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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
excessive pain during menstrual period suprapibic pain - can radiate down thigh of to the back usually close to time prior to period or during
dysmenrrhoea
26
management for dysmenorrhoea
first line = NSAIDs - mefanamic acid/ibuprofen | second line = COCP
27
``` bloating breast pain anxiety stress fatigue mood swings ``` usually in luteal phase of cycle
pre-menstrual syndrome
28
management of premenstrual syndrome
if mild = lifestyle advice moderate = COCP severe = SSRI - fluoxetine
29
``` sub/infertility menstrual disturbances hirsutism acne obesity acanthosis nigracans ```
Polycystic ovarian disease (PCOS)
30
Ix of PCOS
pelvic US
31
management for PCOS
``` general = weight reduction and COCP hirsutism/acne = topical eflornithine infertility = clomiphene (+metformin) ```
32
failure to establish menstruation
primary amenorrhoea 15yrs 13yrs without any secondary sexual characteristic
33
cessation of mestruation
secondary amenorrhoea 3-6months for normal 6-12 months for oligomenorrhoea
34
management of primary amenorrhoea
investigate and treat cause
35
management of secondary amenorrhoea
exclude pregnancy, lactation, menopause (40yrs+) | gynae referral - tx underlying cause
36
hypertension in pregnancy
systolic >140mmHg | diastolic >90mmHg
37
management of HTN in pregnancy
labetalol nifedipine (if asthmatic) definitive mx = delivery of the baby
38
pregnancy induced hypertension after 20 weeks with associated proteinuria some oedema (brisk tendon reflexes)
pre-eclampsia
39
management of pre-eclampsia
aspirin 75mg- 150mg from 12 weeks till birth | definitive management is delivery of the baby if at 34weeks
40
gestational diabetes mellitus (GDM) diagnosis
fasting glucose is >= 5.6 mmol/L | 2-hour glucose is >= 7.8 mmol/L
41
screening for gestational diabetes
previous GD = OGTT asap and at 24-28weeks
42
management of GDM
start off with diet and exercise 1-2 week if target not met = start netformin persists = start insulin (fasting gluc >=7)
43
pre-existing DM in pregnancy
weight loss in BMI >27kg/m metformin and commence insulin folic acid pre-conception - 12 weeks
44
``` hx amenorrhoea for 6-8weeks lower abdo pain vaginal bleeding shoulder tip pain dizziness, fainting/syncope breast tenderness cervical excitation ```
ectopic pregnancy
45
Ix of ectopic pregnancy
serum bHCG >1,500 = indicative of ectopic pregnancy test = positive TVUS
46
management of ectopic pregnancy
watchful waiting 48hrs - bHCG levels medical = methotrexate surgical = salpingotomy/ectomy if >35mm
47
condition seen after 20 weeks gestation pregnancy-induced hypertension proteinuria development of seizures
eclampsia
48
management of ecalmpsia
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
``` shock disproportionate to blood loss constant pain/contractions tender, tense uterus fetal heart = absent/distressed coagulation problems ```
abruptio placenta
50
Management of abruptio placenta
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
shock appropriate to visible loss no pain, non-tender uterus fetal heart normal small bleeds prior to large bleed
Placenta previa
52
management of normal placenta previa
detected at 20week scan - repeat TVUS at 32 & 36wks - corticosteroid between 34 - 35+6 wks - planned C section considered between 36-37wks
53
management of placenta previa with bleeding
admit & ABC approach | stabilise pt & emergency c-section
54
blood loss of >500mls after delivery
post-partum haemorrhage
55
Primary PPH?
within 24hrs after delivery usually due to uterine atony
56
secondary PPH?
12-24hrs due to retained placental tissue/endometriosis
57
management of PPH
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
pre-term prelabour rupture of amniotic fluid
Premature rupture of membranes (PPROM)
59
Ix for PPROM
sterile speculum exam - check for pooling of amniotic fluid | US = oligohydramnios
60
management of PPROM
admit + regular observation oral erythromycin 10 days oral antenatal corticosteroids = lowers respiratory distress syndrome consider delivering at 34 weeks.
61
RUQ pain nausea and vomiting lethargy in pregnancy
HELLP syndrome
62
HELLP syndrome management
delivery of baby
63
oedematous fetus, jaundice, anaemia, hepatosplenomegaly, heart failure and kernicterus (brain damage)
Rh incompatibility
64
Ix in Rh incompatibility
FBC, group and save Coombs test kleihauer test
65
management of Rh incompatibility
transfusions and UV phototherapy
66
bleeding in first/early second trimester large uterus exaggerated pregnancy symptoms very high hCG
gestational trophoblastic disease
67
management of gestational trophoblastic disease
urgent specialist care referral = evacuation of uterus | effective contraception recommended to avoid pregnancy for 12months
68
management for multiple gestation
``` rest US for diagnosis + monthly checks additional iron + folate supplementation more antenatal care >=30 weeks precautions at labour induce at 38-40weeks ```
69
``` abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea ``` IBS in elderly - peak incidence 60yrs
ovarian cancer
70
Ix for ovarian cancer
Ca125 and US diagnosis usually needs laprotomy
71
management of ovarian cancer
a combination of surgery and platinum-based chemotherapy
72
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
ovarian torsion
73
Ix for ovarian torsion
US = whirpool/free fluid
74
management of ovarian torsion
laparoscopic surgery with detorsion
75
``` strawberry cervix purulent vaginal or cervical discharge dysuria and urinary frequency intermenstrual/postcoital bleeding lower abdo pain ```
cervicitis | secondary to STI
76
management of cervicitis
1g oral azithromycin OR 100mg doxycycline 7days
77
small cysts identified on cervix
nabothian cysts (self-limiting)
78
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.
cervical incompetence
79
generally asymptomatic PCB excessive discharge
ectropion
80
management of cervical incompetence
Treatment involves prophylactic placement of a cervical stitch (cerclage) with the aim to prevent loss of the pregnancy
81
cervical dysplasia
are abnormal, or precancerous, cells in and around a woman's cervix usually removed to prevent progression into cervical cancer
82
what is needed for Termination of pregnancy
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
TOP at less than 9 weeks
mifepristone
84
TOP at less than 13 weeks
surgical dilation and suction of uterine contents
85
TOP more than 15 weeks
surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')
86
termination of pregnancy has to be before ....
24 weeks

FCM (16 decks)

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