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Its the final countdown > Womens > Flashcards

Womens Flashcards

1
Q

Menopause - duration of amenorrhoea for Dx

A

12 months

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2
Q

Premature menopause
age
cause

A

<40 yo
primary ovarian insufficiency

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3
Q

give 4 premenopausal Sx

A

Systemic: Hot flushes
Emotional lability or low mood
Premenstrual syndrome (PMS)

MSK: Joint pains

Gynae:
Vaginal dryness and atrophy
Reduced libido
Heavier or lighter periods
Irregular periods

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4
Q

Menopause can be dx clinically, or with the help of which test?

A

FSH blood test

(should be high due to lack of oestorogen –> lack of -ve feedback on pit. gland)

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5
Q

When is contraception needed around menopause

A

Effective contraception is needed for:
* 2yrs post LMP if <50 yo
* 1yr post LMP in >50 yo

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6
Q

contraception options in premenopausal women

A

Options in premenopausal women
UKMEC1 ( no restrictions)
everything: coils, progesterone, sterilisation
remember: Progesterone depot injection ( only in <45 years)
 2 main S/E: weight gain, reduced BMD
 Osteoporosis risk makes it unsuitable in >45

UKMEC2 (advantages > risks)
o COCP <50 yo
o Norethisterone/ levonorgestrel have low VTE risk

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7
Q

What are the suitable forms of HRT in
Uterus? (Y/N)
Period in last 12m? (Y/N)

A

Uterus?
* No: continuous oestrogen-only HRT.
* Yes: combined HRT (inc progeesterone)

Period in last 12m?
* Perimenopausal (yes) = cyclical combined HRT.
* Postmenopausal (no) = continuous combined HRT.

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8
Q

Give 3 C/I of HRT

A
  • Undiagnosed vaginal bleeding
  • Pregnancy
  • Breastfeeding
  • Oestrogen receptor-positive breast cancer
  • Acute liver disease
  • Uncontrolled hypertension
  • History of breast cancer or venous thromboembolism (VTE)
  • Recent stroke, myocardial infarction or angina
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9
Q

HRT increases the risk of (5 - 2x cancer, 3x vascular)

A

Cancer: breast, endometrial
Vascular: VTE, stroke, IHD

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10
Q

define
endometrioma
chocolate cyst
adenomyosis

A
  • endometrioma lump of endometrial tissue outside the uterus
  • chocolate cysts endometriomas in the ovaries
  • Adenomyosis endometrial tissue within the myometrium (uterine muscle layer).
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11
Q

give 7 endometriosis Sx

A

Can be Asx or Sx:
* cyclical abdominal or pelvic pain
* Deep dyspareunia
* Dysmenorrhoea
* Infertility
* Cyclical bleeding from other sites (e.g haematuria)

Other cyclical sx:
* Urinary symptoms
* Bowel symptoms

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12
Q

give 3 examination findings in endometriosis

A
  • Speculum: endometrial tissue visible in the vagina (esp in posterior fornix)
  • Bimanual:
    o A fixed cervix
    o Tenderness in the vagina, cervix and adnexa
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13
Q

Gold standard test in endometriosis

A

Laparoscopic surgery

definitve Dx = biopsy of the lesions during laparoscopy.

(Pelvic US can also be used but may be unremarkable )

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14
Q

endometriosis stepwise Mx

A

PRN analgesia (NSAIDs/paracetamol 1st line)

Hormonal mx (contraceptives/GnRH agonist)

Surgical : laporascopic excision/adhesiolysis
hysterectomy

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15
Q

define salpingitis

A

inflammation of the fallopian tubes (PID)

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16
Q

defime parametritis

A

infection of the parametrium ( PID)

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17
Q

give 3 potential STI causes of PID. Which form produces more severe PID?

A

N. Gonorrhea (most severe)
Chlamydia trachomatis
Mycoplasma genitalium

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18
Q

Give 43 non-STI causes of PID

A

G. Vaginalis ( also causes bacterial vaginosis)
H.Influenza ( also causes resp infections)
E. coli ( also causes UTI)

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19
Q

give 4 examination findings suggestive of PID

A

Pelvic tenderness
Cervical excitation
Inflamed cervix
Purulent discharge

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20
Q

give 3 risk factors for PID

A

STI risk, PID Hx, IUD

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21
Q

absence of what finding under microscope can exclude PID

A

pus cells

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22
Q

medical mx for PID

A

IM ceftriaxone 1g stat, Doxyclycine 100mg BD 14/7, Metronidaxole 400mg BD 14/7

ceftriaxone -gonorrhoea
Doxycycline - chlamydia and Mycoplasma genitalium)

Metronidazole - anaerobes such as Gardnerella vaginalis)
 Ceftriaxone and doxycycline - cover -other bacteria, including H. influenzae and E. coli.

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23
Q

give 6 complications of PID

A
  • Sepsis
  • Abscess
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
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24
Q

waht is the presentation of Fitz-Hugh-Curtis syndrom?

A

RUQ pain that referrs to right shoulder tip

Fitz-Hugh-Curtis Syndrome - inflammation and infection of the liver capsule causing adhesions between the liver and peritoneum.

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25
Q

what is the Ix for Fitz-Hugh-curtis syndrom

A

laproscopy ( visually & adhesiolysis (tx)

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26
Q

a 23 yo attends the clinic with severe bilateral lower abdominal pain.
bimanual examination: adnexal tenderness and the moments of extreme pain during the examination.

What is the most important initial investigation?

A

Beta-HCG . tis presentation suggests PID, but its important to exclude ectopic

swabs etc would be suitable to explore PID, once ectopic excluded

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27
Q

what organism causes a painful, potentially necrotic genital lesion, associated w/ painful lymphadenopathy & bleeding on contact

A

defined - chancroid ( STI)

cause: Haemophilus ducreyi - G-ve bacillus

  • The bacterium is sexually transmitted and can cause a genital ulcer and inflammation of the inguinal lymph nodes.
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28
Q

a pt presents with symptoms suggestive of chancre, what key (non-sex related) picece of infomration should eb asked about in their PMHx?

A

recent travel

chancroid is more common in tropical areas & greenland

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29
Q

how does genital infection with Haemophilus ducreyi present?

A

painful genital lesipon
may bleed on contact
painful swollen lymph nodes (lymphadenopathy), may rupture and discharge pus
Sx develop 4-10days post ex-posure

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30
Q

multiple small vesicular lesions which become ulcers

accompanied by fever & malaise

cause?

A

HSV

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31
Q

painless ulcer and generalised non-tender lymphadenopathy

A

syphilis

do not confuse with chancroid which is PAIFUL lesion, blleds to touch, painful lymphadenopathy

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32
Q

painless ulcer or papule, followed by pain

A

lymphogranuloma venereum

( lymdenopathy which is painful called bubo - similar to chancroid)

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33
Q

Mx chancroid

A

antibiotics ( ceftriaxone, azithromycin, ciprofloxacin)
analgesia
incision & drainage (buboes)

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34
Q

a pt attends the GP clinic with a 2week old geneital lesion & enlarged nofdes around the region. the pt is sexually active so you suspect Chancroid. a penile swab is taken, describe the appearance of the findings

A

gram -ve rods
school fish patter

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35
Q

why is migraine with aura CI in COCP?

A

significantly increased stroke risk

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36
Q

Syphilis is casued by a bacteria
- name
- appearance

A

Name Treponema pallidum
appearance: spirochete (spiral shaped bacteria)

37
Q

how long is the syphilis incubation period

A

21 days

38
Q

How many stages are there in syphilis infection, how do these present

A

(5)
Primary syphilis
* painless ulcer (chancre) at original site of infection.

Secondary syphilis
* Systemic sx (especially of the skin and mucous membranes)
* Sx resolve after 3 – 12 weeks, then goes to latent stage.

Latent syphilis
* occurs after 2ᴼ stage
* Sx disappear & patient ASx (despite still being infected).
* 2 subcategories
o Early latent syphilis - within 2yrs of the initial infection
o Late latent syphilis – from 2yrs post initial infection.

Tertiary syphilis
* many years after the initial infection
* affects many organs of the body (causes the development of gummas sores that grow deep and eat away at the area where they develop, such as the skin, lungs, liver, or bone (Gummatous syphilis) and cardiovascular and neurological complications.

Neurosyphilis occurs
* CNS infection, presenting with neurological symptoms.

39
Q

what eye finding is associated with syphilis

A

Argyll-Robertson pupil i ( propstitues puil)
constricted pupilm that accommodates (when focusing on near objects) but does not react (to light)

40
Q

Tx syphilis

A

deep IM benzathine benzylpenicillin (or cef/amoxicillin/dox)

41
Q

what type of bacteria is chlamydia trachomatis?

A

gram -ve, intracellular organism

42
Q

describe the National Chlamydia screening programme

A

screen sexually active people <25yo
Annually / when sexual partner is changed

In positive test:
- treatment
- re-test in 3 months

43
Q

what is the main complication of induction of labour

A

uterine hyperstimulation

tachysystole (high contraction frequency), for >20mins. May/may not have fetal distress

44
Q

what is a normal rate of contractions in labour

A

<4 contractions in 4mins

45
Q

Give risk factors for uterine hyperstimulation

A

oral misoprostol

46
Q

foetal tachycardia

A

> 160bpm

47
Q

risk factors for uterine rupture

A

multiparous
connective tissue disease
Macrosomia
Multiple pregnancy

48
Q

Give 5 indications for induction of labour

A
  • Weeks 41-42
  • PRoM
  • Fetal growth restriction
  • Pre-eclampsia
  • Obstetric cholestasis
  • Existing diabetes
  • Intrauterine fetal death
49
Q

the bishops score has a minimum of 0 and maximum of 13. What is the
- use of the score
- the categories of it

A

Determining whether to induce labour

SCOPED
* Station of foetal head (foetal station: 0 – 3)
* Consistency of the cervix (scored 0 – 2)
* Position of cervix(scored 0 – 2)
* Effacement of the cervix (scored 0 – 3)
* Dilatation of the cervix (scored 0 – 3)

9-13 = cervix facouurable for IOL

50
Q

Give the 5 methods used in IOL

A

Membrane sweep (fingers - should induce in <48hrs)
Vaginal prostaglandin E2 (dinoprostone) - (gel, tablet. pessary inserted)
Cervical ripening balloon (dilates cervix, where prostaglandins not preferred e.g. C-section Hx/ muliparous/ prostaglandins havenent worked
Oxytocin infusion (where prostaglandis haven’t worked

51
Q

when os oral mifeprostone + misoprostol combined in IOL ?

A

interuterine death

Oral mifepristone (anti-progesterone)

52
Q

what are the 3 risks of the main complication of IOL with prostaglandins

A
  • foetal compromise ( hypoxia and acidosis)
  • emergency C-section
  • uterine rupture

prostaglandin - e.g. misoprostol

53
Q

Mx uterine hyperstimulation

A

removing inducing agent ( prostaglandin/ oxytocin infuction)

Tocolysis ( using terbutaline)

54
Q

HTN in pregnancy

1st line
if asthmatic

A

1st line - oral labetalol

2nd line nifedipine + hydralazine

55
Q

What antiHTN should be vavoided in pregnancy

A

ACEi, ARBs, Thiazide & thaizide-like diuretics (cause congenital abnormalities), and most B-blockers

56
Q

what cuses pre-eclampsia

A

malformation of spiral arteries of the placenta –> vascuar resistance

1st shows after 20wks

57
Q

pre-eclampsia features triad:

A

HTN, substantial proteinuria, oedema

  • substantial as mild proteinuria may be subsequent to the chronic HTN (e.g. protein +1)
58
Q

the risk factors of pre-eclampsia can be sorted into high risk/ moderate risk. what are the high risk factors>

A
  • Hx HTN (including in pregnancy)
  • Hx autoimmune conditions (e.g.SLE)
  • Diabetes
  • CKD
59
Q

the risk factors of pre-eclampsia can be sorted into high risk/ moderate risk. what are the moderate risk factors?

A
  • > 40
  • BMI > 35
  • More than 10 years since previous pregnancy
  • Multiple pregnancy
  • First pregnancy
  • FHx pre-eclampsia
60
Q

You are assessing a pregnant pt for pre-eclampsia risk, when and using what criteria would you offer prophylctic medication

A

medication: Aspirin
from 12 wks

in 1 high risk factor
>1mod risk factor

61
Q

pre-eclampsia Sx

A

Headaches, visual disturbances, brisk reflexes

N&V
epigastric pain

Oedema

Oliguria

62
Q

Pre-eclampsia diagnostic features

A
  • BP > 140/90 mmHg
    PLUS any of:
  • Proteinuria (>1+ on urine dipstick)
  • Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
  • Placental dysfunction
63
Q

Preeclampsia Mx

HTN Mx
Seizure prevention during labour
fluid overload prophylaxis

A

HTN: Labetolol (1st) Nifedipine (2nd) Methyldopa(3rd)
IV hydralazine - in critical care in severe pre-eclampsia or eclampsia

Seizure prophylaxis: IV magnesium sulphate - give 24hrs pre & during labour

Fluid overload - Fluid restriction during labour in severe pre-eclampsia or eclampsi

64
Q

Preeclampsia can continue for 1m post delivery, what medical Mx is used (1st to 3rd line)

A
  1. Enalapril
  2. Nifedipine or amlodipine (1st line Afro-Caribbean )
  3. Labetolol or atenolol
65
Q

Give 2 complications of pre-eclampsia and their Mx

A

Eclampsia - IV MgSO4

HELLP Syndrome ( Haemolysis, Elevated Liver enzymes, low Platelets) - delivery

66
Q

Management: Pt presents with placental abruption at 3t6 wks. The foetus is alive and not showing signs of distress.

A
  • Adx
  • Administer steroids ( lung maturation)
  • deliver at 37-38 wks (risk of stillbirth)
67
Q

Pt presents with placental abruption at 36 wks. There are signs of foetal distress. What is the correct management?

A

immediate C-section ( the stage of labour doesn’t matter, foetal distress + placental abruption = C-section immediately)

68
Q

give 3 placental abruption risk factors

A
  • Previous placental abruption
  • Pre-eclampsia
  • Bleeding early in pregnancy
  • Trauma (consider domestic violence)
  • Multiple pregnancy
  • Fetal growth restriction
  • Multigravida
  • Increased maternal age
  • Smoking
  • Cocaine or amphetamine use
69
Q

typical presentation of placental abruption

A

sudden onset CONTINUOUS pain, with WOODY abdomen

70
Q

what is the most significant foetal complication in maternal GDM?

A

macrosomia

71
Q

what risk factors suggest a need to test for GDM?

A
  • Personal Hx GDM
  • FHx GDM (1st degree relative)
  • Hx macrosomic baby (≥ 4.5kg)
  • BMI > 30
  • Ethnic origin (black Caribbean, Middle Eastern and South Asian)
72
Q

what test is used to screen for GDM

A

OGT
measure blood sugar –> 75g glucose drink –> 2hrs repeat of blood sugar

normal : <5.6mmol (fasting)
<7.8mmol (2hrs)

73
Q

in pt with GDM, the Mx is 1-2wks lifestyle trial (1st line), then metformin (2nd line) , then insulin (3rd line).

what is the indicator for starting metformin & insulin immediately

A

fasting glucose> 7mmol/l

fasting glucose >6mmol/l plus macrosomia

74
Q

what is the folic acid regimen in women with pre-existing diabetes wanting t get pregnant

A

mg folic acid from preconception until 12 weeks gestation.

75
Q

at what gestational age should women with diabetes

  • pre-existing
  • GDM

give birth

A

pre-existing diabetes : 37- 38 + 6 wks

GDM: up to 40 + 6

76
Q

What screening is important to do for pregnant women with diabetes?

A

retinopathy screening - 28wks

77
Q

when should GDM pts stop their medication post-natally?

A

immediately

diabetes improves immediately after birth

78
Q

when should a follow up test of fasting glucose be done in GDM pts post labour

A

after 6 weeks

79
Q

Give 6 neonatal complications following maternal diabetes

A

macrosomia
neonatal hypoglycaemia ( the 2 main ones)

polycythaemia, jaundice, congenital heart disease, cardiomyopathy

80
Q

What is the management for a hypoglycaemic neonate (BM <2mmol/L

A

IV dextrose
or
NG feeding

81
Q

how long after a ToP does the urine pregnancy remain positive

A

up to 4 weeks following termination.

Following termination of pregnancy, HCG decreases by about 50% every two days.
- A positive test beyond 4 weeks indicates incomplete abortion or persistent trophoblast

so a pt who’s urine pregnancy test remains +ve should repeat 4 weeks following ToP

82
Q

who should anti-D prophylaxis be given to in ToP?

A

RhD-ve women with ToP >10+0 weeks

83
Q

ToP regime

A

mifepristone ( porgesterone)
then mifoprostol (oprostaglandin) 48 hrs later

84
Q

how long should barrier contraception be used when moving from POP to COCP

A

7 days

85
Q

what triad of features suggest vasa previa

A

rupture of membranes
then
painless vaginal bleeding
and
fetal bradycardia

86
Q

what is the standard folic acid dose in women wanting to be pregnant

A

0.4mg ( 400mcg)

87
Q

what is the folic acid dose in women at increased NTD risks?

give examples of women in this high risk category

A

5mg

previous child w/ NTD
DM
on AED
Obese
HIV+ve on co-trimoxazole
sickle cell, coeliac, thalassaemia

88
Q

second line in endometriosis medical management

A

1st line - ibuprofen + / paracetamol

2nd line COCP/ progestogen

89
Q
A

Its the final countdown (23 decks)

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