Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Genitourinary Medicine > Flashcards

Genitourinary Medicine Flashcards

1
Q

Which bacteria are essential to controlling the vaginal pH?

A

Lactobacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiology of bacterial vaginosis?

A

Reduced lactobacilli = reduced lactic acid = increased pH = anaerobic bacteria multiply e.g. G vaginalis / M hominids/ Prevotella sp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give the risk factors for bacterial vaginosis.

A 
Multiple sexual partners
Excessive vaginal cleaning 
Recent ABX
Smoking 
Copper coil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical features of bacterial vaginosis?

A

Asymptomatic

Vaginal odour: fishy (due to amines)
White/grey vaginal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clue cells are pathognomonic of?

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which criteria can be used to make a diagnosis of Bacterial Vaginosis?

A 
Amsel Criteria (3/4):
pH > 4.5 
White/grey discharge 
Fishy odour 
Clue cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management for Bacterial vaginosis?

A

Metronidazole PO 400mg BDS 5-7 days

Can use throughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of Bacterial vaginosis?

A

Gardnerella vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the gold standard investigation in Bacterial vaginosis?

A

Vaginal swab and microscopy + gram-stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What pathogen is the cause for vaginal candidiasis?

A

C albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How may genital thrush be classified?

A

Uncomplicated: simple, single cause and no other comorbidities

Complicated: recurrent (≥4 episodes); severe infection; major co-morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 RFs for Vulvovaginal candidiasis

A

Poorly controlled diabetes

Immunocompromised

Local irritants

Broad-spectrum ABX

Sexual activity

HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of vulvovaginal candidiasis?

A

Non-malodorous, thick and white vaginal discharge
Vaginal itching
Vaginal soreness

Vulvovaginal irritation
Vaginal fissuring
Excoriation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is VV Candidiasis managed?

A

Uncomplicated
Intra-vaginal Clotrimazole 10% single dose

Complicated
Fluconazole PO 150mg BDS for 2/7 (3 days apart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient has VV Candidiasis refractory to treatment within 7-14 days, what is your next steps?

A 
Confirm Tx course and adherence
\+ 
Reassess RF
\+ 
Consider alternative diagnosis 
\+
Consider treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A patient is on their 4th episode of thrush this year. How would you manage them?

A

Supportive: RF modification
+
Medical: Oral Fluconazole 14/7 (induction) + Oral Fluconazole for 6/12 (maintenance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which pathogen causes Trichomonas?

A

Trichomonas vaginalis - a protozoa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the clinical features of Trichomonas?

A

Malodorous, frothy green-yellow discharge
Vulval itchiness

Inflammation of the vulva/glans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What investigations should be conducted in a patient with potential Trichomonas infection?

A

Cervical inspection

Vaginal swab

Microscopy

NAAT

Culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management for Trichomonas?

A

Metronidazole PO 400mg BDS for 5/7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what pathogen causes Chlamydia?

A

Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the gold-standard test for Chlamydia?

A

NAAT

VVS (F)

FCU (M)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which serovars of Chlamydia cause Trachoma?

A

A-C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which serovars of Chlamydia cause LGV?

A

L1-L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which serovars of Chlamydia cause Urogenital infection?

A

D-K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the clinical features of Chlamydia?

A

Majority (75% F cf 50% M) are asymptomatic

If symptoms: 
Vaginal/ Urethral discharge
Post-coital bleeding 
Intermenstrual bleeding 
Dysuria 
Lower abdominal pain
Deep dyspareunia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the complications of Chlamydia?

A

Tubo-ovarian abscess
Fitz-Hugh-Curtis Syndrome

Infertility
Ectopic pregnancy
Chronic pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the clinical features of Fitz-Hugh-Curtis Syndrome?

A

Complication of PID due to Chlamydia/Gonorrhoeal infection featuring RUQ due to pelvic adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the management of Chlamydia?

A

Doxycycline 200mg STAT then 100mg PO OD 7/7
+
Ceftriaxone IM 1g STAT

+
Test of cure 4 weeks later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which conditions cause genital ulcers?

A 
Syphilis 
HSV
HPV 
Granuloma inguinale 
LGV
Chancroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which patient group is Lymphgranuloma venereum more prevalent amongst?

A

MSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 3 stages of infection of LGV?

A

Primary: Painless papule/pustule or ulcer

Secondary: Regional lymphadenopathy (femoral/inguinal) days to weeks after primary lesion with lymphadenitis become confluent to form a buboe

Tertiary: Recover OR chronic anogenital infection which causes proctocolitis, fistulae, strictures or fibrotic areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the clinical features of LGV?

A

Two areas affected - the genitals + the anus

Painless pustule/papule/ulcer

Rectal pain
Rectal bleeding
Rectal discharge
Tenesmus

Lymphadenopathy
Lymphadenitis
Buboes
Groove sign (inguinal and femoral lymphadenopathy separated by inguinal ligament) 
Systemic upset

Proctitis
Fistulae
Strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What conditions is Groove sign seen in and how is it caused?

A

LGV due to lymphadenopathy of femoral and inguinal regions which is separated by the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is LGV diagnosed?

A

Swab + NAAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is LGV managed?

A

Supportive: Avoid sexual contact + trace testing (4 weeks of symptoms or 3 months of asymptomatic carriage)
+
Medical: Doxycycline 100mg PO 3/52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the complications of LGV?

A

Lymphoedema
Fistulae formation
Strictures
Disfiguring fibrotic scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which organism causes Gonorrhoea?

A

Neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the morphology of N gonorrhoea?

A

Gram negative diplococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What proportion of gonorrhoea infections cause disseminated infection?

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the complications of Gonorrhoea?

A 
Septic arthritis 
Meningitis 
Reiter's Syndrome
Conjunctivitis 
Endocarditis 
PID
Tubal infertility
Ectopic pregnancy 
Chronic pelvic pain
Fitz-Hugh-Curtis Syndrome

Prostatitis
Epididymo-orchitis
PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the clinical features of Gonorrhoea infection?

A

Urethral discharge (M > F) - mucopurulent discharge

Cervicitis - and vaginal discharge

Lower abdominal pain
Dysuria
Testicular pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the gold-standard test for Gonorrhoea?

A

NAAT - urethral swabs (M) and VVS (F)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the management of Gonorrhoea?

A

Supportive: Contact tracing 3/12; Stop sexual contact until 7 days post-treatment; Test of cure 1/12
+
Medical: Ceftriaxone IM 1g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which pathogen causes Syphilis?

A

T pallidum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the clinical features of Syphilis?

A

Primary features:

  • Chancre (painless ulcer)
  • Local, non-tender lymphadenopathy

Secondary features:

  • Fever
  • Lymphadenopathy
  • Rash on trunk and volar surfaces
  • Buccal snail track ulcers
  • Condylomata lata (painless, warty lesions on genitalia)

Tertiary features:

  • Gummas (granulomatous lesions of skin and bone)
  • Ascending aortic aneurysms
  • Tabes dorsalis
  • Argyll-Robertson pupil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the clinical features of congenital syphilis?

A

Deafness
Saddle nose
Rhagades (linear scars at angle of mouth)
Keratitis
Blunted upper incisor teeth (Hutchinson’s teeth)
Mulberry molars
Clutton’s joints (symmetrical joint swelling - e.g. knees)
Saber shins (tibial bowing from chronic inflammation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is Latent Syphilis?

A

An asymptomatic period in which there is serological evidence of infection but no symptoms

1) Early latent syphilis = <2 years from infection
2) Late latent syphilis =>2 years from infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

In which condition is an Argyll-Robertson pupil seen?

Outline what is seen.

A

Neurosyphilis - constricted pupil accommodates when focusing to nearby object but does not react to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How is Syphilis diagnosed?

A

Ab test - Serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is Syphilis managed?

A

IM Benzathine benzylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is a Jarisch-Herxheimer reaction?

A

Acute febrile illness presenting in first 24 hours of Syphilis treatment with headache, myalgia, chills and rigors.

Reaction occurs following initial dose of anti-treponemal treatment.

Occurs in 10-35% patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How do you manage a Jarisch-Herxheimer reaction?

A

NSAIDs
+
Prednisolone PO 40-60mg 3/7 (after first dose of anti-treponemal ABx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which bacterium causes Granuloma inguinale?

A

Klebsiella granulomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the clinical features of Granuloma inguinale?

A

Painless papule/nodule with beefy red appearance (high vascularity) in the genital or inguinal region

Papule/Nodule develop an ulcerated appearance - ulcerate from the middle with friable, raised and rolled margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How is Granuloma inguinale diagnosed?

A

Clinically, due to lack of resources in endemic regions

PCR with Donovan bodies seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How is Granuloma inguinale managed?

A

Azithromycin 1g PO weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the complications of Granuloma Inguinale?

A 
Malignant change - e.g. Squamous Cell Carcinoma 
Lymphoedema 
Haematogenous spread
Polyarthritis 
Osteomyelitis 
Stenosis (anus/vagina)
Mental Health Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which pathogen causes Chancroid?

A

Haemophilus ducreyi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the clinical presentation of Chancroid?

A

Multiple painful papules which become ulcers

Lymphadenopathy

Buboe (infected, painful lymphadenitis, ulcerating and becoming supportive

61
Q

How is Chancroid diagnosed?

A

Swab + NAAT

Microscopy - gram negative coccobacili

62
Q

What is the management for Chancroid?

A

Azithromycin PO 1mg STAT

63
Q

Which pathogen causes Pediculosis pubis?

A

Phthirus pubis (crab louse)

Pediculosis humanus capitis

Pediculosis humanus corporis

64
Q

What are the clinical features of Pediculosis pubis?

A

Pruritus
Visible lice

Small blue macules - prolonged infestation and injection of natural anticoagulant from live saliva

65
Q

How is diagnosis of Pediculosis pubis made?

A

Direct visualisation with naked eye or microscopic examination to identify lice/nits

66
Q

How is Pediculosis pubis managed?

A

Supportive: wash bedding at high temperature setting
+
Medical: Topical permethrin 1%

Apply to site, wash after 10 minutes, remove nits with comb and put clean clothes on

67
Q

Which pathogen causes Anogenital herpes?

A

HSV-1

HSV-2

68
Q

What is the most common cause of Anogenital herpes?

A

HSV-1

69
Q

What is the typical location of HSV in recurrent oro-labial herpes?

A

Trigeminal ganglia

70
Q

What is the typical location of HSV in recurrent anogenital herpes?

A

Sacral nerve root ganglia

71
Q

What are the clinical features of anogenital herpes?

A

Painful vesicle/pustule/ulceration present on genitals (F+M) or anus (M)
Discharge

Systemic symptoms: fever, headache, malaise, myalgia
Proctitis: bleeding, tenesmus, pain, discharge

Lymphadenopathy/lymphadenitis

72
Q

How is anogenital herpes diagnosed?

A

Swab + NAAT

Serology (if recurrent genital ulcers)

73
Q

How is anogenital herpes managed?

A

Aciclovir PO 400mg TDS 5/7

74
Q

What are the complications of Anogenital herpes?

A 
Aseptic meningitis 
Encephalitis 
Pneumonia 
Oesophagitis 
Hepatitis 
Urinary retention
75
Q

Which pathogen causes anogenital warts?

A

HPV-6 and HPV-11

76
Q

What are the clinical features of anogenital warts?

A

Anal wart (condylomata): cauliflower appearance
Irritation
Bleeding

77
Q

How are Anogenital warts diagnosed?

A

Clinical diagnosis

78
Q

How are anogenital warts managed?

A

Supportive: use condoms; GUM referral
+
Medical: Podophyllotoxin cream 0.15%; Imiquimod 5%

±
Surgery: Cryotherapy; Electrocautery; Excision

79
Q

What genotypes of HPV is protected against by the vaccine given at 12-13 years old in the UK?

A

HPV-6, -11, -16, -18 (Gardasil)

80
Q

Explain how the Cervical Screening Programme in the UK works?

A

Aged 25-64 invited

25-49 = every 3 years

49-65 = every 5 years

Test for hrHPV - positive?

If positive, then cytology of cells conducted

Any dyskaryosis (low-grade or high-grade) = Colposcopy within 2 weeks

81
Q

What type of epithelium lines the endocervix?

A

Simple columnar epithelium

82
Q

What epithelium lines the ectocervix?

A

Non-keratinised stratified squamous epithelia

83
Q

What is the most common type of cervical cancer?

A

Invasive squamous cell carcinoma

84
Q

What does Colposcopy comprise of?

A

Visualisation of the cervix with additional tests.

Lugol’s iodine test: add iodine-based solution with normal tissue containing glycogen going brown/black.

CIN/Invasive cancer does not contain much glycogen thus does not stain.

Acetic acid can be applied which causes abnormal cells to become white - acetowhite

Biopsy - tissue sample to allow further analysis to be performed

See and treat policy may be offered to those with high-grade CIN

85
Q

What reasons are there to delay cervical screening?

A

Menstruating
Pregnancy
Less than 3/12 after a pregnancy (post-natal/ miscarriage/ ToP)
Abnormal vaginal discharge

86
Q

If cytology is normal but hrHPV positive, what is your next action?

A

Repeat cervical screening at 12 months

87
Q

If the hrHPV is positive but cytology is negative, you have recalled 12-months later and hrHPV +ve at 24 months, what is your next course of action?

A

Colposcopy

88
Q

How is CIN treated?

A

LLETZ

89
Q

What are the grades of CIN?

A

CIN 1 = mild dysphasia

CIN 2 = moderate dysplasia

CIN 3 = severe dysplasia

90
Q

A patient enquires about contraception. She asks which types are available.

A

Abstinence
Natural family planning

Barrier - condoms

COCP
POP

Copper coil
Progesterone coil

Progesterone injection

Progesterone implant

Surgery

91
Q

Which form of IUD would you use in a patient with Wilson’s Disease?

A

Progesterone-secreting coil - avoid Copper coil

92
Q

In a patient with previous cervical cancer, which form of contraception should be avoided?

A

IUD

93
Q

A patient is worried about the risk factors for the combined oral contraceptive pill.

What risks factors would you check in her?

A 
Migraine with aura 
Uncontrolled hypertension (>160/ >100)
VTE Hx 
Aged 35+ and smoker
Major surgery with prolonged immobility 
Arteriopath (vascular disease; IHD; CM; AF) 
Liver disease 
SLE 
Antiphospholipid syndrome
94
Q

Why should the progesterone injection be stopped before 50 years old?

A

Risk of OP

95
Q

How long should contraception be used following menopause?

A

> 50 = 1 year

<50 = 2 years

96
Q

When can an IUD be inserted for postpartum contraception?

A

within 48 hours of birth and 4 weeks of birth

97
Q

When can the COCP be started after childbirth?

A

6 weeks after childbirth if breastfeeding

98
Q

What is the MOA of the COCP?

A

Contains both oestrogen and progesterone.

1) Prevent ovulation
2) Progesterone thickens cervical mucous
3) Progesterone inhibits proliferation of endometrium, reducing chance of successful implantation

Both oestrogen and progesterone have negative feedback on Hypothalamus and Anterior pituitary to suppress GnRH, LH and FSH thus ovulation does not occur

99
Q

What are the two types of COCP?

A

Monophasic (same amount)

Multiphasic (varying amounts)

100
Q

What does Microgynon contain?

A

Ethinylestradiol + Levornogestrel

101
Q

What does Loestrin pill contain?

A

Ethinylestradiol and Norethisterone

102
Q

What are the different pill regimes?

A

21 days on, 7 days off

63 days on, 7 days off

Continuous use without pill-free period

103
Q

What are the side effects of the pill?

A 
Breakthrough bleeding 
Mastalgia 
Mood changes/depression
Headaches
Hypertension
VTE
Small increased risk of breast and cervical cancer (returns to normal 10 years after stopping) 
Small increased risk of MI/Stroke
104
Q

What are the benefits of the COCP?

A

Contraception

Rapid return to fertility after stopping

Improvement in premenstrual symptoms, menorrhagia, dysmenorrhoea

Reduced risk of benign ovarian cysts

Reduced risk of endometrial, ovarian and colon cancer

105
Q

What are the contraindications to starting the COCP?

A 
Uncontrolled hypertension (>160; >100)
VTE Hx
Immobility 
Migraine with aura (risk of stroke)
Vascular disease
Ischaemic Heart Disease
AF
Liver cirrhosis and liver tumours
SLE
Antiphospholipid syndrome
106
Q

What level of protection does starting the pill have depending on where you are in your menstrual cycle?

A

Before day 5 = immediately

After day 5 = condoms for first 7 days

107
Q

How should you swap from a POP to a COCP?

A

7 days of extra contraception required

108
Q

How may you screen for contraindications in a consultation regarding the contraceptive pill?

A 
Age 
PMHx -VTE/ Migraine/Cancer/ CVD/ SLE
FHx - VTE/ Breast Cancer 
Weight and height
Blood pressure
109
Q

When missing the pill and it is <72 hours since the last pill was taken, what is the advice?

A

Take missed pill ASAP - can take 2 in one day

No extra contraception is required

110
Q

If a woman misses her pill in Day 2 and Day 6 of her cycle, what is the advice?

A

Emergency contraception - Days 1-7 and 2 missed pills = emergency contraception

111
Q

What rule can we use when deciding if a woman requires emergency contraception when missing the pill?

A

Use the “Rule of 7” when a woman has missed her pill 2 times (>72 hours since last pill was taken)

Days 1-7 = emergency contraception

Days 8-14 = none needed

Days 15-21 = none needed, take next pack back-to-back

112
Q

Prior to a major operation, when should you stop the COCP?

A

4 weeks before

113
Q

How do you take the POP?

A

Continuously

114
Q

Which type of pill cannot be delayed by more than 3 hours?

A

Traditional POP - Norgeston

115
Q

How late can the Desogestrel-only pill be taken for and still be effective?

A

12 hours

116
Q

What is the MOA of the POP?

A

Only progesterone

Inhibit ovulation (Desogestrel)

Thicken cervical mucous

Altering endometrium to make implantation less likely

Reduce ciliary action of fallopian tubes

117
Q

How long does it take for the POP to have full effect as a contraceptive?

A

48 hours

118
Q

When switching from a COCP to a POP, what precautions should be taken?

A

Week of hormone-free period after COCP pack is best time to swap, no additional contraception required

If sexual intercourse since completing last pack of COCP, take Days 1-7 then switch, then use 48 hours of additional contraception

119
Q

What are the side effects of POP?

A

Bleeding changes: 1/3 less; 1/3 normal; 1/3 unscheduled

Breast tenderness
Headaches
Acne

Small risk of ovarian cysts; ectopic pregnancy (reduced ciliary action); increased risk of breast cancer

120
Q

When is a pill considered missed if a POP?

A

3 hours if traditional POP

12 hours if desogestrel POP

121
Q

What should you do if you miss a POP?

A

Take normal pill, take missed pill, use extra contraception for 48 hours

Emergency contraception if sex since missed pill or within 48 hours of restarting regular pills

122
Q

How is the Progesterone injection administered?

A

Depot medroxyprogesterone acetate (DMPA) given IM or SC in 3/12 interns

123
Q

How long may it take for fertility to resume following the Depot Medroxyprogesterone acetate injection?

A

12 months

124
Q

What are the contraindications for the Depot Medroxyprogesterone Acetate injection?

A 
Breast cancer
Ischaemic Heart Disease and Stroke 
Unexplained vaginal bleeding
Severe liver cirrhosis 
Liver cancer
125
Q

What are the side effects of the Progesterone Injection?

A

Weight gain
Osteoporosis

Acne 
Reduced libido
Mood changes
Headaches
Flushes
Alopecia 
Skin irritation at injection sites

Osteoporosis

126
Q

What are the potential benefits of the Progesterone injection?

A

Improve dysmenorrhoea
Improves endometriosis
Reduces risk of ovarian and endometrial cancer
Reduces the severity of sickle cell crisis in patients with sickle cell anaemia

127
Q

How long does the progesterone implant last?

A

3 years

128
Q

Which form of progesterone is used in the Nexplanon implant?

A

Etonogestrel

129
Q

How may the progesterone implant affect the bleeding pattern?

A

1/3 = infrequent bleeding

1/4 = prolonged bleeding

1/5 = no bleeding

Remainder have normal, regular bleeding

130
Q

Which two types of IUD exist?

A

Copper coil IUD

Levornogestrel

131
Q

What is the difference between a IUD and IUS?

A

the two types of coils are referred to as IUD and IUS. The intrauterine device (IUD) refers to the copper coil, and the intrauterine system (IUS) refers to the levonorgestrel (e.g. Mirena) coil. The copper coil is just a “device”, whereas the hormones in the Mirena make it a “system”.

132
Q

When are IUDs contraindicated?

A 
PID
Immunosuppression 
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion e.g. fibroids
133
Q

Which genetic condition is the Copper coil contraindicated?

A

Wilson’s disease

134
Q

When the Copper IUD is inserted, how long does it take to be effective?

A

Instantly

135
Q

How long is the Mirena coil licensed for in contraception?

A

5 years for contraception

136
Q

How long is the Mirena coil licensed for in HRT?

A

4 years

137
Q

When is irregular bleeding considered normal following insertion of an IUD?

A

6 months, after this, exclude other causes such as sexually transmitted infections, pregnancy, cervical screening etc.

138
Q

Which organisms may be found on the cervical smears of women with the coil?

A

Actinomyces-Like Organisms (ALO) on smears

139
Q

Which forms of emergency contraception exist? When would you use each?

A

Levornogestrel (within 72 hours of UPSI)

Ulipristal (within 120 hours of UPSI)

Copper coil (within 5 days of UPSI)

140
Q

A woman presents following an UPSI. She is in day 11 of her cycle, she had the UPSI on day 5. Her cycle is usually 30 days long.

What form of emergency contraception would you use and why?

A

Copper coil as it is within 5 days of her estimated date of ovulation.

Cycle is 30 days thus 30 - 14 = 16

141
Q

A woman presents following an UPSI. She is in day 11 of her cycle, she had the UPSI on day 10. Her cycle is usually 30 days long.

What form of emergency contraception would you use and why?

A

Levornogestrel as she is within 72 hours

142
Q

A woman presents following an UPSI. She is in day 11 of her cycle, she had the UPSI on day 7. Her cycle is usually 30 days long.

What form of emergency contraception would you use and why?

A

Ulipristal - as within 120 hours of UPSI

143
Q

What is the dose of Levornogestrel given as emergency contraception?

A

1.5mg STAT

or

3mg STAT (if >70kg or BMI >26)

144
Q

What are the side effects of Ulipristal?

A

N/V

Spotting 
Abdominopelvic pain
Back pain
Mood changes
Headache
Dizziness
Breast tenderness
145
Q

What are the main cautions when using Ulipristal?

A

Breastfeeding avoided for 1 week

Avoid in severe asthma

146
Q

Which forms of sterilisation exist?

A

Female: Tubal occlusion

Male: Vasectomy

147
Q

What is Gillick Competence?

A

Judgement surrounding a child able to consent to treatment - decision by decision basis

148
Q

What are the Frazer Guidelines?

A

Guidelines specific to provision of contraception to patients under 16 years old without parental input and consent

Child must be mature and intelligent enough to understand treatment
Cannot be persuaded to discuss with parents
Likely to have intercourse regardless of treatment
Physical/Mental health likely to suffer without treatment
Treatment is in their best interest

149
Q

Strawberry cervix is present in which infection?

A

Trichomonas

Medicine (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions