Unit 2 Flashcards
What ages do you need to have a cervical screening test
25-49 every 3 yrs
50-64 every 5 yrs
How often do you need to have breast cancer screenign
Every 3 yrs between the ages of 50-70
How do you take COCs
21 day pills
7 day break
How long to intra-uterine progesterone only systems last
5 yrs
How often do progesterone only implants last
3 yrs
How often do prog-only injections last
3 months
If you’re sick within 2 hrs of taking the pill what do you do
Take another one straight away
What happens is you miss a coc- microgynon
less than 12 hrs ago-take it straight away- still covered
More than 12 hrs/missed more than 1 pill- tkae pill and check how many pills are left. if theres 7 or more use condoms for 7 days
If there less than 7 just finish this pack then start new one with no break and use condoms for 7 days
Whats the latest you can take a POP
3 hrs late or 12hrs for desogesterel
What are the 2 methods of emergency contraception
Intra-uterine device
Emergency Hormonal contraceptive
What is the main ingredient Levonelle
What dose do you take it at
When do you take it
How does it work
Leveorgestrel
1.5mg tab once stat
Within 3 days- max effectiveness within 12 hrs
Works by preventing ovulation and fertilization- prevent the surge in LH
How many days after unprotected sex can you take ella one
5 days
Whats the main ingredient in ellaOne
Ulipristal acetate
What happens in patient needs EC and is taking an inducer e.g. Carbamazepine
Give double the dose of Levenoelle (2 tabs)
What are the legal requirments of termination of pregnancy
2 drs need to certify there are good reasons for doing the abortion
Can do under 16s without parental consent if she can make an informed decision
What are the 2 tabs that you need to take to have an abortion
Mifepristone and Misoprostol
Explain the treatment for abortion within 7 weeks
Mifepristone 200mg orally - 24-48 hrs the misoprostol 400mcg
Less than 9 weeks
Mifiepristone 200mg orally then 24-48hs layer 800mcg of misoprostal either vaginally, buccal or sublingual
Between 7-9 weeks
Mifepristone 200mg, Misoprostal 800mcg, if abortion doesn’t occur within 4 hrs give another misoprostal 400mcg
9-13 weeks
Mifepristone 200mg, 36-48rs give Misoprostal 800mcg vaginally, Misoprostal 400mcg every 3 hrs (max 4 further doses of misoprostal)
13-24 weeks
Mifespristone 200mg orally, 36-48hrs later misoprostal 800mcg vaginally.
misoprostal 400mcg (max 4 further doses 3hrs apart)
If abortion hasn’t occurred give Mifepristone 200mg 3 hrs after last misoprostal
What is arthrotec and why do women have to be caredul with taking it
Diclofenac +misoprostal as a gastro protectant - cna cause miscarriages- BE CAREFUL
What is the importance of finasteride in women at child bearing age
If absorbed through the skin/ take Orally by a women whose pregnant with a male foetus can cause malformed genitals
What is the importance of Methotrexate in women at child bearing age
Birth defects, harms the unborn child due to malformations of the skull, face, heart or blood vessels or causes miscarriage
How many days treatment can you give of isotretinoin
28 days
How many days is the isotrtinoin Rx valid for
7 days
What is dysmenorrhea
Painful cramping in lower abdomen and radiates to thighs
At what age dysmenorrhea peak
late teens, early 20s
When are dysmenorrhea symptoms the worst
1st day
What is primary dysmenorrhea
No identifiable cause
What is secondary dysmenorrhea
Underlying pelvic pathology such as endometriosis, Fibroids, PID
Why are IUDs not recommended for dysmenorrhea
Inserting of device causes inflammation triggering the release of PGs
What symptoms are associated with the intense pain
N+V and migraine
What is the physiological reason for dysmenorrhoea
imbalance of uterine prostaglandins
1st line treatment for primary dysmenorrhea
NSAIds- ibuprofen, mefanamic acid or naproxen- inhibit PGs or hormonal contraception or TENS
When is hormonal contraception contraindicated in Dysmenorrhea
Obese, VTE, high BP
When do the onset of symptoms occur for primary Dys
6-12 months after first period
When is pain present in primary and secondary dysmenorrhea
primary- 1st day and few days before period
secondary- pain throughout the cycle
What is meorrhagia
Excessive menstrual blood loss over several cycles
What are the underlying causes of menorrhagia
hypothyroidsm, kidney/liver, coagulation disorders
pelvic patholgoies lile endometriois, PID and fibroids
Iatrogenic causes such as chemo or anticoagulant
What are the treatment options for menorrhagia
Levenorestrel-releasing intrauterine device
Tranexamic acid- NSAIDs
COC
oral norethisterone or long acting progesterone
What is endometriosis
endometrial tissue outside the uterine
How is endometriosis thought to happen
Retrograde menstruation
genetic predisposition, immune dysfuntion, metaplasia
Symptoms of endometriosis
Symptoms of dysmenorrhea
PG levels increase
Reduction in bone mass
Where does PID affect
Female upper genital tract-uterus, fallopian tubes and ovaries
Treatment of Endometriosis
Analgesia
COC + non-contraceptive progesterone (medroxyprogesterone) + POP
Symptoms of PID
Bilateral lower abdo pain Bilateral abnormal abdo apin Deep dyspareunia abnormal vag bleeding fever over 38
When do you have the highest risk of PID
Under 25, not using barrier contraception,
history of new sexual partner
What is menopause
12 months of amenorrhoea `
What happens in the phase before menopause to estrogen and inhibin
Ostrogen and inhibin levels decreased and reduced feedback to the pituitary results in rise in FSH and LH levels
What symptoms are caused by reduced oestrogen in menopause
Hot flushes +Night sweats muscoskeletal (joint and muscle pain) Effects on mood (low mood) urogenital symptoms (vaginal dryness) Sexual difficulties (low sexual desirE) Osteoporosis CHD-imbalance of lipid profile
How do you establish menopause
Low oestrogen and persistently high FSH and LH
Treatment of Menopause
HRT Surgery Ethinylestradiol Tibolone Raloxifene
What are the side effects of the HRT
Increases risk of breast cancer, cervical cancer, endometrial and ovarian cancer, venous thromboembolism, stroke and CHD
Side effects of Ethinylestradiol
Short term treatment for oestrogen deficiency
What symptoms does tibolone treat
treats vasomotor symptoms
SE of raloxifene
treats and prevents postmenopausal osteoporosis
What is the 1st line outpatient regimen for PID
IM ceftriaxone 500mg single dose
Doxycylcine 100 BD
Metronidazole 400mg BD for 14 days
2nd line outpatient regimen for PID
Oral ofloxacin 400mg BD orally and Metronidazole 400mg BD for 13 days
What are the main complications associated with PID
Tubal infertility, ectopic pregnancy and chronic pelvic pain
What is the usual cause of PID
STI
What are the symptoms of chamydia in women
Discharge, heavy periods, bleedings between periods, and pain
What are the symptoms of chamydia in
White, cloudy or watery discharge, swollen testicles, burning, pain on urinating,
How do women and men test themselves with chlamydia
women: swab
Males: urine sample or swab around urethra
Treatment for Chlamydia
Azithromycin one dose stat
or
Doxycyline BD for 7 days
Describe the symptoms of genital herpes
blisters around genitals, rectum, thighs and buttocks
Pain urinating
Stinging of genitals
Flu-like symptoms
Treatment of genital herpes
Antivirals like Acyclovir
Symptoms Genital Warts
Warms around genital area for both sexes
Can condoms treat you against genital warts
No because the condom doesn’t cover all the area around e.g. thighs, testicles
Treatment of genital warts
use creams/lotions like podophyllotxin or physical removal
Symptoms of gonorrhoea
Thick and green/yellow discharge, bleeding between periods and pain on urination
How is HIV transmitted
Contaminated body fluids
Symptoms of HIV
Raised temp, sore throat, body rash, joint pain, swollen glands, weight loss
Treatment of HIV
Antivirals and Emergency HIV drugs like PEP medication
Symptoms of public lice
scratching causing itching and inflammation
Black powder in underwear
Blue spots on thighs and lower abdo
Treatment of public lice
Insecticides- topical wash
Symptoms of primary syphilis
1 or more painless ulcers/sores on penis opening, vagina or even the mouth
What is secondary syphilis
4-10 weeks after ulcers you develop a rash, have patchy hair loss, flu-like symptoms
Treatment of syphillis
3 Penicillin injection into buttocks or 28 day course of AB
What are the symptoms of trichomona vaginalis for women
Abnormal vag discharge, soreness, itchy, smell and pain
What are the symptoms of trichomona vaginalis in men
thin white discharge, soressness, pain on urination and ejaculation
What is the definition of infertile
Unable to conceive within a year
For women aged 35 and older, after how long is infertility diagnosed
pregnancy hasn’t occurred within 6 months of trying
For women younger than 35, after how long is infertility diagnosed
1 yr of trying to get pregnant
What is primary infetility
Never conceived a child
What is secondary infertility
Had a child before but can’t have another
What are the 3 types of treatment to restore fetility
Medical, surgical or assisted reproduction techniques
What are the 4 main causes of fertility
25%- unknown
25%- ovulatory disorders
20%- tubal damage
30%- abnormal sperm
How long of unprotected sexual intercourse is recommended before IVF should be tried
2 yrs
What are the 2 types of ovulatory problems
Infrequent ovulation- Oligoovulation
absence of ovulation-Anovulation
What is Oligozoospermia
Decreased number of sperm
What is Asthenozoospermia
Decreased sperm motility
What is teratozoospermia
Abnormal shaped sperm
What is primary spermatogenic failure
Failure to produce sperm
What is Hypogonadism
Low testosterone levels
What is retrograde ejaculation
Semen enters the bladder instead of out the penis
How is an erection caused
Vasorelaxation of the arteries and arterioles supplying the erectile tissue- increase in penile blood flow, increase in sinusoidal filling- compressing the venous, occluding venous outflow
Before a man is classed as a non-responder, which medication for Erectile dysfucntion should he have taken
8 doses of PDE-V at max strength with sexual stimulation
What is the max recommended cycling allowed for ED p/week
3 hrs
Which drugs work on the CYP1A2 receptors and what is happening to the clearance
Theophylline, clozapine, olanzapine, Caffeine
Decrease clearance
Which receptors does nicotine work on
CYP2A6
Increases clearance
Which drugs work on the CYP2D6 receptors and what happens to the clearance
Citalopram, fluoxetine, metoprolol and dextromethorpahn
Increase clearance
Which drugs
Clearance?
CYP2C9
Phenytoin and glyburide
Increases clearance
What is the normal length of pregnancy
37-42 weeks
What is pre term
less than 37 weeks
What is the neonatal period
up to 28 days
Why does Respiratory distress syndrome occur
Lack of pulmonary surfactant at birth- usually happens in preterm babies
What is first line for seizures in neonates
Phenobarbital
What is second and third line for seizures in babies
DAIZEPAM- can cause sedation
Phenytoin- not for long term and has narrow therapeutic index
What is colic
excessive and inconsolable crying in infant
When does GORD resolve by
2 months, latest 6 motnhs
What is croup
Inflammation of the trachea, bronchiole and the larynx- viral infection
What are the symptoms of croup
Seal-like barking cough
fever
cold symptoms
Treatment for croup
Self limiting- takes 48hrs
Refer to GP
Managment advice for croup
Increase fluid intake
Pctml and ibuprofen
Dexamethosone as a single dose
