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FCM > FEMALE HEALTH > Flashcards

FEMALE HEALTH Flashcards

1
Q

chronic pelvic pain, dysmenorrhoea, deep dyspareunia, subfertility and urinary symptoms, dyschezia

A

endometriosis

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2
Q

Investigation for endometriosis?

A

Laproscopy

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3
Q

management of endometriosis?

A
  1. NSAIDS/paracetamol

2. COCP/progestogens e.g. medroxyprogesterone

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4
Q

dysmenorrhoea, menorrhagia and an enlarged, boggy uterus

A

adenomyosis

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5
Q

management of adenomyosis?

A

GnRH analogues + hysterectomy

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6
Q

more common in Afro-Carribean
can be asymptomatic
otherwise, menorrhagia, lower abdo pain usually linked to menstruation, bloating, urinary symptoms, subfertility

A

uterine fibroids/leimyoma

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7
Q

Investigation for uterine fibroids

A

TVUS

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8
Q

Management for uterine fibroids

A

asymptomatic = no Tx

GnRH analogues, myomectomy

control any menorrhagia with LNG-IUS, NSAIDs and COCP

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9
Q

pressure, heaviness and bearing down sensation

and urinary symptoms

A

Uterine prolapse

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10
Q

management of uterine prolapse

A

start off with conservative = weight loss pelvic floor muscle exercises
ring pessary
hysterectomy or sacrohysteropexy

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11
Q 
often postpartum 
abdo pain radiated to adanexae 
fever 
abnormal PV bleeds
dyspareunia/uria 
malaise and tachycardic
A

endometritis

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12
Q

investiagtion for endometritis

A

FBC, Blood cultures, high vaginal swabs and biopsy (diagnostic)

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13
Q

management for endometritis

A

clindamycin and gentamicin

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14
Q

post-menopausal bleeding
pre-menopausal = Intermenstrual bleeding
pain and discharge unusual

A

endometrial cancer

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15
Q

Ix for endometrial cancer

A

first line = TVUS

hysteroscopy with endometrial biopsy

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16
Q

management for endometrial cancer

A

localised disease = total abdo hysterectomy
bilateral salphingo-oophrectomy with post opertaive radiotherapy

frail/elderly - give progestrogen therapy, not suitable for surgeryv

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17
Q

protective factors in endometrial cancer

A

COCP and smoking

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18
Q 
lower abdo pain 
fever 
cervical excitation 
dysuria/discharge 
menstrual changes 
deep dyspareunia
A

pelvic inflammatory disease (PID)

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19
Q

Ix PID

A

pregnancy test
high vaginal swab
STI screen
urine dip

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20
Q

management of PID

A

ofloxacin and metronidazole
OR
oral doxy, oral metronidazole and IM ceftriaxone

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21
Q

usually detected on smear

PMB, IMB, PCB
vaginal discharge

A

cervical cancer

mainly squamous cell but can also have adenocarcinoma

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22
Q

which HPV are linked to cervical cancer

A

16, 18 & 33

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23
Q

Cervical screening

A 
25-49yrs = every 3 years 
50-64 = every 5 years 
64+ = self refer

if pregnant = delay screening 3 months post partum

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24
Q

management of cervical cancer

A

hysterectomy, radiation and concurrent chemo

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25
Q

excessive pain during menstrual period

suprapibic pain - can radiate down thigh of to the back
usually close to time prior to period or during

A

dysmenrrhoea

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26
Q

management for dysmenorrhoea

A

first line = NSAIDs - mefanamic acid/ibuprofen

second line = COCP

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27
Q 
bloating
breast pain 
anxiety 
stress
fatigue 
mood swings

usually in luteal phase of cycle

A

pre-menstrual syndrome

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28
Q

management of premenstrual syndrome

A

if mild = lifestyle advice
moderate = COCP
severe = SSRI - fluoxetine

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29
Q 
sub/infertility 
menstrual disturbances 
hirsutism 
acne 
obesity 
acanthosis nigracans
A

Polycystic ovarian disease (PCOS)

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30
Q

Ix of PCOS

A

pelvic US

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31
Q

management for PCOS

A 
general = weight reduction and COCP
hirsutism/acne = topical eflornithine 
infertility = clomiphene (+metformin)
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32
Q

failure to establish menstruation

A

primary amenorrhoea
15yrs
13yrs without any secondary sexual characteristic

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33
Q

cessation of mestruation

A

secondary amenorrhoea

3-6months for normal
6-12 months for oligomenorrhoea

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34
Q

management of primary amenorrhoea

A

investigate and treat cause

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35
Q

management of secondary amenorrhoea

A

exclude pregnancy, lactation, menopause (40yrs+)

gynae referral - tx underlying cause

36
Q

hypertension in pregnancy

A

systolic >140mmHg

diastolic >90mmHg

37
Q

management of HTN in pregnancy

A

labetalol
nifedipine (if asthmatic)

definitive mx = delivery of the baby

38
Q

pregnancy induced hypertension after 20 weeks
with associated proteinuria
some oedema

(brisk tendon reflexes)

A

pre-eclampsia

39
Q

management of pre-eclampsia

A

aspirin 75mg- 150mg from 12 weeks till birth

definitive management is delivery of the baby if at 34weeks

40
Q

gestational diabetes mellitus (GDM) diagnosis

A

fasting glucose is >= 5.6 mmol/L

2-hour glucose is >= 7.8 mmol/L

41
Q

screening for gestational diabetes

A

previous GD = OGTT asap and at 24-28weeks

42
Q

management of GDM

A

start off with diet and exercise
1-2 week if target not met = start netformin
persists = start insulin (fasting gluc >=7)

43
Q

pre-existing DM in pregnancy

A

weight loss in BMI >27kg/m

metformin and commence insulin

folic acid pre-conception - 12 weeks

44
Q 
hx amenorrhoea for 6-8weeks 
lower abdo pain 
vaginal bleeding 
shoulder tip pain 
dizziness, fainting/syncope 
breast tenderness 
cervical excitation
A

ectopic pregnancy

45
Q

Ix of ectopic pregnancy

A

serum bHCG >1,500 = indicative of ectopic
pregnancy test = positive
TVUS

46
Q

management of ectopic pregnancy

A

watchful waiting 48hrs - bHCG levels
medical = methotrexate
surgical = salpingotomy/ectomy if >35mm

47
Q

condition seen after 20 weeks gestation
pregnancy-induced hypertension
proteinuria
development of seizures

A

eclampsia

48
Q

management of ecalmpsia

A

IV Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop.
give when decision to deliver has been made
continue for 24hrs after seizure or delivery

calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression

49
Q 
shock disproportionate to blood loss 
constant pain/contractions
tender, tense uterus 
fetal heart = absent/distressed 
coagulation problems
A

abruptio placenta

50
Q

Management of abruptio placenta

A

ABC approach = high-flow oxygen and fluids (2L of Hartmann’s)
assess fetus and decide on whether to deliver
fetus alive = C-section
fetus not alive = vaginal delivery

51
Q

shock appropriate to visible loss
no pain, non-tender uterus
fetal heart normal
small bleeds prior to large bleed

A

Placenta previa

52
Q

management of normal placenta previa

A

detected at 20week scan
- repeat TVUS at 32 & 36wks

  • corticosteroid between 34 - 35+6 wks
  • planned C section considered between 36-37wks
53
Q

management of placenta previa with bleeding

A

admit & ABC approach

stabilise pt & emergency c-section

54
Q

blood loss of >500mls after delivery

A

post-partum haemorrhage

55
Q

Primary PPH?

A

within 24hrs after delivery usually due to uterine atony

56
Q

secondary PPH?

A

12-24hrs due to retained placental tissue/endometriosis

57
Q

management of PPH

A

ABC, 2 peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) or IV ergometrine 500cmg
IM carboprost

failure of medical options = surgical = intrauterine balloon tamponade
in severe cases = hysterectomy

58
Q

pre-term prelabour rupture of amniotic fluid

A

Premature rupture of membranes (PPROM)

59
Q

Ix for PPROM

A

sterile speculum exam - check for pooling of amniotic fluid

US = oligohydramnios

60
Q

management of PPROM

A

admit + regular observation
oral erythromycin 10 days
oral antenatal corticosteroids = lowers respiratory distress syndrome
consider delivering at 34 weeks.

61
Q

RUQ pain
nausea and vomiting
lethargy
in pregnancy

A

HELLP syndrome

62
Q

HELLP syndrome management

A

delivery of baby

63
Q

oedematous fetus, jaundice, anaemia, hepatosplenomegaly, heart failure and kernicterus (brain damage)

A

Rh incompatibility

64
Q

Ix in Rh incompatibility

A

FBC, group and save
Coombs test
kleihauer test

65
Q

management of Rh incompatibility

A

transfusions and UV phototherapy

66
Q

bleeding in first/early second trimester
large uterus
exaggerated pregnancy symptoms
very high hCG

A

gestational trophoblastic disease

67
Q

management of gestational trophoblastic disease

A

urgent specialist care referral = evacuation of uterus

effective contraception recommended to avoid pregnancy for 12months

68
Q

management for multiple gestation

A 
rest
US for diagnosis + monthly checks 
additional iron + folate supplementation 
more antenatal care >=30 weeks 
precautions at labour 
induce at 38-40weeks
69
Q 
abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea

IBS in elderly - peak incidence 60yrs

A

ovarian cancer

70
Q

Ix for ovarian cancer

A

Ca125 and US

diagnosis usually needs laprotomy

71
Q

management of ovarian cancer

A

a combination of surgery and platinum-based chemotherapy

72
Q

Usually the sudden onset of deep-seated colicky abdominal pain.
Associated with vomiting and distress
fever may be seen in a minority
Vaginal examination may reveal adnexial tenderness

majority present with an ovarian mass
usually in reproductive age group

A

ovarian torsion

73
Q

Ix for ovarian torsion

A

US = whirpool/free fluid

74
Q

management of ovarian torsion

A

laparoscopic surgery with detorsion

75
Q 
strawberry cervix 
purulent vaginal or cervical discharge
dysuria and urinary frequency
intermenstrual/postcoital bleeding
lower abdo pain
A

cervicitis

secondary to STI

76
Q

management of cervicitis

A

1g oral azithromycin
OR
100mg doxycycline 7days

77
Q

small cysts identified on cervix

A

nabothian cysts (self-limiting)

78
Q

It presents as a painless dilatation of the cervix through which the membranes bulge and eventually spontaneously erupt.

usually those with a history of three or more spontaneous preterm births or second-trimester losses.

A

cervical incompetence

79
Q

generally asymptomatic
PCB
excessive discharge

A

ectropion

80
Q

management of cervical incompetence

A

Treatment involves prophylactic placement of a cervical stitch (cerclage) with the aim to prevent loss of the pregnancy

81
Q

cervical dysplasia

A

are abnormal, or precancerous, cells in and around a woman’s cervix

usually removed to prevent progression into cervical cancer

82
Q

what is needed for Termination of pregnancy

A

two registered medical practitioners must sign a legal document (in an emergency only one is needed)

only a registered medical practitioner can perform an abortion, which must be in a NHS hospital or licensed premise

83
Q

TOP at less than 9 weeks

A

mifepristone

84
Q

TOP at less than 13 weeks

A

surgical dilation and suction of uterine contents

85
Q

TOP more than 15 weeks

A

surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)

86
Q

termination of pregnancy has to be before ….

A

24 weeks

FCM (16 decks)

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