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Medical School Finals > Women's health > Flashcards

Women's health Flashcards

1
Q

Urinary incontinence

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Age, previous pregnancy, high BMI, hysterectomy, FHX.
  2. Classified as; Urge (overactive detrusor), stress (leakage on stress), mixed and overflow (mainly males) 3. Bladder diary. Vaginal exam for prolapse, Urine dip for DM or UTI. Urodynamics.
  3. Bladder retraining. Oxybutynin, tolterodine. Mirabegron. Kegels.
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2
Q

VTE in pregnancy management

A

Four or more of the below indicate LMWH should be used immediately until 6 weeks post-natal.

  • Age >35
  • BMI >30
  • Parity >3
  • Smoker
  • Gross varicose veins
  • Current pre-eclampsia
  • Immobility
  • FHx or personal Hx of unprovoked VTE
  • Low risk thrombophilia
  • Multiple pregnancy
  • IVF
    3 RFs = LMWH from 28 weeks until 6 weeks after birth.
  • Avoid warfarin and DOACs
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3
Q

COCP Advice & Risks

A
  • If taken within first 5 days of cycle. no need for further contraception.
  • If taken at any other point - condoms should be used for the first 7 days.
  • Take same time every day
  • Take for 21 days then stop. however not required.
  • Efficacy reduced when; N&V, liver enzyme inducing drugs.
  • Risks = clots, MI and stroke, Breast Ca and Cervical Ca.
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4
Q

Ectopic

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Implantation of fertilised ovum in the fallopian tube (not in the uterus)
  2. Lower abdo pain and bleeding following 6-8 weeks amenorrhoea.
  3. BHCG >1500, USS
  4. MTX as a single dose. repeat if levels have not fallen. Surgical laparoscopy. Salpingectomy/salpingotomy.
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5
Q

Contraception postpartum

A
  • Require contraception day 21 postpartum.
  • POP can be used.
  • IUD, IUS
  • Progestogen only implant

Avoid all combined contraceptives. NO COCP

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6
Q

HRT prescribing

A
  • Cyclical combined HRT if LMP was <1y ago.
  • Continuous combined HRT if LMP was >1y ago or they have been using cyclical for 1y or 2y post LMP in premature menopause
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7
Q

Vaginal Discharge

A
  1. Bacterial vaginosis.
    - Fishy, green. Low pH.
    - Oral metronidazole
  2. Trichamonas vaginalis
    - Strawberry cervix on exam (red with point of exudate). musty, frothy, green discharge.
    - Oral metronidazole
  3. Gonorrhoea
    - Thin, purulent mild smelling discharge + Dysuria, bleeding and dyspareunia.
    - IM ceftriaxone 500mg + oral azithromycin 1g
  4. Candida
    - Thick white discharge
    - Local clotrimazole pessary or oral clotrimazole (CI in pregnancy)
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8
Q

Active management of third stage of labour

A
  • Uterotonic drugs
  • Deferred clamping and cord cutting >1min after delivery but less than 5.
  • Controlled cord traction for placental separation.
  • Drugs = 10IU oxytocin
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9
Q

TOP HCG levels

A
  • It is normal for a urinary pregnancy test to return positive for up to 4 weeks post TOP.
  • HCG has a stepwise decrease.
  • Further than 4 weeks requires more Ix
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10
Q

Emergency contraception

A
  1. Levonorgestrel - up to 3 days but ASAP is better. 1.5mg of levonorgestrel (progesterone).
  2. Ulipristal acetate (progesterone receptor modulator) up to 5 days afterwards.
  3. Copper coil - up to and over 5 days and if high BMI
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11
Q

Management of a missed miscarriage

A
  1. Expectant - wait for 7-14 days
  2. Medical - Vaginal misoprostol. (contact Dr if bleeding hasn’t started in 24hrs) + antiemetics and pain relief.
  3. Surgical - vacuum.
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12
Q

Cancerous HPV subtypes

A

16 and 18

- If positive refer to colposcopy

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13
Q

Post term pregnancy complications

A

Fetal - Reduced placental perfusion
- Oligohydramnios

Maternal - Increased rates of labour intervention; section + forceps.
- Increased rates of IOL

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14
Q

Placenta Praevia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Placenta lying wholly or partly in the lower uterine segment - obscuring to os.
    - Associated w/ multiparity, multiple pregnancy, previous section.
  2. Shock
    - No pain
    - Uterus non tender
    - High lying foetus
    - Small bleeds before large haemorrhage.
  3. USS to locate, looked for at 20 week scan.
    - Vaginal USS if safe - is more specific.
  4. If low lying placenta a 20 weeks;
    - Rescan at 34 weeks.
    - Still low at 34 weeks, scan every 2 weeks.
    - If low at 37 weeks or high presenting part - Section.
  • Admit all those w/ bleeding.
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15
Q

Ovarian Cysts

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Benign cysts are common.
    - Physiological cysts =
    a) Follicular - common. Due to non-rupture of the dominant follicle or failure of atresia.. Commonly regress after a few menstrual cycles.
    b) Corpus luteum cysts - more likely to present with intraperitoneal bleeding.
    - Benign germ cell tumours =
    a) Dermoid cyst - Lined with epithelium, most common in women under 30. Torsion risk.
    - Benign epithelial tumours =
    a) Serous cystadenoma - resembles ovarian cancer.
    b) Mucinous cystadenoma - common, large.
  2. Subfertility
    - Often incidental findings
    - Torsion
    - Dyspareunia
    - Pressure effects locally
  3. Bimanual exam
    - Pregnancy test (ectopic)
    - USS
    - Cancer markers in complicated cyst; CA-125, LDH, AFP and BHCG
    - RMI = USS score + Menopausal status + ca125
  4. Expectant management in simple cysts.
    - Surgical cystectomy or drainage in all which are symptomatic, complex or large.
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16
Q

COCP Contraindications

A
  • More than 35yo and smoking <15 cigs a day
  • BMI >35
  • FHx of thromboembolic disease
  • Controlled HTN
  • Immobility
  • BRCA gene
  • Migraine w/ aura
  • Personal Hx of thromboembolic disease
  • Breast feeding <6 weeks post-partum
  • Uncontrolled HTN
  • Breast Ca
  • DM
17
Q

Gynaecological causes of Abdominal Pain

A
  • Mittelschmerz - mid-cycle pain w/ little systemic disturbance. Often settles w/ conservative Rx.
  • Endometriosis - Menstrual irregularity, infertility, deep dyspareunia. USS shows free fluid and laparoscopy shows lesions. Rx medically or surgery if severe or complex.
  • Ovarian torsion - sudden onset, deep colicky pain. Vomiting and distress. Vaginal exam shows adnexal tenderness. USS free fluid. Laparoscopy is diagnostic and treatmentive.
  • Ectopic - pregnancy Sx w/o evidence of intra-uterine pregnancy. Rupture + circulatory collapse. USS shows no pregnancy in-utero. Beta HCG is elevated. MTX or laparoscopy or laparotomy.
  • PID - BL lower abdo pain + discharge. Dysuria. peri-hepatic pain (fitz hugh Curtis) w/ chlamydia. Pregnancy test -‘ve, high vaginal swab.
18
Q

Types of miscarriage

A
  • Threatened = painless vaginal bleeding before 24 weeks. Os is closed.
  • Missed = dead fetus before 20 weeks w/o expulsion.
  • Light vaginal bleeding.
  • Os is closed

Inevitable = Heavy bleeding w/ clots.
- Os is open

Incomplete = Not all products evacuated

  • Pain and bleeding
  • Os is open
19
Q

Recall for smear following treatment of CIN 2

A
  • 6 months after Rx .

- In the community

20
Q

COCP and surgery

A
  • Stop 4 weeks previous.
21
Q

Bishops score for IOL

A
  • Looks at cervical dilatation, effacement, consistency, position and foetal station.
  • Score over 8 is likely to achieve successful vaginal birth.
  • Scores less than 6 usually require cervical ripening.
22
Q

Methods for IOL with a low bishops score

A
  • Membrane sweep
  • Insertion of foley catheter
  • Vaginal prostaglandins
23
Q

Hormonal therapy in Breast Cancer

A
  • Tamoxifen for 5 years in pre- and peri-menopausal women.
  • Post-menopausal - letrozole or anastrozole. Aromatase inhibitors.
  • Herceptin for HER2 +’ve.
24
Q

Pre-eclampsia

A
  • Pregnancy induced HTN
  • Associated with proteinuria (>3g/24hrs)
  • Occur after 20 weeks gestation.
25
Q

Endometrial carcinoma

A
  • Linked to HNPCC
26
Q

Cholestasis of pregnancy

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. UK
    - Bile stasis and back flow.
    - Worse w/ twins
    - More linked to premature birth.
  2. Itching, intense and worse palms, soles and abdomen.
    - Jaundice
    - Raised bilirubin.
  3. LFT
    Liver USS
  4. IOL at 37 weeks
    - Ursodeoxycholic acid
    - Vit K
27
Q

Menorrhagia Investigations and Management

A
  1. FBC
    - Vaginal USS
  2. Does not require contraception =
    - Mefenamic acid 500mg ads or tranexaminc acids 1g ads. Started on first day of period.

Requires contraceptions =

  • Mirena coil is first line.
  • COCP
28
Q

Mirena coil

A
  • 99% effective
  • Levonorgesterel prevents endometrial proliferation and thickens cervical mucus.
  • Associated with initial frequent bleeding then lighter or absent periods.
29
Q

Nuchal translucency scan

A
  • Performed at 11-13 weeks

- Looks for; Downs, congenital heart defects, abdominal wall defects.

30
Q

Premature ovarian failure

A

Onset of menopausal Sx and elevated gonadotrophin levels before the age of 40.

  • Causes; idiopathic, chemo, autoimmune, radiation.

Medical School Finals (24 decks)

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