1 / 30

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

calista-schneider
Download Presentation

iBSc: Question 8

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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.

More Related