Contraception, Infertility, genital infections and STI

Question 1

what types of combined hormonal contraception exist?

Answer 1

pill
patch
ring

Question 2

what types of progesterone only contraception exist?

Answer 2

mini-pill
implant
injection

Question 3

what intrauterine contraception devices are there?

Answer 3

copper coil

hormonal coil

Question 4

name some side effects of combined hormonal contraception

Answer 4

• headaches
• nausea
• breast tenderness
• mood swings

Question 5

what does combined hormonal contraception put women at more risk of?

Answer 5

• venous and arterial thrombosis
• liver/gallbladder damage if underlying disease
• slightly higher risk of certain cancers (cervical, breast)

Question 6

what is the mechanism of action of combined hormonal contraception?

Answer 6

maintain low levels of hormone causing a negative feedback to pituitary/hypothalamus
no ovulation as result

Question 7

name a few benefits of the combined pill

Answer 7

• reduces heavy bleeding
• hormonal control (acne, hirsutism)
• reduces certain cancers (ovarian, endometrial, colon)
• reduces RA, osteoporosis

Question 8

name some side effects of progestogen only contraception methods

Answer 8

• increased appetite
• weight gain
• headache
• acne
• mood changes
• bloatedness
• hair changes

Question 9

what is the mechanism of action of progestogen contraception?

Answer 9

reduces ovulation

thickens cervical mucus

Question 10

what are the two types of intrauterine contraception devices?

Answer 10

• copper (non hormonal) coil

- hormonal coil

Question 11

how long after UPSI can the Levonorgestrel pill (Levonelle) be taken?

Answer 11

72 hours

Question 12

how long after UPSI can the ulipristal pill (Ellaone)

Answer 12

120 hours

Question 13

what is the incidence of pregnancy after taking emergency contraception measures?

Answer 13

0-2%

Question 14

what is the most effective option for emergency contraception, and when can it be taken?

Answer 14

copper coil

• 120 hrs after UPSI
• by day 19 of 28 day cycle

Question 15

how does the copper coil promote contraception?

Answer 15

copper is toxic to sperm
can stop fertilisation of egg
can stop implantation of egg

Question 16

which type of progestogen only contraception has a direct causal side effects, and what are the side effects?

Answer 16

progestogen injection

• weight gain
• delayed return of fertility
• reduced bone density

Question 17

what is an important downside to choosing progestogen injections for contraception?

Answer 17

it can delay return of fertility for about 9 months

Question 18

what is the window of gestation during which medical termination of pregnancy can be carried out?

Answer 18

week 5 to 24

Question 19

what is the window of gestation during which surgical termination of pregnancy can be carried out?

Answer 19

week 5 to 12

Question 20

how is medical termination of pregnancy carried out?

Answer 20

• mifepristone (antiprogesterone) is given to stop its effect on endometrium
• 36-48 hours later misoprostol (prostaglandin) is given to induce uterine contractions

Question 21

how is surgical termination of pregnancy carried out?

Answer 21

misoprostol (prostaglandin) given to initiate uterine contractions, under local or general anaesthetic

Question 22

what is the contraception option for males?

Answer 22

vasectomy

Question 23

what are the sterilisation options for women?

Answer 23

sterilisation:

• tube clipping
• salpingectomy

Question 24

how long after delivery, miscarriage or abortion can a woman get pregnant again?

Answer 24

21 days after delivery

5 days after miscarriage/abortion

Question 25

which type of contraception is progestogen only but doesn't stop ovulation?

Answer 25

levonorgestrel (hormonal) coil

Question 26

levonorgestrel is used in which types of contraception?

Answer 26

hormonal coil and emergency contraception pill

Question 27

if a woman starts contraception at any given point of her cycle, when will she be covered?

Answer 27

after 7 days

Question 28

if a woman starts contracaeption within first few days of her cycle, when will she be covered?

Answer 28

immediately

Question 29

what is the legal document that describes the guidelines for termination of pregnancy?

Answer 29

1967 Abortion Act

Question 30

who is eligible for home abortion?

Answer 30

healthy women who are under 10 weeks gestation

Question 31

name a few possible symptoms that can present in genital infections

Answer 31

- ulcers - rashes - discharge - pain - lumps - dysuria - itch

Question 32

if symptomatic, what is vulvovaginal candidosis called?

Answer 32

thrush

Question 33

what are typical symptoms of vulvovaginal candidosis?

Answer 33

thick "cottage cheese" discharge | itch

Question 34

what causes vulvovaginal candidosis?

Answer 34

candida albicans

Question 35

what investigations are done to diagnose vulvovaginal candidosis?

Answer 35

microscopy and culture

Question 36

how is vulvovaginal candidosis treated?

Answer 36

antifungals (azoles): | clotrimazole or fluconazole

Question 37

what kind of discharge is seen in bacterial vaginosis?

Answer 37

thin, grey/white discharge

Question 38

how is bacterial vaginosis treated?

Answer 38

metronidazole | clindamycin

Question 39

how is ovulation assessment carried out in an infertility clinic?

Answer 39

serum progesterone measured halfway through luteal phase of cycle

Question 40

if ovulation assessment needs to be carried out for a woman with irregular periods, what test is carried out instead of serum progesterone?

Answer 40

- serum gonadotrophins (FSH and LH) - prolactin - testosterone - TSH

Question 41

what type of imaging is carried out in an infertility clinic to assess for fallopian tube occlusion?

Answer 41

HyCoSy - hysterosalpingo contrast sonography

Question 42

what investigations are carried out in women who have been referred to the infertility clinic?

Answer 42

- abdominal/pelvic exam - rubella immunity - STI (chlamidia) screen - ovulation assessment

Question 43

what investigations are carried out in men who have been referred to the infertility clinic?

Answer 43

- abdominal/inguinal/genital exam | - semen testing

Question 44

if a couple presents to the GP because they are struggling to conceive, how long should they keep trying until they are referred to the infertility clinic?

Answer 44

one year, unless there are signs that point to infertility

Question 45

what are the three groups of ovulatory disorders?

Answer 45

Group 1: hypothalamic-pituitary dysfunction Group 2: hypothalamic-pituitary-ovarian dysfunction Group 3: primary ovarian insufficiency

Question 46

how are women with Group 1 ovulatory disorder managed?

Answer 46

- advice on BMI, intense exercise, stress reduction | - gonadotrophins/gonadotrophin releasing hormone agonist

Question 47

what group of ovulatory disorders does PCOS belong to?

Answer 47

Group 2

Question 48

what group of ovulatory disorders does primary ovarian insufficiency belong to?

Answer 48

Group 3

Question 49

what medications are used to help induce ovulation in women with ovulatory disorders?

Answer 49

- clomifene - gonadotrophins - gonadotrophin-releasing hormone

Question 50

what is the drug clomifene used for, and what is its mechanism of action?

Answer 50

it's used to induce ovulation, by blocking oestrogen receptors in the pituitary and promoting FSH and LH release

Question 51

when are gonadotrophins given to a woman with an ovulatory disorder?

Answer 51

when clomifene has not resulted in ovulation/pregnancy

Question 52

what is the main disadvantage of using gonadotrophins in ovulatory disorders?

Answer 52

- high risk of multifollicular recruitment | - increased risk of ovarian hyperstimulation syndrome

Question 53

what genetic condition can result in azoospermia, infertility and small testicles?

Answer 53

Klinefelter's syndrome

Question 54

what investigations are done to identify the cause of azoospermia in a man?

Answer 54

- FSH/LH/testosterone/prolactin - karyotype for Klinefelter's syndrome - CF screen

Question 55

how long should women with unexplained infertility keep trying to conceive before they can receive fertility treatment?

Answer 55

2 years

Question 56

can women with unexplained infertility get clomifene to help them ovulate?

Answer 56

no

Question 57

what is a tubal cause of infertility in women?

Answer 57

hydrosalpinx

Question 58

what is the difference between IVF and ICSI?

Answer 58

in IVF egg and sperm fertilise on their own | in ICSI one sperm is injected directly into the egg with a needle

Question 59

what is the difference between Gillick competence and Fraser guideline?

Answer 59

Gillick competence is used to assess the capacity of a person under 16 years of age regarding any medical decision Fraser guideline is specific for girls under 16 who seek contraception