Womens health Flashcards
(109 cards)
1
Q
Define premature menopause
A
Periods cease before 40
2
Q
What blood test can support a diagnosis of premature menopause?
A
Two FSH levels taken 4 weeks apart
3
Q
What are the management options for menorrhagia with no organic cause?
A
1) IUS
2) antifibrinolytics (e.g. transexamic acid), NSAIDs
3) Progesterone
4) Surgery (hysterectomy)
4
Q
What tests would you to investigate new onset menorrhagia?
A
FBC, clotting, TFT
TVUS and endometrial biopsy
5
Q
Ix for amennorhoea
A
Preg test FSH/LH Prolactin Testosterone Pelvic USS (PCOS) TFT
6
Q
DDx IMD
A
Fibroids, polyps, adenomyosis
Malignancy
7
Q
What are the three types of fibroid?
A
Submucosal
Intramural
Subserous
8
Q
What causes adenomyosis?
A
Endometrial tissue within the myometrium
9
Q
What finding is suggestive of adenomyosis o/e?
A
Enlarged, boggy uterus
10
Q
How does adenomyosis px?
A
Dysmennorhoea
menorrhagia
11
Q
How can adenomyosis be dx?
A
MRI
12
Q
Which HPV types are most associated with cervical ca?
A
16 and 18
13
Q
What is the main conservative management strategy in PCOS?
A
Weight loss
14
Q
What drug can be used to stimulate ovulation in PCOS?
A
Clomifene
15
Q
COCP increases risk which cancers
A
Breast and cervical
16
Q
COCP decreases risk which cancers
A
Endometrial and ovarian (less ovulations, less endometrial turnover)
17
Q
Which conditions do women need a increased dose of folic acid in pregnancy?
A
Epilepsy
DM
18
Q
What week is dating scan?
A
10-13
19
Q
What week is anomaly scan?
A
20
20
Q
What is parity?
A
Number of times given birth to a foetus of 24 weeks or more
21
Q
Define miscarriage
A
Loss of foetus before 24 weeks
22
Q
What does G5P1(+3) tell you?
A
Currently pregnant, 4 pregnancies in past (3 lost before 24 weeks and 1 delivered past 24 weeks)
23
Q
What forms the combined test?
A
nuchal translucency
B-HCG
pregnancy associated plasma protein A
24
Q
How do you treat breech presentation in pregnancy?
A
External cephalic version (ECV) at 36 weeks (or 37 if multiparous)
25
Causes of polyhydramnios
```
(DITCH)
Diabetes
Idiopathic
Twins
Congen.abnormalities
Infection
```
26
How far does the cervix dilate in the latent stage of labour?
4cm
27
Indications for induction
Prolonged pregnancy
PROM
Diabetic mother post term
28
Steps of inducing labour
Membrane sweep
Intravaginal prostaglandins
AROM
Oxytocin
29
Risks of DM in pregnancy
```
Miscarriage
Macrosomia
Polyhydramnios
intrauterine death
Shoulder dystocia
Neonatal hypoglycaemia
```
30
Mx shoulder dystocia
McRoberts
Suprapubic pressure
Episiotomy
31
test results in HELPP syndrome
Haemolyis, raised liver enzymes, low platelets
32
4 causes of PPH
Tone
Tissue
Trauma
Thrombin
33
Which STI px with strawberry cervix and green/grey discharge?
Trichomonas vaginalis
34
What sign on microscopy is suggestive of BV?
Clue cells
35
How are BV and trichomonas treated?
Metronidazole
36
Comps of BV in pregnancy
Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage
37
Which form of contraception is preferred post-partum?
POP
| don't need for first 21 days
38
Which criteria are used to dx PCOS?
Rotterdam
39
tx for chlamydia
Single dose azithromycin
40
Tests for tubal patency
Hysterosalpingo contrast sonography (HyCOSy)
Hysterosalpingogram (HSG)
Laparoscopy and dye
41
What type of cancer are 90% of ovarian cancers?
Epithelial
42
What type of cancers are majority of cervical cancers?
Squamous cell carcinoma
43
What is APGAR score?
Used for assessing status of newborn infant
44
Which drug is used to terminate a pregnancy less than 9 weeks?
Mifepristone
| followed by prostaglandins - misoprostol
45
What is the cut off for an abortion?
24 weeks
46
What type of cancer is endometrial cancer?
adenocarcinoma
47
How long does an implant last?
3 years
48
Name two emergency contraception options
```
Levonogestrel (Levonelle)
Ulipristal acetate (EllaOne)
```
49
Within what window can emergency contraception be used?
5 days (if use EllaOne)
50
Which infectious diseases are screened for during pregnancy?
Hep B
HIV
Syphilis
51
What tests are offered if combined test comes back positive?
Chorionic villus sampling
| Amniocentesis
52
Which test, done at 5-8 days, screens for 9 conditions in neonates?
Guthrie test
53
Give two classes of drug (and drug name) used to treat urge incontinence
Anticholinergic (oxybutynin)
| Beta3 - adrenergic receptor agonist (mirabegron)
54
Define puerperium
From delivery of placenta to 6 weeks following birth
55
Define PPH
Greater than 500ml blood loss
56
How do fibroids px?
Heavy periods
Anaemia
Infertility
Miscarriage
57
How are fibroids dx?
TVUSS
58
What is first line mx of fibroids?
Mirena coil
59
Causes of secondary dysmenorrhoea
Endometriosis
Adenomyosis
PID
Copper coil
60
Most common cause of PID
Chlamydia
61
Which two conditions classically present with cervical excitation (motion tenderness)?
PID
| Ectopic pregnancy
62
Define gestational htn
>140/90 new after 20 weeks gestation
63
Define pre-eclampsia
New htn after 20th week and proteinuria
64
Define preterm birth
Less than 37 weeks
65
What Ix are involved in the secondary prevention of PTB in mothers deemed at high risk?
TV cervical USS
| Qualitative foetal fibronectin test
66
How could you treat patients at high risk of PTB
Progesterone injections
67
How does a threatened miscarriage present?
Painless bleeding
68
How does inevitable miscarriage px?
Heavy bleeding with crampy pain
69
How does ectopic px?
Constant pain
6-8weeks amennorhoea
Small amount of bleeding
70
How to manage miscarriage in primary care?
Do pregnancy test - negative (miscarried)
| positive - refer to early pregnancy assessment unit (for USS)
71
What is expectant management for miscarriage?
Used when incomplete or missed
| If no comps advise to take pregnancy test after 3 weeks and only return if positive
72
What is medical management of miscarriage and when is it used?
Ongoing sx after 14 days expectant management
MISOPROSTOL (PO/PV)
Medical uterine evacuation
(surgery and anti-D immunoglobulin if medical mx fails)
73
How is placenta praevia diagnosed?
Abdo USS
74
What is the sign of placental abruption?
Tense hard uterus on exam
75
How to manage PPH?
1) Explore uterine cavity if placenta retained
2) Exclude vaginal tears
3) UTERINE MASSAGE
4) IV oxytocin
5) IV ergometrine
6) PR misoprostol
7) surgery
76
Indications for instrumental delivery
Delay in second stage of labour
Foetal distress
Maternal exhaustion
77
How is ovarian/adnexal torsion diagnosed and treated?
Laparoscopy
78
Tx for atrophic vaginitis
Lubricants
Vaginal oestrogen
HRT
79
How does PID present?
Bilateral pelvic pain
Fever
Offensive vaginal discharge
80
Stages of female puberty in order
Growth
Breast development
Hair growth
Menarche
81
What tests would you do in a female px with delayed puberty?
LH/FSH
TFT
Prolactin
Karyotype
82
What drug can be used in preterm labour to delay progression?
Ritodrine
83
What is asymmetric IUGR a sign of?
Uteroplacental insufficiency
84
3 methods of foetal monitoring during pregnancy
Pinard stethoscope
Hand-help doppler
Cardiotocography (CTG)
85
What sort of decels are sinister on CTG?
Late decels
86
Define infertility
Failure to conceive after 1 year regular intercourse
87
Ix to check women ovulation
Mid-luteal progesterone (taken 7 days before menstruation)
88
A woman px with intense pruritus in third trimester, what's most likely dx?
Obstetric cholestasis
89
What condition px with massive bleeding post membrane rupture/
Vasa praevia
90
Tx for vasa praevia
C section if identified before delivery on USS
91
How long must women use contraception from their last menstrual period?
1 year (or 2 if <50yr)
92
What is a whirlpool sign on USS suggestive of?
Ovarian torsion
93
what is triple assessment for breast Ca?
Clinical
Imaging
Biopsy
94
What are the two most common types of breast Ca?
```
Ductal carcinoma (70%)
Lobular (10%)
```
95
Name the endocrine tx for breast Ca
```
Pre-men = tamoxifen
Post-men = aromatase inhibitors (letrozole)
```
96
What drug can be used to tx HER +ve breast Ca?
Trastuzumab (Herceptin)
97
What are the side effects of tamoxifen?
Hot flushes, nausea, PV bleeding (menopause like sx)
98
How can you manage labour not progressing in first stage?
```
AROM
Syntocin gradually (risk uterine rupture and foetal distress)
```
99
How can you manage labour not progressing in second stage?
Syntocin
| Instrumental delivery
100
What are the causes of breast lumps?
```
Malignancy
Fibroadenoma
Cysts
Infective mastitis/breast abscess
Duct ectasia
Fat necrosis
```
101
What is the indication for giving oestrogen only HRT?
If pt has no uterus
102
When do you use sequential and when do you use continuous HRT?
If pre-menopausal can only give sequential HRT (will get withdrawal bleed every 4 weeks) (LMP < 1yr ago)
If known amennorhagic can give continuous HRT
103
What scoring system can be used in prognosis prediction in breast Ca/
Nottingham prognostic index
104
How do aromatase inhibitors like letrozole work?
Prevent peripheral conversion (in fatty tissues) of androgens to oestrogen
105
What are the risks associated with HRT?
VTE
STROKE
BREAST CA
106
What are the benefits assoc. with HRT?
```
Fewer symptoms (vasomotor, urogenital, mood)
Decreased risk osteoporosis and CVD
```
107
What is the tx for puerperal mastitis?
Warm compress
| Fluclox if systemically unwell
108
What scoring system is used to determine whether induction of labour is required?
Bishop score
109
What is the name of the chart used to track labour?
Partogram
