Genitourinary medicine Flashcards
What is the management for Pneumocystis pneumonia (PCP)?
Co-trimoxazole and steroids
Why are patients with HIV often at increased risk of stroke?
HIV
cART
What ocular disease are people with HIV more susceptible to?
CMV retinitis
HSV infection
VZV infection
TB
Ocular malignancies
How does CMV retinitis present?
Pizza pie appearance on fundoscopy
How do you treat CMV retinitis?
Intraocular ganciclovir and systemic oral valganciclovir
What is the most likely diagnosis in a HIV patient with a raised opening pressure on lumbar puncture?
Cryptococcal meningitis (note that they will have a normal CSF profile)
What is the most likely minding in cryptococcal meningitis on CSF investigations?
Encapsulated yeast organisms on India ink stain
What are cysts on a silver stain indicative of?
Pneumocystic jirovecci infection (pneumonia in immunocompromised patients)
What are asymmetrical demyelinating white matter lesions on MRI indicative of?
Progressive multifocal leukoencephalopathy, which occurs due to reactivation of John Cunningham virus in immunosuppressed patients
How does HIV commonly present?
Flu-like illness 6-8 weeks after infection.
Fever and lymphadenopathy
Maculopapular rash to upper chest, with mucosal ulcers
Myalgia, arthralgia, fatigue
Onset of symptoms within 3 weeks of infection or progression to CNS involvement suggest a rapid progression to AIDS
What is the time window for PEP (post exposure prophylaxis) for HIV?
72 hrs
What drugs are in PEP for HIV?
Raltegravir
Truvada
28 day course
What is first line for candida?
Fluconazole
What is a potential causative organism in a HIV immunocompromised patient with non-bloody diarrhoea, night sweats, fever, severe abdominal pain?
Mycobacterium avium intracellulare
Causes intra-abdominal lymph node enlargement - abdo pain
Elevates ALT and LDH. Can affect lungs too
What are the features of PCP (pneumocystis pneumonia)
Fever
Non-productive cough
Exertional SOB
CXR: bilateral bihilar interstitial infiltrates
What is Chancroid?
Infection of the genital skin caused by Haemophilus ducreyi
Common in the tropics
Always think about travel history
Can bleed on contact
Often associated with painful lymphadenopathy
What are some potential side effects of Co-trimoxazole?
Steven-Johnson syndrome, agranulocytosis, drug-induced lupus
How do you treat Chancroid?
Ciprofloxacin and Ceftriaxone
What is the classical appearance of Bacterial Vaginosis?
Thick discharge and fishy odour
What is the management of Bacterial Vaginosis?
Oral/pessary metronidazole or clindamycin
What does Lymphogranuloma vereneum look like?
Small single painless penile ulcer and unilateral lymphadenopathy
What is the initial screening tool for syphilis?
Enzyme immunosorbent assay (EIA)
What are the features of tertiary syphilis?
Neurological signs (stroke, sensory ataxia, proprioceptive loss, mixed UMN and LMN signs), Cardiac signs (aortic regurgitation),
Cutaneous granulomas
Dementia
What is a psoas sign in a TB psoas abscess?
Worsening back pain, spreading to affect the left buttock, hip and thigh with severe pain on hip hyperextension
