Obstetrics and Gynaecology Flashcards
(174 cards)
1
Q
Define gestational diabetes:
A
Defined as the glucose intolerance with fasting blood glucose >= 5.6 mmol/L OR 2 hour plasma glucose levels >= 7.8 mmol/L on 75g OGTT.
2
Q
What are the risk factors of developing gestational diabetes?
A
- asian/ black
- hx GDM/ thx
- hx of babies delivered >4.5 kg
- hx of stillbirth/ perinatal death
- maternal obesity (BMI>30)
3
Q
What are the symptoms of gestational diabetes?
A
- polyuria
- thirst
- fatigue
- no noticable symptoms
4
Q
What are the investigations to diagnose gestational diabetes?
A
75g OGTT
* fasting glucose >=5.6
* 2 hour glucose >= 7.8
HbA1c (to distinguish between gestational diabetes/ pre-existing diabetes mellitus)
Urinanalysis (glycosuria)
5
Q
What is the management of gestational diabetes?
A
- lifestyle modifications when fasting glucose is < 7 mmol/L; if lifestyle measures not helping in 2 weeks then start on metformin.
- if fasting glucoses >= 7 mmol/L = insulin +/- metformin 1st line!!
6
Q
What are the maternal complications of untreated gestational diabetes?
A
- increased risk of HTN and Pre-eclampsia
- increased risk of T2DM
7
Q
What are the foetal complications of untreated gestational diabetes?
A
Macrosomia (>4.5kg)
* increased risk of birth injuries, c-section, shoulder dystocia
* increased risk of sacral agenesis
* pre-term delivery
* Neonatal hypoglycaemia= seizures
* increased risk of child getting T2DM later in life
8
Q
Define gestational Hypertension:
A
The onset of high BP after 20 weeks gestation with NO proteinuria.
This increases the mother’s risk of pre-eclampsia and low birth weight of baby.
9
Q
What are the risk factors of gestational hypertension:
A
- genetic
- lifestyle
- physiological changes of pregnancy
10
Q
What are the symptoms of Gestational HTN?
A
- Raised BP
- NO proteinuria
11
Q
What are the Ix of gestational hypertension?
A
- BP
- Urine dip
Do these at every appointment
12
Q
What is the management of gestational hypertension?
A
- discontinue ACEi- give labetolol
- monitor BP regularly and do urine dip
- if BP >140/90:
- 1st Oral labetalol
- 2nd methyldopa/ nifedipine - diet/ exercise
13
Q
Define Pre-eclampsia:
A
A placental condition affecting preganant women from 20 weeks of getsation, characterised by HTN and PROTEINURIA.
14
Q
What are the risk factors to developing Pre-eclampsia?
A
- nulliparity
- hx/ fhx
- increasing maternal age
- pre-existing DM/ HTN/ renal/ autoimmune
- obesity
15
Q
What are the symptoms of Pre-eclampsia?
A
- HTN
- proteinuria
- peripheral edema including face
- severe headache
- drowsy
- visual disturbance
- RUQ/ epigastric [pain
*Nausea and vomiting - hyperreflexia
16
Q
What is the aetiology of Pre-eclampsia?
A
- dysfunctional trophoblast invasion of the spiral arterioles which decreased uteroplacental blood flow and causes endothelia damage.
17
Q
What is the investigations indicated in a patient who is suspected to have Pre-eclampsia?
A
- BP= HTN
- Urinanalysis
- bloods test: LFT, kidney, clotting
18
Q
What is the management of Pre-eclampsia?
A
- Aspirin as prophylaxis from 12 weeks until birth
- 1st line= labetolol ( can give nifedipine, methyldopa, hydralazine)
- magnesium sulphate for prevention and treatment of ECLAMPTIC SEIZURES.
- curative= delivery of placenta
19
Q
What are the complications to the mother if Pre-eclampsia is left untreated?
A
- eclampsia/ seizures
- Organ failure
- DIC
- HELLP syndrome ( Haemolysis, Elevated liver enzymes, Low platelets)
20
Q
What are the complications to the foetus if Pre-eclampsia is left untreated?
A
- intrauterine growth restriction
- pre-term delivery
- placental abruption
- neonatal hypoxia
21
Q
Define Placental Abruption:
A
This is the premature separation of the placenta from the uterine wall during pregnancy, causing maternal haemorrhage.
22
Q
What are the risk factors to developing Placental Abruption?
A
- trauma
- pre-eclampsia/ HTN
- multiparity
- increased age
- polyhydramnios
- hx
- substance abuse during pregnancy
- coagulation disorders
23
Q
What are the symptoms of Placental Abruption?
A
- sudden/ severe abdominal pain
- ‘woody’/ hard uterus
- contractions
- vaginal bleeding ( which can be concealed)
- reduced foetal movements
- Abnormal CTG
- hypovolaemic shock
24
Q
How to manage Placental Abruption?
A
- resus ABCDE
- emergency delivery which is usually c-section
- induced labour if haemorrhage
- conservative management ( only for partial/ marginal abruptions with no compromise)
- FOR ALL PATIENTS: ANTI-D <= 72 hours of bleeding if woman is resus D negative.
25
Define preterm rupture of membranes at term (PROM)?
The rupture of amniotic membranes before the onset of labour before 37 weeks gestation.
This increases the risk of neonatal infection and chorioamniotics.
26
What are the risk factors to developing pre-term ruptures of membranes at term?
* infection
* inflammation
* stress
* mechanical forces
27
What are the symptoms of a preterm rupture of membranes at term?
* foul smelling/ greenish amniotic fluid
* maternal fever
* reduced foetal movements
28
What are the investigations into a preterm rupture of membranes at term?
* avoid vaginal exam in absence of labour
* assess foetal heart and movements
* observe vaginal discharge
* monitor maternal temperature
29
What are the complications of pre-term ruptures of membranes at term?
* chorioamniotitis
* increased risk of respiratory distress syndrome, foetal death, necrotisignenterocolitis
* developmental problems
30
What is the management of pre-term ruptures of membranes at term?
* offer labour induction if >24 hours
* signs of infection= induce labour + broad abx (erythromycin)
* foetal compromise consider C-section
* observe 12 hours post-birth
31
What to do if patient has a spontaneous rupture of membranes:
- at term, if the patient is not in labour then must induce to reduce the risk of getting an infection.
32
Define Placenta Previa:
This is the term to describe when the placenta is overlying the cervical os (so it is covering the os).
33
What is the symptoms of Placenta Previa?
* painless
* bright red vaginal bleeding
* suspect this if patient is >24 weeks gestation
* sx of shock if it is severe
34
What is the Ix of Placenta Previa?
TVUS
35
What is the management of Placenta Previa?
* if the bleeding is not controlled = C-section
* if known/ at risk of Preterm labour, consider corticosteroids 24-34 weeks gestation
* In labour = C-section
* No bleeding + no labour = monitor with USS, pelvic rest, safety net
* At term: of the placental edge >20mm from OS then trial labour
36
What are the complications of Placental previa?
Antepartum Haemorrhage
37
What is a post-partum haemorrhage:
This is defined as the loss of at least 500ml of blood within the first 24 hrs of delivery.
38
How much blood loss classes as a massive post-partum haemorrhage?
>2000ml
39
What are the causes of post-partum haemorrhage?
4Ts
* Tone- the failure of uterus to contract after delivery
* Trauma- birth canal injury/ tear
* Tissue- retained placental/ foetal tissue = TVUS
* Thrombin- coagulopathies due to failure to clot
40
What are the risk factors to developing post-partum haemorrhage?
* hx
* BMI > 35
* multiple pregnancy
* parity >4
* obstetrics conditions
* C-section
* induced labour
* instrument delivery
* prolonged labour >12 hours
* macrosomia
* advanced maternal age
41
What investigations should be done in a patient with post-partum haemorrhage?
* USS
* group and save
* swabs
42
What is the initial management of a patient who is currently undergoing a post-partum haemorrhage?
* resus A-E
* major haemorrhage protocol ??
* supine position
* insert 2x large bore cannulas
* O2
* fresh frozen plasma if abnormal clotting
43
What is the surgical management options of a patient who is currently undergoing a post-partum haemorrhage?
* intrauterine balloon tamponade
* B-lynch suture
* uterine artery ligation
* hysterectomy
44
What is the management of post-partum haemorrhage caused by TONE?
* uterotonic meds
* bimanual compression
* oxytocin, syntocinon, ergometrine, carboprost, misoprostol, tranexamic acid
* rubbing uterus/ catheter
45
Define Shoulder Dystocia:
Is a type of obstructed labour where following the delivery of the foetal head, the anterior shoulder becomes impacted behind the maternal pubic symphysis.
46
What are the risk factors for Shoulder Dystocia?
* hx
* diabetes
* BMI >30
* macrosomia
* increased maternal age
* small maternal pelvis
47
What are the symptoms for Shoulder Dystocia?
* difficult delivery of the foetal face/ chin
* retraction of the foetal head ( turtle-neck sign)
* failure of restitution ??
* Failure of descent of foetal shoulders following the delivery of the head.
48
What is the management for Shoulder Dystocia?
* call for help
* do not apply fundal pressure- causes uterine rupture
* Mc Robert's manoeuvre/ all fours position
* internal rotational manoeuvres
49
What is the mother at risk of when there is shoulder dystocia?
Monitor and examine the mother as there is an increased risk of
* Postpartum haemorrhage
* Perineal tears
* Genital tract trauma
50
What is the child at risk of when there is shoulder dystocia?
Monitor and examine the foetus as there is an increased risk of:
* Brachial plexus injury (C5-C6-erbs palsy)
* humeral/ clavicular fractures
* neurodevelopmental delay
51
What is the induction of labour:
Medically initiated process of starting labour artificially.
52
When is the induction of labour indicated?
* > 41 weeks gestation
* preterm prelabour rupture of membranes
* intrauterine foetal death
* Abnormal CTG
* maternal conditions e.g., pre-eclampsia, diabetes
53
What are the contraindications of inducing labour?
* hx of C-section
* multiple lower uterine C-sections
* tranomissable ? infections
* placenta previa
* malpresentations?
* severe foetal compromise
* cord prolapse
* vasa previa
54
What are the investigations that should be done leading up to the induction of labour?
- USS to assess gestational age, foetal position, placental location
- blood test
55
How is labour induced? (management)
* membrane sweep = inserting goved finger into external OS and separating membranes from cervix
* vaginal prostaglandins PE2 = to ripen cervix and induce contractions
* Amniotomy = artificial rupture of membranes
* Balloon catheter = inserted onto cervix to mechanically dilate it
56
Define Misscarriage?
Defined as the loss of pregnancy prior to 24 weeks gestation.
57
Define Threatened Miscarriage?
Bleeding up until 24 weeks gestation.
58
Define Missed Miscarriage?
Usually asymptomatic, usually the uterus still contained the foetal tissue but it is dead.
59
Define Complete Miscarriage?
When all the products of conception has been expelled from uterus.
60
Define incomplete Miscarriage?
Some of the product of conception and some still inside uterus.
61
What are the causes of a Miscarriage?*
Foetal
* genetic disorder
* abnormal development
* placental failure
Maternal
* uterine abnormality
* cervical incompetence
* PCOS
* poorly controlled DM/ thyroid disease
* antiphospholipid syndrome
62
What are the symptoms of a Miscarriage?
* vaginal bleeding
* pain
* vaginal tissue loss
* vaginal fluid loss
* loss of pregnancy symptoms
63
What is the management of a miscarriage?
* Expectant tx- to wait for POC to pass naturally
* Medical tx- misoprostol
* Surgical tx- d&c; manual vacuum aspiration (under local anaesthetic); ERPC (under general anaesthetic)
64
Define Ectopic Pregnancy?
This is a medical condition when the fertilized egg/ embryo implants and grows outside of uterine cavity (common in the fallopian tubes).
65
What are the risk factors of an Ectopic Pregnancy?
- hx
- PID, endometriosis
- IUD
- genital infection
- assisted pregnancy
- pelvic surgery
66
What are the symptoms of an Ectopic Pregnancy?
* unilateral pelvic pain
* shoulder tip pain (referred)
* abnormal vaginal bleeding
* haemodynamic instability
* vomiting
* cervical tenderness (chandelier sign)
* collapse ( massive rupture)
* faint/ lightheaded rupture
67
What are the investigations done as the work up of an Ectopic Pregnancy?
* pregnancy test showing a slow rise of HCG which eventually stops
* TVUS for adnexal mass/ empty uterus
68
What is the management of an Ectopic Pregnancy?
Medical
* Methotrexate if diagnosed early to stop the development of pregnancy
Surgical
* salpingectomy
69
Define Stillbirth?
When a baby is born dead after 24 weeks of gestation.
70
What are the causes of stillbirth?
* placental insufficiency
* birth defect
* cord-accident
* pre-eclampsia
* infection
* increased risk with smoking, drugs and alcohol
71
What are the signs of a stillborn pregnancy?
* absent foetal movements
* incidental finding
72
How do we diagnose a Stillborn pregnancy?
USS will show no foetal haertbeat
73
What is the management of Stillborn pregnancy?
* induced vaginal delivery
* C-section
74
Define Neonatal death?
* when baby dies within the first 28 days of life.
75
Define Hyperemesis Gravidarum?
This is the severe nausea and vomiting before 20 weeks gestation.
76
What are the symptoms of Hyperemesis Gravidarum?
* relentless vomiting
* dehydration
* metabolic disturbance
77
What is the management of Hyperemesis Gravidarum?
* hospital admission
* fluid replacement
* potassium-chloride to treat hypokalaemia
* 1st line- Cyclizine OR Prochlorperazine
* 2nd line- Ondansetron OR Metoclopramide
* Thiamine and folic acid to prevent Wernicke's encephalopathy
* Thromboembolic stocking + LMWH
78
What is the medical TOP?
Mifepristone (blocks projesterone) + Misoprostol (prostaglandin analogue)
79
What is the surgical TOP?
* suction
* Dilation and Curettage
80
Define Fibroids (uterine leiomyomas):
Are benign smooth muscle tumors originating from the myometrium of the uterus.
81
What are the risk factors of developing Fibroids?
* >50 years
* genetic
* hormonal
* environmental
* black women
82
What are the symptoms of Fibroids?
* asymptomatic
* dysmenorrhea
* abdominal distension
* dyspareunia
* increased pressure on bowel/ bladder
* infertility
* Menorrhagia
* enlarged uterus
83
What investigations should be done when looking for fibroids?
* TVUS
* MRI
* Biopsy
84
What is the management of Fibroids?
Refer when:
- fibroid >3cm/ submucosal on scan
- severe sx/ failed tx in primary care
- fertility issues
- rapid/ unexpected growth post-menopause
Non surgical:
- NSAIDs
- anti-fibrinolytics
- COCP
- Mirena coil
Surgical tx:
- myomectomy
- ablation
- uterine artery embolisation
- hysterectomy
85
Define Endometriosis?
This is an oestrogen dependant chronic inflammatory disease where endometrium-like-tissue grows outside of the uterus.
86
What are the symptoms of Endometriosis?
* dysmenorrhea
* dyspareunia
* subfertility
* cyclical rectal bleeding
* abdominal distension
* HMB
87
What are the investigations of Endometriosis?
GOLD- laparoscopy
TVUS- cyst
88
What is the management of Endometriosis?
Refer:
- severe, persistent, recurrent symptoms
- pelvic signs
- bowel/ bladder/ ureter involvement
Medical:
- analgesia
- hormone therapies
Surgical
89
Define PCOS?
A hormonal imbalance affecting periods; a disorder of the endocrine system.
90
What is the risk factors of developing PCOS?
* obese
* fhx
* DM
* dyslipideamia
* hyperandrogenism
* increased LH
91
What are the symptoms of PCOS?
* acne
* hirsutism
* infertility
* oligomennorhoea
* mood changes
* acanthosis nigrans (DM)
* male pattern baldness
92
How is PCOS investigated?
* Rotterdam Diagnostic Criteria
* Abdo/ vaginal USS
* LH:FSH ratio high (>2)
* +/- raised testosterone
* OGTT/ fasting insulin resistance
* TFT
93
What is the management of PCOS?
Weight loss/ exercise
Tx for those not planning pregnancy:
* co-cyprindol (reduced hirsutism)
* COCP
* Metformin
Tx for those who want to concieve:
* Clomiphene
* metformin
* ovarian drilling
* gonadotrophins
94
Define Atrophic Vaginitis?
Also known as vulvovaginal atrophy.
Characterised by the inflammation and thinning of the genital tissues due to reduced oestrogen levels
Meaning this is most common in post-menopausal women.
95
What are the symptoms of Atrophic Vaginitis?
* thinning of the vaginal mucosa
* loss of pubic hair
* narrowed introitus
* dryness/ itchy vagina
* loss of vaginal rugae (folds)
* dyspareunia
* post-coital bleeding
* vaginal discharge
* urinary symptoms (dysuria, recurrent UTI, incontinence)
96
What is the Investigations of Atrophic Vaginitis?
- clinical
- TVUS + endometrial biopsy
- infection screen if itchy/ discharge
- biopsy for abnormal skin lesions
- urinanalysis
97
What is the management of Atrophic Vaginitis?
Hormones:
* HRT
* Topical oestrogen preparation
Non-hormonal:
* lubricants
* moisturisers
Transvaginal laser therapy ??
98
Define Pelvic Inflammatory disease?
When an infection spreads from the vagina to teh cervix and upper genital tract.
99
What is the risk factors to developing PID?
* gonorrhoea
* chlamydia
100
What are the symptoms of PID?
* bilateral abdo pain
* discharge
* post-coital bleeding
* adnexal tenderness
* cervical motion tenderness
* fever
101
What investigations are done for PID?
* pelvic exam
* pregnancy test
* blood tests
* TVUS
* swabs for STI
102
What are the management of PID?
Abx combination:
* IM ceftriaxone + doxycycline + metronidazole
* Ofloxacin + metronidazole
Analgesia
103
What is the complication of PID?
* chronic pelvic pain
* infertility
* ectopic pregnancy
104
What is Fitz-Hugh Curtis Syndrome?
??
105
What are the symptoms of Fitz-Hugh Curtis Syndrome?
* RUQ pain
* inflammation of liver capsule
* LFT normal
106
What is the definitive investigation for Fitz-Hugh Curtis Syndrome?
Laparoscopy
107
What is the treatment of Fitz-Hugh Curtis Syndrome?
Antibiotics
108
What is meant by primary amenorrhoea?
The failure of menstrual periods to start by 15 years of age in a female with normal growth and secondary sexual characteristics.
109
What are the causes of Primary Amenorrhoea?
* delay in puberty
* Chromosomal abnormalities
* dysregulation of the hypothalamic/ pituitary glands due to:
- anorexia
- excessive exercise
- extreme stress
* structural abnormalities of genital tract
* preganacy
110
What investigations should be done if someone has Primary Amenorrhoea?
- imaging
- genetic test
- hormonal tests (LH/ FSH/ estrodiol)
111
What is the management of Primary Amenorrhoea?
- HRT
- surgery
- psychological support
- lifestyle modifications
112
What is meant by secondary amenorrhoea?
Absence of menstruation for 6 months/ longer in a woman who previously had regular menstrual cycles.
113
What are the causes of secondary amenorrhoea?
* PCOS
* thyroidism
* menopause
* intrauterine adhesions
* pregnancy
* drug induced
* stress
* pituitary gland pathology
114
What are the investigations of secondary amenorrhoea?
* pregnancy test
* hormones
* USS
* hysteroscopy
115
What is the most common type of cervical cancer?
Squamous cell carcinoma
116
What are the risk factors of developing cervical cancer?
* HPV 16 & 18 infection
* early age of sex
* multiple sexual partners
* low socioeconomic status
* COCP use
* immunosuppression
117
What are the symptoms of cervical cancer?
* post-coital bleeding
* IMB
* discharge
* vaginal discomfort
* urine/ bowel habit change
* suprapubic pain
* abnormal white/ red patches on cervix
* pelvic bulkiness
* mass of DRE
* Inflamed cervix
* contact bleeding
* lesion on cervix
118
What is the investigation for cervical cancer?
1st line is urgent 2ww for colposcopy + biopsy
Consider CT for metastases
119
What is the cervical screening programme in the UK?
* every 3 years if age 25-49 years old
* every 5 years if age 50-65 years old
* sample is tested for HPV (dyskaryotic cells)- pre cancerous
* Results:
- negative HPV = routine recall
- positive HPV = cytological test
120
What does the HPV vaccine try to protect you from?
* genital warts
* cervical cancer
* mouth/throat cancer
* anal cancer
* HPV infections
121
What is the management for cervical cancer?
Refer!!
CHECK NOTES
122
What is Endometrial cancer?
This is hyperplasia/ abnormal thickening of the uterine lining.
123
What are the risk factors to developing Endometrial Cancer?
* exposure to unexposed oestrogen
* nulliparity
* obesity
* early menarche
* late menopause
* PCOS/ DM
* Oestrogen only HRT
* 75-79 years old
* Tamoxifen
* genetics (Lynch)
124
What are the symptoms of Endometrial Cancer?
- post-menopausal bleeding
- IMB
- dyspareunia
- pelvic pain
- abdo discomfort/ bloating
- weight loss
- anaemia
- enlarged uterus
125
What are the investigations done for Endometrial Cancer?
* Endometrial Biopsy via hysteroscopy/ pipelle
* TVUS is >55 and :
- unexplained PV discharge
- visible haematuria
126
When would you do an URGENT referral for suspected Endometrial Cancer?
* post menopausal bleeding AND not on HRT
* unscheduled bleeding 4-6 months after HRT
* abnormal abdo/ pelvic USS suggestive of endometrial cancer.
127
What is the management of Endometrial cancer which is limited to the uterus?
Hysterectomy and bilateral salpingo-oophorectomy
128
What is the most common type of vulval cancer?
Squamous cell carcinoma
129
What are the risk factors for developing vulval cancer?
* HPV
* >60 years women
130
What are the symptoms of Vulval Cancer?
* a lump associated with lymphadenopathy
* itching/ discomfort in vulval area
* non-healing ulcer
* changes in the skin of the vulva
* bleeding/ discharge not related to the menstrual cycle
131
What is the investigations done for Vulval cancer?
* Examination of Vulva
* Biopsy
* Imaging
* Bloods
132
What is the Tx for Vulval Cancers?
Surgery/ chemo/ radio
133
What is the most common type of Ovarian cancer:
Epithelial Ovarian Tumors
134
Provide more information of Epithelial Ovarian Tumors:
* originates from fimbria of fallopian tubes/ ovaries
* particularly cystic with fluids
* metastases to peritoneal cavity, bladder, paracolic gutters and diaphragm
* most common
135
Provide more information of Germ Cell Ovarian Tumors:
* originate from the germ cells in embryonic gonad
* rapid growth and spread spread via lymphatic route
* common in young women
* tumour markers = alpha-fetoprotein + beta-HCG
136
Provide more information of Sex Chord Stromal Ovarian Tumors:
Originate from connective tissue
137
What are the Risk Factors of developing Ovarian Cancer?
* advanced age
* smoking
* increased n.o of ovulations
* obestity
* HRT
* genetics- BRCA gene
138
What are the Protective Factors of developing Ovarian Cancer?
* child bearing
* breastfeeding
* Early menopause
* COCP
139
What investigations are to be done for Ovarian cancer?
* CA-125 blood test
* pelvic/ abdo USS
* CT = staging
* laparotomy (biopsy)
* AFP and Beta-HCG
140
What are the symptoms of Ovarian Cancer?
* abdo discomfort
* bloating
* early satiety
* urinary frequency
* change in bowel habits
* ascites
* pelvic/ back pain
* abdo pain
* palpable pain
141
The different staging of Ovarian Cancer:
Stage I- ovaries only
Stage II- one/ both ovaries with pelvic extension &/ implants
Stage III- Microscopically conformed peritoneal implants outside the pelvis
Stage IV- distant metasteses
142
What are the Risk Factors of developing Breast Cancer?
* increased hormone exposure
* BRCA gene mutations
* advancing age
* caucasian people
* obesity + lack of activity
* alcohol
* tobacco
* hx breast cancer
* radiotherapy hx
143
What are the symptoms of Breast Cancer?
* Unexpalined breast mass in >= 30 yrs
* >= 50 yrs with nipple discharge, retraction
* skin changes
* unexplained axillary mass in >= 30 yrs
144
What are the investigations of Breast Cancer?
* TRIPLE ASSESSMENT ( mammogram, USS/MRI, Biopsy)
* CT/PET if looking for metastases
145
What is the most common type of Breast Cancer?
Invasive Ductal Carcinoma
146
What is the Breast Cancer Screening Programme in the UK?
Women ages 50-70 years for breast screening every 3 years.
147
What is the management of Breast cancer?
* Surgical tx
* radiotherapy- post-mastectomy
* chemotherapy- before surgery
* Biological therapy- Trastuzumab (herceptin)
* hormone therapy:
- Anastrozole (aromatase inhibitor) in post-
menopausal women
- Tamoxifen (oestrogen receptor antagonist) in
pre-menopausal women
* Bisphosponates
148
Define Premature Ovarian Insufficiency:
Also known as 'early menopause' and is a medical condition characterised by the onset of menopause in a women ages less than 40 years.
149
What is Puerperal Mastitis:
This is the inflammation and potential infection of breast tissue that is associated with lactation in postpartum women
150
What are the Risk Factors of developing Puerperal Mastitis?
* 3m post partum
* cracked/ sore nipple
* Staph. aureus
151
What are the symptoms of Puerperal Mastitis?
* localised: pain, tender, red, hot breast
* ststemic sx: fevers, rigors, myalgia, fatigue, headache, nausea
* can appear as early as one week post partum
152
What are the Ix for Puerperal Mastisitis?
* Breast exam
* ultrasonography when abscess suspected
* culture for abscess
153
What is the treatment for Puerperal Mastitis?
* analgesia
* continue breast feeding
* empirical abx- flucloxicillin
* surgical drainage if abscess
154
What are the Complications of Puerperal Mastitis?
* abscess formation (fluctuant, tender mass with erythema.
155
Define Fibrocystic Breast Disease:
Is a benign condition characterized by the presence of fibrous tissues and cysts in the breast.
156
What are the risk factors for developing fibrocystic breast disease?
* 20-50 yrs age
* oestrogen + progesterone
* cysts
157
What are symptoms of fibrocystic breast disease?
* bilateral lumps in the breast
* common in the upper outer quadrant
* symptoms that worsen with menstrual cycle- pears 1 weak pre-menses.
158
What are the Treatment of Fibrocystic Breast Disease?
* soft and well-fitted bra
* analgesia
* usually resolves after menopause
159
What are the Investigations of Fibrocystic Breast Disease?
* mammograms
* USS
* biopsy to exclude malignancy
160
Define Fibroadenoma:
Is a benign tumour containing a mixture of fibrous and epithelial tissue which originate from lobules.
161
What are the risk factors for developing Fibroadenomas?
* early 20s
* puberty
* menopause
* pregnancy
162
What are the Symptoms of Fibroadenoma?
* firm, non-tender breast mass
* round with smooth edges
* mobile, rubbery
* < 3cm
163
What are the Investigations of Fibroadenoma?
Triple assesment
164
What is the treatment of fibroadenoma?
* conservative
* surgical excision if > 3cm
165
Define Mastitis:
inflammation of breast tissue +/- infection
166
What is the investigation for Mastitis?
* USS
* Early referral to secondary care if abscess suspected.
166
Define Vaginismus
Involuntary contraction of the vaginal musculature
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What is the management of Mastitis?
* continue breastfeeding
* manual expression
* analgesia
* abx
* breast abscess treatmen
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What are the symptoms of Vaginismus?
- Pain during vaginal penetration (sex, gyn exam, tampon)
- Dyspareunia
- Lack of interest in sex
- Inability to be aroused
- Vaginal dryness & lack of lubrication
- Inability to use tampons
- Anorgasmia
- History of traumatic examination or sexual experience
- +/- urogenital anomalies, scarring, lichenification, inflammation
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What is the Treatment of Vaginismus?
- Vaginal trainers
- Psychosexual & couples therapy
- Topical lidocaine
- HRT in post-hysterectomy & perimenopausal females
- Pelvic floor exercises
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Define Menopause
12 months no period
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What are the symptoms of Menopause?
Gynaecological Symptoms:
- Irregular periods
- Prolapse
- Urinary problems
- Loss of libido
- Dyspareunia
- Vaginal atrophy
Physical Symptoms:
- Joint/ muscle ache, Headache
- Skin/ hair symptoms
- Weight gain
- Vasomotor symptoms
Psychological Symptoms:
- Anxiety, mood changes
- Brain fog
- Sleep issues/ fatigue
- irritability
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What is the Ix for Menopause?
PLEASE FINISH
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First line Ix adenomyosis
TVUS
