OSCE Flashcards
(30 cards)
Initiating CHC
Choice of regimes
explained tailoring is unlicensed
-may reduce bleed frequency and withdrawal symptoms
-unscheduled bleeding is common
-written information
When to seek urgent review
How/when to start, any precautions
Incorrect use + need for EC
Health risks
Specific advice for: travel, altitude and surgery
Key signs and symptoms
Significant new health events should prompt medical r/v
Check with prescriber any new medication (POM and OTC)
Arrangements for f/u and subsequent supply
What to do if wish to discontinue/change method
Preconception Care- Questions
Obstetric/Gynae history
Diet and BMI
Smoking/alcohol/drugs
caffeine
medications and OTC
Smear
HBV/HIV risk
Rubella/chickenpox immunity
Occupation (exposure)
travel plans (ie zika)
chronic health conditions
Diaphragm
Up to 3 hours before, 6 hours after
Repeat if >3 hours or further SI
can use condoms if non nonoxinol-9
Caya gel- stabilise pH and further barrier- 2 2cm strips
extra on leading edge to help insertion
UKMEC3 if high risk of HIV acquisition/TSS
max 30 hrs (48 if cap)
typical 12 perfect 6 (caps are worse)
Difficulty?
slinga rod, bear down
replace after 2 years
latex free
80% women (65-80mm)
link to website
any concerns
trial and examine
Bleeding on HRT
Initiation 6/12
Dose change 3/12
40% will have
1-5%Ca (10% nil HRT)
ccHRT 4mm
sHRT 7mm
Pt decision re continuing- write on histology form, discuss risk/benefits
If stops 28/7 after stopping- NAD, if persists- Ca pathway
Urgent Ca pathway:
1 Major or 3 minor
TVS 6 weeks
2 minor
heavy/persistent
>3 months change or 6 months started
Major RF (1)
BMI >40
genetic predisposition
no P >6/12
tricycling >12 months
sequential >5 years and >50
inadequate P for >12 months
Minor RF (3)
BMI>30
PCOS
DM
E only >3 months
tricycling <6 months
suboptimal P >12 months
LNGIUD expired >12 months
If do not fit any:
Optimise for 6 months
- if worse/same = ca pathway
-if slightly better= TVS 6 weeks
Offer examination, most likely cause= atrophy
HSV- not HSV
Recent sexual partners
-country of birth
-recent travel
-pain
associated symptoms
recent testing
document recommend disclosure to partners
MHX- eczema
Chlamydia
Nil SI until finished doxy or 1.52 after azithro
TOC after 5 weeks
Contact Tracing
side effects
BASHH:
Detailed explanation of condition
Particular emphasis on long-term implications for health of themselves and their partners
Reinforced with clear and accurate written information - BASHH leaflet
Syphilis
Ask about new headache/eye/ear symptoms if secondary (changes treatment)
- Procaine penicillin 1.8–2.4 MU IM OD PLUS probenecid 500 mg PO QDS for 14 days
- Steroids should be given with all anti-treponemal antibiotics for neurosyphilis; 40–60 mg prednisolone OD
for 3 days starting 24 h before the antibiotics
Warn about JH- keep on site 15 mins
Yaws- ulcers on leg in childhood- Ghana/PNG
Generic
Travel
New drugs/OTC
Statistics
Start with open question about concerns
Risk:
disease/total for drug (%)
disease/total for control (%)
RR= drug/control (%)
ARR= control - drug (%)
NNT= 100/ARR in %
NNH= event in treated - event in control = ARI (100/ARI in %)
Think about:
Cohort (patient’s age/gender/ethnicity based on study participants
modifiable RF of patient (BMI/Alcohol)
FAM
Natural Cycles:
Menopause
BMI
BP
MUST ask about SI
Alcohol/smoking
medications
stress
Calcium/Vit D
exercise
CBT
Screening- breast/cervical
How using (eg showering), 2 hours after food P. with food E
check T levels after 3 months.
Postnatal MH
during the past month have you -felt down, depressed or hopeless?
- had little interest/pleasure in doing things?
Crisis
AD
-single drug, lowest effective dose
-PNMH
-no evidence of birth defects (no proven cause but some association)
-hospital delivery (monitor neonate for withdrawal syx)
Sexual Dysfunction
MHx
Meds
O+G Hx
DA/SV
How long (any key events/changes)
-sensation
-desire
-response
-interest/fantasies
Every time?
Other mood/anxiety
DSH/suicidal ideation
What would you like outcome to be?
Erectile Dysfunction
MHx
Meds
SA/DV
How long for
-sensation
-pleasure
In all setting? Ie masturbation
- FBC
- LFTs
- U&Es
- TFTs
- Lipid profile
- Fasting glucose and/or HbA1C
- Serum total testosterone
PDE5 inhibitor regardless of cause- 1 hour before (lasts 4-5hours) take on empty stomach
PMS
COCP if physical dominate, SSRI if psychological
Testosterone
Schedule 4 controlled drug
-as potential to be misused by athletes
-prescribe by brand:
1/8 of a sachet/day = approx. 5mg/day i.e. each sachet should last 8 days
-wash hand, cover with clean clothing
no evidence etc etc
Lack of long term safety data for CV/Breast risk
excess hair growth, acne and weight gain (usually
reversible)
Alopecia, deepening of voice and clitoral
enlargement are rare
Bullying
1) Stay calm, remind bullied that it is th ebully’s weakness, not theirs
2) Suggest they speak to that person, explain how their behaviour makes you feel. Offer to accompany/do for them
3) Keep a diary/record
4) Make a formal complaint (if not solved by above)
5) Legal complaint/union/ACAS
What is harassment?
Unwanted conduct in relation to protected characteristics
-intimidating/humiliating
-even if not intended
Ulcerative Genital Disease
Contacts
Travel
Prodrome
Harm
Apologise
Discussion
Record
What happened, what this means (long/short term, what we can do for you)
How to stop from happening again
SA
SARC
EC
HBV
PEP (avoid gaviscon/supplements)
MH/PH
ISVA
Support
Crisis
PrEP
Counselling points from BASHH:
-Adherence, dosing options
-regular testing
-BMD
-condoms for STIs
-chemsex/substance misuse
-lead in (2-24 or 7/7)
new HIV
BV
1 study
higher cure rates if also rx partner
164 couples
30% recurrence in rx group, 60% in control
AR -2.6
high rates of s/e in men
