Womens COPY Flashcards
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
Causes of dyspareunia (4)
- Insufficient lubrication
- Inflammation/infection
- Vaginismus
- Pudenal neuralgia
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
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
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
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
