Men and Women's Health

Question 1

contraceptive options for an epileptic pt

Answer 1

contraceptive injection (progesterone)
nb. phenytoin / carbamazepine / phenobarbitone interacts with hepatic enzymes > v efficacy of COCP

Question 2

endometriosis definition

Answer 2

chronic inflammatory condition

presence of endometrial tissue & stroma outside endometrial cavity / uterine musculature

Question 3

endometriosis presentation

Answer 3

chronic pelvic pain
dysmenorrhea
dyspareunia 
sub fertility
freq. / dysuria / haematuria / dyschezia

Question 4

endometriosis investigations

Answer 4

laparoscopy = gold standard

Question 5

endometriosis management

Answer 5

NSAIDs / paracetamol
OCP
no relief / fertility is priority = secondary care referral (GnRH analogues / surgery)

Question 6

adenomyosis features

Answer 6

= endometrial tissue within the myometrium

Question 7

adenomyosis presentation

Answer 7

dysmenorrhea
enlarged, boggy uterus
menorrhagia

Question 8

adenomyosis vs endometriosis

Answer 8

adenomyosis = multiparous + older (+Hx of cesarian section / endometriosis)
endometriosis = nulliparous + younger

Question 9

adenomyosis treatment

Answer 9

GnRH analogues

hysterectomy

Question 10

fibroids features

Answer 10

benign smooth muscle tumor of uterus
more common in black women of reproductive age
more common later in life

Question 11

fibroids presentation

Answer 11

menorrhaagia
pelvic pain
dysmenorrhea / cramping 
urinary sx: dyuria / freq 
sub fertility

Question 12

fibroids diagnosis

Answer 12

USS

Question 13

fibroids management

Answer 13

monitoring of size / sx
levonegestrel IUS
tranexamic acid
NSAIDs
contraceptives
GnRH analogues
ulipristal acetate
surgery / hysterectomy / ablation / myomectomy

Question 14

fibroids complications

Answer 14

sub fertility

iron deficiency anaemia

Question 15

PCOS features

Answer 15

poorly understood condition of ovarian dysfunction

associated with hyperinsulinaemia, ^ LH with overlap with metabolic syndrome

Question 16

PCOS presentation

Answer 16

sub-fertility, infertility
oligomenorrhoea, menorrhagia
hirsutism, acne, acanthosis nigricans, obesity

Question 17

PCOS investigations

Answer 17

pelvic USS (cysts)
^ LH:FSH ratio
impaired glucose tolerance

Question 18

PCOS management

Answer 18

weight loss
COCP (hirtuism, period sx)
metformin
clomifene 
specialist input

Question 19

HRT contraindications

Answer 19

untreated endometrial hyperplasia
current or past breast Ca
any oestrogen-sensitive Ca
undiagnosed vaginal bleeding

Question 20

menopause management

Answer 20

lifestyle - diet, exercise, sleep hygiene, stress, alcohol / smoking, CBT, support groups
non-HRT - fluoxetine (SSRI), vaginal lubricants, vaginal symptoms
HRT -

Question 21

indications of HRT for women with a uterus

Answer 21

use oral / transdermal combined HRT

NOT unopposed oestrogen therapies for women with a uterus

Question 22

risks of HRT

Answer 22

CHD / VTE / stroke

breast / ovarian Ca

Question 23

menopause indication for referral to secondary care

Answer 23

ongoing side effects
no change in relation to treatment
unexplained bleeding

Question 24

RFs of ED

Answer 24

CVD
Drugs: SSRIs, BXs
alcohol use

Question 25

Investigations of ED

Answer 25

``` CVD risk assessment: fasting glucose levels, lipid levels Free testosterone (9-11am sample) - abnormal = test again + LH, FSH, prolactin - abnormal = refer to endocrinology ```

Question 26

BPH presentation

Answer 26

voiding: hesitancy, weak stream, incomplete emptying, storage: urgency, frequency, urgency incontinence, nocturia post-micturation: dribbling complications: recurrent UTI, retention, obstructive uropathy

Question 27

BPH management

Answer 27

alpha 1 antagonists eg. tamsulosin (v SM tone) 5 alpha reductase inhibitors eg. finasteride (blocks peripheral conversion of testosterone > DHT)

Question 28

tamsulosin side effects

Answer 28

postural hypotension dizziness dry mouth depression

Question 29

finasteride side effects

Answer 29

gynaecomastia ED decreased libido ejaculation problems

Question 30

vaginal candidiasis management

Answer 30

``` OTC clotrimazole cream oral fluconazole (if recurrent / sev) ```

Question 31

what hormone is tested to confirm menopause

Answer 31

FSH ^^^^^