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Year 4 - ObGyn > GUM > Flashcards

GUM Flashcards

1
Q

GUM History Taking
- Steps

A

Sexual History Taking
- Steps

  1. Concerns and expectations
  2. Check identity/pronouns
  3. PMC
  4. Drug history
    - chemsex
  5. If uterus
    - Gynae/smear/HPV vaccine
    - Menstrual
    - Contraception
    - Pregnancies
  6. Social Hx
  7. Sexual History
    - Chemsex
  8. BBI risk (blood born)
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2
Q

HPV vaccine
- Valency
- Age
- Years introduced

A

HPV

  • Vaccine
    1. Now quadra-valent
    2. Was bi-valent
  • Age
    3. 12-13
  • Years introduced
    4. 2008 onwards
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3
Q

GUM
- Presenting complaint AFAB

A

GUM AFAB
- Presenting complaint

  1. Vaginal discharge
  2. Lumps/ulcers
  3. IMB/PCB
  4. Dyspareunia (deep/superficial)
  5. Urinary symptoms
  6. Abdo pain
  7. STI contact
    - contraception
  8. Rectal symptoms
  9. Sexual assault
  10. Asymptomatic screens
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4
Q

GUM AMAB
- Presenting complaint

A

GUM AMAB
- Presenting complaint

  1. Urethral discharge
  2. Urinary symptoms
  3. Lumps/ulcers
  4. Testicular pain/swelling
  5. Rectal symptoms
  6. Sexual dysfunction
  7. Asymptomatic screens
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5
Q

GUM
- Sexual history

A

GUM
- Sexual history

  1. STI Hx
  2. Last sex episode
  3. Male/female/trans
  4. Regular or casual contact
  5. Duration of sexual relationship
  6. Sexual activity
    - use of barriers
  7. Type of sex
    - MSM (active/passive)
  8. Partner details/contact tracing
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6
Q

GUM
- BBI risk factors

A

GUM
- BBI risk factors

  1. IVDU
  2. MSM/Anal sex
  3. Swingers
  4. Partners
    - High risk countries
  5. Paid-for sex
  6. Blood products
    - 1985 or abroad
  7. Tattoos/piercings
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7
Q

GUM
- Examination principles

A

GUM
- Examination principles

  1. Explain rationale
  2. Consent
    - offer to stop at any point
  3. Chaperone
    - Document even if declined
  4. Privacy for dressing/undressing
  5. Expose only area needed
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8
Q

GUM
- Male examination

A

GUM
- Male examination

  1. Palpate inguinal region
    - lymphadenopathy
  2. Inspect pubic area and scrotum
  3. Inspect penis
    - retract foreskin (eg thrush)
  4. Palpate scrotum
    - symmetry of size, firmness,
    - swelling/cyst/hydrocele
  5. MSM
    - Peri-anal
    - Proctoscope
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9
Q

GUM AMAB
- Symptomatic investigations

A

GUM
- Symptomatic investigations

  1. Urethral smear
    - GC or NSU (non-specific)
    - GC culture (gonorrhoea)
  2. First pass urine
    - GC/CT dual Naats
  3. Bloods
    - HIV/syphilis
    - Hep B/C
  4. Rectal/pharyngeal swab/culture
    - MSM
    - “Triple site testing”
  5. Other swabs
    - MC&S/Candida/Herpes
  6. Urine dip
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10
Q

GUM AFAB
- Examination

A

GUM AFAB
- Examination

  1. Lithotomy position
  2. Inspect and palpate inguinal region
    - Lymphadenopathy
  3. Inspect pubic area
    - labia majora/minora
    - perianal areas
  4. Speculum exam
  5. Bimanual exam (PID - CMT cervical movement tenderness)
    - Abdominal pain
    - Deep dyspareunia
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11
Q

Speculum examination
- Technique

A

Speculum examination
- Technique

  1. Lubricant and warmed
  2. Insert using dominant hand
  3. Part labia with non-dominant hand
  4. Slowly insert
    - open blades to visualize the cervix
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12
Q

Bimanual examination
- Technique

A

Bimanual examination
- Technique

  1. Gloved right hand
    - separate labia
  2. Index and middle finger
    - insert into vagina and palpate cervix
  3. Left hand
    - palpates uterus and adnexa
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13
Q

GUM
- Symptomatic afab investigations

A

GUM
- Symptomatic afab investigations

  1. TV, BV, Candida
    - High vaginal loop swab for MC & pH
  2. Chlamydia and gonorrhoea
    - Vulvovaginal swab ‘dual NAAT’
    - May offer triple site testing
  3. Bloods
    - HIV/Syphilis
    - Hep B/C
  4. History dependant
    - TV - High vaginal charcoal/PCR
    - Gonorrhoea - endocervical
    - Herpes simplex - PCR
    - Pregnancy test (?PID)
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14
Q

GUM - Asymptomatic screening
- Afab

A

GUM - Asymptomatic screening
- Afab

  1. Self- vulvo-vaginal swab
    - Dual NAAT chlamydia
  2. Serology
    - STS, HIV
  3. Pregnancy test/Urinalysis
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15
Q

Partner notification
- Definition

A

Partner notification
- Definition

  1. Contacting and advising
  2. Those at high risk of
    - STI/HIV
    - encouraged to attend
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16
Q

GUM - Partner notification
- Securing co-operation

A

GUM - Partner notification
- Securing co-operation

  1. Voluntary
  2. Non-judgement and supportive
  3. Emphasize patient choice
  4. Confidentiality
  5. Risk of re-infection
  6. Partner at risk from infections
  7. Risk of transmission
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17
Q

GUM
- Identifying partner’s at risk

A

GUM
- Identifying partner’s at risk

  1. Look-back period
    - infection specific
  2. Memory prompts can help recall
  3. Document details to track progress
  4. Safer sex advice
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18
Q

GUM
- HIV non-notification

A

GUM
- HIV non-notification

  1. In ‘x’ time, if you have not notified, we will
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19
Q

Genital Warts
- Latin name
- Pathology

A

Genital Warts

  • Latin name
    1. Condyloma acuminata
  • Pathology
  1. HPV manifestation
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20
Q

Condyloma acuminata

  • Commonest
  • High risk
A

Condyloma acuminata

  1. Commonest (90%)
    - Types 6, 11
  2. 16 & 19
    -High risk
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21
Q

HPV types

  • Hands
  • Face
  • Genital/laryngeal
  • CIN
  • Head and Neck Ca
A

HPV types

  • Hands
    2, 4, 26, 27
  • Face
    2
  • Genital/laryngeal
    6,11
  • CIN
    16,18
  • Head and Neck Ca
    18
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22
Q

HPV
- Pathophysiology

A

HPV
- Pathophysiology

  1. Basal layer invaded
  2. Latent phase
    - Dormancy
  3. Viral DNA, capsids
    - Wart formation
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23
Q

HPV
- Infectivity rate
- Incubation
- Prevention

A

HPV
- Infectivity rate
1. 60% (sexual contact)

  • Incubation
    2. 2. weeks to 8 months
    3. 3 Months average
  • Prevention
    4. Condoms do NOT prevent skin contact
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24
Q

Gential warts
- Presentations

A

Gential warts
- Presentations

  1. Usually asymptomatic and painless
  2. Noticed after sexual contact aqcuiring them
  3. Itching or sore
  4. Peri-anal common
  5. Internal lesions
    - Bleeding from urethra, anus, cervix
    - Distorsion of urine flow
  6. Pscyhological distress
  7. Site of trauma
  8. Warm or moist conditions
  9. Multifocal infection
    - Ano-genital
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25
Q

Condyloma acuminata (Warts)
- Clinical appearance

A

Condyloma acuminata (Warts)
- Clinical appearance

  1. Solitary or often multiple
  2. Can be
    - Broad based
    - Pedunculated
    - Pigmented
  3. Warm, moist, non-hairy skin
    - soft
    - non keratinised
  4. On hariry skin
    - firm and keratinised
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26
Q

Condyloma acuminata (warts)
- Female follow up

A

Condyloma acuminata (warts)
- Female follow up

  1. Sepculum exam
  2. Colposcopy
    - if internal warts
  3. Proctoscopy
    - if rectal bleeding
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27
Q

Condyloma acuminata (warts)
- Common differentials
- Other things to consider

A

Condyloma acuminata (warts)

  • Common differentials
    1. Fordyce spots
    2. Pearly papules
    3. Skin tags
    4. Follicles
    5. Tyson’s glands
    6. Vestibular papillosis
    7. Haemangiokeratoma
    8. Sebaceous cysts
  • Other things to consider
    1. Conylomata lata (syphilis)
    2. VIN, PIN, SCC
    3. Molluscum contagiosum
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28
Q

Buscheke-Lowenstein

  • Pathology
A

Buscheke-Lowenstein

  • Pathology
    1. Giant condyloma accuminata
  • HPV
  1. Higher rate of malignant transformation
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29
Q

Condyloma acuminata
- Mx

A

Condyloma acuminata (Warts)
- Mx

  1. Screen for STIs
  2. Reassure
  • Cosmetic rather than immune
  1. cryoRx
  2. Podophyllotoxin
    - antimitotic
  3. Immune modifiers
    - Imiquimod cream
  4. Catephen
    - Green tea leaf extract
  5. Surgery
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30
Q

Condyloma accuminata
- Patient applied therapy

A

Condyloma accuminata
- Patient applied therapy

  1. Softer warts
  2. 4 weeks to 16 weeks
  3. Include:
    - Podophyllotoxin
    - Imiquimod
    - Catephen
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31
Q

Genital warts
- Threshold to refer

A

Genital warts
- Threshold to refer

  1. Suspicious/uncertain/internal
  2. Recalcitrant lesions (consider HIV)
  3. Cervical lesions
  4. Meatal warts
  5. Immunosuppressed
  6. Pregnant
  7. Children/young
  8. Elderly
  9. High risk
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32
Q

HPV
- Quadravelent vaccine

A

HPV
- Quadravelent vaccine

  • 6&11
  • 16&18
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33
Q

Genital warts in pregnancy

  1. Vertical transmission
  2. Management
A

Genital warts in pregnancy

  1. Vertical transmission
    - Very low risk
  2. Management
    - Watch and wait
    - Cryoablation
    - Surgical if extreme
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34
Q

HIV
- Replication

A

HIV
- Replication

  1. Uses reverse transcriptase
  2. Generates proviral DNA from RNA
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35
Q

HIV Presentation

  1. Asymptomatic
  2. Early infection
  3. Advanced HIV
A

HIV Presentation

  • Asymptomatic
    0. screening
  • Early infection
    1. Seroconversion symptoms
    2. TB
    3. Blood dyscrasias
    4. Lymphomas
  • Advanced HIV
  1. PCP
  2. Cryptococcal meningitis
  3. Malignancies/pathology
    - KC
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36
Q

HIV Seroconversion illness
- Mx

A

HIV Seroconversion illness
- Mx

  1. Early treatment
    - TasP (treatment as prevention)
  2. Risk behaviour modification
  3. PN
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37
Q

HIV
- Testing

A

HIV
- Testing

  1. EIA
    - 4th Generation combo assay
    - Detects antibodies
    - Detects P24 antigen
    - 45 day window
  2. Immunoblot in lab
    - other antigens
  3. PCR
    - Viral load measure
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38
Q

HIV
- Testing in Sero-conversion

A

HIV
- Testing in Sero-conversion

  1. False negatives possible
    - Test and repeat over time
  2. Viral load
    - help diagnose before antibodies (45 day window)
  3. Pro-viral DNA
    - considered in some circumstances
  4. PrEP and PEPSE
    - Delayed or unusual seroconversion
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39
Q

HIV
- Monitoring tests

A

HIV
- Monitoring tests

  1. CD4 count
  2. Viral load
  3. HIV resistance testing
  4. Patient health
    - FBC, U&E, LFT, Bone, Physical, Fundoscopy, Urine dip
  5. Infection screening
    - STIs/BBIs
    - TB
    - OI
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40
Q

HIV
- TasP

A

HIV
- TasP

  1. Treatment as prevention
  2. Valid if VL<50 for 6mo
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41
Q

HIV
- PrEP
- PEPSE

A

HIV
- PrEP
1. High risk eligible patients
2. Truvada daily or ‘event based’
3. At least 86% successful

  • PEPSE
    1. Within 72 hours of exposure
    2. Truvada and Raltegravir for 28 days
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42
Q

HIV
- Treatment

A

HIV Treatment

  • Triple Anti-retroviral
  1. Typically 2 NRTI + 3rd agent
  2. Many one pill OD
  3. Monitored 6 monthly
    - viral load
    - regular blood tests
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43
Q

HIV
- Drug classes

A

HIV
- Drug classes

  1. NRTI
    - Nucleoside reverse transcriptase inhibitors
    eg. Tenofovir, abacovir, emtricitabin, lamivudine
  2. NNRTI
    eg. Efavirenz, doravarine
  3. Protease inhibitors
    - co-prescribed with a booster
    eg. Darunavir pulus Ritonovir
  4. Integrase inhibitors
    - eg. Raltegravir, bictegravir
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44
Q

Hepatitis C
- Virus
- Transmission

A

Hepatitis C

  • Virus
    1. RNA
    2. Flaviviridae family
  • Transmission
    1. Parenteral
    2. Vertical (5% risk)
    3. Sexual transmission (very low)
  • UP AI
  • Fisting, rimming, chemsex IV ‘slamming’
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45
Q

Hepatitis C
- Symptoms
- Incubation
- Progression

A

Hepatitis C

  • Symptoms
    1. Icteric hepatitis
    2. Chronic hepatitis
  • Incubation
    1. 6 wks (4-20)
    2. 90% positive serology at 3/12
  • Progression
    1. 80% progress to chronic
    2. 30% to Cirrhosis
    3. Hepatocellular carcinoma
46
Q

Hep C
- Testing

A

Hep C
- Testing

  1. Anti-HCV
    - CUrrent or past infection
    - 4-10 weeks after exposure
    - Some detect HCV-Ag
  2. HCV RNA
    - Current vs past infection
  3. Hep C genotyping
    - guides treatment
47
Q

Hep C
- Mx

A

Hep C
- Mx

  1. Curable
  2. Liver function
    - hepatology involvement
  3. DAAs
    - Direct acting antivirals
    - eg. Harvoni
48
Q

Hepatitis B
- Virus
- Transmission

A

Hepatitis B

  • Virus
    1. DNA virus
  • Transmission
    1. Parenteral
    2. Vertical
    3. Sexual
  • Rimming, multiple partners
49
Q

Hep B
- Presentation

A

Hep B
- Presentation

  1. Children
    - no Sx
  2. Incubation for 40-160 days
  3. Acute phase
    - Similar to Hep A
    - Prodrome/icteric phase
50
Q

Hep B
- Complications

A

Hep B
- Complications

  1. Acute liver failure/mortality
    <1%
  2. Chronic
    - 5-10% of symptomatic cases
    - Higher in HIV, immunosuppressed, LD
  3. 90% of infants will progress to chronic unless treated quickly
51
Q

Hep B Prevention

  • Pregnancy
  • Sexual contacts
  • Household contacts
A

Hep B Prevention

  • Pregnancy
    1. Antivirals in high load
    2. Vaccination of neonate
    3. HBIG if HR
  • Sexual contacts
    1. Vaccinate
    2. HBIG if recent (<7 days)
    3. Condoms until immune
  • Household contacts
    1. Vaccination
    2. Do not share razors/toothbrushes
52
Q

Hepatitis B Serology
- Interpretation

A

Hepatitis B Serology
- Interpretation

  1. Surface antigen
    - Hep B activity
  2. Core antibody?
    - Hep B exposure
  3. Surface antibody
    - Immunity
53
Q

Hep B
- Management

A

Hep B
- Management

  1. Notify
  2. Self-limiting acute infection
  3. Hepatology referral for persistent
  4. STI/BBI screening
  5. Vaccinate against Hep A
  6. Treatment options
    - Peg interferon alpha 2a
    - Antivirals (Entecavir, tenofovir)
54
Q

Genital sores
- Infective causes

A

Genital sores
- Common infectious causes

  1. Candida
  2. Herpes simplex
  3. Herpes zoster
  4. Syphilis
  5. Tropical diseases
    - LGV
    - Granuloma inguinale
  6. Chancroid
55
Q

Genital soreness
- Non-infective causes

A

Genital soreness
- Non-infective causes

  1. Trauma
    - physical/chemical
  2. Dermatological
    - Drug reactions
    - Bechets
    - Apthosis
    - Lichen planus
    - Pemphigus
  3. Malignancy
56
Q

Herpes simplex
- Incubation period
- Stages of primary attack

A

Herpes simplex

  • Incubation period
    1. 3-14 days
  • Stages of primary attack
    1. Tingling and itching
    2. Fluid filled blisters
    3. Burst, painful sores
    4. Scabbing, itching, cracking
57
Q

HSV
- Tests

A

HSV Tests

  • Immediate
    1. PCR
  • Delayed
    1. Full STI screen
    2. Syphilis serology
    3. HIV antibody test
58
Q

HSV 1 vs HSV 2

  1. Location
  2. Seropositivity
  3. Recurrence in year 1
A

HSV 1 vs HSV 2

  1. Location
    - Orofacial vs genital
  2. Seropositivity
    - 80% vs 7%
  3. Recurrence in year 1
    - 1 vs 4
59
Q

HSV
- Management

A

HSV Management

  • Supportive
    1. Rest
    2. Analgesia (eg lidocaine 5%)
    3. Saline washing
  • Medical
    1. Antivirals
  • in systemic infection
    eg. Aciclovir 400mg TDS 5/7
60
Q

Herpes simplex
- Complications

A

Herpes simplex
- Complications

  1. Urinary retention
  2. Adhesions
  3. Meningism
  4. Recurrence/emotional distress
61
Q

HSV
- Pregnancy
1. Recurrence
2. Trimesters

A

HSV
- Pregnancy

  1. If recurrent - low risk
  2. If third trimester, caesarian
62
Q

Syphilis diagnosis
- Lesions
- Blood

A

Syphilis diagnosis

  • Lesions
    1. Dark ground microscopy
    2. Treponemal PCR
  • Blood
    1. EIA
  • Treponemal enzyme immunoassay
    2. TPPA
  • Treponema pallidum particle agglutination assay
    3. RPR
  • Rapid plasma reagin test
63
Q

Syphilis
- Natural history

A

Syphilis
- Natural history

  • Infectious
    1. Primary
    2. Secondary
    3a. Early Latent period (<2y)
  • Non-infectious
    3b. Late latent (>2y)
    4. Tertiary
64
Q

Syphilis
- Mx

A

Syphilis
- Mx

  1. Benzathine Penicillin
    - IM
  2. Once weekly when infectious
  3. Thrice weekly in late latent
    - CVS and gummatous syphilis
65
Q

MPox
- Virus
- Symptoms

A

MPox

  • Virus
    1. Zoonotic disease
    2. Monkeypox virus
  • Symptoms
    1. Rash
  • face and body
  • Palms and soles
  1. Anorectal symptoms
66
Q

PID
- Complications

A

PID
- Complications

  1. Ectopic
  2. Infertility
  3. Tubo-ovarian abscess
  4. Chronic pelvic pain
  5. Fitz-Hugh-Curtis
    - Peri-hepatitis
    - CT PID
67
Q

PID
- Locations

A

PID
- Locations

  1. Cervicitis
  2. Endometritis
  3. Salpingitis
  4. Intra-abdominal
68
Q

PID
- Infections

A

PID
- Infections

-STIs
1. Chlamydia
2. Gonorrhoea
3. Mycoplasma genitalium

Non-STIs
1. Anaerobes
2. Gardnerella vaginalis
3. Vaginal flora

  • Poly-microbial
69
Q

PID
- Symptoms

A

PID
- Symptoms

  1. Abdo pain
    - bilateral and lower
  2. Deep dyspareunia
  3. Discharge
    - ICB/HMB
  4. Dysmenorrhoea
    - Purulent dischrge
    - Fever, rigors, chills, night sweats
70
Q

PID
- Signs

A

PID
- Signs

  1. Abdo tenderness
    - bilateral lower
  2. Uterine/adnexal tenderness
  3. Cervical motion tenderness
  4. Adnexal mass
    - abscess
  5. Muco-purulent vaginal discharge
  6. Cervicitis/contact bleeding
  7. Pyrexia
  8. Peritonitis
  9. Fitz-Hugh-Curtis
71
Q

PID
- Differentials

A

PID
- Differentials

  • Gynae
    1. Ectopic
    2. Ovarian cyst (torsion, rupture, haemorrhage)
    3. Endometriosis
  • UTI
    1. Cystitis
  • GI
    1. IBD
    2. Appendicitis
    3. IBS
72
Q

PID
- Ix

A

PID
- Ix

  1. Swabs
    - Gonorrhoea, chlamydia, trichomonas vaginalis, mycoplasma genitalium
    - Confirmation, not exclusion
  2. Urine Dip/MSU
    - Exclude urinary tract
  3. Pregnancy
  4. Microscopy
    - Discharge
  5. TUS
    - If uncertainty, severity
  6. Laparoscopy
    - In severe cases with uncertainty
73
Q

PID
- Empirical treatment

A

PID
- Empirical treatment

  1. Low threshold
    - Sexually active
    - New onset lower bilateral abdo pain
    - Tenderness
  2. Condition
    - Pregnancy excluded
    - No other cause of pain
74
Q

PID
- Outpatient treatment

A

PID
- Outpatient treatment

  1. Stat IM Ceftriaxone (gonorrhoea)
    +Doxycycline PO (chlamydia)
    + Metronidazole PO (anaerobes)
  2. Mycoplasma:
    Moxifloxacin OD PO
  3. Analgesia
  4. Rest
  5. Abstinence
    - self and partner treated
75
Q

PID
- Outpatient follow-up

A

PID
- Outpatient follow-up

  1. 72hrs
    - Consider removing IUC
    - Consider IV abx
  2. 2-4 weeks
    - Symptom resolution
    - Abx compliance
    - Screening of contacts
76
Q

PID
- Inpatient indications

A

PID
- Inpatient indications

  1. Nausea, vomiting, high fever
  2. Peritonitic
  3. Pregnant
  4. Unresponsive to po abx
  5. Uncertain diagnosis
77
Q

PID
- Inpatient abx

A

PID
- Inpatient abx

  1. IM Ceftriaxone
    + IV doxycycline
    -> PO Met and PO Doxy
  2. IV clindamycin
    + IV gentamicin
    -> PO Clinda and PO Met
78
Q

Vaginal discharge
- Questions

A

Vaginal discharge
- Questions

  1. Colour, blood
  2. Consistency, odour

3.Itch/soreness
4. IMB/PCB

  1. Dyspareunia
  2. Rash/lesions
79
Q

Vaginal secretion

  • Vaginal
  • Cervical
A

Vaginal secretion

  • Vaginal
    1. Candidiasis
    2. Trichomoniasis
    3. Gardnerella-associated
    4. Bacteria (FB)
    5. Postmenopausal vaginitis
  • Cervical
    1. Gonorrhoea
    2. Non-specific
    3. Herpes
    4. Ectopy
    5. Neoplasm eg. polyp
80
Q

Vaginal discharge

  • High VS
  • Vulvlovaginal
  • Endocervical
  • Other
A

Vaginal discharge

  • High vaginal swab
    1. Culture
  • T. vaginalis
  • Candida
    2. Wet mount
    3. Gram stain
  • Vulvlovaginal
    1. NAAT
  • N.gonorrhoeae
  • C. trachomatis
  • Endocervical
    1. Gonorrhoea culture
  • Other
    1. Other organisms
    2. HSV PCR cervix
81
Q

Candidiasis
- Epidemiology
- Risk Factors

A

Candidiasis

  • Epidemiology
    1. 75% lifetime risk for women
  • Risk Factors
    1. Immunosuppression
    2. High oestrogen
  • pregnnacy
  • luteal phase
  • COCs
  1. ABx
  2. DM
  3. Mucosal breakdown
    - sex, dermatitis
  4. Atopy
    - Recurrent candidiasis
82
Q

Candida
- Tests

A

Candida
- Tests

  1. Clinical
    - Normal pH
    - Infection
  2. Samples
    - Vaginal Wall
    +/- vulval swab
  3. Gram staining
    - 60% sensitive
    - 90% albicans/5% glabrata
83
Q

Candida
- Mx

A

Candida
- Mx

  1. Antifungal
    - Fluconazole
    - Clotrimazole
    +/- Hydrocortisone 1%
  2. Recurrent
    - >4 episodes per year
    - Induction then maintenance
    - Fluconazole every 72 hours then weekly
    - Fluconazole weekly
84
Q

BV

  • Epidemiology
  • Precipitants
A

BV

  • Epidemiology
    1. Most common discharge in child-bearing age
  • Precipitants
    1. Unprotected sex
    2. Receptive oral
    3. Douching
    4. Menstruation
85
Q

BV
- Diagnosis

A

BV
- Diagnosis

  1. Hay-Ison criteria
    - Posterior fornix gram
  2. Amsel (3 of:)
    - Characterisitc discharge
    - Wet mount epithelial ‘clue’ cells
    - Raised pH
    - KOH “whiff test”
86
Q

BV
- Mx

A

BV
- Mx

  1. Metronidazole
    - BD 5/7
  2. Avoid precipitants
87
Q

Trichomonas
- Sx

A

Trichomonas

  • Discharge
    1. Off-white, blood-staining
    2. Putrid, frothy
  1. Itch/soreness
  2. Strawberry cervix
    - contact bleedin
88
Q

Trichomonas
- Ix

A

Trichomonas

  1. Posterior fornix sample
  2. Vulvo-vaginal swab
    - self-taken
  3. First void urine in men
    - urethra swab
    - centrifuged
  4. Wet mount
    - 70% sensitive compared to culture
89
Q

Trichomonas
- Mx

A

Trichomonas
- Mx

  1. Metronidazole
    - 400mg BD 7/7
90
Q

Male urethral discharge
- Investigations

A

Male urethral discharge
- Investigations

  1. Exam
  2. Gram stain
    - urethra smear
  3. Gonorrhoea culture
  4. Urine NAAT
    - NG and CT
  5. Considere
    - Micro of urine threads
    - TV - wet smear
    - MSU
    - HSV PCR
91
Q

Gonorrhoea
- Dx

A

Gonorrhoea
- Dx

  1. Microscopy
    - Urethral/cervical
  2. NAAT
    - >95% sensitivity
  3. Culture
    - After NAAT, for treatment
92
Q

Gonorrhoea
- Mx

A

Gonorrhoea
- Mx

  1. Ceftriaxone
    - Susc not known
  2. Cipro
    - Susc known
  3. Allergy
    - Discuss with GUM
93
Q

Non-specific Urethritis
- NSU
- Common agents

A

Non-specific Urethritis
- NSU
- STI pathogens

  1. CT
  2. Mycoplasma genitalium
  3. Ureaplasma urealyticum
  4. TV
  5. HSV
  6. HPV
94
Q

Non specific urethritis
- Non STI

A

Non specific urethritis
- Non STI

  • Infective
    1. UTI
    2. Adenovirus
    3. Candida
  • Non-infective
    1. Drugs
    2. Alcohol
    3. Trauma/FB
95
Q

Chlamydia
- Mx

A

Chlamydia
- Mx

  1. Doxy
    - BD 7/7
  2. Azithro/erythro
96
Q

Mycoplasma genitalium

  • Microscopic appearance
  • Presentation
A

Mycoplasma genitalium

  • Microscopic appearance
    1. Flask shaped
    2. Small gram +ve
  • Presentation
    1. Urethritis, epididymitis, proctitis
    2. PID, mucopurulent cervicitis
97
Q

Mycoplasma genitalium
- Dx

A

Mycoplasma genitalium
- Dx

  1. First void urine
  2. Swab
    - Self-taken vaginal
    - Anal
  3. NAATs
    - detect resistance
98
Q

Mycoplasma genitalium
- Mx

A

Mycoplasma genitalium
- Mx

  • ABx (no cell wall)
    1. Doxy 7/7 + Azithro 4/7
    2. Moxifloxacin 7-10/7
  • PID/Epididymitis
    1. Moxifloxacin 14/7
99
Q

POP
- Active ingredients?

  1. Cerazette
  2. Micronor
  3. Noriday
  4. Norgeston
A

POP
- Active ingredients?

  1. Cerazette
    - Desogestrel
  2. Micronor & Noriday
    - Norethisterone
  3. Norgeston
    - Levonorgestrel
100
Q

LARC contraception
- Routes

A

LARC contraception
- Routes

  1. Injections
  2. Implants
  3. Devices/systems
101
Q

LARC contraception
- Injectables (POIC)

A

Progestogen-only Injectable

  1. Depo Provera (IM)
    - 12 wk
  2. Sayana Press (SC)
    - 13wk
102
Q

LARC contraception
- LNG-IUS

A

Levonorgestrel-releasing IUS (LNG IUS)

  1. Mirena
  2. Kyleena
  3. Jaydess
  4. Levosert
103
Q

Lactational Amenorrhea Method
- Effectiveness

A

Lactational Amenorrhea Method
- Effectiveness

  1. 98% if all of:
    - Fully breastfeeding
    - No periods
    - <6 mo postpartum
104
Q

IUD vs IUS
- Fertilisation or implantation?

A

IUD vs IUS
- Fertilisation or implantation?

  1. IUD
    - Prevents fertilisation
  2. IUS
    - Prevents implantation
105
Q

COCP vs POP

  • Missed pills
  • Clots
  • Periods
  • Acne
A

COCP vs POP

  • Missed pills
    1. Daily for POP (12hrs)
  • Clots
    2. Increased in COCP
  • Periods
    3. Lighter in COCP
  • Changes in POP
  • Acne
    4. Can improve with COCP
106
Q

1 Missed Pill?

A

1 Missed Pill?

  1. Take the missed pill
  2. Continue as normal
107
Q

2 -7 missed pills
- Week 1
- Week 2
- Week 3

A

2 or more missed pills

  • Week 1
    1. Emergency contraception
    2. Take last pill missed
    3. 7 days contraception
    4. Continue as normal
  • Week 2
    1. Take last missed pill
    2. Extra contraception
    3. Continue as normal
  • Week 3
    1. Take last missed pill
    2. Skip break (dummy or pill-free)
108
Q

8 or more missed pills
- COCP

A

8 or more missed pills
- COCP

  1. Preg test
  2. Emergency contraception
109
Q

LARC
- Injection ADRs

A

LARC
- Injection ADRs

  1. Bleeding
    - Erratic then amenorrhoea
  2. Weight gain
  3. Fertility
    - 1 year in delay
110
Q

LARC
- Implant brand
- Length of activity
- Return of fertility

A

LARC

  • Implant brand
    1. Nexplanon
  • Etonogestrel
  • Length of activity
    2. 3 years
    3. Rapid return of fertility
111
Q

Contraception
- EC methods

A

Contraception
- EC methods

  1. LNG
    3 days
  2. UPA
    5 days
  3. IUD
    5 days (UPSI or ovulation)
112
Q

Emergency contraception
- Physiology
- Failure

A

Emergency contraception

  • Physiology
    1. Delays ovulation
  • Failure
    2. After ovulation

Year 4 - ObGyn (9 decks)

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