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Obstetrics And Gynaecology > GUM > Flashcards

GUM Flashcards

1
Q

what is pid?

A

infection or inflammation of upper reproductive tract

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2
Q

pathophysiology of PID?

A

inflammation of cervix following infection affects mucus plug and allow infection to ascend

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3
Q

what symptoms are seen with PID?

A

lower abdominal or pelvic pain (usually bilateral), deep dyspareunia, abnormal vaginal bleeding, secondary dysmennorhoea, abnormal PV discharge (often purulent)
if severe can have fever, rigors, chills, night sweats

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4
Q

what are some intra-abdominal complications of PID?

A
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5
Q

what are other complications of PID?

A

infertility, ectopicpregnancy, tubo-ovarian abscess, chronci pelvic pain, fitz-hugh curtis syndrome

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6
Q

whatis Fitz-hugh curtis syndrome?

A

peri-hepatitis, RUQ pain, morecommonly associated with PID secondary to chlamydia.

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7
Q

what is a sign of fitz-hugh curtis syndrome?

A

adhesions, violin string like around liver capsule??? double check

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8
Q

what can cause PID?

A

usually polymicrobial
STIs: gonorrhoea, chlamydia, mycoplasma genitalium
non STI: introduction of vaginal flora with intrauterine coil, anaerobes (prevotella, atopobium), gardnerella vaginalis

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9
Q

Who is at higher risk of developing PID?

A

low economic status, multiple sexual partners young age <25, TOP/miscarriage, coil insertion, appendicitis

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10
Q

what signs are seen with PID?

A

lower abdominal tenderness, uterine/adnexal tenderness, cervical motion tenderness, adnexal mass, mucopurulent vaginaldischarge, contact bleeding, fever, RUQ tenderness

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11
Q

what conditions can cause pelvic pain?

A

UTI, ectopic pregnancy, ovarian torsion, endometriosis, appendicitis, bowel inflammation, degenerative fibroids

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12
Q

what investigations can be done for PID?

A

endocervical/vaginal swabs
urine dipstick
pregnancy test (rule out ectopic pregnancy)
bedside microscopy of vaginal/cervical discharge

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13
Q

how is PID diagnosed?

A

clinical diagnosis but investigations can help support diagnosis

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14
Q

what can be seen on imaging or laproscopy in PID (usually more severe)?

A

free fluid in endometrium swollen fallopian tubes or ovaries, abscesses, peri-hepatic adhesions,

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15
Q

management of PID?

A

mutliple antibiotic course for 2 weeks, analgesia, rest, abstain from sex until patient and partner completed antibiotic treatment

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16
Q

which PID patients will be treated as inpatient?

A

severe symptoms (nausea, vomiting, pyrexia), signs of peritionitis, not responding to oral antibiotics, pregnancy (higher risk of complication)

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17
Q

what is most common causative organism of PID?

A

chlamydia

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18
Q

is PID more common in pregnancy?

A

no it is uncommon in pregnancy

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19
Q

is PID a cause of tubal factor infertility?

A

yes

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20
Q

what are features of advanced HIV?

A

CD4<200, opportunistic infections like PCP or crytococcal meningtitis, HIV associated malignancies like Kaposi sarcoma

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21
Q
A

patients on PrEP and PEPSE may
have delayed or unusual seroconversion
due to very early ART- seek expert advice.

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22
Q

what are some infectious causes of gential sores?

A
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23
Q

what are non-infectious causes of genital sores?

A
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24
Q

what associated symptoms are good to ask about with genital sores?

A

fever, flu like symptoms rashes, any problems with eyes/mouth/joints, urinary symptoms, discharge

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25
Q

what is commonest cause of genital ulceration?

A

herpes simplex

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26
Q

how can genital herpes affect a pregnancy?

A

if this is the first case then mum wont have antibodies to pass onto baby so may require C section

26
Q

what is asymptomatic shedding?

A

when a patient does not have any symptoms but they are able to transmit the virus

27
Q

what is another viral differential for herpes simplex infection?

A

herpes zoster infection

28
Q

what is a key distinguishing factor between typical presentation of syphilis and herpes simplex infection?

A

syphilis- painless ulcer
herpes- painful, usually numerous

29
Q

how do we diagnose syphilis from genital ulcer?

A

treponemal PCR from ulcer base
treponemal enzyme immunoassay, rapid plasma reagin test, treponema pallidum particle agglutination assay

30
Q

what is the hallmark sign of primary syphilis?

A

chancre lesion

31
Q

what is the management of syphilis?

A

benzathine penicillin (longer course if more advanced)

32
Q

what examination should all women with external genital warts have?

A

speculum exam

33
Q

what are differentials of genital warts?

A

fordyce spots, pearly papules, skin tags, syphilis, sebaceous cysts, squamous cells carcinomas or VIN/PIN, haemangiokeratoma, molluscum conagiosum

34
Q

what is buschke-lowenstein?

A

giant wart associated with HPV, theyare rare and have higher rate of malignant transformation

35
Q

how do we manage genital warts?

A

screen for stis
explain condition, reassure it usually clears itself as bpdy clears virus over time, HPV that causes warts different to those related to cancer
can occur in monogamous relationship due to dormant phase
condoms don’t help wart transmission
cosmetic treatment to remove lesions

36
Q

what ways can we remove genital warts?

A

cryotherapy, anti-mitotic agents (podophyllotoxin), immune modifiers (imiquimod), surgery

37
Q

what is the first line treatment for candidiasis?

A

oral fluconazole

38
Q

what are some risk factors for candiasis?

A

immunosupression, high oestrogen levels, recent anitbiotics, DM, mucosal breakdown

39
Q

what is amsel criteria which helps us diagnose BV?

A

characteristic discharge
clue cells on wet mount
raised pH
odour with KOH

40
Q

what is the treatment of BV?

A

metronidazole BD for 5 days

41
Q

how does TV present? it is an STI?

A

yes it is an STI
presents with off white, putrid,frothy blood stained discharge with vulval soreness/itch, strawberry cervix

42
Q

how is TV treated?

A

metronidazole 400mg BD 7 days and treat male partners empirically

43
Q

whatare likely causes of penile urthral discharge?

A

gonorrhoea (50%)
chlamydia (25%)
non-specific urethritis

44
Q

what investigations would you do for penile discharge?

A

urethral smear, gonorrhoea culture, urine NAAT
consider: MSU, herpes simplex, mycoplasma genitalis

45
Q

what does gonorrhoea look like on a slide?

A

gram negative intracellular diplococci

46
Q

how do we treat gonorrhoea?

A

ceftriaxone 1g IM stat dose

47
Q

what percentage of men and women are asymptomatic with chlamydia?

A

men 50%
women 70%

48
Q

what treatment is used in chlamydia?

A

doxycycline for 7 days
or azithromycin/erythromycin

49
Q

how long does implant last?

A

3 years

50
Q

how long do the copper and hormonal coils last?

A

copper: 5 or 10
hormone: 3, 5, 8

51
Q

what are differences between implant and injection?

A

higher failure rate with injection as has toget it done every few months

52
Q

what are side effects of depo provera?

A

altered bleeding patterns, weight gain
delay in return of fertility, may slightly reduce bone mineral density

53
Q

how long after implant removal will fertility return?

A

over a couple weeks

54
Q

when are people on contraception not covered?

A

missed COCP 2 days or more
POP >36 hours
>14 weeks since last depo injection

55
Q

up til when can you give emergency contraception?

A

3 days - levonogestrel
5 days- ulipristal
5days after unprotected sex or 5 days after estimated ovulation- IUD

56
Q

if a patient wanting emergency contraception has had any hormonal meds in the last 5 days, which one can they not have?

A

EllaOne (ulipristal) which works as anti progesterone

57
Q
A
58
Q

What are non infective causes of abnormal vaginal discharge?

A

Foreign bodies, fistulae, malignancy, cervical polyps and ectopy, allergic reactions

59
Q

What are non-STI infective causes of abnormal vaginal discharge?

A

Bacterial vaginosis, candida

60
Q

What are STIs that cause abnormal vaginal discharge?

A

Chlamydia, trichomonas vaginalis, neisseria gonorrhoeae, herpes simplex virus

61
Q

What questions do you ask about abnormal vaginal discharge?

A

Change in volume? Colour? Consistency (watery or thickened)? Smell?
Onset, course, exacerbating, relieving factors, previous episodes? Associated symptoms?

62
Q

What are the 6 Cs important to ask in a sexual history?

A

Contraception
Cycle- last menstrual period
Children- been pregnant before
Cytology- when was last smear, abnormal results?
Chlamydia- STIs
hepatitis C- blood born virus risk factors

63
Q

What are questions to asks to assess risks of blood born infections?

A
  • had sex with man that has sex with men?
  • IVDU
  • had sex under influence of drugs
  • had sex with sex worker
  • had sex with someone not from UK
  • medical procedures/blood transfusions abroad
  • tattoos/pericings in non-professional place
  • sexually assaulted?
  • had Hep B vaccine

Obstetrics And Gynaecology (8 decks)

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