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4th yr- CMS- Medicine > Womens health > Flashcards

Womens health Flashcards

1
Q

How do we split up pregnancy

A

In three phases:

1st, 2nd, 3rd trimester

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2
Q

How do we write how many weeks a patient is pregnant

A

x/40

eg 10 weeks pregnant= 10/40

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3
Q

What is the pregnancy mortality rate in the UK

A

7/10,000

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4
Q

Name the most common cause of mortality in pregnancy

A

Thromboembolism leading to Deep vein thrombosis and pulmonary embolus

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5
Q

What is though to lead to a higher risk of maternal death in the future

A

Obesity and rising material age

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6
Q

What is the range of a normal pregnancy

A

37-42 weeks

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7
Q

How many pregnancies fail in the first trimester

A

1 in4-5 pregnancies fail here

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8
Q

What can cause spontaneous miscarriage int eh first trimester

A

Significant genetic abnormalities

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9
Q

What increases the risk of pregnancy los

A

Increasing maternal age

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10
Q

What is formed by the end of the first trimester

A

All the major organs

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11
Q

When is the foetus potentially viable

A

24 weeks

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12
Q

What is a miscarriage

A

Pregnancy loss before 24 weeks

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13
Q

What is a pregnancy lost after 24 weeks caused

A

intrauterine death (still birth)

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14
Q

What is an ectopic pregnancy

A

A pregnancy outside of the uterus

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15
Q

How common is ectopic pregnancy

A

Occurs in 1 in 300 pregnancies

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16
Q

Where are ectopic pregnancies usually found

A

In the Fallopian tube

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17
Q

Give some symptoms of ectopic pregnancy

A
  1. Extreme nausea
  2. Abdominal pain
  3. Vaginal bleeding
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18
Q

Are ectopic pregnancies successful

A

No

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19
Q

What happens if an ectopic pregnancies is left untreated

A

Will lead to rupture of the Fallopian tube with a potential fatal haemorrhage

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20
Q

How are ectopic pregnancies managed

A

Terminated via resection the involved Fallopian tube and or via methotrexate

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21
Q

Up to how many weeks is it legal to terminate a pregnancy for social rasosn

A

12-14 weeks

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22
Q

Which substances must we advise pregnant mothers to stay away from

A

Tobacco and alcohol

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23
Q

How does tobacco affect the foetus

A

Can lead to growth restriction

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24
Q

How does alcohol affect the foetus

A

Can cause foetal alcohol syndrome if taken in large amounts

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25
Q

When do pregnant mothers usually book appoitnemtns with doctors

A

12 weeks
20 weeks
babies birth

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26
Q

What happens at the 12 week appointment

A
  1. Booking bloods

2. 1st Ultrasound

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27
Q

What do we aim to find in the 1st scan

A
  1. Dating the foetus
  2. Initial screening
  3. Viability scan
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28
Q

What happens at the 20 week appointment

A

Look fo anatomy and any serious abnormalities

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29
Q

How are most babies delivered

A

In the hospitals with the help of midwife

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30
Q

When might medical intervention be required during birth

A
  1. Elective Caesarian section

2. Failure to progress once in labour

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31
Q

What do we recommend pregnant women carry with them at all times .

A

Their obstetric notes

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32
Q

What do obstetric notes usually include

A
  1. Contact info of the doctor
  2. Blood tests
  3. Blood pressure recordings
  4. Ante-natal visits documented
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33
Q

What common changes occur to women in pregnancy

A
  1. Nausea and vomiting
  2. Hypotension
  3. Breathlessness (dyspnoea)
  4. Anaemia
  5. Flow heart murmur
  6. Procoagulant state
  7. Gastro-oesophageal reflux (GORD)
  8. Chloasma or melasma
  9. Fluid retention
  10. Urinary urgency
  11. Skeletal pain
  12. Weight gain
  13. Haemorrhoids
  14. Periodontal disease
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34
Q

When is nausea and vomiting worse for pregnant women

A

Weeks 6-12

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35
Q

Why do pregnant women experience nausea and vomiting

A

Relates to the levels of beta-HCG from trophoblast during placental development

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36
Q

What leads to hypertension in pregnant women

A

Vascular muscular relaxation

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37
Q

Which type of hypotension can be a particular problem in pregnant women

A

Postural hypotension

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38
Q

What do we need to be careful in regards to positioning a pregnant women

A

Do not lay them on their back especially in the later stages of the pregnancy as the uterus will compress major blood vessels

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39
Q

What is dyspnoea

A

Breathlessness

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40
Q

Why might a pregnant women experience dyspnoea

A
  1. Oxygen demands increase
  2. The pattern of cheat movements alters at the uterus enlarges and limits movement of diaphragm
  3. Progesterone induces changes that promote respiratory exchange and hyperventilation
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41
Q

Why might a pregnant women experience anaemia

A

Primarily reflects increased circulating volume to meet the needs of the placenta as well as the women

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42
Q

What does a flow heart murmur reflect in a pregnant

A

Reflects hyper dynamic circulation as the heart works harder to pump the increased circulating volume

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43
Q

By how much does cardiac output increase during pregnancy

A

30-50%

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44
Q

Pregnancy increases the risk of T________ F_________ and…..

A

Thrombus formation and thrombosis- embolism (DVT and PE)

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45
Q

How much weight can a women gain during pregnancy

A

12kg

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46
Q

What oral complications can pregnant women experience

A
  1. Plaque induced inflammation often worsens

2. Pregnant epulis

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47
Q

Give examples of some pre existing lines that may be considered high risk pregnancies

A
  1. Diabetes
  2. HIV
  3. Renal transplant
  4. Systemic lupus erythematous
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48
Q

What do we do in a high risk pregnancies

A

Close monitoring and greater medical care from the outset with close monitoring and greater medical care from the outset to reduce the risks to the women and increase the likelihood of a good outcome from the pregnancy

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49
Q

What can sjögrens syndrome increase the likelihood of in pregnant women

A

Leads to 1 in 20 risk of permeant heart block in the foetus which persists after birth

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50
Q

Why can sjögrens syndrome be problematic for a foetus

A

Maternal Ro antibodies can cross the placenta and damage the developing foetal heart

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51
Q

Name some significant illnesses that arise in pregnancy for the first time

A
  1. Gestational diabetes mellitus

2. Pre eclampsia or eclampsia

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52
Q

How common is Pre eclampsia or eclampsia

A

5-10% pregnancies develop pre eclampsia

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53
Q

When does Pre eclampsia or eclampsia usually arise

A

Most 3rd trimester but may occur in the second

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54
Q

What is pre eclampsia characterised by

A
  1. Hypertension
  2. Oedema
  3. Proteinuria
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55
Q

What is proteinuria

A

Protein lost inappropratley in the urine signifying end organ renal damage due to the HTN

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56
Q

What is eclampsia

A

It is an extension of pre eclampsia characterised by seizures

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57
Q

Give some risk factors for Pre eclampsia or eclampsia

A
  1. <20 or >40 years of age
  2. Pre existing hypertension
  3. Obesity
  4. First pregnancy
  5. Twin pregnancy
  6. Previous pre eclampsia
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58
Q

What can Pre eclampsia or eclampsia increase the risk of

A

Risk of pregnancy related morbidity and mortality

59
Q

What can er prescribe to patients with high blood pressure

A

Anti hypertensive drugs

60
Q

How do we treat Pre eclampsia or eclampsia

A

Delivery of the baby is the only intervention that resolves Pre eclampsia or eclampsia

61
Q

Give examples of maternal infections that may lead to significant foetal developmental abnormalities

A
  1. The ToRCH infections
  2. Measles
  3. Syphilis
62
Q

Name the ToRCH infections

A

Toxoplasmosis
Rubella,
Cytomegalovirus,
Herpes Zoster Virus

63
Q

How can you get Toxoplasmosis

A

By eating food infected with cat faeces

64
Q

Name some maternal infections that spread to the baby via vertical transmission

A
  1. HIV
  2. Hep B and C
  3. Measles
  4. HSV
65
Q

How is immunity from rubella usually acquired

A
  1. Previous infection

2. Immunisation

66
Q

How is immunity from Varicella Zoster Virus usually acquired

A

Immunity to VZV is very high and typically reflects childhood chickenpox

67
Q

What can Varicella Zoster Virus cause

A

Significant developmental abnormalities in the unborn foetus eg blindness, paralysis and seizures

68
Q

When are the e risk from Varicella Zoster Virus greatest

A

Greatest in the first trimester with 10% babies affected

69
Q

What can chicken pox cause in pregnant mothers

A

Miscarriage or pre term labour

70
Q

When can we manage Varicella Zoster Virus

A

Interventions may be useful only if given very early after the infection

71
Q

How is immunity from Herpes Simplex Virus usually acquired

A

It Is very high and reflects childhood primary herpes infection

72
Q

What can primary HSV infection lead to to

A

Miscarriage and premature Labour

73
Q

How is immunity from measles usually acquired

A
  1. Previous infection

2. MMR vaccine

74
Q

What can measles cause in pregnant women

A

Can cause serious illness and increases the risks of miscarriage or premature labour and associated risk to the baby

75
Q

What does IVF stand for

A

In-vitro fertilisation

76
Q

What does IVF allow

A

Ive allows many couples who cannot conceive naturally to have a child together

77
Q

What requirement do couples have to complete before being considered for IVF

A

Must have been trying to conceive for at least a year

78
Q

What does IVF involve

A
  1. Ovarian hyper stimulation and egg collection
  2. Collected eggs are mixed with sperm in Vitro
  3. Zygotes are removed from eh Petri dish at the 4 cell cycle and transferred to 4th recipients uterus
79
Q

What is the success rate for IVF

A

30% per cycle

80
Q

How much does IVF cost

A

£3000-£4000 per cycle in the private sector

81
Q

Does the NHS cover IVF

A

In Leeds the NHS will fund only one cycle if the couple has no children and the woman is <40 yrs

82
Q

What risks can IVF pose to women

A

Ovarian hyper stimulation may prove fatal

83
Q

How many zygotes are usually inserted into the mother

84
Q

What problems are associated with post natal period

A
  1. Breast feeding breast engorged with milk can be uncomfortable
  2. Baby blue and general low Mood
  3. Post natal depression
85
Q

What problems can we encounter when administrating amide LA to a pregnant mother

A

Levels of this protein fall in pregnancy meaning that more LA is freely available in the circulation
Greater risk of LA toxicity

86
Q

What are some things we need to consider in terms of vasoconstrictors and pregnancy

A

May cause vasoconstriction of the blood vessels of the placenta reducing blood supply to the embryo/ foetus

87
Q

Give examples of some antibiotics that are considered safe with regards to teratogenicity

A
  1. Penicillins
  2. Cephalosporins
  3. Erythromycin
88
Q

Which drugs should we be weary of prescribing to pregnant women

A
  1. Metronidazole

2. Tetracyclines

89
Q

Why do we avoid prescribing metronidazole in pregnant woman

A

Cited as potential teratogenic

90
Q

Why do we avoid prescribing Tetracyclines in pregnant woman

A

Can cause yellow/ brown/ grey discolouration of mineralised tissues including teeth and bone if the foetus is exposed to the drugs which cross the placenta

91
Q

Name the first choice of analgesia to give to pregnant woman

A

Paracetamol

92
Q

Which analgesia should be avoided giving to pregnancy women

A
  1. Aspirins
  2. NSAIDs
  3. COX-2 inhibitors
93
Q

What should Aspirin, NSAIDs and COX-2 inhibitors be avoided in pregnant patients

A
  1. Antiplateltt effects
  2. May exacerbate fluid retention
  3. In third trimester NSAID can lead to premature closure of the ductus arteriosus
94
Q

Can we prescribe Benzodiazepines to pregnant women

A

No as they are considered teratogenic

95
Q

Will every pregnant woman tell you they are pregnant

A

no some mat not know as many pregnancies are unplanned

96
Q

What is a rule of thumb regarding treating pregnant women

A
  1. Avoid non urgent oral health care in the first trimester

2. Oral healthcare can be safely undertaken in the 2nd and 3rd trimesters but positioning on chair may be difficult

97
Q

How can we position pregnant women in their 2nd or 3rd trimester

A

The left lateral decubitus position with the right buttock and hip elevated by 15 ̊ reduces aorto-caval compression

98
Q

Give examples of women’s health unrelated to pregnancy

A
  1. Breast cancer
  2. Cervical cancer
  3. Endometrial cancer
  4. Ovarian cancer
  5. Hysterectomy
  6. Endometriosis
  7. PCOS
99
Q

Name the most common cancer in the uk

A

Breast cancer

100
Q

How many women annually are diagnosed with breast cancer

A

49,500 Women

More than 100 a day

101
Q

Can men get breast cancer

A

Yes each year 400 men are diagnosed with breast cancer

102
Q

Have breast cancer rates increased or decreased in the last 20 years

A

Increased by more than 50%

103
Q

Where in the world is there the highest risk of breast cancer

A

North Europe, north America

104
Q

Is breast cancer fatal

105
Q

How many people die from breast cancer in the uK

A

11,500 WOMEN AND 75 MEN

106
Q

In whom is breast cancer most common

A

8 in 10 breast cancers are diagnosed in women aged 50 years plus

107
Q

Who is most likely to die from breast cancer

A

More than half of breast cancer deaths are in women aged 70 or over

108
Q

Name the most common cause of death from cancer

A

Lung then breast

109
Q

Who do we invite for a breast cancer screening

A

Targets 50-70 year old

They are invited every 3-5 years

110
Q

Is the breast cancer screening effective

A

Yes it picks up around 14,000 cases annually

111
Q

What is breast cancer management based on

A
  1. Disease staging
  2. Co morbid diseases
  3. Patients wishes
112
Q

How can we manage and treat breast cancer

A
  1. Surgery (in most)
  2. Radiotherapy
  3. Some cancers are hormone sensitive and many patients receive tamoxifen or similar drugs
113
Q

List some risk factors for breast cancer

A
  1. Increasing age
  2. Early age art menarche
  3. Older age
  4. Parity (number of live births)- less is more risk
  5. Late menopause
  6. Oral contraceptive
  7. HRT increases breast cancer risk and lowers sensitivity of mammograms
  8. Overweight and obesity increases the risk
  9. Alcohol intake
  10. Family history
114
Q

What can be protective against breast cancer

A

Breastfeeding

115
Q

How common is cervical cancer

A

3200 new cases per year

116
Q

What is the peak age of cervical cancer

A

30-39 years

117
Q

How many deaths are caused by cervical cancer

A

890 deaths per year

118
Q

List some risk factors for cervical cancer

A
  1. Tobacco smoking

2. HPV especially subtype HPV 16 and 18

119
Q

What is cervical cancer

A

A SCC of the cervical

120
Q

What is endometrial cancer

A

It is an adenocarcinoma of the uterine endometrium

121
Q

How common is endometrial cancer

A

9300 new cases per year

122
Q

How many deaths are caused by endometrial cancer

A

2200 deaths per year

123
Q

In which age is endometrial cancer most common

A

55-69 years

124
Q

What can increase the risk of developing endometrial cancer

A
  1. Obesity
  2. tamoxifen
  3. Combines OCP use
  4. Pregnancy
  5. Low parity
125
Q

How do we treat endometrial cancer

A

Perform hysterectomy

126
Q

What is ovarian cancer

A

Adenocarcinoma of the ovary

127
Q

How common is ovarian cancer

A

7000 new cases

128
Q

How many deaths are caused by ovarian cancer

A

4300 deaths per year

129
Q

In which age is ovarian cancer most common

A

55-74 years

130
Q

List some protective factors for ovarian cancer

A
  1. Pregnancy
  2. High parity
  3. Breast-feeding
131
Q

What do we mean by parity

A

Live births

132
Q

What is a hysterectomy

A

A commonly undertaken surgical removal of the uterus via an abdominal or vaginal approach

133
Q

When might a hysterectomy be indicated

A
  1. Heavy painful, prolonged or irregular periods
  2. Due to fibroids
  3. Due to malignancy
134
Q

What are fibroids

A

vey common, leiomyomas (benign overgrowth of uterine muscle) which are mostly asymptomatic but can cause heavy painful irregular periods

135
Q

How common is endometriosis

A

Affects around 2 million women in the uK

136
Q

At what age is endometriosis most common

137
Q

How do endometriosis causing cells behave

A

They behave as if they would inside the uterus and therefore shed blood during the menstrual cycle
These trapped tissues lead to pain, swelling and bleeding wherever they are migrated to

138
Q

Name the most common symptoms of endometriosis

A

Pain or discomfort but some women are asymptomatic

139
Q

How can we manage endometriosis

A
  1. NSAIDs for analgesia
  2. Hormone manipulaiton
  3. Surgery including ablation of foci of endometrial cells
  4. Hysterectomy and bilateral
140
Q

What does PCOS stand for

A

POLYCYSTIC OVARIAN SYNDROME

141
Q

PCOS is commonly diagnosed in women with

A
  1. Anovulatory infertility
  2. Oligomenorrhoea
  3. Hyperandrogenic problems such as hirsutism and acne
142
Q

What is Anovulatory infertility

A

failure to ovulate so can’t conceive)

143
Q

What is Oligomenorrhoea

A

light periods

144
Q

What is PCOS associated with

A

Obesity
Metabolic syndrom
Type 2 diabetes

4th yr- CMS- Medicine (14 decks)

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