Repro Quiz

1. Repro Quiz Emily Hodgson and Natalie Fox

2. A 49 year old woman presented to her GP after finding a lump in her right breast. She is worried about breast cancer • Which arteries supply the breast? • Medial mammary artery (from internal thoracic/anterior intercostal) • Lateral mammary artery (from lateral thoracic artery/posterior intercostals) • What tissues does the breast rest upon posteriorly? • Fascia of pectoralis major and serratus anterior • Retromammary space – loose connective tissue and fat

3. State THREE features the GP may find on examination of a breast lump that would suggest malignancy • Hard • Irregular/’craggy’ • Immobile • Overlying skin changes • Peaud’orange • Attachments

4. This woman has a wide local excision and sentinel node biopsy. Explain the term sentinel node in this case and its role in the diagnostic process. • The first node in the tumour drainage pathway • SLNBx = an acceptable alternative to complete axillary dissection • If sentinel node negative for metastasis there is no need for further axillary node clearance

5. A healthy 32 year old woman discovers a lump in her left breast. After considerable delay, an appointment with the hospital consultant is arranged • On arrival in the consultation room the woman appears angry. The consultant adopts a ‘patient-centred approach’. List FOUR reasons for adopting this approach. • Better patient satisfaction • Better patient outcomes • Autonomy • Increased adherence to treatment

6. A 28 year old obese woman has just had her first baby at term. She had a prolonged second stage of labour. She opts to breast feed. • Define the second stage of labour • From full dilatation of the cervix to the birth of the baby • List the THREE major factors that together influence the outcome of any labour • Power • Passage • Passenger

7. Explain the physiology of an erection (2) • Stimulus (physical of psychological) • Parasympathetic dilation of arteries • Increased blood flow compressed veins • Build up of blood causes erection

8. What is the process of ejaculation (2)? • Sympathetic impulses • Urethra fills with semen • Contraction of muscles at the base of the penis • Pressure forces semen through urethra

9. What are the four stages of coitus? • A. Excitement, engorgement, climax, resolution • B. Excitement, plateau, resolution • C. Excitement, engorgement, orgasmic, resolution • D. Excitement, ejaculation, resolution • E. Excitement, plateau, orgasmic, resolution

10. What is produced by the seminal vesicles? • A. Sperm, testosterone, L-carnitine • B. Fructose, proteins, semen clotting factors • C. Phosphate, bicarbonate buffers, PSA • D. Zinc, citric acid, spermine • E. Lubrication, anti-sperm antibodies

11. Which of the following is correct?The Umbilical cord has… • A. 1 umbilical artery carrying oxygenated blood and 2 umbilical veins carrying deoxygenated blood • B. 2 umbilical arteries carrying oxygenated blood and one umbilical vein carrying deoxygenated blood • C. 2 umbilical arteries carrying deoxygenated blood and one umbilical vein carrying oxygenated blood • D. 1 umbilical artery carrying deoxygenated blood and 2 umbilical veins carrying oxygenated blood • E. 1 umbilical artery carrying deoxygenated blood and 1 umbilical vein carrying oxygenated blood

12. Give three forms of transport across the placenta? (3) • Simple diffusion • Facilitated diffusion • Active transport • Pinocytosis/transcytosis

13. What is transported across the placenta by simple diffusion? • A. Oxygen • B. Iron • C. Glucose • D. Amino Acids • E. Globulins

14. Give three factors that affect the onset of puberty. (3) • Malnutrition • Chronic disease (renal failure, CCF, Crohn’s) • Low BMI • High BMI • Exercise in females • Endocrine (thyroid, adrenal) • Genetic factors • Black girls develop earlier than white • Emotional deprivation

15. What is the classical symptom triad of the menopause? (3) • Hot flushes • Sweats • Vaginal dryness

16. Explain the process of cervical ripening. (2) • Marked reduction in collagen and increase in glycosaminoglycans which decrease the aggregation of collagen fibres • Collagen bundles ‘loosen’ • Influx of inflammatory cells, and increase in nitric oxide output • All changes are triggered by prostaglandins

17. What is brachystasis? (2) • At each contraction muscle fibres shorten, but do not relax fully • The uterus, particularly the fundus shortens progressively • Pushes the presenting part towards the birth canal and stretches or dilates the cervix over it

18. When does the first stage of labour end? • A. When the cervix begins to dilate • B. When the cervix is fully dilated • C. When the head is delivered • D. When the baby is delivered • E. When the placenta is delivered

19. How is the risk of tearing to the perineum and vagina reduced? (1) • Episiotomy

20. What happens in the third stage of labour? (3) • Powerful uterine contractions, which separates the placenta, positioning it in the upper part of the vagina • Placenta and the membranes are then expelled • Contraction of the uterus compresses blood vessels and reduced bleeding

21. What are the three elements of labour? • A. Pain, Passenger, Passage • B. Powers, Pain, Passage • C. Passage, Pain, Passenger • D. Powers, Passage, Passenger • E. Powers, Passenger, Parturition

22. Name three foetal presentations (3) • Vertex – cephalic presentation • Breech • Shoulder • Face – complete extension • Brow – partial extension

23. Give three methods of induction. (3) • Membrane sweep • Prostaglandins (PGE2) – vaginally • Artificial rupture of membranes • Oxytocin – given as infusion

24. What is meconium and what is the significance of it being present in the liquor? (2) • First stool, blackish green and tenacious • Presence in liquor may be indicative of foetal distress