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SCA MRCGP > SCA online - Gender, reproductive, sex, womens > Flashcards

SCA online - Gender, reproductive, sex, womens Flashcards

1
Q

Baldness differentials

A

Male pattern baldness (androgenic alopecia)
Telogen effluvium - sudden loss, triggered by stress
Trichotillomania - intentional pulling, psych
Alopecia areata - patchy loss, inflammatory cause

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2
Q

Male pattern baldness (androgenic alopecia) Mx

A

Do nothing - this is natural.

Non drug - wigs, cosmetic camouflage, extensions

drug - scalp foam

Private - finasteride, scalp solutions, hair transplant

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3
Q

Contraception in menopause

A

1st - COCP
- Contraindications: DVT/ breast ca/ liver disease/ migraine with aura/ smokers
- stop at 50yo

2nd - POP
- stop at 55yo

2nd - Depot
- CI: osteoporosis
- stop at 50yo

2nd - Implant
- stop at 55

2nd - Mirena coil
- last 10 years if inserted after 45yo

3rd - sterilisation

All progesterone-only preparations are adequate with HRT

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4
Q

Gender dysphoria

A

Main priority is patients mental and physical wellbeing. Therefore the safest option is referral to gender specialist. As a GP, I can not prescribe hormone treatment, but can support you through out this process.

Ask about mental and physical health
be empathetic in consultation
Refer CAMHs if long waiting times for gender clinic
Offer family therapy, child psychology, counselling for both child and parents

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5
Q

Erectile dysfunction

A

Common condition
Mx - 1st Viagra/ Cailis
2nd refer to urology for vacuum pumps, penile injections, surgery
Manage other causes diabetes, cholesterol, HTN. Exercise and healthy diet, stop smoking, reduce alcohol

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6
Q

Genital herpes

A

common viral STI. Need to go to GUM clinic for viral swabs for confirmation.
Can aquire the infection many years ago or may have spread from elsewhere eg fingers, mouth
there is no cure, but symptoms improve with time
Mx - PO aciclovir, avoid sex until lesion have healed, screen for other STI with self vaginal swab or urine sample - but aim to send to GUm clinic

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7
Q

Causes of gynaecomastia

A

Physiological - puberty, old aging

Pathological - hypogonadism, hyperthyroid, pituitary tumour, testicular tumour, liver disease, ckd, cancers

Pharmacological - spironolactone, finasteride, SSRI, digoxin, metronidazole, anabolic steroids, alcohol

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8
Q

Gynaecomastia Ix

A

Bloods - LFTs, UE, TFT hormones, tumour markers (afp, hcg)

USS breast if lumps felt

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9
Q

Hyperemesis gravidarum

A

A more severe morning sickness during pregnancy - vomiting, unable to keep food/ fluids down

Mx - rest, eat and drink what you can, medications (cyclizine, promethazine) - if resistant to treatment for antenatal clinic

Admission if unwell - unable to take fluids, immunocompromised, dehydration, poor mental health

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10
Q

Hypertension in pregnancy (<20/40)

A

Mx
restriction of dietary salt
if on ACEi/ ARB - stop and switch
if thiazide - stop and seek referral
Stop anti hypertensives if BP <110/70
Safe anti hypertensives include labetalol, Nifedipine
Give aspirin 75mg OD until 12/40
Urine protein:creatinine ratio >30 = significant proteinuria

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11
Q

Providing care for travelling communities

A

Ask patient if wanting to be registered as permanent (use GP address) or temporary.
Stay registered with own GP even if moving out of area (just be aware can not do home visits if out of area)
Can use telephone calls for appointments rather than letters

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12
Q

Infertility counselling

A

> 80% couples get pregnant within 1 year
90% couples get pregnant within 2 years

25% have no cause. common causes include ovulation problems, fallopian tube problems, pelvic conditions (PID, endomet), male issues

Key Qs - prev pregnancies, how long have been trying and last contraception, menstrual history, DDx PCOS, diabetes, thyroid; lifestyle, sexual health Hx

Male Key Qs - prev children, sexual hx, diabetes/ thyroid, steroids

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13
Q

Infertility Mx

A

regular intercourse 2-3 times per week
take folic acid 400mcg OD
lifestyle - reduce stress, stop smoking and alcohol, health weight

Refer is trying for >1 year (or >35yo, known issues eg chemotherapy)

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14
Q

Intermenstrual bleeding Ix

A

1st - Pregnancy test, STI screen (vaginal swabs), speculum exam (cervical polyps, ca, ectropion), hormone contraceptives can expect up to 6 months of break through bleeding

2nd - if bleeding >3 months and above all clear
pelvic USS (fibroids, polyps)
refer for hysteroscopy, endometrial biopsy

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15
Q

Latex allergy

A

your immune system reacts to proteins within the rubber latex

latex can be found in condoms, balloons, gloves, rubber bands

Ix - skin prick testing through derm/ immunology

Mx - avoidance, MedicAlert band (highlight allergy), if anaphylactic then needs Epipen

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16
Q

Erectile dysfunction Ix

A

Bloods - testosterone, FSH, LH, HCG, prolactin, HBA1C, TFT, LFT.
Obs - weight

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17
Q

Menopause + HRT

A

Menopause - is the last period. Perimenopause is the period leading up to this point. As women get older, the hormone oestrogen reduces leading to symptoms such as mood swings, hot flushes, changes in periods.

Risk factors for HRT - Breast ca, undiagnosed vaginal bleeding, VTE, Recent MI, Liver disease, current pregnancy, clotting disorder

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18
Q

Effects of HRT

A

VTE - reduce risk with transdermal preparations

CHD - no risk or protective against CHD

Stroke - increased risk above 60yo

Dementia - protective factor

Breast ca - combined is associated with increased risk

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19
Q

HRT Mx

A

If perimenopausal (still having periods) = for cyclical HRT

If has uterus = Combined. Progesterone to protect the uterus lining.

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20
Q

Testosterone in HRT

A

Indications - Low libido after other alternative have been used
Currently, GP should consult specialist before prescribing - eg needs to go to menopause clinic

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21
Q

Contraception in HRT

A

if under 50yo/ perimenopause - need contraception.

POP - can be used to combined HRT. POP is given daily. Despite sequential or continuous HRT

COCP - only under 50yo due to risks. not advised.

IUS Mirena coil - both contraception and endometrial protection in HRT. effective for 5 years.

Progesterone depot/ implant - good for contraception, not for endometrial protection

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22
Q

HRT bleeding

A

expected in first 6 months of starting or changing HRT.

If ongoing past 6 months may need further Ix such as USS or even biopsy - via gynaecologists

Need to examine for other causes of PVB - pelvic exam, STI screen

If bleeding started within 6 months of starting HRT and continues past 6 months, then change HRT. If still bleeding, then stop HRT if possible. if not possible or restarting HRT and bleeding then for pelvic USS>

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23
Q

HRT and Breast cancer

A

Increased risk if on HRT for >5 years or older than 60yo.

Other risk factors - Obesity(BMI >29)

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24
Q

Menorrhagia

A

causes - fibroids, endometriosis, other

Mx
1st - IUS Mirena coil
2nd - Tranexamic acid/ COCP/ cyclical POP
3rd - refer

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25
Q

HPV

A

Common virus, passed through skin to skin contact, often sexual activity. The majority do not cause any problems and go away on their own. Some, can cause changes to the cells of the cervix.

HPV Positive means the virus is present

Dyskaryosis mean changes to the cells of the cervix

This does not mean cancer, but if not monitored, could become cancer later on.

Is it an STI? Technically yes, but it is extremely common and often harmless.

Remember, HPV is extremely common, it is nothing to be ashamed of and does not reflect on anyone’s character or behaviour.

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26
Q

HPV screening

A

ANY Dyskaryosis (or abnormal cytology) = needs colposcopy
- a special microscope to look at the cells of the cervix, done by a specialist

HPV +ve = repeat in 12 months
HPV +ve again = repeat in 12 months
HPV +ve again (3rd in 2 years) = colposcopy

HPV inadequate result = repeat in 3 months

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27
Q

Needle-Stick injury

A

If <72 hours - go to A&E for post exposure prophylaxis

If >72 hours - come to GP
- explain risk of infection is low
tetanus vaccine

28
Q

Post Menstrual Bleeding risk factors for endometrial Ca

A

Oestrogen only HRT
early menarche/ late menopause
Infertility
Tamoxifen
PCOS
Obesity
Diabetes

29
Q

Post menopausal bleeding causes

A

Most serious - Endometrial Ca, cervical ca, vulval ca

Most Common - vaginal atrophy, endometrial hyperplasia, polyps

30
Q

Post menopausal bleeding Ix

A

if >55 + period free for >12 months = 2WW

if <55 or = consider 2WW - urgent USS first

31
Q

Pre-clampsia

A

A condition that only happens during pregnancy, results in high blood pressure and protein leaking from the kidneys into the urine
Symptoms include headache, tummy pain and swelling

HTN (BP >140/90)
Proteinuria (>1+)
After 20/40 gestation

32
Q

Risk factors for pre eclampsia and Mx

A

If 2 or more risk factors = start Aspirin 75mg OD

first pregnancy
>10yr since last pregnancy
>40yo
BMI >35
previous pre eclampsia
FHx first degree relative pre eclampsia
pre existing - diabetes/ renal disease/ HTN/ antiphospholipid antibodies

33
Q

Premature ejactulation

A

achievement of orgasm very soon after penetration or even before. This is extremely common and the vast majority of causes are harmless.

Causes:
Anxiety
Medication
Drugs (cocaine, amphetamine)
Chronic prostatitis
MS/ peripheral neuropathy
Erectile dysfunction

34
Q

Premature ejaculation Mx

A
  • Self help
    masturbating 1-2 hours before sex
    thick condom, local anaesthetic condom
    taking breaks during sex
  • Couples/ sexual therapy
  • Medication (for anxiety)
    Sertraline however be aware these can also cause erectile dysfunction.
    Dapoxetine - license for premature ejaculations
35
Q

Severe PMS/ PMDD

A

Severe form of pre menstrual syndrome causing significant emotional and physical symptoms impacting daily life

Must:
Begins before menstruation
improves after menstruation

Symptoms:
Labile mood
irritability
feelings of hopelessness
anxiety

36
Q

PMDD Mx

A

Medication
- SSRI
- COCP (Yasmin)

Non pharmacological
- CBT, DBT
- regular exercise, healthy diet, management of stress

CAMHS if under 18

37
Q

PSA request

A

Prostate gland sits around the neck of the bladder. It can grow, compressing the urine tube, causing problems passing urine.

The prostate grows with age and this is normal

As with all tests, nothing is 100% accurate. A raised PSA can be due to cancer, but also harmless causes. Likewise a normal PSA, can not fully exclude cancer.

Therefore, a blood test (PSA) and examination are helpful to determine the probability of prostate cancer

If either are raised then for urology review

PSA reference points
40-49 >2.5
50-59 >3.5
60-69 >4.5
70-79 > 6.5

38
Q

Recurrent UTI (in older women)

A

Very common in post menopausal women - due to lack of oestrogen

Mx
Treat UTI and urine MCS
self initiate Abx if feeling symptoms arise or prophylactic abx
Urology if indicated
Topical oestrogen
Self care

39
Q

UTI Self care

A

Adequate hydration >1.5L/ day
Avoid douching (cleaning the inside of the vagina)
Wipe front to back
Post-coital urination
Post coital hygiene
Offer follow up after tried all above

40
Q

Serotonin syndrome

A

Excess serotonin (a naturally formed chemical within our body) - leading to headaches, confusion, fast heart rate, high blood pressure, dilated pupils, muscle stiffness. In severe cases can lead to fevers and seizures.

Caused by medications increasing serotonin levels
- Eg SSRI, Gabapentin, Tramadol

Must be addressed immediately
- mild = stop contributing medication - needs close monitoring and regular follow up
- mod to severe = hospital admission

41
Q

Chlamydia (STI) counselling

A

Ensure confidentiality
if safeguarding issues - ensure that this is not because anyone is in trouble, but that it is my job to keep you safe
Needs treatment and follow up a few months later to check is cured
Encourage safe sex - condom
Contraception
Check having consensual sex

42
Q

Teenage sex laws and safeguarding

A

Sex under 13yo is illegal - needs referral to child protection or police

Legal age of consent is 16 - however if both are under this age and same level of maturity, it is unlikely to prosecute.

43
Q

Ovarian cancer risk factors

A

Women (any women, particularly over 50 or >12 months ) +
bloating (IBS symptoms)
loss appetite
pelvic/ abdo pain
increased urinary frequency
weight loss
malaise

44
Q

Suspected ovarian ca Ix

A

Abdo and pelvic exam
2WW gynae - if ascites or mass found
Ca 125
if positive for USS
if USS positive for gynae 2WW

45
Q

Termination of pregnancy

A

“I understand that this is a personal and difficult decision to make.”

Full gynae Hx, confirm pregnancy, consensual sex, sex work

Termination can be carried up to 24 weeks gestation

Mx/
Self refer to specialist clinic
- medical or surgical management

46
Q

Testosterone replacement for men

A

Treat/ refer for treatment if Total Testosterone levels <12 and symptomatic

symptoms:
Low mood, ED, low energy

Mx
refer if necessary
treat other aspects eg low mood = counselling, SSRI; ED = sildenafil; improve diet and exercise, sleep, manage stress, reduce smoke/ alcohol/ drugs

47
Q

Urinary incontinence

A

Two types
- Urge - need to go urgently, often unable to get to toilet in time
- stress - coughs, sneezes, leaks
- Mixed - combination of both

Ix/
abdominal and pelvic examination
urine dip - infection

48
Q

Urge incontinence Mx

A

1st
- bladder training (physio, apps)
- lifestyle - reduce alcohol, caffiene, reduce fluids in evening

2nd - relax the bladder muscle, therefore less contractions
Oxybutynin, tolterodine
Mirabegron

3rd
Urology
BoTox to bladder

49
Q

Stress incontinence Mx

A

1st
- Pelvic floor exercise
- Lifestyle changes

2nd
- Duloxetine - increased urethral sphincter tone

3rd
- urology refer

50
Q

Vasectomy counselling

A

Form of birth control for men that cuts the vas deferens (which is the tube that connects sperm from the testicles to the penis)

Extremely but not 100% effective. Failure rate of 1/2000 men.

Can be reversible (not on NHS) but should be considered irreversible

Main side effect - long term testicular pain

51
Q

Autism Spectrum disorder (ASD)

A

Broad term referring to children’s challenges with communication and social situations.

Qs
- Social - how does the child play with others
- Communication - any delay in speech development
Imaginative - Do they have strong attachment to certain toys, do they struggle with imaginative play

Useful to get collateral Hx from parents, nursery/ school

Can be more difficult to see in girls - often shy, fewer friends, not into fashion

52
Q

Autism Mx

A

ICE - what do you think is going on? what do you know about autism? How would you feel if this is confirmed autism?

Majority of children with autism go to mainstream school and can cope with a little bit extra help in school

Local support groups
Speech and language groups
Behavioural specialists

Refer Community peads

53
Q

Stimming in Autism

A

Self stimulatory behaviour - repetitive movements, noises or actions to help manage stress
- very normal process of ASD, usually harmless - but scratching or head banging - may need further assessment to keep person safe

Differentials include - Tics, Tourettes, Myoclonus

54
Q

Carer breakdown

A

Normally irritable, low mood, low energy, high stress

TATT case really

Red flags - weight loss, fevers, bruising, weakness/ paraesthesia

DDx
- Infectious - HIV, Tb, viral
- Endocrine - thyroid, cushings, diabetes, anaemia
- psych - depression
- Chronic fatigue
- Heart failure, COPD
- Malignancy

Ix/
Examination, Bloods, Urinalysis, ECG

Review safeguarding for cared person!! eg carer using excessive mood stabilisers because patient is agitated.

Mx/
adult safeguarding group - if necessary
support groups
respite care
social services
Follow up

55
Q

Cold sore

A

small painful blister, usually on lips, due to common virus HSV. usually last 7-10 days. Very common, usually harmless, is contagious.

Mx/
If unwell/ immunocompromised/ dehydrated - hospital admission
Generally - fluids, analgesia, rest. Can still go to school
Check safeguarding - who spends time with child

56
Q

Constipation in children

A

Very common

Qs - diet, fluid intake, PEG feeding, medications (+side effects), activity levels, psychological factors, is this recurrent

Red flags - vomiting, abdo pain, blood in stool, urinary retention

57
Q

Constipation in children Mx

A

Lifestyle- address underlying causes - diet, fluid, movement

Laxatives
- movicol/ laxido

Follow up

Referral to paeds if necessary

58
Q

Domestic abuse/ violence

A

This can take many forms - physical, sexual, financial, psychological - this is a way of controlling somebody and is a crime

Red flags
- any children involved?

Qs
- support from friends or family (safe place to go)
- patients mental health

Ensure confidentiality - but may need to involve other if safeguarding issues

Refer
- Independent Domestic violence Advisors (IDVA) service
- Domestic abuse helplines, charities, support groups (national domestic abuse helpline)

Arrange follow up regular

59
Q

Downs screening

A

Genetic problems, an extra copy of chromosome 21 in the cells of the body. Often people with Downs syndrome have learning disability, the extent can range. Most children with downs live happy and fulfilled lives.

Risk by age
20yo = 1:1500
30yo = 1:800
40yo = 1:100

Screening
- Combined test at 11-14/40 - Blood (bHCG, PAPP-A) and USS (nuchal translucency)
- If late, then Quad test at 20/40

Diagnostic test
- Chorionic villus sampling (sample from placenta)
- Amniocentesis (sample from amniotic fluid)
Both are invasive and carry small risk of miscarriage

60
Q

Female genital mutilation

A

Procedure of deliberate injury to female genitals. Common procedure in certain cultures, ages infancy to 15. This is illegal in UK and is form of child abuse.
Cause long term problems with sex, childbirth and mental health - there are no benefits to FGM

Refer
Police non urgent - 101
Support groups
Child safeguarding
NSPCC
NHS gynae or FGM specialist

61
Q

Forced Marriage

A

Qs
- Mood (mental health)
- Physical health
- Safety at home
- Support network
- Coping mechanisms
- Finances

Refer - Forced Marriage Unit (FMU), speak to local support groups

62
Q

Substance abuse during pregnancy

A

Ensure confidentiality and safety for mother

Substance Hx - what, how (needles?), how much
Obstetric Hx - pregnancy so far - further tests, HIV, Hep
Psychosocial - own mental health, social support networks, ?safeguarding

Mx/
be non judgemental
specialist services - substance misuse services, antenatal care
mental health support - MDT approach
encourage folic acid
Buprenorphine/ Methadone - if on heroin
Screen bloods - HIV, Hep, syphillis
Stop smoking
regular follow ups

63
Q

Fragility hip fracture

A

Signs and symptoms will be less pronounced than a traumatic hip fracture. Fragility fracture due to frailty (osteoporosis)

Symptoms:
pain in groin/ hip - radiate to knee/ lower back

Examination:
Bruising/ swelling, reduced ROM, short externally rotated leg, tenderness

Risk factors - Medications
Corticosteroids, PPIs, SSRI, Depo contraception, Pioglitazone, Letrozole/ Anastrozole

64
Q

PTSD

A

Anxiety disorder caused by distressing events.

Features include - Flashbacks/ Nightmares, feelings of isolation, guilt, irritability. Difficulty sleeping/ concentrating. If severe, can impact daily life.

Mx
high risk of suicide - same day crisis review
Address any mental, physical and social concerns - F2F review
Refer to psychiatry - therapy and medications - eye movement desensitization and reprocessing therapy, trauma-focused CBT
Specific support for veterans
Support groups

65
Q

Safeguarding

A

Any concerns - see vulnerable person/ child F2F

“this could involve social services, but I want to reassure you that their (and our) primary goal is to ensure the child’s safety and well being. They are not there to separate families unnecessarily but to support families in creating safe environments for children”

Full Hx
- describe any injuries or events
- who has access to child
- who is to be trusted

66
Q
A

SCA MRCGP (27 decks)

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