Normal vaginal pH
<4.5
Clue cells on microscopy indicate which infection?
Bacterial Vaginosis
Ulnar nerve arises from which cord?
Medial cord
Name the structures at the Angle of Louis, and what level?
4th Intervertebral disc level - RATPLANT
Rib 2
Arch of aorta
Tracheal bifurcation
Pulmonary Trunk
Ligamentum Arteriosum
Azygos vein entering IVC
Left recurrent laryngeal n.
Thoracic duct right to left movement
What is Primary Sclerosing Cholangitis?
Inflammation and obliterative fibrosis of intra-hepatic and extra-hepatic bile ducts
Leads to cholestasis --> biliary cirrhosis
Commonly associated with IBD
Most common organism associated with Bacterial Vaginosis
Gardnerella Vaginalis (anaerobic bacteria)
What is the treatment of uncomplicated Chlamydia
Uncomplicated Chlamydia: Doxycycline 100mg oral twice a day for 7 days
Only 2 nerves come off a trunk of the brachial plexus.
What trunk is it and what nerves are they?
Upper trunk
Suprascapular nerve and nerve to subclavius
What is a Bochladek hernia?
Where is it more common?
Congenital diaphragmatic hernia where abdominal organs protrude into the chest through a defect in the diaphragm's posterolateral part. Most common type of congenital diaphragmatic hernia.
More common on left side of diaphragm
What are the name of malignant bone forming and malignant cartilage forming bone tumours?
Give 1 feature of each
Osteosarcoma - Near metaphysis, periosteal reaction (Codman's triangle, Sunburst sign), bimodal age distribution
Chondrosarcoma - axial skeleton, typically 40+, infiltration into bone
List 2 possible presenting symptoms of chlamydia in females and males
Females: Abnormal vaginal discharge, pelvic pain, Abnormal Vag bleeding, dyspareunia, dysuria
Males: Clear penile discharge, dysuria, Testicular pain or swelling (epididymo-orchitis)
List 2 possible presenting symptoms for Gonorrhea in males and females
Females: Odourless ourulent discharge, possibly green or yellow, dysuria, pelvic pain
Males: Odourless ourulent discharge, possibly green or yellow, Dysuria, Testicular pain or swelling (epididymo-orchitis)
What is the origin of the Long thoracic nerve and what muscle does it supply?
What clinical feature seen in damage to this nerve?
C5,6,7 roots, supplies Serratus anterior
Winging of Scapula
WHat are the 3 areas of unprotected pleura?
1. Cervical pleura
2. Right costo-sternal angle
3. Right and left costo-vertebral angles
What are the stages of lobar pneumonia inflammation?
1) Congestion (day 1-2)
- Vascular engorgement, intra-alveolar oedema with presence of neutrophils & bacteria
2) Red Hepatisation (day 3-4)
- Massive exudation as neutrophils, red cells and fibrin fill alveolar spaces
3) Gray hepatisation (day 5-7)
- Disintegration of red cells and peristence of exudate (neutrophils and macrophages)
4) Resolution (day 8-week 4)
- Exudate broken down by enzymes and is either resorbed, ingested by macrophages, coughed up or organised by fibroblasts
What is the empirical treatment for severe PID
Ceftriaxone IV + Azithromycin IV + Metranidazole IV
(Note: non-severe is pretty much the same but IM/PO administration)
A 'strawberry cervix' on speculum examination indicates which infection?
This infection might have what type of discharge?
Trichomoniasis (causes by Trichomonas Vaginalis)
Discharge typically: Frothy, and yellow-green, foul odour
What nerves come of the posterior cord? (3)
What are the terminal branches? (2)
Upper and lower subscapular nerves, thoracodorsal nerve
Terminal: Radial and Axillary
Describe location of an intercostal nerve block
How does it differ to intercostal catheterisation
Nerve block - 5th to 11th intercostal nerves ideal and needle near lower border of rib (near neurovascular bundle)
Intercostal catheterisation best spots: 5th ICS just ant. to mid-axillary line and 2nd ICS in MCL, Upper border of rib chosen to avoid damage to neurovascular bundle
What are 3 risk factors for lung cancer, 4 presenting symptoms, 2 most common histological types, which type most common in smokers, and 2 features of this type
Risk factors: Cigarette smoking, Passive smoking, Radon exposure, family history, occupational exposure
4 presenting symptoms: Cough, haemoptysis, chest pain, dyspnoea, weight loss + lots of others
2 most common histological subtypes: Adenocarcinoma, SCC
SCC: Most common in smokers, features are central location, more common in men, keratinisation with dense eosinophilic cytoplasm
Outline what is involved in the standard asymptomatic checkup for STI testing.
Outline how this differs to testing for symptomatic individuals
HIV & Syphillis, HepB (only if unvaccinated)
Gonorrhea & Chlamydia (NAAT) - Urethral FPU (males or females who cant swab) or self-collected vaginal swab
SYMPATOMATIC: Must swab. Generally clinician collected rather than self-collected vaginal
Others: HepC Virus, Trichomonas, Mycoplasma, BV, HPV not recommended except for special circumstances (Check STI guidelines) E.g. HepC should be tested in patients with HIV, IVDU or sexual partner with HCV
WHat are the indications for testing for Mycoplasma?
Is it included in asymptomatic testing?
What test is done?
Asymptomatic testing not indicated
Indications for testing:
- Acute, persistent and recurrent non-gonococcal urethritis
- Cerrvicits
- PID
- Post coital bleeding
- Sexual contact with M.Genitalium infection
Test done: Vaginal swab most sensitive specimen (clinician or self collected), endocervical not as sensitive, FPU in males/cant do vag swab
What does the lateral cord give rise to?
Lateral pectoral nerve, lateral root of median n. terminal muculocutaneous n.
Detail how cancer can spread to vertebrae
- Most frequent route is intravenous due to venous reflux that occurs after an increase of intrathroacic pressure
- Azygos vein which communicates with vertebral venous plexus of Batson, has no valves that control flow of blood
Contrast HL and NHL in terms of:
1) Reed Sternberg cells
2) Common sites
3) Spread
4) Extranodal presentation
5) Age of onset
HL:
- Reed Sternberg cells are the hallmark, Often localised to single axial group of nodes (cervical, mediastinal, para-aortic), predictable contiguous spread from one group of nodes to the next, rarely extra-nodal, bimodal age distribution (20-40 then older)
NHL:
- No Reed Sternberg cells, can arise in any lymph node/peripheral lymph nodes, spread is random/non-contiguous, Extranodal presentation common (E.g. stomach, brain, skin), Age of onset (more common 55+)