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1 Obs & Gyn > STIs and Contraception > Flashcards

STIs and Contraception Flashcards

1
Q

What are the components of a sexual history?

A

PC- dysuria, pain, itch, discharge, bleeding, systemic syx

BBV risk

Gynae history

Partners

Gender based violence

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2
Q

What questions should you ask in the BBV risk section?

A

nationality of partner
IV drug use
Partner high risk HIV/Hep B/C?
Non professional tattoo/piercing
Paid for sex?

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3
Q

What should you ask about in the gynae history?

A

assess pregnancy risk
last menstrual period
contraception
smear up to date
HPV vaccines

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4
Q

What test is available for herpes simplex virus?

A

PCR test via swab

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5
Q

What is the management of herpes?

A

aciclovir
saline bathing

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6
Q

What is the latest time post exposure prophylaxis for HIV can be administered?

A

72 hours

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7
Q

What is the length of course for post exposure prophylaxis?

A

28 days

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8
Q

What agents are used for post prophylactic exposure?

A

truvada and raltegravir

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9
Q

Patient presents to A&E with unprotected anal sex with another male. When would you test for HIV?

A

at 8 weeks

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10
Q

Name one criteria for prescribing HIV pre exposure prophylaxis

A

MSM or transwoman who has had >2 partner in past 12 months or STI in past 12 months

Partner with HIV detectable viral load

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11
Q

Which virus causes genital warts?

A

HPV 6 and 11

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12
Q

What is the management of genital warts?

A

Imiquimod
Cryotherapy
Podophyllotoxin

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13
Q

What is the most common cause of abnormal discharge?

A

bacterial vaginosis

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14
Q

What is normal vaginal pH?

A

4-4.5

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15
Q

What is the pH of someone with bacterial vaginosis?

A

> 4.5

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16
Q

How is bacterial vaginosis diagnosed?

A

Thin homogenous discharge
High pH
Miscroscopy

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17
Q

What is the name of the criteria to diagnose bacterial vaginosis?

A

Amsel’s criteria

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18
Q

Which cells can be seen on microscopy in bacterial vaginosis?

A

clue cells

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19
Q

What is the most common causative agent of candida?

A

candida albicans

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20
Q

How is candida diagnosed?

A

history and macroscopic appearance
pH <5
miscroscopy

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21
Q

What is the management of uncomplicated candida?

A

pessary or cream clotrimazole
fluconazole

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22
Q

Name two indicator conditions for HIV

A

thrombocytopaenia
recurrent shingles
recurrent bacterial pneumonia
dementia
any STIs

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23
Q

What are the stages of syphilis infection?

A

primary lesion (chancre)
secondary lesion (Rash)
latent serology
tertiary syphilis (CDV, neuo)

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24
Q

How many days after giving birth do you need contraception?

A

21 days

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25
Q

How many days after an abortion to you require contraception?

A

5 days

26
Q

When do you need to use contraception until?

A

45-50 and 2 years amenorrhoea (with no OCP use)
50 and 1 year amenorrhoea
until 55 years old

27
Q

How long does it take to exclude pregnancy following unprotected sex?

A

3 weeks/21 days

28
Q

Name three contraception options where there are no user failures

A

copper IUD
Female and male sterilisation
Levonorgestrel releasing intrauterine system
progestogen only implant

29
Q

List three side effects of hormonal contraception

A

irregular bleeding
headache
mood swings
acne
weight gain
breast tenderness
vaginal dryness
greasy skin/hair
chloasma

30
Q

What is chloasma?

A

=melasma (facial pigmentation)

31
Q

What is the MOA of the implant?

A

prevents ovulation

32
Q

What is the MOA of the hormonal intrauterine device?

A

progestogen- thins endometrium and thickens mucus

10% inhibition of ovulation

33
Q

What is the lifespan of IUS?

A

3-5 years

34
Q

What are the disadvantages of IUS?

A

minor medical procedure to insert- can be painful
risk of vaginal bleeding/spotting 3-6 months after
small chance of infection

35
Q

What is the MOA of the IUD/copper coil?

A

copper kills sperm, stops implantation, mucus thicker

36
Q

Name two disadvantages of the IUD

A

painful
heaver bleeding
perforation and expulsion risk
infection risk

37
Q

What is the MOA of progestogen injection?

A

prevents ovulation

38
Q

Name two disadvantages of progestogen injection?

A

every 3 months
delay in return to fertility
weight gain
erratic bleeding

39
Q

What are the two options for progestogen only injection?

A

depo provera
sayana press- sub cut injection (Self-administered)

40
Q

Which OCP can be used in migraines?

A

progestogen only pill

41
Q

Name one example of progestogen only pill?

A

desogestrel

42
Q

Which contraceptive methods reduce the risk of endometrial and ovarian cancer?

A

progestogen only pill and injection

43
Q

What is the MOA of the combined hormonal pill?

A

prevents ovulation

44
Q

Which contraceptive method is associated with increased risk of breast and cervical cancer?

A

combined OCP

45
Q

List three contraindications for combined hormonal contraception

A

CDV disease
VTE risk factors
migraine with aura
cancer- breast/liver
post-natal

46
Q

Female missed one pill. What advice do you give them?

A

no condoms needed, no emergency contraception. Take the last missed pill and continue the pack (2 in one day)

47
Q

Female misses three pills in a row. What do you advise them?

A

need to ask where in the pack (for any >2 pills)

48
Q

Female misses two pills in the first week. What advice do you give her?

A

condoms for 7 days
emergency contraception might be needed- seek advice

49
Q

Female misses three pills in the second week. Advice?

A

Use condoms for 7 days
NO EC needed
carry on taking pills as usual

50
Q

Female misses 4 pills in week 3. Advice?

A

condoms for 7 days and no EC needed. Start next packet of pills without a break

51
Q

How do you assess Fraser competency?

A

Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed?
Is it impossible to persuade the child to tell their parents, or let the Doctor tell them?
Are they likely to begin or continue having sexual intercourse with or without contraception?
Are their physical or mental health likely to suffer unless they get the advice or treatment?
Is the advice or treatment in their best interest?

52
Q

List two options for emergency contraception

A

Cu IUD
Ulipristal acetate EC
Levonorgstrel EC

53
Q

What is the time frame of Cu IUD?

A

within 5 days of unprotected sex

54
Q

When can Cu IUD be inserted?

A

A copper IUD can be inserted up to 5 days after unprotected intercourse or 5 days after the calculated ovulation day or anytime in the cycle if a high sensitivity pregnancy test is negative.

55
Q

Patient needs emergency contraception 4 days after they had unprotected sex. Which EC method can they not opt for?

A

can’t do levonorgestrel (within 72 hours)

56
Q

List three unacceptable risks wherein the combined OCP cannot be prescribed/considered

A

UKMEC4:
- >35 years old and smoker of > 15 cigarettes per day
- migraine with aura
- Personal history of deep vein thrombosis or pulmonary embolism
- Personal history of stroke or ischaemic heart disease
- Uncontrolled hypertension
- Breast cancer
- Recent major surgery with prolonged immobilisation
- Breast feeding and < 6 weeks postpartum earliest expected day of ovulation

57
Q

Aside from contraception, name three other indications for the COCP

A

aids heavy menstrual bleeding
dysmennorhoea
symptoms of endometriosis
treatment of PCOS
menopausal symptoms may improve
acne
reduction in benign ovarian cysts and tumours

58
Q

Which cancers does COCP reduce the risk of?

A

endometrial and ovarian cancer
colorectal cancer

59
Q

Name two contraindications for COCP

A

high BMI
smoking
VTE
IHD
migraines
hypertension
stroke hx
liver disease

60
Q

How does the COCP prevent pregnancy

A

inhibits ovulation
thickens cervical mucus
thins endometrium

1 Obs & Gyn (31 decks)

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