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Year 4 - 1. Reproductive Health > Group C - Emergency Gynaecology and GUM > Flashcards

Group C - Emergency Gynaecology and GUM Flashcards

1
Q

Outline the 3 main tests for HIV, explain when they are used and how long after exposure they can be used

A

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

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2
Q

Explain the difference between PrEP and PEP in HIV management

A

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)

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3
Q

State some risk factors for HIV

A
  • 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
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4
Q

How long can HIV test be negative for after exposure

A

Up to 3 months

Can get a negative HIV test up to 3 months after initial exposure, therefore repeat testing may be necessary

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5
Q

State what HIV and AIDS stands for

A

HIV = human immunodeficiency virus

AIDS = acquired immunodeficiency syndrome

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6
Q

State 2 ways by which HIV can be monitored

A
  1. CD4 count (blood test) = < 200 is end stage disease / AIDS
  2. Viral load
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7
Q

Outline who should be tested for HIV and how often is recommended

A
  • 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

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8
Q

Briefly outline the management of uncomplicated HIV, including additional measures

A

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)

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9
Q

State the 4 main types of drugs used in antiretroviral therapy of HIV

A
  1. Nucleoside reverse transcriptase inhibitors (NRTIs)
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  3. Protease inhibitors (PIs)
  4. Integrase strand transfer inhibitors (INSTIs)

First-line ART regimen = 2 x NRTIs + additional agent

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10
Q

List some aims of HIV treatment

A
  • 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
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11
Q

Outline 2 laws that govern abortion and it’s regulation

A
  • Abortion act (1967)
  • Human fertilisation and embryology authority
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12
Q

List 6 conditions laid out by the Abortion Act (1967) that need to be met for a legal termination of pregnancy

A
  1. Gestation below 24 weeks
  2. Necessary to prevent grave injury to physical or mental health of woman
  3. Substantial risk that if the baby was born it would be serious handicapped
  4. 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

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13
Q

Outline the 2 main types of termination of pregnancy
1. Medical
2. Surgical

A
  1. Medical abortion
    - Mifepristone (blocks progesterone)
    - Misoprostol (stimulates prostaglandin receptors)
  2. Surgical abortion
    - Surgical (vacuum) evacuation
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14
Q

Outline the advantages and disadvantages of medical vs surgical abortion

A

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

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15
Q

Outline some safety steps to be taken post-termination of pregnancy

A
  • b-hCG test 3 weeks after TOP
  • Discussion of future contraception or fertility
  • Offer support and counselling
  • Safety net, including signs on ongoing pregnancy
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16
Q

Outline some complications of termination of pregnancy

A
  • Haemorrhage
  • Uterine perforation, cervical trauma and damage to local structures
  • Pain
  • Infection
  • Failure of abortion (pregnancy continues)
  • Need for further intervention
17
Q

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)

A

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

18
Q

Outline the presentation (men and women) and management of chlamydia

A

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

19
Q

Outline the presentation and management of gonorrhoea

A

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:
- Oral antibiotics
- Cephalosporin or Gentamycin

20
Q

Explain the 3 stages of syphilis (primary, secondary and tertiary)

A

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

21
Q

State some additional symptoms seen in secondary syphillis

A
  • 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
22
Q

Briefly explain the 3 types of tertiary syphilis
- Gummatous syphilis
- Neurosyphilis
- Cardiovascular syphilis

A

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

23
Q

Outline the management of syphilis

A

IM Benzylpenicillin single dose

(3 doses at weekly intervals if late syphilis)

24
Q

Outline the presentation and management of thrush

A

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

25
Q

Outline which strains of herpes simplex are responsible for coldsores and which ones for genital herpes

A

HSV-1 = coldsores
HSV-2 = genital herpes

26
Q

Outline the presentation and management of bacterial vaginosis

A

Presentation:
- Thin white/grey fishy-smelling vaginal discharge
- Not usually associated with soreness, itching, or irritation

Management:
- Advise on self-management measures e.g. avoid douching
- Oral metronidazole

27
Q

Outline the presentation and management of trichomoniasis vaginalis

A

Presentation:
50% cases asymptomatic
- Yellow-green frothy vaginal discharge, may smell fishy
- Itching
- Dysuria
- Dyspareunia
- Balanitis in males
- Strawberry cervix

Management:
- Metronidazole

28
Q

Outline the presentation and management of herpes

A

Presentation:
- Ulcers or blistering lesions
- Neuropathic pain
- Flu like symptoms
- Dysuria
- Inguinal lymphadenopathy

Management:
- Aciclovir

29
Q

Outline the presentation and management of genital warts

A

Presentation:
- Anogenital fleshy papules
- Painless, may be hard or soft

Management:
Treatment is not always necessary and lesions will most likely resolve spontaneously over time
- Podophyllotoxin
- Also physical ablation e.g. excision, cryotherapy

30
Q

Outline the presentation and management of pubic lice

A

Presentation: commonly found on pubic and perianal hairs, could be coarse body hair
- Itching, particularly at night
- Spots of blood / gritty debris in underwear

Management:
- Insecticide: Permethrin
Follow up should be arranged 1 week after completion of treatment

31
Q

List some potential causes of penile ulcers / lesions

A
  • Trauma
  • Herpes simplex virus (multiple painful ulcers)
  • Malignancy (various presentations, usually painless)
  • Syphilis (single painless ulcer, indurated base)
  • Chancroid (multiple painful ulcers)
  • Lichen sclerosis (erosion / ulceration)

Year 4 - 1. Reproductive Health (7 decks)

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