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MFSRH Part 2 (2023) > UKMEC Quiz > Flashcards

UKMEC Quiz Flashcards

1
Q

UKMEC for CHC in hepatocellular adenoma

A

4

[3 for progestogen-only methods]
[1 for Cu IUD]

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2
Q

UKMEC for DMPA in SLE with positive antiphospholipid antibodies

A

2
[2 for all progestogen-only methods]
[4 for CHC]
[1 for Cu IUD]

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3
Q

UKMEC for LNG IUD in focal nodular hyperplasia

A

2 (same for all hormonal methods, including CHC)

[1 for Cu IUD]

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4
Q

UKMEC for POP in IBD

A

2 (due to absorption, therefore CHC is the same)

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5
Q

UKMEC for CHC in Sickle cell disease

A

2 (higher VTE risk than patients without sickle cell disease)

[1 for progestogen-only methods]
[2 for Cu IUD due to possible anaemia]

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6
Q

UKMEC for Cu IUD in thalassaemia

A

2
[because of anaemia]
[all other methods are UKMEC 1]

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7
Q

UKMEC for CHC in benign focal nodular hyperplasia (liver tumours)

A

2 (same as all hormonal methods)

[1 for Cu IUD]

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8
Q

UKMEC for CHC in SLE without antiphospholipid antibodies

A

2 (same as all progestogen only methods)

[becomes a 4 WITH antiphospholipid antibodies]

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9
Q

UKMEC for DMPA in thyroid disorders

A

1

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10
Q

UKMEC for CHC in medically treated but symptomatic gallbladder disease

A

3 (2 if treated with cholecystectomy or asymptomatic)

[all progestogen-only methods are a 2 regardless of symptoms or treatment]

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11
Q

UKMEC for implant in asymptomatic gallbladder disease

A

2

[2 for all hormonal methods, including CHC]
[1 for Cu IUD]

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12
Q

UKMEC for CHC in previous obstetric cholestasis

A

2 (1 for everything else)

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13
Q

UKMEC for commencing CHC in someone who has an acute flare of viral hepatitis

A

3
But a 2 for continuing the method

[UKMEC 1 for all other methods with hepatitis, regardless of acuteness/chronicity]

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14
Q

UKMEC for LNG-IUD in someone with severe (decompensated) liver cirrhosis

A

3
[3 for all progestogen-only methods]
[4 for CHC]
[1 for Cu IUD]

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15
Q

UKMEC for implant in someone with past COC related cholestasis

A

2
[2 for all progestogen only methods]
[3 for CHC]
[1 for Cu IUD]

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16
Q

UKMEC for initiating Cu IUD in someone with HIV who has a CD4 count <200

A

3 (but a 2 for continuining)
Same as LNG IUD

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17
Q

UKMEC for initiating LNG IUD in someone with HIV who has a CD4 count >200

A

2 (same as Cu IUD)

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18
Q

UKMEC for starting CHC in someone with pelvic tuberculosis

A

1
[all are 1 apart from IUCs - they are 4 for initiating, and 3 for continuing)
[all method are a 1 for non-pelvic TB]

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19
Q

UKMEC for initiating Cu IUD in someone with pelvic tuberculosis

A

4
But a 3 for continuing
Same as LNG IUD

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20
Q

UKMEC for DMPA in someone with nephropathy/retinopathy/neuropathy in a diabetic

A

2

[although clinically this patient probably also has vascular disease?? And UKMEC for DMPA in vascular disease with HTN is a 3]

[2 for all progestogen-only methods]
[3 for CHC]
[1 for Cu IUD]

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21
Q

UKMEC for CHC in someone with vascular disease who has diabetes

A

3

[2 for progestogen only methods]
[1 for Cu IUD]

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22
Q

UKMEC for fitting a Cu IUD in someone with known uterine fibroids with distortion of the uterine cavity

A

3 (same for LNG IUD)

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23
Q

UKMEC for fitting an LNG IUD in someone with a previous history of PID

A

1 (same as Cu IUD)

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24
Q

UKMEC for fitting a Cu IUD in someone with current PID

A

4
(but a 2 for continuing)

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25
Q

UKMEC for fitting an LNG IUD in someone with symptomatic chlamydia infection

A

4
(but a 2 for continuing, and a 3 if asymptomatic)

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26
Q

UKMEC for fitting a Cu IUD in someone who has purulent cervicitis or gonorrhoea

A

4
(but a 2 for continuing)

[GC the UKMEC is 4 regardless of symptoms, CT the UKMEC changes based on symptoms - 4 for symptomatic, 3 for asymptomatic]

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27
Q

UKMEC for fitting an LNG-IUD in someone with vaginitis (including TV and BV)

A

2 (same as Cu IUD)

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28
Q

UKMEC for fitting an LNG IUD in someone with CIN

A

2

[but 1 for Cu IUD]
[also a 2 for DMPA and CHC]
[but a 1 for imp and POP]

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29
Q

UKMEC for giving DMPA in someone with cervical cancer awaiting treatment

A

2

[1 for POP only]
[2 for imp and CHC - although personally would argue the VTE risk of having cancer would rule out CHC]
[4 for initiating IUCs, 2 for continuing IUCs]

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30
Q

UKMEC for fitting a Cu IUD in someone who has had a radical trachelectomy for cervical cancer

A

3 (same as LNG IUD)

[POP is the only UKMEC 1]
[DMPA, Imp, CHC are UKMEC 2]

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31
Q

UKMEC for continuing someone’s CHC if they have an undiagnosed breast mass / breast symptoms

A

2
(3 for initiating)

[2 for progestogen only methods - does not specify difference between continuing or initiating]
[1 for Cu IUD]

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32
Q

UKMEC for CHC in family history of breast cancer

A

1

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33
Q

UKMEC for CHC in someone who is a known carrier of BRCA gene

A

3

[2 for progestogen only methods]
[1 for Cu IUD]

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34
Q

What is the only UKMEC 1 method in current breast cancer

A

Cu IUD

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35
Q

UKMEC for continuing someone’s Cu IUD after they have been diagnosed with endometrial cancer

A

2
[UKMEC 4 for initiating]

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36
Q

UKMEC for CHC in someone with previous ovarian cancer

A

1

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37
Q

UKMEC for CHC in someone with idiopathic intracranial hypertension

A

2

[1 for everything else]

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38
Q

UKMEC for DMPA in someone with unexplained vaginal bleeding (suspicious for serious condition) before evaluation

A

3 (same as implant)

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39
Q

UKMEC for Cu IUD in someone with endometriosis

A

2 (due to increased risk of dysmenorrhoea and IMB/HMB)

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40
Q

UKMEC for LNG IUD in someone with benign ovarian tumours, including cysts

A

1

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41
Q

UKMEC for Cu IUD in someone with GTD but has decreasing hCG levels

A

3 (same as LNG IUD)

[UKMEC 1 for all other methods]

42
Q

UKMEC for CHC in someone with malignant GTN

A

1 (?? are these patients at increased risk of VTE though)

43
Q

UKMEC for CHC in uncomplicated valvular / congenital heart disease

A

2 (4 when complicated)

[1 for all other methods]

44
Q

UKMEC for DMPA in someone with complicated valvular or congenital heart disease (i.e. pulmonary HTN or bacterial endocarditis)

A

1 (same as POP and imp)

[2 for both IUDs]
[4 for CHC]

45
Q

UKMEC for LNG IUD in someone with complicated valvular or congenital heart disease (i.e. pulmonary HTN or bacterial endocarditis)

A

2 (same as Cu IUD)
- Doesn’t differentiate between initiation or continuation

[4 for CHC]
[2 for other progestogen-only methods]

46
Q

UKMEC for CHC in cardiomyopathy with impaired cardiac function

A

4 (2 if normal cardiac function)

[UKMEC 2 for everything else with impaired function, UKMEC 1 for everything else with normal function]

47
Q

UKMEC for CHC in AF

A

4

[2 for all progestogen only methods]
[1 for Cu IUD]

48
Q

UKMEC for DMPA in someone with AF

A

2 (same as imp, POP, IUS)

49
Q

UKMEC for initiating Cu IUD in someone with AF

A

1 (but 2 for LNG-IUD)

50
Q

UKMEC for initiating LNG IUD in someone with known long QT syndrome

A

3
(a 1 for continuing)
- same as Cu IUD

[DMPA and CHC are a 2, IMP and POP are a 1]

51
Q

UKMEC for continuing CHC in someone with severe non-migrainous headaches

A

2 (would be a 1 for initiating)

52
Q

UKMEC for continuing CHC in someone with migraine without aura

A

3 (would be a 2 for initiating)

[POP and Cu IUD are the only ones that are a 1, but POP becomes a 2 for continuing]

53
Q

UKMEC for CHC in someone who used to have migraines with aura (>5 years ago)

A

3
(would be a 4 if current / more recent)

54
Q

UKMEC for DMPA in someone with a current VTE on anticoagulants

A

2 (same for POP, imp, IUS)

55
Q

UKMEC for CHC in family history of VTE (first-degree relative age <45 years)

A

3
Would be a 2 if 45 years or older

56
Q

UKMEC for CHC in someone having major surgery with prolonged immobilisation

A

4
(is a 2 without prolonged immobilisation)

57
Q

UKMEC for implant in someone having major surgery with prolonged immobilisation

A

2 (same for IUS, POP, DMPA)

58
Q

UKMEC for CHC in a long-term wheelchair user

A

3

59
Q

UKMEC for CHC for someone with superficial venous thrombosis

A

2

60
Q

UKMEC for CHC in someone with protein C deficiency

A

4 (any known thombogenic mutations)

[2 for all progestogen only methods]
[1 for Cu IUD]

61
Q

UKMEC for DMPA for someone with factor V leiden

A

2 (same as all hormonal methods apart from CHC)

62
Q

UKMEC for CHC for BMI 32 with recent bariatric surgery

A

2 (just depends on their current BMI. Take into account any oral malabsorption issues though)

63
Q

UKMEC for initiating LNG IUD in someone with a complicated organ transplant

A

3 (would be a 2 for continuing) - same as Cu IUD

UKMEC 2 if uncomplicated organ transplant

64
Q

UKMEC for CHC in someone with an uncomplicated renal transplant

A

2 (would be a 3 if complicated)

UKMEC 2 for all contraceptives in uncomplicated organ transplants

65
Q

UKMEC for DMPA in someone who smokes, is obese, and has diabetes

A

3 (i.e. multiple risk factors for CVD)
- The other contraceptive this would be a 3 for is CHC
- The rest hormonal options are UKMEC 2
- Cu IUD is UKMEC 1

66
Q

UKMEC for DMPA in someone with adequately controlled HTN

A

2 (1 for other progestogen-only methods, 3 for CHC)

67
Q

UKMEC for CHC in someone with BP >160/100

A

4

[UKMEC 2 for DMPA]
[UKMEC 1 for everything else]

68
Q

UKMEC for DMPA in someone with known peripheral vascular disease (under the HTN section)

A

3
- Would be UKMEC 2 for imp, POP, IUS
- UKMEC 1 for Cu IUD
- UKMEC 4 for CHC

69
Q

UKMEC for CHC in someone with known vascular disease

A

4

[3 for DMPA]
[2 for POP, imp, LNG IUD]
[1 for Cu IUD]

70
Q

UKMEC for CHC in someone with previous history of high BP during pregnancy

A

2

71
Q

UKMEC for LNG IUD in someone with a history of IHD

A

2 for initiating
3 for continuing

72
Q

UKMEC for implant in someone with a history of TIA

A

2 for initiating
3 for continuing
(Same as IHD. Same as POP)

73
Q

UKMEC for DMPA in history of TIA

A

3 (same as IHD)
DMPA is the only progestogen-only method where it is a 3 for both initiating AND continuing

74
Q

UKMEC for CHC in someone with known dyslipidaemia

A

2 (same as all hormonal contraceptives)

75
Q

UKMEC for Cu IUD in someone who is 27 days post partum

A

3

76
Q

UKMEC for CHC in a smoker who is 32 years old

A

2 (any number of cigarettes)

77
Q

UKMEC for CHC in someone who is 36 and only smokes 2 a day

A

3 (would be 4 if smokes more than 15 a day)

78
Q

UKMEC for CHC in someone who is 40 but stopped smoking 18 months ago

A

2 (becomes a 2 when stopped ≥1 year ago. Is a 3 if stopped <1 year ago)

79
Q

UKMEC for CHC based on BMI

A
  • BMI ≥30-34 = UKMEC 2
  • BMI ≥35 = UKMEC 3
80
Q

UKMEC for CHC in someone who is 5 weeks post partum and breastfeeding

A

4 (turns to 2 once over 6 weeks and still breastfeeding, and turns to a 1 once 6 months post partum)

81
Q

UKMEC for DMPA in someone who is 5 weeks post partum and breastfeeding

A

2

82
Q

UKMEC for CHC who is 5 days post partum but VTE score of 0 and not breastfeeding

A

3 (turns to a 4 if any additional VTE risk factors)

83
Q

UKMEC for CHC in someone who is 4 weeks post partum but VTE score of 0 and not breastfeeding

A

2 (would be a 3 if additional VTE risk factors)

  • If NOT breast feeding, and no VTE risk factors, and >3 but <6 weeks post-partum, UKMEC 2
  • If NOT breast feeding, but VTE risk factors, and >3 but <6 weeks post-partum, UKMEC 3
  • UKMEC 1 once over 6 weeks and NOT breastfeeding
84
Q

UKMEC for DMPA in someone who is 4 weeks post partum and has a VTE score of 3 but is not breastfeeding

A

2 (would be a 1 without additional VTE risk factors)

85
Q

List the UKMEC 4s for POP

A

Current breast cancer

86
Q

List the UKMEC 3s for POP

A
  • Hepatocellular adenoma
  • Hepatocellular carcinoma
  • Severe (decompensated) liver cirrhosis
  • Past breast cancer
  • Continuation of with stroke / IHD
87
Q

List the UKMEC 4s for progestogen only injection

A

Current breast cancer

88
Q

List the UKMEC 3s for progestogen only injection

A
  • Hepatocellular carcinoma
  • Hepatocellula adenoma
  • Severe (decompensated) liver cirrhosis
  • Past breast cancer
  • Unexplained vaginal bleeding (suspicious for serious pathology)
  • Stroke
  • IHD
  • Vascular disease
  • Multiple risk factors for CVD
89
Q

UKMEC for LNG IUD insertion in under 20s

A
  • 2 if <20
  • 1 if ≥20
  • Same for Cu IUD
90
Q

UKMEC for DMPA by age

A
  • menarche to <18 = UKMEC 2
  • 15-45 = UKMEC 1
  • > 45 = UKMEC 2

[and advise a woman over 50 stop DMPA, although not in UKMEC specifically]

91
Q

UKMEC for age in CHC

A
  • Menarche to <40 = 1
  • ≥40 = 2

[and advise someone over 50 to stop CHC, although not in UKMEC specifically]

92
Q

UKMEC for IUDs in nulliparous women

A

UKMEC 1

93
Q

UKMEC for IUD in past ectopic pregnancy

A

1

94
Q

UKMEC for IUC in history of pelvic surgery

A

1

95
Q

List the UKMEC 4s for implant

A

Current breast cancer

96
Q

List the UKMEC 3s for implant

A
  • Continuing if has IHD or stroke whilst using it
  • Unexplained vaginal bleeding suspicious for serious condition
  • Past breast cancer
  • Severe (decompensated) liver cirrhosis
  • Hepatocellular adenoma
  • Hepatocellular carcinoma
97
Q

List the UKMEC 4s for CHC

A
  • Breastfeeding and <6 weeks post partum
  • Not breast feeding, under 3 weeks post partum with VTE risk factors
  • Age ≥35 and smokes ≥15 cigarettes a day
  • BP ≥160/100
  • Vascular disease with HTN
  • History IHD or stroke
  • History / current VTE
  • Major surgery with prolonged immobilisation
  • Known thrombogenic mutations
  • Complicated valvular and CHD
  • Cardiomyopathy with impaired cardiac function
  • Migraine with aura, any age
  • Current breast cancer
  • Severe, decompensated liver cirrhosis
  • Hepatocellular adenoma
  • Hepatocellular carcinoma
  • SLE with positive antiphospholipid antibodies
  • Positive antiphospholipid antibodies
98
Q

List the UKMEC 3s for CHC

A
  • Not breast feeding, no VTE risk factors, but under 3 weeks post partum
  • Not breast feeding, has VTE risk factors, 3-6 weeks postpartum
  • Age ≥35 and smokes <15 cigarettes a day
  • Age ≥35 and stopped smoking <1 year ago
  • BMI ≥35
  • Complicated organ transplant
  • Multiple risk factors for CVD
  • Adequately controlled HTN
  • BP >140/90
  • First degree relative FH VTE <45
  • Immobility (wheelchair use e.g.)
  • Continuing if develops migraine without aura
  • History (≥5 years ago) migraine with aura
  • Initiating with undiagnosed breast mass/symptoms
  • BRCA carrier
  • Past breast cancer
  • Nephropathy/retinopathy/neuropathy secondary to diabetes
  • Other vascular disease secondary to diabetes
  • Medically treated / current gallbladder disease
  • Past COC related cholestasis
  • Initiating in acute flare of viral hepatitis
99
Q

List the UKMEC 4s for Cu IUD

A
  • Postpartum sepsis
  • Post-abortion sepsis
  • Unexplained vaginal bleeding suspicious for serious condition (initiation)
  • Persistently elevated hCG levels or GTN
  • Awaiting treatment for cervical cancer (initiation)
  • Endometrial cancer (initiation)
  • PID (initiation)
  • Symptomatic CT (initiation)
  • GC or purulent cervicitis (initiation)
  • Pelvic TB (initiation)
100
Q

List the UKMEC 3s for Cu IUD

A
  • 48 hours - <4 weeks post partum
  • Initiating with complicated organ transplant
  • Initiating with prolonged QT
  • Decreasing hCG levels (GTD)
  • Post radical trachelectomy for cervical cancer
  • Distortion of uterine cavity (fibroids or anatomical abnormalities)
  • Asymptomatic chlamydia
  • Initiating HIV CD4 count <200
  • Continuing in pelvic TB
101
Q

List the UKMEC 4s for LNG IUD

A
  • Postpartum sepsis
  • Post abortion sepsis
  • Initiating in unexplained vaginal bleeding suspicious for serious condition
  • Persistently elevated hCG levels / malignant GTN
  • Initiating cervical cancer awaiting treatment
  • Current breast cancer
  • Initiating current endometrial cancer
  • Initiating current PID
  • Initiating symptomatic CT
  • Initiating GC or purulent cervicitis
  • Initiating pelvic TB
102
Q

List the UKMEC 3s for LNG IUD

A
  • 48 hours to <4 weeks post partum
  • Initiating in complicated organ transplant
  • Continuing if IHD/stroke occurs during use
  • Initiating in prolonged QT
  • Decreasing hCG levels (GTD)
  • Post radical trachelectomy for cervical cancer
  • Past breast cancer
  • Distortion of uterine cavity (fibroids or anatomical abnormality)
  • Asymptomatic chlamydia infection
  • HIV CD4 count <200 (initiating)
  • Continuing pelvic TB
  • Severe, decompensated liver cirrhosis
  • Hepatocellular adenoma
  • Hepatocellular carcinoma

MFSRH Part 2 (2023) (22 decks)

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