1A

Question 1

Define Premenstrual Syndrome (PMS)

Answer 1

Cyclic episodes of behavioural, psychological and physical symptoms during the luteal phase

Question 2

What are the phases of menstruation?

Answer 2

Menstrual phase, follicular phase, ovulation phase and luteal

or follicular (14 days before ovulation) and luteal phase

Question 3

Pathophysiology of PMS

Answer 3

Not fully known but associated with changes in hormones- drop in progesterone and estradiol in the late luteal phase

Question 4

Risk factors of PMS

Answer 4

Stress
FHx
Smoking
Overweight/obese

Question 5

Symptoms of PMS

Answer 5

Psychological: mood swings, irritability, depression, anxiety- low serotonin (since oestrogen regulates serotonin)
Low libido
Breast tenderness
Bloating
Leg swelling
Painful periods
Headache
Painful sex
GI upset
Back ache
Acne

Question 6

Examination of PMS

Answer 6

Thyroid exam - hypothyroidism
Breast exam - tenderness, discharge, mass
Abdo exam - mass/signs of distention

Question 7

DDx PMS

Answer 7

Depression
Hypothyroidism
Anxiety

Question 8

Investigation for PMS

Answer 8

Not required
FBC - anaemia
TFT - hypothyroidism
TTG (tissue transglutaminase)- GI (Coeliac)

Question 9

Conservative management for PMS

Answer 9

Conservative:
avoid excess sugar,
swelling - reduce salt
tenderness - firm supportive bra
reschedule stressful tasks
cut down caffeine
CBT/relaxation exercises
regular sleep
smoking cessation
alcohol reduction

Question 10

Causes of secondary dysmenorrhoea

Answer 10

Fibroids
Endometriosis
PID
Ectopic pregnancy

Question 11

Management for dysmenorrhoea

Answer 11

Smoking cessation
Supine position
Back/abdo massage

NSAID - ibuprofen 400mg TDS, mefenamic acid 500mg TDS
No plans to conceive: oral desogestrel 75mcg, IUD

Hysterectomy- severe cases and does not want children

Question 12

Define breast abscess

Answer 12

Pus in the breast

Question 13

Pathophysiology of breast abscess

Answer 13

breast inflammation of infectious aetiology
Can be related to mastitis

Organisms:
Strep A
Streptococcal
Enterococcal
Anaerobic bacteria

Question 14

Risk factors of breast abscess

Answer 14

Breast trauma
Blocked milk ducts
Breast feeding

Question 15

Presentation/history of breast abscess

Answer 15

Fever
Breast pain , swelling/redness

Question 16

Examination of breast abscess

Answer 16

tenderness with fluctuant lump
erythema
Axillary lymphadenopathy

Question 17

DDx of breast abscess

Answer 17

Breast cellulitis
breast engorgement
Inflammatory breast cancer

Question 18

Investigations for breast abscess

Answer 18

Clinical diagnosis

FBC/CRP - underlying inflammatory pathology
Breast USS- confirmation

Question 19

Management of Breast abscess

Answer 19

Referral for general surgeon for confirmation and drainage
Conservative:
don’t wear a tight bra, continue breastfeeding if possible

Medical:
Analgesia
Parenteral Abx- secondary care e.g. Clarithromycin plus metronidazole (to cover organisms)

Question 20

Complication of breast abscess

Answer 20

Sepsis

Question 21

Define Mastitis

Answer 21

Inflammation of breast
Usually associated with lactation but can also occur with non-lactating women

Question 22

Pathophysiology of mastitis

Answer 22

Lactating women:
milk stasis causing an inflammatory response
if infection- caused by Strep A

Non-lactating women:
usually accompanied by infection - can be central/subareolar or peripheral

Question 23

Risk factors for peripheral mastitis

Answer 23

DM
RA
Trauma
Corticosteroid treatment
Granulomatous lobular mastitis- benign inflammatory disorder

Question 24

Examination of Mastitis

Answer 24

Tender, swollen
Warm/hot
Red skin- sometimes wedge-shaped pattern
Fever

Question 25

DDx of Mastitis

Answer 25

Full breasts - common up to 6 days after birth, usually bilateral hot, heavy and hard Engorged breasts- milk overfill or infant not feeding frequently, usually bilateral enlarged, swollen and painful Blocked duct - painful lump, may be red, no fever Galactocoele - smooth, rounded and painless swelling in breast, milky discharge when pressed, no fever Infection of mammary ducts- deep burning, aching and shooting pain. May have radiation down the arm or into the back, no fever or malaise Breast cancer Duct Ectasia

Question 26

Investigation for Mastitis

Answer 26

Usually clinical diagnosis Send breast milk for microscopy, culture and sensitivity if: severe, recurrent, hospital-acquired infection, burning sensation

Question 27

Management of mastitis

Answer 27

Referral to general surgeon Conservative: reassurance, analgesia, warm compress continue breastfeeding treat underlying cause: poor infant attachment, nipple damage, smoking Medical Abx if neeeded: Flucloxacillin 500mg QTS 10-14 days or clarithromycin 500mg BD 10-14days or erythromycin 250mg QTD 10-14 days If abscess present: incision and drainage

Question 28

What can cause recurrence of mastitis

Answer 28

Candidal infection after a course of Abx - causes cracked skin on nipple- for infection entrance

Question 29

Signs of candida of nipple

Answer 29

associated with oral thrush and candidal nappy rash in infant Bilateral sore nipples, particularly after feeding Tenderness/itching cracked/ flaky or shiny areola