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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
What is the COCP?
Immediate protection that inhibits ovulation, alters the cervical mucus and thins the endometrium E.g. Rigevidon containing Levonorgestrel + Ethinylestradiol (hormones)
26
What is the window to take the COCP pill?
12 hours
27
What should you do if you miss a COCP dose?
Take double dose
28
What circumstances describes a person as UKMEC 4 (absolutely shouldn't take the COCP)
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
29
What circumstances describes a person as UKMEC 3 for COCP
>35 + <15 cigarettes daily >35 BMI Controlled HTN Immobility Carrie of breast cancer gene FHx of thromboembolic disease
30
Give 7 advantages of the COCP as a contraceptive
1. Reversible 2. Reliable 3. Regular cycle 4. Reduces menorrhagia 5. Helps with acne 6. Reduces post-menopausal symptoms 7. Protective against some cancer
31
Give 4 disadvantages of the COCP as a contraceptive
- No protection against STI’s - Drug interactions - Increased risk of breast and cervical cancer - VTE risk
32
How do progesterone only pills work and give an example?
Thickens cervical mucus and thins the endometrium-prevents sperm attachment: E.g. - Micronor - Noriday - Cerazette (Desogestrel)
33
What is Depo Provera as a contraception?
Medroxyprogesterone acetate given via IM every 12 weeks Inhibits ovulation
34
What are the side-effects of Depo Provera as a contraception?
- Irregular bleeding - Weight gain - Not quickly reversed - May take 12 months to return fertility - Increased risk of osteoporosis
35
Give 2 advantages of the POP as a contraceptive
1. Prevents oestrogenic side effects: e.g. breast tenderness. 2. Suitable for those who are smokers, obese, high risk VTE and breast cancer
36
Give 4 disadvantages of the POP as a contraceptive
1. Less effective than the COCP 2. Increased risk of ectopic pregnancy 3. Disrupts menstrual pattern 4. Functional ovarian cysts may develop
37
What is the IUS Mirena coil? How long does it work?
Intra-uterine system of Levonorgestrel that prevents endometrial prolifeation and causes cervical mucous thickening. Up to 5 years
38
Give 3 examples of emergency contraception
1) Levonelle (Contains levonorgestrel (progesterone)): 3 days 2) Ellaone (Ulipristal acetate (progesterone receptor modulator)): 5 days 3) IUD (most effective)
39
Give 5 symptoms of STI’s that are seen in men
1. Pain on micturition 2. Urethral pain 3. Abnormal discharge 4. Ulcers and blisters 5. Swelling
40
Give 5 symptoms of STI’s that are seen in women
1. Abnormal discharge 2. Itching 3. Soreness 4. Ulcers and lumps 5. Post intercourse bleeding
41
What is Candidiasis?
Yeast infection of the lower female reproductive tract
42
What are the risk factors for Candidiasis?
- Pregnancy - DM - Recent Abx use - Oral contraceptives - Chemotherapy
43
What causes candidiasis?
Candida albicans: reproduces by budding
44
What is the clinical presentation of Candidiasis?
- Pruritis vulvaw - Vulval soreness/dryness - White cottage cheese discharge - Dyspareuria - Dysuria
45
How is Candidiasis diagnosed?
Charcoal swab + microscopy Vaginal pH
46
What is the management of Candidiasis?
Soap substitute Emollient: moisturises vulval skin ANTIFUNGAL: Clotrimazole pessary Fluconizole tablet Two doses of Oral FLuconazole 150mg 3 days apart: if severe
47
What is chlamydia?
STI The most common preventable cause of infertility Intracellular gram negative bacteria effecting columnar and transitional epithelium
48
What are the risk factors for chlamydia?
Age <25 Multiple sexual partners Lack of condom use Poor socio-economic status
49
What causes chlamydia?
Chlamydia trachomatis
50
What is the clinical presentation of chlamydia in male and females?
Majority asymptomatic Female: Discharge, dysuria and post-coital bleeding Male: Urethritis, dysuria and urethral discharge
51
How is chlamydia diagnosed?
Sample taken + NAATs (Nucleic Acid Amplification Tests) - Women: vulvovaginal swab - Men: First catch urine specimen
52
What is the management of chlamydia?
- Doxycycline - Azithromycin - Erythromycin 500mg BD for 10-14 days: if contraindicated - Contraceptive advice
53
What causes Gonorrhoea?
Neisseria Gonorrhoea Gram negative diplococcus that infects mucous mebranes of the urethra, endocervix, rectum, pharynx and conjunctiva.
54
What are the risk factors for Gonorrhoea?
- Sexually active age - Hx of previous STIs - New/multiple sexual partners - Anal/oral sex - Poor condom use - Drug/sex work
55
What is the pathophysiology of Gonorrhoea?
Transmission by direct inoculation of infection secretions from one mucous membrane to another Incubation period is 2-5 days Increased Abx resistance
56
What is the incubation period of Gonorrhoea?
2-5 days
57
What is the clinical presentation of Gonorrhoea?
Men: - Discharge - Peri-anal pain - Pruritis Women: - Green/yellow discharge - Lower abdomen pain - Dysuria - Contact bleeding
58
How is Gonorrhoea investigated?
Sample taken + NAATs (Nucleic Acid Amplification Tests) - Women: vulvovaginal swab - Men: First catch urine specimen
59
What is the management of Gonorrhoea?
Single dose: Ceftriaxone IM OR Single dose of: Oral cefixime 400mg + oral azithromycin 2g
60
What is Syphilis?
Contagious systemic disease Transmitted by abraded skin or intact mucous membranes
61
What is the incubation time of Syphilis?
3 weeks
62
What causes Syphilis?
Treponema Pallidum
63
What is primary and secondary Syphilis?
Primary: Incubation 2-3 weeks (local infection) Secondary: Incubation 6-12 weeks (generalised infection)
64
What is the biggest risk factor for Syphilis?
MSM
65
What is the clinical presentation of primary Syphilis?
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
What is the clinical presentation of secondary Syphilis?
6 weeks after primary lesion Multi-system involvement within 2 years of infection Night: headaches, fever, malaise Rash: palms, soles and face
67
How is Syphilis diagnosed?
Treponemal enzyme immunoassay: - IgM for early infection - IgG for latter
68
What is the management of Syphilis?
Benzathine Penicillin: 2.4 mega units IM
69
What is the most common cause of abnormal vaginal discharge in women of reproductive age?
Bacterial Vaginosis
70
What are the causes of Bacterial Vaginosis?
Overgrowth of predominantly anaerobic organisms in the vagina e.g.: Gardnerella Vaginalis Prevotella spp Mycoplasma hominis Mobiluncus spp
71
What is normally the dominant bacteria in the vagina?
Lactobacilli- these are replaced in Bacterial Vaginosis
72
What are the risk factors for bacterial vaginosis?
Sexually active Afro caribbean IUCD Vaginal douching Receptive oral sex Smoking
73
What is the clinical presentation of bacterial vaginosis?
Offensive, fishy smelling vaginal discharge No soreness or irritation
74
What is the management of bacterial vaginosis?
Avoid vaginal douching Abx: Metronidazole 400-500mg BD for 5-7 days
75
What is Trichomonas Vaginalis?
A flagellated protozoan that is the most common curable STI in the world
76
What can Trichomonas Vaginalis cause?
Vaginitis Cervicitis Urethritis
77
What is the female clinical presentation of Trichomonas Vaginalis?
- Frothy green discharge - Strawberry cervix - Dysuria - Offensive odour - pH > 4.5 - Lower abdominal discomfort
78
What is the male clinical presentation of Trichomonas Vaginalis?
Asymptomatic Urethritis Dysuria and urethral discharge
79
How is Trichomonas Vaginalis diagnosed?
High vaginal swabs + NAATs
80
What is the management of Trichomonas Vaginalis?
Treat both partners at same time: - Metronidazole BD 5-7 days - Avoid sexual intercourse for one week following treatment
81
What is Lichen Sclerosis?
Chronic inflammatory dermatosis that affects the skin of: - Women: anogenital region - Men: glans (penis tip) and foreskin
82
What is the pathophysiology of Lichen Sclerosis?
Auto-immune induced disease in genetically predisposed patients
83
Who is affected by Lichen Sclerosis?
Pre-pubertal and post-menopausal women 9-11yr old boys
84
What is the key clinical presentation of Lichen Sclerosis?
White thickened patches with ecchymosis, hyperkeratosis or bullae
85
What is the female clinical presentation of Lichen Sclerosis?
- Itch worse at night - Pain - Perianal lesions - White lesions around vulva - Shrinking of labia - Clitoral adhesions
86
What is the male clinical presentation of Lichen Sclerosis?
- Soreness + haemorrhagic blisters - Dyspareuria - Painful erections: due to phimosis (can't retract foreskin) - Poor stream/dysuria
87
What is the investigation of Lichen Sclerosis?
Clinical Biopsy if suspected malignancy
88
What is the management of Lichen Sclerosis?
Topical steroids e.g Clobetasol propionate

3a Exam (9 decks)

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