Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP - General Practice > OBGYN > Flashcards

OBGYN Flashcards

1
Q

1 in 20 women have heavy menstrual bleeding. Define Heavy Menstrual Bleeding

A

Excessive menstrual bleeding affecting the patient’s QoL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What quantity of bleeding constitutes heavy menstrual bleeding

A

> 80ml/month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 28 year old patient, G1P0 presents with excessive PV bleeding. Give your differentials.

A

Physiological bleeding
Presence of IUD (especially copper)
Congenital uterine abnormality (e.g. bicornuate uterus)
Hormone producing tumours
+PALM COEIN

Polyp
Adenomyosis
Leiomyoma
Malignancy/Hyperplasia

Coagulopathy
Ovulatory dysfunction
Endometrial cancer/endometriosis
Infection/Iatrogenic (anticoagulant)
Not known/Idiopathic = Dysfunctional Uterine Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Dysfunctional Uterine Bleeding

A

Abnormal bleeding in the absence of detectable/recognizable organic pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the only 2 investigations that should be done routinely in the case of Heavy Menstrual Bleeding?

What are the other tests you should do, giving the condition to perform them

A

FBC for anaemia (technically and coagulation with platelets)
+ B-HCG to rule out pregnancy

Ferritin only if evidence of anaemia from FBC
Coagulation profile/checking for coagulation disorders only if heavy menstrual bleeding since periods started or if personal/family history suggesting coag disorder

Female hormone profile only if symptoms of menopause

TFTs only if symptoms and signs of hypo/hyperthyroidism (other than the heavy menstrual bleeding ofcourse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the management options for heavy menstrual bleeding in primary care

What about secondary care

A

Hormonal Therapy => Contraception but possibility for future planning in the future
!!!! Iron supplements (if anaemic) AND
First Line: LNG-IUS
Second Line: COCP
Third Line: Systematic Pregestogen
Fourth Line: Depot Progestogen
Notice no GnRH in primary care
Hormonal therapy should be given outside of the period

Non-hormonal => Future planning
First Line: NSAIDS
Second Line: Anti-fibrinolytic Agents - Tranexamic Acid
Non-hormonal therapy should be prescribed during the period

Secondary care:
GnRH analogues prior to surgery

Surgical:
First Line: Endometrial Ablation
Second Line: Myomectomy (acceptable for future planning)
Third Line: Uterine Artery Embolisation
Fourth Line: Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What NSAIDs are used in the treatment of Heavy Menstrual Bleeding?

A

Iburpofen or Mefenamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give the generic name for a Systemic Progestogen

A

Norethisterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give the generic name for a depot progesterone

A

Medroxyprogesterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

LNG-IUS is the first like treatment of HMB
What type of drug is it releasing?
What should be explained to the patient when starting?
LNG is indicated as the first-line treatment of HMB only in 3 circumstances. What are they?

A

Progestogen

Anticipate changes to bleeding pattern (irregular bleeding) that can last up to 6 months. Wait 6 months to assess effects of tx

  • No identified pathology, or
  • Fibroids <3cm diameter that are not distorting the uterine cavity, or
  • Adenomyosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A patient presents to you with very heavy bleeding. a lot… How would you manage?

A

1) Resuscitate as necessary— admit if shocked
2) Reduce/ stop bleeding with progestogen, e.g. norethisterone 5mg tds or Medroxyprogesterone 10mg tds for 10d. Effective in 24– 48h. A lighter bleed follows on stopping. An alternative is tranexamic acid 1– 1.5g tds for 4d
3) Correct anaemia and refer for specialist gynaecology assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the average age of menopause?

A

51 (median is 52)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the effect of smoking on menopause

A

Average menopause in smokers is 2 years before (49) that of non-smokers (51)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the follow up after starting any treatment of menopause

A

3 months and then annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Without laboratory tests,
What is the diagnosis of perimenopause?
What is the diagnosis of menopause?
Define Early menopause
Define Premature menopause

A

Clinical for both
For a healthy female aged >45,
Perimenopause = vasomotor symptoms and infrequent periods
Menopause = If not period for 12+ months AND not using hormonal contraception.
Early: <45 yo
Premature: <40 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How would you diagnose menopause in a patient who has had a hysterectomy?

A

Based on symptoms of menopause alone

17
Q

When should FSH be tested (in general)?

A

Days 2-5 of the cycle

18
Q

With laboratory testing, how would you diagnose menopause?
What is the indication for this test to be done?

A

If the age of the woman is <45 (=> early) and having menopausal symptoms, check FSH.
If FSH >30IU/L on 2 occasions, >1 month apart => suggests that the patient is post-menopausal

19
Q

A patient aged 40 presents with changes to her menstrual pattern and with some symptoms similar to that of menopause. What other causes may lead to this?

A

Physical illness: Chronic diseases such as DM, CKD, thyroid disease, and anemia (think hypo hypo amenorrhoea)
Social or psychiatric problems
Medications: Calcium medications cause flushing

20
Q

How does the period pattern change as you approach menopause?

A

At the age of 40, the cycle typically shortens about 7-10 days before lengthening to about 2-3 months before finally stopping at menopause

21
Q

Late menstruation >54yo should be investigated especially because of

A

Risk of malignancy (endometrial)

22
Q

What are the 5 main groups of complications of Menopause?

A

1) Vasomotor instability
2) Urogenital symptoms
3) Osteoporosis
4) Heart disease
5) Psychiatric

23
Q

What are the vasomotor instability symptoms of menopause?

In primary care, how would you manage this?

A

Hot flushes (palpitations, sweating, nausea, lightheadedness, anxiety), may occur at night (fatigue, depression, lethargy)

tx
1) Lifestyle changes
2) HRT
3) Non-hormonal treatments including SSRIs and SNRIs (sertraline, gabapentin, clonidine)
Note: do not prescribe fluoxetine or paroxetine if woman is on tamoxifen (for breast cancer prevention and treatment)

24
Q

What are the urogenital symptoms of menopause?

In primary care, how would you manage the uro and genital part separately?

A

Vulval and vaginal dryness (estrogen in charge of secretions) => Dyspareunia and increased risk of bacterial vaginosis

tx
1) Vaginal lubricants/moisturizers
2) Topical oestrogen

+ Loss of libido

Urethral + Bladder tissue atrophy => readuced elasticity => Increased frequency, dysuria (pain on urination), Nocturia = Incontinence
+ Recurrent UTIs!!

tx:
Recurrent UTIs and urge incontinence is reduced with the use of topical vaginal oestrogen but not stress incontinence

25
Q

A patient presents to your clinic complaining of loss of libido and wants medication to fix it. She is already on HRT. What will you give her?

A

It responds well to testosterone along with HRT however it is unlicensed (applied to abdomen and upper thigh)

26
Q

Is it safe to prescribe oestrogen cream in a patient already on HRT?

Is it safe to prescribe topical oestrogen cream to a patient with a history of breast cancer/previously had breast cancer?

A

Yes it is safe if on HRT

It is thought to be safe but check with supervising specialist if current/recent breast cancer

27
Q

A post-menopausal has developed osteoporosis with bone pain as of her last DEXA scan showing -2.5 (T score). In primary care, how would you manage this?

A

Imp: Do no prescribe HRT unless premature menopause (<40)
1) Lifestyle advise:
a) Nutrition: Maintain BMI >19 + Vit. D + Calcium supplements
b) Physiotherapy + Weight bearing exercises
c) Smoking and alcohol cessation

2) Medical management:
a) Bisphosphonates (Alendronate/Ibandronate) weekly
b) Denosumab (monoclonal antibody)
c) Raloxifine (not indicated here because needs past hx of fragility fracture - SERM)
d) Teriparatide (daily injection for maximum duration of 18 months)

28
Q

A patient is diagnosed with premature menopause at the age of 39. She suffers from bone pain and on her DEXA scan her T score was -1.6.

A

The patient is osteopenic and with early menopause, runs the risk of developing osteoporosis. HRT is only recommended in the prevention of osteoporosis in premature menopause. The only other time is if it is prescribed for reasons outside of menopause

29
Q

A 54 year old patient presents with a fragility fracture in T12 on MRI. You decide to perform a DEXA scan which reveals her score to be <2.5. You ask the patient if shes been on bisphosphonates before and she tells you her previous doctor told her she cant take it. What does the patient likely have (2)?

What drug is she likely on now?
Give 1 contraindication and 1 disease that this drug increases the risk for.

A

Bisphosphonates are contraindicated in oesophageal disease or CKD (renaly excreted)

She is likely on the second-like drug Tamoxifen (not brought up in the oxford handbook). It is contraindicated in pregnancy and severely increases the risk of endometrial cancer

30
Q

A 57 year old woman presents with new onset low mood and is asking for help with it. How do you manage the psychological complication of low mood as a result of menopause?

A

Most important: Do not prescribe SSRI or SNRI unless clinical depression (go study that later)
1) HRT (if not on already)
2) Regular sustained aerobic exercise (swimming, running) (a/w reduced psychological symptoms and insomnia)
3) CBT

31
Q

Is HRT also considered a contraceptive

A

Not unless it contains levonorgestrel IUS as the progesterone component

32
Q

Are women on contraception advised to continue using contraception after menopause?

A

Only women who are on non-hormonal contraception (barrier or copper IUD) should be advised to continue using until 1 year since their last LMP if >50 and 2 years after their last LMP if <50

33
Q

Give 5 contraindications to HRT

A

Hx of/current breast or endometrial cancer
Unknown/irregular vaginal bleed
Active Liver disease
Porphyria Cutanea Tarda (mcq shit)
VTE/Stroke/TIA (not in oxford)
Pregnancy (not in oxford)

34
Q

Explain your management approach to a 52 patient presenting with amenorrhoea for the past 14 months.

A

If the patient does not wish for hormonal therapy, Natural Phytoestrogens (diet) will help.

In terms of hormonal replacement therapy, this depends on whether the patient has a uterus or not. If there is no uterus, Oestrogen-only therapy would be used.

If the patient does have a uterus then the next thing to look at is whether they are pre- or post-menopausal. If the patient is pre-menopausal, then we would have a Sequential approach whereby the patient will have continuous oestrogen + Cyclical progesterone to ensure monthly withdrawal bleed. If the patient is Post-menopausal, then a Continuous approach is used whereby both oestrogen and progesterone are continuous.

35
Q

A women, with a uterus, wants HRT. She does not want anything inserted into her vagina or uterus. She is post-menopausal. What type of HRT should she be given?
What is the best medication for HRT according to the oxford handbook?

A

She should be given continuous oestrogen and progesterone therapy.

Tibolone is the best. It contains oestrogen and progesterone as well as weak andronergic action. It is used as a continuous HRT.

36
Q

In menopause what days are most important for the woman to receive progesterone to prevent endometrial hyperplasia?

A

Last 12-14 days of her cycle (remember the last portion of the menstrual cycle is constant which is why ovulation always occurs 14 days before menstruation and progesterone levels are taken 7 days before.

37
Q

HRT should eventually be stopped due to risks of ongoing therapy.
If no complications occur, when should HRT be stopped?

How should HRT be stopped

A

After about 5 years of starting

HRT should be stopped gradually

38
Q

A patient for HRT is due for an elective major surgery. How long before then should it be stopped?
When can they commence HRT again?

What would you do in the case of an emergency surgery?

A

Stop HRT 4-6 weeks before surgery and may resume only after full mobilization

LMWH prophylaxis and compression hosiery (If ABPI >0.8) is needed

39
Q

What are the risks of HRT?

A

1) VTE risk (incl. stroke) with oral not transdermal HRT Note: Tibolone increases stroke risk by x2.2 after first year
2) Breast cancer: oestrogen alone has no increased risk but togeher (including tibolone does) Risk returns to baseline <5 years after stopping
3) Endometrial cancer (if oestrogen-only) but shouldnt happen if protocol followed
4) Ovarian cancer: Slight increased risk but returns to baseline on stopping

Note: No increased CVD risk (oestrogen actually reduces), No increased T2DM risk as well

GP - General Practice (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions