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Phase 3a Medicine > General Practise > Flashcards

General Practise Flashcards

1
Q

What is Bacterial Vaginosis?

A

overgrowth of anaerobic organisms in vagina namely Gardenella Vaginalis.

caused by loss of lactobacilli (friendly bacteria) in vagina.

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2
Q

what 3 organisms can cause bacterial Vaginosis?

A

Gardenella Vaginalis - MC

Mycoplasma Hominis

Prevotella Species.

bv - can happen with other infections like candidiasis, chlamydia and gonorrhoea.

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3
Q

what happens when you get overgrowth of anaerobic organisms in BV?

A

fall in lactic acid.
so you get aerobic lactobacilli = raised vaginal ph

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4
Q

normal vaginal ph

A

3.5-4.5

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5
Q

features of BV

A

vaginal discharge: fishy, offensive

asx in 50%

when you do speculum exam - typical discharge.

do a high vaginal swab to exclude other things.

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6
Q

what criteria is used in diagnosis of BV?

A

Amsels criteria:

3 of following 4 :

thin white homogenous discharge
vaginal ph over 4.5
clue cells on microscopy: stippled epithelial vaginal cells
positive whiff test: additional of potassium hydroxide = fishy odour

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7
Q

what investigations can you do for BV?

A

check vaginal ph: swab and ph paper. - bv is ph over 4.5

standard charcoal vaginal swab for microscopy. - you can do high vaginal swab during speculum exam or self-taken low vaginal swab.

clue cells on microscopy - epithelial cells from cervix that have bacteria stuck inside them.

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8
Q

how would you manage BV?

A

if asx: no tx. unless women is undergoing pregnancy termination

if sx: oral metronidazole for 5-7 days.

if compliance issue: single oral dose metronidazole 2g.

can use topical metronidazole or topical clindamycin as alternative.

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9
Q

when treated, what is the relapse rate and inital cure rate for bv?

A

relapse rate: over 50% within 3 months

initial cure rate: 70-80%

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10
Q

what does bv cause in pregnancy?

A

increased risk of preterm labour
low birth weight
chorioamnionitis
late miscarriage

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11
Q

treating bv in pregnancy

A

oral metronidazole 5-7 days.
dont give stat dose.

if asx : no tx

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12
Q

what is lactobacilli

A

main component of healthy vaginal bacterial flora.

produce lactic acid. keeps vaginal ph low.

acidic environment prevents over bacteria from overgrowing.

more alkaline environment , anaerobic bacteria can multiple.

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13
Q

what advice would you give to bv patient?

A

avoid vaginal irrigation

avoid cleaning with soaps - disrupt natural flora

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14
Q

what advice do you give to bv patient when prescribing metronidazole

A

avoid alcohol.

disulfiram like reaction - n+v, flusing and sometimes shock and angioedema.

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15
Q

complications of bv

A

increased risk of stis like chlamydia, gonorrhoea and hiv

miscarriage - late
preterm delivery
premature rupture of membranes
chorioamnionitis
low birth weight
postpartum endometritis

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16
Q

What is Trichomniasis/ Trichomonas Vaginalis?

A

highly motile flagellated protozoan parasite.

sti
men and women
more in women 14:1

mc non-viral sti.

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17
Q

transmission of trichomonas Vaginalis

A

sexual contact.
parasite primarily infects the squamous epithelial cells in urogenital tract.

can persist of inanimate objects like toilet seat and towel for short period.

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18
Q

pathophysiology of trichomonas vaginalis

A

after transmission , the trophozoites adhere to squamous epithelial cell of urogenital tract and use adhesins on their surface.

evade host immune response through loads of mechanisms including antigenic variation and interference with host immune factors.

cell mediated and humoral immune respose occur post infection, but ineffective at clearing infection because parasite immune evasion strategies.

reinfection common - protective immune not acquired.

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19
Q

features of TV - trichomonas

A

vaginal discharge : offensive, yellow/green frothy

vulvovaginitis
strawberry cervix

vaginal ph over 4.5

men usually asx can be urethritis.

itching
dysuria (painful urination)
dyspareunia(painful sex)
balanitis(inflammation of glans penis)

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20
Q

how would you investigate to trichominas vaginalis?

A

micrscopy of wet mount: motile trophozoites

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21
Q

how would you treat trichomonas?

A

oral metronidazole 5-7 days.

can do 1 stat dose of metronidazole oral 2g.

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22
Q

what can trichomonas increase the risk of?

A

contracting hiv

bacterial vaginosis

cervical cancer

pelvic inflammatory disease

pregnancy-related comps like preterm delivery

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23
Q

another word for strawberry cervix - TV

caused by?

A

colpitis macularis

inflammation cervicitis relating to trichomonas infection.

tiny haemorrhages across surface of cervix. - strawberry look.

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24
Q

how would you diagnose someone with trichomonas vaginalis?

A

standard charcoal swab with microscopy - examination under microscopy

swab from posterior fornix of vagina - (behind cervix) inwomen.

self taken low vaginal swab - alternative

urethral swab or first-catch urine: men

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25
Q

What is trigeminal neuralgia?

A

severe unilateral pain

mostly idiopathic or compression of trigeminal roots by tumours or vascular problems

female 2:1 men
peak: 60-70 yrs

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26
Q

clinical features of trigeminal neuralgia

A

unilateral disorder
brief-electric shock like pain
abrupt in onset and termination
limited to 1 or more division of trigeminal nerve.

small areas in nasolabial fold or chin - trigger areas

pain remit for variable periods

27
Q

what is the pain in trigeminal neuralgia evoked by?

A

light touch

like
smoking shaving brushing teeth talking washing

28
Q

red flag sx of trigeminal neuralgia

A

age under 40
sensory changes
deafness or other ear problems

hx of skin or oral lesions that can spread perineurally

optic neuritis
fhx of ms

pain only in opthalmic division of trigeminal nerve - eye socket, forehead or nose) or bilaterally

29
Q

management of trigeminal neuralgia

A

1st line: carbamazepine

if not respond to tx or atypical like under 50 : refer to neuro

30
Q

What are upper limb soft tissue injuries? (acute)

A

sprains - injury to ligament - what connects bones to form joints. sudden twist or fall

strains - injury to muscle or tendons - connect muscles to bones. overstretching or overuse

contusion - direct blows damage to small blood vessel - discolouration and swelling

dislocations - abnormal separation in joint , where 2 or more bones meet.

fractions - break in bone. simple if single break with aligned bone pieces. complex if multiple breaks or shattered bone.

31
Q

what are upper limb soft tissue injuries? (chronic)

A

bursitis - inflammation of bursa - fluid filled sac reducing friction in joints

tendinopathy: tendonitis and tendinosis (denegeration of tendon)

osteoarthritis: degeneration of cartilage (what cushions bone)

RA: autoimmune. immune system attacks own tissue , including joints in hands and wrist.

ganglion cyst: noncancerious lumps develop along tendons or joints of wrists or hands.

32
Q

management of upper limb soft tissue injury

A

rice : rest, ice, compression and elevation

physio

analgesics

surgical intervention

33
Q

Clinical Features of Upper Limb Soft Tissue Injury

A

Pain : dull to sharp to stabbing. constant or intermittent. exacerbated by movement/pressure

Swelling: oedema or haematoma (localised swelling with discolouration due to accumulation of blood within tissues following vascular rupture)

Functional Impairment - limited RoM, muscle weakness, instability (ligamentous injury)

Tenderness - on palpation.

34
Q

what is bruising?

A

secondary to capillary damage = blood leakage into tissues.

colour: dark purple to yellowish-green - as haematoma resolves

35
Q

what is a compound fracture?

A

protusion of bone through skin.

36
Q

What is Whooping Cough

A

infectious disease highly contagious
URTI

caused by gram-negative bordetella pertussis.

typically children.

37
Q

Risk Factors of Whooping Cough

A

Age - immunity wheenes off.

Immunisation: if not vaccinated or partially or too young to have immunisations

Pregnancy: 3rd trimester: if not recently vaccination can get it and give it to newborns.

Exposure - close contact. respiratory droplets

health conditions: immune system disorders, severe malnutrition.

38
Q

Clinical Features of Whooping Cough

A

acute cough - 14 days +

paroxysmal cough - coughing fit starts after a week. on and off.

inspiratory whoop

post-tussive vomiting

undiagnosed apnoeic attack in young infants.

39
Q

typical clinical findings for whooping cough pt

A

2-3 days of coryza precede:

cough bouts - worse at night and after feed. could end in vomiting. central cyanosis poss

inspiratory whoop- not always. caused by forced inspiration against closed glottis.

infants spells of apnoea.

sx could last 10-14 days and can be more severe in infants.

40
Q

in whooping cough what can persistent coughing cause?

A

subconjunctival haemorrhages or even anoxia = syncope and seizures.

41
Q

how would you diagnose whooping cough

A

per nasopharyngeal/ nasal swab culture - check for bordetella pertussis. - could take weeks/days to come back. TAKE 2-3 WEEKS OF ONSET OF SX.

pcr and serology.

if bloods: lymphocytosis

if cough been for more than 2 weeks : test for anti-pertussis toxin immunoglobulin G. - test in oral fluid of kids 5-16 and in blood of those over 17.

42
Q

how would you manage whooping cough

A

Antimicrobial:
oral macrolide - erythromycin, clarithromycin,azithromycin) - if cough within previous 21 days to eradicate organism and reduce spread. Abx no diff the course of illness.
alternative : co-trimoxazole

Supportive Care:
Hospital : severe case. infants. oxygen supplementation,fluid and nutrition.
pulmonary hygien: chest physio if mucus production loads.

43
Q

when would you admit a whooping cough pt?

A

infant under 6 months.

44
Q

how would you prevent transmission of whooping cough?

A

household/close contacts : propylactic abx. azithromycin, clarithromycin,erythromycin depending on age/contraindications.

check vaccination status.

acellular pertussis vaccine is in routine childhood immunisation programme in uk.

45
Q

complications of whooping cough

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
pneumothorax - cough so hard they faint, vomit.
seizures

46
Q

vaccinations and screening for whooping cough

A

infants at 2,3,4 months and 3-5 yrs.

pregnant women vaccination. 20-32 weeks.

no infection or immunisation is permanent - could still get it.

47
Q

is pertussis a notifiable disease?

A

yes - TELL PUBLIC HEALTH

48
Q

how long should it take to resolve (whooping cough)

A

typically within 8 weeks. can last several months

“100 day cough”

49
Q

Tell me about lower limb soft tissue injury

A

sprains - joint forced beyond normal RoM.

strains - overstretching or tearing of muscle or tendon fibres - due to overuse or sudden force.

contusions - direct impact leads to haematoma formation within soft tissues.

lacerations - check for involvement of underlying structures like nerves or vessels.

50
Q

how would you manage lower limb soft tissue injury?

A

immobilisation

pain relief

physiotherapy

surgical intervention

51
Q

Who is urinary incontinence more popular in?

A

elderly females

52
Q

risk factors of urinary incontinence

A

advancing age
fhx
hysterectomy
high bmi
previous pregnancy/vaginal deliveries and childbirth
pelvic floor surgery
postmenopausal status
neuro conditions:MS
cognitive impairment and dementia

53
Q

classifying urinary incontinence

A

overactive bladder OAB/urge incontinence : due to detrusor overactivity

stress incontinence : leak small amounts when coughing/laughing. weakness of pelvic floor and sphincter muscles.

mixed incontinence : urge+stress

overflow incontinence : due to bladder outlet obstruction eg: prostate enlargement

54
Q

how would you investigate urinary incontinence?

A

bladder diary - min 3 days

urodynamic studies

urine dipstick and culture

vaginal exam - exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (KEGEL exercise)

55
Q

how would you manage urinary incontinence if urge incontinent predominant?

A

bladder retraining - min 6 weeks - idea to gradually increase intervals between voiding

bladder stabilising drugs: antimuscarinics 1st line. OXYBUTININ (IMMEDIATE RELEASE), TOLTERODINE (immediate release), DARIFENACIN(once daily prep).

Mirabegron (beta-3 agonist) if concern about anticholinergic side-effects in frail elderly pts.

56
Q

what drug would you avoid in treating urinary incontinence? FRAIL OLDER WOMEN

A

oxybutinin

57
Q

how would you manage urinary incontinence stress incontinent predominant?

A

pelvic floor muscle : training: 8 contractions performed 3 times a day- min 3 months.

surgical : retropubic mid-urethral tape procedures.

58
Q

how does stress incontinence happen?

A

pelvic floor has sling of muscles that support contents of pelvic.

3 canals through centre of the female pelvic floor : urethral, vaginal and rectal canal.

when muscles of pelvic floor are weak, canals become lax, organs are poorly supported within pelvis.

59
Q

is overflow incontinence more common in men or women?

A

men - rare in women

if women: refer for urodynamic testing

60
Q

how can overflow incontinence happen?

A

chronic urinary retention due to obstruction to outflow of urine.

chronic urinary retention happens when overflow of urine and incontinence occurs without urge to pass urine.

61
Q

causes of chronic urinary retention

A

anticholinergic medications

fibroids

pelvic tumours

neuro conditions: MS, diabetic neuropathy and spinal cord injuries.

62
Q

Assessing someone for urinary incontinence

A

medical hx.

differentiate between stress and urge.

assess lifestyle: caffeine,alcohol,meds,bmi

assess severity: frequency of urination,incontinence, nightime urination, use of pads/change of clothes

exam: pelvic tone. check for:
- pelvic organ prolapse
- atrophic vaginitis
- urethral diverticulum
-pelvic masses
ask pt to cough and watch for leakage from urethra.

63
Q
A

Phase 3a Medicine (2 decks)

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