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Final year > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Trichomonas vaginalis symptoms

A

Fishy smelling green/yellow discharge. DYsuria, urinary frequency and itch. Can cause premature labour if infected during pregancy

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2
Q

Trichomonas vaginalis treatment

A

7 days oral metronidazole

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3
Q

Is trichomonas vaginalis sexually transmitted?

A

Yes

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4
Q

Gonorrhoea treatment

A

IM ceftriaxone 500mgh stat

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5
Q

Neisseria gonorrhoea microscopic appearance

A

Gram neg diplococcus

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6
Q

Chlamydia treatment

A

1g azithromhycin oral

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7
Q

Candida presentation

A

White curd discharge. Vulva often itchy, red and fissured

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8
Q

Candida treatment

A

Pessary or topical clotrimazole. Can use fluconazole if resistant

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9
Q

Syphillis causitive organism

A

Treponema Pallidum

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10
Q

Syphillis presntation/treatment

A

Primary stage is chancre in genital region. Benzathine penicillin to treat

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11
Q

What is anovulatory dysfunctional uterine bleeding?

A

Irrgular and unpredictable uterine bleeding within first years of menarche due to immaturity of HPO axis. Hyperoestrogenic state leading to endometrial hyperplasia. Patchy degeneration causes irregular/unpredicatble bleeding

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12
Q

Ovulatory dysfunctional uterine bleeding (+ treatment)

A

Excessive production of vasoconstrictive prostaglandins during menstrual period causing sever and prolonged menstrual bleeding and painful contractions. Treat with NSAIDs

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13
Q

Cervical cancer risk factors

A

Smoking, early intercourse, multiple sexual partners, oral contraceptives and immunosupression

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14
Q

Cervical cancer symptoms

A

Asymptomatic often in early stages. Then causes vaginal spotting, post-coital bleeding, dyspareunia and vaginal discharge

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15
Q

Prolactinoma treatment

A

Bromocriptine or cabergoline (dopamine agonists)

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16
Q

Effect of prolactinoma (hyperprolactinaemia) in women

A

Amenorrhea, oligomenorrhea, galactorrhoea, reduced labido and interility. Mass can cause visual field diefects, headaches, hypopituitarism and cranial nerve palsies

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17
Q

Prolactinoma investigations

A

TFTs, prolactin level, visual field tests and pituitary MRI

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18
Q

Age at which girls with secondary sexual characteristics but primary amenorrhoea should be referred

A

16

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19
Q

Age at which girls with no secondary sexual characteristics and primary amenorrhoea should be referred

A

14

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20
Q

First investigation in primary and ammenorhoea

A

Pregnancy test

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21
Q

Recommended investigation into tubal patency (comorbidities eg endometriosis)

A

Laparoscopy and dye test

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22
Q

Recommended investigation into tubal patency (no comorbidities)

A

hysterosalpingography - do just after menstruation as this is when the uterine lining is at its thinnest

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23
Q

Recommended test to check ovulation

A

Mid luteal progesterone - 7 days prior to expected next period

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24
Q

Which nerve should be blocked prior to ventouse extraction?

A

Puedendal

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25
Where is the puedendal nerve located? | *MAYBE DELETE*
Lateral wall of the ischiorectal fossa and into the obturatus internus fascia in Alcock's canal
26
Vulvodynia
Chronic vulvovaginal pain lasting at least 3 months with no identifiable cause
27
Vulvodynia treatment
Amitriptyline
28
First line ix placental abruption?
Transabdominal US
29
Condition not compatible with bimanual palpation
Placental praevia
30
Signs of septic miscarriage
Increasing pain, bleeding and fever. Fetal tissue often stuck in os. May be discharge too.
31
Microscopic appearance of T. vaginalis
Pear-shaped trichomonads (100% specific)
32
Investigation to confirm trichomonas vaginalis
High vaginal swab and wet mount microscopy
33
Trichomonas vaginalis treatment
Single dose metronidazole (treat both patients)
34
Is trichomonas vaginalis an STI?
Yes
35
Trichomonas vaginalis symptoms
Yellow green vaginal discharge with a strong odour. May be dysuria, dyspanuria, irritation and itching. (men often asymptomatic but can develop penile irritation, mild discharge, dysuria or pain after ejaculating)
36
Appearance of molar pregnancy on ultra-sound
Snow storm
37
Treatment for gestational trophoblastic disease
Suctioning/manual evacuation followed by 6 months close monitoring of beta HCG levels to check it wasn't invasive choriocarcinoma. Avoid pregnancy for 6 months
38
Complications during evacuation of molar pregnancy
Thyrotoxic storm - betaHCG resembles TSH
39
Presentation of molar pregnancy
Signs of early pregnancy failure - PV bleed. US shows large for dates pregnancy with snow storm. Can have exaggerated symptoms of pregnancy
40
First line treatment for stress incontinence
Pelvic floor training - 8 contractions 3x per day for 6 weeks
41
Conditions in which oxybutinin is used
Overactive bladder or mixed urinary incontinence
42
Cervical screening ages and frequencies UK
25-49 three yearly, 50-64 is five yearly
43
Liver enzyme/s raised during pregnancy
ALP only. AST and ALT remain normal.
44
What is colestyramine?
A chelating agent used to bind bile acids
45
Risk factors for placenta praevia
Mum >35, multiparity,multiple pregnancy, assisted fertility, previous placenta praevia, smoking and short interpregnancy interval
46
Placenta praevia presentation
Painless fresh vaginal bleeding. Can be spontaneous or provoked by intercourse/vaginal examination. Bleeding usually resolves spontaneously.
47
Diagnosis of placenta praevia
US - if placenta is low lying at anomaly scan then re-scan to check for this at 32 weeks
48
Concealed placental abruption presentation
Sudden onset pain as placenta detaches. No bleeding as contained in uterus though
49
Placental abruption presentation
Significant sudden abdo pain, hard 'woody' contracted uterus and dark red blood
50
At which week of pregnancy does uterus reach the umbilicus?
Week 20. SFH will be 20cm.
51
Risk factors for placental abruption
Smoking, cocaine use, short umbilical cord, trauma, pre-eclampsia, subchorionic haematoma and maternal age >35
52
Management of severe placental abruption
Emergency c-section
53
What is HELLP syndrome?
Haemolysis (anaemia, fragmented red cells on film, LDH >600 IU/l and raised bilirubin) Raised liver enzymes (AST/ALT) Low platelets
54
Criteria for pre-eclampsia
BP >140/90 or increase from booking >30/20 in the second half of pregnancy (need 2 readings 4-6 hours apart) Evidence of proteinuria on dipstick
55
Severity grading pre-eclampsia
Mild: 140-149/90-99 Moderate: 150-159/100-109 Severe: >160/110
56
Treatment mild pre-eclampsia
1. Admit 2. Monitor BP QDS, bloods (FBC, U&Es and LFTs) twice weekly and fetal complications 3. Deliver between 34 and 37 weeks depending on symptoms or within 24-48 hours if diagnosed after 37 weeks
57
Treatment moderate pre-eclampsia
1. Admit 2. Treat BP (aim <150) with oral labetelol 3. Monitor maternal BP QDS and bloods (FBC, U&Es and LFTs) three times a week and fetal complications 4. Deliver between 34 and 37 weeks depending on symptoms or within 24-48 hours if diagnosed after 37 weeks
58
Treatment severe pre-eclampsia
1. Admit 2. Treat BP (aim <150) with oral labetelol 3. Magnesium sulphate (anticonvulsant), steroids e.g betamethasone (fetal lung and HELLP treatment) 4. Delivery and/or referral to ITU/HDU
59
Most likely cause of vulval carcinoma
Squamous cell carcinoma
60
Risks for placenta accreta/increta/percreta
Previous c-section, myomectomy, multiparity, >35y/o, placenta praevia and uterine anomalies
61
Diagnostic investigation for placenta accreta/increta/percreta
Ultrasound (may be supplemented by MRI)
62
Delivery method if placenta accreta/increta/percreta identified
C-section - often an incidental finding at delivery however
63
What is vasa praevia
Where the fetal vessels run over the cervical os
64
Management for Vasa Praevia
C-section to avoid significant bleeding
65
Treatment of vaginal atrophy
(rule out UTI) | Topical oestrogen cream or lubricants
66
Symptoms of atrophic vaginitis
Dyspareunia, burning, irritation, vaginal discharge and bleeding
67
Bladder symptoms of oestrogen deficiency
Bladder and urethra atrophy leading to dysuria, urinary frequency and urinary incontinence
68
Signs of vaginal atrophy
Erythematous vaginal wall with petechiae and ecchymoses - if not seen and have PMB then 2 week referal necessary
69
First line treatment of allergic rhinitis in pregnancy
Oral loratadine - non-sedative which is preferable in pregnancy. Avoid during breast feeding as excreted and inhibits milk production
70
Endometrial cancer symptoms
PMB, unexplained abdo pain and bloating
71
Endometrial cancer risk factors
PCOS, obesity, nulliparity, late menopause, early menarche (after 52), endometrial hyperplasia, diabetes, tamoxifen and unopposed oestrogen HRT (not if progesterone given concurrently)
72
Most common cause of vaginal lump in woman of reproductive age
Bartholin cyst
73
Position of bartholin's cysts
Posterior vestibule. 4 and 8 o'clock
74
Treatment of suspected bartholin's cyst
Under 40yo, not treatment required if asymptomatic. Over 40, removal and histology to rule out vaginal carcinoma
75
Threatened miscarriage - signs/symptoms
Lower abdo pain, light brown discharge, os is closed
76
First step in management of delayed first stage of labour
Amniotomy - reasses in 2 hours. Oxytocin if still not progressing
77
Contraindication to syntocin infusion
Previous caesarean section
78
What must be given prior to oxytocin infusion?
Pain relief - usually epidural
79
Rate of cervical dilatation in primigravida
1cm hour
80
Infections screened for antenataly
HIV, Hep B and syphilis
81
Effects on child of CMV in pregnancy
Deafness, blindness, restricted growth and still birth
82
Treatment for nipple candida - breast feeding
Topical miconazole 2% applied to nipple and babys mouth (prevent reinfection). Treat for 2 weeks.
83
Paget's disease of nipples symptoms/signs
Itching, tingling, or redness in the nipple and/or areola Flaking, crusty, or thickened skin on or around the nipple A flattened nipple Discharge from the nipple that may be yellowish or bloody Usually unilateral
84
Diagnostic criteria for PCOS
2 of: US evidence of bilateral enlarged multicystic ovarian cysts Infrequent ovulation/anovulatory Clinical/biochemical evidence of hyperandrogenism
85
Biochemical signs of PCOS
High testosterone and raised LH (higher than FSH)
86
Predisposing factors to developing thyroid disease during pregnancy
``` Current/previous thyroid disease FH thyroid disease in 1st degree Autoimmune conditions eg coeliac T1DM, T2DM or gestDM These patients should be screened ```
87
Effects of hypothyroidism during pregnancy (maternal and fetal)
``` Fetal demise Severe neurodevelopmental disorders Congenital malformations Congenital hypothyroidism Increased risk gestational hypertension, placental abruption, premature delivery, PPH and postnatal depression ```
88
What is clicking during breast feeding a sign of?
Poor latch - esp. if pain
89
Criteria for c-section in HIV +ve women
Co-infection with HCV Zidovudine monotherapy HAART but >50 copies/ml Any of these need c-section at 38 weeks after 48 hours of cortico-steroids
90
Symptoms of blocked duct during breast feeding
Nipple pain which is unilateral and, on examination, a small, round white area at the end of the nipple
91
Can endometriosis raise CA-125 levels
Yes - can also cause chocolate cysts which mimic tumour
92
What is mittelschmerz?
Mid-cycle pain - thought to be due to follicle rupture. Sudden onset abdo pain, usually subsides within a few hours but can last longer (2-3 days)
93
Treatment for infertility in PCOS
First line is Clomifene citrate. Second line add metformin or use gonadotrophins or even laparoscopic ovarian drilling
94
Management of hypothyroid during pregnancy
Increase thyroxine dose by 25micrograms as soon as pregnancy is confirmed and retest in 2 weeks to ensure patient is euthyroid

Final year (18 decks)

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