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 Peau d’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