PSA Specialities- O+G

Question 1

What are the risks of taking the COCP?

Answer 1

Small risk of blood clots
Increased risk of breast + cervical cancer
Very small risk of heart attacks + strokes

Question 2

What advice should be given if COCP on starting with regards to contraception?

Answer 2

In first 5 days of cycle: No need for additional contraception.

Any other point in cycle: alternative contraception should be used (e.g. condoms) for the first 7 days

Question 3

Advice during pill free period?

Answer 3

UPSI during pill-free period is only safe if the next pack is started on time

Question 4

List 3 circumstances where the effect of the COCP are reduced

Answer 4

if vomit within 2h of taking
Drugs that induce D+V may reduce effectiveness of OCP (e.g. Orlistat)
if taking liver enzyme-inducing drugs

Question 5

With which antibiotics should extra precautions be taken with the COCP?

Answer 5

Enzyme inducers e.g. Rifampicin

Question 6

8 UKMEC 4 contraindications to the COCP

Answer 6

> 35y + smoking >15 cigarettes/day
Migraine with aura
Hx of thromboembolic disease/ thrombogenic mutation
Hx of stroke or IHD
Breast feeding <6w post-partum
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation
+ve antiphospholipid antibodies (e.g. in SLE)

Question 7

Use of Levonorgestrel as emergency contraceptive

Answer 7

1.5mg (double for BMI >26)
Use within 72h of UPSI
Efficacy decreases with time
If vomit within 3h, repeat dose
Hormonal contraception can be started immediately after

Question 8

Describe Ulipristal as emergency contraceptive

Answer 8

30mg PO
Use within 120h of UPSI
May reduce efficacy of hormonal contraception- start/ restart after 5 days
Caution in severe asthma

Question 9

Which emergency contraceptive can be used while breastfeeding?

Answer 9

Levonorgestrel
(wait 1w if use Ulipristal)

Question 10

What is the most effective method of emergency contraception that should be offered to all?

Answer 10

Copper intrauterine device
Must be inserted within 5 days of UPSI/ within 5 days of predicted ovulation date

Question 11

What is the implantable contraceptive?

Answer 11

Nexplanon
Inserted in proximal non-dominant arm
Slow release of progestogen
No Oestrogen- can be used if hx of VTE/ migraine

Question 12

List 4 adverse effects of nexplanon

Answer 12

Irregular/ heavy bleeding
Headache
Nausea
Breast pain

Question 13

Length of efficacy of insertable contraceptive devices

Answer 13

Copper IUD: 5-10y
IUS (levonorgestrel releasing): 5y

Question 14

List 5 potential problems of insertable contraceptive devices

Answer 14

IUDs: periods heavier, longer + more painful
IUS a/w spotting then amenorrhoea
Risk of PID in first 20 days
Expulsion risk 1 in 20 within 3 months
Uterine perforation 2/1000

Question 15

Most common side effect of progestogen only pill

Answer 15

Irregular vaginal bleeding

Question 16

Advice on missed POP

Answer 16

if < 3h late: continue as normal
if > 3h: take missed pill ASAP, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48h

Question 17

Which progestogen only pill has a longer window in which the pack can be continued normally with no extra precautions?

Answer 17

Cerazette (Desogestrel)
12h

Question 18

What are the 2 indications for starting HRT?

Answer 18

Vasomotor Sx: flushing, insomnia, headaches

Premature menopause: to prevent osteoporosis

Question 19

What is HRT composed of?

Answer 19

Oestrogen to replace diminished levels + progestogen if a women has a uterus to reduce risk of endometrial cancer

Question 20

Which route of HRT is preferred in those with VTE risk?

Answer 20

Transdermal
(no increased risk)

Question 21

List 3 possible side effects of HRT

Answer 21

Nausea
Breast tenderness
Fluid retention + weight gain

Question 22

List 5 complications of HRT

Answer 22

Increased risk breast cancer (increased by progestogen)
Increased risk endometrial cancer (reduced but not eliminated by progestogen)
Increased risk VTE (increased by progestogen)
Increased risk stroke
Increased risk IHD if >10y after menopause

Question 23

Management of PID

Answer 23

Ofloxacin + Metronidazole PO
OR
IM Ceftriaxone + oral Doxycycline + oral Metronidazole

Question 24

Management of vaginal candidiasis

Answer 24

1. Fluconazole PO 150mg single dose
2. Clotrimazole 500mg pessary as a single dose if PO contraindicated
   If vulval Sx, consider adding TOP imidazole in addition

Question 25

Management of vaginal candidiasis in pregnancy

Answer 25

100mg Clotrimazole pessary 7 days

Question 26

Management for stress incontinence

Answer 26

Pelvic floor exercises
Surgery: colposuspension
Duloxetine

Question 27

Management of urge incontinence

Answer 27

Bladder training
Oxybutynin (IR) or Tolterodine (IR)

Question 28

Which drug should be used for urge incontinence in elderly to reduce risk of falls?

Answer 28

Mirabegron