Gynae3 Flashcards

Question

Subfertility history in a male?

Answer 1

1. **Sexual function** - problems with erections and ejaculation 2. Age of **puberty** 3. Previous **testicular problems/injury** 4. Past history of **STIs** 5. Past Hx of **Mumps** 6. Past Hx of **urethral issues** 7. Genitourinary **surgery** (hernia? vasectomy reversal?) 8. **Occupational** history (exposure to heat, pesticides, herbicides) 9. **Meds and drug use (Etoh, smoking, substances**, anabolic steroids, sulfasalazine, spironolactone, phenytoin, etc)

Answer 2

1. Onset of **menarche** 2. **Menstrual history** 3. **Symptoms of ovulation** (mittelschmerz, cervical mucous changes) 4. **Symptoms of endometriosis** (dysmenorrhea, menorrhagia, dyspareunia) 5. **PHx of STIs and Pelvic infection** 6. Previous **IUCD** use? 7. PHx of intra-abdominal **surgery** 8. PHx of genital surgery 9. **Meds and Drugs** - **ETOH, Smoking (esp over 20/day)**, past contraception esp depot provera, anabolic steroids)

Answer 3

1. Time trying to concieve 2. Timing of intercourse, use of lubricants 3. Attitudes to pregnancy and subfertility 4. Expectations for the future

Answer 4

Male: 1. Secondary sexual characteristics - note any gynacomastia 2. Testicular exam - size and consistency - compare to an orchidometer (average 18ml - normal 15-35ml) - small in klinefelter - 7m 3. Palpate epidydimis and vas 4. Evidence of varicocele 5. PR -check prostate 6. Note penis and location of urethra

Answer 5

Secondary sexual characterisitcis thyroid examination Note skin for acne, hirsutism Vaginal and pelvic examination - assess uterus and ovaries (present? mobile? non-tender? - normal) Check adnexae for any masses

Answer 6

Collection should be made **directly into a sterile container after 2-3 days of sexual abstinence** If collected at home semen should be kept at body temperature during transport to the andrology lab and **should be analysed within one hour of collection.** **A repeat test in 1-3 months if the first is abnormal**

Answer 7

_Man_ **Semen analysis** _Female_ LH, FSH, Oestradiol **Mid luteal phase progesterone** - **Day 21 of 28 day cycle** (or 7 days before next period) - to confirm ovulation Serum testosterone, SHBG, Free Androgen index **TFT** **Serum prolactin** **Transvaginal ultrasound** Then refer to specialist _{They may go on to do tests of tubal patency like hysterosalpyngogram}

Answer 8

12 months of frequent unprotected intercourse earlier if concerns

Answer 9

bleeding (at any point - during cycle (irreg/reg) or after sex) and pain PLUS acute - bilateral lower abdo pain and fever chronic - mid lower abdo pain and back pain

Answer 10

Must have ALL of the following: 1. Lower abdo tenderness (with or without rebound) 2. Cervical motion tenderness 3. Adnexal tenderness (may be unilateral) PLUS ONE OF THE FOLLOWING: 1. Temp \>/ 38 degrees 2. Purulent fluid via culdocentesis 3. WBC over 10.5 4. ESR over 15, CRP over 1 5. Histological evidence of infection 6. isolation of neisseria g, or chlamydia

Answer 11

exogenous - Chlamydia trach, n. gonno Endogenous - Ecoli Bacteroides fragilis Actinomycosis - due to prolonged IUD

Answer 12

1. **Ceftriaxone 500mg** (in 2ml of lignocaine 1 %) Intramuscular or IV on its own as a single dose PLUS **Metronidazole 400mg bd for two weeks** PLUS **Doxycycline 100mg bd for two weeks**

Answer 13

Urine pregnancy test Urinalysis **Endocervical swabs for NAAT -** chlamydia trachomatis, neisseria gonorrhea and mycoplasma genitalium Also collect a **high vaginal swab** for M/C/S if **anal** sex - offer self collected anal swab for **chlamydia** If **sex work** identified- off **throat swab** for n. **gonorrhea** **If not a monogamous partner - syphilis serology, HIV, Hepatitis B, C**

Answer 14

1. When was the last time you had sex 2. Was this a regular or a casual partner 3. How did you have sex with your most recent partner (vaginal/anal/oral) 4. Have your partners been male, female or both? 5. In the past three months how many sexual partners have you had? (Repeat question about type of sex and condom use for all partners) 6. Have you ever been diagnosed with or thought you had an STI? 7. Have you ever been paid for sex? If so when was the most recent time 8. Have you had sexual contact overseas in the last twelve months? If So which countries

Answer 15

Pregnant, severe symptoms has a suspicion of a pelvic abcess or cannot exclude a surgical emergency

Answer 16

- Review treatment progress in 48 hours and then in 2 weeks for resolution of symptoms Contact tracing of all partners for last six months Follow up in 3 months - offer first pass urine test to check for re-infection

Answer 17

1.Thickened endometrium pre-menopausal - greater than 12 mm post meno - greater than 5mm 2. Increased length of uterus - over 12 cm 3. Fibroid

Answer 18

Hysteroscopy AND D&C

Answer 19

**ACUTE** Acute PID ruptured graffian follicle Ruptured ovarian cyst ovarian torsion Ectopic pregnancy Fibroid **CHRONIC** endo adeno fibroids primary dysmenorrhea chronic PID adhesions ovarian Ca

Answer 20

PID endometriosis Adenomyosis Pelvic adhesions Vaginismus (Due to medical/physical/interpersonal causes)

Answer 21

Differentiate difference between issue with penetrative sex and relationship issues Encourage discussion about pain, fears around intercourse, muscle tension, depression and presence or absence of sexual pleasure Broach issues of intimate partner violence and safety Encourage non penetrative sex until ready for penetration Consider sexual health therapist Review and support

Gynae3 Flashcards

(46 cards)