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MFSRH Part II 2022 > GUM > Flashcards

GUM Flashcards

1
Q

Which serovars are implicated in causing LGV?

A

Serovars L1 - L3

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2
Q

What is the incubation period for primary lesion of LGV? What are the signs to look for?

A

3-30 day incubation period
painless papule, pustule or ulcer
proctitis

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3
Q

When would a secondary symptoms appear in LGV and what are the signs?

A 
10-30 days after the primary lesion
Tender lymphadenopathy
Bubo formation - may ulcerate or cause fistula
Groove sign
Systemic symptoms
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4
Q

What is the first line treatment for LGV?

A

Doxycycline 100mg BD 21/7

Tetracycline 2g OD 21/7

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5
Q

What are the most common manifestations of neonatal chlamydia and when would they appear in the post natal period?

A

Conjunctivitis - 5 - 12 / 7 PN

Pneumonia 1-3/12 PN

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6
Q

What is the treatment for neonatal chlamydial infection?

A

erythromycin 50mg/kg/day - divided QDS 14/7

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7
Q

What proportion of GC positive cases will also be positive for CT?

A

1/3

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8
Q

Incubation period for GC

A

2-5/7

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9
Q

What is the look back for PN with LGV?

A

4/52 from symptoms

6/12 if asymptomatic

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10
Q

What proportion of GC positive patients are asymptomatic?

A

Women 50%

Men 5-10%

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11
Q

What are the clinical manifestations of neonatal gonorrhea infection?

A

Ophthalmia neonatorum
Pharyngitis
Pneumonia
Occurs 2-7 days following birth

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12
Q

What proportion of female infants born to women infected with TV will become infected?

A

5%

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13
Q

What is the PN lookback for TV?

A

4/52

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14
Q

What are the potential complications of TV infection?

A

Pregnancy related - preterm delivery, LBW, intra/postpartum sepsis
Increase risk of HIV acquisition

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15
Q

When treating BV, what are the alternative treatment regimes to PO metronidazole?

A

0.75% metronidazole gel 5g OD PV 5/7

2% clindamycin gel 5g OD PV 7/7

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16
Q

What percentage of M Gen infections are macrolide resistant?

A

40-70%

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17
Q

What type of antibiotic is moxyfloxacin?

A

4th gen Fluoroquinolone

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18
Q

What are the predisposing factors for candida infection?

A 
Diabetes
Hormonal - luteal phase, pregnancy, CHC, HRT
Immunodeficiency - HIV, steroid use
Mannose binding lectin deficiency
Antibioitic use
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19
Q

How would you treat recurrent VVC where candida culture indicates fluconazole resistance?

A

Nystatin 100,000IU PV pessaries 14/7 ON

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20
Q

When giving longer courses of PO fluconazole, in whom should caution be taken?

A

Moderate CYP450 inhibitor
Caution in:
- co-administration with other medications metabolized by the liver
- hepatic impairment
- co-administration with medications that can cause prolonged QT - TCAs, antipsychotics, SSRIs, SSNRIs, erythromycin)
- renal impairment (eGFR < 50) - use inital loading dose then half subsequent doses

21
Q

How long dose fluconazole inhibit CYP450 for?

A

4-5 days after administration

22
Q

What is the incubation period of HSV?

A

2-14 days

23
Q

What are the 3 subgroups of neonatal herpes infections?

A
  • Localised disease - skin, eye and/or mouth (SEM) 30% of infections
  • Local CNS infection - encephalitis only
  • Disseminated infection
24
Q

What are the features of neonatal HSV SEM infection?

A

Appears 10-12/7 PN
Not systemically unwell
Non-purulent conjunctivitis
Herpetic vesicles to skin/mucous membranes

25
Q

What are the features of disseminated/CNS neonatal HSV infection?

A

70% of cases
Appears 10 days to 4 weeks PN
Jaundice, GI bleeding, irritability, resp distress, feeding issues, seizures
Mortality with antiviral treatment 6-17 %
Neurological mobidity common
Encephalitis alone presents later - 3-6/52 old

26
Q

What is the risk of neonatal HSV infection in recurrent maternal infection with active genital lesions having vaginal delivery?

A

3%

27
Q

In a pregnant patient living with HIV with history of genital HSV when would you commence aciclovir prophylactically?

A

32/40 (vs 36/40 in HIV - patients)

28
Q

What type of virus is the hep B virus?

A

DNA ds

29
Q

What is the incubation period for hep B?

A

40 - 160 dys

avg 60 - 90 days

30
Q

What is the most common route of transmission of Hep B in the UK?

A

Sexual

31
Q

What are the symptoms of prodrome in hep B?

A

Most are asymptomatic
First 1 - 3 weeks
anorexia, nausea and severe malaise

32
Q

When is a patient with acute hep B infectious?

A

2 weeks prior to onset of jaundice and 1 week after (until patient becomes surface antigen negative)

33
Q

Up to how long after exposure to hep B will a vaccination confer some protection (theoretically)?

A

Up to 6 weeks

34
Q

How would you manage someone presenting with chronic hep B?

A 
Test for hep A, C and D
Full SHS
Vaccinate against hep A
Avoid alcohol
Use condoms
Test partners - vaccinate new partners
Refer to hepatology
35
Q

What is the risk of transmission of hep B to the fetus in a pregnant woman who is infected and goes untreated?

A

If HBsAg positive only - 10%
If HBeAG also positive - 90%
Most infections occur at delivery

36
Q

What are the risks of Hep B in pregnancy?

A

Miscarriage, low brith weight, pre term delivery

37
Q

What is the vaccination schedule for a neonate born to hep B pos mother?

A

Vaccination within 24h
If mother HBsAg+ and HBeAg- - vaccination only
If mother HBeAG + - vaccination and HBIG

38
Q

What advice should be given to a Hep B positive mother regarding breastfeeding?

A

Safe once baby is immunised

39
Q

What type of virus is hep A?

A

RNA picorna virus

40
Q

What is the incubation period of hep A?

A

15-40 days

Avg 28 days

41
Q

What is the risk of HIV transmission with condomless anal sex?

A

1:90 overall
with ejaculation 1:65
without ejaculation 1:170

42
Q

What is the risk of HIV transmission of insertive anal sex?

A

Overall 1:666
uncircumcised 1:161
circumcised 1:909

43
Q

What is the risk of HIV transmission with receptive vaginal intercourse?

A

1:1000

44
Q

What is the risk of HIV transmision from a needlestick injury?

A

1:333

45
Q

Risk of HIV transmission from sharing injecting equipment?

A

1:149

46
Q

How do you calculate risk of transmission of HIV?

A

Risk of transmission = risk that the source is HIV positive with a detectable viral load x risk per type of exposure

47
Q

In a patient who has been fully vaccinated for Hep B without any natural immunity, which serology tests would be positive?
A. HBsAg
B. antiHBc
C. anti-HBs

A

C - anti-HBs (hep B surface antibodies)

48
Q 
In an acute Hep B infection, which serology tests would be positive?
A. HBsAg (surface antigen)
B. antiHBc (core antibodies)
C. IgG anti-HBc (IgM core antibodies)
D. IgM anti-HBc (IgG core antibodies)
E. anti-HBs (surface antibodies)
A

A HBsAg
B antiHBc
D IgM anti-HBc

MFSRH Part II 2022 (8 decks)

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