Genito-urinary

Question 1

What are the 2 types of urinary incontinence?

Answer 1

Urge and stress

Question 2

What is urge incontinence?

Answer 2

Involuntary muscle contraction of the bladder causing a sudden urge to pass urine

Question 3

What are the non-drug treatments for urinary incontinence?

Answer 3

Exercising pelvic floor muscles or bladder training

Question 4

Drug treatment of urge incontinence?

Answer 4

1st line = antimuscarinic drugs which relax the bladder muscle

2nd line = beta-3 agonists (mirabegron) which causes the bladder to relax and store urine

Question 5

Caution for mirabegron?

Answer 5

QT prolongation

Question 6

Contraindication for mirabegron?

Answer 6

Severe uncontrolled hypertension as hypertension is a common side effect

Question 7

What is stress incontinence?

Answer 7

When urine is leaked when stress is put on the bladder E.g. when you cough or sneeze

Question 8

What are the drug treatments for stress incontinence in men?

Answer 8

There aren’t any

Question 9

What are the drug treatments for stress incontinence in women?

Answer 9

Duloxetine (SNRI) for moderate - severe incontinence. Avoid abrupt withdrawal

Question 10

First line treatment for nocturnal enuresis?

Answer 10

Enuresis alarm until 2 weeks of uninterrupted dry nights. Alarm has sensors which goes off when a child starts wetting which wakes them up and they can finish in the toilet.

Question 11

Second line treatment of nocturnal enuresis?

Answer 11

Desmopressin SL/PO

Question 12

What age is desmopressin licensed for?

Answer 12

5+

Question 13

What route should desmopressin not be given due increased side effects?

Answer 13

Intranasally

Question 14

Side effects of desmopressin?

Answer 14

Fluid retention which leads to hyponatraemia due to dilution of the blood. This can lead to hyponatraemic convulsions.

Question 15

Counselling for desmopressin?

Answer 15

Avoid fluid overload
Restrict fluid intake 1H before and 8H after desmopressin
Avoid concomitant drugs that increase vasopressin E.g. TCAs

Question 16

How long should desmopressin be stopped for during vomiting/diarrhoea?

Answer 16

Until fluid balance is normal due to loss of electrolytes. Particularly sodium

Question 17

Treatment of acute urinary retention?

Answer 17

Catheterisation - via the bladder or or super pubric catheter inserted into the lower abdomen

Question 18

Treatment of BPH?

Answer 18

Surgery or drugs such as alpha blockers

Question 19

Examples of alpha blockers?

Answer 19

Alfuzosin
Tamsulosin

Question 20

Side effects of alpha blockers?

Answer 20

Hypotension - particularly postural hypotension leading to: dizziness, fainting, blurred vision, tachycardia and palpitations

Intra-operative floppy iris syndrome

Question 21

Contraindications for alpha blockers?

Answer 21

Postural hypotension

Question 22

Patient counselling for alpha blockers?

Answer 22

Take first dose at bedtime due to first dose postural hypotension
Can impair driving

Question 23

Alternatives to alpha blockers in BPH?

Answer 23

Finasteride - reduces prostate size to increase urinary flow

Question 24

Side effects of finasteride?

Answer 24

Male breast cancer - report breast symptoms
Depression and suicidal thoughts - stop and report

Question 25

What other indication can finasteride be used for?

Answer 25

Alopecia in men under a PGD

Question 26

Is finasteride safe to use if partner is pregnant or likely to get pregnant?

Answer 26

No, use a condom as it is excreted in the semen

Question 27

Finasteride caution for women of child-bearing age?

Answer 27

Avoid handling crushed finasteride (or leaked dutasteride capsules)

Question 28

What oestrogen do the majority of COCs contain?

Answer 28

Ethinylestradiol

Question 29

Example if progesterone content in contraceptives?

Answer 29

Desogestrel, Norethisterone, Levenogestrel

Question 30

Which oral contraceptive requires a pill-free period?

Answer 30

COC

Question 31

How are COCs taken?

Answer 31

OD for 3 weeks followed by 1 week pill-free interval for withdrawal bleeding

Question 32

What age is COC licensed for?

Answer 32

Under 50

Question 33

When can a COC be started?

Answer 33

Any time in the menstrual cycle

Question 34

What must be done if a COC is started on day 6 or later of the menstrual cycle?

Answer 34

Use barrier protection for 7 days

Question 35

Is withdrawal bleeding during the pill-free period in COCs the same as a normal bleeding?

Answer 35

No

Question 36

What are the 4 different preparations for COC?

Answer 36

Monophasic Phasic Everyday Low-strength

Question 37

What is a monophasic preparation?

Answer 37

Fixed amount of oestrogen and progestogen

Question 38

What is a phasic preparation of COC?

Answer 38

Varying amounts of oestrogen and progestogen

Question 39

When is a phasic preparation of COC preferred?

Answer 39

Mimic the normal menstrual cycle for women who do not have withdrawal bleeding or have breakthrough bleeding with monophasic preparations

Question 40

What is an every day preparation of COC?

Answer 40

Pill-free period replaced with inactive tablets

Question 41

Example of a low strength oestrogen preparation?

Answer 41

20mg ethinylestradiol

Question 42

When is a low strength oestrogen preparation of COC preferred?

Answer 42

When there are significant risk factors for circulatory disease such as VTE

Question 43

Which contraceptives increase risk of VTE?

Answer 43

COC

Question 44

What are the risk factors for VTE?

Answer 44

Obesity (BMI > 30) Smoking Age > 35 Taking a COC Certain types of progestogens e.g. desogestrel, gestodene, drosperinone

Question 45

Risk factors of arterial thromboembolism?

Answer 45

Diabetes, hypertension, migraine without aura

Question 46

When should the risk of VTE be considered too great to give COC?

Answer 46

Avoid if 2 or more risk factors present for VTE

Question 47

When should COC be stopped before surgery?

Answer 47

4 weeks before

Question 48

When can a patient restart COC after surgery?

Answer 48

On first menses at least 2 weeks after full mobilisation

Question 49

What can/should be done if COC could not be stopped 4 weeks prior to surgery?

Answer 49

Give thromboprophylaxis

Question 50

Does a POP have to be stopped before surgery?

Answer 50

No therefore can be used as an alternative in patients taking COC

Question 51

How does COC work?

Answer 51

Inhibits ovulation

Question 52

How do POPs work?

Answer 52

Thickens the mucus in the cervix to stop sperm reaching the egg

Question 53

When should stockings be considered if a PT taking COC is travelling?

Answer 53

Journeys longer than 3H

Question 54

Reasons to stop COC or HRT?

Answer 54

VTE? - sudden severe chest pain / breathlessness / cough with blood stained sputum - PE? Or DVT? Stroke? - unusually severe prolonged headaches, loss of vision or hearing / serious neurological effects such as slurred speech Liver dysfunction? BP > 160/95 (can be one or the other)

Question 55

Can a patient with valvular heart disease take a COC?

Answer 55

No

Question 56

Can a patient with migraine history take a COC?

Answer 56

No

Question 57

Are menstrual irregularities more common with COC or POP such as heavy or light bleeding?

Answer 57

POP

Question 58

How are POPs taken?

Answer 58

OD on a continuous basis starting on day 1

Question 59

What should be done if a PT starts a POP after day 5 of their cycle?

Answer 59

Use barrier protection for 2 days

Question 60

Which oral contraceptive increases the risk of breast cancer?

Answer 60

Both

Question 61

Which oral contraceptive increases the risk of cervical cancer?

Answer 61

COC

Question 62

Which oral contraceptive decreases risk of ovarian or endometrial cancer?

Answer 62

COC

Question 63

How long is considered a missed dose for COC?

Answer 63

24 hours Zoey / Qlaira = 12 hours

Question 64

How long is considered a missed dose for POP

Answer 64

Over 3 hours Desogestrel = over 12 hours

Question 65

1 missed pill in COC?

Answer 65

Take one ASAP and next one at normal even if that means taking 2 in one go. No extra precautions needed

Question 66

2 missed pills in COC?

Answer 66

Take one pill ASAP + condom for 7 days (9 days for Zoely / Qlaira) Omit pill free period - if missed in the last 7 days of the cycle EHC - if missed in first 7 days of cycle and had unprotected sex

Question 67

Missed pill in POP?

Answer 67

Take ASAP and use condom for 2 days EHC if unprotected sex before 2 pills taken correctly

Question 68

How does the response to a missed pill compare to nausea and diarrhoea in oral contraceptives?

Answer 68

It’s the same

Question 69

How are transdermal contraceptive patches (Evra) used?

Answer 69

Weekly patch for 3 weeks then 1 week patch free

Question 70

What can be done if a contraceptive patch is partially detached for < 24 hours or delayed application at the beginning of the cycle?

Answer 70

Reattach or apply new patch and restart cycle from day 1 using a condom for 7 days

Question 71

What can be done if delayed application of contraceptive patches after the first week?

Answer 71

< 48 hours = apply new patch and continue as normal > 48 hours = restart cycle + condom for 7 days

Question 72

Which oral contraceptives are not effected by enzyme inducers?

Answer 72

Copper IUD (can also be used as EHC) Progestogen only injection

Question 73

How long should the alternative be used for after stopping the interacting drug?

Answer 73

4 weeks

Question 74

First line emergency contraceptive?

Answer 74

Copper IUD

Question 75

How many days after unprotected sex can I copper IUD be used?

Answer 75

5

Question 76

If a patient’s BMI > 26 which EHC should be given?

Answer 76

Ulipristal or double the dose of levenogestrel

Question 77

What age is contraindicated for IUDs?

Answer 77

< 25 due to pelvic inflammatory disease risk

Question 78

If a patient has abdominal pain after taking EHC?

Answer 78

Visit GP to rule out ectopic pregnancy

Question 79

Levenogestrel EHC dose?

Answer 79

1500mg within 3 days of UPSI

Question 80

Cautions for levenogestrel?

Answer 80

Crohn’s disease Past ectopic pregnancy Ciclosporin Depression

Question 81

Ulipristal dose?

Answer 81

30mg within 5 days

Question 82

Ulipristal causations?

Answer 82

Severe asthma treated with oral corticosteroids Severe liver impairment

Question 83

Can Ulipristal be taken more than once in the same cycle?

Answer 83

No

Question 84

Impact of Ulipristal on regular contraceptives?

Answer 84

Reduces effectiveness, use barrier protection for 14 days in COC and 9 days in POP

Question 85

How long after taking Ulipristal can regular contraception be taken?

Answer 85

5 days

Question 86

Which IUD should be prescribed by brand?

Answer 86

Levenogestrel releasing IUDs

Question 87

How long does the medroxyprogesterone injection provide cover for?

Answer 87

2 years

Question 88

Side effects of medroxyprogesterone injection?

Answer 88

Risk of osteoporosis

Question 89

How long does the norethisterone injection probe cover for?

Answer 89

8 weeks

Question 90

How long does etonogestrel implant provide cover for?

Answer 90

8 weeks

Question 91

MHRA alert with etinogestrel implant?

Answer 91

Device has been found to travel to the lung or vasculature. Must be able to be felt. If not removal is required

Question 92

How long before sex does sildenafil need to be taken?

Answer 92

1 hour

Question 93

Main side effect of sildenafil?

Answer 93

Hypotension and other side effects similar to nitrates

Question 94

When is sildenafil contraindicated?

Answer 94

Ischaemic occlusion conditions such as MI or unstable angina as it reduces blood proliferation

Question 95

Treatment of bacterial vaginosis or vaginal trichomoniasis?

Answer 95

Metronidazole 2g as a single dose

Question 96

Treatment of vulvovaginal thrush?

Answer 96

Topical imidazole for 7 days E.g. clotrimazole pessary