Womens Flashcards
Individuals who require a co-test (with regards to CST) (5)
- Sx: PCB, IMB, PMB
- Undergoing test-of-cure following treatment of HSIL
- Previous total hysterectomy with a history of HSIL without a completed TOC
- Previous been treated for a glandular abnormality, including adenocarcinoma in situ
- Were exposed to diethylstilbestrol (DES) in utero
32yoF Jenny, identifies as Aborginal, presents for rpt CST as had HPV non-16/18 on testing 12months ago with low risk LBC. You complete HPV DNA testing + co-test as required. Once again it is positive for HPV non16/18, and still low risk (negative,pLSIL or LSIL).
What is your management plan?
Direct referral to colposcopy.
- this is special circumstance
12month rpt testing for prev positive non 16/18 with low risk LBC
-> standard is to rpt again at 12mo
-> direct referral for colposcopy for:
- Women >50
- ATSI patients
- Overdue for screening by >2yrs at initial screen
Post partum - when is COCP contra-indicated?
Breastfeeding 0-6wks (cat 4)
Non breastfeeding 0-3wks
- cat 4 if other VTE risk factors, cat 3 if no other RF
37yo F presents seeking COCP as in new relationship. No recent partners, otherwise well. 2STD weekly, quit smoking 6 months ago.
Advice for COCP
COCP contra-indicated!
Age >35 + smoking = Cat 3 or 4, UNLESS stopped >1yr ago
Stopped >1yr, or smoking+<35 = cat 2
COCP cut-off with obesity
BMI >35 = cat 4 contra for COCP
30-34 = cat 2
VTE-related risk factors to consider prior to prescribing COCP (4)?
COCP = cat 3 or 4:
- Current or previous VTE
- 1st degree relative <45 with VTE
- Major surgery with prolonged immobilization
- Immobility unrelated to surgery (eg. wheelchair)
COCP Cat3+4 categories (8)
- Peripartum
- Smoking
- Obesity
- HTN
- IHD
- CVA/TIA
- VTE
- Breast cancer
IUD Contra-indications (4)
Current PID
Initiating with gonorrhoea or chlamydia
Initiating with unexplained vaginal bleeding
Hormonal IUD - Breast cancer hx
Folic acid for low + high risk
AND who is high risk (5)
0.5 mg/day for average risk for 1 month prior -> first trimester
5mg for high risk
- Anticonvulsant on
- Pre-pregnancy diabetes
- Previous history of child with NTD
- BMI >30
- Risk of malabsorption
Antenatal testing for T21 for high risk screening results (3)
- Do nothing
- CVS: 11-14wks
- Amniocentesis: after 15wks
28F, presents 32wks pregnant concerned that baby hasnt been moving much. Had a big day, very busy. Tried call maternity, but advised GP review.
Examines well, normal obs, FHR 150bpm.
What are your steps in management?
Urgent referral to obstetric unit of CTG
All pts presenting with decreased foetal movements from 28wks -> refer in
Causes of dyspareunia (4)
- Insufficient lubrication
- Inflammation/infection
- Vaginismus
- Pudenal neuralgia
Treatment options for dyspareunia (with unknown cause) - 3
- Manage psycho social stress around intercourse
- Refer to pelvic floor physio therapist
- Refer to psychologist for behavioral interventions
Person wanting not to breast feed after birth. What single management step?
Stat dose of Cabergoline (dopamine agonist)
23F, 3wks post partum, breast feeding. Feeling little unwell, low grade fever, tender red area in lower outer quadrant of breast.
Management steps? (5)
- Continue to breast feed
- Oral analgesia - paracetamol QID
- Cold packs
- Oral antibiotics - flucloxacillin QID for 5-10days
- Review in 24-48hrs to ensure improvement
Advice if needing to increase milk supply (6)
- Hold baby skin-to-skin at breast
- Ensure good attachment
- Breast feed frequently - Q2-3H
- Switch feed
- Express after breastfeeds
- Oral domperidone TDS
KFP: Features on exam that support PCOS (7)
- High BMI
- Hirsutism
- Acne
- Acanthosis nigricans
- skin tags involving neck/axillae
- Striae
- Signs of hypothyroid
KFP: History to ask if suspecting ovarian cancer? (4)
- Abdo bloating or increased abdo girth
- Early satiety
- Urinary frequency/urgency
- Pelvic or abdo pain
POP important points (5)
- POP only effective if taken within 3hr window
- Takes 3 days to become effective (unless start during period)
- Back up contraceptive for 48hrs if missed, ie. until 3 pills taken as normal
- Often changes menstrual bleeding
- Vomitting/diarrhoea withing 3hrs can decrease effectiveness
Rule of 3 - 3 hours, 3 days to effect + if missed
KFP: Relevant counselling points for Depot contraception (5)
- Contraceptive for at most 14wks
- Can cause uncertain + long delay to fertility (8mo - 2years)
- Irregular bleeing
- Can accelerate bone loss with long term use
- Takes 7 days to become effective
What anti-depressant to start in post-natal depression
- setraline for mod-severe depression
- avoid fluoxetine in breast feeding
Risk factors for Ectopic (5)
- Previous ectopic
- previous tubal surgery (or tubal pathology)
- Previous genital infection (PID, chlamydia, gonorrhoea)
- IUD - even after discontinuation
- In-utero DES exposure
65F with 6mo of urge incontinence. Initial investigations that will help with assessment (4 - non exhaustive)
- Urine MCS
- Bladder diary
- Fasting glucose
- Renal tract US with PVR
49F, 3 irregular light periods in last 7 months, in addition to hot flushes and low libido. Wanting HRT.
Should she have continuous, cyclical or other?
A. Continuous estrogen with CYCLICAL progesterone
Peri-menopause = cyclical progesterone
Post-menopausal = continuous estrogen+progesterone
No uterus = can use just estrogen
DDx for post-menopausal bleeding (5)
- Endometrial cancer
- Endometrial polyp
- Endometrial Hyperplasia
- Vaginal atrophy
- Cervical cancer
4, 5, 12 rule ?
Endometrial thickness cut-off for referral for endometrial sampling
- >4mm for post-menopausal
- >5mm for perimenopausal
- >12mm for pre-menopausal
Routine investigations for first trim antenatal visit (9)
- FBE
- BG + Abs
- Rubella Ab
- Syphilis serology
- Hep B serology
- Hep C serology
- HIV serology
- Mid stream urine
- CST if overdue
Indications for anti-D in first trimester (5)
- Abortion (after 10wks, for STOP or MTOP)
- Miscarriage
- Chorionic Villus Sampling
- Ectopic pregnancy
- Molar pregnancy
TORCH exposures to pregnancy that we worry about? (7)
T-toxoplasmosis
O-Other (Hep B, VZV, Parvo)
R-Rubella
C-CMV
H-HSV
KFP: Discussion points re CST (4)
- Recommended 5 yearly testing
- Option of self collect
- Can detect HPV before it can cause cervical cancer
- Will need further follow-up if HPV detected
KFP: Non-pharma management for women presenting with hot flushes (4)
- CBT or mindfulness for stress reduction
- 10% wt loss / BMI <25
- Hypnosis
- Lower room temp at night
KFP: Hx to ask to assess suitability for MHT (which are essentially the risks) (5)
- Current/previous/FHx hormone dependent cancer
- Any recent unexplained vaginal bleeding
- Previous IHD, TIA, CVA
- Previous VTE
- Known active liver disease
Need for contraception at menopause (2)
+ what if on prog-only contraception (2)
If FMP >50yo - need contraception for 1yr then cease
If FMP <50 - need for 2yrs then cease
If on prog-only + ammenorrhoeic:
- >50yo + single FSH >30, cont contraception for 1yr then cease
- if FSH <30 - rpt FSH in 12mo, then as above
Only time breast symptoms don’t need imaging straight away
AND how to manage
Hx + Ex must be consistent with:
No lump or discrete lesion
OR Finding consistent with hormonal change
Treat any pain, Review in 6-8wks immediately after a period
Imaging if problem persists
Pt with breast lump, sent for US -> benign results. What is the next step (2)
- If simple symptomatic cyst -> FNA
- If solid lesion or complex cyst -> non excisional core biopsy or FNA cytology
37 yro with breast lump - best imaging modality
US + Mammography
- both if >35
- if <35 - just US to start with
Criteria for breast discharge for that can by observed before referral (4) + Mx
<60
Bilateral and/or only on expression
No discrete lesion on ex
Negative for blood
Mx
Advise to cease expression
Image with mammography +- US
Review in 2-3 months
KFP: Management steps in adult who has been sexually assaulted (6)
- Offer reporting to local police
- Referral to local Sexual Assault + Family Violence centre
- Assess suicide risk
- Discuss emergency contraception if <120hrs
- Discuss PEP if <72hrs
- Arrange early follow-up
Treatment of UTI/cystitis in pregnancy
1st line - oral nitrofurantoin QID for 5/7
2nd line - Cefalexin BD for 5/7
Recurrent miscarriage causes (7):
- Advanced maternal age
- Maternal obesity (or significantly underweight)
- Smoking or etoh
- Anatomical - congenital uterine abnormality
- Endocrine - PCOS, DM, Thydroid, hyperprolactinaemia
- Thrombophilias - acquired (antiphospholipid) + hereditary
- Genetic
Recurrent miscarriage investigations (5):
- Pelvic US - Exclude anatomical
- TSH
- Prolactin
- Antiphospholipid screen - anticardiolipin Abs, lupus anticoagulant Abs
- Products of conception for karyotype
Management plan for menopause
Education - AMS handout or Jeane Hailes
Pharma - SNRI, gabapentin
HRT
Non pharma - limit ETOH, limits smoking, yoga
Lifestyle/SNAP - as above
Preventative
Referral - CBT if above fails, support groups
Review - 4wks maximum for initial review
