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Handbook Section 3a Flashcards

1
Q

Common skin lesions, cancers

A

Basal Cell Carcinoma - pearly pink bump/flat area
Squamous Cell Carcinoma - red scaly occasionally tender plaque
Melanoma - Irregular multicolored flat area

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2
Q

Common skin lesions, benign

A

Benign Mole - single colored demarcated brown area
Seborrhoeic Keratosis - Stuck on mole

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3
Q

Neurofibromatosis, general definition

A

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.

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4
Q

Types of neurofibromatosis

A

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

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5
Q

Reactive arthritis (Reiter syndrome) triad

A

conjunctivitis, urethritis, arthritis

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6
Q

Cranial nerves (OOOTTA FAG VAH)

A
  1. Olfactory - smell
  2. Optic - Visual acuity
  3. Oculomotor - all eye movement (except SO4, LR6)
  4. Trochlear - SO eye movement (down medial)
  5. Trigeminal - Facial sensation, chewing
  6. Abducens - LR eye movement
  7. Facial - facial muscles (except chewing)
  8. Auditory - hearing and balance
  9. Glossopharyngeal - taste on posterior tongue
  10. Vagus - swallowing
  11. Accessory - shoulder shrug
  12. Hypoglossal - Tongue movement
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7
Q

Common causes of postoperative fever

A

Lung (aspiration, atelectasis)
Infection
Embolism
Drugs

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8
Q

Ulcer types

A

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

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9
Q

Acute primary angle closure glaucoma, presentation

A

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

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10
Q

Acute primary angle closure glaucoma, examination results

A
  • 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
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11
Q

Acute Primary Angle Closure Glaucoma, Management

A

After history and examination, discuss with specialist if still with doubt

  1. Acetazolamide - carbonic anhydrase inhibitor (WOF renal)
  2. Pilocarpine - muscarinic cholinergic (dry)
  3. Brimonidine - alpha adrenergic (dry)
  4. Timolol - beta blocker
  5. Prednisolone - instant corticosteroids
  6. Mannitol - diuretic
  7. Laser PI

Follow up 1 week or earlier

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12
Q

Brain death confirmation requirements

A

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.

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13
Q

Wernicke encephalopathy, overview

A

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)

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14
Q

3 major nerves in the arm

A

Front arm
- thumb side (medial nerve)
- pinky side (ulnar nerve)

Back arm (radial nerve)

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15
Q

Cushing’s triad (Increased ICP)

A
  1. bradycardia
  2. irregular respirations
  3. hypertension
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16
Q

Common fractures - artery/vein and nerve injuries
(TORSO and PELVIS)

A

TORSO
Vertebra - Spinal cord, nerve root
Clavicle - Subclavian artery, Brachial plexus

PELVIS
Sacroiliac - Sacral plexus, lumbosacral plexus
Acetabulum - Sciatic

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17
Q

Common fractures - artery and nerve injuries
(UPPER EXTREMITIES)

A
  1. Proximal Humerus - Axillary and brachial artery; Axillary and Suprascapular nerve
  2. Humerus shaft - Brachial artery; Radial, Median and Ulnar nerve
  3. Supracondylar (humerus) - Brachial artery; Median, Anterior interosseous, Radial and Ulnar nerve
  4. Radius/Ulna - Brachial, Axillary and Ulnar artery; Median and Ulnar nerve
  5. Scaphoid - Median nerve (Acute carpal tunnel)
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18
Q

Common fractures - artery and nerve injuries
(LOWER EXTREMITY)

A
  1. Femur - Femoral artery; Femoral nerve
  2. Tibia - Popliteal, Anterior tibial and Posterior tibial artery; Tibial, Superficial peroneal and deep peroneal artery
  3. Fibular head and neck - Peroneal nerve
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19
Q

Stenosing Tenosynovitis (Trigger finger), presentation

A

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)

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20
Q

Dupuytren’s contracture, presentation

A

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

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21
Q

De quervain’s tenosynovitis, definition

A

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

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22
Q

Mallet finger, presentation

A

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

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23
Q

Inflammatory Myopathies, presentation (Chronic Inflammatory Demyelinating Polyradiculoneuropathy)

A

Triggered autoimmune attack on the nervous system causing:

slow progressive weakness (legs> arms>sensation>cranial nerves)

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24
Q

Inflammatory Myopathies, presentation (Dermatomyositis)

A

inflammation causes

  • skin rash (gottron’s, shawl sign, v sign, nails)
  • muscle weakness (trunk going outward)
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25
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.
26
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
27
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
28
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
29
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
30
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)
31
ECG rhythms, ventricular tachycardia
- fat saw tooth Stable treatment - procainamide - amiodarone
32
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)
33
High risk for ACS, features
Ongoing chest pain Dyspnea Syncope/presyncope Palpitations
34
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
35
Chronic stable angina, management
Goal: relieve angine, prevent cardiovascular events RELIEF: Betablockers Calcium channel antagonists Short acting nitrates PREVENT: Low dose aspirin statins
36
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)
37
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.
38
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 2. Clinical evidence
39
PTB treatment
Pyrazinamide Isoniazid Rifampicin Ethambutol subject to change after culture results
40
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)
41
Atypical pneumonia, treatment
Macrolides - Azithromycin, Clarithromycin Fluoroquinolones - Ciprofloxacin, Levofloxacin Tetracyclines - Doxycycline, Tetracycline
42
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
43
Laboratory tests that suggest advanced cirrhosis
1. Low albumin 2. Raised bilirubin 3. Raised INR
44
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
45
Child-Pugh Score for Cirrhosis Mortality
- estimates cirrhosis severity Components: - Total bilirubin - Albumin - INR - Ascites - Encephalopathy
46
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
47
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
48
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
49
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
50
Imaging features of solid liver lesions (Intrahepatic cholangiocarcinoma)
ULTRASOUND - homogenous hypoechoic CONTRAST CT SCAN - hypodense with rim/peripheral enhancement
51
Imaging features of solid liver lesions (Liver metastases)
ULTRASOUND - multiple lesions, character depends on source CONTRAST CT SCAN - multiple lesions, character depends on source
52
Acute appendicitis, initial investigations
- urine test (plus pregnancy test) - Blood tests (FBC, CRP) Optional - Abdominal xray - UEC (urea, electrolytes, creatinine) - Ultrasound - CT scan
53
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)
54
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
55
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
56
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
57
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
58
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)
59
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.
60
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
61
Cause of per rectal bleeding
1. Diverticular disease – most common cause of significant bleeding 2. Haemorrhoids - most common cause of all cause bleeding 3. Angiodysplasia 4. Ischaemia 5. Neoplastic 6. Inflammatory – infectious/non infectious 7. Iatrogenic e.g. polypectomy.
62
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
63
Bile pathway
Common hepatic duct (liver) + Cystic duct (gallbladder) = Common Bile Duct + Pancreatic duct = END (Duodenum)
64
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
65
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)
66
Diabetes Screening, low risk
every 3 years after 40 years old using Australian type 2 diabetes risk assessment tool (AUSDRISK)
67
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)
68
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
69
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
70
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
71
Colovesical Fistula, symptoms
- Pneumaturia (gas in the urine) - Fecaluria (fecal matter in the urine) - Dysuria (painful upon urinating) - Hematuria (blood in the urine)
72
Colovesical Fistula, causes
- cancer - IBD - surgery - radiation therapy - diverticulitis
73
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)
74
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)
75
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)
76
Urinary retention, acute vs chronic
Acute - cannot urinate at all, requires immediate emergency management Chronic - cannot completely empty the bladder
77
Urinary retention, investigations
- Physical examination - post voidal residual management (ultrasound) OPTIONAL - cystoscopy - CT scan - urodynamic tests - electromyography
78
Crush syndrome characteristics
Rhabdomyolysis Lactic acidosis Hyperkalaemia Renal failure Shock Dysrhythmia
79
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
80
Hyperkalaemia, treatment
- Calcium gluconate - Salbutamol - IV fluids (optional bicarbonate) - Insulin or Glucose - Remove potassium from bowel - Dialysis - Treat cause
81
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
82
Q fever (Coxiella burnetii), transmission
- contaminated aerosol/dust (animal residue) - injury with contaminated objects - unpasteurised milk consumption
83
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)
84
Q fever, treatment
If clinically suspected, start treatment - Doxycycline x 2 weeks Pregnant women - Trimethoprim + Sulfamethoxazole
85
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
86
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
87
Organ timeframes in storage
Heart - 4-6 hours Lungs - 4-6 hours Liver - 8-12 hours Kidney - 24-36 hours
88
Top 3 most frequent cause of death in transplant recipients
1. Cancer (19%) - Kaposi sarcoma, etc 2. Rejection (18%) 3. Infection (17%)
89
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
90
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
91
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
92
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
93
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
94
Antihypertensive drugs allowed in pregnancy
Hydralazine Labetalol Methyldopa Nifedipine Prazosin
95
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)
96
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
97
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
98
Physiological ovarian cysts on ultrasound
1. Follicular - unilocular, thin walled, anechoic contents 2. Corpus luteum - thick walled, hyperechoic spider web contents 3. Peritoneal Pseudocysts - irregular walled, flapping multilocular, thin walled cystic contents
99
Risk of malignancy, ultrasound factors
- irregular solid tumors - ascites - >4 papillary structures - irregular multilocular solid tumour with largest diameter >10cm - very good blood flow
100
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)

AMC notes (6 decks)

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