women's health

Question 1

Recurrent pregnancy loss - dfn

Answer 1

2 or more miscarriages

Question 2

Recurrent pregnancy loss - causes (5)

Answer 2

Genetic/chromosomal anomaly
Anatomial anomaly
Endocrine causes
Thrombophilias
Lifestyle factors

Question 3

Recurrent pregnancy loss - Ix

Answer 3

karyotyping
pelvic uss
TFT and antibodies
progesterone, prolactin, fasting glucose
Antiphospholipid screen and antibodies

Question 4

PCOS - Rotterdam dx criteria (3)

Answer 4

2/3 of:

• oligo- or anovulation: cycle length ≥35 or <21 days
• hyperandrogenism, clinical and/or biochemical:(hirsutism or acne and/or raised FAI or testosterone)
• polycystic ovarian morphology - ≥12 antral follicles per ovary +/or ovarian volume ≥10ml

Question 5

PCOS - clinical presentation

Answer 5

classic triad
- oligomenorrhoea
- hirsutism
- obesity
sub/infertility
androgenic alopecia
depression/anxiety

Question 6

POI - dx criteria

Answer 6

under 40yrs old, oligo or amenorrhea ≥ 4/12

AND FSH ≥ 25, on 2 occassions ≥ 4/52 apart

Question 7

menorrhagia - mx

Answer 7

Initial - stop very heavy bleeding
mefenemic acid 500mg tds
tranexamic acid 1g tds first 3-5days of cycle

norethisterone 5mg PO tds OR medroxyprogesterone 10mg PO tds, for 3 days, then od for further 5-10days

ongoing -
COCP
levonorgestrel 52mcg IUD (mirena)
cyclical progestins - medroxyprogesterone 10mg PO od- tds, day 1 to 21 of cycle
norethisterone 5mg PO od-tds, day 1 to 21 of cycle

Question 8

Abnormal vaginal bleeding – indication for gynae referral

Answer 8

• endometrial thickness ≥12mm premenopause, or ≥5mm peri/postmenopause
• focal lesion on USS
• intermenstrual bleeding
• postcoital bleeding
• fails to improve with medical management

Question 9

Abnormal vaginal bleeding - ix

Answer 9

cervical co-test
chlamydia PCR
bHCG
FBC
TSH
TVUSS (first half of cycle, after bleeding stops)

+/- ferritin, coag studies

Question 10

Abnormal vaginal bleeding - Examination

Answer 10

abdomen palpation
bimanual exam -pelvic palpation
speculum exam - inspect vulva, cervix, vagina

Question 11

menorrhagia - RF for malignancy

Answer 11

Hx anovulation/PCOS
nulliparity
tamoxifen
obesity
FHx malignancy
endometrial thickness ≥12mm premenopause, or ≥5mm peri/postmenopause

Question 12

antepartum haemorrhage (bleeding after 20/40) causes

Answer 12

placenta praevia
placentae abruptio
Heavy show / onset of labour
Abnormal placentation - placenta accreta/increta
Circumvallate placenta

Question 13

urinary incontinence - RF

Answer 13

obesity
mutliparity
multiple vaginal deliveries
fhx of vaginal prolapse
perimenopausal/menopause
caffeine intake++
PMHx recurrent UTI

Question 14

Menopause/perimenopause - symptoms

Answer 14

change in menstrual periods - length, duration, blood flow
hot flushes, night sweats
Sleeping problems - sleeplessness and/or unusual tiredness 
Joint aches
dry skin, crawling feelings under skin
reduced libido
Anxiety/mood changes/irritability
Dry vagina, uncomfortable intercourse
Overactive bladder/frequency/continence