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Gynae > GUM > Flashcards

GUM Flashcards

1
Q

Bacterial vaginosis Ix:

A 
pH
Whiff
Gram stain
HIV
NAAT
VDRL (syphilis)
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2
Q

Bacterial vaginosis Rx

A

PO/PV Metronidazole 5-7d
or
Topical clindamycin
Avoid douching and washing

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3
Q

Risks of bacterial vaginosis in pregnancy

A

preterm labour

chorioamonitits

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4
Q

Vulvovaginal Candidiasis most women

A 
PV antifungal (clotrimazole, econazole, miconazole)
PO antifungal (fluconazole, itraconazole)
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5
Q

VV Candidiasis >60 yo

A

Oral more acceptable for eae

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6
Q

VV candidiasis 12-15yo

A

topical 1% clotrimazole 2-3/daily

NOT intravaginal

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7
Q

Pregnanct VV candidiasis

A

intravaginal clotrimazole (NOT oral antifungals)

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8
Q

Vulval symptoms of candidiasis

A

Topical imidazole + oral/intravaginal

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9
Q

Canesten

A

intravaginal clotrimazole or oral fluconazole can be purchased OTC

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10
Q

Recurrent VV candidiasis

A

> 4/yr
check compliance
Confirm diagnosis (high vaginal swab)
Exclude predisposing (eg DM)

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11
Q

Advise VV Candidiasis

A

Return if not resolved 7-14d
Avoid: excess cleaning, biological washing powder, non absorbant clothing
DO NOT treat male partner if asymptomatic

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12
Q

VV candidiasis Rx and dose

A

Local: clotrimazole pessary/cream e.g. PV 500mg stat
Oral: itraconazle 200mg PO BD 1 day or fluconazle 150mg PO stat
Pregnancy: only local rx

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13
Q

PACES counselling VV candiasis

A

RF: recent ABx, oral contraceptive, DM, washing
Explain is a yeast naturally occuring
Explain PV/PO rx
Explain hygiene measures (douching, clothing, washing powder)

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14
Q

Trichomoniasis Vaginalis

A

Ix: pH, whiff, gram-stain, HIV, NAAT

Metronidazole 2g stat

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15
Q

Chlamydia Ix

A

Ix: NAAT and swab

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16
Q

Chlamydia Rx

A 
1st line: Doxycycline 100mg BD 7d
2nd line (or pregnancy): azithromycin 3d, erythromycin 10-14d

Recommend STI screen
Refer GUM for partner notif.
FU by 5wks to confirm cure

17
Q

Gonorrhoea

A

-NAAT and swab
1st line: Ceftriaxone 1g (IM) + Azithromyin 1g (PO)
- safe in pregnancy
alternative = doxy replaces azithromycin

18
Q

Pelvic Inflammatory Disease Ix

A
  1. FBC + CRP (+culture if febrile)
  2. Endocervical swab - chlamydia and gonorrohea
  3. High vag, swab - anaerobes (BV)
  4. Speculum (inflam./damage)
  5. Bimanual (mass/cervical excitation
  6. Detailed Sexual Hx
19
Q

PID Mx

A
  1. Consider removing IUS/D in situ (if not responsive after 72hr)
  2. OutPt ABx if suitable:
    - ceftriaxone 500mg IM (stat)
    - Doxycycline 100mg BD PO 14d
    - Metronidazole 400mg BD PO 14d
    - alternative: ofloxacin PO and metro PO
  3. STI screen and contact trace
    - contacts get 1g azithromycin
20
Q

PID: ABx if pyrexial or oral management fails

A

1st line: IV cefoxitin + doxycycline

2nd line: IV clindamycin and gentamicin

21
Q

PID fertility?

A

Slightly reduced due to possible tubal damage

22
Q

PID follow up

A

If OutPt Abx: 72hr to check response
If no improvment admit for IV
2-4 wks after this ensure resolution
Reassure if compliant fertility unlikely to be affected

23
Q

PID Cx

A

Infertility
Ectopic
Chronic pain
up to 30% require admission at some point

24
Q

PACES counselling of PID

A 
RF: <25, STI, multiple partners
ASSESS if needs admission
Explain is inf. -> womb
Risks:infertility, ectopic, pain
Rx: 1 inj + 2 tablets 14d
NO sex until Rx complete
Recommend STI screen and tracing
Discuss contraception
FU: 3d and 2-4wks
25
Q

Genital Herpes

A

Ix: clinical, PCR
Rx: aciclovir, symptomatic (simple analgesia)

26
Q

Genital Warts

A

Lesions benign - Rx optional
Cryopathy if single + large
Topical podophyllotocin if mulitple and non-keratinised
Alternative: imiquimod, sinecatechins

27
Q

Syphilis Ix

A
  1. Serology
  2. Detection (dark field microscopy/PCR)
  3. non-treponemal
    - RPR
    - VDRL titre (false -ve early infection, false +ve in rheum disease)
  4. ELISA
  5. TPPA
    4 and 5 will be -ve early in dx repeat in 6wks if suspected
28
Q

Syphilis organism

A

Treponema pallidum

29
Q

Syphilis Mx

A 
IM benzathinepencillin 
Not available routinely at GP
Refer GUM
2nd line: doxycycline
warning: Jarisch-Herxheimer so oral pred for preventative
Contract tracing

Gynae (20 decks)

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