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PHASE 3A > Sexual health and Contraception > Flashcards

Sexual health and Contraception Flashcards

1
Q

What is the mechanism of an IUD?

A

contains copper which is toxic to the egg and sperm thus preventing implantation

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2
Q

How long can an IUD remain effective?

A

10 years

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3
Q

When is the IUD contraindicated for use?

A

Abnormal cervix
Unexplained bleeding
Repeated History of STIs
Currrent pelvic infection
Distorted uterus

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4
Q

What is the most effective emergency contraception?

A

IUD- can be used 120 hours after UPSI (5 days)

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5
Q

What is the only suitable contraceptive option for a patient w/ Hx of breast cancer?

A

IUD

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6
Q

What is the mechanism of the IUS?

A

releases progesterone thus interfering with ovulation as it thickens cervical mucus and thins the lining of the uterus

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7
Q

How long can the IUS be used for?

A

5 years

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8
Q

What are the common SE of using the IUS ?

A

Irregular bleeding, spotting, amenorrhoea, ovarian cysts

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9
Q

When would the IUS be a useful contraceptive device?

A

useful for women who get heavy and painful periods

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10
Q

When are IUS use CI?

A

Breast cancer, PID, Unexpalined bleeding, Abnormal uterus/cervix anatomy

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11
Q

What is the mechanism of the implant and how long can it be used for?

A

releases progesterone thus interfering with ovulation as it thickens cervical mucus and thins the lining of the uterus.

Can be used for 3 years

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12
Q

SE of implants?

A

periods may stop, become longer, or become irregular + ACNE

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13
Q

What is the mechanism of Combined Hormonal Contraception (CHC)?

A

Contains oestrogen (inhibits ovulation) and progesterone

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14
Q

What are the different ways the CHC can be administerd?

A

Oral
Transdermal
Intravaginal

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15
Q

What are the different types of COCP?

A

1) Monophasic- each pill contains the same doe of hormones

2) Phasic- pills contain differing amounts of hormones which must be taken in the correct order

3) Everyday pills- usually contains 21 hormone pills and 7 hormone free pills

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16
Q

List 5 CI of using CHC?

A

Less than 6wks postpartum and breastfeeding
RF of VTE
Previous VTE, IHD, Cerebrovascular incident, AFib
Current Breast Cancer
Being age 35+ and smoking >15 cigarettes
Migraine with aura
Liver cirrhosis, hepatocellular adenoma/carcinoma

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17
Q

What are the 4 different regimens for taking CHC?

A

TRADITIONAL- Takes one pill per day/one patch per week/one vaginal ring for 3 weeks followed by 7 day HFI

EXTENDED USE- Continuous use for 9 weeks followed by 7 day HFI

CONTINUOUS USE- continuos use w/o HFI

FLEXIBLE EXTENDED USE- user uses the method until bleeding and when bleeding occurs 4 day HFI

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18
Q

If the COCP is started on the 1st day of the natural period cycle, is extra contraception required to protect from pregnancy?

A

No, the suer will be protected form pregnancy immediately

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19
Q

If the COCP is started on anytime during cycle, is extra contraception required to protect from pregnancy?

A

Yes, user will need to use additional precautions (condoms) for 7 days

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20
Q

Give a name for oral progesterone only contraceptive?

A

Desogestrel

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21
Q

How long does the OCP need to be taken for in order to be effective?

A

7 days

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22
Q

What is the scoring metric used for the potential cautions and CI of COPC use?

A

UKMEC

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23
Q

What are the two ways in which HRT can be used?

A

1) CYCLICALLY- for perimenopausal women who still continue to have periods

2) CONTINUOUSLY- for postmenopausal women who do not have periods

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24
Q

List 3 benefits of HRT?

A

Relief of vasomotor sx
Relief of urogenital sx
Decreases risk of osteoporosis

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25
Q

List 3 risks of using HRT?

A

Increases risk of breast cancer
Increases risk of endometrial cancer
Increases risk ok VTE

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26
Q

What annual check is recommended to women who use the OCP?

A

Blood pressure

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27
Q

What haemantic tests are required in IDA and what would they show?

A

Total Iron Binding Capacity- HIGH
Ferritin- LOW

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28
Q

Cases of Microcytic anaemia?

A

Thalassemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic Anaemia

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29
Q

What is the immediate primary treatment for suspected meningial septicaemia?

A

IM Benzylpenicillin

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30
Q

What criteria is used in GP for dianosis of acute tonsillitis, and what are they?

A

ModifiedCENTOR Criteria (requires 3 out 4 to reach diagnosis of acute bacterial tonsillitis)
-Age 3-14
-History of fever
-Tonsillar exudates
-No cough
-Tender anterior cervical lymphadenopathy

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31
Q

What is the treatment given to patients presenting with otitis externa?

A

Topical acetic acid (combined antibiotic/steroid drops)

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32
Q

What is a common side effect of IUDs?

A

Long and heavier periods

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33
Q

What is a side effect of the depopovera injections and the oral progesterone pills?

A

Weight gain

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34
Q

Which contraceptive is well known for improving the regularity of period cycles and may improve acne?

A

Combined oral contraceptive pill

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35
Q

Which virus can cause slapped cheek syndrome?

A

Parovirus b19

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36
Q

What virus causes a rash in children which tends to start at the face, moves down to trunk and spares the limbs?

A

Rubella

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37
Q

What virus causes hand foot and mouth disease?

A

Cocksackievirus A16

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38
Q

Describe the rash associated with rosella infantum?

A

Macular erythemous rash on trunk following high fever and Coryzal illness

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39
Q

What is the spirometery measurements expected in obstructive lung disease?

A

FEV1 - decreased
Normal FVC
FEV1/FVC ratio <70%
Increase in TLC and RV

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40
Q

What spirometry measurements would you expect in restrictive lung disease?

A

FEV1- decrease
FVC- decrease
FEV1/FVC ratio normal or increase
Decrease in TLC and RV

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41
Q

What is the first line treatment in diabetic neuropathy?

A

Amitryptiline, duloxetine, gabapentin, pregabalin

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42
Q

What is the management of asthma in adults according to NICE guidelines?

A

1st- SABA
2nd- LD ICS
3rd- Add LTRA
4th- Add LABA
5th- MART therapy

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43
Q

What is the causative agent in chlamydia?

A

Chlamydia trachomatis

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44
Q

What is the PEFR in the BTS asthma classification of moderate, severe, and life threatening?

A

Moderate- PEFR 50-75%
Severe- PEFR 33-50%
Life threatening- PEFR <33%

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45
Q

What medications must be ceased in someone with AKI?

A

NSAIDS
Aminoglycosides
ACEI
Diuretics
Angiotensin II receptor antagonist

46
Q

Which cancers is the COCP pill;
A) increases risk against
B) protective against

A

A) breast and cervical

B) ovarian and endometrial

47
Q

Which contraception is a associated with weight gain?

A

Depo provera

48
Q

What is the most common side effect of the POP?

A

Irregular vaginal bleeding

49
Q

What kind of organism causes a Trichomonasis infection?

A

Flagellated protozoan

50
Q

What Sx and signs can be found when a person has trichiomonaisis infection?

A

Profuse yellow vaginal discharge
Strawberry cervix
Dysparenuia
Itching
Post coital bleeding

51
Q

What is the management of Trichomonasis infection?

A

Oral metronidiazole
Abstain from sex for at least a week or until screening has been completed
Contact tracing

52
Q

What is the synonymous finding in chancroid?

A

Painful lesion that bleeds on contact

53
Q

What is the Sx of genital candidiasis and is management?

A

White cottage cheese discharge + itchiness + soreness

Tx- oral fluconazole, vaginal pessary

Topical azoles for vuvlal symptoms

54
Q

What are the signs and symptoms in the different stages of syphyllis infection?

A

Primary- single painless lesion/ulcer

Secondary-
Manifests 4-10 weeks after infection
Symmetrical maculopapular rash (soles, palms and feet)
Mucosal ulcers and lymphadenopathy
Malaise, fever, hepatitis, glomerulonephritis

Tertiary- occurs 20-40 years after primary infection

55
Q

What is the causative organism if syphyllis?

A

Treponema palladium (bacteria)

56
Q

What is the treatment of syphyllis?

A

IM benzathine benzylpenicillin

57
Q

When should ellaone be cautioned for use?

A

In patients with asthma controlled with steroids

58
Q

What is the description for mollascum contagiosum and what’s its management?

A

Small domed shaped flesh colour/pink papules with central indentation

Tx- generally self resolves within 18 months
Can have cryotherapy for aesthetics

59
Q

Management of chlamydia?

A

Oral doxycycline BD 7 days

60
Q

What is the causative organism in genital warts and list sx?

A

HPV 6 + 11
Painless flesh coloured bumps in genital area + itching + burning

61
Q

What is the causative organism of genital herpes?

A

HSV1 and HS2

62
Q

What is Ix and tx of genial herpes?

A

Ix- NAAT/viral PCR
IV acyclovir and analgesia

63
Q

What is the causative organism in Chancroid?

A

Haemophillus Ducreyi

64
Q

What is the tx of chancroid?

A

Ceftriaxone, Azithromycin and Ciprofloxacin

65
Q

What is the causative organism in bacterial vaginosis?

A

Gardnella vaginalis

66
Q

List the ix in bacterial vaginosis?

A

Positive whiff test
clue cells on wet mount
ph >4.5

67
Q

Tx for bacterial vaginosis

A

Metronidazole

68
Q

Tx for genital warts

A

Podophiltoxin ointmnet
Inquuimod crema
Trichloracetic acid
Cryotheraphy

69
Q

Odourless prulent discharge is indicative of what?

A

N. Gonorrhoea

70
Q

What is the most common caustaive organism in PID?

A

Chlamydia

71
Q

What is first line Mx for thrush?

A

Fluconazole oral 150mg single dose

72
Q

How long does it take for the Progesterone-only pill to become effective?

A

48 hours

73
Q

In terms of emergency contraceptive use of Levonorgestrel what changes for patients with a BMI over 26kg/m² or over 70kg

A

Double the dose

74
Q

At what time post partum can an IUD or IUS be inserted?

A

Within 48 hours of childbirth or after 4 weeks

75
Q

For emergency contraception, when must Levonorgestrel be taken?

A

Within 72 hours of UPSI

76
Q

Post-partum when do women require contraception?

A

21 days after giving birth

77
Q

How long does it take for the combined oral contraceptive pill to become effective?

A

7 days

78
Q

You can provide contraception, abortion and STI advice/treatment without parental knowledge or consent to people under 16 provided that. (5)

A

1) Understand all aspects and its implications
2) You can’t persuade them to tell their parents or allow you to tell them
3) Young person likely to have sex with or without treatment
4) Their physical or mental health is likely to suffer
5) Best interest of young person to receive treatment without parental knowledge

79
Q

For emergency contraception, up to how long after UPSI can Ulipristal acetate be taken?

A

120 hours post-UPSI

80
Q

What are the guidelines for stopping non-hormonal contraception before and after 50 years old

A

<50 years old - Stop contraception after 2 years of amenorrhoea

> =50 years old - Stop contraception after 1 years of amenorrhoea

81
Q

What are the guidelines for stopping COCP before and after 50 years old

A

<50 years old - Can be continued to 50 years

> =50 years old - Switch to non-hormonal or progestogen only

82
Q

What are the guidelines for stopping Depo-Provera before and after 50 years old

A

<50 years old - Can be continued to 50 years

> =50 years old - Switch to non-hormonal (stop after 2 years amenorrhoea) OR Switch to progestogen-only method

83
Q

What are the guidelines for stopping Implant, POP and IUS before and after 50 years old

A

<50 years old - Can be continued to 50 years

> =50 years old - Continue,
If amenorrhoeic check FSH and stop after 1 year if FSH >= 30u/l or stop at 55 years old

84
Q

Under what conditions is lactational amenorrhoea a reliable method of contraception

A

Amenorrhoeic
Baby <6 months
Breastfeeding exclusively

85
Q

For patients using the COCP, If 1 pill is missed at any time in the cycle, what is the advice?

A

Take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
No additional contraceptive protection needed

86
Q

For patients using the COCP, If 2 or more pills are missed, what is the advice?

A

Take the last pill even if it means taking two pills in one day, leave any earlier missed pills and continue one a day

Women should use condoms abstain from sex until pills taken for 7 days in a row

87
Q

For patients using the COCP, what is the emergency contraception guidance if 2 or more pills are missed in week 1?

A

Emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

88
Q

For patients using the COCP, what is the emergency contraception guidance if 2 or more pills are missed in week 2?

A

After seven consecutive days of taking the COCP there is no need for emergency contraception

88
Q

For patients using the COCP, what is the emergency contraception guidance if 2 or more pills are missed in week 3?

A

She should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

89
Q

What is the contraceptive advice when switching from a traditional POP to COCP?

A

7 days of barrier contraception is needed

90
Q

After how many hours of missing taking the POP is action required?

A

3 hours

Due to short window of acting

91
Q

What does UKMEC1 mean?

A

No restriction to use of contraceptive

92
Q

What does UKMEC2 mean?

A

Advantages of contraception generally outweigh the disadvantages

93
Q

What does UKMEC3 mean?

A

Disadvantages of contraception generally outweigh the advantages

94
Q

What does UKMEC4 mean?

A

Unacceptable health risk

95
Q

What is the Mx of Gonorrhoea?

A

IM Ceftriaxone

If injection refused use

Oral Cefixime 400mg and 2g Azithromycin Single Dose

96
Q

What two pathogens most commonly cause Urethritis?

A

Chlamydia trachomatis

Mycoplasma genitalium

97
Q

What are the features of epidiymo-orchitis?

A

Unilateral testicular pain and swelling

Ureteral discharge

98
Q

Name the important differential diagnosis epididymo-orchitis?

A

Testicular torsion

99
Q

What is the Ix for epididymo-orchitis?

A

Sexually active younger adults: NAAT for STIs

Older adults with a low-risk sexual history: MSSU

100
Q

What would a

Positive non-treponemal and Positive treponemal test mean

A

Consistent with active syphilis infection

101
Q

What would a

Positive non-treponemal and Negative treponemal test mean

A

Consistent with a false-positive syphilis result

102
Q

What would a

Negative non-treponemal and Positive treponemal test mean

A

Consistent with successfully treated syphilis

103
Q

What is the Mx for occupational exposure to HIV?

A

Immediate washing of wound

Refer to A+E

Post-exposure prophylaxis (PEP) within 72 and taken for 4 weeks

104
Q

If a pregnant person is positive for Chlamydia what is the Mx?

A

Azithromycin or Erythromycin or Amoxicillin

The SIGN guidelines suggest azithromycin 1g stat

105
Q

What are the features of herpes simplex virus infection?

A

Malaise
Fever
Extensive painful oral ulceration
Submandibular lymphadenopathy

106
Q

What type of drug is Tamoxifen?

A

A SERM (Selective Oestrogen Receptor Modulators) acts as a oestrogen receptor antagonist and partial agonist.

Used in the management of oestrogen receptor positive breast cancer

107
Q

What are the adverse effects of Tamoxifen use?

A

Menstrual disturbance
Hot flushes
VTE
Endometrial cancer

108
Q

Give an example of 2 aromatase inhibitors

A

Anastrozole and Letrozole

109
Q

What are aromatase inhibitors?

A

Reduces peripheral oestrogen synthesis

110
Q

What are the adverse effects of aromatase inhibitors?

A

Osteoporosis
Hot flushes
Arthralgia, Myalgia
Insomnia

111
Q

What is the main factor influencing the longevity of a copper IUD?

A

Amount of copper on the device

PHASE 3A (11 decks)

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