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CP - JL > Disease of Reproductive System - Part 2 > Flashcards

Disease of Reproductive System - Part 2 Flashcards

1
Q

What is pregnancy

A

conception to delivery

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2
Q

What is puerperium

A

The few weeks following delivery during which the mothers tissues return to their non pregnant state (6-8 weeks)

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3
Q

What are neonates

A

Newborns less than 4 weeks old

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4
Q

Diseases that can be transmitted from mother to baby during pregnanct

A

VZV, CMV, Parvovirus, Toxoplasmosis, Syphilis, Mosquito

Reach via haematogenous

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5
Q

How are VZV, CMV & Parvovirus spread

A

Respiratory/droplet secretions

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6
Q

How is tozoplasmosis spread

A

Ingestion of an oocyte

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7
Q

How it syphilis spread

A

Sexual

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8
Q

How is zika spread

A

Mosquito bites

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9
Q

What disease are transmitted from mother to baby during delivery

A

Group B streptococcus, HSV, gonorrhoea, chlamydia, HIV, Hep B

HSV Must be active to transmit

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10
Q

What does gonorrhoea require to be transmitted during delivery

A

Mucosal contact

E.g. eyes causing conjunctivitis

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11
Q

How does drugg handling differ in pregnancy

A

Increased GFR causes increased renal excretion of many antimicrobials - serum levels of antimicrobials generally lower hence many effectively underdosed

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12
Q

Do antimicrobials appear in the breast milk

A

Usually all do

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13
Q

What are 2 safe antimicrobials in pregnancy

A

Penicillin and cephalosporins

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14
Q

What antimicrobials aren’t safe in pregnancy

A

Choloramphenicol
Tetracylcine
Fluoroguinolones (ciprofloxacin)
Trimethoprim - sulphamethoxazole

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15
Q

2 teratogenic viruses

A

Rubella and zika

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16
Q

How do we test for viral infections

A

Serology and PCR (PCR more reliable)

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17
Q

Why do we treat asymptomatic bacteriruire

A

Can become sypmtomatic causing premature delivery and increased perinatal mortality

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18
Q

How do we treat UTI’s in pregancny

A

7 days non-toxic antibiotics (amoxicillin or cefalexin or trimethoprim)
Trimethoprim is a folate antagonist so give folate - and avoid in 1st trimester

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19
Q

What is chorioamnionitis

A

Inflammation of the umbilical cord, amniotic membrane, placents
Presents with a fever

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20
Q

Presentation of chorioamnionitis

A 
Sustained maternal fever
Uterine tenderness
Malodorous amniotic fluid
Maternal/foetal tachycardia
Increased WBC's
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21
Q

Risk factors of chorioamnionitis

A

Prolonged rupture of membranes

Amniocentesis, cardiocentesis, cervical cirvlage, multivple vaginal examinatins, BV

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22
Q

Causative organisms of chorioamnionitis

A

Group B Streptococcus (normal vaginal flora)

Enteroccoi, E, Coli (normal in GI)

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23
Q

Rare haemoatogenous cause of chorioamnionitis

A

Listeria

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24
Q

Treatment of chorioamnionitis

A

Antimicrobials and delivery of foetus - treat at diagnosis

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25
Q

What is puerperal endometritis

A

Infection of womb during puerperium

Puerperium sepsis is a major cause of death

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26
Q

Risk factors of puerperal endometritis

A

Caesarean, prolonged labour, prolonged rupture of membranes, multiple vaginal examinations

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27
Q

Presentation of puerperal endometritis

A

Fever (over 38.5), uterine tenderness, purulent foul smelling lachia, High WCC, general malaise, ado pain, fl like sympotms

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28
Q

Causes of puerperal endometritis

A

E coli
Beta haemolytic Streptococi
Anarobes

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29
Q

Diagnose of puerperal endometritis

A

Blood cultures for systemic symptoms

Swabs not usefl

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30
Q

Treatment of puerperal endometritis

A

Broad spectrum IV - co-amoxiclav

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31
Q

Clinical features of puerperal mastitis

A 
5.5 weeks post delivery
Abrupt onset fever
Chills
Breast soreness
Redness
Warmth
Breast tenderness
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32
Q

What causes puerperal masitics

A

Staphylcoccus aureus

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33
Q

How to diagnose puerperal mastitis

A

Clinical and pus culture

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34
Q

How do we treat puerperal mastitis

A

Flucloaxcillin (hs activity against B-lactamase producing organsims)

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35
Q

Other causes of puerperal sepsis

A

Pneumonia, IV related infection, C section/wound infection

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36
Q

What does treat staph aureus

A

Amoxicillin as staph aureus produces beta lactamase

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37
Q

What is sepsis

A

Syndrome resulting from invasion of pathogenic bacteria into blood
Early onset within 2 weeks after birth

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38
Q

Clinical features of sepsis in neonates

A 
Hypothermia/pyrexia
Dyspnoea, apnoea, cyanosis
Tachycardia, bradychardia, hypotension
Hepatomegaly, jaundice
Anorexia, vomitig, abdo distention, diarrhoea
Bleeding disorders
Lethargy/irritable

VARYING PRESENTATION

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39
Q

Causes of neonatal spsis

A

Group B Streptococci
E coli
Listeria (but rare)

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40
Q

Treatment of neontala sepsis

A

Broad spectrum antibiotics:
Amoxicillin (against listeria in high doses)
Gentamicin (against in E. Coli)TI

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41
Q

What is an STI

A

transmitted person - person by sexual contact - may be asymptomatic

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42
Q

What is an STD

A

Have evidence of a disease

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43
Q

What is a genital infectious disease

A

Not always acquired by sexual transmittion - can be normal vaginal & GI flora

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44
Q

Organisms causing local infection

A

Gonorrheae, HSV, HPV, Trichomonas Vaginalis

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45
Q

What causes mixed sites of infection

A

Syphilis, occasionally gonorrhea

46
Q

Types of vertical transmission

A

In utero
Peri natal - through infected birth canal
Eye mucous membrane - Conjuntivits, Kertanitis
Present in breast milk

47
Q

What type of bacteria is neisseria gonorrhea

A

gram -ve diplocci

48
Q

Desrribe feature of neisseria gonorrhea

A

Pili on cell surface - can attach

Intracellular

49
Q

Deserve 3 layers of cell envelope of gram -ves

A

Outer cytoplasmic membrane - lipo-oligosaccharides
Thin peptidoglycan cell wall
Inner cytoplasmic membrane

50
Q

Incubation period of gonorrhea

A

2-5 days

60% of women are asymptomatic

51
Q

Symptoms of gonorrhea

A

Urethral discharge and dysuria

52
Q

Local complications of gonorrhea

A

Epididymitis, prostatitis

Barthonilitis, salpingitis, PID

53
Q

What are 30% of people with gonorrhoea also infected with

A

Chlamydia

54
Q

What happens in metastatic disseminated gonococcal infection

A

Occur in unto 13% if complement deficient

Get bacteraemia, arthritis, dermatitis, meningitis

55
Q

What happens in gonorrheae in pregnancy

A

Spontaneous abortion
Preamture
Labour

56
Q

Neonatal gonorrhea

A

opthalmia neonatal

Acute purulent conjunctivitis

57
Q

Diagnosis of gonorrheae

A

Microscopy - urethral swabs
Culture - 48 hours. Do endocervical
NAAT

58
Q

Treatment of gonorrhea

A

Cepaholsporins - cefataxime (oral), ceftriaxone (IV or IM)

Highly resistant to ciprofloxacin and tetracycline also increasing to beta-lactams

59
Q

What causes non-gonorrhoea urethritis

A

Chlamydia trochomatous types D-K Or Ureaplasma Urelyteum
Occurs 1-2 wk incubation
Test for with NAAT

60
Q

Treatment of non-gonorrhoea urethritis

A

Doxycylcine and macrolide

61
Q

Life cycle of chlamydia trachomatis

A

Obligate intracellular pathoden

Extracellular infection form - elementary body
Intracellular replicative form = reticulate body

62
Q

Target cells of chlamydia

A

Squamocolumnar in endocervix/upper genital tract
Conjunctiva, urethra, rectum
Respiratory cells in infants

63
Q

Symptoms of chlamydia

A

Often asymptomatic (more women than men)
Urethritis - but less purulent than gonorrhoea
Cervicitis
Dysuria/pregnancy

64
Q

Complications of chlamydia

A

PID, perihepatitis, tubal infertility, extopic pregnancy, chornic pain, epidiymitis

65
Q

Complications of chlamydia in neonates

A

Conjunctivitis - onset 5-12 days
Infacnt pneumonia (4-11 weeks)
Conjunctivitis
Reites Syndrome

66
Q

Diagnosis of chlamydia

A

NAAT mainly

67
Q

Treatment of chalmydia

A

Azithromycin or doxycycline

If paediatrics: erythromycin for conjunctivits/pneumonia

68
Q

Complication of PID

A

High risk of infertility

Diagnosse with laproscopy

69
Q

Causes of PID

A

Gonorrhea/chlamydia

Infection of anaerobes/enteric organisms following infection

70
Q

What is condylomata

A

Epidermal manifestation/genital warts due to HPV

71
Q

How to treat condylomatas

A

Burn, freeze, cut, imiquimad

72
Q

What type of virus is HSV

A

Double stranded DNA virus

HSV 2 is more common in women

73
Q

Primary genital herpes symptoms

A

Pain, itching, dysuria, vaginal/urethral discharge

Bilateral vesicles/ulcers accompanied by constitutional sympotms

74
Q

Where does HSV go latent

A

In sensory neutron cells, sacral nerve ganglia

75
Q

Diagnosing of genital herpes

A

Clinical, PCR, histology

76
Q

How do we treat HSV

A

Aciclovir

Consider suppresion if frequent recurrence

77
Q

Complications of HSV

A 
Dissemination
Meningitis
Encephalitis
Sacral nerve parasthesia
Urinary Retetnion
78
Q

What causes syphilis

A

Spirochete - treponema pallidum

79
Q

How does syphilis cause infection

A

Penetrates via abraded skin or intact mucous membranes

Disseminates within days via lympathics and blood

80
Q

Classic histological picture of syphilis

A

Obliterative endarteritis

  • concentrial endothelial/fibroblastic proliferation
  • microvascular compromise
81
Q

Incubation of sypihlis

A

21 days median

3-90

82
Q

Primary syphilis

A

Site of inoculation, painless indurated lesions

Heals spontaneously within 3 to 6 weeks

83
Q

Secondary syphilis

A

Maculopopular rash on trunk, limbs, palsm, soles
Condylomata lata - coalesce in warm body areas
Mucous Patches

Fever, malaise, w eight loss, lymphadenopathy, CNS involvement

Spontaneous resolvement after 3-12 weeks

84
Q

What percentage of untreated people develop tertiary sypilis

A

30%

85
Q

Describe tertiary syphilis

A

Neuro-syphilis:
Meningovascular
Parenchymatous - General paresis - personality changes and Argyll Robertson pupils
Tabes doralsis - spinal cord demyelination

Aorititis - regurgitation and sacular aneurysm
Late benign sypihlis gummas - non-sepcific granulomatous reactions

86
Q

Tabes dosrsalis changes in tertiary sypihlis

A

Demyelination of the poster column, dorsal roots and dorsal root gaggle
Causes ataxic wide based gait
Lightening pain in eggs, loss of position/vibratory sense

87
Q

Early signs of neonatal syphilis

A

Snuffles, rash, hepatosplenomegaly

88
Q

Late signs of neonatal syphilis

A

Frontal bosses
Saddle nose
Sabre shings
Hutchinsons incisorsz

89
Q

Diagnosis of Syphilid

A

Diret detection - Darkfield microscopy for primary or secondary lesions, PCR

Indirect: 2 types

a) Specific - anti-trepomonal antibodies
b) Non-specific - reagents antibodies versus lipoid antigens

90
Q

Treatment of syphilis

A

Penicillin

Amoxicillin, ceftraxione and doxycyline

91
Q

When can Jarish-Herxheimer reaction occur

A

Occurs in treating syphilis
Most common in secondary sypihlis
Hypersensitivirt reaction - organism lysis causing release of heat stable proteins
Causes fever, chills and myalgia

92
Q

What causes trichomonas vaginals

A

Protozoa

Trophozite transmitted, no known cysts, humans are the only natural host

93
Q

What does trichomonas cause

A

Mucousal inflammation
Greenish frothy vaginal disacharge

Males usually asymptomatic but can spread it

94
Q

Treatment of trichomonas

A

Metronidazole

95
Q

What causes bacteria (anaerboic) Vaginosis

A

Low vaginal lactobacilli

High gardenia vaginalis and anaerobes

96
Q

Symptoms of BV

A

+ve KOH - fish odour

Vaginal pH >4.5

97
Q

Treatment of BV

A

Metronidazole
Amoxycillin
Topical Clindamycin

98
Q

What contributes to candidiasis - thrush/balantis

A

Oral contraceptives
Poorly controlled diabetes
Antibitoics - inibits normal flora
Bowel source/sexual transmission

99
Q

Symptoms of candidiasis

A

Vulval, vaginal, penile erythema: itching/irritation
Thick/adherent discharge; white plaques
Maculopapular and disarming lesions

100
Q

What causes the majority of candidiasis

A

Candidiasis albicans

101
Q

Treatment of uncomplicated candidiasis

A

C. albicans - non recurrent - not sever

Use topical agent - clo-trimzaole
Fluconazole for systemic disease

102
Q

Treatment of complicated candidiases

A

10-14 treatment topical or oral

Consider partner treatment too

103
Q

What is HIV

A

Retrovirus - posses reverse transcriptase

Causes CD4/macrophage tropic - reducing host immunity

104
Q

How does HIB gain cell entry

A

Viral protein gp120 interacts with cellular receptor CD4 ad chemokine receptor CCR5 for vision to gain host cell entry

Reverse transcription in the cytoplasm

105
Q

Stages of HIV

A 
Based of CD4 count
stage 1 - over 500
stage 2 - 349-499
stage 3 - 200-349
stage 4 - less than 200
106
Q

Early stages of HIV

A

Pulmonary TB (test HIV in all new cases)
Persistent oral candidiass, unexplained chronic diarrhoea and persistent fever
Severe bacterial infection e.g. S. pneumoniae

107
Q

Diagnosis of HIV

A

Antibody testing (sero-conversion
PCR - detects viral nucleic acid - quantitative to see the viral load
CD4 count

108
Q

Treatment of HIV

A

Nucleoside reverse transcriptase inhibitors
Non-Nucleoside reverse transcriptase inhibitors
Protease inhibitors - sparkly protease required to cleave viral poly-proteins
Viral entry inhibitor
Integrase strand transfer inhibitors

109
Q

examples of Nucleoside reverse transcriptase inhibitors

A

zidovudine, lamuvidine

110
Q

examples of non-Nucleoside reverse transcriptase inhibitors

A

Efarenz

111
Q

examples of protease inhibitors

A

Riotnovir, saquinovir

112
Q

What converts natural resistance to HIV

A

CCR5 delta 32 mutation

CP - JL (14 decks)

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