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FCM > Female Health > Flashcards

Female Health Flashcards

1
Q

The stages of prolapse

A

Stage 0 = no prolapse
Stage 1 = prolapse of >1cm above the hymen
Stage 2 = prolapse within 1cm proximal/distal to the plane of the hymen
Stage 3 = prolapse >1cm below the hymen but doesn’t protrude further than 2cm less than the total length of the vagina
Stage 4 = complete eversion of the vagina

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2
Q

What organism usually causes cervicitis?

How do you investigate it?

A

STIs - Chlamydia / T.Vaginalis / Gonorrhoea

NAAT / Cervical swab

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3
Q

What causes cervical cancer and how is it diagnosed?

A

Persistent HPV infection leading to squamous cell carcinoma.
Colposcopy is diagnostic for cervical cancer
PET scanning helps with staging

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4
Q

What are the early-stage symptoms of cervical cancer?

A
  • vaginal discharge
  • variation of bleeding
  • vaginal discomfort
  • urinary symptoms
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5
Q

What are the late-stage symptoms of cervical cancer?

A
  • painless haematuria
  • chronic urinary frequency
  • painless/fresh rectal bleeding
  • white/red patches on cervic
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6
Q

Investigation + Management of cervical cysts

A

Ix - pelvic exam: usually found on routine as patients are usually asymptomatic
Mx - if <4cm, no further Mx. If >4cm then cryotherapy or electrocautery ablation can be carried out.

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7
Q

What is the most common cause of bleeding in post-menopausal women?

A

Atrophic vaginitis

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8
Q

What condition is vaginitis commonly associated with and what test would you do?

A

Diabetes

do a fasting glucose test

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9
Q

What causes vulval cancer?

A

HPV - 16 / HPV - 18, causes squamous cell cancer

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10
Q

A 56 year old female comes in with itchiness down below, pain on urination. She also complains of night sweats and weight loss. On pelvic examination, you see a lump on the vulva. What confirms the diagnosis?

A

Dx - vulval cancer

Ix - Colposcopy with biopsy

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11
Q

What is vulval intraepithelial neoplasia?

A

The pre-malignant state where existing vulval disorders such as lichen sclerosis or squamous cell hyperplasia can transform.

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12
Q

A 32-year-old nulliparous woman presents with severe vulval pain and swelling. She has had increasing pain over the last day unrelieved by oral analgesics (paracetamol). She denies history of STIs, and her partner is asymptomatic. On exam, the patient is in severe discomfort and finding it difficult to sit down. She is mildly pyrexial. On vulval exam the left vulva is erythematous with swelling of the medial aspect and introitus, with the labium minus transecting a cystic swelling.

What is the condition?
How do you treat it?

A

Bartholin’s cyst

Incision and drainage + antibiotics (usually broad-spectrum like Co-Amoxiclav of Flucloxacillin)

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13
Q

A 32-year-old nulliparous white female presents with a history of progressively worsening menstrual pain that is now causing her distress for most of the month. She misses 2 to 3 days of work each month. She finds no relief from ibuprofen and can no longer tolerate the headaches associated with her contraceptive pills. She is currently sexually active with her long-term partner. Her relationship is being affected by associated stress and pain during intercourse. On vaginal examination, her pelvic musculature is moderately tender. Her uterus is of normal size and minimally tender. Rectovaginal examination reveals uterosacral nodularity and exquisite tenderness. Stool is soft, brown, and haeme-negative.

What condition is being described?
What is your next step in investigation?
What is the diagnostic investigation?

A

Endometriosis
Next step - TVUSS
Diagnostic Ix - laparoscopy

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14
Q

What blood tests would you do to investigate amenorrhoea?

A
  • FSH
  • LH
  • Prolactin levels
  • Total testosterone
  • TSH
  • USS
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15
Q

A 32-year-old woman presents with a chief complaint of difficulty becoming pregnant. She was prescribed oral contraceptives at the age of 17 years because of irregular periods (4 to 6 periods per year). She continued with oral contraception until 30 years of age, at which point she and her husband decided they wanted to have a baby. Since ceasing oral contraception, she has gained weight and has only 3 to 5 periods per year. She has actively been trying to conceive, with no results.

What condition?
What investigations do you need to do next?
How do you confirm the diagnosis?

A

PCOS
Next Ix - Blood tests: Total testosterone, sex-hormone binding globulin, free androgen index, LH:FSH (2:1), prolactin, TSH and USS (looking for cysts)

Confirming the diagnosis: Rotterdam diagnostic criteria
PCOS can be diagnosed if two of the following are present:

Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
Oligo-/anovulation
Clinical or biochemical features of hyperandrogenism

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15
Q

A 32-year-old woman presents with a chief complaint of difficulty becoming pregnant. She was prescribed oral contraceptives at the age of 17 years because of irregular periods (4 to 6 periods per year). She continued with oral contraception until 30 years of age, at which point she and her husband decided they wanted to have a baby. Since ceasing oral contraception, she has gained weight and has only 3 to 5 periods per year. She has actively been trying to conceive, with no results.

What condition?
What investigations do you need to do next?
How do you confirm the diagnosis?

A

PCOS
Next Ix - Blood tests: Total testosterone, sex-hormone binding globulin, free androgen index, LH:FSH (2:1), prolactin, TSH and USS (looking for cysts)

Confirming the diagnosis: Rotterdam diagnostic criteria
PCOS can be diagnosed if two of the following are present:

Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
Oligo-/anovulation
Clinical or biochemical features of hyperandrogenism

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16
Q

What is the common organism causing mastitis and how do you investigate/treat it?

A

Staph aureus
clinical diagnosis
Flucloxacillin

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17
Q

What causes breast abscess?

How do you diagnose and treat it?

A

When mastitis is left untreated - mix of staph aureus and streptococcus
breast exam is sufficient but can do USS with biopsy of the fluid
Antibiotics can be given but incision & drainage or needle aspiration can be done every other day until pus no longer accumulates

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18
Q

What is fibrocystic disease?
How does it present?
How do you diagnose it?

A

Hormone-induced acing and fibrous hyperplasia due to oestrogen, commonly associated with menstrual cycle.
Presents as irregular and multiple lumps, usually in line with menstrual cycle
Mammogram +/- USS if breast cancer suspected although clinically diagnosed

19
Q

What is fibroadenoma?
How does it present?
How do you diagnose it?

A

Benign tumour of interlobular storm and acing hyperplasia
Presents as firm, nodular, palpable mass usually around 2-3cm in size. very mobile (BREAST MICE) and occurs in 20-30 years of age.

Diagnosis - clinical HOWEVER:
If <40 - do USS
if >40 - do mammogram
if <25 - needle biopsy

20
Q

Confirmatory diagnosis for HIV?

A

ELISA or Western Blot

21
Q

Patient experiences mild symptoms of bleeding with little to no pain.
O/E Cervical OS is closed.

What type of miscarriage is this?

A

Threatened

22
Q

Patient experiences heavy bleeding with clots & pain.
O/E Cervical OS is open.

What type of miscarriage is this?

A

Inevitable

23
Q

Products of conception are partially expelled after a miscarriage.

What type of miscarriage is this?

A

Incomplete

24
Q

Patient experiences heavy bleeding and clots.
USS shows no pregnancy tissue in the uterine cavity.

What type of miscarriage is this?

A

Complete

25
Q

Uterus is small for dates + pregnancy test remains positive + patient presents with persistent, dark-brown discharge.
What type of miscarriage is this?

A

Missed

26
Q

At how many weeks do you check for foetal structural anomalies on a scan?

A

18-20 weeks scan

27
Q

Patient presents with severe sudden-onset lower abdominal pain, mainly focused in the LIF.
Pregnancy test is +ve

is your next step to carry out a vaginal examination OR do a TVUSS?

A

TVUSS - to identify location of pregnancy and foetal heartbeat

cannot do vaginal examination due to risk of rupture

28
Q

A 25 year old attends for her first cervical smear. Her test is reported as High risk HPV positive.What is the most appropriate next test?

  1. Cervical biopsy
  2. Colposcopy
  3. Cytology
  4. Large loop excision of the Transformation Zone (LLETZ)
  5. Repeat HPV test in 12 months
A

Cytology

If it’s positive, you would do cytology and if that’s abnormal, then you would do colposcopy
if cytology normal, then repeat HPV test in 12 months

29
Q

Can you diagnose Ovarian cancer based on CA-125 only?

A

No
It is used more to monitor treatment to ovarian cancer
also used for screening

30
Q

BRCA1 and BRAC2 increases the risk of … ?

A

Breast and tubo-ovarian cancers

31
Q

A 50 year old attends gynae clinic. She has a new diagnosis of a BRCA1 gene based on her family history of breast cancer. She is asymptomatic and her last smear was 12 months ago.What is the most appropriate management to recommend to her at this point to reduce her risk of gynaecological cancer?

  1. Bilateral salpingo-oopherectomy
  2. CA125 measurement
  3. Hysterectomy
  4. MRI pelvis
  5. TVUS screening
A

Bilateral salpingo-oopherectomy - reduces the risk of cancer

32
Q

A 25-year old lady 28/40, has come in with sudden, profuse painless bleeding, which did not last for long. What is your next step in investigation?

A

Placenta previa - placenta is inserted in part or fully into the lower segment of the uterus
need to do ultrasound scan where a low placenta can be seen

33
Q

A 25-year old lady 28/40, has come in with sudden bleeding associated with severe, continuous abdominal pain and contractions.
What is your next step?

A

Placental abruption - premature separation of the normally placed placenta before delivery.

No investigation - O/E: uterus is tense + tender + woody like feeling, check CTG and platelet count.
OBSTETRIC EMERGENCY

34
Q

What is the gold-standard investigation for ovarian torsion?

A

TVUSS

  • enlarged ovary >4cm
  • follicles may appear like a ‘string of pearls’
  • can show if Fallopian tube is also twisted
35
Q

HELLP in pre-eclampsia

A

H - haemolysis
EL - elevated liver enzymes
LP - low platelet count

36
Q

What is the initial test in pre-eclampsia?

A

urine dipstick

  • looking for proteinuria
  • send MSU
37
Q

at how many weeks do you check screen for diabetes in a pregnant woman?

A

24-48 weeks with a fasting blood glucose or an OGTT
fasting blood glucose >5.1
OGTT >7.8

38
Q

what Contraceptive would you give within 3 days of UPSI?

A

Levongesterol (Progesterone tablet (minipill)

39
Q

what contraceptive pill would you give within 120 hours?

A

Ella one (ulipristal) - but not to be used in severe asthma

40
Q

what intrauterine device can be used as an emergency contraceptive?

A

Copper IUD.

41
Q

What is placenta previa?

A

Previa means first - so the placenta has bound to the bottom of the uterus (covering the OS)
can have complete, partial and marginal (2cm of OS covered)

42
Q

What is the RF and symptoms of placenta preiva?

A 
RF: Multiple parity 
maternal smokine
intrauterine Fibroids 
age over 35 years
ceaserean section

Symptoms: abrupt onset of bright red painless bleeding.

43
Q

how is placenta previa diagnosed?

A

18-20 week ultrasound scan

44
Q

Management of gestational diabetes if <7mmol/l

A

Exercise and diet

If after 2 weeks this has not changed offer metformin

45
Q

Management of diabetes over 7mmol/l

A

Short acting Insulin must be started

FCM (13 decks)

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