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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

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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
Outline the order of puberty / secondary sexual characteristics in females
1. Breast development 2. Pubic hair 3. Growth spurt 4. Menarche
26
Outline the order of puberty / secondary sexual characteristics in males
1. Testes enlargement 2. Pubic hair 3. Spermatogenesis 4. Growth spurt
27
Outline the meaning of menarche
First menstrual period
28
Outline the meaning of dysmenorrhoea
Painful periods
29
Outline the meaning of menorrhagia
Heavy periods, defined either by: - > 80ml loss of blood per cycle - Having an impact on the quality of life of the woman
30
Outline the meaning of oligomenorrhoea
Infrequent periods, defined by: > 35 days long (4-9 cycles per year)
31
Outline the red flags for endometrial cancer
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
Outline some red flag symptoms for ovarian cancer
- 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
Outline the meaning of breakthrough bleeding
Irregular bleeding that occurs associated with hormonal contraception
34
List some causes of post-coital bleeding
- Cervical ectropion - Cervical / endometrial polyps - Infection - Malignancy (vaginal or cervical) - Trauma/abuse - Vaginal atrophic change
35
List some causes of intermenstrual bleeding
- 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
List some investigations to consider for intermenstrual bleeding or post-coital bleeding
- 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
List some causes of menorrhagia (local and systemic pathology)
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
Outline the difference between primary and secondary dysmenorrhoea and when they start
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
When do you decide that following conditions are present? - Perimenopause - Menopause
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
Outline specific conditions where you might test FSH levels to diagnose menopause
- Aged < 40 (premature menopause - Aged 40-45 (early menopause) - Over 45 but with atypical symptoms Can be complicated in women using COCP!
41
Outline polyuria
- 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
Outline nocturia
- 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
Outline the 3 main categories of lower urinary tract symptoms and list some examples of symptoms from each category
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
Explain the difference between terminal dribble and post-micturition dribble
Terminal dribble: where the flow slows and reduces at the end of voiding Post-micturition dribble: involuntary loss of urine immediately after urination
45
List some common types of incontinence
Stress incontinence Urge incontinence (+/- OAB) Mixed incontinence OAB Also: Urogenital fistula Urethral diverticulum
46
Outline the aspects that are recorded in a frequency volume chart for bladder monitoring
Fluids: - Volume of fluid intake - Fluid type e.g. water or coffee Urination: - Volume of urination - Any urgency to urination - Any accidental leaks
47
Outline what flow-volume charts can detect
Increased frequency Polyuria (high amount) Nocturia Nocturnal polyuria
48
List some lower urinary tract symptoms in women
- 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
List some causes of urinary tract symptoms in women
- UTI - Menopause - Detrusor instability - Diabetes - Renal colic - Bladder cancer - Neurological conditions - Diuretics and other medications
50
Outline the management for stress incontinence
- 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
Outline the management for urge incontinence
- 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
Suggest how mixed urinary incontinence is managed
Managed according to the most prevalent type of incontinence - stress or urge
53
Outline red flag signs/symptoms for males presenting with LUTS
- 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
Outline some management options for males presenting with predominantly voiding LUTS (e.g. terminal dribbling, spraying, hesitancy)
- 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
Outline some management options for males presenting with predominantly overactive bladder LUTS
- 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
List some causes / risk factors of erectile dysfunction (local, systemic, psychological, medications)
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
List some medications that can result in erectile dysfunction (list by category)
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
Outline questions you might ask in the clinical assessment of erectile dysfunction
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
Outline the management options for erectile dysfunction
- 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
List some common causes of oligomenorrhoea
- 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
Outline some treatment options for women with menorrhagia
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
Outline initial investigations for patients presenting with urinary symptoms (voiding, storage, incontinence)
- Urine dipstick - Urine MC&S - Routine blood tests, including FBC and U&Es (consider PSA) - Abdominal examination - DRE examination - Vaginal examination
63
Outline management options for BPH
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
Outline some steps that can be taken if you suspect child safeguarding issues / abuse in general practice
- 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
By describing the mechanism of action of both GTN spray and Sildenafil, explain why it is important to stop sildenafil when starting GTN
- 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
Other than breast cancer, what 3 cancers is the BRCA1 gene mutation shown to increase the risk of?
BOP - Bowel - Ovarian - Prostate

Year 3 - GP (11 decks)

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