Womens health Flashcards

Question

Treatment vaginal candidiasis

Answer 1

clotrimazole

Answer 2

yellow vaginal discharge, which is often profuse and frothy, associated with vulval itch and soreness, dysuria, abdominal pain and superficial dyspareunia.t may have a fishy smell. Examination of the cervix can reveal a characteristic “strawberry cervix”

Answer 3

Metronidazole and clindamycin administered either orally or vaginally

Answer 4

oral metronidazole.

Answer 5

Odourless purulent discharge, possibly green or yellow Dysuria Lower Pelvic pain (25%) abnormal bleeding (rare)

Answer 6

ceftriaxone

Answer 7

bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5)

Answer 8

BV, 3/4 criteria need to be met Vaginal pH > 4.5 Typical discharge Positive whiff-amine test: development of fishy odour with addition of 10% potassium hydroxide to vaginal discharge Clue cells (on microscopy): vaginal epithelial cells studded with adherent coccobacilli

Answer 9

Treponema pallidum

Answer 10

1. intrauterine contraceptive system Mirena coil 2.Combined oral contraceptive pill 3. Cyclical oral progestogens, such as norethisterone 4.Progesterone only contraception

Answer 11

1.tranexamic acid ( if there is no associated pain) 2.NSAID- mefanamic acid ( if there is associated pain)

Answer 12

1. Lifestyle changes – weight loss and smoking cessation. 2. Treatments of risk factors – such as conditions that raise the intra abdominal pressure (e.g chronic cough). 3. trial of at least 3 months' supervised pelvic floor muscle training. 4. surgery should be considered. 5. duloxetine (combined noradrenaline and serotonin reuptake inhibitor)

Answer 13

1.Lifestyle changes- advice on fluid intake and aversion to caffeine and diuretics (including alcohol) smoking cessation 2.bladder training for a minimum of 6 weeks 3.antimuscarinic drug eg oxybutynin 4.β3-adrenoceptor agonists (e.g. Mirabegron) 5.injection of botulinum toxin type A into the bladder wall, percutaneous sacral nerve stimulation 6.surgery

Answer 14

Anterior vaginal wall: Cystocele: bladder (may lead to stress incontinence) Urethrocele: urethra Cystourethrocele: both bladder and urethra Posterior vaginal wall: Enterocele: small intestine Rectocele: rectum Apical vaginal wall Uterineprolapse: uterus Vaginal vault prolapse: roof of vagina (common after hysterectomy)

Answer 15

Conservative:Watchful waiting, lifestyle modification, pelvic floor exercises,Vaginal oestrogen creams for women who have signs of vaginal atrophy. Vaginal pessary insertion into the vagina to reduce the prolapse, provide support and relieve pressure on the bladder and bowel Surgery

Answer 16

Breast tissue development Growth and development of the female sex organs (vulva, vagina and uterus) at puberty Blood vessel development in the uterus Development of the endometrium,endometrial thickening Causes LH surge thinning of the cervical mucus to allow easier passage of sperm to penetrate the cervix around the time of ovulation. also inhibition of LH and FSH production by the pituitary gland Responsible for female fat distribution Increases hepatic synthesis of transport proteins Upregulates oestrogen, progesterone and LH receptors

Answer 17

Thicken and maintain the endometrium Thicken the cervical mucus Increase the body temperature Decreases myometrial excitability Responsible for spiral artery development

Answer 18

M- menstrual history/menopause O- obstetric history C- contraception/cervical smear S- sexual health

Answer 19

A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea) Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium) Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)

Answer 20

Raised LH Raised LH to FSH ratio (high LH compared with FSH, >2) Raised testosterone, can be normal Raised insulin Normal or raised oestrogen levels

Answer 21

Cyclical abdominal/pelvic pain , constant if adhesions Deep dyspareunia Dysmenorrhoea Infertility Cyclical bleeding from other sites Urinary symptoms eg dysuria ( Bowel symptoms eg dyschezia

Answer 22

Endometrial tissue visible in the vagina on speculum examination fixed retroverted cervix on bimanual examination Uterosacral ligament nodules Tenderness in the vagina, cervix and adnexa,

Answer 23

cervical ectropion, polyps, or cervicitis. Cervical cancer and vaginal cancer are serious causes Condylomata accuminata and vaginitis may also cause

Answer 24

Endometrial cancer is the neoplasm most commonly associated with postmenopausal bleeding. Vaginal atrophy can also cause pruritus, dyspareunia, and vaginal discharge. HRT causes regular vaginal bleeding. Additionally, with continuous HRT, in the first 6 months it is common to experience breakthrough bleeding. bleeding disorders

Answer 25

prevalence increases with age until menopause, promoted and maintained by exposure to oestrogen and progestogen more common in black women

Answer 26

menorrhagia Prolonged menstruation Abdominal pain Abdominal swelling Bloating Urinary or bowel symptoms due to pelvic pressure Deep dyspareunia Dysmenorrhea Reduced fertility

Answer 27

Mirena coil (1st line) Symptomatic management with NSAIDs(mefanamic acid) and tranexamic acid Combined oral contraceptive or Cyclical oral progestogens GnRH agonists, such as goserelin (Zoladex) or leuprorelin (Prostap), may be used to reduce the size of fibroids before surgery. They work by inducing a menopause-like state and reducing the amount of oestrogen maintaining the fibroid

Answer 28

<3cm Endometrial ablation Resection of submucosal fibroids during hysteroscopy Hysterectomy >3cm Uterine artery embolisation Myomectomy ( surgery to remove fibroid) Hysterectomy

Answer 29

ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply. more likely to occur in larger fibroids (above 5 cm) during the second and third trimester of pregnancy

Answer 30

presents with severe abdominal pain, low-grade fever, tachycardia and often vomiting. Management is supportive, with rest, fluids and analgesia.

Answer 31

occurs when the columnar epithelium (the canal of the cervix) of the endocervix has extended out to the stratified squamous epithelium of the ectocervix (the outer area of the cervix). ectropion tissue is darker pink

Answer 32

associated with higher oestrogen levels such as OCP and pregnancy

Answer 33

increased vaginal discharge vaginal bleeding dyspareunia

Answer 34

cauterisation of the ectropion using silver nitrate or cold coagulation during colposcopy.

Answer 35

commonly occurs in young women , and usually in women who have had at least 2-3 children may also be associated with polycystic ovaries.

Answer 36

symptoms of PVCS are due to the dilatation of the pelvic veins and because the blood is flowing the wrong way varicose veins in the pelvis surround the ovary and can also push on the bladder and rectum. - pain is usually one sided, dragging sensation, Feeling of fullness in the legs, its like symptoms,Worsening of stress incontinence

Answer 37

medroxyprogesterone acetate or more recently, goserelin reduces pain and the size of the varicose veins usual treatment is percutaneous transcatheter pelvic vein embolisation

Answer 38

Bloating Fullness in the abdomen A palpable pelvic mass

Answer 39

when developing follicle fail to rupture and release the egg, the cyst can persist most common ovarian cyst disappear after a few menstrual cycles

Answer 40

corpus luteum fails to break down and instead fills with fluid. They may cause pelvic discomfort, pain or delayed menstruation. often seen in early pregnancy.

Answer 41

benign tumours of the epithelial cells characterised by the presence of Psammoma bodies on histology which are round collections of microscopic calcification

Answer 42

benign tumour of the epithelial cells can become huge complication of rupture is pseudomyxoma peritonei. This is the progressive accumulation of mucin-producing cells

Answer 43

benign ovarian tumours. They are teratomas, meaning they come from the germ cells and may contain various tissue type particularly associated with ovarian torsion histological appearance that is similar to 'fried eggs'

Answer 44

rare,can be benign or malignant several types, including Sertoli–Leydig cell tumours and granulosa cell tumours

Answer 45

Lactate dehydrogenase (LDH) Alpha-fetoprotein (α-FP) Human chorionic gonadotropin (HCG)

Answer 46

Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy

Answer 47

Simple ovarian cysts in premenopausal women can be managed based on their size: Less than 5cm cysts will almost always resolve within three cycle 5cm to 7cm: Require routine referral to gynaecology and yearly ultrasound monitoring. More than 7cm: Consider an MRI scan or surgical evaluation

Answer 48

involves a triad of: 1. Ovarian fibroma mass (a type of benign ovarian tumour) 2. Pleural effusion 3. Ascites

Answer 49

Cyst Pregnancy Hormonal medications

Answer 50

usually unilateral acute severe pelvic or abdominal pain,often preceded by occasional cramps for several days Sudden intense nausea, vomiting usually with a palpable abdominal mass.

Answer 51

Raised CRP and WCC Transvaginal ultrasound may show an enlarged ovary. Whirlpool sign is a characteristic sign of ovarian torsion that can be seen on US or CT, demonstrates the twisting of the ovarian pedicle

Answer 52

Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility Oophorectomy ( surgical procedure to remove one or both of your ovaries ) may be performed if not interested in fertility

Answer 53

usually result from haemorrhage into a corpus luteum or other functional cyst They typically resolve within eight weeks.

Answer 54

more likely to rupture during strenuous exercise or sexual activity often Mild symptoms more severe symptoms can include extreme unilateral pain in your lower belly and bleeding. Nausea and/or vomiting. Fever if infected Dizziness

Answer 55

natural cessation of menstruation due to loss of ovarian follicular activity. dx made after a woman has had no periods for 12 months. roughly at 51 years

Answer 56

menopause before the age of 40 y

Answer 57

causes include ovarian surgery, radiotherapy, or chemotherapy. Autoimmune disease and genetic disorders eg turner syndrome

Answer 58

Lack of oestrogen release form ovaries leads to increased release of fsh and lh from pituitary gland through negative feedback

Answer 59

patient should be treated with hormone replacement therapy (HRT) until at least the age of normal menopause (51), unless the risks of HRT treatment outweigh the benefits.

Answer 60

Menstrual irregularity Vasomotor symptoms:Hot flushes, night sweats Urogenital symptoms: Vaginal dryness and atrophy, Dyspareunia, UTIS,Urinary frequency Emotional lability or low mood Sleep disturbance Difficulty concentrating Reduced libido Joint pains

Answer 61

Cardiovascular disease and stroke Osteoporosis Pelvic organ prolapse Urinary incontinence

Answer 62

Women need to use effective contraception for: Two years after the last menstrual period in women under 50 One year after the last menstrual period in women over 50

Answer 63

Lifestyle modifications (reduced smoking, reduce caffeine, exercise) Hormone replacement therapy (HRT) SSRI antidepressants, such as fluoxetine or citalopram and/or CBT Testosterone can be used to treat reduced libido (usually as a gel or cream) Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)

Answer 64

Relief of vasomotor symptoms Relief of urogenital symptoms Reduced risk of osteoporosis

Answer 65

most common symptom is the sensation of a lump ‘coming down’ Urinary symptoms Coital difficulty Bowel symptoms low back pain

Answer 66

Increased risk of breast and ovarian cancer Increased risk of endometrial cancer if oestrogen given alone Increased risk of venous thromboembolism

Answer 67

Current, past or suspected breast ca Oestrogen-sensitive ca Undiagnosed vaginal bleeding Untreated endometrial hyperplasia Previous or current VTE/DVT unless on anticoagulant Active/recent arterial disease eg angina/MI Uncontrolled BP Acute liver disease/abnormal LFTs Porphyria Pregnancy Dubin-Johnson/Rotor (close monitoring)