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MODES OFACTION (BOTH BARRIERAND PHARMACOLOGICAL) (H5) LO PRESENTED BY JOHN HELOA 30 year old woman presents to you in clinic seeking contraception.Her BMI is 28kg/m and she smokes 20 cigarettes a day.She does not drink alcohol and has no significant past medical history. Which of the following contraception options is contraindicated for this woman? A Copper intra-uterine device (IUD) B Combined oral contraceptive pill (COCP) C Progesterone only pill (POP) D Intra-uterine system (Mirena IUS) E CondomsA 30 year old woman presents to you in clinic seeking contraception.Her BMI is 28kg/m and she smokes 20 cigarettes a day.She does not drink alcohol and has no significant past medical history. Which of the following contraception options is contraindicated for this woman? A Copper intra-uterine device (IUD) B Combined oral contraceptive pill (COCP) C Progesterone only pill (POP) D Intra-uterine system (Mirena IUS) E CondomsA 40 year old woman presents to you in clinic seeking contraception.She tells you that she wants to go on the combined pill.She smokes 25 cigarettes a day,consumes 30 units of alcohol a week and has a past medical history of migraines with an aura.Her BMI is 36kg/m2 Which of the following is NOT a contraindication for the combined oral contraceptive pill (COCP)? A Her age B Her BMI C Her alcohol consumption D Her smoking history E Migraine with auraA 40 year old woman presents to you in clinic seeking contraception.She tells you that she wants to go on the combined pill.She smokes 25 cigarettes a day,consumes 30 units of alcohol a week and has a past medical history of migraines with an aura.Her BMI is 36kg/m2 Which of the following is NOT a contraindication for the combined oral contraceptive pill (COCP)? A Her age B Her BMI C Her alcohol consumption D Her smoking history E Migraine with auraA 24 year old patient presents to you seeking contraception.She has no children,and tells you that she is not planning to have children in the next 10 years.She does not mind which contraceptive you give her but tells you that she is afraid of needles.She does not have any past medical history or history of menorrhagia. What contraception is the most appropriate for her? A Combined oral contraceptive pill (COCP) B Progesterone only pill (POP) C Copper intra-uterine device (IUD) D Mirena intra-uterine system (IUS) E Injectable contraceptives (Depo Provera)A 24 year old patient presents to you seeking contraception.She has no children,and tells you that she is not planning to have children in the next 10 years.She does not mind which contraceptive you give her but tells you that she is afraid of needles.She does not have any past medical history or history of menorrhagia. What contraception is the most appropriate for her? A Combined oral contraceptive pill (COCP) B Progesterone only pill (POP) C Copper intra-uterine device (IUD) D Mirena intra-uterine system (IUS) E Injectable contraceptives (Depo Provera)A 33 year old mother of one presents to you seeking contraception.She tells you that she is not planning to have any more children.She also tells you that she does not get on well with the POP pill as she accidentally became pregnant with her child 2 years ago when she was on it.She has past medical history of stroke and complains of heavy periods. What is the most appropriate of the below contraception to give her? A Combined oral contraceptive pill (COCP) B Progesterone only pill (POP) C Copper intra-uterine device (IUD) D Mirena intra-uterine system (IUS) E Injectable contraceptives (Depo Provera)A 33 year old mother of one presents to you seeking contraception.She tells you that she is not planning to have any more children.She also tells you that she does not get on well with the POP pill as she accidentally became pregnant with her child 2 years ago when she was on it.She has past medical history of stroke and complains of heavy periods. What is the most appropriate of the below contraception to give her? A Combined oral contraceptive pill (COCP) B Progesterone only pill (POP) C Copper intra-uterine device (IUD) D Mirena intra-uterine system (IUS) E Injectable contraceptives (Depo Provera)A 31 year old mother has just given birth to her first child.She intends to bottle-feed her baby. For how long postpartum does this mother not require any contraception? A One day B 7 days C 21 days D One month E 6 monthsA 31 year old mother has just given birth to her first child.She intends to bottle-feed her baby. For how long postpartum does this mother not require any contraception? A One day B 7 days C 21 days D One month E 6 monthsCHANGES INADOLESCENCEAND HOW IT CONTRIBUTESTO HEALTHFE (H10) LO PRESENTED BY JOHN HELOA 16 year old female presents to you with symptoms suggestive of an STI following unprotected sex.She discloses an abuse experience to you which occurred in her early childhood,which prompts you to ask about any otherACEs she may have experienced.You find that she has a total of 6ACEs.You advise the use of contraception in the future. As a result of her abuse experience,what may lead to difficulties in negotiating contraceptive use for this patient? A Low assertiveness B Sense of powerlessness C Low self-esteem D All of the above E None of the aboveA 16 year old female presents to you with symptoms suggestive of an STI following unprotected sex.She discloses an abuse experience to you which occurred in her early childhood,which prompts you to ask about any otherACEs she may have experienced.You find that she has a total of 6ACEs.You advise the use of contraception in the future. As a result of her abuse experience,what may lead to difficulties in negotiating contraceptive use for this patient? A Low assertiveness B Sense of powerlessness C Low self-esteem D All of the above E None of the aboveWhat is a teenage pregnancy associated with an increased risk of? A Poorer health and wellbeing for mother and baby B Improved health and wellbeing for mother and baby C Social inclusion D Increased social support E All of the aboveWhat is a teenage pregnancy associated with an increased risk of? A Poorer health and wellbeing for mother and baby B Improved health and wellbeing for mother and baby C Social inclusion D Increased social support E All of the aboveAdolescents have a greater involvement in risk-taking behaviour more than any other age group. This is thought to be due to: A Irrationality B Faulty calculations C Delusions of invulnerability D Ignorance E Emotional and social factors,rather than aboveAdolescents have a greater involvement in risk-taking behaviour more than any other age group. This is thought to be due to: A Irrationality B Faulty calculations C Delusions of invulnerability D Ignorance E Emotional and social factors,rather than aboveEXAMPLES Insufficient ties to community Living in societies without formal rites of passage Isolated from mainstream society Lives overly regulated or circumscribed Suffering discrimination Low social status and suffering effects of inequalities Born into risk-taking“habitus”Adolescents have a greater likelihood than adults over 25 to be involved in which of the following risk-taking behaviours? A Smoking B Binge drinking C Violence D Have casual sex partners E All of the aboveAdolescents have a greater likelihood than adults over 25 to be involved in which of the following risk-taking behaviours? A Smoking B Binge drinking C Violence D Have casual sex partners E All of the aboveLHEALTHAND HOWTHESEARE REFLECTED INTHE COMMUNITIES IN WHICHWEWORK (H11) LO PRESENTED BY JOHN HELOA 19 year old man presents in clinic with anxiety and low mood.He explains that his colleagues often banter about him being gay,but he thinks they will stop eventually so he doesn’t want to report them to his manager. What Social Determinant of Health (SDH) is being implicated in this scenario? A Unemployment and job insecurity B Early childhood development C Social inclusion and non-discrimination D Income and social protection E EducationA 19 year old man presents in clinic with anxiety and low mood.He explains that his colleagues often banter about him being gay,but he thinks they will stop eventually so he doesn’t want to report them to his manager. What Social Determinant of Health (SDH) is being implicated in this scenario? A Unemployment and job insecurity B Early childhood development C Social inclusion and non-discrimination D Income and social protection E EducationAdverse Childhood Experiences (ACEs) can significantly impact an individual throughout their life. At how manyACEs is an individual said to be at an increased risk of developing health-harming behaviours in the future? A One B 2 C 3 D 4 or more E ACEs are not linked to developing health-harming behavioursAdverse Childhood Experiences (ACEs) can significantly impact an individual throughout their life. At how manyACEs is an individual said to be at an increased risk of developing health-harming behaviours in the future? A One B 2 C 3 D 4 or more E ACEs are not linked to developing health-harming behavioursWhich of the following are risk factors for teenage pregnancies in young women? A Unemployment B Poor education C In care or homeless D Living in areas with high social deprivation E All of the aboveWhich of the following are risk factors for teenage pregnancies in young women? A Unemployment B Poor education C In care or homeless D Living in areas with high social deprivation E All of the aboveThe Social Determinants of Health are non-medical factors that improve health outcomes.What are they sought to influence? A Health equality/inequality B Health equity/inequity C Education D Employment status E All of the aboveThe Social Determinants of Health are non-medical factors that improve health outcomes.What are they sought to influence? A Health equality/inequality B Health equity/inequity C Education D Employment status E All of the aboveA 17 year old girl presents to you looking for contraception.She is sexually active and admits to never using contraception before.You spend some time discussing with her the different forms of contraception available to her. She tells you that she’s not sure if she wants to go on the‘pill’ yet and that condoms are expensive. What Social Determinant of Health is negatively affecting her ability to access contraception? A Education B Income C Social inclusion and non-discrimination D Early childhood development E Employment statusA 17 year old girl presents to you looking for contraception.She is sexually active and admits to never using contraception before.You spend some time discussing with her the different forms of contraception available to her. She tells you that she’s not sure if she wants to go on the‘pill’ yet and that condoms are expensive. What Social Determinant of Health is negatively affecting her ability to access contraception? A Education B Income C Social inclusion and non-discrimination D Early childhood development E Employment status LOCONTRACEPTIONANDAN UNDER-AGETIONTO ADOLESCENT PATIENT (H12) LO PRESENTED BY JOHN HELODON’T IGNORE SOCIAL LEARNING OUTCOMES! “Medical students often struggle with this aspect of the course at this stage,because a lot of the concepts can seem abstract.However,as you encounter more patients throughout your training,you will come to appreciate the impact of social determinants on an individual's health and the choices they make.Often there are no ''right'' answers,only lots of complex and inter-related problems with several options of solutions.This makes it a challenging area,in both medical school and as a practicing doctor.” -Dr Naomi StantonDON’T IGNORE SOCIAL LEARNING OUTCOMES! “Medical students often struggle with this aspect of the course at this stage,because a lot of the concepts can seem abstract.However,as you encounter more patients throughout your training,you will come to appreciate the impact of social determinants on an individual's health and the choices they make.Often there are no ''right'' answers,only lots of complex and inter-related problems with several options of solutions.This makes it a challenging area,in both medical school and as a practicingtopic!r.” -Dr Naomi StantonA 15 year old girl presents to clinic on her own seeking contraception.She tells you that she is afraid of becoming pregnant and does not want her parents to know she is sexually active.You want to assess her competency in accordance with‘Gillick’s Competency’.Which of the below will aid your assessment in determining if she is Gillick Competent? A Asking her if she smokes or drinks regularly B Assessing her understanding of the advantages and disadvantages of the contraception C Asking her why she does not want her parents to know she is sexually active D A conversation about stopping sexual activity until she reaches the legal age of consent E There is no need to assess for Gillick’s CompetencyA 15 year old girl presents to clinic on her own seeking contraception.She tells you that she is afraid of becoming pregnant and does not want her parents to know she is sexually active.You want to assess her competency in accordance with‘Gillick’s Competency’.Which of the below will aid your assessment in determining if she is Gillick Competent? A Asking her if she smokes or drinks regularly B Assessing her understanding of the advantages and disadvantages of the contraception C Asking her why she does not want her parents to know she is sexually active D A conversation about stopping sexual activity until she reaches the legal age of consent E There is no need to assess for Gillick’s CompetencyA 14 year old girl presents to clinic seeking contraception.She tells you that she wants contraception‘just in case’, and has never engaged in sexual intercourse before.She has a boyfriend who is also 14.She asks you not to tell her parents that she has a boyfriend or that she is seeking contraception. What is the best form of action in accordance with the Fraser Guidelines? A Assess for Gillick’s Competency then give her contraception if she is competent B Call her parents and ask them for consent to give the child contraceptive advice,treatment or both C Refuse to give her contraception as she is below the legal age of consent D Try your best to convince her to abstain from sexual activity until she is 16 E Try to persuade her to tell her parents firstA 14 year old girl presents to clinic seeking contraception.She tells you that she wants contraception‘just in case’, and has never engaged in sexual intercourse before.She has a boyfriend who is also 14.She asks you not to tell her parents that she has a boyfriend or that she is seeking contraception. What is the best form of action in accordance with the Fraser Guidelines? A Assess for Gillick’s Competency then give her contraception if she is competent B Call her parents and ask them for consent to give the child contraceptive advice,treatment or both C Refuse to give her contraception as she is below the legal age of consent D Try your best to convince her to abstain from sexual activity until she is 16 E Try to persuade her to tell her parents first FRASER GUIDELINES: 1.that the girl (although under the age of 16 years of age) will understand [the doctor’s] advice; 2.that [the doctor] cannot persuade her to inform her parents or to allow [the doctor] to inform the parents that she is seeking contraceptive advice; 3.that she is likely to continue having sexual intercourse with or without contraceptive treatment; 4.that unless she receives contraceptive advice or treatment,her physical or mental health or both are likely to suffer; 5.that her best interests require [the doctor] to give her contraceptive advice, treatment or both without the parental consent. FRASER GUIDELINES: 1.that the girl (although under the age of 16 years of age) will understand [the doctor’s] advice; 2.that [the doctor] cannot persuade her to inform her parents or to allow [the doctor] to inform the parents that she is seeking contraceptive advice; The actual guidelines are 3.that she is likely to continue having sexual intercourse with or without not gendered;this is just contraceptive treatment; the way the university has written them out in a 4.that unless she receives contraceptive advice or treatment,her physical or resource. mental health or both are likely to suffer; 5.that her best interests require [the doctor] to give her contraceptive advice, treatment or both without the parental consent.A 15 year old girl presents into clinic with her 15 year old boyfriend.She is sexually active.She is seeking contraception.You do not find her to be Gillick Competent. What is the next best form of action in regards to her contraception? A Give her the contraception anyway B Call the police C Tell her to go to the pharmacy and buy barrier contraceptives D Get parental consent to proceed with treatment as she cannot give consent E Assess the boyfriend for Gillick CompetenceA 15 year old girl presents into clinic with her 15 year old boyfriend.She is sexually active.She is seeking contraception.You do not find her to be Gillick Competent. What is the next best form of action in regards to her contraception? A Give her the contraception anyway B Call the police C Tell her to go to the pharmacy and buy barrier contraceptives D Get parental consent to proceed with treatment as she cannot give consent E Assess the boyfriend for Gillick CompetenceA 14 year old girl presents seeking contraception.She is sexually active with her boyfriend,who is 23 years old.She is worried that her parents might find out that she is seeking contraception,but explains that her boyfriend convinced her to see you for contraception.You do not find her to be Gillick Competent. What is the next best step to managing this patient? Immediately raise the issue as a safeguarding concern and escalate the concern by following the A local safeguarding guidelines B Call her parents and let them know what is happening so they can help C Give her the contraception anyway D Ask her to break up with her boyfriend as it is illegal because he is 23 E No management neededA 14 year old girl presents seeking contraception.She is sexually active with her boyfriend,who is 23 years old.She is worried that her parents might find out that she is seeking contraception,but explains that her boyfriend convinced her to see you for contraception.You do not find her to be Gillick Competent. What is the next best step to managing this patient? Immediately raise the issue as a safeguarding concern and escalate the concern by following the A local safeguarding guidelines B Call her parents and let them know what is happening so they can help C Give her the contraception anyway D Ask her to break up with her boyfriend as it is illegal because he is 23 E No management needed UNDER 16:SAFEGUARDING CONCERNS If a young person under the age of 16 presents to a health care professional,then discloses a history raising safeguarding concerns: If they are not deemed to be Gillick competent,the health professional is obliged to raise the issue as a safeguarding concern and escalate their concerns through the safeguarding process If they are deemed to be Gillick competent and disclosure is considered essential to protect them from harm or to be in the public interest,the health professional should escalate concerns through the safeguarding processes In both cases,the health professional should inform the young person of this action, unless doing so could pose significant additional risk for their safe care. It is reasonable for the local authority or police to decide whether it is appropriate to inform the parents of the concerns raised.In some circumstances this may not be in the best interest of the young person.A 16 year old girl presents to you at clinic.She is pregnant.Though she was previously advised by her doctor to stop smoking and drinking alcohol during the pregnancy,she tells you that she knows the risks and now only smokes and drinks in moderation. Of the factors listed below,which best explains the pregnant woman’s behaviour? A Poor education B Coercion C Different opinion to the doctor as to what is and is not‘risky behaviour’ D Depression E Poor self-disciplineA 16 year old girl presents to you at clinic.She is pregnant.Though she was previously advised by her doctor to stop smoking and drinking alcohol during the pregnancy,she tells you that she knows the risks and now only smokes and drinks in moderation. Of the factors listed below,which best explains the pregnant woman’s behaviour? A Poor education B Coercion C Different opinion to the doctor as to what is and is not‘risky behaviour’ D Depression E Poor self-discipline REFERENCES https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-8-gillick- competency-fraser- guidelines#:~:text=Therefore%20each%20individual%20decision%20requires,order%20to %20proceed%20with%20treatment. LO 6,7,8,9 LO PRESENTED BYYEW-ERNAU LO 6 LO PRESENTED BYYEW-ERNAUA male patient has presented to their GP with pain on urination,described a burning sensation.They are able to pass urine.They have a low grade pyrexia and recall that they have frequent infections of their waterworks.They work as a solicitor and mention that they will spend long hours of sitting and being a workaholic,only taking rare breaks to top up their coffee.What is the single most important risk factor of developing a UTI in this patient? A Recurrent urinary tract infections B Frequent hospital admissions C Seldom bowel emptying D Being a male E Seldom voidingA male patient has presented to their GP with pain on urination,described a burning sensation.They are able to pass urine.They have a low grade pyrexia and recall that they have frequent infections of their waterworks.They work as a solicitor and mention that they will spend long hours of sitting and being a workaholic,only taking rare breaks to top up their coffee.What is the single most important risk factor of developing a UTI in this patient? A Recurrent urinary tract infections B Frequent hospital admissions C Seldom bowel emptying D Being a male E Seldom voiding LOWER URINARYTRACT INFECTION Clinical features: ¡ Urinary frequency Definition:Infection of the ¡ Dysuria Cause:Most commonly caused lower urinary tract (bladder) by E.Coli ¡ Urgency also known as cystitis ¡ Foul-smelling urine ¡ Suprapubic pain ¡ Normal clinical examination LOWER URINARYTRACT INFECTION Management: Investigations: ¡ Urine dipstick ¡ First line:Oral nitrofurantoin or ¡ +ve leucocytes Trimethoprim Differentials:Pyelonephritis ¡ +ve Nitrites ¡ Advice on conservative ¡ No further investigations care to reduce risk of (uncomplicated) further infection ¡ Mid stream urine ¡ Regular fluids sample ¡ Post-coital voiding URINARYTRACT INFECTION Clinical features: ¡ Fevers/Rigors Cause:Transurethral ascent of ¡ Malaise Definition:Infection of the kidneys is called pyelonephritis colonic commensal,most ¡ Loin/Flank pain commonly E.Coli ¡ Vomiting ¡ Clinical examination reveals loin/flank tenderness URINARYTRACT INFECTION Investigations: ¡ Urine dipstick ¡ +ve leucocytes Management: Differentials: ¡ +ve Nitrites ¡ IV antibiotics ¡ Broad spectrum ¡ Cystitis ¡ FBC,U&E,CRP and blood Cephalosporin cultures ¡ Kidney stones ¡ Urine Midstream ¡ Quinolone Sample ¡ Gentamicin (urosepsis) ¡ Renal ultrasound (hydronephrosis)URINARYTRACT INFECTIONALGORITHMURINARYTRACT INFECTIONALGORITHMA 60 year old female patient presents with a UTI.She has noticed pain on urination 2 weeks ago and has begun a course of antibiotics (Nitrofurantoin).She has a past medical history of diabetes and a weak detrusor muscle.2 weeks ago she was admitted to hospital for previous UTI and sepsis and recalls being catheterised.How many risk factors of a UTI does she elicit? A 2 B 3 C 4 D 5 E 6A 60 year old female patient presents with a UTI.She has noticed pain on urination 2 weeks ago and has begun a course of antibiotics (Nitrofurantoin).She has a past medical history of diabetes and a weak detrusor muscle.2 weeks ago she was admitted to hospital for previous UTI and sepsis and recalls being catheterised.How many risk factors of a UTI does she elicit? A 2 B 3 C 4 D 5 E 6URINARYTRACT INFECTION RISK FACTORS ¡ Female ¡ Previous UTI ¡ Sexual activity ¡ Changes in the vaginal microflora (spermicides) ¡ Pregnancy ¡ Age (post-menopause) ¡ Anatomical pathologies of the urinary tract ¡ Poor hygiene ¡ Diabetes ¡ Voiding weakness/inability ¡ Catheterisation ¡ ImmunosuppressionURINARYTRACT INFECTION RISK FACTORS ¡ Female ¡ Previous UTI ¡ Sexual activity ¡ Changes in the vaginal microflora (spermicides) ¡ Pregnancy ¡ Age (post-menopause) ¡ Anatomical pathologies of the urinary tract ¡ Poor hygiene ¡ Diabetes ¡ Voiding weakness/inability ¡ Catheterisation ¡ ImmunosuppressionA 22 year old female patient has a 2 week history of burning urine and a temperature of 38 degrees.She has no known sexual partners and is not aware of any changes in voiding.Analysis of her serum shows low mannan-binding lectin.She is otherwise well and is not on any contraception.She mentions that her family is prone to recurrent UTIs.What is the most likely cause? A Family history due to susceptibility to UTIs B Urine retention C Low complement production D High complement production E ImmunocompromiseA 22 year old female patient has a 2 week history of burning urine and a temperature of 38 degrees.She has no known sexual partners and is not aware of any changes in voiding.Analysis of her serum shows low mannan-binding lectin.She is otherwise well and is not on any contraception.She mentions that her family is prone to recurrent UTIs.What is the most likely cause? A Family history due to susceptibility to UTIs B Urine retention C Low complement production D High complement production E ImmunocompromiseCOMPLEMENT SYSTEMCOMPLEMENT SYSTEMYou are studying about the defense mechanisms of the urinary tract and you come across the bactericidal product called defensins.What cell secrets defensins? A Epithelial cells B Macrophage C Neutrophils D Endothelial cells E LymphocytesYou are studying about the defense mechanisms of the urinary tract,and you come across the bactericidal product called defensins.What cell secrets defensins? A Epithelial cells B Macrophage C Neutrophils D Endothelial cells E Lymphocytes LO 7 LO PRESENTED BYYEW-ERNAUA 32 year old female presents to the GUM clinic with a 1-week history of white frothy vaginal discharge.She describes it as a“fishy odour” that impacts her self-esteem.She reports having multiple sexual partners and is currently on the COCP.She has no notable past medical history.She reports vulval itching and a burning sensation on urination.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 32 year old female presents to the GUM clinic with a 1 week history of white frothy vaginal discharge.She describes it as a“fishy odour” that impacts her self-esteem.She reports having multiple sexual partners,and is currently on the COCP.She has no notable past medical history.She reports vulval itching and a burning sensation on urination.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP. She also notices increasing pain during sexual intercourse and heavier periods.The lab report comes back with“gram negative diplococci”.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP. She also notices increasing pain during sexual intercourse,green discharge and heavier periods.The lab report comes back with“gram negative diplococci”.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumMICROSCOPY OF NEISSERIA GONORRHEAA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP.The lab report comes back with“gram negative cocci”.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP.The lab report comes back with“gram negative cocci”.What is the most likely organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumCHLAMYDIATRACHOMATISA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP.The lab report comes back with“gram negative cocci”.Given the most likely diagnosis,what is a major complication? A Ovarian cyst B Polycystic Ovarian Syndrome C Ovarian torsion D Pelvic inflammatory Disease E InfertilityA 22 year old patient presents with a burning sensation on urination and the urge to void often.She has been feeling under the weather and has recently been quite feverish.She would like to have this investigated.She has multiple sexual partners and is on the COCP.The lab report comes back with“gram negative cocci”.Given the most likely diagnosis,what is a major complication? A Ovarian cyst B Polycystic Ovarian Syndrome C Ovarian torsion D Pelvic inflammatory Disease E InfertilityA 60 year old male has been admitted to hospital for severe pneumonia for which they scored 4 on the CURB-65 scoring system. They have been catheterised and management is carried out to treat the pneumonia.On review the urine bag has become cloudy and the patient reports pain in the suprapubic region.Morphological analysis shows gram negative bacilli and cocci.What is the most likely causative organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 60 year old male has been admitted to hospital for severe pneumonia for which they scored 4 on the CURB-65 scoring system. They have been catheterised and management is carried out to treat the pneumonia.On review the urine bag has become cloudy and the patient reports pain in the suprapubic region.Morphological analysis shows gram negative bacilli and cocci.What is the most likely causative organism? A E.Coli B ChlamydiaTrachomatis C Trichomoniasis vaginalis D Neisseria Gonnorhoea E Treponema PallidumA 34 year old male patient has a 2 week history of left flank pain,for which they rate a 9/10 severity in nature.They describe it as a initially intermittent pain but the pain is now constant.They are febrile and nauseous,with an episode of vomiting.A CTKUB shows a ‘staghorn calculi’. There is blood in their urine.There is no varicocele on examination of the genitalia.They have a past medical history of recurrent UTIs.What is the most likely cause? A Struvite stone B Pyelonephritis C Renal Cell Carcinoma D Calcium Oxalate stones E Urate stonesA 34 year old male patient has a 2 week history of left flank pain,for which they rate a 9/10 severity in nature.They describe it as a initially intermittent pain but the pain is now constant.They are febrile and nauseous,with an episode of vomiting.A CTKUB shows a ‘staghorn calculi’. There is blood in their urine.There is no varicocele on examination of the genitalia.They have a past medical history of recurrent UTIs.What is the most likely underlying cause? A Struvite stone B Pyelonephritis C Renal Cell Carcinoma D Calcium Oxalate stones E Urate stones LO 8 & 9 LO PRESENTED BYYEW-ERNAUA patient is being prescribed an antibiotic that works on the 50s ribosome.What is the class of antibiotics? A Glycopeptide B Macrolide C Penecillin D Cephalosporin E AminoglycosideA patient is being prescribed an antibiotic that works on the 50s ribosome.What is the class of antibiotics? A Glycopeptide B Macrolide C Penecillin D Cephalosporin E AminoglycosideYou would like to prescribe antibiotics for a patient iliciting an upper respiratory tract infection.The patient has no known allergies.Analysis of the microbe shows that it elicits ß-lactamase enzyme production.What is the best antibiotic to prescribe in this case? A Vancomycin B Azithromycin C Gentamicin D Clarithromycin E Co-amoxiclavYou would like to prescribe antibiotics for a patient iliciting an upper respiratory tract infection.The patient has no known allergies.Analysis of the microbe shows that it elicits ß-lactamase enzyme production.What is the best antibiotic to prescribe in this case? A Vancomycin B Azithromycin C Gentamicin D Clarithromycin E Co-amoxiclavA 25 year old patient presents with a 2 week fever .They have a respiration rate of 26 and is being prescribed an antibiotic for community acquired pneumonia.They have a penicillin allergy for which they are anaphylactic.What is the first-line treatment for this patient? A Amoxicillin 500mgTDS B Metronidazole 400mg for 7 days C Doxycycline 200mg once,then 100mg for 4 days D Levofloxacin 500 mg IV E Co-amoxiclav 500mgTDS for 5 daysA 25 year old patient presents with a 2 week fever .They have a respiration rate of 26 and is being prescribed an antibiotic for community acquired pneumonia.They have a penicillin allergy for which they are anaphylactic.What is the first-line treatment for this patient? A Amoxicillin 500mgTDS B Metronidazole 400mg for 7 days C Doxycycline 200mg once,then 100mg for 4 days D Levofloxacin 500 mg IV E Co-amoxiclav 500mgTDS for 5 daysA 28-year-old female patient has come to the GP with dysuria,mild fever and foul-smelling urine.She has a diagnosis of type 1 diabetes and has been sexually active with 3 partners.She mentions that she is on the combined oral contraceptive pill but is adamant on using barrier method.On urinalysis nitrates and leucocytes are positive.What is the best initial management for the patient? A Nitrofurantoin 50 mg 4 times a day for 3 days B Nitrofurantoin 100mg BD for 7 days C Pivemecillinam 400mg,then 200mgTD for 3 days D Fosfomycin 3g single dose sachet E Cefalexin 500mg BD for 3 daysA 28-year-old female patient has come to the GP with dysuria,mild fever and foul-smelling urine.She has a diagnosis of type 1 diabetes and has been sexually active with 3 partners.She mentions that she is on the combined oral contraceptive pill but is adamant on using barrier method.On urinalysis nitrates and leucocytes are positive.What is the best initial management for the patient? A Nitrofurantoin 50 mg 4 times a day for 3 days B Nitrofurantoin 100mg BD for 7 days C Pivemecillinam 400mg,then 200mgTD for 3 days D Fosfomycin 3g single dose sachet E Cefalexin 500mg BD for 3 daysURINARYTRACT INFECTIONALGORITHMURINARYTRACT INFECTIONALGORITHMA 30 year old male patient has severe abdominal cramps and diarrhoea for which they are pyrexic (39 degrees).They are tachycardic and have a blood pressure of 115/65mmHg.A stool sample reveals Clostridium Difficile.What is the best first line treatment? A Fidaxomicin 200mg BD for 10 days B Vancomycin 125 mg QDS for 10 days C Vancomycin 500 mg QDS for 10 days + Metronidazole 500mg IVTDS for 10 days D Ceftriaxone 2g OD E Amoxicillin + Clarithromycin + PPIA 30 year old male patient has severe abdominal cramps and diarrhoea for which they are pyrexic (39 degrees).They are tachycardic and have a blood pressure of 115/65mmHg.They have never experienced anything like this before.A stool sample reveals Clostridium Difficile.What is the best first line treatment? A Fidaxomicin 200mg BD for 10 days B Vancomycin 125 mg QDS for 10 days C Vancomycin 500 mg QDS for 10 days + Metronidazole 500mg IVTDS for 10 days D Ceftriaxone 2g OD E Amoxicillin + Clarithromycin + PPIANTIBIOTIC MNEMONIC “Antibiotics CanT erminate Protein Synthesis For Microbial Cells Like Germs” ¡ Aminoglycosides Gentamicin ¡ Carbapenems Meropenem ¡ Tetracyclines Doxycycline ¡ Penicillin Amoxicillin ¡ Sulfonamides Sulfamethoxazole ¡ Fluoroquinolones Ciprofloxacin,Levofloxacin ¡ Macrolides Clarithromycin,Erythromycin ¡ Cephalosporins Ceftriaxone,Cefepime ¡ Lincosamides Clindamycin ¡ Glycopeptides VancomycinA 35 year old female presents with a productive cough and a fever.She has no past medical history and has never been admitted to hospital before.She is a strong believer in not taking any medication at all but on this occasion she allows for the prescription of Amoxicllin 500mgTDS.She has no known allergies.She however begins to deteriorate and is now gasping for her breath.She is also developing rashes all over her trunk and is going blue.What is the single best initial management of the patient? A Administer 1:1000 IM adrenaline B Watch and wait C Assess the airway for obstruction D Buccal Midazolam E IV fluid bolusA 35 year old female presents with a productive cough and a fever.She has no past medical history and has never been admitted to hospital before.She is a strong believer in not taking any medication at all but on this occasion she allows for the prescription of Amoxicllin 500mgTDS.She has no known allergies.She however begins to deteriorate and is now gasping for her breath.She is also developing rashes all over her trunk and is going blue.What is the single best initial management of the patient? A Administer 1:1000 IM adrenaline B Watch and wait C Assess the airway for obstruction D Buccal Midazolam E IV fluid bolusANTIBIOTIC MNEMONIC “Antibiotics CanT erminate Protein Synthesis For Microbial Cells Like Germs” ¡ Aminoglycosides Gentamicin ¡ Carbapenems Meropenem ¡ Tetracyclines Doxycycline ¡ Penicillin Amoxicillin ¡ Sulfonamides Sulfamethoxazole ¡ Fluoroquinolones Ciprofloxacin,Levofloxacin ¡ Macrolides Clarithromycin,Erythromycin ¡ Cephalosporins Ceftriaxone,Cefepime ¡ Lincosamides Clindamycin ¡ Glycopeptides Vancomycin ANTIBIOTIC MNEMONICS Antibiotics Aminoglycosides Streptomycin 30s ribosome Gram -ve Gentamicin Can Carbapenems Meropenem Beta lactam Gram +ve/-ve Terminate Tetracyclines Doxycycline 30s ribosome Gram +ve/-ve Protein Penicillins Amoxicillin Beta lactam Gram +ve/-ve Synthesis Sulfonamides Sulfasalazine Folate synthesis Gram +ve/-ve Sulfamethoxazole For Fluoroquinolones Ciprofloxacin DNA replication Gram +ve/-ve Levofloxacin Microbial Macrolides Azithromycin 50s ribosome Gram +ve Clarithromycin Cells Cephalosporins Ceftriaxone Beta lactam Gram +ve/-ve Like Lincosamides Clindamycin 50s ribosome Gram +ve Germs Glycopeptides Vancomycin Beta lactam Gram +veA 40 year old female patient has presented with urosepsis.They had sepsis six conducted and are now stable on the ward.The patient now complains of a new nausea,an episode of vomiting and a sense of imbalance.They note that relatives that visit need to talk louder than before,which causes mild embarrassment due to the neighbouring patients being disturbed due to this. She works a 9-5 in an office job.What is the most likely underlying cause of this? A Presbycusis B Ciprofloxacin use C Gentamicin use D Metronidazole use E Clarithromycin useA 40 year old female patient has presented with urosepsis.They had sepsis six conducted and are now stable on the ward.The patient now complains of a new nausea,an episode of vomiting and a sense of imbalance.They note that relatives that visit need to talk louder than before,which causes mild embarrassment due to the neighbouring patients being disturbed due to this. She works a 9-5 in an office job.What is the most likely underlying cause of this? A Presbycusis B Ciprofloxacin use C Gentamicin use D Metronidazole use E Clarithromycin useLO Relatetheanatomicalstructureof thepelvisandgenitourinaryorgans (maleandfemale)totheirfunction PresentedbyRachaelDavisA35yearoldfemalepresentsintheGPwitha12monthhistoryofnumbnessandpinsandneedlesinherperineum. Shealsonotesanincreasedurinaryfrequencyandpainduringsex.Thepatientisanavidhorse-riderandhasridden competitivelysincechildhood.TheGPsuspectshersymptomsareduetodamageofacertainnerve. WhichnervedoestheGPsuspectisdamaged? A Superior gluteal B Inferiorgluteal Sciatic C D Genitofemoral Pudendal EA35yearoldfemalepresentsintheGPwitha12monthhistoryofnumbnessandpinsandneedlesinherperineum. Shealsonotesanincreasedurinaryfrequencyandpainduringsex.Thepatientisanavidhorse-riderandhasridden competitivelysincechildhood.TheGPsuspectshersymptomsareduetodamageofacertainnerve. WhichnervedoestheGPsuspectisdamaged? A Superior gluteal B Inferiorgluteal Sciatic C D Genitofemoral Pudendal ETheperineumissuppliedbythepudendalnerve S2,3,4keepspoooffthefloor!Afemale18yearoldpatientpresentstoherGPwithrecurrentUTIsymptomsincludingpainonurinationand increasedurinaryfrequency.AfterbeingprescribedantibioticssheaskstheGPwhyitisthatmanyofherfemale friendsgetUTIsbutnothermalefriends? A MenarelesslikelytoseekmedicalhelpforUTIs B Thefemaleureterislongerthanthemaleureter Thefemaleurethraisshorterthanthemaleurethra C D The female urethra is longer than the male urethra Thefemaleureterisshorterthanthemaleureter EAfemale18yearoldpatientpresentstoherGPwithrecurrentUTIsymptomsincludingpainonurinationand increasedurinaryfrequency.AfterbeingprescribedantibioticssheaskstheGPwhyitisthatmanyofherfemale friendsgetUTIsbutnothermalefriends? A MenarelesslikelytoseekmedicalhelpforUTIs B Thefemaleureterislongerthanthemaleureter Thefemaleurethraisshorterthanthemaleurethra C D The female urethra is longer than the male urethra Thefemaleureterisshorterthanthemaleureter EThefemaleurethraisshorterthanthemaleurethra Maleurethra=15-20cm Femaleurethra=~4cmA26-yearoldfemalepatientpresentsinA&Ewitha2-dayhistoryofsharpintermittentrightlowerquadrant abdominalpain.Historyrevealsherlastmenstrualperiodwas7weeksago.Suspectinganectopicpregnancy,a transvaginalultrasoundisorderedtodeterminethelocationofthepregnancy. Whereisthemostlikelylocationfortheectopicpregnancy? A Fimbriae B Infundibulum Ampulla C D Isthmus Ovary EA26-yearoldfemalepatientpresentsinA&Ewitha2-dayhistoryofsharpintermittentrightlowerquadrant abdominalpain.Historyrevealsherlastmenstrualperiodwas7weeksago.Suspectinganectopicpregnancy,a transvaginalultrasoundisorderedtodeterminethelocationofthepregnancy. Whereisthemostlikelylocationfortheectopicpregnancy? A Fimbriae B Infundibulum Ampulla C D Isthmus Ovary EStesofectopcpregnancy FourInchesAcrossIs....A76-year-oldfemalepatientpresentstohergynaecologistwithabulgeinhervaginaandincreasedurinary frequency.Sheisdiagnosedwithaprolapseduterus.Thedoctorexplainsoneofthecausescanbeduetoweakening ofuterineligaments. Which ligamentconnectstheuterustothelabiamajora,passingthroughtheinguinalcanal? A Broad ligament B Roundligament Cardinalligament C D Uterosacralligament Suspensoryligament EA76-year-oldfemalepatientpresentstohergynaecologistwithabulgeinhervaginaandincreasedurinary frequency.Sheisdiagnosedwithaprolapseduterus.Thedoctorexplainsoneofthecausescanbeduetoweakening ofuterineligaments. Which ligamentconnectstheuterustothelabiamajora,passingthroughtheinguinalcanal? A Broad ligament B Roundligament Cardinalligament C D Uterosacralligament Suspensoryligament ELgam entsA60-year-oldmanpresentswithfrequentinabilitytomaintainanerectionforintercourse.Hehasahistoryof hypertensionandtype2diabetesmellitus.TheGPexplainsthaterectiledysfunctioncanoccurwhenthereispoor bloodflowtoerectiletissuesinthepenis. Whicherectiletissueformsthemajorityofthepenis? A Corpus spongiosum B Corpuscavernosus Bulbospongiosus C D Ischiocavernosus Glanspenis EA60-year-oldmanpresentswithfrequentinabilitytomaintainanerectionforintercourse.Hehasahistoryof hypertensionandtype2diabetesmellitus.TheGPexplainsthaterectiledysfunctioncanoccurwhenthereispoor bloodflowtoerectiletissuesinthepenis. Whicherectiletissueformsthemajorityofthepenis? A Corpuscavernosus B Corpus spongiosum Bulbospongiosus C D Ischiocavernosus Glanspenis EM aereprodutvea ntom y Cavern=big!Distinguishthedifferenttissuespresentinthe genitourinaryorgansofthemaleandfemale PresentedbyRachaelDavisAhistologistisexaminingasectionofuterustakenonday7ofapatient'smenstrualcycleandnotesthatalayeris missingthatwouldbepresentonday28. Whichhistologicallayerislostatthispointofthecycle? A Myometrium B Stratumbasalis Stratumfunctionalis C D Endometrium Exometrium EAhistologistisexaminingasectionofuterustakenonday7ofapatient'smenstrualcycleandnotesthatalayeris missingthatwouldbepresentonday28. Whichhistologicallayerislostatthispointofthecycle? A Myometrium B Stratumbasalis C Stratumfunctionalis D Endometrium Exometrium EUterush stology inmenstruationtionalisislost Thestratumbasalisis unaffectedA27-year-oldfemalepatientisawaitingsurgerytoremoveanovariancyst.Thesurgeonknowsovariancysts commonlydevelopfromfollicles. Inwhichhistologicalsectionoftheovariesdofolliclesdevelop? A Medulla B Cortex Epithelium C D Tunicaalbuginea Fimbriae EA27-year-oldfemalepatientisawaitingsurgerytoremoveanovariancyst.Thesurgeonknowsovariancysts commonlydevelopfromfollicles. Inwhichhistologicalsectionoftheovariesdofolliclesdevelop? A Medulla B Cortex Epithelium C D Tunicaalbuginea Fimbriae EO aryh stoog yA25yearoldwomanattendsclinicforaroutinecervicalsmeartest. Theclinicianexplainsthecervixhasahighriskof cancerduetoatransitionbetweendifferentcelltypesintheectocervixandendocervix. Whatcelltypemakesuptheectocervixepithelium? A Pseudostratifiedcolumnar B Simple squamous Simplecolumnar C D Simplecuboidal Stratified squamous EA25-year-oldwomanattendsclinicforaroutinecervicalsmeartesttoreducetheriskofcervicalcancer.Theclinician explainsthatsomeofthecervixhasahighriskofcancerduetoatransitionbetweendifferentcelltypesinthe ectocervixandendocervix. Whatcellypemakesuptheectocervixepithelium? A Pseudostratifiedcolumnar B Simple squamous Simplecolumnar C D Simplecuboidal Stratified squamous ECe rvxh sto og y non-keratinizedepitheliumtratifiedsquamous columnarepitheliumalislinedwithsimple columnarjunction-relevantincervicalcancer!A7-year-oldboypresentswithrapidgrowth.Investigationrevealsheightinthe90thcentile,pubichair,axillaryhair andpenilegrowth.Investigationsrevealhehasabenigntumourofaspecificcellwithinthetestesresponsiblefor producingtestosterone. Whichcellisthis? A Sertoli cells B Spermatazoa Thecacells C D Leydigcells Granulosacells EA7-year-oldboypresentswithrapidgrowth.Investigationrevealsheightinthe90thcentile,pubichair,axillaryhair andpenilegrowth.Investigationsrevealhehasabenigntumourofaspecificcellwithinthetestesresponsiblefor producingtestosterone. Whichcellisthis? A Sertoli cells B Spermatazoa Thecacells C D Leydigcells Granulosacells ELeydigcelsprodu et esosterone tubulesandhelpmatureeminiferous Leydigcellssitintheinterstitialspace andproducetestosterone Granulosa-Leydig A12-month-oldboypresentstohisGPwitharightscrotalmass.Themassistransilluminatedwhenalightis shoneonthescrotum,suggestingitisfluid-filled.Heisdiagnosedwithhydrocele,whichisacollectionoffluid inthescrotum. Inwhichlayerofthescrotumdoesthisoccur? A Tunica albigenia B Tunica vaginalis Seminiferous tubules C D Cremasteric fascia External spermatic fascia E A12-month-oldboypresentstohisGPwitharightscrotalmass.Themassistransilluminatedwhenalightis shoneonthescrotum,suggestingitisfluid-filled.Heisdiagnosedwithhydrocele,whichisacollectionoffluid inthescrotum. Inwhichlayerofthescrotumdoesthisoccur? A Tunica albigenia B Tunica vaginalis Seminiferous tubules C D Cremasteric fascia External spermatic fascia ELayesofthescroumLO Relatethephysiologyofthe menstrualcycletoreproductionand thereproductivehormones PresentedbyRachaelDavisAwomanwhoistryingtoconceiveusesatestingkittotrackherhormones.Onacertainday,thekit measuresamuch-increasedlevelofLHfromthedaybefore. Atwhichdayinthemenstrualcyclewasthismeasurementtaken? A Day 1 B Day 7 Day 14 C D Day 21 Day 28 EAwomanwhoistryingtoconceiveusesatestingkittotrackherhormones.Onacertainday,thekit measuresamuch-increasedlevelofLHfromthedaybefore. Atwhichdayinthemenstrualcyclewasthismeasurementtaken? A Day 1 B Day 7 Day 14 C D Day 21 Day 28 ELH surge coincides with ovulationAmedicalstudentisstudyingfortheirexamsandnoticesthatoestrogenincreasesinthefollicularphaseof themenstrualcyclealongwiththegrowthofthefollicle.Theyknowthatthefolliclereleasesoestrogenbut cannotrecallthespecificcell. Whichcellisthis? A Granulosa cells B Theca cells Oocyte C D Cumulus cells Zona pellucida EAmedicalstudentisstudyingfortheirexamsandnoticesthatoestrogenincreasesinthefollicularphaseof themenstrualcyclealongwiththegrowthofthefollicle.Theyknowthatthefolliclereleasesoestrogenbut cannotrecallthespecificcell. Whichcellisthis? A Granulosa cells B Theca cells Oocyte C D Cumulus cells Zona pellucida EGranulosa cells release oestrogen and progesterone Theca-Sertoli Granulosa-LeydigAmedicalstudentstudingthemenstrualcyclenotesthatinthelutealphasethereisincreasedlevelsof progesteroneasitservesanimportantfunctioninthisphase. Whatfunctiondoesitserve? A Proliferation of the endometrium B Dilation of lactic ducts Stimulating ovulation C D Stimulating follicle growth Maintenence of the endometrium EAmedicalstudentstudingthemenstrualcyclenotesthatinthelutealphasethereisincreasedlevelsof progesteroneasitservesanimportantfunctioninthisphase. Whatfunctiondoesitserve? A Proliferation of the endometrium B Dilation of lactic ducts Stimulating ovulation C D Stimulating follicle growth Maintenence of the endometrium EProgesterone causes proliferation of the endometrium Progesteroneisreleasedbythe corpusluteum Progesteronealsocausesthe secretionofuterinemilkAgynaecologistisexplainingtheHPGaxis,whichcontrolsthemenstrualcycle,tooneofherpatients.She explainstheGraafianfolliclereleasesahormonecalledinhibinwhichinhibitsanotherhormoneintheaxis. Whichhormonedoesitinhibit? A Progesterone B Oestrogen LH C D FSH GnRH EAgynaecologistisexplainingtheHPGaxis,whichcontrolsthemenstrualcycle,tooneofherpatients.She explainstheGraafianfolliclereleasesahormonecalledinhibinwhichinhibitsanotherhormoneintheaxis. Whichhormonedoesitinhibit? A Progesterone B Oestrogen LH C D FSH GnRH EInhibin inhibits FSHA21-year-oldwomanisresearchingfolliculardevelopmentandiswonderingatwhatstageherfollicleisat hercurrentpointinthemenstrualcycle.Sheiscurrentlyonday18ofhercycleandisnotsexuallyactive. Atwhichstageisherfollicle? A Primary follicle B Secondary follicle Graafian follicle C D Corpus luteum Corpus albicans EA21-year-oldwomanisresearchingfolliculardevelopmentandiswonderingatwhatstageherfollicleisat hercurrentpointinthemenstrualcycle.Sheiscurrentlyonday18ofhercycleandisnotsexuallyactive. Atwhichstageisherfollicle? A Primary follicle B Secondary follicle Graafian follicle C D Corpus luteum Corpus albicans EFollicular developmentLO Relatethephysiologyofpuberty includingdevelopmentofsexual function PresentedbyRachaelDavisA6-year-oldgirlisdiagnosedwithhypergonadotrophichypergonadismleadingtoprecociouspuberty. WhichhormoneintheHPGaxisisoverproducedinthehypothalamusinthiscondition? A FSH B LH GnRH C D ACTH CRH EA6-year-oldgirlisdiagnosedwithhypergonadotrophichypergonadismleadingtoprecociouspuberty. WhichhormoneintheHPGaxisisoverproducedinthehypothalamusinthiscondition? A FSH B LH GnRH C D ACTH CRH EHPG axis GnRHproducedinthe hypothalamus Couldbecausedbyexposureto GnRHagonistmedication,ora tumourinthehypothalamusA16yearoldboycomesintotheGPwithconcernsoverhisappearance.Heismuchshorterthanhisfriends,hasa higherpitchedvoice,andlackspubichairandaxillaryhair.Afterrunningsometestsyoufindhehasaboneageofa 12yearoldbutdoeshaveelevatedFSHandLHlevels.Therewerelowlevelsofoestrogenandprogesteronedetected intheblood.Whichofthefollowingisthemostlikelydiagnosis? A Centralprecociouspuberty B Hypergonadotrophichypogonadism Hypogonadotrophichypogonadism C D Peripheralprecociouspuberty Isolatedadrenarche EA16yearoldboycomesintotheGPwithconcernsoverhisappearance.Heismuchshorterthanhisfriends,hasa higherpitchedvoice,andlackspubichairandaxillaryhair.Afterrunningsometestsyoufindhehasaboneageofa 12yearoldbutdoeshaveelevatedFSHandLHlevels.Therewerelowlevelsofoestrogenandprogesteronedetected intheblood.Whichofthefollowingisthemostlikelydiagnosis? A Centralprecociouspuberty B Hypergonadotrophichypogonadism Hypogonadotrophichypogonadism C D Peripheralprecociouspuberty Isolatedadrenarche EHypergonadotrophic hypergonadismA30-year-oldfemalewhoisstrugglingtoconceiveattendsafertilityclinicwherebloodtestsshowthatsheisinfertile duetohypergonadotrophichypogonadism. Whichofthefollowingconditionscouldbethecauseofthis? A Adrenalhyperplasia B Pituitarytumour TurnerSyndrome C D Hyperprolactinaemia Klinefeltersyndrome EA30-year-oldfemalewhoisstrugglingtoconceiveattendsafertilityclinicwherebloodtestsshowthatsheisinfertile duetohypergonadotrophichypogonadism. Whichofthefollowingconditionscouldbethecauseofthis? A Adrenalhyperplasia B Pituitarytumour TurnerSyndrome C D Hyperprolactinaemia Klinefeltersyndrome ETurner's syndrome 45X(oneXchromosomemissing)A5-year-oldboypresentstohisGPwithhisparentsashehasshownsignsofprecociouspubertyincludingaxillary hairandtesticulargrowth.Bloodtestsrevealhehashighlevelsoftestosterone,FSHandLH. Whichofthefollowingcouldbethecauseofhisprecociouspuberty? A Adrenalhyperplasia B Pituitarytumour Adrenaltumour C D Testiculartumour Exposuretotestosteronecreams EA5-year-oldboypresentstohisGPwithhisparentsashehasshownsignsofprecociouspubertyincludingaxillary hairandtesticulargrowth.Bloodtestsrevealhehashighlevelsoftestosterone,FSHandLH. Whichofthefollowingcouldbethecauseofhisprecociouspuberty? A Adrenalhyperplasia B Pituitarytumour Adrenaltumour C D Testiculartumour Exposuretotestosteronecreams EPrecocious pubertyA14-yearoldgirlisconcernedthatshehasn'thadherfirstperiodyetandwantstoknowifthisisnormal.Youexplain therangeofagesthatarenormalforgirlstoexperiencepuberty. Whatisthisrange? A 9-15 B 8-15 10-15 C D 7-14 9-14 EA14-yearoldgirlisconcernedthatshehasn'thadherfirstperiodyetandwantstoknowifthisisnormal.Youexplain therangeofagesthatarenormalforgirlstoexperiencepuberty. Whatisthisrange? A 9-15 B 8-15 10-15 C D 7-14 9-14 E Normal puberty Girls 8 13 Precocious Delayed puberty Boys puberty 9 14