OSCE 5, 6, 7 Flashcards
The Pill, PCOS and postmenopausal bleeding.
What OCP would you recommend to an 18-yo, nulliparous pt?
2nd gen combined pill (low-dose estrogen, 20-35 mg)
Name 4 contraindications to the pill.
Hx of thrombosis, stroke, MI; pregnancy; thrombophilia; Hx of severe esttrogen- or preg-induced disease
Name 3 non-contraceptive benefits to the pill.
reduced menstrual blood loss; regularization of periods; reduced risk of ovarian, endometrial ca
List for pieces of key advice for a healthy, young woman starting OCPs.
- signs of DVT
- what to do if miss pill
- how to take pill
- breakthrough bleeding
- seek alt. contraceptive or pre-preg counseling before stopping
What would you advise a pt to do if she misses her OCP one day? Two days?
take double dose next day; take double dose next 2 days; use alt. form of contraception until you finish pack
What would you tell a pt. starting OCPs about breakthrough bleeding?
normal in first 2 or 3 mos., should normalize after. If not, may need to switch formulation.
You suspect a pt has PCOS, name 4 tests you would run.
follicular phase LH or LH:FSH
US of ovaries
BMI, OGTT
Rubella and chix pox status
What tx would you arrange for a pt w/ PCOS who wants to conceive? (2)
clomiphene; wt. loss, metformin if appropriate
What counseling would you give to a pt w/ PCOS who wants to conceive?
pre-preg counseling; side fx of clomiphene
What are the side fx of clomiphene?
multiple gestation, ovarian hyperstimulation syndrome, ovarian cysts and theoretical risk of ovarian cancer.
What follow up investigation would you arrange for a PCOS pt that you have put on clomiphene?
Luteal phase progesterone once regular menstrual cycles are achieved.
What type of drug is clomiphene?
SERM
How does clomiphene induce ovulation?
prevents negative feedback of estrogen on gonadotropin release
Define postmenopausal bleeding.
genital tract bleeding 12 mos after menopause
List 4 issues to cover in history-taking for postmenopausal bleeding.
- onset and number of occurrences
- assoc’ed Sx: discharge
- obvious explanation: trauma, anticoagulants
- cancer risk: Hx, tamoxifen use