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Year 3 - GP Block > 12&13 - Women’s, Men’s And Sexual Health > Flashcards

12&13 - Women’s, Men’s And Sexual Health Flashcards

1
Q

What is the criteria for Menorrhagia?

A

Menorrhagia:

  1. 80ml
  2. Over 7 days
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2
Q

Menorrhagia Mx options?

A
  1. Transexamic acid (antifibrinolytic)
  2. Iron tablets
  3. Norethisterone
  4. COCP
  5. Levonorgestrel releasing IUS
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3
Q

Menorrhagia Ix?

A
  1. Bloods
  2. Exam
  3. USS/hysteroscopy
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4
Q

LUTS DDs (5)

A
  1. BPH
  2. Prostatitis
  3. Prostate cancer
  4. Neuropathy
  5. Detrusor myopathy
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5
Q

LUTS Conservative Mx

A

LUTS Mx

  1. Conservative
    Post-micturative milking
    Bladder training
  2. Collection aids
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6
Q

LUTS Medical Management

- 2 ‘Alphas’, 2 ‘5’s

A
  1. Alpha Blockade
    Doxazosin 1-8mg PO
    Tamsulosin 0.4-0.8mg PO
    Terazosin 1mg-20mg PO
  2. 5-alpha-reductase inhibitor
    Finasteride 5mg PO
    Dutasteride 0.5mg PO
  3. Phosphodiesterase-5 inhibitor (PDE-5)
    Sildenafil 25-100mg PO
    Tadalafil 5-20mg PO
  4. Anticholinergic
    Oxybutynin 5mg OD-QDS
    Tolterodine 2mg BD
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7
Q

Criteria for menopause

A

Menopause

- 12 months of amenorrhoea

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8
Q

Lifestyle management of menopause

A
  1. Exercise
  2. Weight loss
  3. Layered clothing
  4. Sleep hygiene
  5. Maintanence of contraception
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9
Q

HRT options for menopause

A
  1. Combined therapy - Oral or Transdermal
  2. Post-hysterectomy
    Oestrogen only therapy (PO or TD)
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10
Q

Follow up for menopause Mx?

A

3 monthly menopause follow-up

Symptom free -> withdraw meds

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11
Q

HRT

  1. ADRs
  2. Red flags
A
  1. Oestrogen therapy
    i. Fluid retention and bloating
    ii. Breast tenderness
    iii. Nausea, dyspepsia, and headaches
  2. Progesterone therapy
    i. Fluid retention and bloating
    ii. Breast tenderness
    iii. Headaches or migraines
    iv. Pre-menstrual syndrome symptoms
    v. Mood swings and depression
    vi. Acne
    vii. Back and lower abdo pain
  3. Red flags
    a. Post-coital bleeding
    b. Post-menopausal bleeding
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12
Q

ADRs of Copper Coil

A 
1. Menorrhagia
	3-6 months of insertion
	Improves with time
2. Expulsion (5% in 6 weeks)
3. Perforation (0.5%)
4. Cervical shock
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13
Q

What is the effect of the COCP and the PIP on menstruation?

A

Both COCP and PIP generally lighten and regulate periods

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14
Q

What is a significant contraindication to ask about for COCP?

A

Migraine
With Aura

[Any neurological changes
Visual
Or otherwise]

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15
Q

What are the methods of Vasectomy?

A 
Vasectomy:
	Cut
	Diathermy (burn)
	Clip
	Stitch
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16
Q

Sterilisation: important questions to ask

A
  1. Is your family complete?

2. If you lost a child, would your family still be complete?

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17
Q

Vasectomy follow up?

A

Post vesectomy semen analysis
6 Weeks
12 Weeks

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18
Q

Options for emergency contraception?

A

A. Ask date of UPSI and LMP
B. Ask about previous hormonal EC
C. Current medications NB Liver enzymes
D. Risk assess for assault

  1. Copper IUD (120 hrs)
    Most effective
  2. Ulipristal acetate 30mg (120 hours)
    Not with CYP
    Reduced effect if recently taken progestogen
    Avoid breastfeeding for a week
  3. Levonorgestrel 1.5mg (72 hrs, max 96hrs)
    Double to 3mg with CYP
    Avoid breastfeeding for 8 hours
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19
Q

Ulipristal acetate ADRs

A

Ulipristal acetate

  1. Vomitting
    Take 2nd dose if within 3 hours
  2. Menstrual irregularity
  3. Ectopic pregnancy
  4. Mood disorder, headache, nausea, fatigue
20
Q

Levonorgestrel EC ADRs

A

Levonorgestrel EC ADRs

  1. Vomitting
    2nd dose if within 3hrs of EC
  2. Menstrual irregularities
  3. Ectopic
  4. Headache, abdo pain, fatigue, N+D, breast tenderness
21
Q

What are the options for hormonal coil?

A

Jay Kl M

  1. Mirena 20mcg/day
  2. Jaydess 13.5mg
  3. Kyleena 19.5mg
22
Q

What is an example of a contraceptive ring?

A

NuvaRing 0.12mg/0.015mg

Ethinylestradiol 2.7mg
Etonogestrel 11.7mg
23
Q

What are injectable options for Progesterone?

A
  1. Deep IM 12 weekly
    - Depo-Provera 150mg/1ml
    Medroxyprogesterone acetate
  2. Subcut 12 weekly
    - Sayana Press 104mg/0.65ml
    Medroxyprogesterone acetate 160mg/ml
24
Q

What is the contraceptive implant?

A

Nexplannon 68mg implant
Etonogestrel
Up to 3 years

25
Q

Menorrhagia differentials?

A

Menorrhagia differentials

P olyp c3%
A denomyosis 10
L eiomyoma 22
M alignancy 3

C oagulopathy 1
O varian disorders 30
E ndometrial disorder 20
I atrogenic 4

N ot classified 8

26
Q

Erectile dysfunction

- Mx

A

ED Mx

  1. Underlying
    - Psychosexual therapy
    - Weight/diet/exercise
  2. PDE5i
    - Sildenafil
  3. Intracavernous injection
    - alprostadil (PGE1 dilator)
    - Papaverine (opioid dilator)
  4. Suppository
    - Alprostadil
  5. Vaccum device, topical alprostadil
  6. Penile prosthesis
27
Q

Ovarian cycle

- Pituitary hormones

A

Ovarian cycle

2 FSH peaks

  • 1º/2º follicles
  • Endometrium troughs
  1. LH rises
    - 3º follicles
  2. Oestrogen rises
    - Approaches ovulation
  3. LH surge
    - Oestrogen peaks
    - FSH peaks again
    - Ovulation

16 Progesterone surge

  • Others all fall
  • Corpus luteum develops
  1. Endometrial peak
    - Progesterone starts to fall
28
Q

Gynaecology

- Red Flags

A

Gynaecological Red Flags

Vulval
1 Vulval bleeding
2. Vulval lump

Vaginal
3. Vaginal mass

Endometrial
4. >55 + High BMs /+ VH
+/discharge+/ thrombocytosis
5. <55 and post-menopausal bleeding

Ovarian

  1. Appetite loss
    - x12 per mo
  2. Abdo distension
    - x12 per mo
  3. Ascites or pelvic mass
  4. Pelvic pain (50+)
  5. Bowel habit/IBS sx
    - 12mo and 50+
  6. Recurrent UTI sx
29
Q

Dysmenorrhoea

- Classifications

A

Dysmenorrhoea

Primary

  1. Adolescents and <30s
  2. Endometriosis in 70%
  3. Cramping and lower abdominal

Secondary

  1. 30s & 40s
  2. Worses during menses
30
Q

Secondary Dysmenorrhoea

- DDx

A

Secondary Dysmenorrhoea

  1. Polyps
  2. Adenomyosis
  3. Chronic PID
  4. Cervical stenosis
  5. Ovarian pathology
  6. Endometriosis
  7. Iagtrogenic
    - IUCD
31
Q

Dysmenorrhoea

- Mx

A

Dysmenorrhoea Mx

  1. Heat
  2. NSAIDs
  3. Paracetamol
  4. COCP
  5. IUD
32
Q

Amenorrhoea

- Classification

A

Amenorrhoea

Primary

  1. 15 with 2º characteristics
  2. 13 with no maturation

Secondary

  1. Non-pregnant
  2. 3 missed or 6 months
33
Q

Amenorrhoea

- DDx

A

Amenorrhoea DDx

Physiological

  1. Constitutional delay
  2. Outflow obstruction
  3. Stress/ED/Athlete
  4. Malnutrition
  5. Chronic disease

Hormonal

  1. PCOS
  2. Hyperprolactinaemia

Genetic

  1. CAH
  2. Kallman’s/Turner’s
34
Q

Delayed puberty

- S&S

A

Delayed puberty S&S

  1. 2º characteristics
    - Testes < 3ml
    - Absent breast
    - Pubic hair
    - Menarche
  2. Absent growth spurt
    - Constitutional
    - Turner
  3. Anosmia
    - Kallman’s
35
Q

Hypogonadotropic hypogonadism

- Classifications

A

HH

Congenital

  1. Anosmic (Kallman’s)
  2. Normosmic HH
  3. Acquired
    - GnRH releasing disorder
    - Pituitary gonadotroph cell
    - Eg. Sarcoid, hypophysitis, adenoma, CNS tumour, drugs
36
Q

Hypergonadotropic hypogonadism

- Classifications

A

Hypogonadism (Hypergonadotropic)

  1. Congenital
    - Turner’s/Klinefelter’s/Swyer’s
    - Leydig hypoplasia, FSH insensitivity
  2. Acquired
    - Damage or dysfunction
    - Torsion, orchitis, primary failure, resistance syndromes
    - Trauma, surgery, chemo, radio
37
Q

Hypergonadotropic hypogonadaism

- Mx

A

Hyper H Mx

HRT

  1. Androgen
    - Males
  2. Oestrogen
    - Females
38
Q

Hypogonadotropic hypogonadism

- Mx

A

HH Mx
10-20% reversal

  1. HRT
    - T and Oe
  2. hCG and FSH
    - Leydig and Sertoli
    - Granulosa and luteal
39
Q

CAH

- Pathophysiology

A

CAH

  1. CST enzyme deficiency
  2. Increased hormones
    - Delta-androstenedione
    - Progesterone
  3. Precocious puberty
    - Early virility
    - Masculinization
40
Q

CAH

- Management

A

CAH Mx

  1. Stress-dose steroids
  2. Negative feedback
    - Glucocorticoid
    - Mineralcorticoid
  3. Oral contraceptive
    - Hirsuitism
41
Q

PCOS

- Complications

A

PCOS Complications

  1. Infertility
  2. Pregnancy complications
  3. Insulin resistance
  4. DM TII
42
Q

PCOS Mx

  1. Features
  2. Fertility
A

PCOS Mx

  • Weight loss

For features

  1. COCP
  2. Metformin
  3. Anti-androgen
    - Spironolactone (r blocker)
    - Finasteride (5ari)
  4. GnRH analogue and COCP
    - Leuprorelin

For pregnancy:
1. Metformin

  1. Letrozole
    - AI
  2. Clomifene
    - SERM
    - GnRH increase
  3. Dexamethasone
    - Reduce androgens
  4. Gonadotrophins
    - Follitropin/menotrophin
43
Q

Turner’s Syndrome

- Pathophysiology

A

Turner’s Pathophys

  1. Second x absent
    - Complete
    - Partial
  2. Haplo-insufficiency
    - Pseudo-autosomal genes
  3. Poor growth from infancy
    - Below 5% at 10yo
  4. Delayed puberty
    - Detected 10-16 yo
    - Primary Amenorrhoea
44
Q

Turner’s syndrome Management

  1. General
  2. Childhood
  3. Puberty
  4. Adulthood
A

Turner’s Mx

  • Diet and exercise
  1. Surveillance
    - Ovarian hormones
    - Heart defects
    - CHD
    - Thyroid
    - Turrner’s hepatitis
    - DM and HTN
    - Coeliac
  2. Growth
    - Oxandrolone
  3. Puberty
    - Low-dose oestrogen
    - Cyclic progesterone
  4. Adulthood
    - Ovarian HRT
    - Breast implants
    - Education and monitoring
45
Q

COCP

- Week regimins

A

COCP regimens

  1. Monpills

Phasic 21-day

  • Take 1 for 21 days
  • 7 days break for bleed
  1. Phasic 21-day
    - 2 or 3 sections
    - Different balances of hormones
  2. Everyday pills
    - 21 active pills
    - 7 inactive i
46
Q

COCP

- Starting pills

A

Starting COCP

  1. Day 1 (of period/cycle)
    - Protected straight away
  2. Day 5
    - Protected straight away
  3. Day 6 or later
    - Not protected immediately
47
Q

COCP

- Missed Pills

A

COCP missed pills

  1. 1 day anywhere in cycle
    - Take missed pill as well
    - Continue as normal
  2. 2 or more missed pills
    - Take missed pill as well
    - 7 days of condoms
    - Emergency if sex in last 7
  • If 7 or more pills left
    A Finish as normal
  • If 6 or fewer left
    A Finish pack
    B Skip break
    C Start new pack

Year 3 - GP Block (13 decks)

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