A contraception request with migraine with aura needs a safety screen before oestrogen-containing options enter the plan.
Migraine with aura rules out oestrogen-containing combined contraception.
Contraception requests should begin with a safety screen before method choice. Sexual and reproductive health is worth opening first because migraine with aura, VTE history, mobility, age and cardiovascular risk change what can be offered, while menopause care still needs fertility risk, bleeding pattern and endometrial protection documented. Symptomatic discharge also needs more than swabs alone: history, examination, STI testing, microscopy or culture and follow-up all matter.
Histoplasmosis gives the respiratory companion: persistent fever, bilateral pneumonia and breathlessness should trigger exposure and immune-status history. Cannabinoid toxicity adds route and timing, especially edibles and synthetic products. R2D2 sharpens restraint reassessment in ventilated ICU patients, while difficult treatment conversations and adult metabolic disease bring the same habit to family involvement and clustered multi-system clues.
A contraception request is not just method matching. Check medical eligibility first, especially migraine with aura, VTE history, mobility, age and cardiovascular risk. The same structured approach helps menopause care, intrauterine device pain planning, symptomatic discharge and self-collected screening follow-up.
Persistent fever with bilateral pneumonia, fatigue and exertional breathlessness should bring exposure history forward. Ask about geography, soil disturbance, caves, birds, bats and immunosuppression, then use imaging, antigen testing, PCR where available and culture together when histoplasmosis fits.
Cannabis presentations depend on product and route. Edibles can behave differently because oral THC becomes 11-hydroxy-THC, while chronic vomiting with hot-shower relief suggests cannabinoid hyperemesis. Synthetic cannabinoids need surveillance for seizures, respiratory effects, dehydration, rhabdomyolysis and acute kidney injury.
Ventilated ICU patients do not all need wrist restraints by default. A lower-use approach depends on agitation scoring, delirium status, airway and line risk, light sedation practice and clear criteria for applying, loosening or removing restraints.
Difficult treatment conversations need more than asking whether there are questions. Identify the choice, check understanding, ask how involved the patient wants to be and decide who else should join the conversation, especially when culture, capacity or family support affects care.
Adult cirrhosis with hyperuricaemia, gout, renal stones or mild neutropenia may point to attenuated glycogen storage disease type 1b. More than one affected sibling should push the history toward a unifying inherited diagnosis rather than separate organ labels.
When a patient asks for contraception, pause before naming a method. Check migraine with aura, VTE history, mobility, age and cardiovascular risk, then document contraceptive and non-contraceptive priorities. The sexual and reproductive health discussion is worth opening for this structured safety screen.
What should come before prescribing combined hormonal contraception?
Check medical eligibility, including migraine with aura, VTE history, mobility, age and cardiovascular risk. This safety screen comes before method choice.
In symptomatic vaginal discharge, what should not be reduced to swabs alone?
Use an inclusive sexual history with targeted examination, STI tests, microscopy or culture and follow-up. Consider cervical pathology, PID and retained foreign body when symptoms require it.
If pneumonia with fever and fatigue persists, what history becomes important?
Ask about geography, soil disturbance, caves, bird or bat exposure and immunosuppressive treatment. Bilateral pneumonia or an unexpected course should bring fungal infection into the differential.
.svg)