Gynaecology Flashcards by Emily Gardner

HPV

6+11 cause condylomas
16+18 cause cervical cancer (upregulate E6 and E7 which inactivate p53 and RB1)
Cleared by immune system

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Vulval Intraepithelial Neoplasia

1-3 depending on appearance
Due to HPV
Differentiated VIn due to lichen sclerosus (causes SCC)

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Vulval SCC

Most common
Associated with VIN, CIN and LC
Eroded plaques and ulcers
Spreads to vagina, urethra and nodes

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Vulval Malignant Melanoma

Recurs
Spreads to urethra
Invades nodes and blood

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Extramammary Paget’s

Burning and itchy
In-situ adenocarcinoma
Recurs and invades

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Cervical Intraepithelial Neoplasia

Pre-invasive SCC
Graded 1-3
In TZ
Looked at in screening programme

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SCC of Cervix

RFs= HPV, multiple partners, smoking, losing virginity early

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Adenocarcinoma of Cervix

Precursor= CGIN
Treated same but worse prognosis (radioresistant)
Spreads
Mets to nodes, lungs, bones

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Endometriosis

Causes= regurg, metaplasia, differentiation, mets
Treatment= COCP, GnRH agonist/antagonist, progesterone antagonist, surgery

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Endometritis

Acute= retained foetus, complicated labour, lots of neutrophils
Chronic= PID, TB, IUCD, more lymphocytes
Treatment= analgesia, abx, remove cause

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Endometrial Polyps

Polypoid overgrowths
Causes= tamoxifen
Treatment= progesterone or GnRH antagonists, surgery

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Leiomyomata

RFs= genetics, no kids, obesity, PCOS, high BP
Subfertility
Pressure symps
Treatment= IUS, NSAIDs, OCP, progesterone, iron, ablation, hysterectomy

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Hyperplasia

RFs= obese, high oestrogen, PCOS, tamoxifen, HPNCC
Non-atypical or atypical
Treatment= IUS, progesterone, hysteretomy
Risk of cancer

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Endometrial Cancer

Type 1= endometriod (oestrogen-dependent)

Type 2= serous (atrophy, grade 3)

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Polycystic Ovarian Syndrome

2/3 of hyperandrogenism, menstrual abnormalities, polycystic ovaries
Treatment= metformin, OCP, ovarian drilling
Comps= hyperplasia and adenocarcinoma

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Ovarian Failure

Primary= infection, surgery, radio, toxins, Turner's, Klinefelter's
Secondary= Sheehan's, pit tumours, brain injury, PCOS

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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