Womens health Flashcards
Name a 2 medical or surgical causes that trigger menopause
hysterectomy and GnRH analogues
During menopause: what two hormone levels fall first
Oestrogen and progesterone
During menopause: what 2 hormone levels rise
FSH and LH
what contradictions are there for HRT
Current or past breast cancer, oestrogen sensitive cancer, undiagnosed vaginal bleeding or untreated endometrial hyperplasia
what causes are there for starting antibiotic treatment for mastitis and what is your choice?
systematically unwell, nipple fissure present, unresolved after 24hrs when milk is removed, or culture indicating infection. Treat with flucloxacillin 10-14 days.
PC in breastfeeding: pain while feeding 3 days after birth in both breasts. pain worse before feed. diagnosis and management?
Engorgment, hand expression
PC in breastfeeding: pain intermittent and present during feed, nipple blanch followed by cyanosis. diagnosis?
Reynaud’s disease of nipple
what is the treatment for nipple candidiasis
miconazole cream for mother and nystatin infusion for child
what are the most common types of carcinoma of the breast
ductal and lobular
What are the risk factors for breast cancer?
COC, no breastfeeding, PMHx of breast cancer, western diet, obesity, HRT, 1st degree FHx, nulliparous or child after 30, early menarche or late menopause, BRAC1+2
what are the 4 most common sites of breast cancer metastasis
liver, lung, bone, brain
what are the appropriate investigations for confirmed breast cancer?
oestrogen and progesterone receptor status, HER2 status, routine bloods including LFTs and CXR.
what type of breast lump has increased incidence in HRT
Fibroademoma
what type of breast lump can be recurrent and should settle spontaneously?
breast cyst
What is the name given to a benign warty lesion located behind the areola?
intraductal papilloma
what is done with patients with positive HPV screen but a normal cytology
repeat after 12 months
what is done with patients with positive HPV screen but a abnormal cytology
colposcopy
Chronic pelvic pain, secondary dysmenorrhoea, deep dyspareunia, sub fertility, urinary symptoms, painful bowel movements and tender modularity in posterior vaginal fornix are all features of what condition
Endometriosis
What is the gold standard in diagnosis endometriosis?
laparoscopy
what is the primary management of endometriosis?
NSAIDS and/or paracetamol, COC pill or progestergens,
17F with a BMI of 28, complaining of excessive bodily hair (hirsutism), Balding on the back of the head and deeper voice, acne and depression is what condition?
PCOS
PCOS usually presents with what Physical signs
hirsutism, male pattern balding, obesity, dark colour in fat folds (acanothosis nigricans) and clitomegoly, increased muscle mass.
what investigations are there for suspected PCOS
total testosterone (normal to raised), free testosterone (>5mmol), LH may be elevated compared to FSH, TFTs CAH, Cortisol, fasting glucose tolerance
what are the 3 diagnostic criteria for PCOS which you need 2 of
polycystic ovaries, oligo-ovulation or annovulation, clinical or biochemical signs of hyperandrogenism
what is characterised by preterm PROM and what are the typical causes?
amniotic sac breaks before 37wks, INFECTION, other factors include smoking, vaginal bleeding, previous preterm
what 4 over the counter medications are big no-nos in pregnancy?
peptobismol, Decongestants like phenylephrine, cough and cold meds like guaifenesin, Pain meds like aspirin, ibuprofen, naproxen
name 10 prescription meds not safe in pregnancy?
paroxetine, xanax or diazapan (valium), lithium, warfarin, methotrexate, doxycycline and tetracycline, valoproic acid, ACE inhibitors, Acne meds like isotretinoins
What medication is given and for how long for risk management in high risk pregnancies for preeclampsia
75-150mg of aspirin daily for 12 weeks
what are the two laboratory tests of diagnosing preeclampsia
Protein/creatinine ratio of >/30mg/mmol (first line)
albumin/creatinine ratio of >/ 8mg/mmol
what what 2 medications can be given to treat preeclampsia where the bpm is higher than 135/85
labetalol or nifedipine
how does IUS work
Hormal contraceptions (progesterone), prevents implant by increasing endometrial phagocytotic cells and decreasing sperm penetrance and migration
how does IUD work
Copper coil, Cytotoxic inflammatory reaction in endometrium, inhibits sperm motility and prevents implant if fertilised.
what are contraindications for IUD
Wilsons disease, cancer, current pregnancy (48hr to 4wks post partum), infection including PID, recent STD or septic abortion
in HER2+ tutors what drug can be given
trastuzamab but not in heart disease
In ER+ tumors what is given before/during menopause and then post menopause
tamoxifen in pre or peri, aromatase inhibitors like anastrozole for post
in what cases do you change the dose of the emergency contraception levongestel
BMI >26
how long is levongestel effective?
up to 72hrs
how long is ulipristal effective?
up to 120hrs
which emergency contraception can be used twice in the same cycle out of levongestel or ulipristal
BOTH lol
what is the most effective form of emergency contraception
IUD
How long after exposure is an IUD effective for emergency contraception?
5 days or after likely ovulation date
what is the management for HMP or menorrhagia for patients who do not want contraception?
tramexamic acids or NSAIDS
what is the management for HMP or menorrhagia for patients who do want contraception?
1st - IUS, 2nd - COC, 3rd - long acting progesterones
what can be used as a short-term option to rapidly stop heavy menstrual bleeding?
Oral norethisterone
glucose in her urine at her 28-week midwife appointment and so her fasting plasma glucose was measured. The result was 7.2mmol/L.
What is the next step in her management?
insulin should be commenced if fasting glucose level is >= 7 mmol/l insulin at the time of diagnosis
what is the choice of antidepressant in breastfeeding women?
serataline
