Women's Health

Question 1

what is endometriosis

Answer 1

presence of endometrial tissue outside the uterus

Question 2

what are common sites affected by endometriosis

Answer 2

ovaries
pelvic cavity 
distal ureters
rectosigmoidal colon
bladder
pouch of douglas
uterosacral ligaments

Question 3

risk factors for endometriosis

Answer 3

first degree relative with severe endometriosis 
early menarche, late menopause
delayed childbearing 
short menstrual cycle 
long menstrual flow
obstruction to vaginal outflow

Question 4

common presentation of endometriosis

Answer 4

dyspareunia
dysmenorrhea
cyclical or chronic pelvic pain
infertility

Question 5

differential diagnosis of endometriosis

Answer 5

adenomyosis
chronic PID
IBS

Question 6

investigations for endometriosis

Answer 6

laparoscopy
MRI: adenomyosis + bladder, bowel and ureteric involvement
TVS: endometrioma

Question 7

signs of endometriosis on laparoscopy

Answer 7

active stage: red vesicles + punctate marks on peritoneum
less active: powder burn spots or white scars surrounded by abnormal blood vessels
severe disease: adhesions and chocolate cysts in ovaries

Question 8

management of endometriosis

Answer 8

pain management: NSAIDs
ovarian suppression: COCP, IUS, GnRH analogues
surgical: laparoscopic excision or ablation; ovarian cystectomy; hysterectomy + salpingo-oopherectomy

Question 9

what is gestational trophoblastic disease

Answer 9

group of disorders ranging from molar pregnancy (complete or incomplete hydatidifore mole) to malignant conditions like choriocarcinoma

Question 10

STI symptoms in women

Answer 10

vaginal discharge 
vulval discomfort, itching or pain
pelvic pain or dyspareunia
vulval lumps or ulcers
postcoital or intermenstrual bleeding

Question 11

STI symptoms in men

Answer 11

urethral discharge, pain or discomfort
dysuria
testicular pain or swelling
genital ulcers, sores, blisters lumps or rash

Question 12

what is the triple swab

Answer 12

endocervical chlamydia swab
endocervical charcoal media swab
high vagina swab

Question 13

discharge in bacterial vaginosis

Answer 13

thin 
profuse
fishy smelling
not usually associated with itching 
vaginal pH>4.5

Question 14

discharge in candidiasis

Answer 14

thick 
white
cottage cheese
non-offensive
associated with itching, soreness, dysuria and superficial dyspareunia
normal pH

Question 15

First line management of BV

Answer 15

oral metronidazole

Question 16

management of candidiasis

Answer 16

clotrimazole: topical or pessary

Question 17

causative agent and treatment of chlamydia

Answer 17

Chlamydia trachomatis

single dose oral azythromycin

Question 18

causative agent and treatment of gonorrhoea

Answer 18

neisseria gonorrhoeae

oral azithromycin + IM ceftriaxone

Question 19

causative agent and treatment syphilis

Answer 19

treponema pallidum

oral prednisolone followed by benzathine benzylpenicillin

Question 20

causative agent and treatment of HSV

Answer 20

HSV 1 + 2

acyclovir

Question 21

causative agent and treatment of genital warts

Answer 21

HPV 6 and 11

podophyllotoxin

Question 22

causative agent and treatment of HIV

Answer 22

HIV

Antiretroviral therapy

Question 23

causative agent and treatment of trichomoniasis

Answer 23

trichomonas vaginalis

oral metronidazole

Question 24

Endometrial polyps: presentation, investigation and management

Answer 24

menorrhagia, intermenstrual bleeding
I: US, hysteroscopy
management: cutting diatherimy

Question 25

management of ovarian torsion

Answer 25

laparoscopic surgery to uncoil affected ovary; salpingo-oopherectomy if severe vascular compromise

Question 26

ovarian cysts presentation

Answer 26

``` asymptomatic dull ache in abdomen dyspareunia swollen abdomen + palpable mass pressure effects: urinary frequency, varicose veins ```

Question 27

risk factors for ovarian cyst

Answer 27

obesity, tamoxifen therapy, early menarche, infertility family history (dermoid cyst)

Question 28

types of fibroids

Answer 28

most: intramural submucosal subserosal

Question 29

presentation of fibroids

Answer 29

asymptomatic menorrhagia intermenstrual bleeding (pedunculated submucosal fibroids) enlarged uterus: urinary frequency, lower abdominal discomfort/pain recurrent miscarriage or infertility

Question 30

investigations for suspected fibroids

Answer 30

pregnancy test TV ultrasound FBC + iron studies

Question 31

management of fibroids

Answer 31

menorrhagia: antifibrinolytic agent e.g. tranexamic acis levonorgestrel IUS surgery: myomectomy or hysterectomy

Question 32

what foods should women avoid when pregnant

Answer 32

``` uncooked meat, fish or eggs unpasteurised milk soft mould ripened cheese unwashed fruit/veg raw shellfish fish high in mercury vitamin A and liver ```

Question 33

how much folic acid is needed

Answer 33

400mcg up to 12 weeks 5mg if family Hx of NTD or diabetes

Question 34

what other medication is recommended during pregnancy and at what dose

Answer 34

Vitamin D 400 units 1000 units if at high risk - darker skin - housebound - pre-pregnancy BMI >30 pre-eclampsia risk: 800 units + calcium

Question 35

define anaemia in pregnancy

Answer 35

<110 in first trimester <105 in second and 2rd trimester <100 post partum

Question 36

effects of smoking on pregnancy

Answer 36

IUGR and low birth weight miscarriage and still birth premature delivery placental problems

Question 37

what investigations should occur in antenatal appointments

Answer 37

BP | urine: proteinuria

Question 38

risk factors for pre-eclampsia

Answer 38

``` previous history nulliparous multiple pregnancy aged > 40 close family history BMI > 35 pre-existing vascular, renal or diabetic disease ```

Question 39

what is the booking appointment

Answer 39

1st appointment; before week 12 ideally by week 10

Question 40

what happens during the booking appointment

Answer 40

lifestyle advice measure weight, BMI and BP screening (anaemia, red cell antibodies, hepatitis B, HIV, rubella, syphilis, chlamydia, sickle cell and thalassaemia, risk of gestational diabetes) offer screening for foetal chromosomal abnormalities

Question 41

what screening is available for chromosomal abnormalities

Answer 41

combined screening test quadruple serum screening test

Question 42

what are risk factors for gestational diabetes

Answer 42

``` BMI>30 previous gestational diabetes previous baby >4.5kg 1st degree relative with diabetes afro-caribbean, south asian or middle eastern origin ```

Question 43

what other appointments are there in antenatal care

Answer 43

16 weeks: review test results 18-20 weeks: structural abnormalities + placenta position 25 weeks: nulliparous, (plotting of symphysis fundal height from this appointment onwards) 28 weeks: proteinuria, BP, anaemia, anti-D prophylaxis, pertussis vaccination 31 weeks: nulliparous women 34 weeks: preparation for labour/birth information; second dose anti-D prophylaxis 36 weeks: external cephalic version 38 weeks 40 weeks: nulliparous women 41 weeks: membrane sweep/ induction of labour

Question 44

management of shoulder dystocia

Answer 44

``` Help Episiotomy Legs in McRoberts position Pressure on suprapubic Enter the pelvis Remove posterior shoulder ```

Question 45

the combined test when is it done what does it screen for what is composed of

Answer 45

10 - 13+6 weeks Nuchal translucency increased PAPP-A (pregnancy associated plasma protein) reduced B-HCG increased chromosomal abnormalities

Question 46

the quadruple test

Answer 46

``` free beta-hCG (raised) alpha fetoprotein (AFP) (decreased) inhibin-A and (raised) unconjugated estriol (decreased) ```