STI's
STI's
Brachial Plexus
Thorax Anatomy
Lucky dip
100

Normal vaginal pH

<4.5

100

Clue cells on microscopy indicate which infection?

Bacterial Vaginosis

100

Ulnar nerve arises from which cord?

Medial cord

100

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

100

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

200

Most common organism associated with Bacterial Vaginosis

Gardnerella Vaginalis (anaerobic bacteria)

200

What is the treatment of uncomplicated Chlamydia

Uncomplicated Chlamydia: Doxycycline 100mg oral twice a day for 7 days 

  • Alternative (as in      pregnancy/breastfeeding) is Azithromycin 1g stat
200

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

200

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

200

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

300

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)

300

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)

300

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

300

WHat are the 3 areas of unprotected pleura?

1. Cervical pleura

2. Right costo-sternal angle

3. Right and left costo-vertebral angles

300

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

400

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)

400

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

400

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

400

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

400

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

500

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

500

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

500

What does the lateral cord give rise to?


Lateral pectoral nerve, lateral root of median n. terminal muculocutaneous n.

500

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


500

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+)

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