Men + Women Health Flashcards
(55 cards)
what ref flags in LUTS require referral
- recurrent UTIs/haematuria
- retention
- stress incontinence (coughing)
BPH medication options
just enlarged = alpha blocker (alfuzosin, tamsulosin, doxazosin)
- hypotension, rhinitis. r.v in 1month then 6months
enlarged with raised PSA = 5alpha reductase finasteride
- takes 3months to work
- council on tetrogenic, impotence, reduced lidio, gynaecomastia
When offer PSA + DRE
is it a good test - sens vs spec
LUTS, ED, haematuria
low sens but high spec
- higher in age, infection etc
- low in statins, thiazides, aspirin, 5apls reductase
Sensitivity refers to a test’s ability to designate an individual with disease as positive. A low sensitive test means that there are lots false negative results
The specificity of a test is its ability to designate an individual who does not have a disease as negative - v unlikely if it’s negative
how is prostate ca staged
TNM staging, PSA, glenosone score (micrscopic appereance)
when is hormones + orchidectomy considered
as neo=adjuctant to RxT or advanced mets
is LHRH agonist (gosrelin) + bilateral orchidectomy
- can get menopause symptoms, ostemoalacia!
what is the gold standard 1st Ix after PSA raised
multiparameteric MRI before biopsy
antibiotics choice for prostasis
- some risk of them
Quinolones = ciprofloaxin or olfaxacin for 14
- tendon rupture, aortic aneursm, seizures
Ix for ED
Lipids, HbA1c, Testetone (LHFSH), PRL, PSA, TFT
Type of drug sildenafil is
- some s/e and avoidence
PDE5 inhibitor
- hypotentsion, flushing, nasuesa, dizzy
NOT with nitrates
what are some secondary causes of testetone def
Microprolactinoma, endogenous Cushing’s syndrome, functional/late-onset hypogonadism.
GnRH, LH/FSH, Testosterone all low
Drug causes of testosterone deficiency include:
Oral glucocorticoids and anabolic steroids.
Opioids (including methadone) and marijuana.
Antipsychotics, antiretrovirals and some anticonvulsants.
Androgen deprivation therapy.
Radiotherapy and chemotherapy.
Painful phimosis tx
Hydrocortisone/betametasone 4 weeks with gentle traction
What is Balanitis Xeretiea Obliterons
Thickened white foreskin, scarred and non-retractable
Need circu
When does hypospadias surgery usually occur
1 - 2 years
Undescended testes at 6 week check
- plan
Re-check at 3months, if still there refer to urology
When would it be appropriate to check FSH
What can cause false low
<45year + menopausal (x2 positive tests + > 30year - early), <40 = premature
>50 + want or stop contraception
>55 years you are not fertile
Depop
Would need to stop COCP + HRT 6 weeks before
What are the UKMEC 3 for COCP (7)
Examples of UKMEC 3 conditions include
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
UKMEC 4 for COCP (8)
Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
What cancers does the COCP reduce risk and increase risk of
Reduced = endo, colorectal, ovarian
Increase = breast + cervical (which normalises after stopping)
Rules if not starting contraception on day 1 of cycle
- COCP
- POP
- Implant/depot
- IUS
- Copper
Fine first 5 days, then need protection for 7 days
Fine first 5 days, then need protection for 2 days
Fine first 5 days, then need protection for 7 days
Fine first 7 days, then need protection for 7 days
Nothing needed for copper
Rules for starting COCP after emergency contraception
Start immediate after levorgesterol, use extra for 7 days, preg test at 3 weeks
Wait 5 days after ullipristal, then use extra for 7 and preg test at 3 weeks
What might you do if you get on going breakthrough bleeding
Rule out STI, check cervix
Consider US
If okay - try increase oestrogen preparation, then change prog and finally increase prog
What is Co-cyprindiol license for
Acne symptoms
But higher VTE risk, switch after 3 months of acne control
Drugs that reduce efficacy of COCP (enzyme inducing)
Rifamycins, antiviral like ritonavir
St. John’s wort
Phenyotin, carbamazepine, topirmate, modafinl
