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Exams :) > Women's Health > Flashcards

Women's Health Flashcards

1
Q

When to stop contraception for women >50 y.o:
1) Mirena, Implanon, POP
2) Copper IUD/barrier contraception
3) Depot injection
4) COCP/vaginal ring

A

1) Amenorrhoeic for >12 mths - check 2x FSH levels, 6 weeks apart. If both >30 then only required for another 12 mths OR continue until age >55 y.o
2) Stop after amenorrhoeic for >12 mths
3) Not recommended >50, change to non-hormonal method until 24 mths amenorrhoea OR alternative POP method
4) Not recommended >50, change to non-hormonal method until 12 mths amenorrhoea OR switch to Mirena/implnanon/POP

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2
Q

Pregnancy - folic acid dose if low risk
High risk factors (4) & dose

A

0.4-0.5mg daily 1/12 before pregnancy –> 3/12 post-partum
5mg dose if
-BMI >30
-On anti-convulsant med
-Pre-pregnancy diabetes
-PHx/FHx of neural tube defect

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3
Q

Cervical Co-test indications (3)

A

Persistent/vaginal bleeding (post-coital, intermenstrual, post-menopausal)
Unusual unexplained discharge - bloodstained
Deep persistent dyspareunia (if accompanied by bleeding)

  • HPV test ONLY indications:
    ○ Other vaginal discharge - not bloodstained
    ○ Deep dyspareunia in absence of other symptoms
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4
Q

?Diagnosis/infection

  • > 80% of people with any sexual activity have been exposed to it
    ○ Common viral infection. Types detected on CST not a/w genital warts
    ○ Generally cleared by immune system within 12-24 months, no Rx required
    ○ Can persist in 10% of people - risk of high-grade changes
    ○ No need to test partners
A

HPV

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5
Q

Vaginitis DDx (8)

A

-Vulvovaginal candidiasis
-Bacterial vaginosis
-Herpes simplex
-Irritant dermatitis
-Localiesd provoked vestibulodynia (most common type of vulvodynia)
-Atrophic vaginitis
-Psoriasis
-Lichen planus

Thrush very uncommon in post-menopausal women

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6
Q

Vulvovaginal candidiasis Rx dose examples (4)

A

-Clotrimazole 1% cream 1 applicatorful nocte for 6 nights
-Clotrimazole 2% cream 1 applicatorful nocte for 3 nights
-Clotrimazole 100mg pessary intravaginally nocte for 6 nights
-Fluconazole 150mg stat

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7
Q

Lichen sclerosis complications (2)
Management

A

-Transformation into vulval SCC
-Anatomical distortion of vuvla –> labia minora fusion, stenosis of introitus

-Potent corticosteroind (dip 0.0% OV) BD until itch resolves, then daily until skin normalises
-ongoing maintenance steroids lifelone

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8
Q

Intermenstrual bleeding DDx (11)

A

-Pregnancy
-Mid-cycle bleeding w/ ovulation
-Hormonal (around menarche/perimenopause)
-HRT after menopause
-Contracetpion (COCP, Depot, IUD)
-Infections
-Polyps
-Fibroids
-Endometrial hyperplasia
-Endometriosis
-Malignancy

PALM COEIN = polyps, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, Endometrial, iatrogenic, not classified

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9
Q

General indications for a co-test (5)

A

-Unexplained intermenstrual bleeding
-Post-coital bleeding
-Post-menopausal bleeding
-Unexplained persistent unusual vaginal discharge
-Follow-up of previous high grade changes/post-LLETZ (test of cure)

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10
Q

Management aspects post-sexual assault (7)

A

-Assess safety and serious injuries
-Offer forensic medical examination at sexual assault service
-Give emergency contraception if needed
-Refer to sexual assault support service/1800 RESPECT
-Discuss STI screening baseline (chla/gono, consider trich)
-Discuss pregnancy test in 3 weeks
-Mental health risk

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10
Q

Sexual assault recommendations per timeline:
-72-120 hrs (3)
-4 weeks (1)
-6 weeks (1)
-12 weeks (1)

A

-72-120 hrs: assess immediate safety/wellbeing, emergency contraception. baseline STI testing
-4 weeks - pregnancy test
-6 weeks - HIV blood test
-12 weeks - repeat HIV, syphilis, Hep B blood tests

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10
Q

Vulval lichen sclerosis non-pharm Rx (4)

A

-Vulval examination every 12 mths to monitor for vulval carcinoma
-Regular use of topical emollients
-Avoid use soap for cleansers
-Avoid tight clothing

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11
Q

Recurrent pregnancy loss DDx (7)

A

-Uterine fibroids
-Septate uterus
-Antiphospholipid syndrome (thrombophilias)
-T2DM
-Hypothyroidism
-Chromosomal abnormality
-Unexplained/idiopathic (up to 50%)

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12
Q

Deceased foetal movements - examination features (4)
-Management (1)

A

-Abdo palpation for uterine tone, foetal lie/presentation
-Symphyseal fundal hieght
-Maternal obs
-Doppler for foetal HR

-CTG within 2 hours (urgent referral to maternity unit), consider USS within 24 hours

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13
Q

Mastitis management aspects (8)

A

-Continue breastfeeding
-Fluclox/diclox 500mg QID for 5-10 days
-Feed from affected side first
-Paracetamol/pain relief
-Massage affected area
-Cold packs
-Check positioning/latching technique, lactation consultant
-Review 1-2 days

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14
Q

Management aspects to increase breastmilk supply (6)

A

-Ensure skin-to-skin contact & good attachment
-Frequent feeds, 2-3 hrly
-Express after breastfeeds for stimulation/drainage
-Compress/massage during feeding or expressing
-Switch feed - offer each breast twice
-Domperidone 10mg TDS

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15
Q

Post-menopausal bleeding - when to refer to gynae (3)

A

-Endometrial thickness >4mm
-Endometrial thickness <4mm but persistent bleeding or risk factors
-Women on tamoxifen

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16
Q

Vaginal bleeding in post-menopausal women
Risk factors for malignancy (7)

A

-Hx. of or PCOS a/wchronic anovulation
-Exposure to unopposed oestrogen
-Tamoxifen use
-Strong FHx of endometrial/colon ca
-Nulliparity
-Obesity
-Endometrial thickness >8mm

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17
Q

Other causes of raised CA-125 (8)

A

-Endometrial cancer
-Functional ovarian cyst
-Fibroids/adenomyosis/endometriosis
-Hepatitis/cirrhosis/liver cancer
-Pelvic inflammatory disease
-Bowel cancer
-SLE
-Other malignancies - pancreatic, breast etc.

If raised, repeat 4-6 weeks after initial test

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18
Q

Ovarian cancer examination findings (4)

A

-Adnexal/ovarian mass on bimanual exam
-Palpable liver mass/hepatomegaly
-Asciteis or shifting dullness
-Inguinal/cervical lymphadenopathy

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19
Q

Secondary amenorrhoea DDx (8)

A

-Pregnancy
-PCOS
-Primary ovarian insufficiency
-Pituitary tumour - hyperprolactinaemia
-Functional amenorrhoea
-Intrauterine adhesions
-Congenital adrenalhyperpasia, Thyroid disease
-Medications

Ix - pregnancy test, TSH, prolactin, LH/FSH, ultrasound

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20
Q

Progesterone only pill commencement - counselling (5)

A

-Strict time adherence - same time every day
-Need back-up contraceptive for at least 2 days if >3 hrs late
-Same with vomiting/severe diarrhoea within 3 hrs of taking
-Unscheduled intermenstrual bleeding
-Takes 3 days to start working

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21
Q

Menorrhagia treatment options

A

-Mefenamic acid 500mg TDS/other NSAIDs, just before period –> up to 5 days
-Tranexamic acid 1g TDS first 3-5 days of cycle
-Levonorgestral 52mg IUD
-COCP
-Norethisterone 5mg daily for same 12 days of cycle

Norethisterone dose 5mg TDS for 10/7 to stop acute heavy bleeding

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22
Q

Unsatisfactory sample on HPV or LBC test - next step

A

Return in 6-12 weeks for repeat HPV or LBC test (respectively)

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23
Q

Screening (cervical) intervals for below populations:
-Total hysterectomy for benign reason
-Hysterectomy for HSIL
-Subtotal hysterectomy (cervix present)

A

-Total hysterectomy for benign reason
–No screening needed
-Hysterectomy for HSIL
–Annual co-test until 2 negative results
-Subtotal hysterectomy (cervix present)
–Screening as usual

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24
Q

Age for imaging cutoff for mammography PLUS uss (breast cancer)

A

35 y.o

25
Q

Benign breast symptom/no breast lump/hormonal change - review timeframe

Benign nipple discharge w/ normal clinical exam - recommendation/review timeframe

A

Review 6-8 weeks (immediately after period). If persisting problem –> imaging

-Advise cease expression
-Get imaging
-Review in 2-3 months

26
Q

Combined hormonal contraception MEC 3/4 criteria (10)

A

-0-6 weeks post-partum if breastfeeding (0-3 weeks PP if not BFeeding)
-Age >35 + smoking
-HTN w/ sBP >160
-IHD, stroke history, VTE history or current
-AF/complicated valvular disease or cardiomyopathy
-Major surgery w/ prolonged immobilisaton
-Migraine w/ aura
-Current/PHx of Breast Ca
-FHx of VTE in 1st-degree relative <45 y.o
-BMI >35

27
Q

Implanon MEC 3/4 criteria (4)

A

-Current/PHx of breast Ca
-Unexplained vaginal bleeding, suspicious for serious condition (before evaluation)
-Severe liver cirrhosis
-IHD/stroke or TIA developing during use (for continuation)

28
Q

Mirena/Copper IUD MEC 3/4 criteria (5)

A

Current PID/chlamydia/gonorrhoea (for insertion)
Postpartum 48 hours-4 weeks (either insert immediately OR wait 4 weeks)
IHD/stroke or TIA developing during use (for continuation) (Mirena)
Unexplained vaginal bleeding, suspicious for serious condition (before evaluation)
Endometrial/Breast Ca hx or current

29
Q

(complications)

Gestational Diabetes risks to mum (4), risks to neonate (4)

A

-Pre-eclampsia
-Early delivery
-Induction of labour
-C-section

-Macrosomia
-Hypoglycaemia
-Shoulder dystocia
-Resp distress

30
Q

Risk factors for developing gestational diabetes (7)

A

-Previous hyperglycaemia in preg
-Age >40 y.o
-FHx of diabetes
-PCOS
-BMI >30
-Previous macrosomia
-Medications - steroids/antipsychotics

31
Q

Gestation diabetes treatments (2), post-partum monitoring

A
  1. Insulin - start 4-8 units daily, usually 1st choice
  2. Metofmrin - no evidence of harm to mum/foetus

OGTT from6 weeks to 3 months post-partum
?Annual HbA1c

32
Q

Pre-conception checklist:
* Diet
○ Supplements - folic acid
○ Iodine
○ Vit D
○ Calcium
○ Vit B12

A

○ Supplements - folic acid
§ 5mg for high risk (BMI>30, previous NTD, anticonvulsant med, GDM) - at least 4 weeks prior –> first 12 weeks gestation
§ 500mcg all other women, same duration
§ Prevents risk NTD + congenital heart disease
○ Iodine
§ 150mcg daily whilst pregnant + breastfeeding
§ Prevents subclinical hypothyroidism
○ Vit D
§ 1000 IU if 30-49, 2000 IU if <30
§ 400 IU if normal levels
§ Prevents neonatal low Vit D, impaired skeletal development, hypocalcaemia
○ Calcium
§ At least 1g daily
§ Prevents hypertensive disorders and preterm labour
○ Vit B12 - consider if vegan/vegetarian

33
Q

PRE-CONCEPTION CHECKLIST

  • Weight
    • Exercise
    • Genetic screening
    • Smoking/alcohol/illicit drugs
    • Psychosocial
    • Medical conditions
      ○ Hypothyroidism
      ○ Hypertension
      ○ Epilepsy
    • Contraception/family planning
    • STI/Infectious Disease screen
A
  • Weight
    ○ Measure BMI
    ○ Lose 5-10% of pre-pregnancy weight = realistic goal
    ○ Expect 11.5-16kg weight gain total normally during preg
    • Exercise
      ○ 150 mins per week/30 mins most days
    • Genetic screening
      ○ If indicated PHx/FHx/ethnic background
    • Smoking/alcohol/illicit drugs
      ○ Nicotine replacement therapy safe
    • Psychosocial
      ○ Screen for domestic violence
      ○ Screen mental health conditions
    • Medical conditions
      ○ Review and optimise current medications/conditions
      ○ Hypothyroidism - maintain TSH <2.5 in 1st trimester
      ○ Hypertension - switch to safe meds such as labetalol/methyldopa
      ○ Epilepsy - sodium valproate NOT recommended in pregnancy
    • Contraception/family planning
    • STI/Infectious Disease screen
      ○ MMR, Varicella, Hep B testing
      § Avoid pregnancy until 28 days after live MMR vaccine
      ○ DTP (20-32 weeks) and Flu Vax (any time)
      -Discuss TORCH
34
Q

Recurrent pregnancy loss Ix
Female (4)
Male (1)

A

Female: karyotype, USS + sonohysterography, TFTs, acquired thrombophilia screen
Male: karyotype

35
Q

Post-menopausal bleeding DDx (6)

A

-MHT
-Endometrial Ca
-Atrophic vaginitis
-Endometrial hyperplasia
-Cervical/endometrial polyps
-Cervical Ca

36
Q

Vulvodynia management aspects (5)

A

-Lubrication for sexual activity
-Topical lignocaine gel 2% prior to sex
-Physiotherapy for pelvic muscle dysfunction
-Avoid irritants- soaps/pads/perfumes
-Low dose TCAs, duloxetine/venlafaxine

37
Q

OCP

Late pill definition + Rx
Missed pill definition + Rx
Missed early cycle pill Rx
Late cycle missed pill Rx

A

-Late - between 24-48 hours, take late pill ASAP and continue as reg
-Missed - >48 hours sinc last pill, take missed pill ASAP + continue as reg + condoms for 7 days
-Missed early - missed during first days of pack after a hormone break - emergency contraception if unprotected sex in last 5 days - (LG can continue pill as reg, UP need to stop for 5 days before pill, condoms for 12 days in this case)
-Late missed - skip inactive pills, use condoms 7 days as precaution

38
Q

Which mood stabilisers safe in preg (2)
Which are contraindicated (2)

A

-Lithium (small risk foetal heart defect - foetal echo, UEC/TFTs and lit level. Can’t breastfeed)
-Lamotrigine

-Sodium valproate
-Carbamazepine

39
Q

How to manage irregular bleeding whilst on a LARC (4)

A

-Adding on COCP continuously/cyclically for 3 months
-5 day course of NSAID (e.g mefenamic acid 500mg BD)
-5 day course of tranexamic acid (500mg BD)

2nd line option
-Norethisterone 5mg TDS 21 days

40
Q

Tests to order for early pregnancy loss (3)

A

-serial b-HCG (falling bhcg after 48-72 hrs = non-viable, but not determinant of location)
-Transvaginal USS (rule out ectopic)
-Blood group (Rh-ve needs Anti-D)

41
Q

Management options for early pregnancy loss (3)

A

-Expectant 6-8 weeks
-Medical - misoprostol
-Surgical

42
Q

Ovarian cysts in pregnancy - advice/management aspects (4)

A

Usually incidental finding, 50% resolve
○ Repeat 12-14 weeks to ensure resolution
○ CA-125 only if mass is suspicious for malignancy on USS appearance
○ >7cm usually needs further Ix

43
Q

Secondayr dysmenorrhoea causes (4)

A

Endometriosis
Pelvic fincetion
Adenomyosis
Fibroids

44
Q

Ix for menorrhagia/AUB (8)

A

FBE
iron studies
B-hCG
TFTs
coags
CST/co-test
Gonorrhoea/chlamydia PCR
Transvaginal USS day 5-10 of cycle

45
Q

Vaginismus (genito-pelvic pain/penetration disorder) management aspects (5)

A

Vaginal dilation + progressive desensitisation + relaxation
education
CBT
Sex therapy
Pelvic floor physio

46
Q

SCOFF Questionnaire for eating disorder screening

A

Do you make yourself Sick w/ feeling uncomfortably full
Lost Control
One stone (6.3kg) in past month
Belief that they are Fat
Does Food dominate your life

47
Q

Eating disorder physical examination findings (10)

A

-Dorsal finger callouses
-Stress fractures
-Muscle cramps/weakness (squat test)
-Dental caries
-Parotid enlargment
-Irregular menses/amenorrhoea
-Dry hair/skin
-Lanugo hair
-Hypercarotenaemia
-Postural hypotension

48
Q

Primary amenorrhoea DDx (6)

A

-Constitutional delay
-Hypothalamic (e.g functional - stress/exercise/nutritional def.)
-Prolactinoma/hypopituitarism
-Premature ovarian insufficiency
-Turner syndrome
-Mullerian agenesis/imperforate hymen

49
Q

Secondary amenorrhoea DDx (9)
-Initial Ix

A

-Pregnancy!
-Perimenopause
-PCOS
-Hypothalamic (e.g functional)
-Prolactinoma
-Hypopituitariusm
-Primary ovarian insufficiency
-Intrauterine adhesions - Asherman’s syndrome
-Medications

-hCG, FSH/LH, TSH, prolactin, androgen levels, ?oestrogen/progesterone

50
Q

Frequent loose/green/frothy stools (Ddx 1)

A

lactose overload - complete feed on one side of breast (↓foremilk)

Others; UTI, pyloric stenosis. Very unlikely = GORD, cow’s milk protein intolerance, colic, lactose intolerance

51
Q

Ovarian cyst management:
-Premenopausal
○ Asymptomatic <5cm cysts
○ Cyst 5-7cm
○ Cyst >7cm

	* Post-menopausal
	○ Simple, unilateral, unilocular ovarian cyst <5cm + low risk malignancy
	○ If moderate to high RMI
	○ If malignancy suspected
A
  • Pre-menopausal
    ○ Asymptomatic <5cm cysts - no f/u - resolve within 3 cycles
    ○ Cyst 5-7cm - repeat USS
    ○ Cyst >7cm - consider surgical intervention
          * Post-menopausal
  ○ Simple, unilateral, unilocular ovarian cyst <5cm + low risk malignancy - conservative. 50% resolve within 3 mths
  ○ If moderate to high RMI - refer gynae
  ○ If malignancy suspected --> oophrectomy

Ovarian torsion - needs urgent gynae review

52
Q

Antenatal bloods must do
+ to consider

A

** ○ FBE, Blood group/Ab, Rubella, Hep B, Hep C, Syphilis serology, HIV serology**
○ +/- iron studies, TSH, Vit D, Vit B12/folate, Urine PCR gonorrhoea/chlamydia, CST

53
Q

PCOS Rx aspects (6)

A

○ Lifestyle - weight loss 5%, calorie restriction, exercise (150 mins weekly)
○ COCP/Mirena - effective for menstrual regularity
○ Metformin - insulin resistance, improved frequency of ovulation/fertility
○ Vit D supplementation
○ Anti-androgen added on to COCP (e.g cyproterone, spironolactone)

	○ Letrozole - anovulatory infertility (refer Gynae), clomifene
54
Q

PCOS monitoring aspects (4)

A

○ Lipids 2 yearly
○ BP annually
○ OGTT 2 yearly
○ Co-morbid mental health

55
Q

Indications for tubal testing for tubal disease (5)
Imaging modalities used (2)

A

Long-standing ingertility
Prior pelvic surgery
Endometriosis
Adenomyosis
STI/pelvic infection hx

Hysterosalpingography (HSG) or HyseroSalpingo Contrast Synography (HyCoSy)

56
Q

Infertility history questions (8)

A

-Frequency and timing of intercourse
-Menstrual history
-CST previous results
-Previous pregnancies
-Pelvic infection
-Medication/contraceptive use
-Vaccination - Rubella, varicella, Hep B/influenza
-Smoking/alcohol/drug use

57
Q

Female infertility Ix: (7)
Male infertility Ix: (4)

A

-FSH/LH
-Oestradiol
-TSH
-Prolactin
-Transvaginal USS
-HSography/HyCoSy
-AMH

FSH, LH, serum testosterone, semen analysis

58
Q

Nipple trauma DDx (5)

A

○ Suboptimal fit and hold
○ Breast pump trauma/misuse
○ Nipple bacterial infection
○ Blocked/plugged nipple duct
○ Tongue-tie

  • Tongue tie - not expected to have an impact on breastfeeding
    high rate false positives for nipple swab MCS - normal flora on skin/baby’s mouth
59
Q

Perceived low milk supply DDx (6)

A

○ Poor fit and hold
○ Top-up feeds –> longer durations between feeds
○ PCOS
○ Hypothyroidism
○ Meds - COCP, bromocriptine
-Smoking/eTOH

60
Q

Bacterial vaginosis 1st line Rx (2)

A

-Metronidazole 0.75% gel 1 applicatorful intravaginally nocte for 5 nights
-Metronidazole oral 400mg BD for 7/7

61
Q

Pre-eclampsia high risk risk-factors (5)
Prophylaxis (2)

A

-Chronic HTN
-Chronic kidney disease
-PHx of hypertensive disease in pregnancy
-Diabetes
-Autoimmune disease

Aspirin 100-150mg daily + calcium 1.5g daily

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