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Phase 3A > Women's health > Flashcards

Women's health Flashcards

1
Q

At which fat percentage does ovulation cease?

A

below 22%

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2
Q

How does fluid balance change in the body of a pregnant woman?

A

30-50% increase in plasma volume
Decrease in plasma oncotic pressure
Decreased threshold for thirst
Increased natriuretic factors

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3
Q

What happens to the kidneys during pregnancy?

A

Dilation of renal pelvis and calyxes
Reduced renal peristalsis - causes hydronephrosis
Increased renal blood flow
Increased GFR by 50%

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4
Q

What changes occur in the cardiovascular system during pregnancy?

A

Increased HR, stroke volume and cardiac output

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5
Q

What changes occur in the blood during pregnancy?

A

Increase in plasma fibrinogen
Increase in clotting factors 7, 8, 10
Increased plasminogen inhibitor
Increased WBCs and fluid

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6
Q

What physical changes occur in the thoracic cavity during pregnancy?

A

Diaphragm elevated by up to 4cm
Heart displaced up and left
Increased pulmonary blood flow and subcostal angle

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7
Q

What changes occur in the lungs during pregnancy?

A

Increased O2 consumption
Tidal volume increases
PCO2 decreases to allow a fetal:maternal gradient
Bronchial smooth muscle relaxation

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8
Q

What changes occur in the gastrointestinal system during pregnancy?

A 
Delayed gastric emptying
Sphincter relaxation
Increased nutrient and water absorption
decreased bowel motility
reduced CCK secretion
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9
Q

What is ptyalism/ sialorrhea gravidarum?

A

Sensation of excess salivation

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10
Q

What is pica?

A

Consumption of not-nutritive substances; eg. paper/mud

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11
Q

What changes in plasma glucose occur during preganacy?

A

Raised glucose levels

Increase in maternal insulin response but decreased maternal sensitivity

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12
Q

What is foetal HPL?

A

Human placental lactogen - diabetogenic agent, mobilises glucose from fat reserves and converts mammary glands into milk-secreting tissue

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13
Q

What changes occur in the reproductive system during pregnancy?

A

Uterine mass increases 46g to 1kg
Endovascular invasion
Cervix softens and increases in vascularity
Early on tissues become purple/blue - chadwick’s sign

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14
Q

What is IMB?

A

Intermenstrual bleeding

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15
Q

What is PCB?

A

Post-coital bleeding

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16
Q

What is PMB?

A

Post menopausal bleeding

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17
Q

What is menarche?

A

Time when first period occurred

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18
Q

What is menopause?

A

Age of last spontaneous period

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19
Q

What is Climacteric?

A

Years before menopause, symptomatic but still menstruating

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20
Q

What is postmenopausal?

A

No periods for 1 year if over 50, or no periods for two years if under 50

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21
Q

What is gravidity?

A

Total number of pregnancies

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22
Q

What is parity?

A

Total number of deliveries after 20 weeks

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23
Q

What is a miscarriage?

A

A loss of a pregnancy before 24 weeks

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24
Q

What is an IUFD?

A

Intrauterine foetal demise

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25
Q

What is a still birth?

A

A baby born dead after 24 weeks

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26
Q

What is a neonatal death?

A

Death of a baby within the first 28 days of life

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27
Q

How long is normal gestation?

A

37-42 weeks

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28
Q

What is macrosomia?

A

A large baby

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29
Q

What could cause positive haematuria on a urine dip?

A

cancer, nephropathy, infection

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30
Q

What could cause positive proteinuria on a urine dip?

A

renal/cardiac disease

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31
Q

What percentage of adult women have urinary incontinence?

A

20%

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32
Q

What are the treatments for urinary incontinence?

A

catheters, pads, pessaries, barrier creams, HRT: vaginal oestrogen

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33
Q

What are the treatments for an overactive bladder?

A

Bladder drill, anticholinergics, antimuscarinics, adrenergic agonists, botox - blocks Ach release

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34
Q

What is colposuspension?

A

Supporting the bladder neck pulling the vagina up

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35
Q

How do you treat a utero-vaginal prolapse?

A

Pessary: shelf, ring, gelhorn, sacrospinal fixation, sacropopexy

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36
Q

What are the symptoms of a utero-vaginal prolapse?

A

SCD lump, discomfort, pelvic floor and sexual dysfunction

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37
Q

What is a sacrospinous fixation?

A

Attaching the vagina to the sacrospinous ligaments to hold it up - preventing prolapse

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38
Q

What is sacropopexy?

A

Mesh to hold the vagina up

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39
Q

Name some non sexually transmitted infections of the genitals

A

Candidiasis, bacterial vaginosis, genital dermatoses, vulval conditions

40
Q

What do you need to ask when taking a sexual history?

A

Last time, how many partners in last 3 months, protection used, gender of partners, type of sex

41
Q

What tests do you do for asymptomatic STI screening in women?

A

Self vaginal swab, NAAT: chlamydia and gonorrhoea

Bloods for syphilis and HIV

42
Q

What tests do you do for asymptomatic STI men who have sex with men?

A

First void - NAAT for chlamydia and gonorrhoea
Pharyngeal and rectal swab
Bloods for syphilis, HIV and Hep B

43
Q

What tests do you do for symptomatic STI screening in women?

A

Vaginal swab for NAAT, and high vaginal swab: bacterial vaginosis, trichomonas vaginalis and candida
Cervical swab on slide
Dipstick urinalysis

44
Q

What tests do you do for symptomatic STI screening in men who have sex with men?

A

First void - NAAT for chlamydia and gonorrhoea
Pharyngeal and rectal swab
Bloods for syphilis, HIV and Hep B
Cultures and slides from all areas involved

45
Q

In which groups would you do hep B screening?

A

MSM, commercial sex workers and users, IVDU, african, asian and eastern european people

46
Q

Which types of diseases usually get better during pregnancy?

A

Autoimmune disease, as pregnancy causes some immune suppression

47
Q

Why is anaemia more common in pregnancy?

A

Increased iron and folate requirements

48
Q

What are the consequences of anaemia during pregnancy?

A

Low birth weight and pre-term delivery

49
Q

What are the risk factors for venous thromboembolism during pregnancy?

A

Being pregnant, increased maternal age, increased BMI, operative delivery

50
Q

How does pregnancy affect asthma?

A

Physiological changes can make asthma slightly worse, most medications are fine to use during pregnancy

51
Q

Which cardiac conditions mean that the pregnancy is high risk?

A

aortic stenosis, prosthetic valves, cyanosed patients

52
Q

What is obstetric cholestasis?

A

Reduction in the flow of bile from the gallbladder during pregnancy

53
Q

What are the symptoms of obstetric cholestasis?

A

Itching without rash, jaundice, dark urine pale stools

54
Q

How do you treat obstetric cholestasis?

A

Ursodeoxycholic acid improves liver function but not foetal complications, resolved by delivery

55
Q

What are the complications of obstetric cholestasis?

A

Stillbirth, premature birth

56
Q

What are the complications of hyperthyroidism during pregnancy?

A

Maternal: thyroid crisis with cardiac failure
Foetal: thyrotoxicosis due to TSantibodies

57
Q

How do you treat hyperthyroidism during pregnancy?

A

Propylthiouracil

58
Q

What are the complications of hypothyroidism during pregnancy?

A

early foetal loss, impaired neurodevelopment

59
Q

How do you treat hypothyroidism during pregnancy?

A

thyroxine

60
Q

How do you treat gestational diabetes?

A

Stop ACEI and statins, higher folic acid dose, insulin and metformin

61
Q

What is gestational diabetes?

A

Diabetes that is first recognised during pregnancy

62
Q

What are the complications of gestational diabetes?

A

Miscarriage, still birth, genetic abnormalities, premature, macrosomia, shoulder dystocia, neonatal polycythaemia, hypoglycaemia, respiratory distress

63
Q

What are the maternal complications of Chronic renal disease?

A

Increased risk of pre-eclampsia

64
Q

What are the foetal complications of chronic renal disease?

A

malformations due to drugs, growth restriction, stillbirth, premature

65
Q

What are the maternal complications of epilepsy?

A

Increased seizure frequency usually because they take less medications as they are teratogenic, increased risk of SUDEP

66
Q

What are the foetal complications of epilepsy?

A

abnormalities, inheritance of epilepsy, foetal hypoxia with maternal seizures

67
Q

Which epilepsy medication is the worst during pregnancy?

A

Sodium valproate

68
Q

What are the complications of taking sodium valproate during pregnancy?

A

neural tube defects, ASD, cleft palate, polydactyly, craniosynostosis, learning difficulties

69
Q

What is heavy menstrual bleeding?

A

<80ml per cycle, or affecting daily life - 1/20 women

70
Q

What investigations could you do for heavy menstrual bleeding?

A

vaginal examination, FBC, Transvaginal ultrasound, hysteroscopy

71
Q

What are the main causes of heavy menstrual bleeding?

A

polyps, adenomas, leiomyomas, malignancy, coagulopathy, endometriosis, iatrogenic

72
Q

Name some medical treatments for heavy menstrual bleeding

A

mirena coil, tranexamic acid, NSAIDS, COCP, POP, implant

73
Q

Name some surgical treatments for heavy menstrual bleeding

A

Endometrial ablation, Uterine artery embolization, myomectomy, hysterectomy

74
Q

How does the (levonogestrel-releasing intrauterine system) mirena coil reduce menstrual bleeding?

A

releases progesterone which thins the lining of the womb, contraceptive and lasts up to 5 years

75
Q

Pros and cons of tranexamic acid for managing heavy menstrual bleeding

A

2 tablets, 3x a day for 1st 4 days of period, not contraceptive or hormonal, doesn’t reduce length or pain of periods

76
Q

Pros and cons of NSAIDs for heavy menstrual bleeding

A

3x a day for 1st 5 days of period, helps with period pain as well, non contraceptive and worsens asthma

77
Q

Pros and cons of Combined Oral Contraceptive pill for heavy menstrual bleeding

A

Take every day for 3 weeks then 1 week off, helps with pain, contraceptive, increases risk of clots

78
Q

Pros and cons of progesterone for heavy menstrual bleeding

A

Weight gain, bloating, acne, contraceptive, doesn’t increase risk of clots

79
Q

What is endometrial ablation?

A

Surgery to destroy the lining of the womb by norvasure or thermal balloon

80
Q

Pros and cons of endometrial ablation for heavy menstrual bleeding

A

Minimally invasive, can be done under local anaesthetic, cannot get pregnant after

81
Q

How does uterine artery embolization work?

A

Blocks blood supply to the endometrium and fibroids so they shrink, allows for pregnancy in the future

82
Q

Pros and cons of myomectomy

A

Major surgery, allows for pregnancy in the future

83
Q

Pros and cons of Hysterectomy

A

Periods stop permanently, cannot get pregnant, major surgery, can effect bladder

84
Q

What are the signs of pre-eclampsia?

A

proteinuria >0.3g protein/24hrs and hypertension > 140/90

85
Q

What is pre-eclampsia?

A

Systemic syndrome, abnormal development of placenta, less vasodilatation of the spiral arteries

86
Q

What are the maternal complications of pre-eclampsia?

A

Can become eclampsia - seizures, and can develop renal failure, liver failure and pulmonary oedema

87
Q

What are the foetal complications of pre-eclampsia?

A

Foetal growth retardment, DIC, pre term birth, hypoxia

88
Q

What are the symptoms of pre-eclampsia?

A

Visual disturbances, migraine, epigastric pain, oedema, rapid weight gain, brisk reflexes and ankle clonus

89
Q

How do you treat pre-eclampsia?

A

Delivery is the only treatment, magnesium sulphate is used to prevent eclampsia, hydralazine and labetalol for hypertension

90
Q

What is a premature birth?

A

A baby born earlier than 37 weeks

91
Q

What is low birth weight?

A

<2.5kg at birth

92
Q

What are some consequences of premature birth?

A

Cerebral palsy, learning difficulties, death

93
Q

What can you give to promote foetal development?

A

Antenatal steroids

94
Q

Name some causes of spontaneous preterm labour

A

Premature rupture of membranes, cervical weakness, amnionitis

95
Q

Why does maternal infection cause pre term birth?

A

Prostaglandins are released which trigger contractions causing labour

96
Q

What is a tocolytic?

A

Oxytocin receptor antagonist

Phase 3A (14 decks)

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