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Danny's Phase 3A Medicine > GU Medicine > Flashcards

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)
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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%)
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3
Q

FEMALE INFERTILITY

List some disorders of ovulation

A
  • PCOS
  • Ovarian insufficiency
  • Pituitary tumours
  • Hyperprolactinaemia (prolactin inhibits GnRH)
  • Turner syndrome
  • Premature menopause
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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)
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5
Q

FEMALE INFERTILITY

Risk factors?

A
  • Smoking
  • Low/high BMIs
  • High alcohol intake
  • Drug use
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6
Q

FEMALE INFERTILITY

Diagnostic tests?

A

TVS- rule out adnexal masses

Chlamydia screens (PID)

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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

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8
Q

FEMALE INFERTILITY

Assessment of tubal patency?

A

CT, US

Laparoscopy and dye test (GOLD STANDARD)

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9
Q

FEMALE INFERTILITY

Treatment?

A

Lifestyle factors

  • Increase sex
  • Weight loss
  • Reduce alcohol, smoking, caffeine
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10
Q

FEMALE INFERTILITY

Treatment of Anovulation?

A
  • Clomifene
  • GnRH
  • Gonadotrophins
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11
Q

FEMALE INFERTILITY

Treatment of Tubal disease?

A

Salpinostomy

Adhesiolysis

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12
Q

MALE INFERTILITY

Causes of Azospermia?

A

Klinefelters
Chlamydia
vasectomy

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13
Q

MALE INFERTILITY

Causes of Teratozoospermia?

A

Testicular cancer

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14
Q

MALE INFERTILITY

Diagnostic tests?

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

MALE INFERTILITY

Diagnostic tests?

A
  • Semen analysis (count >15 million, motility >40%)
  • Testicular biopsy (azoospermia)
  • FSH increases in testicular failure
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16
Q

MALE INFERTILITY

treatment?

A
  • Intrauterine insemination (IUI)
  • In-vitro fertilisation (IVF)
  • Intracytoplasmic sperm injection (ICSI)
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17
Q

CONTRACEPTION

What is the COCP?

A
  • Rigevidon/ Microgynon

Immediate protection that inhibits ovulation

Levonorgestrel and Ethinylestradiol

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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

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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

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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

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21
Q

CONTRACEPTION

How do progesterone only pills work and give an example?

A
  • thickens cervical mucous
  • Micronor
  • Noriday
  • Cerazette (Desogestrel)
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22
Q

CONTRACEPTION

What is Depo Provera?

A

Medroxyprogesterone acetate given via IM every 12 weeks.

it inhibits ovulation

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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
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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

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25
Q

CONTRACEPTION

Give examples of emergency contraception

A

Levonorgestrel (progesterone) LEVONELLE - 3 days

Ulipristal acetate (progesterone receptor modulator) ELLAONE - 5 days

IUD (most effective)

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26
Q

CANDIDIASIS

What is it?

A

Yeast infection of the lower female reproductive tract

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27
Q

CANDIDIASIS

Risk factors?

A
  • Pregnancy
  • DM
  • Recent Antibiotic use
  • Oral contraceptives
  • Chemotherapy
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28
Q

CANDIDIASIS

What is the most likely organism?

A

80-92% is Candida albicans that reproduces by budding

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29
Q

CANDIDIASIS

Clinical presentation?

A
  • Pruritis vulvaw
  • Vulval soreness/dryness
  • White cottage cheese discharge
  • Dyspareuria
  • Dysuria
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30
Q

CANDIDIASIS

Ddx?

A
  • STIs
  • Bacterial vaginosis
  • Lichen sclerosis
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31
Q

CANDIDIASIS

Diagnostic tests and results?

A
  • take swabs

- Clinical tests

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32
Q

CANDIDIASIS

Treatment?

A

Soap substitute
Emollient to moisturise vulval skin

ANTIFUNGAL:

Clotrimazole pessary
Fluconizole tablet

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33
Q

CANDIDIASIS

Tx for severe?

A

Two doses of Oral FLuconazole 150mg 3 days apart

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34
Q

CHLAMYDIA

What is it?

A

STI that is the most common preventable cause of infertility

Intracellular gram negative bacteria effecting columnar and transitional epithelium

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35
Q

CHLAMYDIA

Risk factors?

A

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

36
Q

CHLAMYDIA

What is the causing bacteria and how many people are infected per year?

A

131 million new cases worldwide per annum

Chlamydia trachomatis

37
Q

CHLAMYDIA

Clinical presentation?

A

50% men and 75% women are asymptomatic

Female: Discharge, dysuria, post-coital bleeding

Male: Urethritis, dysuria, urethral discharge

38
Q

CHLAMYDIA

Ddx?

A
  • Gonorrhoea
  • Prostatits
  • Trichomonas vaginalis infection
  • UTI
  • Endometriosis
  • Bacterial vaginosis
39
Q

CHLAMYDIA

Diagnostic tests?

A

Sample taken for NAATs

Nucleic Acid Amplification Tests

Women- vulvovaginal swab

Men- First catch urine specimen

40
Q

CHLAMYDIA

treatment?

A
  • Doxycycline
  • Azithromycin
  • Erythromycin 500mg BD for 10-14 days if contraindicated

Contraceptive advice

41
Q

GONORRHOEA

What is the causing bacteria?

A

Neisseria Gonorrhoea

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

42
Q

GONORRHOEA

Risk factors?

A
  • Sexually active age
  • Hx of previous STIs
  • New/multiple sexual partners
  • Anal/oral sex
  • Poor condom use
  • Drug/ sex work
43
Q

GONORRHOEA

Pathophysiology?

A
  • 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
Q

GONORRHOEA

Epidemiology?

A

7% of new STIs in GUM clinics

47% chlamydia

45
Q

GONORRHOEA

Clinical presentation?

A

Men:

  • Discharge
  • Peri-anal pain
  • Pruritis

Women:

  • Green/yellow discharge
  • Lower abdo pain
  • Dysuria
  • Contact bleeding
46
Q

GONORRHOEA

Diagnostic tests and results?

A

Nucleic acid amplification test (NAAT)

Female: Swab

Male: First void urine

47
Q

GONORRHOEA

Ddx?

A
  • Chlamydia
  • Endometriosis
  • Pharyngitis
48
Q

GONORRHOEA

Treatment?

A

Ceftriaxone IM single dose

OR

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)

49
Q

PELVIC INFLAMMATORY DISEASE (PID)

What is it?

A

General term for infection of upper female genital tract (uterus, fallopian, ovaries)

Can lead to ectopic pregnancy, abscess, chronic pelvic pain

50
Q

PELVIC INFLAMMATORY DISEASE (PID)

Cause?

A

Ascending infection from the cervix e.g.

Chlamydia
Gonorrhoea
+- e.coli, Staph,

WORRIED ABOUT GROUP A STREP

51
Q

PELVIC INFLAMMATORY DISEASE (PID)

Risk factors?

A
  • younge age
  • New sexual partner
  • LAck of barrier contraception
  • Lower socio-economic group
  • TOP
  • IUD present
52
Q

PELVIC INFLAMMATORY DISEASE (PID)

Clinical presentation?

A
  • Bilateral lower abdo pain
  • Dyspareuria
  • Abnormal vaginal bleeding
  • Purulent discharge
  • Fever
53
Q

PELVIC INFLAMMATORY DISEASE (PID)

Presentation of Acute Salpingitis/PID?

A
  • Fever/ tachycardia
  • Lower abdo pain
  • Cervicitis
  • Cervical motion tenderness (excitiation
  • Adnexal tenderness
54
Q

PELVIC INFLAMMATORY DISEASE (PID)

Ddx?

A
  • Appendicitis
  • Ectopic pregnancy
  • Other causes of vaginal bleeding
55
Q

PELVIC INFLAMMATORY DISEASE (PID)

Diagnostic tests and results?

A
  • Pregnancy test
  • Cervical swabs
  • Elevated ESR&CRP
  • Endometrial biopsy
  • USS
  • Urinalysis
  • Laparoscopy with direct visualisation of fallopian tubes
56
Q

PELVIC INFLAMMATORY DISEASE (PID)

Treatment?

A

Clinically severe requires hospital admission for IV Abx:

oral ofloxacin + oral metronidazole
OR
intramuscular ceftriaxone + oral doxycycline + oral metronidazole

57
Q

SYPHILLIS

What is it?

A

Contagious systemic disease with an incubation of around 3 weeks.

Transmitted by abraded skin or intact mucous mebranes

58
Q

SYPHILLIS

Causing micro-organism?

A

Treponema Pallidum

59
Q

SYPHILLIS

What is primary and secondary?

A

Primary: Incubation 2-3 weeks
(local infection)

Secondary Incubation 6-12 weeks (generalised infection)

60
Q

SYPHILLIS

What is the biggest risk factor?

A

MSM- 79% of male attendees with syphillis are men who had sex with men

61
Q

SYPHILLIS

clinical presentation of primary?

A

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
Q

SYPHILLIS

Clinical presentation of secondary?

A

6 weeks after primary lesion, multisystem involvement within 2 years of infection

Night headaches, fever, malaise

Rash on palms, soles and face

63
Q

SYPHILLIS

Diagnostic test?

A

Treponemal enzyme immunoassay

IgM for early infection
IgG for latter

64
Q

SYPHILLIS

Treatment?

A

Benzathine Penicillin- 2.4 mega units IM

2nd Line -
Oral azithromycin single dose

65
Q

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

A

BACTERIAL VAGINOSIS

66
Q

BACTERIAL VAGINOSIS

Cause?

A

Overgrowth of predominantly anaerobic organisms in the vagina such as:

Gardnerella Vaginalis
Prevotella spp
Mycoplasma hominis
Mobiluncus spp

67
Q

BACTERIAL VAGINOSIS

What is normally the dominant bacteria in the vagina?

A

Lactobacilli, these are replaced by the the anaerobic organisms

68
Q

BACTERIAL VAGINOSIS

Risk factors?

A 
Sexually active
Afro caribbean
IUCD
Vaginal douching
Receptive oral sex
Smoking
69
Q

BACTERIAL VAGINOSIS

Clinical presentation?

A

Offensive, fishy smelling vaginal discharge without soreness or irritation

70
Q

BACTERIAL VAGINOSIS

Ddx?

A
  • other vaginal infections
  • tumours
  • Post menopausal discharge due to atrophic vaginitis
71
Q

BACTERIAL VAGINOSIS

Treatment?

A

Avoid vaginal douching

Antibiotics-

Metronidazole 400-500mg BD for 5-7 days

Clindamycin and Tinidazole are alternatives

72
Q

TRICHOMONAS VAGINALIS

What is it?

A

Trichomonas Vaginalis is a flagellated protozoan that is the most common curable STI in the world

Can cause:
Vaginitis
Cervicitis
Urethritis

73
Q

TRICHOMONAS VAGINALIS

Female clinical presentation?

A

Women:

  • Frothy green discharge (70%)
  • Strawberry cervix
  • Dysuria
  • Offensive odour
  • pH > 4.5
  • Lower abdo discomfort
74
Q

TRICHOMONAS VAGINALIS

Male clinical presentation?

A

Men are usually asymptomatic

Urethritis

Dysuria and urethral discharge

75
Q

TRICHOMONAS VAGINALIS

Diagnostic tests?

A
  • High vaginal swabs

- NAATs - Nucleic acid amplification test

76
Q

TRICHOMONAS VAGINALIS

Treatment?

A

Treat both partners at same time;

Metronidazole BD 5-7 days

Avoid sexual intercourse for one week following receiving treatment

77
Q

LICHEN SCLEROSIS

What is it?

A

Chronic inflammatory dermatosis that affects the skin of anogenital region in women or glans penis and foreskin in men

78
Q

LICHEN SCLEROSIS

Cause?

A

Auto-immune induced disease in genetically predisposed patients

79
Q

LICHEN SCLEROSIS

Epidemiology?

A

1 in 1000 women
(pre-pubertal and post-menopausal)

1 in 100,000 men
(boys aged 9-11 years)

80
Q

LICHEN SCLEROSIS

Common sign?

A
  • White thickened patches which may have, ecchymosis, hyperkeratosis or bullae
81
Q

LICHEN SCLEROSIS

Female clinical presentation?

A
  • Itch worse at night
  • pain
  • perianal lesions
  • white lesions around vulva
  • shrinking of labia, clitoral adhesions
82
Q

LICHEN SCLEROSIS

Male clinical presentation?

A
  • Soreness, haemorrhagic blisters
  • Dyspareuria
  • Painful erections
    due to phimosis
  • Poor stream/dysuria
83
Q

LICHEN SCLEROSIS

Ddx?

A
  • Child sex abuse
  • Vitiligo
  • Lichen planus
  • Scleroderma
84
Q

LICHEN SCLEROSIS

Diagnostic tests?

A
  • Clinical

- Biopsy if suspected malignancy

85
Q

LICHEN SCLEROSIS

Treatment?

A

Topical steroids

e.g Clobetasol propionate

Danny's Phase 3A Medicine (10 decks)

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