Gynae, uro, sexual

Question 1

what class of medication is finasteride?

Answer 1

5 alpha reductase

Question 2

which cocp is no longer licensed for contraception?

Answer 2

dianette due to VTE risk
but can be used still for e.g. hirsutism

Question 3

Ullipristal acetate/EllaOne emergency contraception:
- mechanism
- timeframe to take
- contraindications
- when to restart cocp/hormonal contra if had this

Answer 3

• delay ovulation
• 5 days after UPSI
• ineffective if ovulation already occurred, not to take if asthma & taking steroids
• delay breastfeeding by 7 days after taking
  -wait 5 days to restart

Question 4

Levonorgestrel/Levonelle emergency contraception:
- mechanism
- timeframe to take
- contraindications
- when to restart cocp if had this

Answer 4

• inhibit ovulation for next 5 days
• 72 hrs after UPSI
• if taking enzyme inducing meds/if BMI>26 need bigger dosec
• can continue breastfeeding
• can take COCP directly after having

Question 5

what is the best emergency contraception?
- mechanism
- timeframe to take

Answer 5

copper coil
- inhibits ovulation - toxic to sperm/ova, inflammation of endometrium
- 5 days after UPSI or within 5 days after likely ovulation
- 0.1% failure rate, the only emergency contraception that works after ovulation

Question 6

Vaccinations while pregnant:
- covid, flu - when in gestation is it ok?
- pertussis - when in gestation?

Answer 6

covid and flu - any time during pregnancy
pertussis - 18-20 weeks

Question 7

According to the Civil Aviation Authority (CAA) what is the gestation at which most airlines no longer permit flying?

Answer 7

36 weeks for singleton pregnancy
32 for multiple gestation

Question 8

How to treat hirsutism in pcos?

Answer 8

topical eflornithine

Question 9

SSRI of choice for breastfeeding women?

Answer 9

sertraline
paroxetine

Question 10

Diagnosis of gestational diabetes - what is the threshold for fasting glucose? and for 2-hour glucose?

Answer 10

5.6 mmol/L for fasting
7.8 for 2-hour glucose

Question 11

list 2 possible complications of diabetes in pregnancy

Answer 11

polyhydramnios

Question 12

what level of progesterone at ovulation is indicative of it?

Answer 12

> 30mmol/l

Question 13

How long does it take for POP to become effective, if not taken on day 1 of period?

Answer 13

2 days

Question 14

How long does it take for COCP & depot to become effective, if not taken on day 1 of period?

Answer 14

7 days

Question 15

what is the most appropriate time to test for STIs after UPSI?

Answer 15

2-12 weeks

Question 16

64 y/o F, recurrent lower abdominal pain associated with urinary urgency and frequency + Hunner lesions on cystoscopy. Dx?

Answer 16

Interstitial cystitis

Question 17

1st, 2nd line treatments for chlamydia?

Answer 17

1. doxycycline 200mg 7 days
2. azithromycin or 1st line if pregnant. If pregnant, erythromycin, amoxicillin.

Question 18

Tx for PID?

Answer 18

Intramuscular ceftriaxone 1000mg single dose plus
Oral doxycycline 100mg BD for 14 days plus
Oral metronidazole 400mg BD for 14 days

Question 19

How long to go back for, in partner notification for:
gonococcal infections
non-gonococcal infections

Answer 19

Patients with gonococcal urethritis: all partners since, and in the two weeks prior to, the onset of symptoms
Patients with non-gonococcal urethritis: all partners since, and in the four weeks prior to, the onset of symptoms

Question 20

how long to avoid sexual intercourse after treating chlamydia with azithromycin?

Answer 20

7 days

Question 21

You see a 21-year-old woman who is taking a combined contraceptive pill. She is worried because she went away for a weekend and has missed two pills. She is on the second week of her 21-day pill pack. Her last period was two weeks ago. She had unprotected sexual intercourse last night.

Answer 21

Take the most recent missed pill as soon as possible and continue the remaining pills at the usual time. Condoms should be used or sex avoided until pills have been taken for 7 consecutive days

Question 22

What is the ideal method to obtain sample to test for chlamydia for men & women?

Answer 22

women: endocervical swab
men: first catch urine

Question 23

what is the most type of hpv virus to cause genital warts?
what about cervical ca?

Answer 23

genital warts: hpv 6, 11
cervica ca: hpv 16, 18

Question 24

An 18-year-old woman is on day 14 of her cycle and has had unprotected intercourse two days previously. You prescribe single dose levonorgestrel 1500 microgram as emergency contraception and agree to restart her previous combined pill (ethinylestradiol 30 microgram/levonorgestrel 150 microgram) immediately.
For HOW MANY days should she take additional contraceptive precautions according to current guidance?

Answer 24

7 days
If quick starting combined hormonal contraception (except Qlaira) immediately after progestogen-only emergency contraception, condoms or avoidance of sex should be advised for seven days if the woman is day six or beyond in her cycle. No precautions are required between days 1–5.

Question 25

What to Rx for pt w acne & needs contraception? (Kill 2 birds w 1 stone)

Answer 25

Marvelon COCP, more oestrogenic than Microgynon
POP doesn’t work for acne

Question 26

how long after exposure should a negative HIV test be repeated to exclude HIV infection?

Answer 26

45 days

Question 27

COCP - perfect use and typical use failure rate?

Answer 27

Failure rate with perfect use is less than 1% & with typical use is 8%

Question 28

Contraindic to HPV vaccine?

Answer 28

pregnancy

Question 29

how long should the copper coil remain in situ after the final period of a menopausal women?

Answer 29

1 year after LMP if age >50
2 years after LMP if age <50

Question 30

Abx for trichomonas?

Answer 30

metronidazole

Question 31

A 23-year-old woman phones at 11am for advice. She is taking the combined oral contraceptive (COC) pill Microgynon. She started her new pack of 21 tablets at the usual time and is now on day 6 of the new pack. However, she has forgotten yesterday’s pill. She last had unprotected sexual intercourse (UPSI) two days ago. She is normally a consistent pill taker and had been taking the COC as directed prior to the pill-free interval.

Answer 31

Take missed pill and today’s pill and continue packet
According to the Faculty of Sexual and Reproductive Healthcare (FSRH) guidelines, in this scenario, the recommendation is to take the missed pill as soon as possible and continue the remaining pills at the usual time. Emergency contraception is not required.

This only applies if the first pill in week 1 after the pill-free interval has been taken correctly and she has been consistent with taking the pills in the 7 days prior to the pill-free interval. If there is any doubt around this then emergency contraception may be considered especially if unprotected sexual intercourse has also occurred.

Question 32

how long after treatment should young patients under the age of 25 years be offered a repeat test for chlamydia infection

Answer 32

3 months

Question 33

what is the most common abnormality associated w infertility in men?

Answer 33

varicocele

Question 34

how long is mirena coil licnesed for:
1) contraception
2) HRT
3) HMB

Answer 34

1) 8 yrs
2) 4 yrs
3) 5 yrs

Question 35

cervical screening programme:
age range & how frequent?

Answer 35

age 25-49 = 3 yrs
age 50-64 = 5 yrs

Question 36

what agent to use for constipation in palliative care ?

Answer 36

softener + stimulant

Question 37

starting COCP - need extra precaution if starting within first 5 days of cycle?

Answer 37

no

Question 38

Pt on carbamazepine - what contraception is best to offer?

Answer 38

IUD, IUS, depot
UKMEC 2 - implant
NOT COCP/POP (UK MEC 3)

Question 39

1st line tx for:
OAB
stress incontinence

Answer 39

bladder retraining
pelvic floor exercises

Question 40

age and freq of breast screening?
cervical screening?

Answer 40

breast: 50-71, three yearly
cervical: 25-49 3 yearly; 50-64 5 yearly