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Prep for Phase 3A > GU Medicine Gynae > Flashcards

GU Medicine Gynae Flashcards

1
Q

Bacterial vaginosis?

A

Overgrowth of bacteria in vagina, specifically anaerobic bacteria

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2
Q

Bacteria vaginosis STI?

A

No, caused by loss of lactobacilli

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3
Q

Function of lactobacilli

A

Produce lactic acid to keep vaginal pH under 4.5

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4
Q

Bacteria causing Bacterial Vaginosis

A

Gardnerella vaginalis, Mycoplasma hominis, Prevotella species

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5
Q

Bacteria vaginosis risk factors

A

Multiple sexual partners, excessive vaginal cleaning, recent antibiotics, smoking, copper coil

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6
Q

Bacterial vaginosis presentation

A

half are asymptomatic,

Rest have standard fishy smelling watery grey vaginal discharge

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7
Q

Investigations Bacterial Vagionsis

A

Speculum examination (confirm discharge)

Vaginal swab and pH paper (>4.5)

Charcoal vaginal swab microscopy (clue-cells)

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8
Q

Bacterial vaginosis management

A

Metronidazole (orally/vaginal gel)

Provide information to prevent i.e. avoid vaginal cleaning with soaps that disrupt flora

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9
Q

Metronidazole contraindication with alcohol

A

causes disulfiram reaction i.e. nausea, vomiting, flushing, shock, angioedema

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10
Q

Complications of bacterial vaginosis

A

Increased risk of catching STIs

Miscarriage, Preterm delivery. PROM. chorioamnioitis, low birth weight, postpartum endometritits

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11
Q

Candidiasis?

A

Vaginal infection with candida yeast family

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12
Q

Most common cause of candidiasis

A

Candida albicans

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13
Q

Risk factors candidiasis

A

Increased oestrogen, poorly controlled diabetes, immunosuppression, broad spectrum antibiotics

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14
Q

Candidiasis presentation

A

Thick, odourless, white cheese curd discharge

Vaginal itching, irritation,discomfort

Dyspareunia

Dysuria

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15
Q

Candidiasis investigation

A

Speculum examination (confirm discharge)

Vaginal swab and pH paper (pH <4.5)

Charcoal swab with microscopy

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16
Q

Management of candidiasis

A

Antifungal i.e. clotrimazole cream/pessary or fluconazole tablets

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17
Q

Bacteria causing Chalmydia

A

Chlamydia trachomatis (gram-negative bacteria)

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18
Q

Epidemiology of chlamydia

A

Most common STI in UK, significant cause of infertility

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19
Q

Investigations for Chlamydia

A

Examination (pelvic tenderness, cervical excitation, discharge)

Charcoal swabs (microscopy, culture, sensitivities)

NAAT

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20
Q

Presentation of Chlamydia

A 
Vaginal discharge, clear
Pelvic pain
Abnormal vaginal bleeding (intermenstrual/postcoital)
Dyspareunia
Dysuria
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21
Q

Chlamydia management

A

Doxycycline 100mg twice daily, 7 days (contraindicated in pregnancy and breastfeeding)

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22
Q

Chlamydia complication

A

PID, Chronic pelvic pain, infertility, ectopic pregnancy, epidymo-orchitis, conjunctivitis

preterm, PROM, low birth weight

Lymphogranuloma venereum

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23
Q

Lymphogranuloma venereum ?

A

Condition affecting lymphoid tissue around site of chlamydial infection. Presents with painless ulcer, lymphadenitis, proctitis

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24
Q

chlamydial conjunctivitis presentation?

A

Chronic erythema, irritation, discharge, mostly unilateral

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25
Q

Gonorrhoea cause?

A

Gram-negative diplococcus bacteria i.e. Neisseria Gonorrhoea

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26
Q

Where does gonorrhoea affect?

A

Mucous membranes with columnar epithelium i.e. endocervix,

urethra, rectum, conjunctiva, pharynx

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27
Q

Presentation gonorrhoea (4)

A

Odourless purulent discharge (green/yellow)
Dysuria
Pelvic pain

Males (epididymo-orchitis)

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28
Q

Presentation of gonorrhoea in other sites?

A

Rectal infection -> anal discomfort, discharge
Pharyngeal infection -> sore throat
Prostatitis -> Perineal pain, urinary symptoms, prostate tenderness
Conjunctivitis -> erythema and purulent discharge

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29
Q

Gonorrhoea investigation

A

NAAT

Charcoal endocervical swab

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30
Q

Gonorrhoea management

A

single IM ceftriaxone 1g if sensitivities unknown
single oral ciprofloxacin 500mg in known sensitivity

Followed up with test of cure (RNA and DNA NATT)

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31
Q

Gonorrhoea complications

A

PID, Chronic pelvic pain, Infertility, epidymo-orchitis, Conjunctivitis, Fitz-Hugh Curtis, Septic arthritis, Disseminated Gonococcal infection

32
Q

Mycoplasma Genitalium

A

Bacteria that causes non-gonococcal urethritis

33
Q

Which antibiotic does Mycoplasma Genitalium have resistance issues with?

A

Azithromycin

34
Q

What can Mycoplasma genitalium lead to?

A 
Urethritis
Epididymitis
Cervicitis
Endometritis
PID
RA
Preterm delivery in pregnancy
Tube infertility
35
Q

Mycoplasma genitalium investigation?

A

NAAT via first urine sample men, vaginal swabs women

36
Q

Management Mycoplasma genitalium

A

Doxycycline 100mg, 2x 7days then azithromycin 1g stat then 500mg once daily, 2 days

Then test of cure

37
Q

PID?

A

Inflammation and infection of organs of the pelvis caused by infection spreading up through cervix

38
Q

PID causes?

A

Neisseria gonorrhoea, chlamydia trachomatis, mycoplasma genitalium

non STIs : Gardnerella vaginalis, Haemophilus influenzae, E.coli

39
Q

RF PID?

A

Multiple sexual partners, no contraception, younger age, existing STIs, Previous PID, IUD

40
Q

PID presentation

A

Pelvic pain, Deep dyspareunia, dysuria, fever, abnormal vaginal discharge, abnormal bleeding

41
Q

PID investigations

A

Examination: Pelvic tenderness, Cervical excitation, purulent discharge

STIs: NAAT, HIV test, Syphilis test

High vaginal swab (microscopy pus cells)

Pregnancy test

Inflammatory markers

42
Q

Management PID

A

GUM referral, contact tracing services

IM ceftriaxone 1g (gonorrhoea)
Doxycycline 100mg 2x daily,14 days (chlamydia, mycoplasma genitalium)

43
Q

PID complications

A

Sepsis, abscess, infertility, chronic pelvic pain, ectopic pregnancy, Fitz-Hugh-Curtis syndrome

44
Q

Fitz-Hugh-Curtis?

A

inflammation and infection of liver capsule, leading to adhesions between liver and peritoneum

45
Q

Fitz-Hugh-Curtis presentation?

A

RUQ that can be referred to right shoulder tip

46
Q

Treatment for Fitz-Hugh-Curtis?

A

Laparoscopy to visualise and treat adhesions by adhenolysis

47
Q

Trichomonas?

A

Protozoan parasite with flagella

48
Q

Trichomonas complications? (2)

A

Increases risk of catching HIV, BV, Cervical cancer, PID, Pregnancy-related complications

49
Q

Trichomonas Vaginalis presentation (5)

A 
Vaginal discharge (frothy and green) (fishy smell?)
Itching
Dysuria
Dyspareunia
Balantis
50
Q

Trichomonas vaginalis investigations?

A

Examination: Strawberry cervix

Vaginal PH (>4.5)

Charcoal swab with microscopy

51
Q

Trichomonas vaginalis management

A

GUM referral, contact tracing

Metronidazole

52
Q

Strains of HSV?

A

Two main strains HSV-1, HSV-2

53
Q

Presentation of genital herpes

A

Ulcers/ blistering lesions on genital area
Neuropathic pain (tingling/burning/shooting)
Flu-like symptoms (fatigue and headaches)
Dysuria
Inguinal lymphadenopathy

54
Q

Genital herpes investigations?

A

History for sexual contacts

Viral PCR from lesion

55
Q

Genital herpes management?

A

GUM referral, aciclovir

56
Q

HIV?

A

An RNA retrovirus. HIV-1 most common, HIV-2 rare outside west africa

57
Q

HIV target?

A

CD4-T helper cells

58
Q

HIV transmission

A

Unprotected sexual activity
Vertical transmission
Mucous membrane, blood, open wound exposure

59
Q

AIDS defining illnesses e.g.?

A 
Kaposi's sarcoma
Pneumocystis jirovecii pneumonia
Cytomegalovirus
Candidiasis
Lymphomas
Tuberculosis
60
Q

HIV investigation

A

Antibody testing
Testing p24 antigen
PCR Test

Monitor CD4 count and viral load

61
Q

Management HIV

A

ART

NRTI (tenofovir and emtricitabine)

Prophylactic co-tromoxazole for patients with CD4 under 200/mm3

Statins for Cardiovascular disease

62
Q

HIV management to prevent transmission during birth

A

Normal vaginal deliver - <50 copies/ml

C-section considered if >50 copies/ml and in all with >400 copies/ml

IV zidovudine if viral load unknown or if >10k copies/ml

63
Q

Breast feeding in HIV mothers?

A

not recommended, transmissable

64
Q

Syphilis cause?

A

Treponema palidum

65
Q

Syphilis mode of transmission

A

oral, vaginal, anal sex involving direct contact with infected area
Vertical transmission
IVDU
Blood transfusions and other transplants

66
Q

Stages of Syphilis

A

Primary -> Secondary -> Latent -> Tertiary & Neurosyphilis

67
Q

Primary syphilis presentation

A

Chancre, local lymphadenopathy

68
Q

Secondary syphilis presentation (6)

A 
Maculopapular rash
Condylomata lata
Low-grade fever
Lymphadenopathy
Oral lesions
Aloplecia
69
Q

Tertiary syphilis presentation

A

Gummatous lesions
Aortic aneurysms
Neurosyphilis

70
Q

Gummas?

A

Granulomatous lesions that affect the skin, organs, bones

71
Q

Condylomata lata?

A

Grey wart-like lesions around genitals and anus

72
Q

Neurosyphilis presentation (7)

A 
Headache
Altered behaviour
Dementia
Tabes dorsalis 
Ocular syphilis 
Paralysis
Sensory impairment
73
Q

Argyll-Robertson pupil?

A

Constricted pupil that accommodates but does not react to light

74
Q

Syphilis investigations? (4)

A

Antibody testing for T.pallidum
Microscopy
PCR

Rapid plasma reagin (RPR) and venereal disease research laboratory (VDLR)

75
Q

Syphilis management?

A

GUM referral

Deep IM benzanthine Benzylpenicllin

Prep for Phase 3A (6 decks)

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