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FCM Matrix > Female Health > Flashcards

Female Health Flashcards

1
Q

What is labour defined as?

A

Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part

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2
Q

Signs of labour

A
  1. regular and painful uterine contractions
  2. a show (shedding of mucous plug)
  3. rupture of the membranes (not always)
  4. shortening and dilation of the cervix
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3
Q

Stages of labour

A

Stage 1: from the onset of true labour to when the cervix is fully dilated

Stage 2: from full dilation to delivery of the fetus

Stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

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4
Q

What do you monitor in labour?

A
  1. FHR monitored every 15min (or continuously via CTG)
  2. Contractions assessed every 30min
  3. Maternal pulse rate assessed every 60min
  4. Maternal BP and temp should be checked every 4 hours
  5. VE should be offered every 4 hours to check progression of labour
  6. Maternal urine should be checked for ketones and protein every 4 hours
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5
Q

What is the normal delivery position?

A

The head normally delivers in an occipito-anterior position

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6
Q

When is instrumental delivery indicated?

A

If longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section

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7
Q

What is the indication for elective c-section?

A

Breech
>2 previous CS
maternal request

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8
Q

Indication for emergency c-section

A
  • Foetal distress
  • Failure to progress
  • cord prolapse
  • footling breech
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9
Q

Indications for induction of labour

A
  1. prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
  2. prelabour premature rupture of the membranes, where labour does not start
  3. diabetic mother > 38 weeks
  4. pre-eclampsia
  5. rhesus incompatibility
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10
Q

what score is used to induce labour?

A

Bishop score

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11
Q

Methods of induction of labour

A
  1. membrane sweep
  2. vaginal prostaglandin E2 (PGE2)
  3. maternal oxytocin infusion
  4. amniotomy (‘breaking of waters’)
  5. cervical ripening balloon
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12
Q

Define HTN in pregnancy

A

systolic > 140 mmHg or diastolic > 90 mmHg

  • -> No proteinuria, no oedema
  • -> Resolves following birth (typically after one month).
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13
Q

Management of pregnancy induced HTN

A
  1. methyldopa, labetalol, nifedipine
    - -> Severe HTN: IV hydralazine or labetalol

–> Contraindications: ACEi, ARB, Thiazide-like diuretic

  1. Aspirin 75mg od from 12 weeks until the birth of the baby for HIGH RISK GROUP
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14
Q

Who are at high risk of developing pre-eclampsia?

A
  1. hypertensive disease during previous pregnancies
  2. chronic kidney disease
  3. autoimmune disorders such as SLE or antiphospholipid syndrome
  4. type 1 or 2 diabetes mellitus
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15
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension in association with proteinuria

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16
Q

Classic signs of pre-eclampsia

A
  1. Proteinuria
  2. High BP
  3. Oedema
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17
Q

Other signs & symptoms of pre-eclampsia

A
  1. Headache and visual disturbance (floaters)
  2. RUQ pain (liver)
  3. Acute onset oedema
  4. Hyper-reflexia (brisk reflexes) & clonus
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18
Q

Management of pre-eclampsia

A

Control BP

- refer to maternity unit

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19
Q

Post-partum management of pre-eclampsia

A
  1. Remains at risk of eclampsia despite delivery (first 5 days)
  2. Continue antihypertensives for 1-2weeks –> GP weans off medications
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20
Q

What is eclampsia?

A

Grand mal seizures in a woman with preeclampsia

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21
Q

Management of eclampsia

A

emergency delivery of baby

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22
Q

Symptoms of ectopic pregnancy

A
  1. Severe lower abdominal pain – usually unilateral
  2. PV bleeding
  3. Vomiting
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23
Q

Symptoms of ruptured ectopic pregnancy

A
  1. Shoulder tip pain
  2. Feeling faint/light-headed
  3. Collapse
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24
Q

Investigation for ectopic pregnancy

A

Diagnostic = Transvaginal USS

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25
Q

Management of ectopic pregnancy

A
  1. Medical – Methotrexate
    - -> Stops development of pregnancy
  2. Surgical – Salpingectomy
    - -> Removal of fallopian tube containing the ectopic pregnancy
    - -> Usually laparoscopic unless haemodynamically unstable
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26
Q

What is the most common cause of severe infection in neonates?

A

Group B Streptococcal disease (GBS)

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27
Q

What is gestational diabetes?

A

High blood sugars that develop during pregnancy and usually disappears after delivery.

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28
Q

Screening for gestational diabetes

A

Oral glucose tolerance test

  • fasting glucose is >= 5.6 mmol/L
  • 2-hour glucose is >= 7.8 mmol/L
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29
Q

Management gestational diabetes

A
  1. plasma glucose < 7 mmol/l = trial of diet and exercise
  2. if target not met within 1-2 weeks = start metformin
  3. if targets still not met = start insulin with metformin + exercise
  4. plasma glucose > 7 mmol/l insulin
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30
Q

Targets for self monitoring

A

Fasting = 5.3 mmol/l

1 hour after meals = 7.8 mmol/l, or:

2 hour after meals = 6.4 mmol/l

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31
Q

Abortion time frame

A

<24 weeks – can be maternal choice

> 24 weeks if risk to maternal or foetal health

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32
Q

Medical TOP:
At how many weeks?
What medication?

A

Less than 9 weeks = mifepristone (an anti-progestogen) followed 48 hours later by prostaglandins to stimulate uterine contractions

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33
Q

Surgical TOP:
At how many weeks?
What method?

A
  1. less than 13 weeks: surgical dilation and suction of uterine contents
  2. more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
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34
Q

Define abruptio placenta

A

Separation of a normally sited placenta from the uterine wall
–> resulting in maternal haemorrhage into the intervening space

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35
Q

Clinical features of abruptio placenta

A
  • pain constant + PVB *
  • shock out of keeping with visible loss
  • tender, tense uterus
  • normal lie and presentation
  • foetal heart: absent/distressed
  • coagulation problems
  • beware pre-eclampsia, DIC, anuria
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36
Q

Investigations in abruptio placenta

A

FBC + USS

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37
Q

Management of abruptio placenta

A
  1. Urgent referral
  2. Foetus alive and < 36 weeks
    - foetal distress: immediate caesarean
    - no foetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
  3. Foetus alive and > 36 weeks
    - foetal distress: immediate caesarean
    - no foetal distress: deliver vaginally
  4. Foetus dead
    - induce vaginal delivery
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38
Q

Maternal complications of abruptio placenta

A
  1. shock
  2. DIC
  3. renal failure
  4. PPH
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39
Q

Foetal complications of abruptio placenta

A

Hypoxia

Death

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40
Q

Define placenta praevia

A

placenta lying wholly or partly in the lower uterine segment

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41
Q

Clinical features of placenta praevia

A
  1. shock in proportion to
  2. visible loss
  3. no pain
  4. uterus not tender
  5. lie and presentation may be abnormal
  6. fetal heart usually normal
  7. small bleeds before large
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42
Q

Investigations for placenta praevia

A

Usually picked up on 20- week USS

–> transvaginal USS (improves accuracy on placental localisation)

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43
Q

Management of low-lying placenta at 20 week scan

A
  1. Rescan at 34 weeks
  2. if placenta praevia at 34 weeks, scan every 2 weels
  3. final USS at 36-37 week to determine method of delivery
  • grades III/IV = elective c-section between 37-38 weeks
  • if grade I = vaginal delivery
  • if in labour prior to elective c-section, then emergency c-section due to risk of PPH
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44
Q

Management of placenta praevia with bleeding

A
  1. Admit
  2. ABC approach to stabilise the woman
  3. if not able to stabilise → emergency caesarean section
  4. if in labour or term reached → emergency caesarean section
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45
Q

Define Postpartum haemorrhage (PPH)

A

blood loss of > 500mls

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46
Q

Types of PPH

A

Primary: occurs within 24 hours

Secondary:
occurs between 24 hours - 12 weeks

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47
Q

Symptom of PPH

A

Uncontrolled PV bleeding

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48
Q

Causes of PPH

A
  1. Tone - Uterine atony (failure of uterus to contract down post delivery) (primary)
  2. Trauma - perineal trauma (primary)
  3. Tissue - retained placenta (secondary)
  4. Thrombosis- clotting disorder (primary)
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49
Q

Management of PPH

A
  1. ABC including two peripheral cannulae, 14 gauge
  2. IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
  3. IM carboprost
  4. if medical options fail to control the bleeding then surgical options
  5. intrauterine balloon tamponade (1st line ) = uterine atony
  6. other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
  7. if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
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50
Q

Define premature rupture of membranes

A

Rupture of the amniotic sac prior to the commencement of labour.

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51
Q

Investigation for PROM

A

Speculum examination

Pelvic USS

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52
Q

Management of PROM

A
  1. Admission
  2. regular observations to ensure chorioamnionitis is not developing
  3. oral erythromycin should be given for 10 days
  4. antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
  5. delivery should be considered at 34 weeks of gestation
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53
Q

What is Rh incompatability?

A

Rhesus sensitisation

  • When a mothers Rh-ve blood mixes with foetal Rh+ve blood
  • Mothers immune system develops antibodies against Rh+ve RBCs

This may lead to haemolytic disease of the new-born in future pregnancies:

  • -> If in their next pregnancy the foetus is Rh+ve
  • -> Antibodies attack RBCs -> haemolytic anaemia & neonatal jaundice
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54
Q

What tests need to be carried out in rh incompatability?

A
  1. all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test
  2. Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
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55
Q

Management of rh incompatability

A

Prophylactic anti-D at 28 & 34/40 + if any bleeding antenatally

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56
Q

Features for rh incompatibility in affected foetus

A
  1. oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
  2. jaundice, anaemia, hepatosplenomegaly
  3. heart failure
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57
Q

What is shoulder dystocia?

A
  1. complication of vaginal cephalic delivery.

2. inability to deliver the body of the foetus using gentle traction, the head having already been delivered.

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58
Q

Risk factors for shoulder dystocia

A
  1. Previous shoulder dystocia
  2. Diabetes
  3. BMI >30
  4. Macrosomia (large baby)
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59
Q

Management of shoulder dystocia

A
  1. Senior help should be called as soon as shoulder dystocia is identified
  2. McRoberts’ manoeuvre should be performed:
    this manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen
  3. An episiotomy will not relieve the bony obstruction but is sometimes used to allow better access for internal manoeuvres.
  4. C-section
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60
Q

Complications of shoulder dystocia

A

maternal

  • postpartum haemorrhage
  • perineal tears

fetal

  • brachial plexus injury
  • neonatal death
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61
Q

What are the risk factors for ovarian cancer?

A
  • Family hx of BRCA1/2 gene mutation

- many ovulations: early menarche, late menopause, nulliparity

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62
Q

Clinical features of ovarian cancer

A

Usually vague:

  • abdo distension + bloating
  • abdo + pelvic pain
  • urinary symptoms (urgency)
  • early satiety
  • diarrhoea
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63
Q

Investigations for ovarian cancer

A
  1. CA125 test
    - -> raised: urgent USS of abdo + pelvis
    - -> usually raised in endometriosis, menstruation, ovarian cysts
  2. Diagnostic laparotomy
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64
Q

Management of ovarian cancer

A

Combo of surgery and platinum-based chemotherapy

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65
Q

What is breast abscess?

A

localized collection of pus within the breast

- more common in lactating women

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66
Q

Features of breast abscess

A
  1. Red, hot tender swelling

2. O/E : tender fluctuant mass

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67
Q

Diagnosis of breast abscess

A

USS

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68
Q

Treatment for breast absecess

A

Abx + USS guided aspiration

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69
Q

What are breast fibroadenoma?

A
  1. Breast tissues are arranged into lobules which are milk secreting glands
  2. Fibroadenomas occur due to increase in size of these milk secreting glands.
  3. Fibroadenomas are benign breast tumours that are thought to occur due to hormonal fluctuations.
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70
Q

Features of breast fibroadenoma

A

Mobile, firm, smooth, non-tender breast lump - a ‘breast mouse’

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71
Q

Management of breast fibroadenoma

A
  • Referral to breast clinic
  • Usually self-limiting

> 3cm = surgical excision

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72
Q

Investigations for breast fibroadenoma

A

USS if pt < 40, mammogram & needle biopsy

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73
Q

Features of fibrocystic disease

A
  • ‘Lumpy’ breasts which may be painful.

- Symptoms may worsen prior to menstruation

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74
Q

Investigations for fibrocystic disease

A

USS/ mammogram if suspecting breast cancer

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75
Q

Management for fibrocystic disease

A

Conservative : Pain relief

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76
Q

What is mastitis?

A

Mastitis is a painful inflammatory condition of the breast.

–> usually occurs in lactating women

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77
Q

Features of mastitis

A
  1. A painful breast.
  2. Fever and/or general malaise.
  3. A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.
78
Q

Investigations for mastitis

A

send a sample of breast milk for microscopy, culture, and antibiotic sensitivity

79
Q

1st line management of mastitis

A

continue breastfeeding

80
Q

When is abx indicated in mastitis?

A
  1. if systemically unwell
  2. if nipple fissure present
  3. if symptoms do not improve after 12-24 hours of effective milk removal
  4. if culture indicates infection’
81
Q

What abx is given in mastitis?

A

1st line = flucloxacillin for 10-14 days

Allergic to penicillin: erythromycin

82
Q

What is the most common infective organism in mastitis?

A

Staphylococcus aureus

83
Q

Complication of mastitis if left untreated

A

Develop into breast abscess

84
Q

Clinical features of breast cancer

A
  1. breast lump
    - Malignant –> painless
  2. Nipple symptoms: change in shape or bleeding
    - -> Tethering or peau d’orange
    - -> Unilateral discharge, retraction
85
Q

Investigations for breast cancer

A

Mammography and core biopsy

86
Q

What is the 2 - week wait referral indication for breast cancer?

A
  1. > 30 y/o + unexplained breast lump with or without pain

or

  1. > 50 y/o + unilateral discharge/retraction
87
Q

What other symptoms which consider 2WW

A
  1. with skin changes that suggest breast cancer

or

  1. > aged 30 with an unexplained lump in the axilla
88
Q

Non-urgent referral indication for breast cancer

A

< 30 y/o with an unexplained breast lump with or without pain.

89
Q

Treatment for breast cancer

A
  1. Wide local excision or mastectomy

2. Chemo or radiotherapy

90
Q

What is pelvic inflammatory disease?

A

sudden or severe inflammation of the womb, fallopian tubes, ovaries and surrounding areas in the lower abdomen

91
Q

Features of PID

A
  1. lower abdominal pain
  2. fever
  3. deep dyspareunia
  4. dysuria
  5. menstrual irregularities may occur
  6. vaginal or cervical discharge - purulent
  7. cervical excitation
92
Q

Investigation for PID

A
  1. pregnancy test - exclude pregnancy
  2. high vaginal swab
  3. screen for chlamydia + gonorrhoea

Diagnosis is usually clinical

93
Q

Management of PID

A

1st line:

  • -> IM ceftriaxone 1g stat
  • -> Doxycycline 100mg bd 14 days + Metronidazole 400mg bd 14 days

2nd line:
Ofloxacin 400mg bd + Metronidazole 400mg BD 14 days.

Small delay in treatment causes large increase in risk subfertility and ectopic pregnancy

94
Q

What is menorrhagia?

A

excessive blood loss with regular menstruation (>80ml)

95
Q

Common causes of menorrhagia

A

no underlying pathology - dysfunctional uterine bleeding

anovulatory cycles : chaotic cycles common at extremes of reprodutive life

fibroids
Hypothyrodism
PID

96
Q

Investigations for menorrhagia

A

FBC

routine transvaginal US if sx like pelvic pain, intermentrual or post-coital bleeding

97
Q

Management options for menorrhagia

A

Requires contraception:

  • IUS (Mirena) first-line
  • COCP

Does not require contraception:
- mefanamic acid / tranexamic acid

98
Q

Is it necessary to measure blood loss to diagnose menorrhagia?

A

NO

99
Q

What is endometritis?

A

infection or inflammation of the endometrium, the inner lining of the uterus

100
Q

When is endometritis a common problem?

A

during pregnancy as bacteria can easily reach the uterus during childbirth

101
Q

Sx of endometritis

A
  • abnormal vaginal bleeding
  • dyspareunia
  • fever
  • abdominal swelling
  • lower abdominal pain / discomfort
102
Q

Causes of endometritis

A
  • normal vaginal bacteria

- STI

103
Q

How is endometritis tested for

A
  • blood cultures
  • FBC
  • MSU
  • high vaginal swab
  • endometrial biopsy is diagnostic but rarely appropriate
104
Q

Management of endometritis

A

clindamycin and gentamicin combined

105
Q

What is urogenital prolapse

A

descent of one of the pelvic organs resulting in protrusion on the vaginal walls

106
Q

Risk factors of urogenital prolapse

A
  • increasing age (commonly post-menopausal women)
  • multiparity
  • obesity
  • spina bifida
107
Q

Sx of urogenital prolapse

A 
pressure, heaviness, ' bearing-down'
urinary sx (incontinence, frequency and urgency)
108
Q

Management of asymptomatic/mild prolapse

A

none needed

conservative: weight loss, pelvic floor excercise

109
Q

Management of symptomatic urogenital prolapse

A

ring pessary

surgery (hysterectomy / sacrohysteropexy)

110
Q

adenomyosis vs endometriosis

A

The difference between these conditions is where the endometrial tissue grows. Adenomyosis: Endometrial tissue grows into the muscle of the uterus. Endometriosis: Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.

111
Q

What is endometriosis?

A

growth of ectopic endometrial tissue outside of the uterine cavity

112
Q

clinical features of endometriosis

A
  • chronic pelvic pain
  • secondary dysmenorrhoea (pain often days before bleeding)
  • deep dyspareunia
  • urinary sx
113
Q

Gold standard investigation for endometriosis

A

laparoscopy

114
Q

treatment for symptomatic relief of endometriosis

A

NSAIDs +/- paracetamol (first-line)

Hormonal (COCP/Progestogens)

115
Q

Features of adenomyosis

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

116
Q

management of adenomyosis

A

GnRH agonists

hysterectomy

117
Q

What is a leimyoma also known as

A

fibroids

118
Q

What is leimyoma

A

benign smooth muscle tumours of the uterus

119
Q

epidemiology of leimyoma

A

more common in afro-carribean, rare before puberty

120
Q

sx of leimyoma

A
  • may be asymptomatic
  • menorrhagia
  • lower abdo pain
  • bloating
  • urinary sx e.g frequency
  • subfertility
    polycythaemia (rare)
121
Q

how is leimyoma diagnosed

A

transvaginal US

122
Q

treatment of asymptomatic fibroids

A

none-

periodic review to monitor size and growth

123
Q

management to shrink fibroids

A

GnRH agonists
surgical
- myomectomy (if woman wishes to conceive in future)
- hysterectomy

124
Q

Risk factors for endometrial cancer

A
  • obesity
  • nulliparity
  • early menarche
  • late menopause
  • PCOS
  • Diabetes
  • tamoxifen
125
Q

Features of endometrial cancer

A
  • postmenopausal bleeding

- change in inter-menstraul bleeding in premenopausal

126
Q

When should a patient be referred under the cancer pathway for suspected endometrial cancer?

A

women >= 55 years who present with postmenopausal bleeding

127
Q

First line investigation for endometrial cancer

A

transvaginal US

Other investigations:
- hysteroscopy with endometrial biopsy

128
Q

Management of endometrial cancer

A

localised disease :
total abdominal hysterectomy with bilateral salpingo-oophorectomy
- may have post-op radiotherapy

not suitable for surgery
- progestogen therapy

129
Q

Which factors are considered protective in endometrial cancer

A

COCP and smoking

130
Q

Symptoms of cervicitis

A
  • purulent yellow/green discharge
  • intermenstrual / postcoital bleeding
  • dysuria
  • Pelvic pain
131
Q

main cause of cervicitis

A

STI

132
Q

management of cervicitis

A

depends on causative organism

133
Q

What is cervical dysplasia

A

abnormal growth of cells on the surface of the cervix

134
Q

The primary cause of cervical dysplasia

A

HPV

135
Q

Risk factors of cervical dysplasia

A

multiple sexual partners
smoking
immunocompromised

136
Q

symptoms of cervical dysplasia

A

usually asymptomatic

- genital warts can indicate exposure to certain types of HPV

137
Q

How is cervical dysplasia diagnosed

A

smear - cervical screening programme , HPV first system

138
Q

What is the HPV first system?

A

sample tested for high-risk strains for HPV first and cytological examination performed if positive

139
Q

What happens if hrHPV is negative?

A

return to normal recall

140
Q

Positive hrHPV + abnormal cytology. What should you do next?

A

colposcopy

141
Q

hrHPV +ve but cytologically normal- next steps?

A

repeat test in 12 months

142
Q

inadequate hrHPV sample? - next step

A

repeat sample in 3 months

143
Q

2 consecutive inadequate hrHPV samples - next step?

A

colposcopy

144
Q

treatment of CIN

A

Large loop excision of transformation zone (LLETZ)

145
Q

What is cervical insufficency / incompetent cervix

A

weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy

146
Q

Sx of incompetent cervix

A

discharge during pregnancy
usually asymptomatic
premature labour

147
Q

How is incompetent cervix diagnosed

A

transvaginal US

148
Q

what is a nabothian cyst

A

small bump or bumps on the cervix caused by a build-up of normal mucus that is produced by the cervix

149
Q

How is a nabothian cyst diagnosed

A

pelvic exam

transvaginal US

150
Q

How is a nabothian cyst treated

A

none necessary

151
Q

Symptoms of vaginitis

A
  • itchy, sore vagina
  • vaginal discharge
  • vaginal dryness
  • dysuria
  • dyspareunia
  • spotting
152
Q

causes of vaginitis and sx associated to each

A 
thrush - white thick discharge
STI - green/yellow/smelly discharge
menopause (hormonal) - dry, itchy
skin condition (eczema) - itschy, sore patches
153
Q

investigation for vaginitis

A

pelvic examination and STI screen

154
Q

management of vaginitis

A

depends on cause

  • antifungal for thrush
  • abx for STI
  • vaginal lubricant
  • hormone tx
  • steroid medication for derm
155
Q

Most common cause of vaginal neoplasm

A

HPV

156
Q

Vaginal neoplasm sx

A
  • lump in vagina
  • ulcers and skin changes
  • post-menopausal bleeding
  • intermenstrual bleeding
  • post-coital bleeding
  • dyspareunia
157
Q

management of women with an unexplained palpable mass in or at the entrance to the vagina

A

2WW referral

158
Q

What is a cystocele

A

when the wall between the bladder and the vagina weakens (bladder prolapse)

159
Q

sx of cystocele

A
  • feeling of a vaginal bulge / pressure
  • frequent voiding
  • increased urgency
  • urinary incontinence
  • freuqnet UTI
160
Q

major cause of cystocele

A
  • multiparity

- difficult childbirth

161
Q

diagnosis of cystocele

A
  • pelvic exam
  • cytsoscopy
  • MRI / US/ Xrays
162
Q

management of cystocele

A
  • none if asymptomatic
  • kegel exercise (pelvic floor)
  • pessary
  • oestrogen replacement therapy
  • surgery
163
Q

What is a rectocele

A

tissues between the rectum and vagina weaken, causing the rectum to bulge into the vagina - posterior vaginal prolapse

164
Q

rectocele sx

A

may include pelvic, vaginal and rectal pressure

165
Q

risk factors of rectocele

A

multiparity, age, obesity, chronic constipation

166
Q

management of rectocele

A

bowel training

surgery

167
Q

What is a Bartholin’s cyst

A

small fluid-filled sac just inside the opening of the vagina

168
Q

sx of Bartholin’s cyst

A

soft, painless lump
usually only noticeable and uncomfortable after growth
- pain when walking
- pain during sex

169
Q

What causes Bartholin’s cyst

A

Bacterial infections / STI which clog the bartholin gland

170
Q

diagnosis of Bartholin’s cyst

A
  • examination
  • bacterial swab
  • biopsy if ?Bartholin gland cancer
171
Q

epidemiology of Bartholin’s cyst

A

sexually active women aged 20 to 30

172
Q

Management of Bartholin’s cyst

A
  • warm compress
  • analgesia
  • abx / drainage if infected
173
Q

Define Dysmenorrhoea

A

excessive pain during the menstrual period

174
Q

How is dysmenorrhoea divided?

A

primary - no underlying pelvic pathology

secondary - underlying pathology including:
endometriosis
PID
fibroids

175
Q

features of primary dysmenorrhoea

A
  • pain before/ within few hours of periods starting

- suprapubic cramping pain radiating to back / thigh

176
Q

Management of primary dysmenorrhoea

A

First line: NSAIDs (mefenamic acid / ibuprofen)

COCP

177
Q

Management of secondary dysmenorrhoea

A

refer to gynae

178
Q

Which phase of the menstrual cycle does PMS occur

A

luteal phase - after ovulation (when your ovaries release an egg) and before your period starts. During this time, the lining of your uterus normally gets thicker to prepare for a possible pregnancy.

179
Q

sx of premenstrual syndrome

A

emotional:

  • anxiety
  • stress
  • fatigue
  • mood swings

physical:

  • bloating
  • breast pain
180
Q

management of PMS

A

mild : lifestyle (sleep, exercise, healthy diet)

moderate sx: COCP

severe sx: SSRI

181
Q

Define Primary Amenorrhea

A

failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development)

or by 13 years of age in girls with no secondary sexual characteristics

182
Q

Define secondary Amenorrhea

A

cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea (irregular periods)

183
Q

initial investigations for amenorrhoea

A
  • EXCLUDE PREGNANCY
  • FBC
  • TFT
  • coeliac screen
  • gonadotrophins (low = hypothalamic cause, high = ovarian problem)
  • prolactin
  • androgen level (high in PCOS)
  • oestradiol
184
Q

management of amenorrhoea

A

treat underlying cause

HRT if gonadal dysgenesis

185
Q

3 main features of PCOS

A
  • irregular periods
  • excess androgen (excess facial / body hair)
  • polycystic ovaries
  • sub/infertility
  • obesity
186
Q

Why might a woman with PCOS have acanthosis nigricans

A

insulin resistance is commonly seen with PCOS

187
Q

investigations for PCOS

A
  • Pelvic US : multiple cysts
  • fsh, LH, (LH:FSH raised)
  • prolactin normal/mildly elevated
  • TSH
  • testosterone normal/mildly elevated
  • check for impaired glucose tolerance
188
Q

management of PCOS

A
  • COCP to regulate periods and hirsutism
  • weight reduction
  • cyclical progestogen for amenorrhoea
189
Q

Which supplement should be given to pregnant women, why and until when

A

folic acid until 3 months to reduce risk of neural tube defects (spina bidifda)

190
Q

Which vaccination should a pregnant woman have if they havent already had it?

A

MMR

191
Q

Which anti-epileptic medication should be switched in pregnancy

A

sodium valproate

FCM Matrix (17 decks)

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