Female Health Flashcards
The stages of prolapse
Stage 0 = no prolapse
Stage 1 = prolapse of >1cm above the hymen
Stage 2 = prolapse within 1cm proximal/distal to the plane of the hymen
Stage 3 = prolapse >1cm below the hymen but doesn’t protrude further than 2cm less than the total length of the vagina
Stage 4 = complete eversion of the vagina
What organism usually causes cervicitis?
How do you investigate it?
STIs - Chlamydia / T.Vaginalis / Gonorrhoea
NAAT / Cervical swab
What causes cervical cancer and how is it diagnosed?
Persistent HPV infection leading to squamous cell carcinoma.
Colposcopy is diagnostic for cervical cancer
PET scanning helps with staging
What are the early-stage symptoms of cervical cancer?
- vaginal discharge
- variation of bleeding
- vaginal discomfort
- urinary symptoms
What are the late-stage symptoms of cervical cancer?
- painless haematuria
- chronic urinary frequency
- painless/fresh rectal bleeding
- white/red patches on cervic
Investigation + Management of cervical cysts
Ix - pelvic exam: usually found on routine as patients are usually asymptomatic
Mx - if <4cm, no further Mx. If >4cm then cryotherapy or electrocautery ablation can be carried out.
What is the most common cause of bleeding in post-menopausal women?
Atrophic vaginitis
What condition is vaginitis commonly associated with and what test would you do?
Diabetes
do a fasting glucose test
What causes vulval cancer?
HPV - 16 / HPV - 18, causes squamous cell cancer
A 56 year old female comes in with itchiness down below, pain on urination. She also complains of night sweats and weight loss. On pelvic examination, you see a lump on the vulva. What confirms the diagnosis?
Dx - vulval cancer
Ix - Colposcopy with biopsy
What is vulval intraepithelial neoplasia?
The pre-malignant state where existing vulval disorders such as lichen sclerosis or squamous cell hyperplasia can transform.
A 32-year-old nulliparous woman presents with severe vulval pain and swelling. She has had increasing pain over the last day unrelieved by oral analgesics (paracetamol). She denies history of STIs, and her partner is asymptomatic. On exam, the patient is in severe discomfort and finding it difficult to sit down. She is mildly pyrexial. On vulval exam the left vulva is erythematous with swelling of the medial aspect and introitus, with the labium minus transecting a cystic swelling.
What is the condition?
How do you treat it?
Bartholin’s cyst
Incision and drainage + antibiotics (usually broad-spectrum like Co-Amoxiclav of Flucloxacillin)
A 32-year-old nulliparous white female presents with a history of progressively worsening menstrual pain that is now causing her distress for most of the month. She misses 2 to 3 days of work each month. She finds no relief from ibuprofen and can no longer tolerate the headaches associated with her contraceptive pills. She is currently sexually active with her long-term partner. Her relationship is being affected by associated stress and pain during intercourse. On vaginal examination, her pelvic musculature is moderately tender. Her uterus is of normal size and minimally tender. Rectovaginal examination reveals uterosacral nodularity and exquisite tenderness. Stool is soft, brown, and haeme-negative.
What condition is being described?
What is your next step in investigation?
What is the diagnostic investigation?
Endometriosis
Next step - TVUSS
Diagnostic Ix - laparoscopy
What blood tests would you do to investigate amenorrhoea?
- FSH
- LH
- Prolactin levels
- Total testosterone
- TSH
- USS
A 32-year-old woman presents with a chief complaint of difficulty becoming pregnant. She was prescribed oral contraceptives at the age of 17 years because of irregular periods (4 to 6 periods per year). She continued with oral contraception until 30 years of age, at which point she and her husband decided they wanted to have a baby. Since ceasing oral contraception, she has gained weight and has only 3 to 5 periods per year. She has actively been trying to conceive, with no results.
What condition?
What investigations do you need to do next?
How do you confirm the diagnosis?
PCOS
Next Ix - Blood tests: Total testosterone, sex-hormone binding globulin, free androgen index, LH:FSH (2:1), prolactin, TSH and USS (looking for cysts)
Confirming the diagnosis: Rotterdam diagnostic criteria
PCOS can be diagnosed if two of the following are present:
Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
Oligo-/anovulation
Clinical or biochemical features of hyperandrogenism
A 32-year-old woman presents with a chief complaint of difficulty becoming pregnant. She was prescribed oral contraceptives at the age of 17 years because of irregular periods (4 to 6 periods per year). She continued with oral contraception until 30 years of age, at which point she and her husband decided they wanted to have a baby. Since ceasing oral contraception, she has gained weight and has only 3 to 5 periods per year. She has actively been trying to conceive, with no results.
What condition?
What investigations do you need to do next?
How do you confirm the diagnosis?
PCOS
Next Ix - Blood tests: Total testosterone, sex-hormone binding globulin, free androgen index, LH:FSH (2:1), prolactin, TSH and USS (looking for cysts)
Confirming the diagnosis: Rotterdam diagnostic criteria
PCOS can be diagnosed if two of the following are present:
Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
Oligo-/anovulation
Clinical or biochemical features of hyperandrogenism
What is the common organism causing mastitis and how do you investigate/treat it?
Staph aureus
clinical diagnosis
Flucloxacillin
What causes breast abscess?
How do you diagnose and treat it?
When mastitis is left untreated - mix of staph aureus and streptococcus
breast exam is sufficient but can do USS with biopsy of the fluid
Antibiotics can be given but incision & drainage or needle aspiration can be done every other day until pus no longer accumulates