QuestionSBA
QuestionChoice
Whilst this patient is hypertensive, she is asymptomatic and systemically well. Hypertension with a systolic pressure of over 180mmHg and signs of end-organ damage such as retinal haemorrhage, papilloedema, new confusion, chest pain or signs of heart or kidney failure would require immediate admission as this would suggest malignant hypertension. It would therefore not be appropriate to admit this patient. The most important step at this stage would be stopping her COCP as this could be a cause of her hypertension. (!)
50215
e
Admit to hospital
QuestionChoice
Microgynon and Dianette are both combined oral contraceptive pills. Dianette is used specifically to treat acne. This patient has a blood pressure of over 160mmHg systolic and so any COCP would be inappropriate.
50212
b
Change microgynon to dianette
QuestionChoice
This patient is hypertensive. A systolic blood pressure of over 160mmHg (or >100mmHg diastolic) is a contraindication to COCP usage and it should be stopped.
50211
a
Stop microgynon
QuestionChoice
Ramipril is an angiotensin-converting enzyme inhibitor (ACE-i) used to treat hypertension. Although an ACE-i would be the first choice of antihypertensive in a patient under the age of 55, stopping microgynon would be a more appropriate initial step. The patient's blood pressure may improve on cessation of the combined oral contraceptive pill.
50213
c
Start ramipril
QuestionChoice
This patient has a blood pressure of over 160mmHg systolic and the combined oral contraceptive pill should be stopped. Taking a 7-day break from the pill would not be appropriate here. Breaks from the combined oral contraceptive pill are used to induce withdrawal bleeds.
50214
d
Take a 7-day break from microgynon
QuestionComment
where is the supporting info?
39911
QuestionComment
UKMEC
40294
User
subscriber
Hypertension Kinase
User
subscriber
Danniboi
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3620
Blood Pressure and COCP
Topic
76
Obstetrics and Gynaecology
10090
Case Presentation:  A 26-year-old female patient takes the combined oral contraceptive pill (COCP) for endometriosis. She feels well in herself. 


**PMH**
Endometriosis

**DH**
Microgynon 30 one tablet daily

**On Examination**

* HR 84 bpm
* Blood pressure 166/92 mm/Hg

Question: Given the results of the above investigations, what is the most appropriate next step?
a