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GP Year 4 > Women Health > Flashcards

Women Health Flashcards

1
Q

What are the symptoms of urethral pathology

A 
Discharge (STI > UTI) 
Dysuria
Frequency 
Urgency
Tingling, burning
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2
Q

Pelvic pain in female - Murtagh model

A

Probability - primary dysmenorrhea, mittelschmerz, adhesions, internal ilial claudication
Must not miss - pregnancy (ectopic, abortion), PID/pelvic abscess, neoplasia, acute appendicitis
Pitfalls - endometriosis/adenomyosis, misplaced IUCD, referred pain, ovari torsion
Masquerades - depression, drugs, spinal dysfunction, UTI

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3
Q

Vaginal discharge - Murtagh model

A

Most common - physiological discharge, vaginitis (bacterial 40-50%, candidiasis 20-30%)
Must not miss - STI/PID, ectopic pregnancy, sexual abuse, neoplasa (cancers/fistulas), tampon toxic shock syndrome
Pitfalls - chemical vaginitis, retained foreign bodies, endometriosis (brown discharge)

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4
Q

Signs of child abuse

A

Low weight for age and/or failure to thrive and develop
untreated physical problems e.g. sores, serious nappy rash and urine scalds, significant dental decay
poor standards of hygiene i.e. child or young person consistently unwashed
poor complexion and hair texture
child not adequately supervised for their age
scavenging or stealing food and focus on basic survival
extended stays at school, public places, other homes
longs for or indiscriminately seeks adult affection
rocking, sucking, head-banging
poor school attendance

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5
Q

Signs of abused adult

A

Nervous, ashamed, abusive
Describe partner as controlling or prone to anger
Seem uncomfortable or anxious in presence of their partner
Be accompanied by their partner who does most of the talking
Provide unconvincing explanation for their injuries
Physical signs of violence
Delayed response in seeking attention

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6
Q

Criteria for diagnosis of PCOS

A

2 out of 3 of
(1) hyperandrogenism: acne, hirsuitism, high serum concentration of at least one androgen

(2) oligomenorrhea/amenorrhea
(3) polycystic ovaries on ultrasound

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7
Q

Causes of post-coital bleeding

A 
Cervicitis
Sexually transmitted ulcerations 
Cervical polyps
Cervical cancer 
Cervical ectropion (cervical erosion)
Endometritis/PID
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8
Q

management of acute menorrhagia

A

(first line) IV oestrogen then oral, oral high dose progesterone till bleeds stop then low dose for hte next 14 days

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9
Q

management of chronic menorrhagia

A

for anovulatory women: cyclical progesterones for 14 days, and then give with tranexmic acid
for ovulatory women: COCP and tranexmic acid OR prostaglandin inhibitor (mefanamic acid) OR hormonal IUD (mineria)

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10
Q

emergency menorrhagia treatment

A

norethisterone (oral) 5 - 10mg 2 hourly until bleeding stops then 10mg daily for 14 days

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11
Q

what are the age groups assoc. w/ dysfunctional uterine bleeding

A

two peaks at extreme of reproductive age 12 - 16 and 45 - 55 years old

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12
Q

differentiate between primary dysmenorrhea and secondary dysmenorrhea

A

age: adolescence vs mid to late 20s
duration: usually 2 - 3 days of period vs before and beyond 2 - 3 days of period
secondary can cause pain at other times of menstrual period
secondary is also associated with dyspareunia (with intercourse)

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13
Q

treatment for primary dysmenorhea

A

educate and reassure
preventive: warm water bottle, exercise, dietary changes, stress management, stop smoking, counselling possible
(first line) NSAIDS + COCP (if patient is requires contraception)

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14
Q

management of uterine fibroids

A

COCP
if patient is > 42 years old, can use GnRH analogues
surgical options: myomectomy, hysteroscopic resection, hysterectomy

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15
Q

treatment outline of PCOS

A
  1. weight loss (beneficial for both metabolic and reproductive symptoms of PCOS and also its cardiovascular implications )
  2. uterine protection w/ cyclical progestin or low dose OCP
  3. target symptoms:
    oligomenorrhea - COCP, cyclical progestins,
    hirsutism - COCP, if ineffective, add anti androgen to COCP - such as spironolactone, cyproterone acetate
    infertility - infertility therapy may be such as clomiphene, , gonadotrophins
    cardiometabolic risk - lifestyle change, metformin
    emotional issues - depression, eating disrorder, body image problems, psychosexual dysfunction
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16
Q

features of PCOS

A

metabolic symptoms: obesity, hirsutism, male pattern baldness, dyslipidemia
reproductive symptoms: irregular menstrual cycles, subfertility/fertility
psychological features: depression, eating disorder, psychosexual, anxiety

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17
Q

clinical features of uterine fibroids

A

dysmenorrhea
menorrhagia
pelvic discomfort +/- pain/pressure
bladder dysfunction

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18
Q

what are some risk factors for testicular cancer?

A

crytpoorchidism
phx and fhx of testicular cancer
infertility

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19
Q

what is the most common testicular cancer?

A

germ cell tumor which includes seminoma and non seminomatous cancer

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20
Q

compare between the prognosis of seminoma and non seminoma cancer (and explain)

A

seminoma - generally good prognosis, more sensitive to radiotherapy, chemotherapy
non seminoma - worse prognosis, more aggressive in particular a pure choriocarcinoma, that may be associated with early dissemination and metastatic disease

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21
Q

compare the spread between seminomas and non seminoma cancer?

A

seminoma: more localized disease at presentation, rarely spreads by bloodstream, indolent growth pattern w/ long natural history
non seminoma: more disseminated at presentation, usually spread through bloodstream, malignant fast growing pattern

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22
Q

compare treatment options for seminoma and non seminoma cancer (what it is sensitive to)

A

seminoma: sensitive to radiotherapy

non seminatmous: sensitive to chemotherapy, and resistant to radiotherapy

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23
Q

what are the associated tumor markers w/ testicular cancers

A

AFP (yolk sac testicular carcinoma)
B-hCG (embryonal testicular carcinoma and choriocarcinoma)
LDH (more for prognostic marker in advanced cancer)
pure seminoma cancers do not AFP, and only a 20% of them have b-hcg

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24
Q

describe the work up of suspected testicular cancer in a GP setting?

A

testicular U/S in 2 days
specialist referral and r/v in 2 weeks
further investigation on metastases of chest, abdo, pelvis CT scan w/ contrast (but not at the cost of specialist referral)

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25
Q

what is the usual first line treatment of a testicular cancer of any stage?

A

radical inguinal orchidectomy - that will determine histology and staging

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26
Q

what is the clinical features of testicular cancer?

A 
scrotal mass (nodular, hard, painless) 
dull ache, heaviness in the lower abdomen, perianal area, scrotum 
metastatic symptoms: 
neck mass
cough, SOB
LOA, n/v
lumbar back pain 
bone pain 
paraneoplastic symptoms: 
hcg production - gynecomastia, hyperthyroidism
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27
Q

what is the pathophysiology of BPH?

A

stromal cell hypertrophy in the transitional zone of the prostate

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28
Q

what zones and lobes are affected in BPH and prostate cancer?

A

BPH: transitional zone and middle lob

prostate CA: posterior lobe and peripheral zone

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29
Q

clinical features of BPH

A

obstructive symptoms: frequency, urgency, nocturia, urgency incontinence
voiding symptoms: weak stream, terminal dribbling, intermittent stream, straining, incomplete emptying, terminal driblling
post micturition: sensation of incomplete emptying, post micturition driblling

30
Q

risk factors for developing BPH

A 
age 
gender 
BB blocker use 
diabetes 
lack of physical exercise 
family history
31
Q

describe the different features of prostate on a DRE

A

prostatitis: warm, acutely tender prostate
BPH: smooth enlarged growth that is symmetrical
prostate cancer: firm, hard, nodular w/ induration prostate w/ loss of median sulcus

32
Q

what is the treatment of BPH

A

acute mx: foley catheter/suprapubic catheter, urine MCS
conservative mx: avoid fluids prior to going out, before going out, reduce consumption of mild diuretics (caffeine/alcohol), double voiding to empty bladder completely
medical mx: finesteride +/- tamsulosin
surgical mx: TURP

33
Q

what are some of the risks of TURP?

A

common: pain, bleed, anesthesia risk
retrograde ejaculation
erectile dysfunction
urethral strictures and urinary retention
urinary incontinence
TURP syndrome: systemic absorption of hypotonic irrigation fluid used to flush during TURP, causing hyponatremia that may lead to coma and seizure

34
Q

which regions of the prostate is involved in prostatic cancer? what tissue is involved?

A

peripheral zone and posterior lobe

tissue involved is glandular tissue (c.f stromal tissue in BPH)

35
Q

what is the clinical manifestation of prostate CA

A 
obstructive symptoms (FUN-WISE) 
storage symptoms: frequency, urgency, nocturia 
voiding symptoms: weak stream, intermittent voiding, straining, incomplete emptying 
metastatic symptoms: back pain
constitutional symptoms: weight loss, LOA, fatigue
36
Q

investigative work up for prostate CA

A

DRE (first line)
PSA + ALP (for bony mets)
TRUS + biopsy
staging: pelvic/abdo/chest CT + LN biopsy

37
Q

describe the histopathological slide of a prostatic CA slide

A

back to back glands w/ little to no intervening stroma between the glands.
enlarged round, hyperchromatic nuclei w/ a single prominent nucleolus

38
Q

male that has dysuria, fever and perineal pain

A

acute prostatitis

39
Q

male that has poor urine flow, straining to void, frequency

A

bladder outlet obstruction

40
Q

treatment of prostatitis

A

acute (mild): amox/clauv or tmp or norfloxacin
acute (serious): IV amp + gentamicin
chronic bacterial: TMP, ciprofloxacin
if C. Trachomatis, add doxycycline

41
Q

treatment of non bacterial chronic prostatitis

A

no indication for antibiotics

use NSAIDS, encourage voiding hygiene, avoid straining at end of micturition,

42
Q

what is the best indicator of puberty in adolescent boys

A

testicular volume of more than > 5ml

43
Q

what is the similarity and differences between PCOS and congenital adrenal hyperplasia?

A

similarity: hirsutism, irregular menstrual cycle, precocious puberty or failure of puberty to occur
differences: basal 17a-hydoxyprogesterone is raised in adrenal hyperplasia (dt to defective enzymes in the condition), compare to PCOS just raised androgens (free testosterone, androstenedione, or free androgen index), PCOS happen to happen at later ages while congenital adrenal hyperplasia tend to present quite young

44
Q

A 24-yr-old man complains of decreased libido, erectile dysfunction & galactorrhoea. The prolactin level is increased and MRI shows a 4mm pituitary tumour what is the treatment?

A

prolactinoma - usually considered a microadenoma, hence less often to cause mass effect (headache, visual impariment)
first line tx: bromocriptine (dopamine agonist) for about 3 years of treatment

45
Q

multiple shallow, painful, moist ulcers on the penis. tender inguinal lymphadenopathy. what is the treatment?

A

famciclovir

46
Q

what type of cancer does pap smears screen for?

A

squamous cell carcinoma of the cervix, not adenocarcinoma

47
Q

what is the mode of action when PAP smear shows LSIL?

A

repeat smear again in 12 months time and r/v

48
Q

scrotal lump differentials

A

epidydimis swelling: epidydimitis, spermatocele
testis swelling: testicular torsion, orchitis, testicular carcinoma, hydrocele
spermatic cord swelling: indirect inguinal hernia, varicolee, hydrocele
skin swelling: SCC, sebaceous cyst

49
Q

inguinal/groin lump differentials

A 
L SHAPE: 
lipoma/lymph nodes 
saphena varix/skin lesions (cyst) 
hernia 
aneurysmal dilation of femoral artery 
psoas abscess/bursa 
ectopic testis/undescended testis
50
Q

what are the features of premenstrual syndrome?

A

happens 2 - 14 days before menstruation and stops before menstruation

symptoms experienced can be:

(psychological) depression, irritability, tiredness, headache, aggression, violence, feeling out of control, decreased libido, tense
(physical) bloatedness, breast tenderness, weight gain

51
Q

what are the diagnosis of pre menstrual syndrome?

A

no clinical diagnosis - menstrual symptoms have to start up to 2 weeks before and stop upon period starting

52
Q

what are some risk factors for pre menstrual syndrome?

A

predisposing risk factors: existing mental illness, alcoholism, sexual abuse, family history of PMS, stress

precipitating risk factors: tubal ligation, recent cessation of COCP, hysterectomy

sustaining risk factors: diet containing caffeine, alcohol, sugar, smoking, stress, sedentary lifestyle

53
Q

what is the peak incidence of PMS?

A

30 - 40 years old

54
Q

what is the management of PMS?

A

mild: non pharmacological management - CBT, mood diary, exercise, diet, relaxation + pyridoxine (vitamin B6)
moderate: SSRI (fluoxetine or sertraline) given 14 days before anticipated onset of menstruation through to the first day of menstruation

55
Q

what are some lifestyle modifications for PMS?

A

CBT
mood diary
SNAP - smoking cessation, dietary changes, alcohol abstinence, increasing physical activities
relaxation techniques

56
Q

what are the risk factors for primary dysmenorrhea?

A 
young age menarche 
long duration of menses 
smoking
obesity 
alcohol consumption 
high levels of stress 
anxiety/depression 
disruption of social networks
57
Q

what is the pathophysiology of primary dysmenorrhea?

A

elevated endometrial production of prostaglandin F2 alpha –> causing uterine contractions, hypercontractility, and increased uterine muscle tone leading to pain
the prostaglandin excess also result in n/v, diarrhoea

58
Q

describe the pain features of primary dysmenorrhea

A

lower abdominal pain that radiate around to the back or to the thighs
may present as dull dragging, or a severe cramping pain
pain is usually maximum at the beginning
pain begins with the onset of mensus, lasts 24 hours, but may be able to persist 2 - 3 days
can be accompanied by: n/v, diarrhoea

59
Q

what is the first line pharamcological treatment for primary dysmenorrhea/

A

NSAIDS

(second line) COCP - unless contraception is required

60
Q

what are some non pharmacological treatment for primary dysmenorrhea?

A

preventive: SNAP modifications, relaxation techqniues, avoid exposure to extreme cold, place hot water bottle over painful area and curl knees into chest

61
Q

what is the diagnostic criterion for primary dysmenorrhea?

A

diagnosis can be made clinically - developed in ovulatory adolescents and normal pelvic examination

62
Q 
state the difference between primary and secondary dysmenorrhea; 
age of onset 
duration 
pain at other times of menstrual cycle
other association with pain
A

primary start at around adolescence, while secondary start at mid - late 20s
primary usually lasts first 2 - 3 days, while secondary persists throughout period and beyond
secondary dysmenorrhea may have pain during other periods of menstrual period
secondary dysmenorrhea can be associated with dyspareunia (pain w/ intercourse)

63
Q

what are some causes of secondary dysmenorrhea?

A

gynecological causes: endometriosis, adenomyosis, fibroids, ovarian cysts, intrauterine or pelvic adhesions, chronic pelvic inflammatory disease, cervical stenosis, use of an IUD, pelvic congestion syndorme

non gynecological: IBD, IBS, uteropelvic junction obstruction, psychogenic disorders

64
Q

what are the risk factors for cervical cancer?

A 
age > 55 
multiple partner
multiparity 
lower SES 
early first intercourse, early first pregnancy
65
Q

what are the two strains of HPV most assoc with cervical CA

A

HPV 16 and 18

66
Q

what are type of cervical cancers and which are the most common?

A

squamous (70%)
adenocarcinoma (20%)
mixed and others

67
Q

where does neoplastic transformation most commonly occur in the cervix?

A

most commonly in the transformation zone

68
Q

what is the victorian cervical cancer immunization plan?

A

gardasil (hpv 16, 18, 6, 11) for all year 7 boy and girls

69
Q

what are the pap smear recommendation for asymptomatic women

A

performed every 2 year, starting at 18 - 20, or 1 - 2 years after sexual intercourse
ceased at 70 if 2 normal smears in the past 5 years

70
Q

if pap smear comes back with a low grade lesion, what is the next management step?

A

repeat pap smear in 12 months:
if nil, repeat again in 12 months if nil again, return to 2 yearly screening
if low grade or high grade lesion presnet, go for colposcopy

GP Year 4 (14 decks)

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