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1. Jim > Womens COPY > Flashcards

Womens COPY Flashcards

1
Q

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?

A

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

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2
Q

Post partum - when is COCP contra-indicated?

A

Breastfeeding 0-6wks (cat 4)
Non breastfeeding 0-3wks
- cat 4 if other VTE risk factors, cat 3 if no other RF

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3
Q

37yo F presents seeking COCP as in new relationship. No recent partners, otherwise well. 2STD weekly, quit smoking 6 months ago.
Advice for COCP

A

COCP contra-indicated!
Age >35 + smoking = Cat 3 or 4, UNLESS stopped >1yr ago
Stopped >1yr, or smoking+<35 = cat 2

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4
Q

COCP cut-off with obesity

A

BMI >35 = cat 4 contra for COCP
30-34 = cat 2

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5
Q

VTE-related risk factors to consider prior to prescribing COCP (4)?

A

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)

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6
Q

COCP Cat3+4 categories (8)

A
  • Peripartum
  • Smoking
  • Obesity
  • HTN
  • IHD
  • CVA/TIA
  • VTE
  • Breast cancer
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7
Q

IUD Contra-indications (4)

A

Current PID
Initiating with gonorrhoea or chlamydia
Initiating with unexplained vaginal bleeding
Hormonal IUD - Breast cancer hx

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8
Q

Folic acid for low + high risk
AND who is high risk (5)

A

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

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9
Q

Antenatal testing for T21 for high risk screening results (3)

A
  • Do nothing
  • CVS: 11-14wks
  • Amniocentesis: after 15wks
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10
Q

Causes of dyspareunia (4)

A
  1. Insufficient lubrication
  2. Inflammation/infection
  3. Vaginismus
  4. Pudenal neuralgia
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11
Q

23F, 3wks post partum, breast feeding. Feeling little unwell, low grade fever, tender red area in lower outer quadrant of breast.
Management steps? (5)

A
  1. Continue to breast feed
  2. Oral analgesia - paracetamol QID
  3. Cold packs
  4. Oral antibiotics - flucloxacillin QID for 5-10days
  5. Review in 24-48hrs to ensure improvement
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12
Q

Advice if needing to increase milk supply (6)

A
  1. Hold baby skin-to-skin at breast
  2. Ensure good attachment
  3. Breast feed frequently - Q2-3H
  4. Switch feed
  5. Express after breastfeeds
  6. Oral domperidone TDS
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13
Q

KFP: Features on exam that support PCOS (7)

A
  • High BMI
  • Hirsutism
  • Acne
  • Acanthosis nigricans
  • skin tags involving neck/axillae
  • Striae
  • Signs of hypothyroid
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14
Q

KFP: History to ask if suspecting ovarian cancer? (4)

A
  1. Abdo bloating or increased abdo girth
  2. Early satiety
  3. Urinary frequency/urgency
  4. Pelvic or abdo pain
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15
Q

POP important points (5)

A
  1. POP only effective if taken within 3hr window
  2. Takes 3 days to become effective (unless start during period)
  3. Back up contraceptive for 48hrs if missed, ie. until 3 pills taken as normal
  4. Often changes menstrual bleeding
  5. Vomitting/diarrhoea withing 3hrs can decrease effectiveness

Rule of 3 - 3 hours, 3 days to effect + if missed

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16
Q

KFP: Relevant counselling points for Depot contraception (5)

A
  1. Contraceptive for at most 14wks
  2. Can cause uncertain + long delay to fertility (8mo - 2years)
  3. Irregular bleeing
  4. Can accelerate bone loss with long term use
  5. Takes 7 days to become effective
17
Q

What anti-depressant to start in post-natal depression

A
  • setraline for mod-severe depression
  • avoid fluoxetine in breast feeding
18
Q

Risk factors for Ectopic (5)

A
  1. Previous ectopic
  2. previous tubal surgery (or tubal pathology)
  3. Previous genital infection (PID, chlamydia, gonorrhoea)
  4. IUD - even after discontinuation
  5. In-utero DES exposure
19
Q

65F with 6mo of urge incontinence. Initial investigations that will help with assessment (4 - non exhaustive)

A
  1. Urine MCS
  2. Bladder diary
  3. Fasting glucose
  4. Renal tract US with PVR
20
Q

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

A. Continuous estrogen with CYCLICAL progesterone

Peri-menopause = cyclical progesterone
Post-menopausal = continuous estrogen+progesterone
No uterus = can use just estrogen

21
Q

DDx for post-menopausal bleeding (5)

A
  1. Endometrial cancer
  2. Endometrial polyp
  3. Endometrial Hyperplasia
  4. Vaginal atrophy
  5. Cervical cancer
22
Q

4, 5, 12 rule ?

A

Endometrial thickness cut-off for referral for endometrial sampling
- >4mm for post-menopausal
- >5mm for perimenopausal
- >12mm for pre-menopausal

23
Q

Routine investigations for first trim antenatal visit (9)

A
  • FBE
  • BG + Abs
  • Rubella Ab
  • Syphilis serology
  • Hep B serology
  • Hep C serology
  • HIV serology
  • Mid stream urine
  • CST if overdue
24
Q

Indications for anti-D in first trimester (5)

A
  1. Abortion (after 10wks, for STOP or MTOP)
  2. Miscarriage
  3. Chorionic Villus Sampling
  4. Ectopic pregnancy
  5. Molar pregnancy
25
Q

KFP: Non-pharma management for women presenting with hot flushes (4)

A
  1. CBT or mindfulness for stress reduction
  2. 10% wt loss / BMI <25
  3. Hypnosis
  4. Lower room temp at night
26
Q

KFP: Hx to ask to assess suitability for MHT (which are essentially the risks) (5)

A
  1. Current/previous/FHx hormone dependent cancer
  2. Any recent unexplained vaginal bleeding
  3. Previous IHD, TIA, CVA
  4. Previous VTE
  5. Known active liver disease
27
Q

Need for contraception at menopause (2)
+ what if on prog-only contraception (2)

A

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

28
Q

Only time breast symptoms don’t need imaging straight away
AND how to manage

A

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

29
Q

Pt with breast lump, sent for US -> benign results. What is the next step (2)

A
  1. If simple symptomatic cyst -> FNA
  2. If solid lesion or complex cyst -> non excisional core biopsy or FNA cytology
30
Q

37 yro with breast lump - best imaging modality

A

US + Mammography
- both if >35
- if <35 - just US to start with

31
Q

KFP: Management steps in adult who has been sexually assaulted (6)

A
  1. Offer reporting to local police
  2. Referral to local Sexual Assault + Family Violence centre
  3. Assess suicide risk
  4. Discuss emergency contraception if <120hrs
  5. Discuss PEP if <72hrs
  6. Arrange early follow-up
32
Q

Recurrent miscarriage causes (7):

A
  1. Advanced maternal age
  2. Maternal obesity (or significantly underweight)
  3. Smoking or etoh
  4. Anatomical - congenital uterine abnormality
  5. Endocrine - PCOS, DM, Thydroid, hyperprolactinaemia
  6. Thrombophilias - acquired (antiphospholipid) + hereditary
  7. Genetic
33
Q

Recurrent miscarriage investigations (5):

A
  1. Pelvic US - Exclude anatomical
  2. TSH
  3. Prolactin
  4. Antiphospholipid screen - anticardiolipin Abs, lupus anticoagulant Abs
  5. Products of conception for karyotype
34
Q

Management plan for menopause

A

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

1. Jim (20 decks)

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