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iBSc: Question 8

iBSc: Question 8. By Alan McLeod. Getting the best marks. Read the whole question – a latter section may give you a clue about an earlier one. To see how many points you need look at the marks allocated – for example a 3 point question is generally looking for 3 salient points

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iBSc: Question 8

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  1. iBSc: Question 8 By Alan McLeod

  2. Getting the best marks Read the whole question – a latter section may give you a clue about an earlier one. To see how many points you need look at the marks allocated – for example a 3 point question is generally looking for 3 salient points If giving a list answer put the best answers first – examiners will not usually mark answers too far down a list Always write something – it may get you part of a mark and is anonymised so no one will think you are stupid! If you genuinely have no clue then re-write the question to see if this sparks some ideas. If not then move on and come back at the end. And remember – always write something. Good luck!

  3. Question 8 Andrea, a 19 year old girl presents with right iliac fossa pain. Q8.1 • List 3 differentials (3)

  4. Question 8 Your SHO tells you not to forget to palpate McBurneys point in the exam. Q8.2 • Where is McBurneys point? (2) Q8.3 • What is it’s significance? (1)

  5. Question 7 Andrea has missed her last period. Q8.4 • Illustrate the hormonal changes of the menstrual cycle showing the four main hormones (8)

  6. Question 7 A pregnancy test is performed Q8.5 • What is the molecule detected by this test (3) Q8.6 • What is this molecules physiological purpose? (1)

  7. Question 7 The test is positive - it is a reliable test with a good sensitivity and specificity. Q8.7 • Define the statistical terms sensitivity and specificity (2+2)

  8. Question 8 Ultrasound shows no foetus in the uterus and an ectopic pregnancy is diagnosed Q8.8 • What is the commonest site for an ectopic pregnancy to implant? (1) Q8.9 • List two other sites of ectopic implant (2)

  9. Question 8 After successful treatment, Andrea reveals she is sexually active with multiple partners and does not use contraception. Q8.10 • Compare the combined oral contraceptive pill and the condom for mode of action, advantages and disadvantages (6)

  10. Question 8 Andrea’s chaotic lifestyle lead you to believe that a long term contraceptive option may be best. Q8.11 • List a long term mode of contraception (lasts at least 3 months) and its mode of operation. (2)

  11. The Answers View these on ‘note view’ rather than on full screen – additional notes are provided for some slides

  12. Abdo Pain?

  13. Abdominal Organs

  14. Abdominal Organs Junction Points: Foregut becomes Midgut: Ampulla of Vater – halfway along second section of duodenum Midgut becomes Hindgut: approximately at the splenic flexure R= primary retroperitoneal structure r= secondary retroperitoneal structure

  15. Right Iliac Fossa Pain Umbilicus Rt ASIS McBurney’s Point

  16. Basis of Pregnancy Test • Implanting embryo produces human chorionic gonadotrophin (hCG) • This stabilises the corpus luteum allowing continued progesterone production and pregnancy to continue • hCG has 2 chains – alpha and beta • Pregnancy test detects the beta-chain of the hCG molecule. • Levels peak at 9-11 weeks • Detectable 14 days post ovulation in urine and 6-7 days in plasma

  17. Menstrual Cycle

  18. Menstruation Follicular phase • Reducing oestrogen and progesterone – reduction of neg feedback on pituitary • Pituitary releases FSH/LH Within the follicle • LH + Thecal cells gives choleterol  androgens • FSH causes proliferation of granulosa cells • FSH + Granulosa gives androgens  oestrogens Little Tiny Follicles Grow: LH + Thecal cells; FSH + Granulosa

  19. Menstruation • Follicular phase (cont…) • Selection of dominant follicle – produces oestrogen • Oestrogen levels rise until passing level for inducing positive feedback on LH • FSH + oestrogen induce LH receptors • LH receptor levels rise • Luteinisation of follicle occurs • Progesterone produced • Progesterone potentiates positive feedback of oestrogen • LH Surge

  20. Menstruation Ovulation • Occurs 36 hours after LH surge • Meiosis restarts within the oocyte • Follicle wall breaks down  release of oocyte Luteal phase • Corpus luteum produces progesterone • Induced by LH • Continued production needed for pregnancy • LH levels falling…

  21. Sensitivity and Specificity Or: The Spinning Snout Test • SPPIN = Sp+P+In If a test has a high • Specificity then a • Positive result rules the diagnosis • In • SNNOUT = Sn+N+Out If a test has a high • Sensitivity then a • Negative result rules the diagnosis • Out

  22. Ectopic Pregnancy

  23. Combined Oral Contraceptive Effectiveness • Pearl index: 0.3 – 4 Main Mode of action • Suppress synthesis and secretion of FSH and the mid-cycle surge of LH. Other actions • Endometrium: Results in inadequte proliferation and secretory phases – preventing implantation. • Cervical mucus: inhibits sperm penetration

  24. Combined Oral Contraceptive Advantages • Usually results in pain-free, moderate periods • Less PID / ectopics • Less ovarian / endometrial cancer • Less iron defic anaemia • Less benign breast disease • Less symptoms of the menopause • Fewer ovarian cysts Disadvantages: • No STI protection • Breast tenderness • Nausea • Headaches • Leg cramps • Depression • Acne • Alopecia • Hirsutism • Weight gain

  25. Condom Advantages: • Protection from STI’s e.g. Chlamidia, HIV. Limited protection against HPV. • Easy to use. • Non-hormonal. • Available free from family planning clinics and similar sites. • Disadvantages: • Interfere with sex. • Allergy. • Can be damaged by oil-based products e.g. baby oil, some thrush treatments.

  26. Condom Effectiveness: • Pearl index 2-15 dependent on care in useage. Mode of action: • A physical barrier that prevents entry of the sperm into the vagina or cervix. Barrier methods need to be put in place before genital contact as the pre-ejaculate contains sperm.

  27. Long term contraception Male sterilisation • Ads: Very low failure rate (0 – 0.05% over lifetime), does not interfere with sex. Nothing to remember. • Disads: should be considered permanent, no protection vs STIs Female sterilisation • Ads: Does not interfere with sex. Nothing to remember. • Disads: Relatively high failure rate (0 – 0.5% over lifetime) – recanalisation not uncommon. Should be considered permanent, no protection vs STIs

  28. Long term contraception Implanon device • Action: Slow release of a progestogen - inhibits ovulation, thickens the cervical mucus, inhibiting the passage of sperm to the uterus, and thins the endometrium, preventing implantation. • Ads: Virtually no failure chance, Lasts years, reversible • Disads: May cause Irregular bleed, acne, ‘wt gain’

  29. Long term contraception IUCD ‘coil’ • Action: induces an inflammatory response in the uterus which affects the viability of sperm and ova. Prevent fertilisation and implantation • Ads: Low failure (Pearl index 0.2 - 1), reversible. • Disads: Often causes menorrhagia

  30. The End The slides here should allow you to mark your own work – remember 1 mark per answer up to the maximum for the question. Multiply by 3 to get percentage points. I assume a 60% pass mark. Sorry but I am unable to give further advice on answers due to time constraints.

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