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Year 3 Primary Care > Contraception and sexual health > Flashcards

Contraception and sexual health Flashcards

1
Q

Patients with gonorrhoea who are symptomatic should contact trace who?

A

All sexual partners in the last 2 weeks

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2
Q

Patients with gonorrhoea who are asymptomatic should contact trace who?

A

All sexaul partners in the last 3 months

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3
Q

Patients with chlamydia who are symptomatic should contact trace who?

A

All sexual partners in the previous 4 weeks

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4
Q

Patients with chlamydia who are asymptomatic should contact trace who?

A

All sexual partners in the previous 6 months

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5
Q

Patients with non-specific urethritis should contact trace who?

A

All previous sexual partners in the previous 4 weeks

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6
Q

Structures of the kidney, from outside to in?

A 
Cortex 
Medulla
Pyramids and columns
Major and minor calyx 
Renal pelvis
Pelviureteric junction
Ureter
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7
Q

Structures of the urinary tract?

A 
Kidneys
Ureters
Bladder (with detrouser muscle)
Urethra
Internal urethral sphincter
Prostate
Exteternal urethral spinchter
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8
Q

What type of muscle and control is the internal urethral sphincter?

A

Smooth

Autonomic

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9
Q

What type of muscle and control is the external urethral sphincter?

A

Skeletal muscle

Voluntary control

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10
Q

What is vesicoureteral reflux?

A

Urine refluxing from the bladder back into the ureters

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11
Q

When obstructive uropathy leads to an acute reduction in kidney function what is this reffered to?

A

Post-renal AKI

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12
Q

How does an upper urinary tract obstruction present?

A

Loin to groin flank pain (stretching of urerter and kidney)
Reduced or no urine output
Systemic symptoms: vommiting
Impaired renal function on blood tests (raised creatinine)

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13
Q

How does lower urinary tract obstruction present?

A

Difficulty or inability to pass urine (e.g. poor flow, difficulty initiating urination or terminal dribbling)
Urinary retention, with an increasingly full bladder
Impaired renal function on blood tests

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14
Q

How can obstructive uropathy be diagnosed?

A

USS KUB

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15
Q

Common causes of upper urinary tract obstruction?

A

Kidney stones
Tumour pressing on ureter
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer (blocking ureteral openings to bladder)
Uretocele (ballooning of the most distal portion of the ureter - this is usually congenital)

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16
Q

Common causes of lower urinary tract obstruction?

A 
BPH
Prostate cancer
Bladder cancer (blocking neck of bladder)
Urethral strictures (due to scar tissue)
Neurogenic bladder
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17
Q

What is neurogenic bladder

A

Abnormal function of the nerves innervating the bladder and urethra,
Can result in overactivity or underacitivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra

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18
Q

Key causes of neurogenic bladder?

A 
Multiple sclerosis
Diabetes
Storke 
Parkinson's disease
Brain or spinal cord injury
Spina bifida
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19
Q

What problems can neurogenic bladder cause?

A

Urge incontinence
Increased bladder pressure
Obstructive uropathy

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20
Q

How is obstructive uropathy managed?

A

Nephrostomy to bypass an upper urinary tract

Urethral or suprapubic catheter may be used to bypass an obstruction in the lower urinary tract

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21
Q

Complications of obstructive uropathy?

A

Pain
Acute kidney injury (post-renal)
CKD
Infection (from bacteria tracking up urinary tract into areas of stagnated urine)
Hydronephrosis (swelling of the renal pelvis and calyces in the kidney)
Urinary retention and bladder distention
Overflow incontinence of urine

22
Q

Why does hydronephrosis occur?

A

Obstruction in the urinary tract, leading to back-pressure into the kidneys

23
Q

What causes idiopathic hydronephrosis and how is it treated?

A

Result of a narrowing at the pelviuteric junction (site where renal pelvis becomes the ureter)
Can be congenital or develop later
Can be treated with pyeloplasty to correct the narrowing and restructure the renal pelvis

24
Q

Typical presenting features of hydronephrosis?

A

Vague renal angle pain and a mass in the kidney area
May be seen on USS KUB
non contrast KUB
Intravenous urogram

25
Q

How do you treat hydronephrosis?

A
  • Percutaneous nephrostomy – inserting a tube through the skin and kidney into the ureter, under radiological guidance
  • Antegrade ureteric stent – inserting a stent through the kidney into the ureter, under radiological guidance
26
Q

Tamsulosin side effects?

A

Dizziness

POstural hypotension

27
Q

TURP complications?

A

T urp syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate

28
Q

What is TURP syndrome?

A

Transurethral resection of the prostate (TURP) syndrome occurs when irrigation fluid enters the systemic circulation. The triad of features are:

  1. Hyponatraemia: dilutional
  2. Fluid overload
  3. Glycine toxicity
29
Q

Medical indications for circumcision

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

30
Q

What is tamsulosin and how does it treat BPH?

A

Alpha-1 antagonists promote relaxation of the smooth muscle of the prostate and the bladder to reduce LUTS

31
Q

What, other than prostate cancer, can cause a raised PSA level?

A

benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

32
Q

What are stag horn calculi?

A

Stag-horn calculi involve the renal pelvis and extend into at least 2 calyces. They develop in alkaline urine and are composed of struvite (ammonium magnesium phosphate, triple phosphate). Ureaplasma urealyticum and Proteus infections predispose to their formation

33
Q

Most common organic cause of ED?

A

Vascular

34
Q

First line investigation for prostate cancer?

A

Multiparametric MRI

35
Q

Which tumour markers are teratomas associated with?

A

Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated with raised hCG and AFP

36
Q

How does RCC present and how is it managed?

A

Renal cell carcinoma typically presents with a triad of haematuria, abdominal mass and loin pain. There may be associated malaise and weight loss. Radiotherapy and chemotherapy may be offered but renal cell carcinoma is relatively resistant to these so surgery is often the first line option.

37
Q

What drug is used to treat both BV and trichomoniasis?

A

Metronidazole

38
Q

What samples used to diagnose Gonorrhoea and chlamydia?

A

High end cervical swab
Urethral swab
Urine

39
Q

What organisms will be picked up and by vaginal swabs?

A

Candida, trichanomus, BV

40
Q

When is birth control immediately effective?

A

Day one of period

41
Q

How long should a barrier method be used when starting birth control?

A

7 days (unless starting on first day of period)

42
Q

How does trichomonas vaginalis present?

A

Trichomonas vaginalis. Infection most commonly presents with malodorous, green discharge, as well as classic features of any sexually transmitted disease such as dysuria and vulval discomfort. Speculum examination may reveal, as in this case, a ‘strawberry cervix’; a term used to describe an erythematous, punctiform appearance of the cervix, which is classically associated with this specific infection. The diagnosis can be made using vaginal swabs, or wet-mount microscopy - Trichomonas is a flagellated protozoan, which makes it very distinctive.

43
Q

How is trichomonas vaginalis treated?

A

7 day course of metronidazole

44
Q

How is chlamydia trachomatis treated?

A

Oral doxycycline for 7 days and a one-off dose of azithromycin are two of the main treatment options for treating an infection with Chlamydia trachomatis.

45
Q

Main treatment option of syphilis?

A

Intramuscular benzylpenicillin is the main treatment option for syphilis

46
Q

What is the pearl index?

A

The Pearl Index is the most common technique used to describe the efficacy of a method of contraception. The Pearl Index describes the number of pregnancies that would be seen if one hundred women were to use the contraceptive method in question for one year.

47
Q

The COCP is absolutely contraindicated (UKMEC 4) for women who are breastfeeding less than how many weeks post-partum.

A

6 weeks

48
Q

After giving birth, women require contraception after how many days?

A

21

49
Q

When is the LAM method of contraception effective?

A

is 98% effective providing the woman is fully breast-feeding (no supplementary feeds, over 85 percent breast), amenorrhoeic and < 6 months post-partum

50
Q

How is malathion treated?

A

treated with insecticides - either malathion lotion or permethrin cream.

Year 3 Primary Care (16 decks)

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