GUM Flashcards
When is fertility thought to return after giving birth?
21 days after giving birth
How long does lactational amenorrhea normally last?
6 months after birth if fully breast feeding
Can you use the POP after giving birth?
Yes, considered safe for breast feeding and can be started at any time
Can you have the implant after giving birth?
Yes, considered safe for breast feeding and can be started at any time
Can you use the combined oral contraceptive pill after giving birth?
NOT considered safe for breast-feeding
Avoid for 6 weeks post partum
Can you have a copper coil or intrauterine device after giving birth?
Yes, if inserted within 48 hours of birth OR after more than 4 weeks since birth
Give 9 UKMEC4 contraindications for the combined oral contraceptive pill:
- Uncontrolled HTN
- migraine with aura
- aged >35 and smoking more than 15 cigs a day
- Hx of VTE
- vascular disease or stroke
- majory surgery with prolonged immobility
- liver cirrhosis or liver tumours
- SLE and antiphospholipid syndrome
- IHD, cardiomyopathy, AF
What contraception should be avoided in women at an increased risk of breast cancer?
Any hormonal contraception, go for the copper coil or barrier
What contraception should be avoided in women at an increased risk of cervical or endometrial cancer?
Intrauterine systems
Two types of COCP:
Monophasic - same amount of hormone in each pill
Mutliphasic - varying amounts to mimic normal cycle changes more closely
When should you start the COCP? How quickly are you protected from conception?
On the first day of the cycle (first day of bleeding).
Protection starts straight away, no additional contraception is needed if the COCP is started up to day 5 of the cycle.
If you start you COCP after day 5 of your cycle, how long until you are protect from conception?
7 days
If you miss one COCP and it has been less than 72 hours since you took the last one, what should happen now? Are you protected from conception?
Take the missed pill as soon as possible, even if this means taking two pills in one day.
No extra protection is needed as long as you’re not in the first 7 days of your pill packet.
What happens if more than one COCP is missed (i.e. it has been more than 72 hours since your last pill)?
Take the pill asap.
Use additional contraception for 7 days.
If in days 1 to 7 of the pill packet seek emergency contraception if you’ve had unprotected sex.
During days 15 to 21 of her cycle, a woman misses more than one COC pill, what should she do?
Take the missed pill asap.
Use additional contraception for 7 days.
No need for emergency contraception BUT go back-to-back with next pill pack and skip the pill free period
Two types of POP:
- Traditional: 3 hour delay window
2. Desogestrel: 12 hour delay window
4 mechanisms of action of desogestrel POP:
- inhibits ovulation
- thickens cervical mucus
- alters the endometrium
- reduces ciliary action in the fallopian tubes
How quickly does the POP protect from conception when starting it for the first time?
Starting on days 1 to 5 provides immediate protection. Starting at any other time requires additional contraception for 48hours.
How frequently is the progesterone injection given?
every 12 to 13 weeks
Side effects of the depot injection:
- reduced bone mineral density
2. small increase in risk of breast and cervical cancer
Which contraceptive method might reduce the severity of sick cell crises in patients with sickle cell anaemia?
depot injection
How long does the copper coil last for?
5 to 10 years
How long does the mirena coil last for?
5 years for contraception, 4 years for HRT
3 options for emergency contraception:
- Levonorgestrel within 72 hours
- Ulipristal within 120 hours
- Copper coil within 5 days
Which emergency contraceptive is most effective? Why?
Copper coil: not affected by BMI, enzyme-inducing drugs, or malabsorption
What type of bacteria is chlamydia trachomatis?
Small obligate gram negative bacteria
What type of cells does CT infect?
Human columnar and transitional epithelial cells
Symptoms of CT infection in women: (6)
Often asymptomatic!
- Change in vaginal discharge
- Dysuria
- Vague lower abdo pain
- Fever
- Intermenstrual or postcoital bleeding
- Deep dyspareunia
Symptoms of CT in men: (4)
- Urethritis with dysuria
- Urethral discharge
- Epididymo-orchitis presenting as unilateral testicular pain +/- swelling
- Fever
5 signs of CT infection in women on examination:
- Inflamed “cobblestone” cervix
- Mucopurulent endocervical discharge
- Abdo tenderness
- Pelvic adnexal tenderness on bimanual palpation
- Cervical excitation
3 signs of CT infection in men on examination:
- Epididymal tenderness
- Mucoid or purulent discharge
- Perineal fullness due to prostatis
Investigating CT in women:
Vulvovaginal or endocervical swab
First catch urine is a less sensitive alternative
Investigating CT in men:
First catch urine
Tx for CT infection:
Doxycycline 100mg BD for 7 days
OR
Single dose 1g azithromycin
How do you treat CT infection in a pregnant or breastfeeding woman?
Single dose of 1g azithromycin
How does HPV infection present? (5)
- Painless lesion(s)
- Lesion(s) might be itchy
- Lesion(s) might bleed
- Dyspareunia
- Confluent mass of lesions in immunocompromised individuals
Which strains of HPV cause warts?
6 and 11
How do you treat HPV warts?
1/3rd regress spontaneously within 6 months
Topical symptom relief:
- Podophyllotoxin
- Imiquimod
- Trichloroacetic acid
What type of bacteria is neisseria gonorrhoea (NG)?
Gram negative diplococcus
What type of cells does NG infect?
Mucuous membranes of the urethra, endocervic, rectum pharynx and conjunctiva
How does NG infection present in women? (3)
Often asymptomatic!
- Change in discharge
- Lower abdo pain
- Dysuria without frequency
How does NG infection present in men? (3)
- Urethral discharge
- Dysuria
- Anal discharge, pain, pruritus or bleeding
Signs of NG infection in women on examination: (3)
A normal examination is VERY common!
- Mucupurulent endocervical discharge
- Easily induced contact bleeding of endocervix
- Pelvic/lower abdo tenderness
Signs of NG infection in men on examination: (2)
- Mucopurulent urethral discharge
2. Epididymal tenderness/swelling or blantitis (rare)
Investigations for NG infection in men and women:
Swab for NAAT and culture from urethral, endocervix or first catch urine
Tx for NG infection:
500mg ceftriazone IM stat
OR
Azithromycin 1g orally stat
Test in two weeks time to ensure cure
What is trichomoniasis?
A flagellated protozan organism
Symptoms of trichomoniasis infection in women: (6)
- Frothy yellow discharge
- ‘Strawberry cervix’
- Vulval itching
- Dysuria
- Offensive odour
- Sign of local inflammation
Symptoms of trichomoniasis infection in men: (2)
Usually asymptomatic!
- Dysuria
- Urethral discharge
Tx of trichomoniasis:
Oral metronidazole 2g single dose
Avoid sex for one week!
Which types of HSV cause oral and genital herpes warts? Which is more common?
HSV-1 and HSV-2 both cause oral and anogenital infections
HSV-1 is more common in the UK
Symptoms of a primary HSV infection: (6)
May be asymptomatic!
- febrile flu-like prodrome
- tingling neuropathic pain in genital area
- local oedema
- tender lymph nodes
- bilateral lesions
- painful crops of blisters/ulcers in genital area
Symptoms of recurrent HSV: (3)
- Unilateral lesions
- Shorter episodes (up to 10 days)
- Mild/self-limiting symptoms
Viral shedding becomes less frequent over time, but you can still transmit the virus for more than ten years after original infection
Investigations for HSV:
- viral culture
2. DNA PCR of swab from base of an ulcer
How do you treat HSV?
Antivirals: 400mg acicylovir TID
supportive: painkillers, saline bath, topical lidocaine 5% gel
5 categories of symptom included in the NICE traffic light system for identifying risk of serious illness in children under 5:
- Colour (skin, lips, tongue)
- Activity
- Respiratory
- Circulation and hydration
- Other
NICE red traffic light signs: colour (1) activity (2) resp (3) circulation (1) other (7)
- Colour:
- pale/mottled/ashen/blue - Activity:
- doesn’t wake on stimulation
- continuous/weak/high pitched cry - Resp:
- grunting
- tachyp >60
- moderate/severe chest indrawing - Circulation and hydration:
- reduced skin turgor - Other:
- Age <3 months
- Temp >38
- Non-blanching rash
- Neck stiffness
- Status epilepticus
- Focal neuro signs
- Focal seizures
Symptoms under the “other” criteria of the NICE red traffic light category: (7)
- Age <3 months
- Temp >38
- Non-blanching rash
- Neck stiffness
- Status epilepticus
- Focal neuro signs
- Focal seizures
NICE amber traffic light signs: colour (1) activity (2) resp (4) circulation (5) other (5)
- Colour: pallor reported by parent
- Activity:
- decreased
- wakes only on prolonged stimulation - Respiratory:
- nasal flaring
- tachyponea
- sats <95 in air
- crackles - Circulation:
- tachycardia
- CRT>3 seconds
- dry mucous membranes
- poor feeding
- reduced urine output - Other:
- age 3-6 months
- Fever>5 days
- rigors
- swelling of limb or joint
- non-weight bearing limb/not using an extremity
NICE green traffic light signs:
Normal colour, activity, respiratory function, circulation and hydration.
NONE of the amber or red signs/symptoms
What is the feverPAIN score used for?
To assess severity of infection. Higher score indicates higher likelihood of bacterial (strep) infection.
What does a FeverPain score of 4-5 indicate?
Thought to be associated with a 62 to 65% likelihood to isolating streptococcus
FeverPAIN criteria:
Fever during the past 24 hours (1) Purulence (pus on tonsils) (1) Attend clinic rapidly (within 3 days of onset) (1) severely Inflamed tonsils (1) No cough or coryza (1)
What are the Fraser guidelines? (4)
Guidelines that state a doctor should proceed to give contraceptive advice/treatment to an under 16 girl if they are statisfied that:
- she will UNDERSTAND the advice
- she will likely have SEX regardless
- she will likely SUFFER without the advice/treatment
- it is in her BEST INTEREST to continue without parental consent
How is Gillick competency assessed? (4)
The child must display an:
- UNDERSTANDING of relevant info
- Ability to HOLD info in their mind for long enough
- Ability to WEIGH UP the info to make the decision
- Ability to COMMUNICATE their decision
Sexual activity is a criminal offence and should always result in a child protection referral if the child is under what age?
13
Biological risks of teenage pregnancy: (6)
Increased risk of:
- anaemia
- preterm labour
- UTI
- pre-eclampsia
- preterm birth
- low birth weight
Risk factors for acquiring TB: (5)
- Time spent with someone who has TB
- Travel to or residence in high risk countries (Latin America, the Carribean, Africa, Asia, Eastern Europe, Russia)
- High risk occupation e.g. correctional facilities, nursing homes, hospital
- Immunocompromised
- Smoking
9 symptoms of TB:
- Persistent cough for more than 2-3 weeks - starts dry, becomes productive
- SOB
- Haemoptysis
- Weight loss
- Fever
- Night sweats
- Anorexia
- Malaise
- Clubbing
Tx of active TB without CNS involvement:
RIPE for two months: - Rifampicin - Isoniazid - Pyrazinamide - Ethambutol Then just isoniazid and rifampicin for another 4 months
Tx of active TB with CNS involvement:
RIPE for two months: - Rifampicin - Isoniazid - Pyrazinamide - Ethambutol Then just isoniazid and rifampicin for another 10 months
How do you diagnose latent TB?
Mantoux test
2 important side effects to look out for with TB treatment:
- Liver dysfunction: itching, jaundice, vomiting
2. Contraceptive failure with rifampicin! Use condoms
UKMEC 4 criteria for the COCP
- > 35 years old and smoking >15 /day
- Personal hx of VTE or DVT
- Personal hx of stroke or IHD
- Migraine with aura
- Uncontrolled HTN
- Breast cancer
- Recent major surgery with immobilisation
- Breast feeding and <6 weeks post partum
UKMEC risk categories: 1 2 3 4
1 = no restriction in use 2 = benefits > risks 3 = risks > benefits 4 = unacceptable risk
