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Obs Gynae > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Bacteria associated with bacterial vaginosis?

A

Gardnerella vaginalis

mycoplasma hominis
prevotella species

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2
Q

RFs for bacterial vaginosis?

A

multiple sexual partners (not STI)
excessive vaginal cleaning
recent antibiotics
smoking
copper coil

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3
Q

Presentation of bacterial vaginosis?

A

fishy-smelling watery grey or white vaginal discharge

(not typical to have itching or pain -> alt diagnosis)

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4
Q

Investigations of bacterial vaginosis?

A

vaginal pH >4.5
vaginal swab (‘clue cells’ on microscopy)

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5
Q

Mx of bacterial vaginosis?

A

no treatment if asymptomatic (self-resolves)
metronidazole (oral or topical)
check for chlamydia or gonorrhoea where appropriate

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6
Q

Metronidazole interacts with?

A

alcohol

disulfiram-like reaction

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7
Q

Complications of bacterial vaginosis?

A

incr. risk of STIs

in pregnant women:
miscarriage
preterm delivery
PROM
chorioamnionitis
low birth weight
postpartum endometritis

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8
Q

What is bacterial vaginsosis?

A

overgrowth or bacteria in the vagina caused by a loss of friendly lactoballi

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9
Q

RFs for candidiasis?

A

incr. oestrogen
poorly controlled DM
immunosuppression
ABx

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10
Q

Presentation of thrush?

A

thick, white discharge that does not smell
vulval and vaginal itching, irritation or discomfort

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11
Q

Investigations for candidiasis?

A

not always necessary

vaginal pH <4.5
charcoal swab with microscopy

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12
Q

Mx of candidiasis?

A

antifungals

topical cream, pessary or oral

fluconazole oral
clotrimazole topically

pregnant women: topical only, fluconazole C/I

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13
Q

What is chlamydia trachomatis?

A

gram-negative bacteria
most common STI
cause of infertility

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14
Q

Presentation of chlamydia?

A

women asymptomatic

abnormal discharge
pelvic pain
abnormal vaginal bleeding
dyspareunia
dysuria

on exam:
pelvic or abdo tenderness
cervical excitation
cervicitis
purulent discharge

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15
Q

Diagnosis of chlamydia?

A

nucleic-acid amplification test

endocervical swab preferred

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16
Q

Mx of chlamydia?

A

oral doxycycline 100mg BD for 7 days

refer to GUM
notify sexual partners
abstain from sex for duration of treatment

17
Q

Complications of chlamydia?

A

PID
chronic pelvic pain
infertility
ectopic pregnancy
conjunctivitis
reactive arthritis

pregnant:
preterm
PROM
low birth weight
postpartum endometritis
neonatal infection

18
Q

Presentation of gonorrhoea?

A

50% women symptomatic

odourless purulent discharge
dysuria
pelvic pain

19
Q

Diagnosis of gonorrhoea?

A

NAAT for presence
charcoal swab with microscopy for antibiotic sensitivity as high rates or resistance

20
Q

Mx of gonorrhoea?

A

refer to GUM

IM ceftriaxone 1g if sensitivities unknown
oral cipro 500mg if sensitivities known

test of cure

21
Q

Complications of gonorrhoea?

A

PID
chronic pelvic pain
infertility
conjunctivitis
urethral strictures
disseminated gonococcal infection
skin lesions
Fitz-Hugh-Curtis syndrome
septic arthritis
endocarditis

22
Q

Causes of PID?

A

gonorrhoea
chlamydia
mycoplasma genitalium

Gardnerella vaginalis
haemophilus influenzae
E coli

23
Q

RFs for PID?

A

UPSI
multiple sexual partners
younger age
existing STIs
previous PID
IUD

24
Q

Presentation of PID?

A

pelvic or lower abdo pain
abnormal vaginal discharge
abnormal bleeding
dyspareunia
fever
dysuria

exam:
pelvic or abdo tenderness
cervical excitation
cervicitis
purulent discharge

25
Q

Investigations for PID?

A

NAAT swabs
HIV test
syphilis test

high vaginal swab
pregnancy test
inflammatory markers

26
Q

Mx of PID?

A

IM 1g ceftriaxone (gonorrhoea)
doxycycline 100mg BD (chlamydia, mycoplasma)
metronidazole 400mg BD (bacterial vaginosis)

27
Q

Complications of PID?

A

sepsis
abscess
infertility
chronic pelvic pain
ectopic pregnancy
Fitz-Hugh-Curtis syndrome

28
Q

What is Fitz-Hugh-Curtis syndrome?

A

adhesions form between the liver and the peritoneum
RUQ pain

29
Q

Complications of trichomoniasis?

A

incr. risk of:
HIV
bacterial vaginosis
cervical ca
PID
pregnancy-related complications

30
Q

Presentation of trichomoniasis?

A

discharge
itching
dysuria
dyspareunia
‘strawberry cervix’
vaginal pH >4.5

31
Q

Diagnosis of trichomoniasis?

A

charcoal swab from the posterior fornix of the vagina

32
Q

Mx of trichomoniasis?

A

metronidazole

Obs Gynae (4 decks)

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