RHCN - Block 3 Flashcards
(93 cards)
What is the name given to the scale that we use to categorise pubertal development?
Tanner scales
What is the correct order of development for pubertal development in females?
Breast development>pubic hair growth>rapid height spurt>menarche
A 16.5 year old girl presents to your GP surgery concerned about menstruation. She reports that she has never had a true ‘period’, but sometimes has some pains that she feels could be related to her periods. Her health otherwise is good and did not report anergia. She is not sexually active. Mum describes a normal childhood development, and she is in the 60th centile for height for her age. Her BMI is 23.4. On examination she has normal breast development and pubic hair growth for her age. What is the most likely diagnosis?
a) Secondary amenorrhoea; b) Hypothyroidism; c) Menstrual outflow tract obstruction; d) Pituitary adenoma
c) Menstrual outflow tract obstruction
Which of the following is a known cause of Asherman’s syndrome?
a) IUD contraception; b) Myomectomy; c) Endometriosis; d) All of the above
d) All of the above
A 17 year old girl visits the gynae clinic with a PC of amenorrhea. She has not experienced menarche. On examination she has no secondary sexual characteristics. You perform a blood test that shows serum FSH 30 IU/L (5-20 IU/L). Which organ in the HPG axis is at fault?
Ovaries
A 59 year old post-menopausal women presents to your GP clinic with some PV bleeding. She first noticed this 2 months ago but recently it has become more regular. She has a PMH of asthma, COPD and has recently had surgery to remove a breast cyst. She smokes 20/day and drinks 17 units of alcohol per week. Her mother died of cancer ‘down below’ but cannot remember the name of the type. What is the most appropriate management of this patient?
a) Non-urgent referral to gynaecology for investigations; b) 2WW referral to gynaecology for ?endometrial cancer; c) Reassure and give lifestyle advice such as exercise; d) Prescribe TXA and ask her to come back in 2 weeks
b) 2WW referral to gynaecology for ?endometrial cancer
A 35 year old pre-menopausal woman presents to GP clinic with post-coital bleeding and intermittent pelvic pain. The bleeding started 3 months ago and pelvic pain has been a more recent feature. Examination findings were normal. She did not receive the HPV vaccination due to her age and has not participated in the screening programme due to a fear of internal examination. What is the most appropriate management for this patient?
a) Non-urgent referral to colposcopy clinic; b) Treat for infection for 6-8 weeks before considering referral; c) Smear and 2WW referral to colposcopy clinic; d) Smear test
c) Smear and 2WW referral to colposcopy clinic
Kathryn is a 29-year-old woman who attended for cervical cancer screening 12 months ago and the result was positive for high-risk human papillomavirus (hrHPV) with a negative cytology report.She has just attended for a repeat smear and the result is positive again for hrHPV with a negative cytology report. What is the most appropriate next step?
a) Refer for colposcopy; b) Repeat sample in 3 months; c) Return to routine call in 3 years; d) Repeat sample in 12 months
d) Repeat sample in 12 months
A 41-year-old female undergoes a cervical smear at her GP practice as part of the UK cervical screening programme. Her result comes back as an ‘inadequate sample’. What is the most appropriate action?
a) Colposcopy; b) Repeat test in 1 months; c) Repeat test in 3 months; d) Repeat test within 6 months
c) Repeat test in 3 months
A G2P1 32year old mother pregnant with MCDA twins presents with PV bleeding that started 2 hours ago. She has no pain and the blood is bright red and fresh in appearance. She has soaked 5 pads and the bleeding has not stopped even since her arrival at the emergency pregnancy unit. Her MEOWS score is normal. Ultrasound investigations revealed a low-lying placenta. What is the most likely cause of this lady’s antepartum haemorrhage?
Placenta praevia
A G6P3 32+6 pregnant mother presents to the emergency pregnancy unit with severe abdominal pain and small quantities of vaginal bleeding. The pain begun in the early hours of the morning, it is now 10AM. Her fundal-pubic symphysis height is measuring 35cm. At her last appointment (32+0) she was measuring 32cm. Her uterus feels tense and the blood is dark red. The CTG shows decelerations (90BPM) and uterine contractions. What is the most likely cause of antepartum haemorrhage?
Placental abruption
Which risk factor is specifically associated with vasa previa?
a) Smoking during pregnancy; b) Cocaine use during pregnancy; c) Multiparity; d) Velamentous umbilical cord insertion
d) Velamentous umbilical cord insertion
A young woman of 28 weeks gestation presents to the emergency department with painless vaginal bleeding, she appears well and is haemodynamically stable. Which investigation is most likely to help confirm the diagnosis?
Abdominal USS with colour flow doppler
How many appointments do NICE recommend a woman to have during pregnancy if nulliparous and uncomplicated?
10
Ideally, between what gestations does the booking visit take place?
8-10 weeks
When is the fetus screening for down’s syndrome?
11-13 weeks
Oestrogen level begins to rise around day 5-7 of the menstrual cycle. What triggered this change?
The maturation of follicles triggered by FSH leads to the selection of the Graafian follicle on day 5 -7 – the follicle releases oestrogen
What is the corpus luteum and what hormones does it produce?
Empty Grafiaan follicle (after the release of eggs). Produces inhibin, progesterone and oestrogen
What is the role of progesterone in the menstrual cycle?
Building and maintenance of endometrial lining
True or False. If fertilisation is successful, the corpus luteum degrades
False
Name 3 structural issues which can cause menorrhagia
i. Endometrial polyps (polyps is allowed)
ii. Endometriosis
iii. Uterine fibroids (fibroids is allowed)
iv. Endometrial hyperplasia
v. Endometrial Carcinoma
vi. Adenomyosis
Which endocrine abnormality can cause menorrhagia?
Hypothyroidism
True or false – IUS and IUD can help improve menorrhagia
False. IUS i.e. Mirena coil is a medical management of Menorrhagia, however, IUD can CAUSE iatrogenic menorrhagia
Name 3 possible “medical” management of menorrhagia:
IUS – Mirena coil Tranexamic acid Mefenamic acid COCP Norethisetrone Depo provera GnRh analogues
