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64 Cards in this Set

  • Front
  • Back
What are the main methods for female contraception?
- Hormonal methods.
- Emergency contraception.
- Depo provera.
- Subdermal contraceptive implants.
- Mirena.
- Non-hormonal methods.
What are the choices for emergency contraception?
- High dose progesterone (levonorgestrel 750ug has an efficacy of 85%).
- Yuzpe method ethinyloest (efficacy of 76%).
What is depo provera?
- An injectable method of contraception containing medroxyprogerteron.
- 150mg every 12 weeks.
- Failure rate of less than 1%.
What are the side effects of using depo provera?
- Irregular bleeding in the first few months.
- By 12 months, 80% of women have amenorrhoea or occasional spot bleeding only.
- Bone mass returns to normal after depo is discontinued.
Subdermal implants (implanon) involve what process?
Progesterone (etongestrel) inserted via a trochar into the upper arm.
How long does implanon (subdermal implant) usually last?
3 years.
What side effects may occur with the subdermal implant, implanon?
Progestogenic side effects such as:
- Irregular bleeding (common).
- Weight gain.
- Acne.
- Amenorrhoea (50%)
- Troublesome bleeding in 10%.
How long does it take for a woman to return to fertility after removal of a subdermal implant?
1 day.
What is the overall effectiveness of the combined OCP?
What might be another oral alternative to the combined OCP if contraindicated?
Possibly the progestogen-only pill (mini pill) may work.
What are the absolute contraindications to use of the combined oral contraceptive pill?
- Focal migraines with neurological signs.
- Active liver disease.
- History of thromboembolism.
- Breast or gynaecological cancer.
- Lactation.
- History of CVA/CAD.
- Undiagnosed vaginal bleeding.
- Uncontrolled hypertension.
What are the relative contraindications to use of the combined oral contraceptive pill?
- Suspected pregnancy.
- Irregular vaginal bleeding.
- Common migraine.
- Hypertension.
- Obesity.
- Strong family history of thromboembolism disease.
- Concurrent med interactions e.g. rifampicin.
What possible reasons could the OCP fail?
- Non-compliance.
- Vomiting and diarrhoea.
- Drugs which may interact with the OCP.
What is cystitis?
Cystitis is an infection of the lower urinary tract.
What symptoms can occur with cystitis?
- Dysuria.
- Frequency.
- Urgency.
- Haematuria.
- Suprapubic pain.
What is pyelonephritis?
Pyelonephritis is infection of the upper urinary tract.
What are some of the typical symptoms of pyelonephritis?
- Kidney infection.
- Fever.
- Flank pain.
- N.V.
What is the incidence of infection in premenopausal, sexually-active women?
0.5-0.7 infections per person per year.
What percentage of women experience cystitis in their lifetime?
20-40%. Of those, 20% develop recurrence. The majority (90%) experience reinfection rather than relapse.
UTI can exist without symptoms. True or false?
Asymptomatic UTIs are common in what populations?
- Sexually active women.
- Elderly.
- Those with urinary tract abnormalities.
Asymptomatic bacturia leads to acute clinical UTI in what percentage of women?
30% (exclude in early pregnancy).
Mixed organisms in the urine indicates...
A distal urethral origin of the UTI.
Causes of pyuria:
- Current bacterial infection.
- Incorrectly collected specimen.
- Treated UTI.
- Urethritis.
- Tumours.
- Stones.
- Glomerulonephritis.
- Anatomical abnormalities.
- Nephritis abnormalities.
- Analgesic nephropathy.
- Indwelling catheters.
- Genitourinary surgery.
If a patient has an upper UTI, you have to be suspicious of... underlying UT abnormality. You need to investigate the renal tract of these patients.
When would you do investigations for cystitis?
If it recurs or persists (always consider chlamydia). Otherwise, just treat a clinical case of cystitis empirically.
What would be considered a baseline rate of infection for a non-pregnant woman who suffers from recurrent cystitis?
2 UTIs per year over many years.
What are the main benefits of HRT?
HRT reduces the risk of:
- Hot flushes.
- Urogenital symptoms.
- Sleep problems.
- Osteoporotic fracture.
- Colorectal cancer.
What are the main risks of HRT?
HRT increases the risk of:
- Stroke.
- Breast cancer (combined HRT).
- Endometrial cancer (oestrogen-only HRT).
- Ovarian cancer (eostrogen-only HRT).
- Cardiovascular events and dementia in older women.
How does HRT affect weight gain, headache, and migraine?
There is no evidence that it causes any change in risk of these.
Is there good evidence of the efficacy of the CAM product 'black cohosh' in treating hot flushes?
Is there good evidence of the efficacy of the soy products in treating hot flushes?
No (level 1 no impact).
Is there good evidence of the efficacy of the CAM product dong quai, evening primrose oil, red clovers and chinese herbs in treating hot flushes?
No (level 2 no impact).
Which is better for bone protection? HRT or bisphosphonates?
Compared with HRT, bisphosphonates have stronger
evidence of efficacy for prevention of fractures in women with osteoporosis.

However, HRT is sometimes appropriate for bone protection if fracture risk is high and other medicines are intolerable.
How long would you have to stay on HRT to have an increase in breast cancer risk?
2 years, which is why short-term HRT (1-2 years) is a viable option for menopausal symptom relief.
How do you cease HRT treatment?
When ceasing HRT, it is important to reduce doses incrementally over a few months to prevent rebound symptoms.

Ceasing HRT during the cooler months may be helpful for
some patients.
Women using HRT are likely to have a _____ fold increased risk for idiopathic
thromboembolism compared with non-users.
Women using HRT are likely to have a 2-4 fold increased risk for idiopathic
thromboembolism compared with non-users.
Would you recommend continuing HRT treatment?
Understand and balance both the risks and benefits of HRT when making a recommendation as each woman's situation is different and there is no
one-size-fits-all solution.
What complementary medicines might you recommend after ceasing HRT treatment on a post-menopausal woman?
Black cohosh has the best evidence of commonly used alternatives, but there is a lack of uniformity in the components of the various preparations. The evidence of benefit applies only to the product used in trials (i.e. Remifemin).

Other products had placebo effects but that's it.
When might HRT be recommended for longer than 2 years?
HRT is sometimes appropriate for bone protection if fracture risk is high and other
medicines (i.e. bisphosphonates) intolerable. It is not recommended in women who are not at high risk of fracture.
When should you review management after ceasing HRT treatment?
6 weeks to check on wellbeing, general health and for return of menopausal symptoms.
How frequently should you review a patient on HRT treatment?
Review women using HRT for symptom relief 6-12 monthly and assess the need for
ongoing therapy.
What essential things should a patient be recommended in having post-menopause?
- Vitamin D.
- Calcium.
- Weight-bearing exercise.
What are the major determinants of fracture risk?
- Postmenopausal women.
- Low bone mineral density.
- Calcium and/or vitamin D deficient states.
- Previous minimal-trauma.
- Fracture or family history
of such a fracture.
- Long-term (> 3 months) oral corticosteroid therapy.
- Ageing.
- Cigarette smoking.
- Low body weight.
How do you prevent falls in the elderly?
- Assess personal aspects: visual deficits, cognitive
impairment, muscle weakness, gait or balance abnormalities.

- Assess environmental/home aspects: inadequate lighting,
hazardous rugs, slippery floors, the height of chairs and beds, the need for safety rails (e.g. in the bathroom or
on stairs), appropriate footwear.

- Review medication to identify drugs causing sedation (e.g. hypnotics, antidepressants), postural hypotension (e.g. antihypertensives, psychotropic drugs), hypoglycaemia, or drugs associated with osteoporosis (e.g. oral corticosteroids, anti-epileptic agents).

- Encourage exercise to improve muscle strength and balance.
In poste-menopausal women, raloxifene is most effective in preventing...
Vertebral fractures.
What is the absolute contraindication for raloxifene use?
History of venous thromboembolism.
What are the main side effects of bisphosphonates and how can you prevent them?
Oral bisphosphonates commonly cause gastro-intestinal
disturbances; severe oesophageal erosions and ulcers have been reported.

To minimise these adverse effects, bisphosphonate tablets should be taken with a full glass of water, with the patient in an upright position and remaining upright for 30 minutes.
Bisphosphonate absorption can be impaired by other substances. What should the patient do to avoid it?
Bisphosphonate tablets must be taken 30–120 minutes
before food, drink (other than water), or medications
containing calcium, magnesium, iron, or aluminium salts as absorption is impaired.
Men with osteoporosis or vertebral fractures tend to have an underlying medical conditions. What medical conditions could it be?
- Hypogonadism.
- Oral corticosteroid use.
- Excess alcohol use.
What are the most common symptoms associated with pelvic inflammatory disease?
- 60% subclinical/asymptomatic.
- Abnormal vaginal discharge.
- Lower abdominal pain.
- Dyspareunia with adnexal tenderness.
- Cervical motion tenderness.
- Cervicitis.

For those with more severe disease:
- Fever.
- Nausea.
- Vomiting.
Why may there been a decline of acute PID in response to recent increases in reports of chlamydial infection?
This may represent improved and earlier treatment or increased testing of chlamydia.
What proportion of PID infections are derived from STIs such as gonorrhoea and chlamydia?
One third to one half of PID infections.
Non-sexually acquired PID may result from what?
Procedures such as intrauterine device (IUD) insertion, dilatation and
curettage, and operative termination of pregnancy (TOP) that breach the protective cervical barrier and introduce bacteria
from the vagina or cervix directly into the endometrial cavity.
How long does the risk of PID last with insertion of an IUD?
Risks associated with IUD insertion have been shown
to be limited to the 4 weeks following insertion in women
at low risk of STIs.
What is the 'gold standard' for diagnosis of PID?
The ‘gold standard’ for diagnosis is laparoscopy,
however this is invasive, costly and impractical in addition to underestimating rates of mild disease that present without overt tubal hyperaemia, oedema and exudate.
The Centre for Disease Control guidelines suggest treatment for PID in what patients with what signs and symptoms?
The Centre for Disease Control guidelines suggest
treatment for PID when uterine/adnexal tenderness or
cervical motion tenderness is present in sexually active
young women at risk of STIs where no other cause is
What are the common signs and symptoms of PID?
- Lower abdominal pain/discomfort.
- Vaginal discharge.
- Abnormal vaginal bleeding.
- Dyspareunia.

- Lower abdominal tenderness/guarding/rebound.
- Adnexal tenderness or a mass.
- Cervical motion tenderness.
- Raised temperature.
What is the differential diagnosis of lower abdominal and pelvic pain?
- PID.
- Endometriosis.
- Ruptured ovarian cyst.
- Dysmenorrhoea.
- Ectopic pregnancy.
- Appendicitis.
- IBS.
- UTI.
- Gastroenteritis.
What potential complications are there for patients with PID?
- Tubal factor infertility (20%).
- Chronic pelvic pain (20%).
- Ectopic pregnancy (10%).
What are the useful investigations for the management of PID?
Microbiological tests for possible specific bacterial aetiology:
• Chlamdyia trachomatis PCR (vaginal self collected/first catch urine/endocervical).
• Neisseria gonorrhoea culture (endocervical) or gonorrhoea PCR (vaginal/
cervical/urine) (beware false positives).
• Endocervical swab microscopy/sensitivity/culture.
• High vaginal swab and wet mount or gram stain
• Bacterial vaginosis: vaginal pH and ‘whiff’ test

Tests to assess severity:
• Full blood count.
• ESR or C-reactive protein.

Tests to exclude other causes of pelvic pain:
• Pregnancy test.
• Mid stream urine.
• +/- pelvic ultrasound.
What does outpatient treatment of PID entail for young sexually active women with no predisposing factors?
Azithromycin + Doxycycline + Metronidazole + Ceftriaxone.
What does outpatient treatment of PID entail for post-procedural PID (including IUD insertion, operative TOP)?
Doxycycline OR Amoxycillin
In what circumstances would you consider hospital admission for PID?
• Tubo-ovarian abscess is suspected.
• The patient is pregnant.
• Nonresponsive to oral antibiotic treatment.
• Unable to tolerate or follow outpatient oral regimen.
• Suffering severe illness (eg. nausea, vomiting or febrile).
• Surgical emergencies such as appendicitis cannot be excluded.