OSCE Flashcards
What to tell a CT positive patient
Leaflet What CT is Complications if not Rx Ses of Rx Partner Rx No sex until both completed Rx Condoms!!!!
What to discuss when initiating pepse?
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
Follow up for patient started onto pepse including baseline
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
Initiating prep hx
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
When giving prep tell patient….
Schedule Time until effective SEs - GI Adherence Risk of hiv Sx of seroconversion Condoms!!! Leaflet!!!! Sti check every 3/12
Baseline assessment prep
HIV poct/ 4th gen Hep b vaccine Hep c screen Sti inc sts Creatinine, eGFR and urinalysis for protein If eGFR < 60 - renal advice
Follow up whilst on prep
3/12 sti screen and hiv and hep c
Annual renal function
Give 90 day supply
F/u 1/12
HSV diagnosis station and what info to give patient
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
Mx of primary HSV in 1st or 2nd trimester
Until 28/40
Inform obstetric team and write in orange notes
Standard RX
Vaginal del
Daily suppressive aciclovir 400mg tds from 36/40
Mx of primary HSV in third trimester (28/40+)
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
If hiv positive and HSV recurrence during pregnancy what mx
Daily suppression from 32 weeks
( increased risk of preterm del and also risk of transmitting hiv if HSV ulceration in pregnancy
How to use a diaphragm
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
Osce on CHC
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
Key signs to present when on CHC
Calf pain swelling Chest pain Loss of movement or feeling in limbs Breast lump New migraine New symptoms before migraines Persistent vag bleeding
What to discuss in a sterilisation consultation
Medical Hx Leaflet Both partners Not reversible Vasectomy safer LARC Regret Risks
Vasectomy procedure
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
Cardiac disease consideration in Hx
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
Threads not visible Mx
PT test Alternative contraception TVUSS If not intrauterine - X-ray If perf confirmed - elective New insertion min 1/12 post
Implant insertion site on arm
8-10 cm from medical epicondyle
Over biceps
Switch arm for third implant
Hx for amenorrhoea
Fhx Anosmia Medications Pubertal development Thyroid disease Head injury Emotional stress Chronic illness Generic disorders in family
What to do for sexual assault consultation
Serious injuries Police Metal health Support EC Pepse Hep b Forensic exam Baseline screen
Mifepristone moa
Antiprogesterone
Misoprostol Moa
Prostaglandin
All psychosex patients
Ferritin Recurrent use of antifungals Reduce allergens Wash with water Soap substitute Non bio
Perineal massage
Stretch perineum with coconut oil
HRT osce risks
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
Indications for transdermal therapy for HRT
Previous or fhx dvt BMI >30 HTN Migraine Enzyme inducers Gall bladder disease
POI
Thyroid autoantibodies, adrenal, karyotype, fragile x testing
Counsel and support Genetic counselling HRT Fertility - IVF, IVF with donor egg Dexa Lifestyle measures
HRT for women with Hx of breast cancer
Paroextine and fluoxetine once daily but abnormal dreams, confusion
Venlafaxine
Lifestyle
Triggers
CBT, acupuncture
Which herbal preps for menopause?
Black cohosh
Isoflavones
HRT contraindications
Oestrogen dependent Tumors
Undiagnosed vag bleeding
Liver disease
Active VTE or Mi
Migraine without aura definition
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
Migraine with aura
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
Consent to TOP and risks
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
HSV in pregnancy
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
Lamptrigine and which contraceptives ok?
Potential interaction for POP and CHC all others ok
Griseofulvin which contraceptives can you have?
Dmpa
Ius
IUD
Sodium valproate and CHC
Ee May reduced valproate levels
Give any other method than CHC
Key osce Hx
Pmhx Dhx Fx Shx Dv / FGM Gynae Obs Smear F Stis Contraception Vaccines Condoms Leaflets Lifestyle
