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Women's Health Flashcards

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1
Q

What is the most common cause of breast lump in women age 30-50?

A

Fibrocystic change
- Overreaction to hormone changes
- Smooth and mobile lumps
- Fluctuate in size with cycle
- Tenderness/aching (out + upper)
- Spontaneous green/brown d/c
- NO increased cancer risk
Mx
- Nil if mild. Mod analgesia, bra. Severe may need aspiration

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2
Q

How are breast cysts investigated and managed?

A
  • Can have single or multiple
  • More common with age but prior to menopause (oestrogen related)
    IX: USS +/- biopsy if USS doubt
    MX: mild = nil, severe = drainedm (may refill and return)
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3
Q

What benign lumps can affect the breast?

A
  1. Fibrocystic changes: smooth and mobile lumps, tender, cyclical, 30-50
    - Alcohol, MHT, OCP, pre-MP
  2. Fibroedenoma: younger, preg, feeding, HRT (hormone related). 15-40. Most shrink. Surg if large/pain
  3. Breast cysts
  4. Sebaceous cysts
  5. Lipoma: soft, non-tender, mobile, can be slow-growing
  6. Fat necrosis: due to trauma (injury, surgery, RT, bld thinners), can look like ca on scan. Can get cysts within. Usually self-resolves
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4
Q

Describe physiological discharge?

A
  • From endocervical cells, sloughed epithelial cells, products of n flora
  • white, clear, min odour, 1-4ml/day
  • > near ovulation, thicker after
  • n pH 3.8-4.4 (lactobacilli)
  • > alkaline in young and post-MP, menstruation, sex, meds, stress
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5
Q

What is standard vulvovaginal hygeine advice?

A
  • Avoid soaps, gels, shampoos etc
  • Wash gently with tepid water
  • Non-soap cleansers pH 5.5 ok
  • Douching not recommended (alters pH, flushes bacteria up, >risk: PID, BV, ectopic, STI, HSV, HIV)
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6
Q

What is BV? How is it managed?

A

W:
- Anaerobic replacement, pH >4
- ASSOCIATED with sexual activity, abx use, douching, IUD/S

Cx: misscarraige, PROM, STI, post-op infection

Sx: grey, watery, fishy d/c, >after sex
- Also: itch, irritation, pain

Ix: speculum/swab if not clear Dx
- ?STI ?Other Dx ?preg/TOP/miss, bleeding, pain, fever, persisting sx

Mx: 30% self-resolves
- Empiric: Sx, low STI risk, not preg
- No Sx (50%): treat if preg, pre-TOP
- Sx: Metronidazole 400mg BD 7/7 OR 2G STAT (>compliance, <effect)

Preg/breast: 7d only, re-test after 1mth

Persisting: ?Dx, course, STAT -> 7d, ?removed IUD
Recurrent: high -> swab

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7
Q

What is VV candiasis? How is it managed? What are the options for recurrent candidiasis?

A

W:
- Found in 20-40% healthy women
- Risk: Abx, preg, DM, <immune, NOT clothing or vaginal habits

Sx: itch, stinging, burning, dysuria (Ext), dyspareunia. Cheesy/white d/c
Ex: erythema, swelling, fissuring

Mx:
- Empiric if classical Sx, no STI risks
- Clotrimazole 2% 3/7, 1% 6/7
CREAMS CAN WEAKEN CONDOMS
- Fluconazole 150mg STAT (quciker)

Recurrent: 4/year, try 10-14 days treatment OR 150mg monthly 6m

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8
Q

Causes of vulval itch?

A
  • Candidiasis
  • Dermatitis
  • Lichen sclerosus
  • Lice, worms, scabies
  • Warts
  • Atrophic vulvovaginitis
  • Psoriasis
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9
Q

Who does lichen sclerosus effect? How is it investigated and managed?

A

W: AI origin, mostly >50
SX: severe itch and pain
EX: white, thickened skin, fissures
IX: biopsy if uncertain
MX: Refer derm for confirmation/FU
- potent steroid to reduce symptom
- reduce potency as improves
CX: increased risk of VIN and SCC

Lichen planus more rare. Similar Sx. Typically an erosive form. Difficult to control and may require PO Rx -> refer to derm. Also ca risk

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10
Q

What are bartholins cysts? how are abscesses managed?

A

W: glands produce mucous
Sx: lump 1-3cm size, no sx
- Larger cysts cause discomfort
- Develop abscess if infected
Mx
- Warm compress, saline baths
- I&D under LA or excision
- Abx (broad) if systemic symptoms

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11
Q

Who does VIN affect?

A

W: post-MP, >30-40, 90% SCC
- Can also be BCC, melanoma
- Risks: lichen, HPV, HIV
SX: can be asymptomatic, itch, lump, pain, ulcer, bleeding
EX: inner edges of labia most common

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12
Q

How is vulvodynia managed?

A

W:
- Vulvodynia, pain at introitus, burning, triggered by contact
- Constant more likely to be neuro
MX
- HX and EX
- Treat any cause (infection, lesions)
- Refer to specialist. Pelvic floor PT
- Topical gels at night and for sex
- TCA, gabapentin

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13
Q

Vulvovaginitis in young girls?

A

W:
- low eos, higher pH, thin/flat labia (reduced barrier), close anus
- Think r/e worms (night itch), abuse, lichen sclerosus, trauma
Sx:
- Itch, erythema, d/c, bleeding
Hx:
- Sx, toileting, hygeine, meds, SH
- MOST = local irritants -> dermatitis

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14
Q

What are the management options for pre-menstrual symptoms?

A

W:
- Symptoms + impact + cyclical (not just exacerbate pre-existing issue) + 2 succesive cycles
- Severe symptoms 3-8% cases
- Mood, behavioural, somatic Sx
- 2d to 2w, worst 2d before period

Risks: trauma, cigs, obesity

IX: PSST questionnaire

Mx:
- Non-Rx: exercise, intake complex carbs (slow burning -> Seretonin), stress management, calcium, vit B6
- SSRI mid-cycle to menses
- Benzo if severe anxiety, insomnia
- Hormonal: COCP with <androgen

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15
Q

How is GORD managed during pregnancy?

A

W: 30-50%, start end 1st trim
- inverse to maternal age, >twin
Mx:
- lifestyle, dietary change
- then antacid
- then PPI if affecting QOL
- Can also be taken in breastfeeding
Px:
- Resolves after birth

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16
Q

What types of ovarian cancer are there?

A
  1. Epithelial 90%
  2. Sex cord-stromal
  3. Malignant germ cell (<40, 20s most common)
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17
Q

What are the risk factors for ovarian cancer?

A
  1. Lifetime number of cycles
    - early menarche, late MP, no preg
    - OCP, preg, early MP protective
  2. FH (BRCA, lynch)
  3. Pacific
  4. Obesity, Cigarettes
  5. Endometriosis / PCOS/ PID may
  6. MHT if >5years

Note more common than cervical but less than endometrial
Highest mortality of gynae cancers as detected late

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18
Q

What are the symptoms and signs of ovarian cancer?
How is it investigated and treated?

A

SX: 90-95% will have symptoms
- 3-5 visits before diagnostic tests
- Pain, bloating, anorexia, satiety, PU

EX:
- abdo exam (mass, ascites)
- bimanual for adnexal mass

IX:
N exam -> ca125
- <35: W&W
- 35-200: rpt 6w OR scan if post-MP, falling then ok, up/same -> scan
- >200: pelvic USS -> gynae if ABN
ABN exam -> both -> refer either AB

MX
- BRCA: surgery after childbearing, ideally between 35-40. prevent 90%
Refer with. Hysterectomy if lynch or if wish to have oes only MHT

Meigs: benign ovarian mass with ascites and pleural effusion

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19
Q

What do you need to ask for AUB?

A
  1. Pregnancy?
  2. N frequency, duration, flow
  3. Timing, character of bleeding
  4. IMB, PCB, PMB
    • pain/sex, d/c, itch, rash, fever
  6. Products, CP, thinners, OTC meds
  7. Sexual health
  8. BG: obs, surgical
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20
Q

What are the expected mensturation cycle times?

A

Freq:
<23d
n 24-38
>38d

Duration
n <9
Long >8

Regularity (short-longest)
reg 1 week

Flow subjective

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21
Q

What do look for on exam with AUB?

A
  1. Obs
  2. Abdo exam: mass
  3. Pelvic and bimanual IF not obvious e.g. younger on CP
  4. Thyroid, acne, alopecia, acantho, galactorrhoea, petechiae
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22
Q

How is heavy menstrual bleeding defined?

A
  • Defined by patient
  • change products 1-2 hours
  • using 2 types sani products
  • involves clothes or bedding
  • clots
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23
Q

How is HMB classed? How is it investigated?

A

Structural:
- Fibroids
- Polyps
- Adenomyosis
- Endometrial hplasia, ca

Others:
- Iatrogenic: CP, tamoxifen, MHT, Rx
- Dysfunction: stress, kg, ET, PCOS
- Coag issues: vWBD

IX:
- HCG
- CBC +/- ferritin
- TSH if symptoms
- Coag if concern
- Pipelle if ca expected
- USS if structural expected (AGE)

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24
Q

What are the risk factors for endometrial cancer?

A
  1. Age >45
  2. Age >35 +
    - BMI, DM, HTN, Oes only
    - Nulliparity, infertility, PCOS
    - MAPAS
    - FH endometrial, CRC, renal ca
    - Tamoxifen
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25
What are the treatment options for HMB?
Hormonal - 1st if need LARC: 60% get less - COCP cont if want preg / No CIx - Depot/POP but can be erratic - Cyclical prog d5-25, less good, double dose if spotting (>SEs) Non-hormonal - 1g TDS TDS 1-4d @ start bleeding. NOT with OCP as >VTE risk - Mefanamic 500mg TDS 3-4d
26
What are common causes of IMB/Unscheduled bleeding? How is it investigated?
W: between or breakthrough outside of withdrawal bleed for MHT/CP. Random OR cylic. - Ovulation - STI - Polyps, hyperplasia, malignancy IX - Pregnancy test - STI test - Smear (>6-12 months ago) - Pelvic USS if persists or abn exam -> gynae if abnormal results Unscheduled - COC: increase eos, or change prog - If cont COC >3d, pause for 4d - Prog bleeding may not settle
27
How are primary amenorrhoea and secondary amenorrhoea defined? How are they managed?
Primary - No development by 13 - No menses by 5y after breasts - No menses by 15 Most common: constitutional delay if no secondary characteristics Also think r/e anorexia, else W&W Infrequent is common just after menarche and peri-MP Secondary: - Cessation >3m if regular (preferred definition) inc if after coming of COCP - Cessation >6m if irregular Oligomenorrhoea = <9 cycles per year Most common is pregnancy. Also: anovulatory cycles, PCOS, functional (>ET, anorexia, stress, Rx, Thyroid, >PRL) All of above apart from PCOS will have low oestradiol = then ovarian e.g. primary ovarian insufficiency - check PRL if FSH/LH low. If low -> TSH. If both normal then likely functional (stress etc) - Normal with LH touch high e.g. PCOS. Check testosterone. FLAGS: raised FSH recheck 4w (POI), PRL >1000 - PCOS + amenorrhoea => do USS ?endometrial thickness as >ca risk. INDUCE W/D BLEED Mx: - lifestyle - PCOS - w/d bleed e.g. COCP if want contraception - FHA - bone health e.g. fractures, dexa. Might consider HRT (better than ocp for bone)
28
How is PCB defined? What causes it? How is it investigated?
W: bleeding in 24hrs after sex C: - STI - ectropion/polyps - atrophic vaginitis - cancers - trauma IX: - HCG - STI test - Smear if >6-12m - USS if exam abn Mx: - Single ep + n Ex/smear -> W&W - Post-MP: top eos, lube, emollient - Colposcopy if persists/abn Ix
29
How is PMB defined? How is it investigated? Managed?
W: after 12m of amenorrhoea - RED FLAG for endometrial ca Ix: - Smear if >6-12m ago - STI if risk - Pipelle, USS - Hysteroscopy if tamoxifen ALL not on MHT recently -> USS + hysteroscopy if on tamoxifen
30
What symptoms are there with the menopause?
Vasomotor: flushing, sweats Vaginal: dryness, bleeding Mood and sleep Muscle and jount pains Bone loss (
31
How can MHT be prescribed?
Start within 10 years of menopause CI: - unexplained bleeds, breast/endom ca, - CHD, CVA, BG/FH VTE, dementia Continuous IF >12m since last period Cyclical: transition <12m / still bleeding - reduces breakthrough bleeding - common in 1st 6m - After 6m should be IX for ?Ca - prog 10-14d each month (bleed) Before: - Hx + Ex, check screening - Ix unexplained vaginal bleeding Risks - VTE - Small >breast ca (higher if prog/ longer use) - CVD neutral, stroke higher if risks Benefits: - most effective Rx for vasomotor - reduces vaginal dryness - reduces risk of fractures Topical: if
32
What are the options for starting MHT?
Oestrogen - 25mcg estradot patch 2x/week (funded) - 1mg Progynova (funded), estrofem can be devided to 500mcg but partly funded Progestogen - Oral for 14d or continuously - IUS, good if need contraception Stopping contraception - IF periods >55 or >1yr over 50, >2 year under 50 - If IUS/implant/pill >55 or >50 if FSH >30 then stop 1yr later Combos partly funded Persistent symptoms -> increase dose/switch Breast tender -> W&W, cyclical, >prog, to IUD Bleeding >6m -> Ix for endom ca
33
What other options are there for menopause symptoms other than MHT?
Lifestyle change: - avoid triggers, no smoking, 0.1% estriol cream or pessary - funded Pharma: - SSRI, clonidine, gabas, oxybutynin
34
What are the complications of PCOS? How is it diagnosed?
W: - most common endo young F - 5-10%, often not diagnosed Cx: INSULIN RESISTANCE - IGT, metabolic, HTN, lipid, CVD - OSA independent of BMI - Fertility problems - Endometrial hyperplasia -> Ca Dx: 2/3: - oligo/anov - clinical/IX androgenism - USS folicles
35
What investigations should be requested for PCOS diagnosis and then subsequently?
Initial: - PT (most common cause x period) - Pelvic USS (if x make clinical dx) - Testosterone (further Ix if v high) After diagnosis: - HbA1, fast bsl >5.5, random >7.7 - Lipids, fasting for high TGL - >LH/nFSH = high ratio If suspicion: - PRL if x periods, galactorrhoea - TSH if other thyroid symptoms - Oes + FSH if <40 and MP signs - 24hr cortisol: striae, moon face
36
How is PCOS managed?
1. Weight (if high BMI) - even 5% will help cycle 2. Androgenism - Acne, hair removal - COCP a/o spironalactone 3. Cycle regulation - Weight loss, COCP - Metformin 4. Specialist referral for fertility
37
What skin conditions are associated with pregnancy?
Linea nigra - increase in pigmentation, 90% - first trimester - mostly fades after delivery Striae Melasma - second half, 70%, >darker skin - usually fades, UV protection Melanocytic naevus - May change -> Ix if ?ca Spider naevi: disappear after Palmar erythema: 70% >light skin Pyogenic granuloma: 5% PUPPP/polymorphic eruption - 3rd trim, 1/150 pregs, >in 1st preg - Stretching -> immune response - usually resolves 4-6 weeks - emolient, top steroid, po severe, hist
38
What are the risk factors for breast cancer?
- Weight, alcohol - MHT, OCP - Nulliparous, early start / late MP - Dense breasts
39
What are the different types of miscarriage and their features?
Threatened - Minimal pain - Light bleeding - Cervix closed - Uterus = dates, FH ok Inevitable - Pain ++ - Heavy bleeding - Cervix open - Uterus = dates, FH x/ok Complete - No pain - Light bleeding - Cervix closing - Uterus = dates, FH empty Incomplete - Pain minimal or + - Heavy bleeding - Cervix open - Uterus =
40
How long does it take to make sperm?
74-78 days - hence why repeat sperm sample in a couple of months if abnormal
41
Causes of impotence?
Antihypertensives - Thiazides then bb's - ACE are best Hypogonadism Vascular disease Anxiety Diabetes mellitus Cigarette smoking
42
What is the supressive dose of fluconazole for Candida?
Fluconazole 150mg weekly for 6 months
43
What is the supressive dose of valciclovir for genital herpes?
Valaciclovir 500mg orally, daily for 12 months
44
When is HIV untransmissible?
After maintaining an undetectable viral load for 6 months
45
How can you change contraceptive pills if issues?
POP and COCP = affective - <0.3% preg if use properly - 9% chance with typical use Start: <35 eos + lev/noreth - COCP preferred as less strict with times - non-con: cyproterone >VTE VTE risk highest in first few months. W/o other risks, risk is 7-10/10,000 per year. Preg is 20-30. COCP, X if: - Current/Hx VTE, clotting dx - Major surgery, >35 + >15 cigs /day - If surgery, stop 4 week prior, restart 2 weeks after - other risks for stroke/MI: IHD, AF, CHF, uncontrolled HTN, DM + vasc, multiple risks, migraine + aura OR new during use of COCP - Current breast Ca/cervical - >50 as risks > benefits COCP, Cautioned if" - VTE 1st deg <45 - Obese >35 - Age >35 + <15 cigs per day Travel >3hrs: mobilise, stockings if other risks. >4500m for >1wk -> SWITCH Post-partum - 3w if not breastfeeding - 6w if breastfeeding Starting: - 1st 5 days: no condom - >5d: 7day - pregnancy test 21d after - no health benefits to pill free week. Only extra risk is breakthrough bleed - < over time. If happens, stop 4d then resume Issues: - Acne: >oes, deso / cypro - Bloat: oes, levon/deso - Breast: POP - Mood: reported but
46
What are the missed pill rules?
COCP: 1: take when remember >1: 1x when remember, condoms until 7x pills taken. Week 1 or during pill free week: ECP. Week 3: omit gap POP - >1, 48hr condom. If unprotected sex within 48hr missed pill -> ECP Vomiting <2hrs post taking pill - take another. If POP >3hrs after intended dose then condom 48hrs
47
What is standard pre-conception advice?
KP - 50% pregnancies x planned - Fertility reduces after 35y - Risks increase after 40y First - regular sex throughout cycle - optimal: 5d before ov + 1 after - start folic acid 4w b4 until 12/40 - check immunity rubella/varicella - UTD smear and STI check - Check LTR meds - Smoking, alcohol, drugs, nutrition - X soft cheese, raw, unwashed, deli ?Ref: >12m if <35, >6m if >35 - 85% 1st year. Extra 50% next 36m - 1-2 days during fertile phase - Ov is 14d before next period so sex end of period, until 10d b4 next Folate: - 5mg if: Hx neural tube, FH of, anti-epileptic, diabetes, obese Iodine: - From pregnancy onwards Iron: - Need adequate stores b4. Supplement before 1st trimester Smoking: - Risks: abrupt, miscarry, prem, SGA - Associated w CVD, T2DM, obesity - NRT much smaller risk to baby - NOT bupropion / champix Weight: optimum 20-25 - BMI >35 = 2x time to conceive - BMI >27 - GDM, HTN, >labour, LGA LGA -> shoulder dystocia Exercise: >7hr strenuous temp of testes (limited) - Best 2-3d between ejaculation - Menevit benefit in trial 4
48
Vulvovaginal health
pelvic floor muscles are oestrogen -dependent. Reduced vasculaity, secretions. More basic pH. Progressive atophy. -> prolapse, incontinence, UTI, BV, C -> Increased STI risk Only 20-25% will seek help from GP -> embarassed, think n, unaware Mx: - oestriol cream 0.1% / 500mcg pess - nocte until better (2-3w) then 2/wk SE: stinging, burning, usually 2wk +/- Replens (not funded) / lubricant Refer: - ?Ca - Failed to respont to treatment
49
Prolapse management
1. Estriol cream 2. Pelvic floor PT 3. Pessary -> refer for fitting 4. Surgery Refer: - failed 6m conservative - outside hymen - associated with incontinence, incomplete voiding or recurrent UTIs
50
Vulval dermatitis
W: most likely to be contact dermatitis e.g. soap, fragrance, over-washing, urine. X atopic. If chronic can develop lichen simplex Mx: - remove irritant - emolient, topical hydrocortisone - sedating antihist nocte / TCA Strategies: - Cut nails short, gloves nocte - Luke warm baths - White, unscented TP - NO wet wipes - Treat urine incontinence - Specific pads, rinse with water - Petrolleum jelly for barrier - Naked at night unless need pads
51
Lichen simplex
W: excessive scratching/rubbing of area with underlying condition - HAIR-BEARING SKIN Sx: thickened, itchy +++, nocte/heat - also: lower legs, arms, wrists, neck Mx: - emolient, cold pack - sedating antihist/TCA to x cycle - potent steroid, reducing potency over 4-6 weeks. Ultra only if biopsy - refer to derm if not working
52
Lichen Sclerosus
W: AI, inflammatory, >50 mostly - 20% other AI disease - HAIRLESS SKIN Sx: asymptomatic or itch -> can get adhesions, fissures Mx -> refer for biopsy - Associated with VIN/scc 5% - Review skin anually - Potent/ultrapotent steroid + eostrogen cream - Dilators if narrowing
53
Lichen Planus
W: similar to LS but less common - More likely to affect other areas - 30-60 mostly Sx: itch, pain - Cutaneous: purple papules in hear-bearing areas - Mucosal: painless, itchy, white - Erosive: marked redness with white broder -> scarring, pain ++ and BLOODY DISCHARGE Mx: refer, ca risk also - Similar treatment but may need immuno meds + PO steroids
54
VIN
W: most post-men - 90% SCC Sx: asymmetrical, papules, erosions, plaques. Mx: Refer
55
Sexual health post-menopause
Are you sexually active? Do you have any questions or problems with sex that you would like to discuss? Libido: medicines, ?MH, counselling Discomfort/dry: lube, topical eos Pain: Ix/Mx, lube, eos, floor exercise Incont: Mx factors, pads, excercises, Lack of privacy, e.g. in a residential care setting; encourage discussion with carers Self-esteem issues; encourage discussion and coping strategies, offer referral for counselling Relationship issues, e.g. new partner, pressure to have sex; encourage discussion, consider referral for counselling Inadequate knowledge about STIs; educate about STIs, testing, appropriate protection and possible symptoms
56
BRCA
Breast - Begin screening from 25-30 <40: MRI >40: MRI + Mam OR USS + Mam - Pre-men: tamoxifen, post-men: that or raloxifene or aromatase inhibitors - BL mastectomy, timing based on scoring Ovarian/uterine: NOT uss/Ca125 - BRCA1: 35-40 for surgical SO - BRCA2: 30-45 Only + hysterectomy if wish to use oes only MHT to minimise breast ca risk Pancreas only if history in family (1 or 2nd deg)
57
When are hormone tests due in fertility investigation?
FSH and oestradiol on day 2-4 of cycle, progesterone 6-8 days before menses
58
Sexual harm disclosure
W: uncommon without being probed. 94% don't go to Police. - 1/4 females. 1/6 - 1/12 men - Mapas/deprived, young women, LGBT, drugs/alcohol, CSW HX: 1. Confidential UNLESS... I would always let you know 2. Ensure have time... may need to delay other consults 3. I can see that you look distressed... do you feel able to tell me what happened? -> closed or short replies -> probe - Thank you for telling me this - very brave of you. I'm really sorry this has happened to you. BELIEVE IT. - Whatever happens is going to be your choice, I will talk through options but it will be your decision. - Is this person known to you? Are you safe to go home? threatened with violence? 4. Routinely ask, enquire. May still NOT get disclosure. NOT if someone else in room, including child >2 - we ask all patients as part of a sexual history.... - have you had any encounters where you felt unsafe or where consent hasn't seemed clear - consent: w/d any time, can change, not if asleep/unconcious/unwell/alcohol/drugs/intellectual impairment/misled Outcomes: - Immediate: injury (30% in SI), strangulation, pregnancy (eMCP), STI, mental health especially if previous Hx - Safety: Who? waiting room, safe to leave - Long-term: relationships, pelvic pain/migraine/IBS, resistant depression, PTSD Referrals: - Support and listen. Refer ALL to sexual assault. - Any time frame for advice. - Within 7-10d forensic. Have support there. Advise can take support person. Doesn't mean need to involve police etc. Haven't decided or wants police - avoid exam, e+d, pu, take clothes in paper bag. Can hold for 6 months to decide. - Nearly everybody wants referral. Offer phone call at least if don't want to be seen. Take time to make decision as initial shock. - At pohutukawa: There for a few hours. brief history, doctor, nurse, specific questions about body, talked through examination, provide new clothes and have shower if needed. May take blood and samples from nails and hair. Genital exam for injury/samples. Only will do exam feel comfortable with. Then support worker. They will then FU 1-2w, 2-3m. - FU after at GP: 1-2w, FREE with ff. - ACC can be done later, sensitive claims. If physical injury then easier as long as happy to be documented on ACC45. Specialised counsellors can do rest. Don't need to fill in before person sees trauma-focused counsellor.
59
Ovarian cyst
Pre-men: Simple <5cm - no FU 5-7cm - USS/yr, FU if 3x >7cm: non-acute gynae Complex: - Gynae if unclear dx - dermoid: ok <5cm / x Sx - endometrioma: FU USS 3m ?haemorrhagic cyst Post-MP: - <5cm refer if persists - BL/Sx/Ca125 -> refer - >5cm -> advice
60
Pregnancy UTI
Test of cure 1w after completing abx and repeat MONTHLY until pregnancy completed May need supressive treatment. Amox or cef best. No TMP 1st trim. No nitro after 36w

MCQ Notes (8 decks)

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