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Year 3 Knowledge - Conditions and Procedures > O&G > Flashcards

O&G Flashcards

1
Q

Define candidiasis.

A

(Yeast infection!)

A fungal infection that causes irritation, discharge and intense itchiness of the vagina and vulva.

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2
Q

Explain the aetiology / risk factors of candidiasis.

A
  • Skin folds
  • Moisture

Penile yeast infections - unprotected vaginal intercourse with a woman who has the infection

Prevention - condoms during sex

Risk Factors:

  • Pregnant
  • Antibiotic therapy
  • DM
  • Immunosuppressed
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3
Q

Summarise the epidemiology of candidiasis.

A

Affects 3/4 women at some point in their lifetimes.

Very common

No evidence for treatment of sexual partners.

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4
Q

Recognise the presenting symptoms of candidiasis.

A
  • Genital itch
  • Burning
  • Cottage cheese-like discharge
  • Dyspareunia - painful intercourse
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5
Q

Recognise the signs of candidiasis on physical examination.

A
  • Genital itch
  • Burning
  • Cottage cheese-like discharge
  • Dyspareunia - painful intercourse
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6
Q

Identify appropriate investigations for candidiasis and interpret the results.

A

Microscopy and culture for Candida.

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7
Q

Define epidural.

A

Opioids and anaesthetics are given into the epidural space by infusion or as boluses.

Side effects are thought to be less, as the drug is more localized - watch for respiratory depression and local anaesthetic-induced autonomic blockade (drop in BP).

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8
Q

Summarise the indications for an epidural.

A
  • Blunt trauma - with or without rib fractures, thoracic, abdominal, orthopedic and vascular surgery
  • Non-surgical problems - intractable angina pectoris, acute pancreatitis.
  • Childbirth
  • Control pain after major surgery
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9
Q

Identify the possible complications of an epidural.

A
  • Patient refusal
  • Active maternal haemorrhage
  • Septicaemia
  • Infection at or near the site of needle insertion
  • Clinical signs of coagulopathy
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10
Q

Define mastitis / breast abscesses.

A

Mastitis

  • Inflammation of the breast with or without infection
  • May be lactational (puerperal) or non-lactational (e.g. duct ectasia)
  • Non-infectious - e.g. idiopathic granulomatous inflammation, foreign body reaction etc

Breast Abscess

  • Localised area of infection with a walled-off collection of pus
  • May or may not be associated with mastitis
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11
Q

Explain the aetiology of mastitis / breast abscesses.

A
  • Caused by Staphylococcus aureus

Risk Factors:

  • Female sex
  • Women aged >30 years
  • Poor breastfeeding technique
  • Lactation
  • Milk stasis
  • Nipple injury
  • Previous mastitis
  • Prolonged or prior mastitis (breast abscess)
  • Shaving or plucking areola hair
  • Anatomical breast defect, mammoplasty or scar
  • Nipple piercing
  • Foreign body
  • Skin infection
  • Staphylococcus aureus carrier
  • Immunosuppression
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12
Q

Summarise the epidemiology of mastitis / breast abscesses.

A

Women 15-45 years most common
Especially if lactating
Can occur at any age

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13
Q

Recognise the presenting symptoms of mastitis / breast abscesses.

A
  • Fever
  • Decreased milk outflow
  • Breast warmth
  • Breast tenderness
  • Nipple discharge
  • Nipple inversion / retraction
  • Lymphadenopathy
  • Extra-mammary skin lesions
  • Breast mass
  • Fistula
  • Flu-like symptoms
  • Malaise
  • Myalgia
  • Breast firmness
  • Breast swelling
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14
Q

Recognise the signs of mastitis / breast abscesses on physical examination.

A
  • Fever
  • Decreased milk outflow
  • Breast warmth
  • Breast tenderness
  • Nipple discharge
  • Nipple inversion / retraction
  • Lymphadenopathy
  • Extra-mammary skin lesions
  • Breast mass
  • Fistula
  • Flu-like symptoms
  • Malaise
  • Myalgia
  • Breast firmness
  • Breast swelling
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15
Q

Identify appropriate investigations for mastitis / breast abscesses and interpret the results.

A
  • Breast ultrasound
  • Diagnostic needle aspiration drainage
  • Cytology of nipple discharge or sample from fine-needle aspiration
  • Milk, aspirate, discharge or biopsy tissue for culture and sensitivity
  • Pregnancy test
  • Blood culture and sensitivity
  • Mammogram
  • Milk for leukocyte counts and bacteria quantification
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16
Q

Generate a management plan for mastitis / breast abscesses.

A
  • Antibiotics
  • Open incision or percutaneous drainage if abscess

Different algorithms for lactational, non-lactational mastitis and breast abscess depending on whether acute or ongoing or recurrance.

17
Q

Identify the possible complications of mastitis / breast abscesses and its management.

A
  • Breast abscess
  • Chronic pain
  • Scarring
  • Disfigurement & nipple inversion
  • Metastases
  • Post-surgical complications - e.g. ipsilateral lymphedema
  • Fistula
18
Q

Summarise the prognosis for patients with mastitis / breast abscesses.

A

Breast abscess formation from mastitis in less than 10% of cases.

19
Q

Define polycystic ovary syndrome (PCOS).

A

Characterized by oligomenorrhoea/amenorrhoea and hyperandrogenism (clinical or biochemical).

Frequently associated with obesity, insulin resistance, T2DM, dyslipidaemia.

20
Q

Explain the aetiology /risk factors of polycystic ovary syndrome (PCOS).

A
  • Environmental factors - e.g. diet, obesity
  • Genetic variants - genes regulation gonadotrophin, insulin, androgens (synthesis, secretion, action), weight and energy regulation
  • Hyperinsulinaemia - increased ovarian androgen synthesis, reduced hepatic SHBG synthesis (increased free androgens)
21
Q

Summarise the epidemiology of polycystic ovary syndrome (PCOS).

A

Most common cause of infertility in women

6-8% of women

22
Q

Recognise the presenting symptoms of polycystic ovary syndrome (PCOS).

A
  • Menstrual irregularities - oligomenorrhoea / amenorrhoea
  • Dysfunctional uterine bleeding
  • Infertility
  • Symptoms of hyperandrogenism - e.g. hirsutism, male-pattern hair loss, acne
23
Q

Recognise the signs of polycystic ovary syndrome (PCOS) on physical examination.

A
  • Hirsutism
  • Male-pattern hair loss
  • Acne
  • Acanthosis nigricans - sign of severe insulin resistance, involving velvety thickening and hyperpigmentation of skin of axillae or neck
24
Q

Identify appropriate investigations for polycystic ovary syndrome (PCOS) and interpret the results.

A
  1. Bloods
  2. Tests to Excluse
  3. Looking for Impaired Glucose Tolerance / T2DM
  4. Transvaginal USS

Bloods

  • High LH
  • High LH: FSH ratio (>3)
  • High testosterone
  • High androstenedione
  • High DHEA-S
  • Low SHBG

Tests to Exclude

  • Hyperprolactinaemia - do serum prolactin
  • Hypo/ hyperthyroidism - do TFTs
  • Congenital adrenal hyperplasia - do 17-OH-progesterone
  • Cushing’s Syndrome - if clinically suspected

T2DM

  • Fasting glucose
  • HbA1C
  • Oral glucose tolerance test
  • Fasting lipid profile

Transvaginal USS

  • 12 or more folicles in each ovary
  • Measuring 2-9mm
  • Increased ovarian volume >10mL

Year 3 Knowledge - Conditions and Procedures (19 decks)

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