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AKT > Men + Women Health > Flashcards

Men + Women Health Flashcards

1
Q

what ref flags in LUTS require referral

A
  • recurrent UTIs/haematuria
  • retention
  • stress incontinence (coughing)
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2
Q

BPH medication options

A

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

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3
Q

When offer PSA + DRE
is it a good test - sens vs spec

A

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

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4
Q

how is prostate ca staged

A

TNM staging, PSA, glenosone score (micrscopic appereance)

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5
Q

when is hormones + orchidectomy considered

A

as neo=adjuctant to RxT or advanced mets

is LHRH agonist (gosrelin) + bilateral orchidectomy
- can get menopause symptoms, ostemoalacia!

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6
Q

what is the gold standard 1st Ix after PSA raised

A

multiparameteric MRI before biopsy

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7
Q

antibiotics choice for prostasis
- some risk of them

A

Quinolones = ciprofloaxin or olfaxacin for 14
- tendon rupture, aortic aneursm, seizures

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8
Q

Ix for ED

A

Lipids, HbA1c, Testetone (LHFSH), PRL, PSA, TFT

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9
Q

Type of drug sildenafil is
- some s/e and avoidence

A

PDE5 inhibitor
- hypotentsion, flushing, nasuesa, dizzy
NOT with nitrates

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10
Q

what are some secondary causes of testetone def

A

Microprolactinoma, endogenous Cushing’s syndrome, functional/late-onset hypogonadism.

GnRH, LH/FSH, Testosterone all low

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11
Q

Drug causes of testosterone deficiency include:

A

Oral glucocorticoids and anabolic steroids.
Opioids (including methadone) and marijuana.
Antipsychotics, antiretrovirals and some anticonvulsants.
Androgen deprivation therapy.
Radiotherapy and chemotherapy.

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12
Q

Painful phimosis tx

A

Hydrocortisone/betametasone 4 weeks with gentle traction

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13
Q

What is Balanitis Xeretiea Obliterons

A

Thickened white foreskin, scarred and non-retractable
Need circu

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14
Q

When does hypospadias surgery usually occur

A

1 - 2 years

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15
Q

Undescended testes at 6 week check
- plan

A

Re-check at 3months, if still there refer to urology

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16
Q

When would it be appropriate to check FSH
What can cause false low

A

<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

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17
Q

What are the UKMEC 3 for COCP (7)

A

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

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18
Q

UKMEC 4 for COCP (8)

A

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)

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19
Q

What cancers does the COCP reduce risk and increase risk of

A

Reduced = endo, colorectal, ovarian

Increase = breast + cervical (which normalises after stopping)

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20
Q

Rules if not starting contraception on day 1 of cycle
- COCP
- POP
- Implant/depot
- IUS
- Copper

A

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

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21
Q

Rules for starting COCP after emergency contraception

A

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

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22
Q

What might you do if you get on going breakthrough bleeding

A

Rule out STI, check cervix
Consider US

If okay - try increase oestrogen preparation, then change prog and finally increase prog

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23
Q

What is Co-cyprindiol license for

A

Acne symptoms
But higher VTE risk, switch after 3 months of acne control

24
Q

Drugs that reduce efficacy of COCP (enzyme inducing)

A

Rifamycins, antiviral like ritonavir
St. John’s wort
Phenyotin, carbamazepine, topirmate, modafinl

25
Q

What happens if develops migraines on pill

A

Goes from 2 to 3 (without

26
Q

UKMEC for POP stage 3 + 4

A

UKMEC 3 (relative contraindication)
A new diagnosis while on the POP of: IHD, CVA or migraine with aura.
Active gestational trophoblastic neoplasia (abnormal hCG).
History of breast cancer >5y ago.
Active viral hepatitis.
Severe cirrhosis.
Liver tumours.

UKMEC 4 (absolute contraindication)
Current breast cancer.

27
Q

UKMEC 2 for POP

A

UKMEC 2 (benefits usually outweigh risks)
HISTORY of:
Current or past VTE.
Ectopic pregnancy.
Migraine with aura.
IHD or CVA.

28
Q

Side effects of
- oestrogen
- progresterone

A

Breast tenderness, nausea, headaches

Mood swings, dry vagina, acne

29
Q

Pill check rules

A

3months, then 6 monthly, then annual

30
Q

Smoking rules on COCP

A

Ukmec 3 if stopped within 1 year + >35
Ukmec 2 if less 35 and smokes what ever

31
Q

First line for emergency contraception
- timings
- CI

A

Copper IUD
- within 5d (120hr) or 5 days after ovulation (D19)
- active STI

32
Q

Drug option of emergency conception

A

Ullipristal acetate - x1 a cycle, 5 days after UPSI (pre ovulation)
- need to delay regular conception for 5 days

Levonorgestrel - within 3 days (72hrs)
- avoid if BMI >26. Double dose if on enzyme drugs

33
Q

Age POP can be continued to

A

55

34
Q

Stopping contraception after the menopause

A

Non-Hornmonal = 2yr no period <50 + 1yr >50

COCP or inject prog = till 50

Implant, POP or IUS = till 50
- if stopped, continued till 55
- if not check FSH. >30 = stop after 1yr, <30 = rpt in 1 yr
- stop 55 definitely

35
Q

What are the majority abortions done under 1967 act

A

C: the pregnancy is ≤24w and continuance would involve risk, greater than if the pregnancy were terminated, of injury to the mental/physical health of the woman.

36
Q

Age (with symptoms) and diagnosis of menopause can be made

A

> 45

37
Q

When would you check FSH x2

A

Concerned about early (<45) or premature (<40) menopause
> 50 + want to stop POP

38
Q

1 st line for vasomotor symptoms in menpause

A

HRT - reduced OP for 5 years
Oestrogen if no uterus or minrena

39
Q

Menopausal options if needs contraception

A

Mirena + oestrogen
Sequenstral and POP

40
Q

When would you consider testosterone supplement in menopausal
(After androgen is progesteron

A

Low sexual desire

Vag atrophy can give topical oestrogen

41
Q

Risk of HRT

A

Smal risk of Breast, endo and ovaria Ca
- duration and dose dependent, reduced after stopping

Small CVD + VTE
- patches after

42
Q

Premature ovarain failure HRT advice

A

Till 50/52 - no cancer risk
Better for bone and CVD health

43
Q

Absolute CI to HRT

A

Breast, endo and ovarian cancer
Liver disease
Confirmed VT diseased
Undiagnosised vaginal bleeding
Previous arterial clots (MI, stroke)

44
Q

What is an example of a more androgenic testerone
Alternative to this

A

Norethesisone
Micronised prog (MPA)

45
Q

When would continuous HRT be advised

A

No periods for 2yr if <50 or 1yr >50

46
Q

Alernatives to HRT for vasomotor symptoms

OP

A

Venlaflaxine, SSRI
Clonidine - stop if no better after 6 weeks
Gabapentin

OP -bisophospahtes, ca/vit d

47
Q

Complimentary HRT therapies what can be effective

A

Isoflavones (red clover), black cohosh, don quai, primrose oil, sage leaf

48
Q

Tests for secondary or oligomenorrhoea

A

Commonest hypothalamic amenorrhea (low LH+oestodial), PCOS, premature ovarian failure

2x FSH taken 6 weeks a part (>30 = Premature menopause)
LH
Oestridaol (fertility!)

Testosterone (high) + SHBG (low) in PCOS LH also raised more the FSH
Symptoms relating to PRL, TSH
Glucose tolerance if BMI >30

49
Q

What is cause of gynaecomastia
- not mid to late puberty where it is useless oestrogen levels, resolved 1 - 2 years once testosterone levels increase

Tests

A

anti-androgens, TCAs, metrondidazole, spironolactone, CCB, cimetidie
cirrhosis, puberty, overweight

Testerone (hypogonadism) + oesterodiol
Rare testicular cancer => hCG

50
Q

conditions associated with low serum tesoterone

A

Primary (hypergonadotropic) TD - testicular failure - raised LH/FSH (Klinefelter syndrome, undescended testes, mumps orchitis, cancer treatment)

Secondary (hypogonadotropic) TD - commoner- hypothalamus-pituitary dysfunction - Low LH/FSH (age>50y, prolactinoma, obesity/metabolic syndrome, late-onset hypogonadism)

Combined Primary and Secondary TD- variable LH/FSH (glucocorticoids, alcoholism, sickle cell disease, haemochromatosis, thalassaemia)

Impaired action/suppression of testosterone
Side-effects of glucocorticoids, opioids, anticonvulsants, antipsychotics, antiretrovirals, chemotherapy

51
Q

Diagnosis of test def requires what

Who do yo consider screening

A

Requires BOTH characteristic symptoms and signs of TD AND reduced serum total testosterone (TT) or free testosterone (FT).

All men presenting with ED, loss of spontaneous erections or low sexual desire
All men with type 2 diabetes mellitus, BMI >30 kg/m2 or waist circumference >102 cm (40.2 inches)
All men on long-term opiate, antipsychotic or anticonvulsant medication

52
Q

Tx options for stress incontience

A

lifestyle + bladder diary
pelvic floor (8 contrace TDS) for 3 months
biofeedback
Duloxetine

consider if mixed = anticholeirgeic

53
Q

red flags for urology referral
>45
>60
x2

whats no urgent

A

visible haematuria without or post UTI
(even if on anticoag or warfarin)

non-visble haematuria + WCC/dysuria

non-urgent if >60 + persisent UTI
>40 + NVH
efgr <30
haematuri wih raised BP or afer URTI

54
Q

tx for urge incontience/OAB

A

bladder retraining
Oxybutynin/Tolteridone/Tropsium
- trail for 4 weeks, not in elderlt frail, dry/cins s/es

55
Q

what can mirabgeron be used for

A

3rd line OAB - caution can raise BP

AKT (14 decks)

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