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Phase 3a > Urinogenital Medicine > Flashcards

Urinogenital Medicine Flashcards

1
Q

Name 2 types of POP

A

Desogestrel Only Pill (Cerazette)

Traditional progestogen-only pill (Norgeston)

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2
Q

What is the MOA for POP? (4)

A

Thickens cervical mucus

Makes endometrium less accepting of implantation

Reduces ciliary action in the fallopian tubes

Inhibits ovulation (desogestrel)

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3
Q

When is it best to start the POP and why?

A

Starting on day 1-5 of the menstrual cycle provides immediate protection (as ovulation is unlikely during this period and it takes 48 hours for cervical mucus to thicken)

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4
Q

If a POP is started after day 5 of the menstrual cycle, what advice is given?

A

Use additional contraception (i.e condoms) for 48 hours after starting POP

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5
Q

Can POP be used in pregnancy?

A

Yes. POP is not harmful in pregnancy.

But, women should do a pregnancy test 3 weeks after last unprotected intercourse.

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6
Q

When is it best to switch from COCP to POP?

A

Day 1-7 of the hormone free period after finishing the COCP pack. Here no additional contraception is required.

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7
Q

What is the only unacceptable health risk for POP use?

A

Active breast cancer

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8
Q

If a patient had sex since completing the last pack of COCP what must they do before switching to POP?

A

Complete at least 7 consecutive days of COCP before switching AND use extra contraception for 48 hours.

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9
Q

List 5 side effects of POP

A

Unscheduled bleeding (common in 1st 3 months)

Amenorrhoea/Irregular bleeding

Breast tenderness

Headaches

Acne

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10
Q

Give 3 possible complications of POP use

A

Ovarian cysts

Ectopic pregnancy (due to reduced ciliary action in fallopian tubes)

Breast cancer (small chance)

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11
Q

How are missed pills classified in POP? (3)

A

Traditional POP - >3 hours late - >26 hours after last pill

Desogestrel POP - >12 hours late - >36 hours after last pill

Diarrhoea or vomiting - Extra contraception is required until 48 hours after diarrhoea and vomiting settles

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12
Q

What should a patient do if they miss a POP pill? (3)

A

Continue with next pill at usual time (take 2)

Use extra contraception for next 48 hours of regular use

Use emergency contraception if they had sex since missing the pill or within 48 hours of restarting regular pills.

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13
Q

Give 4 examples of COCP and state what they contain

A

Microgynon - Ethinylestradiol + Levonorgestrel

Loestrin - Ethinylestradiol + Norethisterone

Marvelon - Ethinylestradiol + Desogestrel

Yasmin - Ethinylestradiol + Drospirenone

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14
Q

When is noresthisterone useful?

A

Useful for delaying periods (i.e if a woman is going on holiday)

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15
Q

When is drospirenone useful? and why?

A

1st line for premenstrual syndrome

(spironolactone analogue)

Has antimineralocorticoid and antioandrogen effects which helps with bloating, water retention and mood changes.

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16
Q

What is drospirenones pattern of use?

A

Continuous rather than cyclical

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17
Q

What is the MOA of the COCP? (2)

A

Prevents ovulation

Thickens cervical mucus, inhibits implantation and reduces ciliary action in fallopian tubes

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18
Q

How does COCP prevent ovulation?

A

Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FHS.

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19
Q

What is a withdrawal bleed (COCP). How often should they occur?

A

Describes when the pill is stopped (inactive pills) and the endometrium breaks down and sheds, resulting in a withdrawal bleed.

Should occur at lasts 3 times/year

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20
Q

Give 3 regimes for the COCP

A

21 days on and 7 days off

63 days on (3 packs) and 7 days off (tricycling)

Continuous use without a pill free period

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21
Q

Give 3 side effects of COCP

A

Unscheduled bleeding (common in 1st 3 months)

Breast pain/tenderness

Mood changes/depression

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22
Q

Give 2 risks of taking the COCP

A

VTE

Breast + Cervical Cancer

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23
Q

Give 3 non-contraceptive benefits of COCP use

A

Improves premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhea (painful periods)

Reduces risk of endometrial, ovarian and colon cancer

Reduces risk of benign ovarian cysts.

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24
Q

Give 5 contraindications for COCP use

A

Uncontrolled hypertension (>160/100)

Migraine with aura

History of VTE

Smoking >15/ day and >35 years old

SLE/anti-phospholipid syndrome

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25
Q

When is it best to start the COCP? What should you advise if the COCP is started after this period?

A

Day 1-5 of menstrual cycle - offers immediate protection

Starting > day 5 requires use of extra contraception for the first 7 days of consistent pill use

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26
Q

What antibiotic can reduce the effect of COCP?

A

Rifampicin

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27
Q

What is classified as a ‘missed pill’ when taking COCP? What should be done if this happens? Is emergency contraception needed? (3)

A

Missed pill = >24 hours late (48 hours since last pill was taken)

Take missed pill ASAP (even if that means taking 2 pills in 1 day)

No emergency contraception is required (as mons as all other pills have been taken correctly)

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28
Q

What is advised if >1 COCP pill is missed (>72 hours since last pill was taken)? (2)

A

Take most recent missed pill ASAP (even if it means taking 2 pills in one day)

Use additional contraception regularly for 7 days

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29
Q

Regarding days of the menstrual cycle, what is the emergency contraception advice for missing >1 COCP? (3)

A

Day 1-7 missed - Emergency contraception required

Day 8-21 missed - No emergency contraception required

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30
Q

List 3 factors that can reduce COCP effectiveness

A

Vomiting

Diarrhoea

Rifamipicin

31
Q

For how long does the copper coil remain effective?

A

5-10 years

32
Q

How long does it take for the copper coil to act as an effective contraceptive?

A

Works immediately

33
Q

How long is the LNG-IUS effective for as a contraceptive?

A

5 years

34
Q

How long does it take for the LNG-IUS to become an effective means of contraception?

A

7 days

35
Q

Give 7 contraindications for Coil use

A

PID/Infection

Immunosuppression

Pregnancy

Unexplained bleeding

Pelvic cancer

Uterine cavity distortion (fibroids)

Wilson’s disease (copper coil)

36
Q

What should all women be screened for before coil implantation?

A

Gonorrhoea and Chlamydia

37
Q

What must women do before removal of a contraceptive coil? Why?

A

Abstain from sex or use condoms for 7 days before the coil is removed.

Sperm can survive for 7 days after sex

38
Q

If coil threads cannot be seen or palpated, what 3 things must be excluded? And what are the 1sr and 2nd line investigations?

A

Expulsion
Pregnancy
Uterine perforation

1st line - Ultrasound
2nd line - Abdominal/Pelvic X-ray

39
Q

Give 3 side effects of the copper coil

A

Heavy menstrual bleeding

Pelvic pain

Increased risk of ectopic pregnancy

40
Q

What is Gillick Competency?

A

Guidance on whether a child (under 16) can consent to their own medical treatment without their parents having to know of give permission.

41
Q

What are Fraser Guidelines?

A

Provide advice regarding whether to give contraception to a child under 16 without parental consent.

42
Q

What 5 factors should be considered in Fraser Guidelines?

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 advice or treatment?

Is the advice or treatment in their best interest?

43
Q

What is the difference between Gillick and Fraser guidelines?

A

Gillick competence is used to assess a child’s capability to make and understand their decisions in a wider context.

Fraser guidelines are applied specifically to advice and treatment regarding a young persons sexual health and contraception.

44
Q

What is the commercial name for the progesterone implant?

A

Nexplanon

45
Q

Where is the progesterone implant (Nexplanon) implanted?

A

Subdermally, non-dominant arm

46
Q

What pathogen commonly causes bacterial vaginosis?

A

Gardnerella vaginalis

47
Q

Give 3 risk factors for bacterial vaginosis

A

Sexual intercourse

Intrauterine devices

Pregnancy

48
Q

Give 1 ‘exam’ clinical features of bacterial vaginosis

A

Milky/gray vaginal discharge with fishy odor

49
Q

How is bacterial vaginosis diagnosed? (4)

A

3 of the following Amsel criteria;

Presence of Clue Cells (vaginal epithelial cells with fuzzy borders due to bacteria adhering to cell wall)

Vaginal PH >4.5

Positive Whiff test - Intensified fishy odour after adding potassium hydroxide

Thin, homonymous gray-white or yellow discharge that adheres to vaginal wall

50
Q

How is bacterial vaginosis managed?

A

Asymptomatic - Reassurance

Symptomatic;

Non pregnant
1st line - Metronidazole
2d line - Clindamycin

Pregnant ;
1st line - Metronidazole
2nd line - Clindamycin
Repeat testing after 1 month

51
Q

Syphilis is caused by what pathogen?

A

Treponema pallidum

52
Q

What is the incubation period of Syphilis?

A

9-90 days

53
Q

How many stages of Syphilis are there?

A

3

Primary, Secondary and Tertiary Stages

54
Q

Name 3 features of the primary stage of syphilis

A

Chancre - Painless ulcer at the site of sexual contact

Local non-tender lymphadenopathy

Often not seen in women

55
Q

Name 4 secondary features of Syphilis. When do they occur?

A

Occur 6-10 weeks after primary infection

Systemic features; fever, lymphadenopathy

Rash on trunk, palms and soles

Buccal ‘snail track’ ulcers

Condylomata lata (painless, watery lesions on the genitalia)

56
Q

Name 4 tertiary features of syphilis

A

Gummas (granulomatous lesions of the skin and bones)

Ascending aortic aneurysms

Tabes dorsalis (sudden lightning like pain/paraesthesias in leg or trunk)]

Argyll Robertson Pupil (small and irregular pupils that have no constriction to light but constricts to near targets)

57
Q

In what condition would you see Argyll Robertson Pupils? Describe how they present.

A

Seen in Syphilis

Describes small and irregular pupils that have no constriction to light but constricts to near targets (light-near dissociation)

58
Q

Give 5 features of congenital syphilis

A

Blunted upper incisor teeth (Hutchinson’s teeth)

Rhagades (linear scars at the angle of the mouth)

Keratitis

Saber Shins (anterior bowing of the tibia)

Saddle nose

59
Q

How is syphilis diagnosed?

A

Treponema pallidum is a very sensitive organism and cannot be grown on artificial media, therefore diagnosis is made on clinical features, serology and microscopic examination of infective tissue.

60
Q

Name 2 serological tests used to diagnose syphilis

A

Non-treponemal tests (VDRL)
- Not specific for syphilis (so can have false positives)
- Based on reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen

Treponemal-specific (TPHA)
- More specific but expensive

61
Q

Syphilis tests - If Positive Non-treponemal test (VRDL) + Positive treponemal test (TPHA), what is the diagnosis?

A

Results consistent with active syphilis infection

62
Q

Syphilis tests - Positive Non treponemal test (VRDL) + negative treponemal test (TPHA)

A

Consistent with false positive syphilis result (due to pregnancy or SLE)

63
Q

Syphilis tests - Negative non-treponemal test (VRDL) + positive treponemal test (TPHA)

A

Consistent with successfully treated syphilis

64
Q

How is syphilis managed?

A

1st line - IM Benzathine Penicillin

2nd line - Doxycycline

65
Q

What reaction may be seen following initiation of syphilis treatment? How may it present?

A

Jarisch-Herxheimer reaction

May present with fever, tachycardia and rash after 1st dose of antibiotics.

66
Q

How may chlamydia present in women? (4)

A

Yellow, odourless vaginal discharge

Deep dyspareunia

PV bleeding

Dysuria

67
Q

Give 4 complications of chlamydia

A

Epididymitis

PID

Endometritis

Increased incidence of ectopic pregnancy

68
Q

What investigations are performed to diagnose chlamydia? How is the sample obtained?

A

Nuclear acid amplification tests (NAATs)

Female - Vulvovaginal swab

Male - Urine test (first catch)

69
Q

When should chlamydia testing be performed?

A

2 weeks after possible exposure

70
Q

How is chlamydia managed?

A

1st line - Doxycycline

2nd line - Azithromycin

71
Q

How is chlamydia managed in pregnancy?

A

Azithromycin

Alternatives; erythromycin or amoxicillin

72
Q

How are contacts managed in chlamydia management? (male and female)

A

Male with urethral symptoms - All contacts since and in 4 weeks prior to onset of symptoms

Female and asymptomatic men - all partners from last 6 months or most recent sexual partner

73
Q

Give 4 possible neonatal complications of chlamydia exposure

A

Chorioamnionitis

Neonatal conjunctivitis

Neonatal pneumonia

Prelabour rupture of membranes

74
Q

Give 4 features of congenital syphilis

A

Generalised lymphadenopathy

Hepatosplenomegaly

Rash

Skeletal malformations

Phase 3a (6 decks)

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