Clinical OSCE With Answers

End of 4th Year Clinical OSCE A/L 2001 Batch

Dinusha Liyanapatabendi

Q7 1. Identify A-G 2. Write the corresponding letters in order of most effective method to least effective method

A

B

C

D

E

F

G

A

B

C

1. Identify A-G 2. Write the corresponding letters in order of most effective method to least effective method D

E

F

G

• A – Female condom • B – Levonorgestrel releasing intra uterine contraceptive device (Mirena®) • C – Copper T-380 A intrauterine contraceptive device • D - Depot medroxy progesterone acetate injectable suspension • E – Norplant subdermal contraceptive implant system • F – Combined oral contraceptive pill • G- Male condoms E>B>F=D>C>G>A

% of women experiencing an unintended pregnancy within the first year of use Method

Typical use1

Perfect use2

No method4

85

85

Withdrawal

27

4

Periodic abstinence Calendar Ovulation method Sympto-thermal6 Post-ovulation

25 9 3 2 1

Condom - Female

6

21

5

Condom - Male

5

15

2

8

0.3

3

0.3

4

0.8

0.6

Mirena (LNG IUS)

2

0.1

0.1

LNG implants (Norplant)

1

0.05

0.05

0.5

0.5

0.15

0.10

Combined pill and minipill DMPA (Depo-Provera) IUD (copper T)

Female sterilization Male sterilization

3 3

Emergency contraceptive pills: Treatment initiated within 72 hours after unprotected intercourse reduces the risk of pregnancy by at least 75%.

A) 21 yrs old unmarried girl presents to your clinic after having unprotected sex last night. What method/s that you can use in this patient as post-coital contraceptive method/s. B) A 35 yrs old healthy woman with two children aged 3 & 5 yrs requests an emergency contraceptive after unplanned coitus 4 days ago. Name a method that you would offer to this woman. 1 3

2

4

A. 1 – Postinor2® take one tab immediately and the second tablet 12 hrs later 2 – Combined oral contraceptive pill Take 4 tablets immediately and repeat the same dose 12 hrs later B. Copper T 380-A intrauterine contraceptive device • A copper-releasing IUD (Cu-IUD) can be used within 5 days of unprotected intercourse as an emergency contraceptive. However, when the time of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days after intercourse, if necessary, as long as the insertion does not occur more than 5 days after ovulation.

Q11 1. How long can it be used 2. List 2 advices you would give after inserting this to a patient 3. What should you do if a woman gets pregnant after placing it

1. 2.

10 years (6-8)

Expect some bleeding PV for a few days Check for the presence of the threads (Specially during menstruation period) First 3-4 menstrual periods may be heavier than normal Take paracetamol tablets if she develops lower abdominal pain. Follow up – In one month and thereafter annually Prompt medical advice should be taken if - the threads are not felt - delayed menstrual period (Pregnancy?) - Severe abdominal pain Prolonged or excessive bleeding

3.

Remove the IUCD

•

Timing of insertion 1st seven days of the cycle (Ideal during menstruation)

•

Removal of IUD pregnancy Perforation Acute PID Menopause – one year after last period

•

Absolute contraindications Pregnancy Acute/Chronic PID Abnormal uterine bleeding Suspected/confirmed genital tract malignancy

•

What you should ask in the Hx: LRMP – to rule out possibility of pregnancy Mucopurulent vaginal discharge - ? PID

A

B

Q7

C

1. Name above items and write one non-contraceptive benefit of each above given methods 2. 30 yrs old female who is on OCP has forgotten to take her last two pills. what advise would you give her?

1) A - Levonorgestrel

releasing intra uterine contraceptive device (Mirena®)

B – Male condom C – Combined oral contraceptive pills 2) A-

Improves menorrhagia Decrease dysmenorrhoea and pelvic pain in patients with endometriosis

B- Protection against STD Protection from carcinoma of the Cx C- Relief of menstrual problems Regularizes previously irregular cycles Decrease number of days of bleeding and amount Improves iron deficiency anaemia Relieves and reduces premenstrual tension Protection against ovarian and endometrial cancers Decreases incidence of benign breast cysts and fibroadenoma Prevent ectopic pregnancy

Missed pills Sri Lanka Family Planning Association Guidelines • Missed one tablet Take the missed pill as soon as you remember & take the scheduled pill at the usual time • Missed consecutive two pills on two days Take two pills on the third day and two on the fourth day. From next day onwards take one pill daily. Till you get your next menstrual period use condoms as a backup method OR abstain from sex.

Missed “Pill” WHO Guidelines

1. What is the advice you would give to the patient when prescribing this 2. List 3 Common side effects

Advice

•

Postinor contains two tabs. Treatment necessitate to take 2 tabs

•

Reliable (75%) post coital contraceptive method if it takes