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3a Exam > GU Medicine > Flashcards

GU Medicine Flashcards

1
Q

How can the majority of couples in the general population conceive within 1 year?

A
  • Women is aged <40 years
  • Do not use contraception
  • Regular sexual intercourse (2-3 days a week)
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2
Q

When would you refer a couple for infertility investigations?

A

After 1 year of trying to conceive

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3
Q

What pre-conception advice would you give to a couple?

A
  • Have intercourse 2-3/week
  • Folic acid
  • Vitamin D
  • Smears: up to date
  • Smoking cessation
  • Reduce alcohol intake
  • Manage co-morbidities
  • Healthy weight
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4
Q

What are the causes of infertility?

A

Unexplained
Ovulatory disorders
Tubal Damage
Male causing
Cervical
Coital

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5
Q

What 3 things are investigated in specialised infertility tests?

A
  1. Ovulation
  2. Semen quality
  3. Tubal patency
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6
Q

What initial tests would the GP do before referring for specialist infertility testing?

A
  • Hormone profile (D2, FSH, D21 progesterone)
  • TFT’s
  • Rubella
  • Smear
  • Semen analysis
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7
Q

What are 6 disorders of ovulation that can cause infertility?

A
  • PCOS
  • Ovarian insufficiency
  • Pituitary tumours
  • Hyperprolactinaemia (prolactin inhibits GnRH)
  • Turner syndrome
  • Premature menopause
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8
Q

What are disorders of the tubes, uterus or cervix that can cause infertility?

A
  • PID
  • Endometriosis
  • Asherman’s syndrome (adhesions)
  • STIs
  • Sterilisation
  • Deformity of uterus (septum)
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9
Q

What are risk factors for female infertility?

A
  • Smoking
  • Low/high BMIs
  • High alcohol intake
  • Drug use
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10
Q

What are investigations for female infertility?

A

TVS: rules out adnexal masses
Chlamydia screens (PID)

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11
Q

How would you assess the HPO axis in female infertility?

A

Mid-luteal phase progesterone level to assess ovulation (day 21):
<16 = anovulation
16-30 = equivocal
>30 = ovular

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12
Q

How would you assess tubal patency (blockage) in female infertility?

A

CT
US
Laparoscopy and dye test (GOLD STANDARD)

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13
Q

What is the general management of female infertility?

A

Increase sex
Weight loss
Reduce alcohol, smoking and caffeine

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14
Q

What is the management of anovulation in female infertility?

A
  • Clomifene (stimulates ovulation)
  • GnRH
  • Gonadotrophins
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15
Q

What is the management of Tubal disease in female infertility?

A

Salpinostomy
Adhesiolysis

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16
Q

What are two types of male infertility?

A

Azoospermia
Teratozoospermia

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17
Q

What can cause Azospermia in male infertility?

A

Klinefelters
Chlamydia
Vasectomy

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18
Q

What can cause Teratozoospermia in male infertility?

A

Testicular cancer

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19
Q

How can male infertility be tested?

A
  • Semen analysis (count >15 million, motility >40%)
  • Testicular biopsy (azoospermia)
  • FSH increases: testicular failure
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20
Q

A sperm count less than what will indicate the need for clinical examination and further tests?

A

<5m/ml:
- Endocrine tests
- Karyotyping (e.g. klinefelters)

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21
Q

What is the general management of male infertility?

A
  • Intrauterine insemination (IUI) (mild)
  • In-vitro fertilisation (IVF) (moderate)
  • Intracytoplasmic sperm injection (ICSI)(severe)
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22
Q

How can infertility be managed if azoospermia is the cause?

A
  1. Surgical sperm recovery.
  2. Donor insemination.
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23
Q

Why is only 1 egg transferred in IVF?

A

To avoid multiple pregnancy

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24
Q

Give 4 risks associated with IVF

A

Multiple pregnancy
Miscarriage
Ectopic pregnancy
Foetal abnormality

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25
Q

What is the COCP?

A

Immediate protection that inhibits ovulation, alters the cervical mucus and thins the endometrium

E.g. Rigevidon containing Levonorgestrel + Ethinylestradiol (hormones)

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26
Q

What is the window to take the COCP pill?

A

12 hours

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27
Q

What should you do if you miss a COCP dose?

A

Take double dose

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28
Q

What circumstances describes a person as UKMEC 4 (absolutely shouldn’t take the COCP)

A

1) >35 + smoker/>15 a day
2) Migraine + aura
3) Hx of stroke/MI
4) Hx of thromboembolism
5) Breast feeding <6 weeks postpartum
6) Uncontrolled HTN
7) Breast cancer
8) Major surgery

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29
Q

What circumstances describes a person as UKMEC 3 for COCP

A

> 35 + <15 cigarettes daily
35 BMI
Controlled HTN
Immobility
Carrie of breast cancer gene
FHx of thromboembolic disease

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30
Q

Give 7 advantages of the COCP as a contraceptive

A
  1. Reversible
  2. Reliable
  3. Regular cycle
  4. Reduces menorrhagia
  5. Helps with acne
  6. Reduces post-menopausal symptoms
  7. Protective against some cancer
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31
Q

Give 4 disadvantages of the COCP as a contraceptive

A
  • No protection against STI’s
  • Drug interactions
  • Increased risk of breast and cervical cancer
  • VTE risk
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32
Q

How do progesterone only pills work and give an example?

A

Thickens cervical mucus and thins the endometrium-prevents sperm attachment:
E.g.
- Micronor
- Noriday
- Cerazette (Desogestrel)

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33
Q

What is Depo Provera as a contraception?

A

Medroxyprogesterone acetate given via IM every 12 weeks

Inhibits ovulation

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34
Q

What are the side-effects of Depo Provera as a contraception?

A
  • Irregular bleeding
  • Weight gain
  • Not quickly reversed
  • May take 12 months to return fertility
  • Increased risk of osteoporosis
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35
Q

Give 2 advantages of the POP as a contraceptive

A
  1. Prevents oestrogenic side effects: e.g. breast tenderness.
  2. Suitable for those who are smokers, obese, high risk VTE and breast cancer
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36
Q

Give 4 disadvantages of the POP as a contraceptive

A
  1. Less effective than the COCP
  2. Increased risk of ectopic pregnancy
  3. Disrupts menstrual pattern
  4. Functional ovarian cysts may develop
37
Q

What is the IUS Mirena coil?
How long does it work?

A

Intra-uterine system of Levonorgestrel that prevents endometrial prolifeation and causes cervical mucous thickening.

Up to 5 years

38
Q

Give 3 examples of emergency contraception

A

1) Levonelle (Contains levonorgestrel (progesterone)): 3 days
2) Ellaone (Ulipristal acetate (progesterone receptor modulator)): 5 days
3) IUD (most effective)

39
Q

Give 5 symptoms of STI’s that are seen in men

A
  1. Pain on micturition
  2. Urethral pain
  3. Abnormal discharge
  4. Ulcers and blisters
  5. Swelling
40
Q

Give 5 symptoms of STI’s that are seen in women

A
  1. Abnormal discharge
  2. Itching
  3. Soreness
  4. Ulcers and lumps
  5. Post intercourse bleeding
41
Q

What is Candidiasis?

A

Yeast infection of the lower female reproductive tract

42
Q

What are the risk factors for Candidiasis?

A
  • Pregnancy
  • DM
  • Recent Abx use
  • Oral contraceptives
  • Chemotherapy
43
Q

What causes candidiasis?

A

Candida albicans: reproduces by budding

44
Q

What is the clinical presentation of Candidiasis?

A
  • Pruritis vulvaw
  • Vulval soreness/dryness
  • White cottage cheese discharge
  • Dyspareuria
  • Dysuria
45
Q

How is Candidiasis diagnosed?

A

Charcoal swab + microscopy
Vaginal pH

46
Q

What is the management of Candidiasis?

A

Soap substitute
Emollient: moisturises vulval skin
ANTIFUNGAL:
Clotrimazole pessary
Fluconizole tablet
Two doses of Oral FLuconazole 150mg 3 days apart: if severe

47
Q

What is chlamydia?

A

STI
The most common preventable cause of infertility
Intracellular gram negative bacteria effecting columnar and transitional epithelium

48
Q

What are the risk factors for chlamydia?

A

Age <25
Multiple sexual partners
Lack of condom use
Poor socio-economic status

49
Q

What causes chlamydia?

A

Chlamydia trachomatis

50
Q

What is the clinical presentation of chlamydia in male and females?

A

Majority asymptomatic

Female: Discharge, dysuria and post-coital bleeding

Male: Urethritis, dysuria and urethral discharge

51
Q

How is chlamydia diagnosed?

A

Sample taken + NAATs (Nucleic Acid Amplification Tests)
- Women: vulvovaginal swab
- Men: First catch urine specimen

52
Q

What is the management of chlamydia?

A
  • Doxycycline
  • Azithromycin
  • Erythromycin 500mg BD for 10-14 days: if contraindicated
  • Contraceptive advice
53
Q

What causes Gonorrhoea?

A

Neisseria Gonorrhoea

Gram negative diplococcus that infects mucous mebranes of the urethra, endocervix, rectum, pharynx and conjunctiva.

54
Q

What are the risk factors for Gonorrhoea?

A
  • Sexually active age
  • Hx of previous STIs
  • New/multiple sexual partners
  • Anal/oral sex
  • Poor condom use
  • Drug/sex work
55
Q

What is the pathophysiology of Gonorrhoea?

A

Transmission by direct inoculation of infection secretions from one mucous membrane to another
Incubation period is 2-5 days
Increased Abx resistance

56
Q

What is the incubation period of Gonorrhoea?

A

2-5 days

57
Q

What is the clinical presentation of Gonorrhoea?

A

Men:
- Discharge
- Peri-anal pain
- Pruritis
Women:
- Green/yellow discharge
- Lower abdomen pain
- Dysuria
- Contact bleeding

58
Q

How is Gonorrhoea investigated?

A

Sample taken + NAATs (Nucleic Acid Amplification Tests)
- Women: vulvovaginal swab
- Men: First catch urine specimen

59
Q

What is the management of Gonorrhoea?

A

Single dose: Ceftriaxone IM

OR

Single dose of: Oral cefixime 400mg + oral azithromycin 2g

60
Q

What is Syphilis?

A

Contagious systemic disease

Transmitted by abraded skin or intact mucous membranes

61
Q

What is the incubation time of Syphilis?

A

3 weeks

62
Q

What causes Syphilis?

A

Treponema Pallidum

63
Q

What is primary and secondary Syphilis?

A

Primary: Incubation 2-3 weeks (local infection)

Secondary: Incubation 6-12 weeks (generalised infection)

64
Q

What is the biggest risk factor for Syphilis?

A

MSM

65
Q

What is the clinical presentation of primary Syphilis?

A

Primary lesion (Chancre) at site of infection heals in 2-6 weeks; where bacteria first enters body

Small painless papule forms an ulcer: red margin and discharging clear serum on coronary sulcus; glans and inner surface of prepuce

66
Q

What is the clinical presentation of secondary Syphilis?

A

6 weeks after primary lesion
Multi-system involvement within 2 years of infection
Night: headaches, fever, malaise
Rash: palms, soles and face

67
Q

How is Syphilis diagnosed?

A

Treponemal enzyme immunoassay:
- IgM for early infection
- IgG for latter

68
Q

What is the management of Syphilis?

A

Benzathine Penicillin: 2.4 mega units IM

69
Q

What is the most common cause of abnormal vaginal discharge in women of reproductive age?

A

Bacterial Vaginosis

70
Q

What are the causes of Bacterial Vaginosis?

A

Overgrowth of predominantly anaerobic organisms in the vagina e.g.:
Gardnerella Vaginalis
Prevotella spp
Mycoplasma hominis
Mobiluncus spp

71
Q

What is normally the dominant bacteria in the vagina?

A

Lactobacilli- these are replaced in Bacterial Vaginosis

72
Q

What are the risk factors for bacterial vaginosis?

A

Sexually active
Afro caribbean
IUCD
Vaginal douching
Receptive oral sex
Smoking

73
Q

What is the clinical presentation of bacterial vaginosis?

A

Offensive, fishy smelling vaginal discharge
No soreness or irritation

74
Q

What is the management of bacterial vaginosis?

A

Avoid vaginal douching
Abx: Metronidazole 400-500mg BD for 5-7 days

75
Q

What is Trichomonas Vaginalis?

A

A flagellated protozoan that is the most common curable STI in the world

76
Q

What can Trichomonas Vaginalis cause?

A

Vaginitis
Cervicitis
Urethritis

77
Q

What is the female clinical presentation of Trichomonas Vaginalis?

A
  • Frothy green discharge
  • Strawberry cervix
  • Dysuria
  • Offensive odour
  • pH > 4.5
  • Lower abdominal discomfort
78
Q

What is the male clinical presentation of Trichomonas Vaginalis?

A

Asymptomatic
Urethritis
Dysuria and urethral discharge

79
Q

How is Trichomonas Vaginalis diagnosed?

A

High vaginal swabs + NAATs

80
Q

What is the management of Trichomonas Vaginalis?

A

Treat both partners at same time:
- Metronidazole BD 5-7 days
- Avoid sexual intercourse for one week following treatment

81
Q

What is Lichen Sclerosis?

A

Chronic inflammatory dermatosis that affects the skin of:
- Women: anogenital region
- Men: glans (penis tip) and foreskin

82
Q

What is the pathophysiology of Lichen Sclerosis?

A

Auto-immune induced disease in genetically predisposed patients

83
Q

Who is affected by Lichen Sclerosis?

A

Pre-pubertal and post-menopausal women
9-11yr old boys

84
Q

What is the key clinical presentation of Lichen Sclerosis?

A

White thickened patches with ecchymosis, hyperkeratosis or bullae

85
Q

What is the female clinical presentation of Lichen Sclerosis?

A
  • Itch worse at night
  • Pain
  • Perianal lesions
  • White lesions around vulva
  • Shrinking of labia
  • Clitoral adhesions
86
Q

What is the male clinical presentation of Lichen Sclerosis?

A
  • Soreness + haemorrhagic blisters
  • Dyspareuria
  • Painful erections: due to phimosis (can’t retract foreskin)
  • Poor stream/dysuria
87
Q

What is the investigation of Lichen Sclerosis?

A

Clinical
Biopsy if suspected malignancy

88
Q

What is the management of Lichen Sclerosis?

A

Topical steroids e.g Clobetasol propionate

3a Exam (9 decks)

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