Repro 3 Flashcards
HIV
retro virus transcribes its RNA using reverse transcription
normal CD4
OI CD4 count
500-1600
<200 but can get infections 200-500
HIV viral replication
rapid in very early and very late
new gen every 6-12 weeks
average time to death without treatment
9-11 years
infection
infection of mucosal CD4 (langerhan and dendritic cells) - regional LNs
infection established within 3 days
epidemiology of HIV
MSM
low SES
when do px present
2-4 weeks after infection
fever, maculopapular rash, myalgia, pharyngitis, headache/aseptic meningitis
pneumocystis pneumonia
CD <200
inside onset, SOB, dry cough, exercise desat
high dose co tramoxazole (+/- steroid)
proph for low CD4 low dose co -tramox
TB and immune reconstitution syndrome
immune system reactivated but is more aggressive
cerebral toxoplasmosis
CD4 <150
reactivation of latent virus
multiple cerebral abscess, chorioventinitis
headache fever decrease level of consciousness focal neurology seizures increased ICP
MRI ring enhancing lesions
cytomegalovirus
CMV
CD4<50
reactivation of latent virus - retinitis, colitis, oesophagitis
decreased visual acuity, floaters, abdominal pain, diarrhoea, PR bleeding
ophthalmic screening CD4<50
HIV assoc neurocognitive impairment
HIV1
reduce short term memory +/- motor dysf
progressive multifocal leukonencephalophathy
JC virus
cd4<100
rapidly progressive
focal neurology, confusion, personality change
haematological
anaemia thrombocytopenia
non opportunistic infection symptoms
mucosal candida, seborrheic derm, diarrhoea, fatigue, worsening psoriasis, LD, STIs, hep B, hep C
kaposkis sarcoma
HPV 8
more common in MSM
HAART, local therapies - systemic chemo
non hodgkins lymphoma
EBV
HIV and HAARTs
cervical cancer
HPV
women screened every year rather than every 3 years
risks of HIV transmission
concurrent STIs, anoreceptve sex, trauma, genital ulceration
types of HIV transmission
sexual
parental
maternal
risk of maternal tranmission
1-2%
<0.1% when viral load undetectable
what markers are used in HIV
viral rNA
antigen P24
antibody
3rd gen
ABs IgG/IgM
window period 20-25 days
4th gen
AB and AG P24
WP 14-28 days
rapid hiv testing (POCT)
finger prick or saliva
short wait. simple. good sensitive
expensive. not suitable for high load
recent infection testing algorithm
can be used to measure if an infection has occurred within the preceding 4-6 months
large margin of error
HAART drugs taken how
single tablet taking once daily
tenofovir (NERTI)
emtricitabine (NRTI)
efavicrenz (NNTRI)
preventing drug resistance main thing
compliance
prevention of HIV
condoms
rx
STI screening and treatment
post and pre exposure proph
hiv pos female and hiv neg male
hiv pos male and hiv neg female
insemination for baby
unprotected sex with HAART, inseminsation
prevention of maternal transmission
HAART during preg
if viral load undetectable vaginal, if high CS
4 weeks PEP for neonate
formula feeding
risk factors for breast cancer
age gene mutations BRCA1, BRCA2, TP53, PTEN, ATM, STKII/LKBI hyperplasia birth of first born after 30 alcohol early onset of periods FH early menarche low parity no BF late menopause endogenous or exogenous hormones BMI
what reduces the risk of BC
NSAIDs
BRCA1
BRCA2
chromosome 17
chromosome 13
pre meno
post meno
tamoxifen for 5 years
aromatase inhibitors such as letrozole, Anastrozole
beyond 5 years adjuvant therapy
5 years of tamox and now post meno then aromatase
if 5 years of tamox and still pre meno then more years of temox
HER2
tratsuzumab (herceptin) for a year
phyllodes tumrou
can be malignant
cut surface looks like a leaf
stromal and epithelial but stromal bit is neoplastic
angiosarcoma
post radiotherapy for breast cancer
atypical lobular hyperplasia
lobular carcinoma in situ
<50% of lobule involved
>50%
e cadherin gene
negative in lobular
CDH1 gene deletion
cell adhesion gene
pagets
high grade DCIS
extending along ducts to epidermis of nipple
still in situ
cytokerin used to stain
micro invasive carcinoma
DCIS high grade
invasion of <1mm
ER positive
oophorectomy
tamoxifen
letrozole
gosenlin
nottingham prognostico index
adjuvant online
PREDICT
histopatho
histopatho + ER +CF
histopatho + ER + CF + HER2 + mode of detection
triple assessment
clinical history and exam
imaging - mam, USS, MRI
pathology - cytopathology, histopatho, therapeutic
fibroadenoma
looks like phyllodes but phyllodes is in older women and are larger and increase in size
fibroadenoma
peak in 30s and repro life
can grow rapidly if become pregnant
african women
breast mouse
fibroadenoma
cysts
late repro life
FNA to dx and rx
tender before mentruation
cysts
papilloma
benign intracytic papillary prolif assoc with bloody cyst fluid
pagets disease
eczema like changes to nipple
adenolipoma
smooth palpable mass
characteristic mam pattern
apocrine metaplasia
of epithelial cells which enlarge and are eosinophillis
line cysts
glactocele
FNA to dx and treat
lipoma
palpable
think smooth borders on mam
adipose cells on biopsy
inflam of being just under chest wall
mordoms
firm vertical cords and history of trauma
resolves spontaneously in 8-12 weeks
gynacamastia
ductal growth but no lobular growth
fibrocystic change
40-50s
smooth discrete lumps, sudden pain of ruptured cyst, cyclic pain which changes with menstrual cycle, lump
haemartoma
circumscribed lesion composed of cell types normal to the breast but in abnormal proportion or distribution
not troublesome - left alone
sclerosing lesions
benign disorderly proliferation of acini and stroma
can cause mass of calcification
may mimic cancer
sclerosising adenoma
pain or tenderness or lump/thickening
often asymp
benign
radial scar
complex sclerosing lesions
RA 1-9mm
CSL >10mm
mimic cancer
cancer in situ/invasive can occur in the middle
stellate architecture
central puckering
radiating fibrosis
fibroelastic core
epithelial prolif
RS/CSL
duct ectasia
green/purulent/bloody dc
assoc with smoking
duct ectasia what is it
keratin plugging
causes stasis of secretion - can lead to infection
affects sub areolar ducts
how long does it take for the hcg to double
in 48 hours in early
