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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
Q

Where is the puedendal nerve located?

MAYBE DELETE

A

Lateral wall of the ischiorectal fossa and into the obturatus internus fascia in Alcock’s canal

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26
Q

Vulvodynia

A

Chronic vulvovaginal pain lasting at least 3 months with no identifiable cause

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27
Q

Vulvodynia treatment

A

Amitriptyline

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28
Q

First line ix placental abruption?

A

Transabdominal US

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29
Q

Condition not compatible with bimanual palpation

A

Placental praevia

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30
Q

Signs of septic miscarriage

A

Increasing pain, bleeding and fever. Fetal tissue often stuck in os. May be discharge too.

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31
Q

Microscopic appearance of T. vaginalis

A

Pear-shaped trichomonads (100% specific)

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32
Q

Investigation to confirm trichomonas vaginalis

A

High vaginal swab and wet mount microscopy

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33
Q

Trichomonas vaginalis treatment

A

Single dose metronidazole (treat both patients)

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34
Q

Is trichomonas vaginalis an STI?

A

Yes

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35
Q

Trichomonas vaginalis symptoms

A

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)

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36
Q

Appearance of molar pregnancy on ultra-sound

A

Snow storm

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37
Q

Treatment for gestational trophoblastic disease

A

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

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38
Q

Complications during evacuation of molar pregnancy

A

Thyrotoxic storm - betaHCG resembles TSH

39
Q

Presentation of molar pregnancy

A

Signs of early pregnancy failure - PV bleed. US shows large for dates pregnancy with snow storm. Can have exaggerated symptoms of pregnancy

40
Q

First line treatment for stress incontinence

A

Pelvic floor training - 8 contractions 3x per day for 6 weeks

41
Q

Conditions in which oxybutinin is used

A

Overactive bladder or mixed urinary incontinence

42
Q

Cervical screening ages and frequencies UK

A

25-49 three yearly, 50-64 is five yearly

43
Q

Liver enzyme/s raised during pregnancy

A

ALP only. AST and ALT remain normal.

44
Q

What is colestyramine?

A

A chelating agent used to bind bile acids

45
Q

Risk factors for placenta praevia

A

Mum >35, multiparity,multiple pregnancy, assisted fertility, previous placenta praevia, smoking and short interpregnancy interval

46
Q

Placenta praevia presentation

A

Painless fresh vaginal bleeding. Can be spontaneous or provoked by intercourse/vaginal examination. Bleeding usually resolves spontaneously.

47
Q

Diagnosis of placenta praevia

A

US - if placenta is low lying at anomaly scan then re-scan to check for this at 32 weeks

48
Q

Concealed placental abruption presentation

A

Sudden onset pain as placenta detaches. No bleeding as contained in uterus though

49
Q

Placental abruption presentation

A

Significant sudden abdo pain, hard ‘woody’ contracted uterus and dark red blood

50
Q

At which week of pregnancy does uterus reach the umbilicus?

A

Week 20. SFH will be 20cm.

51
Q

Risk factors for placental abruption

A

Smoking, cocaine use, short umbilical cord, trauma, pre-eclampsia, subchorionic haematoma and maternal age >35

52
Q

Management of severe placental abruption

A

Emergency c-section

53
Q

What is HELLP syndrome?

A

Haemolysis (anaemia, fragmented red cells on film, LDH >600 IU/l and raised bilirubin)
Raised liver enzymes (AST/ALT)
Low platelets

54
Q

Criteria for pre-eclampsia

A

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
Q

Severity grading pre-eclampsia

A

Mild: 140-149/90-99
Moderate: 150-159/100-109
Severe: >160/110

56
Q

Treatment mild pre-eclampsia

A
  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
Q

Treatment moderate pre-eclampsia

A
  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
Q

Treatment severe pre-eclampsia

A
  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
Q

Most likely cause of vulval carcinoma

A

Squamous cell carcinoma

60
Q

Risks for placenta accreta/increta/percreta

A

Previous c-section, myomectomy, multiparity, >35y/o, placenta praevia and uterine anomalies

61
Q

Diagnostic investigation for placenta accreta/increta/percreta

A

Ultrasound (may be supplemented by MRI)

62
Q

Delivery method if placenta accreta/increta/percreta identified

A

C-section - often an incidental finding at delivery however

63
Q

What is vasa praevia

A

Where the fetal vessels run over the cervical os

64
Q

Management for Vasa Praevia

A

C-section to avoid significant bleeding

65
Q

Treatment of vaginal atrophy

A

(rule out UTI)

Topical oestrogen cream or lubricants

66
Q

Symptoms of atrophic vaginitis

A

Dyspareunia, burning, irritation, vaginal discharge and bleeding

67
Q

Bladder symptoms of oestrogen deficiency

A

Bladder and urethra atrophy leading to dysuria, urinary frequency and urinary incontinence

68
Q

Signs of vaginal atrophy

A

Erythematous vaginal wall with petechiae and ecchymoses - if not seen and have PMB then 2 week referal necessary

69
Q

First line treatment of allergic rhinitis in pregnancy

A

Oral loratadine - non-sedative which is preferable in pregnancy.
Avoid during breast feeding as excreted and inhibits milk production

70
Q

Endometrial cancer symptoms

A

PMB, unexplained abdo pain and bloating

71
Q

Endometrial cancer risk factors

A

PCOS, obesity, nulliparity, late menopause, early menarche (after 52), endometrial hyperplasia, diabetes, tamoxifen and unopposed oestrogen HRT (not if progesterone given concurrently)

72
Q

Most common cause of vaginal lump in woman of reproductive age

A

Bartholin cyst

73
Q

Position of bartholin’s cysts

A

Posterior vestibule. 4 and 8 o’clock

74
Q

Treatment of suspected bartholin’s cyst

A

Under 40yo, not treatment required if asymptomatic. Over 40, removal and histology to rule out vaginal carcinoma

75
Q

Threatened miscarriage - signs/symptoms

A

Lower abdo pain, light brown discharge, os is closed

76
Q

First step in management of delayed first stage of labour

A

Amniotomy - reasses in 2 hours. Oxytocin if still not progressing

77
Q

Contraindication to syntocin infusion

A

Previous caesarean section

78
Q

What must be given prior to oxytocin infusion?

A

Pain relief - usually epidural

79
Q

Rate of cervical dilatation in primigravida

A

1cm hour

80
Q

Infections screened for antenataly

A

HIV, Hep B and syphilis

81
Q

Effects on child of CMV in pregnancy

A

Deafness, blindness, restricted growth and still birth

82
Q

Treatment for nipple candida - breast feeding

A

Topical miconazole 2% applied to nipple and babys mouth (prevent reinfection). Treat for 2 weeks.

83
Q

Paget’s disease of nipples symptoms/signs

A

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
Q

Diagnostic criteria for PCOS

A

2 of: US evidence of bilateral enlarged multicystic ovarian cysts
Infrequent ovulation/anovulatory
Clinical/biochemical evidence of hyperandrogenism

85
Q

Biochemical signs of PCOS

A

High testosterone and raised LH (higher than FSH)

86
Q

Predisposing factors to developing thyroid disease during pregnancy

A 
Current/previous thyroid disease
FH thyroid disease in 1st degree
Autoimmune conditions eg coeliac
T1DM, T2DM or gestDM
These patients should be screened
87
Q

Effects of hypothyroidism during pregnancy (maternal and fetal)

A 
Fetal demise
Severe neurodevelopmental disorders
Congenital malformations
Congenital hypothyroidism
Increased risk gestational hypertension, placental abruption, premature delivery, PPH and postnatal depression
88
Q

What is clicking during breast feeding a sign of?

A

Poor latch - esp. if pain

89
Q

Criteria for c-section in HIV +ve women

A

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
Q

Symptoms of blocked duct during breast feeding

A

Nipple pain which is unilateral and, on examination, a small, round white area at the end of the nipple

91
Q

Can endometriosis raise CA-125 levels

A

Yes - can also cause chocolate cysts which mimic tumour

92
Q

What is mittelschmerz?

A

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
Q

Treatment for infertility in PCOS

A

First line is Clomifene citrate. Second line add metformin or use gonadotrophins or even laparoscopic ovarian drilling

94
Q

Management of hypothyroid during pregnancy

A

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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