Women's and men's health

Question 1

Red flags of menstrual irreg

Answer 1

• Cervical cancer = post coital/inter menstrual bleeding, abnormal cervix exam
• Ascites/pelvic/abdo mass

Question 2

What is the management of primary amenorrhoea?

Answer 2

• Refer if no secondary sexual characteristics and amenorrhoea by 15
• Advise weight gain, reducing exercise and consider stress strategies eg. CBT if relevant to cause of amenorrhoea

Question 3

What is the management of secondary amenorrhoea?

Answer 3

• Manage the cause eg. PCOS, hypothyroidism

Question 4

What is the management of primary amenorrhoea?

Answer 4

• Refer if no secondary sexual characteristics and amenorrhoea by 15

Question 5

What is the management of secondary amenorrhoea?

Answer 5

• Manage the cause eg. PCOS, hypothyroidism
• Advise weight gain, reducing exercise and consider stress strategies eg. CBT if relevant to cause of amenorrhoea
• If amenorrhoea for 12 months consider OP prophylaxis eg. HRT or bisphosphonates

Question 6

What is the management of dysmenorrhoea?

Answer 6

• NSAIDs - ibuprofen, naproxen, mefenamic acid
• Consider 3-6 month trial of COCP
• Non drug measures - heat packs, TENS
• If don’t respond/severe sx refer

Question 7

What is the management of menorrhagia?

Answer 7

• IUS eg. mirena - first line
• Tranexamic acid/NSAIDs if decline IUS
• COCP can help lighten periods and make them less painful
• Surgical methods eg. endometrial ablation

Question 8

What is the management of menopause?

Answer 8

• Lifestyle mods for hot flushes, avoiding triggers
• w uterus = combined HRT (O+P) no uterus = O only, no risks of endometrial cancer as no uterus
• Mood disorders and vasomotor sx - oral/transdermal HRT
• Urogenital sx - low dose vaginal O1st line, can use lubricants

Question 9

What are the voiding LUTS?

Answer 9

• Slow stream
• Splitting
• Intermittent stream
• Hesitancy
• Straining
• Terminal dribble

Question 10

What are the storage LUTS?

Answer 10

• Urgency
• Frequency
• Nocturia
• Urinary incontinence
• Need to wee again after passing urine

Question 11

Urge vs stress incontinence

Answer 11

Urge - urine leak as feel sudden intense urge to wee/soon after feeling
Stress - urine leak when bladder under increased pressure eg. sneeze, laugh

Question 12

Red flags urinary sx

Answer 12

• Haematuria
• Blockage/pain/urge - stones
• Retention - BPH/prostate cancer
• Erectile dysfunc

Question 13

What is the management of urge incontinence?

Answer 13

• Treat causes of overactive bladder syndrome
• Bladder training eg. continence nurse/physio
• Oxybutynin - anticholinergic - can take 4 weeks to work and causes dry mouth and constipation
• Intravaginal O if vaginal atrophy/post menopausal
• Desmopressin for nocturia

Question 14

What is the management of stress incontinence?

Answer 14

• Lifestyle - reduce caffeine intake, weight loss, stop smoking
• Pelvic floor training
• Can refer to secondary care for mesh slings and urethral bulking agents

Question 15

What is the management of BPH?

Answer 15

• Milking urethra
• Acute urinary retention - hospital, if recurrent = a blocker eg. tamulosin
• Intermitten catheterisation or long term indwelling catheter for retention
• 5a reductase inhibitor - finasteride

Question 16

What are the causes of erectile dysfunction?

Answer 16

• T2DM
• Atherosclerosis
• HTN
• CKD
• SE of medication
• Psychological causes

Question 17

What is the treatment of erectile dysfunction?

Answer 17

• Sildenafil = viagra, PDE-5 inhibitor
• Lose weight, stop smoking, reduce alc consumption, increase exercise
• Cycle >3 hours a week = stop cycling lol