Group C - Emergency Gynaecology and GUM Flashcards
Outline the 3 main tests for HIV, explain when they are used and how long after exposure they can be used
1) Antigen / antibody test (screening test)
- Looks at presence of antibodies/antigens
- Used for screening
Window period: 45 days
2) Finger prick antibody test
- Rapid testing by finger prick
- Needs further confirmation by antigen / antibody test
Window period: 90 days
3) NAAT
- Looks at presence of HIV RNA and viral load
- Used to monitor HIV treatment
Window period: 10-33 days
Explain the difference between PrEP and PEP in HIV management
PrEP - pre-exposure prophylaxis
- Taken daily
- HIV test taken prior to starting, also 3 monthly thereafter
PEP - post-exposure prophylaxis (Truvada )
- Taken after suspected or known diagnosis (prevents infection from taking hold)
- Must be started within 72 hours, taken for 28 days thereafter (od or bd)
State some risk factors for HIV
- Known HIV positive contact / mother
- IVDU
- From of high HIV prevalence
- Blood transfusion abroad
- High risk sexual practice e.g. chemsex
- Sex abroad / sex with partner born abroad
- Paid for sex / been paid for sex
- Sex with men / partner sex with men
- Multiple unprotected sexual partners
How long can HIV test be negative for after exposure
Up to 3 months
Can get a negative HIV test up to 3 months after initial exposure, therefore repeat testing may be necessary
State what HIV and AIDS stands for
HIV = human immunodeficiency virus
AIDS = acquired immunodeficiency syndrome
State 2 ways by which HIV can be monitored
- CD4 count (blood test) = < 200 is end stage disease / AIDS
- Viral load
Outline who should be tested for HIV and how often is recommended
- Individuals identified as high risk e.g. MSM, IVDU
- Patients with conditions that could be associated with HIV e.g. TB, other STIs or atypical infections
- Indicator symptoms for HIV
- Sexual partners of anyone who is newly diagnosed with HIV
- Routine screening antenatally
Frequency of testing:
At least once in groups above
3 monthly - MSM with multiple sexual partners and those taking PrEP
Yearly - high risk e.g. IVDU / sex workers
Briefly outline the management of uncomplicated HIV, including additional measures
Mainstay: antiretroviral therapy (2 x NRTIs + additional agent)
Additional measures:
- General STI screen
- Contact tracing
- Advise about safe practises in the future for prevention e.g. condoms, no needle sharing
- Yearly smear tests if female
- Ensure vaccinations up to date
- Follow up monitoring by HIV clinic of viral load and CD4 level
- General monitoring of cardiovascular risk factors (increased risk cardiovascular disease)
State the 4 main types of drugs used in antiretroviral therapy of HIV
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Integrase strand transfer inhibitors (INSTIs)
First-line ART regimen = 2 x NRTIs + additional agent
List some aims of HIV treatment
- Undetectable load, reduce transmission
- Allow CD4 count / immune system to recover, avoiding the secondary complications of HIV
- Improve quality of life for patient and normalise lifespan
Outline 2 laws that govern abortion and it’s regulation
- Abortion act (1967)
- Human fertilisation and embryology authority
List 6 conditions laid out by the Abortion Act (1967) that need to be met for a legal termination of pregnancy
- Gestation below 24 weeks
- Necessary to prevent grave injury to physical or mental health of woman
- Substantial risk that if the baby was born it would be serious handicapped
- Continuation would involve a risk to life greater than if there was a TOP
Logistical:
5. Requires agreement by 2 registered clinicians
6. Must be undertaken at licensed premises
Outline the 2 main types of termination of pregnancy
1. Medical
2. Surgical
- Medical abortion
- Mifepristone (blocks progesterone)
- Misoprostol (stimulates prostaglandin receptors) - Surgical abortion
- Surgical (vacuum) evacuation
Outline the advantages and disadvantages of medical vs surgical abortion
Medical:
+ avoid surgery
+ manage at home
+ more ‘natural’ as mimics miscarriage
- significant cramping and bleeding
- takes time for miscarriage to occur, may fail
Surgical:
+ quick procedure / one stop
+ complete abortion can be confirmed
+ sterilisation can occur
- risk of injury to uterus/cervix
- more invasive / traumatic
Outline some safety steps to be taken post-termination of pregnancy
- b-hCG test 3 weeks after TOP
- Discussion of future contraception or fertility
- Offer support and counselling
- Safety net, including signs on ongoing pregnancy
Outline some complications of termination of pregnancy
- Haemorrhage
- Uterine perforation, cervical trauma and damage to local structures
- Pain
- Infection
- Failure of abortion (pregnancy continues)
- Need for further intervention
Outline the medical schedule for the following situations
- Medical TOP (< 14 weeks)
- Medical TOP (14-24 weeks)
- Surgical TOP (< 14 weeks)
- Surgical TOP (14-24 weeks)
Medical TOP (< 14 weeks)
- Mifepristone oral
- Misoprostol 24-48 hours later
(if later 7-14) PLUS Misoprostol every 3 hours until abortion occurs
Medical TOP (14-24 weeks)
- Mifepristone oral
- Misoprostol 24-48 hours later
PLUS Misoprostol every 3 hours until abortion occurs
If doesn’t occur after 24 hours = start all over again
Surgical TOP (< 14 weeks)
- Cervical preparation
(manual or electric)
- Suction cannula to evacuate uterus (forceps if required)
Surgical TOP (14-24 weeks)
- Vacuum aspiration
- Dilation and evacuation
Outline the presentation (men and women) and management of chlamydia
Presentation (men):
- Penile discharge
- Dysuria
- Testicular pain (epididymo-orchitis)
Presentation (women):
- Yellow, cloudy discharge
- Cervical inflammation
- IMB or PCB
- Deep dyspareunia
- Lower abdominal pain
Management:
- Oral antibiotics: Doxycycline 100mg bd for 7 days
- Best started after confirmation of test results, however if high clinical suspicion start empirically
Outline the presentation and management of gonorrhoea
Presentation (men):
- Purulent urethral discharge
Dysuria
- Epididymal tenderness
Presentation (women):
- Altered vaginal discharge (commonly thin, watery, green or yellow)
- Dysuria
- Dyspareunia
- Lower abdominal pain
Management:
- IM Ceftriaxone if sensitivities NOT known
- Oral Ciprofloxacin if sensitivities known
Explain the 3 stages of syphilis (primary, secondary and tertiary)
Primary:
- Single papule (slightly elevated lesion with no fluid)
- Develops into a painless, undulating ulcer in anogenital region (typically develops 9-90 days post infection)
- Painless ulcer heals after approx. 3-10 weeks, but may persist during secondary syphilis
Secondary:
Usually develops 3 months post infection
- Additional symptoms e.g. rash on hands and soles, fever, malaise etc.
Tertiary:
Can present many years after the initial infection
Categorised into
- Neurosyphilis
- Cardiovascular syphilis
- Gummatous syphilis
State some additional symptoms seen in secondary syphillis
- Rash on hands and soles (not usually itchy or painful)
- Fever
- Malaise
- Arthralgia
- Weight loss
- Headaches
- Condylomata lata (elevated plaques like warts at moist areas of skin)
- Painless lymphadenopathy
- Silvery-gray mucous membrane lesions
Briefly explain the 3 types of tertiary syphilis
- Gummatous syphilis
- Neurosyphilis
- Cardiovascular syphilis
Gummatous syphilis:
- Granulomas can form in bone, skin, mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue
- Non-infectious at this stage
- Symptoms vary depending on tissue affected
Neurosyphilis:
- Dementia
- Meningovascular complications e.g. stroke
- Argyll Robertson pupil
- Tabes dorsalis neurological symptoms e.g. numb legs, absence of tendon reflexes, lightning pains
Cardiovascular syphilis:
- Angina
- Aortic regurgitation due to aortic valvulitis
- Calcification of the ascending aorta
Outline the management of syphilis
IM Benzylpenicillin single dose
(3 doses at weekly intervals if late syphilis)
Outline the presentation and management of thrush
Presentation:
- Vulval / vaginal itch
- Thick, white, non-offensive vaginal discharge
- Superficial dyspareunia
- Dysuria
Management:
- Advise on self-management measures e.g. avoid douching
- Oral Fluconazole
- Intravaginal pessary of Clotrimazole
