Genitourinary Flashcards
What is 1st line treatment of BV ?
Metronidazole
What is treatment for chlamydia?
Doxycycline
What is treatment for gonorrhea ?
Ceftriaxone
What cell are characteristic in BV?
Clue cells (stippled vaginal epithelial)
What’s a complication in HIV patients that can cause breathlessness?
Pneumocystitis jivroveci pneumonia
How in labs i.e. what stain can identify fungus that causes pneumocystis jivroveci?
Silver stain
What organism does India ink stain identify?
Cryptococcus
What type of meningitis is an AIDs defining illness?
Cryptococcal meningitis
What is classic presentation for cryptococcal meningitis?
Blurred vision
Bilateral papilledema
Confusion
CT head will be normal
What’s the name of the single painless ulcer in syphilis?
Chancre
What type of bacteria is gonorrhoea?
Gram negative diplococci
What is first line treatment for trichomoniasis (strawberry cervix)?
Metronidazole
When can sex be resumed with hsv genital lesions?
Once lesions are gone
How many cigarettes smoked is a contraindication for COCP?
Over 35 a day
How long is the pill not effective for when first taken?
7 days
How is fitz-hugh-curtis characterised?
Hepatitis and liver adhesions, can cause RUQ pain and shoulder tip pain : can be due to gonorrhea or chlamydia
What is prescribed prophylactically to prevent further episodes of PCP in HIV patients with CD4 below 200?
Co-trimoxaloe - continued until immune function improves - i.e. CD4 above 200 for a while
What’s a good CD4 count?
Anything above 500
What’s treatment for secondary syphilis?
IM benzathine benzylpenicillin
Which infection is caused by a flagellated protozoan parasite?
Trichomoniasis
What are the features of PID?
Fever
Lower abdo pain
Deep dyspareunia
Cervical excitation
Pain on movement of cervix
What is treatment of PID?
IM ceftriaxone, oral doxycycline + metronidazole
What is oral treatment for thrush?
Fluconazole
How is outbreak of HSV managed?
Oral aciclovir
Which type of pessary do you use in thrush?
Clotrimazole
Why is COCP a risk factor for thrush?
The oestrogen in the pill can alter the vaginal environment making it more conductive for fungal growth
If patient is pen allergic and has gonorrhea what should be given? Because remember the cross similarity of cefotaxime and penicillin’s
IM gentamicin and oral azithromycin
Missing more than one pill means?
Barrier method or abstinence is needed for a week
When would a pill free week be skipped?
If the missed pills are from the last week of the pack
Which pill week prevents ovulation and therefore if missed would need emergency contraception?
The first week
Which bacteria most commonly causes BV?
Gardnerella vaginalis
If patients vomit within 3 hours of taking COCP or within 2 hours of taking progesterone only pill then what?
Take another pill straight away
If COCP pills are missed in week 3 then what?
Finish current pack and start next pack immediately
Which condition can cause painless genital ulcer and painful inguinal nodes?
Lymphogranuloma venereum - caused by a strain of chlamydia
What is first line treatment for pneumocystitis pneumonia? with and without an oxygen of 8 or less?
Without oxygen less than 8 is co-triomxazole
When oxygen is 8 or less than C–Trimoxazole and steroids.
What’s treatment of chlamydia in breastfeeding women?
Oral azithromycin and doxycycline is contraindicated
Which herpes causes kaposi’s sarcoma?
HHV-8
Which HPV causes genital warts?
HPV 6
When does latent syphilis occur?
Absence of any symptoms and occurs after primary and secondary stages
What are the potential side effects of co-trimoxazole?
Stevens-johnson syndrome
Drug induced Lupus
Agranulocytosis
Toxic epidermal necrolysis
How long after UPSI can ella one be taken?
Up to 120 hours so five days
How long within can levonelle be used after UPSI as emergency contraception?
Within 3 days
What is a complication of untreated or recurrent urethritis?
Urethral stricture - can lead to scarring and narrowing of the urethra
Which tests are used for diagnostic of gonorrhoea and chlamydia?
NAAT
How would molluscum vs. HSV genital bumps present differently?
Molluscum: dome shaped flesh coloured or pink papule with a central indentation
HSV: painful fluid filled blisters- no central indentation
How long can IUD last for?
5-10 years
What is a chancroid?
Bacterial STI - erythematous papule forms at site of inoculation: deep ulcer with soft , irregular border and friable base
How can BV affect a pregnancy?
Can cause preterm rupture of membranes and premature labour
Which pessary is treatment in women with recurrent candida infections?
Nystatin pessary
What’s the difference between chancroid and lymphogranuloma venereum?
Lymphogranuloma venereum: Painless ulcer and tender inguinal lymph nodes
Chancroid: PAINFUL ulcer + tender inguinal lymph nodes
What is chancroid caused by?
Bacterium haemophilus ducreyi
Which patients is oral fluconazole contraindicated in?
Pregnant or breastfeeding
What does HBsAg mean?
Detected following initial infection
What does Anti-HBs mean?
Either cleared infection OR vaccination against hep b
What does anti-HBc mean?
Hep b infection is either chronic or resolved
If there is negative anti-HBc and positive Anti-HBs what does this mean?
Patient is vaccinated against hep B
Is oesophageal candidiasis a AIDS defining illness?
Yes
What are pearly penile papules?
Harmless rounded / finger like growths found near head of penis - may also look yellow or pinkish - patient can be reassured and discharged
What treatment is used for genital warts that are non keratinsed?
Podophyllotoxin
What is an alternative treatment for non-keratinized genital warts other than podophyllotoxin?
Imiquimod
What is disseminated gonococcal infection?
Rare complication of gonorrhoeae.
Involving arthritis-dermatitis syndrome and tenosynovitis
There will pain with passive flexion and tenderness along flexor sheath
Commonly affects fingers, wrists, and toes.
What is jarisch herxheimer reaction?
Self resolving high fever, heart rate and unwell can be due to IM benzylpeniccilin for a primary syphilis
What HIV viral load is appropriate for a vagina delivery ?
Under 50 if greater than 50 then it should be C-section
What is infant post-exposure prophylaxis for HIV ?
Zidovudine monotherapy or cART
Is breastfeeding safe in HIV?
Only okay if women has low viral load on cART - even so more recommended to formula milk
What the gold standard for diagnosis for HIV?
HIV antibody and HIV antigen
When can the HIV antibody test detect HIV infection?
21-25 days post infection -it’s used as the point of care test
What is bronchoalveolar lavage?
diagnostic procedure that involves collecting a fluid sample from the lungs to help diagnose lung conditions
What is the gold standard investigation for PCP?
Bronchoalveolar lavage
How do anti-epileptics and COCP react?
Anti-epileptics will increase metabolism of COCP due to being enzyme inducers , therefore the COCP becomes less effective
What is an appropriate contraception of choice in epileptics?
Contraceptive injection as it does not interact with liver enzymes
What is treatment for primary CNS lymphoma (HIV related0
Commence CRT and whole brain irradiation
How is Primary CNS lymphoma seen on brain CT?
Single lobulated lesion with single homogenous enhancement
Who can receive HIV post-exposure prophylaxis?
Anyone - don’t need to have risk factors but they must have a determined HIV status first so that it isn’t given to someone who already has HIV
What would a smear show for chlamydia?
5 or more polymorphs per high power field with no evidence of gram negative diplococci
If doxycycline is contraindicated what is offered?
Azithromycin, ofloxacin, erythromycin
What are the most specific signs for primary HIV infection?
Maculopapular rash on upper areas and mucosal ulcers
What is treatment for toxoplasmosis?
Sulfadiazine and pyramethamine
Which medication needs to be co-prescribed with sulfadiazine and why?
Folate as sulfadiazine can lead to folate deficiency
How often does the progesterone injection need to be administered?
Every 3 months
What organism is responsible for molluscum?
Poxvirus
Except from ovarian cancer why else can ca-125 be raised?
PID
How can PID present?
Bilateral abdominal pain
Inter-menstrual bleeding
Are HIV patients on long term cART at risk of stroke?
Yes
What’s the most common cause of fitz-hugh curtis syndrome?
Chlamydia
What is mitterlschmerz?
Mic-cycle abdo pain in lower abdomen - subsides within 24-48 hours after onset
What is treatment for recurrent thrush?
3 doses of oral fluconazole 150mg to be taken every 3 days. Then 150mg oral fluconazole once a week for 6 months as maintenance
Can molluscum cause eye things?
Yes small umbilicated lesions on lid margins but also other stuff around eye
What is a trachoma?
Leading cause of blindness worldwide. Particularly endemic in Africa. Damage to cornea occur when eyelid turns inward - entropion
aused by chlamydia
What’s the normal dose of oral aciclovir for hsv vs in pregnancy?
200mg three times a day normally but in pregnancy due to higher circulating blood volume it’s 400mg three times a day
Which antiepileptics interact with cocp to induce liver enzymes and which one is safe?
Phenytoin, barbituates, carbamezapine - induce liver enzymes
Levetiracetam - is fine
How many years breast cancer free in order to take cocp?
Not within 5 years
Is cholestatic jaundice in pregnancy a contraindication for cocp?
Yes
What BP measures are contraindications for cocp?
systolic higher than 160 or diastolic higher than 100
What is treatment regime with doxycycline for chlamydia?
100mg twice a day for 7 days
What does multiple ring enhancing lesions on CT scan suggest in a HIV patient?
Toxoplasmosis
What is treatment for CMV retinitis?
IV ganciclovir
How does CMV retinitis present?
Rapid painless vision loss
Flashes of light
Retina has pizza slice appearance
Affected section appear to have marked haemorrhages
What’s the mechanism of action of doxycycline?
Tetracycline antibiotic that blocks translation by binding the bacterial 30s ribosomal subunit
What is most definitive option for diagnosing fitz-hugh-curtis syndrome?
Laparoscopy - may reveal adhesions between diaphragm and liver or between liver and anterior abdominal wall
