Women's Health Flashcards
1
Q
What is primary amenorrhoea?
A
When menstruation has not commenced by the age of 16
2
Q
What is secondary amenorrhoea?
A
When menstruation has ceased for 6 months or more
3
Q
Give examples of primary amenorrhoea where sexual characteristics are present
A
- Constitutional delay
- Genitourinary malformation
- Testicular feminisation
- Hyperprolactinaemia
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)
5
Q
Give examples of secondary amenorrhoea
A
- Pregnancy
- Lactation
- Polycystic Ovary Syndrome
- Hypothalamic amenorrhoea
- Hyperprolactinaemia
- Primary Ovarian insufficiency
- Hypothyroidism
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
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
8
Q
What is the management of endometriosis?
A
- Analgesia - NSAIDs, Paracetamol
- Hormonal - pill, GnRH, Oral progestogens, Mirena
- Surgery to ablate the endometrial lesions
9
Q
What are the risk factors for endometrial cancer?
A
- Obesity
- Diabetes
- Null parity
- Late menopause
- Early menstruation
- Polycystic ovary syndrome
- Pelvic irradiation
10
Q
What is a typical presentation of endometrial cancer?
A
Post-menopausal bleeding
11
Q
How is endometrial cancer investigated and diagnosed?
A
- Transvaginal ultrasound (thickness of endometrium)
- Hysteroscopy
- Endometrial biopsy
12
Q
What are the risk factors for cervical cancer?
A
- HPV infection
- Early first intercourse
- Multiple sexual partners
- STDs
- Smoking
- Multiparity
- OCD
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
14
Q
What procedure is done to remove abnormal cells from the cervix?
A
Large Loop Excision of the Transformation Zone
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
16
Q
What are the two main types of breast cancer?
A
- Ductal (invasive or in-situ)
- Lobular (invasive or in-situ)
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
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)
19
Q
When is breast screening offered to women and how often?
A
50 to 50 years old every three years
20
Q
What is the triple assessment when investigating for breast cancer?
A
- Examination
- Mammogram
- Biopsy
21
Q
Where are the common metastases sites with Breast cancer?
A
- Bone
- Liver
- Pleura
- Soft tissue
- Brain
22
Q
What are the differential diagnoses of breast lumps?
A
- Breast cysts
- Fibroadenoma
- Fibrocystic
- Trauma/injury
- Lipoma
- Mastitis
- Milk cyst (galactocele)
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
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
25
What are the Amin risk factors for ovarian cancer?
- Duration of ovulation (the longer it is the greater the risk)
- BRCA 1 or 2 or HNPCC
26
What are fibroids?
Oestrogen-dependent benign tumours made of smooth muscle that develop in/on the uterus
27
What clinical features do you get with fibroids?
- Many are asymptomatic
- Menorrhagia
- Anaemia
or may present as cause of infertility or miscarriage
28
What can be done to treat fibroids?
- Asymptomatic = none
- Medical = Tranezamic acid, GnRH agonist
- Surgical = Embolisation, resection, myomectomy, hysterectomy
29
What symptoms can people experience with an ovarian cyst?
Pelvic pain, dyspareunia, constipation, urinary frequency, menorrhagia, irregular periods, bloating, early satiety, sub-fertility
30
What test would you do to rule out malignancy in suspect ovarian cysts?
CA125
31
If someone presents with irregular periods, hirsutism and bad acne what diagnosis would you consider?
Polycystic ovary syndrome
32
What criteria do you need to meet to diagnose polycystic ovary syndrome?
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
What is the management for polycystic ovary syndrome?
- Lifestyle changes (lose weight and exercise)
- Contraceptive pill (for irregular periods)
- Clomifene (encourages the monthly release of an egg)
34
What is pre-eclampsia?
Hypertension in pregnancy with proteinuria after 20 weeks of pregnancy
35
What symptoms can patients get with pre-eclampsia?
- Sometimes none
- Visual disturbance
- Headache
- Epigastric pain
- Oedema
- Rapid weight gain
36
How is pre-eclampsia managed?
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
What is the potential complication of pre-eclampsia if it is left?
Eclampsia - seizures occur due to untreated pre-eclampsia
38
A pregnancy women presents with painless, bright red vaginal bleeding. What would you be worried about?
Placenta previa
39
A pregnant women presents with abdominal pain, tenderness and vaginal bleeding. What would you be worried about?
Placental abruption
40
A pregnant women presents with ruptured membranes followed by painless vaginal bleeding. What would you be concerned about?
Vasa previa
41
What is placenta previa?
Where the placenta is covering or is very close to the cervical os
42
What is placental abruption?
Premature separation of try placenta from the uterine wall
43
What is vasa previa?
Where the fetal vessels course through the membranes that are over the cervical os and below the presenting part of the fetus
44
What are the causes of postpartum haemorrhage?
- Tone (uterine atony)
- Trauma (injury during birth)
- Tissue (abnormal placenta or placenta retention)
- Thrombin (blood disorder)
45
What is menopause and at what point is it said to have occurred?
The permanent cessation of menstruation - classed as menopause after 12 months of no periods
46
What are the symptoms of the menopause?
Flushing, mood change, irritability, mild difficulty with memory, headaches, dry itchy skin, lack of energy
47
What problems can arise long-term post menopause?
- Urogenital atrophy and prolapse
- Osteoporosis
- Cardiovascular disease
- Dementia
48
What can be done to manage the menopause?
- Lifestyle change e.g. lose weight, stop smoking, improve diet
- HRT
- CBT
- Clonidine (alpha-blocker)
49
What regimens are there of HRT?
- 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
What are the potential risks of HRT?
- Increased risk of breast cancer
- Increased risk of endometrial cancer
- Increased risk of VTE
- Increased risk of cardiovascular disease
- Increased risk of stroke
51
When should menopause be investigated?
If it occurs before 45 years of age
52
What are the causes of premature menopause?
- Majority idiopathic
- Ovarian failure
- Chromosomal
- Infection TB, malaria, mumps)
- Cancer treatments
53
What is menorrhagia? How is it defined?
Excessive menstrual bleeding defined as bleeding that is greater than 80ml
54
What are the possible causes of menorrhagia?
- Physiological
- Endometriosis
- Fibroids
- Pelvic Inflammatory Disease
- Endometrial polyps
- Polycystic Ovary Syndrome
- Gynaecological cancers
55
How is menorrhagia managed (other than attempting to remove cause)?
First line - IUS
| Second line - Trnexamic acid, NSAIDs, COCP
56
What are the possible causes of intermenstrual bleeding?
- Missed or newly started hormonal contraceptive
- STI
- Vaginal dryness
- Stress
- Vaginal injury
- Gynaecological cancers
- Cervical ectropion
- Anticoagulants
- Cervical polyps
57
What are the possible causes of post-coital bleeding?
- Infection
- Cervical ectropion
- Cervical or endometrial polyps
- Vaginal or cervical cancer
- Trauma
58
What are the possible causes of post-menopausal bleeding?
- Vaginal atrophy
- Vaginal dryness
- Endometrial atrophy
- Polyps
- Endometrial hyperplasia
- Gynaecological cancers
59
What are the causes of dysmenorrhoea?
- Primary
| - Secondary: Endometriosis, fibroids, Pelvic Inflammatory Disease, Intrauterine Device (IUD)
60
What is the management of primary dysmenorrhoea?
- NSAIDs
| - COCP
61
A women comes to you complaining of an abnormal amount of discharge and a bad vaginal smell. What is the likely diagnosis?
Bacterial vaginosis
62
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?
Thrush
63
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?
Trichomoniasis
64
What is the treatment of thrush?
Fluconazole (oral) or Clotrimazole (cream or pessary)
65
What is the treatment for bacterial vaginosis?
Metronidazole (oral or gel)
66
What is the treatment for trichomoniasis
Metronidazole
67
What are the three main types of prolapse?
- Cystocele
- Rectocele
- Uterovaginal
68
What are the risk factors for prolapse?
- Pregnancy
- Smoking (chronic cough)
- Constipation
- Heavy lifting
- Surgery
- Connective tissue disorders e.g. Ehlers danlos
69
What management is there for prolapses?
- Physiotherapy
- Intravaginal devices e.g. pessaries
- Surgical repair
70
What is a threatened miscarriage?
When bleeding occurs but the fetus is still alive, the cervical os is closed and the baby is of expected size
71
What is a complete miscarriage?
Tis is where the fetus has died and all fetal parts have passed , bleeding has diminished and the cervical os is closed
72
What is a missed miscarriage?
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
What are the risk/causes of miscarriage?
- Chromosomal abnormalities
- Age
- Obesity
- Smoking
- Alcohol consumption
- Caffeine consumption
74
What are the symptoms of miscarriage?
- 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
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?
Ectopic pregnancy
76
What is the management for ectopic pregnancy?
- Expectant management (monitor and hope egg dissolves)
- Methotrexate injection
- Surgery
