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Y3 GP > Men’s And Women’s Health > Flashcards

Men’s And Women’s Health Flashcards

1
Q

What is endometriosis ?

A

A common disorder characterised by the presence of endometrial glands and stroma outside of the endometrial cavity.

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2
Q

What are some risk factors for endometriosis ?

A

Obstruction to menstrual flow
Prolonged exposure to endogenous oestrogen
Short menstrual cycles
Low birth weight

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3
Q

Where are the most common sites for endometriosis ?

A

Ovaries
Pouch of Douglas
Uterosacral ligaments

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4
Q

What are some clinical features of endometriosis ?

A

Symptoms may be asymptomatic
Dysmenorrhoea
Dyspareunia
Chronic pelvic pain
Pain at time of ovulation
Infertility
Chronic fatigue

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5
Q

What are some differentials for endometriosis ?

A

Chronic pelvic inflammatory disease
Recurrent acute salpingitis
Ovarian tumour
Ectopic pregnancy
IBS
Urinary causes

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6
Q

What is the management of endometriosis ?

A

Analgesia - NSAIDs or paracetamol
Hormonal treatment
COCP
Surgical treatment

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7
Q

Define menopause

A

The permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhea for which there is no other obvious pathological or physiological cause.

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8
Q

What age range does menopause occur in ?

A

40 - 58 years old

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9
Q

What are some clinical features of menopause ?

A

Hot flushes
Thinning of vaginal skin
Increased risk of UTI
Dysuria or nocturia
Irritability
Lethargy
Depression
Loss of libido
Increased risk of breast cancer

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10
Q

What is the management of menopause ?

A

HRT
Lifestyle measures
Gabapentin - reduces hot flushes
SSRI - alternative to HRT
Diet and supplements

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11
Q

What is infertility ?

A

The failure of conception in a couple having regular, unprotected coitus for one year, provided that normal intercourse is occurring not less than twice weekly.

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12
Q

What are the main causes of infertility ?

A

Unexplained infertility
Ovulatory disorders
Tubal damage
Factors affecting male infertility
Uterine or peritoneal disorders

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13
Q

What are some investigations for infertility ?

A

History and examination of both partners
Semen analysis
Assessment of ovulation
LH, FSH, TFT’s, testosterone level blood test
Assessment for tubal patency

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14
Q

What is the management of male infertility ?

A

Decrease smoking or drinking
Clomiphene citrate

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15
Q

What is the management for female infertility ?

A

Clomiphene citrate
Surgery for tubal damage
Intrauterine insemination

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16
Q

What are fibroids ?

A

The most common benign gynaecological tumour. Monoclonal tumours of the smooth muscle cells of the uterine myometrium.

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17
Q

What are some risk factors for fibroids ?

A

Race
Genetics
Age - rare before menarche
Early menarche
Obesity
High meat diet
Hypertension
Smoking
diabetes

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18
Q

What are some clinical features of fibroids ?

A

Abnormal uterine bleeding
Abdominal bloating
Urinary frequency and urgency
Urinary incontinence
Constipation
Pelvic pain

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19
Q

What may be felt on examination when suspecting fibroids ?

A

Very large fibroids may be palpated abdominally
Vaginal exam reveals a firm, irregularly enlarged uterus - non tender

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20
Q

What are some differentials for fibroids ?

A

Ovarian tumours - cysts, carcinoma and fibroma
Pregnancy
Uterine endometriosis
Diverticular disease
Colonic carcinoma

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21
Q

What are some investigations for fibroids ?

A

FBC - check Hb
Mid stream urine test
USS
MRI
Hysteroscopy

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22
Q

What are some complications of fibroids ?

A

Hyaline degeneration - muscle and fibrous tissue replaced by hyaline tissue

Fatty degeneration

Calcification

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23
Q

What is the management of fibroids ?

A

Majority are asymptomatic so require no treatment

NSAIDs
Oral contraceptives
Myomectomy - removal of fibroid
Hysterectomy
Uterine artery embolisation

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24
Q

What are the 3 main features of PCOS?

A

Irregular periods
Excess androgens
Polycystic ovaries - ovaries become enlarged and contain fluid filled sacs

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25
Q

What are some symptoms of PCOS ?

A

Irregular periods
Difficulty getting pregnant
Hirsutism
Weight gain
Thinning hair and hair loss
Oily skin and acne

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26
Q

What are the investigations performed when suspecting PCOS ?

A

Endocrine tests
Imaging of the ovaries - USS

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27
Q

What are some complications of PCOS ?

A

Infertility
DM
TIA / stroke
Obstructive sleep apnoea

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28
Q

What are the management options for people with PCOS ?

A

Lose weight, Clomiphene citrate for infertility

Anti-androgens or oestrogen for Hirsutism

Lose weight or Metformin for insulin resistance

COCP for menstrual irregularity

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29
Q

What is the ovarian cycle ?

A

The normal process whereby the ova mature and are released during the menstrual cycle.

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30
Q

At what day does ovulation occur and what happens after ?

A

Day 14
After ovulation the theca and granulosa cells proliferate and the luteal cells form the corpus luteum. These cells proliferate and produce oestrogen and progesterone.
If pregnancy does not occur the corpus luteum begins to degenerate.

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31
Q

What are the 3 phases of the uterine cycle ?

A

Proliferative
Secretory
Menstrual

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32
Q

What happens in the proliferative phase ?

A

The lining becomes thicker and the uterine glands become thicker. There is mitosis in both stromal and epithelial cells leading to growth of the glands and thickening of the endometrium.

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33
Q

What occurs in the secretory phase ?

A

The endometrium becomes more vascular and the glandular component become coiled and tortuous. This is stimulated by oestrogen and progesterone.

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34
Q

What occurs in the menstrual phase ?

A

Regression of the corpus luteum and loss of hormonal support, necrosis and subsequent bleeding and sloughing of the endometrium occurs.

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35
Q

What is menstruation ?

A

Normal menstruation occurs as the endometrium sloughs from the uterus, with consequent bleeding. The flow usually lasts for 3 - 5 days. This marks the start of the new menstrual cycle.

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36
Q

What is the follicular phase and what hormones are involved ?

A

First phase of the cycle.
FSH stimulate growth in follicles
Inhibin is produced and FSH starts to decline
Increase in oestrogen

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37
Q

What hormones are involved in ovulation ?

A

LH surge causes ovulation. LH surge is caused by a rise in oestrogen.
Meiosis is completed in the oocyte as a result of the LH surge.

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38
Q

What is the luteal phase ?

A

Occurs after the release of the ovum.
The follicle forms the corpus luteum and starts to produce progesterone, androgens and oestrogen.
The corpus luteum regresses after 9 - 11 days unless pregnancy occurs.

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39
Q

A massive rise in progesterone results in ?

A

Preparation of the endometrium for implantation
Suppression in growth of the new follicles past the preantral stage

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40
Q

What are the most common penile disorders affecting ?

A

The foreskin

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41
Q

What is balanitis ?

A

Inflammation of the glans penis.
Common in young boys with non-retraction foreskin and in elderly men.

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42
Q

How does balanitis present ?

A

Irritation or pain in the penis and discharge beneath the foreskin.
Inflammation is usually visible.
Recurrent balanitis may cause phimosis with disturbance of micturition.

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43
Q

What is the management of balanitis ?

A

Avoid contact with any potential skin irritants
Keep area clean by bathing twice daily with weak saline solution
If fungal - topical anti fungals imidazole
If bacterial - oral antibiotics flucloxacillin
Referral for consideration for circumcision may be necessary

44
Q

What is phimosis ?

A

The inability to retract the foreskin because of a narrow preputial ring.

45
Q

What are some causes of phimosis ?

A

Primary physiology - congenital ( rare )
Recurrent balanitis
Traumatic retraction of the foreskin

46
Q

How does phimosis present ?

A

Poor stream
Ballooning of the foreskin on Micturition
Spraying on Micturition
Recurrent attacks of balanitis
Pain on intercourse

47
Q

What is the management of phimosis ?

A

Topical steroids
Circumcision

48
Q

What is paraphimosis ?

A

The inability to pull the foreskin forward that has been retracted behind the glans penis.
Can occur at any age

49
Q

How does paraphimosis present ?

A

Substantial pain
Penile swelling

Treated as a medical emergency

50
Q

What is the treatment of paraphimosis ?

A

Manual reduction after applying anaesthetic jelly
In difficult cases a dorsal slit is made
Circumcision should be performed when inflammation has resolved.

51
Q

What is benign prostatic hypertrophy ?

A

A histological diagnosis characterised by non-malignant proliferative process of the prostatic stromal cells. Affecting the transition zone

52
Q

What are some clinical features of BPH ?

A

LUTS - frequency, urgency, poor stream, post-micturition dribble
Retention
Overflow incontinence
Haematuria
Infections

53
Q

What is felt on examination in BPH ?

A

Smooth and symmetrical prostate
Enlarged

54
Q

What investigations are performed when suspecting BPH ?

A

Urine dipstick
Cystoscopy
FBC
MSU
PSA

55
Q

What is the treatment for BPH ?

A

Pelvic floor exercises
Alpha blockers
5-alpha reductase inhibitors
TURP

56
Q

What are some complications of BPH ?

A

Chronic retention
Infection
Overflow incontinence
Calculi
Bilateral hydronephrosis
Renal failure

57
Q

What are some risk factors of prostatic cancer ?

A

Increasing age
Ethnically origin - black African or black Caribbean
Family history
Diet
Obesity
Smoking

58
Q

How does a prostatic carcinoma spread ?

A

Direct local invasion - seminal vesicles, bladder and urethra
Lymphatics -
Haematogenous - usually to bone and can be liver and lung

59
Q

What are some clinical features of prostatic cancer ?

A

May be asymptomatic
Outflow obstruction
Haematuria
Back pain
Constipation

60
Q

What are some signs that prostatic cancer has metastasised ?

A

Bone pain
Jaundice and pain in RUQ
Fits - spread to brain
Swollen legs - pelvic lymph nodes
Lung - usually incidental finding

61
Q

How does prostatic cancer feel on examination ?

A

Asymmetrical
Nodular
Enlargement
Stony hard

62
Q

What investigations are performed when suspecting prostate cancer ?

A

PSA test
DRE
Transrectal USS
MRI
MSU to see if infection
U&E to assess renal function

63
Q

What is the management plan for localised prostate cancer ?

A

Low risk - Active surveillance
Higher risk - radical prostatectomy or radiotherapy or chemotherapy

64
Q

What is the management plan for advanced metastatic prostate cancer ?

A

Bilateral orchidectomy
LHRH agonist
Anti-androgen mono therapy
Chemotherapy
Bisphosphonates

65
Q

What is prostatitis ?

A

Inflammation of the prostate gland and is usually caused by coliform bacteria. It is uncommon and is characterised into acute and chronic.

66
Q

What is acute prostatitis ?

A

An acute focal or diffuse suppurative inflammation of the prostate gland. It is a bacterial infection needing prompt treatment.

67
Q

What is usually the causative pathogen in acute prostatitis ?

A

E. Coli
Proteus species
Klebsiella species

68
Q

What are some complications of acute prostatitis ?

A

Acute urinary retention
Chronic prostatitis
Prostatic abscess
Epididymitis
Pyelonephritis

69
Q

What are some clinical features of acute prostatitis ?

A

Fever
Chills
Muscle pain
Perineal pain
Bladder outflow obstruction
Haematuria
Pain

70
Q

What is seen on examination when suspecting acute prostatitis ?

A

Tender and swollen
Prostatic massage may cause pus to be exuded from the urethra.

71
Q

What is the management of acute prostatitis ?

A

Ciprofloxacin orally for 14 days
Second line Trimethoprim for 1 days

72
Q

What investigations are performed when suspecting acute prostatitis ?

A

MSU - mid stream sample

73
Q

What causes chronic prostatitis ?

A

Inflammation most commonly resulting from inadequately treated acute prostatitis or genito-urinary TB.

74
Q

How does chronic prostatitis present ?

A

Low grade perineal pain
Pain exacerbated by sitting on a chair
Low back pain - may extend down the leg
Dysuria
Mild bouts of fever

75
Q

What is seen on examination when suspecting chronic prostatitis ?

A

Enlarged firm and irregular prostate
Massage exuded a purulent urethral discharge

76
Q

What is the treatment for chronic bacterial prostatitis ?

A

Ciprofloxacin for 4-8 weeks

77
Q

What is Menorrhagia ?

A

Regular excessive menses occurring over several consecutive cycles in an otherwise normal menstrual cycle.
More than 80mL in an otherwise normal menstrual cycle.

78
Q

What are some causes of Menorrhagia ?

A

Pelvic endometriosis
PID
Endometrial hyperplasia
Uterine fibroids
Hypothyroidism
Copper IUD
Dysfunctional uterine bleeding - if other causes have been excluded

79
Q

What should be covered in a history for heavy bleeding ?

A

Nature of the bleeding
Any other related symptoms - intermenstrual bleeding or post - coital bleeding, pelvic pain
Impact on the quality of life
Previous history of Menorrhagia

80
Q

What are some investigations for Menorrhagia ?

A

Blood tests - FBC, clotting studies, ferritin levels,
TFT’s
Cervical smear
HVS, chlamydia screen

81
Q

What is the management for Menorrhagia ?

A

Levonorgestrel releasing IUS - first line
Tranexamic acid or NSAIDs
COCP or POP

82
Q

What is HRT ?

A

Hormone replacement therapy aims to replace oestrogen in post menopausal women and reverses the adverse effects of a lack of oestrogen.

83
Q

The type of HRT depends on which factors ?

A

Whether the individual has had a hysterectomy
Menopause status
Preference for type of treatment - oral or not
PMH
Current medications

84
Q

What are some clinical indications for HRT ?

A

Perimenopausal or early postmenopausal women
Over 50 years old ( over 60 risks start to outweigh benefits )
Experiencing trouble some vasomotor symptoms

85
Q

Why would you start someone on HRT ?

A

Perimenopausal or recently postmenopausal symptomatic women where risk factors for CVD or thromboembolic are low
At risk of fractures

86
Q

What should be discussed before starting HRT ?

A

Modifiable factors for CVD - alcohol, smoking, DM, hypertension
Risks and benefits
Breast and cervical screening should be up to date

87
Q

What are some benefits from starting HRT ?

A

Decreases flushing
Improves headaches and insomnia
Reverses genital tract atrophy
Reduces osteoporosis and fracture rate
May be protective against Alzheimer’s disease

88
Q

What are some side effects of HRT ?

A

Nausea and breast tenderness
Weight gain and fluid retention
Headaches
Bloated sensation
Leg cramps
Glucose intolerance may be impaired
Slight increased risk of cholelithiasis

89
Q

What complications are there for unopposed oestrogen replacement therapy ?

A

Endometrial hyperplasia
Endometrial carcinoma
Abnormal bleeding patterns

90
Q

What complications can occur if a person is on HRT for longer than 5 years ?

A

Increased risk of breast cancer

91
Q

What are some contraindications of HRT ?

A

History of breast cancer
History or know risk of venous or arterial thromboembolic disease, stroke or CVD
Uncontrolled hypertension

92
Q

Which conditions require caution when using HRT ?

A

Abnormal vaginal bleeding
Abnormal liver function
Migraines
High risk of gall bladder disease

93
Q

What is stress incontinence ?

A

The involuntary loss of urine through an intact urethra secondary to an increase in intra-abdominal pressure and in the absence of detrusor activity ( coughing or straining ).

94
Q

What are the most common situations that cause stress incontinence ?

A

Following childbirth
After menopause

95
Q

What assessments should be taken when suspecting stress incontinence ?

A

History
Physical exam
Assess pelvic organ prolapse
Bladder pressure tests

96
Q

What are some management options for stress incontinence ?

A

Caffeine reduction
Fluid intake modifications
Pelvic floor training
Bladder training

97
Q

What is urgency incontinence ?

A

The sudden need to pass urine, which if ignored, may produce incontinence.

98
Q

What are the combined hormonal contraceptions ?

A

COCP
Combined transdermal patch
Combined vaginal ring

99
Q

What are some progestogen only contraception ?

A

POP
Progestogen only implant
Progestogen only injectable

100
Q

What are some intrauterine contraception ?

A

Copper IUD
Levonorgestrel IUS - marina coil

101
Q

What are the sterilisation methods for contraception ?

A

Vasectomy
Tubal occlusion

102
Q

what does the COCP contain ?

A

Oestrogen and progestogen

103
Q

What is the mechanism of action of combined hormonal contraceptives ?

A

Ovulation is inhibited by the oestrogen and progestogen components. These act on the hypothalamo-pituitary axis to reduce the production of LH and FSH. This means ovulation doesn’t occur.

104
Q

Why is progestogen given with oestrogen in contraceptions?

A

The oestrogen component causes the endometrium to proliferate and grow. The progestogen prevents hyperplasia of the endometrium.

105
Q

What is the normal regime of the COCP ?

A

21 days of the pill followed by 7 days without

Y3 GP (12 decks)

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