GU Medicine Flashcards
1
Q
FEMALE INFERTILITY
80% of couples in the general population will conceive within 1 year if:
A
- the women is aged under 40 years
- They do not use contraception
- they have regular sexual intercourse (2-3 days a week)
2
Q
by approximate percentages what are the causes of infertility?
A
Unexplained (30%) Ovulatory disorders (30%) Tubal Damage (25%) Male causing (25%) Cervical (5%) Coital (5%)
3
Q
FEMALE INFERTILITY
List some disorders of ovulation
A
- PCOS
- Ovarian insufficiency
- Pituitary tumours
- Hyperprolactinaemia (prolactin inhibits GnRH)
- Turner syndrome
- Premature menopause
4
Q
FEMALE INFERTILITY
List some problems of tubes, uterus or cervix
A
- PID
- Endometriosis
- Asherman’s syndrome (adhesions)
- STIs
- Sterilisation
- Deformity of uterus (septum)
5
Q
FEMALE INFERTILITY
Risk factors?
A
- Smoking
- Low/high BMIs
- High alcohol intake
- Drug use
6
Q
FEMALE INFERTILITY
Diagnostic tests?
A
TVS- rule out adnexal masses
Chlamydia screens (PID)
7
Q
FEMALE INFERTILITY
Assessment of axis?
A
- Mid-luteal phase progesterone level to assess ovulation (day 21)
<16 anovulation
16-30 equivocal
>30 ovular
8
Q
FEMALE INFERTILITY
Assessment of tubal patency?
A
CT, US
Laparoscopy and dye test (GOLD STANDARD)
9
Q
FEMALE INFERTILITY
Treatment?
A
Lifestyle factors
- Increase sex
- Weight loss
- Reduce alcohol, smoking, caffeine
10
Q
FEMALE INFERTILITY
Treatment of Anovulation?
A
- Clomifene
- GnRH
- Gonadotrophins
11
Q
FEMALE INFERTILITY
Treatment of Tubal disease?
A
Salpinostomy
Adhesiolysis
12
Q
MALE INFERTILITY
Causes of Azospermia?
A
Klinefelters
Chlamydia
vasectomy
13
Q
MALE INFERTILITY
Causes of Teratozoospermia?
A
Testicular cancer
14
Q
MALE INFERTILITY
Diagnostic tests?
A
- Semen analysis (count >15 million, motility >40%)
- Testicular biopsy (azoospermia)
- FSH increases in testicular failure
15
Q
MALE INFERTILITY
Diagnostic tests?
A
- Semen analysis (count >15 million, motility >40%)
- Testicular biopsy (azoospermia)
- FSH increases in testicular failure
16
Q
MALE INFERTILITY
treatment?
A
- Intrauterine insemination (IUI)
- In-vitro fertilisation (IVF)
- Intracytoplasmic sperm injection (ICSI)
17
Q
CONTRACEPTION
What is the COCP?
A
- Rigevidon/ Microgynon
Immediate protection that inhibits ovulation
Levonorgestrel and Ethinylestradiol
18
Q
CONTRACEPTION
What is the window to take the pill and what should you do if you miss one?
A
Take double dose
12 hour window
19
Q
CONTRACEPTION
What circumstances describes a person as UKMEC 4 (absolutely shouldnt take the pill)
A
1) >35 + smoke/ >15 a day
2) Migraine with aura
3) Hx of stroke/MI
4) Hx of thromboembolism
5) Breast feeding <6 weeks postpartum
6) Uncontrolled HTN
7) current breast cancer
8) Major surgery
20
Q
CONTRACEPTION
What circumstances describes a person as UKMEC 3
A
- > 35+ <15 cigarettes daily
▪ >35 BMI
▪ Controlled HTN
▪ Immobility
▪ Carrier of breast cancer gene
▪ Family Hx of thromboembolic disease in 1st degree relatives
21
Q
CONTRACEPTION
How do progesterone only pills work and give an example?
A
- thickens cervical mucous
- Micronor
- Noriday
- Cerazette (Desogestrel)
22
Q
CONTRACEPTION
What is Depo Provera?
A
Medroxyprogesterone acetate given via IM every 12 weeks.
it inhibits ovulation
23
Q
CONTRACEPTION
Side effects of Depo Provera?
A
- irregular bleeding
- weight gain
- Not quickly reversed and may take 12 months to return to fertility
- Increased risk of osteoporosis
24
Q
CONTRACEPTION
What is IUS- Mirena and how does it work?
A
Intra-uterine system of Levonorgestrel that prevents endometrial prolifeation and causes cervical mucous thickening.
up to 5 years
25
CONTRACEPTION
Give examples of emergency contraception
Levonorgestrel (progesterone) LEVONELLE - 3 days
Ulipristal acetate (progesterone receptor modulator) ELLAONE - 5 days
IUD (most effective)
26
CANDIDIASIS
What is it?
Yeast infection of the lower female reproductive tract
27
CANDIDIASIS
Risk factors?
- Pregnancy
- DM
- Recent Antibiotic use
- Oral contraceptives
- Chemotherapy
28
CANDIDIASIS
What is the most likely organism?
80-92% is Candida albicans that reproduces by budding
29
CANDIDIASIS
Clinical presentation?
- Pruritis vulvaw
- Vulval soreness/dryness
- White cottage cheese discharge
- Dyspareuria
- Dysuria
30
CANDIDIASIS
Ddx?
- STIs
- Bacterial vaginosis
- Lichen sclerosis
31
CANDIDIASIS
Diagnostic tests and results?
- take swabs
| - Clinical tests
32
CANDIDIASIS
Treatment?
Soap substitute
Emollient to moisturise vulval skin
ANTIFUNGAL:
Clotrimazole pessary
Fluconizole tablet
33
CANDIDIASIS
Tx for severe?
Two doses of Oral FLuconazole 150mg 3 days apart
34
CHLAMYDIA
What is it?
STI that is the most common preventable cause of infertility
Intracellular gram negative bacteria effecting columnar and transitional epithelium
35
CHLAMYDIA
Risk factors?
Age <25
Multiple sexual partners
Lack of condom use
Poor socio-economic status
36
CHLAMYDIA
What is the causing bacteria and how many people are infected per year?
131 million new cases worldwide per annum
Chlamydia trachomatis
37
CHLAMYDIA
Clinical presentation?
50% men and 75% women are asymptomatic
Female: Discharge, dysuria, post-coital bleeding
Male: Urethritis, dysuria, urethral discharge
38
CHLAMYDIA
Ddx?
- Gonorrhoea
- Prostatits
- Trichomonas vaginalis infection
- UTI
- Endometriosis
- Bacterial vaginosis
39
CHLAMYDIA
Diagnostic tests?
Sample taken for NAATs
Nucleic Acid Amplification Tests
Women- vulvovaginal swab
Men- First catch urine specimen
40
CHLAMYDIA
treatment?
- Doxycycline
- Azithromycin
- Erythromycin 500mg BD for 10-14 days if contraindicated
Contraceptive advice
41
GONORRHOEA
What is the causing bacteria?
Neisseria Gonorrhoea
Gram negative diplococcus that infects mucous mebranes of the urethra, endocervix, rectum, pharynx and conjunctiva
42
GONORRHOEA
Risk factors?
- Sexually active age
- Hx of previous STIs
- New/multiple sexual partners
- Anal/oral sex
- Poor condom use
- Drug/ sex work
43
GONORRHOEA
Pathophysiology?
- Transmission by direct inoculation of infection secretions from one mucous membrane to another
Incubation period is 2-5 days but may be up to 10
Increased Abx resistance
44
GONORRHOEA
Epidemiology?
7% of new STIs in GUM clinics
47% chlamydia
45
GONORRHOEA
Clinical presentation?
Men:
- Discharge
- Peri-anal pain
- Pruritis
Women:
- Green/yellow discharge
- Lower abdo pain
- Dysuria
- Contact bleeding
46
GONORRHOEA
Diagnostic tests and results?
Nucleic acid amplification test (NAAT)
Female: Swab
Male: First void urine
47
GONORRHOEA
Ddx?
- Chlamydia
- Endometriosis
- Pharyngitis
48
GONORRHOEA
Treatment?
Ceftriaxone IM single dose
OR
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
49
PELVIC INFLAMMATORY DISEASE (PID)
What is it?
General term for infection of upper female genital tract (uterus, fallopian, ovaries)
Can lead to ectopic pregnancy, abscess, chronic pelvic pain
50
PELVIC INFLAMMATORY DISEASE (PID)
Cause?
Ascending infection from the cervix e.g.
Chlamydia
Gonorrhoea
+- e.coli, Staph,
WORRIED ABOUT GROUP A STREP
51
PELVIC INFLAMMATORY DISEASE (PID)
Risk factors?
- younge age
- New sexual partner
- LAck of barrier contraception
- Lower socio-economic group
- TOP
- IUD present
52
PELVIC INFLAMMATORY DISEASE (PID)
Clinical presentation?
- Bilateral lower abdo pain
- Dyspareuria
- Abnormal vaginal bleeding
- Purulent discharge
- Fever
53
PELVIC INFLAMMATORY DISEASE (PID)
Presentation of Acute Salpingitis/PID?
- Fever/ tachycardia
- Lower abdo pain
- Cervicitis
- Cervical motion tenderness (excitiation
- Adnexal tenderness
54
PELVIC INFLAMMATORY DISEASE (PID)
Ddx?
- Appendicitis
- Ectopic pregnancy
- Other causes of vaginal bleeding
55
PELVIC INFLAMMATORY DISEASE (PID)
Diagnostic tests and results?
- Pregnancy test
- Cervical swabs
- Elevated ESR&CRP
- Endometrial biopsy
- USS
- Urinalysis
- Laparoscopy with direct visualisation of fallopian tubes
56
PELVIC INFLAMMATORY DISEASE (PID)
Treatment?
Clinically severe requires hospital admission for IV Abx:
oral ofloxacin + oral metronidazole
OR
intramuscular ceftriaxone + oral doxycycline + oral metronidazole
57
SYPHILLIS
What is it?
Contagious systemic disease with an incubation of around 3 weeks.
Transmitted by abraded skin or intact mucous mebranes
58
SYPHILLIS
Causing micro-organism?
Treponema Pallidum
59
SYPHILLIS
What is primary and secondary?
Primary: Incubation 2-3 weeks
(local infection)
Secondary Incubation 6-12 weeks (generalised infection)
60
SYPHILLIS
What is the biggest risk factor?
MSM- 79% of male attendees with syphillis are men who had sex with men
61
SYPHILLIS
clinical presentation of primary?
Primary lesion at site of infection that heals in 2-6 weeks
Small painless papule forms an ulcer, red margin and discharging clear serum on coronary sulcus, glans and inner surface of prepuce.
FIRST SIGN - small sore called a 'Chancre' where bacteria first enters body
62
SYPHILLIS
Clinical presentation of secondary?
6 weeks after primary lesion, multisystem involvement within 2 years of infection
Night headaches, fever, malaise
Rash on palms, soles and face
63
SYPHILLIS
Diagnostic test?
Treponemal enzyme immunoassay
IgM for early infection
IgG for latter
64
SYPHILLIS
Treatment?
Benzathine Penicillin- 2.4 mega units IM
2nd Line -
Oral azithromycin single dose
65
What is the most common cause of abnormal vaginal discharge in women of reproductive age?
BACTERIAL VAGINOSIS
66
BACTERIAL VAGINOSIS
Cause?
Overgrowth of predominantly anaerobic organisms in the vagina such as:
Gardnerella Vaginalis
Prevotella spp
Mycoplasma hominis
Mobiluncus spp
67
BACTERIAL VAGINOSIS
What is normally the dominant bacteria in the vagina?
Lactobacilli, these are replaced by the the anaerobic organisms
68
BACTERIAL VAGINOSIS
Risk factors?
```
Sexually active
Afro caribbean
IUCD
Vaginal douching
Receptive oral sex
Smoking
```
69
BACTERIAL VAGINOSIS
Clinical presentation?
Offensive, fishy smelling vaginal discharge without soreness or irritation
70
BACTERIAL VAGINOSIS
Ddx?
- other vaginal infections
- tumours
- Post menopausal discharge due to atrophic vaginitis
71
BACTERIAL VAGINOSIS
Treatment?
Avoid vaginal douching
Antibiotics-
Metronidazole 400-500mg BD for 5-7 days
Clindamycin and Tinidazole are alternatives
72
TRICHOMONAS VAGINALIS
What is it?
Trichomonas Vaginalis is a flagellated protozoan that is the most common curable STI in the world
Can cause:
Vaginitis
Cervicitis
Urethritis
73
TRICHOMONAS VAGINALIS
Female clinical presentation?
Women:
- Frothy green discharge (70%)
- Strawberry cervix
- Dysuria
- Offensive odour
- pH > 4.5
- Lower abdo discomfort
74
TRICHOMONAS VAGINALIS
Male clinical presentation?
Men are usually asymptomatic
Urethritis
Dysuria and urethral discharge
75
TRICHOMONAS VAGINALIS
Diagnostic tests?
- High vaginal swabs
| - NAATs - Nucleic acid amplification test
76
TRICHOMONAS VAGINALIS
Treatment?
Treat both partners at same time;
Metronidazole BD 5-7 days
Avoid sexual intercourse for one week following receiving treatment
77
LICHEN SCLEROSIS
What is it?
Chronic inflammatory dermatosis that affects the skin of anogenital region in women or glans penis and foreskin in men
78
LICHEN SCLEROSIS
Cause?
Auto-immune induced disease in genetically predisposed patients
79
LICHEN SCLEROSIS
Epidemiology?
1 in 1000 women
(pre-pubertal and post-menopausal)
1 in 100,000 men
(boys aged 9-11 years)
80
LICHEN SCLEROSIS
Common sign?
- White thickened patches which may have, ecchymosis, hyperkeratosis or bullae
81
LICHEN SCLEROSIS
Female clinical presentation?
- Itch worse at night
- pain
- perianal lesions
- white lesions around vulva
- shrinking of labia, clitoral adhesions
82
LICHEN SCLEROSIS
Male clinical presentation?
- Soreness, haemorrhagic blisters
- Dyspareuria
- Painful erections
due to phimosis
- Poor stream/dysuria
83
LICHEN SCLEROSIS
Ddx?
- Child sex abuse
- Vitiligo
- Lichen planus
- Scleroderma
84
LICHEN SCLEROSIS
Diagnostic tests?
- Clinical
| - Biopsy if suspected malignancy
85
LICHEN SCLEROSIS
Treatment?
Topical steroids
e.g Clobetasol propionate
