Gynae Part 2 Flashcards
(87 cards)
1
Q
What are common symptoms of STIs?
A
Pain, discharge, itching, urinary symptoms
These symptoms can vary depending on the specific STI.
2
Q
What factors are included in sexual history when assessing STIs?
A
- Time since last contact
- Number of partners in last 3 months
- Gender of partners
- Partnership type and contactability
- Previous STDs
- Contraception use
- Type of sex
Contraception use includes methods like condoms and barriers.
3
Q
What vaccinations are relevant in the context of STIs?
A
HPV vaccination
HPV vaccination is crucial in preventing certain types of STIs.
4
Q
What swabs are typically taken for STI investigations?
A
1) Endocervical
- Chlamydia, Gonorrhoea
2) High vaginal
- VP3: Candida, Gardnerella, Trichomonas
- HSV (if vesicles present)
Endocervical swabs are specifically used for chlamydia and gonorrhoea.
5
Q
What is the tx of genital herpes?
A
Acyclovir
Symptoms can become more pronounced when the immune system is compromised.
6
Q
What is the treatment for Trichomonas?
A
Metronidazole
Partners should also be screened and treated.
7
Q
What is the management for Gonorrhea?
A
- IM ceftriaxone 1g single dose
- PO cipro 500mg once
- Test of cure required
Gonorrhea can be difficult to eradicate.
8
Q
What is the classic triad of symptoms for Pelvic Inflammatory Disease (PID)?
A
Abdominal pain, fever, vaginal discharge
PID can lead to severe complications if not treated.
9
Q
What are common risk factors for developing PID?
A
- Multiple sex partners
- No barrier contraception
- Diabetes
- Immunocompromised state
Understanding risk factors is essential for prevention and early intervention.
10
Q
What are the complications associated with PID?
A
Fitz Hugh Curtis syndrome, septic shock
Fitz Hugh Curtis syndrome involves perihepatic adhesions secondary to PID.
11
Q
What is the general management approach for STDs?
A
- Build rapport
- Identify condition as STD
- Breaking bad news
- Advise on preventing disease transmission
- Advise conditions needing test of cure (gonorrhea, chlamydia if pregnant)
- Mandatory notification
Effective management includes communication and education.
12
Q
Fill in the blank: The treatment for Chlamydia in non-pregnant women includes _______.
A
[Doxycycline]
Doxycycline is contraindicated in pregnancy.
13
Q
True or False: A test of cure is required for Gonorrhea.
A
True
This is important due to the difficulties in eradicating the infection.
14
Q
What are features of trichomonas
A
Yellow-green discharge
strawberry cervix
15
Q
What is the tx for chlamydia
A
doxycycline
azithromycin
16
Q
What is contraceptive efficacy?
A
Assessed by measuring the number of unplanned pregnancies that occur during a specified period of exposure using a particular contraception method
Methods include the Pearl index and life table analysis.
17
Q
What is the Pearl index?
A
Number of failures per 100 women-years (HWY) of exposure
Rate per HWY = (total no. of accidental pregnancies x 12 x 100) / (total months of use).
18
Q
Name three types of barrier contraception.
A
- Condoms
- Cervical caps
- Diaphragms
19
Q
What is the mechanism of spermicides?
A
Causes sperm cell membrane to break.
20
Q
What is the mechanism of progesterone-only contraceptives?
A
- Suppresses FSH/LH, stops ovulation
- Thickens cervical mucus to block sperm penetration
- Induces endometrial thinning & atrophy
21
Q
List some benefits of progesterone-only contraceptives.
A
- Regulates cycles
- Reduces menstrual loss
- Reduces ovarian/endometrial cancer risk
- Relieves dysmenorrhea
- Protects against cysts/fibroids
22
Q
What are some side effects of progesterone-only contraceptives?
A
- Reduced bone density
- Breakthrough bleeding
23
Q
How long does it take for combined contraceptives to work?
A
7 days to work, protects for 7 days if missed.
24
Q
What are some absolute contraindications to combined oral contraceptives (COC)?
A
- Thrombotic disorders
- CVA
- Coronary artery disease
- Impaired liver function
- Oestrogen-dependent malignancies
- Pregnancy
- Breastfeeding
- Undiagnosed irregular genital tract bleeding
- Migraine with aura
25
Can breastfeeding mothers use progesterone-only contraceptives?
Yes, they do not suppress lactation.
26
What is the duration of efficacy for injections in contraception?
Every 3 months.
27
What is the duration of efficacy for implants in contraception?
Every 3 years.
28
What is the duration of efficacy for patches in contraception?
Applied once a week for 3 weeks.
29
What is the primary function of the hormonal IUD?
Prevents fertilization and can last for 5 years.
30
What is the mechanism of action of the copper IUD?
Prevents fertilization and can be used as emergency contraception.
31
What are some side effects of the copper IUD?
* Risk of perforation
* Expulsion
* PID
* Menstrual irregularities (heavy, longer, more painful)
32
What is the purpose of emergency contraception?
Used when no contraception is used, there is a contraceptive accident, or in cases of sexual assault.
33
What are two methods of emergency contraception?
* Morning-after pills (Oestrogen + progesterone or each one alone)
* Copper IUCD
34
What is the mechanism of ulipristal acetate (EllaOne)?
Postpones follicular rupture and inhibits/delays ovulation.
35
True or False: Intrauterine contraception can only be used for a maximum of 3 years.
False.
36
What is menopause defined as?
No menstruation for 12 consecutive months
## Footnote
Occurs between ages 45-55 years (average 49), not on hormonal contraception, and no uterus means clinical symptoms are used for diagnosis.
37
What constitutes early menopause?
Menopause occurring before 45 years of age
## Footnote
Causes include surgical removal of ovaries, cancer treatment (radiation/chemotherapy), and idiopathic reasons.
38
What happens to primary ovarian follicles after age 40?
Number and responsiveness of primary ovarian follicles reduce markedly
## Footnote
This leads to reduced estradiol and inhibin B, resulting in increased FSH.
39
What are the effects of menopause on cardiovascular health?
Higher risk of cardiovascular disease in postmenopausal women
## Footnote
Loss of protective effects of estrogen increases risks for cholesterol issues and plaque formation.
40
What are common symptoms to inquire about during a menopause history?
Vasomotor symptoms, sleep issues, urogenital symptoms, sexual health concerns.
41
What hormone level indicates menopause?
≥ 30 iu/ml FSH
## Footnote
Not typically required in women over 45 years with a history of menopause symptoms.
42
What are key components of lifestyle management for menopause?
Behavior modification, exercise, cognitive behavioral therapy, support groups, pelvic floor exercises.
43
What is the goal of Hormone-Replacement Therapy (HRT)?
To relieve symptoms related to estrogen deficiency
## Footnote
Symptoms include hot flushes, vaginal dryness, and osteoporosis.
44
What are the contraindications for HRT?
Hormone-sensitive cancers, unexplained genital bleeding, active venous arterial blood clots, CHD, liver disease.
45
What are the two types of HRT administration?
Systemic and non-systemic
## Footnote
Systemic includes oral/tablet and topical estrogen; non-systemic includes vaginal applications.
46
What are the risks associated with HRT?
Cardiovascular disease, stroke, venous thromboembolism, breast cancer.
47
What is the risk factor for osteoporosis in women under 50?
No need for screening unless there are major risk factors
## Footnote
Examples include glucocorticoid use or untreated primary ovarian insufficiency.
48
What medications are associated with increased osteoporosis risk?
Steroids, PPIs, anti-epileptics, SSRIs, heparin
* Over-supplementation with thyroxine
* Chemo agents
49
What are some tools for osteoporosis risk assessment?
DEXA score (T score <-2.5)
FRAX score
OSTA score (age - weight)
50
What is the DEXA score used for?
Evaluating bone mineral density (BMD)
## Footnote
DEXA (Dual Energy X-ray Absorptiometry) is a standard method for assessing bone density.
51
What is the FRAX score and who is it used for?
Gives probability of 10 year risk of fracture; used in all women 65 years old and older
## Footnote
FRAX helps to assess the risk of hip or major osteoporotic fractures.
52
What does dual energy X-ray absorptiometry evaluate?
BMD of spine and hip
## Footnote
It provides T scores and Z scores for bone density comparison.
53
What are some lifestyle modifications recommended for osteoporosis management?
* Modify fall risk
* Weight bearing exercises
* Avoid smoking
* Reduce alcohol intake to <2 units/day
## Footnote
These lifestyle changes can significantly reduce the risk of fractures.
54
What supplements are recommended for osteoporosis management?
* Calcium
* Vitamin D
## Footnote
These nutrients are essential for maintaining bone health.
55
What is the role of bisphosphonates in osteoporosis management?
Pharmacological treatment to strengthen bone
## Footnote
Bisphosphonates are commonly prescribed to prevent bone loss and reduce fracture risk.
56
Sequential combined vs continuous combined HRT
sequential: progesterone half a month + estrogen everyday (will have "menses")
continuous combined: progesterone + esterogen everyday (bleed-free)
57
when to choose estrogen alone vs estrogen+progesterone for HRT
no uterus = estrogen alone is ok
uterus = needs progesterone and oestrogen
58
What is a cystocele?
Descent of the anterior vaginal wall
## Footnote
Cystocele is a common type of pelvic organ prolapse where the bladder bulges into the anterior wall of the vagina.
59
What is a rectocele?
Prolapse of the rectum into the posterior vaginal wall
## Footnote
Rectocele occurs when the rectal wall weakens and bulges into the vagina.
60
What are some risk factors for pelvic organ prolapse?
* Pregnancy and vaginal delivery (especially instrumental)
* Congenital and genetic factors
* Ageing and menopause
* Chronic raised intra-abdominal pressure (e.g., obesity, COPD, chronic cough, constipation, heavy lifting)
* Ehlers-Danlos syndrome
## Footnote
Understanding these risk factors can help in prevention and management strategies.
61
What complications can arise from pelvic organ prolapse?
* Erosions/bleeding
* Ulceration/superimposed infections
* Voiding dysfunction
* High residual urine leading to recurrent UTIs
* Hydroureters/hydronephrosis affecting renal function
## Footnote
Complications can significantly impact quality of life and require medical attention.
62
What are common symptoms to assess in pelvic organ prolapse?
* Duration of feeling a lump below
* Pelvic heaviness/pain/discomfort
* Vaginal discharge or abnormal bleeding
* Associated urinary or bowel symptoms
## Footnote
A thorough clinical history is essential for diagnosis.
63
What physical examination findings are significant in evaluating pelvic organ prolapse?
* Atrophic vaginitis (pale and loss of rugae)
* Stress urinary incontinence (leakage on coughing)
* Pelvic floor tone assessment
* Pop-Q assessment
## Footnote
These findings help determine the severity and type of prolapse.
64
What does the Pop-Q assessment measure?
It measures the degree of pelvic organ prolapse
## Footnote
The Pop-Q system provides a standardized way to quantify prolapse and assess treatment outcomes.
65
What conservative management options are available for pelvic organ prolapse?
* Pelvic floor exercises
* Lifestyle modifications (weight loss, avoiding constipation)
* Topical vaginal estrogen
* Vaginal pessaries
## Footnote
Conservative management is often the first line of treatment before considering surgery.
66
What are the types of vaginal pessaries used in managing pelvic organ prolapse?
* Ring pessary
* Gelhorn pessary
## Footnote
Pessaries are non-surgical options that can help support pelvic organs.
67
What is urinary incontinence?
Complaint of involuntary leakage of urine
## Footnote
Urinary incontinence is a common condition that can significantly affect quality of life.
68
What defines overactive bladder?
Clinical syndrome characterized by urinary frequency, urgency, and possibly urge incontinence
Urge incontinence: sudden compelling desire to pass urine that is difficult to defer
## Footnote
Overactive bladder can lead to significant lifestyle changes and discomfort.
69
What is stress incontinence?
Leakage of urine during increased intra-abdominal pressure
## Footnote
Stress incontinence is often associated with activities that increase abdominal pressure, such as coughing or exercising.
70
What are the risk factors for urge incontinence?
* Caffeine
* Smoking
* Dementia
## Footnote
Identifying risk factors can aid in the management and prevention of urge incontinence.
71
Investigations for incontinence
Bladder diary
Urodynamic studies
Urine dipstick TRO UTI
## Footnote
A bladder diary helps in understanding the patient's urinary habits and identifying patterns.
72
What lifestyle interventions can help with stress incontinence?
* Smoking cessation
* Weight loss
* Caffeine reduction
* Regular timed voiding
## Footnote
Lifestyle changes are foundational in managing stress incontinence effectively.
73
What surgical options are available for stress incontinence?
* Mid-urethral tapes
* Urethral sling procedures
* Colposuspension
## Footnote
Surgical interventions are considered when conservative measures fail to provide relief.
74
What medications are typically used for urge incontinence?
Anticholinergics (3rd generation) and beta agonists (mirabegron)
## Footnote
Medications can help manage symptoms of overactive bladder and urge incontinence.
75
What class of medication is commonly used as a second line treatment for overactive bladder?
Anticholinergics
## Footnote
They block cholinergic receptors in the bladder.
76
Name a common anticholinergic used for treating overactive bladder.
Oxybutynin
3rd gen: solifenacin (blocks m3 receptors in bladder)
## Footnote
It helps prevent bladder contraction.
77
What are some side effects of oxybutynin?
* Dry eyes
* Dry mouth
* Tachycardia
* Cognitive impairment
## Footnote
These effects are due to its anticholinergic properties.
78
What are contraindications for using anticholinergics?
* Narrow angle glaucoma
* Arrhythmias
## Footnote
These conditions can be exacerbated by anticholinergic medications.
79
What distinguishes third-generation anticholinergics from earlier generations?
Increasingly selective for M3 receptors
## Footnote
This leads to less stimulation of other muscarinic receptors.
80
What is a topical treatment option for urge incontinence?
Topical vaginal oestrogen
## Footnote
This can help improve symptoms related to estrogen deficiency.
81
Surgical options for urge incontinence
Detrusor botox
Bladder augmentation
## Footnote
Botox helps to paralyze the muscles and some efferent neurons.
82
What is bladder augmentation?
A surgical procedure to increase bladder capacity
## Footnote
It is typically used for patients with severe urge incontinence.
83
What does posterior tibial nerve stimulation target?
S2-S4 nerve roots
## Footnote
This method is similar to bladder augmentation and helps manage bladder control.
84
What is the difference between urge and stress incontinence?
Urge: always feel like peeing; Stress: leakage on coughing/sneezing
## Footnote
Understanding these differences is key for diagnosis.
85
What are some associated symptoms to consider during diagnosis?
* Bowel control issues
* Neurological symptoms
* Back pain
## Footnote
These can indicate underlying conditions affecting bladder control.
86
What lifestyle changes may benefit urge incontinence management?
* No caffeine
* Reduce water intake before bed
* Sleep hygiene
* Bladder training
## Footnote
These changes can help reduce symptoms.
87
Surgical options for pelvic organ prolapse
- colporraphy
- hysterectomy
- sacrohysteropexy
- sacrospinous ligament fixation
- colpocleisis (suture vagina closed)
