Repro 2 Flashcards
Epithelial ovarian tumours types
serous muncinous endeomtroid clear cell brenners
serous ovarian cancer
low grade - borderline, less common
high grade - serous tubal intra epithelial carcinoma precursor
endometriod/clear cell ovarian cancer
astong assoc with endometriosis and Lynch syndrome
primary dx made on ascitic fluid
brenners tumour
tumour of transitional type epithelium
usually benign
commonest type of germ cell ovarian tumour
mature teratoma (dermoid)
dysgerminoma
most common malignant CGT
1-2% of all malignant ovarian tumours
children and young women 22yo
types of sex cord ovarian tumours
fibroma/thecoma benign oestrogen producing
granulosa - all potentially malignant asssoc with oestrogenic manifestations
sertoli lydegi - androgen producing
precarious puberty, PMG
granulosa
oestrogen
hirsutism/virilisation
theca/leydig
androgen
mets in ovary
stomach, colon, breast, pancreas
Figo staging of ovarian cancer
1A one ovary 1B both 1c ovarian surface/rupture 2a fallopian tubes/uterus 2b other pelvic intraperitoneal 3a retroperitoneal LN mets, micro extra pelvic peritoneal involvement 3b macro mets up to 2cm beyond pelvis 3c >2cm 4 distant mets
symtoms of ovarian tumours
ascities bloating pelvic mass bladder dysfunction pleural effusion/SOB incidental
CA125 vs CEA
raised in 80%, normal level doesn’t exclude
mod raised esp in mucinous
which of the two is more useful for follow up
CA125
what else other than an ovarian tumour raise CA125
endometriosis, infection, pregnancy, pancreatitis, ascitis
RMI calculated how
USS: multilocular, solid, bilateral, ascites, intra abd mets 0=0 1=1 3=2 or more pre meno =1 post meno=3 Ca 125 u/ml US X meno X CA125 >200 refer
cause of endometriosis
regurg, metaplasia
complications of endometriosis
infertility, pain, cyst formation, adhesions, ectopic pregnancy, endometriod malignancy
macroscopic endometriosis
micro
peritoneal spots/nodules, fibrous adhesions, choc cysts
endometrial glands and stroma, haemo, inflam, fibrosis
dx of endometriosis
laparoscopically
malignancy germ cell
increased HCG increased AFP
hydrosalpinx
pylosapinx
distally blocked fallopian tube with serous/clear fluid
pus
acute/chronic salpingitis
chronic if lymphocytes
increase risk for ectopic pregnancy
what forms need to be filled with a TOP
HSA1 two medication practitioners for planned
HSA2 doctor needs to complete within 24 hours of emergency TOP
HSA4 doctor needs to complete and send to chief medical officer within 7 days of TOP
TOP limits
23 +6 in the UK
18+6 in tayside
medical
whenever
oral mifepristone 200mg (anti progesterone)
24-48 hours later vaginal (gemeprest) or oral (misoprastol) prostag
differences in medical
early 0-9 both steps at home
9-24 repeated dose of prostag 3 hourly max 5/24
surgical
vacuum aspiration 6-12 weeks
dilatation evactuation 13-24
cervical priming, vaginal prostag
risks of surgical
pain haem, infection, incomplete/failed, uterine perf, trauma, anaesthetic cx, ongoing preg, uterine rupture
after care of TOP
upt at 3 weeks
anti D
contraception
Levonelle
1.5mg inhibits ovulation 72 hour after UPSI failure rate 1-2% enzyme inducers
ellaone
30mg inhibits/delayes ovulation 120 hours after failure rate <1% antacids
copper IUD
up to 120 hours post UPSI
5 days after ovulation
all methods of EC
UPT at three weeks
risk factors for candida
recent AB therapy high oestrogen levels - prog poorly controlled DM immunocomprimised v low CD4 count
c albicans
budding (hyphae)
rx for candida
topical clotrimazole cream or pessary available OTC
oral fluconazole
BV
rx
gardnella vaginalis
metro 400mg twice daily for 7 days or 2g stat
prostitis treatment
ciprofloxacin 500mg bd 28 days
erimethoprim 200mg bd 28 days if high risk of C Diff
treponema pallidum
doesn’t stain with gram stain
non specific AB to see how active the disease is and monster response to treatment
VDRL, RPR
become negative after treatment
may be falsely positive
specific serology to confirm syphilis
TPPA, INNO LIA, FTAAb
stay positive for life
tayside screening of syph
ELISA/EIA
IgG/IgM
if positive IgG/IgM then IgM ELISA, VDRLA, TPPA
IgG and TPAA
stay positive for life
IgM and VDRLA
neg after treatment within a few months
gonorrhoea
gran neg intracellular diploccosu - two kidney beans
easily phavgpcytosed by macrophages
can’t survive outside the body
purulent green/yellow discharge in males
gon
rx of gon
ceftriaxone 500mg IM and azitho 1g stat
ceftriaxone 400mg orally if IM contra indicated or refused
test of cure
chlamydia
biphasic life cycle
does not reproduce outside the host cell
doesn’t stain with grams stain - no peptidoglycan in cell wall
A-C
D-K
L1-L3
trachoma
genital
lymphogranulotoma venercum in MSM
PID increases the risk of what
chlamydia by 10
rx of chlamyd
azitho 1g stat
rectal - doxy 100mg bd 7 days
PCR/NAATS > culture
less invasive specimens
more sensitive
positive even if organisms die in transit
hours not days
culture > PCR/NAATS
can’t tell AB sensitivities
will detect dead organisms - have to wait 5 w to do test of cure
enveloped virus containing double stranded DNA
HSV1 and HSV2
treatment for genital herpes
none self limiting topical lidocaine 5% cream if v painful saline bathing analgesia aciclovir vaccine
treatment for genital warts
cryotherapy
podophyllotoxin cream
imiquimod
non enclosed corohedral virus contains dsDNA
can grow in artificial culture
HPV
single cells protozoal parasite divides by binary fission
humans onky
TV
metro
pubic lice
males live for 22 days
females 17
malothian lotion
