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MFSRH > 8 - GUM > Flashcards

8 - GUM Flashcards

1
Q

Symptoms of Trichomonas in F

A 
Vulval itching
Dysuria
Offensive smelling yellow frothy discharge
Abdominal pain
Vulval ulceration - occasional 
10-50% asymptomatic
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2
Q

Diagnosis of Trichomonas

A

Vaginal swab for saline wet microscopy

NAATS

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3
Q

Organism causing chlamydia infection

A

Chlamydia trachomatis intracellular gram negative bacteria

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4
Q

Symptoms of chlamydia in F

A 
Asymptomatic
Vaginal discharge
Low Abdominal pain
Deep Dyspareunia
Intermenstrual bleeding
Postcoital bleeding
Dysuria
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5
Q

Symptoms of chlamydia in M

A

Urethritis
Dysuria
Penile discharge

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6
Q

What is reiters syndrome

A

Urethritis arthritis and conjunctivitis

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7
Q

Diagnosis of chlamydia in men

A

NAATs. Testing on first void urine

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8
Q

Chlamydia diagnosis in women

A

Self-administered high vagina swab for NAATs testing

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9
Q

What type of organism is Trichomonas

A

Flagellated Protozoan

Parasite

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10
Q

What STI is a gram negative diplococcus

A

Neisseria gonorrhoea

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11
Q

On what samples is gonorrhoea diagnosed

A

NAATs on first void urine
Microscopy - gram stain
Culture - for sensitivities - done after NAATs +ve or known contact of GC

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12
Q

Symptoms of Trichomonas in M

A 
15-50% asymptomatic 
Urethral discharge 
Dysuria
Urethral irritation
Urinary frequency
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13
Q

Complications of TV

A

Preterm delivery
Low birth weight infants
TV at delivery may predispose to maternal sepsis
Association with HIV

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14
Q

Diagnosis of TV

A

F - Posterior fornix swab - NAATs

M - urethral culture / 1st void urine NAATs

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15
Q

What is seen on microscopy in TV

A

Mobile trichomonads on wet prep

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16
Q

How quickly must a wet prep slide be read for TV microscopy

A

10 mins - trichomonads quickly lose motility

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17
Q

Treatment of TV

A

Systemic treatment (as PV tx has 50% cure rate)
Metronidazole 2g PO STAT
Or metronidazole 400-500mg BD 5-7/7

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18
Q

Treatment of TV when metronidazole has failed

A

Tinidazole = longer serum 1/2 life 2g PO STAT

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19
Q

Duration of scabies lifecycle

A

4-6 weeks

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20
Q

How long does it take for scabies eggs to become adults

A

10-15 days

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21
Q

Mode of transmission of scabies

A

Close skin contact
Can be sexually transmitted
Formite transmission uncommon

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22
Q

Presentation of scabies

A

Intense, generalised pruritus - worse at night
Delayed IV hypersensitivity reaction to mites / faeces / eggs
Erythematous papules
Excoriation
Visible burrow

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23
Q

Duration between primary infection and symptom development in scabies

A

3-6 weeks

Infectious before symptoms develop

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24
Q

Common areas affected by scabies

A 
Webspaces, sides of fingers, under fingernails
Flexor side of wrist
Extensor side of elbow
Axilla
Around nipple, penis, scrotum
Around umbilicus, medial thigh, buttock
Side + back of feet
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25
Q

Presentation of crusted scabies

A 
Erythematous, crusted, scaly lesions
Malodour
Fissuring
Affects any area of the baby including face + scalp
Itching mild or absent
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26
Q

Management of scabies

A

5% permethrin cream - apply 8-12hr, repeat 1/52
0.5% malathion aqueous - apply 24hrs, repeat 1/52
25% benzyl-benzoate emulsion - not recommended

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27
Q

Treatment for crusted scabies

A

Permethrin cream OD for 7/7 then 2x/wk until cured

+ PO ivermectin 200mcg/kg on day 1,2,8,9,15

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28
Q

Who should receive a Hep A vaccine

A

MSM who have oro-anal or digital anal contact

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29
Q

Who should receive Hep B vaccination

A 
MSM
CSW
IVDU
partner from high prevalence area
HIV +ve
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30
Q

At what level do most labs detect a HIV viral load

A

50 copies / ml

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31
Q

Immediate needs for a sexual assault victim

A 
Immediate safety
Treat injuries - may need A+E 1st
Baseline screen for STIs +/- prophylaxis
Baseline HIV test and serum save
HIV PEP
Hep B vaccination 
EC
Refer to SARC + forensic medical examiner 
Consider safeguarding and child protection issues
Self harm risk assessment
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32
Q

Medium term needs for sexual assualt victim - disclosure after 7 days of assault

A 
STI screening baseline + repeat 2/52 after assault
Hep B vaccination
Pregnancy test
Assess coping
Identify symptoms of PTSD
psychological support
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33
Q

Long term needs for sexual assualt victim - disclosure after 1 yr of assault

A 
STI screen
Involve GP in psychological problems
\+/- counselling
\+/- CBT
\+/- antidepressants
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34
Q

What samples are taken in a police/A+E early evidence kit

A

Urine, mouth swab, mouth rinse

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35
Q

Forensic timescale for evidence from kissing / licking / biting

A

48 hours

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36
Q

Forensic timescale for evidence from oral penetration

A

48 Hours

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37
Q

Forensic timescale for evidence from vaginal penetration

A

7 days

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38
Q

Forensic timescale for evidence from digital penetration

A

12 hours

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39
Q

Forensic timescale for evidence from anal penetration

A

72 hours

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40
Q

Significance of a +ve STI result in a victim of a sexual assault

A

+ve STI result rarely important a evidence - hard to prove not pre-existing
Concern a +ve result may be used to present victim as promiscuous.
Important in child victims and the elderly
Need clear chain of evidence - chronological documentation of collection, transfer + Analysis

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41
Q

STI prophylaxis regime for sexual assault victim

A

Ceftriaxone 500mg IM STAT
Azithromycin 1g PO STAT
metronidazole 2g PO STAT

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42
Q

Risk of HIV transmission from a known +ve source - for receptive anal and insertive anal

A 
Receptive = 0.1-3%
Insertive = 0.06%
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43
Q

Risk of HIV transmission from a known +ve source - for receptive vaginal and insertive vaginal

A

Receptive vaginal = 0.1 - 0.2%

Insertive vaginal = 0.03 - 0.09%

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44
Q

Risk of HIV transmission from a known +ve source - for receptive oral (fellatio)

A

Receptive oral = 0.04%

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45
Q

Risk of HIV transmission from a known +ve source - for mucous membrane exposure

A

Mucous membranes exposure = 0.09%

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46
Q

Risk of HIV transmission from a known +ve source - for needles tick injury

A

Needlestick injury = 0.3%

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47
Q

% risk of an assailant being HIV +ve in:
London
Scotland
Elsewhere

A 
London = 15%
Scotland = 2.5%
Elsewhere = 2.3%
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48
Q

Types of PEPSE available (2)

A

Truvada = tenofovir + emtricitabine OD

Kaletra = lopinavir + ritonavir BD

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49
Q

Duration of PEPSE treatment

A

28 days

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50
Q

Side effects of PEPSE treatment

A

Nausea
Vomiting
Diarrhoea

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51
Q

Which patients groups need HIV specialist advice before starting PEPSE

A

Children
Low BMI adults
Pregnant women

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52
Q

When may Hep B immunoglobulin be considered

A

Within 48hours to 7 days of exposure to a known Hep B positive / high risk person

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53
Q

Risk of pregnancy from rape

A

5%

Higher than a single episode of consensual UPSI

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54
Q

What groups can gillick competency be applied to

A

Z

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55
Q

Symptoms of gonorrhoea in men

A 
Asymptomatic 10% Urethral discharge
Dysuria
rectal infection - discharge / pain / asymptomatic
Pharyngeal infection - asymptomatic 
Rare - epiddymal tenderness / swelling
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56
Q

Symptoms of gonorrhoea in women

A 
Asymptomatic
Vaginal discharge 
Lower abdo pain
Dysuria
Rare - intermenstrual bleeding / heavy bleeding
Rectal infection
Pharyngeal infection
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57
Q

Complications of gonorrhoea

A 
Epididymo-orchitis
Prostatitis
PID 
Tubal infertility
Ectopic pregnancy 
Haematogenous spread - Skin lesions/ arthralgia / arthritis/ teno-synovitis
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58
Q

Treatment of gonorrhoea

A

Ceftriaxone 500mg IM STAT
+ azithromycin 1g PO STAT
If rectal + doxycycline 100mg BD 7/7

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59
Q

Treatment for gonococcal PID

A

Ceftiaxone 500mg IM
+ doxycycline 100mg BD 14/7
+ metronidazole 400mg BD

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60
Q

Treatment of gonococcal epididymo-orchitis

A

Ceftriaxone 50mg IM

+ doxycycline 100mg BD 10-14/7

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61
Q

Treatment of gonococcal conjunctivitis

A

3 day systemic treatment as the cornea may be involved + is relatively avascular
Irrigate eye with saline
Ceftriaxone 500mg IM OD 3/7

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62
Q

Look back window for PN of gonorrhoea

A

2/52 if symptomatic

3m if asymptomatic

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63
Q

What FU is required for GC

A

Test of cure - due to resistance

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64
Q

Complications of chlamydia

A 
PID
Endometritis
Salpingitis
Tubal infertility
Peri-hepatitis
Ectopic pregnancy
Sexually acquired reactive arthritis
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65
Q

Signs of chlamydia in F

A

Mucopurulent cervicitis
Contact cervical bleeding
Pelvic tenderness
Cervical motion tenderness

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66
Q

Symptoms of rectal chlamydia

A

Asymptomatic
Pain/ discomfort
Anal discharge

67
Q

Rates of rectal chlamydia in MSM

A

3-10%

68
Q

% risk of tubal infertility after PID

A

20%

69
Q

Management of chlamydia in F with IUD / IUS

A

Uncomplicated chlamydia is not an indication to remove IUD/IUS.
Azithromycin 1g STAT PO

70
Q

Management of chlamydia in pregnancy / breastfeeding

A

Doxycycline and ofloxacin CI
Use azithromycin 1g PO STAT
+ test of cure

71
Q

Symptoms of neonatal chlamydia

A

Ophthalmia neonatorum
Conjunctivitis
Pneumonia

72
Q

Treatment of neonatal chlamydia

A

Erythromycin 50mg/kg 14/7 in 4 divided doses

Test + treat mother

73
Q

Most common organisms in non-gonococcal urethritis

A 
Chlamydia 
Mycoplasma genitalium
Ureaplasma
Trichomonas
Adenovirus
Herpes simplex
74
Q

Non infective causes of non-gonococcal urethritis

A

Urethral stricture

Foreign body

75
Q

Symptoms of NGU

A 
Asymptomatic
Urethral discharge
Urethral discomfort
Dysuria
Penile irritation
76
Q

Complications of NGU

A

Epididymo-orchitis
Sexually aquired reactive arthritis
Reiters syndrome

77
Q

How is the diagnosis of NGU made

A

> /= 5 polymorphonuclear leukocytes per high power field - averaged over 5 fields

78
Q

Investigations for patients with urethral symptoms and negative urethral smear on microscopy

A

Leucocyte esterase dipstick - if >1+ likely smear was inadequate
Reattend for early morning urethral smear if syx not settling

79
Q

Treatment for NGU

A

Azithromycin 1g PO STAT
Or doxycycline 100mg BD 7/7
If mycoplasma - azithromycin 500mg STAT then 250mg OD 4/7

80
Q

Look back period for NGU PN

A

4 weeks

81
Q

Treatment of persisting NGU after treatment

A

Azithromycin 500mg STAT then 250mg OD 4/7

+ metronidazole 400mg BD 5/7

82
Q

Management of continuing symptoms of NGU after 2x courses abx

A

Consider moxifloxacin 400mg PO OD
Consider abacterial prostatitis
Consider chronic pelvic pain syndrome / psychological causes

83
Q

Symptoms of trichomonas in men

A

Asymptomatic
Urethral discharge
Urinary frequency
Prostatitis - rare

84
Q

Look back period for PN in TV

A

4 weeks prior to syx onset

85
Q

Most common cause of abnormal vaginal discharge in F of reproductive age

A

BV

86
Q

What risk cut off is used to decide to give PEPSE

A

recommend PEPSE where significant risk of HIV transmission (risk>1/1000)

87
Q

Risk of HIV transmission from known HIV +ve pt with receptive anal intercourse

A

No ejaculation 1:170
If ejaculation 1:65
Overall 1:90

88
Q

Risk of HIV transmission from known HIV +ve pt with insertive anal intercourse

A

Not circumcised 1:161

Circumcised 1:909

89
Q

Risk of HIV transmission from known HIV +ve pt with receptive vaginal intercourse

A

1:1000

90
Q

Risk of HIV transmission from known HIV +ve pt with insertive vaginal intercourse

A

1:1219

91
Q

Risk of HIV transmission from known HIV +ve pt with semen splash to eye

A

<1:10,000

92
Q

Risk of HIV transmission from known HIV +ve pt with receptive or I service oral sex

A

<1:10,000

93
Q

Risk of HIV transmission from known HIV +ve pt for blood transfusion

A

1:1

94
Q

Risk of HIV transmission from known HIV +ve pt with needle stick inj

A

1:300

95
Q

Risk of HIV transmission from known HIV +ve pt with sharing inj equipment / Chen sex

A

1:149

96
Q

Risk of HIV transmission from known HIV +ve pt with a human bite

A

<1:10,000

97
Q

When is PEPSE by recommended after high risk contact with a known HIV +ve patient

A

if the source patient is on ART with a confirmed and sustained (>6 months) and undetectable plasma HIV VL (<200 c/mL)

98
Q

What drugs are used as PEPSE

A

first-line regimen is Truvada and Raltegravir for 28 days.

99
Q

How is PEPSE used

A

Start ASAP - within 72 hours.
28day course
Follow-up HIV testing at 8–12

100
Q

Other things to offer / do for patients requesting PEPSE

A

STI screen + repeat in 2 week
Ultra rapid Hep B vaccination
Preg test

101
Q

Why may fly like symptoms during PEPSE course be a concern?

A

Consider seroconversion illness

102
Q

Advice if missed PEP doses

A

<24 hour - continue - take missed one now and normal one at usual time
24-48 hr - continue
>48 hour - stop

103
Q

When is universal testing for HIV recommended

A

GUM / SHS
AN
TOP
drug dependency services
Patients diagnosed with TB, HBV, HCV and lymphoma
All GP pts/ gen med admissions in an area of prevalence >2:1000

104
Q

Respiratory clinical indicator disease for HIV testing

A

TB
Pneumocystis
Bacterial pneumonia
Aspergillosis

105
Q

Neurology clinical indicator disease for HIV testing

A 
Cerebral toxoplasmosis
Primary cerebral lymphoma
Cryptococcal meningitis
Progressive multifocal leucoencephalopathy
Aseptic meningitis / encephalitis 
Cerebral abscess
SOL
Guillain-Barre 
Transverse myelitis
Peripheral neuropathy
Dementia
Leucoencephalopathy
106
Q

Dermatology clinical indicator disease for HIV testing

A

Kaposi sarcoma
Severe seborrhoeic dermatitis
Severe psoriasis
Multi dermatomal / recurrent herpes zoster

107
Q

Gastroenterology clinical indicator disease for HIV testing

A 
Persistent cryptosporidiosis
Oral candidiasis 
Chronic diarrhoea
Oral hairy leukoplakia
Weight loss of unknown cause
Salmonella
Shigella
Campylobacter 
Hep B
Hep C
108
Q

Oncology clinical indicator disease for HIV testing

A 
Non-hodgkin lymphoma
Hodgkin lymphoma
Lung cancer
Anal cancer
Seminoma
Head and neck cancer
Castlemans disease
109
Q

Gynaecology clinical indicator disease for HIV testing

A

Cervical cancer
VIN
CIN grade 2+

110
Q

Haematology clinical indicator disease for HIV testing

A

Unexplained thyrombocytopenia / neutropenia / lymphopenia

111
Q

Ophthalmology clinical indicator disease for HIV testing

A

Cytomegalovirus retinitis
Infective retinal diseases
Unexplained retinopathy

112
Q

ENT clinical indicator disease for HIV testing

A

Lymphadenopathy of unknown cause
Chronic parotitis
Lymphoepithelial parotid cysts

113
Q

Primary HIV seroconversion symptoms

A 
Fever
Maculopapular rash
Myalgia
Pharyngitis 
Headache
Aseptic meningitis
114
Q

Cervical smear recommendation for HIV positive female

A

Annual

115
Q

Contraception for HIV F on HAART

A

Depo
Mirena
IUD

116
Q

What do fourth-generation HIV tests trustful test for?

A

HIV antibodies

P24 antigen

117
Q

Window period for fourth generation HIV test

A

4 weeks after exposure

118
Q

How to take prep

A
  • Event based = 24 hours before sex and continue for 2 days after condomless sex
  • Daily regimen
119
Q

Issues to consider when seeing children in SRH

A 
Competency - Fraser guidelines
Emotional maturity
Psychological wellbeing
Physical development
Drug / alcohol use
Age of partner 
Number of partners
Current / previous sexual abuse / exploitation
Other young people at risk - e.g. Siblings
Social support
Schooling
Homelessness
Grooming 
CSW
Physical disabilities
Learning difficulties 
STI / pregnancy risk
120
Q

Is it mandatory to report sex in an <13yo to social services or the police

A

No.
Must be considered case by case.
Always a cause for concern but benefit of reporting needs to be weighed againstr encouraging the young person to seek / accept help.

121
Q

Causative organism of LGV

A

Chlamydia trachomatis L1-3

122
Q

Usual features of LGV

A

Transient small ulcer - may be unnoticed
Lymphadenopathy
Systemic - fever, malaise
Buboes +/- rupture

123
Q

Complications of LGV

A 
Elephantitis
Chronic oedema 
Rectal ulceration
Fistula 
Adhesions
124
Q

Causative organism of chancroid

A

Haemophilus ducreyi

Gram negative bacillus

125
Q

Usual features of chancroid

A

Papule / pustule
Inguinal lymphadenopathy
Buboes possible

126
Q

Causative organism of donovanosis

A

Calymmatobacterium (kebsiella) granulomatis

127
Q

Usual features of donovanosis

A

Firm papule

Subcutaneous nodule may ulcerate

128
Q

Can Vertical transmission occur with TV

A

Perinatally in 5% of female babies of infected mothers

129
Q

Examination findings for TV in F

A

5-15% - no abnormality
70% - vaginal discharge
Classically yellow and frothy
2% strawberry cervix

130
Q

Examination findings in TV in M

A

No signs
Urethral discharge - 20-60%
Rarely balanoposthitis

131
Q

Location of swab for TV

A

Posterior fornix

132
Q

How to sample for TV in men

A

Urethral swab
First void urine
Sampling both increases pick up rate

133
Q

Sensitivity and specificity of TV NAAT

A

Both almost 100%

134
Q

Can metronidazole be used In pregnancy and breastfeeding

A

Yes - not teratogenic

May make milk taste bitter

135
Q

Symptoms of thrush

A 
Vulval itch / burning
Curdy white discharge
No smell
External dysuria
Superficial dysparunia
Erythematous vulva
136
Q

Signs of thrush

A 
Erythema
Fissuring 
Excoriation 
Oedema
Satellite lesions
White discharge
137
Q

Definition of recurrent thrush

A

4+ episodes per year
Either positive microscopy or culture grown
Symptoms with partial / full resolution between

138
Q

Predisposing factors for thrush

A 
Sexual activity
Antibiotics
Hormone status
Tight clothing
Panty liners
Uncontrolled DM
Steroids
HIV and immunosuppression
139
Q

Treatment of thrush

A

Fluconazole 150mg PO stat

Clotrimazole 500mg PV stat or 200mg x 3 nights

140
Q

Treatment of non-albicans candida

A

Standard azole treatment for 14 days

141
Q

Common associations with BV

A 
Change in partner 
Receiving cunnilingus 
Increased no of lifetime partners
Smoking
Black ethnicity
IUD 
STI presence 
Menstruation
Douching
142
Q

Symptoms of BV

A

Vaginal discharge
Fishy odour
Watery white / yellow

143
Q

Treatment of BV

A

Metronidazole 400mg BD for 5-7/7

Alternative - 0.75% metronidazole gel or 2% clindamycin cream

144
Q

Complications of BV

A

Risk factor for HIV acquisition
Associated with STIs
Increased risk of second trimester miscarriage and preterm birth
Increased risk of endometritis after termination
Stigmatisation

145
Q

Define recurrent thrush

A

4+ episodes per year
At least 2 with positive microscopy or culture.
At least partial resolution between

146
Q

Treatment of recurrent thrush

A 
Longer treatment 7-14/7
Fluconazole 150mg 3x over 1 wk
Fluconazole 50mg OD 7/7
Clotrimazole peasant 200mg OD 7/7
THEN
Regular fluconazole 150mg weekly for 6m
Or clotrimazole 500mg peasant weekly 6m
147
Q

3 clinical features of reiters syndrome

A

Conjunctivitis
Urethritis
Arthritis

148
Q

Organisms linked with triggering reactive arthritis

A 
Chlamydia trachomatis
Yersinia
Shigella 
Salmonella
Campylobacter
Streptococcus viridans 
Mycoplasma pneumoniae
149
Q

Risk of transmission of hepatitis B following a needlestick injury

A

20-40% if hep B eAg +ve

1-6% if Hep B eAg -ve

150
Q

Following a needlestick injury from a Hep B +ve patient who would require post-exposure prophylaxis

A

Non vaccinated staff and
Non responders to the Hep B vaccine
If the source is sAg +ve

151
Q

What post-exposure prophylaxis is used for Hep B and what timeframe

A

Hepatitis B immunoglobulin within 24 hr

And rapid course Hep B vaccination

152
Q

How many infected with Hep C clear the virus

A

20%

153
Q

What treatment increases the chance of Hep C clearance

A

Interferon - alpha

Ribavirin

154
Q

Management of a needlestick from Hep C PCR +ve patient

A

HCV antibody check
ALT
Baseline, 3m, 6m

155
Q

Features of primary syphilis

A

Painless ulcer =Primary chancre
At site of inoculation
10-90 days after contact
localised lymphadenopathy

156
Q

Features of secondary syphilis

A 
Fever
Headache
Lethargy
Macular then popular rash
50% have generalised lymphadenopathy
157
Q

Define early latent syphilis

A

Treponema pallidum persists
Asymptomatic
Infection occurred in the last 12m
Remain infectious

158
Q

Define late latent syphilis

A

Asymptomatic syphilis
Infection occurred >12m ago
Not infectious
Maternal to fetal transfer can occur

159
Q

Define late or tertiary syphilis

A 
Progressive inflammatory distressed
Can affect any organ system 
- neurosyphilis - at any time
- gummata in skin or visceral organs - 10+ yrs
- Cardiovascular syphilis - 10+yr
160
Q

Presentation of HSV encephalitis

A

Short prodrome of fever, lethargy, headache
Severe CNS dysfunction
Delirium
Fluctuating consciousness
Seizures
Aphasia
60-80% progress to coma and death if untreated

161
Q

Investigation for suspected HSV encephalitis

A

CSF PCR
EEG
MRI head - often normal in 1st 4 days then hypo-dense areas in temporal lobes

162
Q

Treatment of HSV encephalitis

A

Aciclovir 10mg/kg 8 hourly IV
Reduces mortality to <25%
14-21 days

163
Q

What factors affect treatment outcome for Hep C

A

Viral genotype - 2 and 3 = better response
High Hep C viral load
Degree of hepatic fibrosis
Alcohol consumption before and during treatment reduced effectiveness
Age - success decrease by 5% with increased decade

MFSRH (18 decks)

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