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O+G Flashcards

1
Q

What is candidiasis?

A

A fungal infection due to any type of Candida (type of yeast)

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2
Q

Summarise the epidemiology of candidiasis

A

75% of women have at least 1 at some point (vaginal)
Almost half have at least 2
5% have more than 3 infections in single year

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3
Q

Explain the aetiology of candidiasis

A

Candida - type of yeast

Candida albicans = most common

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4
Q

What are the presenting symptoms of candidiasis?

A 
Genital itching
Genital burning
White "cottage cheese-like" discharge
Redness of skin
Burning with urination
Pain during sex
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5
Q

What are the signs O/E of candidiasis?

A 
Thick white discharge
Erythema
Vaginal fissuring
Oedema
Satellite lesions (sores)
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6
Q

How is candidiasis investigated?

A

Vaginal wet mount microscopy
Microbial culture
Antigen tests

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7
Q

What are the risk factors for candidiasis?

A 
Immunosuppression
HIV/AIDS
DM
Corticosteroids
ABx
Pregnancy
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8
Q

What is an epidural?

A

Medical route of administration in which a drug such as epidural analgesia and anaesthesia or contrast agent is injected into the epidural space around the spinal cord

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9
Q

What are the indications for an epidural?

A
  • For analgesia alone e.g. childbirth
  • Adjunct to GA to reduce opioid requirement e.g. gynae/ortho/general/vascular surgery
  • Alone as surgical anaesthesia e.g. C section
  • Post-op analgesia
  • Back pain - analgesics + steroids
  • Chronic pain/symptom palliation in terminal care
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10
Q

What are the possible complications of an epidural?

A
  • Failure to achieve full analgesia/anaesthesia
  • Accidental dural puncture with headache
  • Delayed onset of/shorter duration of breastfeeding
  • Bloody tap (punctured epidural veins)
  • Catheter placed into a vein –> seizures, cardiac arrest
  • Catheter placed in subarachnoid space –> high/total spinal block
  • Epidural abscess/haematoma
  • Paraplegia
  • Arachnoiditis
  • Death
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11
Q

What is mastitis?

A

Inflammation of the breast with or without infection

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12
Q

What age group does breast infection most commonly affect?

A

Women aged 15-45 years

Especially those who are lactating

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13
Q

What is the most frequent pathogen isolated from breast infection?

A

Staphylococcus aureus

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14
Q

Summarise the epidemiology of mastitis and breast abscess

A

15-45 years

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15
Q

What are the risk factors for mastitis and breast abscess?

A 
Female > 30
Poor breastfeeding technique
Lactation
Milk stasis
Nipple injury
Previous mastitis
Prolonged mastitis --> breast abscess
Shaving/plucking areola hair
Anatomical breast defect, mammoplasty, or scar
Breast cancer
Nipple piercing
Implants
Skin infection
Staph aureus carrier
Immunosuppression
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16
Q

What are the presenting symptoms of mastitis and breast abscess?

A 
Flu-like symptoms, malaise, myalgia
Fever
Sharp, shooting breast pain
Decreased milk outflow
Breast warmth, firmness, swelling, erythema
17
Q

What are the signs O/E of mastitis and breast abscess?

A

Fever

Breast warmth, firmness, swelling, erythema

18
Q

How are mastitis and breast abscess investigated?

A
  1. US - hypoechoic lesion (abscess); may be well circumscribed, macrolobulated, irregular, or ill defined w possible septae
  2. Needle aspiration drainage - purulent fluid = breast abscess
  3. Cytology of nipple discharge/FNA sample - infection
  4. Milk, aspirate, discharge or biopsy tissue MC&S - positive culture = infection
  5. Histopathological examination of biopsy tissue - infection, granulomatous inflammation
  6. Pregnancy tes if in adolescent
19
Q

How is mastitis managed?

A

Mild = effective milk removal + paracetamol/ibuprofen

Severe = ADD ABx - flucloxacillin/dicloxacillin/cloxacillin or cefalexin/clindamycin

MRSA confirmed by culture/prevalent locally = non-beta-lactam ABx - clindamycin/trimethoprim/sulfamethoxazole/vancomycin or doxycycline instead

20
Q

What are the possible complications of mastitis and breast abscess?

A 
Cessation of breastfeeding
Abscess (complicating mastitis)
Sepsis
Scarring
Functional mastectomy - breast unable to lactate
Breast hypoplasia
Necrotising fasciitis
Extra-mammary skin infection
Fistula
21
Q

What is a breast abscess?

A

A localised area of infection with a walled-off collection of pus

22
Q

How is a breast abscess managed?

A
  1. FNA w LA w/wo US guidance to drain abscess
  2. IV/oral ABx:
    a) MRSA excluded = activity vs methicillin-sensitive staphylococci - dicloxacillin/cefalexin
    b) MRSA +ve = non-B-lactam - clindamycin/trimethoprim/sulfamethoxazole
  3. Paracetamol/ibuprofen
23
Q

What is polycystic ovary syndrome?

A

PCOS includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound

24
Q

Summarise the epidemiology of polycystic ovary syndrome

A

Affects 6-8% of women of reproductive age

Symptoms generally start at time of puberty

Accounts for 80-90% of cases of hyper-androgenism in women

25
Q

Explain the aetiology of polycystic ovary syndrome

A

Unknown
Primary defect is unclear

?Defect in hypothalamic-pituitary axis - increased amplitude and frequency of LH pulses

Inherited as common complex disorder: multiple genes w mild/moderate effects on overall disease risk involved

26
Q

What are the signs O/E of polycystic ovary syndrome?

A

Hirsutism
Acne
Overweight/obese
Hypertension

27
Q

How is polycystic ovary syndrome investigated?

A
  1. Serum total and free testosterone - elevated
  2. Serum DHEAS - elevated
  3. Serum 17-hydroxyprogesterone - normal (>24 nanomol/L = adrenal hyperplasia)
  4. Serum prolactin - normal (elevated –> prolactinoma)
  5. Serum TSH - normal
  6. Oral glucose tolerance test - fasting glucose 5.6-6.9 mmol/L; 2 hour glucose 7.8-11.0
  7. Fasting lipid panel - elevated total cholesterol, LDL, triglycerides + low HDL
28
Q

What are the different types of mastitis?

A

Mastitis with infection may be lactational (puerperal) or non-lactational (eg duct ectasia)

Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions, eg foreign body reaction

Y3 (20 decks)

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