Womens health Flashcards

Question

Mechanisms of labour - what occurs during internal rotation

Answer 1

With each contraction, the fetal head is pushed onto the pelvic floor. Following each contraction, a rebound effect supports a small degree of rotation. Regular contractions eventually lead to the fetal head completing the 90° turn.

Answer 2

The fetal occiput will slip beneath the suprapubic arch allowing the head to extend. the fetal head is now born

Answer 3

the head rotates externally left or right as the shoulders move downwards

Answer 4

downward traction can be conducted by the midwife to help the delivery of the shoulder

Answer 5

spontaneous artificial

Answer 6

where the umbilical cord is not immediately clamped and cut at birth

Answer 7

allows baby time to transition to extra uterine life increase in red cells, iron and stem cells (aids in growth) reduced need for inotropic support

Answer 8

Entonox (gas and air) paracetamol codeine diamorphine pethidine remifentanyl

Answer 9

epidural (mix of bupivacaine and fentanyl)

Answer 10

at least 3 months pre pregnancy

Answer 11

Blood pressure Proteinuria UTI testing Weight Height Haemoglobinopathies HIV Hep B Syphilis FBC - look at RBC, platelets and MCH Rhesus testing Ultrasound

Answer 12

Measure the nuchal translucency

Answer 13

Nuchal translucency Mums age two blood tests (Pap A and HCG)

Answer 14

Trisomy 21 Trisomy 13 and 18 in combination

Answer 15

previous gestational diabetes BMI age previous large baby family history of diabetes ethnicity previous pre eclampsia hypertension renal disease rheumatological disease

Answer 16

put them on aspirin - 150mg daily

Answer 17

hypertension renal disease SLE/other autoimmune disease cyanotic cardiac disease

Answer 18

pregnancy over 40 previous small baby early birth

Answer 19

sickle cell and thalassemia infectious disease screening Down's, Edwards and pataus syndrome fetal anomaly scan diabetic eye screening newborn infant physical examination newborn hearing screen newborn blood spot

Answer 20

one to one care maternal comfort and hygiene maternal monitoring assessment of progression of labour fetal monitoring bladder care and urine output through out labour

Answer 21

blood loss rupture of membrane pain presence of meconium

Answer 22

cervical cancer: bleeding after sex and spotting Uterine cancer: post menopausal bleeding Ovarian cancer: abdo mass, pain, bloating, weight loss, change in bowel habit, tired all the time

Answer 23

it is bleeding anywhere within the genital tract after the 24th week of pregnancy

Answer 24

it is when the placenta implants in the lower segment of the uterus

Answer 25

major or minor depending on the implantation site

Answer 26

minor - many can move as pregnancy progresses - come into the hospital if there is any pain or bleeding - avoid sexual intercourse until 34 week scan - cross match the mother in case of haemorrhage - deliver baby by elective c section

Answer 27

a condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of a baby.

Answer 28

start with ABCDE assessment abdominal and general examination foetal monitoring and potentially delivery steroids if the baby is less than 34 weeks

Answer 29

dexamethasone and magnesium sulphate

Answer 30

this is when the fetal vessels are over the internal cervical opening leaving them unprotected by placental tissue

Answer 31

an elective c section at 37 weeks

Answer 32

this is a placental that invades abnormally though the uterus which can go through to the myometrium and onto other internal structures

Answer 33

elective c section at 36-37 weeks, sometimes with a hysterectomy as well if severe

Answer 34

early separation of the placenta from the uterine wall which can cause a concealed or revealed haemorrhage

Answer 35

maternal shock is out of proportion of the bleeding present fetal distress

Answer 36

premature labour transfusion acute tubular necrosis DIC post partum haemorrhage ARDS fetal morbidity and mortality

Answer 37

hypertension and proteinurea plus at least one of the following - severe headache - visual disturbance - papilloedema - clonus - liver tenderness (HELLP syndrome) - abnormal liver enzymes - platelet count under 100 X10^9/L

Answer 38

HELLP syndrome is a severe form of pre-eclampsia, and combines: Haemolysis Elevated liver enzymes Low Platelets

Answer 39

stabilise BP (oral antihypertensives - labetalol) Check bloods (HELLP syndrome) fluid restriction (80mL/h) magnesium sulphate (reduce seizure risk)

Answer 40

it is the onset of seizures in women with pre-eclampsia

Answer 41

- bolus magnesium sulphate and IV BP management - stabalise mum and then deliver baby

Answer 42

Premature rupture of membranes prolonged rupture of membrane cervical cerclage infection

Answer 43

when there is abnormality within the CGT trace of the baby - babies HR is unstable

Answer 44

this is when the cord comes out first and then the baby

Answer 45

because the exposure of the cord leads to vasospasm and reduce/prevent blood supply to the baby

Answer 46

premature waters polyhydramnios long cord fetal malpresentation multiparity

Answer 47

trendelenburg position (feet higher than head) emergency c section

Answer 48

it is failure of the anterior shoulder to pass under the symphysis pubis

Answer 49

disproportion between mum and baby post mature baby maternal obesity prolonged first or second stage of labour instrumental delivery

Answer 50

call for help evaluate for episiotomy legs into Mc Roberts Suprapubic pressure enter the pelvis - rotational maneuvers - remove the posterior arm replace the head and deliver by c section

Answer 51

hypoxia fits cerebral palsy injury to the brachial plexus

Answer 52

primary secondary

Answer 53

occurs within 24 hours of birth with over 500mls of blood

Answer 54

it occurs over 24 hours after birth and is split into minor and major haemorrhage

Answer 55

retained tissue (placenta) Uterus not fully contracting (tone) trauma (tears) low thrombin

Answer 56

larger baby multiple babies long labour infection operative delivery APH previous post partum haemorrhage

Answer 57

syntocinon

Answer 58

mentrual history pregnancy history contraception use cervical cytology history

Answer 59

genital skin inguinal nodes pubic hair

Answer 60

vulva, perineum, vagina, cervix

Answer 61

penis, scrotum, urethral meauts, perianal area, oropharynx

Answer 62

a self taken vulvo-vaginal swab for gonorrhoea/chlamydia blood test for HIV and STS

Answer 63

first void urine for gonorrhoea and chlamydia blood for STS and HIV

Answer 64

same as heterosexual men plus a pharyngeal and rectal swab as well as blood for STS, HIV, Hep B and C

Answer 65

discharge changes vulval discomfort/soreness/itching vulval lumps or ulcers inter mentrual bleeding post coital bleeding

Answer 66

pain or burning on urinating sores or blisters discharge genital lumps or rash testicular pain or swelling

Answer 67

asymptomatic tests + swab for bacterial vaginosis, thrush and TV dipstick for urinalysis bimanual examination swabs and culture is performed

Answer 68

urethral swab before voiding dipstick urinalysis

Answer 69

urethral and rectal slides urethral, rectal and pharyngeal culture plates

Answer 70

HSV PCR Dark ground microscopy

Answer 71

men who have sex with men sex workers IVDU people from high risk areas - africa, asia, eastern europe

Answer 72

it is HIV prophylaxis. You take it within 72 hours of exposure and you take it for one month - combination of three antiretrovirals

Answer 73

this is pre-exposure medication it is offered to those who are identified as high risk of HIV exposure

Answer 74

previous ectopic tubular damage - pelvic inflammatory disease/STI history of infertility smoker over 35 use of IUD/IUS/POP

Answer 75

PV bleeding abdominal pain shoulder tip pain dizziness

Answer 76

abdominal ultrasound and beta HCG levels

Answer 77

a mass that moves separately from the ovary you may also see free fluid

Answer 78

an ectopic pregnancy

Answer 79

if their bHCG is below 1500

Answer 80

they must have bHCG monitoring on days 4-7 and then weekly until it is negative

Answer 81

in severe pain mass >35mm live ectopic hcg > 5000 signs of rupture haemodynamically unstable

Answer 82

an empty uterus on USS bleeding follow up on beta hcg monitoring

Answer 83

when a miscarriage begins, but some pregnancy tissue stays in the womb diagnosed on USS <35mm - expectant, medical, surgical >35mm - surgical/medical

Answer 84

it requires visualisation of gestation sac, yolk sac, and fetal poles with no fetal heart activity

Answer 85

problem with a fertilised egg, which means a baby and a placenta do not develop the way they should after conception

Answer 86

it is caused by one/two sperm fertilise an egg which has lost its DNA

Answer 87

the father supplies two sets of DNA and the mum supplies one (2 sperm and 1 egg)

Answer 88

surgery only

Answer 89

it is when the ovary twists on its vascular and ligamentous supports which blocks the blood flow

Answer 90

it is a surgical emergency !!!

Answer 91

severe abdominal pain nausea and vomiting

Answer 92

an infection of the uterus, fallopian tubes and ovaries, causing pain around the pelvis or lower abdomen discomfort

Answer 93

dyspareunia - painful sexual intercourse pelvic pain dysuria change in discharge IMB/PCB

Answer 94

IUS/IUD STI UPSI

Answer 95

infection chlamydia gonorrhoea mycoplasma

Answer 96

14 days of antibiotics - 1 dose ceftriaxone plus PO metronidazole and doxycycline

Answer 97

haemorrhage due to an increase in size or rupture of the cyst

Answer 98

removal of the ovary removal of the cyst - can cause chemical peritonitis can leave it and wait

Answer 99

it occurs in 20% of cases

Answer 100

it is one associated with vaginal bleeding with or without pain

Answer 101

where the miscarriage is incomplete and not associated with heavy bleeding/at an early stage (<8 weeks)

Answer 102

start with anti - progestogen then 36-48 hours later use synthetic prostaglandin (misoprostol)

Answer 103

the fallopian tube - in the ampulla

Answer 104

deaths per 100,000 maternities

Answer 105

the number of maternal deaths with live births as the denominator

Answer 106

when serum hcg <1500 and it is unruptured

Answer 107

needs to have a good liver and renal function

Answer 108

it is excessive vomiting associated with dehydration and ketosis

Answer 109

rehydrate with fluid, vitamins and nil by mouth until oral fluids can be tolerated small frequent means are recommended once eating is tolerated

Answer 110

it is a rare complication that occurs in the third trimester/after delivery. it causes abdo pain, nausea, vomiting, headache, jaundice and hypoglycemia.

Answer 111

an ALT of greater than 500 U/l

Answer 112

in a normal 28 day cycle check on day 21 (cycle length take 7 days)

Answer 113

when their BMI is over 30

Answer 114

this is when the cervix is assessed and if possible a finger is passed into the cervical opening to stretch it and separate the chorionic membranes from the cervix

Answer 115

all women should be offered a vaginal examination and membrane sweep at 40 weeks gestation

Answer 116

Placenta accreta

Answer 117

it can lead to severe haemorrhage at birth and the placenta failing to deliver spontaneously

Answer 118

this is when the villi of the placenta invade the myometrium

Answer 119

this is when the villi of the placenta invade the full thickness of the myometrium to the serosa, and have the potential to attach to other organs

Answer 120

Low dose aspirin and low molecular heparin - low dose aspirin started once pregnancy is confirmed - LMWH started once a fetal heart is seen on ultrasound

Answer 121

nifedipine (calcium channel blocker)

Answer 122

for prevention of post partum haemorrhage

Answer 123

resus haemolytic disease of the newborn

Answer 124

that there is immune mediated haemolytic anaemia

Answer 125

metformin 500mg OD

Answer 126

isophane insulin injection OD in the morning

Answer 127

Doxycycline (100 mg orally twice a day for 2 weeks) plus ceftriaxone 500 mg intramuscularly (IM) for one dose or cefoxitin 2 g IM with probenecid (1g orally) for one dose or another parenteral third-generation cephalosporin.

Answer 128

first line: lifestyle changes and bladder retraining medical: Oxybutynin (anticholinergic)

Answer 129

this is when on ultrasound it shows foetal oedema in at least two compartments

Answer 130

there are 4 stages depending on how much the placenta is covering the cervical opening

Answer 131

pitting oedema flow murmurs

Answer 132

the corpus albicans

Answer 133

it is the age of the fetus starting from the date of the last period

Answer 134

this is the total number of pregnancies a person has had

Answer 135

this is a patient who is pregnant for the first time

Answer 136

this is a patient who is on her 2nd or more pregnancy

Answer 137

this is from the start of the last period until 12 weeks gestation

Answer 138

from 13 to 26 weeks

Answer 139

from 27 weeks until birth

Answer 140

around 20 weeks

Answer 141

a 7-9 week booking clinic (community midwife) a 10-13 week dating scan a 16 week community midwife appointment a 20 week anomaly scan then further appointments are dependent on the risk status of the mother and baby

Answer 142

at 16 weeks she will have an oral glucose tolerance test if this is negative she will have another one at 28 weeks

Answer 143

this is tested for with ultrasound at 32 weeks

Answer 144

it is measured from 24 weeks

Answer 145

pre-eclampsia

Answer 146

whooping cough - 16 weeks influenza flu given during cold season

Answer 147

400mg three months before the pregnancy and then up to 12 weeks during the pregnancy

Answer 148

multivitamins (unless specific pregnancy ones) vitamin A

Answer 149

unpasteurized dairy and blue cheese undercooked or raw poultry

Answer 150

miscarriage small fetus preterm delivery fetal alcohol syndrome

Answer 151

microcephaly thin upper lip smooth flat philtrum (space between lips and nose) short palpebral fissure learning disabilities hearing and vision problems cerebral palsy

Answer 152

fetal growth restriction miscarriage stillbirth premature labour placental abruption pre-eclampsia cleft lip or palate sudden infant death syndrome

Answer 153

37 weeks in an single pregnancy 32 weeks in a twin pregnancy after 28 weeks she will need a mote from a doctor or registered healthcare worker to fly

Answer 154

blood grouping antibodies resus D status FBC to screen for anaemia, thalassaemia and sickle cell also offered HIV, Hep B and syphilis screening

Answer 155

rhesus D status VTE risk gestational diabetes risk fetal growth restriction pre-eclampsia risk

Answer 156

this is performed between 11-14 weeks and combines ultrasound results and blood tests US - nucal translucency bloods - beta hCG and pregnancy associated plasma protein

Answer 157

this is performed between 14 and 20 weeks and only uses maternal bloods - beta hCG, alpha fetoprotein and serum oestriol

Answer 158

this is the same as the triple test but with inhibin A checked as well

Answer 159

- non invasive prenatal testing: bloods from mum and extract fetal DNA for testing - amniocentesis: testing amniotic fluid (after 15 weeks) - chronic villous sampling (before 15 weeks)

Answer 160

miscarriage, anaemia. small gestational age and pre-eclampsia

Answer 161

levothyroxine is given - dose in pregnancy needs to be increased (usually by at least 30-50%)

Answer 162

Ace inhibitors angiotensin receptor blockers (losartan) thiazide diuretics

Answer 163

labetalol (only beta blocker that is safe) calcium channel blockers (nifedipine) alpha blockers (doxazosin)

Answer 164

pregnancy may worsen seizure control due to lack of sleep, hormonal changes, and altered medications

Answer 165

sodium valporate - neural tube defects and malformation phenytoin - cleft lip or cleft palate

Answer 166

levetiracetam, lamotrigine, carbamazepine

Answer 167

oral fluconazole

Answer 168

it means abnormal nuclei and refers to pre-cancerous changes in cells

Answer 169

squamous cell carcinoma

Answer 170

Tamoxifen (oestrogen receptor antagonist)

Answer 171

Chlamydia trachomatis Neisseria gonorrhoeae

Answer 172

intravenous magnesium sulphate

Answer 173

this is when there are multiple fluid filled cysts within the breast tissue, which can change in size and tenderness with the menstrual cycle

Answer 174

uterine fibroids adenomyosis tumour

Answer 175

it is a cyclical pain and tenderness of the breasts being more severe in the days leading up to menstruation and resolving after the start of the period - common in premenopausal women

Answer 176

Group B streptococcus

Answer 177

benzylpenicillin

Answer 178

this is an eczema like rash on the nipple and is associated with an underlying malignancy - single lesion with discrete edges and nipple may appear ulcerated or destroyed

Answer 179

this is when there is enlargement of the cervix, and the columnar cells from inside the cervix grow outside where they can be seen with a speculum

Answer 180

post coital bleeding

Answer 181

presence of menopausal symptoms (vaginal dryness, hot flushes, secondary amenorrhoea) two elevated FSH levels

Answer 182

a snowstorm appearance

Answer 183

at 28 and 32 weeks

Answer 184

metronidazole

Answer 185

frothy yellow discharge accompanied by pruritis, vaginitis and post coital bleeding

Answer 186

small punctuate haemorrhages - strawberry cervix

Answer 187

it is a complication of pelvic inflammatory disease where adhesions form due to inflammation of the liver capsule

Answer 188

it occurs when amniotic fluid is introduced into the vascular system leading to the obstruction of blood flow and impaired gas exchange

Answer 189

shortness of breath chest pain hypotension

Answer 190

re-do the smear in 12 months

Answer 191

drainage of the abscess (needle aspiration) course of antibiotics

Answer 192

that the person has syphilis

Answer 193

invasive ductal carcinoma

Answer 194

dilation of the cervix and removal with a curettage (scrapes away the molar pregnancy) dilation of the cervix and suction

Answer 195

this is post partum pituitary gland ischemic necrosis due to blood loss and hypovolemic shock after PPH. it causes hypopituitarism symptoms such as hypothyroidism, hypoadrenalism, hypogonadism and growth hormone deficiency

Answer 196

it is when the patient suddenly feels an urgent need to pass urine, which cannot be controlled

Answer 197

overactivity of the detrusor muscle (overactive bladder syndrome)

Answer 198

this refers to leakage of urine when there is increased pressure in the pelvis and occurs due to weakness of the pelvic floor muscles

Answer 199

sensorineural deafness congenital cataracts blueberry muffin rash salt and pepper chorioretinitis heart disease - PDA and pulmonary stenosis learning disability

Answer 200

U+E, FBC, transaminases and bilirubin three times per week

Answer 201

anti-histamines such as promethazine

Answer 202

lengthening of the umbilical cord a rush of blood

Answer 203

test the woman's serum progesterone on day 21 of her cycle

Answer 204

keep breast feeding to help stop the milk building up

Answer 205

this is when the full thickness of the cervical epithelium is affected by abnormal cells

Answer 206

formation of fibrous cords that extend from the axilla to the ipsilateral hand characterized by a visible and palpable cord like structure and the sensation of tightness and pulling in the chest area

Answer 207

increased age family history of ovarian and breast cancer BRCA1 and 2 mutations obesity smoking nulliparity endometriosis

Answer 208

intense pruritis worse on hands and feet fatigue nausea abdominal pain mild jaundice

Answer 209

Herpes simplex virus

Answer 210

nifedipine

Answer 211

with an early delivery (37-38 weeks) as it can increase the chance of spontaneous fetal death and maternal haemorrhage

Answer 212

intramural fibroid - located within the myometrium

Answer 213

Clomiphene citrate - used to increase endogenous FSH and acts to induce ovulation

Answer 214

it is mid cycle ovulatory pain

Answer 215

squamous cell carcinomas

Answer 216

ulcerated lesion on labia persistent soreness and itching

Answer 217

they should induce a withdrawal bleed at least once every three months - to reduce the risk of endometrial cancer

Answer 218

analgesia as required help establishing feeding VTE risk assessment monitoring for PPH monitoring for sepsis monitoring recovery after caesaren or tear FBC anti D in rhesus negative women routine baby check

Answer 219

general wellbeing mood and depression bleeding and menstruation urinary incontinence and pelvic floor exercises scar healing contraception breastfeeding vaccines

Answer 220

general wellbeing mood and depression bleeding and mensuration scar healing contraception breast feeding fasting blood glucose (after gestational diabetes) blood pressure (after pre-eclampsia) urine dipstick for protein (after pre-eclampsia)

Answer 221

lochia - mix of blood, endometrial tissue and mucus

Answer 222

about 21 days post birth

Answer 223

it is over 98% effective up to 6 months after birth, but only if the woman is fully breastfeeding and amenorrhoeic

Answer 224

the progesterone only pill and the implant - can be started any time after birth

Answer 225

no - it should be avoided in breastfeeding

Answer 226

yes but only within 48 hours of birth or more than four weeks after birth

Answer 227

it is inflammation of the endometrium after birth usually caused by infection introduced into the vagina during the labour/delivery of a baby

Answer 228

foul smelling discharge or lochia bleeding that gets heavier or doesnt improve with time lower abdominal or pelvic pain fever sepsis

Answer 229

vaginal swabs and urine culture

Answer 230

septic patients - sepsis 6, and broad spectrum antibiotics (clindamycin and gentamicin) non septic patients - co-amoxiclav

Answer 231

this is when pregnancy related tissue (placental tissue or fetal membranes) remain within the uterus after delivery

Answer 232

- vaginal bleeding that gets heavier and doesnt improve - abnormal vaginal discharge - lower abdominal or pelvic pain - fever (if infection occurs)

Answer 233

ultrasound

Answer 234

ERPC - evacuation or retained products of conception

Answer 235

endometriositis Ashermans syndrome - adhesions that form within the uterus due to scraping

Answer 236

it is feeling low in the first week or so after birth and affects around 50% of women

Answer 237

mood swings, low mood, anxiety, irritability, tearfulness

Answer 238

significant hormonal changes, recovery from birth, fatigue and sleep deprivation, the responsibility of caring for a neonate, establishing feeding

Answer 239

it is a classic triad of low mood, anhedonia (lack of pleasure in activities) and low energy

Answer 240

around three months after birth - symptoms have to be at least two weeks for it to be classed as postnatal depression

Answer 241

additional support, self help and follow up

Answer 242

antidepressant medications and CBT

Answer 243

specialist psychiatry services and rarely impatient care on the mother baby unit

Answer 244

the Edinburgh postnatal depression scale - ten questions with a total score of 30. anything over 10 suggests postnatal depression

Answer 245

a severe illness that typically has an onset of between two to three weeks post delivery where a woman experiences full psychotic symptoms

Answer 246

delusions hallucinations depression mania confusion thought disorder

Answer 247

admission to the mother and baby unit CBT medications - antidepressants, antipsychotics and mood stabilisers electroconvulsive therapy

Answer 248

neonatal abstinence syndrome - presents a few days after birth with irritability and poor feeding

Answer 249

it is inflammation of the breast tissue and is a common complication for breast feeding

Answer 250

-obstruction in the ducts and accumulation of milk - infection due to bacteria entering the nipple

Answer 251

staph aureus

Answer 252

unilateral breast pain and tenderness erythema in a focal area of breast tissue local warmth and inflammation nipple discharge fever

Answer 253

- when mastitis is due to blockage of the ducts management is continues breastfeeding and expressing milk - when infection is suspected flucloxacillin is first line (or erythromycin if allergic to penicillin)

Answer 254

a breast abscess - may need surgical incision and drainage

Answer 255

this often occurs after a course of antibiotics and leads to recurrent mastitis

Answer 256

sore nipples bilaterally nipple tenderness and itching cracked flaky and shiny areola in the baby may have white patches in the mouth and on the tongue/candida nappy rash

Answer 257

topical miconazole 2% after each feed treatment for the baby - miconazole gel or nystatin

Answer 258

this is a condition where there is changes in thyroid function within 12 months of delivery leading to hyper and hypothyroidism

Answer 259

thyrotoxicosis (usually in the first three months) hypothyroid ( usually from months 3-6) thyroid function gradually returns to normal (usually within 1 year)

Answer 260

hyperthyroid: anxiety and sweating, heat intolerance, tachycardia, weight loss, fatigue, frequent loose stools hypothyroid: weight gain, fatigue, dry skin, coarse hair/hair loss, low mood, fluid retention, heavy or irregular periods, constipation

Answer 261

referral to an endocrinologist for specialist management thyrotoxicosis: symptomatic control such as propranolol hypothyroidism: levothyroxine patients will need annual monitoring to ensure they dont develop long term hypothyroidism

Answer 262

it is a rare complication of post partum haemorrhage where the drop in circulating blood volume leads to avascular necrosis of the anterior pituitary

Answer 263

the hypothalamo-hypophyseal portal system

Answer 264

TSH, ACTH, FSH, LH, GH, prolactin

Answer 265

reduced lactation, amenorrhoea, adrenal insufficiency and adrenal crisis, hypothyroidism with low thyroid hormones

Answer 266

with hormone replacement therapy - oestrogen and progesterone - hydrocortisone - levothyroxine - growth hormone

Answer 267

it lack of menstrual periods

Answer 268

it when a patient has never developed periods

Answer 269

abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism) abnormal functioning of the gonads (hypergonadotropic hypogonadism) structural pathology such as imperforate hymen

Answer 270

it is when the patient previously had periods which have subsequently stopped

Answer 271

pregnancy (MC) menopause phycological stress - excessing exercise, low body weight, chronic disease, psychosocial factors polycystic ovarian syndrome medications - hormonal contraceptives premature ovarian insufficiency thyroid hormone abnormalities excessive prolactin cushings

Answer 272

it is when there is irregularities in the menstrual cycle affecting the frequency, duration and regularity of the length cycle and volume bled

Answer 273

extremes of reproductive age polycystic ovarian syndrome phycological stress medications such as the progesterone only pill, antidepressants and antipsychotics hormonal imbalance such as thyroid abnormalities, cushings and high prolactin

Answer 274

this is bleeding that occurs between menstrual periods - RED FLAG

Answer 275

hormonal contraception cervical ectropion, polyps or cancer sexually transmitted infection endometrial polyps or cancer vaginal pathology including cancer pregnancy ovulation medications such as SSRI and anticoagulants

Answer 276

this is painful periods

Answer 277

primary dysmenorrhoea (no cause) endometriosis or adenomyosis fibroids pelvic inflammatory disease copper coil cervical or ovarian cancer

Answer 278

it refers to heavy menstrual bleeding

Answer 279

dysfunctional uterine bleeding (no cause) extremes of reproductive age fibroids endometriosis and adenomyosis pelvic inflammatory disease contraceptives such as the copper coil bleeding disorders anticoagulants connective tissue disorder endocrine disorders endometrial hyperplasia or cancer PCOS

Answer 280

cervical cancer, ectropion or infection trauma atrophic vaginitis polyps endometrial cancer vaginal cancer

Answer 281

urinary tract infection dysmenorrhoea irritable bowel syndrome ovarian cysts endometriosis pelvic inflammatory disease ectopic pregnancy appendicitis Mittelschmerz pelvic adhesions ovarian torsion inflammatory bowel disease

Answer 282

bacterial vaginosis candidiasis chlamydia gonorrhoea trichomonas vaginalis foreign body cervical ectropion polyps malignancy ovulation hormonal contraception

Answer 283

it refers to itching of the vulva and vagina

Answer 284

irritants - soaps, detergents, barrier contraception atrophic vaginitis infections - candidiasis skin conditions such as eczema vulval malignancy pregnancy related vaginal discharge urinary or faecal incontinence stress

Answer 285

not starting menstruation by 13 years when there is no other evidence of puberty 15 years when there are other signs of puberty

Answer 286

hypopituitarism - under production damage to the hypothalamus or pituitary significant chronic conditions - CF/IBD excessive exercise or dieting constitutional delay in growth and development endocrine disorders kallman syndrome - failure to start puberty plus loss/reduced sense of smell

Answer 287

previous damage to the gonads - torsion, cancer, infections (mumps) congenital absence of the ovaries turners syndrome

Answer 288

it is an ender production of cortisol and aldosterone and an overproduction of androgens caused by a congenital deficiency of the 21 hydroxylase enzyme

Answer 289

tall for their age facial hair absent periods (primary) deep voice early puberty

Answer 290

this is where the tissues are unable to respond to androgen hormones (testosterone) so typical male sexual characteristics do not develop. This results in a female phenotype other than the internal female pelvic organs

Answer 291

imperforate hymen transverse vaginal septae vaginal agenesis absent uterus female genital mutilation

Answer 292

with pulsatile GnRH to induce ovulation and menstruation

Answer 293

as high levels of prolactin act on the hypothalamus to prevent release of GnRH, thus preventing the release of LH and FSH

Answer 294

osteoporosis - lack of oestrogen increases their risk if they have had amenorrhoea longer than 12 months then ensure there is adequate vitamin D and calcium intake and put on hormone replacement therapy

Answer 295

this is the psychological, emotional and physical symptoms that occur during the luteal phase of the menstrual cycle. these symptoms can be distressing and significantly impact patients quality of life

Answer 296

they resolve once menstruation begins

Answer 297

low mood anxiety mood swings irritability bloating fatigue headache breast pain reduced confidence cognitive impairment clumsiness reduced libido

Answer 298

made based on a symptom diary spanning two menstrual cycles definitive diagnosis may be made by giving GnRH analogues which halt the menstrual cycle and temporarily induce menopause to see if symptoms improve

Answer 299

- general healthy lifestyle changes -combined oral contraceptive pill -SSRI antidepressants - CBT in severe cases an MDT team gets involved GnRH analogues can be used Hysterectomy with oophorectomy can be done danazole and tamoxifen can be used to help cyclical breast pain spironolactone can be used to help with breast swelling, water retention and bloating

Answer 300

they are benign tumours of the smooth muscle of the uterus - oestrogen sensitive

Answer 301

intramural subserosal submucosal pedunculated

Answer 302

this is a fibroid that grows within the myometrium and as they grow they change the shape and distort the uterus

Answer 303

this fibroid grows just below the outer layer of the uterus, they grow outward and can become large filling the abdominal cavity

Answer 304

this grows just below the lining of the uterus

Answer 305

this is a fibroid that grows on a stalk

Answer 306

heavy menstrual bleeding prolonged menstrual bleeding abdominal pain bloating or full feeling urinary or bowel symptoms deep dyspareunia reduced fertility

Answer 307

fibroids less than 3cm - Mirena coil (1st line) - symptomatic management - combined oral contraceptive - cyclical oral progestogens for those larger than 3cm - surgical management first line: uterine artery embolism, myomectomy, hysterectomy - medical management is: symptomatic, mirena coil, cocp, progestogens

Answer 308

heavy menstrual bleeding reduced fertility pregnancy complications - miscarriages, premature labour, obstructive delivery constipation urinary outflow obstruction/UTI red degeneration of the fibroid torsion of the fibroid malignant change to a leiomyosarcoma

Answer 309

GnRH agonists: goserelin or leuprorelin

Answer 310

red degeneration refers to ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply - more likely to occur in larger fibroids during the second and third trimester of pregnancy - can occur as the fibroid rapidly enlarges during pregnancy

Answer 311

severe abdominal pain, low grade fever, tachycardia and often vomiting

Answer 312

it is a condition where there is ectopic endometrial tissue outside the uterus

Answer 313

endometrial tissue within the myometrium of the uterus

Answer 314

cyclical abdominal or pelvic pain deep dyspareunia dysmenorrhoea infertility cyclical bleeding from other sites can also have urinary and bowel symptoms

Answer 315

endometrial tissue visible in the vagina on speculum examination (posterior fornix) a fixed cervix on bimanual examination tenderness in the vagina, cervix and adnexa

Answer 316

pelvic ultrasound - large endometriomas and chocolate cysts laparoscopic surgery (GOLD)

Answer 317

stage 1: small superficial lesions stage 2: mild but deeper lesions than stage 1 stage 3: deeper lesions, with lesions on the ovaries and mild adhesions stage 4: deep and large lesions affecting the ovaries with extensive adhesions

Answer 318

initial management involves - analgesia as required hormonal management - COCP / POP - medroxyprogesterone acetate injection - nexplanon implant - mirenal coil - GnRH agonists Surgical - laparoscopic surgery to excise and ablate the tissue - hysterectomy

Answer 319

it is used to treat oestrogen receptor positive breast cancer in those who are pre/peri menopausal

Answer 320

because it is a partial agonist for oestrogen so increases the risk of endometrial cancer increases the risk of thrombosis

Answer 321

oral acyclovir 400mg three times a day

Answer 322

pre term delivery late miscarriage

Answer 323

when endometrial tissue is inside the myometrium (muscle layer of the uterus)

Answer 324

painful periods heavy periods pain during intercourse may alsoe be related with infertility or pregnancy related complications

Answer 325

enlarged and tender uterus more soft than a uterus containing fibroids

Answer 326

transvaginal ultrasound MRI/transabdominal ultrasound golf standard is histological examination of the uterus post hyperectomy

Answer 327

when a woman doesnt want contraception - tranexamic acid to reduce bleeding - mefenamic acid when there is associated main when contraception is wanted - mirena coil is first line - combined oral contraceptive pill - cyclical oral progestogens can also do GnRH analogues, endometrial ablation, uterine artery embolism, hysterectomy

Answer 328

infertility miscarriage preterm birth small for gestational age preterm premature rupture of membranes malpresentation need for cs postpartum haemorrhage

Answer 329

it is when a woman has had no periods for 12 montsh and is defined as a permanent end to mentruation

Answer 330

it is the period from 12 months after the final menstrual period onwards

Answer 331

this refers to the time around the menopause where the woman may be experiencing vasmotos symptoms and irregular periods

Answer 332

it is menopause before the age of 40 years, it is a result of premature ovarian insufficiency

Answer 333

it is caused by a lack of ovarian follicular function resulting in low oestrogen and progesterone, and high FSH and LH

Answer 334

hot flushes emotional lability or low mood prementrual syndrome irregular periods joint pains heavier or lighter periods vaginal dryness and atrophy reduced libido

Answer 335

cardiovascular disease and stroke osteoporosis pelvic organ prolapse urinary incontinence

Answer 336

made in women over 45 with typical symptoms without performing investigations FSH blood tests to help diagnosis in women under 40 with suspected premature menopause, or women ages 40-45 with menopausal symptoms

Answer 337

- two years after the last menstrual period in women under 50 - one year acter the last menstrual period in women over 50

Answer 338

barrier methods mirena or copper coil progesterone only pill progesterone implant progesterone depot injection (under 45) sterilisation combined oral contraceptive pill can be used after 40 and up to 50 if there are no other contraindications

Answer 339

HRT tibolone - continuous HRT (only after 12 months of amenorrhoea) - Clonidine - agonists of alpha adrenergic and imidazole receptors - CBT - SSRI antidepressants - testosterone - vaginal oestrogen - vaginal moisturizers

Answer 340

hypergonadotropic hypogonadism - lack of negative feedback on the pituitary gland resulting in excess of gonadotropins

Answer 341

idiopathic iatrogenic - chemotherapy, radiotherapy, surgery autoimmune - coeliac disease, adrenal insufficiency, T1DM, thyroid disease genetic - i.e turners infections - mumps, tuberculosis, cytomegalovirus

Answer 342

cardiovascular disease stroke osteoporosis cognitive impairment dementia parkinsonism

Answer 343

hormone replacement therapy - typical hormone replacement therapy (may be an increase in VTE with HRT under 50) - combined oral contraceptive pill

Answer 344

it needs to be given to women that have a uterus to prevent endometrial hyperplasia and endometrial cancer

Answer 345

they should go on cyclical HRT and have regular breakthrough bleeds

Answer 346

it is an alpha 2 adrenergic and imidazoline receptor agonist. it lowers blood pressure and reduces heart rate. it helps vasomotor symptoms and hot flushes

Answer 347

dry mouth headaches dizziness fatigue

Answer 348

black cohosh - helps with hot flushes dong quai - acts like oestrogen red clover - helps to improve blood flow, helps with hot flushes and night sweats evening primrose oil - help relieve symptoms of menopause ginseng - helps with hot flushes and symptoms

Answer 349

increased risk of breast cancer increased risk of endometrial cancer increased risk of VTW increased risk of stroke and CAD (no increased risk of CAD with oestrogen only HRT)

Answer 350

undiagnosed abnormal bleeding endometrial hyperplasia or cancer breast cancer uncontrolled hypertension venous thromboembolism liver disease active angina or myocardial infarction pregnancy

Answer 351

full history to ensure no contraindications check BMI and BP ensure cervical and breast screening is up to date encourage lifestyle changes

Answer 352

1. do they have local or systemic symptoms 2. does the woman have a uterus 3. have they had a period in the last 12 months

Answer 353

oral transdermal - patch intrauterine system - mirena coil

Answer 354

it is used as a form of continuous combined HRT - it is a synthetic steroid that stimulates oestrogen and progesterone receptors

Answer 355

in menopause there is reduced testosterone in women which results in low energy and reduced libido, so it can be given as a transdermal replacement therapy

Answer 356

3-6 months

Answer 357

nausea and bloating breast swelling breast tenderness headache leg cramps

Answer 358

mood swings bloating fluid retention weight gain acne and greasy skin

Answer 359

Multiple ovarian cysts infertility oligomenorrhoea hyperandrogenism insulin resistance

Answer 360

it refers to irregular infrequent ovulation

Answer 361

refers to the growth of dark thick hair often in a male pattern

Answer 362

the rotterdam criteria

Answer 363

it requires two of the three key features - oligoovulation or anovulation presenting with irregular or absent menstrual periods - hyperandrogenism - hirsutism and acne - polycystic ovaries on ultrasound (volume or more than 10cm3)

Answer 364

oligomenorrhoea or amenorrhoea infertility obesity (in about 70% of patients) hirsutism acne hair loss in a male pattern

Answer 365

insulin resistance and diabetes acanthosis nigricans cardiovascular disease hypercholesterolaemia endometrial hyperplasia and cancer obstructive sleep apnoea depression and anxiety sexual problems

Answer 366

- blood tests to look at testosterone, sex hormone binding globulin, luteinizing hormone, FHS, prolactin and TSH - pelvic ultrasound (string of pearls) - OGTT

Answer 367

weight loss calorie controlled diet exercise smoking cessation antihypertensive medications were required statins where indicated

Answer 368

endometrial cancer

Answer 369

mirena coil for continuous endometrial protection inducing withdrawal bleed every 3-4 months if they are on cyclical progestogens or the COCP

Answer 370

obesity diabetes insulin resistance amenorrhoea

Answer 371

weight loss (1st initial step) clomifene - stimulates ovaries to release egg each month laparoscopic ovarian drilling in vitro fertilitsation

Answer 372

weight loss Co-cyprindiol - COCP topical eflornithine - treat facial hirsutism electolysis laser hair removal spirololactone (anti-androgen effects) finasteride (5a reductase inhibitor) flutamide (non steroidal ani-androgen) cyproterone acetate (anti-androgen and progestin)

Answer 373

COCP (1st line) Co-cyprindiol topical adapalene (retinoid) topical antibiotics (clindamycin) topical azelaic acid oral tetracycline antibiotics

Answer 374

most are asymptomatic - found incidentally pelvic pain bloating fullness in the abdomen palpable pelvic mass pain if there is ovarian torsion, haemorrhage or rupture

Answer 375

follicular cyst - developing follicle, when they fail to rupture the cyst persists. these are harmless and tend to disappear corpus luteum cysts - when the corpus luteum fails to break down and fills with fluid instead

Answer 376

- serous cystadenoma (benign tumours) - mucus cystadenoma (benign tumour -become large) - endometrioma (lumps of endometrial tissue) - dermoid cysts/germ cell tumours - sex cord stromal tumours

Answer 377

abdominal bloating reduced appetite early satiety weight loss urinary symptoms pain ascites lymphadenopathy

Answer 378

age postmenopause increased number of ovulations obesity hormone replacement therapy smoking breastfeeding (protective) family history and BRCA1/2

Answer 379

CA 125 lactate dehydrogenase alpha fetoprotein HCG

Answer 380

possible ovarian cancer needs a two week wait referral possible dermoid cysts require referral to gynaecologist for further investigation simple ovarian cysts can be managed based on their size - less than 5cm are left alone. 5-7 have yearly monitoring, over 7 consider MRI or surgical evaluation in post menopausal women look at ca 125 and refer to gynaecologist

Answer 381

any persistent or enlarged cysts may require surgery (laparoscopy) may need to remove affected ovary small cysts just need monitoring

Answer 382

torsion haemorrhage rupture

Answer 383

this is a triad of ovarian fibroma (benign tumour) plural effusion ascites occurs in older women

Answer 384

where the ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

Answer 385

ischaemia and necrosis of the ovary

Answer 386

sudden severe unilateral pelvic pain nausea and vomiting localised tenderness palpable mass

Answer 387

history pelvic ultrasound transvaginal ultrasound - whirlpool sign laparoscopic surgery - definitive diagnosis

Answer 388

emergency admission laparoscopic surgery to either untwist and fix the ovary or to remove the affected ovary depending on visual inspection

Answer 389

delay in treatment can lead to loss of function if not removed it may become infected and develop into an abscess and lead to sepsis may rupture leading to peritonitis

Answer 390

this is where adhesions form within the uterus following damage to the uterus - can bind the walls together or bind the endocervix shut

Answer 391

after pregnancy related dilation and curettage procedure (scraping) uterine surgery several pelvic infections

Answer 392

secondary amenorrhoea significantly lighter periods dysmenorrhoea infertility

Answer 393

hysteroscopy (GOLD STANDARD) hysterosalpingography (contrast and Xray) Sonohysterography (USS) MRI scan

Answer 394

dissecting the adhesions during hysteroscopy

Answer 395

hydrocephalus seizures visual and hearing impairment

Answer 396

Ceftriaxone, doxycycline, metronidazole - covers chlamydia, gonorrhoea and anaerobic vaginal commensals

Answer 397

it is an overgrowth of bacteria in the vagina -anaerobic caused by a loss of the lactobacilli in the vagina

Answer 398

lactobacilli - produce lactic acid that keeps vaginal pH low (under 4.5)

Answer 399

gardnerella vaginalis - most common mycoplasma hominis prevotella

Answer 400

multiple sexual partners excessive vaginal cleaning products recent antibiotics smoking copper soil

Answer 401

fishy smelling watery grey or white vaginal discharge

Answer 402

vaginal pH charcoal vaginal swab clue cells from epithelial cells on microscopy

Answer 403

asymptomatic doesnt require treatment metronidazole - orally or vaginal gel

Answer 404

increases the risk of catching STIs complications in pregnant women: miscarriage preterm delivery premature rupture of membranes chorioamnionitis low birth weight postpartum endometritis

Answer 405

it is inflammation of the glans penis and foreskin

Answer 406

Non specific dermatitis with infection: candida albicans (blotchy redness), group A beta haemolytic strep and staph aureus (painful redness of penis) other infections can cause balanitis - Gardnerella, chlamydia, gonorrhoea, herpes, HPV, trichomonas, syphilis, scabies

Answer 407

irritant or allergic contact dermatitis - soap, lubricants, latex (pain and rash) seborrhoeic dermatitis psoriasis lichen sclerosus lichen planus plasma cell balanitis

Answer 408

mechanical irritation poor hygiene over washing systemic disease - crohns or sarcoidosis

Answer 409

it is a sexually transmitted infection most common in poor resource countries

Answer 410

fastidious gram negative coccobacillus haemophilus ducreyi

Answer 411

three to seven days

Answer 412

raised and painful bumps of genital skin ulcers with ragged soft edges that develop from bumps reddened and shiny skin of the sores leakage of pus lymphadenitis and buboes

Answer 413

multiple sexual partners sexual contact with a sex worker unprotected intercourse substance abuse

Answer 414

gram stain of ulcer swabs and bubo aspirates culture of ulcer swabs PCR syphilis serology HIV testing

Answer 415

Azithromycin 1g orally - one dose ceftriaxone 250 mg IM ciprofloxacin 500mg orally BD for 3 days erythromycin 500mg orally TD for 7 days

Answer 416

it is a programme that aims to screen every sexually active person under the age of 25 for chlamydia annually or when they change their sexual partner

Answer 417

charcoal swabs - microscopy NAAT swabs

Answer 418

bacterial vaginosis candidiasis gonorrhoea trichomonas vaginalis group B streptococcus

Answer 419

asymptomatic In women: abnormal vaginal bleeding, pelvic pain, abnormal vaginal bleeding, painful sex, painful urination in men: urethral discharge or discomfort, painful urination, epididymo-orchitis, reactive arthritis

Answer 420

pelvic or abdominal tenderness cervical motion tenderness inflamed cervix purulent discharge

Answer 421

doxycycline 100mg BD for 7 days in breastfeeding/pregnant women: azithromycin 1g stat and then 500mg OD for 2 days erythromycin 500mg QD for 7 days erythromycin 500mg BD for 14 days amoxicillin 500mg TD for 7 days

Answer 422

abstain from sex for 7 days of treatment of all partners to reduce risk of re infection refer all patients to GUM for contact tracing test for and treat any other STI

Answer 423

PID chronic pelvic pain infertility ectopic pregnancy epididymo-orchitis conjunctivitis lymphogranuloma venereum reactive arthritis

Answer 424

it is a condition affecting the lymphoid tissue around the site of infection with chlamydia - commonly occurs in MSM

Answer 425

primary - painless ulcer secondary stage - lymphadenitis: swelling, inflammation and pain in the lymph nodes infected with the bacteria tertiary - inflammation of the rectum and anus

Answer 426

anal pain change in bowel habit tenesmus - feeling of needing to empty the bowels even after they are empty discharge

Answer 427

doxycycline 100mg BD for 21 days - erythromycin, azithromycin and ofloxacin are alternatives

Answer 428

cold sores - herpes labialis genital herpes

Answer 429

trigeminal nerve ganglion with cold sores sacral nerve ganglia with genital herpes

Answer 430

direct contact with affected mucous membranes or viral shedding in mucous secretions

Answer 431

genital herpes - HSV2 cold sores HSV 1

Answer 432

may display no symptoms or develop symptoms years after an initial infection - ulcers or blistering lesions - tingling, burning or shooting pain (neuropathic) - flu like symptoms - dysuria - inguinal lymphadenopathy

Answer 433

clinically - history and exam viral PCR

Answer 434

GUM referral Acyclovir manage symptoms: paracetamol, lidocaine (2% gel), cleaning with warm salt water, Vaseline, additional oral fluids, wear loose clothing, avoid intercourse with symptoms

Answer 435

neonatal herpes simplex infection - high risk of morbidity and mortality

Answer 436

small lumps that develop on the genitals and or around the anus

Answer 437

human papillomavirus 6 and 11

Answer 438

sexual contact - close skin to skin contact to pass on the virus

Answer 439

in men: outer skin of the penis in women: vulva, just outside the vagina, sometimes can develop in the vagina or on the cervix warts may also develop on the skin round the anus in both men and women

Answer 440

small skin coloured lumps on the skin can be red/pink/white looking warts that develop on skin that is war/moist/non hairy tend to be soft warts that develop on dry and hairy skin tend to be firm

Answer 441

often no symptoms other than a lump on the skin being noticed they can sometimes cause irritation and soreness especially round the anus can bleed or cause pain on intercourse can be itchy

Answer 442

history and examination swabs - NAAT

Answer 443

can take several weeks to clear the infection Chemical treatments: podophyllotoxin or imiquimod cream physical treatments: freezing warts with liquid nitrogen, surgical removal under local anaesthetic, electrocautery, laser

Answer 444

gram negative diplococcus

Answer 445

mucous membranes with a columnar epithelium such as the endocervix in women, urethra, rectum, conjunctiva and pharynx

Answer 446

females: odourless purulent discharge, possible green or yellow, dysuria, pelvic pain males: odourless purulent discharge, dysuria, testicular pain or swelling

Answer 447

NAAT testing - endocervical, vulvovaginal or urethral swabs or first catch urine - rectal and pharyngeal swab are recommended in all men who have sex with other men charcoal swab should be taken for MCS before initiating antibiotics

Answer 448

GUM clinic for contact tracing Uncomplicated: single dose IM ceftriaxone 1g if sensitivities not known, or single dose oral ciprofloxacin 500mg if they are known - all patients should have a follow up test of cure which is with NAAT testing

Answer 449

72 hours after treatment for culture 7 days after treatment for RNA NAAT 14 days after treatment for DNA NAAT

Answer 450

PID chronic pelvic pain infertility epididymo-orchitis prostatitis conjunctivitis urethral strictures disseminated gonococcal infection skin lesions fitz-hugh-curtis syndrome septic arthritis endocarditis

Answer 451

it is a complication of intreated gonococcal infection where the bacteria spreads to the skin and the joints

Answer 452

skin lesions polyarthralgia migratory polyarthritis tenosynovitis systemic symptoms - fever and fatigue

Answer 453

RNA retrovirus

Answer 454

unprotected anal, vaginal or oral sexual activity mother to child at any stage of pregnancy, birth or breastfeeding mucus membrane, blood or open wound exposure

Answer 455

kaposis sarcoma pneumocystis jjrovecii pneumonia cytomegalovirus infection candidiasis lymphomas tuberculosis

Answer 456

- need verbal consent to perform test fourth generation tests check for antibodies to HIV and the p24 antigen. Have a 45 window period - point of cade tests for HIV antibodies give results within 90 minutes they have a 90 day window - home kits: self sampling or point of care tests

Answer 457

the CD4 count - 500-1200 cells/mm3 is normal < 200 cells/mm3 puts patient at risk of opportunistic infections testing HIV RNA per ml of blood indicates the viral load

Answer 458

GUM centre referral antiretroviral therapy - two NRTIs (tenofovir +emtricitabine) plus a third agent

Answer 459

protease inhibitors integrase inhibitors nucleoside reverse transcriptase inhibitors non nucleoside reverse transcriptase inhibitors entry inhibitors

Answer 460

- prophylactic co-trimoxazole given to all HIV positive patients with CD4<200 - close monitoring of CV risk factors - lipids - yearly cervical smears - vaccines up to date (done give live attenuated)

Answer 461

viral load under 50 copies/ml - normal birth " " over 50 copies/ml - consider pre labour caesarean section over 400 copies/ml pre labour caesarean is recommended

Answer 462

IV zidovudine if the viral load is over 1000

Answer 463

prophylaxis low risk given zidovudine for 2-4 weeks high risk babies given zidovudine, lamivudine and nevirapine for four weeks

Answer 464

post exposure prophylaxis - ART therapy Pre-exposure prophylaxis

Answer 465

emtricitabine/tenofovir and raltegravir for 28 days

Answer 466

emtricitabine/tenofovir

Answer 467

physically being able to see them itching - worse at night small red or blue spots on your skin white/yellow dots attached to your hair dark red or brown spots in your underwear crusted or sticky eyelashes if they are affected

Answer 468

medicated creams/shampoos: malathion, ivermectin (pills) - use treatment on whole body and leave it on for a few hours before washing it off - will need to repeat after a week to ensure all the lice have been killed

Answer 469

very close body contact - sexual contact

Answer 470

it is persistent physical issues, psychological issues or both that prevent someone engaging in sexual activities - can affect any phase of the sexual response from arousal to orgasm

Answer 471

- be present 75-100% of the time - last for at least 6 months - have caused significant distress

Answer 472

1. desire disorder - hypoactive sexual desire disorder in which a person lacks sexual desire 2. arousal disorder - may find it difficult or impossible to respond to sexual stimuli despite desire for sexual activity 3. orgasm dysfunction 4. pain disorders - vaginismus, dyspareunia, painful ejaculation

Answer 473

this is a condition that prevents a person from getting or maintaining an erection firm enough for enjoyable sexual activity

Answer 474

premature ejaculation delayed ejaculation retrograde ejaculation - semen passes backward into the bladder

Answer 475

pain and discomfort during sex difficulty reaching orgasm

Answer 476

lack of arousal, vaginal dryness or irritation vaginismus - vagina tightens when a person attempts to insert something in there STI endometriosis PID genital injury fibroids cystitis ovarian cysts IBS uterine prolapse

Answer 477

primary: person has never had an orgasm secondary: had orgasms in the past but cant reach them any more

Answer 478

hormone change - thyroid disorders, menopause, decrease in testosterone metabolic conditions - obesity, high cholesterol heart conditions neurological disorders substance use medications - birth control pills, antidepressants, blood pressure medication

Answer 479

stress anxiety depression trauma relationship issues strict sexual beliefs low self esteem fear of sexual performance

Answer 480

bloods - TFTs, FBC etc samples of vaginal discharge hormone profile cholesterol level tests

Answer 481

alprostadil PDE5 inhibitors such as sildenafil penis pumps to stimulate blood flow/surgical penile implants

Answer 482

flibanserin - female Viagra Bremelanotide

Answer 483

buspirone - anxiety medication

Answer 484

topical creams, gels, sprays or wipes that contain numbing agents such as lidocaine

Answer 485

sex education and therapy couples counselling cognitive behavioural therapy relaxation therapy

Answer 486

bacteria treponema pallidum - spirochete bacteria

Answer 487

oral, vaginal or anal sex vertical transmission from mother to baby intravenous drug use blood transfusions and other transplants

Answer 488

primary secondary latent tertiary neurosyphilis

Answer 489

there is a painless ulcer called a chancre which resolves over 3-8 weeks there is local lymphadenopathy

Answer 490

systemic symptoms: - maculopapular rash - condylomata lata (grey wart like lesions around genitals and anus) - low grade fever - lymphadenopathy - alopecia - oral lesions these symptoms can resolve after 3-12 weeks

Answer 491

this occurs after the secondary phase where the symptoms disappear and the patient becomes asymptomatic. - early latent is within two years of initial infection - late latent is after two years

Answer 492

it affects many organs of the body key features are: Gummatous lesions - granulomatous lesions affecting the skin, organs and bones Aortic aneurysms neurosyphilis

Answer 493

it is infection of the CNS with syphilis and it can occur at any stage of infection

Answer 494

headache altered behaviour dementia tabes dorsalis - demyelination affecting the spinal cord posterior columns ocular syphilis - Argyll-robertson pupil paralysis sensory impairment

Answer 495

it is a specific finding of neurosyphilis which is a constricted pupil that accommodates when focusing on a near object but doesnt react to light - often irregularly shaped

Answer 496

antibody testing samples from sites of infection - dark field microscopy and PCR

Answer 497

rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) - these are non specific but sensitive

Answer 498

GUM referral - deep IM dose of benzathine benzylpenicillin

Answer 499

it is a bacterial that causes non gonococcal urethritis - STI

Answer 500

most cases do not cause symptoms - urethritis - epididymitis - cervicitis - endometritis - PID - reactive arthritis - preterm delivery in pregnancy - tubal infertility

Answer 501

NAAT testing - first urine sample - vaginal swabs need to test for macrolide resistance and perform a test of cure as well

Answer 502

doxycycline - 100mg BD for 7 days azithromycin - 1g stat then 500mg OD for 2 days

Answer 503

moxifloxacin azithromycin in pregnancy

Answer 504

thrush - caused by yeast infection

Answer 505

increased oestrogen - pregnancy, lower pre puberty and post menopause poorly controlled diabetes immunosuppression broad spectrum antibiotics

Answer 506

thick while discharge that doesnt typically smell vulval and vaginal itching, irritation and discomfort in severe infection: erythema, fissures, oedema, pain during sex, dysuria, excoriation

Answer 507

testing vaginal pH charcoal swab with microscopy, culture and sensitivities

Answer 508

antifungal cream - clotrimazole antifungal pessary - clotrimazole oral antifungal tablets - fluconazole

Answer 509

induction and maintenance regime over six months with oral or vaginal antifungal medications

Answer 510

it is an infection caused by a parasite (protozoan - flagella) that is spread through sexual intercourse

Answer 511

contracting HIV- damaging vaginal mucosa bacterial vaginosis cervical cancer PID pregnancy related complications

Answer 512

up to 50% asymptomatic - vaginal discharge: frothy, green-yellow, fishy - itching - dysuria - dyspareunia - balanitis (inflammation of glans penis)

Answer 513

strawberry cervix - tiny haemorrhages across surface of the cervix high vaginal pH

Answer 514

charcoal swab with microscopy - swab should be taken from the posterior fornix of the vagina urethral swab or first catch urine in men

Answer 515

referral to GUM metronidazole

Answer 516

they are fluid filled cysts that are often seen on the surface of the cervix - also called nabothian follicles or mucinous retention cysts

Answer 517

The columnar epithelium of the endocervix (the canal) produces cervical mucus. When the squamous epithelium of the ectocervix slightly covers the mucus-secreting columnar epithelium, the mucus becomes trapped and forms a cyst. This can happen after childbirth, minor trauma to the cervix or cervicitis secondary to infection.

Answer 518

often found incidentally on speculum examination dont typically cause symptoms, rarely if large can cause feeling of fullness in pelvis appear as smooth round bumps on the cervix usually near to the OS, can range in size and have a whitish or yellow appearance

Answer 519

often no treatment is required as they dont cause harm and often resolve spontaneously if diagnosis is uncertain refer for colposcopy and they can be excised and biopsied

Answer 520

Vault prolapse occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina.

Answer 521

defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina

Answer 522

constipation foacal loading urinary retention palpable lump

Answer 523

Cystoceles are caused by a defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina. Prolapse of the urethra is also possible (urethrocele). Prolapse of both the bladder and the urethra is called a cystourethrocele.

Answer 524

Pelvic organ prolapse is the result of weak and stretched muscles and ligaments. The factors that can contribute to this include: Multiple vaginal deliveries Instrumental, prolonged or traumatic delivery Advanced age and postmenopause status Obesity Chronic respiratory disease causing coughing Chronic constipation causing straining

Answer 525

A feeling of “something coming down” in the vagina A dragging or heavy sensation in the pelvis Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention Bowel symptoms, such as constipation, incontinence and urgency Sexual dysfunction, such as pain, altered sensation and reduced enjoyment

Answer 526

a sims speculum - U shaped support the anterior or posterior wall while the other walls are examined

Answer 527

Pelvic organ prolapse quantification system: Grade 0: Normal Grade 1: The lowest part is more than 1cm above the introitus Grade 2: The lowest part is within 1cm of the introitus (above or below) Grade 3: The lowest part is more than 1cm below the introitus, but not fully descended Grade 4: Full descent with eversion of the vagina

Answer 528

Physiotherapy (pelvic floor exercises) Weight loss Lifestyle changes for associated stress incontinence, such as reduced caffeine intake and incontinence pads Treatment of related symptoms, such as treating stress incontinence with anticholinergic mediations Vaginal oestrogen cream

Answer 529

Ring pessaries: ring shape, and sit around the cervix holding the uterus up Shelf and Gellhorn: flat disc with a stem, that sits below the uterus with the stem pointing downwards Cube pessaries: cube shape Donut pessaries: thick ring, similar to a doughnut Hodge pessaries are almost rectangular. One side is hooked around the posterior aspect of the cervix and the other extends into the vagina.

Answer 530

Mesh repairs involve inserting a plastic mesh to support the pelvic organs. After review, NICE recommend that mesh procedures should be avoided entirely

Answer 531

Chronic pain Altered sensation Dyspareunia (painful sex) for the women or her partner Abnormal bleeding Urinary or bowel problems

Answer 532

it is dryness and atrophy of the vaginal mucosa related to lack of oestrogen

Answer 533

epithelial lining of the vagina and urinary tract responds to oestrogen by becoming thicker, more elastic and producing secretions, as oestrogen falls the mucosa becomes thinner, less elastic and more dry also contributes to pelvic organ prolapse and stress incontinence

Answer 534

Itching Dryness Dyspareunia (discomfort or pain during sex) Bleeding due to localised inflammation recurrent UTI stress incontinence pelvic organ prolapse

Answer 535

Pale mucosa Thin skin Reduced skin folds Erythema and inflammation Dryness Sparse pubic hair

Answer 536

vaginal lubricants - sylk, replens, YES topical oestrogen cream: estriol cream, pessaries, tablets, ring

Answer 537

breast cancer angina VTE

Answer 538

pair glands located either side of the posterior part of the vaginal introitus (the vaginal opening). They are usually pea-sized and not palpable. They produce mucus to help with vaginal lubrication.

Answer 539

When the ducts become blocked, the Bartholin’s glands can swell and become tender, causing a Bartholin’s cyst. The swelling is typically unilateral and forms a fluid-filled cyst between 1 – 4 cm.

Answer 540

it is when a bartholins cyst becomes infected

Answer 541

good hygiene, analgesia, warm compresses biopsy may be required if malignancy needs to be excluded

Answer 542

antibiotics - E.coli is most common cause surgical interventions - word catheter (pus drained and balloon put into abscess to prevent refilling) or marsupialisation (drained and abscess is sutured open to allow drainage and prevention of recurrence)

Answer 543

chronic inflammatory skin condition that presents with patches of shiny, porcelain white skin commonly affecting the labia, perineum and perianal skin in women

Answer 544

chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin. This presents with excoriations, plaques, scaling and thickened skin.

Answer 545

autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.

Answer 546

45-60 year old women with vulval itching and skin changes: Itching Soreness and pain possibly worse at night Skin tightness Painful sex (superficial dyspareunia) Erosions Fissures

Answer 547

“Porcelain-white” in colour Shiny Tight Thin Slightly raised There may be papules or plaques may be associated fissures, cracks, erosions or haemorrhages under the skin

Answer 548

cant be cured, symptom management potent topical steroids: clobetasol propionate 0.05% - used once a day for 4 weeks then weaned regular use of emollients

Answer 549

The critical complication to remember is a 5% risk of developing squamous cell carcinoma of the vulva. Other complications include: Pain and discomfort Sexual dysfunction Bleeding Narrowing of the vaginal or urethral openings

Answer 550

surgically changing the genitals of a female for non-medical reasons. Female genital mutilation is illegal as stated in the Female Genital Mutilation Act 2003, and there is a legal requirement for healthcare professionals to report cases of FGM to the police.

Answer 551

Many african countries - Somalia = highest ethiopia, sudan, eritrea yemen, kurdistan, indonesia, south and western asia

Answer 552

Type 1: Removal of part or all of the clitoris. Type 2: Removal of part or all of the clitoris and labia minora. The labia majora may also be removed. Type 3: Narrowing or closing the vaginal orifice (infibulation). Type 4: All other unnecessary procedures to the female genitalia.

Answer 553

Pregnant women with FGM with a possible female child Siblings or daughters of women or girls affected by FGM Extended trips with infants or children to areas where FGM is practised Women that decline examination or cervical screening New patients from communities that practise FGM

Answer 554

Pain Bleeding Infection Swelling Urinary retention Urethral damage and incontinence

Answer 555

Vaginal infections, such as bacterial vaginosis Pelvic infections Urinary tract infections Dysmenorrhea (painful menstruation) Sexual dysfunction and dyspareunia (painful sex) Infertility and pregnancy-related complications Significant psychological issues and depression Reduced engagement with healthcare and screening

Answer 556

education of patients mandatory to report all cases of FGM in patients under 18 to the police - contact social services, paeds, specialist gynaecological or FGM services, counselling de-infibulation may be performed by a specialist in FGM cases of type 3

Answer 557

upper vagina cervix uterus fallopian tubes

Answer 558

where there are two 'horns' in the uterus giving the uterus a heart shaped appearance

Answer 559

miscarriage premature birth malpresentation

Answer 560

when the hymen at the entrance of the vagina is fully formed without an opening

Answer 561

imperforate hymen may be discovered when the girl starts to menstruate, and the menses are sealed in the vagina. This causes cyclical pelvic pain and cramping that would ordinarily be associated with menstruation, but without any vaginal bleeding.

Answer 562

surgical incision to make opening

Answer 563

Theoretically, if an imperforate hymen is not treated retrograde menstruation could occur leading to endometriosis.

Answer 564

the septum forms transversely across the vagina, which can either be perforate or imperforate - where it is perforate girls will still menstruate but have difficulty with intercourse or tampon use - imperforate will present similarly to imperforate hymen

Answer 565

surgery - vaginal stenosis and recurrence

Answer 566

abnormally small vagina

Answer 567

absent vagina

Answer 568

vaginal dilator over a prolonged period to create adequate vaginal size or surgery

Answer 569

cells are unable to respond to androgen hormones due to a lack of androgen receptors. It is an X-linked recessive genetic condition, caused by a mutation in the androgen receptor gene on the X chromosome

Answer 570

. Extra androgens are converted into oestrogen, resulting in female secondary sexual characteristics, while being genetically male patients have testes in abdomen or inguinal canal and absence of uterus, upper vaginal, cervix, fallopian tubes and ovaries lack of pubic hair, facial hair and male type muscle development infertile

Answer 571

inguinal hernias containing testes. Alternatively, it presents at puberty with primary amenorrhoea. The results of hormone tests are: Raised LH Normal or raised FSH Normal or raised testosterone levels (for a male) Raised oestrogen levels (for a male)

Answer 572

MDT approach Bilateral orchidectomy (removal of the testes) to avoid testicular tumours Oestrogen therapy Vaginal dilators or vaginal surgery can be used to create an adequate vaginal length

Womens health Flashcards

Obstetrics and Gynecology