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Womens Health > Womens Health > Flashcards

Womens Health Flashcards

1
Q

Pre-eclampsia

  • hypertensive syndrome >20 weeks
A 
RF
fam hx
prev preg pre-eclampsia/HELLP
nulliparity
BMI >30
age >40
multiple (twin) pregnancy
diabetes
PCOS
autoimmune disease
pre-existing htn
CKD

Sx
hypertension after 20 weeks (>140/90)
proteinuria
headache, blurry vision, abdo pain, peripheral edema

Inv
proteinuria
fbc
e/lfts
fetal ultrasound
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2
Q

Pre-eclampsia Mx

A

Mx
low dose aspirin (100mg nocte) from 12 weeks
hospital admission and monitoring
labetalol 100mg bd. {methyldopa associated with depression}
seizure prevention
fluid restriction
early delivery (corticosteroid injection to mature baby lungs and organs)

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3
Q

HELLP (subtype of severe pre-eclampsia)

A 
RF
Sx
H (haemolysis)
EL (elevated liver enzymes)
LP (low platelets)
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4
Q

HELLP Mx

A

Mx
Low dose aspirin (100mg nocte) from 12 weeks.
hospital admission and monitoring
early delivery

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5
Q

Placenta Previa
Placenta Abrupta
Placenta Accreta
Vasa Previa

A

Placenta Previa - placenta located close to os (lscs)
Placenta Abrupta - placenta ruptured from uterus
Placenta Accreta - placenta attached to muscle/bladder
Vasa Previa - fetal vessels unprotected or at os (lscs)

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6
Q

Early pregnancy bleeding

A

RF
20-40% pregnancies have 1st trimester bleeding

Ddx
threatened miscarriage
ectopic pregnancy
endometrial implantation bleed (early weeks)
trophoblastic disease (raised hCG)

Sx
Inv
bhcg serial every 48-72 hrs
u/s obstetric - rule out ectopic. review in a week

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7
Q

Early pregnancy bleeding mx

A

Mx
bhcg serial 48-72hrs apart
u/s obstetric

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8
Q 
Miscarriage - 
Threatened
Inevitable
Incomplete
Missed
Complete
Septic
Recurrent
A

Threatened - PV bleed <20 weeks gestation
Inevitable - passage of POC of nonviable IUP occurring or about to occurr
Incomplete - retention of POC of non-viable IUP
Missed - no PV bleed. u/s diagnosis of non-viable IUP
Complete - full expulsion of POC of an IUP
Septic - miscarriage complicated by infection
Recurrent - 3+ consecutive miscarraiges

POC - products of conception
IUP - intrauterine pregnancy

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9
Q

Miscarriage Mx

A

Mx
expectant - wait and watch
- 60% incomplete miscarriage will complete in 2 weeks
- 90% complete in 6-8 weeks
- missed miscarriages take longer to expel

medicinal - misoprostol (prostaglandin) given (refer)

surgical - D&C

  - for haemorrhage 
  - for sepsis
  - risk anaesthetic, perforation, endometritis

RhD immunoglobulin for RhD negative women (ideally within 72 hours of sensitising event)

Follow up complications if pv bleeding, pv offensive discharge, lower pelvic pain for longer than 2 weeks -
retained products of conception
endometritis

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10
Q

Molar pregnancy (gestational trophoblastic disease)

  • pregnancy related tumours
  • hydatidiform moles are chromosomally abnormal
A

RF
prior molar pregnancy
extremes of age

Sx
PV bleed (early pregnancy)
unusually large uterus for gestational age

Inv
bHcg elevated
u/s obstetric

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11
Q

Molar pregnancy Mx

A

Mx
potential to become malignant
refer specialist
D&C +/- hysterectomy

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12
Q

Breast cancer

A 
RF
fam hx - red book
long oestrogen exposure - early menarche, exogenous
overweight
inc age
Sx
lumps, swelling breasts or armpits
nipple change
nipple discharge
Peau d' orange, dimpling skin changes
rash

Mod risk -

  • one first-degree relative <50y or
  • two first-degree relatives, same side or
  • two second-degree relatives, same side, one <50y

Inv
Breast screening, 50-74y, every 2 years
- 40+, yearly, if first-degree relative <50y

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13
Q

Breast cancer Mx

A

Mx
FNA or core biopsy
Refer breast surgeon
Surgical, chemo, radiation, endocrine treatment

Types -
DCIS (ductal carcinoma in situ) - non-invasive
LCIS (lobular carcinoma in situ) - non-invasive
Invasive ductal carcinoma
Invasive lobular carcinoma
Inflammatory breast cancer
Phyllodes tumour of the breast
Paget's disease of the nipple
Locally advanced breast cancer
Metastatic breast cancer

Subtypes -
Hormone receptor positive - ER+ (oestrogen receptor)
- PR+ (progesterone receptor)
HER2 positive (human epidermal growth factor receptor)
Triple negative breast cancer

Medication (endocrine treatment) -
Tamoxifen - for ER+ / PR+ (for pre and post menopausal women), 5-10yr course

Aromatase inhibitor - for ER+ (for postmenopausal women), 5-10yr course. Monitor bmd

Herceptin (trastuzumab) monoclonal antibody - for HER2+. 1 yr course

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14
Q

Colorectal cancer

A

RF
fam hx - red book

Mod risk -

  • one first-degree relative <55y or
  • two first-degree relative, same side or
  • one first-degree and one second-degree relative, same side

Inv
FOBT 50-75y, every 2 years
if mod risk, colonoscopy 50+, every 5 years
if mod risk, colonoscopy from age (10 years prior to earliest age diagnosed crc in family), every 5 years

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15
Q

Colorectal cancer Mx

A

Mx
Refer GI for colonoscopy
Surgical

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16
Q

Mastitis

A 
RF
breastfeeding
milk stasis
poor infant positioning
nipple damage
Sx
swollen, painful, red breast
17
Q

Mastitis Mx

A

Mx
continue breastfeeding, expressing, heat
if not resolved 24-48 hrs or systemic sx, ab to prevent abscess formation
dicloxacillin 500mg qid 5-10 days, till resolved
review within 24-48hrs
if not resolving, u/s for breast abscess
outpatient aspiration under local anaesthetic

18
Q

Dysfunctional uterine bleeding

  • heavy menstrual uterine bleeding not due to any recognisable cause
  • diagnosis of exclusion
  • ovulatory and anovulatory
A

RF
fam hx

Sx
heavy bleeding

Inv
u/s pelvis Day 5-10 cycle - exclude fibroids, endometrial polyps, systemic disease, endometrial/ovarian cancer
bloods - fbc, ferritin, coagulation screen, tsh
CST

19
Q

Dysfunctional uterine bleeding Mx

A

Mx
- if anovulatory (irregular), use hormonal tx -
mirena
ocp
oral progestin (days1-21 of 28 day cycle)

NSAIDS (ponstan=mefanamic acid 500mg tds prn)
anti-prostaglandins
tranexamic acid (1-1.5g, 3-4times/day, for 3-5 days)

refer gynae
endometrial ablation
hysterectomy

20
Q

PID
Pelvic Inflammatory Disease

DDX - 
            bacteria vaginosis
            endometriosis
           ectopic pregnancy
           torsion or rupture ovarian cyst
A

RF
prior infection chlamydia or gonorrhoea or pid
sexual activity early age
unprotected sex with multiple sexual partners
iud (first 3 weeks after insertion in low risk women)

Sx
dyspareunia deep
uterine tenderness
cervical motion tenderness
discharge
Inv
endocervicals swab for chlamydia and gonorrhoea
preg test
urine mcs
fbc
21
Q

PID Mx

A 
ceftriaxone 500mg IM stat AND
metronidazole 400mg bd for 14 days
PLUS
doxycycline 100mg bd for 14 days
(OR azithromycin 1g stat and another 1 week later, if pregnant, breastfeeding or noncompliant with doxy)

contact tracing for chlamydia and gonorrhea

no need to remove iud unless severe infection or no improvement after first 48 to 72 hours of treatment. can insert new iud when infection cleared.

22
Q

Ovarian cancer

A

RF
fam hx breast cancer and colon cancer
No screening for ovarian cancer

Sx
bloating
increased abdominal girth
early satiety
pelvic/abdo pain
urinary frequency or incontinence
dyspareunia
GORD
constipation
PR bleed
back pain
Exam
adnexal mass
abdominal mass
liver mass / ascites
enlarged lymph nodes
INV
ROMA - ovarian malignancy risk algorithm :-
Ca125
HE4
menopausal status

Note - Ca125 also elevated in ovarian cyst, endometriosis, fibroids, PID, pregnancy, menstruation, diverticulitis, UTI, pneumonia, heart failure, other cancers (breast and colon), cirrhosis.

23
Q

Ovarian cancer Mx

A

Mx
Refer gynaecologist
Monitor relatives for breast and colon cancers

24
Q

Amenorrhea DDX

A

Primary -
delayed puberty - absence of menarche by age 14

Secondary - (absense of menstruation for 6 months or 3 regular cycles after commencement of menarche) -
pregnancy
menopause
premature ovarian failure
PCOS
prolactinoma (pituitary adenoma)
illicit drugs
stress
extreme wt loss / anorexia nervosa
extreme overexercise
hypothyroidism
25
Q

Amenorrhea

A

RF

Sx
absense of menstruation for 6 months

Inv
bhcg
TSH
FSH, LH, oestradiol
FAI - free testosterone
prolactin
pelvic u/s
karyotype if no uterus
MRI if pituitary tumour
26
Q

OCP

A

RF

CI - migraine with aura
clotting disorders
fam hx breast cancer
breast cancer
smoking
pregnancy
obesity (BMI>35)

UK Mec

27
Q

Dysfunctional uterine bleeding ddx

A 
endometrial cancer
ovarian cancer
endometrial hyperplasia
endometrial polyps
bleeding disorder (von willibrand)
pregnancy
ectopic pregnancy
molar pregnancy
abortion/miscarriage
PID
fibroids
adenomyosis
hypothyroidism
hyperprolactinemia
diabetes
28
Q

Ectopic Pregnancy

A 
RF
prev ectopic pregnancy
previous tubal surgery
tubal ligation
PID
cervicitis
fam hx
current IUD use
multiple sexual partners
smoking
previous pelvic/abdominal surgery
early intercourse <18
vaginal douching
in utero des exposure

Sx
abdo/pelvic pain
pv bleeding
amenorrhea

Inv
bHCG
transvaginal ultrasound

29
Q

Ectopic Pregnancy Mx

A

Mx
Refer ED - surgical removal
anti-D if rhesus negative within 72 hours of event

30
Q

Emergency Contraception

  • not required within 21 days postpartum or 5 days abortion
A 
1. Copper IUD - 
prevents fertilisation and implantation. 
99% effective. 
5 days (120 hours) after unprotected sex
for high BMI
  1. Ulipristal (oral) - 30mg stat
    prevents ovulation (even after LH surge has started)
    85% effective
    5 days (120 hours) after unprotected sex
    wait 5 days before initiating hormonal contraception
  2. Levonorgestrel (oral) - 1.5mg stat
    prevents ovulation (but NOT after LH surge has started)
    85% effective
    4 days (96 hours) after unprotected sex
    can continue hormonal contraception immediately

Repeat dosing if vomit within 3 hours of taking.
Preg test 3 weeks after commencing contraception or 4 weeks after commencing quick start contraception or if next menstrual period is more than 7 days late or light.

31
Q

Post rape / sexual assault Mx

A 
Mx
Encourage to report the incidence to police
Refer to sexual assault referral centre
Refer ED for forensic examination
Offer ulipristal 30mg stat
Offer levonorgestrel 1.5mg stat
Offer post-exposure prophylaxis for HIV
Refer to sexual assault community support group / counselling

O

32
Q

Post natal depression and breastfeeding issues Mx

A

Mx
Refer to clinical psychologist for cognitive behavioural therapy
Refer to CHILD HEALTH NURSE
Refer to lactation consultant to address breastfeeding issues
Provide crisis numbers or resources eg LIfeline phone number
Arrange specific follow up in 1 week

33
Q

Complications following termination of pregnancy

A

Ongoing vaginal bleeding
Offensive vaginal discharge
lower abdominal cramping for 2 weeks

Retained products of conception
Endometritis

34
Q

IUD insertion

A

CI (UK Mec)

current pid

35
Q

Neural tube defect (spina bifida)

A

400mg folate 1 month before and 3 months into pregnancy
chance of spina bifida is 0.1%
if have one child with spina bifida, increased risk for second child 4%
if have two children with spina bifida, increased risk for third child 10%

36
Q

hormones

A 
menstruation
FSH
oestrogen building
when oestrogen reaches enough, LH surge
ovulation
oestrogen drops
if fertilisation, progesterone increases
pregnancy, oestrogen and progesterone increase continually
post birth, oestrogen and progesterone drop, prolactin increases (lactation)

DHEA promotes production sex hormones (oestrogen and testosterone)
can be higher in pcos

testosterone above 7 in women is pathological

37
Q

Post partum check

A 
Brain - mood. Edinburgh postnatal depression scale
Breasts - painful nipples
Belly - contracted fundus
Bladder - incontinence, uti, 
Vagina - bleeding, discharge, endometritis
Bowels - constipstion
Breathing - any sob (pe)
Baby -
38
Q

Endometriosis

A 
Risk - 
family history
retrograde menstruation
Cause - 
unknown
Hx -
dysmenorrhoea
dyspareunia
pain opening bowels or passing urine
back pain
ovulation pain
Exam -
nil abnormal
Inv - 
imaging not helpful often
laparoscopy - gold standard
39
Q

Endometriosis Mx

A

Can affect fertility
Removal by laparoscopy
Hormone treatment to prevent ovulation and cycles - continuous ocp, mirena (not implanon due to bleeding)
Laparoscopy
Laparotomy
Hysterectomy
Analgesia - NSAIDS
HRT - tibolone does not stimulate uterine cells
Usually goes away after menopause. can return with hrt

Womens Health (1 decks)

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