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med > Womens health > Flashcards

Womens health Flashcards

1
Q

Define premature menopause

A

Periods cease before 40

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2
Q

What blood test can support a diagnosis of premature menopause?

A

Two FSH levels taken 4 weeks apart

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3
Q

What are the management options for menorrhagia with no organic cause?

A

1) IUS
2) antifibrinolytics (e.g. transexamic acid), NSAIDs
3) Progesterone
4) Surgery (hysterectomy)

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4
Q

What tests would you to investigate new onset menorrhagia?

A

FBC, clotting, TFT

TVUS and endometrial biopsy

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5
Q

Ix for amennorhoea

A 
Preg test
FSH/LH
Prolactin
Testosterone
Pelvic USS (PCOS)
TFT
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6
Q

DDx IMD

A

Fibroids, polyps, adenomyosis

Malignancy

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7
Q

What are the three types of fibroid?

A

Submucosal
Intramural
Subserous

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8
Q

What causes adenomyosis?

A

Endometrial tissue within the myometrium

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9
Q

What finding is suggestive of adenomyosis o/e?

A

Enlarged, boggy uterus

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10
Q

How does adenomyosis px?

A

Dysmennorhoea

menorrhagia

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11
Q

How can adenomyosis be dx?

A

MRI

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12
Q

Which HPV types are most associated with cervical ca?

A

16 and 18

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13
Q

What is the main conservative management strategy in PCOS?

A

Weight loss

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14
Q

What drug can be used to stimulate ovulation in PCOS?

A

Clomifene

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15
Q

COCP increases risk which cancers

A

Breast and cervical

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16
Q

COCP decreases risk which cancers

A

Endometrial and ovarian (less ovulations, less endometrial turnover)

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17
Q

Which conditions do women need a increased dose of folic acid in pregnancy?

A

Epilepsy

DM

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18
Q

What week is dating scan?

A

10-13

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19
Q

What week is anomaly scan?

A

20

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20
Q

What is parity?

A

Number of times given birth to a foetus of 24 weeks or more

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21
Q

Define miscarriage

A

Loss of foetus before 24 weeks

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22
Q

What does G5P1(+3) tell you?

A

Currently pregnant, 4 pregnancies in past (3 lost before 24 weeks and 1 delivered past 24 weeks)

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23
Q

What forms the combined test?

A

nuchal translucency
B-HCG
pregnancy associated plasma protein A

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24
Q

How do you treat breech presentation in pregnancy?

A

External cephalic version (ECV) at 36 weeks (or 37 if multiparous)

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25
Q

Causes of polyhydramnios

A 
(DITCH)
Diabetes
Idiopathic
Twins
Congen.abnormalities 
Infection
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26
Q

How far does the cervix dilate in the latent stage of labour?

A

4cm

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27
Q

Indications for induction

A

Prolonged pregnancy
PROM
Diabetic mother post term

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28
Q

Steps of inducing labour

A

Membrane sweep
Intravaginal prostaglandins
AROM
Oxytocin

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29
Q

Risks of DM in pregnancy

A 
Miscarriage
Macrosomia 
Polyhydramnios
intrauterine death
Shoulder dystocia
Neonatal hypoglycaemia
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30
Q

Mx shoulder dystocia

A

McRoberts
Suprapubic pressure
Episiotomy

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31
Q

test results in HELPP syndrome

A

Haemolyis, raised liver enzymes, low platelets

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32
Q

4 causes of PPH

A

Tone
Tissue
Trauma
Thrombin

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33
Q

Which STI px with strawberry cervix and green/grey discharge?

A

Trichomonas vaginalis

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34
Q

What sign on microscopy is suggestive of BV?

A

Clue cells

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35
Q

How are BV and trichomonas treated?

A

Metronidazole

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36
Q

Comps of BV in pregnancy

A

Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage

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37
Q

Which form of contraception is preferred post-partum?

A

POP

don’t need for first 21 days

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38
Q

Which criteria are used to dx PCOS?

A

Rotterdam

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39
Q

tx for chlamydia

A

Single dose azithromycin

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40
Q

Tests for tubal patency

A

Hysterosalpingo contrast sonography (HyCOSy)
Hysterosalpingogram (HSG)
Laparoscopy and dye

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41
Q

What type of cancer are 90% of ovarian cancers?

A

Epithelial

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42
Q

What type of cancers are majority of cervical cancers?

A

Squamous cell carcinoma

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43
Q

What is APGAR score?

A

Used for assessing status of newborn infant

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44
Q

Which drug is used to terminate a pregnancy less than 9 weeks?

A

Mifepristone

followed by prostaglandins - misoprostol

45
Q

What is the cut off for an abortion?

A

24 weeks

46
Q

What type of cancer is endometrial cancer?

A

adenocarcinoma

47
Q

How long does an implant last?

A

3 years

48
Q

Name two emergency contraception options

A 
Levonogestrel (Levonelle) 
Ulipristal acetate (EllaOne)
49
Q

Within what window can emergency contraception be used?

A

5 days (if use EllaOne)

50
Q

Which infectious diseases are screened for during pregnancy?

A

Hep B
HIV
Syphilis

51
Q

What tests are offered if combined test comes back positive?

A

Chorionic villus sampling

Amniocentesis

52
Q

Which test, done at 5-8 days, screens for 9 conditions in neonates?

A

Guthrie test

53
Q

Give two classes of drug (and drug name) used to treat urge incontinence

A

Anticholinergic (oxybutynin)

Beta3 - adrenergic receptor agonist (mirabegron)

54
Q

Define puerperium

A

From delivery of placenta to 6 weeks following birth

55
Q

Define PPH

A

Greater than 500ml blood loss

56
Q

How do fibroids px?

A

Heavy periods
Anaemia
Infertility
Miscarriage

57
Q

How are fibroids dx?

A

TVUSS

58
Q

What is first line mx of fibroids?

A

Mirena coil

59
Q

Causes of secondary dysmenorrhoea

A

Endometriosis
Adenomyosis
PID
Copper coil

60
Q

Most common cause of PID

A

Chlamydia

61
Q

Which two conditions classically present with cervical excitation (motion tenderness)?

A

PID

Ectopic pregnancy

62
Q

Define gestational htn

A

> 140/90 new after 20 weeks gestation

63
Q

Define pre-eclampsia

A

New htn after 20th week and proteinuria

64
Q

Define preterm birth

A

Less than 37 weeks

65
Q

What Ix are involved in the secondary prevention of PTB in mothers deemed at high risk?

A

TV cervical USS

Qualitative foetal fibronectin test

66
Q

How could you treat patients at high risk of PTB

A

Progesterone injections

67
Q

How does a threatened miscarriage present?

A

Painless bleeding

68
Q

How does inevitable miscarriage px?

A

Heavy bleeding with crampy pain

69
Q

How does ectopic px?

A

Constant pain
6-8weeks amennorhoea
Small amount of bleeding

70
Q

How to manage miscarriage in primary care?

A

Do pregnancy test - negative (miscarried)

positive - refer to early pregnancy assessment unit (for USS)

71
Q

What is expectant management for miscarriage?

A

Used when incomplete or missed

If no comps advise to take pregnancy test after 3 weeks and only return if positive

72
Q

What is medical management of miscarriage and when is it used?

A

Ongoing sx after 14 days expectant management
MISOPROSTOL (PO/PV)
Medical uterine evacuation
(surgery and anti-D immunoglobulin if medical mx fails)

73
Q

How is placenta praevia diagnosed?

A

Abdo USS

74
Q

What is the sign of placental abruption?

A

Tense hard uterus on exam

75
Q

How to manage PPH?

A

1) Explore uterine cavity if placenta retained
2) Exclude vaginal tears
3) UTERINE MASSAGE
4) IV oxytocin
5) IV ergometrine
6) PR misoprostol
7) surgery

76
Q

Indications for instrumental delivery

A

Delay in second stage of labour
Foetal distress
Maternal exhaustion

77
Q

How is ovarian/adnexal torsion diagnosed and treated?

A

Laparoscopy

78
Q

Tx for atrophic vaginitis

A

Lubricants
Vaginal oestrogen
HRT

79
Q

How does PID present?

A

Bilateral pelvic pain
Fever
Offensive vaginal discharge

80
Q

Stages of female puberty in order

A

Growth
Breast development
Hair growth
Menarche

81
Q

What tests would you do in a female px with delayed puberty?

A

LH/FSH
TFT
Prolactin
Karyotype

82
Q

What drug can be used in preterm labour to delay progression?

A

Ritodrine

83
Q

What is asymmetric IUGR a sign of?

A

Uteroplacental insufficiency

84
Q

3 methods of foetal monitoring during pregnancy

A

Pinard stethoscope
Hand-help doppler
Cardiotocography (CTG)

85
Q

What sort of decels are sinister on CTG?

A

Late decels

86
Q

Define infertility

A

Failure to conceive after 1 year regular intercourse

87
Q

Ix to check women ovulation

A

Mid-luteal progesterone (taken 7 days before menstruation)

88
Q

A woman px with intense pruritus in third trimester, what’s most likely dx?

A

Obstetric cholestasis

89
Q

What condition px with massive bleeding post membrane rupture/

A

Vasa praevia

90
Q

Tx for vasa praevia

A

C section if identified before delivery on USS

91
Q

How long must women use contraception from their last menstrual period?

A

1 year (or 2 if <50yr)

92
Q

What is a whirlpool sign on USS suggestive of?

A

Ovarian torsion

93
Q

what is triple assessment for breast Ca?

A

Clinical
Imaging
Biopsy

94
Q

What are the two most common types of breast Ca?

A 
Ductal carcinoma (70%)
Lobular (10%)
95
Q

Name the endocrine tx for breast Ca

A 
Pre-men = tamoxifen
Post-men = aromatase inhibitors (letrozole)
96
Q

What drug can be used to tx HER +ve breast Ca?

A

Trastuzumab (Herceptin)

97
Q

What are the side effects of tamoxifen?

A

Hot flushes, nausea, PV bleeding (menopause like sx)

98
Q

How can you manage labour not progressing in first stage?

A 
AROM
Syntocin gradually (risk uterine rupture and foetal distress)
99
Q

How can you manage labour not progressing in second stage?

A

Syntocin

Instrumental delivery

100
Q

What are the causes of breast lumps?

A 
Malignancy
Fibroadenoma
Cysts
Infective mastitis/breast abscess
Duct ectasia
Fat necrosis
101
Q

What is the indication for giving oestrogen only HRT?

A

If pt has no uterus

102
Q

When do you use sequential and when do you use continuous HRT?

A

If pre-menopausal can only give sequential HRT (will get withdrawal bleed every 4 weeks) (LMP < 1yr ago)
If known amennorhagic can give continuous HRT

103
Q

What scoring system can be used in prognosis prediction in breast Ca/

A

Nottingham prognostic index

104
Q

How do aromatase inhibitors like letrozole work?

A

Prevent peripheral conversion (in fatty tissues) of androgens to oestrogen

105
Q

What are the risks associated with HRT?

A

VTE
STROKE
BREAST CA

106
Q

What are the benefits assoc. with HRT?

A 
Fewer symptoms (vasomotor, urogenital, mood)
Decreased risk osteoporosis and CVD
107
Q

What is the tx for puerperal mastitis?

A

Warm compress

Fluclox if systemically unwell

108
Q

What scoring system is used to determine whether induction of labour is required?

A

Bishop score

109
Q

What is the name of the chart used to track labour?

A

Partogram

med (25 decks)

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