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Year 3 - GP > Week 7 - Paediatrics (B) and Men & Women's health > Flashcards

Week 7 - Paediatrics (B) and Men & Women's health Flashcards

1
Q

Outline the range of days for a complete menstrual cycle that is considered normal

A

21-35 days

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2
Q

Outline the difference between central precocious puberty and peripheral precocious puberty

A

Central precocious puberty is due to increased GnRH production

Peripheral precocious puberty is due to increased oestrogen or testosterone production (normal GnRH levels)

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3
Q

List a few causes of central precocious puberty

A
  • Idiopathic or constitutional
  • Obesity related (levels of leptin)
  • CNS lesions
  • Gonadotropin-secreting tumours
  • Systemic conditions e.g. neurofibromatosis
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4
Q

List a few causes of peripheral precocious puberty

A
  • Ovarian cysts
  • Congenital adrenal hyperplasia
  • Primary hypothyroidism
  • Obesity related (compensatory hyperinsulin-aemia)
  • Tumours e.g. ovarian, adrenocortical, leydig-cell
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5
Q

List some causes of delayed onset puberty

A
  • Constitutional delay (most commonly)
  • Malnutrition or chronic disease e.g. IBD
  • Hypogonadism
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6
Q

Outline the definition of primary amenorrhoea

A

Absence of menarche either by the age of:
14 if there is the absence of secondary sexual characteristics
16 if there is the presence of secondary sexual characteristics

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7
Q

Outline the definition of secondary amenorrhoea

A

Cessation of periods for:
6 months if periods previous regular
12 months if periods previous irregular

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8
Q

List some causes of primary amenorrhoea

A

Anatomical:
- Imperforate hymen
- Vaginal septum (vertical or horizontal)
- No vagina
- No uterus

Genetic:
- Turner’s syndrome (XO)
- Complete androgen insufficiency syndrome (XY)
- GnRH deficiency

Other:
- Constitutional delay
- Pregnancy!
- Hypothalamic failure e.g. malnutrition or weight loss

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9
Q

List some causes of secondary amenorrhoea

A

Anatomical:
- Cervical stenosis
- Asherman syndrome (intrauterine adhesions)
- Early menopause
- PCOS (main reason)

Endocrine:
- Thyroid disease (both hyper and hypo)
- Pituitary disorders e.g. prolactinoma, pituitary necrosis, drugs affecting pituitary gland
- Functional hypothalamic amenorrhoea (weight loss or excessive exercise)

PLUS physiological:
- Pregnancy!! Or lactational amenorrhoea
- Menopause!!
- Contraception

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10
Q

Outline causes of abnormal intrauterine bleeding (PALM-COEIN)

A

Structural:
- Polyps
- Adenomyosis
- Leiofibroma (fibroids)
- Malignancy / hyperplasia

Non-structural:
- Coagulopathy
- Ovulatory dysfunction (includes thyroid)
- Endometrial issues
- Iatrogenic
- Not yet classified

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11
Q

State the definition of menopause and what it’s caused by

A

Menopause is the absence of periods for 12 months, in the absence of any other biological or physiological cause

Cause:
- Failure of follicle development and oestrogen production

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12
Q

Outline the age of which menopause is considered early menopause

A

Under age of 45

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13
Q

Outline the age of which menopause is considered premature menopause (also called premature ovarian failure)

A

Under age of 40

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14
Q

Outline the age range of which menopause normally happens

A

Between ages of 45 and 55 (average 50 years)

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15
Q

State the 4 menopausal stages

A
  1. Pre-menopausal - slightly changes to FSH/LH levels
  2. Peri-menopausal
  3. Menopausal - ovulation actually stops
  4. Post-menopausal
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16
Q

Outline what happens during the pre-menopause period, with regards to FSH / LH levels, oestrogen levels and fertility

A
  • Less oestrogen secreted
  • FSH / LH levels may rise (due to less oestrogen)
  • Reduced fertility, but periods remain similar
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17
Q

Outline what happens during the peri-menopause period

A

Transition phase
- Follicular phase shortens
- Ovulation early / absent

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18
Q

Outline what happens during the menopause period

A

Permanent cessation of menstruation - lack of ovulation and follicular development failure

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19
Q

Outline what is meant by the post-menopause period

A

Period of time after 12 consecutive months of no periods

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20
Q

What hormone do you measure to confirm the menopause

A

FSH - rises (not oestrogen as that is decreasing)

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21
Q

List some physiological symptoms of the menopause

A
  • Hot flushes / sweating
  • Sleep changes / tiredness
  • Itching
  • Restless limbs
  • Mood changes
  • Forgetfulness
  • Vaginal dryness
  • Urinary incontinence (increased risk UTIs)
  • Constipation and bloating

Appearance:
- Hair thinning
- Thin / fine skin
- Increased weight
- Voice deepening (thickening vocal cords)
- Breast changes
- Sparse pubic hair and reduced fat of labia

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22
Q

List some long term consequences of low oestrogen (post-menopausal)

A
  • Osteoporosis
  • Increased cardiovascular risk
  • Alzheimer’s disease
    Reduced quality of life
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23
Q

List the different methods of administration of HRT and an advantage and disadvantage for each

A

Oral
+ cheap and effective
- higher doses required

Patch/transdermally
+ reduces risk of VTE
- more expensive / skin reactions

Vaginal
+ minimal systemic absorption
- only treats vaginal symptoms

Mirena coil
+ provides progesterone aspect
- still need oestrogen aspect

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24
Q

State some conservative and non-hormonal pharmacological measures for women with menopause symptoms

A

Conservative:
- Wear loose/light clothing
- Regular exercise
- Weight loss
- Reduce stress
- Sleep hygiene measures
- CBT
- Vaginal lubricants / moisturisers

Non-hormonal:
- Clonidine (lowers BP and reduces hot flushes)
- Gabapentin
- SSRIs e.g. Fluoxetine

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25
Q

Outline the order of puberty / secondary sexual characteristics in females

A
  1. Breast development
  2. Pubic hair
  3. Growth spurt
  4. Menarche
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26
Q

Outline the order of puberty / secondary sexual characteristics in males

A
  1. Testes enlargement
  2. Pubic hair
  3. Spermatogenesis
  4. Growth spurt
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27
Q

Outline the meaning of menarche

A

First menstrual period

28
Q

Outline the meaning of dysmenorrhoea

A

Painful periods

29
Q

Outline the meaning of menorrhagia

A

Heavy periods, defined either by:
- > 80ml loss of blood per cycle
- Having an impact on the quality of life of the woman

30
Q

Outline the meaning of oligomenorrhoea

A

Infrequent periods, defined by: > 35 days long (4-9 cycles per year)

31
Q

Outline the red flags for endometrial cancer

A

Visible haematuria AND hyperglycaemia (older than 55)
Visible haematuria AND Low haemoglobin (older than 55)
Unexplained vaginal discharge (older than 55)
Post-menopausal bleeding, more than 12 months after menopause

32
Q

Outline some red flag symptoms for ovarian cancer

A
  • Abdominal distension (> 12 times per month)
  • Abdominal or pelvic pain (> 12 times per month)
  • Appetite loss or early satiety
  • Abdominal mass or ascites (not fibroids)
  • Change in bowel habit / IBS symptoms within last 12 months (older than 50)
  • Urinary urgency or frequency
  • Unexplained weight loss
  • Fatigue
33
Q

Outline the meaning of breakthrough bleeding

A

Irregular bleeding that occurs associated with hormonal contraception

34
Q

List some causes of post-coital bleeding

A
  • Cervical ectropion
  • Cervical / endometrial polyps
  • Infection
  • Malignancy (vaginal or cervical)
  • Trauma/abuse
  • Vaginal atrophic change
35
Q

List some causes of intermenstrual bleeding

A
  • Pregnancy including ectopic
  • In association with ovulation

Vaginal:
- Adenosis (glandular epithelium in vagina)

Cervical:
- Infection
- Cancer
- Cervical polyps
- Cervical ectropion

Uterine:
- Polyps
- Fibroids
- Cancer
- Adenomyosis
- Endometriosis

Oestrogen secreting ovarian cancers

Other:
- Tamoxifen
- Smear or cervix treatment
- Missed COCP/POP
- Coagulant-interfering drugs

36
Q

List some investigations to consider for intermenstrual bleeding or post-coital bleeding

A
  • Pregnancy test
  • Infection screen
  • Cervical smear only if overdue
  • Blood tests: FBC, clotting profile, TFT, FSH/LH
  • Transvaginal ultrasound
  • May need hysteroscopy +/- endometrial biopsy
37
Q

List some causes of menorrhagia (local and systemic pathology)

A

Local pathology:
- Endometriosis
- Adenomyosis
- Cancer of the ovary, uterus, cervix, or endometrium
- Endometrial fibroids
- Endometrial polyps
- PCOS
- PID
- Intrauterine contraception / COCP / POP

Systemic:
- Coagulation disorders e.g. Von Willebrand disease
- Hypothyroidism
- Diabetes
- Hyperprolactinaemia
- Liver or renal disease
- Medications e.g. anticoagulants

38
Q

Outline the difference between primary and secondary dysmenorrhoea and when they start

A

Primary dysmenorrhoea:
- Occurs in the absence of any identifiable underlying pelvic pathology
- Caused by the production of uterine prostaglandins during menstruation, which causes uterine contractions and pain
- Usually starts 6–12 months after the menarche, once cycles are regular

Secondary dysmenorrhoea:
- Caused by an underlying pelvic pathology e.g. endometriosis, fibroids, or pelvic inflammatory disease [PID] or by intrauterine device (IUD) insertion
- Starts after several years of painless periods
- Pain is not consistently related to menstruation alone +/- other gynaecological symptoms

39
Q

When do you decide that following conditions are present?
- Perimenopause
- Menopause

A

Generally clinical diagnoses based on age and symptoms

Perimenopause:
- If the woman has vasomotor symptoms and irregular periods.

Menopause:
- If the woman has not had a period for at least 12 months (and is not using hormonal contraception)

40
Q

Outline specific conditions where you might test FSH levels to diagnose menopause

A
  • Aged < 40 (premature menopause
  • Aged 40-45 (early menopause)
  • Over 45 but with atypical symptoms
    Can be complicated in women using COCP!
41
Q

Outline polyuria

A
  • Passage of large volumes of urine with an increase in urinary frequency
  • Daily urine output of more than three litres

However it is different to increased urinary frequency, which is a much more common presenting complaint

42
Q

Outline nocturia

A
  • The need to wake and pass urine at night

It is different to enuresis, where urine is passed unintentionally during sleep (wetting the bed)

43
Q

Outline the 3 main categories of lower urinary tract symptoms and list some examples of symptoms from each category

A

Voiding/obstructive symptoms:
- Terminal dribbling
- Spraying
- Hesitancy
- Poor / intermittent stream
- Straining to wee
- Prolonged micturition

Storage symptoms:
- Increased frequency
- Nocturia
- Urgency / urge incontinence
- Bedwetting (chronic urinary retention)

Post-micturition symptoms:
- Post-micturition dribble
- Feeling of incomplete bladder emptying

44
Q

Explain the difference between terminal dribble and post-micturition dribble

A

Terminal dribble: where the flow slows and reduces at the end of voiding

Post-micturition dribble: involuntary loss of urine immediately after urination

45
Q

List some common types of incontinence

A

Stress incontinence
Urge incontinence (+/- OAB)
Mixed incontinence
OAB

Also:
Urogenital fistula
Urethral diverticulum

46
Q

Outline the aspects that are recorded in a frequency volume chart for bladder monitoring

A

Fluids:
- Volume of fluid intake
- Fluid type e.g. water or coffee

Urination:
- Volume of urination
- Any urgency to urination
- Any accidental leaks

47
Q

Outline what flow-volume charts can detect

A

Increased frequency
Polyuria (high amount)
Nocturia
Nocturnal polyuria

48
Q

List some lower urinary tract symptoms in women

A
  • Dysuria
  • Abdominal pain / suprapubic pain
  • Increased urinary frequency
  • Nocturia
  • Urinary urgency
  • Incontinence
  • Slow stream
  • Difficult initiating urinary
  • Feeling of incomplete bladder emptying
  • Dribble of urine once finished
  • Haematuria
49
Q

List some causes of urinary tract symptoms in women

A
  • UTI
  • Menopause
  • Detrusor instability
  • Diabetes
  • Renal colic
  • Bladder cancer
  • Neurological conditions
  • Diuretics and other medications
50
Q

Outline the management for stress incontinence

A
  • Lifestyle advice e.g. reducing caffeine intake, weight loss, fluid intake etc.
  • Pelvic floor training (trial of at least 3 months)
  • Bladder diary

Consider referral - offer slings and Duloxetine

51
Q

Outline the management for urge incontinence

A
  • Lifestyle advice e.g. reducing caffeine intake, weight loss, fluid intake etc.
  • Bladder training (at least 6 weeks)
  • Consider Oxybutynin (antimuscarinic)
  • Mirabegron as an alternative

Consider referral - botulinum toxin injection into bladder wall, percutaneous sacral nerve stimulation, augmentation cystoplasty, and urinary diversion

52
Q

Suggest how mixed urinary incontinence is managed

A

Managed according to the most prevalent type of incontinence - stress or urge

53
Q

Outline red flag signs/symptoms for males presenting with LUTS

A
  • DRE revealing hard /craggy prostate
  • Unexplained haematuria
  • Weight loss
  • Lower back pain
  • Bone pain
  • Any symptoms of cauda equina / neurological symptoms
  • Feeling generally unwell
  • Fever
  • Loin pain
54
Q

Outline some management options for males presenting with predominantly voiding LUTS (e.g. terminal dribbling, spraying, hesitancy)

A
  • Lifestyle measures e.g. avoiding constipation, smoking cessation, limit caffeine intake
  • Pelvic floor or bladder training
  • Alpha blocker e.g. Tamsulosin
  • If enlarged prostate 5 alpha reductase inhibitor e.g. Finasteride

Consider referral - TURP or long-term urethral catheterisation

55
Q

Outline some management options for males presenting with predominantly overactive bladder LUTS

A
  • Lifestyle measures e.g. avoiding constipation, smoking cessation, limit caffeine intake
  • Don’t reduce fluid intake to avoid symptoms
  • Supervised bladder training
  • Oxybutynin (antimuscarinic)
56
Q

List some causes / risk factors of erectile dysfunction (local, systemic, psychological, medications)

A

Local:
- Acute reduced blood supply
- Malignancy e.g. penile or prostate
- Congenital curvature
- Hypospadias / epispadias
- Phimosis

Systemic diseases:
Cardiovascular diseases e.g. Diabetes, HTN, metabolic syndrome, smoking
- Neurological conditions e.g. MS, Parkinson’s disease, spinal cord trauma
- Endocrine e.g. Diabetes, hypogonadism, hyperprolactinaemia, Cushing’s disease
- CKD
- Chronic liver disease

Psychological:
- Generalised libido issues
- Depression / anxiety
- PTSD

Medications:
- Prescription medications (see next card)
- Recreational drugs e.g. alcohol, smoking, heroin, cocaine, cannabis
- Anabolic steroids

57
Q

List some medications that can result in erectile dysfunction

A

BP/CVS drugs:
- Antihypertensives e.g. beta blockers
- Diuretics e.g. Spironolactone

Psychological drugs:
- Opiates e.g. Morphine
- Antidepressants e.g. SSRIs
- Antipsychotics / antiepileptics e.g. Haloperidol or Carbamazepine
- Hormones e.g. anti-androgens

Other drugs:
- Anticholinergics e.g. Duloxetine
- Histamine antagonists e.g. Ranitidine

58
Q

Outline questions you might ask in the clinical assessment of erectile dysfunction

A

Psychosexual:
- Sexual orientation / relationships
- Other sexual dysfunction symptoms
- Libido
- Contributing events e.g. recent parents, abuse, sexual trauma
- Mental state e.g. depression or anxiety

Medical history:
- Diabetes / HTN / CVS disease / HF / peripheral arterial disease / stroke
- Surgery on abdomen / pelvis?
- Revascularisation procedures previously

Other symptoms:
- LUTS
- Fatigue

Other:
- Smoking
- Alcohol
- Recreational drugs

59
Q

Outline the management options for erectile dysfunction

A
  • Address any underlying cause e.g. review medications
  • Optimise management of any modifiable risk factors e.g. HTN, diabetes
  • Modify any lifestyle factors e.g. limit alcohol intake, smoking cessation

Medical:
- Prescribe Sildenafil (PDE-5 inhibitor), irrespective of underlying cause

Consider referral to urology specialist if above treatment is ineffective

60
Q

List some common causes of oligomenorrhoea

A
  • PCOS (main)
  • Diabetes
  • Hyperthyroidism
  • Pelvic inflammatory disease (PID)
  • Eating disorders / anorexia / malnutrition / weight loss
  • Premature menopause / early menopause
  • Medications e.g. COCP / POP / antipsychotics / antiepileptics

Hormonal:
- Testosterone secreting tumours from ovaries or adrenal glands
- Cushing’s syndrome
- Prolactinoma
- Congenital adrenal hyperplasia (CAH)

61
Q

Outline some treatment options for women with menorrhagia

A

Medical:
- Progesterone intrauterine device
- COCP / POP
- Tranexamic acid
- NSAIDs

Physical pathology - referral to secondary care e.g. fibroids or polyps:
- Second-generation endometrial ablation
- Hysterectomy

62
Q

Outline initial investigations for patients presenting with urinary symptoms (voiding, storage, incontinence)

A
  • Urine dipstick
  • Urine MC&S
  • Routine blood tests, including FBC and U&Es (consider PSA)
  • Abdominal examination
  • DRE examination
  • Vaginal examination
63
Q

Outline management options for BPH

A

After DRE examination

Conservative:
- Reduce caffeine
- Moderate fluid intake, not late at night
- Symptom diary
- Medication review
- Watch and wait approach

Medical:
- Alpha blocker e.g. Tamsulosin
- Alpha 5 reductase inhibitors e.g. Finasteride

Surgical:
- TURP

64
Q

Outline some steps that can be taken if you suspect child safeguarding issues / abuse in general practice

A
  • Talk to safeguarding lead at the practice (named GP or nurse)
  • Can seek advice at any time from the NSPCC helpline
  • Refer to local authority children’s social care
  • Police if the child is in immediate danger
65
Q

By describing the mechanism of action of both GTN spray and Sildenafil, explain why it is important to stop sildenafil when starting GTN

A
  • Sildenafil is a phosphodiesterase inhibitor, allowing cGMP to remain around for longer
  • GTN causes vasodilation of peripheral arteries and veins, leading to reduced preload and afterload
  • Both of these drugs cause vasodilation therefore there is a risk of significant hypotension which could be fatal
66
Q

Other than breast cancer, what 3 cancers is the BRCA1 gene mutation shown to increase the risk of?

A

BOP

  • Bowel
  • Ovarian
  • Prostate

Year 3 - GP (11 decks)

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