Women's Health Flashcards
1
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Understand the role of the anaesthetist in the care of a pregnant woman.
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2
Q
Understand the issues specifically relevant to anaesthesia in pregnancy.
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3
Q
Describe the key components and rationale for pre-pregnancy counselling.
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4
Q
Describe the key components and rationale for the first antenatal visit.
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5
Q
Describe the key components and rationale for subsequent antenatal visits.
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6
Q
Explain the principles behind planning the timing and mode of delivery.
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7
Q
Describe the possible causes of congenital abnormalities.
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8
Q
Understand the tests used to detect abnormalities.
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9
Q
Distinguish between screening and diagnostic tests.
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10
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Appraise the advantages and disadvantages of antenatal screening and diagnostic tests.
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11
Q
Describe the options available when a congenital abnormality is detected.
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12
Q
Recognise the difference between primary and secondary prevention of abnormalities and can provide examples of both.
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13
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List the risk factors for shoulder dystocia in the antenatal period.
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14
Q
Recognise the signs of shoulder dystocia in labour.
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15
Q
Describe how to manage shoulder dystocia in an emergency situation.
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16
Q
Describe the indications for caesarean section.
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17
Q
Distinguish between an elective and an emergency caesarean section.
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18
Q
Outline the process of a caesarean section operation.
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19
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List the possible complications of a caesarean section, both in the short and longer term.
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20
Q
Appraise the advantages and disadvantages of caesarean section for both the mother and baby.
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21
Q
Consider a differential diagnosis for antepartum haemorrhage (APH).
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22
Q
Differentiate between placenta praevia and abruption placentae from history and clinical examination findings.
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23
Q
Appreciate the need for teamwork in the management of antepartum haemorrhage (APH).
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24
Q
Describe the principles of assessing metal well-being antenatally and in labour.
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25
Explain the principles of managing the situation where tests of metal well-being indicate acute severe metal compromise.
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26
List the differential forms of hormonal contraception available.
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27
State the main method of action for each form of hormonal contraception.
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28
List the main contraindications for combined hormonal contraception, intrauterine systems and implants.
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29
Discuss the advantages and disadvantages of all forms of hormonal contraception.
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30
Discuss the factors that contribute to a difference in efficacy between perfect use and typical use for hormonal contraception.
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31
Explain how BhCG levels correlate to the progression of normal and abnormal pregnancy in the first trimester.
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32
Describe the pathophysiology, diagnosis and management of hyperemesis gravidarum.
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33
Describe the pathophysiology, diagnosis and management of miscarriage and molar pregnancy.
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34
Describe the pathophysiology, diagnosis and management of ectopic pregnancy.
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35
Compare and contrast the basic diagnostic capabilities and limitations of ultrasonography in the first trimester of pregnancy.
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36
Describe the spectrum of psychological reactions to early pregnancy loss and complications and appraise the efficacy of early interventions that may reduce long term sequelae.
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37
List three to four common presenting symptoms each for endometriosis and adenomyosis.
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38
Explain the roles of investigations/tests used to diagnose endometriosis and adenomyosis.
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39
Describe the medical and surgical treatments that are currently available and the impact of desire for pregnancy on these choices.
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40
Discuss the impacts of autonomy and quality of life on a patient's choice of treatment.
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41
Describe what is happening to the foetus in utero that is important for survival after birth.
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42
Describe the causes of heavy menstrual bleeding (6).
1. Dysfunctional Uterine Bleeding (DUB; 60%; no organic pathology)
2. Systemic Causes (e.g. endocrine, bleeding disorders, liver disease)
3. Uterine and Local Causes (adenomyosis, fibroids, polyps, infection, carcinoma)
4. Iatrogenic
5. Pregnancy Complications
6. Trauma
43
Discuss the approach to evaluation of heavy menstrual bleeding, including the principles of gynaecological history and examination.
History
- First menarche (perimenarcheal- ?anovulatory)
- Regularity of cycle (irregular or long- ?anovulatory)
- Last Normal Menstrual Period (LMNP; consider pregnancy or anovulation)
- Quantify blood loss (days of bleeding + no. of heavy days, no. of pads/tampons, layers of protection, clots/flooding,
- Post-coital and inter-menstrual bleeding (suggests local cause)
- Dysmenorrhoea or dyspareunia (may suggest endometriosis, adenomyosis, infection)
- Symptoms of anaemia
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- Endocrine symptoms
- Bleeding disorder (
- Last Pap smear (cervical cancer)
- Medications
- Impact on life
Examination
- Vital signs: BP, postural drop, pulse, diaphoresis
- Systemic: pallor, endocrine disturbance (tremor, eye findings, skin, gore, acne, BMI), bruising, petechiae, bleeding mucosal surfaces
- Abdominal: mass
- Speculum:
- Bimanual:
44
Outline the medical and surgical management options for heavy menstrual bleeding under differing clinical circumstances.
Treat an underlying cause (e.g. endocrine cause) if one exists
Medical Therapy
1. Non-Hormonal
- PG inhibitors (restores imbalance of endometrial PGs)
- Antifibrinolytics (inhibits clot breakdown)
2. Hormonal
- OCP
- Depot provera
- Other (e.g. Danazol, GnRH analogues)- second line, side effects
3. Procedural
- Mirena IUCD
Surgical Therapy (used if medical treatments fail, and if fertility not desired)
1. Endometrial Ablation
- Laser, Roller ball diathermy, transcervical endometrial resection
- Thermal balloon, Microwave ablation, Heated saline
- 90% reduction in bleeding, TEMPORARY
- 60% satisfaction at 5 years
2. Hysterectomy
- Total or subtotal +/- oophorectomy
- Vaginal, abdominal or laparoscopically assisted
45
Describe the symptoms and signs of pre-eclampsia and eclampsia as well as the biochemical and haematological changes that may occur in association with these diagnoses.
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46
Outline the current understanding regarding the aetiology and pathophysiology of pre-eclampsia.
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47
Describe the possible maternal and foetal effects of pre-eclampsia.
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48
Describe the factors which may determine the decision to deliver and timing of delivery in cases of pre-eclampsia/eclampsia.
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49
Outline the principles of clinical management of pre-eclampsia/eclampsia.
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50
List the drugs that are commonly used in the management of pre-eclampsia/eclampsia and their side effects.
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51
Describe the methods available to monitor foetal well-being in cases of pre-eclampsia/eclampsia.
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52
Outline the post-natal management of the mother with pre-eclampsia.
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53
Understand the issues specifically relevant to indigenous women in pregnancy and gynaecological care.
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54
Understand the role of the Aboriginal liaison officer in the care of a woman seeking obstetric or gynaecological care.
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55
Understand the reasons for augmentation and induction of labour.
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56
Distinguish between augmentation and induction of labour.
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57
Describe the methods available for augmentation and induction of labour.
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58
Appraise the advantages and disadvantages of inducing labour.
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59
Understand the indications for an instrumental delivery.
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60
Describe the requirements for an instrumental vaginal delivery.
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61
Describe the devices available for instrumental delivery.
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62
Describe the risks to the mother and baby of an instrumental delivery.
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63
Appreciate the clinical public health significance of infectious diseases in pregnancy.
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64
Describe the preventative measures offered by antenatal screening.
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65
Understand the impact of maternal infection on the infant.
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Describe the differential diagnoses and appropriate tests to diagnose infection.
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67
Describe the principles of management of infections in pregnancy.
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68
Explain where to obtain expert assistance in complicated infections in pregnancy.
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69
Appreciate the boundaries of natural fertility.
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70
Understand common pathologies in subfertile individuals and partnerships.
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71
Take a medical history and perform a clinical examination relevant to fertility.
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72
Understand useful tests used to assess aetiology of infertility.
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73
Describe the interventions of IVF, ICSI and PGD.
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74
Describe the principles of intrapartum analgesia.
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75
Describe the principles of anaesthesia for operative birth.
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76
Understand the need for a team approach to manage women in labour.
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77
Describe the physiology of the first, second and third stages of labour.
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78
Understand the physical and emotional demands of labour on women and have an approach to the assessment and management of normal labour.
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79
Recognise the potential for foetal distress in labour and understand the principles of foetal surveillance in labour.
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80
Understand how to assess and document progress in labour.
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81
Explain the implications of IUGR with respect to the short and long term consequences.
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82
Appreciate the importance of IUGR diagnosis.
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83
Describe the principles of management of IUGR.
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84
List the most common problems encountered in the puerperium.
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85
Define puerperal sepsis and list the most common types of infections, most common organisms and discuss diagnosis and management strategies.
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86
Define secondary postpartum haemorrhage and the most common causes and outline medical and surgical approaches to its management.
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87
Recognise postnatal depression and psychosis.
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88
List specific complications after caesarean section and vaginal delivery.
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89
Understand the importance of post part haemorrhage and be able to actively manage the third stage of labour.
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90
Know how to recognise, diagnose and manage puerperal sepsis.
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91
Be able to manage a request for post part contraception.
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92
Describe the major medical diseases contributing to maternal mortality.
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93
Describe the physiological changes associated with normal pregnancy.
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94
Understand how pregnancy impacts on women with pre-existing medical disease.
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95
Understand which cardiac lesions pose the greatest risk in pregnancy.
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96
Provide basic pre-pregnancy counselling to a woman with cardiac disease.
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97
Outline the principles of management during pregnancy and labour of women with cardiac disease.
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98
Understand the approach to management of women with a past history of, or current, thromboembolism.
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99
Explain the principles of diagnostic imaging as applied to the pregnant mother.
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100
Explain the principles of how to perform effective resuscitation in a pregnant woman.
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101
Define the terminology used in menopause.
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Menopause:
Perimenopause:
Menopause Transition:
Postmenopause:
Early Menopause:
Premature Ovarian Insufficiency:
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102
List the core symptoms of menopause.
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103
Describe the health risks associated with menopause.
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104
Take a reproductive history and menopause history from a patient.
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105
Describe normal screening schedules for midlife women.
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106
Take a mental health history.
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107
Describe how to manage menopausal symptoms using hormonal and non-hormonal treatments.
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108
Determine zygosity and chorionicity in twins and understand the significance of both.
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109
Recognise the range of complications of multiple pregnancy.
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110
Understand the principles of antenatal twin management.
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111
Discuss timing and mode of delivery of twins.
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112
Have a general understanding of twin-twin transfusion syndrome (TTTS).
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113
Describe the different causes of respiratory distress.
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114
Explain the principles for how to treat a baby with respiratory distress.
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115
Understand the importance of neonatal resuscitation.
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116
Understand the unique physiology of the newborn and the importance of normal transition.
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117
Identify and assess the newborn at risk of needing resuscitation.
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118
Understand the importance of airway management and mask ventilation.
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119
Describe the resuscitation algorithm.
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120
Discuss the ethical issues surrounding resuscitation.
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121
Describe when different disorders are likely to present, relative to a newborn's age after birth.
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122
Understand how to manage a baby over the first week of life, including aspects of newborn screening.
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123
Identify specific and general problems related to obesity in pregnancy.
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124
Describe strategies for management of obesity in pregnancy.
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125
Discuss the risks and complications association with pre-gestational diabetes and describe the management of a pregnancy in these patients.
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126
Discuss the diagnostic criteria for gestational diabetes and its management in pregnancy.
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127
Be familiar with the spectrum of carcinoma types (histological classification) at various obstetric & gynaecological sites.
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128
Understand important histological prognostic variables in obstetric and gynaecological tumour pathology.
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129
Be familiar with the concept of tumours of borderline type (ovary).
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130
Understand the possible aetiologies for endometriosis and what is required to make a histological diagnosis of endometriosis.
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131
Have an understanding of the premalignant lesions of the female genital tract and risk factors for these.
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132
Understand the role of HPV in neoplasia of the cervix.
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133
Appreciate the spectrum of carcinoma types (histological classification) at various sites of the female genital tract (e.g. ovary, including the concept of borderline tumours).
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134
Understand the important histological prognostic variables in tumour pathology.
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135
Describe the possible aetiologies for endometriosis and what is required to make a histological diagnosis of endometriosis.
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136
Describe the underlying genetic abnormalities of molar pregnancy and how the diagnosis of molar gestation is made histologically.
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137
Identify sites of ectopic gestation and list predisposing factors.
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138
Appreciate the clinical and public health significance of preterm labour and delivery.
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139
Understand the aetiology and pathogenesis of preterm labour.
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140
Describe the risk factors associated with preterm labour.
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141
Discuss the management of preterm labour and delivery.
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142
Understand the use of corticosteroids and tocolysis in preterm labour.
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143
Understand the role of foetal neuroprotection in preterm labour and delivery.
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144
Discuss the management of preterm pre-labour rupture of membranes (PPROM).
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145
Discuss the symptoms and signs of chorioamnionitis.
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146
Describe the principles of antibody mediated disease and its impact on the foetus.
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147
Explain the difference between autoimmunity and alloimmunity.
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148
Understand the principles of primary and secondary immunisation stimulus.
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149
Describe the principles behind anti-red cell antibodies screening, management of the woman with anti-red cell antibodies in pregnancy and prevention of anti-D immunisation with passive anti-D administration.
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150
Describe the principles of (obstetric and gynaecological) cancer screening.
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151
Describe the symptoms and signs of the common gynaecological cancers.
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152
Describe the various treatment options for common gynaecological cancers.
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153
Describe the different causes of being born too small or too early.
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154
Describe the common and the different problems of being born too small or too early in the first days or weeks.
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155
Describe the maternal, placental, cord and foetal contributors to stillbirth.
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156
Describe the approach to diagnosis, investigation and management of stillbirth.
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157
Discuss the value of perinatal autopsy.
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158
Understand the principles of bereavement care as it applies to stillbirth, and to women contemplating a future pregnancy after a stillbirth.
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159
Describe the aetiology, epidemiology and prevalence of female urinary incontinence.
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160
Take a history and perform a relevant examination of a patient with urinary incontinence.
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Discuss investigations for urinary incontinence including urodynamic and imaging tests.
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Describe conservative treatment for incontinence including pelvic floor exercises and lifestyle changes.
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Appreciate surgical treatments available including vaginal and abdominal (open/laparoscopic) procedures.
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164
Discuss the aetiology, epidemiology and prevalence of prolapse of pelvic organs.
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Describe the common symptoms or prolapse of pelvic organs.
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Describe conservative treatments for prolapse of pelvic organs, including pelvic floor exercises and lifestyle changes.
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167
Appreciate the surgical treatments available for prolapse of pelvic organs including vaginal and abdominal (open/laparoscopic) procedures.
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168
Understand the causes of acute pelvic pain and have a systematic clinical approach to this common problem.
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169
Understand the differential diagnoses for acute pelvic pain as belonging to two main groups- gynaecological vs. non-gynaecological.
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170
Have knowledge of common gynaecological (pregnancy and non-pregnancy) causes that will be essential in formulating questions during history taking.
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171
Learn to understand and appreciate clinical signs pertaining to different clinical conditions in the presentation of acute pelvic pain.
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172
Appreciate and quickly identify the presence of life-threatening conditions that demand immediate surgical intervention, e.g. ruptured ectopic pregnancy, acute appendicitis.
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173
Describe the aetiology, pathophysiology, clinical presentation and management of antepartum haemorrhage.
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174
Describe the aetiology, pathophysiology, clinical presentation and management of alloimmunisation (isoimmunisation).
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175
Describe an approach to PMB, AUB, assessment of women at risk of premalignant and malignant endometrial disease.
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176
Describe an approach to a woman with a complex adnexal mass.
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177
Describe an approach to a woman with risk of ovarian cancer.
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178
Describe an approach to a woman with suspected cervical cancer.
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179
Describe an approach to a woman with a vulval lesion or persistent vulval itch.
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180
Explain the principles of non-hormonal contraception.
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181
Explain the principles of safe sex.
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182
Explain the principles of non-hormonal emergency contraception.
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183
Explain the principles of informed consent.
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184
Explain the principles of an STI screen.
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185
Describe the principles of screening for Down Syndrome in the first and second trimesters of pregnancy.
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186
Describe the diagnostic tests available for screening for Down Syndrome.
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187
Discuss the law as it pertains to the situation of termination of pregnancy (in context of Down Syndrome screening).
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188
Describe the pharmacological and surgical management methods for termination of pregnancy (abortion).
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189
Describe the aetiology, pathophysiology, clinical presentation and management of heavy menstrual bleeding (HMB) in different age groups.
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190
Describe the aetiology, pathophysiology, clinical presentation and management of uterine fibroids in different age groups.
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191
Outline management approaches to heavy menstrual bleeding (HMB) and fibroid uterus (hormonal, MRgFUS, UAE, surgical including ablation).
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192
Explain the basic principles of varying surgical approaches to fibroids (hysteroscopic vs. laparoscopic vs. open myomectomy vs. hysterectomy).
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| hysteroscopic vs. laparoscopic vs. open myomectomy vs. hysterectomy
193
Describe how the foetus at certain ages is more or less vulnerable to organ specific damage with infection.
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194
Discuss the public health issues of herpes simplex virus and Group B Streptococcal disease and the principles of an ineffective or effective screening program.
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195
Describe th aetiology, pathophysiology, clinical presentation and management of common newborn infections acquired from the maternal genital tract, including bacterial Group B Streptococcal disease, HIV and HSV.
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196
Discuss the prevention of chorioamnionitis and postpartum endometritis at term.
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197
Describe the aetiology, pathophysiology, clinical presentation and management of female infertility.
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198
Describe the aetiology, pathophysiology, clinical presentation and management of male infertility.
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199
Describe the aetiology, pathophysiology, clinical presentation and management of combined infertility.
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200
Describe the aetiology, pathophysiology, clinical presentation and management of unexplained fertility.
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201
Describe the aetiology, pathophysiology, clinical presentation and management of recurrent implantation failure.
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202
Describe the aetiology, pathophysiology, clinical presentation and management of a fundus less than dates, intrauterine growth restriction (IUGR) and acute foetal compromise.
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203
Describe features of a normal cardiotocograph (CTG).
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204
Recognise abnormal features on a CTG.
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205
Describe the indications for and complications of emergency caesarean section.
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206
Define oligomenorrhoea.
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207
Describe the aetiology, pathophysiology, clinical presentation and management of anovulatory dysfunctional uterine bleeding.
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208
Describe the aetiology, pathophysiology, clinical presentation and management of PCOS and its sequelae.
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209
Describe the steps involved in obstetric abdominal examination, to a level that allow the student to perform the examination in antenatal clinics with identification of all key aspects: fundal height, lie, presentation, station and foetal heart.
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210
Take an obstetric history at the first antenatal visit, subsequent antenatal visits and other antenatal presentations.
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211
Describe the aetiology, clinical presentation and management of malpresentations.
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212
Describe the aetiology, pathophysiology, clinical presentation and management of the menopause transition and the menopause.
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213
Describe mental health issues that occur at menopause.
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214
Describe the non-hormonal treatments available for menopausal symptoms.
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215
Define the different types of miscarriage and recurrent miscarriage.
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216
Understand the embryology of early pregnancy loss.
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217
Describe the recognised causes of recurrent first trimester and/or sporadic second trimester loss.
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218
Discuss the investigation and management of different forms of miscarriage.
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219
Discuss the causes and management of mid-trimester loss.
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220
Appreciate the grief process.
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221
Recognise the clinical presentations of: shock from uterine blood loss, cervical shock and genital tract sepsis.
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222
Outline the management for: shock from uterine blood loss, cervical shock and genital tract sepsis.
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223
Describe the aetiology, pathophysiology, clinical presentation and management of twin pregnancy.
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224
Describe the aetiology, pathophysiology, clinical presentation and management of chorionicity and twin-twin transfusion.
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225
Describe the aetiology, pathophysiology, clinical presentation and management of preterm labour and preterm rupture of membranes.
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226
Discuss the management of the premature neonate.
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227
Recognise when a baby has jaundice that requires either investigation or treatment.
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228
Describe the major causes of neonatal jaundice and outline the available treatments.
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229
Describe the foetal and maternal risks and benefits of vaginal birth after caesarean (VBAC) and elective repeat caesarean section (ERC).
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230
Appraise the strengths and weaknesses of the research and data on the risks and benefits of both modes of birth (VBAC vs. ERC).
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231
Acknowledge the role of the mother's wishes in the decision regarding the birth.
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232
Discuss the differing risk/benefit profiles between women at different stages of their reproductive life (i.e. the 18yo planning a large family, vs. the 42yo woman with long history of infertility).
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233
Discuss birthing options with a pregnant woman who has had a previous caesarean section.
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234
Describe the aetiology, pathophysiology, clinical presentation and management of obesity, gestational diabetes mellitus, shoulder dystocia and neonatal hypoglycaemia (due to maternal diabetes).
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235
Describe the indications for, methods and potential complications of induction of labour and instrumental delivery.
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236
Describe the natural defence mechanisms of the genital tract.
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237
Describe the natural vaginal flora.
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238
Explain the differential diagnoses of a vaginal discharge.
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239
List the common causative organisms causing infection of the vagina and cervix.
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240
Describe the aetiology, pathophysiology, clinical presentation and management of sexually transmitted infections.
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241
Describe the understanding of the aetiology, pathophysiology, clinical presentation and management of acute pelvic inflammatory disease.
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242
Describe the aetiology, pathophysiology, clinical presentation and management of retained placenta.
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243
Describe the aetiology, pathophysiology, clinical presentation and management of primary PPH.
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244
Describe the aetiology, pathophysiology, clinical presentation and management of puerperal fever.
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245
Describe the aetiology, pathophysiology, clinical presentation and management of secondary PPH.
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246
Describe the symptoms and signs of pre-eclampsia and eclampsia, as well as the biochemical and haematological changes that may occur in association with these diagnoses.
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247
Discuss the current understanding regarding the aetiology and pathophysiology of pre-eclampsia.
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248
Describe the possible maternal and foetal effects of pre-eclampsia.
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249
List the factors which may determine the decision to deliver and timing of delivery in cases of pre-eclampsia/eclampsia.
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250
Discuss the principles of clinical management of pre-eclampsia/eclampsia.
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251
List the drugs that are commonly used in the management of pre-eclampsia/eclampsia and their side effects.
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252
Outline the methods available to monitor foetal well-being in cases of pre-eclampsia/eclampsia.
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253
Discuss the post-natal management of the mother with pre-eclampsia.
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254
Explain why pre-pregnancy counselling is important.
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255
Outline the key elements of a pre-pregnancy consultation.
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256
Outline the strategies available to optimise fertility, implantation, embryogenesis and to prevent congenital anomalies.
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257
Discuss how epilepsy affects pregnancy and how pregnancy can affect the epilepsy.
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258
Discuss how type 1 diabetes affects pregnancy and how pregnancy can affect type 1 diabetes.
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259
Describe the measures that can help to prevent maternal and foetal complications in epilepsy and type 1 diabetes.
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260
Describe the aetiology, pathophysiology, clinical presentation and management of puberty.
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261
Describe the aetiology, pathophysiology, clinical presentation and management of primary amenorrhoea.
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262
Describe the aetiology, pathophysiology, clinical presentation and management of secondary amenorrhoea.
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