GP

Question 1

What categories are used to judge risk of starting contraceptives
and how many stages are there?

Answer 1

UKMEC, 4 staegs

UKMEC 1: No restriction (risk minimal)
UKMEC 2: Benefits outweigh risks
UKMEC 3: Risks outweigh benefits
UKMEC 4: Unacceptable risk (CI)

Question 2

Contraceptive risk factors: considerations in * Breast cancer

Answer 2

No hormonal contraceptives
Options: Copper coil / barrier methods

Question 3

Which contraceptive is contraindicated in cervical/ endometrial cancer

Answer 3

IUS (intrauterine system - i.e. Mirena coil)

Question 4

Which contraceptive is CI in wilsons disease

Answer 4

IUD ( copper coil)

Question 5

RF in COCP (10)

Answer 5

*≥ 35yo
*≥ 15 cigarettes per day
*Uncontrolled HTN (particularly ≥160 / ≥100)
*Migraine with aura
*History of VTE
*Major surgery with prolonged immobility
*Vascular disease or stroke
*IHD, cardiomyopathy or AF
*Liver cirrhosis and liver tumours
*SLE and antiphospholipid syndrome

Question 6

what hormone(s) are in the implant

Answer 6

Progestogen only

Question 7

what hormone(s) are in depot?

Answer 7

Depo-provera is a Progestogen-only injection

Question 8

why is depo classed as UKMEC 2 in <20yo

Answer 8

reduces BMD

Question 9

describe the contraceptive advice for COCP/POP postpartum

Answer 9

• COCP – from day 21, use condoms additionally for 7 days - unsafe in breastfeeding
• POP - from day 21, use condoms additionally for 2 days - safe in breasfeeding

(As very infertile <21 days postpartum

Question 10

When can IU methods NOT be used post partum

Answer 10

48hrs - 4weeks post partum ( fie outsdie the range

Question 11

What should be communicated to someone starting COCP on day 4 of menstrual period

Answer 11

Use contraceptive, No additional contraception is required

Starting < day 5
* Starting on day 1 of cycle (day 1 of period)  immediate protection
* No additional contraception is required if the pill is started ≤ day 5 of the menstrual cycle.

Question 12

What should be communicated to someone starting COCP on day 6 of menstrual period

Answer 12

1. check pt not preggers
2. require condom for 7 days

Starting > day 5
* Requires extra contraception (i.e. condoms) for the first 7 day
* Ensure woman is not already pregnant before starting the pill.

Question 13

Advice for switching between COCP

Answer 13

Finish pack –> start new pack immediately, no pill-free period.

Question 14

Advice for switching from traditional POP to COCP

Answer 14

o Switch at anytime
o Require extra contraception ( e.g. condoms) for 7 days

** except dostrogel - no additional contraceptive needed

Question 15

Advice for missing 1 COCP

Answer 15

• Take the missed pill ASAP (even if this means taking two pills on the same day)
• No extra protection

Question 16

Advice for missing > 1 COCP
generally
day 1-7
day 8-14
day 15-21

Answer 16

• Take the most recent missed pill ASAP (even if this means taking two pills on the same day)
• Additional contraception (i.e. condoms) is needed, if the pill taken regularly, for 7 days straight
  o Day 1 – 7 of the packet  emergency contraception if unprotected sex occurred
  o Day 8 – 14 of the pack  no emergency contraception is required
  o Day 15 – 21 of the pack  no emergency contraception is needed. Skip the pill-free period, take next pack immediately .

Question 17

how does the function of desogestrel differ from traditional POP

Answer 17

Both
* Thickens the cervical mucus
* Alter endometrium (so it’s less accepting of implantation)
* Reducing ciliary action in the fallopian tubes

Desogestrel also
* Inhibits ovulation

Question 18

Advice for starting contraceptive pill
day 4
day 6

Answer 18

day 1-5 = immediate protection
day >5 = additional contraceptive for 48hrs

Question 19

Advice for switching contraceptives (POP)

Question 20

How long does a Woman / Man need contraceptives following sterilisation

Answer 20

woman - until next menstrual period ( ovum may have already reached uterus during that cycle)

man - 2 months ( with test @ 12 wks due to length of time sperm remain in tubes)

Question 21

2 key S/E of depot

Answer 21

weight gain
low BMD - so not suitable in >45yo women

Question 22

In a 28day cycle, what day is the suspected day of ovulation

Answer 22

day 14

ovulation day is 14 days before next cycle (28-14 day 14), (32-14 = day 18) etc

Question 23

7 steps in verifying death

Answer 23

1. Identify ( check wristband)
2. Carotid pulse
3. Pain (squeeze trapezius muscle)
4. Pupillary light response - confirm absece ( fixed and dilated pupils)
5. Heart sounds ( confirm absence) - for a FULL MIN
6. Lung sounds ( confirm absence) - for a FULL MIN
7. Note time of examination completion - this is the OFFICIAL time of death