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Y3 GP > Men’s And Women’s Health > Flashcards

Men’s And Women’s Health Flashcards

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1
Q

What is endometriosis ?

A

A common disorder characterised by the presence of endometrial glands and stroma outside of the endometrial cavity.

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2
Q

What are some risk factors for endometriosis ?

A

Obstruction to menstrual flow
Prolonged exposure to endogenous oestrogen
Short menstrual cycles
Low birth weight

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3
Q

Where are the most common sites for endometriosis ?

A

Ovaries
Pouch of Douglas
Uterosacral ligaments

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4
Q

What are some clinical features of endometriosis ?

A

Symptoms may be asymptomatic
Dysmenorrhoea
Dyspareunia
Chronic pelvic pain
Pain at time of ovulation
Infertility
Chronic fatigue

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5
Q

What are some differentials for endometriosis ?

A

Chronic pelvic inflammatory disease
Recurrent acute salpingitis
Ovarian tumour
Ectopic pregnancy
IBS
Urinary causes

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6
Q

What is the management of endometriosis ?

A

Analgesia - NSAIDs or paracetamol
Hormonal treatment
COCP
Surgical treatment

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7
Q

Define menopause

A

The permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhea for which there is no other obvious pathological or physiological cause.

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8
Q

What age range does menopause occur in ?

A

40 - 58 years old

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9
Q

What are some clinical features of menopause ?

A

Hot flushes
Thinning of vaginal skin
Increased risk of UTI
Dysuria or nocturia
Irritability
Lethargy
Depression
Loss of libido
Increased risk of breast cancer

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10
Q

What is the management of menopause ?

A

HRT
Lifestyle measures
Gabapentin - reduces hot flushes
SSRI - alternative to HRT
Diet and supplements

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11
Q

What is infertility ?

A

The failure of conception in a couple having regular, unprotected coitus for one year, provided that normal intercourse is occurring not less than twice weekly.

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12
Q

What are the main causes of infertility ?

A

Unexplained infertility
Ovulatory disorders
Tubal damage
Factors affecting male infertility
Uterine or peritoneal disorders

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13
Q

What are some investigations for infertility ?

A

History and examination of both partners
Semen analysis
Assessment of ovulation
LH, FSH, TFT’s, testosterone level blood test
Assessment for tubal patency

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14
Q

What is the management of male infertility ?

A

Decrease smoking or drinking
Clomiphene citrate

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15
Q

What is the management for female infertility ?

A

Clomiphene citrate
Surgery for tubal damage
Intrauterine insemination

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16
Q

What are fibroids ?

A

The most common benign gynaecological tumour. Monoclonal tumours of the smooth muscle cells of the uterine myometrium.

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17
Q

What are some risk factors for fibroids ?

A

Race
Genetics
Age - rare before menarche
Early menarche
Obesity
High meat diet
Hypertension
Smoking
diabetes

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18
Q

What are some clinical features of fibroids ?

A

Abnormal uterine bleeding
Abdominal bloating
Urinary frequency and urgency
Urinary incontinence
Constipation
Pelvic pain

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19
Q

What may be felt on examination when suspecting fibroids ?

A

Very large fibroids may be palpated abdominally
Vaginal exam reveals a firm, irregularly enlarged uterus - non tender

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20
Q

What are some differentials for fibroids ?

A

Ovarian tumours - cysts, carcinoma and fibroma
Pregnancy
Uterine endometriosis
Diverticular disease
Colonic carcinoma

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21
Q

What are some investigations for fibroids ?

A

FBC - check Hb
Mid stream urine test
USS
MRI
Hysteroscopy

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22
Q

What are some complications of fibroids ?

A

Hyaline degeneration - muscle and fibrous tissue replaced by hyaline tissue

Fatty degeneration

Calcification

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23
Q

What is the management of fibroids ?

A

Majority are asymptomatic so require no treatment

NSAIDs
Oral contraceptives
Myomectomy - removal of fibroid
Hysterectomy
Uterine artery embolisation

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24
Q

What are the 3 main features of PCOS?

A

Irregular periods
Excess androgens
Polycystic ovaries - ovaries become enlarged and contain fluid filled sacs

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25
What are some symptoms of PCOS ?
Irregular periods Difficulty getting pregnant Hirsutism Weight gain Thinning hair and hair loss Oily skin and acne
26
What are the investigations performed when suspecting PCOS ?
Endocrine tests Imaging of the ovaries - USS
27
What are some complications of PCOS ?
Infertility DM TIA / stroke Obstructive sleep apnoea
28
What are the management options for people with PCOS ?
Lose weight, Clomiphene citrate for infertility Anti-androgens or oestrogen for Hirsutism Lose weight or Metformin for insulin resistance COCP for menstrual irregularity
29
What is the ovarian cycle ?
The normal process whereby the ova mature and are released during the menstrual cycle.
30
At what day does ovulation occur and what happens after ?
Day 14 After ovulation the theca and granulosa cells proliferate and the luteal cells form the corpus luteum. These cells proliferate and produce oestrogen and progesterone. If pregnancy does not occur the corpus luteum begins to degenerate.
31
What are the 3 phases of the uterine cycle ?
Proliferative Secretory Menstrual
32
What happens in the proliferative phase ?
The lining becomes thicker and the uterine glands become thicker. There is mitosis in both stromal and epithelial cells leading to growth of the glands and thickening of the endometrium.
33
What occurs in the secretory phase ?
The endometrium becomes more vascular and the glandular component become coiled and tortuous. This is stimulated by oestrogen and progesterone.
34
What occurs in the menstrual phase ?
Regression of the corpus luteum and loss of hormonal support, necrosis and subsequent bleeding and sloughing of the endometrium occurs.
35
What is menstruation ?
Normal menstruation occurs as the endometrium sloughs from the uterus, with consequent bleeding. The flow usually lasts for 3 - 5 days. This marks the start of the new menstrual cycle.
36
What is the follicular phase and what hormones are involved ?
First phase of the cycle. FSH stimulate growth in follicles Inhibin is produced and FSH starts to decline Increase in oestrogen
37
What hormones are involved in ovulation ?
LH surge causes ovulation. LH surge is caused by a rise in oestrogen. Meiosis is completed in the oocyte as a result of the LH surge.
38
What is the luteal phase ?
Occurs after the release of the ovum. The follicle forms the corpus luteum and starts to produce progesterone, androgens and oestrogen. The corpus luteum regresses after 9 - 11 days unless pregnancy occurs.
39
A massive rise in progesterone results in ?
Preparation of the endometrium for implantation Suppression in growth of the new follicles past the preantral stage
40
What are the most common penile disorders affecting ?
The foreskin
41
What is balanitis ?
Inflammation of the glans penis. Common in young boys with non-retraction foreskin and in elderly men.
42
How does balanitis present ?
Irritation or pain in the penis and discharge beneath the foreskin. Inflammation is usually visible. Recurrent balanitis may cause phimosis with disturbance of micturition.
43
What is the management of balanitis ?
Avoid contact with any potential skin irritants Keep area clean by bathing twice daily with weak saline solution If fungal - topical anti fungals imidazole If bacterial - oral antibiotics flucloxacillin Referral for consideration for circumcision may be necessary
44
What is phimosis ?
The inability to retract the foreskin because of a narrow preputial ring.
45
What are some causes of phimosis ?
Primary physiology - congenital ( rare ) Recurrent balanitis Traumatic retraction of the foreskin
46
How does phimosis present ?
Poor stream Ballooning of the foreskin on Micturition Spraying on Micturition Recurrent attacks of balanitis Pain on intercourse
47
What is the management of phimosis ?
Topical steroids Circumcision
48
What is paraphimosis ?
The inability to pull the foreskin forward that has been retracted behind the glans penis. Can occur at any age
49
How does paraphimosis present ?
Substantial pain Penile swelling Treated as a medical emergency
50
What is the treatment of paraphimosis ?
Manual reduction after applying anaesthetic jelly In difficult cases a dorsal slit is made Circumcision should be performed when inflammation has resolved.
51
What is benign prostatic hypertrophy ?
A histological diagnosis characterised by non-malignant proliferative process of the prostatic stromal cells. Affecting the transition zone
52
What are some clinical features of BPH ?
LUTS - frequency, urgency, poor stream, post-micturition dribble Retention Overflow incontinence Haematuria Infections
53
What is felt on examination in BPH ?
Smooth and symmetrical prostate Enlarged
54
What investigations are performed when suspecting BPH ?
Urine dipstick Cystoscopy FBC MSU PSA
55
What is the treatment for BPH ?
Pelvic floor exercises Alpha blockers 5-alpha reductase inhibitors TURP
56
What are some complications of BPH ?
Chronic retention Infection Overflow incontinence Calculi Bilateral hydronephrosis Renal failure
57
What are some risk factors of prostatic cancer ?
Increasing age Ethnically origin - black African or black Caribbean Family history Diet Obesity Smoking
58
How does a prostatic carcinoma spread ?
Direct local invasion - seminal vesicles, bladder and urethra Lymphatics - Haematogenous - usually to bone and can be liver and lung
59
What are some clinical features of prostatic cancer ?
May be asymptomatic Outflow obstruction Haematuria Back pain Constipation
60
What are some signs that prostatic cancer has metastasised ?
Bone pain Jaundice and pain in RUQ Fits - spread to brain Swollen legs - pelvic lymph nodes Lung - usually incidental finding
61
How does prostatic cancer feel on examination ?
Asymmetrical Nodular Enlargement Stony hard
62
What investigations are performed when suspecting prostate cancer ?
PSA test DRE Transrectal USS MRI MSU to see if infection U&E to assess renal function
63
What is the management plan for localised prostate cancer ?
Low risk - Active surveillance Higher risk - radical prostatectomy or radiotherapy or chemotherapy
64
What is the management plan for advanced metastatic prostate cancer ?
Bilateral orchidectomy LHRH agonist Anti-androgen mono therapy Chemotherapy Bisphosphonates
65
What is prostatitis ?
Inflammation of the prostate gland and is usually caused by coliform bacteria. It is uncommon and is characterised into acute and chronic.
66
What is acute prostatitis ?
An acute focal or diffuse suppurative inflammation of the prostate gland. It is a bacterial infection needing prompt treatment.
67
What is usually the causative pathogen in acute prostatitis ?
E. Coli Proteus species Klebsiella species
68
What are some complications of acute prostatitis ?
Acute urinary retention Chronic prostatitis Prostatic abscess Epididymitis Pyelonephritis
69
What are some clinical features of acute prostatitis ?
Fever Chills Muscle pain Perineal pain Bladder outflow obstruction Haematuria Pain
70
What is seen on examination when suspecting acute prostatitis ?
Tender and swollen Prostatic massage may cause pus to be exuded from the urethra.
71
What is the management of acute prostatitis ?
Ciprofloxacin orally for 14 days Second line Trimethoprim for 1 days
72
What investigations are performed when suspecting acute prostatitis ?
MSU - mid stream sample
73
What causes chronic prostatitis ?
Inflammation most commonly resulting from inadequately treated acute prostatitis or genito-urinary TB.
74
How does chronic prostatitis present ?
Low grade perineal pain Pain exacerbated by sitting on a chair Low back pain - may extend down the leg Dysuria Mild bouts of fever
75
What is seen on examination when suspecting chronic prostatitis ?
Enlarged firm and irregular prostate Massage exuded a purulent urethral discharge
76
What is the treatment for chronic bacterial prostatitis ?
Ciprofloxacin for 4-8 weeks
77
What is Menorrhagia ?
Regular excessive menses occurring over several consecutive cycles in an otherwise normal menstrual cycle. More than 80mL in an otherwise normal menstrual cycle.
78
What are some causes of Menorrhagia ?
Pelvic endometriosis PID Endometrial hyperplasia Uterine fibroids Hypothyroidism Copper IUD Dysfunctional uterine bleeding - if other causes have been excluded
79
What should be covered in a history for heavy bleeding ?
Nature of the bleeding Any other related symptoms - intermenstrual bleeding or post - coital bleeding, pelvic pain Impact on the quality of life Previous history of Menorrhagia
80
What are some investigations for Menorrhagia ?
Blood tests - FBC, clotting studies, ferritin levels, TFT’s Cervical smear HVS, chlamydia screen
81
What is the management for Menorrhagia ?
Levonorgestrel releasing IUS - first line Tranexamic acid or NSAIDs COCP or POP
82
What is HRT ?
Hormone replacement therapy aims to replace oestrogen in post menopausal women and reverses the adverse effects of a lack of oestrogen.
83
The type of HRT depends on which factors ?
Whether the individual has had a hysterectomy Menopause status Preference for type of treatment - oral or not PMH Current medications
84
What are some clinical indications for HRT ?
Perimenopausal or early postmenopausal women Over 50 years old ( over 60 risks start to outweigh benefits ) Experiencing trouble some vasomotor symptoms
85
Why would you start someone on HRT ?
Perimenopausal or recently postmenopausal symptomatic women where risk factors for CVD or thromboembolic are low At risk of fractures
86
What should be discussed before starting HRT ?
Modifiable factors for CVD - alcohol, smoking, DM, hypertension Risks and benefits Breast and cervical screening should be up to date
87
What are some benefits from starting HRT ?
Decreases flushing Improves headaches and insomnia Reverses genital tract atrophy Reduces osteoporosis and fracture rate May be protective against Alzheimer’s disease
88
What are some side effects of HRT ?
Nausea and breast tenderness Weight gain and fluid retention Headaches Bloated sensation Leg cramps Glucose intolerance may be impaired Slight increased risk of cholelithiasis
89
What complications are there for unopposed oestrogen replacement therapy ?
Endometrial hyperplasia Endometrial carcinoma Abnormal bleeding patterns
90
What complications can occur if a person is on HRT for longer than 5 years ?
Increased risk of breast cancer
91
What are some contraindications of HRT ?
History of breast cancer History or know risk of venous or arterial thromboembolic disease, stroke or CVD Uncontrolled hypertension
92
Which conditions require caution when using HRT ?
Abnormal vaginal bleeding Abnormal liver function Migraines High risk of gall bladder disease
93
What is stress incontinence ?
The involuntary loss of urine through an intact urethra secondary to an increase in intra-abdominal pressure and in the absence of detrusor activity ( coughing or straining ).
94
What are the most common situations that cause stress incontinence ?
Following childbirth After menopause
95
What assessments should be taken when suspecting stress incontinence ?
History Physical exam Assess pelvic organ prolapse Bladder pressure tests
96
What are some management options for stress incontinence ?
Caffeine reduction Fluid intake modifications Pelvic floor training Bladder training
97
What is urgency incontinence ?
The sudden need to pass urine, which if ignored, may produce incontinence.
98
What are the combined hormonal contraceptions ?
COCP Combined transdermal patch Combined vaginal ring
99
What are some progestogen only contraception ?
POP Progestogen only implant Progestogen only injectable
100
What are some intrauterine contraception ?
Copper IUD Levonorgestrel IUS - marina coil
101
What are the sterilisation methods for contraception ?
Vasectomy Tubal occlusion
102
what does the COCP contain ?
Oestrogen and progestogen
103
What is the mechanism of action of combined hormonal contraceptives ?
Ovulation is inhibited by the oestrogen and progestogen components. These act on the hypothalamo-pituitary axis to reduce the production of LH and FSH. This means ovulation doesn’t occur.
104
Why is progestogen given with oestrogen in contraceptions?
The oestrogen component causes the endometrium to proliferate and grow. The progestogen prevents hyperplasia of the endometrium.
105
What is the normal regime of the COCP ?
21 days of the pill followed by 7 days without

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