GP gauntlet #2

elliptic's version from 2018-03-18 03:02

Contraceptive methods: pros and cons

Question Answer
ImplanonPros: Lasts 3 years. Immediately reversible. Cons: Wound infection or scarring. Can cause irregular bleeding. Progestogenic side effects.
MirenaPros: Lasts 5 years. Reduced bleeding/ectopic risk/dysmenorrhea. Endometrial protection. Cons: may cause errratic bleeding. Progestogenic side effects. Problems with insertion or retrieval.
COCPPros: Regular cycle/cycle control. Lighter periods. Reduced dysmenorrhoea. Cons: Compliance. Side effects. Increased breast cancer and thromboembolism risk.
POPPros: Few side effects and contraindications. Cons: Compliance. Irregular bleeding. Progestogenic side effects.
IUCDPros: Lasts >5y. No systemic side effects. Cons: Heavy periods. Problems with insertion/removal. No protection from PID or ectopic pregnancy.
Depo-ProveraPros: no pill-taking. Decreased bleeding. Can help PMS. Lower risk of ectopic pregnancies, endometrial cancer. Cons: Menstrual irregularity. Weight gain. Unpredictable return of fertility. Increased risk of osteoporosis.
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.

Contraceptive methods: examples and contraindications.

Question Answer
ImplanonContra: pregnancy, liver disease, personal history of breast cancer, undiagnosed abnormal vaginal bleeding.
COCPContra: <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.
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.

Neurological fundings in nerve root compression

Question Answer
L3 + L4↓ power: knee extension. ↓ sensation: anterior + lateral thigh. ↓ reflex: knee jerk.
L5↓ power: dorsiflexion of big toe and ankle. ↓ sensation; particularly dorsum of foot. ↓ reflex: ankle jerk.
S1↓ power: plantar flexion of ankle. ↓ sensation: particularly lateral aspect and sole of foot. ↓ reflex: ankle jerk.