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GUM Flashcards

1
Q

Herpes causative organisms

A

Oral: HSV1
Genital: HSV2

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2
Q

Herpes attack management

A

PO acyclovir
Avoid sex until lesions are gone
Return if symptoms persist for 10 days

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3
Q

Herpes management during pregnancy

A

PO acyclovir for attacks > 28 weeks
Elective C section

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4
Q

Herpes investigations

A

Best: NAAT

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5
Q

Prodromal phase of herpes

A

Tingling and itching

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6
Q

Thrush causative organisms

A

Candida albicans

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7
Q

Medications which increase risk of thrush

A

COCP
Antibiotics
SGLT-2 inhibitors

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8
Q

1st line management for thrush

A

Oral fluconazole

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9
Q

3 medical conditions which increase risk of candida albicans infection

A

Diabetes
Immunosuppression
Pregnancy

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10
Q

Number of episodes to meet recurrent vaginal candidiasis diagnosis

A

4 or more episodes in 1 year

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11
Q

Management of recurrent vaginal candidiasis

A

Induction-maintenance regime

Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months

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12
Q

Thrush in pregnancy

A

Oral fluconazole contraindicated

Cream
Intravaginal pessary

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13
Q

Thrush investigations

A

Usually a clinical diagnosis
High vaginal swab

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14
Q

Lichen sclerosis treatment

A

Topical dermovate
Emollients

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15
Q

Lichen planus appearance

A

Purple, pruritic, polygonal papules

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16
Q

BV discharge appearance + classical timing

A

Grey, thin fishy discharge
After sex

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17
Q

Causative organisms of BV

A

Gardenerella vaginosis
Mycoplasma hominis
Prevotella species

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18
Q

BV treatment

A

PO metronidazole 5-7 days
Alternative topical metronidazole/clindamycin

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19
Q

BV investigations

A

Wet microscopy
Whiff test

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20
Q

Amstel criteria

A

Clue cells
Whiff test +ve
Discharge
pH > 4.5

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21
Q

What are clue cells?

A

Vaginal squamous epithelial cells coated with Gardenerella vaginosis

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22
Q

BV pathophysiology

A

Loss of lactobacilli due to overgrowth of anerobic bacteria

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23
Q

BV risk in pregnancy

A

Preterm birth

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24
Q

BV protective factors

A

COCP
Condom use

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25
Q

BV risk factors

A

Excessive vaginal cleaning
Intercourse
Recent Abx
Copper IUD
Smoking

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26
Q

Trichomoniasis causative organism

A

Trichomonas vaginalis
Flagellated protozoan

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27
Q

BV discharge appearance

A

Grey, fishy discharge

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28
Q

Trichomoniasis wet microscopy

A

Charcoal swab
Motile trophozoites

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29
Q

Trichomoniasis cervix appearance

A

Strawberry cervix
Erythematous, punctate, and papilliform appearance

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30
Q

Trichomoniasis pregnancy risk

A

Preterm birth, LBW, vertical transmission

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31
Q

Chlamydia investigations for diagnosis

A

NAAT
F: vulvovaginal swab
M: 1st catch urine

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32
Q

Chlamydia antibiotics

A

Doxycycline 7 days
Azithromycin 3 days

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33
Q

Polymorphonuclear leukocytes associations

A

Gonorrhoea

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34
Q

Cause of purulent discharge

A

Usually STIs like chlamydia and gonorrhoea

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35
Q

Gonorrhoea antibiotics + other management

A

1st: IM ceftriaxone
2nd: Oral cefixime + azithromycin
Abstain from sex until 7 days after completing treatment
Follow up 1 week after for test of cure
Contact tracing

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36
Q

Most common cause of septic arthritis in adults

A

Gonorrhoea

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37
Q

Features of disseminated gonococcal infection

A

Tenosynovitis
Migratory polyarthritis
Dermatitis

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38
Q

Manifestations of gonorrhoea in neonates

A

Ophthalmia neonatorum
Sepsis: arthritis and meningitis

Less severe manifestations rhinitis, vaginitis, urethritis, and scalp infection at sites of previous fetal monitoring

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39
Q

Gonorrhoea microscopy findings

A

Gram -ve diplococci with polymorphonuclear leukocytes

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40
Q

Syphilis aetiology

A

Spirochaete bacteria:
Treponema pallidum

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41
Q

Syphilis: non-treponemal tests

A

Cardiolipin based tests
Can result in false +ves
-ve after treatment

RPR & VDRL

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42
Q

Syphilis: treponemal-specific tests

A

Reactive or non-reactive
Detects IgG and remains after treatment - immunity

TP-EIA, TPHA

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43
Q

Syphilis antibiotic + other management

A

IM benzylpenicllin
Contact tracing

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44
Q

Primary syphilis features

A

Chancre – painless ulcer
Local non-tender lymphadenopathy
Often not seen in women (lesion may be on cervix)

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45
Q

Secondary syphilis features

A

Fever, lymphadenopathy
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers (30%)
Condylomata lata (pink or grey discs)

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46
Q

Tertiary syphilis features

A

Gummas
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil

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47
Q

Congenital syphilis features

A

Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
Rhagades
Keratitis, saber shins, saddle nose, deafness

48
Q

Jarisch-Herzheimer reaction presentation + aetiology

A

Acute febrile reaction associated with treatment of syphilis
Sudden release of toxins from killed bacteria

49
Q

Jarisch-Herzheimer reaction management

A

Resolves with 24h
Reassurance + paracetamol

50
Q

+ve EIA, -ve RPR and -ve TPPA

A

False positive result

51
Q

TP-EIA

A

T. pallidum enzyme immunoassay

52
Q

TPHA

A

T. pallidum Haem Agglutination test

53
Q

Condylomata accuminata

A

Genital warts

54
Q

Genital warts causative organism

A

HPV 6 and 11

55
Q

Genital warts diagnosis

A

Clinical

56
Q

Genital warts management

A

Conservative if pt unbothered by appearance

Otherwise:
1st: topical podophyllum or cryotherapy (better for solitary/ keratinised)
2nd: Imiquimod

57
Q

Genital warts method of transmission

A

Skin to skin contact

58
Q

Lymphogranuloma venereum aetiology + presentation

A

Chlamydia strain L1, L2 or L3
Painless penile ulcer, can be tender

59
Q

Lymphogranuloma venereum management

A

Doxycycline

60
Q

Groove sign

A

Seen in lymphogranuloma venereum
Painful inguinal buboes

61
Q

Pearly penile papules appearance

A

Uniform, smooth lesions present around coronal margin of glans

62
Q

Circinate balanitis

A

Ring-shaped dermatitis associated with reactive arthritis

63
Q

Haemophilus ducreyi appearance

A

Chancroid
Multiple and painful

64
Q

Chancroid antibiotic treatment

A

Azithromycin
Or
Ceftriaxone
Or
Ciprofloxacin

65
Q

Chancroid travel associations

A

Greenland
Tropical areas

66
Q

HIV in pregnancy: treatment

A

Zidovudine orally if viral load < 50 copies/ml
Otherwise triple ART
4-6 weeks

Zidovudine also given before C-section

67
Q

HIV in pregnancy: mode of delivery

A

C-section

Unless viral load < 50 copies/ml at 36 weeks

68
Q

Diagnosing HIV

A

Presence of HIV antibody and HIV p24 antigen

Repeated to confirm diagnosis

69
Q

When do HIV antibodies develop?

A

Usually 4-6 weeks after infection

70
Q

How are HIV antibodies tested for?

A

ELISA test and confirmatory Western Blot Assay

71
Q

When should HIV be tested for in asymptomatic patients?

A

4 weeks after possible exposure

If -ve, offer repeat test at 12 weeks post exposure

72
Q

Presentation of HIV seroconversion

A

Sore throat
Lymphadenopathy
Maculopapular rash

Malaise, myalgia, arthralgia
Diarrhoea
Mouth ulcers
Rarely meningoencephalitis

73
Q

When does HIV seroconversion typically occur?

A

3-12 weeks after infection

74
Q

Antiretroviral therapy options

A

At least 3 drugs used

2 NRTI + PI/NNRTI

75
Q

NRTI examples

A

Nucleoside reverse transcriptase inhibitor

Zidovudine
Abacavir

76
Q

NRTI side effects

A

Peripheral neuropathy

77
Q

Protease inhibitor examples

A

Indinavir
Nelfinavir

78
Q

Indinavir side effect

A

Renal stones

79
Q

Nelfinavir side effect

A

P450 enzyme inhibition
Diabetes

80
Q

NNRTI examples + side effects

A

Non-nucleotide reverse transcriptase inhibitor

Nevirapine
Efavirenz

P450 enzyme inhibition, rashes

81
Q

Pneumocystis pneumonia presentation

A

SOB
Non-productive cough
Fever
Exertional dyspnoea

82
Q

Pneumocystis pneumonia causative organism

A

Pneumocystis jiroveci

83
Q

Pneumocystis pneumonia CXR findings

A

Bilateral bihilar interstitial infiltrates

84
Q

Pneumocystis pneumonia CT findings

A

Cysts and nodules

85
Q

Pneumocystis pneumonia diagnostic investigations

A

Bronchoscopy with bronchoalveolar lavage
Grocott’s silver stain: Mexican hat appearance

86
Q

Pneumocystis pneumonia management

A

Co-trimoxazole
Steroids
IV pentamidine if severe
PCP prophylaxis if CD4 < 200

87
Q

HIV: oesophageal candiasis symptoms

A

Dysphagia
Odynophagia

88
Q

HIV: oesophageal candidiasis management

A

Fluconazole
Itraconazole

89
Q

HIV: diarrhoea causative organisms

A

Cryptosporidium + other protozoa
CMV
Giardia
Mycobacterium avium intracellulare

90
Q

HIV opportunistic infections: CD4 count < 50

A

CMV retinitis
Mycobacterium avium-intracellulare

91
Q

HIV opportunistic infections: CD4 count 50 - 100

A

Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma

92
Q

HIV opportunistic infections: CD4 count 100 - 200

A

Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
PCP
HIV dementia

93
Q

HIV opportunistic infections: CD4 count 200 - 500

A

Oral thrush – candida albicans
Shingles – herpes zoster
Kaposi sarcoma – HHV-8
Hair leukoplakia – EBV

94
Q

HIV: CMV retinitis features

A

Most common ocular opportunistic infection

Reduced visual acuity
Pizza pie appearance on fundoscopy

95
Q

CMV retinitis treatment

A

Intraocular injections ganciclovir
Systemic oral valganciclovir

96
Q

HSV ocular infection features + management

A

Anterior or posterior segment of the eye
Permanent blindness if central area of cornea affected

Topical acyclovir

97
Q

HIV: neurological lesions

A

Toxoplasmosis 50%
Primary CNS lymphoma 30%
TB less common

98
Q

HIV: toxoplasmosis presentation

A

Headache
Confusion
Drowsiness

99
Q

HIV: toxoplasmosis CT findings

A

Multiple ring enhancing lesions

100
Q

HIV: toxoplasmosis management

A

Sulfadiazine + Pyrimethamine

101
Q

HIV: CNS lymphoma cause

A

EBV

102
Q

HIV: CNS lymphoma CT findings

A

Single homogenous enhancing lesion

103
Q

HIV: CNS lymphoma treatment

A

Steroids
Chemo
Brain irradiation
Surgery

104
Q

HIV: neurological TB CT finding

A

Single enhancing lesion

105
Q

HIV: CT oedematous brain - what does this indicate?

A

Encephalitis
Caused by CMV or HIV itself

106
Q

HIV: cryptococcus meningitis investigations + results

A

CSF: high opening pressure, India ink test +ve
CT: meningeal enhancement, cerebral oedema

107
Q

HIV: cryptococcus treatment

A

Induction
IV Amphotericin B + Oral flucytosine
Or
Fluconazole + Oral flucytosine

Maintenance
Fluconazole

108
Q

HIV: pathophysiology of progressive multifocal leukoencephalopathy

A

Oligodendrocytes infected by JCV virus

109
Q

HIV: progressive multifocal leukoencephalopathy findings

A

Widespread demyelination

110
Q

AIDS dementia complex presentation

A

Behavioural changes + motor impairment

111
Q

Management of hypoactive sexual desire disorder

A

CBT (psychodynamic, cognitive, integrative, behavioural)

M: Testosterone replacement
F: Flibanserin if premenopausal

112
Q

Erectile dysfunction management

A

1st: sildenafil (phosphodiesterase inhibitor)
2nd: alprostadil injection

Non medical: vacuum device, kegel exercises, psychotherapy

113
Q

Female sexual arousal disorder

A

Failure of genital response
Reduced physical response to sex stimuli and reduced sexual pleasure

114
Q

Management of rapid ejaculation

A

1st: SSRIs (dapexetine)
STUD 100 spray (topical anaesthetic)
Psychosexual therapy

Behavioural (stop start technique, kegel exercises)

115
Q

Management of female orgasmic disorder

A

Topical oestrogens
Behavioural interventions: Guided masturbation, vibrators

Medicine (13 decks)

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