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Women's Health > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What are the different methods of emergency contraception?

A

1st line = Copper IUD - most effective method and should be offered to all women
2nd line = Levenorgestrel or Ulipristal

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2
Q

How is the copper IUD used?

A
  • Must be inserted within 5 days of unprotected sexual intercourse
  • May inhibit fertilisation/ implantation
  • Can be left in situ to provide long term contraception
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3
Q

How is Levenorgestrel used?

A
  • Must be taken within 72 hours of unprotected sexual intercourse
  • Single 1.5mg dose should be given
  • If vomiting occurs within 3 hours the dose should be repeated
  • Can start hormonal contraception straight away
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4
Q

How is Ulipristal used?

A
  • Must be taken within 5 days of unprotected sexual intercourse
  • Single 30mg dose
  • May need to use barrier contraception for first 5 days after taking (reduces effectiveness of hormonal contraception)
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5
Q

What are the rules if someone misses 1 combined oral contraceptive pill?

A

Take the missed pill as soon as possible along with today’s pill (both in one day) and then carry on as normal from tomorrow.

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6
Q

What are the rules if someone misses 2 or more combined oral contraceptive pills?

A

*Take the last pill and today’s pill, leaving any earlier missed pills and then carry on as normal
Week 1: Emergency contraception may be required if had sex in week 1 or pill-free interval
Week 2: No need for emergency contraception
Week 3: Finish the pills in current pack, then start new pack straight away without pill-free interval

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7
Q

What is the treatment of group B strep infection in pregnant women?

A

Intravenous antibiotic (ben-pen) given as soon as possible after start of labour, then at 4 hourly intervals until delivery.
Women who have had previous baby with GBS should be offered intravenous antibiotic prophylaxis
All women in preterm labour should be offered intravenous antibiotic prophylaxis

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8
Q

What is the management of pelvic inflammatory disease?

A

Oral ofloxacin + oral metronidazole
OR
Intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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9
Q

What are the antenatal tests offered for Down’s Syndrome?

A

Combined test is standard:
- Should be done between 11-13+6 weeks
- Tests offered: nuchal translucency, serum B-HCG, PAPP-A

Quadruple test is offered for women who book later in pregnancy (15-20 weeks)
- Tests offered: AFP, unconjugated oestriol, human chorionic gonadotrophin, inhibin A

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10
Q

What is the purpose of non-invasive prenatal screening test (NIPT) ?

A

Women considered to have a “higher chance” result from combined/ quadruple test will be offered NIPT (chromosomal analysis)
Usually very sensitive and specific so is preferred over chorionic villous sampling and amniocentesis

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11
Q

Differentiate between primary and secondary dysmenorhhoea…

A

Primary dysmenorrhoea:
- Occurs within 1-2 years of menarche
- Usually occurs just before or within first few hours of period

Secondary dysmenorrhoea:
- Occurs many years after menarche, cause by underlying pathology
- Pain usually starts 3-4 days BEFORE period

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12
Q

What is the management of primary dysmenorrhoea?

A

1st line = NSAIDs e.g. ibuprofen or mefenamic acid
2nd line = combined oral contraceptive

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13
Q

What is the management of secondary dysmenorhhoea?

A

Referral to gynaecology for further investigation

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14
Q

What are the three forms of miscarriage?

A

Threatened miscarriage - painless vaginal bleeding occuring around 6-9 weeks
Missed miscarriage - light vaginal bleeding and sx of pregnancy dissapear
Inevitable miscarriage:
Incomplete miscarriage -heavy bleeding, crampy abdominal pain
Complete miscarriage - little bleeding

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15
Q

How does ectopic pregnancy present?

A

6-8 weeks of amenorrhoea
Lower abdominal pain - unilateral
Tender cervix or shoulder tip pain

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16
Q

How does hydatiform mole present?

A

Everything is increased!
Bleeding associated with:
High bHCG levels
Large uterus
Increased pregnancy sx e.g. hypermesis

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17
Q

How does placental abruption present?

A

Constant lower abdominal pain
Shock - low BP
Tender, tense uterus

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18
Q

What are the rules for missing a contraceptive patch?

A

Delay in changing patch end of week 1 or week 2:
<48 hours delay –> change patch immediately, no further action
>48 hours delay –> change patch immediately and use barrier contraception for 7 days

Delay in changing patch end of week 3:
Remove patch and start next patch at the start of next cycle (after patch-free week)

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19
Q

What is the Bishop score?

A

Scoring system used to determine if induction of labour is required:
- Cervical position
- Cervical consistency
- Cervical effacement
- Cervical dilatation
- Fetal station

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20
Q

How is the Bishop score interpreted?

A

Bishop score <5 = labour unlikely to start without induction
Bishop score >8 = cervix is ripe, high chance of spontaneous labour

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21
Q

What is the NICE guidance for labour induction?

A

Bishop score <=6: Vaginal prostaglandins or oral misoprostol
Bishop score >6 : Amniotomy (breaking waters) and IV oxytocin infusion

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22
Q

What is the diagnostic triad for hyperemesis gravidarum?

A
  1. > 5% body weight loss
  2. Dehydration
  3. Electrolyte imbalance
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23
Q

What is the management of hyperemesis?

A

1st line = antihistamines - oral cyclizine/ promethazine
Phenothiazines - chlopromazine or prochlorperazine

2nd line = oral ondansetron
oral metoclopramide or domperidone

Admission required if continued N+V and unable to keep liquids and oral antiemetics down
OR
ketonuria/ >5% body weight loss

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24
Q

Which HPV serotypes are associated with cervical cancer?

A

16, 18 and 33

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25
Q

What are the features of endometriosis?

A
  • Chronic pelvic pain
  • Dysmenorrhoea (pain starts days before bleeding)
  • Deep dyspareunia
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26
Q

What is the management for endometriosis?

A

1st line = analgesia (paracetamol/ NSAIDs)

2nd line = hormonal treatment (combined oral contraceptive/ progesterones) - if needing contraception and no contraindications

3rd line = used if fertility is a priority –> GnRH analogues –> lowers oestrogen levels

Surgery if medical treatment does not work –> laparoscopic excision

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27
Q

What is the management of mastitis?

A

Non-pharmacological: Encourage continued breastfeeding and cold compresses for pain

Pharmacological: Oral antibiotics used for systemic disease e.g. fever

Surgery: Indicated when there is evidence of abscess formation –> incision and drainage / aspiration

28
Q

What tumour marker is most associated with ovarian cancer?

A

CA-125

29
Q

What are the main complications of pelvic irradiation?

A
  • Pelvic fractures
  • Bowel cancer
  • Bowel obstruction
30
Q

What cancer is associated with oestrogen only HRT?

A

Oestrogen only HRT leads to unopposed endometrial hyperplasia (precursor to endometrial cancer)

31
Q

How does Paget’s disease of the nipple present?

A
  • Eczematous rash of the nipple and areola
  • Nipple discharge - bloody or serous
  • Sometimes ulceration
32
Q

What is the management of urge incontinence?

A

1st line = bladder retraining course (lasts min of 6 weeks)
2nd line = bladder stabilising drugs (oxybutynin, tolteridone)

33
Q

What is the usual routine for investigation in cervical screening programme?

A

All women invited for HPV testing initially…
HPV negative –> return to normal screening programm
HPV positive –> referred for cytology

Cytology takes place…
Cytology shows NO abnormality –> returns to normal screening programme
Cytology shows abnormality –> colposcopy within 2 weeks
Cytology shows borderline changes –> a further high risk HPV (HR HPV) test is carried out:
- Negative –> return to normal screening
- Positive –> colposcopy within 6 weeks

34
Q

Management of fibroids…

A

Menorrhagia secondary to fibroids:
- Levonorgestrel intrauterine system –> woman requires contraception
- NSAIDS e.g. mefenamic acid
- TXA

Removal of fibroids:
- Medical: GnRH agonists - can help in reducing size of fibroid
- Surgical: Myomectomy - most common for large fibroids
Endometrial ablation
Abdominal hysterectomy (last resort for women who have completed families and refractory to other treatments)

35
Q

What are the main features of intrahepatic cholestasis of pregnancy?

A
  • Occurs in late pregnancy
  • Pruritis
  • Clinically detectable jaundice
  • Raised bilirubin
36
Q

What is the presentation of ovarian cancer?

A
  • Abdominal bloating/ distension
  • Abdominal pain
  • Urinary symptoms e.g. urgency
  • Early satiety
37
Q

Referral criteria for suspected breast cancer…

A
  • Patients <30 years old with new breast lump –> referred routinely to breast clinic
  • Patients > 30 years old with new breast lump AND skin or nipple changes suggestive of underlying breast cancer
38
Q

What is the management of placenta praevia?

A

Placenta praevia = placenta which is lying in the lower uterine segment, potentially covering cervical os
Usually presents with bleeding in final trimester
**Assessment with ultrasound is required, NEVER use digital cervical examination

Close observation can be used if gestation <36 weeks and bleeding has stopped
Admit to hospital if known placenta praevia with new onset vaginal bleeding for a t least 48 hours
If bleeding persists or is heavy –> emergency C-section is indicated

39
Q

What dietary components should be avoided in pregnancy?

A
  • Soft cheeses –>increased risk of Listeria infection
  • Swordfish –> contains mercury which can accumulate
  • Caffeine –> no more than 200mg/day - linked to miscarriages
  • Vitamin A –> harmful to foetal development, should be avoided throughout pregnancy
40
Q

What is the best diagnostic test for a foetal karyotype?

A

Chorionic villous sampling (CVS) is DIAGNOSTIC

41
Q

What are some of the ABSOLUTE contraindications to combined oral contraception?

A
  • Cerebrovascular disease
  • > 15 cigarettes per day and > 35 years old
  • History of VTE
  • Uncontrolled hypertension
  • Migraine with aura
  • Current Breast cancer
  • Breast feeding <6 years weeks post partum
42
Q

What are Amstel’s criteria for BV?

A
  1. Thin, white discharge
  2. Clue cells on microscopy
  3. pH > 4.5
  4. Positive whiff test - fishy odour when adding potassium hydroxide
43
Q

What is the treatment for BV?

A

Asymptomatic –> treatment not usually required
Symptomatic –> Oral metronidazole 5-7 days
Alternatively clindamycin can be used

44
Q

What is hydrops fetalis, and name a common cause?

A

Hydrops = accumulation of fluid in baby’s organs leading to oedema
Can be caused by Parvovirus B19 transmitted during pregnancy –> viral suppression of fetal erythropoesis –> heart failure due to severe anaemia –> accumulation of fluid

45
Q

What are the features of fibrocystic disease?

A
  • Dilatation of breast lobules which form cysts
  • Leads to “lumpy breasts”
  • Lumps worsen prior to menstruation
46
Q

What is the management of postpartum haemorrhage?

A
  1. Bimanual uterine compression –> trying to stimulate uterine contractions
  2. IV oxytocin
  3. IM or intrauterine carboprost
  4. Rectal or sublingual misoprostol

Surgery if medical options do not work –> intrauterine balloon tamponade

47
Q

What is the management of PCOS?

A

1st line in overweight women = weight loss

Hirsutism and acne –> combined oral contraceptive (Dianette) can be used, if wanting to avoid pregnancy

if struggling with fertility –> Clomiphene citrate can help with ovarian stimulation
Metformin can also be helpful

48
Q

Risk factors for ovarian cancer…

A

Risk increases with more ovulation over lifetime:
- Early menarche
- No pregnancies
- Late menopause

49
Q

What are the adverse effects of using aspirin in pregnancy?

A
  • Persistent pulmonary hypertension
  • Kernicterus of neonates
50
Q

What is the preferred treatment for hyperthyroidism in pregnancy and why?

A

Propylthiouracil - preferred to carbimazole but can still cause adverse effects to child such as fetal goitre so needs to be used in low doses

Definitive treatment would be thyroidectomy to prevent need to use thyroid replacement drugs which could cause harm to baby

51
Q

Why are NSAIDs avoided in pregnancy?

A

Can cause closure of fetal ductus arteriosus

52
Q

What is the most common side effect of the progesterone only pill (mini pill)?

A

Irregular vaginal bleeding (spotting between periods and irregular periods)

53
Q

How soon after starting does POP become effective?

A

2 days

54
Q

How soon after insertion does IUD become effective?

A

Immediately

55
Q

What is the first line treatment for menorrhagia for a woman requiring contraception and not requiring?

A

Requires contraception = Intrauterine system - Mirena

Does not require contraception = Mefenamic acid or TXA

56
Q

What hormonal changes are seen during the menopause?

A

Reduction in oestradiol and progesterone levels
Consequent rise in FSH and LH levels

57
Q

What are the triad of features seen in pre-eclampsia?

A
  1. New onset hypertension
  2. Proteinuria
  3. Oedema
58
Q

What are the main risks of smoking during pregnancy?

A
  • Pre-term labour
  • IUGR
  • Still birth
  • Miscarriage
59
Q

What is the management of hypertension in pregnancy?

A

1st line = Labetalol
2nd line = Nifedipine

60
Q

Diagnosis of gestational diabetes…

A

Fasting glucose > 5.6 mmol/L
2 hours post OGTT > 7.8 mmol/L

61
Q

Management of gestational diabetes…

A

If found to have fasting glucose 5.6-7.0:
1st line = 1-2 week trial of diet and exercise
2nd line = metformin
3rd line = insulin

If found to have fasting glucose >7.0:
1st line = insulin

62
Q

What is puerperal pyrexia?

A

Fever > 38C within 14 days of delivery

63
Q

What supplements should a healthy woman take during pregnancy?

A

Folic acid 400 micrograms OD until 12th week of pregnancy
Vitamin D 10 micrograms OD throughout pregnancy

64
Q

Which women are required to take 5mg of folic acid?

A
  • Partner has neural tube defect/ family history/ previous history
  • Diabetes
  • Obesity
65
Q

What is the treatment for eclampsia?

A

IV magnesium sulfate

Women's Health (1 decks)

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