OSCE 5, 6, 7 Flashcards

The Pill, PCOS and postmenopausal bleeding.

1
Q

What OCP would you recommend to an 18-yo, nulliparous pt?

A

2nd gen combined pill (low-dose estrogen, 20-35 mg)

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2
Q

Name 4 contraindications to the pill.

A

Hx of thrombosis, stroke, MI; pregnancy; thrombophilia; Hx of severe esttrogen- or preg-induced disease

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3
Q

Name 3 non-contraceptive benefits to the pill.

A

reduced menstrual blood loss; regularization of periods; reduced risk of ovarian, endometrial ca

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4
Q

List for pieces of key advice for a healthy, young woman starting OCPs.

A
  1. signs of DVT
  2. what to do if miss pill
  3. how to take pill
  4. breakthrough bleeding
  5. seek alt. contraceptive or pre-preg counseling before stopping
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5
Q

What would you advise a pt to do if she misses her OCP one day? Two days?

A

take double dose next day; take double dose next 2 days; use alt. form of contraception until you finish pack

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6
Q

What would you tell a pt. starting OCPs about breakthrough bleeding?

A

normal in first 2 or 3 mos., should normalize after. If not, may need to switch formulation.

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7
Q

You suspect a pt has PCOS, name 4 tests you would run.

A

follicular phase LH or LH:FSH
US of ovaries
BMI, OGTT
Rubella and chix pox status

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8
Q

What tx would you arrange for a pt w/ PCOS who wants to conceive? (2)

A

clomiphene; wt. loss, metformin if appropriate

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9
Q

What counseling would you give to a pt w/ PCOS who wants to conceive?

A

pre-preg counseling; side fx of clomiphene

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10
Q

What are the side fx of clomiphene?

A

multiple gestation, ovarian hyperstimulation syndrome, ovarian cysts and theoretical risk of ovarian cancer.

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11
Q

What follow up investigation would you arrange for a PCOS pt that you have put on clomiphene?

A

Luteal phase progesterone once regular menstrual cycles are achieved.

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12
Q

What type of drug is clomiphene?

A

SERM

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13
Q

How does clomiphene induce ovulation?

A

prevents negative feedback of estrogen on gonadotropin release

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14
Q

Define postmenopausal bleeding.

A

genital tract bleeding 12 mos after menopause

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15
Q

List 4 issues to cover in history-taking for postmenopausal bleeding.

A
  • onset and number of occurrences
  • assoc’ed Sx: discharge
  • obvious explanation: trauma, anticoagulants
  • cancer risk: Hx, tamoxifen use
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16
Q

What will you look for on pelvic exam in the case of postmenopausal bleeding (3)?

A
  • lesion on vagina, cervix
  • vaginal atrophy
  • pelvic masses
  • foreign object
17
Q

What further investigations will be necessary in the case of postmenopausal bleeding? (3)

A
Pap smear (colposcopy, biopsy if nec)
US for endometrial thickness, tumors
hysteroscopy and endometrial biopsy (Pipelle)
18
Q

If pt w/ postmenopausal bleeding has totally normal workup, what can you say about the risk of malignancy?

A

<10%; serious conditions are treatable if not curable