OSCE - O&G Flashcards
What are the 3 types of emergency contraception available?
- Levonelle
- contains hormone similar to progesterone
- within 3 days of UPSI - EllaOne
- ulipristal acetate
- within 5 days UPSI - Copper IUD
- up to 5 days after USPI
- or within 5 days of expected ovulation
- 99% effective
- can be left in for 10 years for ongoing contraception
Advantages & Disadvantages of Levonelle
Advantages
- safe
- can start today
Disadvantages
- nausea , vomitting
- next period may be early or late
- least effective form of emergency contraception
- not effective if already ovulated
Advantages & Disadvantages of EllaOne
Advantages
- safe, more effective than Levonelle
- 5 day window
Disadvantages
- nausea and vomitting
- next period early or late
- not effective is already ovulated
- cannot be taken around same time as other hormones
Advantages & Disadvantages of copper IUD
Advantages
- 99% effective
- can be regular contraception for up to 10 years
- can be used alongside emergency contraception as extra precaution
Disadvantages
- requires quick procedure, can be uncomfortable
- carries risk of infection, expulsion and perforation
- some patients have breakthrough bleeding
- periods can be heavier, more painful
What are important bits of follow up information to give a patient who has had unprotected sexual intercourse?
- Follow up
- take pregnancy test 3 weeks after UPSI to check if emergency contraception has worked - Access to emergency contraception
- gp
- sexual health clinic
- pharmacies
- NHS walk ins - STI screening
- should be offered - ongoing contraception
Describe some appropriate further investigations for:
27F pc: post-coital and intermenstrual bleeding
- High vaginal swab
- HPV testing
- USS scan
Differential diagnoses for erythematous cervix with discharge?
- Cervical ectropion
- Cervical cancer / Cervical intraepithelial neoplasia
- Cervicitis
Management for cervical ectropion?
No treatment due to benign nature.
If symptoms persist and are bothersome:
- ablative treatment:
1. cold coagulation / cryotherapy
How would you manage early stage cervical cancer , where cancer is less than 7mm wide?
- Hysterectomy +/- lymph node clearance
OR
- cone biopsy with negative margins (if patients with to retain fertility)
Name the lymph nodes you would palpate in a breast exam?
- axillary
- cervical
- supraclavicular
- infraclavicular
- parasternal
Give some differential diagnoses to the following key findings found on a breast exam:
- scaly, thickened, erythematous lesion to the nipple areolar complex of right breast
- underlying central mass, irregular, rubbery, non-fluctuant, poor mobility
- right nipple gives thin, serous discharge
- Paget’s disease of the nipple
- breast cancer: inflammatory breast cancer
- nipple eczema
Give some differential diagnoses to the following key findings found on a breast exam:
- scaly, thickened, erythematous lesion to the nipple areolar complex of right breast
- underlying central mass, irregular, rubbery, non-fluctuant, poor mobility
- right nipple gives thin, serous discharge
- Paget’s disease of the nipple
- breast cancer: inflammatory breast cancer
- nipple eczema
What examples of adjuvant hormonal therapy do you know for the management of oestrogen receptor-positive breast cancers?
- Tamoxifen for pre-peri menopausal women
- Aromatase inhibitors (anastrozole) for post menopausal women
—-> when menstrual cycle stops most oestrogen derived from action of aromatase in bodily fat tissue
Describe how you would interpret a CTG?
- Confirm patient’s name and DOB
Define Risk
Contraction: freq / duration
Baseline rate: brady/ tachy / normal
Variability: 5-10 bpm
Acceleration: present / absent
Deceleration: early/ variable / late
Overall: comment / management
Normal foetal heart rate on CTG
110-160bpm
