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GP gauntlet #2 (contraception, peripheral nerves)

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elliptic's version from 2018-05-20 03:20

Long acting contraceptives

Question Answer
Copper IUD (annual pregnancy rate; duration; effect on menses; not a good idea if; adverse effects; advantages)<1%;10 years. Menses may be heavier. Bad idea if heavy/painful periods; Fe deficiency; severely distorted uterine cavity or active uterine infection; copper allergy or Wilson's. Cons: perforation, expulsion, increased risk of infection for 20 days. Pros: Highly effective, long-acting, no hormones.
Levonorgestrel-releasing IUD (annual pregnancy rate; duration; effect on menses; not a good idea if; adverse effects; advantages)<1%; 5 years. Menses lighter; irregular esp. in first 3-6 months. Bad idea if: severely distorted uterine cavity or active uterine infection, poor tolerance of amenorrhoea or unscheduled bleeding, sensitive to hormonal adverse effects. Cons: perforation, expulsion, increased risk of infection in the first 20 days. Pros: reduced menorrhagia, dysmenorrhoea, endometrial hyperplasia.
Etonogestrel implant (annual pregnancy rate; duration; effect on menses; not a good idea if; adverse effects; advantages)<1%; 3 years. Menses lighter, irregular. Bad idea if: poor tolerance of amenorrhoea/unscheduled bleeding. Cons: infection/scarring at site or difficult removal. Pros: good for women who want/need to avoid oestrogen.
Depot medroxyprogesterone acetate (annual pregnancy rate; duration; effect on menses; not a good idea if; adverse effects; advantages)6%; 12 weeks. Menses lighter, irregular. Bad idea if: poor tolerance of amenorrhoea/unscheduled bleeding; known low BMD; wants to get pregnant quickly upon discontinuation. Cons: weight gain, mood changes, and osteopenia with long-term use. Pros: Good for women who want/need to avoid oestrogen.
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Contraceptive pills

Question Answer
COCP (pros, cons)Pros: Regular cycle/cycle control. Lighter periods. Reduced dysmenorrhoea. Cons: Compliance. Side effects. Increased breast cancer and thromboembolism risk.
COCP contraindicationsContra: <6wks postpartum, smoker >15cigs >35, HTN >160/100, VTE hx, IHD/CVA/complicated valvular heart disease, migraine with focal neurology, breast cancer, diabetes with microvascular complications, cirrhosis or liver tumour.
POP (pros, cons)Pros: Few side effects and contraindications. Cons: Compliance. Irregular bleeding. Progestogenic side effects.
Side effects of relative progestogen excessMood swings. PMT. Dry vagina. Sustained weight gain. Low libido. Lassitude. Acne.
Oestrogenic side effectsBreast tenderness. Nausea. Dizziness. Cyclical weight gain. Bloating. Vaginal discharge.
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Contraceptive methods: examples and contraindications.

Question Answer
ImplanonContra: pregnancy, liver disease, personal history of breast cancer, undiagnosed abnormal vaginal bleeding.
POPContra: current breast cancer, trophoblastic disease, liver disease, if new IHD/CVD or migraine with aura while on POP, SLE with antiphospholipid antibodies
Depo-ProveraContra: Similar to POP. Relatively contraindicated if DM with complications or multiple risk factors for CVD.
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Neurological fundings in nerve root compression

Question Answer
L2-3 (reflex, motor, sensory, test)Reflex: none. Motor: quads. Sensory: anterior thigh. Test: knee extension.
L4 (reflex, motor, sensory, test)Reflex: patella. Motor: tibialis anterior (foot dorsiflexion, invesion). Sensory: medial lower leg and foot. Test: walk on heels.
L5 (reflex, motor, sensory, test)Reflex: medial hamstring (difficult to assess). Motor: extensor hallucis longus (big toe dorsiflexion). Sensory: dorsal foot. Test: hold up great toe.
S1 (reflex, motor, sensory, test)Reflex: achilles. Motor: peroneus longus and brevis (ankle eversion) and plantar flexion of foot. Sensory: lateral foot. Test: walk on toes.
S2-4 (reflex, motor, sensory, test)Reflex: anal wink. Motor: intrinsic foot muscles, anal sphincter tone. Sensory: perianal. Test: nil.
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Upper limb entrapment syndromes

Question Answer
Ulnar side of arm and forearmScalenus anticus syndrome; entrapment of brachial plexus at scalenus anticus muscle or a cervical rib.
Posterior and lateral shoulderSuprascapular nerve entrapment at suprascapular notch
Proximal forearm and palmar surface of the first 3 digitsPronator syndrome; entrapment of median nerve at pronator teres
Palmar surface of first 3 digitsCarpal tunnel syndrome; entrapment of median nerve at carpal tunnel.
Fourth and fifth digits of the handUlnar nerve entrapment, at the cubital fossa (cubital tunnel syndrome) or guyon's canal.
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Lower limb entrapment syndromes

Question Answer
Anterolateral thighMeralgia paresthetica; entrapment of lateral femoral cutaneous nerve under the inguinal ligament.
Upper medial thighObturator entrapment in the obturator canal
Buttock and legSciatic nerve at sciatic notch (piriformis syndrome)
Undersurface of footPosterior tibial nerve entrapment at posterior tarsal tunnel
Between toes and footMorton's neuroma; interdigital nerve entrapment at deep transverse tarsal ligament
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