answers

    What molecular profiling subsets exist for breast cancer, and how are they significant?

    <p>The main subsets are Luminal A, Luminal B, HER2 enriched, and Basal-like, each with distinct prognostic and predictive values.</p> Signup and view all the answers

    What is the predictive value of HER2 positivity in breast cancer treatment?

    <p>HER2 positivity strongly predicts a response to anti-HER2 therapies, like Trastuzumab.</p> Signup and view all the answers

    What additional treatments might be recommended for high-risk breast cancer patients?

    <p>Chemotherapy, radiotherapy, and surgical interventions may be recommended based on risk factors.</p> Signup and view all the answers

    How does gene amplification affect the prognosis of breast cancer?

    <p>HER2 gene amplification is associated with poorer survival outcomes compared to HER2 negative cases.</p> Signup and view all the answers

    What are the implications of performing routine genome-wide expression profiling in breast cancer?

    <p>Routine profiling is impractical due to cost, leading to more focused gene subset tests being developed.</p> Signup and view all the answers

    What surgical approaches are typically used in breast cancer treatment?

    <p>Surgical options include mastectomy or wide local excision, often accompanied by axillary surgery.</p> Signup and view all the answers

    What are common clinical symptoms associated with invasive breast cancer?

    <p>Common symptoms include a discrete mass, pain, nipple changes, and skin changes.</p> Signup and view all the answers

    How is lobular carcinoma in situ (LCIS) typically identified histologically?

    <p>LCIS is identified by the negative E-cadherin stain and expansion of lobules by neoplastic cells.</p> Signup and view all the answers

    What does the modified Bloom and Richardson method evaluate in breast cancer grading?

    <p>It evaluates tubule formation, nuclear atypia, and mitotic rate.</p> Signup and view all the answers

    What role do estrogen and progesterone receptors play in breast cancer prognosis?

    <p>ER/PR positive breast cancers generally have improved survival and predict better responses to anti-estrogen therapy.</p> Signup and view all the answers

    What is the clinical significance of lymph node involvement in staging breast cancer?

    <p>Lymph node involvement indicates the extent of cancer spread and helps determine prognosis and treatment options.</p> Signup and view all the answers

    How does the histological type of invasive breast cancer affect prognosis?

    <p>Histological types such as invasive ductal carcinoma and invasive lobular carcinoma have different implications for prognosis.</p> Signup and view all the answers

    What does the AJCC system assess in breast cancer staging?

    <p>The AJCC system assesses primary tumor size, local invasiveness, nodal burden, and presence of metastases.</p> Signup and view all the answers

    What types of breast carcinomas are associated with favorable and poor prognosis?

    <p>Mucinous and tubular carcinomas are associated with a good prognosis, while micropapillary and basal-like carcinomas are associated with poor prognosis.</p> Signup and view all the answers

    What factors determine the need for increased surveillance after a core biopsy indicates LCIS?

    <p>Increased surveillance is needed when LCIS is isolated or associated with a moderate to high-risk lesion.</p> Signup and view all the answers

    How does the loss of E-cadherin expression relate to breast cancer pathology?

    <p>Loss of E-cadherin expression indicates a loss of cell adhesion, contributing to tumor invasion and metastasis.</p> Signup and view all the answers

    Which of these options are correct? (Select all that apply)

    <p>Moraxella catarrhalis</p> Signup and view all the answers

    Which condition is characterized by fever, hoarseness, and a barking cough?

    <p>Croup</p> Signup and view all the answers

    What is the most common pathogen associated with chronic sinusitis?

    <p>Haemophilus influenzae</p> Signup and view all the answers

    Which of the following is a key feature of a granuloma in tuberculosis (TB)?

    <p>Granulomas contain central caseous necrosis</p> Signup and view all the answers

    What is the significance of a positive IGRA test?

    <p>It indicates prior exposure to TB antigens</p> Signup and view all the answers

    Which infection control measure is most effective in preventing TB transmission in healthcare settings?

    <p>Using N95 masks and natural ventilation</p> Signup and view all the answers

    Which type of lung cancer is most commonly found in non-smokers?

    <p>Adenocarcinoma</p> Signup and view all the answers

    Which of the following is a characteristic feature of squamous cell carcinoma of the lung?

    <p>Central location &amp; keratin pearl formation</p> Signup and view all the answers

    Which diagnostic test would confirm active tuberculosis?

    <p>Sputum acid-fast bacilli (AFB) smear and culture</p> Signup and view all the answers

    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?

    <p>Chronic Obstructive Pulmonary Disease (COPD)</p> Signup and view all the answers

    What is the most appropriate initial treatment for a patient presenting with sudden onset of chest pain and shortness of breath?

    <p>Intravenous heparin</p> Signup and view all the answers

    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?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    Which of the following findings is most indicative of mesothelioma?

    <p>Pleural plaques &amp; thickening</p> Signup and view all the answers

    What is the most appropriate management strategy for a patient with chronic productive cough and dilated bronchi?

    <p>Long-term antibiotic therapy</p> Signup and view all the answers

    Which long-term management is most appropriate for a 12-year-old with episodes of wheezing and a history of atopic dermatitis?

    <p>Inhaled corticosteroids</p> Signup and view all the answers

    What is the most likely cause of a pleural effusion in a patient with pneumonic symptoms and an exudative effusion?

    <p>Pneumonia</p> Signup and view all the answers

    What is the most likely causative organism for a patient with foul-smelling sputum and a right lower lobe cavity?

    <p>Klebsiella pneumoniae</p> Signup and view all the answers

    What is the likely diagnosis for a patient with a honeycomb pattern on high-resolution CT scan?

    <p>Pulmonary fibrosis</p> Signup and view all the answers

    Which paraneoplastic syndrome is most commonly associated with small cell lung carcinoma?

    <p>SIADH</p> Signup and view all the answers

    What is the most likely causative organism for a 5-year-old with a productive cough and crackles?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What is the likely diagnosis for a patient with reticular opacities and honeycombing on CT scan?

    <p>Idiopathic pulmonary fibrosis</p> Signup and view all the answers

    Which statement is NOT correct about lung adenocarcinoma?

    <p>It often presents as a central lung mass.</p> Signup and view all the answers

    Which statement is NOT correct about tuberculosis?

    <p>A positive tuberculin skin test indicates an active infection with the tuberculosis bacteria.</p> Signup and view all the answers

    Which statement is NOT correct about chronic obstructive pulmonary disease?

    <p>There are ground-glass opacities on imaging.</p> Signup and view all the answers

    Which treatment is NOT correct regarding pulmonary embolism?

    <p>Thrombolytic therapy is the first line treatment.</p> Signup and view all the answers

    What best defines cultural safety?

    <p>Effective care by healthcare professionals after reflecting on their cultural identity</p> Signup and view all the answers

    What is the initial step in Coffin's Cultural Security Model?

    <p>Cultural awareness</p> Signup and view all the answers

    What percentage of pharyngitis cases are caused by rhinoviruses?

    <p>20%</p> Signup and view all the answers

    What happens to alveolar partial pressure of oxygen (PAO2) when there is low ventilation but normal perfusion (low VA/Q ratio)?

    <p>PAO2 decreases</p> Signup and view all the answers

    Which condition is associated with a high ventilation-perfusion (VA/Q) ratio?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What is the primary cause of hypoxaemia in cases of ventilation-perfusion mismatch?

    <p>Shunted blood bypassing oxygenation</p> Signup and view all the answers

    What is atelectasis?

    <p>Collapse of the alveoli</p> Signup and view all the answers

    Which respiratory centre is primarily responsible for generating the basic rhythm of breathing?

    <p>Dorsal respiratory group (DRG)</p> Signup and view all the answers

    Which area of the brainstem coordinates the transition between inhalation and exhalation?

    <p>Pneumotaxic centre</p> Signup and view all the answers

    Which nerve supplies the anterior 2/3 of the tongue for general sensation?

    <p>Lingual nerve (CN V3 branch)</p> Signup and view all the answers

    What is the role of the greater petrosal nerve?

    <p>Parasympathetic innervation to the nasal cavity and palate</p> Signup and view all the answers

    Which cytokines are primarily involved in the stimulation of allergen-specific IgE production?

    <p>IL-4 and IL-13</p> Signup and view all the answers

    Which immune cells are primarily responsible for the late-phase reaction in IgE-mediated hypersensitivity?

    <p>Eosinophils and Th2 cells</p> Signup and view all the answers

    What is the primary function of regulatory T (Treg) cells in allergic responses?

    <p>Suppressing Th2 cell responses via IL-10 and TGF-B</p> Signup and view all the answers

    What is the primary goal of allergen-specific immunotherapy (SCIT or SLIT)?

    <p>To reduce Th2 cell responses and increase blocking antibodies (IgG4)</p> Signup and view all the answers

    The presence of which sign on a chest x-ray indicates pneumothorax?

    <p>Pleural line with no lung markings peripheral to it</p> Signup and view all the answers

    What type of medication is tiotropium?

    <p>Long-acting muscarinic antagonist (LAMA)</p> Signup and view all the answers

    What class of drugs includes medications like montelukast?

    <p>Leukotriene receptor antagonists</p> Signup and view all the answers

    What feature is characteristic of obstructive lung diseases?

    <p>Increased airway resistance</p> Signup and view all the answers

    Which disease is associated with alpha-1 antitrypsin deficiency?

    <p>Emphysema</p> Signup and view all the answers

    Which clinical feature is NOT typical of chronic bronchitis?

    <p>Hyperinflation of the lungs</p> Signup and view all the answers

    What is the main cause of bronchiectasis?

    <p>Recurrent infections</p> Signup and view all the answers

    Which term describes a high-pitched, polyphonic sound produced in the airways during expiration?

    <p>Wheeze</p> Signup and view all the answers

    Which of the following is NOT a feature of restrictive lung disease?

    <p>Increased airway resistance</p> Signup and view all the answers

    What histological pattern is commonly associated with ARDS?

    <p>Diffuse alveolar damage (DAD)</p> Signup and view all the answers

    Which disease is characterized by temporally heterogeneous fibrosis and honeycomb lung?

    <p>Idiopathic Pulmonary Fibrosis (IPF)</p> Signup and view all the answers

    Which restrictive lung disease is associated with tight non-necrotising granulomas and multisystem involvement?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the most common cause of Acute Lung Injury (ALI) leading to ARDS?

    <p>Sepsis</p> Signup and view all the answers

    Which type of interstitial pneumonia is characterized by polyploid plugs of loose organizing connective tissue in alveolar ducts and alveoli?

    <p>Cryptogenic organizing pneumonia (COP)</p> Signup and view all the answers

    What oxygen delivery device provides the highest concentration of oxygen?

    <p>Non-rebreather mask</p> Signup and view all the answers

    What is the recommended target oxygen saturation for a patient with COPD?

    <p>88-92%</p> Signup and view all the answers

    Which test involves intradermal injection to detect TB infection?

    <p>Mantoux test</p> Signup and view all the answers

    What form of extrapulmonary TB involves the spine?

    <p>Pott’s disease</p> Signup and view all the answers

    What statement about pulmonary embolism (PE) is true?

    <p>It causes a ventilation-perfusion mismatch.</p> Signup and view all the answers

    Goodpasture syndrome involves autoantibodies against which structure?

    <p>Basement membrane of the a3 chain of collagen IV</p> Signup and view all the answers

    Which is NOT a common clinical feature of diffuse pulmonary hemorrhage?

    <p>Pleuritic chest pain</p> Signup and view all the answers

    Which pathogen is most commonly associated with healthcare-associated pneumonia (HCAP)?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    Which of the following is a common cause of ventilator-associated pneumonia (VAP)?

    <p>Methicillin-Resistant Staphylococcus Aureus</p> Signup and view all the answers

    What type of pleural effusion is characterized by low glucose levels, pleural fluid acidosis, and elevated LDH?

    <p>Complicated parapneumonic effusion</p> Signup and view all the answers

    What condition is characterized by abnormal and permanent dilation of bronchi?

    <p>Bronchiectasis</p> Signup and view all the answers

    Which organism is most commonly responsible for lung abscesses following aspiration?

    <p>Klebsiella pneumoniae</p> Signup and view all the answers

    What pathogen is associated with melioidosis?

    <p>Burkholderia pseudomallei</p> Signup and view all the answers

    What is the most common opportunistic infection in HIV patients with a CD4 count below 200 cells/mm3?

    <p>Pneumocystitis pneumonia (PCP)</p> Signup and view all the answers

    Which pathogen is most commonly associated with community-acquired pneumonia (CAP) in children?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What is the most common bacterial cause of pharyngitis?

    <p>Streptococcus pyogenes</p> Signup and view all the answers

    Which treatment is recommended for acute epiglottitis caused by Haemophilus influenzae type B (Hib)?

    <p>Ceftriaxone</p> Signup and view all the answers

    What clinical features are characteristic of inflammatory breast cancer (IBC)?

    <p>Rapid breast enlargement, skin changes resembling peau d’orange, and erythema.</p> Signup and view all the answers

    Why is inflammatory breast cancer (IBC) often associated with a poorer prognosis compared to other breast cancers?

    <p>IBC tends to be diagnosed at a more advanced stage due to its aggressive nature and early lymphatic spread.</p> Signup and view all the answers

    What are the primary treatment strategies for inflammatory breast cancer (IBC)?

    <p>Neoadjuvant chemotherapy, surgery, and radiation.</p> Signup and view all the answers

    Which region of the prostate is most commonly affected by benign prostatic hyperplasia (BPH)?

    <p>Transition zone</p> Signup and view all the answers

    What is the main mechanism of action of 5-alpha reductase inhibitors in the treatment of BPH?

    <p>Reduction of prostate volume by inhibiting the conversion of testosterone to DHT</p> Signup and view all the answers

    Which subtype of breast cancer is associated with the poorest survival rate?

    <p>Triple-negative breast cancer (TNBC)</p> Signup and view all the answers

    Which of the following drugs is contraindicated in patients taking nitrates for cardiovascular disease?

    <p>Sildenafil</p> Signup and view all the answers

    What characteristic feature is associated with inflammatory breast cancer?

    <p>Peau d’orange appearance</p> Signup and view all the answers

    Which prostate cancer treatment involves androgen receptor antagonism?

    <p>Flutamide</p> Signup and view all the answers

    What role does breast density play in breast cancer screening?

    <p>Higher breast density reduces the sensitivity of mammograms.</p> Signup and view all the answers

    Which drug class provides rapid symptom relief in BPH but does not affect prostate size?

    <p>Alpha-adrenergic blockers</p> Signup and view all the answers

    What is the most commonly reported adverse effect of PDE-5 inhibitors?

    <p>Headache</p> Signup and view all the answers

    Which factor is NOT considered a modifiable risk for breast cancer?

    <p>Family history of breast cancer</p> Signup and view all the answers

    What type of receptor is primarily involved in the mechanism of action for PDE-5 inhibitors in erectile dysfunction?

    <p>cGMP-specific phosphodiesterase receptors</p> Signup and view all the answers

    Which breast cancer subtype is most associated with overexpression of HER2/neu?

    <p>HER2-positive breast cancer</p> Signup and view all the answers

    Which drug used for BPH treatment may cause gynecomastia as a side effect?

    <p>Finasteride</p> Signup and view all the answers

    Which population group is most likely to benefit from selective estrogen receptor modulators (SERMs) for breast cancer prevention?

    <p>Postmenopausal women with a high risk of developing ER-positive breast cancer</p> Signup and view all the answers

    What histological feature is most characteristic of prostate adenocarcinoma?

    <p>Glandular structures with prominent nucleoli</p> Signup and view all the answers

    Which statement regarding selective estrogen receptor modulators (SERMs) is NOT correct?

    <p>SERMs stimulate estrogen receptors in all tissues.</p> Signup and view all the answers

    Which of the following statements about maternal nutrition during pregnancy is NOT correct?

    <p>Excessive vitamin A intake is beneficial for fetal vision development.</p> Signup and view all the answers

    Which statement about fetal heart monitoring is NOT correct?

    <p>Continuous electronic fetal monitoring is always necessary for low-risk pregnancies.</p> Signup and view all the answers

    Which statement about antenatal care is NOT correct?

    <p>Group B Streptococcus screening is standard at the first prenatal visit.</p> Signup and view all the answers

    Which statement regarding fetal growth assessments is NOT correct?

    <p>Serial measurements are not needed after diagnosing growth restriction.</p> Signup and view all the answers

    Which statement about sexual health history taking is NOT correct?

    <p>It should only include questions about the patient's current sexual partner.</p> Signup and view all the answers

    Which statement regarding maternal immunizations is NOT correct?

    <p>The rubella vaccine should be administered during pregnancy if needed.</p> Signup and view all the answers

    What role does folic acid play in preventing neural tube defects (NTDs)?

    <p>It facilitates neural tube closure by promoting DNA synthesis.</p> Signup and view all the answers

    Which factor is most likely to lead to fetal hypoxia during labor?

    <p>Prolonged uterine contractions with reduced intervals.</p> Signup and view all the answers

    What is a significant risk factor for congenital cytomegalovirus (CMV) infection?

    <p>Maternal asymptomatic primary CMV infection.</p> Signup and view all the answers

    Which hormone primarily supports the maintenance of pregnancy until the placenta takes over?

    <p>Progesterone from the corpus luteum.</p> Signup and view all the answers

    Which feature of fetal alcohol syndrome (FAS) is most indicative of its diagnosis?

    <p>Growth restriction and neurodevelopmental deficits.</p> Signup and view all the answers

    Which of the following mechanisms contributes to increased risk of fetal anemia in maternal parvovirus B19 infection?

    <p>Direct lysis of erythroid progenitor cells in the fetal liver.</p> Signup and view all the answers

    What distinguishes congenital toxoplasmosis from other congenital infections in terms of common clinical presentations in the neonate?

    <p>Chorioretinitis, hydrocephalus, and intracranial calcifications.</p> Signup and view all the answers

    Which aspect of fetal circulation is most affected by congenital diaphragmatic hernia (CDH)?

    <p>Compression of the lung, leading to pulmonary hypoplasia.</p> Signup and view all the answers

    What placental change is most commonly associated with asymmetrical intrauterine growth restriction (IUGR)?

    <p>Decreased placental weight and infarctions.</p> Signup and view all the answers

    Which type of genetic anomaly is most likely to result in recurrent pregnancy loss before 12 weeks gestation?

    <p>Trisomy 16 in the fetus.</p> Signup and view all the answers

    Which fetal cardiovascular adaptation is most critical for maintaining blood flow during periods of reduced placental perfusion?

    <p>Increased ductus venosus shunting.</p> Signup and view all the answers

    What is the most significant risk associated with monochorionic twin pregnancies compared to dichorionic twin pregnancies?

    <p>Twin-twin transfusion syndrome (TTTS).</p> Signup and view all the answers

    Which fetal measurement is most sensitive for detecting asymmetrical growth restriction?

    <p>Abdominal circumference (AC).</p> Signup and view all the answers

    What fetal abnormality is associated with an increase in maternal serum alpha-fetoprotein (AFP) during pregnancy?

    <p>Neural tube defect (NTD).</p> Signup and view all the answers

    Which placental disorder can lead to abrupt cessation of fetal blood flow and requires immediate intervention?

    <p>Placental abruption.</p> Signup and view all the answers

    What fetal consequence is most commonly associated with maternal phenylketonuria (PKU) if not well-managed during pregnancy?

    <p>Microcephaly and intellectual disability.</p> Signup and view all the answers

    What is the most definitive prenatal diagnostic test for detecting chromosomal abnormalities such as trisomy 21?

    <p>Chorionic villus sampling (CVS).</p> Signup and view all the answers

    Which type of congenital malformation is associated with polyhydramnios?

    <p>Esophageal atresia.</p> Signup and view all the answers

    What is the primary function of human placental lactogen (hPL) during pregnancy?

    <p>Modulating maternal glucose metabolism for fetal growth.</p> Signup and view all the answers

    What key feature on prenatal ultrasound suggests a diagnosis of anencephaly?

    <p>Frog-eye appearance due to absent cranial vault.</p> Signup and view all the answers

    What is the significance of LCIS as a risk marker?

    <p>LCIS is a marker of increased risk for developing invasive breast cancer in either breast.</p> Signup and view all the answers

    What treatment options are considered for LCIS?

    <p>Options include observation, chemoprevention, or prophylactic surgery in high-risk cases.</p> Signup and view all the answers

    What genetic alteration is commonly associated with ILC?

    <p>Loss of E-cadherin expression.</p> Signup and view all the answers

    How does ILC typically present on physical examination compared to other breast cancers?

    <p>ILC may present as subtle thickening rather than a discrete mass.</p> Signup and view all the answers

    What histological pattern is characteristic of ILC?

    <p>Single-file pattern of tumor cells infiltrating the stroma.</p> Signup and view all the answers

    What are the potential treatment options for CIN III?

    <p>Treatment options include LEEP, cryotherapy, and cone biopsy.</p> Signup and view all the answers

    What factors influence the choice of treatment for CIN III?

    <p>Factors include patient age, reproductive plans, and lesion size.</p> Signup and view all the answers

    What is the risk of progression to invasive cancer if CIN III is left untreated?

    <p>CIN III has a significant risk of progressing to invasive cancer if untreated.</p> Signup and view all the answers

    What is the primary site of origin for choriocarcinoma?

    <p>The trophoblastic cells of the placenta.</p> Signup and view all the answers

    Which marker is used for diagnosing and monitoring choriocarcinoma?

    <p>β-hCG.</p> Signup and view all the answers

    Why is choriocarcinoma often highly responsive to chemotherapy?

    <p>Choriocarcinoma cells are highly proliferative and sensitive to chemotherapeutic agents.</p> Signup and view all the answers

    What are common causes of placental insufficiency?

    <p>Causes include maternal hypertension, preeclampsia, and placental infarctions.</p> Signup and view all the answers

    How does placental insufficiency affect fetal growth?

    <p>It can lead to intrauterine growth restriction (IUGR) due to inadequate nutrient and oxygen delivery.</p> Signup and view all the answers

    Name one long-term consequence for the infant born after significant placental insufficiency.

    <p>Increased risk of metabolic syndrome and cardiovascular disease in adulthood.</p> Signup and view all the answers

    What is the most common type of benign breast lesion in young women?

    <p>Fibroadenoma.</p> Signup and view all the answers

    How does fibrocystic change present histologically?

    <p>Cystic dilation of ducts, fibrosis, and epithelial hyperplasia.</p> Signup and view all the answers

    What distinguishes a fibroadenoma from other benign breast conditions?

    <p>A fibroadenoma is a well-circumscribed, mobile mass with a biphasic pattern of glandular and stromal components.</p> Signup and view all the answers

    What histological subtype of invasive breast carcinoma is associated with a single-file pattern of cells infiltrating the stroma?

    <p>Invasive lobular carcinoma</p> Signup and view all the answers

    Which type of ovarian tumor is associated with Call-Exner bodies on histology?

    <p>Granulosa cell tumor</p> Signup and view all the answers

    What is the primary hormonal mechanism contributing to the development of polycystic ovary syndrome (PCOS)?

    <p>Increased androgen production by the ovaries</p> Signup and view all the answers

    Which marker is most commonly elevated in patients with epithelial ovarian cancer?

    <p>CA-125</p> Signup and view all the answers

    What is the typical age group affected by seminomas?

    <p>Men aged 15-35</p> Signup and view all the answers

    What is the most common cause of a complete mole?

    <p>Fertilization of an empty egg by one sperm that duplicates</p> Signup and view all the answers

    Which breast pathology is characterized by stromal overgrowth and a 'leaf-like' pattern?

    <p>Phyllodes tumor</p> Signup and view all the answers

    What is the common presentation of placental site trophoblastic tumor (PSTT)?

    <p>Postpartum bleeding with moderate elevation of β-hCG</p> Signup and view all the answers

    Which genetic alteration is commonly associated with invasive ductal carcinoma of the breast?

    <p>HER2 amplification</p> Signup and view all the answers

    What histological feature distinguishes endometrial hyperplasia with atypia from simple hyperplasia?

    <p>Nuclear atypia in glandular cells</p> Signup and view all the answers

    How do phyllodes tumors typically present clinically?

    <p>Phyllodes tumors often present as a rapidly growing, firm breast mass.</p> Signup and view all the answers

    What distinguishes benign from malignant phyllodes tumors histologically?

    <p>Malignant phyllodes tumors exhibit increased mitotic activity, stromal overgrowth, and cellular atypia.</p> Signup and view all the answers

    What is the primary treatment approach for phyllodes tumors?

    <p>Wide local excision with clear margins.</p> Signup and view all the answers

    What are the risk factors for developing placenta previa?

    <p>Risk factors include prior cesarean section, multiparity, and advanced maternal age.</p> Signup and view all the answers

    How does placenta previa typically present during pregnancy?

    <p>It presents with painless vaginal bleeding in the second or third trimester.</p> Signup and view all the answers

    What management strategies are used for a diagnosed case of placenta previa?

    <p>Management includes close monitoring, avoiding digital cervical exams, and planning for cesarean delivery.</p> Signup and view all the answers

    What is the role of E-cadherin in normal breast tissue?

    <p>E-cadherin helps maintain cell adhesion and tissue structure.</p> Signup and view all the answers

    How does the loss of E-cadherin contribute to the behavior of ILC?

    <p>Loss of E-cadherin results in a more diffuse growth pattern and single-file infiltration.</p> Signup and view all the answers

    What histological pattern is characteristic of ILC?

    <p>Single-file infiltration of tumor cells.</p> Signup and view all the answers

    What histological features distinguish ADH from DCIS?

    <p>ADH shows partial features of DCIS but does not involve the complete duct.</p> Signup and view all the answers

    How does ADH impact the risk of developing breast cancer?

    <p>ADH increases the risk of future breast cancer development.</p> Signup and view all the answers

    What management strategy is recommended for patients diagnosed with ADH?

    <p>Management includes close surveillance and possibly chemoprevention.</p> Signup and view all the answers

    What are common histological subtypes of type 2 endometrial carcinoma?

    <p>Serous and clear cell carcinoma.</p> Signup and view all the answers

    What molecular marker is frequently associated with type 2 endometrial carcinoma?

    <p>p53 mutation.</p> Signup and view all the answers

    Why does type 2 endometrial carcinoma often have a worse prognosis?

    <p>It is usually diagnosed at an advanced stage and has aggressive behavior.</p> Signup and view all the answers

    What types of breast cancer are most responsive to hormonal therapy?

    <p>ER-positive and PR-positive breast cancers.</p> Signup and view all the answers

    How does tamoxifen function as a hormonal therapy agent?

    <p>Tamoxifen acts as a selective estrogen receptor modulator (SERM), blocking estrogen in breast tissue.</p> Signup and view all the answers

    What are common side effects associated with tamoxifen use?

    <p>Side effects include hot flashes, increased risk of venous thromboembolism, and endometrial hyperplasia.</p> Signup and view all the answers

    What are the classic symptoms of testicular torsion?

    <p>Sudden, severe scrotal pain and swelling.</p> Signup and view all the answers

    How does testicular torsion differ from epididymitis on physical exam?

    <p>Testicular torsion often presents with an absent cremasteric reflex, while epididymitis may have fever and tenderness with a preserved reflex.</p> Signup and view all the answers

    What is the time frame for intervention to prevent testicular necrosis?

    <p>Intervention is required within 6 hours to maximize testicular salvage.</p> Signup and view all the answers

    What treatment is specifically targeted for HER2-positive breast cancer?

    <p>Trastuzumab (Herceptin).</p> Signup and view all the answers

    How is HER2 status typically determined in breast cancer patients?

    <p>HER2 status is determined using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).</p> Signup and view all the answers

    What are potential side effects of HER2-targeted therapies?

    <p>Cardiotoxicity and infusion reactions.</p> Signup and view all the answers

    Which condition is most likely to present with peau d’orange skin changes?

    <p>Inflammatory breast cancer</p> Signup and view all the answers

    What is the main difference in presentation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC)?

    <p>DCIS is confined within the ductal system</p> Signup and view all the answers

    Which statement about benign breast diseases is NOT correct?

    <p>Atypical ductal hyperplasia significantly reduces breast cancer risk</p> Signup and view all the answers

    Which statement regarding HPV and cervical cancer is NOT correct?

    <p>HPV vaccination has no impact on the incidence of cervical intraepithelial neoplasia (CIN)</p> Signup and view all the answers

    Which statement regarding testicular germ cell tumors is NOT correct?

    <p>Yolk sac tumors secrete β-hCG</p> Signup and view all the answers

    Which statement about breast cancer risk factors is NOT correct?

    <p>High parity and early first pregnancy are strong risk factors for breast cancer</p> Signup and view all the answers

    Which statement regarding the pathology of endometrial carcinoma is NOT correct?

    <p>Type 2 endometrial carcinoma is associated with PTEN mutations</p> Signup and view all the answers

    Which statement about gestational trophoblastic diseases (GTD) is NOT correct?

    <p>Complete moles always contain fetal tissue</p> Signup and view all the answers

    Which statement about prostate cancer is NOT correct?

    <p>Adenocarcinoma of the prostate commonly originates in the transitional zone</p> Signup and view all the answers

    Which statement regarding cervical pathology is NOT correct?

    <p>The transformation zone is not involved in HPV-related dysplasia</p> Signup and view all the answers

    Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?

    <p>BPH originates primarily in the peripheral zone of the prostate</p> Signup and view all the answers

    Which statement about the menstrual cycle is NOT correct?

    <p>The secretory phase is associated with the lowest endometrial thickness</p> Signup and view all the answers

    Which statement regarding ovarian cancer is NOT correct?

    <p>Mucinous carcinomas commonly involve mutations in the BRCA gene</p> Signup and view all the answers

    Which statement about breast cancer subtypes is NOT correct?

    <p>Luminal A subtype has a poorer prognosis compared to HER2-positive</p> Signup and view all the answers

    Which statement about the histology of testicular tumors is NOT correct?

    <p>Teratomas in prepubertal males are considered malignant</p> Signup and view all the answers

    Which statement regarding breast pathologies is NOT correct?

    <p>Lobular carcinoma in situ (LCIS) always progresses to invasive cancer</p> Signup and view all the answers

    Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?

    <p>Invasive moles contain fetal tissue</p> Signup and view all the answers

    What is the most common type of malignant ovarian tumor?

    <p>High-grade serous carcinoma</p> Signup and view all the answers

    Which ovarian tumor is often linked with endometriosis?

    <p>Clear cell carcinoma</p> Signup and view all the answers

    What tumor marker is commonly used for monitoring epithelial ovarian cancer?

    <p>CA-125</p> Signup and view all the answers

    What is the genetic composition of a complete mole?

    <p>Complete moles are typically diploid and consist of only paternal DNA</p> Signup and view all the answers

    What is the primary risk associated with neural tube defects (NTDs) if the anterior neuropore fails to close?

    <p>Anencephaly</p> Signup and view all the answers

    How does a partial mole differ histologically from a complete mole?

    <p>Partial moles contain triploid karyotypes and can include fetal tissue</p> Signup and view all the answers

    Which of the following best explains why intrauterine growth restriction (IUGR) predisposes an individual to long-term metabolic disease?

    <p>Reduced placental blood flow and nutrient delivery</p> Signup and view all the answers

    What is the risk of developing choriocarcinoma from each type?

    <p>Complete moles have a higher risk of progression to choriocarcinoma compared to partial moles</p> Signup and view all the answers

    Which congenital malformation is characterized by the herniation of brain tissue through a skull defect?

    <p>Encephalocele</p> Signup and view all the answers

    Which high-risk HPV types are most commonly associated with cervical cancer?

    <p>HPV 16 and 18</p> Signup and view all the answers

    What is a primary characteristic of Tetralogy of Fallot?

    <p>Ventricular septal defect (VSD)</p> Signup and view all the answers

    How does HPV integrate into the host genome, contributing to carcinogenesis?

    <p>Integration disrupts regulatory genes, leading to overexpression of oncogenes like E6 and E7</p> Signup and view all the answers

    What histological changes are seen in cervical intraepithelial neoplasia (CIN) III?

    <p>Full-thickness dysplasia without invasion of the basement membrane</p> Signup and view all the answers

    What factor is essential for the transport of glucose across the placenta?

    <p>Glucose transporters (e.g., GLUT1)</p> Signup and view all the answers

    In which zone of the prostate does BPH primarily occur?

    <p>The transitional zone</p> Signup and view all the answers

    Which statement regarding folic acid supplementation is NOT correct?

    <p>Folic acid is only necessary in the first trimester.</p> Signup and view all the answers

    Which statement about sexual health history taking is NOT correct?

    <p>It is only relevant when a patient presents with urogenital symptoms.</p> Signup and view all the answers

    How does dihydrotestosterone (DHT) contribute to the development of BPH?

    <p>DHT stimulates the growth of prostate tissue, leading to hyperplasia</p> Signup and view all the answers

    Which statement regarding congenital heart defects is NOT correct?

    <p>An atrial septal defect always presents with cyanosis.</p> Signup and view all the answers

    What are common complications associated with untreated BPH?

    <p>Urinary retention, increased risk of urinary tract infections, and bladder hypertrophy</p> Signup and view all the answers

    Which of the following statements about fetal growth is NOT correct?

    <p>Growth assessments are equally reliable at all gestational stages.</p> Signup and view all the answers

    What type of endometrial carcinoma is associated with prolonged unopposed estrogen exposure?

    <p>Type 1 endometrial carcinoma</p> Signup and view all the answers

    Which statement about prenatal screening for congenital abnormalities is NOT correct?

    <p>Screening tests for trisomy 21 can only be performed after 20 weeks.</p> Signup and view all the answers

    What is the role of progesterone in protecting against endometrial hyperplasia?

    <p>Progesterone counteracts the proliferative effects of estrogen on the endometrium</p> Signup and view all the answers

    Name one condition that can cause unopposed estrogen exposure.

    <p>Chronic anovulation (e.g., polycystic ovary syndrome)</p> Signup and view all the answers

    Which statement about fetal growth restriction (FGR) is NOT correct?

    <p>FGR is always symmetrical.</p> Signup and view all the answers

    Which statement regarding the use of ultrasound in pregnancy is NOT correct?

    <p>Ultrasound can definitively diagnose genetic disorders.</p> Signup and view all the answers

    How is DCIS typically detected?

    <p>Mammography, often showing microcalcifications</p> Signup and view all the answers

    What distinguishes DCIS histologically from invasive ductal carcinoma (IDC)?

    <p>DCIS does not invade the basement membrane, unlike IDC</p> Signup and view all the answers

    Which statement regarding maternal diabetes and fetal growth is NOT correct?

    <p>All fetuses of diabetic mothers exhibit macrosomia.</p> Signup and view all the answers

    What distinguishes structural from functional congenital abnormalities?

    <p>Structural abnormalities involve physical malformations, while functional abnormalities affect how organs or systems work.</p> Signup and view all the answers

    Why is DCIS considered a precursor to invasive breast cancer?

    <p>DCIS has the potential to progress to invasive cancer if left untreated</p> Signup and view all the answers

    What imaging techniques are used to diagnose structural abnormalities in utero?

    <p>Ultrasound and MRI.</p> Signup and view all the answers

    What clinical signs are characteristic of inflammatory breast cancer?

    <p>Peau d’orange skin changes and rapid breast enlargement</p> Signup and view all the answers

    What is the role of amniocentesis in prenatal diagnosis?

    <p>Amniocentesis can provide a genetic diagnosis by analyzing fetal DNA from amniotic fluid.</p> Signup and view all the answers

    What histological findings support the diagnosis of inflammatory breast cancer?

    <p>Tumor cell invasion into dermal lymphatics</p> Signup and view all the answers

    Why does inflammatory breast cancer have a poorer prognosis compared to other types?

    <p>Its aggressive nature and tendency for early metastasis contribute to a poorer prognosis</p> Signup and view all the answers

    How does the placenta facilitate nutrient transfer to the fetus?

    <p>Through facilitated diffusion, active transport, and other transport mechanisms.</p> Signup and view all the answers

    What placental dysfunction can lead to intrauterine growth restriction (IUGR)?

    <p>Reduced placental blood flow and nutrient delivery.</p> Signup and view all the answers

    What differentiates a complete mole from a partial mole on histology?

    <p>Complete moles have diffuse trophoblastic proliferation without fetal tissue, while partial moles may contain fetal parts</p> Signup and view all the answers

    What is the significance of persistently elevated β-hCG levels after evacuation of a mole?

    <p>It suggests the possibility of invasive mole or choriocarcinoma</p> Signup and view all the answers

    Name one hormone produced by the placenta and its function in pregnancy.

    <p>Human chorionic gonadotropin (hCG), which maintains the corpus luteum and supports early pregnancy.</p> Signup and view all the answers

    Name one treatment option for invasive gestational trophoblastic neoplasia.

    <p>Chemotherapy, such as methotrexate or actinomycin D</p> Signup and view all the answers

    What is the embryological basis of neural tube defects (NTDs)?

    <p>NTDs occur when the neural tube fails to close properly during early development.</p> Signup and view all the answers

    Name one type of NTD and describe its main features.

    <p>Spina bifida, characterized by incomplete closure of the spinal column.</p> Signup and view all the answers

    What is the pathophysiological basis of adenomyosis?

    <p>The presence of endometrial glands and stroma within the myometrium</p> Signup and view all the answers

    What preventive measure is recommended to reduce the risk of NTDs?

    <p>Folic acid supplementation before conception and in early pregnancy.</p> Signup and view all the answers

    How does adenomyosis typically present clinically?

    <p>Heavy menstrual bleeding, dysmenorrhea, and an enlarged, tender uterus</p> Signup and view all the answers

    What is the most common maternal condition associated with fetal macrosomia?

    <p>Maternal diabetes, particularly poorly controlled gestational diabetes.</p> Signup and view all the answers

    What imaging modality is most useful for diagnosing adenomyosis?

    <p>MRI or transvaginal ultrasound</p> Signup and view all the answers

    How does fetal hyperinsulinemia contribute to macrosomia?

    <p>Fetal hyperinsulinemia promotes excess nutrient storage and growth.</p> Signup and view all the answers

    What are two potential complications of macrosomia during delivery?

    <p>Shoulder dystocia and increased risk of cesarean delivery.</p> Signup and view all the answers

    What is the significance of early diagnosis for conditions like transposition of the great arteries?

    <p>Early diagnosis allows for planned interventions, including potential surgery soon after birth.</p> Signup and view all the answers

    How can fetal echocardiography help guide management before and after birth?

    <p>It helps in assessing the severity and planning necessary medical or surgical treatments.</p> Signup and view all the answers

    What is the difference between symmetrical and asymmetrical intrauterine growth restriction (IUGR)?

    <p>Symmetrical IUGR affects the whole body proportionately, while asymmetrical IUGR typically spares the head.</p> Signup and view all the answers

    Which trimester is most critical for diagnosing growth abnormalities?

    <p>The third trimester.</p> Signup and view all the answers

    What are the potential long-term health impacts of intrauterine growth restriction on the infant?

    <p>Increased risk of metabolic syndrome and cardiovascular disease in later life.</p> Signup and view all the answers

    Which maternal serum marker is commonly elevated in pregnancies with neural tube defects?

    <p>Alpha-fetoprotein (AFP).</p> Signup and view all the answers

    What imaging technique is most effective in confirming neural tube defects?

    <p>Ultrasound, specifically detailed anatomy scans.</p> Signup and view all the answers

    How does genetic counselling play a role in pregnancies at risk of neural tube defects?

    <p>Genetic counseling provides families with information on recurrence risk and potential interventions.</p> Signup and view all the answers

    What are two common congenital infections screened for during pregnancy?

    <p>CMV and rubella.</p> Signup and view all the answers

    How can maternal vaccination impact the risk of congenital rubella?

    <p>Maternal vaccination before pregnancy prevents rubella and its congenital complications.</p> Signup and view all the answers

    What prenatal intervention is recommended to prevent vertical transmission of Group B Streptococcus?

    <p>Intrapartum antibiotic prophylaxis.</p> Signup and view all the answers

    What specific questions should be included when taking a sexual health history?

    <p>Questions should cover sexual practices, number of partners, STI history, and contraception use.</p> Signup and view all the answers

    Why is patient confidentiality essential in sexual health consultations?

    <p>It encourages honesty and trust, ensuring accurate information is provided.</p> Signup and view all the answers

    How can sexual health history taking influence patient outcomes?

    <p>It helps identify potential risks, inform screening decisions, and guide patient education.</p> Signup and view all the answers

    How does maternal nutrition impact fetal brain development?

    <p>Adequate intake of nutrients such as folic acid and omega-3 fatty acids supports brain formation.</p> Signup and view all the answers

    Name one maternal infection that can disrupt fetal neurological development.

    <p>Maternal CMV infection can affect fetal neurological development.</p> Signup and view all the answers

    What is the role of prenatal vitamins in supporting healthy brain development?

    <p>Prenatal vitamins supply essential micronutrients that reduce the risk of developmental defects.</p> Signup and view all the answers

    How does cardiac output change during pregnancy?

    <p>Cardiac output increases to support increased blood flow.</p> Signup and view all the answers

    What adaptations occur in maternal glucose metabolism?

    <p>Maternal insulin resistance increases to ensure more glucose is available for the fetus.</p> Signup and view all the answers

    What is the primary cause of polyhydramnios?

    <p>Fetal anomalies that impair swallowing or increased production of amniotic fluid.</p> Signup and view all the answers

    What complications are associated with oligohydramnios?

    <p>Oligohydramnios can lead to growth restriction and musculoskeletal deformities.</p> Signup and view all the answers

    What role does the maternal innate immune system play during pregnancy?

    <p>The innate immune system remains active to protect the mother from external pathogens.</p> Signup and view all the answers

    What does an increased nuchal translucency measurement indicate?

    <p>It indicates a higher risk of chromosomal abnormalities such as Down syndrome.</p> Signup and view all the answers

    At what stage of pregnancy is nuchal translucency measurement typically performed?

    <p>Between 11 and 14 weeks of gestation.</p> Signup and view all the answers

    What additional follow-up testing may be needed if increased nuchal translucency is found?

    <p>Chorionic villus sampling (CVS) or amniocentesis for genetic testing.</p> Signup and view all the answers

    Which statement regarding prenatal diagnostic techniques is NOT correct?

    <p>Amniocentesis carries no risk of miscarriage.</p> Signup and view all the answers

    Name two potential long-term complications of untreated PID.

    <p>Infertility and ectopic pregnancy.</p> Signup and view all the answers

    What imaging modality is useful for assessing complications of PID?

    <p>Pelvic ultrasound or MRI.</p> Signup and view all the answers

    What are the distinguishing histological features of a complete mole?

    <p>Diffuse trophoblastic proliferation, hydropic villi, and absence of fetal tissue.</p> Signup and view all the answers

    What is the primary treatment for a complete mole?

    <p>Uterine evacuation through suction curettage.</p> Signup and view all the answers

    How is persistent trophoblastic disease monitored post-treatment?

    <p>Serial β-hCG measurements.</p> Signup and view all the answers

    Which histological pattern is characteristic of invasive ductal carcinoma with a poor prognosis?

    <p>Sheets of high-grade cells with central necrosis</p> Signup and view all the answers

    What is the primary mechanism behind the formation of endometrial hyperplasia?

    <p>Prolonged estrogen stimulation without progesterone opposition</p> Signup and view all the answers

    Which of the following testicular tumors is most likely to produce both AFP and β-hCG?

    <p>Embryonal carcinoma</p> Signup and view all the answers

    What is a distinctive clinical feature of complete hydatidiform mole compared to partial mole?

    <p>Higher β-hCG levels</p> Signup and view all the answers

    What is a key distinguishing feature of invasive lobular carcinoma compared to invasive ductal carcinoma?

    <p>Single-file infiltration pattern and lack of E-cadherin</p> Signup and view all the answers

    Which of the following is least likely to be associated with fibrocystic changes in the breast?

    <p>Atypical ductal hyperplasia</p> Signup and view all the answers

    What is the primary diagnostic feature of choriocarcinoma under histological examination?

    <p>Sheets of trophoblastic cells without chorionic villi</p> Signup and view all the answers

    What is the most common type of cervical cancer?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which germ cell tumor of the testis is most likely to show a “fried egg” appearance on histology?

    <p>Seminoma</p> Signup and view all the answers

    Which ovarian tumor type is associated with Meigs syndrome?

    <p>Thecoma-fibroma</p> Signup and view all the answers

    Which statement about invasive ductal carcinoma (IDC) is NOT correct?

    <p>IDC can show a “single-file” growth pattern.</p> Signup and view all the answers

    Which statement about testicular torsion is NOT correct?

    <p>Doppler ultrasound always shows increased blood flow.</p> Signup and view all the answers

    Which statement regarding placental abruption is NOT correct?

    <p>The risk of abruption is decreased in hypertensive disorders of pregnancy.</p> Signup and view all the answers

    Which statement regarding benign prostatic hyperplasia (BPH) is NOT correct?

    <p>BPH most commonly occurs in the peripheral zone of the prostate.</p> Signup and view all the answers

    Which statement about cervical intraepithelial neoplasia (CIN) is NOT correct?

    <p>CIN III has already invaded the basement membrane.</p> Signup and view all the answers

    Which statement regarding invasive lobular carcinoma (ILC) is NOT correct?

    <p>ILC is more likely to present with a palpable mass than IDC.</p> Signup and view all the answers

    Which statement about ovarian teratomas is NOT correct?

    <p>Immature teratomas are commonly found in postmenopausal women.</p> Signup and view all the answers

    Which statement about endometrial cancer is NOT correct?

    <p>Type 2 endometrial cancer arises in a hyperplastic endometrium.</p> Signup and view all the answers

    Which statement about fibrocystic breast changes is NOT correct?

    <p>These changes are associated with an increased risk of breast cancer.</p> Signup and view all the answers

    Which statement regarding gestational trophoblastic neoplasia (GTN) is NOT correct?

    <p>Persistent GTN is always managed surgically.</p> Signup and view all the answers

    How does the integration of high-risk HPV types into the host genome contribute to the development of cervical cancer?

    <p>High-risk HPV types integrate into the host genome and disrupt the regulation of cell cycle control, leading to genetic instability and potential malignancy.</p> Signup and view all the answers

    What is the role of the HPV E6 and E7 oncoproteins in this process?

    <p>The E6 oncoprotein promotes the degradation of p53, while the E7 oncoprotein inactivates Rb, both of which allow uncontrolled cell proliferation.</p> Signup and view all the answers

    How does HPV vaccination help reduce the incidence of cervical cancer?

    <p>HPV vaccination prevents infection with the most common high-risk types (e.g., HPV 16 and 18), thereby reducing the incidence of precancerous and cancerous cervical lesions.</p> Signup and view all the answers

    What is the typical presentation of DCIS on mammography?

    <p>DCIS typically presents as microcalcifications on mammography.</p> Signup and view all the answers

    Why is DCIS considered a non-invasive form of breast cancer, and what is its potential for progression?

    <p>DCIS is confined to the ductal system without invasion of the basement membrane, but it has the potential to progress to invasive ductal carcinoma if left untreated.</p> Signup and view all the answers

    What treatment options are available for DCIS, and how do they vary based on patient factors?

    <p>Treatment options include lumpectomy, mastectomy, and radiation therapy; choice depends on factors such as tumor size, grade, and patient preference.</p> Signup and view all the answers

    What causes endometrial hyperplasia, and what differentiates atypical hyperplasia from non-atypical hyperplasia?

    <p>Endometrial hyperplasia results from prolonged unopposed estrogen stimulation; atypical hyperplasia is characterized by nuclear atypia in glandular cells, unlike non-atypical hyperplasia.</p> Signup and view all the answers

    What is the risk of progression to endometrial cancer for patients with atypical hyperplasia?

    <p>Atypical hyperplasia has a significant risk of progression to endometrial cancer, estimated at approximately 30%.</p> Signup and view all the answers

    What treatment strategies are used for patients with atypical hyperplasia who wish to preserve fertility?

    <p>High-dose progestin therapy and close follow-up with endometrial sampling are considered for fertility preservation.</p> Signup and view all the answers

    What are the main differences in pathogenesis between type 1 and type 2 endometrial carcinoma?

    <p>Type 1 endometrial carcinoma is estrogen-dependent and arises from hyperplastic endometrium, while type 2 is estrogen-independent and arises from atrophic endometrium.</p> Signup and view all the answers

    Which type of endometrial carcinoma is typically more aggressive and associated with poorer prognosis?

    <p>Type 2 endometrial carcinoma is more aggressive and has a poorer prognosis.</p> Signup and view all the answers

    How does the management of type 2 endometrial carcinoma differ from type 1?

    <p>Type 2 carcinoma often requires more aggressive treatment, including surgery, chemotherapy, and radiation.</p> Signup and view all the answers

    What imaging modality is most commonly used to evaluate ovarian masses?

    <p>Transvaginal ultrasound is commonly used to evaluate ovarian masses.</p> Signup and view all the answers

    How do functional cysts differ from pathological ovarian tumors in terms of presentation and management?

    <p>Functional cysts are typically simple and resolve spontaneously, while pathological tumors may be complex and require further investigation or surgical management.</p> Signup and view all the answers

    What tumor markers are useful for assessing epithelial ovarian cancer?

    <p>CA-125 is a useful tumor marker for epithelial ovarian cancer.</p> Signup and view all the answers

    Which germ cell tumor is most likely to produce β-hCG?

    <p>Choriocarcinoma is most likely to produce β-hCG.</p> Signup and view all the answers

    How is AFP used in diagnosing and monitoring testicular cancer?

    <p>AFP is elevated in non-seminomatous germ cell tumors such as yolk sac tumors and embryonal carcinoma.</p> Signup and view all the answers

    What imaging study is initially used to evaluate a suspected testicular mass?

    <p>Scrotal ultrasound is used as the initial imaging study.</p> Signup and view all the answers

    What differentiates invasive mole from complete hydatidiform mole?

    <p>An invasive mole penetrates the myometrium, whereas a complete mole is confined to the uterine cavity.</p> Signup and view all the answers

    How is gestational trophoblastic neoplasia monitored after initial treatment?

    <p>Monitoring involves serial β-hCG measurements.</p> Signup and view all the answers

    What is the mainstay treatment for high-risk gestational trophoblastic neoplasia?

    <p>High-risk GTN is treated with multi-agent chemotherapy.</p> Signup and view all the answers

    What are the most common HPV types associated with squamous cell carcinoma and adenocarcinoma of the cervix?

    <p>HPV 16 is most commonly associated with squamous cell carcinoma, while HPV 18 is more frequently linked with adenocarcinoma.</p> Signup and view all the answers

    How does the clinical presentation of adenocarcinoma of the cervix differ from squamous cell carcinoma?

    <p>Adenocarcinoma may present later and with more subtle symptoms compared to squamous cell carcinoma.</p> Signup and view all the answers

    Between squamous cell carcinoma and adenocarcinoma of the cervix, which subtype generally has a poorer prognosis and why?

    <p>Adenocarcinoma generally has a poorer prognosis due to its often later detection.</p> Signup and view all the answers

    How does the luteal phase support potential pregnancy?

    <p>The luteal phase is marked by high progesterone levels, which support the endometrial lining for potential implantation.</p> Signup and view all the answers

    What hormonal imbalance is associated with the development of polycystic ovary syndrome (PCOS)?

    <p>Elevated LH levels and hyperandrogenism are associated with PCOS.</p> Signup and view all the answers

    How can ovulatory dysfunction impact fertility?

    <p>Ovulatory dysfunction can lead to infertility due to irregular or absent ovulation.</p> Signup and view all the answers

    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?

    <p>a) The incubation period for rubella is 14-21 days b) Congenital Rubella Syndrome (CRS) may result in deafness and cardiac defects c) Rubella-specific IgM and IgG serology should be performed</p> Signup and view all the answers

    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?

    <p>a) Cytomegalovirus (CMV) b) CMV can lead to systemic complications like disseminated infection involving the liver or gastrointestinal tract c) First-line treatment is ganciclovir</p> Signup and view all the answers

    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?

    <p>a) Kaposi’s sarcoma. b) Human herpesvirus 8 (HHV-8). c) HHV-8 primarily establishes latency in lymphoid cells</p> Signup and view all the answers

    What is the likely diagnosis for a 25-year-old woman with a history of abnormal Pap smears showing acetowhite changes?

    <p>Cervical intraepithelial neoplasia (CIN)</p> Signup and view all the answers

    What procedure should be performed to confirm the diagnosis for cervical intraepithelial neoplasia (CIN)?

    <p>Colposcopic-directed biopsy</p> Signup and view all the answers

    What treatment options are available if CIN II/III is confirmed?

    <p>LEEP, cryotherapy, or cone biopsy</p> Signup and view all the answers

    What is the likely diagnosis for a 67-year-old man presenting with nocturia and enlarged, non-nodular prostate?

    <p>Benign prostatic hyperplasia (BPH)</p> Signup and view all the answers

    What initial pharmacological treatment is recommended for BPH?

    <p>Alpha-adrenergic blockers such as tamsulosin</p> Signup and view all the answers

    What are potential side effects of the recommended treatment for BPH?

    <p>Dizziness, orthostatic hypotension, and ejaculatory dysfunction</p> Signup and view all the answers

    What imaging technique could be used for further evaluation in a woman with dense breast tissue and a suspicious solid mass?

    <p>Breast MRI</p> Signup and view all the answers

    What is the next diagnostic step if the mass in the breast appears suspicious?

    <p>A core needle biopsy</p> Signup and view all the answers

    What histological findings would confirm a diagnosis of invasive ductal carcinoma?

    <p>Glandular structures with malignant cells and invasion beyond the basement membrane</p> Signup and view all the answers

    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?

    <p>Bone metastases from prostate cancer</p> Signup and view all the answers

    What additional tests can confirm the diagnosis of bone metastases?

    <p>Bone scan or PET-CT; serum PSA levels</p> Signup and view all the answers

    What treatment options are available for bone metastases?

    <p>Androgen deprivation therapy, radiotherapy, and bisphosphonates</p> Signup and view all the answers

    What is the most likely diagnosis for a 32-year-old woman with a rapidly enlarging breast mass resembling peau d’orange?

    <p>Inflammatory breast cancer (IBC)</p> Signup and view all the answers

    What diagnostic tests are needed to confirm the diagnosis of inflammatory breast cancer?

    <p>Biopsy of the mass and affected skin; imaging studies like mammography or MRI</p> Signup and view all the answers

    What is the primary treatment strategy for inflammatory breast cancer?

    <p>Neoadjuvant chemotherapy followed by surgery and radiation</p> Signup and view all the answers

    What is the next best step for diagnosis in a postmenopausal woman with thickened endometrial lining?

    <p>Endometrial biopsy</p> Signup and view all the answers

    What histological feature would confirm endometrial carcinoma?

    <p>Malignant glandular cells invading the myometrium</p> Signup and view all the answers

    What are common risk factors for endometrial carcinoma?

    <p>Obesity, unopposed estrogen use, and late menopause</p> Signup and view all the answers

    What are common side effects of androgen deprivation therapy (ADT)?

    <p>Hot flashes, osteoporosis, and metabolic changes</p> Signup and view all the answers

    What strategies can be used to mitigate the side effects of ADT?

    <p>Bisphosphonates or denosumab for bone health, and lifestyle modifications</p> Signup and view all the answers

    What additional monitoring should be considered for patients on long-term ADT?

    <p>Bone density scans (DEXA) and monitoring for cardiovascular health</p> Signup and view all the answers

    What is the most likely diagnosis for a 29-year-old man with a painless testicular mass and elevated serum AFP?

    <p>Non-seminomatous germ cell tumor, possibly a yolk sac tumor</p> Signup and view all the answers

    What is the standard initial treatment for a non-seminomatous germ cell tumor?

    <p>Radical inguinal orchiectomy</p> Signup and view all the answers

    How is the diagnosis of a non-seminomatous germ cell tumor confirmed post-surgery?

    <p>Histopathological examination of the excised tissue</p> Signup and view all the answers

    How does atypical ductal hyperplasia (ADH) influence breast cancer risk?

    <p>ADH increases the risk of developing breast cancer</p> Signup and view all the answers

    What surveillance strategies should be considered for a patient with ADH?

    <p>Regular mammograms and possibly MRI for high-risk monitoring</p> Signup and view all the answers

    What preventive options can be discussed for a patient with ADH?

    <p>Chemoprevention with SERMs or prophylactic mastectomy</p> Signup and view all the answers

    What is the most likely diagnosis for a 50-year-old male presenting with hematuria and elevated PSA?

    <p>Prostate cancer</p> Signup and view all the answers

    What biopsy technique is used for confirmation of prostate cancer?

    <p>Transrectal ultrasound-guided prostate biopsy</p> Signup and view all the answers

    What are common histological findings in prostate cancer?

    <p>Glandular structures with prominent nucleoli</p> Signup and view all the answers

    What are the implications of a BRCA1 mutation for a patient with a family history of breast cancer?

    <p>BRCA1 mutation significantly increases the risk of breast and ovarian cancer</p> Signup and view all the answers

    What surveillance strategies should be implemented for a patient with a BRCA1 mutation?

    <p>Enhanced surveillance with mammograms and MRI, and consideration of genetic counseling</p> Signup and view all the answers

    What preventive surgical options could be considered for a patient with a BRCA1 mutation?

    <p>Prophylactic mastectomy and salpingo-oophorectomy</p> Signup and view all the answers

    What condition could findings of mild ventriculomegaly and a lemon-shaped skull suggest?

    <p>Spina bifida</p> Signup and view all the answers

    What further imaging or diagnostic test would be appropriate for ventriculomegaly?

    <p>A detailed fetal MRI</p> Signup and view all the answers

    What counseling should be provided regarding spina bifida?

    <p>Discussion on prognosis, potential surgical interventions, and long-term outcomes</p> Signup and view all the answers

    What are common causes of polyhydramnios?

    <p>Fetal anomalies, gestational diabetes, and multiple pregnancies</p> Signup and view all the answers

    What complications could arise for the mother and fetus due to polyhydramnios?

    <p>Preterm labor, placental abruption, and umbilical cord prolapse</p> Signup and view all the answers

    What management strategies should be considered for polyhydramnios?

    <p>Amnioreduction or careful monitoring</p> Signup and view all the answers

    What potential causes should be considered for oligohydramnios?

    <p>Placental insufficiency, premature rupture of membranes (PROM), and fetal renal anomalies</p> Signup and view all the answers

    How could oligohydramnios affect labor and delivery?

    <p>It can lead to umbilical cord compression and increase the likelihood of cesarean delivery</p> Signup and view all the answers

    What interventions should be recommended for oligohydramnios?

    <p>Increased maternal hydration, monitoring, and possible induction of labor</p> Signup and view all the answers

    What chromosomal abnormalities could an increased nuchal translucency measurement indicate?

    <p>Trisomy 21, trisomy 18, or Turner syndrome</p> Signup and view all the answers

    What follow-up tests are advised to confirm the diagnosis related to nuchal translucency?

    <p>Chorionic villus sampling (CVS) or amniocentesis</p> Signup and view all the answers

    How should the patient be counseled about findings associated with increased nuchal translucency?

    <p>Provide information on potential outcomes, further diagnostic procedures, and support options</p> Signup and view all the answers

    What complications are associated with fetal macrosomia?

    <p>Shoulder dystocia, cesarean delivery, and postpartum hemorrhage</p> Signup and view all the answers

    How should labor be managed in a patient with suspected macrosomia?

    <p>Planned cesarean delivery or careful monitoring during labor</p> Signup and view all the answers

    What long-term risks should be discussed for the infant born with macrosomia?

    <p>A higher likelihood of obesity and type 2 diabetes</p> Signup and view all the answers

    What is the risk of congenital CMV infection, and what are the potential outcomes?

    <p>Hearing loss, neurodevelopmental delays, and microcephaly</p> Signup and view all the answers

    What initial diagnostic tests can be performed to assess the risk of congenital CMV infection?

    <p>Maternal serology for CMV IgM and IgG, followed by amniocentesis for PCR testing if needed</p> Signup and view all the answers

    What management options are available if congenital CMV infection is confirmed?

    <p>Antiviral therapy for the mother and postnatal monitoring and interventions for the infant</p> Signup and view all the answers

    What prenatal screening options are available to detect neural tube defects?

    <p>Maternal serum alpha-fetoprotein (AFP) and detailed ultrasound at 18-20 weeks</p> Signup and view all the answers

    How does folic acid supplementation affect the risk of neural tube defects?

    <p>It significantly reduces the risk when taken preconception and during early pregnancy</p> Signup and view all the answers

    What additional precautions should be taken if there is a strong family history of neural tube defects?

    <p>Higher doses of folic acid and genetic counseling should be considered</p> Signup and view all the answers

    What are the potential maternal and fetal causes of asymmetrical fetal growth restriction (FGR)?

    <p>Placental insufficiency, maternal hypertension, and smoking</p> Signup and view all the answers

    How is asymmetrical FGR managed in the third trimester?

    <p>Close monitoring with Doppler ultrasound and possible early delivery if fetal distress is noted</p> Signup and view all the answers

    What is the long-term impact on the child if born with asymmetrical FGR?

    <p>Growth and developmental delays and an increased risk of metabolic disorders</p> Signup and view all the answers

    What potential maternal and fetal conditions could cause oligohydramnios?

    <p>Placental insufficiency, PROM, and fetal renal issues</p> Signup and view all the answers

    How should a patient with oligohydramnios be monitored moving forward?

    <p>Close monitoring with non-stress tests and serial ultrasounds</p> Signup and view all the answers

    What interventions may be necessary if oligohydramnios persists?

    <p>Early induction of labor may be necessary to prevent complications</p> Signup and view all the answers

    What prenatal tests are available for diagnosing Down syndrome?

    <p>Non-invasive prenatal testing (NIPT) and confirmatory diagnostic tests such as amniocentesis</p> Signup and view all the answers

    How does maternal age influence the risk of trisomy 21?

    <p>The risk of trisomy 21 increases with maternal age</p> Signup and view all the answers

    What are the potential challenges in counseling a patient with a family history of Down syndrome?

    <p>Discussing the risk of recurrence, potential outcomes, and options if a positive diagnosis is confirmed</p> Signup and view all the answers

    What is a potential differential diagnosis for a thickened endometrial stripe with heterogeneous echotexture?

    <p>Endometrial hyperplasia or endometrial carcinoma</p> Signup and view all the answers

    What histological feature would confirm a diagnosis of endometrial carcinoma?

    <p>Invasion of malignant cells beyond the endometrial lining into the myometrium</p> Signup and view all the answers

    What additional imaging or diagnostic tests would be appropriate for staging suspected endometrial carcinoma?

    <p>Pelvic MRI and endometrial biopsy</p> Signup and view all the answers

    What is a likely cause of bone pain and elevated serum calcium in a patient with a history of breast cancer?

    <p>Bone metastases from breast cancer</p> Signup and view all the answers

    Which imaging modality is best suited to evaluate for metastatic disease in this breast cancer patient?

    <p>Bone scan or PET-CT</p> Signup and view all the answers

    What blood test could further support suspicion of metastatic breast cancer?

    <p>Elevated serum alkaline phosphatase</p> Signup and view all the answers

    What is the most likely diagnosis for a left adnexal mass combined with a serum AFP level of 300 ng/mL?

    <p>Yolk sac tumor</p> Signup and view all the answers

    What histological findings would support the diagnosis of a yolk sac tumor?

    <p>Schiller-Duval bodies</p> Signup and view all the answers

    What is the typical treatment approach for a yolk sac tumor?

    <p>Surgical excision followed by chemotherapy</p> Signup and view all the answers

    What is the most likely diagnosis for a firm, irregular prostate as noted in a DRE?

    <p>Prostate cancer</p> Signup and view all the answers

    What diagnostic test should be performed next for suspected prostate cancer?

    <p>PSA testing and prostate biopsy</p> Signup and view all the answers

    What histopathological findings would confirm the diagnosis of prostate cancer?

    <p>Glandular structures with prominent nucleoli and possible perineural invasion</p> Signup and view all the answers

    What is a potential diagnosis for bloody nipple discharge and microcalcifications on a mammogram?

    <p>Ductal carcinoma in situ (DCIS)</p> Signup and view all the answers

    What biopsy technique is appropriate for confirming the diagnosis of DCIS?

    <p>Core needle biopsy</p> Signup and view all the answers

    What histological features would indicate ductal carcinoma in situ (DCIS)?

    <p>Malignant cells within ducts without invasion of the basement membrane</p> Signup and view all the answers

    What is the likely diagnosis for a postmenopausal woman with severe itching and white, atrophic plaques?

    <p>Lichen sclerosus</p> Signup and view all the answers

    What histological changes would confirm the diagnosis of lichen sclerosus?

    <p>Thinned epithelium with a loss of rete ridges and a homogeneous band of sclerosis</p> Signup and view all the answers

    What is the risk associated with lichen sclerosus if left untreated?

    <p>Increased risk of squamous cell carcinoma</p> Signup and view all the answers

    What is the most likely diagnosis for a palpable right breast mass identified on ultrasound?

    <p>Fibroadenoma</p> Signup and view all the answers

    What clinical feature supports the diagnosis of fibroadenoma?

    <p>A mobile, non-tender, well-defined mass</p> Signup and view all the answers

    What management approach is recommended for a fibroadenoma?

    <p>Observation or excisional biopsy if symptomatic or enlarging</p> Signup and view all the answers

    What is the likely diagnosis for a patient with acetowhite epithelium during colposcopy?

    <p>Cervical intraepithelial neoplasia (CIN III)</p> Signup and view all the answers

    What biopsy findings would confirm the diagnosis of CIN III?

    <p>Full-thickness squamous dysplasia without stromal invasion</p> Signup and view all the answers

    What treatment options are available for CIN III?

    <p>LEEP, cryotherapy, or cone biopsy</p> Signup and view all the answers

    What is the likely diagnosis for a pregnant woman with new onset hypertension and proteinuria?

    <p>Preeclampsia</p> Signup and view all the answers

    What complications could arise if preeclampsia progresses?

    <p>Eclampsia, HELLP syndrome, and fetal growth restriction</p> Signup and view all the answers

    What management strategies should be considered for preeclampsia?

    <p>Close monitoring, antihypertensives, and possible early delivery if severe</p> Signup and view all the answers

    What is the most likely diagnosis for a painless testicular mass found on ultrasound?

    <p>Seminoma</p> Signup and view all the answers

    What serum markers should be evaluated for suspected seminoma?

    <p>Serum β-hCG, AFP, and LDH</p> Signup and view all the answers

    What is the standard initial treatment for seminoma?

    <p>Radical inguinal orchiectomy</p> Signup and view all the answers

    What is the next best step in management for a patient with postmenopausal bleeding and atypical hyperplasia?

    <p>Total hysterectomy</p> Signup and view all the answers

    What is the risk of progression to endometrial carcinoma if atypical hyperplasia is untreated?

    <p>Up to 30%</p> Signup and view all the answers

    What treatment options are available if a postmenopausal woman with atypical hyperplasia wishes to preserve fertility?

    <p>High-dose progestin therapy and close monitoring</p> Signup and view all the answers

    What are potential differential diagnoses for a 50-year-old male with urinary symptoms and slightly elevated PSA levels?

    <p>Benign prostatic hyperplasia (BPH) and prostate cancer</p> Signup and view all the answers

    What further diagnostic evaluation should be performed for suspected prostate issues?

    <p>Digital rectal examination (DRE) and prostate biopsy if warranted</p> Signup and view all the answers

    How is benign prostatic hyperplasia (BPH) distinguished from prostate cancer?

    <p>BPH typically affects the transitional zone, while prostate cancer usually arises in the peripheral zone</p> Signup and view all the answers

    What is the likely diagnosis for a 30-year-old woman with irregular menstrual cycles and multiple small ovarian cysts?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What hormonal findings are expected in a woman with PCOS?

    <p>Elevated LH:FSH ratio and hyperandrogenism</p> Signup and view all the answers

    What treatment options can be considered to improve fertility in patients with PCOS?

    <p>Lifestyle modifications, clomiphene citrate, and metformin</p> Signup and view all the answers

    What are common risk factors for vulvar squamous cell carcinoma?

    <p>HPV infection, lichen sclerosus, and smoking</p> Signup and view all the answers

    What is the typical treatment approach for early-stage vulvar cancer?

    <p>Wide local excision or vulvectomy with possible lymph node dissection</p> Signup and view all the answers

    What is the prognosis for localized vulvar squamous cell carcinoma?

    <p>Good prognosis with early detection and treatment</p> Signup and view all the answers

    What is likely the cause of new-onset jaundice and hepatomegaly in a woman with breast cancer?

    <p>Liver metastasis from breast cancer</p> Signup and view all the answers

    What imaging studies would be appropriate for evaluating liver conditions in suspected metastatic breast cancer?

    <p>Abdominal CT or MRI</p> Signup and view all the answers

    What tumor marker can help support the diagnosis of metastatic breast cancer?

    <p>Elevated CA 15-3 or CEA</p> Signup and view all the answers

    What condition should be considered for a patient with hyperemesis gravidarum and markedly elevated β-hCG levels?

    <p>Complete hydatidiform mole</p> Signup and view all the answers

    What imaging findings would support the diagnosis of complete hydatidiform mole?

    <p>Ultrasound showing a 'snowstorm' pattern with no fetal tissue</p> Signup and view all the answers

    What is the initial treatment for a complete hydatidiform mole?

    <p>Uterine evacuation via suction curettage</p> Signup and view all the answers

    What is the likely diagnosis for a painless scrotal mass characterized by a well-circumscribed hypoechoic lesion?

    <p>The specific diagnosis is not provided</p> Signup and view all the answers

    What further steps should be taken for evaluation of a suspected testicular lesion?

    <p>The specific steps are not provided</p> Signup and view all the answers

    What is the prognosis for a patient with a well-circumscribed hypoechoic lesion in the testicle?

    <p>The specific prognosis is not provided</p> Signup and view all the answers

    What is a potential concern with long-term hormone replacement therapy (HRT) use?

    <p>Long-term HRT use can increase the risk of breast cancer.</p> Signup and view all the answers

    What diagnostic steps should be taken for a woman on long-term HRT presenting with breast tenderness?

    <p>A clinical breast exam and mammogram.</p> Signup and view all the answers

    What are alternative management strategies for menopausal symptoms?

    <p>Alternatives include non-hormonal therapies and lifestyle modifications.</p> Signup and view all the answers

    What hormone is likely affected by stress in postpartum women experiencing breastfeeding difficulties?

    <p>Oxytocin.</p> Signup and view all the answers

    How does stress impact lactation?

    <p>Reduced oxytocin levels impair milk ejection.</p> Signup and view all the answers

    What strategies can support successful breastfeeding in a postpartum woman dealing with stress?

    <p>Relaxation techniques, lactation counseling, and creating a supportive environment.</p> Signup and view all the answers

    What is the significance of a woman's history of deep vein thrombosis (DVT) when choosing contraception?

    <p>A history of DVT increases the risk of clotting with combined hormonal contraceptives.</p> Signup and view all the answers

    Which methods of contraception should a woman with a history of DVT avoid?

    <p>Combined oral contraceptives.</p> Signup and view all the answers

    What are safer contraceptive options for a woman with a history of DVT?

    <p>Progestogen-only options or non-hormonal methods like copper IUDs.</p> Signup and view all the answers

    What is a potential complication of long-term testosterone therapy?

    <p>Secondary polycythemia.</p> Signup and view all the answers

    What tests should be done to monitor complications from long-term testosterone therapy?

    <p>Complete blood count (CBC) and hematocrit levels.</p> Signup and view all the answers

    How should secondary polycythemia from testosterone therapy be managed?

    <p>Adjusting the testosterone dose or considering phlebotomy to reduce hematocrit.</p> Signup and view all the answers

    What is the most likely diagnosis for a woman presenting with galactorrhea and amenorrhea and elevated prolactin levels?

    <p>Hyperprolactinemia.</p> Signup and view all the answers

    What could be potential causes of hyperprolactinemia?

    <p>Pituitary adenoma, hypothyroidism, or certain medications.</p> Signup and view all the answers

    What are the treatment options for hyperprolactinemia?

    <p>Dopamine agonists such as bromocriptine or cabergoline.</p> Signup and view all the answers

    What type of hypogonadism is indicated by having low testosterone and high LH/FSH levels?

    <p>Primary hypogonadism.</p> Signup and view all the answers

    What are potential causes of primary hypogonadism?

    <p>Klinefelter syndrome, mumps orchitis, or trauma.</p> Signup and view all the answers

    What treatment options are available for primary hypogonadism?

    <p>Testosterone replacement therapy and fertility treatments if needed.</p> Signup and view all the answers

    Which of the following best describes the impact of stigma on testing and treatment for STIs?

    <p>It increases reluctance to seek testing and treatment.</p> Signup and view all the answers

    Which approach is most effective for reducing the incidence of congenital syphilis?

    <p>Mandatory syphilis screening during pregnancy</p> Signup and view all the answers

    Why are STIs such as gonorrhea considered significant public health concerns?

    <p>Gonorrhea has shown increasing antibiotic resistance.</p> Signup and view all the answers

    What is a major limitation in controlling the spread of viral STIs compared to bacterial STIs?

    <p>The limited availability of vaccines for viral STIs</p> Signup and view all the answers

    What is the most effective approach to reducing HPV-related cancers at the population level?

    <p>Widespread HPV vaccination programs</p> Signup and view all the answers

    What is the public health rationale for regular screening of high-risk populations for STIs?

    <p>To identify and treat asymptomatic infections early</p> Signup and view all the answers

    Which of the following contributes most significantly to the global burden of STIs?

    <p>Lack of accessible STI clinics in low-income regions</p> Signup and view all the answers

    What is a critical public health challenge in managing antibiotic-resistant STIs like gonorrhea?

    <p>Limited development of new antibiotics</p> Signup and view all the answers

    What is a major driver of high STI transmission rates in populations despite the availability of treatment?

    <p>Poor adherence to treatment protocols</p> Signup and view all the answers

    What are three major risk factors for acquiring STIs?

    <p>Multiple sexual partners, inconsistent condom use, and young age.</p> Signup and view all the answers

    What primary prevention strategies can reduce the spread of STIs?

    <p>Comprehensive sex education, consistent use of condoms, and regular screening programs.</p> Signup and view all the answers

    What are the primary stages of syphilis?

    <p>Primary, secondary, latent, and tertiary stages.</p> Signup and view all the answers

    What are the potential complications of untreated HSV infection?

    <p>Complications include neonatal herpes, chronic pain, and psychological distress.</p> Signup and view all the answers

    Why is chlamydia often underdiagnosed?

    <p>Many infections are asymptomatic.</p> Signup and view all the answers

    What screening tests should be offered to asymptomatic individuals?

    <p>NAAT for chlamydia and gonorrhea, HIV test.</p> Signup and view all the answers

    What is the recommended treatment for syphilis in pregnancy?

    <p>Penicillin G.</p> Signup and view all the answers

    What ligaments provide primary support to the uterus, and how do they function?

    <p>The primary supportive ligaments include the uterosacral ligaments, which anchor the uterus to the sacrum, and the cardinal ligaments, which provide lateral support.</p> Signup and view all the answers

    What role do the round ligaments play in the positioning of the uterus?

    <p>The round ligaments help maintain the anteverted position of the uterus by extending from the uterine horns to the labia majora.</p> Signup and view all the answers

    What are the key hormones involved in regulating the menstrual cycle, and how do they interact?

    <p>Key hormones include GnRH, FSH, LH, estrogen, and progesterone. GnRH from the hypothalamus stimulates the release of FSH and LH, which regulate ovarian function.</p> Signup and view all the answers

    What is the role of FSH during the follicular phase?

    <p>FSH promotes the growth and maturation of ovarian follicles during the follicular phase.</p> Signup and view all the answers

    How does the interplay of estrogen and progesterone influence the endometrial cycle?

    <p>Estrogen stimulates endometrial proliferation during the follicular phase, while progesterone stabilizes and prepares the endometrium for implantation during the luteal phase.</p> Signup and view all the answers

    What is the pathway of milk from production to ejection?

    <p>Milk is produced in the alveoli, flows through the lactiferous ducts, and collects in the lactiferous sinuses before being ejected through the nipple.</p> Signup and view all the answers

    What role do the lactiferous sinuses play during lactation?

    <p>The lactiferous sinuses act as reservoirs for milk, allowing a small amount to be stored before ejection during breastfeeding.</p> Signup and view all the answers

    What role do Sertoli cells play in spermatogenesis?

    <p>Sertoli cells provide structural and nutritional support to developing sperm cells and help in forming the blood-testis barrier.</p> Signup and view all the answers

    What is the primary function of Leydig cells?

    <p>Leydig cells produce testosterone in response to LH stimulation, supporting spermatogenesis and male secondary sexual characteristics.</p> Signup and view all the answers

    What histological changes are seen in the endometrium during the proliferative phase?

    <p>During the proliferative phase, the endometrium thickens, glands become more elongated, and stromal cells proliferate under the influence of estrogen.</p> Signup and view all the answers

    How does the secretory phase prepare the endometrium for potential implantation?

    <p>The secretory phase, regulated by progesterone, involves the glandular secretion of nutrients and further vascularization, preparing for embryo implantation.</p> Signup and view all the answers

    What triggers the shedding of the endometrial lining during menstruation?

    <p>The drop in progesterone and estrogen levels triggers the breakdown of the endometrial lining, leading to menstruation.</p> Signup and view all the answers

    How does the scrotum contribute to maintaining optimal temperature for spermatogenesis?

    <p>The scrotum holds the testes outside the body to maintain a temperature approximately 2-3°C lower than body temperature, essential for spermatogenesis.</p> Signup and view all the answers

    What is the role of the cremaster muscle in temperature regulation?

    <p>The cremaster muscle contracts or relaxes to move the testes closer to or away from the body, helping regulate their temperature.</p> Signup and view all the answers

    How does the pampiniform plexus assist in cooling the blood supply to the testes?

    <p>The pampiniform plexus acts as a heat exchanger that cools arterial blood before it enters the testes, maintaining a lower testicular temperature.</p> Signup and view all the answers

    What role does estrogen play during the follicular phase of the menstrual cycle?

    <p>Estrogen promotes the growth and proliferation of the endometrium during the follicular phase.</p> Signup and view all the answers

    How does estrogen influence secondary sexual characteristics in females?

    <p>Estrogen contributes to the development of secondary sexual characteristics, such as breast development, wider hips, and body fat distribution.</p> Signup and view all the answers

    What feedback mechanism does estrogen exert on the hypothalamus and pituitary during the late follicular phase?

    <p>Estrogen exerts positive feedback during the late follicular phase, leading to the LH surge that triggers ovulation.</p> Signup and view all the answers

    Which hormone primarily facilitates milk ejection during breastfeeding?

    <p>Oxytocin</p> Signup and view all the answers

    What is the primary mechanism by which combined oral contraceptives prevent pregnancy?

    <p>Inhibition of both FSH and LH, preventing ovulation</p> Signup and view all the answers

    Which anabolic effect is associated with the use of testosterone replacement therapy?

    <p>Increased red blood cell production</p> Signup and view all the answers

    What is the most common side effect of the progestogen-only 'mini-pill'?

    <p>Breakthrough bleeding</p> Signup and view all the answers

    What is a significant non-reproductive effect of estrogen on the cardiovascular system?

    <p>Improved HDL to LDL ratio</p> Signup and view all the answers

    Which of the following substances can inhibit milk production by interfering with oxytocin release?

    <p>Opiates</p> Signup and view all the answers

    What is the typical clinical presentation of hyperparathyroidism?

    <p>Polyuria, bone pain, and renal calculi</p> Signup and view all the answers

    Which radiopharmaceutical is most commonly used for myocardial perfusion imaging?

    <p>Tc-99m sestamibi</p> Signup and view all the answers

    Which clinical scenario would most likely prompt the use of an I-123 thyroid scan?

    <p>Diagnosing a toxic adenoma</p> Signup and view all the answers

    Which condition is most commonly associated with episodic headaches, sweating, and tachycardia?

    <p>Phaeochromocytoma</p> Signup and view all the answers

    What is the primary imaging feature of a toxic thyroid adenoma on a thyroid uptake scan?

    <p>Hot nodule with suppression of surrounding tissue</p> Signup and view all the answers

    What imaging modality is typically used for localizing a parathyroid adenoma?

    <p>Tc-99m sestamibi scan</p> Signup and view all the answers

    In nuclear medicine, what property of beta particles makes them useful in therapeutic applications?

    <p>DNA damage through localized energy deposition</p> Signup and view all the answers

    Which statement about Tc-99m pertechnetate is NOT correct?

    <p>It emits beta particles for therapeutic use.</p> Signup and view all the answers

    Which statement regarding parathyroid scintigraphy is NOT correct?

    <p>It has low sensitivity for adenoma detection.</p> Signup and view all the answers

    Which statement about I-123 thyroid imaging is NOT correct?

    <p>It is commonly used for long-term therapeutic purposes.</p> Signup and view all the answers

    Which statement regarding nuclear medicine in hyperthyroidism evaluation is NOT correct?

    <p>I-131 is used exclusively for diagnostic thyroid scans.</p> Signup and view all the answers

    Which statement about phaeochromocytoma imaging is NOT correct?

    <p>Tc-99m sestamibi is the preferred agent for imaging.</p> Signup and view all the answers

    Which statement regarding the use of beta particles in nuclear medicine is NOT correct?

    <p>They are effective for imaging because of their high penetration.</p> Signup and view all the answers

    Which statement about thyroid scintigraphy findings is NOT correct?

    <p>'Cold' nodules are always benign.</p> Signup and view all the answers

    Which statement about parathyroid imaging using Tc-99m sestamibi is NOT correct?

    <p>It is ineffective for detecting ectopic parathyroid tissue.</p> Signup and view all the answers

    Which statement regarding nuclear medicine imaging in oncology is NOT correct?

    <p>Bone scans are used primarily for detecting osteolytic metastases.</p> Signup and view all the answers

    Which statement about thyroid function tests in nuclear medicine is NOT correct?

    <p>Scintigraphy can definitively diagnose malignancy.</p> Signup and view all the answers

    What is the mechanism of action of Tc-99m sestamibi in parathyroid imaging?

    <p>Tc-99m sestamibi is taken up by both thyroid and parathyroid tissues, but washes out more quickly from thyroid tissue.</p> Signup and view all the answers

    Why is delayed imaging used in detecting parathyroid adenomas?

    <p>Delayed imaging helps distinguish adenomas by their slower washout compared to normal thyroid tissue.</p> Signup and view all the answers

    How does SPECT-CT improve parathyroid localization?

    <p>SPECT-CT combines functional and anatomical imaging, enhancing localization.</p> Signup and view all the answers

    What role does prolactin play during the lactation process?

    <p>Stimulates milk synthesis in the alveolar cells</p> Signup and view all the answers

    Which condition is associated with a decreased level of testosterone and high levels of luteinizing hormone (LH)?

    <p>Primary hypogonadism</p> Signup and view all the answers

    Which of the following does NOT accurately describe the action of progesterone in the female body?

    <p>Increases uterine excitability</p> Signup and view all the answers

    What is the main factor affecting the synthesis of prolactin post-lactation initiation?

    <p>The number of infant suckling sessions</p> Signup and view all the answers

    Which hormone is primarily responsible for the development of male secondary sexual characteristics?

    <p>Testosterone</p> Signup and view all the answers

    What is the main function of estrogen in the regulation of the menstrual cycle?

    <p>Triggering the LH surge for ovulation</p> Signup and view all the answers

    Which contraceptive method has the highest risk of failure when not used consistently?

    <p>Natural family planning</p> Signup and view all the answers

    Which type of androgenic agent is most likely to cause liver toxicity?

    <p>Oral anabolic steroids</p> Signup and view all the answers

    What is a known side effect of long-term anabolic steroid use?

    <p>Hypogonadotropic hypogonadism</p> Signup and view all the answers

    Which statement regarding hormonal contraceptives is NOT correct?

    <p>Progestogen-only pills primarily act by inhibiting ovulation.</p> Signup and view all the answers

    Which statement about testosterone therapy is NOT correct?

    <p>It has no effect on red blood cell production.</p> Signup and view all the answers

    Which statement regarding oxytocin’s role in lactation is NOT correct?

    <p>Oxytocin stimulates milk synthesis in the alveoli.</p> Signup and view all the answers

    Which statement about anabolic steroid use is NOT correct?

    <p>Injectable testosterone is associated with a higher risk of liver toxicity than oral anabolic steroids.</p> Signup and view all the answers

    Which statement regarding lactation physiology is NOT correct?

    <p>Milk ejection depends on prolactin release.</p> Signup and view all the answers

    Which statement about hormonal regulation in the male reproductive system is NOT correct?

    <p>Inhibin inhibits LH release from the pituitary.</p> Signup and view all the answers

    Which statement about combined oral contraceptives is NOT correct?

    <p>They can be used safely in women with a history of stroke.</p> Signup and view all the answers

    Which statement regarding the physiology of testosterone is NOT correct?

    <p>It decreases muscle protein synthesis.</p> Signup and view all the answers

    Which statement regarding the action of progesterone in pregnancy is NOT correct?

    <p>It increases cervical mucus permeability.</p> Signup and view all the answers

    Which statement about anabolic steroids is NOT correct?

    <p>They are known to cause significant liver damage when injected.</p> Signup and view all the answers

    What roles do LH and FSH play in the follicular phase?

    <p>LH stimulates the thecal cells to produce androgens, while FSH acts on granulosa cells to convert androgens to estrogen.</p> Signup and view all the answers

    How does the LH surge impact ovulation?

    <p>The LH surge triggers the release of the oocyte from the dominant follicle.</p> Signup and view all the answers

    What changes occur in progesterone levels during the luteal phase?

    <p>Progesterone levels rise during the luteal phase to maintain the endometrial lining.</p> Signup and view all the answers

    How do combined oral contraceptives inhibit ovulation?

    <p>They inhibit ovulation by suppressing FSH and LH secretion through feedback inhibition.</p> Signup and view all the answers

    What are potential risks associated with long-term use of combined oral contraceptives?

    <p>Potential risks include venous thromboembolism and increased risk of stroke in susceptible individuals.</p> Signup and view all the answers

    What is the likely diagnosis for a woman presenting with irregular periods and signs of hyperandrogenism?

    <p>Polycystic ovary syndrome (PCOS).</p> Signup and view all the answers

    What condition is characterized by low testosterone levels with high LH and FSH?

    <p>Primary hypogonadism.</p> Signup and view all the answers

    What complications can arise from anabolic steroid use?

    <p>Complications include infertility, liver damage, and cardiovascular issues.</p> Signup and view all the answers

    What distinguishes primary from secondary hypogonadism?

    <p>Primary hypogonadism originates in the testes with elevated LH and FSH, while secondary hypogonadism involves a pituitary or hypothalamic defect with low or normal LH/FSH.</p> Signup and view all the answers

    Which anatomical structure is responsible for producing progesterone during the luteal phase?

    <p>Corpus luteum</p> Signup and view all the answers

    What is the primary physiological effect of inhibin B secretion in females?

    <p>Inhibition of FSH secretion</p> Signup and view all the answers

    Which phase of the menstrual cycle is characterized by the highest level of progesterone?

    <p>Luteal phase</p> Signup and view all the answers

    Which hormone triggers the acrosome reaction during fertilization?

    <p>Progesterone</p> Signup and view all the answers

    What is the primary function of Leydig cells in the male reproductive system?

    <p>Production of testosterone</p> Signup and view all the answers

    During which stage of spermatogenesis does the primary spermatocyte undergo the first meiotic division?

    <p>Primary spermatocyte</p> Signup and view all the answers

    What structural feature allows the mammary gland to produce milk during lactation?

    <p>Myoepithelial cells surrounding the alveoli</p> Signup and view all the answers

    Which phase of the uterine cycle corresponds with the proliferative phase of the endometrium?

    <p>Follicular phase</p> Signup and view all the answers

    What is the function of the pampiniform plexus in male reproductive anatomy?

    <p>Temperature regulation of the testes</p> Signup and view all the answers

    Which ligament provides primary support to the uterus, preventing it from prolapsing?

    <p>Uterosacral ligament</p> Signup and view all the answers

    Which anatomical structure in the breast is responsible for milk storage before ejection?

    <p>Lactiferous sinuses</p> Signup and view all the answers

    What phase of the ovarian cycle involves the rupture of the dominant follicle and release of the oocyte?

    <p>Ovulatory phase</p> Signup and view all the answers

    Which nerve innervates the external anal sphincter?

    <p>Pudendal nerve</p> Signup and view all the answers

    Which cells in the male reproductive system are involved in forming the blood-testis barrier?

    <p>Sertoli cells</p> Signup and view all the answers

    Which hormone surge is primarily responsible for the onset of ovulation?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    Which statement about the male reproductive system is NOT correct?

    <p>Leydig cells produce inhibin to regulate spermatogenesis.</p> Signup and view all the answers

    Which statement regarding the pelvic viscera is NOT correct?

    <p>The ureters enter the bladder at its superior aspect.</p> Signup and view all the answers

    Which statement about the phases of the menstrual cycle is NOT correct?

    <p>The menstrual phase is when the endometrial lining is maintained by progesterone.</p> Signup and view all the answers

    Which statement about breast anatomy is NOT correct?

    <p>Myoepithelial cells within the mammary alveoli are responsible for milk production.</p> Signup and view all the answers

    Which statement about the hormonal control of spermatogenesis is NOT correct?

    <p>Testosterone directly stimulates the anterior pituitary to secrete FSH and LH.</p> Signup and view all the answers

    Which statement about ovulation is NOT correct?

    <p>The oocyte released during ovulation is a primary oocyte.</p> Signup and view all the answers

    Which statement regarding the anatomy of the pelvic floor is NOT correct?

    <p>The internal anal sphincter is under voluntary control.</p> Signup and view all the answers

    Which statement about the corpus luteum is NOT correct?

    <p>Its function is sustained by FSH during early pregnancy.</p> Signup and view all the answers

    Which statement regarding mammary gland development is NOT correct?

    <p>Oxytocin stimulates milk production within the alveoli.</p> Signup and view all the answers

    Which statement about the pampiniform plexus is NOT correct?

    <p>It plays a role in testosterone production.</p> Signup and view all the answers

    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?

    <p>The corpus luteum secretes progesterone to maintain the endometrium for potential implantation.</p> Signup and view all the answers

    Discuss the role of the corpus luteum in the female reproductive cycle: How is the corpus luteum maintained if pregnancy occurs?

    <p>It is maintained by human chorionic gonadotropin (hCG) secreted by the developing embryo.</p> Signup and view all the answers

    Discuss the role of the corpus luteum in the female reproductive cycle: What hormonal changes lead to its degeneration if pregnancy does not occur?

    <p>The decline in LH levels leads to its degeneration into the corpus albicans if pregnancy does not occur.</p> Signup and view all the answers

    Analyze the hormonal regulation of male reproductive function: What is the role of LH in the male reproductive system?

    <p>LH stimulates Leydig cells to produce testosterone.</p> Signup and view all the answers

    Analyze the hormonal regulation of male reproductive function: Which hormone provides negative feedback to the hypothalamus and pituitary, regulating LH and FSH secretion?

    <p>Testosterone provides negative feedback to regulate LH and FSH secretion.</p> Signup and view all the answers

    Analyze the hormonal regulation of male reproductive function: What effect does inhibin have on FSH?

    <p>Inhibin, produced by Sertoli cells, inhibits FSH secretion.</p> Signup and view all the answers

    Discuss the physiological changes in breast tissue during lactation: What role does prolactin play in lactation?

    <p>Prolactin stimulates the production of milk within the alveolar epithelial cells.</p> Signup and view all the answers

    Discuss the physiological changes in breast tissue during lactation: How does oxytocin contribute to the breastfeeding process?

    <p>Oxytocin causes contraction of myoepithelial cells, leading to milk ejection.</p> Signup and view all the answers

    Discuss the physiological changes in breast tissue during lactation: What structural adaptation in the breast supports milk ejection?

    <p>Myoepithelial cells surrounding the alveoli contract to push milk into the ducts.</p> Signup and view all the answers

    Compare the phases of the menstrual cycle with their corresponding hormonal profiles: What are the main hormonal changes during the follicular phase?

    <p>Estrogen levels rise during the follicular phase as the dominant follicle matures.</p> Signup and view all the answers

    Compare the phases of the menstrual cycle with their corresponding hormonal profiles: How do hormone levels shift during the luteal phase?

    <p>The luteal phase is characterized by high levels of progesterone produced by the corpus luteum.</p> Signup and view all the answers

    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?

    <p>The menstrual phase is triggered by a drop in progesterone and estrogen, leading to the shedding of the endometrial lining.</p> Signup and view all the answers

    Explain the role of Sertoli cells in spermatogenesis: How do Sertoli cells contribute to the formation of the blood-testis barrier?

    <p>Sertoli cells form tight junctions that create the blood-testis barrier, protecting developing germ cells from autoimmune reactions.</p> Signup and view all the answers

    Explain the role of Sertoli cells in spermatogenesis: What role do they play in nourishing developing sperm?

    <p>They provide physical and nutritional support to developing sperm cells during spermatogenesis.</p> Signup and view all the answers

    Explain the role of Sertoli cells in spermatogenesis: What substance do Sertoli cells produce to regulate FSH?

    <p>Sertoli cells produce inhibin, which negatively regulates FSH secretion.</p> Signup and view all the answers

    Discuss the anatomical and physiological role of the pelvic diaphragm: Which muscles comprise the pelvic diaphragm?

    <p>The pelvic diaphragm is composed of the levator ani muscles and the coccygeus muscle.</p> Signup and view all the answers

    Discuss the anatomical and physiological role of the pelvic diaphragm: What is the primary function of the pelvic diaphragm?

    <p>It provides support to the pelvic organs and maintains continence.</p> Signup and view all the answers

    Discuss the anatomical and physiological role of the pelvic diaphragm: How does the pelvic diaphragm contribute to the support of pelvic organs?

    <p>The pelvic diaphragm creates a muscular sling that supports the organs in the pelvic cavity and assists in resisting intra-abdominal pressure.</p> Signup and view all the answers

    Analyze the stages of spermatogenesis and their regulation: What are the stages of spermatogenesis from spermatogonia to mature sperm?

    <p>The stages include spermatogonia → primary spermatocytes → secondary spermatocytes → spermatids → spermatozoa.</p> Signup and view all the answers

    Analyze the stages of spermatogenesis and their regulation: How is spermatogenesis regulated hormonally?

    <p>Spermatogenesis is regulated by FSH (stimulating Sertoli cells) and LH (stimulating Leydig cells for testosterone production).</p> Signup and view all the answers

    Analyze the stages of spermatogenesis and their regulation: What is the significance of the first and second meiotic divisions in this process?

    <p>The first meiotic division produces haploid secondary spermatocytes, and the second meiotic division forms spermatids, leading to genetic diversity.</p> Signup and view all the answers

    Evaluate the impact of progesterone on the female reproductive system: What changes does progesterone induce in the endometrium during the luteal phase?

    <p>Progesterone thickens the endometrium, making it more glandular and vascularized to support a potential pregnancy.</p> Signup and view all the answers

    Evaluate the impact of progesterone on the female reproductive system: How does progesterone affect the myometrium?

    <p>It reduces myometrial contractions, helping maintain a stable uterine environment.</p> Signup and view all the answers

    Evaluate the impact of progesterone on the female reproductive system: What role does progesterone play in early pregnancy?

    <p>Progesterone supports early pregnancy by maintaining the endometrial lining and preventing menstruation.</p> Signup and view all the answers

    Discuss the significance of the pampiniform plexus in testicular function: What is the primary function of the pampiniform plexus?

    <p>The pampiniform plexus functions as a heat exchanger that cools arterial blood before it enters the testes.</p> Signup and view all the answers

    Discuss the significance of the pampiniform plexus in testicular function: How does it contribute to temperature regulation of the testes?

    <p>It surrounds the testicular artery and absorbs heat from the blood, helping maintain optimal testicular temperature.</p> Signup and view all the answers

    Discuss the significance of the pampiniform plexus in testicular function: Why is temperature regulation important for spermatogenesis?

    <p>Spermatogenesis requires a temperature lower than core body temperature for proper function.</p> Signup and view all the answers

    Compare the structural and functional aspects of the uterus and its supportive ligaments: What are the main structural components of the uterus?

    <p>The main structural components include the endometrium, myometrium, and perimetrium.</p> Signup and view all the answers

    What is the diagnosis for chronic pelvic pain and painful menstruation?

    <p>Endometriosis</p> Signup and view all the answers

    What are the typical histological features of endometriosis?

    <p>Endometrial glands and stroma outside the uterine cavity</p> Signup and view all the answers

    How can endometriosis be managed?

    <p>Hormonal therapy or surgical resection</p> Signup and view all the answers

    What is the most likely diagnosis for sudden testicular pain and swelling?

    <p>Testicular torsion</p> Signup and view all the answers

    What imaging test should be performed immediately for suspected testicular torsion?

    <p>A scrotal ultrasound with Doppler flow</p> Signup and view all the answers

    What is the standard treatment for testicular torsion?

    <p>Immediate surgical detorsion and fixation (orchidopexy)</p> Signup and view all the answers

    What is the most likely diagnosis for difficulty urinating and increased urinary frequency in an older male?

    <p>Benign prostatic hyperplasia (BPH)</p> Signup and view all the answers

    Which zones of the prostate are most likely affected in benign prostatic hyperplasia?

    <p>Transitional zone</p> Signup and view all the answers

    What are the treatment options for benign prostatic hyperplasia?

    <p>Alpha-blockers, 5-alpha reductase inhibitors, and surgical intervention</p> Signup and view all the answers

    Which statement about Type 2 diabetes is NOT correct?

    <p>It is always autoimmune in origin.</p> Signup and view all the answers

    Which statement regarding gestational diabetes is NOT correct?

    <p>It poses no risk for type 2 diabetes later in life.</p> Signup and view all the answers

    Which statement about PTH's effects is NOT correct?

    <p>It lowers blood calcium levels.</p> Signup and view all the answers

    Which statement about HbA1c testing is NOT correct?

    <p>It directly measures blood glucose concentrations.</p> Signup and view all the answers

    What immune mechanism underlies Type 1 diabetes?

    <p>Autoimmune destruction of pancreatic β-cells, typically mediated by T cells.</p> Signup and view all the answers

    How does insulin resistance contribute to the development of Type 2 diabetes?

    <p>It impairs glucose uptake by peripheral tissues, leading to hyperglycemia and compensatory β-cell hyperplasia.</p> Signup and view all the answers

    How does glucagon maintain blood glucose levels during fasting?

    <p>By stimulating glycogenolysis and gluconeogenesis in the liver.</p> Signup and view all the answers

    What effect does insulin have on hepatic glucose production?

    <p>It inhibits gluconeogenesis and promotes glycogen synthesis.</p> Signup and view all the answers

    Which signaling pathway is activated by insulin binding to its receptor in muscle and adipose tissue?

    <p>PI3K/Akt pathway</p> Signup and view all the answers

    Which enzyme deficiency is associated with a rare form of rickets that leads to hypocalcemia despite adequate vitamin D intake?

    <p>1-alpha-hydroxylase</p> Signup and view all the answers

    Which hormone plays a key role in inhibiting bone resorption by osteoclasts?

    <p>Calcitonin</p> Signup and view all the answers

    What are the potential benefits of using SGLT2 inhibitors over metformin?

    <p>They can promote weight loss and provide cardiovascular benefits.</p> Signup and view all the answers

    What is the effect of chronic hyperglycemia on the basement membrane of blood vessels in diabetic patients?

    <p>Increased thickness and stiffness</p> Signup and view all the answers

    What is the main cause of gestational diabetes?

    <p>Placental hormone-induced insulin resistance</p> Signup and view all the answers

    What are the treatment options for acute hypocalcemia?

    <p>Intravenous calcium and addressing the underlying cause.</p> Signup and view all the answers

    What is the response of insulin secretion during a hypoglycemic event?

    <p>Insulin secretion decreases to prevent further lowering of blood glucose.</p> Signup and view all the answers

    Match the following conditions with their typical features:

    <p>Type 1 diabetes = Autoimmune β-cell destruction Type 2 diabetes = Insulin resistance Gestational diabetes = Hormonal changes affecting glucose metabolism Hypoparathyroidism = Low calcium and high phosphate levels</p> Signup and view all the answers

    What potential complications should a pregnant woman with gestational diabetes be aware of?

    <p>Macrosomia, preeclampsia, and increased risk of type 2 diabetes post-pregnancy.</p> Signup and view all the answers

    What non-pharmacological management strategies can be recommended for gestational diabetes?

    <p>Dietary modifications and regular physical activity.</p> Signup and view all the answers

    When is pharmacological treatment indicated for gestational diabetes, and what is commonly used?

    <p>If blood glucose is not controlled with lifestyle changes, insulin is the preferred treatment.</p> Signup and view all the answers

    What condition might a 63-year-old woman on long-term glucocorticoid therapy be developing?

    <p>Steroid-induced diabetes.</p> Signup and view all the answers

    How do glucocorticoids contribute to hyperglycemia?

    <p>They increase gluconeogenesis and insulin resistance.</p> Signup and view all the answers

    What management options are available for steroid-induced hyperglycemia?

    <p>Adjusting glucocorticoid dose, adding metformin, or initiating insulin therapy if necessary.</p> Signup and view all the answers

    What is the likely diagnosis for a 34-year-old male with signs of insulin resistance and elevated fasting blood glucose?

    <p>Type 2 diabetes with metabolic syndrome.</p> Signup and view all the answers

    What initial pharmacological treatment should be considered for a patient with type 2 diabetes and metabolic syndrome?

    <p>Metformin.</p> Signup and view all the answers

    What non-pharmacological measures can improve insulin resistance?

    <p>Weight loss, increased physical activity, and dietary changes.</p> Signup and view all the answers

    What condition might indicate impaired glucose tolerance (IGT) in a 45-year-old woman with episodic fatigue and elevated postprandial levels?

    <p>Impaired glucose tolerance (IGT).</p> Signup and view all the answers

    What tests should be conducted to confirm the diagnosis of IGT?

    <p>Oral glucose tolerance test (OGTT).</p> Signup and view all the answers

    What management strategies would be effective for someone with impaired glucose tolerance?

    <p>Lifestyle modifications, including diet and exercise.</p> Signup and view all the answers

    What is the most likely underlying condition for a patient with polyuria, increased thirst, and significant weight loss?

    <p>Uncontrolled type 2 diabetes mellitus with significant insulin resistance.</p> Signup and view all the answers

    What is indicative of the skin findings in a 40-year-old male with significant insulin resistance?

    <p>Acanthosis nigricans, which is associated with hyperinsulinemia.</p> Signup and view all the answers

    What pharmacological management plan should be outlined for a patient with uncontrolled type 2 diabetes?

    <p>Initiate metformin therapy, consider adding an SGLT2 inhibitor or GLP-1 receptor agonist, and recommend lifestyle modifications.</p> Signup and view all the answers

    Which metabolic pathway is upregulated during prolonged fasting to maintain blood glucose levels?

    <p>Gluconeogenesis</p> Signup and view all the answers

    Which enzyme's activity is directly inhibited by metformin to reduce hepatic gluconeogenesis?

    <p>Glucose-6-phosphatase</p> Signup and view all the answers

    Which of the following is the primary glucocorticoid in the human body?

    <p>Cortisol</p> Signup and view all the answers

    Which class of antidiabetic drugs mimics the action of incretin hormones to increase insulin secretion?

    <p>GLP-1 receptor agonists</p> Signup and view all the answers

    What is the primary reason for including dietary fiber in the management plan for diabetes?

    <p>To slow gastric emptying and reduce postprandial glucose spikes</p> Signup and view all the answers

    Which hormone is responsible for promoting ketogenesis during prolonged fasting?

    <p>Glucagon</p> Signup and view all the answers

    Which condition is commonly associated with insulin resistance and hyperinsulinemia?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    Which glucose transporter mediates glucose uptake in pancreatic β-cells?

    <p>GLUT2</p> Signup and view all the answers

    What is a common side effect of thiazolidinediones (e.g., pioglitazone)?

    <p>Weight gain</p> Signup and view all the answers

    Which statement about metformin is NOT correct?

    <p>It promotes glycogenolysis in the liver.</p> Signup and view all the answers

    What is the most common cause of secondary hyperparathyroidism?

    <p>Chronic kidney disease (CKD)</p> Signup and view all the answers

    Match the following conditions with their descriptions:

    <p>Gestational diabetes = Increased insulin resistance due to placental hormones Type 2 diabetes = Often associated with obesity and insulin resistance Steroid-induced diabetes = Developing diabetes due to glucocorticoid therapy Impaired glucose tolerance = A condition indicating risk for developing diabetes</p> Signup and view all the answers

    Which statement regarding the structure of the male perineum is NOT correct?

    <p>The ischiocavernosus muscle compresses the anal canal.</p> Signup and view all the answers

    Which statement about the female reproductive histology is NOT correct?

    <p>The uterine tubes are lined by transitional epithelium.</p> Signup and view all the answers

    Which statement regarding the development of the reproductive tract is NOT correct?

    <p>The genital tubercle remains undifferentiated in both sexes until birth.</p> Signup and view all the answers

    Which statement about the male reproductive anatomy is NOT correct?

    <p>The epididymis is responsible for the production of sperm cells.</p> Signup and view all the answers

    Which statement regarding the embryological development of the gonads is NOT correct?

    <p>The mesonephric duct develops into the female reproductive structures.</p> Signup and view all the answers

    Which statement about the pelvic diaphragm is NOT correct?

    <p>It contributes to the formation of the deep perineal pouch.</p> Signup and view all the answers

    Which statement regarding the histology of the ovary is NOT correct?

    <p>The tunica albuginea is a thick, keratinised layer covering the ovary.</p> Signup and view all the answers

    Which statement about the perineal body is NOT correct?

    <p>It separates the urogenital and anal triangles.</p> Signup and view all the answers

    Which statement regarding the development of the external genitalia is NOT correct?

    <p>The cloacal membrane persists throughout development.</p> Signup and view all the answers

    Which statement about Sertoli cells is NOT correct?

    <p>They produce testosterone in response to luteinising hormone.</p> Signup and view all the answers

    Discuss the development of the male and female reproductive tracts.

    <p>a) The mesonephric (Wolffian) duct develops into the male reproductive duct system. b) Anti-Müllerian hormone (AMH), secreted by Sertoli cells, signals the regression of the paramesonephric ducts. c) The paramesonephric (Müllerian) ducts develop into the fallopian tubes.</p> Signup and view all the answers

    Compare the histological features of the male and female gonads.

    <p>a) The seminiferous tubules are lined by germinal epithelium. b) The ovarian follicle is the functional unit that releases an oocyte during ovulation. c) Sertoli cells support spermatogenesis in the testes, while granulosa cells support oogenesis in the ovaries.</p> Signup and view all the answers

    Explain the formation and role of the perineal body in the pelvis.

    <p>a) The perineal body is located at the midpoint between the ischial tuberosities. b) The bulbospongiosus, superficial and deep transverse perineal muscles, and external anal sphincter attach to the perineal body. c) The perineal body provides structural support and can be damaged during childbirth, leading to potential pelvic floor disorders.</p> Signup and view all the answers

    Describe the role of Sertoli and Leydig cells in the testes.

    <p>a) Follicle-stimulating hormone (FSH) stimulates Sertoli cells, which support and nourish developing sperm. b) Leydig cells produce testosterone in response to luteinising hormone (LH) stimulation. c) Sertoli cells form tight junctions that create the blood-testis barrier, protecting developing sperm from the immune system.</p> Signup and view all the answers

    Compare the structural and functional differences between the male and female perineum.

    <p>a) The perineum is bounded by the pubic symphysis anteriorly, the coccyx posteriorly, and the ischial tuberosities laterally in both sexes. b) The bulbospongiosus muscle is present in both sexes but plays a more prominent role in males for ejaculation. c) These differences affect the mechanics of erection and ejaculation in males and support the vaginal orifice in females.</p> Signup and view all the answers

    Discuss the embryological development of external genitalia.

    <p>a) The genital tubercle develops into the penis in males and the clitoris in females. b) The urethral folds fuse to form the penile urethra in males and remain unfused to form the labia minora in females. c) Androgens, primarily testosterone, promote the masculinisation of external genitalia.</p> Signup and view all the answers

    Explain the structural differences and functions of the tunica albuginea in the male and female reproductive systems.

    <p>a) The tunica albuginea in the testes encloses and supports the seminiferous tubules. b) The tunica albuginea in the ovaries is thinner than in the testes. c) The tunica albuginea helps maintain the structural integrity of the ovary and is involved in the rupture of the follicle during ovulation.</p> Signup and view all the answers

    Describe the hormonal regulation of the menstrual cycle.

    <p>a) Follicle-stimulating hormone (FSH) and oestrogen dominate the follicular phase. b) A surge in luteinising hormone (LH) triggers ovulation. c) The luteal phase is maintained by progesterone secreted by the corpus luteum.</p> Signup and view all the answers

    Discuss the formation of the uterine tubes during embryological development.

    <p>a) The uterine tubes develop from the paramesonephric (Müllerian) ducts. b) Ciliated columnar epithelium lines the uterine tubes, aiding in the transport of the oocyte. c) Congenital absence or obstruction of the uterine tubes can impact fertility.</p> Signup and view all the answers

    Describe the anatomy and significance of the pelvic diaphragm.

    <p>a) The primary muscles of the pelvic diaphragm are the levator ani and coccygeus muscles. b) The pelvic diaphragm forms a muscular floor that supports the pelvic organs and maintains continence. c) Weakening of the pelvic diaphragm can lead to conditions such as pelvic organ prolapse and incontinence.</p> Signup and view all the answers

    What is the most likely diagnosis for the 28-year-old woman with pelvic pain and an ovarian cyst?

    <p>The most likely diagnosis is an ovarian follicular cyst.</p> Signup and view all the answers

    What hormonal assessments should be performed for the 35-year-old male with infertility?

    <p>Hormonal assessments should include testosterone, luteinising hormone (LH), and follicle-stimulating hormone (FSH).</p> Signup and view all the answers

    What anatomical structure is most likely weakened in the 42-year-old woman with pelvic floor dysfunction?

    <p>The pelvic diaphragm, particularly the levator ani muscles, is likely weakened.</p> Signup and view all the answers

    What is the most likely diagnosis for the 22-year-old male with a painless scrotal mass?

    <p>The most likely diagnosis is a testicular tumour, potentially a seminoma.</p> Signup and view all the answers

    What hormonal change is most likely responsible for the symptoms in the 50-year-old postmenopausal woman?

    <p>Oestrogen deficiency is most likely responsible.</p> Signup and view all the answers

    What is the likely diagnosis for the pregnant woman with an abnormal mass adjacent to the fetus?

    <p>The likely diagnosis is a teratoma.</p> Signup and view all the answers

    What is the differential diagnosis for a 29-year-old male with haematospermia?

    <p>Differential diagnosis includes seminal vesicle inflammation, prostate issues, or a vascular anomaly.</p> Signup and view all the answers

    What is a major side effect associated with the chronic use of thiazolidinediones (e.g., pioglitazone)?

    <p>Fluid retention and weight gain</p> Signup and view all the answers

    Which statement regarding the pathophysiology of Type 1 diabetes is NOT correct?

    <p>It is characterized by insulin resistance.</p> Signup and view all the answers

    Which statement about PTH function is NOT correct?

    <p>It decreases blood calcium levels.</p> Signup and view all the answers

    Which statement regarding the effects of insulin is NOT correct?

    <p>It promotes lipolysis in adipose tissue.</p> Signup and view all the answers

    Which statement about glucocorticoids is NOT correct?

    <p>They promote protein synthesis in muscle.</p> Signup and view all the answers

    Which statement about metformin is NOT correct?

    <p>It can cause hypoglycemia as a common side effect.</p> Signup and view all the answers

    Which statement about vitamin D metabolism is NOT correct?

    <p>Active vitamin D decreases calcium absorption in the intestines.</p> Signup and view all the answers

    Which statement about the role of GLP-1 in glucose regulation is NOT correct?

    <p>It promotes glucose reabsorption in the kidneys.</p> Signup and view all the answers

    Which statement about insulin secretion is NOT correct?

    <p>It results in increased glycogenolysis in the liver.</p> Signup and view all the answers

    Which statement about the hormonal changes during the fasting state is NOT correct?

    <p>Insulin secretion increases.</p> Signup and view all the answers

    Which statement about diabetic nephropathy is NOT correct?

    <p>It is reversible with strict glycemic control.</p> Signup and view all the answers

    Which enzyme is the rate-limiting step of glycolysis and is activated by insulin?

    <p>Phosphofructokinase-1 (PFK-1)</p> Signup and view all the answers

    What metabolic shift occurs in the liver during prolonged fasting to maintain blood glucose levels?

    <p>Increased gluconeogenesis</p> Signup and view all the answers

    Which intermediate of the TCA cycle is also an important substrate for gluconeogenesis?

    <p>Oxaloacetate</p> Signup and view all the answers

    Which enzyme is responsible for converting pyruvate to oxaloacetate in the first step of gluconeogenesis?

    <p>Pyruvate carboxylase</p> Signup and view all the answers

    What role does AMP-activated protein kinase (AMPK) play in metabolic regulation?

    <p>It inhibits gluconeogenesis and stimulates fatty acid oxidation.</p> Signup and view all the answers

    Which of the following molecules acts as a feedback inhibitor of hexokinase in glycolysis?

    <p>Glucose-6-phosphate</p> Signup and view all the answers

    What enzyme catalyzes the conversion of fructose-1,6-bisphosphate to fructose-6-phosphate in gluconeogenesis?

    <p>Fructose-1,6-bisphosphatase</p> Signup and view all the answers

    Which molecule is an allosteric activator of pyruvate carboxylase, promoting gluconeogenesis?

    <p>Acetyl-CoA</p> Signup and view all the answers

    What is the function of glucose-6-phosphatase in gluconeogenesis?

    <p>Converts glucose-6-phosphate to glucose.</p> Signup and view all the answers

    Which enzyme in the liver is responsible for trapping glucose by phosphorylation, but is not subject to feedback inhibition by its product?

    <p>Glucokinase</p> Signup and view all the answers

    Which of the following best describes the biochemical basis of insulin resistance in type 2 diabetes?

    <p>Decreased PI3K/Akt signaling</p> Signup and view all the answers

    What is the primary metabolic change during the fed state that supports glucose storage?

    <p>Activation of glycogen synthase</p> Signup and view all the answers

    Which of the following enzymes is activated by insulin to promote glycolysis in the liver?

    <p>Phosphofructokinase-1 (PFK-1)</p> Signup and view all the answers

    Which pathway is upregulated in the liver to maintain blood glucose levels during prolonged fasting?

    <p>Gluconeogenesis</p> Signup and view all the answers

    Which drug is first-line therapy for type 2 diabetes due to its ability to reduce hepatic gluconeogenesis?

    <p>Metformin</p> Signup and view all the answers

    What is the main consequence of chronic hyperglycemia on blood vessels in diabetic patients?

    <p>Enhanced glycation of proteins</p> Signup and view all the answers

    What is the primary mechanism of action for SGLT2 inhibitors in managing hyperglycemia?

    <p>Inhibiting glucose reabsorption in the kidneys</p> Signup and view all the answers

    Which enzyme in the liver catalyzes the final step of gluconeogenesis, allowing glucose to be released into the bloodstream?

    <p>Glucose-6-phosphatase</p> Signup and view all the answers

    Which glucose transporter is insulin-sensitive and primarily found in adipose tissue and skeletal muscle?

    <p>GLUT4</p> Signup and view all the answers

    What is the role of AMP-activated protein kinase (AMPK) in muscle cells under low-energy conditions?

    <p>Stimulates fatty acid oxidation</p> Signup and view all the answers

    Which of the following hormones counteracts the action of insulin by increasing blood glucose levels?

    <p>Glucagon</p> Signup and view all the answers

    Which hormone inhibits glycogenesis and promotes glycogenolysis in response to low blood glucose levels?

    <p>Glucagon</p> Signup and view all the answers

    What metabolic adaptation occurs in the liver during prolonged fasting to conserve glucose for the brain?

    <p>Upregulation of ketone body production</p> Signup and view all the answers

    What is the main side effect associated with long-term use of systemic glucocorticoids?

    <p>Cushing's syndrome</p> Signup and view all the answers

    Which of the following accurately describes the role of glucocorticoids in metabolism?

    <p>Promote protein catabolism</p> Signup and view all the answers

    Which enzyme's activity is inhibited by insulin in order to reduce gluconeogenesis in the liver?

    <p>Fructose-1,6-bisphosphatase</p> Signup and view all the answers

    Which enzyme is inhibited by metformin to decrease gluconeogenesis in the liver?

    <p>Glucose-6-phosphatase</p> Signup and view all the answers

    What is the biochemical role of glucokinase in the liver during the fed state?

    <p>Facilitates glucose trapping for glycolysis</p> Signup and view all the answers

    What is a notable side effect of SGLT2 inhibitors?

    <p>Genitourinary infections</p> Signup and view all the answers

    Which structure serves as the functional unit for spermatogenesis in the male reproductive tract?

    <p>Seminiferous tubules</p> Signup and view all the answers

    During which developmental week do the primordial germ cells migrate into the dorsal body wall mesenchyme?

    <p>6th week</p> Signup and view all the answers

    Which of the following is true regarding the mechanism of glucocorticoids?

    <p>They cross the cell membrane and bind to cytoplasmic receptors.</p> Signup and view all the answers

    Which statement about insulin's role in metabolism is NOT correct?

    <p>Insulin promotes glucose uptake in the liver via GLUT4.</p> Signup and view all the answers

    What is the primary hormone responsible for inducing mesonephric duct development in the male embryo?

    <p>Testosterone</p> Signup and view all the answers

    Which statement regarding glucocorticoids is NOT correct?

    <p>They promote protein synthesis in muscles.</p> Signup and view all the answers

    Which ligament in females represents the remnant of the gubernaculum?

    <p>Round ligament</p> Signup and view all the answers

    The clitoris and the penis develop from which embryonic structure?

    <p>Genital tubercle</p> Signup and view all the answers

    Which statement about SGLT2 inhibitors is NOT correct?

    <p>They increase insulin secretion.</p> Signup and view all the answers

    Which statement about metformin is NOT correct?

    <p>It increases glucose uptake in muscles directly.</p> Signup and view all the answers

    Which type of epithelium lines the vagina, enabling its protective function?

    <p>Stratified squamous, non-keratinized</p> Signup and view all the answers

    Which statement regarding type 1 diabetes is NOT correct?

    <p>It is associated with insulin resistance.</p> Signup and view all the answers

    What tissue structure provides mechanical support to the testes and encloses the seminiferous tubules?

    <p>Tunica albuginea</p> Signup and view all the answers

    Which statement about glucagon's role in metabolism is NOT correct?

    <p>It decreases blood glucose levels.</p> Signup and view all the answers

    In the male, which embryonic structure gives rise to the vas deferens?

    <p>Mesonephric duct</p> Signup and view all the answers

    The ampulla of the uterine tube is most notable for which reproductive function?

    <p>Site of fertilization</p> Signup and view all the answers

    Which statement about the action of insulin on lipid metabolism is NOT correct?

    <p>It promotes the mobilization of fatty acids from adipose stores.</p> Signup and view all the answers

    Which cells within the seminiferous tubules provide nourishment to developing spermatozoa?

    <p>Sertoli cells</p> Signup and view all the answers

    Which statement about the GLUT4 transporter is NOT correct?

    <p>It facilitates glucose entry into liver cells.</p> Signup and view all the answers

    Which statement regarding glucocorticoid therapy is NOT correct?

    <p>It decreases protein catabolism.</p> Signup and view all the answers

    What structure marks the boundary between the urogenital and anal triangles in the perineum?

    <p>Perineal body</p> Signup and view all the answers

    Which statement about the mechanism of metformin is NOT correct?

    <p>It increases glycogenolysis.</p> Signup and view all the answers

    Which component of the female reproductive system remains open to the peritoneal cavity, enabling ectopic pregnancies?

    <p>Uterine tube (infundibulum)</p> Signup and view all the answers

    What muscle within the male perineum aids in the expulsion of semen and residual urine?

    <p>Bulbospongiosus</p> Signup and view all the answers

    Discuss the regulation of blood glucose levels during the fed state: What hormones are primarily involved during the fed state?

    <p>Insulin is the primary hormone involved.</p> Signup and view all the answers

    Discuss the regulation of blood glucose levels during the fed state: How does insulin promote glucose uptake in muscle and adipose tissue?

    <p>Insulin binds to its receptor, leading to the translocation of GLUT4 to the cell membrane.</p> Signup and view all the answers

    Which structure is homologous to the male bulbourethral glands in females?

    <p>Bartholin's glands (greater vestibular glands)</p> Signup and view all the answers

    Which structure anchors the ovaries and connects them to the uterus?

    <p>Ovarian ligament</p> Signup and view all the answers

    Discuss the regulation of blood glucose levels during the fed state: Which metabolic pathways are activated in the liver?

    <p>Glycogenesis and glycolysis are activated to store and utilize glucose.</p> Signup and view all the answers

    Compare the mechanisms of action between insulin and glucagon: How does insulin affect glycogen synthesis in the liver?

    <p>Insulin stimulates glycogen synthase, promoting glycogen synthesis.</p> Signup and view all the answers

    Compare the mechanisms of action between insulin and glucagon: What is glucagon’s role in gluconeogenesis?

    <p>Glucagon activates key enzymes in gluconeogenesis, such as PEPCK.</p> Signup and view all the answers

    Compare the mechanisms of action between insulin and glucagon: How do these hormones interact to maintain blood glucose homeostasis?

    <p>Insulin lowers blood glucose by promoting storage, while glucagon increases blood glucose by promoting glycogen breakdown and gluconeogenesis.</p> Signup and view all the answers

    Analyze the pathophysiological basis of type 2 diabetes: What are the primary defects in type 2 diabetes?

    <p>Insulin resistance and relative insulin deficiency.</p> Signup and view all the answers

    Analyze the pathophysiological basis of type 2 diabetes: How does insulin resistance develop at the cellular level?

    <p>Insulin signaling pathways become impaired, reducing GLUT4 translocation and glucose uptake.</p> Signup and view all the answers

    Analyze the pathophysiological basis of type 2 diabetes: What long-term complications are associated with poor glycemic control?

    <p>Complications include nephropathy, neuropathy, and retinopathy.</p> Signup and view all the answers

    Discuss the effects and therapeutic uses of glucocorticoids: What are the main metabolic effects of glucocorticoids?

    <p>They increase gluconeogenesis, protein catabolism, and lipolysis.</p> Signup and view all the answers

    Discuss the effects and therapeutic uses of glucocorticoids: In what clinical scenarios are glucocorticoids used?

    <p>Glucocorticoids are used for anti-inflammatory and immunosuppressive purposes.</p> Signup and view all the answers

    Discuss the effects and therapeutic uses of glucocorticoids: What are potential side effects of long-term glucocorticoid therapy?

    <p>Side effects include osteoporosis, hyperglycemia, and adrenal suppression.</p> Signup and view all the answers

    Explain the role of metformin in the management of type 2 diabetes: What is the primary mechanism of action of metformin?

    <p>It decreases hepatic gluconeogenesis and improves insulin sensitivity.</p> Signup and view all the answers

    Explain the role of metformin in the management of type 2 diabetes: How does metformin impact weight?

    <p>Metformin is associated with weight neutrality or modest weight loss.</p> Signup and view all the answers

    Explain the role of metformin in the management of type 2 diabetes: What are contraindications for metformin use?

    <p>Contraindications include severe renal impairment and risk of lactic acidosis.</p> Signup and view all the answers

    Discuss the role of SGLT2 inhibitors in diabetes management: What is the mechanism of action of SGLT2 inhibitors?

    <p>They inhibit the SGLT2 transporter in the kidneys, reducing glucose reabsorption.</p> Signup and view all the answers

    Discuss the role of SGLT2 inhibitors in diabetes management: What are the benefits of using SGLT2 inhibitors in type 2 diabetes patients?

    <p>Benefits include glycemic control, weight loss, and reduced cardiovascular risk.</p> Signup and view all the answers

    Discuss the role of SGLT2 inhibitors in diabetes management: What are the potential side effects?

    <p>Side effects include genitourinary infections and dehydration.</p> Signup and view all the answers

    Analyze how the feed-fast cycle regulates metabolism: What changes occur in hormone levels during the fasting state?

    <p>Glucagon and cortisol levels increase, while insulin levels decrease.</p> Signup and view all the answers

    Analyze how the feed-fast cycle regulates metabolism: How is gluconeogenesis regulated during prolonged fasting?

    <p>Key enzymes such as PEPCK and glucose-6-phosphatase are upregulated.</p> Signup and view all the answers

    Analyze how the feed-fast cycle regulates metabolism: What adaptations in metabolism occur during starvation?

    <p>Ketogenesis increases to provide an alternative energy source.</p> Signup and view all the answers

    Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: How do sulfonylureas stimulate insulin secretion?

    <p>Sulfonylureas close ATP-sensitive potassium channels in β-cells, triggering insulin release.</p> Signup and view all the answers

    Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What is the mechanism of action of DPP-4 inhibitors?

    <p>DPP-4 inhibitors prolong the action of incretin hormones, enhancing glucose-dependent insulin secretion.</p> Signup and view all the answers

    Compare the pharmacological actions of sulfonylureas and DPP-4 inhibitors: What are the main differences in their side effect profiles?

    <p>Sulfonylureas can cause hypoglycemia and weight gain, while DPP-4 inhibitors have a lower risk of hypoglycemia.</p> Signup and view all the answers

    Describe the regulation and impact of glucagon in the fasting state: How does glucagon stimulate gluconeogenesis?

    <p>It activates enzymes such as PEPCK and glucose-6-phosphatase.</p> Signup and view all the answers

    Describe the regulation and impact of glucagon in the fasting state: What is its effect on glycogenolysis?

    <p>Glucagon promotes glycogenolysis to release glucose from the liver.</p> Signup and view all the answers

    Describe the regulation and impact of glucagon in the fasting state: How does prolonged glucagon release affect muscle protein?

    <p>Prolonged glucagon release can lead to muscle protein breakdown for gluconeogenic substrates.</p> Signup and view all the answers

    Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the main pathophysiological mechanism behind type 1 diabetes?

    <p>Autoimmune destruction of pancreatic β-cells.</p> Signup and view all the answers

    Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What are common clinical signs at presentation?

    <p>Signs include polyuria, polydipsia, weight loss, and hyperglycemia.</p> Signup and view all the answers

    Discuss the pathophysiological basis and treatment strategies for type 1 diabetes: What is the cornerstone of treatment for type 1 diabetes?

    <p>Lifelong insulin therapy.</p> Signup and view all the answers

    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?

    <p>Type 1 diabetes.</p> Signup and view all the answers

    Case 1: What initial laboratory tests should be performed?

    <p>Fasting blood glucose, HbA1c, and serum C-peptide.</p> Signup and view all the answers

    Case 1: What is the primary treatment plan if the diagnosis is confirmed?

    <p>Initiation of insulin therapy.</p> Signup and view all the answers

    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?

    <p>SGLT2 inhibitors or GLP-1 receptor agonists.</p> Signup and view all the answers

    Case 2: What factors should be considered when selecting this therapy?

    <p>Cardiovascular benefits, renal function, and risk of hypoglycemia.</p> Signup and view all the answers

    Case 2: What are potential side effects of the chosen medication?

    <p>SGLT2 inhibitors can cause genitourinary infections; GLP-1 agonists may cause nausea.</p> Signup and view all the answers

    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?

    <p>Iatrogenic Cushing’s syndrome.</p> Signup and view all the answers

    Case 3: What is the pathophysiology behind this condition?

    <p>Long-term glucocorticoid use leading to cortisol excess.</p> Signup and view all the answers

    Case 3: What management strategies should be considered to mitigate the side effects?

    <p>Gradual tapering of the glucocorticoid dose and consideration of alternative immunosuppressants.</p> Signup and view all the answers

    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?

    <p>Hypoglycemia due to sulfonylurea use.</p> Signup and view all the answers

    Case 4: How should his medication regimen be adjusted?

    <p>Consider reducing the dose or switching to a medication with a lower risk of hypoglycemia.</p> Signup and view all the answers

    Case 4: What alternative medication could reduce the risk of this complication?

    <p>DPP-4 inhibitors or metformin.</p> Signup and view all the answers

    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?

    <p>Metformin.</p> Signup and view all the answers

    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).
    • Stage: AJCC system (8th edition).
      • Takes into account:
        • Primary tumour size and local invasiveness
        • Nodal burden
        • Metastases
    • 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)

    1. Invasive lobular carcinoma is associated with a single-file pattern of cells infiltrating the stroma.
    2. Granulosa cell tumor is associated with Call-Exner bodies on histology.
    3. Increased androgen production by the ovaries is the primary hormonal mechanism contributing to the development of polycystic ovary syndrome (PCOS).
    4. CA - 125 is the marker most commonly elevated in patients with epithelial ovarian cancer.
    5. 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 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.

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