Contraceptive Choices in Migraine

24 Year Old Woman With Heart Murmur Inquiring About Contraception

A 24-year-old woman presents for a well-adult visit. Her health history includes the diagnosis of mitral valve prolapse without significant mitral regurgitation. She is feeling well, has no chief complaint, and denies activity intolerance, stating she plays tennis or pickleball for about one hour three to four times a week. Her only medication is an oral combined hormonal contraceptive and reports being pleased with her contraceptive method. She states that she read online that “I know I have a heart murmur and I'm worried about whether the birth control pill is safe for me.” The nurse practitioner considers the following when advising this patient A. she should switch to a progestin only contraceptive method B. if no other contraindications are present, she can continue to use combined hormonal contraception C. in this clinical scenario, barrier contraceptive method is advised D. she should be referred to cardiology for advice on contraceptive methods --- YouTube: https://www.youtube.com/watch?v=fkJkZLA1BM8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=144 [https://www.youtube.com/watch?v=fkJkZLA1BM8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=144] Visit fhea.com [https://fhea.com/] to learn more!

HRT in a 51-Year Old Woman

A 51 year old woman who works as a real estate agent presents for an office visit with a chief complaint of severe vasomotor symptoms reporting, "I can't sleep through the night without being drenched in sweat. I have at least four hot flashes a day. Sometimes while I'm working with clients. I need some help. What do you think about hormone therapy? " Her LMP was approximately 13 months ago and she's without chronic health problems.  When considering postmenopause hormone therapy, which of the following is the most accurate statement? A. The use of hormone therapy post menopause is associated with a significant increase in cardiovascular and cancer risk. B. The use of select low dose SSRIs for the management of vasomotor symptoms is as effective as hormone therapy. C. Short duration lower dose hormone therapy offers an effective form of therapy for menopausal vasomotor symptoms. D. Hormone therapy postmenopause offers an effective treatment for osteoporosis. --- YouTube: https://www.youtube.com/watch?v=80j1H7FVrJY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=143 [https://www.youtube.com/watch?v=80j1H7FVrJY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=143] Visit fhea.com [https://fhea.com/] to learn more!

Contraceptive Choices in Migraine

Which of the following best describes the use of contraception for a 26 year old woman who has migraine without aura, usually three episodes per month controlled with high dose ibuprofen who is otherwise well states. "I want to get on some birth control that's really reliable for the next three years while I'm in graduate school." A. All combined hormonal contraceptive forms are contraindicated with any type of migraine. B. Combined hormonal contraception is acceptable for use in this clinical situation. C. Progestin-only contraceptive methods should be avoided in migraine with or without aura due to the increased risk for elevated blood pressure. D. Barrier contraceptive methods are preferred in this situation. --- YouTube: https://www.youtube.com/watch?v=PyCwq8NMkPw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=142 [https://www.youtube.com/watch?v=PyCwq8NMkPw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=142] Visit fhea.com [https://fhea.com/] to learn more!

HTN Interventions

A 56-year-old man with a 10-year history of hypertension presents for a primary care visit, stating he has not taken his high blood pressure medicines, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the last three months due to, quote, running out of medication and not getting to the pharmacy, close quote. Today's blood pressure is 192 over 120, and he's without complaint, denying shortness of breath, chest pain, or visual changes. He states, "I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a half an hour." His physical exam shows no acute distress, grade one hypertensive retinopathy, and S4 heart sound. His neck veins are within normal limit, chest is clear, no peripheral edema with a resting heart rate of 73. Respiratory rate 16, 12 lead ECG is within normal limits. His BMI is 33.  Which of the following is the next best step in the patient's care? A. Administer in-office oral clonidine and reassess blood pressure in 1 hour.  B. Activate EMS with prompt transfer to emergency department C. Restart prior blood pressure medications with follow-up within the next month D. Advise restricting dietary sodium and weight loss to help with BP control.  --- YouTube: https://www.youtube.com/watch?v=xpsNR1uxO4Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=141 [https://www.youtube.com/watch?v=xpsNR1uxO4Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=141] Visit fhea.com [https://fhea.com/] to learn more!

HTN Findings

A 56 year old man with a 10 year history of hypertension presents for a primary care visit, stating he's not taking his hypertension med, a calcium channel blocker, an angiotensin converting enzyme inhibitor, and a thiazide diuretic for the past three months due to  "running out of the medication and not getting to the pharmacy." Today, his blood pressure is 192 over 120 and he has no complaint, denying shortness of breath, chest pain or visual changes. He states, "I just came in today for a visit since I ran out of my blood pressure refills. I need to get back to work in a half an hour." When considering the diagnosis of asymptomatic markedly elevated blood pressure, the clinician would predict his physical exam is normal with the exception of which of the following. A. S4 heart sound B. Grade 3 HTN retinopathy C. Neck vein distension D. Murmur of aortic regurgitation --- YouTube: https://www.youtube.com/watch?v=GlnpCn_tg48&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=140 [https://www.youtube.com/watch?v=GlnpCn_tg48&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=140] Visit fhea.com [https://fhea.com/] to learn more!