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GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • o Clinical or biochemical hyperandrogenism: acne/hirsutism/alopecia, raised FAI. What are the main risks associated with PCOS? Insulin resistance, increased CVD risk, OSA, increased endometrial cancer risk. How do we d...

GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • o Clinical or biochemical hyperandrogenism: acne/hirsutism/alopecia, raised FAI. What are the main risks associated with PCOS? Insulin resistance, increased CVD risk, OSA, increased endometrial cancer risk. How do we diagnose BV? Based on Amsells criteria, ¾ need to be present: o Homogenous discharge o pH >4.5 o Fishy odor when combined with 10% KOH o Clue cells on microscopy CLUE CELLS ARE VAGINAL EPITHELIAL CELLS COVERED BY ADHERENT GRAM-NEGATIVE RODS What are examples of estrogenic side effects? Nausea, headache, dizziness, breast tenderness, cyclical weight gain. What are examples of progestogenic side effects? Weight gain, mood swings, acne, hirsutism, seborrhea. What are the options for emergency contraception? o IUCD: most effective form of emergency contraception, it also provides ongoing contraception. Offered as first-line. o Ulipristal acetate: mixed progestin agonist/antagonist. Maintains nearly full efficacy at 4th and 5th days unlike plan B. Particularly given in women with a raised BMI. MORE EFFECTIVE THAN PLAN B. Delay for 5 or more days before starting regular contraception. Can only be given once per cycle. o Levonorgestrel Plan B: progestin. Efficacy declines after 5 days, the sooner it is taken the better it is. Can be given more than once per cycle. Half as effective as ulipristal acetate. BEST TAKEN WITHIN THE FIRST 3 DAYS AFTER UPSI o Remember that oral EC works by delaying ovulation, meaning that they are ineffective once ovulation has occurred. What are NICE guidelines for HTN drug management? o <55yrs: first-line ACEi/ARB, second-line combine with CCB, third-line combine with thiazide-like diuretic. o >55yrs or African/Caribbean origin: first-line CCB, second-line combine with ACEi/ARB (ARB is preferred if African or Caribbean origin), third-line combine with thiazide-related diuretic. o If steps 1-3 fail to control, then this is resistant HTN. Consider adding spironolactone or increasing indapamide dose depending on potassium levels/doxazosin/atenolol. What are the stages of HTN according to NICE guidelines? o Stage 1: Clinic BP 140/90 or more AND ABPM/HBPM average of 135/85 or more. OFFER DRUG TX IF <80yrs and has at least 1 of: DM, renal disease, end-organ damage, established CVD, 10yr CVD risk of 10% or more. o Stage 2: Clinic BP 160/100 or more AND ABPM/HBPM average of 150/95 or more. OFFER DRUG TREATMENT TO ALL PATIENTS o Severe HTN: Clinic SBP 180 or more OR DBP 110 or more. OFFER DRUG TREATMENT TO ALL PATIENTS