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GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • • • • • What are the causes of menorrhagia? Fibroids, congenital uterine abnormality, pelvic infection, endometriosis, endometrial or cervical polyps, endometrial cancer, IUCD, bleeding tendency or anticoagulant use, ho...

GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • • • • • What are the causes of menorrhagia? Fibroids, congenital uterine abnormality, pelvic infection, endometriosis, endometrial or cervical polyps, endometrial cancer, IUCD, bleeding tendency or anticoagulant use, hormone-producing tumors. What are contraindications to IUCD? Copper allergy, Wilson’s disease, menorrhagia or dysmenorrhea. What is the contraceptive method of choice in a woman >40 years and has heavy periods? Progestin IUD such as Mirena. DEFINITELY NOT IUCD What are the treatment options available for osteoporosis? N.B. DMA scan will show BMD of less than -2.5. o Lifestyle modifications: smoking cessation, exercise, weight loss, maintaining adequate nutrition with a BMI above 19. OFFERED TO ALL AT RISK. o Vitamin D and calcium supplements. Post-menopausal with dietary deficiency, >80yrs, on steroids, housebound/institutionalized. o Bisphosphonates such as alendronic acid ONCE WEEKLY, ibandronate and risedronate. This is the mainstay of treatment in osteoporosis. (N.B. SE? Esophagitis and osteonecrosis of the jaw. Esophagitis can be prevented by taking the pill with water, up straight and remaining so for 30 minutes). o SERMs such as raloxifene (N.B. Caution in DVT/PE/stroke). o Denosumab, SC injection 60mg every 6 months, works by RANKL inhibition. USED IN SEVERE OSTEOPOROSIS WHERE BISPHOSPHONATES ARE CONTRAINDICATED Decreases osteoclast activation and decreases bone resorption. Which breast conditions require urgent referral? Abscesses within 24 hours for I+D, mastitis first give antibiotics and refer if symptoms do not resolve within 48 hours, suspicious breast cancer. What is the definition of menopause? 1 year of amenorrhea. It is a retrospective diagnosis. N.B. Biochemically, LH/FSH will both be high. What are possible adverse outcomes of menopause? Osteoporosis, CVD, stroke. What is the most effective treatment for hot flashes in menopause? HRT, lowest dose should be used for the shortest time (N.B. SEs include VTE, CVA, breast cancer). Grey/white, thin, fishy vaginal discharge, no soreness? Bacterial vaginosis (CAUSED BY GARDNERELLA VAGINALIS), NOT AN STI thus no need to treat partner, treated with metronidazole or clindamycin or tinidazole (N.B. Commonest cause of vaginal discharge in women of reproductive age, pH will be >4.5 due to replacement of lactobacilli by mixed anaerobes). Cottage cheese, thick, creamy discharge, pruritis, superficial dyspareunia (versus deep dyspareunia in PID)? Candidiasis, treated with clotrimazole pessaries or oral fluconazole which is contraindicated in pregnancy and breastfeeding. N.B. Candidiasis will only be treated if the patient is symptomatic, as a lot of women are carriers. THERE IS NO NEED TO TREAT PARTNER. How do we diagnose and treat STIs caused by chlamydia? Diagnosed with appropriate swabs sent for NAAT, treated with doxycycline OR azithromycin if allergic/pregnant/breastfeeding.