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Flashcards in ILA 3 Deck (54)
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1
Q

A woman presents w/ intermenstrual bleeding (bleeding between periods). What are some differentials and therefore investigations you want to consider?

A

Infection –> do swabs

Cervical Ca –> speculum/smear

pregnancy –> urinary beta hCG

2
Q

What are the 3 causes of (abnormal) vaginal discharge?

A

Physiological, infective, non-infective

3
Q

Give some non-infective causes of vaginal discharge

A

physiological, foreign body (tampon), cervical ectropion, malignancy, cervical polyp, chemical vaginitis

4
Q

How does physiological discharge vary during the menstrual cycle?

A

thick + sticky most of cycle

Becomes clearer and wetter + stretchy during ovulation

5
Q

How can you differentiate normal from abnormal discharge?

A

Abnormal discharge is characterised by a change in colour, consistency, odour and smell AND have associated symptoms (itch, soreness, dysuria, pelvic pain or IMB or PCB)

Abnormal discharge most commonly caused by infection

6
Q

What is the mechanism of action of the COCP?

A

MAIN: Negative feedback (suppresses FSH secretion + mid-cycle LH surge) –> inhibiting (follicle maturation) + ovulation (basically: INHIBITION OF OVULATION)

Also: cervical mucous thickening + prevents implantation

7
Q

Give some SEs and risks of the COCP?

A

SEs: breakthrough bleeding, breast tenderness, mood swings…etc (progestogenic + oestrogenic)

Risks: VTE, stroke, MI, breast cancer ^ risk; maybe ^ cervical Ca (but may be due to ^ number of sexual partners)

8
Q

Give some benefits of the COCP?

A

Reduces risk of ovarian and endometrial Ca

9
Q

Give some absolute contraindications of the COCP? What would you give instead?

A

breast feeding, BMI >40, Smokers >30yo (>15 cigs/d), DM w/ vascular complications, Hx of VTE, Hx of IHD/cerebrovascular accident/severe HTN, pregnancy, migraine with aura

Give mini-pill

10
Q

Give some oestrogenic SEs?

A

Nausea, heacahes, ^ mucous, fluid retention (vasodilator), weight gain HTN. breast tender, bleeding

11
Q

How is the efficacy of contraceptives measures?

A

Pearl index (/100) –> i.e. if 2/100 then for every 100 women using it, 2 will get pregnant by the end of the year

12
Q

If a woman is breastfeeding would you give her to minipill or COCP?

A

Minipill because the COCP reduces milk production

13
Q

Why is the depo-provera injection not 1st line in adolescents and IBD?

A

Cuases reduced bone mineral density and so ^ risk of OP –> IBD already at ^ risk of OP

14
Q

Give some other forms of combined contraception other than the COCP?

A

Transdermal patch, vaginal ring

15
Q

who might the transdermal patch be useful in?

A

IBD (as malabsorption an issue w/ oral contraceptives)

16
Q

How does the progestogen only pill work?

A

traditional: thickens cervical mucours (impenetrable to sprerm)

Desogestrel: also inhibits ovulation

17
Q

What is the issue with the minipill? Is this always the case?

A

Has to be taken within 3 hours of the same time each day

However, DESOGESTREL has a 12 hour window

18
Q

Give some SEs of the mini pill?

A

Acne, breast tenderness

19
Q

Is the minipill as effective as the COCP?

A

No, only 92% effective

20
Q

give some risks and benefits of the minipill

A

Benefits: no ^ risk of vte

risks: ECTOPIC, ovarian cysts

21
Q

Which contraceptive ^ the risk of ectopic?

A

Minipill and IUS + IUD

22
Q

What is the difference between the IUS + IUD?

A

IUD = copper

IUS = progestogen (e.g. Mirena)

23
Q

How does the copper coil work (IUCD)?

A

inflammatory endometrial reaction –> prevents impantation

24
Q

How does the mirena/other IUDs work?

A

Contain levenorgestrel –> cervical mucous thickening, reduces endometrial growth (prevents implantation)

N.b. doesn’t inhibit ovulation

25
Q

What are the advantages of IUD, IUS, depot injection?

A

No need to remember to take the pill (helps w/ compliance)

26
Q

Give some examples of barrier methods of contraception? What are their advantages over ?

A

Condoms (male + female), diaphragms, caps

reduced risk of STIs (not diaphragms/caps)

27
Q

Give some complications of IUD/IUS?

A

Pain or cervical shock (^ vagal tone),

device expelled

perforation of uterus

heavier/more painful menstruation

If woman is asymtpomatic STI in cervix –> PID

If pregnancy occurs: ^ risk of it being an ectopic

28
Q

Give some CI’es to the IUS?

A

Previous ectopic, Endometrial/cervical ca, undiagnosed vaginal bleeding, active/recent pelvic infection. current breast cancer (can use copper though)

29
Q

What are two absolute forms of contraception?

A

Sterilisation (male + female)

30
Q

What are some forms of emergency contraception?

A

1) (if <72hrs after unprotected sex): single dose levonorgestrel
2) (if <120 hours): ulipristal (selective progestogen receptor modulator) [like mifepristone used in abortion]
3) <5d: copper IUD

31
Q

Why do you need to ask a woman about antibiotics before commencing the COCP?

A

reduces the absorption of the COCP as P450 inducers (and other drugs)

Examples: nitrofurantoin, penicillin, rifampicin

32
Q

What are some of the problems associated with teenage pregnancy?

A

^ post-natal depression, infant mortality

less likely to finish education

delivering teenage births more risks

^ risk of poverty…etc

SAFEGUARDING ISSUE

^ pre-eclampsia / other things

33
Q

Who must you offer a chlamydia screen to?

A

All sexually active <25s

34
Q

What is gillick competence?

A

Term in medical law to decide whether a child <16 is able to consent to his or her own medical Rx, w/out the need for parental permission or knowledge

35
Q

What is Fraser competence?

A

Specifically relates to contraception + sexual health

36
Q

What are the 5 points to Fraser competence?

A
  1. Young person understands the advice
  2. Can’t be persuaded to inform parents or allow clinician to inform them
  3. Is likely they will continue to have sexual intercourse w/ or w/out the use of condoms
  4. their physical or mental health may suffer as a result of witholding contraception or treatment
  5. in the best interest of the young person for the clinician to provide contraceptive advise, treatment or both w/out parental

UPSSI
Understands, persuaded, still continue yo have sex, suffer (physical/mental health), best Interest

37
Q

What is the vaginal pH like in vulvovaginal candidiasis (thrush)?

A

normal (<4.5)

38
Q

What can be seen under microscopy in someone w/ BV?

A

Clue cells

39
Q

What is needed for a diagnosis of BV?

A

3/4 of:

  1. +ve amine test (whiff test) - release of amine odour w/ 10% KOH
  2. vaginal pH >4.5
  3. Clue cells on microscopy
  4. Homogenous white-grey non inflammatory discharge
40
Q

Describe the discharge seen in BV?

A

Homogenous grey/white discharge (thin)

Fishy/offensive

41
Q

Describe the discharge seen in thrush?

A

White curdy discharge

42
Q

Describe the discharge seen in Trichomoniasis? How does it differ from BV?

A

Yellow, green FROTHY discharge that is offensive/fishy

Distinguish from bv: other symptoms present (e.g. itching. vaginitis, dysuria)

43
Q

What is trichomiasis caused by?

A

Trichomonas vaginalis = flegellated protozoan

44
Q

How do you treat vaginal candidiasis?

A

topical antifungal (or pessary) - clotrimazole

OR oral fluconazole

45
Q

What is the antibiotic of choice in BV + trichomoniasis?

A

metronidazole

46
Q

What kind of swab is used for gonorrhoea / chlamydia?

A

Endocervical

can use vaginal [self sample] for chlamydia too

47
Q

What is the high vaginal swab for?

A

trichomoniasis / other infections (NOT Gonorrhoea or Chlamydia)

48
Q

How do you treat chlamydia?

A

Stat dose azithromycin

OR doxycycline

49
Q

How do you treat gonorrhoea?

A

3rd generation cephalosporin: ceftriaxone

like meningitis

50
Q

What are the SEs of the depot- injections

A

Weight gain
Reduced bone density (^ risk OP)
Unpredictable return of fertility
Menstrual irregularity

+ other progestognenic SEs

51
Q

what is the problem with the depot injection?

A

Can take up to 12mths to return to normal fertility after stopping it

52
Q

What does the transdermal contraceptive patch contain?

A

COMBINED

53
Q

What vaginal infection is associated with high pH? (>4.5)

A

BV

54
Q

Give 2 uses of ullipristal acetate

A
  • Emergency contraception

- Fibroids