GYNECOLOGY Flashcards
Urinary incontinence types and tx.
Affects 4-5% of population. More common in elderly females.
RF; advancing age, previous preg and childbirth, high BMI, Hysterectomy and family hx.
Types; overactive bladder/ urge incontinence due to detrusor overactivity.
Stress incontince; leaking small amounts when coughing/laughing
Mixed
Overflow; due to bladder outlet obstruction
Initial investigation;
Bladder diaries completed for minimum 3day
Vaginal exam - look for prolapse can they kegal
Urine dipstick and culture
If urge; bladder retraining for 6 weeks
Bladder stabilising drugs antimuscurinic first line eg oxybutynin
If stress; pelvic floor muscle training 8x3 for 3 months
Surgical ; taping procedures
Hypomania vs mania
Psychotic symptoms are present in mania not hypomania
Delusions of grandeur, auditory hallucinations
Common in both
Mood elevated / irritable
Speech/ thought: pressured, flight of ideas, poor attention
Behaviour insomnia loss of inhibit, increased appetite
Chlamydia
70% women and 50% men are asymptomatic
1 in 10 young women have it
If symptoms: W; discharge, bleeding, dysuria M; discharge, dysuria
Complications; epidymitis PID endometriosis, infertility reactive arthritis
Swab/ urine
Tx single dose azithromycin
Contact trace 6mts
Delivery and pre eclampsia
Mild to moderate hypertension after 37 weeks- delivery within 24-48 hours. Use mag sul if if birth is planned within 24 hours or if concern that she’ll develop eclampsia
Pre eclampsia
Seen after 20 weeks, hypertension and proteinuria, oedema
Pre eclampsia predisposes fetaus to prematurity, growth retardation, eclampsia, haemorrhsge, cardiac failure multi organ failure
RF for preeclampsia
Over 40 Nulliparous Multiple preg High BMI Diabetes Family hx Pre existing htn
Fits of severe pre eclampsia
Hypertension 170/110 Proteinuria Headache Visual disturbance Pspilloedema Ruq epigastric pain Hyper reflex is Hellp
To oral labetalol and delivery
Ectopic presentation
6-8 weeks of amenorrhea
Presents lower abdo pain- constant and unilateral
Later develops bleeding- less than normal period, dark brown
Peritoneal bleeding can cause shoulder tip pain and pain on defecation or urination
Exam finding ectopic
Abdo tenderness
Cervical excitation
Don’t look for adnexal mass due to increased risk of rupture
Tx for ectopic
Methotrexate
Salpingectomy- if not infertile
Salpingotomy - 1in 5 need further tx, above
Sheehan’s syndrome
Complication of severe postpartum haemorrhage
Pit gland undergoes ischemic necrosis and become hypopituitarism.
Most commmon sign is lack of postpartum milk and amenorrhea
Uterine fibroids
Benign smooth muscle tumors of the uterus
20% of white song 50% black women in later reproductive years
May be asymptomatic Menorrhagia Lower abdo pain Bloating Uriary symptoms Sub fertility
Tx; IUD
Sensitive to estrogen and can grow during preg- abdo pain and low grade temp, vomiting, conservative management
Primary amenorrhea
Failure to start menses by the age of 16
Causes; Turners Testicular feminisation Congenital adrenal hyperplasia Congenital malformations of the genital tract
Secondary amenorrhoea
Menstruation has previously occurred but has now stopped for greater than 6 months
CAUSES; Hypothalamic amenorrhoea PCOS Hyperprolactinaemia Premature ovarian failure Tyroroxicosis Sheehan’s syndrome Ashermans syndrome
Investigations for amenorrhoea
Exclude preg Gonadotrophins Prolactin Androgen levels Estradiol Thyroid function tests
