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Phase 3a > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What is primary amenorrhoea?

A

When menstruation has not commenced by the age of 16

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2
Q

What is secondary amenorrhoea?

A

When menstruation has ceased for 6 months or more

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3
Q

Give examples of primary amenorrhoea where sexual characteristics are present

A
  • Constitutional delay
  • Genitourinary malformation
  • Testicular feminisation
  • Hyperprolactinaemia
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4
Q

Give examples of primary amenorrhoea where sexual characteristics are not present

A
  • Ovarian failure (chemo, irradiation, chromosomal)

- Hypothalamic failure (chronic disease, excess exercise, stress, underweight)

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5
Q

Give examples of secondary amenorrhoea

A
  • Pregnancy
  • Lactation
  • Polycystic Ovary Syndrome
  • Hypothalamic amenorrhoea
  • Hyperprolactinaemia
  • Primary Ovarian insufficiency
  • Hypothyroidism
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6
Q

A 30 year old female presents with dysmenorrhoea, lower back pain and dyspareunia which tends to get worse with at the time of periods- what is the most likely diagnosis

A

Endometriosis

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7
Q

What happens in endometriosis?

A

There is retrograde menstruation leading to endometrial tissue being present outside of the uterus. This tissue is oestrogen dependent and grows and bleeds in the presence of oestrogen

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8
Q

What is the management of endometriosis?

A
  • Analgesia - NSAIDs, Paracetamol
  • Hormonal - pill, GnRH, Oral progestogens, Mirena
  • Surgery to ablate the endometrial lesions
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9
Q

What are the risk factors for endometrial cancer?

A
  • Obesity
  • Diabetes
  • Null parity
  • Late menopause
  • Early menstruation
  • Polycystic ovary syndrome
  • Pelvic irradiation
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10
Q

What is a typical presentation of endometrial cancer?

A

Post-menopausal bleeding

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11
Q

How is endometrial cancer investigated and diagnosed?

A
  • Transvaginal ultrasound (thickness of endometrium)
  • Hysteroscopy
  • Endometrial biopsy
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12
Q

What are the risk factors for cervical cancer?

A
  • HPV infection
  • Early first intercourse
  • Multiple sexual partners
  • STDs
  • Smoking
  • Multiparity
  • OCD
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13
Q

What are the symptoms of cervical cancer if symptoms are present?

A
  • Abnormal bleeding e.g. after sex, intermenstrual or postmenopausal
  • Additional: dyspaeuria, vaginal discharge, pain in the lower back or pelvis
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14
Q

What procedure is done to remove abnormal cells from the cervix?

A

Large Loop Excision of the Transformation Zone

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15
Q

At what age is cervical screening given and how often is is done?

A
  • 25 to 49 - every 3 years

- 50 to 64 - every 5 years

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16
Q

What are the two main types of breast cancer?

A
  • Ductal (invasive or in-situ)

- Lobular (invasive or in-situ)

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17
Q

What are the risk factors for breast cancer?

A
  • Increasing age
  • Family history
  • Long duration of oestrogen exposure
  • Late first pregnancy
  • HRT
  • Obesity
  • Alcohol
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18
Q

What features can be found in breast cancer?

A
  • Painless lump
  • Nipple discharge
  • Nipple in-drawing
  • Rash
  • Breast lump
  • Peau d’orange (pitted skin similar to orange peel)
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19
Q

When is breast screening offered to women and how often?

A

50 to 50 years old every three years

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20
Q

What is the triple assessment when investigating for breast cancer?

A
  • Examination
  • Mammogram
  • Biopsy
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21
Q

Where are the common metastases sites with Breast cancer?

A
  • Bone
  • Liver
  • Pleura
  • Soft tissue
  • Brain
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22
Q

What are the differential diagnoses of breast lumps?

A
  • Breast cysts
  • Fibroadenoma
  • Fibrocystic
  • Trauma/injury
  • Lipoma
  • Mastitis
  • Milk cyst (galactocele)
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23
Q

A 60 year old female presents with a history of bloating, abdominal discomfort and having to frequently go to the toilet. When you ask further questions she also mentions her bowels have changed over the last few months. What would you you be concern about?

A

Ovarian cancer - it can present with IBS-like symptoms

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24
Q

How is the risk of malignancy index calculated in relation to ovarian cancer?

A

RMI = CA125 x ultrasound score x pre or post menopause score

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25
Q

What are the Amin risk factors for ovarian cancer?

A
  • Duration of ovulation (the longer it is the greater the risk)
  • BRCA 1 or 2 or HNPCC
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26
Q

What are fibroids?

A

Oestrogen-dependent benign tumours made of smooth muscle that develop in/on the uterus

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27
Q

What clinical features do you get with fibroids?

A
  • Many are asymptomatic
  • Menorrhagia
  • Anaemia

or may present as cause of infertility or miscarriage

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28
Q

What can be done to treat fibroids?

A
  • Asymptomatic = none
  • Medical = Tranezamic acid, GnRH agonist
  • Surgical = Embolisation, resection, myomectomy, hysterectomy
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29
Q

What symptoms can people experience with an ovarian cyst?

A

Pelvic pain, dyspareunia, constipation, urinary frequency, menorrhagia, irregular periods, bloating, early satiety, sub-fertility

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30
Q

What test would you do to rule out malignancy in suspect ovarian cysts?

A

CA125

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31
Q

If someone presents with irregular periods, hirsutism and bad acne what diagnosis would you consider?

A

Polycystic ovary syndrome

32
Q

What criteria do you need to meet to diagnose polycystic ovary syndrome?

A

The patient should ave 2 or more of the following:

  • Irregular periods
  • Blood test showing high level of androgens
  • Ultrasound scan showing polycystic ovaries
33
Q

What is the management for polycystic ovary syndrome?

A
  • Lifestyle changes (lose weight and exercise)
  • Contraceptive pill (for irregular periods)
  • Clomifene (encourages the monthly release of an egg)
34
Q

What is pre-eclampsia?

A

Hypertension in pregnancy with proteinuria after 20 weeks of pregnancy

35
Q

What symptoms can patients get with pre-eclampsia?

A
  • Sometimes none
  • Visual disturbance
  • Headache
  • Epigastric pain
  • Oedema
  • Rapid weight gain
36
Q

How is pre-eclampsia managed?

A

Monitoring, only way to cure is to deliver (indications for delivery - low platelets, deterioration in liver and renal function, abruption of placenta, severe headaches, visual changes, vomiting)

37
Q

What is the potential complication of pre-eclampsia if it is left?

A

Eclampsia - seizures occur due to untreated pre-eclampsia

38
Q

A pregnancy women presents with painless, bright red vaginal bleeding. What would you be worried about?

A

Placenta previa

39
Q

A pregnant women presents with abdominal pain, tenderness and vaginal bleeding. What would you be worried about?

A

Placental abruption

40
Q

A pregnant women presents with ruptured membranes followed by painless vaginal bleeding. What would you be concerned about?

A

Vasa previa

41
Q

What is placenta previa?

A

Where the placenta is covering or is very close to the cervical os

42
Q

What is placental abruption?

A

Premature separation of try placenta from the uterine wall

43
Q

What is vasa previa?

A

Where the fetal vessels course through the membranes that are over the cervical os and below the presenting part of the fetus

44
Q

What are the causes of postpartum haemorrhage?

A
  • Tone (uterine atony)
  • Trauma (injury during birth)
  • Tissue (abnormal placenta or placenta retention)
  • Thrombin (blood disorder)
45
Q

What is menopause and at what point is it said to have occurred?

A

The permanent cessation of menstruation - classed as menopause after 12 months of no periods

46
Q

What are the symptoms of the menopause?

A

Flushing, mood change, irritability, mild difficulty with memory, headaches, dry itchy skin, lack of energy

47
Q

What problems can arise long-term post menopause?

A
  • Urogenital atrophy and prolapse
  • Osteoporosis
  • Cardiovascular disease
  • Dementia
48
Q

What can be done to manage the menopause?

A
  • Lifestyle change e.g. lose weight, stop smoking, improve diet
  • HRT
  • CBT
  • Clonidine (alpha-blocker)
49
Q

What regimens are there of HRT?

A
  • Cyclical = oestrogen everyday with progesterone for the last 14 days of the month
  • 3 monthly = oestrogen every day with progesterone the last 14 days of the 3 months
50
Q

What are the potential risks of HRT?

A
  • Increased risk of breast cancer
  • Increased risk of endometrial cancer
  • Increased risk of VTE
  • Increased risk of cardiovascular disease
  • Increased risk of stroke
51
Q

When should menopause be investigated?

A

If it occurs before 45 years of age

52
Q

What are the causes of premature menopause?

A
  • Majority idiopathic
  • Ovarian failure
  • Chromosomal
  • Infection TB, malaria, mumps)
  • Cancer treatments
53
Q

What is menorrhagia? How is it defined?

A

Excessive menstrual bleeding defined as bleeding that is greater than 80ml

54
Q

What are the possible causes of menorrhagia?

A
  • Physiological
  • Endometriosis
  • Fibroids
  • Pelvic Inflammatory Disease
  • Endometrial polyps
  • Polycystic Ovary Syndrome
  • Gynaecological cancers
55
Q

How is menorrhagia managed (other than attempting to remove cause)?

A

First line - IUS

Second line - Trnexamic acid, NSAIDs, COCP

56
Q

What are the possible causes of intermenstrual bleeding?

A
  • Missed or newly started hormonal contraceptive
  • STI
  • Vaginal dryness
  • Stress
  • Vaginal injury
  • Gynaecological cancers
  • Cervical ectropion
  • Anticoagulants
  • Cervical polyps
57
Q

What are the possible causes of post-coital bleeding?

A
  • Infection
  • Cervical ectropion
  • Cervical or endometrial polyps
  • Vaginal or cervical cancer
  • Trauma
58
Q

What are the possible causes of post-menopausal bleeding?

A
  • Vaginal atrophy
  • Vaginal dryness
  • Endometrial atrophy
  • Polyps
  • Endometrial hyperplasia
  • Gynaecological cancers
59
Q

What are the causes of dysmenorrhoea?

A
  • Primary

- Secondary: Endometriosis, fibroids, Pelvic Inflammatory Disease, Intrauterine Device (IUD)

60
Q

What is the management of primary dysmenorrhoea?

A
  • NSAIDs

- COCP

61
Q

A women comes to you complaining of an abnormal amount of discharge and a bad vaginal smell. What is the likely diagnosis?

A

Bacterial vaginosis

62
Q

A women comes to you complaining about a funny discharge and irritation of the vagina, particularly while having sex. On examination the discharge is a thick white discharge similar to cottage cheese. What is the most likely diagnosis?

A

Thrush

63
Q

A women presents to you complaining of a thick frothy yellow discharge and itchy skin and soreness around the vagina and thighs. What is the most likely diagnosis?

A

Trichomoniasis

64
Q

What is the treatment of thrush?

A

Fluconazole (oral) or Clotrimazole (cream or pessary)

65
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole (oral or gel)

66
Q

What is the treatment for trichomoniasis

A

Metronidazole

67
Q

What are the three main types of prolapse?

A
  • Cystocele
  • Rectocele
  • Uterovaginal
68
Q

What are the risk factors for prolapse?

A
  • Pregnancy
  • Smoking (chronic cough)
  • Constipation
  • Heavy lifting
  • Surgery
  • Connective tissue disorders e.g. Ehlers danlos
69
Q

What management is there for prolapses?

A
  • Physiotherapy
  • Intravaginal devices e.g. pessaries
  • Surgical repair
70
Q

What is a threatened miscarriage?

A

When bleeding occurs but the fetus is still alive, the cervical os is closed and the baby is of expected size

71
Q

What is a complete miscarriage?

A

Tis is where the fetus has died and all fetal parts have passed , bleeding has diminished and the cervical os is closed

72
Q

What is a missed miscarriage?

A

This is where the fetus has died but this has been missed and is only noticed on ultrasound or upon the start of bleeding

73
Q

What are the risk/causes of miscarriage?

A
  • Chromosomal abnormalities
  • Age
  • Obesity
  • Smoking
  • Alcohol consumption
  • Caffeine consumption
74
Q

What are the symptoms of miscarriage?

A
  • Bleeding (from light spotting to brown discharge to heavy bleeding)
  • Cramping pain in the lower abdomen
  • Discharge of fluid
  • Discharge of tissue
  • Loss of pregnancy symptoms
75
Q

A 25 year old sexually active female presents to you with lower right abdominal pain and pain at the tip of the shoulder. What would you need to rule out?

A

Ectopic pregnancy

76
Q

What is the management for ectopic pregnancy?

A
  • Expectant management (monitor and hope egg dissolves)
  • Methotrexate injection
  • Surgery

Phase 3a (5 decks)

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