Handbook Section 3a Flashcards
Common skin lesions, cancers
Basal Cell Carcinoma - pearly pink bump/flat area
Squamous Cell Carcinoma - red scaly occasionally tender plaque
Melanoma - Irregular multicolored flat area
Common skin lesions, benign
Benign Mole - single colored demarcated brown area
Seborrhoeic Keratosis - Stuck on mole
Neurofibromatosis, general definition
Usually diagnosed in childhood, it is a genetic condition characterised by the growth of usually benign neurofibromas
A common sign is ‘café au lait’ spots with vision problems.
Types of neurofibromatosis
Neurofibromatosis type 1 (NF1) — the most common form, caused by a change in a gene on chromosome 17, presents with more than 6 cafe au lait spots
Neurofibromatosis type 2 (NF2) — a very rare form, caused by a change in a gene on chromosome 22, found in ears, brain, spinal cord
Schwannomatosis — similar to NF2, but not associated with inner ear tumours and hearing loss, initially presents with random localized pain
Reactive arthritis (Reiter syndrome) triad
conjunctivitis, urethritis, arthritis
Cranial nerves (OOOTTA FAG VAH)
- Olfactory - smell
- Optic - Visual acuity
- Oculomotor - all eye movement (except SO4, LR6)
- Trochlear - SO eye movement (down medial)
- Trigeminal - Facial sensation, chewing
- Abducens - LR eye movement
- Facial - facial muscles (except chewing)
- Auditory - hearing and balance
- Glossopharyngeal - taste on posterior tongue
- Vagus - swallowing
- Accessory - shoulder shrug
- Hypoglossal - Tongue movement
Common causes of postoperative fever
Lung (aspiration, atelectasis)
Infection
Embolism
Drugs
Ulcer types
Neuropathic ulcers are painless ulcers over areas of abnormal pressure, often secondary to joint deformity in diabetics
Venous ulcers are shallow ulcers with a granulated base, often with other clinical features of venous insufficiency present
Arterial ulcers are found at distal sites, often with well-defined borders and other evidence of arterial insufficiency
Acute primary angle closure glaucoma, presentation
Risk factors
1. Asian
2. Hypermetropia (far sighted)
3. medications that affects the eye
Signs and Symptoms
1. blurred vision
2. haloes
3. eye/brow pain
4. headache
5. red eye
6. nausea and vomiting
Acute primary angle closure glaucoma, examination results
- IOP usually >35mmHg
- Corneal oedema
- Mid-dilated, poorly reactive pupil
- Shallow central and peripheral anterior chamber (AC) in the affected/both eyes
- Closed angle on gonioscopy
- Anterior chamber inflammation
- Signs of previous angle-closure attacks; e.g. peripheral anterior synechiae,
segmental iris atrophy, glaukomflecken, posterior synechiae or irregular pupil
Acute Primary Angle Closure Glaucoma, Management
After history and examination, discuss with specialist if still with doubt
- Acetazolamide - carbonic anhydrase inhibitor (WOF renal)
- Pilocarpine - muscarinic cholinergic (dry)
- Brimonidine - alpha adrenergic (dry)
- Timolol - beta blocker
- Prednisolone - instant corticosteroids
- Mannitol - diuretic
- Laser PI
Follow up 1 week or earlier
Brain death confirmation requirements
REQUIREMENTS MUST BE SUFFICIENT:
1. severe brain injury.
2. condition is not due to sedatives
3. No other reversible cause of the condition
Two senior doctors must perform separate tests to check if the cranial nerves are working
They also check to see if the person:
1. response to pain
2. response when a light is shone in the pupil of each eye
3. blinks or moves when each eye is touched
4. responds to ice cold water put into the ear canal
5. has a cough or gag (swallowing) reaction
6. can breathe when disconnected from the ventilator
For a person to be certified brain dead, they must show no response to every one of these tests.
Wernicke encephalopathy, overview
Risk factor - alcoholic, Vit B1 (thiamine) deficiency
Complication - Wernicke - Korsakoff syndrome (alcohol related dementia)
Presentation:
1. Eyes (drooping, jerking, double vision)
2. Balance (difficulty standing)
3. Movement (difficulty walking)
4. Consciousness (drowsy/confused, disoriented)
3 major nerves in the arm
Front arm
- thumb side (medial nerve)
- pinky side (ulnar nerve)
Back arm (radial nerve)
Cushing’s triad (Increased ICP)
- bradycardia
- irregular respirations
- hypertension
Common fractures - artery/vein and nerve injuries
(TORSO and PELVIS)
TORSO
Vertebra - Spinal cord, nerve root
Clavicle - Subclavian artery, Brachial plexus
PELVIS
Sacroiliac - Sacral plexus, lumbosacral plexus
Acetabulum - Sciatic
Common fractures - artery and nerve injuries
(UPPER EXTREMITIES)
- Proximal Humerus - Axillary and brachial artery; Axillary and Suprascapular nerve
- Humerus shaft - Brachial artery; Radial, Median and Ulnar nerve
- Supracondylar (humerus) - Brachial artery; Median, Anterior interosseous, Radial and Ulnar nerve
- Radius/Ulna - Brachial, Axillary and Ulnar artery; Median and Ulnar nerve
- Scaphoid - Median nerve (Acute carpal tunnel)
Common fractures - artery and nerve injuries
(LOWER EXTREMITY)
- Femur - Femoral artery; Femoral nerve
- Tibia - Popliteal, Anterior tibial and Posterior tibial artery; Tibial, Superficial peroneal and deep peroneal artery
- Fibular head and neck - Peroneal nerve
Stenosing Tenosynovitis (Trigger finger), presentation
The first indication of the condition may be slight stiffness or even “clicking” when flexing the finger/thumb especially in the morning, due to an increasing blockage in the finger “pulley” that facilitates movement.
History:
- common in middle aged women
- trauma/surgery
- repetitive work
- some systemic conditions (gout, arthritis,diabetes)
Dupuytren’s contracture, presentation
palmar fascia becomes thicker and tighter causing the first sign, one or more nodules on the palm. Over time these nodules get bigger which pulls your fingers towards your palm
De quervain’s tenosynovitis, definition
Affecting the extensor pollicis brevis and abductor pollicis longus, inflammation and swelling of the tendon sheaths puts pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist which get worse while making a fist, grasping or gripping things, or turning the wrist
Mallet finger, presentation
Caused by forceful flexion to the end of an extended finger, usually occuring in contact or ball-handling sports. The terminal extensor tendon on the dorsum of the finger at the distal interphalangeal joint (DIP) is torn, stretched or avulsed.
Assessment
- Pain, swelling (+ / bruising) on the dorsum of the DIP joint
- Flexed posture of finger tip due to inability to actively extend it
- Passive (by the examiner) extension is usually possible
Inflammatory Myopathies, presentation (Chronic Inflammatory Demyelinating Polyradiculoneuropathy)
Triggered autoimmune attack on the nervous system causing:
slow progressive weakness (legs> arms>sensation>cranial nerves)
Inflammatory Myopathies, presentation (Dermatomyositis)
inflammation causes
- skin rash (gottron’s, shawl sign, v sign, nails)
- muscle weakness (trunk going outward)
Inflammatory Myopathies, presentation (Inclusion Body Myositis)
A muscle condition that causes thin and weak muscles
Skeletal muscle weakness and wasting progresses from quadriceps (thigh) to forearm muscles.
Inflammatory Myopathies, presentation (Polymyositis)
Connective tissue disease that triggers inflammation and muscular weakness.
- Muscle weakness develops gradually over the course of a few weeks or months
- Inflammation may spread to other areas of the body including the heart
ECG rhythms, Heart blocks
1st degree
- PR interval >200ms
- benign, usually asymptomatic
2nd degree (Mobitz I - Wenckebach)
- P-R increasingly slows then a QRS is dropped
- benign, usually asymptomatic
2nd degree (Mobitz II)
- P-R is regular, sudden QRS dropped
- benign, usually asymptomatic
3rd degree
- Atria and ventricles is completely separate
- syncope, weakness
TREATMENT
- pacemaker
ECG rhythms, atrial flutter vs fibrillation
Flutter
- irregular rapid heartbeat
- sawtooth pattern
Treatment - HR, rhythm, anti emboli, ablation
Fibrillation
- irregular heartbeat, palpitations
- irregularly irregular, 0 pattern
Treatment
maintenance - digoxin, bb,ccb
stable/no HF - betablocker, calcium channel blocker
unstable - amiodarone
dying - cardioversion
ECG rhythms, supraventricular tachycardia
Supraventricular Tachycardia
- 140-200 bpm, palpitations, chestpain, syncope
- very slim sinus rhythm
Treatment
- modified valsalva
- carotid sinus massage
- adenosine (CI asthma) (safer)
- verapamil
- cardioversion
- catheter ablation
ECG rhythms, ventricular fibrillation/flutter
Ventricular flutter
- saw tooth pattern, 250-300bpm
Ventricular Fibrillation
- irregular sawtooth
Treatment
1st line - atenolol, metoprolol, diltiazem, verapamil
2nd line - digoxin, defibrillation, flecainide( only for normal hearts)
ECG rhythms, ventricular tachycardia
- fat saw tooth
Stable treatment
- procainamide
- amiodarone
Heart pathway, blood
Superior/Inferior vena cava
Right atrium
Tricuspid Valve
Right ventricle
Pulmonic valve (inside RV)
Lungs
Pulmonary vein
Left atrium
Mitral valve
Left ventricle
Aortic valve (inside LV)
High risk for ACS, features
Ongoing chest pain
Dyspnea
Syncope/presyncope
Palpitations
ACS management
Prehospital: Aspirin and sublingual GTN
Serial 12L ECG (10-15mins until pain-free)
Cardiac troponin (or other biomarkers)
Chest x-ray
MONA
morphine
oxygen
nitrates
aspirin
anti-thrombotic
Chronic stable angina, management
Goal: relieve angine, prevent cardiovascular events
RELIEF:
Betablockers
Calcium channel antagonists
Short acting nitrates
PREVENT:
Low dose aspirin
statins
Types of pneumothorax
Closed - Lungs to pleural cavity
(cavity pressure < atmosphere pressure)
Open - open passage pleural cavity to environment
(cavity pressure = environement)
Tension - one way passage environment to pleural cavity, no exit of air thus increasing tension
(cavity pressure > atmospheric pressure)
Cardiac tamponade vs Tension pneumothorax
Only cardiac tamponade and tension pneumothorax produce jugular venous distention with a chest injury. How you tell the difference is by auscultating the lungs. Tamponade will typically reveal clear, bilateral, lung sounds while a tension pneumothorax will not.
Confirming a TB diagnosis case requirement
Cases are confirmed via
1. Laboratory
- Culture (except for BCG recipients)
- Nucleic acid amplification test (NAAT) (except for prior or current TB patients)
OR
- Clinical evidence
PTB treatment
Pyrazinamide
Isoniazid
Rifampicin
Ethambutol
subject to change after culture results
Hospital acquired pneumonia, treament
Low risk for MRO (non ICU, ICU<5 days)
- Amoxycillin+clavulanate or Benzylpenicillin+gentamicin
- Pen allergic (ceftriaxone)
High risk for MRO
- piptaz + genta
- Pen allergic (cefepime + genta)
Atypical pneumonia, treatment
Macrolides - Azithromycin, Clarithromycin
Fluoroquinolones - Ciprofloxacin, Levofloxacin
Tetracyclines - Doxycycline, Tetracycline
Detecting alcohol problem
(CAGE questionnaire)
- Felt the need to CUT DOWN
- ANNOYED at the suggestion to cut down
- felt GUILTY about your drinking
- needed an EYE OPENER (morning alcohol)
2 or more - alcohol problem
Laboratory tests that suggest advanced cirrhosis
- Low albumin
- Raised bilirubin
- Raised INR
Maddrey’s Discriminant Function for Alcoholic Hepatitis
- Suggests which patients with alcoholic hepatitis may have a poor prognosis and benefit from steroid administration.
Components:
- PT
- Total bilirubin
Child-Pugh Score for Cirrhosis Mortality
- estimates cirrhosis severity
Components:
- Total bilirubin
- Albumin
- INR
- Ascites
- Encephalopathy
Imaging features of solid liver lesions
(Hepatic hemangioma)
ULTRASOUND - well demarcated homogenous hyperechoic mass
CONTRAST CT - well demarcated hypodense mass, peripheral nodular enhancement in early phase, centripetal pattern in late phase
Imaging features of solid liver lesions
(Focal nodular hyperplasia)
ULTRASOUND - Variable general appearance, central hyperechoic area (scar)
CONTRAST CT SCAN - Isodense on portal venous phase, hyperdense on central scar
Imaging features of solid liver lesions
(Hepatocellular Adenoma)
ULTRASOUND - heterogenous, hyperechoic lesion
CONTRAST CT SCAN - well demarcated with peripheral enhancement in early phase and centripetal in late phase, appears as high attenuating if with recent bleeding
Imaging features of solid liver lesions
(Hepatocellular carcinoma)
ULTRASOUND - poorly defined margin, coarse, irregular internal echoes
CONTRAST CT SCAN - hypervascular during the arterial phase, contrast washout in later phase
Imaging features of solid liver lesions
(Intrahepatic cholangiocarcinoma)
ULTRASOUND - homogenous hypoechoic
CONTRAST CT SCAN - hypodense with rim/peripheral enhancement
Imaging features of solid liver lesions
(Liver metastases)
ULTRASOUND - multiple lesions, character depends on source
CONTRAST CT SCAN - multiple lesions, character depends on source
Acute appendicitis, initial investigations
- urine test (plus pregnancy test)
- Blood tests (FBC, CRP)
Optional
- Abdominal xray
- UEC (urea, electrolytes, creatinine)
- Ultrasound
- CT scan
Acute appendicitis, management
- refer to general surgical team
- analgesia
- NBM (nil by mouth)
- resuscitate
- rehydrate (over 24 hrs)
- start IV fluid maintenance
- antibiotics (if ordered by surgery team, septic)
Stomach (gastric) cancer, risk factors
- > 60 yrs old
- Male
- Helicobacter pylori infection
- Gastrectomy
- Smoking
- Pernicious anemia
- Family history (gastric adenocarcinoma, familial adenomatous polyposis, lynch syndrome, stomach proximal polyposis, hereditary diffuse gastric cancer)
- chronic inflammation of the stomach (chronic gastritis)
- overweight
- alcohol intake
- salt preserved foods
Bowel (colorectal) cancer, risk factors
- > 50 yrs of age
- inflammatory bowel disease
- bowel polyps
- history of any bowel cancer
- family history of bowel cancer or adenomatous polyps
Liver cancer, risk factors
- fatty liver disease
- genetic disorders (haemochromatosis, alpha 1-antitrypsin deficiency)
- type 2 DM
- hepatitis B or C
- alcohol
- obesity
- tobacco
- certain chemicals
Oesophageal cancer, risk factors
- tobacco
- alcohol
- low fruit and vegetable diet
- obesity
- certain chemical fumes
- family history of gastrointestinal disorders
- family history of cowden syndrome or peutz-jeghers syndrome
- medical conditions such as barrett’s oesophagus or GERD
Small bowel cancer, risk factors
- crohn’s disease
- celiac disease
- animal fat and protein
- familial adenomatous polyposis
- lynch syndrome (hereditary nonpolyposis colorectal cancer)
- peutz-jeghers syndrome
- cystic fibrosis
- multiple endocrine neoplasia (MEN 1)
Barrett’s oesophagus, endoscopic description
A premalignant condition of the oesophagus defined as the presence of metaplastic columnar epithelium, which appears as salmon pink mucosa, extending above the gastro-oesophageal junction (GOJ) and into the tubular oesophagus, thereby replacing the stratified squamous epithelium that normally lines the distal oesophagus.
Barrett’s Oesophagus, management
Goal is the reduction in the length or area of metaplastic columnar epithelium
Anti-reflux surgery
medical therapy not shown as effective
Cause of per rectal bleeding
- Diverticular disease – most common cause of significant bleeding
- Haemorrhoids - most common cause of all cause bleeding
- Angiodysplasia
- Ischaemia
- Neoplastic
- Inflammatory – infectious/non infectious
- Iatrogenic e.g. polypectomy.
Ulcerative Colitis vs Crohn’s disease
LOCATION
UC - large intestine
CD - whole GI tract
INFLAMMATION PATTERN
UC - continuous, inner lining only
CD - patchy, entire thickness
BLEEDING
UC - common during BM
CD - uncommon
Bile pathway
Common hepatic duct (liver)
+
Cystic duct (gallbladder)
=
Common Bile Duct
+
Pancreatic duct
=
END (Duodenum)
Lactation Mastitis, management
First line antibiotics - Fluocloxacillin, dicloxacillin, cephalexin
Continue frequent feeding on affected breast
if symptoms do not resolve within 2 days
- ultrasound for abscess
DM type 2 clinical goals
HBA1c (<7%)
Lipids (depends on absolute cvd risk)
Total cholesterol (4 mmol/L)
HDL (>1 mmol/L)
LDL (<2 mmol/L, <1.8 mmo/L - CVD)
Triglycerides (<2.0 mmol/L)
Blood Pressure (<140/90)
Urine Albumin (Women: <3.5mg/mmol, Men: <2.5 mg/mmol)
Vaccination (Influenza, Pneumococcus, dTpa)
Diabetes Screening, low risk
every 3 years after 40 years old using
Australian type 2 diabetes risk assessment tool (AUSDRISK)
Diabetes screening, Aboriginal and Torres straight islander people
Annual screening from 18 years of age using
blood testing (fasting plasma glucose, random venous glucose, HBA1c)
Thyroid nodule diagnostic tests
TSH suppressed - Technetium pertechnetate thyroid scan
TSH not suppressed
- Sonographic risk stratification
Low risk - serial ultrasound
Intermediate risk - Fine needle aspiration, molecular testing
High risk - surgery
Idiopathic thrombocytopenic purpura, treatment
1st - corticosteroids (prednisone, dexamethasone)
* may add immunoglobulin periprocedurally or as add-on to steroid
2nd line
Diagnosis <12 months
- TPO-RA (avoids infections and splenectomy)
- rituximab (avoids thrombosis)
Diagnosis >12 months
- splenectomy (avoids medications and monitoring)
- TPO-RA
- Rituximab
Malaria presentation
- History of travel within 9-14 days
- Malaria is either benign (vivax, ovale) or malignant (falciparum)
- fever + chills + headache
P. falciparum
- most likely to progress to severe
P. vivax
- include splenomegaly (with, rarely, splenic rupture)
P. malariae
- include nephrotic syndrome
Colovesical Fistula, symptoms
- Pneumaturia (gas in the urine)
- Fecaluria (fecal matter in the urine)
- Dysuria (painful upon urinating)
- Hematuria (blood in the urine)
Colovesical Fistula, causes
- cancer
- IBD
- surgery
- radiation therapy
- diverticulitis
Renal colic, diagnostic tests
- Urine dipstick
- Urine microscopy and culture
- X ray KUB (less radiation)
or CT scan (Gold standard)
or Ultrasound (only for specific stones)
Renal colic management
- Majority of stones will pass within 6 months
5-7mm stones, passable at 60%
Analgesia (NSAID)
Repeat imaging at 4 wks
Refer to urologist (high risk for complications, >7mm stones, still present after 3 weeks)
Surgery (pending urologist)
Prostate cancer management
Modified Whitmore and Jewett staging
A1 (focal, microscopic)
- observation (usually for life expectancy <10 years independent of the prostate cancer)
A2/B (within the capsule)
- Radical prostatectomy (risk for incontinence and impotence), radiotherapy (risk for bowel damage), observation
C (beyond capsule/seminal vesicle invasion)
- radiotherapy, chemical ablation
D (Distant Metastasis/ pelvic lymph node invasion)
- Androgen ablation (such as orchidectomy, LHRH agonists, antiandrogens, total androgenic blockade, radiotherapy, strontium-89)
Urinary retention, acute vs chronic
Acute - cannot urinate at all, requires immediate emergency management
Chronic - cannot completely empty the bladder
Urinary retention, investigations
- Physical examination
- post voidal residual management (ultrasound)
OPTIONAL
- cystoscopy
- CT scan
- urodynamic tests
- electromyography
Crush syndrome characteristics
Rhabdomyolysis
Lactic acidosis
Hyperkalaemia
Renal failure
Shock
Dysrhythmia
Hyperkalaemia, investigation
Serum electrolytes
ECG
KFT
FBC
Venous blood gas
Glucose
ECG CHANGES
5.5 - 6.5 peaked T waves
6.5 - 7.5 loss P wave
>7.5 wide QRS
>8.0 Sine wave, VT, VF
Hyperkalaemia, treatment
- Calcium gluconate
- Salbutamol
- IV fluids (optional bicarbonate)
- Insulin or Glucose
- Remove potassium from bowel
- Dialysis
- Treat cause
Trace element deficiency, presentation
Zinc - hair/nail/skin changes, infection, wound healing, sight/taste loss
Selenium - muscle weakness, mental fog, hair loss
Copper - anemia, osteoporosis, thyroid problem, hypopigmented skin
Cobalt - anemia, vit b12 deficiency
Magnesium - vit k deficiency
Q fever (Coxiella burnetii), transmission
- contaminated aerosol/dust (animal residue)
- injury with contaminated objects
- unpasteurised milk consumption
Q fever, investigation
Definitive
- nucleic acid testing
- Antibody to antigen level (only for absence of vaccination)
- Culture (discouraged)
Suggestive
- IgM (only for absence of vaccination)
Q fever, treatment
If clinically suspected, start treatment
- Doxycycline x 2 weeks
Pregnant women
- Trimethoprim + Sulfamethoxazole
Cellulitis, management
No penicillin allergy, no known MRSA
* Abscess/boil/wound - Dicloxacillin, Flucloxacillin
* Erysipelas/non purulent - Phenoxymethylpenicillin
With non severe penicillin allergy, no known MRSA - Cephalexin
With immediate/severe penicillin allergy, MRSA
* depends on culture and sensitivity
* First line - Clindamycin
* Clindamycin resistant - Trimethoprim + Sulfamethoxazole
Lithium therapy overview
- used for bipolar
- steady state achieved at 4-5 days
- monitor every 3-6 months
SHORT TERM SIDE EFFECTS
- tremor, fatigue, diarrhoea, thirst, polyuria, nv
LONG TERM SIDE EFFECTS
KIDNEY (Diabetes Insipidus, ESRD)
THYROID (Hypothyroidism)
PARATHYROID (Inc PTH)
WT gain (1-2kg)
TERATOGENIC
TOXICITY - chronic neural toxicity
- lethargy
- drowsiness
- muscle weakness
- hand tremor
Organ timeframes in storage
Heart - 4-6 hours
Lungs - 4-6 hours
Liver - 8-12 hours
Kidney - 24-36 hours
Top 3 most frequent cause of death in transplant recipients
- Cancer (19%) - Kaposi sarcoma, etc
- Rejection (18%)
- Infection (17%)
Anaesthesia risk classification (ASA)
ASA I - normal completely healthy
ASA II - with mild systemic disease
ASA III - with severe systemic disease
ASA IV - with constant threat to life
ASA V - not expected to survive without surgery
ASA VI - brain dead
Epidemiology computation, Test results
Prevalence = concerned case/total included popn
Sensitivity = TP/All with disease
Specificity = TN/All without the disease
Positive Predictive Value = TP/All positive results
Negative Predictive Value = TN/All negative results
TP = true positive
TN = true negative
Epidemiology, rates computation
BASIC
Rate = in 1 year, unless specified
Rate = Total Cases/ Total population
Mortality rate = deaths/ midyear popn
Birth rate = births/ midyear popn
Fertility rate = live births/ mid year popn of fertile women, 15-44 years old
Infant mortality rate = Infant deaths without stillbirths/ live births in a year
Perinatal mortality rate = infant deaths with stillbirths/ total births in a year
Neonatal mortality rate = neonate deaths/ live births in a year
Examples of single gene conditions
AD - huntington, familial hypercholesterolaemia
AR - cystic fibrosis, phenylketonuria, sickle cell anaemia
XR - duchenne muscular dystrophy, haemophilia
XD - vit D resistant rickets
Cervical Ectropion, management
- no treatment unless with significant symptoms
- unremarkable tests
Optional treatments
- Change to nonhormonal contraceptives
- Cautery
- Laser
- Microwave tissue coagulation
- Alpha intereron suppository
- Polydeoxyribonucleotide vaginal suppository
- Boric acid vaginal suppository
- Autologous platelet-rich plasma application
- Focused ultrasound
Antihypertensive drugs allowed in pregnancy
Hydralazine
Labetalol
Methyldopa
Nifedipine
Prazosin
Regular menstrual cycle, by day
Day 1 - Menstruation, lasts 3-7 days
Day ? - Follicular phase, lasts 13-14 days
Day 14 - Ovulation, egg survives 24hrs
Day 15 - Luteal phase
Day 28 - End of cycle (Range 28-35 days)
Natural family planning methods
Cervical mucous/ Billings method
- no sex until 3 “dry” days have passed
Ovulation sign - clear stretchy mucous
Temperature method
- no sex until 3 subsequent temp rise
Symptothermal methods
- combines mucous and temp methods
Calendar/Rhythm method
- Based on the shortest and longest cycle out of three
Shortest cycle days - 21 = start of fertility
Longest cycle days - 10 = end of fertility
Endometriosis, presentation
Suspect endometriosis if with 1 or more of:
- infertility
- persistent pelvic pain
- significant dysmenorrhoea
- deep pain during or after sex
- period related or cyclical GI symptoms
- period related or cyclical GUT symptoms
Physiological ovarian cysts on ultrasound
- Follicular - unilocular, thin walled, anechoic contents
- Corpus luteum - thick walled, hyperechoic spider web contents
- Peritoneal Pseudocysts - irregular walled, flapping multilocular, thin walled cystic contents
Risk of malignancy, ultrasound factors
- irregular solid tumors
- ascites
- > 4 papillary structures
- irregular multilocular solid tumour with largest diameter >10cm
- very good blood flow
Ovarian mass, tumor markers
Serum Ca125 - Common screening test
Human epididymis protein 4
Alpha-feta protein (AFP)
Human chorionic gonadotropin (hCG)
Lactate dehydrogenase (LDH)
Carcinoembryonic antigen (CEA)
Cancer antigen 19.9 (Ca19.9)
