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17, not 17. Anyway, um We are live. Hi guys. My name is Christine Rifer. I'm one of the education leads for um pediatric society. I hope this is really useful for you guys. Um So today we're gonna do a little study session um for case one and case two, um it should cover everything you need to know and if you're like confused or you feel a bit like if you at any point just pop in a message and we'll answer it. Um So today we've got lovely volunteers that have um very kindly offered some of their teach you guys. So we've got Tal who's our phase one and two lead. We've got Hannah who is our secretary and we've got Karen who is our um charity and wellbeing society um lead. So yeah, if you guys don't have any questions, we can get started, I guess. Um So OK, can everyone see that just put in the chat if you can't? No. OK. Right. I think we're all good. So we'll start. Um So yeah, these slides were made by the Lovely to um so I'll just kind of be presenting them today. Um And as a disclaimer. So I'm not gonna lie. I think case one is the hardest case um of semester one and it's also one of the heaviest. So there's some things where the info is on the slide, but we won't go into tons of detail of it today, but we'll focus on the really, really high yield stuff because you guys will get these slides at the end anyway. Um So there are some things to kind of do in your own time, but we'll cover on the main bits today. Um If that sounds good. Um OK. So, um yeah, so this is an example of that um in your own time, just make sure that you're happy with what these keywords are. There's some more on the next slide as well. Um Just because if you don't understand what these keywords are, then it can make learning the case quite difficult. Um And it's not necessarily like they're gonna ask you for definitions um in the kind of um se test and whatever, but it's just about knowing the terminology and some of them do sound quite similar as well. So just getting your head around that is, is quite useful to do. OK. Next slide. Cool. OK. Um So we'll start off just by talking about a little bit um of anatomy. Um Just because it kind of contextualizes the whole thing. Um And you'll, you'll kind of have covered this mostly in anatomy and histology and whatnot. So it's just kind of um revision. So there are three layers of the uterus, you've got the endometrium, the myometrium and the perimetrium. Um And the endometrium is the one that's kind of really relevant for this case. Um But it's still just important to know about the other two layers as well because in kind of um a s exam question, they could ask you about it. Um And endo means inside um myo means muscle. Um And then perry kind of means a that's enclosing something else. So that's quite an easy way to remember, not only layers of the uterus, but as you kind of go further, you'll see that lots of other bits of anatomy follow kind of the same structure. Um And then the endometrium gets divided into two other layers. So you've got the stratum functionalis and then the stratum basalis. Um and these are kind of two really high yield um areas to know about. So you've got the stratum functionalis which is the outermost layer. Um And it's where fertilization occurs. Um And I used to remember it because they both begin with f um And it's what gets shed when menstruation occurs. Um And the spiral arteries supply it. So that's also a high yield bit of info. Um If in doubt, in this case, if you're looking for a blood supply for something, it's probably gonna be the spiral arteries. Um And it makes up two thirds of the endometrium. Um And then the stratum basalis is the innermost layer of the endometrium. Um And nothing actually really happens to it, it's constant, it's just the base um and it's supplied by the straight arteries, but they're not as relevant. Um And it makes up one third of the endometrium. Um And then in your own time, you can kind of just have a look at the little diagrams um and make sure you're happy with recognizing everything, especially that kind of middle slide. Um Just because sometimes for histology stations, they would expect you to know the different layers. Um the ones that look distinct, they'd never give you ones that are really difficult to tell by eye, but ones that are clearly distinct, they could expect you to know. OK. So in terms of menstruation in the ovarian cycle, so it can look quite complicated. Um But I think the easiest way to kind of do it is learning this graph um because sometimes they will just give you bits of the graph as well and refer back to that. Um So if you kind of just have an idea um of what you'd expect to see um in terms of the kind of shedding of the uterus. Um And then also in terms of the hormones, you can't really go wrong to be honest. Um So in terms of a brief timeline, you've got menstruation occurring on your days, 1 to 5 and then you've got your follicular phase with days 16 to 12, um and ovulation days 13 to 15. And then finally, your, your luteal phase is day 15 to 28. Um And most of the questions they tend to give you about this um Either revolve around, kind of knowing which woman's, which um or kind of doing some simple math calculations. Um So they might tell you where in a cycle a person is and then you'd kind of be expected to know roughly what would be going on. Um But everyone's cycle is different. The average one is 28 days, but lasting between 20 to 35 days um is normal. Um And so within your menstrual cycle, you've got two cycles. So you've got the ovarian cycle, which is the development of the follicle and then ovulation. And then you've also got the uterine cycle, which is where you've got the endometrium thickening and then shedding if there's, there's no kind of implantation there. Um And that's in response to ovarian activity. So I'd say definitely learn this graft. It's one of the most important things from the case. Um And you'll need it when you come to fourth year and do obs and Gynae as well. So if you learn it in your first year, it will set you up quite nicely. OK. Um Yeah. So as the slide says, this is kind of just one to go over it in your own time. I could sit here and talk about lots of different hormones, um, and lots of different parts of the anatomy, but I don't think that's really gonna be that helpful. Um And you don't need to kind of learn it every single point. Um You just kind of have to have a vague idea of what's going on, but specifically what the hormones are doing. Um So like when your LH is relevant, when your FSH is relevant and correlating that with the graft, basically, um um all the kind of names do sound quite similar. So just making sure that, you know, you know, the order of things and you know, roughly what's kind of normal and what you'd expect to happen. Um So, yeah, learning the follicular phase, learning the luteal phase. Um and then just a little bit about menstruation as well, but tell slides are very comprehensive. So it covers everything you need to know. OK. So we'll talk a little bit about the uterine cycle. Um So the average amount of blood that you lose on a menstrual period is 43 mL. That's the fun factor of the day. Um So, basically, you've got different phases. So your first one is going to be your proliferative phase. Um And it's when you've got the maturation of your follicle in the ovarian cycle. Um and this increases the amount of estrogen that you have um in the blood. Um And it's really important to know what changes this kind of leads to in the uterus. Um So there's five main ones and these are really high yield as well. Um I think in my first like se one exam, they gave us like three questions on kind of things. Um And it's also important to just remember which kind of layers you're looking at because in the heat of the moment in the exam, spiral arteries can sound very different to straight arteries and stuff like that. So um you get the thickening of the endometrial lining, which if you think about it is what you want because if you're gonna have something implanting, you want it to be thick. Um You've also got growth and enlargement of the glands in the endometrium for the same reason. Um And you've also got mitosis in the stratum basalis um which kind of um produces your functional layer. Um And that's the stratum functionalis. Um and then spiral arteries also form in functional layer. Um And estrogen also affects um the consistency of cervical mucus. Um and it makes it more hospitable to sperm because at this point, you're kind of gearing up for kinds of fertilization and implantation to occur. So you want to try and make it um um uh environment where sperm can kind of do that thing. Um So, in terms of the secretory phase, um so there's less to say, to be honest, um this is really where progesterone comes into play um because the corpus luteum produces it. Um and it increases the cervical mucus, making it thicker. Um And this means it's less hospitable for sperm. Um Because at this point, they, they don't need to be there anymore. There's nothing really for them to do. Um And the spiral arteries in the stratum functionalis um grow longer basically. Um And then in the menstrual phase, the corpus ctm is degrading and therefore, you've got less progesterone because your source of progesterone has now gone and broken down. Um And the progesterone meant that the spiral arteries in the functional layer um were dilated. So, when you've got progesterone, decreasing, the arteries just collapsed because there's nothing to really sustain them. Um And so the functional layer of the endometrium doesn't get any oxygen supply. Um And it degenerates. Um And that's kind of causing period cramps. Um And then you go on to shedding basically and you're shedding your functional. Um And so that is kind of what you end up losing. Um And that's what your blood loss basically is. So, if you learn those kind of three phases, just learn a little bit about what happens in each. Um And obviously, it's a cycle, but it's quite a logical cycle, like everything makes sense and just know when estrogen is relevant, know when progesterone is relevant and then know what happens when you lose that progesterone. Cool. Um So, basically, in terms of your hormones. Um so they're a really, really high yield question. Um, so I'm not gonna go through it now because it's put really nicely into this little table. Um, but yeah, really just kind of learn what the actual full name of the hormones are because sometimes they ask you about that. Um, and it's like GNRH, if you've not really thought about what it stands for in the semester and suddenly you get a question that can be a little bit intimidating. Um But you have to just kind of know what they do and some of them work together, some of them kind of work antagonistically. So just make sure you're happy with this basically. Um But yeah, there's not much more to say about that. OK. So we'll go over this a little bit. Um So, in terms of the structure of an oocyte, um so your cytoplasm is your ooplasm. Um And you've got your Zon Lucida and it's got lots of different roles. Um So it's involved in development of the ocys um protection during growth and transport. Um And also fertilization. Um And also you want to try and prevent polyspermine. So it's involved in that as well. Um And it's also involved in preventing premature implantation. Um Because if you get that, then you can get ectopic pregnancies. Um And yeah, really common questions about what changes there are to the ocys to prevent polyspermia. Um And in terms of ovulation. So, the kind of key thing to know is that it's your 14th day of a standard 28 day cycle. And ovulation will kind of depend on how long an individual cycle is. But usually in a question, they'll give you someone with a standard 28 day cycle. Um And if they kind of don't, they'll make it explicit and then you just shift basically um depending on the maths. So it's, they'll always make it quite, quite nice. Um And the math will work out. Um So you've also kind of got um your area of the ovarian surface where your graft and follicles burst through during ovulation and reduce the ovum. Um And a few days before ovulation, your follicle swells um and causes a protrusion against the edge of the ovary. Um So then you've got the kind of stigma in the ovarian capsule. Um And then the, the external cells of the follicle produce lysosomes and these get activated by progesterone. So, progesterone is really important here. Um And these enzymes kind of then get released and they rupture the follicular capsule. Um and this releases the oc into the fallopian tubes. Um And then it kind of goes on its journey basically. Um And we won't spend too much time on the contraceptive pill because for some one, it's not really that relevant, it's kind of just worth one or two marks. Um It's more kind of relevant in fourth year for obs. And um but congea is kind of like a baseline. It's important to know that there are two different types of pills. Um And your most common one is the combined oral contraceptive pill. Um And that contains estrogen and progesterone and they're combined. Um So you've got gastro because it suppresses GNRH and that suppresses your FSH and LH. Um So a follicle can't develop and you don't get an LH surge and there's no ovulation. Um and it also thickens the mucus and alters the paracels of the fallopian tubes. Um So basically, overall, it makes the endometrium really hostile to implantation. Um And it means the environment isn't really kind of um going to be um welcoming to it and then the cervix yeah, is basically impermeable. Um And then that's what progesterone does and then in terms of estrogen. So it suppresses FSH. Um And that means that the follicle can't develop and it also increases the number of progesterone receptors. Um And you can also kind of get emergency contraceptions like the morning after pills and stuff. Um But there are kind of guidelines as to whether you can get that and usually you're looking between 3 to 5 days after so that there's nothing really you can do. Um And then progesterone only pill. Um So it's known as a mini pill because you take it basically every day. Um You can start it straight after delivery and it doesn't affect lactation. Um But you have to take it at the same time every day. Um And there are guidelines on what to do if you miss pills. It's not really that relevant for someone, but, you know, for progress tests and stuff like that. If you want to get a few extra marks, it's a question that comes up every year. Um So yeah. Um so in terms of fetal development, once again, this is a massive topic. So we'll kind of go over the, the main principles. Um And then, you know, you can go over the smaller detail in your own time. Um So it will cover this little kind of flow diagram. So you start off with fertilization. Um And then you've got your cleavage divisions and then you've got your formation of your blastocyst and then implantation occurs. Um And then you've got like your extraembryonic membrane production. Um And then you've got gastrulation and knowing the days is quite important. Um You don't have to kind of, you know, um remember them specifically, but you need to have kind of an idea of what order for you to kind of be going through. Um So, yeah, so in terms of fertilization, so conception is the fertilization of the ovum by the sperm. Um and it usually occurs in the pela or the isthmus of the fallopian tube. So that's quite how you ought to know as well because there's a question not like every year. Um So we won't go into this in too much detail. Um But basically in ovulation, your infundibulum of your fallopian tube moves over to the site of the ovary. Um And that's where your follicle is gonna rupture and your oocytes gonna be released. Um And then you've got your fimbrae that basically waft the ovum into the fallopian tube. Um And then you've also got peristaltic action of the kind of muscle, um which also help to kind of move it down the fallopian tube. Um And relevant in terms of histology, you've got ciliated epithelium lining um as well, that kind of helps the wafting as well. So that's, that's just basically a lot of things working together to try and get the ovum to where it needs to be. Um And there are lots of sperm that get released in ejaculation because the sperm are much smaller than ovum. Um So you need lots to kind of fertilize the egg. Um And also not all of them actually make it to where they need to be because they have to kind of get past the corona radiata, which is the outer layer of the ovum. Um And if you don't break that down, then sperm aren't going to be able to fertilize the oocyte. Um So, basically, a lot get released. Um And then in terms of the of fertilization, so to kind of kind of written it on the slide. Um So I'd say just learn this um and learn the key words in bread particularly um because they're kind of really specific things. Um and they could technically ask questions about it. So just know your enzymes and kind of know which bits relate to which stage. Um And yeah, it's broken down into six little bits. So in terms of the structure of the oocytes, we haven't touched on this earlier. But your zona pellucida is your inner layer and your corona radiata is your outer layer. And that's the bit that the sperm need to kind of try and break through. Um And then it's also useful to know the structure of the sperm um because it's very different to a structure of a neurocyte. Um So you've got your acrosome which um contains acrosin, which is an enzyme and that's what lyes the corona radiata. Um And then you've also got lysosomes which break down the bonds between the cells between the corona radiata. Um So really just kind of trying to break that down and gain entry. Um And you've also got your flga which helps the sperm kind of swim through whatever it needs to swim through um and travel. Um And then you've also got acrosin which breaks down the zona pellucida. So it's useful to know what breaks down your corona radiata and what breaks down your zona pellucida. Ok. So, um in terms of the kind of little stages, um we'll talk a little bit about the high yield bits. So when we start off with cleavage divisions. This is basically a series of cell divisions where the cytoplasm subdivides um into other cells. And that's what's known as cleavage. Um So, in terms of the cells, your number of cells increases, but the overall size, the size of the embryo stays the same. Um So that's quite important to just remember. So it's not necessarily getting bigger if you're just getting more cells. Um So the divisions are asynchronous. Um So you can have um an odd number of cells. Um And the first division of the cells usually occurs around 30 hours after fertilization and then they kind of continuously happen every 10 to 12 hours. Um And then on day two, there's usually four cells and then by day three, there's eight. and then on day three, you get the Marula stage. Um And that's when you kind of develop into a blastic. Um So it's just useful to know kind of um how many cells roughly you'd expect because sometimes they ask you questions about it, but they'll pick nice numbers. Once again, they're not gonna pick anything kind of really, really high. Um And then in terms of your chond of blastocyst, yeah, it's created about 4 to 5 days after fertilization and it contains 32 to 64 cells depending on whether it's day four or day five. And the blastocyst has two parts. So you've got your intercell mass. Um And you've also got your trophoblasts. Um And your intercell mass is basically a group of cells in the blastocyst um where you've got stem cells and those are what go on to produce your embryo. Um And then your trophoblasts basically develop the embryonic components of the placenta and also all your extra embryonic tissues. Um And then in terms of implantation, so there's kind of a lot to say um but usually it happens on day eight, post fertilization. Um And it's a blastocyst, basically embedding itself into the endometrial lining of the uterus. Um And that's kind of why the endometrial is the most important part of the uterus and times of this case. Um So once again, this one's a bit longer. So I'll leave you to go through it in your own time, but basically just making sure, you know, when HCG becomes relevant um in this. So it's in 0.5 here. Um And beta HCG is what you then start testing for in pregnancy tests. Um So, until you've got implantation occurring, if you test from pregnancy, it'll be negative. Ok. So, in terms of extra embryonic membrane production, um so now the embryo is completely embedded into the endometrium and the surface epithelium has encapsulated it and it's kind of covered it. Um So the embryonic membrane entirely surrounds the embryo and makes the cavity filled with amniotic fluids. Um And the term for this is the amnion. Um And then there's four kind of different things to kind of know um about this. And once again, they like asking about it. Um But they all kind of have distinctive, kind of functions um and really distinctive names. So if you learn these, it's quite high yield. Um So you've got your primitive yolk sac. Um And that's the first site of blood cell formation. Um And then you've got your allantois and that's the vascular connection between the placenta and the embryo. Um And then you've got your chorion, which is the main part of the placenta. Um And then you've got your ICM and like we said before, that's kind of where you've got your stem cells. Um And it's important because then when you start to form tissues, you need to make sure that you've kind of covered all bases, really. So you need pluripotent stem cells because they can turn into anything. Um You can't have specialized stem cells, otherwise there are some parts of your embryo that wouldn't develop. Um And then we move on to embryogenesis. Um So you've kind of got your three germ cell layers. Um And this is kind of high yield as well because they like just giving you random parts of the body and asking where um they would arise from. So you've got your endoderm, which is the innermost layer, you've got your mesoderm, which is the middle layer. Um And you've also got your ectoderm. Um and it's kind of just a case of learning. Um these, to be honest, um there are kind of different ways and different mnemonics that people learn it. Um But also it kind of makes sense. So in terms of your ectoderm, it tends to be kind of your more high yield things um and high yield functions. Um And then the meo is kind of basically the the most common area. Um And then the endoderm is kind of all the smaller cells basically. So you've got like your alveolar cells, your thyroid cells and pancreatic cells. Um but it's just a case of learning them basically. Um And yeah, organs derived from the different germ layers as well. Um And yeah, that's kind of the most high yield thing from this slide. And then there's also a little bit about the bottom to kind of just supplement that. Um But definitely, definitely learn the three germ cell layers because it comes up all the time. Um So, in terms of organogenesis, um so, I mean, you're kind of touching upon it in some one, but in sem three, you learn it in lots and lots and lots of detail. Um So they don't really tend to ask that many questions about it um in se one, but if you've got a good kind of grasp of it in se one, it helps a lot in sem three. and nervous system development occurs after gastrulation. Um and it begins in days 19 to 21 and neuro tissues arise from the Exoderm layer. Um And the embryo undergoes neuralation um which is when you've got your neural plate forming from the neural tube. Um And it produces a cephalic region and that is the future brain. Um And then you've also got your caudal region and there's a slide coming up which helps you determine which is cephalic and which is caudal. Um So, once again, just in the interest of time, I'll kind of leave you guys to look at neuralation in your own time. But I would emphasize like they kind of just introduce you to it in sem one, but you go into proper, proper detail in sem three. So if it's a bit confusing now, I wouldn't worry too much. OK. Yeah. So here we go, here's the slide. Um So Cephal has an H in it. So, h head. Um So yeah, it's just worth knowing which is cephalic, which is caudal and then also ventral and dorsal. Um because in terms of kind of questions and in terms of anatomy, in this particular area, those are your four kind of areas that you're referring to. Um So it's really important to remember particularly ventral and dorsal because they're kind of brand new terms. Um but they come up quite often. So just, just spend a bit of time making sure you're happy with that. Um So in terms of organogenesis, um so you've got different um kind of areas that are high you to know about. So, ear development. Um So around week four, you've got otic placodes that form. Um and they're from ectodermal thickening. Um and they go on to develop the ears. Um and then they begin to develop uh disappear from the surface at around week five and then they form the inner components of the ears. Um And then kind of similarly, you've got eye development also around week four and these are optic placodes. Um So yeah, optic and optic placodes. Um and it's basically the same thing, your cells in your optic placode form the optic lens and then go on to develop the eyes. Um And then in terms of limb development, so limbs develop from limb buds and you've got four limb buds and high limb buds because obviously, you need to have kind of more and more different type of limb bud. Um And at week seven, you get hands and feet becoming distinguishable. And then later on, you can also see the actual digits. Um and apoptosis of webbing between digits allows the fingers to separate. So at first, you'll actually kind of just see it as one big clump. And then slowly when you've got apoptosis occurring, the webbing kind of disappears. Um And then, yeah, lung development is branching morph genesis. Um So even though the endoderm amet supply most of the alveoli and the exo supplies neural innovation, amet also supplies musculoskeletal support. Um So just kind of have an awareness of kind of what happens briefly between the weeks. Um And there's also a nice little diagram there which you don't have to learn of by heart that kind of contextualizes it. Um So in terms of the heart and the gut, um so, I mean, these ones are a little bit more complicated, but basically heart development occurs around day 22 to 23 and then your circulation kind of begins um around 27 to 28. So when people talk about, oh, I can hear the baby's heartbeat, fetal heartbeat, this is kind of what they're referring to. Um And then in, in terms of gut development, once again, you kind of cover this more in sem four. So, I mean, for sem one, it's kind of sufficient to just have an awareness of four gut midgut and hind gut. Um So they don't tend to focus on this either in sem one. for some reason, branching morphogenesis is always one that they really like asking about, maybe just because it's a complicated name. I don't know. Um But yeah, just because of time, I'll let you read heart and gut yourselves as well. Um But they're, they're not really that much more complicated. Um But I'd say out of the two hearts probably more important to focus on just cos gut you do revisit. Um So in terms of the structure of the placenta, um So it's got a maternal placental side and then a fetal placental side. Um And it's important to just kind of know why. Basically, because your placenta is a barrier between fetal circulation and maternal circulation. Um And it's really, really important to remember, these are different circulation systems. Um And the placenta provides the interface for oxygen and nutrients perfusion because there's no way that they could kind of have the same circulation system at this point. Um So the fetus floats in the amnion, which is a little sac. Um and the amnions filled with amniotic fluid. Um And then we kind of talked earlier about the ch the yolk sac. Um and the placenta and then your umbilical cord goes from the fetus through the amnion and into the placenta and then your placenta attached to your uterine wall. So, it's important to just be able to kind of label this diagram essentially. Um like if in the exam they gave you this and one of the labels was removed to just kind of know what would be what. And if you kind of start inwards and work your way out, like, logically, you can kind of think about what would be where and always think about what's going to be closer to the fetus and what's going to be closer to the mother, basically. Um So, in terms of the fetal placida, the placenta, um so you've got vili um and the fetal chorionic vili, um and the fetal chorionic vili have two layers. Um So you've got this inci trophoblast and you've also got the cytotrophoblast. Um So, it's important to just kind of be happy with where the two are basically. Um And to just remember this is specifically for the fetal side of the placenta. Um And the two kind of types of trophoblasts work together in tandem. Um So it's just important to basically not get them mixed up and remember what does what um and your fetal blood supply comes from the umbilical cord. Um And basically, you've got umbilical arteries and umbilical veins. Um So the arteries carry deoxygenated and nutrient poor blood from the fetus and the placenta. And then your veins carry oxygen and nutrient rich blood from the placenta to the fetus. Um And that's basically how your fetus gets your blood supply um and stays nice and healthy. Ok. So, in terms of fetal circulation, once again, we'll kind of go through the kind of three main things here. Um And then the rest kind of you can use to supplement what we've talked about today. Um So your fetus basically has three shunts to direct blood um because you can't really have the same kind of um structure as kind of an adult has. So you need to shunt your blood and, and there are three kind of shunts that you have. Um So you've got your Foramen ovale, which is a space that connects the left atrium and the right atrium. Um, and it bypasses the lungs basically. Um, and if this doesn't close in adults, you can get, um, patent for and ovale, um P FO, which is actually quite common to be fair. Um And so sometimes if you meet people later with leaky bowels and stuff, it's, you find out that they have P FO, um, you've also got ductus arteriosis and that divide, uh, directs blood from the pulmonary artery into the aorta. And then you've got the ductal stenosis and that shunts some of the highly oxygenated blood to bypass the liver and go straight to the vena cava. Um and then into the right atrium. Um So it's really, really important to learn the three shunts and also what they do. Um And yeah, they all remain open until birth and then they should close, basically. Um So just make sure you're happy with kind of what goes where um ductus arteriosis, I mean, pulmonary artery and AORTA both begin with a um and ductal stenosis is the one that involves the vena cava. Um And then also the liver. So it should be OK to memorize. Ok. Um So once again, we won't talk about this too much cos it's kind of just um a case of reading the graph. Um and it's kind of a trend that you'd expect, but basically, um as you kind of increase in age, a female's kind of fertility um decreases Um So at early embryogenesis of a fertilized egg, the ovum begins to develop and you've got your primordial germ cells which make up the reproductive parts of the embryo and they produce primary oocytes. Um So at around 20 weeks, gestation, there's a peak number of oocytes, it's about 7 million. Um And the important thing is that a female is born with all of her primary ocys that she'll ever have in her life. Um which is why kind of fertility decreases with age because you're using them up basically. Um And that's why eventually you get to a point where you're no longer fertile. Um And then you enter the menopause and so on. Um Yeah, so in terms of ultrasounds, um the kind of important things here to know are the dates and days basically um that you would do it. Um So you've got two types of ultrasound, you've got transvaginal or transabdominal. Um And so your kind of timeline of the pregnancy is gonna dictate which one you choose. Um And you can also have different types. So you've got two D, you've got 3d. Um And you've got 40 as well. Um So, in terms of ultrasounds that you can have, um so you can have an early one done that's around 12 to 13 days. Um And you can also have one at 12 weeks and this is your booking ultrasound. Um And booking appointments are really, really important because it's when you're screened for infections. Um And it's also the first point where pregnancies are described as viable. So, usually kind of when you're pregnant, people say that you shouldn't tell anyone before 12 weeks because 12 weeks is the first point where it's properly viable because that's when you see the fetal heart pulsations. Um And this is also when you kind of start to see rapid placental growth and organensis. So your booking era is very, very important. Um And then you can also have um an ultrasound scan at 20 weeks and this is your anomaly scan. Um So it's the longest scan. Um and it's basically just kind of checking that there are no abnormalities, the fetus is fully formed um and kind of checking that um everything's OK. Basically, you can also see the sex of the baby at 20 weeks. If parents want to know, then you can tell them at the anomaly scan. Um And in terms of Down Syndrome, you can detect 75% of cases within the 1st 20 weeks. Um And you do this by measuring hormones. So you've got your beta HCG, your inhibin A, your unconjugated estriol and then your PAP A and also your AFP. And it's really important to remember whether these would be high or low in a baby with Down Syndrome. Um So, yeah, in terms of key ultrasound to know, definitely booking and definitely anomaly. Um So, in terms of the corpus C tum cyst, it is just the cyst that forms inside the corpus cum. Um And it's because you've got a build up of fluid. Um And most of the time they just go away without their own treatment. Um And some women may experience a burst cyst. Um and that can cause lots of pain and potentially internal bleeding as well. Um And if you've got a really, really large cysts, then you can get an ovarian portion, which is just the ovary kind of twisting um over itself, which is like a complete medical emergency, like it's a really, really serious condition. Um But you've kind of got your obstetrician to kind of monitor everything as appropriate. Um And if you need to be referred to other specialists, they'll refer you, but they're not that common. Um Yeah, so this is once again a slide to kind of read in your own time. Um It's kind of just got some general kind of points um mainly about the induction of labor. Um And this is important to kind of know um just once again how the fetal kind of contribution um play a role in labor as well. Um And particularly the little blue kind of box on this side is very high yield. Um So it's just important to kind of know about termination as well. Um And so that's, that's your pill. Um And other than that, yeah, there's nothing we'll go over specifically now. So in terms of the birthing process. So, labor is regular uterine contractions that cause cervical dilatation. Um And normal labor occurs between 37 and 42 weeks. Um So you've got three stages. Um And your stages are kind of dictated by how far it's kind of progressed. So stage one is cervical dilatation, 0 to 10 centimeters. Um And then at stage two, you've got the descent and delivery of the fetus at 10 centimeters. Um And then in stage three, you've got the placenta being delivered and also kind of the membranes. Um And it's really important to know how the cervix changes in labor. Um So the cervix remains closed during the pregnancy up until the onset of labor. Um and then it ripens and it softens, um it shortens and then it also dilates. Um And so it's really important to kind of just remember um what happens to the cervix, which when you think about it, if you want something to come out, then it does need to ripen, it does need to soften, it does need to shorten and then it does need to dilate. So you can kind of remember it by thinking about what's actually going on. Um And then oxytocin is really important here as well. So it's a peptide hormone um and it's released from the posterior pituitary glands. Um and basically at labor, um you kind of get more of it. Um And the level of Oxytocin increases. Um and it kind of plays a role in once and helping the burping process and it works in conjunction with uterine contractions as well. Um So, estrogen is stimulating the uterine smooth muscle to go undergo hypertrophy hyperplasia. And then you want your uterine contractions to try and get movement kind of happening as well. Um So in terms of baby adaptations at birth, when a baby enters the world, they usually scream and cry a lot. And it's because it's a massive shock to the system and they're not actually fully kind of ready to enter the world in terms of their circulation. So we've already talked about the shunts, but there are also kind of other things that happen. Um And one of the major things is the blood supply. So when babies come out, they tend to like blue tinged and it's not anything kind of really to worry about. It's just because they're poorly deoxygenated. Um And the baby then slowly becomes more pink when the three shunts close and then the blood starts being pumped around the body um correctly. So that's also just high yield to know. So if they talk about in a question, kind of the baby having a blue tint and then going pink. Um So it's because your shunts are closing. Um So these are some youtube videos to watch um in your own time, depending on kind of what you want to focus on. Um Because there's a lot in this case. Um So kind of whatever you think is gonna be most beneficial to you, to you you can use. Um And yeah, there's some more here. So it's basically covered everything. Um So it's good consolidation. Um And then these are some links for a case, one anatomy as well. Um And these are some for histology too. Um And I would say that the lectures that the uni give you in terms of histology are everything you need and more. Um So if you're kind of struggling, definitely refer back to kind of one med and just have a look at those because they'll, they'll set you up really nicely for your sys um and also for progress tests. Um and your s one tests. Um So yeah, that was a very, very whistle stop tour of case one. But hopefully that all made sense. Hi. Thanks so much Karen for that. That was really, really useful. Um Before we move on to case two, does anybody have any questions? I'm just looking at the chat right now, if you have any questions about case one speak now. Ok. I'm not seeing anything at the moment. I'm just gonna give it another minute and if not, then we'll move on to case two. But um just to reaffirm what Karen said, case one is quite hard because it's first of all, a massive jump from um a levels and gap years to doing medicine and they do tend to like carry quite a lot in it. So um the slides will be provided and hopefully if you go through the slides and if you go through the notes that should give you all the information that you need. Um But don't fret if you're a bit overwhelmed by case two. Yeah. Um Natalia just put on the chart as well that if you have any questions, not just about case one, but case two, case three, any of them, um you can put it in the chart and then we'll answer it. But since there are no questions at the moment, um Hannah, do you wanna um your case two presentation? Yeah. Hi guys, I'm Hannah and I'm gonna do the case two presentation. OK? So case two is uh Martha Jenkins. Um I'm guessing you all can see this. OK? So these like in the last um presentation, these are the worst for in your own time about how um sorry about the case that will are kind of high yield um phrases to know and to kind of test yourself on. So first of all, we'll start off talking about Down Syndrome and the main thing to know is that it's Trisomy 21 and that means that there's three copies of chromosome 21 and this can occur in all the cells or some cells. So 95% of Down Syndrome cases are caused by non disjunction and we'll talk about these different chromosomal abnormalities. Later in the presentation, 2% have a parent carrying a Robertsonian translocation. 2% will have um mosaicism and 1% are due to other chromosomal rearrangements. So, in non destruction of chromosome 21 there's failure of the chromosomes of the cris cysto chromatis to separate in cell division. And with mosaic down syndrome mutation happens a bit later on in development. So some cells will have trisomy 21 whereas some cells won't have trisomy 21. And so these individuals are often less severely affected and sometimes they don't actually necessarily know that they have it if it's really happened quite a lot later on. Um But obviously, again, it depends on where it happens in the development because the earlier on it happens, it's gonna affect more cells. And so they're gonna be more severely affected. And here or you can see there's a carrier type. Um and you can see on chromosome 21 that circle though they've got three copies. And it's just important to know that if you get something like this in the exam just to have a look um at the number of chromosomes. And obviously X and Y, you would only expect to have one. But um they, they can ask you and it's quite likely that they'll ask you about a karyotype and to identify what the disorder is. So it could be um Down Syndrome, it could be Edwards Syndrome, Turner syndrome, Kleinfeld those are like the main ones that they expect you to know and be able to pick up on. Ok. So there's quite a lot of different features of Down Syndrome, which again, it it depends on how severely affected they are. So, in terms of facial features, there are some distinctive facial features to be aware of. So flat facial features, a bulging ton, um almond shaped eyes and then they have epic folds and this is um a fold on the side of the eyelid and it covers the inner corner and it just goes from the nose to the inner side of the eyebrow. Um And that's quite a distinctive feature and they can have low set ears and a shorter neck than usual. And they can have low tone, um which can make them feel or appear quite floppy as a child. And it may mean as they get older because of the low tone, they can be quite flexible. Um So it's um it's quite, that's quite common in Down Syndrome is to have low tone and they also have um a single palmic crea to where we all have quite a few different creases on our hands. They'll just have one across the top of the palm and this is the fusion of two palmic creases. Um So if you see that or in an exam or on a um on a picture that, that's quite distinctive for Down Syndrome as well, they can have learning disabilities, not everybody will. Um So it could be communication challenges. They might have um problems, understanding and completing simple uh tasks or trouble with learning new things. And in terms of health problems, heart defects are quite common. So, Down Syndrome, they tend to get ventricular septal defects. They can get gastrointestinal problems such as um duodenal atresia, um hearing and vision problems, hypothyroidism. They tend to be a bit more susceptible to infection. And it's been shown that also individuals Down Syndrome are more likely to develop um dementia in the future. The average lifespan of an individual with Down Syndrome is about 60 years. But I would hope that this is going up. Now, given that we are much better at treating all the complications that come with Down Syndrome and also better at picking up on it as well earlier on, which means we can treat Children earlier. Um But unfortunately, 5% of Children with Down Syndrome won't live past their first birthday. So that's important for parents to be counseled on if it's picked up antenatally. This is an overview of cell division by versus mitosis. I won't go into this in detail because this is a really good summary table that you can go to go on in your own time. Um But the most important thing to remember is that you get four haploid cells in meiosis and two diploid cells in mitosis. Ok. So you've got the cell cycle which has flat. So you have growth phase where the mass increases, then s phase where the DNA replicates, then a second growth phase, the cell grows again and more proteins are made and then you have mitosis. So, mitosis is prophase, then prometaphase metaphase anaphase and tel phase. And then after that, you have cytokinesis, which is where you have the new cell formed. And again, this is, goes into lots of detail here. Um And it's very, there's not really anything much added from a level biology um from this. So I'll leave you to go over that in your own time. And again, this is quite detailed. So again, the red bits are the really important things to know, especially the, the um enzymes are really important to be aware of. And it says it has a few enzymes on the side. And at the end of this, there is a really good youtube video on the process. But definitely, I'm sure we've said it quite a few times and I'll probably definitely be aware of the enzymes. So another little on cell division. Again, you've got meiosis here. So meiosis has two, has two phases. And this is because obviously you're making haploid cells. So the first one will make a diploid cell and then the second meiosis makes a haploid cell. OK. So a chromosome V is a one long continuous set of DNA and the DNA wraps around histones and the DNA and the histones form chromatin and this looks a bit like spaghetti. So a functional chromosome can only have one centromere and this joins the two sister chromatids. And then when the, when the er sister chromator are pulled apart, they, they pull apart from the, from the centromere at the end of the chromosomes, you have telomeres and they contain lots of repeats of DNA sequences. And every time cells divide, you lose about 10 to 20 of these units. And then once the telomere ha is completely lost, the um cell death occurs. And this is important because this is one of the theories of aging is that as the telomeres get shorter and more, this happens to more cells, that that's one of the reasons for aging. Um and in cancer cells, they have the ability to have renewed uh telomeres, which is why they keep growing and dividing indefinitely. And the, these have um common questions on centromeres and telomeres and C chromatis. This is a good table. All the different um chromosomal abnormalities that can come up. It's important to know. However, that only about nat 0.6% of babies are actually born with a chromosomal abnormality because the majority are not compatible with life. So a lot of babies like almost, you know, as it says here, it is 7.5%. So that's quite a significant number of zygotes contain chromosomal abnormalities, but a lot of those just will not go on to form a viable fetus. So we just, you might not even know that you're pregnant by the time that that fetus doesn't survive it. You know, it might not even make it past the embryo stage. And so the common ones to be aware of are your triploidy, your monosomy, you need to know about Turner syndrome, then your trom Down syndrome, Edwards syndrome, Patel syndrome and syndrome. Um I'm gonna be honest until I looked at these slides a couple of weeks ago, I'd never actually heard of tetrazomine and I never, that never came up for me. And at all in first year with these SYN syndromes here, I don't know, obviously, maybe it's changed a few like cos I'm in fifth year. So it's been quite a long time since I did this. Um Obviously, it's here. So it must have come up at some point. But I would, the main ones I would say are the troms and Turner syndrome. They're the main ones that they are likely to ask you about. And then it's important to know about the translocations. So you've got a Robertsonian translocation and a reciprocal translocation. So your Roberto Robertsonian translocation is where two acrocentric chromosomes. So this is chromosome 1314, 1521 and 22 which is why it will happen in Down Syndrome because obviously, that's trom me 21. Um they fuse together and it becomes one large chromosome and if this happens and you pass this on to a child. That's one of the reasons you can get down syndrome. On the other hand, you've got reciprocal translocations, which is where two non homologous chromosomes exchange segments. And this can cause as well um genetic problems. And then it's also important to be aware of other forms of structural chromosomal abnormalities like deletions, inversions, duplications, isochromosomes and insertions. And this is a really good page of all the key words to know. So, polyploidy, triploidy, tetraploidy, aneuploidy, melizame, monoamine, trazamine, tetrazomine. Now, of course, melizame you, that's one of the ones where it's very likely to be noncompatible with life because you're missing a whole chromosomal chromosome that you should have. So it would be like not having any chromosome 21. Um So there aren't, I would I imagine, you know, there aren't any syndromes that they would test you on for melimine. But it's important to know about because if it happens, obviously, that's one of the reasons that an embryo would not go on to form a viable fetus. And again, these Edward Syndrome, Turner syndrome, Klinefelter's, they, they're, they're very common questions. So this is just some examples of features of these syndromes. Edward syndrome is Trisomy 18. Um Unfortunately, Edwards syndrome is not very survivable. Um And again, it forms very distinct features. Um babies that are born with this often don't survive very long. Um Turner syndrome only affects the females because it's an x uh when an X chromosome is missing. And Klinefelter syndrome is only affecting males because they have an extra copy of the X chromosome. Um Inline filters, it could be that sometimes they are a mistake for being intersex because of this um extra X chromosome. And it can cause some confusion around the gender of the child, but they are classically quite tall and thin. Um And females with Turner Syndrome often have a webbed neck. Um That's one that comes up quite often is the web neck and trying to identify that with Turner syndrome. So it may be pictures, it may be descriptions and then you might have to match them up. So as discussed before, this is non disjunction and this can happen either in meiosis, one or meiosis two and the pictures on the sides show non destruction of various points in in meiosis. Um And again, it's, it's quite detailed and the pictures are really helpful and I'll leave you to go over this in your own time. Um But the pictures really help kind of get you to understand what, what it is and what happens um at different points and the the consequences of that because if you look in meiosis one, it's much more likely to be a genetic disorder that you can live with. Whereas when it happens in oogenesis, you are gonna end up with some options that are lethal, for example, where you just have 45 Y nothing. Mhm. Ok. So, structural abnormalities are caused by the breaking of one or two chromosomes. And there are things that can increase the likelihood of structural abnormalities like ionizing radiation and certain chemicals. And there are also certain inherited conditions that affect DNA replication and repair. So, in single chromosomes, you can have deletions, inversions, duplications and isochromosomes. Whereas when it's affecting two chromosomes, you have, you can have insertions and translocations which we've already talked about. Uh I would say the translocations, the Robertsonian translocation is really important to be aware of because it's a very specific one with those acrocentric chromosomes and it's related to Down Syndrome and it's quite, it could come up. Ok. So this is screening for Down Syndrome. So the combined test is the first test that women are offered and this usually happens at the 12 week scan, but can happen any time between 10 and 14 weeks. And it's called a combined test because it's an ultrasound and a blood test. And the, the blood test screens for pa and free beta HCG. And then the ultrasound looks for neutral translucency, which is the little fluid pocket at the back of the neck of the fetus. And if that's thickened, then it indicates that there may be Down Syndrome. But these are screening tests, they're not definitive tests. These will only give you a risk. So the Pope A will be low and the neutral translucency and free beta HCG will be raised in Down Syndrome, if a result is obtained, that shows that there's a high risk for Down Syndrome. So that would be one in 150 or higher. And then the mother is offered the choice of having a follow up test for a definitive diagnosis. Whereas if it's for Edward syndrome, they offered this, if the risk is over one in 100 there's quite a low false positive rate at 6.1%. And the combined test is offered first um because this is more accurate than the quadruple test. Um And most women should be able to have the combined test because it's done at the 12 week scan. But for if, for example, they didn't realize they were pregnant by this point, then obviously, there's also the option of the quadruple test, quadruple test is another screening test and it looks for alpha fet protein HC gue three and Inhibin and in Down Syndrome A FP and UE three tend to be low. Whereas again, the HCG will be high as will the inhibin A FP is also used to determine if there's a risk of spider bi to run cephal, but it's only a screen and it is less accurate. And again, if the risk is more than one in 150 then they'll be offered an amnio am an amniocentesis. Um But it's just important that when women are counseled on this, that they know that this is not to say yes your child will have Down Syndrome. This is you have this amount of risk of having a child with Down Syndrome because they can't be, they're just indicators of a condition. They're not looking at genetics. That's the only way you can say that for definite. A child has this abnormality. So, CVS and amniocentesis are Vastic tests. These will give you a definitive answer and some mothers or families will opt to go for this or some will just take the risk and not want to go through the invasive procedures of finding out for definite, which is, it's a very individual decision and it is that there is a risk of carrying out both cvs and amnio amniocentesis. So C vs can be carried out from 11 weeks and there is a slight risk of miscarriage at 1% and it can cause some, some very rare side effects um if it's done before nine weeks, which is why obviously it's not, it can form um infection and limb defects. But thankfully, this is rare. Um And of course, we do it after this point to really reduce that risk. And then amniocentesis, you take a very small amount of amniotic fluid between 10 and 20 mL and it contains the cells with the genetics of the fetus and then they use it to check the chromosomes and it's very accurate. And you have to be 15 weeks of pre, 15 weeks of gestation to have this one, but the miscarriage rate is slightly lower at naught 0.5%. But this risk is higher if it's carried out before 15 weeks. But they don't exactly know why. Um, but it could be that. It's because it damages the amniotic sac or slightly reduces the amniotic fluid. Um, amniotic fluid is really important for baby's growth and development and it's something that's monitored when, um, others are pregnant and it can cause issues with growth if there's problems with it. So on the left, you can see a limb abnormality that's caused by C vs. Um it's you can have missing digits, but this is quite rare if it's not carried out before 10 weeks. So it's just something to be aware of with amniocentesis. If you have it early, there is an increased risk of clubfoot. Um This is why we don't do amniocentesis before 15 weeks of pregnancy. Um And another reason we don't do it before 15 weeks of pregnancy is that the fluid, the amniotic fluid is a lot lower. So there, there isn't enough to test, but also it then increases the risk of abnormalities by removing what is already a smaller amount of amniotic fluid. So this is the me test. So if you have a high risk result from the combined test, you can be offered this. So this is a maternal blood test. So they take, it's just like a blood sample from the mother. It's just like a normal blood test. Um, and it tests for something called cell free fetal DNA. Now, this is really interesting because when I was in first year, this was not done on the NHS. Um, this was something they were looking into getting on the NHS within the next couple of years, but it was something you could only get done privately. You could offer it to women and tell them they can get this done privately. But now it's really, it's really good to see that this is available on the NHS and a recommended test. Um because of course, it's a lot safer for the fetus cos it's just like a normal blood test. So the cell free fetal DNA is released from the placental trophoblasts and it circulates in the maternal blood and then they can isolate that blood and test the DNA and look at the genetic make up to see if there is something such as Down Syndrome Edwards syndrome and Patau syndrome. It's much more accurate and it's more than 99% sensitive for Down Syndrome and Patau syndrome and 91.7% sensitive to Edward. So they're really good, really good um sensitivities. But again, it's, you know, it's a, it's a risk that it gives. So it can be high risk, low risk or no results obtained. And this is usually because there's not enough fetal DNA present. However, it has shown that the amount of CFF DNA decreases as BM I increases, which means there can be an actual result. And of course, if you're having twins, it wouldn't, it can't differentiate between the two fetuses. And so the results won't be accurate and it, you know, you'll get that there's a risk of either one or both of the Children, you know, having, um, having, uh, a genetic abnormality but not able to know which one specifically because it's the, it's not, they've know, distinguished maternal and fetal DNA. They can't distinguish between two types of fetal DNA. And of course, it, it, there are the ethical and psychosocial issues with that. Yes, it's, it's a blood test and so it's safer for the fetus. But of course, you are aware of what exactly this is for. And it's not just like a run of the mill blood test where you take your blood and, you know, you test for your full blood count and everything. It's, you know, it's, it's got a lot of underlying psychosocial complexities to it because you are testing for a genetic condition and you're looking obviously as well, you're taking fetal DNA, even though you're using maternal blood, you are taking fetal DNA. Um However, the test is a choice but it's, it's, it's a complicated choice for people to make, but it's a very good, less invasive test. Ok. So this is a history of abortion laws. They are very likely to ask you something along the lines of abortion. It's really important to have a good kind of grasp of the situation. You know, you don't need to know details but just kind of know how it's evolved and where we stand today. Um But it, it kind of, it's not as complicated. It looks like there's a lot to learn, but it's, it kind of, it flows very nicely and it all kind of melts into one and it, it's quite, I've nev, I think it's quite easy to learn. I think it's, you know, it's not like trying to learn all the different chromosome or abnormalities and what they mean. It's, it's, it's not too bad to learn and they will ask you about it. Um And it comes up, you know, in clinical years, it's, it's something that you're gonna always have to know. Um So the earlier you can get kind of a handle on it. It, the better. Um So in the earliest days, termination was acceptable before Christening, which is a religious term. It doesn't mean anything, it doesn't have a set date. Um And then in 1803, they punished it by death if you did have a termination post quickening. And then in 1823 they created the offenses against the person at which took away this distinction between pre and post quick in. And it just became an offense. In 1861 they altered the offenses against the person act and they changed the life sentence to unlawfully abortion, a child, whether it was intended or not. So in case, instead of it just being, if you intended to take to have an abortion, but now even accident, you know, miscarrying um would also carry a life sentence and also have it getting drugs for the abortion will also a life sentence. Then in 1929 they passed the Infant Life Preservation Act. And so this is to protect the fetus while being born. So you weren't allowed to have a termination after 28 weeks unless it was to save the mother's life. And in 1938 a doctor performed an abortion on a 14 year old rape victim, which was both physically and mentally indicated and they won the case. So this created case law in terms of there being justification in other circumstances for abortions and this kinds of this really set the basis for abortion law today. So that that's really, really important in the 19 sixties. There was a lot of kind of in the, you know, back alley dangerous unhygienic abortions because it, you know, even though they had this case law of it being being legal in certain cases, obviously, there's if you think about the stigma now, you know, the stigma around it was huge. And so there was still, you know, a very big risk to having an people be aware that you were having an abortion because yes, there was this case law, but it was still illegal because they still had the Infant Life Preservation Act. In 1967 they passed the Abortion Act and they decided at that point that it's not an offense if two licensed medical professionals deem it necessary. And a licensed medical professional carries out the abortion. And that's basically where we stand today. So, you know, it's a bit shocking that it's not really changed that much since 1967 but it became not an offense. So, whilst technically, abortion is still legal, there are caveats and it's, it's um exceptions to the law which make it legal. And of course, there are reasons why it would be legal such as um the mother, not feeling able to care for another child because if they have a severe. So for example, they already have one fairly disabled child and they feel that they can't care for another child. If the child has a condition that they don't think is compatible with life or has a very short life, um life kind of limitation or if it's gonna cause undue harm to the mother to have the baby or if there's a mental impact on the mother or other Children, then that can be a reason. Um Then it's obviously it's made it a lot better, but there's, there's a lot of debate around it, especially around the being able to have an abortion with medical conditions because there are some medical conditions which people think should not be allowed. There's a lot of, for example, Down Syndrome is one of the conditions that means you are allowed to have a termination of the pregnancy. But of course, that is quite a contentious issue, especially as care gets better that people feel that that should not be included. And there's a lot of kind of debate at the moment going on about what should be included and just how, how open those rules should be. And obviously that's, it's very, um, heated, but it's a very interesting area of ethics and law. Um, and if it's something you're interested in, I definitely recommend kind of reading around. I'm very interested in ethics and law and so it's something that I quite aware of and always kind of read up about in the news, um, and obviously with everything going on in America as well. Um, it's really quite interesting and it's quite a, quite an interesting time for abortion law pretty much all over the world, really. Um, so, yeah, if it's something you're interested in, definitely look, have a read around. So it's great for your exams. And, um, it's really, it's really quite interesting and of course, in, with the Coronavirus, we then allowed people to take medications at home. Now, of course, that also brings complexities with it because you know, what if things go wrong, you know, you can have, obviously 11 of the things that having the tablets does is it makes you bleed and one of the side effects is that you can't have a severe, severe major hemorrhage. And so, obviously, that is one of the things that is a real concern about abortions at home. Now, whether this will carry on that's remains to be seen. It. I it seems to still be going on obviously now that the Coronavirus has not really impacting healthcare as it was in 2020. I don't think it's quite as common, but I'm not sure if that legislation has been changed to reflect that or if it's still an option that people have, I can imagine that most doctors would prefer the patient we in hospital to be monitored. But as far as I'm aware that's still allowed. Um So that's just something to be aware of and it, that could, that could change back. Um But I'm not sure about that one. So in order for the abortion to be legal, which again, you will be asked about abortion, um, you've got to have it um confirmed by two registered medical practitioners. Um And it has to really, it has to go against each criteria. Two professionals must agree and it has to be carried out by some someone qualified. So it can't be more than 24. But again, this is something that could change in the near future as we are getting better at dealing with premature babies because we're having 22 weekers survive. It's not very common but it does happen and because that shows that they can survive, it may be that 24 weeks gets lower. Um But of course, at the moment, it's still 24 weeks. But, but again, that's something to keep an eye on and see maybe that changes in the near future. So in addition to it, having to be 24 weeks or lower continuing the pregnancy would be a greater risk than if the pregnancy were terminated or f injuring the physical or mental health of the pregnant woman or any existing Children, or if you are preventing grave permanent injury to the physical or mental health of the pregnant woman, or that the pregnancy would involve the risk to the life of the pregnant woman greater than if the pregnancy were terminated. Or that there's a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities, it would be seriously handicapped. And this fourth one is the one that's quite a contentious issue at the moment because that substantial risk is a very objective, uh sorry, very subjective, not very objective. Um And that it could be that you get differing opinions on whether you meet criteria for depending on which doctor you visit. Um So that's one that is, that is the one that Down Syndrome would come under. Um Now, obviously, as we've said, it's, it's a spectrum. And so just because the child has Down Syndrome, it doesn't mean that they are going to be seriously handicapped, but there's no way of knowing that while the parent or the mother I should say is pregnant. Um And that's part of the reason that it's quite contested. Um But number three and four, you don't have to be uh under 24 weeks pregnant. You can be any, this is another reason why it's contested is because you can be any age because it's talking about risk of life. You don't have to on the 24 weeks. Um, which is another reason it's been tested is because technically speaking, although it never happens, you could under the law for number four, abort have a termination at the ninth month of pregnancy. Now, obviously that does not happen. Um But technically, it wouldn't be illegal, but like I say, that really doesn't happen unless it was such, you know, it might not for number four, it could happen for number three. But again, the baby is l at that point likely to survive. So it's not considered a termination. Um But that is again, one of the reasons that it's such a debate at the moment and it must be carried out in a licensed place. Um Of course, if it doesn't, that that becomes a little. Um but you can also ob con conscientiously object unless by doing so you would put the woman's life at risk so you can conscientiously object, but you also have to give, you have to give another person. So say you have the woman in front of you who wants to take, have a termination, but you don't agree with it, for example, religious grounds or just personal reasons, you can say that you don't agree with it, but you have to give them a second opinion. You can't just leave them. So you have to be able to provide somebody else to do it. Um And if the woman's life, basically, they're there at the, in that, in that moment and it's not, you know, and it's an acute setting that it's not that the woman's come asking for a termination, it's that their life is at risk and you, you know, that that is your only option. Then if there is no one else to take over the care, then you have to do it. Um And ideally even if there was someone else to take over the care because it's an emergency situation, you shouldn't be conscientiously objecting. Um And there are certain records that need to be kept, but it doesn't appear as far as I'm aware on a woman's medical record for, for with like a shared care record. Um So it's not like every time you go into the hospital they're aware of it, but of course, the woman can make it known if it's pertinent information or if they feel that it's relevant. Um But yeah, it, it often doesn't go on medical records as far as I'm aware. So it's not just like everybody that they come into contact with in healthcare will be aware. Um So these are really good youtube videos, how has found that will help with your revision. Um There's lots of different ones here that can really help you kind of get all these um scenarios and um, concepts really locked in because they're all really important high yield questions and there's some more here and that's the end. So, thank you very much. And I hope that all made sense and of course, if you have any questions, do let me know cos I II appreciate that. That's quite a lot of information in a short amount of time. But I hope that all makes sense and that, that's helped you. Yeah, thanks, Hannah. That was really, really good. Um, I find like, personally for me, like case 20, I struggled so much cos I'm not the best at medical genetics and it's really hard to sort of get your mind over it. Um, also like with the abortion laws, I also think it's really interesting with the whole like, um, thing in America as well. And if you guys have extra time and if you're interested in it, it'll be worth looking at the Northern Ireland, um, abortion laws that got changed in 2020 because, um, I actually found that quite interesting because, um, abortion used to be illegal in Northern Ireland until, until 2020 where they went from having one of the strictest um, abortion laws to the, one of the more progressive abortion laws relative to Europe. So, it's sort of like, interesting, are we heading in that direction or are we heading more like America? I don't know. I don't know. Um, what I do have before we end because we're running a little bit like we're not, we still got time. So I've got a quick powerpoint about chromosomal abnormalities just again because um I felt that that was quite hard when I was in first year and um t's been amazing and provided this like amazing, like content and very high yield stuff, but I just wanted to sort of like simple it down and just explain sort of why chromosomal abnormalities form. So let me, let me, let me it. OK. No. Um I don't. OK. How do I do it? Write it down in? Can you guys see my screen? No, I didn't know whether it's just me but I can't, I can't. Sorry. Oh, no. OK. Let me try again. Show um OK. It's not letting me share my screen, which is a shame, but don't worry, I'll um send everyone the slides um so that you have that um does anyone have any questions before we end the session? I'm just looking at the chart. So if you have any questions um speak now, forever. Hold your silence. I've been using the an cards for anatomy about how the, how best do you think it is to revise? Ilos. Ilos are really important to revise. Um cos ilos basically, um they use the uni uses the I OS to set the um exam. So the exam questions come from like the II OS. That's what you're supposed to know. Um What I do for anatomy is I like to use the ilos um and use the ilos to um create little revision um packs and then I turn those revision packs into an cars. I think an cars are amazing, especially for anatomy because you're constantly reminding yourself. But um I think if you're going to use content, make sure all of the content you use covers the alos well and ask me questions. Usually use cadaver images um or illustrated diagrams, uh mixture of both, mixture of both. Um I really liked in first year and second year. I was part of the um what's it called the COVID year. So we didn't really have a lot of cadavers. So I used, was it complete anatomy, I think? And that really helped. Um But you can also get cadaver images in the exams. Would these slides and lectures be sufficient enough for semester exams? Yes, it should be. It should cover um all of the Il Os. When we make the slides, we make sure that we cover the Il Os in them. Um What produces HCG um Hannah's also put something just to go back to anatomy. Um Grey's anatomy, that's also really good. Um And they have flash ps for anatomy that can help. Yeah, that's true. Um Yeah. What produces H CG? So beta H CG can be produced is usually produced by two different things. Um Before the baby is sort of develops before the placenta, I guess develops. Um The beta HED is produced by the corpus luteum, which is this sort of like, it's, if you think about the egg, it sort of holds the eggs. Um And the corpus luteum produces B to HCD. Um But then after I think I'm not really sure how many weeks it is. Um cos I've fini, I've finished my S and Gyne block. But once the placenta has developed, then um beta HCD production goes from the Corpus Lum to the placenta and the placenta is what um produces beta HCD. Um Will you guys be holding more of these sessions in the future? Yes, we will. Um So we plan the session specifically to be during your reading week. Um because I understand it's hard if you've got like, you know, lectures and stuff like that to come and spend your evening doing a revision session, it's not the most ideal. Um Hopefully, during next reading week, we can do a recap of case three and four. So, yeah, and also, I'm really sorry, I wasn't able to share my um screen and go over chromosomal abnormalities. But I just wanna confirm, you guys will get all of the sides. You're gonna get um all of the sides that have been presented, all of the slides that hasn't been presented and you should get a recording. Um Do we have any other questions? Oh, and Tal also said, um if you want sessions on specific topics, um put it in the feedback form or email um or send an Insta to the Mumps Instagram. If there's no other questions, I think we can go. Thank you so much for attending. I appreciate that. It's not the easiest thing to do on Tuesday evening. Um When you end, there is an option to um put in a feedback form. If you wanna get the slides, put in the feedback form, share your feedback, no matter how small it is. Once you um fill out the feedback form, you should be able to um get the slides and the recordings and stuff like that. So, yeah, I think if does anybody have anything else to say, I'm gonna take that science as no. So, um again, I wanna thank you all for coming. Um You guys have been absolutely amazing. Um Also, I wanna give a massive thank you to our speakers, Hannah and Karen and t who, even though she didn't speak, she was the one who like wrote all the slides. So she's an absolute lifesaver. Um Yeah, and I think that should be it. So, bye guys. No.