TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Contraception Goto page 1, 2  Next          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Jan 20, 2007 11:53 am    Post subject: Contraception 1. Women with family history of breast Ca can safely use the COC, POC, IUS. 2. Women with family history ov VTE/PE cannot use the COC 3. A single dose of 10 mg mifepristone is highly effective emergency contraception used 5 days after UPSI 4. The recommended regimen for levonorgestrel emergency contraception is 0.75mgs repeated after 12 hours 5. Levonelle can be given for emergency contraception if the woman presents beyond 72hours from UPSI 6. IUCD should be avoided in women with history of ectopic pregnancy 7. In HIV +ve women a) may need higher doses of COC b)IUS should be avoided c) Barrier methods with spermicides is a safe alternative Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Jan 20, 2007 1:21 pm    Post subject: Re: Contraception wolverine wrote: 1. Women with family history of breast Ca can safely use the COC, POC, IUS.True 2. Women with family history ov VTE/PE cannot use the COC...False 3. A single dose of 10 mg mifepristone is highly effective emergency contraception used 5 days after UPSI...false 4. The recommended regimen for levonorgestrel emergency contraception is 0.75mgs repeated after 12 hours...True 5. Levonelle can be given for emergency contraception if the woman presents beyond 72hours from UPSI....False 6. IUCD should be avoided in women with history of ectopic pregnancy..True7. In HIV +ve women a) may need higher doses of COC ...False b)IUS should be avoided ..False c) Barrier methods with spermicides is a safe alternative.True Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Jan 20, 2007 1:36 pm    Post subject: (( Women with a personal history of venous thromboembolism should not use combined oral contraception but may use progestogen-only methods.))....RCOG Guidline October 2004 Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Jan 20, 2007 1:51 pm    Post subject: Oral contraceptives not only pose a risk for breast cancer, but for liver and cervical cancer as well, this make a woman with COC have increased risk of these malignancy.....but in women with family history of breast cancer I think the same risk as general population exposed to COC..... Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:34 pm    Post subject: Re: Contraception wolverine wrote: 1. Women with family history of breast Ca can safely use the COC, POC, IUS These methods should be OK in the absence of a BRCA or related mutation. There are exceptions but as this question stands I would answer true. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:36 pm    Post subject: wolverine wrote: 2. Women with family history ov VTE/PE cannot use the COC False - they can use it even if they have a personal history and a thrombophilia although caution is required, other methods may be more suitable, and in some cases prophylactic anticoagulation needs to be prescribed cocomitantly. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:38 pm    Post subject: wolverine wrote: 3. A single dose of 10 mg mifepristone is highly effective emergency contraception used 5 days after UPSI Not sure about earlier treatment but unlikely at 5 days post UPSI although there will be an effect on the endometrium. Anyway the words 'highly effective' make this false regardless. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:40 pm    Post subject: wolverine wrote: 4. The recommended regimen for levonorgestrel emergency contraception is 0.75mgs repeated after 12 hours FALSE - 1.5mg as a single dose. wolverine wrote: 5. Levonelle can be given for emergency contraception if the woman presents beyond 72hours from UPSI TRUE - up to 5 days although most effective within 24 hours and then 72 hours. Still important to avoid use of the term 'morning after pill' which gives people the wrong impression. Click here for a nice link. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:45 pm    Post subject: wolverine wrote: 6. IUCD should be avoided in women with history of ectopic pregnancy FALSE - the IUCD is such an effective contraceptive one could consider previous ectopic as an indication! The risk of ectopic is reduced in IUCD uswers but increased in IUCD users who become pregnant. Common misconception _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 5:48 pm    Post subject: wolverine wrote: 7. In HIV +ve women wolverine wrote: a) may need higher doses of COC Can't remember why but may relate to the drugs used but the question has the magic word "MAY" so has to be true anyway wolverine wrote: b)IUS should be avoided It is an effective form of contraception if used alongside barrier methods. Not sure to be honest and cannot remember the guideance although have read it once! Pretty sure it can be used and is just as effective and does not increase transmission. wolverine wrote: c) Barrier methods with spermicides is a safe alternative Absolutely not plus spermicides been shown to increase transmission rates! _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Jan 20, 2007 6:15 pm    Post subject: Nick, absolutely spot on!! I would agree with all except mifepristone. In the most recent WHO trial comparing the effectiveness of the standard two-dose levonelle the double dose (1.5mg) and low dose mifepristone there was no difference in effectiveness in the three groups. But I agree maybe the words highly effective is misleading. What excactly is "highly effective"?.. IUS should be avoided (cat 3) in those with AIDS but is cat 2 in those with well controlled disease Antiretroviral therapy can alter the bioavailability of steroid hormones in hormonal contraceptives. Could you kindly sit the exams for me please?! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 8:47 pm    Post subject: wolverine wrote: Nick, absolutely spot on!! I Could you kindly sit the exams for me please?! Of course but I would expect some X-men powers in return _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Jan 20, 2007 8:50 pm    Post subject: wolverine wrote: I would agree with all except mifepristone. In the most recent WHO trial comparing the effectiveness of the standard two-dose levonelle the double dose (1.5mg) and low dose mifepristone there was no difference in effectiveness in the three groups. But I agree maybe the words highly effective is misleading. What excactly is "highly effective"? Good question ... I think 'effective' suggests close to 100% success rate i.e. prevent pregnancy. This would be hard to achieve at 5 dasy post UPSI hence I stay with false for this reason alone. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Sun Jan 21, 2007 10:12 am    Post subject: IUS should be avoided- False, it was the previous advice, not anymore. Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Sun Jan 21, 2007 10:19 am    Post subject: In HIV +ve may need higher doses of COC , Though shaw mentions we have to make pt's aware of possibility of reduced dose availability, it does not mention dose has to be increased anywhere, though they mention to encourage use of condoms because of that. Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Sun Jan 21, 2007 10:20 am    Post subject: For rest thanks to Nick. Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Sun Jan 21, 2007 10:21 am    Post subject: They advice to give inj. depot every 10 wks instead of 12 in HIV +ve Back to top bronwyn Century Club Joined: 19 Jul 2006 Posts: 144 Location: Alton, Hampshire Posted: Sun Jan 21, 2007 9:03 pm    Post subject: Quote: a) may need higher doses of COC Can't remember why but may relate to the drugs used but the question has the magic word "MAY" so has to be true anyway Some reasons why the COCP may not be the best option in women infected with HIV Possible interaction between the steroids and immune function or anti-HIV medication/antibiotics. Possible increased shedding of HIV from cervix. No protection from HIV or STDs. _________________ Bronwyn Bell SpR Portsmouth Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Mon Jan 22, 2007 1:28 pm    Post subject: Nick Raine-Fenning wrote: wolverine wrote: 2. Women with family history ov VTE/PE cannot use the COC False - they can use it even if they have a personal history and a thrombophilia although caution is required, other methods may be more suitable, and in some cases prophylactic anticoagulation needs to be prescribed cocomitantly. The RCOG guideline on this says quite clearly that COCs should be avoided in women with a personal history of VTE. It then goes on to say that it is WHO cat 3 which means benefits outweigh risks. Surely this means that for the sake of exams we should assume that COCs should not be used in this case? Abi Back to top bronwyn Century Club Joined: 19 Jul 2006 Posts: 144 Location: Alton, Hampshire Posted: Mon Jan 22, 2007 1:39 pm    Post subject: True. You mean risks outweigh benefits for WHO 3. And if you look at the WHO table previous VTE is actually under WHO 4 (unacceptable health risk)! Think Nick's thinking of HRT maybe B _________________ Bronwyn Bell SpR Portsmouth Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions All times are GMT Goto page 1, 2  Next Page 1 of 2   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group