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Reproductive Health Tutorials Flashcards

1
Q

Define partner notification

A

the process of contacting the sexual partners of an individual with a sexually transmitted infection including HIV, and
advising them that they have been exposed to infection

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2
Q

What is the value of contact slips / cards for partner notification?

A

Can provide anonymity and confidentiality for the index patient
* Enable sexual contacts to seek medical advice or treatment
* Inform the contact’s clinic of index patient’s diagnosis, and date of diagnosis.
* Enable cross-referencing and
evaluation of partner notification

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3
Q

Give infective causes of genital soreness / sores

A

Candida
Herpes simplex
Herpes zoster
Syphilis

Tropical diseases-
LGV, Granuloma inguinale, Chancroid

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4
Q

Give non-infective causes of genital soreness/ sores

A

A) Trauma
Physical
Chemical

B) Dermatological conditions
Fixed drug reactions
Beçhets
Apthosis
Lichen planus
Pemphigus
Malignancy

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5
Q

Differentials for penile ulcer?

A

Syphilis
Herpes simplex
Lymphogranuloma venereum
Aphthous ulceration
Trauma

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6
Q

How can syphilis be diagnosed?

A

From lesions:
Dark ground microscopy
Treponemal PCR

In blood:
Treponemal enzyme immunoassay (EIA)
Treponema pallidum particle agglutination assay
(TPPA)
Rapid plasma reagin test (RPR)

Always perform full STI screen

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7
Q

What is Condyloma acuminata?

A

genital warts

epidermal manifestation of the papilloma virus
(HPV)

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8
Q

How should genital warts be investigated?

A

All female patients presenting with external genital warts should have a speculum exam

And colposcopy referral if internal warts (Similarly consider proctoscopy if anal warts and rectal bleeding)

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9
Q

Give some normal anatomical variants that could be mistaken for genital warts?

A

Fordyce spots
Pearly papules
Skin tags
Tyson’s glands
Vestibular papillosis
Haemangiokeratoma
Sebaceous cysts

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10
Q

What infective and malignant conditions can be mistaken for genital warts?

A

Conylomata Lata (syphilis)
VIN, PIN or squamous cell carcinomas
Molluscum contagiosum

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11
Q

How can genital warts be managed?

A

No treatment (may spontaneously resolve)
Destruction (cryoRx)
Anti-mitotic agents (Podophyllotoxin)
Immune modifiers (Imiquimod cream)
Surgery

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12
Q

Questions to ask somebody with genital warts/ lumps?

A

How long?
Other symptoms?
– Itch, bleed, rectal symptoms
Change in size, number, appearance?
Any treatment tried? Medical reviews?
Had before?

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13
Q

It is common for genital warts to appear for the first time in pregnancy. How should this be managed?

A

reassure that v low risk of vertical transmission, watch and wait

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14
Q

What is chronic pelvic pain?

A

Intermittent or constant pain
In the lower abdomen or pelvis
At least 6 months in duration
Not occurring exclusively with menstruation or intercourse and not associated with pregnancy.

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15
Q

how does chronic pelvic pain due to nerve entrapment present? mx?

A

A highly localised, sharp, stabbing or aching pain, exacerbated by particular movements and persisting beyond 5 weeks or occurring after a pain free interval

Treatment- Analgesia, Physiotherapy, Nerve modulation and Antidepressant

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16
Q

How does chronic pelvic pain due to MSK problems present? Tx?

A

May be:
Pain at joints in pelvis
Damage to the muscles in the abdominal wall or pelvic floor
Pelvic organ prolapse

Trigger points-localised areas of deep tenderness – chronic muscle contraction

Treatment- Analgesia, Physiotherapy, Nerve modulation and Antidepressant

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17
Q

What is the ROME III criteria for diganosis of IBS?

A

Continuous or recurrent abdominal pain or discomfort on at least 3 days a month in the last 3 months
Onset at least 6 months previously

Associated with at least two of the following:
Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in the form of stool.

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18
Q

How can you investigate chronic pelvic pain?

A

STI Screening
TV USS -identify and assess adnexal masses
TVUSS and MRI - useful tests to diagnose adenomyosis

Laparoscopy:
Now second line after therapeutic intervention
Not helpful for IBS, IC and adenomyosis diagnosis
Carries risk of death 1:10,000 and organ injury 2.4 : 1,000

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19
Q

Define oligomenorrhea

A

Infrequent periods
Cycle >35 days but less than 6 months in length

20
Q

What can cause oligomenorrhea?

A

‘Constitutional’

Anovulation:
PCOS
Thyroid disease
Prolactinoma
CAH

21
Q

Give some causes of primary amenorrhea

A

Delayed puberty
Imperforate hymen/transverse septum
Absent vagina
Mullerian agenesis
Gonadal dysgenesis (Turner)
PCOS (less common in primary)
CAH

22
Q

Give some causes of secondary amenorrhea

A

Pregnancy
PCOS
Premature menopause
Prolactinoma
Thyroid disease
Cushing’s
Eating disorder
Exercise induced
Asherman Syndrome
Sheehan Syndrome

23
Q

Differential diagnoses for PCOS?

A

Simple obesity
Premature ovarian failure
Thyroid disease
Hyperprolactinaemia
CAH
Androgen secreting tumours
Cushing’s syndrome

24
Q

Blood tests to do in PCOS?

A

Sex Hormone Binding Globulin (SHBG)
Total testosterone
Free androgen index (FAI)
FSH, LH
TFT
Prolactin

25
Mx of PCOS in woman who wants to conceive?
Reduce BMI to <30 Start Folic acid Baseline fertility assessment, including semen analysis on partner Refer to fertility services May require ovulation induction e.g. clomiphene citrate Metformin controversial
26
Mx of patient with PCOS who wants regular periods?
COCP Cyclical progestogens
27
Fetal movements are usually perceived from 18-20 weeks gestation and most women should be aware of them by 20/40, They are defined as any discrete kick, flutter, swish or roll. What can affect fetal movements?
Prior to 28/40 an anteriorly placed placenta may reduce the woman’s perception of fetal movements Sedating drugs which cross the placenta such as alcohol, benzodiazepines, methadone and other opioids can have a transient effect on fetal movements Normal or excessive fetal activity has been reported in anencaphalic fetuses. A lack of vigorous motion may relate to abnormalities of the CNS, muscular dysfunction or skeletal abnormalities Fetal position can have an effect – if the fetal spine lies anterior the woman may be less likely to perceive fetal movements
28
What is important to ask in a patient experiencing RFM?
assess the woman’s risk factors for stillbirth and fetal growth restriction What is normal for her baby and what are they like now? Reduced or completely absent? Diabetes, smoking, obesity, extremes of maternal age (<20 and >40), language barriers, SGA, recurrent episodes
29
What investigations can be done for RFM?
Assess viability: Sonicaide / Handheld doppler CTG monitoring Assessment of fetal growth – may be SFH or referral for growth scan BP and urine dip - raised BP/PET are known to increase the risk
30
What is USS helpful for in twin pregnancies?
Number of babies Chorionicity and No of placentae Dividing membrane – present / absent/ how thick Determining sex of each baby Best done at 11-14 weeks
31
What advice should be given to patients with multiple pregnancy?
Enhanced scan schedule/hospital visits pre-eclampsia sxs - e.g. epigastric pain, headache, swelling Sudden increase in abdominal girth or breathlessness - ? TTTS Symptoms of preterm labour By 28 weeks discuss a plan for labour, delivery in consultant led unit Discuss if any objections to blood transfusion
32
What is the risk of prematurity with twin pregnancy?
60%
33
What can cause one twin to die in utero? What should be done if one twin dies in utero?
Cause: Maybe due to – no reason / growth restriction / TTTS Hypo-perfusion/hypotension related injury Mx: Screen for fetal anaemia- DV/ MCA doppler Fetal brain MRI in 4 wks MDT decision whether to deliver
34
When should additional scans be offered in twin pregnancy?
Additional ultrasound scans are required in multiple pregnancy to monitor for fetal growth restriction, unequal growth and twin-twin transfusion syndrome: * 2 weekly scans from 16 weeks for monochorionic twins * 4 weekly scans from 20 weeks for dichorionic twins
35
How can twin pregnancies be delivered?
Monoamniotic twins: Elective caesarean section between 32 and 33+ 6 weeks. Diamniotic twins (aim to deliver between 37 and 37 + 6 weeks): * Vaginal delivery is possible when first baby has a cephalic presentation * Caesarean section may be required for the second baby after successful birth of the first baby * Elective caesarean is advised when the presenting twin is not cephalic presentation
36
Potential complications during labour for twin pregnancy?
Malpresentation Stuck twin / interlocked heads Cord prolapse Abruption Fetal hypoxia TTTS Operative delivery PPH PET
37
When should women with HMB be referred for hysteroscopy?
Red flag signs/symptoms/ Risk factors women taking tamoxifen women for whom treatment for HMB has been unsuccessful
38
When should women with HMB be referred for USS?
their uterus is palpable abdominally history or examination suggests a pelvic mass examination is inconclusive or difficult, for example in women who are obese
39
What is dysfunctional uterine bleeding?
primary menorrhagia Heavy menstrual bleeding with no recognisable pelvic pathology, pregnancy or general bleeding disorders.
40
What can be used in the short term for emergency control of menorrhagia?
Norethisterone: 5mg tds for up to 7 days. Can be used in a 3-weeks-on, 1-week-off pattern for 3-4 months to temporise, for example where patient is on waiting list for treatment. GnRH analogues: Monthly (or quarterly, depending on preparation) injection to downregulate the cycle and induce temporary ‘medical menopause’
41
Questions to ask a woman presenting with infertility?
Age Duration of fertility Type of infertility Menstrual cycle – ovulating? Tubal surgery/ PID Menorrhagia/dysmenorrhoea/pelvic pain Pelvic surgery
42
Examination features of a woman with infertility?
BMI Body hair distribution Galactorrhoea Secondary sexual characteristics Pelvic – structural abnormalities fixed or tender uterus
43
What might you see on laparoscopy for endometriosis ?
Active endometriosis – “powder-burn” spots, chocolate cysts Inactive endometriosis – “scars”
44
Advnatges of breastfeeding?
Promotes bonding Improves uterine involution ? Reduced risk of breast cancer Contraception Safe and cheap
45
Disadvantages of breastfeeding?
Nipple inversion: correct by Waller shields in late pregnancy Maternal fatigue Emotional stress

Y4 Reproductive Health (13 decks)

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