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Year 4 > Genitourinary Medicine > Flashcards

Genitourinary Medicine Flashcards

1
Q

What is bacterial vaginosis?

A

= bacterial imbalance of the vagina caused by overgrowth of anaerobic bacteria

(such as Gardnerella vaginalis)

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2
Q

Most common cause of abnormal vaginal discharge in women of childbearing age?

A

= bacterial vaginosis

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3
Q

What is the Amsel criteria used for?

A

= used to diagnose bacterial vaginosis

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4
Q

What features are involved in the Amsel criteria for BV?

A
  • vaginal pH > 4.5
  • homogenous grey or milky discharge
  • positive whiff test (additional of 10% potassium hydroxide produces a fishy odour)
  • clue cells present on wet mount

(3 out of the 4 features are needed to confer a diagnosis)

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5
Q

In what condition may clue cells be present on wet mount?

A

= bacterial vaginitis

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6
Q

Treatment of choice for bacterial vaginitis (2)

A

= Metronidazole or Clindamycin

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7
Q

What is chancroid?

A

= sexually transmitted infection (STI) of the genital skin primarily caused by the gram-negative bacillus Haemophilus ducreyi

infection typically manifests as a painful, potentially necrotic genital lesion. Commonly associated symptoms include painful lymphadenopathy and bleeding on contact

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8
Q

Patient presents with painful genital lesion which bleeds on contact. They have painful lymphadenopathy and have just come back from Greenland.

What is the diagnosis which comes to mind?

A

= Chancroid

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9
Q

Chancroid is usually diagnosed based on a clinical picture. However, what investigations can be used to help confirm diagnosis? (2)

A
  • culture
  • PCR (faster)
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10
Q

Treatment of chancroid?

A

= managed using antibiotics:
- Ceftriaxone
- Azithromycin
- Ciprofloxacin

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11
Q

What is Chlamydia caused by?

A

= Chlamydia trachomatis

(an obligate intracellular bacterium)

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12
Q

What are the risks to neonates if they are exposed to chlamydia during delivery? (2)

A

= can develop pneumonia or conjunctivitis

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13
Q

How is chlamydia tested for?

A

= nucleic acid amplification tests (NAATs) - swabs taken

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14
Q

Pharmacological treatment for chlamydia

(including dosage)

A

= orał doxycycline 100mg twice daily for 7 days

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15
Q

What inflammatory joint condition is a known chlamydia complication?

A

= reactive arthritis

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16
Q

What is AIDS?

(CD4 count less than?)

A

= terminal stage of HIV infection where combination antiretroviral therapy (cART) has not halted the spread of the virus

It is defined by presence of an AIDS-defining illness alongside a CD4 count of less than 200 cells/mm3

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17
Q

Causative agent of AIDs?

A

= HIV

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18
Q

How is HIV transmitted? (4)

A
  • unprotected sexual contact
  • sharing of infected needles
  • mother-to-child transmission during birth or breastfeeding
  • exposure to infected blood products
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19
Q

How are we able to determine the progression of AIDs in a patient?

A

= CD4 cell count

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20
Q

What are the different ways combined hormonal contraception (CHC) can be administered? (3)

A
  • orally, pill form
  • transdermally, via patch
  • intravaginally, through use of vaginal ring
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21
Q

How does combined hormonal contraception function? (3)

A
  • thickening cervical mucous, obstructing sperm
  • thinning of endometrium, making transplantation difficult
  • inhibits ovulation
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22
Q

What is the difference in hormone dosages with the 3 different types of oral combined contraceptive pills?

  • monophasic
  • phasic
  • everyday pills
A

Monophasic: each pill has same dose of hormones

Phasic: pills contain different amounts of hormone and must be taken in correct order

Everyday pills: usually contain 21 hormone-containing pills, and 7 hormone-free pills

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23
Q

When starting on combined hormonal contraception, when will a patient be protected from day 1?

A

= if patient starts the pill on 1st day of natural period

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24
Q

For how long must a women use additional precautions when starting combined hormonal contraception, if unsure where abouts in her cycle she is?

A

= for 7 days

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25
Q

How long postpartum can a patient begin combined hormonal contraception?

A

= 21 days postpartum, as long as NOT breastfeeding

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26
Q

What hormone is in contraceptive injection?

A

= progesterone

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27
Q

How often is the contraception injection given?

A

= every 13 weeks

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28
Q

Side-effects of contraception injection? (2)

A
  • associated with weight-gain
  • can take some time for fertility to return (6-12 months)
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29
Q

Which contraceptive method has been associated with weight gain?

A

= contraception injection

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30
Q

What is fitz-hugh-curtis?

A

= medical condition that describes perihepatitis, a condition characterised by inflammation of the liver capsule and the subsequent development of adhesions

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31
Q

What infections can cause fitz-hugh-curtis? (2)

A
  • Neisseria gonorrhoeae infection
  • Chlamydia trachomatis infection
32
Q

How are adhesions in Fitz-hugh-curtis syndrome treated?

A

= surgical intervention, laparoscopic adhesiolysis

33
Q

What is genital herpes?

A

= infectious disease characterised by the appearance of painful sores or ulcers on the genitals

Caused by infection with the herpes simplex viruses, either HSV-1 or HSV-2

34
Q

Is HSV-1 or HSV-2 associted with oral herpes?

A

= HSV-1

35
Q

Treatment of genital herpes?

A
  • Aciclovir 400mg 3 times daily for 5 days
  • Valaciclovir 500mg twice daily for 5 days
  • Aciclovir 200mg five times daily for 5 days
  • Famciclovir 250mg 3 times daily for 5 days
36
Q

What is genital candidiasis?

A

= often referred to as a yeast infection. Is an inflammation of the vagina and the vulva due to an overgrowth of the yeast fungus, primarily Candida albicans

37
Q

Main causative organism of genital candidiasis?

A

= Candida albicans

38
Q

Key factors which may increase the risk of developing a Candida infection (3)

A
  • pregnancy
  • antibiotics use
  • immunosuppression
39
Q

What is white curdy, or lumpy discharge suggestive of?

A

= genital candidiasis (thrush)

40
Q

Management of genital candidiasis?

A

= antifungal treatment

oral: Fluconazole, itraconazole
intravaginal: clotrimazole pessary
vulval: topical clotrimazole cream

41
Q

Oral therapies in the treatment of genital candidiasis should be avoided in…? (2)

A
  • pregnant women
  • breast feeding women
42
Q

Important note to warn patients about if on intravaginal & topical treatments for genital candidiasis?

A

= can compromise the integrity of latex condoms and diaphragms

43
Q

What are genital warts caused by? (+ serotypes (2))

A

= human papillomavirus (HPV)

HPV 6 + 11

44
Q

Transmission of genital warts

A

= direct skin-to-skin contact

45
Q

Genital warts: what is Podophyllotoxin?

A

= plant-based antiviral that can destroy wart tissue

46
Q

Genital warts: what is Imiquimod?

A

= immune response modifier that stimulates the body’s immune system to fight the virus

47
Q

Genital warts: what is Trichloroacetic acid?

A

= chemical treatment that burns off warts

48
Q

Are genital warts likely to come back after treatment (reoccur)?

A

= yes

Patient should be informed about high likelihood of recurrence despite treatment

49
Q

Without intervention, what is the likelihood of passing HIV from mother to child?

  • 5-10%
  • 25-40%
  • 50-65%
  • > 85%
A
  • 25-40%
50
Q

When does the majority of HIV transmissions from mother to child happen?

A

= during labour (90%)

51
Q

HIV: What is the mother’s viral load cut-off value in which a normal vaginal delivery can be recommended and supported vs. an elective caesarean section recommended?

A

Mother’s viral load < 50 - normal vaginal delivery can be recommened and supported

> 50 - elective caesarean section recommended

52
Q

Safest way to feed infants born to women with HIV?

A

= formula milk

53
Q

What are AID-defining malignances?

A

= refer to a set of cancers more prevalent or exclusively found in people with acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection

54
Q

Example of AIDS-defining malignangies (3)

A
  • Kaposi’s sarcoma
  • High-grade-B-cell non-Hodgkin’s lymphoma
  • invasive cervical cancer
55
Q

Which of the following oncogenic viruses is associated with Kaposi’s sarcoma?

  • Epstein-Barr virus (EBV)
  • Human Herpesvirus 8 (HHV8)
  • Human Papillomavirus (HPV)
A
  • Human Herpesvirus 8 (HHV8)
56
Q

Which of the following oncogenic viruses is associated with non-Hodgkin’s lymphoma?

  • Epstein-Barr virus (EBV)
  • Human Herpesvirus 8 (HHV8)
  • Human Papillomavirus (HPV)
A
  • Epstein-Barr virus (EBV)
57
Q

Which of the following oncogenic viruses is associated with invasive cervical cancer?

  • Epstein-Barr virus (EBV)
  • Human Herpesvirus 8 (HHV8)
  • Human Papillomavirus (HPV)
A
  • Human Papillomavirus (HPV)
58
Q

What is molluscum contagiosum?

A

= common, contagious skin infection caused by the molluscum contagiosum virus, a member of the poxvirus family

59
Q

Small, smooth, pearly-coloured papules with a central area of umbilication are suggestive of?

A

= molluscum contagiosum

60
Q

Management options for molluscum contagiosum (3)

A
  • cryotherapy
  • topical treatments e.g., salicyclic acid, potassium hydroxide, imiquimod
  • curettage
61
Q

Is Neisseria gonorrhoea gram positive or negative?

A

= gram negative

62
Q

Extragenital complications associated with gonorrhoea? (3)

A
  • pharyngitis
  • rectal pain & discharge
  • disseminated infection
63
Q

Investigations for gonorrhoea? (4)

A
  • self taken vulvovginal swab in women, or first pass urine in men
  • microscopy (monomorphic gram-negative diplococci wihtin polymorphonuclear leukocytes)
  • nucleic acid amplification tests (NAAT)
  • culture
64
Q

The following findings on microscopy is suggestive of which sexually transmitted infection?

Findings: monomorphic gram-negative diplococci within polymorphonuclear leukocytes

A

= gonorrhoea

65
Q

Mainstay treatment for gonorrhoea?

A

= antibiotics

First-line: Ceftriaxone

66
Q

Important to include following treatment for gonorrhoea?

A

= test of cure - essential to monitor disease clearance and assess effectiveness of chosen antibiotic regimen

67
Q

Complications associated with gonorrhoea (3)

A
  • infertility
  • disseminated infection (affecting joints)
  • susceptibility to HIV infection
68
Q

What is priamary HIV infection?

A

= the phase that commences immediately after the initial exposure to HIV

This phase is characterised by a surge in viral replication and often coincides with the onset of clinical symptoms

69
Q

Retroviruses that cause primary HIV infection (2)

A
  • HIV-1
  • HIV-2
70
Q

Transmission of HIV (3)

A
  • sexual
  • parenteral (e.g., injection drug use, needlestick injury)
  • mother to child (during childbirth or breastfeeding)
71
Q

HIV: symptoms onset within 3 weeks of infection, lasting longer than 2 weeks OR involving the CNS, is associated with?

A

= rapid progression to AIDS

72
Q

How is HIV primarily established (diagnosied)?

A

= serum HIV ELISA (enzyme-linked immunosorbent assay)

Positive results must be confired using a second test

73
Q

Management of primary HIV infection? (2)

A

= combination antiretroviral therapy (cART)

(offered to all regardless of their CD4 count)

= Contact tracing necessary

74
Q

In primary HIV infection, is the CD4 count used to assess if cART should be offered?

A

= no, offered to all regardless of CD4 count

75
Q

What is Erythroplasia of Queyrat (EQ)?

A

= type of squamous cell carcinoma in situ

Well-circumscribed, red, and painless lesion on the gland or prepuce (foreskin)

76
Q
A

Year 4 (11 decks)

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