OSCE Flashcards
Initiating CHC
Choice of regimes
explained tailoring is unlicensed
-may reduce bleed frequency and withdrawal symptoms
-unscheduled bleeding is common
-written information
Preconception Care- Questions
Obstetric/Gynae history
Diet and BMI
Smoking/alcohol/drugs
caffeine
medications and OTC
Smear
HBV/HIV risk
Rubella/chickenpox immunity
Occupation (exposure)
travel plans (ie zika)
chronic health conditions
Diaphragm
Up to 3 hours before, 6 hours after
Repeat if >3 hours or further SI
can use condoms if non nonoxinol-9
Caya gel- stabilise pH and further barrier- 2 2cm strips
extra on leading edge to help insertion
UKMEC3 if high risk of HIV acquisition/TSS
max 30 hrs (48 if cap)
typical 12 perfect 6 (caps are worse)
Difficulty?
slinga rod, bear down
replace after 2 years
latex free
80% women (65-80mm)
link to website
any concerns
trial and examine
Bleeding on HRT
Initiation 6/12
Dose change 3/12
40% will have
1-5%Ca (10% nil HRT)
ccHRT 4mm
sHRT 7mm
Pt decision re continuing- write on histology form, discuss risk/benefits
If stops 28/7 after stopping- NAD, if persists- Ca pathway
Urgent Ca pathway:
1 Major or 3 minor
TVS 6 weeks
2 minor
heavy/persistent
>3 months change or 6 months tarted
Major RF (1)
BMI >40
genetic predisposition
no P >6/12
tricycling >12 months
sequential >5 years and >50
inadequate P for >12 months
Minor RF (3)
BMI>30
PCOS
DM
E only >3 months
tricycling <6 months
suboptimal P >12 months
LNGIUD expired >12 months
If do not fit any:
Optimise for 6 months
- if worse/same = ca pathway
-if slightly better= TVS 6 weeks
Offer examination, most likely cause= atrophy
HSV- not HSV
Recent sexual partners
-country of birth
-recent travel
-pain
associated symptoms
recent testing
document recommend disclosure to partners
MHX- eczema
Chlamydia
Nil SI until finished doxy or 1.52 after azithro
TOC after 5 weeks
Contact Tracing
side effects
BASHH:
Detailed explanation of condition
Particular emphasis on long-term implications for health of themselves and their partners
Reinforced with clear and accurate written information - BASHH leaflet
Syphilis
Ask about new headache/eye/ear symptoms if secondary (changes treatment)
-procaine penicillin and probenacid
Yaws- ulcers on leg in childhood- Ghana/PNG
Generic
Travel
New drugs/OTC
