Clinical- Week 2 Flashcards
1
Q
how many medical practitioners need to be of the opinion that am abortion is justified for it to be lawful? (HSA1 form)
A
2 (unless emergency)
2
Q
how many hours after an emergency abortion should the HSA2 form be filled out?
A
24 hours
3
Q
how many days after an abortion must the HSA4 form be sent to the chief medial officer?
A
7 days
4
Q
in NHS tayside, up until what gestation is termination of pregnancy done?
A
18 weeks and 6 days
5
Q
what is the legal limit for social termination of pregnancy?
A
23 weeks 6 days
6
Q
what is the legal limit for termination of a fetus with an anomaly?
A
any gestation
7
Q
for medical termination of pregnancy, what classes as early, late and mid-trimester?
A
early- less then 9 weeks
late- 9- 12 weeks
mid-trimester- 12-24 weeks
8
Q
what is the drug treatment for a medical termination of pregnancy?
A
- oral mifepristone
2. vaginal (or oral) prostaglandin eg misoprostol
9
Q
what is different about the early and late/mid-trimester of termination of pregnancy?
A
early: stage 2 can be done at home
late/mid-trimester: stage 2 done in hospital, need repeated doses every 3 hours
10
Q
in medical termination of pregnancy, how long after stage 1 does stage 2 occur?
A
24-48 hours
11
Q
in the medical termination of a late/mid-trimester pregnancy, what is max number of prostaglandin (misoprostol) doses that can be given?
A
5 doses
12
Q
if medical termination pregnancy fails, what is the next step?
A
surgical termination of pregnancy
13
Q
what are the 2 methods of surgical termination? at what gestation weeks are they done?
A
- vacuum aspiration (MVA) from 6-12 weeks
- dilatation and evacuation from 13-24 weeks
14
Q
before surgical termination of pregnancy, what drug is given and why?
A
vaginal prostaglandin to prime cervix
15
Q
what is MVA?
A
manual vacuum aspiration
16
Q
in terms of anaesthetic what is different about manual vacuum aspiration to electric vacuum aspiration?
A
manual- local
electric- general
17
Q
what are the 3 methods of emergency contraception?
A
- levonelle (3 days after UPSI)
- ellaOne (Ulipistral acetate) (5 days after UPSI)
- copper IUD (5 days after UPSI conception)
18
Q
what drugs may interact with levonelle?
A
enzyme inducers
19
Q
what drugs may interact with ellaOne?
A
antacids
20
Q
when should a urine pregnancy test be performed after emergency contraception?
A
at 3 weeks
21
Q
what is LARC and VLARC?
A
LARC- long acting reversible contraception
VLARC- very long acting reversible contraception
22
Q
in the luteal phase of the menstrual cycle, what is the difference in body temperature?
A
greater than 0.2 degrees C
23
Q
what is the post ovulation mucous like?
A
thick and sticky
24
Q
compare the cervix when fertile and less fertile?
A
fertile- high in vagina, soft and open
less fertile- low in vagina, firm and closed
25
in a standard 28 day cycle, which days are most fertile?
8 to 18
26
what criteria need to be met for breast feeding to be effective contraception?
- exclusively breast feeding
- less than 6 months post natal
- amenorrhoeic
27
what is UK MEC?
UK medical eligibility criteria for contraception
28
what does UK MEC category 1 mean?
1. no restriction for the use of the contraception method
29
what does UK MEC category 2 mean?
2. advantage of this contraception method outweigh the risks
30
what does UK MEC category 3 mean?
3. risks of this contraception outweigh the advantages, still can use if nothing else is suitable
31
what does UK MEC category 4 mean?
4. unacceptable risk of this contraceptive method
32
what is the pearl index?
number of contraceptive failures per 100 women users per year
33
what are the 2 types of long-acting reversible contracpetion?
-depo provera IM
-sayana press SC
(progesterone depots)
34
what are the 3 types of very long-acting reversible contracpetion?
IUD
IUS
Implant
35
how do progesterone depots work?
inhibits ovulation
| also effects on cervical mucus and endometrium
36
how often are progesterone depots given?
every 13 weeks
37
when do you start the depot in the menstrual cycle?
-up to and including day 5
(no need for extra contraception)
-beyond day 5 if reasonably certain she is not pregnant plus use condoms for 7 days
38
how long can sperm survive in the genital tract for?
7 days once passed the cervix
39
how can someone be reasonably certain they are not pregnant?
- no sex since last period
- consistently using reliable contraception
- less than 7 days since last normal period
- less than 4 weeks post partum (not breast feeding)
- breastfeeding as contraception
- neg pregnancy test and greater then 3 weeks since UPSI
40
post partum, up to what day can you start the progesterone depot for immediate cover?
up to day 21
41
post TOP, up to what day can you start the progesterone depot for immediate cover?
up to day 5
42
if the patient is amenorrhoeic, when can you start the progesterone depot?
negative pregnancy and greater than 3 weeks since UPSI
43
if pregnancy cannot be excluded, for example after EC, when can you start the progesterone depot?
do pregnancy test in 3 weeks and give depo thereafter
44
what are the 4 main risks of progesterone depot?
weight gain
delay in return of fertility
irregular bleeding
possible risk of osteoporosis
45
what is the intra-uterine device?
copper coil
46
what is the primary mode of IUD action?
prevention of fertilisation
| also prevents implantation
47
in addition to contraception, what is the mirena additionally licensed for?
menorrhagia and HRT
| -some other IUS are not
48
what is the mirena?
intra-uterine system
| plastic device with progesterone
49
what is the primary mode of IUS?
prevents implantation
| also thickend cervical mucous
50
when can an IUD be fitted for immediate cover?
- within 7 days of a period
| - any time provided reasonably certain not pregnant
51
after TOP when can you fit an IUD?
immediately
52
post-partum, when can you fit an IUD?
within 48 hours or greater than 4 weeks
53
when can an IUS be fitted for immediate cover?
- within 7 days of a period
| - any time provided reasonably certain not pregnant (plus use condoms for a week)
54
after TOP when can you fit an IUS?
immediately (up to day 7)
55
post-partum, when can you fit an IUS?
within 48 hours or greater than 4 weeks
56
what are the 6 main side effects of IUD?
- heavy, prolonged menses
- pain
- perforation
- explusion
- infection (first 20 days after insertion)
- ectopic risk
57
what does IUS do to periods?
lighter, less frequent bleeding
58
what does IUD do to periods?
heavy, prolonged menses
59
what are the 5 main side effects of IUS?
- pain
- infection (first 20 days)
- expulsion
- perforation
- ectopic risk
60
where is the implant placed?
over biceps/triceps
61
how long is the implant licensed for?
3 years
62
what is the drug within the implant?
68mg ENG
63
what is the primary mode of action in the implant?
inhibition of ovulation
64
when can the the implant be fitted?
- within 5 days of cycle for immediate protection
| - any time if reasonably certain she is not pregnant (7 days condom use)
65
post patrum when can the implant be fitted for immediate protection?
up to day 21
66
when can the implant be fitted after TOP?
up to day 5
67
when switching from another contraceptive method to implant, what should you do?
immediate protection if switched from combined hormonal contracption or depot (ie methods that prevent ovulation)
additional 7 days protection if progesterone only pill or IUS or non-hormonal method (ie methods that dont prevent ovulation)
68
what are the 3 main side effects of the implant?
irregular bleeding
weight gain
acne
69
what are the 2 main side effects of fitting the implant?
nerve/vascular damage
| deep insertion
70
what is the primary mode of action for combined hormonal contraception?
inhibit ovulation
| also alters cervical mucous and thins endometrium
71
what is the maximum weight for using the combined transdermal patch?
90kg
72
with the combined OCP, what do the first 7 pills do and what do the next 14 pills do?
first 7- inhibit ovulation
| next 14- maintain anovulation
73
with the combined OCP, after how many omitted pills may follicular activity resume?
after 9 pills (remember there are 7 pill free days during pill-free week)
74
how do you used the contraceptive transdermal patch?
changed weekly for 3 weeks
| patch free week for withdrawal bleed
75
how do you used the contraceptive vaginal ring?
placed in vagina and left continuously for 21 days
| ring free week for withdrawal bleed
76
with the combined OCP, what should you do if you have missed one pill or if you have started the pack one late?
- take the last pill you have missed immediately
- continue taking rest as normal
- consider EC if pills have been missed earlier in the pack or in the last week of the previous pack
77
with the combined OCP, what should you of if you have missed 2 or more pills or have started the new pack 2 or more days late?
- take the last pill you missed now (leave earlier pills)
- use additional contraception for 7 days
- if you have had UPSI in the previous 7 days you may need EC (esp if in day 1-7 of cycle)
- if you have seven more pill days, take them as normal
- if you have less than seven more pills, finish pack and miss the break
78
what are the main 3 risks of combined hormonal contraception?
- venous thrombosis
- arterial thrombosis
- adverse effects of some cancers
79
what is the UKMEC risk factors for venous thrombo-embolism when using combined hormonal contraception?
- obesity
- smoking
- age
- known thrombophilia
- VTE in first degree relative before 45 years old
- up to 6 weeks postnatal
80
how often should you check the BP of someone on COCP?
3 months initially
| then annually
81
why is COCP contraindicated in someone with migraine with aura?
increases risk of ishaemic stroke
82
if you are aged over 35 years, CHC is what category of UKMEC?
category 2
83
if you have a family history of breast cancer, CHC is what category of UKMEC?
category 1
84
if you have the BRACA gene, CHC is what category of UKMEC?
category 3
85
if you are breast feeding from 0-6 weeks, CHC is what category of UKMEC?
category 4
86
why shouldn't you change the COCP before 3 months for irregular bleeding?
usually settles with time
87
where is the one place you shouldnt place the contraceptive transdermal patch?
breasts
88
when can the COCP be started?
- up to day 5 for immediate protection
| - beyond day 5 provided she is reasonable certain she is not pregnant, use condoms for 7 days
89
why should you avoid starting hormonal contraception for 5 days after ellaOne contraception?
interferes with the action of ulipristal acetate
90
when can you start CHC after TOP?
as soon as possible
91
what is a UKMEC 4 contraindication to the progesterone only pill?
current breast cancer
92
what contraception options are there for patients on liver enzyme enducers such as anti-epileptics?
progesterone depot
IUS
IUD
93
when using the POP what do you do if you miss one pill and have UPSI?
emergency contraception plus 2 days extra protection
94
what is the life-expectancy of someone living with HIV?
normal (possibly even longer)
95
compare HIV 1 and HIV 2 in terms of virulence?
HIV 2 is less virulent
96
what is the HIV type which is responsible for the global pandemic?
HIV-1 group M
97
what receptors are the target site for HIV?
CD4+ receptors
98
what cells are CD4+ receptors found on?
T helper lymphocytes (CD4 cells)
dendritic cels
macrophages
microglial cells
99
what happens to the levels of CD4 and CD8 cells in untreated HIV?
CD4 levels decrease
| CD8 levels increase
100
what are the 4 groups of micro-organisms which patients with HIV are more susceptible to?
- viral infections
- fungal infections
- mycobacterial infections
- infection-induced cancers
101
what is the normal CD4 Th cell parameter?
500 - 1600 cells/mm3
102
at what level of CD4 Th cell is there a risk of AIDS-related complications and opportunistic infections?
<200 cells/mm3
103
what is the average time from infection to death of a patient living with HIV without treatment?
9-11 years
104
how long does it take from infection for HIV to become established?
72 hours
105
within the first 72 hours of HIV exposure, what can be given to prevent HIV infection becoming established?
post-exposure prophylaxis
106
what is an opportunistic infection?
an infection caused by a pathogen that does not normally produce disease in a healthy immunocompetent individual
107
what pneumonia is caused by an opportunistic infection and seen commonly in patients with low CD4 levels?
pneumocystis pneumonia (PCP)
108
what organism causes pneumocystis pneumonia?
pneumocystis jiroveci
109
what is the CD4 threshold for being at risk of pneumocystis pneumonia?
<200 CD4 cells/mm3
110
describe the cough of pneumocystis pneumonia?
dry cough
111
how do we diagnose pneumocystis pneumonia?
bronchoalveolar lavage and immunofluorescence
112
what is the treatment of pneumocystis pneumonia?
high dose co-trimoxazole (+/- steroid)
113
for patients with a CD4 count of less than 200 cells/mm3, what prophylaxis for pneumocystis pneumonia do we offer them?
low dose co-trimoxazole
114
even though chlamydia doesnt gram stain, what gram stain is it usually said to be?
gram neg
115
what is the term for pain during sex?
dyspareunia
116
chlamydia accounts for what percentage of PID cases?
50%
117
what is Fitz Hugh Curtis Syndrome?
a perihepetitis, liver capsue becomes inflamed and adhesions form
(a complication of PID)
118
how long should you wait following exposure for chlamydia to test?
14 days
119
what is the treatment for chalmydia?
azithromycin 1G stat
or
doxycycline 100mg BD for 1 week
120
what is the incubation period of gonorrhoea urethral infection in men?
2-5 days
121
which genital infection sheds more- HSV1 or HSV2?
HSV 2
122
what is the incubation period of genital herpes?
3-6 days
123
how long does the primary genital herpes infection last for?
2 - 3 weeks
124
are recurrent episodes of HSV more common with type 1 or 2?
type 2
125
how long does a recurrent episode of genital herpe infection last?
1 week
126
what is the management of genital herpes?
PO aciclovir
topical lidocaine 5% ointment if very painful
saline bathing
analgesia
127
what is the treatment for HPV?
- Podophyllotoxin
- imiquimod
- cryotherapy
- electrocautery
128
when in the course of acquired syphilis does it become non-infectious?
late latent phase
129
what is the incubation period of primary syphilis?
up to 90 days (usually 3 weeks)
130
what is the incubation period of secondary syphilis?
up to 6 months
131
what is a condylomata lata?
a highly infectious wart like lesion found on the genitals (found in syphilis)
132
what vaccination do you give to any women with a recent rape?
HBV vaccination
133
how many hours before sex do you put a diaphragm in? how many hours after sex should it stay in for?
4 hours before
| 6 hours after
134
what disease in the eyes does CMV cause?
retinitis
135
what can toxoplasma gondii cause in the brain?
multiple cerebral abscess (chorioretinitis)
136
why is there ophthalmic screening for all individuals with a CD4 count below 50 cells/mm3?
to look for CMV retinitis
137
what does JC virus cause in HIV patients with CD4 counts under 100?
progressive multifocal leukoencephalopathy
138
what 4 factors are the cause for HIV-associated wasting?
- metabolic factors
- anorexia
- malabsorption/diarrhoea
- hypogonadism
139
what organism causes Kaposi's sarcoma?
human herpes virus 8 (HHV 8)
140
what organism causes non-hodgkins lymphoma?
EBV
141
how often are are women living with HIV screened for cervical cancer compared with women without HIV?
every year compared to every three
142
why does psoriasis get worse in patients with HIV?
due to overproduction of CD8+ cells
143
what 4 factors increase sexual transmission risk of HIV?
- anoreceptive sex
- trauma
- genital ulceration
- concurrent STI
144
how do you test for HIV?
combine antibody and antigen (p24) serology
145
how long is the window period between HIV entering the body and becoming detectable on serology?
4 weeks
146
at what CD4 count do you get AIDS-related complications?
<200 cells/mm3
147
what is the treatment of rectal chlamydia?
doxycycline 100mg BD for 7 days
148
does HIV contain RNA or DNA?
RNA
149
what is HAART?
highly active anti-retroviral therapy
| -a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible
150
what do liver enyzme inhibitors do to the efficacy of a drug?
make it more effective
151
what do liver enzyme inducers do to the efficacy of a drug?
make it less effective
152
are protease inhibitors used for anti-viral therapy for HIV liver enzyme inhibitors or inducers?
liver enzyme inhibitors
153
are NNRTIs used for anti-viral therapy for HIV liver enzyme inhibitors or inducers?
liver enzyme inducers
154
how often do people living with HIV get a blood test?
every 6 months
155
compare how child is delivered for a mother living with HIV with an undetectable viral load compared to a detectable viral load?
undetectable- vaginal delivery
| detectable- C section
156
how long must a neonate born to a mum with HIV be put on post-exposure prophylaxis for?
4 weeks
