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Year 3- Primary Care Tutorial Notes > Women’s and Men’s Health > Flashcards

Women’s and Men’s Health Flashcards

1
Q

List 3 key aspects of Breakthrough Bleeding

Irregular bleeding on hormonal contraception

A
  • Common when new contraceptive is started, often settles without treatment
  • More common with Progestogen-only methods.
  • Greater risk in smokers
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2
Q

List causes of PCB (No specific cause in 50%)

A
  • Infection
  • Cervical Ectropion (especially if taking COCP)
  • Cervical/ Endometrial Polyps
  • Vaginal/ Cervical Cancer
  • Trauma/ Sexual abuse
  • Vaginal atrophic change
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3
Q

List investigations for Menorrhagia

A
  • FBC (Anaemia), TFTs, Clotting screen
  • Hysteroscopy/ USS if suspected Fibroids, Polyps, Endometrial pathology
  • Vaginal/ Cervical Swab
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4
Q

Outline 1st and 2nd line Menorrhagia treatment

A

1: IUS/ Hormonal (COCP)/ Hormonal (NSAIDs, Tranexamic Acid- can take 4mths to work)

2: Uterine artery embolisation, Surgery:
- Hysterectomy
- Endometrial ablation (Full lining, Increased ectopic risk, Lining grows back)

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5
Q

When would you consider treating Menorrhagia without examination?

(Unless treatment is IUS, always needs examination)

A

Menorrhagia history without other symptoms

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6
Q

When would you consider treating Menorrhagia without investigating cause?

A

Low risk of Fibroids, Adenomyosis, Uterine Cavity/Histological abnormality

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7
Q

When do you refer someone with Menorrhagia

A
  • Symptoms of cancer
  • Iron deficiency anaemia
  • Complications (such as compressive symptoms from Fibroids)
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8
Q

List Investigations for Dysmenorrhea

A

USS, Pregnancy test, Vaginal/ Cervical swabs

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9
Q

Outline Primary treatment of Dysmenorrhea

Secondary: Treat underlying cause or Refer

A
  • NSAID or Paracetamol/ 3-6mth trial of Hormonal contraceptive/ Combination of both
  • Local application of heat or Transcutaneous Electrical Nerve Stimulation (TENS)
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10
Q

List Investigations for Amenorrhoea

Treatment: treat underlying cause

A
  • TFTs, PRL, FSH+LH, Total testosterone and Sex-hormone binding globulin
  • Pregnancy test, Pelvic USS
  • Karyotyping, MRI/ CT, Hysteroscopy
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11
Q

List 3 scenarios where you would consider asking bloods to diagnose Menopause

A
  • Women> 45 with Atypical symptoms
  • Women 40-45 with Menopausal symptoms
  • Women< 45 in whom Premature Menopause is suspected
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12
Q

List causes of incontinence other than Stress, Mixed, Urgency

A
  • Overflow incontinence
  • Urogenital fistula
  • Urethral Diverticulum
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13
Q

When do you refer a woman with incontinence for bladder cancer?

A
  • ≥ 60 with non-visible haematuria + Dysuria/ Raised WCC
  • ≥45 with unexplained visible haematuria without UTI
  • ≥45 with persistent/ recurrent visible haematuria after successful UTI treatment
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14
Q

Outline General Management of Incontinence in Women

A
  • Absorbent containment products/ toileting aids
  • Manage RFs (Age, Parity, Obesity, Constipation, Smoking, FHx, Drugs, Menopause)
  • Less caffeine
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15
Q

Outline Urgency Incontinence management in women

A
  • Bladder training for 6/+wks. Add Antimuscarinic if symptoms continue.
  • Review after 4wks
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16
Q

Name 3 Antimuscarinics used in Urgency Incontinence (may take 4wks to work)

A
  • Oxybutinin
  • Tolterodine
  • Darifenacin
17
Q

Name 3 Antimuscarinics that can’t be used in Urgency Incontinence

A

Flavoxate, Propantheline, Imipramine

18
Q

Outline the follow-up when treating Urgency incontinence in women with Antimuscarinics

A
  • Review after 4wks. Consider referral, dose adjustment/ alternate drug then review in another 4wks
  • If treatment effective, review every 12mths (6mths if >75)
19
Q

When treating Urgency Incontinence in women, when do you consider Desmopressin and Intravaginal Oestrogen

A

Desmopressin: If Nocturia (unless 65y/o with CVD/ HyperT)

Intravaginal Oestrogen: If Post-menopausal + Vaginal Atrophy

20
Q

How is Stress and Mixed Incontinence managed in Women?

A

1st line: Pelvic floor muscle training
2nd line: Referral or Duloxetine if not surgery

Manage according to most predominant type of incontinence

21
Q

How do you assess LUTS in Men

A
  • History (Storage/ Voiding/ Post-micturition symptoms)
  • Exam (Ab dissension, Suprapubic dullness, Genitalia, DRE)
  • IPSS (3/+ day urinary frequency-volume chart)
22
Q

How are Voiding Symptoms managed in men?

Non-pharmacologically

A
  • Manage cause (Drugs, BPH, Cancer, Diabetes etc)
  • Active surveillance (Reassurance, Lifestyle advice)

Conservative treatment;

  • Pelvic floor muscle + Bladder training
  • Avoid constipation, Excessive limit of fluid intake, Caffeine, Fizzy drinks
  • Containment products (Pads, Catheters, Waterproof pants)
23
Q

How are Voiding Symptoms managed in men?

Pharmacologically, including Reviews

A

Moderate-Severe/ IPSS of 8;

  • Alpha-blocker
  • Review at 4-6wks, then every 6-12mths

Enlarged Prostate + High Progression risk;

  • 5-Alpha-reductase inhibitor
  • Review at 3-6mths, then every 6-12mths

Storage + Voiding symptoms after alone Alpha blocker treatment;

  • Add 1st line Antimuscarinic
  • Review every 3-6wks until stable, then every 6-12mths
24
Q

What advice do you give to pt with Overactive Bladder?

A

Fluid Intake, Constipation, Healthy lifestyle, Caffeine, Fizzy drinks, Containment products

25
Q

How do you treat a pt with Overactive Bladder?

Pharmacologically, 1st+2nd lines

A

1: Antimuscarinic;
- Oxybutinin, Tolterodine, Darifenacin
- Review every 4-6wks then every 6-12mths

2: If Antimuscarinic Contra-I/ not tolerated or effective;
- Mirabegron
- Review at 4-6wks

26
Q

When would you suspect an Organic cause of ED

A
  • Slow onset of symptoms
  • Normal libido
  • Risk factor presence
27
Q

When would you suspect a Psychological cause of ED

A
  • Sudden onset
  • Less libido
  • Good spontaneous/ self-induced erections
  • Major life events
  • Relationship problems/ changes
28
Q

Outline Examination of a pt with ED

A
  • General (BP, HR, BMI, Circumference)
  • Genitalia (Pre/ malignant lesions, Hypogonadism signs, Deformities)
  • Gynecomastia and Reduced body hair, to assess degree of Androgenisation
  • DRE if: 50/over, Prostate cancer history, Enlarged prostate signs
29
Q

What lifestyle advice would you give to manage someone with ED?

A
  • Weight loss, Smoke, Alcohol, Exercise
  • Don’t take unlicensed herbal remedies
  • If cycling >3hrs a week, try not cycling to see improvement
30
Q

What is the pharmacological management of a pt with ED?

Which drugs can be used? Which is most effective?

What advice do you give about their effectiveness to patients?

(Admit to hospital if PRIAPISM)

A

If no Contra-I, PDE-5 Inhibitor REGARDLESS of cause

  • Sildenafil (Viagra), Tadalifil (Cialis), Vardenafil (Levitra), Avanafil (Spedra) are equally effective
  • Drugs don’t initiate erection
31
Q

When do you refer a pt with ED to Urology

Endocrinology if Hypogonadism
(Cardiology if CVD makes sex unsafe)
(MH services if Psychogenic cause)

A
  • History of trauma

- Young men who always had difficulty obtaining/ maintaining erection

32
Q

When on Fe tablets, body replenishes lost Fe before symptoms improve.

How long can this take

A

5-6mths

33
Q

When giving Alpha blockers for LUTS in men, what do we warn pts about, regarding the 1st dose?

A

1st dose Hypotension is common, so advise to take before sleeping

34
Q

Can you get pregnant on HRT?

A

Yes, as lower hormone dose than COCP

35
Q

What is Cyclical HRT?

A

14 days Oestrogen, 14 days Progesterone

36
Q

When can you switch from Cyclical to Continuous HRT

A

After 12mths of Amenorrhea

37
Q

When is it advised to stop HRT?

A

After 2yrs

38
Q

How long does the risk of breast cancer stay after COCP/HRT treatment?

A

For upto 10yrs after stopping treatment

Year 3- Primary Care Tutorial Notes (15 decks)

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