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MFSRH > OSCE > Flashcards

OSCE Flashcards

1
Q

What to tell a CT positive patient

A 
Leaflet
What CT is
Complications if not Rx
Ses of Rx
Partner Rx
No sex until both completed Rx
Condoms!!!!
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2
Q

What to discuss when initiating pepse?

A 
Rationale
I want prep now website 
Ses - GI
Arrange f/u
HIV test
28/7 pepse if hiv neg
Follow up hiv test in 8-12 weeks post exposure
Condoms
Hep B vaccination
Ec 
Interactions antacids
Support
HA
Leaflet
Advise to present urgently if rash, flu like Sx
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3
Q

Follow up for patient started onto pepse including baseline

A 
Baseline:
HIV
HBsAg
STS, HepC
STI screen
Creatinine urinalysis for protein
ALT

14/7: Ct/GC f/u

8-12/52 post exposure:
HBsAg and HIV

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4
Q

Initiating prep hx

A

Risk assess - partners, stis, condomless, chensex, pep in prev 12/12
Medical Hx- renal, bone
Meds- nephrotoxic?
Drugs, needle sharing
Assess for Renal disease risk - >40, eGFR <90, HTN, DM

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5
Q

When giving prep tell patient….

A 
Schedule
Time until effective 
SEs - GI
Adherence 
Risk of hiv 
Sx of seroconversion
Condoms!!!
Leaflet!!!!
Sti check every 3/12
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6
Q

Baseline assessment prep

A 
HIV poct/ 4th gen
Hep b vaccine 
Hep c screen
Sti inc sts
Creatinine, eGFR and urinalysis for protein
If eGFR < 60 - renal advice
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7
Q

Follow up whilst on prep

A

3/12 sti screen and hiv and hep c
Annual renal function

Give 90 day supply
F/u 1/12

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8
Q

HSV diagnosis station and what info to give patient

A 
Condoms
Leaflet
No sex when lesions or prodromes
Asymp shedding
Tell all partners
Aciclovir when needed
HA
Can’t transmit via towels, sheets
Don’t transmit to pregnant women in third trimester - abstain from sex if lesions in 3rd trimester
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9
Q

Mx of primary HSV in 1st or 2nd trimester

A

Until 28/40
Inform obstetric team and write in orange notes
Standard RX
Vaginal del
Daily suppressive aciclovir 400mg tds from 36/40

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10
Q

Mx of primary HSV in third trimester (28/40+)

A

Usual Rx
Then daily suppressive Rx
C/s ( risk of neonatal transmission if Sx in prev 6/52 is 41%)

If within 6/52 of del with Sx type specific igG and swab lesions

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11
Q

If hiv positive and HSV recurrence during pregnancy what mx

A

Daily suppression from 32 weeks

( increased risk of preterm del and also risk of transmitting hiv if HSV ulceration in pregnancy

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12
Q

How to use a diaphragm

A

2x2cm strips onto upper surface of diaphragm
Apply additional spermicide if over 3 hours since applied
Leave in for 6 hours post sex
Max 30hours
Vaginal exam first to ensure fit and find size

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13
Q

Osce on CHC

A 
Ukmec
Medications
Bri and BP
Lifestyle factors
Fhx
Effectiveness
Missed pills
Health risks
Side effects
Non contraceptive benefits 
When work?
Leaflet
Signs to seek medical advice 
To attend if new meds’ new headache
What to do if wishes to stop
How to get next px
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14
Q

Key signs to present when on CHC

A 
Calf pain swelling
Chest pain
Loss of movement or feeling in limbs
Breast lump
New migraine
New symptoms before migraines
Persistent vag bleeding
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15
Q

What to discuss in a sterilisation consultation

A 
Medical Hx
Leaflet
Both partners
Not reversible
Vasectomy safer
LARC
Regret
Risks
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16
Q

Vasectomy procedure

A 
Interrupt vas deferens
Make 1 or two incisions in scrotal skin 
Expose vas
Occlude vas 
LA warm to 37degrees, subcut and direct into vas deferens

Minimally invasive vasectomy - fixation clamp to secure vas and use sharp forceps to puncture skin and vas sheath
No need for skin sutures

Lowest risk of failure is cauterisation then division of vas with or without excision

17
Q

Cardiac disease consideration in Hx

A

Surgery
Rhythm disturbance
Functional status- breathless, odema, fatigue, syncope
Discuss with cardiologist
BP/BMI
F/ u if d/c or interval review less than 2 years - low risk indicator

18
Q

Threads not visible Mx

A 
PT test
Alternative contraception 
TVUSS
If not intrauterine - X-ray 
If perf confirmed - elective 
New insertion min 1/12 post
19
Q

Implant insertion site on arm

A

8-10 cm from medical epicondyle
Over biceps
Switch arm for third implant

20
Q

Hx for amenorrhoea

A 
Fhx
Anosmia
Medications
Pubertal development
Thyroid disease
Head injury
Emotional stress
Chronic illness
Generic disorders in family
21
Q

What to do for sexual assault consultation

A 
Serious injuries
Police
Metal health
Support
EC
Pepse
Hep b
Forensic exam
Baseline screen
22
Q

Mifepristone moa

A

Antiprogesterone

23
Q

Misoprostol Moa

A

Prostaglandin

24
Q

All psychosex patients

A 
Ferritin
Recurrent use of antifungals
Reduce allergens
Wash with water
Soap substitute 
Non bio

Perineal massage
Stretch perineum with coconut oil

25
Q

HRT osce risks

A

Under 60
Cv protective

Breast ca for combined, extra 5 per 1000 after 7.5 years of use. Mortality not increased

Dvt/ pe - 2-3 x risk with oral 1.7per 1000. Greatest risk in first 12 months. Risk with transdermal no greater than population

26
Q

Indications for transdermal therapy for HRT

A 
Previous or fhx dvt
BMI >30
HTN
Migraine
Enzyme inducers
Gall bladder disease
27
Q

POI

A

Thyroid autoantibodies, adrenal, karyotype, fragile x testing

Counsel and support
Genetic counselling
HRT
Fertility - IVF, IVF with donor egg
Dexa
Lifestyle measures
28
Q

HRT for women with Hx of breast cancer

A

Paroextine and fluoxetine once daily but abnormal dreams, confusion

Venlafaxine

Lifestyle
Triggers
CBT, acupuncture

29
Q

Which herbal preps for menopause?

A

Black cohosh

Isoflavones

30
Q

HRT contraindications

A

Oestrogen dependent Tumors
Undiagnosed vag bleeding
Liver disease
Active VTE or Mi

31
Q

Migraine without aura definition

A

At least 5 attacks of Recurring headache with:

4-72 hours
Two of the following:
Unilateral
Pulsating
Mod to severe pain
Avoiding or caused by usual routine

And at least one of:
Nausea
Vomiting
Photophobia

32
Q

Migraine with aura

A

Migraine criteria plus at least 2 attacks with:

One or more of:
Visual often scotoma, zigzag shape
Sensory pins and needles numbness 
Speech
Motor
Retinal

And at least 2 of
One aura Sx spreads gradually over more than 5mins and or two or more symptoms occur in succession
Each symptom lasts less than 60mins
At least one Sx is unilateral
Accompanied by or followed within 60mins by headache

33
Q

Consent to TOP and risks

A 
Mtop <13/40
Heavy bleed <1 in 1000
Evac 7in 100
Sepsis <1 in 1000
Ongoing PT - 0.5%
Stop <13/40
Perf 1 in 1000
Cervical trauma <1 in 100
Evac 3 per 100
Sepsis 1 in 1000
Bleeding 1 in 1000
Ongoing 0.2%
Mtop >13/40
Uterine rupture 1in100
Sepsis 4 in 100
Severe bleeding 1in 100
Evac 13 in 100

STOP > 13/40
Sepsis 1 in 100
Bleeding 7/100
Evac 3 in 100

34
Q

HSV in pregnancy

A

If recurrent - aciclovir 400mg tds from gestation
If primary in 1st or 2nd - aciclovir 400mg TDS from 36/40
Both above can have vaginal delivery

If primary in third trimester
Aciclovir until delivery
Planned c/s

35
Q

Lamptrigine and which contraceptives ok?

A

Potential interaction for POP and CHC all others ok

36
Q

Griseofulvin which contraceptives can you have?

A

Dmpa
Ius
IUD

37
Q

Sodium valproate and CHC

A

Ee May reduced valproate levels

Give any other method than CHC

38
Q

Key osce Hx

A 
Pmhx
Dhx 
Fx
Shx 
Dv / FGM 
Gynae
Obs
Smear
F
Stis
Contraception
Vaccines 
Condoms
Leaflets 
Lifestyle

MFSRH (8 decks)

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