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Female Health > 1A > Flashcards

1A Flashcards

1
Q

Define Premenstrual Syndrome (PMS)

A

Cyclic episodes of behavioural, psychological and physical symptoms during the luteal phase

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2
Q

What are the phases of menstruation?

A

Menstrual phase, follicular phase, ovulation phase and luteal

or follicular (14 days before ovulation) and luteal phase

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3
Q

Pathophysiology of PMS

A

Not fully known but associated with changes in hormones- drop in progesterone and estradiol in the late luteal phase

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4
Q

Risk factors of PMS

A

Stress
FHx
Smoking
Overweight/obese

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5
Q

Symptoms of PMS

A

Psychological: mood swings, irritability, depression, anxiety- low serotonin (since oestrogen regulates serotonin)
Low libido
Breast tenderness
Bloating
Leg swelling
Painful periods
Headache
Painful sex
GI upset
Back ache
Acne

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6
Q

Examination of PMS

A

Thyroid exam - hypothyroidism
Breast exam - tenderness, discharge, mass
Abdo exam - mass/signs of distention

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7
Q

DDx PMS

A

Depression
Hypothyroidism
Anxiety

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8
Q

Investigation for PMS

A

Not required
FBC - anaemia
TFT - hypothyroidism
TTG (tissue transglutaminase)- GI (Coeliac)

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9
Q

Conservative management for PMS

A

Conservative:
avoid excess sugar,
swelling - reduce salt
tenderness - firm supportive bra
reschedule stressful tasks
cut down caffeine
CBT/relaxation exercises
regular sleep
smoking cessation
alcohol reduction

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10
Q

Causes of secondary dysmenorrhoea

A

Fibroids
Endometriosis
PID
Ectopic pregnancy

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11
Q

Management for dysmenorrhoea

A

Smoking cessation
Supine position
Back/abdo massage

NSAID - ibuprofen 400mg TDS, mefenamic acid 500mg TDS
No plans to conceive: oral desogestrel 75mcg, IUD

Hysterectomy- severe cases and does not want children

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12
Q

Define breast abscess

A

Pus in the breast

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13
Q

Pathophysiology of breast abscess

A

breast inflammation of infectious aetiology
Can be related to mastitis

Organisms:
Strep A
Streptococcal
Enterococcal
Anaerobic bacteria

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14
Q

Risk factors of breast abscess

A

Breast trauma
Blocked milk ducts
Breast feeding

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15
Q

Presentation/history of breast abscess

A

Fever
Breast pain , swelling/redness

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16
Q

Examination of breast abscess

A

tenderness with fluctuant lump
erythema
Axillary lymphadenopathy

17
Q

DDx of breast abscess

A

Breast cellulitis
breast engorgement
Inflammatory breast cancer

18
Q

Investigations for breast abscess

A

Clinical diagnosis

FBC/CRP - underlying inflammatory pathology
Breast USS- confirmation

19
Q

Management of Breast abscess

A

Referral for general surgeon for confirmation and drainage
Conservative:
don’t wear a tight bra, continue breastfeeding if possible

Medical:
Analgesia
Parenteral Abx- secondary care e.g. Clarithromycin plus metronidazole (to cover organisms)

20
Q

Complication of breast abscess

A

Sepsis

21
Q

Define Mastitis

A

Inflammation of breast
Usually associated with lactation but can also occur with non-lactating women

22
Q

Pathophysiology of mastitis

A

Lactating women:
milk stasis causing an inflammatory response
if infection- caused by Strep A

Non-lactating women:
usually accompanied by infection - can be central/subareolar or peripheral

23
Q

Risk factors for peripheral mastitis

A

DM
RA
Trauma
Corticosteroid treatment
Granulomatous lobular mastitis- benign inflammatory disorder

24
Q

Examination of Mastitis

A

Tender, swollen
Warm/hot
Red skin- sometimes wedge-shaped pattern
Fever

25
Q

DDx of Mastitis

A

Full breasts - common up to 6 days after birth, usually bilateral hot, heavy and hard

Engorged breasts- milk overfill or infant not feeding frequently, usually bilateral enlarged, swollen and painful

Blocked duct - painful lump, may be red, no fever

Galactocoele - smooth, rounded and painless swelling in breast, milky discharge when pressed, no fever

Infection of mammary ducts- deep burning, aching and shooting pain. May have radiation down the arm or into the back, no fever or malaise

Breast cancer
Duct Ectasia

26
Q

Investigation for Mastitis

A

Usually clinical diagnosis

Send breast milk for microscopy, culture and sensitivity if: severe, recurrent, hospital-acquired infection, burning sensation

27
Q

Management of mastitis

A

Referral to general surgeon
Conservative:
reassurance, analgesia, warm compress
continue breastfeeding
treat underlying cause: poor infant attachment, nipple damage, smoking

Medical
Abx if neeeded:
Flucloxacillin 500mg QTS 10-14 days or clarithromycin 500mg BD 10-14days or erythromycin 250mg QTD 10-14 days

If abscess present: incision and drainage

28
Q

What can cause recurrence of mastitis

A

Candidal infection after a course of Abx - causes cracked skin on nipple- for infection entrance

29
Q

Signs of candida of nipple

A

associated with oral thrush and candidal nappy rash in infant

Bilateral sore nipples, particularly after feeding
Tenderness/itching
cracked/ flaky or shiny areola

Female Health (2 decks)

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