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Fifth Year Medicine > GUM > Flashcards

GUM Flashcards

1
Q

What are risk factors for thrush?

A

PMH:Pregnancy
Immunodeficiency
Diabetes

DHx: Contraceptives
Steroids
Antibiotics

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2
Q

White curd discharge, what tests?

A

Culture- thrush, trichomoniasis (motile flagellates) and bacterial vaginosis

Microscopy- thrush shows mycelia or spores, trichomoiasis on wet film

Vaginal pH- above 4.5

STI screen- gonorrhoea

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3
Q

Thrush treatment

A

Rx: topical CLOTRIMAZOLE 500mg pessary + cream

or FLUCONAZOLE 150mg PO (single dose)

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4
Q

Candida glabrata causes what?

How is it treated?

A

5% of thrush- harder to treat

Nystatin PV (use if breastfeeding/pregnant)
or Imidazole 7-14 days
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5
Q

Culture comes back positive for trichomoniasis. What Rx?

A

METRONIDAZOLE 2g PO STAT

or 400mg BD for 5 days

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6
Q

Which STIs do caps give protection against?

A

Semen-borne gonorrhoea and chlamydia

not mucosal syphilis or herpes

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7
Q

When should nonoxinol-9 be avoided?

A

Nonoxinol-9 is the only spermicide available in the UK.
Not recommended for those at high risk of HIV as it irritates vaginal epithelium, making transmission more likely.

Other spermicides have been found to inactivate HIV in vitro.

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8
Q

Which questions may be asked to determine that a women is not pregnant (with 99% neg predictive value)?

A
  1. Have you given birth in the last 4 weeks
  2. Have you given birth less than 6 months ago and fully breastfeeding, and free from menstrual bleeding since your last child.
  3. Did your last menstrual period start within the last week?
  4. Have you been using a reliable contraceptive consistently and correctly?
  5. Have you not had sex since your last period?
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9
Q

What are the Fraser guidelines (Gilick competence) for prescribing contraception to under 16s?

A
  1. They understand the doctor’s advice.
  2. The young person cannot be persuaded to inform their parents that they are seeking contraceptive advice.
  3. They are likely to have intercourse with or without contraceptives.
  4. Unless the young person receives contraceptive treatment their physical or mental health is likely to suffer.
  5. The young person’s best interests require that the doctor gives advice and/or treatment without parental consent.
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10
Q

What are the commonest causes of vaginal discharge?

A
  1. Bacterial vaginosis
    (fishy discharge, vagina is not inflamed)
  2. Thrush
    95% is candida albicans, 5% candida glabrata
    (white curd discharge, vagina may be red and sore)
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11
Q

If suspect sexually acquired urethritis, what investigations should be performed?

A

Urethral smear - high numbers of polymorphonuclear leucocytes

Swab to look for Neisseria gonorrhoea and chlamydia trachomatis
CULTURE + NAAT (nucleic acid amplification test) on first pass urine for men

Midstream urine to exclude UTI.

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12
Q

Lady has itchy vulva, some discomfort, no blisters or ulcers. How should she be investigated?

A

Microscopy:
Spores + hyphae- candidiasis
Trichomoniasis (protozoa)- often a discharge

Bacterial vaginosis- rarely

If negative, culture for candida, trichomona
Consider derm possibilities.

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13
Q

Watery white/grey discharge
Fishy smell worse after sex/during period

Most likely diagnosis?
Investigations?

A

Bacterial Vaginosis
pH vaginal fluid >4.5
Microscopy- loss of lactobacilli, instead small cocci-bacilli forming clue cells (epithelial cells of vagina that look stippled from bacteria covering them)
Culture unhelpful as commensals are cause

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14
Q

White curdy discharge
Itchy vulva
PMH pregnancy, recent antibiotics, diabetes

A

Candidiasis
EHx: satellite lesions- sores around the genitals
Microscopy- spores and hyphae
Culture- dry high vaginal swab

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15
Q

Smelly yellow green discharge
Vulval burning
External dysuria

Diagnosis and examination findings, investigations

A

Trichomoniasis (protozoa)
Hx: sexual risk
EHx: 2-5% strawberry cervicitis
Microscopy- use phase contrast, motile flagellated protozoa
Culture- needs to be sent in transport medium

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16
Q

Which STIs are often asymptomatic?

A

Gonorrhoea- gram negative intracellular diplococci

Chlamydia- gram negative intracellular bacteria

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17
Q

What investigations can be used for asymptomatic STIs?

A

Culture + NAAT- Neisseria gonorrhoeae

NAAT- Chlamydia trachomatis

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18
Q

Woman with
Watery purulent discharge
Ulcers around genitals

A

Cervical herpes simplex infection
EHx: purulent cervical ulcers
IHx: swab DNA PCR

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19
Q

What are the signs of a retained foreign body- like a tampon?

A

Heavy discharge

Very smelly discharge

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20
Q

Multiple vesicles that turned into ulcers on genitals. Very painful

A

Herpes- do PCR swab

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21
Q

Single or multiple painless ulcer on genitals

A

Primary syphilis chancre
Syphilis= treponema pallidum, a spirochete bacterium

Microscopy- dark ground
Serology

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22
Q

Which syphilis serology tests indicates disease activity?

A

RPR test is nonspecific for syphilis, but quantifies levels of cardiolipin antigen.
Can lead to false positives- where cardiolipin is raised from other causes.

Can be negative in late syphilis.
Can be used to screen.

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23
Q

Which serology tests are specific for syphilis?

A

TPPA, EIA and IgM detect antibodies against treponema, don’t show disease activity. PCR treponema.

TPPA- Treponema pallidum particle assay
agglutination (if patient’s serum contains antibodies against treponema antigen, clumping will occur)

EIA- Enzyme immunoassay
(Antigen + Pt’s serum ±Ab + Ab against Ab with colour attached)
Will remain positive for years despite treatment.

IgM
positive 2-3 weeks post infection (earlier than IgG response)

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24
Q

What the incubation periods for positive test results in TPPA, EIA and RPR syphilis tests?

A

As long as it takes to form antibodies (TPPA, EIA) or increase the volume of syphilis in blood to detectable levels (RPR)

TPPA = 2-4 weeks
EIA = 2-3 weeks
RPR = 4 weeks +
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25
Q

How long can sperm survive in the uterus/tubes?

A

7 days

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26
Q

When does a woman ovulate?

A

Cycle length minus 14 days.

If variable cycle length, use the shortest cycle she gets.

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27
Q

How soon can a woman ovulate post birth?

A

28 days postpartum

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28
Q

How long can an unfertilised egg survive for?

A

One day

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29
Q

How long does it take a fertilised egg to implant?

A

5 days

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30
Q

For how long after unprotected sex can an intrauterine device be fitted?

A

Up to 5 days post ovulation.
Up to five days after unprotected sex to prevent implantation.

After 5 days, legally it would be defined as abortion.

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31
Q

What emergency contraceptive pills are available and how soon do they need to be taken?

A

ellaOne- ulipristal acetate
has to be taken within 120 hours of unprotected sex
acts on progesterone receptor
MUST stop other hormonal contraception normally taken for 5 days.

Levonelle- up to 72 hours after unprotected sex
Levonorgestrel
Prevents ovulation, not implantation

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32
Q

How do combined contraceptive pills, injectables and implants work?

A

Inhibit ovulation

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33
Q

Which contraceptives cause thickening of cervical mucus as well as their other effects?

A

Progesterone only pill

Intrauterine system- (mirena)

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34
Q

Which contraceptives inhibit implantation?

A

Intrauterine system- (mirena, but also thickens cervical mucosa)
Intrauterine device- (copper coil, but also is toxic to sperm and egg, blocking fertilisation)

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35
Q

How long after the intrauterine system is fitted does it take for it’s contraceptive effect to start?

A

Mirena takes 7 days.

Need to use condoms to cover this period.

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36
Q

How long after starting the combined contraceptive pill, depot or implant does it take to exert contraceptive effect?

A

7 days

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37
Q

How long does the progesterone only pill take to exert it’s contraceptive effect?

A

2 days

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38
Q

How long does the intrauterine device take to exert it’s contraceptive effect?

A

Copper coil works immediately.

Hormonal coil- the Mirena works after 7 days.

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39
Q

After how many hormone free days will it take for the oral combined contraceptive pill to lose it’s contraceptive effect?

A

After 9 hormone free days within a 3 week period, an ovulation will occur.
If a woman has a week off to have a withdrawal bleed and misses two days of her pills in Week 1 she can become pregnant.

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40
Q

How soon after having a depot injection contraceptive can a woman become pregnant?

A

14 weeks after her last injection.

but only reduces fertility for a year after stopping it

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41
Q

How soon after taking out the implant could a woman become pregnant?

A

7 days.

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42
Q

How soon after taking out the intrauterine device (copper coil) can a woman become pregnant?

A

Immediately

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43
Q

How soon after taking out an intrauterine system (mirena) can a woman become pregnant?

A

Immediately- because it only blocks implantation.

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44
Q

How soon after stopping the progesterone only pill can a woman become pregnant?

A

Immediately, 27 hours after the last pill so if a woman is 3 hours late taking her pill one day technically she’s not covered.

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45
Q

When is the worst week for a woman to forget to take her combined oral contraceptive pill?

A

Week 1, enables ovulation to occur

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46
Q

What should a woman do if she forgets to take a pill?

A

If it’s just one pill, take the forgotten pill now (even if it means taking two in one day).
Continue taking the pill as normal.
Take the 7 day break as normal.

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47
Q

What should a woman do if she’s missed two or more pills?

A

Take extra pill
Use extra protection until 7 pills have been taken consecutively.

Missed pills in week 1: emergency contraception.

Missed pills week 2: continue as normal, with the usual 7 day break.

Missed pills week 3: miss out the 7 day break.

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48
Q

Woman has missed two days of pill in week 1, luckily hasn’t had unprotected sex for last 7 days so no need for emergency contraception. What advice should you give her?

A

Ensure she uses condoms for the next seven days, as she has ovulated today so if continuing the pill (which works by preventing ovulation) needs additional cover to make sure she doesn’t get pregnant.

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49
Q

When does contraceptive need to be used until in a woman’s life?

A

Until the menopause.
If a woman is under 50, wait until she hasn’t had a period for two years.
If a woman is over 50, wait until she hasn’t had a period for one year

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50
Q

Which form of contraception may cause heavier, longer or more painful periods?

A

Intrauterine device (copper coil)

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51
Q

Which patients is the contraceptive patch not appropriate for?

A

For women who are very overweight

or who smoke and are over 35.

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52
Q

Patient tests:
HBsAg +ve
Anti- HBc +ve
Anti-HBs -ve

What could be patient’s Hep B status?

A

Late acute infection
Chronic infection

(Early acute wouldn’t have antibodies yet?)

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53
Q

Patient tests:
HBsAg +ve
Anti-HBs -ve
Anti- HBc -ve

What is their Hep B status?

A

Early infection.

Not yet seroconverted.

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54
Q

How can a late acute infection of Hep B be differentiated from a chronic infection using serology.

A

Acute infection will have high Anti-HBc IgM

Chronic infections will tend to be -ve for Anti-HBc IgM

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55
Q

How can a high and low infectivity chronic Hep B infection be differentiated?

A

Highly infective chronic= HBe-Ag +ve

Low infectivity chronic = Anti-HBe +ve

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56
Q

Does IgM or IgG form earliest in a Hep B infection?

A

IgM

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57
Q

For which medical conditions is Hep B immunization recommended?

A

SxHx: Promiscuous, MSM
PMH: CKD, liver disease, regular blood transfusions
FHx: infected mum or family or partner
SHx: IVDU, working in hospital, prison or dentists
Prisoners, prostitutes
THx: travelling to high risk country

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58
Q

Who should be offered screening tests but not the vaccine?

A

Patients from countries where Hep B is endemic.

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59
Q

What happens if someone from an at risk group for Hep B and due to be vaccinated is found to be HBV positive?

A

They don’t get the vaccine.

If infected vaccine response is reduced, carrier rate is increased and the virus becomes more infective.

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60
Q

What are the contraindications to the combined oral contraceptive?

A

PC: Pregnancy
Oestrogen- dependent tumours (breast, uterine)
Hepatobiliary disease or liver tumours
Genital tract bleeding (if cause unknown)

PMH: 
Thromboembolic disease
CVS disorders
Migrane + aura
Hypertension 
Diabetes
BMI above 35

SHx:
Smoker who is 35+

61
Q

What does the oral combined contraceptive reduce the risk of?

A

Benign ovarian tumours
Pelvic inflammatory disease
Acne
Colorectal cancer

62
Q

What does the combined oral contraceptive increase the risk of?

A 
Slight increased risk of:
VTE- about 1 per 10,000
Stroke
CVS disease
Breast cancer- but risk returns to normal 10 years after stopping
Tiny risk of cervical cancer
63
Q

Aside from the pill, what other forms does the combined hormonal contraceptive come in?

A

Vaginal ring, remove after 21 days for a withdrawal bleed.

Transdermal patch, applied weekly. Remove for a week for a withdrawl bleed.

64
Q

Which conditions is a progesterone only pill preferred over the combined oral contraceptive?

A

During lactation- doesn’t effect quality or quantity of milk
Sickle cell disease
SLE and autoimmune disease

due to VTE risk

65
Q

Contraindications to the progesterone only pill?

A 
Pregnancy
Undiagnosed genital tract bleeding
Severe arterial disease
Active hepatic disease- (metabolised by liver)
Recurrent follicular cysts
66
Q

Woman throws up after taking her progesterone only pill. What should she do?

A

If vomiting within 2hours of ingestion, take another pill asap and use extra contraception for the next 48 hours.

67
Q

What are the SEs of the injectable progestagen- the depot?

A

Menstrual disturbance- no periods or irregular periods
Delayed conception- may take 12 months to regain fertility
Weight gain- progestagens may increase appetite
Bone loss- small

68
Q

What are potential complications of the copper coil/intrauterine device?

A

Irregular bleeding, especially in the first 3-6 months
Risk of infection- screen for Chlamydia before insertion
IUCD expulsion- commonest in the first 3 months after insertion
Perforation
Dysmenorrhoea

69
Q

How soon after a termination of pregnancy can a copper coil be inserted?

A

Within first 48 hours.

70
Q

Uterine abnormalities or fibroids distorting the cavity is a contraindication for which type of contraception?

A

Intrauterine device (copper coil).

71
Q

What is the commonest cause for female sterilization failing. How can this be countered?

A

Due to women already being pregnant when the procedure is performed or within the same cycle that it is given.
To avoid this contraception should be used until the first period after the sterilisation.

72
Q

What factors predispose to bacterial vaginosis?

A

Black ethnicity
Sexually active
Genital washing

Lack of condom use
Intrauterine device (coil)
73
Q

How does the discharge differ between bacterial vaginosis and trichomoniasis?

A

Bacterial vaginosis- fishy, watery grey/white discharge

Trichomoniasis- bubbling white/green odorous discharge

74
Q

What are the signs of pelvic inflammatory disease on bimanual exam?

A

Cervical excitation

Adnexal tenderness

75
Q

What is the commonest STI in the UK?

A

Chlamydia

76
Q

Which causes of discharge will lead to a vaginal pH of more than 4.5?

A

bacterial vaginosis

trichomoniasis

77
Q

Rx for bacterial vaginosis?

A

Metronidazole

Clindamycin vaginal cream

78
Q

Rx for trichomoniasis?

A

Metronidazole

79
Q

Rx for gonorrhoea?

A

Ceftriaxone + azithromycin

80
Q

Rx for Chlamydia?

A

Azithromycin

or Doxycycline

81
Q

Man comes in with white urethral discharge since having unprotected sex 8 days ago.
He is an MSM

Likely cause?
What should be checked for on EHx?

A

Gonorrhoea

Scrotal swelling/pain (epididymitis)

82
Q

How does the presentation of non-gonoccocal urethritis differ from gonoccocal urethritis in men?

A

Non-gonoccocal- less dramatic discharge
Meatal tingling/itching

Gonococcal- purulent discharge
Scrotal swelling sometimes

83
Q

Causes of non-gonococcal urethritis in men?

A

Chlamydia

unknown- possibly Mycoplasma gentialium

84
Q

condylomata acuminata = ?

A

anogenital warts

85
Q

Man comes in worried about small uniform spots around the ridge of the glans on his penis.
What are they likely to be?

A

Pearly penile papules

Just an anatomical variation

86
Q

Man has noticed some flesh-coloured domed lesions around his genitals.

What is likely to be the cause?
Rx?

A

Molluscum contagiosum
benign, caused by the pox virus

Rx: normally self-resolves.
can cryotherapy for cosmetic reasons

87
Q

IHx for man with discharge and dysuria?

A

urethral smear- 5 polymorphonuclear leucocytes
first pass urine/ urethral swab- NAAT (chlamydia + gonorrhoea)
mid-stream urine culture + microscopy - exclude UTI

88
Q

Man with dysuria and discharge, which factors suggest sexual cause and which a underlying UTI?

A

SexHx- new partner in last 4 weeks Vs long term regular partner

Age- teens to 50s Vs over 50 years

PC- dysuria + discharge Vs malaise, loin pain, fever, frequency

89
Q

Tropical causes of genital ulcer

Different characteristics of PC?

A

Chancroid- multiple soft painful ulcers (Gram -ve bacteria)

Lymphogranuloma venereum- small painless ulcer then bilateral inguinal lymphadenopathy (chlamydia trachomatis)

Granuloma inguinale/ Donovanosis- pruritic papule then granulomatous ulcer (Klebsiella granulomatis)

Herpes + Syphilis

90
Q

Difference in presentation between syphilitic ulcer and herpes?

A

Herpes- multiple painful ulcers

Syphilis- single painless ulcer
or if secondary- snail track ulcer with skin rash

91
Q

IHx to differentiate herpes ulcer from syphilis ulcer?

A

Swab and PCR for herpes
Dark ground examination for treponemes (syphilis)
Syphilis serology

92
Q

IHx to differentiate tropical causes of genital ulcers?

A 
Swab for:
haemophilus ducreyi (chancroid)
chlamydia trachomatis (LGV)

Biopsy for Donovan bodies- granulomatous (granuloma inguinale)

93
Q

Man over 50 comes in, has noticed an ulcerous lesion on genitalia growing over the last months.
What would you be worried about?

A

Neoplastic cause- refer to urology

94
Q

22 year old female, recent sexual partner
Flu-like symptoms and tender glands.
No Hx of genital or oral ulceration
Ehx: painful genital ulcers

Diagnosis?
Want to exclude what things?

A

First ever Herpes Simplex infection (hence systemic symptoms)

Exclude:
Syphilis
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
95
Q

Bilateral small pupils that do not constrict with light but do constrict on accommodation. Cause?

A

Argyll robertson pupil

=neurosyphilis

96
Q

Woman with vaginal discharge, name the cause if miscroscopy shows:
A. Motile flagellates on wet film
B. Mycelia or spores
C. Stippled ‘clue’ cells

A

A. Trichomoniasis
B. Thrush
C. Bacterial vaginosis

97
Q

How does the Rx of trichomoniasis and bacterial vaginosis change if the patient is pregnant?

A

Rather than metronidazole 2g PO once off
If pregnant:

400mg BD PO for 5 days

98
Q

Rx of acute salpingitis in a patient presenting with pain, fever and spasm of lower abdominal muscles?

A

Ceftriaxone slow IV with doxycycline

Then doxycyline BD PO + metronidazole BD PO for 2 weeks

99
Q

Acute salpingitis but not so bad that IV antibiotics are required. Rx?

A

Ofloxacin BD PO + metronidazole BD PO for 2 weeks

Oxofloxacin is a fluoroquinolone

100
Q

Woman has deep dyspareunia, pelvic adhesions, how you can you differentiate between chronic salpingitis (secondary to sti) and endometriosis?

A

laparoscopy

101
Q

Rx for chronic salpingitis from unresolved infection that is long lasting?

A

Broad-spectrum Tetracycline QDS PO for 3 months

Taken 1 hour before food

102
Q

Pain at the time of periods + on EHx an enlarged, boggy uterus?

A

Adenomyosis

103
Q

Rx for endometriosis?

A 
1st: aim to suppress ovulation for 6-12 months
Combined pill (continuously)
2nd: Progestogens
Danazol (functional anti-oestrogen)
Gonadorelin analogues (not for adolescents)
104
Q

Pro’s and con’s of surgery for endometriosis?

A

Best if symptoms seriously impinging on patient’s life
Relapse common

(Excision, electric current destruction, laser ablation, nodule removal)

105
Q

Who should be offered a HIV test routinely?

A

Those seeking an STI check up or obtaining pre-exposure prophylaxis
Each pregnancy

More frequent testing recommended for:
MSM, IVDU, prostitutes, partners of high risk people

106
Q

Respiratory conditions which are red flags for a HIV test?

A

TB
Pneumocystis (PCP)

Consider for:
bacterial pneumonia
aspergillosis (fungal)

107
Q

Which neurological conditions are red flags for needing HIV testing?

A

Cerebral toxoplasmosis
Cryptococcal meningitis
Primary cerebral lymphoma
Progressive multifocal leucoencephalopathy (JC virus)

108
Q

Which GI conditions are red flags for needing a HIV test?

A

Persistent cryptosporidiosis (PC: diarrhoea- microscopy)

Consider in:
Oral candidiasis, oral hairy leukoplakia
Chronic diarrhoea or weight loss of unknown cause
Hep B or Hep C infection

109
Q

Which types of cancer are red flag indications for a HIV test?

A

Neuro- primary cerebral lymphoma
Derm- kaposi’s sarcoma
Onc- Non-hodgkins lymphoma
Gynae- cervical cancer

110
Q

Which eye condition is a red flag for indicating need of HIV test?

A

CMV retinitis

Consider for:
Herpesvirus, toxoplasma
Unexplained retinopathy

111
Q

What is the typical first line Rx for HIV?

A

2 nucleoside/nucleotide analogues

+ 1 non-nucleoside or protease inhibitor

112
Q

What are the 6 types of HIV antivirals?

A

Reverse transcriptase inhibitors (non-nucleoside + nucleoside analogues)

Entry inhibitors: fusion inhibitors + CCR5 chemokine receptor blockers

Integrase inhibitors (needed for viral DNA to get into genome)
Protease inhibitors (needed to cleave viral proteins)
113
Q

What is the mechanism of toxicity in nucleoside reverse transcriptase inhibitors of HIV?

A

NRTI- thought to damage mitochondrial DNA as it is incorporated into it.

= peripheral neuropathy, myopathy, pancreatitis, hepatic steatosis

114
Q

What CD4 count would prompt a doctor to consider starting HAART?

A

Recent change to guidelines, may start on HAART at any time, but especially if CD4 is below 350

115
Q

How does PCP present on xray?

A

Early on- normal
Then- Bilateral perihilar interstitial infiltrates
Progresses to- diffuse alveolar shadowing

116
Q

How is mild moderate and severe PCP stratified?

A

Mild: PaO2 >11kPa
Moderate: PaO2 8-11kPa
Severe: Pa O2

117
Q

1st line Rx of PCP?

A

High dose co-trimoxazole

Sulfamethoxazole + trimethoprim

118
Q

2nd line Rx for PCP who develop toxicity or do not respond to 1st line Rx?

A

Clindamycin PO/IV QDS

+ Primaquine PO

119
Q

Adjunct therapy aside from co-trimoxazole for HIV patient admitted with PCP and has PaO2 of 7kPa

A

Glucocorticoids within 72 hours

120
Q

Once someone has had an episode of PCP you start prophylactic Rx, when can they stop this?

A

Co-trimoxazole (sulfamethoxazole + trimethoprim)

Until CD4 > 200 or HIV RNA is undetectable
for more than 3 months

121
Q

What is 2nd + 3rd line after co-trimoxazole for PCP prophylaxis in HIV?

A

2nd: pentamidine NEB
Or dapsone + pyrimethamine PO

3rd: atovaquone

122
Q

What signs in the eye can arise with non-infectious HIV retinopathy?

A

Present at any stage of untreated HIV infection:
Cotton wool spots
Retinal micro-aneurysms
Retinal haemorrhages

123
Q

Commonest opportunistic eye infection occurring with HIV?

A

CMV retinitis

124
Q

Rx for CMV retinitis close to the macula/optic disc that may risk visual loss?

A

Intraocular injection of
ganciclovir (DNA polymerase inhibitor)
or foscarnet (binds viral DNA polymerase)

125
Q

What medium of Rx can be used in CMV retinitis to prevent the need of repeated intraocular injections of anti-viral Rx?

A

Ganciclovir implant placed in the affected eye

126
Q

Why does someone with CMV retinitis require systemic anti-CMV therapy alongside intraocular therapy?

A

To prevent disease spread to the uninvolved eye or the rest of the body

127
Q

When can someone stop maintenance Rx of oral valganciclovir following CMV retinitis?

A
  • retinal disease confirmed to be inactive

- CD4 >100 for 3 months

128
Q

What is the long term risk to the eye when someone has had CMV retinitis in the past

A

Retinal detachment- even long after retinal disease has been controlled

129
Q

How does treatment of CMV retinitis and HSV keratitis differ in someone with HIV?

A

CMV retinitis: ganciclovir/foscarnet intraocular implant/injection
Then PO valganciclovir PO

HSV keratitis: foscarnet- intravitreal injection
Then IV aciclovir for 7 days and then PO for 6 weeks

130
Q

Which CD4 counts are associated with toxoplasma primary infection or reactivation?

A
131
Q

If you know someone with Hep B, what does your relation to them need to be to warrant a Hep B vaccine?

A

FHx: infected mum or family or partner

132
Q

Management of someone who obtains a needle-stick injury from a patient known to be HIV +ve?

A

Wash profusely with soap and water.
HIV baseline test
PEP- (tenofavir-emtricitabine + integrase inhibitor) within 1-2 hours

133
Q

What is the time limit on giving PEP for a healthcare’s exposure to HIV?

A

Normally 72 hours

If very high risk ie needle-stick from blood from a HIV+ve person’s vein then 1 week.

134
Q

After someone has had a needlestick injury, how long should they take PEP for?

A

28 days (triple therapy)

135
Q

Someone had a needlestick injury and received PEP, when should they return for HIV testing?

A

HIV test immediately after
PEP for 28 days
HIV test at 3 months

Weekly follow up for side effects: LFTs, amylase + glucose, FBC, U+Es

136
Q

If exposed to Hep C via a needlestick injury how often should they come in for follow tests?

A

Immediately- baseline
6 weeks- HCV RNA
3 months- HCV RNA + HCV antibodies
6 months- HCV antibodies

137
Q

Which antibody in HepB needs to be +ve to confer immunity?

A

Anti-HBs

Core antibodies don’t equate to immunity, so if positive without anti-HBs there is either a chronic infection or it is in the acute phase where core Abs have been produced but surface haven’t yet.

138
Q

Drugs causing erectile dysfunction?

T- SSSiCK

A 
Thiazide
Spironolactone
Sympathetic blockers (clonidine)
SsrI
Cimeditine (H2 antagonist for acid)
Ketaconazole
139
Q

How long after a painless ulcer might someone get secondary syphilis (rash on trunk, lymphadenopathy, uveitis, condylomata lata etc etc)?

A

6 weeks to 6 months

140
Q

What are the four types of neurosyphilis?

A

Tabes dorsalis- wipe out dorsal columns (vibration, proprioception, fine touch): abnormal gait, numbness, lightning pain

Taboparesis- spastic paraparesis (pyramidal tract involvement)
General paralysis of the insane- dementia, psychosis
Meningovascular- cranial nerve palsy, stroke

141
Q

Between primary, secondary and tertiary syphilis, when might serology be negative, and dark ground microscopy?

A

Primary: serology often -ve, microscopy +ve
Secondary: serology +ve, microscopy +ve
Tertiary: serology +ve, microscopy -ve
Consider CSF analysis with a high RPR titre

142
Q

What is the jarisch-herxheimer reaction?

A

Temperate, high HR, vasodilatation hours after 1st antibiotic dose for syphilis.

Commonest in secondary disease (rash, lymphadenopathy etc)

143
Q

Which test is used to screen for syphilis and which is used to confirm that finding?

A

Screening- EIA

Confirmation- TPPA

144
Q

What change in RPR titre suggests reactivation of latent syphilis?

A

4 fold change in titre

145
Q

Which opportunistic infection do you not start HAART off immediately with?

A

Cryptococcal meningitis- can trigger immune reconstitution syndrome worsening syndromes

(Also in TB, use all four TB drugs first for 2 months before reintroducing HAART)

146
Q

If a woman is on hormonal contraceptive pills, which emergency contraction should be avoided?

A

Ulipristal if hormone taken 5 days before unprotected sex event

147
Q

If giving a woman who is breastfeeding ulipristal emergency contraception what do you need to advise her?

A

No breastfeeding for 7 days

148
Q

If prescribing emergency contraception, what do you need to tell patients about if they are sick after taking it?

A

Repeat pill if vomiting
within 2 hours of taking levongestrel
within 3 hours of taking ulipristal

149
Q

What illogical advise should tell a woman who misses two oestrogen pills any time in her cycle?

A

Use condoms for 7 days

Fifth Year Medicine (32 decks)

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