Sexual And Reproductive Health Test Part 2
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1) A woman who is 14 weeks pregnant presents with a thin vaginal discharge and fishy odour. She gives history of this getting worse before her periods and with sexual intercourse. On examination, the vulva and vagina looked normal and not inflamed.
The diagnosis in her case is which of the following?
BACTERIAL VAGINOSIS (BV)
2) Contraindications to the insertion of a Cu-IUD for EC are the same as those for routine IUD insertion. Which of the following is a relative contraindication?
3) Miss Y is a 22 year old nulliparous young woman who presents at her local sexual reproductive health clinic having had unprotected sexual intercourse on day 16 of a regular 28day cycle. She is in a new relationship, having had intercourse last night with her 27 year old boyfriend who she met last week at a party. She has not had any other episodes of unprotected intercourse this cycle. She suffers from epilepsy and takes carbamazepine 400 mg twice daily. She is otherwise well with no relevant family history. She looks well and her measurements are as follows: height: 159 cm weight: 58 kg BP: 115/65 mmHg.
A copper IUD is the goldstandard of emergency contraception and should be offered to everyone. It would also make good ongoing contraception for someone taking enzymeinducing medication (carbamazepine). If the patient refuses an IUD, then the unlicensed option of doubledose levonelle (3 mg) should be offered
4) Epileptic woman on Carbamazepine. Came for emergency contraception & refused cupper IUC. What is the suitable alternative?
5) Which one of the following statements regarding CHC and migraine is correct?
CHC users with migraine with aura are at greater risk of ischaemic stroke than CHC users without migraine. UKMEC 2019 recommends that use of CHC by women who have migraine with aura is UKMEC 4. For women who have migraine without aura, initiation of CHC is UKMEC 2, but if there is new-onset migraine after starting CHC, the risks of continuation generally outweigh the benefits (UKMEC 3).
6) 25 year old woman had a normal delivery at term 4 months ago. She is exclusively breast feeding and had an episode of UPSI. She takes ulipristal acetate for emergency contraception. What breast feeding advice would you give her?
7) Mrs P, a 32yearold para 4+0, has just delivered a baby boy (SVD) following an unplanned pregnancy, having recently separated from her husband and entered into a new short term relationship. She is a week postpartum and requesting a reliable form of contraception. She has a family history of VTE in a first degree relative and is known to carry a protein S deficiency but has never had a VTE episode herself. She is bottle feeding, her puerperium has been uncomplicated and she is keen to start contraception as soon as possible. Height: 160 cm Weight: 65 kg BP: 135/80
8) A 21-year-old woman comes to the genitourinary medicine clinic complaining of vaginal discharge. Vaginal high-swab results show that she has bacterial vaginosis. She asks you about treatment of her sexual partner.
Which infection needs treatment of an asymptomatic sexual partner?
_ Current sexual partners of women diagnosed with Trichomonas vaginalis (TV)
should be offered a full sexual health screen and should be treated for TV
irrespective of the results of their tests.
_ Concurrent treatment of all sexual partners is essential for symptomatic
relief, microbiological cure, and to prevent reinfections or transfer to a new
_ Sexual partners are advised to abstain from intercourse until they and their
sexual partners have been cured
_ Oral nitroimidazole drugs (e.g. metronidazole) are effective in treating
_ In the management of BV, testing and treatment of male sexual partners is not
_ In herpes simplex virus (HSV), symptomatic sexual partners should receive the
same treatment. Asymptomatic sexual partners should be offered type-specific
serological testing for HSV infection.
9) 25-year-old woman is at 15 weeks gestation in her first pregnancy. Booking syphilis screening is positive and the diagnosis is confirmed with the Treponema pallidum particle agglutination assay. The patient is otherwise fit and well, is on no medication and is allergic to penicillin. What antibiotic treatment would you suggest to treat this patient?
10) Regarding management of gonorrhea,which of the following is correct
11) A missed DSG pill (all brands) is one that is:
12) When counselling a man regarding vasectomy, which of the following is it important to stress
The answer is that contraception should be used for a further 3 months with a negative semenalysis at the end of that time. Vasectomy is reversible but usually not offered within NHS services and although reanastamosis may be successsful , this does not guarantee patency or fertility. Men should be advised that vasectomy is associated with a 1:2000 failure rate in comparison with 1:200 lifetime failure rate for tubal occlusion .There is no evidence of an increased testicular cancer risk after vasectomy.
13) A 24 yearold woman attends and STI clinic with suspected Chlamydia infection. What is the best technique for detecting Chlamydia?
NAAT testing is the gold standard, and self collected vulvovaginal swabs are more sensitive than urine tests in women.
14) A woman taking lamotrigine is using the combined hormonal transdermal patch (CTP). Which one of the following statements is correct?
Serum levels of lamotrigine can be reduced by CHC. Lamotrigine is not thought to be an enzyme-inducing drug, but the manufacturer advises that contraceptive effectiveness of CHC could be reduced by concurrent use of lamotrigine. . The risks of using CHC could outweigh the benefits.
15) 32 years old G2P1 First time attending antenatal clinic at 20weeks. C/o Mucocutaneous rashes on palms. Papule on vulva. Scan- fetal ascites .RPR test positive at booking What is the Treatment?.
16) Rate of uterine perforation in IUC insertion is
17) For which of the following conditions would you consider a hospital setting for the insertion of an intrauterine device?
18) A 35yearold para3 comes to clinic for contraceptive advice. She was advised to come off the combined pill as she developed migraines with aura while taking it. She is now using the diaphragm but is looking for something more reliable. With regards to duration of action of longacting reversible contraception, which one of these statements is not correct?
Nexplanon ® is effective for 3 years. . It is a subcutaneous reversible progesterone contraceptive device. It is a 4cmlong radiopaque flexible tube inserted in the subcutaneous tissue of the upper arm.
19) A 20-year-old pregnant woman presented to the genitourinary medicine clinic with anogenital warts. She is diagnosed with human papillomavirus (HPV) infection-type. What are her treatment options?
The options for the treatment of anogenital warts during pregnancy are limited
by potential teratogenicity of some modalities such as podophylline. TCA and
imiquimod can be used safely, as well as ablative techniques such as
_ Treatment of the warts may reduce transmission of the human papillomavirus
(HPV) to the fetus during vaginal delivery
20) A 35-year-old woman presented with a offensive frothy vaginal discharge
On speculum examination, the cervix was red, punctate and inflamed.
The wet mount shows the mobile organism.
What is a likely diagnosis in her case?
21) Which of the following is true about antibiotic resistance and gonorrhoea?
22) Which one of the following statements about venous thromboembolic (VTE) risk with CHC is correct?
23) Concerning progestogen only pills (POPs), which of the following is true? .
All hormonal contraception is contraindicated in women who are undergoing treatment for breast cancer as it is a hormone dependent malignancy. Women with insulin dependent diabetes may use the POP safely and there is no evidence that POPs increases thromboembolic risk or that standard antibiotic treatment reduces its contraceptive efficacy.
24) Which AED concentration is affected by COCs
CHC is not usually recommended in women on lamotrigine monotherapy due to the risk of reduced seizure control whilst on CHC, and the potential for toxicity in the CHC-free week.
25) The following facts about chlamydia are true except for which one?
Chlamydia is caused by obligate intracellular pathogen which usually affects the
mucous membranes of the endocervix, rectum, urethra, conjunctiva and pharynx.
The risk factors include below the age of 25 years, recent sexual partner, more
than one partner within the previous year and lack of consistent use of condoms.
Women can present with vaginal discharge, dysuria, lower abdominal pain,
deep dyspareunia, cervicitis, postcoital bleeding and intermenstrual bleeding.
Oedematous cervix and contact bleeding (cervix) can be seen on speculum
examination. For diagnosis, an endocervical swab is needed for culture or for
NAAT to identify DNA.
If not treated, chlamydia may cause severe complications which include pelvic inflammatory disease (PID) (without treatment 10%–40% will develop PID).
26) A 47 years old women with irregular periods and vasomotor symptoms is requesting advice on contraception .She has had a myomectomy in the past .During the history taking she admits that she had unprotected sex 3 days ago with new partner. Her last period 2 weeks ago. What is the correct treatment for her on this occasion?
27) A 25-year-old woman presents to A&E with painful vulva. Examination
reveals multiple ulcers (around the fourchette) with ragged undermined edges
with necrotic base and purulent exudate. There was contact bleeding. Also
noted were enlarged tender left inguinal lymph modes.
The like diagnosis in her case is which of the following?
Chancroid, caused by infection with Haemophilus ducreyi, presents with
anogenital ulceration plus lymphadenitis and the formation of bubo (abscess). This
is found in 50% of cases and is mostly unilateral. Buboes form and can become
Fluctuant and rupture, releasing thick pus, resulting sometimes in extensive
Ulceration. The incubation period ranges between 3 and 10 days.
Culture from the ulcer base, or the undermined edges of the ulcer or from pus aspirated from the bubo should be obtained.
28) A 27yearold nulliparous woman comes to the outpatient clinic requesting Depo Provera injection. She wants to know about the no contraceptive benefits and risks with injectable progesterones. Which of the following is incorrect?
UKMEC indicates that a history of VTE or thrombogenic mutations are conditions where the advantages of using the progestogen injectable outweigh the risks (UKMEC2) and are therefore a potential option for women with these conditions. Women with SLE are at increased risk of a number of cardiovascular conditions like ischemic heart disease, stroke and VTE. It is for this reason that greater caution is advised in women with SLE or antiphospholipid antibody syndrome than woman who have a history of VTE due to other cause.
29) A 19yearold attends A&E with acute urinary retention. She also describes myalgia, feeling feverish and headache, as well as pain when she urinates. When the nurse catheterizes her she notices widespread labial blisters. What is the most likely diagnosis?
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