Women's

Question 1

what is menopause

Answer 1

permanent end to menstruation
diagnosed after a woman has had no periods for 12 months

Question 2

when is the average age that women experience menopause

Answer 2

51yrs

Question 3

what is premature menopause

Answer 3

menopause before the age of 40yrs. results in premature ovarian insufficiency

Question 4

what is perimenopause

Answer 4

refers to the time around menopause where woman may be experiencing vasomotor symptoms and irregular periods

Question 5

when must serum FSH test not be used to diagnose menopause

Answer 5

if combined oestrogen and progestogen contraception or high-dose progestogen is being used

Question 6

when to consider FSH test to diagnose menopause

Answer 6

40-45yrs with menopausal symptoms incl, change in menstrual cycle

under 40yrs where menopause is suspected

Question 7

symptoms of menopause

Answer 7

• change in periods - length of cycle or uterine bleeding
• vasomotor symptoms- hot flushes and night sweat
• urogenital changes - vaginal dryness and urinary frequency
• anxiety and depression
• short- term memory impairment
• joint pains
• reduced libido

Question 8

what causes perimenopausal/ menopause symptoms

Answer 8

lack of oestrogen

Question 9

how long do women need to use contraception for

Answer 9

2 years after last period if <50yrs
1 year after last period if >50yrs

Question 10

management for menopause

Answer 10

HRT
CBT
antidepressants
vaginal moisturisers
vaginal oestrogen

Question 11

what is atrophic vaginitis

Answer 11

dryness and atrophy of the vaginal mucosa due to lack of oestrogen during menopause

Question 12

how does atrophic vaginitis occur

Answer 12

as oestrogen levels fall the mucosa becomes thinner, less elastic and drier which makes the tissue more prone to inflammation

Question 13

role of oestrogen on mucosa of the vagina and urinary tract

Answer 13

makes it thicker, more elastic and produces secretions

Question 14

clinical presentation of atrophic vaginitis in postmenopausal women

Answer 14

itching
dryness and discomfort
dyspareunia
recurrent UTI
bleeding due to localised inflammation

Question 15

examination of labia and vagina showing atrophic vaginitis

Answer 15

pale mucosa
thin skin and reduced skin folds
erythema and inflammation
dryness
sparse pubic hair

Question 16

management of atrophic vaginitis

Answer 16

vaginal lubricants

topical oestrogen - needs to be monitored due to potential risks of endometrial cancer and endometrial hyperplasia

Question 17

what is bacterial vaginosis

Answer 17

overgrowth of bacteria in the vagina especially anaerobic bacteria leading to a fall in lactic acid producing aerobic lactobacilli which increases pH

Question 18

risks of bacterial vaginosis

Answer 18

increased risk of STI

Question 19

risk factors for bacterial vaginosis

Answer 19

multiple sexual partners
excessive vaginal cleaning
smoking
copper coil

Question 20

clinical presentation of bacterial vaginosis

Answer 20

fishy smelling watery grey or white vaginal discharge

half are asymptomatic

Question 21

what criteria is used to diagnose bacterial vaginosis

Answer 21

amsel criteria

Question 22

explain criteria used to diagnose bacterial vaginosis

Answer 22

any 3 of the 4 needed:
- thin, white homogenous discharge
- pH of more than 4.5
- clue cells on microscopy
- positive whiff test (fishy odour)

Question 23

management for bacterial vaginosis

Answer 23

oral metronidazole 5-7days - twice a day (400mg) or once a day (2g)

or

topical intravaginal metronidazole gel

Question 24

what does bacterial vaginosis in pregnancy increase the risk of

Answer 24

preterm labour
low birth weight
late miscarriage
chorioamnionitis

Question 25

what is pelvic inflammatory disease

Answer 25

inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix

Question 26

what organs are affected in PID

Answer 26

• endometritis
• salpingitis (fallopian tubes)
• oophoritis (ovaries)
• parametritis (parametrium -connective tissue around the uterus)
• peritonitis

Question 27

common causes of PID

Answer 27

STI - neisseria gonorrhoeae, chlamydia trachomatis

Question 28

risk factor for PID

Answer 28

multiple sexual partners
younger age
existing STI
previous PID
IUD

Question 29

presentation of PID

Answer 29

pelvic or lower abdo pain
abnormal vaginal discharge
abnormal bleeding
dyspareunia
fever
dysuria

Question 30

examination for PID

Answer 30

pelvid tenderness
cervical motion tenderness
inflamed cervix
purulent discharge

Question 31

investigations for PID

Answer 31

screen for gonorrhoea and chlamydia
high vaginal swab
pregnancy test to rule out exctopic pregnancy
bloods - crp (to support diagnosis)

Question 32

why is a high vaginal swab done in PID

Answer 32

to look for bacterial vaginosis, candidiasis, trichomoniasis

Question 33

management for PID

Answer 33

abx started empirically before results to avoid delay and complications

• IM ceftriaxone - gonorrhoea
• doxycycline (100mg 2x daily for 14 days)- chlamydia
• metronidazole (400mg 2x daily for 14 days)- anaerobes e.g. Gardnerella vaginalis

Question 34

complications of PID

Answer 34

sepsis
infertility
chronic pelvic pain
ectopic pregnancy
abscess
fitz-hugh-curtis syndrome

Question 35

what is fitz-hugh-curtis syndrome

Answer 35

inflammation and infection of the liver capsule leading to adhesions between the liver and peritoneum

Question 36

presentation of fitz-hugh-curtis syndrome

Answer 36

RUQ pain - referred to the right shoulder if diaphragmatic irritation