COUNSELLING FOR OSCE

Question 1

EMERGENCY CONTRACEPTION

Answer 1

To reduce the likelihood of pregnancy occurring.

THREE TYPES AVAILABLE

Levonelle
–> within 3 days of UPSI
–> will not work after ovulation

EllaOne
–> single tablet within 5 days of UPSI
–> will not work after ovulation

Copper IUD
–> within 5 days of UPSI
–> within 5 days of expected ovulation date
–> 10 years!
–> 99% effective

**Advantages & Disadvantages **
Levonelle
Advantages –> safe, can start immediately
Disadvantages –> N&V, next period might be early or late, shortest window

EllaOne
Advantages –> safe, within 5 days
Disadvantages –> N&V

Copper IUD
Advantages –> most effective
Disadvantages –> procedure for insertion, small risk of infection

FOLLOW UP

ACCESSING EMERGENCY CONTRACEPTION

STI SCREENING

ONGOING CONTRACEPTION

Question 2

CLOZAPINE

Answer 2

What is clozapine

• antipsychotic medication
• help reduce symptoms of schizophrenia (hallucinations, paranoia or delusions)
• blocks dopamine!
• we think too much dopamine causes symptoms of schizophrenia
• treatment resistance (to other forms have failed)

Preparation

• can be tablet or liquid
• start at low dose, gradually increasing over several weeks
• important not to miss any doses

MONITORING
- establish baseline: weight and height, ECG, blood tests
- infection: WBC

Side effects
- hypersalivation
- may increase risk of getting seizures
- infection
- constipation

SAFETY NETTING
- keep an eye out for symptoms such as sore throat, high temperature and chest infections
- don’t stop clozapine suddenly of let doctors know if you do

MISSED DOSE
- take as soon as remember
- if in time for next dose don’t double up
- if 2 or more doses missed will need to let doc know

SUMMARISE BACK NOW

Question 3

MENTAL HEALTH ACT

Answer 3

WHAT IS SECTIONING
- patient involuntarily admitted to hospital due to concern that mental health condition is putting them at risk of harm
- last resort
- requires 2 doctors and a person called an approved mental health practioner AMHP
- patients will be given medication even if they refuse
- try to encourage and collaboratively work with patients about any changes for their treatment first

Question 4

FEBRILE SEIZURES

Answer 4

How common
- common –> 3% of children

NOTES
- 6 months to 3 years
- occur due to high temperatures kids can get when they’re sick
- usually harmless although frightening to watch
- most children make full recovery
- reassure patients they have done the right thing by coming in

SAFETY NET
- if child lasts longer than 5 minutes call for help
- can give some medication to keep at home if patient gets another one

FIRST AID
- recovery position (leaflet)
- avoid putting anything in their mouth
- time the seizure
- call an ambulance if longer than 5 mins
- of if concerns about breathing

Management
- benzodiazepine to stop them at home
- 1/3rd risk during different illness

SUMMARISE BACK THE KEY POINTS

Question 5

LITHIUM COUNSELLING

Answer 5

What do you understand about bipolar disorder?

LITHIUM KNOWLEDGE
- mood stabilising drug
- can help with depressive (low) and manic (high) episodes

TAKING LITHIUM
- one tablet a day with lots of water
- take at night same time of day
- don’t stop suddenly or change dose
- if miss dose , take next one as normal don’t double up

LITHIUM PURPLE RECORD BOOK
- to keep track of blood results
- keep with you and bring to appointments

Tests and monitoring
- regular blood tests
- 12 hours after last dose
- at the start blood lithium once a week
- once at optimal level then once a month
- then once every 3 months if results are good
- calcium, thyroid and kidney function twice a year
- reviews with psychiatric team

SIDE EFFECTS
- increased thirst
- going to toilet more
- tiredness
- weight gain
- tremor

LITHIUM TOXICITY
- confusion
- drowsiness
- visual disturbances
- loss of appetite
- difficulty speaking
- seizures
————> MEDICAL ATTENTION

Question 6

MIGRAINES

Answer 6

What are migraines
- type of primary headache (no underlying medical condition)
- nausea, photophobia, phonophobia
- aura?

TRIGGERS
- lack of sleep
- hormone changes
- foods (cheese, chocolate)

MANAGEMENT
- cut out triggers
- nausea –> antiemetics?
- several migraines within a month: frequent

PREVENTION
–> propranolol
–> topiramate (avoid in pregnancy)

Complications
- small risk of ischaemic stroke
- disabling in performing normal activities

Question 7

List 5 examples of atypical antipsychotics

Answer 7

• clozapine
• olanzapine
• risperidone
• quetiapine
• aripiprazole

Question 8

Risk factors for developing schizophrenia

Answer 8

• family history
• pregnancy
• drug abuse
• social and environment: lower socioeconomic classes

Question 9

OLANZAPINE

Answer 9

• antipsychotic
• works to reduce symptoms of
• schizophrenia: hallucinations, paranoia or delusions
• tablet or infection

MONITORING
- baseline tests: ECG, weight and height, blood tests

SIDE EFFECTS
- sedation, weight gain, drowsiness, dizziness, constipation, dry mouth, high blood sugar

DOSING
- gradually increases
- will take a while to work before you feel effects
- try the lowest possible dose to avoid side effects

Question 10

How is chlamydia diagnosed?

Answer 10

Nucleic acid amplification test (NAAT)
- urinalysis in men
- vulvovaginal swabs in women

Question 11

Why should pregnant women with chlamydia not be treated with doxy and what alternative is there?

Answer 11

• doxy contraindicated due to effects on foetal skeletal development
• AZITHROMYCIN