womens health Flashcards
best way to measure hyperemesis gravidum
pregnancy unique quantification of emesis (PUQE)
causes of heavy mentsrual bleeding
- idiopathic - dysfunctional uterine bleed
- systemtic - hypothy coagulopathy
- local - polyp fibroid PIB cancer
- iatrogenic - copper coil warfarin
abnormal bleeding in the adsence of recognisable pelvic pathology general medical disease of pregnancy
dysfunctional uterine bleeding
symptoms and signs of dysfunctional uterine bleeding
irregular heavy periods metromenorrhagia problems with luteal phase due to annovulation
heavy irregular menstrual bleeding and subfertility
impaired positive feedback to the pituitary leads to a failure in LH surge which conditions is this true for
PCOS
peri menopausal women
falling oestrogen levels
young teenagers with immature folliciles
What causes annovulatory cycles
failure of ovulation in absence of corpus leuteum inaequate luteal phasse means proliferative hyperplastic endometrium therefore heavy irregular bleeding subfertility
what are fibroids
leiomyomata benign tumours of smooth muscles which protrudde into the uterine cavity increasing the surface area and surrounding structures causing heavy menstrual bleeding
a) a fibroid inside the muscle
b) protruding inside the uterus like polyp
c) poking the intrcavity but not intra cavity
d) most superficial
a) intramural
b) intracavity
c) submucosal
d) subserosal
when would you do a endometrial biopsy
with IMB > 40 years old resistant to mediclation to eclude carcinoma endometrial hyperplasia
managment of HMB when is tranexamic acid contraindicated
in people with previous thromboembolitic disease
what are the three indications for mirena
contraception
primary menhorrhagia
endometrial protection against HRT
how does hormonal contraception work
thickens mucus thin the epithelium and inhibits ovulations
the organism that causes syphilis
treponium pallidum
progress of syphilis
- Chancre - non painful ulcer SWAB HERE
- rash nodule immune reaction
- cardiac cns nodules gumma SEROLOGY DONE AT 3
what would you seen unders a microscope if you swabbed a chancre
(dark microscope corkscrew spirla shaped microscope seen)
what would you find in syphilis screening and screening will be used
antibodies to cardiolipin - this is the bodies non specific response to treponumal disease one of which is syphilis. these levels fall after treatment so are best markers for active disease eventhough it may not be specific
VDRL needed to interpret the microscope and RPR is a quick card based test read without microsocpe
Confirmatory tests in syphilis screening - specific to syphilis
specific trempemal tests TPHA and FTA-ABS
these are used together with the screening test to deduce whether the patient has syphilis
Can IGM and IGG tests be used for syphilis
yes will detect congenital syphilis but IGM cannot cross the placenta
if both screening and confirmatory test for syphils were positive what would happen
request a second sample. given antibitotics as the treament. if syphilis was found in confirmatory tests and not screening the lab would say infected with sypilis at some point
pt with history of syphilis non painful ulcer on left labia but small and doesnt need swab VDLR and RPR negative
repeat tesing later as antibody response has not yet started
pt with untreated active syphilis would have what type of positive result
evry test will be high even treponemal IgM
pt treated with syphilis years ago how to check this
low screening test high confirmatory tests
in an elderly confused patient the consults asks to check for syphilis why
neurosyphilis can mimic dementia untreated or unsucessful treatment can lead to confusion and would show serology tetisng similar to oatietn with active disease . A lp can check for treponium antibodies in CSF
IMB investigations 5
- pregnancy test
- cervical smear and triple swabs
- endo cervix (x2) and high vaginal
- USS and endo biopsy
- imaging for pelvic mass
- Colposcopy and biopsy - exclude endo ca
post coital bleeding is more common in what type of cancer
cervical cancer
endometrial ca treatment
totla abdo hysperectomy and bilateral sapingoophrectomy
radiotherapy vaginal brachytherapy or external beam radiotherapy
chemo in advanced disease
presentation of ovarian ca
low abdominal pain and bloating
risk factors
anything that would have lead to an increase in the no of ovulation e.g. nulliparity brca gene inc age
staging of ovarian cancer
stage 1- confined to organ
stage 2- local sread but confined to pelvis
stage 3 - spread to abdo but confined to peritoneal cavity
stage 4 - distant spread
what are the regional lyph nodes for ovarian ca
paraaortic lumph nodea and so if spread here can rapidly pass to stage 4
pt with bilateral adenexal mass with small amount of ascities they have multiocular masses with enlargment of the para aortic lymph nodes ca125 = 2000 normal being 0-35
ovarian cancer
treatment for ovarian cancer
debulking and pelvic clearance neoadjuvant chemo with platinum based meds taxane and cisplatin
a flagellated protozoal with a incubation period of 1-3 weeks and frofthy green or grey discharge and a strawberry cervix what is the diagnosis and treatment
tricomonas vaginalis and metronidaozle is the treatment
diferenctial for vaginal discharge with fish smell
bacterial vaginitis
retained tampon
trichomonas
how to deal with STI in a history
SEX
s- screen for other stis
e- education the use of condoms
x- explain about partner notification
what is triple testing
high vag swab
endocervical dry swab
endocervucal dry swab and urine sample
what is high vaginal swab for
candida gardnerella bacterial vaginosis and tricomonas
what is endocerivcal dry swab for
nisseria gonhorrea in the NAAT TEST
ENDOCERVICAL DRY SWAB WITH URIN TEST
for chylamydia in the NAAT test
disease caused by an imbalance of vaginal flora rather than STI and no symptoms in male parner may be triggered by vag touching or sex causes fish diacharge but no itch
bacterial vaginosis
identification and treatment of bacterial vaginosis
clue cells on microscopy and vaginal epithelial cell coated with numerous bacteria typical swab report is heavy growth of anaeobs
treatment is metronidazole and topical clindamycin
HPV cancer causing ones
16 and 18
what happens is cervical smear is positive and how often to screen
colposcopy needed and screening is every three years
treatment of CIN
excision and destriction of affected area at colposcopy large loop excision of the transformation zone (LLETZ) Colc coagulation cryptherapy and lazer vapourisation under general anaesthetic cone biopsy
treatment of cervical ca.
excesion for early radiacal hysterectomy and traclectomy removal of cervical and pelvic lymph nodes with persevation fo the body of uterus for those wanting to persever fertility
Classifciation of gynae cancers using…..
FIGO classification
- local
- pelvis
- lymph notes/ pelvis walls
- whole body mets
carcinoma of vulva type and presentation
older women with a cut or a itch patch in labia or vestibule squamous cell ca
pre cancer of vulva and Rx
lychen sclerosis et atophicus rarely melanoma can affect adenocarcinoma of the batholins gland
Rx - radical vulvectomy
