Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

PreClinEazy X Cardiff Medsoc BACK TO SCHOOL 3 Mia GoddardBack to School 3 Reproductive Anatomy Histology Hormones and the Menstrual Cycle Contraception STIsReproductive AnatomyFunctional Anatomy Ureter Ureter Uterus Fallopian tube Ovary Vas Bladder deferens Vagina Epididymis Bladder Urethra Penis Testi Female Anatomy Fallopian Myometrium Endometrium tube Fimbriae Ovarian ligament Ovary Perimetrium Internal Os Lateral External Os fornix Cervix Vagina Question 1 A Ovary Infundibulum of uterine tube B In which part of the reproductive system is fertilization mCst Ampulla of uterine tube likely? D Cervix Endometrium E Question 1 A Ovary Infundibulum of uterine tube B In which part of the reproductive system is fertilization mCst Ampulla of uterine tube likely? D Cervix Endometrium E Uterine Tube Ampulla Isthmus The Ampulla is wide and convoluted with a thin wall – it is where the ovum has the highest chance of Infundibulum fertilisation Fimbriae Ovary Uterine Wall Endometrium = where the zygote is embedded Epithelial layer that increases in thickness through the menstrual cycle Myometrium = thickest layer made up of smooth muscle This increases in size (hypertrophy) and cell number (hyperplasia) during pregnancy Perimetrium = outermost layer of the uterus which is the same as visceral peritoneum Question 2 A Simple columnar Simple squamous B What is the cell type of the ectocervix? C Stratified keratinized squamous D Stratified non-keratinized squamous Stratified cuboidal E Question 2 A Simple columnar Simple squamous B What is the cell type of the ectocervix? C Stratified keratinized squamous D Stratified non-keratinized squamous Stratified cuboidal ECervix Cervix: Transformational zone – in the squamocolumnar junction where cells change and undergo dysplasia. This area is tested in the cervical smear test as it the most likely area to be precancerous Fornix: Gutters surrounding the cervix. These are an important landmark for a culdocentesis to drain fluid from the pelvic cavity Ruggae: Ruggae in the vagina expand during child birth and sexual intercourse • Cervical cancer is the 4th most common cancer effecting women globally • HPV types 16 and 18 are responsible for approximately 70% of cases • Cervical screening is offered to women Smear Testing aged 25 to 64 and is every 3-5 years dependent on where in the UK you live • Tests for HPV, if positive, this is a triage for cytology testing which looks to see if the cell cytoplasm has shrunk which can be indicative of cancerous cells Question 3 A Broad ligament Round ligament B What structure connects the uterus to the labia majora via the C Ovarian ligament inguinal canal? D Cardinal ligament Suspensary ligament E Question 3 A Broad ligament Round ligament B What structure connects the uterus to the labia majora via the C Ovarian ligament inguinal canal? D Cardinal ligament Suspensary ligament E Ovarian ligament – connects ovary to uterus Round ligament – connects uterus to labia majora via INSERT HEADING the inguinal canal INSERT SUBHEADING contains ovarian artery and vein, connects ovaries to lateral pelvic wall INSERT TEXT INSERT TEXT Broad ligament – double fold of peritoneum that attaches uterus to pelvic INSERT TEXT wall Cardinal ligament – contains uterine artery and vein, connects cervix to lateral pelvic wallMenstrual Cycle Question 4 A Inhibition of LH and FSH by negative feedback Granulosa cells development B Which of the following is a function of progesterone? C Ovulation D Spiral artery elongation Proliferation of the stratum functionalis E Question 4 A Inhibition of LH and FSH by negative feedback Granulosa cells development B Which of the following is a function of progesterone? C Ovulation D Spiral artery elongation Proliferation of the stratum functionalis EOvarian and Uterine Cycle Oestrogen • Granulosa cell developmentt • Stratum functionalis formation • Spiral artery elongation INSERT IMAGE HERE • Oviduct peg cells secrete nourishment Progesterone • Endometrium secretes mucus • Endometrium thickens • Decrease FSH and LH by negative feedbackContraception Barrier COCP POP Emergency Other Methods Barrier Methods Diaphragms and cervical caps Condoms • Silicone caps that fit over the cervix • Perfect use = 98% effective • Perfect use with spermicide gel = • Typical use = 82% effective 95% effective • Protects against STIs • Little STI protection Question 5 A IUD Combined oral contraceptive pill B A 23 year old female who has recently had a DVT is C Progesterone only contraceptive pill requesting contraception. Which of the following forms of contraception should the GP NOT prescribe? D Implant Depot injection E Question 5 A IUD Combined oral contraceptive pill B A 23 year old female who has recently had a DVT is C Progesterone only contraceptive pill requesting contraception. Which of the following forms of contraception should the GP NOT prescribe? D Implant Depot injection E Barrier Methods COCP POP Emergency Other COCP contains both Oestrogen: Progesterone: - Inhibits LH oestrogen and progesterone - Inhibits FSH - Thickens cervical mucus - Reduces ciliary action in uterine tube - Means there is no follicular development - Reduces proliferation of the endometrium Combined Pill Over 99% effective with Increases risk of breast and Increases risk of VTE and perfect use cervical cancer hypertension About 92% effective with Avoid use in patients with Reduces risk of endometrial BRCA genes and cervical cancer real use Barrier COCP POP Emergency Other Methods Progesterone Taking the pill - Take at the same time everyday - Levonorgestrel or Norethisterone - No pill free break - Inhibits LH - Desogestrel (12 hour window) and - Thickens cervical mucus - Reduces ciliary action in uterine tubes Levonorgestrel (3 hour window) - Reduces proliferation of the endometrium - If pill is missed, must use barrier contraception for 48 hours How effective? Side effects - Over 99% with perfect use - Unscheduled bleeding - Around 91% with typical use - Breast pain and tenderness - Acne - Increased risk of ovarian cysts - Amenorrhea Combined pill (COCP) – take pill breaks and bleed Progesterone only pill (POP) - no breaks and random bleeding Contraindications to COCP: - Are pregnant or think you may be pregnant - are breastfeeding - smoke and are 35 or over - are 35 or over and stopped smoking less than a year ago Which pill? - are very overweight - take certain medicines, such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV - thrombosis (blood clots) in a vein or artery - a heart problem or a disease affecting your blood circulatory system (including high blood pressure) - migraine with aura (warning signs) - breast cancer - disease of the liver or gallbladder - diabetes with complications, or diabetes for more than 20 years Methodsr COCP POP Emergency Other Emergency Contraception IUD Ulipristal Acetate Levonorgestre l • Copper IUD inserted • Take within 72 hours within 5 days of • Take within 5 days of unprotected sex unprotected sex of unprotected sex • Most effective – less than • Less effective than IUD • High dose of 0.1% pregnancy rates progesterone delays after insertion ovulationSTIs Chlamydia Trachomatis Organism Treatment - gram-ve Doxycycline 7 days PO or Azithromycin PO Symptoms Key fact Male – urethritis, proctitis, epididymitis Chlamydia is the top risk factor for PID and causing infertility Female – urethritis, cervicitis, PID Neisseria Gonorrhoea Organism Treatment - gram-ve Ciprofloxacin/ceftriaxone IM injection - Diplococci (when patient goes for treatment, take a - Capsulated swab of infected area and send off for culture for resistance) Symptoms Male – yellow or green discharge from the penis, painful bowel movements, prostate infection Female – dysuria, yellow or green discharge, painful bowel movement, PID, bleeding between periods HPV Organism Treatment - Types 6&11 – genital warts Imiquimod - Type 16&18 – cervical cancer and oropharyngeal cancer - Non-enveloped dsDNA virus Symptoms Key fact Warts on genitals Boys and girls aged 12/13 are now vaccinated against HPV 6,11,16 and 18 Test for virus in throat Trichomoniasis Vaginalis Organism Treatment Metronidazole 7 days PO - Protozoan parasite - Flagellated (patients on metronidazole cannot drink - Highly motile alcohol for the 7 days of treatment + 2 days after due to vomiting risk) Symptoms Strawberry cervix Offensive fishy discharge Itching or burning after urination or ejaculation Question 6 A 45-year-old man presents with episodes of A Subacute degeneration of the spinal cord back pain and unintentional falls. The patient describes these pain episodes as a brief and stab-like sensation that lasts a few minutes. He B Side effect of HIV medications reports that the falls are most frequent when he is in a dark room. Medical history is significant C Spinal cord injury for HIV infection, which is being managed with anti-retroviral therapy. However, he states that he forgets to take his medication on multiple D HIV related illness occasions. On physical examination, the patient's pupils do not respond when exposed to light, but E Tabes dorsalis has normal accommodation. There is impaired vibratory and proprioception sense of the lower extremity along with absent patellar reflexes. What is the likely diagnosis? Question 6 A 45-year-old man presents with episodes of A Subacute degeneration of the spinal cord back pain and unintentional falls. The patient describes these pain episodes as a brief and stab-like sensation that lasts a few minutes. He B Side effect of HIV medications reports that the falls are most frequent when he is in a dark room. Medical history is significant C Spinal cord injury for HIV infection, which is being managed with anti-retroviral therapy. However, he states that he forgets to take his medication on multiple D HIV related illness occasions. On physical examination, the patient's pupils do not respond when exposed to light, but E Tabes dorsalis has normal accommodation. There is impaired vibratory and proprioception sense of the lower extremity along with absent patellar reflexes. What is the likely diagnosis? Syphilis Organism Treatment - Treponema pallidum Benzylpenicillin - Gram negative - Spiral shaped Symptoms Early stage – painless sores (chancres) Secondary stage– skin rashes, sore throat, weight loss, fatigue, hair loss Tertiary stage – neurological deficits (tabes dorsalis) HSV Organism Treatment Oral acyclovir - Virus- enveloped DNA Symptoms HSV type 1 – oral sores HSV type 2 – genital sores HIV Organism Treatment Anti-retroviral therapy - Retrovirus with ssRNA - 4 stages to disease - Stage 4 = AIDS Symptoms High risk groups Stage 1 No symptoms >500-600 CD4 MSM cells/ul IVDU Stage 2 Minor symptoms 350-500 CD4 cells0/ul Prison workers Stage 3 Major symptoms 200-350 CD4 Sex workers and clients and opportunistic cells/ul diseases Transgender people Stage 4 AIDS <200 CD4 cells/ulKey Facts – High Yield Ampulla is the most common site of fertilisation The transformation zone of the cervix is the squamo-columnar junction where cells undergo dysplasia so is the most likely area to be pre-cancerous Smear tests are for cervical screening which is one of 3 UK wide screening programmes (others are breast and bowel) LH peak causes ovulation Progesterone is secreted by the corpus luteum in high levels, until in a non-pregnant women it degenerates into the corpus albicans Chlamydia is the most common cause of PID 12/13 year old boys and girls are vaccinated against HPV Do not give the combined oral contraceptive pill to patients who have history of breast/ovarian cancer, VTE or smokingPLEASE FILL OUT THE FEEDBACK FORM PLEASE TUNE IN TO OUR REMAINING SESSIONS THIS WEEK