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Phase 3A Conditions > Women's key facts > Flashcards

Women's key facts Flashcards

1
Q

What is the difference between stress and urge incontinence?

A

Stress - leakage occurs when coughing or laughing.
Urge - Frequency with sudden rushes to the toilet.

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2
Q

What is the first line treatment for stress and urge incontinence?

A

Stress - Pelvic floor exercises for at least 3 months
Urge - Bladder retraining.

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3
Q

What is the second line (medical) management for stress and urge incontinence?

A

Stress - Duloxetine (SNRI)
Urge - Oxybutynin (anticholinergic)

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4
Q

What are the initial investigations for incontinence?

A

Bladder diary
Urine dipstick (UTI?)
Urodynamics (if no response to treatment)

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5
Q

What is a:
Uterine prolapse
Vault prolapse
Cystocele
Rectocele

A

Uterine prolapse - Uterus descends into the vagina
Vault prolapse - after a hysterectomy, the top of the vagina descends into the vagina
Cystocele - the bladder prolapses backwards into the vagina through the anterior vaginal wall
Rectocele - the rectum prolapses forwards into the vagina through the posterior vaginal wall.

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6
Q

What are the key risk factors for vaginal prolapse?

A
  • Multiparity
  • Obesity
  • Traumatic delivery
  • Menopause
  • Advanced age
  • Chronic coughing or constipation
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7
Q

What is the key initial investigation for prolapse?

A

Speculum examination

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8
Q

How is prolapse graded?

A

Grade 1 - the uterus is more than 1cm away from the opening of the vagina.
Grade 2 - the uterus is within 1cm of the introitus (above or below)
Grade 3 - the uterus is more than 1cm from the introitus, but not fully descended
Grade 4 - the uterus is fully everted and descended

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9
Q

What is the conservative management for a uterine prolapse?

A

Pelvic floor exercises
Incontinence pads
Weight loss
Reduce caffeine
Oestrogen cream

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10
Q

What can be inserted to help manage prolapse?

A

A vaginal pessary - adds support to the pelvic organs to help with prolapse

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11
Q

What is the definitive management for pelvic organ prolapse?

A

Surgery

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12
Q

What are the key risk factors for perianal tear?

A

First pregnancy
Macrosomia
Shoulder dystocia
Instrumental delivery

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13
Q

How is a perianal tear graded?

A

Grade 1 - just involves the vagina
Grade 2 - involves the vagina and the perianal muscles
Grade 3 - involves the anal sphincter:
- 3a - involves less than 50% of the external sphincter
- 3b - involves more than 50% of the external anal sphincter
- 3c - involves the internal anal sphincter.
Grade 4 - involves the rectal mucosa.

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14
Q

What is the management for a perianal tear (grade dependant)?

A

Grade 1 - repairs on own.
Grade 2 - repair with sutures on the ward.
Grade 3 or 4 - requires suturing in theatre.

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15
Q

What timeframe is the copper coil suitable for emergency contraception?

A
  • 5 days after unprotected sexual intercourse
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16
Q

What timeframe is levonorgestrel suitable for?

A

Must be taken within 72 hours of unprotected sexual intercourse.

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17
Q

What timeframe is ulipristal acetate (EllaOne) suitable for?

A

Must be taken within 5 days of unprotected sexual intercourse.

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18
Q

What are the categories of C-section and what are the timeframes for each?

A

Cat 1 - within 30 mins
Cat 2 - within 75 mins
Cat 3 - Delivery is required but mother and baby are stable.
Cat 4 - elective C-section

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19
Q

What medication is given to treat HER2 positive breast cancer?

A

Trastuzumab

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20
Q

How is estimated day of delivery calculated?

A

Add one year and seven days to the first day of the last menstrual period, and then subtract three months.

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21
Q

What are some common risk factors that indicate thromboprophylaxis after giving birth?

What drug is given?

A

Give LMWH
- Previous VTE
- Age over 35
- BMI over 30
- Smoking
- Multiple pregnancy
- Pre-eclampsia
- C-section
- Prolonged labour
- Preterm birth
- Stillbirth
- Postpartum haemorrhage.

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22
Q

What hormone should be checked to check for ovulation and when?

A

Check progesterone 7 days before the end of the cycle

e.g. 28 day cycle check at 21 days.

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23
Q

What is the likely history for fat necrosis of the breast?

A

Breast trauma followed by a firm/hard irregular lump in the breast.

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24
Q

What are the three components of triple assessment of any breast lump?

A
  • Clinical examination
  • Imaging (mammography and/or USS)
  • Tissue sampling/biopsy.
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25
Q

What drugs are given in intrahepatic cholestasis of pregnancy?

A

Chlorphenamine and aqueous cream.

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26
Q

What is the management for a UTI during pregnancy?

A

Trimethoprim - avoid alltogether
Nitrofurantoin - avoid in the third trimester of pregnancy

Amoxicillin - the next best option when trimethoprim and nitrofurantoin are not suitable.

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27
Q

What is HELLP syndrome?

A

H - Haemolysis
EL - Elevated Liver enzymes
LP - Low Platelets

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28
Q

What is the management for HELLP syndrome?

A

Delivery of the baby.
Steroids to develop baby’s lungs
Blood transfusion if very anaemic/thrombocytopenic.

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29
Q

What is the main risk factor for cervical cancer?

A

HPV
By extension:
more unprotected sex.
Poor compliance with cervical screening.

Smoking
COCP

30
Q

What are the risk factors for endometrial cancer?

A

Excess oestrogen:
- Early menarche
- Late menopause
- Nulliparity
- Unopposed oestrogen therapy.

31
Q

What are the risk factors for ovarian cancer?

A

More ovulations:
Early menarche
Late menopause
Nulliparity

BRCA1 and BRCA2 genes

32
Q

What is the main risk factor for vulval cancer?

A

Lichen sclerosis

33
Q

What are the risk factors for breast cancer?

A

Prolonged exposure to oestrogen:
Early menarche
Late menopause
Nulliparity

BRCA1 and BRCA2
Hormonal therapy (combined)
Breast cancer in a first degree relative.

34
Q

What is the breast cancer screening programme in the UK?

A

Mammography every 3 years between ages 50 and 70.

35
Q

What are the protective factors for endometrial cancer?

A

Anything that reduces unopposed oestrogen:
- COCP
- Mirena Coil
- Multiparity

Smoking is protective

36
Q

What are the protective factors for ovarian cancer?

A

Anything that reduces ovulation:
COCP
Breastfeeding
Multiparity

37
Q

What are the findings for androgen insensitivity syndrome (blood tests and physical)?

A

Bilateral inguinal testes.
Female genitalia externally.

LH:FSH ratio at 2:1
High oestrogen
High testosterone.

38
Q

What is the management for androgen insensitivity syndrome?

A

Bilateral orchidectomy
Oestrogen
Counselling

39
Q

When is early puberty for males and females?

A

Before age 8 in females, before 9 in males.

40
Q

What is classified as late menarche?

A

16 or older and no menarche.

41
Q

Menopause criteria?

A

Women over 50 - 1 year without a period.
Women under 50 - 2 years without a period.

42
Q

What can be given to manage perimenopausal symptoms?

A

HRT.
Should be combined if a woman has a uterus (reduce endometrial cancer risk).

Cyclical if there are still periods.

Continuous if post-menopausal.

43
Q

What are the symptoms of adenomyosis?

A

BOGGY UTERUS
Menorrhagia
Dysmenorrhoea

44
Q

What is the pathophys of adenomyosis?

A

Endometrial tissue in the myometrium.

45
Q

What is the first line investigation for adenomyosis?

A

Transvaginal USS

46
Q

What is the management for adenomyosis?

A

Contraception (mirena or COCP)

Tranexamic acid for the bleeding if no contraception wanted.

Definitive is hysterectomy.

47
Q

What is the key history for Asherman’s syndrome?
Symptoms?
Investigation?
Treatment?

A

Previous damage to the uterus (surgery, miscarriage, traumatic abortion).

Symptoms:
- Secondary amenorrhoea
- Light periods
- Dysmenorrhoea
- Infertility

Treatment:
Hysteroscopy with cutting of the lesions.

48
Q

How does lichen sclerosis present?

A

Tight shiny white skin on the vulva.
Itchy.

49
Q

What is the management for lichen sclerosis?
What does it increase the risk of?

A

Topical steroids.
Increases risk of vulval cancer.

50
Q

What are the symptoms of atrophic vaginitis?

A

Dyspareunia.
Dryness of vagina
Light bleeding.

51
Q

What is the management for vaginal atrophy?

A

Vaginal lubricants.
Topical oestrogen.

52
Q

What is the HPV screening programme schedule?

A

Every 3 years for women between 25 and 49.
Every 5 years for women between 50 and 64.

53
Q

What happens if sample is inadequate twice?

A

Colposcopy.

54
Q

What happens if there is high-risk HPV three times?

A

Colposcopy.

55
Q

When is the HPV vaccine offered?

A

Age 12-13.

56
Q

What race are uterine fibroids more common in?

A

Afro-carribean women.

57
Q

What are the symptoms of uterine fibroids?

A

BULKY UTERUS
Menorrhagia
Prolonged menstruation
Abdominal pain that is CYCLICAL
Dyspareunia.

58
Q

What is the diagnostic test for uterine fibroids?

A

TV USS

59
Q

What is the management for uterine fibroids?

A

Less than 3cm:
- 1st line is mirena coil
- Tranexamic acid/NSAIDs for the pain.

Over 3cm:
Refer to gynae for surgical excision (myomectomy).

60
Q

What is red degeneration of Fibroids?

Symptoms?

Treatment?

A

Ischaemia and necrosis of a fibroid due to disrupted blood supply.

Severe abdominal pain, fever, tachycardia.

Supportive management.

61
Q

What is endometriosis?

Symptoms?

Management?

A

Presence of endometrial tissue outside the uterus.

Chronic pelvic pain
Deep dyspareunia.
Secondary dysmennorhoea
Reduced fertility

Laparoscopy in secondary care is gold standard.
NSAIDs and paracetamol for pain are first line.
Can use hormonal if needed (mirena, COCP)
Laparoscopic excision is used if medical management doesnt work.

62
Q

Molar pregnancy:
Key signs
Managment:

A

Uterus big for gestational age
Severe morning sickness
Abnormally high hCG.

Snowstorm appearance on USS.

Manage with evacuation of the uterus.

63
Q

What test can be used for screening for suspected ovarian cancer?

A

CA-125

64
Q

What are the symptoms of ovarian torsion?

Investigation?

Management?

A

Sudden onset unilateral pelvic pain
Nausea and vomiting

TV USS

Laparoscopic surgery to untwist the ovary.

65
Q

What are the risk factors for PID?

A

Same as any STI:
Regular unprotected sex.
Multiple sexual partners
Previous STI
Previous PID.

66
Q

What are the two most common pathogens that cause PID?

A

Chlamydia and gonorrhoea

67
Q

PID:
Symptoms?
Investigations?

A

Dyspareunia
Abnormal vaginal discharge
Lower abdo/pelvic pain.
Fever.

68
Q

What are the investigations for PID?

A

NAAT testing for Gonorrhoea and Chlamydia.
Pregnancy test.
Inflammatory markers.

69
Q

What criteria is used to diagnose PCOS? What does it include?

A

Rotterdam criteria
Two of the following three
Hirsutism
Polycystic ovaries on USS
Oligo or amenorrhoea.

70
Q

How does PCOS present?

A

High BMI
Oligomennorrhoea/amenorrhoea
Hirsutism
Acne
Infertility
Hair loss

71
Q

PCOS - investigations?

Treatment?

A

Pelvic USS - polycystic ovaries/”string of pearls appearance”
LH:FSH ratio at least 2:1 (not routinely used anymore)

Weight loss is key
Combined pill for acne and hirsutism
IVF for fertility

72
Q
A

Phase 3A Conditions (13 decks)

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