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Women's Health > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Potential causes for raised CA125

A

Endometrial cancer
Bowel cancer
Any disseminated intra-abdominal cancer
Pancreatic Cancer
Benign ovarian neoplasms
Uterine leiomyomas
Hepatitis
Liver cancer
Liver cirrhosis
SLE
Pelvic inflammatory disease
Normal variation

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2
Q

Precautions to COCP use

A

Personal or 1st degree degree relative < 45yo with DVT
Recent breast lumps
Pregnancy status
Breastfeeding or post-partum status
Carrier of BRCA gene
Migraine with aura
Known thrombogenic mutations
Previous VTE

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3
Q

Advice regarding POP use

A

Only effective if taken at same time every day
Barrier prophylaxis should be used for at least 2 days if POP taken 3hours outside of time.
Vomiting or severe diarrhoea will reduce efficacy
Possibly will cause intermenstrual bleeding
Takes 3 days for method to start working

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4
Q

MEC

A

UK Medical Eligbility Criteria Categorisation

1 No restriction
2 Advantages outweigh theoretical or proven risk
3 Risks outweigh advantages
4 Unacceptable health risk if method is used.

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5
Q

MEC Criteria relating to COCP

A

Age < 35 - 2
Age >= 35, ex-smoker >= 1 year - 2
Age >= 35 + smoker < 15cigs/day - 3
Age >= 35 + smoker >= 15cigs/day - 4
BMI >= 30-34 - 2
BMI >=35 - 3

Breastfeeding < 6 weeks post-partum - 4
6 weeks to 6 months - 2
>= 6 months - 1

VTE
- Personal history - 4
- Family history < 45yo - 3
- Family history >=45 - 2
- Major surgery with prolonged immobilisation - 4
- Immobility unrelated to surgery - 3

Migraine with Aura - 4

Current breast cancer - 4
Past breast cancer - 3
BRCA mutation - 3

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6
Q

Alternatives to COCP safe according to MEC

A

Cu-IUD, Levenorgestrel IUD - Progestogen-only Implant, POP, Progestogen-only injectable.

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7
Q

Symptomatic pharmacological management of menorrhagia

A

Mirena IUD
Oral progestins - Medroxyprogesterone 10mg PO TDS on days 1-21 of 28 days cycle for up to 6 months, Norethisterone 5mg PO TDS Day 5-26 of cycle
Mefenamic acid 500mg PO TDS
Tranexamic acid 1.5g PO TDS for first 3-5 days of cycle.

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8
Q

Causes of menorrhagia

A

Pregnancy-related - Miscarriage, implantation bleed
Uterine pathology
- Adenomyosis, leiomyoma, malignancy, endometrial hyperplasia
Fumctional Pathology
- Coagulopathy (vWF), Ovulatory dysfunction (Hypothyroidism, PCOS), endometrial haemostasis
Iatrogenic
- IUD, Anticoagulation, Tamoxifen, Exogenous oestrogens
- Alternative medicines - Gingko, soya, ginseng

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9
Q

Approach to menorrhagia

A

Exclude pregnancy
Perform CST if due
Check FBC/Ferritin
Consider coag profile
Consider TSH.

US - Day 5-10 of menstrual cycle.

Symptomatic teatment.
- Attempting to conceive? Transexamic acid 1.5g PO TDS for first 3-5 days of cycle. NSAIDS can also be used until conception.
- No attempting to conceive? Contraception

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10
Q

Causes of oligomenorrhoea

A

PCOS
HPO axis changes - Anorexia, weight loss, excessive exercise, stress
Prolactinoma - ?Galactorrhoea
Hypothyropidism - Cold intolerance, weight gain, dry skin
Iatrogenic - Contraceptive use

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11
Q

Advice surrounding Depot Medroxyprogesterone use

A

Medroxyprogesterone 150mg deep IM every 12 weeks
Delay of 8 months in return to fertility
Can cause amenorrhoea, irregular beeding
Accelerated bone lose with long-term use.
Contraceptive effects last less than 14 weeks and needs to be given regularly.
May experience breast tenderness.

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12
Q

Antibiotic choice for acute cystitis in pregnant women

A

1 - Nitrofurantoin 100mg PO QID x 5 days
2 - Cefalexin 500mg pO BD x 5 days

2nd or 3rd trimester? Can consider trimethoprim.

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13
Q

Indications for 5mg folic acid in pregnancy

A

Previous NT defect in pregnancy
Diabetes Mellitus
5-MTHFR deficiency
BMI > 30
Risk of malabsorption.

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14
Q

Ectopic Pregnancy Risk factors

A

Risk factors
- Previous EP, Previous tubal surgery, IUD use, IVF treatment, Previous PID, previous STI, Smoking, previous abdominal surgery, In-utery DES exposure

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15
Q

COCP Missed pills plan

A

< 24 hours late (<48 hours since last pill)?
- Take 1 pill as soon as able to. Then take next pill at normal time.

> 24 hours late?
- Take 1 pill as soon as able to. Take the next 1 at usual time.
- Use barrier protection or abstain from sex for 7 days.
- May need to use emergency contraception.
- <7 hormone pills left in pack? Discard non-hormone pills and go straight to hormone pills of next pack.

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16
Q

Consideration of emergency contraceptive pill

A

Unprotected sex in previous 5 days
- Missed more than 1 pill in first 7 days of new pack of pills.
- Started a new pack more than 24 hours late.
- missed more than 1 pill.

17
Q

Causes of secondary amenorrhoea

A
  • Functional Amenorrhoea (Excessive exercise, weight loss, low BMI, severe chronic illness, psychological stress)
  • PCOS
  • Pregnancy
  • Hypothyroidism
  • Prolactinoma
  • Premature ovarian insufficiency
  • Medications (Antipsychotics, opiates, chemotherapy, hormonal contraception)
  • Adrenal (Cushings, Congenital Adrenal Hyperplasia)
  • Asherman syndrome

Testing
- Baseline - Prolactin, Testosterone, TSH, FSH +/- serum bHCG, LH, oestrogen, progesterone.

18
Q

Vaginitis

A

Differential
- Vulvovaginal candidiasis
- Bacterial vaginosis
- HSV
- Irritant contact dermatitis
- Atrophic vaginitis
- Lichen Planus
- Psoriasis
- Vulvodynia (Chronic vulvar pain syndrome)
- STI

19
Q

Treatment for Vaginal candidiasis

A

Pharmacological
- Fluconazole 150mg PO Stat (Use if not tolerating Topical therapy and is not pregnant.)
- Clotrimazole 1% cream intravaginally nocte x 6 nights
- Miconazole 2% cream intravaginally nocte x 7 nights

Non-pharmacological
- Wear cotton underwear
- Wash clothing in unperfumed laundry detergent
- Avoid wearing tight-fitting pants
- Avoid using soap or shampoo on the vulva.
- Wipe from front to back after going to toilet.
- Do not perform vaginal douching.

20
Q

Genital Lichen Sclerosis

A
  • Chronic inflammatory dermatosis
  • White sclerotic patches that susequently coalesce, becoming shiny porcelain-white or ivory-white

Symptoms
- Asymptomatic
- Pruritus
- Pain, bleeding from fissuring or erosion.
- Dyspareunia
- Constipation and painful defecation if perianal skin is involved.
- Atrophy and distortion of anatomical structures including the clitoris, fusion of the labia majora and minora, stenosis of the introitus.

5% risk of vulvar SCC.

Associated auto-immune related illnesses
- Thyroid disease
- Vitiligo
- Alopecia Areata
- Pernicious anaemia

Treat with ultra-high potency corticosteroid
- Topical clobetasol 0.05% ointment OD

21
Q

Risk factors for endometrial cancer

A
  • History of chronic anovulation
  • Exposure to unopposed oestrogen
  • PCOS with chronic anovulation
  • Exposure to tamoxifen
  • Family history of Lynch Syndrome or endometrial cancer.
  • Nulliparity
  • Obesity
  • Endometrial Thickness > 8mm
22
Q

Approach to post-menopausal vaginal bleeding

A
  • TVUS is initial screening tool
  • Cervical Co-Test indicated
23
Q

Advice regarding quick-start method to contraception with implanon and IUDs

A
  • Explain possibility of missing an early pregnancy
  • Urine bHCG performed prior to insertion of device
  • If Ulipristal 30mg taken, must wait for 5 days following use to insert progesterone-based implants.
  • Use of barrier protection for 7 days following insertion
  • Repeat urine bHCG at 4 weeks after insertion
  • Document actions taken in consult notes.
24
Q

Causes of Primary Amenorrhoea

A
  • Hypothalamic Amenorrhoea
  • Hypopituitarism
  • Constitutional delay in puberty
  • PCOS
  • Hypothyroidism
  • Prolactinoma
  • Turnery Syndrome
  • Imperforate Hymen
  • Vaginal Agenesis
  • Congenital Adrenal hyperplasia.

Women's Health (9 decks)

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