Gynaecology Flashcards
HPV
6+11 cause condylomas
16+18 cause cervical cancer (upregulate E6 and E7 which inactivate p53 and RB1)
Cleared by immune system
Vulval Intraepithelial Neoplasia
1-3 depending on appearance
Due to HPV
Differentiated VIn due to lichen sclerosus (causes SCC)
Vulval SCC
Most common
Associated with VIN, CIN and LC
Eroded plaques and ulcers
Spreads to vagina, urethra and nodes
Vulval Malignant Melanoma
Recurs
Spreads to urethra
Invades nodes and blood
Extramammary Paget’s
Burning and itchy
In-situ adenocarcinoma
Recurs and invades
Cervical Intraepithelial Neoplasia
Pre-invasive SCC
Graded 1-3
In TZ
Looked at in screening programme
SCC of Cervix
RFs= HPV, multiple partners, smoking, losing virginity early
Adenocarcinoma of Cervix
Precursor= CGIN
Treated same but worse prognosis (radioresistant)
Spreads
Mets to nodes, lungs, bones
Endometriosis
Causes= regurg, metaplasia, differentiation, mets Treatment= COCP, GnRH agonist/antagonist, progesterone antagonist, surgery
Endometritis
Acute= retained foetus, complicated labour, lots of neutrophils Chronic= PID, TB, IUCD, more lymphocytes Treatment= analgesia, abx, remove cause
Endometrial Polyps
Polypoid overgrowths
Causes= tamoxifen
Treatment= progesterone or GnRH antagonists, surgery
Leiomyomata
RFs= genetics, no kids, obesity, PCOS, high BP
Subfertility
Pressure symps
Treatment= IUS, NSAIDs, OCP, progesterone, iron, ablation, hysterectomy
Hyperplasia
RFs= obese, high oestrogen, PCOS, tamoxifen, HPNCC
Non-atypical or atypical
Treatment= IUS, progesterone, hysteretomy
Risk of cancer
Endometrial Cancer
Type 1= endometriod (oestrogen-dependent)
Type 2= serous (atrophy, grade 3)
Polycystic Ovarian Syndrome
2/3 of hyperandrogenism, menstrual abnormalities, polycystic ovaries
Treatment= metformin, OCP, ovarian drilling
Comps= hyperplasia and adenocarcinoma
Ovarian Failure
Primary= infection, surgery, radio, toxins, Turner's, Klinefelter's Secondary= Sheehan's, pit tumours, brain injury, PCOS
Ovarian Cancer
Protective factors= OCP, breastfeeding, hysterectomy
Often have TAH/BSO and chemo
Epithelial Ovarian Tumour
Serous, mucinous or endometrioid
Benign= cystadenoma, fibroma or cystadenofibroma
Malignant= cystadenocarcinoma
Germ Cell Ovarian Tumour
Germinomatous= malignant
Non- germinomatous= teratoma, yolk sac (malignant) or choriocarcinoma (malignant)
Sex Cord Stromal Tumour
Thecoma, fibrothecoma and fibroma benign (make oestrogen)
Granulosa cell malignant+ makes oestrogen
Sertoli-Leydig malignant+ makes androgens
Ovarian Mets
Mullerian= uterus, fallopian, peritoneum, other ovary Lymph/Haem= bowel, stomach, pancreas, breast, melanoma, kidney, lung Direct= bladder, rectal
Breast Cancer
RFs= obese, alcohol, HRT, radiation, height, digoxin
Get puckered skin, indrawn nipple, inflam, infections and nipple discharge
Mammary Paget’s
Overexpression of HER2
Fibrocystic Change
Duct hyperplasia
Apocrine metaplasia
Cysts
Calcified lump
Fibroadenoma
Mobile lump
Controlled growth of glandular and connective tissue
Phyllodes Tumour
Rare neoplasm
Spectrum of lesions
Stromal overgrowth
Infections transmitted to baby
Blood= CMV, syphilis, VZV, zika, tosmoplasmosis, parvovirus Labour= Strep, HSV, gonorrhoea, chlamydia, HIV, Hep B
UTIs in pregnancy
More common
Asymp bacteriuria treated
7 days amoxicillin (cephalexin if have folate and 2-3 trimester)
Chorioamnionitis
Inflam of cord, placenta and membranes
RFs= membrane rupture, amniocentesis, cordocentesis, cerclage, BV
Causes= B strep, enterococci, e coli, listeria
Abx in Pregnancy
Safe= penicillins, cephalosporins Unsafe= chloramphenicol, tetracyclines, fluoroquinolones, trimethoprim
Endometritis in Puerprium
RFs= C section, long labour
Causes sepsis
Causes= e coli, anaerobes, group B strep
Mastitis
S aureus
Keep nursing, drain abscess+ give flucloxacillin
Neonatal Sepsis
Men happens
Causes= group b strep, e coli, listeria
N Gonorrhoea
Gram -ve
Attaches to mucosal epithelium
Get discharge+ dysuria
Comps= PID, Fitz-Hugh-Curtis, miscarraige, conjunctivitis
Can disseminate
Treatment= b lactams, cephalosporins, fluoroquinolones (ceftriaxone and azithromycin)
Chlamydia
Intracellular bacteria
Targets squamocolumnar junction, conjunctiva, urethra, rectum, resp tract
Symp= urethritis, cervicitis, dysuria, frequency
Comps= PID, infertility
Treatment= azithromycin or doxycycline
Genital Herpes
HSV1 (slightly 2)
Symps= pain, itch, dysuria, discharge, ulcers
Lies dormant before reactivation
Treatment= aciclovir
Comps= men, encephalitis, retention, paraesthesia
Syphilis (treponema pallidum)
Penetrate mucous membranes or broken skin
Disseminate in lymph or blood
Primary= chancre at entry site
Secondary= rash, fever and infectious condylomata lata
Tertiary= neuro, paresis, tabes dorsalis, aortitis
Can be congenital
Treatment= penicillin (Jarish-herxheimer)
Trichomoniasis
Vaginal protozoan
Symps= green frothy discharge+ inflam
Treatment= metronidazole
Bacterial Vaginosis
Less lactobacilli, more Gardnerella and anaerobes
Watery fishy discharge
Treatment= metronidazole, amoxicillin, clindamycin
Candidiasis
RFs= OCP, DM, abx Treatment= topical co-trimazole and fluconazole
HIV
Lose CD4
CD4 below 200= AIDS
Treatment= AZT, nevirapine
